Retrosigmoid Transtentorial Approach Compared to Traditional Transpetrosal Approaches for the Resection of Petroclival Meningiomas: A Case-Control Study.

Background Transpetrosal approaches have become standard technique for resection of petroclival meningiomas (PCM). The retrosigmoid craniotomy has also been extensively studied as an alternative approach. The need to resect the tentorium at the end of a retrosigmoid approach has been described, but the upfront transtentorial variation of the retrosigmoid craniotomy has never been described nor evaluated in detail as a possible alternative to the standard petrosectomy approaches. Objective This study was aimed to directly compare the transpetrosal approaches to the retrosigmoid transtentorial approach (RSTTA) in terms of degree of resection, duration of surgery, and estimated blood loss (EBL). Methods A retrospective case-control study of patients who underwent resection of PCM between January 2014 and December 2018 was performed. Patients in the two surgical approach groups were matched for age and tumor location. The primary measured outcomes were duration of surgery, EBL, extent of resection, length of postoperative hospital stay, and complications. Data analysis was performed using analysis of variance (ANOVA), multivariate analysis of variance (MANOVA), and analysis of covariance (ANCOVA) tests. Results Thirteen patients had microsurgical resection of PCM at our center between January 2014 and December 2018. Nine patients underwent a transpetrosal approach and four patients underwent RSTTA. The average duration of surgery was shorter in the RSTTA group (425 vs. 525.4 minutes) and had less blood loss (94 vs. 425 mL). Extent of resection was comparable between the groups. Conclusion The RSTTA appears to be a safe and efficient technique for resecting PCMs and in selected cases a valid alternative to standard petrosectomies approaches.

Primary cervical spine AL-κ amyloidoma: A case report and review of the literature.

Of the myriad of variants of amyloidoses where abnormally folded proteins damage native tissue, primary cervical spine amyloidoma represents one of the rarest forms. Since clinical presentations and imaging findings appear similar to other pathologies, including abscesses, metastatic lesions, and inflammatory lesions, a definitive diagnosis requires a biopsy with specific immunohistochemical stains. We present the first known case of primary cervical amyloid light-chain (AL)-κ subtype amyloidoma and compare the clinical presentations, imaging findings, treatment options, and immunohistochemical subtypes of primary, hemodialysis, and multiple myeloma cervical amyloidomas. Our case is of a 58-year-old man who developed neck pain radiating to the left arm with bilateral upper extremity weakness over several months. Magnetic resonance imaging revealed a circumferential C1-C2 mass extending into the neural foramina inducing severe mass effect. The patient underwent C2 laminectomy and resection of the lesion which was discovered during surgery to be completely epidural. Postoperatively, his pain and weakness improved. A complete work-up was negative for systemic amyloidosis or inflammatory conditions. In the setting of a long clinical history of hemodialysis, this patient required specific staining and laboratory testing to correctly diagnose his primary cervical AL-κ subtype amyloidoma. Cervical amyloidomas comprise a very small minority of amyloid pathology with an exceptional prognosis following successful surgical resection and stabilization. It is recommended these patients undergo surgical resection with appropriate characterization and a complete work-up to rule out systemic disease.

Contralateral Approach for Minimally Invasive Treatment of Upper Lumbar Intervertebral Disc Herniation: Technical Note and Case Series.

BACKGROUND: Upper lumbar disc herniations comprise only 1%-2% of all lumbar disc herniations. Patients exhibit nonspecific signs and symptoms in comparison to predictable radiculopathies, as seen in lower lumbar disc herniations. The unique anatomic characteristics of the upper lumbar spine present several challenges for safe and effective surgical treatment of disc herniations. The authors review the anatomy of the upper lumbar spine, describe a novel approach to upper lumbar disc herniations, and present 3 cases with a focus on clinical outcome and technical pearls. METHODS: Conventional techniques for upper lumbar discectomy require a near complete facetectomy and pars interarticularis resection for adequate bony exposure, possibly leading to spinal destabilization. A tubular retractor system was used to approach upper lumbar disc herniation using a contralateral minimally invasive technique, while completely preserving the facet complex and pars interarticularis. RESULTS: We report 3 cases of minimally invasive discectomy from a contralateral approach. The patients experienced complete resolution of presenting symptoms, and the facet complexes were preserved. All cases were free of complications. CONCLUSION: A contralateral approach to perform a minimally invasive discectomy for paracentral and central upper LDH is a safe, efficient, and effective technique. The approach that we describe in this study preserves the facet complex and may prevent future spinal instability.

Concurrent Intraventricular and Sacral Spinal Drop Metastasis of Ganglioglioma in an Adult Patient: A Case Report and Review of Literature.

Gangliogliomas are uncommon tumors of the central nervous system and rarely occur in the lateral ventricle or present with drop metastasis. We report a 49-year-old male who presented with a six-week history of left leg pain and numbness. Clinical examination revealed no focal neurological deficits. Magnetic resonance imaging (MRI) demonstrated enhancing nodular lesions in the sacral spine abutting the S2 nerve root. Further imaging of the neuroaxis demonstrated a cystic lesion in the left frontal horn of the lateral ventricle. Gross total surgical resection of the ventricular lesion was performed through a transcortical approach, followed by resection of the sacral spinal drop metastasis in a staged manner. A histopathological analysis revealed the diagnosis of low-grade ganglioglioma. To our knowledge, this is the first reported case of a low-grade intraventricular ganglioglioma presenting with symptoms associated with drop metastasis in an adult patient.

Surgical Adhesive Drape (IO-ban) as Postoperative Surgical Site Dressing.

STUDY DESIGN: Retrospective chart analysis. OBJECTIVE: The objective of this study is to describe the senior author's (MNN) experience applying a widely available surgical drape as a postoperative sterile surgical site dressing for both cranial and spinal procedures. SUMMARY OF BACKGROUND DATA: Surgical site infection (SSI) is an important complication of spine surgery that can result in significant morbidity. There is wide variation in wound care management in practice, including dressing type. Given the known bactericidal properties of the surgical drape, there may be a benefit of continuing its use immediately postoperatively. METHODS: All of the senior author's cases from September 2014 through September 2015 were reviewed. These were contrasted to the previous year prior to the institution of a sterile surgical drape as a postoperative dressing. RESULTS: Only one surgical case out of 157 operative interventions (35 cranial, 124 spinal) required operative debridement due to infection. From September 2013 to September 2014, prior to the institution of a sterile surgical drape as dressing, the author had five infections out of 143 operations (46 cranial, 97 spinal) requiring intervention. CONCLUSION: The implementation of a sterile surgical drape as a closed postoperative surgical site dressing has led to a decrease in surgical site infections. The technique is simple and widely available, and should be considered for use to diminish surgical site infections.