Cent Eur Neurosurg
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Case Reports
Fiber tracking with distinct software tools results in a clear diversity in anatomical fiber tract portrayal.
Fiber tract portrayal, based on diffusion tensor imaging (DTI), is becoming more and more important in functional neuronavigation. No standard exists to guarantee anatomically correct fiber tract depiction for neurosurgical purposes. Therefore, showing the anatomically correct extension of fiber tracts beyond the pure connection of functional areas remains an area of important research and investigation. Standards for fiber tracking software applications are elusive. The purpose of this study was to compare the performance of different fiber tracking software tools (FT-tools). We tested the software performance, comparability and anatomical accuracy of the tracking results of several programs. ⋯ Distinct FT-tools performed very differently with respect to the time required to achieve CST portrayal (track generation time varied between 16 and 50 min). None of the software applications was able to display the CST in its full anatomical extent. Especially the lateral precentral areas were not pictured. Surprisingly, the application of the four distinct FT-tools did not lead to comparable tracking results. As very similar or identical tracking algorithms were used, this difference cannot be easily explained. Clearly, neurosurgeons have to be cautious about applying fiber tracking results intraoperatively, especially when dealing with an abnormal or distorted fiber tract anatomy. The authors recommend the use of adjunct strategies such as intraoperative electrophysiology to enhance patient safety and improve anatomical accuracy when using tracking results for surgical procedures.
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Surgery on the degenerative cervical spine disorders aims at decompression of the neural structures and restoring the physiological profile of the cervical spine. The aims of internal fixation are to gain primary stability, introduce a bony fusion and to correct the shape of the spine. The present study will give answers to the following questions: 1. What is the overall revision rate following an operative treatment of degenerative cervical disorders using common operative techniques? 2. Is there any influence of the fusion length to the overall revision rate and especially to the decompensation ratio of adjacent segments? 3. What is the rate of revisions due to instrumentation failures? 4. Are there any differences concerning the revision rate between posterior and anterior instrumentation? ⋯ The influence of the fusion length on the revision rate was unexpectedly high. Adjacent level decompensation was neither influenced by the length of the fusion nor the performed procedure. Compared to anterior instrumentation, posterior instrumentation showed a tendency for a lower revision rate without statistical significance. However, the posterior procedures showed a high revision rate regarding to wound healing problems.