Pub Date : 2024-01-01DOI: 10.1016/j.bas.2024.103330
Georges Versyck , Johannes van Loon , Robin Lemmens , Jelle Demeestere , Lawrence Bonne , Jo P. Peluso , Steven De Vleeschouwer
Introduction
Decision-making for the treatment of ruptured aneurysms is an intricate process, which involves several factors. There has been a rapid advancement in endovascular, but also in the surgical treating field of ruptured intracranial aneurysms, with a growing body of evidence for either treatment technique.
Research question
As there is a wide variety of treatment possibilities, it can be hard to understand the intricacies which lie behind the decision-making process for a given aneurysm.
Materials and methods
An overview of the most relevant literature in decision-making on ruptured intracranial aneurysms is given.
Results
Different decision-altering factors were identified, which can be divided into information from the general evidence, to influential factors such as the patient's age, initial presenting status, and aneurysmal factors such as size, morphology and aneurysmal location.
Discussion and conclusion
This review provides an evidence-based overview of the most pertinent literature on these different aspects of decision-making in ruptured aneurysm cases and provides some recommendations after each of these segments. As always, all different aspects of the patient and aneurysmal factors should be taken into consideration before coming to a conclusion, as to obtain the best possible result for an individual patient.
{"title":"An overview of decision-making in cerebrovascular treatment strategies: Part II - Ruptured aneurysms","authors":"Georges Versyck , Johannes van Loon , Robin Lemmens , Jelle Demeestere , Lawrence Bonne , Jo P. Peluso , Steven De Vleeschouwer","doi":"10.1016/j.bas.2024.103330","DOIUrl":"10.1016/j.bas.2024.103330","url":null,"abstract":"<div><h3>Introduction</h3><p>Decision-making for the treatment of ruptured aneurysms is an intricate process, which involves several factors. There has been a rapid advancement in endovascular, but also in the surgical treating field of ruptured intracranial aneurysms, with a growing body of evidence for either treatment technique.</p></div><div><h3>Research question</h3><p>As there is a wide variety of treatment possibilities, it can be hard to understand the intricacies which lie behind the decision-making process for a given aneurysm.</p></div><div><h3>Materials and methods</h3><p>An overview of the most relevant literature in decision-making on ruptured intracranial aneurysms is given.</p></div><div><h3>Results</h3><p>Different decision-altering factors were identified, which can be divided into information from the general evidence, to influential factors such as the patient's age, initial presenting status, and aneurysmal factors such as size, morphology and aneurysmal location.</p></div><div><h3>Discussion and conclusion</h3><p>This review provides an evidence-based overview of the most pertinent literature on these different aspects of decision-making in ruptured aneurysm cases and provides some recommendations after each of these segments. As always, all different aspects of the patient and aneurysmal factors should be taken into consideration before coming to a conclusion, as to obtain the best possible result for an individual patient.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"Article 103330"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424005861/pdfft?md5=deb5557c1e2b072f6221710087ba6689&pid=1-s2.0-S2772529424005861-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239628","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 : 2024-01-01DOI: 10.1016/j.bas.2024.102779
Arija Jacobi , Philipp Schenk , Esra Aydin , Friederike Klauke , Thomas Mendel , Bernhard W. Ullrich
Introduction
Predicting the pre-morbid sagittal profile of the spine or segmental angles could enhance the process of planning the extent of fracture reduction. There is evidence that spinopelvic parameters may be suitable for this purpose.
Research question
Is it possible to determine the inflection point and the mono- and bi-segmental endplate angles (EPA) in the thoracolumbar transition (from Th9 to L2) based on age, gender, spinopelvic parameters, and the adjacent EPA in the supine position?
Material and methods
Based on Polytrauma CT scans in the supine position, the following spinopelvic parameters were measured using non-fractured spines: pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and the apex of the LL.
Results
In this study, a total of 287 patients with a mean age of 42±16 years were included. Age-related changes were observed, where LL, thoracic kyphosis (TK), and PI increase with age. Gender-related comparisons showed that females had a more pronounced LL and reduced TK. Significant correlations between IP and spinopelvic parameters, with the apex of LL providing the best prediction, were found. However, the overall model quality remained low. Predicting mEPA and bEPA showed positive correlations. The prediction for mEPA L2/3 demonstrated the highest correlation. For bisegmental angles, the most caudal bEPA (L2) exhibited the highest correlation, albeit with some notable absolute differences in the values between measured and predicted values.
Discussion and conclusion
While this study highlights the complexity of the relationship between the pelvis and thoracolumbar parameters, finding a predictive tool for thoracolumbar reduction and stabilization was not possible.
{"title":"Relation between sagittal pelvic and thoracolumbar parameters in supine position – Pelvic parameters and their predictive value for spinal Cobb angles","authors":"Arija Jacobi , Philipp Schenk , Esra Aydin , Friederike Klauke , Thomas Mendel , Bernhard W. Ullrich","doi":"10.1016/j.bas.2024.102779","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102779","url":null,"abstract":"<div><h3>Introduction</h3><p>Predicting the pre-morbid sagittal profile of the spine or segmental angles could enhance the process of planning the extent of fracture reduction. There is evidence that spinopelvic parameters may be suitable for this purpose.</p></div><div><h3>Research question</h3><p>Is it possible to determine the inflection point and the mono- and bi-segmental endplate angles (EPA) in the thoracolumbar transition (from Th9 to L2) based on age, gender, spinopelvic parameters, and the adjacent EPA in the supine position?</p></div><div><h3>Material and methods</h3><p>Based on Polytrauma CT scans in the supine position, the following spinopelvic parameters were measured using non-fractured spines: pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and the apex of the LL.</p></div><div><h3>Results</h3><p>In this study, a total of 287 patients with a mean age of 42±16 years were included. Age-related changes were observed, where LL, thoracic kyphosis (TK), and PI increase with age. Gender-related comparisons showed that females had a more pronounced LL and reduced TK. Significant correlations between IP and spinopelvic parameters, with the apex of LL providing the best prediction, were found. However, the overall model quality remained low. Predicting mEPA and bEPA showed positive correlations. The prediction for mEPA L2/3 demonstrated the highest correlation. For bisegmental angles, the most caudal bEPA (L2) exhibited the highest correlation, albeit with some notable absolute differences in the values between measured and predicted values.</p></div><div><h3>Discussion and conclusion</h3><p>While this study highlights the complexity of the relationship between the pelvis and thoracolumbar parameters, finding a predictive tool for thoracolumbar reduction and stabilization was not possible.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"Article 102779"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424000353/pdfft?md5=4a78f37742a08de189077f0af05ac18a&pid=1-s2.0-S2772529424000353-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140187882","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 : 2024-01-01DOI: 10.1016/j.bas.2024.102771
Eleanor M. Moncur , Linda D'Antona , Amy L. Peters , Graziella Favarato , Simon Thompson , Celine Vicedo , Lewis Thorne , Laurence D. Watkins , Brian L. Day , Ahmed K. Toma , Matthew J. Bancroft
Introduction
Positional changes in intracranial pressure (ICP) have been described in humans when measured over minutes or hours in a static posture, with ICP higher when lying supine than when sitting or standing upright. However, humans are often ambulant with frequent changes in position self-generated by active movement.
Research question
We explored how ICP changes during movement between body positions.
Material and methods
Sixty-two patients undergoing clinical ICP monitoring were recruited. Patients were relatively well, ambulatory and of mixed age, body habitus and pathology. We instructed patients to move back and forth between sitting and standing or lying and sitting positions at 20 s intervals after an initial 60s at rest. We simultaneously measured body position kinematics from inertial measurement units and ICP from an intraparenchymal probe at 100 Hz.
Results
ICP increased transiently during movements beyond the level expected by body position alone. The amplitude of the increase varied between participants but was on average ∼5 mmHg during sit-to-stand, stand-to-sit and sit-to-lie movements and 10.8 mmHg [95%CI: 9.3,12.4] during lie-to-sit movements. The amplitude increased slightly with age, was greater in males, and increased with median 24-h ICP. For lie-to-sit and sit-to-lie movements, higher BMI was associated with greater mid-movement increase (β = 0.99 [0.78,1.20]; β = 0.49 [0.34,0.64], respectively).
Discussion and conclusion
ICP increases during movement between body positions. The amplitude of the increase in ICP varies with type of movement, age, sex, and BMI. This could be a marker of disturbed ICP dynamics and may be particularly relevant for patients with CSF-diverting shunts in situ.
{"title":"Ambulatory intracranial pressure in humans: ICP increases during movement between body positions","authors":"Eleanor M. Moncur , Linda D'Antona , Amy L. Peters , Graziella Favarato , Simon Thompson , Celine Vicedo , Lewis Thorne , Laurence D. Watkins , Brian L. Day , Ahmed K. Toma , Matthew J. Bancroft","doi":"10.1016/j.bas.2024.102771","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102771","url":null,"abstract":"<div><h3>Introduction</h3><p>Positional changes in intracranial pressure (ICP) have been described in humans when measured over minutes or hours in a static posture, with ICP higher when lying supine than when sitting or standing upright. However, humans are often ambulant with frequent changes in position self-generated by active movement.</p></div><div><h3>Research question</h3><p>We explored how ICP changes during movement between body positions.</p></div><div><h3>Material and methods</h3><p>Sixty-two patients undergoing clinical ICP monitoring were recruited. Patients were relatively well, ambulatory and of mixed age, body habitus and pathology. We instructed patients to move back and forth between sitting and standing or lying and sitting positions at 20 s intervals after an initial 60s at rest. We simultaneously measured body position kinematics from inertial measurement units and ICP from an intraparenchymal probe at 100 Hz.</p></div><div><h3>Results</h3><p>ICP increased transiently during movements beyond the level expected by body position alone. The amplitude of the increase varied between participants but was on average ∼5 mmHg during sit-to-stand, stand-to-sit and sit-to-lie movements and 10.8 mmHg [95%CI: 9.3,12.4] during lie-to-sit movements. The amplitude increased slightly with age, was greater in males, and increased with median 24-h ICP. For lie-to-sit and sit-to-lie movements, higher BMI was associated with greater mid-movement increase (β = 0.99 [0.78,1.20]; β = 0.49 [0.34,0.64], respectively).</p></div><div><h3>Discussion and conclusion</h3><p>ICP increases during movement between body positions. The amplitude of the increase in ICP varies with type of movement, age, sex, and BMI. This could be a marker of disturbed ICP dynamics and may be particularly relevant for patients with CSF-diverting shunts in situ.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"Article 102771"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424000274/pdfft?md5=1ef45c04901e498cb15d8299b3e36007&pid=1-s2.0-S2772529424000274-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140209220","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 : 2024-01-01DOI: 10.1016/j.bas.2024.102785
Luca Papavero , Jana Wilke , Nawar Ali , Kathrin Schawjinski , Annette Holtdirk , Karsten Schoeller
Introduction
It is reasonable to assume that lumbar spinal stenosis (LSS) affects the cauda nerve roots also at night.
Research question
Does microsurgical decompression influence sleep quality and position?
Materials and methods
A study nurse interviewed 140 patients scheduled for LSS decompression using the Pittsburgh Sleep Quality Index (PSQI), Spinal Stenosis Measure (SSM), Numeric Rating Scale (NRS) for back and leg pain, Douleur Neuropathique (DN4), and Charlson Comorbidity Index. Epidemiologic and MRI data were collected along with self-reported rankings of preferred sleep positions (prone, supine, side, and fetal). Follow-up interviews were conducted by telephone six and 18 months after discharge. Statistical analysis was performed using SSPS 24, with significance set at p < 0.05.
Results
132 patients (55% female, mean age 73 years) were evaluated. Preoperatively, 45 (34.1%) patients were classified as good sleepers (GS: PSQI ≤5, range 1–21 (worst)) and 87 (65.9%) as poor sleepers (PS: PSQI ≥6). Decompression surgery reversed the relationship between PS (31.8%) and GS (68.2%, recovered/improved). Protective fetal sleeping position was the most common (≥70%) before and after surgery for both PS and GS. Risk factors for PS included female sex (p = 0.03), obesity (p = 0.03), high NRS back pain score (p = 0.008), and high SSM symptom score (p = 0.004). MRI imaging did not differ between PS and GS.
Discussion and conclusion
LSS had a negative effect on sleep quality, whereas surgical decompression had a positive effect. The protective fetal sleeping position was the preferred position both before and after surgery.
{"title":"Lumbar spinal stenosis and surgical decompression affect sleep quality and position in patients. A prospective cross-sectional cohort study","authors":"Luca Papavero , Jana Wilke , Nawar Ali , Kathrin Schawjinski , Annette Holtdirk , Karsten Schoeller","doi":"10.1016/j.bas.2024.102785","DOIUrl":"10.1016/j.bas.2024.102785","url":null,"abstract":"<div><h3>Introduction</h3><p>It is reasonable to assume that lumbar spinal stenosis (LSS) affects the cauda nerve roots also at night.</p></div><div><h3>Research question</h3><p>Does microsurgical decompression influence sleep quality and position?</p></div><div><h3>Materials and methods</h3><p>A study nurse interviewed 140 patients scheduled for LSS decompression using the Pittsburgh Sleep Quality Index (PSQI), Spinal Stenosis Measure (SSM), Numeric Rating Scale (NRS) for back and leg pain, Douleur Neuropathique (DN4), and Charlson Comorbidity Index. Epidemiologic and MRI data were collected along with self-reported rankings of preferred sleep positions (prone, supine, side, and fetal). Follow-up interviews were conducted by telephone six and 18 months after discharge. Statistical analysis was performed using SSPS 24, with significance set at p < 0.05.</p></div><div><h3>Results</h3><p>132 patients (55% female, mean age 73 years) were evaluated. Preoperatively, 45 (34.1%) patients were classified as good sleepers (GS: PSQI ≤5, range 1–21 (worst)) and 87 (65.9%) as poor sleepers (PS: PSQI ≥6). Decompression surgery reversed the relationship between PS (31.8%) and GS (68.2%, recovered/improved). Protective fetal sleeping position was the most common (≥70%) before and after surgery for both PS and GS. Risk factors for PS included female sex (p = 0.03), obesity (p = 0.03), high NRS back pain score (p = 0.008), and high SSM symptom score (p = 0.004). MRI imaging did not differ between PS and GS.</p></div><div><h3>Discussion and conclusion</h3><p>LSS had a negative effect on sleep quality, whereas surgical decompression had a positive effect. The protective fetal sleeping position was the preferred position both before and after surgery.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"Article 102785"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424000419/pdfft?md5=eb7bb88cdbabf2d39cecb571529b55e2&pid=1-s2.0-S2772529424000419-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140274313","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 : 2024-01-01DOI: 10.1016/j.bas.2023.102741
Elise K. Kristensen , Kay Müller , Tor Ingebrigtsen , Haakon Lindekleiv , Roar Kloster , Jørgen G. Isaksen
Introduction
Studies report rates of treatment-requiring postoperative intracranial haemorrhage after craniotomy around 1–2%, but do not distinguish between supratentorial and posterior fossa operations. Reports about intracranial haemorrhages’ temporal occurrence show conflicting results. Recommendations for duration of postoperative monitoring vary.
Research question
To determine the rate, temporal pattern and clinical presentation of reoperation-requiring postoperative intracranial posterior fossa haemorrhage.
Material and methods
This retrospective case-series identified cases operated with posterior fossa craniotomy or craniectomy between January 1, 2007 and December 31, 2021 by an electronic search in the patient administrative database, and collected data about patient- and treatment-characteristics, postoperative monitoring, and the occurrence of haemorrhagic and other serious postoperative complications.
Results
We included 62 (n = 34, 55% women) cases with mean age 48 (interquartile range 50) years operated for tumours (n = 34, 55%), Chiari malformations (n = 18, 29%), ischemic stroke (n = 6, 10%) and other lesions (n = 3, 5%). One (2%) 66-year-old woman who was a daily smoker operated with decompressive craniectomy and infarct resection, developed a reoperation-requiring postoperative intracranial haemorrhage after 25.5 h. In four (6%) cases, other serious complications requiring reoperation or transfer from the post anaesthesia care unit or regular bed wards to the intensive care unit occurred after 0.5, 6, 9 and 54 h, respectively.
Discussion and conclusion
Treatment-requiring postoperative intracranial haemorrhage and other serious complications after posterior fossa craniotomies occur over a wide timespan and are difficult to capture with a standardized postoperative monitoring time. This indicates that the duration of monitoring should be individualized based on assessment of risk factors.
{"title":"Reoperation-requiring postoperative intracranial haemorrhage after posterior fossa craniotomy: Retrospective case-series","authors":"Elise K. Kristensen , Kay Müller , Tor Ingebrigtsen , Haakon Lindekleiv , Roar Kloster , Jørgen G. Isaksen","doi":"10.1016/j.bas.2023.102741","DOIUrl":"https://doi.org/10.1016/j.bas.2023.102741","url":null,"abstract":"<div><h3>Introduction</h3><p>Studies report rates of treatment-requiring postoperative intracranial haemorrhage after craniotomy around 1–2%, but do not distinguish between supratentorial and posterior fossa operations. Reports about intracranial haemorrhages’ temporal occurrence show conflicting results. Recommendations for duration of postoperative monitoring vary.</p></div><div><h3>Research question</h3><p>To determine the rate, temporal pattern and clinical presentation of reoperation-requiring postoperative intracranial posterior fossa haemorrhage.</p></div><div><h3>Material and methods</h3><p>This retrospective case-series identified cases operated with posterior fossa craniotomy or craniectomy between January 1, 2007 and December 31, 2021 by an electronic search in the patient administrative database, and collected data about patient- and treatment-characteristics, postoperative monitoring, and the occurrence of haemorrhagic and other serious postoperative complications.</p></div><div><h3>Results</h3><p>We included 62 (n = 34, 55% women) cases with mean age 48 (interquartile range 50) years operated for tumours (n = 34, 55%), Chiari malformations (n = 18, 29%), ischemic stroke (n = 6, 10%) and other lesions (n = 3, 5%). One (2%) 66-year-old woman who was a daily smoker operated with decompressive craniectomy and infarct resection, developed a reoperation-requiring postoperative intracranial haemorrhage after 25.5 h. In four (6%) cases, other serious complications requiring reoperation or transfer from the post anaesthesia care unit or regular bed wards to the intensive care unit occurred after 0.5, 6, 9 and 54 h, respectively.</p></div><div><h3>Discussion and conclusion</h3><p>Treatment-requiring postoperative intracranial haemorrhage and other serious complications after posterior fossa craniotomies occur over a wide timespan and are difficult to capture with a standardized postoperative monitoring time. This indicates that the duration of monitoring should be individualized based on assessment of risk factors.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"Article 102741"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529423010299/pdfft?md5=68b3bb59d2c5634e06bfb830d3f358c0&pid=1-s2.0-S2772529423010299-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099675","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 : 2024-01-01DOI: 10.1016/j.bas.2024.102822
K. Gousias , A. Hoyer , L.A. Mazurczyk , J. Bartek Jr. , M. Bruneau , E. Celtikci , N. Foroglou , C. Freyschlag , R. Grossman , C. Jungk , P. Metellus , D. Netuka , R. Rola , P. Schucht , C. Senft , F. Signorelli , A.J.P.E. Vincent , M. Simon
Introduction
Technical advances and the increasing role of interdisciplinary decision-making may warrant formal definitions of expertise in surgical neuro-oncology.
Research question
The EANS Neuro-oncology Section felt that a survey detailing the European neurosurgical perspective on the concept of expertise in surgical neuro-oncology might be helpful.
Material and methods
The EANS Neuro-oncology Section panel developed an online survey asking questions regarding criteria for expertise in neuro-oncological surgery and sent it to all individual EANS members.
Results
Our questionnaire was completed by 251 respondents (consultants: 80.1%) from 42 countries. 67.7% would accept a lifetime caseload of >200 cases and 86.7% an annual caseload of >50 as evidence of neuro-oncological surgical expertise. A majority felt that surgeons who do not treat children (56.2%), do not have experience with spinal fusion (78.1%) or peripheral nerve tumors (71.7%) may still be considered experts. Majorities believed that expertise requires the use of skull-base approaches (85.8%), intraoperative monitoring (83.4%), awake craniotomies (77.3%), and neuro-endoscopy (75.5%) as well as continuing education of at least 1/year (100.0%), a research background (80.0%) and teaching activities (78.7%), and formal interdisciplinary collaborations (e.g., tumor board: 93.0%). Academic vs. non-academic affiliation, career position, years of neurosurgical experience, country of practice, and primary clinical interest had a minor influence on the respondents’ opinions.
Discussion and conclusion
Opinions among neurosurgeons regarding the characteristics and features of expertise in neuro-oncology vary surprisingly little. Large majorities favoring certain thresholds and qualitative criteria suggest a consensus definition might be possible.
{"title":"Expertise in surgical neuro-oncology. Results of a survey by the EANS neuro-oncology section","authors":"K. Gousias , A. Hoyer , L.A. Mazurczyk , J. Bartek Jr. , M. Bruneau , E. Celtikci , N. Foroglou , C. Freyschlag , R. Grossman , C. Jungk , P. Metellus , D. Netuka , R. Rola , P. Schucht , C. Senft , F. Signorelli , A.J.P.E. Vincent , M. Simon","doi":"10.1016/j.bas.2024.102822","DOIUrl":"10.1016/j.bas.2024.102822","url":null,"abstract":"<div><h3>Introduction</h3><p>Technical advances and the increasing role of interdisciplinary decision-making may warrant formal definitions of expertise in surgical neuro-oncology.</p></div><div><h3>Research question</h3><p>The EANS Neuro-oncology Section felt that a survey detailing the European neurosurgical perspective on the concept of expertise in surgical neuro-oncology might be helpful.</p></div><div><h3>Material and methods</h3><p>The EANS Neuro-oncology Section panel developed an online survey asking questions regarding criteria for expertise in neuro-oncological surgery and sent it to all individual EANS members.</p></div><div><h3>Results</h3><p>Our questionnaire was completed by 251 respondents (consultants: 80.1%) from 42 countries. 67.7% would accept a lifetime caseload of >200 cases and 86.7% an annual caseload of >50 as evidence of neuro-oncological surgical expertise. A majority felt that surgeons who do not treat children (56.2%), do not have experience with spinal fusion (78.1%) or peripheral nerve tumors (71.7%) may still be considered experts. Majorities believed that expertise requires the use of skull-base approaches (85.8%), intraoperative monitoring (83.4%), awake craniotomies (77.3%), and neuro-endoscopy (75.5%) as well as continuing education of at least 1/year (100.0%), a research background (80.0%) and teaching activities (78.7%), and formal interdisciplinary collaborations (e.g., tumor board: 93.0%). Academic vs. non-academic affiliation, career position, years of neurosurgical experience, country of practice, and primary clinical interest had a minor influence on the respondents’ opinions.</p></div><div><h3>Discussion and conclusion</h3><p>Opinions among neurosurgeons regarding the characteristics and features of expertise in neuro-oncology vary surprisingly little. Large majorities favoring certain thresholds and qualitative criteria suggest a consensus definition might be possible.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"Article 102822"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277252942400078X/pdfft?md5=983375cb604b16d482539e4c85e875bc&pid=1-s2.0-S277252942400078X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141056576","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 : 2024-01-01DOI: 10.1016/j.bas.2024.102840
Frank Kandziora, Wilco Peul
{"title":"Becoming an affiliated society of Brain and spine","authors":"Frank Kandziora, Wilco Peul","doi":"10.1016/j.bas.2024.102840","DOIUrl":"10.1016/j.bas.2024.102840","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"Article 102840"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424000961/pdfft?md5=8aef2347332e25d9d6f3f59b3563e875&pid=1-s2.0-S2772529424000961-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141142624","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}
{"title":"Letter to the Editor: “AI and ML in Alzheimer's disease: Transforming early detection and drug development”","authors":"Senthamil Selvi Poongavanam, Archana Behera, Mukesh Kumar Dharmalingam Jothinathan","doi":"10.1016/j.bas.2024.102847","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102847","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"Article 102847"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424001036/pdfft?md5=643c8af2ceb256810b52d0b17b64306e&pid=1-s2.0-S2772529424001036-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141303726","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}
Surgical approaches for tumors of the orbital apex and the spheno-orbital region (SOR) comprehend medial and lateral corridors. The TransOrbital NeuroEndoscopic (TONE) approach has recently been reported as a possible effective alternative to the classic lateral corridors, but literature about is still underestimated.
Research question
The aim of this study was to make a critical appraisal of the results of using the lateral TONE approach in a monocentric consecutive series of SOR tumors.
Material and methods
Data from 38 consecutive patients managed surgically by means of a lateral TONE approach for a tumor involving the orbital apex and the SOR were collected and retrospectively reviewed from 2016, January 1st to 2023, December 31st.
Results
Mean age was 57 ± 14,9 years (23 female). 20 tumors were intraconal, with intradural involvement of SOR in 5 cases. Gross total resection was achieved in 82,9% of the 35 cases treated with a curative intent. Average operative time was 94,8 ± 28,5 and 140,2 ± 43,3 min for extraconal and intraconal tumors, respectively. Meningiomas had an overall prevalence of 31,6%. The complication rate was 21%, of which 87,5% transient. The recurrence rate was 0 for meningiomas and 14,3% for malignant tumors based on a follow-up of 55,3 ± 26,3 and 68,6 ± 17 months, respectively.
Discussion and conclusion
The lateral TONE approach is the approach of choice for tumors involving the lateral compartment of the orbital apex. It is also an effective and minimal invasive option in selected cases of spheno-orbital intradural tumors with no encasement of intracranial vessels.
导言眶顶和眶隔区（SOR）肿瘤的手术方法包括内侧和外侧走廊。最近有报道称，经眶神经内窥镜（TONE）方法可能是经典外侧走廊的有效替代方法，但有关文献对此仍估计不足。本研究的目的是对在单中心连续系列 SOR 肿瘤中使用外侧 TONE 方法的结果进行严格评估。材料和方法收集了自2016年1月1日至2023年12月31日期间，通过侧向TONE方法对累及眶顶和SOR的肿瘤进行手术治疗的38例连续患者的数据，并进行了回顾性回顾。20例肿瘤为锥体内肿瘤，5例肿瘤累及SOR。在以治愈为目的进行治疗的 35 例病例中，82.9% 实现了全切。锥体外肿瘤和锥体内肿瘤的平均手术时间分别为94.8±28.5分钟和140.2±43.3分钟。脑膜瘤的总发病率为31.6%。并发症发生率为21%，其中87.5%为一过性。脑膜瘤的复发率为 0，恶性肿瘤的复发率为 14.3%，随访时间分别为 55.3 ± 26.3 个月和 68.6 ± 17 个月。对于选择性眶内硬膜外肿瘤且未包绕颅内血管的病例，它也是一种有效的微创方法。
{"title":"Lateral transorbital neuroendoscopic approach for tumors of the orbital apex and spheno-orbital region: Technique, feasibility, efficacy, and safety based on a consecutive case series","authors":"Cesare Zoia , Daniele Bongetta , Giannantonio Spena , Giorgio Mantovani , Gianluca Mezzini , Pasquale De Bonis , Sabino Luzzi","doi":"10.1016/j.bas.2024.102856","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102856","url":null,"abstract":"<div><h3>Introduction</h3><p>Surgical approaches for tumors of the orbital apex and the spheno-orbital region (SOR) comprehend medial and lateral corridors. The TransOrbital NeuroEndoscopic (TONE) approach has recently been reported as a possible effective alternative to the classic lateral corridors, but literature about is still underestimated.</p></div><div><h3>Research question</h3><p>The aim of this study was to make a critical appraisal of the results of using the lateral TONE approach in a monocentric consecutive series of SOR tumors.</p></div><div><h3>Material and methods</h3><p>Data from 38 consecutive patients managed surgically by means of a lateral TONE approach for a tumor involving the orbital apex and the SOR were collected and retrospectively reviewed from 2016, January 1st to 2023, December 31st.</p></div><div><h3>Results</h3><p>Mean age was 57 ± 14,9 years (23 female). 20 tumors were intraconal, with intradural involvement of SOR in 5 cases. Gross total resection was achieved in 82,9% of the 35 cases treated with a curative intent. Average operative time was 94,8 ± 28,5 and 140,2 ± 43,3 min for extraconal and intraconal tumors, respectively. Meningiomas had an overall prevalence of 31,6%. The complication rate was 21%, of which 87,5% transient. The recurrence rate was 0 for meningiomas and 14,3% for malignant tumors based on a follow-up of 55,3 ± 26,3 and 68,6 ± 17 months, respectively.</p></div><div><h3>Discussion and conclusion</h3><p>The lateral TONE approach is the approach of choice for tumors involving the lateral compartment of the orbital apex. It is also an effective and minimal invasive option in selected cases of spheno-orbital intradural tumors with no encasement of intracranial vessels.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"Article 102856"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424001127/pdfft?md5=da56d8e05f0fb5549ca1da7c6f83cca5&pid=1-s2.0-S2772529424001127-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541039","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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