World Neurosurg
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Computer vision (CV) is a subset of artificial intelligence that performs computations on image or video data, permitting the quantitative analysis of visual information. Common CV tasks that may be relevant to surgeons include image classification, object detection and tracking, and extraction of higher order features. Despite the potential applications of CV to intraoperative video, however, few surgeons describe the use of CV. A primary roadblock in implementing CV is the lack of a clear workflow to create an intraoperative video dataset to which CV can be applied. We report general principles for creating usable surgical video datasets and the result of their applications. ⋯ CV techniques can be applied to surgical video, but challenges for novice users may limit adoption. We outline principles in annotation workflow that can mitigate initial challenges groups may have when converting raw video into useable, annotated datasets.
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The present study aimed to perform a comprehensive data analysis of 47 consecutive patients treated in 8 years and to observe how clinical, radiologic, and surgical factors affect early and long-term outcomes, recurrence rate, and survival. ⋯ Among the examined variables, age seemed to strongly correlate with outcomes; better chances of recovery and a good postoperative outcome were observed in younger patients. Surfacing lesions had a better early functional outcome than did intramedullary located lesions. Patients' preoperative neurologic and functional status (mRS score ≤2) had a significant impact on late neurologic outcome. Progression-free survival correlated with the extent of tumor resection. Surgery should probably be performed before patients' neurologic decline, aiming to achieve maximal resection without compromising patients' quality of life.
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Many efforts are expended to improve health care quality in the surgical treatment of spinal conditions. However, the prevalence of reporting complications in spinal surgeries is highly heterogeneous, which is partially due to the lack of a universal and comprehensive system. ⋯ Almost one-third of spine surgical studies did not report complications in their results despite reporting clinical outcomes. The evidence quality of the study was directly related with the reporting of complications. A high heterogeneity regarding complication reporting was seen in the literature.
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The pterygopalatine fossa (PPF) is an inverted, pyramid-shaped space immediately behind the posterior wall of the maxillary sinus, and lesions arising here include juvenile angiofibromas, schwannomas, and, in exceptionally rare cases, malignant peripheral nerve sheath tumors.1,2 Surgical access to the PPF is challenging and has been historically achieved via an open transmaxillary approach associated with facial scaring/deformity as well as potential injury to facial and infraorbital nerve branches.3 We present the case of a 67-year-old woman with facial numbness secondary to a presumed trigeminal schwannoma in the right PPF on magnetic resonance imaging. This surgical video highlights the key stages in performing an endoscopic endonasal excision of a PPF tumor. We start with a wide medial maxillary antrostomy, mobilization of the inferior turbinate, ethmoidectomy, and sphenoidotomy. ⋯ The patient did not have any new deficits postoperatively, but histology indicated a malignant peripheral nerve sheath tumor and she underwent postoperative proton beam therapy. Postoperative surveillance magnetic resonance imaging at 14 months showed no tumor recurrence. The patient consented to the procedure in a standard fashion (Video 1).
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Computer-assisted spinal surgery as a technique for reducing radiation exposure to the operating staff and the complications of spinal deformity are receiving considerable attention. However, no technical reports have described the technique for navigating anterior correction of adolescent idiopathic scoliosis without C-arm fluoroscopy. The purpose of this study was to evaluate the efficacy and safety of this new C-arm-free anterior correction for scoliosis. ⋯ C-arm-free anterior correction offers safe, effective surgery for adolescent idiopathic scoliosis. The advantage of this new technique is no radiation exposure for medical staff at centers performing large numbers of spinal procedures.