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Microneurosurgery for Ruptured Aneurysm of Distal Intracranial Vertebral Artery: A Case Report 颅内椎动脉远端动脉瘤破裂的显微神经外科手术:病例报告
Pub Date : 2024-05-09 DOI: 10.1055/s-0044-1786704
Tushar V. Soni, Shreyansh Patel, Varshesh Shah, Sandip Singh, Nirav Shah
The International Subarachnoid Aneurysm Trial led to a shift from clipping to endovascular coiling as the primary therapy for cerebral aneurysm particularly in the management of posterior circulation aneurysm. However, endovascular therapy is often unavailable in low-resource settings, emphasizing the importance of maintaining surgical skill sets in resource-poor countries. This article presents a detailed case report on the successful microneurosurgical management of a 65-year-old female with a history of headache and weakness with past history of hypertension and a right posterior cerebral artery territory infarct who was diagnosed with a ruptured aneurysm situated within the intracranial vertebral artery. Patient was operated with the far lateral approach and clipping of the aneurysm. This case report elucidates the intricate surgical techniques employed, and the challenges neurosurgeons encountered in treating posterior circulation intracranial aneurysms, particularly those with ruptured complications. The aneurysms' intricate anatomy and increased rupture risk necessitate a meticulous microneurosurgical approach. The severity of subarachnoid hemorrhage from ruptured aneurysms increases morbidity and mortality rates.
国际蛛网膜下腔动脉瘤试验(International Subarachnoid Aneurysm Trial)促使脑动脉瘤的主要治疗方法从夹闭术转变为血管内旋转术,尤其是在后循环动脉瘤的治疗方面。然而,血管内治疗在资源匮乏的环境中往往无法使用,这就强调了在资源匮乏的国家保持外科技能的重要性。本文详细报告了一例成功实施显微神经外科手术的病例,患者是一名 65 岁女性,既往有高血压病史,头痛和乏力,右侧大脑后动脉境界部梗死,被诊断为颅内椎动脉内动脉瘤破裂。患者接受了远外侧入路手术并切除动脉瘤。本病例报告阐明了所采用的复杂手术技术,以及神经外科医生在治疗后循环颅内动脉瘤,尤其是有破裂并发症的动脉瘤时所遇到的挑战。动脉瘤的解剖结构复杂,破裂风险增加,因此必须采用精细的显微神经外科手术方法。动脉瘤破裂引起的蛛网膜下腔出血的严重程度会增加发病率和死亡率。
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引用次数: 0
A Rare Case of Panton-Valentine Leukocidin-Related Cervical Empyema 潘顿-瓦伦丁白细胞介素相关性颈椎水肿的罕见病例
Pub Date : 2023-12-29 DOI: 10.1055/s-0043-1776307
Hung Le, Dung Le Thuy Nguyen, My Nu Tra Ton, Duy Phan, Anh Hoang Ngoc Tran, Van Tri Truong
Abstract Staphylococcus aureus is found in the normal skin and mucosa of approximately 30% of healthy populations and is the most common pathogen in human disease associated with bacteria. They are divided into methicillin-sensitive S . aureus (MSSA) and methicillin-resistant S. aureus (MRSA). The S. aureus strains carrying the Panton-Valentine leukocidin genes (SA-PVL) were initially believed to belong to the MRSA group; however, recent reports showed they also belonged to the MSSA group (MSSA-PVL). SA-PVL is common in skin and soft-tissue infections but rare in musculoskeletal infections, especially in spondylodiscitis. We are reporting a case suffering from cervical spondylodiscitis and epidural abscess associated with MSSA carrying the Panton-Valentine leukocidin genes.
摘要 金黄色葡萄球菌存在于约 30% 健康人群的正常皮肤和粘膜中,是人类疾病中最常见的细菌病原体。金黄色葡萄球菌分为对甲氧西林敏感的金黄色葡萄球菌(MSSA)和对甲氧西林耐药的金黄色葡萄球菌(MRSA)。携带潘顿-瓦伦丁白细胞介素基因(SA-PVL)的金黄色葡萄球菌菌株最初被认为属于 MRSA 组,但最近的报告显示它们也属于 MSSA 组(MSSA-PVL)。SA-PVL 常见于皮肤和软组织感染,但罕见于肌肉骨骼感染,尤其是脊柱盘炎症。我们报告了一例颈椎盘炎和硬膜外脓肿病例,该病例与携带潘顿-瓦伦丁白细胞介素基因的 MSSA 有关。
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引用次数: 0
Predicting Morphological Changes to Vessel Walls Adjacent to Unruptured Cerebral Aneurysms Using Computational Fluid Dynamics 利用计算流体力学预测未破裂脑动脉瘤邻近血管壁的形态变化
Pub Date : 2023-12-15 DOI: 10.1055/s-0043-1771367
Kento Sasaki, Fuminari Komatsu, Kyosuke Miyatani, Riki Tanaka, Yasuhiro Yamada, Yoko Kato, Yuichi Hirose
Abstract Objective  This study compared intraoperative findings with preoperative computed tomography angiography (CTA) and computational fluid dynamics (CFD) analysis of perianeurysmal findings for the indication of possible vessel wall thinning. Materials and Methods  Participants comprised 38 patients with unruptured middle cerebral artery aneurysms treated by surgical clipping at our hospital between May 2020 and April 2021. We defined parent artery radiation sign (PARS) as the presence of each of the following three findings in CFD analysis based on preoperative CTA: (1) impingement of the stream line on the outer parent vessel wall of the aneurysm; (2) radiation of wall shear stress vectors outwards from the same site; and (3) increased wall pressure compared with the surrounding area. CFD analysis showing PARS was compared with intraoperative findings. Results  In all nine cases with PARS, no morphological abnormalities were found in the same area on CTA. However, intraoperative findings showed thinning of the parent artery wall in one of the nine cases and formation of a very small mass in three cases, differing from CTA findings. All nine patients underwent additional clipping and/or wrapping and coating at the site of PARS. Conclusion  Detecting thinning of the vessel wall or the presence of a microaneurysm may be difficult in endovascular therapy, which is based on the visualization of the vessel lumen. CFD analysis suggests the necessity of confirming findings for the vessel wall around an aneurysm by direct manipulation, as the presence of PARS may indicate partial thinning of the vessel wall or formation of a microaneurysm.
摘要 目的 本研究比较术中发现与术前计算机断层扫描血管造影(CTA)和计算流体动力学(CFD)分析动脉瘤周围发现,以确定血管壁可能变薄的迹象。材料与方法 2020 年 5 月至 2021 年 4 月期间,在我院接受手术夹闭治疗的 38 例未破裂大脑中动脉动脉瘤患者。我们将母动脉辐射征(PARS)定义为基于术前 CTA 的 CFD 分析中出现以下三个结果中的每一个:(1)流线撞击动脉瘤外母血管壁;(2)管壁剪切应力矢量从同一部位向外辐射;以及(3)与周围区域相比,管壁压力增加。将显示 PARS 的 CFD 分析与术中发现进行了比较。结果 在所有九例 PARS 病例中,CTA 均未在同一部位发现形态学异常。然而,术中结果显示,9 例患者中有 1 例患者的母动脉壁变薄,3 例患者形成了很小的肿块,这与 CTA 的结果不同。所有九名患者都在 PARS 的部位进行了额外的剪切和/或包裹和涂层。结论 在血管内治疗中,检测血管壁变薄或是否存在微动脉瘤可能比较困难,因为血管内治疗的基础是血管腔的可视化。CFD 分析表明,有必要通过直接操作确认动脉瘤周围血管壁的发现,因为 PARS 的存在可能表明血管壁部分变薄或形成微动脉瘤。
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引用次数: 0
Surgical Outcome of Basal Ganglia Hemorrhage: A Retrospective Analysis of Nearly 3,000 Cases over 10 Years 基底节出血的手术效果:10年间近3000例病例的回顾性分析
Pub Date : 2023-12-14 DOI: 10.1055/s-0043-1776049
D. Hazra, G. Chandy, Amit Ghosh
Abstract Background  Basal ganglia hemorrhage (BGH) is a severe neurologic condition associated with significant morbidity and mortality, and its optimal management remains a topic of debate. Our study assessed the surgical outcomes of BGH patients at the 3-month mark using the modified Rankin Scale (mRS). Methods  This retrospective observational study was conducted over 10 years at an advanced neuro-specialty hospital in Eastern India, including patients who underwent decompressive craniotomy and hematoma evacuation. Variables were systematically coded and analyzed to evaluate the postoperative outcome with age (in years), preoperative motor (M) status, and hematoma volume. Results  This study enrolled 2,989 patients with a mean age of 59.62 (standard deviation: 9.64) years, predominantly males ( n  = 2,427; 81.2%). Hypertension (1,612 cases) and diabetes mellitus (1,202 cases) were the most common comorbidities. Common clinical presentations included ipsilateral weakness (1,920 cases) and/or altered mental status (1,670 cases). At the 3-month mark postsurgery, 2,129 cases (71.2%) had a favorable outcome based on mRS, while 389 cases (13.0%) had an unfavorable outcome. The regression equation showed that age was inversely related to the percentage of individuals achieving a favorable outcome. It also revealed that the preoperative motor score was positively correlated with favorable outcomes. Hematomas smaller than 60 mL had better outcomes, with 1,311 cases (69.1%) classified as good outcomes and 337 cases (17.8%) as bad outcomes. Fatal outcomes related to the illness were observed in 471 patients (15.8%) within the study population. Conclusion  Surgery for BGH showed a substantial improvement in outcomes, particularly in patients with M5/M4 motor status. The preoperative motor score (M status) emerged as a crucial predictor of favorable neurological outcomes. Age and hematoma volume, however, were found to be nondefinitive factors in determining good outcomes.
摘要 背景 基底节区出血(BGH)是一种严重的神经系统疾病,具有显著的发病率和死亡率,其最佳治疗方法仍是一个争论不休的话题。我们的研究采用改良Rankin量表(mRS)评估了BGH患者3个月后的手术效果。方法 该回顾性观察研究在印度东部一家先进的神经专科医院进行,历时10年,包括接受开颅减压术和血肿清除术的患者。研究人员对变量进行了系统编码和分析,以评估术后结果与年龄(单位:岁)、术前运动(M)状态和血肿量的关系。结果 本研究共纳入 2,989 名患者,平均年龄为 59.62 岁(标准差:9.64),主要为男性(n = 2,427; 81.2%)。高血压(1,612 例)和糖尿病(1,202 例)是最常见的合并症。常见的临床表现包括同侧肢体无力(1,920 例)和/或精神状态改变(1,670 例)。术后3个月,根据mRS,2129例(71.2%)患者的预后良好,389例(13.0%)患者的预后不良。回归方程显示,年龄与获得良好疗效的比例成反比。回归方程还显示,术前运动评分与良好预后呈正相关。血肿小于60毫升的患者预后较好,其中1311例(69.1%)预后良好,337例(17.8%)预后不良。研究人群中有 471 名患者(15.8%)出现了与疾病相关的致命后果。结论 BGH手术能显著改善预后,尤其是M5/M4运动状态的患者。术前运动评分(M状态)是预测良好神经功能预后的关键因素。然而,年龄和血肿量并不是决定良好疗效的决定性因素。
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引用次数: 0
Erratum: Ventriculoperitoneal Shunt Surgery in Brunei Darussalam: A Population-Based Perspective 勘误:文莱达鲁萨兰国的脑室腹腔分流手术:基于人口的视角
Pub Date : 2023-10-12 DOI: 10.1055/s-0043-1776296
Merlin Boban, John Mathew, Ady Thien
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引用次数: 0
Refractory Delayed Pneumocephalus after Transsphenoidal Cyst Drainage for Rathke's Cleft Cyst in a Patient with a Cerebrospinal Fluid Shunt. 脑脊液分流术治疗Rathke裂隙囊肿经蝶窦引流后难治性迟发性脑积水1例。
Pub Date : 2023-06-01 DOI: 10.1055/s-0043-1768573
Tetsuo Hashiba, Masahiro Nonaka, Haruka Iwamura, Takamasa Kamei, Junichi Takeda, Akio Asai

A 75-year-old man presented with bilateral lower limb weakness to our hospital from another clinic. Radiological examinations implied the possibilities of idiopathic normal pressure hydrocephalus (iNPH) and a suprasellar cyst, but both were observed conservatively at that time. Due to the progressive gait disturbance, a lumboperitoneal shunt was implanted 1 year later. The clinical symptoms improved, but the cyst had grown after another year, causing visual impairment. Transsphenoidal drainage of the cyst was performed, but delayed pneumocephalus occurred. Repair surgery was performed with temporary suspension of shunt function, but pneumocephalus relapsed two and a half months after the resumption of shunt flow. In the second repair surgery, the shunt was removed because it was assumed that it would prevent closure of the fistula by lowering intracranial pressure. Two and a half months later, after confirming involution of the cyst and no pneumocephalus, a ventriculoperitoneal shunt was implanted, and cerebrospinal fluid (CSF) leakage has not relapsed since then. The coexistence of idiopathic normal pressure hydrocephalus (iNPH) and Rathke's cleft cyst (RCC) is rare, but it can occur. RCC can be cured by simple drainage, but delayed pneumocephalus can occur in cases whose intracranial pressure decreases due to CSF shunting. When simple drainage without sellar reconstruction for RCC is attempted after CSF shunting for coexistent iNPH, attention should be paid to changes in intracranial pressure, and it is desirable to stop the flow of the shunt for a certain period.

一名75岁男性从外院就诊,以双侧下肢无力就诊。放射检查提示特发性常压脑积水(iNPH)和鞍上囊肿的可能性,但当时都是保守观察。由于进行性步态障碍,1年后植入腰腹腔分流器。临床症状有所改善,但囊肿又在一年后增大,造成视力损害。经蝶窦引流囊肿,但迟发性脑气发生。在分流功能暂时暂停的情况下进行了修复手术,但在分流血流恢复两个半月后,气脑复发。在第二次修复手术中,分流器被移除,因为它被认为可以通过降低颅内压来防止瘘的关闭。两个半月后,在确认囊肿复发且无脑气后,植入脑室-腹膜分流器,此后脑脊液(CSF)渗漏未复发。特发性正常压力脑积水(iNPH)和Rathke's裂性囊肿(RCC)共存是罕见的,但它可以发生。RCC可以通过简单引流治愈,但由于脑脊液分流导致颅内压下降的病例可发生迟发性气脑。合并iNPH的脑脊液分流术后尝试单纯引流不重建鞍区治疗RCC时,应注意颅内压的变化,并应停止分流一段时间的血流。
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引用次数: 0
Outcome of Transforaminal Endoscopic Discectomy in Rural India in a Single-Level Lumbar Disc Prolapse Under Local Anesthesia. 印度农村经椎间孔内窥镜椎间盘切除术在局部麻醉下治疗单节段腰椎间盘脱垂的结果。
Pub Date : 2023-06-01 DOI: 10.1055/s-0043-1769756
Vishnu Vikraman Nair, Sarabjeet Kohli, Nilesh Vishwakarma, Juilee Mhatre

Aim  The aim of this study was to undertake a clinical study to evaluate the outcomes of transforaminal endoscopic discectomy under local anesthesia and to study the complication rate. Study Design  It is a prospective study. Methods  We prospectively analyzed outcomes of 60 patients with a single-level lumbar disc prolapse in rural India from December 2018 to April 2020 who underwent endoscopic discectomy under local anesthesia. Follow-up was done using the visual analogue score (VAS) and Oswestry Disability Index (ODI) scoring systems with a minimum follow-up up to 1 year postoperatively. Results  In our study of 60 patients, there was 38 cases of L4-L5 disc pathology, 13 L5-S1 discs, and 9 L3-L4 discs. Our study showed a significant clinical reduction in mean VAS score that was 7.07/10 preoperatively and reduced to 3.88/10 at the third month and 3.64/10 at 1 year of follow-up ( p -value < 0.05) showing clinical significance. The ODI scoring done preoperatively was an average mean of 57.37% pointing to how crippled the patients were with lumbar disc prolapse and showed a significant reduction to 29.32% postoperatively at 1 year ( p -value < 0.05) showing clinical significance. This reduction in ODI directly corelates to how almost all patients returned to normal life coping to all activities and were completely pain free at 1 year of follow-up. Conclusion  Endoscopic spine surgery in lumbar disc prolapse is highly effective and can deliver a good functional outcome if done with correct preoperative planning and approach.

目的探讨局麻下经椎间孔内窥镜椎间盘切除术的临床效果及并发症发生率。本研究为前瞻性研究。方法前瞻性分析2018年12月至2020年4月印度农村60例单节段腰椎间盘突出症患者在局部麻醉下行内窥镜椎间盘切除术的结果。采用视觉模拟评分(VAS)和Oswestry残疾指数(ODI)评分系统进行随访,术后最低随访时间为1年。结果60例患者中,L4-L5椎间盘病变38例,L5-S1椎间盘病变13例,L3-L4椎间盘病变9例。我们的研究显示,临床平均VAS评分显著降低,术前为7.07/10,随访第3个月降至3.88/10,随访1年降至3.64/10。结论内镜下脊柱手术治疗腰椎间盘突出症是非常有效的,如果采用正确的术前计划和入路,可以提供良好的功能结局。
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引用次数: 0
A Rare Case of COVID-19-Associated Solitary Aspergillus Brain Abscess. 罕见的新冠肺炎相关性孤立曲霉性脑脓肿1例
Pub Date : 2023-06-01 DOI: 10.1055/s-0043-1768570
Rajeev Mandaka Parambil, Binoy Damodar Thavara, Saji Francis, Poornima Mankara Valsan, Byjo Valiyaveetil Jose, Vishal Mangla, Harikrishnan Sreenivasan, Shanavas Cholakkal
Abstract Surgically operated case of solitary Aspergillus brain abscess caused by Aspergillus fumigatus in coronavirus disease 2019 (COVID-19) patient is not reported. The authors report a case of 33-year-old diabetic female patient presented with generalized seizure followed by left hemiparesis. Patient was treated with steroids for COVID-19 pneumonia. Initial imaging revealed a right frontal lobe infarct that later confirmed as a case of frontal lobe abscess. Patient underwent craniotomy and thick yellow pus was drained. Abscess wall was excised. Postoperatively patient improved with Glasgow coma scale 15/15 and Medical Research Committee grade 5 power of all limbs. Microbiological examination of pus was done. The gram stain showed numerous pus cells with acute angle branching hyphae. Gomori methenamine silver (GMS) preparation showed filamentous black colored hyphae. Mycelial colonies appeared on chocolate agar after 48 hours of incubation. Cellophane tape mount from the plate showed conical shaped vesicle with conidia arising from the upper third of vesicle. Light green velvety colonies appeared on Sabouraud Dextrose Agar that later turned into smoky green. The isolate was identified as Aspergillus fumigatus . The hematoxylin and eosin stain of abscess wall section showed extensive areas of necrosis with few fungal hyphae. GMS stain of abscess wall showed fungal hyphae that are septate and showing acute angled branching which are consistent with Aspergillus species. Patient was treated with voriconazole. Imaging done after 8 months of surgery revealed no residue. Surgical excision of life-threatening solitary Aspergillus brain abscess along with antifungal medication voriconazole carries good result. The authors believe that decreased immunity in patient has contributed to the development of this rare disease. This is a rarest case of surgically operated solitary brain abscess caused by Aspergillus fumigatus in COVID-19 patient.
新冠肺炎(COVID-19)患者由烟曲霉引起的孤立性曲霉性脑脓肿手术治疗一例未报道。作者报告了一例33岁的糖尿病女性患者,表现为全身性癫痫发作,随后出现左偏瘫。患者因COVID-19肺炎接受类固醇治疗。最初的影像显示为右额叶梗死,后来证实为额叶脓肿。病人接受开颅手术,排出厚厚的黄色脓液。切除脓肿壁。术后患者的格拉斯哥昏迷评分为15/15,医学研究委员会评分为5级。对脓液进行微生物学检查。革兰氏染色显示大量脓液细胞,有锐角分枝菌丝。Gomori甲基苯丙胺银(GMS)制备的菌丝呈丝状黑色。培养48小时后,在巧克力琼脂上出现菌丝菌落。玻璃纸贴片示圆锥形囊泡,囊泡上三分之一处有分生孢子。浅绿色丝绒菌落出现在Sabouraud葡萄糖琼脂上,后来变成烟绿色。该分离物经鉴定为烟曲霉。苏木精和伊红染色显示脓肿壁大面积坏死,真菌菌丝较少。脓肿壁GMS染色显示真菌菌丝分离,呈尖角分支,与曲霉属一致。患者给予伏立康唑治疗。手术8个月后影像学显示无残留。手术切除危及生命的孤立曲霉性脑脓肿,配合抗真菌药物伏立康唑治疗效果良好。作者认为,患者免疫力下降是导致这种罕见疾病发生的原因。这是COVID-19患者中最罕见的一例由烟曲霉引起的孤立性脑脓肿手术病例。
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引用次数: 0
Oral Midodrine as an Adjunct in Rapid Weaning of Intravenous Vasopressor Support in Spinal Cord Injury. 口服米多卡因在脊髓损伤后静脉血管加压剂支持快速脱机中的辅助作用。
Pub Date : 2023-06-01 DOI: 10.1055/s-0043-1769755
Arunkumar Sekar, Debajyoti Datta, Avinash Lakha, Sritam Swaroop Jena, Sumit Bansal, Rabi Narayan Sahu

Background  Majority of acute cervical spinal cord injury end up requiring long-term stay in intensive care unit (ICU). During the initial few days after spinal cord injury, most patients are hemodynamically unstable requiring intravenous vasopressors. However, many studies have noted that long-term intravenous vasopressors remain the main reason for prolongation of ICU stay. In this series, we report the effect of using oral midodrine in reducing the amount and duration of intravenous vasopressors in patients with acute cervical spinal cord injury. Materials and Methods  Five adult patients with cervical spinal cord injury after initial evaluation and surgical stabilization are assessed for the need for intravenous vasopressors. If patients continue to need intravenous vasopressors for more than 24 hours, they were started on oral midodrine. Its effect on weaning of intravenous vasopressors was assessed. Results  Patients with systemic and intracranial injury were excluded from the study. Midodrine helped in weaning of intravenous vasopressors in the first 24 to 48 hours and helped in complete weaning of intravenous vasopressors. The rate of reduction was between 0.5 and 2.0 µg/min. Conclusion  Oral midodrine does have an effect in reduction of intravenous vasopressors for patients needing prolonged support after cervical spine injury. The real extent of this effect needs to be studied with collaboration of multiple centers dealing with spinal injuries. The approach seems to be a viable alternative to rapidly wean intravenous vasopressors and reduce duration of ICU stay.

背景:大多数急性颈脊髓损伤最终需要在重症监护病房(ICU)长期住院。在脊髓损伤后的最初几天,大多数患者血流动力学不稳定,需要静脉注射血管加压药物。然而,许多研究指出,长期静脉注射血管加压药物仍然是延长ICU住院时间的主要原因。在这个系列中,我们报道了口服米多卡因减少急性颈脊髓损伤患者静脉血管加压药的用量和持续时间的效果。材料与方法对5例经初步评估和手术稳定后的成年颈脊髓损伤患者进行静脉加压药物的评估。如果患者继续需要静脉血管加压药超过24小时,他们开始口服米多卡因。评估其对静脉加压药物断奶的影响。结果排除全身及颅内损伤患者。Midodrine有助于在最初24 ~ 48小时内静脉血管加压药物的脱机,并有助于静脉血管加压药物的完全脱机。还原速率在0.5 ~ 2.0µg/min之间。结论对于颈椎损伤后需要长时间支持的患者,口服米多卡因可减少静脉加压药物用量。这种影响的真正程度需要与多个处理脊髓损伤的中心合作研究。该方法似乎是一种可行的替代快速断奶静脉血管加压药物和减少ICU住院时间。
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引用次数: 0
Controlled-Release Levodopa for the Treatment of Rapid Motor Fluctuations in Parkinson's Disease Subjects with Subthalamic Nucleus Deep Brain Stimulation. 控释左旋多巴对丘脑下核深部脑刺激治疗帕金森病患者快速运动波动的影响。
Pub Date : 2023-06-01 DOI: 10.1055/s-0043-1769757
Halil Onder, Selcuk Comoglu

Objectives  We aimed to investigate the efficiency of controlled-release levodopa/benserazide (Madopar HBS) use during daytime in our pilot study on advanced-stage Parkinson's disease (PD) subjects with deep brain stimulation of the subthalamic nucleus (STN-DBS) therapy. Methods  We have evaluated all PD subjects with STN-DBS who had admitted to our outpatient polyclinic between February 2022 and March 2022. Among these patients, those who were taking levodopa therapy at least five times throughout the day and the efficiency of levodopa lasted less than 3 hours were detected. The standard levodopa therapy was switched to Madopar HBS in all patients who accepted the therapy chance and the clinical evaluation of the patients on Madopar HBS therapy was performed in the second month of the therapy. Results  Ultimately, the follow-up of all four patients in whom the levodopa therapy was changed to Madopar HBS yielded a significant reduction in the "off" periods and improvement in the PSQ-39 scores. Conclusion  We suggest the use of Madopar HBS in PD patients with STN-DBS surgery suffering from motor fluctuations, particularly in the subgroup with milder dyskinesias. Future study results of a large number of PD subjects with STN-DBS therapy are warranted to confirm our observations. The results of these studies may provide critical applications in clinical practice.

目的:在我们对晚期帕金森病(PD)患者进行丘脑底核深部脑刺激(STN-DBS)治疗的前期研究中,研究白天使用左旋多巴/苯塞拉齐(美多巴HBS)的有效性。方法:我们评估了2022年2月至2022年3月期间在我们门诊综合诊所就诊的所有伴有STN-DBS的PD患者。在这些患者中,检测全天服用左旋多巴治疗至少5次且左旋多巴疗效持续时间小于3小时的患者。所有接受治疗机会的患者将标准左旋多巴治疗转为美多帕HBS治疗,并在治疗的第二个月对美多帕HBS治疗的患者进行临床评估。最终,对所有4名左旋多巴治疗改为美多巴HBS的患者进行随访,发现“关闭”期明显减少,PSQ-39评分明显改善。结论:我们建议在STN-DBS手术中出现运动波动的PD患者,特别是轻度运动障碍亚组中使用美多巴HBS。未来对大量PD患者进行STN-DBS治疗的研究结果有理由证实我们的观察结果。这些研究的结果可能在临床实践中提供关键的应用。
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Asian Journal of Neurosurgery
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