Intraoperative CT Monitoring During Stereotactic Brain Surgery

Introduction: The authors analyzed a series of ankylosing spondylitis patients with cervical spine fracture undergoing posterior stabilization using spinal navigation based on intraoperative CT imaging. The purpose of this study was to evaluate the accuracy and safety of navigated posterior stabilization and to analyze the adequacy of this method for treatment of fractures in ankylosed cervical spine. Methods: Prospectively collected clinical data, together with radiological documentation of a series of 8 consecutive patients with 9 cervical spine fracture were included in the analysis. The evaluation of screw insertion accuracy based on postoperative CT imaging, description of instrumentation- related complications and evaluation of morphological and clinical results were the subjects of interest. Results: Of the 66 implants inserted in all cervical levels and in upper thoracic spine, only 3 screws (4.5%) did not meet the criteria of anatomically correct insertion. Neither screw malposition nor any other intraoperative events were complicated by any neural, vascular or visceral injury. Thus we did not find a reason to change implant position intraoperatively or during the postoperative period. The quality of intraoperative CT imaging in our group of patients was sufficient for reliable trajectory planning and implant insertion in all segments, irrespective of the habitus, positioning method and comorbidities. In addition to stabilization of the fracture, the posterior approach also allows reducing preoperative kyphotic position of the cervical spine. In all patients, we achieved a stable situation with complete bone fusion of the anterior part of the spinal column and lateral masses at one year follow-up. Conclusion: Spinal navigation based on intraoperative CT imaging has proven to be a reliable and safe method of stabilizing cervical spine with ankylosing spondylitis. The strategy of posterior stabilization seems to be a suitable method providing high primary stability and the conditions for a subsequent high fusion rate.

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Dual Intentional Agency

10.1093/oso/9780198809654.003.0003 ◽

2018 ◽

Author(s):

Elizabeth Schechter

Keyword(s):

Left Hemisphere ◽

Practical Reasoning ◽

Right Hemisphere ◽

Brain Surgery ◽

Experimental Conditions ◽

Split Brain ◽

Intentional Agency ◽

Intentional Agents ◽

Experimental Findings ◽

The Right

This chapter defends the 2-agents claim, according to which the two hemispheres of a split-brain subject are associated with distinct intentional agents. The empirical basis of this claim is that, while both hemispheres are the source or site of intentions, the capacity to integrate them in practical reasoning no longer operates interhemispherically after split-brain surgery. As a result, the right hemisphere-associated agent, R, and the left hemisphere-associated agent, L, enjoy intentional autonomy from each other. Although the positive case for the 2-agents claim is grounded mainly in experimental findings, the claim is not contradicted by what we know of split-brain subjects’ ordinary behavior, that is, the way they act outside of experimental conditions.

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Evaluation of Stroke Volume Variation Obtained by the FloTrac™/Vigileo™ System to Guide Preoperative Fluid Therapy in Patients Undergoing Brain Surgery

Journal of International Medical Research ◽

10.1177/147323001204000338 ◽

2012 ◽

Vol 40 (3) ◽

pp. 1175-1181 ◽

Cited By ~ 6

Author(s):

J Li ◽

Fh Ji ◽

Jp Yang

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Stroke Volume ◽

Stroke Volume Variation ◽

Brain Surgery ◽

Fluid Loading ◽

Volume Loading ◽

Fluid Infusion ◽

Volume Variation ◽

Ringer’S Lactate

OBJECTIVE: The accuracy of stroke volume variation (SVV) obtained by the FloTrac™/Vigileo™ system in otherwise healthy patients undergoing brain surgery was assessed. METHODS: Anaesthesia was induced in 48 patients with minimal fluid infusion. Before surgery, fluid volume loading was performed by infusion with Ringer's lactate solution in 200 ml steps over 3 min, repeated successively if the patient responded with an increase in stroke volume of ≥ 10%, until the increase was < 10% (nonresponsive). RESULTS: A total of 157 volume loading steps were performed in the 48 patients. Responsive and nonresponsive steps differed significantly in baseline values of blood pressure, heart rate and SVV. Significant correlations were found between the change in stroke volume after fluid loading and values of blood pressure, heart rate and SVV before fluid loading, with SVV the most sensitive variable. CONCLUSION: Stroke volume variation obtained using the FloTrac™/Vigileo™ system is a sensitive predictor of fluid responsiveness in healthy patients before brain surgery.

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Intraoperative Computed Tomography Scanner-Guided Craniovertebral Junction Surgery in a Patient with an Occipitalized C1

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1730088 ◽

2021 ◽

Author(s):

Mohammad Ashraf ◽

Usman Ahmad Kamboh ◽

Naveed Ashraf

Keyword(s):

Craniovertebral Junction ◽

Facet Joints ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Transoral Odontoidectomy ◽

Posterior Subluxation ◽

Lateral Mass Screws ◽

Complex Surgery ◽

Computed Tomography Scanner

AbstractCraniovertebral junction surgery is associated with unique difficulties. Type 2 odontoid fractures (Anderson and D Alonzo) have a great potential for nonunion and malunion. These fracture patients may require a circumferential decompression and fixation. The addition of intraoperative CT with neuronavigation greatly aids in craniovertebral junction surgery. We operated on a 59-year-old-male with a type 2 fracture with posterior subluxation of C1 anterior arch and a cranially displaced odontoid peg. First, a transoral odontoidectomy was performed followed by a craniocervical fixation. Occipital plates and C3–C4 lateral mass screws were used as C1 was discovered to be occipitalized intraoperatively and atlantoaxial facet joints could not be reduced as discovered by intraoperative CT resconstruction. Intraoperative CT scan was crucial to this circumferential decompression and fixation, allowed us to resect the odontoid peg safely and completely and to confirm adequate screw trajectory making this complex surgery easier for us and safer for the patient. The patient was discharged 4 months after admission with stable neurology. Intraoperative CT was fundamental to correct decision making.

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SURG-40. SURGICAL RESECTIONS IN BROCA’S AREA DO NOT LEAD TO BROCA’S APHASIA

Neuro-Oncology ◽

10.1093/neuonc/noaa215.886 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii212-ii212

Author(s):

John Andrews ◽

Nathan Cahn ◽

Benjamin Speidel ◽

Valerie Lu ◽

Mitchel Berger ◽

...

Keyword(s):

Inferior Frontal Gyrus ◽

Brain Surgery ◽

Broca’S Area ◽

Broca's Area ◽

Supramarginal Gyrus ◽

Broca's Aphasia ◽

Broca’S Aphasia ◽

Language Evaluations ◽

Lesion Symptom Mapping ◽

Normal Speech

Abstract Brodmann’s areas 44/45 of the inferior frontal gyrus (IFG), are the seat of Broca’s area. The Western Aphasia Battery is a commonly used language battery that diagnoses aphasias based on fluency, comprehension, naming and repetition. Broca’s aphasia is defined as low fluency (0-4/10), retained comprehension (4-10/10), and variable deficits in repetition (0-7.9/10) and naming (0-8/10). The purpose of this study was to find anatomic areas associated with Broca’s aphasia. Patients who underwent resective brain surgery in the dominant hemisphere were evaluated with standardized language batteries pre-op, POD 2, and 1-month post-op. The resection cavities were outlined to construct 3D-volumes of interest. These were aligned using an affine transformation to MNI brain space. A voxel-based lesion-symptom mapping (VLSM) algorithm determined areas associated with Broca’s aphasia when incorporated into a resection. Post-op MRIs were reviewed blindly and percent involvement of pars orbitalis, triangularis and opercularis was recorded. 287 patients had pre-op and POD 2 language evaluations and 178 had 1 month post-op language evaluation. 82/287 patients had IFG involvement in resections. Only 5/82 IFG resections led to Broca’s aphasia. 11/16 patients with Broca’s aphasia at POD 2 had no involvement of IFG in resection. 35% of IFG resections were associated with non-specific dysnomia and 36% were normal. By one-month, 76% of patients had normal speech. 80% of patients with Broca’s aphasia at POD 2 improved to normal speech at 1-month, with 20% improved to non-specific dysnomia. The most highly correlated (P< 0.005) anatomic areas with Broca’s aphasia were juxta-sylvian pre- and post-central gyrus extending to supramarginal gyrus. While Broca’s area resections were rarely associated with Broca’s aphasia, juxta-sylvian pre- and post-central gyri extending to the supramarginal gyrus were statistically associated with Broca’s type aphasia when resected. These results have implications for planning resective brain surgery in these presumed eloquent brain areas.

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Minimally invasive debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis: a long‐term follow‐up study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-03988-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jianbiao Xu ◽

Leiming Zhang ◽

Rongqiang Bu ◽

Yankang Liu ◽

Kai-Uwe Lewandrowski ◽

...

Keyword(s):

Minimally Invasive ◽

Clinical Manifestations ◽

Operation Time ◽

Intervertebral Discs ◽

Intraoperative Ct ◽

Long Term Follow Up ◽

Invasive Method ◽

Vertebral Bodies ◽

Adjacent Segments

Abstract Background Spondylodiscitis is an unusual infectious disease, which usually originates as a pathogenic infection of intervertebral discs and then spreads to neighboring vertebral bodies. The objective of this study is to evaluate percutaneous debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis. Methods From January 2002 to May 2017, 23 patients with multilevel spondylodiscitis were treated with minimally invasive debridement and drainage procedures in our department. The clinical manifestations, evolution, and minimally invasive debridement and drainage treatment of this refractory vertebral infection were investigated. Results Of the enrolled patients, the operation time ranged from 30 minutes to 124 minutes every level with an average of 48 minutes. Intraoperative hemorrhage was minimal. The postoperative follow-up period ranged from 12 months to 6.5 years with an average of 3.7 years. There was no reactivation of infection in the treated vertebral segment during follow-up, but two patients with fungal spinal infection continued to progress by affecting adjacent segments prior to final resolution. According to the classification system of Macnab, one patient had a good outcome at the final follow-up, and the rest were excellent. Conclusions Minimally invasive percutaneous debridement and irrigation using intraoperative CT-Guide is an effective minimally invasive method for the treatment of multilevel spondylodiscitis.

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