Augmented Reality-Supported Rod Bending in Multilevel Spinal Fusion Using the ADVISE Software.

Background: One of the most common reasons for poor patient outcomes and revision surgery in spinal fusion is hardware failure. Screw loosening or pullout occurs in up to one-quarter of all cases. It is known that even small screw-rod misalignments can cause significant mechanical overloads during rod fixation, which can result in hardware failure.

The role of intraoperative microelectrode recording and stimulation in subthalamic lead placement for Parkinson's disease.

Objective: Intraoperative microelectrode recording (MER) and test-stimulation are regarded as the gold standard for proper placement of subthalamic (STN) deep brain stimulation (DBS) electrodes in Parkinson's disease (PD), requiring the patient to be awake during the procedure. In accordance with good clinical practice, most attending neurologists will request the clinically most efficacious trajectory for definite lead placement. However, the necessity of microelectrode-test-stimulation is disputed, as it may limit the access to DBS therapy, excluding those not willing or incapable of undergoing awake surgery.

Diagnostic yield of fluorescence-assisted frame-based stereotactic biopsies of intracerebral lesions in comparison with frozen-section analysis.

Purpose: Stereotactic biopsies are routinely used to establish a histological diagnosis of unclear cerebral pathologies. Intraoperatively, frozen-section analysis often confirms diagnostic tissue but also exhibits methodological pitfalls. Intraoperative five-aminolevulinic acid (5-ALA)-fluorescence has been described not only in gliomas but also in other cerebral pathologies.

Prophylactic nimodipine treatment improves hearing outcome after vestibular schwannoma surgery in men: a subgroup analysis of a randomized multicenter phase III trial.

A 2016 published randomized multicenter phase III trial of prophylactic nimodipine treatment in vestibular schwannoma surgery showed only a tendency for higher hearing preservation rates in the treatment group. Gender was not included in statistical analysis at that time. A retrospective analysis of the trial considering gender, preoperative hearing, and nimodipine treatment was performed.

It is time for a change in the management of elderly severely injured patients! An analysis of 126,015 patients from the TraumaRegister DGU.

Background: The number of elderly patients among the severely injured has been increasing continuously. It has been suggested that an increased life expectancy and a higher level of activity and mobility in older ages could explain this observation. Elderly trauma patients have relevant higher mortality rates and poorer functional outcomes.

A critical comparison between the semisitting and the supine positioning in vestibular schwannoma surgery: subgroup analysis of a randomized, multicenter trial.

Objective: Patient positioning in vestibular schwannoma (VS) surgery is a matter of ongoing discussion. Factors to consider include preservation of cranial nerve functions, extent of tumor resection, and complications. The objective of this study was to determine the optimal patient positioning in VS surgery.

Development of evidence-based quality indicators for deep brain stimulation in patients with Parkinson's disease and first year experience of implementation of a nation-wide registry.

Introduction: Deep Brain Stimulation (DBS) is a complex, invasive and cost-intensive therapy that requires a high level of expertise. To date, data on quality of DBS in clinical routine in the German health care system are lacking.

Methods: The development of evidence-based QIs for DBS in PD patients was performed following a standardized process by a multidisciplinary board between 2014 and 2016.

Predictors of ventricular tension pneumocephalus after posterior fossa surgery in the sitting position.

Background: Ventricular pneumocephalus is a rare but potentially life-threatening complication of cranial surgery in the sitting position.

Objective: The objective of the study is to assess the incidence and risk factors of postoperative ventricular pneumocephalus.

Methods: We performed a retrospective chart review of 307 consecutive patients (147 men, 160 women) treated at our institution by intracranial surgery in the sitting position from January 2010 to October 2014.

Rescue Implantation of Expandable Cages for Severe Osteolysis and Cage Dislocation in the Lumbosacral Junction.

Background: Osteolysis and implant loosening are commonly encountered problems after spinal instrumentation.

Case Description: In a patient who had previously undergone a posterior lumbar interbody fusion procedure, fusion did not occur, and a secondary cage dislocation led to an impingement of the L5 nerve root with severe radiculopathy. Revision surgery was performed.

Robot guidance for percutaneous minimally invasive placement of pedicle screws for pyogenic spondylodiscitis is associated with lower rates of wound breakdown compared to conventional fluoroscopy-guided instrumentation.

Postoperative wound healing can pose a problem in patients undergoing instrumented surgery for pyogenic spondylodiscitis. Robotic guidance allows the minimally invasive placement of pedicle screws in the thoracolumbar spine. We assessed whether using this technique to perform minimally invasive surgery had an impact on wound healing in patients with pyogenic spondylodiscitis when compared to conventional open fluoroscopy-guided surgery.

Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: a matched-cohort comparison.

OBJECTIVE Robot-guided pedicle screw placement is an established technique for the placement of pedicle screws. However, most studies have focused on degenerative disease. In this paper, the authors focus on metastatic spinal disease, which is associated with osteolysis.

Interobserver variability of the House-Brackmann facial nerve grading system for the analysis of a randomized multi-center phase III trial.

Background: Evidence of a high interobserver variability of the subjective House-Brackmann facial nerve grading system (HBGS) would justify cost- and time-consuming technological enhancements of objective classifications for facial nerve paresis.

Method: A total of 112 patients were recruited for a randomized multi-center trial to investigate the efficacy of prophylactic nimodipine treatment in vestibular schwannoma (VS) surgery. For the present investigation both treatment groups were pooled for the assessment of facial nerve function preoperatively, in the early postoperative course and 1 year after the surgery.

Asphyxia due to laryngeal spasm as a severe complication of awake deep brain stimulation for Parkinson's disease: a case report.

Background: In accordance with German neurosurgical and neurological consensus recommendations, lead placements for deep brain stimulation (DBS) in patients with Parkinson's disease (PD) are usually performed with the patient awake and in "medication off" state. This allows for optimal lead position adjustment according to the clinical response to intraoperative test stimulation. However, exacerbation of Parkinsonian symptoms after withdrawal of dopaminergic medication may endanger the patient by inducing severe "off" state motor phenomena.

Contrast-enhanced shunt series ("shuntography") compare favorably to other shunt imaging modalities in detecting shunt occlusion.

Background: Obstruction is a common cause of ventriculo-peritoneal shunt failure. Head computed tomography and plain x-ray examinations of shunt tubing ("shunt series") are routinely used in patients readmitted for reemerging symptoms but are of limited value. The validity of shunt series can be improved by applying contrast agent into the system (contrast-enhanced shunt series, a.

Stability of hearing preservation and regeneration capacity of the cochlear nerve following vestibular schwannoma surgery via a retrosigmoid approach.

OBJECTIVE The purpose of this research was to examine the stability of long-term hearing preservation and the regeneration capacity of the cochlear nerve following vestibular schwannoma (VS) surgery in a prospective study. METHODS A total of 112 patients were recruited for a randomized multicenter trial between January 2010 and April 2012 to investigate the efficacy of prophylactic nimodipine treatment versus no prophylactic nimodipine treatment in VS surgery. For the present investigation, both groups were pooled to compare hearing abilities in the early postoperative course and 1 year after the surgery.

Enlightening the Cerebellopontine Angle: Intraoperative Indocyanine Green Angiography in Microvascular Decompression for Trigeminal Neuralgia.

In microvascular decompression of the trigeminal nerve for trigeminal neuralgia (TN), the site of conflict is occasionally difficult to identify. Endoscopy has been described to better evaluate the anatomical conflict in such situations. We hypothesized that indocyanine green (ICG) angiography could allow for better visualization of the compressing artery and its anatomical relation to the nerve.

Unskilled unawareness and the learning curve in robotic spine surgery.

Background: Robotic assistance for the placement of pedicle screws has been established as a safe technique. Nonetheless rare instances of screw misplacement have been reported.The aim of the present retrospective study is to assess whether experience and time affect the accuracy of screws placed with the help of the SpineAssist™ robot system.

Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial.

Objective: A pilot study of prophylactic nimodipine and hydroxyethyl starch treatment showed a beneficial effect on facial and cochlear nerve preservation following vestibular schwannoma (VS) surgery. A prospective Phase III trial was undertaken to confirm these results.

Methods: An open-label, 2-arm, randomized parallel group and multicenter Phase III trial with blinded expert review was performed and included 112 patients who underwent VS surgery between January 2010 and February 2013 at 7 departments of neurosurgery to investigate the efficacy and safety of the prophylaxis.

When battery exhaustion lets the lame walk: a case report on the importance of long-term stimulator monitoring in deep brain stimulation.

Background: Deep brain stimulation is increasingly used in the treatment of advanced Parkinson's disease. While its short-term effectiveness is well documented, there are only few reports on long-term outcomes, and the need to repeatedly reprogram the stimulator is seldom reported.

Case Presentation: We present a 74-year-old man with gait impairment, which had been mistaken for worsening of the disease and only remitted when the stimulator battery was exhausted indicating that the stimulator itself had been the cause.

Neuronavigated microvascular Doppler sonography for intraoperative monitoring of blood flow velocity changes during aneurysm surgery - a feasible monitoring technique.

Introduction And Aim Of The Study: The intraoperative microvascular Doppler sonography (iMDS) is a well-established tool in vascular surgery for blood flow velocity (BFV) monitoring, capable of detecting vessel occlusion. However, identification of subtotal vessel compromise is more difficult, since the measured BFV may substantially vary with changing insonation angles and insonated vessel segments. To keep these parameters constant we combined neuronavigation with iMDS (niMDS).

Use of closed suction devices and other drains in spinal surgery: results of an online, Germany-wide questionnaire.

Purpose: The risks of drains in spine surgery (e.g., increasing venous plexus bleeding, maintaining CSF leakage, and infections) must be balanced with their benefits (e.

Unnecessary dental procedures as a consequence of trigeminal neuralgia.

Trigeminal neuralgia (TN) is a disorder characterized by repetitive lancinating pain along one or more branches of the trigeminal nerve and is commonly triggered by chewing and manipulation of the gums. The second and third divisions are most commonly affected. Due to these symptoms, patients are likely to consult their local dentist when symptoms first develop and may receive further dental evaluation and treatment before they are referred to a neurologist or neurosurgeon.

The significance of intraoperative electromyographic "lateral spread" in predicting outcome of microvascular decompression for hemifacial spasm.

Objectives: During microvascular decompression (MVD) of the facial nerve for hemifacial spasm (HFS), an abnormal muscle response can be recorded upon stimulation of the facial nerve, also known as the lateral spread response. This response may vanish after MVD and has been associated with a successful outcome. The purpose of this study was to determine if resolution of lateral spread correlated with the elimination of HFS in a single surgeon's experience.