Comparison of the inter-laminar approach and laminotomy open approach for filum terminale lipoma: A retrospective analysis.

PURPOSE: Filum terminale lipoma (FTL) causes spinal-cord tethering and is associated with tethered-cord syndrome, which is treated by dissection of the entrapment. The conventional treatment for FTL involves dissection of the spinal cord through a laminotomy open approach (LOA). However, in recent years, the interlaminar approach (ILA) has gained popularity as a minimally invasive surgery. This study compares the effectiveness of the minimally invasive ILA with the conventional LOA in treating FTL. METHODS: We retrospectively evaluated data on the ILA and LOA for FTL at our center. In total, 103 participants were enrolled, including 55 in the ILA group and 48 in the LOA group. RESULTS: The ILA required significantly less surgical time and resulted in less blood loss. The improvement rate of symptoms in symptomatic patients was 84%, and for urinary symptoms and abnormal urodynamic study findings, it was 77%. The postoperative maintenance rate for asymptomatic patients was 100%. Postoperative complications of ILA included delayed wound healing in two patients (3.6%). CONCLUSION: Compared with LOA, ILA offers advantages in terms of shorter operative time and less blood loss, with no significant difference in long-term symptom-improvement rates between the groups.

Minor Suture Fusion is Associated With Chiari Malformation in Nonsyndromic Craniosynostosis.

Here, we focused on the association between minor suture fusion and Chiari malformation (CM) occurrence in nonsyndromic craniosynostosis (NSC), and evaluated how the minor suture affects the posterior cranial fossa by measuring the posterior fossa deflection angle (PFA). In this retrospective study, the clinical records of 137 patients who underwent surgery for NSC at Aichi Children's Health and Medical Center between April 2010 and May 2022 were analyzed. Clinical data from Aichi Developmental Disability Center Central Hospital was collected for 23 patients as the external validation set. Among the 137 patients, 123 were diagnosed with NSC and the remaining 14 with syndromic craniosynostosis. Of the 123 NSC patients, 23 patients presented with CM. Multivariate analysis showed that occipito-mastoid fusion was the only significant risk factor for CM ( P =0.0218). Within the NSC group, CM patients had a significantly increased PFA (6.33±8.10 deg) compared with those without CM (2.76±3.29 deg, P =0.0487). Nonsyndromic craniosynostosis patients with occipito-mastoid suture fusion had a significantly increased PFA (6.50±7.60 deg) compared with those without occipito-mastoid fusion (2.60±3.23 deg, P =0.0164). In the validation cohort, occipito-mastoid suture fusion was validated as an independent risk factor for CM in univariate analysis. Minor suture fusion may cause CM associated with NSC. Chiari malformation could develop due to an increased PFA due to minor suture fusion, which causes growth disturbance in the affected side and compensatory dilation in the contralateral side within the posterior cranial fossa.

The usage of the three-dimension distractor in the NAVID system for plagiocephaly-three case reports.

BACKGROUND: Distraction osteogenesis is a standard method for craniosynostosis. However, the technique using conventional devices still has some disadvantages, especially for anterior or posterior plagiocephaly with complex deformities. In the Nakajima's angle-variable internal distraction (NAVID) system originally for maxillary surgeries, the cranial three-dimension (D) distractor with three dimensionally movable joint at the anterior arm has been developed recently in order to prevent the interference in the distraction process and excessive force. CASE REPORTS: In this paper, we first reported two cases of anterior plagiocephaly, and one case of posterior plagiocephaly received distraction osteogenesis using new 3-D distractor in the NAVID system. In two cases of anterior plagiocephaly, the reshaping of supra-orbital bar in reference of simulating by the 3-D skull model was performed. In all cases, we fixed two paralleled 2-D distractors and a 3-D distractor in the upper frontal or parietal region. CONCLUSION: Within the limitations of this study, we believe that the NAVID system is suitable for infant plagiocephaly due to the simple and small joint arm. Furthermore, the usage of the 3-D distractor would reduce the interference with 2-D distractors and easily lead to attainment of targeted distracting distance.

Alpha horizontal stent delivery for coil embolization of a broad-necked large basilar apex aneurysm: a case report.

Here we describe a novel technique for single stent horizontal reconstruction and coil embolization for a broad-necked large basilar artery (BA) apex aneurysm. A previously healthy 77-year-old woman presented with a broad-necked large BA apex aneurysm. Due to difficulty accessing the right posterior cerebral artery (PCA), we abandoned the Y-stent technique. Instead, we decided to navigate the stent through the BA to the left PCA making a loop of the stent delivery catheter inside the aneurysm in an "alpha" fashion. The procedure outcome was excellent without any complications. Alpha horizontal stent delivery via an antegrade approach for coil embolization of broad-necked large BA apex aneurysms may provide an effective therapeutic alternative, if other techniques are not feasible.

Combined endovascular and endoscopic surgery for acute epidural hematoma in a patient with poor health.

A 74-year-old woman presented with right acute epidural hematoma (AEDH) associated with a skull fracture after a fall. Emergency craniotomy under general anesthesia could not be performed because of her poor medical condition. Therefore, transfemoral endovascular embolization and hematoma evacuation via a burr hole were performed using endoscopy under local anesthesia. The patient recovered and was discharged without neurological deficits. AEDH is a common traumatic disease often requiring emergency craniotomy to prevent death and restore neurological function. The present combined surgical approach was effective in treating AEDH that could not be treated under general anesthesia in a patient with poor medical condition.