Pub Date : 2024-09-11DOI: 10.1016/j.wneu.2024.09.020
Milena Zadra Prestes,Leonardo B Oliveira,Cid Soares,Jefferson Ramos de Souza,José Geris da Costa,Nicollas Nunes Rabelo,Sávio Batista,Raphael Bertani,Leonardo C Welling,Agostinho C Pinheiro,Nirav J Patel,Eberval G Figueiredo
BACKGROUNDAmong the reconstructive methods for treating dissecting posterior circulation aneurysms (DPCAs), there are stent-assisted coiling (SAC), and sole stenting (SS) therapy. Despite SAC being widely employed when compared to SS, no study systematically analyzed the difference in their outcomes.METHODSThe authors conducted a meta-analysis of studies employing both therapies to compare their outcomes. A search was performed in January 2024, including only studies with consecutive patients submitted to SS or SAC. The studies had to have at least one of the following outcomes: complete aneurysm occlusion, complications, mortality, aneurysm recurrence, retreatment, and good clinical outcome. Odds Ratio (OR) with 95% confidence interval (CI) were utilized for statistics.RESULTSIn a pooled analysis of 17 studies, comparing 173 SS and 377 SAC procedures for DPCAs, no significant differences were found in related mortality (OR 1.44; 95% CI 0.49-4.27); total mortality (OR 1.33; 95% CI 0.53-3.37); retreatment (OR 0.45; 95% CI 0.16-1.26); recurrence (OR 1.00; 95% CI 0.43-2.33); postoperative complete aneurysmal occlusion (OR 0.79; 95% CI 0.09-6.77); follow-up complete aneurysmal occlusion (OR 1.57; 95% CI 0.62-3.94); intraoperative complications (OR 1.04; 95% CI 0.29-3.73); postoperative complications (OR 1.22; 95% CI 0.61-2.45); hemorrhagic complications (OR 2.16; 95% CI 0.77-6.06); ischemic complications (OR 1.68; 95% CI 0.68-4.15). Good clinical outcomes significantly favored SAC (OR 0.45; 95% CI 0.23-0.86).CONCLUSIONThe findings suggest there is no substantial basis for favoring SAC over SS across all cases. Instead, an individualized approach should be considered, according to the patient's characteristics, surgeon skills, and the available material.
背景在治疗剥脱性后循环动脉瘤（DPCAs）的重建方法中，有支架辅助卷曲（SAC）和单纯支架治疗（SS）。作者对采用这两种疗法的研究进行了荟萃分析，以比较它们的疗效。研究人员于 2024 年 1 月进行了一项检索，其中只包括对连续接受 SS 或 SAC 治疗的患者进行的研究。这些研究必须至少有以下一项结果：动脉瘤完全闭塞、并发症、死亡率、动脉瘤复发、再治疗和良好的临床结果。结果在对 17 项研究进行的汇总分析中，比较了 173 例 SS 和 377 例 SAC DPCA 手术，发现在相关死亡率（OR 1.44；95% CI 0.49-4.27）、总死亡率（OR 1.33；95% CI 0.53-3.37）、再治疗（OR 0.45；95% CI 0.16-1.26）、复发（OR 1.00；95% CI 0.43-2.33）；术后完全动脉瘤闭塞（OR 0.79；95% CI 0.09-6.77）；随访完全动脉瘤闭塞（OR 1.57；95% CI 0.62-3.94）；术中并发症（OR 1.04；95% CI 0.29-3.73）；术后并发症（OR 1.22；95% CI 0.61-2.45）；出血性并发症（OR 2.16；95% CI 0.77-6.06）；缺血性并发症（OR 1.68；95% CI 0.68-4.15）。良好的临床结果明显倾向于 SAC（OR 0.45；95% CI 0.23-0.86）。结论：研究结果表明，在所有病例中，SAC 比 SS 更受青睐并无实质性依据，相反，应根据患者的特征、外科医生的技能和可用材料考虑个体化方法。
{"title":"Sole Stenting Versus Stent-Assisted Coiling For Treating Dissecting Posterior Circulation Aneurysms: A Systematic Review And Meta-Analysis.","authors":"Milena Zadra Prestes,Leonardo B Oliveira,Cid Soares,Jefferson Ramos de Souza,José Geris da Costa,Nicollas Nunes Rabelo,Sávio Batista,Raphael Bertani,Leonardo C Welling,Agostinho C Pinheiro,Nirav J Patel,Eberval G Figueiredo","doi":"10.1016/j.wneu.2024.09.020","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.020","url":null,"abstract":"BACKGROUNDAmong the reconstructive methods for treating dissecting posterior circulation aneurysms (DPCAs), there are stent-assisted coiling (SAC), and sole stenting (SS) therapy. Despite SAC being widely employed when compared to SS, no study systematically analyzed the difference in their outcomes.METHODSThe authors conducted a meta-analysis of studies employing both therapies to compare their outcomes. A search was performed in January 2024, including only studies with consecutive patients submitted to SS or SAC. The studies had to have at least one of the following outcomes: complete aneurysm occlusion, complications, mortality, aneurysm recurrence, retreatment, and good clinical outcome. Odds Ratio (OR) with 95% confidence interval (CI) were utilized for statistics.RESULTSIn a pooled analysis of 17 studies, comparing 173 SS and 377 SAC procedures for DPCAs, no significant differences were found in related mortality (OR 1.44; 95% CI 0.49-4.27); total mortality (OR 1.33; 95% CI 0.53-3.37); retreatment (OR 0.45; 95% CI 0.16-1.26); recurrence (OR 1.00; 95% CI 0.43-2.33); postoperative complete aneurysmal occlusion (OR 0.79; 95% CI 0.09-6.77); follow-up complete aneurysmal occlusion (OR 1.57; 95% CI 0.62-3.94); intraoperative complications (OR 1.04; 95% CI 0.29-3.73); postoperative complications (OR 1.22; 95% CI 0.61-2.45); hemorrhagic complications (OR 2.16; 95% CI 0.77-6.06); ischemic complications (OR 1.68; 95% CI 0.68-4.15). Good clinical outcomes significantly favored SAC (OR 0.45; 95% CI 0.23-0.86).CONCLUSIONThe findings suggest there is no substantial basis for favoring SAC over SS across all cases. Instead, an individualized approach should be considered, according to the patient's characteristics, surgeon skills, and the available material.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263369","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 : 2024-09-11DOI: 10.1016/j.wneu.2024.09.033
Ryan B Juncker,Vicente de Paulo Martins Coelho Junior,Maxwell D Gruber,Vikram Chakravarthy
{"title":"Intradural Extramedullary Small Cell Lung Cancer Metastasis Resection: 2-Dimensional Operative Video.","authors":"Ryan B Juncker,Vicente de Paulo Martins Coelho Junior,Maxwell D Gruber,Vikram Chakravarthy","doi":"10.1016/j.wneu.2024.09.033","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.033","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263371","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 : 2024-09-11DOI: 10.1016/j.wneu.2024.09.038
Ashley Knebel,Manjot Singh,Rhea Rasquinha,Mohammad Daher,Joseph E Nassar,John Hanna,Bassel G Diebo,Alan H Daniels
BACKGROUNDPostoperative delirium (POD) is frequently reported in the elderly after major surgery. Several risk factors have been identified, including age, surgical complexity, and comorbidities.METHODSPosterior lumbar fusion patients were identified using PearlDiver and filtered into two cohorts based on presence or absence of POD within 7 days of surgery. Epidemiological analyses were performed to examine trends in POD by age and year. Comparative analyses were performed on patient demographics and baseline cognitive status. After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analyzed.RESULTSAmong 476,482 no POD and 2,591 POD patients, mean age was 60.90 years, 57.6% were female, and mean CCI was 1.78. POD patients frequently had baseline cognitive impairment (p<0.001). Incidence of POD decreased from 0.7% in 2010 to 0.4% in 2022 (p<0.001) and increased with increasing patient age (p<0.001). POD patients had higher length of stay (12 vs 6 days, p<0.001) and 90-day costs ($20,605 vs $17,849, p<0.001). After matching, POD patients had higher hypernatremia (5.8% vs 3.5%, p=0.001) and hypocalcemia (5.0% vs 3.5%, p=0.026). POD patients had higher 90-day postoperative complications (p<0.05) than no POD patients.CONCLUSIONNearly 0.5% of patients who underwent posterior spinal fusion between 2010-2022 developed delirium, although incidence rates have decreased over time. POD was common in elderly patients with electrolyte disturbances who underwent multi-level fusions. Patients suffering from POD had higher rates of 90-day postoperative complications. Ongoing efforts to deliver interventions to mitigate the consequences of POD among spine surgery patients are warranted.
背景术后谵妄（POD）是老年人大手术后的常见症状。方法使用 PearlDiver 对腰椎后路融合术患者进行识别，并根据术后 7 天内是否出现 POD 筛选出两个队列。进行流行病学分析，研究不同年龄和年份的 POD 变化趋势。对患者的人口统计学特征和基线认知状态进行了比较分析。结果在 476,482 名无 POD 患者和 2,591 名有 POD 患者中，平均年龄为 60.90 岁，57.6% 为女性，平均 CCI 为 1.78。POD 患者常伴有基线认知障碍（p<0.001）。POD 发生率从 2010 年的 0.7% 降至 2022 年的 0.4%（p<0.001），并随着患者年龄的增加而增加（p<0.001）。POD患者的住院时间（12天 vs 6天，p<0.001）和90天费用（20,605美元 vs 17,849美元，p<0.001）均较高。匹配后，POD 患者的高钠血症（5.8% vs 3.5%，p=0.001）和低钙血症（5.0% vs 3.5%，p=0.026）发生率更高。结论 2010-2022 年间接受后路脊柱融合术的患者中约有 0.5% 出现谵妄，尽管随着时间的推移发病率有所下降。电解质紊乱的老年患者接受多层次脊柱融合术时常出现谵妄。POD患者术后90天并发症发生率较高。我们有必要继续努力提供干预措施，以减轻脊柱手术患者的 POD 后果。
{"title":"Postoperative Delirium Following Posterior Lumbar Spinal Fusion: Epidemiology, Risk Factors, and Associated Complications.","authors":"Ashley Knebel,Manjot Singh,Rhea Rasquinha,Mohammad Daher,Joseph E Nassar,John Hanna,Bassel G Diebo,Alan H Daniels","doi":"10.1016/j.wneu.2024.09.038","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.038","url":null,"abstract":"BACKGROUNDPostoperative delirium (POD) is frequently reported in the elderly after major surgery. Several risk factors have been identified, including age, surgical complexity, and comorbidities.METHODSPosterior lumbar fusion patients were identified using PearlDiver and filtered into two cohorts based on presence or absence of POD within 7 days of surgery. Epidemiological analyses were performed to examine trends in POD by age and year. Comparative analyses were performed on patient demographics and baseline cognitive status. After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analyzed.RESULTSAmong 476,482 no POD and 2,591 POD patients, mean age was 60.90 years, 57.6% were female, and mean CCI was 1.78. POD patients frequently had baseline cognitive impairment (p<0.001). Incidence of POD decreased from 0.7% in 2010 to 0.4% in 2022 (p<0.001) and increased with increasing patient age (p<0.001). POD patients had higher length of stay (12 vs 6 days, p<0.001) and 90-day costs ($20,605 vs $17,849, p<0.001). After matching, POD patients had higher hypernatremia (5.8% vs 3.5%, p=0.001) and hypocalcemia (5.0% vs 3.5%, p=0.026). POD patients had higher 90-day postoperative complications (p<0.05) than no POD patients.CONCLUSIONNearly 0.5% of patients who underwent posterior spinal fusion between 2010-2022 developed delirium, although incidence rates have decreased over time. POD was common in elderly patients with electrolyte disturbances who underwent multi-level fusions. Patients suffering from POD had higher rates of 90-day postoperative complications. Ongoing efforts to deliver interventions to mitigate the consequences of POD among spine surgery patients are warranted.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263405","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 : 2024-09-11DOI: 10.1016/j.wneu.2024.09.025
Dineth Foneska,Sayan Biswas,Hamza Ahmed,Ved Sarkar,Joshua MacArthur,K Joshi George
OBJECTIVECauda Equina Syndrome (CES) is diagnosed both clinically and radiologically. However, it's unclear if a specific degree of cauda equina compression (CEC) on imaging can confirm the diagnosis. This study aimed to identify an optimal percentage of prolapse to canal ratio (PCR) on MRI that correlates with CEC, facilitating reliable decision-making for CES symptoms.METHODSA single-center retrospective case series analysis was conducted from 2020 to 2021. Sixty-one patients who underwent emergency lumbar discectomy within 48 hours of presentation were included, divided into a CES group and a disc prolapse (DP) group. CES cases were identified using ICD-10 code G83.4. PCR was calculated by dividing the width of the disc herniation by the total width of the spinal canal at the level of the herniation on single mid-sagittal T2 MRI scans, using the IC Measure software on Windows.RESULTSCES most frequently occurred at the L4/5 level (37/61). The median PCR in CES cases was 76.19% (66.67 - 85.71), significantly higher than in DP cases, 48.08% (31.33 - 55.56) (p<0.001). A PCR threshold of 40% maximized sensitivity at 100% but had a specificity of 45%. Conversely, a threshold of 75% maximized specificity at 100% with a sensitivity of 50%. The optimal PCR, determined by the Youden index, was 66%, yielding a sensitivity of 75% and specificity of 97%, with an area under the curve (AUC) of 0.923.CONCLUSIONSSimple radiological measurements of PCR can potentially triage CES patients and guide their management. Future studies should correlate PCR with clinical signs and symptoms for a comprehensive assessment.
{"title":"What Degree of Radiological Compression Predicts Cauda Equina Syndrome: A Retrospective Study at a National Tertiary Centre.","authors":"Dineth Foneska,Sayan Biswas,Hamza Ahmed,Ved Sarkar,Joshua MacArthur,K Joshi George","doi":"10.1016/j.wneu.2024.09.025","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.025","url":null,"abstract":"OBJECTIVECauda Equina Syndrome (CES) is diagnosed both clinically and radiologically. However, it's unclear if a specific degree of cauda equina compression (CEC) on imaging can confirm the diagnosis. This study aimed to identify an optimal percentage of prolapse to canal ratio (PCR) on MRI that correlates with CEC, facilitating reliable decision-making for CES symptoms.METHODSA single-center retrospective case series analysis was conducted from 2020 to 2021. Sixty-one patients who underwent emergency lumbar discectomy within 48 hours of presentation were included, divided into a CES group and a disc prolapse (DP) group. CES cases were identified using ICD-10 code G83.4. PCR was calculated by dividing the width of the disc herniation by the total width of the spinal canal at the level of the herniation on single mid-sagittal T2 MRI scans, using the IC Measure software on Windows.RESULTSCES most frequently occurred at the L4/5 level (37/61). The median PCR in CES cases was 76.19% (66.67 - 85.71), significantly higher than in DP cases, 48.08% (31.33 - 55.56) (p<0.001). A PCR threshold of 40% maximized sensitivity at 100% but had a specificity of 45%. Conversely, a threshold of 75% maximized specificity at 100% with a sensitivity of 50%. The optimal PCR, determined by the Youden index, was 66%, yielding a sensitivity of 75% and specificity of 97%, with an area under the curve (AUC) of 0.923.CONCLUSIONSSimple radiological measurements of PCR can potentially triage CES patients and guide their management. Future studies should correlate PCR with clinical signs and symptoms for a comprehensive assessment.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263367","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 : 2024-09-11DOI: 10.1016/j.wneu.2024.09.004
Xiaomei Xu, Hongqiao Yang, Xinyang Wang, Li Wang, Yuhai Wang
Objective: In poor-grade aneurysm subarachnoid hemorrhage (PaSAH), the use of external ventricular drainage (EVD) may be closely related to the occurrence of shunt-dependent hydrocephalus (SDHC). The purpose of this study was to investigate the effect of EVD on SDHC and prognosis after microsurgical clipping patients with PaSAH.
Methods: The clinical data of 99 patients with PaSAH admitted to the 904th Hospital of PLA from October 2011 to December 2020 were analyzed retrospectively. Univariate and multivariate logistic regression analyses were used to clarify the relationship between EVD implantation and its drainage volume and SDHC after PaSAH. ROC curves were plotted to compare the prognostic efficiency of different drainage volumes on SDHC. Modified possion regression analysis was used to determine the effect of SDHC on prognosis after PaSAH.
Results: EVD implantation increased the risk of SDHC (OR=6.715, 95% CI 1.120-40.248, P=0.037). The increased drainage volume on day 1, mean daily drainage volume within 2 days, and average within 3 days increased the risk of SDHC. EVD drainage volume on the first postoperative day has a good predictive ability for SDHC after PaSAH, with an AUC of 0.829 (95% CI 0.731 - 0.928), the optimal cut-off value was 208 ml, with a sensitivity of 79.4%, a specificity of 81.6%, and a Youden index of 0.61. The occurrence of SDHC after aneurysm clipping significantly increases the risk of poor prognosis of PaSAH.
Conclusions: EVD implantation is an independent risk factor for SDHC after PaSAH, and a large drainage volume in the first 3 days after EVD implantation is an independent risk factor for SDHC after PaSAH. The drainage volume on the first day after surgery is the best predictor of SDHC after PaSAH. SDHC after PaSAH is the strongest independent risk factor for poor prognosis and prolongs hospital stay.
{"title":"Effect of external ventricular drainage on shunt-dependent hydrocephalus and prognosis after microsurgical clipping in patients with poor-grade aneurysmal subarachnoid hemorrhage.","authors":"Xiaomei Xu, Hongqiao Yang, Xinyang Wang, Li Wang, Yuhai Wang","doi":"10.1016/j.wneu.2024.09.004","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.004","url":null,"abstract":"<p><strong>Objective: </strong>In poor-grade aneurysm subarachnoid hemorrhage (PaSAH), the use of external ventricular drainage (EVD) may be closely related to the occurrence of shunt-dependent hydrocephalus (SDHC). The purpose of this study was to investigate the effect of EVD on SDHC and prognosis after microsurgical clipping patients with PaSAH.</p><p><strong>Methods: </strong>The clinical data of 99 patients with PaSAH admitted to the 904th Hospital of PLA from October 2011 to December 2020 were analyzed retrospectively. Univariate and multivariate logistic regression analyses were used to clarify the relationship between EVD implantation and its drainage volume and SDHC after PaSAH. ROC curves were plotted to compare the prognostic efficiency of different drainage volumes on SDHC. Modified possion regression analysis was used to determine the effect of SDHC on prognosis after PaSAH.</p><p><strong>Results: </strong>EVD implantation increased the risk of SDHC (OR=6.715, 95% CI 1.120-40.248, P=0.037). The increased drainage volume on day 1, mean daily drainage volume within 2 days, and average within 3 days increased the risk of SDHC. EVD drainage volume on the first postoperative day has a good predictive ability for SDHC after PaSAH, with an AUC of 0.829 (95% CI 0.731 - 0.928), the optimal cut-off value was 208 ml, with a sensitivity of 79.4%, a specificity of 81.6%, and a Youden index of 0.61. The occurrence of SDHC after aneurysm clipping significantly increases the risk of poor prognosis of PaSAH.</p><p><strong>Conclusions: </strong>EVD implantation is an independent risk factor for SDHC after PaSAH, and a large drainage volume in the first 3 days after EVD implantation is an independent risk factor for SDHC after PaSAH. The drainage volume on the first day after surgery is the best predictor of SDHC after PaSAH. SDHC after PaSAH is the strongest independent risk factor for poor prognosis and prolongs hospital stay.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296756","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}
OBJECTIVEThis study aims to evaluate the safety and efficacy of the ultrasonic bone burr (UBB) in facilitating C1 pedicle screw placement for atlantoaxial instability (AAI) treatment, compared to the conventional high-speed drill (HSD) technique.METHODSA retrospective analysis was conducted on patients undergoing posterior screw-rod fixation for AAI between December 2017 and July 2023. The patients were divided into two groups based on the tools used for screw placement: UBB and HSD. Data on surgical duration, estimated blood loss, spinal cord and arterial injury incidence, screw placement accuracy, neurological status measured by the Japanese Orthopedic Association (JOA) score and fusion rates, were collected and analyzed.RESULTS13 patients received C1 pedicle screw placement via UBB facilitation, while 8 were treated using the HSD approach. The UBB group showed a significant reduction in blood loss and operation time compared to the HSD group (P=0.002 and P<0.001, respectively). No spinal cord or arterial injuries occurred in either group. Optimal screw placement was confirmed in all UBB cases versus 87.5% in the HSD group (P=0.139). Both groups demonstrated significant improvements in JOA scores with no inter-group difference. The fusion rate was 100% in the UBB group and 87.5% in the HSD group, not statistically different (P=0.381).CONCLUSIONSUBB is a viable alternative for C1 pedicle screw placement, associated with reduced blood loss and shorter operation time, while achieving comparable clinical outcomes to the conventional HSD method. Nevertheless, further research with a larger sample size is needed.
{"title":"Improving C1 Pedicle Screw Placement for Atlantoaxial Instability with Ultrasonic Bone Burr Assistance.","authors":"Changjiang Ou,Yongjun Tong,Junhui Liu,Zhi Shan,Yilei Chen,Bao Huang,Xuyang Zhang,Yili Chen,Fengdong Zhao","doi":"10.1016/j.wneu.2024.09.037","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.037","url":null,"abstract":"OBJECTIVEThis study aims to evaluate the safety and efficacy of the ultrasonic bone burr (UBB) in facilitating C1 pedicle screw placement for atlantoaxial instability (AAI) treatment, compared to the conventional high-speed drill (HSD) technique.METHODSA retrospective analysis was conducted on patients undergoing posterior screw-rod fixation for AAI between December 2017 and July 2023. The patients were divided into two groups based on the tools used for screw placement: UBB and HSD. Data on surgical duration, estimated blood loss, spinal cord and arterial injury incidence, screw placement accuracy, neurological status measured by the Japanese Orthopedic Association (JOA) score and fusion rates, were collected and analyzed.RESULTS13 patients received C1 pedicle screw placement via UBB facilitation, while 8 were treated using the HSD approach. The UBB group showed a significant reduction in blood loss and operation time compared to the HSD group (P=0.002 and P<0.001, respectively). No spinal cord or arterial injuries occurred in either group. Optimal screw placement was confirmed in all UBB cases versus 87.5% in the HSD group (P=0.139). Both groups demonstrated significant improvements in JOA scores with no inter-group difference. The fusion rate was 100% in the UBB group and 87.5% in the HSD group, not statistically different (P=0.381).CONCLUSIONSUBB is a viable alternative for C1 pedicle screw placement, associated with reduced blood loss and shorter operation time, while achieving comparable clinical outcomes to the conventional HSD method. Nevertheless, further research with a larger sample size is needed.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263363","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 : 2024-09-11DOI: 10.1016/j.wneu.2024.09.006
Daniel J Burkett,Simon G Ammanuel,Christopher Baggott
BACKGROUNDAdult spinal deformity (ASD) is a common problem in today's aging adult population, particularly in the thoracolumbar spine. This can lead to severe pain and disability, leading to poorer quality of life. Traditionally, open deformity correction has been the mainstay of treatment for these patients as it provides an excellent operative corridor; however, this comes with severe risk and high complication rates. There has been a trend towards more minimally invasive approaches to correct the deformity while persevering the muscle and soft tissue surrounding the bony spine across the fusion.METHODSWe describe a minimally invasive surgical technique through a Wiltse approach without invading the paraspinal musculature to gain access to the bony spine to perform lumbar interbody fusions and osteotomies.RESULTSA total of 3 patients were identified for this technical note who underwent the TROPIC procedure for ASD. The patients had severe coronal and rotational imbalance. We were able to achieve adequate correction through an approach without disturbing the spinal musculature and soft tissues.CONCLUSIONSThis technique provides benefits of spinal rotational and coronal plane correction and restores lordosis with current advancements of today's technologies without the downsides of an open surgical approach.
{"title":"TROPIC: Transfascial Oblique Posterior Interbody Correction: Technical Note.","authors":"Daniel J Burkett,Simon G Ammanuel,Christopher Baggott","doi":"10.1016/j.wneu.2024.09.006","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.006","url":null,"abstract":"BACKGROUNDAdult spinal deformity (ASD) is a common problem in today's aging adult population, particularly in the thoracolumbar spine. This can lead to severe pain and disability, leading to poorer quality of life. Traditionally, open deformity correction has been the mainstay of treatment for these patients as it provides an excellent operative corridor; however, this comes with severe risk and high complication rates. There has been a trend towards more minimally invasive approaches to correct the deformity while persevering the muscle and soft tissue surrounding the bony spine across the fusion.METHODSWe describe a minimally invasive surgical technique through a Wiltse approach without invading the paraspinal musculature to gain access to the bony spine to perform lumbar interbody fusions and osteotomies.RESULTSA total of 3 patients were identified for this technical note who underwent the TROPIC procedure for ASD. The patients had severe coronal and rotational imbalance. We were able to achieve adequate correction through an approach without disturbing the spinal musculature and soft tissues.CONCLUSIONSThis technique provides benefits of spinal rotational and coronal plane correction and restores lordosis with current advancements of today's technologies without the downsides of an open surgical approach.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263366","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 : 2024-09-11DOI: 10.1016/j.wneu.2024.09.035
Simon Diaz,Mejdeddine Al Barajraji,Victoria Deambour,Dominique Rothenfluh,Juan Barges-Coll
BACKGROUNDThe presence of clear high-grade rotatory subluxation, in addition to an odontoid fracture, is a definite indication for surgery. However, the presence of a more subtle subluxation-Grades 1, 2, or 3-can often be overlooked, and as a result, prognostic associations with C2 fractures are rare. In light of this, we assessed the failure rate of conservative management in patients with both an odontoid fracture and a concurrent C1‒C2 rotatory subluxation.METHODSRetrospective, cohort (nested case‒control) study of patients with odontoid C2 fractures with or without C1‒C2 joint rotatory subluxation was performed. Patients were classified according to the type of odontoid fracture (Alonzo classification) and the presence of C1-C2 subluxation (Feldings classification). The number of patients who were initially treated with collars and then underwent surgery due to conservative treatment failure was analyzed. We performed logistic regression analysis to determine the odds ratio (OR) and generate a ROC curve of the association between the degree of subluxation and failure of conservative treatment.RESULTS115 patients with C2 fractures that were treated conservatively with or without C1‒C2 rotatory subluxation. Of all 115 , 29 (25%) experienced treatment failure and required surgery. A statistically significant correlation was found between treatment failure and the presence of rotatory subluxation ,(odds ratio 10), compared with patients without C1-C2 subluxation.CONCLUSIONSIn our series, C2 Alonzo fractures with a C1‒C2 rotatory subluxation had a 10-fold increased risk of secondary displacement and subsequent need for surgery. Further research on this association could improve the management of these conditions.
{"title":"Assessing the impact of undiagnosed C1-C2 rotatory subluxation in the conservative treatment of Odontoid fractures.","authors":"Simon Diaz,Mejdeddine Al Barajraji,Victoria Deambour,Dominique Rothenfluh,Juan Barges-Coll","doi":"10.1016/j.wneu.2024.09.035","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.035","url":null,"abstract":"BACKGROUNDThe presence of clear high-grade rotatory subluxation, in addition to an odontoid fracture, is a definite indication for surgery. However, the presence of a more subtle subluxation-Grades 1, 2, or 3-can often be overlooked, and as a result, prognostic associations with C2 fractures are rare. In light of this, we assessed the failure rate of conservative management in patients with both an odontoid fracture and a concurrent C1‒C2 rotatory subluxation.METHODSRetrospective, cohort (nested case‒control) study of patients with odontoid C2 fractures with or without C1‒C2 joint rotatory subluxation was performed. Patients were classified according to the type of odontoid fracture (Alonzo classification) and the presence of C1-C2 subluxation (Feldings classification). The number of patients who were initially treated with collars and then underwent surgery due to conservative treatment failure was analyzed. We performed logistic regression analysis to determine the odds ratio (OR) and generate a ROC curve of the association between the degree of subluxation and failure of conservative treatment.RESULTS115 patients with C2 fractures that were treated conservatively with or without C1‒C2 rotatory subluxation. Of all 115 , 29 (25%) experienced treatment failure and required surgery. A statistically significant correlation was found between treatment failure and the presence of rotatory subluxation ,(odds ratio 10), compared with patients without C1-C2 subluxation.CONCLUSIONSIn our series, C2 Alonzo fractures with a C1‒C2 rotatory subluxation had a 10-fold increased risk of secondary displacement and subsequent need for surgery. Further research on this association could improve the management of these conditions.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263642","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 : 2024-09-11DOI: 10.1016/j.wneu.2024.09.029
Andreas Seas,Liming Qiu,Emma Paradie,Jasmine Hughes,Pranav I Warman,Romaric Waguia-Kouam,Nathan A Shlobin,Kennedy Carpenter,Megan von Isenburg,Michael M Haglund,Anthony T Fuller,Alvan-Emeka K Ukachukwu
BACKGROUND AND OBJECTIVESThere are critical disparities in the neurosurgical care provided around the globe due to challenges in resource allocation, training, and infrastructure. Global neurosurgical collaborations have replaced classical mission trips to address these disparities. However, the development of these collaborations and the impact of research funding on their growth has not yet been systematically studied. In this article, we use a graph theoretical approach to investigate trends in funding and co-authorship between and among authors from high-income countries (HICs) and authors from low- and middle-income countries (LMICs).METHODSA bibliometric search of the global neurosurgical literature returned 307 articles between 1985 and 2020. A connectivity analysis was conducted to compute the number of co-authorships between HIC-HIC, LMIC-HIC, and LMIC-LMIC authors. The number of connections, summarized as either a global sum of connections or an average number of connections per manuscript, were analyzed in the context of time and funding through parametric statistical tests.RESULTSAn exponential increase in co-authorship collaboration was observed over time, especially after 2015. Notably, LMIC-LMIC collaborations appear to be rising at over twice the rate of other collaboration types. The presence of funding, in general, was associated with increased co-authorship of manuscripts by LMIC and HIC authors together (p = 0.033). A significant majority of the funding associated with LMIC-HIC co-authorships was supplied through charitable organizations and government grants (p = 0.034, p = 0.009, respectively). Most LMIC-LMIC co-authorships had no funding.CONCLUSIONThis work shows significant and rapid growth in international neurosurgical partnerships, especially in HIC-LMIC and LMIC-LMIC collaborations. Also, a significant positive relationship exists between research funding and LMIC-HIC co-authorship trends. This work encourages us as a community to continue to expand our translational collaborations with LMIC neurosurgeons and establish funding mechanisms independent of HIC authors.
{"title":"Exploring the evolution of research connectivity and funding in global neurosurgical publications.","authors":"Andreas Seas,Liming Qiu,Emma Paradie,Jasmine Hughes,Pranav I Warman,Romaric Waguia-Kouam,Nathan A Shlobin,Kennedy Carpenter,Megan von Isenburg,Michael M Haglund,Anthony T Fuller,Alvan-Emeka K Ukachukwu","doi":"10.1016/j.wneu.2024.09.029","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.029","url":null,"abstract":"BACKGROUND AND OBJECTIVESThere are critical disparities in the neurosurgical care provided around the globe due to challenges in resource allocation, training, and infrastructure. Global neurosurgical collaborations have replaced classical mission trips to address these disparities. However, the development of these collaborations and the impact of research funding on their growth has not yet been systematically studied. In this article, we use a graph theoretical approach to investigate trends in funding and co-authorship between and among authors from high-income countries (HICs) and authors from low- and middle-income countries (LMICs).METHODSA bibliometric search of the global neurosurgical literature returned 307 articles between 1985 and 2020. A connectivity analysis was conducted to compute the number of co-authorships between HIC-HIC, LMIC-HIC, and LMIC-LMIC authors. The number of connections, summarized as either a global sum of connections or an average number of connections per manuscript, were analyzed in the context of time and funding through parametric statistical tests.RESULTSAn exponential increase in co-authorship collaboration was observed over time, especially after 2015. Notably, LMIC-LMIC collaborations appear to be rising at over twice the rate of other collaboration types. The presence of funding, in general, was associated with increased co-authorship of manuscripts by LMIC and HIC authors together (p = 0.033). A significant majority of the funding associated with LMIC-HIC co-authorships was supplied through charitable organizations and government grants (p = 0.034, p = 0.009, respectively). Most LMIC-LMIC co-authorships had no funding.CONCLUSIONThis work shows significant and rapid growth in international neurosurgical partnerships, especially in HIC-LMIC and LMIC-LMIC collaborations. Also, a significant positive relationship exists between research funding and LMIC-HIC co-authorship trends. This work encourages us as a community to continue to expand our translational collaborations with LMIC neurosurgeons and establish funding mechanisms independent of HIC authors.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263364","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 : 2024-09-10DOI: 10.1016/j.wneu.2024.09.026
Omar Alwakaa,Alejandro Enriquez-Marulanda,Felipe Ramirez-Velandia,Jean Filo,Emmanuel Mensah,Aryan Wadhwa,Thomas B Fodor,Samuel D Pettersson,Evan Paul McNeil,Michael Young,Sandeep Muram,Alfred P See,Justin H Granstein,Philipp Taussky,Christopher S Ogilvy
BACKGROUNDThe Matsushima Grade has traditionally been used to evaluate vessel ingrowth from the STA after EDAS for MMD-patients. However, this grading is subjective and prone to measurement variability. Herein, we propose the orbital grading system quantifying leptomeningeal and burr hole-related vessel-ingrowth from the STA and/or MMA to the middle and anterior cerebral arteries post-EDAS in MMD patients.METHODSAn anatomical classification was developed by reference to two parallel vertical lines from the bony landmarks of the orbit, categorized from Grade 0-3. Regression models were used to compare clinical and functional outcomes of our grading system with the Matsushima scale.RESULTSForty MMD patients, with median age of 48 years, mostly females (72.5%), were included. Presentation included ischemic events (65.0%), hemorrhage (22.5%), and seizures (7.5%). Most patients were categorized as Suzuki ≥ IV (69.5%). Fifty EDAS (89.9%) had concurrent burr holes placed (parietal and frontal regions). At a median follow-up of 13.7 months, collateral growth was graded as follows: grade 0 (6;10.8%), grade 1 (12;21.4%), grade 2 (23;41.1%) and grade 3 (15;26.8%). Linear regression showed similarities in the distribution between the orbital grading system and Matsushima grading (r=0.86;p<0.01). Ischemic events were fewer in hemispheres categorized as grade 2-3 compared to grade 0-1 (p=0.047) as well as in Matsushima grading A or B compared to C (p=0.047).CONCLUSIONThe orbital grading system demonstrated agreement in identifying postoperative ischemic events as the Matsushima grade and provides a more practical and objective evaluation of collateral vessel ingrowth after EDAS with and without burr-holes.
{"title":"Characterizing Revascularization after Encephalo-Duro-Arterio-Synangiosis (EDAS) in Adult Patients with Moyamoya Disease Using the Orbital Grading System.","authors":"Omar Alwakaa,Alejandro Enriquez-Marulanda,Felipe Ramirez-Velandia,Jean Filo,Emmanuel Mensah,Aryan Wadhwa,Thomas B Fodor,Samuel D Pettersson,Evan Paul McNeil,Michael Young,Sandeep Muram,Alfred P See,Justin H Granstein,Philipp Taussky,Christopher S Ogilvy","doi":"10.1016/j.wneu.2024.09.026","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.026","url":null,"abstract":"BACKGROUNDThe Matsushima Grade has traditionally been used to evaluate vessel ingrowth from the STA after EDAS for MMD-patients. However, this grading is subjective and prone to measurement variability. Herein, we propose the orbital grading system quantifying leptomeningeal and burr hole-related vessel-ingrowth from the STA and/or MMA to the middle and anterior cerebral arteries post-EDAS in MMD patients.METHODSAn anatomical classification was developed by reference to two parallel vertical lines from the bony landmarks of the orbit, categorized from Grade 0-3. Regression models were used to compare clinical and functional outcomes of our grading system with the Matsushima scale.RESULTSForty MMD patients, with median age of 48 years, mostly females (72.5%), were included. Presentation included ischemic events (65.0%), hemorrhage (22.5%), and seizures (7.5%). Most patients were categorized as Suzuki ≥ IV (69.5%). Fifty EDAS (89.9%) had concurrent burr holes placed (parietal and frontal regions). At a median follow-up of 13.7 months, collateral growth was graded as follows: grade 0 (6;10.8%), grade 1 (12;21.4%), grade 2 (23;41.1%) and grade 3 (15;26.8%). Linear regression showed similarities in the distribution between the orbital grading system and Matsushima grading (r=0.86;p<0.01). Ischemic events were fewer in hemispheres categorized as grade 2-3 compared to grade 0-1 (p=0.047) as well as in Matsushima grading A or B compared to C (p=0.047).CONCLUSIONThe orbital grading system demonstrated agreement in identifying postoperative ischemic events as the Matsushima grade and provides a more practical and objective evaluation of collateral vessel ingrowth after EDAS with and without burr-holes.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263413","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}
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