Neurosurgical Review最新文献

The surgical management of complex craniovertebral junction (CVJ) anomaly requires decompression of the neurovascular structures. Besides the atlantoaxial dislocation, the spectrum of anomalies noticed at CVJ is myriad. This includes an occipitalised C1 arch, hypoplasia of the C2 pedicle, basilar invagination, a high-riding vertebral artery (VA), a lower origin of the posterior inferior cerebellar artery (PICA), and unilateral or bilateral VA hypoplasia. The aberrant course of the VA has been the most challenging entity to access the C1-C2 joint. The atlantoaxial joint remodelling and reorientation play a vital role in achieving stability in this region. Here, we aim to describe the surgical nuances and share our experience with tailored VA mobilisation for the efficient management of CVJ anomalies. All cases of CVJ anomaly operated between January 2018 and December 2024 were included in this retrospective observational study. The clinical, radiological and operative details were collected from the neurosurgery record-keeping system. The surgical nuances and follow-up recovery of patients with VA anomaly (study group) were compared with those of patients having a normal course of VA (control group). Postoperative clinicoradiological improvement was evaluated at three-month follow-up visits. A total of 32 patients were analysed with a mean age of 47.21 ± 16.20 years. The median pre-operative Nurick's grade amongst the study population was 4 (IQR: 3,4 and Range: 3-5). Eighteen patients (18/32, 56.3%) underwent unilateral VA mobilisation (VAM), whereas fourteen patients (14/32, 43.7%) underwent bilateral VAM. After surgery, at the three-month follow-up visit, the median post-operative Nurick's grade was 3 (IQR: 2,3 and Range: 2-5), which was statistically significant (P = 0.002). The mean follow-up duration was 28.5 months (range: 6-85 ± 13.6 months) without any procedure-related mortality. Tailored VAM is an excellent surgical strategy for the management of complex CVJ pathology with an anomalous VA course. It provides a safe surgical corridor to access the C1-C2 joint without increasing the risk of injury to neurovascular structures.

Background: Stent-assisted coiling (SAC) and flow diverters (FDs) are common endovascular treatments for intracranial bifurcation aneurysms. However, studies comparing FDs and SAC were scarce. Thus, we performed a two-center, propensity score matched (PSM) cohort study to compare the FDs and SAC devices for intracranial bifurcation aneurysms.

Methods: Consecutive patients with intracranial bifurcation aneurysms were treated with FDs or SAC at two advanced stroke centers were enrolled in the study. Propensity score matching (PSM) was employed to adjust for demographic and aneurysm characteristics. The perioperative and midterm follow-up outcomes were compared between the two devices.

Results: A total of 131 patients with 131 intracranial bifurcation aneurysms were included. After PSM, 66 aneurysms treated with the FDs and SAC were matched (n = 33 in each group). At a median follow-up of 6-7 months, significant differences were observed in procedure time (105.00 min vs. 155.00 min, p < 0.001), rate of complete aneurysm occlusion (60.6% vs. 93.9%, p = 0.001) between the FDs and SAC group. There were no statistical differences in total perioperative complications (3.0% vs. 9.1%, p = 0.302), in-stent stenosis (9.1% vs. 9.1%, p = 1.000), device-related challenges (3.0% vs. 6.1%, p = 0.555) and follow-up mRS score of 3-5 (3.0% vs. 3.0%, p = 1.000) between the FDs and SAC group.

Conclusion: Compared with SAC, FDs provide a comparable rate of perioperative and clinical outcomes in unruptured intracranial bifurcation aneurysms. Nevertheless, a better occlusion status in the SAC group needs to be further verified over a longer follow-up period.

Moderate-to-severe traumatic brain injury (msTBI) is associated with heterogeneous long-term outcomes, yet the dynamic trajectories of functional recovery remain poorly characterized. This study aimed to identify distinct prognostic trajectory subgroups and their risk factors in msTBI patients. A retrospective cohort study was conducted on msTBI patients admitted to our institution. Glasgow Outcome Scale (GOS) scores were assessed at discharge and at 3, 6, 12, and 24 months post-discharge. Latent class growth analysis (LCGA) was employed to identify distinct prognostic trajectories. Univariate analysis and multivariable ordinal regression models were used to identify factors associated with trajectory membership. A total of 401 patients were included in the final analysis. Four distinct prognostic trajectories were identified: (1) Catastrophic Outcome without Recovery (Trajectory 1), (2) Limited Improvement with Unfavorable Outcome (Trajectory 2), (3) Delayed but Sustained Favorable Recovery (Trajectory 3), and (4) Early Stable Favorable Outcome (Trajectory 4). Multivariable ordinal regression analysis identified admission and discharge levels of consciousness (LOC), discharge GOS score, age, and chronic comorbidities as significant independent factors associated with the prognostic trajectories. msTBI patients exhibit heterogeneous long-term recovery patterns that can be classified into four distinct trajectories. Early identification of trajectory membership through baseline clinical characteristics may facilitate personalized rehabilitation strategies and prognostic counseling.

Background: The choice of structural grafts for transforaminal lumbar interbody fusion (TLIF) may influence clinical and radiographic outcomes. It remains unclear whether using one versus two grafts per level affects postoperative results.

Purpose: To compare clinical and radiographic outcomes in patients undergoing one- or two-level TLIF with either one or two structural grafts per level.

Methods: This is a single-center post hoc analysis of prospectively collected data (October 2011-April 2017). The study allocated subjects who underwent one- or two-level TLIF into two groups based on the number of structural allografts per spinal level. Primary clinical outcomes included Visual Analog Scale, VAS back and leg; Oswestry Disability Index, ODI; Short Form, SF-36 v2, Physical and Mental Component Summary. Secondary radiographic outcomes included fusion rates, lumbar/segmental sagittal alignment, anterior and posterior vertebral body height.

Results: A total of 115 patients were included: 38 and 78 were implanted with one or two grafts per level, respectively. At the 24 months postoperatively, there were no significant differences between the groups in primary clinical and radiographic outcomes, nor complication rates. However, both groups showed statistically significant (p < 0.0001) improvements from baseline across all primary clinical measures at the 24 months follow-up.

Conclusions: One or two structural grafts per level yield comparable clinical and radiographic outcomes in one- or two-level TLIF. When feasible, using a single graft per level may be considered without compromising patient outcomes.