World Neurosurg
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This case series looks at the role of intraoperative ultrasound in spine surgery for extradural pathologies. ⋯ Intraoperative ultrasound is a useful tool in routine spine surgery. It is effective and easy to read to determine decompression for various pathologies including disk herniation, epidural abscess, tumors, and deformity and reconstructive surgeries. This simple tool can help plan surgeries.
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As a result of increased practicality and decreased costs and radiation, interest has increased in intraoperative ultrasonography (iUS) in spinal surgery applications; however, few studies have provided a robust overview of its use in spinal surgery. We synthesize findings of existing literature on use of iUS in navigation, pedicle screw placement, and identification of anatomy during spinal interventions. ⋯ iUS eliminates radiation, decreases costs, and provides sufficient accuracy and reliability in identification of anatomic and neurovascular structures in various spinal surgery settings.
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We sought to compare the dosimetric accuracy of postoperative stereotactic body radiation therapy in a carbon-fiber (CF) versus titanium instrumented spine using a cadaveric model. ⋯ More accurate dosimetry and radiation therapy delivery with CF screws compared with traditional titanium screws may have implications on optimal radiation delivery, as well as complication avoidance. This may be due to reduced scatter and thus lower variability in radiation delivery with the volumetric modulated arc therapy technique.
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Access to the petroclival region has always been challenging owing to the surrounding neurovascular structures. The ideal approach to the region depends not only on the specific tumor characteristics, but also on surgeon preference. In this video article, we have highlighted the use of the modified Dolenc-Kawase approach to expand the standard anterior petrosectomy corridor for challenging tumors that need additional exposure.1-5 A 60-year-old woman presented with facial sensory loss and occasional diplopia. ⋯ Tumor was removed piecemeal alternately using the bone CUSA and scissors. Tumor was dissected from above and below the trigeminal nerve that forms the center of the corridor followed by dissection off the sixth cranial nerve as it enters the Dorello canal. An endoscope may be used at the end to ensure complete removal of the tumor.
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This work illustrates the case of surgical treatment of trigeminal neuralgia (TN), as a tardive complication after vestibular schwannoma (VS) removal (Koos III, Figure 1), in a female patient. After VS surgery, the postoperative computed tomography scan did not show any significant complication, although a thin blood clot was present in the surgical bed (Figure 2). However, 3 months later, our patient developed a TN involving the territories V2-V3. ⋯ The paucity of cases reported in the literature lead us to think that TN as complication of VS removal is underestimated because it may be responsive to medical treatment. Laser-evoked potentials may be useful to study the integrity of the Tn, ensuring that no anatomic damage has been done during surgery. On the basis of our experience, surgery can be an effective treatment option when TN is not responsive to medical therapy and the anatomic-functional integrity of the Tn has been preserved.