World Neurosurg
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To investigate the clinical and imaging outcomes of posterior unilateral vertebral lamina fenestration debridement and bone grafting fusion combined with laminar reconstruction and instrumentation compared with the traditional posterior-only method for treating monosegment spinal tuberculosis. ⋯ The procedure of posterior unilateral vertebral lamina fenestration debridement and bone grafting fusion combined with laminar reconstruction and internal fixation is safe and effective in treating monosegment spinal tuberculosis. Compared with the conventional posterior-only approach, this method maximizes the retention and reconstruction of the posterior column and is minimally invasive, achieving faster postoperative recovery with fewer complications.
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Level I trauma centers use patient triaging systems to deploy neurosurgical resources and pursue good outcomes; however, data describing the effectiveness these triage systems are lacking. We reviewed the leveling protocol (cases designated urgent and emergent) of a regional Level I trauma center to obtain epidemiologic data about the efficiency of that system and identify areas for improvement. ⋯ To our knowledge, this is the first study of variability in PTR timing as a function of surgical urgency or indication. The most common leveled cases were craniectomies or craniotomies to relieve increased intracranial pressure, which were also the most common level 1 cases. Significant variability occurred within each leveling category; thus, further investigation is required.
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Internal auditory canal (IAC) lipomas are rare intracranial lesions. Consequently, preoperative imaging is essential in differentiating IAC lipomas from more common tumors such as vestibular schwannomas. The hallmark of lipomas on magnetic resonance imaging (MRI) is hyperintensity on T1-weighted images that suppresses on fat-suppressed sequences and does not enhance with gadolinium administration. ⋯ This case demonstrates the importance of ensuring that both fat-suppressed and non-fat-suppressed T1-weighted pregadolinium images are obtained in the diagnostic process of IAC lesions. It is therefore recommended that imaging centers ensure that such sequences are included in their MRI protocols.
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Case Reports
Novel Treatment of Cerebral Vasospasm Using Solitaire Stent Retriever-assisted Angioplasty: A Case Series.
Endovascular procedures such as intraarterial (IA) vasodilator injection and balloon angioplasty are used to treat medically refractory cerebral vasospasm. The effects of IA therapy may be short lived and thus require multiple treatments. Balloon angioplasty also has limitations including transient occlusion of the spastic blood vessel, possible endothelial injury, and limited access to proximal vessels. We aim to demonstrate a novel technique using a stent retriever for the management of medically refractory vasospasm, especially in distal vessels. Compared with balloon angioplasty, stent retrievers provide a passive, self-limiting expansion of blood vessels. Other benefits over balloon angioplasty include 1) ability to simultaneously inject IA vasodilators, 2) limited contact and damage to vessel wall, 3) nonocclusive expansion, and 4) technical ease. ⋯ We demonstrate the safety and efficacy of a novel technique for the treatment of medically refractory cerebral vasospasm using stent retriever angioplasty in distal vessels. Stent angioplasty can be used as an additional tool in the management of subarachnoid hemorrhage-induced cerebral vasospasm.
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Surgical proficiency is classically acquired through live experience in the operating room. Trainee exposure to cases and complex pathologies is highly variable between training programs.1 Currently, there is no standard for neurosurgical skill assessment for specific operative techniques for trainees. Cadaveric simulation has been used to demonstrate surgical technique and assess resident skill but often presents a significant financial and facility burden.2-4 Three-dimensional (3D) printing is an alternative to cadaveric tissue in providing high-quality representation of surgical anatomy; however, this technology has significant limitations in replicating conductive soft tissue structures for the use of cauterization devices and haptic learning for proper tissue manipulation.5-7 Our team has combined novel synthesis methods of conductive thermoplastic polymerization and 3-dimensional-printed cervical spine models to produce a layered biomimetic simulation that provides cost-effective and anatomically accurate education for neurosurgical trainees (Video 1). ⋯ The consistency of the thermoplastics can be tailored according to the desired soft tissue structures (skin, fat, fascia, muscle) according to the degree of polymerization. This cost-effective simulation was designed to represent the material and biomechanical properties of the cervical spine cortico-cancellous interface, as well as individual soft tissue components with specific anatomic details of muscle tendinous and ligamentous insertion. These features allow for representative start-to-finish surgical simulation that has not yet been made widely available to neurosurgical training programs.