World neurosurgery最新文献

Objectives: Aneurysmal subarachnoid hemorrhage is more prevalent in post-menopausal women and it has been postulated that this relationship is hormonally driven by lower circulating levels of estrogens. We examined the association between circulating plasma estrogen levels and subsequent development of aneurysmal subarachnoid hemorrhage in women.

Methods: Women from the Nurses' Health Study with confirmed aneurysmal subarachnoid hemorrhage (n=38) were matched with controls (n=38) on age, smoking, menopausal status, and other reproductive factors. Plasma estriol, estradiol and sex hormone-binding globulin (SHBG) were measured at baseline, prior to the development of aSAH. Conditional logistic regressions were performed to assess the association between hormone levels and incident aSAH.

Results: Plasma estradiol, estriol, and SHBG were not associated with the subsequent development of aneurysmal subarachnoid hemorrhage. Women with a history of current or former smoking were associated with lower levels of circulating estriol (β = -0.35±0.12, p=0.004), and estradiol (β = -0.63±0.16, p=0.0002) levels.

Conclusions: In this study, we did not find an association between estrogen levels and incidence of aneurysmal subarachnoid hemorrhage in women.

Background: In endoscopic transsphenoidal surgery for pituitary adenoma with suprasellar extension, the prolapse of the stretched floppy diaphragma sellae can obstruct the surgical corridor, posing challenges during pituitary surgery. We have introduced a simple postural change technique to mitigate this issue and are sharing our clinical experience.

Methods: Pituitary surgery is performed on an operating bed where the patient's position can be adjusted. During transsphenoidal pituitary surgery, raising the patient's head to a Fowler's position causes the diaphragma sellae to move upward, while lowering the head to a supine position causes it to descend. This simple adjustment minimizes hindrance from the floppy diaphragm sellae during surgery.

Results: We illustrate this technique in pituitary surgery, where diaphragm sellae relocation is necessary.

Conclusion: A simple postural change technique effectively manages prolapsed floppy diaphragma sellae, enhancing visualization and surgical accessibility during endoscopic transsphenoidal pituitary surgery.

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a reversible cause of dementia, typically treated with shunt surgery, although outcomes vary. Artificial intelligence (AI) advancements could improve predictions of shunt response (SR) by analyzing extensive data sets.

Methods: We conducted a systematic review to assess AI's effectiveness in predicting SR in iNPH. Studies using AI or machine learning (ML) algorithms for SR prediction were identified through searches in MEDLINE, EMBASE, and Web of Science up to September 2023, adhering to Synthesis Without Meta-Analysis reporting guidelines.

Results: Out of 3541 studies identified, 33 were assessed for eligibility, and 8 involving 479 patients were included. Study sample sizes varied from 28 to 132 patients. Common data inputs included imaging/radiomics (62.5%) and demographics (37.5%), with Support Vector Machine being the most frequently used ML algorithm (87.5%). Two studies compared multiple algorithms. Only four studies reported the Area Under the Curve (AUC) values, which ranged between 0.80 and 0.94. The results highlighted inconsistency in outcome measures, data heterogeneity, and potential biases in the models used.

Conclusions: While AI shows promise for improving iNPH management, there is a need for standardized data and extensive validation of AI models to enhance their clinical utility. Future research should aim to develop robust and generalizable AI models for more effective diagnosis and management of iNPH.

Background and objectives: Surgical resection of intracranial meningioma carries the risk of several complications, including intraoperative blood loss. The objective of this study was to investigate preoperative clinical and radiographic factors predictive of intraoperative estimated blood loss (EBL).

Methods: This case-control study evaluated EBL for all adults who underwent intracranial meningioma resection from January, 2010 to December, 2021 at our institution. Fifty cases of high EBL (i.e., ≥500 milliliters [mL]) and seventy-five instances of low EBL (i.e., <500mL) were randomly selected. Patients were excluded if they had a recurrent meningioma, preoperative embolization, or lack of imaging data. A multivariable logistic regression model of high EBL likelihood was created.

Results: A total of 92 patients met eligibility criteria, with 48 (52%) cases of high EBL. Bivariable analyses identified maximal tumor diameter, intratumoral flow voids, skull base location, and dural venous sinus invasion as potential predictors of high EBL. Multivariable regression found intratumoral flow voids (aOR=5.68 [1.52-21.23], p=0.009), maximal tumor diameter (aOR=1.58 [1.11-2.25] per one-centimeter increase, p=0.01), and skull base location (aOR=3.35 [1.19-9.41], p=0.02) to be independent predictors of high EBL.

Conclusion: Intratumoral flow voids, larger maximal tumor diameter, and skull base location were independently predictive of EBL ≥500mL. Intratumoral flow void presence was the strongest predictor, with 5.68 times the odds of high EBL. Each one-centimeter increase in tumor diameter had 58% greater odds of high EBL. Skull base location was associated with 3.35 times the odds of high EBL. These results can inform preoperative patient counseling and blood management preparation.

Objective: To analyze the clinical efficacy of ultrasonic bone scalpel (UBS)-assisted unilateral biportal endoscopic lamina osteotomy replantation (ULOR) for treating lumbar infectious spondylitis (LIS).

Methods: We conducted a retrospective analysis of patients with LIS who had therapy with UBS-assisted ULOR at our hospital between January 2020 and May 2023. A total of 17 instances matched the inclusion criteria, consisting of 7 females and 10 males. The UBS was utilized during surgery to extract the lamina completely followed by large bone grafting to fuse the cleaned intervertebral space. The study recorded and analyzed various parameters in the included patients before and after surgery.

Results: All 17 patients underwent a successful operation with an average duration of 136.82 ± 21.35 minutes, average blood loss of 77.43 ± 10.19 ml, and an average follow-up period of 18.55 ± 3.47 months. Following the surgical intervention, the patients experienced a substantial improvement in their clinical symptoms, accompanied by a significant drop in WBC, ESR, and CRP levels (all P<0.001). The postoperative VAS scores and ODI showed considerable improvement (both P<0.001). The postoperative Cobb angle and intervertebral space height were significantly corrected (P<0.001). At the last follow-up, the success rate of lumbar fusion was 100% and there were no instances of infection recurring.

Conclusion: The use of ULOR, with assistance from UBS, for the treatment of LIS has proven to be beneficial. It provides significant relief from symptoms and corrects lumbar deformity. This surgical procedure is both effective and safe.

Aim: Pain is a complex sensory and emotional experience that significantly impacts individuals' well-being. Lumbar radicular pain (LRP) is a prevalent neuropathic pain affecting 9.9% to 25% of the population annually. Accurate identification of pain patterns in LRP is essential for diagnosis and management. Artificial intelligence has potential in healthcare but faces challenges in reliably and accuracy. This study aimed to investigate the accuracy and consistency of LRP patterns demonstrated by ChatGPT-4o.

Methods: The study was conducted at Üsküdar State Hospital from June 1 to June 30, 2024, utilizing the GPT-4o language model. ChatGPT-4o was prompted to generate and mark LRP patterns for L4, L5, and S1 radiculopathies on an anatomical model. The process was repeated after two weeks to assess consistency. The markings by ChatGPT were compared with those by two experienced specialists using OpenCV for analysis. Statistical tests, including the Mann-Whitney U-Test, were conducted.

Results: ChatGPT's initial and follow-up markings of L4, L5, and S1 radiculopathy pain patterns were statistically significantly different from each other and from the specialists' markings (p<0.001 for all comparisons).

Conclusion: ChatGPT currently lacks the capacity to accurately and consistently represent LRP patterns. AI tools in healthcare require further refinement, validation, and regulation to ensure reliability and safety. Future research should involve multiple AI platforms and broader medical conditions to enhance generalizability.

Background: Medicare reimbursements for otolaryngology and neurosurgery procedures have generally declined since 2000. We explore Medicare reimbursement trends for anterior (ACF), middle (MCF), posterior cranial fossa (PCF), pituitary surgery (PS), and skull base reconstruction (SBR) surgery from 2000-2022.

Methods: Cross-sectional analysis of the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule was performed from 2000-2022 on approach, resection, and repair of the skull base (CPTs 31290-31291, 61546, 61548, 61575-61619, 62165). Reimbursement data was adjusted for inflation to 2022 US dollars, and annual and total changes calculated. The CMS Part B National Summary Data File was analyzed for trends in Medicare procedure volume and total payment.

Results: Adjusted for inflation since 2000, reimbursements for ACF, MCF, PCF, PS, and SBR codes had an overall decrease of 22.85%, 32.43%, 28.09%, 44.22%, and 38.65%, respectively. Simultaneously, procedure volume increased at an average annual rate of 63.99%, 128.57%, 19.75%, 36.11%, and 12.79%, respectively.

Conclusions: While nominal per-service Medicare reimbursement has increased for skull base surgery codes, there has been a downward trend in inflation-adjusted procedural reimbursement. This parallels findings in other otolaryngology and neurosurgery procedures. Despite this, surgical volume in all skull base surgery subfields has increased, indicating increased utility and adoption of these techniques.

Background and objectives: Suprasellar hypothalamic-opticochiasmatic glioma (HOCG) and craniopharyngioma (CP) have similar appearances on conventional MRI and are difficult to distinguish. Moreover, these tumors are situated near vital structures like the optic chiasm and hypothalamus, rendering conventional surgery susceptible to significant complications. We mainly discussed the surgical application value and diagnostic value of diffusion tensor imaging (DTI) in HOCG and CP.

Methods: The retrospective analysis of 13 cases of HOCG and 16 cases of CP was conducted. All patients underwent conventional MRI and DTI prior to surgery, and were pathologically diagnosed postoperatively.

Results: Both CP and HOCG appeared as heterogeneous mixed signal masses on conventional MRI. For HOCGs, fiber tractography revealed two different growth patterns of the tumor: infiltrative type and inflated type. The surgical approach and risk levels differ between these growth patterns. Additionally, fiber tractography demonstrates significant differences compared to CPs. The surgical approach and extent of resection for all cases of these two tumors were guided by DTI.

Conclusion: DTI enhances the accuracy of HOCG and CP differentiation. Furthermore, patterns of tractography described in this study assist neurosurgeons in delineating the surgical pathway and tumor resection range without damaging important fiber bundles, thereby avoiding permanent neurological deficits and improving survival quality for patients.