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

Training neurosurgery specialists is a challenging and demanding process. This national survey study was conducted to evaluate the infrastructure of neurosurgery residency programs and training clinics in Turkey and to assess how these factors impact specialist practice.A national survey consisting of 32 questions was distributed to neurosurgeons who had been practicing as specialists for at least two years. The survey was divided into four sections: demographic information, residency training process, hospital where they currently work as specialists, and microsurgical experience. Statistical analyses, including chi-square and logistic regression, were conducted to examine factors influencing surgical performance in specialist practice.Regression analyses indicated that performing skin-to-skin surgeries during residency significantly and most effectively increased the likelihood of performing these procedures as a specialist. Additionally, working in anatomy laboratories, attending hands-on cadaver courses, and increased years of practice were all positively associated with surgical performance. It was also found that participants who graduated within the last 5 years were statistically significantly less likely to have attended hands-on courses or visited another clinic for observerships/fellowships compared with those who graduated more than 5 years ago.Findings suggest that neurosurgical training in Turkey is affected by disparities in clinical infrastructure and hands-on experience. Standardizing residency experiences and ensuring access to necessary equipment and training resources could enhance neurosurgical competency and consistency in specialist practice.

A retrospective analysis of prospectively collected data.The Zurich Claudication Questionnaire (ZCQ) has been recently reported to be the most responsive assessment tool for lumbar spinal stenosis among the ZCQ, the Oswestry Disability Index, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, the visual analog scale, the 8-Item Short Form Health Survey, and the EuroQol 5 dimensions 5 level. There has been no study comparing surgical outcomes of additional posterior lumbar interbody fusion (PLIF) for adjacent segment disease (ASD) after previous PLIF with those of primary PLIF.We compared the clinical outcomes of additional PLIF for unstable ASD after previous PLIF with those of primary PLIF assessed with the ZCQ to examine whether surgical outcomes of additional PLIF for ASD following previous PLIF are inferior to those of primary PLIF.Thirteen consecutive patients undergoing additional single-level PLIF for unstable ASD after previous PLIF (A group) and 61 consecutive patients undergoing primary single-level PLIF (P group) were included in the study. Clinical outcomes were assessed with the ZCQ before PLIF surgery and at 2 years postoperatively. Achievement rates of the minimum clinically important difference (MCID) of each domain (symptom severity [SS] and physical function [PF]) on the ZCQ were evaluated in each group.In the A group, the mean SS and PF before additional PLIF were 3.615 and 3.1, respectively, which significantly improved to 2.231 and 2.0, respectively, at 2 years after surgery. In the P group, the mean SS and PF before primary PLIF were 3.438 and 2.5, respectively, which also significantly improved to 2.194 and 1.6, respectively, at 2 years postoperatively. PF before additional PLIF in the A group was significantly inferior to that in the P group, but SS both before and after PLIF and PF at 2 years postoperatively showed no significant differences between the two groups. The achievement rates of the MCID of SS and PF were 92.3 and 76.9%, respectively, in the A group and 59.0 and 59.0%, respectively, in the P group. The MCID achievement rates of SS was significantly higher in the A group than in the P group.Assessed with the ZCQ at 2 years after surgery, the clinical outcomes of additional single-level PLIF for unstable ASD after previous PLIF were equivalent to those of primary single-level PLIF.

A realistic phantom created from a three-dimensional (3D)-reconstructed digital patient model would enable researchers to investigate the morphological aspects of the pathological spine, thereby resolving the issue of scarce cadaveric specimens. We designed a patient-specific, human-like, reliable, and cost-effective prototype of the examined pathological spine through open-source editing software analysis, a desktop 3D printer, and alginate material. We aimed to validate that the major surgical steps and anatomy replicated the real surgery as it would be conducted in actual patients.We cover the fundamental principles and procedures involved in 3D printing, from spine imaging to phantom manufacturing. Three representative simulation cases were included in the study. All phantoms were sequentially evaluated by surgeons for fidelity. Following each surgery, participants were given a survey that included 20 questions regarding the fidelity of the training phantom.We validated this simulation model by analyzing neurosurgeons' performance on the phantom trainer. Based on a 20-item survey to test content validity and reliability, there was little variation among participants' ratings, and the feedback was consistently positive. The gross appearance of the phantom was analogous to the cadaveric specimen and the phantoms demonstrated an excellent ability to imitate the intraoperative condition. The plastic material expenditure ranged from 170 to 470 g, and the alginate expenditure was 450 g. The total cost of acrylonitrile butadiene styrene (ABS) varied from $5.1 to $17.6 ($0.03 per gram of ABS), whereas the total cost of alginate was $14.3. The average cost of our phantoms was approximately $25.7, and the 3D printer used in this study costs approximately $200.The basic properties of this phantom were similar to cadaveric tissue during manipulation. We believe our phantoms have the potential to improve skills and minimize risk for patients when integrated into trainee education.

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.

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.

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.

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.

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.