World Neurosurg
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The aim of this study was to discuss the relationship between Ki-67 values and the degree to which chordoma invade the clivus and to certify that the prognosis of chordoma is worse when it invades the middle and lower clivus than when it does not. ⋯ Statistical analysis revealed that Ki-67 values when the chordoma invaded the middle and lower clivus were significantly higher than when it did not. Thus, we can conclude that the prognosis is worse when chordoma invade the middle and lower clivus.
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The treatment of spinal metastasis carries significant surgical morbidity, and decompression and stabilization are often necessary. Less invasive techniques may reduce risks and postoperative pain. This study describes the differences between a mini-open (MO) procedure and a traditional open surgery (OS) for symptomatic spinal metastasis, and reports differences in outcome for similar patients undergoing each procedure. ⋯ Although further studies are needed, the MO approach appears to result in decreased blood loss and postoperative pain, without compromising neural element decompression or spinal stability. These findings are consistent with the use of muscle sparing, minimally invasive pedicle screw fixation.
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Posterior circulation strokes account for over one quarter of all ischemic strokes. The frequency of vertebral artery origin stenosis (VAOS) in patients with vertebrobasilar insufficiency (VBI) has been estimated to be as high 26%-32%, and VAOS is the direct cause of posterior circulation strokes in 9% of patients. This association could have a significant genetic component. This study examines the feasibility of the internal thoracic artery (ITA) as a donor vessel for revascularization in patients with VAOS. ⋯ This study indicates that the ITA is anatomically and hemodynamically an excellent option for bypass surgery in a VAOS scenario. We present convincing and reproducible data to aid neurosurgeons in choosing the procedure best suited to their patients.
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Quality assurance (QA) is a way to prevent mistakes in advance. Although it has been previously reported for surgical setup, there is no effective approach for minimizing microsurgical technical errors before an operation is done. Neurosurgery resident operative errors during brain aneurysm surgery could be foreseen by practicing in an ex vivo hybrid simulator with microscopic fluorescein vessel flow image. ⋯ There was a left-shift on the quality assurance line with residents who practiced brain aneurysm microsurgical errors in an ex vivo model. A multicentric prospective study is necessary to confirm the hypothesis that real operative error could be reduced after training in a realistic simulator.
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Stereotactic radiosurgery is a modern discipline that emerged after World War II. It represents a synthesis of an approach to patient care that was not immediately embraced by either neurosurgeons or radiation oncologists, but which has been shown, time and again, to be advantageous for the treatment of intracranial pathology. ⋯ Any examination of the individuals, devices, and technological advances that permitted stereotactic radiosurgery to become a preferred approach for patient care cannot be absolutely comprehensive but can provide insights into the evolution of the specialty and potential future prospects for further improvements in patient care. As Shakespeare wrote in The Tempest, "What's past is prologue."