Brain & spine最新文献

Introduction: Ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) is recognized as a diagnostic and prognostic blood biomarker for traumatic brain injury (TBI). This study aimed to evaluate whether UCH-L1 concentrations measured in patients' urine post-injury could serve as a diagnostic or prognostic biomarker for outcomes in various types of acute brain injuries (ABI).

Material and methods: This pilot study included 46 ABI patients: aneurysmal subarachnoid hemorrhage (n = 22), ischemic stroke (n = 16), and traumatic brain injury (n = 8), along with three healthy controls. Urine samples were collected at early (1.50 ± 0.70 days) and late (9.17 ± 3.40 days) periods post-admission. UCH-L1 and creatinine levels were quantified using ELISA. UCH-L1 concentrations were compared to functional outcomes (modified Rankin Scale, mRS) and dichotomized into favorable (mRS 0-3) and unfavorable (mRS 4-6) groups. Non-parametric statistical tests and ROC analysis was performed.

Results: UCH-L1 concentrations in healthy controls were significantly lower compared to both early and late samples after ABI (p ≤ 0.001). The diagnostic performance of urine UCH-L1 at early timepoint showed excellent discriminatory ability, with AUC of 97.6% (95% CI: 93.0-100, p = 0.006 (sensitivity 98%, specificity 100%). Urine UCH-L1 concentrations, both with and without creatinine normalization, did not distinguish between favorable and unfavorable outcomes in either early (p = 0.88 and p = 0.36) or late samples (p = 0.98 and p = 0.30) in any types of ABI.

Discussion and conclusions: Although UCH-L1 concentrations in urine did not differentiate between favorable and unfavorable outcomes, a significant difference was observed between healthy subjects and ABI patients. This finding underscores the significant diagnostic utility of urine UCH-L1 concentrations, regardless of the type of acute brain injury.

Introduction: Sex-related differences in the epidemiology of malignant gliomas are acknowledged; however, information regarding their clinical characteristics and outcomes after surgery is limited.

Research question: To identify sex-specific differences of all patients with high-grade glioma at our institution and assessed clinical outcomes and prognostic factors.

Material and methods: This single-center study included those who underwent surgery for malignant gliomas between 2010 and 2020. Categorical, normally distributed, and skewed continuous variables were compared between men and women using the chi-square test, independent samples t-test, and Mann-Whitney U test, respectively. Survival was calculated using the log-rank and Kaplan-Meier methods.

Results: In total, 621 patients with WHO grade IV gliomas were identified (370 (59.58%) male). Men were significantly younger, underwent surgery faster after imaging diagnosis, and had a slightly higher surgical complications incidence than women. Women reported a worse preoperative performance status. Multivariate analysis showed that sex did not affect survival, surgical complications, nicotine or alcohol abuse, or preoperative tumor volume. Age, Karnofsky performance status, neurosurgical resection, and adjuvant radiotherapy with temozolomide showed a survival advantage.

Discussion and conclusions: Men are diagnosed with malignant glioma at a younger age than women; however, no advantage in clinical outcomes was observed. No sex-related differences were observed.

Introduction: Posterior reversible encephalopathy syndrome (PRES) is an acute form of encephalopathy. Main characteristic of this syndrome is the development of subcortical/cortical edema in the occipital lobes. The most common causes are diseases such as pre-eclampsia, autoimmune diseases, allogeneic stem cell transplantation and after treatment with immunosuppressants or cytostatics. However, PRES is also occasionally observed in connection with neurosurgical procedures, particularly in the posterior fossa in pediatric patients.

Research question: PRES in adults is extremely rare. After cranial surgery, the impaired consciousness caused by this syndrome may be misdiagnosed.

Material and methods: We present a rare case of PRES associated with vestibular schwannoma (VS) surgery and metronidazole use and have conducted a literature review.

Results: We found only two cases of PRES after surgery of a VS in the literature and three cases in connection with the administration of metronidazole. All cases involved women but the onset of symptoms was highly variable. The constellation of surgery and administration of metronidazole has not yet been described.

Discussion and conclusion: The purpose of this review is to raise awareness of a very rare complication such as PRES in this setting. Antibiotics should be chosen carefully after such an operation, as this syndrome can be triggered by certain substances.

Introduction: The use of robotics in spine surgery has gained popularity. This study aims to assess the current state of robotics and raise awareness of its educational implications.

Research question: What are the current adoption trends and barriers to the implementation of robotic assistance in spine surgery?

Material and methods: An online questionnaire comprising 27 questions was distributed to AO spine members between October 25th and November 13th, 2023, using the SurveyMonkey platform (https://www.surveymonkey.com; SurveyMonkey Inc., San Mateo, CA, USA). Statistical analyses (descriptive statistics, Pearson Chi-Square tests) and generation of all graphs were performed using SPSS Version 29.0.1.0 (IBM SPSS Statistic).

Results: We received 424 responses from AO Spine members (response rate = 9.9 %). The participants were mostly board-certified orthopedic surgeons (46 %, n = 195) and neurosurgeons (32%, n = 136). While 49% (n = 208) of the participants reported occasional or frequent use of navigation assistance, only 18 % (n = 70) indicated the use of robotic assistance for spinal instrumentation. A significant difference based on the country's median income status (p < 0.001) and the respondent's number of annual instrumentation procedures (p < 0.001) has been observed. While 11 % (n = 47) of all surgeons use a spinal robot frequently, 36 % (n = 153) of the participants stated they don't need a robot from a current perspective. Most participants (77%, n = 301) concluded that high acquisition costs are the primary barrier for the implementation of robotics.

Discussion and conclusion: Although the hype for robotics in spine surgery increased recently, robotic systems remain non-standard equipment due to cost constraints and limited usability.

Introduction: Interspinous devices are an alternative to instrumented fusion for the treatment of lumbar spinal stenosis (LSS) with radiological instability or deformity. The devices claim to improve clinical symptoms by indirect foraminal decompression with fewer complications and similar functional outcomes compared to conventional fusion techniques, and by avoiding a (further) deterioration of the anatomy of the spine while being less invasive than instrumented fusion.

Research question: Do interspinous devices provide a benefit in combination with a decompression of degenerative LSS?

Material and methods: In this observational study, 117 patients were treated by decompression surgery alone (n = 37), decompression plus instrumented spinal screw fixation and anterior cage support (n = 41) or decompression plus stabilisation with interspinous devices (n = 39). Pelvic tilt, pelvic incidence, lumbar lordosis, and spondylolisthesis were measured on X-ray scans before surgery, 3 and 12 months postoperative. The Oswestry Disability Index, back and leg pain were also assessed. Generalized Estimating Equation regression models were used to determine the relationship between the outcomes and treatment group over time.

Results: After interspinous stabilisation surgery the mean pelvic tilt remained at 22.7°, and the difference between the pelvic incidence and lumbar lordosis (PI-LL) remained at 10.5°. In all three groups, the ODI decreased by 14-18 points (p<0.01), and the pain levels decreased by 2.6-3.2 points (p<0.01).

Conclusion: We found no scientific evidence to support the use of interspinous devices. The sagittal profile could not be stabilised by this intervention, and no clinical advantage over decompression surgery alone was evident.

Introduction: While cadaveric dissections remain the cornerstone of education in skull base surgery, they are associated with high costs, difficulty acquiring specimens, and a lack of pathology in anatomical samples. This study evaluated the impact of a hand-crafted three-dimensional (3D)-printed head model and virtual reality (VR) in enhancing skull base surgery training.

Research question: How effective are 3D-printed models and VR in enhancing training in skull base surgery?

Materials and methods: A two-day skull base training course was conducted with 12 neurosurgical trainees and 11 faculty members. The course used a 3D-printed head model, VR simulations, and cadaveric dissections. The 3D model included four tumors and was manually assembled to replicate tumor-modified neuroanatomy. Trainees performed surgical approaches, with pre- and post-course self-assessments to evaluate their knowledge and skills. Faculty provided feedback on the model's educational value and accuracy. All items were rated on a 5-point scale.

Results: Trainees showed significant improvement in understanding spatial relationships and surgical steps, with scores increasing from 3.40 ± 0.70 to 4.50 ± 0.53 for both items. Faculty rated the educational value of the model with a score of 4.33 ± 0.82, and a score of 5.00 ± 0.00 for recommending the 3D-printed model to other residents. However, realism in soft tissue simulations received lower ratings.

Discussion and conclusion: Virtual reality and 3D-printed models enhance anatomical understanding and surgical training in skull base surgery. These tools offer a cost-effective, realistic, and accessible alternative to cadaveric training, though further refinement in soft tissue realism is needed.

Introduction: Breathing-synchronized hypoglossal-nerve stimulation is a treatment option for suitable patients with severe obstructive-sleep-apnoea. The classical implantation technique requires three incisions: submental to place the stimulating-electrode on terminal branches of the hypoglossal-nerve, sub-clavicular to place the impulse generator, and on the lateral chest-wall to place a breathing-sensor lead. A two-incision-technique has been propagated and widely adopted whereby the respiratory-sensing-lead is placed deeper to the IPG-pocket.

Research question: Our department switched to the 2-incision-technique in May 2021 and we set out to compare the two methods concerning the generated respiratory-sensing-curves.

Material and method: Cases operated between October 2020 and September 2022 were included. Parameters included age, gender, BMI, OR time, positioning of the detection-lead, and preoperative Apnoea-Hypopnoea Index (AHI). The generated respiratory-sensing curves were categorized by an independent expert blinded to the surgical-technique regarding conduciveness to optimal stimulation.

Result: 21 patients were included. 5 were operated with the 3-incision-technique. Women were underrepresented. There were no further significant differences in patient characteristics. The expert-opinion on the respiratory-sensing-curves did not vary between groups. Mean OR-time was marginally less in the 2-incision group without being statistically significant.

Conclusion: The 2-incision-technique generates respiratory-sensing curves at par with those generated with 3-incision-implants. The limited patient data collected in this analysis suggests that OR-time can be reduced using the 2-incision-technique. There were no cases of postoperative complications in our cohort. It can be postulated that a 2-incision-implant has a lower risk of infection due to the reduced wound-surface.

Introduction: Aneurysmatic subarachnoid hemorrhages (aSAH) are life-threatening events with high mortality and morbidity. Hydrocephalus is a common complication, initially managed with an external ventricular drain (EVD). Persistent hydrocephalus often requires ventriculoperitoneal shunt (VPS) placement to relieve intracranial pressure and prevent further neurological damage.

Research question: What factors predict the need for VPS placement in patients with aSAH, and how does a new predictive model compare to the Mayo Age, Grades, EVD score (MAGE score)?

Materials and methods: A retrospective study of 105 patients with aSAH treated with EVD between 2014 and 2023 was conducted. Patients were divided into two groups: those requiring VPS (n= 45) and those not requiring VPS (n= 60). Sociodemographic, clinical, and treatment variables were analysed, and a new predictive model (SAH-VP) was developed and compared to the MAGE score.

Results: Patients who required VPS had higher WFNS scores on admission (p= 0.045), more infections requiring antibiotics (p= 0.002), more failed weaning attempts (p= 0.004), more failed closure attempts (p= 0.002), and longer EVD use (p< 0.01). The new SAH-VP model demonstrated an area under the curve (AUC) of 0.800.

Discussion and conclusion: There is no consensus on the factors predicting VPS need in SAH patients. This study identified key predictors and developed a new predictive model, SAH-VP, which could improve patient management by identifying those at higher risk of requiring VPS, offering an alternative to the existing MAGE score.