Researchers compared the treatment efficacy and safety between endovascular treatment and stereotactic radiosurgery (SRS) for cavernous sinus dural arteriovenous fistula (CS dAVF). In the treatment of symptomatic CS dAVF without ophthalmological emergency, SRS is comparable to endovascular treatment in terms of efficacy and safety, with a 94.4% obliteration rate and an 8.1% morbidity and mortality rate. SRS could be an alternative treatment modality for symptomatic CS dAVF without ophthalmological emergency.
Sagittal craniosynostosis (SC) is the most commonly encountered form of craniosynostosis. Despite its relative frequency, there remains significant heterogeneity in both operative management and follow-up between centers and a relative paucity of long-term outcome data in the literature. At the authors’ institution, families of children presenting with SC are offered the following options: 1) conservative management with ophthalmic surveillance, 2) minimally invasive surgery at < 6 months of age (spring-assisted cranioplasty [SAC]) or 3) calvarial vault remodeling at any age (CVR). The authors reviewed outcomes for all children presenting with SC during a 5-year period, regardless of the treatment received.
Consecutive children born between January 1, 2008, and December 31, 2012, presenting with SC were identified, and detailed chart reviews were undertaken. Demographic, surgical, perioperative, head shape, scar, and neurodevelopmental (behavioral, education, speech, and language) data were analyzed. The cohort was divided by type of surgery (none, SAC, or CVR) and by age at surgery (early, defined as ≤ 6 months; or late, defined as > 6 months) for comparison purposes.
A total of 167 children were identified, 129 boys and 38 girls, with a median age at presentation of 5.0 (range 0.4–135) months. Three families opted for conservative management. Of the 164 children who underwent surgery, 83 underwent SAC, 76 underwent CVR, and 5 underwent a "hybrid" procedure (CVR with springs). At a median age of 7.0 (range 0.5–12.3) years, there was no significant difference in concerns regarding head shape, scar, or neurodevelopmental outcomes between the early and late intervention groups over all procedures performed, or between the early or late SAC and CVR cohorts. There were more head shape concerns in the SAC group than in the CVR group overall (25.7% vs 11.8%, respectively; p = 0.026), although most of these concerns were minor and did not require revision.
In this cohort, regardless of operative intervention and timing of intervention, infants achieved similar neurodevelopmental outcomes. Minimally invasive surgery (SAC) appears to result in less complete correction of head shape than CVR, but this may be balanced by advantages in reduced operative time, hospitalization, and blood loss. SAC was equal to CVR in neuropsychological outcomes.
Researchers evaluated hearing preservation after a middle fossa approach to vestibular schwannoma resection. Seventy-eight percent of patients maintained American Academy of Otolaryngology-Head and Neck Surgery class A or B hearing, and 93% achieved House-Brackmann grade I or II facial nerve outcome. Poor baseline hearing status, longer anesthesia duration, and large overlap between the internal auditory canal fundus and cochlea were independently associated with unfavorable hearing outcomes. These results demonstrate that surgery can achieve higher hearing preservation rates than conservative management or stereotactic radiosurgery with acceptable facial nerve outcomes.
Prophylactic surgery for fibrofatty filum terminale (FFT) in asymptomatic children is currently controversial. No previous study has been undertaken to assess the neurosurgical outcomes for FFT from Southeast Asia. This is the first clinical study from Southeast Asia that reports the role and safety of neurosurgical intervention for this condition.
The authors used telomere length to assess associations between biological age and postoperative complications after spinal deformity surgery. Shorter telomere length (older biological age) was associated with increased complications despite a nonsignificant difference in chronological age. These data provide the impetus to further investigate biomarkers of aging and their potential to improve the accuracy of current risk assessment tools. In some cases, biological age may be a modifiable risk factor that can be optimized preoperatively.
Researchers evaluated the biomechanics of a new anterior atlanto-occipital transarticular screw fixation technique on cadaveric specimens. Regarding atlanto-occipital instability, there was no statistically significant difference in the range of motion and neutral zone for anterior atlanto-occipital transarticular screw fixation compared with conventional posterior fixation. Anterior transarticular screw fixation is a biomechanically effective salvage technique for posterior atlanto-occipital fixation and may also serve as supplemental fixation.