Čimbenici rizika i poslijeoperacijski prediktori za ponavljajuću herniju lumbalnog diska: dugoročno praćenje

The purpose of this study is to identify some risk factors and post-operative predictors for recurrent lumbar disc hernia (rLDH) during a long-term follow-up in patients treated with microdiscectomy. Aim of the paper: This study analyzes some risk factors and postoperative predictors for recurrent lumbar disc hernia (rLDH) during a long-term follow-up in patients treated with microdiscectomy. Material and methods. We analyzed retrospectively a consecutive series of patients who underwent lumbar spinal microdiscectomy for lumbar disc herniation (LDH) from January 2013 to June 2018 at our Institute. The rate of rLDH during long-term follow-up was analyzed and correlated with baseline and post-operative data. Results. A total of 263 patients were included with a median follow-up time of 24 months (from 13 to 43 months). Most of the patients had rLDH within the first 36 months after surgery. At multivariate analysis, recurrence of LDH was associated with higher pre-operative body mass index (BMI) and higher post-operative Oswentry disability index (ODI) with statistical significance. Conclusions. Baseline BMI and post-surgery ODI could predict rLDH after surgery during a long-term follow-up.Cilj. Ova studija analizira određene čimbenike rizika i poslijeoperacijske prediktore za ponavljajuću herniju lumbalnog diska (engl. recurrent lumbar disc hernia – rLDH) tijekom dugotrajnog praćenjaa bolesnika liječenih mikrodiskektomijom. Metode. Retrospektivno smo analizirali niz uzastopnih serija pacijenata koji su podvrgnuti lumbalnoj spinalnoj mikrodiskektomiji zbog hernije lumbalnog diska (engl. lumbar disc hernia – LDH) u razdoblju od siječnja 2013. do lipnja 2018. u našem Institutu. Stopa ponavljajuće hernije lumbalnog diska tijekom dugotrajnog praćenja analizirana je i korelirana s početnim anamnestičkim podacima i poslijeoperacijskim podacima. Rezultati. U studiju je uključeno ukupno 263 pacijenta s prosječnim vremenom praćenja od 24 mjeseca (od 13 do 43 mjeseca). Većina pacijenata imala je ponavljajuću herniju lumbalnog diska u prvih 36 mjeseci nakon operacije. Pri multivarijantnoj analizi, recidiv hernije lumbalnog diska povezan je s višim indeksom tjelesne mase (engl. body mass index – BMI) prije operacije i višim Oswestry indeksom invaliditeta nakon operacije (engl. Oswestry disability index – ODI) sa statističkom značajnošću. Zaključak. Početni indeks tjelesne mase i poslijeoperacijski Oswestry indeks invaliditeta mogu poslužiti kao prediktori ponavljajuće hernije lumbalnog diska nakon operacije tijekom dugotrajnog praćenja

Haemostatic technique in malignant gliomas

Introduction. Haemostasis in brain surgery is mandatory to avoid postoperative re-bleeding and a poor outcome. Postoperative intra-cavity haemorrhage is a frequent complication, especially in surgery of malignant gliomas because of the fragility of pathological vessels. Material and methods. In this technical note, we describe our ‘compression’ technique used to achieve haemostasis in adult patients who underwent surgery for supratentorial malignant gliomas (GBM) at our Institute from January 2019 to January 2022. Peri-operative work-up included clinical status, laboratory data and contrast brain CT, performed at 24 hours after surgery, or earlier for patients with neurological worsening. Results. A total of 82 patients was included in this study, 46 males (57%) and 36 females (43%). A post-operative intra-cavity haemorrhage was documented by postoperative CT-scan in 3/82 patients (3.65%), and the mean surgical time was 3.66 hours. No late bleeding was observed 48 hours after surgery. Conclusions. We have documented the good results of our technique to achieve haemostasis in patients operated for malignant glioma (GBM). The technique described in this study seems to be safe and useful to avoid post-operative bleeding in the surgery of cerebral GBM

A case of very delayed surgical site infection after instrumented spine surgery

This is a case of a 69-year-old obese woman treated with posterior spinal stabilization for lumbar degenerative stenosis who developed delayed and persistent surgical site infection sustained by Bacteriodes fragilis. This microorganism is characterized by slow growth and resistance to antimicrobial agents. The patient underwent a surgical treatment with debridement of the surgical wound without hardware removal. After fourteen months the patient had a recurrence of low back pain, low-grade fever and dehiscence of surgical wound with the need of hardware removal. The intra-operative culture was positive for the same microrganism, than she healed with target antibiotic therapy

Letter to the editor by Dobran Mauro, Paracino Riccardo, and Iacoangeli Maurizio regarding "Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy." Zoia C, Bongetta D, Veiceschi P, Cenzato M, Di Meco F, Locatelli D, Boeris D, Fontanella MM. Acta Neurochir (Wien). 2020 Mar 28. doi: 10.1007/s00701-020-04305-w

Dear Editor, we read with great interest the article by Cesare Zoia, Daniele Bongetta, Pierlorenzo Veiceschi, Marco Cenzato, Francesco Di Meco, Davide Locatelli, Davide Boeris, Marco M. Fontanella “Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy” [4]. This study provided important insights into the mangement of patients with the COVID-19 disease discovered in Wuhan [5] and the interpretation of these findings may be enhanced by the following considerations. In Italy since February 2020 spread a massive Coronavirus Disease (COVID-19) with a great number of infected patients and deaths. To contrast the infection spread on March 2020 in Italy was declared the lockdown and the neurosurgical activity of the Department of Neurosurgery AOU Ancona – Italy was centered on emergency and oncolological pathology. In consideration that human coronaviruses could start from the respiratory tract and spread to the central nervous system through transneural and hematogenous routes as reported by Desforges M. et al. in 2014 we must assume that also the new COVID-19 might infect the central nervous system too [1,2]. In this light all neurosurgical departments should perform an early diagnosis and a correct management of all suspect infected patients to prevent the diffusion of the infection itself to the neurosurgical area [3]. Firstly the general rule is that all patients transferred from one hospital to another undergo a swab test before the transfer. In non hospitalized patients admitted to hospital for urgent surgery a swab test is performed but, cause the long time for its result, when a surgical procedure is urgent a pulmonary CT-scan is performed to search for a COVID-19 pneumonia. In fact in emergency surgery a pulmonary CT-scan is the only method for a fast potential diagnosis of COVID-19 pneumonia. In COVID-19 positive patients surgery is performed with adequate personnel protections and dedicate path in the postoperative period. In our hospital to concentrate resources on COVID-19 emergency, the non-urgent activities were suspended and each department provided some of its doctors and nurses to renforce the COVID-19 staff. To face the danger of contagion even in our neurosurgical department, measures have been implemented such as the suspension of all scheduled surgical activity with the exception of class A for oncologic patients, mainteinance of neurosurgical emergencies (cerebral hemorrhages, hydrocephalus, tumors with intracranial hypertension, spinal cord compression and traumatic cranial and spinal) and the urgent neurosurgical visit or the scheduled ones within 10 days. Luckily during this lockdown the cranial and spinal traumatic pathology decreased drammatically allowing the medical staff to be more available for COVID-19 emergencies. Unexpectedly there was a drop in the request of surgical treatments also for pathologies unrelated to traumatology (figure 1). While the decline of traumatology is explained by the block of car traffic and work activities, the demand decrease for neurosurgical treatment in spinal degenerative pathology appears incomprehensible. A possible reason could be the widespread fear of the population to go to hospital seen as dangerous place for a possible infection. Another potential reason may be the patients’ overestimation of their disability and pain with consequent neurosurgical overtreatment. We should investigate if since now we have been surgically treating too many patients who might have been healed by anti-inflammatory drugs and real long rest as is probably occurring now. Compliance with ethical standards No funding sources were utilized for this project None of the Authors has any potential conflict of interest Conflict of interest: none References 1. Desforges M, Le Coupanec A, Brison E, Meessen-Pinard M, Talbot PJ Neuroinvasive and neurotropic human respiratory coronaviruses: potential neurovirulent agents in humans. Adv Exp Med Biol. 2014;807:75-96. doi: 10.1007/978-81-322-1777-0_6. Review. 2. Desforges M, Le Coupanec A, Stodola JK, Meessen-Pinard M, Talbot PJ Human coronaviruses: viral and cellular factors involved in neuroinvasiveness and neuropathogenesis. Virus Res. 2014 Dec 19;194:145-58. doi: 10.1016/j.virusres.2014.09.011. Epub 2014 Oct 2. Review. 3. Tan YT, Wang JW, Zhao K, Han L, Zhang HQ, Niu HQ, Shu K, Lei T Preliminary Recommendations for Surgical Practice of Neurosurgery Department in the Central Epidemic Area of 2019 Coronavirus Infection. Curr Med Sci. 2020 Mar 26. doi: 10.1007/s11596-020-2173-5. 4. Zoia C, Bongetta D, Veiceschi P, Cenzato M, Di Meco F, Locatelli D, Boeris D, Fontanella Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy. MM. Acta Neurochir (Wien). 2020 Mar 28. doi: 10.1007/s00701-020-04305-w 5. Zou J1, Yu H1, Song D1, Niu J1, Yang H1 Advice on Standardized Diagnosis and Treatment for Spinal Diseases during the Coronavirus Disease 2019 Pandemic. Asian Spine J. 2020 Mar 30. doi: 10.31616/asj.2020.0122. [Epub ahead of print

Haemostatic technique in malignant gliomas

Introduction: Haemostasis in brain surgery is mandatory to avoid postoperative re-bleeding and a poor outcome. Postoperative intra-cavity haemorrhage is a frequent complication, especially in surgery of malignant gliomas because of the fragility of pathological vessels. Material and methods: In this technical note, we describe our 'compression' technique used to achieve haemostasis in adult patients who underwent surgery for supratentorial malignant gliomas (GBM) at our Institute from January 2019 to January 2022. Peri-operative work-up included clinical status, laboratory data and contrast brain CT, performed at 24 hours after surgery, or earlier for patients with neurological worsening. Results: A total of 82 patients was included in this study, 46 males (57%) and 36 females (43%). A post-operative intra-cavity haemorrhage was documented by postoperative CT-scan in 3/82 patients (3.65%), and the mean surgical time was 3.66 hours. No late bleeding was observed 48 hours after surgery. Conclusions: We have documented the good results of our technique to achieve haemostasis in patients operated for malignant glioma (GBM). The technique described in this study seems to be safe and useful to avoid post-operative bleeding in the surgery of cerebral GBM

Fronto-orbito-zygomatic (FOZ) approach for infratemporal fossa lesions extending to middle cranial fossa: our experience and review of literature

Aim of the study: Tumours of the infratemporal fossa (ITF) are rare and include primary tumours, contiguity lesions and metastases. Surgical resection is the gold standard. The fronto-orbito-zygomatic (FOZ) approach is commonly used in order to obtain safe access to the lateral skull base and ITF to resect intra- and extra-cranial tumours. We here describe our series of ITF lesions extending to the middle cranial fossa and/or orbit, treated by single- or two piece FOZ. Material and methods: All cases of single- or two-piece FOZ approach for an infratemporal fossa lesion extending to the middle cranial fossa operated at our Institution from January 2014 to January 2018 were retrospectively reviewed. The follow-up was for a minimum of four months and a maximum of 60 months. The inclusion criteria were lesions involving the ITF with an extension to the middle cranial fossa and/or orbit. Baseline characteristics of patients, tumour localisation, tumour extension, diffusion route, histology, extent of tumour resection, postoperative treatment, and post-operative complications were evaluated. Results: Nine patients underwent a surgical procedure with a FOZ approach, two of them with a single-piece approach and the remainder with a two-piece one. All patients had an ITF localisation. Gross total removal (GTR) was achieved in 7/9 patients. Only one patient, with non-total removal (NTR), underwent radiotherapy. Conclusions: For the treatment of ITF fossa tumours extending to the orbit and or middle cranial fossa, we believe that both FOZ techniques are effective and allow a good medial extension toward the cavernous sinus and parasellar region. But a two-piece craniotomy may ensure a more medial extension and a wider angle of work compared to a one-piece craniotomy

Fronto-orbito-zygomatic (FOZ) approach for infratemporal fossa lesions extending to middle cranial fossa: our experience and review of literature

Aim of the study. Tumours of the infratemporal fossa (ITF) are rare and include primary tumours, contiguity lesions and metastases. Surgical resection is the gold standard. The fronto-orbito-zygomatic (FOZ) approach is commonly used in order to obtain safe access to the lateral skull base and ITF to resect intra- and extra-cranial tumours. We here describe our series of ITF lesions extending to the middle cranial fossa and/or orbit, treated by single- or two piece FOZ.Material and methods. All cases of single- or two-piece FOZ approach for an infratemporal fossa lesion extending to the middle cranial fossa operated at our Institution from January 2014 to January 2018 were retrospectively reviewed. The follow-up was for a minimum of four months and a maximum of 60 months. The inclusion criteria were lesions involving the ITF with an extension to the middle cranial fossa and/or orbit. Baseline characteristics of patients, tumour localisation, tumour extension, diffusion route, histology, extent of tumour resection, postoperative treatment, and post-operative complications were evaluated.Results. Nine patients underwent a surgical procedure with a FOZ approach, two of them with a single-piece approachand the remainder with a two-piece one. All patients had an ITF localisation. Gross total removal (GTR) was achieved in 7/9 patients. Only one patient, with non-total removal (NTR), underwent radiotherapy.Conclusions. For the treatment of ITF fossa tumours extending to the orbit and or middle cranial fossa, we believe that both FOZ techniques are effective and allow a good medial extension toward the cavernous sinus and parasellar region. But a two-piece craniotomy may ensure a more medial extension and a wider angle of work compared to a one-piece craniotomy

Laminectomy versus Unilateral Hemilaminectomy for the Removal of Intraspinal Schwannoma: Experience of a Single Institution and Review of Literature

Background and Study Aims Spinal schwannomas are benign slow-growing tumors, and gross total resection is the gold standard of treatment. The conventional surgical approach is laminectomy, which provides a wide working area. Today minimally invasive surgery (MIS) is popular because it is associated with shorter hospital stay, less operative blood loss, minimized tissue traumas and relative postoperative pain, and, and spine surgery, avoidance of spinal instability. Material and Methods From January 2016 to December 2019, we operated on 40 patients with spinal intradural extramedullary tumor (schwannoma) with laminectomy or hemilaminectomy. Baseline medical data, including patients' sex and age, tumor location, days of postoperative bed rest, operative time, length of hospitalization, and 1-month visual analog scale (VAS) value were collected and analyzed. Data analysis was performed using STATA/IC 13.1 statistical package (StataCorp LP, College Station, Texas, United States). Results Hemilaminectomy was associated with faster operative time (p < 0.001), shorter postoperative time spent in bed (p < 0.001), and shorter hospitalization (p < 0.001). At 1-month follow-up, the mean VAS score was 4.6 (1.7) among the laminectomy patients and 2.5 (1.3) among the hemilaminectomy patients (p < 0.001). Postoperative complications occurred in 1 (7.7%) and 7 (25.9%) patients in the hemilaminectomy and laminectomy groups, respectively (p = 0.177). Conclusions Unilateral hemilaminectomy has significant advantages compared with laminectomy in spinal schwannoma surgery including shorter operative time, less time spent in bed, shorter hospitalization, and less postoperative pain. © 2021 Georg Thieme Verlag. All rights reserved

Laminectomy versus open-door laminoplasty for cervical spondylotic myelopathy: A clinical outcome analysis

Background: Cervical spondylotic myelopathy (CSM) is one of the most common diseases in the geriatric population. Decompressive laminectomy or laminoplasty is the predominant surgical procedure of choice, but there remains debate as to which procedure is optimal for managing CSM. Methods: Here, we retrospectively analyzed 64 patients with CSM undergoing laminectomy (39 patients) versus laminoplasty (25 patients). The data were collected included respective Japanese orthopedic association (JOA) scores, Nurick grades, and Visual analog scale (VAS) values preoperatively versus 12 months postoperatively. Results: The JOA score after 1 month improved in both groups utilizing laminectomy or laminoplasty. However, at 12 postoperative months, the JOA scores and Nurick grades showed greater improvement following laminoplasty, despite no differences in postoperative pain and complication rates. Conclusion: Patients with cervical spondylotic myelopathy undergoing laminoplasty (25 patients) showed better 12-month postoperative outcomes (JOA scores and Nurick grades) versus those having laminectomies (39 patients). Keywords: Cervical laminectomy, Cervical myelopathy, Cervical spondylotic myelopathy, Laminoplasty, Open-door technique, Spinal cord decompressio