World Neurosurg
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To analyze the clinical efficacy of ultrasonic bone scalpel (UBS)-assisted unilateral biportal endoscopic lamina osteotomy replantation (ULOR) for treating lumbar infectious spondylitis (LIS). ⋯ The use of ULOR with assistance from UBS for the treatment of LIS has proven to be beneficial. It provides significant relief from symptoms and corrects lumbar deformity. This surgical procedure is both effective and safe.
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Deep brain stimulation (DBS) is a well-established treatment for Parkinson's disease (PD). However, infection following DBS surgery is a serious complication that can lead to the recurrence and worsening of Parkinson's symptoms or related hardware reimplantation, causing considerable patient suffering and financial burden. ⋯ Scalp incision infections following DBS surgery can affect deep tissues, and the implementation of a comprehensive treatment strategy involving local debridement and removal of potentially affected implants can significantly reduce the risk of infection recurrence and its spread.
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The Stealth Autoguide (Medtronic, Minneapolis, MN) is a robotic auto-targeting device for stereotactic brain biopsy, placement of stereoelectroencephalography electrodes, and laser ablation therapy. This paper evaluates its off-label application as robotic endoscope holder in transnasal and intraventricular neurosurgery. The potential to enhance stability, reduce manual adjustments, and improve surgical precision is discussed, alongside cost-effectiveness and feasibility. ⋯ This experience proves that the Stealth Autoguide can be safely and effectively used as a robotic support for endoscopic procedures. This device ensures precise positioning and manipulation of neuroendoscopes, facilitating visualization and targeting of the desired area. Further researches are needed to verify applications and limitations.
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Case Reports
Surgical Video: Percutaneous fusion and endoscopic resection of a thoracic metastatic tumor.
While endoscopic approaches to the spine have become increasingly utilized for spinal degenerative disease, there is a paucity of literature regarding the role of endoscopic approaches in spinal oncology.1 The endoscopic approach offers patients lower risk of wound infection, wound dehiscence, and postoperative hematoma when compared with an open approach.1 In many spinal oncology patients, an endoscopic approach allows for prompt postoperative radiation when compared with an open approach.2 Both the lower complication profile and decreased time to postoperative radiation highlight the importance of considering an endoscopic approach to metastatic spinal tumors. We present a case of a patient with a metastatic carcinoma to the thoracic spine resected via an endoscopic approach. The patient's tumor was first treated with endovascular embolization, followed by endoscopic hemilaminectomy, foraminotomy, and tumor resection. ⋯ Per institutional guidelines, the current case Video 1 did not classify as human subject research or require institutional review board review. In the Video 1, particular focus is placed on the surgical techniques involved in the endoscopic approach for resection a spinal metastatic tumor. With the increasing utilization of endoscopic approaches to the spine, the described technique for resection of spinal metastatic lesions will become increasingly relevant to spinal oncology surgeons.
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Feasibility and safety of endoscopic endonasal approaches have become well established, and focus has now shifted to minimizing nasal morbidity. To this end, several modifications in the nasal stage have been described that focus primarily on preservation of nasal mucosa on right side of the nasal cavity. However, nasal mucosal preservation on the left side of the nasal cavity has largely been ignored. This technical note describes a modified technique that can eliminate mucosal damage in the left nasal cavity. ⋯ A combination of endonasal and transseptal approaches uses the advantages of both endoscopic and microscopic approaches sans the disadvantage of restricted space seen in microscopic approaches. It makes the binostril approach least disruptive to the left nasal mucosa and thus can reduce overall morbidity of endoscopic endonasal approaches.