Journal of neurosurgical sciences最新文献

Background: We have previously shown the usefulness of a new confocal endomicroscopy system (CONVIVO^®) in providing a quick and reliable method for intraoperative diagnosis ex vivo in glioblastoma (GBM). In this study, we aimed to assess the intraoperative usefulness of CONVIVO^® in an in-vivo setting, focusing on its capability to explore the presence of residual tumor at the resection margins of Central Nervous System (CNS) tumors.

Methods: We consecutively enrolled patients submitted to fluorescein-guided CNS-tumor removal (May 2020 to December 2022). CONVIVO^® was used in vivo to obtain images from virtual biopsies at the central tumor core and at its margin of resection, evaluating its ability to offer a histological diagnosis at the center and a tumor tissue identification at the periphery, with respect to corresponding standard histological sections. CONVIVO^® images were analyzed before interpretation of permanent or frozen sections, with the pathologist being totally blinded to histological results.

Results: Seventy-five patients were studied. The most frequent diagnoses were GBM (50.6%) and metastasis (13.3%). At the tumor margins, on a total of 169 biopsies, we obtained an overall accuracy in tumor tissue identification of 82.2% (95% CI 75.0-89.5) in GBM/Grade 4 IDH-mutated astrocytomas, and 85.8% (95% CI 80.5-91.1) considering all tumors together. At the tumor center, a correct intraoperative diagnosis was obtained in 67.6% (95% CI 56.9-78.2) of all the cases, and in 80.9% (95% CI 69.1-92.8) of the GBM/Grade 4 IDH-mutated astrocytoma subgroup.

Conclusions: CONVIVO^® allowed to accurately assess the presence of pathological marginal tissue remnants during resection of aggressive CNS tumors. More studies are needed to evaluate if this could possibly improve the extent of resection.

Background: Cauda equina syndrome (CES) is a critical condition requiring timely intervention to prevent severe morbidity. This study investigates the epidemiology and socioeconomic factors influencing access to CES care in USA Emergency Departments.

Methods: Data was used from the Nationwide Emergency Department Sample (NEDS) from 2016-2020. Encounters for patients presenting with suspected CES were queried using ICD 10 codes. Incidence estimates for suspected and surgically managed CES were constructed. Encounter characteristics were tabulated to describe aspects of a typical CES presentation to a USA ED. Multivariable regression analysis ascertained the impact of hospital and socioeconomic features on in-hospital mortality, surgical management, length of stay, visit costs, and patient transfer.

Results: The incidences of suspected and surgically managed CES rose year-by-year (P=0.006; P=0.005). Uninsured patients (P<0.001) and African American (P=0.002) were less likely to be admitted for care. Patients residing in the wealthiest quartile of zip codes were more likely to be admitted for care (P<0.001). In addition, uninsured (P=0.017) and African American patients (P=0.009) were less likely to receive surgical management of suspected CES. Lastly, uninsured (P<0.001), Hispanic (P=0.038), and rurally located patients (P=0.007) were more likely to be transferred, while patients residing in the wealthiest zip codes (P=0.007) were less likely to be transferred.

Conclusions: Socioeconomic factors like race, income, insurance, and residence potentially alter CES management, which may inform health policy and future patient care.

Background: One in four patients with moderate to severe traumatic brain injury (TBI) also has other body district injuries (OBD). The impact of OBD on mortality and disability is debated. This study compared outcomes of TBI patients with polytrauma (p-TBI) versus isolated TBI (alone-TBI) and identified outcome determinants, focusing on survival time and prognosis.

Methods: This single-center, retrospective cohort study analyzed 193 patients with moderate to severe TBI admitted to an ICU from 2011 to 2012. Patients were divided into p-TBI and alone-TBI groups. Clinical, demographic, and outcome data were extracted from medical records. Key outcomes included survival time and Glasgow Outcome Scale-Extended (GOSE) scores at 1-year.

Results: The alone-TBI group (N.=126) was older with more comorbidities and higher use of antiplatelet/anticoagulant medications. The p-TBI group (N.=67) had greater physiological dysfunction (hypotension, acidosis, anemia, coagulopathy). Trauma severity (Glasgow Coma Scale), in-hospital mortality, and GOSE were similar between groups, but p-TBI patients had a shorter median survival time (3.5 vs. 18 days, P=0.016). Key determinants of poor outcomes were age, coagulopathy, neurological impairment at admission, and intracranial hypertension.

Conclusions: Polytrauma does not appear to be independently associated with the prognosis of moderate to severe TBI patients but is associated with earlier mortality. Coagulopathy and physiological instability are more critical factors in determining mortality and poor outcomes. Future research should explore whether polytrauma is a bystander in TBI or if it has a causal role in adverse outcomes.

Background: In laboratory-based neuroanatomical studies, surgical freedom, the most important metric of instrument maneuverability, has been based on Heron's formula. Inaccuracies and limitations hinder this study design's applicability. A new methodology, volume of surgical freedom (VSF), may produce a more realistic qualitative and quantitative representation of a surgical corridor.

Methods: Overall, 297 data set measurements assessing surgical freedom were completed for cadaveric brain neurosurgical approach dissections. Heron's formula and VSF were calculated specifically to different surgical anatomical targets. Quantitative accuracy and the results of an analysis of human error were compared.

Results: Heron's formula for irregularly shaped surgical corridors resulted in overestimation of the respective areas (minimum overestimation 31.3%). In 92% (188/204) of data sets reviewed for influence of offset, areas calculated on the basis of measured data points were larger than areas calculated on the basis of the translated best-fit plane points (mean [SD] overestimation of 2.14% [2.62%]). Variability in the probe length attributable to human error was small (mean [SD] calculated probe length 190.26 mm [5.57 mm]).

Conclusions: VSF is an innovative concept that can develop a model of a surgical corridor producing better assessment and prediction of the ability to maneuver and manipulate surgical instruments. VSF corrects for deficits in Heron's method by generating the correct area for an irregular shape using the shoelace formula, adjusting the data points to account for offset, and attempting to correct for human error. VSF produces 3-dimensional models and, therefore, is a preferable standard for assessing surgical freedom.

Background: High-mobility group AT-hook protein 2 (HMGA2) is a gene regulatory protein that is correlated with metastatic potential and poor prognosis. It has been shown that HMGA2 is overexpressed in various tumors such as lung cancer or pancreatic cancer. The invasive character and highly aggressive structure of glioblastoma let us to investigate HMGA2 expression in the border zone of the tumor more closely. We compared HMGA2 expression between glioblastoma and normal brain tissue. In addition, we analyzed and compared HMGA2 expression in the border and center zones of tumors. Correlation tests between HMGA expression and clinical parameters such as MGMT-status and survival were performed.

Methods: Samples from 23 patients with WHO grade 4 glioblastomas were analyzed for HMGA2 expression using quantitative real-time polymerase chain reaction (qPCR) and immunohistochemistry (IHC) and correlated with clinical parameters. The areas from the tumor center and border were analyzed separately. Two normal brain tissue specimens were used as the controls.

Results: Our results confirm that HMGA2 is higher expressed in glioblastoma compared to healthy brain tissue (qPCR, P=0.013; IHC, P=0.04). Moreover, immunohistochemistry revealed significantly higher HMGA2 expression in the border zone of the tumor than in the tumor center zone (P=0.012). Survival analysis revealed a tendency for shorter survival when HMGA2 was highly expressed in the border zone.

Conclusions: The results reveal an overexpression of HMGA2 in the border zone of glioblastomas; thus, the expression cluster of HMGA2 seems to be heterogenous and thorough borough surgical resection of the vital and aggressive border cells might be important to inhibit the invasive character of the tumor.

Background: The aim of this study was to evaluate the predictive power of electromagnetic disturbance technology in patients with hydrocephalus after subarachnoid hemorrhage.

Methods: This prospective, observational cohort study was conducted at The First Affiliated Hospital of Zhengzhou University and Nanfang Hospital. A total of 155 patients with subarachnoid hemorrhage (SAH) were enrolled in this study. Disturbance coefficients were recorded using a continuous sinusoidal signal in real time after SAH. The patients were divided into two groups: hydrocephalus group (patients who underwent shunt insertion within a month after SAH) and non-hydrocephalus group (patients without need for a ventriculoperitoneal shunt). We used SPSS to draw a ROC Curve to assess the ability of disturbance coefficients to predict the probability of hydrocephalus.

Results: Hydrocephalus occurred in 37 patients after SAH. The average disturbance coefficient of patients with hydrocephalus decreased by 25.14±9.78, and the disturbance coefficient of patients with no hydrocephalus decreased by 6.58±10.10 (one aspect of the present invention is a system of non-invasively monitoring hydrocephalus, cerebral edema, and intracranial bleeding comprising of a source emitting electromagnetic waves to brain tissue, a detector detecting said wave that propagates through said tissue, a signal conditioning unit amplifying and filtering said wave, a quadrature detector estimating magnitude and phases of said wave, and a parameter estimator calculating the complex wave number, relative attenuation coefficient (RAC), relative phase shift (RPS), wave speed change (WSC), and travel-time difference (TTD) of said brain, and assessing status of hydrocephalus and cerebral edema). The difference was statistically significant (t=9.825, P<0.001). The decrease in disturbance coefficient can be used to predict the occurrence of hydrocephalus, and if the disturbance coefficient decreases by more than 15.5 (sensitivity, 92.37%; specificity, 86.49%), it can be used to indicate the occurrence of hydrocephalus.

Conclusions: The disturbance coefficient can predict the occurrence of hydrocephalus. The greater decline of the disturbance coefficient, the greater probability of occurrence of intracranial hydrocephalus. Hydrocephalus can be early detected. However, the CT scan is necessary to confirm the occurrence of hydrocephalus. Early diagnosis and early treatment may improve the prognosis of patients with hydrocephalus after subarachnoid hemorrhage.

Introduction: Magnetic resonance-guided focused ultrasound (MRgFUS) is a contemporary non-invasive ablative procedure that utilizes high- or low-intensity ultrasound, guided and monitored by magnetic resonance imaging (MRI). While MRgFUS has been established as an effective treatment for conditions like essential tremor and tremor-dominant Parkinson's disease, it has recently emerged as a safe and promising ablative minimally invasive procedure for the management of treatment-resistant psychiatric disorders. Indeed, despite the availability of various pharmacological and behavioral therapies, a subset of psychiatric patients remains refractory to conventional treatments.

Evidence acquisition: To assess the feasibility and safety of MRgFUS in psychiatric disorders, a comprehensive literature search in PubMed and Scopus databases was conducted, resulting in the inclusion of five relevant articles in this review.

Evidence synthesis: While data on this innovative procedure are still limited, MRgFUS demonstrates potential as a safer and less invasive surgical technique for treating these disorders.

Conclusions: Continued research efforts and data validation are imperative to establish MRgFUS as an additional, minimally invasive procedure for treatment-resistant psychiatric patients in the near future.