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Ferreira NR, Marto CM, de Sousa BM, Loureiro M, Oliveira AT, DosSantos MF, Rodrigues MJ. Synthesis of temporomandibular disorders management intervention outcomes for development of core outcome sets: A systematic review. J Oral Rehabil 2024; 51:1303-1319. [PMID: 38572886 DOI: 10.1111/joor.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/12/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION The selection of appropriate outcomes in clinical trials and systematic reviews is a crucial factor in determining the results that are useful, reliable, and relevant for both patients and healthcare professionals. Clinicians and researchers have been encouraged to develop and apply core outcome sets (COS) to minimise the discrepancy between studies. AIM This systematic review is the first phase of the COS development project for clinical trials in temporomandibular disorders (COS-TMD). It aims to identify and synthesise the outcomes used in the randomised controlled trials (RCT) that evaluated the effectiveness of interventions used in TMD management. MATERIALS AND METHODS An electronic search was performed in several databases: MEDLINE (via PubMed), Scopus, Web of Science, Cochrane Library and EMBASE. The eligibility criteria comprised RCT that applied any intervention to treat temporomandibular joint disorders or masticatory muscle disorders. The identified outcomes were categorised according to domains of the Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT). RESULTS The electronic search resulted in 1606 studies. After removing duplicates and applying the eligibility criteria, 106 RCT were included. A total of 43 studies evaluated masticatory muscle disorders, 27 evaluated temporomandibular joint disorders, and 36 analysed mixed TMD. CONCLUSIONS The evaluation showed significant variability in the types of outcomes and their measurement instruments. In addition, some domains such as physical and emotional functioning, participant ratings of global improvement and adverse events have been neglected when determining the effectiveness of treatments for TMD.
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Affiliation(s)
- N R Ferreira
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
| | - C M Marto
- Faculty of Medicine, Institute of Experimental Pathology, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra, CACC, Coimbra, Portugal
| | - B M de Sousa
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
| | - M Loureiro
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
| | - A T Oliveira
- Postgraduate Program in Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - M F DosSantos
- Postgraduate Program in Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Laboratory of Mechanical Properties and Cell Biology (PropBio) School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - M J Rodrigues
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
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Svedung Wettervik T, Hånell A, Howells T, Engström ER, Lewén A, Enblad P. Autoregulatory Cerebral Perfusion Pressure Insults in Traumatic Brain Injury and Aneurysmal Subarachnoid Hemorrhage: The Role of Insult Intensity and Duration on Clinical Outcome. J Neurosurg Anesthesiol 2024; 36:228-236. [PMID: 37212723 DOI: 10.1097/ana.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/10/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND This single-center, retrospective study investigated the outcome effect of the combined intensity and duration of differences between actual cerebral perfusion pressure (CPP) and optimal cerebral perfusion pressure (CPPopt), and also for absolute CPP, in patients with traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (aSAH). METHODS A total of 378 TBI and 432 aSAH patients treated in a neurointensive care unit between 2008 and 2018 with at least 24 hours of CPPopt data during the first 10 days following injury, and with 6-month (TBI) or 12-month (aSAH) extended Glasgow Outcome Scale (GOS-E) scores, were included in the study. ∆CPPopt-insults (∆CPPopt=actual CPP-CPPopt) and CPP-insults were visualized as 2-dimensional plots to highlight the combined effect of insult intensity (mm Hg) and duration (min) on patient outcome. RESULTS In TBI patients, a zone of ∆CPPopt ± 10 mm Hg was associated with more favorable outcome, with transitions towards unfavorable outcome above and below this zone. CPP in the range of 60 to 80 mm Hg was associated with higher GOS-E, whereas CPP outside this range was associated with lower GOS-E. In aSAH patients, there was no clear transition from higher to lower GOS-E for ∆CPPopt-insults; however, there was a transition from favorable to unfavorable outcome when CPP was <80 mm Hg. CONCLUSIONS TBI patients with CPP close to CPPopt exhibited better clinical outcomes, and absolute CPP within the 60 to 80 mm Hg range was also associated with favorable outcome. In aSAH patients, there was no clear transition for ∆CPPopt-insults in relation to outcome, whereas generally high absolute CPP values were associated overall with favorable recovery.
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Echevarria AC, Hershfeld B, Verma R, Bruni M. Recurrent Laryngeal Nerve Injury During Anterior Cervical Discectomy and Fusion (ACDF): A Case Presentation and Review of the Literature. Cureus 2024; 16:e64603. [PMID: 39144844 PMCID: PMC11323947 DOI: 10.7759/cureus.64603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/14/2024] [Indexed: 08/16/2024] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) is a surgical procedure used to manage spine pathology including disc herniation, spondylosis, and myelopathy. During the operation, the vertebral segment of interest is accessed via the anterior neck and the disc space is fully resected along with osteophytes to relieve the compression along the affected nerve. While the procedure is regarded as being highly effective in improving symptoms, there are several complications associated with the surgery that patients should be cautioned about. We present a case of a patient with oropharyngeal and cervical esophageal dysphagia and left vocal cord paralysis following a C5/C6, C6/C7, and C7/T1 ACDF for multilevel cervical stenosis and disc herniation. Otolaryngology evaluation confirmed vocal cord paralysis from recurrent laryngeal nerve palsy (RLNP) and the patient's symptoms were managed with a vocal cord injection and speech therapy. This report explores the surgical approach for ACDF along with its complications and postoperative care.
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Affiliation(s)
- Alexandra C Echevarria
- Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | | | - Rohit Verma
- Orthopedic Surgery, Northwell Health, Manhasset, USA
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Nthumba PM. Global Surgery: The Challenges and Strategies to Win a War That Must Be Won. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5953. [PMID: 38962157 PMCID: PMC11221857 DOI: 10.1097/gox.0000000000005953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/17/2024] [Indexed: 07/05/2024]
Abstract
Background Modern science has conquered seas, land, and space. Although great strides have been made in technology and infectious diseases, global surgery, which was reborn in 2015, has not made much progress. The burden of surgical disease in low- and middle-income countries remains seemingly unconquerable, and its growth unstoppable. The myriad challenges in meeting the surgical needs of 5 billion people has intrigued the author. Methods The author collected the views of plastic surgeons on sources and impediments to the scale-up of plastic surgery in low- and middle-income countries, as well as potential strategies for overcoming these obstacles. The author then performed a literature search reviewing the topics that arose from those discussions. The author proposes a strategy using plastic surgery as a model surgical discipline. Results A root-cause analysis suggests that the Alma Ata Declaration, with its focus on primary healthcare, is the probable genesis of global surgery (GS) woes. The absence of a clear GS community leader and the fragmented nature of GS advocates who operate in multiple silos, without a clear unified goal, are the primary reasons GS advocates have achieved so little on the ground. Conclusions Global surgery requires a business model to sustainably meet the surgical needs of the 5 billion people globally. The proposed and implemented strategies must meet rigorous criteria to ensure sustainability, as quick-fix solutions are counterproductive. The development of centers of excellence offers a viable solution to problems that must be addressed successfully.
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Affiliation(s)
- Peter M. Nthumba
- From Department of Plastic Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
- Department of Plastic Surgery, Baylor College of Medicine, Temple, Tex
- EACH Research, Kijabe, Kenya
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Yamada K, Yoshii T, Toba M, Egawa S, Morishita S, Matsukura Y, Hirai T, Kudo A, Fushimi K. Trends in the surgical treatment for metastatic spinal tumor in Japanese administrative data between 2012 and 2020. Int J Clin Oncol 2024; 29:911-920. [PMID: 38829471 DOI: 10.1007/s10147-024-02537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/14/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Both cancer diagnosis/treatment modality and surgical technique for the spine have been developed recently. Nationwide trends in the surgical treatment for metastatic spinal tumors have not been reported in the last decades. This study aimed to examine recent trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes using nationwide administrative hospital discharge data. METHODS The Diagnosis Procedure Combination database from 2012 to 2020 was used to extract data from patients who underwent surgical procedures for spinal metastasis with the number of non-metastatic spinal surgery at the institutions that have performed metastatic spine surgeries at least one case in the same year. Trends in the surgical treatment for spinal metastasis, patients' demographics, and in-hospital mortality/outcomes were investigated. RESULTS This study analyzed 10,321 eligible patients with spinal metastasis. The surgical treatment for spinal metastasis increased 1.68 times from 2012 to 2020, especially in fusion surgery, whereas the proportion of metastatic spinal surgery retained with a slight increase in the 2%s. Distributions of the primary site did not change, whereas age was getting older. In-hospital mortality and length of stay decreased over time (9.9-6.8%, p < 0.001; 37-30 days, p < 0.001). Postoperative complication and unfavorable ambulatory retained stable and slightly decreased, respectively. CONCLUSION During the last decade, surgical treatment for spinal metastasis, especially fusion surgery, has increased in Japan. In-hospital mortality and length of stay decreased. Recent advances in cancer treatment and surgical techniques might influence this trend.
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Affiliation(s)
- Kentaro Yamada
- Department of Orthopaedics and Trauma Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Mikayo Toba
- Department of Quality Management Center, Tokyo Medical and Dental Univ Hospital, Tokyo, Japan
| | - Satoru Egawa
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shingo Morishita
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yu Matsukura
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takashi Hirai
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Atsushi Kudo
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics Section, Tokyo Medical and Dental University, Tokyo, Japan
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Yuan S, Chen R, Liu X, Wang T, Wang A, Fan N, Du P, Xi Y, Gu Z, Zhang Y, Zang L. Artificial intelligence automatic measurement technology of lumbosacral radiographic parameters. Front Bioeng Biotechnol 2024; 12:1404058. [PMID: 39011157 PMCID: PMC11246908 DOI: 10.3389/fbioe.2024.1404058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/17/2024] [Indexed: 07/17/2024] Open
Abstract
Background Currently, manual measurement of lumbosacral radiological parameters is time-consuming and laborious, and inevitably produces considerable variability. This study aimed to develop and evaluate a deep learning-based model for automatically measuring lumbosacral radiographic parameters on lateral lumbar radiographs. Methods We retrospectively collected 1,240 lateral lumbar radiographs to train the model. The included images were randomly divided into training, validation, and test sets in a ratio of approximately 8:1:1 for model training, fine-tuning, and performance evaluation, respectively. The parameters measured in this study were lumbar lordosis (LL), sacral horizontal angle (SHA), intervertebral space angle (ISA) at L4-L5 and L5-S1 segments, and the percentage of lumbar spondylolisthesis (PLS) at L4-L5 and L5-S1 segments. The model identified key points using image segmentation results and calculated measurements. The average results of key points annotated by the three spine surgeons were used as the reference standard. The model's performance was evaluated using the percentage of correct key points (PCK), intra-class correlation coefficient (ICC), Pearson correlation coefficient (r), mean absolute error (MAE), root mean square error (RMSE), and box plots. Results The model's mean differences from the reference standard for LL, SHA, ISA (L4-L5), ISA (L5-S1), PLS (L4-L5), and PLS (L5-S1) were 1.69°, 1.36°, 1.55°, 1.90°, 1.60%, and 2.43%, respectively. When compared with the reference standard, the measurements of the model had better correlation and consistency (LL, SHA, and ISA: ICC = 0.91-0.97, r = 0.91-0.96, MAE = 1.89-2.47, RMSE = 2.32-3.12; PLS: ICC = 0.90-0.92, r = 0.90-0.91, MAE = 1.95-2.93, RMSE = 2.52-3.70), and the differences between them were not statistically significant (p > 0.05). Conclusion The model developed in this study could correctly identify key vertebral points on lateral lumbar radiographs and automatically calculate lumbosacral radiographic parameters. The measurement results of the model had good consistency and reliability compared to manual measurements. With additional training and optimization, this technology holds promise for future measurements in clinical practice and analysis of large datasets.
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Affiliation(s)
- Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ruiyuan Chen
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xingyu Liu
- School of Life Sciences, Tsinghua University, Beijing, China
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yu Xi
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhao Gu
- Longwood Valley Medical Technology Co., Ltd., Beijing, China
| | - Yiling Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
- Longwood Valley Medical Technology Co., Ltd., Beijing, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Hamilton A. The Future of Artificial Intelligence in Surgery. Cureus 2024; 16:e63699. [PMID: 39092371 PMCID: PMC11293880 DOI: 10.7759/cureus.63699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
Until recently, innovations in surgery were largely represented by extensions or augmentations of the surgeon's perception. This includes advancements such as the operating microscope, tumor fluorescence, intraoperative ultrasound, and minimally invasive surgical instrumentation. However, introducing artificial intelligence (AI) into the surgical disciplines represents a transformational event. Not only does AI contribute substantively to enhancing a surgeon's perception with such methodologies as three-dimensional anatomic overlays with augmented reality, AI-improved visualization for tumor resection, and AI-formatted endoscopic and robotic surgery guidance. What truly makes AI so different is that it also provides ways to augment the surgeon's cognition. By analyzing enormous databases, AI can offer new insights that can transform the operative environment in several ways. It can enable preoperative risk assessment and allow a better selection of candidates for procedures such as organ transplantation. AI can also increase the efficiency and throughput of operating rooms and staff and coordinate the utilization of critical resources such as intensive care unit beds and ventilators. Furthermore, AI is revolutionizing intraoperative guidance, improving the detection of cancers, permitting endovascular navigation, and ensuring the reduction in collateral damage to adjacent tissues during surgery (e.g., identification of parathyroid glands during thyroidectomy). AI is also transforming how we evaluate and assess surgical proficiency and trainees in postgraduate programs. It offers the potential for multiple, serial evaluations, using various scoring systems while remaining free from the biases that can plague human supervisors. The future of AI-driven surgery holds promising trends, including the globalization of surgical education, the miniaturization of instrumentation, and the increasing success of autonomous surgical robots. These advancements raise the prospect of deploying fully autonomous surgical robots in the near future into challenging environments such as the battlefield, disaster areas, and even extraplanetary exploration. In light of these transformative developments, it is clear that the future of surgery will belong to those who can most readily embrace and harness the power of AI.
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Affiliation(s)
- Allan Hamilton
- Artificial Intelligence Division for Simulation, Education, and Training, University of Arizona Health Sciences, Tucson, USA
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Seghier ML. 7 T and beyond: toward a synergy between fMRI-based presurgical mapping at ultrahigh magnetic fields, AI, and robotic neurosurgery. Eur Radiol Exp 2024; 8:73. [PMID: 38945979 PMCID: PMC11214939 DOI: 10.1186/s41747-024-00472-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/22/2024] [Indexed: 07/02/2024] Open
Abstract
Presurgical evaluation with functional magnetic resonance imaging (fMRI) can reduce postsurgical morbidity. Here, we discuss presurgical fMRI mapping at ultra-high magnetic fields (UHF), i.e., ≥ 7 T, in the light of the current growing interest in artificial intelligence (AI) and robot-assisted neurosurgery. The potential of submillimetre fMRI mapping can help better appreciate uncertainty on resection margins, though geometric distortions at UHF might lessen the accuracy of fMRI maps. A useful trade-off for UHF fMRI is to collect data with 1-mm isotropic resolution to ensure high sensitivity and subsequently a low risk of false negatives. Scanning at UHF might yield a revival interest in slow event-related fMRI, thereby offering a richer depiction of the dynamics of fMRI responses. The potential applications of AI concern denoising and artefact removal, generation of super-resolution fMRI maps, and accurate fusion or coregistration between anatomical and fMRI maps. The latter can benefit from the use of T1-weighted echo-planar imaging for better visualization of brain activations. Such AI-augmented fMRI maps would provide high-quality input data to robotic surgery systems, thereby improving the accuracy and reliability of robot-assisted neurosurgery. Ultimately, the advancement in fMRI at UHF would promote clinically useful synergies between fMRI, AI, and robotic neurosurgery.Relevance statement This review highlights the potential synergies between fMRI at UHF, AI, and robotic neurosurgery in improving the accuracy and reliability of fMRI-based presurgical mapping.Key points• Presurgical fMRI mapping at UHF improves spatial resolution and sensitivity.• Slow event-related designs offer a richer depiction of fMRI responses dynamics.• AI can support denoising, artefact removal, and generation of super-resolution fMRI maps.• AI-augmented fMRI maps can provide high-quality input data to robotic surgery systems.
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Affiliation(s)
- Mohamed L Seghier
- Department of Biomedical Engineering and Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, UAE.
- Healtcare Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, UAE.
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Mohammadi M, Roohollahi F, Mahmoudi MM, Mohammadi A, Mohamadi M, Kankam SB, Ghamari Khameneh A, Baghdasaryan D, Farahbakhsh F, Martin AR, Harrop J, Rahimi-Movaghar V. Correlation Between Pre-Operative Diffusion Tensor Imaging Indices and Post-Operative Outcome in Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis. Global Spine J 2024; 14:1800-1817. [PMID: 38168663 PMCID: PMC11268306 DOI: 10.1177/21925682231225634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The correlation between pre-operative diffusion tensor imaging (DTI) metrics and post-operative clinical outcomes in patients with degenerative cervical myelopathy (DCM) has been widely investigated with different studies reporting varied findings. We conducted a systematic review to determine the association between DTI metric and clinical outcomes after surgery. METHODS We identified relevant articles that investigated the relationship between pre-operative DTI indices and post-operative outcome in DCM patients by searching PubMed/MEDLINE, Web of Science, Scopus, and EMBASE from inception until October 2023. In addition, quantitative synthesis and meta-analyses were performed. RESULTS FA was significantly correlated with postoperative JOA or mJOA across all age and follow up subgroups, changes observed in JOA or mJOA from preoperative to postoperative stages (Δ JOA or Δ mJOA) in subgroups aged 65 and above and in those with a follow-up period of 6 months or more, as well as recovery rate in all studies pooled together and also in the under-65 age bracket. Additionally, a significant correlation was demonstrated between recovery rate and ADC across all age groups. No other significant correlations were discovered between DTI parameters (MD, AD, and ADC) and post-operative outcomes. CONCLUSION DTI is a quantitative noninvasive evaluation tool that correlates with severity of DCM. However, the current evidence is still elusive regarding whether DTI metric is a validated tool for predicting the degree of post-operative recovery, which could potentially be useful in patient selection for surgery.
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Affiliation(s)
| | - Faramarz Roohollahi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Yas Spine Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Mahdi Mahmoudi
- Department of General Surgery, Shahid Mofateh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aynaz Mohammadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mobin Mohamadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samuel Berchi Kankam
- Image guided Neurosurgery Lab, Department of Neurosurgery, Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA
- Brain Trauma Lab, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Afshar Ghamari Khameneh
- Department of Radiology, Advanced Diagnostic and Interventional Radiology (ADIR) Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farzin Farahbakhsh
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Allan R. Martin
- Department of Neurosurgery, University of California Davis, Davis, CA, USA
| | - James Harrop
- Department of Neurological and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
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Jazayeri SB, Maroufi SF, Akbarinejad S, Ghodsi Z, Rahimi-Movaghar V. Development of a regional-based predictive model of incidence of traumatic spinal cord injury using machine learning algorithms. World Neurosurg X 2024; 23:100280. [PMID: 38497064 PMCID: PMC10943041 DOI: 10.1016/j.wnsx.2024.100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
Objective To develop a predictive model of incidence of traumatic spinal cord injury (TSCI). Methods The data for training the model included both the incidence data and the covariates. The incidence data were extracted from systematic reviews and the covariates were extracted from data available in the international road federation database. Then the feature processing measures were taken. First we defined a hyper-parameter, missing-value threshold, in order to eliminate features that exceed this threshold. To tackle the problem of overfitting of model we determined the Pearson correlation of features and excluded those with more than 0.7 correlation. After feature selection three different models including simple linear regression, support vector regression, and multi-layer perceptron were examined to fit the purposes of this study. Finally, we evaluated the model based on three standard metrics: Mean Absolute Error, Root Mean Square Error, and R2. Results Our machine-learning based model could predict the incidence rate of TSCI with the mean absolute error of 4.66. Our model found "Vehicles in use, Total vehicles/Km of roads", "Injury accidents/100 Million Veh-Km", "Vehicles in use, Vans, Pick-ups, Lorries, Road Tractors", "Inland surface Passengers Transport (Mio Passenger-Km), Rail", and "% paved" as top predictors of transport-related TSCI (TRTSCI). Conclusions Our model is proved to have a high accuracy to predict the incidence rate of TSCI for countries, especially where the main etiology of TSCI is related to road traffic injuries. Using this model, we can help the policymakers for resource allocation and evaluation of preventive measures.
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Affiliation(s)
- Seyed Behnam Jazayeri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Seyed Farzad Maroufi
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Shaya Akbarinejad
- TRON - Translational Oncology at the University Medical Center of the Johannes Gutenberg University Mainz gGmbH, Mainz, Germany
| | - Zahra Ghodsi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Spine Program, University of Toronto, Toronto, Canada
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Spine Program, University of Toronto, Toronto, Canada
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Oliveira LB, Sousa MP, Andreão FF, Prestes MZ, Palavani LB, Batista S, Koester SW, Rabelo NN, Bertani R, Welling LC, Figueiredo EG, Lawton MT. Clinical and Technical Outcomes of Intracranial-Intracranial Bypass for Treating Complex Intracranial Aneurysms: An Analysis of 255 Patients. World Neurosurg 2024; 187:223-235.e4. [PMID: 38762027 DOI: 10.1016/j.wneu.2024.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Despite the recent increase in publications centered on intracranial-intracranial (IC-IC) bypasses for complex aneurysms, there is no systematic evidence regarding their outcomes. The purpose was to assess the outcomes of patients subjected to IC-IC bypass for aneurysms. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, a systematic review was conducted. Criteria for inclusion entailed studies with a cohort of at least 4 patients having undergone IC-IC bypass for aneurysms, detailing at least one outcome, such as patency, clinical outcomes, complications, and procedure-related mortality. When the study included patients who had undergone extracranial-intracranial (EC-IC) bypass, the authors extracted the patency and clinical data to juxtapose them with the results of IC-IC. RESULTS Of the 2509 shortlisted studies, 22 met our inclusion criteria, encompassing 255 patients and 263 IC-IC bypass procedures. The IC-IC bypass procedure exhibited a patency rate of 93% (95% confidence interval [CI]: 89%-95%). The patency rate of IC-IC and EC-IC bypasses did not significantly differ (odds ratio=0.60 [95% CI: 0.18-1.96]). Concerning clinical outcomes, 91% of the IC-IC patients had positive results (95% CI: 85%-97%), with no significant disparity between the IC-IC and EC-IC groups (odds ratio=1.29 [95% CI: 0.43-3.88]). After analysis, the complication rate was 11% (95% CI: 5%-18%). Procedure-related mortality was 1% (95% CI: 0%-4%). CONCLUSIONS IC-IC bypass is valuable for the treatment of complex intracranial aneurysms, boasting high patency and positive clinical outcomes. Complications are unusual, and procedure-related mortality is minimal. Comparing IC-IC and EC-IC led to no significant differences.
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Affiliation(s)
- Leonardo B Oliveira
- Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil.
| | - Marcelo Porto Sousa
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipi Fim Andreão
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Milena Zadra Prestes
- Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | | | - Sávio Batista
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stefan W Koester
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Leonardo C Welling
- Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | - Eberval G Figueiredo
- Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Esmaeilzadeh M, Atallah O, Müller JA, Bengel F, Polemikos M, Heissler HE, Krauss JK. Brain Metastases from Thyroid Carcinoma: Prognostic Factors and Outcomes. Cancers (Basel) 2024; 16:2371. [PMID: 39001433 PMCID: PMC11240759 DOI: 10.3390/cancers16132371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Intracranial metastases from thyroid cancer are rare. Although the prognosis of thyroid cancer patients is generally favorable, the prognosis of patients with intracranial metastases from thyroid cancer has been considered unfavorable owing to lower survival rates among such patients compared to those without intracranial involvement. Many questions about their management remain unclear. The aim of the present study was to analyze the characteristics, treatment modalities, and outcomes of patients with brain metastases from thyroid cancer. Among 4320 patients with thyroid cancer recorded in our institutional database over a 30-year period, the data of 20 patients with brain metastasis were retrospectively collected and analyzed. The clinical characteristics, histological type of primary cancer and metastatic brain tumor, additional previous distant metastasis, treatment modalities, locations and characteristics on radiologic findings, time interval between the first diagnosis of primary thyroid cancer and brain metastasis, and survival were analyzed. Among our patient cohort, the mean age at initial diagnosis was 59.3 ± 14.1 years, and at the manifestation of diagnosis of cerebral metastasis, the mean age was found to be 64.8 ± 14.9 years. The histological types of primary thyroid cancer were identified as papillary in ten patients, follicular in seven, and poorly differentiated carcinoma in three. The average interval between the diagnosis of thyroid cancer and brain metastasis was 63.4 ± 58.4 months (range: 0-180 months). Ten patients were identified as having a single intracranial lesion, and ten patients were found to have multiple lesions. Surgical resection was primarily performed in fifteen patients, and whole-brain radiotherapy, radiotherapy, or tyrosine kinase inhibitors were applied in the remaining five patients. The overall median survival time was 15 months after the diagnosis of BMs from TC (range: 1-252 months). Patients with thyroid cancer can develop brain metastasis even many years after the diagnosis of the primary tumor. The results of our study demonstrate increased overall survival in patients younger than 60 years of age at the time of diagnosis of brain metastasis. There was no difference in survival between patients with brain metastasis from papillary carcinoma and those with follicular thyroid carcinoma.
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Affiliation(s)
- Majid Esmaeilzadeh
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany
| | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany
| | - Jörg Andreas Müller
- Department of Nuclear Medicine, Hannover Medical School, 30625 Hannover, Germany
| | - Frank Bengel
- Department of Nuclear Medicine, Hannover Medical School, 30625 Hannover, Germany
| | - Manolis Polemikos
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany
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Zhang H, Liu X, Shi J, Su X, Xie J, Meng Q, Dong H. Research progress on the mechanism of exosome-mediated virus infection. Front Cell Infect Microbiol 2024; 14:1418168. [PMID: 38988816 PMCID: PMC11233549 DOI: 10.3389/fcimb.2024.1418168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
Exosomes are extracelluar vesicles that facilitate intercellular communication and are pivotal in post-transcriptional regulation within cellular gene regulatory networks, impacting pathogen dynamics. These vesicles serve as crucial regulators of immune responses, mediating cellular interactions and enabling the introduction of viral pathogenic regions into host cells. Exosomes released from virus-infected cells harbor diverse microRNAs (miRNAs), which can be transferred to recipient cells, thereby modulating virus infection. This transfer is a critical element in the molecular interplay mediated by exosomes. Additionally, the endosomal sorting complex required for transport (ESCRT) within exosomes plays a vital role in virus infection, with ESCRT components binding to viral proteins to facilitate virus budding. This review elucidates the roles of exosomes and their constituents in the invasion of host cells by viruses, aiming to shed new light on the regulation of viral transmission via exosomes.
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Affiliation(s)
- Hanjia Zhang
- College of Life Sciences, Jilin Agricultural University, Changchun, Jilin, China
| | - Xuanyi Liu
- College of Life Sciences, Jilin Agricultural University, Changchun, Jilin, China
| | - Jiuming Shi
- College of Life Sciences, Jilin Agricultural University, Changchun, Jilin, China
| | - Xuan Su
- College of Life Sciences, Jilin Agricultural University, Changchun, Jilin, China
| | - Jiayuan Xie
- College of Life Sciences, Jilin Agricultural University, Changchun, Jilin, China
| | - Qingfeng Meng
- College of Life Sciences, Jilin Agricultural University, Changchun, Jilin, China
- Engineering Research Center of Bioreactor and Pharmaceutical Development, Jilin Agricultural University, Changchun, China
| | - Hao Dong
- College of Life Sciences, Jilin Agricultural University, Changchun, Jilin, China
- Engineering Research Center of Bioreactor and Pharmaceutical Development, Jilin Agricultural University, Changchun, China
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Boissiere L, Haleem S, Liquois F, Aunoble S, Cursolle JC, Régnault de la Mothe G, Petit M, Pellet N, Bourghli A, Larrieu D, Obeid I. Prospective same day discharge instrumented lumbar spine surgery - a forty patient consecutive series. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08365-9. [PMID: 38918227 DOI: 10.1007/s00586-024-08365-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 05/16/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Outpatient lumbar decompression surgeries have been successfully performed in France for over twenty years, earning acceptance. However, outpatient instrumented lumbar spine procedures and arthroplasties are less documented. This study aimed to evaluate the feasibility, efficiency, and safety of outpatient lumbar instrumented surgery. METHODS A prospective single-center study involving three experienced surgeons was conducted from September 2020 to September 2021, with a minimum six-month postoperative follow-up. Inclusion criteria comprised patients aged 18 to 75 eligible for same-day discharge, undergoing single-level lumbar spinal fusion or arthroplasty via anterior or posterior Wiltse approach. The primary endpoint was assessing the percentage of successful outpatient discharges (within twelve hours), with secondary endpoints including perioperative/postoperative complications and discharge pain prescriptions in terms of frequency and severity. RESULTS Forty patients (mean age: 44 years; 16/24 male/female ratio) underwent surgery, including 18 lumbar arthroplasties, twelve ALIF, and ten TLIF procedures. The majority of surgeries were performed at L4-L5 (18 procedures) and L5-S1 levels (22 procedures). 95% (38/40) of patients were successfully discharged within twelve hours, with only two patients discharged the following day. No postoperative hematomas, serious adverse events, or revision surgeries were noted. CONCLUSION 95% of patients were discharged successfully within twelve hours following outpatient lumbar fusion surgery, with a 100% patient satisfaction rate. Specific technical solutions were not necessary, and oral pain relief sufficed. Patient selection and education, including early pain management, played crucial roles in complication avoidance. This study underscores the safety of outpatient instrumented lumbar spine procedures, leading to cost reduction and expedited recovery.
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Affiliation(s)
- Louis Boissiere
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France.
| | - Shahnawaz Haleem
- Royal Orthopaedic Hospital, Spinal House, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - Frédéric Liquois
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France
| | - Stéphane Aunoble
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France
| | | | | | - Marion Petit
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France
| | - Nicolas Pellet
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Daniel Larrieu
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France
| | - Ibrahim Obeid
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France
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Shah HA, Chen A, Green R, Ber R, D'Amico RS, Sciubba DM, Lo SFL, Silverstein JW. Direct (D)-Wave Monitoring Enhancement With Subdural Electrode Placement: A Case Series. J Clin Neurophysiol 2024:00004691-990000000-00140. [PMID: 38916920 DOI: 10.1097/wnp.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
PURPOSE Direct-wave (D-wave) neuromonitoring is a direct measure of corticospinal tract integrity that detects potential injury during spinal cord surgery. Epidural placement of electrodes used for D-wave measurements can result in high electrical impedances resulting in substantial signal noise that can compromise signal interpretation. Subdural electrode placement may offer a solution. METHODS Medical records for consecutive patients with epidural and subdural D-wave monitoring were reviewed. Demographic and clinical information including preoperative and postoperative motor strength were recorded. Neuromonitoring charts were reviewed to characterize impedances and signal amplitudes of D-waves recorded epidurally (before durotomy) and subdurally (following durotomy). Nonparametric statistics were used to compare epidural and subdural D-waves. RESULTS Ten patients (50% women, median age 50.5 years) were analyzed, of which five patients (50%) were functionally independent (modified McCormick grade ≤ II) preoperatively. D-waves were successfully acquired by subdural electrodes in eight cases and by epidural electrodes in three cases. Subdural electrode placement was associated with lower impedance values ( P = 0.011) and a higher baseline D-wave amplitude ( P = 0.007) relative to epidural placement. No association was observed between D-wave obtainability and functional status, and no adverse events relating to subdural electrode placement were encountered. CONCLUSIONS Subdural electrode placement allows successful D-wave acquisition with accurate monitoring, clearer waveforms, and a more optimal signal-to-noise ratio relative to epidural placement. For spinal surgeries where access to the subdural compartment is technically safe and feasible, surgeons should consider subdural placement when monitoring D-waves to optimize clinical interpretation.
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Affiliation(s)
- Harshal A Shah
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, U.S.A
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, U.S.A
| | - Adrian Chen
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, U.S.A
| | - Ross Green
- Department of Neurological Surgery, Northern Westchester Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, U.S.A
| | - Roee Ber
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, U.S.A
| | - Randy S D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, U.S.A
| | - Daniel M Sciubba
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, U.S.A
| | - Sheng-Fu Larry Lo
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, U.S.A
| | - Justin W Silverstein
- Department of Neurology, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, U.S.A
- Department of Neurology, North Shore University Hospital /Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, U.S.A.; and
- Department of Clinical Neurophysiology, Neuro Protective Solutions, New York, New York, U.S.A
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Sun T, Shao D, Li J, Xu D, Zhang T, Li L, Sun W, Zhang C, Wen X, Chen H, Zhang R, Jiang Z. Therapeutic efficacy of drilling drainage combined with intraoperative middle meningeal artery occlusion in the management of chronic subdural hematoma: a clinical study. Neurosurg Rev 2024; 47:293. [PMID: 38914867 PMCID: PMC11196335 DOI: 10.1007/s10143-024-02501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/27/2024] [Accepted: 06/04/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND The bone holes in the skull during surgical drainage were accurately located at the site of the MMA. The MMA was severed, and the hematoma was removed intraoperatively; furthermore, surgical drainage removed the pathogenic factors of CSDH. This study aimed to describe and compare the results of the new treatment with those of traditional surgical drainage, and to investigate the relevance of this approach. METHODS From December 2021 to June 2023, 72 patients were randomly assigned to the observation group and the control group. The control group was treated with traditional surgical drainage, while the observation group was treated with DSA imaging to accurately locate the bone holes drilled in the skull on the MMA trunk before traditional surgical drainage. The MMA trunk was severed during the surgical drainage of the hematoma. The recurrence rate, time of indwelling drainage tube, complications, mRS, and other indicators of the two groups were compared, and the changes of cytokine components and imaging characteristics of the patients were collected and analyzed. RESULTS Overall, 27 patients with 29-side hematoma in the observation group and 45 patients with 48-side hematoma in the control group were included in the study. The recurrence rate was 0/29 in the observation group and 4/48 in the control group, indicating that the recurrence rate in the observation group was lower than in the control group (P = .048). The mean indwelling time of the drainage tube in the observation group was 2.04 ± 0.61 days, and that in the control group was 2.48 ± 0.61 days. The indwelling time of the drainage tube in the observation group was shorter than in the control group (P = .003). No surgical complications were observed in the observation group or the control group. The differences in mRS scores before and after operation between the observation group and the control group were statistically significant (P < .001). The concentrations of cytokine IL6/IL8/IL10/VEGF in the hematoma fluid of the observation and control groups were significantly higher than those in venous blood (P < .001). After intraoperative irrigation and drainage, the concentrations of cytokines (IL6/IL8/IL10/VEGF) in the subdural hematoma fluid were significantly lower than they were preoperatively. In the observation group, the number of MMA on the hematoma side (11/29) before STA development was higher than that on the non-hematoma side (1/25), and the difference was statistically significant (P = .003). CONCLUSION In patients with CSDH, accurately locating the MMA during surgical trepanation and drainage, severing the MMA during drainage, and properly draining the hematoma, can reduce the recurrence rate and retention time of drainage tubes, thereby significantly improving the postoperative mRS Score without increasing surgical complications.
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Affiliation(s)
- Tao Sun
- School of Continuing Education, Anhui Medical University, Hefei, China
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Dongqi Shao
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Jian Li
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Decai Xu
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Tao Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Lei Li
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Wenjie Sun
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Caihong Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Xinjie Wen
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Haonan Chen
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Renhao Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Zhiquan Jiang
- School of Continuing Education, Anhui Medical University, Hefei, China.
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China.
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Mustapha MJ, Chaurasia B, Javed S. The Unequal Battlefield: Addressing Academic Racism in Neurosurgery. World Neurosurg 2024:S1878-8750(24)01054-4. [PMID: 38909752 DOI: 10.1016/j.wneu.2024.06.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Affiliation(s)
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Saad Javed
- Neurosurgery, Brain Surgery Hospital, Violence, Injury Prevention and Disability Unit, Health Services Academy, and Ministry of National Health Services, Regulations & Coordination, Islamabad, Pakistan
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Xiao S, Zhu S, Guan B, Zhao J. Functional Outcomes of Therapeutic Selective Nerve Root Block for Single-Segment Lumbar Spinal Stenosis: A Retrospective Study. Med Sci Monit 2024; 30:e943634. [PMID: 38905165 PMCID: PMC11305107 DOI: 10.12659/msm.943634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/29/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Functional evaluation after therapeutic selective nerve root block (SNRB) has been rarely reported. We explored functional outcomes of SNRB for single-segment lumbar spinal stenosis (LSS). MATERIAL AND METHODS Data for 117 patients with single-segment LSS who underwent single therapeutic SNRB were retrospectively collected between January 2019 and December 2021. Functional outcomes were assessed using Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) scores preoperatively, and 3 days, and 3, 6, and 12 months after SNRB, which were compared in subgroups stratified by age, sex, BMI, sedentary time, hypertension, diabetes, affected side, pathology level, intervertebral disk. Correlation between ODI and JOA was analyzed using univariate linear regression analysis. RESULTS Clinical symptoms of LSS significantly improved within 12 months after SNRB, especially at 6 months (P<0.05). ODI scores in each subgroup gradually decreased within 6 months after SNRB, and JOA scores gradually increased. Most subgroup analyses revealed significantly increased ODI scores and decreased JOA scores at 12 months after SNRB, compared with 6-month scores (P<0.05). Notably, ODI and JOA scores at 12 months after SNRB were not significantly different than those before SNRB in patients with BMI >25 or sedentary time >8 h (P>0.05). A significant correlation existed between ODI and JOA scores (P<0.05). CONCLUSIONS Therapeutic SNRB was an effective treatment for alleviating LSS within at least 6 months. Changing sedentary habits with appropriate exercise and controlling weight with a healthy diet can improve the effectiveness of SNRB, especially in patients for whom conservative treatment is ineffective and who are unsuitable for surgical treatment.
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Affiliation(s)
- Shiqian Xiao
- Digital Subtraction Room, Tianjin Hospital, Tianjin, PR China
| | - Shan Zhu
- Department of Radiology II, Tianjin Hospital, Tianjin, PR China
| | - Binggang Guan
- Department of Spine Surgery Section One, Tianjin Hospital, Tianjin, PR China
| | - Jianlan Zhao
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, PR China
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Santhumayor BA, Chen A, Pelcher I, Cater E, Mishra A, Ward M, White TG, Schulder M, Sciubba DM, Tracey KJ, Baum GR. Organizing a Regional In-Person Medical Student Symposium in Neuroscience and Neurosurgery Research: A How-To Guide. World Neurosurg 2024; 189:249-255. [PMID: 38909749 DOI: 10.1016/j.wneu.2024.06.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Medical students are increasingly seeking out research opportunities to build their skills and network with future colleagues. Medical student-led conferences are an excellent endeavor to achieve this goal. METHODS The American Association of Neurological Surgeons student chapter at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell designed an in-person medical student research symposium alongside the Northwell Health Department of Neurosurgery. Postconference feedback forms were sent out digitally to student attendees to evaluate event planning and execution and responses were given on a scale of 1-5 (5 being the highest score). RESULTS In December 2023, the Northeast Medical Student Research Symposium was held with over 80 participants and 52 medical student presenters. Keynote speakers delivered lectures geared toward students interested in neurosurgery and neuroscience research, followed by an interactive poster board session and resident/attending networking dinner. After the conference, students affirmed that they learned more about neuroscience research after the event (mean: 4.3), were more inclined to attend other neuroscience research events in the future (mean: 4.7), and would attend this event if held next year (mean: 4.8). The poster sessions (mean: 4.75) and keynote lectures (mean: 5) were the highest rated events, while the resident/attending networking dinner (mean: 3.6) was a potential area for improvement. CONCLUSIONS Regional in-person conferences are an excellent way to foster interest in neurosurgery and neuroscience research, network with like-minded peers, and prepare students for presentations at national meetings.
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Affiliation(s)
- Brandon A Santhumayor
- Department of Neurosurgery, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
| | - Adrian Chen
- Department of Neurosurgery, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Isabelle Pelcher
- Department of Neurosurgery, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Evan Cater
- Department of Neurosurgery, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Akash Mishra
- Department of Neurosurgery, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Max Ward
- Department of Neurosurgery, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Timothy G White
- Department of Neurosurgery, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Michael Schulder
- Department of Neurosurgery, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Kevin J Tracey
- Feinstein Medical Research Institute, Northwell Health, Manhasset, New York, USA
| | - Griffin R Baum
- Department of Neurosurgery, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Kashif M, Muthana A, Al-Qudah AM, Hoz SS. The influence of artificial intelligence on neurological surgery and patient outcome. Surg Neurol Int 2024; 15:211. [PMID: 38974533 PMCID: PMC11225402 DOI: 10.25259/sni_321_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/31/2024] [Indexed: 07/09/2024] Open
Affiliation(s)
- Muhammad Kashif
- Department of Neurosurgery, Medical School, Midwestern University, Glendale, United States
| | - Ahmed Muthana
- Department of Neurosurgery, University of Baghdad, College of Medicine, Medical City, Baghdad, Iraq
| | - Abdullah M. Al-Qudah
- University of Pittsburgh Medical Center (UPMC) Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pennsylvania, United States
| | - Samer S. Hoz
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Chen Y, Xu W, Liu J, Zhao C, Cao X, Wang R, Feng D, Zhang R, Zhou X. Color-coded parametric imaging support display of vessel hemorrhage-an in vitro experiment and clinical validation study. Front Cardiovasc Med 2024; 11:1387421. [PMID: 38966753 PMCID: PMC11222601 DOI: 10.3389/fcvm.2024.1387421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/04/2024] [Indexed: 07/06/2024] Open
Abstract
Background Digital Subtraction Angiography (DSA) is currently the most effective diagnostic method for vascular diseases, but it is still subject to various factors, resulting in uncertain diagnosis. Therefore, a new technology is needed to help clinical doctors improve diagnostic accuracy and efficiency. Purpose The objective of the study was to investigate the effect of utilizing color-coded parametric imaging techniques on the accuracy of identifying active bleeding through DSA, the widely accepted standard for diagnosing vascular disorders. Methods Several variables can delay the diagnosis and treatment of active bleeding with DSA. To resolve this, we carried out an in vitro simulation experiment to simulate vascular hemorrhage and utilized five color-coded parameters (area under curve, time to peak, time-of-arrival, transit time, and flow rate of contrast agent) to determine the optimal color coding parameters. We then verified it in a clinical study. Results Five different color-coded parametric imaging methods were compared and the time-of-arrival color coding was the most efficient technique for diagnosing active hemorrhage, with a statistically significant advantage (P < 0.001). In clinical study, 135 patients (101 with confirmed bleeding and 34 with confirmed no bleeding) were collected. For patients whose bleeding could not be determined using DSA alone (55/101) and whose no bleeding could not be diagnosed by DSA alone (35/55), the combination of time-of-arrival color parametric imaging was helpful for diagnosis, with a statistically significant difference (P < 0.01 and P = 0.01). Conclusions The time-of-arrival color coding imaging method is a valuable tool for detecting active bleeding. When combined with DSA, it improves the visual representation of active hemorrhage and improves the efficiency of diagnosis.
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Affiliation(s)
- Yi Chen
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Oncology and Vascular Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Provincial Clinical Research Center for Interventional Medicine (202204010501004), Taiyuan, China
| | - Wenji Xu
- College of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jiaxin Liu
- College of Electronic Information Engineering, Beihang University, Beijing, China
| | - Chao Zhao
- Department of Oncology and Vascular Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Provincial Clinical Research Center for Interventional Medicine (202204010501004), Taiyuan, China
| | - Xiaojing Cao
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rong Wang
- Department of Oncology and Vascular Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Provincial Clinical Research Center for Interventional Medicine (202204010501004), Taiyuan, China
| | - Duiping Feng
- Department of Oncology and Vascular Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Provincial Clinical Research Center for Interventional Medicine (202204010501004), Taiyuan, China
| | - Ruiping Zhang
- The Radiology Department of Shanxi Provincial People's Hospital, The Fifth Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiang Zhou
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Pongeluppi RI, Coelho G, Ballestero MFM, Aragon DC, Colli BO, Santos de Oliveira R. Development and Evaluation of a Mixed Reality Model for Training the Retrosigmoid Approach. World Neurosurg 2024:S1878-8750(24)01042-8. [PMID: 38906470 DOI: 10.1016/j.wneu.2024.06.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND The use of simulation has the potential to accelerate the learning curves and increase the efficiency of surgeons. However, there is currently a scarcity in models dedicated to skull base surgical approaches. Thus, the objective of this study was to develop a cost-effective mixed reality system consisting of an ultrarealistic physical model and augmented reality and evaluate its use in training surgeons on the retrosigmoid approach. METHODS The virtual models were developed from images of patients with vestibular schwannoma. The tumor was mirrored to allow bilateral approaches and the model has drawers for repositioning structures, allowing reuse of the material and cost reduction. Pre and posttest assessments were applied to 10 residents and young neurosurgeons, divided into control and test groups. Only the control group was exposed to the model. The difference in scores obtained by participants before and after exposure to the models was considered for analysis and participants in the control group answered self-satisfaction questionnaires. RESULTS The mean differences were 4.80 in the control group (95% credibility intervals=1.08-9.79) and 5.43 in the test group (95% credibility intervals=1.67-8.20). The average score of the self-satisfaction questionnaires was 24.0 (23-25). CONCLUSIONS The ultrarealistic model efficiently allowed retromastoid access to the cerebellopontine angle. A tendency toward greater gains in performance in the group exposed to the model was verified. Scores from the self-satisfaction questionnaires demonstrated that participants considered the model relevant for neurosurgical training and increased confidence among surgeons.
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Affiliation(s)
- Rodrigo Inacio Pongeluppi
- Division of Neurosurgery, University Hospital, Medical School of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil.
| | - Giselle Coelho
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, Brazil
| | | | - Davi Casale Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil
| | - Benedicto Oscar Colli
- Division of Neurosurgery, University Hospital, Medical School of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Santos de Oliveira
- Division of Neurosurgery, University Hospital, Medical School of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil
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Hidalgo ET, Schnurman Z, Harter DH. The Predictive Role of Early Postoperative Magnetic Resonance Imaging After Endoscopic Third Ventriculostomy. World Neurosurg 2024:S1878-8750(24)01002-7. [PMID: 38901477 DOI: 10.1016/j.wneu.2024.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/09/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Endoscopic third ventriculostomy (ETV) is a treatment option for obstructive hydrocephalus; reported success rates vary. We investigated immediate postoperative magnetic resonance imaging to evaluate the role of imaging parameters associated with outcomes. METHODS Retrospective chart review was performed on patients undergoing initial ETV between 2005 and 2019. Patients with preoperative and postoperative magnetic resonance imaging with follow-up>one year were included. The following were noted: changes in subarachnoid cerebrospinal fluid, third ventricle diameter, bowing of the third ventricle floor, and postoperative flow void. Kaplan-Meier survival methods were used to assess ETV success and univariable and multivariable Cox proportional-hazards models were fitted to assess factors contributing to ETV success. RESULTS Fifty-eight subjects were included. Nineteen (32.8%) experienced failure within one year; individually, no single imaging parameter predicted success. However, all cases of failure had no identifiable flow void. Any postoperative radiological change was not consistently associated with decreased odds of failure. Obstructive hydrocephalus treated with ETV demonstrated significantly better ETV success than patients treated with nonobstructive hydrocephalus. Interobserver reliability was moderate for 2 of the radiological variables and substantial for 1 of the radiological variables. CONCLUSIONS Individually, none of the qualitative radiologic parameters measured in our study predicted ETV success. Absence of a flow void predicted ETV failure, but additional studies are needed to determine its true negative predictive value. Inability to clarify which specific parameter predicts success reflects the limited role of immediate postoperative imaging in influencing clinical management.
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Affiliation(s)
- E Teresa Hidalgo
- NYU Grossman School of Medicine, NYU Langone Health Division of Pediatric Neurosurgery, New York, NY
| | - Zane Schnurman
- NYU Grossman School of Medicine, NYU Langone Health Division of Pediatric Neurosurgery, New York, NY
| | - David H Harter
- NYU Grossman School of Medicine, NYU Langone Health Division of Pediatric Neurosurgery, New York, NY.
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74
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Zhang T, Shan W, Le Dot M, Xiao P. Structural Functions of 3D-Printed Polymer Scaffolds in Regulating Cell Fates and Behaviors for Repairing Bone and Nerve Injuries. Macromol Rapid Commun 2024:e2400293. [PMID: 38885644 DOI: 10.1002/marc.202400293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/04/2024] [Indexed: 06/20/2024]
Abstract
Tissue repair and regeneration, such as bone and nerve restoration, face significant challenges due to strict regulations within the immune microenvironment, stem cell differentiation, and key cell behaviors. The development of 3D scaffolds is identified as a promising approach to address these issues via the efficiently structural regulations on cell fates and behaviors. In particular, 3D-printed polymer scaffolds with diverse micro-/nanostructures offer a great potential for mimicking the structures of tissue. Consequently, they are foreseen as promissing pathways for regulating cell fates, including cell phenotype, differentiation of stem cells, as well as the migration and the proliferation of key cells, thereby facilitating tissue repairs and regenerations. Herein, the roles of structural functions of 3D-printed polymer scaffolds in regulating the fates and behaviors of numerous cells related to tissue repair and regeneration, along with their specific influences are highlighted. Additionally, the challenges and outlooks associated with 3D-printed polymer scaffolds with various structures for modulating cell fates are also discussed.
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Affiliation(s)
- Tongling Zhang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
| | - Wenpeng Shan
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
| | - Marie Le Dot
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
| | - Pu Xiao
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
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Mohammadi M, Roohollahi F, Farahbakhsh F, Mohammadi A, Mortazavi Mamaghani E, Kankam SB, Moarrefdezfouli A, Ghamari Khameneh A, Mahmoudi MM, Baghdasaryan D, Martin AR, Harrop J, Rahimi-Movaghar V. Diffusion Tensor Imaging in Diagnosing and Evaluating Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis. Global Spine J 2024:21925682241263792. [PMID: 38877604 DOI: 10.1177/21925682241263792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Degenerative cervical myelopathy (DCM) is a common spinal cord disorder necessitating surgery. We aim to explore how effectively diffusion tensor imaging (DTI) can distinguish DCM from healthy individuals and assess the relationship between DTI metrics and symptom severity. METHODS We included studies with adult DCM patients who had not undergone decompressive surgery and implemented correlation analyses between DTI parameters and severity, or compared healthy controls and DCM patients. RESULTS 57 studies were included in our meta-analysis. At the maximal compression (MC) level, fractional anisotropy (FA) exhibited lower values in DCM patients, while apparent diffusion coefficient (ADC), mean diffusivity (MD), and radial diffusivity (RD) were notably higher in the DCM group. Moreover, our investigation into the diagnostic utility of DTI parameters disclosed high sensitivity, specificity, and area under the curve values for FA (.84, .80, .83 respectively) and ADC (.74, .84, .88 respectively). Additionally, we explored the correlation between DTI parameters and myelopathy severity, revealing a significant correlation of FA (.53, 95% CI:0.40 to .65) at MC level with JOA/mJOA scores. CONCLUSION Current guidelines for DCM suggest decompressive surgery for both mild and severe cases. However, they lack clear recommendations on which mild DCM patients might benefit from conservative treatment vs immediate surgery. ADC's role here could be pivotal, potentially differentiating between healthy individuals and DCM. While it may not correlate with symptom severity, it might predict surgical outcomes, making it a valuable imaging biomarker for clearer management decisions in mild DCM.
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Affiliation(s)
| | - Faramarz Roohollahi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Yas Spine Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Farahbakhsh
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Aynaz Mohammadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Samuel Berchi Kankam
- Image guided Neurosurgery Lab, Department of Neurosurgery, Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA
- Brain Trauma Lab, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Azin Moarrefdezfouli
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshar Ghamari Khameneh
- Department of Radiology, Advanced Diagnostic and Interventional Radiology (ADIR) Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Mahdi Mahmoudi
- Department of General Surgery, Shahid Mofateh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Allan R Martin
- Department of Neurosurgery, University of California Davis, Davis, CA, USA
| | - James Harrop
- Department of Neurological and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
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Baranidharan G, Bretherton B, Feltbower RG, Timothy J, Khan AL, Subramanian A, Ahmed M, Crowther TA, Radford H, Gupta H, Chandramohan M, Beall DP, Deer TR, Hedman T. 24-Month Outcomes of Indirect Decompression Using a Minimally Invasive Interspinous Fixation Device versus Standard Open Direct Decompression for Lumbar Spinal Stenosis: A Prospective Comparison. J Pain Res 2024; 17:2079-2097. [PMID: 38894862 PMCID: PMC11182879 DOI: 10.2147/jpr.s453343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 06/06/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose An early-stage, multi-centre, prospective, randomised control trial with five-year follow-up was approved by Health Research Authority to compare the efficacy of a minimally invasive, laterally implanted interspinous fixation device (IFD) to open direct surgical decompression in treating lumbar spinal stenosis (LSS). Two-year results are presented. Patients and Methods Forty-eight participants were randomly assigned to IFD or decompression. Primary study endpoints included changes from baseline at 8-weeks, 6, 12 and 24-months follow-ups for leg pain (visual analogue scale, VAS), back pain (VAS), disability (Oswestry Disability Index, ODI), LSS physical function (Zurich Claudication Questionnaire), distance walked in five minutes and number of repetitions of sitting-to-standing in one minute. Secondary study endpoints included patient and clinician global impression of change, adverse events, reoperations, operating parameters, and fusion rate. Results Both treatment groups demonstrated statistically significant improvements in mean leg pain, back pain, ODI disability, LSS physical function, walking distance and sitting-to-standing repetitions compared to baseline over 24 months. Mean reduction of ODI from baseline levels was between 35% and 56% for IFD (p<0.002), and 49% to 55% for decompression (p<0.001) for all follow-up time points. Mean reduction of IFD group leg pain was between 57% and 78% for all time points (p<0.001), with 72% to 94% of participants having at least 30% reduction of leg pain from 8-weeks through 24-months. Walking distance for the IFD group increased from 66% to 94% and sitting-to-standing repetitions increased from 44% to 64% for all follow-up time points. Blood loss was 88% less in the IFD group (p=0.024) and operating time parameters strongly favoured IFD compared to decompression (p<0.001). An 89% fusion rate was assessed in a subset of IFD participants. There were no intraoperative device issues or re-operations in the IFD group, and only one healed and non-symptomatic spinous process fracture observed within 24 months. Conclusion Despite a low number of participants in the IFD group, the study demonstrated successful two-year safety and clinical outcomes for the IFD with significant operation-related advantages compared to surgical decompression.
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Affiliation(s)
- Ganesan Baranidharan
- Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Beatrice Bretherton
- Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Richard G Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Jake Timothy
- Department of Neuroscience, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Almas Latif Khan
- Department of Spine Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Ashok Subramanian
- Somerset Spinal Surgery Service, Musgrove Park Hospital, Taunton, UK
| | - Mushtaq Ahmed
- Department of Trauma and Orthopaedic Surgery, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Tracey A Crowther
- Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Research & Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helen Radford
- Research & Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Harun Gupta
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Thomas Hedman
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
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Butler M, Shah P, Ozgen B, Michals EA, Geraghty JR, Testai FD, Maharathi B, Loeb JA. Automated segmentation of ventricular volumes and subarachnoid hemorrhage from computed tomography images: Evaluation of a rule-based pipeline approach. Neuroradiol J 2024:19714009241260791. [PMID: 38869365 DOI: 10.1177/19714009241260791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
Changes in ventricular size, related to brain edema and hydrocephalus, as well as the extent of hemorrhage are associated with adverse outcomes in patients with subarachnoid hemorrhage (SAH). Frequently, these are measured manually using consecutive non-contrast computed tomography scans. Here, we developed a rule-based approach which incorporates both intensity and spatial normalization and utilizes user-defined thresholds and anatomical templates to segment both lateral ventricle (LV) and SAH blood volumes automatically from CT images. The algorithmic segmentations were evaluated against two expert neuroradiologists on representative slices from 20 admission scans from aneurysmal SAH patients. Previous methods have been developed to automate this time-consuming task, but they lack user feedback and are hard to implement due to large-scale data and complex design processes. Our results using automatic ventricular segmentation aligned well with expert reviewers with a median Dice coefficient of 0.81, AUC of 0.91, sensitivity of 81%, and precision of 84%. Automatic segmentation of SAH blood was most reliable near the base of the brain with a median Dice coefficient of 0.51, an AUC of 0.75, precision of 68%, and sensitivity of 50%. Ultimately, we developed a rule-based method that is easily adaptable through user feedback, generates spatially normalized segmentations that are comparable regardless of brain morphology or acquisition conditions, and automatically segments LV with good overall reliability and basal SAH blood with good precision. Our approach could benefit longitudinal studies in patients with SAH by streamlining assessment of edema and hydrocephalus progression, as well as blood resorption.
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Affiliation(s)
- Mitchell Butler
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Parin Shah
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
| | - Burce Ozgen
- Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Edward A Michals
- Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Joseph R Geraghty
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
| | - Biswajit Maharathi
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
| | - Jeffrey A Loeb
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA
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Saleh I, Hutami WD, Librianto D, Prasetyo M, Rahyussalim AJ, Hendriarto A, Noor EA, Rifki A. The Development of New Scoring System to Define the Presence of Instability and the Need of Fusion in Degenerative Lumbar Spinal Stenosis - Jakarta Instability Score. Global Spine J 2024:21925682241262713. [PMID: 38867437 DOI: 10.1177/21925682241262713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
STUDY DESIGN Systematic review, expert opinion and Delphi technique, and validity and reliability studies. OBJECTIVE We developed Jakarta Instability Score (JIS) to identify spinal instability and the need of fusion in degenerative lumbar spinal stenosis (LSS). METHODS This study consisted of systematic review to find predictors of spinal instability, expert opinion and modified Delphi technique to develop JIS, and validity and reliability studies of the newly developed JIS. RESULTS A total of 54 studies were included in the systematic reviews to obtain predictors of spinal instability. Through expert opinion and modified Delphi technique, JIS was developed and consisted of the clinical component (back pain), dynamic radiograph component (dynamic translation and angulation), and MRI component (facet joint effusion), each of the component would be scored, and the total scoring would be from 0 to 14. The final scoring would classify patients into three groups: stable group (score of 0 to 4) in which the fusion is not needed, potentially unstable group (score of 5 to 8) in which the decision of fusion is based on surgeon's clinical judgment, and unstable group (score of 9 to 14) in which the fusion is needed. Final step of study concluded that this JIS had a high validity and reliability. CONCLUSION The newly developed JIS was a valid and reliable scoring system that could help to identify the presence of instability in LSS and can be used as a guideline to decide whether spinal fusion will be needed.
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Affiliation(s)
- Ifran Saleh
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia
| | - Witantra Dhamar Hutami
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia
| | - Didik Librianto
- Department of Orthopaedic and Traumatology, Universitas Indonesia, Fatmawati Central General Hospital, Jakarta, Indonesia
| | - Marcel Prasetyo
- Department of Radiology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia
| | - Ahmad Jabir Rahyussalim
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia
| | - Andra Hendriarto
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia
| | - Erwin Ardian Noor
- Department of Orthopaedic and Traumatology, Universitas Indonesia, Fatmawati Central General Hospital, Jakarta, Indonesia
| | - Aliyya Rifki
- Department of Radiology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia
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Shinn RL, Hollingsworth C, Parker RL, Rossmeisl JH, Werre SR. Comparison of stereotactic brain biopsy techniques in dogs: neuronavigation, 3D-printed guides, and neuronavigation with 3D-printed guides. Front Vet Sci 2024; 11:1406928. [PMID: 38915886 PMCID: PMC11194692 DOI: 10.3389/fvets.2024.1406928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/29/2024] [Indexed: 06/26/2024] Open
Abstract
The objective of this research was to compare two previously described stereotactic brain biopsy (SBB) techniques, three-dimensional skull contoured guides (3D-SCGs) and neuronavigation with Brainsight, to a novel SBB technique using Brainsight combined with a 3D-printed headframe (BS3D-HF) to improve the workflow of SBB in dogs. This was a prospective methods comparison with five canine cadavers of different breeds and size. Initial helical CT was performed on cadavers with fiducial markers in place. Ten different target points were randomly selected for each method. The headframe for the BS3D-HF was designed and printed. Trajectories were planned for each method. Steinmann pins (SPs) were placed into the target points using the planned trajectories for each method, and CT was repeated (post CT). Accuracy was assessed by overlaying the initial CT onto the post CT and measuring the difference of the planned target point to the SP placement. For 3D-SCG, the median deviation was 2.48 mm (0.64-4.04). With neuronavigation, the median deviation was 3.28 mm (1.04-4.64). For BS3D-HF, the median deviation was 14.8 mm (8.87-22.1). There was no significant difference between 3D-SCG and neuronavigation for the median deviation (p = 0.42). When comparing BS3D-HF to 3D-SCG, there was a significant difference in the median deviation (p < 0.0001). Additionally, when comparing BS3D-HF to neuronavigation, there was a significant difference for the median deviation (p < 0.0001). Our findings concluded that both 3D-SCGs and neuronavigation were accurate for SBB, however BS3D-HF was not. Although feasible, the current BS3D-HF technique requires further refinement before it can be recommended for use for SBB in dogs.
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Affiliation(s)
- Richard L. Shinn
- Clinical Applications Laboratory, Department of Small Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - Christopher Hollingsworth
- Clinical Applications Laboratory, Department of Small Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - Rell L. Parker
- Clinical Applications Laboratory, Department of Small Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - John H. Rossmeisl
- Clinical Applications Laboratory, Department of Small Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
- Department of Cancer Biology, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Stephen R. Werre
- Department of Population Health Sciences, Virginia Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
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Pascual JSG, de Lotbiniere-Bassett M, Khu KJO, Starreveld YP, Lama S, Legaspi GD, Berger MS, Duffau H, Sutherland GR. Challenges and Opportunities in Awake Craniotomy for Brain Tumor Surgery in Low- and Lower-Middle-Income Countries: A Narrative Review and Perspective. World Neurosurg 2024; 189:118-126. [PMID: 38857864 DOI: 10.1016/j.wneu.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Low-income countries (LICs) and lower-middle-income countries (LMICs) are presented with unique challenges and opportunities when performing awake craniotomy (AC) for brain tumors. These circumstances arise from factors that are financial, infrastructural, educational, personnel, and sociocultural in nature. METHODS We performed a systematic narrative review of series on AC for intra-axial brain tumors in LICs/LMICs using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, focusing on the challenges and opportunities in these settings. The PubMed, Scopus, and Web of Science databases were searched. RESULTS After initially identifying 74 studies, inclusion-exclusion criteria were applied, leaving a total of 14 studies included in the review. These involved 409 patients who underwent AC in LICs/LMICs. These series were from India, Ghana, Nigeria, Iran, Pakistan, Morocco, the Philippines, and Egypt. The most common pathology encountered were gliomas (10-70%). Most studies (11/14, 78.5%) reported on their technique of cortical-subcortical mapping. All reported on motor mapping and 8 of these performed language mapping. The most common outcomes reported were seizure and neurologic deficits, and longest follow-up was at 1 year. Challenges noted were lack of equipment and trained personnel, need for validated tests for the local setting, and sociocultural factors. Opportunities identified were volume for training, technique innovation, and international collaboration. CONCLUSIONS There are numerous challenges and opportunities that arise when performing AC in LICs/LMICs. A collaborative approach toward harnessing the opportunities, and seeking creative solutions to address the challenges, would provide an ideal mechanism toward advancing neurosurgical care and specialty worldwide.
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Affiliation(s)
- Juan Silvestre G Pascual
- Department of Clinical Neurosciences; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Madeleine de Lotbiniere-Bassett
- Department of Clinical Neurosciences; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen Joy O Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Yves P Starreveld
- Department of Clinical Neurosciences; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sanju Lama
- Department of Clinical Neurosciences; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gerardo D Legaspi
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France; Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors, Institute of Functional Genomics, INSERM U1191, University of Montpellier, Montpellier, France
| | - Garnette R Sutherland
- Department of Clinical Neurosciences; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
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Omland LH, Nielsen H, Bodilsen J. Update and approach to patients with brain abscess. Curr Opin Infect Dis 2024; 37:211-219. [PMID: 38547383 DOI: 10.1097/qco.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW The epidemiology of brain abscess has changed in recent decades. Moreover, acute and long-term management remains challenging with high risks of mortality and neurological sequelae. This review describes recent advances in epidemiology, diagnosis, and treatment of brain abscess. RECENT FINDINGS The incidence of brain abscess is increasing, especially among elderly individuals. Important predisposing conditions include dental and ear-nose-throat infections, immuno-compromise, and previous neurosurgery. Molecular-based diagnostics have improved our understanding of the involved microorganisms and oral cavity bacteria including anaerobes are the predominant pathogens. The diagnosis relies upon a combination of magnetic resonance imaging, neurosurgical aspiration or excision, and careful microbiological examinations. Local source control by aspiration or excision of brain abscess combined with long-term antimicrobials are cornerstones of treatment. Long-term management remains important and should address neurological deficits including epilepsy, timely diagnosis and management of comorbidities, and potential affective disorders. SUMMARY A multidisciplinary approach to acute and long-term management of brain abscess remains crucial and source control of brain abscess by neurosurgery should be pursued whenever possible. Numerous aspects regarding diagnosis and treatment need clarification. Nonetheless, our understanding of this complicated infection is rapidly evolving.
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Affiliation(s)
- Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | - Henrik Nielsen
- Department of Infectious Diseases
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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82
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Cooper RJ, Akie TE, Gujral T, Rana S, Bui K, Factora R, Quinones A, Gupta M, Hendey GW, Rodriguez RM, Mower WR. Traumatic injury to the posterior fossa: a secondary analysis and description of case series from the NEXUS head injury dataset. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100760. [PMID: 38764982 PMCID: PMC11101874 DOI: 10.1016/j.lana.2024.100760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/21/2024]
Abstract
Background Traumatic brain injuries involving the posterior fossa are rare and case reports indicate they often result in severe outcomes. We seek to describe characteristics and outcomes of traumatic posterior fossa injuries. Methods We performed a planned secondary analysis of all patients with posterior fossa injuries enrolled in the NEXUS head computed tomography (CT) validation study dataset. The dataset includes prospectively collected data on all patients undergoing non-contrast cranial CT following blunt traumatic head injury from April 2006 to December 2015, at four emergency departments comprising community and university sites, as well as urban, suburban and rural settings in California (Antelope Valley Hospital, San Francisco General Hospital, UCLA Ronald Reagan Medical Center, UCSF Fresno Community Regional Medical Center). We classified each patient into one of three injury patterns: Type I-notable traumatic injuries primarily above the tentorium, with minimal posterior fossa involvement; Type II-notable traumatic injuries both above and within the posterior fossa; and Type III-notable traumatic injuries primarily within the posterior fossa. We extracted demographic data for each patient as well as physician assessments of the NEXUS head CT and Canadian Head CT rule clinical criteria, mechanisms of injury, patient outcomes, and the location and types of intracranial injuries sustained. Findings Of 11,770 patients in the database, 184 (1.6%) had posterior fossa injuries on CT imaging. Mean age was 55.4 years (standard deviation 22.5 years, range 2-96 years); 131 (71.2%) were males. We identified 63 patients with Type I injuries, 87 with Type II injuries, and 34 Type III injuries. The most common mechanisms of injury were falls (41%), pedestrian vs automobile (15%), and motor vehicle collisions (13%). On presentation most patients had altered mental status (72%), abnormal behavior (53%), or a neurologic deficit (55%). The majority of individuals, 151 (82%), had clinically important injuries and 111 (60%) required neurosurgical intervention. The dispositions for the subjects included 52 deaths (28%), 49 (27%) patients discharged home, and 48 (26%) discharged to rehabilitation facilities. When compared to individuals with Type I and Type II injuries, patients with Type III injuries had lower mortality (6% vs 30% and 35%) and higher percentage of patients discharged home (60% vs 19% and 21%). Interpretation Patients with Type I and II injury patterns (those that involve both the posterior fossa and supratentorium) experienced high mortality and disability. Patients with Type III injuries (isolated posterior fossa) had a better prognosis. Funding None.
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Affiliation(s)
- Richelle J. Cooper
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thomas E. Akie
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Tarika Gujral
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shivam Rana
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kyle Bui
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ryan Factora
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alexandra Quinones
- Department of Emergency Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Malkeet Gupta
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- Antelope Valley Hospital, Lancaster, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gregory W. Hendey
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- UCSF-Fresno, Medical Education Program, Fresno, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert M. Rodriguez
- Department of Emergency Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - William R. Mower
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Ruella ME, Caffaratti G, Chaves H, Yañez P, Cervio A. Transoperative Magnetic Resonance Imaging in Awake Glioma Surgery: Experience in a Latin American Tertiary-Level Center. World Neurosurg 2024; 186:e65-e74. [PMID: 38417621 DOI: 10.1016/j.wneu.2024.02.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/19/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Analyze the usefulness, efficacy, and safety of transoperative magnetic resonance imaging (tMRI) in glioma surgery in awake patients. METHODS Retrospective, single-center, analytical study of a cohort of patients who underwent awake surgery for gliomas by the same surgeon in a third-level Argentine center, in the period between 2012 and 2022. Only patients with pathology-confirmed gliomas, with 6-month follow-up, who had preoperative and postoperative volumetric magnetic resonance imaging, were included in this sample. Subsequently, we analyzed which patients received surgery with the tMRI protocol and the results using multivariate regression analysis. RESULTS A total of 71 patients were included. A tMRI study was performed on 22 (31%) of these patients. The use of tMRI increased the percentage of resection by 20% (P = 0.03), thereby increasing the possibility of gross total resection. However, using tMRI significantly extended surgical time by 84 minutes (P < 0.001). In 55% of the patients in whom tMRI was performed, the resection was continued after it. The use of tMRI did not increase the rate of infections or the development of surgically associated neurological deficits in the long term, despite the fact that 47% of the patients showed the development of a new deficit or worsening of a previous one during the intraoperative period. CONCLUSIONS The use of tMRI in awake glioma surgery proved to be a safe tool that contributes to increasing the degree of tumor resection, compared to the use of neurophysiological mapping and neuronavigation, at the expense of increased surgical times and costs. We consider tMRI in awake glioma surgery should be used in properly selected cases.
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Affiliation(s)
- Mauro E Ruella
- Department of Neurosurgery, Fleni, Buenos Aires, Argentina.
| | | | - Hernan Chaves
- Department of Neuro-Radiology, Fleni, Buenos Aires, Argentina
| | - Paulina Yañez
- Department of Neuro-Radiology, Fleni, Buenos Aires, Argentina
| | - Andrés Cervio
- Department of Neurosurgery, Fleni, Buenos Aires, Argentina
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84
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Della Valle A, Compagnoni R, Puglia F, Priano D, Menon A, Teani L, La Maida GA, De Feo T, Sacchi M, Ambrogi F, Cicatelli A, Randelli PS. Allografts use in orthopedic surgery: trend change over the past 11 years from a regional tissue bank. Cell Tissue Bank 2024; 25:713-720. [PMID: 38386210 DOI: 10.1007/s10561-024-10134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024]
Abstract
Allografts are the second most transplanted tissue in medicine after blood and are now increasingly used for both primary and revision surgery. Allografts have the advantages of lower donor site morbidity, availability of multiple grafts, and shorter operative time. The Banks represents the bridge between Donor and Recipient and guarantees the quality and safety of the distributed allografts Given the increasing interest in these tissues, a retrospective analysis of data collected from the Regional Musculoskeletal Tissue Bank registry over an 11-year period (2009-2019) was conducted. The statistical analyses used were the Shapiro-Wilk normality test and a Poisson regression model. From January 2009 to December 2019, a total of 14,199 musculoskeletal tissues stored in the Regional Musculoskeletal Tissue Bank were provided for surgical allograft procedures. In 2009, the number of allografts performed was 925; this figure has steadily increased to 1599 in 2019. Epiphyses were taken as the reference tissue with an almost constant trend over the period, while a significant increase was denoted for extensor mechanism allograft, ligaments, tendons and long bone corticals (p < 0.001), processed bone tissues had no change in trend (p = 0.841). There was also a gradual decrease in the rate of microbiological positivity, as determined by bacteriological and serological tests performed on the collected tissues. This phenomenon is due to improved sampling techniques and the training of a dedicated team. Thus, we have seen how the use of allografts in orthopedic surgery has increased over the past 11 years, uniformly in terms of tissue type, except for the noticeable increase in ligamentous tissue.
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Affiliation(s)
- Andrea Della Valle
- Banca del Tessuto Muscolo-Scheletrico Regione Lombardia, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- U.O.C. Patologie Vertebrali e Scoliosi, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Riccardo Compagnoni
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi di Milano, Via Della Commenda 10, 20122, Milan, Italy
| | - Francesco Puglia
- U.O.C. Ortopedia e Traumatologia Pediatrica, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.
| | - Daniele Priano
- U.O.C. Ortopedia e Traumatologia Pediatrica, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Alessandra Menon
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- Scuola Di Specializzazione in Statistica Sanitaria E Biometria, Dipartimento Di Scienze Cliniche E Di Comunità, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Lorenzo Teani
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Giovanni Andrea La Maida
- U.O.C. Patologie Vertebrali e Scoliosi, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Tullia De Feo
- S.C. Trapianti Lombardia- NITp, IRCCS Fondazione Ca'Granda Ospedale Maggiore Policlinico di Milano, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Marco Sacchi
- AREU, Coordinamento Regionale Trapianti, DG Welfare - Regione Lombardia, Piazza Città Di Lombardia 1, 20124, Milan, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology ''G.A. Maccaro,'' Università Degli Studi di Milano, Milan, Italy
| | - Alfonso Cicatelli
- U.O.C. Patologie Vertebrali e Scoliosi, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Pietro Simone Randelli
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
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85
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Tardivo V, Scudieri C, Bruzzo M, Lupidi F. Acute neurologic decline in a patient with spinal stenosis: blame it on the epidural fat. Br J Neurosurg 2024; 38:765-770. [PMID: 34319197 DOI: 10.1080/02688697.2021.1958149] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/15/2021] [Accepted: 06/30/2021] [Indexed: 10/25/2022]
Abstract
Spinal epidural lipomatosis [SEL] is defined as an excessive accumulation of extradural normal adipose tissue. This condition may be idiopathic or acquired. Surgical decompression is considered the gold standard treatment in patients presenting with progressive neurologic deficit. We report a case of a 69-year-old male patient presented with neurogenic claudication and lower left limb radiculopathy. The magnetic resonance imaging (MRI) revealed a L5-S1 epidural compression sustained by a large epidural plaque whose signal was consistent with adipose tissue. A conservative approach, including weight loss attempt, revealed unsuccessful and the patient presented some months after the diagnosis at the emergency department with acute onset bilateral drop foot, more severe on the right side and urinary disturbances. Microsurgical decompression via L5 laminectomy and partial L4 laminectomy and fatty plaque debulking was performed. The post operative course was uneventful and at the two months post operative follow up the patient reported a significative improvement of the pre operative neurological signs and symptoms and of pain control. SEL deserves attention as an identifiable cause of radiculopathies, typically attributed to spinal stenosis, with a higher incidence than previously reported. Moreover cases of acute onset of cauda equina like syndrome were reported in patent affected by SEL, probably related to a local venous engorgement with stasis and edema. Therefore it should be considered as a possible diagnosis not only in patients complaining of stenosis-type symptoms but also in cases of acute neurological decline with cauda equina like syndrome, especially when provided with a "benign" imaging reading.
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Affiliation(s)
- Valentina Tardivo
- Neurosurgery Unit San Carlo Borromeo Hospital, Milan, Italy
- Neurosurgery Unit, EO Ospedali Galliera, Genova, Italy
| | - Claudia Scudieri
- Neurosurgery Unit, EO Ospedali Galliera, Genova, Italy
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Mattia Bruzzo
- Neurosurgery Unit San Carlo Borromeo Hospital, Milan, Italy
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86
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Nasir-Moin M, Wadiura LI, Sacalean V, Juros D, Movahed-Ezazi M, Lock EK, Smith A, Lee M, Weiss H, Müther M, Alber D, Ratna S, Fang C, Suero-Molina E, Hellwig S, Stummer W, Rössler K, Hainfellner JA, Widhalm G, Kiesel B, Reichert D, Mischkulnig M, Jain R, Straehle J, Neidert N, Schnell O, Beck J, Trautman J, Pastore S, Pacione D, Placantonakis D, Oermann EK, Golfinos JG, Hollon TC, Snuderl M, Freudiger CW, Heiland DH, Orringer DA. Localization of protoporphyrin IX during glioma-resection surgery via paired stimulated Raman histology and fluorescence microscopy. Nat Biomed Eng 2024; 8:672-688. [PMID: 38987630 DOI: 10.1038/s41551-024-01217-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/20/2024] [Indexed: 07/12/2024]
Abstract
The most widely used fluorophore in glioma-resection surgery, 5-aminolevulinic acid (5-ALA), is thought to cause the selective accumulation of fluorescent protoporphyrin IX (PpIX) in tumour cells. Here we show that the clinical detection of PpIX can be improved via a microscope that performs paired stimulated Raman histology and two-photon excitation fluorescence microscopy (TPEF). We validated the technique in fresh tumour specimens from 115 patients with high-grade gliomas across four medical institutions. We found a weak negative correlation between tissue cellularity and the fluorescence intensity of PpIX across all imaged specimens. Semi-supervised clustering of the TPEF images revealed five distinct patterns of PpIX fluorescence, and spatial transcriptomic analyses of the imaged tissue showed that myeloid cells predominate in areas where PpIX accumulates in the intracellular space. Further analysis of external spatially resolved metabolomics, transcriptomics and RNA-sequencing datasets from glioblastoma specimens confirmed that myeloid cells preferentially accumulate and metabolize PpIX. Our findings question 5-ALA-induced fluorescence in glioma cells and show how 5-ALA and TPEF imaging can provide a window into the immune microenvironment of gliomas.
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Affiliation(s)
- Mustafa Nasir-Moin
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Vlad Sacalean
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany
| | - Devin Juros
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Emily K Lock
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Andrew Smith
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Matthew Lee
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Hannah Weiss
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Michael Müther
- Department of Neurosurgery, Münster University Hospital, Münster, Germany
| | - Daniel Alber
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Camila Fang
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Eric Suero-Molina
- Department of Neurosurgery, Münster University Hospital, Münster, Germany
| | - Sönke Hellwig
- Department of Neurosurgery, Münster University Hospital, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, Münster University Hospital, Münster, Germany
| | - Karl Rössler
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry (Obersteiner Institute), Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - David Reichert
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Mario Mischkulnig
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Rajan Jain
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Jakob Straehle
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein Clinician Scientist Program, Faculty of Medicine, University Freiburg, Freiburg, Germany
| | - Nicolas Neidert
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein Clinician Scientist Program, Faculty of Medicine, University Freiburg, Freiburg, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for NeuroModulation (NeuroModul), University of Freiburg, Freiburg, Germany
| | | | | | - Donato Pacione
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Eric Karl Oermann
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Center for Data Science, New York University, New York, USA
| | - John G Golfinos
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Todd C Hollon
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matija Snuderl
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Dieter Henrik Heiland
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany.
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany.
- Comprehensive Cancer Center Freiburg (CCCF), Medical Center - University of Freiburg, Freiburg, Germany.
- German Cancer Consortium (DKTK), partner site Freiburg, Freiburg, Germany.
| | - Daniel A Orringer
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA.
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA.
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87
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Chen Y, Cappucci SP, Kim JA. Prognostic Implications of Early Prediction in Posttraumatic Epilepsy. Semin Neurol 2024; 44:333-341. [PMID: 38621706 DOI: 10.1055/s-0044-1785502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Posttraumatic epilepsy (PTE) is a complication of traumatic brain injury that can increase morbidity, but predicting which patients may develop PTE remains a challenge. Much work has been done to identify a variety of risk factors and biomarkers, or a combination thereof, for patients at highest risk of PTE. However, several issues have hampered progress toward fully adapted PTE models. Such issues include the need for models that are well-validated, cost-effective, and account for competing outcomes like death. Additionally, while an accurate PTE prediction model can provide quantitative prognostic information, how such information is communicated to inform shared decision-making and treatment strategies requires consideration of an individual patient's clinical trajectory and unique values, especially given the current absence of direct anti-epileptogenic treatments. Future work exploring approaches integrating individualized communication of prediction model results are needed.
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Affiliation(s)
- Yilun Chen
- Department of Neurology, Yale University, New Haven, Connecticut
| | | | - Jennifer A Kim
- Department of Neurology, Yale University, New Haven, Connecticut
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88
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Yasamineh S, Mehrabani FJ, Derafsh E, Danihiel Cosimi R, Forood AMK, Soltani S, Hadi M, Gholizadeh O. Potential Use of the Cholesterol Transfer Inhibitor U18666A as a Potent Research Tool for the Study of Cholesterol Mechanisms in Neurodegenerative Disorders. Mol Neurobiol 2024; 61:3503-3527. [PMID: 37995080 DOI: 10.1007/s12035-023-03798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/03/2023] [Indexed: 11/24/2023]
Abstract
Cholesterol is an essential component of mammalian cell membranes and a precursor for crucial signaling molecules. The brain contains the highest level of cholesterol in the body, and abnormal cholesterol metabolism links to many neurodegenerative disorders. The results indicate that faulty cholesterol metabolism is a common feature among people living with neurodegenerative conditions. The researchers suggest that restoring cholesterol levels may become a beneficial new strategy in treating certain neurodegenerative conditions. Several neurodegenerative disorders, such as Alzheimer's disease (AD), Niemann-Pick type C (NPC) disease, and Parkinson's disease (PD), have been connected to abnormalities in brain cholesterol metabolism. Consequently, using a lipid research tool is vital to study further and understand the effect of lipids in neurodegenerative disorders such as NPC, AD, PD, and Huntington's disease (HD). U18666A, also known as 3-(2-(diethylamino) ethoxy) androst-5-en-17-one, is a pharmaceutical drug that suppresses cholesterol trafficking and is a well-known class-2 amphiphile. U18666A has performed many functions, allowing for essential discoveries in lipid studies and shedding light on the pathophysiology of neurodegenerative disorders. Additionally, U18666A prevented the downregulation of low-density lipoprotein (LDL) receptors that are induced by LDL and led to the buildup of cholesterol in lysosomes. Numerous studies show that U18666A impacts the function of cholesterol trafficking to control the metabolism and transport of amyloid precursor proteins (APPs). Treating cortical neurons with U18666A may provide a new in vitro model system for studying the underlying molecular process of NPC, AD, HD, and PD. In this article, we review the mechanism and function of U18666A as a vital tool for studying cholesterol mechanisms in neurological diseases related to abnormal cholesterol metabolism, such as AD, NPC, HD, and PD.
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Affiliation(s)
| | | | - Ehsan Derafsh
- Windsor University School of Medicine, Cayon, Saint Kitts and Nevis
| | | | | | - Siamak Soltani
- Department of Forensic Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Meead Hadi
- Department Of Microbiology, Faculty of Basic Sciences, Tehran Central Branch, Islamic Azad University, Tehran, Iran
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89
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Biswas C, Shetty PM, Sahu A, Velayutham P, Singh V, Shah K, Moiyadi AV. Factors affecting the extent of resection and neurological outcomes following transopercular resection of insular gliomas. Acta Neurochir (Wien) 2024; 166:244. [PMID: 38822919 PMCID: PMC11144144 DOI: 10.1007/s00701-024-06124-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Surgical resection of insular gliomas is a challenge. TO resection is considered more versatile and has lower risk of vascular damage. In this study, we aimed to understand the factors that affect resection rates, ischemic changes and neurological outcomes and studied the utility of IONM in patients who underwent TO resection for IGs. METHODS Retrospective analysis of 66 patients with IG who underwent TO resection was performed. RESULTS Radical resection was possible in 39% patients. Involvement of zone II and the absence of contrast enhancement predicted lower resection rate. Persistent deficit rate was 10.9%. Although dominant lobe tumors increased immediate deficit and fronto-orbital operculum involvement reduced prolonged deficit rate, no tumor related factor showed significant association with persistent deficits. 45% of patients developed a postoperative infarct, 53% of whom developed deficits. Most affected vascular territory was lenticulostriate (39%). MEP changes were observed in 9/57 patients. 67% of stable TcMEPs and 74.5% of stable strip MEPs did not develop any postoperative motor deficits. Long-term deficits were seen in 3 and 6% patients with stable TcMEP and strip MEPs respectively. In contrast, 25% and 50% of patients with reversible strip MEP and Tc MEP changes respectively had persistent motor deficits. DWI changes were clinically more relevant when accompanied by MEP changes intraoperatively, with persistent deficit rates three times greater when MEP changes occurred than when MEPs were stable. CONCLUSION Radical resection can be achieved in large, multizone IGs, with reasonable outcomes using TO approach and multimodal intraoperative strategy with IONM.
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Affiliation(s)
- Chandrima Biswas
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prakash M Shetty
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Arpita Sahu
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Parthiban Velayutham
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vikas Singh
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kanchi Shah
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Aliasgar V Moiyadi
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
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90
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Ariyaprakai C, Kusdiansah M, Degollado-García J, Ota N, Noda K, Kamiyama H, Tanikawa R. Training in Sylvian Arachnoid Dissection: The Art of Using Kamiyama Scissors and a Simple Novel Model for Practice Sylvian Arachnoid Dissection Using Cotton Fiber with Brain Model. Asian J Neurosurg 2024; 19:228-234. [PMID: 38974453 PMCID: PMC11226268 DOI: 10.1055/s-0044-1787091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background Transsylvian approach is one of the main approaches for a variety of vascular, tumor, and skull-base lesions. Sylvian fissure harbors a lot of critical structures including the middle cerebral artery and many venous structures. If not done properly, the transsylvian approach could cause several complications. Up to now, there is no simple training model for practicing Sylvian fissure dissection. In this article, we describe the technique of using microscissors for the sharp dissection of arachnoid trabeculae. We also propose a new model for practicing Sylvian arachnoid dissection using a three-dimensional (3D) brain model with cotton fiber. Materials and Method We inserted cotton fiber into the Sylvian fissure of the brain model (aneurysm box from UpsurgeOn) and covered the Sylvian fissure with a cotton sheet, then sprayed the water over it. We dissected this model under a microscope by using Kamiyama scissors in the right hand and suction in the left hand. Result Under the microscope, our model appears comparable with the real Sylvian fissure. We can use this model for practicing arachnoid dissection with Kamiyama scissors. Conclusion The arachnoid dissection model by using a 3D brain model with cotton fiber is a simplified and novel approach for practicing the Sylvian fissure dissection.
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Affiliation(s)
- Chanon Ariyaprakai
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Muhammad Kusdiansah
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
- Department of Neurosurgery National Brain Center, East Jakarta City, Indonesia
| | - Javier Degollado-García
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
- Division of Neurovascular Surgery, Department of Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez Hospital, Mexico City, Mexico
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
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91
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Hjazi A, Alghamdi A, Aloraini GS, Alshehri MA, Alsuwat MA, Albelasi A, Mashat RM, Alissa M. Combination use of human menstrual blood stem cell- derived exosomes and hyperbaric oxygen therapy, synergistically promote recovery after spinal cord injury in rats. Tissue Cell 2024; 88:102378. [PMID: 38663114 DOI: 10.1016/j.tice.2024.102378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 06/17/2024]
Abstract
Traumatic spinal cord injury (TSCI) is one of the catastrophic events in the nervous system that leads to the loss of sensory and motor function of the spinal cord at the site of injury. Considering that several factors such as apoptosis, inflammation, and oxidative stress play a role in the spread of damage caused by trauma, therefore, the treatment should also be based on multifactorial approaches. Currently, we investigated the effects of human menstrual blood stem cells (MenSCs)-derived exosomes in combination with hyperbaric oxygen therapy (HBOT) in the recovery of TSCI in rats. Ninety male mature Sprague-Dawley (SD) rats were planned into five equal groups, including; control group, TSCI group, Exo group (underwent TSCI and received MenSCs -derived exosomes), HBOT group (underwent TSCI and received HBOT), and Exo+HBOT group (underwent TSCI and received MenSCs -derived exosomes plus HBOT). After the behavioral evaluation, tissue samples were obtained for stereological, immunohistochemical, biochemical, and molecular assessments. Our results showed that the numerical density of neurons, the concentrations of antioxidative biomarkers (CAT, GSH, and SOD), and neurological function scores were significantly greater in the treatments group than in the TSCI group, and these changes were more obvious in the Exo+HBOT ones (P<0.05). This is while the numerical densities of apoptotic cells and glial cells, the levels of an oxidative factor (MDA) and proinflammatory cytokines (IL-1β and TNF-α) were considerably decreased in the treatment groups, specially the Exo+HBOT group, compared to the TSCI group (P<0.05). We conclude that the co-administration of exosomes derived from MenSCs and HBOT has more neuroprotective effects in animals with TSCI.
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Affiliation(s)
- Ahmed Hjazi
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Ghfren S Aloraini
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mohammed A Alshehri
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Meshari A Alsuwat
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif 21974, Saudi Arabia
| | - Abdullah Albelasi
- Department of Medical Laboratories, College of Applied Medical Sciences, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Reham M Mashat
- Nutrition and Food Sciences, College of Home Economics, King Khalid University, Abha 62529, Saudi Arabia
| | - Mohammed Alissa
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
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92
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Fiehler J, Bechstein M. Does Every Subdural Hematoma Patient Need an Embolization? Clin Neuroradiol 2024; 34:289-291. [PMID: 38753157 PMCID: PMC11130060 DOI: 10.1007/s00062-024-01425-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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93
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Yu J. Current state and confusion of twig-like middle cerebral artery. Interv Neuroradiol 2024; 30:361-371. [PMID: 35979607 PMCID: PMC11310732 DOI: 10.1177/15910199221121380] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
A twig-like middle cerebral artery (MCA) is an uncommon lesion in which a plexiform network of small vessels replaces the M1 segment of the MCA. Currently, we have insufficient information for twig-like MCAs. Therefore, a review of the literature using PubMed was conducted. In this review of twig-like MCAs, the following were discussed: the definition, pathogenesis, hemodynamics, associated aneurysm, clinical manifestations, imaging examinations, therapeutic strategies, therapeutic complications and prognosis. In addition, we proposed a reasonable grading system for twig-like MCAs, which is significant. For a twig-like MCA, the pathogenesis is unclear, and congenital and acquired factors can be involved. A twig-like MCA disturbed cerebral hemodynamics. An associated aneurysm can occur in patients with twig-like MCAs. Twig-like MCAs can present subclinically and without clinical symptoms, hemorrhage, or ischemic strokes. Of all the available imaging examinations, digital subtracted angiography is the gold standard. When treating a twig-like MCA, it is feasible to target the associated aneurysm, and extracranial-intracranial bypass can be effective in reducing the risk of strokes, but more evidence is needed. Now, the decision to perform surgery for twig-like MCAs should be made on a case-by-case basis.
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Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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94
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Thommen R, Bowers CA, Segura AC, Roy JM, Schmidt MH. Baseline Frailty Measured by the Risk Analysis Index and 30-Day Mortality After Surgery for Spinal Malignancy: Analysis of a Prospective Registry (2011-2020). Neurospine 2024; 21:404-413. [PMID: 38955517 PMCID: PMC11224747 DOI: 10.14245/ns.2347120.560] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To evaluate the prognostic utility of baseline frailty, measured by the Risk Analysis Index (RAI), for prediction of postoperative mortality among patients with spinal malignancy (SM) undergoing resection. METHODS SM surgery cases were queried from the American College of Surgeons - National Surgical Quality Improvement Program database (2011-2020). The relationship between preoperative RAI frailty score and increasing rate of primary endpoint (mortality or discharge to hospice within 30 days, "mortality/hospice") were assessed. Discriminatory accuracy was assessed by computation of C-statistics (with 95% confidence interval [CI]) in receiver operating characteristic (ROC) curve analysis. RESULTS A total of 2,235 cases were stratified by RAI score: 0-20, 22.7%; 21-30, 11.9%; 31-40, 54.7%; and ≥ 41, 10.7%. The rate of mortality/hospice was 6.5%, which increased linearly with increasing RAI score (p < 0.001). RAI was also associated with increasing rates of major complication, extended length of stay, and nonhome discharge (all p < 0.05). The RAI demonstrated acceptable discriminatory accuracy for prediction of primary endpoint (C-statistic, 0.717; 95% CI, 0.697-0.735). In pairwise ROC comparison, RAI demonstrated superiority versus modified frailty index-5 and chronological age (p < 0.001). CONCLUSION Preoperative frailty, as measured by RAI, is a robust predictor of mortality/ hospice after SM surgery. The frailty score may be applied in clinical settings using a user-friendly calculator, deployed here: https://nsgyfrailtyoutcomeslab.shinyapps.io/spinalMalignancyRAI/.
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Affiliation(s)
- Rachel Thommen
- School of Medicine, New York Medical College, Valhalla, NY, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA
| | | | - Aaron C. Segura
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA
| | | | - Meic H. Schmidt
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA
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95
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Ehler J, Sakowitz OW, Harnisch LO, Michels P. [Specialized Concepts for the Management of Severe Neurotrauma]. Anasthesiol Intensivmed Notfallmed Schmerzther 2024; 59:368-384. [PMID: 38914079 DOI: 10.1055/a-2156-6790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Neurotrauma results from violence on structures of the central or peripheral nervous system and is a clinically common disease entity with high relevance for patients' long-term outcome. The application of evidence-based diagnostic and therapeutic concepts aims to minimize secondary injury and thus to improve treatment outcome. This article describes the current management of the two main injury patterns of neurotrauma - traumatic brain and spinal cord injury.
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96
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Hermansen E, Myklebust TÅ, Austevoll IM, Hellum C, Storheim K, Banitalebi H, Indrekvam K, Brisby H. Dural Sac Cross-sectional area change from preoperatively and up to 2 years after decompressive surgery for central lumbar spinal stenosis: investigation of operated levels, data from the NORDSTEN study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2234-2241. [PMID: 38587545 DOI: 10.1007/s00586-024-08251-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/18/2024] [Accepted: 03/31/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The aim of the present study was to investigate how canal area size changed from before surgery and up to 2 years after decompressive lumbar surgery lumbar spinal stenosis. Further, to investigate if an area change postoperatively (between 3 months to 2 years) was associated with any preoperative demographic, clinical or MRI variables or surgical method used. METHODS The present study is analysis of data from the NORDSTEN- SST trial where 437 patients were randomized to one of three mini-invasive surgical methods for lumbar spinal stenosis. The patients underwent MRI examination of the lumbar spine before surgery, and 3 and 24 months after surgery. For all operated segments the dural sac cross-sectional area (DSCA) was measured in mm2. Baseline factors collected included age, gender, BMI and smoking habits. Furthermore, surgical method, index level, number of levels operated, all levels operated on and baseline Schizas grade were also included in the analysis. RESULTS 437 patients were enrolled in the NORDSTEN-SST trial, whereof 310 (71%) had MRI at 3 months and 2 years. Mean DSCA at index level was 52.0 mm2 (SD 21.2) at baseline, at 3 months it increased to 117.2 mm2 (SD 43.0) and after 2 years the area was 127.7 mm2 (SD 52.5). Surgical method, level operated on or Schizas did not influence change in DSCA from 3 to 24 months follow-up. CONCLUSION The spinal canal area after lumbar decompressive surgery for lumbar spinal stenosis increased from baseline to 3 months after surgery and remained thereafter unchanged 2 years postoperatively.
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Affiliation(s)
- Erland Hermansen
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.
- Institute of Health Sciences, Norwegian University of Technology and Science, Ålesund, Norway.
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Registration, Cancer Registry Norway, Oslo, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Hellum
- Division of Orthopedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kjersti Storheim
- Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo University Hospital Oslo, Oslo, Norway
| | - Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Nordbyhagen, Norway
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Helena Brisby
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Koneru S, Bhavsar S, Pugazenthi S, Koller GM, Karuparti S, Kann MR, Strahle JM. A qualitative analysis of patient and caregiver experiences with myelomeningocele through online discussion boards. Childs Nerv Syst 2024; 40:1783-1790. [PMID: 38578480 DOI: 10.1007/s00381-024-06331-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/21/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Patients and caregivers impacted by myelomeningocele (MMC) use online discussion board forums to create community and share information and concerns about this complex medical condition. We aim to identify the primary concerns expressed on these forums with the goal of understanding gaps in care that may merit investment of resources to improve care received by this population. METHODS Anonymous posts from online MMC discussion boards were compiled using internet search engines. Posts were then analyzed using an adaptation of the Grounded Theory Method, a three-step system involving open, axial, and selective coding of the data by two independent researchers to identify common themes. RESULTS Analysis of 400 posts written primarily by parents (n = 342, 85.5%) and patients (n = 45, 11.25%) yielded three overarching themes: questions surrounding quality of life, a lack of support for mothers of children with MMC, and confusion with a complex healthcare system. Many posts revealed concerns about management and well-being with MMC, including posts discussing symptoms and related conditions (n = 299, 75.75%), treatments (n = 259, 65.75%), and emotional aspects of MMC (n = 146, 36.5%). Additionally, families, especially mothers, felt a lack of support in their roles as caregivers. Finally, in 118 posts (29.5%), patients and families expressed frustration with navigating a complex healthcare system and finding specialists whose opinions they trusted. CONCLUSIONS MMC is a complex medical condition that impacts patients and families in unique ways. Analysis of online discussion board posts identified key themes to be addressed in order to improve the healthcare experiences of those impacted by MMC.
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Affiliation(s)
- Shriya Koneru
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sanjeevani Bhavsar
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sangami Pugazenthi
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Gretchen M Koller
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sasidhar Karuparti
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael R Kann
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jennifer M Strahle
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA.
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Kobayashi Y, Satoh S, Kishida Y, Goto H, Fujimori D, Onuki A, Watanabe K, Tomura N. Primary intraosseous cavernous hemangioma of the clivus: A case report and literature review. Surg Neurol Int 2024; 15:177. [PMID: 38840598 PMCID: PMC11152543 DOI: 10.25259/sni_106_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/26/2024] [Indexed: 06/07/2024] Open
Abstract
Background The radiographic presentation of the primary intraosseous cavernous hemangiomas (PICHs) is nonspecific. We report a case of clival PICH mimicking a chordoma with a literature review. Case Description A 57-year-old woman presented with diplopia that started a few days before the presentation. She had transient diplopia at the right lateral gaze and upper gaze with normal eye movement. The symptoms disappeared spontaneously 1 week later. She had no other complaints or neurological deficits. Computed tomography revealed an intraosseous mass lesion and bone erosion of the middle and lower clivus, extending laterally to the right occipital condyle. Magnetic resonance imaging (MRI) showed hyperintense and hypointense components on T2- and T1-weighted images, respectively. The lesion was larger than on MRI performed 10 years earlier. Chordoma or chondroma was considered a possible preoperative diagnosis. An endoscopic transsphenoidal approach removed the tumor. In the operating view, the lesion appeared as "moth-eaten" bony interstices filled with vascular soft tissue. Histologically, an intraosseous cavernous hemangioma was diagnosed. Conclusion Diagnosis before surgery is difficult without characteristic radiographic findings. When making a differential diagnosis of malignant skull lesions, PICH should be considered.
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Affiliation(s)
- Yuta Kobayashi
- Department of Neurosurgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Shunsuke Satoh
- Department of Neurosurgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Yugo Kishida
- Department of Neurosurgery, Tokyo D Tower Hospital, Koto-Ku, Japan
| | - Hiromi Goto
- Department of Neurosurgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Daichi Fujimori
- Department of Neurosurgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Akinori Onuki
- Department of Neurosurgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Kazuo Watanabe
- Department of Neurosurgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Noriaki Tomura
- Department of Neuroradiology, Southern Tohoku General Hospital, Koriyama, Japan
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Montante B, Zampa B, Balestreri L, Ciancia R, Chini G, Ranavolo A, Rupolo M, Sawacha Z, Urbani M, Varrecchia T, Michieli M. Instrumental Evaluation of the Effects of Vertebral Consolidation Surgery on Trunk Muscle Activations and Co-Activations in Patients with Multiple Myeloma: Preliminary Results. SENSORS (BASEL, SWITZERLAND) 2024; 24:3527. [PMID: 38894318 PMCID: PMC11175183 DOI: 10.3390/s24113527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024]
Abstract
Multiple myeloma (MM) patients complain of pain and stiffness limiting motility. To determine if patients can benefit from vertebroplasty, we assessed muscle activation and co-activation before and after surgery. Five patients with MM and five healthy controls performed sitting-to-standing and lifting tasks. Patients performed the task before and one month after surgery. Surface electromyography (sEMG) was recorded bilaterally over the erector spinae longissimus and rectus abdominis superior muscles to evaluate the trunk muscle activation and co-activation and their mean, maximum, and full width at half maximum were evaluated. Statistical analyses were performed to compare MM patients before and after the surgery, MM and healthy controls and to investigate any correlations between the muscle's parameters and the severity of pain in patients. The results reveal increased activations and co-activations after vertebroplasty as well as in comparison with healthy controls suggesting how MM patients try to control the trunk before and after vertebroplasty surgery. The findings confirm the beneficial effects of vertebral consolidation on the pain experienced by the patient, despite an overall increase in trunk muscle activation and co-activation. Therefore, it is important to provide patients with rehabilitation treatment early after surgery to facilitate the CNS to correctly stabilize the spine without overloading it with excessive co-activations.
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Affiliation(s)
- Barbara Montante
- Unit of Onco-Hematology and Stem Cell Transplantation and Cellular Therapies, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (B.M.); (B.Z.); (R.C.); (M.R.); (M.M.)
| | - Benedetta Zampa
- Unit of Onco-Hematology and Stem Cell Transplantation and Cellular Therapies, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (B.M.); (B.Z.); (R.C.); (M.R.); (M.M.)
| | - Luca Balestreri
- Radiology Department, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (L.B.); (M.U.)
| | - Rosanna Ciancia
- Unit of Onco-Hematology and Stem Cell Transplantation and Cellular Therapies, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (B.M.); (B.Z.); (R.C.); (M.R.); (M.M.)
| | - Giorgia Chini
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00078 Monte Porzio Catone, Italy; (A.R.); (T.V.)
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00078 Monte Porzio Catone, Italy; (A.R.); (T.V.)
| | - Maurizio Rupolo
- Unit of Onco-Hematology and Stem Cell Transplantation and Cellular Therapies, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (B.M.); (B.Z.); (R.C.); (M.R.); (M.M.)
| | - Zimi Sawacha
- Department of Information Engineering, University of Padua, 35131 Padua, Italy;
| | - Martina Urbani
- Radiology Department, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (L.B.); (M.U.)
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00078 Monte Porzio Catone, Italy; (A.R.); (T.V.)
| | - Mariagrazia Michieli
- Unit of Onco-Hematology and Stem Cell Transplantation and Cellular Therapies, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (B.M.); (B.Z.); (R.C.); (M.R.); (M.M.)
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Grabala P, Fani N, Gregorczyk J, Grabala M. Posterior-Only T11 Vertebral Column Resection for Pediatric Congenital Kyphosis Surgical Correction. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:897. [PMID: 38929517 PMCID: PMC11206005 DOI: 10.3390/medicina60060897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024]
Abstract
Background: Congenital kyphosis is a spinal deformity that arises from the inadequate anterior development or segmentation of the vertebrae in the sagittal plane during the initial embryonic stage. Consequently, this condition triggers atypical spinal growth, leading to the manifestation of deformity. Concurrently, other congenital abnormalities like renal or cardiac defects within the gastrointestinal tract may co-occur with spinal deformities due to their shared formation timeline. In light of the specific characteristics of the deformity, the age range of the patient, deformity sizes, and neurological conditions, surgical intervention emerges as the optimal course of action for such cases. The selection of the appropriate surgical approach is contingent upon the specific characteristics of the anomaly. Case Presentation: This investigation illustrates the utilization of a surgical posterior-only strategy for correcting pediatric congenital kyphoscoliosis through the implementation of a vertebral column resection method along with spine reconstruction employing a mesh cage. The individual in question, a 16-year-old female, exhibited symptoms such as a progressive rib hump, shoulder asymmetry, and back discomfort. Non-invasive interventions like bracing proved ineffective, leading to the progression of the spinal curvature. After the surgical procedure, diagnostic imaging displayed a marked enhancement across all three spatial dimensions. After a postoperative physical assessment, it was noted that the patient experienced significant enhancements in shoulder alignment and rib hump prominence, with no discernible neurological or other adverse effects. Conclusions: Surgical intervention is considered the optimal approach for addressing such congenital anomalies. Typically, timely surgical intervention leads to favorable results and has the potential to halt the advancement of deformity and curvature enlargement.
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Affiliation(s)
- Pawel Grabala
- Department of Pediatric Orthopedic Surgery and Traumatology, Medical University of Bialystok, University Children’s Hospital, Waszyngtona 17, 15-274 Bialystok, Poland
- Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland
- Department of Neurosurgery, Medical University of Bialystok, M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
| | - Negin Fani
- Medical Faculty, Medical University of Warsaw, 02-091 Warsaw, Poland; (N.F.); (J.G.)
| | - Jerzy Gregorczyk
- Medical Faculty, Medical University of Warsaw, 02-091 Warsaw, Poland; (N.F.); (J.G.)
| | - Michal Grabala
- 2nd Clinical Department of General and Gastroenterogical Surgery, Medical University of Bialystok, ul. M. Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland;
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