World Neurosurg
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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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Schwannoma originating from the oculomotor nerve has been reported. However, meningioma originating from this nerve was unknown. ⋯ In such a case, tumor resection after GKS should be considered.
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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.
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Anterior lumbar interbody fusion (ALIF) is a widely performed lumbar fusion procedure especially suited for treating lower lumbar degenerative disk disease, discogenic disease, and revision of failed posterior fusion. Advantages of the technique include maximizing implant size and correction of lordosis, and disadvantages include approach-related complications such as retrograde ejaculation, visceral injury, and vascular injury. ⋯ Transforaminal endoscopic spine surgery is suggested here as a possible treatment approach for lumbar radiculopathy after ALIF.
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Patients with Klippel-Feil syndrome may present with neurologic complaints such as neck pain, radiculopathy and gait instability. Here we describe surgical management of a patient with congenital fusion of the occipital-cervical region and also block circumferential fusion of dens to T3 with spinal cord compression. This report is the first of its kind with such extensive fusion. ⋯ This is the first reported case of Klippel-Feil syndrome with fusion of all cervical vertebrae down to T3. We recommend surgery for advanced cases of myelopathy or radiculopathy due to stenosis and spinal instability.