Neurosurgery
-
Newer versions of the commercial Medtronic StealthStation allow the use of only 8 landmark pairs for patient-to-image registration as opposed to 9 landmarks in older systems. The choice of which landmark pair to drop in these newer systems can have an effect on the quality of the patient-to-image registration. ⋯ When using 8 landmarks to perform the patient-to-image registration, the protocol using 4 ear landmarks and 4 facial landmarks greatly outperformed the other 8-landmark protocols and 9-landmark protocol, resulting in the lowest target registration error.
-
The US Food and Drug Administration recently approved a detachable-tip microcatheter, the Apollo microcatheter (eV3, Inc, Irvine, California), to prevent catheter entrapment during embolization of brain arteriovenous malformations (AVMs) using liquid embolic systems. ⋯ Our initial experience supports the feasibility, safety, and effectiveness of detachable-tip microcatheters in treating brain AVMs and arteriovenous fistulas.
-
Simulation-based training may be incorporated into neurosurgery in the future. ⋯ Because technical performance of percutaneous rhizotomy increases with training, we proposed that the skills in performing the procedure in our virtual reality model would also increase with PGY level, if our simulator models the actual procedure. Our results confirm this hypothesis and demonstrate construct validity.
-
Endovascular treatment is increasingly being used in acute stroke care. However, although stent retrievers show improved flow restoration rates, their clinical benefits have been uncertain. ⋯ Patients with acute ischemic stroke who received IV tPA or revascularization therapies had a higher likelihood of achieving independence at 3 months. Stent retriever technology combined with tPA was associated with the greatest benefit compared with placebo, tPA alone, or endovascular therapy alone.
-
Melanoma metastases to the spine remain a challenge for neurosurgeons. ⋯ On multivariate analysis, involvement of ≥3 vertebral bodies and progressive systemic disease were associated with worse overall survival. Consideration of these factors should influence surgical decision making in this patient population.