Articles: neuronavigation.
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Randomized Controlled Trial
Visual field preservation in surgery of occipital arteriovenous malformations: A prospective study.
We reviewed our prospective study of patients with occipital arteriovenous malformations (AVMs) to assess whether the display of optic radiation diffusion tensor imaging (DTI) during neuronavigation-guided surgery can reduce the severity of postoperative visual field deficits (VFDs) and to evaluate the factors associated with visual field preservation. ⋯ A history of hemorrhage is an independent risk factor for VFDs associated with occipital AVMs. Although not showing superiority in postoperative mRS, functional MRI navigation-guided surgery may help to radically resect occipital AVMs and preserve patient visual fields. A 5-mm distance from the optic radiation may be a suitable safety margin for visual field preservation.
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Journal of neurosurgery · Nov 2015
Case ReportsBalloon-assisted microcatheter navigation for AVM embolization: technical note.
Recurrent feeders may preclude a successful arterial catheterization of arteriovenous malformations (AVMs). In this paper, the authors report their experience with the use of a compliant balloon to assist the microcatheter navigation in AVMs supplied by feeders with recurrent configuration. Eight patients with AVMs supplied by recurrent feeders had unsuccessful microcatheter navigation after multiple attempts to catheterize the pedicle. ⋯ There were no arterial perforations or thromboembolic events. The described technique is a straightforward method for providing support to microcatheter navigation in certain cases of cerebral AVMs supplied by recurrent arterial feeders. This simple yet effective maneuver may enhance outcomes of AVM embolization by eliminating the need for excessive attempts of catheterization.
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Journal of neurosurgery · Nov 2015
Cerebrospinal fluid reconstitution via a perfusion-based cadaveric model: feasibility study demonstrating surgical simulation of neuroendoscopic procedures.
Cadaveric surgical simulation carries the advantage of realistic anatomy and haptic feedback but has been historically difficult to model for intraventricular approaches given the need for active flow of CSF. This feasibility study was designed to simulate intraventricular neuroendoscopic approaches and techniques by reconstituting natural CSF flow in a cadaveric model. In 10 fresh human cadavers, a simple cervical laminectomy and dural opening were made, and a 12-gauge arterial catheter was introduced. ⋯ Furthermore, navigation of the cerebral aqueduct, fourth ventricle, prepontine cistern, and suprasellar cistern via the lamina terminalis was possible, providing a complementary educational paradigm for resident education that cannot typically be performed in live surgery. Surgical simulation plays a critical and increasingly prominent role in surgical education, particularly for techniques with steep learning curves including intraventricular neuroendoscopic procedures. This novel model provides feasible and realistic surgical simulation of neuroendoscopic intraventricular procedures and approaches.
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We report our institutional experience using an electromagnetic navigation system, without rigid head fixation, for awake craniotomy patients. The StealthStation® S7 AxiEM™ navigation system (Medtronic, Inc.) was used for this technique. Detailed preoperative clinical and neuropsychological evaluations, patient education and contrast-enhanced MRI (thickness 1.5mm) were performed for each patient. ⋯ This offers the same accuracy as optical navigation, but without head pin fixation or interference with intraoperative neurophysiological techniques and surgical instruments. The application of the electromagnetic neuronavigation technology without rigid head fixation during an awake craniotomy is accurate, and offers superior patient comfort. It is recommended as an effective adjunctive technique for the conduct of awake surgery.
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The Apollo system is a low profile irrigation-aspiration system which can be used for the evacuation of intracranial hemorrhage. We demonstrate the feasibility of using Apollo to evacuate intracranial hemorrhage in a series of three patients with combined neuronavigation, neuroendoscopy, and cone beam CT (CB-CT). ⋯ The Apollo system can be used within the neuroangiography suite for the minimally invasive evacuation of intracranial hemorrhage using simultaneous neuronavigation for planning and intraprocedural guidance, direct visualization with neuroendoscopy, and real time monitoring of progress with CB-CT.