World neurosurgery最新文献

Background: With the increasing use of polymethyl methacrylate (PMMA) for vertebral augmentation, the complications caused by PMMA have also increased. In order to avoid the complications, metal stents combined with artificial bone are currently used in clinical practice for vertebral augmentation. We conducted finite element analysis on the biomechanical differences between metal stents combined with artificial bone versus PMMA on adjacent vertebrae and intervertebral discs, in order to find whether metal stents combined with artificial bone have more advantages.

Methods: Finite element models of a functional spinal unit from T11 to L1 were created based on computed tomography data. The T12 vertebra was augmented using three different materials: one metal stent with artificial bone, two metal stents with artificial bone, and PMMA. The model assumed fixation of the lower endplate of L1. A 350 N follower load was applied at the centre of the upper endplate of T11, with flexion, extension, lateral bending, and axial rotation under a 7.5 Nm moment.

Results: Compared to the PMMA augmentation model, the maximum von Mises stress within the augmented vertebra significantly increased with metal stents combined with artificial bone. Meanwhile, the augmentation materials in the vertebral body among the three models showed no significant difference. Furthermore, compared to the PMMA augmentation model, metal stents combined with artificial bone models exhibited reduced stress on adjacent vertebrae and intervertebral discs during flexion-extension and lateral bending. No significant biomechanical differences were observed between one or two metal stents combined with artificial bone models.

Conclusions: Metal stents combined with artificial bone and PMMA can enhance the strength and rigidity of the augmented vertebra, aiding reconstruction of vertebral function. Metal stents combined with artificial bone offer biomechanical advantages over PMMA for adjacent vertebrae and intervertebral discs.

It is imperative to conduct extensive research to elucidate the intricate relationship between neuropathological biomarkers and neonatal sepsis, which represents an intriguing and significant subject for exploration. Such research will enhance our comprehension of the underlying neuropathological mechanisms and potentially identify biomarkers that could facilitate the diagnosis of nSAE and inform treatment decisions. Integrating neuropathological biomarkers into diagnostic protocols may provide a more thorough understanding of the impact of sepsis on the brain, thereby aiding in the early detection and improved management of neurological complications, ultimately leading to more targeted and efficacious therapeutic interventions.

Importance: Ventriculoperitoneal shunt implantation provides immediate improvement in hydrocephalus management; however, it is associated with various complications, including infection and shunt malfunction.

Objective: We systematically reviewed studies on patients of all ages who received ventriculoperitoneal shunts for managing hydrocephalus. The prevalence, severity, risk factors, and management of adverse dermatological effects were assessed.

Evidence review: To find relevant studies, PubMed, Scopus, Google Scholar, and Web of Science were searched from their inception to April 2023. Medical subject headings, including "ventriculoperitoneal shunt" and "skin diseases" were searched as keywords. All studies that investigated the adverse effects of ventriculoperitoneal shunts on the skin were included. The strength of the included studies was assessed according to the modified version of the Oxford Centre for Evidence-Based Medicine.

Findings: 29 articles, including 35 cases, were reviewed. Complications such as infection, allergies, skin breakdown, metastases due to underlying cancer, and breast-related problems occurred within days to 36 years after shunt insertion or the last revision. These common complications can be aggravated by underlying conditions, including previous surgeries, cancer, malnutrition, and breast implants.

Conclusions and relevance: Dermatological complications of ventriculoperitoneal shunts are important to consider because they can significantly impact patient care. Promoting interdisciplinary collaboration among healthcare professionals is essential to facilitate the early identification and management of potential complications.

Background: Recent studies have shown that inflammation plays a crucial role in the progression of cauda equina syndrome(CES). However, the exact cause-and-effect relationship between them is still unclear.

Methods: We utilized CES data from the FinnGen genome wide association study (GWAS), containing 329 cases and 408,351 controls. Inflammatory proteins data was obtained from a large scale GWAS of 14,828 European ancestry participants and inflammatory cells data was obtained from a GWAS summary of 3,757 Sardinians. We chose Inverse variance weighted (IVW) as main method and the Cochrane Q test to assess heterogeneity in the results. The MR-Egger intercept test and MR pleiotropy residual sum and outliers (MR-PRESSO) test were used to evaluate the horizontal pleiotropy and sensitivity analysis was performed by leave-one-out analysis.

Results: We examined robust associations between inflammatory proteins, inflammatory cells and CES using Mendelian randomization. 2 inflammatory proteins and 12 inflammatory cells were found as risk factors for CES: IL-8 and PD-L1;basophil plasmacytoid dendritic cell, CD86+plasmacytoid dendritic cell, CD62L-plasmacytoid dendritic cell, CD39+secreting Treg, IgD+CD38-B cell, switched memory B cell, IgD+CD24+B cell, CD62L+dendritc cell, CD4+T cell, γδ T cell and CD33dim HLA DR- myeloid cell. While 2 inflammatory proteins and 7 inflammatory cells were found as protective factors for CES: IL-10RA and CCL25; transitional B cell, terminal differentiation double negative T cell, CD28-CD127-CD25++CD8br T cell, IgD+CD38br B cell, CD28+CD45RA-CD8br Treg, IgD+CD38-naive B cell and granulocyte. Heterogeneity and pleiotropy analysis confirmed the reliability of the results. Our study reveals the causal relationship between inflammatory proteins, inflammatory cells and CES, offering new insights for the development of future therapeutic drugs and early warning indicators.

Conclusion: Our findings extend genetic research to causal analysis between inflammatory proteins, cells and CES. We found 2 proteins and 12 cells as risk factors as well as 2 proteins and 7cells as protective factors. Further investigations are needed to verify whether these inflammation markers can be used to prevent or treat CES.

Background: Lumbar disc herniation (LDH) is a common cause of back and leg pain. Diagnosis relies on clinical history, physical exam, and imaging, with magnetic resonance imaging (MRI) being an important reference standard. While artificial intelligence (AI) has been explored for MRI image recognition in LDH, existing methods often focus solely on disc herniation presence.

Methods: We retrospectively analyzed MRI images from patients assessed for surgery by specialists. We then trained deep learning convolutional neural networks to detect LDH on MRI images. This study compared pure AI, pure human, and AI-assisted approaches for diagnosis accuracy and decision time. Statistical analysis evaluated each method's effectiveness.

Results: Our approach demonstrated the potential of deep learning to aid LDH diagnosis and treatment. The AI-assisted group achieved the highest accuracy (94.7%), outperforming both pure AI and pure human approaches. AI integration reduced decision time without compromising accuracy.

Conclusions: Convolutional neural networks effectively assist specialists in initial LDH diagnosis and treatment decisions based on MRI images. This synergy between AI and human expertise improves diagnostic accuracy and efficiency, highlighting the value of AI-assisted diagnosis in clinical practice.

Background: Meningiomas can be embolized to facilitate safe tumor resection. However, the procedure may be associated with complications that have not been well-characterized. We aimed to compare the safety of liquid versus particulate agents and to assess the safety of embolization using internal carotid artery (ICA) branches.

Methods: Studies evaluating outcomes of preoperative meningioma embolization from 1974 to 2024 were systematically searched on PubMed, Embase, and Scopus. Data on embolic agents used, feeder arteries embolized, and complication outcomes were extracted. Complication rates were statistically compared using Z-scores calculated from the standard errors of the pooled rates.

Results: The meta-analysis encompassed 3,069 patients from 50 studies. Embolization appears safe with an overall complication rate of 3.2% (95% CI: 2.4-4.0%) and a permanent neurological deficit rate of only 1.2% (0.8-1.6%). Overall complication rates were comparable between liquid (4.1%, 1.8-6.5%) and particulate agents (2.7%, 1.7-3.6%) (P = 0.28). The rate of tumor edema causing neurologic deficits was slightly higher for liquid agents (2.4%, 0.6-4.2%) compared to particulate agents (0.5%, 0.2-0.8%) (P = 0.041). No significant differences were observed in hemorrhagic (liquid 2.3%, particulate 0.7%; P = 0.087) or ischemic complications (liquid 1.6%, particulate 1.1%; P = 0.53). For the carotid systems embolized, the pooled complication rate for ICA branches embolization (5.2%, 1.1-9.2%) was comparable to the pooled complication rate of external carotid artery embolization (2.5%, 1.8-3.2%) (P = 0.20).

Conclusions: Preoperative embolization is a safe adjunct for meningioma resection, with similarly low complication rates for liquid and particulate agents. Furthermore, embolization of ICA branches can be as safe as external carotid artery branches in select cases.

Objective: Posterior Interbody fusion can be associated to adjacent segment disease (ASD) some years after surgery. The aim of this study is to confirm the rate of ASD in isthmic spondylolisthesis treated by posterior fusion.

Methods: Patients treated by posterior lumbar fusion were collected between January 2014 to June 2022. Inclusion criteria encompassed adults diagnosed with isthmic spondylolisthesis and available preoperative, postoperative, and FU radiological images.

Results: Out of the 140 patients included in the study, the majority were female (53.6%) with a mean age of 48.5 years. In 111 (79.3%) patients the spondylolisthesis was located at L5-S1; in 20 (14.3%) patients at L4-L5; 5 (3.6%) cases presented the defect at L4-L5-S1, and in 4 (2.8%) cases at L3-L4. In 75 (53.6%) patients, the listhesis was classified as Grade I (Meyerding); in 50 (35.7%) cases as Grade II; in 12 (8.6%) cases as Grade III; and in 3 (2.1%) cases as Grade IV. The average follow-up of this study was 67 (10-111) months. Two cases (1.43%, 95% CI: 0.17%-5.07%) of ASD were observed. Evaluations of clinical symptoms revealed a notable reduction in the average Numeric Rating Scale (NRS) score from 8 to 1.9 at the last follow-up. Postoperative PI-LL mismatch < 10 correlating with a favorable outcome (NRS ≤ 3).

Conclusions: This study confirms data already present in the literature regarding the low incidence of ASD in patients who underwent surgery for isthmic spondylolisthesis. The posterior approach seems to remain a safe and effective technique in these patients.

Introduction: Artificial intelligence (AI) has become an increasingly prominent tool in the field of neurosurgery, revolutionizing various aspects of patient care and surgical practices. AI-powered systems can provide real-time feedback to surgeons, enhancing precision and reducing the risk of complications during surgical procedures. The objective of this study is to review the role of AI in training neurosurgical residents, improving accuracy during surgery and reducing complications.

Methods: The literature search method involved searching PubMed using relevant keywords to identify English literature publications, including full texts, and concerning human subject matter from its inception until May 2024, initially generating 247,747 results. Articles were then screened for topic relevancy by abstract contents. Further articles were retrieved from the sources cited by the initially reviewed articles. A comprehensive review was then performed on various studies, including observational studies, case-control studies, cohort studies, clinical trials, meta-analyses, and reviews by 4 reviewers individually and then collectively.

Results: Studies on AI in neurosurgery reach more than 4,000 produced over a decade alone. The majority of studies regarding clinical diagnosis, risk prediction, and intraoperative guidance remain retrospective in nature. In its current form, AI based paradigm performed inferiorly to neurosurgery residents in test taking.

Conclusion: AI has potential for broad applications in neurosurgery from use as a diagnostic, predictive, intraoperative, or educational tool. Further research is warranted for prospective use of AI based technology for delivery of neurosurgical care.