scholarly journals Study of comparative surgical exposure to the petroclival region using patient-specific, petroclival meningioma virtual reality models

2021 ◽  
Vol 51 (2) ◽  
pp. E13
Author(s):  
Walter C. Jean ◽  
Yang Yang ◽  
Aneil Srivastava ◽  
Alexander X. Tai ◽  
Aalap Herur-Raman ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Tumor Volume ◽  
Surgical Techniques ◽  
Patient Specific ◽  
Surgical Approaches ◽  
Imaging Data ◽  
Petroclival Region ◽  
Petroclival Meningiomas ◽  
Retrolabyrinthine Approach ◽  
Ct And Mri

OBJECTIVE Despite advancement of surgical techniques, the attachments of petroclival meningiomas near the central clival depression (CCD) remain difficult to visualize. With existing methods, the amount of tumor near the CCD that is inaccessible through various approaches cannot be compared. Tumors distort the brainstem, changing the size of the operative corridor for some but not all approaches; therefore, using cadavers with normal posterior fossae makes it impossible to compare different approaches to the tumor. The authors used virtual reality (VR) models created from the imaging data of patients to compare various surgical approaches that have otherwise been incomparable in previous studies. METHODS CT and MRI data obtained in 15 patients with petroclival meningiomas were used to create anatomically accurate 3D VR models. For each model, various surgical approaches were performed, and the surgical freedom to 6 targets of the regions were measured. Furthermore, portions of the tumor that were visually blocked by the brainstem or bony structures were segmented and recorded as blinded volumes for comparison. RESULTS The extended retrosigmoid approach generated excellent exposure of the petroclival region, but for most specimens, there was inaccessible tumor volume adjacent to the brainstem (mean 641.3 mm3, SE 161.8). In contrast, the brainstem sides of the tumors were well-visualized by all the transpetrosal approaches. The blinded volume of the tumor was largest for the retrolabyrinthine approach, and this was statistically significant compared with all other approaches (mean 2381.3 mm3, SE 185.4). CONCLUSIONS The authors performed a novel laboratory study by using patient CT and MRI data to generate 3D virtual models to compare surgical approaches. Since it is impossible to perform various approaches in separate surgeries in patients for comparison, VR represents a viable alternative for such comparative investigations.

scholarly journals Minimally Invasive Mini-orbitozygomatic Approach for Clipping an Anterior Communicating Artery Aneurysm: Virtual Reality Surgical Planning

2020 ◽  
Author(s):  
Nicolás González Romo ◽  
Franco Ravera Zunino
Keyword(s):  
Virtual Reality ◽  
Minimally Invasive ◽  
Surgical Planning ◽  
Artery Aneurysm ◽  
Patient Specific ◽  
Anterior Communicating Artery ◽  
Imaging Data ◽  
Advantages And Disadvantages ◽  
Orbitozygomatic Approach ◽  
Skull Base Anatomy

AbstractVirtual reality (VR) has increasingly been implemented in neurosurgical practice. A patient with an unruptured anterior communicating artery (AcoA) aneurysm was referred to our institution. Imaging data from computed tomography angiography (CTA) was used to create a patient specific 3D model of vascular and skull base anatomy, and then processed to a VR compatible environment. Minimally invasive approaches (mini-pterional, supraorbital and mini-orbitozygomatic) were simulated and assessed for adequate vascular exposure in VR. Using an eyebrow approach, a mini-orbitozygomatic approach was performed, with clip exclusion of the aneurysm from the circulation. The step-by-step process of VR planning is outlined, and the advantages and disadvantages for the neurosurgeon of this technology are reviewed.

Immersive 3-Dimensional Virtual Reality Modeling for Case-Specific Presurgical Discussions in Cerebrovascular Neurosurgery

2020 ◽  
Author(s):  
Taku Sugiyama ◽  
Tod Clapp ◽  
Jordan Nelson ◽  
Chad Eitel ◽  
Hiroaki Motegi ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Surgical Planning ◽  
Objective Assessment ◽  
Surgical Techniques ◽  
Patient Specific ◽  
Decision Making Process ◽  
3 Dimensional ◽  
Head Mounted Display ◽  
Precise Understanding ◽  
Cerebrovascular Surgery

Abstract BACKGROUND Adequate surgical planning includes a precise understanding of patient-specific anatomy and is a necessity for neurosurgeons. Although the use of virtual reality (VR) technology is emerging in surgical planning and education, few studies have examined the effectiveness of immersive VR during surgical planning using a modern head-mounted display. OBJECTIVE To investigate if and how immersive VR aids presurgical discussions of cerebrovascular surgery. METHODS A multiuser immersive VR system, BananaVisionTM, was developed and used during presurgical discussions in a prospective patient cohort undergoing cerebrovascular surgery. A questionnaire/interview was administered to multiple surgeons after the surgeries to evaluate the effectiveness of the VR system compared to conventional imaging modalities. An objective assessment of the surgeon's knowledge of patient-specific anatomy was also conducted by rating surgeons’ hand-drawn presurgical illustrations. RESULTS The VR session effectively enhanced surgeons’ understanding of patient-specific anatomy in the majority of cases (83.3%). An objective assessment of surgeons’ presurgical illustrations was consistent with this result. The VR session also effectively improved the decision-making process regarding minor surgical techniques in 61.1% of cases and even aided surgeons in making critical surgical decisions about cases involving complex and challenging anatomy. The utility of the VR system was rated significantly higher by trainees than by experts. CONCLUSION Although rated as more useful by trainees than by experts, immersive 3D VR modeling increased surgeons’ understanding of patient-specific anatomy and improved surgical strategy in certain cases involving challenging anatomy.

Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Bartanusz ◽  
Porchet
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Management Algorithm ◽  
Specific Manner ◽  
Extensive Surgery ◽  
Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

Understanding the Patterns of Deformity of Wrist Fractures Using Computer Analysis

2020 ◽  
Vol 16 (3) ◽  
pp. 194-200
Author(s):  
Shai Luria
Keyword(s):  
Computer Modeling ◽  
Computer Analysis ◽  
Computer Models ◽  
Fracture Morphology ◽  
Patient Specific ◽  
Surgical Approaches ◽  
Surgical Indications ◽  
Wrist Fractures ◽  
Novel Methods ◽  
Made In

Computer modeling of the wrist has followed other fields in the search for descriptive methods to understand the biomechanics of injury. Using patient-specific 3D computer models, we may better understand the biomechanics of wrist fractures in order to plan better care. We may better estimate fracture morphology and stability and evaluate surgical indications, design more adequate or effective surgical approaches and develop novel methods of therapy. The purpose of this review is to question the actual advances made in the understanding of wrist fractures using computer models.

scholarly journals The concept of “Four Walls, Two Poles” in the lesions of the thalamus and ganglion regions: case report and literature review

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Haiyang Yang ◽  
Gang Bai ◽  
Yongli Zhang ◽  
Guolong Chen ◽  
Lei Duan ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Literature Review ◽  
Surgical Resection ◽  
Three Dimensional ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Surgical Results ◽  
Case Presentation ◽  
Operation Process ◽  
Thalamic Glioma

Abstract Background There are few articles about the surgical techniques of thalamic glioma and the lesions in the basal ganglia area. According to three existing cases and the literature review (Twelve articles were summarized which mainly described the surgical techniques), we discuss the surgical characteristics of lesions of the thalamus and basal ganglia area and summarize the relevant surgical skills. Case presentation Of the three cases, two were thalamic gliomas and one was brain abscess in basal ganglia. According to the three-dimensional concept of the “Four Walls, Two Poles”, lesions of the thalamus and basal ganglia were surgically removed, and the operative effect was analysed by relevant surgical techniques. Surgical resection of the lesions of the thalamus and basal ganglia area according to the three-dimensional concept of the “Four Walls, Two Poles” has achieved good surgical results. Relevant surgical techniques, such as the use of retractors, the use of aspirators, the choice of surgical approaches, and the haemostasis strategy, also played an important role in the operation process. Conclusions In the presented three cases the three-dimensional concept of the “Four Walls, Two Poles” allowed for safe surgical resection of lesions of the thalamus and basal ganglia.

scholarly journals Granular Cell Tumor: A Technical Approach for Resection of a Rare Suprasellar Mass

2020 ◽  
Vol 1 (4) ◽  
Author(s):  
Alexander J Schupper ◽  
Frank J Yuk ◽  
Hongyan Zou ◽  
Sadhna Ahuja ◽  
Nadejda M Tsankova ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Granular Cell Tumor ◽  
Clinical Presentation ◽  
Granular Cell ◽  
Cell Tumor ◽  
Patient Specific ◽  
Surgical Approaches ◽  
Technical Approach ◽  
Multiple Strategies ◽  
Current State

Abstract BACKGROUND AND IMPORTANCE Granular cell tumors (GCTs) of the sellar and suprasellar regions are rare tumors that may be managed surgically by multiple strategies. The technical approaches for these tumors have rarely been described in the literature. CLINICAL PRESENTATION We introduce the case of a patient presenting with dizziness and headaches who was found to have a suprasellar and retrochiasmatic mass and eventually underwent surgical resection. We discuss the characteristics of this tumor, and the current state of the literature. Also included are details regarding the surgical approach utilized in this case, and a discussion of the various surgical approaches for this type of tumor. CONCLUSION There are several approaches for the surgical resection of suprasellar GCTs, and the approach utilized may depend on patient and/or surgeon considerations. Patient-specific considerations must be made to ensure maximal safe resection of these lesions.

scholarly journals Primary Malignant Orbital Tumors

2021 ◽  
Vol 82 (01) ◽  
pp. 081-090
Author(s):  
Jacquelyn Laplant ◽  
Kimberly Cockerham
Keyword(s):  
Multimodal Therapy ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Imaging Features ◽  
Orbital Surgery ◽  
Diagnosis And Management ◽  
Microsurgical Techniques ◽  
Invasive Techniques ◽  
Traditional Approaches ◽  
Orbital Imaging

Abstract Objective Primary orbital malignancy is rare. Awareness of the characteristic clinical and imaging features is imperative for timely identification and management. Surgery remains an important diagnostic and treatment modality for primary orbital malignancy, but determining the optimal surgical approach can be challenging. The purpose of this article is to explore recent advances in the diagnosis, management, and surgical approaches for primary orbital malignancies. Design In this review, the clinical presentation, imaging features, and medical and surgical management of primary orbital malignancies with representative cases will be discussed. Setting Outpatient and inpatient hospital settings. Participants Patients with diagnosed primary orbital malignancies. Main Outcome Measures Descriptive outcomes. Results Advancements in orbital imaging, microsurgical techniques, and multimodal therapy have improved the diagnosis and management of primary orbital malignancies. Special considerations for biopsy or resection are made based on the tumor's location, characteristics, nearby orbital structures, and goals of surgery. Minimally invasive techniques are supplanting traditional approaches to orbital surgery with less morbidity. Conclusions Advances in imaging technologies and surgical techniques have facilitated the diagnosis and management of primary orbital malignancies. Evolution toward less invasive orbital surgery with focus on preservation and restoration of function is underway.

Surgical Management of Petroclival Meningiomas: Defining Resection Goals Based on Risk of Neurological Morbidity and Tumor Recurrence Rates in 137 Patients

Neurosurgery ◽  
2005 ◽  
Vol 56 (3) ◽  
pp. 546-559 ◽  
Author(s):  
Kenneth M. Little ◽  
Allan H. Friedman ◽  
John H. Sampson ◽  
Masahiko Wanibuchi ◽  
Takanori Fukushima
Keyword(s):  
Cranial Nerve ◽  
Tumor Recurrence ◽  
Critical Role ◽  
Recurrence Rates ◽  
Total Resection ◽  
Petroclival Region ◽  
Petroclival Meningiomas ◽  
Increased Risk ◽  
Neurological Morbidity

Abstract OBJECTIVE: Meningiomas arising from the petroclival region remain a challenging surgical problem. Because of the substantial risk of neurological morbidity, uniformly pursuing a gross total resection (GTR) to minimize tumor recurrence rates may not be justified. We sought to define optimal resection goals based on risk factors for postoperative neurological morbidity and tumor recurrence rates. METHODS: This series represents our experience with 137 meningiomas arising from the petroclival region resected between June 1993 and October 2002. There were 38 male and 99 female patients with a mean age of 53 years. RESULTS: GTR was achieved in 40% of patients, and near total resection (NTR) was achieved in 40% of patients. One operative death occurred. Twenty-six percent of patients experienced new postoperative cranial nerve deficits, paresis, or ataxia when assessed at a mean follow-up of 8.3 months. The risk of cranial nerve deficits increased with prior resection (P < 0.001), preoperative cranial nerve deficit (P = 0.005), tumor adherence to neurovascular structures (P = 0.046), and fibrous tumor consistency (P = 0.005). The risk of paresis or ataxia increased with prior resection (P = 0.001) and tumor adherence (P = 0.045). Selective NTR rather than GTR in patients with adherent or fibrous tumors significantly reduced the rate of neurological deficits. Radiographic recurrence or progression occurred in 17.6% of patients at a mean follow-up of 29.8 months. Tumor recurrence rates after GTR and NTR did not differ significantly (P = 0.111). CONCLUSION: Intraoperatively defined tumor characteristics played a critical role in identifying the subset of patients with an increased risk of postoperative deficits. By selectively pursuing an NTR rather than a GTR, neurological morbidity was reduced significantly without significantly increasing the rate of tumor recurrence.

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