The Long-Term Patency of the Internal Jugular Vein and the Common Facial Vein as Entrance Sites for Venous Access in Ventriculoatrial Shunts: A Comparative Analysis from a Single-Center Study.

OBJECTIVE: The ventriculoatrial (VA) shunt is a surgical intervention used to manage hydrocephalus, although it is less often utilized compared to the ventriculoperitoneal (VP) shunt or endoscopic third ventriculostomy. Placement of the distal catheter typically involves the utilization of either the common facial vein (CFV) or the internal jugular vein (IJV), 2 frequently employed options for venous access. This study aims to determine whether there is a statistically significant difference between the long-term patency (2 years) of the distal end of the VA shunt of these 2 options. METHODS: A retrospective cohort analysis was conducted of patients who received VA shunt surgeries with the employment of the CFV or IJV as access veins at Rajavithi Hospital in Thailand between January 2015 and December 2020. The analysis focused on long-term patency and potential complications. RESULTS: The study comprised a total of 42 participants. Twenty-six (61.9%) individuals underwent ventriculoatrial (VA) shunt surgery via the CFV, while the other 16 (38.1%) underwent the same procedure using the IJV. Neither of the 2 groups required shunt revision due to distal catheter malfunction. Most cases exhibited no significant complications apart from a single instance of shunt system infection. CONCLUSIONS: In VA shunt surgery, both the CFV and IJV can be used as venous access sites for the right atrium because there is no discernible difference between their complications or long-term patency. Anatomical considerations, patient-specific characteristics, and the surgeon's preference should all be considered when choosing the venous access location for the placement of a VA shunt.

Customized anterior temporal augmentation for treating anterior temporal hollowing (ATH) by 3D-printed cranioplasty.

BACKGROUND: Anterior temporal hollowing (ATH) leads to unattractive facial asymmetry and significant distress for the patient. This study aimed to correct ATH by a prefabricated cranioplasty using soft-tissue volume augmentation created by 3D printing and to evaluate the esthetic improvement. METHODS: This prospective study was conducted on 19 patients with ATH after brain surgery. Quantitative assessment used Materialized Mimics® and Images® to compare defect volume and quantitative measurement of the "defect value" pre- and post-PMMA implantation. Qualitative assessment was rated by patients on VAS pre- and 6 months post-surgery. RESULTS: The mean defect value decreased significantly with the innovative PMMA implant, from 2.42 ± 0.57 cm to 0.57 ± 0.45 cm (p < 0.01). There was a statistically significant reduction between pre- and postoperative defect value: 1.85 ± 0.48 (p < 0.01; 95% CI 2.08-1.61). After PMMA cranial implantation, 100% of patients reported esthetic improvement, 79% (15 out of 20) rating their esthetic improvement with the highest possible VAS score: mean VAS rating, 0.84 ± 1.2 preoperatively, and 4.63 ± 0.83 postoperatively, for a significant mean improvement of 3.789 ± 1.273 (p < 0.01; 95% CI 3.176-4.403). CONCLUSIONS: The innovative PMMA cranial implants created by advanced customized 3D technology successfully managed ATH. This could be a therapeutic alternative for correcting ATH and can be routinely employed in clinical practice.

Comparative outcomes of keyhole supraorbital approach (KSA) and endonasal endoscopic transsphenoidal approach (EETA) in pituitary surgery.

BACKGROUND: Currently, minimal invasive surgery (the endonasal endoscopic transsphenoidal approach-EETA or keyhole supraorbital approach-KSA) is widely accepted as the best choice for pituitary tumor removal. To the best of the authors' knowledge, there is no study comparing the relative safety of these methods. OBJECTIVE: To evaluate safety and compare the complications resulting from pituitary surgery using EETA and KSA. MATERIAL AND METHOD: The retrospective review was performed between January 2003 and September 2013. One hundred thirty patients with pituitary adenomas were operated by using either EETA or KSA. The KSA was used on 92 cases, and the EETA was utilized on the other 38. Postoperative complications were analyzed using statistical methodologies to show statistical significance. The study was approved by the ethical committee of Rajavithi Hospital. RESULTS: After statistical analysis, KSA provided better outcome in term of "headache improvement" than EETA. For complications, EETA had higher incidences of unimproved vision and reoperation rate than KSA. The other major finding of the present study was that in the early year of the operations, there was higher incidence of complications. This could be associated with the level of skills of the surgeons. CONCLUSION: KSA had better outcome in term of operative time, length of hospital stay, estimated blood loss, and headache improvement than EETA. For complications, EETA had higher incidence of unimproved vision and reoperation rate than KSA.

What is the better minimally invasive surgery in pituitary surgery: endoscopic endonasal transsphenoidal approach or keyhole supraorbital approach?

Endoscopic endonasal transsphenoidal approach (EETA) is an acceptable procedure as truly minimally invasive neurosurgery in handling pituitary tumor. EETA can serve many patients in many aspects especially the hospital stay and the scarification. However EETA still has some limitations that can cause serious complications. These complications such as cerebrospinal fluid leakage and bleeding control are less likely to occur ifneurosurgeons use conventional approach named as Pterional approach which was described by Yarsargil. To gain the benefit of both pterional approach and minimally invasive surgery Keyhole Supraorbital Approach (KSA) was proposed by Perneczky in 1999. This approach has not the mentioned limitation. However, there are many controversies between these two approaches in that what is the better minimally invasive surgery in pituitary surgery? The present article, by clearing the pro and con of each approach, can help neurosurgeons select the most appropriate way in handling pituitary surgery.

The comparison of conventional pterional and transciliary keyhole approaches: pro and con.

For years, neurosurgical operations have developed. Treatment modalities involving new devices and instruments have been innovated. Another principle of management that has been created and developed is the approach to enter the intracranial structure. Yasargil was credited to the standard and may be the most important approach, pterional or frontotemporal approach. Many modifications of this approach by new neurosurgeons has been created. Until now the concept of minimally invasive neurosurgery has been well accepted. The fundamental tendency to be as minimally invasive as possible with a minimum of iatrogenic traumatization and to achieve a maximum of efficiency in the treatment of a patient has existed since the beginning of surgery. The development of unconventional or "difficult approaches", which is based on increased knowledge of microsurgical anatomy, improved preoperative diagnostic techniques, and well-adapted microsurgical instruments, definitely forms one important aspect of "refinement in microneurosurgical operating". The supraorbital keyhole via the eyebrow incision is one of the minimally invasive approaches. Until now, there are debates between the advantage and disadvantage of this approach. The authors present the comparative approaches between these young and old methods. The pros and cons are listed in detail.