Articles: surgery.
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Neuronavigation is a result of the introduction and integration of high technologies into modern neurosurgery. The method is becoming increasingly available, and more than ever, its "fashionable", ungrounded application (literally, in each neurosurgical procedure) requires objective evaluation of its real usefulness. The aim of the present survey was to analyze the use of neuronavigation in the general fields of modern cranial neurosurgery. ⋯ We studied the neuronavigation assisted interventions in tumor surgery, skull-base surgery, biopsies, neuroendoscopy, functional neurosurgery, vascular neurosurgery and surgical procedures in the proximity of functionally important cortical zones. We showed the modern tendencies in neuronavigation and outlined the social and economic aspects of neuronavigation-assisted neurosurgery. A summary of the advantages and disadvantages of frameless stereotaxy is made.
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The use of C2 laminar screws in posterior cervical fusion is a relatively new technique that provides rigid fixation of the axis with minimal risk to the vertebral artery. The techniques of C2 laminar screw placement described in the literature rely solely on anatomical landmarks to guide screw insertion. The authors report on their experience with placement of C2 laminar screws using three-dimensional (3D) fluoroscopy-based image-guidance in eight patients undergoing posterior cervical fusion. ⋯ Postoperative computed tomographic (CT) scanning was available for seven patients allowing evaluation of placement of thirteen C2 laminar screws, all of which were in good position with no spinal canal violation. The intraoperative planning function of the image-guided system allowed for 4-mm diameter screws to be placed in all cases. Using modified Odom's criteria, excellent or good relief of preoperative symptoms was noted in all patients at final follow-up.
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To investigate if the addition of dexmedetomidine to meperidine in a patient-controlled analgesia (PCA) device would reduce postoperative meperidine consumption when compared with meperidine alone. ⋯ When compared with meperidine PCA, meperidine-dexmedetomidine PCA reduces postoperative meperidine consumption.
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We present a case of traumatic fibular bowing associated with ankle fracture in a 14-year-old girl. Acute traumatic bowing deformities of the fibula have always been reported as associated with mid-shaft tibial fractures, but involvement of the distal fibula associated with an ankle fracture has not been reported. The clinical picture is described and the mechanism of injury discussed.
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Journal of neurosurgery · Apr 2008
Intraoperative acquisition of three-dimensional imaging for frameless stereotactic guidance during transsphenoidal pituitary surgery using the Arcadis Orbic System.
Intraoperative fluoroscopy has long been used for anatomical localization in transsphenoidal pituitary surgery. More recently, frameless stereotaxy has been used to supplement 2D sagittal radiographs with 3D multiplanar reconstructions. Use of Arcadis Orbic allows both conventional fluoroscopic views and multiplanar reconstructions to be acquired intraoperatively without need for preoperative planning studies. The authors report their initial experience using Arcadis Orbic during transsphenoidal pituitary surgery. ⋯ Arcadis Orbic provides excellent quality 2- and 3D images during transsphenoidal pituitary surgery, and intraoperative frameless navigation using these images is highly accurate. Arcadis Orbic is easy to use, even in patients with large body habitus, and image acquisition takes no longer than registration during a frameless stereotactic case. Based upon our preliminary experience, Arcadis Orbic precludes the need for preoperative CT studies in patients with pituitary lesions requiring frameless stereotactic navigation.