World Neurosurg
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Spinal vascular malformations (SVMs) are a heterogenous group of vascular abnormalities. The gold standard for diagnosis of SVMs is spinal digital subtraction angiography (DSA), which can be challenging because of the large number of segmental arteries that need to be catheterized and the limitations in term of contrast volume used and fluoroscopy time. We describe and compare the use of the time-resolved imaging of contrast kinetics (TRICKS) sequence and DSA in the diagnosis of spinal dural arteriovenous fistulas (SDAVFs) in our institution. ⋯ TRICKS MRI represents an accurate screening tool to be performed before a spinal DSA in order to guide the interventionalist to focus on the correct level ±2 levels; this extra noninvasive screening tool will decrease the risk of a kidney injury from an overuse of contrast and minimize the fluoroscopy/radiation overexposure.
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Neuronavigation applied to Piezosurgery: towards Robotic image-aided craniotomies? A technical note.
Although simple in its concept, craniotomy can still cause serious consequences to the patient. A recent alternative to standard techniques (i.e., perforator and craniotome) is represented by piezosurgery (PS), which exploits a microvibration-emitting blade that cuts the bone directly from the outer surface of the skull. Although PS has been demonstrated to decrease complications, dural lacerations and neurovascular injuries are still possible from inadvertent penetration of the inner tabula. Modern neuronavigation systems can provide the surgeon with the possibility to track the instrument while carving the skull, thus potentially lowering the complication rates. ⋯ Neuronavigated PS has the potential to decrease craniotomy-related complication rates. By allowing for real-time visualization of the blade's level of penetration, it provides the surgeon with the ability to halt progression when needed, avoiding dural lacerations and neurovascular injuries. The principles behind this technique could anticipate the advent of robotic-image aided craniotomy.
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Chondroblastomas are rare tumors that account for <1% of all bone tumors, and 5.7% of them occur in the skull. The aim of this study was to investigate factors related to their functional prognosis by conducting a systematic review, including our own case. ⋯ As temporal chondroblastoma poses a risk of residual postoperative symptoms when the tumor grows, aggressive surgical treatment should be considered even in asymptomatic or small tumors.
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The S2-alar-iliac (S2AI) screws have been described as an alternative method for lumbosacropelvic fixation in place of iliac screws. However, the clinical effect of the short-segment S2AI screw fixation technique in the treatment of unstable posterior pelvic ring injuries remains unclear. In this study, we report the preliminary clinical results of the internal fixation connecting a S2-alar-iliac screw and a S1 pedicle screw (i.e., S2AI-S1 fixation) in the treatment of unstable pelvic posterior ring injuries. ⋯ The case series presented in this study show the successful use of S2AI-S1 fixation to treat unstable posterior pelvic ring injuries. The S2AI-S1 fixation, not including the lumbar spine in the fixation range, is a simple, safe, and effective fixation method.
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Spinal epidural lipomatosis (SEL) is characterized by symptomatic neurogenic compression from adipose tissue in the spinal canal. The question arises whether patients with morbid obesity have higher volumes of epidural adipose tissue (EAT) in their lumbar spinal canal compared with patients with a normal weight, and to what extent this decreases after bariatric surgery. ⋯ Patients with obesity have significantly larger volumes of EAT in comparison with patients with normal weight. After bariatric surgery, a significant weight loss coincided with a significant volumetric reduction of this adipose tissue in the spinal canal. Future prospective studies in patients with symptomatic SEL may elucidate whether decreases in EAT volume influence concurrent neurogenic claudication symptoms.