World Neurosurg
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Variance between providers in neurosurgery can lead to inefficiencies and poor patient outcomes. Evidence-based guidelines (EBGs) have been developed; however, they have not been well implemented into the clinician workflow. Therefore, clinicians have been left to make decisions with incomplete information. Equally underused are the electronic health records (EHRs), which house enormous amounts of health data, but the power of that "big data" has failed to be capitalized on. ⋯ Variance reduction in neurosurgery through the integration of evidence-based decision support in EHRs will lead to improved patient safety, a reduction in medical errors, maximization of the use of the available data, and enhanced decision-making power for clinicians.
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Case Reports
Endoscopic Treatment of Thoracic Discitis with Robotic Access: A Case Report Merging Two Cutting-edge Technologies.
Emerging technologies in minimally invasive spinal surgery include surgical robots for navigation and spinal endoscopy. We applied these technologies in concert to treat a critically ill patient with thoracic discitis. ⋯ This case represents a novel endoscopic-robotic hybrid spine surgery that we believe will find further applications in spinal surgery.
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Dissection of C2 guiding to the C1 lateral mass and facilitation of screw placement: Technical note.
Surgical intervention at the craniovertebral junction requires preoperative and intraoperative planning to get optimum postoperative results. Careful positioning minimizes the risk of iatrogenic injury and can also facilitate adequate surgical exposure. Tortuous venous channels that are usually encountered as the dissection proceeds may cause excessive bleeding before reaching the lateral mass (LM). However, both localization and placement may be made easier by altering the dissection technique and modifying the patient's position. Traditionally, the military tuck position is described for the dorsal approach to the craniovertebral junction. The objective of this study is to emphasize the role of arc or bow like position, a modification of prone position for adequate placement of C1 LM screw in these cases. ⋯ Visual axis to the lateral mass of C1 in an arc/bow position with head elevation puts C1 LM more in the visual axis of the operator, which makes the trajectory straight without causing much angulation while inserting the screw. At the same time, the axis vertebra guides the surgeon to the C1 lateral mass with no handling of dura.
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Head trauma and neurosurgical-related osteomyelitis are common causes of cranial bone defect. Even though cranioplasty is considered a safe and well-consolidated procedure, there are still some issues about the flap's vascularization assessment. In this paper we describe a 2-staged cranioplasty procedure, focusing on the perioperative evaluation of the skin flap vascularization. Our goal is to assess if the skin flap's perfusion measurement with indocyanine green fluorescence can be considered a reliable method to predict good outcome in cranioplasties. ⋯ Surgical procedures were well tolerated; at 1 year of follow-up the cosmetic defect was unremarkable. Indocyanine green fluorescence can be a good aid to predict the probability of the skin flap survival by measuring its perfusion.
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Destruction of the spine is a huge complication of infectious spondylitis and surgical intervention is required. However, vertebral defect is a major problem after surgical intervention and numerous methods have been researched to solve this problem. There are known methods that use variously designed, patient-customized 3-dimensional (3D)-printed implants in various medical fields. The use of 3D-printed implants has also been attempted in treating defects in the spine. We present a case of failure of expandable titanium cage fusion after infection, treated using a 3D-printed implant. ⋯ A 3D-printed implant could be an acceptable and alternative treatment option for replacing a large vertebral defect.