High Cervical Carotid Endarterectomy-Outcome Analysis.

OBJECTIVE: Carotid endarterectomy (CEA) for high cervical internal carotid artery stenosis is considered to be technically demanding because of the difficulty in dissecting the distal end. We report the surgical technique and outcome analysis of CEA for high cervical lesions. METHODS: We retrospectively analyzed the records of 98 patients treated by CEA from December 2013 to June 2018. The plaque positions rostral to the C2 vertebral level was defined as the high cervical lesions (n = 34). The surgical technique is to successfully expose the distal end, as follows: 1) extend the skin incision; 2) expose the great auricular nerve maximally; 3) dissect between the SCM and parotid gland fascia; 4) resect the internal deep cervical lymph nodes; and 5) retract the digastric muscle, hypoglossal nerve, and occipital artery. RESULTS: There were 8 cases (high cervical group, 4 cases; non-high cervical group, 4 cases) of postoperative diffusion-weighted imaging high signal and 6 cases (high cervical group, 3 cases; non-high cervical group, 3 cases) of symptomatic ischemic lesion. Four cases belonged to the technique-related cerebral infarction group and 4 cases to the perioperative-related cerebral infarction (PRCI) group. High cervical lesion is not considered to be a risk factor for either PRCI (P = 0.610) or technique-related cerebral infarction (P = 0.610). The difference of the diastolic blood pressure between the preoperative period and the second postoperative day showed a risk factor of PRCI (P = 0.033). CONCLUSIONS: The surgical outcomes for high cervical lesions are equivalent to that of non-high cervical lesions. Excessive blood pressure management from the early postoperative days is a risk of PRCI.

Percutaneous posterolateral approach for the simulation of a far-lateral disc herniation in an ovine model.

PURPOSE: This work describes a minimally invasive damage model for ovine lumbar discs via partial nucleotomy using a posterolateral approach. METHODS: Two cadavers were dissected to analyze the percutaneous corridor. Subsequently, 28 ovine had their annulus fibrosus punctured via awl penetration under fluoroscopic control and nucleus pulposus tissue removed via rongeur. Efficacy was assessed by animal morbidity, ease of access to T12-S1 disc spaces, and production of a mechanical injury as verified by discography, radiography, and histology. RESULTS: T12-S1 were accessible with minimal nerve damage morbidity. Scar tissue sealed the disc puncture site in all animals within 6 weeks, withstanding 1 MP of intradiscal pressure. Partial nucleotomy led to a significant reduction in intervertebral disk height and an increased histological degeneration score. CONCLUSION: Inducing a reproducible injury pattern of disc degeneration required minimal time, effort, and equipment. The posterolateral approach allows operation on several discs within a single surgery and multiple animal surgeries within a single day.

Experiences with TachoSil® in microneurosurgery.

BACKGROUND: We analyze our experience of using TachoSil® (Takeda Austria GmbH: Linz, Austria) in microneurosurgical procedures as a hemostat and also as a sealant to patch dural defects. MATERIALS AND METHODS: Beginning on January 1, 2012, we prospectively analyzed 100 consecutive surgeries where TachoSil was used. The patient group included 58 women (58 %) and 42 men (42 %); the mean age was 52 years (range, 3-85 years). Indications for surgery included removal of the tumor (53 cases; 53 %), clipping of the cerebral arterial aneurysm (31 cases; 31 %), and treatment of other pathologies, including AVM (four cases; 4 %), cavernomas (four cases; 4 %), spinal tumor, and traumatic subdural hematoma. Patients received postoperative care according to local neurosurgical department protocol, including a postoperative CT scan after each craniotomy. Primary assessment of the wound took place during the hospital stay as well as at discharge or transfer to a rehabilitation unit. Mean follow-up time was 4 months (range, 1-12 months). RESULTS: None of the patients developed postoperative hematoma after craniotomy or spinal procedure. At primary assessment during hospital stay, 93 patients (93 %) had had no wound-related problems over the normal course of healing. No case registered any liquor leak from the wound, and none of the patients showed any signs of allergic response related to TachoSil usage. At the last follow-up, 96 patients (96 %) experienced uneventful wound healing, and in four patients (4 %), superficial wound infection was successfully treated with oral antibiotics. CONCLUSIONS: Our results indicate that TachoSil can serve in neurosurgical practice at no additional risks. TachoSil proved to be an effective hemostat, sealant, and adhesive in either cranial or spinal procedures.