In general, electromagnetic navigation is an accurate, safe, and effective technique that can be used in surgical treatment of patients with various brain lesions. The mean navigation error in our series of cases was 1.9±0.5 mm for transcranial surgery and 2.5±0.8 mm for endoscopic surgery. Electromagnetic navigation can be used for different, both transcranial and endoscopic, neurosurgical interventions. Electromagnetic navigation is most convenient for interventions that do not require fixation of the patient's head, in particular for CSF shunting procedures, drainage of various space-occupying lesions (cysts, hematomas, and abscesses), and optimization of the size and selection of options for craniotomy. In repeated interventions, disruption of the normal anatomical relationships and landmarks necessitates application of neuronavigation systems in almost mandatory manner. The use of electromagnetic navigation does not limit application of the entire range of necessary intraoperative neurophysiological examinations at appropriate surgical stages. Succession in application of neuronavigation should be used to get adequate test results.
The paper presents a review of three clinical cases of treating patients with chronic fractures of the odontoid process of C2 vertebra using various combinations of surgical techniques. In all cases, complete decompression of the spinal cord and stabilization of the upper cervical segment of the spine were achieved. A decrease in the range of motion in the cervical spine was observed, which did not affect patient satisfaction. A gradual regression of the neurological status and increase in muscle strength were recorded. Comparative analysis of the neurological status was carried out before and after surgical treatment. When assessing the general condition of patients using the index of disability due to pain in the neck (NDI), an improvement in the quality of life was noted. These data show the opportunities and peculiarities of methods for treating patients with chronic C2 odontoid fractures.Type of publication: description of clinical cases. Evidence level: IV.
Развитие минимально-инвазивных технологий в последние десятилетия позволило расширить показания к использованию эндоскопических трансназальных транссфеноидальных доступов в хирургии опухолей основания черепа. Стало возможно удалять опухоли основания черепа, распространяющиеся в область прохождения черепных нервов, что сопряжено с риском их повреждения. Цель исследования -оценка эффективности применения триггерной электромиографии с целью обеспечения анатомической и функциональной сохранности черепных нервов при эндоскопическом трансназальном удалении различных распространенных новообразований основания черепа. Материалы и методы. Проведен статистический анализ и сравнение результатов хирургического лечения 2 групп пациентов с различными опухолями основания черепа. В основную группу включены 30 пациентов, у которых интраоперационно осуществляли триггерную электромиографию для идентификации черепных нервов. В контрольную группу вошли 43 пациента, у которых метод не использовался. Эффективность и безопасность метода интраоперационной идентификации черепных нервов оценивали на основании сравнения базовых характеристик, исходов лечения и факторов, потенциально на них влияющих.
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