World Neurosurg
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Case Reports
Augmented Reality Fluorescence Imaging in Cerebrovascular Surgery: A Single-Center Experience with Thirty-Nine Cases.
Several intraoperative imaging methods exist in cerebrovascular surgery to visualize and analyze the vascular anatomy flow. A new method based on multispectral fluorescence (MFL) imaging of indocyanine green (ICG) video angiography (VA) allows real-time, augmented reality (AR) visualization of blood flow superimposed on white-light microscopic images. We describe our single-center experience using MFL AR in cerebrovascular surgery. ⋯ MFL AR is an easy-to-use adjunct in cerebrovascular surgery and shows a high correlation with intraoperative DSA. No interruption of the surgery is necessary because MFL AR images of the blood flow are superimposed in real time on white-light microscopic images.
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Surgical strategy in vestibular schwannomas may require subtotal resection to preserve neurologic function. Residual tumor growth pattern and contrast enhancement in the immediate postresection period remain uncertain. We sought to evaluate changes in the enhancement pattern and volume of vestibular schwannomas after subtotal resection in the immediate postoperative period. ⋯ Vestibular schwannomas that undergo subtotal resection tend to decrease in size over the first 3 months after resection. Residual tumor volume may fail to enhance on the immediate postresection MRI. Both of these findings could lead surgeons to misinterpret degree of resection after surgery and have implications for clinical decision making and research reporting in the scientific literature for vestibular schwannomas after subtotal resection.
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To directly compare robotic-versus fluoroscopy-guided percutaneous pedicle screw (PPS) placement in thoracolumbar spine trauma with a focus on clinically acceptable pedicle screw accuracy and facet joint violation (FJV). ⋯ There was no significant difference in clinically acceptable screw trajectory accuracy between robotic versus fluoroscopy-guided PPS placement. However, the robot cohort demonstrated a statistically significantly decreased FJV overall and specifically within the thoracic spine region. Use of robotic technology may improve radiographic outcomes for a subset of patients or spine surgeries.
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To analyze the clinical and biomechanical outcome of professional athletes after lumbar total disk replacement, with a focus on restoration of the functional activity. ⋯ Total lumbar disc replacement using M6-L prosthesis in professional athletes made it possible to achieve statistically significant reduction of pain and facilitated early return to normal sports activities. In our opinion, preservation of movement of the operated lumbar segment can help to reduce the mechanical stress with beneficial impact on the rate of degeneration of the adjacent level.
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The fence post technique, which involves insertion of catheters as fence posts around a tumor, has been widely used to demarcate the tumor border for maximal resection of intraparenchymal tumors, such as gliomas. However, a standard procedure for fence post insertion has not been established, and there are some limitations. To overcome this problem, a simple microscopic navigation-guided fence post technique was developed. The feasibility and efficacy of this novel technique during glioma surgery were assessed. ⋯ Clinical experience indicated that the microscopic navigation-guided fence post technique, in which fence posts can be placed without requiring the surgeon to take their eyes off the microscope, is safe and useful in glioma surgery.