World Neurosurg
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Case Reports
Data-driven identification of the regions of interest for fiber tracking in patients with brain tumors.
We investigated the added value of combining information from direction-encoded color (DEC) maps with high-resolution structural magnetic resonance imaging scans (T1-weighted images [T1WIs]) to improve the identification of regions of interest (ROIs) for fiber tracking during preoperative planning for patients with brain tumors. ⋯ Combining the information from diffusion-derived color-encoded maps with high-resolution anatomical details from structural imaging (T1WI-DEC map), especially in patients with brain tumors, could be useful for accurate identification of the ROIs.
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Comparative Study
Robot-assisted Percutaneous Pedicle Screw Placement: Evaluation of Accuracy of the First 100 Screws and Comparison to Cohort of Fluoroscopy-guided Screws.
Percutaneous pedicle screws (PPS) are used to stabilize the spine after interbody fusion in minimally invasive approaches. Recently, robotic assistance has been developed to improve the accuracy of PPS. We report our initial experience with ExcelsiusGPS and compare its accuracy with our historical cohort of fluoroscopy-guided PPS. ⋯ Our breach rates with ExcelsiusGPS were low and consistent with others reported in the literature, as well as with other robotic systems. Our series shows equivalent accuracy of placement of PPS with this robotic platform compared with fluoroscopic guidance and suggests a relatively short learning curve.
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Many studies of external-internal carotid artery (EC-IC) bypass as cerebral revascularization for unclippable internal carotid artery (ICA) aneurysms have reported surgical outcomes, including bypass patency and aneurysm resolution. However, no previous studies have assessed the long-term outcomes of cerebral blood flow (CBF), brain neural density, and cognition. The purpose of the present study was to evaluate the long-term outcomes of CBF and neurotransmitter receptor function using early and late images of iodine-123 (123I)-iomazenil (IMZ) single-photon emission computed tomography (SPECT) and the cognitive function of patients who had undergone EC-IC bypass for symptomatic aneurysms in the cavernous portion of the ICA. ⋯ Using early and late 123I-IMZ SPECT, the present study has demonstrated that patients undergoing uncomplicated cerebral revascularization for unclippable ICA aneurysms will not experience reductions in CBF or neurotransmitter receptor function, and their cognitive function was not impaired.
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Comparative Study
A comparison of subgaleal versus subperiosteal dissection in open cranial vault expansion for sagittal craniosynostosis.
The aim of this study was to evaluate surgical outcomes for patients with sagittal craniosynostosis undergoing open cranial vault remodeling with a modified pi procedure comparing subgaleal versus subperiosteal dissection. ⋯ Open posterior and middle cranial vault expansion is a safe and efficient method of open cranial vault expansion in sagittal craniosynostosis regardless of the plane of dissection. Elevation of the scalp flaps in the SG plane is a minor technical modification that can reduce blood loss and operative times.
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Rare and deep located tumors are surgical challenge with high morbidity. Minimal invasive techniques should be encouraged for a better outcome. Intralabyrinthine schwannoma (ILS) is a rare benign tumor that usually presents with hearing loss and tinnitus. Surgery is associated with high rate of facial paralysis and deafness. Radiosurgery is an option for tinnitus treatment, without the risk of facial paralysis. ⋯ Tumor control and symptoms relief could be safely achieved through a precisely plan using Gamma Knife radiosurgery, decreasing morbidity. This is the first radiosurgical description for a transmodiolar schwannoma.