Neurology India最新文献

Background: Over 2/3rd of strokes are caused by carotid artery disease (CAD). Be it symptomatic or asymptomatic patients, the role of carotid artery stenting (CAS) in carotid artery disease is well established. Data on the effect of morphology on the CAS outcomes are limited. In addition, there are limited Indian data on the long-term outcomes of this procedure. This study attempted to address this data deficiency.

Objective: To determine the effect of the morphological types of carotid artery lesions like soft stenosis, soft plaque, and ulcerative and total obstruction on the long-term follow-up of patients who underwent CAS.

Materials and methods: This was a single-center retrospective study conducted at a tertiary care facility. In total, 116 patients underwent CAS between 2000 and 2017. The mean follow-up period was 4.5 years. Stenosis was quantified using the North American Symptomatic Carotid Endarterectomy Trial. Long-term outcomes such as all-cause mortality and stroke (Major and Minor) were recorded.

Results: Among the 116 patients with CAS, 31.03% (36) were asymptomatic and 68.97% (80) were symptomatic. The various symptoms included motor weakness in 50 (43.1%) patients, loss of consciousness in 8 (6.9%), amaurosis in 9 (7.7%), giddiness in 6 (5.2%), dysarthria in 5 (4.3%), and headache in 2 (1.7%). Post CAS, the first 30 days mortality was 0.86% (one death), and stroke was 1.72% (two major strokes). A total of 53 (45.7%) patients had soft stenosis, 57 (49.13%) had ulcerated plaques, 5 (4.31%) had soft plaques, and 1 (0.86%) had total occlusion. Long-term follow-up (69% follow-up) showed a mortality rate of 17.5% (14 deaths) and stroke of 5% (4 major strokes).

Conclusions: CAS is an effective treatment modality for symptomatic and asymptomatic CAD. Almost all the stroke patients had ulcerated plaque and soft stenosis with worst outcomes compared to soft plaque/total occlusion. The long-term all-cause mortality and incidence of major stroke were comparable to those of carotid endarterectomy.

Objective: Robot-assisted spine surgery is expected to become increasingly common in the future as advancements in technology allow for even greater precision and efficiency. We share our experience with using the Excelsius global positioning system (GPS) spine surgical robot in spine surgery.

Methods: We analyzed 100 patients who underwent robotic-assisted transforaminal interbody fusion at our hospital. Demographic details, pedicle screw accuracy, and cranial facet joint violation were evaluated. Gretzbein Robbins classification was used for pedicle screw accuracy, and Yson classification was used to assess facet joint violation.

Results: A total of 424 screws were placed in 100 patients with robotic assistance. We found accuracy with robotic assistance was 98.10% and the grades 1 and 2 facet joint violation rates as 16.5% and 0%.

Conclusion: Adding to the expanding body of knowledge on robotic-assisted spine surgery, sharing our early experience and useful tips and techniques will inspire other surgeons to embrace this cutting-edge technology for better patient care.

Background and objective: The aim was to investigate reasons for a pre-hospital delay in patients with acute ischemic stroke (AIS) and patients within the thrombolytic window who did not receive thrombolysis.

Subjects and methods: This study was conducted on AIS patients admitted to the stroke center through interviews and questionnaires.

Results: Of the 160 consecutive patients included, 67 (41.9%) arrived at the emergency department (ED) within 4.5 h, and 93 (58.1%) were delayed. The early arrival patients had shorter median onset-to-arrival times (P < 0.001). Of the 93 delayed patients, 70 (75.3%) were unaware of the occurrence of a stroke, and 17 (18.3%) had the stroke onset during sleeping. Multivariate logistic regression analysis showed that private car [odds ratio (OR) 4.310, 95% confidence interval (CI) 1.732-10.728] and other traffic tools (OR 6.189, 95%CI 1.843-20.786) were independent of a delayed arrival, whereas symptomatic remission, symptomatic aggravation, education of stroke, and the Oxfordshire Community Stroke Project classification were independently related to early arriving at the hospital after a stroke. Of the 67 patients, 33 (49.3%) who arrived within the window time did not receive thrombolytic therapy. Except for minor stroke (n = 9/27.3%) and contradictions (n = 2/6.1%), the main reasons for pre-hospital delay were patients' refusal (n = 12/36.4%) and misdiagnosis on the part of the physician due to atypical symptoms (n = 4/12.1%).

Conclusions: Lack of stroke education, symptom stabilization, and non-emergency medical system utilization were the main reasons for the pre-hospital delay. Patients' refusal and misdiagnosis were the main reasons of patients who were eligible for thrombolytic treatment but did not finally receive thrombolysis.

Background: Microscopic transoral approach (TOA) has been considered as the gold standard for anterior decompression of the cranio-vertebral junction (CVJ). The progress in endonasal endoscopic procedures has made it possible to perform odontoidectomy via a minimally invasive transnasal route.

Objective: The aim is to critically analyze our cases of odontoid subluxation and those described in the literature that were treated by the endonasal endoscopic odontoidectomy (EEA).

Methods: Seven consecutive patients that failed conservative treatment and other surgical procedures of atlanto-axial dislocation, were managed surgically by endonasal endoscopic odontoidectomy at our institution. There were 4 patients with basilar invagination, Chiari malformation, and atlanto-axial dislocation, and one patient each with a tumor of the odontoid process, retropharyngeal abscess, and osteomyelitis.

Results: None of our patients developed velopharyngeal insufficiency, respiratory distress, speech disturbances, or CSF leak after surgery. Transoral odontoidectomy, tracheostomy, gastrostomy, or prolonged ventilation was not required in any patients. One patient developed transient swallowing difficulty postoperatively which improved after a few weeks.

Conclusions: The endonasal endoscopic odontoidectomy is a safe and effective procedure for patients with non-reducible atlanto-axial dislocation. The technique allows optimal viewing when using angulated instruments and angled endoscopes.