Articles: surgery.
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AJNR Am J Neuroradiol · Nov 2003
Refractory occipital neuralgia: preoperative assessment with CT-guided nerve block prior to dorsal cervical rhizotomy.
Occipital neuralgia syndrome can cause severe refractory headaches. In a small percentage of people, these headaches can be devastating and debilitating, with the potential for complete relief following surgical rhizotomy. We describe CT fluoroscopy-guided percutaneous C2-C3 nerve block for the confirmation of diagnosis of occipital neuralgia and for demonstrating to patients the sensory effects of intradural cervical dorsal rhizotomy before the definitive surgical procedure. ⋯ CT fluoroscopy-guided percutaneous cervical nerve block is useful for the confirmation of occipital neuralgia, for demonstrating to patients the sensory effects of nerve sectioning, and possibly as a guide for selection of patients for intradural cervical dorsal rhizotomy. Although not statistically significant, there was a trend toward better response to rhizotomy in patients without prior head or neck surgery.
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Comparative Study
[CT and fluoroscopy based navigation in pelvic surgery].
Navigation procedures based upon CT data were introduced into spine surgery in 1994. Since then the method has been used in other areas, such as joint replacement, reconstructive surgery and tumor surgery, because of its high precision and reduced radiation exposure. The original CT-based spine module can be adapted for pelvic surgery with the prerequisite, that the positioning of the fragments is identical in CT and at operation; otherwise, a new data set has to be acquired. ⋯ In one screw an anterior cortex perforation of the sacrum was seen on CT, but without neurological consequences. Based upon our clinical experience we believe that CT-based navigation is indicated in screw fixations for minimally displaced pelvic injuries or dysplasia and, with increasing importance, in tumor surgery. Fluoroscopy based navigation with adequate image quality is the method of choice for SI screw fixations in traumatic or degenerative instabilities, especially if an update of the images is needed.
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Journal of neurosurgery · Oct 2003
Three-dimensional fluoroscopy-guided percutaneous thoracolumbar pedicle screw placement. Technical note.
The authors sought to evaluate the feasibility and accuracy of three-dimensional (3D) fluoroscopic guidance for percutaneous placement of thoracic and lumbar pedicle screws in three cadaveric specimens. After attaching a percutaneous dynamic reference array to the surgical anatomy, an isocentric C-arm fluoroscope was used to obtain images of the region of interest. Light-emitting diodes attached to the C-arm unit were tracked using an electrooptical camera. ⋯ Two of the violations were less than 2 mm beyond the cortex; the others were between 2 and 3 mm. Coupled with an image guidance system, 3D fluoroscopy allows highly accurate spinal navigation. Results of this study suggest that this technology will facilitate the application of minimally invasive techniques to the field of spine surgery.
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Chronic hip pain is often a debilitating problem and many patients are not good surgical candidates. Furthermore, hip replacement surgery has significant associated risks. We offer a conservative approach to hip replacement using radiofrequency lesioning. ⋯ Percutaneous radiofrequency lesioning of the sensory branches of the obturator and femoral nerves appears to be a safe alternative to hip replacement, especially in those patients where surgery is not an option. Further studies are needed to confirm our results.