Neurosurgery
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The CO2 laser has a long history in both experimental and clinical neurosurgery. However, its use over the past decade has been limited by its cumbersome design and bulky set-up of the micromanipulator. These limitations are amplified when it is used with the operating microscope. These restrictions are addressed by the Omniguide fiber, which delivers the beam through flexible hollow-core photonic bandgap mirror fibers and allows the laser to be wielded like any other surgical instrument. ⋯ In our early experience, the Omniguide laser was very helpful in selected cases in resecting specific types of lesions without complications; we have added the device to our neurosurgical armamentarium.
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This case series reports an incidence of anomalous vascular anatomy within the cerebellopontine angle. The relevant literature effectively describes techniques for mobilization yet underestimates the incidence. There has been no literature on the use of magnetic resonance imaging (MRI) to preoperatively identify this anatomic variant. ⋯ The presence of this vessel creates the potential for technical difficulty and significant complications. We report the incidence and techniques of mobilization. This variant can potentially be identified on preoperative 3D-FIESTA MRI sequences. Knowledge of this anatomy may guide neurosurgeons in their case preparation.
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Occipitocervical instability with vertical migration of the odontoid is a rare but potentially debilitating anomaly of the craniocervical junction. Anterior decompression by means of a transoral or transcervical approach followed by posterior instrumentation commonly is used to treat this pathology. ⋯ We achieved intraoperative reduction of occipitocervical instability through a purely posterior approach. This technique adds a tool to the armamentarium of techniques used for the treatment of occipitocervical instability.
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The authors have developed a novel intraoperative neuronavigation with 3-dimensional (3D) virtual images, a 3D virtual navigation system, for neuroendoscopic surgery. The present study describes this technique and clinical experience with the system. ⋯ The interactive method of intraoperative visualization influenced the decision-making process during surgery and provided useful assistance in identifying safe approaches for neuroendoscopic surgery. The magnetically guided navigation system enabled navigation of surgical targets in both rigid and flexible endoscopic surgeries.
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This study defines the indications, results, and limits of lateral orbitotomy coupled with resection of the sphenoid wing for removing lateral sphenoid wing meningiomas with intraorbital extension. ⋯ A select group of lateral sphenoid wing meningiomas with tumor extension in the lateral or superolateral compartments of the orbital cavity may be successfully approached and removed through a lateral orbitotomy with resection of the sphenoid wing and without craniotomy. Cases with tumor extension to the anterior clinoid process and superior orbital fissure and those with extension medial to the axis of the optic nerve require a transcranial approach.