Brain & spine最新文献

{"title":"Mapping the circle of Trolard: A holistic view of its role in neurosurgical practice, anatomical perspectives and clinical applications","authors":"Oday Atallah ,&nbsp;Ahmed Muthana ,&nbsp;Vivek Sanker ,&nbsp;Omar Wawi ,&nbsp;Samer S. Hoz","doi":"10.1016/j.bas.2024.102789","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102789","url":null,"abstract":"<div><h3>Introduction</h3><p>An anatomical structure that resembles the circle of Willis, the circle of Trolard is generated in the basal cistern and travels around the midbrain in a roundabout manner, passing adjacent to the lateral side of the cerebral peduncle.</p></div><div><h3>Research question</h3><p>The primary objective of this article is to provide neurosurgeons with a comprehensive understanding of Trolard's circle, emphasizing its anatomical features and clinical significance.</p></div><div><h3>Material and methods</h3><p>A comprehensive evaluation of the available literature pertaining to the venous circle of Trolard was conducted by conducting searches in the PubMed, Web of Science, and Scopus databases. In the present overview, the terminologies “venous circle of Trolard,” “basal venous circle,” and “basal vein of Rosenthal” were employed.</p></div><div><h3>Results</h3><p>Upon doing a comprehensive examination of the existing literature and primary sources pertaining to the venous circle of Trolard, it was discovered that an only six studies had been conducted on this particular subject matter. We made observations regarding the anatomical characteristics of the subject and engaged in a discussion regarding their prospective applications and importance within the context of neurosurgical procedures.</p></div><div><h3>Discussion and conclusion</h3><p>The scarcity of research on these structures is attributed to the challenges associated in studying them in vivo. Through directing focus towards these structures, our aim is to stimulate further investigation into their potential involvement in a range of neurological and neurosurgical disorders.</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/S2772529424000456/pdfft?md5=d85392ff70f9816155d1c7792d8eb7f3&pid=1-s2.0-S2772529424000456-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140209480","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":"Mathematical modelling of cerebral haemodynamics and their effects on ICP","authors":"Ka Hing Chu ,&nbsp;Ihsane Olakorede ,&nbsp;Erta Beqiri ,&nbsp;Marek Czosnyka ,&nbsp;Peter Smielewski","doi":"10.1016/j.bas.2024.102772","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102772","url":null,"abstract":"<div><h3>Introduction</h3><p>Electrical-equivalence mathematical models that integrate vascular and cerebrospinal fluid (CSF) compartments perform well in simulations of dynamic cerebrovascular variations and their transient effects on intracranial pressure (ICP). However, ICP changes due to sustained vascular diameter changes have not been comprehensively examined. We hypothesise that changes in cerebrovascular resistance (CVR) alter the resistance of the bulk flow of interstitial fluid (ISF).</p></div><div><h3>Research question</h3><p>We hypothesise that changes in CVR alter the resistance of the bulk flow of ISF, thus allowing simulations of ICP in response to sustained vascular diameter changes.</p></div><div><h3>Material and methods</h3><p>A lumped parameter model with vascular and CSF compartments was constructed and converted into an electrical analogue. The flow and pressure responses to transient hyperaemic response test (THRT) and CSF infusion test (IT) were observed. Arterial blood pressure (ABP) was manipulated to simulate ICP plateau waves. The experiments were repeated with a modified model that included the ISF compartment.</p></div><div><h3>Results</h3><p>Simulations of the THRT produced identical cerebral blood flow (CBF) responses. ICP generated by the new model reacted in a similar manner as the original model during ITs. Plateau pressure reached during ITs was however higher in the ISF model. Only the latter was successful in simulating the onset of ICP plateau waves in response to selective blood pressure manipulations.</p></div><div><h3>Discussion and conclusion</h3><p>Our simulations highlighted the importance of including the ISF compartment, which provides mechanism explaining sustained haemodynamic influences on ICP. Consideration of such interactions enables accurate simulations of the cerebrovascular effects on ICP.</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/S2772529424000286/pdfft?md5=aeb793258ac787bba144d812460a34d4&pid=1-s2.0-S2772529424000286-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139936893","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":"A rare trifocal presentation of a choroid plexus papilloma: Case report and review of the literature","authors":"Senne Broekx ,&nbsp;Mania De Praeter","doi":"10.1016/j.bas.2024.102774","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102774","url":null,"abstract":"<div><h3>Introduction</h3><p>CPP's present as slow-growing intraventricular neoplasms arising from epithelium of choroid plexus. They account for approximately 0.5–4% of intracranial neoplasms in adults and children, respectively. A trifocal presentation is exceedingly rare.</p></div><div><h3>Research question</h3><p>We describe the case of a trifocal presentation of a CPP and explored the importance of genetic analyses.</p></div><div><h3>Material and methods</h3><p>We present the case of an 18-year old adolescent who was treated for a fourth ventricular and suprasellar neoplasm. Brain MRI revealed an intraventricular lesion in the fourth ventricle, as well as a suprasellar lesion and a lesion located in the left internal auditory meatus. An adult-subtype CPP (WHO grade 1) was confirmed by means of histological and genetic analyses in the first two regions.</p></div><div><h3>Results</h3><p>Optimal treatment strategy remains controversial, although it is accepted that surgical resection alone remains the gold standard, whereas chemoradiotherapy is reserved for specific cases. There are only a few articles reporting on a multifocal presentation or the coexistence of synchronous histologically different primary brain neoplasms. Reports on genetic examination are scarce.</p></div><div><h3>Discussion and conclusion</h3><p>CPP's should be included in the differential diagnosis of posterior fossa tumors, both in children and adults. Genetic analyses (TP53/TERT mutations) should be considered, since they entail important diagnostic, prognostic and therapeutic implications. When a TERT mutation is present, adjuvant radiotherapy should be used with caution, since it plays a role in tumorigenesis, even when GTR could not be achieved. There is an association between TERT methylation status and malignant transformation, indicating that these patients should be followed more closely.</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/S2772529424000304/pdfft?md5=05fc6a66a15a789bc147541a9537c7a1&pid=1-s2.0-S2772529424000304-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140000060","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":"Discussing sexual health with patients eligible for spine surgery: An online survey in spine surgeon and pain physicians","authors":"Lisa Goudman ,&nbsp;David van Schaik ,&nbsp;Tjeerd Jager ,&nbsp;Maarten Moens ,&nbsp;Thierry Scheerlinck","doi":"10.1016/j.bas.2024.102776","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102776","url":null,"abstract":"<div><h3>Introduction</h3><p>Spinal pain syndromes have a severe impact on the patient's sex life, contributing to a decrease in sexual function and sexual satisfaction. Despite the importance of sexual health on mental and physical wellbeing, sexual health is rarely discussed during consultations.</p></div><div><h3>Research question</h3><p>The aim of this study is to explore to what extent influencing factors can alter the discussion about sexual health during consultations. More specifically, we will evaluate the influence of healthcare profession, sex of the patient and the surgical approach that is proposed.</p></div><div><h3>Material and methods</h3><p>An online survey was sent to neurosurgeons, pain physicians and orthopedists in Belgium and The Netherlands in April 2019. Participants were asked about; counseling routine, knowledge, and opinion on sexual health. Answers were scored on a 5-point Likert scale. Independence between the response levels and type of surgery as well as profession were tested.</p></div><div><h3>Results</h3><p>In total, 350 respondents were approached of whom 57 completed the survey. The majority of respondents (61.4%) indicated that they rarely or never discussed sexual disturbances. Profession and type of surgery had an influence on discussing erectile dysfunction, retrograde ejaculation, and alterations in orgasms. Thirty-five percent of healthcare providers considered it the patient's responsibility to bring up the subject of sexual health.</p></div><div><h3>Discussion and conclusion</h3><p>Sexual health is rarely addressed by healthcare providers during spinal care. Profession as well as type of surgery seems to play a role on whether sexual health is discussed during consultations.</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/S2772529424000328/pdfft?md5=e23b5c6f4f4fef1a207177c4a8d86fef&pid=1-s2.0-S2772529424000328-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140031350","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":"Preoperative risk factors for nonsatisfaction after lumbar interbody fusion","authors":"Cyrus Zamany ,&nbsp;Søren Ohrt-Nissen ,&nbsp;Peter Muhareb Udby","doi":"10.1016/j.bas.2024.102784","DOIUrl":"10.1016/j.bas.2024.102784","url":null,"abstract":"<div><h3>Introduction</h3><p>Low back pain (LBP) is a common cause of impaired quality of life and disability and studies regarding surgical management of patients with LBP show a high variation in patient-reported success rate.</p></div><div><h3>Research question</h3><p>To find valuable preoperative clinical risk factors and variables associated with a non-satisfactory patient-reported outcome following surgery.</p></div><div><h3>Materials and methods</h3><p>The Danish surgical spine database (DaneSpine) was used to collect eight years of pre- and postoperative data on patients undergoing single-level fusions with either posterior- (PLIF) or transforaminal lumbar interbody fusions (TLIF). The primary outcome was patient nonsatisfaction. We collected data on European Quality of Life–5 Dimensions (EQ-5D), visual analogue scale (VAS), Oswestry Disability Index (ODI) score, pain intensity, duration of back pain, previous discectomy, and expectations regarding return to work after surgery at 2-year follow-up.</p></div><div><h3>Results</h3><p>The cohort included 453 patients of which 19% reported treatment nonsatisfaction. The nonsatisfaction group demonstrated higher preoperative VAS scores for back pain (75 ± 19 vs. 68 ± 21, p = 0.006) and leg pain (65 ± 25 vs. 58 ± 28, p = 0.004). The preoperative EQ-5D score was significantly lower in the nonsatisfaction group (0.203 + 0.262 vs. 0.291 ± 0.312, p = 0.016). There was no statistical significance between patient nonsatisfaction and preoperative ODI score, age, body mass index, duration of back pain or expectations regarding return to work after surgery.</p></div><div><h3>Discussion and conclusion</h3><p>Low preoperative EQ-5D scores and high VAS leg and back pain scores were statistically significant with patient nonsatisfaction following surgery and may prove to be valuable tools in the preoperative screening and alignment of patient expectations.</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/S2772529424000407/pdfft?md5=c0b8db6d142d6c587b383f86a29b4a4e&pid=1-s2.0-S2772529424000407-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277795","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":"Long-term follow-up after vertebroplasty – A mean 10-years follow-up control study","authors":"Fabian Cedric Aregger ,&nbsp;Felix Gerber ,&nbsp;Christoph Albers ,&nbsp;Katharina Oswald ,&nbsp;Christian Knoll ,&nbsp;Lorin Benneker ,&nbsp;Paul Heini ,&nbsp;Ulrich Berlemann ,&nbsp;Sven Hoppe","doi":"10.1016/j.bas.2024.102783","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102783","url":null,"abstract":"<div><h3>Objectives</h3><p>To evaluate the clinical 10 year outcome of patients treated with percutaneous vertebroplasty for vertebral compression fractures and to determine the incidence of new fractures in this time interval, as well as the mortality of the patients who underwent this procedure.</p></div><div><h3>Methods</h3><p>All patients undergoing vertebroplasty for vertebral compression fractures between May 2007 until July 2008 were prospectively followed up at 10 years postoperatively. Patients were assessed for radiologic outcome and self-reported outcome parameters (PROs). Gathered parameters remained unmodified to the initial ones analyzing QoL improvement (EQ5D 3L and NASS score) and pain alleviation (VAS, NRS). Mortality was defined as an additional endpoint. Exclusion criteria include additional instrumentation, use of additional devices such as kyphoplasty balloons/stentoplasty, cognitive impairment, insufficient radiological documentation or absent re-consent.</p></div><div><h3>Results</h3><p>Of 280 patients who underwent vertebroplasty, 49 (17.5%) were available for re-assessment with a mean follow-up of 10.5 years (9.9–11.1). Thirty patients (10.7%) were assessed clinically and radiologically, 16 (5.7%) in written form and three (1.1%) by phone only. A total of 186 (66.4%) died during the follow up period. Out of the remaining 45 patients, 27 patients declined participation, eight couldn't participate due to cognitive impairment, four had insufficient radiologic documentation. Six patients were lost to follow-up. At 10 years, patients reported a consistently improved quality of life (EQ-5D; p &lt; 0.01) and global satisfaction. Vertebroplasty demonstrated a substantial and enduring effect on alleviating back pain over 10 years (p &lt; 0.001). 26 (53%) patients experienced a new fracture since the initial procedure.</p></div><div><h3>Conclusion</h3><p>A decade following vertebroplasty, patients continue to demonstrate a quality of life and pain level comparable to short and medium-term assessments, with a significant difference from baseline measurements. More than half (53%) of the patients participating at last follow-up experienced new fractures during this interim period. The cohort as a whole has been impacted by an elevated mortality rate over the time period.</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/S2772529424000390/pdfft?md5=240fbbc17685ea3bc6c2f4cd9912fd76&pid=1-s2.0-S2772529424000390-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140540446","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":"Neurosurgery compared to orthopedic spine consultation: A single level I trauma center experience","authors":"Shaina Sedighim ,&nbsp;Brynn Sargent ,&nbsp;Areg Grigorian ,&nbsp;Christina Grabar ,&nbsp;Anvesh R. Macherla ,&nbsp;Michael Oh ,&nbsp;Yu-Po Lee ,&nbsp;John Scolaro ,&nbsp;Jefferson Chen ,&nbsp;Jeffry Nahmias","doi":"10.1016/j.bas.2024.102808","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102808","url":null,"abstract":"<div><h3>Introduction</h3><p>Both Orthopedic Surgery (OS) and Neurosurgery (NS) perform spine surgery in the setting of trauma. However, it is unknown whether outcomes differ between these specialties. This study compares management and outcomes for vertebral fractures between NS and OS, hypothesizing similar operation rate, length of stay (LOS), and readmission.</p></div><div><h3>Research question</h3><p>Do outcomes differ between NS and OS in the management of vertebral fractures following trauma?</p></div><div><h3>Methods</h3><p>A retrospective single-center study was conducted on adult patients with cervical, thoracic, lumbar, and sacral fractures treated at a single trauma center, where no standardized pathway exists across NS and OS. Patients were compared for injury profile, diagnostic imaging, and operative techniques as well as LOS, mortality, and complications.</p></div><div><h3>Results</h3><p>A total of 630 vertebral fracture patients (OS:350 (55.6%); NS:280 (44.4%)) were included. NS utilized magnetic resonance imaging (MRI) more commonly (36.4% vs. 22.6%, p &lt; 0.001). NS patients more often underwent operation (13.2% vs. 7.4%, p = 0.016) despite similar fracture number and severity (p &gt; 0.05). Post-operative complications, LOS, and readmission rates were similar between cohorts (p &gt; 0.05).</p></div><div><h3>Discussion and conclusion</h3><p>Despite similar injury profiles, NS had higher rates of MRI usage and operative interventions in the context of traumatic spine fractures. Despite differences in management, major clinical outcomes were similar between NS and OS. However, we do call for further standardization of evaluation and treatment of patients based on established algorithms from such as the AOSpine Thoracolumbar Spine Injury Classification System (ATLICS).</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/S277252942400064X/pdfft?md5=a50312dec2b25597817877dc3ae7b6bf&pid=1-s2.0-S277252942400064X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140535576","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":"Simulation to become a better neurosurgeon. An international prospective controlled trial: The Passion study","authors":"Claudia Fanizzi ,&nbsp;Giovanni Carone ,&nbsp;Alessandra Rocca ,&nbsp;Roberta Ayadi ,&nbsp;Veronika Petrenko ,&nbsp;Cecilia Casali ,&nbsp;Martina Rani ,&nbsp;Marta Giachino ,&nbsp;Lydia Viviana Falsitta ,&nbsp;Enrico Gambatesa ,&nbsp;Tommaso Francesco Galbiati ,&nbsp;Eleonora Francesca Orena ,&nbsp;Irene Tramacere ,&nbsp;Nicole Irene Riker ,&nbsp;Alessandro Mocca","doi":"10.1016/j.bas.2024.102829","DOIUrl":"10.1016/j.bas.2024.102829","url":null,"abstract":"<div><h3>Introduction</h3><p>Surgical training traditionally adheres to the apprenticeship paradigm, potentially exposing trainees to an increased risk of complications stemming from their limited experience. To mitigate this risk, augmented and virtual reality have been considered, though their effectiveness is difficult to assess.</p></div><div><h3>Research question</h3><p>The PASSION study seeks to investigate the improvement of manual dexterity following intensive training with neurosurgical simulators and to discern how surgeons' psychometric characteristics may influence their learning process and surgical performance.</p></div><div><h3>Material and methods</h3><p>Seventy-two residents were randomized into the simulation group (SG) and control group (CG). The course spanned five days, commencing with assessment of technical skills in basic procedures within a wet-lab setting on day 1. Over the subsequent core days, the SG engaged in simulated procedures, while the CG carried out routine activities in an OR. On day 5, all residents' technical competencies were evaluated. Psychometric measures of all participants were subjected to analysis.</p></div><div><h3>Results</h3><p>The SG demonstrated superior performance (p &lt; 0.0001) in the brain tumour removal compared to the CG. Positive learning curves were evident in the SG across the three days of simulator-based training for all tumour removal tasks (all p-values &lt;0.05). No significant differences were noted in other tasks, and no meaningful correlations were observed between performance and any psychometric parameters.</p></div><div><h3>Discussion and conclusion</h3><p>A brief and intensive training regimen utilizing 3D virtual reality simulators enhances residents' microsurgical proficiency in brain tumour removal models. Simulators emerge as a viable tool to expedite the learning curve of in-training neurosurgeons.</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/S2772529424000857/pdfft?md5=c37936d5d9f29332ca79de902f83580c&pid=1-s2.0-S2772529424000857-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141028499","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":"Acute neuroendocrine changes after traumatic brain injury","authors":"Zsofia Dina Magyar-Sumegi ,&nbsp;Levente Stankovics ,&nbsp;Dominika Lendvai-Emmert ,&nbsp;Andras Czigler ,&nbsp;Emoke Hegedus ,&nbsp;Mark Csendes ,&nbsp;Luca Toth ,&nbsp;Zoltan Ungvari ,&nbsp;Andras Buki ,&nbsp;Peter Toth","doi":"10.1016/j.bas.2024.102830","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102830","url":null,"abstract":"<div><h3>Introduction</h3><p>Post-traumatic hypopituitarism (PTHP) is a significant, but often neglected consequence of traumatic brain injury (TBI).</p></div><div><h3>Research question</h3><p>We aimed to provide a comprehensive overview of epidemiology, pathophysiology, clinical features and diagnostic approaches of PTHP.</p></div><div><h3>Materials and methods</h3><p>MEDLINE, EMBASE, Cochrane Library and Web of Science were searched. 45 articles of human studies evaluating acute endocrine changes following mild, moderate and severe TBI were selected.</p></div><div><h3>Results</h3><p>Severity of TBI seems to be the most important risk factor of PTHP. Adrenal insufficiency (AI) was present in 10% of TBI patients (prevalence can be as high as 50% after severe TBI), and hypocortisolemia is a predictor of mortality and long-term hypopituitarism. Suppression of the thyroid axis in 2–33% of TBI patients may be an independent predictor of adverse neurological outcome, as well. 9–36% of patients with severe TBI exhibit decreased function of the somatotrophic axis with a divergent effect on the central nervous system. Arginine-Vasopressin (AVP) deficiency is present in 15–51% of patients, associated with increased mortality and unfavorable outcome. Due to shear and injury of the stalk hyperprolactinemia is relatively common (2–50%), but it bears little clinical significance. Sex hormone levels remain within normal values.</p></div><div><h3>Discussion and conclusion</h3><p>PTHP occurs frequently after TBI, affecting various axis and determining patients’ outcome. However, evidence is scarce regarding exact epidemiology, diagnosis, and effective clinical application of hormone substitution. Future studies are needed to identify patients at-risk, determine the optimal timing for endocrine testing, and refine diagnostic and treatment approaches to improve outcome.</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/S2772529424000869/pdfft?md5=676cc9b51ab387c91eb576a401d50658&pid=1-s2.0-S2772529424000869-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140906079","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":"Global Sagittal Angle and T9-tilt seem to be the most clinically and functionally relevant global alignment parameters in patients with Adult Spinal Deformity","authors":"Nabil Nassim ,&nbsp;Elio Mekhael ,&nbsp;Rami El Rachkidi ,&nbsp;Maria Saadé ,&nbsp;Elma Ayoub ,&nbsp;Ali Rteil ,&nbsp;Elena Jaber ,&nbsp;Celine Chaaya ,&nbsp;Rami Rehayem ,&nbsp;Julien Abi Nahed ,&nbsp;Mohamad Karam ,&nbsp;Ismat Ghanem ,&nbsp;Abir Massaad ,&nbsp;Ayman Assi","doi":"10.1016/j.bas.2024.102805","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102805","url":null,"abstract":"<div><h3>Introduction</h3><p>Radiographic analysis is necessary for the assessment and the surgical planning in adults with spinal deformity (ASD). Restoration of global alignment is key to improving patient's quality of life. However, the large number of existing global alignment parameters can be confusing for surgeons.</p></div><div><h3>Research question</h3><p>To determine the most clinically and functionally relevant global alignment parameters in ASD.</p></div><div><h3>Material and methods</h3><p>ASD and controls underwent full body biplanar X-ray to calculate global alignment parameters: odontoid to hip axis angle (OD-HA), global sagittal angle (GSA), global tilt (GT), SVA, center of auditory meatus to hip axis (CAM-HA), SSA, T1-tilt and T9-tilt. All subjects filled HRQoL questionnaires: ODI, SF-36, VAS for pain and BDI (Beck's Depression Inventory). 3D gait analysis was performed to calculate kinematic and spatio-temporal parameters. A machine learning model predicted gait parameters and HRQoL scores from global alignment parameters.</p></div><div><h3>Results</h3><p>124 primary ASD and 47 controls were enrolled. T9 tilt predicted the most BDI (31%), hip flexion/extension during gait (36%), and double support time (39%). GSA predicted the most ODI (26%), thorax flexion/extension during gait (33%), and cadence (36%).</p></div><div><h3>Discussion and conclusion</h3><p>Among all global alignment parameters, GSA, evaluating both trunk shift and knee flexion, and T9 tilt, evaluating the shift of the center of mass, were the best predictors for most of HRQoL scores and gait kinematics. Therefore, we recommend using GSA and T9 tilt in clinical practice when evaluating ASD because they represent the most quality of life and functional kinematic of these patients.</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/S2772529424000614/pdfft?md5=365199a7f18aa7ab6592023017b8215c&pid=1-s2.0-S2772529424000614-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140549394","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}