Interdisciplinary Neurosurgery: Advanced Techniques and Case Management最新文献

Epilepsy is a neurological condition characterized by temporary disruptions in the brain's electrical activity. This disorder can significantly impact the quality of life for those affected, leading to limitations on driving and employment opportunities. The seriousness of epilepsy is further emphasized by the risk of SUDEP (sudden unexpected death in epilepsy). Additionally, individuals with epilepsy commonly experience memory problems and emotional disorders. In this article, we present a bibliometrix analysis of epilepsy research, examining influential articles, keywords, authors, institutions, and countries. Our analysis focuses on research articles published from 2015 to 2023.The findings of our analysis reveal that China and India are the leading countries in terms of epilepsy publications and total citations. Furthermore, we propose a framework that encompasses technology, enablers, and barriers, providing valuable insights into the future trajectory of epilepsy research. Various factors can contribute to the development of epilepsy, including neurotransmitter imbalances, tumors, strokes, brain damage resulting from illnesses or injuries, or a combination of these causes. To gather scientific papers related to epilepsy seizures, we employed the Scopus database and extracted information such as titles, authors, contributing institutes, source journals, times cited, and countries. For data analysis, we used the R package (Bibliometricx R package), VOSviewer, and SciMAT facilitated co-authorship and co-occurrence analyses, allowing us to visualize the results. By shedding light on the current state of epilepsy research and identifying emerging trends, the aim of this study is to provide guidance for future investigations in understanding, managing, and treating epilepsy more effectively.

Aim

To investigate the role of fusion construct properties, vertebral column reconstruction (VCR) techniques, steroid therapy, laminectomy versus ligamentotaxis in treatment of thoracolumbar junction fractures (TLJF).

Methods

A non-randomized clinical trial was conducted. All the eligible patients with TLJF (T12-L2) were operated with a standardized long fusion protocol and followed. Fusion rate, hardware failure, sagittal imbalance and functional outcome were identified as the primary outcome. P < 0.05 was defined as significant.

Results

Ninety-nine long fusions were reviewed in the final analysis. The mean age was 35.7 ± 13.80 years with 79.8 % male predominance. Fifty-eight percent of the patients were neurological intact. Fifty-six percent underwent concurrent laminectomy and VCR using autografts while the remaining 43.4 % received ligamentotaxis. The patients follow up (median = 25 months) showed 93.9 % solid fusion rate, 70.7 % activity independency, 1% hardware failure, 10.1 % sagittal imbalance and 4 % wound complications. Sagittal imbalance was associated with steroid therapy (p = 0.006), laminectomy (p = 0.003) and preoperative neurological deficits (p = 0.0001) and age (p = 0.049). Interestingly, Steroid therapy was associated with improved neurological and functional outcomes in impaired patients (p < 0.05). Laminectomy was associated with favorable functional outcome (OR = 9.7, CI: 2.09–45.67).

Conclusion

Our standardized long fusion protocol was associated with significant outcomes with low morbidities. Autograft mixture yield to a robust union in and over fusion construct. Methylprednisolone therapy in non-intact patients was associated with improved clinical outcomes but simultaneously, has negative impact on sagittal imbalance. Laminectomy and steroid therapy should be carefully considered in impaired patients due to their negative impact on sagittal balance.

Background

Eagle syndrome is a rare condition with a prevalence estimated at 4%, with 0.16% exhibiting symptoms of Eagle’s syndrome resulting from an elongated styloid process or a calcified stylohyoid ligament, compressing over nearby vessels and nerves. Symptoms range from simple headache, neck pain, and odynophagia to cerebral ischemia. Since it can be an incidental finding, management is controversial and ranges from conservative treatment to surgical intervention, including internal carotid stenting and styloidectomy.

Clinical presentation

We report two cases of Eagle’s syndrome. Case one (Vascular variant): 44 years old presented with left-sided weakness with Magnetic Resonance Imaging and an angiogram of the brain showing a right middle cerebral artery hemispheric infarct with a right internal carotid artery (ICA) dissection and elongated styloid processes more on the left. The patient’s condition improved with supportive care. He was treated with aspirin, atorvastatin, and an intensive 16-week rehabilitation program. Case two (Classic variant): 41 years old presented with refractory occipital headache and neck pain without vascular insult. Magnetic resonance of both patients showed a long styloid process.

Conclusions

Eagle’s Syndrome is a rare entity and perhaps overlooked as an anatomical variant that ought to be considered a possible etiology in atraumatic ICA dissection in patients with no discernable risk factors. As observed in case one, with atraumatic ICA dissection and unremarkable connective tissue disease work-up, highlighting anatomical variant, as an etiology to his ischemic stroke. Styloidectomy should be considered to avert risk of recurrent IC dissections in such patients with atraumatic IC dissection and classic eagle’s syndrome with refractory orofacial pain syndromes exacerbated by head movement or yawning.

Intradural extramedullary Ewing's sarcoma(IDEM) is a rare form of spinal tumor that requires a multidisciplinary approach and has high rates of recurrence and metastasis. This case report describes a 28-year-old male who presented with two months history of back pain and with sudden exacerbation and acute onset rapidly progressing lower limb weakness and numbness below the umbilicus with bowel and bladder incontinence. MRI spine showed a well-defined homogeneously enhancing IDEM at D11 – D12 vertebral level with the lesion pushing the spinal cord to the right side. The patient underwent laminectomy and excision of the lesion, and histopathology confirmed Ewing's sarcoma. He received adjuvant chemotherapy and radiotherapy based on multidisciplinary team advice, and at 12 months follow-up, he was able to walk on his own and carry out his daily activities with minimal support. This case emphasizes the importance of early diagnosis and multidisciplinary management in improving the prognosis of intradural extramedullary Ewing's sarcoma. Given the rarity of this lesion, further research is needed to standardize its management. This report also includes a review of the existing literature on intradural extramedullary Ewing's sarcoma, highlighting the clinical features, radiological findings, treatment options, and outcomes.

Introduction

Spinal surgical procedures became very frequent in the last decades with fusion techniques being widely used for several indications. Many of these surgeries imply a significant tissue disruption and muscle atrophy with subsequent pain and functional impairment.

Research question

How to prepare and manage patients according to a rapid/enhanced recovery (RR/ERAS) protocol in a private setting while improving patient’s peri-operative experience and minimizing surgical footprint?

Material and methods

All patients suffering from a thoracolumbar degenerative disease and with an indication for fusion between January 2018 and October 2021 were screened. Pain control, functional recovery, complication rate and patient’ satisfaction were recorded for at least one-year of follow-up (FU).

Results

100 patients were prospectively followed for at least one year after surgery. More than two thirds (n = 69, 69.0 %) had a trans-psoas extreme lateral interbody fusion (X-LIF) or anterior approach with posterior instrumentation and direct decompression when needed, 14 (14.0 %) had an anterior lumbar interbody fusion (ALIF) and 17 (17.0 %) patients had a posterior approach only (posterior LIF or transforaminal LIF). Most patients had multi-level surgery (n = 56, 56.0 %). All patients improved their quality of life and back and leg pain at one year FU with those having an antero-lateral approach improving significantly more. Overall satisfaction rate was higher than 90 %.

Discussion and Conclusion

The application of RR/ERAS protocols to fusion surgery in degenerative spine proves to feasible and beneficial in a private care setting. Patients having anterolateral approaches tend to improve more than those with posterior only approaches.

Background

Depressed skull fractures constitute a common trauma condition in neurosurgery. Their surgical aspects and outcome remain less studied at Niamey.

Objective

To study the surgical aspects and describe the outcome of surgical depressed skull fractures at Niamey National Hospital in Niger republic.

Method

This is a three years retro and prospective study from January 1st, 2020 to December 31st, 2022 run at National Hospital of Niamey in Niger republic.

Results

A total of 233 patients were included of which, 202 men (86.7 %) and 31 females (13,3%) with a sex-ratio of 6.51. Road traffic accident was the common cause (n = 141; 60.5 %) followed by assault (n = 43; 18.5 %) and fall (n = 27; 11.6 %). Patients from urban area were predominant (n = 161; 69.1 %). Head CT Scan constituted the most common diagnosis tool. Considering the type of depressed fractures, greenstick depressed fractures were the most frequent (n = 139; 59.7 %) followed by comminuted ones (n = 70; 30 %). Ping-pond fractures accounted for 24 cases (10.3 %) and were only seen in children. About the type of associated injury, cranio-cerebral wound (n = 73; 31,3%), extradural hematoma (n = 31; 13.3 %), and cerebral contusion (n = 10; 4.3 %) were commonly seen. Most of the patients had mild head trauma (n = 194; 83.3 %). Craniotomy with bone fragment replacement was commonly performed (n = 102; 43.8 %) followed by simple fracture elevation in 42.5 % (n = 99;). Most of the patients experienced an uneventful outcome (n = 227; 97.4 %). The death rate was very low (0.9 %; n = 2).

Conclusion

Depressed skull fractures constitute a common traumatic neurosurgical pathologies met at Niamey National Hospital. CT Scan constitutes the main diagnosis tool. Its treatment is often surgical.

Purpose

This study aims to evaluate axonal injury in supratentorial acute stroke patients and predict motor function recovery.

Methods

A cross-sectional descriptive study was performed on 28 patients with supratentorial acute stroke. All patients underwent brain magnetic resonance imaging (MRI) at Bach Mai Hospital from September 2021 to August 2022. Diffuse tensor imaging (DTI) was conducted using a 3-Tesla MRI machine to evaluate the association between the corticospinal tract and infarct area. Therefore, axonal injury and motor function recovery levels could be predicted.

Results

Almost patients had no change in the signal of the axons, which did not pass through the infarct lesion (28.6%), and the signals strongly decreased in patients whose axons completely stayed inside the infarct lesion (32.1%). The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) indices of the axons on the infarcted side were lower than those of axons on the contralateral side. The patient group, in which the axons did not pass through the infarct lesion or had no change in axonal signals, had a higher rate of better motor function recovery after 3 months than the other groups (39.3% and 25 %, respectively), whereas the axon group, in which the axons stayed completely inside the infarct lesion or had a remarkably decreased signal, had a very poor rate of recovery (32.1% and 39.3 %, respectively). The FA index of the axons on the infarct side in the poor recovery group was lower than that in the good recovery group. The ADC index did not differ between the groups.

Conclusion

MRI finding with axonal signal, location, and infarct side could significantly predict motor recovery after 3 months in acute stroke patients.

Endoscopic third ventriculostomy (ETV) is a major treatment procedure for obstructive hydrocephalus in children and adults. However, previous studies to predict the outcome of ETV, such as ETV success score, were primarily based on pediatric populations; hence, the effectiveness of ETV in elderly populations remains unclear. Here, we report the case of an 80-year-old woman with cognitive impairment and gait disturbance due to obstructive hydrocephalus caused by a pineal region meningioma. Considering that the radical resection was risky for this patient, simultaneous endoscopic tumor biopsy and ETV was performed. Based on the histopathological findings, the patient was diagnosed with meningioma. Cognition improved and gait disturbances diminished gradually 2 months after the operation. Surgical treatments for the elderly patients should not compromise activity of daily living (ADL). Our findings might help the management of elderly patients with obstructive hydrocephalus, especially in aging societies.

Objective

Puncture site complications in neuro-endovascular therapy, which represent a significant cause of morbidity, are often difficult to treat. Vascular closure devices have evolved in endovascular therapy. We analyzed risk factors for puncture site complications and examined the efficacy of hemostasis methods in neuro-endovascular therapy.

Methods

This retrospective, observational, single-center study was conducted from January 2021 to January 2023. We enrolled 202 puncture sites of patients who underwent neuro-endovascular therapy at Kawaguchi Municipal Medical Center and analyzed the complications requiring additional intervention.

Results

There were 12 (5.94%) puncture site complications. No patient had permanent puncture-related complications. Univariate analyses revealed that a higher risk of puncture site complications was significantly associated with multiple antiplatelet agents (p = 0.03), hypertension (p = 0.03), scheduled treatment (p < 0.01), higher activated clotting time (ACT) immediately before sheath removal (>310 seconds, p < 0.01), and the non-use of Perclose (manual compression or Angio-seal, p < 0.01). Multivariate analyses revealed that puncture site complications were significantly higher in patients with an ACT immediately before sheath removal >310 s (HR: 10.4, 95% CI: 2.45–44.15, p < 0.01), scheduled treatment (HR: 10.16, 95% CI: 1.81–56.95, p < 0.01), and the non-use of Perclose (HR: 21.97, 95% CI: 2.42–199.34, p < 0.01).

Conclusion

A higher ACT immediately before sheath removal was significantly associated with puncture site complications. Perclose is an efficient device, and it may reduce the risk of puncture site complications.