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Idiopathic pyogenic thoracic and lumbar spondylodiscitis: outcome of long segment fixation 特发性化脓性胸椎和腰椎盘炎:长节段固定术的结果
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-08 DOI: 10.1186/s41984-024-00314-4
A. Elnaggar, Hosam Eldin Habib
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引用次数: 0
Comparative study of low-density versus high-density pedicular screw implantations in management of adolescent idiopathic scoliosis: a randomized clinical trial 在青少年特发性脊柱侧凸治疗中植入低密度与高密度椎弓根螺钉的比较研究:随机临床试验
Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-05 DOI: 10.1186/s41984-024-00308-2
Hosam Eldin Mostafa, Abdelrhman Saber Sayed Moustafa, Hazem Hassan El Zayat, Ahmed Koheil, Omar Abdel Aleem Ragab
A number of studies have yielded disparate findings regarding the relationship between implant density and curve correction in adolescent idiopathic scoliosis (AIS) surgery. This study compared the efficacy and safety of low-density (LD) versus high-density (HD) pedicular screw implants in the correction of deformity in AIS regarding clinical, radiological, and quality of life outcomes. This study was a single-blind, parallel, randomized trial that enrolled 20 adolescent patients with idiopathic scoliosis scheduled for posterior spinal fusion surgery with all pedicle screw constructs. Patients were randomized into two groups of 10 patients each. The LD group included patients in whom the number of screws per fused spinal level had a density of 1.5 or less, while the HD group had a density greater than 1.5. The primary outcomes were the radiological findings of curve correction. The secondary outcomes included the correlation between implant density and curve correction, the amount of blood loss, operation time, number of screws, fusion level, hospital stay duration, and quality of life assessed by the Scoliosis Research Society 22r questionnaire. Radiologically, the postoperative main curves Cobb angles and their changes were comparable between both approaches without statistical correlation with the implant density (p˃0.05). The LD approach significantly shortened the operative time (p=0.015), number of screws (p=0.011), implant density (p<0.001), and hospital stay (p<0.001). However, quality of life scores before surgery and at final follow-up did not differ between the two techniques (p˃0.05). The use of a low-density approach is an effective and safe methodology for attaining satisfactory deformity correction in AIS patients. Furthermore, this approach confers the additional advantage of reduced operative time, number of screws, implant density, and hospital stay in comparison to the high-density approach. Trial registration Pan African Clinical Trial Registry, PACTR202404611444119. Registered 28 March 2024-Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=29382
关于青少年特发性脊柱侧凸(AIS)手术中植入物密度与曲线矫正之间的关系,许多研究都得出了不同的结论。本研究比较了低密度(LD)和高密度(HD)脊柱螺钉植入物在矫正青少年特发性脊柱侧凸畸形中的临床、放射学和生活质量方面的有效性和安全性。该研究是一项单盲、平行、随机试验,共招募了20名青少年特发性脊柱侧凸患者,他们计划使用所有椎弓根螺钉结构进行脊柱后路融合手术。患者被随机分为两组,每组 10 人。LD组包括每个融合脊柱水平的螺钉数量密度为1.5或以下的患者,而HD组的密度大于1.5。主要结果是曲线矫正的放射学结果。次要结果包括植入物密度与曲线矫正之间的相关性、失血量、手术时间、螺钉数量、融合水平、住院时间,以及脊柱侧弯研究协会 22r 问卷评估的生活质量。从影像学角度看,两种方法的术后主要曲线Cobb角及其变化情况相当,但与植入物密度无统计学相关性(p˃0.05)。LD方法明显缩短了手术时间(p=0.015)、螺钉数量(p=0.011)、植入物密度(p<0.001)和住院时间(p<0.001)。然而,手术前和最后随访时的生活质量评分在两种技术之间没有差异(p˃0.05)。使用低密度方法是一种有效且安全的方法,可使 AIS 患者获得满意的畸形矫正效果。此外,与高密度方法相比,这种方法还具有缩短手术时间、减少螺钉数量、降低植入物密度和缩短住院时间的优势。试验注册泛非临床试验注册中心,PACTR202404611444119。注册日期:2024 年 3 月 28 日-回顾注册,https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=29382
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引用次数: 0
A review on the applications of artificial intelligence and big data for glioblastoma multiforme management 人工智能和大数据在多形性胶质母细胞瘤管理中的应用综述
Q4 CLINICAL NEUROLOGY Pub Date : 2024-07-29 DOI: 10.1186/s41984-024-00306-4
Mahdi Mehmandoost, Fatemeh Torabi Konjin, Elnaz Amanzadeh Jajin, Farzan Fahim, Saeed Oraee Yazdani
Glioblastoma is known as an aggressive type of brain tumor with a very poor survival rate and resistance to different treatment methods. Considering the difficulties in studying glioblastoma, the development of alternative methods for the identification of prognostic factors in this disease seems necessary. Noteworthy, imaging, pathologic, and molecular data obtained from patients are highly valuable because of their potential for this purpose. Artificial intelligence (AI) has emerged as a powerful tool to perform highly accurate analyses and extract more detailed information from available patient data. AI is usually used for the development of prediction models for prognosis, response/resistance to treatments, and subtype identification in cancers. Today, the number of AI-aided developed algorithms is increasing in the field of glioblastoma. Challenges in the diagnosis of tumors using imaging data, prediction of genetic alterations, and prediction of overall survival are among the most popular studies related to glioblastoma. Hereby, we reviewed peer-reviewed articles in which AI methods were used for various targets in glioblastoma. Reviewing the published articles showed that the use of clinical imaging data is reasonably more popular than other assessments because of its noninvasive nature. However, the use of molecular assessments is becoming extended in this disease. In this regard, we summarized the developed algorithms and their applications for the diagnosis and prognosis of glioblastoma tumors. We also considered the accuracy rates of algorithms to shed light on the advancements of different methodologies in the included studies.
众所周知,胶质母细胞瘤是一种侵袭性脑肿瘤,存活率极低,对不同的治疗方法都有抵抗力。考虑到研究胶质母细胞瘤的困难,似乎有必要开发其他方法来确定这种疾病的预后因素。值得注意的是,从患者身上获得的成像、病理和分子数据具有很高的价值,因为它们在这方面具有潜力。人工智能(AI)已成为一种强大的工具,可从现有患者数据中进行高精度分析并提取更多详细信息。人工智能通常用于开发癌症预后、治疗反应/抗药性和亚型识别的预测模型。如今,在胶质母细胞瘤领域,人工智能辅助开发的算法越来越多。使用成像数据诊断肿瘤、预测基因改变和预测总生存期等方面的挑战是与胶质母细胞瘤相关的最热门研究之一。在此,我们回顾了同行评议的文章,这些文章将人工智能方法用于胶质母细胞瘤的各种靶点。对已发表文章的回顾表明,由于临床成像数据的无创性,它比其他评估方法更受欢迎。不过,分子评估的使用在这种疾病中也逐渐得到推广。为此,我们总结了已开发的算法及其在胶质母细胞瘤肿瘤诊断和预后方面的应用。我们还考虑了算法的准确率,以阐明所纳入研究中不同方法的进步。
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引用次数: 0
Anterior cervical discectomy and fusion with and without plating versus laminectomy with and without fusion for multilevel cervical spondylotic myelopathy: a prospective observational study 前路颈椎椎间盘切除术和融合术(带或不带钢板)与椎板切除术(带或不带钢板)治疗多级颈椎病:一项前瞻性观察研究
Q4 CLINICAL NEUROLOGY Pub Date : 2024-07-23 DOI: 10.1186/s41984-024-00309-1
Omar El Farouk Ahmed, Salah A. Hemida, Tarek H. Elserry, Wael Ashour, Abdelrahman Elgayar
Cervical spondylotic myelopathy (CSM) is a chronic progressive spinal compression that usually accompanies age-related degeneration of the cervical spine and represents one of the most common causes of spinal cord dysfunction. Surgical intervention is the foundation of management in symptomatic cases, but the approach of choice is constantly contentious. The aim of this study is to evaluate and appraise different surgical approaches for multilevel cervical spondylotic myelopathy (anterior cervical discectomy and fusion (ACDF) with or without plating and laminectomy with and without fusion) regarding the perioperative data, clinical outcomes, complications rates and radiographic parameters. In this prospective study, sixty patients in four matched cohorts were followed up. The first group (n = 15) underwent ACDF only, the second group (n = 15) underwent ACDF with anterior plate, the third group (n = 15) underwent laminectomy alone, and the fourth group (n = 15) underwent laminectomy with lateral mass fusion. Patients were followed up for twelve-month duration using modified Japanese orthopedic score (mJOA), neck disability index (NDI), visual analogue scale (VAS) and short form 36 (SF-36) in addition to measurement of C2-C7 cobb`s angle to evaluate postoperative cervical sagittal alignment. All the four groups were associated with functional clinical improvement with no statistically significant differences between them. Postoperative cervical lordosis and its change were highest in anterior groups, both plated (11.1 ± 5.2a, 5.1 ± 4.0a) and non-plated (12.0 ± 5.3a, 4.4 ± 3.2a) (p value < 0.001) with no significant difference between them. Postoperative quality of life score and its change were significantly better in plated anterior approach (55.8 ± 4.8a, 21.6 ± 4.9a) and in non-plated (55.6 ± 3.2a, 21.3 ± 4.0a) (p value < 0.001) with no significant difference between both techniques. Operative time was statistically higher in plated anterior approach (202.1 ± 55.9b) and in laminectomy with fusion (229.2 ± 92.9b) (p value < 0.001) with no statistically significant difference between either group. Posterior approaches were associated with significantly higher intraoperative blood loss (280.0 ± 52.3b for laminectomy and 310.0 ± 60.3b for laminectomy with fusion) (p value < 0.001) with no difference between both techniques. Hospital stay was higher in posterior groups as well, but it was not statistically significant (p value = 0.127). Both anterior and posterior approaches were associated with significant functional improvements with no difference in complications severity or frequency. Anterior surgery had shorter hospital stay and less blood loss with better quality of life scores and more successful restoration of cervical lordosis.
颈椎脊髓病(CSM)是一种慢性进行性脊髓压迫症,通常伴随着与年龄有关的颈椎退化,是导致脊髓功能障碍的最常见原因之一。手术干预是治疗无症状病例的基础,但选择何种方法一直存在争议。本研究旨在评估和评价多椎间脊柱病的不同手术方法(带或不带钢板的颈椎前路椎间盘切除和融合术(ACDF)以及带或不带融合术的椎板切除术)的围术期数据、临床疗效、并发症发生率和影像学参数。在这项前瞻性研究中,对四组匹配的六十名患者进行了随访。第一组(15 人)仅接受了 ACDF,第二组(15 人)接受了带前路钢板的 ACDF,第三组(15 人)仅接受了椎板切除术,第四组(15 人)接受了椎板切除术和侧块融合术。对患者进行了为期12个月的随访,采用改良日本骨科评分(mJOA)、颈部残疾指数(NDI)、视觉模拟量表(VAS)和SF-36短表(SF-36)以及C2-C7 cobb`s角测量来评估术后颈椎矢状排列。所有四组患者的临床功能均有所改善,组间差异无统计学意义。术后颈椎前凸及其变化在前路组中最高,包括有钢板组(11.1 ± 5.2a,5.1 ± 4.0a)和无钢板组(12.0 ± 5.3a,4.4 ± 3.2a)(P值< 0.001),两者之间无显著差异。术后生活质量评分及其变化在有钢板前路法(55.8±4.8a,21.6±4.9a)和无钢板前路法(55.6±3.2a,21.3±4.0a)中明显更好(P值<0.001),两种技术之间无明显差异。据统计,带钢板的前路手术(202.1 ± 55.9b)和带融合的椎板切除术(229.2 ± 92.9b)的手术时间较长(P值< 0.001),两组之间的差异无统计学意义。后路方法的术中失血量明显更高(椎板切除术为 280.0 ± 52.3b,椎板切除加融合术为 310.0 ± 60.3b)(p 值 < 0.001),两种方法之间没有差异。后路组的住院时间也更长,但无统计学意义(p 值 = 0.127)。前路和后路手术都能显著改善患者的功能,但并发症的严重程度和发生频率没有差异。前路手术的住院时间更短,失血量更少,生活质量评分更高,颈椎前凸的恢复更成功。
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引用次数: 0
Shunt-related brain tumor, a case report presenting a rare complication and review of literature 与顺行有关的脑肿瘤:罕见并发症病例报告和文献综述
Q4 CLINICAL NEUROLOGY Pub Date : 2024-07-17 DOI: 10.1186/s41984-024-00313-5
Michael Zohney, Mohamed M Aziz, Shebl Izz-alarab, Ahmed A Algredly, Abdelaleem Abdelwahab
Congenital hydrocephalus is a well-known neurosurgical condition in the pediatric age group. Ventriculoperitoneal shunt (VPS) placement is a standard procedure with a high incidence of complications in the first year postoperatively. We present a very rare complication, with only a few reported cases in the accessible literature, in which a tumor arises in relation to a shunt catheter. A case report. We describe a case of a VPS placement in an eleven-month-old boy who, at the age of thirteen, presented with a two-month period of convulsions caused by a cortical mass related to the shunt catheter. Surgical excision of the mass revealed atypical meningioma (WHO Grade 2). The tumor may have been initiated by direct irritation of the shunt catheter or just an unfortunate simultaneous event for this child. Further analysis is needed to determine which factors could have led to such a complication and to predict its occurrence in future patients. In this case, the pathologic features, duration, and unusual radiologic findings are interesting and unique.
先天性脑积水是众所周知的小儿神经外科疾病。脑室腹腔分流术(VPS)是一种标准手术,术后第一年的并发症发生率很高。我们介绍了一种非常罕见的并发症,在可查阅的文献中仅有几例报道,即肿瘤与分流导管相关。病例报告。我们描述了一例为 11 个月大的男孩植入 VPS 的病例,该男孩在 13 岁时因与分流导管相关的皮质肿块引起了两个月的抽搐。手术切除肿块后发现了非典型脑膜瘤(世卫组织 2 级)。肿瘤可能是由分流导管直接刺激引起的,也可能只是该患儿同时发生的不幸事件。需要进行进一步分析,以确定哪些因素可能导致这种并发症,并预测其在未来患者中的发生率。在这个病例中,病理特征、病程和不寻常的放射学发现都非常有趣和独特。
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引用次数: 0
Surgical outcome of endoscopic endonasal approach as a modality of management for large and giant pituitary adenomas: a retrospective case series 以内窥镜鼻内入路治疗巨大垂体腺瘤的手术效果:回顾性病例系列研究
Q4 CLINICAL NEUROLOGY Pub Date : 2024-07-11 DOI: 10.1186/s41984-024-00311-7
Shebl Izz-alarab, Michael Zohney, Saied A. Issa, Abdelaleem Abdelwahab, Ashraf G. Al-Abyad, Mohamed M. Aziz
Large and giant pituitary adenomas (defined as tumors of maximal diameter ≥ 3–3.9 cm and ≥ 4 cm, respectively) present considerable surgical challenges regarding the extent of resection and perioperative morbidity. Endoscopic endonasal resection is considered the most effective treatment for pituitary adenomas. It allows for better visualization, maneuverability, and access to distant and lateral tumor compartments, ultimately enhancing the extent of resection. This article evaluates our initial experience with endoscopic endonasal resection of large and giant pituitary adenomas. The clinical outcomes, perioperative complications, and extent of tumor resection would be specifically addressed. The primary goal of surgery was to decompress the optic pathways, and the secondary goals were to achieve maximal safe resection and hormonal control in hormone-secreting adenomas. The degree of tumor resection was classified as gross-total resection (100%), near-total resection (90–100%), subtotal resection (70–90%), and partial resection (< 70%). 42 patients were included in this study. A good visual outcome achieved with 80% improvement in visual symptoms. Gross-total resection (GTR) was achieved in 19 patients (45.2%), near-total resection (NTR) was achieved in 12 patients (28.6%), subtotal resection (STR) in 6 patients (14.3%), and partial resection in the remaining 5 patients (11.9%). Subgroup analysis revealed that GTR, NTR rates were higher in large, compared to giant tumors. GTR, NTR rates of large adenomas were 59.3%, and 29.6%, compared to 20%, and 26.7% in giant adenomas respectively (p-value: 0.01428). Surgical complications were observed in 19 patients (45.2%) with CSF leakage being the most common complication (11 patients, 26.2%). Post-operative diabetes insipidus was observed in 5 patients (11.9%), major vascular injury in one case (2.4%), transient post-op 6th nerve palsy observed in 3 patients (7.1%), while two patients (4.8%) presented with post-operative paranasal sinuses infection. Endoscopic endonasal transsphenoidal resection of large and giant pituitary adenomas is a safe and efficient procedure. Large adenomas (3–3.9 cm) have excellent resection rates and lower complications than giant adenomas (≥ 4 cm), which may require extending our approach to achieve more tumor resection rates in the future. However, only adequate resection of these giant adenomas can be enough to achieve the main surgical goals of visual improvement, hormonal control, and decompression of surrounding structures.
大垂体腺瘤和巨大垂体腺瘤(分别定义为最大直径≥ 3-3.9 厘米和≥ 4 厘米的肿瘤)在切除范围和围手术期发病率方面给手术带来了相当大的挑战。内镜下腔内切除术被认为是治疗垂体腺瘤最有效的方法。它能更好地观察、操作和进入远侧和侧方肿瘤区,最终提高切除范围。本文评估了我们对巨大垂体腺瘤进行内镜下切除的初步经验。文章将具体讨论临床结果、围手术期并发症和肿瘤切除范围。手术的首要目标是减压视神经通路,次要目标是实现最大程度的安全切除和对分泌激素腺瘤的激素控制。肿瘤切除程度分为全切(100%)、近全切(90%-100%)、次全切(70%-90%)和部分切除(<70%)。本研究共纳入 42 名患者。视觉效果良好,视觉症状改善率达 80%。19名患者(45.2%)实现了大部切除(GTR),12名患者(28.6%)实现了近全切(NTR),6名患者(14.3%)实现了次全切(STR),其余5名患者(11.9%)实现了部分切除。亚组分析显示,与巨大肿瘤相比,巨大肿瘤的 GTR 和 NTR 率更高。大腺瘤的GTR和NTR率分别为59.3%和29.6%,而巨大腺瘤的GTR和NTR率分别为20%和26.7%(P值:0.01428)。19名患者(45.2%)出现了手术并发症,其中最常见的并发症是脑脊液渗漏(11名患者,26.2%)。5名患者(11.9%)出现术后糖尿病,1名患者(2.4%)出现大血管损伤,3名患者(7.1%)术后出现一过性第六神经麻痹,2名患者(4.8%)出现术后副鼻窦感染。内镜下经鼻窦切除巨大垂体腺瘤是一种安全有效的手术。与巨大腺瘤(≥ 4 厘米)相比,大腺瘤(3-3.9 厘米)的切除率极高,并发症较少,因此今后可能需要扩展我们的方法,以实现更高的肿瘤切除率。然而,只有充分切除这些巨大腺瘤,才能实现改善视力、控制激素分泌和为周围结构减压的主要手术目标。
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引用次数: 0
Effects of normal saline versus isotonic balanced crystalloid on acid–base balance and renal functions in patients undergoing intracranial tumor resection surgeries 生理盐水和等渗平衡晶体液对颅内肿瘤切除手术患者酸碱平衡和肾功能的影响
Q4 CLINICAL NEUROLOGY Pub Date : 2024-07-11 DOI: 10.1186/s41984-024-00312-6
Renu Bala, Akanksha, Vandna Arora, Divyansh Yadav, Ankur Singh
Normal saline (NS) infusion in large volumes may result in hyperchloremic metabolic acidosis and renal compromise. Balanced crystalloid (BC) with physiochemical composition akin to that of plasma may avoid these problems associated with NS. The present study aimed to evaluate effects of NS versus BC on acid–base balance and renal functions in patients undergoing intracranial tumor resection surgeries. Fifty adult patients scheduled to undergo elective neurosurgery for intracranial tumor resection were randomized to receive either NS or BC as intraoperative or maintenance fluid. Metabolic and renal parameters were estimated prior to induction (baseline), at 1 h and 2 h after induction, at the end of surgery and 4 h after extubation. Serum neutrophil gelatinase-associated lipocalin (NGAL) was measured postoperatively. Brain relaxation score was assessed by the operating surgeon. Baseline values of variables were similar between the groups. At rest of the observed time-points, pH was significantly lower, while blood urea, serum creatinine, sodium, chloride, NGAL and plasma osmolality were significantly higher in the NS group as compared to the BC group. Brain relaxation score, serum bicarbonate and base excess were comparable between the two groups. Use of balanced crystalloid (plasmalyte) resulted in better metabolic and renal profile as compared to normal saline in neurosurgical patients.
大量输注生理盐水(NS)可能会导致高胆红素代谢性酸中毒和肾功能损害。平衡晶体液(BC)的理化成分与血浆相似,可避免与正常生理盐水相关的这些问题。本研究旨在评估 NS 和 BC 对颅内肿瘤切除手术患者酸碱平衡和肾功能的影响。50名计划接受颅内肿瘤切除术的成人患者被随机分配接受NS或BC作为术中或维持液。在诱导前(基线)、诱导后 1 小时和 2 小时、手术结束时和拔管后 4 小时分别对代谢和肾脏参数进行了评估。术后测量血清中性粒细胞明胶酶相关脂质钙蛋白(NGAL)。脑松弛评分由手术医生评估。各组变量的基线值相似。与 BC 组相比,NS 组在其余观察时间点的 pH 值明显降低,而血尿素、血清肌酐、钠、氯、NGAL 和血浆渗透压则明显升高。两组的脑松弛评分、血清碳酸氢盐和碱过量相当。与正常生理盐水相比,使用平衡晶体液(血浆蛋白)可改善神经外科患者的代谢和肾功能状况。
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引用次数: 0
Gamma knife radio surgery for cerebral arteriovenous malformation (AVM) in children: a systematic review and meta-analysis of clinical outcomes 伽玛刀放射手术治疗儿童脑动静脉畸形(AVM):临床结果的系统回顾和荟萃分析
Q4 CLINICAL NEUROLOGY Pub Date : 2024-07-05 DOI: 10.1186/s41984-024-00307-3
William Andrés Florez-Perdomo, Juan Sebastián Reyes Bello, Luis Rafael Moscote Salazar, Amit Agrawal, Tariq Janjua, Vishal Chavda, Ezequiel García-Ballestas, Ebtesam Abdulla
This article aims to evaluate the safety and effectiveness of Gamma Knife radiosurgery as a treatment modality for pediatric cerebral arteriovenous malformations (AVMs) by assessing mortality rates, the rate of complete AVM obliteration, and the incidence of complications while exploring potential risk factors. A comprehensive search was conducted through multiple databases to identify relevant studies, including randomized controlled trials and observational studies. The studies were assessed for risk of bias using the ROBINS-I tool and methodological quality with the Newcastle–Ottawa Scale. Data on mortality, AVM obliteration rates, and complications were systematically extracted. Pooled rate analysis was performed to assess outcomes, and heterogeneity was evaluated. The analysis included 21 studies involving 2142 pediatric patients with cerebral AVMs. A low mortality rate of 0.75% (95% CI 0.09% to 2.71%) and a high rate of complete obliteration of AVMs was observed, with a rate of 71.64% (95% CI 65.716% to 77.211%). Complications, including new neurological deficits, post-radiosurgery intracranial hemorrhage, and other complications (such as seizures and radiation-related issues), were relatively low, with rates of 2.57%, 2.463%, and 4.784%, respectively. Gamma Knife radiosurgery demonstrates its potential as a safe and effective treatment option for pediatric cerebral AVMs. The low mortality rate and high rate of AVM obliteration suggest that this approach offers significant benefits. While some complications were observed, they were generally non-severe. However, further high-quality studies with extended follow-up periods are needed to better understand long-term efficacy and safety.
本文旨在评估伽玛刀放射外科手术作为小儿脑动静脉畸形(AVM)治疗方式的安全性和有效性,方法是评估死亡率、AVM 完全消失率和并发症发生率,同时探讨潜在的风险因素。我们通过多个数据库进行了全面搜索,以确定相关研究,包括随机对照试验和观察性研究。研究采用 ROBINS-I 工具评估偏倚风险,并采用纽卡斯尔-渥太华量表评估方法质量。系统地提取了有关死亡率、动静脉畸形阻塞率和并发症的数据。对结果进行了汇总率分析,并对异质性进行了评估。该分析包括 21 项研究,涉及 2142 名患有脑动静脉畸形的儿科患者。观察到的死亡率较低,为 0.75%(95% CI 为 0.09% 至 2.71%),AVM 完全消失率较高,为 71.64%(95% CI 为 65.716% 至 77.211%)。包括新的神经功能缺损、放射手术后颅内出血和其他并发症(如癫痫发作和辐射相关问题)在内的并发症发生率相对较低,分别为 2.57%、2.463% 和 4.784%。伽玛刀放射外科手术证明了其作为一种安全有效的小儿脑动静脉畸形治疗方案的潜力。较低的死亡率和较高的反车辆畸形清除率表明,这种方法具有显著的优势。虽然出现了一些并发症,但一般都不严重。不过,为了更好地了解其长期疗效和安全性,还需要进一步开展高质量的研究并延长随访时间。
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引用次数: 0
Letter to the Editor regarding medical students’ perception toward neurosurgery as a career: a cross-sectional study 致编辑的信--医学生对神经外科职业的看法:一项横断面研究
Q4 CLINICAL NEUROLOGY Pub Date : 2024-06-26 DOI: 10.1186/s41984-024-00293-6
Krish Kuhar, Bipin Chaurasia

Kaleem et al. [1] in this engrossing article presented an overview of perception of medical students toward the field of neurosurgery and enrolling in neurosurgical training programs. This article provides an insight into the mindset of undergraduates and may guide the institutions to meet the demands of aspirants. The study also attempts to fill the knowledge gap and motivate the young minds to pursue an influential career in neurosurgery.

In a similar context, the study conducted by Mokhtari et al. [2] described the perspective of medical students in Iran to opt for residency in neurosurgery and indicated that female decisions were particularly influenced by duration of residency, number of on-calls and stress levels. Chan et al. [3] in his research in the Philippines concluded that merely 18.7% students were interested in pursuing neurosurgery as a career. Balogun et al. [4] in his study appreciated the willingness of final year medical students of Nigeria to enroll in neurosurgery and concluded that the number of interested candidates is low and sex disparity profoundly exists.

These studies recognize the extensive efforts by the world neurosurgery community to comprehend the outlook and inclination of medical students toward opting neurosurgery as a career branch and imply that paramount changes are required to draw more students and increase workforce in neurosurgery.

The fundamental objective of this article is to assess the status of perception and apprehension of contemporary medical undergraduates regarding neurosurgery as a branch and to highlight the necessity of exposure to neurosurgery before graduation.

However, we do not completely agree with the results of the study as it majorly involves some of students leaving out more than half of the total medical student’s population and thus deviating the study from yielding effective conclusions. Further, even if the database was collected after face and content validation, being an online questionnaire survey, renders the source passive for reliable results.

One of the similar study done by Shah et al. [5] concluded that almost 60% of the respondents are willing to consider neurosurgery as a career option, but in our opinion this cannot be held entirely true. It can be understood from an analogy that when students are questioned about opting a stream after high school, a vast majority of students prefers to select the branch which seems alluring among their peers, but eventually they may end up choosing another branch after achieving proper exposure and assessing their personal requirements. Thus, compatibility of a branch can only be concluded after its adequate exposure.

We completely agree with the author that exposure to neurosurgery is negligible in the medical curriculum of undergraduates. Zukerman et al. [6] in his study also elucidated the crucially of neurosurgery electives for preclinical medical students.

Further, it is adequately h

文章 PubMed Google Scholar Shah H, Pandey K, Raheja A, Garg K, Singla R, Mishra S, Tandon V, Servadei F, Kale S. Neurosurgery as a top-drawer choice for residency in India: reality or Myth?https://doi.org/10.1016/j.wneu.2023.12.133.Article PubMed Google Scholar Zuckerman SL, Mistry AM, Hanif R, Chambless LB, Neimat JS, Wellons JC III, Mocco J, Sills AK, McGirt MJ, Thompson RC.临床前医学生的神经外科选修课:早期接触和态度转变。World Neurosurg. 2016;86:120-6. https://doi.org/10.1016/j.wneu.2015.08.081.Article PubMed Google Scholar Farooq M, Tariq S, Zahra SG, Atallah O, Chaurasia B. Neurosurgery abroad?来自低收入国家医学毕业生的观点。脑脊柱》。2023. https://doi.org/10.1016/j.bas.2023.102710.Article PubMed PubMed Central Google Scholar Pahwa B, Chaurasia B, Garg K, Bozkurt I, Deora H. Factors affecting the choice of neurosurgery subspecialty: a geographic and gender-wise analysis.https://doi.org/10.1016/j.wneu.2023.01.012.Article PubMed Google Scholar Idrees A, Rehman AU, Mehmood MA, Pahwa B, Mohsin A, Shaikh T, Jesrani EK, Chaurasia B. Perception of neurosurgery as a career choice among early career doctors in Pakistan: a nationwide cross sectional survey.https://doi.org/10.1016/j.wneu.2023.12.151.Article PubMed Google Scholar Deora H, Garg K, Tripathi M, Mishra S, Chaurasia B. Residency perception survey among neurosurgery residents in lower-middle-income countries: grassroots evaluation of neurosurgery education.Neurosurg Focus.https://doi.org/10.3171/2019.12.FOCUS19852.Article PubMed Google Scholar Javed S, Shabbir RK, Khan T, Yaqoob E, Park KB, Chaurasia B. Global neurosurgery: the Pakistani perspective.神经外科。2023; 92(2):e31-2. https://doi.org/10.1227/neu.0000000000002265.Article PubMed Google Scholar Chaurasia B, Raut R, Chaurasia R, Thapa A. Neurosurgery training in Nepal: then and now.Front Surg.10.3389%2Ffsurg.2023.1211722.下载参考文献不适用.不适用.作者注释两位作者对所有形式手稿的形成做出了同等贡献作者和所属单位Dr.Baba Saheb Ambedkar医学院和医院,印度德里Krish Kuhar神经外科,神经外科诊所,尼泊尔比尔根杰Bipin Chaurasia作者Krish Kuhar查看作者发表的文章您也可以在PubMed Google Scholar中搜索该作者Bipin Chaurasia查看作者发表的文章您也可以在PubMed Google Scholar中搜索该作者贡献两位作者阅读并批准了最终手稿。通讯作者通讯作者:Bipin Chaurasia。伦理批准和参与同意书不适用.出版同意书不适用.竞争利益不适用.出版者注释Springer Nature对出版地图中的管辖权主张和机构隶属关系保持中立.开放获取本文采用知识共享署名 4.0 国际许可协议进行许可,该协议允许以任何媒介或格式使用、共享、改编、分发和复制,只要您适当注明原作者和来源,提供知识共享许可协议的链接,并说明是否进行了修改。本文中的图片或其他第三方材料均包含在文章的知识共享许可协议中,除非在材料的署名栏中另有说明。如果材料未包含在文章的知识共享许可协议中,且您打算使用的材料不符合法律规定或超出许可使用范围,则您需要直接从版权所有者处获得许可。要查看该许可的副本,请访问 http://creativecommons.org/licenses/by/4.0/.Reprints and permissionsCite this articleKuhar, K., Chaurasia, B. Letter to the Editor regarding medical students' perception toward neurosurgery as a career: a crosssectional study.Egypt J Neurosurg 39, 45 (2024). https://doi.org/10.1186/s41984-024-00293-6Download citationReceived:14 February 2024Accepted:15 February 2024Published: 26 June 2024DOI: https://doi.org/10.1186/s41984-024-00293-6Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article
{"title":"Letter to the Editor regarding medical students’ perception toward neurosurgery as a career: a cross-sectional study","authors":"Krish Kuhar, Bipin Chaurasia","doi":"10.1186/s41984-024-00293-6","DOIUrl":"https://doi.org/10.1186/s41984-024-00293-6","url":null,"abstract":"<p>Kaleem et al. [1] in this engrossing article presented an overview of perception of medical students toward the field of neurosurgery and enrolling in neurosurgical training programs. This article provides an insight into the mindset of undergraduates and may guide the institutions to meet the demands of aspirants. The study also attempts to fill the knowledge gap and motivate the young minds to pursue an influential career in neurosurgery.</p><p>In a similar context, the study conducted by Mokhtari et al. [2] described the perspective of medical students in Iran to opt for residency in neurosurgery and indicated that female decisions were particularly influenced by duration of residency, number of on-calls and stress levels. Chan et al. [3] in his research in the Philippines concluded that merely 18.7% students were interested in pursuing neurosurgery as a career. Balogun et al. [4] in his study appreciated the willingness of final year medical students of Nigeria to enroll in neurosurgery and concluded that the number of interested candidates is low and sex disparity profoundly exists.</p><p>These studies recognize the extensive efforts by the world neurosurgery community to comprehend the outlook and inclination of medical students toward opting neurosurgery as a career branch and imply that paramount changes are required to draw more students and increase workforce in neurosurgery.</p><p>The fundamental objective of this article is to assess the status of perception and apprehension of contemporary medical undergraduates regarding neurosurgery as a branch and to highlight the necessity of exposure to neurosurgery before graduation.</p><p>However, we do not completely agree with the results of the study as it majorly involves some of students leaving out more than half of the total medical student’s population and thus deviating the study from yielding effective conclusions. Further, even if the database was collected after face and content validation, being an online questionnaire survey, renders the source passive for reliable results.</p><p>One of the similar study done by Shah et al. [5] concluded that almost 60% of the respondents are willing to consider neurosurgery as a career option, but in our opinion this cannot be held entirely true. It can be understood from an analogy that when students are questioned about opting a stream after high school, a vast majority of students prefers to select the branch which seems alluring among their peers, but eventually they may end up choosing another branch after achieving proper exposure and assessing their personal requirements. Thus, compatibility of a branch can only be concluded after its adequate exposure.</p><p>We completely agree with the author that exposure to neurosurgery is negligible in the medical curriculum of undergraduates. Zukerman et al. [6] in his study also elucidated the crucially of neurosurgery electives for preclinical medical students.</p><p>Further, it is adequately h","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141506476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Subthalamic deep brain stimulation in advanced Parkinson’s disease using the STarFix system 使用 STarFix 系统对晚期帕金森病患者进行眼下丘脑下深部脑刺激治疗
Q4 CLINICAL NEUROLOGY Pub Date : 2024-06-17 DOI: 10.1186/s41984-024-00281-w
Amr Elnaggar, Ahmad Elshanawany, Ahmad Ebrahim Elgheriany, Mahmoud Hasan Ragab, Ahmad Radwan Nouby
Deep brain stimulation (DBS) is a well-established and highly effective treatment for patients with medically uncontrolled Parkinson’s disease (PD). This study presents the outcome of patients with PD after subthalamic deep brain stimulation (STN DBS) using the microtargeting the platform (MTP) stereotactic system (the STarFixSystem, FHC Inc., Bowdoin, Me., USA) for accurate localization of the target and precise placement of DBs electrodes. Patients were evaluated preoperatively and the follow up period was 1 year utilizing the Unified Parkinson’s Disease Rating Scale (UPDRS II and III) in on and off medication-stimulation conditions. It included 18 STN DBS procedures in 10 patients over a 2-year period. The technical features and the practical application of the STarFix system and the clinical outcome are reported. Also lead location analysis is done by doing postoperative CT to evaluate the clinical accuracy of the stereotactic system. The mean age of PD patients was 67.7 years. Six patients were males (60%) and 4 patients were females (40%). The mean postoperative improvement in ADL was 83.47 ± 2.39 over Dopa therapy alone. The mean postoperative improvement in UPDRs motor score was 78.96 ± 7.74 over Dopa therapy alone. The STarFix system showed high accuracy with target error 1.89 mm (SD 0.8) without accounting for brain shift. Deep brain stimulation (DBS) targeting the subthalamic nucleus (STN) offers fundamental benefits for patients with advanced Parkinson’s disease (PD). The usage of the STarFix system for implanting DBS electrodes in the STN provides an accurate, safe, and effective alternative to traditional stereotactic techniques. This approach simplifies the surgical procedure, boosts patient comfort, and minimizes the duration of the operation. Clinical trial registration ClinicalTrials.gov identifier: NCT03562403. Registered 19 June 2018, https://classic.clinicaltrials.gov/ct2/show/NCT03562403 .
深部脑刺激(DBS)是治疗药物无法控制的帕金森病(PD)患者的一种行之有效的方法。本研究介绍了使用微定位平台(MTP)立体定向系统(STarFixSystem,FHC Inc.术前对患者进行了评估,并利用统一帕金森病评分量表(UPDRS II 和 III)在药物刺激和非药物刺激条件下对患者进行了为期 1 年的随访。该项目包括对 10 名患者进行 18 次 STN DBS 手术,为期 2 年。报告了 STarFix 系统的技术特点、实际应用和临床效果。此外,还通过术后 CT 对导联位置进行了分析,以评估立体定向系统的临床准确性。脊髓灰质炎患者的平均年龄为 67.7 岁。六名患者为男性(60%),四名患者为女性(40%)。与单纯多巴治疗相比,术后ADL的平均改善率为(83.47 ± 2.39)。与单独使用多巴治疗相比,术后UPDRs运动评分的平均改善幅度为(78.96 ± 7.74)。STarFix 系统显示出很高的准确性,目标误差为 1.89 毫米(标度 0.8),且不考虑脑偏移。针对丘脑下核(STN)的深部脑刺激(DBS)为晚期帕金森病(PD)患者带来了根本性的益处。使用 STarFix 系统在 STN 植入 DBS 电极为传统的立体定向技术提供了准确、安全和有效的替代方案。这种方法简化了手术过程,提高了患者的舒适度,并最大限度地缩短了手术时间。临床试验注册 ClinicalTrials.gov 标识符:NCT03562403。2018年6月19日注册,https://classic.clinicaltrials.gov/ct2/show/NCT03562403 。
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引用次数: 0
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Egyptian journal of neurosurgery
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