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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
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
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
Prognostication or predestination? 预言还是宿命?
Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102793
José Pedro Lavrador, Savvas Vlachos
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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
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
Artificial food dyes are toxic: Neurobehavioral implications in children 人造食品染料有毒:对儿童神经行为的影响
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102869

Emerging research highlights the potential neurobehavioral impacts of synthetic food dyes on children, prompting a reevaluation of their safety and regulatory standards. This letter discusses recent findings that associate synthetic food dyes with adverse behavioral outcomes, such as hyperactivity, particularly in children with or without identified behavioral disorders. It calls for updated regulatory guidelines that reflect current research, advocating for protecting children's behavioral health.

新的研究突显了合成食品染料对儿童神经行为的潜在影响,促使人们重新评估其安全性和监管标准。这封信讨论了合成食品染料与不良行为结果(如多动)相关的最新研究结果,尤其是在有或没有发现行为障碍的儿童中。信中呼吁更新监管指南,以反映当前的研究结果,倡导保护儿童的行为健康。
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引用次数: 0
An evidence based conceptual framework for the multifactorial understanding of proximal junctional kyphosis 以证据为基础的概念框架:对近交界脊柱侧凸的多因素理解
Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102807
Pearce B. Haldeman , Samuel R. Ward , Joseph Osorio , Bahar Shahidi

Introduction

Adult spinal deformity (ASD) is a debilitating pathology that arises from a variety of etiologies. Spinal fusion surgery is the mainstay of treatment for those who do not achieve symptom relief with conservative interventions. Fusion surgery can be complicated by a secondary deformity termed proximal junctional kyphosis (PJK).

Research question

This scoping review evaluates the modern body of literature analyzing risk factors for PJK development and organizes these factors according to a multifactorial framework based on mechanical, tissue or demographic components.

Materials and methods

An extensive search of the literature was performed in PubMed and Embase back to the year 2010. Articles were assessed for quality. All risk factors that were evaluated and those that significantly predicted the development of PJK were compiled. The frequency that a risk factor was predictive compared to the number of times it was evaluated was calculated.

Results

150 articles were reviewed. 57.3% of papers were of low quality. 76% of risk factors analyzed were focusing on the mechanical contribution to development of PJK versus only 5% were focusing on the tissue-based contribution. Risk factors that were most frequently predictive compared to how often they were analyzed were Hounsfield Units of vertebrae, UIV disc degeneration, paraspinal muscle cross sectional area and fatty infiltration, ligament augmentation, instrument characteristics, postoperative hip and lower extremity radiographic metrics, and postoperative teriparatide supplementation.

Discussion and conclusion

This review finds a multifactorial framework accounting for mechanical, patient and tissue-based risk factors will improve the understanding of PJK development.

导言成人脊柱畸形(ASD)是一种使人衰弱的病理现象,由多种病因引起。对于保守治疗无法缓解症状的患者,脊柱融合手术是主要的治疗手段。融合手术可能会因继发性畸形而变得复杂,这种畸形被称为近端交界性脊柱后凸(PJK)。研究问题本范围综述评估了分析 PJK 发生风险因素的现代文献,并根据基于机械、组织或人口统计学成分的多因素框架对这些因素进行了整理。对文章的质量进行了评估。对所有经过评估的风险因素以及对 PJK 的发生有显著预测作用的因素进行了汇总。结果 150 篇文章接受了审查。57.3%的论文质量不高。所分析的风险因素中,76%侧重于PJK发生的机械因素,只有5%侧重于组织因素。与分析频率相比,最常预测的风险因素是椎体的 Hounsfield 单位、UIV 椎间盘变性、脊柱旁肌肉横截面积和脂肪浸润、韧带增强、器械特征、术后髋关节和下肢放射学指标以及术后补充特立帕肽。
{"title":"An evidence based conceptual framework for the multifactorial understanding of proximal junctional kyphosis","authors":"Pearce B. Haldeman ,&nbsp;Samuel R. Ward ,&nbsp;Joseph Osorio ,&nbsp;Bahar Shahidi","doi":"10.1016/j.bas.2024.102807","DOIUrl":"10.1016/j.bas.2024.102807","url":null,"abstract":"<div><h3>Introduction</h3><p>Adult spinal deformity (ASD) is a debilitating pathology that arises from a variety of etiologies. Spinal fusion surgery is the mainstay of treatment for those who do not achieve symptom relief with conservative interventions. Fusion surgery can be complicated by a secondary deformity termed proximal junctional kyphosis (PJK).</p></div><div><h3>Research question</h3><p>This scoping review evaluates the modern body of literature analyzing risk factors for PJK development and organizes these factors according to a multifactorial framework based on mechanical, tissue or demographic components.</p></div><div><h3>Materials and methods</h3><p>An extensive search of the literature was performed in PubMed and Embase back to the year 2010. Articles were assessed for quality. All risk factors that were evaluated and those that significantly predicted the development of PJK were compiled. The frequency that a risk factor was predictive compared to the number of times it was evaluated was calculated.</p></div><div><h3>Results</h3><p>150 articles were reviewed. 57.3% of papers were of low quality. 76% of risk factors analyzed were focusing on the mechanical contribution to development of PJK versus only 5% were focusing on the tissue-based contribution. Risk factors that were most frequently predictive compared to how often they were analyzed were Hounsfield Units of vertebrae, UIV disc degeneration, paraspinal muscle cross sectional area and fatty infiltration, ligament augmentation, instrument characteristics, postoperative hip and lower extremity radiographic metrics, and postoperative teriparatide supplementation.</p></div><div><h3>Discussion and conclusion</h3><p>This review finds a multifactorial framework accounting for mechanical, patient and tissue-based risk factors will improve the understanding of PJK development.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424000638/pdfft?md5=31ff91ebec3667a62a4758bd8a79fbb8&pid=1-s2.0-S2772529424000638-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140794293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparing image normalization techniques in an end-to-end model for automated modic changes classification from MRI images 比较端到端模型中的图像归一化技术,实现磁共振成像模态变化自动分类
Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2023.102738
Andrea Cina , Daniel Haschtmann , Dimitrios Damopoulos , Nicolas Gerber , Markus Loibl , Tamas Fekete , Frank Kleinstück , Fabio Galbusera

Introduction

Modic Changes (MCs) are MRI alterations in spine vertebrae's signal intensity. This study introduces an end-to-end model to automatically detect and classify MCs in lumbar MRIs. The model's two-step process involves locating intervertebral regions and then categorizing MC types (MC0, MC1, MC2) using paired T1-and T2-weighted images. This approach offers a promising solution for efficient and standardized MC assessment.

Research question

The aim is to investigate how different MRI normalization techniques affect MCs classification and how the model can be used in a clinical setting.

Material and methods

A combination of Faster R–CNN and a 3D Convolutional Neural Network (CNN) is employed. The model first identifies intervertebral regions and then classifies MC types (MC0, MC1, MC2) using paired T1-and T2-weighted lumbar MRIs. Two datasets are used for model development and evaluation.

Results

The detection model achieves high accuracy in identifying intervertebral areas, with Intersection over Union (IoU) values above 0.7, indicating strong localization alignment. Confidence scores above 0.9 demonstrate the model's accurate levels identification. In the classification task, standardization proves the best performances for MC type assessment, achieving mean sensitivities of 0.83 for MC0, 0.85 for MC1, and 0.78 for MC2, along with balanced accuracy of 0.80 and F1 score of 0.88.

Discussion and conclusion

The study's end-to-end model shows promise in automating MC assessment, contributing to standardized diagnostics and treatment planning. Limitations include dataset size, class imbalance, and lack of external validation. Future research should focus on external validation, refining model generalization, and improving clinical applicability.

导言Modic Changes(MCs)是脊柱椎体信号强度的 MRI 改变。本研究介绍了一种端到端模型,用于自动检测和分类腰椎磁共振成像中的 MCs。该模型的两个步骤包括定位椎间区域,然后使用成对的 T1 和 T2 加权图像对 MC 类型(MC0、MC1、MC2)进行分类。这种方法为高效、标准化的 MC 评估提供了一种很有前景的解决方案。研究问题旨在研究不同的 MRI 归一化技术对 MC 分类的影响,以及该模型在临床环境中的应用。该模型首先识别椎间区域,然后使用成对的 T1 和 T2 加权腰椎 MRI 图像对 MC 类型(MC0、MC1、MC2)进行分类。结果该检测模型在识别椎间区域方面达到了很高的准确度,其 "交集大于联合"(Intersection over Union,IoU)值高于 0.7,表明定位对齐度很高。置信度得分超过 0.9,表明该模型能够准确识别椎间区。在分类任务中,标准化证明了 MC 类型评估的最佳性能,MC0 的平均灵敏度为 0.83,MC1 为 0.85,MC2 为 0.78,平衡准确度为 0.80,F1 得分为 0.88。不足之处包括数据集的大小、类别不平衡以及缺乏外部验证。未来的研究应侧重于外部验证、完善模型的通用性和提高临床适用性。
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引用次数: 0
Dural reconstruction with or without a bone graft of paranasal and anterior skullbase malignancies: Retrospective single-center analysis of 11 cases and review of literature 鼻旁和前颅底恶性肿瘤硬脑膜重建与否的骨移植:对11个病例的单中心回顾性分析和文献综述
Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2023.102740
Björn Sommer , Ina Konietzko , Maximilian Niklas Bonk , Tina Schaller , Bruno Märkl , Klaus Henning Kahl , Georg Stüben , Johannes Zenk , Ehab Shiban

Introduction

The reconstruction of frontobasal defects following oncologic resections of paranasal and anterior skull base (ASB) malignancies remains challenging. Ineffective reconstruction could lead to cerebrospinal fluid leak, meningitis, and tension pneumocephalus.

Research question

Aim of this investigation was to analyse postoperative complication rates with or without bone graft for anterior skull base reconstruction.

Material and methods

In this retrospective study, we included patients following resection of paranasal and/or anterior skull base malignancies between October 2013 and December 2022. Complications were analysed with regards to the type of skull base reconstruction.

Results

Eleven patients were identified (2 female, 9 male, age (median, SD) 64 ± 14.1 years (range 38–81). There were nine cases of paranasal sinus and nasal cavity carcinomas and two cases of olfactory neuroblastomas. Overall survival was 22.5 ± 28 months (range: 5–78), progression free survival was 17.0 ± 20.3 months (range: 11–78). Bone skull base reconstruction using a split graft was performed in three cases. Postoperative complications requiring surgical intervention were seen in 33% (one tension pneumocephalus) of cases in the bone reconstruction group and 50% (three patients with cerebrospinal fluid leak, one infection) in the non-bone reconstruction group.

Discussion and conclusion

The structural reinforcement of structural bone chip grafting might provide additional support of the ASB and prevent CSF leakage or encephalocele. Especially in large (>10 cm2) bone defects of advanced sinonasal malignancies extending into the middle cranial fossa, the full armamentarium of reconstruction possibilities should be considered.

导言鼻旁和前颅底(ASB)恶性肿瘤切除术后的前颅底缺损重建仍具有挑战性。材料和方法在这项回顾性研究中,我们纳入了 2013 年 10 月至 2022 年 12 月间接受副鼻腔和/或前颅底恶性肿瘤切除术的患者。结果共发现 7 名患者(2 名女性,9 名男性,年龄(中位数,标码)64 ± 14.1 岁(38-81 岁)。其中9例为鼻旁窦和鼻腔癌,2例为嗅觉神经母细胞瘤。总生存期为(22.5±28)个月(范围:5-78),无进展生存期为(17.0±20.3)个月(范围:11-78)。三例患者使用劈裂移植进行了骨颅底重建。术后需要手术干预的并发症在骨重建组中占 33%(1 例张力性气胸),在非骨重建组中占 50%(3 例脑脊液漏患者,1 例感染)。特别是对于延伸至中颅窝的晚期鼻窦鼻腔恶性肿瘤的大面积(10 平方厘米)骨缺损,应全面考虑重建的可能性。
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引用次数: 0
Parent perception of telemetric intracranial pressure monitoring in children - A qualitative case study 家长对遥测儿童颅内压监测的看法--定性案例研究
Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102820
Sarah Hornshøj Pedersen , Sara Duus Gustafsen , Marianne Juhler , Rikke Guldager

Introduction

Telemetric monitoring of intracranial pressure (ICP) in children with a complex cerebrospinal disorder might help parents distinguish acute and potential life-threatening symptoms of hydrocephalus from other illnesses.

Research question

What is patient and parent perceptions of system utility of telemetric ICP monitoring, and how does a long-term telemetric implant influence daily life of both patients and their families?

Material and methods

A qualitative case study design with a focus group interview including parents of children with a complex cerebrospinal fluid disorder and an implanted telemetric ICP sensor.

Results

Three parents participated. Based on thematic analysis, three themes were created: ‘Daily living with telemetric ICP monitoring’, ‘Parenting a child with a CSF disorder’, and ‘The healthy sibling’. The ICP sensor provided the parents with security and made them trust their intuition, while the possibility of home monitoring ensured stability for the entire family and had a calming effect on healthy siblings. Home monitoring was seen as the system's greatest advantages, whereas size, weight, and functionality of the external monitoring equipment were highlighted as disadvantages.

Discussion and conclusion

All parents supported the telemetric ICP sensor as a valued tool in treatment guidance of their child and stated that advantages exceeded disadvantages. It was stated that the possibility of conducting ICP measurements at home reduced the need for acute hospital admissions, which consequently led to a more stable daily life for the entire family. Suggestions regarding technical improvements with focus on more compatible external monitoring equipment were raised by all parents included.

导言遥测监测复杂性脑脊髓疾病患儿的颅内压(ICP)可帮助家长区分脑积水的急性和潜在生命威胁症状与其他疾病。研究问题患者和家长对遥测 ICP 监测系统效用的看法如何,长期植入遥测 ICP 对患者及其家属的日常生活有何影响?根据主题分析,确定了三个主题:带着遥测 ICP 监测器的日常生活"、"养育脑脊液紊乱患儿 "和 "健康的兄弟姐妹"。ICP 传感器为父母提供了安全感,使他们相信自己的直觉,而家庭监控的可能性则确保了整个家庭的稳定,并对健康的兄弟姐妹产生了安抚作用。家庭监测被视为该系统的最大优点,而外部监测设备的尺寸、重量和功能则被视为缺点。讨论和结论所有家长都支持将遥测式 ICP 传感器作为指导其子女治疗的重要工具,并表示利大于弊。他们表示,在家中进行 ICP 测量的可能性减少了急性入院治疗的需要,从而使整个家庭的日常生活更加稳定。所有家长都提出了有关技术改进的建议,重点是改进外部监测设备的兼容性。
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引用次数: 0
Sacroiliac joint fusion guided by intraoperatively superimposed virtual surgical planning using simulated fluoroscopic images 利用模拟透视图像在术中叠加虚拟手术规划引导下进行骶髂关节融合术
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102905

Introduction

Sacroiliac joint fusion (SIJF) is a minimally invasive treatment for sacroiliac (SI) dysfunction. It involves placing implants through the SI joint under fluoroscopic guidance, requiring precise implant positioning to avoid nerve injury. Preoperative virtual surgical planning (VSP) aids in optimal positioning, but replicating it accurately in the operating room is challenging.

Research question

This study aims to assess the feasibility of superimposing VSP onto intraoperative fluoroscopic images to aid in optimal implant placement.

Material and methods

A method for intraoperative guidance using 3D/2D registration was developed and tested during SIJF as an available and potentially efficient alternative for costly and more invasive navigation systems. Preoperatively, a VSP is performed and simulated fluoroscopic images are generated from a preoperative CT scan. During surgery, the simulated image that visually best matches the intraoperative fluoroscopic image is selected. Subsequently, the VSP is superimposed onto the intraoperative fluoroscopic image using a developed script-based workflow. The surgeon then places the implants accordingly. Postoperative implant placement accuracy was evaluated.

Results

Five interventions were performed on five patients, resulting in a total of 15 placed implants. Minor complications without clinical consequences occurred in one case, primarily attributable to the patient's anatomy and pathological manifestations. Mean deviations at implant apex and 3D angle were 4.7 ± 1.6 mm and 3.5 ± 1.3°, respectively.

Discussion and conclusions

The developed intraoperative workflow was feasible and resulted in implants placed with low deviations from the VSP. Further research is needed to automate and validate this method in a larger cohort.

导言骶髂关节融合术(SIJF)是一种治疗骶髂关节(SI)功能障碍的微创疗法。它需要在透视引导下通过骶髂关节植入假体,要求对假体进行精确定位以避免神经损伤。研究问题本研究旨在评估将虚拟手术规划叠加到术中透视图像上以帮助最佳植入物放置的可行性。材料和方法在 SIJF 中开发并测试了一种使用 3D/2D 注册的术中引导方法,作为昂贵且更具侵入性的导航系统的可用且潜在的有效替代方法。术前进行 VSP,并根据术前 CT 扫描生成模拟透视图像。在手术过程中,选择视觉上与术中透视图像最匹配的模拟图像。随后,利用开发的脚本工作流程将 VSP 叠加到术中透视图像上。然后,外科医生据此植入种植体。结果对五名患者进行了五次干预,共植入 15 个种植体。有一例患者出现了轻微的并发症,但未造成临床后果,主要原因是患者的解剖结构和病理表现。种植体顶点和三维角度的平均偏差分别为 4.7 ± 1.6 mm 和 3.5 ± 1.3°。讨论和结论所开发的术中工作流程是可行的,植入的种植体与 VSP 的偏差较小。还需要进一步研究,以便在更大的群体中自动验证这种方法。
{"title":"Sacroiliac joint fusion guided by intraoperatively superimposed virtual surgical planning using simulated fluoroscopic images","authors":"","doi":"10.1016/j.bas.2024.102905","DOIUrl":"10.1016/j.bas.2024.102905","url":null,"abstract":"<div><h3>Introduction</h3><p>Sacroiliac joint fusion (SIJF) is a minimally invasive treatment for sacroiliac (SI) dysfunction. It involves placing implants through the SI joint under fluoroscopic guidance, requiring precise implant positioning to avoid nerve injury. Preoperative virtual surgical planning (VSP) aids in optimal positioning, but replicating it accurately in the operating room is challenging.</p></div><div><h3>Research question</h3><p>This study aims to assess the feasibility of superimposing VSP onto intraoperative fluoroscopic images to aid in optimal implant placement.</p></div><div><h3>Material and methods</h3><p>A method for intraoperative guidance using 3D/2D registration was developed and tested during SIJF as an available and potentially efficient alternative for costly and more invasive navigation systems. Preoperatively, a VSP is performed and simulated fluoroscopic images are generated from a preoperative CT scan. During surgery, the simulated image that visually best matches the intraoperative fluoroscopic image is selected. Subsequently, the VSP is superimposed onto the intraoperative fluoroscopic image using a developed script-based workflow. The surgeon then places the implants accordingly. Postoperative implant placement accuracy was evaluated.</p></div><div><h3>Results</h3><p>Five interventions were performed on five patients, resulting in a total of 15 placed implants. Minor complications without clinical consequences occurred in one case, primarily attributable to the patient's anatomy and pathological manifestations. Mean deviations at implant apex and 3D angle were 4.7 ± 1.6 mm and 3.5 ± 1.3°, respectively.</p></div><div><h3>Discussion and conclusions</h3><p>The developed intraoperative workflow was feasible and resulted in implants placed with low deviations from the VSP. Further research is needed to automate and validate this method in a larger cohort.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424001619/pdfft?md5=53564ab2a6a9f9f27ee216aac99b13b5&pid=1-s2.0-S2772529424001619-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142050378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Brain & spine
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