“…The paper by Belotti et al aligned with Stage 0, the preclinical stage of the IDEAL framework [ 8 ]. This study involved the use of 10 specimens for testing in one clinical center, another two for filming in a second center.…”
Background
The Idea, Development, Exploration, Assessment and Long-term study (IDEAL) framework was created to provide a structured way for assessing and evaluating novel surgical techniques and devices.
Objectives
The aim of this paper was to investigate the utilization of the IDEAL framework within neurosurgery, and to identify factors influencing implementation.
Methods
A bibliometric analysis of the 7 key IDEAL papers on Scopus, PubMed, Embase, Web of Science, and Google Scholar databases (2009–2019) was performed. A second journal-specific search then identified additional papers citing the IDEAL framework. Publications identified were screened by two independent reviewers to select neurosurgery-specific articles.
Results
The citation search identified 1336 articles. The journal search identified another 16 articles. Following deduplication and review, 51 relevant articles remained; 14 primary papers (27%) and 37 secondary papers (73%). Of the primary papers, 5 (36%) papers applied the IDEAL framework to their research correctly; two were aligned to the pre-IDEAL stage, one to the Idea and Development stages, and two to the Exploration stage. Of the secondary papers, 21 (57%) explicitly discussed the IDEAL framework. Eighteen (86%) of these were supportive of implementing the framework, while one was not, and two were neutral.
Conclusion
The adoption of the IDEAL framework in neurosurgery has been slow, particularly for early-stage neurosurgical techniques and inventions. However, the largely positive reviews in secondary literature suggest potential for increased use that may be achieved with education and publicity.
“…The paper by Belotti et al aligned with Stage 0, the preclinical stage of the IDEAL framework [ 8 ]. This study involved the use of 10 specimens for testing in one clinical center, another two for filming in a second center.…”
Background
The Idea, Development, Exploration, Assessment and Long-term study (IDEAL) framework was created to provide a structured way for assessing and evaluating novel surgical techniques and devices.
Objectives
The aim of this paper was to investigate the utilization of the IDEAL framework within neurosurgery, and to identify factors influencing implementation.
Methods
A bibliometric analysis of the 7 key IDEAL papers on Scopus, PubMed, Embase, Web of Science, and Google Scholar databases (2009–2019) was performed. A second journal-specific search then identified additional papers citing the IDEAL framework. Publications identified were screened by two independent reviewers to select neurosurgery-specific articles.
Results
The citation search identified 1336 articles. The journal search identified another 16 articles. Following deduplication and review, 51 relevant articles remained; 14 primary papers (27%) and 37 secondary papers (73%). Of the primary papers, 5 (36%) papers applied the IDEAL framework to their research correctly; two were aligned to the pre-IDEAL stage, one to the Idea and Development stages, and two to the Exploration stage. Of the secondary papers, 21 (57%) explicitly discussed the IDEAL framework. Eighteen (86%) of these were supportive of implementing the framework, while one was not, and two were neutral.
Conclusion
The adoption of the IDEAL framework in neurosurgery has been slow, particularly for early-stage neurosurgical techniques and inventions. However, the largely positive reviews in secondary literature suggest potential for increased use that may be achieved with education and publicity.
“…We performed an endoscopic endonasal approach to the sellar region according to the established technique (Cappabianca et al, ) with ad hoc instruments (Cappbianca's Set, Karl Stortz Endoskop, Wien, Austria) and 0°‐ and 30° optics. Once we completed the sphenoidal phase (transsphenoidal transrostral variant—Belotti et al, ), we performed a durotomy and created an artificial type of sellar barrier (i.e., strong, mixed, or weak). We placed an artificial tumor, composed of autologous muscle and mucosal tissue into the pituitary fossa and we recorded the morphology of the sellar barrier and the subsequent resection of the tumor (Tele Pack X unit, Karl Stortz Endoscope, Wien, Austria).…”
Background
The sellar barrier concept reflects the association between the components of the roof of the pituitary fossa and the risk of intraoperative cerebrospinal fluid (CSF) leak in the surgery of pituitary adenomas. We based our concept in previous reports on the microsurgical anatomy of the pituitary fossa's superior wall. However, proof of the usefulness of this concept in endoscopic approaches is yet missing. The aim of this study was to describe the endoscopic anatomy of the sellar barrier and its subtypes in a laboratory setting and to provide evidence of its clinical usefulness.
Methods
We provided anatomical models in six fresh‐frozen head and neck specimens. We performed an endoscopic endonasal approach and recreated a pathological model of each possible subtype of sellar barrier. To demonstrate the usefulness of this model in clinical practice, we conducted a prospective study including all patients with pituitary adenoma operated by an endoscopic approach between June and July 2019.
Results
We successfully recreated the models for each subtype of sellar barrier. When analyzing the clinical cases, we found that intraoperatively, 73.69% (14) had a strong sellar barrier; 21.05% (4) had mixed sellar barrier, and 5.26% (1) had weak sellar barrier. We recorded one case of intraoperative CSF leak in a patient with a weak sellar barrier by magnetic resonance imaging.
Conclusion
We described the endoscopic anatomy of the sellar barrier and we recreated the three subtypes in anatomical models. We also identified these subtypes in a series of clinical cases, proving its clinical usefulness.
“…[18][19][20][21][22] Deep surfaces of the surgical corridor were tracked by drawing with a navigated probe the perimeter of the exposed portion of the prevertebral space (for anterior approaches) or lateral pharyngeal wall (for lateral approaches). The quantification method has been previously validated by our group for quantification of skull base approaches.…”
Section: Quantificationmentioning
confidence: 99%
“…The quantification method has been previously validated by our group for quantification of skull base approaches. [18][19][20][21][22] Deep surfaces of the surgical corridor were tracked by drawing with a navigated probe the perimeter of the exposed portion of the prevertebral space (for anterior approaches) or lateral pharyngeal wall (for lateral approaches). Superficial surfaces of the surgical corridor were tracked at the pyriform, oral, and skin apertures for transnasal, transoral, and lateral approaches, respectively.…”
Background
Several surgical approaches to the parapharyngeal space (PPS) have been proposed. An objective description of advantages and limitations of the surgical routes is lacking.
Methods
Ten cadaver heads were dissected using the transnasal (medial, lateral), sublabial, transoral (transpharyngeal, transvestibular, transmandibular), transcervical (transcervical, transparotid, transmandibular, transmastoid), and type C and D infratemporal approaches. Neurovascular and musculoskeletal structures encountered were analyzed. A navigation‐based quantification of working volume and exposure of PPS compartments was accomplished.
Results
Transnasal approaches exposed the upper PPS, though with limited working volume. Transoral approaches exposed the middle PPS, minimizing neurovascular structures crossed. Only transcervical and skull base approaches exposed the entire PPS, crossing several neurovascular structures.
Conclusion
A tentative systematization of the surgical approach(es) to PPS in relation to different targets is provided: unicompartmental resection can be performed with a single, conservative access, whereas multicompartmental dissections frequently require a wider or multiportal approach.
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