World Neurosurg
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Although the interforniceal approach with the preservation of the fornix is useful during the endoscopic approach for retroforaminal colloid cysts, it carries a significant risk of memory and cognitive difficulties. Because most reports have reported the endoscopic approach to colloid cysts through the foramen with little emphasis on retroforaminal cysts, the aim of this study was to investigate colloid cysts as a special entity with regard to their different characteristics and surgical approaches and outcomes. ⋯ Retroforaminal colloid cyst represents a unique entity that requires special attention to its mode of growth. The endoscopic approach for retroforaminal colloid cysts is nearly the same as that for foraminal cysts. It has a lower incidence rate of postoperative memory changes, lower chances of total resection, and lower incidence rate of hard contents. Moreover, sufficient knowledge on morbid anatomy is important to avoid fornix injury.
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Magnified intraoperative visualization is of paramount importance during microsurgical procedures. Although the introduction of the operating microscope represented one of the most relevant innovations in modern neurosurgery, surgical vision and maneuverability can be limited in cases with unfavorable angles of attack. In such cases, the placement of the operating microscope can be difficult and result in significant discomfort to the surgeon. In previous decades, exoscopes were introduced as alternative tools to provide optimal ergonomics by decoupling the line of sight of the surgeon from the binocular lenses. However, exoscopic platforms entail interim manual adjustments of the camera position and setting. To overcome this limitation, robotic-assisted digital microscopy was developed. We have reported our preliminary experience with the RoboticScope to investigate the feasibility and safety of this novel digital system for intraoperative magnification. ⋯ The RoboticScope is a promising device that might represent a valuable alternative to conventional tools for intraoperative visualization in the resection of intracranial tumors.
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The thin-walled regions (TIWRs) of intracranial aneurysms have a high risk of rupture during surgical manipulation. They have been reported to be predicted by wall shear stress and pressure (PS) based on computational fluid dynamics analysis, although this remains controversial. In this study, we investigated whether the oscillatory shear index (OSI) can predict TIWRs. ⋯ OSI may be a unique predictor for TIWRs. Low OSI strongly corresponds with TIWRs of intracranial aneurysms.
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Few studies have examined a possible correlation between cervical disc degeneration and disc height. The aim of this study was to establish age-related changes and sex-specific differences of cervical disc height using magnetic resonance imaging (MRI) and to evaluate the relationship between degree of cervical disc degeneration and disc height in asymptomatic subjects. ⋯ This large-scale cross-sectional analysis of cervical spine MRI data in healthy subjects demonstrated that cervical disc height narrowing progresses with age. Cervical disc height narrowing is highly correlated with the progression of disc degeneration.
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Observational Study
Does COVID-19 affect perioperative morbidity and mortality for patients requiring emergency instrumented spinal surgery? A single-centre cohort study.
The coronavirus disease 2019 (COVID-19) pandemic sent shockwaves through health services worldwide. Resources were reallocated. Patients with COVID-19 still required instrumented spinal surgery for emergencies. Clinical outcomes for these patients are not known. The objective of this study was to evaluate the effects of COVID-19 on perioperative morbidity and mortality for patients undergoing emergency instrumented spinal surgery and to determine risk factors for increased morbidity/mortality. ⋯ Emergency instrumented spinal surgery in patients positive for COVID-19 was associated with increased length of hospital stay. There was no difference in occurrence of complications or intensive care unit admission. Risk factors for increased morbidity in patients with COVID-19 included smoking, abnormal BMI, preoperative oxygen requirement, fever and saturations <95%.