Neurosurgery
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Comparative Study Clinical Trial
Single-stage thoracolumbar vertebrectomy with circumferential reconstruction and arthrodesis: surgical technique and results in 15 patients.
Circumferential reconstruction and arthrodesis can be necessary after thoracolumbar vertebrectomy. The authors describe a technique for single-stage thoracolumbar vertebrectomy with circumferential reconstruction and arthrodesis. The surgical results using this technique are reviewed. ⋯ The authors present a method for thoracolumbar vertebrectomy, circumferential reconstruction, and arthrodesis performed in a single stage, solely via a posterior approach. This is an alternative to anterior (i.e., thoracoabdominal and retroperitoneal) and lateral (i.e., lateral extracavitary) approaches that can be used for circumferential reconstruction and arthrodesis. Potential advantages and pitfalls are discussed.
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Case Reports
Video-assisted thoracoscopic dissection of the brachial plexus: cadaveric study and illustrative case.
Standard surgical approaches to the brachial plexus require an open operative technique with extensive soft tissue dissection. A transthoracic endoscopic approach using video-assisted thoracoscopic surgery (VATS) was studied as an alternative direct operative corridor to the proximal inferior brachial plexus. ⋯ VATS provided an alternative surgical corridor to the proximal inferior brachial plexus and obviated the need for the extensive soft tissue dissection associated with the anterior supraclavicular and posterior subscapular approaches.
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Comparative Study
Efficacy of postural reduction in osteoporotic vertebral compression fractures followed by percutaneous vertebroplasty.
Vertebroplasty in the symptomatic osteoporotic vertebral fracture has become increasingly popular. However, there have been some limitations in restoring the height of the collapsed vertebrae and in preventing the leaking of cement. In the severely collapsed vertebrae of more than two thirds of their original height, vertebroplasty is regarded as a contraindication. We tried postural reduction using a soft pillow under the compressed level. This study was undertaken to investigate the effectiveness of the combination of postural reduction and vertebroplasty for re-expansion and stabilization of the osteoporotic vertebral fractures. ⋯ This new method of vertebroplasty leads to significant restoration of height and correction of kyphosis. The re-expansion was closely related with onset duration. In cases of severely collapsed vertebrae which is able to be re-expanded by postural reduction, vertebroplasty could be applied safely.
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Case Reports
two-stage operation for resection of spinal cord astrocytomas: technical case report of three cases.
Surgery for excision of intramedullary spinal cord tumors without increasing neurological deficit is one of the more difficult operations in spinal surgery. In particular, infiltrating astrocytomas without a clear cleavage between the tumor and normal spinal cord parenchyma are difficult to remove totally without producing additional neurological impairment. In this study, we describe a two-stage resection facilitating total resection of intramedullary tumors. ⋯ A two-stage operation may enhance the surgeon's ability to completely resect extensive low-grade spinal cord astrocytomas and, at the same time preserve neurological function.
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The combination of classic neuronavigation and intraoperative ultrasound is a recent innovation in image guidance technology. However, this technique requires two hardware components (neuronavigation and an ultrasound system). It was the aim of the study to describe a new simplified technology of a so-called one-platform navigation system developed by our institution in collaboration with the industry and to demonstrate its range of various applications. ⋯ The integration of an ultrasound device into an existing navigation system has been successfully developed. The system offers a friendly user interface and cost-effective intraoperative imaging feedback. Although brain shift can be visualized by an image overlay technology as demonstrated by the present system, future developments should aim at fusion techniques of both intra- and preoperative image data sets.