Neurosurgery
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Clinical Trial
Intraoperative cortical surface characterization using laser range scanning: preliminary results.
To present a novel methodology that uses a laser range scanner (LRS) capable of generating textured (intensity-encoded) surface descriptions of the brain surface for use with image-to-patient registration and improved cortical feature recognition during intraoperative neurosurgical navigation. ⋯ This study demonstrates clinical deployment of an LRS capable of generating textured surfaces of the surgical field of view. Data from the LRS was registered accurately to the corresponding preoperative data. Visual inspection of the registration results was provided by overlays that put the intraoperative data within the perspective of the whole brain's surface. These visuals can be used to more readily assess the fidelity of image-to-patient registration, as well as to enhance recognition of cortical features for assistance in comparing the neurotopography between magnetic resonance image volume and physical patient. In addition, the feature-rich data presented here provides considerable motivation for using LRS scanning to measure deformation during surgery.
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A VIRTUAL REALITY system has been devised to superimpose a computer-generated rendering of a volumetric target to be surgically approached or resected on a real-time video image of the surgical field. A stereotactic frame is used to register the image from the video camera with the image of the target volume for accurate localization. The volumetric target is obtained from preoperative imaging studies and can be modified to adjust the intended line of resection or to avoid eloquent vascular or neural tissue. ⋯ To date, 74 intracranial tumor resections have been performed under video virtual reality guidance. Postoperative scanning corresponds in every case with preoperative planning. This system is also designed to be adapted to frameless guidance, which can be further enhanced by the incorporation of an audible tone to signal the relationship of the tip of the resection instrument to the line of resection.
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Randomized Controlled Trial Multicenter Study Comparative Study
The comparative impact of video consultation on emergency neurosurgical referrals.
Neurosurgical resources are concentrated in tertiary referral centers, whereas emergencies identified from district general hospitals are traditionally referred by telephone consultation (TC). Recent advances in communication technology offer the alternative options of teleradiology (TR) and video consultation (VC). This study aimed to determine the differences among these three consultation methods on the basis of their process-of-care indicators, clinical outcomes, and cost-effectiveness. ⋯ Emergency neurosurgical consultation assisted by TR and VC achieved a higher diagnostic accuracy in comparison with conventional TC. Although VC did not show an advantage over TR in process-of-care indicators, clinical outcome, and cost, it has been proven to be a safe mode of consultation in emergency neurosurgery.
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Comparative Study
Preoperative prediction of long-term outcome in poor-grade aneurysmal subarachnoid hemorrhage.
To evaluate which presentation indices, demographics, and clinical information predict 12-month outcome in poor-grade aneurysmal subarachnoid hemorrhage (SAH), and to provide a preoperative index of prognosis. ⋯ Outcome in poor-grade aneurysmal SAH is strongly predicted by patient age, worst preoperative Hunt and Hess clinical grade, and aneurysm size. Hyperglycemia on admission after poor-grade aneurysmal SAH increases the likelihood of poor outcome, and is a potentially modifiable risk factor. The Prognosis Score is a useful tool for preoperatively assessing the likelihood of a favorable outcome for poor-grade aneurysmal SAH patients.
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Comparative Study
Cervical catheter tip placement for intrathecal baclofen administration.
Intrathecal baclofen can reduce congenital and posttraumatic spasticity. Traditionally, the catheter tip for baclofen delivery is placed in a low thoracic position, which can result in a lumbar-to-cisternal cerebrospinal fluid baclofen concentration gradient. We investigated whether more rostral catheter placement was technically feasible, safe, and able to control upper extremity spasticity. ⋯ In this series, placement of intrathecal baclofen catheters in the cervical region resulted in equal control of spasticity in the upper and lower extremities and did not increase complications related to the catheter position.