World Neurosurg
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Electromagnetic (EM) navigation has been reported to be a noninvasive and easy-to-use technique. However, the use of metal neurosurgical instruments (e.g., skin hooks, head frames, brain retractors systems) can interfere with the magnetic fields of such systems. We present the freehand technique, a new technique involving the manual manipulation of the emitter of an EM navigation system, which helps to prevent interference caused by metal instruments during surgery. ⋯ During the use of EM navigation systems, the freehand technique with the emitter can prevent interference caused by metal instruments.
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Case Reports
Imaging-Ambiguous Lesions of Meckel's Cave-Utility of Endoscopic Endonasal Transpterygoid Biopsy.
Meckel's cave is a dural-lined cavity in the middle fossa skull base in which lies the Gasserian ganglion, a potential site for tumors and inflammatory lesions. A variety of lesions can be predominantly isolated to Meckel's cave, including extension from head and neck cancers, other malignant tumors, as well as benign lesions. Clinical presentation and imaging findings are often insufficient to establish a diagnosis. Hence, histologic confirmation is required to determine the appropriate treatment strategy. Several surgical approaches have been used to reach this deep-seated area, often with significant morbidity and prolonged recovery. Given advancements in endoscopy and greater facility with the technique, the endoscopic endonasal approach has been used increasingly to reach lesions in the region. ⋯ We explore not only the relevance of this approach in the armamentarium of the modern skull-base surgeon but also its limitations and conclude that the endoscopic endonasal approach provides a safe and relatively direct, minimally invasive corridor to many lesions of Meckel's cave.
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A tenosynovial giant cell tumor (TGCT) is a rare type of tumor that primarily arises from the tendon sheath, synovium, and bursae. In rare cases, these tumors can affect joints of the head and neck such as the temporomandibular joint. This is the only case to our knowledge of an intracranial TGCT tumor of the clinoid. ⋯ A tumor originating from the left anterior clinoid was found intraoperatively and confirmed by histology to be a TGCT.
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Comparative Study
Pros and Cons of C2 Nerve Sectioning/Preservation in Posterior Fusion for Congenital Atlantoaxial Dislocation.
Deliberate C2 nerve root sectioning and its preservation have been described during posterior fusion for atlantoaxial dislocation (AAD). However, the associated outcomes have been less studied, especially in congenital AAD. Our objective was to study the clinical outcomes after C2 nerve root sectioning and the feasibility of C2 preservation in these patients. ⋯ The advantages of sectioning the C2 nerve root are many. However, a subset of patients is prone to morbid occipital neuropathic ulcers. After C2 nerve sectioning, one should be cautious of such complications. C2 nerve root preservation should be strongly considered for patients with favorable anatomy.
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Neuronavigation systems are routinely used during neurosurgical procedures. Currently, new imaging technologies are emerging, such as virtual, augmented, and mixed reality. With mixed-reality devices, the user can analyze and interact with the real environment using virtual objects. The aim of this prospective pilot study was to offer a proof of concept by testing the clinical feasibility and accuracy of a wearable mixed-reality device (Hololens) for preoperative neurosurgical planning. ⋯ This prospective clinical study offers a proof of concept of the clinical feasibility of the Hololens for brain tumor surgery planning in the operating room, with quantitative outcome measures. Further development is needed to improve the accuracy of this wearable mixed-reality device.