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Scientific Articles

Monday, 19 August 2019 06:23

Augmented Reality in Transsphenoidal Surgery

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The introduction of microscope-based augmented reality in transsphenoidal surgery represents an indispensable adjunct to improve the safety of the surgical procedure. This technology reduces complications that may be encountered due to anatomical variants or invasive tumors. The authors of this article report the results from comparisons between the new and existing methods.

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Nowadays technology is changing surgery at any level, representing an invaluable support for surgeon. This article outlines the potential improvement in terms of precision generated by iCT combined with augmented reality applied to spine surgery.

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Intramedullary spinal cord tumours have an estimated incidence of 1.1 cases in 100,000. Previously, the plane of dissection when surgically excising these lesions has been the key indicator for gauging extent of resection. Other articles have called into question the influence of histopathological characteristics on the definition of tumour boundary. The authors of this article report the results of a retrospective analysis determining the influence of tumour histology on resectability and neurological outcomes in cases of intramedullary spinal cord tumours. The 2016 WHO CNS classification emphasised the importance of genetic findings. This should be borne in mind when approaching results presented in articles in which this is not accounted for.

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This review lends an insight into the use of cerebral microdialysis in patients with traumatic brain injury and subarachnoid haemorrhage. Developed in the 1970s, the technique involves the placement of a fenestrated microcatheter into the brain parenchyma - conclusions can then be drawn from analysis of the returned dialysate regarding the physiological state of the brain.

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Ganglioglioma is a rare and slowly growing low-grade glioma, usually occuring in the cerebral hemispheres with a predilection for the temporal lobe. Patients frequently present with seizures which are resistant to pharmacological treatment. For this reason surgical resection or gamma knife irradiation are the best choices in the management of this pathology. This article describes the case of a 26-year-old woman with a frontal ganglioglioma, who presented with epilepsy and cerebrospinal fluid (CSF) rhinorrhea caused by skull base erosion.

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Diffuse villous hyperplasia of the choroid plexus (DVHCP) associated with genetic abnormalities could be rare cause of communicating hydrocephalus. The article describes the case report of a 14-month-old girl diagnosed with partial trisomy 9p and hydrocephalus with DVHCP. A ventriculoperitoneal shunt (VPS), adjuvant bilateral endoscopic choroid plexus coagulation (CPC) and embolization of anterior choroidal artery were performed to control the symptoms connected to CSF overproduction. The authors go on to review the literature regarding DVHCP.

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The resection of primary spinal tumors necessitates a multidisciplinary approach. Not only neurosurgeons but also other clinicals such as medical and radiology specialists have to collaborate to obtain the best prognosis for their patients. Biomedical engineers are playing an increasingly important role thanks to the creation of patient-specific 3D-printed models which help surgeons to understand the features of lesions and their anatomical relationship with adjacent structures. In this article the authors underline the role of 3D-printed patient models and neoadjuvant therapies on two complex clinical cases for which this multidisciplinary management was employed.

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Wednesday, 27 March 2019 07:22

Arteriovenous Malformations of the Brain

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Arteriovenous malformations (AVMs) develop when abnormal shunts form between arteries and veins, bypassing the capillary network. Cerebral AVMs typically present following haemorrhage or seizures. This article outlines the risks associated with AVMs, the various treatment options available and how these relate to the Spetzler-Martin grade.

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Invasive orbital apex aspergillosis (IOAA) is a rare and pernicious manifestation of aspergillus infection. The authors describe a series of cases in which immunocompetent patients with IOAA developed mycotic aneurysms and subsequently subarachnoid haemorrhage.

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Chordomas continue to present a significant clinical challenge in skull base neurosurgery. Not only does the location of these lesions often necessitate anatomically complex approaches, but seeding along the surgical tract and the neuraxis is common. Optimal surveillance imaging regimes following surgery for chordoma resection is a source of some contention. The authors of this article compare various protocols to identify which is superior in elucidating recurrences.

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