Neurosurgery
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VarioGuide (BrainLAB AG, Feldkirchen, Germany) is a new system for frameless image-guided stereotaxy. In the present study, we aimed to assess target point accuracy in a laboratory setting and the clinical feasibility of the system. ⋯ Concluding from the phantom measurements with ideal image-object registration, assumed spherical lesions with a volume of 0.524 cm can be biopsied with 100% target localization. Early clinical data revealed VarioGuide to be safe and accurate for lesions of 0.2 cm3 and larger. Thereby, the system seems feasible for the biopsy of most intracranial lesions.
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The planning of retrosigmoid craniotomies often relies on anatomic landmarks on the posterolateral surface of the cranium, such as the asterion. However, the location of the asterion is not fixed with respect to the underlying transverse-sigmoid sinus complex. We introduce a simple procedure that uses 3-dimensional (3D) computed tomographic imaging to project the transverse-sigmoid sinus complex onto the external surface of the cranium. ⋯ Retrosigmoid craniotomy standardized according to anatomic landmarks raises the risk for sinus injury because of variations in their location. We offer our 3D computed tomographic imaging-based procedure as a useful device for the planning of safer retrosigmoid craniotomies.
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Intraoperative localization of cortical areas for motor and language function has been advocated to minimize postoperative neurological deficits. We report herein the results of a retrospective study of cortical mapping and subsequent clinical outcomes in a large series of patients. ⋯ Negative mapping of eloquent areas provides a safe margin for surgical resection with a low incidence of neurological deficits. However, identification of eloquent areas not only failed to eliminate but rather increased the risk of postoperative deficits, likely indicating close proximity of functional cortex to tumor.
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To determine the clinical value of motor functional magnetic resonance imaging (fMRI) in the presurgical evaluation of a large group of children and adolescents with epilepsy caused by lesions close to the central sulcus. ⋯ Motor fMRI can be performed with a high degree of success and good data quality in this population of patients. It has an important additive role in the discussion of the feasibility of resective surgery contributing to the decision-making process for children with epilepsy caused by brain lesions close to the central sulcus.
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We have developed an interactive virtual model of the temporal bone for the training and teaching of cranial base surgery. ⋯ The Virtual Temporal Bone and its surrounding 3-dimensional workspace provide an effective way to study the essential surgical anatomy of this complex region and to teach and train operative strategies, especially when used as an adjunct to cadaver dissections.