World Neurosurg
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The metrics of imaging-to-puncture and imaging-to-reperfusion were recently found to be associated with the clinical outcomes of endovascular thrombectomy for acute ischemic stroke. However, measures for improving workflow within hospitals to achieve better timing results are largely unexplored for endovascular therapy. The aim of this study was to examine our experience with a novel smartphone application developed in house to improve our timing metrics for endovascular treatment. ⋯ The use of smartphone applications may reduce treatment times for endovascular therapy in acute ischemic stroke. Further studies are needed to confirm our findings.
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Disturbances in water and electrolyte homeostasis are common after transsphenoidal surgery. These disorders are variable and unpredictable, increasing patient risk and complicating postsurgical treatment. Clinically, it is generally accepted that damage to the pituitary is the cause, but the mechanisms behind the response variability and underlying pathophysiology remain unknown. ⋯ We postulate that our model provides a plausible mechanistic explanation for some varieties of postsurgical water and electrolyte disturbances, in which increasing damage to the pituitary potentiates the likelihood of a full triphasic response. However, our simulation shows that merely modifying the level of damage does not produce every presentation of water and electrolyte imbalance. This theory suggests that other mechanisms, which are still unclear and not a part of this model, may be responsible for postoperative hyponatremia and require further investigation.
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Residents' lives are hectic-it is hard to find a place and time for training basic and advanced microsurgical skills. Surgical instruments and sutures can be purchased (or loaned from another department), but the most expensive and space-occupying device is the microscope. In developing countries, microscopes are used where they are needed most, in operating rooms. Furthermore, a conventional microscope is not portable. For all of these reasons, the availability of microscopes for training microsurgery is limited. ⋯ CCS is efficient, mobile, and easy to set up. Even though our smartphone-based training was in 2 dimensions, we could improve our microsurgical performance with conventional microscopes, which have 3-dimensional capability. CCS also provides an easy method to record one's microsurgical training. CCS improved both of the subjects' microsurgical performance, making it a good alternative for a traditional microscope.
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Traumatic injuries, degenerative/rheumatologic conditions, tumors, or infections of the upper cervical spine may in certain circumstances require surgical stabilization. C1 lateral mass screws (Harms technique) in combination with C2 instrumentation (pars, pedicle, translaminar screws) have become a mainstay of surgical treatment. The surgical anatomy of the C1 lateral mass can be challenging especially with the robust venous plexus that often causes significant bleeding with exposure of the C1-C2 articular complex. The purpose of this study was to examine whether the use of navigation reduced intraoperative blood loss during atlantoaxial fixation. ⋯ In our series, surgical navigation significantly reduced blood loss compared with non-navigated cases without increasing surgical time or risk of complication. Furthermore, navigation has the potential to reduce operative times due to a reduction in blood loss.
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Degenerative changes in the upper cervical spine may be age related degeneration or a pathological process such as rheumatoid arthritis. However, to our knowledge, the relationship between the apical and alar ligaments and these anomalies has not been discussed. We present anatomical variations of the anterior atlantodental joint observed during cadaveric dissection of adult craniovertebral junctions, the relationship with the alar and apical ligaments and discuss possible origins and clinical implications. ⋯ The possible etiologies and the clinical applications of these craniovertebral anomalies in a geriatric population should be appreciated by the clinician treating patients with disease in this area or interpreting imaging in the region.