Application of intraoperative O-arm-assisted real-time navigation technique for spinal fixation

This study explored the combined use of the O-arm and real-time navigation during spinal fixation. The clinical data for 60 patients undergoing spinal fixation, at Beijing Tsinghua Chang Gung Hospital between May 5, 2015 and May 1, 2017, were retrospectively analyzed. Pre-, intra-, and postoperative imaging findings were assessed. The patients were classified into the occipitocervical fusion(32 cases) and thoracic/lumbar/sacral spine fixation(28 cases, including 6 cases of percutaneous pedicle screw) groups. Lesion resections were performed microscopically. An O-arm, combined with real-time navigation, was used to assess spinal fixation. Efficacy was evaluated using operative times, X-ray times, screw positioning, and complications. Within the occipitocervical fusion group, 182 screws were placed in the cervical spine and 96 in the occipital bone. However, 6 screws penetrated the bone cortex and were adjacent to the vertebral arteries, based on O-arm three-dimensional imaging; therefore, the precision rate was 96.7%. Within the thoracic/lumbar/sacral spine fixation group, 148 pedicle screws were implanted, with 4 initially outside the vertebral body,yielding a precision rate of 97.3%. Ten percutaneous pedicle screws were implanted and well positioned. O-arm scans were performed 3 times/patient, with an average of 20–30 min/time. Screw implantation times were 5–7 min(cervical spine), 8–10 min(thoracic spine), and 6–8 min(lumbar spine). Intraoperative O-arm scans, combined with real-time navigation technology, allow real-time observation of screw angles and depths, improving the accuracy and safety of posterior screw fixations and reducing the radiation dose and frequency experienced by patients and surgeons.

Posterior mediastinal ganglioneuroma: A case report and literature review

Objectives: Ganglioneuroma is a rare, benign neurogenic tumor arising from the sympathetic ganglia. In this report, we reviewed and summarized the clinical features,treatment, and prognosis of a posterior mediastinal ganglioneuroma. Case: Here, we report on a 29-year-old man referred to us with transient pain in the right side of the chest, lasting for three days. Physical examination revealed no abnormalities.The results of routine laboratory tests were within the normal ranges. Thoracic spinal magnetic resonance imaging showed a well-defined, solid mass in the right paravertebral region at the T5-T8 level, measuring 7.5 cm × 4.2 cm × 1.5 cm. To accurately locate the lesion during surgery, O-arm intraoperative imaging was used in conjunction with the Stealth Station navigation system. The tumor was completely excised and no related complications occurred. The tumor was an encapsulated mass with a solid, homogenous, grayish-tan cut surface. Histopathological examinations confirmed that the mass was a ganglioneuroma. Conclusions: Ganglioneuroma is a rare, benign tumor. Prior to treatment, a careful imaging evaluation is necessary in order to obtain an accurate diagnosis. A definitive diagnosis can be made by histological examination. En bloc resection is the preferred treatment for ganglioneuroma as it has an excellent prognosis.

Fluorescein sodium use during spinal ependymoma resection

Spinal ependymomas(SEs) are common adult intramedullary tumors; however,determining the absolute boundary between the tumor and the tumor residual may be difficult. We assessed outcomes following the use of fluorescein sodium(FS) during surgical removal of SEs. We performed a retrospective analysis of 112 patients with SEs who were treated at Beijing Tsinghua Changgung Hospital between December 2014 and December 2016. Each patient received intravenous FS(3–4 mg/kg) to determine the SE boundaries during surgery. Tumor removal efficiencies and tumor residuals were assessed using magnetic resonance imaging(MRI) at 10 days and 3 months after surgical recovery; McC ormick's spinal function classification was also performed at the 3-month follow-up. The complete tumor removal rate was 92%(103/112). Ninetyfour patients underwent tumor removal under fluorescent light, which provided distinctive tumor fluorescence. Tumor removal under white light was performed in18 patients; fluorescent images were invisible or indistinctive in these 18 patients. At the 3-month follow-up, sensory function(85.8%(91/106)) and movement(84.3%(86/102)) were improved in patients with pre-surgical dysfunction; urination and defecation functions were improved in 66.7%(16/24). The Mc Cormick spinal cord functional classifications, at the 3-month follow-up, showed significant differences in the percentages of patients with disease classified to each grade(I–IV), compared with preoperative classifications(each, P < 0.05). There was no MRI evidence of tumor relapse or residuals at the 3-month follow-up. FS use during the surgical treatment of SE enables complete tumor removal and detection of tumor residuals.