Articles: neuronavigation.
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Comparative Study
Comparing Cortical Bone Trajectories for Pedicle Screw Insertion using Robotic Guidance and Three-Dimensional Computed Tomography Navigation.
Cortical bone trajectories (CBTs) for pedicle screw insertion can be used to stabilize the spine. Surgeons often rely on fluoroscopy or computed tomography (CT)-navigation technologies to guide screw placement. Robotic technology has potential to increase accuracy. We report our initial experience with robotic guidance for pedicle screw insertion utilizing CBTs in patients with degenerative disc disease. ⋯ Robotic technology and CT-navigation technology for CBT pedicle screw insertion were safe and accurate.
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The use of 5-aminolevulinic acid (5-ALA) in pediatric neuro-oncology is considered off-label, and little data are available on its use in tumor recurrence surgery. Here we present our experience with 5-ALA fluorescence-guided surgery for recurrent supratentorial tumors in the pediatric population. ⋯ The positive predictive value of solid fluorescence is high in recurrent disease but is substantially lower in areas of vague fluorescence. The rate of false-negative fluorescence is high. 5-ALA should be considered as an adjuvant in revision surgery with the aforementioned caveats in mind.
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Comparative Study
A 360° Approach to the Craniovertebral Junction in a Cadaveric Laboratory Setting: Historical Insights, Current, and Future Perspectives in a Comparative Study.
We herein outline the experience matured in our equipped Cranio-Vertebral Junction Laboratory for anatomic dissection. ⋯ During dissections, as in the clinical setting, endoscope and image guidance give the surgeon a constant orientation, increasing the accuracy and the safety of the approach. Nonetheless, the encumbrance of the endoscope could represent a limit in deep and narrow corridors as those running across the craniovertebral junction, especially in "oblique" FLA and ELA, in which the surgical target is often hidden by a delicate tangle of nerves and vessels. Its use appears more suitable and safer in "straight" approaches as transoral and transnasal in which there are no neurovascular structures interposed.
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Deep brain stimulation of the ventral intermediate nucleus (VIM) or caudal zona incerta (cZI) is effective for refractory essential tremor (ET). To refine stereotactic planning for lead placement, we developed a unique individualized anatomy-based planning protocol that targets both the VIM and the cZI in patients with ET. ⋯ Individualized anatomy-based VIM-cZI targeting is feasible and safe and is associated with favorable tremor outcomes.
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Endoscopic third ventriculostomy (ETV) is a widely accepted treatment for obstructive hydrocephalus. For most practitioners, this procedure will be performed without navigation guidance. Without such guidance, the complications associated with the procedure have ranged from 1% to 8%. We hypothesized that the discrepancy between the surface bony anatomy and internal cranial anatomy contributes to the morbidities associated with ETV. We tested this hypothesis by comparing the position of the entry point defined by the classic Kocher's point relative to the ideal entry point that would result in no manipulation of the endoscope defined by frame-based stereotaxis. ⋯ The use of stereotactic endoscopic techniques increase the safety of third ventriculostomy by adding precision and reducing otherwise unnecessary surgical maneuvering.