Investigation of the Use of Hollow Elastic Biomodels Produced by Additive Manufacturing for Clip Choice and Surgical Simulation in Microsurgery for Intracranial Aneurysms.

Background: Intracranial aneurysms (IAs) are dilatations of the cerebral arteries, whose treatment is commonly based on the implant of a metallic clip on the aneurysm neck. Despite the dissection and understanding of the surgical anatomy of the IA when often only parts of it are visible, the choice of the ideal clip to be used is one of the surgical difficulties. Although current imaging tests guarantee IA visualization, currently there is no planning method that allows for a real three-dimensional (3D) visualization for optimal choice of clip prior to surgery.

Three-Dimensional Hollow Elastic Models for Intracranial Aneurysm Clipping Election - A Case Study.

We describe a method for fabricating a three-dimensional hollow and elastic aneurysm model, which is useful for surgical clipping simulation. In this paper, we explain the generation of such hollow elastic model, based on 3D printing. Also, we report on the effects of applying it to presurgical clipping election and simulation.

Elastomers three-dimensional biomodels proven to be a trustworthy representation of the angiotomographic images.

Methods: 3D biomodels were printed with flexible material (elastomer) using angiotomographic DICOM acquired images and compared to 3D digital subtraction angiography (DSA) images.

Results: 3D biomodels represented the aneurysm angioarchitecture exactly, especially the neck and domus features.

Conclusion: Elastomers 3D biomodels proved to be a trustworthy representation of the angiotomographic images and could be used to help surgical planning in IA treatment.

Embolization of a giant hypervascularized choroid plexus papilloma with onyx by direct puncture: a case report.

Background: Choroid plexus papilloma is a rare intracranial neoplasm derived from choroid plexus epithelium accounting for less than 1 % of all brain tumors. These tumors are highly vascularized, and tumor resection is difficult, especially in small children, due to severe intraoperative bleeding. Preoperative embolization is helpful to reduce intraoperative bleeding, but it may not be possible in small children or if the tumor has no suitable feeding vessels for embolization.

Surgical exposure of the internal auditory canal through the retrosigmoid approach with semicircular canals anatomical preservation.

Objective: Evaluate the feasibility of an adequate exposure with anatomical preservation of labyrinth structures through retrosigmoid transmeatal approach (RSA) in surgeries for resection of acoustic neuromas/vestibular schwannomas (VS).

Method: Thirty patients underwent surgical resection and were preoperatively evaluated with fine slice high definition CT scans and 3D-MRI volumetric reconstructions. Extension of internal auditory canal (IAC) opening during surgery was measured using 3 mm right-angle calibrated hook and neuronavigation parameters.

Rapid prototyping of three-dimensional biomodels as an adjuvant in the surgical planning for intracranial aneurysms.

Purpose: To fabricate a three-dimensional biomodels of intracranial aneurysms, using rapid prototyping technology, to facilitate optimal anatomical visualization of aneurysms prior to and during surgery.

Methods: Four intracranial aneurysms cases were selected for this study. Using CT angiography images, the rapid prototyping process was completed using a PolyJet technology machine.

Image-guided surgical planning using anatomical landmarks in the retrosigmoid approach.

Objective: The suboccipital lateral or retrosigmoid approach is the main neurosurgical approach to the cerebellopontine angle (CPA). It is mainly used in the treatment of CPA tumors and vascular decompression of cranial nerves. A prospective study using navigation registered with anatomical landmarks in order to identify the transverse and sigmoid sinuses junction (TSSJ) was carried out in a series of 30 retrosigmoid craniotomies.

Transitional lumbosacral vertebrae and low back pain: diagnostic pitfalls and management of Bertolotti's syndrome.

Objective: Bertolotti's syndrome is a spine disorder characterized by the occurrence of a congenital lumbar transverse mega-apophysis in a transitional vertebral body that usually articulates with the sacrum or the iliac bone. It has been considered a possible cause of low back pain.

Method: We analyzed the cases of Bertolotti's syndrome that failed clinical treatment and reviewed the literature concerning this subject.

Surgical management of trigeminal schwannomas.

Object: The authors provide a detailed review of the surgical management of trigeminal schwannomas (TSs) and also discuss the best surgical approach based on the surgical anatomy and tumor extension.

Methods: A series of 17 patients with TSs who were surgically treated between 1987 and 2008 at the authors' institution is reported. The lesions were small (< 3 cm) in 2, medium (between 3 and 4 cm) in 5, large (> 4 cm) in 6, and giant (> 5 cm) in 4 cases.

Primary filum terminale ependymoma: a series of 16 cases.

Filum terminale ependymomas are slow growing tumors of the cauda equina with a high incidence in young adults. Although a complete microsurgical resection can lead to a cure, recurrence is not uncommon. Sixteen cases of filum terminale ependymomas treated at the Instituto de Neurologia de Curitiba were analyzed.

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

Lumbar disc herniation (LDH) is a common cause of back and sciatic pain. When clinical treatment fails, surgery may be indicated in selected patients. Although surgery is effective in most cases, some of these patients may have a poor outcome.