World Neurosurg
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Case Reports
Novel bendable ring curette for endoscopic transsphenoidal surgery for pituitary tumors. Technical note.
In transsphenoidal resection of pituitary tumors, even dedicated instruments sometimes cannot readily reach the surgical fields and they interfere with the endoscope and other instruments, making instrumental manipulations difficult and often ineffective. To solve these problems, we invented a bendable ring curette to further improve maneuverability and accessibility. ⋯ Our newly developed bendable ring curette improves maneuverability and accessibility and can be efficiently used as a dissector in the far lateral and frontal sites, compared with the conventional fixed instrument.
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To elucidate the incidence rate of enlargement of vertebral artery dissecting aneurysms (VADAs) during the acute phase and factors associated with enlargement. ⋯ VADAs enlarged by approximately 25% until day 30 after the initial examination. Younger age and the presence of hyperintense intramural signal were significantly associated with VADA enlargement.
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The occipital transtentorial approach (OTA) is a very useful but challenging approach to expose the pineal region because the deep-seated arachnoid membranes usually fold and extend over the great vein of Galen (GVG), leading to dense and poor visibility. In addition, the practical aspects of arachnoid anatomy are not well understood. We aimed to develop a safe surgical procedure for the OTA according to the practical aspects of arachnoid anatomy. ⋯ A 2-layered arachnoid structure interposes the GVG from above and below the tentorium. The arachnoid membrane below the tentorium can be peeled off bluntly from the GVG to the attachment bundle limited by the penetrating veins. This detachment technique is useful for safe enlargement of the surgical field for the OTA.
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The oblique lateral interbody fusion (OLIF) procedure is an important component of the surgeon's armamentarium for the treatment of degenerative spinal conditions. OLIF with posterior spinal fixation frequently is performed and requires additional time because the patient is flipped to a prone position and redraped. We report a series of cases in which robotic-assistance was used for a 2-surgeon workflow in which OLIF and single lateral position posterior spinal fixation were performed at the same time, termed simultaneous robotic single position surgery (SR-SPS). ⋯ We report the first case series describing SR-SPS. Our study shows that this method can reduce operative time while ensuring accurate and timely screw placement with minimal complications.
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The goal of this study was to identify predictors of prolonged operative time (OT) in patients receiving posterior/transforaminal lumbar interbody fusion (P/TLIF) and examine the relationship between prolonged OT and perioperative outcomes in this population. ⋯ The results of this study highlight several factors associated with prolonged OT and underscore its association with poorer perioperative outcomes. These data can be used to risk stratify patients before single-level P/TLIF.