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Traumatic Middle Meningeal Artery Aneurysm: A Rare Cause of Recurrent Acute Epidural Hematoma. A Case Report. 外伤性中脑膜动脉瘤:复发性急性硬膜外血肿的罕见病因。病例报告。
Pub Date : 2024-10-04 eCollection Date: 2024-12-01 DOI: 10.1055/s-0044-1791580
Toshihide Takahashi, Kiyoyuki Yanaka, Hitoshi Aiyama, Minami Saura, Michihide Kajita, Nobuyuki Takahashi, Eiichi Ishikawa

Traumatic middle meningeal artery aneurysm (TMMA) is a rare condition and a known cause of several different bleeding patterns after head injury. Once detected, they need to be treated as an emergency due to their potential for morbidity and mortality. Generally, recurrence does not occur in surgery for acute epidural hematoma if adequate hemostasis is achieved. Here, we report a case of atypical postoperative recurrence of an acute epidural hematoma, possibly due to the development and rupture of a TMMA. A 41-year-old man with left acute epidural hematoma after a head injury was referred to our hospital. Emergency craniotomy was performed immediately, and the hematoma was removed. The source of the bleeding was near the fracture site in the middle cranial fossa, and sufficient hemostasis was confirmed. However, a head computed tomography (CT) scan the next day revealed a recurrence of the acute epidural hematoma. Magnetic resonance (MR) angiogram showed an aneurysm with a diameter of approximately 4 mm in the left middle meningeal artery. The recurrence of the acute epidural hematoma appeared to be related to the formation and a rupture of a middle meningeal artery aneurysm, and to prevent subsequent rebleeding, the patient underwent reoperation, and the hematoma and aneurysm were removed. In surgery for acute epidural hematoma, recurrence can be prevented by removing the hematoma and ensuring hemostasis. Although conventional surgery was performed in this case, a repeat of epidural hematoma occurred. A postoperative middle meningeal artery aneurysm had been thought to have developed, ruptured, and caused a repeat epidural hematoma. In treating acute epidural hematoma, a TMMA development should be considered when an atypical clinical course occurs, such as a recurrence of postoperative bleeding.

外伤性脑膜中动脉瘤(TMMA)是一种罕见疾病,也是导致头部受伤后多种不同出血模式的已知原因。一旦发现,由于其潜在的发病率和死亡率,需要作为急症进行治疗。一般来说,如果止血充分,急性硬膜外血肿手术后不会复发。在此,我们报告了一例非典型的急性硬膜外血肿术后复发病例,其原因可能是 TMMA 的发生和破裂。一名 41 岁男子因头部受伤后出现左侧急性硬膜外血肿而被转诊至我院。我们立即进行了紧急开颅手术,并清除了血肿。出血源位于中颅窝骨折部位附近,止血效果良好。然而,第二天的头部计算机断层扫描(CT)显示急性硬膜外血肿复发。磁共振(MR)血管造影显示左侧脑膜中动脉有一个直径约 4 毫米的动脉瘤。急性硬膜外血肿的复发似乎与脑膜中动脉瘤的形成和破裂有关,为了防止再次出血,患者接受了再次手术,血肿和动脉瘤都被切除。在急性硬膜外血肿的手术中,清除血肿并确保止血可以防止复发。虽然在该病例中进行了常规手术,但硬膜外血肿再次发生。术后脑膜中动脉瘤被认为已经形成、破裂,并导致硬膜外血肿再次发生。在治疗急性硬膜外血肿时,如果出现不典型的临床过程,如术后出血复发,则应考虑 TMMA 的形成。
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引用次数: 0
Case Report and Literature Review: A Severe Case of Blast-Related Traumatic Brain Injury. 病例报告和文献综述:一个与爆炸相关的严重创伤性脑损伤病例。
Pub Date : 2024-10-03 eCollection Date: 2024-12-01 DOI: 10.1055/s-0044-1791582
Wei Lun Lee, Azmi Alias, Mei Sin Lim

Blast-related traumatic brain injuries (bTBIs), once considered the signature wound of wars, have increasingly affected civilian populations due to the rise in terrorist attacks and industrial accidents. These injuries are complex, resulting from a combination of primary blast effects, secondary projectiles, tertiary impacts, and quaternary injuries from burns and toxic gas inhalation. Understanding the clinical presentation, management strategies, and outcomes of bTBIs is essential for enhancing patient care and improving prognosis. We report a case of industrial-related severe bTBI with opened depressed skull fracture and intracranial hematoma. The patient underwent decompressive craniectomy and evacuation of clot but postoperatively had a stormy recovery and multiple complications. He eventually succumbed due to his complications. This underscores the complexity of bTBIs and highlights the importance of a multidisciplinary approach in the management of bTBIs. Further research is needed to optimize treatment protocols and rehabilitation strategies for individuals with bTBIs.

与爆炸有关的创伤性脑损伤(bTBIs)曾被认为是战争中的标志性创伤,但由于恐怖袭击和工业事故的增加,这种创伤对平民的影响也越来越大。这些损伤非常复杂,由一次爆炸效应、二次射弹、三次撞击以及烧伤和吸入有毒气体造成的四次损伤共同导致。了解 bTBIs 的临床表现、管理策略和结果对于加强患者护理和改善预后至关重要。我们报告了一例与工业相关的重度 bTBI,伴有开放性凹陷性颅骨骨折和颅内血肿。患者接受了颅骨减压切除术和血凝块清除术,但术后恢复过程一波三折,并出现多种并发症。他最终因并发症而死亡。这凸显了 bTBIs 的复杂性,并强调了多学科方法在 bTBIs 治疗中的重要性。我们需要进一步开展研究,以优化针对 bTBIs 患者的治疗方案和康复策略。
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引用次数: 0
Management of Compound Depressed Fractures over Venous Sinuses. 静脉窦复合凹陷骨折的处理。
Pub Date : 2024-09-30 eCollection Date: 2024-12-01 DOI: 10.1055/s-0044-1790607
Mohammad Elbaroody, Ahmed A Marei, Karim Fathy Sawy, Alaa Eldin Mahmoud, Mark Charl Amin, Amr A M Elkatatny, Hazem Abd Al Badea

Objective  The aim of this study was to report our experience in the surgical treatment of compound depressed fractures over the venous sinuses with special highlights on the prediction and dealing with intraoperative sinus injury. Materials and Methods  We conducted a retrospective review of all patients who underwent surgery for compound depressed fractures overlying the dural venous sinuses in our hospital between January 2019 and December 2021. Results  A total of 34 patients were included in our study. The mean age of the patients was 19.85 years, most of our patients were males 27 (79.4%), and isolated head trauma was the most common mode of trauma (76.5%). The superior sagittal sinus (SSS) was distinguished as the most commonly involved venous sinus below the fractures in 28 patients (82.4%). An intraoperative tear in the sinus was found in 17 patients (50%), which was easily controlled with different methods. In two patients who had a severe head injury with a Glasgow Coma Scale (GCS) score of ≤8 associated with a fissure fracture crossing the sinus, there was a complete tear of the sinus followed by massive bleeding, which required sinus ligation. We lost both of them in following days. Conclusion  In experienced tertiary neurotrauma centers, compound depressed fractures over the venous sinuses should be surgically elevated in most cases, taking into consideration that bleeding from the sinus can be controlled in most cases, and complete tear of the sinus with massive bleeding is the least scenario faced in reality and is usually associated with a severe head injury. If expert opinion favors the conservative approach, then close follow-up for months is recommended due to the high possibility of sinus thrombosis and intracranial hypertension, especially in children.

目的 本研究旨在报告我们在静脉窦上复合凹陷性骨折手术治疗方面的经验,特别强调术中静脉窦损伤的预测和处理。材料与方法 我们对 2019 年 1 月至 2021 年 12 月期间在我院接受硬膜静脉窦上复合凹陷性骨折手术的所有患者进行了回顾性研究。结果 本研究共纳入 34 例患者。患者的平均年龄为 19.85 岁,大多数患者为男性,占 27 人(79.4%),孤立性头部外伤是最常见的外伤方式(76.5%)。28名患者(82.4%)的骨折下方最常累及的静脉窦为上矢状窦(SSS)。有 17 名患者(50%)在术中发现静脉窦撕裂,但通过不同方法很容易控制。有两名患者头部严重受伤,格拉斯哥昏迷量表(GCS)评分≤8 分,伴有横穿静脉窦的裂隙骨折,静脉窦完全撕裂,随后大量出血,需要进行静脉窦结扎。随后几天,我们失去了他们两人。结论 在经验丰富的三级神经创伤中心,考虑到静脉窦出血在大多数情况下可以得到控制,静脉窦完全撕裂并伴有大量出血是现实中最不常见的情况,而且通常与严重的头部损伤有关,因此在大多数情况下,静脉窦上方的复合凹陷性骨折应通过手术抬高。如果专家意见倾向于保守治疗,则建议进行数月的密切随访,因为鼻窦血栓形成和颅内高压的可能性很高,尤其是对儿童而言。
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引用次数: 0
Emergency Surgical Management of Meningiomas: Factors Affecting Early Outcomes and Complications. 脑膜瘤的急诊手术治疗:影响早期疗效和并发症的因素。
Pub Date : 2024-09-30 eCollection Date: 2024-12-01 DOI: 10.1055/s-0044-1790514
Gaurav Tyagi, Mustafa Iqbal Chandshah, Gyani Jail Singh Birua, Nishanth Sadashiva, Subhas Konar, Manish Beniwal, A R Prabhuraj, T S Lingaraju, Gopal Krishna, Nupur Pruthi, Dhaval P Shukla

Objective  Intracranial meningiomas constitute a third of all brain tumors and are among the most common indications for neurosurgical procedures performed worldwide. Most meningiomas present with an indolent, longstanding history. However, the data on outcomes of emergency surgeries for meningioma is limited. This study aims to present our experience of urgent surgical intervention in patients with meningiomas presenting acutely. We also analyze the factors influencing early neurological outcomes and complications. Materials and Methods  All nonelective meningioma surgeries done on an emergency basis between January 2015 and December 2019 were retrospectively reviewed. Patients' demography, clinical, and radiological details were recorded for analysis. The surgical procedure, complications, and follow-up outcomes were also included for statistical comparison. Results  Forty-four patients qualified for the study with a mean age of 49.4 ± 13.4 years. The average presenting Glasgow Coma Scale (GCS) was 13; 47.7% of cases presented with altered sensorium. The most common lesion location was convexity (25, 56.8%), and the mean tumor volume was 74.1 ± 36.5 mL. Gross peritumor edema with mass effect was seen in 16 patients (36.4%). The mean Karnofsky Performance Status at 3 months' follow-up was 89.3 ± 18.2. Patient age and tumor size did not affect outcomes. The presenting GCS of < 15 (odds ratio [OR] 8.8, confidence interval [CI] 0.95-80.72, p 0.03) and the occurrence of postoperative complications (OR 25.71, CI 2.65-249.2, p 0.001) were associated with unfavorable outcomes. Although not statistically significant, a poor tumor grade was also associated with worse clinical outcomes ( p 0.20). Conclusion  Emergency meningioma surgery has comparable outcomes and complication rates with routine elective procedures. Grade II/III meningiomas are more likely to present with acute neurological deterioration and carry a relatively worse prognosis. Poor presenting GCS and postoperative complications are the most critical factors associated with poor patient outcomes in our study.

目的 颅内脑膜瘤占所有脑肿瘤的三分之一,是全世界神经外科手术最常见的适应症之一。大多数脑膜瘤症状不明显,病程较长。然而,有关脑膜瘤急诊手术结果的数据却很有限。本研究旨在介绍我们对急诊脑膜瘤患者进行紧急手术干预的经验。我们还分析了影响早期神经系统预后和并发症的因素。材料和方法 回顾性分析了 2015 年 1 月至 2019 年 12 月间所有非选择性急诊脑膜瘤手术。记录患者的人口统计学、临床和放射学细节,以便进行分析。手术过程、并发症和随访结果也包括在内,以便进行统计比较。结果 44 名患者符合研究条件,平均年龄(49.4±13.4)岁。患者的格拉斯哥昏迷量表(GCS)平均值为 13;47.7% 的病例出现感觉改变。最常见的病变位置是凸面(25 例,占 56.8%),平均肿瘤体积为 74.1 ± 36.5 mL。16例患者(36.4%)出现肿瘤周围水肿和肿块效应。随访 3 个月时的平均 Karnofsky 表情状态为 89.3 ± 18.2。患者年龄和肿瘤大小对预后没有影响。出现 GCS(P 0.03)和术后并发症(OR 25.71,CI 2.65-249.2,P 0.001)与不良预后有关。虽然没有统计学意义,但肿瘤分级较低也与较差的临床预后有关(P 0.20)。结论 脑膜瘤急诊手术的疗效和并发症发生率与常规择期手术相当。II/III 级脑膜瘤更有可能出现急性神经功能恶化,预后相对较差。在我们的研究中,GCS表现不佳和术后并发症是导致患者预后不佳的最关键因素。
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引用次数: 0
Endovascular Treatment of Mycotic Intracranial Aneurysms: A Series of Three Cases with Institutional Treatment Algorithm. 霉菌性颅内动脉瘤的血管内治疗:三例系列病例与机构治疗算法。
Pub Date : 2024-09-30 eCollection Date: 2024-12-01 DOI: 10.1055/s-0044-1791268
Bheru Dan Charan, Shailesh B Gaikwad, Sushant Agarwal, Savyasachi Jain

Mycotic intracranial aneurysms (MIAs) are rare but can cause significant morbidity and mortality due to rupture. Most patients have additional systemic medical comorbidities making endovascular treatment a vital modality in the treatment of these aneurysms. We aimed to share our institutional experience with the role of endovascular therapy in the treatment of mycotic aneurysms with a literature review. We conducted a retrospective review of our patient database to identify individuals diagnosed with MIAs who underwent endovascular intervention at our institution between January 2002 and December 2021. We have found three patients with ruptured MIAs. All three patients had a heart disease with infective endocarditis. Two patients presented with subarachnoid hemorrhage (SAH) in which, one had a rebleed resulting in intracerebral hemorrhage (ICH), the third patient initially presented with ICH. Distal anterior cerebral artery (ACA) was the site of MIA in two cases and distal middle cerebral artery (MCA) in one patient. Two patients were treated with simple coiling and one patient was treated by glue (n-butyl cyanoacrylate [NBCAs]) injection within the aneurysm. There was no periprocedural complication with complete obliteration of the aneurysm and preservation of the parent artery. All the patients had good outcomes on follow-up. Two patients had a modified Rankin scale (mRS) score of 0 at 6 months and one patient had an mRS score of 3 at the end of 3 months whose preprocedure mRS score was 5. Endovascular embolization of MIAs with coils or liquid embolic agents can be performed in critically ill patients and is an excellent treatment modality with high occlusion rates and low procedural complications.

霉菌性颅内动脉瘤(MIAs)虽然罕见,但可因破裂而导致严重的发病率和死亡率。大多数患者还伴有全身性并发症,因此血管内治疗是治疗这些动脉瘤的重要方法。我们旨在通过文献综述,分享本院在血管内治疗霉菌性动脉瘤方面的经验。我们对患者数据库进行了回顾性审查,以确定 2002 年 1 月至 2021 年 12 月期间在我院接受血管内介入治疗的被诊断为霉菌性动脉瘤的患者。我们发现了三名 MIA 破裂的患者。这三位患者都患有感染性心内膜炎。其中两名患者出现蛛网膜下腔出血(SAH),一名患者再次出血导致脑内出血(ICH),第三名患者最初出现 ICH。两例患者的 MIA 发生部位为大脑前动脉(ACA)远端,一例患者的 MIA 发生部位为大脑中动脉(MCA)远端。两名患者接受了简单的卷曲治疗,一名患者接受了动脉瘤内注射胶水(氰基丙烯酸正丁酯 [NBCAs])治疗。治疗过程中没有出现并发症,动脉瘤完全闭塞,并保留了母动脉。所有患者的随访结果均良好。两名患者在 6 个月后的改良兰金量表(mRS)评分为 0,一名患者在 3 个月后的 mRS 评分为 3,而其术前的 mRS 评分为 5。 使用线圈或液体栓塞剂对 MIA 进行血管内栓塞治疗可在重症患者中进行,是一种具有高闭塞率和低手术并发症的出色治疗方法。
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引用次数: 0
The Role of Helmet Therapy in Craniosynostosis: A Systematic Review. 头盔疗法在颅骨发育不良症中的作用:系统综述。
Pub Date : 2024-09-30 eCollection Date: 2024-12-01 DOI: 10.1055/s-0044-1791228
Fatima Suleman, Ayesha Sohail, Gohar Javed, Syeda Sana Samar

The aim of this study was to determine the impact of helmet therapy (HT) as a treatment for craniosynostosis, with a focus on the outcomes of skull morphology, reoperation rate, complications of HT, and quality of life of patients who receive it. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review utilized the PICO format: Does HT following strip craniectomy (SC) improve outcomes (outcome) compared to SC alone (comparison) in patients undergoing craniosynostosis correction (intervention)? Searches were performed from January 1, 2000 to December 31, 2022, using PubMed, Cochrane Library, and Ovid Medline databases. Study quality was evaluated using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment scale. Fourteen studies meeting the inclusion criteria were identified. Among these, 438 patients underwent SC-HT, while 104 patients underwent SC without HT. The preoperative cephalic indices for sagittal craniosynostosis in the HT and non-HT groups were 66.8 and 67.8, respectively, which improved postoperatively to 75 and 76.2, respectively. Limited long-term follow-up hindered a definitive assessment of reoperation rates. Complication rates related to HT were low at approximately 2.9%, primarily consisting of skin irritation. Parental satisfaction was high, correlating with a strong compliance rate. Existing literature does not demonstrate a clear superiority between SC with or without HT for treating nonsyndromic sagittal craniosynostosis. Outcomes appear comparable, but evidence is constrained by the predominance of single-center retrospective studies with limited methodological rigor. There is a pressing need for international multicenter trials to furnish more robust and generalizable findings.

本研究旨在确定头盔疗法(HT)作为颅骨发育不良治疗方法的影响,重点关注头骨形态、再次手术率、头盔疗法并发症以及接受头盔疗法患者的生活质量。我们按照《系统综述和元分析首选报告项目》(PRISMA)指南进行了系统性文献综述。综述采用了 PICO 格式:在接受颅骨发育不良矫正术(干预)的患者中,条状颅骨切除术(SC)后的高温治疗与单纯的条状颅骨切除术(比较)相比,是否能改善治疗效果(结果)?检索时间为 2000 年 1 月 1 日至 2022 年 12 月 31 日,使用的数据库包括 PubMed、Cochrane Library 和 Ovid Medline。研究质量采用美国国家心肺血液研究所(NHLBI)质量评估量表进行评估。最终确定了 14 项符合纳入标准的研究。其中,438 名患者接受了 SC-HT 术,104 名患者接受了 SC 而未接受 HT 术。HT 组和非 HT 组的矢状颅畸形术前头颅指数分别为 66.8 和 67.8,术后分别提高到 75 和 76.2。有限的长期随访阻碍了对再次手术率的最终评估。与 HT 相关的并发症发生率较低,约为 2.9%,主要包括皮肤刺激。家长的满意度很高,这与较高的依从率有关。在治疗非综合征矢状颅畸形方面,现有文献并未显示SC与HT之间有明显的优劣之分。结果似乎具有可比性,但由于单中心回顾性研究居多,方法的严谨性有限,因此证据受到限制。目前迫切需要进行国际多中心试验,以提供更可靠、更可推广的研究结果。
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引用次数: 0
The Impact of the Pandemic of COVID-19 on the Head Injury Fast-Track System and Surgical Outcome. COVID-19 大流行对头部创伤快速通道系统和手术结果的影响。
Pub Date : 2024-09-30 eCollection Date: 2024-12-01 DOI: 10.1055/s-0044-1791267
Thunya Norasethada, Kriengsak Limpastan, Tanat Vaniyapong, Wanarak Watcharasaksilp, Chumpon Jetjumnong, Chanon Srihagulang, Thanat Kanthawang, Todsapon Praphanuwat, Withawat Vuthiwong, Jirapong Vongsfak

Objective  This study aims to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the head injury fast-track system and surgical treatment outcomes. Materials and Methods  A retrospective review was conducted on patients who underwent emergency neurological procedures according to the head injury fast-track system. Data from April 2018 to April 2020 (pre-COVID) were compared with data from May 2020 to May 2022 (during COVID). Results  The analysis comprised 128 patients in the prepandemic group and 119 patients in the pandemic group, with 5 patients diagnosed with COVID infection during the pandemic. Acute subdural hematoma resulting from motorcycle accidents was the most common diagnosis in both groups (56.3 and 47.5%, respectively). The initial Glasgow coma scale (GCS) score was significantly lower during the pandemic compared to the prepandemic period ( p  = 0.025). Time metrics in the emergency department, including door to computed tomography (CT), emergency room (ER) exit, and incision times, were significantly longer in the pandemic group ( p  < 0.05). However, there were no statistically significant differences in in-hospital mortality rates (25.8 and 17.7%, respectively; p  = 0.12) or the percentage of patients with a favorable functional outcome (Glasgow outcome scale ≥4). At 1 month, a favorable functional outcome was observed in 51.6% of prepandemic patients and 57.1% of pandemic patients ( p  = 0.69), while at 6 months, the percentages were 56.8 and 64.5%, respectively ( p  = 0.23). Conclusions  Our study revealed significant delays in hospital processes for head injuries during the COVID-19 pandemic. However, we found no significant impact on mortality rates or functional outcomes of patients.

目的 本研究旨在评估冠状病毒病 2019(COVID-19)大流行对头部损伤快速通道系统和手术治疗结果的影响。材料与方法 对根据头部损伤快速通道系统接受急诊神经外科手术的患者进行了回顾性审查。将 2018 年 4 月至 2020 年 4 月(COVID 前)的数据与 2020 年 5 月至 2022 年 5 月(COVID 期间)的数据进行比较。结果 分析包括大流行前组的 128 名患者和大流行组的 119 名患者,其中有 5 名患者在大流行期间确诊感染了 COVID。两组患者中最常见的诊断都是摩托车事故导致的急性硬膜下血肿(分别占 56.3% 和 47.5%)。与大流行前相比,大流行期间的格拉斯哥昏迷量表(GCS)初始评分明显较低(P = 0.025)。大流行组患者在急诊科的时间指标,包括门到计算机断层扫描(CT)、急诊室(ER)出口和切口时间均明显长于大流行组(P = 0.12),功能结果良好(格拉斯哥结果量表≥4)的患者比例也明显长于大流行组。在 1 个月时,51.6% 的大流行前患者和 57.1% 的大流行患者获得了良好的功能预后(P = 0.69),而在 6 个月时,这两个比例分别为 56.8% 和 64.5%(P = 0.23)。结论 我们的研究显示,在 COVID-19 大流行期间,医院处理头部损伤的流程出现了严重延误。然而,我们发现这对患者的死亡率或功能结果没有明显影响。
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引用次数: 0
Evolution of Robotics in Neurosurgery. 神经外科机器人技术的发展。
Pub Date : 2024-09-27 eCollection Date: 2024-12-01 DOI: 10.1055/s-0044-1790606
Salman T Shaikh, T A Dwarakanath, Aliasgar V Moiyadi

Technology and neurosurgery have gone hand in hand since a long time. Technological development of robotics in neurosurgery over the last couple of decades has been rapid, yet it still has a long way to go before it becomes a "routine" element of the standard neurosurgical procedure. Apart from the obvious advantages they have over humans, that is, precision, consistency, endurance, and reproducibility, robots also provide additional freedom of movement beyond what is anatomically feasible for humans. Since its first practical application in 1985, the promise of robotics has spurred development and design of numerous such devices for application in neurosurgery. In the current era, the role of robots in neurosurgery is limited to programming movements and planning trajectories for deep cranial targets, biopsies, spinal screw placements, deep brain stimulation, and stereotactic radiosurgery. This narrative, nonsystematic review discusses the evolution of various robotic systems, with a focus on their neurosurgical applications.

技术与神经外科相辅相成由来已久。过去几十年来,神经外科机器人技术发展迅速,但要成为神经外科标准手术的 "常规 "要素,还有很长的路要走。与人类相比,机器人除了在精确性、一致性、耐久性和可重复性等方面具有明显优势外,还提供了人类解剖学上无法实现的额外行动自由。自 1985 年首次实际应用以来,机器人技术的发展前景推动了神经外科领域大量此类设备的开发和设计。在当今时代,机器人在神经外科中的作用仅限于为深颅目标、活组织检查、脊柱螺钉植入、脑深部刺激和立体定向放射外科手术编制运动程序和规划轨迹。这篇叙述性的非系统综述讨论了各种机器人系统的演变,重点是它们在神经外科中的应用。
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引用次数: 0
Efficacy of Ketamine as an Adjuvant to Scalp Block for Hemodynamic Stability in Patients Undergoing Elective Craniotomy for Supratentorial Glioma: A Prospective Randomized Controlled Trial. 氯胺酮作为头皮阻滞的辅助药物对稳定因脑室上胶质瘤而接受开颅手术的患者血流动力学的效果:前瞻性随机对照试验》。
Pub Date : 2024-09-27 eCollection Date: 2024-12-01 DOI: 10.1055/s-0044-1791269
Ashutosh Kaushal, Sharmishtha Pathak, Priyanka Gupta, Praveen Talwar, Anuj Jain, Sunaina Tejpal Karna

Introduction  Scalp nerve block (SNB) attenuates the hemodynamic response to pin insertion and delivers excellent postoperative analgesia. This study aimed to evaluate the efficacy of SNB using ketamine as an adjuvant to bupivacaine on perioperative hemodynamic responses and postoperative pain in patients undergoing craniotomy for supratentorial glioma. Materials and Methods  Sixty patients were randomized into two groups. They were given scalp nerve block either with bupivacaine and saline (group S) or bupivacaine and ketamine (group K). Primary outcome was to compare the change in mean arterial pressure (MAP) and heart rate (HR) at defined time points from baseline. Secondary outcomes included time to request for first analgesia, total analgesic consumption in intraoperative and postoperative periods till 24 hours, and numeric rating scale pain score at various time points in postoperative period till 24 hours. Results  Fifty-seven patients were included in analysis. HR and MAP were comparable intraoperatively till closure. As soon as closure began, a significant increase in HR (group K vs. group S, 69.76 ± 9.03 vs. 93.96 ± 9.98, p -value = < 0.0001) and MAP (group K vs. group S, 79.4 ± 4.12 vs. 87.17 ± 12.67, p -value = 0.002) was noted in group S patients. This increase persisted in the postoperative period as well. The median total opioid consumed during intraoperative period in group K was 200 mcg versus 300 mcg in group S, p -value < 0.0001. Conclusion  Adding ketamine as an adjuvant to bupivacaine for SNB not only provides significant hemodynamic stability but also reduces both intra- and postoperative analgesic consumption.

引言 头皮神经阻滞(SNB)可减轻插针时的血流动力学反应,并提供良好的术后镇痛效果。本研究旨在评估使用氯胺酮辅助布比卡因进行头皮神经阻滞对接受幕上胶质瘤开颅手术的患者围术期血流动力学反应和术后疼痛的疗效。材料和方法 60 名患者被随机分为两组。他们分别接受布比卡因和生理盐水(S 组)或布比卡因和氯胺酮(K 组)头皮神经阻滞。主要结果是比较平均动脉压(MAP)和心率(HR)在规定时间点与基线的变化。次要结果包括要求首次镇痛的时间、术中和术后至 24 小时的镇痛剂总用量,以及术后至 24 小时不同时间点的疼痛评分。结果 57 名患者参与了分析。术中至闭合前,心率和血压相当。关闭手术一开始,S 组患者的心率(K 组 vs. S 组,69.76 ± 9.03 vs. 93.96 ± 9.98,p 值 = < 0.0001)和血压(K 组 vs. S 组,79.4 ± 4.12 vs. 87.17 ± 12.67,p 值 = 0.002)就显著增加。这种增加在术后也持续存在。K 组患者术中阿片类药物总消耗量的中位数为 200 微克,而 S 组为 300 微克,p 值=0.002 结论 在 SNB 中加入氯胺酮作为布比卡因的辅助药物,不仅能显著稳定血流动力学,还能减少术中和术后镇痛药的消耗。
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引用次数: 0
Successful Microsurgical Clipping under Extracorporeal Membrane Oxygenation Treatment for a Poor-Grade Subarachnoid Hemorrhage Patient with Severe Pulmonary Neurogenic Lung. 体外膜氧合治疗下的显微外科夹闭手术成功救治一名重度肺神经源性蛛网膜下腔出血患者
Pub Date : 2024-09-19 eCollection Date: 2024-12-01 DOI: 10.1055/s-0044-1791189
Katsuya Saito, Shoko Ito, Takahiro Miyata, Keita Mayanagi, Joji Inamasu, Masashi Nakatsukasa

Hemorrhagic strokes are considered as contraindications of extracorporeal membrane oxygenation (ECMO) therapy because of anticoagulant administration and ECMO-associated coagulopathy. We present a rare case of successful microsurgical clipping under ECMO for a poor-grade subarachnoid hemorrhage (SAH) patient with severe neurogenic pulmonary edema (NPE). A 50-year-old man presenting with the sudden loss of consciousness was diagnosed with poor-grade SAH with severe NPE, and was intubated. Because of severe hypoxemia refractory to conventional treatment, venovenous ECMO was used 6 hours after admission. To avoid thrombosis inside the ECMO circuit despite no anticoagulants, a heparin-bonded ECMO was maintained at a comparatively high blood flow rate. Subsequently, the patient underwent a microsurgical clipping under ECMO. Intraoperatively we had difficulty in bleeding control, and therefore the multiple transfusions were necessary to correct anemia and ECMO-associated coagulopathy. The aneurysmal clipping was accomplished without hemorrhagic intracranial complications. After 2 years from onset, his activities of daily life were independent. To our knowledge, this is the first report of successful microsurgical clipping for poor-grade SAH under ECMO without any anticoagulants. The use of a heparin-bonded ECMO tubing, maintenance of a slightly higher ECMO pump speed, and multiple transfusions to correct ECMO-associated coagulopathy could make the micro-neurosurgical procedures under ECMO possible. This report demonstrated the possibility to extend the range of application of microsurgical clipping for poor-grade SAH patients requiring ECMO treatment.

出血性脑卒中被认为是体外膜肺氧合(ECMO)治疗的禁忌症,因为需要使用抗凝剂和 ECMO 相关凝血病。我们介绍了一例罕见的在 ECMO 下成功进行显微外科剪切术的病例,该病例是一名伴有严重神经源性肺水肿(NPE)的低级别蛛网膜下腔出血(SAH)患者。一名 50 岁男子突然意识丧失,被诊断为低级别蛛网膜下腔出血伴严重 NPE,并进行了插管。由于常规治疗无效,患者出现严重低氧血症,因此在入院 6 小时后使用了静脉 ECMO。尽管没有使用抗凝剂,但为了避免 ECMO 循环内血栓形成,肝素粘合的 ECMO 以相对较高的血流速度维持。随后,患者在 ECMO 下接受了显微外科剪切术。术中我们难以控制出血,因此需要多次输血来纠正贫血和 ECMO 相关凝血病症。动脉瘤夹闭术顺利完成,未出现颅内出血并发症。发病 2 年后,他的日常生活可以自理。据我们所知,这是第一例在不使用任何抗凝剂的情况下,在 ECMO 下成功进行显微外科夹闭治疗低级别 SAH 的报道。使用肝素粘合的 ECMO 管道、保持稍高的 ECMO 泵速以及多次输血以纠正 ECMO 相关凝血病症,可使 ECMO 下的显微神经外科手术成为可能。该报告表明,对于需要 ECMO 治疗的低级别 SAH 患者,显微神经外科剪切术的应用范围有可能扩大。
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Asian journal of neurosurgery
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