Background: Simulation-based techniques using three-dimensional models are gaining popularity in neurosurgical training. Most pre-existing models are expensive, so we felt a need to develop a real-life model using 3D printing technology to train in endoscopic third ventriculostomy. Methods: The brain model was made using a 3D-printed resin mold from patient-specific MRI data. The mold was filled with silicone Ecoflex™ 00-10 and mixed with Silc Pig^® pigment additives to replicate the color and consistency of brain tissue. The dura mater was made from quick-drying silicone paste admixed with gray dye. The blood vessels were made from a silicone 3D-printed mold based on magnetic resonance imaging. Liquid containing paprika oleoresin dye was used to simulate blood and was pumped through the vessels to simulate pulsatile motion. Results: Seven residents and eight senior neurosurgeons were recruited to test our model. The participants reported that the size and anatomy of the elements were very similar to real structures. The model was helpful for training neuroendoscopic 3D perception and navigation. Conclusions: We developed an endoscopic third ventriculostomy training model using 3D printing technology that provides anatomical precision and a realistic simulation. We hope our model can provide an indispensable tool for young neurosurgeons to gain operative experience without exposing patients to risk.

Cadaveric models remain an essential part of medical training across all specialties. Due to their scarcity, high costs, and possible health hazards, there is a need for more accessible and affordable alternatives, especially in low-resource settings. We introduce cost-effective and easily replicable three-dimensional (3D) printed models to help democratize access to hands-on neuroanatomy education. Silicone-based glue is applied on the surface of a 3D-printed or cadaveric bone frame. Using plastiline on a 3 mm 3D acrylonitrile butadiene styrene pen, the desired anatomical structure is printed on the bone frame. A heat gun is used to smoothen the plastic edges. The structure can then be painted according to its appearance in the real anatomy. Using this technique, we successfully generated a variety of anatomical models to study the cerebrovascular anatomy, the course of the cranial nerves in relation to the skull base, and extracranial structures including the spine. Procurement and conservation of cadaveric specimens can be cumbersome. Our model may be an affordable and easily replicable approach to bridging the gap in anatomy education between low- and high-resource facilities.

Objectives: Variations in the morphological anatomy of the median nerve such as formation, distribution, and communication have been well documented. All these variations should be taken into account when practicing any surgical approach for the treatment of injuries affecting the median nerve. Furthermore, they are of the utmost importance for interpretation of the clinical presentation. Methods: The objective of this investigation was to determine the anatomical variations in the formation of the median nerve in cadavers at the Forensic Pathology department in Central Clinical Hospital of the Academy of Sciences of the Russian Federation between January 2022 and April 2022. A descriptive, cross-sectional, and prospective information source study was conducted on 42 anatomical bodies (corpses) and 84 brachial plexuses. Results: After analyzing the results obtained in this investigation, we concluded that the median nerve presented variation in its formation in 22.6% of the investigated cases. These variations were more common in males (81.8%) than females (18.2%). The anatomical variation was unilateral in 7.1% and bilateral in 19% of all anatomical bodies examined. Conclusions: The median nerve presented a great number of variations in its formation in roughly 23% of the anatomical bodies, with male being the predominant gender. Furthermore, the most frequent region of formation was the axillary region (92.9%). For clinicians, it is important to remember these variations during surgical procedures in this area and during brachial plexus block.

More contemporary options have been presented in the last few years as surgical methods and materials have improved in patients with degenerative spine illnesses. The use of biologically integrated titanium cages of a unique design based on computer 3D modeling for the surgical treatment of patients with degenerative illnesses of the spine’s intervertebral discs has been proposed and experimentally tested. The goal of this study is to compare the radiographic and clinical outcomes of lumbar posterior interbody fusion with a 3D porous titanium alloy cage versus a titanium-coated polyetheretherketone (PEEK) cage, including fusion quality, time to fusion, preoperative and postoperative patient assessments, and the presence, severity, and other side effect characteristics. (1) Methods: According to the preceding technique, patients who were operated on with physiologically integrated titanium cages of a unique design based on 3D computer modeling were included in the study group. This post-surveillance study was conducted as a randomized, prospective, interventional, single-blind, center study to look at the difference in infusion rates and the difference compared to PEEK cages. The patients were evaluated using CT scans, Oswestry questionnaires (every 3, 6, and 12 months), and VAS scales. (2) Results: Six months following surgery, the symptoms of fusion and the degree of cage deflation in the group utilizing the porous titanium 3D cage were considerably lower than in the group using the PEEK cage (spinal fusion sign, p = 0.044; cage subsidence, p = 0.043). The control group had one case of cage migration into the spinal canal with screw instability, one case of screw instability without migration but with pseudoarthrosis formation and two surrounding segment syndromes with surgical revisions compared with the 3D porous titanium alloy cage group. (3) Conclusions: The technique for treating patients with degenerative disorders or lumbar spine instability with aspects of neural compression utilizing biologically integrated titanium cages of a unique design based on computer 3D printing from CT scans has been proven. This allows a new approach of spinal fusion to be used in practice, restoring the local sagittal equilibrium of the spinal motion segment and lowering the risk of pseudarthrosis and revision surgery.

Background: Low-energy penetrating brain injuries are rarely encountered in neurosurgical practice. Immediate surgical management remains the primary treatment strategy to control potential bleeding and prevents infectious complications. Case Description: A 28-year-old man presented with an orbital injury with left-sided chemosis, amaurosis, and ophthalmoplegia following an assault. Cranial CT revealed an industrial drill bit causing a penetrating injury to the skull base. The tip of the object reached the petrous apex. CT angiography showed no signs of cerebrovascular damage. The drill bit was visualized through a frontotemporal craniotomy. It was then carefully removed under direct microscopic vision. Postoperative ceftriaxone was administered. The patient was discharged in good condition on postoperative day 6. His vision impairment remained. Conclusion: Timely access to neuroimaging diagnostics and microneurosurgical facilities allows for good outcomes in the surgical treatment of low-velocity penetrating brain injuries.

Background: Recurrent disc herniations remain a challenge in spinal surgery. Although some authors recommend a repeat discectomy, others offer more invasive secondary fusions. Here, we reviewed the literature (2017–2022) regarding the safety/efficacy of treating recurrent disc herniations with repeated discectomy alone. Methods: Our literature search of recurrent lumbar disc herniations included; Medline, PubMed, Google scholar, and the Cochrane database. We focused on the types of discectomy performed, perioperative morbidity, costs, length of surgery, pain scores, and incidence of secondary dural tears. Results: We identified 769 cases that included 126 microdiscectomies, and 643 endoscopic discectomies. Rates of disc recurrence ranged from 1% to 25% with accompanying secondary durotomy varying from 2% to 15%. In addition, operative times were relatively short, ranging from 29.2 min to 125 min, with a relatively small average estimated blood loss (i.e., minimal to maximally 150 mls). Conclusion: Repeated discectomy was the most commonly performed treatment for same-level recurrent disc herniations. Despite minimal intraoperative blood loss and short operating times, there was a significant risk of durotomy. Notably, patients must be informed that more extensive bone removal for treating recurrent disc increases the risk for instability warranting subsequent fusion.