World Neurosurg
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Refinements in optics and instrumentation have enabled surgeons to approach deep-seated intracranial diseases with reduced exposure and brain retraction. The anterior subtemporal keyhole approach is a minimally invasive route to the posterolateral aspect of the suprasellar area and petroclival region. ⋯ Endoscope-assisted microsurgery provides a means to approach selected lesions located in the posterolateral suprasellar region, perimesencephalic cisterns, and upper clivus and midclivus. The operative view can be maximized by introducing the 0° and 30° angled endoscopes. Minimally invasive techniques help to optimize surgical exposure and lessen parenchymal retraction, thus improving control of the surrounding neurovascular structures.
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Comparative Study
Spine Surgery Outcomes in the Elderly versus the General Adult Patient Population in the United States: A MarketScan Analysis.
To compare spine surgery outcomes in elderly patients (80-103 years old) versus general adult patients (18-79 years-old) in the United States. ⋯ Our results revealed significantly longer hospital stays, more in-hospital mortalities, and more in-hospital and 30-day complications after decompression without fusion, fusion without decompression, or decompression with fusion procedures in elderly patients.
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To investigate risk factors and complications of cervical spine surgery in elderly patients. ⋯ Patient comorbidities and clinical factors, such as longer operating time and emergency cases, impact risk of adverse events. Patients 70-74 years old and patients with at least 1 postoperative complication had an increased risk of unplanned readmission.
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Comparative Study
Postoperative neurosurgical infection rates after shared-resource intraoperative magnetic resonance imaging - a single center experience with 195 cases.
To determine the rate of surgical-site infections (SSI) in neurosurgical procedures involving a shared-resource intraoperative magnetic resonance imaging (ioMRI) scanner at a single institution derived from a prospective clinical quality management database. ⋯ The use of a shared-resource ioMRI in neurosurgery did not demonstrate increased rates of infection compared with the current available literature. The likelihood of infection decreased with the accumulating number of operations, underlining the importance of surgical staff training after the introduction of a shared-resource ioMRI.
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Case Reports
Ultra-high field template-assisted target selection for deep brain stimulation surgery: Technical note.
Template and atlas guidance are fundamental aspects of stereotactic neurosurgery. The recent availability of ultra-high field (7 Tesla) magnetic resonance imaging has enabled in vivo visualization at the submillimeter scale. In this Doing More with Less article, we describe our experiences with integrating ultra-high field template data into the clinical workflow to assist with target selection in deep brain stimulation (DBS) surgical planning. ⋯ In this article, we have described a workflow for the integration of high-resolution in vivo ultra-high field templates into the surgical navigation system as a means to assist with DBS planning. The method does not require any additional cost or time to the patient. Future work will include prospectively evaluating different templates and their impact on target selection.