Study designProspective pilot study.ObjectivesThe aim of this study was to measure titanium, niobium and aluminium levels in various intraoperative and postoperative samples to determine patterns of metal ion release that occur within the first month following instrumented spinal fusion.Summary of background dataRaised serum metal ion levels are reported following instrumented spinal fusion in adolescent idiopathic scoliosis. The exact topological origin and chronology of metal ion release remains conjectural. Recent literature suggests an immediate rise in serum metal levels within the first postoperative week.MethodsTitanium, niobium and aluminium levels were measured before, during and after surgery in serum and local intraoperative fluid samples obtained from two pediatric patients undergoing posterior correction and instrumentation for scoliosis.ResultsMeasurable metal ion levels were detected in all local samples obtained from wound irrigation fluid, cell saver blood, and fluid that immersed metal universal reduction screw tabs. Postoperative serum metal ion levels were elevated compared to baseline preoperative levels. In general, metal ion levels were considerably higher in the intraoperative fluid samples compared to those observed in the serum levels.ConclusionOur findings of contextually high metal ion concentrations in intraoperative and early postoperative samples provide further empirical support of a ‘putting-in’ phenomenon of metal ion release following instrumented spinal fusion. This challenges existing beliefs that metal ion release occurs during an intermediate ‘wearing-in’ phase. We recommend thorough irrigation of the operative site prior to wound closure to dilute and remove intraoperative metal ion debris. Possibilities of filtering trace metal ions from cell saver content may be considered.
Results from this study indicate that this highly realistic simulation model provides surgeons with an increased level of confidence in their ability to deal with the rare but potentially catastrophic event of major vessel injury in endoscopic skull-base surgery.
Background:Malignant squamous cell differentiation of an epidermoid cyst can carry a significantly poor prognosis and very little is known about this entity.Case Description:We present the case of a 35-year-old lady, with primary malignant squamous cell carcinoma (SCC) arising from a previously partially resected cerebellopontine angle epidermoid cyst almost 5 years after initial resection. We also review the relevant literature.Conclusion:The imaging findings, histopathology, and management of a malignant SCC arising from a benign epidermoid cyst are discussed with recommendation for increased surveillance and follow-up, even for classically accepted benign lesions.
BACKGROUND
Iatrogenic internal carotid artery (ICA) injury is a catastrophic complication in open skull base surgery. There is a lack of information regarding the most appropriate techniques on how to manage this complication.
OBJECTIVE
To highlight the difficulties encountered when an ICA injury arises intraoperatively and discuss the role and the potential pitfalls of the crushed muscle patch in the management of an ICA injury during open skull base surgery.
METHODS
In this technical video, we demonstrate the management of intraoperative ICA injury, which occurred during the resection of a diffuse planum sphenoidale meningioma via a left pterional craniotomy.
RESULTS
When isolation of the defect with temporary clips failed, we opted for a crushed muscle graft to plug the defect. Hemostasis was achieved, but because of prolonged pressure application and “overpacking,” the parent vessel was occluded.
CONCLUSION
The crushed muscle patch can be easily applied; however, care must be taken not to “overpack” and occlude the ICA.
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