World neurosurgery最新文献

Objective: Risk factors for noncontiguous spinal fractures (NSFs), which are important for early, timely diagnoses and treatments of elderly individuals with traumatic spinal fractures, have not been discussed in depth. Thus, this study aimed to investigate the risk factors for NSFs.

Methods: The records of 1415 elderly patients (aged 60 years and over) who presented with traumatic spinal fractures between 2013 and 2019 were retrospectively reviewed. The patients' clinical and radiographic records were reviewed.

Results: The patients were divided into an NSF group (n = 281 patients) and a control group (n = 1134 patients). Univariate analysis revealed that female sex (P = 0.013), fractures with no obvious incentives (P = 0.003), osteoporosis (P = 0.003), occurrence in the spring (P < 0.05), and previous vertebral fractures (P < 0.001) were associated with NSFs. Multivariate logistic regression revealed that fractures occurring in the spring (P < 0.05) and a history of previous vertebral fractures (P < 0.001) were independent risk factors for NSFs.

Conclusions: Independent risk factors for NSFs among the elderly population include fractures that occur in the spring and a history of previous vertebral fractures, which is important for determining the surgical segment.

Objective: Aneurysmal subarachnoid hemorrhage (SAH) is frequently complicated by permanent shunt-dependent hydrocephalus, but it is difficult to predict which patients are at highest risk. This study seeks to identify novel variables associated with shunt dependency after aneurysmal SAH and to create a predictive algorithm that improves upon existing models.

Methods: Retrospective case-control design was used. Patients who presented with aneurysmal SAH and external ventricular drain (EVD) placement were included. Those who successfully weaned off their EVD were compared with those who required shunt placement. Demographic and treatment data were analyzed using univariate and multivariable logistic regression. Receiver operating characteristic was used to compare the proposed model's performance against existing ones (Barrow Neurological Institute, chronic hydrocephalus ensuing from SAH score, and shunt dependency in SAH scores).

Results: One hundred patients were included: 50 no shunt and 50 shunt. Advanced age, elevated modified Graeb score, intraventricular hemorrhage, increased clot thickness, acute hydrocephalus, and cerebrospinal fluid protein >110 mg/dL prior to wean attempt were all found to be significantly associated with progression to shunt-dependency (P = 0.0351, 0.0022, 0.0407, 0.0274, 0.0014, and 0.0064, respectively). Multivariate regression demonstrated an area under the curve of 0.7852 (P < 0.0001), outperforming those of the other models.

Conclusions: Our study suggests that elevated modified Graeb score on initial computed tomography and high cerebrospinal fluid protein levels prior to EVD wean are important prognostic indicators for the development of shunt dependency after aneurysmal SAH. Integrating these findings into clinical practice may aid in earlier and more targeted decision-making.

Background: The Spinal Instability Neoplastic Score (SINS) is used in determining instability in patients with spinal metastases. Intermediate scores of 7 to 12 suggest possible instability, but there are no clear guidelines to address patients with these scores.

Methods: We searched in PubMed, EMBASE, and Cochrane databases for studies that included patient demographics, tumor histology, surgical or radiotherapy management, and outcomes of patients with intermediate SINS. We reported mean differences and odds ratios (ORs) to assess differences between patients managed surgically versus with radiotherapy alone.

Results: Thirteen articles, totaling 1822 patients with intermediate SINS were analyzed. In 5 studies (38.4%), the management decision was based on a tumor board review. There was no significant difference between surgical management versus radiotherapy (P = 0.24). When dichotomized into SINS 7-9 and 10-12, the OR for surgical management in the 10-12 group compared to the 7-9 group was 6.88 (95% confidence interval [CI] 2.31-20.5, P = 0.0005). More renal cell carcinomas were managed surgically instead of with radiotherapy alone than other tumor types (OR = 1.87, 95% CI = 1.14-3.05, P = 0.01). There was no statistical difference in overall complications between the 2 treatment groups (OR = 1.12, 95% CI = 0.49-2.54, P = 0.79). Vertebral fracture rates after any radiotherapy type ranged between 20% and 66%. The need for a surgical procedure, including stabilization, vertebroplasty, or kyphoplasty after radiotherapy ranged from 5% to 34.2%.

Conclusions: Complication rates after surgery versus radiotherapy in the intermediate SINS category are similar, but the complication types differ. Patients in the 10-12 SINS subgroup, due to larger lytic area and higher probability of vertebral body fracture, could benefit from stabilization before radiotherapy.

Aneurysms of the middle cerebral artery (MCA) account for up to 40% of all unruptured intracranial aneurysms [1-3] and 14% to 20% of ruptured ones. [4-5] Giant MCA aneurysms are rare, representing 10% of cases [6], but carry an aggressive natural history, with the UCAS Japan study reporting an annual rupture rate of ∼ 17%. [7]. Additionally, unruptured giant MCA aneurysms can present with neurological symptoms including headache, focal neurological deficit, seizure, or ischemia infarcts. Here we report a 58-year-old male with a history of alcohol abuse, hypertension, diabetes, and smoking that presented after a first-time seizure. Imaging revealed an unruptured, giant (2.9 cm), partially thrombosed right MCA aneurysm. A microsurgical approach using clipping and bypass was planned due to the aneurysm's complexity. Six weeks later, the patient underwent a right frontotemporal craniotomy with radial artery graft (RAG) extraction, followed by two bypasses: an M2-M2 intracranial bypass and a right external carotid to M2 bypass using the RAG. The aneurysm was successfully excised. Otolaryngology assisted with the RAG extraction during the craniotomy and neck dissection. This case highlights the technical complexities involved in managing giant aneurysms via microsurgical technique, including appropriate pre-operative strategy development. Informed consent from next of kin as well as IRB approval (IRB #23.0720) was obtained for this retrospective study of patients with cerebrovascular disease.

Objective: To investigate the risk factors and their diagnostic efficacy for postoperative intestinal mucosal barrier dysfunction (IBD) following severe traumatic brain injury (sTBI).

Methods: There were 140 patients with sTBI enrolled in this study. Univariate and multivariate logistic regression analyses were conducted to assess the relationship between the clinical data and postoperative IBD in sTBI patients and determine the independent risk factors. The diagnostic efficacy of each risk factor was evaluated using the receiver operating characteristic (ROC) curve and the area under the curve (AUC).

Results: According to the diagnostic criteria for IBD, the 140 enrolled patients were classified into the IBD group (n = 60) and the non-IBD group (n = 80). The levels of intraoperative initial intracranial pressure (iICP) of patients with IBD were significantly higher compared with those of patients without IBD (P < 0.001). Furthermore, intraoperative iICP presented high diagnostic efficacy for postoperative IBD (AUC = 0.91, 95% confidence interval [CI] 0.85-0.96, P < 0.001). Patients with higher intraoperative iICP were more prone to suffering unfavorable neurological outcomes.

Conclusions: Intraoperative iICP could act as an independent and quantifiable predictor with high diagnostic efficacy for IBD in patients with sTBI after emergency surgery.

Objective: To compare the rates of postoperative hemorrhages for aneurysms associated with brain AVM evaluating the lesion that was initially treated.

Methods: A systematic review of the literature was carried out following the PRISMA guidelines. The search was performed in PubMed, Embase and Scopus . After the data extraction, the total numbers and percentages were calculated through summary statistics and were subject to meta-analysis. The methodological quality and risk of bias were assessed using the ROBINS-I tool and to determine the certainty of the evidence, we utilized the GRADE methodology.

Results: Out of the 738 records screened, 28 studies were chosen for data extraction with a total of 1,671 patients. Hemorrhagic presentation was observed between 38% to 100% of patients across the studies included. The pooled period prevalence of postoperative hemorrhage (PH) after intervention was 6% (95% CI=0.03-0.07). Stratified analysis according to which lesion was treated first demonstrated a slightly lower rates of PH when aneurysms were treated first, compared when the AVM was managed first or if both lesions were treated simultaneously (p=0.02). Rates of hemorrhage for lesions in the infratentorial location (0.21; 95 % CI=0.01-0.42) were much higher after intervention compared to non-infratentorial location (0.05; 95% CI=0.03-0.07), and this difference reached statistical significance (p<0.01).

Conclusions: Hemorrhage rates were lower when treating the aneurysm first, but their risk was higher when treating infratentorial lesions. The decision on which lesion should be treated first should be individualized according to the feeder vessels, the AVM and aneurysmal size, location, and overall functionality of the patients.

Objective: This study evaluates the extent of perfusion abnormalities in pediatric traumatic head injury patients by using computed tomography perfusion (CTP) and compares the efficacy of voxel based and whole brain perfusion data clinically with functional outcome scales GOSE-P and MRS.

Methodology: In this Prospective study 100 eligible patients of age group 0-15 years were enrolled. Subjects were categorized into mild, moderate and severe traumatic brain injury using GCS.CT perfusion scans were performed at admission and at time of discharge. Both voxel-based and whole brain perfusion data were acquired at five regions of interest: orbitofrontal cortex, internal capsule, thalamus, caudate nucleus, and sensorimotor cortex for cerebral blood perfusion. The extent of perfusion abnormalities were noted in CTP scans. GOSE-P and MRS were utilised to clinically evaluate functional outcomes.

Results: Significant differences in CT perfusion findings between voxel-based and whole brain approaches were noted. Voxel-based scans demonstrated superior predictive value in severe cases, while whole brain scans were promising in moderate cases. GCS scores and specific CT parameters (CBF AND MTT) were also significant predictors of outcomes.

Conclusion: The comparative analysis highlights the complementary roles of voxel-based and whole brain perfusion CT in predicting functional outcomes in pediatric head injury cases. Clinicians should consider both approaches when evaluating cerebral perfusion status and making treatment decisions. Further research is warranted to validate these findings and refine imaging protocols to optimize predictive accuracy in this vulnerable population.

Jacob Fidelis Ackermann was a German Medical Doctor born in 1765 in the city of Rüdesheim. Between 1789 and 1815 years he was professor of medicine at the universities of Mainz and Heidelberg, teaching the disciplines of anatomy, physiology, botany, and natural history. In his famous work on basilar invagination, Ackermann described and illustrated the cranial base flattening in two skulls from Italy. For this, he traveled through various European Alps analyzing autopsies and cranial specimens to describe the basilar invagination as an extremely inclined foramen magnum, with hypoplasia of occipital condyles, and elevation of the petrous part of the temporal bone. In his analyses, the thyroid gland dysfunction was the main etiology of the basilar invagination, in which the brainstem compression was a major pathological relevance discussed.

Background: Recent advances within the last decade have allowed robotics to become commonplace in the operating room. In the field of neurosurgery, robotics assist surgeons in pedicle screw placement and vertebral fusion procedures. The purpose of this review is to look at currently used spinal robots available on the market and compare their overall accuracy, cost, radiation exposure, general adverse events, and hospital readmission rates.

Methods: The authors searched databases including PubMed and Google Scholar for studies on robotic spine surgery using robotic systems: Mazor X/Mazor Renaissance, Cirq, ExcelsiusGPS, and ROSA ONE Spine. The literature was examined for robot accuracy, hospital readmission rates, adverse events, radiation exposure, and cost of the robots.

Results: In general, many studies recognize that robot assisted spinal surgery is of equal or greater accuracy compared to freehand surgical techniques. Limited and conflicting data exists regarding radiation exposure and overall adverse events. The upfront cost of robotic spine-based surgery tends to be more than freehand, but minimal data evaluates the cost-effectiveness among robotic systems.

Conclusion: This review summarizes the findings comparing the individual robotic systems and their comparison to freehand surgery. As robotics become more popular in clinical practice, additional research is needed to assist hospitals and surgeons in making an informed decision about implementing robotics in spinal surgery.