Ahead of Print: Mini-open Stabilization of a Sacral Fracture

Background and Importance: Comminuted sacral fractures present significant challenges for operative management. Open and percutaneous sacroiliac screws have been used for stabilization but carry not insignificant rates of complications including wound infection for the former, and malposition and neurological injury for the latter. We report use of a novel mini-open lumbar-ilium fixation for stabilization of a patient with a comminuted sacral fracture.

Clinical Presentation: A 33-year-old man with intact neurologic function was admitted following a fall of approximately 25 feet. A comminuted sacral fracture was diagnosed. The patient was unable to tolerate conservative management due to pain in upright positions. The patient was taken to the operating room for stabilization with a “mini-open” procedure involving L4 and L5 pedicle screws and bilateral iliac screws. Four two-inch paramedian incisions were made overlying the L4-L5 facet joints and medial to the sacroiliac joints. Minimally invasive retractors were placed to expose bony landmarks. L4-L5 pedicle screws and bilateral iliac screws were placed with minimal fluoroscopic guidance. Titanium rods were tunneled inferior-superiorly between incisions and affixed to screw heads. Total operative time was approximately 3.5 hours. The patient remained neurologically intact and had an uncomplicated recovery. One-year follow up CT showed successful healing of the sacrum.

Ahead of Print: Minimally-invasive Surgery for Subinsular Tumor

Background and Importance: To describe the novel use of AutoLITT(R) System (Monteris Medical, Winnipeg, MB) for focused laser interstitial thermal therapy (LITT) using intraoperative MRI and stereotactic image guidance for the treatment of metastatic adenocarcinoma to the left insula.

Clinical Presentation: The patient is a 61-year-old right-handed male with a history of metastatic adenocarcinoma of the colon. He has previously undergone resection of multiple lesions, Gamma Knife and whole brain radiation. Despite treatment to a left insular tumor, serial imaging revealed that the lesion continued to enlarge. Given the refractory nature of this tumor to radiation and the deep seated location, the patient elected to undergo LITT treatment. The center of the lesion and entry point on the scalp were identified using STEALTH (Medtronic, Memphis, TN) image-guided navigation. The AXiiiS(R) Stereotactic Miniframe (Monteris Medical, Winnipeg, MB) for the LITT system was secured onto the skull and a trajectory was defined to achieve access to the centroid of the tumor. After performing a burr hole, a gadolinium template probe was inserted into the AXiiiS base. The trajectory was confirmed via an intraoperative MRI and the LITT probe driver was attached to the base and CO2-cooled, side-firing laser LITT probe. The laser was activated and thermometry images were obtained. Two trajectories, posterior-medial and antero-lateral, produced satisfactory tumor ablation.

Ahead of Print: O-Arm Navigation Pedicle Screw Placement

Background: Increasing popularity of minimally invasive surgery (MIS) for lumbar fusion has led to dependence upon intraoperative fluoroscopy for pedicle screw placement, as limited muscle dissection does not expose the bony anatomy necessary for traditional, freehand techniques nor for registration steps in image-guidance techniques. This has raised concerns about cumulative radiation exposure for both surgeon and OR staff. The recent introduction of the O-arm Multidimensional Surgical Imaging System allows for percutaneous placement of pedicle screws but there is limited clinical experience with the technique and data examining its accuracy.

Objective: We present the first large clinical series of percutaneous screw placement using navigation of O-arm imaging and compare the results with the fluoroscopy-guided method.

Methods: A retrospective review of a 24-month period identified patients undergoing minimally-invasive lumbar interbody fusion. The O- arm was introduced in the middle of this period and was used for all subsequent patients. Accuracy of screw placement was assessed by examination of axial computed tomography or O-arm scans.

Editor Choice: Simple Endoscopic Decompression of Cubital Tunnel Syndrome With the Agee System: Anatomic Study and First Clinical Results

Full article access for Neurosurgery subscribers.

Stadie, Axel Thomas MD; Keiner, Doerthe MD; Fischer, Gerrit MD; Conrad, Jens MD; Welschehold, Stefan MD; Oertel, Joachim MD

BACKGROUND: Simple decompression in ulnar nerve compression syndromes offers options for endoscopic applications.

OBJECTIVE: The authors present their initial experience with the Agee device.

PATIENTS AND METHODS: The monoportal endoscopic technique (Agee system) was evaluated on 10 cadaveric arms. Subsequently, 32 arms of 29 patients were operated on between January 2006 and March 2009. All patients presented with typical clinical signs and neurophysiologic studies. Long-term follow-up examinations were obtained in 27 of 32 arms.

Ahead of Print: Simple Endoscopic Decompression of Cubital Tunnel Syndrome With the Agee System: Anatomic Study and First Clinical Results

Full article access for Neurosurgery subscribers.

Stadie, Axel Thomas MD; Keiner, Doerthe MD; Fischer, Gerrit MD; Conrad, Jens MD; Welschehold, Stefan MD; Oertel, Joachim MD

BACKGROUND: Simple decompression in ulnar nerve compression syndromes offers options for endoscopic applications.

OBJECTIVE: The authors present their initial experience with the Agee device.

PATIENTS AND METHODS: The monoportal endoscopic technique (Agee system) was evaluated on 10 cadaveric arms. Subsequently, 32 arms of 29 patients were operated on between January 2006 and March 2009. All patients presented with typical clinical signs and neurophysiologic studies. Long-term follow-up examinations were obtained in 27 of 32 arms.