Articles: neuronavigation.
-
Minimally invasive surgery is receiving considerable attention as a technique for reducing the complications of adult spinal deformity (ASD) surgery. For this technique, a new lateral osteotomy plays an important role to release fused vertebrae. We describe herein a novel navigated lateral osteotomy technique not requiring C-arm fluoroscopy to correct adult spinal deformities. ⋯ This novel navigated lateral osteotomy for ASD is a useful technique that enables minimally invasive surgery for fixed deformity. With this new technique, surgeons and operating room staff can avoid adverse effects of intraoperative radiation.
-
Case Reports
2-Dimensional Long Film O-Arm Imaging, an Alternative When Intraoperative Fluoroscopy Is Inadequate.
Obtaining intraoperative images of the spine in the obese patient and at the cervicothoracic junction have historically been technically difficult due to variable penetration and x-ray scatter. This is particularly true for spinal deformity cases, where clear visualization of the end plates is needed to determine if functional alignment has been restored to the spine. ⋯ The purpose of this report is to highlight 2 example spinal deformity cases that underscore the utility of this imaging technology. In both cases, standard intraoperative fluoroscopy visualization was unacceptable, so 2D long film images were obtained to assess postcorrection spinal alignment.
-
Computer-assisted navigation (CAN) has been shown to improve accuracy of screw placement in procedures involving the posterior cervical spine, but whether the addition of CAN affects complication rates, neurologic or otherwise, is presently unknown. The objective of this study is to determine the effect of spinal CAN on short-term clinical outcomes following posterior cervical fusion. ⋯ Surgeons should embrace navigation in the cervical spine at their own discretion, as use of CAN does not appear to be associated with increased rates of surgical complications or readmissions despite longer operative time.
-
Computer-assisted spinal surgery as a technique for reducing radiation exposure to the operating staff and the complications of spinal deformity are receiving considerable attention. However, no technical reports have described the technique for navigating anterior correction of adolescent idiopathic scoliosis without C-arm fluoroscopy. The purpose of this study was to evaluate the efficacy and safety of this new C-arm-free anterior correction for scoliosis. ⋯ C-arm-free anterior correction offers safe, effective surgery for adolescent idiopathic scoliosis. The advantage of this new technique is no radiation exposure for medical staff at centers performing large numbers of spinal procedures.
-
While benefits of neurosurgical intraoperative ultrasound (IOUS) are reported frequently, this method still has some significant pitfalls, which are described less often. However, sufficient knowledge on dealing with IOUS drawbacks, particularly various image artifacts, is important for successful surgery. We report a case of failed IOUS-guided pediatric cerebellar pilocytic astrocytoma resection, incorrectly evaluated as gross total resection according to IOUS. ⋯ Successful IOUS-guided reoperation using new IOUS technology and appropriate ultrasound imaging technique are described. The most probable reasons for initial resection failure and crucial points of reoperation, predominantly dealing with IOUS artifacts, are discussed. Neurosurgeons should be aware of IOUS limitations and have sufficient knowledge about how to overcome them before adopting routine use of this intraoperative imaging modality.