World Neurosurg
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Unreliable neuronavigation owing to inaccurate patient-to-image registration and brain shift is a major problem in conventional magnetic resonance imaging-guided neurosurgery. We performed a prospective intraoperative validation of a system for fully automatic correction of this inaccuracy based on intraoperative three-dimensional ultrasound and magnetic resonance imaging-to-ultrasound registration. ⋯ Automatic and accurate correction of spatially unreliable neuronavigation is feasible within the constraints of surgery. The current limitations of the system were also identified and addressed.
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On September 25, 2015, the United Nations General Assembly adopted a 17-goal action plan to transform the world by the year 2030, ushering in the Era of Sustainable Development. These Sustainable Development Goals (SDGs) were designed to continue where the preceding Millennium Development Goals left off, expanding on the Millennium Development Goal successes, and facing the challenges encountered during the previous decade and a half. The current Era of Sustainable Development and its impact on a breadth of neurosurgical concerns provide several unprecedented opportunities to enhance political prioritization of neurosurgical care equity. Neurosurgeons could therefore be well positioned to participate in the leadership of these global health development and policy reform efforts. ⋯ This article contributes to the global neurosurgery movement by providing the socially and globally conscious neurosurgeon with a compass for directing the place of neurosurgery in the international agenda for sustainable development.
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The fundamental role of technological instruments in contemporary Neurosurgery is undisputed, and intraoperative magnetic resonance imaging (MRI) represents one of the best examples. The use of a modern high-field magnet and the possibility to match the MRI with an operative microscope and an integrated neuronavigation system has led to successful results in the surgical treatment of different diseases. At our institute, we have performed surgery routinely with the aid of intraoperative MRI over the last 15 years. ⋯ Furthermore, the possibility performing an intraoperative scan allows a comparison with preoperative images and, subsequently, the updating of the surgical strategy. Intraoperative diffusion-weighted imaging can detect possible territorial ischemia that would be amenable to intensive treatment. Although increased costs, increased surgical times, increased anesthesiology times, and the possible increased risk of surgical infection may represent some major limitation, the use of intraoperative MRI-equipped operative theaters with integrated neuronavigation systems can prove extremely helpful in the management of neurovascular conditions.
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Direct and/or indirect bypass surgery is the established approach for preventing stroke in patients with moyamoya disease. However, conventional indirect revascularization, including encephalo-myo-synangiosis, has some disadvantages associated with the mass effect of the temporal muscle under the bone flap and postsurgical depression in the temporal region. We devised a novel indirect revascularization method, using only the temporal fascia, to address the aforementioned disadvantages. ⋯ This surgical technique provides good clinical and cosmetic outcomes. It may also be one of the good surgical treatments available for symptomatic moyamoya disease.
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We sought to develop a new posterior fusion technique composed of bilateral C1 titanium cables and C2 pedicle screw-rods for treatment of atlantoaxial instability not suitable for C1 screw placement. ⋯ Posterior atlantoaxial fixation using C1 titanium cables and C2 pedicle screw-rod construct appears to be an effective and safe technique for treatment of atlantoaxial instability, which could be an alternative method for cases unsuitable for C1 screw placement when using C1-C2 screw fixation.