World Neurosurg
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Advancements in microscopy and more recently in neuroendoscopy have revolutionized the field of neurosurgery. Handheld neurosurgical instruments are integral components of these procedures. However, these instruments have many limitations, such as poor ergonomics, constrained maneuverability, and limited degrees of freedom. A need for developing better instruments is commonly felt by neurosurgeons. Also, the focus of modern neurosurgical training is shifting toward simulation models. The baseline data of surgical instruments play a vital role in the development of virtual and physical simulators. A primary factor impeding development of novel instruments and simulators is lack of a comprehensive surgical instrument database. The aim of this study was to develop and validate a virtual repository of microscopic and neuroendoscopic instruments. ⋯ The virtual database is an efficient starting aid to foster research collaborations related to neurosurgical instruments and surgical simulation platforms.
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Stiff neck or nuchal rigidity is a significant clinical sign of neurologic disease. It is commonly associated with meningitis, subarachnoid hemorrhage, and posterior fossa tumors. It may also occur as a result of tonsillar impaction following pressure in the infratentorial compartment from an expanding posterior fossa mass. It is, however, not commonly known to be associated with uncal herniation. ⋯ In the presence of stiff neck or nuchal rigidity in a patient with clinical signs of uncal herniation from a temporal arachnoid cyst, this unusual association could possibly be owing to the effect of increased pressure in the posterior fossa from massive shift of brain tissue posteriorly following a rapid rise in middle cranial fossa pressure consequent on an acute enlargement of the cyst. A false impression of acute meningeal irritation in such a situation could be quite misleading, resulting in late diagnosis and subsequently a delay in timely intervention.
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Electrical bicycles (E-bikes) allow people of all ages to ride at high speeds but have an inherent risk of traumatic brain injury (TBI). Their sales have increased tremendously in recent years. ⋯ E-bikers had a significantly greater risk of moderate to severe TBI compared with bicyclists. Helmet use was associated with decreased odds of severe TBI in bicyclists and a tendency toward a more favorable outcome for E-bikers.
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Ventricular shunts are most commonly placed via a frontal or parietal approach. However, there is a paucity of data comparing complication and revision rates associated with these approaches in the idiopathic normal pressure hydrocephalus (iNPH) population. ⋯ These results suggest that the type of approach for shunting may not have a significant impact on complication and revision rates in patients with iNPH, and either approach is a reasonable first-line option.
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Migratory tumors of the spinal cord are rare and can present as a missing tumor intraoperatively. This can lead to unnecessary abandonment of surgery or unnecessary laminectomies. ⋯ Migratory schwannoma should be suspected in case of a missing lesion. Intraoperative ultrasonography and myelography use should be definitely considered where facility for intraoperative magnetic resonance imaging is not available. Preventive measures should be taken to avoid tumor migration in all routine cases of intradural extramedullary lesions.