World Neurosurg
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In the present study, we investigated the role of intraoperative neuromonitoring (IONM) in internal carotid artery (ICA) injury during endoscopic endonasal skull base surgery (EESBS). ⋯ SSEP and EEG monitoring can accurately detect cerebral hypoperfusion and provide real-time feedback during surgery. SSEP and EEG changes predicted for neurologic outcomes and guide surgical decisions regarding the preservation or sacrifice of the ICA. Comprehensive multimodality monitoring according to the surgical risks can serve to detect and guide the management of ICA injury in EESBS.
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Cessation of elective procedures and lower bed capacity during the COVID-19 pandemic have led to a rise in the waiting lists for surgery, but it is unclear if workload has recovered sufficiently to account for this backlog. We describe the change in neurosurgical workload at a tertiary neurosciences center in the United Kingdom after the first pandemic wave in comparison with the months before and during the first wave. ⋯ In the aftermath of COVID-19, higher referral volumes and operative procedures were apparent in the post-wave months as services returned to normal. With the expectation of a second wave of infections, it is unclear whether this will be sustainable.
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This video describes an awake robotic minimally invasive transforaminal lumbar interbody fusion (TLIF). Minimally invasive spine surgery leads to reduced perioperative morbidity while accelerating recovery by limiting soft tissue damage, blood loss, and postoperative pain. Robotic guidance systems have recently emerged to increase accuracy of instrumentation placement, reduce radiation burden, and enhance surgical ergonomics. ⋯ Given that the patient failed conservative measures, and considering that she had severe nausea and delirium after general anesthesia, she was offered an awake L4-5 robotic TLIF using the Mazor X robotic guidance system (Medtronic, Minneapolis, Minnesota, USA) (Video 1). We document the first awake robotic TLIF in the literature. This video describes how to efficiently insert robotic techniques into the awake spine workflow.1,2.
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Ossified posterior longitudinal ligament (OPLL) of the cervical spine can lead to spinal stenosis and become clinically symptomatic. The optimal approach in addressing OPLL is a debated topic and dependent on factors such as preoperative lordosis and levels affected. ⋯ All 3 approaches in the management of OPLL were associated with clinical improvement without 1 approach surpassing the others. Laminoplasty had the advantage of addressing more levels of stenosis than the anterior approach and was associated with a shorter operating time. Laminoplasty patients had a shorter hospital stay than those undergoing laminectomy and instrumentation and appeared to have fewer complications than the other approaches. Laminoplasty is the preferred approach in patients with preserved motion and lordosis, with the anterior approach effective in the correction of kyphosis.