World neurosurgery最新文献

Objective: To determine the prognostic impacts of the characteristics in routine plasma and blood tests for patients with traumatic brain injury (TBI).

Methods: A total of 136 consecutive adult patients with TBI were recruited. Blood and plasma routine tests were performed within 24 hours from admission. All patients were briefly followed up at the third month after discharge. We analyzed the prognostic factors with univariate and multifactor logistic regression models in the patients receiving surgical and conservative treatments, respectively.

Results: We found different prognostic factors in the patients receiving diverse treatments. In the patients receiving surgical treatment, infection is the only influencing factor, while in the patients receiving conservative treatment, age (P = 0.004), white blood cell count (WBC) (P = 0.008), and albumin (P = 0.040) were the independent factors of prognosis. In the receiver operator characteristic analysis, the values of area under the curve of these factors were 0.788 for age, 0.695 for WBC, and 0.709 for albumin, respectively. The combined area under the curve of the 3 factors was 0.898.

Conclusions: TBI patients receiving diverse treatments might have different pathophysiologic conditions and different influencing factors of prognosis.

Objective: Stereotactic neuromodulation, such as deep brain stimulation (DBS) and responsive neurostimulation (RNS), have emerged as some of the more promising means for managing drug-resistant epilepsy. This study serves as a comprehensive analysis of DBS of the anterior nucleus of the thalamus (ANT), centromedian nucleus of the thalamus, and hippocampus and RNS for seizure reduction in adult intractable epilepsy.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was conducted of PubMed, Cochrane Library, and Embase databases from January 2000 to January 2024 to objectively assess the effectiveness of the various neuromodulation modalities on seizure reduction. Different software such as EndNote and Rayyan was used to organize the 1996 total reviewed studies and to run a blinded multiphase review process.

Results: A total of 25 studies were included for review with 21 studies and 166 patients suitable for the meta-analysis. DBS ANT, DBS hippocampus, and RNS were all found to have significant individual seizure reductions of 54.0%, 70.0%, and 63.5%, respectively. DBS centromedian nucleus of the thalamus was excluded since only 1 study met inclusion criteria and was, therefore, not suitable for meta-analysis. Furthermore, the 3 analyzed procedures were found to be not significant when compared to one another. Focal versus general epilepsy in DBS ANT also had no significant difference. DBS hippocampus had a significantly higher reduction rate in patients with mesial temporal sclerosis compared to patients with normal imaging findings.

Conclusions: These results provide a vast amount of supporting data for these neurostimulation procedures while also indicating no significant difference between operations. Therefore, in this target population, operative decisions can be made based on surgeon preference and patient circumstance without affecting seizure reduction outcomes.

Objective: This study was to evaluate the initial efficacy of lateral lumbar interbody fusion (LLIF) in treating degenerative lumbar spinal stenosis (DLSS), encompassing a spectrum of stenosis severity from minor to extreme cases.

Methods: This retrospective study analyzed the outcomes of 43 patients with DLSS, involving 55 surgical segments, who underwent LLIF. Clinical efficacy and radiographic parameters were recorded during the perioperative period and at the final follow-up. Pursuant to the Schizas' classification criteria, the 55 surgical segments were categorized into 2 groups: the Schizas grade A or B group and the C or D group. Simultaneously, the 43 patients were divided into 2 groups: the minor-moderate stenosis (MM) group and the severe-extreme stenosis (SE) group. Comparative analyses were subsequently conducted.

Results: All patients successfully underwent the LLIF procedure, without the need for additional posterior decompression surgery. Both 16 MM and 27 SE group patients demonstrated significant improvements in clinical efficacy scores compared to their preoperative baselines (P < 0.001). Furthermore, there were no statistically significant differences between the MM group and the SE group in postoperative clinical metrics (P > 0.05). Both 23 Schizas grade A or B and 32 C or D group segments exhibited significant postoperative improvements in radiographic parameter values (P < 0.001), with no statistically significant differences between the 2 groups (P > 0.05).

Conclusions: Under certain indications, patients with varying degrees of DLSS, ranging from mild to extreme, can achieve favorable outcomes through LLIF, and preoperative imaging revealing severe or extreme stenosis does not automatically disqualify patients from undergoing indirect decompression surgery.

Background: This study analyzes the factors influencing the 90-day prognosis of acute ischemic stroke (AIS) patients after mechanical thrombectomy (MT) and established a multidimensional risk model to predict postoperative 90-day outcomes.

Methods: A retrospective analysis of clinical data was conducted for AIS patients who underwent MT at our hospital. A total of 111 patients who met the inclusion criteria were included in the study. Based on the modified Rankin Scale (mRS) scores from follow-up records at 3 months post-surgery, the patients were divided into a good prognosis group (88 cases, 79.28%), a poor prognosis group (23 cases, 20.72%). Receiver operating characteristic (ROC) curves were plotted using MedCalc software, and area under the curve (AUC) values were calculated to establish a risk prediction model, presented in the form of a nomogram.

Results: Logistic regression analysis showed that C-reactive protein (T3) (p < 0.001), NIHSS score at admission (p = 0.001), and a history of atrial fibrillation (p = 0.004) were independent predictors of poor prognosis, while albumin (T2) (p = 0.008) was a protective factor for the 90-day outcome. The AUC values for these factors were 0.812, 0.760, 0.655, and 0.757, respectively. The AUC values of Normotu was 0.945. Calibration slope = 0.856, Calibration-in-the-Large ≈ 0, and Observed/Expected (O/E) ratio ≈ 1.

Conclusion: Post-MT CRP levels, NIHSS score at admission, and a history of atrial fibrillation are significantly associated with poor prognosis in these patients. Moreover, higher levels of endogenous albumin are a protective factor for the 3-month prognosis of AIS patients after MT.

Objective: In recent decades, many physicians have chosen to opt out of Medicare, allowing them to set their own pricing models for their patients. Characterization of Medicare opt-outs has not been thoroughly studied in any surgical specialty, including Neurosurgery. Our study characterizes the factors that may influence a neurosurgeon's decision to opt out of Medicare acceptance and contextualizes them both within the field and across various surgical specialties.

Methods: Retrospective cross-sectional analysis using Centers for Medicare and Medicaid Services (CMS) data on starting date of physician opting out as well as geographic state of practice for neurosurgeons and other specialty surgeons. Additional parameters were collected from publicly available profiles of neurosurgeons regarding medical school graduation year, subspecialty, and type of practice.

Results: 63 neurosurgeons opted out of Medicare. The rate of Medicare opt-outs was highest for Neurosurgery during 2023, while for most other surgical specialties it was highest between the years 2015 and 2017. 54.0% of opt-out neurosurgeons were exclusively private practice physicians. Most were spine (66.7%) or general neurosurgeons (20.6%). Most Medicare non-participating neurosurgeons chose to opt out in their mid-career compared to early or late career. A higher number of these neurosurgeons were located in Alaska, Iowa, California, Connecticut, Florida, and New Jersey.

Conclusions: The circumstances influencing a neurosurgeon's decision to opt out of Medicare acceptance are multifaceted, and our findings suggest that physician experience, specialty, location, and practice structure may all play roles and should be further investigated.

The authors present a comprehensive review on the history and development of oncolytic herpes simplex viral therapies for malignant glioma with a focus on mechanisms of delivery in prior and ongoing clinical trials. This review highlights the advancements made with regard to delivering these therapies to a highly complex immunologic environment in the setting of the blood-brain and blood-tumor barrier in a safe and effective manner.

Background: Perioperative neurocognitive disorders are common perioperative complications associated with various poor outcomes. Regional cerebral oxygen saturation (rSO2) monitoring is a noninvasive technique based on near-infrared spectroscopy detection. Due to the considerable controversy among currently published studies on the application of intraoperative rSO2 monitoring in adult patients undergoing elective noncardiac surgery, this study aims to conduct a systematic review and meta-analysis to provide more comprehensive and robust evidence to support clinical decision-making.

Methods: This study conducted a systematic literature search of databases including PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science, from their inception to May 1, 2024. The eligible randomized controlled trials included adult patients undergoing elective noncardiac surgery under general anesthesia who received optimized anesthesia management guided by rSO2 monitoring and those in the control group who received routine anesthesia management under standard monitoring or blinded rSO2 monitoring. The primary outcomes were the incidence of perioperative neurocognitive disorders, including postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), and Mini-Mental State Examination (MMSE) scores. Secondary outcomes included the incidence of intraoperative cerebral desaturation and length of hospital stay (LOS).

Results: The pooled results showed that compared to the control group, optimized anesthesia management guided by intraoperative rSO2 monitoring significantly reduced the incidence of POCD within 7 days postoperatively and may reduce the incidence of POCD at 3 months and longer periods postoperatively. However, it may not reduce the incidence of POD within 7 days or longer periods postoperatively, improve MMSE scores, reduce the incidence of intraoperative cerebral desaturation, or shorten LOS. Given the substantial heterogeneity in the pooled results for MMSE scores within 7 days postoperatively and LOS, and the limited number of studies reporting the incidence of POD, POCD, and MMSE scores after 7 days postoperatively, the related results should be interpreted with caution.

Conclusions: Despite the presence of heterogeneity and the inclusion of a limited number of studies for some outcomes, it is still recommended that clinical anesthesiologists routinely perform intraoperative rSO2 monitoring and optimize intraoperative anesthesia management based on the monitoring results to maximize rSO2 and improve cerebral perfusion, thereby improving patients' neurocognitive outcomes. Further large-scale, high-quality studies are needed to confirm the conclusions of this study.