Pub Date : 2024-11-01DOI: 10.1227/neu.0000000000003250
Annabelle Shaffer, Helen Kemprecos, Zelda Moran, Aaron T Anderson, Adam Tarr, John Flannell, Graham Huesmann, Tracey M Wszalek, Jerrad Zimmerman, Paul M Arnold
Background and objectives: Over a million sport-related concussions (SRC) affect children annually in the United States, posing a significant public health concern. Limited data exist on the premorbid risk factors and injury characteristics of SRCs in high school athletes. This study aims to understand acute SRC injury characteristics and describe premorbid risk factors in high school athletes.
Methods: Athletes (aged 14-19 years) from 19 central Illinois high schools participating in school-sponsored sports from 2009 to 2023 were included. Sports Concussion Assessment Tool evaluations were performed as part of preseason and postinjury evaluations. Injury characteristics, such as mechanism, setting, and symptoms, were described using all SRCs in the study period. Odds ratios (OR) were computed to determine risk factors using athletes with a baseline Sports Concussion Assessment Tool before SRC and nonconcussed athletes.
Results: In total, 4360 athletes were included (3953 without SRC; 407 with ≥1 SRC of whom 168 had a previous baseline). Overall, 24.2% of SRCs occurred in female athletes, and most SRCs occurred in competitions while playing American football (52.3%), soccer (20.4%), and basketball (7.6%). Blow/hit to the head was the most common mechanism. Headache was the most severe symptom (2.55 ± 1.51 [SD]), and symptoms of emotionality and nervousness/anxiety were significantly more severe in female athletes (P < .05). Students with previous concussions (OR 2.64 95% CI [1.81, 3.78]), previous hospitalization for head injury (OR 3.19 95% CI [1.9, 5.14]), headache/migraine disorders (OR 2.23 95% CI [1.29, 3.66]), and learning disabilities (OR 2.69 95% CI [1.47, 4.61]) had greater odds of SRC (P < .05). Lower odds of SRC were seen in athletes identifying as Black or African American (vs White) (OR 0.54 95% CI [0.32, 0.86]) and those attending larger (vs smaller) schools (OR 0.64 95% CI [0.46, 0.88]).
Conclusion: Understanding SRC risk factors and characteristics in high school athletes is critical for developing prevention and management programs, guiding neurosurgeons in mitigating SRC risk, and informing return-to-play decisions.
{"title":"Injury Characteristics and Risk Factors of Sport-Related Concussion Among High School Athletes in School-Sponsored Sports.","authors":"Annabelle Shaffer, Helen Kemprecos, Zelda Moran, Aaron T Anderson, Adam Tarr, John Flannell, Graham Huesmann, Tracey M Wszalek, Jerrad Zimmerman, Paul M Arnold","doi":"10.1227/neu.0000000000003250","DOIUrl":"https://doi.org/10.1227/neu.0000000000003250","url":null,"abstract":"<p><strong>Background and objectives: </strong>Over a million sport-related concussions (SRC) affect children annually in the United States, posing a significant public health concern. Limited data exist on the premorbid risk factors and injury characteristics of SRCs in high school athletes. This study aims to understand acute SRC injury characteristics and describe premorbid risk factors in high school athletes.</p><p><strong>Methods: </strong>Athletes (aged 14-19 years) from 19 central Illinois high schools participating in school-sponsored sports from 2009 to 2023 were included. Sports Concussion Assessment Tool evaluations were performed as part of preseason and postinjury evaluations. Injury characteristics, such as mechanism, setting, and symptoms, were described using all SRCs in the study period. Odds ratios (OR) were computed to determine risk factors using athletes with a baseline Sports Concussion Assessment Tool before SRC and nonconcussed athletes.</p><p><strong>Results: </strong>In total, 4360 athletes were included (3953 without SRC; 407 with ≥1 SRC of whom 168 had a previous baseline). Overall, 24.2% of SRCs occurred in female athletes, and most SRCs occurred in competitions while playing American football (52.3%), soccer (20.4%), and basketball (7.6%). Blow/hit to the head was the most common mechanism. Headache was the most severe symptom (2.55 ± 1.51 [SD]), and symptoms of emotionality and nervousness/anxiety were significantly more severe in female athletes (P < .05). Students with previous concussions (OR 2.64 95% CI [1.81, 3.78]), previous hospitalization for head injury (OR 3.19 95% CI [1.9, 5.14]), headache/migraine disorders (OR 2.23 95% CI [1.29, 3.66]), and learning disabilities (OR 2.69 95% CI [1.47, 4.61]) had greater odds of SRC (P < .05). Lower odds of SRC were seen in athletes identifying as Black or African American (vs White) (OR 0.54 95% CI [0.32, 0.86]) and those attending larger (vs smaller) schools (OR 0.64 95% CI [0.46, 0.88]).</p><p><strong>Conclusion: </strong>Understanding SRC risk factors and characteristics in high school athletes is critical for developing prevention and management programs, guiding neurosurgeons in mitigating SRC risk, and informing return-to-play decisions.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1227/neu.0000000000003242
Helen Michaela de Oliveira, Lucas Mendes Barbosa, Fernanda Valeriano Zamora, Bruna Oliveira de Paula, Guilherme Oliveira de Paula, Julie G Pilitsis, Pablo Ramon Fruett da Costa
Background and objectives: Neuromodulation is an advanced therapeutic intervention for managing various neurological, psychiatric, and functional disorders. However, a significant challenge is the risk of infections at the device implantation site. Previous studies have shown that antibacterial envelopes used in cardiovascular surgeries significantly reduce infection risk. It is postulated that similar benefits could occur in neurosurgeries involving implant insertion, but the literature lacks studies analyzing this efficacy. This study aimed to evaluate the effectiveness of antibacterial envelopes in reducing infection rates associated with neuromodulation implants.
Methods: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases up to August 2024 for clinical trials comparing the use of antibacterial impregnated envelopes in patients undergoing neuromodulation-related implant insertion. This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Statistical analyses were performed using R version 4.3.2. Risk of bias was assessed using the Risk Of Bias In Nonrandomized Studies-of Interventions tool, and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation assessment. The study was registered in Prospective Register of Systematic Reviews.
Results: Four studies, comprising 1242 patients, were included, of whom 704 (56.7%) received antibacterial envelopes. The pooled analysis showed that the odds of infection were 77% lower in patients using the antibacterial envelope compared with the control group (odds ratios = 0.23; 95% CI = 0.10-0.51; P < .001; I2 = 2%).
Conclusion: The use of an antibacterial envelope significantly reduces the odds of infection in patients undergoing neuromodulation-related implant insertion by 77%. These findings underscore the potential of antibacterial envelopes to improve postoperative outcomes.
背景和目的:神经调控是一种先进的治疗干预手段,可用于治疗各种神经、精神和功能性疾病。然而,一个重大挑战是装置植入部位的感染风险。先前的研究表明,心血管手术中使用的抗菌包膜可显著降低感染风险。据推测,神经外科手术中的植入物植入也会产生类似的益处,但文献中缺乏对这种功效的分析研究。本研究旨在评估抗菌包膜在降低神经调控植入物相关感染率方面的效果:我们系统地检索了 PubMed、Embase 和 Cochrane Central Register of Controlled Trials 数据库(截止到 2024 年 8 月)中关于比较在接受神经调控相关植入物的患者中使用抗菌浸渍包膜的临床试验。本研究遵循《系统综述和元分析首选报告项目》指南。统计分析使用 R 4.3.2 版本进行。使用 "非随机干预研究中的偏倚风险 "工具对偏倚风险进行了评估,并使用 "建议评估、开发和评价分级 "对证据质量进行了评估。该研究已在前瞻性系统综述注册中心注册:结果:共纳入了四项研究,包括 1242 名患者,其中 704 人(56.7%)接受了抗菌包膜治疗。汇总分析显示,与对照组相比,使用抗菌包膜的患者感染几率降低了 77%(几率比 = 0.23;95% CI = 0.10-0.51;P < .001;I2 = 2%):结论:使用抗菌包膜可将接受神经调控相关植入物插入手术的患者的感染几率大幅降低 77%。这些发现强调了抗菌包膜改善术后效果的潜力。
{"title":"Use of Antibacterial Envelopes in Neuromodulation Surgeries With Implantable Device Insertion: A Systematic Review and Meta-Analysis.","authors":"Helen Michaela de Oliveira, Lucas Mendes Barbosa, Fernanda Valeriano Zamora, Bruna Oliveira de Paula, Guilherme Oliveira de Paula, Julie G Pilitsis, Pablo Ramon Fruett da Costa","doi":"10.1227/neu.0000000000003242","DOIUrl":"https://doi.org/10.1227/neu.0000000000003242","url":null,"abstract":"<p><strong>Background and objectives: </strong>Neuromodulation is an advanced therapeutic intervention for managing various neurological, psychiatric, and functional disorders. However, a significant challenge is the risk of infections at the device implantation site. Previous studies have shown that antibacterial envelopes used in cardiovascular surgeries significantly reduce infection risk. It is postulated that similar benefits could occur in neurosurgeries involving implant insertion, but the literature lacks studies analyzing this efficacy. This study aimed to evaluate the effectiveness of antibacterial envelopes in reducing infection rates associated with neuromodulation implants.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases up to August 2024 for clinical trials comparing the use of antibacterial impregnated envelopes in patients undergoing neuromodulation-related implant insertion. This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Statistical analyses were performed using R version 4.3.2. Risk of bias was assessed using the Risk Of Bias In Nonrandomized Studies-of Interventions tool, and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation assessment. The study was registered in Prospective Register of Systematic Reviews.</p><p><strong>Results: </strong>Four studies, comprising 1242 patients, were included, of whom 704 (56.7%) received antibacterial envelopes. The pooled analysis showed that the odds of infection were 77% lower in patients using the antibacterial envelope compared with the control group (odds ratios = 0.23; 95% CI = 0.10-0.51; P < .001; I2 = 2%).</p><p><strong>Conclusion: </strong>The use of an antibacterial envelope significantly reduces the odds of infection in patients undergoing neuromodulation-related implant insertion by 77%. These findings underscore the potential of antibacterial envelopes to improve postoperative outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1227/neu.0000000000003254
Senta Frol, Gustavo M Cortez, Janja Pretnar-Oblak, George Ntaios, Adnan H Siddiqui, Elad I Levy
{"title":"Letter: Use of Andexanet Alfa Before Urgent Neurosurgical and Neurointerventional Procedures: An Unresolved Issue.","authors":"Senta Frol, Gustavo M Cortez, Janja Pretnar-Oblak, George Ntaios, Adnan H Siddiqui, Elad I Levy","doi":"10.1227/neu.0000000000003254","DOIUrl":"https://doi.org/10.1227/neu.0000000000003254","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1227/neu.0000000000003222
Milos Duba, Dagmar Al Tukmachi, Tetiana Samoilenko, Marek Vecera, Michaela Ruckova, Tereza Vankova, Lenka Radova, Milos Kerkovsky, Marek Dostal, Tereza Koprivova, Ivana Roskova, Andrej Mrlian, Ondrej Hrdy, Jaroslav Duba, Leos Kren, Martin Smrcka, Ondrej Slaby, Pavel Fadrus, Jiri Sana
Background and objectives: Meningioma, the most common primary intracranial tumor, presents challenges in surgical treatment because of varying tissue stiffness. This study explores the molecular background of meningioma stiffness, a critical factor in surgical planning and prognosis, focusing on the utility of microRNAs (miRNAs) as diagnostic biomarkers of tissue stiffness.
Methods: Patients with meningiomas treated surgically at the University Hospital Brno were included in this study. Total RNA, isolated from tumor tissue samples, underwent quality control and small RNA sequencing to analyze miRNA expression. Differentially expressed miRNAs were identified, and their association with tumor stiffness was assessed.
Results: This study identified specific miRNAs differentially expressed in meningiomas with different stiffness levels. Key miRNAs, such as miR-31-5p and miR-34b-5p, showed significant upregulation in stiffer meningiomas. These findings were validated using reverse transcription-quantitative polymerase chain reaction, revealing a potential link between miRNA expression and tumor consistency. The expression of miR-31-5p was most notably associated with the stiffness of the tumor tissue (sensitivity = 71% and specificity = 83%).
Conclusion: This research highlights the potential of miRNAs as biomarkers for determining meningioma tissue stiffness. Identifying specific miRNAs associated with tumor consistency could improve preoperative planning and patient prognosis. These findings pave the way for further exploration of miRNAs in the clinical assessment of meningiomas.
{"title":"MicroRNA Analysis in Meningiomas with Different Degrees of Tissue Stiffness: A Potential Tool for Effective Preoperative Planning.","authors":"Milos Duba, Dagmar Al Tukmachi, Tetiana Samoilenko, Marek Vecera, Michaela Ruckova, Tereza Vankova, Lenka Radova, Milos Kerkovsky, Marek Dostal, Tereza Koprivova, Ivana Roskova, Andrej Mrlian, Ondrej Hrdy, Jaroslav Duba, Leos Kren, Martin Smrcka, Ondrej Slaby, Pavel Fadrus, Jiri Sana","doi":"10.1227/neu.0000000000003222","DOIUrl":"https://doi.org/10.1227/neu.0000000000003222","url":null,"abstract":"<p><strong>Background and objectives: </strong>Meningioma, the most common primary intracranial tumor, presents challenges in surgical treatment because of varying tissue stiffness. This study explores the molecular background of meningioma stiffness, a critical factor in surgical planning and prognosis, focusing on the utility of microRNAs (miRNAs) as diagnostic biomarkers of tissue stiffness.</p><p><strong>Methods: </strong>Patients with meningiomas treated surgically at the University Hospital Brno were included in this study. Total RNA, isolated from tumor tissue samples, underwent quality control and small RNA sequencing to analyze miRNA expression. Differentially expressed miRNAs were identified, and their association with tumor stiffness was assessed.</p><p><strong>Results: </strong>This study identified specific miRNAs differentially expressed in meningiomas with different stiffness levels. Key miRNAs, such as miR-31-5p and miR-34b-5p, showed significant upregulation in stiffer meningiomas. These findings were validated using reverse transcription-quantitative polymerase chain reaction, revealing a potential link between miRNA expression and tumor consistency. The expression of miR-31-5p was most notably associated with the stiffness of the tumor tissue (sensitivity = 71% and specificity = 83%).</p><p><strong>Conclusion: </strong>This research highlights the potential of miRNAs as biomarkers for determining meningioma tissue stiffness. Identifying specific miRNAs associated with tumor consistency could improve preoperative planning and patient prognosis. These findings pave the way for further exploration of miRNAs in the clinical assessment of meningiomas.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1227/neu.0000000000003258
Neel H Mehta, Ruchit V Patel, Saksham Gupta, Harshit Arora, Noah L Nawabi, Rayha Karanth, Samantha Sadler, Lila Medeiros, Rohan Jha, Velina S Chavarro, Joshua D Bernstock, Timothy R Smith, Omar Arnaout
Background and objectives: Cerebellopontine angle (CPA) meningiomas present challenges given their proximity to neurovascular structures. Postoperative complications and persistent symptoms can debilitate patients, and our ability to predict recovery course remains variable. Here, we examine the presentation, management, and outcomes of patients with CPA meningiomas.
Methods: We retrospectively reviewed CPA meningiomas resected at Mass General Brigham, using descriptive statistics and logistic regression to identify predictors of progression or recurrence.
Results: In total, 95 patients were identified (median age 59.1 years, 82.1% female) who presented most commonly with hearing loss (49.5%), ataxia (42.1%), and headaches (29.5%). The retrosigmoid (78.9%) or transmastoid retrosigmoid (17.9%) approaches were most frequently used for resection, with gross total resection (GTR) achieved in 62.1% of patients: Simpson grade 1 (32.6%), grade 2 (17.9%), and grade 3 (11.6%). Smaller tumor size (t = 3.17, P = .002) is associated with GTR. For tumors with intracanalicular invasion, drilling the internal auditory canal (IAC) was also associated with GTR (χ2 = 21.8, P < .001). Among cases with invasion, GTR was achieved in 88.5% of cases when the IAC was drilled vs 11.8% of cases when the IAC was not drilled. The cranial nerve VII/VIII complex was frequently inferior (45.6%) or superior (19.1%) to the meningioma. Postoperative hearing loss was stable (38.7%) or improved (54.8%) in most of patients at the final clinical follow-up (median: 39.4 months). 25.3% of patients had progression/recurrence, with some difference between World Health Organization grade 1 (median: 3.0 years, IQR: 2.9 years) and World Health Organization grade 2 (median: 1.6 years, IQR: 2.8 years) tumors. After multivariate adjustment, Simpson grade I (P = .02), Simpson grade II (P = .01), or being of older age (P = .003) were associated with lower odds of progression/recurrence.
Conclusion: GTR remains critical to achieve optimal symptom control and reduce progression/recurrence rates for CPA meningiomas. Drilling the IAC is an important predictor of GTR in tumors with intracanalicular invasion.
{"title":"Cerebellopontine Angle Meningiomas: A Multi-Institutional Cohort Study.","authors":"Neel H Mehta, Ruchit V Patel, Saksham Gupta, Harshit Arora, Noah L Nawabi, Rayha Karanth, Samantha Sadler, Lila Medeiros, Rohan Jha, Velina S Chavarro, Joshua D Bernstock, Timothy R Smith, Omar Arnaout","doi":"10.1227/neu.0000000000003258","DOIUrl":"https://doi.org/10.1227/neu.0000000000003258","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cerebellopontine angle (CPA) meningiomas present challenges given their proximity to neurovascular structures. Postoperative complications and persistent symptoms can debilitate patients, and our ability to predict recovery course remains variable. Here, we examine the presentation, management, and outcomes of patients with CPA meningiomas.</p><p><strong>Methods: </strong>We retrospectively reviewed CPA meningiomas resected at Mass General Brigham, using descriptive statistics and logistic regression to identify predictors of progression or recurrence.</p><p><strong>Results: </strong>In total, 95 patients were identified (median age 59.1 years, 82.1% female) who presented most commonly with hearing loss (49.5%), ataxia (42.1%), and headaches (29.5%). The retrosigmoid (78.9%) or transmastoid retrosigmoid (17.9%) approaches were most frequently used for resection, with gross total resection (GTR) achieved in 62.1% of patients: Simpson grade 1 (32.6%), grade 2 (17.9%), and grade 3 (11.6%). Smaller tumor size (t = 3.17, P = .002) is associated with GTR. For tumors with intracanalicular invasion, drilling the internal auditory canal (IAC) was also associated with GTR (χ2 = 21.8, P < .001). Among cases with invasion, GTR was achieved in 88.5% of cases when the IAC was drilled vs 11.8% of cases when the IAC was not drilled. The cranial nerve VII/VIII complex was frequently inferior (45.6%) or superior (19.1%) to the meningioma. Postoperative hearing loss was stable (38.7%) or improved (54.8%) in most of patients at the final clinical follow-up (median: 39.4 months). 25.3% of patients had progression/recurrence, with some difference between World Health Organization grade 1 (median: 3.0 years, IQR: 2.9 years) and World Health Organization grade 2 (median: 1.6 years, IQR: 2.8 years) tumors. After multivariate adjustment, Simpson grade I (P = .02), Simpson grade II (P = .01), or being of older age (P = .003) were associated with lower odds of progression/recurrence.</p><p><strong>Conclusion: </strong>GTR remains critical to achieve optimal symptom control and reduce progression/recurrence rates for CPA meningiomas. Drilling the IAC is an important predictor of GTR in tumors with intracanalicular invasion.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1227/neu.0000000000003259
Giuseppe Corazzelli, Sergio Corvino, Maria Marvulli, Valentina Cioffi, Alessandro D'Elia, Vincenzo Meglio, Roberto Tafuto, Ciro Mastantuoni, Maria Rosaria Scala, Francesco Ricciardi, Salvatore Di Colandrea, Settimio Leonetti, Pasqualino De Marinis, Sergio Paolini, Vincenzo Esposito, Alfonso Fiorelli, Gualtiero Innocenzi, Oreste de Divitiis, Raffaele de Falco, Antonio Bocchetti
Background and objectives: The optimal surgical management of thoracic schwannomas (TSs) remains contentious, with various approaches proposed. Video-assisted thoracoscopic surgery (VATS) and combined VATS with neurosurgical procedures have shown promise, particularly for Eden type IV and III lesions. However, unanimous consent on the most effective surgical intervention and understanding of prognostic factors for tumor recurrence needs to be improved. The aim of this study was to elucidate the optimal surgical approach according to the Eden type and investigate predictive factors for TS recurrence.
Methods: This retrospective, multicentric, observational study analyzed 98 surgically treated patients with TS from 2011 to 2023, assessing preoperative and 6-month follow-up clinical (recurrences, pain, and myelopathy recovery) and surgical parameters (operative time, intraoperative blood loss, extent of resection). Surgical procedures included thoracic laminectomy or hemilaminectomy for type I, laminectomy or thoracic transpedicular (TPD) approach for type II, laminectomy alone or combined laminectomy with VATS for type III, and VATS or thoracotomy (open thoracotomy [OT]) for type IV. Descriptive and deductive analyses were conducted between and within the 4 cohorts, with multivariate analysis assessing the contribution of predictor variables.
Results: No significant differences were found between hemilaminectomy and laminectomy for all analyzed parameters for type I. Type II lesions treated with TPD exhibited similar outcomes to laminectomy, albeit with longer procedure times. Type III lesions benefited from combined approaches compared with neurosurgical-only approaches. Video-assisted thoracoscopic surgery emerged as more favorable than OT for type IV lesions. Multivariate analysis revealed that patient sex, tumor location, extent of resection, and pathology significantly influenced recurrence rates.
Conclusion: For Eden type III TSs, neurosurgical and VATS combined surgery achieved better outcomes than neurosurgery alone; for Eden type IV TSs, VATS achieved better results than OT. For Eden types I and II, hemilaminectomy and bilateral laminectomy and laminectomy and TPD achieved similar outcomes, respectively.
背景和目的:胸椎裂孔瘤(TSs)的最佳手术治疗方法仍存在争议,提出了多种方法。视频辅助胸腔镜手术(VATS)和联合 VATS 与神经外科手术已显示出前景,特别是对于伊甸园 IV 型和 III 型病变。然而,关于最有效的手术干预的一致意见以及对肿瘤复发预后因素的了解还有待提高。本研究旨在根据伊甸园类型阐明最佳手术方法,并调查 TS 复发的预测因素:这项回顾性、多中心、观察性研究分析了2011年至2023年接受手术治疗的98例TS患者,评估了术前和6个月随访的临床(复发、疼痛和脊髓病恢复)和手术参数(手术时间、术中失血量、切除范围)。手术方法包括:I型采用胸椎椎板切除术或半椎板切除术;II型采用椎板切除术或胸椎经椎管(TPD)方法;III型采用单独椎板切除术或与VATS联合椎板切除术;IV型采用VATS或开胸(开胸手术[OT])。在 4 个队列之间和队列内部进行了描述性和演绎性分析,并通过多变量分析评估了预测变量的作用:在所有分析参数中,半椎板切除术与椎板切除术在I型病变方面无明显差异。与单纯神经外科方法相比,联合方法对III型病变更有利。对于 IV 型病变,视频辅助胸腔镜手术比 OT 更为有利。多变量分析显示,患者性别、肿瘤位置、切除范围和病理学对复发率有显著影响:结论:对于伊甸园III型TS,神经外科和VATS联合手术比单独神经外科手术取得更好的疗效;对于伊甸园IV型TS,VATS手术比OT手术取得更好的疗效。对于伊甸园 I 型和 II 型 TS,半椎板切除术和双侧椎板切除术以及椎板切除术和 TPD 分别取得了相似的疗效。
{"title":"Comprehensive Surgical Management of Thoracic Schwannomas: A Retrospective Multicenter Study on 98 Lesions.","authors":"Giuseppe Corazzelli, Sergio Corvino, Maria Marvulli, Valentina Cioffi, Alessandro D'Elia, Vincenzo Meglio, Roberto Tafuto, Ciro Mastantuoni, Maria Rosaria Scala, Francesco Ricciardi, Salvatore Di Colandrea, Settimio Leonetti, Pasqualino De Marinis, Sergio Paolini, Vincenzo Esposito, Alfonso Fiorelli, Gualtiero Innocenzi, Oreste de Divitiis, Raffaele de Falco, Antonio Bocchetti","doi":"10.1227/neu.0000000000003259","DOIUrl":"https://doi.org/10.1227/neu.0000000000003259","url":null,"abstract":"<p><strong>Background and objectives: </strong>The optimal surgical management of thoracic schwannomas (TSs) remains contentious, with various approaches proposed. Video-assisted thoracoscopic surgery (VATS) and combined VATS with neurosurgical procedures have shown promise, particularly for Eden type IV and III lesions. However, unanimous consent on the most effective surgical intervention and understanding of prognostic factors for tumor recurrence needs to be improved. The aim of this study was to elucidate the optimal surgical approach according to the Eden type and investigate predictive factors for TS recurrence.</p><p><strong>Methods: </strong>This retrospective, multicentric, observational study analyzed 98 surgically treated patients with TS from 2011 to 2023, assessing preoperative and 6-month follow-up clinical (recurrences, pain, and myelopathy recovery) and surgical parameters (operative time, intraoperative blood loss, extent of resection). Surgical procedures included thoracic laminectomy or hemilaminectomy for type I, laminectomy or thoracic transpedicular (TPD) approach for type II, laminectomy alone or combined laminectomy with VATS for type III, and VATS or thoracotomy (open thoracotomy [OT]) for type IV. Descriptive and deductive analyses were conducted between and within the 4 cohorts, with multivariate analysis assessing the contribution of predictor variables.</p><p><strong>Results: </strong>No significant differences were found between hemilaminectomy and laminectomy for all analyzed parameters for type I. Type II lesions treated with TPD exhibited similar outcomes to laminectomy, albeit with longer procedure times. Type III lesions benefited from combined approaches compared with neurosurgical-only approaches. Video-assisted thoracoscopic surgery emerged as more favorable than OT for type IV lesions. Multivariate analysis revealed that patient sex, tumor location, extent of resection, and pathology significantly influenced recurrence rates.</p><p><strong>Conclusion: </strong>For Eden type III TSs, neurosurgical and VATS combined surgery achieved better outcomes than neurosurgery alone; for Eden type IV TSs, VATS achieved better results than OT. For Eden types I and II, hemilaminectomy and bilateral laminectomy and laminectomy and TPD achieved similar outcomes, respectively.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1227/neu.0000000000003243
Basel Musmar, Joanna M Roy, Hammam Abdalrazeq, Anand Kaul, Elias Atallah, Kareem El Naamani, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan A Grossberg, Adam A Dmytriw, Aman B Patel, Mirhojjat Khorasanizadeh, Christopher S Ogilvy, Ajith J Thomas, Andre Monteiro, Adnan Siddiqui, Gustavo M Cortez, Ricardo A Hanel, Guilherme Porto, Alejandro M Spiotta, Anthony J Piscopo, David M Hasan, Mohammad Ghorbani, Joshua Weinberg, Shahid M Nimjee, Kimon Bekelis, Mohamed M Salem, Jan-Karl Burkhardt, Akli Zetchi, Charles Matouk, Brian M Howard, Rosalind Lai, Rose Du, Rawad Abbas, Georgios S Sioutas, Abdelaziz Amllay, Alfredo Munoz, Nabeel A Herial, Stavropoula I Tjoumakaris, Michael Reid Gooch, Robert H Rosenwasser, Pascal Jabbour
Background and objectives: Moyamoya disease (MMD) is characterized by progressive steno-occlusion of the internal carotid arteries, leading to compensatory collateral vessel formation. The optimal surgical approach for MMD remains debated, with bilateral revascularization potentially offering more comprehensive protection but involving more extensive surgery compared to unilateral revascularization. This study aims to compare bilateral revascularization and unilateral revascularization short-term safety profile in the treatment of MMD.
Methods: This multicenter retrospective study included patients with MMD who underwent surgical revascularization at 13 academic institutions. Patients were categorized into unilateral and bilateral revascularization groups. Data collected included demographics, clinical characteristics, and outcomes. Propensity score matching was used to balance baseline characteristics. Statistical analyses were conducted using Stata (V.17.0; StataCorp).
Results: A total of 497 patients were included, including 90 who had bilateral revascularization and 407 who had unilateral revascularization. Bilateral revascularization was associated with more perioperative asymptomatic strokes (10% vs 2.4%; odds ratio [OR] 4.41, 95% CI 1.73 to 11.19, P = .002) and higher rates of excellent functional outcomes (modified Rankin Scale 0-1) at discharge (92.2% vs 79.1%; OR 3.12, 95% CI 1.39 to 7, P = .006). After propensity score matching, 57 matched pairs were analyzed. There was a higher rate, though not statistically significant difference, of perioperative stroke in the bilateral revascularization group (15.7% vs 8.7%; OR 1.95, 95% CI 0.61 to 6.22, P = .26). No significant differences were noted in modified Rankin scale 0 to 1 and 0 to 2 scores at discharge, National Institute of Health Stroke Scale at discharge, intraoperative complications, or length of hospital stay. The follow-up stroke rates were also not significantly different (OR 0.40, 95% CI 0.11 to 1.39, P = .15).
Conclusion: This study found no significant differences between bilateral and unilateral revascularization in MMD. Patients who had bilateral revascularization had higher tendency of perioperative stroke, though not statistically significant. Further prospective studies are needed to validate these results.
背景和目的:莫亚莫亚病(MMD)的特点是颈内动脉进行性狭窄闭塞,导致代偿性侧支血管形成。治疗 MMD 的最佳手术方法仍存在争议,双侧血管重建术可能提供更全面的保护,但与单侧血管重建术相比,需要进行更广泛的手术。本研究旨在比较双侧血管重建术和单侧血管重建术治疗多发性硬化症的短期安全性:这项多中心回顾性研究纳入了在 13 家学术机构接受手术血管重建的 MMD 患者。患者被分为单侧和双侧血管重建组。收集的数据包括人口统计学、临床特征和结果。采用倾向评分匹配法平衡基线特征。统计分析使用Stata(V.17.0;StataCorp)进行:结果:共纳入497例患者,其中90例为双侧血管再通,407例为单侧血管再通。双侧血管再通与更多的围手术期无症状中风(10% vs 2.4%;比值比 [OR] 4.41,95% CI 1.73 至 11.19,P = .002)和更高的出院时优良功能预后率(改良 Rankin 量表 0-1)相关(92.2% vs 79.1%;比值比 3.12,95% CI 1.39 至 7,P = .006)。经过倾向评分匹配后,对 57 对匹配者进行了分析。双侧血管重建组围手术期中风发生率较高,但差异无统计学意义(15.7% vs 8.7%; OR 1.95, 95% CI 0.61 to 6.22, P = .26)。在出院时改良 Rankin 量表 0 至 1 级和 0 至 2 级评分、出院时美国国立卫生研究院卒中量表、术中并发症或住院时间方面无明显差异。随访卒中发生率也无明显差异(OR 0.40,95% CI 0.11 至 1.39,P = .15):结论:本研究发现,在 MMD 患者中,双侧血管再通与单侧血管再通之间没有明显差异。结论:本研究发现,双侧和单侧血管再通在 MMD 患者中无明显差异,但双侧血管再通患者围术期中风的发生率较高,但无统计学意义。需要进一步的前瞻性研究来验证这些结果。
{"title":"Comparative Outcomes of Unilateral vs Bilateral Revascularization in Moyamoya Disease: A Multicenter Retrospective Study.","authors":"Basel Musmar, Joanna M Roy, Hammam Abdalrazeq, Anand Kaul, Elias Atallah, Kareem El Naamani, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan A Grossberg, Adam A Dmytriw, Aman B Patel, Mirhojjat Khorasanizadeh, Christopher S Ogilvy, Ajith J Thomas, Andre Monteiro, Adnan Siddiqui, Gustavo M Cortez, Ricardo A Hanel, Guilherme Porto, Alejandro M Spiotta, Anthony J Piscopo, David M Hasan, Mohammad Ghorbani, Joshua Weinberg, Shahid M Nimjee, Kimon Bekelis, Mohamed M Salem, Jan-Karl Burkhardt, Akli Zetchi, Charles Matouk, Brian M Howard, Rosalind Lai, Rose Du, Rawad Abbas, Georgios S Sioutas, Abdelaziz Amllay, Alfredo Munoz, Nabeel A Herial, Stavropoula I Tjoumakaris, Michael Reid Gooch, Robert H Rosenwasser, Pascal Jabbour","doi":"10.1227/neu.0000000000003243","DOIUrl":"https://doi.org/10.1227/neu.0000000000003243","url":null,"abstract":"<p><strong>Background and objectives: </strong>Moyamoya disease (MMD) is characterized by progressive steno-occlusion of the internal carotid arteries, leading to compensatory collateral vessel formation. The optimal surgical approach for MMD remains debated, with bilateral revascularization potentially offering more comprehensive protection but involving more extensive surgery compared to unilateral revascularization. This study aims to compare bilateral revascularization and unilateral revascularization short-term safety profile in the treatment of MMD.</p><p><strong>Methods: </strong>This multicenter retrospective study included patients with MMD who underwent surgical revascularization at 13 academic institutions. Patients were categorized into unilateral and bilateral revascularization groups. Data collected included demographics, clinical characteristics, and outcomes. Propensity score matching was used to balance baseline characteristics. Statistical analyses were conducted using Stata (V.17.0; StataCorp).</p><p><strong>Results: </strong>A total of 497 patients were included, including 90 who had bilateral revascularization and 407 who had unilateral revascularization. Bilateral revascularization was associated with more perioperative asymptomatic strokes (10% vs 2.4%; odds ratio [OR] 4.41, 95% CI 1.73 to 11.19, P = .002) and higher rates of excellent functional outcomes (modified Rankin Scale 0-1) at discharge (92.2% vs 79.1%; OR 3.12, 95% CI 1.39 to 7, P = .006). After propensity score matching, 57 matched pairs were analyzed. There was a higher rate, though not statistically significant difference, of perioperative stroke in the bilateral revascularization group (15.7% vs 8.7%; OR 1.95, 95% CI 0.61 to 6.22, P = .26). No significant differences were noted in modified Rankin scale 0 to 1 and 0 to 2 scores at discharge, National Institute of Health Stroke Scale at discharge, intraoperative complications, or length of hospital stay. The follow-up stroke rates were also not significantly different (OR 0.40, 95% CI 0.11 to 1.39, P = .15).</p><p><strong>Conclusion: </strong>This study found no significant differences between bilateral and unilateral revascularization in MMD. Patients who had bilateral revascularization had higher tendency of perioperative stroke, though not statistically significant. Further prospective studies are needed to validate these results.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1227/neu.0000000000003252
Kathryn N Kearns, Kristina P Kurker, Alexandria C Marino, Patricia Zhao, Purushotham Ramanathan, Mark E Shaffrey, John A Jane, Min S Park
Background and objectives: Women represent ∼20% of the national neurosurgical resident cohort but only ∼10% of academic neurosurgeons in the United States. Recognizing that the publication of scientific literature contributes to academic advancement, we measured authorship trends of academic neurosurgeons to query publication differences as an explanation for the discrepancy of female representation in academic positions.
Methods: Physician data were obtained from program and individual physician webpages. Annual total, first author, and senior author publications were recorded for each neurosurgeon from 1980 to 2020. Mean publication number as a function of the year relative to residency graduation was calculated for all, first author, and senior author publications for all timepoints with >50 individuals. The mean first years of publication were compared using unpaired 2-tailed t-tests. The slope of publication for the senior author and all publications was calculated using individual best-fit lines from years 0 to 10 relative to residency graduation.
Results: Overall, 1601 faculty members were evaluated (female = 167 [10.4%], male = 1434 [89.6%]). First-author publication for female members peaked at 0.60 publications/year, and for male members at 0.80 publications/year, both at -1 year from graduation (P = .038). Female first publication occurred earlier (-2.4 vs 1.45 years; P < .00001). The mean increase in all publications/year from years 0 to 10 was 0.25 for women and 0.28 for men (P = .68). The increase in senior publications/year was 0.11 for women and 0.13 for men (P = .39). The ratio of total publications to the Scopus h-index was 3.08 for women and 3.62 for men (P = .07).
Conclusion: These data suggest that women publish earlier but have fewer first-author publications at -1 year, the timepoint of peak publication for both genders. There was no significant gender difference in rates of the first author and all publications over the years 0 to 10. The ratio of publications to the h-index did not differ significantly but showed a trend suggesting that women produce higher-impact articles and may need fewer publications to achieve the same change in the h-index.
{"title":"Academic Neurosurgery Gender and Authorship Trends in the United States.","authors":"Kathryn N Kearns, Kristina P Kurker, Alexandria C Marino, Patricia Zhao, Purushotham Ramanathan, Mark E Shaffrey, John A Jane, Min S Park","doi":"10.1227/neu.0000000000003252","DOIUrl":"https://doi.org/10.1227/neu.0000000000003252","url":null,"abstract":"<p><strong>Background and objectives: </strong>Women represent ∼20% of the national neurosurgical resident cohort but only ∼10% of academic neurosurgeons in the United States. Recognizing that the publication of scientific literature contributes to academic advancement, we measured authorship trends of academic neurosurgeons to query publication differences as an explanation for the discrepancy of female representation in academic positions.</p><p><strong>Methods: </strong>Physician data were obtained from program and individual physician webpages. Annual total, first author, and senior author publications were recorded for each neurosurgeon from 1980 to 2020. Mean publication number as a function of the year relative to residency graduation was calculated for all, first author, and senior author publications for all timepoints with >50 individuals. The mean first years of publication were compared using unpaired 2-tailed t-tests. The slope of publication for the senior author and all publications was calculated using individual best-fit lines from years 0 to 10 relative to residency graduation.</p><p><strong>Results: </strong>Overall, 1601 faculty members were evaluated (female = 167 [10.4%], male = 1434 [89.6%]). First-author publication for female members peaked at 0.60 publications/year, and for male members at 0.80 publications/year, both at -1 year from graduation (P = .038). Female first publication occurred earlier (-2.4 vs 1.45 years; P < .00001). The mean increase in all publications/year from years 0 to 10 was 0.25 for women and 0.28 for men (P = .68). The increase in senior publications/year was 0.11 for women and 0.13 for men (P = .39). The ratio of total publications to the Scopus h-index was 3.08 for women and 3.62 for men (P = .07).</p><p><strong>Conclusion: </strong>These data suggest that women publish earlier but have fewer first-author publications at -1 year, the timepoint of peak publication for both genders. There was no significant gender difference in rates of the first author and all publications over the years 0 to 10. The ratio of publications to the h-index did not differ significantly but showed a trend suggesting that women produce higher-impact articles and may need fewer publications to achieve the same change in the h-index.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1227/neu.0000000000003239
Salem M Tos, Georgios Mantziaris, Ahmed Shaaban, Stylianos Pikis, Chloe Dumot, Jason P Sheehan
Background and objectives: Better local control but higher rates of adverse radiation events (ARE) have been reported when combining American Society for Radiation Oncology (ASTRO)-guideline-suggested dose (SD) stereotactic radiosurgery (SRS) with immunotherapy or targeted therapy for melanoma brain metastases. The objective of this study is to explore the efficacy and safety of lower prescription doses compared with ASTRO guidelines for single-fraction SRS for patients with melanoma metastases who are concurrently receiving immunotherapy or targeted therapy.
Methods: We conducted a retrospective, single-center study on 194 patients who underwent SRS between 2009 and 2022. After propensity score matching, 71 patients with 292 metastases were included in the ASTRO-SD (20-24 Gy for <2 cm, 18 Gy for ≥2 to <3 cm) group and 33 patients with 292 metastases in the reduced dose (RD, <20 Gy for <2 cm, <18 Gy for ≥2 to <3 cm) group.
Results: The median diameter (5.4 vs 5.2 mm, P = .6), prescription volume (0.2 vs 0.2 cm3, P = .2), and radiographic follow-up (11 vs 12 months, P = .2) were similar in the 2 groups. The cumulative incidence of progressing metastases was significantly higher in the SD compared with the RD group (P = .018). Higher prescription volumes and ASTRO-suggested radiation doses were associated with local progression in multivariable analysis. Radiographic AREs were significantly more common in the SD compared with the RD group (8.6% vs 3.1%, P = .005). BRAF and other tyrosine kinase inhibitors' concurrent use, higher prescription volumes, and ASTRO-suggested radiation doses were associated with an increased risk of radiographic ARE.
Conclusion: This study provides evidence that RD SRS could offer reduced toxicity rates, while maintaining high local control as compared with the current guideline-SDs for the treatment of melanoma brain metastases.
{"title":"Stereotactic Radiosurgery Dose Reduction for Melanoma Brain Metastases Patients on Immunotherapy or Target Therapy: A Single-Center Experience.","authors":"Salem M Tos, Georgios Mantziaris, Ahmed Shaaban, Stylianos Pikis, Chloe Dumot, Jason P Sheehan","doi":"10.1227/neu.0000000000003239","DOIUrl":"https://doi.org/10.1227/neu.0000000000003239","url":null,"abstract":"<p><strong>Background and objectives: </strong>Better local control but higher rates of adverse radiation events (ARE) have been reported when combining American Society for Radiation Oncology (ASTRO)-guideline-suggested dose (SD) stereotactic radiosurgery (SRS) with immunotherapy or targeted therapy for melanoma brain metastases. The objective of this study is to explore the efficacy and safety of lower prescription doses compared with ASTRO guidelines for single-fraction SRS for patients with melanoma metastases who are concurrently receiving immunotherapy or targeted therapy.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center study on 194 patients who underwent SRS between 2009 and 2022. After propensity score matching, 71 patients with 292 metastases were included in the ASTRO-SD (20-24 Gy for <2 cm, 18 Gy for ≥2 to <3 cm) group and 33 patients with 292 metastases in the reduced dose (RD, <20 Gy for <2 cm, <18 Gy for ≥2 to <3 cm) group.</p><p><strong>Results: </strong>The median diameter (5.4 vs 5.2 mm, P = .6), prescription volume (0.2 vs 0.2 cm3, P = .2), and radiographic follow-up (11 vs 12 months, P = .2) were similar in the 2 groups. The cumulative incidence of progressing metastases was significantly higher in the SD compared with the RD group (P = .018). Higher prescription volumes and ASTRO-suggested radiation doses were associated with local progression in multivariable analysis. Radiographic AREs were significantly more common in the SD compared with the RD group (8.6% vs 3.1%, P = .005). BRAF and other tyrosine kinase inhibitors' concurrent use, higher prescription volumes, and ASTRO-suggested radiation doses were associated with an increased risk of radiographic ARE.</p><p><strong>Conclusion: </strong>This study provides evidence that RD SRS could offer reduced toxicity rates, while maintaining high local control as compared with the current guideline-SDs for the treatment of melanoma brain metastases.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1227/neu.0000000000003213
Sunny Abdelmageed, Prottusha Sarkar, Nathan A Shlobin, Daniel G Davila, Matthew B Potts
Background and objectives: The most common treatment of hydrocephalus is ventriculoperitoneal (VP) shunting. Peritoneal access is commonly conducted through an open laparotomy, but laparoscopic peritoneal access is gaining popularity. Many studies have reported the benefits of minimally invasive laparoscopic peritoneal access, but there is no consensus on its use. We conducted a systematic review and meta-analysis to compare open laparotomy vs laparoscopic peritoneal access in VP shunting.
Methods: A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 3 databases. Twelve studies included only adults, 3 included only pediatric patients, and 3 included both adults and pediatric patients.
Results: Compared with open laparotomy, laparoscopic peritoneal access was associated with a reduction in distal shunt failure (6.1% vs 2.2%, P = .01), operative time (69.4 vs 56.3 minutes, P < .001), and length of stay (LOS) (9.6 vs 7.3 days, P < .001). There were no differences in proximal shunt failure, total shunt failure, intraoperative complications, or infection rate. In the pediatric population, laparoscopic access was associated with a reduced LOS (7.8 vs 5.9 days, P < .001). Heterogeneity was high but explained by the varying study populations and techniques.
Conclusion: Laparoscopic peritoneal access for VP shunt insertion is associated with improved outcomes, including reduced distal shunt failure, reduced operative time, and reduced hospital LOS, when compared with open laparotomy and should be considered for shunt insertion. Additional studies are necessary to further determine the benefit of laparoscopic access, especially in the pediatric population.
背景和目的:脑积水最常见的治疗方法是脑室腹腔分流术(VP)。腹膜入路通常通过开腹手术进行,但腹腔镜腹膜入路正越来越受欢迎。许多研究报告了微创腹腔镜腹膜入路的好处,但对其使用还没有达成共识。我们进行了一项系统性回顾和荟萃分析,比较开腹手术与腹腔镜腹膜入路在 VP 分流中的应用:方法:根据《系统综述和荟萃分析首选报告项目》指南,我们使用 3 个数据库进行了系统检索。12项研究仅包括成人患者,3项研究仅包括儿童患者,3项研究同时包括成人和儿童患者:结果:与开腹手术相比,腹腔镜腹膜入路可减少远端分流失败(6.1% vs 2.2%,P = .01)、手术时间(69.4 分钟 vs 56.3 分钟,P < .001)和住院时间(LOS)(9.6 天 vs 7.3 天,P < .001)。在近端分流失败、总分流失败、术中并发症或感染率方面没有差异。在儿童患者中,腹腔镜入路可缩短患者的住院时间(7.8 天 vs 5.9 天,P < .001)。异质性很高,但研究人群和技术的不同可以解释这一点:结论:与开腹手术相比,腹腔镜腹膜入路插入VP分流管可改善预后,包括减少分流管远端失败、缩短手术时间和缩短住院时间,因此应考虑将腹腔镜腹膜入路用于插入分流管。有必要进行更多研究,以进一步确定腹腔镜入路的益处,尤其是在儿科人群中。
{"title":"Laparoscopic-Assisted Peritoneal Access in Ventriculoperitoneal Shunt Placement: Systematic Review and Meta-Analysis.","authors":"Sunny Abdelmageed, Prottusha Sarkar, Nathan A Shlobin, Daniel G Davila, Matthew B Potts","doi":"10.1227/neu.0000000000003213","DOIUrl":"https://doi.org/10.1227/neu.0000000000003213","url":null,"abstract":"<p><strong>Background and objectives: </strong>The most common treatment of hydrocephalus is ventriculoperitoneal (VP) shunting. Peritoneal access is commonly conducted through an open laparotomy, but laparoscopic peritoneal access is gaining popularity. Many studies have reported the benefits of minimally invasive laparoscopic peritoneal access, but there is no consensus on its use. We conducted a systematic review and meta-analysis to compare open laparotomy vs laparoscopic peritoneal access in VP shunting.</p><p><strong>Methods: </strong>A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 3 databases. Twelve studies included only adults, 3 included only pediatric patients, and 3 included both adults and pediatric patients.</p><p><strong>Results: </strong>Compared with open laparotomy, laparoscopic peritoneal access was associated with a reduction in distal shunt failure (6.1% vs 2.2%, P = .01), operative time (69.4 vs 56.3 minutes, P < .001), and length of stay (LOS) (9.6 vs 7.3 days, P < .001). There were no differences in proximal shunt failure, total shunt failure, intraoperative complications, or infection rate. In the pediatric population, laparoscopic access was associated with a reduced LOS (7.8 vs 5.9 days, P < .001). Heterogeneity was high but explained by the varying study populations and techniques.</p><p><strong>Conclusion: </strong>Laparoscopic peritoneal access for VP shunt insertion is associated with improved outcomes, including reduced distal shunt failure, reduced operative time, and reduced hospital LOS, when compared with open laparotomy and should be considered for shunt insertion. Additional studies are necessary to further determine the benefit of laparoscopic access, especially in the pediatric population.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}