Pub Date : 2024-08-05DOI: 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
{"title":"Comparative study of low-density versus high-density pedicular screw implantations in management of adolescent idiopathic scoliosis: a randomized clinical trial","authors":"Hosam Eldin Mostafa, Abdelrhman Saber Sayed Moustafa, Hazem Hassan El Zayat, Ahmed Koheil, Omar Abdel Aleem Ragab","doi":"10.1186/s41984-024-00308-2","DOIUrl":"https://doi.org/10.1186/s41984-024-00308-2","url":null,"abstract":"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 ","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141931177","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}
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.
{"title":"A review on the applications of artificial intelligence and big data for glioblastoma multiforme management","authors":"Mahdi Mehmandoost, Fatemeh Torabi Konjin, Elnaz Amanzadeh Jajin, Farzan Fahim, Saeed Oraee Yazdani","doi":"10.1186/s41984-024-00306-4","DOIUrl":"https://doi.org/10.1186/s41984-024-00306-4","url":null,"abstract":"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.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141871116","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}
Pub Date : 2024-07-23DOI: 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.
{"title":"Anterior cervical discectomy and fusion with and without plating versus laminectomy with and without fusion for multilevel cervical spondylotic myelopathy: a prospective observational study","authors":"Omar El Farouk Ahmed, Salah A. Hemida, Tarek H. Elserry, Wael Ashour, Abdelrahman Elgayar","doi":"10.1186/s41984-024-00309-1","DOIUrl":"https://doi.org/10.1186/s41984-024-00309-1","url":null,"abstract":"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.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141754113","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}
Pub Date : 2024-07-17DOI: 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.
{"title":"Shunt-related brain tumor, a case report presenting a rare complication and review of literature","authors":"Michael Zohney, Mohamed M Aziz, Shebl Izz-alarab, Ahmed A Algredly, Abdelaleem Abdelwahab","doi":"10.1186/s41984-024-00313-5","DOIUrl":"https://doi.org/10.1186/s41984-024-00313-5","url":null,"abstract":"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.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"90 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141743136","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}
Pub Date : 2024-07-11DOI: 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.
{"title":"Surgical outcome of endoscopic endonasal approach as a modality of management for large and giant pituitary adenomas: a retrospective case series","authors":"Shebl Izz-alarab, Michael Zohney, Saied A. Issa, Abdelaleem Abdelwahab, Ashraf G. Al-Abyad, Mohamed M. Aziz","doi":"10.1186/s41984-024-00311-7","DOIUrl":"https://doi.org/10.1186/s41984-024-00311-7","url":null,"abstract":"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.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141612350","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}
Pub Date : 2024-07-11DOI: 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。
{"title":"Effects of normal saline versus isotonic balanced crystalloid on acid–base balance and renal functions in patients undergoing intracranial tumor resection surgeries","authors":"Renu Bala, Akanksha, Vandna Arora, Divyansh Yadav, Ankur Singh","doi":"10.1186/s41984-024-00312-6","DOIUrl":"https://doi.org/10.1186/s41984-024-00312-6","url":null,"abstract":"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.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141584939","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}
Pub Date : 2024-07-05DOI: 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.
{"title":"Gamma knife radio surgery for cerebral arteriovenous malformation (AVM) in children: a systematic review and meta-analysis of clinical outcomes","authors":"William Andrés Florez-Perdomo, Juan Sebastián Reyes Bello, Luis Rafael Moscote Salazar, Amit Agrawal, Tariq Janjua, Vishal Chavda, Ezequiel García-Ballestas, Ebtesam Abdulla","doi":"10.1186/s41984-024-00307-3","DOIUrl":"https://doi.org/10.1186/s41984-024-00307-3","url":null,"abstract":"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.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141550835","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}
Pub Date : 2024-06-26DOI: 10.1186/s41984-024-00293-6
Krish Kuhar, Bipin Chaurasia
<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
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":"86 1","pages":""},"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}
Pub Date : 2024-06-17DOI: 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 .
{"title":"Subthalamic deep brain stimulation in advanced Parkinson’s disease using the STarFix system","authors":"Amr Elnaggar, Ahmad Elshanawany, Ahmad Ebrahim Elgheriany, Mahmoud Hasan Ragab, Ahmad Radwan Nouby","doi":"10.1186/s41984-024-00281-w","DOIUrl":"https://doi.org/10.1186/s41984-024-00281-w","url":null,"abstract":"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 .","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141506477","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}
Carboxymethylcellulose/polyethylene oxide, also known as Oxiplex gel, is commonly used during lumbar discectomy operations. It serves to cover the surgical site, preventing adhesions and providing relief from pain and symptoms. However, there is ongoing debate regarding the extent of its beneficial effects on postoperative pain intensity, level of disability, and overall improvement of musculoskeletal conditions. Therefore, the objective of this study is to evaluate the advantages and limitations of using Oxiplex gel in lumbar laminectomy procedures specifically for herniated discs. A randomized controlled trial was conducted on 56 consecutive patients who were candidates for unilateral lumbar discectomy on one lumbar surface. The patients were chosen based on their clinical manifestations and imaging findings. After the initial assessment, the patients underwent either laminectomy or laminotomy surgery. Following the surgery, the patients were randomly assigned to either the intervention group (receiving Oxiplex gel) or the control group. This assignment was done using a computerized random number generator. Assessments were conducted before the operation, as well as 3 and 6 months post-surgery for all patients. There was no significant difference found between the Oxiplex gel and control groups in terms of radicular and low back pain intensity, as well as disability scores, at different time points after surgery (p = 0.336, p = 0.65, and p = 0.336, respectively). Additionally, there were no significant differences found in the prevalence of sexual or sphincteric disorders between the two groups during postoperative assessments (p = 0.639 and p = 0.15, respectively). Furthermore, no significant differences were observed in the results of the postsurgical neuromuscular evaluation under different lower extremities conditions between the two groups. Based on our findings, it was observed that Oxiplex gel did not demonstrate any improvement in post-unilateral lumbar discectomy symptoms or musculoskeletal power.
羧甲基纤维素/聚环氧乙烷又称 Oxiplex 凝胶，常用于腰椎间盘切除手术。其作用是覆盖手术部位，防止粘连，缓解疼痛和症状。然而，关于其对术后疼痛强度、残疾程度和肌肉骨骼状况整体改善的有益影响程度，目前仍存在争议。因此，本研究旨在评估在腰椎间盘突出症的腰椎椎板切除术中使用 Oxiplex 凝胶的优势和局限性。本研究对 56 名连续接受单侧腰椎间盘切除术的患者进行了随机对照试验。这些患者是根据其临床表现和影像学检查结果选择的。经过初步评估后，患者接受了椎板切除术或椎板切开术。手术后，患者被随机分配到干预组（接受 Oxiplex 凝胶治疗）或对照组。这一分配是通过电脑随机数字生成器完成的。对所有患者进行了手术前、手术后 3 个月和 6 个月的评估。在手术后的不同时间点，Oxiplex 凝胶组和对照组在根性疼痛和腰痛强度以及残疾评分方面没有明显差异（分别为 p = 0.336、p = 0.65 和 p = 0.336）。此外，在术后评估中，两组患者的性功能障碍或括约肌障碍发生率没有明显差异（分别为 p = 0.639 和 p = 0.15）。此外，两组患者在不同下肢条件下的术后神经肌肉评估结果也无明显差异。根据我们的研究结果，Oxiplex 凝胶并未改善单侧腰椎间盘切除术后的症状或肌肉骨骼力量。
{"title":"Early and midterm efficacy of oxiplex gel on postoperative pain intensity, physical disability, and musculoskeletal power in patients undergoing lumbar discectomy","authors":"Alireza Tabibkhooei, Maziar Azar, Mohsen Nabiuni, Javid Jahandideh, Mohsen Benam, Farid Qoorchi Moheb Seraj, Feizollah Ebrahimnia, Ali Moradi","doi":"10.1186/s41984-024-00266-9","DOIUrl":"https://doi.org/10.1186/s41984-024-00266-9","url":null,"abstract":"Carboxymethylcellulose/polyethylene oxide, also known as Oxiplex gel, is commonly used during lumbar discectomy operations. It serves to cover the surgical site, preventing adhesions and providing relief from pain and symptoms. However, there is ongoing debate regarding the extent of its beneficial effects on postoperative pain intensity, level of disability, and overall improvement of musculoskeletal conditions. Therefore, the objective of this study is to evaluate the advantages and limitations of using Oxiplex gel in lumbar laminectomy procedures specifically for herniated discs. A randomized controlled trial was conducted on 56 consecutive patients who were candidates for unilateral lumbar discectomy on one lumbar surface. The patients were chosen based on their clinical manifestations and imaging findings. After the initial assessment, the patients underwent either laminectomy or laminotomy surgery. Following the surgery, the patients were randomly assigned to either the intervention group (receiving Oxiplex gel) or the control group. This assignment was done using a computerized random number generator. Assessments were conducted before the operation, as well as 3 and 6 months post-surgery for all patients. There was no significant difference found between the Oxiplex gel and control groups in terms of radicular and low back pain intensity, as well as disability scores, at different time points after surgery (p = 0.336, p = 0.65, and p = 0.336, respectively). Additionally, there were no significant differences found in the prevalence of sexual or sphincteric disorders between the two groups during postoperative assessments (p = 0.639 and p = 0.15, respectively). Furthermore, no significant differences were observed in the results of the postsurgical neuromuscular evaluation under different lower extremities conditions between the two groups. Based on our findings, it was observed that Oxiplex gel did not demonstrate any improvement in post-unilateral lumbar discectomy symptoms or musculoskeletal power.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"157 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141506478","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}
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