World neurosurgery最新文献

Background: Combining surgery and radiotherapy is the gold standard in treating spinal metastasis when spinal stabilization or surgical decompression is required. Determining the optimal timing for radiotherapy postsurgery is crucial to balance treatment efficacy minimizing wound complications. The study aimed to identify consensus and nonconsensus areas among Latin American spinal surgeons regarding the use, timing, risks, and surgical approach to conventional external beam radiotherapy (cEBRT) following spinal surgery for metastases, specifically focusing on the risk of radiotherapy-related wound complications.

Methods: A modified Delphi survey was conducted. The expert panel included active members of AOSpine Latin America with extensive experience in vertebral metastasis surgery. The surveys include 37 statements covering areas of interest. Inter-expert consensus was considered weak (70-79.9%), moderate (80-89.9%), and strong (≥90%).

Results: At least 70% consensus was reached on 32 of the 37 statements (86.5%). This included strong consensus on 10 statements, moderate on 13, and weaker on nine. There was high consensus on sutures and lower consensus on risk factors for cEBRT delay. Experts reached strong agreement on the importance of poor nutrition as a risk factor for cEBRT-related wound complications. Perception of wound risk was greater with a posterior midline approach compared to other approaches, and the highest perceived complication risks were for junctional locations and sacral spine.

Conclusions: We report strong agreements among the experts on important issues such as waiting times and risk factors for cEBRT. The findings underscore the significance of considering factors such as, spinal levels, surgical approaches, and sutures when making clinical decisions.

Objective: Currently, there is no established treatment consensus for craniocervical unruptured dissecting aneurysms (UDAs). This study aimed to assess the safety and efficacy of the Surpass Streamline Flow Diverter (SSFD) for treating craniocervical UDAs.

Methods: A retrospective review of 3 centers' databases was conducted to identify patients with craniocervical UDAs treated with SSFDs from January 2021 to December 2023. Data, including patient and aneurysm characteristics, procedure details, imaging findings, and follow-up data were analyzed.

Results: The study included 35 patients with 35 craniocervical UDAs. The mean maximal length of the UDAs was 13.0 ± 6.0 mm, with 57% ranging from 10 to 25 mm. At a mean follow-up of 8.7 ± 2.5 months, the complete occlusion rate was 71% (25/35), with no recurrences detected. Perioperative complications occurred in 3 patients (9%), comprising ischemic stroke in 2 patients (6%) and hemorrhagic stroke in 1 patient (3%). All patients had a good clinical outcome at the 6-month follow-up (modified Rankin Scale <3). Multivariate logistic regression analysis revealed that aneurysmal dilation with stenosis (odds ratio = 0.034, 95% confidence interval: 0.001-0.845; P = 0.04) was a significant predictive factor for incomplete occlusion of treated aneurysms.

Conclusions: Our findings suggest that SSFD is a safe and effective tool for craniocervical UDAs, demonstrating a high occlusion rate, acceptable complication rate, and good clinical outcome.

Objective: Sarcopenia significantly impacts prognosis in patients with acute ischemic stroke (AIS). This study investigates the relationship between serum creatinine/serum cystatin C (Cr/CysC) levels and short-term prognosis in AIS patients, aiming to inform post-treatment strategies.

Methods: We analyzed AIS patients at the First Affiliated Hospital of the University of Science and Technology of China from January 2022 to January 2024. Baseline data were collected through interviews and medical records, with a 3-month follow-up for prognosis assessment. 265 were included in the final analysis. Cr/CysC levels were categorized into quartiles (Q1-Q4). Logistic regression and restricted cubic spline analysis were employed to evaluate the association between Cr/CysC and prognosis.

Results: Among the 265 patients, the average age was 66.18 ± 12.41 years, and 129 (48.68%) had poor short-term prognosis. Multivariate logistic regression showed that patients in the lowest quartile of Cr/CysC (Q1) had a significantly lower risk of poor prognosis compared to those in the highest quartile (Q4) (odds ratio = 0.287, 95% confidence interval: 0.090-0.917, P = 0.035). A linear relationship was identified between Cr/CysC and prognosis (P overall<0.001, P nonlinear = 0.571).

Conclusions: This study establishes a significant linear correlation between Cr/CysC levels and poor short-term prognosis in AIS patients. Encouraging muscle function exercises may enhance patient outcomes.

Background: Simultaneous C1 and C2 fractures are increasingly common, but contemporary series are limited.

Methods: All patients with traumatic fractures of both C1 and C2 admitted to an academic trauma center from 2012 to 2022 were retrospectively analyzed. Multivariable regression was used to identify characteristics relevant to management and outcomes.

Results: Of 103 patients identified, most were ≥80 years old (52.4%), sustained ground-level falls (80.6%), and had minor associated injuries (median Injury Severity Score 1); a 28.2% had a 1-year mortality rate. Landells type 1 fractures were the most common C1 fracture (50.5%), and dens fractures were the most common C2 fracture (74.8%). Most patients did not undergo magnetic resonance imaging, but ligamentous injury was seen in 54.8% of those who did. Fourteen patients (13.6%) had upfront surgery, and 7 patients (6.8%) had surgery after a trial of nonoperative management. Selection for upfront surgery was associated with neurologic deficits (P = 0.010) and age (P = 0.026). Patients with dens fracture tended to have C2 as their lower instrumented vertebra (P = 0.0902), and patients with hangman's fracture tended to have C3 as their lower instrumented vertebra (P = 0.0714). Upfront surgery decreased the odds of bony nonunion (P = 0.0281). In 91.7% of patients with bony nonunion with flexion-extension x-rays, the x-rays showed fibrous nonunion.

Conclusions: Simultaneous atlantoaxial fractures commonly occur in elderly patients after ground-level falls with minor associated injuries. Surgical selection is driven by neurologic deficits and age, and C2 fracture type may influence procedure choice. Surgery decreases the odds of bony nonunion, and fibrous nonunion is common in the absence of surgery.