Acta Neurochir (Wien)
August 2024
Objective - Addressing the challenges that come with identifying and delineating brain tumours in intraoperative ultrasound. Our goal is to both qualitatively and quantitatively assess the interobserver variation, amongst experienced neuro-oncological intraoperative ultrasound users (neurosurgeons and neuroradiologists), in detecting and segmenting brain tumours on ultrasound. We then propose that, due to the inherent challenges of this task, annotation by localisation of the entire tumour mass with a bounding box could serve as an ancillary solution to segmentation for clinical training, encompassing margin uncertainty and the curation of large datasets.
View Article and Find Full Text PDFBackground: The classical supraorbital minicraniotomy (cSOM) constitutes a minimally invasive alternative for the resection of anterior skull base meningiomas (ASBM). Surgical success depends strongly on optimal patient selection and surgery planning, for which a careful assessment of tumor characteristics, approach trajectory, and bony anterior skull base anatomy is required. Still, morphometrical studies searching for relevant anatomical factors with surgical relevance when intending a cSOM for ASBM resection are lacking.
View Article and Find Full Text PDFHigh-acuity trauma necessitates experienced and rapid intervention to prevent patient harm. However, upskilling junior trainees through hands-on management of real trauma cases is rarely feasible without compromising patient safety. This quality education report sought to investigate whether a simulation course operated via mixed reality (MR) headset devices (Microsoft HoloLens) could enhance the clinical knowledge recall and preparedness to practice of junior trainees with no prior experience managing trauma.
View Article and Find Full Text PDFImportance: Mixed-reality (MR) technology has the potential to enhance care delivery, but there remains a paucity of evidence for its efficacy and feasibility.
Objective: To assess the efficacy and feasibility of MR technology to enhance emergency care delivery in a simulated environment.
Design, Setting, And Participants: This pilot randomized crossover trial was conducted from September to November 2021 at a single center in a high-fidelity simulated environment with participants block randomized to standard care (SC) or MR-supported care (MR-SC) groups.
The endoscopic-assisted supraorbital approach (eSOA) constitutes a minimally invasive strategy for removing anterior skull base meningiomas (ASBM). We present the largest retrospective single-institution and long-term follow-up study of eSOA for ASBM resection, providing further insight regarding indication, surgical considerations, complications, and outcome. We evaluated data of 176 patients operated on ASBM via the eSOA over 22 years.
View Article and Find Full Text PDFBackground: The advantages and limitations of different craniotomy positions and approach trajectories to the gasserian ganglion (GG) and related structures using an anterior subtemporal approach have not been studied systematically. Knowledge of these features is of importance when planning keyhole anterior subtemporal (kAST) approaches to the GG to optimize access and minimize risks.
Methods: Eight formalin-fixed heads were used bilaterally to assess temporal lobe retraction (TLR), trigeminal exposure, and relevant anatomical aspects of extra- and transdural classic anterior subtemporal (CLAST) approaches compared with slightly dorsally and ventrally allocated corridors.
Background: To date, morphometrical data providing a systematic quantification of accessibility and operability parameters to the boundaries of the posterior portion of the third ventricle (PTV) when applying an endoscopic-assisted paramedian supracerebellar infratentorial approach (EPSIA) are lacking. We performed an anatomical study and complemented our findings with surgical cases.
Methods: Eight EPSIAs towards the PTV were performed in cadaveric specimens.
Resection of complex falcotentorial meningiomas, growing along the pineal region (PR), and posterior incisural space (PIS) represents a neurosurgical challenge. Here, we present our strategy for effective resection of large falcotentorial meningiomas applying a paramedian supracerebellar infratentorial and interhemispheric occipital transtentorial approach in staged surgeries. We further systematically compared the effectiveness of midline (MSIA) and paramedian (PSIA) supracerebellar infratentorial, as well as interhemispheric occipital transtentorial approaches (IOTA) to operate along the PR and PIS in 8 cadaveric specimens.
View Article and Find Full Text PDFPurpose: The mechanical properties of orthodontic aligners made from thermoplastic polymers decrease over time in the intraoral milieu. However, there is a lack of information on this topic in the literature. Thus, the elastic properties of polyethylene terephthalate glycol (PETG) aligner films were investigated in vitro under extreme temperature changes simulated by thermocycling, environmental temperature and water absorption.
View Article and Find Full Text PDFBackground: The interoptic triangle (IOT) offers a key access to the contralateral carotid artery's ophthalmic segment (oICA) and its perforating branches (PB), the ophthalmic artery (OA), and the superior hypophyseal artery (SHA). It has been previously reported that the assessment of IOT's size is relevant when attempting approaches to the contralateral oICA. However, previous studies have overseen that, since the oICA is a paramedian structure and a lateralized contralateral approach trajectory is then required, the real access to the oICA is further limited by the approach angle adopted by the surgeon with respect to the IOT's plane.
View Article and Find Full Text PDFObjective: Medially pointing aneurysms of the ophthalmic segment of the internal carotid artery (oICA) represent a neurosurgical challenge. Conventional ipsilateral approaches require internal carotid artery and optic nerve (ON) mobilization as well as anterior clinoidectomy (AC), all associated with increased surgical risk. Contralateral approaches could provide a better exposure of the superomedial aspect of the oICA, ophthalmic artery, and superior hypophyseal artery, sparing AC and internal carotid artery or ON mobilization.
View Article and Find Full Text PDFIpsilateral approaches remain the standard technique for clipping paraclinoid aneurysms. Surgeons must however be prepared to deal with bony and neural structures restricting accessibility. The application of a contralateral approach has been proposed claiming that some structures in the region can be better exposed from this side.
View Article and Find Full Text PDFBackground: Burst fractures of the lumbar vertebrae and laminar fractures associated with dural tears and entrapment of neural elements have been reported in the past as a relatively rare occurrence. To the best of our knowledge, there is no consensus on the approach to repairing these types of fractures. The objective of this study is to describe a method of repair for traumatic burst fractures of the lumbar spine and vertical laminar fractures associated with entrapped neural elements.
View Article and Find Full Text PDFBackground: Minimally invasive pedicle screw placement may have a higher incidence of violation of the superior cephalad unfused facet joint.
Study Aims: We investigated the incidence and risk factors of upper facet joint violation in percutaneous robot-assisted instrumentation versus percutaneous fluoroscopy-guided and open transpedicular instrumentation.
Methods: A retrospective study including all consecutive patients who underwent lumbar instrumentation, fusion, and decompression for spondylolisthetic stenosis and degenerative disk disease was conducted between January 2012 and January 2016.
World Neurosurg
September 2017
Background: A drawback of conventional neuronavigation is the necessity of focusing on two-dimensional images in 3 planes at the same time to determine one's position in the operating field. A solution would be to merge the images into a single three-dimensional (3D) image that mirrors the actual anatomy. The introduction of holographic glassless 3D monitors paved the way to 3D navigation.
View Article and Find Full Text PDFOBJECTIVE The goal of this study was to demonstrate the clinical and technical nuances of a minimally invasive, dorsolateral, tubular approach for partial odontoidectomy, autologous bone augmentation, and temporary C1-2 fixation to treat dens pseudarthrosis. METHODS A cadaveric feasibility study, a 3D virtual reality reconstruction study, and the subsequent application of this approach in 2 clinical cases are reported. Eight procedures were completed in 4 human cadavers.
View Article and Find Full Text PDFActa Neurochir (Wien)
September 2014
Background: Two-dimensional image guidance and navigation can help to reduce the number of misplaced pedicle screws, but do not completely prevent misplacement. This experimental, retrospective, non-inferiority study was designed to evaluate and compare the efficacy of a novel 3D imaging technique versus conventional postoperative CT-scan, for intra-operative determination of pedicle screw position accuracy.
Methods: The capacity of C-OnSite® to intraoperatively assess screw placement was evaluated in 28 clinical cases and 23 deliberately misplaced screws in a cadaver model, and compared to placement accuracy determined by standard CT.