World neurosurgery最新文献

Objectives: Robotic-assisted laser interstitial thermal therapy (LITT) is a minimally invasive method for ablating seizure foci and has gained prominence in epilepsy treatment. The use of robotic guidance in these procedures can minimize errors in probe placement, potentially leading to better clinical outcomes. In this meta-analysis, we assessed the accuracy, safety, and effectiveness of robot-assisted LITT for drug-resistant epilepsy.

Methods: A systematic search was conducted in Scopus, Web of Science, PubMed, and Embase till July 7^th, 2024. Two independent authors performed screening and data extraction. Random-effect meta-analysis was performed to determine the accuracy, procedure duration, efficacy, and complications of robot-assisted LITT.

Results: Overall, 11 studies were included in the meta-analyses. The results demonstrated that the overall target point localization error (TPLE) was 1.66 (95%CI = 1.23-2.25) with higher precision in frame-based methods (P = 0.02). The mean procedure duration was 5.35 hours (95%CI = 3.69-7.74) and the pooled ablation time was 11.24 minutes (95%CI = 2.78-45.49); both were longer in disconnection surgery compared to the ablative procedure (P < 0.001 and P < 0.0001, respectively). In follow-up, 0.58 (95%CI = 0.47-0.69) of patients became seizure-free, and 0.86 (95%CI = 0.72-0.95) of patients had improvements. Individual patient data analysis showed that robots in LITT are usually used when there are more lesions (P < 0.01).

Conclusions: Robot-assisted LITT offers high precision, positive seizure outcomes, and minimal complications, comparable to non-robotic methods, and is suitable for treating drug-resistant epilepsy with multiple lesions.

Background: This meta-analysis was conducted to compare the efficacy and safety of vertebral augmentation (VA) plus pedicle screw fixation (PSF) with VA for treating osteoporotic thoracolumbar fractures (OTLFs).

Methods: A comprehensive search was conducted in PubMed, Embase, Cochrane Library and China National Knowledge Infrastructure (CNKI) to identify studies comparing PSF+VA with VA for treating OTLF. The primary outcomes were operation time, blood loss, length of stay, visual analogue scale (VAS) score, Oswestry disability index (ODI), Cobb angle, anterior vertebral height (AVH), bone cement leakage, secondary fracture and other adverse events. Standardized mean deviation (SMD) and risk ratio(RR) with 95% confidence interval (CI) were calculated.

Results: Totally 14 studies met the entire inclusion criteria for our meta-analysis. The PSF+VA group was associated with significantly more operation time (SMD 4.41, 95% CI 3.32-5.51), blood loss (SMD=6.72, 95%CI 4.50 - 8.95), and length of stay (SMD=2.05, 95%CI 1.02 - 3.07). There was no significant VAS or ODI score difference at early follow-up. No significant difference was found in AVH between the two groups before two years. The remaining outcomes (VAS at six months and two years; ODI at six months and 1 year; Cobb angle at all follow-up periods; AVH at two years; bone cement leakage and secondary fracture) favored the PSF+VA group.

Conclusion: PSF+VA was superior to VA for the VAS score, ODI, Cobb angle, AVH and complications, especially in the long-term follow-up. However, more operation time, blood loss and length of stay were the disadvantages for PSF+VA.

Introduction: Patients in the neurological intensive care unit (ICU) are at an increased risk of venous thromboembolism (VTE). Anticoagulation is often indicated because deep venous thrombosis (DVT) can develop into pulmonary embolism (PE). However, anticoagulation also increases the risk of intracranial bleeding. Physicians must weigh the opposing risks carefully. It is commonly believed that upper extremity DVT (UEDVT) is less likely to develop into PE as compared to lower extremity DVT (LEDVT), but this lacks evidence, and our study investigates its validity.

Methods: Retrospective review of patients admitted to a neurological ICU from 2017 to 2022 and developed VTE.

Results: We reviewed 2,891 patients and 97 patients met study criteria. VTE occurred in 3.55% of patients, DVT in 2.63%, and PE in 0.96%. Of the recorded DVTs, 52.3% were in the upper extremities, 42.3% in the lower extremities, and 6.4% in both. PE rate was not significantly different in patients with UEDVT than in those with LEDVT (p = 0.233). Cather-associated DVT was more common in the upper extremities (p=0.002), but the PE rate was no different in catheter-associated DVT than non-catheter-associated DVT (p=0.193). The proportion of patients treated with therapeutic anticoagulation was not significantly different between patients with UEDVT alone and those with LEDVT (p=1.000).

Conclusion: In this sample of neurocritical care patients, the coexistence of DVT and PE did not differ in patients with upper versus lower extremity DVT. This should be considered in the neurocritical care unit when deciding whether to treat patients with DVT with anticoagulants.

Objective: Neurosurgical care is difficult to access in many scenarios. Aeromedical evacuation of acutely unwell neurosurgical patients from remote, isolated or poorly equipped locations can be considered. This article aims to provide a framework of logistical factors which deserve special consideration in the preparation of these patients for transfer.

Methods: We searched all relevant medical literature, military reports, and travel industry documents on transfer of neurosurgical patients. This review was combined with a senior author's (MJ) extensive relevant experience, to present important factors for neurosurgeons to consider during planning of aeromedical evacuation, highlighting potential preventable causes of deterioration en-route.

Results: Several criteria must be met for a transfer to be considered. The safe transfer of patients with cranio-spinal pathology requires efficient collaboration between the referring teams, the receiving units/departments, and the medical transfer service. Clear communication, qualified personnel and appropriate transportation equipment must be available for the transfer. One must consider unique stressors during the air transfer, including the risk of hypoxia on certain types of flights. Vibration, loud noise, acceleration, and changes in barometric pressure en-route may negatively affect the patient during transfer. Patient stabilization before transfer is a priority. Medical conditions which can potentially worsen in-flight should be corrected before transfer. The use of a checklist before departure is highly recommended, and is included below. The timing of transfer concerning the postoperative patient deserves special consideration.

Conclusions: Although there is little published information, this review provides useful criteria and parameters needed for safe aeromedical evacuation of neurosurgical patients.

Background: A rapid and smooth emergence is essential in patients undergoing trans-sphenoidal pituitary surgeries. Ketofol has been used as an anesthetic agent with good recovery characteristics. We conducted this study to compare the recovery profile of the patients receiving propofol-dexmedetomidine or ketofol-dexmedetomidine infusions for trans-sphenoidal excision of pituitary tumours.

Materials and methods: Forty adult patients undergoing endoscopic pituitary surgery received either an infusion of propofol (Group P) or ketofol, 1:5 (Group KP)at 0.6-0.9ml/kg/h. Dexmedetomidine (0.5 μg/kg/ h) was administered in both groups. Our aim was to assess the recovery time, extubation time, emergence time. We also assessed the intraoperative hemodynamics, cerebral oxygenation, quality of the surgical field and postoperative pain.

Results: The recovery time (Group KP v/s P; 16.5 ± 4.3 v/s 8.3 ± 2.7 mins, P <0.01), emergence time (12.9 ± 3.9 v/s 5.7 ± 2.7 mins, P<0.01) and extubation time (14.3 ± 4.2 v/s 7.2 ± 2.8 mins, P <0.01) was longer in Group KP as compared to Group P. However, the patients in Group KP had lower cough scores, and pain scores, along with better maintenance of hemodynamic stability and cerebral oxygenation. The agitation score, cognition score, and quality of the surgical field were comparable.

Conclusion: The use of ketofol resulted in a longer recovery time compared to the use of propofol alone. However, ketofol was associated with a better quality of extubation, maintenance of hemodynamic stability, and enhanced postoperative analgesia. Further research is needed to conclusively establish its efficacy and optimal dosage in pituitary surgery.

Objective: Large or giant paraclinoid aneurysms have been treated with various strategies, including clipping, coiling, and parent artery occlusion (PAO). In addition, flow diverters (FDs) have been introduced for the management of these aneurysms. The aim of this study was to examine the management of unruptured large/giant paraclinoid aneurysms in Japan when FDs were being introduced by a nationwide survey.

Methods: A total of 576 unruptured large/giant paraclinoid aneurysms treated in Japan between January 2012 and December 2016 were retrospectively studied.

Results: Half of the large paraclinoid aneurysms were treated by coiling (50.3%), whereas giant aneurysms were occluded mainly by PAO (51.4%). A high nearly complete occlusion rate was achieved with clipping (94.1%), coiling (85.9%), PAO (82.4%), and FDs (77.6%). Coiling had higher risks of recurrence (28.3%) and retreatment (20.3%). Major procedure-related complications were observed in 9.7%. Ischemic complications were common in PAO (9.5%), with cranial nerve symptoms common in clipping (10.9%). All treatment modalities achieved good clinical outcomes (93.5%-96.6%). Although not significant, pre-existing visual disturbance improved most frequently by clipping (53.7%), but also worsened most frequently by clipping (24.4%). Consequently, FD achieved a high occlusion rate with minimal complication and retreatment rates.

Conclusions: All treatment modalities offer high rates of complete occlusion and good clinical outcomes. Coiling has the disadvantage of high rates of recurrence and retreatment. Clipping and PAO have the disadvantage of a high rate of major procedure-related complications; however, PAO can provide comparable treatment outcomes even in cases with refractory giant aneurysms. FDs are the optimal choice for the management for large/giant paraclinoid aneurysms due to its safety and efficacy.

Objective: This study aims to assess whether preoperative hematoma reconstruction and precise volume calculation can improve hematoma evacuation rate in patients with spontaneous intracerebral hemorrhage(sICH) undergoing stereotactic aspiration(SA).

Methods: A retrospective analysis was conducted on patients with sICH who underwent SA from January 2021 to December 2023. Patients were divided into two groups based on the use of 3D Slicer for preoperative hematoma reconstruction and volume calculation. Propensity score matching (PSM) was applied to adjust for baseline differences between groups. Statistical analysis was performed to compare hematoma evacuation rate and residual hematoma volume.

Results: After PSM, the 3Dslicer group achieved a higher mean evacuation rate (70.9%) compared to the non-3Dslicer group (53.1%), with a median residual hematoma volume of 7.4 mL versus 15.3 mL, respectively.

Conclusion: Preoperative hematoma reconstruction and volume calculation using 3D Slicer in patients with sICH undergoing SA significantly improves hematoma evacuation rate and reduces residual hematoma volume.