World Neurosurg
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With the evolution of endoscopic instruments and techniques, full-endoscopic spine surgery has attracted more attention worldwide in recent years. At the initial stage, surgeons conducted endoscopic lumbar discectomy using the transforaminal approach. Next, interlaminar endoscopic lumbar discectomy was developed to treat a herniation disc at the L5-S1 level. ⋯ However, the steep learning curve of endoscopic procedures has remained challenging. The use of interlaminar endoscopic lumbar discectomy entails many essential skills to manage the different anatomical structures of the spine. From the perspective of successful and safe interlaminar endoscopic lumbar discectomy, we have discussed the technical considerations for endoscopic procedures.
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Transforaminal full endoscopic lumbar diskectomy (TELD) is a typical minimally invasive surgery, with the associated benefit of decreased possibility of anatomic structural injury, and is an effective alternative to open diskectomy. Among the various endoscopic spinal surgical techniques currently available, TELD is the most basic and traditional surgery that can be performed through the transforaminal route; it has been used for >30 years. Recently, with the advancements in surgical techniques, TELD has been successfully performed for patients with lumbar disk herniation of different types. ⋯ The second step is to determine a safe and easily accessible entry point and then landing and docking the working sleeve as close to the target as possible without causing exiting nerve root injury. The third step is complete decompression of the symptomatic nerve with free mobilization of the neural tissue. The final step involves performing foraminoplasty using an advanced technique to overcome the limitations associated with TELD in difficult cases.
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Magnetic resonance-guided focused ultrasound is a powerful new technology that is enabling development of noninvasive applications for complex brain disorders. This is currently revolutionizing the treatment of tremor disorders, and a variety of experimental applications are under active investigation. To fully realize the potential of this disruptive technology, many challenges have been identified, some of which have been addressed and others remain to be solved. ⋯ While lesioning is the primary approved application of magnetic resonance-guided focused ultrasound at present, the ability to transient and precisely open the blood-brain barrier has the potential to clear brain pathologies and deliver restorative therapies, but this more experimental method presents unique difficulties to overcome. Finally, regulatory and reimbursement hurdles currently remain complex and continue to limit widespread application of even approved, effective applications. Here we review many of these challenges, discuss several solutions that have already been developed, and propose potential options for addressing some of these complexities in the future.
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Bilateral subthalamic nucleus deep brain stimulation improves motor symptoms and treatment-related complications in patients with Parkinson's disease. However, some patients have trouble adjusting socially after successful neurosurgery, in part because of "unrealistic" expectations and psychiatric disorders. Preoperative psychological interventions focusing on these aspects could be beneficial for such patients. ⋯ Our results suggest that even if no overall increase in the social adjustment score was observed, patients with Parkinson's disease eligible for neurosurgery should undergo preoperative psychosocial therapy to define their expectations and help them in their psychological restructuration. This type of therapy, complementary to psychoeducation, could represent an opportunity to prevent postoperative deception and social maladjustment.
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We describe the possibility to create precise preoperative planning for endonasal endoscopic approaches to the anterior skull base by overlapping endoscopic and radiologic anatomy. The important anatomic structures were marked. Morphometric measurements between these anatomic landmarks were performed endoscopically and compared with radiologic measurements of the same areas to ensure result compatibility. ⋯ During endonasal endoscopic anterior skull base surgery, the area between the anterior border of the sphenoid sinus and PEA artery was safe as the first dissection zone. Preoperative radiologic width and depth measurements facilitate orientation to the endoscopic anatomy during surgery and help predict the endonasal surgical corridor anatomy preoperatively.