Eponyms in Vascular Neurosurgery: Comprehensive Review of 18 Veins

Posterior epidural migration of thoracic and lumbar disc material: a comprehensive 63-year systematic review with anatomical perspectives

This study aims to thoroughly investigate the clinical presentation, duration of symptoms, radiological aspects of posterior epidural migration of disc fragments (PEMDF), and assess various treatment options and their impacts on patient functionality. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We conducted a comprehensive search in PubMed, Web of Science, and Scopus from inception to March 2024. Patient demographic and clinical outcomes data were extracted from articles that met the inclusion criteria. The extracted data included patients' age, sex, duration of symptoms (months), clinical presentation, diagnostic imaging, PEMDF spinal level, surgical technique used, and functional outcome and clinical improvement with follow-up (months). The primary outcomes of interest were total recovery (complete resolution of neurological deficits), partial recovery (clinical improvement with residual neurologic deficits), stable status (no change from the patient's baseline), and worst outcome (new symptoms or neurological deficits appearing post-surgical treatment). This review examined 105 studies on the pathology of posterior epidural migration of disc fragments, including 29 case series and the remainder as case reports, involving a total of 175 patients. The median age of the cohort was 54 years (range, 19-95), with 75.61% male and 24.39% female. Symptoms lasted a median of 0.5 months (range, 0.1-120 months), with cauda equina syndrome (45.7%) as the most common presenting symptom, followed by radiculopathy (34.3%) and lower back pain (21.1%). A history of heavy lifting was reported in 10.7% of patients. In terms of treatment, 5 patients (2.9%) were managed conservatively, while 162 (92.6%) underwent laminectomy. Additional interventions included minimally invasive interlaminar surgery (3 patients, 1.7%), transforaminal lumbar interbody fusion (2 patients, 1.1%), interlaminar lumbar interbody fusion (1 patient, 0.6%), and endoscopic spine surgery (2 patients, 1.1%). Functional outcomes showed symptomatic improvement in 173 patients (98.9%), with one patient remaining stable and one experiencing worsening symptoms. Partial recovery occurred in 42 patients (24%), while 131 patients (74.9%) achieved total recovery. Our study highlights the rarity and diagnostic complexity of posterior epidural migration of disc fragments. Prompt and precise diagnosis is crucial to prevent further neurological decline. Surgical intervention to remove sequestered disc fragments has demonstrated excellent functional and clinical outcomes.

The neurosurgeon's familiarity with the vein of Rolando

The vein of Rolando, also known as the central sulcal vein, is a critical superficial cerebral vein located in the central sulcus, playing a pivotal role in the venous drainage of the motor and sensory cortices. Named after the Italian anatomist Luigi Rolando, this vein serves as a crucial anatomical landmark in neurosurgery, guiding surgeons to approach critical brain structures with minimal damage. This article explores the anatomy and clinical significance of the vein of Rolando, emphasizing its role in neurosurgery and neuroimaging. Advanced imaging techniques such as functional MRI (fMRI), Magnetic Resonance Venography (MRV), and CT Angiography have enhanced the ability to diagnose and preserve this vein, reducing surgical risks. The article also discusses the interconnectedness of the vein of Rolando with other cerebral veins like the vein of Trolard and underscores the importance of understanding venous variations and drainage patterns for successful surgical outcomes. Preventive measures to protect the vein during neurosurgery are essential to prevent complications such as venous congestion and intracranial pressure. This overview highlights the necessity for precise anatomical knowledge and advanced diagnostic tools in optimizing neurosurgical procedures and patient care.

Sphenoparietal Sinus Dural Arteriovenous Fistulas: A Series of 10 Patients

BACKGROUND

Dural arteriovenous fistulas (DAVFs) of the sphenoparietal sinus or sphenoid wing region are uncommon lesions with unique and interesting angioarchitecture. Understanding appropriate anatomy and recognizing patterns provide important treatment implications.

OBJECTIVE

To describe a single surgeon's experience with open surgical treatment of sphenoparietal sinus DAVFs, the surgical indications for this uncommon lesion, and the microsurgical techniques related to its treatment and to review the literature on its surgical treatment.

METHODS

Consecutive cases of sphenoparietal sinus DAVF treatment conducted by a single surgeon over 24 years (1997-2020) were retrospectively reviewed. Published reports of similar cases were reviewed.

RESULTS

Of 202 surgically treated DAVFs, 10 lesions in 10 patients were sphenoparietal sinus DAVFs. Four patients presented with intracranial hemorrhage, 3 with headache, and 2 with pulsatile tinnitus; 1 patient was incidentally identified as having a DAVF during treatment for a ruptured aneurysm. Most patients (7 of 10) had undergone endovascular embolization previously. Nine patients had Borden type III DAVFs and one had a Borden type II fistula. Surgery in all 10 patients resulted in angiographically confirmed fistula obliteration. Clinical outcomes at the last follow-up, measured by a modified Rankin Scale (mRS) score, were excellent in 6 patients (mRS ≤ 2) and poor in 1 patient (mRS ≥ 3); late outcomes were not available for 3 patients.

CONCLUSION

Sphenoparietal sinus DAVFs are an uncommon anatomic subtype. Careful attention to angiographic detail leads to identification of the site of venous interruption and results in a high rate of surgical cure with excellent clinical outcomes.