Tag: Microsurgical techniques

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Microsurgical Repair of Ventral Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension: Efficacy and Safety of Patch-Sealing Versus Suturing

 

Operative Neurosurgery 28:379–385, 2025

This study compares microsurgical suturing and patch-sealing techniques for repairing ventral cerebrospinal fluid leaks in spontaneous intracranial hypotension. Both methods are equally effective, but sealing is faster and involves less spinal cord manipulation, potentially reducing surgical complications.

Study Overview and Methods

• Compared microsurgical suture vs. patch-sealing for ventral dural leaks in SIH patients.

• Retrospective analysis conducted between 2013 and 2023 at a single center.

• 85 patients with Type 1 SIH leaks were included in the study.

Results

• No significant difference in headache resolution between techniques (89% vs 94%).

• Sealing technique was significantly faster than suturing (139 vs 169 minutes).

• Complication rates: 23% in suture group, 9% in sealing group (not statistically significant).

Clinical Outcomes

• No significant difference in postoperative Bern-Score between techniques.

• SLEC-positive postoperative rate: 13% in suture group, 22% in sealing group.

• 90% of patients reported headache improvement post-surgery.

Discussion

• Both techniques are effective, but sealing minimizes spinal cord manipulation.

• Sealing preferred due to faster surgery time and fewer complications.

• Limitations include retrospective design and potential selection bias.

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Lateral Supraorbital Approach Applied to Tuberculum Sellae Meningiomas

Neurosurgery 70:1504–1519, 2012 DOI: 10.1227/NEU.0b013e31824a36e8

Various surgical approaches for the removal of tuberculum sellae meningiomas (TSMs) have previously been described.

OBJECTIVE: To assess the reliability and safety of the lateral supraorbital (LSO) approach to remove TSMs.

METHODS: We identified all TSM patients operated on at the Department of Neurosurgery at Helsinki University Central Hospital, Finland, by the senior author (J.H.) using the LSO approach between September 1997 and August 2010. We retrospectively analyzed the clinical data, radiological findings, surgical treatment, histology, and outcome of patients and discuss the operative technique.

RESULTS: Apparent complete tumor removal was achieved in 45 patients (87%). Of 42 patients, preexisting visual deficit improved in 22, remained the same in 13, and worsened in 7, and de novo visual deficit occurred in 1 patient. At 3 months postdischarge, 47 patients (90%) had a good recovery, 4 (8%) were moderately disabled, and 1 (2%) died 40 days after surgery of unexplained cardiac arrest. Seven patients (13%) had minimal residual tumors, 2 of which required reoperation. During the median follow-up of 59 months (range, 1-133 months), tumor recurred in 1 of the patients who had undergone a second operation.

CONCLUSION: TSMs of all sizes can be removed via the LSO approach with minimal morbidity and mortality. Low-power or no coagulation is recommended near the optic nerves and the optic chiasm to preserve their vascular support from the internal carotid artery perforators. Our results are comparable to those obtained using more extensive and time-consuming approaches. We recommend the LSO approach to remove TSMs.

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