Neurosurgery
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Multiple methods for minimally invasive (MIS) thoracic and lumbar pedicle screw placement exist. The guide wire is almost universally used for most insertion techniques; however, its use is not without complication and potentially prolongs surgical procedures. ⋯ MIS, minimally invasive spineTP, transverse process.
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Skull reconstruction can be challenging due to the complex 3-dimensional shape of some structures, such as the orbital walls, and for cases involving a large cranial vault. In such situations, computer-assisted design and modeling of prostheses is especially helpful to achieve an adequate reconstruction. Simultaneous tumor resection and skull defect reconstruction are also challenging because the preoperative imaging does not display the anticipated defect. Currently, sophisticated methods based on physical prototypes and templates are required to enable simultaneous resection and reconstruction techniques. ⋯ ROI, region of interest.
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Retrochiasmatic, retroinfundibular craniopharyngiomas are surgically challenging tumors. Anterolateral, posterolateral, and endoscopic endonasal approaches represent the most commonly used techniques to access these tumors, but all require an extensive exposure time, and each has its own risks and limitations. The subtemporal approach is a well-known neurosurgical approach that is rarely described for craniopharyngiomas. ⋯ DCL, dorsal clival line.
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As magnetic resonance-guided laser-induced thermal therapy (MRgLITT) becomes more accepted, there needs to be an evaluation of the techniques required to achieve accurate laser placement. ⋯ ANOVA, analysis of varianceMRgLITT, magnetic resonance-guided laser-induced thermal therapyPAD, precision aiming deviceRE, radial errorRegE, registration errorSPGR, spoiled gradient echoTAE, target alignment errorTL, trajectory length.
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Surgical wounds after craniotomy heal with primary closure in most cases; however, significant comorbidities, multiple procedures, and history of tumor increase the risk of wound breakdown. Craniotomy wounds often require sophisticated coverage by a plastic surgeon using regional or microvascular flaps to address exposed intracranial contents. Unfortunately, timely treatment of craniotomy wounds may be difficult as a result of limitations of plastic surgery consultation, specialized operating room staffing, and operating room time. Infected wounds may need serial debridement and antibiotic therapy before definitive closure, and patients with dehisced or infected craniotomy wounds may need medical and nutritional optimization. ⋯ DRT, dermal regeneration template.