ABSTRACT
Background: Surgical wound complications represent an important risk factor, particularly in multilevel lumbar fusions. However, the literature regarding optimal wound closure techniques for these procedures is limited. Methods: We performed an online survey of 61 spinal surgeons from 11 countries, involving 25 different hospitals. The study included 26 neurosurgeons, 21 orthopedists, and 14 residents (Neurosurgery - 6 and orthopedics 8). The survey contained 17 questions on demographic information, closure techniques, and the use of drainage in posterior lumbar fusion surgery. We then developed a "consensus technique." Results: The proposed standardized closure techniques included: (1) using subfascial gravity drainage (i.e., without suction) with drain removal for <50 ml/day or a maximum duration of 48 h, (2) paraspinal muscle, fascia, and supraspinous ligament closure using interrupted-X stitches 0 or 1 Vicryl or other longer-lasting resorbable suture (i.e., polydioxanone suture), (3) closure of subcutaneous tissue with interrupted inverted Vicryl 2-0 sutures in two planes for subcutaneous tissue greater >25 mm in depth, and (4) skin closure with simple interrupted nylon 3-0 sutures. Conclusion: There is great variability between closure techniques utilized for multilevel posterior lumbar fusion surgery. Here, we have described various standardized/evidence-based proven techniques for the closure of these wounds.
ABSTRACT
BACKGROUND: In several epilepsy etiologies, the macroscopic appearance of the epileptogenic tissue is identical to the normal, which makes it hard to balance between how much cytoreduction or disconnection and brain tissue preservation must be done. A strategy to tackle this situation is by evaluating brain metabolism during surgery using infrared thermography mapping (IrTM). METHODS: In 12 epilepsy surgery cases that involved the temporal lobe, we correlated the IrTM, electrocorticography, and neuropathology results. RESULTS: Irritative zones (IZ) had a lower temperature in comparison to the surrounding cortex with normal electric activity (difference in temperature (ΔT) from 1.2 to 7.1, mean 3.40°C standard deviation ± 1.61). The coldest zones correlated exactly with IZ in 9/10 cortical dysplasia (CD) cases. In case 3, the coldest area was at 1 cm away from the IZ. In 10/10 dysplasia cases (cases 1-4, 6-11), there was a radial heating pattern originating from the coldest cortical point. In 2/2 neoplasia cases, the temporal lobe cortical temperature was more homogeneous than in the CD cases, with no radial heating pattern, and there were no IZ detected. In case 8, we found the coldest IrTM recording in the hippocampus, which correlated to the maximal irritative activity recorded by strip electrodes. The ΔT is inversely proportional to epilepsy chronicity. CONCLUSION: IrTM could be useful in detecting hypothermic IZ in CD cases. As the ΔT is inversely proportional to epilepsy chronicity, this variable could affect the metabolic thermic patterns of the human brain.
ABSTRACT
BACKGROUND: Safety and efficacy are irrebuttable goals in neurosurgery. METHODS: We performed a subcortical cavernoma resection in an eloquent area, where we recorded and compared the maximal and minimal brain temperature measured by an infrared thermographic camera and thermometer with the neuronavigation (NN) target location and real anatomical lesion location. RESULTS: The hottest cortical point correlated to the subcortical cavernoma location. The NN located the target at 10 mm away from the hottest point. CONCLUSION: More studies are needed to better understand the thermic radiation of the brain in health and in disease, but we believe that evaluating brain temperature, it could be possible to improve accuracy in neurosurgery and generate more knowledge about brain metabolism in vivo.
