Pub Date : 2025-01-01DOI: 10.1016/j.bas.2024.104172
Maria Goldberg , Laura-Sophie Frank , Ghaith Altawalbeh , Chiara Negwer , Arthur Wagner , Jens Gempt , Bernhard Meyer , Amir Kaywan Aftahy
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.
{"title":"Do clinical outcomes in individuals with malignant gliomas differ between sexes?","authors":"Maria Goldberg , Laura-Sophie Frank , Ghaith Altawalbeh , Chiara Negwer , Arthur Wagner , Jens Gempt , Bernhard Meyer , Amir Kaywan Aftahy","doi":"10.1016/j.bas.2024.104172","DOIUrl":"10.1016/j.bas.2024.104172","url":null,"abstract":"<div><h3>Introduction</h3><div>Sex-related differences in the epidemiology of malignant gliomas are acknowledged; however, information regarding their clinical characteristics and outcomes after surgery is limited.</div></div><div><h3>Research question</h3><div>To identify sex-specific differences of all patients with high-grade glioma at our institution and assessed clinical outcomes and prognostic factors.</div></div><div><h3>Material and methods</h3><div>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 <em>t</em>-test, and Mann–Whitney <em>U</em> test, respectively. Survival was calculated using the log-rank and Kaplan–Meier methods.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Discussion and conclusions</h3><div>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.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104172"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017312","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}
Pub Date : 2025-01-01DOI: 10.1016/j.bas.2024.104176
Frederick J.A. Meijer , Vincent Raymaekers , Sjoert A.H. Pegge , Jeroen HD. Boogaarts
Research question
The goal of this study was to assess the diagnostic accuracy of spinal time-resolved contrast-enhanced MR angiography (4D-MRA) for the detection and localization of spinal dural arteriovenous fistulas (SDAVF) in our institution.
Material and methods
Single center retrospective cohort study of patients with the clinical suspicion of a SDAVF. Patients were included who had undergone spinal 4D-MRA in the period January 2010–February 2021. A subgroup was identified, who had subsequent digital subtraction angiography (DSA), or clinical/radiological follow-up. Diagnostic performance measures of 4D-MRA were calculated (sensitivity, positive predictive value, specificity, and negative predictive value) with DSA serving as the reference standard.
Results
Overall, 120 patients with the clinical suspicion of having a SDAVF and who underwent spinal 4D-MRA were identified. A subgroup of 30 patients had both 4D-MRA and DSA, or follow-up. In this group, the sensitivity of 4D-MRA for the detection of a SDAVF was 100% and specificity was 91% (positive predictive value of 95% and a negative predictive value of 100%). Sidedness was correctly identified on 4D-MRA in 74% of the cases and the level of the SDAVF in 68%.
Discussion and conclusion
The results indicate that 4D-MRA has a high sensitivity and specificity for the detection and localization of a SDAVF, which is in line with previous studies published in literature. Furthermore, 4D-MRA can serve to guide DSA and shorten the procedural time, which reduces the risk of angiography related complications, and decreases patient discomfort.
{"title":"Diagnostic accuracy of 4D-MRA for the detection and localization of spinal dural arteriovenous fistulas: A retrospective 10-year cohort study","authors":"Frederick J.A. Meijer , Vincent Raymaekers , Sjoert A.H. Pegge , Jeroen HD. Boogaarts","doi":"10.1016/j.bas.2024.104176","DOIUrl":"10.1016/j.bas.2024.104176","url":null,"abstract":"<div><h3>Research question</h3><div>The goal of this study was to assess the diagnostic accuracy of spinal time-resolved contrast-enhanced MR angiography (4D-MRA) for the detection and localization of spinal dural arteriovenous fistulas (SDAVF) in our institution.</div></div><div><h3>Material and methods</h3><div>Single center retrospective cohort study of patients with the clinical suspicion of a SDAVF. Patients were included who had undergone spinal 4D-MRA in the period January 2010–February 2021. A subgroup was identified, who had subsequent digital subtraction angiography (DSA), or clinical/radiological follow-up. Diagnostic performance measures of 4D-MRA were calculated (sensitivity, positive predictive value, specificity, and negative predictive value) with DSA serving as the reference standard.</div></div><div><h3>Results</h3><div>Overall, 120 patients with the clinical suspicion of having a SDAVF and who underwent spinal 4D-MRA were identified. A subgroup of 30 patients had both 4D-MRA and DSA, or follow-up. In this group, the sensitivity of 4D-MRA for the detection of a SDAVF was 100% and specificity was 91% (positive predictive value of 95% and a negative predictive value of 100%). Sidedness was correctly identified on 4D-MRA in 74% of the cases and the level of the SDAVF in 68%.</div></div><div><h3>Discussion and conclusion</h3><div>The results indicate that 4D-MRA has a high sensitivity and specificity for the detection and localization of a SDAVF, which is in line with previous studies published in literature. Furthermore, 4D-MRA can serve to guide DSA and shorten the procedural time, which reduces the risk of angiography related complications, and decreases patient discomfort.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104176"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030287","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}
Pub Date : 2025-01-01DOI: 10.1016/j.bas.2024.104180
Julia Shawarba , Matthias Tomschik , Jonathan Wais , Fabian Winter , Christian Dorfer , Florian Mayer , Martha Feucht , Karl Roessler
Introduction and research question
Augmented reality (AR) is increasingly being used to improve surgical planning and assist in real time surgical procedures. A retrospective investigation was conducted to study its feasibility in pediatric epilepsy surgery at a single institution.
Methods
Functional neuronavigation using multimodal imaging data (fMRI, DTI-tractography, PET, SPECT, sEEG) were used to augment the surgical navigation by transferring MRI imaging reconstructions as AR maps into the surgical microscope overlaying the surgical field.
Results
Altogether, 43 patients (17 female, 0–18 yrs, mean 9 yrs) were operated between 10/2020 and 10/2023 and fulfilled the inclusion criteria. 26 patients (60.5%) had an extra-temporal and 17 (39.5%) a temporal seizure origin. The 3 top histological diagnoses encountered were: FCD (32.6%), ganglioglioma (23.3%) and DNET (11.6%). Preoperative MRI studies showed no epileptogenic lesion in 11 patients (25.6%, MRI negativ group), which necessitated implantation of depth electrodes before resection. There were no adverse events while using AR enhanced neuronavigation. Altogether, of 24 patients with a follow up of more than one year, 83.3% displayed a favorable ILAE grade 1 seizure outcome (75% ILAE 1a), 14 % experienced a transient hemiparesis, 4.3% a permanent quadrantanopia and one needed a subdural-peritoneal shunt.
Discussion and conclusion
AR supported navigated microscope resection allowed targeting and removal of lesional as well as non-lesional (sEEG defined) epileptogenic zones in pediatric epilepsy surgery with low morbidity and an expected seizure outcome.
{"title":"Augmented reality (AR) in microsurgical multimodal image guided focal pediatric epilepsy surgery: Results of a retrospective feasibility study","authors":"Julia Shawarba , Matthias Tomschik , Jonathan Wais , Fabian Winter , Christian Dorfer , Florian Mayer , Martha Feucht , Karl Roessler","doi":"10.1016/j.bas.2024.104180","DOIUrl":"10.1016/j.bas.2024.104180","url":null,"abstract":"<div><h3>Introduction and research question</h3><div>Augmented reality (AR) is increasingly being used to improve surgical planning and assist in real time surgical procedures. A retrospective investigation was conducted to study its feasibility in pediatric epilepsy surgery at a single institution.</div></div><div><h3>Methods</h3><div>Functional neuronavigation using multimodal imaging data (fMRI, DTI-tractography, PET, SPECT, sEEG) were used to augment the surgical navigation by transferring MRI imaging reconstructions as AR maps into the surgical microscope overlaying the surgical field.</div></div><div><h3>Results</h3><div>Altogether, 43 patients (17 female, 0–18 yrs, mean 9 yrs) were operated between 10/2020 and 10/2023 and fulfilled the inclusion criteria. 26 patients (60.5%) had an extra-temporal and 17 (39.5%) a temporal seizure origin. The 3 top histological diagnoses encountered were: FCD (32.6%), ganglioglioma (23.3%) and DNET (11.6%). Preoperative MRI studies showed no epileptogenic lesion in 11 patients (25.6%, MRI negativ group), which necessitated implantation of depth electrodes before resection. There were no adverse events while using AR enhanced neuronavigation. Altogether, of 24 patients with a follow up of more than one year, 83.3% displayed a favorable ILAE grade 1 seizure outcome (75% ILAE 1a), 14 % experienced a transient hemiparesis, 4.3% a permanent quadrantanopia and one needed a subdural-peritoneal shunt.</div></div><div><h3>Discussion and conclusion</h3><div>AR supported navigated microscope resection allowed targeting and removal of lesional as well as non-lesional (sEEG defined) epileptogenic zones in pediatric epilepsy surgery with low morbidity and an expected seizure outcome.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104180"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081398","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}
Pub Date : 2025-01-01DOI: 10.1016/j.bas.2024.104167
Solveig Stadsholt , Aivars Strauss , Jenny Kintzel , Stefan Schob , Erck Elolf , Mareike Rutenkröger , Christian Strauss , Christian Scheller , Sandra Leisz , Julian Prell , Maximilian Scheer
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.
{"title":"Posterior reversible enzephalopathie syndrome (PRES) following vestibular schwannoma surgery – Case report and review of the current theories on pathophysiology of PRES","authors":"Solveig Stadsholt , Aivars Strauss , Jenny Kintzel , Stefan Schob , Erck Elolf , Mareike Rutenkröger , Christian Strauss , Christian Scheller , Sandra Leisz , Julian Prell , Maximilian Scheer","doi":"10.1016/j.bas.2024.104167","DOIUrl":"10.1016/j.bas.2024.104167","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Research question</h3><div>PRES in adults is extremely rare. After cranial surgery, the impaired consciousness caused by this syndrome may be misdiagnosed.</div></div><div><h3>Material and methods</h3><div>We present a rare case of PRES associated with vestibular schwannoma (VS) surgery and metronidazole use and have conducted a literature review.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Discussion and conclusion</h3><div>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.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104167"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081479","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}
Pub Date : 2025-01-01DOI: 10.1016/j.bas.2025.104189
Roua Nasir , Midhat e Zahra Naqvi , Salaar Ahmed , Maarij ul Hassan , Rabeet Tariq , Saad Akhter Khan , Pia Koeskemeier , Rajiv K. Khajuria , Mohammad Hamza Bajwa , Sajjad Muhammad
Introduction
Giant intracranial aneurysms (GIAs) of the anterior communicating artery (AComm) are rare and challenging to treat due to their distinct angioarchitecture.
Research question
To review demographic, morphological, clinical, and prognostic factors in the treatment of giant AComm aneurysms to inform decision-making.
Materials and methods
Medline, Scopus, and Cochrane databases were searched for records examining cases diagnosed with giant AComm aneurysms. The study type, sample size, patient age, aneurysm site, aneurysm size, presenting complaints, and treatment modality were tabulated, and methodological quality was assessed. Additionally, two cases from our institution were included.
Results
The data from 24 retrieved records, including 45 cases (60% treated with direct clipping/clip reconstruction, 20% with surgical bypass±trapping, and 16% with endovascular/combined methods) were obtained. The mean age was 52 years with an overall male preponderance (3:1). 73% presented with symptoms; mostly visual impairment/loss and subarachnoid hemorrhage. 82% had favorable outcomes (mRS 0–2). 56% had a mean maximum diameter between 25 and 30 mm. Cases treated by direct clipping/reconstruction were primarily ruptured, while cases treated by surgical bypass/trapping were unruptured or asymptomatic. Endovascular/combined methods were utilized for only few cases.
Discussion and conclusion
Immediate suspicion is warranted for visual impairment with headaches in adults or seizures in the elderly. Direct clipping is the first-line treatment for ruptured cases closely followed by surgical bypass and trapping for unruptured cases. There is limited data on endovascular/combined methods. Evidence from case reports/series should be interpreted with caution. Both inter-modality and intra-modality nuances exist.
{"title":"The morphological, clinical, and prognostic factors in the management of giant anterior communicating artery aneurysms: A systematic review of cases","authors":"Roua Nasir , Midhat e Zahra Naqvi , Salaar Ahmed , Maarij ul Hassan , Rabeet Tariq , Saad Akhter Khan , Pia Koeskemeier , Rajiv K. Khajuria , Mohammad Hamza Bajwa , Sajjad Muhammad","doi":"10.1016/j.bas.2025.104189","DOIUrl":"10.1016/j.bas.2025.104189","url":null,"abstract":"<div><h3>Introduction</h3><div>Giant intracranial aneurysms (GIAs) of the anterior communicating artery (AComm) are rare and challenging to treat due to their distinct angioarchitecture.</div></div><div><h3>Research question</h3><div>To review demographic, morphological, clinical, and prognostic factors in the treatment of giant AComm aneurysms to inform decision-making.</div></div><div><h3>Materials and methods</h3><div>Medline, Scopus, and Cochrane databases were searched for records examining cases diagnosed with giant AComm aneurysms. The study type, sample size, patient age, aneurysm site, aneurysm size, presenting complaints, and treatment modality were tabulated, and methodological quality was assessed. Additionally, two cases from our institution were included.</div></div><div><h3>Results</h3><div>The data from 24 retrieved records, including 45 cases (60% treated with direct clipping/clip reconstruction, 20% with surgical bypass±trapping, and 16% with endovascular/combined methods) were obtained. The mean age was 52 years with an overall male preponderance (3:1). 73% presented with symptoms; mostly visual impairment/loss and subarachnoid hemorrhage. 82% had favorable outcomes (mRS 0–2). 56% had a mean maximum diameter between 25 and 30 mm. Cases treated by direct clipping/reconstruction were primarily ruptured, while cases treated by surgical bypass/trapping were unruptured or asymptomatic. Endovascular/combined methods were utilized for only few cases.</div></div><div><h3>Discussion and conclusion</h3><div>Immediate suspicion is warranted for visual impairment with headaches in adults or seizures in the elderly. Direct clipping is the first-line treatment for ruptured cases closely followed by surgical bypass and trapping for unruptured cases. There is limited data on endovascular/combined methods. Evidence from case reports/series should be interpreted with caution. Both inter-modality and intra-modality nuances exist.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104189"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102291","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}
Pub Date : 2025-01-01DOI: 10.1016/j.bas.2025.104217
Vita M. Klieverik , Pierre A. Robe , Marvick S.M. Muradin , Peter A. Woerdeman
Introduction
Autografts are considered more cost-effective than cranial implants due to the use of the patient's own bone. However, autografts are associated with a higher revision surgery rate because of their intrinsic risk of resorption. As revision surgeries imply additional hospital stays and therefore higher costs, autografts may be less cost-effective than cranial implants.
Research question
To analyze the cost-effectiveness of cranial implants compared with autografts.
Material and methods
We performed a retrospective cohort study of patients who underwent cranioplasty between 2014 and 2020. We collected data on the costs of cranioplasty using each patient's diagnosis and treatment combination (DBC) code. We used the incremental cost-effectiveness ratio (ICER) to assess cost-effectiveness, which was calculated as the ratio of incremental cost and incremental effect of using a cranial implant instead of an autograft.
Results
A total of 168 patients were included (mean age 43.0 ± 20.0 years). The median cost of the first cranioplasty procedure was €6249.37 (IQR €5250.64 – €8551.36) for cranial implants and €6261.36 (IQR €5189.14 – €7792.10) for autografts (p = 0.094). The median total cost of all health care related to the cranioplasty procedure was €6460.64 (IQR €6039.68 – €9533.03) for cranial implants and €12,075.01 (IQR €6409.63 – €16,420.71) for autografts (p < 0.001). The ICER of cranial implants compared with autografts was –€7663.22 per revision surgery avoided.
Discussion and conclusion
This study found that the use of cranial implants is at a lower cost and more clinically effective than the use of autologous bone grafts.
{"title":"Cost-effectiveness of cranial implants compared with autologous bone grafts","authors":"Vita M. Klieverik , Pierre A. Robe , Marvick S.M. Muradin , Peter A. Woerdeman","doi":"10.1016/j.bas.2025.104217","DOIUrl":"10.1016/j.bas.2025.104217","url":null,"abstract":"<div><h3>Introduction</h3><div>Autografts are considered more cost-effective than cranial implants due to the use of the patient's own bone. However, autografts are associated with a higher revision surgery rate because of their intrinsic risk of resorption. As revision surgeries imply additional hospital stays and therefore higher costs, autografts may be less cost-effective than cranial implants.</div></div><div><h3>Research question</h3><div>To analyze the cost-effectiveness of cranial implants compared with autografts.</div></div><div><h3>Material and methods</h3><div>We performed a retrospective cohort study of patients who underwent cranioplasty between 2014 and 2020. We collected data on the costs of cranioplasty using each patient's diagnosis and treatment combination (DBC) code. We used the incremental cost-effectiveness ratio (ICER) to assess cost-effectiveness, which was calculated as the ratio of incremental cost and incremental effect of using a cranial implant instead of an autograft.</div></div><div><h3>Results</h3><div>A total of 168 patients were included (mean age 43.0 ± 20.0 years). The median cost of the first cranioplasty procedure was €6249.37 (IQR €5250.64 – €8551.36) for cranial implants and €6261.36 (IQR €5189.14 – €7792.10) for autografts (p = 0.094). The median total cost of all health care related to the cranioplasty procedure was €6460.64 (IQR €6039.68 – €9533.03) for cranial implants and €12,075.01 (IQR €6409.63 – €16,420.71) for autografts (p < 0.001). The ICER of cranial implants compared with autografts was –€7663.22 per revision surgery avoided.</div></div><div><h3>Discussion and conclusion</h3><div>This study found that the use of cranial implants is at a lower cost and more clinically effective than the use of autologous bone grafts.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104217"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487942","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}
Pub Date : 2025-01-01DOI: 10.1016/j.bas.2025.104225
Youssef Jamaleddine , Ahmad Haj Hussein , Mohamad Omar Honeine , Elio Daccache , Sarah El Hajjar , Ramzi Moucharafieh , Nizar Natout , Mohammad Badra
Introduction
Lumbar disc herniation is common in spine surgery, and endoscopic lumbar discectomy (ELD) offers a minimally invasive alternative with reduced complications. However, the learning curve of ELD, particularly between interlaminar and transforaminal techniques, remains a challenge.
Research question
To determine the learning curve for both interlaminar and transforaminal ELD in terms of operative time, and analyze factors that affect it.
Materials and methods
Single-center retrospective study of 376 patients who underwent ELD between January 2013 and March 2024. In the cohort, 319 were in the interlaminar group and 57 in the transforaminal group. The learning curves were analyzed by CUSUM. The data regarding surgical technique, operative time, and postoperative outcome were analyzed.
Results
The learning curve reached a plateau at 50 cases for the interlaminar technique and 23 cases for the transforaminal technique. Operative time was significantly lower for the transforaminal approach compared to the interlaminar approach: 69.18 ± 28.85 min versus 78.71 ± 28.86 min, p = 0.022. A second learning curve could not be demonstrated for the interlaminar approach in the long term. Operative time was influenced variably by factors such as age, gender, and level of herniated disc between the two techniques.
Discussion and conclusion
Both the interlaminar and transforaminal ELD are minimally invasive techniques with different learning curves. The transforaminal approach shows a steeper learning curve and shorter operative time. The interlaminar approach did not show a second learning curve in the long term.
{"title":"Evaluating the learning curve and operative time of interlaminar and transforaminal endoscopic lumbar discectomy","authors":"Youssef Jamaleddine , Ahmad Haj Hussein , Mohamad Omar Honeine , Elio Daccache , Sarah El Hajjar , Ramzi Moucharafieh , Nizar Natout , Mohammad Badra","doi":"10.1016/j.bas.2025.104225","DOIUrl":"10.1016/j.bas.2025.104225","url":null,"abstract":"<div><h3>Introduction</h3><div>Lumbar disc herniation is common in spine surgery, and endoscopic lumbar discectomy (ELD) offers a minimally invasive alternative with reduced complications. However, the learning curve of ELD, particularly between interlaminar and transforaminal techniques, remains a challenge.</div></div><div><h3>Research question</h3><div>To determine the learning curve for both interlaminar and transforaminal ELD in terms of operative time, and analyze factors that affect it.</div></div><div><h3>Materials and methods</h3><div>Single-center retrospective study of 376 patients who underwent ELD between January 2013 and March 2024. In the cohort, 319 were in the interlaminar group and 57 in the transforaminal group. The learning curves were analyzed by CUSUM. The data regarding surgical technique, operative time, and postoperative outcome were analyzed.</div></div><div><h3>Results</h3><div>The learning curve reached a plateau at 50 cases for the interlaminar technique and 23 cases for the transforaminal technique. Operative time was significantly lower for the transforaminal approach compared to the interlaminar approach: 69.18 ± 28.85 min versus 78.71 ± 28.86 min, p = 0.022. A second learning curve could not be demonstrated for the interlaminar approach in the long term. Operative time was influenced variably by factors such as age, gender, and level of herniated disc between the two techniques.</div></div><div><h3>Discussion and conclusion</h3><div>Both the interlaminar and transforaminal ELD are minimally invasive techniques with different learning curves. The transforaminal approach shows a steeper learning curve and shorter operative time. The interlaminar approach did not show a second learning curve in the long term.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104225"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511728","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}
Pub Date : 2025-01-01DOI: 10.1016/j.bas.2025.104219
Merijn Foppen , Roger Lodewijkx , Mariam Slot , William P. Vandertop , Dagmar Verbaan
Background
The effect of a conservative (wait-and-watch) approach in chronic subdural hematoma (cSDH) patients with mild to moderate symptoms, is poorly studied. Surgical evacuation is effective, but inherently carries the risk of surgical or anesthetic complications.
Research question
To assess the effect of conservative or operative (burrhole craniostomy) treatment on clinical outcome, in cSDH patients with mild to moderate symptoms.
Methods
This single center, retrospective cohort study included 444 cSDH patients with a Markwalder Grading Scale score 1 or 2, treated between 2012 and 2022. The primary outcomes were complication rate, length of hospital stay and 30-days’ mortality. The results were analyzed using both intention-to-treat and as-treated approaches. Propensity score techniques were applied to adjust for clinical and radiological baseline differences.
Results
Of the 114 conservatively treated patients, 49 (43%) crossed-over to surgery. The 330 remaining patients were treated surgically. In the intention-to-treat and as-treated analysis, initial surgery was associated with a higher complication rate (OR 2.02, 95% CI 1.04–3.94; OR 2.87, 95% CI 1.04–7.91) and longer hospital stay (β 2.34, 95% CI 0.15–4.52; β 6.62, 95% CI 3.60–9.64). Conservative treatment was associated with higher 30-day mortality (as-treated OR 0.19, 95% CI 0.06–0.66, favoring surgery), but this was unrelated to cSDH.
Conclusion
In this selected cohort of cSDH patients with mild to moderate symptoms, a conservative approach was associated with less complications and hospital stay. For these patients, a ‘conservative treatment first’ regimen may therefore be considered. Corroboration in a prospective cohort with neurological and functional outcomes is warranted.
{"title":"Chronic subdural hematoma with mild to moderate symptoms: The effect of initial treatment approach on clinical outcome","authors":"Merijn Foppen , Roger Lodewijkx , Mariam Slot , William P. Vandertop , Dagmar Verbaan","doi":"10.1016/j.bas.2025.104219","DOIUrl":"10.1016/j.bas.2025.104219","url":null,"abstract":"<div><h3>Background</h3><div>The effect of a conservative (wait-and-watch) approach in chronic subdural hematoma (cSDH) patients with mild to moderate symptoms, is poorly studied. Surgical evacuation is effective, but inherently carries the risk of surgical or anesthetic complications.</div></div><div><h3>Research question</h3><div>To assess the effect of conservative or operative (burrhole craniostomy) treatment on clinical outcome, in cSDH patients with mild to moderate symptoms.</div></div><div><h3>Methods</h3><div>This single center, retrospective cohort study included 444 cSDH patients with a Markwalder Grading Scale score 1 or 2, treated between 2012 and 2022. The primary outcomes were complication rate, length of hospital stay and 30-days’ mortality. The results were analyzed using both intention-to-treat and as-treated approaches. Propensity score techniques were applied to adjust for clinical and radiological baseline differences.</div></div><div><h3>Results</h3><div>Of the 114 conservatively treated patients, 49 (43%) crossed-over to surgery. The 330 remaining patients were treated surgically. In the intention-to-treat and as-treated analysis, initial surgery was associated with a higher complication rate (OR 2.02, 95% CI 1.04–3.94; OR 2.87, 95% CI 1.04–7.91) and longer hospital stay (β 2.34, 95% CI 0.15–4.52; β 6.62, 95% CI 3.60–9.64). Conservative treatment was associated with higher 30-day mortality (as-treated OR 0.19, 95% CI 0.06–0.66, favoring surgery), but this was unrelated to cSDH.</div></div><div><h3>Conclusion</h3><div>In this selected cohort of cSDH patients with mild to moderate symptoms, a conservative approach was associated with less complications and hospital stay. For these patients, a ‘conservative treatment first’ regimen may therefore be considered. Corroboration in a prospective cohort with neurological and functional outcomes is warranted.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104219"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535132","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}
Pub Date : 2024-11-28eCollection Date: 2024-01-01DOI: 10.1016/j.bas.2024.104146
Edoardo Picetti, Nicolò Marchesini, Walter L Biffl, Susan E Biffl, Fausto Catena, Raul Coimbra, Michael G Fehlings, Wilco C Peul, Chiara Robba, Michele Salvagno, Fabio S Taccone, Andreas K Demetriades
Introduction: Traumatic spinal cord injury (tSCI) is frequently observed in polytrauma patients.
Research question: What is the optimal strategy to manage tSCI in the setting of polytrauma?
Material and methods: This narrative review focuses on: 1) extraspinal damage control surgery and resuscitation, 2) the perioperative protection of the injured spine during emergency surgery, 3) imaging and timing of spinal surgery in polytrauma, 4) early interventions for skin, bowel and bladder, and 5) the multidisciplinary approach to tSCI polytrauma patients.
Results: Damage control resuscitation (DCR) and damage control surgery (DCS), aim to prevent/correct post-traumatic physiological derangements to minimize bleeding until definitive hemostasis is achieved. Spinal protection during emergency surgery is of paramount importance to reduce secondary insults to the injured spine. Imaging, especially magnetic resonance imaging (MRI), is useful for decision-making regarding surgical management of the injured spine. Early decompressive surgery (within 24 h from trauma) is associated with better neurological outcomes. Early consultation with a physical medicine and rehabilitation physician is beneficial to optimize recovery. A close collaboration between different medical specialties involved in the early management of tSCI patients with polytrauma is advisable to improve outcome.
Discussion and conclusion: This narrative review aims to collate basic knowledge regarding acute phase management of tSCI patients in the context of polytrauma. More evidence and data form well-powered studies are necessary in this setting.
{"title":"The acute phase management of traumatic spinal cord injury (tSCI) with polytrauma: A narrative review.","authors":"Edoardo Picetti, Nicolò Marchesini, Walter L Biffl, Susan E Biffl, Fausto Catena, Raul Coimbra, Michael G Fehlings, Wilco C Peul, Chiara Robba, Michele Salvagno, Fabio S Taccone, Andreas K Demetriades","doi":"10.1016/j.bas.2024.104146","DOIUrl":"10.1016/j.bas.2024.104146","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic spinal cord injury (tSCI) is frequently observed in polytrauma patients.</p><p><strong>Research question: </strong>What is the optimal strategy to manage tSCI in the setting of polytrauma?</p><p><strong>Material and methods: </strong>This narrative review focuses on: 1) extraspinal damage control surgery and resuscitation, 2) the perioperative protection of the injured spine during emergency surgery, 3) imaging and timing of spinal surgery in polytrauma, 4) early interventions for skin, bowel and bladder, and 5) the multidisciplinary approach to tSCI polytrauma patients.</p><p><strong>Results: </strong>Damage control resuscitation (DCR) and damage control surgery (DCS), aim to prevent/correct post-traumatic physiological derangements to minimize bleeding until definitive hemostasis is achieved. Spinal protection during emergency surgery is of paramount importance to reduce secondary insults to the injured spine. Imaging, especially magnetic resonance imaging (MRI), is useful for decision-making regarding surgical management of the injured spine. Early decompressive surgery (within 24 h from trauma) is associated with better neurological outcomes. Early consultation with a physical medicine and rehabilitation physician is beneficial to optimize recovery. A close collaboration between different medical specialties involved in the early management of tSCI patients with polytrauma is advisable to improve outcome.</p><p><strong>Discussion and conclusion: </strong>This narrative review aims to collate basic knowledge regarding acute phase management of tSCI patients in the context of polytrauma. More evidence and data form well-powered studies are necessary in this setting.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"104146"},"PeriodicalIF":1.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866652","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}
Pub Date : 2024-11-26eCollection Date: 2024-01-01DOI: 10.1016/j.bas.2024.104147
Diogo Roque, Nida Kalyal, Yasir A Chowdhury, Ali Elhag, Matthew Elliot, Keyoumars Ashkan, Francesco Vergani, Ranjeev Bhangoo, José Pedro Lavrador
{"title":"Letter to Editor: Fluorescence-guided surgery for high-grade gliomas.","authors":"Diogo Roque, Nida Kalyal, Yasir A Chowdhury, Ali Elhag, Matthew Elliot, Keyoumars Ashkan, Francesco Vergani, Ranjeev Bhangoo, José Pedro Lavrador","doi":"10.1016/j.bas.2024.104147","DOIUrl":"10.1016/j.bas.2024.104147","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"104147"},"PeriodicalIF":1.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11655689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866706","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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