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Advanced magnetic resonance imaging for glioblastoma: Oncology-radiology integration. 胶质母细胞瘤的高级磁共振成像:肿瘤学与放射学的整合。
Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_498_2024
Abdulsalam Mohammed Aleid, Abdulrahim Saleh Alrasheed, Saud Nayef Aldanyowi, Sami Fadhel Almalki

Background: Aggressive brain tumors like glioblastoma multiforme (GBM) pose a poor prognosis. While magnetic resonance imaging (MRI) is crucial for GBM management, distinguishing it from other lesions using conventional methods can be difficult. This study explores advanced MRI techniques better to understand GBM properties and their link to patient outcomes.

Methods: We studied MRI scans of 157 GBM surgery patients from January 2020 to March 2024 to extract radiomic features and analyze the impact of fluid-attenuated inversion recovery (FLAIR) resection on survival using statistical methods, proportional hazards regression, and Kaplan-Meier survival analysis.

Results: Predictive models achieved high accuracy (area under the curve of 0.902) for glioma-grade prediction. FLAIR abnormality resection significantly improved survival, while diffusion-weighted image best-depicted tumor infiltration. Glioblastoma infiltration was best seen with advanced MRI compared to metastasis. Glioblastomas showed distinct features, including irregular shape, margins, and enhancement compared to metastases, which were oval or round, with clear edges and even contrast, and extensive peritumoral changes.

Conclusion: Advanced radiomic and machine learning analysis of MRI can provide noninvasive glioma grading and characterization of tumor properties with clinical relevance. Combining advanced neuroimaging with histopathology may better integrate oncology and radiology for optimized glioblastoma management. However, further studies are needed to validate these findings with larger datasets and assess additional MRI sequences and radiomic features.

背景:多形性胶质母细胞瘤(GBM)等侵袭性脑肿瘤预后较差。虽然磁共振成像(MRI)对 GBM 的治疗至关重要,但使用传统方法很难将其与其他病变区分开来。本研究探索先进的磁共振成像技术,以更好地了解 GBM 的特性及其与患者预后的关系:我们研究了 2020 年 1 月至 2024 年 3 月期间 157 例 GBM 手术患者的 MRI 扫描图像,以提取放射学特征,并使用统计方法、比例危险回归和 Kaplan-Meier 生存分析,分析流体增强反转恢复(FLAIR)切除对生存的影响:预测模型对胶质瘤分级预测的准确率很高(曲线下面积为 0.902)。FLAIR异常切除能显著提高生存率,而弥散加权图像能最好地显示肿瘤浸润情况。与转移瘤相比,胶质母细胞瘤的浸润在晚期磁共振成像中显示得最好。与转移瘤相比,胶质母细胞瘤显示出明显的特征,包括不规则的形状、边缘和强化,而转移瘤呈椭圆形或圆形,边缘清晰,对比度均匀,瘤周变化广泛:结论:先进的磁共振成像放射学和机器学习分析可提供无创胶质瘤分级和具有临床意义的肿瘤特性特征。将先进的神经影像学与组织病理学相结合,可以更好地整合肿瘤学和放射学,优化胶质母细胞瘤的治疗。不过,还需要进一步的研究,用更大的数据集来验证这些发现,并评估更多的磁共振成像序列和放射学特征。
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引用次数: 0
Long-term survival following molecular-targeted therapy for intramedullary non-small-cell lung cancer metastasis. 髓内非小细胞肺癌转移分子靶向治疗后的长期生存率。
Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_603_2024
Ryo Kanematsu, Junya Hanakita, Toshiyuki Takahashi, Manabu Minami, Koichi Mitsuya

Background: Intramedullary spinal cord metastases (ICSMs) are very rarely curable; these patients typically have very short-term survival rates. Here, a 22-year-old male with non-small-cell lung cancer (NSCLC) later developed ICSM twice; the first C4-C7 tumor responded well to surgery, radiation, and alectinib molecular-targeted therapy. The secondary ICSM C1 lesion seen years later (i.e., likely due to alectinib having been stopped) resolved once alectinib was again administered.

Case description: A 22-year-old male with a limited smoking history presented with advanced non-small-cell lung cancer (NSCLC) treated with pulmonary surgery followed by radiotherapy and chemotherapy. Four years later, he developed cervical myelopathy attributed to a C4-C7 stage IV NSCLC ICSM (i.e., notably associated with an anaplastic lymphoma kinase [ALK] rearrangement). After cervical surgery and irradiation (40 Gy/20 fr) of the resection cavity, he was also given alectinib; the patient remained disease-free for the next 7 years, remaining on alectinib. However, 1 year after alectinib was discontinued, he experienced a newly occurrent C1 ICSM lesion; the alectinib was restarted, and his tumor regressed over the next 3 years. At present, 14 years after the original ICSM surgery, the patient remains disease free but continued alectinib (Karnofsky Performance Scale: 90%).

Conclusion: Although the prognosis for ICSM is generally poor, molecular-targeted therapies, such as alectinib, as administered in this case, may provide long-term survival for patients with ALK-positive NSCLC tumors.

背景:髓内脊髓转移瘤(ICSM)很少能治愈,这些患者的生存期通常很短。这里有一名患有非小细胞肺癌(NSCLC)的22岁男性患者,后来出现了两次髓内脊髓转移瘤;第一次C4-C7肿瘤对手术、放疗和阿来替尼分子靶向治疗反应良好。数年后出现的第二次ICSM C1病变(可能是由于阿来替尼停药所致)在再次使用阿来替尼后得到缓解:一名 22 岁的男性,吸烟史有限,曾因晚期非小细胞肺癌(NSCLC)接受肺部手术治疗,随后接受放疗和化疗。四年后,他出现了颈椎脊髓病,归因于C4-C7期NSCLC ICSM(即明显伴有无性淋巴瘤激酶[ALK]重排)。在进行了颈椎手术和切除腔照射(40 Gy/20 fr)后,他还接受了阿来替尼治疗;在接下来的 7 年中,患者一直保持无病状态,并继续服用阿来替尼。然而,在停用阿来替尼 1 年后,他又出现了新的 C1 ICSM 病变;阿来替尼被重新启用,在接下来的 3 年中,他的肿瘤有所消退。目前,距离最初的 ICSM 手术已经过去了 14 年,该患者仍未患病,但仍在继续服用阿来替尼(卡诺夫斯基表现评分:90%):结论:尽管ICSM的预后普遍较差,但分子靶向疗法,如本病例中使用的阿来替尼,可为ALK阳性NSCLC肿瘤患者提供长期生存。
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引用次数: 0
A single-session stereotactic radiosurgery for vagal paraganglioma: Effective tumor reduction and innovative treatment option. 迷走神经旁神经节瘤的单次立体定向放射手术:有效缩小肿瘤,创新治疗方案。
Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_443_2024
Masayuki Nakamura, Motoyuki Umekawa, Yuki Shinya, Hirotaka Hasegawa, Atsuto Katano, Nobuhito Saito

Background: Vagal paragangliomas (VPs) are rare tumors in the upper cervical region. Although surgical resection is the standard treatment for these tumors, it carries significant risks due to the tumor's high vascularity and proximity to vital structures. Stereotactic radiosurgery (SRS) for skull base paraganglioma could be a minimally invasive alternative.

Case description: We report the case of a 47-year-old man with a large, asymptomatic VP who was successfully treated with SRS with Gamma Knife Icon, which was performed in the parapharyngeal space (volume: 25.7 mL) using a marginal dose of 14 Gy to the 45% isodose line. This case illustrates the successful treatment of a lesion near the conventional limits (lower limit of C2 vertebral body) using noninvasive mask fixation. Excellent tumor control without neurological deficits was achieved for 25 months after SRS. The tumor volume decreased by 70% (final volume: 7.6 mL).

Conclusion: This study demonstrates the utility of Gamma Knife Icon, which facilitates optimal SRS for upper cervical lesions, including VPs.

背景:迷走神经旁神经节瘤(VPs)是上颈部的罕见肿瘤。虽然手术切除是治疗这类肿瘤的标准方法,但由于肿瘤血管丰富且靠近重要结构,因此手术切除存在很大风险。立体定向放射外科手术(SRS)治疗颅底副神经节瘤是一种微创的替代方法:我们报告了一例 47 岁男性患者的病例,他患有一个巨大、无症状的 VP,在咽旁间隙(体积:25.7 mL)成功接受了伽玛刀 Icon 的 SRS 治疗,边缘剂量为 14 Gy,达到 45% 等剂量线。该病例说明了利用无创面罩固定成功治疗了接近常规界限(C2椎体下限)的病变。SRS 术后 25 个月,肿瘤控制良好,无神经功能障碍。肿瘤体积减少了 70%(最终体积:7.6 mL):这项研究证明了伽玛刀 Icon 的实用性,它有助于上颈椎病变(包括 VPs)的最佳 SRS 治疗。
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引用次数: 0
Complications of ventriculoperitoneal shunts: Infection and exposure in hydrocephalus patients: A case series. 脑室腹腔分流术并发症:脑积水患者的感染和暴露:病例系列。
Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_545_2024
Tommy Alfandy Nazwar, Sumarno Sumarno, Farhad Balafif, Donny Wisnu Wardhana, Ronald Aprianto Parubak, Melani Melani, Prima Putri Dyah Titisari, Christin Panjaitan, Indri Febriani

Background: Ventriculoperitoneal shunt (VPS) is an effective intervention for managing hydrocephalus; however, various complications may arise, one of which is infection due to shunt exposure. In this study, we report the incidence, risk factors, clinical presentation, and management strategies of four cases of shunt exposure in patients with hydrocephalus.

Case description: The first case involves a 1-year-10-month-old female who underwent her initial VPS placement at 7 months old due to hydrocephalus. The second case is a 3-month-old female who had a VPS placed at 20 days old for obstructive hydrocephalus and ventriculomegaly secondary to toxoplasmosis. The third case is a 15-year-old female who received a VPS due to a cerebral abscess with a prior history of tuberculous meningoencephalopathy. The fourth case is a 38-year-old male who underwent VPS placement for hydrocephalus. Two years post-intervention, the fourth patient was diagnosed with VPS exposure and subsequently underwent shunt removal.

Conclusion: The identification of risk factors and clinical symptoms in patients, supported by ancillary examinations such as cerebrospinal fluid analysis, can predict the incidence of VPS infections. Bacterial VPS infections can be managed with appropriate antibiotics tailored to the specific bacterial species. However, in certain cases, surgical removal of the VPS may be considered as a measure to eradicate infectious pathogens.

背景:脑室腹腔分流术(VPS)是治疗脑积水的一种有效干预措施;然而,可能会出现各种并发症,其中之一就是分流管暴露引起的感染。在本研究中,我们报告了四例脑积水患者分流管暴露的发生率、风险因素、临床表现和处理策略:第一个病例是一名 1 岁 10 个月大的女性患者,由于脑积水,她在 7 个月大时接受了首次 VPS 植入术。第二个病例是一名 3 个月大的女性,因弓形虫病继发梗阻性脑积水和脑室肥大,在出生 20 天时接受了 VPS 植入术。第三个病例是一名 15 岁女性,因脑脓肿接受了 VPS,之前曾有结核性脑膜脑病病史。第四个病例是一名 38 岁的男性,因脑积水接受了 VPS 植入术。干预两年后,第四位患者被诊断为 VPS 暴露,随后接受了分流管移除手术:结论:识别患者的危险因素和临床症状,并辅以脑脊液分析等辅助检查,可以预测 VPS 感染的发生率。细菌性 VPS 感染可使用针对特定细菌种类的适当抗生素进行治疗。但在某些情况下,可考虑通过手术切除 VPS,以根除感染性病原体。
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引用次数: 0
Small-cell neuroendocrine carcinoma of the cervix with leptomeningeal spread: A rare coincidence report and literature review. 宫颈小细胞神经内分泌癌伴脑膜扩散:罕见的巧合报告和文献综述。
Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_431_2024
Mohammed A Azab, Oday Atallah, Nour El-Gohary, Ahmed Hazim, Hamed Abdelma'aboud Mostafa

Background: Metastasis from cancers of the cervix to the central nervous system is relatively uncommon. Small-cell neuroendocrine cancer of the cervix is a very rare tumor with a high tendency to spread early.

Case description: A 33-year-old-woman was diagnosed with a small-cell neuroendocrine cancer of the cervix after complaining about a long time of post-coital bleeding. The patient was treated with eight cycles of chemotherapy and whole pelvis consolidation radiotherapy. One year later, the patient experienced local recurrence with metastases to the liver, left adrenal, and brain. Brain metastases were treated with radiosurgery. The patient started immunotherapy. Two months later, the patient was presented to the emergency department with urinary incontinence, neck pain, and difficulty walking. She was then diagnosed with craniospinal leptomeningeal disease (LMD). The patient received craniospinal palliative radiation therapy. The disease activity was severely progressive, and the patient passed out within 10 days after being diagnosed with cranial LMD.

Conclusion: A high index of suspicion for LMD is essential in patients diagnosed with cervix cancer who present with unexplained neurologic symptoms, especially with the high-grade neuroendocrine cancer type. Implementing robust research to uncover the biology of these aggressive tumors is important due to the rarity of this pathology.

背景:宫颈癌转移至中枢神经系统的情况相对少见。宫颈小细胞神经内分泌癌是一种非常罕见的肿瘤,具有高度的早期扩散倾向:病例描述:一名 33 岁的女性因长期性交后出血而被诊断为宫颈小细胞神经内分泌癌。患者接受了八个周期的化疗和全盆腔综合放疗。一年后,患者局部复发,并出现肝脏、左肾上腺和脑转移。脑转移灶接受了放射外科手术治疗。患者开始接受免疫治疗。两个月后,患者因尿失禁、颈部疼痛和行走困难到急诊科就诊。随后,她被诊断为颅骨脊髓脑膜病(LMD)。患者接受了颅骨姑息放射治疗。疾病活动严重进展,患者在被诊断为颅脑LMD后10天内昏迷不醒:结论:对于确诊为宫颈癌并伴有不明原因神经症状的患者,尤其是高级别神经内分泌癌患者,高度怀疑 LMD 至关重要。由于这种病理罕见,因此开展强有力的研究以揭示这些侵袭性肿瘤的生物学特性非常重要。
{"title":"Small-cell neuroendocrine carcinoma of the cervix with leptomeningeal spread: A rare coincidence report and literature review.","authors":"Mohammed A Azab, Oday Atallah, Nour El-Gohary, Ahmed Hazim, Hamed Abdelma'aboud Mostafa","doi":"10.25259/SNI_431_2024","DOIUrl":"10.25259/SNI_431_2024","url":null,"abstract":"<p><strong>Background: </strong>Metastasis from cancers of the cervix to the central nervous system is relatively uncommon. Small-cell neuroendocrine cancer of the cervix is a very rare tumor with a high tendency to spread early.</p><p><strong>Case description: </strong>A 33-year-old-woman was diagnosed with a small-cell neuroendocrine cancer of the cervix after complaining about a long time of post-coital bleeding. The patient was treated with eight cycles of chemotherapy and whole pelvis consolidation radiotherapy. One year later, the patient experienced local recurrence with metastases to the liver, left adrenal, and brain. Brain metastases were treated with radiosurgery. The patient started immunotherapy. Two months later, the patient was presented to the emergency department with urinary incontinence, neck pain, and difficulty walking. She was then diagnosed with craniospinal leptomeningeal disease (LMD). The patient received craniospinal palliative radiation therapy. The disease activity was severely progressive, and the patient passed out within 10 days after being diagnosed with cranial LMD.</p><p><strong>Conclusion: </strong>A high index of suspicion for LMD is essential in patients diagnosed with cervix cancer who present with unexplained neurologic symptoms, especially with the high-grade neuroendocrine cancer type. Implementing robust research to uncover the biology of these aggressive tumors is important due to the rarity of this pathology.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparative anatomical analysis between lateral supraorbital and minipterional approaches. 眶上外侧入路和小翼入路的解剖学对比分析。
Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_550_2024
Ricardo Marques Lopes de Araujo, Dan Zimelewicz Oberman, Leonardo Christiaan Welling, Bipin Chaurasia, Alexander I Evins, Antonio Bernardo, Gustavo Rassier Isolan, Jose Paulo Dourado, Nicollas Nunes Rabelo, Eberval G Figueiredo

Background: The pterional craniotomy, described by Yasargil and Fox in 1975, constitutes the most traditional and important surgical access in vascular neurosurgery. Minimally invasive alternatives include the minipterional (MP) and lateral supraorbital (LSO) craniotomies, which avoid complications such as injury to the frontal branch of the facial nerve, temporal muscle dysfunction, depression of the craniotomy site, frontal sinus opening, and cosmetically unacceptable outcomes. We evaluated and compared the exposures provided by MP and LSO craniotomies through quantitative measurements of the surgical exposure area around the circle of Willis and parasellar regions, as well as angular and linear exposures of the internal carotid artery (ICA) bifurcation, middle cerebral artery (MCA), midpoint of the anterior communicating artery, and tip of the basilar artery (BA).

Methods: Seven fresh cadavers were dissected at the São Paulo Medical Examiner's Office, SP, and three at the skull base laboratory of Weill Cornell Medical College, New York, USA. The craniotomies were performed sequentially, initially with the LSO craniotomy followed by the MP. After the craniotomy, the surgical exposure area, craniotomy area, and angular exposures in the horizontal and vertical axes were determined.

Results: The MP craniotomy provided better angular exposure for the ipsilateral MCA, while the LSO craniotomy and BA provided better vertical axis exposures. The LSO craniotomy provided better angular exposure in the vertical axis for the midpoint of the anterior communicating artery and contralateral ICA bifurcation. Regarding surgical exposure and craniotomy area, there were no statistically significant differences.

Conclusion: The MP craniotomy offers a significantly larger surgical exposure compared to the LSO craniotomy, with specific advantages regarding angular exposure to important neurovascular structures. This study provides important quantitative data to guide the choice between these minimally invasive access techniques in vascular neurosurgery.

背景:翼部开颅术由 Yasargil 和 Fox 于 1975 年描述,是血管神经外科最传统、最重要的手术入路。微创手术的替代方法包括蝶骨小切口(MP)和眶上外侧(LSO)开颅术,可避免面神经额支损伤、颞肌功能障碍、开颅部位凹陷、额窦开放等并发症,以及外观上无法接受的结果。我们通过定量测量 Willis 圈和髌旁区域周围的手术暴露面积,以及颈内动脉 (ICA) 分叉、大脑中动脉 (MCA)、前交通动脉中点和基底动脉 (BA) 尖端的角度和线性暴露面积,评估并比较了 MP 和 LSO 开颅术提供的暴露面积:七具新鲜尸体在巴西圣保罗法医办公室解剖,三具在美国纽约威尔康奈尔医学院颅底实验室解剖。开颅手术按顺序进行,首先进行 LSO 开颅手术,然后进行 MP 开颅手术。开颅手术后,确定手术暴露面积、开颅面积以及水平轴和垂直轴的角度暴露:结果:MP开颅术为同侧MCA提供了更好的角度暴露,而LSO开颅术和BA提供了更好的垂直轴暴露。LSO开颅手术能更好地暴露前交通动脉中点和对侧ICA分叉的垂直轴角度。在手术暴露和开颅面积方面,差异无统计学意义:结论:与 LSO 开颅术相比,MP 开颅术的手术暴露面积明显更大,在重要神经血管结构的角度暴露方面更具优势。这项研究提供了重要的定量数据,为血管神经外科选择这些微创入路技术提供了指导。
{"title":"Comparative anatomical analysis between lateral supraorbital and minipterional approaches.","authors":"Ricardo Marques Lopes de Araujo, Dan Zimelewicz Oberman, Leonardo Christiaan Welling, Bipin Chaurasia, Alexander I Evins, Antonio Bernardo, Gustavo Rassier Isolan, Jose Paulo Dourado, Nicollas Nunes Rabelo, Eberval G Figueiredo","doi":"10.25259/SNI_550_2024","DOIUrl":"10.25259/SNI_550_2024","url":null,"abstract":"<p><strong>Background: </strong>The pterional craniotomy, described by Yasargil and Fox in 1975, constitutes the most traditional and important surgical access in vascular neurosurgery. Minimally invasive alternatives include the minipterional (MP) and lateral supraorbital (LSO) craniotomies, which avoid complications such as injury to the frontal branch of the facial nerve, temporal muscle dysfunction, depression of the craniotomy site, frontal sinus opening, and cosmetically unacceptable outcomes. We evaluated and compared the exposures provided by MP and LSO craniotomies through quantitative measurements of the surgical exposure area around the circle of Willis and parasellar regions, as well as angular and linear exposures of the internal carotid artery (ICA) bifurcation, middle cerebral artery (MCA), midpoint of the anterior communicating artery, and tip of the basilar artery (BA).</p><p><strong>Methods: </strong>Seven fresh cadavers were dissected at the São Paulo Medical Examiner's Office, SP, and three at the skull base laboratory of Weill Cornell Medical College, New York, USA. The craniotomies were performed sequentially, initially with the LSO craniotomy followed by the MP. After the craniotomy, the surgical exposure area, craniotomy area, and angular exposures in the horizontal and vertical axes were determined.</p><p><strong>Results: </strong>The MP craniotomy provided better angular exposure for the ipsilateral MCA, while the LSO craniotomy and BA provided better vertical axis exposures. The LSO craniotomy provided better angular exposure in the vertical axis for the midpoint of the anterior communicating artery and contralateral ICA bifurcation. Regarding surgical exposure and craniotomy area, there were no statistically significant differences.</p><p><strong>Conclusion: </strong>The MP craniotomy offers a significantly larger surgical exposure compared to the LSO craniotomy, with specific advantages regarding angular exposure to important neurovascular structures. This study provides important quantitative data to guide the choice between these minimally invasive access techniques in vascular neurosurgery.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
CT correlation of spinal canal diameter with pedicle size for safer posterior cervical pedicle screw fixation. 椎管直径与椎弓根尺寸的 CT 相关性,以实现更安全的颈椎后路椎弓根螺钉固定。
Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_590_2024
Yushi Nagano, Hitoshi Yamahata, Ryutaro Makino, Nayuta Higa, Jun Sugata, Shingo Fujio, Ryosuke Hanaya

Background: Utilizing computed tomography (CT) studies, we correlated cervical spinal canal diameters (SCDs) with pedicle size between the C3 and C7 levels to more safely perform posterior cervical surgery.

Methods: We retrospectively analyzed CT studies for 71 patients with cranial or spinal disorders and correlated the cervical SCD with the pedicle outer width (POW) between the C3 and C7 levels. Patients were divided into normal (SCD ≥12 mm at any level, n = 30) and stenosis groups (SCD <12 mm at any level, n = 41).

Results: C7 exhibited the largest SCD and POW values, while C3 and C4 exhibited the smallest SCD and POW values. Moderate correlations (r = 0.3, P = 0.002) were observed at the C3 and C4 levels but no significant correlations were observed from the C5 to C7 levels. For SCD values, the normal group demonstrated significantly greater values between the C3 and C7 levels versus the stenosis group. For POW values, only the C4 level differed significantly between the two groups (P = 0.014, Mann-Whitney U-test).

Conclusion: Preoperative pedicle size evaluation remains an essential manoeuvre before performing cervical C3-C7 pedicle screw placement. In 71 cervical CT studies, we found no consistent correlation between POW and SCD values, indicating that it is difficult to estimate POW values based on spinal canal size.

背景:利用计算机断层扫描(CT)研究,我们将颈椎椎管直径(SCD)与C3和C7水平之间的椎弓根大小相关联,以便更安全地实施颈椎后路手术:我们回顾性地分析了71名颅骨或脊柱疾病患者的CT检查结果,并将颈椎椎管直径(SCD)与C3和C7水平之间的椎弓根外宽(POW)相关联。患者被分为正常组(任何级别的SCD≥12毫米,n = 30)和狭窄组(SCD n = 41):结果:C7 的 SCD 和 POW 值最大,而 C3 和 C4 的 SCD 和 POW 值最小。在 C3 和 C4 水平观察到中度相关性(r = 0.3,P = 0.002),但在 C5 至 C7 水平未观察到显著相关性。在 SCD 值方面,正常组与狭窄组相比,C3 和 C7 水平的值明显更大。就POW值而言,两组之间只有C4水平有显著差异(P = 0.014,曼-惠特尼U检验):结论:在进行颈椎C3-C7椎弓根螺钉置入术之前,术前椎弓根尺寸评估仍然是一项重要的操作。在 71 项颈椎 CT 研究中,我们发现 POW 值和 SCD 值之间没有一致的相关性,这表明很难根据椎管大小来估计 POW 值。
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引用次数: 0
Unilateral percutaneous balloon kyphoplasty for thoracic osteoporotic vertebral compression fractures: A case report and literature review. 单侧经皮球囊椎体后凸成形术治疗胸椎骨质疏松性椎体压缩骨折:病例报告和文献综述。
Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_526_2024
Marthinson Andrew Tombeng, Christopher Lauren, Tjokorda Gde Bagus Mahadewa

Background: Unilateral percutaneous balloon kyphoplasty (PBK) is increasingly utilized for the management of osteoporotic vertebral compression fractures (OVCFs). Its potential advantages include procedural simplicity, reduced tissue trauma, and minimal radiation exposure.

Case description: A 59-year-old female with osteoporosis presented with back pain but was neurologically intact 2 weeks after a fall. The magnetic resonance imaging documented a thoracic 12 vertebral compression fracture that was successfully treated with a unilateral PBK.

Conclusion: Unilateral PBK appears promising for managing OVCFs in the aging population and offers rapid pain relief, vertebral height restoration, and functional improvement.

背景:单侧经皮球囊椎体后凸成形术(PBK)越来越多地被用于治疗骨质疏松性椎体压缩骨折(OVCF)。其潜在优势包括手术简单、减少组织创伤和辐射暴露:一名 59 岁的女性骨质疏松症患者在一次跌倒后 2 周出现背部疼痛,但神经系统完好。磁共振成像显示其胸椎 12 节椎体压缩性骨折,单侧 PBK 手术成功治疗了该骨折:结论:单侧椎体后凸成形术在治疗老年人群的椎体压缩性骨折方面前景广阔,可迅速缓解疼痛、恢复椎体高度并改善功能。
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引用次数: 0
Safety and efficacy of mechanical thrombectomy for acute ischemic stroke with volume over 50 mL and significant perfusion mismatch. 对容量超过 50 毫升且灌注严重不匹配的急性缺血性中风进行机械血栓切除术的安全性和有效性。
Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_365_2024
Douglas Gonsales, Eberval Gadelha Figueiredo, Joao Paulo Mota Telles, Pedro Aguilar-Salinas, Nima Amin Aghaebrahim, Eric Sauvageau, Saul Almeida da Silva, Ricardo A Hanel

Background: This study aims to address the safety and efficacy of mechanical thrombectomy (MT) in acute ischemic stroke with an established infarction equal to or >50 mL with a significant difference between penumbra and established infarction detected by perfusion cerebral computed tomography (CT) with the Rapid® system.

Methods: This was a retrospective case-control study. Patients diagnosed with established and extensive ischemic stroke, defined by an ischemic volume equal to or >50 mL on CT or magnetic resonance imaging perfusion using the RAPID® system, were examined. The intervention group received endovascular interventional treatment with or without recombinant tissue plasminogen activator (rt-PA) in addition to standard therapy, and the control group received conservative treatment with or without rt-PA plus standard therapy.

Results: A total of 59 patients were enrolled, including 38 in the intervention group and 21 in the control group. Baseline characteristics were similar between groups. Patient National Institutes of Health Stroke Scale at discharge was significantly different between the control (median 30, interquartile range [IQR] 13) and intervention group (median 8, IQR 14) (P < 0.001). Modified Rankin scale (mRS) scores were significantly different at discharge between intervention (median mRS 2, IQR 3) and controls (median mRS 5, IQR 1) (P = 0.002). These mRS differences remained significant at 90 days, with median (IQR) values of 2 (2.75) and 5 (1), respectively (P < 0.001).

Conclusion: MT is safe and effective for large-core ischemic strokes with significant perfusion mismatch, leading to better functional outcomes without significant complications compared to the best medical treatment.

研究背景本研究旨在探讨机械性血栓切除术(MT)在急性缺血性脑卒中中的安全性和有效性:这是一项回顾性病例对照研究。方法:这是一项回顾性病例对照研究。研究对象为确诊为广泛缺血性卒中的患者,其缺血容量等于或大于 50 mL,CT 或磁共振成像灌注采用 RAPID® 系统。干预组除接受标准治疗外,还接受使用或不使用重组组织浆细胞酶原激活剂(rt-PA)的血管内介入治疗,对照组则接受使用或不使用重组组织浆细胞酶原激活剂(rt-PA)的保守治疗加标准治疗:共有59名患者入组,其中干预组38人,对照组21人。两组患者的基线特征相似。对照组(中位数 30,四分位数间距 [IQR] 13)和干预组(中位数 8,四分位数间距 [IQR] 14)患者出院时的美国国立卫生研究院卒中量表差异显著(P < 0.001)。干预组(中位数 mRS 2,IQR 3)和对照组(中位数 mRS 5,IQR 1)出院时的改良朗肯量表(mRS)评分差异显著(P = 0.002)。这些 mRS 差异在 90 天后仍然显著,中位数(IQR)分别为 2(2.75)和 5(1)(P < 0.001):MT对灌注严重失配的大核心缺血性脑卒中安全有效,与最佳的药物治疗相比,MT能带来更好的功能预后,且无明显并发症。
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引用次数: 0
Successful administration of clazosentan in subarachnoid hemorrhage patient with severe heart failure. 对严重心力衰竭的蛛网膜下腔出血患者成功施用克拉索坦。
Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_554_2024
Fuga Ayabe, Tomoyuki Kino, Tomo Kinoshita, Kana Sawada, Kuniyasu Saigusa

Background: Clazosentan, an endothelin receptor antagonist, has been shown to prevent cerebral vasospasms following subarachnoid hemorrhage (SAH) effectively. However, clazosentan-induced pulmonary edema is a frequently reported adverse effect and a primary reason for discontinuing treatment. The presence of preexisting heart conditions predisposes patients to severe pulmonary edema; thus, the administration of clazosentan is generally contraindicated.

Case description: We report the successful administration of clazosentan in a 58-year-old female patient with SAH and severe heart failure (Takotsubo cardiomyopathy). The patient initially presented with a ruptured left internal carotid posterior communicating artery aneurysm, leading to SAH. She successfully underwent neck clipping, and postoperative treatment to prevent cerebral vasospasm, including clazosentan, was initiated. Following the emergency surgical intervention, she exhibited pulmonary edema and diffused left ventricular hypokinesis with an ejection fraction of 10-20%. Although drug-induced pulmonary edema emerged after the administration of clazosentan, tailored fluid management based on daily cardiac function and ventilator management in response to pulmonary edema enabled the completion of a 2-week clazosentan therapy regimen. This approach guaranteed the patient's stability throughout the treatment period. Neither cerebral vasospasm nor cardiopulmonary complications were observed.

Conclusion: This case highlights the importance of a multidisciplinary approach in managing complex patients with severe cardiac comorbidities undergoing clazosentan therapy.

研究背景氯唑生坦是一种内皮素受体拮抗剂,已被证明能有效预防蛛网膜下腔出血(SAH)后的脑血管痉挛。然而,克拉生坦引起的肺水肿是经常报告的不良反应,也是中断治疗的主要原因。患有先心病的患者容易出现严重的肺水肿,因此一般禁用克拉索坦:我们报告了一名患有 SAH 和严重心力衰竭(Takotsubo 心肌病)的 58 岁女性患者成功使用克拉索坦的病例。患者最初因左颈内后交通动脉瘤破裂导致 SAH。她成功地接受了颈部剪切术,术后开始了包括克拉生坦在内的预防脑血管痉挛的治疗。紧急手术干预后,她出现了肺水肿和弥漫性左心室运动功能减退,射血分数为 10-20%。虽然在服用克拉索坦后出现了药物诱发的肺水肿,但根据每日心功能和肺水肿时的呼吸机管理情况进行了有针对性的液体管理,从而完成了为期两周的克拉索坦治疗方案。这种方法保证了患者在整个治疗期间的病情稳定。结论:本病例强调了综合治疗的重要性:本病例强调了多学科方法在管理接受克拉索坦治疗的患有严重心脏并发症的复杂患者中的重要性。
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Surgical neurology international
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