World neurosurgery最新文献

Background: Chronic posthemorrhagic hydrocephalus often arises following spontaneous subarachnoid hemorrhage (SAH). Timely identification of patients predisposed to develop chronic shunt-dependent hydrocephalus may significantly enhance clinical outcomes.

Methods: We performed an analysis of 510 SAH-patients treated at our institution between 2013 and 2018. Clinical and radiological variables, including age, sex, Hunt & Hess grade, Fisher-Score, external ventricular drainage placement, central nervous system infection, aneurysm characteristics, and treatment modalities, were evaluated. Supervised machine learning models, trained and compared using Python and scikit-learn, were employed to predict chronic shunt-dependent hydrocephalus. Model performance was rigorously assessed through repeated cross-validation. To facilitate transparency and collaboration, we publicly released the dataset and code on GitHub (https://github.com/RISCSoftware/shuntclf) and developed an interactive web application (https://huggingface.co/spaces/risc42/shuntclf).

Results: Among the evaluated machine learning models, logistic regression exhibited superior performance, with an AUC-ROC of 0.819 and an AUC-PR of 0.482, along with the highest F1 score of 0.473. Although the balanced accuracy scores of the models were generally proximate, ranging from 0.735 to 0.764, logistic regression consistently outperform others in key metrics such as AUC-ROC and AUC-PR. Conversely, female gender and absence of aneurysm within the anterior communicating artery were associated with reduced shunt requirement likelihood.

Conclusion: Machine learning models, including logistic regression, demonstrate strong predictive capability for early chronic shunt-dependent hydrocephalus following spontaneous SAH, which may potentially contribute to more timely shunt placement interventions. This predictive capability is supported by our web interface, which simplifies the application of these models, aiding clinicians in efficiently determining the need for shunt placement.

Background: Anterior and posterior compression of the cervical spinal cord is usually called pincer cervical spondylotic myelopathy (p-CSM), and surgery is generally recommended; however, there is some controversy about the choice of surgical approach because single anterior or posterior surgery cannot effectively relieve contralateral compression, and combined surgery may cause problems related to trauma and effects on cervical spine function.

Objective: To investigate the feasibility and indications of single anterior cervical discectomy and fusion (ACDF) for the treatment of p-CSM.

Methods: The data of twenty-one p-CSM patients who were treated with ACDF at a single center from 2019 to 2022 were collected. Neurological status was evaluated by the Japanese Orthopedic Association (JOA) scoring system. The radiological parameters included the percentage of space occupied by the spinal canal, the cervical sagittal Cobb angle, and the cross-sectional area of the spinal cord before and after the operation. Complications and spinal cord compression rates were also observed. Correlations between the decompressive effects and various prognostic factors were statistically analyzed.

Results: The mean follow-up period was 24.1±3.55 months. The average JOA score significantly increased, with a mean recovery rate of 65.88±8.97%. The fusion rate was satisfactory. Correlation analysis revealed that the number of operation segments and age were important predictors of decompressive effects. There was no further deterioration of spinal cord function after the operation.

Conclusion: ACDF is an effective method for treating pincer spinal cord compression in terms of neurological recovery, radiological parameters, fusion rates, and complications, especially for patients younger than 60 years of age with single operative segments.

Objective: The link between Tethered Cord Syndrome (TCS) and Neurofibromatosis Type 1 (NF1) remains unclear. To date, only two studies have indicated a high occurrence of TCS in the pediatric NF1 patient population. Our study aims to ascertain the incidence of TCS among Chinese pediatric patients with NF1.

Methods: A single-institution, 8-year retrospective analysis at a tertiary-level children's hospital was conducted for patients with NF1 who underwent surgery for TCS. The clinical features, imaging characteristics, genetic testing outcomes, and histopathological findings of pediatric NF1 patients with TCS were analyzed.

Results: During the study period, a total of 115 pediatric patients were diagnosed with NF1. Among these 115 NF1 patients, 11 individuals, accounting for 9.6% of the sample, were confirmed to have TCS. This rate of occurrence is significantly higher than the incidence rate of TCS in the general population, which stands at 0.17%. All 11 of the pediatric NF1 patients underwent surgery for TCS. Out of the 11 patients who were advised to have tethered cord release surgery, 4 (which is 36.4%) were girls, and the average age of these 11 patients was 8.6 years old, with ages ranging from 2 to 17 years old. The conus medullaris position of the 11 pediatric NF1 patients ranged from L1 to L2, and 10 of them (91%) had a filum terminale lipoma, characterized by high signal intensity on T1-weighted magnetic resonance (MR) images. Another patient was diagnosed with Occult Tethered Cord Syndrome (OTCS). All 11 pediatric NF1 patients exhibited symptoms associated with TCS, such as neuromotor dysfunction, abnormalities in urination, defecation, skeletal system abnormalities, or pain. Eight of the 11 pediatric NF1 patients had undergone genetic testing, which is a crucial part of the diagnostic process for NF1. The histopathological examination of the 11 pediatric NF1 patients who underwent surgery revealed that 10 patients had fatty infiltration of the filum terminale (FT), while the remaining patient exhibited fibrosis of the filum terminale (FT).

Conclusions: In the group of pediatric patients with NF1, the incidence of TCS, presenting to the pediatric neurosurgery clinic for any reason, is significantly higher than that of the general population. However, the pathophysiological relationship between NF1 and TCS is still not clear. It is essential to provide counseling to NF1 patients and their families about the symptoms of TCS to make sure they are aware and can seek the necessary care when needed. This underscores the importance of not only diagnosing NF1 but also staying alert for related conditions like TCS, which may have a higher occurrence in this demographic.