Intraoperative Cone-Beam Computed Tomography Assessment of Spinal Pedicle Screws Placement Precision Is in Full Agreement with Postoperative Computed Tomography Assessment.

Objective: To assess agreement between pedicle screw placement evaluated on postoperative computed tomography (CT) and on intraoperative cone-beam CT (CBCT) and compare procedure characteristics when using first-generation and second-generation robotic C-arm systems in the hybrid operating room.

Methods: All patients who received pedicle screws for spinal fusion at our institution between June 2009 and September 2019 and underwent intraoperative CBCT and postoperative CT were included. The CBCT and CT images were reviewed by 2 surgeons to assess the screw placement using the Gertzbein-Robbins and the Heary classifications.

Preoperative assessment of dominant occipital sinus in patients with Chiari malformation type I: anatomical variations and implications for preventing potentially life-threatening surgical complications.

Objective: The surgical treatment of Chiari malformation type I (CM-I) frequently involves dural incision at the posterior cranial fossa. In cases of persistent patent occipital sinus (OS), the sinus is usually obliterated and divided. However, there are some patients whose OS is prominent and requires crucial modification of the operative planning to avoid potentially life-threatening massive hemorrhage and disturbance of cerebral venous circulation.

MRI characteristics of syringomyelia associated with foramen magnum arachnoiditis: differentiation from Chiari malformation.

Background: It is important to distinguish foramen magnum arachnoiditis (FMA) from Chiari malformation (CM) before surgery because the operative strategies for these diseases differ. In the current study, we compared pretreatment magnetic resonance imaging (MRI) of FMA with CM and investigated the MRI findings useful to differentiate between these diseases.

Methods: We retrospectively reviewed patients with FMA or CM aged ≥ 18 years who underwent surgeries at our institution between 2007 and 2019.

Severity by National Institute of Health Stroke Scale Score and Clinical Features of Stroke Patients with Patent Foramen Ovale Stroke and Atrial Fibrillation.

The comparative severity of patent foramen ovale (PFO)-related stroke in patients without atrial fibrillation (AF) and AF-related stroke in patients without PFO is unknown. Therefore, we compared the severity of PFO-related stroke and AF-related stroke. Twenty-six patients who underwent transesophageal echocardiography (TEE) were diagnosed with cardioembolic stroke from July 2018 to March 2020.

[A Case of Foix-Alajouanine Syndrome due to Perimedullary AVF: Remission and Aggravation Mechanism Considered by an Open Surgical Biopsy and Intraoperative ICG Angiography].

Foix-Alajouanine syndrome (FAS), also known as congestive myelopathy due to spinal vascular malformations, presents with paraplegia, sensory disturbance of lower limbs, and dysfunction of the bladder and rectum. Although FAS is characterized by a subacute onset of neurological symptoms that may wax and wane over a few years, the progression mechanism remains unclear. We report a case of FAS due to an angiographically occult arteriovenous fistula (AVF) that was diagnosed by an open surgical biopsy and intraoperative indocyanine green (ICG) angiography.

Prevalence of spinal meningeal cyst in the sacrum.

Spinal meningeal cysts in the sacrum (SMC) are known to be occasionally symptomatic with low back pain as well as leg pain, but no distinct prevalence of this pathological entity including asymptomatic lesions has been described. This prospective study investigated the prevalence of SMCs based on magnetic resonance (MR) myelography in 102 consecutive Japanese women with gynecological problems, who underwent pelvic conventional MR imaging. Ten of 102 patients were suspected of being positive for SMC (9.

Robotic digital subtraction angiography systems within the hybrid operating room.

Background: Fully equipped high-end digital subtraction angiography (DSA) within the operating room (OR) environment has emerged as a new trend in the fields of neurosurgery and vascular surgery.

Objective: To describe initial clinical experience with a robotic DSA system in the hybrid OR.

Methods: A newly designed robotic DSA system (Artis zeego; Siemens AG, Forchheim, Germany) was installed in the hybrid OR.

New titanium spacer for cervical laminoplasty: initial clinical experience. Technical note.

Many commercially available hydroxyapatite (HA) spacers for cervical laminoplasty have been introduced but have disadvantages such as lack of plasticity, easy cracking, and occasional difficulty in fixation by sutures. Here we present the short-term results of a newly designed titanium spacer (Laminoplasty Basket) in open-door cervical laminoplasty, and evaluated clinically and radiologically. The titanium box-shaped spacer with two arms for fixation was easily inserted and fixed into the laminoplasty space with 4-mm or 5-mm length screws after the posterior cervical arch was repositioned for the canal expansion.

A unique device, the disc space-fitted distraction device, for anterior cervical discectomy and fusion: early clinical and radiological evaluation.

Object: To perform interbody distraction and to obtain spinal curvature correction during anterior cervical discectomy and fusion (ACDF), the authors recently adopted a new stand-alone device, a disc space-fitted distraction device (DFDD). In this preliminary report the authors introduce this unique device and discuss some advantages in terms of short-term clinical and radiological evaluations.

Methods: The most unique aspect of the DFDD is the function of gentle distraction at anterior disc space with maximum lordotic correction of up to 8 degrees while rotating a screw at the front of the device.

New surgical technique to secure the bone strut during anterior cervical corpectomy and fusion: kusabi fixation technique--technical note.

Fixation using an anterior cervical plate is frequently used in anterior cervical discectomy or corpectomy and fusion procedures because of the higher fusion rate than without instrumentation. The surgical outcomes with the anterior plate technique are acceptable, but various hardware-related complications have been reported. The authors describe a new surgical technique, called the kusabi fixation technique, for securing the bone strut during anterior cervical corpectomy using cylindrical cages.

[Intraoperative photodynamic diagnosis for spinal ependymoma using 5-aminolevulinic acid: technical note].

Objective: The fluorescence-guided resection using 5-aminolevulinic acid (5-ALA) is a well established method for the treatment of brain tumor, especially malignant glioma. However, there is no report on photodynamic diagnosis (PDD) for spinal tumor. In the present study, we evaluated the usefulness of PDD for spinal ependymoma using 5-ALA.

Laminoplasty with preservation of posterior cervical elements: surgical technique.

Objective: We have developed a modified laminoplasty procedure that preserves the posterior cervical elements, and we have used it to treat multilevel cervical canal stenosis, with or without spondylotic changes, in 30 patients.

Methods: In this procedure, the posterior bony elements, such as the spinous processes, are not completely detached from the ligaments and musculature and are repositioned in the midline, to maintain normal cervical anatomic relationships. Thirty patients (mean age, 55.