World Neurosurg
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Comparative Study
A comparison of visual rating scales and simulated virtual reality metrics in neurosurgical training: a generalizability theory study.
Adequate assessment and feedback remains a cornerstone of psychomotor skills acquisition, particularly within neurosurgery where the consequence of adverse operative events is significant. However, a critical appraisal of the reliability of visual rating scales in neurosurgery is lacking. Therefore, we sought to design a study to compare visual rating scales with simulated metrics in a neurosurgical virtual reality task. ⋯ To our knowledge, this is the first study comparing participant's ratings with simulated performance. Given rating scales capture less well instrument force, quantity of brain volume removed, and blood loss, we suggest adopting a hybrid educational approach using visual rating scales in an operative environment, supplemented by simulated sessions to uncover potentially problematic surgical technique.
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Vascular loop compression remains the most accepted theory for trigeminal neuralgia (TN). Apart from the normal adjoining vascular loops, certain unusual vascular loops incriminated in TN such as vertebrobasilar dolichoectasia and pure venous compressions do not truly fit into the traditional classification. Moreover, vascular diseases such as cavernoma and aneurysms causing TN are considered as secondary TNs. There is a lack of unified classification for TN with underlying vascular offenders, otherwise amenable to microvascular decompression. ⋯ Unusual vascular offenders in TN do constitute a significant population. They differ from the usual group with respect to the type of pain, gender, and side of involvement and tend to have more complications with similar pain outcomes after microvascular decompression.
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Proximal anterior cerebral artery (A1) aneurysms are difficult to clip because of their frequent proximity to perforators, location behind the parent artery, or adherence to surrounding structures. ⋯ A1 aneurysms are rare but have their own complex characteristics and are difficult to treat. Meticulous analysis of the relevant angiographs is needed for their diagnosis. An important consideration in surgery is the preservation of perforators and prevention of rupture. Wide opening of the sylvian fissure and temporary control of the parent artery can facilitate dissection of the A1 aneurysms dome. Multiple intraoperative monitoring methods, such as microvascular Doppler ultrasonography and somatosensory and motor evoked potential monitoring, can reduce the relevant complications of surgery.
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To explore the feasibility and effectiveness of C1 lateral mass fixation via the posterior arch using pedicle screws of 3.5-mm diameter in patients whose atlas in the vertebral artery groove (C1 pedicle) was ≤3.5 mm in height. ⋯ Pedicle screws of 3.5-mm diameter could be fixed with a high success rate using the viscoelasticity and expansivity of the bone tissue even if the atlas pedicles were ≤3.5 mm in height. Although the screws had a certain probability of breaking the superior/inferior wall, they provided sufficient stability and enabled fracture or bone graft healing. Extraverted atlas pedicle screws should be considered in some cases.
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To analyze the correlation between C2 incidence (C2I) and cervical and thoracolumbar sagittal parameters and determine the effectiveness of C2I for evaluating global spinopelvic sagittal alignment. ⋯ C2I was significantly correlated with both cervical and thoracolumbar sagittal parameters, and different sagittal alignment patterns were presented regarding the amount of C2I. As the geometric summation from the pelvis to C2 vertebra, C2I would be a beneficial clue to connect correlation chains of spinal sagittal alignment.