Neurosurgery
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Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is the gold standard surgical treatment for medically intractable Parkinson disease, and unilateral electrodes are reported to have beneficial effects. However, assessment of patients after electrode failure needs to be established. ⋯ The UPDRS motor score with unilateral STN-DBS was compromised relative to bilateral STN-DBS for ipsilateral motor and axial symptoms. When 1 electrode is compromised, revision of that electrode will eventually be required, but not immediately in all patients. If a patient tolerates loss of 1 electrode according to motor score while maintaining activities of daily living and quality of life, it is possible to wait and observe the situation instead of immediately revising the electrode.
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Outcome assessment for the management of Chiari malformation type 1 is difficult because of the lack of a reliable and specific surgical outcome assessment scale. Such a scale could reliably correlate postoperative outcomes with preoperative symptoms. ⋯ We describe a CCOS that assigns higher scores to patients judged improved by gestalt I/U/W ratings and lower scores to those who were unchanged or worse while defining outcome in 4 specific subcategories. As such, this CCOS should allow for a more unified and quantifiable outcome assessment after Chiari surgery.
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Transtemporal approaches require surgeons to drill the temporal bone to expose target lesions while avoiding the critical structures within it, such as the facial nerve and other neurovascular structures. We envision a novel protective neuronavigation system that continuously calculates the drill tip-to-facial nerve distance intraoperatively and produces audiovisual warnings if the surgeon drills too close to the facial nerve. Two major problems need to be solved before such a system can be realized. ⋯ Neurosurgeons using our new NerveClick algorithm can robustly segment facial nerve centerlines to construct a facial nerve safety zone, which potentially allows timely audiovisual warnings during navigated temporal bone drilling despite tracking inaccuracies.
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Case Reports
En bloc resection of sacral chordomas aided by frameless stereotactic image guidance: a technical note.
The most important predictor of survival for patients with sacral chordomas is an initial en bloc resection with negative margins. However, obtaining negative margins can be technically challenging. Intraoperative navigation may be helpful in attempting an excision with negative margins. ⋯ The use of frameless stereotaxy during the en bloc resection of sacral tumors is safe and feasible. Frameless stereotactic navigation was a useful adjunct to preoperative imaging and to the surgeon's anatomic knowledge. Image guidance was used during the osteotomies to decrease the likelihood of injury to vital adjacent structures or violation of the tumor capsule and to increase the likelihood that the appropriate surrounding tissue was resected to attempt a wide or marginal resection.
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Identifying the extent of involvement of the vessel and nerve, particularly in regard to preoperative evaluation and precise localization of the tumor and its relation to the structures of the extremities, has important applications for advancing the treatment of lower extremity diseases. ⋯ The proposed MP-SWI demonstrates the feasibility of simultaneously visualizing nerves and vessels of the lower extremities without using an exogenous contrast agent. It may enable straightforward localization of a disease process to a specific nerve and vessel.