Clivus-Cervical Stabilization through Transoral Approach in Patients with Craniocervical Tumor: Three Cases and Surgical Technical Note

Pioneering Augmented and Mixed Reality in Cranial Surgery: The First Latin American Experience

INTRODUCTION

Augmented reality (AR) and mixed reality (MR) technologies have revolutionized cranial neurosurgery by overlaying digital information onto the surgical field, enhancing visualization, precision, and training. These technologies enable the real-time integration of preoperative imaging data, aiding in better decision-making and reducing operative risks. Despite challenges such as cost and specialized training needs, AR and MR offer significant benefits, including improved surgical outcomes and personalized surgical plans based on individual patient anatomy.

MATERIALS AND METHODS

This study describes three intracranial surgeries using AR and MR technologies at Hospital Ángeles Universidad, Mexico City, in 2023. Surgeries were performed with VisAR software 3 version and Microsoft HoloLens 2, transforming DICOM images into 3D models. Preoperative MRI and CT scans facilitated planning, and radiopaque tags ensured accurate image registration during surgery. Postoperative outcomes were assessed through clinical and imaging follow-up.

RESULTS

Three intracranial surgeries were performed with AR and MR assistance, resulting in successful outcomes with minimal postoperative complications. Case 1 achieved 80% tumor resection, Case 2 achieved near-total tumor resection, and Case 3 achieved complete lesion resection. All patients experienced significant symptom relief and favorable recoveries, demonstrating the precision and effectiveness of AR and MR in cranial surgery.

CONCLUSIONS

This study demonstrates the successful use of AR and MR in cranial surgery, enhancing precision and clinical outcomes. Despite challenges like training and costs, these technologies offer significant benefits. Future research should focus on long-term outcomes and broader applications to validate their efficacy and cost-effectiveness in neurosurgery.

Transpedicular Corpectomy in Minimally Invasive Surgery for Metastatic Spinal Cord Compression: A Single-Center Series

Introduction The role of separation surgery in managing symptomatic spinal metastases has been increasing in recent years, and it represents a crucial part of the definitive management of this condition. Methods We report on a series of seven patients treated at the National Cancer Institute in Mexico using minimally invasive approaches to perform transpedicular corpectomy. The goal was to obtain a margin of tumor-free tissue, enabling the completion of oncological treatment with radiotherapy. Results We collected data from six cases. The mean age was 61.2 years. Surgical outcomes were good in 83.3% of patients. Ranging from minimally invasive instrumentations to total or partial corpectomies, these procedures achieved their intended function of generating healthy neural tissue free of tumor. This ensures that the radiation gradient does not affect this tissue. No surgical complications were reported. The objective of these surgeries was to establish a radiotherapy or radiosurgery regimen as soon as possible, thereby improving patients' quality of life (QoL). Conclusions Low-cost transpedicular corpectomy via minimally invasive surgery (MIS) is a safe and effective method that meets the goals of separation surgery. However, prospective studies are needed to directly compare open techniques with minimally invasive methods.

Integrating Augmented Reality in Spine Surgery: Redefining Precision with New Technologies

INTRODUCTION

The integration of augmented reality (AR) in spine surgery marks a significant advancement, enhancing surgical precision and patient outcomes. AR provides immersive, three-dimensional visualizations of anatomical structures, facilitating meticulous planning and execution of spine surgeries. This technology not only improves spatial understanding and real-time navigation during procedures but also aims to reduce surgical invasiveness and operative times. Despite its potential, challenges such as model accuracy, user interface design, and the learning curve for new technology must be addressed. AR's application extends beyond the operating room, offering valuable tools for medical education and improving patient communication and satisfaction.

MATERIAL AND METHODS

A literature review was conducted by searching PubMed and Scopus databases using keywords related to augmented reality in spine surgery, covering publications from January 2020 to January 2024.

RESULTS

In total, 319 articles were identified through the initial search of the databases. After screening titles and abstracts, 11 articles in total were included in the qualitative synthesis.

CONCLUSION

Augmented reality (AR) is becoming a transformative force in spine surgery, enhancing precision, education, and outcomes despite hurdles like technical limitations and integration challenges. AR's immersive visualizations and educational innovations, coupled with its potential synergy with AI and machine learning, indicate a bright future for surgical care. Despite the existing obstacles, AR's impact on improving surgical accuracy and safety marks a significant leap forward in patient treatment and care.

Treatment of Ankylosing Spondylitis Patients with Cervical Spinal Injury with Anterior Single-Stage Fixation with Bone Cement Augmentation

Background/Objectives: Cervical spine fractures in ankylosing spondylitis (AS) are characterized as highly unstable fractures posing an elevated risk of neurological deficit and a significantly elevated mortality rate. This study assesses the efficacy and safety of single-stage plate stabilization with ventral cement augmentation in treating subaxial cervical spine fractures in patients with AS. Methods: Over 86 months, 38 patients diagnosed with AS received ventral plate stabilization with cement augmentation after suffering unstable subaxial cervical fractures. No additional dorsal stabilization was used in any of these surgeries. Results: There were no complications as a result of cement leakage. During the follow-up period, screw loosening and implant displacement were documented in two out of 38 cases. At the time of data analysis, 17 patients who had undergone treatment had died, representing 44.7% of the total cases. Seven patients died within 1 month, two patients died within 6 months, four patients died within 1 year, and four patients died after 1 year. Conclusions: Our study shows that a single-stage anterior screw and plate fixation of the cervical spine with cement augmentation could be a feasible and effective method to treat cervical spine fractures in patients with AS.

Low-Cost 3D Models for Cervical Spine Tumor Removal Training for Neurosurgery Residents

BACKGROUND AND OBJECTIVES

Spinal surgery, particularly for cervical pathologies such as myelopathy and radiculopathy, requires a blend of theoretical knowledge and practical skill. The complexity of these conditions, often necessitating surgical intervention, underscores the need for intricate understanding and precision in execution. Advancements in neurosurgical training, especially with the use of low-cost 3D models for simulating cervical spine tumor removal, are revolutionizing this field. These models provide the realistic and hands-on experience crucial for mastering complex neurosurgical techniques, filling gaps left by traditional educational methods.

MATERIALS AND METHODS

This study aimed to assess the effectiveness of 3D-printed cervical vertebrae models in enhancing surgical skills, focusing on tumor removal, and involving 20 young neurosurgery residents. These models, featuring silicone materials to simulate the spinal cord and tumor tissues, provided a realistic training experience. The training protocol included a laminectomy, dural incision, and tumor resection, using a range of microsurgical tools, focusing on steps usually performed by senior surgeons.

RESULTS

The training program received high satisfaction rates, with 85% of participants extremely satisfied and 15% satisfied. The 3D models were deemed very realistic by 85% of participants, effectively replicating real-life scenarios. A total of 80% found that the simulated pathologies were varied and accurate, and 90% appreciated the models' accurate tactile feedback. The training was extremely useful for 85% of the participants in developing surgical skills, with significant post-training confidence boosts and a strong willingness to recommend the program to peers.

CONCLUSIONS

Continuing laboratory training for residents is crucial. Our model offers essential, accessible training for all hospitals, regardless of their resources, promising improved surgical quality and patient outcomes across various pathologies.