World Neurosurg
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It is crucial to identify a shunt point for spinal arteriovenous malformation (AVM) treatment. For this purpose, some intraoperative supports have been reported-intravenous injection of indocyanine green (ICG), selective arterial injection of ICG, and selective arterial injection of saline with a high frame rate digital camera. However, there are difficulties in accurately identifying the shunt point, especially if the lesion has multiple feeders. The aim of this technical note was to report a novel method, selective arterial injection of saline to subtract signals of ICG, to precisely identify perimedullary arteriovenous fistula shunt points having multiple feeding arteries. ⋯ Despite having similar invasiveness, selective arterial injection of saline to subtract signals of ICG is superior to previously described techniques, such as selective arterial injection of ICG. Therefore, it will be useful in spinal arteriovenous malformation surgical treatment.
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Stand-alone minimally invasive approaches for the surgical management of spinal dumbbell tumors carry the risk of incomplete resections and impaired hemostasis. More-extensive approaches require subsequent instrumentation with metal artifacts impairing follow-up imaging. Here, we present a technical note on percutaneous instrumentation using carbon fiber-reinforced polyether ether ketone (CFR-PEEK) hardware combined with a minimally invasive posterolateral approach for tumor resection. ⋯ Resection of dumbbell tumors via a minimally invasive posterolateral approach and instrumentation with CFR-PEEK hardware allows maximal and safe resection. Due to lack of major metal artifacts, carbon fiber hardware improves the interpretation of follow-up imaging as well as planning of radiation if required for tumor recurrence.
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Attainment of micro-neurosurgical skills is a challenge in teaching hospitals throughout training. Models that mimic the workflow as well as haptics are time-consuming, expensive, and unsuitable to serve as a routine platform. Our objective was to present a model and a set of tasks, based on a hard-boiled egg, microscope, and a Cavitron ultrasonic aspirator (CUSA; Integra Lifesciences Corp., Tullamore, Ireland), which is cheap, easy to setup and can be used for training microsurgery and CUSA skills, required for removal of deep-seated tumors. ⋯ The egg model is an easy-to-handle, cheap model that enables the acquisition of basic micro-neurosurgical skills and basic workflow required for removing of intrinsic brain tumors. This study has validated and defined reproducible tasks that can be scored, correlated with performance. This model can be incorporated into a resident's routine and potentially provide an accessible training platform for neurosurgical trainees.