Asian journal of neurosurgery最新文献

Background  Chronic subdural hematoma (SDH) is notoriously known to have high recurrence rates after surgery. We followed the course of 100 postoperative patients to determine the various stipulated factors associated with recurrence. Materials and Methods  In our study of 100 patients, there was a significant association with the size of SDH, amount of midline shift, increasing age, less duration of primary injury, and the increasing incidence of delayed resolution and recurrence. Also, the membrane of the patients with recurrent SDH was found to have a collection of neutrophils, plasma cells, histiocytes, and lymphocytes. Conclusion  Large size of SDH, increasing age, and recent injury were significant determining factors for delayed resolution and recurrence.

Traumatic brain injury (TBI) poses a significant public health challenge in the United States, with diverse causes and outcomes. Understanding the trends in TBI-related mortality is crucial for effective prevention and intervention strategies. This comprehensive analysis utilized data from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database, covering the period from 1999 to 2020. Cause-of-death records were examined using the 10th Edition of the International Classification of Diseases and Related Health Problems diagnostic code S06 for TBI-related fatalities. Mortality rates were calculated per 100,000 individuals, adjusted for age and urban/rural status. Joinpoint Regression analysis was employed to identify significant trends over time. Between 1999 and 2020, 1,218,667 TBI-related deaths occurred, with varying mortality rates across demographic groups and geographic regions. Within the overall population, the highest annual average mortality rates were observed in the non-Hispanic (NH) American Indian or Alaska Native cohort, followed by NH white, NH black or African American, Hispanic or Latino, and NH Asian or Pacific Islander groups. Overall, there was an initial decrease in mortality rate from 1999 to 2012, followed by a subsequent significant increase. Males consistently exhibited higher mortality rates than females across all age groups. Disparities were also observed based on race/ethnicity, with NH American Indian or Alaska Native populations showing the highest mortality rates. Regional variations were evident, with the southern region consistently exhibiting the highest mortality rates. Evolving trends in TBI-related mortality in the United States highlight the need for targeted interventions, particularly in high-risk demographic groups and regions.

Background  The surgical management guidelines for any intracranial hemorrhage were objectively defined by the Brain Trauma Foundation (BTF) in 2006 for patients who should be treated surgically or conservatively. Since then, not much work has been done toward the identification of patients who are at high risk and may have progression of the hematoma who may ultimately require surgery. This study aimed to apply the said criteria to all patients coming to the hospital with extradural hematoma (EDH) and analyze the outcome of the patient whether treated conservatively or surgically on the basis of the Glasgow Outcome Scale (GOS) and to observe the factors and variables that are associated with EDH that will help in furthering the demographic design of the entity in central India. Materials and Methods  A prospective and retrospective, ambivalent cohort study was performed at a hospital in central India involving all cases of computed tomography (CT) diagnosed EDH that were reported to the center from October 2016 to March 2018. A total of 78 patients were included in the study. Patients were selected and managed conservatively or surgically as per the criteria and were followed up until the outcome. In retrospective analysis, we evaluated the current criteria for surgery in all patients of posttraumatic EDH in the past 5 years and whose records were available. Condition on discharge or the outcome along with GOS was taken as the endpoint for retrospective analysis. Results  Temporoparietal and frontal regions were the most common sites of EDH and also presented higher mortality rates as compared with other sites. The majority of patients had EDH of length of greater than 5 cm and the mortality rate for the same group also increased with lesser survival chances with length of greater than 10 cm. Patients who presented with an EDH of greater than 1-cm width were higher in numbers, with survival rates decreasing with an increase in width, especially with an EDH greater than 2 cm. Conclusion We conclude that the criteria laid out by the BTF, namely, CT findings of an EDH volume greater than 30 mL, width greater than 15 mm, and mildline shift of greater than 5 mm, hold good in cases of EDH. This study reviewed the previous criteria in the Indian setting and found them to hold good so far.

Background  The surgical management of adolescent idiopathic scoliosis (AIS) often incorporates the utilization of pedicle screws, which are three-column construct devices. A comprehensive understanding of the pedicle morphology is essential for determining the appropriate pedicle screw diameter. While previous studies have examined pedicle morphology in Lenke type 1 AIS, there is a scarcity of information about the pedicle morphology in Lenke type 5 AIS, especially in the Thai population. Objective  The aim of this study is to analyze the morphology of the thoracolumbar pedicle, specifically the pedicle width and trajectory length on both the concave and convex sides within a sample of the Thai population diagnosed with Lenke type 5 AIS. Materials and Methods  In this study, we used computed tomography (CT) measurements to examine the thoracolumbar pedicle morphology in Lenke type 5 AIS patients in the Thai population. We also analyzed the pedicle width and trajectory length on both concave and convex sides in 112 AIS patients with Lenke type 5 curvature. Results  A total of 3,808 pedicles from 112 consecutive AIS patients of Lenke type 5 were enrolled in the study. It was observed that the transverse pedicle width was notably smaller on the concave side compared with the convex side in the apical region of the thoracolumbar spine (T12 to L2). Additionally, the pedicle width of T3 was also found to be significantly smaller on the concave side. Moreover, it was noted that the pedicle trajectory length is significantly longer on the concave side, indicating that the concave side in the apical region may have the capacity to accommodate a slightly longer pedicle screw at T3, T6, L2, L3, and L4. Conclusion  Our analysis of measurements indicates that the thoracolumbar pedicle morphology in Lenke type 5 AIS among the Thai population typically shows smaller widths and longer trajectory lengths on the concave side. This information enhances our understanding of the appropriate selection of pedicle screw diameter and length for treating Lenke type 5 AIS in the Thai population.

Background  There has been a surge in sudden and unexpected deaths, presenting a significant challenge for health policymakers and researchers. These individuals showed no signs of recent or past illnesses and died suddenly during routine activities like walking, standing, or working. Objective  This study focuses on exploring nontraumatic brain hemorrhage as a cause of death in autopsies of individuals without prior illnesses. The research aims to explore patterns, prevalence, and risk factors associated with nontraumatic brain hemorrhage, specifically obesity in sudden and unexpected deaths. Materials and Methods  This retrospective, observational study was conducted using autopsy cases with nontraumatic brain hemorrhage as the identified cause of sudden and unexpected deaths. Information on demographic details, medical history, and circumstances surrounding the deaths was collected. The cases were classified based on the body mass index according to the classification of the World Health Organization. Results  From April 2023 to January 2024, 10 cases of sudden and unexpected deaths due to nontraumatic brain hemorrhage were identified. Key findings included predominantly cases of obesity or overweight, deaths occurring predominantly between 8 p.m. and midnight, and all cases being males. Conclusion  The study sheds light on the surge in sudden deaths, specifically attributed to nontraumatic brain hemorrhage. The findings reveal a significant association between obesity and brain hemorrhage in sudden deaths, especially among males. The study's temporal analysis adds depth to understanding these patterns.

Objective  The objective of this study is to establish a precise database detailing the width of vertebral endplates, the depth of vertebral endplates (anterior-posterior [A-P] width), and the height of intervertebral discs within the lumbar spine of the Asian population. Materials and Methods  The stand-alone lateral lumbar interbody fusion (LLIF) procedure is increasingly popular for minimally invasive spine surgery and has demonstrated effectiveness in treating various spinal pathologies. Previous studies have indicated that the use of a 26-mm wide cage in stand-alone LLIF can significantly decrease the incidence of cage subsidence. However, most of these studies were conducted on the Caucasian population, which has a larger anatomical structure compared with the Asian population. Consequently, the appropriate wide cage size suitable for stand-alone LLIF in the Asian population has not been previously explored. Ninety-one computed tomography (CT) images were obtained from patients who presented with back pain and had negative imaging results between 2017 and 2021. These images were analyzed using the Picture Archiving Communication System to assess the vertebral body's topography. The analysis involved measuring the vertebral endplate width, vertebral endplate depth (A-P width), and intervertebral disc height. Results  The findings of this study reveal that there is a noticeable increase in the overall width, depth, and intervertebral disc height of the lumbar vertebrae from the upper to the lower regions. Additionally, the morphometric attributes of the lumbar vertebrae observed in this study closely resemble those of Caucasian subjects. Conclusion  The morphometric measurements of the lumbar vertebrae in the Asian population closely resemble those of Caucasian subjects. As a result, it is suggested that a 26-mm wide cage may be a suitable option for stand-alone LLIF in the Asian population.

Objective  This narrative highlights a student-led initiative that explored white matter dissection techniques within the framework of the National Undergraduate Neuroanatomy Competition 2023. Materials and Methods  The project aimed to enhance neuroanatomical education by developing a novel approach to dissection that deviates from the traditional Klingler's method. Instead, it incorporated contemporary techniques, including diffusion tensor imaging and other radiological tools, to ensure greater anatomical precision and enrich the learning experience. Results  The dissections focused on key white matter structures, such as the uncinate fasciculus and the inferior longitudinal fasciculus, and outlined a step-by-step methodology for creating high-quality specimens. These specimens are designed to serve as educational resources, particularly for students with limited access to formal neuroanatomy courses. Conclusion  This study emphasizes the critical role of hands-on dissection in neuroanatomy education, showcasing its ability to enhance student engagement, deepen anatomical understanding, and inspire interest in clinical neuroscience careers. By introducing innovative educational tools and methodologies, this initiative makes a meaningful contribution to addressing the issue of "neurophobia" in medical education.

Objective  Moyamoya disease is a chronic, progressive, intracranial steno-occlusive disease. Cerebral revascularization has proved that it is more beneficial than medical therapy for prevention of recurrent stroke. We aimed to report clinical and surgical outcome of moyamoya disease after combined revascularization in Thai population. Materials and Methods  From October 2015 to March 2023, patients diagnosed with moyamoya disease and were operated with combined revascularization were included. Patients were evaluated for hemodynamic state with preoperative and postoperative blood oxygenation level-dependent magnetic resonance (BOLD MR) imaging. Demographic data, serial imaging, surgical outcome, and clinical outcome were analyzed. Morbidity and mortality rates of surgery were reported. For clinical outcome evaluation, modified Rankin Scale (mRS) scores were compared between preoperative and postoperative outcome. The mRS score of 0 to 2 signify good outcome after surgery. Results  There were a total of 55 patients. Ischemic stroke was the most common presentation (87.3%). Based on the Suzuki's classification, most of the patients were stage 3 and 4. Clinical outcome measured with mRS score had good outcome, 100% (mRS score 0-2). For surgical outcome, overall graft patency was 94.8%, overall complication rate was 6.5%, and mortality rate was zero. Mean follow-up duration was 44.5 ± 25.1 months. Recurrent stroke occurred in 1.3%, which was recurrent ischemic stroke. Conclusion  Combined revascularization in moyamoya disease in the Thai population has a good clinical outcome, an acceptable risk of complication, and a reduced recurrent rate of stroke. Clinical and surgical outcome should be studied in the long term with the use of BOLD MR with carbon dioxide stimuli for the evaluation of cerebral blood flow in the patient.

Dural arteriovenous fistulas (DAVFs) with concurrent flow-related ophthalmic artery aneurysms, particularly intraorbital aneurysms, are rare. Retrograde cortical blood flow and sinus thrombosis heighten the risk of rupture and optic nerve compression, yet treatment strategies remain poorly defined. This study aims to explore effective management for these complex cases. A 66-year-old hypertensive man presented with an acute severe headache, loss of consciousness, and decreased vision in the left eye. Imaging revealed a left frontal intracranial hemorrhage and an anterior cranial fossa DAVF with a left ophthalmic artery aneurysm. Endovascular embolization via the left ophthalmic artery, using a microcatheter distal to the aneurysm and controlled reflux of glue injection (N-butyl cyanoacrylate and lipiodol), successfully treated the DAVF and ophthalmic artery aneurysm. Visual acuity improved to finger counting at 1 foot, with no residual DAVF at 6 months. This case demonstrates that controlled glue embolization is a viable alternative when microsurgery is not feasible due to complex anatomy.

Background  Ventriculoatrial (VA) shunts have the potential to preserve life in the event of failure of ventriculoperitoneal (VP) shunts. Contrary to VP shunts, they are susceptible to consequences, particularly cardiac problems. There are no established guidelines for screening patients following VA shunt placement regarding prevention, anticoagulant treatment, or risk factor screening. Objective  We aim to investigate aspirin's potential function and effectiveness in enhancing shunt survival and preventing secondary morbidity from distal thrombosis in children with VA shunts. Materials and Methods  The study's design is prospective and observational. It began in 2011 and is ongoing. Before inclusion in the study, we obtained clearance from the hospital ethics board and consent from the family. All patients with VA shunts were given a once-a-day antiplatelet dose of 5 mg/kg of aspirin from the first postoperative day. The study's primary end points include: (1) Major distal end malfunction documented on echocardiography or (2) any cardiac complications directly associated with the VA shunt. Results  Since March 2011, 13 patients have been followed up. So far, no cardiac complications have been ascribed to VA shunts in any of the patients. The current follow-up period is 28 to 170 months. Patient follow-up is continuing. Conclusion  Our observations regarding the efficacy and safety of aspirin in VA shunts are encouraging. However, sufficient time would be needed to establish its effectiveness in chronic sequelae such as pulmonary hypertension.