World Neurosurg
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In recent years laser interstitial thermal therapy (LITT) has become the ablative neurosurgical procedure of choice. Multiple methods for registration and laser fiber verification have been described, with each method requiring multiple steps and significant time expenditure. We evaluated the use of a commercially available mobile computed tomography (CT) scanner for stereotactic registration during LITT for brain tumors in an attempt to simplify the procedure and improve intraoperative awareness of laser position. ⋯ Use of a mobile intraoperative CT scanner for navigation registration and confirmation of laser position during LITT may play a role in streamlining the procedure and improving patient safety and comfort.
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Case Reports
Post-Traumatic Charcot (Neuropathic) Spinal Arthropathy at Cervicothoracic Junction: Case Report.
Charcot spine arthropathy (posttraumatic neuroarthropathy of the spine) has been reported to be a very late and rare complication of spinal cord injury. Charcot of the cervicothoracic and upper thoracic region rarely is reported in the literature. Charcot spinal arthropathy is a cause of progressive deformity and may present as late as 30 years after the original spinal cord injury. This is more common in paraplegic patients who are actively ambulating. ⋯ We present this case because of the challenges in surgery for instrumentation of new Charcot spinal arthropathy. Reports of neuroarthropathy developing above the level of spinal cord injury and at the cervicothoracic junction are rare. The treating surgeon should be cognizant of the possibility of developing secondary levels of neuroarthropathy above and below a previously successful fusion.
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Clinical Trial
Minimally Invasive Tubular Resection of Lumbar Synovial Cysts: Report of 40 Consecutive Cases.
Lumbar synovial cysts are a relatively common clinical finding. Surgical treatment of symptomatic synovial cysts includes computed tomography-guided aspiration, open resection and minimally invasive tubular resection. We report our series of 40 consecutive minimally invasive microscopic tubular lumbar synovial cyst resections. ⋯ Minimally invasive microscopic tubular retractor resection of lumbar synovial cysts can be done safely and with comparable outcomes and complication rates as open procedures with potentially reduced operative time, length of stay, and healthcare costs. Patient selection for microscopic tubular synovial cyst resection is based in part on the anatomy of the spine and synovial cyst and is critical when recommending minimally invasive vs. open resection to patients.
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The lumbar neural foraminal stenosis still is a challenging condition in minimally invasive spine surgery. Because of the anatomic situation a complete decompression of the nerve root often leads to a subtotal facetectomy associated with potential instability and the need for additional instrumentation of the decompressed segment. The iO-Flex system was introduced to address this problem by using a minimally invasive wire-guided microblade shaver to increase the neuroforaminal space by reducing the stenosis from intraforaminal while sparing bigger parts of the facet joint. In this study, we evaluated the feasibility and the surgical and radiological success in relation to the experience of the surgeon. ⋯ The flexible micro blade shaver system is feasible with a steep learning curve and achieves sufficient decompression of the neuroforamen in this cadaveric study.
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Although chronic subdural hematoma (CSH) can be treated by surgery, little is known about age-dependent symptoms and age-adjusted rates of restoring functional integrity. To evaluate the clinical symptoms and the course of CSH in patients of different age groups (AGs), we reviewed patients with CSH treated at our department over the past 22 years. ⋯ CSH predominantly caused unspecific symptoms such as headache and cognitive decline. CSH surgery immediately relieved symptoms in patients of all AGs. However, improvement rates significantly depended on patient age. This should be taken into consideration when advising on surgical treatment of CSH.