Articles: neuronavigation.
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Traumatic spondylolisthesis or hangman's fracture is a common cervical spine fracture. Most cases of traumatic spondylolisthesis are treated nonoperatively with external immobilization. The indications for surgery have generally included fracture instability or failed nonoperative management. Operative stabilization can be performed through either anterior or posterior approaches and has generally required instrumentation using open methods. We propose a technique for surgical repair of hangman's fracture that is minimally invasive and motion preserving using recent advances in 3-dimensional image-guidance technology. We believe this method represents another option in the treatment of hangman's fractures, because it allows for immediate stabilization, prompt recovery, and quick mobilization. ⋯ We have provided 2 examples in which minimally invasive unilateral fixation of hangman's fractures proved to be safe and effective. In both cases, the patients were immediately relieved of their pain, quickly mobilized, and promptly discharged. The achievement of successful fusion confirmed at the follow-up examinations.
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Minimally invasive surgery using a mini-open lateral retropleural or retroperitoneal approach for corpectomy is a well-described procedure for treating unstable thoracolumbar burst fractures. Most surgeons have incorporated fluoroscopy for localization and determination of hardware placement accuracy; however, the utility of computer-assisted image-guided spinal navigation has not been well described. We report a series of mini-open lateral approach thoracolumbar corpectomy cases using either fluoroscopy or intraoperative computed tomography (iCT) with computer-assisted navigation and discuss the technical nuances and advantages of using iCT with navigation versus fluoroscopy. ⋯ The use of iCT with spinal navigation for mini-open lateral corpectomy for thoracolumbar burst fractures yields perioperative and clinical outcomes comparable to those using traditional fluoroscopy, with decreased radiation exposure to surgeons.
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J. Neurosci. Methods · Jan 2019
MRI guidance technology development in a large animal model for hyperlocal analgesics delivery to the epidural space and dorsal root ganglion.
Development of new analgesic drugs or gene therapy vectors for spinal delivery will be facilitated by "hyperlocal" targeting of small therapeutic injectate volumes if spine imaging technology can be used that is ready for future clinical translation. ⋯ MRI-guided hyperlocal delivery in swine provides a translatable and faithful model of future human spinal novel drug- or gene therapy vector delivery.
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J Neurosurg Pediatr · Jan 2019
Accuracy of robot-assisted versus optical frameless navigated stereoelectroencephalography electrode placement in children.
OBJECTIVE The aim of this study was to compare the accuracy of optical frameless neuronavigation (ON) and robot-assisted (RA) stereoelectroencephalography (SEEG) electrode placement in children, and to identify factors that might increase the risk of misplacement. METHODS The authors undertook a retrospective review of all children who underwent SEEG at their institution. Twenty children were identified who underwent stereotactic placement of a total of 218 electrodes. Six procedures were performed using ON and 14 were placed using a robotic assistant. ⋯ Increased soft-tissue thickness, bone thickness, and younger age reduced accuracy at entry. There were no complications. CONCLUSIONS RA stereotactic electrode placement is highly accurate and is significantly more accurate than ON. Larger safety margins away from vascular structures should be used when placing deep electrodes in young children and for trajectories that pass through thicker soft tissues such as the temporal region. ABBREVIATIONS CTA = CT angiography; IQR = interquartile range; MEG = magnetoencephalography; ON = optical frameless neuronavigation; RA = robot-assisted; SEEG = stereoelectroencephalography.
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Real-time stereotactic navigation for transanal total mesorectal excision has been demonstrated to be feasible in small pilot series using laparoscopic techniques. The possibility of real-time stereotactic navigation coupled with robotics has not been previously explored in a clinical setting. ⋯ The combination of stereotactic navigation and robotic surgery is feasible, although some limitations and technical challenges were observed. For complex surgery, the addition of navigation to robotics can improve surgical precision. This will likely represent the next step in the evolution of robotics and in the development of digital surgery.