Journal of neurosurgical sciences最新文献

Predictive modeling has the potential to improve preoperative planning and resource allocation in lumbar fusion surgery. This study aimed to identify the 20 most important variables for predicting prolonged postoperative length of stay (pLOS) using machine learning (ML). The ACS-NSQIP database was queried for lumbar fusion procedures performed between 2012 and 2022, including ALIF, PlatIF, PLIF, and combined PLIF+PlatIF. Variable selection was performed using MUVR and Boruta, followed by hierarchical clustering and 5-fold cross-validation to ensure feature robustness. The 20 selected features were used to train multiple ML models, including tree-based classifiers (Random Forest, XGBoost, CatBoost, LightGBM), support vector classifiers, neural networks, ensemble methods, and logistic regression. A total of 114,892 patients were included. Eleven patient-specific and nine procedural variables were identified as most predictive of prolonged pLOS. Among patient factors, dialysis, congestive heart failure, and bleeding disorders were strongest predictors. Among procedural factors, osteotomy, billing of additional fusion codes, and longer operation time had the greatest impact. The neural network achieved the highest accuracy (71.2%), recall (79.4%), and F1-score (73.8%), though all models performed similarly, with minimal variation in classification metrics. These findings underscore that model choice plays a limited role once optimal features are selected - feature selection was the most critical determinant of predictive performance.

Background: Spinal chondrosarcoma is a rare malignant tumor requiring complex resection due to its resistance to chemotherapy and radiation. This study aimed to identify predictors of both 30-day readmission and prolonged length of hospital stay (LOS) following surgical resection of spinal chondrosarcoma using data from the National Cancer Database (NCDB).

Methods: Using the NCDB, we conducted a retrospective analysis of adult patients diagnosed with spinal or sacral chondrosarcoma between 2004 and 2017 who underwent surgical resection. We collected patient demographics, tumor characteristics, and treatment details. Patients were grouped based on 30-day readmission. A separate analysis was conducted on LOS, defining prolonged LOS as >75^th percentile. Multivariable analyses identified risk factors for each outcome.

Results: Of the 1971 patients in the 30-day readmission analysis, 114 (5.8%) experienced readmission. Of the 1392 patients included in the LOS analysis, 341 (24.5%) experienced prolonged LOS. The risk factors of prolonged LOS included age (OR=1.015; 95% CI, 1.006-1.024; P<0.001), male sex (OR=1.440; 95% CI, 1.076-1.926; P=0.014), tumor volume >11 cm³ (OR=1.001; 95% CI, 1.000-1.002; P=0.018), sacral/coccygeal tumors (OR=1.831; 95% CI, 1.162-2.844; P<0.001), and gross total resection (GTR) (OR=1.514; 95% CI, 1.068-2.146; P=0.020). Multivariate regression identified no significant predictors of 30-day readmission.

Conclusions: Tumor volume, sex, and other factors influence 30-day readmission and prolonged LOS. Prolonged LOS was further associated with sacral/coccygeal tumors and GTR, reflecting the complexity of surgical management.

Background: Falcine/parasagittal lesions account for the largest rate of high-grade (WHO grade 2-3) lesions. The ability to preoperatively estimate the tumors' grade and outcome would be of great value in customizing treatment.

Methods: This is a single-center, retrospective study designed to assess the pre-operative peripheral blood markers' diagnostic and prognostic role in patients harboring falcine (FM) and parasagittal (PM) high-grade meningiomas. N=116 patients undergoing surgical resection were included. A propensity score-matched analysis accounted for gender imbalances in low-grade (LG) vs. high-grade (HG) cohorts.

Results: Seventy-three (N.=73) FM (63%) and 43 PM (37%) lesions were included. Patients harboring HG lesions showed significantly higher Hb levels than LG (mean 14.5±1.40 vs. 13.5±1.16 g/dL, P<0.001). Multivariate analysis controlling for demographics, lesion characteristics, blood markers, and steroid dose confirmed preoperative Hb as an independent predictive value of lesion grade (OR 1.75, 95% CI:1.01-3.07, P=0.04). Accordingly, patients showing increased Hb levels >15.4 g/dL achieved shorter OS (60.4 months, 95% CI: 14.7-106.1 vs. 134.7 months, 95% CI: 111.2-158.2) compared to patients with lower Hb values, P<0.001. Data were confirmed in matched cohorts.

Conclusions: Increased levels of circulating erythrocytic hemoglobin might be independent predictors for high-grade histology and be associated with shorter overall survival in falcine and parasagittal meningiomas.

This article was published in Volume 67, issue 4 of publishing year 2023, with a mistake in Figure 3. The correct Figure 3 is the one included in this erratum.

Introduction: Traumatic brain injury (TBI) is a critical condition where the management of oxygen levels plays a pivotal role in patient outcomes. While hypoxemia is known to worsen outcomes, the impact of hyperoxemia on mortality and neurological outcomes remains controversial. This systematic review and meta-analysis aims to evaluate the effects of hyperoxemia on these outcomes in TBI patients.

Evidence acquisition: This study followed PRISMA guidelines and was registered with PROSPERO (registration number: CRD42024537543). A comprehensive search was conducted across MEDLINE, Embase, and SCOPUS databases, identifying relevant studies on hyperoxemia and its impact on mortality and neurological outcomes in TBI patients. Both observational studies and randomized controlled trials were included, and data were synthesized and analyzed using a random-effects model.

Evidence synthesis: Fifteen studies including 38,718 patients were included in the qualitative synthesis, with 13 studies included in the quantitative meta-analysis. Hyperoxemia was not significantly associated with mortality (pooled OR=0.88 [0.66-1.16]; P=0.36; I²=86%) or with unfavorable neurological outcomes (pooled OR=1.04 [0.83-1.29]; P=0.75; I²=67%). Sensitivity analyses limited to studies with low or low/moderate risk of bias showed a statistically significant association between hyperoxemia and reduced mortality, although with high heterogeneity (OR=0.65 [0.48-0.88]; P=0.005; I²=82%). A subgroup analysis of studies assessing neurological outcome at 6 months suggested a trend toward improved functional outcomes with early moderate hyperoxemia (OR=1.32 [0.99-1.75]; P=0.06). An explorative meta-regression did not show a significant linear association between PaO2 thresholds and outcomes.

Conclusions: This systematic review and meta-analysis do not provide sufficient evidence to discourage the use of moderate hyperoxemia in TBI patients. Exploratory analyses suggesting potential benefits from early moderate hyperoxemia require further validation in selected patients. High-quality prospective studies are urgently needed to determine the optimal use of oxygen therapy in TBI.

Introduction: Giant intracranial aneurysms are rare vascular lesions consisting of cerebral aneurysms measuring ≥25 mm in diameter. Their formation is the result of multiple factors including their association with a unique genomic landscape, pathophysiologic processes associated with the pathognomonic, histopathological changes observed within the arterial wall, the physical effects of the cerebral vasculature's unique fluid dynamics, and slow growth rates. Because giant intracranial aneurysms are considered among the most complex to manage, we herein perform a systematic review of the extant evidentiary base found within the neurosurgical literature with the goal of profiling multimodality management strategies for these lesions. Additionally, we will highlight the importance of integrating neuroendovascular surgery into microsurgical treatment regimens for giant cerebral aneurysms.

Evidence acquisition: To this end, we performed a systematic review of the literature through the PubMed, Scopus and Web of Science databases according to PRISMA guidelines. By using predefined search terms, we intended to identify prior reports involving multimodality management of giant intracranial aneurysms. Specifically, we sought to highlight the integral role of both neuroendovascular and microsurgical interventions in treatment of these rare vascular lesions.

Evidence synthesis: Ten studies reporting outcomes for 91 patients met criteria for inclusion in the present meta-analysis. Within this cohort of patients, mean age varied from 39.0 to 60.1 years. Among the giant aneurysms in the present review, many were found extending off of the supraclinoid ICA, which is one of the most common sites for giant intracranial aneurysms to form. In 1988, Batjer described the earliest combined intervention included in the present study. Since then, two common approach type themes involved in multimodal management have evolved: combined strategies often consist of 1) an endovascular approach to vessel occlusion, such as embolization, and 2) a microsurgical method capable of eliminating the aneurysm following control of blood flow. In other words, achieving obliteration via clipping, bypass surgery, clip reconstruction, wrapping, and Hunterian ligation (among others). Review of the literature indicated an overall mortality rate associated with multimodal management of 5.4%. Radiographic obliteration rates were reported in three of ten studies. One of the studies reported an 82.9% rate of successful obliteration. Rates of good outcomes (mRS 0-2, GOS 4-5) ranged from 60% up to a maximum of 87.5%.

Conclusions: Combined, multimodality endovascular and microsurgical treatments appear to be most successful for the treatment of giant aneurysms because of their adaptability, the flexibility they confer, and the synergistic effect of combining the strengths of multiple modalities.

Background: The Italian Association of Neuro-Oncology (AINO) and the Italian Society of Neurosurgery (SINch) promoted a national survey to explore how the 2021 WHO molecular diagnostic criteria for gliomas have been implemented into clinical practice.

Methods: A survey containing 38-item multiple-choice questions was sent to members of the AINO and SINch from January 2022 to March 2022.

Results: We collected 152 answers. Participants from non-academic vs. academic hospitals were 78 (51.3%) and 74 (48.7%). Assessment of IDH mutations and 1p/19q codeletion was reported by 140 (92.1%) and 88 (57.9%) responders, respectively. MGMTp methylation, either at diagnosis or at second surgery, was reported by 110 (72.4%) and 82 (53.9%) responders, respectively. CDKN2A/B homozygous deletion in IDH-mutant astrocytomas was investigated according to 53 (34.9%) responders. Assessment of either EGFR amplification or pTERT mutation or +7-10 chromosome changes in IDH-wild type astrocytomas was reported by 76 (50.0%), 43 (28.3%), and 16 (10.5%) responders, respectively. Academic vs. non-academic hospitals had a higher availability of molecular markers, including CDKN2A/B deletion (34/70, 48.6% vs. 19/82, 23.2%, P=0.001), MGMTp at second surgery (48/69, 69.6% vs. 34/72, 47.2%, P=0.008), EGFR/pTERT/+7-10 (46/70, 65.7% vs. 32/77, 41.6%, P=0.003), BRAF mutation (14/70, 20.0% vs. 4/82, 4.9%, P=0.002), NTRK fusion (14/70, 20.0% vs. 2/81, 2.5%, P<0.001).

Conclusions: The availability of molecular markers for gliomas is widespread among Italian centers. The implementation of the molecular criteria for diagnostic and prognostic purposes in gliomas according to WHO 2021 Classification needs to be improved. Moreover, a critical issue for the future will be the search for rare actionable mutations, which is continuously evolving, in light of the use of targeted therapy.

Introduction: Traumatic brain injury (TBI) impacts over 69 million people annually worldwide and causes significant disability. Gastrointestinal (GI) dysfunction is becoming increasingly recognized as post-TBI sequelae, however best practices for their detection and management remain lacking. The current review aimed to improve the understanding of the epidemiology, pathophysiology, risk factors, and interventions of GI disorders after TBI in order to advance clinical diagnosis and treatment.

Evidence acquisition: A comprehensive literature search was conducted using the PubMed database between 1996 and 25 January 2025 pertaining to post-TBI GI disorders. Special focus was given to relevant reports on the pathophysiology, epidemiology, risk factors, and management for GI disorders.

Evidence synthesis: Post-TBI GI dysfunction occurs primarily due to autonomic dysfunction, increased intracranial pressure, and systemic inflammation, causing intestinal dysmotility and malabsorption, which commonly present as feeding intolerance and malnutrition. Proposed diagnostic criteria include increased gastric residual volume (with/without concurrent GI symptoms), decreased weight, body mass index, and albumin. Standardized nutritional screening methodologies, prokinetic agents, and small bowel and transpyloric feeding have shown benefits in symptomatic management and recovery of GI function, and represent targets for formal study in prospective trials.

Conclusions: Post-TBI GI dysfunction is prevalent and can progress to further systemic injuries, impairment, and long-term disability. Early recognition of autonomic and GI system dysfunction, early implementation of formalized nutritional support and multidisciplinary consultation, and inclusion of prokinetic medications and autonomic nervous system modulators are promising avenues for prevention and treatment of post-TBI feeding intolerance, dysmotility, and malnutrition to improve outcomes.