World Neurosurg
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The greatest advantage of local anesthesia (LA) in endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs) is that direct neurologic evaluation can be performed during the procedure, unlike with general anesthesia. However, the usefulness of such direct evaluation has not been established. In this study, we attempted to assess the effects of direct neurologic evaluation by identifying the causes, management, and outcomes of clinical symptoms during the procedure and procedure-related events during EVT under LA. ⋯ We demonstrated that appropriate management of clinical symptoms and procedure-related events under LA led to favorable outcomes of EVT of UIAs.
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We have described the integrated use of a neuronavigation-guided system for frameless stereotaxy (VarioGuide [Brainlab AG, Munich, Germany]) with intraoperative magnetic resonance imaging (iMRI) and 5-aminolevulinic acid (5-ALA) and report the advantages and disadvantages that the use of these tools together can have in the treatment of various types of intracerebral lesions. ⋯ The use of combination frameless stereotaxy with iMRI and 5-ALA has shown benefits in terms of safety and precision. Moreover, the use of these tools can simplify tumor removal after simple biopsy, widening the spectrum of indications.
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Observational Study
Navigated 3-dimensional intraoperative ultrasound for spine surgery.
To integrate 3-dimensional (3D) intraoperative ultrasound (iUS) data in spinal navigation. ⋯ Using 3D-iUS can be successfully integrated in spinal navigation. Automatic registration applying low-dose iCT and non-linear image registration offers displaying preoperative images in the same orientation as the 3D-iUS scan, as well as visualizing segmented structures in the navigated 3D-iUS data. This greatly facilitates image interpretation. Navigated 3D-iUS provides a possibility for navigation updating and immediate online quality control.
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We present a narrated video simulation (Video 1) using 3-dimensional anatomic software demonstrating the proper landmarks and relevant neuroanatomy for successful bedside external ventricular drain placement. External ventricular drains are commonly inserted at the bedside for emergent intracranial pressure monitoring and/or treatment of elevated intracranial pressure by cerebrospinal fluid drainage.1 Often, neurosurgical trainees perform this procedure early in their residency years.2,3 The relationship of the ventricle to the external skull landmarks may be a difficult concept to grasp for junior trainees who have had limited procedural experience. ⋯ In this video we highlight the relationship of the borders of the lateral ventricle to the insertion point at the skull during catheter placement. By using this resource for resident education, patient safety factors and resident procedural competence may be enhanced.
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In the setting of a previous proximal fusion, an asymmetric 3-column osteotomy (3CO) can provide tremendous deformity correction. Our goal was to evaluate outcomes and complications of asymmetric 3CO through the proximal fusion mass, for coronal malalignment in patients with previous long thoracic fusion for adolescent idiopathic scoliosis. ⋯ Patients with a history of previous thoracic fusion for adolescent idiopathic scoliosis and coronal malalignment may develop painful degeneration of the segments caudal to the fusion as adults. In this setting, extension of fusion to the sacropelvis alone may worsen the patient's coronal alignment. An asymmetric 3CO may be considered at the proximal fusion mass to achieve realignment objectives, with an acceptable complication rate and an expected improvement in outcomes.