World neurosurgery最新文献

Objective: To investigate the effect of microcatheter shaping based on the parent artery mainstream line of blood flow simulated using the computational fluid dynamics (CFD) technique on embolization of unruptured aneurysms on the posterior wall of the anterior cerebral artery (ACA) A1 segment.

Materials and methods: Patients with unruptured cerebral aneurysms on the posterior wall of the ACA A1 segment were retrospectively enrolled and treated with endovascular embolization after microcatheter shaping. The clinical, embolization and follow-up data were analyzed.

Results: Eight patients were enrolled and treated with endovascular embolization. Eight microcatheters were steam shaped in vitro and were all successfully navigated to the right location in the in vitro experiment. During the embolization procedure, seven microcatheters were successfully navigated to the right location for embolization. In the remaining one patient who had tortuous cerebral arteries, reshaping of the microcatheter based on the parent artery mainstream of blood flow made successful navigation of the microcatheter to the right place. Complete occlusion was obtained in seven (87.5%) aneurysms and residual aneurysm neck in the remaining one (12.5%). At angiographic follow-up in 6 (75%) patients, the Raymond grade was I in 5 (83.3%) and II in the rest one (16.7%).

Conclusion: Use of CFD simulation of parent artery blood flow for microcatheter shaping in the embolization of unruptured aneurysms on the posterior wall of the ACA A1 segment is safe and effective in navigating the microcatheter to the right location for embolization, resulting in good stability and support for the embolization.

Background: Symptomatic postoperative spinal epidural hematomas (PEDHs) are rare complications with significant implications on patients' functional outcomes. Strategies for PEDH prevention are poorly understood. This study sought to evaluate preoperative and intraoperative variables predicting the risk of PEDH, and patients' functional outcomes after PEDH evacuation.

Methods: This is a single institution study of all PEDH cases requiring a reoperation and matched controls over six year period. The incidence of PEDH was calculated by region and operative technique. The preoperative and intraoperative parameters of 40 cases and 40 matched controls were compared.

Results: 5,941 spine surgeries and 40 symptomatic PEDH cases requiring reoperation were identified (0.67% overall incidence). The highest incidence of PEDH was observed after minimally invasive lumbar laminectomimes. Higher preoperative diastolic blood pressure was a risk factor for PEDH. Of the 17 PEDH cases that had a drain placed at the time of index surgery, 8 patients (47%) still had the drain in place at the time of diagnosis of PEDH. Among the posterior index approaches, 18 cases (51.43%), one cervicothoracic and seventeen lumbar, did not develop paresis at the time of PEDH diagnosis. 17 cases (48.57%), nine cervicothoracic and eight lumbar, developed paresis. Ten of the patients with paresis had complete resolution of motor weakness, while seven never achieved complete resolution.

Conclusion: While the incidence of PEDH was below one percent, nearly half of the patients developed motor weakness as a presenting symptom and a third of the patients never had resolution of the weakness.

Objective: The subsidence of vertebral body replacement may occur after anterior cervical corpectomy and fusion (ACCF) , which may lead to cervical kyphosis, spinal cord compression and neurological dysfunction. The authors aim to investigate the risk factors for early subsidence of 3D printed artificial vertebral (3D-PAVB) after ACCF surgery and to provide guidance for clinical practice.

Methods: A retrospective analysis was conducted on the data of consecutive patients with cervical spondylosis who underwent ACCF surgery at Bethune Hospital of Shanxi from 2017 to 2020. The statistical data included age, gender, disease type, body mass index (BMI), surgical segment, vertebral height, Cobb Angle, and Hounsfeld Units (HU) values of the vertebral body and endplate. The clinical efficacy of the surgery was evaluated using Visual Analog Scale (VAS), Japanese Orthopedic Association (JOA), and Neck Disability Index (NDI). Follow-up data, such as VAS, JOA, NDI, and Cobb Angle, were obtained using a repeated-measures ANOVA analysis. Univariate analysis was conducted to identify the factors contributing to the early subsidence of the3D-PAVB, and independent risk factors were determined using logistic regression. The HU value was analyzed using the Receiver Operating Characteristic (ROC) curve and the area under the Area Under Curve (AUC) to predict the subsidence of the 3D-PAVB.

Results: A total of 66 patients were included in the study, out of which 19 patients experienced subsidence of 3D-PAVB,resulting in an incidence rate of 28.8%. The postoperative JOA, VAS, and NDI scores showed significant improvement in both the subsidence and non-subsidence groups. Upon conducting univariate analysis, significant differences were observed between the two groups in terms of age, diabetes, smoking, and lower vertebral Computed Tomography (CT) values. The average HU value of the subsidence group (251.39±52.615, n=19) was significantly lower than that of the non-subsidence group (317.06±73.587, n=47, p＜0.01). Multivariate analysis revealed that smoking and HU of the lower vertebra were independent risk factors for 3D-PAVB subsidence, with an AUC of 0.772 and an optimal threshold of 272 for HU (sensitivity 78.9%, specificity 74.5%).

Conclusion: The occurrence of early subsidence of 3D-PAVB post ACCF surgery is influenced by two independent risk factors - smoking and low HU. To predict the likelihood of this outcome, it is advisable to consider smoking history and measure CT HU value prior to surgery. A lower CT HU value is indicative of a greater risk of subsidence.

Objective: To assess the overall survival (OS) of internal cerebrospinal fluid shunt (ICSFS) in the adult population.

Methods: Medline database was searched from 2000 to 2023 to identify studies reporting on ICSFS OS. Only articles reporting on adult ICSFS OS by a Kaplan-Meier (KM) OS curve were included. Numerical data were extracted from KM curves and, were then reconstructed to estimate 3, 6, 9, 12, 18, 24, 36, 48 and 60 months restricted mean survival times (RMST). RMST of ICSFS and its standard error (SE) at each time of interest were used as summary measure and primary outcome across studies. To account for the effect of between-study heterogeneity, RMST were pooled using a random effects model.

Results: Out of 421 screened studies, solely 6 were included in the meta-analysis. Calculated ICSFS OS at 3, 6, 12, 18, 24, 36, 48 and 60 months were 92.4%, _95%CI[89.6-95.2]; 89.5%, _95%CI[86.3-92.8]; 87.5%, _95%CI[83.9-91.1]; 85.2%, _95%CI[80.4-90.0]; 83.4%, _95%CI[79.0-87.9]; 81.6%, _95%CI[76.7-86.5]; 78.8%, _95%CI[72.9-84.6]; 76.7%, _95%CI[70.3-83.1]; 74.5%, _95%CI[67.8-81.1] respectively. There was a significant heterogeneity as indicated by a high I² of 82.5%, _95%CI[63.1-91.7]. Heterogeneity test of Q=28.63 was also significant (p-value<0.001).

Conclusions: On contrary to what one might think, there are few available studies assessing adult ICSFS OS. We used a novel technique to meta-analyse adult ICSFS OS. ICSFS failure rate is maximal within the 3 to 6 post-operative months. Afterwards, the risk slowly decrease over time. At 5 years, less than three quarters of the patients still have a naïve functional ICSFS never revised.

Background: The middle meningeal artery (MMA) is a major dural vessel that plays a significant role in developing chronic subdural hematomas (cSDHs). Understanding its variable anatomy is essential for the effective management of cSDH and the prevention of complications.

Methods: MMA anatomy was retrospectively assessed in a population of 92 patients who underwent digital subtraction angiography of cerebral vessels before MMA embolization for cSDH.

Results: We assessed 121 MMAs in 92 patients who underwent digital subtraction angiography for cSDH treatment from October 2020 to July 2023. The most common type in the extended Adachi classification was IC (19.82%) and the rarest was IB (6.31%). The anterior branch of the MMA was the most frequently dominant, while the most common origin of the posterior branch was observed in the distal segment. We reported 4 cases (3.31%) of the MMA arising from the ophthalmic artery.

Conclusions: The most common configuration of MMA was Adachi-type IC. The MMA most often originated from the maxillary artery. The posterior branch of the MMA was typically dominant and most frequently originated from the distal segment. There was no significant impact of Adachi type on treatment results or fluoroscopy time.

Background: Occipitocervical arthrodesis has a variety of indications to treat craniocervical and atlantoaxial pathologies for which a selective cervical fusion would not provide sufficient stability. Over time, the indications for occipitocervical fusions (OCFs) have evolved, as new technologies and surgical techniques were developed. In this bibliometric analysis, we aim to explore the progression of OCF literature over time, analyzing the trends in publications and citations, publishing countries and authors, keywords, and topics.

Methods: The Web of Science database was used for data retrieval on July 3, 2024, with the search "occipitocervical fusion" OR "occipito-cervical fusion" OR "occipitocervical arthrodesis" OR "occipital cervical fusion" OR "occipital cervical arthrodesis" OR ("OCF" AND "spine surgery"). Excel was used to create the citation analysis and publication trend figures, along with the publishing countries and author analysis. The bibliometric software VosViewer was used to generate the keyword co-occurrence network visualizations.

Results: Overall, 762 articles were extracted. The number of pertinent publications and citations increased until 2020 before beginning to decrease. We found that Ehlers Danlos syndrome has become a more prevalent topic, as the association between Ehlers Danlos syndrome and craniocervical instability has received further scrutiny. "Dysphagia" continues to be a commonly cited topic, while, conversely, rheumatoid arthritis has decreased in publication frequency, possibly related to advances in medical management and surgical techniques. Overall, the United States, China, and Japan are the top publishing countries.

Conclusions: This analysis of OCF literature provides a helpful overview of emerging trends and clinician concerns, especially as seen through the perspective of time.

Background: Basilar invagination (BI) is a prolapse of the odontoid process cranially and posteriorly towards the foramen magnum. Several surgical treatment options are available for this condition. Herein, we describe a stress maneuver technique for BI reduction using a single-stage posterior approach.

Methods: We described the case of a 56-year-old male diagnosed with type A BI and brainstem compression, who was treated with posterior fossa decompression and occipitocervical fusion. The BI was reduced intraoperatively using a stress maneuver, and cranial traction or atlantoaxial joint distraction was not necessary.

Results: Postoperative imaging revealed a reduction of the odontoid process and adequate brainstem decompression. The patient showed progressive improvement of his symptoms.

Conclusion: In selected cases, stress maneuvers for BI reduction can be a less morbid, easier, and replicable option within the already existing technical arsenal.

Global neurosurgery has been described as the clinical and public health practice of neurosurgery with the primary purpose of ensuring timely, safe, and affordable neurosurgical care to all who need it. Global neurosurgery activities in the form of mission trips, educational partnerships, and research collaborations have been in place for decades. Still, there have been no central organizing efforts to improve the harmonization of these endeavors until recently. The 2016 Bogotà Declaration on Global Neurosurgery was the first meeting of global neurosurgery practitioners from low- and middle-income countries (LMICs) and high-income countries (HICs) to organize a consensus statement around the global gaps in neurosurgery care and goals for its future development. Since then, interest in global neurosurgery has grown dramatically among neurosurgeons, trainees, nurses, and allied professionals. Global neurosurgery has emerged as a distinct academic subspecialty within neurosurgery. However, recent evidence demonstrates that wide gaps remain in access to safe, timely, and affordable neurosurgical care. Quite as important is the current dominance of global neurosurgery discourse by HIC actors. The Boston Declaration seeks to further define a unified vision of progress as global neurosurgery continues to grow and evolve. This ambitious initiative will review existing evidence, employ on-the-ground expert experience, and seek broad inclusivity and transparency to formulate a new set of goals for global neurosurgery and a structure that shifts the agency to LMIC actors. We propose a path to developing a new consensus statement and action plan, the 2025 Boston Declaration for Global Neurosurgery.

Objective: Postoperative pain is the most common undesirable outcome after neurosurgery. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) which is administered parenterally and carries a theoretical increased risk of bleeding. Our study aims to determine whether ketorolac after craniotomy for tumor resection significantly changes the rate of postoperative adverse events, adequately controls pain, and decreases concurrent narcotic usage.

Methods: We performed a retrospective chart review of all adult patients who underwent craniotomy for brain tumor resection from 2013 to 2022. Analysis of patients who received ketorolac and those who did not in the post-operative period were compared for adverse events associated with ketorolac use. Secondary outcomes included patient-reported pain scores and postoperative opioid usage.

Results: 1,114 patients were included, of which 70 received ketorolac in the postoperative period. Patients who received ketorolac often received it after narcotics failed to provide adequate pain control. Patients receiving ketorolac were younger (p=0.001) and had a lower comorbidity index (p=0.041) compared to the non-ketorolac group. Patients receiving ketorolac did not experience a significantly increased rate of bleeding events (p=0.850). Patients recieving ketorolac had significantly higher baseline levels of pain (p=0.018) and opioid usage (p=0.047). When matched for chronic comorbidities including pain disorders, the ketorolac group only displayed higher levels of pain early in the postoperative course (POD 0-1) but not in latter part of the initial postoperative period.

Conclusions: Ketorolac is a safe and effective option for pain control after craniotomy for tumor resection. Prospective data is needed to better validate these retrospective observations.