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Bianchi F, Ceccarelli GM, Tamburrini G. Surgery for pediatric low-grade gliomas within the vermis. Childs Nerv Syst 2024:10.1007/s00381-024-06545-y. [PMID: 39046475 DOI: 10.1007/s00381-024-06545-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 07/16/2024] [Indexed: 07/25/2024]
Abstract
Pediatric low-grade gliomas (pLGGs) in the cerebellar vermis present unique challenges due to their intricate anatomical location and potential impact on critical neurological functions. Surgical intervention remains a cornerstone in the management of these tumors, aiming to achieve maximal tumor resection while preserving neurological function. In this review, the authors will discuss anatomical consideration and will explore current surgical techniques and strategies employed in the treatment of cerebellar vermis pLGGs such as the midline and lateral suboccipital approaches, as well as endoscopic-assisted technique. Additionally, we will emphasize the importance of intraoperative neurophysiological monitoring (IONM) in ensuring safe and effective tumor resection. Overall, this review provides insights into the neurosurgical approach of pLGGs in the cerebellar vermis.
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Affiliation(s)
- Federico Bianchi
- Pediatric Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy.
| | | | - Gianpiero Tamburrini
- Pediatric Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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2
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Lohss M, Ho J, Naylor N, Cashman S, Fu R, Tonya Stefko S, Byrne LC. Adaptable three-pin skull clamp for large animal research. HARDWAREX 2023; 15:e00472. [PMID: 37680492 PMCID: PMC10480779 DOI: 10.1016/j.ohx.2023.e00472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
Traditionally, surgical head immobilization for neurobiological research with large animals is achieved using stereotaxic frames. Despite their widespread use, these frames are bulky, expensive, and inflexible, ultimately limiting surgical access and preventing research groups from practicing surgical approaches used to treat humans. Here, we designed a mobile, low-cost, three-pin skull clamp for performing a variety of neurosurgical procedures on non-human primates. Modeled after skull clamps used to operate on humans, our system was designed with added adjustability to secure heads with small or irregular geometries for innovative surgical approaches. The system has six degrees of freedom with skull pins attached to setscrews for independent, fine-tuned depth adjustment. Unlike other conventional skull clamps which require additional mounting fixtures, our system has an integrated tray with mounting bracket for easy use on most operating room tables. Our system has successfully secured primate heads in the supine and lateral position, allowing surgeons to match surgical approaches currently practiced when operating on humans. The system also expands the opportunity for researchers to utilize imaged-guided robotic surgery techniques. Overall, we hope that our system can serve as an adaptable, affordable, and robust surgery platform for any laboratory performing neurobiological research with large animal models.
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Affiliation(s)
- Maxwell Lohss
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States
| | - Jonathan Ho
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States
| | - Nathan Naylor
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, United States
| | - Stacy Cashman
- Division of Laboratory Animal Resources, University of Pittsburgh, Pittsburgh, United States
| | - Roxana Fu
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, United States
| | - S. Tonya Stefko
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, United States
| | - Leah C. Byrne
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, United States
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Teping F, Linsler S, Zemlin M, Oertel J. The semisitting position in pediatric neurosurgery: pearls and pitfalls of a 10-year experience. J Neurosurg Pediatr 2021; 28:724-733. [PMID: 34598151 DOI: 10.3171/2021.6.peds21161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to investigate the pearls and pitfalls of using the semisitting position in pediatric neurosurgery, with special focus on related morbidity and surgical practicability. METHODS All pediatric cases at a single institution were evaluated retrospectively. Those patients who underwent procedures in the semisitting position between December 2010 and December 2020 were included in the final analysis. Results were compared with all children who underwent surgery in the prone position for posterior fossa lesions within the same time frame. RESULTS A total of 42 posterior fossa surgeries were performed in 38 children in the semisitting position between December 2010 and December 2020. The mean patient age at the time of surgery was 8.9 years (range 13 months-18 years). The data of 24 surgeries performed in the prone position in 22 children during the same time frame were analyzed in comparison. Three children (7.9%) were diagnosed with a persistent foramen ovale preoperatively. The surgery was completed in all cases. The incidence of venous air embolism (VAE) was 11.9%. There was no VAE-related hemodynamic instability, infarction, or death. Endoscopic techniques were applied safely in 14 cases (33.3%). Postoperative pneumocephalus occurred significantly more frequently in patients who had undergone procedures in the semisitting position (p < 0.05), but without the need for intervention. During 1 surgery (2.4%), the patient experienced a postoperative skull fracture and epidural bleeding due to the skull clamp application. Clinical status of the patients immediately after surgery was improved or stable in 33 of the 42 surgeries (78.6%) performed in the semisitting position. CONCLUSIONS With attentive performance and an experienced surgical team, the semisitting position is a safe option for posterior fossa surgery in the pediatric population. With a comparable complication profile, the semisitting position offers excellent anatomical exposure, which is ideal for the application of endoscopic visualization. Careful skull clamp application and appropriate monitoring are highly recommended.
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Affiliation(s)
- Fritz Teping
- 1Department of Neurosurgery, Saarland University Faculty of Medicine; and
| | - Stefan Linsler
- 1Department of Neurosurgery, Saarland University Faculty of Medicine; and
| | - Michael Zemlin
- 2Department of General Pediatrics and Neonatology, Saarland University Faculty of Medicine, Homburg, Germany
| | - Joachim Oertel
- 1Department of Neurosurgery, Saarland University Faculty of Medicine; and
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Sakakura K, Fujimoto A, Ishikawa E, Enoki H, Okanishi T. Intraoperative Head Slippage with the Head Clamp System Can Occur During Epileptic Surgery. World Neurosurg 2020; 142:e453-e457. [PMID: 32682999 DOI: 10.1016/j.wneu.2020.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND During neurosurgery, we use a head clamp system for firm head fixation. However, we have encountered slippage using the head clamp system, although this has not been adequately studied. In the present study, to increase the reliability of the analysis using a more homogeneous type of patient data, we conducted a prospective study of patients who had undergone epileptic surgery. We examined the potential risk factors for head slippage and postulated that the location of the pins might be important. METHODS We reviewed and compared the positions of the fixed head of the patients on fused preoperative and postoperative computed tomography images. We measured the distance between the corresponding head pins to determine the association with head slippage. We statistically compared the relationship between each head pin and the nasion-inion line. We also assessed age, sex, body weight, body mass index, surgical position, surgical duration, and craniotomy volume as potential risk factors for slippage. RESULTS Head slippage was observed in 3 of 21 patients (14%) in the present prospective study. The most caudal head pin position was not associated with head slippage in the present study. However, the center point between the most caudal point and the most cranial point was significant (P = 0.014). A center point between the most caudal and most cranial pins from the nasion-inion line that was >6.5 cm was more likely to result in slippage. CONCLUSIONS We should consider that head clamp slippage could occur intraoperatively.
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Affiliation(s)
- Kazuki Sakakura
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
| | - Eiichi Ishikawa
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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LoPresti MA, Nguyen J, Lam SK. Pinning in pediatric neurosurgery: the modified rubber stopper technique. J Neurosurg Pediatr 2020; 26:98-103. [PMID: 32276245 DOI: 10.3171/2020.1.peds19541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/31/2020] [Indexed: 11/06/2022]
Abstract
Head immobilization devices with skull pins are commonly used by neurosurgeons to stabilize the head for microsurgical techniques and to maintain accurate intraoperative neuronavigation. Pediatric patients, who may have open fontanelles, unfused sutures, and thin skulls, are vulnerable to complications during placement in pins. We review the various methods of pinning in pediatric neurosurgery and revisit the modified rubber stopper technique using a commonly available rubber stopper from a medication bottle over a standard adult pin of a Mayfield head clamp to prevent the pins from plunging through the thin pediatric skull.
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Affiliation(s)
- Melissa A LoPresti
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
- 2Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas
| | - Joshua Nguyen
- 3Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago; and
- 4Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Sandi K Lam
- 3Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago; and
- 4Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
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Sakakura K, Fujimoto A, Ichikawa N, Ishikawa E, Matsumura A, Enoki H, Okanishi T. Estimation of Risk Factors for Head Slippage Using a Head Clamp System. A Retrospective Study. Ther Clin Risk Manag 2020; 16:189-194. [PMID: 32273710 PMCID: PMC7104198 DOI: 10.2147/tcrm.s247402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/15/2020] [Indexed: 12/03/2022] Open
Abstract
Background Although complications have been associated with head clamp systems, few reports have described head slippage. The present study aimed to determine risk factors for head slippage and speculated that the position of head holder pins might be associated. Patients and Methods We reviewed medical records and compared the positions of the pinned heads of patients on fused preoperative and postoperative computerized tomography (CT) images. We measured the distance between corresponding head pins to determine head slippage. Age, sex, body weight, body mass index, surgical position, surgical duration, craniotomy volume, and the relationship between head pins and the nasion-inion (NI) line were statistically compared between patients with and without head slippage. Results Head slippage in 3 (10%) of 28 patients was significantly associated with the most caudal pin position (p < 0.001) and craniotomy volume (p = 0.036). Receiver operator characteristics curves indicated a cutoff of 4.5 cm from the NI line (sensitivity and specificity, 1.000 and 0.800, respectively). Conclusion Clamped heads can slip during surgical procedures. We found that one head pin should be located within 4.5 cm from the NI line to avoid head slippage.
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Affiliation(s)
- Kazuki Sakakura
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.,Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Naoki Ichikawa
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
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