World Neurosurg
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Intravascular ultrasound (IVUS) provides endoluminal views and cross-sectional images of carotid arteries but lacks overview of vascular territory provided by angiography. Co-registration of IVUS with angiographic images may provide the potential to navigate both imaging modalities in a synchronous manner. The objective of this study is to evaluate the feasibility and accuracy of co-registering both imaging modalities in the carotid vasculature of the neck. ⋯ Semiautomatic tracking and co-registration of angiography and IVUS is a new technology and has the potential to increase the use of IVUS in carotid disease and to proivde the opportunity to optimize procedural outcomes.
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Case Reports
Brain radionecrosis after adjuvant radiation therapy for a primary intracerebral undifferentiated sarcoma.
Primary intracranial sarcomas of the central nervous system are rare tumors. They mainly arise from intracranial mesenchymal tissue present in the meninges and can occur at any age. Sometimes osteosarcoma can involve the skull rather than long body bones. In this latter case it is the more common subtype. Surgery, when possible, is a mandatory option often associated with radiation therapy (RT) and chemotherapy. Brain radionecrosis (BRN) is commonly observed due to the growing use of radiosurgery and higher cumulative doses of radiation therapy. The combination of perfusion magnetic resonance imaging and 18fluoro-deoxy-glucose positron emission tomography can help to differentiate tumor progression from radiation injury. Steroids, anticoagulants, and bevacizumab usually control BRN. However, BRN can also have an unfavorable course. ⋯ Primary intracranial sarcomas of the central nervous system are less prevalent among older adults with respect to the younger population. The use of RT alone or combined with chemotherapy is aimed at prolonging survival. However, it is not clearly defined if adjuvant treatments affect this parameter in older patients. RT should be carefully discussed owing to its potential severe neurologic toxicity. Indeed, a BRN can have a significant impact on quality of life and lead to death in certain cases.
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Bilateral proximal upper limb loss is a dramatic life-changing event. Replacement of the lost function with prosthetic arms, including multiple mechatronic joints, has remained a challenge from the control, comfort, and pain management perspectives. Targeted muscle reinnervation (TMR) is a peripheral nerve surgical procedure proposed to improve the intuitive control of the prosthetic arm and for neuroma and phantom pain management. Moreover, osseointegrated percutaneous implants (OPIs) allow for direct skeletal attachment of the prosthetic arm, ensuring freedom of movement to the patient's residual articulations. ⋯ The use of TMR resolved the phantom pain bilaterally and the right-side neuroma pain. It had also substantially reduced the left side neuroma pain. The actual prosthetic control result was intuitive, although partially different from expectations. At 2 years after TMR, the patient reported improvement in essential activities of daily living, with a remarkable preference for the OPI prosthesis. Only 1 suspected case of superficial infection was noted, which had resolved. Overall, this combined treatment required a highly competent multidisciplinary team and exceptional commitment by the patient and her family.
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Home programme for acquisition and maintenance of Microsurgical Skills during the Covid-19 Outbreak.
During the current global crisis unleashed by the severe acute respiratory syndrome coronavirus 2 outbreak, surgical departments have considerably reduced the amount of elective surgeries. This decrease leads to less time in the surgical room to develop and improve the surgical skills of residents. In this study, we developed a training program to obtain and maintain microsurgical skills at home, using a smartphone camera and low-cost materials, affordable for everyone. ⋯ We developed a microsurgical skills training program to be performed at home, which can be easily reproduced. It allows residents to improve manual coordination skills and is regarded as a feasible adjunct for ongoing training for surgical residents.
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Primary Chiari malformations (CMs) are congenital defects of the skull base and brain. Among the 4 CM types, type I (CM-I) occurs most frequently and may cause somatosensorimotor, autonomic and vision symptoms. Presently, posterior fossa decompression alone (PFD) or with duraplasty (PFDD) and cerebellar tonsil (CbT) shrinkage tactics are standard treatments, albeit inherent issues. There has been no report on devising CbT suspension (CTS) to manage CM-I. ⋯ The PFDD + CTC + CTS regimen appeared to be safe and potentially more efficacious in patients with CM-I evaluated for the period, relative to PFDD + CTC or PFDD treatment. Future prospective studies were warranted.