Pub Date : 2024-09-17DOI: 10.1016/j.wneu.2024.09.065
Pando Alejandro, Hanna Gabriel, Kamil Robert, Raj Jeffrey, Bryk Eli, K Liu James, Gillick John, Goldstein Ira
Introduction: CSF leaks are a known complication of lumbar fusion surgery. There is a scarcity of literature describing the management of this complication. The aim of this study was to identify patients who are at risk of requiring further intervention for managing CSF leaks.
Methods: The Nationwide Inpatient Sample (NIS) database was used to identify patients who had lumbar fusion in the United States from 2002 to 2014. Inpatient outcomes including the incidence and risk factors for requiring an intervention were calculated. Secondary outcomes including average length of stay (LOS), mean cost, and mortality rates were calculated. All statistical analyses were conducted based on multivariate regression models using the SPSS software.
Results: A total of 11,636 patients with post-operative CSF leak after elective lumbar fusion were identified in the NIS database from 2002 to 2014. Of these patients, 79.9% (9,294/11,636) required an advanced intervention including epidural blood patch, simple repair, or operative management. There was an increase of 13% per year in the use of an intervention in managing CSF leaks. After controlling for several confounding factors, independent risk factors for requiring an intervention included: older age (OR: 1.01; 95% CI: 1.005-1.013; p<0.0001), lateral approach (OR: 1.52; 95% CI: 1.26-1.81; p<0.0001) and posterior approach (OR: 1.60; 95% CI: 1.34-1.91; p<0.0001) compared to anterior approach. Nonsurgical treatment was associated with increased length of stay (5.93±4.61 vs. 5.25±3.63;p<0.0001) with similar hospitalization costs (119,537.2±89,045.6 vs. 120,277.9±87,894.1; p=0.72) and mortality (0.3% vs. 0.3%; p>0.05).
Conclusion: Spine surgeons should be aware of certain patient and procedure-specific characteristics that increase the risk of requiring an intervention for CSF leak management after lumbar fusion to improve patient outcomes.
{"title":"Managing Cerebrospinal Fluid (CSF) Leak after Lumbar Spinal Fusion: When Conservative Treatment is not the Answer?","authors":"Pando Alejandro, Hanna Gabriel, Kamil Robert, Raj Jeffrey, Bryk Eli, K Liu James, Gillick John, Goldstein Ira","doi":"10.1016/j.wneu.2024.09.065","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.065","url":null,"abstract":"<p><strong>Introduction: </strong>CSF leaks are a known complication of lumbar fusion surgery. There is a scarcity of literature describing the management of this complication. The aim of this study was to identify patients who are at risk of requiring further intervention for managing CSF leaks.</p><p><strong>Methods: </strong>The Nationwide Inpatient Sample (NIS) database was used to identify patients who had lumbar fusion in the United States from 2002 to 2014. Inpatient outcomes including the incidence and risk factors for requiring an intervention were calculated. Secondary outcomes including average length of stay (LOS), mean cost, and mortality rates were calculated. All statistical analyses were conducted based on multivariate regression models using the SPSS software.</p><p><strong>Results: </strong>A total of 11,636 patients with post-operative CSF leak after elective lumbar fusion were identified in the NIS database from 2002 to 2014. Of these patients, 79.9% (9,294/11,636) required an advanced intervention including epidural blood patch, simple repair, or operative management. There was an increase of 13% per year in the use of an intervention in managing CSF leaks. After controlling for several confounding factors, independent risk factors for requiring an intervention included: older age (OR: 1.01; 95% CI: 1.005-1.013; p<0.0001), lateral approach (OR: 1.52; 95% CI: 1.26-1.81; p<0.0001) and posterior approach (OR: 1.60; 95% CI: 1.34-1.91; p<0.0001) compared to anterior approach. Nonsurgical treatment was associated with increased length of stay (5.93±4.61 vs. 5.25±3.63;p<0.0001) with similar hospitalization costs (119,537.2±89,045.6 vs. 120,277.9±87,894.1; p=0.72) and mortality (0.3% vs. 0.3%; p>0.05).</p><p><strong>Conclusion: </strong>Spine surgeons should be aware of certain patient and procedure-specific characteristics that increase the risk of requiring an intervention for CSF leak management after lumbar fusion to improve patient outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1016/j.wneu.2024.09.059
Zhengkui Shen,Yan Zhu,Xiaotong Yan,Guofeng Wu
OBJECTIVESThe evaluation of hypomagnesemia's significance in predicting the presence of the black hole sign in patients with intracranial hemorrhage (ICH) is currently under investigation.METHODSThe study included 261 patients with cerebral hemorrhage who underwent initial skull computed tomography (CT) within 24 hours of admission.Sixty-nine patients (26.4%) exhibited hypomagnesemia in the initial laboratory examinations. The black hole sign was observed in 123 patients (referred to as the black hole sign group, which includes patients with and without hypomagnesemia), while the remaining 138 patients (non-black hole sign group) did not exhibit this feature. The values of hypomagnesemia were assessed through multivariable logistic regression analyses.RESULTSThe black hole sign occurred in 45 of the 69 (65.2%) patients with hypomagnesemia, and in 78 of the 192 (40.6%) patients without hypomagnesemia.In the black hole sign group, hypomagnesemia was observed in 45 patients (36.6%). However, only 24 patients (19.5%) from the normal magnesium concentration group exhibited hypomagnesemia.The sensitivity, specificity, and positive and negative predictive values of hypomagnesemia for predicting the black hole sign were 69.9%, 82.5%, 36.6%, and 82.8% respectively.The odds ratios for hypomagnesemia, smoking history, and hypokalemia in predicting the presence of the black hole sign were 2.74, 1.971, and 1.629 correspondingly.CONCLUSIONSThe presence of hypomagnesemia may serve as a predictive factor for the black hole sign and rebleeding in patients with intracerebral hemorrhage (ICH), thereby providing valuable guidance for clinical treatment.
{"title":"Hypomagnesemia Is Associated with the Skull CT Black Hole Sign in Patients with Spontaneous Intracerebral Hemorrhage.","authors":"Zhengkui Shen,Yan Zhu,Xiaotong Yan,Guofeng Wu","doi":"10.1016/j.wneu.2024.09.059","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.059","url":null,"abstract":"OBJECTIVESThe evaluation of hypomagnesemia's significance in predicting the presence of the black hole sign in patients with intracranial hemorrhage (ICH) is currently under investigation.METHODSThe study included 261 patients with cerebral hemorrhage who underwent initial skull computed tomography (CT) within 24 hours of admission.Sixty-nine patients (26.4%) exhibited hypomagnesemia in the initial laboratory examinations. The black hole sign was observed in 123 patients (referred to as the black hole sign group, which includes patients with and without hypomagnesemia), while the remaining 138 patients (non-black hole sign group) did not exhibit this feature. The values of hypomagnesemia were assessed through multivariable logistic regression analyses.RESULTSThe black hole sign occurred in 45 of the 69 (65.2%) patients with hypomagnesemia, and in 78 of the 192 (40.6%) patients without hypomagnesemia.In the black hole sign group, hypomagnesemia was observed in 45 patients (36.6%). However, only 24 patients (19.5%) from the normal magnesium concentration group exhibited hypomagnesemia.The sensitivity, specificity, and positive and negative predictive values of hypomagnesemia for predicting the black hole sign were 69.9%, 82.5%, 36.6%, and 82.8% respectively.The odds ratios for hypomagnesemia, smoking history, and hypokalemia in predicting the presence of the black hole sign were 2.74, 1.971, and 1.629 correspondingly.CONCLUSIONSThe presence of hypomagnesemia may serve as a predictive factor for the black hole sign and rebleeding in patients with intracerebral hemorrhage (ICH), thereby providing valuable guidance for clinical treatment.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Magnetic resonance guided laser interstitial thermal therapy (MRgLITT) is a new minimally invasive treatment for Tuberous Sclerosis Complex (TSC) associated epilepsy in children. This video describes a case of a 17-year-old girl with TSC-associated drug resistant epilepsy treated with robotic-assisted MRgLITT. In our case, MRgLITT was safe and effective in simultaneous targeting multiple epileptic tubers in one single procedure, leading to a marked decrease in seizure frequency. MRgLITT could be a promising and more appealing treatment option for children who may need multiple surgeries over their lifetime due to the progressive nature of TSC.
{"title":"Simultaneous robotic-assisted laser thermal ablation of multiple cortical tubers for drug-resistant epilepsy in a 17-year-old patient with Tuberous Sclerosis Complex.","authors":"Nicola Onorini,Giuseppe Mirone,Domenico Cicala,Pietro Spennato,Alfonso Rubino,Pia Bernardo,Carmela Russo,Claudio Ruggiero,Eugenio Covelli,Giuseppe Cinalli","doi":"10.1016/j.wneu.2024.09.055","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.055","url":null,"abstract":"Magnetic resonance guided laser interstitial thermal therapy (MRgLITT) is a new minimally invasive treatment for Tuberous Sclerosis Complex (TSC) associated epilepsy in children. This video describes a case of a 17-year-old girl with TSC-associated drug resistant epilepsy treated with robotic-assisted MRgLITT. In our case, MRgLITT was safe and effective in simultaneous targeting multiple epileptic tubers in one single procedure, leading to a marked decrease in seizure frequency. MRgLITT could be a promising and more appealing treatment option for children who may need multiple surgeries over their lifetime due to the progressive nature of TSC.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVEFlow diverters (FDs) carry the risk of thromboembolic complications associated with the device and bleeding complications associated with dual antiplatelet therapy. We hypothesize that an antithrombotic surface coated flow diverter(BSCFD) would have less acute thrombus formation and better endothelialization on the device surface compared to uncoated flow diverter.METHODSAn antithrombotic surface coated FD(BSCFD) was developed. Acute clot formation and chronic endothelialization over the device were assessed in 8 rabbit models comparing to its prototype FD(PFD) at 2 hours and 1 month by Scanning Electron Microscopy(SEM) and Histologic images. Nonparametric score data, including thrombus, injury, endothelialization, adventitial inflammation, intramural bleeding and intimal hyperplasia were compared between BSCFD and PFD using Kendall coefficient of rank correlation.RESULTSParent artery and branch artery were patent on DSA in 8 BSCFDs and 6 PFDs. There was 1 intra-stent thrombosis in PFDs at 2 hours and 1 intra-stent stenosis in PFD at 1 month. SEM at 2 hours showed that large amount of blood cells adhered to the surface of all 4 PFDs, and no blood cells were found on the surface of all 4 BSCFDs. At SEM and histological analysis of 1 month, there were less inflammation(Kendall's Tau-B=-0.818, p=0.022), less vessel wall injury(Kendall's Tau-B=-0.764, p=0.032)and better endothelialization(Kendall's Tau-B=0.818, p=0.022) in BSCFDs.CONCLUSIONIn the rabbit model, the BSCFD is associated with less thrombus formation at acute stage, less inflammation, less vessel injury and better endothelialization on the device surface compared to the PFD.
{"title":"Evaluation of an antithrombotic surface coated flow diverter in rabbit model.","authors":"Xianli Lv,Huachen Zhang,Weiming Kong,Shikai Liang,Hongyu Zhang","doi":"10.1016/j.wneu.2024.09.060","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.060","url":null,"abstract":"OBJECTIVEFlow diverters (FDs) carry the risk of thromboembolic complications associated with the device and bleeding complications associated with dual antiplatelet therapy. We hypothesize that an antithrombotic surface coated flow diverter(BSCFD) would have less acute thrombus formation and better endothelialization on the device surface compared to uncoated flow diverter.METHODSAn antithrombotic surface coated FD(BSCFD) was developed. Acute clot formation and chronic endothelialization over the device were assessed in 8 rabbit models comparing to its prototype FD(PFD) at 2 hours and 1 month by Scanning Electron Microscopy(SEM) and Histologic images. Nonparametric score data, including thrombus, injury, endothelialization, adventitial inflammation, intramural bleeding and intimal hyperplasia were compared between BSCFD and PFD using Kendall coefficient of rank correlation.RESULTSParent artery and branch artery were patent on DSA in 8 BSCFDs and 6 PFDs. There was 1 intra-stent thrombosis in PFDs at 2 hours and 1 intra-stent stenosis in PFD at 1 month. SEM at 2 hours showed that large amount of blood cells adhered to the surface of all 4 PFDs, and no blood cells were found on the surface of all 4 BSCFDs. At SEM and histological analysis of 1 month, there were less inflammation(Kendall's Tau-B=-0.818, p=0.022), less vessel wall injury(Kendall's Tau-B=-0.764, p=0.032)and better endothelialization(Kendall's Tau-B=0.818, p=0.022) in BSCFDs.CONCLUSIONIn the rabbit model, the BSCFD is associated with less thrombus formation at acute stage, less inflammation, less vessel injury and better endothelialization on the device surface compared to the PFD.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.1016/j.wneu.2024.09.062
Abhijit Goyal-Honavar, Chetan Kumar A, Dwarakanath Srinivas, Arivazhagan Arimappamagan, Andiperumal Raj Prabhuraj, Manish Beniwal, Subhas Konar, Sampath Somanna, Kannepalli V L Narasinga Rao
Background: Trigeminal neuralgia is a debilitating disease, with severe recurrent paroxysms of shock-like facial pain. Although pharmacotherapy may suffice in the majority of cases, a proportion of patients require surgical treatment. Gamma knife radiosurgery (GKRS) represents a potential non-invasive alternative to surgery in these patients.
Methods: We retrospectively analysed all patients that underwent GKRS for classic/idiopathic TN between 2013 and 2023. Pain prior to GKRS was graded per the Barrow Neurological Institute (BNI) pain score, which was also used to define outcomes. "Complete pain relief (CPR)" was defined as a BNI pain score of I or II, while "Adequate pain relief (APR)" was defined as a BNI pain score of III, and "Failure" as a BNI score of IV or V.
Results: The mean age of 70 patients (50 females and 20 males) was 47.4 ± 12.4 years. The mean follow-up was 51.3 ± 16.2 months. Although initial pain relief was achieved in 64 patients (91.4%), recurrence of pain at the latest follow-up occurred in 10 patients (14.3%). Overall, 41 patients (58.6%) achieved CPR, while 13 patients (18.6%) achieved APR. Multivariate analysis revealed that multiple prior failed procedures for TN predicted failure of pain relief.
Conclusion: GKRS is effective among patients with classic/idiopathic TN, with complete pain relief in 58.6% of patients, and adequate pain relief in 18.6% of patients. The most frequent complication is facial hypesthesia, affecting 38.6% of patients. Multiple prior failed procedures for TN significantly predict failure of pain relief at latest follow-up.
背景:三叉神经痛是一种使人衰弱的疾病,会反复发作剧烈的冲击样面部疼痛。虽然药物治疗可满足大多数病例的需要,但仍有一部分患者需要手术治疗。伽玛刀放射外科(GKRS)是这些患者手术治疗的潜在非侵入性替代方法:我们回顾性分析了2013年至2023年期间因典型/特发性TN而接受伽玛刀放射外科治疗的所有患者。GKRS前的疼痛根据巴罗神经研究所(Barrow Neurological Institute,BNI)的疼痛评分进行分级,该评分也用于定义结果。"完全缓解疼痛(CPR)"定义为 BNI 疼痛评分为 I 级或 II 级,"充分缓解疼痛(APR)"定义为 BNI 疼痛评分为 III 级,"失败 "定义为 BNI 评分为 IV 级或 V 级:70 名患者(50 名女性和 20 名男性)的平均年龄为 47.4±12.4 岁。平均随访时间为 51.3 ± 16.2 个月。虽然 64 名患者(91.4%)的最初疼痛得到缓解,但 10 名患者(14.3%)在最近一次随访时疼痛复发。总体而言,41 名患者(58.6%)实现了 CPR,13 名患者(18.6%)实现了 APR。多变量分析显示,之前多次失败的 TN 手术预示着疼痛缓解失败:GKRS对典型/特发性TN患者有效,58.6%的患者疼痛完全缓解,18.6%的患者疼痛充分缓解。最常见的并发症是面部感觉减退,影响了38.6%的患者。在最近的随访中,多次TN手术失败可明显预示疼痛缓解失败。
{"title":"Efficacy and Safety Profile of Gamma Knife Radiosurgery in Classic and Idiopathic Trigeminal Neuralgia.","authors":"Abhijit Goyal-Honavar, Chetan Kumar A, Dwarakanath Srinivas, Arivazhagan Arimappamagan, Andiperumal Raj Prabhuraj, Manish Beniwal, Subhas Konar, Sampath Somanna, Kannepalli V L Narasinga Rao","doi":"10.1016/j.wneu.2024.09.062","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.062","url":null,"abstract":"<p><strong>Background: </strong>Trigeminal neuralgia is a debilitating disease, with severe recurrent paroxysms of shock-like facial pain. Although pharmacotherapy may suffice in the majority of cases, a proportion of patients require surgical treatment. Gamma knife radiosurgery (GKRS) represents a potential non-invasive alternative to surgery in these patients.</p><p><strong>Methods: </strong>We retrospectively analysed all patients that underwent GKRS for classic/idiopathic TN between 2013 and 2023. Pain prior to GKRS was graded per the Barrow Neurological Institute (BNI) pain score, which was also used to define outcomes. \"Complete pain relief (CPR)\" was defined as a BNI pain score of I or II, while \"Adequate pain relief (APR)\" was defined as a BNI pain score of III, and \"Failure\" as a BNI score of IV or V.</p><p><strong>Results: </strong>The mean age of 70 patients (50 females and 20 males) was 47.4 ± 12.4 years. The mean follow-up was 51.3 ± 16.2 months. Although initial pain relief was achieved in 64 patients (91.4%), recurrence of pain at the latest follow-up occurred in 10 patients (14.3%). Overall, 41 patients (58.6%) achieved CPR, while 13 patients (18.6%) achieved APR. Multivariate analysis revealed that multiple prior failed procedures for TN predicted failure of pain relief.</p><p><strong>Conclusion: </strong>GKRS is effective among patients with classic/idiopathic TN, with complete pain relief in 58.6% of patients, and adequate pain relief in 18.6% of patients. The most frequent complication is facial hypesthesia, affecting 38.6% of patients. Multiple prior failed procedures for TN significantly predict failure of pain relief at latest follow-up.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.1016/j.wneu.2024.09.063
Marcio de Mendonça Cardoso, Ricardo Felipe, Paulo Araujo, Ricardo Gepp, Andreia Gushiken, Enio Comerlato
{"title":"Insights into the Medial Pectoral Nerve Transfer for Shoulder Abduction in Brachial Plexus Injuries: A Retrospective Case Series Analysis.","authors":"Marcio de Mendonça Cardoso, Ricardo Felipe, Paulo Araujo, Ricardo Gepp, Andreia Gushiken, Enio Comerlato","doi":"10.1016/j.wneu.2024.09.063","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.063","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.1016/j.wneu.2024.09.061
Gavin M Lockard, Keaton Piper, Zeegan George, Adam Alayli, Elliot Neal, Farina Klocksieben, Nour Shaheen, Oliver Flouty
Objective: Arachnoid cysts are benign, intradural collections of cerebrospinal fluid that are often asymptomatic but, in rare instances, will grow and may cause symptoms. When these are in the posterior fossa, the symptomatology greatly ranges, and the indications for surgery are not well defined. The objective of this study is to examine radiographic and symptomatic outcomes following surgery for posterior fossa arachnoid cysts (PFAC).
Methods: A literature review was performed utilizing PubMed for all studies involving ≥ 5 patients with PFACs who underwent surgery. A single-arm meta-analysis was performed to assess the postoperative radiographic improvement. Given the heterogeneous variety of presenting symptoms, these were not conducive to meta-analyses but the outcomes are reported in detail.
Results: Nine publications with 67 patients met inclusion criteria. Excision/fenestration was the most common operation (n=60). Less common included CP shunts (n=2), concurrent excision/fenestration and ETV (n=4), and one patient who underwent concurrent VP/CP shunts. This literature review revealed improvement of headache in 90% of patients; 88% with cerebellar symptoms; 92% with nausea/emesis; 78% with hearing loss; 60% with tinnitus; and 91% with vision deficits. Meta-analysis of seven studies reporting postoperative radiographic size demonstrated that 75% of people experienced decreased PFAC size (Effect Size: 0.75, 95% CI: 0.50-0.94).
Conclusions: Although there is a high rate of radiographic improvement for PFAC surgery, there is a wide variety of presenting symptoms with differing postoperative improvement rates. This study reinforces the importance of preoperative counseling regarding symptomatic outcomes for PFAC surgery, with supporting statistical analysis but limited by the sample sizes available.
{"title":"Symptomatic and Radiographic Improvement Following Surgery for Posterior Fossa Arachnoid Cysts: Meta-Analysis and Literature Review.","authors":"Gavin M Lockard, Keaton Piper, Zeegan George, Adam Alayli, Elliot Neal, Farina Klocksieben, Nour Shaheen, Oliver Flouty","doi":"10.1016/j.wneu.2024.09.061","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.061","url":null,"abstract":"<p><strong>Objective: </strong>Arachnoid cysts are benign, intradural collections of cerebrospinal fluid that are often asymptomatic but, in rare instances, will grow and may cause symptoms. When these are in the posterior fossa, the symptomatology greatly ranges, and the indications for surgery are not well defined. The objective of this study is to examine radiographic and symptomatic outcomes following surgery for posterior fossa arachnoid cysts (PFAC).</p><p><strong>Methods: </strong>A literature review was performed utilizing PubMed for all studies involving ≥ 5 patients with PFACs who underwent surgery. A single-arm meta-analysis was performed to assess the postoperative radiographic improvement. Given the heterogeneous variety of presenting symptoms, these were not conducive to meta-analyses but the outcomes are reported in detail.</p><p><strong>Results: </strong>Nine publications with 67 patients met inclusion criteria. Excision/fenestration was the most common operation (n=60). Less common included CP shunts (n=2), concurrent excision/fenestration and ETV (n=4), and one patient who underwent concurrent VP/CP shunts. This literature review revealed improvement of headache in 90% of patients; 88% with cerebellar symptoms; 92% with nausea/emesis; 78% with hearing loss; 60% with tinnitus; and 91% with vision deficits. Meta-analysis of seven studies reporting postoperative radiographic size demonstrated that 75% of people experienced decreased PFAC size (Effect Size: 0.75, 95% CI: 0.50-0.94).</p><p><strong>Conclusions: </strong>Although there is a high rate of radiographic improvement for PFAC surgery, there is a wide variety of presenting symptoms with differing postoperative improvement rates. This study reinforces the importance of preoperative counseling regarding symptomatic outcomes for PFAC surgery, with supporting statistical analysis but limited by the sample sizes available.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.1016/j.wneu.2024.08.131
Gabriel Flores-Milan, César Carballo Cuello, Elliot Pressman, Gersham Rainone, Jenna Marek, Adolfo Viloria Hidalgo, Alexander Haas, Erik Hayman, Puya Alikhani
Introduction: Radiographic ASD ranges from 10% to 84%, depending on technique. Occurrence of symptomatic ASD is lower, with a range of 1.9% to 13%. ASD can be very debilitating and necessitate further procedures, leading to high morbidity. Herein, we explore the occurrence of adjacent segment disease when performing anterior column release in lateral interbody fusion.
Methods: After IRB approval, 120 total patients who underwent LLIF at our facility from 2013 to 2020 were retrospectively reviewed, allowing for a minimum of 3 years for follow up time. Surgical variables and spinopelvic parameters were measured and collected by our team. Statistical measures of significance were calculated using IBM SPSS Statistics Version 29.
Results: 120 total patients were included. 73.3% of patients had percutaneous screws, and 11.7% had open. 13 patients underwent LLIF with ACR. The mean LL was 50.1± 12.9, PI was 52.8 ± 11.2, SS was 33.6± 9.2, PT was 18.1 ± 6.8, and SVA was 6.8 mm ± 30.5. 24 total patients had ASD after LLIF. In univariable analysis, ACR (P<0.001) and PI-LL Mismatch (P<0.035) were risk factors for developing ASD. In multivariable analysis, greater PI-LL mismatch was predictive of ASD (p<0.005, OR=1.097, and 95% CI=1.029-1.171), as was ACR (p<0.001, OR=9.667, and 95% CI=2.669-35.09).
Conclusion: Higher PI-LL mismatch after lumbar interbody fusion, and performance of an ACR during LLIF increased the likelihood of developing symptomatic ASD in our patients. Considering ACR to achieve the goal of correcting spinopelvic parameters should be carefully evaluated when undertaking a lateral approach.
{"title":"Lateral Anterior Column Release in Short Lumbar Fusion… Is it worth it?","authors":"Gabriel Flores-Milan, César Carballo Cuello, Elliot Pressman, Gersham Rainone, Jenna Marek, Adolfo Viloria Hidalgo, Alexander Haas, Erik Hayman, Puya Alikhani","doi":"10.1016/j.wneu.2024.08.131","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.08.131","url":null,"abstract":"<p><strong>Introduction: </strong>Radiographic ASD ranges from 10% to 84%, depending on technique. Occurrence of symptomatic ASD is lower, with a range of 1.9% to 13%. ASD can be very debilitating and necessitate further procedures, leading to high morbidity. Herein, we explore the occurrence of adjacent segment disease when performing anterior column release in lateral interbody fusion.</p><p><strong>Methods: </strong>After IRB approval, 120 total patients who underwent LLIF at our facility from 2013 to 2020 were retrospectively reviewed, allowing for a minimum of 3 years for follow up time. Surgical variables and spinopelvic parameters were measured and collected by our team. Statistical measures of significance were calculated using IBM SPSS Statistics Version 29.</p><p><strong>Results: </strong>120 total patients were included. 73.3% of patients had percutaneous screws, and 11.7% had open. 13 patients underwent LLIF with ACR. The mean LL was 50.1± 12.9, PI was 52.8 ± 11.2, SS was 33.6± 9.2, PT was 18.1 ± 6.8, and SVA was 6.8 mm ± 30.5. 24 total patients had ASD after LLIF. In univariable analysis, ACR (P<0.001) and PI-LL Mismatch (P<0.035) were risk factors for developing ASD. In multivariable analysis, greater PI-LL mismatch was predictive of ASD (p<0.005, OR=1.097, and 95% CI=1.029-1.171), as was ACR (p<0.001, OR=9.667, and 95% CI=2.669-35.09).</p><p><strong>Conclusion: </strong>Higher PI-LL mismatch after lumbar interbody fusion, and performance of an ACR during LLIF increased the likelihood of developing symptomatic ASD in our patients. Considering ACR to achieve the goal of correcting spinopelvic parameters should be carefully evaluated when undertaking a lateral approach.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.1016/j.wneu.2024.09.048
Isabela Costola Windlin, Bruno Braga Sisnando da Costa, João Paulo Mota Telles, Leonardo B Oliveira, Edwin Koterba, Vitor Nagai Yamaki, Nicollas Nunes Rabelo, Davi Jorge Fontoura Solla, Manoel Jacobsen Teixeira, Eberval Gadelha Figueiredo
Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with a high incidence of long-term cognitive impairment, decreased quality of life (QoL), and psychiatric disorders. The effects of glibenclamide on such outcomes in the setting of aSAH is unknown.
Objective: To assess the impact of glibenclamide in patients with aSAH on cognitive performance, QoL, and emotional aspects.
Methods: Patients identified with aSAH were randomly allocated to receive 5mg of glibenclamide for 21 days or placebo, starting within 96 hours of the ictus. After six months, patients were evaluated with MoCA test (cognitive performance), SF-36 (QoL), and HADS and SPTSS (emotional aspects).
Results: The mean MoCA score was 22.5 ± 6.2. No statistically significant difference was found between groups, with a mean score of 21.7 ± 6.4 in the Glibeclamide group and 23.4 ± 6.2 in the placebo group (p=0.392). A score <23 was observed in 16 patients (35.6%) and its frequency was similar between groups (p=0.900). The most frequently impaired domains were Attention (N=21/45; 46.7%) and Visuospatial (18/45; 40.0%). Impairment of each domain was similar between groups (p>0.05). In each domain, the mean score was similar between groups (p>0.05). The HADS scores did not differ between groups (p>0.05). The mean SPTSS score as well as the mean scores of its domains were similar between groups (p>0.05).
Conclusions: Glibenclamide did not improve cognitive performance, QoL, and emotional aspects after six months of follow-up of aSAH survivors.
{"title":"THE EFFECTS OF GLIBENCLAMIDE ON COGNITIVE PERFORMANCE, QUALITY OF LIFE, AND EMOTIONAL ASPECTS AMONG PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE: A RANDOMIZED CONTROLLED TRIAL.","authors":"Isabela Costola Windlin, Bruno Braga Sisnando da Costa, João Paulo Mota Telles, Leonardo B Oliveira, Edwin Koterba, Vitor Nagai Yamaki, Nicollas Nunes Rabelo, Davi Jorge Fontoura Solla, Manoel Jacobsen Teixeira, Eberval Gadelha Figueiredo","doi":"10.1016/j.wneu.2024.09.048","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.048","url":null,"abstract":"<p><strong>Introduction: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) is associated with a high incidence of long-term cognitive impairment, decreased quality of life (QoL), and psychiatric disorders. The effects of glibenclamide on such outcomes in the setting of aSAH is unknown.</p><p><strong>Objective: </strong>To assess the impact of glibenclamide in patients with aSAH on cognitive performance, QoL, and emotional aspects.</p><p><strong>Methods: </strong>Patients identified with aSAH were randomly allocated to receive 5mg of glibenclamide for 21 days or placebo, starting within 96 hours of the ictus. After six months, patients were evaluated with MoCA test (cognitive performance), SF-36 (QoL), and HADS and SPTSS (emotional aspects).</p><p><strong>Results: </strong>The mean MoCA score was 22.5 ± 6.2. No statistically significant difference was found between groups, with a mean score of 21.7 ± 6.4 in the Glibeclamide group and 23.4 ± 6.2 in the placebo group (p=0.392). A score <23 was observed in 16 patients (35.6%) and its frequency was similar between groups (p=0.900). The most frequently impaired domains were Attention (N=21/45; 46.7%) and Visuospatial (18/45; 40.0%). Impairment of each domain was similar between groups (p>0.05). In each domain, the mean score was similar between groups (p>0.05). The HADS scores did not differ between groups (p>0.05). The mean SPTSS score as well as the mean scores of its domains were similar between groups (p>0.05).</p><p><strong>Conclusions: </strong>Glibenclamide did not improve cognitive performance, QoL, and emotional aspects after six months of follow-up of aSAH survivors.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.1016/j.wneu.2024.09.054
Bo Zhang, Xiongfei Wang, Jing Wang, Mengyang Wang, Yuguang Guan, Zhao Liu, Yao Zhang, Meng Zhao, Haoran Ding, Ke Xu, Jiahui Deng, Tianfu Li, Guoming Luan, Jian Zhou
Purpose: Anterior temporal lobectomy (ATL) is the most common surgical treatment for temporal lobe epilepsy (TLE), and Stereoelectroencephalography (SEEG) plays a critical role in precisely localizing the epileptogenic zone (EZ). This study aimed to explore the effect of SEEG on the long-term outcomes of different side ATL.
Methods: From March 2012 to February 2020, a retrospective analysis was conducted on 231 TLE patients who underwent standard ATL surgery. According to the surgical sides and the utilization of SEEG during preoperative evaluation, the patients were categorized into four groups, with a follow-up period exceeding two years.
Results: Among the 231 TLE patients, the probability of being seizure-free two years after the surgery was 80.52%, which decreased to 65.65% after five years. There was no significant difference in outcomes between SEEG and non-SEEG patients. For overall and non-SEEG patients, there was no significant difference in short-term outcomes between different surgical sides. However, the long-term outcomes of right ATL patients were significantly better than left. Interestingly, for patients who underwent SEEG, there was no significant difference in both short-term and long-term outcomes between different surgical sides.
Conclusion: Some TLE patients encounter challenges in localizing the EZ through non-invasive evaluation, necessitating the use of SEEG for precise localization. Furthermore, their seizure outcomes after surgery can be the same with the patients who have a clear epileptogenic zone in non-invasive evaluation. And SEEG patients can achieve a more stable long-term prognosis than non-SSEEG patients.
{"title":"The effect of SEEG on the long-term outcomes of different side anterior temporal lobectomy: A single-center retrospective study.","authors":"Bo Zhang, Xiongfei Wang, Jing Wang, Mengyang Wang, Yuguang Guan, Zhao Liu, Yao Zhang, Meng Zhao, Haoran Ding, Ke Xu, Jiahui Deng, Tianfu Li, Guoming Luan, Jian Zhou","doi":"10.1016/j.wneu.2024.09.054","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.054","url":null,"abstract":"<p><strong>Purpose: </strong>Anterior temporal lobectomy (ATL) is the most common surgical treatment for temporal lobe epilepsy (TLE), and Stereoelectroencephalography (SEEG) plays a critical role in precisely localizing the epileptogenic zone (EZ). This study aimed to explore the effect of SEEG on the long-term outcomes of different side ATL.</p><p><strong>Methods: </strong>From March 2012 to February 2020, a retrospective analysis was conducted on 231 TLE patients who underwent standard ATL surgery. According to the surgical sides and the utilization of SEEG during preoperative evaluation, the patients were categorized into four groups, with a follow-up period exceeding two years.</p><p><strong>Results: </strong>Among the 231 TLE patients, the probability of being seizure-free two years after the surgery was 80.52%, which decreased to 65.65% after five years. There was no significant difference in outcomes between SEEG and non-SEEG patients. For overall and non-SEEG patients, there was no significant difference in short-term outcomes between different surgical sides. However, the long-term outcomes of right ATL patients were significantly better than left. Interestingly, for patients who underwent SEEG, there was no significant difference in both short-term and long-term outcomes between different surgical sides.</p><p><strong>Conclusion: </strong>Some TLE patients encounter challenges in localizing the EZ through non-invasive evaluation, necessitating the use of SEEG for precise localization. Furthermore, their seizure outcomes after surgery can be the same with the patients who have a clear epileptogenic zone in non-invasive evaluation. And SEEG patients can achieve a more stable long-term prognosis than non-SSEEG patients.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}