Introduction Glioblastoma multiforme (GBM) is a devastating form of cancer with a poor prognosis ... more Introduction Glioblastoma multiforme (GBM) is a devastating form of cancer with a poor prognosis despite available treatments. Managing recurrent GBM remains challenging and lacks guidelines. This study aims to provide practice patterns for managing recurrent GBMs in India. Methods A panel of experts was assembled to develop practice patterns using the Delphi technique. Their responses were analyzed anonymously to ensure impartiality and generate recommendations. The statements were intended to be nonbinding and focused on promoting best practices in the field, without legal or regulatory authority. Results A total of 23 experts participated in the study, providing their opinions on various aspects of managing recurrent GBM. Consensus was achieved on individualized and multidisciplinary management as the preferred approach. Surgery in combination with other treatments was found to impact survival in patients older than 65 years, with re-surgery and adjuvant radiation and chemotherapy being the preferred options. Gadolinium-enhanced magnetic resonance imaging (MRI) brain with spectroscopy and
INTRODUCTION Treatment options for hypothalamic hamartoma (HH) include microvascular surgery, ste... more INTRODUCTION Treatment options for hypothalamic hamartoma (HH) include microvascular surgery, stereotactic radiofrequency thermocoagulation (SRT), laser interstitial thermal therapy, or Gamma Knife surgery. During SRT, thermographic monitoring cannot be performed and therefore highly accurate placement of electrode and confirmation of its position are required. We have used robotic guidance (ROSA) and coregistered it with O-arm for performing ablation of hamartoma. METHODS Five patients with HH and gelastic seizures underwent SRT. Robotic guidance (ROSA) was used for placement of electrodes. An O-arm was used for coregistering and confirming the robotic trajectory with real-time intraoperative imaging. Intraoperative computed tomography was merged with preoperative magnetic resonance imaging to confirm the exact position and trajectory of the electrode. Ablation was performed using a radiofrequency generator (70°C for 60 seconds). Multiple target sites were ablated to achieve proper ablation and disconnection. RESULTS Most patients (4/5) had International League Against Epilepsy class I outcome. One patient 2 sittings of lesioning. All but 1 electrode could be placed in the planned trajectories. One electrode was detected to have a medial deviation, and it had to be revised. No permanent complication was observed. CONCLUSIONS SRT is a cost-effective method of treating HH when compared with laser interstitial thermal therapy. With the use of a robotic arm we have demonstrated accurate placement of electrodes. Intraoperative computed tomography acquired using an O-arm can be merged with preoperative magnetic resonance imaging. This confirms electrode location and trajectory on a real-time basis by performing intraoperative imaging. This method is safe and can be used for radiofrequency ablation of HH.
Occipital pressure ulcers and wound gaping may occur in unconscious and malnourished patients. Mo... more Occipital pressure ulcers and wound gaping may occur in unconscious and malnourished patients. Most of the time, a large defect requires wound coverage by scalp flaps. This video describes a rotational occipital scalp flap for occipital pressure ulcer and wound gaping in a patient of operated midline posterior fossa mass & ventriculoperitoneal shunt. The defect measured 2.25 × 2.5 cm with exposed inion. The wound was included in an imaginary triangle, and the horizontal and vertical incision lengths were about four times the base of the triangle. The flap was based on the left occipital artery and raised in an avascular plane above the periosteum. The wound margins were freshened and undermined. The flap was rotated to bring it over the defect, and suturing was done in the standard manner. The flap had good healing, and the patient continued to be under care for his cerebellar medulloblastoma.
Background and Introduction: C2 transverse process exostoses are rare lesions. Due to critical st... more Background and Introduction: C2 transverse process exostoses are rare lesions. Due to critical structures surrounding them, their excision is challenging. There are sparse reports of anterior retropharyngeal approach (ARPA) for high-cervical transverse process mass and none for endoscopic ARPA approach. Objective: A step-by-step technical report with its video is presented. Surgical Technique: A 14-year-old girl presented with chronic right-sided neck pain. The computed tomography scan revealed a 6.5 cm3 mass in the right transverse process extending into the lateral mass of the C2 vertebra. The mass was anterior and in direct contact with the vertebral artery. She underwent a minimally invasive endoscopic ARPA. Results: The mass could be excised along with its cartilaginous cap without any complications. The patient's symptoms resolved completely. The biopsy came out as osteochondroma. Conclusion: Endoscopic ARPA is a minimally invasive option for high-cervical tumors and was found safe and effective for C2 transverse process osteochondroma.
Tubercular meningitis (TBM) can have various complications. Sometimes syringomyelia can also occu... more Tubercular meningitis (TBM) can have various complications. Sometimes syringomyelia can also occur as a late complication of tubercular meningitis. Although syrinx formation in early stage of TBM is very rare. There are only four published case reports of syringomyelia in acute stage of TBM. Here we report a patient with tubercular meningitis who developed syringomyelia in early course of illness.
population, associated medical diseases such as hemodialysis, anticoagulant, and/or antiplatelet ... more population, associated medical diseases such as hemodialysis, anticoagulant, and/or antiplatelet therapy. [3,4] Although the surgical techniques are simple, recurrences remain one of the challenges in the treatment. This review is based on last 21 years search (upto May 2012) on Pubmed and Google. Presentation The presentation of CSDH could vary from no symptoms to headache, seizures, decreased memory, and confusion. Patients could have difficulty in speech, swallowing, and walking. There may be weakness or numbness of arms, legs, and face. The CSDHs are usually characterized by history of head trauma, which is usually a trivial trauma. Some cases could be secondary to defective coagulation, after lumbar puncture (LP), etc., CSDH should be suspected in a patient who presents with unusually persistent headache after spinal anesthesia or LP. CSDH should be taken into account as an important differential diagnosis in reversible dementia. The differentiation between CSDH and dementia could be difficult when it is associated with the hallucinations. [5] CSDH generally occurs in elderly although it may present in young patients. It may rarely be seen in infants. The presence of bilateral CSDH in an infant raises the suspicion
Background Migraine is a common form of primary neurologic headache. Many patients are chronic mi... more Background Migraine is a common form of primary neurologic headache. Many patients are chronic migraineurs and suffer from a significant disability and adverse effects of drugs. There are various surgical options available to treat migraines, including peripheral neurectomies. Objective To study the surgical and functional outcomes of migraine surgeries using peripheral neurectomies and compare them with conservatively treated patients. Materials and Methods Migraine patients who had a unilateral onset pain were given local bupivacaine block at the suspected trigger site, and those who were relieved were given the option for surgery. In the operative group, the peripheral nerve of the trigger site was lysed under local anesthesia. The conservative group was continued with the standard treatment. Evaluations with a baseline and 6 months visual analog score (VAS), migraine headache index (MHI), migraine disability assessment test (MIDAS), and pain self-efficacy questionnaire (PSEQ) scores were done. Results A total of 26 patients got benefitted with the local bupivacaine block, out of which 13 underwent surgery. At baseline, the VAS, MHI, MIDAS, and PSEQ scores were similar in both the groups. The operative group had significant (P < 0.001) improvement in all these parameters 6 months after the surgery. All patients of the operative group got free from prophylactic migraine treatment; however, 11 out of 13 patients still needed occasional use of analgesics. There was one complication of transient temporal numbness. Conclusion Migraine surgery using peripheral neurectomies was more effective than chronic drug treatment in appropriately selected patients.
This narrative review appraises low-cost simulation systems for surgical training. Low-cost simul... more This narrative review appraises low-cost simulation systems for surgical training. Low-cost simulators are needed for minimally invasive and other advanced surgeries because opportunities for practicing the necessary surgical skills using high-fidelity simulation in the workplace are limited due to cost, time and accessibility to junior trainees. A low-cost box simulator can be easily made by self-assembly of components that are available locally or online and even with used, discarded or expired disposable instruments. Skills acquired through low-cost simulations translate into improvements in operating room performance and their efficacy is on a par with expensive systems. A brief comparison of various surgical simulation models, ranging from cadaveric, animal, bench-top, virtual reality, augmented reality to robotic simulators is included in this review. In addition, these low-cost systems can result in significant savings in costs of resident training, as well as in annual running costs of skills labs. Every speciality has developed its own versions of lowcost training systems and has shown their benefits. Low-cost laparoscopic training in 3D is also possible by using visual feedback via the transparent/open top of the box trainer. However, it is important to understand the limitations of a low-cost system. It is a widely available cost-effective workhorse, which can lay the foundation of basic generic surgical skills for younger trainees. Advanced skills can then be easily constructed with high-cost high-fidelity systems.
To assess the feasibility of laparoscopy in the treatment of pediatric urolithiasis, we report ou... more To assess the feasibility of laparoscopy in the treatment of pediatric urolithiasis, we report our experience with the transperitoneal laparoscopic removal of stones. Method: Renal pelvic stones of size 1 cm on ultrasound were included for laparoscopic pyelolithotomy while smaller stones were managed with shock-wave lithotripsy monotherapy. Intrarenal stones, calyceal stones, complete staghorn stones, multiple stones and kidneys with intrarenal pelvis were excluded. Ureteric stones included for laparoscopic ureterolithotomy were of size 1 cm in the upper, mid or lower ureter, and smaller stones not responding to non-operative treatment. Results: A total of 22 procedures were performed: 12 pyelolithotomies, and 8 lower and 2 upper ureterolithotomies. Complete removal of calculi was accomplished in 21 (95.45%) procedures. Complications associated with laparoscopic lithotomy included urinoma (4.54%), failure (4.54%) and omental prolapse (4.54%). Conclusion: Laparoscopic lithotomy is safe and feasible in pediatric urolithiasis with pyelic and ureteric stones, with minimal complications and failure rate.
Superspeciality training and subspecialty developments have become vital in the present era. It h... more Superspeciality training and subspecialty developments have become vital in the present era. It helps to gain excellence in patient care, academics, research, and widespread recognition among peers and the community. Selecting a subspecialty is challenging but can be accomplished with perseverance and following some principles. One should be an accomplished surgeon in the concerned superspeciality before deciding to choose a subspecialty. It should be unique, interesting, affordable, and possible in the given setup, having good appeal among masses, and the results should be better or comparable to conventional treatment. Publishing and presentations at appropriate forums are critical. This article details the Jabalpur model for developing a superspeciality and a subspecialty branch with neurosurgery and neuroendoscopy as a prototype.
Background: Endoscopic third ventriculostomy (ETV) has become a proven modality for treating obst... more Background: Endoscopic third ventriculostomy (ETV) has become a proven modality for treating obstructive and selected cases of communicating hydrocephalus. Objective: This review aims to summarize the indications, preoperative workup, surgical technique, results, postoperative care, complications, advantages, and limitations of an ETV. Materials and Methods: A thorough review of PubMed and Google Scholar was performed. This review is based on the relevant articles and authors' experience. Results: ETV is indicated in obstructive hydrocephalus and selected cases of communicating hydrocephalus. Studying preoperative imaging is critical, and a detailed assessment of interthalamic adhesions, the thickness of floor, arteries or membranes below the third ventricle floor, and prepontine cistern width is essential. Blunt perforation in a thin floor, while bipolar cautery at low settings and water jet dissection are preferred in a thick floor. The appearance of stoma pulsations and intraoperative ventriculostomography reassure stoma and basal cistern patency. The intraoperative decision for shunt, external ventricular drainage, or Ommaya reservoir can be taken. Magnetic resonance ventriculography and cine phase-contrast magnetic resonance imaging can determine stoma patency. Good postoperative care with repeated cerebrospinal fluid drainage enhances outcomes in selected cases. Though the complications mostly occur in an early postoperative phase, delayed lethal ones may happen. Watching live surgeries, assisting expert surgeons, and practicing on cadavers and models can shorten the learning curve. Conclusion: ETV is an excellent technique for managing obstructive and selected cases of communicating hydrocephalus. Good case selection, methodical technique, and proper training under experts are vital.
Introduction Posterior midline laminectomy is associated with risks of postoperative instability,... more Introduction Posterior midline laminectomy is associated with risks of postoperative instability, spinal deformity, extensive bilateral subperiosteal muscle stripping, partial or total facetectomy especially in foraminal tumor extension, increased cerebrospinal fluid leakage, and wound infection. Minimally invasive approaches with the help of a microscope or endoscope using hemilaminectomy have been found to be safe and effective. We report our initial experience of 18 patients using the endoscopic technique. Material and Methods A retrospective study of intradural extramedullary tumors extending up to two vertebral levels was studied. Pre-and postoperative clinical status, magnetic resonance imaging was done in all patients. The Destandau technique was used, and resection of ipsilateral lamina, medial part of the facet joint, base of the spinous process, and undercutting of the opposite lamina was performed. Dura repair was done using an endoscopic technique. Fibrin glue was used to reinforce repair in the later part of the study. Results The sagittal and axial diameter of tumor ranged from 21 to 41 mm and 12 to 18 mm, respectively. There were four cervical, two cervicothoracic, five thoracic, three thoracolumbar, and four lumbar tumors, respectively. All 18 patients improved after total excision of tumor. Average duration of surgery and blood loss was 140 minutes and 60 mL, respectively. Postoperative stay and follow-up ranged from 3 to 7 days and 9 to 24 months, respectively. Conclusion Although the study is limited by the small number of patients with a short follow-up and is a technically demanding procedure, endoscopic management of intradural extramedullary tumors was an effective and safe alternative technique to microsurgery in such patients.
Introduction Glioblastoma multiforme (GBM) is a devastating form of cancer with a poor prognosis ... more Introduction Glioblastoma multiforme (GBM) is a devastating form of cancer with a poor prognosis despite available treatments. Managing recurrent GBM remains challenging and lacks guidelines. This study aims to provide practice patterns for managing recurrent GBMs in India. Methods A panel of experts was assembled to develop practice patterns using the Delphi technique. Their responses were analyzed anonymously to ensure impartiality and generate recommendations. The statements were intended to be nonbinding and focused on promoting best practices in the field, without legal or regulatory authority. Results A total of 23 experts participated in the study, providing their opinions on various aspects of managing recurrent GBM. Consensus was achieved on individualized and multidisciplinary management as the preferred approach. Surgery in combination with other treatments was found to impact survival in patients older than 65 years, with re-surgery and adjuvant radiation and chemotherapy being the preferred options. Gadolinium-enhanced magnetic resonance imaging (MRI) brain with spectroscopy and
INTRODUCTION Treatment options for hypothalamic hamartoma (HH) include microvascular surgery, ste... more INTRODUCTION Treatment options for hypothalamic hamartoma (HH) include microvascular surgery, stereotactic radiofrequency thermocoagulation (SRT), laser interstitial thermal therapy, or Gamma Knife surgery. During SRT, thermographic monitoring cannot be performed and therefore highly accurate placement of electrode and confirmation of its position are required. We have used robotic guidance (ROSA) and coregistered it with O-arm for performing ablation of hamartoma. METHODS Five patients with HH and gelastic seizures underwent SRT. Robotic guidance (ROSA) was used for placement of electrodes. An O-arm was used for coregistering and confirming the robotic trajectory with real-time intraoperative imaging. Intraoperative computed tomography was merged with preoperative magnetic resonance imaging to confirm the exact position and trajectory of the electrode. Ablation was performed using a radiofrequency generator (70°C for 60 seconds). Multiple target sites were ablated to achieve proper ablation and disconnection. RESULTS Most patients (4/5) had International League Against Epilepsy class I outcome. One patient 2 sittings of lesioning. All but 1 electrode could be placed in the planned trajectories. One electrode was detected to have a medial deviation, and it had to be revised. No permanent complication was observed. CONCLUSIONS SRT is a cost-effective method of treating HH when compared with laser interstitial thermal therapy. With the use of a robotic arm we have demonstrated accurate placement of electrodes. Intraoperative computed tomography acquired using an O-arm can be merged with preoperative magnetic resonance imaging. This confirms electrode location and trajectory on a real-time basis by performing intraoperative imaging. This method is safe and can be used for radiofrequency ablation of HH.
Occipital pressure ulcers and wound gaping may occur in unconscious and malnourished patients. Mo... more Occipital pressure ulcers and wound gaping may occur in unconscious and malnourished patients. Most of the time, a large defect requires wound coverage by scalp flaps. This video describes a rotational occipital scalp flap for occipital pressure ulcer and wound gaping in a patient of operated midline posterior fossa mass & ventriculoperitoneal shunt. The defect measured 2.25 × 2.5 cm with exposed inion. The wound was included in an imaginary triangle, and the horizontal and vertical incision lengths were about four times the base of the triangle. The flap was based on the left occipital artery and raised in an avascular plane above the periosteum. The wound margins were freshened and undermined. The flap was rotated to bring it over the defect, and suturing was done in the standard manner. The flap had good healing, and the patient continued to be under care for his cerebellar medulloblastoma.
Background and Introduction: C2 transverse process exostoses are rare lesions. Due to critical st... more Background and Introduction: C2 transverse process exostoses are rare lesions. Due to critical structures surrounding them, their excision is challenging. There are sparse reports of anterior retropharyngeal approach (ARPA) for high-cervical transverse process mass and none for endoscopic ARPA approach. Objective: A step-by-step technical report with its video is presented. Surgical Technique: A 14-year-old girl presented with chronic right-sided neck pain. The computed tomography scan revealed a 6.5 cm3 mass in the right transverse process extending into the lateral mass of the C2 vertebra. The mass was anterior and in direct contact with the vertebral artery. She underwent a minimally invasive endoscopic ARPA. Results: The mass could be excised along with its cartilaginous cap without any complications. The patient's symptoms resolved completely. The biopsy came out as osteochondroma. Conclusion: Endoscopic ARPA is a minimally invasive option for high-cervical tumors and was found safe and effective for C2 transverse process osteochondroma.
Tubercular meningitis (TBM) can have various complications. Sometimes syringomyelia can also occu... more Tubercular meningitis (TBM) can have various complications. Sometimes syringomyelia can also occur as a late complication of tubercular meningitis. Although syrinx formation in early stage of TBM is very rare. There are only four published case reports of syringomyelia in acute stage of TBM. Here we report a patient with tubercular meningitis who developed syringomyelia in early course of illness.
population, associated medical diseases such as hemodialysis, anticoagulant, and/or antiplatelet ... more population, associated medical diseases such as hemodialysis, anticoagulant, and/or antiplatelet therapy. [3,4] Although the surgical techniques are simple, recurrences remain one of the challenges in the treatment. This review is based on last 21 years search (upto May 2012) on Pubmed and Google. Presentation The presentation of CSDH could vary from no symptoms to headache, seizures, decreased memory, and confusion. Patients could have difficulty in speech, swallowing, and walking. There may be weakness or numbness of arms, legs, and face. The CSDHs are usually characterized by history of head trauma, which is usually a trivial trauma. Some cases could be secondary to defective coagulation, after lumbar puncture (LP), etc., CSDH should be suspected in a patient who presents with unusually persistent headache after spinal anesthesia or LP. CSDH should be taken into account as an important differential diagnosis in reversible dementia. The differentiation between CSDH and dementia could be difficult when it is associated with the hallucinations. [5] CSDH generally occurs in elderly although it may present in young patients. It may rarely be seen in infants. The presence of bilateral CSDH in an infant raises the suspicion
Background Migraine is a common form of primary neurologic headache. Many patients are chronic mi... more Background Migraine is a common form of primary neurologic headache. Many patients are chronic migraineurs and suffer from a significant disability and adverse effects of drugs. There are various surgical options available to treat migraines, including peripheral neurectomies. Objective To study the surgical and functional outcomes of migraine surgeries using peripheral neurectomies and compare them with conservatively treated patients. Materials and Methods Migraine patients who had a unilateral onset pain were given local bupivacaine block at the suspected trigger site, and those who were relieved were given the option for surgery. In the operative group, the peripheral nerve of the trigger site was lysed under local anesthesia. The conservative group was continued with the standard treatment. Evaluations with a baseline and 6 months visual analog score (VAS), migraine headache index (MHI), migraine disability assessment test (MIDAS), and pain self-efficacy questionnaire (PSEQ) scores were done. Results A total of 26 patients got benefitted with the local bupivacaine block, out of which 13 underwent surgery. At baseline, the VAS, MHI, MIDAS, and PSEQ scores were similar in both the groups. The operative group had significant (P < 0.001) improvement in all these parameters 6 months after the surgery. All patients of the operative group got free from prophylactic migraine treatment; however, 11 out of 13 patients still needed occasional use of analgesics. There was one complication of transient temporal numbness. Conclusion Migraine surgery using peripheral neurectomies was more effective than chronic drug treatment in appropriately selected patients.
This narrative review appraises low-cost simulation systems for surgical training. Low-cost simul... more This narrative review appraises low-cost simulation systems for surgical training. Low-cost simulators are needed for minimally invasive and other advanced surgeries because opportunities for practicing the necessary surgical skills using high-fidelity simulation in the workplace are limited due to cost, time and accessibility to junior trainees. A low-cost box simulator can be easily made by self-assembly of components that are available locally or online and even with used, discarded or expired disposable instruments. Skills acquired through low-cost simulations translate into improvements in operating room performance and their efficacy is on a par with expensive systems. A brief comparison of various surgical simulation models, ranging from cadaveric, animal, bench-top, virtual reality, augmented reality to robotic simulators is included in this review. In addition, these low-cost systems can result in significant savings in costs of resident training, as well as in annual running costs of skills labs. Every speciality has developed its own versions of lowcost training systems and has shown their benefits. Low-cost laparoscopic training in 3D is also possible by using visual feedback via the transparent/open top of the box trainer. However, it is important to understand the limitations of a low-cost system. It is a widely available cost-effective workhorse, which can lay the foundation of basic generic surgical skills for younger trainees. Advanced skills can then be easily constructed with high-cost high-fidelity systems.
To assess the feasibility of laparoscopy in the treatment of pediatric urolithiasis, we report ou... more To assess the feasibility of laparoscopy in the treatment of pediatric urolithiasis, we report our experience with the transperitoneal laparoscopic removal of stones. Method: Renal pelvic stones of size 1 cm on ultrasound were included for laparoscopic pyelolithotomy while smaller stones were managed with shock-wave lithotripsy monotherapy. Intrarenal stones, calyceal stones, complete staghorn stones, multiple stones and kidneys with intrarenal pelvis were excluded. Ureteric stones included for laparoscopic ureterolithotomy were of size 1 cm in the upper, mid or lower ureter, and smaller stones not responding to non-operative treatment. Results: A total of 22 procedures were performed: 12 pyelolithotomies, and 8 lower and 2 upper ureterolithotomies. Complete removal of calculi was accomplished in 21 (95.45%) procedures. Complications associated with laparoscopic lithotomy included urinoma (4.54%), failure (4.54%) and omental prolapse (4.54%). Conclusion: Laparoscopic lithotomy is safe and feasible in pediatric urolithiasis with pyelic and ureteric stones, with minimal complications and failure rate.
Superspeciality training and subspecialty developments have become vital in the present era. It h... more Superspeciality training and subspecialty developments have become vital in the present era. It helps to gain excellence in patient care, academics, research, and widespread recognition among peers and the community. Selecting a subspecialty is challenging but can be accomplished with perseverance and following some principles. One should be an accomplished surgeon in the concerned superspeciality before deciding to choose a subspecialty. It should be unique, interesting, affordable, and possible in the given setup, having good appeal among masses, and the results should be better or comparable to conventional treatment. Publishing and presentations at appropriate forums are critical. This article details the Jabalpur model for developing a superspeciality and a subspecialty branch with neurosurgery and neuroendoscopy as a prototype.
Background: Endoscopic third ventriculostomy (ETV) has become a proven modality for treating obst... more Background: Endoscopic third ventriculostomy (ETV) has become a proven modality for treating obstructive and selected cases of communicating hydrocephalus. Objective: This review aims to summarize the indications, preoperative workup, surgical technique, results, postoperative care, complications, advantages, and limitations of an ETV. Materials and Methods: A thorough review of PubMed and Google Scholar was performed. This review is based on the relevant articles and authors' experience. Results: ETV is indicated in obstructive hydrocephalus and selected cases of communicating hydrocephalus. Studying preoperative imaging is critical, and a detailed assessment of interthalamic adhesions, the thickness of floor, arteries or membranes below the third ventricle floor, and prepontine cistern width is essential. Blunt perforation in a thin floor, while bipolar cautery at low settings and water jet dissection are preferred in a thick floor. The appearance of stoma pulsations and intraoperative ventriculostomography reassure stoma and basal cistern patency. The intraoperative decision for shunt, external ventricular drainage, or Ommaya reservoir can be taken. Magnetic resonance ventriculography and cine phase-contrast magnetic resonance imaging can determine stoma patency. Good postoperative care with repeated cerebrospinal fluid drainage enhances outcomes in selected cases. Though the complications mostly occur in an early postoperative phase, delayed lethal ones may happen. Watching live surgeries, assisting expert surgeons, and practicing on cadavers and models can shorten the learning curve. Conclusion: ETV is an excellent technique for managing obstructive and selected cases of communicating hydrocephalus. Good case selection, methodical technique, and proper training under experts are vital.
Introduction Posterior midline laminectomy is associated with risks of postoperative instability,... more Introduction Posterior midline laminectomy is associated with risks of postoperative instability, spinal deformity, extensive bilateral subperiosteal muscle stripping, partial or total facetectomy especially in foraminal tumor extension, increased cerebrospinal fluid leakage, and wound infection. Minimally invasive approaches with the help of a microscope or endoscope using hemilaminectomy have been found to be safe and effective. We report our initial experience of 18 patients using the endoscopic technique. Material and Methods A retrospective study of intradural extramedullary tumors extending up to two vertebral levels was studied. Pre-and postoperative clinical status, magnetic resonance imaging was done in all patients. The Destandau technique was used, and resection of ipsilateral lamina, medial part of the facet joint, base of the spinous process, and undercutting of the opposite lamina was performed. Dura repair was done using an endoscopic technique. Fibrin glue was used to reinforce repair in the later part of the study. Results The sagittal and axial diameter of tumor ranged from 21 to 41 mm and 12 to 18 mm, respectively. There were four cervical, two cervicothoracic, five thoracic, three thoracolumbar, and four lumbar tumors, respectively. All 18 patients improved after total excision of tumor. Average duration of surgery and blood loss was 140 minutes and 60 mL, respectively. Postoperative stay and follow-up ranged from 3 to 7 days and 9 to 24 months, respectively. Conclusion Although the study is limited by the small number of patients with a short follow-up and is a technically demanding procedure, endoscopic management of intradural extramedullary tumors was an effective and safe alternative technique to microsurgery in such patients.
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