Pub Date : 2024-09-21DOI: 10.1016/j.wnsx.2024.100401
Joshua A. Reynolds , Yashraj Srivastava , Muhammed Amir Essibayi , Anna Nia , Adisson Fortunel , Neil Haranhalli
Pediatric type IVc perimedullary arteriovenous fistulae (PAVF) comprise a rare subcategory of spinal vascular malformations in which multiple spinal arteries directly connect with draining veins resulting in high-flow arteriovenous shunting and large intradural venous varicosities. Complete disconnection of the fistula is necessary to prevent hemorrhage or spinal compression. A surgical, rather than endovascular, approach proves favorable under specific circumstances. Due to the rarity of these pediatric fistulae, no large studies exist to enumerate these circumstances. This case report fills this void by detailing several considerations which favored surgery for a type IVc PAVF in a 17-year-old female patient.
{"title":"Pediatric peri-medullary arteriovenous fistula: Pearls for diagnosis and treatment","authors":"Joshua A. Reynolds , Yashraj Srivastava , Muhammed Amir Essibayi , Anna Nia , Adisson Fortunel , Neil Haranhalli","doi":"10.1016/j.wnsx.2024.100401","DOIUrl":"10.1016/j.wnsx.2024.100401","url":null,"abstract":"<div><div>Pediatric type IVc perimedullary arteriovenous fistulae (PAVF) comprise a rare subcategory of spinal vascular malformations in which multiple spinal arteries directly connect with draining veins resulting in high-flow arteriovenous shunting and large intradural venous varicosities. Complete disconnection of the fistula is necessary to prevent hemorrhage or spinal compression. A surgical, rather than endovascular, approach proves favorable under specific circumstances. Due to the rarity of these pediatric fistulae, no large studies exist to enumerate these circumstances. This case report fills this void by detailing several considerations which favored surgery for a type IVc PAVF in a 17-year-old female patient.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"24 ","pages":"Article 100401"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590139724001327/pdfft?md5=269a74b98d9887552ddeefa1c57240b6&pid=1-s2.0-S2590139724001327-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1016/j.wnsx.2024.100396
Hanne Eline R. Vanluchene , David Bervini , Ross Straughan , Samuel Maina , Fredrick J. Joseph
Objective
Microvascular anastomosis is challenging, and training surgeons to develop and maintain skills is imperative. Current training models either miss the simulation of the surgical workflow, lack 3D key-hole space, need ethical approval, require special preparation, or lack realism. To circumvent these issues, this study describes the use of a mixed reality 3D printed model with integrated blood flow for training cerebral anastomosis and assesses its validity.
Methods
Different-sized 3D-printed artificial micro artery models in a 3D brain space with a keyhole opening were used. The model was connected to a 4D simulator to induce pulsatile blood flow. Neurosurgical microscopes and exoscopes were used for visualization. Nine participants (n = 6 board-certified cerebrovascular neurosurgeons; n = 3 in-training) participated in the study and practiced anastomosis techniques with the simulator. Two senior, experienced vascular neurosurgeons mentored live teaching activity on the simulator. Participants completed a survey to score the face and content validity of the simulation on a 5-point Likert scale. Simulation time and anastomosis score differences between in-training and board-certified participants were compared for construct validity.
Results
Participants scored the simulation difficulty similar to actual surgery, proving face validity. All participants agreed that practice on the provided simulator models would improve bypass techniques (μ = 4.67/5 ± 0.47) and instrument handling (μ = 4.56/5 ± 0.68). Board-certified participants had better anastomosis scores than in-training participants (non-significant difference).
Conclusions
The 4D simulator and the high-fidelity artificial 3D printed model effectively simulated actual bypass surgery in a key-hole fashion with blood flow abilities. Limited resources and preparation time are needed for the training setup. The model provides benefits in learning and maintaining anastomosis skills and allows for easy adaptation to different microanatomical scenarios.
{"title":"Validation of a dynamic 4D microsurgical bypass simulator for training and teaching microvascular anastomosis techniques with blood flow and fluorescence imaging","authors":"Hanne Eline R. Vanluchene , David Bervini , Ross Straughan , Samuel Maina , Fredrick J. Joseph","doi":"10.1016/j.wnsx.2024.100396","DOIUrl":"10.1016/j.wnsx.2024.100396","url":null,"abstract":"<div><h3>Objective</h3><div>Microvascular anastomosis is challenging, and training surgeons to develop and maintain skills is imperative. Current training models either miss the simulation of the surgical workflow, lack 3D key-hole space, need ethical approval, require special preparation, or lack realism. To circumvent these issues, this study describes the use of a mixed reality 3D printed model with integrated blood flow for training cerebral anastomosis and assesses its validity.</div></div><div><h3>Methods</h3><div>Different-sized 3D-printed artificial micro artery models in a 3D brain space with a keyhole opening were used. The model was connected to a 4D simulator to induce pulsatile blood flow. Neurosurgical microscopes and exoscopes were used for visualization. Nine participants (n = 6 board-certified cerebrovascular neurosurgeons; n = 3 in-training) participated in the study and practiced anastomosis techniques with the simulator. Two senior, experienced vascular neurosurgeons mentored live teaching activity on the simulator. Participants completed a survey to score the face and content validity of the simulation on a 5-point Likert scale. Simulation time and anastomosis score differences between in-training and board-certified participants were compared for construct validity.</div></div><div><h3>Results</h3><div>Participants scored the simulation difficulty similar to actual surgery, proving face validity. All participants agreed that practice on the provided simulator models would improve bypass techniques (<em>μ</em> = 4.67/5 ± 0.47) and instrument handling (<em>μ</em> = 4.56/5 ± 0.68). Board-certified participants had better anastomosis scores than in-training participants (non-significant difference).</div></div><div><h3>Conclusions</h3><div>The 4D simulator and the high-fidelity artificial 3D printed model effectively simulated actual bypass surgery in a key-hole fashion with blood flow abilities. Limited resources and preparation time are needed for the training setup. The model provides benefits in learning and maintaining anastomosis skills and allows for easy adaptation to different microanatomical scenarios.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"24 ","pages":"Article 100396"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1016/j.wnsx.2024.100403
John Paul G. Kolcun, Ryan M. Kelly, Bradley L. Kolb, Dustin H. Kim, Alireza Borghei, John E. O'Toole, Richard G. Fessler
Introduction
Paraspinal muscle robustness is an area of growing interest in spinal deformity that may impact biomechanical integrity and patient quality-of-life after reconstructive surgery. Changes in paraspinal musculature after circumferential minimally-invasive (cMIS) deformity correction have not yet been investigated.
Methods
We identified patients who underwent cMIS deformity correction and had lumbar spine MRIs at baseline and at minimum 1-year postoperatively. Using T2-weighted MRI, we measured total muscular volume of the psoas major, erector spinae, and multifidus muscles. We used the threshold method to determine fatty infiltration as percent fat area (PFA) along the length of these scanned regions, encompassing the final surgical construct.
Results
We identified 10 patients who met inclusion criteria. On average, patients underwent interbody fusion at 3.8 ± 0.9 disc levels and posterior instrumentation at 4.6 ± 1.7 vertebral levels. All constructs included lateral interbody fusion (average 2.7 ± 0.8 levels); 6 were from a right-sided approach. Postoperative MRIs were obtained at 28 ± 14.2 months.
There were no significant changes in pre- and postoperative volumes or PFA in any muscle group. There were no significant differences in left/right psoas volume or PFA in patients when stratified by side of lateral approach, nor did the number of lateral interbody fusion levels correlate with psoas volume or PFA. Change in posterior paraspinal musculature characteristics did not correlate with increasing number of fixated levels, nor significantly differ in patients who underwent posterior decompression. Preoperative muscle volumes were strongly correlated with postoperative volumes.
Conclusions
In this pilot series, paraspinal and psoas muscle volumes were preserved after circumferential MIS deformity correction. Fatty infiltration was not increased in paraspinal muscles after multi-level percutaneous instrumentation, nor in the psoas after multi-level trans-psoas approaches. These findings call for more in-depth investigation in a larger cohort of patients with comparison to open deformity correction patients to determine the impact of muscle volume changes on clinical outcomes.
{"title":"Paraspinal muscle volume and fatty infiltration after circumferential minimally-invasive deformity correction","authors":"John Paul G. Kolcun, Ryan M. Kelly, Bradley L. Kolb, Dustin H. Kim, Alireza Borghei, John E. O'Toole, Richard G. Fessler","doi":"10.1016/j.wnsx.2024.100403","DOIUrl":"10.1016/j.wnsx.2024.100403","url":null,"abstract":"<div><h3>Introduction</h3><div>Paraspinal muscle robustness is an area of growing interest in spinal deformity that may impact biomechanical integrity and patient quality-of-life after reconstructive surgery. Changes in paraspinal musculature after circumferential minimally-invasive (cMIS) deformity correction have not yet been investigated.</div></div><div><h3>Methods</h3><div>We identified patients who underwent cMIS deformity correction and had lumbar spine MRIs at baseline and at minimum 1-year postoperatively. Using T2-weighted MRI, we measured total muscular volume of the psoas major, erector spinae, and multifidus muscles. We used the threshold method to determine fatty infiltration as percent fat area (PFA) along the length of these scanned regions, encompassing the final surgical construct.</div></div><div><h3>Results</h3><div>We identified 10 patients who met inclusion criteria. On average, patients underwent interbody fusion at 3.8 ± 0.9 disc levels and posterior instrumentation at 4.6 ± 1.7 vertebral levels. All constructs included lateral interbody fusion (average 2.7 ± 0.8 levels); 6 were from a right-sided approach. Postoperative MRIs were obtained at 28 ± 14.2 months.</div><div>There were no significant changes in pre- and postoperative volumes or PFA in any muscle group. There were no significant differences in left/right psoas volume or PFA in patients when stratified by side of lateral approach, nor did the number of lateral interbody fusion levels correlate with psoas volume or PFA. Change in posterior paraspinal musculature characteristics did not correlate with increasing number of fixated levels, nor significantly differ in patients who underwent posterior decompression. Preoperative muscle volumes were strongly correlated with postoperative volumes.</div></div><div><h3>Conclusions</h3><div>In this pilot series, paraspinal and psoas muscle volumes were preserved after circumferential MIS deformity correction. Fatty infiltration was not increased in paraspinal muscles after multi-level percutaneous instrumentation, nor in the psoas after multi-level trans-psoas approaches. These findings call for more in-depth investigation in a larger cohort of patients with comparison to open deformity correction patients to determine the impact of muscle volume changes on clinical outcomes.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"25 ","pages":"Article 100403"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1016/j.wnsx.2024.100404
Daniel Murtada , Mohammad Daher , Marven Aoun , Antoine Mouawad , Gaby Kreichati , Khalil Kharrat , Amer Sebaaly
Objective
Venous thromboembolism (VTE) associated with bony fractures have been documented in the literature. However, the literature is not very exhaustive when it comes to VTE associated with traumatic spine fractures. Thus the purpose of this systematic review analyzing the incidence of VTE associated with spinal trauma.
Methods
An electronic search strategy was elaborated in Pubmed, Cochrane Library and Google Scholar (page 1–20) since inception till November 2023.
Results
Twelve studies were included with three prospective clinical studies, seven retrospective studies, one observational cohort study, and one propensity-matched analysis. These involved 256,107 subjects with 6039 concomitant VTE (2.4 %). Potential risk factors included age, D-dimer levels, length of hospital stay, associated spinal cord injury, location of the vertebral trauma and other baseline patient-dependent characteristics.
Conclusion
This review found that the rate VTE in spinal trauma patients was 2.4 % (6039/256107). To optimize care, clinical decision making should be tailored to each patient using a combined approach of imaging, laboratory findings, and serial physical examinations.
{"title":"Traumatic spine fractures and concomitant venous thromboembolism: A systematic review","authors":"Daniel Murtada , Mohammad Daher , Marven Aoun , Antoine Mouawad , Gaby Kreichati , Khalil Kharrat , Amer Sebaaly","doi":"10.1016/j.wnsx.2024.100404","DOIUrl":"10.1016/j.wnsx.2024.100404","url":null,"abstract":"<div><h3>Objective</h3><div>Venous thromboembolism (VTE) associated with bony fractures have been documented in the literature. However, the literature is not very exhaustive when it comes to VTE associated with traumatic spine fractures. Thus the purpose of this systematic review analyzing the incidence of VTE associated with spinal trauma.</div></div><div><h3>Methods</h3><div>An electronic search strategy was elaborated in Pubmed, Cochrane Library and Google Scholar (page 1–20) since inception till November 2023.</div></div><div><h3>Results</h3><div>Twelve studies were included with three prospective clinical studies, seven retrospective studies, one observational cohort study, and one propensity-matched analysis. These involved 256,107 subjects with 6039 concomitant VTE (2.4 %). Potential risk factors included age, D-dimer levels, length of hospital stay, associated spinal cord injury, location of the vertebral trauma and other baseline patient-dependent characteristics.</div></div><div><h3>Conclusion</h3><div>This review found that the rate VTE in spinal trauma patients was 2.4 % (6039/256107). To optimize care, clinical decision making should be tailored to each patient using a combined approach of imaging, laboratory findings, and serial physical examinations.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"24 ","pages":"Article 100404"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1016/j.wnsx.2024.100399
Muhammad Saqib , Aanus Zahoor , Ahmed Rahib , Amna Shamim , Hassan Mumtaz
This comprehensive review paper examines the most updated state of research on glioblastoma, an aggressive brain tumor with limited treatment options. By analyzing 76 recent studies, from translational and basic sciences, to clinical trials, we highlight various aspects of glioblastoma and shed light on potential therapeutic strategies. The interplay between tumor cells, neural progenitor cells, and the tumor microenvironment is explored. Targeting the PI3K-Akt-mTOR pathway through extracellular-vesicle (EV)-mediated signaling emerges as a potential therapeutic strategy. Personalized modeling approaches utilizing patient-specific MRI data offer promise for optimizing treatment strategies. The response of glioblastoma stem cells (GSCs) to different treatment modalities is examined, emphasizing the need to inhibit the transformation of proneural (PN) GSCs into resistant mesenchymal (MES) GSCs. Metabolic therapy and combination therapies show potential in reversing treatment resistance and inhibiting both PN and MES GSCs. Immunotherapy, targeted approaches, and molecular dynamics in gliomas are discussed, providing insights into early-stage diagnosis and treatment. Additionally, the potential use of Zika virus as an oncolytic agent is explored. Analysis of phase 0 to 3 clinical trials reveal promising outcomes for various experimental treatments, highlighting the importance of combination therapies, predictive signatures, and patient selection strategies. Specific compounds demonstrate potential therapeutic benefits and tolerability. Phase 3 trials indicate the efficacy of DCVax-L in improving survival rates and depatux-m in prolonging progression-free survival. These findings emphasize the importance of personalized treatment approaches and continued exploration of targeted therapies, immunotherapies, and tumor biology understanding in shaping the future of glioblastoma treatment.
{"title":"Clinical and translational advances in primary brain tumor therapy with a focus on glioblastoma-A comprehensive review of the literature","authors":"Muhammad Saqib , Aanus Zahoor , Ahmed Rahib , Amna Shamim , Hassan Mumtaz","doi":"10.1016/j.wnsx.2024.100399","DOIUrl":"10.1016/j.wnsx.2024.100399","url":null,"abstract":"<div><div>This comprehensive review paper examines the most updated state of research on glioblastoma, an aggressive brain tumor with limited treatment options. By analyzing 76 recent studies, from translational and basic sciences, to clinical trials, we highlight various aspects of glioblastoma and shed light on potential therapeutic strategies. The interplay between tumor cells, neural progenitor cells, and the tumor microenvironment is explored. Targeting the PI3K-Akt-mTOR pathway through extracellular-vesicle (EV)-mediated signaling emerges as a potential therapeutic strategy. Personalized modeling approaches utilizing patient-specific MRI data offer promise for optimizing treatment strategies. The response of glioblastoma stem cells (GSCs) to different treatment modalities is examined, emphasizing the need to inhibit the transformation of proneural (PN) GSCs into resistant mesenchymal (MES) GSCs. Metabolic therapy and combination therapies show potential in reversing treatment resistance and inhibiting both PN and MES GSCs. Immunotherapy, targeted approaches, and molecular dynamics in gliomas are discussed, providing insights into early-stage diagnosis and treatment. Additionally, the potential use of Zika virus as an oncolytic agent is explored. Analysis of phase 0 to 3 clinical trials reveal promising outcomes for various experimental treatments, highlighting the importance of combination therapies, predictive signatures, and patient selection strategies. Specific compounds demonstrate potential therapeutic benefits and tolerability. Phase 3 trials indicate the efficacy of DCVax-L in improving survival rates and depatux-m in prolonging progression-free survival. These findings emphasize the importance of personalized treatment approaches and continued exploration of targeted therapies, immunotherapies, and tumor biology understanding in shaping the future of glioblastoma treatment.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"24 ","pages":"Article 100399"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590139724001303/pdfft?md5=31a4b195b81069e123cbbe9fe53f0218&pid=1-s2.0-S2590139724001303-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-25DOI: 10.1016/j.wnsx.2024.100392
Sutipat Pairojboriboon , Supranee Niruthisard , Chandhanarat Chandhanayingyong , Chalinee Monsereenusorn , Siwaporn Poopan , Sheng-Fu Larry Lo
Background
A wide variety of materials are used for lumbar interbody fusion, but there is no unified consensus on the superiority of one material over another. The aim of this systematic review and network meta-analysis (NMA) is to compare and rank the various TLIF interbody materials based on fusion rates.
Methods
We queried PubMed, EMBASE and Scopus from inception until August 2023, in which 2135 studies were identified. Inclusion criteria were applied based on the PRISMA guidelines. The fusion assessment employed the Bridwell's criteria with a length of follow-up of at least 12 months. The NMA was conducted to compare multiple approaches from multiple studies using the frequentist framework with STATA16.
Results
In total, 13 TLIF studies involving 1919 patients with 1981 lumbar interbody levels fulfilled our eligibility criteria. Seven different cage materials were utilized: polyetheretherketone (PEEK, as the reference), allograft, autograft, PEEK with titanium coating (TiPEEK), titanium, carbon/carbon fiber reinforced polymer (CFRP) and 3D-printed titanium. The average patient age was 60.9 (SD = 7.5) years old. When compared to PEEK, the other six materials did not have a significantly different rate of lumbar fusion. However, the SUCRA number of the 3D-printed titanium, TiPEEK, Ti, allograft, autograft, CFRP, and PEEK were 0.8, 0.6, 0.5, 0.5, 0.4, 0.4, and 0.3 consecutively.
Conclusions
Based on a network meta-analysis within the confines of our clinical study, 3D-printed titanium interbody cage may promote the highest success rate of fusion while PEEK may be the material with the least success rate of fusion in TLIF.
{"title":"A comparison of transforaminal lumbar interbody fusion (TLIF) cage material on fusion rates: A systematic review and network meta-analysis","authors":"Sutipat Pairojboriboon , Supranee Niruthisard , Chandhanarat Chandhanayingyong , Chalinee Monsereenusorn , Siwaporn Poopan , Sheng-Fu Larry Lo","doi":"10.1016/j.wnsx.2024.100392","DOIUrl":"https://doi.org/10.1016/j.wnsx.2024.100392","url":null,"abstract":"<div><h3>Background</h3><p>A wide variety of materials are used for lumbar interbody fusion, but there is no unified consensus on the superiority of one material over another. The aim of this systematic review and network meta-analysis (NMA) is to compare and rank the various TLIF interbody materials based on fusion rates.</p></div><div><h3>Methods</h3><p>We queried PubMed, EMBASE and Scopus from inception until August 2023, in which 2135 studies were identified. Inclusion criteria were applied based on the PRISMA guidelines. The fusion assessment employed the Bridwell's criteria with a length of follow-up of at least 12 months. The NMA was conducted to compare multiple approaches from multiple studies using the frequentist framework with STATA16.</p></div><div><h3>Results</h3><p>In total, 13 TLIF studies involving 1919 patients with 1981 lumbar interbody levels fulfilled our eligibility criteria. Seven different cage materials were utilized: polyetheretherketone (PEEK, as the reference), allograft, autograft, PEEK with titanium coating (TiPEEK), titanium, carbon/carbon fiber reinforced polymer (CFRP) and 3D-printed titanium. The average patient age was 60.9 (<em>SD</em> = 7.5) years old. When compared to PEEK, the other six materials did not have a significantly different rate of lumbar fusion. However, the SUCRA number of the 3D-printed titanium, TiPEEK, Ti, allograft, autograft, CFRP, and PEEK were 0.8, 0.6, 0.5, 0.5, 0.4, 0.4, and 0.3 consecutively.</p></div><div><h3>Conclusions</h3><p>Based on a network meta-analysis within the confines of our clinical study, 3D-printed titanium interbody cage may promote the highest success rate of fusion while PEEK may be the material with the least success rate of fusion in TLIF.</p></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"23 ","pages":"Article 100392"},"PeriodicalIF":0.0,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590139724001236/pdfft?md5=c4f84f89f0b989e6636c8379203aec43&pid=1-s2.0-S2590139724001236-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141244777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Describe the surgical technique and experience using the LSZ growing system in skeletally immature patients for two–stage surgical treatment of adolescent idiopathic scoliosis (AIS).
Methods
Eleven skeletally immature patients who underwent two-stage surgical treatment of AIS in our center were retrospectively analyzed. Patients initially treated with the LSZ growing system were observed for an average of 40.5 months (range 23–64 months) and for 4 years after planned replacement of the LSZ growing system with a standard pedicle screw system.
Results
The average preoperative angle of the main thoracic curve was 64.55 ± 3.21°, and that of the lumbar curve was 46 ± 5.52°. After instrumentation using the LSZ growing system, the thoracic curve was corrected to 17.63 ± 5.14°, and the lumbar curve to 9.2 ± 5.45°. The correction percentages were 72.52 ± 8.35 and 80.59 ± 10.77, respectively. After planned replacement of the LSZ system with a pedicle screw system, the angle of the thoracic curve changed to 11.45 ± 4.84°, and the lumbar curve to 6.4 ± 4.72°. The percentages of final correction were 82,1 ± 7,91 and 85,64 ± 5,47, respectively. The difference in the “LSZ growth coefficient” was 0.063 ± 0.037, which indicates continued growth of the spine along the instrumented region. None of the patients had neurological or infectious complications.
Conclusion
Our study demonstrates the safety and effectiveness of 2-stage treatment of AIS using the LSZ system, which allows for spine growth during the period between stages.
{"title":"A novel approach to surgical treatment of adolescent idiopathic scoliosis in skeletally immature patients","authors":"Mukhammad Tablikhanovich Sampiev , Nikolai Vasilevich Zagorodniy , Shamil Khambalovich Gizatullin , Ilya Petrovich Dubinin , KHava Magomedovna Chemurzieva , Ivan Stanislavovich Lysenko","doi":"10.1016/j.wnsx.2024.100383","DOIUrl":"10.1016/j.wnsx.2024.100383","url":null,"abstract":"<div><h3>Purpose</h3><p>Describe the surgical technique and experience using the LSZ growing system in skeletally immature patients for two–stage surgical treatment of adolescent idiopathic scoliosis (AIS).</p></div><div><h3>Methods</h3><p>Eleven skeletally immature patients who underwent two-stage surgical treatment of AIS in our center were retrospectively analyzed. Patients initially treated with the LSZ growing system were observed for an average of 40.5 months (range 23–64 months) and for 4 years after planned replacement of the LSZ growing system with a standard pedicle screw system.</p></div><div><h3>Results</h3><p>The average preoperative angle of the main thoracic curve was 64.55 ± 3.21°, and that of the lumbar curve was 46 ± 5.52°. After instrumentation using the LSZ growing system, the thoracic curve was corrected to 17.63 ± 5.14°, and the lumbar curve to 9.2 ± 5.45°. The correction percentages were 72.52 ± 8.35 and 80.59 ± 10.77, respectively. After planned replacement of the LSZ system with a pedicle screw system, the angle of the thoracic curve changed to 11.45 ± 4.84°, and the lumbar curve to 6.4 ± 4.72°. The percentages of final correction were 82,1 ± 7,91 and 85,64 ± 5,47, respectively. The difference in the “LSZ growth coefficient” was 0.063 ± 0.037, which indicates continued growth of the spine along the instrumented region. None of the patients had neurological or infectious complications.</p></div><div><h3>Conclusion</h3><p>Our study demonstrates the safety and effectiveness of 2-stage treatment of AIS using the LSZ system, which allows for spine growth during the period between stages.</p></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"23 ","pages":"Article 100383"},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590139724001145/pdfft?md5=12fc9e419e500cc70a3eeb9d423a5d89&pid=1-s2.0-S2590139724001145-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141047342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The modified transbasal bifrontal craniotomy is a variant of the bifrontal craniotomy with a wider surgical corridor than the standard approach. There are several methods for frontal sinus repair in bifrontal craniotomy. This study reports a novel method for frontal sinus repair in the modified transbasal interhemispheric approach by precisely overlapping the frontal sinus mucosa margin (without frontal sinus mucosa exenteration) with packing the frontal sinus with povidone-soaked gel foam and covering it with a vascularized pericranial flap.
Methods
In this case series, we retrospectively collected the clinical outcomes regarding cerebrospinal fluid (CSF) leakage, meningitis, and mucocele formation of patients who underwent modified transbasal bifrontal craniotomy at Vara Hospital.
Results
From January 2016 to December 2021, 65 patients with anterior skull-base lesions were treated with a modified transbasal interhemispheric approach with frontal sinus repair by overlapping frontal sinus mucosa with gel foam packing and vascularized pericranium flap covering. There was no case of postoperative CSF leakage, meningitis, or mucocele formation during the follow-up period of 19.2 months (min 1, max 73).
Conclusions
We demonstrated that the modified transbasal interhemispheric approach with frontal sinus repair using gel foam packing and pericranial flap is effective in preventing postoperative CSF leakage and meningitis.
{"title":"Frontal sinus reconstruction with overlapping sinus mucosa and vascularized pericranial flap Coverage after modified transbasal bifrontal craniotomy: Novel technique and clinical outcomes","authors":"Chanon Ariyaprakai, Nasaeng Akharathammachote, Areeporn Chonhenchob, Kitiporn Sriamornrattanakul","doi":"10.1016/j.wnsx.2024.100389","DOIUrl":"https://doi.org/10.1016/j.wnsx.2024.100389","url":null,"abstract":"<div><h3>Background</h3><p>The modified transbasal bifrontal craniotomy is a variant of the bifrontal craniotomy with a wider surgical corridor than the standard approach. There are several methods for frontal sinus repair in bifrontal craniotomy. This study reports a novel method for frontal sinus repair in the modified transbasal interhemispheric approach by precisely overlapping the frontal sinus mucosa margin (without frontal sinus mucosa exenteration) with packing the frontal sinus with povidone-soaked gel foam and covering it with a vascularized pericranial flap.</p></div><div><h3>Methods</h3><p>In this case series, we retrospectively collected the clinical outcomes regarding cerebrospinal fluid (CSF) leakage, meningitis, and mucocele formation of patients who underwent modified transbasal bifrontal craniotomy at Vara Hospital.</p></div><div><h3>Results</h3><p>From January 2016 to December 2021, 65 patients with anterior skull-base lesions were treated with a modified transbasal interhemispheric approach with frontal sinus repair by overlapping frontal sinus mucosa with gel foam packing and vascularized pericranium flap covering. There was no case of postoperative CSF leakage, meningitis, or mucocele formation during the follow-up period of 19.2 months (min 1, max 73).</p></div><div><h3>Conclusions</h3><p>We demonstrated that the modified transbasal interhemispheric approach with frontal sinus repair using gel foam packing and pericranial flap is effective in preventing postoperative CSF leakage and meningitis.</p></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"23 ","pages":"Article 100389"},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590139724001200/pdfft?md5=b66ea13937539b511a1b87f2cbd363e6&pid=1-s2.0-S2590139724001200-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140901050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-05DOI: 10.1016/j.wnsx.2024.100386
Hoda Hashemi , Taher Babaee , Vahideh Moradi , Mahtab Bagheri , Mohammad Javad Moghadam , Maryam Ashkar , Behnaz Tavakoli , Amir Ali Gordahani , Zohreh Habibi
Deformational plagiocephaly, deformational brachycephaly, and deformational scaphocephaly are the most common types of skull deformities during the first year of life. Using a cranial remolding orthosis (CRO) can have an important role in achieving a satisfactory level of improvement in symmetry and proportion of the deformed skulls. However, there is no consensus on the most important parameters for the success or length of treatment with a CRO. In this study, we did a systematic literature review in PubMed, Scopus, Web of Science, and EMBASE on January 2023. Titles/abstracts of the found studies were screened by two independent reviewers. The Newcastle–Ottawa Scale was used to evaluate the quality of the included articles. The best evidence synthesis was considered to determine the strength of the reported factors. A total of 25 articles with an accumulated sample of 7594 participants were included. Nine predictive factors, including age at initiation of CRO treatment, CRO compliance, deformity severity, deformity type, torticollis, gestational age, gestational type, delivery method, and developmental delay, were considered for CRO treatment length or success. Moderate evidence suggests that CRO treatment length is linked to a patient's age at the start of treatment and the deformity severity. Moreover, treatment success is correlated with a patient's age at the start of treatment, CRO compliance, and deformity severity. Moderate evidence indicates that there is no relationship between the presence of torticollis and gestational age with CRO treatment success.
{"title":"Cranial remolding orthosis for children with deformational skull deformities: A systematic review on the factors affecting success and duration of treatment","authors":"Hoda Hashemi , Taher Babaee , Vahideh Moradi , Mahtab Bagheri , Mohammad Javad Moghadam , Maryam Ashkar , Behnaz Tavakoli , Amir Ali Gordahani , Zohreh Habibi","doi":"10.1016/j.wnsx.2024.100386","DOIUrl":"10.1016/j.wnsx.2024.100386","url":null,"abstract":"<div><p>Deformational plagiocephaly, deformational brachycephaly, and deformational scaphocephaly are the most common types of skull deformities during the first year of life. Using a cranial remolding orthosis (CRO) can have an important role in achieving a satisfactory level of improvement in symmetry and proportion of the deformed skulls. However, there is no consensus on the most important parameters for the success or length of treatment with a CRO. In this study, we did a systematic literature review in PubMed, Scopus, Web of Science, and EMBASE on January 2023. Titles/abstracts of the found studies were screened by two independent reviewers. The Newcastle–Ottawa Scale was used to evaluate the quality of the included articles. The best evidence synthesis was considered to determine the strength of the reported factors. A total of 25 articles with an accumulated sample of 7594 participants were included. Nine predictive factors, including age at initiation of CRO treatment, CRO compliance, deformity severity, deformity type, torticollis, gestational age, gestational type, delivery method, and developmental delay, were considered for CRO treatment length or success. Moderate evidence suggests that CRO treatment length is linked to a patient's age at the start of treatment and the deformity severity. Moreover, treatment success is correlated with a patient's age at the start of treatment, CRO compliance, and deformity severity. Moderate evidence indicates that there is no relationship between the presence of torticollis and gestational age with CRO treatment success.</p></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"23 ","pages":"Article 100386"},"PeriodicalIF":0.0,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590139724001170/pdfft?md5=01516f9efdefb23e6f564afdb1bee959&pid=1-s2.0-S2590139724001170-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141048903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-04DOI: 10.1016/j.wnsx.2024.100387
Ananth P. Abraham , Abi Manesh , Soumya Regi , Joy S. Michael , R Hemanth Kumar , Meera Thomas , Lisa Mary Cherian , Lalee Varghese , Regi Kurien , Ranjith K. Moorthy , Bijesh Ravindran Nair , Vedantam Rajshekhar , Vedantam Rupa
Objective
To describe clinicoradiological features and surgical outcomes in a series of nine patients with rhino-orbito-cerebral mucormycosis (ROCM) who presented with Pott's puffy tumor (ROCM-PPT)
Methods
The records of nine patients with ROCM-PPT seen between March 2020 and December 2021 were analysed. Clinical features, radiology, histopathology, operative findings, management and outcome were noted. Frontal sinus pneumatisation and outflow tract configuration was compared between patients and controls with ROCM and no PPT.
Results
ROCM-PPT was diagnosed in 9 of 284 (3.2 %) patients with ROCM seen during the study period. There were six (66.7 %) males and the median age was 54 (IQR 46–60) years. Eight (88.9 %) patients had diabetes mellitus and seven (77.8 %) had been COVID-19 positive. Radiological features of osteomyelitis, subperiosteal abscess formation and dural enhancement were seen in all patients. No significant differences in pneumatisation or frontal sinus outflow tract configuration were noted between patients and controls. All patients underwent a craniectomy with frontal bone debridement and frontal sinus exteriorisation. All patients were treated with anti-fungal agents for several months. All patients had symptomatic improvement at a median follow-up of 21 (IQR 18–23) months. Repeat CT/MRI scans showed disease regression/resolution in six out of eight (75 %) patients with follow-up imaging, and stable disease in two others.
Conclusions
ROCM-PPT is a rare, delayed complication of mucormycosis that was seen in larger numbers during the recent COVID-19 pandemic. Aggressive debridement of osteomyelitic bone and antifungal therapy results in a good outcome.
{"title":"Pott's puffy tumor: An unusual complication of rhino-orbito-cerebral mucormycosis","authors":"Ananth P. Abraham , Abi Manesh , Soumya Regi , Joy S. Michael , R Hemanth Kumar , Meera Thomas , Lisa Mary Cherian , Lalee Varghese , Regi Kurien , Ranjith K. Moorthy , Bijesh Ravindran Nair , Vedantam Rajshekhar , Vedantam Rupa","doi":"10.1016/j.wnsx.2024.100387","DOIUrl":"https://doi.org/10.1016/j.wnsx.2024.100387","url":null,"abstract":"<div><h3>Objective</h3><p>To describe clinicoradiological features and surgical outcomes in a series of nine patients with rhino-orbito-cerebral mucormycosis (ROCM) who presented with Pott's puffy tumor (ROCM-PPT)</p></div><div><h3>Methods</h3><p>The records of nine patients with ROCM-PPT seen between March 2020 and December 2021 were analysed. Clinical features, radiology, histopathology, operative findings, management and outcome were noted. Frontal sinus pneumatisation and outflow tract configuration was compared between patients and controls with ROCM and no PPT.</p></div><div><h3>Results</h3><p>ROCM-PPT was diagnosed in 9 of 284 (3.2 %) patients with ROCM seen during the study period. There were six (66.7 %) males and the median age was 54 (IQR 46–60) years. Eight (88.9 %) patients had diabetes mellitus and seven (77.8 %) had been COVID-19 positive. Radiological features of osteomyelitis, subperiosteal abscess formation and dural enhancement were seen in all patients. No significant differences in pneumatisation or frontal sinus outflow tract configuration were noted between patients and controls. All patients underwent a craniectomy with frontal bone debridement and frontal sinus exteriorisation. All patients were treated with anti-fungal agents for several months. All patients had symptomatic improvement at a median follow-up of 21 (IQR 18–23) months. Repeat CT/MRI scans showed disease regression/resolution in six out of eight (75 %) patients with follow-up imaging, and stable disease in two others.</p></div><div><h3>Conclusions</h3><p>ROCM-PPT is a rare, delayed complication of mucormycosis that was seen in larger numbers during the recent COVID-19 pandemic. Aggressive debridement of osteomyelitic bone and antifungal therapy results in a good outcome.</p></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"23 ","pages":"Article 100387"},"PeriodicalIF":0.0,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590139724001182/pdfft?md5=ff681b1213a2ad84d2af892a217c8df6&pid=1-s2.0-S2590139724001182-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140879658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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