Percutaneous stereotactic rhizotomy, despite being the most cost-effective, is by far the least utilized treatment

Trigeminal neuralgia is not easily controlled but can be managed with a variety of treatment options.

Stereotactic radiosurgery (SRS) and percutaneous stereotactic rhizotomy (PSR) are 2 noninvasive but ablative options that have rapidly gained support.

The most frequently used surgical management of trigeminal neuralgia is Microvascular decompression (MVD), followed closely by stereotactic radiosurgery (SRS). Percutaneous stereotactic rhizotomy (PSR) , despite being the most cost-effective, is by far the least utilized treatment modality1.

  1. Sivakanthan S, Van Gompel JJ, Alikhani P, van Loveren H, Chen R, Agazzi S. Surgical management of trigeminal neuralgia: use and cost-effectiveness from an analysis of the medicare claims database. Neurosurgery. 2014 Sep;75(3):220-6.
    doi: 10.1227/NEU.0000000000000430. PubMed PMID: 24871139. []

Cochrane Database of Systematic Review in minimally invasive discectomy

Potential advantages of newer minimally invasive discectomy (MID) procedures over standard microdiscectomy MD or open discectomy OD include less blood loss, less postoperative pain, shorter hospitalisation and earlier return to work.

MID may be inferior in terms of relief of leg pain, low back pain (LBP) and re-hospitalisation; however, differences in pain relief appeared to be small and may not be clinically important.

Potential advantages of MID are lower risk of surgical site infection and other infections. MID may be associated with shorter hospital stay but the evidence was inconsistent. Given these potential advantages, more research is needed to define appropriate indications for MID as an alternative to standard MD/OD 1).

1) Rasouli MR, Rahimi-Movaghar V, Shokraneh F, Moradi-Lakeh M, Chou R. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev. 2014 Sep 4;9:CD010328. [Epub ahead of print] PubMed PMID: 25184502.

Differences between anterior circulation aneurysm and posterior circulation intracranial aneurysm

Significant differences between anterior circulation aneurysm and posterior circulation intracranial aneurysm were found for the aspect ratio (AR) (1.91 ± 0.8 vs. 2.75 ± 1.8; p = 0.02) and for the parent artery size (5.08 ± 1.8 mm vs. 3.95 ± 1.5 mm; p < 0.05).

 

(AR = aneurysm dome depth/neck size)

h: aneurysm dome depth

n: neck size or wide

a: parent artery size

Tykocki T, Kostkiewicz B. Aneurysms of the anterior and posterior cerebral circulation: comparison of the morphometric features. Acta Neurochir (Wien). 2014 Sep;156(9):1647-54. doi: 10.1007/s00701-014-2173-y. Epub 2014 Jul 19. PubMed PMID: 25034507; PubMed Central PMCID: PMC4137168.

Full text Free

Lumbar discectomy haptic simulator

A cognitive task analysis (CTA) was performed to define a realistic and helpful scenario-based simulation. Based on the results a simulator for lumbar discectomy was developed. Additionally, a realistic training operating room was built by Adermann et al.,.

The CTA showed a need for realistic scenario-based training in spine surgery. The developed simulator consists of synthetic bone structures, synthetic soft tissue and an advanced bleeding system. Due to the close interdisciplinary cooperation of surgeons between engineers and psychologists, the iterative multicentre validation showed that the simulator is visually and haptically realistic. The simulator offers integrated sensors for the evaluation of the traction being used and the compression during surgery. The participating surgeons in the pilot workshop rated the simulator and the training concept as very useful for the improvement of their surgical skills.

In the context of the present work a precise definition for the simulator and training concept was developed. The additional implementation of sensors allows the objective evaluation of the surgical training by the trainer. Compared to other training simulators and concepts, the high degree of objectivity strengthens the acceptance of the feedback. The measured data of the nerve root tension and the compression of the dura can be used for intraoperative control and a detailed postoperative evaluation1.

  1. Adermann J, Geißler N, Bernal LE, Kotzsch S, Korb W. Development and validation of an artificial wetlab training system for the lumbar discectomy. Eur Spine J. 2014 Sep;23(9):1978-83. doi: 10.1007/s00586-014-3257-3. Epub 2014 Mar 5. PubMed PMID: 24595488. []