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

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

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
Management of giant calcified thoracic disc herniation causing severe canal stenosis and myelopathy using partial vertebrectomy: Clinical and radiological outcomes of a novel posterior-only technique 使用椎体部分切除术治疗引起严重椎管狭窄和脊髓病的巨大钙化胸椎间盘突出症:新型纯后路技术的临床和放射学效果
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102937
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引用次数: 0
How does lumbar spinal fusion affect adjacent-level mechanics and kinematics? – In vitro analysis on the whole torso 腰椎融合术如何影响邻近水平的力学和运动学?- 对整个躯干的体外分析
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102970
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引用次数: 0
Factors explaining clinical improvement beyond the minimal clinical important difference (MCID) in clusters of adult spine deformity (ASD) patients 成人脊柱畸形(ASD)患者群中临床改善程度超过最小临床重要差异(MCID)的原因
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102941
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引用次数: 0
The effectiveness of vitamin D3 supplementation in improving functional outcome of non-surgically treated symptomatic lumbar spinal stenosis: Randomized controlled clinical trial – Pilot study 补充维生素 D3 对改善非手术治疗的无症状腰椎管狭窄症的功能效果:随机对照临床试验--试点研究
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102975
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引用次数: 0
Cervical spondylotic kyphosis with stenosis: Anterior only C3/4/5/6/7 deformity correction and interbody fusion with C7/T1 sparing 颈椎侧弯伴狭窄:仅前路C3/4/5/6/7畸形矫正和椎体间融合术,保留C7/T1
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102995
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引用次数: 0
The five-year survival and risk factor analysis in patients with pyogenic vertebral osteomyelitis: A retrospective study of 155 cases 化脓性脊椎骨髓炎患者的五年生存期和风险因素分析:155例病例的回顾性研究
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.103018
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引用次数: 0
What does proper postoperative spinal alignment mean? Which are the parameters that most correlate with outcome in adult spinal deformity correction? A machine learning approach 术后正确的脊柱排列意味着什么?哪些参数与成人脊柱畸形矫正的结果最相关?机器学习方法
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102962
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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 Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.103024
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引用次数: 0
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