World Neurosurg
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We retrospectively reviewed the institutional experience in patients who underwent microsurgical resection of cavernous malformations (CMs) or arteriovenous malformations (AVMs) using a multimodal intraoperative protocol including neuronavigation, intraoperative ultrasound (i-US), computed tomography (i-CT), and neuromonitoring. ⋯ The combination of different intraoperative real-time imaging modalities (i-CT and i-US), coupled with neuromonitoring, in the surgical management of vascular lesions, particularly if located in eloquent areas, has a positive impact on clinical outcome.
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Pituitary apoplexy is a rare clinical syndrome. Only a few studies have examined factors associated with recovery of neuroendocrine functions following transsphenoidal surgery. This study aimed to identify factors associated with neuroendocrine recovery following surgery for pituitary apoplexy. ⋯ Older age, higher suprasellar extension, and hypertension were poor prognostic factors for visual recovery. Wilson-Hardy inferior invasion grade 3-4 and lower preoperative serum prolactin level were poor prognostic factors for recovery from hypopituitarism. Stratifying patients according to these prognostic factors may assist in selecting patients for surgery.
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Intraaxial tumors of the central lobe are challenging lesions to deal with because of the high eloquence of this anatomic area.1,2 Diffusion tensor imaging magnetic resonance imaging and fluorescein (F) have proven to be useful in the planning and execution, respectively of glioma surgery.3-9 Nevertheless, the advantages of intraoperative use of augmented reality (AR) with diffusion tensor imaging-based high-definition fiber tractography (HDFT) are still underestimated. In the AR HDFT-F technique reported by our group, the integration of AR into the microscope comes through the BrainLAB Curve navigation platform (BrainLAB AG, Munich Germany), Smartbrush software (BrainLAB AG), KINEVO 900 surgical microscope (Carl Zeiss, Oberkochen, Germany), and YELLOW 560 filter (Carl Zeiss).9 The microscope establishes a wired autodetection of the navigation platform, and the eyepiece functions as a "see-through display" of the AR images, which are overlapped onto the surgical field. Video 1 shows the technical key aspects of the intraoperative use of the AR HDFT-F technique in the maximal safe anatomic resection of a postcentral gyrus high-grade glioma.
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Correction of kyphotic deformities of the spine is a common problem faced by spine surgeons. Unfortunately, there are no clear published guidelines available regarding the extent of spinal fusion required to achieve and maintain lasting deformity correction. We aim to share a set of novel radiographic parameters ("the Circle") that can be used as a guideline for determining the extent of fusion required in surgical correction of spinal kyphotic deformity. ⋯ The Circle is a novel set of radiographic parameters that may be used to educate and guide surgical plans and extent of fusion when aiming to correct spinal kyphotic deformities.
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Surgical spinal cord injury (SSCI) is often inevitable in patients with intramedullary lesions. Although regional hypothermia (RH) has been demonstrated neuroprotective, the value of priming RH in SSCI has never been studied. Herein, the authors investigated the impact of pre- and post-RH on neurologic recovery in a clinically relevant model. ⋯ Priming RH before surgical incision could not be supported as it caused excessive cell death. In contrast, instant introduction of RH is beneficial in rescuing neurologic function.