Neurosurgery
-
Increased frameless stereotactic accuracy with high-field intraoperative magnetic resonance imaging.
Frameless stereotaxy commonly registers preoperative magnetic resonance imaging (MRI) to patients by using surface scalp anatomy or adhesive fiducial scalp markers. Patients' scalps may shift slightly between preoperative imaging and final surgical positioning with pinion placement, introducing error. This might be reduced when frameless stereotaxy is performed in a high-field intraoperative MRI (iMRI), as patients are positioned before imaging. This could potentially improve accuracy. ⋯ Frameless stereotactic accuracy is increased by using high-field iMRI compared with standard preoperative imaging.
-
Although rare, recalcitrant cerebrospinal fluid (CSF) leak after skull base tumor resection or major head trauma is a difficult therapeutic challenge, often complicated by lack of local vascularized tissue in a scarred, radiated field. Craniotomy with a free tissue transfer has been described for CSF leak repair from these complicated skull base defects. ⋯ RFFF, radial forearm free flap.
-
During external ventricular drainage (EVD) weaning, cranial computed tomography (cCT) is necessary to evaluate ventricle width. Because intrahospital transfer of critically ill patients is associated with higher mortality, bedside techniques are necessary to evaluate ventricle width. Transcranial sonography is able to show the ventricles in patients with sufficient temporal acoustic window. Contrast-enhanced ultrasound (CEUS) is able to overcome the limitations of insufficient insonation. ⋯ CEUS ventriculography is an effective bedside procedure in critically ill patients with EVD. CEUS allows measurement of ventricle width, ventricle communication, and CSF transfer to the subarachnoidal space through the cisternal foramina.
-
The middle clinoid is an osseous prominence that arises from the body of the sphenoid bone at the anterolateral margin of the sella. ⋯ Recognition of the middle clinoid and caroticoclinoidal ring on preoperative imaging is critical for surgical planning and middle clinoid removal in endonasal skull base surgery.
-
The endoscopic endonasal approach (EEA) has developed as an emerging surgical corridor to the craniovertebral junction (CVJ). In addition to understanding its indications and surgical anatomy, the ability to predict its inferior limit is vital for optimal surgical planning. ⋯ The novel NAxL more accurately predicts the inferior limit of the EEA than the NPL. This method, which can be easily used on preoperative sagittal scans, accounts for variations in patients' anatomy and can aid surgeons in the assessment of the EEA to address caudal CVJ pathology.