Journal of neurosurgical sciences最新文献

Background: The technique for extracranial-intracranial (EC-IC) bypass was introduced in 1976. Over the subsequent 45 years, indications and surgical techniques have significantly evolved. This study aims to analyze the trends in patient demographics, bypass techniques, and clinical indications for bypass surgeries performed at our institution from 1976 to 2020.

Methods: We conducted a retrospective review of patient records, using digital medical records available from 2001 and manually reviewing paper records for cases prior to that year. A comprehensive analysis was performed on surgical procedure descriptions and indications for bypass surgery.

Results: A total of 374 patients underwent EC-IC bypass surgery from 1976 to 2020. The frequency of surgeries increased until 1985, followed by a marked decline in 1986. From 1996 onward, the average number of bypass surgeries performed annually was 4 until 2010, and this number increased to 7 from 2011 to 2020. Indications and detailed techniques were recorded in 284 cases. Between 1976 and 2000, occlusive cerebrovascular disease (OCVD) was the predominant indication for bypass surgery (69.2%); however, in the last two decades, the primary indication shifted to flow preservation for complex aneurysms (74.8%). Prior to 2011, the primary focus was on internal carotid artery (ICA) aneurysms, while in the last decade, middle cerebral artery (MCA) aneurysms have gained prominence. High-flow (HF) graft-mediated bypasses were mainly utilized for the management of complex aneurysms; notably, there has been a decline in HF bypass requirements, with only 10% of flow preservation surgeries needing this technique in the past decade.

Conclusions: Our study underscores the significant evolution of cerebral bypass surgery over the past 45 years, with flow preservation for complex aneurysms currently being the leading indication for EC-IC bypass. The superficial temporal artery to middle cerebral artery (STA-MCA) bypass remains the most frequently performed technique. Moreover, the use of HF EC-IC bypass has declined in the last decade, reflecting the emergence of alternative methods for flow preservation.

Introduction: While some patients require immediate surgery for acute subdural hematoma (ASDH), others can be managed conservatively. A subset of patients, however, may experience the progression of ASDH to a relevant chronic subdural hematoma (CSDH). This systematic review aims to synthesize studies focusing on ASDH which progress to CSDH.

Evidence acquisition: We searched relevant databases for articles. Six issues were addressed: Which percentage of conservatively managed ASDH progressed to CSDH requiring treatment? What were possible risk factors for this progression? How long was the time span for chronification? How did the clinical status change during chronification? How did the radiographic parameters change during chronification? How was this entity surgically treated?

Evidence synthesis: Fourteen studies met the inclusion criteria. The proportion of conservatively managed ASDH patients who eventually required surgery due to CSDH ranged from 6.5% to 45.3%. Several risk factors for progression were identified, with initial hematoma size and midline shift being the most significant. The majority required surgery within two to three weeks following trauma. As ASDH progressed to CSDH, a notable deterioration in clinical status occurred for many patients, including a decline in consciousness. While the hematoma density decreased, its size and midline shift increased. Most patients underwent burr hole trephination.

Conclusions: The progression of ASDH to CSDH often led to an increase in hematoma size and midline shift, resulting in the worsening of clinical symptoms. Surgery was typically required within the second or third week after trauma for these patients.

Introduction: Degenerative cervical myelopathy (DCM) is a debilitating condition caused by compression of the spinal cord. Despite established surgical treatments, accurate diagnosis and prognostication remain challenging in part due to the variability in clinical presentation and lack of screening tools. Machine learning (ML) has emerged as a promising approach to address these challenges through its predictive capabilities for diagnosis, decision-making, and prognostication. Given the recent advent of ML, there is a need to systematically synthesize its applications to the treatment of patients with DCM.

Evidence acquisition: A systematic review was performed in accordance with PRISMA guidelines. We searched five databases (PubMed, Embase, Cochrane, Scopus, Web of Science) in November 2024 and included studies employing predictive ML techniques among a population of patients with DCM. Studies primarily focused on ML applications to neuroimaging were excluded. Variables such as study focus, number of patients with DCM, and ML approaches used were extracted.

Evidence synthesis: Thirty full-text studies were included in this review. These studies encompassed 11,407 patients, with 84% (N.=9615) holding a diagnosis of DCM. Most studies (N.=16, 53%) used ML to predict outcomes for patients with DCM, including functional recovery, quality-of-life, and postoperative complications. Thirteen studies (43%) focused on the diagnosis of DCM using ML-augmented screening tools, and the remaining study focused on surgical decision-making. Support vector machine was the most used ML approach (N.=14 studies, 47%) followed by random forest (N.=8 studies, 27%). Throughout the studies included, ML algorithm predictions were demonstrated to outperform traditional statistical methods.

Conclusions: ML models are a promising step forward for diagnosis, clinical decision-making, and prognostication for patients with DCM. Further validation in large, multi-institutional cohorts is needed to help improve translatability to clinical practice.

Background: The treatment of aneurysmal subarachnoid hemorrhage poses a formidable challenge, given the high mortality rate and associated mortality. Current recommendations are for treatment to be initiated within 24 hours of diagnosis.

Methods: In our study, we compared a cohort of 66 patients who received prompt microsurgical treatment within 6 hours of diagnosis with a cohort of 51 patients who received prompt microsurgical treatment within 12 hours of diagnosis.

Results: The modified Rankin Scale was utilized to evaluate the follow-up of patients at 30 days, 12 months, and 18 months following surgery. We performed a parametric comparison of the distributions of the means of groups, and our results indicate that treatment within 6 hours of diagnosis results in a lower incidence of obstructive hydrocephalus and a more favorable outcome.

Conclusions: A favorable outcome was observed in patients who were treated within 6 hours. The availability of a specialized vascular team ensures the highest levels of care.

Background: Normal pressure hydrocephalus (NPH) is a reversible condition characterized by gait disturbance, dementia, and urinary incontinence. Despite being underdiagnosed, surgical treatment can significantly improve symptoms. Previous studies have shown a lack of awareness of NPH among physicians, prompting further investigation into its recognition.

Methods: A survey was conducted among Italian physicians to assess their awareness of NPH. A 9-point questionnaire was anonymously distributed online to physicians registered with Medical Boards in Italy. Data analysis focused on responses related to NPH knowledge and exposure.

Results: Out of 103 Medical Boards invited, 42 participated, potentially reaching 145,788 physicians. Analysis of 547 valid responses revealed varying levels of awareness across specialties. Neurologists showed higher awareness, but overall exposure to NPH cases in clinical practice was limited.

Conclusions: The survey highlighted a lack of interest and awareness of NPH among Italian physicians. Recommendations were made to enhance recognition, especially among Family Practitioners and Neurologists. Continuous education efforts are crucial to improve early diagnosis and management of NPH. Efforts by medical boards and specialty societies are needed to increase awareness and ensure timely intervention for NPH patients.

Introduction: Isolated spinal artery aneurysms (ISAAs) are rare, often presenting with sub-arachnoid hemorrhage (SAH) and severe neurological deficits. Conclusive evidence about the best management approach is lacking.

Evidence acquisition: Following PRISMA guidelines, a systematic review of papers about ISAAs management was conducted from 1966 to 2024, evaluating age, sex, risk factors/comorbidities, aneurysm rupture and location, treatment modalities and clinical outcome. An illustrative case of a 65-year-old woman with a an ISAA of a radiculomedullary artery at T8 level was reported.

Evidence synthesis: Overall, 106 studies obtained from the literature review showed 138 patients received an ISAA diagnosis and were managed with surgery (52.1%), observation (31.1%), or endovascular treatment (11.5%), with clinical improvement in 76.4%, 86%, 81.2% of cases, respectively. The treatment option was not reported in 5.3% of cases. Only two patients presented neurological worsening related to vasospasm, and none had rebleeding after treatment. The mean follow-up was 8.7 months (range 0.03-73 months). In the reported illustrative case, after left T7-T8 laminectomy and dural opening, a little thrombosed aneurysm was found. Under doppler and neurophysiological monitoring, temporary clips were placed on the afferent and efferent vessel and the aneurysm was resected. The patient reported complete and stable regression of symptoms. No complications were detected after 6 months. Imaging showed complete resection of the aneurysm.

Conclusions: Surgical resection under neurophysiological monitoring is an excellent treatment option to both eliminate the risk of rebleeding, while preserving the neurological function. Observation and endovascular treatment may lead to comparable neurological outcomes. Larger multicentric studies with longer follow-up are needed to determine the best management option.

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.