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Cover Neurosurgical Focus: Video

Biportal endoscopic posterior cervical foraminotomy with discectomy for unilateral radicular arm pain due to cervical herniated disc

Dong Hwa Heo

Recently, biportal endoscopic cervical approaches have been used to treat cervical degenerative disease. Biportal endoscopic posterior cervical foraminotomy with or without discectomy has the advantage of reducing damage to the normal tissues during surgery and enhancing fast recovery after surgery. The biportal endoscopic cervical approach was performed using two portals. The first portal was an endoscopic viewing portal for the spinal endoscope, and the other portal was a working portal for using surgical instruments. The author illustrates the surgical technique of biportal endoscopic posterior cervical foraminotomy with discectomy.

The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23225

Open access

nlm-article

Cover Neurosurgical Focus: Video

Biportal endoscopic transforaminal lumbar interbody fusion using a large cage for degenerative spondylolisthesis with stenosis

Dong Hwa Heo

Recently, biportal endoscopic transforaminal lumbar interbody fusion (TLIF) has been used to treat lumbar degenerative diseases, such as lumbar instability and spondylolisthesis. Biportal endoscopic TLIF may have the advantages of endoscopic spine approaches and minimally invasive lumbar fusion surgeries. In this biportal endoscopic TLIF, large cages similar to oblique lumbar interbody fusion (OLIF) cages have been used. Biportal endoscopic TLIF using a large cage can be successfully performed in the lower lumbar area. The author presents the surgical technique of biportal endoscopic TLIF using a large cage.

The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23231

Open access

nlm-article

Cover Neurosurgical Focus: Video

Combined unilateral biportal endoscopy and video-assisted thoracoscopic surgery for complete excision of a T3–T4 right ganglioneuroma

Enrico Giordan, Changik Lee, Dimas Rahman Setiawan, Phattareeya Pholprajug, and Jin-Sung Kim

Ganglioneuroma (GN) is a rare solid neoplasm developing from neural crest cells of sympathetic ganglia or adrenal medulla. It usually presents as an asymptomatic mass in the retroperitoneal space and mediastinum. Resection through open surgery or minimal access is recommended. The video illustrates the case of a 23-year-old female with an incidental finding of thoracic GN. The authors performed a combined, staged approach to ensure complete resection, which involved unilateral T3–4 biportal endoscopy (UBE) for rhizotomy and nerve root decompression, followed by video-assisted thoracoscopic surgery (VATS) for complete excision. The procedure was uneventful, with full recovery and no postoperative complications.

The video can be found here: https://stream.cadmore.media/r10.3171/2024.2.FOCVID23210

Open access

nlm-article

Cover Neurosurgical Focus: Video

Endoscopic decompression of a C1 osteophyte causing bow hunter’s syndrome in a 22-year-old male

Zachary A. Abecassis, John I. Ogunlade, Whitney Teagle, Guilherme Barros, Christine Park, Michael R. Levitt, and Christoph P. Hofstetter

The patient is a 22-year-old male with a history of C1 avulsion fracture causing vertebral artery compression with pseudoaneurysm and symptomatic stroke. Cerebral angiography demonstrated dynamic compression of the V3 segment of the vertebral artery due to a chronic C1 avulsion fracture. The authors utilized a full endoscopic approach with intraoperative angiography for proximal control and Doppler ultrasound to confirm adequate decompression. The surgery duration was 3 hours with blood loss < 5 ml. The patient was discharged on postoperative day 1 with no complication and has been asymptomatic since surgery. This is the first documented use of endoscopic decompression to treat this condition.

The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23234

Open access

nlm-article

Cover Neurosurgical Focus: Video

Endoscopic endonasal approach for resection of odontoid process, decompression of the cervicomedullary junction spinal cord, and resection of pannus

David T. Fernandes Cabral, Ricardo J. Fernández-de Thomas, Ali Alattar, David A. Paul, Eric W. Wang, and Paul A. Gardner

Odontoid pannus is an abnormal collection of degenerative or inflammatory tissue on the C1-dens joint that can result in severe spinal cord compression myelopathy. Treatment options vary depending on severity and etiology. In cases of severe cord compression, surgical management could be either through a purely posterior approach or in combination with an anterior decompression via endoscopic endonasal approach (EEA). This case presents a 77-year-old female who underwent posterior cervical fixation for odontoid pannus causing dramatic cervical myelopathy who failed to improve over a 6-month period and required anterior transodontoid pannus resection and decompression via EEA.

The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23176

Open access

nlm-article

Cover Neurosurgical Focus: Video

Endoscopic MIS-TLIF with Destandau’s system: leveraging endoscopy with conventional instruments

Ashutosh Kumar, Arun Kumar Srivastava, Jayesh Sardhara, Anant Mehrotra, Kamlesh Bhaisora, and Raj Kumar

This presentation showcases an endoscopic minimally invasive spine surgery (MISS) technique for lumbar interbody fusion. Significantly expanding the scope of Destandau’s system within MISS, it serves as a pivotal link to unilateral biportal endoscopy (UBE) for endofusion. The method involves minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using a 4-mm rigid endoscope through Destandau’s system. With the widespread familiarity with Destandau’s system and the absence of specialized instrument requirements, this approach is easily adoptable, particularly in resource-limited centers. The favorable clinical and radiological outcomes underscore the effectiveness of this technique, propelling the role of endoscopy in MISS, particularly in endofusion.

The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23216

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nlm-article

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Endoscopy for T10 nerve sheath tumor

Sivashanmugam Dhandapani and Chandrashekhar Gendle

Minimally invasive surgery (MIS) is increasingly being adopted for spinal intradural tumors. Through the use of conventional microscopy or exoscopy for large lobulated nerve sheath tumors, the posterior root attachment is often visualized only after mobilizing the tumor. Here, the authors describe the utility of angled endoscopy with its panoramic view for a T10 nerve sheath tumor. Gross-total extracapsular excision was achieved utilizing a minimally invasive right paraspinous approach, fenestration, lateral durotomy, sliding delivery of the tumor, sharp dissection of radicular attachments under neuromonitoring, and dural closure with oblique clips. Angled endoscopes help visualize the attachments behind large multilobulated tumors and confirm the totality of excision.

The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23214

Open access

nlm-article

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Five-step unilateral biportal endoscopic surgery for central lumbar canal stenosis: "Z" technique nuance

Ariel Kaen, Javier Quillo-Olvera, Man Kyu Park, Santiago Rocha, Fernando Durand, Ignacio Martin, and Sang-Kyu Son

The treatment for lumbar spinal stenosis has advanced through the use of minimally invasive surgery techniques. Endoscopic methods go even further, with studies showing that both uniportal and biportal endoscopic techniques have outcomes comparable to traditional approaches. However, there is limited knowledge of the step-by-step decompression process when using the unilateral biportal endoscopic (UBE). To address this, the authors introduce the five steps in the "Z" sequence, which aims to reduce surgical time and complications.

The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23182

Open access

nlm-article

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Full endoscopic resection of large bilateral synovial cysts in lumbar spine

Jannik Leyendecker, Nelson Sofoluke, Christoph P. Hofstetter, and Sanjay Konakondla

Synovial spinal cysts cause radiculopathy and back pain, with rare reports of cauda equina syndrome. Hypermobility and instability are cornerstones for synovial cyst formation. The incidence is around 5%, and data for bilateral cysts are lacking. Surgery is indicated after conservative measures fail. Recurrence is common and is potentially due to joint violation and destabilization from open surgery. This could be prevented via ultra-minimally invasive approaches. The authors present full endoscopic removal of bilateral synovial cysts in a patient with grade 1 stable spondylolisthesis and include a 360° view for confirmation of complete decompression. Postoperatively, the patient reported immediate pain relief.

The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23208

Open access

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Cover Neurosurgical Focus: Video

Full endoscopic resection of ventral thoracic osteophyte and repair of spontaneous CSF leak

Nelson Sofoluke, Jannik Leyendecker, Christoph P. Hofstetter, and Sanjay Konakondla

Spontaneous CSF leaks frequently cause headaches, meningismus, and nausea due to intracranial hypotension. When conservative treatment fails, surgical repair is indicated. Especially ventral leaks necessitate invasive approaches with substantial blood loss and tissue trauma. Full endoscopic spine surgery (FESS) enables circumferential access via the transforaminal approach. Here, the authors show the successful repair of a ventral CSF leak in the thoracic spine after removal of bony osteophytes utilizing FESS with placement of a dural substitute and sealant. Lasting symptom relief was reported. These results suggest that FESS is safe and efficient for the repair of spontaneous and incidental CSF leaks.

The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23209