World Neurosurg
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The aim of this study was to investigate patient clinical features, surgical complications and outcomes, and the prognostic risk factors of surgical treatment of cavernous malformations (CMs) involving the medulla oblongata. ⋯ Surgical treatment of CMs involving the medulla oblongata was challenging, notably, perioperative respiratory dysfunction, with which patients tend to have unfavorable long-term outcomes, especially for elder patients.
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Case Reports
Imaging-Ambiguous Lesions of Meckel's Cave-Utility of Endoscopic Endonasal Transpterygoid Biopsy.
Meckel's cave is a dural-lined cavity in the middle fossa skull base in which lies the Gasserian ganglion, a potential site for tumors and inflammatory lesions. A variety of lesions can be predominantly isolated to Meckel's cave, including extension from head and neck cancers, other malignant tumors, as well as benign lesions. Clinical presentation and imaging findings are often insufficient to establish a diagnosis. Hence, histologic confirmation is required to determine the appropriate treatment strategy. Several surgical approaches have been used to reach this deep-seated area, often with significant morbidity and prolonged recovery. Given advancements in endoscopy and greater facility with the technique, the endoscopic endonasal approach has been used increasingly to reach lesions in the region. ⋯ We explore not only the relevance of this approach in the armamentarium of the modern skull-base surgeon but also its limitations and conclude that the endoscopic endonasal approach provides a safe and relatively direct, minimally invasive corridor to many lesions of Meckel's cave.
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Neuronavigation systems are routinely used during neurosurgical procedures. Currently, new imaging technologies are emerging, such as virtual, augmented, and mixed reality. With mixed-reality devices, the user can analyze and interact with the real environment using virtual objects. The aim of this prospective pilot study was to offer a proof of concept by testing the clinical feasibility and accuracy of a wearable mixed-reality device (Hololens) for preoperative neurosurgical planning. ⋯ This prospective clinical study offers a proof of concept of the clinical feasibility of the Hololens for brain tumor surgery planning in the operating room, with quantitative outcome measures. Further development is needed to improve the accuracy of this wearable mixed-reality device.
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Currently, anterior transdiscal access and posterior interlaminar approach are the main approaches for percutaneous endoscopic cervical discectomy (PECD). To overcome access shortcomings, we previously described a novel anterior endoscopic transcorporeal approach on a migrated cervical disc. We innovatively introduced bone wax into endoscopic surgery to aid hemostasis and facilitate the process of drilling an intracorporeal tunnel. ⋯ The anterior endoscopic transcorporeal approach for PECD is a novel, valuable alternative for the treatment of CIDH. Bone wax could indeed facilitate the operation by guiding the drilling process and instantly controlling the bleeding without obvious interference with bone healing. Long-term follow-up is warranted in further clinical studies.
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This study aimed to investigate the effects of lumbar interbody fusion-induced biomechanical changes on the adjacent segments, especially disc height and segmental lordosis restoration, and to provide more information for proper surgical strategy selection. ⋯ Improved lumbar lordosis is correlated with a lower incidence of ASD, and adequate disc height and segmental lordosis restoration are essential for ASD prevention.