World Neurosurg
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Spinal epidural abscesses (SEA) require prompt diagnosis to avoid devastating consequences. Here, we discuss the case of a healthy 20-year-old college student-with a recent diagnosis of strep pharyngitis-who presented with neck pain, fever, and a neurologic deficit-the most common symptoms of SEA. Magnetic resonance imaging revealed a T1-postcontrast, peripherally enhancing epidural collection from C3-T5 with associated cord compression and T3 osteomyelitis. ⋯ We treated the patient with ceftriaxone for 6 weeks. The patient had a full neurologic recovery and remains without recurrence of infection 11 months postoperatively. Healthy patients without obvious risk factors may present with SEA, highlighting the need for atypical cases such as these to be brought to clinicians' attention.
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Despite the expanding role of machine learning (ML) in health care and patient expectations for clinicians to understand ML-based tools, few for-credit curricula exist specifically for neurosurgical trainees to learn basic principles and implications of ML for medical research and clinical practice. We implemented a novel, remotely delivered curriculum designed to develop literacy in ML for neurosurgical trainees. ⋯ This pilot elective demonstrated the interest, value, and feasibility of a remote elective to establish ML literacy; however, feedback to increase accessibility and flexibility of the course encouraged our team to implement changes. Future elective iterations will have a semiannual, 2-week format, splitting lectures more clearly between theory (the method and its value) and application (coding instructions) and will make lectures open-source prerequisites to allow tailoring of student learning to their planned application of these methods in their practice and research.
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Case Reports
Trans-Peduncular Approach for Resection of Ruptured 4th Ventricular Arteriovenous Malformation.
The lateral recess of the fourth ventricle can be challenging to access surgically. We present a case of a previously ruptured arteriovenous malformation (AVM) of the fourth ventricle that was surgically resected via a retrosigmoid craniotomy and transinferior cerebellar peduncular approach. The patient is a 54-year-old female who experienced an intraventricular hemorrhage several months before presentation to our institution. ⋯ To access the lesion, we performed a retrosigmoid craniotomy and entered into the fourth ventricle via s small incision in the inferior cerebellar peduncle. Postoperative imaging demonstrated complete removal of the AVM nidus. Video 1 demonstrates this approach and discusses the anatomic landmarks used to guide resection.
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The use of minimally invasive port technology has been proposed as a safe method to reduce retractor-induced parenchymal injury, particularly for the resection of deep-seated lesions.1-6 A 69-year-old woman with a history of previous colon cancer surgery presented with gait disturbances and progressive headaches. Magnetic resonance imaging revealed a tumor involving the right ventricular atrium that appeared consistent with metastasis. A parieto-occipital craniotomy was performed on the basis of the preoperatively planned surgical trajectory (Video 1). ⋯ The patient recovered uneventfully without neurologic deficits on follow-up, and the postoperative magnetic resonance imaging evidenced a complete resection of the tumor. The video illustrates technical nuances and demonstrates the feasibility of minimal access port surgery for the resection of intraventricular lesions with low morbidity and mortality using microsurgical techniques. The patient consented to the publication of her image.
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The accurate localization of intracranial lesions is critical in neurosurgery. Most surgeons locate the vast majority of neurosurgical sites through skull surface markers, combined with neuroimaging examination and marking lines. This project's primary purpose was to develop an augmented reality (AR) technology or tool that can be used for surgical positioning using the naked eye. ⋯ The error of AR positioning technology in surgical simulation tests based on brain modeling was millimeter level, which has verified the feasibility of clinical application. More efficient registration remains a need that should be addressed.