World Neurosurg
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Case Reports
3D-exoscope-assisted occlusion of a foraminal intradural left L5-S1 arteriovenous fistula - Operative Video.
Spinal dural arteriovenous fistulas (dAVFs) are a rare type of spinal lesion that can cause severe clinical consequences.1 Early and accurate diagnosis and treatment are crucial to avoid severe complications such as radicular pain, weakness, sensory deficits, and loss of bowel and bladder control.2 Spinal dAVFs are commonly found in the lower thoracic or upper lumbar vertebrae. Spinal dAVFs are the most common spinal vascular malformations, of unknown cause, accounting for 70%-85 % of spinal shunts, with an annual incidence of 5-10 cases/1,000,000.3 Recently, they have been classified into extradural and intradural types, which may be further divided into dorsal and ventral lesions.4,5 Spine magnetic resonance imaging (MRI) is the most performed imaging study for suspected dAVF diagnosis.1 Catheter digital subtraction angiography (DSA) represents the gold-standard diagnosing technique. It provides critical information about the anatomy of the lesion, arterial inflow vessels, venous outflow, and endovascular treatment feasibility. ⋯ Endovascular embolization might be safe and efficient, with high success rates, for selected vascular lesions.7,8 This video presents a rare case of left L5-S1 dAVF, surgically occluded with the aid of a three-dimensional (3D) exoscope (Video 1). There is little evidence about the application of the 3D exoscope in spinal vascular microsurgery, whereas it has been widely used and described in cranial surgery and spinal, degenerative, tumor, and traumatic surgery.9 In our experience, the advantages of this operating tool are the sharp color vividness, which allows adequate discrimination of anatomic structures, the distinct depth perception, the educational value for operating room attendants, and the ergonomics for surgeons. Ergonomics for surgeons, especially, is optimally adapted to spinal surgery, given the contraposed placement of surgeons and the disposition of screens during the operating procedure.
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Preoperative diagnoses of psychiatric disorders have a demonstrated association with higher rates of perioperative complications. However, recent studies examining the influence of psychiatric disorders on lumbar fusion outcomes are scarce. Our objective was to determine the relationship between the most common psychiatric disorders and perioperative outcomes after lumbar fusion. ⋯ Patients with depression, bipolar disorder, or anxiety exhibited higher rates of certain types of complications. However, they appeared to have fewer neurological injuries and wound complications than patients without these psychiatric disorders. These findings highlight the necessity for additional studies to elucidate underlying reasons for these disparities.
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Case Reports
Safe endovascular recanalization of internal carotid artery occlusion using retrograde aspiration angiography.
Cerebral infarction, resulting from acute internal carotid artery (ICA) occlusion, typically manifests with a wide ischemic area and severe symptoms. Mechanical thrombectomy proves effective within 24 hours of disease onset and in less ischemic infarction core. However, in cases with well-developed collateral flow and mild symptoms, conservative treatment is initially selected. If symptoms worsen or ipsilateral hemisphere perfusion decreases, superficial temporal artery-middle cerebral artery anastomosis is considered. Revascularization therapy may also be effective. Contralateral angiography allows for ipsilateral blood flow verification once complete revascularization is achieved, albeit with potential treatment-related complications. Here, we describe retrograde angiography using an intermediate catheter (IMC) and contralateral contrast injection to achieve safer revascularization. ⋯ Advancements in IMC technology facilitate distal catheter guidance to the ICA, even in proximal occlusion. Combining this technique with contralateral imaging allows us to confirm the extent of occlusion and recanalization status without antegrade imaging, making recanalization therapy safer.
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Relationships between low socioeconomic status and surgical outcomes are well established for certain procedures. However, scant literature has focused on relationships between median household income and lumbar fusion outcomes. ⋯ Reduced household income significantly affected perioperative outcomes after lumbar fusion and should be taken into consideration during the perioperative period.
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To assess the utility of 3D printing positioning technology for resection of parasagittal meningioma. ⋯ The application of 3D printing positioning technology in parasagittal meningioma surgery could improve the location of craniotomy, and reduce the postoperative hospital stay. It is a low-cost positioning technology, and has the potential to be applied to other superficial intracranial tumors.