World Neurosurg
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Surgical proficiency is classically acquired through live experience in the operating room. Trainee exposure to cases and complex pathologies is highly variable between training programs.1 Currently, there is no standard for neurosurgical skill assessment for specific operative techniques for trainees. Cadaveric simulation has been used to demonstrate surgical technique and assess resident skill but often presents a significant financial and facility burden.2-4 Three-dimensional (3D) printing is an alternative to cadaveric tissue in providing high-quality representation of surgical anatomy; however, this technology has significant limitations in replicating conductive soft tissue structures for the use of cauterization devices and haptic learning for proper tissue manipulation.5-7 Our team has combined novel synthesis methods of conductive thermoplastic polymerization and 3-dimensional-printed cervical spine models to produce a layered biomimetic simulation that provides cost-effective and anatomically accurate education for neurosurgical trainees (Video 1). ⋯ The consistency of the thermoplastics can be tailored according to the desired soft tissue structures (skin, fat, fascia, muscle) according to the degree of polymerization. This cost-effective simulation was designed to represent the material and biomechanical properties of the cervical spine cortico-cancellous interface, as well as individual soft tissue components with specific anatomic details of muscle tendinous and ligamentous insertion. These features allow for representative start-to-finish surgical simulation that has not yet been made widely available to neurosurgical training programs.
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Internal auditory canal (IAC) lipomas are rare intracranial lesions. Consequently, preoperative imaging is essential in differentiating IAC lipomas from more common tumors such as vestibular schwannomas. The hallmark of lipomas on magnetic resonance imaging (MRI) is hyperintensity on T1-weighted images that suppresses on fat-suppressed sequences and does not enhance with gadolinium administration. ⋯ This case demonstrates the importance of ensuring that both fat-suppressed and non-fat-suppressed T1-weighted pregadolinium images are obtained in the diagnostic process of IAC lesions. It is therefore recommended that imaging centers ensure that such sequences are included in their MRI protocols.
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Case Reports
Microvascular decompression of the trigeminal nerve with petrous sling technique: surgical video.
The retrosigmoid approach for microvascular decompression of the trigeminal nerve (TN) is an established and highly effective technique for the treatment of trigeminal neuralgia due to vascular compression. It is common to place a pledget or other cushion material between the source of vascular compression, typically the superior cerebellar artery (SCA), and the TN after vessel mobilization and decompression. A previous study demonstrated the use of a tentorial sling on the SCA to maintain decompression of the TN, with encouraging results.1 In this video, we demonstrate a novel technique using a Gore-Tex (W. ⋯ Gore & Associates, Newark, Delaware) sling wrapped around the SCA and secured with a vascular clip on the petrous dura to maintain decompression of the TN (Video 1). Informed consent was obtained from the patient. He tolerated the procedure well with excellent pain relief and was discharged on postoperative day 1.
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In ventriculoperitoneal shunt (VPS) placement, distal placement of the peritoneal catheter will typically be performed by a neurosurgeon. More recently, laparoscopic-assisted (LA) placement of the distal peritoneal catheter by general surgeons has become common. The present study examined whether LA placement of a VPS (LAVPS) is associated with a reduced operative time, lower hospital costs, and fewer distal revisions. ⋯ Compared with non-LAVPS, LAVPS was associated with significantly shorter operative times and fewer distal shunt revisions within 30 days. The findings from a subset analysis supported a decrease in total hospital charges. Additional studies are needed; however, these data suggest that LAVPS is a safer, less-expensive alternative to non-LAVPS.
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Case Reports
Tension pneumoventricle after endoscopic transsphenoidal surgery for Rathke cleft cyst.
Tension pneumoventricle is an extremely rare, but treatable, neurosurgical emergency. The prompt and accurate diagnosis of tension pneumoventricle requires vigilance for the detection of clinical signs, which should also be corroborated by the imaging findings. We have reported on the pathophysiology of tension pneumoventricle and its management. ⋯ Tension pneumoventricle is an extremely rare, but life-threatening, complication of TSS. The development of tension pneumoventricle should be kept in mind even when the surgery has proceeded very smoothly. Sellar reconstruction will, theoretically, prevent this extremely rare complication but might increase the recurrence rate of Rathke cleft cysts. The related symptoms and signs should be recognized. Prompt recognition and treatment of this condition can be life-saving, and the long-term outcomes have generally been favorable if the condition has been recognized early.