Neurochirurgie最新文献_第3页

Understanding statistical populations and inferences 了解统计群体和推论。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2024-11-12 DOI: 10.1016/j.neuchi.2024.101608

Jean Raymond , Tim E. Darsaut

Background

The term population is frequently used in clinical research and statistics, but concepts are multiple and confusing. Populations are a roundabout way of conceiving classifications, generalizations and inductive inferences. When misapplied, the term can lead to serious errors in study design, analysis and interpretation.

Methods

We review various notions of populations, their relationship with statistical inferences, and whether they refer to persons, variables or theoretical constructions.

Results

There are design- and model-based statistical inferences. The simplest design-based inference is from a representative random sample to a real definite population, but it is rarely possible or even pertinent in clinical research. The term population rarely concerns patients. Super-populations are theoretical postulates of statistical models that attempt to explain the distributions and relationships of variables. Pseudo-populations are mathematical constructs used to balance baseline characteristics to extract causal inferences from observational studies. Statistical populations are as numerous as variables. This leads to an explosion of entities, with much room for divergent analyses and manipulations. Target populations are to whom study results should apply. In the absence of a real population, they are erroneously assimilated to the eligibility criteria of study subjects. The inductive problem remains unsolved, for inferences from study subjects to future patients then depend on the meaning of words used in indefinite descriptions.

Conclusion

The term population often hides more than it reveals regarding problems of generalizations and inferences. Because the term leads to errors and misconceptions, it should rarely be used in clinical research.

背景：临床研究和统计学中经常使用 "人群 "一词，但其概念繁多，容易混淆。人群是一种迂回的分类、概括和归纳推理的概念。如果使用不当，该术语可能会导致研究设计、分析和解释出现严重错误：我们回顾了各种人群概念，它们与统计推论的关系，以及它们是指人、变量还是理论构造：统计推论分为基于设计的推论和基于模型的推论。最简单的基于设计的推论是从一个有代表性的随机样本到一个真正确定的人群，但这在临床研究中很少可能，甚至不相关。人群一词很少涉及病人。超群是试图解释变量分布和关系的统计模型的理论假设。伪人群是一种数学构造，用于平衡基线特征，从观察性研究中提取因果推论。统计群体和变量一样多。这导致实体数量激增，为不同的分析和操作提供了很大的空间。目标人群是指研究结果应适用的人群。在缺乏真实人群的情况下，目标人群会被错误地同化为研究对象的资格标准。归纳问题仍未解决，因为从研究对象到未来患者的推论取决于不确定描述中所用词语的含义：在概括和推论问题上，"人群 "一词所隐藏的问题往往多于所揭示的问题。由于该术语会导致错误和误解，因此在临床研究中应尽量少用。

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引用次数: 0

Neurosurgery in a Pacific archipelago: how to provide optimal care. Experience of the opening of a first-line neurosurgery department 太平洋群岛的神经外科：如何提供最佳护理。开设一线神经外科的经验。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2024-11-08 DOI: 10.1016/j.neuchi.2024.101612

Paul Roblot , Kaïssar Farah , Lorenzo Mongardi , Thierry De Greslan , Alizee Gessen , Nora Rossetto , Stéphane Litrico , Jean-Rodolphe Vignes , Stéphane Fuentes

Introduction

In the beginning of November 2023, the authors launched a neurosurgery department in Nouméa, New Caledonia. Emergency cranial surgeries are performed by orthopedic surgeons. All other cases are transferred to Australia or mainland France.

Opening a neurosurgery department matches the current needs of the population. The department opened 10 inpatient beds on February 1st, 2024.

First neurosurgical experience

During the first 3 months, 108 surgeries were performed: 32 cranial and 76 spinal. Surgical indications were mostly traumatic, degenerative, infectious, tumoral, vascular pathology, and cerebrospinal fluid resorption disorder.

Patient characteristics

There were 93 patients: 58 male, 35 female; median age, 53 years [IQR, 42 ; 65]. Median body mass index was 27.8 [23.4 ; 31.9]. Seven patients were admitted for spontaneous infection (7.5%). Eight (8.6%) were operated on for postoperative infection, including one cranial and one spinal infection initially managed elsewhere. These 15 patients had a median BMI of 31 [24.9 ; 34.4].

Conclusion

The permanent presence of two neurosurgeons seems justified. Some pathologies can be managed on-site, but transfers to centers in Australia or mainland France will remain necessary. We strongly recommend having such a first-line neurosurgery department in this type of isolated territory.

简介2023 年 11 月初，作者在新喀里多尼亚努美阿成立了神经外科。紧急颅脑手术由整形外科医生实施。所有其他病例均转至澳大利亚或法国本土。开设神经外科符合当地居民的当前需求。该部门于 2024 年 2 月 1 日开设了 10 张住院病床：在最初的 3 个月里，共进行了 108 例手术：头颅手术 32 例，脊柱手术 76 例。手术适应症多为外伤、退行性病变、感染、肿瘤、血管病变和脑脊液吸收障碍：共有 93 名患者：中位年龄为 53 岁 [IQR，42；65]。体重指数中位数为 27.8 [23.4 ; 31.9]。七名患者因自发感染入院（7.5%）。八名患者（8.6%）因术后感染而接受手术，其中包括一名颅内感染者和一名脊柱感染者，他们最初在其他地方接受了治疗。这 15 名患者的体重指数中位数为 31 [24.9 ; 34.4]：结论：两名神经外科医生长期驻院似乎是合理的。结论：两名神经外科医生的常驻似乎是合理的。有些病症可以在现场处理，但仍有必要将病人转至澳大利亚或法国本土的中心。我们强烈建议在这种偏远地区设立这样的一线神经外科。

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引用次数: 0

Cerebral herniation, arterial ischemia and the Kernohan-Woltman notch phenomenon 脑疝、动脉缺血和克诺汉-沃尔特曼缺口现象。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2024-11-08 DOI: 10.1016/j.neuchi.2024.101611

Rodrigo Carrasco Moro , José M. Pascual

引用次数: 0

Understanding the role of induction, intensions and extensions in pragmatic clinical research and practice 了解归纳、意图和延伸在实用临床研究和实践中的作用。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2024-11-07 DOI: 10.1016/j.neuchi.2024.101609

Jean Raymond , Tim E. Darsaut

Background

Pragmatic clinical research methods are poorly understood, but essential to practice outcome-based medical or surgical care. Pragmatic research aims to verify the connections between medical knowledge and the reality of practice. Its methods can be understood by reviewing the problems of induction, as well as the related linguistic and mathematical notions of intensions and extensions.

Methods

We briefly review the source of problems with using inductive methods to gain knowledge, and the relationships between language, mathematics and reality. We discuss linguistic 'sense’ and ‘reference’, and the set-theory terms ‘intensions’ and ‘extensions’, which define the relationship between individuals and whichever pertinent collection these individuals comprise. Both concepts are essential to understand pragmatic medical research and evidence-based practice.

Results

Pragmatic clinical research can be explained in terms of testing (in reality) the repeatability of various inductive referential and inferential steps used in clinical practice - from reliability, diagnostic accuracy, and prognostic studies to pragmatic trials. All pragmatic studies aim to verify the relationship between the extensions of the notions of symptoms, diagnoses, prognoses, treatments, and outcomes. The concepts of intensions and extensions also serve to understand ‘statistical significance’ in analyzing trial results, as well as problems related to eligibility criteria and subgroup analyses. The results of clinical studies can be generalized to the extent that they have been tested in numerous and widely different individuals.

Conclusion

The notions of sense and reference, and of intensions and extensions, help explain the role pragmatic clinical research methods can play in optimizing care.

背景：务实的临床研究方法鲜为人知，但却对基于结果的医疗或外科护理实践至关重要。实用性研究旨在验证医学知识与实际操作之间的联系。通过回顾归纳问题以及与之相关的语言和数学概念--意图和外延--可以理解其方法：我们简要回顾了使用归纳法获取知识的问题根源，以及语言、数学和现实之间的关系。我们将讨论语言学中的 "意义 "和 "参照"，以及集合论中的 "意图 "和 "外延"，它们定义了个体与这些个体组成的相关集合之间的关系。这两个概念对于理解实用医学研究和循证实践至关重要：从可靠性、诊断准确性和预后研究到实用性试验，实用性临床研究都可以用（在现实中）测试临床实践中使用的各种归纳参考和推论步骤的可重复性来解释。所有实用性研究都旨在验证症状、诊断、预后、治疗和结果等概念的外延之间的关系。意图和外延的概念也有助于理解分析试验结果时的 "统计意义"，以及与资格标准和亚组分析相关的问题。临床研究的结果可以推广，因为这些结果已经在众多不同的个体中进行了测试：意义与参照、意图与延伸的概念有助于解释务实的临床研究方法在优化护理方面可以发挥的作用。

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引用次数: 0

Differences in internal carotid artery tortuosity in ruptured and unruptured anterior circulation aneurysms. A matched case-control study 前循环动脉瘤破裂与未破裂时颈内动脉迂曲度的差异。匹配病例对照研究。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2024-11-07 DOI: 10.1016/j.neuchi.2024.101613

Noemi Cinti , Paul J. McKeegan , Peter J. Bazira , Aubrey Smith , Paul Maliakal , Mihai Danciut , Hamed Nejadhamzeeigilani

Objective

Tortuosity of the internal carotid artery is believed to contribute to the formation of intracranial aneurysms, although there is scant literature on its role as a risk factor for rupture specifically. Therefore, this study investigated the influence of cervical internal carotid artery (cICA) tortuosity on rupture of aneurysms of the anterior cerebral circulation.

Methods

Angiographic imaging studies from patients who underwent endovascular embolisation for anterior circulation aneurysms at a tertiary centre were identified. 83 patients with a history of aneurysmal rupture and subarachnoid haemorrhage (SAH group) were matched for age, aneurysm location and size, history of subarachnoid haemorrhage and hypertension to 83 subjects with unruptured aneurysms (control group). cICA tortuosity was assessed utilising subjective (kinks, loops or coils) and objective (tortuosity index) parameters.

Results

Subjective cICA tortuosity was identified in 33.7% and 56.6% of patients in the SAH and control groups respectively (OR 0.39 [95% CI 0.21–0.75]). Objective cICA tortuosity was present in 35.7% and 46.8% of SAH and control patients (OR 0.63 [95% CI 0.32–1.27]). OR values are suggestive of cICA tortuosity as a negative predictor of aneurysmal rupture, with more predictive power attributed to the subjective assessment, despite the limited statistical significance of the objective results.

Conclusions

This study demonstrated an increased presence of cICA tortuosity in unruptured aneurysms compared to ruptured aneurysms, suggesting it is unlikely to represent a risk factor for rupture. Further research in the form of longitudinal observational studies of untreated aneurysms would aid in investigating cICA tortuosity as a protective factor.

目的：颈内动脉迂曲被认为是颅内动脉瘤形成的原因之一，但有关其作为动脉瘤破裂风险因素的文献却很少。因此，本研究调查了颈内动脉（cICA）迂曲对大脑前循环动脉瘤破裂的影响：方法：对在一家三级中心接受血管内栓塞术治疗前循环动脉瘤的患者进行血管造影检查。83名有动脉瘤破裂和蛛网膜下腔出血病史的患者（SAH组）与83名未破裂动脉瘤的患者（对照组）在年龄、动脉瘤位置和大小、蛛网膜下腔出血病史和高血压方面进行了配对：在 SAH 组和对照组中，分别有 33.7% 和 56.6% 的患者发现了主观 cICA 扭转（OR 0.39 [95% CI 0.21-0.75]）。SAH组和对照组分别有35.7%和46.8%的患者存在客观cICA迂曲（OR 0.63 [95% CI 0.32-1.27]）。尽管客观结果的统计学意义有限，但OR值提示cICA迂曲是动脉瘤破裂的阴性预测因子，主观评估的预测能力更强：这项研究表明，与破裂的动脉瘤相比，未破裂的动脉瘤中 cICA 扭转的存在率更高，这表明 cICA 扭转不太可能成为动脉瘤破裂的风险因素。对未经治疗的动脉瘤进行纵向观察研究，将有助于将 cICA 扭转作为一种保护因素进行研究。

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引用次数: 0

Deformational plagiocephaly multi-group outpatient clinics reduce referral to visit times and visit length 畸形儿多组门诊减少了从转诊到就诊的时间和就诊时间。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2024-11-06 DOI: 10.1016/j.neuchi.2024.101617

David Shepetovsky , Asaf Olshinka , Amir Kershenovich

Objective

Deformational plagiocephaly (DP) is a well-recognized condition, affecting up to 20% of all babies. Its prevalence lead centers worldwide to create multi-group clinics and incorporate technology to decrease repetitive counselling, save clinic hours and shorten waiting times.

This paper describes the modalities incorporated in our craniofacial clinic since 2016 and their effect on our patient population.

Methods

Data were collected retrospectively between November 2016 and September 2022 and prospectively between April and May of 2024. This period was divided into eight bimesters constituting several different clinic modalities. Data included the number of patients, no-shows, referral to visit times (RVT), visit length (VL), satisfaction rates, and demographics of all patients visiting our clinic and those referred specifically for DP.

Results

A total of 1794 patients, reviewed retrospectively, were included, 202 were referred for DP. Mean RVT was 38.5 days for all patients. For DP patients, mean RVTs were (according to bimesters): 107 days (older triage system), 59 days (newer system, new monthly craniofacial clinic, additional clinic slots), 58 days (cranial orthosis program, first multi-group clinic), 52 days (online lecture), 35 days (end of Covid lockdown), 43 days (pre-recorded presentations), and 47 days (multi-group encounters). RVT decreased to 17 days in the prospective bimester, during which another 117 DP patients were seen. Mean VL averaged 22 min for the first six bimesters and then decreased to 11 and 7 min during the seventh and eighth bimesters respectively.

Conclusion

Multi-group encounters for DP are highly effective in reducing RVTs and VL.

目的：畸形头畸形（DP）是一种公认的疾病，影响高达 20% 的婴儿。畸形头畸形（DP）的发病率很高，促使世界各地的医疗中心纷纷建立多组门诊，并采用技术手段减少重复咨询，节省门诊时间，缩短候诊时间。本文介绍了我院颅颌面诊所自2016年以来采用的模式及其对患者群体的影响：数据收集时间为 2016 年 11 月至 2022 年 9 月的回顾性数据和 2024 年 4 月至 5 月的前瞻性数据。这一时期分为八个双月，构成了几种不同的门诊模式。数据包括患者人数、未到诊人数、转诊至就诊时间（RVT）、就诊时长（VL）、满意率以及所有就诊患者和专为 DP 转诊的患者的人口统计学特征：通过回顾性分析，共纳入了 1794 名患者，其中 202 人被转诊接受 DP 治疗。所有患者的平均 RVT 为 38.5 天。对于 DP 患者，平均 RVT 为（根据双孕期）：107天（较旧的分诊系统）、59天（较新的系统、新的颅颌面每月门诊、额外的门诊时段）、58天（颅骨矫形计划、首次多组门诊）、52天（在线讲座）、35天（Covid封锁结束）、43天（预先录制的演示）和47天（多组会诊）。在未来的两个月中，RVT 下降到 17 天，在此期间又有 117 名 DP 患者就诊。前六个双孕期的平均 VL 为 22 分钟，第七和第八个双孕期分别降至 11 分钟和 7 分钟：结论：DP 的多组会诊在减少 RVT 和 VL 方面非常有效。

{"title":"Deformational plagiocephaly multi-group outpatient clinics reduce referral to visit times and visit length","authors":"David Shepetovsky , Asaf Olshinka , Amir Kershenovich","doi":"10.1016/j.neuchi.2024.101617","DOIUrl":"10.1016/j.neuchi.2024.101617","url":null,"abstract":"<div><h3>Objective</h3><div>Deformational plagiocephaly (DP) is a well-recognized condition, affecting up to 20% of all babies. Its prevalence lead centers worldwide to create multi-group clinics and incorporate technology to decrease repetitive counselling, save clinic hours and shorten waiting times.</div><div>This paper describes the modalities incorporated in our craniofacial clinic since 2016 and their effect on our patient population.</div></div><div><h3>Methods</h3><div>Data were collected retrospectively between November 2016 and September 2022 and prospectively between April and May of 2024. This period was divided into eight bimesters constituting several different clinic modalities. Data included the number of patients, no-shows, referral to visit times (RVT), visit length (VL), satisfaction rates, and demographics of all patients visiting our clinic and those referred specifically for DP.</div></div><div><h3>Results</h3><div>A total of 1794 patients, reviewed retrospectively, were included, 202 were referred for DP. Mean RVT was 38.5 days for all patients. For DP patients, mean RVTs were (according to bimesters): 107 days (older triage system), 59 days (newer system, new monthly craniofacial clinic, additional clinic slots), 58 days (cranial orthosis program, first multi-group clinic), 52 days (online lecture), 35 days (end of Covid lockdown), 43 days (pre-recorded presentations), and 47 days (multi-group encounters). RVT decreased to 17 days in the prospective bimester, during which another 117 DP patients were seen. Mean VL averaged 22 min for the first six bimesters and then decreased to 11 and 7 min during the seventh and eighth bimesters respectively.</div></div><div><h3>Conclusion</h3><div>Multi-group encounters for DP are highly effective in reducing RVTs and VL.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 1","pages":"Article 101617"},"PeriodicalIF":1.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The current state of Spina Bifida in low- and middle-income countries: where does Africa stand? 中低收入国家脊柱裂现状：非洲的现状如何？

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2024-11-06 DOI: 10.1016/j.neuchi.2024.101616

Inibehe Ime Okon , Agbeniga Elijah Temitope , Ibukunolu Olufemi Ogundele , Usoro Akpan , Emem Okon Mbong , Omar Kasimieh , Bipin Chaurasia , Emmanuel James , Elkan Gbadebo , Fadele Kehinde Precious , Arwa Jader , Olalekan John Okesanya , Vishal Karmani , Michael Erhayanmen , Don Eliseo Lucero-Prisno III

Spina bifida is a congenital neural tube defect that results in abnormal development of the spine and central nervous system. Infants born with this condition face a range of physical disabilities and associated complications. Although the global burden has declined in recent decades due to folic acid fortification and prenatal screening, spina bifida remains a significant public health challenge in many low- and middle-income countries (LMICs), particularly in sub-Saharan Africa. This research aimed to comprehensively assess the current epidemiological trends, clinical management practices, and socioeconomic impacts of spina bifida across African LMICs. Through a systematic analytical search of published literature from major medical databases covering the years 2000–2023, relevant data were extracted on the prevalence, risk factors, clinical presentations, treatment modalities, outcomes, and contextual barriers faced in preventing and caring for spina bifida in these settings. The findings were analyzed and synthesized to provide an overview of the contemporary landscape. The findings highlight the need for collaborative efforts between governments, healthcare providers, nongovernmental organizations, and international stakeholders to address the multifaceted challenges posed by spina bifida in LMICs, particularly within the African continent, and to promote equitable access to comprehensive care and support for affected individuals and their families.

脊柱裂是一种先天性神经管缺陷，会导致脊柱和中枢神经系统发育异常。患有这种疾病的婴儿出生后会面临一系列身体残疾和相关并发症。虽然近几十年来，由于叶酸强化和产前筛查，脊柱裂的全球负担有所下降，但在许多中低收入国家，尤其是撒哈拉以南非洲国家，脊柱裂仍然是一项重大的公共卫生挑战。这项研究旨在全面评估脊柱裂目前在非洲低中收入国家的流行趋势、临床管理实践和社会经济影响。通过对主要医学数据库中 2000-2023 年发表的文献进行系统分析搜索，提取了这些环境中脊柱裂的发病率、风险因素、临床表现、治疗方式、结果以及预防和护理脊柱裂所面临的背景障碍等相关数据。我们对研究结果进行了分析和综合，以提供当代情况概览。研究结果突出表明，政府、医疗保健提供者、非政府组织和国际利益相关者需要通力合作，共同应对脊柱裂在低收入和中等收入国家（尤其是非洲大陆）带来的多方面挑战，并促进受影响的个人及其家庭公平地获得全面的护理和支持。

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引用次数: 0

Early aggressive constriction resection for hourglass-like constriction of peripheral nerve in the upper extremity: a retrospective study 针对上肢周围神经沙漏样收缩的早期积极收缩切除术：一项回顾性研究。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2024-10-23 DOI: 10.1016/j.neuchi.2024.101605

Dandan Yang, Yao Wu, Long Zheng, Zhenzhi Wu, Xing Rong, Buguo Chen

Objectives

The hourglass like constriction (HGC) of peripheral nerves is a characteristic pathological manifestation of Neuralgic Amyotrophy. Once identified, early surgical intervention is essential. However, the method of surgery is controversial, particularly regarding whether HGC needs to be excised. This study aims to explore the efficacy of early aggressive resection of HGC in the upper limb nerves.

Materials and methods

This retrospective study focuses on 13 nerves of spontaneous upper limb paralysis treated at our hospital from June 2019 to July 2023, in which HGC was identified during surgery. During surgery, epineurectomy and interfascicular neurolysis were performed on the constricted areas. Post-neurolysis, constriction excision was carried out if any of the following conditions were met: (1) A single constriction with constriction ≥75%. (2) Constriction combined with torsion. (3) The presence of ≥2 constrictions. Regular face-to-face follow-ups were conducted postoperatively.

Results

Four cases with a single constriction of less than 75% underwent epineurotomy and interfascicular neurolysis; eight underwent constriction excision, of which four cases with a single constriction and associated torsion had direct end-to-end suturing after excision, and four had more than two constrictions treated with autologous sural nerve grafts. Postoperative follow-ups showed good recovery in all but one case, which had unique pathological features and had underwent only epineurectomy, showing moderate recovery.

Conclusions

For early surgical treatment of HGCs in peripheral nerves of the upper limbs, if severe constriction, constriction combined with torsion, or the presence of more than two constrictions are identified during surgery, aggressive constriction resection may be a better option.

目的：周围神经沙漏样收缩（HGC）是神经性肌营养不良症的特征性病理表现。一旦发现，必须尽早进行手术治疗。然而，手术方法仍存在争议，尤其是关于是否需要切除 HGC。本研究旨在探讨早期积极切除上肢神经HGC的疗效：本回顾性研究主要针对2019年6月至2023年7月期间在我院接受治疗的13例自发性上肢瘫痪神经，在手术过程中发现了HGC。在手术过程中，对收缩区域进行了上神经切除术和筋膜间神经切断术。神经切除术后，如果符合以下条件之一，则进行收缩物切除术：(1) 单一收缩且收缩≥75%。(2）收缩合并扭转。(3）存在≥2处收缩。术后定期进行面对面随访：结果：4 例单发收缩小于 75% 的病例接受了上神经切除术和筋膜间神经切断术；8 例接受了收缩切除术，其中 4 例单发收缩并伴有扭转的病例在切除术后直接进行了端对端缝合，4 例收缩超过 2 处的病例接受了自体鞍神经移植术。术后随访显示，除一例病例恢复良好外，其他病例均恢复良好：结论：对于上肢周围神经 HGCs 的早期手术治疗，如果在手术中发现严重收缩、收缩合并扭转或存在两个以上收缩，积极的收缩切除术可能是更好的选择。

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引用次数: 0

Complications following laser interstitial thermal therapy: a review 激光间质热疗后的并发症：综述。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2024-10-23 DOI: 10.1016/j.neuchi.2024.101604

Kyle McGrath , Matthew Frain , Grace Hey , Maryam Rahman

Laser interstitial thermal therapy (LITT) is being performed more frequently for various lesions within neurosurgery, including epileptic foci, vascular malformations, and tumors. Though this technique generally has an excellent safety profile, it is important to be aware of potential complications. Thermal ablation of tissue leads to disruption of the blood brain barrier as well as an inflammatory response both of which cause the majority of complications from LITT. The most common complications of LITT include cerebral edema, focal neurologic deficits, and intracranial hemorrhage. Few studies have identified factors predicting development of these complications, but many of these are transient and resolve without intervention. Modifications to LITT technique that allows better visualization of patient anatomy along the tract, such as fusing vascular imaging with intraoperative MRI, reduce the risk of complications.

激光间质热疗（LITT）越来越多地用于神经外科的各种病变，包括癫痫灶、血管畸形和肿瘤。虽然这种技术通常具有极佳的安全性，但必须注意潜在的并发症。组织热消融会导致血脑屏障破坏和炎症反应，这两种情况是 LITT 并发症的主要原因。LITT 最常见的并发症包括脑水肿、局灶性神经功能缺损和颅内出血。很少有研究能确定预测这些并发症发生的因素，但许多并发症都是一过性的，无需干预即可缓解。对 LITT 技术进行改良，可以更好地观察患者沿导管的解剖结构，例如将血管成像与术中核磁共振成像融合，从而降低并发症的风险。

引用次数: 0

Complete foot drop due to atypical peroneal ganglion in a 13 ½ year old boy 一名 13 ½ 岁男孩因非典型腓总神经节导致完全性足下垂。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2024-10-22 DOI: 10.1016/j.neuchi.2024.101606

Maite Jiménez Siebert, Nadine Kaiser, Kai Ziebarth

Introduction

Peroneal nerve palsy due to compression by an intraneural ganglion is an uncommon entity in the pediatric setting with a need for surgical treatment. Uniquely in this case, the ganglion presented as an elongated instead of a typical round cyst, delaying diagnosis and treatment.

Case presentation

We present the case of a 13 ½ year old boy with increasing peroneal nerve palsy due to an atypically shaped intraneural ganglion. An MRI of the knee revealed an elongated peroneal ganglion compressing the nerve between the lateral insertion of the gastrocnemius muscle and fibular head over a length of 10 cm. After surgical decompression and physiotherapy the peroneal nerve recovered well, achieving M 4–5 one year after surgery.

Conclusion

The atypical shape of the present peroneal ganglion delayed diagnosis and correct treatment. Though rare in the pediatric setting, this entity must be specifically looked for during the diagnostic workup of peroneal palsy, for time to surgery determines neurological outcome.

导言：因硬膜内神经节压迫导致的腓肠神经麻痹在儿科并不常见，需要手术治疗。本病例的独特之处在于，神经节呈拉长状而非典型的圆形囊肿，从而延误了诊断和治疗：本病例中，一名13岁半的男孩因形状异常的硬膜内神经节而导致腓总神经麻痹。膝关节核磁共振成像显示，腓肠肌外侧插入部和腓骨头之间有一个拉长的腓肠神经节，压迫神经的长度达 10 厘米。经过手术减压和物理治疗后，腓总神经恢复良好，术后一年达到 M 4 - 5：目前腓总神经节的不典型形状延误了诊断和正确治疗。虽然这种情况在儿童中很少见，但在腓骨神经麻痹的诊断过程中必须特别注意，因为手术时间决定了神经功能的预后。

引用次数: 0