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  • 1
    Online Resource
    Online Resource
    Evaluating stability of the craniovertebral junction after unilateral C1 lateral mass resection: implications for the direct lateral approach
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2021
    In:  Journal of Neurosurgery: Spine ( 2021-10), p. 1-7
    Details
    In: Journal of Neurosurgery: Spine, Journal of Neurosurgery Publishing Group (JNSPG), ( 2021-10), p. 1-7
    Abstract: The direct lateral approach is an alternative to the transoral or endonasal approaches to ventral epidural lesions at the lower craniocervical junction. In this study, the authors performed, to their knowledge, the first in vitro biomechanical evaluation of the craniovertebral junction after sequential unilateral C1 lateral mass resection. The authors hypothesized that partial resection of the lateral mass would not result in a significant increase in range of motion (ROM) and may not require internal stabilization. METHODS The authors performed multidirectional in vitro ROM testing using a robotic spine testing system on 8 fresh cadaveric specimens. We evaluated ROM in 3 primary movements (axial rotation [AR], flexion/extension [FE] , and lateral bending [LB]) and 4 coupled movements (AR+E, AR+F, LB + left AR, and LB + right AR). Testing was performed in the intact state, after C1 hemilaminectomy, and after sequential 25%, 50%, 75%, and 100% C1 lateral mass resection. RESULTS There were no significant increases in occipital bone (Oc)–C1, C1–2, or Oc–C2 ROM after C1 hemilaminectomy and 25% lateral mass resection. After 50% resection, Oc–C1 AR ROM increased by 54.4% (p = 0.002), Oc LB ROM increased by 47.8% (p = 0.010), and Oc–C1 AR+E ROM increased by 65.8% (p 〈 0.001). Oc–C2 FE ROM increased by 7.2% (p = 0.016) after 50% resection; 75% and 100% lateral mass resection resulted in further increases in ROM. CONCLUSIONS In this cadaveric biomechanical study, the authors found that unilateral C1 hemilaminectomy and 25% resection of the C1 lateral mass did not result in significant biomechanical instability at the occipitocervical junction, and 50% resection led to significant increases in Oc–C2 ROM. This is the first biomechanical study of lateral mass resection, and future studies can serve to validate these findings.
    Type of Medium: Online Resource
    ISSN: 1547-5654
    URL: Article
    DOI: 10.3171/2021.4.SPINE21226
    RVK:
    XA 55270.1
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2021
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  • 2
    Online Resource
    Online Resource
    The history of urea as a hyperosmolar agent to decrease brain swelling
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2014
    In:  Neurosurgical Focus Vol. 36, No. 4 ( 2014-04), p. E3-
    Details
    In: Neurosurgical Focus, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 36, No. 4 ( 2014-04), p. E3-
    Abstract: In 1919, it was observed that intravascular osmolar shifts could collapse the thecal sac and diminish the ability to withdraw CSF from the lumbar cistern. This led to the notion that hyperosmolar compounds could ameliorate brain swelling. Since then, various therapeutic interventions have been used for the reduction of intracranial pressure and brain volume. Urea was first used as an osmotic agent for the reduction of brain volume in 1950. It was associated with greater efficacy and consistency than alternatives such as hyperosmolar glucose. Its use became the standard of clinical practice by 1957, in both the intensive care unit and operating room, to reduce intracranial pressure and brain bulk and was the first hyperosmolar compound to have widespread use. However, the prime of urea was rather short lived. Reports of side effects and complications associated with urea emerged. These included coagulopathy, hemoglobinuria, electrocardiography changes, tissue necrosis with extravasation, and a significant potential for rebound intracranial hypertension. Mannitol was introduced in 1961 as a comparable and potentially superior alternative to urea. However, mannitol was initially purported to be less effective at rapidly reducing intracranial pressure. The debate over the two compounds continued for a decade until mannitol eventually replaced urea by the late 1960s and early 1970s as the hyperosmolar agent of choice due to the ease of preparation, chemical stability, and decreased side effect profile. Although urea is not currently the standard of care today, its rise and eventual replacement by mannitol played a seminal role in both our understanding of cerebral edema and the establishment of strategies for its management.
    Type of Medium: Online Resource
    ISSN: 1092-0684
    URL: Article
    DOI: 10.3171/2014.1.FOCUS13558
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2014
    detail.hit.zdb_id: 2026589-X
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  • 3
    Online Resource
    Online Resource
    Descriptive Epidemiology of Spinal Meningiomas in the United States
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Spine Vol. 40, No. 15 ( 2015-08), p. E886-E889
    Details
    In: Spine, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 15 ( 2015-08), p. E886-E889
    Type of Medium: Online Resource
    ISSN: 0362-2436
    URL: Article
    DOI: 10.1097/BRS.0000000000000974
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2002195-1
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  • 4
    Online Resource
    Online Resource
    Interpreting Incidental Durotomy Rates in Minimally Invasive versus Traditional Techniques in Retrospective Studies: A Word of Caution
    Elsevier BV ; 2015
    In:  World Neurosurgery Vol. 83, No. 3 ( 2015-03), p. 311-312
    Details
    In: World Neurosurgery, Elsevier BV, Vol. 83, No. 3 ( 2015-03), p. 311-312
    Type of Medium: Online Resource
    ISSN: 1878-8750
    URL: Article
    DOI: 10.1016/j.wneu.2014.03.004
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
    detail.hit.zdb_id: 2530041-6
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  • 5
    Online Resource
    Online Resource
    Endoscopic-Assisted Techniques at the Craniovertebral Junction: Understanding Indications and Limitations
    Elsevier BV ; 2014
    In:  World Neurosurgery Vol. 82, No. 6 ( 2014-12), p. e711-e712
    Details
    In: World Neurosurgery, Elsevier BV, Vol. 82, No. 6 ( 2014-12), p. e711-e712
    Type of Medium: Online Resource
    ISSN: 1878-8750
    URL: Article
    DOI: 10.1016/j.wneu.2014.06.036
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
    detail.hit.zdb_id: 2530041-6
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  • 6
    Online Resource
    Online Resource
    Transoral and transnasal odontoidectomy complications: A systematic review and meta-analysis
    Elsevier BV ; 2016
    In:  Clinical Neurology and Neurosurgery Vol. 148 ( 2016-09), p. 121-129
    Details
    In: Clinical Neurology and Neurosurgery, Elsevier BV, Vol. 148 ( 2016-09), p. 121-129
    Type of Medium: Online Resource
    ISSN: 0303-8467
    URL: Article
    DOI: 10.1016/j.clineuro.2016.07.019
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2016
    detail.hit.zdb_id: 2004613-3
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  • 7
    Online Resource
    Online Resource
    Research Productivity and Fellowship Training in Neurosurgery
    Elsevier BV ; 2013
    In:  World Neurosurgery Vol. 80, No. 6 ( 2013-12), p. 787-788
    Details
    In: World Neurosurgery, Elsevier BV, Vol. 80, No. 6 ( 2013-12), p. 787-788
    Type of Medium: Online Resource
    ISSN: 1878-8750
    URL: Article
    DOI: 10.1016/j.wneu.2013.10.005
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2013
    detail.hit.zdb_id: 2530041-6
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  • 8
    Online Resource
    Online Resource
    A pilot study of the utility of a laboratory-based spinal fixation training program for neurosurgical residents
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2016
    In:  Journal of Neurosurgery: Spine Vol. 24, No. 5 ( 2016-05), p. 850-856
    Details
    In: Journal of Neurosurgery: Spine, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 24, No. 5 ( 2016-05), p. 850-856
    Abstract: Pedicle and lateral mass screw placement is technically demanding due to complex 3D spinal anatomy that is not easily visualized. Neurosurgical and orthopedic surgery residents must be properly trained in such procedures, which can be associated with significant complications and associated morbidity. Current training in pedicle and lateral mass screw placement involves didactic teaching and supervised placement in the operating room. The objective of this study was to assess whether teaching residents to place pedicle and lateral mass screws using navigation software, combined with practice using cadaveric specimens and Sawbones models, would improve screw placement accuracy. METHODS This was a single-blinded, prospective, randomized pilot study with 8 junior neurosurgical residents and 2 senior medical students with prior neurosurgery exposure. Both the study group and the level of training-matched control group (each group with 4 level of training-matched residents and 1 senior medical student) were exposed to a standardized didactic education regarding spinal anatomy and screw placement techniques. The study group was exposed to an additional pilot program that included a training session using navigation software combined with cadaveric specimens and accessibility to Sawbones models. RESULTS A statistically significant reduction in overall surgical error was observed in the study group compared with the control group (p = 0.04). Analysis by spinal region demonstrated a significant reduction in surgical error in the thoracic and lumbar regions in the study group compared with controls (p = 0.02 and p = 0.04, respectively). The study group also was observed to place screws more optimally in the cervical, thoracic, and lumbar regions (p = 0.02, p = 0.04, and p = 0.04, respectively). CONCLUSIONS Surgical resident education in pedicle and lateral mass screw placement is a priority for training programs. This study demonstrated that compared with a didactic-only training model, using navigation simulation with cadavers and Sawbones models significantly reduced the number of screw placement errors in a laboratory setting.
    Type of Medium: Online Resource
    ISSN: 1547-5654
    URL: Article
    DOI: 10.3171/2015.8.SPINE15119
    RVK:
    XA 55270.1
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2016
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  • 9
    Online Resource
    Online Resource
    Establishing a surgical skills laboratory and dissection curriculum for neurosurgical residency training
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2015
    In:  Journal of Neurosurgery Vol. 123, No. 5 ( 2015-11), p. 1331-1338
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 123, No. 5 ( 2015-11), p. 1331-1338
    Abstract: Surgical education has been forced to evolve from the principles of its initial inception, in part due to external pressures brought about through changes in modern health care. Despite these pressures that can limit the surgical training experience, training programs are being held to higher standards of education to demonstrate and document trainee competency through core competencies and milestones. One of the methods used to augment the surgical training experience and to demonstrate trainee proficiency in technical skills is through a surgical skills laboratory. The authors have established a surgical skills laboratory by acquiring equipment and funding from nondepartmental resources, through institutional and private educational grants, along with product donations from industry. A separate educational curriculum for junior- and senior-level residents was devised and incorporated into the neurosurgical residency curriculum. The initial dissection curriculum focused on cranial approaches, with spine and peripheral nerve approaches added in subsequent years. The dissections were scheduled to maximize the use of cadaveric specimens, experimenting with techniques to best preserve the tissue for repeated uses. A survey of residents who participated in at least 1 year of the curriculum indicated that participation in the surgical skills laboratory translated into improved understanding of anatomical relationships and the development of technical skills that can be applied in the operating room. In addition to supplementing the technical training of surgical residents, a surgical skills laboratory with a dissection curriculum may be able to help provide uniformity of education across different neurosurgical training programs, as well as provide a tool to assess the progression of skills in surgical trainees.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2014.11.JNS14902
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2015
    detail.hit.zdb_id: 2026156-1
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  • 10
    Online Resource
    Online Resource
    World War II, tantalum, and the evolution of modern cranioplasty technique
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2014
    In:  Neurosurgical Focus Vol. 36, No. 4 ( 2014-04), p. E22-
    Details
    In: Neurosurgical Focus, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 36, No. 4 ( 2014-04), p. E22-
    Abstract: Cranioplasty is a unique procedure with a rich history. Since ancient times, a diverse array of materials from coconut shells to gold plates has been used for the repair of cranial defects. More recently, World War II greatly increased the demand for cranioplasty procedures and renewed interest in the search for a suitable synthetic material for cranioprostheses. Experimental evidence revealed that tantalum was biologically inert to acid and oxidative stresses. In fact, the observation that tantalum did not absorb acid resulted in the metal being named after Tantalus, the Greek mythological figure who was condemned to a pool of water in the Underworld that would recede when he tried to take a drink. In clinical use, malleability facilitated a single-stage cosmetic repair of cranial defects. Tantalum became the preferred cranioplasty material for more than 1000 procedures performed during World War II. In fact, its use was rapidly adopted in the civilian population. During World War II and the heyday of tantalum cranioplasty, there was a rapid evolution in prosthesis implantation and fixation techniques significantly shaping how cranioplasties are performed today. Several years after the war, acrylic emerged as the cranioplasty material of choice. It had several clear advantages over its metallic counterparts. Titanium, which was less radiopaque and had a more optimal thermal conductivity profile (less thermally conductive), eventually supplanted tantalum as the most common metallic cranioplasty material. While tantalum cranioplasty was popular for only a decade, it represented a significant breakthrough in synthetic cranioplasty. The experiences of wartime neurosurgeons with tantalum cranioplasty played a pivotal role in the evolution of modern cranioplasty techniques and ultimately led to a heightened understanding of the necessary attributes of an ideal synthetic cranioplasty material. Indeed, the history of tantalum cranioplasty serves as a model for innovative thinking and adaptive technology development.
    Type of Medium: Online Resource
    ISSN: 1092-0684
    URL: Article
    DOI: 10.3171/2014.2.FOCUS13552
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2014
    detail.hit.zdb_id: 2026589-X
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