Neurosurgery
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To determine whether a novel bipolar forceps device that uses heat-pipe technology to manage tissue temperature would result in less tissue injury compared with a conventional antistick forceps design. ⋯ Bipolar forceps containing heat pipes more effectively limits excessive thermal spread, thereby potentially reducing the risk of unintended injury to collateral or peripheral tissue.
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Minimally invasive spine surgery (MISS) is among the fastest growing technologies in general neurosurgical practice. In addition, great demand exists to teach these skills to neurosurgery residents. With newly enforced work hour restrictions, opportunities to acquire these skills are limited, necessitating development of alternative strategies of education. We describe a novel simulation model for MISS supplemented by resident self-assessment analysis and evaluation. ⋯ The MISS simulator is a feasible, inexpensive, and reproducible adjunct to neurosurgery resident training and provides a new teaching method for spine surgery. Further investigation of this technology is warranted, although multicenter, randomized, controlled trials assessing its validity may not be practical because of ethical constraints with regard to patient safety.
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Review Case Reports
Posterior-only approach for total en bloc spondylectomy for malignant primary spinal neoplasms: anatomic considerations and operative nuances.
MALIGNANT PRIMARY SPINAL tumors are rare tumors that are locally invasive and can metastasize. The majority of these tumors have a poor response rate to chemotherapy and conventional radiotherapy. Studies have shown that long-term survival and the potential for cure is best achieved with en bloc surgical excision of these tumors with negative surgical margins. ⋯ The posterior-only approach offers the advantage of achieving complete tumor excision and circumferential spinal reconstruction in a single setting. In this report, we discuss the operative management of malignant primary vertebral tumors using the posterior-only approach for total en bloc spondylectomy. The oncological considerations and surgical nuances that allow for safe but aggressive surgical excision of primary spinal tumors to achieve favorable oncological and neurological outcomes are highlighted.
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Patients undergoing surgery for degenerative cervical spine disease may require future surgery for disease progression. We investigated factors related to the rate of additional cervical spine surgery, the associated length of stay, and hospital charges. ⋯ Patients undergoing surgery for degenerative cervical spine disease undergo reoperations at the rate of 2.5% per year. An initial ventral approach and/or fusion seem to be associated with lower reoperation rates. An initial nonventral approach and fusion were more expensive.
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One of the most common postoperative complications of surgery using a transsphenoidal approach is cerebrospinal fluid (CSF) leakage, which typically results from inadequate repair of a CSF fistula created at the time of the initial operation. Most techniques use autologous tissue grafts of fat, muscle, or fascia lata, with or without the use of postoperative lumbar CSF drainage; however, patients demonstrate a relatively high incidence of CSF rhinorrhea, especially after extended procedures. We have developed a new technique of dural suturing with fascia graft using special suture-tying microinstruments. ⋯ Our dural suturing technique with fascia graft may be more reliable than the conventional packing technique in achieving watertight dural closure and for the prevention of postoperative CSF rhinorrhea. Watertight dural suturing with fascia graft and the leaking point suture could allow surgeons to avoid unnecessary postoperative lumbar drainage.