A 46-year-old female came to the gynecology outpatient department with heavy and prolonged menstrual bleeding. The examination revealed a thyroid mass and tachycardia. Systemic and gynecological examinations were insignificant. Laboratory tests revealed a deranged thyroid profile which was further explored by performing magnetic resonance imaging. This revealed a functioning pituitary microadenoma producing thyroid-stimulating hormone (TSH). This entity is known as a TSHoma. Ultrasonography of the abdomen and pelvis showed increased endometrial thickness. The patient was treated with antithyroid medication and has undergone Mirena intrauterine contraceptive device insertion. The patient is planned for a hysterectomy when the thyroid profile is normalized.
Spatial computing (SC) in a surgical context offers reconstructed interactive four-dimensional models of radiological imaging. Preoperative and postoperative assessment with SC can offer more insight into personalized surgical approaches. Spine surgery has benefitted from the use of perioperative SC assessment. Herein, we describe the use of SC to perform a perioperative assessment of a revision spinal deformity surgery. A 79-year-old wheelchair-bound male presented to the neurosurgery clinic with a history of chronic lumbar pain associated with bilateral lower extremity weakness. His surgical history is significant for an L2-L5 lumbar decompression with posterior fixation 1 year prior. On examination, there were signs of thoracic myelopathy. Imaging revealed his previous instrumentation, pseudoarthrosis, and cord compression. We perform a two-staged operation to address the thoracic spinal cord compression and myelopathy, pseudoarthrosis, and malalignment with a lack of global spinal harmony. His imaging is driven by a spatial computing and SC environment and offers support for the diagnosis of his L2-3 and L4-5 pseudoarthrosis on the reconstructed SC-based computed tomography scan. SC enabled the assessment of the configuration of the psoas muscle and course of critical neurovascular structures in addition to graft sizing, trajectory and approach, evaluation of the configuration and durability of the anterior longitudinal ligament, and the overlying abdominal viscera. SC increases the familiarity of the patient's specific anatomy and enhances perioperative assessment. As such, SC can be used to preoperatively plan for spinal revision surgery.
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