World neurosurgery最新文献

Background: Deep brain stimulation (DBS) is a well-established treatment for Parkinson's disease (PD). However, infection following DBS surgery is a serious complication that can lead to the recurrence and worsening of Parkinson's symptoms or related hardware re-implantation, causing considerable patient suffering and financial burden.

Objective: This study aims to compare the therapeutic efficiency of different treatment approaches for scalp incision infections after DBS surgery in PD patients.

Methods: We conducted a retrospective review of patients with Parkinson's disease who experienced scalp infections following deep brain stimulation at our hospital between January 2017 and December 2021. The patients were divided into two groups based on whether affected implants were removed or not. Fisher's exact test was applied to compare the reinfection rates between groups A and B.

Results: In group A, four patients underwent debridement only, and all of them experienced reinfection between 2-25 months after the initial treatment. In group B, nine patients underwent debridement and removal of potentially affected implants. Among them, eight patients underwent re-implantation of the DBS device within 3-6 months after the initial treatment, and no cases of reinfection occurred. However, one patient experienced reinfection in the postauricular incision and percutaneous tunnel 5 months after the initial treatment, resulting in the complete removal of the entire DBS system. The reinfection rate in group B (11.11%) was significantly lower than that in group A (100%, P=0.007).

Conclusion: Scalp incision infections following DBS surgery can affect deep tissues, and the implementation of a comprehensive treatment strategy involving local debridement and removal of potentially affected implants can significantly reduce the risk of infection recurrence and its spread.

Objective: This study aimed to characterize long-term cerebral perfusion pressure (CPP) trajectory in traumatic brain injury (TBI) patients and construct an interpretable prediction model to assess the risk of unfavorable CPP evolution patterns.

Methods: TBI patients with CPP records were identified from the Medical Information Mart for the Intensive Care (MIMIC)-IV 2.1, eICU Collaborative Research Database (eICU-CRD) 2.0 and HiRID dataset 1.1.1. The research process consisted of two stages. First, group-based trajectory modeling (GBTM) was used to identify different CPP trajectories. Second, different ANN algorithms were employed to predict the trajectories of CPP.

Results: A total of 331 eligible patients' records from MIMIC-IV 2.1 and eICU-CRD 2.0 were used for trajectory analysis and model development. Additionally, 310 patients' data from HiRID were used for external validation. The GBTM identified 5 CPP trajectory groups, group 1 and group 5 were merged into class 1 based on unfavorable in-hospital mortality. The best 6 predictors were invasive systolic blood pressure coefficient of variation (ISBPCV), venous blood chloride ion concentration, PaCO2, PT (Prothrombin Time), CPP coefficient of variation (CPPCV), and mean CPP. Compared with other algorithms, Scaled Conjugate Gradient (SCG) performed relatively better in identifying class 1.

Conclusion: This study identified 2 CPP trajectory groups associated with elevated risk and 3 with reduced risk. PaCO₂ might be a strong predictor for the unfavorable CPP class. The ANN model achieved the primary goal of risk stratification, which is conducive to early intervention and individualized treatment.

Background and objectives: GSWTH in children remain an underexplored area and all clinical guidelines extrapolated from adult experiences. A key challenge in treating these patients is age stratification, as pediatric survival rates are notably higher than in adults. The objective of the study is to compare two groups of patients based on the severity of their condition and to analyze the impact of various factors on the outcomes of these conditions.

Methods: A single-center retrospective cohort study was conducted. Patient records of individuals (from birth to 18 years old) with cranio-cerebral injuries caused by GSWTH and treated at Morozov Children's City Hospital between 1992 and 2015 were comprehensively reviewed. Data analysis included clinical presentation, CT scan findings, injury site and trajectory, GCS and GOS scores, and the St. Louis Scale.

Results: A total of 29 pediatric patients (79% male, 21% female, median age 8 years) with GSWTH were analyzed. The mortality rate was 17%. A transventricular wound trajectory was found in 17% of patients and was associated with a poor prognosis (p<0.001). The GCS showed insufficient specificity in injury severity assessment. A MLR model predicting injury severity based on bullet type, gender, and time to admission had an accuracy of 80%, while a DT model improved accuracy to 96.6%. A stacking model combining MLR and DT increased sensitivity to 87.5% and explained 65.5% of the variance.

Conclusion: The findings emphasize the importance of a multifactorial approach in children with GSWTH, highlighting its effectiveness for precise outcome prediction.

Objectives: Carry out an update and systematic review on the use of three-dimensional printing (3DP) in spinal surgery.

Methods: A systematic literature review was performed using the PubMed database in March 2024. "Spine surgery" and "3d printing" were the search terms. Only articles published from 2014 to 2024 and clinical trails were selected for inclusion. Non-English or Spanish articles were excluded. This review complied with the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline.

Results: Ten articles were included after screening and evaluation. The majority of the studied diseases were deformities (n = 3) and traumas (n = 3), followed by degenerative diseases (n = 2). Two articles dealt with surgical techniques. Six articles studied the creation of personalized guides for inserting screws; two were about education, one related to educating patients about their disease and the other to teaching residents surgical techniques; two other articles addressed surgical planning, where biomodels were printed to study anatomy and surgical programming.

Conclusions: 3D printing is one of the most-used tools in spine surgeries, but there are still randomized articles available on the subject. Using this technology seems to have a positive effect on patient education regarding their disease and surgical planning.

Objective: To evaluate internal carotid artery's (ICA) anatomical relationships with atlantoaxial joints and posterior pharyngeal wall and to illustrate ICA injury risk during transoral procedures to upper cervical spine.

Methods: Cervical spine computed tomography angiography (CTA) of 238 patients were retrospectively evaluated. Each ICA was classified into one of three zones: areas medial (Zone 1), anterior (Zone 2), or lateral (Zone 3) to the atlantoaxial joint. For an ICA in Zone 1, the shortest distances to the posterior pharyngeal wall and midsagittal plane were measured. For an ICA in Zone 2, the closest distances to the midsagittal plane and anterior cortex of the C1-2 complex were measured.

Results: Fifteen ICAs in Zone 1 were found in 12 (5%) patients, with three female patients having bilateral ICAs medial to the atlantoaxial joint. The incidence of ICA in Zone 1 was higher in females than in males. In cases of ICAs in Zone 2, the ICAs were close to the anterior cortex of C1-2 complex, with the shortest distance being 2.6±1.5 mm. A total of 39.9% of patients had bilateral ICAs in Zone 3.

Conclusion: Transoral surgeries in the upper cervical spine carry potential ICA injury risk. They should be carefully deliberated in patients whose ICAs are in Zone 1. In cases of ICAs in Zone 2, meticulous subperiosteal stripping and gentle traction should be performed on the posterior pharyngeal wall. Preoperative identification of the course of ICAs is mandatory in patients undergoing transoral surgeries in the upper cervical spine.

Objective: We assessed the effectiveness of a treatment strategy based on hematoma characteristics and volume.

Methods: From September 2022 to December 2023 (the Study period), a two-center retrospective observational study of initial chronic subdural hematoma (CSDH) was performed. The baseline period was from January 2018 to December 2019. Patients were classified into the high and low retreatment rate groups (Groups H and L, respectively). During the Study period, Group H was treated with drainage and middle meningeal artery embolization (MMAE), while Group L was treated with drainage or MMAE alone. During the Baseline period, all the patients were treated with drainage alone. The primary and secondary endpoints were group retreatment rates and severe procedure-related complications requiring surgical intervention and permanent sequelae, respectively.

Results: Fifty-two patients were included during the Study period (31 in Group H and 21 in Group L) and 53 during the Baseline period (32 in Group H and 21 in Group L). Three (5.8%) and nine (17.0%) patients required retreatment in the Study and Baseline periods, respectively (p = 0.12). One (3.2%) and nine (28.1%) patients in Group H required retreatment during the Study and Baseline periods, respectively (p = 0.01). Similarly, two patients (9.5%) and no patient in Group L required retreatment during the Study and Baseline periods, respectively (p = 0.49). No severe complications were reported throughout.

Conclusions: CSDH treatment strategies that consider to hematoma volume and characteristics have the potential to identify and reduce treatment rates in cases with high retreatment rates.

Objective: Addiction is a serious spiral where negative events or relationships triggers a craving even when the situation is caused by the addiction in the first place. Nucleus Accumbens (NAcc) is identified as an important hub for the neural pathways involved in the addictive behavior. Stimulation of this structure was demonstrated to be beneficial for addiction previously, but radioneuromodulation was never investigated until today. This study aimed to investigate if radioneuromodulation of the nucleus accumbens has any effect on alcohol addiction.

Methods: An addiction model was employed on 36 Long-Evans Rats (18 females/18 males), via a two-bottle intermittent access protocol and the trial group received 100 Gy of gamma irradiation to their bilateral NAcc. Rats were followed up for an additional 15 weeks. Multiple sets of a behavioral test battery, a 4-week abstinence period and quinine adulteration challenges were employed to evaluate responses.

Results: The experiment showed that the intervention reduced alcohol preference in the presence of aversive stimuli in female rats, compared to the non-irradiated controls, as the trial group showed 9.83-point decrease in alcohol preference rate under high dose quinine adulteration compared to the baseline, whereas the control group did not show any decrease. Also there were implications of additional benefits regarding weight control in females and behavioral tests in males. No evident adverse effect was observed with the treatment.

Conclusions: This study indicates that nucleus accumbens radioneuromodulation, although not significantly affecting baseline consumption, reduces intake when an aversive stimulus is involved, implying improved self-control.

Background: Transarterial embolization (TAE) is generally the endovascular treatment of choice for tentorial dural arteriovenous fistula (dAVF). Although flow control of the feeder vessel has been reported to achieve complete shunt blockade, flow control in the absence of ischemia tolerance of ICA as a feeder has not been reported. we present a case in which treatment by Onyx TAE with intermittent flow control of the meningohypophyseal trunk (MHT) as the feeder was successful for a tentorial dAVF presenting with myelopathy without tolerance of ischemia.

Methods: The intermittent flow control is presented for a tentorial dAVF presenting with myelopathy without tolerance for ischemia. An inflation of the balloon in the internal carotid artery was set for 5 minutes, and the Onyx injection was repeated at intervals of at least 2 minutes. Injections and pauses were repeated to allow Onyx to reach the shunt pouch.

Results: The patient underwent successful TAE with intermittent flow control for a tentorial dAVF presenting with myelopathy. The disappearance of the shunt was confirmed with gait disturbance resolution postoperatively.

Conclusion: Intermittent flow control of the MHT using a balloon may be safe and effective for cases showing no tolerance for ischemia.

Introduction: Over the years, feasibility & safety of EEAs has become well established & the focus has now shifted to minimising the nasal morbidity. To this end, several modifications in nasal stage have been described that have focussed primarily on preservation of nasal mucosa on right side of nasal cavity (NC). However, the issue of nasal mucosal preservation on left side of NC has largely been ignored. In this paper, the author describes a modified technique that can eliminate mucosal damage in left NC.

Method: In modified technique, trans-septal approach is utilised on left & endonasal on right side. A hemitransfixion incision is used to raise left submucosal tunnel. The mucosa of tunnel lies laterally in apposition with lateral nasal wall, thereby protecting it from injury by repeated passage of instruments. When tunnel mucosa is pushed back medially, left NC appears absolutely normal without any evidence of mucosal damage.

Results: Combined endonasal & trans-septal technique for nasal stage was performed in 51 patients with sellar/suprasellar lesions. Nonfunctional pituitary adenomas were the most common pathology (macroadenomas-n=14; Giant adenomas-n=10) followed by functional adenomas (acromegaly-n=10; prolactinomas- n=3; Cushings's disease- n=1), craniopharyngiomas (n=6), clival tumours (n=5), & tuberculum sella meningiomas (n=2).

Conclusions: A combination of endonasal and trans-septal approaches utilises the advantages of both endoscopic & microscopic approaches sans the disadvantage of restricted space seen in microscopic approaches. It makes binostril approach least disruptive to left nasal mucosa & thus can reduce overall morbidity of EEAs.