VA shunting in infants and little children requires careful surgical techniques. Neurosurgeons should necessarily have an appropriate strategy for VA shunting considering the complications and revisions. Our results suggest open surgical solutions to overcome distal catheter placement difficulties in this age group.
Objective
To evaluate the feasibility of an experimentally designed brain tumor model consisting of polyurethane foam and fresh cadaveric cow brain for the surgical training of the technique for tumor ablation.
Methods
A laboratory-training model was created for microneurosurgical intervention of intrinsic brain tumor ablation covering microdissection of the brain tissue and opening of the pia mater, dissection and separation of the sulcal and cisternal structures, and dissection and removal of the tumor tissue. The left front parietal lobe was used as the area of interest for this experimental study. One-centimeter cube polyurethane foam was injected 2-cm deep inside the brain tissue using a plastic injection tube. After 5 minutes, the model was ready to use under the operating microscope for dissection, separation, and removal of the tumor tissue. The compatibility of the training model also was evaluated as poor, acceptable, and perfect.
Results
Ten stripped fresh cadaveric cow brains were used in this experimental feasibility study. The compatibility of the model was evaluated as poor, acceptable, and perfect in 1, 6, and 3 subjects, respectively.
Conclusions
In intrinsic brain tumor ablation, surgical manipulations of sulcal, cisternal, and fissural dissection must be undertaken while preserving vital neural and vascular structures. We believe that our model holds promise in developing the technical skills of neurosurgeons in training.
Conventional biplanar fluoroscopic imaging of the cervical spine is commonly used during cervical spinal surgery. We designed an intraoperative traction device to prevent shoulder superimposition on the cervical fluoroscopic imaging. During surgery at the stage of fluoroscopic examination, an operator can apply traction via the traction band of the device. This device is safe and easy to use, and can be preoperatively fitted to patients. Fluoroscopic images obtained with the new traction device were definitely superior compared with images obtained without the traction device. This device may be useful in cases with difficult fluoroscopic imagination of the lower cervical spine.
AIm:The objective of this study was to introduce a surgical navigation method which provides a safe, quick and effective access to cortical and subcortical tumors, along with a review of other methods in use for this purpose. mAteRIAl and methods: 53 patients have been operated using this technique. The area overlying the tumor is shaved and one half of a smoothly cut hazelnut is taped on the skin. The precise localization of the hazelnut is confirmed with MRI and then stained. After general anesthesia, the stained impression is projected firstly to the bone, dura and then cortex respectively by the Midas Rex cutting tip. Cortical landmarks surrounding the tumor's cortical projection are further confirmed with ultrasonography.Results: After removal, cortical and subcortical tumors were separately graded for efficiency. Grade 1 and 2 were accepted as precise access. Our method accordingly yielded 95.2% and 90.6% success rates for cortical and subcortical tumors respectively.
ConClusIon:Considering the method's success rate along with its inexpensiveness and modest technical requirements, it is believed that this method can be of widespread use.KeywoRds: Cortical landmarks, Subcortical tumor, Cortical tumor, Tumor localization, Surgical navigation ÖZ AmAÇ: Bu çalışmanın amacı, kullanımda olan diğer metodları da gözden geçirerek, topikal işaretler yardımıyla kortikal ve subkortikal yerleşimli tümörlerde etkili, güvenli ve hızlı bir cerrahi yöntemi sunmaktır. yÖntem ve GeReÇleR: 53 hasta bu teknik kullanılarak opere edildi. Tümörün izdüşümündeki saçlı deri traş edildikten sonra düzgün şekilde yarısı kesilmiş fındık cilt üzerine yapıştırıldı. Fındığın tümör izdüşümündeki lokalizasyonu doğrulandıktan sonra alan işaretlendi. Genel anestezi altında işaretlenmiş alanın izdüşümü alınarak sırasıyla kemik ve dura, kortekse kadar Midas rex kesici uç yardımıyla işaretlendi. Tümör ve onu çevreleyen kortikal yapılar ultrasonografi yardımıyla görüldü ve doğrulandı.BulGulAR: Tümör çıkartıldıktan sonra etkinlik açısından derecelendirme yapıldı. Buna göre grade 1 ve grade 2 lokalizasyon açısından kesin doğru giriş noktası olarak kabul edildi. Bizim metodumuzun subkortikal tümörlerde %90,6 ve kortikal tümörlerde %95,2 oranında giriş noktası açısından etkin olduğu saptandı. sonuÇ: Bu yöntem ucuzluğu, basit ve kolay şekilde uygulanabilirliği nedeniyle geniş bir kullanım alanı olabilecek bir teknik gibi gözükmektedir.
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