World neurosurgery最新文献

Background: Increased systemic bone mineral density has been reported in patients with ossification of the posterior longitudinal ligament (OPLL). This study investigated the differences in vertebral Hounsfield unit (HU) values between the bridged and nonbridged groups of patients with OPLL of the cervical spine at the ossification-related segments.

Methods: A total of 436 ossification-related segments from 157 patients were involved in the study. X-ray and computed tomography scans were used to assess the segmental cervical range of motion (ROM), C2-7 Cobb angle, K-line, ossification thickness, maximum canal occupancy, HU values, and presence and type of OPLL.

Results: In terms of imaging parameters, HU values were significantly higher in the OPLL group (P < 0.001), whereas the ROM was greater in the control group (P < 0.05). In the OPLL group, the K-line positive group had a better C2-7 Cobb angle and greater T1 slope. The ossification-related segments were divided into bridging and nonbridging groups, with smaller vertebral HU values, thicker ossification lesions, greater canal occupation, and reduced interbody mobility in the bridging group. However, we found no significant correlation among segmental ROM, ossified material thickness, maximum canal occupancy of the ossified material, and segmental HU values.

Conclusions: We found that the mean HU value of the cervical spine in patients with OPLL was higher than that of the control group, and the ROM was smaller than that of the control group, with the smallest ROM in the continuous type. In the ossification-related segments, the bridging group exhibited lower vertebral HU values, reduced segmental mobility, and thicker ossification thickness.

Objective: This study was to explore the factors associated with prolonged hospital length of stay (LOS) in patients with intracranial aneurysms (IAs) undergoing endovascular interventional embolization and construct prediction model machine learning algorithms.

Methods: Employing a retrospective cohort study design, this study collected patients with ruptured IA who received endovascular treatment at Jingzhou First People's Hospital during the inclusion period from September 2022 to December 2023. The entire dataset was randomly split into training and testing dataset with a 7:3 ratio. Six machine learning models including logistic regression support vector machine, random forest (RF), extreme gradient boosting, K-nearest neighbors, and Naive Bayes were constructed. Each model was assessed using sensitivity with a 95% confidence interval (CI), specificity, positive predictive value, negative predictive value, area under the curve (AUC), accuracy, and F1-score. The performance of the optimal model was compared against other models using the net reclassification index and the integrated discrimination improvement.

Results: In this study, 325 patients were enrolled, with 227 assigned to the training set and 98 to the testing set. The training set comprised 163 patients with LOS below the third quartile and 64 patients with LOS at or above the third quartile. Age, Hunt-Hess grade, National Institutes of Health and Stroke Scale, white blood cell count, Fisher grade above II, moderate aneurysm size, preoperative dexmedetomidine administration, and postoperative complications including electrolyte imbalance correction, encephaledema, and respiratory system disease were identified as predictive factors. The RF model exhibited the best predictive performance with an AUC of 0.928 (95% CI: 0.895-0.961) in the training set. This high performance was consistent in the testing set, where the AUC remained strong at 0.912 (95% CI: 0.851-0.973).

Conclusions: This study comprehensively identified key predictive factors for prolonged LOS in patients with IA undergoing interventional embolization and confirmed the efficacy of an RF model for predicting prolonged LOS in patients with IA undergoing interventional embolization. The construction of the LOS prediction model may effectively optimize healthcare resource utilization, inform better clinical decision-making, and offer valuable prognostic insights.

Spinal cord injury (SCI) poses a complex set of physiological, psychological, and cognitive challenges that significantly affect an individual's quality of life. Analysis of longitudinal studies reveals that cognitive changes following SCI are often underestimated yet significantly impact patient's ability to adapt to their new circumstances. However, the role of neuropsychology in SCI management and rehabilitation is yet to be elucidated. This article offers an in-depth review of the role of neuropsychology in understanding and addressing the cognitive, emotional, and behavioral outcomes of SCI. Additionally, we delve into the emotional and psychological consequences of SCI, which can include increased stress, depression, anxiety, and potential changes in personality and social functioning. Neuropsychological assessment tools are highlighted as essential for diagnosing and monitoring these psychological shifts, aiding in the creation of personalized rehabilitation interventions. We also explore the role of neuroplasticity in cognitive rehabilitation post-SCI, emphasizing the potential of targeted cognitive training to alleviate cognitive deficits and improve adaptive functioning. The article further investigates the interplay between physical and cognitive recovery, underscoring the reciprocal relationship between motor function and cognitive improvement. In conclusion, this review emphasizes the crucial role of neuropsychology in understanding the multifaceted impact of SCI. By enhancing our comprehension of the intricate connections among neural integrity, cognitive function, and psychological well-being, neuropsychology provides valuable insights for developing holistic rehabilitation strategies that address both the cognitive and emotional challenges faced by individuals with SCI. As neurorehabilitation continues to advance, integrating neuropsychological principles offers promise for improving the overall recovery and quality of life for those affected by spinal cord injury.

Background: Hemorrhage is a dangerous complication of deep brain stimulation (DBS) surgery, but a comprehensive explanation of the associated risk factors remains inconclusive, particularly application of microelectrode recording (MER) compared with macrostimulation (non-MER)-based DBS procedures. We conducted a comparative analysis of MER and macrostimulation techniques, evaluating the impact of brain penetrations by microelectrode guiding cannulas on the occurrence of intracranial hemorrhagic events.

Methods: This retrospective study included all DBS procedures (MER-based and non-MER-based) performed at a single medical center from November 2008 to June 2023. Patients underwent comprehensive preoperative and postoperative evaluations, including postoperative computed tomography to assess lead placement and intracranial bleeding, categorized as symptomatic or asymptomatic. Statistical analyses were conducted to ascertain the correlation between different surgical techniques and the risk of hemorrhagic complications.

Results: In a cohort of 618 patients, 1096 electrodes were implanted during 672 consecutive DBS procedures. There were 21 asymptomatic and 6 symptomatic intracranial hemorrhages (ICHs), including 1 death. The bleeding rate was 4.37% per patient and 2.92% per electrode. Patients who developed hematomas were more prevalent in the MER group (25 cases) compared with the non-MER group (2 cases). The MER group had a higher mean number of brain penetrations by guiding cannulas.

Conclusions: DBS procedures are generally safe, with only 0.97% resulting in long-term or permanent deficits. All symptomatic ICH occurred in MER-based procedures, whereas macrostimulation was associated with only 2 asymptomatic ICH cases. The higher number of brain penetrations in MER correlates with higher bleeding rates.

Background: The presence of isocitrate dehydrogenase (IDH) mutations and 1p/19q codeletion significantly influences the diagnosis and prognosis of patients with lower-grade gliomas (LGGs). The ability to predict these molecular signatures preoperatively can inform surgical strategies. This study sought to establish an interpretable imaging feature set for predicting molecular signatures and overall survival in LGGs.

Methods: A cohort of 113 patients with grade 2 or 3 glioma (66 with mutated IDH and 47 with wild-type IDH) was analyzed. The feature set, chief complaints, and onset symptoms were integrated into a logistic regression model to predict IDH mutation and 1p/19q codeletion statuses. Receiver operator characteristic and area under the curve analyses were performed. The predictive model was externally validated using a public database from The Cancer Genome Atlas.

Results: Smooth nonenhancing margin and pial invasion were significant predictors of IDH mutation, with odds ratio values of 3.55 (P = 0.03) and 7.89 (P = 1.0 × 10^-3), respectively. Using the Visually Accessible Rembrandt Images feature set alone to predict IDH mutation status yielded an area under the curve value of 0.83, which increased to 0.85 and 0.87 when incorporating clinical information and onset symptoms for predicting IDH mutation and 1p/19q codeletion, respectively.

Conclusions: Gliomas with IDH mutations were more likely to exhibit smooth nonenhancing margins and pial invasion. In clinical practice, imaging prediction allows for the assessment of IDH mutation to shift from a postoperative outcome to a preoperative guidance indicator, facilitating more precise treatment for patients with LGGs.

Objective: Spinal vertebral fractures pose a significant healthcare burden due to their frequency and impact on quality of life, resulting in substantial social costs. Minimally invasive surgery (MIS) offers advantages over traditional open surgery (OS), such as reduced tissue damage, less postoperative pain, and shorter hospital stays, although it involves higher implant costs. Research comparing the overall direct costs of these interventions is limited. This study aims to compare the direct hospital-care costs associated with OS and MIS for thoracolumbar vertebral fractures in Spain.

Methods: We conducted an ambispective analysis of patients treated for thoracolumbar unstable fractures at our hospital from January 2004 to July 2022. Patients were categorized into OS and MIS groups. We performed analyses on the entire cohort, patients with minor trauma, and applied propensity score matching. Direct hospital costs were documented and adjusted for inflation.

Results: Out of 218 patients, 75 underwent OS and 143 received MIS. Cost analysis indicated that MIS patients had shorter hospital stays and lower admission costs, though total costs did not differ significantly. Multivariate analysis showed OS was slightly more expensive but not significantly so. Propensity score matching confirmed similar findings. For patients with minor trauma, MIS again showed shorter stays and lower costs, with no significant difference in total costs. All cohorts exhibited significantly lower blood expenditure with MIS.

Conclusions: The study demonstrates that MIS is not inferior to OS in terms of costs, with some advantages like reduced blood bank expenses. Further high-quality randomized controlled trials with economic evaluations are needed for more definitive conclusions.

Middle cerebral artery (MCA) aneurysms remain excellent candidates for microsurgical treatment, despite proliferation of new endovascular tools. Nonetheless, patients desire less invasive options for permanent, durable treatment of their aneurysms¹; this is particularly the case for those presenting without subarachnoid hemorrhage, and those with multiple aneurysms that may require several surgical approaches. Keyhole craniotomies, when properly utilized in well-selected patients, allow for minimally invasive treatment of both ruptured and unruptured cerebral aneurysms, including those harboring bilateral aneurysms which may be treated from a single approach². Middle cerebral artery bifurcation aneurysms are ideal aneurysms for application of the keyhole concept: they reside at depth from the skull under a direct, linear path of access; obtaining early proximal control of the in-flow vessel can be accomplished with minimal further dissection at the depth of a narrow corridor; there are few perforators that require dissection; a properly placed craniotomy exposes the entire proximal sylvian fissure as well as the contralateral sylvian contents; sharp dissection of the sylvian fissure further expands the corridor which can be illuminated with lighted instruments as needed; and, conversion to a larger craniotomy can be easily performed is bailout is necessary. A relative contraindication of this approach is if both aneurysms are laterally projecting, although in experienced hands even this remains only a relative contraindication. A possible potential complication that should be prepared for is intraoperative rupture of the distal aneurysm but as demonstrated in this video, it is critical that the surgeon obtain proximal and distal control of the most distal aneurysm as would be obtained from an ipsilateral approach. In this video we demonstrate the use of this approach for bilateral unruptured MCA aneurysms, highlighting nuances for successful performance of this operation.

Introduction: Degenerative lumbar scoliosis (DLS) often causes various issues such as neural symptoms and osteoporosis (OP). Vertebral bone quality (VBQ) is a crucial factor that surgeons take into consider prior to surgery. However, little attention has been given to the use of VBQ in evaluating vertebral bone mass in DLS patients. The aim of this study was to investigate the ability of MRI-based VBQ score to evaluate bone mass in patients with DLS and its ability to predict OP.

Methods: A total of 130 patients were enrolled and divided into the DLS and non-DLS groups. The VBQ scores of the L1-L4 vertebral bodies were measured in noncontrast T1WI. Dual X-ray absorptiometry (DXA) was used to assess osteoporotic status. Additionally, patients with DLS were divided into two groups: with vertebral rotatory subluxation (VRS) and without VRS. The VBQ scores, CT values, and DXA indicators were compared between the DLS and non-DLS groups, and between VRS and non-VRS groups. VBQ was compared with the CT value, bone density and T-score using the Pearson correlation coefficient. VBQ was obtained according to the non-DLS group and compared with the accuracy of diagnosing osteoporosis with DXA.

Results: The DLS group was significantly different from the non-DLS group in terms of the VBQ score (3.53 vs. 2.98), CT value (109.81 vs. 134.60), T score (-1.19 vs. -1.72) and bone mineral density (BMD) value (1.04 vs. 0.94). The VRS group presented a larger Cobb angle, lower CT value and higher VBQ score. The AUC of the VBQ score in the prediction of osteoporosis was 0.804, with a sensitivity of 68.4% and a specificity of 85.7%.

Conclusion: VBQ can reduce interference from degeneration and deformities and can be used as a complementary method for vertebral quality assessment.