World Neurosurg
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We report our initial experience of real-time intraoperative C-arm computed tomography (C-arm CT: DynaCT)-guided navigation surgery for pituitary tumors. ⋯ The proposed technique of intraoperative visualization in the hybrid operating room can be easy to perform and may be a useful adjunct to conventional transsphenoidal surgery for an improved resection rate and less cavernous sinus and internal carotid artery injury.
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Radiation exposure represents significant risk to both operating room health care workers and their patients. The commonplace surgical implantation of spinal instrumentation often relies on fluoroscopy for guidance and verification. Advances in computerized tomography (CT)-based intraoperative navigation have improved accuracy of screw placement. The objective of this article is to quantify the radiation exposure from fluoroscopic and CT-based intraoperative navigation and to provide guidance in mitigating the exposure to patient and operating room (OR) staff. ⋯ Use of intraoperative CT-based navigation systems results in lower radiation dose to the surgeon compared with fluoroscopic-based methods. There is an increase in the radiation to the patient. In addition, it is necessary to consider and eliminate other perioperative sources of radiation, such as a postoperative CT scan, which are made redundant by this technology.
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To describe percutaneous balloon compression (PBC) of the trigeminal rootlets as treatment for trigeminal neuralgia (TN), including history, operative techniques, outcomes, side effects, and some recent findings increasing the likelihood of a positive outcome. ⋯ Complications and side effects include cardiovascular stress during the procedure, local hemorrhages in the cheek, postoperative sensory disturbance, masseter weakness, infections, and transitory diplopia after surgery. Measures to minimize side effects are proposed. With meticulous technique, PBC is a straightforward, effective, and fast procedure that compares well with other percutaneous therapies for TN.
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Case Reports
Adrenocorticotropic hormone-producing pituitary carcinoma with intracranial metastases.
Pituitary carcinomas are rare and challenging clinical entities. Because of the paucity of cases, there is limited information in the literature on how best to diagnose and treat pituitary carcinomas. ⋯ Pituitary carcinomas are rare, may present many years after diagnosis of a primary pituitary adenoma, and should be suspected in patients with persistent or recurrent disease. Reliable histopathologic ways to distinguish between carcinoma and adenoma are difficult because the features of hypercellularity, nuclear pleomorphism, and mitotic figures are not always helpful.
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Motor palsy is a serious complication that can result from cervical surgery. We introduced cases of motor palsy after posterior cervical foraminotomy (PCF) and consider cervical anatomy. ⋯ Although PCF is a good alternative treatment with minimal morbidity for cervical radiculopathy, surgeons should keep in mind the possibility of motor palsy, especially at C4-5.