World Neurosurg
-
Narrowing of the lumbar spinal canal, or lumbar stenosis (LS), may cause debilitating radicular pain or muscle weakness. It is the most frequent indication for spinal surgery in the elderly population. Modern diagnosis relies on magnetic resonance imaging and its inherently subjective interpretation. Diagnostic rigor, accuracy, and speed may be improved by automation. In this work, we aimed to determine whether a deep-U-Net ensemble trained to segment spinal canals on a heterogeneous mix of clinical data is comparable to radiologists' segmentation of these canals in patients with LS. ⋯ We conclude that machine learning algorithms can segment lumbar spinal canals in LS patients, and automatic delineations are both qualitatively and quantitatively comparable to expert-generated segmentations.
-
Despite growing interest in the endoscopic endonasal approach (EEA) to the medial orbital apex (OA), a comprehensive description of the multilayer topology lying at the intersection of the regional compartments is missing. ⋯ Understanding cranial landmarks and the folds of the layers covering the orbito-cavernous-pterygopalatine interface can facilitate tailoring an EEA to the medial orbital space and avoid unnecessary exposure of sensitive anatomy in the vicinity.
-
It remains unclear whether spinal cord untethering is necessary to reduce the chances of neurologic decline in children with myelomeningocele and complex closed spinal dysraphism who undergo thoracolumbar fusion for scoliosis. We sought to determine the neurologic and functional outcomes of children with spinal dysraphism undergoing spinal fusion for scoliosis with and without prophylactic spinal cord untethering. ⋯ Our data suggest that prophylactic spinal cord untethering in children with spinal dysraphism undergoing thoracolumbar fusion for scoliosis may not be necessary in patients with moderate curvatures. Our conclusions are limited by the small sample size. A larger review of registry data may yield more powerful conclusions on the necessity of prophylactic spinal cord untethering in this patient population.
-
Transforaminal lumbar interbody fusion with biportal endoscopic guidance (BE-TLIF) has been previously reported with promising clinical results. However, complications such as delayed union or subsidence occurred as with open surgery. We assumed using larger cages would result in less occurrence of such complications. We aimed to analyze the clinical outcome and technical feasibility of BE-TLIF using larger cages, initially designed for oblique lumbar interbody fusion. ⋯ BE-TLIF using a larger cage was safely performed without risk of subsidence during the 1-year follow-up. A cage with a larger footprint may be advantageous in BE-TLIF in the aspect of interbody fusion and subsidence.
-
We aimed to evaluate the performance of fast and straightforward Murray law-based quantitative flow ratio (μQFR) computation in cerebrovascular stenosis. ⋯ The μQFR computation has a strong correlation and agrees with the FPR calculated from the pressure wire. Therefore, the μQFR might provide an essential therapeutic aid for patients with symptomatic stenosis.