Pub Date : 2024-09-10DOI: 10.1016/j.wneu.2024.09.005
Ohad Rechnitz,Iddo Paldor
{"title":"Intraoperative Intracranial pressure monitoring as an intraoperative guide during operations for relieving elevated intracranial pressure.","authors":"Ohad Rechnitz,Iddo Paldor","doi":"10.1016/j.wneu.2024.09.005","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.005","url":null,"abstract":"","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":"142263416","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.2024.09.007
Pang-Shuo Perng,Ming-Tsung Chuang,Chih-Yuan Huang
Length mismatch between the aspiration catheters and microcatheters can hinder optimal thrombus engagement, particularly in tortuous vessels and cases of vascular stenosis. We present a case in which a side puncture technique was employed to deploy the stent retriever when exchangeable devices is unavailable. A man in his seventies with basilar artery occlusion underwent mechanical thrombectomy. The aspiration catheter failed to advance due to the tortuosity of the vertebral artery, preventing the microcatheter from delivering the stent retriever distal to the thrombus. By puncturing the aspiration catheter, additional microcatheter length was obtained, allowing the stent to be deployed at the targeted site. Thrombus extraction was then successfully performed using the Solumbra technique. This approach is advantageous for its simplicity and eliminates the need for additional devices. However, it also has specific drawbacks, such as damaging the aspiration catheters.
{"title":"An alternative side puncture technique for aspiration catheters in mechanical thrombectomy.","authors":"Pang-Shuo Perng,Ming-Tsung Chuang,Chih-Yuan Huang","doi":"10.1016/j.wneu.2024.09.007","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.007","url":null,"abstract":"Length mismatch between the aspiration catheters and microcatheters can hinder optimal thrombus engagement, particularly in tortuous vessels and cases of vascular stenosis. We present a case in which a side puncture technique was employed to deploy the stent retriever when exchangeable devices is unavailable. A man in his seventies with basilar artery occlusion underwent mechanical thrombectomy. The aspiration catheter failed to advance due to the tortuosity of the vertebral artery, preventing the microcatheter from delivering the stent retriever distal to the thrombus. By puncturing the aspiration catheter, additional microcatheter length was obtained, allowing the stent to be deployed at the targeted site. Thrombus extraction was then successfully performed using the Solumbra technique. This approach is advantageous for its simplicity and eliminates the need for additional devices. However, it also has specific drawbacks, such as damaging the aspiration catheters.","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":"142263410","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}
OBJECTIVETo describe our experience in the resection of gliomas involving the insula and analyze the variables implicated in the management and prognosis of these tumors.MATERIALS AND METHODSThis retrospective, single-center, analytical study included a cohort of 83 patients who underwent surgery for insular gliomas by the same surgeon in a third-level Argentine center, in the period between 2010-2023. We analyzed the population's demographic, clinical, and radiological features and surgical variables associated with postoperative results and prognosis using multivariate regression analysis.RESULTSA total of 53 patients (54% males) were included with a mean follow-up of 40.7 months. Mean age at surgery was 41 years (range 21-73) and 66.1% corresponded to low-grade gliomas. Seizures were the initial symptom in the majority of cases. There was evidence of tumor extension over the insula to temporal or/and frontal lobe in 64.2% of patients. An EOR over 90% was achieved in 62.3% of cases (27% of GTR) with an average resected volume of 89.4%. Awake craniotomy was indicated in 47% of patients and iMRI was performed in 24%. Recurrence was observed in 44% of patients with a mean Progression-Free survival of 31 months (42 months in LGG and 10 months in HGG). A total of 9 patients were re-operated. By the time of 2 years, survival rates were 100% for LGG and 46% for HGG, while 4-year overall survival rates were 92% for patients with LGG and 15.4% for those with HGG.CONCLUSIONSurgery for insular gliomas is a complex task that needs to be managed with adequate preoperative and intraoperative assessment in order to achieve maximum safe resection with low morbidity for better functional and oncological outcomes. Adequate anatomical understanding, radiological analysis, awake craniotomy, cortical and subcortical mapping are paramount to pursue this aim.
{"title":"Insular Gliomas. Experience in a Latin-American center and assessment of variables related to surgical management and prognosis.","authors":"Mauro Ruella,Guido Caffaratti,Facundo Villamil,Lucia Crivelli,Andrés Cervio","doi":"10.1016/j.wneu.2024.09.019","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.019","url":null,"abstract":"OBJECTIVETo describe our experience in the resection of gliomas involving the insula and analyze the variables implicated in the management and prognosis of these tumors.MATERIALS AND METHODSThis retrospective, single-center, analytical study included a cohort of 83 patients who underwent surgery for insular gliomas by the same surgeon in a third-level Argentine center, in the period between 2010-2023. We analyzed the population's demographic, clinical, and radiological features and surgical variables associated with postoperative results and prognosis using multivariate regression analysis.RESULTSA total of 53 patients (54% males) were included with a mean follow-up of 40.7 months. Mean age at surgery was 41 years (range 21-73) and 66.1% corresponded to low-grade gliomas. Seizures were the initial symptom in the majority of cases. There was evidence of tumor extension over the insula to temporal or/and frontal lobe in 64.2% of patients. An EOR over 90% was achieved in 62.3% of cases (27% of GTR) with an average resected volume of 89.4%. Awake craniotomy was indicated in 47% of patients and iMRI was performed in 24%. Recurrence was observed in 44% of patients with a mean Progression-Free survival of 31 months (42 months in LGG and 10 months in HGG). A total of 9 patients were re-operated. By the time of 2 years, survival rates were 100% for LGG and 46% for HGG, while 4-year overall survival rates were 92% for patients with LGG and 15.4% for those with HGG.CONCLUSIONSurgery for insular gliomas is a complex task that needs to be managed with adequate preoperative and intraoperative assessment in order to achieve maximum safe resection with low morbidity for better functional and oncological outcomes. Adequate anatomical understanding, radiological analysis, awake craniotomy, cortical and subcortical mapping are paramount to pursue this aim.","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":"142263411","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.2024.09.017
Rida Mitha,Mark A Mahan,Rujvee P Patel,Jhair Alejandro Colan,Jannik Leyendecker,Mark M Zaki,Edward Samir Harake,Varun Kathawate,Osama Kashlan,Sanjay Konakondla,Meng Huang,Galal A Elsayed,Daniel M Hafez,Brenton Pennicooke,Nitin Agarwal,Christoff P Hofstetter,John O Ogunlade
INTRODUCTIONDegenerative spondylolisthesis is an important cause of chronic low-back and radiculopathy in the adult US population. Open decompression with or without fusion is considered the standard for management, yet optimal treatment remains controversial. Full endoscopic spine surgery offers an alternative surgical approach with possible advantages. There is a paucity of data on the use of FESS in degenerative spondylolisthesis. Therefore, we present the clinical and radiographic outcomes of 73 patients with low-grade degenerative spondylolisthesis with severe stenosis, who underwent lumbar endoscopic unilateral laminectomy for bilateral decompression.METHODSPatients with low-grade degenerative spondylolisthesis who underwent a lumbar endoscopic ULBD at six spine centers in North America were included in this study. Patients were followed up at 3, 9, and 12 months. Static and dynamic imaging was performed and evaluated routinely before surgery to identify the pathology and grade of spondylolisthesis. Patient reported outcomes were prospectively collected.RESULTSThis study included 73 patients from six spine centers. Sixty-two patients were diagnosed with grade 1 spondylolisthesis while 11 were diagnosed with grade 2 spondylolisthesis. Postoperatively 70 patients reported improved symptoms and pain resolution while three patients reported worse pain. Mean VAS back, VAS leg, and ODI scores showed a statistically significant improvement at 3, 9, and 12-months when compared to the preoperative period. Radiographically, no patient in our study had progression of grade of spondylolisthesis.CONCLUSIONPatients with low-grade degenerative spondylolisthesis causing severe stenosis can safely be treated with lumbar endoscopic unilateral laminectomy for bilateral decompression. Head-to-head trial should be undertaken to provide higher level of clinical evidence.
{"title":"Lumbar Endoscopic Unilateral Laminectomy for Bilateral Decompression in Degenerative Spondylolisthesis.","authors":"Rida Mitha,Mark A Mahan,Rujvee P Patel,Jhair Alejandro Colan,Jannik Leyendecker,Mark M Zaki,Edward Samir Harake,Varun Kathawate,Osama Kashlan,Sanjay Konakondla,Meng Huang,Galal A Elsayed,Daniel M Hafez,Brenton Pennicooke,Nitin Agarwal,Christoff P Hofstetter,John O Ogunlade","doi":"10.1016/j.wneu.2024.09.017","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.017","url":null,"abstract":"INTRODUCTIONDegenerative spondylolisthesis is an important cause of chronic low-back and radiculopathy in the adult US population. Open decompression with or without fusion is considered the standard for management, yet optimal treatment remains controversial. Full endoscopic spine surgery offers an alternative surgical approach with possible advantages. There is a paucity of data on the use of FESS in degenerative spondylolisthesis. Therefore, we present the clinical and radiographic outcomes of 73 patients with low-grade degenerative spondylolisthesis with severe stenosis, who underwent lumbar endoscopic unilateral laminectomy for bilateral decompression.METHODSPatients with low-grade degenerative spondylolisthesis who underwent a lumbar endoscopic ULBD at six spine centers in North America were included in this study. Patients were followed up at 3, 9, and 12 months. Static and dynamic imaging was performed and evaluated routinely before surgery to identify the pathology and grade of spondylolisthesis. Patient reported outcomes were prospectively collected.RESULTSThis study included 73 patients from six spine centers. Sixty-two patients were diagnosed with grade 1 spondylolisthesis while 11 were diagnosed with grade 2 spondylolisthesis. Postoperatively 70 patients reported improved symptoms and pain resolution while three patients reported worse pain. Mean VAS back, VAS leg, and ODI scores showed a statistically significant improvement at 3, 9, and 12-months when compared to the preoperative period. Radiographically, no patient in our study had progression of grade of spondylolisthesis.CONCLUSIONPatients with low-grade degenerative spondylolisthesis causing severe stenosis can safely be treated with lumbar endoscopic unilateral laminectomy for bilateral decompression. Head-to-head trial should be undertaken to provide higher level of clinical evidence.","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":"142263611","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.2024.09.016
Michelle N Odonkor,Bhavya Pahwa,Jordina Rincon-Torroella,Nancy Abu-Bonsrah,Gayane Yenokyan,Olaoluwa Ezekiel Dada,C Rory Goodwin,Judy Huang,Mari L Groves
BACKGROUNDThe current neurosurgical workforce is not large enough to address the significant burden of neurosurgical disease worldwide, and women are under-represented in this surgical specialty. However, trainee opportunities are particularly scarce in lower- and -middle income countries, where the burden of neurosurgical disease is high. Thus, the primary aim of this study was to assess the effects of gender and country on perceived access to neurosurgical research and mentorship opportunities.METHODSA cross-sectional survey evaluating perceived access to neurosurgical research and mentorship opportunities was distributed electronically to medical students and unspecialized residents in 10 countries (Colombia, India, Ghana, Nigeria, Saudi Arabia, Spain, Uganda, United Kingdom, United States, Venezuela).RESULTS34.0% of men versus 24.9% of women reported interest in neurosurgery (p<0.001). Only 16.1% of trainees reported adequate access to neurosurgical research opportunities, which did not vary by gender overall (p=0.070). However, more women reported inadequate access in the United States (p=0.038), and more men reported inadequate access in Colombia (p=0.043). In Colombia (p<0.001), Nigeria (p=0.003), Saudi Arabia (p=0.038), the United States (p=0.004), and Venezuela (p<0.001), a lower proportion of women than men reported ever having a neurosurgery mentor of their same gender. 59.0% of female respondents noted that having access to female neurosurgeon mentors would increase their interest in neurosurgery, compared to 28.5% of male respondents (p<0.001).CONCLUSIONSMore male than female medical trainees in the surveyed countries reported interest in neurosurgery. However, access to adequate neurosurgical research opportunities, though relatively low overall, did not vary by gender in most countries. Access to gender-concordant mentorship was less common for women than men, but women expressed that enhanced access to female neurosurgeon mentors would increase their interest in the field. These findings suggest potential avenues for intervention to augment and diversify the global neurosurgical workforce.
{"title":"Effects of Gender and Country of Training on Perceived Access to Opportunities for Neurosurgical Research and Gender-Concordant Mentorship.","authors":"Michelle N Odonkor,Bhavya Pahwa,Jordina Rincon-Torroella,Nancy Abu-Bonsrah,Gayane Yenokyan,Olaoluwa Ezekiel Dada,C Rory Goodwin,Judy Huang,Mari L Groves","doi":"10.1016/j.wneu.2024.09.016","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.016","url":null,"abstract":"BACKGROUNDThe current neurosurgical workforce is not large enough to address the significant burden of neurosurgical disease worldwide, and women are under-represented in this surgical specialty. However, trainee opportunities are particularly scarce in lower- and -middle income countries, where the burden of neurosurgical disease is high. Thus, the primary aim of this study was to assess the effects of gender and country on perceived access to neurosurgical research and mentorship opportunities.METHODSA cross-sectional survey evaluating perceived access to neurosurgical research and mentorship opportunities was distributed electronically to medical students and unspecialized residents in 10 countries (Colombia, India, Ghana, Nigeria, Saudi Arabia, Spain, Uganda, United Kingdom, United States, Venezuela).RESULTS34.0% of men versus 24.9% of women reported interest in neurosurgery (p<0.001). Only 16.1% of trainees reported adequate access to neurosurgical research opportunities, which did not vary by gender overall (p=0.070). However, more women reported inadequate access in the United States (p=0.038), and more men reported inadequate access in Colombia (p=0.043). In Colombia (p<0.001), Nigeria (p=0.003), Saudi Arabia (p=0.038), the United States (p=0.004), and Venezuela (p<0.001), a lower proportion of women than men reported ever having a neurosurgery mentor of their same gender. 59.0% of female respondents noted that having access to female neurosurgeon mentors would increase their interest in neurosurgery, compared to 28.5% of male respondents (p<0.001).CONCLUSIONSMore male than female medical trainees in the surveyed countries reported interest in neurosurgery. However, access to adequate neurosurgical research opportunities, though relatively low overall, did not vary by gender in most countries. Access to gender-concordant mentorship was less common for women than men, but women expressed that enhanced access to female neurosurgeon mentors would increase their interest in the field. These findings suggest potential avenues for intervention to augment and diversify the global neurosurgical workforce.","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":"142263612","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}
OBJECTIVETo compare the elastographic patterns of high-grade gliomas (HGGs) solid portions and those of adjacent healthy brain parenchyma, on intraoperative ultrasound, with magnetic resonance image (MRI) characteristics.METHODSClinical records and images of HGGs patients, operated between June and December 2018, were retrospectively reviewed. Fusion images were used to compare preoperative gadolinium-enhanced T1-weighted MRI/fluid-attenuated inversion recovery images (Gd-T1 MRI/FLAIR) to intraoperative strain elastography (SE). FLAIR/Gd-T1 MRI images were used to define: enhancement patterns (absent/whole lesion/peripheral) and lesions' characteristics (primary and secondary pattern, further subdivided in solid/necrotic/cystic/infiltrating). HGGs SE patterns were categorized as homogeneous/inhomogeneous, while lesions' primary and secondary patterns as stiff/intermediate/elastic. The SE motive of neighboring healthy brain parenchyma was defined similarly.RESULTS18 patients (M:F, 11:7; mean age: 53 years) harboring 14 glioblastomas (77.8%, GBMs) and 4 anaplastic astrocytomas (22.2%, AAs) were compared. GBMs typically enhanced peripherally and had a primary necrotic pattern (78.6% and 64.3%, respectively), while AAs did not enhance and were solid (75% both) at T1-Gd MRI and FLAIR images. At SE AAs had a homogeneous stiff primary pattern, whereas the majority of GBMs primary patterns were heterogeneous (85.7%) and intermediate (78.6%).CONCLUSIONSThree major SE patterns defined HGGs and adjacent healthy brain parenchyma. SE patterns varied accordingly to HGG histotypes and Gd-T1 MRI/FLAIR characteristics.
{"title":"Intraoperative comparison between strain elastography and pre-operative MRI features in high-grade gliomas using fusion imaging: a pilot study.","authors":"Antonio Giulio Gennari,Fabio Martino Doniselli,Justin Coley,Marina Grisoli,Emilio Quaia,Remi Souchon,Francesco Prada,Francesco DiMeco","doi":"10.1016/j.wneu.2024.09.024","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.024","url":null,"abstract":"OBJECTIVETo compare the elastographic patterns of high-grade gliomas (HGGs) solid portions and those of adjacent healthy brain parenchyma, on intraoperative ultrasound, with magnetic resonance image (MRI) characteristics.METHODSClinical records and images of HGGs patients, operated between June and December 2018, were retrospectively reviewed. Fusion images were used to compare preoperative gadolinium-enhanced T1-weighted MRI/fluid-attenuated inversion recovery images (Gd-T1 MRI/FLAIR) to intraoperative strain elastography (SE). FLAIR/Gd-T1 MRI images were used to define: enhancement patterns (absent/whole lesion/peripheral) and lesions' characteristics (primary and secondary pattern, further subdivided in solid/necrotic/cystic/infiltrating). HGGs SE patterns were categorized as homogeneous/inhomogeneous, while lesions' primary and secondary patterns as stiff/intermediate/elastic. The SE motive of neighboring healthy brain parenchyma was defined similarly.RESULTS18 patients (M:F, 11:7; mean age: 53 years) harboring 14 glioblastomas (77.8%, GBMs) and 4 anaplastic astrocytomas (22.2%, AAs) were compared. GBMs typically enhanced peripherally and had a primary necrotic pattern (78.6% and 64.3%, respectively), while AAs did not enhance and were solid (75% both) at T1-Gd MRI and FLAIR images. At SE AAs had a homogeneous stiff primary pattern, whereas the majority of GBMs primary patterns were heterogeneous (85.7%) and intermediate (78.6%).CONCLUSIONSThree major SE patterns defined HGGs and adjacent healthy brain parenchyma. SE patterns varied accordingly to HGG histotypes and Gd-T1 MRI/FLAIR characteristics.","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":"142263610","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}
OBJECTIVETo evaluate long-term outcomes of surgical resection for congenital brain tumors (CBTs) in infants under one year of age and to identify factors related to survival.METHODSOur retrospective study analyzed infants who underwent gross total (GTR) or subtotal resection (STR) for CBTs between 2001 and 2019. Data were obtained from medical records, including demographics, clinical presentation, diagnosis, tumor characteristics, and presence of hydrocephalus. Additional factors such as pre- and/or postoperative ventriculoperitoneal shunt (VPS) placement and adjuvant chemotherapy or radiotherapy were also reviewed. Cox regression analysis was used to identify factors associated with survival.RESULTSThe study included 70 patients, with median age at surgery of 198.5 days, and 28 (40%) were girls. Seizures (31.4%) and vomiting (24.3%) were the most common presenting symptoms. High-grade tumors were present in 29 (41.4%) patients. GTR was achieved in 64.3% of cases, with surgical mortality rate of 7.1%. Overall survival rates at 5 and 10 years were 78% and 63%, respectively. Long-term follow-up data were available for 61 patients (87%), with median follow-up of 74.2 months. Among 45 long-term survivors, 55.5% had neurological sequelae. Factors associated with reduced survival included high-grade, preoperative hydrocephalus, larger tumor size, and VPS placement. The extent of resection improved survival only in low-grade tumor cases. Multivariable Cox regression analysis identified tumor grade and size as independent predictors of poor prognosis.CONCLUSIONSSurgical resection remains crucial for treating CBTs in infants under one year, yet the aggressive nature of malignant tumors results in suboptimal outcomes regarding prognosis.
{"title":"Congenital Brain Tumors: Surgical Outcomes and Long-Term Prognostic Factors.","authors":"Ahmet Ilkay Isikay,Muhammet Enes Gurses,Neslihan Nisa Gecici,Baylar Baylarov,Efecan Cekic,Firat Narin,Dicle Karakaya,Sahin Hanalioglu,Burcak Bilginer","doi":"10.1016/j.wneu.2024.09.021","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.021","url":null,"abstract":"OBJECTIVETo evaluate long-term outcomes of surgical resection for congenital brain tumors (CBTs) in infants under one year of age and to identify factors related to survival.METHODSOur retrospective study analyzed infants who underwent gross total (GTR) or subtotal resection (STR) for CBTs between 2001 and 2019. Data were obtained from medical records, including demographics, clinical presentation, diagnosis, tumor characteristics, and presence of hydrocephalus. Additional factors such as pre- and/or postoperative ventriculoperitoneal shunt (VPS) placement and adjuvant chemotherapy or radiotherapy were also reviewed. Cox regression analysis was used to identify factors associated with survival.RESULTSThe study included 70 patients, with median age at surgery of 198.5 days, and 28 (40%) were girls. Seizures (31.4%) and vomiting (24.3%) were the most common presenting symptoms. High-grade tumors were present in 29 (41.4%) patients. GTR was achieved in 64.3% of cases, with surgical mortality rate of 7.1%. Overall survival rates at 5 and 10 years were 78% and 63%, respectively. Long-term follow-up data were available for 61 patients (87%), with median follow-up of 74.2 months. Among 45 long-term survivors, 55.5% had neurological sequelae. Factors associated with reduced survival included high-grade, preoperative hydrocephalus, larger tumor size, and VPS placement. The extent of resection improved survival only in low-grade tumor cases. Multivariable Cox regression analysis identified tumor grade and size as independent predictors of poor prognosis.CONCLUSIONSSurgical resection remains crucial for treating CBTs in infants under one year, yet the aggressive nature of malignant tumors results in suboptimal outcomes regarding prognosis.","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":"142263409","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}
STUDYDesign Retrospective study Objective To observe and measure the safe distance between the uncinate process (UP) and the V2 vertebral artery (VA).METHODSTwo hundred and sixteen patients who underwent head and neck CTA date were selected and measured. The Upper Tip (UT) of the UP, the Posterior Tip (PT) of the UP and the Center of the VA (CA) were identified. Then, the width between the UT and the CA (WUA), the depth between the UT and the CA (DUA), the distance between the UT and the CA (LUA) were measured. Meanwhile, the width between the PT and the CA (WPA), the depth between the PT and the CA (DPA) and the length between the PT and the CA (LPA) were measured. The values above were compared between the left and right sides of the same vertebral body, also the results of the same side from C3 to C6 were compared.RESULTSThat WUA fluctuates between 6.1- 4.4 mm on the left side with the narrowest at C5 and C6 (4.4 mm), 6.5- 4.6 mm on the right side with the narrowest at C5 (4.6 mm). It could be concluded that the safe space for operation outside UP is about 4mm and more care should be taken when operating on the caudal spine. WPA fluctuates between 10.6- 10.0 mm on the left side with the narrowest at C3 (10mm), 11.0- 9.9 mm on the right side with the narrowest at C4 (9.9 mm). The safe space for operation outside the PT is about 10mm and more care should be taken when operating on the cephalad spine. DPA fluctuates between 6.5- 4.6 mm on the left and is narrowest at C3 (4.6 mm), 6.5- 4.7 mm on the right and narrowest at C3 (4.7 mm). The safe space for operation from the PT to the ventral side is about 4.5 mm, and more care should be taken when operating on the cephalad side of the cervical spine.CONCLUSIONUP and PT could be seen as the landmarks in the operations of ACDF. The safe space outside UP is about 4mm and more care should be taken when operating on the caudal spine. The safe space outside PT is about 10mm and more care should be taken when operating on the cephalad spine. The safe space for operation from the PT to the ventral side is about 4.5 mm, and more care should be taken when operating on the cephalad side of the cervical spine.
研究设计 回顾性研究 目的 观察并测量椎弓根（UP）与 V2 椎动脉（VA）之间的安全距离。确定椎动脉上端（UT）、椎动脉后端（PT）和椎动脉中心（CA）。然后，测量 UT 与 CA 之间的宽度（WUA）、UT 与 CA 之间的深度（DUA）以及 UT 与 CA 之间的距离（LUA）。同时，还测量了 PT 与 CA 之间的宽度（WPA）、PT 与 CA 之间的深度（DPA）以及 PT 与 CA 之间的长度（LPA）。结果左侧的 WUA 在 6.1-4.4 mm 之间波动，C5 和 C6 处最窄（4.4 mm），右侧的 WUA 在 6.5-4.6 mm 之间波动，C5 处最窄（4.6 mm）。由此可以得出结论，UP 以外的安全手术空间约为 4 毫米，在尾椎进行手术时应更加小心。左侧的WPA在10.6-10.0毫米之间波动，最窄处在C3（10毫米），右侧的WPA在11.0-9.9毫米之间波动，最窄处在C4（9.9毫米）。在 PT 外侧操作的安全空间约为 10 毫米，在头侧脊柱上操作时应更加小心。DPA 在左侧 6.5-4.6 毫米之间波动，在 C3（4.6 毫米）处最窄，在右侧 6.5-4.7 毫米之间波动，在 C3（4.7 毫米）处最窄。从 PT 到腹侧的安全操作空间约为 4.5 mm，在颈椎头侧操作时应更加小心。UP外的安全空间约为4毫米，在尾椎进行手术时应更加小心。PT外侧的安全空间约为10毫米，在头侧脊柱进行手术时应更加小心。从 PT 到腹侧的安全操作空间约为 4.5 毫米，在颈椎头侧操作时应更加小心。
{"title":"Anatomic research of the safe space between the cervical uncinate process and the V2 vertebral artery.","authors":"Shuang Wang,Yi-Nan Zhang,Xiao Yang,Hai-Long Yu,Yu Chen","doi":"10.1016/j.wneu.2024.09.028","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.028","url":null,"abstract":"STUDYDesign Retrospective study Objective To observe and measure the safe distance between the uncinate process (UP) and the V2 vertebral artery (VA).METHODSTwo hundred and sixteen patients who underwent head and neck CTA date were selected and measured. The Upper Tip (UT) of the UP, the Posterior Tip (PT) of the UP and the Center of the VA (CA) were identified. Then, the width between the UT and the CA (WUA), the depth between the UT and the CA (DUA), the distance between the UT and the CA (LUA) were measured. Meanwhile, the width between the PT and the CA (WPA), the depth between the PT and the CA (DPA) and the length between the PT and the CA (LPA) were measured. The values above were compared between the left and right sides of the same vertebral body, also the results of the same side from C3 to C6 were compared.RESULTSThat WUA fluctuates between 6.1- 4.4 mm on the left side with the narrowest at C5 and C6 (4.4 mm), 6.5- 4.6 mm on the right side with the narrowest at C5 (4.6 mm). It could be concluded that the safe space for operation outside UP is about 4mm and more care should be taken when operating on the caudal spine. WPA fluctuates between 10.6- 10.0 mm on the left side with the narrowest at C3 (10mm), 11.0- 9.9 mm on the right side with the narrowest at C4 (9.9 mm). The safe space for operation outside the PT is about 10mm and more care should be taken when operating on the cephalad spine. DPA fluctuates between 6.5- 4.6 mm on the left and is narrowest at C3 (4.6 mm), 6.5- 4.7 mm on the right and narrowest at C3 (4.7 mm). The safe space for operation from the PT to the ventral side is about 4.5 mm, and more care should be taken when operating on the cephalad side of the cervical spine.CONCLUSIONUP and PT could be seen as the landmarks in the operations of ACDF. The safe space outside UP is about 4mm and more care should be taken when operating on the caudal spine. The safe space outside PT is about 10mm and more care should be taken when operating on the cephalad spine. The safe space for operation from the PT to the ventral side is about 4.5 mm, and more care should be taken when operating on the cephalad side of the cervical spine.","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":"142263415","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}
OBJECTIVESThis study aims to provide a current and comprehensive analysis of the incidence of delayed intracerebral hemorrhage (dICH) in head trauma patients on oral anticoagulants and to evaluate various potential risk factors.METHODSWe conducted a systematic review and meta-analysis following PRISMA and MOOSE guidelines. PubMed and CENTRAL were searched for studies on dICH in anticoagulated head trauma patients undergoing repeat CT scans. Studies reporting dICH incidence on repeat CT within 24 hours of an initial negative scan were included. Data on demographics, anticoagulant type, risk factors, and clinical outcomes were extracted and analyzed.RESULTSFrom 634 identified articles, 26 studies with 7218 patients were included. The overall incidence of dICH was 2.0%, with 43.8% of these cases requiring hospital admission or changes in clinical management. Only 0.1% required neurosurgical intervention, and 0.1% resulted in death. Meta-analysis of 20 studies revealed pooled dICH incidence per 1000 persons at risk was 27.1 for vitamin K antagonists (VKAs) and 20.5 for direct oral anticoagulants (DOACs). Significant risk factors for dICH included Glasgow Coma Scale (GCS) <15, loss of consciousness, post-traumatic amnesia, and Abbreviated Injury Scale (AIS) head ≥3.CONCLUSIONSA low incidence of dICH requires neurosurgical intervention, however further studies are required to assess the need for other medical management in these patients. Furthermore, selective imaging for high-risk patients could improve care and resource allocation.
{"title":"Incidence and Risk Factors of Delayed Intracranial Hemorrhage in Anticoagulated Head Trauma Patients: A Systematic Review and Meta-Analysis.","authors":"Renato Luís Pessôa,Gabriel Moretti Garcia,Gabriel Goerck Becker,Eduardo Henrique Guadagnin,Lucas Pires Freitas,Eduardo Mensch Jaeger,Andrea de Vargas Tomelero,André Pinheiro Weber,Guilherme Henrique Ávila do Carmo","doi":"10.1016/j.wneu.2024.09.018","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.018","url":null,"abstract":"OBJECTIVESThis study aims to provide a current and comprehensive analysis of the incidence of delayed intracerebral hemorrhage (dICH) in head trauma patients on oral anticoagulants and to evaluate various potential risk factors.METHODSWe conducted a systematic review and meta-analysis following PRISMA and MOOSE guidelines. PubMed and CENTRAL were searched for studies on dICH in anticoagulated head trauma patients undergoing repeat CT scans. Studies reporting dICH incidence on repeat CT within 24 hours of an initial negative scan were included. Data on demographics, anticoagulant type, risk factors, and clinical outcomes were extracted and analyzed.RESULTSFrom 634 identified articles, 26 studies with 7218 patients were included. The overall incidence of dICH was 2.0%, with 43.8% of these cases requiring hospital admission or changes in clinical management. Only 0.1% required neurosurgical intervention, and 0.1% resulted in death. Meta-analysis of 20 studies revealed pooled dICH incidence per 1000 persons at risk was 27.1 for vitamin K antagonists (VKAs) and 20.5 for direct oral anticoagulants (DOACs). Significant risk factors for dICH included Glasgow Coma Scale (GCS) <15, loss of consciousness, post-traumatic amnesia, and Abbreviated Injury Scale (AIS) head ≥3.CONCLUSIONSA low incidence of dICH requires neurosurgical intervention, however further studies are required to assess the need for other medical management in these patients. Furthermore, selective imaging for high-risk patients could improve care and resource allocation.","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":"142263609","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}
BACKGROUNDPostoperative cerebrospinal fluid (CSF) leakage is the leading adverse event in transsphenoidal surgery (TSS). Intraoperative CSF (ioCSF) leakage is one of the most important predictive factors for postoperative CSF leakage. This systematic review and meta-analysis aimed to evaluate the effectiveness of artificial intelligence (AI) models in predicting ioCSF.METHODSLiterature records were retrieved on June 13th, 2024, using the relevant key terms without filters in PubMed, Embase, Scopus, and Web of Science. Records were screened according to the eligibility criteria, and the data from the included studies were extracted. The quality assessment was performed using the QUADAS-2 tool. The meta-analysis, sensitivity analysis, and meta-regression were conducted using R software.RESULTSOur results demonstrate that the AI models achieved a pooled sensitivity of 93.4% (95% CI: 74.8%- 98.6%) and specificity of 91.7% (95% CI: 75%- 97.6%). The subgroup analysis revealed that the pooled sensitivities in ML and DL were 86.2% (95% CI: 83%- 88.8%) and 99% (95% CI: 93%- 99%), respectively (P<0.01). The subgroup analysis demonstrated a pooled specificity of 92.1% (95% CI: 63.1%- 98.7%) for ML and 90.6% (95% CI: 78.2%- 96.3%) for DL models (P= 0.87). The DOR meta-analysis revealed an odds ratio (OR) 114.6 (95% CI: 17.6- 750.9). The SROC curve demonstrated that the overall AUC of the studies was 0.955, which is a considerable performance.CONCLUSIONAI models have demonstrated promising performance for predicting the ioCSF leakage in pituitary surgery and can optimize the treatment strategy.
{"title":"Clinical Application of Artificial Intelligence in Prediction of Intraoperative Cerebrospinal Fluid Leakage in Pituitary Surgery: A Systematic Review and Meta-Analysis.","authors":"Bardia Hajikarimloo,Mohammadamin Sabbagh Alvani,Amir Koohfar,Ehsan Goudarzi,Mandana Dehghan,Seyed Hesam Hojjat,Rana Hashemi,Salem M Tos,Mohammadhosein Akhlaghpasand,Mohammad Amin Habibi","doi":"10.1016/j.wneu.2024.09.015","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.09.015","url":null,"abstract":"BACKGROUNDPostoperative cerebrospinal fluid (CSF) leakage is the leading adverse event in transsphenoidal surgery (TSS). Intraoperative CSF (ioCSF) leakage is one of the most important predictive factors for postoperative CSF leakage. This systematic review and meta-analysis aimed to evaluate the effectiveness of artificial intelligence (AI) models in predicting ioCSF.METHODSLiterature records were retrieved on June 13th, 2024, using the relevant key terms without filters in PubMed, Embase, Scopus, and Web of Science. Records were screened according to the eligibility criteria, and the data from the included studies were extracted. The quality assessment was performed using the QUADAS-2 tool. The meta-analysis, sensitivity analysis, and meta-regression were conducted using R software.RESULTSOur results demonstrate that the AI models achieved a pooled sensitivity of 93.4% (95% CI: 74.8%- 98.6%) and specificity of 91.7% (95% CI: 75%- 97.6%). The subgroup analysis revealed that the pooled sensitivities in ML and DL were 86.2% (95% CI: 83%- 88.8%) and 99% (95% CI: 93%- 99%), respectively (P<0.01). The subgroup analysis demonstrated a pooled specificity of 92.1% (95% CI: 63.1%- 98.7%) for ML and 90.6% (95% CI: 78.2%- 96.3%) for DL models (P= 0.87). The DOR meta-analysis revealed an odds ratio (OR) 114.6 (95% CI: 17.6- 750.9). The SROC curve demonstrated that the overall AUC of the studies was 0.955, which is a considerable performance.CONCLUSIONAI models have demonstrated promising performance for predicting the ioCSF leakage in pituitary surgery and can optimize the treatment strategy.","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":"142263406","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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