World Neurosurg
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Keeping the operating field clean and visible is an important technique in neurosurgery. Continuous irrigation-suction (IS) of the surgical field is currently often done using devices available that are expensive and demand technical proficiency. We report a simple method of continuous IS using a widely available central venous catheter and a controlled suction cannula. ⋯ The proposed IS system could be surgeon friendly, easily manageable, yet cost-effective and efficient.
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Tandem occlusion resulting in acute ischemic stroke is associated with high morbidity and mortality and a poor response to thrombolytic therapy. The use of endovascular strategies for tandem stroke cases results in an improved outcome for this subgroup of patients. We present 2 cases with a pattern of tandem occlusion consisting of proximal obstruction at the origin of the common carotid artery (CCA) with concomitant intracranial occlusion treated by endovascular techniques. ⋯ An anterograde transfemoral approach should be considered in cases of tandem occlusion of the proximal CCA and middle cerebral artery.
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Case Reports
Intraoperative loss of tibialis anterior tceMEP predicted postoperative foot drop: A case report.
Footdrop secondary to L5 root injury is a rare complication associated with lumbar surgery. It is unclear whether intraoperative neuromonitoring can detect such an injury. ⋯ Intraoperative TA tceMEPs could detect L5 root iatrogenic injury.
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Spondylodiscitis still remains a serious problem, especially in immunocompromised patients. Surgery is necessary when nonsurgical treatment is unsuccessful. Although minimally invasive spine stabilization (MISt) with percutaneous pedicle screws is less invasive, percutaneous sacropelvic fixation techniques are not common practice. Here, we describe 2 cases in which spondylodiscitis in the lumbosacral spine was treated with percutaneous stabilization using an S2 alar-iliac (S2AI) screw technique. ⋯ MISt with percutaneous S2AI screws was less invasive and efficacious for lumbosacral spondylodiscitis in providing rigid percutaneous sacropelvic fixation.
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Case Reports
Frameless Stereotactic Robot-Assisted Subthalamic Nucleus Deep Brain Stimulation: Case Report.
Electrode implantation for deep brain stimulation (DBS) can be performed in numerous ways, but the current "gold standard" is the use of frame-based systems for accuracy. Robotic stereotactic procedures, however, have gained increased interest because of their ease of use and reliability, but there could be concern about their safety in the United States as the result of recent lawsuits (e.g., the da Vinci Surgical System). We report the first DBS implantation performed using a robot (ROSA robotic device) approved by Food and Drug Administration for use in North America. ⋯ The advantages of robotic assistance in stereotactic procedures are as follows: 1) improved accuracy, 2) "arc-less" approach, and 3) minor adjustments can be made in multiple planes to the entry point without adjustment of a frame. The case demonstrates robotic stereotactic assistance viability as an alternative to traditional frame-based or frameless systems in U.S. hospitals.