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Guttridge C, Shannon A, O'Sullivan A, O'Sullivan KJ, O'Sullivan LW. Effects of post-curing duration on the mechanical properties of complex 3D printed geometrical parts. J Mech Behav Biomed Mater 2024; 156:106585. [PMID: 38795405 DOI: 10.1016/j.jmbbm.2024.106585] [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: 01/26/2024] [Revised: 03/26/2024] [Accepted: 05/18/2024] [Indexed: 05/27/2024]
Abstract
This study aims to assess the efficacy of post-curing guidance supplied by 3D printing resin manufacturers. Current guidance applies generically to all geometries with the caveat that post-curing should be extended for 'large' or 'complex' geometries but specific guidance is not provided. Two vat-polymerisation 3D printers (Form3B, Figure 4 Standalone) were used to print test models in 6 biocompatible resins (Pro Black, Med White, Med Amber, Biomed Black, Biomed White, Biomed Amber). The test model is of a complex geometry whilst also housing ISO 527 test specimens in concentric layers. Two separate intervals of curing were applied (100%, 500% stated guidance) creating different curing treatments of the specimens throughout the model. Post processed test models were disassembled and pull testing performed on each of the specimens to assess the mechanical properties. The analysis showed that extending the curing duration had significant effects on the mechanical properties of some materials but not all. The layers of the model had a significant effect except for elongation at break for the Med Amber material. This research demonstrates that generic post-curing guidance regarding UV exposures is not sufficient to achieve homogenous material strength properties for complex geometries. Large variations in mechanical properties throughout the models suggest some material was not fully-cured. This raises a query if such materials as originally marketed as biocompatible are fully cured and therefore safe to use for medical applications involving complex geometries.
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Affiliation(s)
- Callum Guttridge
- Rapid Innovation Unit - School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland
| | - Alice Shannon
- Rapid Innovation Unit - School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland
| | - Aidan O'Sullivan
- Rapid Innovation Unit - School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland
| | - Kevin J O'Sullivan
- Rapid Innovation Unit - School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland
| | - Leonard W O'Sullivan
- Rapid Innovation Unit - School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland.
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Chen M, Liu A, Dang Y, Wang N, Zhang Z, Chen H, Zhang C, Du S, Ding X, Fu C. A novel simple laser guidance puncture system for intracerebral hematoma. Clin Neurol Neurosurg 2024; 241:108292. [PMID: 38657327 DOI: 10.1016/j.clineuro.2024.108292] [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: 10/30/2023] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Accurate localization and real-time guidance technologies for cerebral hematomas are essential for minimally invasive procedures, including minimally invasive hematoma puncture and drainage, as well as neuroendoscopic-assisted hematoma removal. This study aims to evaluate the precision and safety of a self-developed laser-guided device in localizing and guiding hematoma punctures in minimally invasive surgery for intracerebral hemorrhage (ICH). METHODS We present the components of the device and its operational procedures. Subsequently, surgeons with different titles conduct hematoma puncture experiments using the device on skull models, comparing it to freehand puncture methods and recording the offset distance from the puncture needle tip to the hematoma center. Additionally, we report the application of this device in 10 patients with ICH, assessing its accuracy and safety in comparison with a neuro-navigation system. RESULTS In simulated puncture experiments, the accuracy of the laser-guided group surpasses that of the freehand puncture group, with a significant statistical difference observed between the two groups (P < 0.05). In the laser-guided group, there is no statistically significant difference in puncture accuracy among the surgeons (P > 0.05). In clinical experiments, no relevant surgical complications were observed. The offset distance for the laser-guided group was 0.61 ± 0.18 cm, while the neuro-navigation group was 0.48 ± 0.13 cm. There was no statistically significant difference between the two groups in terms of offset distance (P > 0.05). However, there was a significant difference in surgical duration (P < 0.05), with the former being 35.0 ± 10.5 minutes and the latter being 63.8 ± 10.5 minutes. CONCLUSION The current study describes satisfactory results from both simulated experiments and clinical applications, achieved through the use of a novel laser-guided hematoma puncture device. Furthermore, owing to its portability, affordability, and simplicity, it holds significant importance in advancing surgical interventions for ICH, especially in underdeveloped regions.
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Affiliation(s)
- Mingle Chen
- Department of Neurosurgery, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei Province 441000, China; Department of Neurosurgery, Jingmen People's Hospital, Jingchu University of Technology Affiliated Central Hospital, Jingmen, Hubei Province 448000, China
| | - Aoqi Liu
- Department of Rehabilitation Medicine, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei Province 441000, China
| | - Yanwei Dang
- Department of Neurosurgery, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei Province 441000, China
| | - Ning Wang
- Department of Neurosurgery, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei Province 441000, China
| | - Zhitao Zhang
- Department of Neurosurgery, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei Province 441000, China
| | - Huayun Chen
- Department of Neurosurgery, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei Province 441000, China
| | - Chao Zhang
- Department of Neurosurgery, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei Province 441000, China
| | - Sai Du
- Department of Neurosurgery, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei Province 441000, China
| | - Xudong Ding
- Department of Rehabilitation Medicine, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei Province 441000, China.
| | - Chuhua Fu
- Department of Neurosurgery, Jingmen People's Hospital, Jingchu University of Technology Affiliated Central Hospital, Jingmen, Hubei Province 448000, China.
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Shen J, Chen Q, Tong Q, Tian X, Han Q. Minimally invasive puncture and drainage guided by 3D printed guide plate for the treatment of primary brain stem hemorrhage. Eur J Intern Med 2024; 124:150-151. [PMID: 38461062 DOI: 10.1016/j.ejim.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Jun Shen
- Department of Neurology, The Second People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Xuzhou Medical University, No. 62 Huaihai SouthRoad, Huai'an 223002, Jiangsu, China
| | - Quan Chen
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huai'anNo.1 People's Hospital of Nanjing Medical University, No.1 Huanghe WestRoad, Huai'an 223300, Jiangsu, China
| | - Qiang Tong
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huai'anNo.1 People's Hospital of Nanjing Medical University, No.1 Huanghe WestRoad, Huai'an 223300, Jiangsu, China
| | - Xiangyang Tian
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huai'anNo.1 People's Hospital of Nanjing Medical University, No.1 Huanghe WestRoad, Huai'an 223300, Jiangsu, China
| | - Qiu Han
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huai'anNo.1 People's Hospital of Nanjing Medical University, No.1 Huanghe WestRoad, Huai'an 223300, Jiangsu, China.
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Bao D, Ni S, Chang B, Zhang W, Zhang H, Niu C. Short-term outcomes of robot-assisted minimally invasive surgery for brainstem hemorrhage: A case-control study. Heliyon 2024; 10:e25912. [PMID: 38384554 PMCID: PMC10878924 DOI: 10.1016/j.heliyon.2024.e25912] [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: 06/06/2023] [Revised: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
Objective This work focused on investigating if robot-assisted minimally invasive surgery improved middle term vital outcome for primary brainstem hemorrhage (PBSH). Methods This work obtained clinical data from patients with PBSH admitted from July 2019 to August 2021. All cases were classified as surgical or conservative treatment group. The general information, Glasgow coma scale (GCS) score, Glasgow outcome score (GOS), along with survival time in patients 60 days after robot-assisted surgery were recorded and analyzed. Results A prospective analysis was performed on 82 cases meeting eligibility criteria, including 36 from surgical group whereas 46 from the conservative group. Sixty days after onset, the death rate was found to be 19.44% and 50.00% of surgical and conservative groups, separately (cases versus controls, P < 0.05). Furthermore, postoperative GOS and GCS scores of surgical group were significantly higher, and hydrocephalus was lower compared with conservative group. Central fever incidence did not exhibit any significant difference between two groups. Conclusion Robot-assisted PBSH drainage may improve survivorship and reduce the occurrence of hydrocephalus.
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Affiliation(s)
- Dejun Bao
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
- Anhui Province Key Laboratory of Brain Function and Brain Disease, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Shengyuan Ni
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
- Anhui Province Key Laboratory of Brain Function and Brain Disease, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Bowen Chang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
- Anhui Province Key Laboratory of Brain Function and Brain Disease, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Wang Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Hong Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Chaoshi Niu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
- Anhui Province Key Laboratory of Brain Function and Brain Disease, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
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Müller M, Winkler D, Möbius R, Werner M, Drossel WG, Güresir E, Grunert R. Analysis of the Technical Accuracy of a Patient-Specific Stereotaxy Platform for Brain Biopsy. J Pers Med 2024; 14:180. [PMID: 38392613 PMCID: PMC10890199 DOI: 10.3390/jpm14020180] [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: 11/30/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
The use of stereotactic frames is a common practice in neurosurgical interventions such as brain biopsy and deep brain stimulation. However, conventional stereotactic frames have been shown to require modification and adaptation regarding patient and surgeon comfort as well as the increasing demand for individualized medical treatment. To meet these requirements for carrying out state-of-the-art neurosurgery, a 3D print-based, patient-specific stereotactic system was developed and examined for technical accuracy. Sixteen patient-specific frames, each with two target points, were additively manufactured from PA12 using the Multi Jet Fusion process. The 32 target points aim to maximize the variability of biopsy targets and depths for tissue sample retrieval in the brain. Following manufacturing, the frames were measured three-dimensionally using an optical scanner. The frames underwent an autoclave sterilization process prior to rescanning. The scan-generated models were compared with the planned CAD models and the deviation of the planned target points in the XY-plane, Z-direction and in the resulting direction were determined. Significantly lower (p < 0.01) deviations were observed when comparing CAD vs. print and print vs. sterile in the Z-direction (0.17 mm and 0.06 mm, respectively) than in the XY-plane (0.46 mm and 0.16 mm, respectively). The resulting target point deviation (0.51 mm) and the XY-plane (0.46 mm) are significantly higher (p < 0.01) in the CAD vs. print comparison than in the print vs. sterile comparison (0.18 mm and 0.16 mm, respectively). On average, the results from the 32 target positions examined exceeded the clinically required accuracy for a brain biopsy (2 mm) by more than four times. The patient-specific stereotaxic frames meet the requirements of modern neurosurgical navigation and make no compromises when it comes to accuracy. In addition, the material is suitable for autoclave sterilization due to resistance to distortion.
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Affiliation(s)
- Marcel Müller
- Fraunhofer Institute for Machine Tools and Forming Technology, Nöthnitzer Straße 44, D-01187 Dresden, Germany
| | - Dirk Winkler
- Department of Neurosurgery, Faculty of Medicine, University Clinic of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - Robert Möbius
- Department of Neurosurgery, Faculty of Medicine, University Clinic of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - Michael Werner
- Fraunhofer Institute for Machine Tools and Forming Technology, Nöthnitzer Straße 44, D-01187 Dresden, Germany
| | - Welf-Guntram Drossel
- Fraunhofer Institute for Machine Tools and Forming Technology, Nöthnitzer Straße 44, D-01187 Dresden, Germany
| | - Erdem Güresir
- Department of Neurosurgery, Faculty of Medicine, University Clinic of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
| | - Ronny Grunert
- Fraunhofer Institute for Machine Tools and Forming Technology, Nöthnitzer Straße 44, D-01187 Dresden, Germany
- Department of Neurosurgery, Faculty of Medicine, University Clinic of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
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Ali A, Morris JM, Decker SJ, Huang YH, Wake N, Rybicki FJ, Ballard DH. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: neurosurgical and otolaryngologic conditions. 3D Print Med 2023; 9:33. [PMID: 38008795 PMCID: PMC10680204 DOI: 10.1186/s41205-023-00192-w] [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: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Medical three dimensional (3D) printing is performed for neurosurgical and otolaryngologic conditions, but without evidence-based guidance on clinical appropriateness. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness recommendations for neurologic 3D printing conditions. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with neurologic and otolaryngologic conditions. Each study was vetted by the authors and strength of evidence was assessed according to published guidelines. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for diseases of the calvaria and skull base, brain tumors and cerebrovascular disease. Recommendations are provided in accordance with strength of evidence of publications corresponding to each neurologic condition combined with expert opinion from members of the 3D printing SIG. CONCLUSIONS This consensus guidance document, created by the members of the 3D printing SIG, provides a reference for clinical standards of 3D printing for neurologic conditions.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | | | - Summer J Decker
- Division of Imaging Research and Applied Anatomy, Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Hou X, Li D, Yao Y, Zeng L, Li C. Clinical application of 3DSlicer and Sina in minimally invasive puncture drainage of elderly patients with spontaneous intracerebral hemorrhage under local anesthesia. J Stroke Cerebrovasc Dis 2023; 32:107192. [PMID: 37216751 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107192] [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: 04/11/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Decreased organ function and poor physical compensatory capacity in elderly patients diagnosed with spontaneous intracerebral hemorrhage (ICH) can make surgical treatment procedures challenging and risky. Minimally invasive puncture drainage (MIPD) combined with urokinase infusion therapy is a safe and feasible method of treating ICH. This study aimed to compare the treatment efficacy of MIPD conducted under local anesthesia using either 3DSlicer + Sina application or computer tomography (CT)-guided stereotactic localization of hematomas in elderly patients diagnosed with ICH. METHODS The study sample included 78 elderly patients (≥ 65 years of age) diagnosed with ICH for the first time. All patients exhibited stable vital signs and underwent surgical treatment. The study sample was randomly divided into two groups, either receiving 3DSlicer+Sina or CT-guided stereotactic assistance. The preoperative preparation time; hematoma localization accuracy rate; satisfactory hematoma puncture rate; hematoma clearance rate; postoperative rebleeding rate; Glasgow Coma Scale (GCS) score after 7 days; and modified Rankin scale (mRS) score 6 months after surgery were compared between the two groups. RESULTS No significant differences in gender, age, preoperative GCS score, preoperative hematoma volume (HV), and surgical duration were observed between the two groups (all p-values > 0.05). However, the preoperative preparation time was shorter in the group receiving 3DSlicer + Sina assistance compared to that receiving CT-guided stereotactic assistance (p-value < 0.001). Both groups exhibited significant improvement in GCS scores and reduction in HV after surgery (all p-values < 0.001). The accuracy of hematoma localization and puncture was 100% in both groups. There were no significant differences in surgical duration, postoperative hematoma clearance rate, rebleeding rate, postoperative GCS and mRS scores between the two groups (all p-values > 0.05). CONCLUSIONS A combination of 3DSlicer and Sina is effective in accurately identifying hematomas in elderly patients with ICH exhibiting stable vital signs, thus simplifying MIPD surgeries conducted under local anesthesia. This procedure may also be preferred over CT-guided stereotactic localization in clinical practice due to its ease of use and accuracy in hematoma localization.
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Affiliation(s)
- Xiaolin Hou
- Department of neurosurgery, Hospital of Chengdu University of Traditional Chinese.
| | - Dingjun Li
- Department of neurosurgery, Hospital of Chengdu University of Traditional Chinese.
| | - Yuan Yao
- Department of neurosurgery, Hospital of Chengdu University of Traditional Chinese.
| | - Lin Zeng
- Department of neurosurgery, Hospital of Chengdu University of Traditional Chinese.
| | - Chengxun Li
- Department of neurosurgery, Hospital of Chengdu University of Traditional Chinese.
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Yu Z, Zhang X, Xu Q, Zhang Z, Xia Y, Li H, Yu X, Deng L, Zhang L. Effect of hematoma volume on the 30-day mortality rate of patients with primary hypertensive brainstem hemorrhage: a retrospective cohort study. Front Surg 2023; 10:1136296. [PMID: 37215349 PMCID: PMC10196262 DOI: 10.3389/fsurg.2023.1136296] [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: 01/02/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Objective The purpose of this study is to investigate the effect of hematoma volume on the 30-Day Mortality Rate of patients with Primary Hypertensive Brainstem Hemorrhage (PHBH). Methods Retrospective analysis was done on the clinical information of 74 patients who underwent treatment for primary hypertensive brainstem hemorrhage at the Department of Neurosurgery of the 908th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army between January 2018 and December 2021. Both univariate and multivariate logistic regression were used to assess clinical signs and risk factors that affect 30-day mortality. Results In the 74 patients with primary hypertensive brainstem hemorrhage included in this investigation, 46 patients died and 28 patients survived. The mortality rate at 30 days was 62.16%. A statistically significant difference was seen (P < 0.001) in the results of the univariate analysis, which suggested that hematoma volume may be a factor affecting the prognosis of patients with hypertensive brainstem hemorrhage. Hematoma volume was further demonstrated to be a risk factor and an independent factor impacting death in patients with brainstem hemorrhage (P < 0.001) by multivariate logistic regression analysis (OR: 2.6, 95% CI: 1.7-3.9, P < 0.001 Crude Model, OR: 3.6, 95% CI: 1.7-7.7, P < 0.001 Multivariate-Adjusted Model). After adjusting for confounding variables such as age, body mass index, sex, history of diabetes mellitus, history of hypertension, admission GCS score, stereotactic aspiration, combined hydrocephalus, admission systolic and diastolic blood pressure, the hematoma volume was revealed to be an independent predictor of 30-day death in patients with brainstem hemorrhage. We discovered by smooth curve fitting that hematoma volume increased in a non-linear manner with 30-day mortality. The 30-day mortality rate did not alter significantly when the hematoma volume was less than 4 ml. When the hematoma volume was greater than 4 ml, the 30-day mortality rate increased rapidly, and when the hematoma volume was 10 ml, the 30-day mortality rate reached the maximum. Conclusions Hematoma volume is an independent factor affecting 30-day mortality in patients with primary hypertensive brainstem hemorrhage. The severe and extensive neurological damage caused by primary hypertensive brainstem hemorrhage is highly unlikely to be fundamentally altered by a single protocol, and new avenues need to be explored scientifically and continuously.
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Affiliation(s)
| | | | | | | | | | | | | | - Lei Deng
- Correspondence: Lei Deng Long Zhang
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Zhou J, Ping A, Mao J, Gu Y, Liu F, Shao A. ZJUSAH Classification: A New Classification for Primary Brainstem Hemorrhage. Life (Basel) 2023; 13:life13030846. [PMID: 36984002 PMCID: PMC10059730 DOI: 10.3390/life13030846] [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: 01/04/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
To analyze and improve ZJUSAH classification for primary brainstem hematoma, we retrospectively reviewed 211 patients with primary brainstem hemorrhage who were admitted to our institution between January 2014 and October 2020. The primary clinical outcomes were the 30-day survival rate and 90-day consciousness recovery rate, which were evaluated using the National Institutes of Health Stroke Scale score. Univariate logistic regression and multivariate Cox regression analyses were performed to evaluate the prognostic model. The overall 30-day survival rate of the 211 patients was 69.7%. The 30-day survival rate was 95% among Type 1 patients, 77.8% among Type 2 patients, and 63.2% among Type 3 patients. The 90-day consciousness recovery rate was 63.2% among Type 1 patients, 61.9% among Type 2 patients, and 30.2% among Type 3 patients. Our findings suggest that ZJUSAH classification can be optimized according to hematoma volume, with Type 3 patients with a hematoma larger than 12.4 mL tending to have a worse state of consciousness. Additionally, we discovered that ZJUSAH classification is valuable in predicting 30-day survival rates in conservative treatment patients. In conclusion, our study established and optimized a new CT-based hematoma classification system for primary brainstem hematoma, which facilitates treatment selection and prognostic prediction.
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Affiliation(s)
- Jingyi Zhou
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - An Ping
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Jizhong Mao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Yichen Gu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Fengqiang Liu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
- Brain Research Institute, Zhejiang University, Hangzhou 310058, China
- Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou 310058, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Anwen Shao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
- Brain Research Institute, Zhejiang University, Hangzhou 310058, China
- Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou 310058, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
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Zhang S, Chen T, Han B, Zhu W. A Retrospective Study of Puncture and Drainage for Primary Brainstem Hemorrhage With the Assistance of a Surgical Robot. Neurologist 2023; 28:73-79. [PMID: 35593907 DOI: 10.1097/nrl.0000000000000445] [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: 11/26/2022]
Abstract
BACKGROUND Whether primary brainstem hemorrhage (PBH) should be treated with a conservative treatment or with surgical intervention (such as craniotomy, puncture, and drainage) is still controversial. The aim of this study was to assess the feasibility and safety of puncture and drainage for PBH with the assistance of a surgical robot. PATIENTS AND METHODS A total of 53 patients diagnosed with PBH were included in this study. They were divided into surgical and nonsurgical groups. All patients in the surgical group underwent puncture and drainage of PBH assisted with surgical robots at Beijing Jingmei General Hospital from June 2017 to January 2021. We evaluated this technology with radiographic and clinical results. RESULTS Postoperative computed tomography showed that all the drainage catheters had been pushed to the target point, which had been designated before the operation. After the operation, the hematoma was reduced by an average of 3.7 mL. None of the patients experienced serious surgery-related complications. Clinical follow-up revealed that 2 patients could not be followed-up, 8 died, and the rest were in disability or in a vegetative state. CONCLUSIONS It may be safe, feasible, and effective to complete the puncture and drainage of PBH with the assistance of a surgical robot. This technique has fewer complications than the traditional puncture method and has high accuracy. It may be more suitable for patients with a hematoma volume of 5 to 10 mL in PBH. The amount of hematoma volume >10 mL may be associated with poor postoperative prognosis. However, high-quality cohorts or case-control studies are needed to verify the effect in this study.
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Affiliation(s)
- Shuai Zhang
- Department of Neurosurgery, Beijing Jingmei Group General Hospital
| | - Tao Chen
- Department of Neurosurgery, Huicheng Brain Research Institute, Beijing, P.R. China
| | - Bing Han
- Department of Neurosurgery, Huicheng Brain Research Institute, Beijing, P.R. China
| | - Weisheng Zhu
- Department of Neurosurgery, Beijing Jingmei Group General Hospital
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Xu HZ, Guo J, Wang C, Liu X, Song ZQ, Chen RF, Qiu B, Wang Q, Huang Y. A Novel Stereotactic Aspiration Technique for Intracerebral Hemorrhage. World Neurosurg 2023; 170:e28-e36. [PMID: 36270590 DOI: 10.1016/j.wneu.2022.10.051] [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: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Minimally invasive surgery is effective and recommended for treatment of intracerebral hemorrhage; however, neurosurgeons in grass-root hospitals in underdeveloped countries lack effective and precise minimally invasive surgery techniques. The aim of this study was to present a technique of computed tomography angiography-based three-dimensional-printed navigation mold-guided stereotactic aspiration and demonstrate its clinical application using a hard needle in a series of patients. METHODS The novel stereotactic aspiration technique was performed in 18 patients with spontaneous intracerebral hemorrhage at our center, and clinical outcomes were reported. We compared the volume of hematoma measured by 3 different methods: ABC/2 formula, manual segmentation with OsiriX, and manual segmentation with 3D Slicer. RESULTS The surgery was completed safely within an average operative time of 15.11 minutes, achieving the goal of <15 mL residual clot volume or >70% clot removal in all patients. No intracranial rebleeding or infection was observed postoperatively. At the end of the 6-month follow-up, 61.11% (11/18) of patients achieved a modified Rankin Scale score <3. There was overall better agreement of hematoma measurement using segmentation with 3D Slicer rather than ABC/2 measurement or hematoma measurement using segmentation with OsiriX. CONCLUSIONS Our novel method of stereotactic aspiration benefited patients in this study with good percent clot removal, few surgery-related complications, and a favorable prognosis. Manual segmentation with 3D Slicer could be used to provide the neurosurgeon with dependable information about hematoma volume. This cheap and convenient technique may be applied in grass-root hospitals in underdeveloped countries. Assessment in multicenter prospective clinical trials is needed.
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Affiliation(s)
- Heng-Zhou Xu
- Department of Neurosurgery, Civil Aviation General Hospital, Beijing, China
| | - Jing Guo
- Department of Neurology, Civil Aviation General Hospital, Beijing, China
| | - Ce Wang
- Department of Neurosurgery, Civil Aviation General Hospital, Beijing, China
| | - Xiao Liu
- Department of Neurosurgery, Civil Aviation General Hospital, Beijing, China
| | - Zhi-Qiang Song
- Department of Neurosurgery, Civil Aviation General Hospital, Beijing, China
| | - Rui-Feng Chen
- Department of Neurosurgery, Civil Aviation General Hospital, Beijing, China
| | - Bing Qiu
- Civil Aviation Medicine Institute, Civil Aviation Medical Center of CAAC, Beijing, China
| | - Qing Wang
- Civil Aviation Aircrew Medical Assessment, Civil Aviation Medical Center, Beijing, China
| | - Yong Huang
- Department of Neurosurgery, Civil Aviation General Hospital, Beijing, China.
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12
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Brain structure segmentation and 3D printed individual craniometric rulers for cortex brain lesions. ANNALS OF 3D PRINTED MEDICINE 2022. [DOI: 10.1016/j.stlm.2022.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Prognosis and Influencing Factors of Early Microsurgery for Severe Hypertensive Brainstem Hemorrhage. DISEASE MARKERS 2022; 2022:5062591. [PMID: 36193500 PMCID: PMC9526571 DOI: 10.1155/2022/5062591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/03/2022] [Indexed: 11/24/2022]
Abstract
Objective To investigate the prognosis and influencing factors of early microsurgery for severe hypertensive brainstem hemorrhage. Methods The clinical data of 19 patients with severe hypertensive brainstem hemorrhage treated in the Department of Neurosurgery of the Second Affiliated Hospital of Shandong First Medical University between January 2018 and December 2021 were retrospectively analyzed. The clinical efficacy and risk factors affecting the prognosis were analyzed by chi-square test and multivariate logistic regression. Results A total of 19 patients with severe hypertensive brainstem hemorrhage were treated by early microsurgery, including 14 cases by subtemporal approach and 5 cases by retrosigmoid approach. After 3 months of follow-up, 6 patients died and 13 patients survived. The 30-day and 90-day mortality rates were 21.1% and 31.6%, respectively, and the good prognosis rate was 15.4%. Univariate analysis showed that hematoma volume and hematoma clearance rate might be the factors affecting the prognosis of patients with severe hypertensive brainstem hemorrhage; the observed difference was statistically significant (P < 0.05). Multivariate logistic regression analysis further confirmed that hematoma volume was an independent factor affecting the death of patients with brainstem hemorrhage (P < 0.05), while hematoma volume (B: 2.909, OR: 18.332, 95% CI: 1.020–329.458, P: 0.048) was a risk factor. Conclusion Hematoma volume resulted as an independent factor affecting the death of patients with severe hypertensive brainstem hemorrhage. Early microsurgical clearance of brainstem hematoma contributed to reducing the 30-day and 90-day mortality and improving the prognosis of patients.
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14
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Management of Primary Brainstem Hemorrhage: A Review of Outcome Prediction, Surgical Treatment, and Animal Model. DISEASE MARKERS 2022; 2022:4293590. [PMID: 35864996 PMCID: PMC9296309 DOI: 10.1155/2022/4293590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022]
Abstract
Primary brainstem hemorrhage (PBH) has the worst prognosis of all types of intracerebral hemorrhage. Currently, the management of PBH is controversial. Hematoma classification, scoring systems, and electrophysiological monitoring are critical for predicting the outcome of PBH. Surgery may be an effective treatment for PBH. Clinical studies have emphasized the importance of animal models for understanding the pathogenesis and pathological mechanisms of PBH. In this study, combined with recent studies, the outcome prediction, surgical treatment, and animal models of PBH were reviewed.
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15
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Wang Q, Guo W, Zhang T, Wang S, Li C, Yuan Z, Wei Q, Geng X, Li Z. Laser Navigation Combined With XperCT Technology Assisted Puncture of Brainstem Hemorrhage. Front Neurol 2022; 13:905477. [PMID: 35756936 PMCID: PMC9218265 DOI: 10.3389/fneur.2022.905477] [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: 03/27/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Brainstem hemorrhage has a rapid onset with high mortality and disability rates. In recent years, an increasing number of studies have reported on the surgical treatment of brainstem hemorrhage. The introduction of stereotaxic instruments and navigation systems has improved the accuracy of surgical treatment; however, the popularity of these devices in the primary hospitals is not high. In this study, we introduce laser navigation combined with the XperCT technology to assist in the puncture and drainage of brainstem hemorrhage, aiming to improve surgical accuracy and facilitate the drainage of brainstem hemorrhage in primary hospitals. Material and Methods A total of five patients (four men and one woman), aged 34-70 years, who underwent hematoma puncture drainage with the assistance of laser navigation combined with XperCT technology at the Binzhou Medical University Hospital, China, between June 2020 and Aug 2021 were included in the study. The brainstem hemorrhages had volumes of 7-18 ml. Statistical analyses of the postoperative puncture deviation distance (distance between the actual puncture end and simulated puncture end) and postoperative improvement were also performed. Results The operations were successfully completed in all five patients. The puncture deviation distance was <6 mm in all five patients and <2 mm in two patients. The postoperative hematoma clearance rate was about 70%-90%. Among four patients with respiratory failure, three had improved breathing and resumed spontaneous breathing. Out of three patients with high fever, one showed a substantial decrease in body temperature. There were no cases of postoperative infection. Of the five patients, two recovered consciousness, one died, and two voluntarily gave up further treatment and were discharged. Conclusions Laser navigation combined with the XperCT technology could improve the accuracy of surgical puncture. The technique might be convenient for widespread clinical application because of its low trauma, high precision, short operation time, and low operation cost.
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Affiliation(s)
- Qingbo Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China.,Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Wei Guo
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Tao Zhang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Shuangquan Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chenglong Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Zhengbo Yuan
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Qi Wei
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Xin Geng
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Zefu Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China.,Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
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16
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Su Y, Sun Y, Hosny M, Gao W, Fu Y. Facial landmark-guided surface matching for image-to-patient registration with an RGB-D camera. Int J Med Robot 2022; 18:e2373. [PMID: 35133715 DOI: 10.1002/rcs.2373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/17/2022] [Accepted: 01/29/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Fiducial marker-based image-to-patient registration is the most common way in image-guided neurosurgery, which is labour-intensive, time consuming, invasive and error prone. METHODS We proposed a method of facial landmark-guided surface matching for image-to-patient registration using an RGB-D camera. Five facial landmarks are localised from preoperative magnetic resonance (MR) images using deep learning and RGB image using Adaboost with multi-scale block local binary patterns, respectively. The registration of two facial surface point clouds derived from MR images and RGB-D data is initialised by aligning these five landmarks and further refined by weighted iterative closest point algorithm. RESULTS Phantom experiment results show the target registration error is less than 3 mm when the distance from the camera to the phantom is less than 1000 mm. The registration takes less than 10 s. CONCLUSIONS The proposed method is comparable to the state-of-the-arts in terms of the accuracy yet more time-saving and non-invasive.
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Affiliation(s)
- Yixian Su
- State Key Laboratory of Robotics and System, School of Life Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Yu Sun
- State Key Laboratory of Robotics and System, School of Life Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Mohamed Hosny
- State Key Laboratory of Robotics and System, School of Life Science and Technology, Harbin Institute of Technology, Harbin, China.,Department of Electrical Engineering, Benha Faculty of Engineering, Benha University, Benha, Egypt
| | - Wenpeng Gao
- State Key Laboratory of Robotics and System, School of Life Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Yili Fu
- State Key Laboratory of Robotics and System, School of Life Science and Technology, Harbin Institute of Technology, Harbin, China
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Shannon A, O'Sullivan KJ, Clifford S, O'Sullivan L. Assessment and selection of filler compounds for radiopaque PolyJet multi-material 3D printing for use in clinical settings. Proc Inst Mech Eng H 2022; 236:740-747. [PMID: 35296167 DOI: 10.1177/09544119221084819] [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: 12/24/2022]
Abstract
The aim of this research was to assess a selection of radiopaque filler compounds for increasing radiopacity in a resin suitable for Polyjet multi-material 3D printing. A radiopaque resin has potential applications in medicine to produce patient-specific anatomical models with realistic radiological properties, training aids, and skin contacting components such as surgical or procedural guides that require visibility under fluoroscopy. The desirable filler would have a high level of radiopacity under ionising imaging modalities, such as X-ray, CT, fluoroscopy or angiography. Nine potential filler compounds were selected based on atomic number and handling risk: barium sulphate, bismuth oxide, zirconium oxide, strontium oxide, strontium fluoride, strontium carbonate, iodine, niobium oxide and tantalum oxide. The fillers were evaluated using selected criteria. A weighted material selection matrix was developed to prioritise and select a filler for future 3D printing on a multi-material 3D printer. Zirconium oxide was the highest scoring filler compound in the material selection matrix, scoring 4.4 out of a maximum of 5. MED610TM resin doped with zirconium oxide was shown to be UV curable, and when cured is non-toxic, environmentally friendly, and has the ability to display antimicrobial properties. In terms of radiopacity, a sample with thickness 1.5 mm of MED610™ resin doped with 20 wt.% zirconium oxide produced X-ray radiopacity equivalent to 3 mm of aluminium. Zirconium oxide was selected using the material selection matrix. This radiopaque resin can be used to produce anatomical models with accurate radiological properties, training aids or skin contacting devices that require visibility under ionising imaging modalities. The 3D printing validation run successfully demonstrated that the material selection matrix prioritised a filler suitable for radiopaque multi-material 3D printing.
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Affiliation(s)
- Alice Shannon
- Design Factors Research Group, School of Design, University of Limerick, Limerick, Ireland.,National Children's Research Centre, Gate 5, Our Lady's Children's Hospital, Crumlin, Dublin 12.,Health Research Institute, University of Limerick, Ireland
| | - Kevin J O'Sullivan
- Design Factors Research Group, School of Design, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Ireland.,Confirm Smart Manufacturing Centre, University of Limerick, University of Limerick, Ireland
| | - Seamus Clifford
- School of Engineering, University of Limerick, Limerick, Ireland
| | - Leonard O'Sullivan
- Design Factors Research Group, School of Design, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Ireland.,Confirm Smart Manufacturing Centre, University of Limerick, University of Limerick, Ireland
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18
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Zheng Z, Wang Q, Sun S, Luo J. Minimally Invasive Surgery for Intracerebral and Intraventricular Hemorrhage. Front Neurol 2022; 13:755501. [PMID: 35273553 PMCID: PMC8901716 DOI: 10.3389/fneur.2022.755501] [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: 08/09/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Spontaneous intracerebral hemorrhage (ICH), especially related to intraventricular hemorrhage (IVH), is the most devastating type of stroke and is associated with high mortality and morbidity. Optimal management of ICH remains one of the most controversial areas of neurosurgery and no effective treatment exists for ICH. Studies comparing conventional surgical interventions with optimal medical management failed to show significant benefit. Recent exploration of minimally invasive surgery for ICH and IVH including catheter- and mechanical-based approaches has shown great promise. Early phase clinical trials have confirmed the safety and preliminary treatment effect of minimally invasive surgery for ICH and IVH. Pending efficacy data from phase III trials dealing with diverse minimally invasive techniques are likely to shape the treatment of ICH.
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Affiliation(s)
- Zelong Zheng
- The Department of Neurosurgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Qi Wang
- Institute of Eco-Environmental and Soil Science, Guangdong Academy of Sciences, Guangzhou, China
| | - Shujie Sun
- Shanghai Clinical Research Centre of Chinese Academy of Sciences, Shanghai, China
| | - Jinbiao Luo
- The Department of Neurosurgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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19
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Kermavnar T, Shannon A, O'Sullivan KJ, McCarthy C, Dunne CP, O'Sullivan LW. Three-Dimensional Printing of Medical Devices Used Directly to Treat Patients: A Systematic Review. 3D PRINTING AND ADDITIVE MANUFACTURING 2021; 8:366-408. [PMID: 36655011 PMCID: PMC9828627 DOI: 10.1089/3dp.2020.0324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Until recently, three-dimensional (3D) printing/additive manufacturing has not been used extensively to create medical devices intended for actual clinical use, primarily on patient safety and regulatory grounds. However, in recent years there have been advances in materials, printers, and experience, leading to increased clinical use. The aim of this study was to perform a structured systematic review of 3D-printed medical devices used directly in patient treatment. A search of 13 databases was performed to identify studies of 3D-printed medical devices, detailing fabrication technology and materials employed, clinical application, and clinical outcome. One hundred and ten papers describing one hundred and forty medical devices were identified and analyzed. A considerable increase was identified in the use of 3D printing to produce medical devices directly for clinical use in the past 3 years. This is dominated by printing of patient-specific implants and surgical guides for use in orthopedics and orthopedic oncology, but there is a trend of increased use across other clinical specialties. The prevailing material/3D-printing technology used were titanium alloy/electron beam melting for implants, and polyamide/selective laser sintering or polylactic acid/fused deposition modeling for surgical guides and instruments. A detailed analysis across medical applications by technology and materials is provided, as well as a commentary regarding regulatory aspects. In general, there is growing familiarity with, and acceptance of, 3D printing in clinical use.
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Affiliation(s)
| | - Alice Shannon
- School of Design, University of Limerick, Limerick, Ireland
| | | | - Conor McCarthy
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Colum P. Dunne
- Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
| | - Leonard W. O'Sullivan
- School of Design, University of Limerick, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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20
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Chen D, Tang Y, Nie H, Zhang P, Wang W, Dong Q, Wu G, Xue M, Tang Y, Liu W, Pan C, Tang Z. Primary Brainstem Hemorrhage: A Review of Prognostic Factors and Surgical Management. Front Neurol 2021; 12:727962. [PMID: 34566872 PMCID: PMC8460873 DOI: 10.3389/fneur.2021.727962] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/19/2021] [Indexed: 01/04/2023] Open
Abstract
Primary brainstem hemorrhage (PBSH) is the most fatal subtype of intracerebral hemorrhage and is invariably associated with poor prognosis. Several prognostic factors are involved, of which the two most predominant and consistent are the initial level of consciousness and hemorrhage size. Other predictors, such as age, hyperthermia, and hydrocephalus, are generally not dependable indicators for making prognoses. Scoring systems have now been developed that can predict mortality and functional outcomes in patients suffering from PBSH, which can thus guide treatment decision-making. A novel grading scale, entitled “the new primary pontine hemorrhage (PPH) score,” represents the latest approach in scoring systems. In this system, patients with a score of 2–3 points appear to benefit from surgical management, although this claim requires further verification. The four main surgical options for the treatment of PBSH are craniotomy, stereotactic hematoma puncture and drainage, endoscopic hematoma removal, and external ventricular drainage. Nevertheless, the management of PBSH still primarily involves conservative treatment methods and surgery is generally not recommended, according to current practice. However, the ongoing clinical trial, entitled Safety and Efficacy of Surgical Treatment in Severe Primary Pontine Hemorrhage Evacuation (STIPE), should provide additional evidence to support the surgical treatment of PBSH. Therefore, we advocate the update of epidemiological data and re-evaluation of PBSH treatment in a contemporary context.
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Affiliation(s)
- Danyang Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingxin Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Nie
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Guofeng Wu
- Department of Emergency, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Mengzhou Xue
- The Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuping Tang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjie Liu
- Beijing WanTeFu Medical Apparatus Co., Ltd., Beijing, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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21
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Li Y, Wu DX, Liu JF, Li H, Wang JW, Li YX, Guo H, Liu W, Ji L, Chen LY, Zhang WH, Jing SQ, Xu LF, Wang ZF, Li CH. Analysis of the curative effect and influencing factors of stereotactic aspiration in the treatment of primary brainstem haemorrhage. J Clin Neurosci 2021; 89:122-127. [PMID: 34119254 DOI: 10.1016/j.jocn.2021.04.014] [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: 01/16/2021] [Revised: 03/31/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
Primary brainstem haemorrhage (PBH) is characterized by acute onset, rapid deterioration, many complications, and poor prognosis. Its treatment has been controversial. This study aimed to explore the clinical risk factors of postoperative survival and neurological function recovery of stereotactic aspiration in the treatment of PBH. The clinical data of 65 patients with severe brainstem haemorrhage from February 2019 to February 2020 in the First Hospital of Hebei Medical University were reviewed. All patients were treated with stereotactic haematoma aspiration. We determined the survival status of patients at 30 days after the operation and the recovery of neurological function at 90 days. The modified Rankin Scale score (mRS) was used to assess the survival status. The 30-day mortality rate was 23.1% (15 patients). The proportion of patients with good neurological recovery at 90 days after the operation was 32.3% (21 patients). According to the multivariate logistic regression analysis, the haematoma classification was an independent risk factor for postoperative survival (OR = 0.197, 95% CI: 0.016-0.385, p = 0.046) and recovery of neurological function 90 days after surgery (OR = 0.019, 95% CI: 0.001-0.267, p = 0.003). The haematoma classification is an independent risk factor for 30-day mortality and recovery of neurological function 90 days after surgery. Massive and basal-tegmental haematomas were associated with higher mortality. The prognosis of patients with unilateral and bilateral tegmental haematoma was better than that of patients with other haematoma types.
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Affiliation(s)
- Yan Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dong-Xue Wu
- Department of Radiology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jian-Feng Liu
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ji-Wei Wang
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya-Xiong Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hao Guo
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Liu
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Le Ji
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ling-You Chen
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wen-Hua Zhang
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shan-Quan Jing
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Li-Feng Xu
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zi-Feng Wang
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Cong-Hui Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China.
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22
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Katsuki M, Narita N, Sato K, Kochi R, Nishizawa T, Kawamura K, Ishida N, Watanabe O, Cai S, Shimabukuro S, Tominaga T. Where to make burr hole for endoscopic hematoma removal against intracerebral hemorrhage at the basal ganglia to increase the hematoma removal rate - Comparison between trans-forehead and along-the-long-axis approaches. Surg Neurol Int 2021; 12:41. [PMID: 33598357 PMCID: PMC7881520 DOI: 10.25259/sni_887_2020] [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: 12/08/2020] [Accepted: 01/13/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Endoscopic hematoma removal is performed to treat intracerebral hemorrhage (ICH) at the basal ganglia. In our hospital, young neurosurgical trainees perform it for the only 1st to the 3rd time. We perform a “trans-forehead approach” and hypothesized that our technique would contribute to higher hematoma removal rate and easiness despite their inexperience. We compared our dataset with an open dataset with along-the-long-axis approaches using pre- and intraoperative neuronavigation by well-trained neurosurgeons and tested the utility of our trans-forehead approach. Methods: We retrospectively investigated our 17 consecutive patients with hypertensive ICH who underwent endoscopic hematoma removal using the trans-forehead approach. We obtained the open dataset and compared our data with the 12 patients from the open dataset using the inverse probability weighting method. Operative time, hematoma removal rate, postoperative hematoma volume, Glasgow Coma Scale (GCS) on day 7, and modified Rankin Scale (mRS) at 6 months were assessed as outcomes. Results: The median age was 68 (interquartile range; 58–78) years. Median postoperative hematoma volume, removal rate, operative time, GCS on day 7, and mRS at 6 months were 9 (2–24) mL, 90 (79–98)%, 53 (41–80) min, 13 (12–13), and 4 (2–5), respectively. The weighted generalized estimating equations revealed that operative time was shorter in the along-the-long-axis group, but other items were not significantly different between the two approaches. Conclusion: The hematoma removal rate of endoscopic hematoma removal with the trans-forehead approach by young trainees was not different from that of the along-the-long-axis approach by well-trained neurosurgeons using neuronavigation.
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Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Japan
| | - Norio Narita
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Japan
| | - Kanako Sato
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Japan
| | - Ryuzaburo Kochi
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Japan
| | - Taketo Nishizawa
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Japan
| | - Kokoro Kawamura
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Japan
| | - Naoya Ishida
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Japan
| | - Ohmi Watanabe
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Japan
| | - Siqi Cai
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Japan
| | | | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Li Y, Cheng H, Li Z, Zhao H, Wang J, Wang P, Jin T, Zheng G, Ye H, Li S, Zhang J. Clinical Value of 3D-Printed Navigation Technology Combined with Neuroendoscopy for Intracerebral Hemorrhage. Transl Stroke Res 2021; 12:1035-1044. [PMID: 33492652 DOI: 10.1007/s12975-021-00893-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/03/2021] [Accepted: 01/17/2021] [Indexed: 11/25/2022]
Abstract
Intracerebral hemorrhage (ICH) is the most common form of hemorrhagic stroke with high morbidity and mortality. Rapid and massive bleeding may compress the brain tissue, causing space-occupying and pathological effects, such as reduced local cerebral blood flow, acidosis, and inflammatory and immune responses. Although the development of minimally invasive technique provides a new option for the treatment of ICH, their application is limited due to the difficulty in achieving accurate puncture localization under the guidance of the marks on CT. We selected 30 patients treated with neuroendoscopic surgery guided by 3D-printed navigation technology (experimental group) and 30 patients treated with neuroendoscopic surgery guided by hand-painted on the patient's body surface according to the marks on CT (control group). Our results showed that patients in the experimental group had a lower number of intraoperative punctures, shorter operation time, less intraoperative blood loss, higher hematoma clearance rate, and smaller volume of perihematomal edema than the patients in the control group. Moreover, patients in the experimental group had higher Glasgow Coma Scale score at discharge, shorter postoperative hospitalization time and ICU stay, and a lower rate of postoperative complications, despite the lack of statistically significant differences. In addition, no statistically significant differences were observed in mortality and Glasgow Outcome Scale score between the two groups. In conclusion, 3D-printed navigation technology used for the neuroendoscopic hematoma removal is a more reliable and less invasive approach in the treatment of ICH. This technique has great application prospects and deserves promotion in the future clinical practice.
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Affiliation(s)
- Yuqian Li
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Hongyu Cheng
- Department of Ultrasound Diagnosis, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Zhenzhu Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Haikang Zhao
- Department of Neurosurgery, The Second Hospital Affiliated of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Jiancai Wang
- Department of Neurosurgery, PLA 982 hospital, Tangshan, Hebei, China
| | - Peng Wang
- Department of Neurosurgery, Dalang Hospital, Dongguan, Guangdong, China
| | - Tongxin Jin
- Department of Intensive Care Unit, Dalang Hospital, Dongguan, Guangdong, China
| | - Guiyong Zheng
- Department of Anesthesiology, Dalang Hospital, Dongguan, Guangdong, China
| | - Haoxiang Ye
- Department of Radiology, Dalang Hospital, Dongguan, Guangdong, China
| | - Shaopeng Li
- Department of Neurosurgery, Dongguan People's Hospital, Affiliated Dongguan People's Hospital of Southern Medical University, Dongguan, China.
| | - Jun Zhang
- Department of Neurosurgery, Dalang Hospital, Dongguan, Guangdong, China.
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Katsuki M, Kakizawa Y, Nishikawa A, Yamamoto Y, Uchiyama T. Lower total protein and absence of neuronavigation are novel poor prognostic factors of endoscopic hematoma removal for intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2020; 29:105050. [PMID: 32807458 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105050] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Endoscopic hematoma removal is widely performed for the treatment of intracerebral hemorrhage. We investigated the factors related to the prognosis of intracerebral hemorrhage after endoscopic hematoma removal. MATERIALS AND METHODS From 2013 to 2019, we retrospectively analyzed 75 consecutive patients with hypertensive intracerebral hemorrhage who underwent endoscopic hematoma removal. Their characteristics, including neurological symptoms, laboratory data, and radiological findings were investigated using univariate and multivariate analysis. Complications during hospitalization, Glasgow Coma Scale (GCS) score on day 7, and modified Rankin Scale (mRS) score at 6 months were considered as treatment outcomes. RESULTS The mean age of the patients (33 women, 42 men) was 71.8 (36-95) years. Mean GCS scores at admission and on day 7 were 10.3 ± 3.2 and 11.7 ± 3.8, respectively. The mean mRS score at 6 months was 3.8 ± 1.6, and poor outcome (mRS score ranging from 3 to 6 at 6 months) in 53 patients. Rebleeding occurred in 4 patients, and other complications in 15 patients. Multivariate analysis revealed that older age, hematoma in the basal ganglia, lower total protein level, higher glucose level, and absence of neuronavigation were associated with poor outcomes. Of the 75 patients, 9 had cerebellar hemorrhages, and they had relatively favorable outcomes compared to those with supratentorial hemorrhages. CONCLUSION Several factors were related to the prognosis of intracerebral hemorrhage after endoscopic hematoma removal. Lower total protein level at admission and absence of neuronavigation were novel factors related to poor outcomes of endoscopic hematoma removal for intracerebral hemorrhage.
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Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, 5-11-50, Kogandori, Suwa, Nagano 981-0945, Japan
| | - Yukinari Kakizawa
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, 5-11-50, Kogandori, Suwa, Nagano 981-0945, Japan.
| | - Akihiro Nishikawa
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, 5-11-50, Kogandori, Suwa, Nagano 981-0945, Japan
| | - Yasunaga Yamamoto
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, 5-11-50, Kogandori, Suwa, Nagano 981-0945, Japan
| | - Toshiya Uchiyama
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, 5-11-50, Kogandori, Suwa, Nagano 981-0945, Japan
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