Transpedicular Approach to Thoracic Disc Herniaton Guided by 3D Navigation System

Object The authors assessed the feasibility, anatomical accuracy, and cost effectiveness of frameless electromagnetic (EM) neuronavigation in conjunction with portable intraoperative CT (iCT) registration for transsphenoidal adenomectomy (TSA). Methods A prospective database was established for data obtained in 208 consecutive patients who underwent TSA in which the iCT/EM navigation technique was used. Data were compared with those acquired in a retrospective cohort of 65 consecutive patients in whom fluoroscope-assisted TSA had been performed by the same surgeon. All patients in both groups underwent transnasal removal of pituitary adenomas or neuroepithelial cysts, using identical surgical techniques with an operating microscope. In the iCT/EM technique–treated cases, a portable iCT scan was obtained immediately prior to surgery for registration to the EM navigation system, which did not require rigid head fixation. Preexisting (nonnavigation protocol) MR imaging studies were fused with the iCT scans to enable 3D navigation based on MR imaging data. The accuracy of the navigation system was determined in the first 50 iCT/EM cases by visual concordance of the navigation probe location to 5 preselected bony landmarks. For all patients in both cohorts, total operating room time, incision-to-closure time, and relative costs of imaging and surgical procedures were determined from hospital records. Results In every case, iCT registration was successful and preoperative MR images were fused to iCT scans without affecting navigation accuracy. There was 100% concordance between probe tip location and predetermined bony loci in the first 50 cases involving the iCT/EM technique. Total operating room time was significantly less in the iCT/EM cases (mean 108.9 ± 24.3 minutes [208 patients]) compared with the fluoroscopy group (mean 121.1 ± 30.7 minutes [65 patients]; p < 0.001). Similarly, incision-to-closure time was significantly less for the iCT/EM cases (mean 61.3 ± 18.2 minutes) than for the fluoroscopy cases (mean 71.75 ± 19.0 minutes; p < 0.001). Relative overall costs for iCT/EM technique and intraoperative C-arm fluoroscopy were comparable; increased costs for navigation equipment were offset by savings in operating room costs for shorter procedures. Conclusions The use of iCT/MR imaging–guided neuronavigation for transsphenoidal surgery is a time-effective, cost-efficient, safe, and technically beneficial technique.

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Sa1943 COECAL INTUBATION TIME WITH THE 3D NAVIGATION SYSTEM SCOPEPILOT VERSUS STANDARD COLONOSCOPY

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2018.04.464 ◽

2018 ◽

Vol 87 (6) ◽

pp. AB259

Author(s):

Fabian Straulino ◽

Alexander Genthner ◽

Sibel Kangalli ◽

Natalja Tscherwinski ◽

Axel Eickhoff

Keyword(s):

Navigation System ◽

Intubation Time ◽

3D Navigation ◽

Standard Colonoscopy

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Contact force technology integrated with 3D navigation system for atrial fibrillation ablation: improving results?

Expert Review of Medical Devices ◽

10.1080/17434440.2017.1330149 ◽

2017 ◽

Vol 14 (6) ◽

pp. 461-467 ◽

Cited By ~ 3

Author(s):

Roberto Rordorf ◽

Antonio Sanzo ◽

Vincenzo Gionti

Keyword(s):

Atrial Fibrillation ◽

Contact Force ◽

Navigation System ◽

Atrial Fibrillation Ablation ◽

3D Navigation

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Posterior Minimally Invasive Transpedicular Approach for Giant Calcified Thoracic Disc Herniation

Global Spine Journal ◽

10.1177/2192568220933275 ◽

2020 ◽

pp. 219256822093327 ◽

Cited By ~ 1

Author(s):

Daniel Shedid ◽

Zhi Wang ◽

Ahmad Najjar ◽

Sung-Joo Yuh ◽

Ghassan Boubez ◽

...

Keyword(s):

Minimally Invasive ◽

Disc Herniation ◽

Case Series ◽

Thoracic Disc Herniation ◽

Retrospective Case ◽

Tubular Retractor ◽

Posterior Surgery ◽

Transpedicular Approach ◽

Dural Tears ◽

Thoracic Disc

Study Design: Retrospective case series. Objective: Posterior surgery for thoracic disc herniation was associated with increased morbidity and mortality and new minimally invasive approaches have been recommended for soft disc herniation but not for calcified central disc. The objective of this study is to describe a posterolateral microscopic transpedicular approach for central thoracic disc herniation. Methods: This is a single center retrospective review of all the cases of giant thoracic calcified disc herniation as defined by Hott et al. Presence of myelopathy, percentage of canal compromise, T2 hypersignal, ASIA score, and ambulatory status were recorded. This posterolateral technique using a tubular retractor was thoroughly described. Results: Eight patients were operated upon with a mean follow-up of 16 months. Mean canal compromise was 61%. Mean operative time was 228 minutes and mean operative bleeding was 250 mL. There were no cases of dural tear or neurologic degradation. Conclusion: This is the first report of posterior minimally invasive transpedicular approach for giant calcified disc herniation. There were neither cases of neurological deterioration nor increased rate of dural tears. This technique is thus safe and could be recommended for treatment of this rare disease.

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Use of 3D Navigation in Subaxial Cervical Spine Lateral Mass Screw Insertion

Journal of Neurological Surgery Reports ◽

10.1055/s-0038-1624574 ◽

2018 ◽

Vol 79 (01) ◽

pp. e1-e8 ◽

Cited By ~ 5

Author(s):

Abdullah Arab ◽

Fahad Alkherayf ◽

Adam Sachs ◽

Eugene Wai

Keyword(s):

Cervical Spine ◽

Navigation System ◽

Lateral Mass ◽

3D Navigation ◽

Subaxial Cervical Spine ◽

Navigation Group ◽

Freehand Technique ◽

Significant Difference ◽

Cord Injury ◽

Screw Malposition

Objective Cervical spine can be stabilized by different techniques. One of the common techniques used is the lateral mass screws (LMSs), which can be inserted either by freehand techniques or three-dimensional (3D) navigation system. The purpose of this study is to evaluate the difference between the 3D navigation system and the freehand technique for cervical spine LMS placement in terms of complications. Including intraoperative complications (vertebral artery injury [VAI], nerve root injury [NRI], spinal cord injury [SCI], lateral mass fracture [LMF]) and postoperative complications (screw malposition, screw complications). Methods Patients who had LMS fixation for their subaxial cervical spine from January 2014 to April 2015 at the Ottawa Hospital were included. A total of 284 subaxial cervical LMS were inserted in 40 consecutive patients. Surgical indications were cervical myelopathy and fractures. The screws' size was 3.5 mm in diameter and 8 to 16 mm in length. During the insertion of the subaxial cervical LMS, the 3D navigation system was used for 20 patients, and the freehand technique was used for the remaining 20 patients. We reviewed the charts, X-rays, computed tomography (CT) scans, and follow-up notes for all the patients pre- and postoperatively. Results Postoperative assessment showed that the incidence of VAI, SCI, and NRI were the same between the two groups. The CT scan analysis showed that the screw breakage, screw pull-outs, and screw loosening were the same between the two groups. LMF was less in the 3D navigation group but statistically insignificant. Screw malposition was less in the 3D navigation group compared with the freehand group and was statistically significant. The hospital stay, operative time, and blood loss were statistically insignificant between the two groups. Conclusions The use of CT-based navigation in LMS insertion decreased the rate of screw malpositions as compared with the freehand technique. Further investigations and trials will determine the effect of malpositions on the c-spine biomechanics. The use of navigation in LMS insertion did not show a significant difference in VAI, LMF, SCI, or NRI as compared with the freehand technique.

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