World Neurosurg
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Case Reports
5-ALA enhanced fluorescence guided microscopic to endoscopic (M2E) resection of deep frontal subcortical GBM.
Glioblastoma multiforme remains the most common adult primary brain tumor with a life expectancy of 15-18 months following best treatment strategies. Current paradigms incorporate maximal safe resection, chemotherapy, and radiation.1 Multiple variables correlate with increased survival; perhaps most notably are stepwise survival advantages following 78% and 98% extent of resection thresholds.2,3 5-Aminolevulinic acid has become a vital tool in the intraoperative identification and differentiation of high-grade glioma as it provides a fluorescent effect capable of distinguishing tumor from normal brain tissue when observed under blue light, which to date has been used primarily via a microscopic light source.4 However, this effect is attenuated with increasing distance between the blue light source and the tumor, as in the case of deep seated resection cavities.5 We aimed to overcome this obstacle by using a blue light endoscope as the primary visualization platform, thereby advancing the light source directly into the resection cavity. We present the case of a 69-year-old man with a deep left frontal subcortical lesion proven to be glioblastoma multiforme on prior biopsy. ⋯ Tumor resection proceeded under direct blue light endoscopy with intermittent subcortical motor mapping until a threshold of 4 mA was reached. The patient had transient right arm and leg weakness. Postoperative magnetic resonance imaging confirmed >98% resection (Video 1).
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Managing retraction of the lumbar plexus is critical to safely perform lateral lumbar interbody fusion (LLIF) via the transpsoas approach. Occasionally, a transitional psoas is encountered at L4/5 and has been postulated to be a contraindication to transpsoas LLIF. A case series of patients with transitional psoas who underwent L4/5 LLIFs is presented. ⋯ Transitional psoas anatomy is frequently encountered in surgical candidates for L4/5 LLIF. Through careful identification of the lumbar plexus and judicious retraction, the transpsoas LLIF can safely be performed in these patients.
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The institution-wide response of the University of California San Diego Health system to the 2019 novel coronavirus disease (COVID-19) pandemic was founded on rapid development of in-house testing capacity, optimization of personal protective equipment usage, expansion of intensive care unit capacity, development of analytic dashboards for monitoring of institutional status, and implementation of an operating room (OR) triage plan that postponed nonessential/elective procedures. We analyzed the impact of this triage plan on the only academic neurosurgery center in San Diego County, California, USA. ⋯ During the COVID-19 pandemic, the University of California San Diego Department of Neurosurgery maintained an operative volume that was only modestly diminished and continued to meet the essential neurosurgical needs of a large population. Lessons from our experience can guide other departments as they triage neurosurgical cases to meet community needs.
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Continuing medical education and continuing professional development have been affected by the ongoing 2019 novel coronavirus disease (COVID-19) pandemic. Therefore, we developed the 2020 International Web-Based Neurosurgery Congress (2020 IWBNC), which became the first successful virtual neurosurgical congress. The aim of this article was to describe the experience designing and organizing a web congress by the 2020 IWBNC method. ⋯ Web-based academic meetings will continue to be a helpful educational tool for continuing medical education and continuing professional development. The 2020 IWBNC double-room method represents an alternative design that may be replicated by the academic community planning web congresses and similar events.
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To retrospectively evaluate influence of intraoperative positioning (semisitting vs. lateral decubitus) and surgeon's learning curve with regard to functional outcome of patients with vestibular schwannoma. ⋯ Follow-up over 3 decades illustrates a learning curve with significantly improved results. While the semisitting position accelerates the procedure and is associated with reduced blood loss, it does not significantly influence functional outcome.