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

Numerous studies have been conducted regarding vertebral restoration, development of kyphotic deformity, and pain control following balloon kyphoplasty. However, there is no consensus regarding the ideal time to perform kyphoplasty. Herein, we aimed to compare the results of treatment of different vertebral levels following early or late kyphoplasty.Between 2017 and 2022, 283 patients with single-level osteoporotic vertebral fractures were retrospectively reviewed. Patients in whom visual analog scale (VAS) values were recorded, and osteoporosis tests performed were included in the study. Traumatic single-level fractures in patients with osteoporosis who were aged > 60 years were included. Patients with a history of malignancy, previous spinal surgery, or neurological deficits were excluded. A total of 100 patients met the inclusion criteria. A total of 50 patients underwent kyphoplasty within 3 days of sustaining the fracture (Group 1), and 50 patients underwent kyphoplasty more than 3 days after sustaining the fracture (Group 2). Groups A, B, and C included fractures at the T7-T11 levels, T12-L1 levels (thoracolumbar junction), and L2-L5 levels, respectively. These groups were compared among themselves. Bilateral balloon kyphoplasty was performed under sedation in the prone position. Preoperative and postoperative VAS scores, anterior vertebral heights, and kyphotic angles (KAs) were measured and recorded. The vertebral segments that underwent early and late kyphoplasty were also compared among themselves.In all the patients who underwent early or late kyphoplasty, there was a significant decrease in the KA and a significant increase in vertebral heights during the early postoperative period (p < 0.001). There was no significant change in the vertebral heights and KA between the early and late postoperative periods (p = 0.780). Early kyphoplasty demonstrated better pain control with a greater improvement in VAS score (p < 0.001) than late kyphoplasty.Kyphoplasty plays an important role in reducing pain and ensuring early mobilization in older patients. In our study, the improvements in both symptoms and radiological features are concrete evidence in favor of performing early kyphoplasty.

This study investigated the diagnostic value of enhanced computed tomography (CT) and magnetic resonance imaging (MRI) in postoperative intracranial infections in patients undergoing craniocerebral surgery.A total of 130 patients suspected of developing intracranial infection after cranial surgery were included in the study. All patients underwent MRI and CT examinations. The results of cerebrospinal fluid (CSF) culture were observed. The diagnostic efficacy of CT and MRI for intracranial infections was compared. In addition, univariate and multivariate logistic regression analyses were conducted to identify the factors influencing intracranial infections after surgery.By CSF culture, 45 intracranial infections were finally diagnosed in 130 patients with suspected intracranial infections, including 20 cases of Staphylococcus aureus infections (44.44%), 14 cases of Staphylococcus haemolyticus infections (31.11%), and 11 cases of Staphylococcus epidermidis infections (24.44%). The sensitivity, specificity, and accuracy of CT in diagnosing intracranial infections were 51.11, 89.41, and 76.15%, respectively. In comparison, MRI demonstrated a sensitivity of 77.78%, specificity of 92.94%, and accuracy of 87.69% in diagnosing intracranial infections. Logistic multifactorial regression analysis showed that surgical approach, surgical time, CSF leakage, and ventricular drainage were independent risk factors of postoperative intracranial infections (odds ratio > 1, p < 0.05).MRI has a higher diagnostic accuracy for intracranial infections compared with CT. Various factors contribute to the development of intracranial infections following cranial surgery, which warrants careful attention and timely targeted interventions to reduce the risk of such infections.

Exposing the proximal extrapelvic sciatic nerve usually requires a partial transsection of the gluteus maximus muscle. The authors describe a modified infragluteal technique for mobilizing the gluteus maximus muscle, with only partial detachment of the muscle aponeurosis attaching to the femur.An illustrative case is reported to demonstrate the surgical feasibility of the approach. The present technique offers good operability, with only a slight decrease in the angle of the surgical corridor compared with the standard infragluteal and transgluteal techniques, while preventing muscle damage resulting from muscle deafferentation.

The authors report on a 21-year-old clinically asymptomatic female patient, who was admitted with two supratentorial intradural lesions in her follow-up magnetic resonance imaging 17 years after treatment of a posterior fossa medulloblastoma. Sequential surgical removal was performed. The left parietal tumor with dural involvement was diagnosed as a transitional meningioma WHO (World Health Organization) grade 1. The right temporal lesion, which had also close relationship to the dura, was diagnosed as a spindle cell sarcoma. We therefore report a metachronous tumor development of a benign and a malignant intradural sarcomatous tumor as secondary neoplasms following childhood medulloblastoma treatment.

Operative management of spinal metastatic disease is largely for symptom palliation rather than curative and revolves around the expectation that postoperative survival will exceed recovery time. While several scoring systems and models to predict survival exist, few studies have unified diverse predictors into integrated models to predict short-term postoperative outcomes as indicators of recovery.The Merative™ MarketScan® Commercial Database and the accompanying Medicare Supplement were queried for adult patients receiving surgery for extradural spinal metastatic disease between 2006 and 2023. Primary outcomes of interest were non-home discharge (NHD) and unplanned 90-day postdischarge readmission. Inpatient length of stay (LOS) was assessed as a secondary outcome. Five models (Extreme Gradient Boosting, Support Vector Machine, Neural Network, Random Forest, and Penalized Logistic Regression) were trained on a 70% training sample and validated on the withheld 30%.A total of 1,926 patients were included. Thoracic spine localization (vs. cervical, odds ratio [OR]: 2.83, 95% confidence interval [CI]: [1.74-4.58]) was associated with higher odds, while postresection arthrodesis (vs. no arthrodesis, OR = 1.24, [0.59-0.97]) and intraoperative neuromonitoring (vs. not, OR = 0.45, [0.31-0.66]) were associated with lower odds, of NHD. Utilizing a combined anterior and posterior approach (vs. anterior, OR = 0.50, [0.33-0.75]) and arthrodesis (OR = 0.96, [0.75-1.23]) were associated with lower odds of 90-day readmission. Similarly, using intraoperative neuromonitoring (B = - 1.84, [-2.72, -0.97]) or operating microscope (vs. not, B = - 1.71, [-2.66, -0.76]), postresection arthrodesis (B = - 0.17 [-2.66, -0.76]) were associated with shorter LOS, while thoracic localization (B = 1.67, [0.57, 2.76]) was associated with extended LOS. The random forest algorithm demonstrated the best overall predictive performance in the withheld validation cohort when assessing NHD (area under the curve [AUC] = 0.68, calibration slope = 0.82) and unplanned 90-day readmission (AUC = 0.67, calibration slope = 0.87).We developed and validated parsimonious predictive models to estimate the risk of NHD and 90-day readmission after surgery for extradural spinal metastatic disease. After integration into physician- and patient-facing interfaces, these models may serve as clinically useful decision tools to enhance prognostication and management.

Intracranial aneurysms (IAs) are persistent, localized dilatations of the arterial wall that are found in ∼3% of the general population. The most severe complication of IAs is rupture, which results in devastating consequences such as subarachnoid hemorrhage and brain damage with serious neurologic sequelae. Numerous studies have characterized the mechanisms underlying IA development and growth and identified several environmental modifiable (smoking, hypertension) and nonmodifiable risk factors (related to the histology of cerebral arteries and genetic factors) in its pathogenesis. Hemodynamic stress also likely plays a crucial role in the formation of IAs and is conditioned by the geometry and morphology of the vessel tree, but its role in the natural history of unruptured IAs remains poorly understood; it is believed that changes in blood flow might generate the hemodynamic forces that are responsible for damage to the vascular wall and vessel remodeling that lead to IA formation. This review summarizes the most relevant data on the current theories on the formation of IAs, with particular emphasis on the roles of special conditions resulting from the microscopic anatomy of intracranial arteries, hemodynamic factors, bifurcation morphometry, inflammatory pathways, and the genetic factors involved in IA formation.

Lately, the wide availability of open-source modelling and rendering software in neurosurgery has led to the development of a methodological pipeline for creating patient-specific three-dimensional (3D) models based on preoperative imaging data. With recent innovations in virtual reality (VR) technology and 3D printing, these models can be applied to enhance preoperative planning and medical training. The main question this paper aims to answer is whether the proposed algorithm of intensity-based CT segmentation and basic 3D modelling is adequate to create a reference library of patient-specific models, categorized according to the AO Spine Injury Classification System, and suitable for VR and 3D printing-based preoperative planning.We used the open-source medical image viewer Horos to create volumetric renderings of CT scans of trauma patients from several European centers. The models were postprocessed using 3D modelling software and exported in appropriate formats for VR or 3D printing.We created 37 models of trauma patients, spanning from the upper cervical to the thoracolumbar segment, categorized according to the AO Spine Injury Classification System. Additionally, a remote case discussion conducted by uploading these models into a collaborative VR environment was demonstrated as a proof of concept.In the present study, we demonstrated that open-source software can create a database of patient-specific 3D models. Additionally, the communication between remote departments can be facilitated by uploading these models into a collaborative VR environment, and the comprehensive evaluation of spine fractures fostered through 3D printing. Further studies are needed to assess the database's educational value.

Collision tumors, defined as the simultaneous occurrence of two distinct neoplasms within the same anatomical location, are exceptionally rare in the clivus. The coexistence of chordoma and chronic lymphocytic leukemia (CLL) within the clivus has not been previously reported, making this case particularly noteworthy.We present the case of a 69-year-old woman with a known history of stable CLL who presented with a 3-month history of progressive right-sided horizontal diplopia and hemianopsia. Imaging revealed a large sellar/suprasellar lesion with significant involvement of both cavernous sinuses, prompting surgical intervention. An endoscopic endonasal transsphenoidal and transclival approach was utilized to achieve near-total mass resection, with a small remnant left in the right cavernous sinus due to its proximity to the internal carotid artery. Histopathological examination confirmed the presence of a collision tumor composed of chordoma and CLL.This case represents the first reported instance of a collision tumor involving a chordoma and CLL within the clivus. The patient's postoperative course was uneventful, and she remains stable at 3-month follow-up after receiving adjuvant radiotherapy. The rarity of such a collision tumor underscores the need for heightened clinical suspicion and thorough pathological evaluation in cases presenting with atypical skull base lesions. The involvement of a multidisciplinary team was crucial in the management and favorable outcome of this complex case.

This study aimed to evaluate clinical and radiological outcomes of patients who underwent anterior cervical discectomy and fusion (ACDF) without additional anterior plate fixation.A retrospective, single-center analysis was conducted. Clinical outcomes were assessed by the Visual Analog Scale (VAS) scores, Neck Disability Index (NDI), and Odom's criteria. Radiological outcomes were evaluated based on changes in segmental disc height (subsidence), and Cobb angle by X-rays. Fusion was defined as a consistent distance between spinous processes.The study population consisted of 98 patients (mean age of 55.8 years) with a follow-up of 22.1 months. Procedures included 55 one-level, 33 two-level, and 10 three-level surgeries. The study results demonstrated good clinical outcomes, with statistically significant reductions in NDI scores with notable improvements in VAS (p < 0.001). Radiologically, we recorded a subsidence and reduction in Cobb angle of 1.6 mm/2.2 degrees in one-level, 3.8 mm/3.0 degrees in two-level, and 2.5 mm/2.4 degrees in three-level surgeries, respectively. Complete postoperative fusion was recorded for 86.7% patients, comprising rates of 87.3% for one-level, 90.9% for two-level, and 70.0% for three-level procedures. No revision surgery had to be performed.ACDF without additional plating appears to be an effective procedure for the surgical treatment of single- and multilevel degenerative cervical disease with good clinical outcome.

Background and Objective Arachnoid cysts are extra-axial cerebrospinal fluid collections within the arachnoid membrane. Ruptured or hemorrhagic arachnoid cysts, though rare, present significant controversies in management. The present study is an attempt to analyze the factors contributing to management decision of ruptured/hemorrhagic arachnoid cysts using patient-level data from the literature. Methods A literature search was conducted on PubMed and EMBASE to identify case reports and series of ruptured arachnoid cysts. Tree-augmented naïve Bayes (TAN) classifiers were implemented to analyze factors influencing surgical decision. The dataset was split into training and testing sets (0.75:0.25) and augmented using data augmentation techniques to address class imbalance. TAN classifiers were evaluated for accuracy and area under the curve (AUC), and a web application was developed to explore the networks. Results The dataset included 254 unique cases after exclusion of missing data. Middle cranial fossa cysts accounted for 95% of cases, with a male predominance (M:F ratio 4.29:1). Management was predominantly surgical (89.8%), with craniotomy being the most common procedure. TAN classifiers for surgery and type of surgery were validated internally with accuracies of 90.48% and 75%, respectively. Cyst location, presence and type of hemorrhage, patient age group, Galassi classification were key influencing variables. The choice of surgical modality was influenced by additional variables like head injury, seizure, and macrocrania. Conclusion TAN models highlighted the interrelated factors influencing management decision, but do not propose definitive strategies. The generalizability of the findings are limited by heterogenous data, imbalance of various management strategies, particularly conservative management and evolution of surgical techniques over time. The complexity of decision-making underscores the need for multicenter registries to improve data quality and to formulate optimal management strategy.