World Neurosurg
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Microscopes with fluorescence modality for videoangiography (VAG) using indocyanine green or sodium fluorescein (FL) have been used in cerebrovascular surgeries as tools for brain blood flow assessment in vascular diseases, especially in brain aneurysms, extracranial-intracranial bypass, and arteriovenous malformations (AVMs). Indocyanine green-VAG is a well-documented tool frequently employed as an adjunct to microsurgery for AVM treatment. Nevertheless, it's worth noting that the use of FL-VAG has been significantly underrepresented in medical literature, with only a few studies addressing its application in this context.1,2 We report a case of a 33-year-old woman with a grade 1 frontal unruptured AVM, admitted because of recurrent headache. ⋯ Postoperative digital angiography showed complete removal of the AVM. FL-VAG represents a valuable adjunct in the AVM resection by facilitating the assessment of blood flow within cerebral vessels. This can be helpful to modify surgical strategies in some circumstances (e.g., selection of the main feeders vs. arteries in passage) and to save time making decisions about draining vein division and nidus removal.
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The erector spinae plane block (ESPB) is a novel regional analgesic technique which improves postoperative outcomes in lumbar surgery patients including length of hospitalization, days to ambulation, and postoperative opioid use. Traditionally, the block is administered by anesthesiologists trained in the ultrasound guidance technique. The use of fluoroscopic guidance may improve the efficiency and accessibility of the ESPB for spine surgeons. We aim to measure the time to administer an ESPB using fluoroscopic guidance and localize the anesthetic using intraoperative three-dimensional (3D) imaging. ⋯ Fluoroscopic guidance allows efficient and appropriate delivery of the anesthetic to the erector spinae plane. Performing an ESPB with fluoroscopic guidance improves efficiency and accessibility of the analgesic technique for spine surgeons, reducing dependence on anesthesiology personnel trained in administering the block.
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In recent years, the endoscopic transorbital (TO) approach has gained increasing interest for the treatment of middle cranial fossa lesions. We propose a technical refinement to the conventional superior eyelid TO approach, which improves the surgical exposure and augments the working angles when targeting the opticocarotid region. ⋯ The modified endoscopic TO approach with the extension of the craniectomy to MacCarty point improves surgical access and visualization of the opticocarotid region. This facilitates anterior clinoidectomy and optic nerve decompression. Although it implies judicious instrument manipulation and a larger incision size, further studies can define its potential benefits.
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Spontaneous intracerebral hemorrhage (ICH) poses a public health issue due to its elevated mortality rates. The International Normalized Ratio-platelet index (INR-Plt index) has recently been recognized as a predictive factor for liver disease progression. The potential of applying the INR-Plt index in forecasting ICH prognosis presents an intriguing subject. This study endeavors to examine the correlation between the INR-Plt index and hospital outcomes in patients with spontaneous supratentorial ICH. ⋯ The INR-Plt index is a predictor of hospital mortality in patients with spontaneous supratentorial ICH. A higher INR-Plt index value is associated with an increased risk of mortality, underlining the potential usefulness of this composite index in guiding clinical decision-making and enabling risk stratification.
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This study evaluates ChatGPT's performance in diagnosing and managing spinal pathologies. ⋯ While helpful in the medical field, ChatGPT falls short in providing reliable management recommendations, with a 30% misdiagnosis rate and 53% mismanagement rate in our study. Its limitations, including reliance on outdated data and the inability to interactively gather patient information, must be acknowledged. Surgeons should use ChatGPT cautiously as a supplementary tool rather than a substitute for their clinical expertise, as the complexities of healthcare demand human judgment and interaction.