Minimally Invasive Technique for Chiari I Decompression Without Durotomy: Surgical Technique and Preliminary Case Series.

BACKGROUND: Chiari I malformation, marked by severe headaches and potential brainstem/spinal cord issues, often requires surgical intervention when conservative methods fail. This study introduces a minimally invasive surgery (MIS) Chiari decompression technique utilizing a 3-blade retractor, aiming to reduce postoperative discomfort and optimize outcomes. METHODS: Chiari type I malformation patients who underwent a MIS technique were included. Technique consisted of a minimal-soft tissue opening using a 3-blade retractor, suboccipital craniectomy, C1 laminectomy, and resection of the atlantooccipital band without a durotomy. RESULTS: Ten patients were treated. Mean age was 43.3 years, with 7 female patients. All patients presented with occipital headaches; 50% retroorbital pain; 40% neck, upper back, or shoulder pain; and 30% limb paresthesias. Median pre-surgical modified Rankin Scale (mRS) was 3 (2-4) and pain visual analog score (VAS) was 7 (5-9). Mean operative time was 59 (59-71) minutes, with mean blood loss of 88.5 (50-140) mL. In our sample, 90% of patients were discharged the same surgical day (mean 7.2 [5.3-7.7] hours postoperative). No immediate or delayed postoperative complications were evidenced. At 6 months, 90% of patients had mRS 0-1. At last follow-up the mean VAS was 1.5 (range: 0-4, P < 0.001). CONCLUSIONS: The MIS 3-blade flexible retractor technique for Chiari decompression is feasible, provides wide visualization angles of the suboccipital region and C1 arch, allows 2-surgeon work, and minimizes skin and soft tissue disruption. This combination may diminish postoperative discomfort, reduce the risk of surgical site infections, and optimize outcomes.

Advancing neurosurgical education in the age of online learning and global knowledge sharing: impact of Cerebrovascular Q&A webinar series.

Background: The Seattle Science Foundation created the Cerebrovascular Q&A series as a free web-based tool to educate physicians and physicians-in-training about cerebrovascular and endovascular neurosurgery across geographical boundaries and different levels of training. Objective: This study aims to assess the educational impact and clinical implications of the Cerebrovascular Q&A webinar series, hosted by the Seattle Science Foundation. Methods: A digital anonymous, self-administered survey was sent to the live webinar participants. The survey contained questions about the socio-demographic characteristics of the participants, their perception of the content of the webinar series, and its impact on academic and clinical practice. The data collected from the Survey-Monkey platform was exported to Microsoft Excel which was used to perform all statistical analyses. The viewer metrics on Zoom and YouTube were also analyzed to understand trends observed among a diverse global cohort of participants. Result: A total of 2,057 people hailing from 141 countries had registered for the Cerebrovascular Q&A series. The response rate to the questionnaire was 12.63% (n = 260). Respondents hailed from 65 countries, of which the majority were from India (13.46%, n = 35) and United States (11.15%, n = 29). Most of the participants were male (82.69%, n = 215), while only 15.77% (n = 41) were female. The maximum number of participants were neurosurgery attendings (36.65%, n = 92) followed by neurosurgeons undergoing fellowship training (24.70%, n = 62) and students who were currently in residency training (15.54%, n = 39). 75.97% (n = 196) heard of the Cerebrovascular Q&A series through the emails from Seattle Science Foundation. 21.5% (n = 56) learned about the webinar series through social media. 75% of participants reported that the webinar content was advanced and comprehensive, and the selection of speakers was relevant. 63.08% (n = 164) found the webinars sparked innovative research ideas. Additionally, 55% (n = 143) reported changes in their clinical practice based on the acquired knowledge. Conclusion: The findings from this study reveal that webinar-based medical education in cerebrovascular neurosurgery is highly effective and influential. Web-based platforms and social media present a potent strategy to overcome barriers, emphasizing the need for targeted efforts to engage more women in medicine and neurosurgery recruitment.