Neurosurgical Review最新文献

Background: Traumatic Brain Injury (TBI) is a leading cause of hospitalization and disability in young and middle-aged adults. This study aims to survey the efficacy of oral modafinil, a low-side-effect central nervous system stimulant, in the enhancement of consciousness recovery in moderate to severe TBI patients in the ICUs of a referral trauma center.

Materials and methods: All ICU patients meeting inclusion criteria between April 2021 and April 2023 were screened. Eligible patients had a motor Glasgow Coma Score(GCS) of 4 or 5 and did not receive continuous intravenous sedatives within 24 h before screening. They were randomly assigned to receive 200mg of enteral modafinil or placebo daily for 7 days. Motor GCS and total GCS scores, ICU/hospital stay duration, mechanical ventilation requirement, tracheal tube removal time, and tracheostomy needs were recorded.

Results: Among the included 85 eligible patients, there was no significant difference between the modafinil and placebo groups in the median days between the intervention and the time of a 2-unit increase in total GCS (P = 0.25) or a 1-unit increase in motor GCS (P-value = 0.31). The group assignment also had no impact on the mean GCS (P-value = 0.533) and mean motor GCS (P-value = 0.167) over time. The only significant difference was in the proportion of patients with an increase in total GCS by 2 units, which was 54% for the modafinil vs. 32% for the placebo group (P-value = 0.04), and an increase in motor GCS by 1 unit, with 56% in the modafinil vs. 34% in the placebo group (P-value = 0.04).

Conclusion: The administration of modafinil appears to be safe and beneficial for patients with severe TBI during their stay in the ICU.

Pilocytic astrocytoma (PA) is a WHO grade I neoplasm with a favorable prognosis. It is the most common pediatric benign tumor. Recently, PA has attracted more and more attention and discussion from scholars. The aim of this study is to comprehensively generalize the evolution of this field over the past two decades through bibliometric analysis and to predict future research trends and hotspots. The literature over the last two decades (2004-2023) related to PA was obtained from the Web of Science Core Collection (WoSCC) database. Bibliometric analyses were conducted based on the following aspects: (1) Annual publication trends; (2) Publications, citations/co-citations of different countries/institutions/journals/authors; (3) the map of Bradford's Law and Lotka's Law for core journals and author productivity; (4) Co-occurrence, cluster, thematic map analysis of keywords. All analyses were performed on VOSviewer and R bibliometrix package, and Excel 2024. Our results showed that research on PA displayed a considerable development trend in the past 20 years. The USA had a leading position in terms of scientific outputs and collaborations. Meanwhile, German Cancer Research Center contributed the most publications. Child's Nervous System had the highest number of publications and Acta Neuropathologica was the most co-cited journal on this subject. Gutmann, D.H. and Louis, D.N. were the authors with the most articles and co-citations in this field. The research emphases were molecular mechanisms, neurofibromatosis, pilomyxoid astrocytoma, differential diagnosis, and therapy. We systematically analyzed the literature on PA from a bibliometric perspective. The demonstrated results of the knowledge mapping would provide valuable insights into the global research landscape.

Residency websites can often be crucial for influencing neurosurgery applicants' first impressions of programs. This study explores the representation of diversity on neurological surgery residency program websites and evaluates the impact of Diversity, Equity, and Inclusion (DEI) statements. The websites of 117 neurological surgery residency programs were evaluated for the presence of 12 diversity and inclusion elements. Univariate analysis was conducted to determine significant differences in DEI scores between neurological surgery residency program websites. Program analysis revealed a mean diversity score of 7.9 out of a maximum score of 12, equating to the presence of 66% of possible DEI elements in our scoring system. Top-50 ranked programs (Doximity) exhibited a significantly higher mean diversity score (8.6 +/- 2.7) compared to those outside the top-50 (7.2 +/- 2.9) (p = 0.009). Accessibility of DEI content varied, with most program websites either having a direct link to a separate DEI webpage (41%) or lacking any DEI elements (42%). A secondary analysis found that the presence of a DEI statement on a program's webpage was not significantly associated with Doximity ranking, NIH funding, geographic region, or hospital funding. However, programs with a DEI statement were significantly more likely to have various additional DEI elements (p < 0.001). While many neurological surgery residencies include elements of DEI on their websites, this is not currently a consistent practice across all programs. We advocate that these initiatives should be prominently featured on program websites to aid applicants in making informed decisions about their training journey.

Anterior choroidal artery (AChA) aneurysms represent 2-5% of intracranial aneurysms. The proximity of the origin of the AChA to the aneurysm neck poses a risk of thromboembolic complications following treatment. AChA occlusion can result in significant neurological deficits. We present a case-series of patients with AChA aneurysms and their treatment outcomes. We describe how treatment was chosen based on aneurysm and patient-specific factors to minimize risks, enhance efficacy of treatment, and improve patient outcomes. We retrospectively reviewed 27 patients who underwent treatment for AChA aneurysms at a single institution from 2015-2024. Clinical presentation, aneurysm characteristics, procedural details, and follow-up data were collected. Twenty-seven AChA aneurysms (median diameter 2.94 mm), were treated in 29 procedures. Treatments included clipping (11 aneurysms), flow diversion (13), or coiling (5). The five coiled aneurysms were ruptured at presentation. Three patients experienced permanent infarction (10.3%), two in the setting of vasospasm after coiling and one after flow diversion in a patient who proved to have resistance to clopidogrel. At a median follow-up of 4.73 months (IQR = 1.23-14.03), 25 patients (93%) had favorable functional recovery (mRS 0-2). Patients treated for AChA aneurysms experienced favorable functional outcomes by utilizing surgical and endovascular techniques carefully chosen based on aneurysm and patient-specific factors. Two patients did not achieve independence post-coiling due to disability from their initial subarachnoid hemorrhage. There were no treatment related causes of unfavorable functional outcomes.

Recent advancements in endovascular treatment (EVT) and different views on optimal management for posterior communicating artery (PComA) aneurysms with oculomotor nerve palsy (ONP) highlight a need to compare recovery timelines between microsurgery and EVT; heterogeneous outcomes and influencing factors may also affect results. A comprehensive systematic review and meta-analysis were conducted by searching PubMed, Embase, Scopus, and Web of Science databases. The extracted data encompassed patient demographics, details on treatment modalities and timing, and characteristics of PComA aneurysms ONP caused by either unruptured or ruptured aneurysms. The primary outcome was ONP favorable recovery, defined as the resolution of admission symptoms, except for subtle ptosis and mild pupillary asymmetry. We used random effect models to calculate odds ratios (OR) and pool prevalence with their corresponding 95% confidence intervals (CI). A total of 40 studies met the inclusion criteria. Overall, microsurgical clipping of PComA aneurysms demonstrated a significantly higher likelihood of ONP recovery compared to EVT at 1,3,6, and 12 months follow-up. However, recovery rates were comparable in long-term follow-up [18 months: (0.87 vs. 0.64, P-value = 0.36); ≥24 months: (0.86 vs. 0.72 P-Value = 0.26)]. The recovery outcomes for early treatment were similar when assessed during the 6-month follow-up (0.75 vs. 0.56, P-value = 0.07). Our findings suggest microsurgery leads to prompt ONP recovery from PComA aneurysms, while EVT shows potential for delayed favorable recovery; both treatments yield short-term recovery when administered early. A case-by-case approach is recommended, emphasizing a comprehensive understanding of patient factors in relation to the immediate and sustained effects of each treatment.

Objective: The burr-hole technique is a minimally invasive transcranial approach designed to minimize the surgical incision size and reduce disruption to brain tissue. We aimed to share our experience with the burr-hole technique for removing brain lesions and to evaluate its effectiveness in treating appropriately sized intra-axial brain lesions.

Methods: In this retrospective cohort study, we analyzed the clinical features, radiological characteristics, surgical techniques, and outcomes of patients who underwent burr-hole surgery for intra-axial brain lesions between January 2019 and December 2023.

Results: A total of 81 patients were included in the study. Gross total resection was achieved in 74 patients (91.4%), whereas subtotal resection was performed in 7 patients (8.6%). There were no perioperative deaths, cerebrospinal fluid leaks, or wound infections. The median follow-up duration was 40.5 months (range, 4.1-63.7 months). At the end of the follow-up period, 14 patients (17.3%) experienced recurrence, including 6 with glioma and 8 with primary cerebral lymphoma. Among these patients, 10 died due to lesion recurrence.

Conclusions: The burr-hole approach using a retractable tubular device is a safe and effective method for the removal of brain lesions. As a novel minimally invasive technique, it significantly facilitates and accelerates the evolution of microsurgical outcomes.

Introduction: Spinal metastases are a significant concern for patients with advanced cancer, leading to pain, neurological deficits, and reduced quality of life. They occur in up to 70% of cancer patients, with the vertebral column being the most common osseous site for metastatic disease^1-3. An approximate 10% of patients with vertebral body metastases eventually develop spinal cord compression, which can potentially cause severe and permanent disability^4-6. This article aims to summarize the consensus statements developed by the World Federation of Neurosurgical Societies (WFNS) Spine Committee on the clinical evaluation, diagnosis, and decision-making for metastatic spine tumors.

Methods: A systematic literature search was conducted in PubMed and Google Scholar from 2014 to 2023 using the search terms "clinical evaluation" + "spine metastases," "spine metastases" + "diagnosis," and "spine metastases" + "decision making" + "treatment." Based on the review of this literature, six members of the WFNS Spine Committee developed five consensus statements using the Delphi method, which were voted on during two rounds of voting at two international meetings.

Results: We agree that a high index of suspicion is required for early detection and diagnosis of spinal metastasis in cancer patients and adult patients more than 60 years presenting with new onset fractures / neurological deficits. Pain is the most common symptom followed by motor deficit. Bowel and bladder dysfunction is noted in nearly half of patients with metastatic spinal cord compression. An effective treatment for spinal metastases should be able to achieve pain relief, tumor control, prevention of neurological compromise and treat instability. Separation surgery combined with SRS is an effective treatment for spinal metastases.

Conclusion: These consensus statements provide evidence-based guidelines for clinical evaluation, diagnosis, and decision-making in patients with metastatic spine tumors.

To investigate the clinical efficacy and safety of microsurgical surgery in patients with proximal vertebral artery stenosis unsuitable for endovascular treatment. A retrospective analysis was conducted on the clinical data of 34 patients with proximal vertebral artery stenosis who underwent microsurgical surgery at the Department of Cerebrovascular Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong, from March 2020 to April 2023. Preoperative imaging confirmation of proximal vertebral artery stenosis or occlusion was obtained using cervical CT angiography (CTA), CT perfusion imaging (CTP), and magnetic resonance angiography (MRA). Postoperative imaging examinations were utilized to evaluate blood flow patency, and clinical symptoms and complications during hospitalization and follow-up were documented. Postoperative imaging examinations in the 34 patients (Males: 79.4%; Mean age: 66.7 ± 9.6 years) revealed patent vertebral and supplying arteries. No new instances of transient ischemic attacks (TIAs) or other cerebrovascular events were observed during hospitalization, and clinical symptoms were improved. The mean follow-up duration was 10 months (range: 6-39 months). One patient died from septic shock due to abdominal infection, and one patient exhibited moderate ipsilateral vertebral artery stenosis on a follow-up CTA at 6 months postoperatively. The Modified Rankin Scale (mRS) scores decreased for 30 patients after surgery compared to preoperative scores, with all postoperative mRS scores being less than 1. The difference between preoperative and postoperative mRS scores was statistically significant (P < 0.01). Six patients experienced temporary postoperative complications, which resolved after active treatment, and one patient developed permanent Horner's syndrome without affecting the quality of life. Microsurgical surgery for patients with proximal vertebral artery stenosis, when endovascular treatment is unsuitable, demonstrates good clinical efficacy and a low incidence of complications, offering a viable surgical treatment option. Further multicenter studies with larger sample sizes will be instrumental in validating its clinical application value.

Introduction: Judo, a martial art created by Jigoro Kano in 1882, is a martial art promoting physical and spiritual development. Despite its "gentle way" philosophy, it poses a significant risk for cervical spine injuries, often resulting from throws and ground techniques.

Methods: This cross-sectional study analyzed cervical injuries among professional judo athletes from January to July 2024. Data were collected via an online questionnaire covering demographics, injury details, circumstances, and prevention. The study included athletes from seven countries, with exclusion criteria being pre-existing non-judo-related cervical conditions and incomplete questionnaires. Descriptive and inferential statistical analyses were performed using RStudio 4.4.0.

Results: Of the 104 participants, 42 athletes reported cervical injuries, primarily during practice and linked to high-risk techniques like uchi-mata and ippon-seoi-nage. Defensive maneuvers, especially involving the "head dive," were significant risk factors. Injuries ranged from contusions to disc herniations and fractures, with symptoms like pain, numbness, and weakness. Most athletes received physical therapy, though some required surgery. Preventive measures were inconsistently applied, despite advice from coaches and physical therapists.

Conclusion: Cervical spine injuries in judo are common, especially during defensive maneuvers and specific high-risk techniques. The variability in treatment outcomes underscores the need for better prevention strategies, education, and tailored training. Further research is essential to mitigate injury risks for judo athletes.