World Neurosurg
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Chronic midline low back pain is the number one reason for disability in the United States despite the prolific use of medical and surgical interventions. Notwithstanding the widespread use of epidural spinal cord stimulators (SCSs), there remains a large portion of the population with inadequate pain control thought to be because of the limited volume of stimulated neural tissue. Intradural SCSs represent an underexplored alternative strategy with the potential to improve selectivity, power efficiency, and efficacy. We studied and carried out development of an intradural form of an SCS. Herein we present the findings of in vivo testing of a prototype intradural SCS in a porcine model. ⋯ Chronically implanted intradural device in the porcine model demonstrated safety and feasibility for translation into humans.
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Many medical students find neurosurgery interesting, but few pursue it as a career. Reasons for this mismatch include lack of exposure and poor perceptions of its career demands, work-life balance, personalities, and patient outcomes. It is imperative to recruit promising students early in medical school to build a pipeline of future neurosurgeons. We aimed to recruit medical students to neurosurgery and improve perceptions of the field by hosting an optional cadaver laboratory event (Neuroanatomy Lab Initiative [NLI]) during first-year students' gross anatomy course. ⋯ An NLI during first-year medical students' anatomy course was an effective, relatively low-resource means of engaging students and improving their perceptions of neurosurgery. We provide a framework for scaling this initiative to other institutions to help recruit the next generation of neurosurgeons.
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To examine the preoperative patients with cervical spondylotic myelopathy (CSM): (1) whether cervical sagittal parameters are related to the progress of patients with CSM, and (2) whether cervical sagittal parameters can predict disease progression or prognosis in patients with CSM. ⋯ In preoperative patients with CSM, the larger CCI-CC is the only independent risk factor for the NDI increase. When the patient has a C2-C7 Cobb angle (F) > 29°, the patient's condition progresses slowly.
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Percutaneous transforaminal endoscopic diskectomy has been a major treatment for lumbar disk herniation. However, damage to exiting nerve roots is one of the most severe complications in this surgery. In this paper, the relationship of the exiting nerve root and the superior articular process in Kambin's triangle of the lumbar intervertebral foramen was assessed using cadavers and computed tomography (CT) imaging. ⋯ The bone-nerve space between the exiting nerve root and the superior articular process in Kambin's triangle of the lumbar intervertebral foramen was exceedingly narrow. It is necessary to perform a foraminoplasty to enlarge the working space and decrease the possibility of injury to the exiting nerve root.
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Surgical approaches to pineal lesions present a challenge because of limited visibility and maneuverability within the posterior fossa. The supracerebellar infratentorial (SCIT) technique has emerged as an approach to pineal lesions. We aim to demonstrate the efficacy of the endoscopic SCIT technique through a case series conducted at our institution and highlight the advantages of the endoscopic technique over the microscopic alternative. ⋯ The purely endoscopic SCIT approach is a safe and effective approach for deep-seated pineal lesions. This approach allows for visibility and maneuverability around the lesion and facilitates high rates of GTR.