Malignant primary tumors of scalp with cranial extension: multidisciplinary surgical strategies and outcomes.

Objective: Malignant cancers arising in the scalp may exhibit calvarial invasion, dural extension, and rarely cerebral involvement. Typically, such lesions require a multidisciplinary approach involving both neurosurgery and plastic surgery for optimal resection and reconstruction. The authors present a retrospective analysis of patients with scalp malignancies who underwent resection and reconstruction.

Long-Term Reoperation Rates After Open versus Minimally Invasive Spine Surgery for Degenerative Lumbar Disease: Five Year Follow-Up of 2130 Patients.

Background: Minimally Invasive Spine Surgery (MISS) is a growing alternative to Open Spine Surgery (OSS). The preservation of musculature and minimization of iatrogenic injury is hypothesized to decrease the need for reoperation by preserving normal anatomy. Our objective is to compare the relative long-term reoperation rates after MISS and OSS for the treatment of degenerative disease of the lumbar spine.

The Addition of Radiofrequency Tumor Ablation to Kyphoplasty May Reduce the Rate of Local Recurrence in Spinal Metastases Secondary to Breast Cancer.

Background: Approximately 10% of all cancer patients develop spinal metastases. When a symptomatic compression fracture occurs without associated deformity or neurologic deficit, it can be treated with kyphoplasty with or without radiofrequency ablation (RFA). Treatment with kyphoplasty is well established but does not address the underlying oncologic disease.

Industry-Sponsored Research Payments in Neurosurgery-Analysis of the Open Payments Database From 2014 to 2018.

Background: The Open Payments Database (OPD) started in 2013 to combat financial conflicts of interest between physicians and medical industry.

Objective: To evaluate the first 5 yr of the OPD regarding industry-sponsored research funding (ISRF) in neurosurgery.

Methods: The Open Payments Research Payments dataset was examined from 2014 to 2018 for payments where the clinical primary investigator identified their specialty as neurosurgery.

Anatomical Variations of the Recurrent Laryngeal Nerve and Implications for Injury Prevention during Surgical Procedures of the Neck.

Accurate knowledge of anatomical variations of the recurrent laryngeal nerve (RLN) provides information to prevent inadvertent intraoperative injury and ultimately guide best clinical and surgical practices. The present study aims to assess the potential anatomical variability of RLN pertaining to its course, branching pattern, and relationship to the inferior thyroid artery, which makes it vulnerable during surgical procedures of the neck. Fifty-five formalin-fixed cadavers were carefully dissected and examined, with the course of the RLN carefully evaluated and documented bilaterally.

Cervical Spine and Craniocervical Junction Reconstruction with a Vascularized Fibula Free Flap.

Background: Long-term stabilization of the cervical spine after extensive multilevel tumor resection is difficult to achieve. The current standard approach of instrumentation combined with allograft or nonvascularized autograft is limited in settings of increased risk of nonunion or delayed union (i.e.

Stand-Alone Balloon Kyphoplasty for Treatment of Traumatic Burst Fracture in Pediatric Patient.

Background: Kyphoplasty is commonly employed in the treatment of compression fractures in the elderly and is increasingly used in the treatment of adult trauma along with concomitant instrumentation. Although kyphoplasty with instrumentation has been reported in pediatric patients, concerns regarding retardation of spinal growth and iatrogenic spinal deformity have been raised. The utilization of kyphoplasty without instrumentation has yet to be reported in the case of pediatric patients.

Histopathological Findings After Reirradiation Compared to First Irradiation of Spinal Bone Metastases With Stereotactic Body Radiotherapy: A Cohort Study.

Background: Stereotactic body radiotherapy (SBRT) of the spine provides superior tumor control, but vertebral compression fractures are increased and the pathophysiological process underneath is not well understood. Data on histopathological changes, particularly after salvage SBRT (sSBRT) following conventional irradiation, are scarce.

Objective: To investigate surgical specimens after sSBRT and primary SBRT (pSBRT) regarding histopathological changes.

Safety and efficacy of balloon kyphoplasty at 4 or more levels in a single anesthetic session.

OBJECTIVE In this case series, the authors evaluated the safety of balloon kyphoplasty at 4 or more vertebral levels in a single anesthetic session. The current standard is that no more than 3 levels should be cemented at one time because of a perceived risk of increased complications. METHODS A retrospective chart review was performed for 19 consecutive patients who underwent ≥ 4-level balloon kyphoplasty between July 1, 2011, and December 31, 2015.

Prognostic Factors and Survival Outcome in Patients with Chordoma in the United States: A Population-Based Analysis.

Objective: To evaluate prognostic factors of patients with chordoma through a population-based analysis.

Methods: Surveillance, Epidemiology, and End Results (SEER) database was queried for patients with chordoma from 1973 to 2013. Kaplan-Meier univariate analysis and Cox regression multivariate analysis were performed to examine prognostic factors in overall survival (OS) and disease-specific survival (DSS).

Re-irradiation stereotactic body radiotherapy for spinal metastases: a multi-institutional outcome analysis.

OBJECTIVE This study is a multi-institutional pooled analysis specific to imaging-based local control of spinal metastases in patients previously treated with conventional external beam radiation therapy (cEBRT) and then treated with re-irradiation stereotactic body radiotherapy (SBRT) to the spine as salvage therapy, the largest such study to date. METHODS The authors reviewed cases involving 215 patients with 247 spinal target volumes treated at 7 institutions. Overall survival was calculated on a patient basis, while local control was calculated based on the spinal target volume treated, both using the Kaplan-Meier method.

Using Provocative Discography and Computed Tomography to Select Patients with Refractory Discogenic Low Back Pain for Lumbar Fusion Surgery.

Background Context Controversy remains over the use of provocative discography in conjunction with computed tomography (CT) to locate symptomatic intervertebral discs in patients with chronic, low back pain (LBP). The current study explores the relationship between discogenic pain and disc morphology using discography and CT, respectively, and investigates the efficacy of this combined method in identifying surgical candidates for lumbar fusion by evaluating outcomes. Methods 43 consecutive patients between 2006 and 2013 who presented with refractory low back pain and underwent discography and CT were enrolled in the study.

Utility of Preoperative Magnetic Resonance Imaging Coregistered with Intraoperative Computed Tomographic Scan for the Resection of Complex Tumors of the Spine.

Background: Complete surgical resection is known to provide the best prognosis when treating complex tumors of the spine. The anatomy of the cervical spine and the extensive involvement often present by the time these lesions are discovered can make total resection challenging. A novel technique combining preoperative and intraoperative imaging for intraoperative navigation can serve as an additional tool for facilitating tumor resection.

Factors affecting survival in 43 consecutive patients after surgery for spinal metastases from thyroid carcinoma.

Object: Spinal metastases account for the majority of bone metastases from thyroid cancer. The objective of the current study was to analyze a series of consecutive patients undergoing spinal surgery for thyroid cancer metastases in order to identify factors that influence overall survival.

Methods: The authors retrospectively reviewed the records of all patients who underwent surgery for spinal metastases from thyroid cancer between 1993 and 2010 at the University of Texas MD Anderson Cancer Center.

Definitive single-stage posterior surgical correction of complete traumatic spondyloptosis at the thoracolumbar junction.

Complete dislocation at the thoracolumbar junction is a rare occurrence, with only 4 previously reported cases in 3 separate series. Surgical procedures in the reported cases of spondyloptosis at the thoracolumbar junction have been described using instrumentation, reduction, decompression, and stabilization techniques. In this report the authors' patient presented with spondyloptosis at the thoracolumbar junction, resulting in a T-11 American Spinal Injury Association Grade A injury.

A rare case of giant cell tumor involving the clivus resected through Le Fort I Osteotomy and median maxillotomy.

Background: Giant cell tumors (GCTs) are bone tumors that seldom involve the skull. Skull GCTs preferentially occur in the sphenoid and temporal bones with few reported cases involving the clivus. Due to the rarity and complex location, surgical management is not well established for clival GCTs.

Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis.

Purpose: To evaluate patient selection criteria, methodology, safety and clinical outcomes of stereotactic body radiotherapy (SBRT) for treatment of vertebral metastases.

Materials And Methods: Eight centers from the United States (n=5), Canada (n=2) and Germany (n=1) participated in the retrospective study and analyzed 301 patients with 387 vertebral metastases. No patient had been exposed to prior radiation at the treatment site.

Impact of preoperative functional magnetic resonance imaging during awake craniotomy procedures for intraoperative guidance and complication avoidance.

Background: We wanted to study the role of functional MRI (fMRI) in preventing neurological injury in awake craniotomy patients as this has not been previously studied.

Objectives: To examine the role of fMRI as an intraoperative adjunct during awake craniotomy procedures.

Methods: Preoperative fMRI was carried out routinely in 214 patients undergoing awake craniotomy with direct cortical stimulation (DCS).

Orthotopic murine model of a primary malignant bone tumor in the spine: functional, bioluminescence, and histological correlations.

Object: There is currently no reproducible animal model of human primary malignant bone tumors in the spine to permit laboratory investigation of the human disease. Therefore, the authors sought to adapt their previously developed orthotopic model of spinal metastasis to a model for primary malignant bone tumors of the spine.

Methods: A transperitoneal surgical approach was used to implant osteosarcoma (Krib-1) into the L-3 vertebral body of nude mice via a drill hole.

Quality-of-life outcomes with minimally invasive transforaminal lumbar interbody fusion based on long-term analysis of 304 consecutive patients.

Study Design: This was a prospective clinical study that took place in an outpatient spine clinic.

Objective: To demonstrate the short-/long-term outcomes from a large cohort of patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF).

Summary Of Background Data: Long-term prospective outcomes in patients undergoing minimally invasive spinal fusion for debilitating back pain has not been well studied.

Subcortical injury is an independent predictor of worsening neurological deficits following awake craniotomy procedures.

Background: Tailored craniotomies for awake procedures limit cortical exposure. Recently we demonstrated that the identification of eloquent areas increased the risk of postoperative deficits. However, it was not clear whether the observed neurological deficits were caused by proximity of functional cortex to the tumor [cortical injury] or subcortical injury.

A clinicopathologic correlation in osteoblastoma of the spine in a child.

Spinal osteoblastomas are considered benign tumors but can be locally aggressive. Patients usually present with pain and undergo radiologic and histologic work-up to establish a diagnosis. Osteoblastomas have discordant appearances on CT scans and MRI because of the inflammatory response seen on MRI that characterizes these tumors - the "flare" phenomenon.

Avoiding abdominal flank bulge after anterolateral approaches to the thoracolumbar spine: cadaveric study and electrophysiological investigation.

Object: The thoracolumbar junction is frequently accessed through an anterolateral approach with the incision and muscle dissection extending from the lower thoracic region to the lateral border of the rectus abdominis muscle. This approach is frequently associated with the subsequent development of an unsightly and uncomfortable relaxation of the ipsilateral abdominal wall, or flank bulge, caused by denervation injury to the intercostal nerves. However, the etiology of this complication is not widely recognized by spine surgeons.