World neurosurgery最新文献

Introduction: Firearm-related traumatic brain injuries (FR-TBIs) pose a public health crisis in the United States (U.S.) and Mexico. We sought to characterize firearm-related traumatic brain injuries in a Level 1 trauma center near the United States-Mexico border.

Methods: A retrospective cohort review was performed of patients who presented at a Level 1 trauma center near the U.S.-Mexico border from 2010-2023 and were diagnosed with FR-TBI. Patients were excluded if they were under eighteen years or did not have an acute TBI diagnosis on admission. Demographic, clinical, and radiographic information including injury characteristics, surgical interventions, and clinical and hospital outcomes was collected. Statistical analyses were performed using StataMP version 18.0.

Results: Eighty-four patients were identified (67 United States, 17 Mexico). Median age was 34 years, with 85.7% male patients and 44.0% Hispanic patients. Median Glasgow Coma Scale on admission was 3 (IQR [3.0, 9.3]). TBIs included intraparenchymal hemorrhage/contusion (n=49), epidural hematoma (n=9), subarachnoid hemorrhage (n=52), and subdural hematoma (n=48). Fourteen patients required intracranial pressure monitoring and 18 underwent neurosurgical operative interventions. Patients from Mexico had lower mortality rate (p=0.015), longer hospital length of stay (p=0.001), and higher median total hospital charges (p<0.001).

Conclusions: This study reveals disparities in hospital stay and hospital charges in patients from Mexico with FR-TBI compared to U.S.

Patients: Our findings underscore the growing burden of firearm-related traumatic brain injuries on the Mexico on U.S. healthcare systems. Future research should further explore why these disparities exist and focus on pre-hospital factors.

The surgery of skull base epidermoid cysts can be challenging because of their intracerebral extensions and the encasement of cranial nerves and internal carotid artery (ICA) branches^1-3. Advances in magnetic resonance imaging, particularly tractography, may help to visualize the trajectory of displaced cranial nerves^4,5, and thus reduce the surgical risks. We report here the case of a 59-year-old woman who presented diplopia, left ataxia, and cognitive impairment, which revealed a large right skull-base epidermoid cyst with infra, supra, and latero sellar extensions. The optic chiasma was pushed superiorly, and the oculomotor nerves were unidentifiable within the tumor. The ICA termination was stretched by the tumor as well as the first segment (M1) of the middle cerebral artery (MCA). Tractography was used to identify the position of the optic, oculomotor and trigeminal nerves, which were encased within the tumor. A trans-sylvian approach allowed to reach the tumor components using interoptic, opticocarotid, and laterocarotid triangles. This "multiple window" method gave access to the majority of the tumor's supratentorial component, which was removed using various size suction. Mirrors were useful to enhance the resection. Finally, a near-total removal of the tumor was achieved including the decompression of the brainstem, cranial nerves and vessels. The capsule was kept in place to preserve critical anatomical structures; however, it should be removed when possible depending on tumor configuration. The patient, who consented to the procedure and to the publication of her images, recovered within a few days.

Objective: Patients undergoing glioma resection are at high risk for venous thromboembolism (VTE), making early diagnosis and prevention critical. This retrospective single-institutional cohort analysis investigated the incidence of VTE on postoperative day (POD) 1 after diffuse glioma resection, screening effectiveness of plasma soluble fibrin monomer complex (SFMC) and D-dimer levels, and management outcomes.

Methods: A total of 81 patients who underwent diffuse glioma resection at our institution from 2021 to 2023 were analyzed. VTE was screened by D-dimer and SFMC levels on POD1 and diagnosed by enhanced computed tomography of the chest, abdomen, and lower extremities. Patients with asymptomatic VTE were managed with mechanical prevention, followed by anticoagulation therapy 1 week after craniotomy.

Results: Of the 81 patients, 33 (40.7%) were diagnosed with VTE; 31 were asymptomatic. D-dimer, SFMC, and their combination had positive predictive values of 83%, 68%, and 69%, respectively. SFMC measurement did not improve D-dimer false positives. Among 12 patients with false-negative D-dimer results, SFMC identified VTE in 3; all 3 had glioblastoma with 9 having other than glioblastoma. No asymptomatic cases progressed to symptomatic VTE.

Conclusion: Asymptomatic VTE frequently developed on POD1 after diffuse glioma resection, but early diagnosis prevented progression. SFMC levels can improve VTE detection in glioblastoma patients.

Objective: To explore the application effect of a telemedicine method supported by a digital rehabilitation platform for patients with cognitive impairment after spontaneous cerebral hemorrhage.

Method: Eighty eligible patients were enrolled in the current study from May 2023 to November 2024, with 40 patients each in the experimental and control groups. Both groups received the same routine treatment. In addition, the control group was given mobile intelligent devices and trained by the same nurses on how to perform the rehabilitation exercises. The experimental group was instructed on the precise treatment offered by the digital rehabilitation platform.

Result: The HAMA 14, HAMD 24, MoCA, MMSE, and modified Barthel score between the two groups were comparable at the time of enrollment. All indicators at the observation endpoint of the experimental and control groups (HAMA 14, HAMD 24, MoCA, MMSE, modified Barthel score, and patient satisfaction) were better than at the time of enrollment (intra-group). These indicators in the experimental group were better at the observation endpoint that the control group.

Conclusion: The telemedicine medical care based on a digital rehabilitation platform achieved individualized, convenient, effective, and satisfactory rehabilitation feeling for spontaneous cerebral hemorrhage patients with concurrent cognitive impairment.

Low back pain and its different clinical varieties of presentation continue to be a very prevalent disease in the general population. Lumbar Spinal Stenosis affects about 50% of the population over 60 years of age and neurogenic claudication is described among its clinical characteristics. The classic description of neurogenic claudication is often attributed to Jean Jules Dejerine in 1911. However, this description corresponds to another symptomatology and disease. In his classic presentation, he describes Intermittent Claudication of the Spinal Cord as a spinal cord syndrome associated with spasmodic (spastic) paraplegia. He first presents the clinical case of a 37-year-old patient who consulted for having a sensation of weight and sudden weakness in the left leg that appears only after walking a certain distance. The osteotendinous reflexes are increased, the plantar response is extensor (Babinski and Oppenheim positive) and is accompanied by alteration in the urinary and fecal sphincters (retention). Dejerine describes that the cause of Intermittent Claudication of the Spinal Cord is syphilitic myelitis. The aim of this paper is to present a historical review of the classic Dejerine study and to differentiate the description made in his article (Intermittent Claudication of the Spinal Cord) from the one that is currently clinically associated with LSS.

Background: Raised intracranial pressure can have devastating consequences on mortality and outcome after acute brain injury. Decompressive craniectomy (DC) is an established surgical procedure for controlling refractory intracranial hypertension, though this requires subsequent cranioplasty. Expansive craniotomy (EC) techniques, where the bone flap is returned but only partially fixed in place, have been developed to avoid the need for cranioplasty. However, comparative safety and efficacy is not well-defined.

Methods: A systematic review to identify studies comparing EC to DC was performed in accordance with PRISMA guidelines, including all study types except systematic/scoping reviews. Meta-analysis was performed for three outcomes (mortality, acute reoperation rate, and Glasgow Outcome Scale (GOS)).

Results: 29 studies met the inclusion criteria, and are summarised in narrative review. Eight studies were included in meta-analysis: two randomised controlled trials (RCT) and six case-control studies. Meta-analysis found no significant difference in mortality. EC was associated with improved GOS (mean difference 0.44, p < 0.05), though this may be attributable to selection bias. There was a marginal increase in early additional surgery rates associated with EC (risk difference 0.08, p = 0.05). Risk of bias was moderate to high across included studies.

Conclusions: Current evidence cannot robustly inform clinical decision-making on the use of EC. Based upon reports of success of EC, EC appears to be a valid alternative to DC in selected cases, though greater acute reoperation rates owing to inadequate decompression is a risk. Overall there is strong support for an appropriately-powered RCT to robustly evaluate EC.