1
|
Estler A, Hauser TK, Brunnée M, Zerweck L, Richter V, Knoppik J, Örgel A, Bürkle E, Adib SD, Hengel H, Nikolaou K, Ernemann U, Gohla G. Deep learning-accelerated image reconstruction in back pain-MRI imaging: reduction of acquisition time and improvement of image quality. Radiol Med 2024; 129:478-487. [PMID: 38349416 PMCID: PMC10943137 DOI: 10.1007/s11547-024-01787-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/15/2024] [Indexed: 03/16/2024]
Abstract
INTRODUCTION Low back pain is a global health issue causing disability and missed work days. Commonly used MRI scans including T1-weighted and T2-weighted images provide detailed information of the spine and surrounding tissues. Artificial intelligence showed promise in improving image quality and simultaneously reducing scan time. This study evaluates the performance of deep learning (DL)-based T2 turbo spin-echo (TSE, T2DLR) and T1 TSE (T1DLR) in lumbar spine imaging regarding acquisition time, image quality, artifact resistance, and diagnostic confidence. MATERIAL AND METHODS This retrospective monocentric study included 60 patients with lower back pain who underwent lumbar spinal MRI between February and April 2023. MRI parameters and DL reconstruction (DLR) techniques were utilized to acquire images. Two neuroradiologists independently evaluated image datasets based on various parameters using a 4-point Likert scale. RESULTS Accelerated imaging showed significantly less image noise and artifacts, as well as better image sharpness, compared to standard imaging. Overall image quality and diagnostic confidence were higher in accelerated imaging. Relevant disk herniations and spinal fractures were detected in both DLR and conventional images. Both readers favored accelerated imaging in the majority of examinations. The lumbar spine examination time was cut by 61% in accelerated imaging compared to standard imaging. CONCLUSION In conclusion, the utilization of deep learning-based image reconstruction techniques in lumbar spinal imaging resulted in significant time savings of up to 61% compared to standard imaging, while also improving image quality and diagnostic confidence. These findings highlight the potential of these techniques to enhance efficiency and accuracy in clinical practice for patients with lower back pain.
Collapse
Affiliation(s)
- Arne Estler
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Till-Karsten Hauser
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Merle Brunnée
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Leonie Zerweck
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Baden-Württemberg, Germany.
| | - Vivien Richter
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Jessica Knoppik
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Anja Örgel
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Eva Bürkle
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Sasan Darius Adib
- Department of Neurosurgery, University of Tübingen, 72076, Tübingen, Germany
| | - Holger Hengel
- Department of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Ulrike Ernemann
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Georg Gohla
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Baden-Württemberg, Germany
| |
Collapse
|
2
|
Kurucz P, Ganslandt O, Buchfelder M, Adib SD, Barany L. Anatomy and microsurgical relevance of the outer arachnoid envelope around the olfactory bulb based on endoscopic cadaveric observations. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38242165 DOI: 10.1055/a-2249-7710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Surgical approaches to the anterior cranial fossa have great risk of damaging the olfactory tract and bulb. The goal of this study was to describe the outer arachnoid envelope around the olfactory bulb which plays significant role in the approach-related injury of the nerve. MATERIAL AND METHODS A total of 20 fresh human cadaveric heads were examined as a following: 5 cadaveric heads were used to describe a gross overview of the topographic anatomy of the outer arachnoid cover of the olfactory bulb. In 15 cadaveric heads endoscopic surgical approaches were performed to examine the in situ undisrupted anatomy of the outer arachnoid around the olfactory bulb. Four cadaveric heads were used for lateral subfrontal approach, 5 heads for medial subfrontal, 3 heads for median subfrontal approach and 3 heads for anterior interhemispheric approach. RESULTS The outer arachnoid membrane of the frontal lobe attaches the olfactory bulb strongly to the above lying olfactory sulcus. Only the most rostral portion of the olfactory bulb became slightly detached from the frontal lobe. The outer arachnoid forms a decent protrusion around the tip of the olfactory bulbs. The fila olfactoria have their own outer arachnoid cover as a continuation of the same layer of the olfactory bulb. The effect of brain retraction and manipulation forces on the olfactory bulb and the role of the here located arachnoid membranes were visually analysed and described in detail through the performed four different neurosurgical approaches. CONCLUSION The results of our observations provide important anatomical details for the preservation of smelling during neurosurgical procedures.
Collapse
Affiliation(s)
- Peter Kurucz
- Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany
- Department of Neurosurgery, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Oliver Ganslandt
- Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sasan Darius Adib
- Department of Neurosurgery, Eberhard Karls Universität Tübingen, Tubingen, Germany
| | - Laszlo Barany
- Department of Neurosurgery, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| |
Collapse
|
3
|
Adib SD, Schittenhelm J, Kurucz P, Hauser TK, Tatagiba M. Surgical management of syringomyelia associated with spinal arachnoid web: strategies and outcomes. Neurosurg Rev 2023; 46:152. [PMID: 37358703 PMCID: PMC10293323 DOI: 10.1007/s10143-023-02071-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/22/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
Spinal arachnoid web (SAW) is a rare disease entity characterized as band-like arachnoid tissue that can cause spinal cord compression and syringomyelia. This study aimed to analyze the surgical management of the spinal arachnoid web in patients with syringomyelia, focusing on surgical strategies and outcomes. A total of 135 patients with syringomyelia underwent surgery at our department between November 2003 and December 2022. All patients underwent magnetic resonance imaging (MRI), with a special syringomyelia protocol (including TrueFISP and CINE), and electrophysiology. Among these patients, we searched for patients with SAW with syringomyelia following careful analysis of neuroradiological data and surgical reports. The criteria for SAW were as follows: displacement of the spinal cord, disturbed but preserved CSF flow, and intraoperative arachnoid web. Patients were evaluated for initial symptoms, surgical strategies, and complications by reviewing surgical reports, patient documents, neuroradiological data, and follow-up data. Of the 135 patients, 3 (2.22%) fulfilled the SAW criteria. The mean patient age was 51.67 ± 8.33 years. Two patients were male, and one was female. The affected levels were T2/3, T6, and T8. Excision of the arachnoid web was performed in all cases. No significant change in intraoperative monitoring was noted. Postoperatively, none of the patients presented new neurological symptoms. The MRI 3 months after surgery revealed that the syringomyelia improved in all cases, and caliber variation of the spinal cord could not be detected anymore. All clinical symptoms improved. In summary, SAW can be safely treated by surgery. Even though syringomyelia usually improves on MRI and symptoms also improve, residual symptoms might be observed. We advocate for clear criteria for the diagnosis of SAW and a standardized diagnostic (MRI including TrueFISP and CINE).
Collapse
Affiliation(s)
- Sasan Darius Adib
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.
| | - Jens Schittenhelm
- Department of Neuropathology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Peter Kurucz
- Department of Neurosurgery, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Till-Karsten Hauser
- Department of Neuroradiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| |
Collapse
|
4
|
Haas P, Hauser TK, Kandilaris K, Skardelly M, Tatagiba M, Adib SD. Case Report: Posterolateral Epidural Supra-C2-Root Approach (PESCA) for Biopsy of a Retro-Odontoid Lesions in Same Sitting After Occipitocervical Fixation and Decompression in a Case of Crowned Dens Syndrome With Brainstem Compression and Displacement. Front Surg 2022; 9:797495. [PMID: 35558389 PMCID: PMC9086508 DOI: 10.3389/fsurg.2022.797495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background ‘Crowned dens syndrome' (CDS) is a special form of calcium pyrophosphate dihydrate deposition disease which is characterized radiologically by a halo-like or crown-like distribution in the periodontoid region and clinically by cervical pain. Herein, we will describe our experience of posterolateral epidural supra-C2-root approach (PESCA) for biopsy of retro-odontoid lesions in one surgical session after occipitocervical fixation and decompression in a patient with CDS and massive brainstem compression. Case Presentation A 70-year-old woman presented to our department with a 4-week history of progressive walking impairment, neck pain, neck rigidity, fever, dizziness, slight palsy of the left hand, and multiple fall episodes. Magnetic resonance imaging (MRI) of the craniovertebral junction (CVJ) and cervical spine revealed a lesion of the odontoid process and the retro-odontoid region with mainly solid components, as well as small cystic components, and brainstem compression and displacement. In first step, fusion surgery of the CVJ C0–C4 was performed with occiptocervical decompression. After fusion and decompression the lower lateral part of the C1 arc and the lateral superior part of the left side of the C2 arc were removed. The entry point was located directly above the superior part of the C2 root. A biopsy of the lateral portions of the lesions was obtained by bioptic forceps under microscope guidance. Pathologic examination of the mass revealed deposition of birefringent crystals compatible with calcium pyrophosphate. In addition to the clinical symptoms (especially neck pain), the diagnosis of CDS was made. Non-steroidal inflammatory drugs (NSAIDs) and colchicine (and later magnesium) were started. At follow-up examination 6 months after surgery, an MRI scan of the cervical spine revealed regression of the pannus and the cyst with replacement of the brainstem, clinical improvement of walking, and increased strength of the left hand. Conclusions This study demonstrates that PESCA can be used to obtain tissue for pathological analysis in one surgical sitting after fusion and decompression and that fusion, decompression, and PESCA (in the same session) together with subsequent conservative management could be a good alternative for the treatment of CDS.
Collapse
Affiliation(s)
- Patrick Haas
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Till-Karsten Hauser
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Kosmas Kandilaris
- Department of Neuropathology, University of Tübingen, Tübingen, Germany
| | - Marco Skardelly
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Sasan Darius Adib
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
- *Correspondence: Sasan Darius Adib
| |
Collapse
|
5
|
Adib SD, Hempel JM, Kandilaris K, Grimm F, Zamora RE, Tatagiba M. Correction to: Surgical management of choroid plexus papilloma of the cerebellopontine and cerebellomedullary angle: classification and strategy. Neurosurg Rev 2021; 44:3593. [PMID: 33844096 DOI: 10.1007/s10143-021-01534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- S D Adib
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - J M Hempel
- Department of Neuroradiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - K Kandilaris
- Department of Neuropathology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - F Grimm
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - R Evangelista Zamora
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - M Tatagiba
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| |
Collapse
|
6
|
Adib SD, Hempel JM, Kandilaris K, Grimm F, Zamora RE, Tatagiba M. Surgical management of choroid plexus papilloma of the cerebellopontine and cerebellomedullary angle: classification and strategy. Neurosurg Rev 2021; 44:3387-3397. [PMID: 33629235 PMCID: PMC8592964 DOI: 10.1007/s10143-021-01506-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/15/2021] [Accepted: 02/14/2021] [Indexed: 11/24/2022]
Abstract
Choroid plexus papillomas (CPPs) are primary neuroectodermal neoplasms that usually arise in the fourth ventricle in adults. In this study, we present 12 patients with CPP arising from the cerebellopontine angle (CPP-CPA) and/or of the cerebellomedullary angle (CPP-CMA) that were treated in our department. Patients who underwent surgery for the treatment for CPP-CPA/CMA from January 2004 to March 2020 were identified by a computer search of their files from the Department of Neurosurgery, Tübingen. CPPs were classified according to their location into type 1 (tumor portion only in the CPA,), type 2 (tumor portions only in the CMA), and type 3 (tumor portions both in the CPA and CMA). Patients were evaluated for initial symptoms, previous therapies in other hospitals, extent of tumor resection, recurrence rate, and complications by reviewing patient documents. Of approximately 1500 CPA lesions, which were surgically treated in our department in the last 16 years, 12 patients (mean age 42 ± 19 years) were found to have CPP-CPA/CMA. Five were male, and seven were female patients. Gross total resection was achieved in nine cases, and a subtotal resection was attained in three cases. Tumor recurrence in the same location after the first surgery in our hospital was observed in 2 patients after 15 and 40 months of follow-up, and in another patient, distant metastases (C3/4 and L3 levels) were observed. Surgical removal of CPP is the treatment of choice, but additional therapeutic options may be necessary in case of remnant tumor portions, recurrence, or malignant transformation.
Collapse
Affiliation(s)
- S D Adib
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - J M Hempel
- Department of Neuroradiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - K Kandilaris
- Department of Neuropathology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - F Grimm
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - R Evangelista Zamora
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - M Tatagiba
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| |
Collapse
|
7
|
Adib SD, Ebner FH, Bornemann A, Hempel JM, Tatagiba M. Corrigendum to "Surgical Management of Primary Cerebellopontine Angle Melanocytoma: Outcome, Recurrence and Additional Therapeutic Options" [World Neurosurgery 128 (2019) e835-e840]. World Neurosurg 2021; 148:270. [PMID: 33485840 DOI: 10.1016/j.wneu.2020.12.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Sasan Darius Adib
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany.
| | - Florian H Ebner
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| | - Antje Bornemann
- Department of Neuropathology, University of Tuebingen, Tuebingen, Germany
| | | | - Marcos Tatagiba
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| |
Collapse
|
8
|
Haas P, Hauser TK, Kandilaris K, Schenk S, Tatagiba M, Adib SD. Posterolateral epidural supra-C2-root approach (PESCA) for biopsy of lesions of the odontoid process in same sitting after occipitocervical fixation and decompression-perioperative management and how to avoid vertebral artery injury. Neurosurg Rev 2021; 44:2947-2956. [PMID: 33428076 PMCID: PMC8490265 DOI: 10.1007/s10143-020-01468-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/29/2020] [Accepted: 12/28/2020] [Indexed: 12/02/2022]
Abstract
This study aims to describe the posterolateral epidural supra-C2-root approach (PESCA), which might be a good alternative to the transoral, anterolateral, and other posterolateral approaches for biopsy of lesions of the odontoid process (OP). The preoperative planning of PESCA included computerized tomography (CT), CT-angiography, and three-dimensional reconstruction (if possible, even with three-dimensional print) to analyze the angle of the trajectory and the anatomy of the vertebral artery (VA). For PESCA, the patient is positioned under general anesthesia in prone position. In case of an osteolytic lesion with fracture of the OP, an X-ray is performed after positioning to verify anatomic alignment. In the first step, in case of instability and compression of the spinal cord, a craniocervical fusion and decompression is performed (laminectomy of the middle part of the C1 arc and removal of the lower part of the lateral C1 arc). The trajectory is immediately above the C2 root (and under the upper rest of the lateral part of C1 arc). Even if the trajectory is narrowed, it is possible to perform PESCA without relevant traction of the spinal cord. The vertical segment of V3 of the VA at the level of C2 is protected by the vertebral foramen, and the horizontal part of V3 is protected by the remnant upper lateral part of the C1 arc (in case of normal variants). PESCA might be a good choice for biopsy of selected lesions of the OP in same sitting procedure after craniocervical stabilization and decompression.
Collapse
Affiliation(s)
- Patrick Haas
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Till-Karsten Hauser
- Department of Neuroradiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Kosmas Kandilaris
- Department of Neuropathology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Sebastian Schenk
- Department of Anesthesiology and Intensive Care Medicine, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Sasan Darius Adib
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| |
Collapse
|
9
|
Adib SD, Lescan M, Renovanz M, Schuhmann MU, Trakolis L, Bongers M, Tatagiba M, Döbele A, Grözinger G. Intracardial Catheter Migration of a Ventriculoperitoneal Shunt: Pathophysiology and Interdisciplinary Management. World Neurosurg 2020; 135:222-227. [PMID: 31877393 DOI: 10.1016/j.wneu.2019.12.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
|
10
|
Adib SD, Herlan S, Ebner FH, Hirt B, Tatagiba M, Honegger J. Interoptic, Trans-lamina Terminalis, Opticocarotid Triangle, and Caroticosylvian Windows From Mini-Supraorbital, Frontomedial, and Pterional Perspectives: A Comparative Cadaver Study With Artificial Lesions. Front Surg 2019; 6:40. [PMID: 31380387 PMCID: PMC6646665 DOI: 10.3389/fsurg.2019.00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/17/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: The mini-supraorbital (MSO) and pterional (PT) approaches have been compared in a number of studies focusing on the treatment of aneurysms, craniopharyngiomas, and meningiomas. The goal of this study was to analyze the surgical exposure to different artificial lesions through interoptic (IO), trans-lamina terminalis (TLT), opticocarotid triangle (OCT), and caroticosylvian (CS) windows from the MSO, frontomedial (FM), and PT perspectives. Methods: The MSO, PT, and FM approaches were performed sequentially in two fixed cadaver heads. Three colored spheres were placed around the optic chiasm: (1) between the optic nerves; (2) between the optic nerve and the internal carotid artery; and (3) between the internal carotid artery and the oculomotor nerve. The surgical exposures to these structures by using the IO, TLT, OCT, and CS windows were compared. Results: (1) IO window: from the MSO and PT approaches, the total surgical exposure mainly allows visualization of contralateral lesions. The FM approach was superior for exploration of both sides of the area between the optic nerves. (2) TLT pathway: the MSO and PT approaches mainly expose the contralateral third ventricle wall. (3) OCT window: the PT approach allows exposure of a larger part of the sphere between the optic nerve and the internal carotid artery than the MSO approach. (4) CS window: the PT approach allows a better exposure of lateral structures such as the oculomotor nerve and of the medial prepontine area in comparison to the MSO approach. Conclusion: Simulation of the surgical situation with artificial lesions is a good model for comparing surgical perspectives and for analyzing feasibility of lesion exposure and resection.
Collapse
Affiliation(s)
- Sasan Darius Adib
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Stephan Herlan
- Department of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Florian H Ebner
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Bernhard Hirt
- Department of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Juergen Honegger
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| |
Collapse
|
11
|
Adib SD, Ebner FH, Bornemann A, Hempel JM, Tatagiba M. Surgical Management of Primary Cerebellopontine Angle Melanocytoma: Outcome, Recurrence and Additional Therapeutic Options. World Neurosurg 2019; 128:e835-e840. [DOI: 10.1016/j.wneu.2019.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/28/2022]
|
12
|
Adib SD, Platz J, Schittenhelm J, Hennersdorf F, Honegger J. Transsphenoidal Removal of Recurrent Osteoid Osteoma of Clivus. World Neurosurg 2018; 120:506-508. [PMID: 30266707 DOI: 10.1016/j.wneu.2018.09.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND An osteoid osteoma (OO) is a benign bone neoplasm that typically occurs in the long bone diaphysis. We found only 8 cases of OOs of the skull base in the literature, and none of them were located in the clivus. CASE DESCRIPTION A 44-year-old female patient with a history of 2 previous transsphenoidal surgeries with partial removal of an OO of the clivus at another hospital, 11 and 4 years ago, presented to our department with recurrent progressive left-sided headache and facial pain over the past 6 months, which were aggravated at night. A new computed tomography (CT) scan of the head revealed a low-density, well-demarcated area surrounded by a high-density sclerotic bone in the clivus. A total transsphenoidal microscopic removal of the lesion was performed with the use of intraoperative neuronavigation. The patient recovered from surgery without any new deficits, and the headache was relieved during her inpatient hospital stay. A CT scan of the head that was performed 1 day after surgery revealed the complete removal of the lesion. The patient was discharged on day 5 after surgery. A follow-up examination conducted 3 months after surgery showed that the patient still had no headache or any other symptoms. A follow-up CT scan revealed no remnant or recurrent tumor. CONCLUSION The transsphenoidal approach with the use of neuronavigation appears to be a good choice to achieve total removal of an OO of the upper part of the clivus in case of persistent pain and lack of sufficient effect by nonsteroidal antiinflammatory drugs.
Collapse
Affiliation(s)
- Sasan Darius Adib
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany.
| | - Johannes Platz
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, University of Tuebingen, Tuebingen, Germany
| | | | - Jürgen Honegger
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| |
Collapse
|
13
|
Adib SD, Bisdas S, Bornemann A, Schuhmann MU. Neuroendoscopic Trans-Third Ventricular Approach for Surgical Management of Ecchordosis Physaliphora. World Neurosurg 2016; 90:701.e1-701.e6. [DOI: 10.1016/j.wneu.2016.02.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
|