Right gyrus cinguli low-grade astrocytoma recurrence removed through a contralateral transfalcine approach with a 4K-3D exoscope

Background Brain tumor surgery has been using operative microscope for years.Recently,thanks to developments in surgical technology with procedures performed on head-up displays,exoscopes have been introduced as an alternative to microscopic vision.Case presentation We present a case of a 46-year-old patient with a low-grade glioma recurrence of the right gyrus cinguli removed with a contralateral transfalcine approach using an exoscope(ORBEYE 4K-three-dimensional(3D)exoscope,Sony Olympus Medical Solutions Inc.,Tokyo,Japan).The operating room setup for this approach is illustrated.During the procedure,the surgeon was seated with head and back in an upright position,while the camera was aligned with the surgical corridor.The exoscope provided detailed,high-quality 4K-3D images of the anatomical structures and optimal depth perception,making surgery accurate and precise.At the end of the resection,an intraoperative MRI scan showed complete removal of the lesion.The patient was discharged on postoperative day 4 with an excellent performance on neuropsychological examination.Conclusions In this clinical case the contralateral approach was favorable because the glioma was located close to the midline and because it offered a straight path to the tumor,minimizing retraction on the brain.The exoscope provided the surgeon with important advantages in terms of anatomical visualization and ergonomics during the entire procedure.

Surgical pitfalls with custom-made porous hydroxyapatite cranial implants

Aim:Cranioplasty implants are used primarily in cases of surgical cranial decompression following pathological elevations of intracranial pressure.Available bone substitutes include porous hydroxyapatite(HA)and polymethylmethacrylate.Whichever material is used,however,prosthetic cranial implants are susceptible to intra-and postsurgical complications and even failure.The aim of this study was to investigate such occurrences in HA cranioplasty implants,seeking not only to determine the likely causes(whether correlated or not with the device itself)but also,where possible,to suggest countermeasures.Methods:We analyzed information regarding failures or complications reported in postmarketing surveillance and clinical studies of patients treated worldwide with custom-made HA cranial implants(Custom Bone Service Fin-Ceramica Faenza,Italy)in the period 1997-2013.Results:The two most common complications were implant fractures(84 cases,2.9%of the total fitted)and infections(51 cases,1.77%).Conclusion:Although cranioplasties are superficial and not difficult types of surgery,and use of custom-made implants are often considered the“easy”option from a surgical perspective,these procedures are nonetheless plagued by potential pitfalls.If performed well they yield more than satisfactory results from the points of view of both the patient and surgeon,but lack of appropriate care can open the door to numerous potential sources of failure,which can compromise-even irreparably-the ability to heal.