Neurosurgery
-
Parsonage-Turner syndrome (PTS) is a rare syndrome of unknown cause, affecting mainly the lower motor neurons of the brachial plexus. The brachial plexus is a group of nerves that conduct signals from the spine to the shoulder, arm, and hand. PTS is usually characterized by the sudden onset of severe 1-sided shoulder pain, followed by paralysis of the shoulder and lack of muscle control in the arm, wrist, or hand several days later. ⋯ Individuals with the condition first experience severe pain across the shoulder and upper arm. Within a few hours or days, weakness, wasting (atrophy), and paralysis may affect the muscles of the shoulder. Although individuals with the condition may experience paralysis of the affected areas for months or, in some cases, years, recovery is usually eventually complete.
-
Herein, we provide an unbiased review of piriformis syndrome (PS), a highly controversial syndrome for which no consensus exists regarding diagnostic criteria or pathophysiology. ⋯ PS remains a controversial diagnosis for sciatic pain. The debate regarding the clinical significance of PS remains active. Nonetheless, there may be a subset of patients in whom the piriformis muscle is a source of pain. The syndrome should be considered in the differential diagnosis of patients with unilateral lower extremity pain.
-
Review
Intraoperative nerve action potential recordings: technical considerations, problems, and pitfalls.
The purpose of this article is to provide our experience with intraoperative nerve action potential (NAP) recordings. In particular, we focus on a discussion of the technical considerations of intraoperative NAP with emphasis on identifying and remedying problems and pitfalls. ⋯ Visual inspection of a nerve lesion in continuity can be misleading. Although there is no "head-to-head" comparison of our data with data obtained without the use of intraoperative NAP recordings, we feel strongly that with experience and knowledge of the problems and pitfalls regarding intraoperative recording techniques, one may take advantage of the great benefits of this very useful and informative surgical tool.
-
With improvements in endovascular techniques, fewer aneurysms are treated by surgical clipping, and those aneurysms targeted for open surgery are often complex and difficult to treat. We devised a hollow, 3-dimensional (3D) model of individual cerebral aneurysms for preoperative simulation and surgical training. The methods and initial experience with this model system are presented. ⋯ Using the hollow 3D models to simulate clipping preoperatively, we could treat the aneurysms confidently during live surgery. These models allow easy and concrete recognition of the 3D configuration of aneurysms and parent vessels.
-
We developed an augmented reality system that enables intraoperative image guidance by using 3-dimensional (3D) graphics overlaid on a video stream. We call this system DEX-Ray and report on its development and the initial intraoperative experience in 12 cases. ⋯ The system was perceived as an improved navigational experience because the augmented see-through effect allowed direct understanding of the surgical anatomy beyond the visible surface and direct guidance toward surgical targets.