Journal of neurosurgical sciences最新文献

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.

Introduction: Simulation is increasingly recognized as an important tool to enhance neurosurgical education. In this field, especially in neurovascular surgery, human placenta (hPl) is being recognized as a valuable training model because of its abundant availability, ethical acceptance, and analogous vasculature with other vessels of the human body. Nevertheless, although a rising body of literature is witnessing a renovated interest toward this "old" model, to date no comprehensive reviews on the topics are available. Main objective of this paper is to comprehensively review hPl use in neurovascular surgery training, focusing on model preparation, type of possible exercises along with assessment tools which can be used to check for trainees learning.

Evidence acquisition: A systematic review of the pertinent literature was performed, following PRISMA guidelines, searching the following key words in "title/abstract" fields in only English-written works: "placenta and neurosurgery." We focused on preclinical works concerning use of hPl models in neurovascular surgery training. We included studies published in the last 40 years, till December 31^st, 2023.

Evidence synthesis: A total of 950 scientific publications were initially screened, and 23 papers met the inclusion and exclusion criteria. In summary, the chorionic surface of hPl may be used as a neurovascular gym where different exercises can be performed. Placenta models can be produced with or without the use of intravascular dyes and or/pumping systems to resemble a beating-heart vascular system. The three main neurovascular surgical fields where hPl is being considered to be highly simulative are: 1) Sylvian fissure dissection; 2) aneurysm dissection and clipping; 3) bypass training. Considering the simulative purpose, face, content and construct validify of hPl model have been tested and verified by many authors, although still few data are available regarding transfer/predictive validity.

Conclusions: This systematic review highlighted the easiness of preparation and availability along with the strong didactical meaning that the use of hPl-based models may have in the field of neurovascular surgery training. In view of current progressive lowering of surgical vascular cases and increasing technical demand related to their management, further studies aimed to assess if this simulator could be able to produce a learning effect and improve performance with continued use are strongly needed.

Background: The impact of different surgical set-ups of endoscopic two surgeon four hand anterior skull base surgeries on surgeons' ergonomics remain unclear. This study aims to explore the effect of surgeon, patient and surgical screen positioning on surgeons' ergonomics using the Rapid Entire Body Assessment (REBA) tool.

Methods: A total of 20 different surgical positions of anterior skull base surgery were simulated and the ergonomic impact on surgeons' neck, truck, leg and wrist were measured using the validated Rapid Entire Body Assessment (REBA) tool. To investigate the ergonomic effect of different surgical setups, the operating surgeon, assisting surgeon, patient head, camera and screen positions were positioned differently in each surgical position.

Results: The lowest REBA Score recorded is 3 whereas the highest score is 8. The REBA scores for the majority of positions are 3 highlighting that these positions are ergonomically favorable. Position 12 is the least ergonomically favorable position with a total REBA score of 19. In this position, operating surgeon is positioned to the right of the patient, assisting surgeon to the left of patient, patient head in central position with camera held by operating surgeon and one screen is placed to the right of patient. Positions 13 and 17 are the most ergonomically favorable positions with a total REBA score of 12. In these positions, the patient's head is positioned to the center, two screens were utilized, and the surgeons were positioned on either side of the patient. The utilization of 2 screens with a central patient head position with the surgeons placed on either side of the patient contribute towards a more ergonomically state in these positions.

Conclusions: Certain positional behaviors are better at reducing musculoskeletal injury risk when compared to other. Positions with two screens and central head positions are more favourable ergonomically and surgeons should consider this set-up to reduce musculoskeletal injuries during anterior skull base surgery.

Background: The treatment of neuropathic deafferentation pain due to avulsion injuries of the brachial plexus is a major problem, albeit rare, in the neurosurgical practice. The aim of the paper is to present step-by-step the main principles of a surgical upgrade of the well-known Dorsal Root Entry Zone lesioning, that we named banana splitting DREZotomy.

Methods: A comparison is made among three groups of patients, two of which were treated following the classic techniques, while in the third no physical agent is applied to the spinal cord during surgery.

Results: The patients operated on following the well-established surgical procedures showed a short-term success rate around 70%, online with the data of the ongoing literature. The results with the banana-splitting technique, instead, have been astonishing both in terms of resolution of pain, absence of true complications and of unpleasant side effects.

Conclusions: A purely dissective technical variant of the surgical procedure called DREZ lesioning has shown better results overcoming the 30% failures of all the reported series. The profound and permanent splitting of the posterior horn and the absence of any other component (heat propagation, radiofrequency, or dotted coagulation) are the major factors which may explain such outstanding results.

Background: Hydrocephalus is a highly heterogeneous multifactorial disease that arises from genetic and environmental factors. Familial genetic studies of hydrocephalus have elucidated four robustly associated hydrocephalus associated loci. This study aims to identify potential genetic causation in cases of hydrocephalus, with or without spina bifida and Dandy Walker Syndrome (DWS), using family-based rare variant association analysis of whole exome sequencing.

Methods: We performed whole exome sequencing in 143 individuals across 48 families where at least one offspring was affected with hydrocephalus (N.=27), with hydrocephalus with spina bifida (N.=21) and with DWS (N.=3), using Illumina HiSeq 2500 instrument.

Results: No pathogenic or putative pathogenic single-nucleotide variants were evident in the four known hydrocephalus loci in our subjects. However, after examining 73 known hydrocephalus genes previously identified from literature, we identified three potentially impactful variants from the cohort. Using a gene panel comprising variants in known neural tube defects loci, we identified a total of 1024 potentially deleterious variants, of which 797 were missense variants and 191 were frameshift variants, 36 were stop gain/loss variants. A small portion of our family pedigree analyses yielded putative genetic signals which may be responsible for hydrocephaly elated phenotypes, however the low diagnostic yield may be due to lack of capture of genetic variants in the exonic regions i.e. structural variants may only be evident from whole genome sequencing.

Conclusions: We identified three potentially impactful variants from our cohort in 73 known hydrocephalus genes previously identified in literature.

Background: In approximately 15% of spontaneous subarachnoid hemorrhage (SAH) patients, no bleeding source is found in the initial imaging. These patients can be categorized as either perimesencephalic (PM-SAH) or non-perimesencephalic (NP-SAH) subarachnoid hemorrhage patients. Follow-up imaging is routinely performed after NP-SAH to detect treatable etiologies; however, the optimal follow-up imaging protocol remains unclear. This study examines the optimal time interval to re-imaging and the performance of magnetic resonance imaging and angiography (MRI/A) in this setting.

Methods: In this retrospective study, the records of NP-SAH patients treated at the University Hospital of Zurich (Switzerland) from 2005 to 2018 were analyzed. Clinical and radiological data were collected. Re-imaging data was grouped according to imaging modality and divided into three time-categories after bleeding: short-term (<2 weeks), medium-term (2-8 weeks) and long-term (>8 weeks) re-imaging.

Results: Eighty-one NP-SAH patients were included. In 8 patients an aneurysm was diagnosed during re-imaging via digital subtraction angiography (9.9% diagnostic yield). Five aneurysms were detected at short-term in 81 patients (6.2% short-term yield) and three at medium-term re-imaging in 27 patients (11.1% medium-term yield). No aneurysms were found after 8 weeks in 56 patients. Five of these 8 patients also received MRI/A re-imaging, which was able to show the aneurysm in all 5 cases.

Conclusions: Our study emphasizes the importance of re-imaging in NP-SAH patients, which should be done both at short-term and at medium-term follow-up after the hemorrhage. Long-term re-imaging after 8 weeks might not be of diagnostic benefit. MRI/A might be considered as a possible noninvasive re-imaging modality in this setting.

Background: The neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), the lymphocyte-monocyte ratio (LMR), the neutrophil-monocyte ratio (NMR) and the systemic immune inflammation index (SII) are associated with clinical outcomes in oncological diseases, cardiovascular diseases, infectious / inflammatory diseases, endocrinological, pulmonary and brain injuries. Here, we investigate its association with hospital mortality in patients with severe traumatic brain injury.

Methods: We retrospectively reviewed clinical data from patients with severe traumatic brain injury (sTBI) who were treated in our department between January 2015 and December 2020. NLR, PLR, NMR, LMR and SII data were collected between admission and day 3, as well as other indicators related. The relationship between hematological ratios and in-hospital mortality were analyzed.

Results: A total of 96 patients were included in study, hospital mortality was 40.6% (N.=39). The levels of NLR on admission (D0), NLR day 1 (D1), NLR day 2 (D2), NLR day 3 (D3), NMR day 1 (D1) and NMR day (2) remained significantly higher in patients with death intra-hospital (P=0.030; P=0.038; P=0.016; P=0.048; P=0.046 and P=0.001, respectively). Multivariate logistic analysis showed that higher NLR values at admission and day 2 NMR were associated with in-hospital mortality (OR=1.120, P=0.037; and OR=1.307, P=0.004, respectively). Analysis of the recipient operating characteristic (ROC) curve showed that the NLR on admission had a sensitivity of 59.0% and a specificity of 66.7% (area under the curve 0.630, P=0.031, Youden's Index 0.26) and the NMR of day 2 had a sensitivity of 67.7% and a specificity of 70.4% (area under the curve 0.719, P=0.001, Youden's index 0.38) to predict mortality intra-hospital based on the best threshold.

Conclusions: Our analysis indicates that higher NLR levels on admission and day 2 NMR are independent predictors of in-hospital mortality in patients with sTBI.