Articles: surgery.
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Technological developments in imaging guidance, intraoperative imaging, and microscopy have pushed neurosurgeons to the limits of their dexterity and stamina. The introduction of robotically assisted surgery has provided surgeons with improved ergonomics and enhanced visualization, dexterity, and haptic capabilities. This article provides a historical perspective on neurosurgical robots, including image-guided stereotactic and microsurgery systems. The future of robot-assisted neurosurgery, including the use of surgical simulation tools and methods to evaluate surgeon performance, is discussed.
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Spinal cord stimulation has been extensively utilized in the treatment of conditions including complex regional pain syndrome, ischemic limb pain, failed back surgery syndrome, and angina pectoris. Recognized complications include infection, dural tap, and electrode movement. We report the case of a patient who experienced a sensation of extremely enhanced stimulation in the area covered by the spinal cord stimulator while in the vicinity of a high-tension electricity substation. Full resolution of symptoms occurred when the spinal cord stimulator was switched off, indicating that active stimulators may be susceptible to the effects of external electrical fields.
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Computed tomography (CT) scanning is the gold standard for displaying and visualizing complex anatomic structures such as the calcaneus, pelvis, and spine, etc. In orthopedic surgery CT scanning is unfortunately not available in the OR where it would be highly effective if scans could be done prior to wound closure. The reasons are high costs, need for constructional changes in the OR, and additional staff (radiologic technologist), etc. ⋯ Since February 2001 we have been able to use the ISO C(3D) in our hospital and meanwhile we have scanned 442 surgical sites including the calcaneus, cervical spine, and acetabulum, etc. The intraoperative scans revealed fracture gaps and steps, unsatisfactory fragment alignment, or incorrectly positioned implants, leading to an overall revision rate of 7.3%The ISO C(3D) is a first step towards a new future for bone visualization. The next steps will bring an increase in scan area and resolution, and the high-contrast pictures will be replaced by ones very similar to modern CT slices showing certain soft tissue structures.
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For pelvic fractures, pre- and postoperative imaging includes spiral computed tomography, providing high resolution and accuracy. In conventional pelvic operations, these image data cannot be used directly. Intraoperative imaging is limited with fluoroscopy and visualization by the approaches. ⋯ However, it helps to reduce complications caused by implant placement. With the introduction of new health care requirements in Germany, this may be an economic argument as well. Current developments focusing on accurate navigated reduction will provide new indications for CAS, further decrease complication rates, and help to reduce the invasiveness of pelvis operations.
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Comparative Study
3D imaging with an isocentric mobile C-arm comparison of image quality with spiral CT.
The purpose of this study was to evaluate the image quality of the new 3D imaging system (ISO-C-3D) for osteosyntheses of tibial condylar fractures in comparison with spiral CT (CT). Sixteen human cadaveric knees were examined with a C-arm 3D imaging system and spiral computed tomography. Various screws and plates of steel and titanium were used for osteosynthesis in these specimens. ⋯ Titanium implants caused the smallest number of artifacts. The image quality of ISO-C is inferior to CT, and metal artifacts were more prominent, but the clinical value was equal. ISO-C-3D can be useful in planning operative reconstructions and can verify the reconstruction of articular surfaces and the position of implants with diagnostic image quality.