Brain & spine最新文献_第3页

Prognostication or predestination? 预言还是宿命？

Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102793

José Pedro Lavrador, Savvas Vlachos

引用次数: 0

Ethical tightrope: Navigating neuro-ethics in brain computer interface (BCI) technology 伦理钢丝绳：脑计算机接口（BCI）技术中的神经伦理导航

Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102800

Allah Yar Yahya Khan, Ammar Anjum, Haseeb Mehmood Qadri (Dr)

引用次数: 0

Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework 振兴神经外科前沿：EANS 神经外科前沿委员会的战略框架

Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102794

Aaron Lawson McLean , Ignazio G. Vetrano , Anna C. Lawson McLean , Alfredo Conti , Patrick Mertens , Michael Müther , Jakob Nemir , Simone Peschillo , Antonio Santacroce , Can Sarica , Constantin Tuleasca , Cesare Zoia , Jean Régis , EANS Frontiers in Neurosurgery Committee

Introduction

The field of neurosurgery faces challenges with the increasing involvement of other medical specialties in areas traditionally led by neurosurgeons. This paper examines the implications of this development for neurosurgical practice and patient care, with a focus on specialized areas like pain management, peripheral nerve surgery, and stereotactic radiosurgery.

Research question

To assess the implications of the expanded scope of other specialties for neurosurgical practice and to consider the response of the EANS Frontiers in Neurosurgery Committee to these challenges.

Materials and methods

Analysis of recent trends in neurosurgery, including the shift in various procedures to other specialties, demographic challenges, and the emergence of minimally invasive techniques. This analysis draws on relevant literature and the initiatives of the Frontiers in Neurosurgery Committee.

Results

We explore a possible decrease in neurosurgical involvement in certain areas, which may have implications for patient care and access to specialized neurosurgical interventions. The Frontiers in Neurosurgery Committee's role in addressing these concerns is highlighted, particularly in terms of training, education, research, and networking for neurosurgeons, especially those early in their careers.

Discussion and conclusion

The potential decrease in neurosurgical involvement in certain specialties warrants attention. This paper emphasizes the importance of carefully considered responses by neurosurgical societies, such as the EANS, to ensure neurosurgeons continue to play a vital role in managing neurological diseases. Emphasis on ongoing education, integration of minimally invasive techniques, and multidisciplinary collaboration is essential for maintaining the field's competence and quality in patient care.

引言随着其他医学专科越来越多地涉足传统上由神经外科医生主导的领域，神经外科领域面临着挑战。本文探讨了这一发展对神经外科实践和患者护理的影响，重点关注疼痛管理、周围神经手术和立体定向放射手术等专业领域。材料和方法分析神经外科的最新趋势，包括各种手术向其他专业的转移、人口统计学挑战和微创技术的出现。结果我们探讨了神经外科在某些领域的参与可能减少的情况，这可能会对患者护理和获得专业神经外科干预产生影响。本文强调了神经外科前沿委员会在解决这些问题方面的作用，特别是在神经外科医生，尤其是处于职业生涯初期的神经外科医生的培训、教育、研究和网络方面。本文强调了神经外科学会（如 EANS）审慎考虑对策的重要性，以确保神经外科医生继续在管理神经系统疾病方面发挥重要作用。强调持续教育、整合微创技术和多学科合作对于保持该领域的能力和患者护理质量至关重要。

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引用次数: 0

Exploration of uncertainty of PRx time trends 探索 PRx 时间趋势的不确定性

Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102795

Erta Beqiri , Michal M. Placek , Ka Hing Chu , Joseph Donnelly , Giada Cucciolini , Virginia Motroni , Claudia A. Smith , Marek Czosnyka , Peter Hutchinson , Peter Smielewski

Introduction

PRx can be used as surrogate measure of Cerebral Autoregulation (CA) in traumatic brain injury (TBI) patients. PRx can provide means for individualising cerebral perfusion pressure (CPP) targets, such as CPPopt. However, a recent Delphi consensus of clinicians concluded that consensus could not be reached on the accuracy, reliability, and validation of any current CA assessment method.

Research question

We aimed to quantify the short-term uncertainty of PRx time-trends and to relate this to other physiological measurements.

Material and methods

Intracranial pressure (ICP), arterial blood pressure (ABP), end-tidal CO₂ (EtCO₂) high-resolution recordings of 911 TBI patients were processed with ICM + software. Hourly values of metrics that describe the variability within modalities derived from ABP, ICP and EtCO₂, were calculated for the first 24h of neuromonitoring. Generalized additive models were used to describe the time trend of the variability in PRx. Linear correlations were studied for describing the relationship between PRx variability and the other physiological modalities.

Results

The time profile of variability of PRx decreases over the first 12h and was higher for average PRx ∼0. Increased variability of PRx was not linearly linked with average ABP, ICP, or CPP. For coherence between slow waves of ABP and ICP >0.7, the variability in PRx decreased (R = −0.47, p < 0.001).

Discussion and conclusion

PRx is a highly variable parameter. PRx short-term dispersion was not related to average ICP, ABP or CPP. The determinants of uncertainty of PRx should be investigated to improve reliability of individualised CA assessment in TBI patients.

导言 PRx 可用作创伤性脑损伤（TBI）患者脑自主调节（CA）的替代测量指标。PRx 可为个体化脑灌注压 (CPP) 目标（如 CPPopt）提供方法。研究问题我们旨在量化 PRx 时间趋势的短期不确定性，并将其与其他生理测量结果联系起来。材料和方法使用 ICM + 软件处理了 911 名 TBI 患者的颅压 (ICP)、动脉血压 (ABP)、潮气末二氧化碳 (EtCO2) 高分辨率记录。根据 ABP、ICP 和 EtCO2 计算了神经监测头 24 小时的每小时度量值，这些值描述了各种模式内的变异性。使用广义加性模型来描述 PRx 变异的时间趋势。研究了线性相关关系，以描述 PRx 变异性与其他生理模式之间的关系。结果 PRx 变异性的时间曲线在前 12 小时内下降，平均 PRx ∼ 0 时变异性较高。当 ABP 和 ICP 的慢波之间的一致性为 0.7 时，PRx 的变异性降低（R = -0.47，p <0.001）。PRx 短期离散度与平均 ICP、ABP 或 CPP 无关。应研究 PRx 不确定性的决定因素，以提高对创伤性脑损伤患者进行个体化 CA 评估的可靠性。

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引用次数: 0

Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102763

Andreas K. Demetriades , Imran Shah , Niklas Marklund , Hans Clusmann , Wilco Peul

Introduction

Sport-related concussions (SRC) have been a concern in all sports, including soccer. The long-term effects of soccer-related head injuries are a public health concern. The Concussion in Sport Group (CISG) released a consensus statement in 2017 and several soccer governing associations have published their own SRC guidelines while referring to it but it is unclear whether this has been universally adopted.

Research question

We aimed to investigate whether guidelines published by soccer associations have any discrepancies; and the extent to which they follow the CISG recommendations.

Materials and methods

A scoping review of available soccer-specific SRC guidelines was performed via databases PubMed, Google Scholar, and official soccer association websites via web browser Google. The inclusion criteria were soccer-specific SRC guidelines. Comparisons between guidelines were made concerning the following index items: initial (on-site) assessment, removal from play, re-evaluation with neuroimaging, return-to-sport protocol, special populations, and education.

Results

Nine soccer associations with available guidelines were included in this review. Guidelines obtained were from official associations in the United Kingdom, United States of America, Canada, Australia, and New Zealand. When compared to each other and the CISG recommendations, discrepancies were found within guidelines regarding the index items. Additionally, major soccer associations in some countries famous for soccer were found to have not published any publicly available guidelines.

Discussion and conclusion

SRC guidelines from different soccer associations contain discrepancies which may be detrimental to athletes, both short and long-term. We recommend that all major soccer governing associations publish guidelines that are standardised and accessible to all athletes.

导言与运动相关的脑震荡（SRC）一直是包括足球在内的所有体育运动中的一个令人担忧的问题。与足球相关的头部损伤的长期影响是一个公共健康问题。体育运动脑震荡小组（CISG）于 2017 年发布了一份共识声明，一些足球管理协会在参考该声明的同时也发布了自己的 SRC 指南，但目前尚不清楚该指南是否已被普遍采纳。研究问题我们旨在调查足球协会发布的指南是否存在差异；以及它们在多大程度上遵循了 CISG 的建议。材料和方法通过 PubMed、Google Scholar 等数据库以及 Google 浏览器的足球协会官方网站，对现有的足球特定 SRC 指南进行了范围审查。纳入标准为足球专用 SRC 指南。对指南中的以下指标项目进行了比较：初始（现场）评估、停赛、神经影像学再评估、恢复运动协议、特殊人群和教育。所获得的指南分别来自英国、美国、加拿大、澳大利亚和新西兰的官方协会。通过相互比较和 CISG 建议，发现指南中的指标项目存在差异。此外，我们还发现一些著名足球国家的主要足球协会并没有发布任何公开的指导原则。我们建议所有主要的足球管理协会发布标准化的指导原则，供所有运动员使用。

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引用次数: 0

Current state of the art of traditional and minimal invasive epilepsy surgery approaches 传统和微创癫痫手术方法的技术现状

Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102755

Fabian Winter , Marie T. Krueger , Daniel Delev , Tom Theys , Dirk MP Van Roost , Kostas Fountas , Olaf E.M.G. Schijns , Karl Roessler

Introduction

Open resective surgery remains the main treatment modality for refractory epilepsy, but is often considered a last resort option due to its invasiveness.

Research question

This manuscript aims to provide an overview on traditional as well as minimally invasive surgical approaches in modern state of the art epilepsy surgery.

Materials and methods

This narrative review addresses both historical and contemporary as well as minimal invasive surgical approaches in epilepsy surgery. Peer-reviewed published articles were retrieved from PubMed and Scopus. Only articles written in English were considered for this work. A range of traditional and minimally invasive surgical approaches in epilepsy surgery were examined, and their respective advantages and disadvantages have been summarized.

Results

The following approaches and techniques are discussed: minimally invasive diagnostics in epilepsy surgery, anterior temporal lobectomy, functional temporal lobectomy, selective amygdalohippocampectomy through a transsylvian, transcortical, or subtemporal approach, insulo-opercular corticectomies compared to laser interstitial thermal therapy, radiofrequency thermocoagulation, stereotactic radiosurgery, neuromodulation, high intensity focused ultrasound, and disconnection surgery including callosotomy, hemispherotomy, and subpial transections.

Discussion and conclusion

Understanding the benefits and disadvantages of different surgical approaches and strategies in traditional and minimal invasive epilepsy surgery might improve the surgical decision tree, as not all procedures are appropriate for all patients.

引言开放性切除手术仍是难治性癫痫的主要治疗方式，但由于其创伤性，通常被认为是最后的选择。研究问题本手稿旨在概述现代癫痫外科手术中的传统和微创手术方法。材料和方法本叙述性综述探讨了癫痫外科手术中的历史、现代和微创手术方法。从 PubMed 和 Scopus 上检索了同行评审发表的文章。本研究只考虑用英语撰写的文章。对癫痫手术中的一系列传统和微创手术方法进行了研究，并总结了它们各自的优缺点。结果讨论了以下方法和技术：癫痫手术中的微创诊断、前颞叶切除术、功能性颞叶切除术、经颞叶、经皮质或颞下途径的选择性杏仁核切除术、与激光间质热疗、射频热凝、立体定向放射外科手术、神经调控、高强度聚焦超声以及包括胼胝体切开术、半球切开术和颞下横断术在内的断裂手术相比，胰岛-小脑皮质切除术的效果更好。讨论和结论了解传统和微创癫痫手术中不同手术方法和策略的利弊可能会改善手术决策树，因为并非所有手术都适合所有患者。

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引用次数: 0

Amantadine for functional improvement in patients with traumatic brain injury: A systematic review with meta-analysis and trial sequential analysis 改善脑外伤患者功能的金刚烷胺：系统综述、荟萃分析和试验序列分析

Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102773

Hantz Filbert C. Siy, Michael Louis A. Gimenez

Introduction

TBIs contribute in over one-third of injury-related deaths with mortality rates as high as 50% in trauma centers serving the most severe TBI. The effect of TBI on mortality is about 10% across all ages. Amantadine hydrochloride is one of the most commonly prescribed medications for patients undergoing inpatient neurorehabilitation who have disorders of consciousness.⁶ It is a dopamine (DA) receptor agonist and a N-Methyl-D-aspartate (NMDA) receptor antagonist via dopamine release and dopamine reuptake inhibition. The current study will synthesize the current available evidence and show the effect of Amantadine in functional improvement after TBI.

Research question

Does Amantadine have an effect on functional improvement of TBI patients?

Material and methods

This systematic review included all randomized placebo-controlled trials that compare the use of Amantadine versus placebo for functional improvement of patients after TBI. Outcome measures included DRS, GCS and/or GOS scores.

Results

Three studies with a total of 281 patients were included in the quantitative analyses. GRADE assessments show that there was a high certainty of evidence for functional improvement in terms of DRS scores.

Discussion and conclusion

Evidence of this review show that the use of Amantadine may have a beneficial effect on functional outcome in moderate to severe traumatic brain injuries among adult patients. Given the still-limited body of knowledge, more relevant studies must be made exploring the impact of Amantadine therapies on promoting functional recovery within the brain injury rehabilitation care continuum, with the goals of achieving larger sample sizes and establishing the early- or later-treatment beneficial effects.

导言：创伤性脑损伤导致的死亡占受伤相关死亡人数的三分之一以上，在为最严重创伤性脑损伤患者提供服务的创伤中心，死亡率高达 50%。在所有年龄段中，创伤性脑损伤对死亡率的影响约为 10%。盐酸金刚烷胺是接受住院神经康复治疗的意识障碍患者最常用的处方药之一。6 它是一种多巴胺（DA）受体激动剂，也是一种 N-甲基-D-天冬氨酸（NMDA）受体拮抗剂，可通过多巴胺释放和多巴胺再摄取抑制作用发挥作用。研究问题金刚烷胺对改善创伤性脑损伤患者的功能有影响吗？材料与方法本系统综述纳入了所有随机安慰剂对照试验，这些试验比较了金刚烷胺与安慰剂对改善创伤性脑损伤患者功能的作用。结果定量分析纳入了三项研究，共计 281 名患者。GRADE评估显示，从DRS评分来看，功能改善的证据确定性较高。讨论与结论本综述的证据显示，使用金刚烷胺可能对中度至重度脑外伤成年患者的功能结果产生有益影响。鉴于目前掌握的知识仍然有限，必须开展更多相关研究，探索金刚烷胺疗法对促进脑损伤康复护理连续性中功能恢复的影响，目标是获得更大的样本量，并确定早期或后期治疗的有益效果。

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引用次数: 0

Fluorescence guidance in skull base surgery: Applications and limitations – A systematic review 颅底手术中的荧光引导：应用和局限性 - 系统综述

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.103328

Eric Suero Molina , Michael Bruneau , Gilles Reuter , Mostafa Shahein , Luigi M. Cavallo , Roy T. Daniel , Ekkehard M. Kasper , Sebastien Froelich , Emanuel Jouanneau , Romain Manet , Mahmoud Messerer , Diego Mazzatenta , Torstein R. Meling , Pierre-Hugues Roche , Henry WS. Schroeder , Marcos Tatagiba , Massimiliano Visocchi , Daniel M. Prevedello , Walter Stummer , Jan F. Cornelius

Introduction

Intraoperative fluorescence guidance is a well-established surgical adjunct in high-grade glioma surgery. In contrast, the clinical use of such dyes and technology has been scarcely reported in skull base surgery.

Research question

We aimed to systematically review the clinical applications of different fluorophores in both open and endonasal skull base surgery.

Material and methods

We performed a systematic review and discussed the current literature on fluorescence guidance in skull base surgery.

Results

After a comprehensive literature search, 77 articles on skull base fluorescence guidance were evaluated. A qualitative analysis of the articles is presented, discussing clinical indications and current controversies. The use of intrathecal fluorescein was the most frequently reported in the literature. Beyond that, 5-ALA and ICG were two other fluorescent dyes most extensively discussed, with some experimental fluorophore applications in skull base surgery.

Discussion and conclusion

Intraoperative fluorescence imaging can serve as an adjunct technology in skull base surgery. The scope of initial indications of these fluorophores has expanded beyond malignant glioma resection alone. We discuss current use and controversies and present an extensive overview of additional indications for fluorescence imaging in skull base pathologies. Further quantitative studies will be needed in the future, focusing on tissue selectivity and time-dependency of the different fluorophores currently commercially available, as well as the development of new compounds to expand applications and facilitate skull base surgeries.

导言术中荧光引导是高级别胶质瘤手术中一种行之有效的手术辅助手段。研究问题我们旨在系统回顾不同荧光剂在开放性和腔内颅底手术中的临床应用。材料和方法我们对颅底手术中荧光引导的现有文献进行了系统回顾和讨论。本文对这些文章进行了定性分析，讨论了临床适应症和目前存在的争议。文献中最常报道的是鞘内荧光素的使用。讨论与结论术中荧光成像可作为颅底手术的辅助技术。这些荧光染料的最初适应症范围已经超出了单纯的恶性胶质瘤切除术。我们讨论了当前的使用情况和争议，并对荧光成像在颅底病变中的其他适应症进行了广泛概述。未来还需要进一步的定量研究，重点关注目前市面上不同荧光团的组织选择性和时间依赖性，以及新化合物的开发，以扩大应用范围并促进颅底手术。

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引用次数: 0

Review of current treatment modalities and clinical outcome of giant saccular aneurysms of the basilar apex 基底动脉尖巨大囊状动脉瘤的现有治疗方法和临床疗效综述

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.103333

Andreas Theofanopoulos , Lucas Troude , Milad Neyazi , Sajjad Muhammad

Introduction

Giant aneurysms of the basilar apex represent formidable challenges as the high rupture rate of untreated lesions must be balanced against the technical complexity and potential morbidity of intervention.

Research question

Review of treatment modalities and outcomes of patients harboring giant (>2.5 cm) basilar apex saccular aneurysms, in an effort to refine treatment decision-making.

Material and methods

A systematic literature review through the PubMed and Scopus databases was performed according to the PRISMA guidelines to identify cases of giant basilar apex saccular aneurysms treated either microsurgically or endovascularly. Patients’ demographics, aneurysm size, preoperative and postoperative neurologic status, angiographic and clinical outcomes as well as follow-up information were obtained.

Results

Data from 32 studies fulfilling the inclusion criteria, including 49 patients (32 treated surgically and 17 endovascularly) was obtained. Mean patient age at presentation was 51.69 years, with a male-to-female ratio of 1:2. Mean maximum aneurysm diameter was 30.57 mm. A favorable outcome (mRS 0–2) was reported on 70.6% of endovascular and 56.3% of open surgical cases. Complete aneurysm occlusion was achieved in 55.6% of the open and 23.5% of the endovascular cases. Death rate was 33% for endovascular and 15.6% for open cases; the higher mortality of endovascular treatment is mainly attributed to the mass effect from continued brainstem compression after treatment.

Discussion and conclusion

Higher rates of complete occlusion but higher morbidity are associated with microsurgery compared to endovascular modalities. Severe, clinically apparent brainstem mass effect may require decompression associated with microsurgery, when technically feasible.

导言基底动脉顶巨大动脉瘤是一项艰巨的挑战，因为未经治疗的病变破裂率很高，必须在介入治疗的技术复杂性和潜在发病率之间取得平衡。材料和方法根据PRISMA指南，通过PubMed和Scopus数据库进行了系统的文献综述，以确定以显微手术或血管内治疗的巨大基底动脉瘤病例。结果 32 项研究的数据符合纳入标准，包括 49 例患者（32 例手术治疗，17 例血管内治疗）。患者发病时的平均年龄为 51.69 岁，男女比例为 1:2。动脉瘤最大直径平均为 30.57 毫米。70.6%的血管内手术病例和56.3%的开放手术病例获得了良好的治疗效果（mRS 0-2）。55.6%的开放手术和23.5%的血管内手术病例实现了动脉瘤完全闭塞。血管内手术病例的死亡率为 33%，开放手术病例的死亡率为 15.6%；血管内治疗死亡率较高的主要原因是治疗后持续压迫脑干造成的肿块效应。在技术可行的情况下，严重的、临床上明显的脑干肿块效应可能需要结合显微手术进行减压。

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引用次数: 0

Lateral decubitus anterior exposure of the L4-5 disc maintains safety compared with supine positioning 与仰卧位相比，侧卧位前方暴露 L4-5 椎间盘更安全

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.103024

A. Buckland , N.V. Huynh , A.K. Calek , J.A. Thomas , D. Robinson , M. Medley , L. Eisen

引用次数: 0