World Neurosurg
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Minimally invasive neurosurgical approaches reduce patient morbidity by providing the surgeon with better visualization and access to complex lesions, with minimal disruption to normal anatomy. The use of rigid or flexible neuroendoscopes, supplemented with a conventional stereoscopic operating microscope, has been integral to the adoption of these techniques. Neurosurgeons commonly use neuroendoscopes to perform the ventricular and endonasal approaches. It is challenging to learn neuroendoscopy skills from the existing apprenticeship model of surgical education. The training methods, which use simulation-based systems, have achieved wide acceptance. Physical simulators provide anatomic orientation and hands-on experience with repeatability. Our aim is to review the existing physical simulators on the basis of the skills training of neuroendoscopic procedures. ⋯ The state of simulation systems demands collaborative initiatives among translational research institutes. They need improved fidelity and validation studies for inclusion in the surgical educational curriculum. Learning should be imparted in stages with standardization of performance metrics for skills evaluation.
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Surgical scalpel broken is rarely reported in posterior lumbar discectomy or fusion surgeries, but when it happens and even the broken part is deeply located in the disk space, there is no guideline to remove it during the initial surgery. ⋯ Arthroscopic retrieval of a broken scalpel deeply located in the intradiskal space is recommended as an alternative method when conventional effort is unable to remove it, especially when the broken blade migrates anteriorly, which may provoke catastrophic consequences.
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Review Case Reports
Minimally Invasive Tubular Approach for Occipital Condylar Biopsy and Resection: Case Report and Review of Literature.
Patients with isolated occipital condyle lesions concerning for metastases rarely undergo surgical biopsies and are more commonly treated with empirical radiation with or without chemotherapy. This is likely related to the morbidity associated with open condylar approaches and the importance of surrounding structures. We present a minimally invasive technique to approach the occipital condyle using a tubular dilating retractor system. ⋯ This report, to our knowledge, presents the first case of a minimally invasive tubular retractor system-based approach for biopsy and resection of an occipital condylar metastasis causing occipital condyle syndrome. This approach allows for tissue diagnosis to precisely dictate medical management and minimizes the morbidity associated with traditional open surgical approaches.
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All interbody fusions are associated with a risk of subsidence. In the case of lateral lumbar interbody fusion (LLIF), an interbody device that spans the apophyseal rings reduces subsidence. Small interbody device size, aggressive end plate preparation, and poor bone quality are contributors to subsidence. The goal of this study was to analyze the perioperative morbidity, particularly the timing of subsidence (intraoperative vs. postoperative), associated with transpsoas LLIF. ⋯ As LLIF becomes more common, it is important to better understand common complications, such as subsidence, and the specific rates at which they occur. A unique finding of exclusive intraoperative subsidence was observed. The use of cage size to obtain segmental lordotic correction and indirect decompression must be weighed against the potential risk of subsidence.
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Review Case Reports
Hydrocephalus resulting from Late-onset Aqueductal Membranous Occlusion: A Case Report and Review of the Literature.
Late-onset aqueductal membranous occlusion (LAMO) is 1 of the few causes of noncommunicating hydrocephalus. Here, we report a case of LAMO and review the associated literature. ⋯ We treated a case of LAMO, which usually presents with headache as an initial symptom. 3D-DRIVE MRI is useful for detecting membranous occlusions and for evaluating pre- and postoperative CSF flow. LAMO can be cured by endoscopic third ventriculostomy and/or endoscopic aqueductoplasty.