Neurosurgery
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Hydrocephalus after Gamma Knife® stereotactic radiosurgery (SRS) for vestibular schwannomas is a rare but manageable occurrence. Most series report post-SRS communicating hydrocephalus in about 1% of patients, thought to be related to a release of proteinaceous substances into the cerebrospinal fluid. While larger tumor size and older patient age have been associated with post-SRS hydrocephalus, the influence of baseline ventricular anatomy on hydrocephalus risk remains poorly defined. ⋯ Patients with vestibular schwannoma with higher baseline EI, larger tumor volumes, and fourth ventricle deformation are at increased odds of developing post-SRS hydrocephalus. These patients should be counseled regarding risk of hydrocephalus and carefully monitored after SRS.
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Image guidance has transformed minimally invasive spine surgery (MISS), allowing for safer procedures without excessive bony exposure and reducing radiation exposure for the surgical team. Robotic platforms have enhanced the benefits of navigation by providing high precision and accuracy. Here we describe a case series to demonstrate the accuracy and low complication rates of real-time image-guided robotic-assisted (RA) MISS at a tertiary referral center. In addition, we performed a narrative review on how robotics and navigation facilitate MISS. ⋯ Robotic platforms have further enhanced navigation benefits by providing high precision and accuracy, with low complication rates.
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Review
Beyond Pedicle Screw Placement: Future Minimally Invasive Applications of Robotics in Spine Surgery.
Advancements in spine surgery have dramatically enhanced minimally invasive techniques, prominently through integrating robotic systems. Although pedicle screw placement remains the most widespread application of this technology, new developments are emerging to create innovative future avenues for these tools. ⋯ We also discuss the potential for integrating artificial intelligence and augmented reality with robotic systems. If the current trajectory of research and innovation continues, there is promise in creating fully autonomous robotic systems that can revolutionize spine surgery by processing, planning, and performing procedures without heavy reliance on the surgeon.
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Single-position prone transpsoas (PTP) lateral interbody fusion has been proposed as an alternative to lateral lumbar interbody fusion performed in the lateral decubitus position. The advantages to this single-position technique include facilitating segmental lordosis, obviating the need for repositioning for posterior instrumentation, and providing access for posterior decompression. ⋯ This review provides a detailed technical description of the PTP technique at L4-L5. In addition, we provide technical pearls aimed at improving surgical ergonomics, workflow, and safety.
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Minimally invasive surgery (MIS) has significantly revolutionized spine surgery by reducing morbidity, minimizing tissue damage, and improving postoperative outcomes compared with traditional open surgeries. Although MIS is well-documented for degenerative spine diseases, its full scope and limitations in spine trauma remains underexplored. Thus, this review aims to address this gap by examining relevant literature on the evolution, current practices, and future directions of MIS applications in spinal trauma care. ⋯ Based on a literature review of 85 studies, the following manuscript focuses on the indications, complications, current literature, clinical outcomes, future directions, and limitations of MIS in managing thoracolumbar and cervical spine injuries with particular emphasis on percutaneous pedicle screw fixation, lateral thoracic and lumbar corpectomies, anterior thoracoscopic/endoscopic approaches, and treatment algorithms. Although MIS for spinal trauma offers numerous advantages, continuous research and data collection are crucial to developing clear treatment algorithms and improving clinical outcomes. However, the future of MIS in spine trauma care remains promising, with advancements in technology and surgical techniques anticipated to enhance safety, efficacy, and patient satisfaction.