Augmented reality (AR), virtual reality (VR), and mixed reality (MR) are emerging technologies that are starting to be translated into clinical practice. Limited data are available regarding these ...tools in use during live surgery of the spine. Our objective was to systematically collect, analyze, and interpret the existing data regarding AR, VR, and MR use in spine surgery on living people.
A systematic review was conducted using the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The PubMed, PubMed Central, Cochrane Reviews, and Embase databases were searched. Combinations and variations of the phrases “augmented reality,” “virtual reality,” and spine surgery using both “AND” and “OR” configurations were used to find relevant studies. The references of the included reports from the systematic review were also screened for possible inclusion as a part of a manual review. The included studies were full-text publications written in English that had included any spine surgery on live persons with the use of VR or AR.
A total of 1566 unique reports were found, and 15 full-text publications met the criteria for the present study. The total number of patients from all studies was 241, with a weighted average age of 50.37 years. Surgical procedures using AR, VR, and/or MR were diverse and spanned from simple discectomy to intradural spinal tumor resection. All patients experienced improvement in their symptoms present at clinical presentation. The highest complication rate reported in the studies was 6.1% and was for suboptimal pedicle screw placement. No complications led to clinical sequelae.
The systematically collected, analyzed, and interpreted data of existing peer-reviewed full-text articles showed favorable metrics regarding surgical efficacy, pedicle screw target accuracy, radiation exposure, clinical outcomes, and disability and pain for patients with spinal pathology treated with the help of AR, VR, and/or MR.
Streambank erosion processes influence the amount of soil material contributed to rivers and sedimentation rates in receiving reservoirs. However, the amount of data on bank erosion rates is limited ...both in range and extent affecting planning for mitigation and watershed management. Dendrogeomorphology is used to determine the date of wood anatomy changes in annual growth increments of roots exposed by erosion of stream banks that when coupled with measurement of the distance of roots to the channel side can be used to calculate the bank retreat rate. Erosion rates derived from dendrogeomorphology are important because these provide erosion data over longer time scales (decades). Here, we use this method to quantify erosion for three different sized watersheds (4 to 3781 km2) located in the water‐scarce southern U.S. prairies that are heavily reliant on surface water and reservoir storage. From 49 roots from the two smaller drainages, erosion ranged from 1.5 to 25.4. For 19 roots collected from the larger subbasin erosion rates were larger ranging from 7.4 to 325.0 cm/years with the larger values and variance associated with two high‐flow events that occurred a year before sampling. We also found differences in straight and meandering portions of the streams where the distance to bank was strongly and positively correlated with the years since root exposure in straight sections. In contrast, meandering bends also showed a positive but low correlation for root exposure date and distance collected. We attribute this difference to erosional processes (i.e., scour and mass wasting) occurring at these channel locations. When compared with other erosion studies across the southern U.S. prairie, our values were similar in magnitude but with low correlation to drainage area indicating site specificity of erosion mechanisms, and watershed landcover influence for different drainages, despite being in the same ecological region.
Stapedial myoclonus is an uncommon condition involving the rhythmic contraction of the stapedial tendon that may result in a host of symptoms, including tinnitus . There is a dearth of robust ...diagnostic modalities to diagnose stapedial myoclonus, and most patients are treated without definitive diagnosis. Herein, we hypothesize that stapedial myoclonus can be readily diagnosed by awake otoendoscopy (see Video, Supplemental Digital Content 1, http://links.lww.com/MAO/A997).
A 21-year-old healthy male professional singer presented with a rhythmic "thumping sound" heard in both ears for 5 years. Symptoms were triggered by singing and were worse on the right side. Work-up, including otologic exam, audiologic testing, and high resolution imaging, was unrevealing. Given symptomatology, stapedial tendon myoclonus was suspected.While awake in the operating room, an inferior myringotomy was made, and both 1.9 mm 0 and 30 degree 3-CCD Hopkins rod endoscopes were used to visualize the middle ear space using a transcanal approach. There was robust movement of the tendon with patient vocalization that corresponded precisely with the timing of tinnitus. The patient subsequently underwent transection of the right stapedial tendon under general anesthesia using otoendoscopic visualization. The pyramidal eminence was also removed to avoid future regeneration. The patient underwent an identical procedure on the contralateral ear 3 months later with complete resolution of symptoms bilaterally.
Stapedial myoclonus was diagnosed by transtympanic otoendoscopy in an awake patient. This approach may be readily applied in awake patients suspected of having stapedial myoclonus. Transection of the stapedial tendon in these patients resolves tinnitus.
The use of three-dimensional (3D) printing in neurosurgery has become more prominent in recent years for surgical training, preoperative planning, and patient education. Several smaller studies are ...available using 3D printing; however, there is a lack of a concise review. This article provides a systematic review of 3D models in use by neurosurgical residents, with emphasis on training, learning, and simulation.
A structured literature search of PubMed and Embase was conducted using PRISMA guidelines to identify publications specific to 3D models trialed on neurosurgical residents. Criteria for eligibility included articles discussing only neurosurgery, 3D models in neurosurgery, and models specifically tested or trialed on residents.
Overall, 40 articles were identified that met inclusion criteria. These studies encompassed different neurosurgical areas including aneurysm, spine, craniosynostosis, transsphenoidal, craniotomy, skull base, and tumor. Most articles were related to brain surgery. Of these studies, vascular surgery had the highest overall, with 13 of 40 articles, which include aneurysm clipping and other neurovascular surgeries. Twenty-two articles discussed cranial plus tumor surgeries, which included skull base, craniotomy, craniosynostosis, and transsphenoidal. Five studies were specific to spine surgery. Subjective outcome measures of neurosurgical residents were most commonly implemented, of which results were almost unanimously positive.
3D printing technology is rapidly expanding in health care and neurosurgery in particular. The technology is quickly improving, and several studies have shown the effectiveness of 3D printing for neurosurgical residency education and training.
Objectives/Hypothesis
To design and validate a classification system for endoscopic ear surgery.
Study Design
Validation study.
Methods
A classification system was devised that quantifies use of the ...endoscope during middle ear surgery. Otologic operative reports were reviewed by attending surgeons and trainees. A power analysis was performed to determine number of cases needed to review. The following categories were used: class 0 is defined by using the microscope only; class 1 describes the use of endoscope for inspection without dissection; and class 2 describes mixed use of the endoscope and the microscope. It is further subdivided into 2a and 2b, where the endoscope is used for less than 50% of dissection and more than 50% of dissection, respectively. Class 3 describes the use of the endoscope for the entire surgery. Fifty cases were reviewed by three attending otologic surgeons, one resident, and one medical student.
Results
Weighted Cohen's Kappa for inter‐rater agreement between the two institutional surgeons was 0.79 (95% bias corrected BC confidence interval CI: 0.58‐0.93). Agreement between the external surgeon and the two institutional surgeons was 0.77 (95% BC CI: 0.58‐0.89) and 0.76 (95% BC CI: 0.57‐0.88). Weighted Kappa between institutional surgeons and a resident was 0.73 (95% BC CI: 0.53‐0.88) and 0.62 (95% BC CI: 0.38‐0.80), and between institutional surgeons and a medical student was 0.75 (95% BC CI: 0.56‐0.89) and 0.70 (95% BC CI: 0.49‐0.85).
Conclusions
There was substantial inter‐rater agreement. This classification system can be used as a simple and reliable tool to describe the extent to which an endoscope was used during ear surgery.
Level of Evidence
NA. Laryngoscope, 128:967–970, 2018
Experimental crowdsourced strategies pertaining to library resource description are becoming increasingly common. This research introduces the term "revolutionary cataloging interface" to describe ...the characteristics of crowdsourced metadata creation portals: capable of being learned during a 10-15 minute tutorial, requiring little or no previous cataloging experience, yet with demonstrated potential for producing robust and rich metadata with an impressive level of automated quality control. Focusing on a case study of Zooniverse's Operation War Diary, this paper investigates, explains, and assesses the potential of such innovations to meet successfully the challenges posed by Hidden Collections.
Abstract Introduction Surgical simulators are designed to improve operative skills and patient safety. Transcanal Endoscopic Ear Surgery (TEES) is a relatively new surgical approach with a slow ...learning curve due to one-handed dissection. A reusable and customizable 3-dimensional (3D)-printed endoscopic ear surgery simulator may facilitate the development of surgical skills with high fidelity and low cost. Herein, we aim to design, fabricate, and test a low-cost and reusable 3D-printed TEES simulator. Methods The TEES simulator was designed in computer-aided design (CAD) software using anatomic measurements taken from anthropometric studies. Cross sections from external auditory canal samples were traced as vectors and serially combined into a mesh construct. A modified tympanic cavity with a modular testing platform for simulator tasks was incorporated. Components were fabricated using calcium sulfate hemihydrate powder and multiple colored infiltrants via a commercial inkjet 3D-printing service. Results All components of a left-sided ear were printed to scale. Six right-handed trainees completed three trials each. Mean trial time (n = 3) ranged from 23.03 to 62.77 s using the dominant hand for all dissection. Statistically significant differences between first and last completion time with the dominant hand (p < 0.05) and average completion time for junior and senior residents (p < 0.05) suggest construct validity. Conclusions A 3D-printed simulator is feasible for TEES simulation. Otolaryngology training programs with access to a 3D printer may readily fabricate a TEES simulator, resulting in inexpensive yet high-fidelity surgical simulation.
Objectives/Hypothesis
During intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery, endotracheal (ET) tube migration can result in a decrease in vocalis electromyographic (EMG) ...amplitude without a concordant latency elevation during stimulation of the recurrent laryngeal nerve (RLN).
Study Design
Retrospective review.
Methods
Data were reviewed retrospectively for thyroid and parathyroid surgery patients with IONM of the laryngeal nerves from January 2015 to December 2015. Recordings of vocalis EMG amplitudes and latencies with RLN stimulation were obtained with the neuromonitoring ET tube surface electrodes in optimal baseline position, with vertical displacement away from the vocalis, and with rotational change away from baseline.
Results
ET tube surface electrode EMG recordings were obtained with stimulation of seven left and three right RLNs in a total of 10 patients. Mean vocalis EMG amplitudes were reduced with vertical displacement 1 and 2 cm both inferior and superior to baseline and with rotational change (45° and 90° clockwise and counterclockwise, 180°), although amplitude change with 45° clockwise and 180° rotation did not meet statistical significance. Mean EMG latency values did not change significantly from baseline with either rotation or vertical displacement of the ET tube.
Conclusions
An isolated decrease in EMG amplitude without concordant latency elevation should warrant re‐evaluation of ET tube position during thyroid and parathyroid surgery and is in contrast to a combined event, with both EMG amplitude decrease and concordant latency increase, which is more suggestive of a true neuropraxic injury.
Level of Evidence
4. Laryngoscope, 127:2182–2188, 2017
Objectives/Hypothesis
Intraoperative neural monitoring is a useful adjunct for the laryngeal nerve function assessment during thyroid and parathyroid surgery. Typically, monitoring is performed by ...measurement of electromyographic responses recorded by endotracheal tube (ETT) surface electrodes. Tube position alterations during surgery can cause displacement of the electrodes relative to the vocal cords, leading to false positive loss of signal. Numerous reports have denoted monitoring equipment–related issues, especially endotracheal tube displacement, as the dominant source of false positive error. The false positive error may result in inappropriate decisions by the surgeon. This study tests the hypothesis that anterior laryngeal electrodes (ALEs) can help reduce this error. Placement of ALEs directly onto the thyroid cartilage represent an adjunctive and possible alternative method to standard ETT surface electrodes.
Study Design
Retrospective review.
Methods
Fifteen consecutive patients undergoing thyroid and parathyroid surgery with intraoperative neuromonitoring using both ETT electrodes and ALEs were studied. Data collected included site of neural stimulation, laterality, and electromyographic parameters.
Results
With vagal and recurrent laryngeal nerve stimulation, the ALEs recorded mean vocalis muscle waveform amplitude within 83% of that recorded with standard ETT electrodes. The latency measurements with the anterior laryngeal and endotracheal electrodes were similar, with both electrodes recording significantly longer latency for the left vagus nerve as compared to the right vagus nerve. With superior laryngeal nerve stimulation, the ALEs recorded a 800% greater mean amplitude than the ETT electrodes. The ALEs demonstrated similar sensitivity to stimulation at low current as ETT electrodes and provided stable intraoperative monitoring information.
Conclusions
Compared to ETT surface electrodes, the ALEs provide similar and stable electromyographic responses with equal sensitivity for recording evoked responses during neural monitoring in thyroid and parathyroid surgery. The ALEs offer significantly more robust monitoring of the external branch of the superior laryngeal nerve. Furthermore, ALEs are contained within the operative field, are totally surgeon controlled, and are unaffected by the potential vicissitudes of ETT position during surgery.
Level of Evidence
4 Laryngoscope, 128:2910–2915, 2018
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