World Neurosurg
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Neuronavigation procedures demand high precision and accuracy. Despite this need, there are still few studies analyzing errors in such procedures. The aim of this study was to use a custom-built cranial phantom to measure target position and orientation errors in different phases of a simulated neuronavigation procedure. ⋯ After a stepwise analysis, registration and mechanical execution were the main contributors to the global position error.
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Randomized Controlled Trial
The utility of diagnostic transforaminal epidural injection in selective percutaneous endoscopic lumbar discectomy for multi-level disc herniation with mono-radicular symptom: a prospective randomized control study.
The aim of this study was to analyze the clinical outcomes of diagnostic transforaminal epidural injection (DTEI) in selective percutaneous endoscopic lumbar discectomy for multilevel disc herniation with monoradicular symptom. ⋯ DTEI can improve the clinical outcomes of selective percutaneous endoscopic lumbar discectomy for multilevel disc herniation with monoradicular symptom, through improving the accuracy of confirmation of responsible level.
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Case Reports
Percutaneous endoscopic C2-C3 medial branches neurotomy for cervicogenic headache: a case report.
Cervicogenic headache (CEH) is characterized by unilateral posterior head and neck pain originating from cervical structures and may be improved or resolved by successful treatment of the causative cervical disorder or lesion. Cervical medial branch radiofrequency (RF) lesion therapy is effective in some CEH patients with no significant pathologic abnormalities that can be surgically corrected. However, patients with refractory CEH are often encountered clinically. ⋯ For patients with refractory CEH who failed medial branch RF lesion, which could be relieved briefly by diagnostic medial branch injection, percutaneous endoscopic C2-C3 medial branches neurotomy may alleviate their pain under the premise of full informed consent, accurate localization, careful intraoperative exploration, and stimulation testing.
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Confirming the exact location of a fistula and the origins of draining veins during surgery for dural and perimedullary arteriovenous fistulas (AVFs) is crucial but sometimes inadequately performed, which can result in incomplete elimination of the lesion. Intraoperative digital subtraction angiography (DSA) is the gold standard for confirming the hemodynamics of an AVF; however, it cannot reveal the location of an AVF in the operative field. In this study, the efficacy of intraoperative intraarterial fluorescence video angiography during surgery for craniocervical junction dural and perimedullary AVFs was investigated. ⋯ Intraarterial fluorescence video angiography, particularly frame-by-frame review, enables surgeons to distinguish the flow dynamics of AVFs and contributes to the planning of effective surgical strategies for optimal results.
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We investigated the outcomes of patients with an unruptured intracranial aneurysm (UIA) and >2 risk factors concerning complications, obliteration rate, and other factors after surgical or endovascular treatment. ⋯ In our study, clipping and coiling showed advantages for the treatment of UIAs with multiple risk factors. Surgical clipping of UIAs is achievable with a low rate of unfavorable outcomes and a high rate of complete obliteration for patients with multiple risk factors. However, endovascular treatment was also successful, with a shorter length of stay and low procedure-related morbidity. Additional randomized evidence are required to support the superior efficacy of clipping.