Intraoperative diagnosis of central nervous system lesions: Comparison of squash smear, touch imprint, and frozen section.

BACKGROUND: Intraoperative diagnosis of central nervous system (CNS) lesions is of utmost importance for neurosurgeons to modify the approach at the time of surgery and to decide on further plan of management. The intraoperative diagnosis is challenging for neuropathologists. AIMS: The study was undertaken to determine the accuracy of cytological techniques (crush smears and touch imprints), frozen sections of space occupying lesions of the CNS and compare it with histopathological diagnosis. MATERIALS AND METHODS: A total of 75 specimens received intraoperatively were subjected to cytology and frozen section study. RESULTS: Neoplastic lesions formed the major group with 62 (82.7%) cases while 13 (17.3%) were nonneoplastic. The diagnostic accuracy of "squash smears" was found to be 89.2%. "Touch imprints" showed diagnostic accuracy of 78.4%. The low accuracy of touch imprints was attributed to poor cellular yield. The diagnostic accuracy of "frozen section" was 75.7%. However, the overall diagnostic accuracy was 96%. CONCLUSION: We believe that the cytololgical methods and frozen sections are complimentary to each other and both should be used to improve the intraoperative diagnostic accuracy in the CNS lesion.

Postoperative Recovery Outcomes in Adult Scoliosis: A Prospective Multicenter Database With 5-Year Follow-Up.

STUDY DESIGN: Retrospective review of a prospective, multi-institutional database. OBJECTIVES: To determine postoperative quality of life outcomes in scoliosis patients using the Oswestry Disability Index (ODI) at defined time points. SUMMARY OF BACKGROUND DATA: Spinal surgery provides significant improvement in both pain and disability in adults with scoliosis compared with conservative treatment; however, the postoperative timing of improvements in quality of life outcomes has not been studied. METHODS: This was a retrospective review of a prospective, multi-center database with 1,750 patients. All patients completed the ODI at first encounter and at 6 follow-ups (6 weeks, 6 months, and 1, 2, 3, and 5 years). The authors stratified by age, primary versus revision, staged surgery, anatomical region of surgery, complexity (osteotomy and levels), and complications (intraoperative and postoperative). RESULTS: At baseline and most follow-up visits, older patients, those with revision surgeries, and those who had an osteotomy had significantly higher ODI scores than did young patients, those with primary surgeries, and those who did not have an osteotomy. All stratified groups showed a significant ODI score decrease between 6 weeks' and 6 months' follow-up. However, most of the stratified group patients' outcomes remained unchanged throughout the postoperative recovery period from 1 to 5 years. CONCLUSIONS: Surgical treatment has the potential to significantly improve the quality of life of patients with adult scoliosis. An understanding of the timing of improvement after surgery will improve both the counseling of surgical candidates and patient care pathways.

Pedicle violation and Navigational errors in pedicle screw insertion using the intraoperative O-arm: A preliminary report.

BACKGROUND: Use of computer-assisted insertion of pedicle screws has some advantages owing to the reportedly decreased incidence of pedicle breach and clinical events. Registration-based methods based on preoperative computed tomography imaging, 2D fluoroscopy, and 3D fluoroscopy are the most popular, however each has its limitations. O-arm-based navigation, which uses intraoperative acquisition and registration of navigated images, may overcome many of these disadvantages. We set out to study the clinical accuracy and navigational accuracy for pedicle screw insertion using our recently acquired O-arm and present our preliminary findings. METHODS: The first 26 patients operated consecutively for L4-5 fusion were included in the study. O-arm-based navigation was used to insert the pedicle screws. Postoperative computed tomography images were acquired and assessed for pedicle breach and anterior cortical perforation. Planned trajectories of each screw were compared with the actual trajectories in the postoperative images to assess navigational accuracy in both axial and sagittal planes. RESULTS: A total of 104 screws were inserted. One screw (1%) breached the pedicle laterally. Nonsignificant anterolateral cortical perforations were noted in 7 screws (6.7%), all of which occurred at L5 level. The mean axial and sagittal navigational error was 2.3° (±1.7) and 3.1° (±2.3), respectively. There were no significant differences in the errors between L4 or L5 level. The occurrence of anterior perforation correlated with the degree of axial (P = .02) but not sagittal (P = .12) navigational error. There were no clinical events related to the screw insertion. CONCLUSION: Use of O-arm-guided pedicle screw insertion was associated with low incidence of pedicle breach (1%) and a low range of navigational error in both sagittal and axial planes. Anterolateral vertebral body perforation was higher at L5 without any negative clinical events. Despite the high need for technical support, we found that O-arm was a very efficient tool for accurate pedicle screw insertion.