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Neurosurgical Focus

Sandro M Krieg, Bernhard Meyer
Since spinal navigation became applicable, including robotic assistance into standard navigational setups seems reasonable. A newly released modular robotic assistance for drill stabilization (Cirq, Brainlab) was used in a 74-year-old man undergoing dynamic stabilization of L3-4 via navigated transfascial pedicle screws. The authors demonstrate the second worldwide surgery with this device and the second case performed in their department. They provide insight in its applicability to estimate its further potential in spinal robotics...
July 2018: Neurosurgical Focus
Michel Lefranc, F François Deroussen, Richard Gouron
Fusionless surgery coupled with growing rod techniques is increasingly advocated for the treatment of early-onset scoliosis in general and neuromuscular scoliosis in particular. Iliosacral screws have excellent biomechanical characteristics but are hard to place safely. Here, the authors report on robot-assisted iliosacral screw positioning as part of growing rod surgery for the fusionless correction of early-onset scoliosis. The technique is based on a bilateral double sliding rod construct anchored to the pelvis proximally with 6 hooks or sublaminar bands and distally with iliosacral screws placed by the robot...
July 2018: Neurosurgical Focus
Nicholas Theodore, Paul M Arnold, Ankit I Mehta
In his 1920 science fiction play R.U.R., Czech writer Karel Capek introduced the word "robot" to the English language. The play tells the story of a factory that produces roboti, which are living creatures that resemble humans and have the capacity for individual thought. While at first the roboti seem content to work for their human masters, they later rebel, ultimately leading to the extinction of the human race. 1 This play and similar depictions of robots in literature and film are probably responsible for the slightly negative reputation of robots in general...
July 2018: Neurosurgical Focus
Grant Booher, Arnold Vardiman
A 63-year-old man presented with progressive lower-extremity paresis over the previous 3 months. He had been unable to support himself to ambulate over the previous 3 weeks. The patient was found to have metastatic renal cell carcinoma to T11. He underwent robotic assisted percutaneous placement of T9-L1 pedicle screws and open T11 laminectomy/debulking of tumor. This approach allowed for decreased blood loss without the need for preoperative embolization. After decompression and placement of the hardware, the patient regained the ability to ambulate on his own...
July 2018: Neurosurgical Focus
Laura A Snyder
Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is a well-accepted procedure with good outcomes. Robotics has the potential to augment these outcomes. This video demonstrates and discusses how surgeons can implement the use of a robotic device in an MIS TLIF workflow. The planning software and robotic arm guidance allow the surgeon to use intraoperative CT to guide the placement of pedicle screws in an MIS TLIF with optimal trajectory and decreased radiation. As robotic technology continues to improve, developing safe workflows that integrate robotics with currently well-established techniques should improve patient outcomes...
July 2018: Neurosurgical Focus
Changhan Jun, Madhav Sukumaran, Jean-Paul Wolinsky
Resection of a giant pre-sacral schwannoma originating from the right S2 nerve in a 22-year-old woman illustrates the potential for robotic surgery. The da Vinci Robot Surgical System facilitates visualization deep in the pelvis and allows for bimanual wristed instrument control to dissect the tumor from surrounding sensitive structures. Neurostimulation to identify critical nerves is possible and complete resection of the tumor can be achieved. There were no complications, she remained neurologically intact, the estimated blood loss was less than 75 ml, the total hospital stay was 3 days, and she returned to work within 2 weeks of her operation...
July 2018: Neurosurgical Focus
Corinna C Zygourakis, A Karim Ahmed, Samuel Kalb, Alex M Zhu, Ali Bydon, Neil R Crawford, Nicholas Theodore
The Excelsius GPS (Globus Medical, Inc.) was approved by the FDA in 2017. This novel robot allows for real-time intraoperative imaging, registration, and direct screw insertion through a rigid external arm-without the need for interspinous clamps or K-wires. The authors present one of the first operative cases utilizing the Excelsius GPS robotic system in spinal surgery. A 75-year-old man presented with severe lower back pain and left leg radiculopathy. He had previously undergone 3 decompressive surgeries from L3 to L5, with evidence of instability and loss of sagittal balance...
July 2018: Neurosurgical Focus
Marc Gallay, Daniel Jeanmonod
No abstract text is available yet for this article.
July 2018: Neurosurgical Focus
Sebastian R Schreglmann, Kailash P Bhatia, Stefan Hägele-Link, Beat Werner, Ernst Martin, Georg Kägi
No abstract text is available yet for this article.
July 2018: Neurosurgical Focus
Jacques J Morcos, Stephan A Munich
No abstract text is available yet for this article.
July 2018: Neurosurgical Focus
Michel Roethlisberger, Lara Gut, Daniel Walter Zumofen, Urs Fisch, Oliver Boss, Nicolai Maldaner, Davide Marco Croci, Ethan Taub, Natascia Corti, Jan-Karl Burkhardt, Raphael Guzman, Oliver Bozinov, Luigi Mariani
OBJECTIVE Women taking combined hormonal contraceptives (CHCs) are generally considered to be at low risk for cerebral venous thrombosis (CVT). When it does occur, however, intensive care and neurosurgical management may, in rare cases, be needed for the control of elevated intracranial pressure (ICP). The use of nonsurgical strategies such as barbiturate coma and induced hypothermia has never been reported in this context. The objective of this study is to determine predictive factors for invasive or surgical ICP treatment and the potential complications of nonsurgical strategies in this population...
July 2018: Neurosurgical Focus
Arturo Sotomayor-González
No abstract text is available yet for this article.
July 2018: Neurosurgical Focus
Justin M Cappuzzo, Ryan M Hess, John F Morrison, Jason M Davies, Kenneth V Snyder, Elad I Levy, Adnan H Siddiqui
OBJECTIVE Idiopathic intracranial hypertension (IIH) is a commonly occurring disease, particularly among young women of child-bearing age. The underlying pathophysiology for this disease has remained largely unclear; however, the recent literature suggests that focal outflow obstruction of the transverse sinus may be the cause. The purpose of this study was to report one group's early experience with transverse venous sinus stenting in the treatment of IIH and assess its effectiveness. METHODS The authors performed a retrospective chart review to identify patients who had undergone stenting of an outflow-obstructed transverse venous sinus for the treatment of IIH at Gates Vascular Institute between January 2015 and November 2017...
July 2018: Neurosurgical Focus
Sunil Manjila, Timothy Bazil, Matthew Kay, Unni K Udayasankar, Maroun Semaan
OBJECTIVE There is no definitive or consensus classification system for the jugular bulb position that can be uniformly communicated between a radiologist, neurootologist, and neurosurgeon. A high-riding jugular bulb (HRJB) has been variably defined as a jugular bulb that rises to or above the level of the basal turn of the cochlea, within 2 mm of the internal auditory canal (IAC), or to the level of the superior tympanic annulus. Overall, there is a seeming lack of consensus, especially when MRI and/or CT are used for jugular bulb evaluation without a dedicated imaging study of the venous anatomy such as digital subtraction angiography or CT or MR venography...
July 2018: Neurosurgical Focus
Sunil Manjila, Timothy Bazil, Matthew Thomas, Sunithi Mani, Matthew Kay, Unni Udayasankar
This paper is a narrative review of extraaxial developmental venous anomalies (eDVAs) of the brain involving dural venous flow or sinuses: persistent embryonic sinuses, sinus pericranii, enlarged emissary veins, and venous varices or aneurysmal malformations. The article highlights the natural history, anatomy, embryology, imaging, clinical implications, and neurosurgical significance of these lesions, which the authors believe represent a continuum, with different entities characterized by distinct embryopathologic features...
July 2018: Neurosurgical Focus
Ching-Jen Chen, Pedro Norat, Dale Ding, George A C Mendes, Petr Tvrdik, Min S Park, M Yashar Kalani
Endovascular embolization of brain arteriovenous malformations (AVMs) is conventionally performed from a transarterial approach. Transarterial AVM embolization can be a standalone treatment or, more commonly, used as a neoadjuvant therapy prior to microsurgery or stereotactic radiosurgery. In contrast to the transarterial approach, curative embolization of AVMs may be more readily achieved from a transvenous approach. Transvenous embolization is considered a salvage therapy in contemporary AVM management. Proposed indications for this approach include a small (diameter < 3 cm) and compact AVM nidus, deep AVM location, hemorrhagic presentation, single draining vein, lack of an accessible arterial pedicle, exclusive arterial supply by perforators, and en passage feeding arteries...
July 2018: Neurosurgical Focus
Jacques J Morcos, Stephan A Munich, Tiit Mathiesen, Marc P Sindou, Vinko V Dolenc
No abstract text is available yet for this article.
July 2018: Neurosurgical Focus
Raúl López-Serna
No abstract text is available yet for this article.
July 2018: Neurosurgical Focus
Francesco Acerbi, Ignazio G Vetrano, Tommaso Sattin, Jacopo Falco, Camilla de Laurentis, Costanza M Zattra, Lorenzo Bosio, Zefferino Rossini, Morgan Broggi, Marco Schiariti, Paolo Ferroli
OBJECTIVE The best management of veins encountered during the neurosurgical approach is still a matter of debate. Even if venous sacrifice were to lead to devastating consequences, under certain circumstances, it might prove to be desirable, enlarging the surgical field or increasing the extent of resection in tumor surgery. In this study, the authors present a large series of patients with vascular or oncological entities, in which they used indocyanine green videoangiography (ICG-VA) with FLOW 800 analysis to study the patient-specific venous flow characteristics and the management workflow in cases in which a venous sacrifice was necessary...
July 2018: Neurosurgical Focus
Nisha Giridharan, Smruti K Patel, Amanda Ojugbeli, Aria Nouri, Peyman Shirani, Aaron W Grossman, Joseph Cheng, Mario Zuccarello, Charles J Prestigiacomo
Idiopathic intracranial hypertension (IIH) is a disease defined by elevated intracranial pressure without established etiology. Although there is now consensus on the definition of the disorder, its complex pathophysiology remains elusive. The most common clinical symptoms of IIH include headache and visual complaints. Many current theories regarding the etiology of IIH focus on increased secretion or decreased absorption of cerebrospinal fluid (CSF) and on cerebral venous outflow obstruction due to venous sinus stenosis...
July 2018: Neurosurgical Focus
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