World Neurosurg
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Case Reports
Resection of a Thoracic Intramedullary Breast Metastasis Through the Dorsal Root Entry Zone: 2-D Operative Video.
Intramedullary spinal cord metastases (ISCMs) are rare, representing 8.5% of central nervous system metastases and 5% of intramedullary lesions.1 With the advent of immunotherapy leading to longer-term survival for cancer patients, intramedullary metastases are on the rise.2 A 43-year-old female presented with acute right leg weakness and sensory loss (Video 1). Magnetic resonance imaging revealed an avidly enhancing mass in the spinal cord at T6 with associated edema. Surgical resection was performed for tumor debulking to stabilize and ideally improve neurologic function, as well as for tissue acquisition for molecular profiling and targeted therapy. ⋯ We strongly recommend use of D-wave monitoring in such cases as it clearly impacted our ability to maximize the resection. This is the first video where the DREZ approach is emphasized along with utilization of D-wave monitoring. The patient consented to the surgical procedure and the use of intraoperative video for education purposes.
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Technological advancement in neurosurgery is a continuous process aimed at improving existing devices and implementing innovative ones. Recently, artificial intelligence (AI)-derived technologies (i.e., machine learning and virtual or augmented reality) have been entering this field, promising to significantly change its future. The acquisition of technological skills should be a goal of training for young neurosurgeons. The aim of this study is the analysis of competence and attitude toward intraoperative devices of young neurosurgeons. ⋯ Italian young neurosurgeons have acquired technical skills sufficient for the autonomous use of the most common operative devices, reporting a positive attitude toward technology with high motivation to learn and awareness of their potential harmfulness. A promising number of participants had already used AI-derived technologies, although only a few had received focused training for these devices.
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We sought to evaluate the accuracy of using patient-specific drill guides to place bilateral laminar screws in C1 and C2. ⋯ The study demonstrates that patient-specific drill guides allow for accurate C1 and C2 bilateral laminar screw placement, with a low risk of cortical breach.
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Flow diversion has revolutionized endovascular treatment for cerebral aneurysms. The Surpass Streamline flow diverter (SSFD) has shown promise for expanding flow diversion device options for aneurysm treatment. SSFD differs from earlier stents by maintaining high porosity with increased pore density to ensure appropriate flow disruption. Given the delivery system's increased dimension options and potential greater flow-diverting properties, SSFD is poised to extend the anatomic and pathologic reaches of flow diversion therapy. ⋯ Our data suggest comparable complete occlusion rates compared with SCENT (66.1% vs. 57% in our center) and adequate occlusion rates. Similar occlusion rates to prior studies despite broadened inclusion criteria and diversity of treated aneurysms demonstrate favorable generalizability of flow-diverting technology to a wide array of aneurysmal pathology.
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To compare outcomes of three-dimensional-printed porous titanium (Ti) versus polyetheretherketone (PEEK) cage implantation for stand-alone lateral lumbar interbody fusion (SA-LLIF) in treatment of symptomatic adjacent segment degeneration. ⋯ In patients undergoing stand-alone lateral lumbar interbody fusion to treat adjacent segment degeneration, Ti cages had a significantly lower overall subsidence rate compared with PEEK cages. Furthermore, Ti cages resulted in fewer recommendations for revision surgery. Whether greater pain reduction in the Ti group is associated with earlier or higher fusion rates needs to be further elucidated.