Asian journal of neurosurgery最新文献

Introduction: Neurosurgical practices have evolved from exploratory techniques requiring extensive craniotomies to more refined methods facilitated by advanced imaging technologies. The advent of neuronavigation systems and modern imaging modalities has enabled precise localization of intracranial lesions, allowing for minor skin and craniotomy flaps, thereby promoting minimally invasive approaches. This study aims to evaluate the efficacy of open-source Digital Imaging and Communications in Medicine (DICOM) software in preoperative planning for keyhole neurosurgical procedures, particularly in resource-limited settings where traditional navigation systems may not be available.

Objective: The primary objective was to assess the utility of open-source DICOM software in planning keyhole surgeries, focusing on parameters such as incision length, lesion identification accuracy, operative time, blood loss, bone loss, craniotomy size, resection extent, recovery rate, and complication rates compared with traditional methods.

Materials and methods: A retrospective analysis was conducted on 176 patients undergoing keyhole procedures using DICOM software versus a control group of 172 matched patients. Preoperative imaging requirements included high-resolution volumetric scans (magnetic resonance imaging and computed tomography) for accurate three-dimensional (3D) reconstruction. The DICOM software enabled interactive 3D visualization and variable windowing for enhanced preoperative and intraoperative planning.

Results: The keyhole technique resulted in significantly smaller incision lengths (50 ± 12 vs. 200 ± 20 mm, p  = 0.001) and craniotomy surface areas (9 ± 2 vs. 120 ± 14 cm ² , p  = 0.001) compared with conventional methods. The mean duration of surgery was reduced (140 ± 28 vs. 345 ± 32 minutes, p  = 0.002), with a lower incidence of wound-related complications in the test group (3 vs. 21, p  = 0.001).

Conclusion: This study demonstrates that accessible DICOM software can effectively support neurosurgeons in executing keyhole procedures and promoting minimally invasive techniques in settings with limited resources. Regular use of this method enhances surgical precision and improves patient outcomes by reducing surgical trauma and recovery times.

Objective: Minimal invasive spine surgery with tubular retractor system avoids contralateral laminectomy, minimizes manipulation of midline supportive structures, and reduces surgical morbidity. The objective of this study was to evaluate the safety and efficacy of microscopic minimal invasive tubular retractor system for intradural spinal tumor resection.

Materials and methods: A retrospective study was performed in 70 patients who were admitted between January 2017 and January 2024 with intradural spinal tumors and underwent excision with microscopic minimal invasive tubular retractor system. Patient's data including age, sex, clinical symptoms, and magnetic resonance imaging were collected. The extent of resection, surgical complications, estimated blood loss, estimated surgical time, and neurological outcomes were recorded. The neurological assessment was done by the modified McCormick grading scale pre- and postoperatively.

Results: Out of 70 patients, there were 38 (54.28%) males and 32 (45.71%) females, with a mean age of 45.16 (range: 8-79) years. The histology of these cases was meningioma (34.28%), schwannoma (51.42%), astrocytoma (2.85%), ependymoma (2.85%), and neurofibroma (8.57%). The average volume of tumors was 1.98 cm ³ , and gross total resection was achieved in 64 (91.53%) cases and subtotal resection was achieved in 6 (8.57%) cases. One patient had neurological deterioration, which was improved on follow-up after 6 months, and cerebrospinal fluid (CSF) leakage was noted in one case, which recovered after keeping lumbar drain for 5 days. No permanent neurological deficits were observed compared with their preoperative status, with improvement noted in visual analog scale and modified McCormick grade in all cases in the long-term follow-up evaluation (6-24 months).

Conclusion: Microscopic minimal invasive resection of intradural spinal tumor by the tubular retractor system is safe and effective with excellent neurological improvement as well as better resection rate, short hospital stay, and less surgical complication.

Surgical strategies for neck tumors extending to the skull base and high-lying carotid artery pathologies present significant challenges for surgeons, necessitating deviations from traditional neck surgery approaches. These tactics are adopted to expand the surgical approach. Although the mandibular sagittal split osteotomy (MSSO) has been routinely utilized in maxillofacial surgery, its integration into combined surgical approaches for head and neck pathologies has not been widely explored. We present our experience using MSSO in patients with neck pathology. A retrospective analysis was conducted on 12 patients who underwent surgery between 2020 and 2022 for benign neck tumors and vascular pathologies that posed challenges for removal using traditional approaches. All patients underwent surgical treatment utilizing the technique of unilateral MSSO and fragment retraction to enhance the surgical approach for neck pathologies. An evaluation of early postoperative outcomes was performed. Based on the criteria presented, the study group consisted of 12 patients with various histological types of benign tumors ( n  = 11) and atherosclerotic plaque in the carotid artery ( n  = 1). Following the osteotomy step, mandibular advancement of an average distance of 17.2 ± 1.6 mm was achieved, allowing for an extended surgical approach on the lateral aspect of the neck measuring 48.7 ± 3.5 mm. This technique facilitated the successful total tumor resection in most of cases. Complications related to the osteotomy were observed in two patients during the early postoperative period, which included malocclusion necessitating plate refixation and hematoma formation in the soft tissues of the neck. The utilization of the unilateral intraoral technique of sagittal split osteotomy with mandibular abduction has demonstrated good outcomes in providing an extended surgical approach for tumors located in the distal neck segment of the internal carotid artery.

Exoscopes, introduced as an alternative to operative microscopes in neurosurgery, aim to enhance intraoperative visualization, ergonomics, cost-effectiveness, and patient outcomes. This study employs bibliometric analysis to delineate topic trends and fields within neurosurgery utilizing exoscopes. Articles and reviews from January 1, 2002 to December 31, 2023, were manually retrieved from Scopus, based on predefined criteria encompassing publications related to exoscopes in neurosurgery. All publication records were imported and analyzed using Microsoft Excel and VOSviewer. A total of 186 articles were included for final analysis. While work on exoscopes was limited until 2015, there was an upsurge in publication output from 2018 to 2022. The United States led in the number of articles (72/186, 38.7%) and in total citations (1259). Brazil ranked first in average citation index (26.00). The Hospital of the University of Pennsylvania, United States, published the most articles (5), while Cedars-Sinai Medical Center USA accrued the highest number of citations (181). A.J. Schupper (4) and Constantinos Hadjipanayis (7) were the authors with the most publications as the first author and the last author, respectively. World Neurosurgery was the most prolific journal with 41 publications. Recent keywords centered around themes such as "ergonomics" (47 times) and "three-dimensional imaging" (44 times). Most collaboration occurred between developed countries such as the United States, Germany, Finland, and Austria. Most articles (87) focused on brain, with 25 articles focusing on spine. Our findings offer valuable insights to identify potential research frontiers within different fields of neurosurgery in the coming years.

Ponticulus posticus (PP), also known as arcuate foramen, is an anatomical variation of the atlas (C1), which is an ossification of the posterior atlanto-occipital membrane and through which the V3 segment of the vertebral artery (VA) runs. Placement of a polyaxial screw in the C1 lateral mass is considered risky in those with PP because of possible risk for VA injury. We report a case with bilateral PP in which posterior fixation for unstable upper cervical spine injury was performed. The patient, a 70-year-old man, sustained a fall-induced unstable upper cervical spine injury (traumatic C2 spondylolisthesis with unilateral dislocation of the C3-4 facet joint). Following initial conservative treatment, a posterior fixation surgery was performed in the subacute phase. Preoperative images revealed the presence of bilateral PP. Therefore, an original plan to place the screws in the C1 lateral mass was discarded, and instead, placement of the laminar hook on one side and placement of the screw into the C1 posterior arch on the other side was performed. His postoperative course was uneventful, and he was transferred to a rehabilitation hospital 27 days after the injury. In cases of upper cervical spine instability with concomitant PP, it is essential to consider the fixation method based on the extent of the injury and the course of the VA on a case-by-case basis.

Robotic assistance in spine surgery has long been pursued to innovate minimally invasive procedures and enhance patient safety, outcomes, operation time, and affordability. Over the past few decades, advancements in navigation and robotics have fundamentally transformed the role of technology in spine surgery, with their applications continuously expanding. In particular, this technology has made significant strides in the setting of adult spinal deformity (ASD), driving innovations for this technically challenging pathology. In this review, the authors explore key aspects of robotic assistance in ASD surgery, including software planning and construct design, pedicle screw placement, sacropelvic fixation, operative outcomes, and the learning curve associated with adopting this technology. Research articles for this qualitative review were indexed using PubMed and Google Scholar. The review also addresses the opportunities and challenges ahead in the field. Although this technology is in its relative infancy, the growing body of research is beginning to fully characterize its utility in surgery and its potential to redefine the standard of care.

Calcifying pseudoneoplasms of the neuraxis (CAPNON) are rare non-neoplastic calcified lesions that can occur throughout the entire neuraxis. Cranial nerves may be involved in skull base lesions. Surgical resection usually has a good prognosis, with only a few cases of recurrence reported in the relevant literature. We experienced a recurrent case of CAPNON in Meckel's cave extending to the cerebellopontine cistern with involvement of the trigeminal nerve after initial resection of the cystic part of the lesion. A 48-year-old man presented with a 4-year history of right-sided ptosis. Magnetic resonance imaging revealed a calcified lesion arising in Meckel's cave, with a cystic lesion extending to the cerebellopontine cistern. The cystic part of the lesion was excised during the initial surgery using the right lateral suboccipital approach. However, the cystic lesion regrew to its preoperative size within 23 months. The right extradural subtemporal approach was used to successfully remove both the calcified mass in the right Meckel cave and the cystic lesion extending to the right cerebellopontine cistern during the resection of the lesion. The patient's neurological symptoms resolved postoperatively. CAPNON was identified during the histopathological examination. This report describes a rare case of CAPNON in Meckel's cave with a unique clinical course. After the first operation, cystic lesions recurred in the cerebellopontine cistern, but they were successfully treated by a second operation.

Objective: With social media's increasing prevalence, platforms like Instagram have emerged as key sources of altmetrics. This study aimed to analyze the posts shared on Instagram referencing traumatic spine injury in terms of account type, languages, geographical distribution, content analysis, and audience engagement.

Materials and methods: Public Instagram posts were isolated and evaluated using the hashtags "#spinetrauma," "#spinefracture," "#spinetraumasurgeries," "#spinalcordinjuryrecovery," "#spinetraumasurvivor," and "#spinalcordinjury." The authors analyzed the top 1,000 posts for the variables: account type, languages, geographical distribution, content analysis, and audience engagement. In total, 345 posts were included for analysis using SPSS (version 26).

Results: Of the 345 Instagram posts and reels (Ps and Rs) that met our eligibility requirements, 183 (53%) were written in English. Surgeons' and physicians' accounts contributed 210 Ps/Rs (60.8%), while patients' accounts amounted to 63 Ps/Rs (18.3%). Out of 263 Ps/Rs with a known country of origin, the United States had the highest number with 56 Ps/Rs (16.2%). Content analysis revealed 114 Ps/Rs (33%) focused on pathology and 118 Ps/Rs (34.2%) posted radiological images. Regarding audience engagement, the survivor stories had the highest mean likes and comments per post, 126.5 ( p  = 0.107) and 8.7 ( p  = 0.018), respectively. It was followed by pathology-related content (mean likes/posts: 117.4 [ p  = 0.015], mean comments/post: 6.9 [ p  = 0.003]).

Conclusion: Reported traumatic spine injury-related content has not been evaluated through social media avenues. This analysis demonstrates the leading role of surgeons in posting and educating the audience regarding traumatic spine injury, with the highest audience interest in survivor stories and pathologies. Our findings advance our knowledge of how social media portrays spine trauma, highlighting opportunities for future research and emphasizing the need for careful consideration of ethical and methodological challenges in social media studies related to medicine.

Introduction: The accurate identification of predictors of mortality is of utmost importance in risk stratification, as it empowers health care teams to efficiently allocate resources and interventions to patients who are at a higher risk. Our objective was to investigate the factors linked to in-hospital mortality in patients who have suffered a traumatic brain injury (TBI).

Materials and methods: This study employed a retrospective design, utilizing data from the National Trauma Registry of Iran spanning September 17, 2016, to July 31, 2022. The study included TBI patients admitted to participating hospitals with a hospital stay exceeding 24 hours, those who died during hospitalization, or those transferred from other facilities. TBI cases were identified using specific International Classification of Diseases, Tenth Revision codes. The study incorporated various variables, including baseline characteristics such as age (categorized into pediatric, adult, and geriatric groups), gender, trauma mechanism, and mode of transportation. Clinical characteristics considered included the Glasgow coma scale (GCS), injury severity score (ISS), types of injuries sustained, interventions performed, and vital signs. The primary outcome was mortality following hospital admission.

Results: The study included 874 patients, and the observed mortality rate was 12.2%. Road traffic crashes were identified as the leading cause of TBI, accounting for 72.5% of the cases. Utilizing multiple logistic regression analysis, the study confirmed that older age, severe GCS score, tracheostomy, and abnormal oxygen saturation were significant predictors of mortality.

Conclusion: The findings of this study demonstrate that older age, lower GCS scores (severe TBI), tracheostomy, and abnormal oxygen saturation are significant predictors of mortality in patients with TBI. These results emphasize the significance of incorporating age, neurological status, and respiratory function into the assessment of prognosis and mortality risk in TBI patients. By considering these factors, health care professionals can better evaluate the potential outcomes and allocate appropriate care for TBI patients.

Spinal extradural angiolipomas (SEALs) are rare, benign neoplasms composed of mature adipocytes and vascular elements. They are often noninfiltrating and located in the posterior aspect of the spinal canal at the level of thoracic/dorsal vertebrae. Back pain, progressive paraparesis, and sensory disturbance in lower limbs are the typical symptoms. Here, we discuss two cases of SEALs presenting with subacute paraparesis. The magnetic resonance imaging of one patient was reported to be suggestive of spinal metastasis/plasmacytoma/sarcoma, while the other was reported as a spinal extradural hematoma. After laminectomy, both lesions were recognized as encapsulated extradural tumors and en-bloc resection was done. Postoperatively, the neurological deficits improved and there was no recurrence on 2-year follow-up. Histopathology characterized both of them to be extradural angiolipomas. Current experience and literature support curative surgical resection as the gold standard. The prognosis is excellent in most cases, even if total resection is not feasible. It is due to the slow-growing nature of the tumor and absence of malignant transformation.