World Neurosurgery 05/2015; 84(1). DOI:10.1016/j.wneu.2015.05.001 · 2.42 Impact Factor
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ABSTRACT: BACKGROUND: Dural arteriovenous fistulas (DAVFs) have traditionally been approached through a bilateral laminectomy procedure with intradural exploration and ligation of the fistulae. A minimally invasive approach for DAVF ligation may be associated with fewer complications and a shorter recovery than the traditional laminectomy procedure. Our objective was to determine the feasibility, safety, and efficacy of intradural DAVF ligation via the use of a minimally invasive microsurgical technique. METHODS: Seven patients with thoracolumbar DAVFs were microsurgically treated with a minimally invasive technique. The procedure entailed localization with the use of fluoroscopy followed by a midline 2.2-cm skin opening. Exposure was facilitated by the use of a tubular retractor. Intradural access was obtained after hemilaminectomy, and the fistula was identified and ligated. Dural closure was facilitated by the use of self-closing nitinol clips. The incidence of postoperative complications, blood loss, and length of hospital stay were reviewed. RESULTS: Each patient tolerated the procedure well. There were no intraoperative or postoperative complications. Specifically, there were no new neurological deficits and no cerebrospinal fluid leaks. Each patient was ambulatory within 18 hours with only mild incisional back pain. Mean length of stay was 1.6 days. One-year follow-up demonstrated obliteration of the fistula with improvement or stabilization of neurological deficits in all cases. CONCLUSIONS: The minimally invasive approach for intradural ligation of DAVFs appears to be a reasonable alternative to bilateral full laminectomies. Although no direct comparison with the more extensive bilateral laminectomy approach has been performed, our initial experience suggests that this novel approach may reduce blood loss and length of hospital stay.
World Neurosurgery 04/2012; 80(6). DOI:10.1016/j.wneu.2012.04.003 · 2.42 Impact Factor
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ABSTRACT: Anterolateral retroperitoneal, retrodiaphragmatic, and/or retropleural (RPDP) approaches have been used to treat a variety of spinal conditions. The traditional extensive thoracoabdominal approach can be modified to focus on the area of pathology. A less invasive "mini-open" anterolateral approach may be associated with fewer complications and shorter recovery than the thoracoabdominal procedure. There are few reports in the literature describing the technique and results of this less invasive approach to thoracolumbar degenerative pathology.
417 spinal fusion cases from a single institution were reviewed from 1999 to 2006, and 23 anterolateral mini-open approaches to degenerative spinal pathology were identified. The mini-open approach entailed a 4-8cm oblique lateral incision with harvesting of a single rib for use in arthrodesis, followed by RPDP access to the lateral spine. A total of 36 levels were fused. These cases were retrospectively reviewed with a minimum of two-year follow-up to determine the feasibility of the approach as well as incidence of complications. In addition, preliminary clinical results were tabulated.
One pseudarthrosis and four minor complications were identified. There were no major complications or deaths. Mean length of hospital stay was 4 days. Blood loss was less than 200cm(3) for all cases. Using modified Odom's criteria, 74% of patients had adequate resolution of their symptoms and rated their outcome as satisfactory, good, or excellent.
Mini-open anterolateral approaches to the thoracolumbar spine are associated with acceptable outcomes with a low complication rate. Although no direct comparison with the more extensive thoracoabdominal approach has been performed, review of the literature suggests that the mini-open approach reduces complications and length of hospital stay.
Clinical neurology and neurosurgery 12/2010; 112(10):853-7. DOI:10.1016/j.clineuro.2010.07.008 · 1.25 Impact Factor