World neurosurgery最新文献

This article presented the author's historical perspective on twenty-five of the most significant neurosurgical breakthrough events of the last 50 years. These breakthroughs have advanced neurosurgical patient care and management. They have improved the management of aneurysms, arteriovenous malformations, tumors, stroke, traumatic brain injury, movement disorders, epilepsy, hydrocephalus, and spine pathologies. Neurosurgery has evolved through research, innovation, and technology. Several neurosurgical breakthroughs were achieved using neuroendoscopy, neuronavigation, radiosurgery, endovascular techniques, and refinements in computer technology. With these breakthroughs, neurosurgery did not change; it just progressed. Neurosurgery should continue its progress through research to obtain new knowledge for the benefit of our patients.

A new era of medicine and surgery began in the mid-16th century, driven by upheavals in religion, art, and science as well as advancements in printing. Two notable contributions were the clinical applications of Andreas Vesalius's anatomy and the surgical innovations of Ambroise Paré. Vesalius and Paré were contemporaries, overlapping in their education, anatomic interests, military experience, professional stature, and visionary use of anatomical illustrations. Nevertheless, their personal intersections, mutual adventures, and conjoint contributions have not been adequately described. During the mid-1530s, Vesalius and Paré performed dissections at the Paris Faculty of Medicine under Jacobus Sylvius. At the battle of Metz in 1552, the two served opposing armies, Vesalius with Charles V and Paré with Francis I. After Paré surrendered to Spanish forces at Hesin in 1553, Vesalius, then a surgeon to the Spanish emperor, bade Paré demonstrate his surgical techniques. Vesalius also attempted to convince Paré to change sides, but he demurred. In 1559, Henry II of France was mortally injured while jousting. Paré, the royal surgeon, took charge, but Vesalius was also summoned from Brussels, and both were engaged in Henry's management. Later, Vesalius permitted Paré to reproduce his illustrations in Paré's 1561 Anatomie Universelle and 1575 Oeuvres. Paré's Oeuvres, reprinted through the mid-1800s, perpetuated Vesalian images and helped ensure their ongoing survival. Although Vesalius's Fabrica and Paré's Oeuvres were at the forefront of medical science, both men faced years of criticism, likely stemming from their challenges to established norms of practice and the jealousy of their peers.

Background: Olfactory groove meningiomas may recur up to 30% of cases. This study focuses on the topographic patterns and location of the recurrences and their surgical management.

Methods: Data on topography of recurrences from a monoinstitutional surgical series of olfactory groove meningiomas were retrospectively reviewed and analyzed along with those from pertinent literature. Analyzed factors included patient age and sex, extent of resection and management of the infiltrating dura and skull base at initial surgery, the time to recurrence, the clinical presentation at recurrence, the size, location and histology of the recurrent tumors and their management.

Results: Overall sample included 33 patients, 4 from our series and 29 from the literature. The main reported symptoms at recurrence were visual function deterioration (67%), nasal obstruction (41%) and headache (40%). The recurrent tumor involved the skull base in all cases (100%). Intracranial regrowth and sinus invasion were observed in 84% of cases. The surgical management was performed mainly through the same transcranial approach (76%) or combined transcranial-transnasal approach (17%). Although Simpson grade I resection was possible in more than half of the patients, a residual intradural tumor (Simpson grade IV) was left in one third.

Conclusion: Recurrences of olfactory groove meningiomas treated by transcranial approach mainly occur at cranial base, bone, paranasal sinuses and the optic canals. This suggests resecting at the initial surgery the involved dura and bone and to decompress the optic pathways. The reoperation should attempt the gross total resection, at least in cases with more limited bone invasion.

Introduction: Many studies have evaluated the effect of preoperative disability status on functional outcomes following spine surgery. However, no research has compared the "value" (outcomes per dollar spent) of surgery for patients with different levels of diagnosis-specific disability.

Methods: We retrospectively reviewed 429 patients who underwent neurosurgical anterior cervical discectomy and fusion. Time-driven activity-based costing (TDABC) was used to calculate total intraoperative costs. Neck Disability Index (NDI) scores were recorded at baseline and three months post-surgery. Patients were categorized into groups based on their preoperative NDI score. Our primary outcome was a novel Operative Value Index (OVI), defined as the percent change in NDI per $1,000 spent intraoperatively. Generalized linear mixed model regression was used to determine if severe-to-complete ("high") baseline neck disability was significantly associated with OVI and total cost.

Results: Compared to patients with "high" preoperative neck disability, the OVI was significantly lower for patients with no neck disability (β-coefficient: -14.0, p<0.001) and mild neck disability (β-coefficient: -4.06, p<0.001). There were no significant associations between the NDI groups and total intraoperative cost.

Conclusion: Surgery provided the most value for patients with "high" baseline neck disability, with more favorable outcomes per dollar spent compared to those with low baseline neck disability. Patients with low baseline neck disability may therefore suboptimal candidates for bundled payments, emphasizing the importance of careful patient selection to optimize resource use and outcomes in value-based care models.

Purpose: Synthetic data (SD) is artificially generated information that mimics the statistical characteristics and correlations of real data, enabling researchers to simulate variables that are challenging to obtain in routine practice while overcoming confidentiality barriers. This study aims to evaluate the utility, validity, and potential limitations of SD in glioblastoma (GBM) and brain metastases (BM) research.

Methods: Three published neuro-oncology studies focusing on prognostic factors were selected: two involving GBM patients and one with BM patients. These studies were replicated using the MDClone platform, a healthcare data exploration tool that enables the creation of SD. Real and SD were compared across patient demographic and outcome variables using summary statistics, normality testing, and t-test as required.

Results: 452 GBM patients and 1320 BM patients were generated with SD. Among GBM patients, longer median overall survival was associated with younger age (age<50: 16.3 months [95%CI 12.8-19.8]; age 50-59: 15.6 [95%CI 13.1-18.1]; age 60-69: 13.9 [95%CI 12.1-15.7]; age>70: 8.8 [95%CI 7.4-10.2], P<0.001), greater extent of resection (debulking: 16.8 months [95%CI 14.9-18.7] vs. biopsy: 10.9 months [95%CI 9.6-12.3], P<0.001), and higher serum albumin (sAlb) (sAlb<30g/L: 7.0 months [95%CI 4.8 - 9.3]; sAlb 30-40g/L: 12.9 [95%CI 11.6 - 14.1]; sAlb>40: 16.2 [95%CI 13.4 - 19.1], P<0.05). Among BM patients, lower systemic inflammation scores (neutrophil-lymphocyte-ratio, leukocyte-lymphocyte-ratio, platelet-lymphocyte-ratio, monocyte-lymphocyte-ratio, and C-reactive-protein/albumin-ratio) were associated with longer overall survival (P<0.05). These results aligned with the findings reported in the literature.

Conclusion: Integrating SD into clinical research offers potential for providing accurate predictive insights without compromising patient privacy.

Objective: Standard resective treatment of mesial temporal lobe epilepsy (MTLE) includes anteromesial temporal resection or amygdalohippocampectomy. One potential risk of these surgeries, especially in patients with MRI-negative findings, is postoperative memory impairment. An alternative to resective procedures that aim to preserve the neuropsychological profile are multiple hippocampal transections (MHT). The objective of transections is to interrupt the longitudinal pathways of the hippocampus to prevent the spread of epileptic seizures while preserving the memory circuits. Previously performed MHT procedures were guided by questionable intraoperative electrocorticography. At our institution, we have developed and tested a modified technique to achieve complete multiple hippocampal transections.

Methods: Patients with pharmacoresistant unilaterally lateralized MTLE and MRI-negative findings with high risk of neuropsychological deterioration were indicated for complete MHT. Comprehensive neuropsychological and epileptological evaluations and MRI follow-ups were conducted one year and two years postoperatively. The primary evaluated parameters were seizure reduction and significant changes in neuropsychological performance (+/- 1 SD).

Results: Complete MHTs were performed on three patients who completed two-year follow-up. Two MHTs were performed on the right and one on the left side. Two patients are classified as Engel 1 and one patient as Engel 3. Two years after surgery neuropsychological evaluation did not show significant decrease in memory performance and performance in majority of cognitive tests. One-year MRI follow-up showed decrease of volume of hippocampus in all three patients.

Conclusion: This modified technique of MHT in patients with MTLE and MRI-negative findings led to seizure reduction while preserving their neuropsychological performance.