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

Previous research emphasizes correcting deformities resulting from spine fractures by restoring sagittal alignment and vertebral height. This study aims to compare radiologic outcomes, including sagittal index (SI) and loss of vertebral body height (LVBH), between stand-alone posterior stabilization (group I) and the posteroanterior/combined approach (group II) in the operative management of traumatic thoracic or lumbar spine fractures.In this retrospective single-center study, all patients with traumatic spine fractures (T1-L5) undergoing surgical stabilization between January 1, 2015, and May 31, 2021, were included. Two spine surgeons independently assessed imaging, recording the SI and LVBH values at baseline, after each surgical intervention, and during follow-up (at least 3 months posttreatment). The mean SI and LVBH values between the assessing surgeons were utilized. Linear mixed-effects regression models, adjusted to baseline values, compared the SI and the LVBH values between the two groups.In all, 71 patients (42 men), with the median age of 38 years (interquartile range [IQR]: 28-54) and median follow-up of 4 months (IQR: 3-17), were included. Thirty-two patients were in group I and 39 patients were in group II. Forty fractures included the thoracolumbar junction (T12 or L1), 15 affected the thoracic spine, and 14 the lumbar spine. The regression model revealed superior sagittal alignment in group II, with an adjusted mean difference for SI of -4.24 (95% confidence interval [CI]: -7.13 to -1.36; p = 0.004), and enhanced restoration of vertebral body height with an adjusted mean difference for LVBH of 0.11 in the combined approach (95% CI: 0.02-0.20; p = 0.02). Nine postoperative complications occurred in the entire cohort (4 in group I and 5 in group II).Combined posteroanterior stabilization for spine fractures improves deformities by enhancing sagittal alignment and increasing vertebral body height, with acceptable morbidity compared with the stand-alone posterior approach.

Hemangioblastomas are rare, benign, highly vascularized tumors, which among other locations arise in the central nervous system. Due to the tumor's dense vascularity, bleeding and interference with the surrounding brain tissue and vasculature have been reported. Rapid neurological deterioration due to hemorrhage from a hemangioblastoma, especially in spinal locations, has been reported.Rapid clinical deterioration occurred in a 47-year-old male patient with a cerebellar hemangioblastoma and delayed extensive cerebellar ischemia, consecutively. Initial cranial magnetic resonance imaging revealed the tumor with small ischemic areas in the left cerebellar hemisphere. A couple of days later, consciousness dropped significantly and immediate computed tomography revealed extensive ischemia of the left cerebellar hemisphere. Emergency suboccipital decompressive craniectomy and tumor resection were performed. The patient recovered and was discharged to neurological rehabilitation a couple of weeks later.Despite the benign character of hemangioblastomas, life-threatening rapid deterioration due to cerebellar ischemia can occur as reported in this case.

Microvascular anastomosis using interrupted suture is a widely accepted standard technique. Continuous suture is less common due to the presumption that its firmness can negatively affect anastomosis maturation. The purpose of this study was to determine whether the use of continuous suture allows maturation of the microanastomosis site.A rat common carotid artery (CCA) end-to-end microanastomosis model was utilized, with 19 Long-Evans rats in the interrupted suture group and 13 in the continuous suture group. Immediate blood flow of the operated and contralateral intact CCAs was compared before clamping, at the completion of the anastomosis and after 14 days. Quantitative transit time flowmetry measurement and histologic examination were employed.Initial blood flow in both intact CCAs was similar across all animals (p = 0.004). In the interrupted suture group, the median anastomosis blood flow was 88.9% of the contralateral CCA blood flow, with a median suture time of 46 minutes. After 2 weeks, blood flow increased to 96.1%. In the continuous suture group, the median anastomosis blood flow was 88.3% of the contralateral CCA blood flow, with a median suture time of 30 minutes. After 2 weeks, blood flow increased to 100.0%. The reduction in suture time achieved with continuous suture was 34.8% (p < 0.001). Histologic examination confirmed scar maturity.The maturation rates of continuous and interrupted suture microanastomosis were comparable in our study, implying that concerns about the suture restricting maturation may be unwarranted. Additional finding is the potential for a reduction in microanastomosis time when using the continuous suture technique.

Most studies on Chiari malformation (CM) are focused on CM Type-1. A new subtype, CM Type-1.5, lacks sufficient research. This study aims to evaluate the long-term surgical outcomes of posterior fossa decompression followed by duraplasty with arachnoid-preserving (PFDD-AP) technique for primary and recurrent CM Type-1.5.The medical charts of patients treated surgically for CM at our institute between January 2011 and January 2022 were reviewed retrospectively. Adult patients consecutively treated for CM Type-1.5 were selected as the core sample for the current study. Group A included primary cases (i.e., patients who had not previously been surgically treated), and Group B included recurrent cases. The surgical outcomes were compared by evaluating clinical and radiological findings.Thirty-four CM Type-1.5 cases out of 202 CM cases met the study criteria. Twenty-three and 11 cases represented Group A and Group B, respectively. The female-to-male ratio was 2/1. In Group B, the preoperative herniated tonsil extension and the obex position were statistically significantly longer, and retroversion and retroflexion angles were statistically considerably smaller ([p = 0.024; Z = - 2.26]; [p = 0.023; Z = - 2.27]; [p = 0.031; Z = - 2.29]; and [p = 0.0002; Z = - 3.72], respectively). For the cases presented with syringomyelia (SM) in both groups (n = 20), total and partial regression were recorded postoperatively in 65% and 15% of cases, respectively. The satisfactory recovery or improvement rate in neurological symptoms was 94.1%.Total or partial SM regression occurred following PFDD-AP in most adult patients with CM Type-1.5 who presented with SM. The PFDD-AP approach offers better results with fewer complications and recurrence rates.

The risk factors for and molecular mechanisms of systemic metastasis of cerebral glioblastoma (GBM) remain to be evaluated.Literature about adult GBM patients with systemic metastasis published before December 31, 2022, was searched in "PubMed" and "Web of Science," and the patient's clinical data were collected and compared with those of patients without metastasis to evaluate the risk factors. The molecular pathology results were summarized to evaluate the mechanism.One hundred and forty-seven patients with metastasis in 113 papers published from 1928 to 2022 were included. Two hundred and forty-nine patients without metastasis who underwent surgery in our department in 2017 were included. Comparison of the two groups showed that age ≤40 years was significantly correlated with metastasis (hazard ratio [HR]: 2.086, 95% CI: 1.124-3.871, p = 0.020) and better overall survival (HR: 1.493, 95% CI: 1.067-2.083, p = 0.019). Molecular pathology results were reported in 39 cases (39/147, 26.5%). The genetic results showed obvious heterogeneity. According to the frequency and positive ratio, IDH-wild type (positive rate 27/30), TERT promoter mutation (11/13), PTEN mutation (10/11), TP53 mutation (10/13), and RB1 mutation (8/9) were common gene changes.In young adult GBM patients, especially those ≤40 years of age with long survival, attention should be given to the development of systemic metastases. Metastasis can be the result of multiclonal gene mutations, in which proliferation- and invasion-related gene changes, such as oncogene or tumor suppressor gene mutations and epithelial-mesenchymal transition-related genes, may play an important role in metastasis.

In contrast to the thoracolumbar spine, where pedicle screws can be inserted via a minimally invasive, percutaneous technique through small skin incisions, all previously available cervical instrumentation systems required a larger midline incision, especially for rod insertion. Screw placement via small incisions reduces the risk of wound healing disorders and blood loss, and patients can be mobilized more quickly and with less pain. In 2022, a cervical, minimally invasive stabilization system became available for the complete percutaneous insertion of both cervical pedicle screws and rods. We report on the first results and experiences with this new technology.In this retrospective case series, we included patients with cervical instability treated by minimally invasive percutaneous cervical and upper thoracic spine pedicle screw and rod insertion between August 2022 and August 2023. Intra- and postoperative complications as well as revision surgeries were recorded. The screw position was evaluated by three examiners in the postoperative computed tomography (CT) using the Bredow classification.Our series includes six male patients (age = 56.9 ± 12.9 years; body mass index [BMI] = 29.8 ± 9.6 kg/m²). The indication for surgery was trauma, tumor, and degenerative stenosis in two patients each. An excellent/good screw position (Bredow 1 and 2) was found in 84.4% of the screws (n = 27/32). None of the screws rated as Bredow 3 (n = 2/32) or Bredow 4 (n = 3/32) resulted in a neurological deficit or radicular pain and none had to be repositioned. No neurologic complication or revision surgery occurred. As a complication not directly related to the surgery technique, one patient died of a pulmonary lung embolism on the seventh postoperative day.The results of this study indicate that minimally invasive percutaneous implantation of a pedicle screw-rod system is also possible in the cervical spine with sufficient accuracy using intraoperative navigation. However, technical details, possible pitfalls and finally careful patient selection must be taken into account.

In Germany, pregnancy often results in a ban from the operating theater for surgeons, reflecting legislation prioritizing maternal and fetal protection over individual autonomy. Due to limited data for German neurosurgeons, we aimed to assess the attitudes of German women neurosurgeons toward continuing surgical work during pregnancy and lactation to provide appropriate recommendations.We conducted an online SurveyMonkey survey among all female members of the German Society for Neurosurgery (Deutsche Gesellschaft für Neurochirurgie) and the Professional Association of German Neurosurgeons (Berufsverband Deutsche Neurochirurgie).Of 286 invited women neurosurgeons, 122 responded (42.6%), with 65 (53.3%) having children or being currently pregnant with their first child. The majority (98.5%) desired to continue surgery during pregnancy, yet 80% expressed concerns about announcing their pregnancy due to potential job-related disadvantages. However, 35.4% (23 out of 65) ceased surgery due to an immediate ban imposed by the company physician and only a minority due to health-related issues (n = 2). Of the remaining 42 women who initially continued operating, 73.2% reported good departmental support during pregnancy. However, 18.5% (12/65) faced a subsequent surgery ban after announcing their pregnancy. Overall, there were no successful appeals (n = 13). Nearly a third eventually resumed surgery, implementing additional protective measures such as extended disease testing. However, self-estimation revealed a reduced surgical performance of approximately 35% compared with the year before pregnancy. Five women (7.7%) informed the company physician only at the end of pregnancy to circumvent the ban. Approximately a quarter (27%) experienced surgery-free periods of 1 to 1.5 years, whereas 21% reported 1.5 to 2 years per pregnancy. Forty-four percent reported discrimination in surgery allocation upon return, whereas 48% reported none.Most women neurosurgeons aspire to continue surgery during pregnancy, yet face involuntary bans. Despite permission to operate, procedural volumes decrease significantly, compounded by surgery-free periods during lactation and parental leave, and reported discrimination upon return. We hypothesize that pregnancy-related bans exacerbate a glass ceiling effect, impeding women neurosurgeons' career progression, and propose removing bureaucratic obstacles to enable continued surgical practice.

Endoscopic endonasal transsphenoidal surgery (EETS) results in disturbance of nasal mucosa and airflow. Previous studies have demonstrated associated sinonasal morbidity but have not prospectively assessed olfactory function.To obtain prospective objective measure of sinonasal morbidity associated with EETS.We report our prospective patient-reported outcome study of 20 unselected, consecutive patients undergoing EETS. Baseline assessment of olfactory function was performed using the validated University of Pennsylvania Smell Identification Test alongside quality of life (QoL) assessments using the 22-item Sino-Nasal Outcomes Test (SNOT-22) and Anterior Skull Base Questionnaire (ASBQ) prior to surgery. Repeat olfactory function testing and QoL questionnaires were performed at 3 months and 12 months postoperatively. All patients underwent pituitary surgery and there was one extended anterior approach.Mean olfactory function score was worse at 3 months (25.9) compared with baseline (30.5), p = 0.02. This improved back toward baseline at 1 year (29.4). Three patients (15.8%) had significant residual olfactory impairment at 1 year. There were no significant differences in SNOT-22 score or ASBQ at 3-month or 1-year follow-up. EETS is associated with minor disturbances in olfactory and sinonasal QoL.Formal assessment of olfactory function has proven more sensitive in identifying deficiencies in olfaction following surgery; however, there is little or no correlation with QoL scores.

Background and objectives: In this study, our goal is to examine the radiological findings and clinical outcomes of nine patients with intradiploic masses, who were treated at our clinic, along with a comprehensive review of the existing literature.

Methods: The study includes a total of nine adult patients, who were under follow-up and treatment for intradiploic masses from 2015 to 2022. All patients included in the study provided signed informed consent forms. Exclusions from the study criteria comprised patients in the pediatric age group, those with a documented history of cancer, prior cranial surgery, active central nervous system infection, and acute head trauma resulting in cranial damage.

Results: Our study comprised a total of 9 patients, with 6 (66.6%) females and 3 (33.3%) males, with a median age of 36 years (range: 18-76). Epidermoid cysts were identified in 2 patients, while others presented with cavernous hemangioma, arachnoid/leptomeningeal cyst, intradiploic lipoma, dermoid cyst, arachnoid cyst, fibrous dysplasia, and eosinophilic granuloma. Among the cohort, 8 patients presented with headaches. The patient with cavernous hemangioma underwent total resection and mini plate stabilization. Similarly, total resection was performed in cases of leptomeningeal cyst (n=1) and intradiploic lipoma (n=1). In a single patient, fibrous dysplasia was diagnosed through open biopsy. For the patient with eosinophilic granuloma, total mass excision and chemotherapy were undertaken. Notably, four patients (44.4%), including those with epidermoid cysts (n=2), dermoid cyst (n=1), and arachnoid cyst (n=1), were managed conservatively without surgical intervention.

Conclusions: The use of CT and MRI imaging in intradiploic lesions seems sufficient to differentiate the mass. However, it may be difficult to reach a definitive diagnosis in some patients without surgery. Therefore, based on the experience of clinical management, it is important to evaluate in detail the various radiological and clinical findings unique to the patient, regarding excision or nonoperative follow-up.