This study confirms the long-term efficacy of aneurysm clip ligation. In addition, the authors found there is a small but significant risk of de novo aneurysm formation, particularly in patients with multiple aneurysms. Most residual aneurysm rests appear to remain stable, although a subset may enlarge or rupture. These findings support the rationale for late angiographic follow-up review in patients with aneurysms.

Background:Over years, surgical training is changing and years of tradition are being challenged by legal and ethical concerns for patient safety, work hour restrictions, and the cost of operating room time. Surgical simulation and skill training offer an opportunity to teach and practice advanced techniques before attempting them on patients. Simulation training can be as straightforward as using real instruments and video equipment to manipulate simulated “tissue” in a box trainer. More advanced virtual reality (VR) simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations.Methods:A PubMed review of the literature was performed for the MESH words “Virtual reality, “Augmented Reality”, “Simulation”, “Training”, and “Neurosurgery”. Relevant articles were retrieved and reviewed. A review of the literature was performed for the history, current status of VR simulation in neurosurgery.Results:Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and credential surgeons as technically competent. The number of published literature discussing the application of VR simulation in neurosurgery training has evolved over the last decade from data visualization, including stereoscopic evaluation to more complex augmented reality models. With the revolution of computational analysis abilities, fully immersive VR models are currently available in neurosurgery training. Ventriculostomy catheters insertion, endoscopic and endovascular simulations are used in neurosurgical residency training centers across the world. Recent studies have shown the coloration of proficiency with those simulators and levels of experience in the real world.Conclusion:Fully immersive technology is starting to be applied to the practice of neurosurgery. In the near future, detailed VR neurosurgical modules will evolve to be an essential part of the curriculum of the training of neurosurgeons.

Background We evaluated the use of a part-task simulator with 3D and haptic feedback as a training tool for a common neurosurgical procedure – placement of thoracic pedicle screws. Objective To evaluate the learning retention of thoracic pedicle screw placement on a high-performance augmented reality and haptic technology workstation. Methods Fifty-one fellows and residents performed thoracic pedicle screw placement on the simulator. The virtual screws were drilled into a virtual patient’s thoracic spine derived from a computed tomography data set of a real patient. Results With a 12.5% failure rate, a two-proportion z-test yielded P= 0.08. For performance accuracy, an aggregate Euclidean distance deviation from entry landmark on the pedicle and a similar deviation from the target landmark in the vertebral body yielded P=0.04 from a two-sample t-test in which the rejected null hypothesis assumes no improvement in performance accuracy from the practice to the test sessions, and the alternative hypothesis assumes an improvement. Conclusion The performance accuracy on the simulator was comparable to the accuracy reported in literature on recent retrospective evaluation of such placements. The failure rates indicated a minor drop from practice to test sessions, and also indicated a trend (P=0.08) towards learning retention resulting in improvement from practice to test sessions. The performance accuracy showed a 15% mean score improvement and over 50% reduction in standard deviation from practice to test. It showed evidence (P=0.04) of performance accuracy improvement from practice to test session.

In patients with treated glioblastoma, rCBV outperforms ADC and K as a single imaging classifier to predict recurrent tumor versus radiation necrosis; however, the combination of rCBV and K may be used to improve overall diagnostic accuracy.

Therapeutic/care management, level IV.

Based on a study of 48 neurological residents using a high fidelity haptic/graphic virtual reality simulator to perform ventricular cannulation, we recorded absolute Euclidean distance from the catheter tip to the foramen of Monroe within the ventricle. The data suggest that as expected, successful first attempts to cannulate the virtual 'shifted ventricle' are much less frequent than previous assessments with normal virtual ventricular anatomy. Furthermore, the significant improvement observed by the second attempt implies that the learning curve has been affected and the process 'jump started'.

Background and Importance: Schwannomas are typically benign tumors of the peripheral nervous system that originate from Schwann cells. It is well known that the optic nerves are myelinated by oligodendrocytes since their cell bodies arise centrally within the lateral geniculate nuclei. Because of this basic cellular anatomy, optic schwannomas should theoretically not exist. It is possible, however, these rare lesions stem from small sympathetic fibers that innervate the vasculature surrounding the optic nerve and its sheath.Clinical Presentation: The patient is a 46-year-old male with a one-year history of progressive right eye blurry vision. To our knowledge, there are only five known reported case of an optic nerve schwannoma. Additionally, because of its medial position relative to the optic nerve and within the orbital apex, it is the first such case to be resected via an endoscopic endonasal approach. The lesion was subtotally resected because of its adherence and continuity with the optic nerve and the patient’s wish to preserve his vision. He was subsequently referred to radiation oncology for external beam radiation therapy.Conclusion: Herein, we discuss the pertinent clinical findings of this rare lesion and review the literature relative to optic nerve and solitary orbital schwannomas.

PCC as an adjunct to FFP decreases the time to craniotomy with faster correction of INR and concomitant decrease in the need for blood product requirement in patients with traumatic brain injury exclusive of prehospital warfarin therapy.