Articles: neuronavigation.
-
Navigated transcranial magnetic stimulation (nTMS) is increasingly used in presurgical brain mapping. Preoperative nTMS results correlate well with direct cortical stimulation (DCS) data in the identification of the primary motor cortex. Repetitive nTMS can also be used for mapping of speech-sensitive cortical areas. ⋯ Good overall correlation between repetitive nTMS and DCS was observed, particularly with regard to negatively mapped regions. Noninvasive inhibition mapping with nTMS is evolving as a valuable tool for preoperative mapping of language areas. Yet its low specificity in posterior language areas in the current study necessitates further research to refine the methodology.
-
Neuronavigation has become an intrinsic part of preoperative surgical planning and surgical procedures. However, many surgeons have the impression that accuracy decreases during surgery. ⋯ After registration, there is an ongoing loss of neuronavigation accuracy. The major factors were draping, attachment of skin retractors, and duration of surgery. Surgeons should be aware of this silent loss of accuracy when using neuronavigation.
-
Pelvic fixation is a crucial adjunct to many lumbar fusions to avoid L5-S1 pseudarthrosis. It is useful for treatment of kyphoscoliosis, high-grade spondylolisthesis, L5-S1 pseudarthrosis, sacral tumors, lumbosacral dislocations, and osteomyelitis. The most popular method, iliac fixation, has drawbacks including hardware prominence, extensive muscle dissection, and the need for connection devices. S-2 alar iliac fixation provides a useful primary or salvage alternative. The authors describe their techniques for using stereotactic navigation for screw placement. ⋯ Stereotactic guidance to navigate the placement of distal pelvic fixation with bilateral S-2 alar iliac fixation can be safely performed in patients with a variety of pathological conditions. Crossing the sacroiliac joint, choosing trajectory, and ensuring adequate screw length can all be enhanced with 3D image guidance. Long-term outcome studies are underway, specifically evaluating the sacroiliac joint.
-
J Neurol Surg A Cent Eur Neurosurg · May 2013
Case ReportsMini supraorbital approach to inferior frontal lobe cavernous malformations: case series.
Anterior surgical approaches to the inferior frontal lobe require large craniotomies with long incisions and some risk of cosmetic defects and surgical morbidity. A mini supraorbital keyhole approach is an alternative to these larger craniotomies. Inferior frontal lobe cavernous malformations are an excellent target for this minimally invasive approach, and we present our experience with two patients. ⋯ The mini supraorbital keyhole craniotomy with microsurgical technique and neuronavigation is an effective approach for treating cavernous malformations in the inferior frontal lobe. This minimally invasive approach reduces incision size, craniotomy size, and associated complications while enhancing cosmetic outcomes.
-
Navigated transcranial magnetic stimulation (nTMS) is a novel technology in the field of neurosurgery for noninvasive delineation of cortical functional topography. This study addresses the spatial accuracy and clinical usefulness of nTMS in brain tumor surgery in or near the motor cortex based on a systematic review of observational studies. ⋯ The nTMS technique spatially correlates well with the gold standard of DES. Its functional information benefits surgical decision making and changes the treatment strategy in one-fourth of cases.