World Neurosurg
-
Case Reports
3D, HD exoscopic Anterior Cervical Discectomy and Fusion: a valid alternative to microscope-assisted surgery.
Anterior cervical discectomy and fusion (ACDF) remains one of the most commonly taught procedures during residency and one of the most frequently performed by neurosurgeons. Neurosurgeons use microscopes to perform surgery and to train other surgeons. Although the microscope provides excellent illumination and magnification, its use will be limited to 2 people: the surgeon and the assistant. Consequently, the scrub nurse and residents watching 2-dimensional images on monitors will have a reduced perception of the surgical field depth and anatomical details. The exoscope has been introduced as an alternative to microscopes and endoscopes. We used a 3-dimensional (3D), high-definition exoscope (3D Vitom [Karl Storz, Tuttlingen, Germany]) in 2 patients undergoing 2-level ACDF for cervical myeloradiculopathy. ⋯ We believe that exoscope-assisted surgery could become a safe and effective alternative to microscope-assisted surgery in ACDF.
-
Interleaving stimulation (ILS) is a stimulation strategy that can help the physician manage more challenging cases of patients with deep brain stimulation (DBS) for Parkinson disease (PD). It consists of altering 2 different programs on the electrode with the same frequency. ⋯ Overall, ILS is useful 1) to use 2 contacts that optimally improve 2 specific symptoms but have different therapeutic windows; 2) to avoid side effects related to current spreading to nearby areas; 3) to increase frequency in a small region; or 4) to stimulate a larger target area.
-
The anterior skull base (ASB) remains one of the greatest challenges for reconstructive surgeons. The current armamentarium includes endoscopic placement of free grafts, endonasal vascularized pedicled flaps, regional flaps, and microvascular free flaps. As the defect size increases, reconstruction complexity increases along with potential complications. Here, we report an endoscopic-assisted paramedian forehead flap, a novel adaptation of an age-old technique, for ASB reconstruction. ⋯ The endoscopic-assisted paramedian forehead flap is a robust regional flap whose advantages include the utilization of muscle, low donor morbidity, and endoscopic placement with avoidance of craniotomies. Therefore it should be considered an important option for ASB reconstruction of recalcitrant CSF leaks when all other options are unavailable.
-
The development of endovascular techniques has offered extraordinary therapeutic opportunities to treat intracranial aneurysms. However, mainly for anterior circulation aneurysms, no clear superiority of these techniques compared with microsurgical clipping has been shown in terms of morbidity, mortality, aneurysm occlusion rate, and long-term protection from recanalization and rebleeding. We reviewed the data from a retrospective case series to determine the clinical and radiological outcomes of clipped ruptured and unruptured aneurysm to analyze the relationship between increasing surgical experience and operative time, recovery time, and clinical outcomes. ⋯ In a subset of patients (aneurysm located in the anterior circulation and <12 mm), microsurgical clipping appeared to be as safe as endovascular treatment and can obtain a very high complete occlusion rate. Increasing surgical experience improved the operative time and recovery time, with a trend toward improvement of the clinical outcomes.
-
Analysis of safety and effectiveness of stent angioplasty for failure of thrombectomy in patients with acute intracranial atherosclerotic occlusion. ⋯ When thrombectomy in patients with acute intracranial atherosclerotic occlusion fails, stent angioplasty is safe and effective; however, short-term stent reocclusion after surgery cannot be ignored. Because of the small sample size, larger multicenter clinical studies are needed to confirm this result.