Enhanced Recovery After Surgery Protocol in Minimally Invasive Lumbar Fusion Surgery Reduces Length of Hospital Stay and Inpatient Narcotic Use.

Background: The application of enhanced recovery after surgery (ERAS) has the potential to improve outcomes, hasten patient recovery, and reduce costs. ERAS has been applied to spine surgery for several years, but data are limited around the impact of ERAS on minimally invasive spine surgery, specifically. The authors report their experience implementing a multimodal ERAS protocol for patients receiving minimally invasive transforaminal lumbar interbody fusion.

Subependymomas Are Low-Grade Heterogeneous Glial Neoplasms Defined by Subventricular Zone Lineage Markers.

Objective: Subependymomas are infrequent, low-grade gliomas associated with the ventricular system and the spinal cord. Little is known about the origin and natural history of these slow-growing lesions.

Methods: We identified all patients with pathologically proven subependymomas presenting to our institution between 1998 and 2016.

Assessment of Paraspinal Muscle Cross-sectional Area After Lumbar Decompression: Minimally Invasive Versus Open Approaches.

Study Design: A retrospective, blinded analysis of imaging studies.

Summary Of Background Data: To evaluate changes in paraspinal muscle cross-sectional area (CSA) after surgical treatment for lumbar stenosis and to compare these changes between minimally invasive and standard open approaches. The open approach to lumbar stenosis is effective, but it involves retraction and resection of muscle from the spinous process, which can result in ischemia and denervation of paraspinal musculature and may lead to muscle atrophy and pain.

Unique microenvironmental responses to PDGF stimulation in brain and spinal cord gliomas determine tumor phenotype.

Injection of a PDGF-B expressing retrovirus into the subcortical white matter of adult rats induces the rapid formation of brain tumors that have the histological features of glioblastoma. In contrast, when the same retrovirus is injected into the spinal cord of adult rats the resulting tumors are more indolent and display a unique histology characterized by nests of tumor cells separated by a dense vascular network without areas of necrosis. To study whether these differences are determined by the tumor cell of origin or due to microenvironmental influences, we conducted a series of transplantation experiments.

Primary dural repair in minimally invasive spine surgery.

We describe an effective surgical technique in primary repair of the spinal dura during minimally invasive spine surgery (MISS). Objective. Minimally invasive spine surgery includes the treatment of intradural lesions, and proper closure of the dura is necessary.

Minimally invasive thoracic microendoscopic diskectomy: surgical technique and case series.

Objective: To present operative details and clinical follow-up of a series of patients with thoracic disk herniation treated with the minimally invasive technique of thoracic microendoscopic diskectomy (TMED).

Methods: TMED was performed in 16 consecutive patients (age range, 18-79 years old) with 18 thoracic disk herniations. One patient with a calcified herniation in a direct ventral location was not included in this series.

Medulloblasoma: challenges for effective immunotherapy.

For medulloblastoma patients, the current therapeutic paradigm of surgery followed by radiation and chemotherapy can lead to long-term remission. However, the sequelae of treatment can be very debilitating, particularly in young children. Immunotherapy is an attractive treatment approach to optimize the targeting of tumor cells while sparing the vulnerable surrounding brain that is still developing in children.

Spinal cord bypass surgery with intercostal and spinal accessory nerves: an anatomical feasibility study in human cadavers.

Object: Despite extensive study, no meaningful progress has been made in encouraging healing and recovery across the site of spinal cord injury (SCI) in humans. Spinal cord bypass surgery is an unconventional strategy in which intact peripheral nerves rostral to the level of injury are transferred into the spinal cord below the injury. This report details the feasibility of using spinal accessory nerves to bypass cervical SCI and intercostal nerves to bypass thoracolumbar SCI in human cadavers.

Platelet-derived growth factor receptor (PDGFR) expression in primary spinal cord gliomas.

Abnormal signaling through the platelet-derived growth factor receptor (PDGFR) has been proposed as a possible mechanism of spinal cord glioma initiation and progression. However, the extent of PDGFR expression in human spinal cord gliomas remains unknown. In this study we perform immunohistochemical analysis of PDGFRα expression in a series of 33 primary intramedullary spinal cord gliomas of different types and grades.

Retroviral delivery of platelet-derived growth factor to spinal cord progenitor cells drives the formation of intramedullary gliomas.

Background: High-grade gliomas of the spinal cord are poorly understood tumors that are very commonly associated with bad outcomes. The transforming effects of platelet-derived growth factor (PDGF) on spinal cord glial progenitor cells may play an important role in the development of these tumors.

Objective: To investigate the possible tumor-initiating effects of PDGF overexpression in the spinal cord, we delivered a PDGF retrovirus directly into the substance of the spinal cord.

Cadaveric evaluation of minimally invasive posterolateral thoracic corpectomy: a comparison of 3 approaches.

Study Design: A cadaver study comparing 3 different minimally invasive approaches to the anterior thoracic spine.

Objective: To assess the feasibility of minimally invasive thoracic corpectomy from a posterolateral approach and to compare surgical results from 3 approaches.

Summary Of Background Data: Traditional posterolateral approaches to the thoracic spine are effective but are associated with a high rate of operative morbidity.

Clinical outcomes after microendoscopic discectomy for recurrent lumbar disc herniation.

Study Design: Retrospective review of consecutive case series.

Objective: To assess the safety and efficacy of the microendoscopic approach for treatment of recurrent lumbar disc herniation.

Summary Of Background Data: The standard surgical approach for the treatment of recurrent disc herniation uses an open technique with a wide exposure.

Operative management of spinal hemangioblastoma.

Hemangioblastomas occur in 2% to 15% of reported series of intramedullary spinal cord tumors. They are benign, highly vascular tumors that can be cured with surgical resection. Complete removal of these tumors with low morbidity is possible with current microneurosurgical techniques and a thorough understanding of the typical relationship of the tumor to adjacent neural structures.

Minimally invasive resection of intramedullary ependymoma: case report.

Objective: This report illustrates the adequacy of minimally invasive exposure for the resection of an intramedullary ependymoma.

Clinical Presentation: The patient presented with a history of upper back pain, but a lesion was found during a workup for increased back pain after a motor vehicle accident.

Intervention: The intramedullary ependymoma was approached using a muscle-splitting retractor and extended hemilaminar exposure.

Minimally invasive posterolateral thoracic corpectomy: cadaveric feasibility study and report of four clinical cases.

Objective: To demonstrate the feasibility of and initial clinical experience with a novel minimally invasive posterolateral thoracic corpectomy technique.

Methods: Seven procedures were performed on 6 cadavers to determine the feasibility of thoracic corpectomy using a minimally invasive approach. The posterolateral thoracic corpectomies were performed with expandable 22 mm diameter tubular retractor paramedian incisions.

A biomechanical evaluation of graded posterior element removal for treatment of lumbar stenosis: comparison of a minimally invasive approach with two standard laminectomy techniques.

Study Design: A validated finite element model of the intact lumbar spine (L1-S1) was modified to study the biomechanical changes as a result of surgical alteration for treatment of stenosis at L3-L4 and L4-L5 using 2 established techniques and 1 new minimally invasive technique.

Objective: To investigate the impact of graded posterior element removal associated with new surgical techniques on postoperative segmental motion and loading in the annulus.

Summary Of Background Data: Several studies have shown that laminectomy increases and produces segmental instability unless fusion is performed.

Biomechanical comparison of traditional and minimally invasive intradural tumor exposures using finite element analysis.

Background: Minimally invasive approaches to intradural pathology have evolved in part in an effort to reduce approach related destabilization of the spine. No biomechanical data exist however evaluating the effects of traditional and minimally invasive exposures.

Methods: A finite element model of the lumbar spine was generated, and a simulated open laminectomy and a modified hemilaminectomy at L4 were performed.

Obesity and self-reported outcome after minimally invasive lumbar spinal fusion surgery.

Objective: Many patients undergoing lumbar spine fusion are overweight or obese. The relationship between body habitus and outcome after lumbar spine fusion surgery is not well defined.

Methods: We analyzed a prospectively maintained database of self-reported pain and quality of life measures, including Visual Analog Scale pain score, Short Form 36, and Oswestry Disability Index.

Anterior approach to cervical intramedullary pilocytic astrocytoma. Case report.

Although there has been considerable experience with anterior approaches to ventral intradural, extramedullary, and pial-based spinal lesions, there is no information in the literature regarding the safety and feasibility of the resection of an intramedullary tumor via an anterior approach. The authors report on the gross-total resection of an intramedullary cervical pilocytic astrocytoma via a C-7 corpectomy and anterior myelotomy. The surgery proceeded without complication, and postoperatively the patient maintained the preoperative deficit of mild unilateral hand weakness but had no sensory deficits.

Minimally invasive posterior thoracic fusion.

Thoracic spine fusion may be indicated in the surgical treatment of a wide range of pathologies, including trauma, deformity, tumor, and infection. Conventional open procedures for surgical treatment of thoracic spine disease can be associated with significant approach-related morbidity, which has motivated the development of minimally invasive approaches. Thoracoscopy and, later, video-assisted thoracoscopic surgery were developed to address diseases of the thoracic cavity and subsequently adapted for thoracic spine surgery.

Preferential in situ CD4+CD56+ T cell activation and expansion within human glioblastoma.

Recent evidence suggests that suppression of the cellular immune response is often attributable to populations of functionally distinct T cells that act to down-regulate Ag-specific effector T cells. Using flow cytometry, we evaluated tumor-infiltrating lymphocytes (TIL) from patients undergoing neurosurgical resection of glioblastoma multiforme (GBM), metastatic lung carcinoma, and meningioma for markers known to be expressed on immunoregulatory T cells. Ex vivo phenotypic characteristics, cellular proliferation, and cytokine expression patterns were compared between T cell subsets found in the PBMC and within TIL from fresh tumor samples.

Intraorbital and intracranial soft-tissue glomus tumor in an 8-year-old child. Case report.

Soft-tissue glomus tumors (or glomangiomas) are unrelated to neuroendocrine paragangliomas (glomus tympanicum, jugulare, and vagale). The authors present the first reported case of an orbital soft-tissue glomus tumor in a child. An 8-year-old girl developed rapidly progressive right-eye blindness, proptosis, and a sixth cranial nerve palsy.

Identification of A2B5+CD133- tumor-initiating cells in adult human gliomas.

Objective: Several studies have shown that human gliomas contain a small population of cells with stem cell-like features. It has been proposed that these "cancer stem cells" may be uniquely responsible for glioma formation and recurrence. However, human gliomas also contain an abundance of cells that closely resemble more differentiated glial progenitors.

Intramedullary inclusion cysts of the cervicothoracic junction. Report of two cases in adults and review of the literature.

Intramedullary inclusion cysts are extremely rare within the rostral spinal cord. In this case report the authors outline the clinical features and surgical treatment of one dermoid cyst and one epidermoid cyst of the cervicothoracic junction. The authors also include a relevant literature discussion regarding the treatment and the embryological origin of these lesions.