Journal of neurological surgery. Part A, Central European neurosurgery最新文献

Objective: This bibliometric analysis aims to identify and evaluate the top 200 most influential articles on the treatment of trigeminal neuralgia (TN), encompassing both pharmacological and surgical interventions. The study seeks to provide a comprehensive overview of research trends, international collaborations, and citation metrics to inform future research and clinical practice.

Methods: A systematic search was conducted in November 2024 using the Web of Science (WoS) database, focusing on articles related to TN treatment. Articles were filtered by language (English) and type (original articles and reviews), excluding letters, errata, and conference abstracts. The top 200 most cited articles were selected and analyzed using the Bibliometrix R package and biblioshiny web application. Data on authorship, institutions, countries, journals, keywords, and citations were extracted and analyzed.

Results: The 200 articles, published between 1953 and 2021, were cited a total of 23,059 times, with an average of 115.3 citations per article. The majority (73%) were published in the 21st century, with the most productive year being 2002. Surgical management was the focus of 56.5% of the articles, with microvascular decompression (MVD) being the most studied surgical technique (25.5%). Pharmacological management was addressed in 18% of the articles. The United States contributed the most articles (39%), followed by the United Kingdom (12.5%) and Italy (5.5%). The most prolific journals were the "Journal of Neurosurgery" (21.5%) and "Neurosurgery" (19.5%). Key trends included a shift towards prospective studies and a decline in radiosurgery-focused research in the last decade.

Conclusion: This analysis highlights the dominance of surgical approaches, particularly MVD, in TN research, with a significant underrepresentation of pharmacological and minimally invasive treatments. The findings underscore the need for more international collaborations, particularly with low- and middle-income countries, and a greater focus on comparative effectiveness research, pharmacological studies, and basic science to address existing gaps in TN management.

Background: Determining the true size or extent of the nerve defect after damage and excision of the post-traumatic neuroma is fundamental in the microsurgical treatment of the patient. It is assumed that the length of the scar in the nerve may depend on the nature of the combat wound of the limb, gunshot or mine-explosive. Determining the extent of scarring in the nerve in cases of these two types of injury may provide an opportunity to establish a relationship with the type of injury or to disprove such a relationship. This should help in the tactics of surgical treatment.

Methods: 50 samples of damaged peripheral nerves were studied, including 36 nerves of the upper limb and 14 nerves of the lower limb. Microsurgical operations were performed after the injury in an average of 5.4±0.4 months (min=2 months, max=17 months). The specifics of scarring in the nerve were investigated by histochemical method and the specific density of collagen at different distances was calculated. A map of scarring was created for each nerve sample to determine the length of the scar.

Results: Based on the mapping of nerve samples, the average length of the scar was determined, which reached 40-50 mm in the nerves (Me=35.5 mm, Q1=30.0, Q3=55.2, min=19 mm, max=120 mm), where after a gunshot wound - 37.5±5.5 mm (Me=30.0) and mine-explosive wound - 43.5±8.0 mm (Me=36.0). Morphological features of nerve scarring after these two types of damage did not differ (p=0.29), neither in length nor in scar density. Conclusion When calculating the true defect of the nerve, one should take into account the spread of the scarring process in the nerve, which in a combat wound is about 30-50 mm. The length of the scar in the nerve does not depend on the nature of the striking projectile, which proves the critical importance of the energy of the injury.

Key words: peripheral nerve, combat injury, scarring.

Arachnoid cysts by virtue of their volume and intracystic tension, produce local mass effect, and impair the perfusion of surrounding brain parenchyma.The magnetic resonance (MR) perfusion parameters cerebral blood flow (CBF), relative cerebral blood volume (rCBV), and mean transit time (MTT) of brain parenchyma contiguous with the arachnoid cyst were compared with corresponding contralateral hemisphere. Twenty cases of arachnoid cyst were treated using endoscopic techniques. The perfusion changes in parenchyma were assessed 3 months postoperatively. Clinical outcomes were assessed at 6 months' postsurgery.Headache was the predominant symptom (85%), with Sylvian fissure representing the most frequent anatomical location (65%). Endoscopic procedure was successful in 80% of the cases, whereas 20% of the cases required conversion to minicraniotomy and microsurgical cyst excision. Preoperatively, mean CBF (mL/100 g/min), rCBV (mL/100 g), MTT (seconds) in perilesional brain area were 42.58 ± 7.17, 4.48 ± 1.25, 5.56 ± 1.72, respectively, and 3 months postoperatively were 45.83 ± 8.87, 4.48 ± 1.62, 4.37 ± 1.68, respectively. The mean CBF (mL/100 g/min), rCBV (mL/100 g), MTT (seconds) in corresponding contralateral hemisphere was 46.77 ± 10.85, 4.29 ± 1.35, 5.24 ± 1.104, respectively, whereas postoperatively they were 46.29 ± 8.49, 5.03 ± 1.16, 5.49 ± 1.97, respectively. The p-value, however, was not significant. Headache improved in 87.5%, whereas seizure in 60% of the cases.Endoscopic treatment of arachnoid cyst is an optimally invasive procedure. The perfusion study is a valuable tool in evaluation of arachnoid cysts. MR perfusion highlights regions of impaired blood flow and focal brain dysfunction. Additionally, changes in perfusion can help assess the therapeutic impact of surgery on the compressed brain tissue.

Background: Although setting a low initial opening pressure in a programmable valve with a gravitational unit seems to be the gold-standard treatment for idiopathic normal pressure hydrocephalus (iNPH) patients, there are no studies in the literature describing the optimal initial low-pressure setting. Here, we sought to describe the optimal initial opening pressure setting for idiopathic normal pressure hydrocephalus in terms of both efficacy and safety.

Material and methods: Patients with probable iNPH underwent shunt surgery with a programmable valve with a gravitational unit, using either an opening pressure of 3 cm H2O or 6.5 cm H2O, and were prospectively followed for one year. Clinical improvement and complications were recorded.

Results: 19 patients with an opening pressure of 3 cm H2O and 37 patients with an opening pressure of 6.5 cm H2O were analyzed. There was no significant difference between the groups. A significant improvement in the iNPH Japanese scale score was observed one year following shunt placement in both the 3.0 cmH2O (p = 0.001) and 6.5 cmH2O groups (p< 0.001), but there was no statistical difference between groups (p= 0.708). 2 patients (10.5%) had subdural effusions that required surgery in the 3 cmH2O group and none in the 6.5 cm H2O group (p= 0.043).

Conclusion: Patients with iNPH treated with a programmable valve with an initial opening pressure of 6.5 cm H2O showed the same clinical improvement as those treated with an initial opening pressure of 3 cm H2O, but with fewer overdrainage complications.

Introduction: Conventional radiographs and bone mineral density are commonly used to predict cage subsidence, though their accuracy can be limited by factors several factors. MRI-based Vertebral Bone Quality (VBQ) and Endplate Bone Quality (EBQ) offer a more detailed assessment of bone quality and subsidence risk. This study aims to evaluate the accuracy of MRI-based VBQ and EBQ in predicting cage subsidence in anterior cervical spine surgery patients.

Methods: A comprehensive search was conducted across databases including PubMed, Europe PMC, ScienceDirect, and Google Scholar using keywords such as "Magnetic Resonance Imaging", "MRI", "Vertebral Bone Quality", "Endplate Bone Quality", "Cage Subsidence", "Anterior Cervical Spine Surgery", "ACDF", "ACCF", combined with Boolean operators "AND" and "OR" up to November 2024. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), with the primary outcome focusing on VBQ and EBQ values, and secondary outcomes examining the AUC, sensitivity, and specificity of VBQ and EBQ.

Results: Nine retrospective cohort studies involving 911 patients were included. Pooled analysis showed that high VBQ and EBQ scores were significantly associated with increased subsidence risk (OR 2.63, 95% CI: 1.51-4.60, p = 0.0007). Pooled sensitivity and specificity for VBQ were 78.9% (95% CI: 72.5%-85.3%) and 85.7% (95% CI: 82.2%-93.1%), respectively, with an AUC of 0.865. EBQ demonstrated pooled sensitivity of 81.8% and specificity of 88.7%, with an AUC of 0.890. The cutoff values for VBQ and EBQ ranged from 2.68-3.445 and 1.973-4.7, respectively.

Conclusions: MRI-based VBQ and EBQ scores demonstrate strong diagnostic accuracy for predicting cage subsidence in anterior cervical spine surgery. These scores could aid in preoperative risk assessment, though further research should aim to standardize MRI protocols and validate cutoff values across diverse populations.

Background: Vertebral haemangiomas are typically benign and asymptomatic, but a small subset, known as aggressive vertebral haemangiomas, may present with neurological deficits due to extraosseous extension and spinal cord compression. These cases require timely diagnosis and a multidisciplinary management approach.

Case presentation: A 42-year-old male presented with acute onset severe mid-back pain for two months. Neurological examination revealed exaggerated reflexes without motor or sensory deficits. MRI showed expansile lesions at T7, T9 and T10, with additional angiomatous lesions at T3 and T4. T7 and T10 lesions caused spinal cord compression. Pre-operative embolization of T7 and T10 was performed using polidocanol. The patient subsequently underwent vertebroplasty at T7, T9 and T10 levels, pedicle screw fixation from T4-T11, posterior decompression at T6-T7 and T9-T10. Intra-operative biopsies revealed a cavernous haemangioma at T7 and a capillary haemangioma at T9. No malignancy was found Results: Post-operative recovery was uneventful, with early mobilization and significant functional improvement. At 2-year follow-up, the patient had no pain or neurological symptoms and radiographs showed stable fixation with no recurrence.

Conclusion: Aggressive vertebral haemangiomas, though rare, should be considered in patients with progressive neurological symptoms. Early diagnosis, embolization, surgical decompression and stabilization can yield excellent outcomes.

Background: Anterior communicating artery (ACoA) aneurysms are common and complex. This study investigated the effect of A1 artery variations (hypoplasia/aplasia) on treatment outcomes.

Methods: We retrospectively reviewed 104 patients with ACoA aneurysms treated either microsurgically or endovascularly.

Results: Ruptured aneurysms were present in 58.7% of patients. A1 variations occurred in 45.2% of cases, more frequently in unruptured aneurysms (69.8%, p<0.01). The neck width of ruptured aneurysms was significantly smaller than that of unruptured ones. Variations reduced the risk of rupture (OR = 0.16, 95% CI 0.06-0.41; p=0.001). Microsurgery was the primary treatment (74%), and the rate of A1 variations was significantly lower in these cases (p<0.05). Second interventions were required in 11.5% of patients, with no significant association to variation or treatment type. Vasospasm occurred in 41% of the ruptured aneurysm cases. Functional outcomes (mRS) were better in patients with A1 variations (p<0.05). Mortality was 11.5% and unrelated to A1 variation. A higher bottleneck ratio increased mortality risk, whereas a higher height/width ratio decreased it.

Conclusion: A1 variations were more common in unruptured ACoA aneurysms. They did not significantly influence retreatment or mortality. These findings may guide management strategies as the detection of unruptured aneurysms increases.

Approximately 14% of cavernous malformations (CMs) occur in the medulla oblongata, where their proximity to vital neural structures makes surgical intervention challenging. Anatomical variations, such as an arcuate foramen (AF), a bony canal that encases the vertebral artery (VA), may further complicate surgery by obstructing the surgical view during exposure of the anterolateral surface of the medulla and by restricting VA mobilization, which may be necessary in some cases. We present a case of a medullary CM coexisting with an AF, which required tailored surgical strategies for safe and effective resection. To our knowledge, this is the first report to document this combined pathology, accompanied by a surgical video.A 25-year-old male presented with right-sided hemiparesis. Magnetic resonance imaging (MRI) revealed a large hemorrhagic medullary CM. The patient underwent a left far-lateral transcondylar approach for resection of the CM.The AF was encountered intraoperatively and had to be unroofed to achieve an adequate surgical trajectory. Gross total resection was achieved, and the patient made an excellent recovery without postoperative neurological deficit.The far-lateral approach provides excellent access for resection of anterior medullary CMs. This case highlights the importance of detailed preoperative planning, intraoperative strategy, and real-time navigation, particularly when anatomical variations such as the AF are present. Although the AF may hinder exposure and require tailored adjustments, it does not inherently complicate the entire procedure unless VA mobilization results in vascular injury.

Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) that can adversely affect prognosis. This study investigates the association between semiautomatic measurement of cerebral hemorrhage volumes in aSAH patients and the onset of shunt-dependent acute hydrocephalus (SDAHC) within the first 72 hours. Furthermore, the study seeks to establish a bleeding volume threshold indicative of SDAHC.A retrospective observational analysis was conducted on a cohort of aSAH patients admitted to a specialized referral hospital between 2016 and 2021. Volumes of SAH, intraventricular hemorrhage (IVH), intraparenchymal hemorrhage (IPH), and total hemorrhage (TH) were computed from brain computed tomography scans utilizing Advantage Workstation Server analytical software. Receiver operating characteristic (ROC) curves and multivariate analyses were employed to determine the association between hemorrhage volumes and SDAHC.The study included 170 patients, of whom 111 (65.3%) were women, with a mean age of 58.5 years (standard deviation: 14.6). Fifty-five patients (32.4%) presented SDAHC. IVH volumes had an area under the ROC curve of 0.757 (95% confidence interval [CI]: 0.674-0.839; p < 0.001). An IVH volume > 2.7 cm³ showed a sensitivity of 70.9% and a specificity of 77.2% for predicting SDAHC, whereas TH volumes > 29.5 cm³ demonstrated a sensitivity of 69.1% and a specificity of 61.4%. Multivariate analysis revealed that IVH volumes > 2.7 cm³ (odds ratio [OR]: 5.373; 95% CI: 2.477-11.657), TH volumes > 29.5 cm³ (OR: 2.232; 95% CI: 1.008-4.942), and a bicaudate index ≥ 0.2 were significantly associated with SDAHC, adjusting for confounders.In aSAH patients, semiautomatic measurement of hemorrhage volumes using specialized software is independently associated with SDAHC. This method could facilitate early prediction and timely intervention.

Spine surgeries are one of the most widely performed operations in orthopaedic surgery and neurosurgery. However, one of the most common complications of spine surgeries is surgical site infection (SSI), which is associated with various postoperative morbidities. The use of antibiotics-impregnated bone cement (AIBC) is common in orthopaedic surgeries. Therefore, we aim to provide a comprehensive review of AIBC use in spine surgeries.Data were gathered from PubMed, Europe PMC, and ScienceDirect using keywords associated with AIBC and spine surgeries. We included all publications associated with AIBC and spine surgeries. Studies without full papers, non-English publications, review articles, and animal or cadaveric studies were excluded. The quality of each included studies were assessed using the Newcastle Ottawa Scale and the Joanna Briggs Institute Critical Appraisal for case reports, case series, and quasi-experimental studies.Fifteen studies of 322 patients using AIBC in spine surgery were included. Ten of 15 studies reported 100% infection-free events with AIBC administration with or without given systemic antibiotics. Two studies did not report 100% infection-free events due to methicillin-resistant Staphylococcus aureus (MRSA) infections and technical causes. Three studies reported the use of AIBC without disclosing outcomes. Various types of bacteria ranging from methicillin-sensitive Staphylococcus aureus to MRSA have been discovered, with polymethylmethacrylate and vancomycin being the most frequently used AIBCs.AIBC can be used to prevent postoperative infections due to its high effectiveness, easy administration, and no side effects. Further studies are needed to determine the most appropriate antibiotics, dose, and type of cement.