Neurosurgery
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Clinical Trial
The utility of using the bispectral index-Vista for detecting cross-clamping decline in cerebral blood flow velocity.
Patients undergoing carotid endarterectomy for extracranial internal carotid artery stenosis are at risk of cerebral ischemia/hypoperfusion. Criterion recommended by European and American committees to determine whether to place a shunt consisted of a decline in transcranial Doppler ultrasonography-measured middle cerebral artery blood flow velocity (MCBFV) to < 30% to 40% of intraoperative preclamp value. ⋯ Although we demonstrated good correlation and high discriminative power of the BIS-Vista monitor in depicting a MCBFV decline that could serve as indicator of decline in cerebral activity, BIS-Vista cannot be considered a reliable indicator of cerebral ischemia/hypoperfusion that could replace transcranial Doppler monitoring to determine whether a shunt is to be placed.
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The accurate position of the ventricular catheter inside the frontal horn of the lateral ventricle is essential to prevent proximal failure in shunt surgery. For optimal placement, endoscopic- and image-guided techniques are available. ⋯ The new tool allows safe and quick placement of ventricular catheters. The adjustment of the tool to the planned trajectory is performed before catheter insertion and allows optimal concentration on the insertion procedure and the fingertip feeling for the penetrated tissue.
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To assess patients' perspective of combined awake craniotomy and intraoperative magnetic resonance imaging (MRI) in a prospective study. ⋯ Although the combination of awake craniotomy and intraoperative MRI is demanding, it was both tolerable and reasonable for the patients. Our data confirm that intraoperative MRI appears to have no additional significant impact on the subjective patient perception, although it does prolong the procedure.
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Adult scoliosis is a condition with increasing prevalence and medical and socioeconomic importance. Surgery is fraught with a significant complication rate in an elderly multimorbid patient population. ⋯ Instrumented correction of adult deformity was significantly facilitated by iCT navigation, eliminating radiation exposure to the surgeon. Intraoperative biplanar CT scout views including pelvis and shoulders allow comprehensive assessment of multiplanar deformity correction. Fusion rates obtained with less invasive access equal those of conventional open technique.
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Case Reports
Intraoperative use of indocyanine green fluorescence videography for resection of a spinal cord hemangioblastoma.
Indocyanine green (ICG) fluorescence videography has been recently applied to the neurosurgical field, mostly in the management of cerebral aneurysms, but has had limited description in the subspecialty of spine or oncological neurosurgery. We describe a novel application of this previously defined surgical tool to assist in the resection of a residual spinal cord hemangioblastoma. ⋯ The adjuvant use of ICG videography is a useful surgical tool that permits greater visualization of the complete extent of the lesion, particularly in managing recurrent or residual lesions obscured by adhesions.