Articles: neuronavigation.
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Glycerol rhizotomy was originally described as an initial surgical treatment for trigeminal neuralgia after the failure of medical therapy. Here we describe its use as a salvage procedure, typically after failure of multiple other modalities including microvascular decompression, stereotactic radiosurgery, and/or other percutaneous procedures. Foramen ovale cannulation as a "salvage procedure" may be complicated by lack of cerebrospinal fluid (CSF) return despite adequate cannulation of the foramen ovale, making conventional fluoroscopic confirmation of adequate needle placement less certain. In this article, we describe the application of intraoperative CT, fused with high-resolution preoperative CT/MRI for neuronavigation to accurately cannulate the foramen ovale and Meckel's cave for glycerol rhizotomy. Intraoperative CT, again fused with high-resolution preoperative CT and MRI studies, was then used to confirm accurate trajectory through the foramen ovale and the adequate location of the needle tip in Meckel's cave before injecting glycerol. We present our initial experience with 14 patients who underwent glycerol rhizotomy by these techniques depending on intraoperative CT. It appears that intraoperative CT-guided neuronavigation provides a practical, reliable, and accurate route to the foramen ovale and aids in the confirmation of adequate needle placement even when there is a lack of CSF return. These methods may be especially useful for difficult cannulations typical in salvage procedures. In an era of feasible intraoperative guidance, with advanced stereotactic planning software allowing the fusion of intraoperative CT with high-resolution preoperative CT and MRI datasets, these techniques can be applied to foramen ovale cannulation for glycerol rhizotomy without major modification.
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A plethora of cutting-edge neuroimaging analyses have been developed and published, yet they have not hitherto been realized as improvements in neurosurgical outcomes. In this paper we propose a novel interface between neuroimaging and neurosurgery for aiding translational research. Our objective is to create a method for applying advanced neuroimaging and network analysis findings to neurosurgery and illustrate its application through the presentation of 2 detailed case vignettes. ⋯ The described interface has widespread applications for translational research including preoperative planning, neurosurgical training, and detailed patient counseling. A protocol for assessing its effectiveness and safety is proposed. Finally, recommendations for effective translation of findings from neuroimaging to neurosurgery are discussed, with the aim of making clinically meaningful improvements to neurosurgical practice.
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Chronic subdural hematoma evacuation can be achieved in select patients through bedside placement of the Subdural Evacuation Port System (SEPS; Medtronic, Inc., Dublin, Ireland). This procedure involves drilling a burr hole at the thickest part of the hematoma. Identifying this location is often difficult, given the variable tilt of available imaging and distant anatomic landmarks. This paper evaluates the feasibility and accuracy of a bedside navigation system that relies on visible light-based 3-dimensional (3D) scanning and image registration to a pre-procedure computed tomography scan. The information provided by this system may increase accuracy of the burr hole location. ⋯ A bedside cranial navigation system based on 3D scanning and image registration has been introduced. Such a system may increase the success rate of bedside procedures, such as SEPS placement. However, technical challenges such as the ability to scan hair and practical challenges such as minimization of patient movement during scans must be overcome.
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Comparative Study
A Single Surgeon Direct Comparison of O-arm Neuronavigation versus Mazor X™ Robotic-Guided Posterior Spinal Instrumentation.
We sought to compare intraoperative surgical instrumentation techniques with image-guidance versus robotic-guided procedures for posterior spinal fusion. ⋯ Although a trend toward greater accuracy was noticed with robotic technology when determining clinically acceptable screws, there was not a significant difference when compared with O-arm neuronavigation. However, robotic technology has a significant effect on both precision and accuracy in Gertzbein-Robbins A screw placement. Robotics does not have a clear advantage when discussing infection rates, intraoperative blood loss, or operative time.
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The present study analyzed the benefits of the use of tractography in the preoperative and intraoperative scenarios. ⋯ Intraoperative navigated tractography shortened the time of awake neuro-oncological surgery and might provide help in performing complete tumor resection. Also, tractography used in the preoperative planning could be a useful tool for better prediction of complete tumor resection.