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Outcomes of Pediatric Neurosurgical Cases Managed by General Neurosurgeons: A Retrospective Study from Eastern India 由普通神经外科医生管理的小儿神经外科病例的结果:一项来自印度东部的回顾性研究
IF 0.2 Pub Date : 2023-06-19 DOI: 10.1055/s-0043-1770098
Abhijit Acharya, S. Senapati, Sumirini Puppala, A. Mahapatra
Abstract Background  India is home to almost 19% of the world's children. The burden of diseases in the pediatric age group is quite high and is just the tip of the iceberg. In India, there are very few neurosurgeons who deal with cases in the pediatric age group. Most parents avoid surgical management for their child due lack of confidence in the expertise of the neurosurgeon in handling pediatric cases. Many challenges are encountered in the pediatric population during the pre-, intra- and post-operative period. Objectives  The aim of this study is to study the demographic profile and respective outcomes of pediatric neurosurgical cases (below 18 years of age). Methods  A retrospective study of cases over a period of 1.5 years in the Department of Neurosurgery, Institute of Medical Sciences and Sum Hospital was done. The variables analyzed were age group, sex, diagnosis, elective or emergency, neurological examination, and outcome. Data analysis was done using Version 3.0.2; 2013-09-25 for Statistical Computing (IBM Corporation's SPSS programme, version 27.0, 2020). Literature review was done through the NCBI PubMed, Scopus, Embase, and Google Scholar databases. Quality of life was assessed by the disability-adjusted life years (DALY) score approved by the World Health Organization. Results  The majority of the patients had significant improvement in achieving milestones with reduced morbidity and one case of mortality. Conclusion  To conclude, we have managed all cases of pediatric age group in a general neurosurgery department with utmost skill and meticulous surgery, with less than 0.1% mortality. In the cases that pertain to low resourced centers, areas, and countries where general neurosurgeons are mandated and obliged to perform pediatric neurosurgical procedures, we general neurosurgeons should take it as a challenge to manage these pediatric cases as our study showed appreciable results although the need for specialized pediatric neurosurgical care cannot be overemphasized.
印度是世界上近19%儿童的家园。儿童年龄组的疾病负担相当高,这只是冰山一角。在印度,很少有神经外科医生处理儿科年龄组的病例。由于对神经外科医生处理儿科病例的专业知识缺乏信心,大多数家长避免对孩子进行手术治疗。许多挑战是遇到在儿科人口在术前,术中和术后时期。目的本研究的目的是研究儿童神经外科病例(18岁以下)的人口统计学特征和各自的结果。方法对苏姆医院医学研究所神经外科1.5年的病例进行回顾性分析。分析的变量包括年龄组、性别、诊断、择期或急诊、神经学检查和结果。数据分析使用版本3.0.2;2013-09-25统计计算(IBM公司的SPSS程序,版本27.0,2020)。文献综述通过NCBI PubMed、Scopus、Embase和谷歌Scholar数据库完成。生活质量通过世界卫生组织批准的残疾调整生命年(DALY)评分进行评估。结果大多数患者在达到里程碑方面有显著改善,发病率降低,死亡率1例。结论:我们在普通神经外科以精湛的技术和细致的手术处理了所有儿童年龄组的病例,死亡率低于0.1%。在资源不足的中心、地区和国家,普通神经外科医生被授权和有义务执行儿科神经外科手术,我们普通神经外科医生应该把它作为一个挑战来管理这些儿科病例,因为我们的研究显示了可观的结果,尽管对专门的儿科神经外科护理的需求怎么强调也不为过。
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引用次数: 0
Lumbar Discal Cyst: Is it a Rare Consequence in Lumbar Disc Disease Spectrum? Short Case Series with Review of Literature and Hypothesis Regarding Etiopathogenesis 腰椎间盘囊肿:是腰椎间盘疾病谱系中一种罕见的结果吗?关于发病机制的文献回顾和假设的简短病例系列
IF 0.2 Pub Date : 2023-06-05 DOI: 10.1055/s-0042-1743396
U. Pai, Devaprasad Sathyanarayanan, Harsha Manjarambath Haridas
Abstract Background  Lumbar discal cysts are rare intraspinal extradural lesions presenting as lumbar radiculopathy. The rarity of the lesion is sufficient to evoke interest in its diagnosis. The hitherto unsolved etiopathogenesis prompted us to look into these areas in this study. Objectives  1) To review the literature and summarize the clinicoradiological and histopathological features of the discal cyst. 2) To investigate possible mechanisms in the etiopathogenesis of discal cysts. Materials and Methods  Three patients presented with features suggestive of lumbar disc prolapse and were diagnosed with discal cyst over 1.5 years and were included in this study. All patients underwent lumbar spine magnetic resonance imaging (MRI) and were subsequently treated by cyst excision. The final diagnosis of the discal cyst was based on histopathological features. Results  Out of three patients, two had a discal cyst with disc prolapse, and one had a discal cyst alone. Discal cyst patient underwent excision of cyst alone. Discal cyst patients with disc prolapse underwent discectomy in addition to excision of the discal cyst. One patient had an L2–L3 level discal cyst with disc prolapse, which is uncommon. Conclusions  Lumbar discal cysts, although rare, form an important differential diagnosis in patients with lumbar radiculopathy. They have a distinctive MRI appearance, and because discal cyst and disc prolapse shared similar etiopathological features, we hypothesize that discal cyst is a part of the degenerative disc disease spectrum. We also conclude that discal cyst excision should be coupled with discectomy when LDC is associated with disc prolapse.
腰椎间盘囊肿是一种罕见的椎管内硬膜外病变,表现为腰椎神经根病。这种病变的罕见足以引起人们对其诊断的兴趣。迄今尚未解决的发病机制促使我们在本研究中探讨这些领域。目的1)回顾文献,总结腰椎间盘囊肿的临床放射学和组织病理学特征。2)探讨椎间盘囊肿的发病机制。材料与方法本研究纳入3例表现为腰椎间盘突出,且诊断为腰椎间盘囊肿超过1.5年的患者。所有患者均行腰椎磁共振成像(MRI),随后行囊肿切除治疗。椎间盘囊肿的最终诊断是基于组织病理学特征。结果3例患者中,2例合并椎间盘囊肿并椎间盘脱垂,1例仅合并椎间盘囊肿。椎间盘囊肿患者行单纯囊肿切除。椎间盘囊肿伴椎间盘脱垂的患者除切除椎间盘囊肿外还行椎间盘切除术。1例患者有L2-L3水平椎间盘囊肿伴椎间盘脱垂,这是罕见的。结论腰椎间盘囊肿虽然罕见,但对腰神经根病是一个重要的鉴别诊断。它们具有独特的MRI外观,并且由于椎间盘囊肿和椎间盘脱垂具有相似的病因病理学特征,我们假设椎间盘囊肿是退行性椎间盘疾病谱的一部分。我们还得出结论,当椎间盘不全合并椎间盘脱垂时,椎间盘囊肿切除应与椎间盘切除术联合进行。
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引用次数: 0
Operative Manual of Neurosurgery: A Step by Step Pictorial Atlas —A Review 神经外科手术手册:一步一步的图像图集-回顾
IF 0.2 Pub Date : 2023-06-01 DOI: 10.1055/s-0043-1769898
G. Menon
Operative Manual of Neurosurgery: A Step by Step Pictorial Atlas, published by Jaypee Brothers and authored byDr. Balaji Pai and his team comprising Asima Banu and Sandesh Khandelwal, is a two-volume visual delight. This twovolume operative atlas of neurosurgery is the sweet product of Dr. Balaji Pai’s “labor of intense fascination and love for thefine art of neurosurgery.”Dr. Balaji, in his preface, highlights that the focus of this venture is to teach neurosurgery through photographs and illustrations rather than through theory. This step-by-step pictorial operative atlas of neurosurgery hits the mark, and the editorial team can certainly be complimented for a goal well accomplished. The book is virtually an illustrated guided tour through all aspects of neurosurgery starting from basic technique to recent advances in neurosurgery. The book has 2 volumes comprising 21 sections with 155 chapters spread over a total of 1,684 pages, with each chapter authored by subject experts (►Fig. 1). Volume I includes preoperative planning, basic techniques, surgery for trauma and tumors, skull base surgery, and cerebrovascular surgery. Volume II concentrates on neuroendoscopy, orbital surgery, functional neurosurgery, pediatric neurosurgery, craniovertebral junction surgery, and spine surgery including spinal endoscopy and minimally invasive spine surgery. Chapters are organized in a systematic manner, starting with a brief introduction and details about positioning followed by a step-by-step operative documentary supplemented by operative photographs and radiological images. The icing on the cake is the pearls of wisdom provided at the end of each chapter. Singling out chapters for special comment would be invidious. In addition to often-discussed chapters on trauma, tumors, and vascular surgery, there are chapters that deal with newer concepts such as neuroendoscopy and minimally invasive spine surgery, which makes this book a comprehensive, go-to reference atlas for any neurosurgeon in evolution. In addition, for a practicing neurosurgeon, it is an easy ready reckoner, which he/she can brush through and revise just before scrubbing up for any surgery. The production aspect of the atlas is excellent considering the fact that this is a book based exclusively on camera photographs, endoscopic views, and highquality microscopic images. Expecting uniformly highquality images from the over hundred authors who have contributed to this book is difficult. Moreover, photographs obtained through the operation microscope vary considerably in clarity and glare often obscures crucial features. Yet, the illustrations are clear and the quality of the print, text, and images provides a smoothening read to the eyes. The annotations of the images and brief and detailed captions make for an easy reference. The text content in each chapter has been reduced to a minimum, and there is an average of 15 illustrations per chapter. Yes, one concern is the physical bulk of the two v
《神经外科手术手册:一步一步的图集》,由Jaypee Brothers出版,dr。Balaji Pai和他的团队包括Asima Banu和Sandesh Khandelwal,这是一本两卷的视觉盛宴。这本两卷本的神经外科手术图谱是Balaji Pai博士“对神经外科艺术的强烈迷恋和热爱的劳动”的甜蜜产物。巴拉吉在他的序言中强调,这次冒险的重点是通过照片和插图而不是通过理论来教授神经外科。这一步一步的图像神经外科手术地图集击中了目标,编辑团队当然可以称赞一个很好的完成目标。这本书实际上是通过神经外科从基本技术到神经外科最新进展的所有方面的插图指导之旅。全书共2卷,共21节155章,共1684页,每章均由学科专家撰写。1).第一卷包括术前计划、基本技术、创伤与肿瘤外科、颅底外科、脑血管外科。第二卷集中在神经内窥镜,眶手术,功能神经外科,小儿神经外科,颅椎交界处手术,脊柱外科,包括脊柱内窥镜和微创脊柱手术。章节以系统的方式组织,以简短的介绍和关于定位的详细信息开始,然后是一步一步的操作纪录片,补充了操作照片和放射图像。锦上添花的是每一章结尾提供的智慧之珠。挑出某些章节进行特别评论会令人反感。除了经常讨论的关于创伤、肿瘤和血管手术的章节外,还有一些章节涉及较新的概念,如神经内窥镜检查和微创脊柱手术,这使得本书成为任何神经外科医生在进化方面的全面参考图集。此外,对于一名神经外科医生来说,这是一个简单的计算工具,他/她可以在任何手术之前快速浏览和修改。考虑到这是一本完全基于相机照片、内窥镜视图和高质量显微图像的书,地图集的制作方面非常出色。期望从为本书做出贡献的一百多位作者那里获得一致的高质量图像是困难的。此外,通过操作显微镜获得的照片在清晰度上差异很大,眩光常常掩盖了关键特征。然而,插图清晰,印刷,文字和图像的质量为眼睛提供了平滑的阅读。图片的注释和简短详细的说明便于参考。每一章的文字内容已经减少到最低限度,平均每章有15个插图。是的,一个问题是这两卷书的体积太大,读者携带起来有点吃力。另一种选择是将其分成多卷,这再次增加了版本的体积。不可避免地,比较将被进行,作为一个有效的地图集,被审查的卷将与其他的进行比较,特别是目前最流行的在线地图集由Aaron Cohen。Balaji博士的书的独特之处在于所描述的手术方法反映了每个作者在多年积累的经验中提炼的技术。该技术可能不同于标准的教科书描述,但提供了一个实用的和经过时间考验的方法来探究学习的头脑。出于同样的原因,编辑们故意省略了参考文献,因为这本手册是根据每个作者的个人经验提炼出来的,经过多年的反复磨练和失败,才得以润色。我相信,正是这一点使这本书成为独一无二的瑰宝,使它从无数的离线和在线的神经外科手术书籍中脱颖而出。
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引用次数: 0
Vascular Compression of Medulla Oblongata by Non-Dolichoectatic Vertebral Artery 非膨大性椎动脉对延髓的血管压迫
IF 0.2 Pub Date : 2023-06-01 DOI: 10.1055/s-0043-1769899
V. Nitheesha Reddy, K. Nagarajan, V. Midhusha Reddy, A. Ramesh
Abstract Neurovascular conflicts are common in the posterior fossa and basal cisterns due to coexistence of important neural and vascular structures. Neurovascular conflict arising from compression of the cranial nerves by pulsatile flow in the adjacent atherosclerotic arteries is well known and is associated with conditions like trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. The medulla is known to be affected by dilated tortuous (dolichoectatic) vertebrobasilar arteries in the elderly or hypertensive. The vertebral artery causing the compression can be dolichoectatic or normal dominant vertebral artery or an elongated tortuous artery. Very few cases of medullary compression by non-dolichoectatic elongated tortuous or dominant vertebral artery were reported in the literature. In this article, we report three cases of medullary compression by the dominant and angulated vertebral artery. Magnetic resonance (MR) imaging with MR angiography showed indentation of the anterolateral aspect of the inferior medulla by the vertebral artery. The patients are managed conservatively and on regular follow-up.
由于重要的神经和血管结构共存,神经血管冲突在后窝和基底池中很常见。神经血管冲突是由相邻动脉粥样硬化动脉的搏动血流压迫脑神经引起的,并与三叉神经痛、面肌痉挛和舌咽神经痛等疾病有关。已知髓质受老年人或高血压患者椎基底动脉扩张弯曲(过度扩张)的影响。造成压迫的椎动脉可以是过度扩张或正常的优势椎动脉,也可以是延长的弯曲动脉。文献中很少报道非膨大性椎动脉延长、扭曲或显性椎动脉压迫髓质。在这篇文章中,我们报告了三例主要椎动脉和成角椎动脉压迫髓质。磁共振血管造影显示下髓质前外侧被椎动脉压痕。患者接受保守治疗并定期随访。
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引用次数: 0
Degenerative Spondylolisthesis of Lumbarized S1-S2 Vertebrae: A Case Report S1-S2腰椎退行性椎体滑脱1例报告
IF 0.2 Pub Date : 2023-05-29 DOI: 10.1055/s-0043-1768640
D. Singh, Kshitij Sinha, R. Singh, V. Chand, ArunD Singh
Abstract Introduction  Degenerative spondylolisthesis (DS) is usually seen at lumbo-sacral region. Lumbarization of S1 is seen in less than 2% of the population and to have spondylolisthesis in this segment is even rarer. The purpose is to report a rare case of DS at S1-S2 level. Case Report  A 52-year-old male, a farmer by profession, presented to Neurosurgery outpatient department with complaint of low back ache for 4 years, which was insidious and progressive. The pain radiated to both lower limbs with more on right than left side. Radiological evaluation with anteroposterior and lateral roentgenogram of lumbo-sacral spine revealed anterolisthesis of S1-S2 (Meyerding's grade 2). Magnetic resonance imaging reported S1-S2 disk bulge with bilateral foraminal stenosis. The patient underwent S1 laminectomy along with S1-S2 discectomy with bilateral S1 and S2 pedicle screws and rod fixation with transforaminal lumbar interbody fusion. Result  Postoperative recovery was good with improvement in back pain along with power on postoperative day 1. Conclusion  The prevalence of lumbarization is less than 2% and getting spondylolisthesis in this segment is even rarer. As this is one of the first of its kind of case, further case series or longitudinal studies of such cases may help understand better the pathomechanics related to spondylolisthesis at this level.
摘要:退行性椎体滑脱(DS)常见于腰骶区。S1腰椎化在不到2%的人群中可见,在这一节段发生脊柱滑脱的情况更罕见。目的是报告一例罕见的S1-S2节段退行性椎体滑移。病例报告男性,52岁,职业为农民,因腰痛4年,隐蔽性进行性腰痛到神经外科门诊就诊。疼痛向双下肢放射,右侧多于左侧。腰骶椎正位和侧位x线片显示S1-S2前滑脱(Meyerding's 2级)。磁共振成像报告S1-S2椎间盘突出伴双侧椎间孔狭窄。患者行S1椎板切除术和S1-S2椎间盘切除术,采用双侧S1和S2椎弓根螺钉和经椎间孔腰椎椎间融合棒固定。结果术后恢复良好,术后第1天腰痛减轻,体力增强。结论腰椎间盘突出的发生率小于2%,腰椎滑脱的发生更为罕见。由于这是第一例此类病例,进一步的病例系列或对此类病例的纵向研究可能有助于更好地理解与该水平椎体滑脱相关的病理力学。
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引用次数: 0
Distal Nerve Exploration in the Palm Avoids Nerve Transfer in a Posttraumatic Ulnar Nerve Injury with a Claw Hand 掌部远端神经探查避免爪手外伤后尺神经损伤的神经转移
IF 0.2 Pub Date : 2023-04-19 DOI: 10.1055/s-0043-57031
J. Terrence, J. Jerome, Indian J Neurosurg
Abstract Posttraumatic low ulnar nerve injuries develop claw hand and poor hand function. Transferring the opponens pollicis branch of the thenar branch at the palm to the terminal division of the deep branch of the ulnar nerve is an effective distal nerve transfer to restore pinch in low ulnar nerve injuries. The author describes the surgical technique for a 4-month-old low ulnar nerve injury in a 25-year-old man with inconclusive electrodiagnostic findings and no clinical findings of distal nerve recovery. The intraoperative electrical stimulation of the nerve in the palm is a simple method to ensure the reinnervation of the ulnar nerve in a claw hand and muscle wasting. Therefore, all postcut injuries with a low ulnar nerve palsy with claw hands may not need a distal nerve transfer. However, performing distal nerve exploration in the palm is vital in cases of doubtful nerve recovery in a low ulnar nerve palsy with a claw hand.
摘要创伤后尺下神经损伤可导致爪状手和手功能差。将掌部大鱼际支对跖支转移至尺神经深支末段是修复下尺神经损伤的一种有效的远端神经转移方法。作者描述了一名25岁男性4个月大的尺神经损伤的手术技术,他的电诊断结果不确定,没有远端神经恢复的临床表现。术中掌部神经电刺激是保证爪手尺神经再生和肌肉萎缩的一种简便方法。因此,所有爪状手的低尺神经麻痹的切后损伤可能不需要远端神经转移。然而,在掌部进行远端神经探查是至关重要的,在神经恢复可疑的情况下,低尺神经麻痹与爪手。
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引用次数: 0
Neuro-navigation: Equipment, Tips, and Tricks on Brain Navigated Surgery 神经导航:脑导航手术的设备、提示和技巧
IF 0.2 Pub Date : 2023-04-14 DOI: 10.1055/s-0043-1764456
E. N. Kingsly, Ismail Bozkurt, B. Chaurasia
Abstract Neuronavigation is a system composed of advanced intraoperative equipment where a virtual link is created between digital images and anatomical structures such that intra-axial lesions are precisely located and removed safely and efficiently. Thus, neuronavigation has enormously increased the success rate of brain and spinal cord surgery compared to the era in which it did not exist. This article takes a look at and emphasizes, as a reminder, the benefits of neuronavigation, equipment used, equipment setup, tips and tricks on preoperative preparation of patients' images, and future perspectives on neuronavigation and equipment, aspects that are very rare in literature. A commonly used neuronavigation system is described, with regard to its parts, setup, instructions, and tips and tricks. This narrative review allows the reader to grasp the main aspects of neuronavigation, the functions of all the aspects, and what to expect during brain surgery. Although training with neuronavigation is a given in most developed parts of the world, in underdeveloped and developing countries the lack of equipment does not allow most neurosurgeons to have a first-hand experience. This article has aimed to ease the learning curve for neurosurgeons that are unfamiliar with neuronavigation.
神经导航是一种由先进的术中设备组成的系统,在数字图像和解剖结构之间建立虚拟链接,从而精确定位和安全有效地切除轴内病变。因此,与没有神经导航的时代相比,神经导航极大地提高了脑部和脊髓手术的成功率。这篇文章着眼于并强调,作为提示,神经导航的好处,设备的使用,设备的设置,术前准备患者图像的提示和技巧,以及神经导航和设备的未来前景,这些方面在文献中非常罕见。本文描述了一种常用的神经导航系统,包括其组成部分、设置、说明、提示和技巧。这种叙述性的回顾使读者能够掌握神经导航的主要方面,各方面的功能,以及在脑外科手术中会发生什么。尽管在世界上大多数发达地区,神经导航培训是一项规定,但在不发达国家和发展中国家,由于缺乏设备,大多数神经外科医生无法获得第一手经验。本文旨在为不熟悉神经导航的神经外科医生简化学习曲线。
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引用次数: 1
Spinal Intramedullary Schwannoma of the Conus 脊髓圆锥髓内神经鞘瘤
IF 0.2 Pub Date : 2023-04-14 DOI: 10.1055/s-0043-1768065
J. Tp, Sekar Chinnamuthu
Abstract Schwannomas are one of the most common primary spinal tumors representing 30% of all intraspinal lesions. Intramedullary schwannomas constitutes 0.3% of all intraspinal tumors and approximately 1% of spinal cord schwannomas. Majority of the tumors are seen in the cervical (58%), followed by thoracic (32%) and lumbar (10%) regions. Very few are reported at the level of conus medullaris. The important radiologic features of intramedullary schwannoma are predominant extramedullary component, intramedullary spinal tumor with a thickened and enhancing spinal nerve root, absent syrinx, enhancing well with contrast, and sharp margins. The aim of surgery in intramedullary spinal schwannomas is total removal whenever possible. Diagnosing intramedullary schwannoma preoperatively needs high index of suspicion. We are reporting the 10th case of intramedullary schwannoma in the conus region.
神经鞘瘤是最常见的原发性脊柱肿瘤之一,占所有椎管内病变的30%。髓内神经鞘瘤占所有椎管内肿瘤的0.3%,约占脊髓神经鞘瘤的1%。大多数肿瘤发生在颈椎(58%),其次是胸椎(32%)和腰椎(10%)。在髓圆锥水平很少有报道。髓内神经鞘瘤的重要影像学特征是主要的髓外成分,髓内脊髓肿瘤伴脊髓神经根增厚和增强,无管状突起,造影剂增强良好,边缘清晰。髓内脊髓神经鞘瘤的手术目的是尽可能完全切除。术前诊断髓内神经鞘瘤需要高度的怀疑指数。我们报告第10例椎圆锥区的髓内神经鞘瘤。
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引用次数: 0
Brain Tumor Vascularity Estimation by Arterial Spin Label Perfusion MRI—A Preoperative Tool for Patient Prognostication 用动脉自旋标记灌注mri评估脑肿瘤血管性——一种预测患者预后的术前工具
IF 0.2 Pub Date : 2023-04-14 DOI: 10.1055/s-0043-1761604
Nidhi Rai, Rupi Jamwal, B. Singh, Jyoti Gupta, K. Shankar, Sufiyan Zaheer
Abstract Introduction  Brain tumors remain a significant cause of morbidity and mortality around the globe. Preoperative estimation of tumor vascularity is of great significance for a neurosurgeon. Aim of our study was to correlate tumor blood flow (TBF) using arterial spin labeling perfusion imaging (ASL-PI) with microvessel density (MVD), tumor grade, and preoperative prognostication of brain tumors. Materials and Methods  This was a prospective observational cross-sectional study conducted in 63 patients of primary brain tumors already referred for magnetic resonance imaging. Absolute and relative mean and maximum TBF were calculated using ASL-PI and correlated with tumor grade and MVD at 10x and 40x magnificantion; thereby stydying the role of ASL-PI in brain tumor prognostication. Results  The mean of maxTBF values (mL/min/100 g) in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 147.15, 251.55, 96.43, 43.3, and 578.3, respectively. The median of maxTBF value in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 131.5, 158.63, 94.5, 43.4, and 578.3, respectively. Discussion  Significant correlation between meanTBF and MVD at 10X magnification ( p -value < 0.001, rho =0.88) and a positive correlation between meanTBF and MVD at 40X magnification ( p -value < 0.001) were seen. Significant correlation was also seen between maxTBF and MVD at 10X magnification ( p -value < 0.001, rho = 0.91) and between maxTBF and MVD at 40X magnification. TBF in case of the hemangioblastoma was higher than other types of brain tumors (gliomas, meningiomas, and schwannomas). HighTBF value was seen in high-grade gliomas compared with low-grade gliomas with worse prognosis. TBF was high in typical meningiomas whereas low in atypical meningioma. Conclusion  TBF by ASL-PI can be considered a noninvasive in vivo marker in predicting the grade of brain tumors and further assist in envisaging prognosis of the patients with brain tumors.
脑肿瘤仍然是全球发病率和死亡率的重要原因。术前对肿瘤血管的评估对神经外科医生具有重要意义。我们的研究目的是通过动脉自旋标记灌注成像(ASL-PI)将肿瘤血流量(TBF)与微血管密度(MVD)、肿瘤分级和脑肿瘤术前预后联系起来。材料和方法本研究是一项前瞻性观察性横断面研究,研究对象为63例已接受磁共振成像的原发性脑肿瘤患者。用ASL-PI计算绝对、相对平均和最大TBF,并与肿瘤分级和MVD在10倍和40倍倍率下相关;从而研究ASL-PI在脑肿瘤预后中的作用。结果脑胶质瘤组、脑膜瘤组、神经鞘瘤组、颅咽管瘤组和血管母细胞瘤组的maxTBF平均值(mL/min/100 g)分别为147.15、251.55、96.43、43.3和578.3。神经胶质瘤组、脑膜瘤组、神经鞘瘤组、颅咽管瘤组和血管母细胞瘤组的maxTBF值中位数分别为131.5、158.63、94.5、43.4和578.3。10倍放大时,meanTBF与MVD显著相关(p值< 0.001,rho =0.88), 40倍放大时,meanTBF与MVD呈正相关(p值< 0.001)。放大10倍时maxTBF和MVD之间也存在显著相关性(p值< 0.001,rho = 0.91),放大40倍时maxTBF和MVD之间也存在显著相关性。血管母细胞瘤的TBF高于其他类型的脑肿瘤(胶质瘤、脑膜瘤和神经鞘瘤)。与预后较差的低级别胶质瘤相比,高级别胶质瘤的tbf值较高。典型脑膜瘤的TBF高,而非典型脑膜瘤的TBF低。结论ASL-PI法测定TBF可作为一种无创的体内指标预测脑肿瘤的分级,进一步帮助预测脑肿瘤患者的预后。
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引用次数: 0
Imaging Features of COVID-19-Associated Acute Invasive Fungal Rhinosinusitis 新型冠状病毒相关急性侵袭性真菌性鼻窦炎的影像学特征
IF 0.2 Pub Date : 2023-04-14 DOI: 10.1055/s-0043-1764351
Nishtha Yadav, Ambuj Kumar, Kavita Sachdeva, S. Asati
Abstract Background  Acute invasive fungal rhinosinusitis (AIFR) is a rare, rapidly progressive, and life-threatening infection involving the nasal cavity and paranasal sinuses. Purpose of this study is to describe imaging features of coronavirus disease-2019 (COVID-19)-associated AIFR. Methods  This was a retrospective observational study. Inclusion criteria: (1) post-COVID-19 patients with fungal rhinosinusitis detected on potassium hydroxide smear or histopathology; (2) onset of symptoms (facial pain, dental pain, facial swelling or discoloration, nasal bleed, periorbital swelling, ptosis, redness of eyes, vision loss) less than 4 weeks; and (3) magnetic resonance imaging/computed tomography (MRI/CT) done within 5 days before surgery. Exclusion criteria: (1) cases of sinusitis without a history of previous COVID-19 infection; and (2) cases in whom fungal hyphae were not demonstrated on pathological examination. Noncontrast CT and dedicated MRI sequences were done initially. Site of involvement, unilateral/bilateral involvement, pattern of mucosal thickening, enhancement pattern, periantral invasion, orbital invasion, intracranial involvement, perineural spread, vascular involvement, and bony involvement were recorded. CT and MRI imaging features were compared. Results  Analysis of 90 studies (CT and MRI) in 60 patients was done. Most common site of involvement was ethmoid followed by maxillary sinus. Bilateral disease was more common. Mucosal thickening with T2 hypointense septations was seen in 88.4% MRI studies. Periantral and orbital involvement was seen, respectively, in 84.6% and 55.7% cases of MRI. Intracranial involvement was noted in form of meningitis, cerebritis, abscess, infarct, hemorrhage, cavernous sinus, or perineural invasion. Vascular involvement was noted in form of vascular occlusion ( n  = 3), vascular narrowing ( n  = 3), and pseudoaneurysm ( n  = 2). MRI was more sensitive in detecting periantral invasion, deep infratemporal fossa, cavernous sinus involvement, perineural invasion, optic nerve involvement, and vascular occlusion and narrowing, while CT was superior in identification of bony erosions. Conclusion  Early recognition of AIFR in post-COVID-19 patients is important to prevent disease-related morbidity/mortality. Several rarely described findings are noted in our series of AIFR, like optic nerve involvement, pituitary fungal abscess, perineural spread, fungal aneurysms, and arteritis-related posterior circulation infarcts. MRI is superior for early detection of disease and in estimation of extent of disease, compared with CT. Imaging can help in early detection of AIFR, which has a significant impact on patient outcome.
背景:急性侵袭性真菌性鼻窦炎(AIFR)是一种罕见的、进展迅速的、危及生命的感染,累及鼻腔和鼻窦。本研究的目的是描述冠状病毒病-2019 (COVID-19)相关AIFR的影像学特征。方法回顾性观察性研究。纳入标准:(1)经氢氧化钾涂片或组织病理学检查为真菌性鼻窦炎的covid -19后患者;(2)出现症状(面部疼痛、牙痛、面部肿胀或变色、鼻出血、眶周肿胀、上睑下垂、眼睛发红、视力丧失)少于4周;(3)术前5天内进行磁共振成像/计算机断层扫描(MRI/CT)。排除标准:(1)无COVID-19感染史的鼻窦炎患者;(2)病理检查未见真菌菌丝的病例。最初进行非对比CT和专用MRI序列检查。记录受累部位、单侧/双侧受累、粘膜增厚模式、增强模式、腹膜周围侵犯、眶内侵犯、颅内侵犯、神经周围扩散、血管受累和骨受累。比较CT与MRI影像学特征。结果对60例患者的90项影像学检查(CT和MRI)进行分析。最常见的受累部位为筛窦,其次为上颌窦。双侧病变更为常见。88.4%的MRI检查显示粘膜增厚伴T2低信号分隔。MRI累及眶周分别占84.6%和55.7%。颅内受累表现为脑膜炎、脑炎、脓肿、梗死、出血、海绵窦或神经周围浸润。血管受累表现为血管闭塞(n = 3)、血管狭窄(n = 3)和假性动脉瘤(n = 2)。MRI对腹壁周围侵犯、颞下深窝、海绵窦受累、神经周围侵犯、视神经受累、血管闭塞和狭窄等敏感,而CT对骨侵蚀的识别较好。结论早期识别covid -19后患者的AIFR对预防疾病相关发病率/死亡率具有重要意义。在我们的一系列AIFR中,我们注意到一些很少被描述的发现,如视神经受累、垂体真菌脓肿、神经周围扩散、真菌动脉瘤和动脉炎相关的后循环梗塞。与CT相比,MRI在早期发现疾病和估计疾病程度方面具有优势。影像可以帮助早期发现AIFR,这对患者的预后有重大影响。
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Indian Journal of Neurosurgery
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