Neurosurgery
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Minimally invasive spine surgery (MISS) is among the fastest growing technologies in general neurosurgical practice. In addition, great demand exists to teach these skills to neurosurgery residents. With newly enforced work hour restrictions, opportunities to acquire these skills are limited, necessitating development of alternative strategies of education. We describe a novel simulation model for MISS supplemented by resident self-assessment analysis and evaluation. ⋯ The MISS simulator is a feasible, inexpensive, and reproducible adjunct to neurosurgery resident training and provides a new teaching method for spine surgery. Further investigation of this technology is warranted, although multicenter, randomized, controlled trials assessing its validity may not be practical because of ethical constraints with regard to patient safety.
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Review Case Reports
Surgical management of spinal catheter granulomas: operative nuances and review of the surgical literature.
Spinal catheter granulomas are a rare and, most likely, underreported complication of intrathecal opioid therapy. Such granulomas can be associated with devastating neurological sequelae if not treated in a timely fashion. Most neurosurgeons, however, are unlikely to have had experience in the surgical management of this condition. ⋯ The operative management of spinal intrathecal granulomas associated with opioid infusion pumps can be challenging and depends on a high degree of clinical suspicion, imaging results, and operative findings.
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Multicenter Study
Five-aminolevulinic acid for fluorescence-guided resection of recurrent malignant gliomas: a phase ii study.
To assess the feasibility of 5-aminolevulinic acid (5-ALA) fluorescence guidance for resection of recurrent malignant brain tumors. ⋯ 5-ALA fluorescence has a high predictive value for the detection of tumor in recurrent gliomas. Prior treatment modalities, such as radiation or chemotherapy, do not invalidate the fluorescence guidance with 5-ALA. 5-ALA fluorescence guidance is an effective surgical adjunct in the surgery of recurrent malignant gliomas.
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Review Case Reports
Posterior-only approach for total en bloc spondylectomy for malignant primary spinal neoplasms: anatomic considerations and operative nuances.
MALIGNANT PRIMARY SPINAL tumors are rare tumors that are locally invasive and can metastasize. The majority of these tumors have a poor response rate to chemotherapy and conventional radiotherapy. Studies have shown that long-term survival and the potential for cure is best achieved with en bloc surgical excision of these tumors with negative surgical margins. ⋯ The posterior-only approach offers the advantage of achieving complete tumor excision and circumferential spinal reconstruction in a single setting. In this report, we discuss the operative management of malignant primary vertebral tumors using the posterior-only approach for total en bloc spondylectomy. The oncological considerations and surgical nuances that allow for safe but aggressive surgical excision of primary spinal tumors to achieve favorable oncological and neurological outcomes are highlighted.