Journal of Korean Neurosurgical Society最新文献

Objective: Anesthetics influence sympathetic tone, a key determinant of anesthetic depth. This study aimed to evaluate whether the perfusion index (Pi), reflecting propofol-mediated sympathetic modulation, can serve as a continuous real-time indicator of anesthetic depth during propofol-based total intravenous anesthesia (TIVA) requiring intraoperative neuromonitoring (IOM) in neurosurgery.

Methods: This single center, prospective observational study included patients scheduled for anterior cervical decompression and fusion under propofol-based TIVA with IOM. Patients were eligible for inclusion (ACDF) if they were aged 40-75 years and classified as American Society of Anesthesiologists (ASA) physical status 1 or 2. At designated time intervals, from pre-induction to extubation, the bispectral index (BIS), a marker of anesthetic depth, alongside finger and ear perfusion indices (FPi and EPi) was assessed to examine correlations between these variables. The primary outcome was to find correlation between FPi and BIS.

Results: Thirty participants were enrolled in this study. FPi and BIS showed significant correlation (correlation coefficient: -0.629, 95% confidence interval: -0.696 to -0.551, p < 0.001), while EPi showed no significant correlation with BIS (correlation coefficient: 0.078, 95% confidence interval: -0.042 to 0.196, p = 0.202).

Conclusion: FPi monitoring may serve as a complementary technique for evaluating anesthetic depth during propofol-based TIVA requiring IOM in neurosurgery, as indicated by its correlation with BIS.

Objective: Aspiration thrombectomy is a widely adopted treatment for acute ischemic stroke due to large vessel occlusion. Among several technical factors, the diameter of the aspiration catheter plays a critical role in determining thrombus fixation, aspiration efficiency, and overall procedural success. This study aimed to investigate the biomechanical effects of a larger catheter diameter on thrombus behavior and vessel wall response during aspiration thrombectomy.

Methods: Finite element analysis was employed to simulate aspiration using three clinically relevant aspiration catheters with different diameters. Thrombi of two lengths and two compositions, varying in red blood cell content, were modeled to reflect clinical variability. Mechanical outcomes, including thrombus deformation, internal stress distribution, and vessel wall loading, were analyzed under standardized aspiration pressure conditions.

Results: 0.080- and 0.084-inch large-bore catheters produced greater thrombus deformation and internal stress than the 0.072-inch catheter, particularly in softer thrombi with higher red blood cell content. In both 3 and 5 mm thrombi with red blood cells, deformation increased by approximately 12.3% with the 0.084-inch catheter compared to the 0.072-inch catheter. These changes indicate improved clot engagement and aspiration efficiency, while vessel stress remained within physiological limits. This mechanical advantage is partly due to greater luminal occupancy, with the 0.084-inch catheter occupying 65.6% of the vessel lumen, about 14% more than the 0.072-inch catheter.

Conclusion: Large-bore aspiration catheters can enhance thrombus fixation and aspiration performance without compromising vascular integrity. These findings support the broader clinical use of larger-bore catheters in patients with large artery occlusion, particularly in cases requiring strong clot engagement and efficient recanalization.

Objective: Alzheimer's disease is a progressive neurodegenerative disorder characterized by amyloid-beta (Aβ) peptide aggregation, representing a major therapeutic target. Emerging evidence suggests certain chemotherapeutic agents may attenuate Aβ pathology.

Methods: This study investigated the effects of Imatinib, a tyrosine kinase inhibitor with limited blood-brain barrier (BBB) penetration, and Nilotinib, with enhanced BBB permeability, in an intracerebroventricular streptozotocin (ICV-STZ) rat model of Alzheimer's disease. Outcomes included behavioral assessments (learning latency), hippocampal CA1 and CA3 neuronal counts, and brain concentrations of TNF-α, NF-κB, BDNF, and NRG-1.

Results: ICV-STZ administration significantly elevated TNF-α and NF-κB levels and reduced BDNF and NRG-1 expression. Both Imatinib and Nilotinib mitigated these alterations, with Imatinib demonstrating greater efficacy despite its limited BBB permeability. Imatinib and Nilotinib reduced TNF-α and NF-κB levels, increased BDNF and NRG-1 expression, and significantly improved cognitive performance, with latency periods extending from 69.8 seconds in the disease model to 193.5 and 183.1 seconds, respectively.

Conclusion: Imatinib and Nilotinib ameliorated neuroinflammation, restored neurotrophic support, and improved cognitive deficits in a preclinical Alzheimer's disease model. These findings highlight the therapeutic potential of tyrosine kinase inhibitors, warranting further translational research in human studies.

Malakoplakia is a rare chronic inflammatory disease that has been rarely reported in the genitourinary tract, gastrointestinal tract, adrenal glands, skin, lungs, bone, and endometrium. Central nervous system malakoplakia is extremely rare, and even then, it has only been reported in the cerebrum and cerebellum. A definite diagnosis of malakoplakia depends on microscopic detection of Michaelis-Gutmann bodies. We would like to present the case of a 61-year-old male who, after undergoing a liver transplant and receiving prolonged antibiotic treatment for Escherichia coli bacteremia, presented with quadriparesis and gait disturbance. The clinical and radiologic appearance of malakoplakia mimics that of malignant tumor. This is a condition with no established appropriate treatment and presents challenges due to its spinal cord location. However, this case presents a case of spinal cord malakoplakia and may provide newly differential diagnosis of an intramedullary mass in the spinal cord.

Objective: This study aimed to compare the clinical outcomes and risk of two skull base reconstruction methods after expanded expanded endoscopic approach (EEA), viz. postoperative cerebrospinal fluid (CSF) lumbar drainage (L-method) and injectable hydroxyapatite cement without lumbar drainage (H-method).

Methods: We enrolled 211 consecutive patients with grade 2 or 3 intraoperative CSF leakage during EEA. The most common preoperative diagnoses were pituitary adenoma (n=62, 29%), meningioma (n=50, 24%), and craniopharyngioma (n=28, 13%). Vascularized nasoseptal flaps were used in most cases (98%). We used the L-method and H-method in 83 (39%) and 103 patients (49%), respectively.

Results: The overall reconstruction-related complication and postoperative CSF leakage rates were 8% (18/211) and 6% (12/211), respectively. The complications included postoperative CSF leakage (n=12), infection (n=4), postoperative optic nerve compression (n=1), and brain herniation (n=1). The postoperative complication and CSF leakage rates did not differ significantly between the L-method (12% and 10%, respectively) and H-method (8% and 4%, respectively) (p=0.326 and 0.112, respectively). Postoperative hospital stay was significantly shorter with the H-method (6.9 days) compared to the L-method (10.0 days) (p<0.001). However, the postoperative infection rate of the H-method (n=4) was higher than that of the L-method (n=0; p=0.070).

Conclusion: Skull base reconstruction using hydroxyapatite effectively prevented postoperative CSF leakage and ensured patient comfort and shorter hospitalization without postoperative lumbar drainage, although postoperative infection requires consideration.

Objective: The first-line treatment for pyogenic spondylitis is conservative management with immobilization and systemic antibiotic therapy. However, in cases where conservative treatment fails or neurological deficits and spinal instability are present, surgical intervention is required. Surgical treatment helps manage spondylitis by decompressing neural structures through abscess drainage and maintaining spinal stability. It includes simple decompression via abscess removal, debridement of inflamed and necrotic tissues, and reconstruction with fixation. This study aims to analyze the risk factors associated with clinical outcomes in patients undergoing simple drainage followed by instrumented fusion.

Methods: We retrospectively evaluated patients who underwent surgical treatment with intravenous antibiotics for pyogenic spondylitis at our hospital between March 2010 and November 2021. We categorized the study group into a group that underwent simple decompression and drainage and a group that was followed up until fusion. We compared the basic demographics, laboratory data, and radiological findings between the two groups.

Results: Overall, 88 patients (50 males and 38 females) with a mean age of 63.8 years were included in this study. Of the 88 patients, 71 underwent simple abscess drainage and 17 underwent instrumented fusion. In the univariate logistic regression analysis based on demographic data, longer duration of antibiotic use (p=0.021), body signal change (p=0.001), facet inflammation (p=0.003), disc abscess (p<0.001), psoas abscess (p=0.003), disc space bone erosion (p=0.006), and hypertension (p=0.024) were significant risk factors for necessitation of fusion surgery after decompression and drainage surgery. Multivariate logistic regression analysis based on these risk factors revealed that the longer the period of total antibiotic use after decompression and drainage (p=0.019), the higher the risk of fusion surgery, as well as a higher risk of body signal change.

Conclusion: When planning surgical treatment for pyogenic spondylitis, close observation is required because the necessity for instrumented fusion surgery increases when antibiotic use is prolonged or body signal changes are confirmed on magnetic resonance imaging.

Objective: C-arm computed tomography (CT) has always played an important role in neurointerventional surgery, in this study, we aimed to investigate the value of high-resolution C-arm CT in evaluating stent expansion and apposition in carotid arteries of Guangxi Bama piglets.

Methods: Twenty-four stents were implanted in the carotid arteries of 24 Guangxi Bama piglets. High-resolution C-arm CT was performed to evaluate stent expansion and the quality of processed images, followed by three-dimensional digital subtraction angiography (3D-DSA). The DSA and high-resolution C-arm CT images were transmitted to a postprocessing workstation for image reconstruction (dual-volume reconstruction method). High-resolution C-arm CT reconstructed images after diluted contrast agent injection (diluted contrast method) were also acquired. In addition to assessing radiation exposure, the accuracy of stent apposition assessment by the two methods was compared, using intravascular ultrasound as the reference standard. Adverse events during and within 24 hours after the procedure were recorded.

Results: One stent was incompletely expanded, while the remaining 23 stents were fully expanded without disruption. The image quality of high-resolution CT was grade I in most cases (n=22/24). Both methods clearly demonstrated stent apposition with a consistency of 100%. However, the dual-volume reconstruction method was associated with significantly higher radiation exposure (p<0.001). Mild-tomoderate vasospasm occurred in four piglets when the diluted contrast method was used. Overall, no serious complications occurred in this study.

Conclusion: High-resolution C-arm CT enables clear microstructure visualization and can be used in combination with different postprocessing techniques to accurately assess the apposition of intracranial stents.

Objective: Radiotherapy is a key treatment for brain tumors and arteriovenous malformations; however, it is associated with adverse effects such as brain edema, demyelination, and delayed necrosis. These adverse effects are driven by inflammation and apoptosis, initiated by cytokines such as tumor necrosis factor-α, transforming growth factor, and interleukin-1β. Adipose tissuederived mesenchymal stromal cells (ADMSCs) offer protection against radiation-induced damage owing to their pluripotency and antiinflammatory properties. In this study, we investigated the neuroprotective effects of ADMSCs on irradiated brain cells.

Methods: Rat cortical neurons, human glioblastoma cells (U87 cell line), and ADMSCs were exposed to radiation doses ranging from 3 Gy to 40 Gy. Co-cultures of irradiated neurons with ADMSCs or their secretomes were assessed for apoptotic and inflammatory markers. Cell viability was measured using lactate dehydrogenase (LDH) and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays. Apoptosis was determined by using Hoechst staining and western blot analysis of proteins such as Bax, caspase-3, and Bcl-2.

Results: Higher radiation doses (30-40 Gy) significantly increased apoptosis and decreased the viability of cortical neurons and U87 cells. Co-culture with ADMSCs reduced the levels of apoptosis markers, particularly Bax and cleaved caspase-3, and promoted cell survival. Direct co-culture provided more pronounced protection than did ADMSC secretome treatment, suggesting that cell-to-cell interactions are crucial for neuroprotection.

Conclusion: ADMSCs have a significant potential for mitigating radiation-induced brain damage by reducing apoptosis and inflammation. Direct ADMSC co-culture outperformed secretome treatment, thereby emphasizing the importance of physical cell interactions. ADMSC therapy may be a promising approach to protect against radiotherapy-induced neural damage. Further studies are required to optimize the delivery and timing of stem cell therapy.