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Lodin J, Jelínek M, Procházka J, Sameš M, Vachata P. Quantitative gait analysis of patients with severe sacroiliac joint dysfunction: a prospective clinical study. J Neurosurg Sci 2023; 67:694-701. [PMID: 34342204 DOI: 10.23736/s0390-5616.21.05448-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sacroiliac joint (SIJ) dysfunction is a chronic painful condition responsible for up to 30% of back pain. Treatment modalities include physiotherapy, intraarticular analgesic injections, ablation techniques or SIJ fusion. The severity of SIJ dysfunction is commonly assessed via subjective pain or disability scales. Quantitative gait analysis offers an objective means of evaluating patients with SIJ dysfunction prior to its surgical treatment. METHODS Ten patients diagnosed with severe SIJ dysfunction were matched with 10 healthy controls. All individuals underwent quantitative 3D gait analysis using the Qualisys program and statistical analysis was performed to identify significant differences in gait parameters between the two groups. RESULTS Two groups of data were obtained; angular parameters described by the Gait Profile Score (GPS) and spatiotemporal parameters described in standard SI units. Statistically significant differences were found between the patient and control group for parameters: overall GPS (P=0.049), hip abduction/adduction (P=0.017) and ankle plantar/dorsal flexion (P=0.003), stride length (P=0.002), step length (P=0.001), swing time (P=0.03) and initial double limb support (P=0.02). CONCLUSIONS This paper is the first to perform complex quantitative gait analysis of patients with SIJ dysfunction and to compare it with healthy individuals. These results can provide clinicians with baseline gait values for these patients to objectively quantify the extent of their disease.
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Affiliation(s)
- Jan Lodin
- Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic -
- Faculty of Medicine in Plzeň, Charles University, Plzeň, Czech Republic -
| | - Marek Jelínek
- University of Jan Evangelista Purkynje, Ústí nad Labem, Czech Republic
| | - Jan Procházka
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, Chronic Pain Therapy Center, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic
| | - Martin Sameš
- Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic
| | - Petr Vachata
- Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic
- Faculty of Medicine in Plzeň, Charles University, Plzeň, Czech Republic
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Lodin J, Terč J, Cihlář F, Sameš M, Cihlář J, Vachata P. Dynamics of atlantoaxial rotation related to age and sex: a cross-sectional study of 308 subjects. Spine J 2023; 23:1276-1286. [PMID: 37182705 DOI: 10.1016/j.spinee.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND CONTEXT Physiological ranges and dynamic changes of atlantoaxial rotation (ROTC1/2), total cervical spine rotation (ROTCs) and the percentage of ROTC1/2 from ROTCs (ROTCperc) for different age groups have not yet been investigated in a sufficiently sized cohort. Furthermore, it is not clear whether demographic variables such a sex, smoking status or diabetes affect ROTC1/2, ROTCs and ROTCperc. PURPOSE Obtain physiological ranges of ROTC1/2, ROTCs and ROTCperc for different age groups and determine their age-based dynamics. Investigate whether ROTC1/2, ROTCs and ROTCperc are affected by sex, smoking status or diabetes. DESIGN Observational cross-sectional study. PATIENT SAMPLE Patients undergoing elective CT examinations of the head and neck region between August 2020 and January 2022. OUTCOME MEASURES Ranges of motion of ROTC1/2, ROTCs and ROTCperc in degrees. METHODS A total of 308 subjects underwent dynamic rotational CT examinations of the upper cervical spine. Patients were divided into three age categories A1 (27-49 years), A2 (50-69 years) and A3 (≥70 years). Category A3 was further divided into B1 (70-79 years) and B2 (≥80 years). Values of ROTC1/2, ROTCs and ROTCperc were compared between all age groups, males and females, smokers and nonsmokers, diabetics a nondiabetics. Dynamics of ROTC1/2, ROTCs related to age and sex were visualized using scatterplot and trendline models. RESULTS ROTC1/2 significantly decreased from group A1 (64.4°) to B2 (46.7°) as did ROTCs from A1 (131.2°) to B2 (97.6°). No significant differences of ROTperc were found between groups A1-B2 with values oscillating between 49% and 51%. Smoking and diabetes did not significantly affect ROTC1/2, ROTCs and ROTCperc, females had significantly higher ROTCs than males. Males and females demonstrated a different dynamic of ROTC1/2 and ROTCs demonstrated by out scatterplot and trendline models. CONCLUSIONS Both ROTC1/2 and ROTCs significantly decrease with age, whereas ROTCperc remains stable. Females demonstrated higher ROTCs and their decrease of ROTC1/2 and ROTCs occurred in higher age groups compared to males. The functional repercussions atlantoaxial fusion are variable based on patient age and sex and should be taken into account prior to surgery.
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Affiliation(s)
- Jan Lodin
- Neurosurgical Department, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic; Faculty of Medicine in Plzeň, Charles University, Husova 3, Plzeň, Czech Republic.
| | - Jan Terč
- Department of Radiology, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic
| | - Filip Cihlář
- Department of Radiology, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic
| | - Martin Sameš
- Neurosurgical Department, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic
| | - Jiří Cihlář
- J. E. Purkyně University, Pasteurova 3544/1, Ústí nad Labem, Czech Republic
| | - Petr Vachata
- Neurosurgical Department, Faculty of Health Studies J. E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Sociální Péče 3316/12A, Ústí nad Labem, Czech Republic; Faculty of Medicine in Plzeň, Charles University, Husova 3, Plzeň, Czech Republic
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Vachata P, Lodin J, Bolcha M, Brušáková Š, Sameš M. Acute Progressive Pediatric Post-Traumatic Kyphotic Deformity. Children (Basel) 2023; 10:932. [PMID: 37371164 DOI: 10.3390/children10060932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
Cervical kyphosis is a rare entity with challenging management due to the limitations of pediatric age, along with a growing spine. The pathogenesis is made up of a large group of congenital, syndromic and acquired deformities after posterior element deterioration or as a result of previous trauma or surgery. In rare progressive cases, kyphotic deformities may result in severe "chin-on-chest" deformities with severe limitations. The pathogenesis of progression to severe kyphotic deformity after minor hyperflexion trauma is not clear without an obvious MR pathology; it is most likely multifactorial. The authors present the case of a six-month progression of a pediatric cervical kyphotic deformity caused by a cervical spine hyperflexion injury, and an MR evaluation without the pathology of disc or major ligaments. Surgical therapy with a posterior fixation and fusion, together with the preservation of the anterior growing zones of the cervical spine, are potentially beneficial strategies to achieve an excellent curve correction and an optimal long-term clinical outcome in this age group.
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Affiliation(s)
- Petr Vachata
- Department of Neurosurgery, J. E. Purkyně University, Masaryk Hospital, 401 13 Ústí nad Labem, Czech Republic
- Department of Neurosurgery, University Hospital in Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, 323 00 Pilsen, Czech Republic
| | - Jan Lodin
- Department of Neurosurgery, J. E. Purkyně University, Masaryk Hospital, 401 13 Ústí nad Labem, Czech Republic
- Department of Neurosurgery, University Hospital in Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, 323 00 Pilsen, Czech Republic
| | - Martin Bolcha
- Department of Neurosurgery, J. E. Purkyně University, Masaryk Hospital, 401 13 Ústí nad Labem, Czech Republic
- Department of Neurosurgery, University Hospital in Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, 323 00 Pilsen, Czech Republic
| | - Štepánka Brušáková
- Department of Neurology, Masaryk Hospital, 401 13 Ústí nad Labem, Czech Republic
| | - Martin Sameš
- Department of Neurosurgery, J. E. Purkyně University, Masaryk Hospital, 401 13 Ústí nad Labem, Czech Republic
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Bartoš R, Hejčl A, Lodin J, Sameš M, Marek T. Rescue version of a carotid micro-endarterectomy: an ACE-ICA anastomosis with proximal Ica and distal ACE hemoclip obliteration. Int J Neurosci 2023; 133:403-407. [PMID: 33926345 DOI: 10.1080/00207454.2021.1923490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aim of the study: To present our rescue approach of carotid artery occlusion as well as to discuss other possible techniques that can be applied in similar situations.Materials and methods: Two cases from our institution with acute complications during carotid micro-endarterectomy (CEA).Results: Two cases from our institution with acute postoperative complications during CEA that were successfully addressed are presented with imaging and detailed description of the surgical techniques used.Conclusion: CEA are common surgical procedures pursued to achieve revascularization of carotid arteries when occluded partially or fully by an atherosclerotic plaque. As with any surgical procedure, associated complications exist in small percentage of the cases. These can include blood flow limitation due to an insufficient artery wall after atherosclerotic plaque extraction as well as distal kinking of the internal carotid artery. A direct end-to-end ACE-ACI bypass with occlusion of the proximal ACI and distal ACE stump preserves distal flow to the ACI, however the original arteriotomy of ACC must be completely sutured up to the arterial stumps.
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Affiliation(s)
- Robert Bartoš
- Department of Neurosurgery, Masaryk Hospital, Ústí nad Labem, Czech Republic.,Department of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Aleš Hejčl
- Department of Neurosurgery, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - Jan Lodin
- Department of Neurosurgery, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - Martin Sameš
- Department of Neurosurgery, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - Tomas Marek
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.,Department of General Surgery, Nassau University Medical Centre, East Meadow, NY, USA
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Clark D, Joannides A, Adeleye AO, Bajamal AH, Bashford T, Biluts H, Budohoski K, Ercole A, Fernández-Méndez R, Figaji A, Gupta DK, Härtl R, Iaccarino C, Khan T, Laeke T, Rubiano A, Shabani HK, Sichizya K, Tewari M, Tirsit A, Thu M, Tripathi M, Trivedi R, Devi BI, Servadei F, Menon D, Kolias A, Hutchinson P, Abdallah OI, Abdel-Lateef A, Abdifatah K, Abdullateef A, Abeygunaratne R, Aboellil M, Adam A, Adams R, Adeleye A, Adeolu A, Adji NK, Afianti N, Agarwal S, Aghadi IK, Aguilar PMM, Ahmad SR, Ahmed D, Ahmed N, Aizaz H, Aji YK, Alamri A, Alberto AJM, Alcocer LA, Alfaro LG, Al-Habib A, Alhourani A, Ali SMR, Alkherayf F, AlMenabbawy A, Alshareef A, Aminullah MAS, Amjad M, Amorim RLOD, Anbazhagan S, Andrade A, Antar W, Anyomih TT, Aoun S, Apriawan T, Armocida D, Arnold P, Arraez M, Assefa T, Asser A, Athiththan S, Attanayake D, Aung MM, Avi A, Ayala VEA, Azab M, Azam G, Azharuddin M, Badejo O, Badran M, Baig AA, Baig RA, Bajaj A, Baker P, Bala R, Balasa A, Balchin R, Balogun J, Ban VS, Bandi BKR, Bandyopadhyay S, Bank M, Barthelemy E, Bashir MT, Basso LS, Basu S, Batista A, Bauer M, Bavishi D, Beane A, Bejell S, Belachew A, Belli A, Belouaer A, Bendahane NEA, Benjamin O, Benslimane Y, Benyaiche C, Bernucci C, Berra LV, Bhebe A, Bimpis A, Blanaru D, Bonfim JC, Borba LAB, Borcek AO, Borotto E, Bouhuwaish AEM, Bourilhon F, Brachini G, Breedon J, Broger M, Brunetto GMF, Bruzzaniti P, Budohoska N, Burhan H, Calatroni ML, Camargo C, Cappai PF, Cardali SM, Castaño-Leon AM, Cederberg D, Celaya M, Cenzato M, Challa LM, Charest D, Chaurasia B, Chenna R, Cherian I, Ching'o JH, Chotai T, Choudhary A, Choudhary N, Choumin F, Cigic T, Ciro J, Conti C, Corrêa ACDS, Cossu G, Couto MP, Cruz A, D'Silva D, D'Aliberti GA, Dampha L, Daniel RT, Dapaah A, Darbar A, Dascalu G, Dauda HA, Davies O, Delgado-Babiano A, Dengl M, Despotovic M, Devi I, Dias C, Dirar M, Dissanayake M, Djimbaye H, Dockrell S, Dolachee A, Dolgopolova J, Dolgun M, Dow A, Drusiani D, Dugan A, Duong DT, Duong TK, Dziedzic T, Ebrahim A, El Fatemi N, El Helou AE, El Maaqili RE, El Mostarchid BE, El Ouahabi AE, Elbaroody M, El-Fiki A, El-Garci A, El-Ghandour NM, Elhadi M, Elleder V, Elrais S, El-shazly M, Elshenawy M, Elshitany H, El-Sobky O, Emhamed M, Enicker B, Erdogan O, Ertl S, Esene I, Espinosa OO, Fadalla T, Fadelalla M, Faleiro RM, Fatima N, Fawaz C, Fentaw A, Fernandez CE, Ferreira A, Ferri F, Figaji T, Filho ELB, Fin L, Fisher B, Fitra F, Flores AP, Florian IS, Fontana V, Ford L, Fountain D, Frade JMR, Fratto A, Freyschlag C, Gabin AS, Gallagher C, Ganau M, Gandia-Gonzalez ML, Garcia A, Garcia BH, Garusinghe S, Gebreegziabher B, Gelb A, George JS, Germanò AF, Ghetti I, Ghimire P, Giammarusti A, Gil JL, Gkolia P, Godebo Y, Gollapudi PR, Golubovic J, Gomes JF, Gonzales J, Gormley W, Gots A, Gribaudi GL, Griswold D, Gritti P, Grobler R, Gunawan R, Hailemichael B, Hakkou E, Haley M, Hamdan A, Hammed A, Hamouda W, Hamzah NA, Han NL, Hanalioglu S, Haniffa R, Hanko M, Hanrahan J, Hardcastle T, Hassani FD, Heidecke V, Helseth E, Hernández-Hernández MÁ, Hickman Z, Hoang LMC, Hollinger A, Horakova L, Hossain-Ibrahim K, Hou B, Hoz S, Hsu J, Hunn M, Hussain M, Iacopino G, Ideta MML, Iglesias I, Ilunga A, Imtiaz N, Islam R, Ivashchenko S, Izirouel K, Jabal MS, Jabal S, Jabang JN, Jamjoom A, Jan I, Jarju LBM, Javed S, Jelaca B, Jhawar SS, Jiang TT, Jimenez F, Jiris J, Jithoo R, Johnson W, Joseph M, Joshi R, Junttila E, Jusabani M, Kache SA, Kadali SP, Kalkmann GF, Kamboh U, Kandel H, Karakus AK, Kassa M, Katila A, Kato Y, Keba M, Kehoe K, Kertmen HH, Khafaji S, Khajanchi M, Khan M, Khan MM, Khan SD, Khizar A, Khriesh A, Kierońska S, Kisanga P, Kivevele B, Koczyk K, Koerling AL, Koffenberger D, Kõiv K, Kõiv L, Kolarovszki B, König M, Könü-Leblebicioglu D, Koppala SD, Korhonen T, Kostkiewicz B, Kostyra K, Kotakadira S, Kotha AR, Kottakki MNR, Krajcinovic N, Krakowiak M, Kramer A, Krishnamoorthy S, Kumar A, Kumar P, Kumar P, Kumarasinghe N, Kuncha G, Kutty RK, Laeke T, Lafta G, Lammy S, Lapolla P, Lardani J, Lasica N, Lastrucci G, Launey Y, Lavalle L, Lawrence T, Lazaro A, Lebed V, Leinonen V, Lemeri L, Levi L, Lim JY, Lim XY, Linares-Torres J, Lippa L, Lisboa L, Liu J, Liu Z, Lo WB, Lodin J, Loi F, Londono D, Lopez PAG, López CB, Lotbiniere-Bassett MD, Lulens R, Luna FH, Luoto T, M.V. VS, Mabovula N, MacAllister M, Macie AA, Maduri R, Mahfoud M, Mahmood A, Mahmoud F, Mahoney D, Makhlouf W, Malcolm G, Malomo A, Malomo T, Mani MK, Marçal TG, Marchello J, Marchesini N, Marhold F, Marklund N, Martín-Láez R, Mathaneswaran V, Mato-Mañas DJ, Maye H, McLean AL, McMahon C, Mediratta S, Mehboob M, Meneses A, Mentri N, Mersha H, Mesa AM, Meyer C, Millward C, Mimbir SA, Mingoli A, Mishra P, Mishra T, Misra B, Mittal S, Mohammed I, Moldovan I, Molefe M, Moles A, Moodley P, Morales MAN, Morgan L, Morillo GDC, Moustafa W, Moustakis N, Mrichi S, Munjal SS, Muntaka AJM, Naicker D, Nakashima PEH, Nandigama PK, Nash S, Negoi I, Negoita V, Neupane S, Nguyen MH, Niantiarno FH, Noble A, Nor MAM, Nowak B, Oancea A, O'Brien F, Okere O, Olaya S, Oliveira L, Oliveira LM, Omar F, Ononeme O, Opšenák R, Orlandini S, Osama A, Osei-Poku D, Osman H, Otero A, Ottenhausen M, Otzri S, Outani O, Owusu EA, Owusu-Agyemang K, Ozair A, Ozoner B, Paal E, Paiva MS, Paiva W, Pandey S, Pansini G, Pansini L, Pantel T, Pantelas N, Papadopoulos K, Papic V, Park K, Park N, Paschoal EHA, Paschoalino MCDO, Pathi R, Peethambaran A, Pereira TA, Perez IP, Pérez CJP, Periyasamy T, Peron S, Phillips M, Picazo SS, Pinar E, Pinggera D, Piper R, Pirakash P, Popadic B, Posti JP, Prabhakar RB, Pradeepan S, Prasad M, Prieto PC, Prince R, Prontera A, Provaznikova E, Quadros D, Quintero NJR, Qureshi M, Rabiel H, Rada G, Ragavan S, Rahman J, Ramadhan O, Ramaswamy P, Rashid S, Rathugamage J, Rätsep T, Rauhala M, Raza A, Reddycherla NR, Reen L, Refaat M, Regli L, Ren H, Ria A, Ribeiro TF, Ricci A, Richterová R, Ringel F, Robertson F, Rocha CMSC, Rogério JDS, Romano AA, Rothemeyer S, Rousseau GRG, Roza R, Rueda KDF, Ruiz R, Rundgren M, Rzeplinski R, S.Chandran R, Sadayandi RA, Sage W, Sagerer ANJ, Sakar M, Salami M, Sale D, Saleh Y, Sánchez-Viguera C, Sandila S, Sanli AM, Santi L, Santoro A, Santos AKDD, Santos SCD, Sanz B, Sapkota S, Sasidharan G, Sasillo I, Satoskar R, Sayar AC, Sayee V, Scheichel F, Schiavo FL, Schupper A, Schwarz A, Scott T, Seeberger E, Segundo CNC, Seidu AS, Selfa A, Selmi NH, Selvarajah C, Şengel N, Seule M, Severo L, Shah P, Shahzad M, Shangase T, Sharma M, Shiban E, Shimber E, Shokunbi T, Siddiqui K, Sieg E, Siegemund M, Sikder SR, Silva ACV, Silva A, Silva PA, Singh D, Skadden C, Skola J, Skouteli E, Słoniewski P, Smith B, Solanki G, Solla DF, Solla D, Sonmez O, Sönmez M, Soon WC, Stefini R, Stienen MN, Stoica B, Stovell M, Suarez MN, Sulaiman A, Suliman M, Sulistyanto A, Sulubulut Ş, Sungailaite S, Surbeck M, Szmuda T, Taddei G, Tadele A, Taher ASA, Takala R, Talari KM, Tan BH, Tariciotti L, Tarmohamed M, Taroua O, Tatti E, Tenovuo O, Tetri S, Thakkar P, Thango N, Thatikonda SK, Thesleff T, Thomé C, Thornton O, Timmons S, Timoteo EE, Tingate C, Tliba S, Tolias C, Toman E, Torres I, Torres L, Touissi Y, Touray M, Tropeano MP, Tsermoulas G, Tsitsipanis C, Turkoglu ME, Uçkun ÖM, Ullman J, Ungureanu G, Urasa S, Ur-Rehman O, Uysal M, Vakis A, Valeinis E, Valluru V, Vannoy D, Vargas P, Varotsis P, Varshney R, Vats A, Veljanoski D, Venturini S, Verma A, Villa C, Villa G, Villar S, Villard E, Viruez A, Voglis S, Vulekovic P, Wadanamby S, Wagner K, Walshe R, Walter J, Waseem M, Whitworth T, Wijeyekoon R, Williams A, Wilson M, Win S, Winarso AWW, Ximenes AWP, Yadav A, Yadav D, Yakoub KM, Yalcinkaya A, Yan G, Yaqoob E, Yepes C, Yılmaz AN, Yishak B, Yousuf FB, Zahari MZ, Zakaria H, Zambonin D, Zavatto L, Zebian B, Zeitlberger AM, Zhang F, Zheng F, Ziga M. Casemix, management, and mortality of patients rreseceiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study. Lancet Neurol 2022; 21:438-449. [PMID: 35305318 DOI: 10.1016/s1474-4422(22)00037-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/19/2021] [Accepted: 01/17/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. METHODS We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)-a composite of life expectancy, education, and income measures-into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. FINDINGS Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24-51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34-69) and the youngest in the low HDI tier (median 28 years, IQR 20-38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6-32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55-5·2) and high HDI tier (2·26, 1·23-4·15), but not the low HDI tier (1·66, 0·61-4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17-2·49). INTERPRETATION Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. FUNDING National Institute for Health Research Global Health Research Group.
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Affiliation(s)
- David Clark
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; Neurosurgery Division, University Teaching Hospital, Lusaka, Zambia.
| | - Alexis Joannides
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Amos Olufemi Adeleye
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Dr Soetomo Hospital, Surabaya, Jawa Timur, Indonesia
| | - Tom Bashford
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Hagos Biluts
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Karol Budohoski
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Ari Ercole
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Rocío Fernández-Méndez
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Anthony Figaji
- Division of Neurosurgery and Neurosciences Institute, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Deepak Kumar Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Corrado Iaccarino
- Neurosurgery Division, University Hospital of Parma, Parma, Emilia-Romagna, Italy
| | - Tariq Khan
- Department of Neurosurgery, North West General Hospital & Research Center, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tsegazeab Laeke
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Andrés Rubiano
- Department of Neurosurgery, Universidad El Bosque, Bogota, Colombia
| | - Hamisi K Shabani
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute and Muhimbili University College of Allied Health Sciences, Dar es Salaam, Tanzania
| | | | - Manoj Tewari
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Abenezer Tirsit
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Myat Thu
- Department of Neurosurgery, Yangon General Hospital, Yangon, Yangon Region, Myanmar
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Rikin Trivedi
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Franco Servadei
- Humanitas Clinical and Research Center-IRCCS and Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - David Menon
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Angelos Kolias
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Peter Hutchinson
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
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Lodin J, Jelínek M, Sameš M, Vachata P. Quantitative Gait Analysis of Patients with Severe Symptomatic Spinal Stenosis Utilizing the Gait Profile Score: An Observational Clinical Study. Sensors 2022; 22:s22041633. [PMID: 35214534 PMCID: PMC8875117 DOI: 10.3390/s22041633] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 12/04/2022]
Abstract
Lumbar spine stenosis (LSS) typically manifests with neurogenic claudication, altering patients’ gait. The use of optoelectronic systems has allowed clinicians to perform 3D quantitative gait analysis to quantify and understand these alterations. Although several authors have presented analysis of spatiotemporal gait parameters, data concerning kinematic parameters is lacking. Fifteen patients with LSS were matched with 15 healthy controls. Quantitative gait analysis utilizing optoelectronic techniques was performed for each pair of subjects in a specialized laboratory. Statistical comparison of patients and controls was performed to determine differences in spatiotemporal parameters and the Gait Profile Score (GPS). Statistically significant differences were found between patient and control groups for all spatiotemporal parameters. Patients had significantly different overall GPS (p = 0.004) and had limited internal/external pelvic rotation (p < 0.001) and cranial/caudal movement (p = 0.034), limited hip extension (p = 0.012) and abduction/adduction (p = 0.012) and limited ankle plantar flexion (p < 0.001). In conclusion, patients with LSS have significantly altered gait patterns in three regions (pelvis, hip and ankle) compared to healthy controls. Analysis of kinematic graphs has given insight into gait pathophysiology of patients with LSS and the use of GPS will allow us to quantify surgical results in the future.
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Affiliation(s)
- Jan Lodin
- Neurosurgical Department, J. E. Purkyně University, Masaryk Hospital of Krajská Zdravotní a.s., Sociální Péče 3316/12A, 400 11 Ústí nad Labem, Czech Republic; (M.S.); (P.V.)
- Faculty of Medicine in Plzeň, Charles University, Husova 3, 306 05 Plzeň, Czech Republic
- Correspondence: ; Tel.: +420-605323238
| | - Marek Jelínek
- Laboratory for the Study of Movement, Faculty of Health Studies, J. E. Purkyně University in Ústí nad Labem, Pasteurova 3544/1, 400 96 Ústí nad Labem, Czech Republic;
| | - Martin Sameš
- Neurosurgical Department, J. E. Purkyně University, Masaryk Hospital of Krajská Zdravotní a.s., Sociální Péče 3316/12A, 400 11 Ústí nad Labem, Czech Republic; (M.S.); (P.V.)
| | - Petr Vachata
- Neurosurgical Department, J. E. Purkyně University, Masaryk Hospital of Krajská Zdravotní a.s., Sociální Péče 3316/12A, 400 11 Ústí nad Labem, Czech Republic; (M.S.); (P.V.)
- Faculty of Medicine in Plzeň, Charles University, Husova 3, 306 05 Plzeň, Czech Republic
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Lodin J, Brušáková Š, Kachlík D, Sameš M, Humhej I. Acute piriformis syndrome mimicking cauda equina syndrome: illustrative case. Journal of Neurosurgery: Case Lessons 2021; 2:CASE21252. [PMID: 36060900 PMCID: PMC9435562 DOI: 10.3171/case21252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/01/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND This report depicts a rare case of acutely developed urinary retention as well as sensory and motor disturbances caused by formation of a large hematoma within the piriformis muscle, which caused compression of nerves within the suprapiriform and infrapiriform foramina, thus imitating cauda equina syndrome. Although cases of acute lumbosacral plexopathy have been described, this case is the first time both urinary retention and sensory and motor disturbances were present. OBSERVATIONS The most useful tools for diagnosis of acute piriformis syndrome are detailed patient history, magnetic resonance imaging (MRI) of the pelvic region, and electrophysiological testing performed by an experienced electrophysiologist. As a result of diligent rehabilitation, including physiotherapy and electrostimulation, the patient was able to successfully recover, regardless of acute compression of the sacral plexus that lasted 6 days. LESSONS Clinicians should actively ask about previous pelvic trauma when taking a patient history in similar cases, especially if the patient is receiving anticoagulation treatment. If MRI of the lumbar spine does not reveal any pathologies, MRI of the pelvic region should be performed. Acute surgical decompression is crucial for preserving neurological function. In similar cases, it is possible to differentiate between spinal cord, cauda equina, and pelvic lesions using electrophysiological studies.
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Affiliation(s)
- Jan Lodin
- Departments of Neurosurgery and
- Neurology, J.E. Purkyne University, Masaryk Hospital Krajská Zdravotní a.s., Ústí nad Labem, Czech Republic
| | - Štěpánka Brušáková
- Faculty of Medicine in Plzeň, Charles University, Plzeň, Czech Republic; and
| | - David Kachlík
- Department of Anatomy, Second Faculty of Medicine in Prague, Charles University, Prague, Czech Republic
| | | | - Ivan Humhej
- Departments of Neurosurgery and
- Department of Anatomy, Second Faculty of Medicine in Prague, Charles University, Prague, Czech Republic
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Kelbich P, Hejčl A, Krejsek J, Radovnický T, Matuchová I, Lodin J, Špička J, Sameš M, Procházka J, Hanuljaková E, Vachata P. Development of the Cerebrospinal Fluid in Early Stage after Hemorrhage in the Central Nervous System. Life (Basel) 2021; 11:life11040300. [PMID: 33915782 PMCID: PMC8065782 DOI: 10.3390/life11040300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022] Open
Abstract
Extravasation of blood in the central nervous system (CNS) represents a very strong damaged associated molecular patterns (DAMP) which is followed by rapid inflammation and can participate in worse outcome of patients. We analyzed cerebrospinal fluid (CSF) from 139 patients after the CNS hemorrhage. We compared 109 survivors (Glasgow Outcome Score (GOS) 5-3) and 30 patients with poor outcomes (GOS 2-1). Statistical evaluations were performed using the Wilcoxon signed-rank test and the Mann–Whitney U test. Almost the same numbers of erythrocytes in both subgroups appeared in days 0–3 (p = 0.927) and a significant increase in patients with GOS 2-1 in days 7–10 after the hemorrhage (p = 0.004) revealed persistence of extravascular blood in the CNS as an adverse factor. We assess 43.3% of patients with GOS 2-1 and only 27.5% of patients with GOS 5-3 with low values of the coefficient of energy balance (KEB < 15.0) in days 0–3 after the hemorrhage as a trend to immediate intensive inflammation in the CNS of patients with poor outcomes. We consider significantly higher concentration of total protein of patients with GOS 2-1 in days 0–3 after hemorrhage (p = 0.008) as the evidence of immediate simultaneously manifested intensive inflammation, swelling of the brain and elevation of intracranial pressure.
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Affiliation(s)
- Petr Kelbich
- Biomedical Centre, Masaryk Hospital Ústí nad Labem, 401 13 Ústí nad Labem, Czech Republic; (I.M.); (E.H.)
- Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University in Prague, 500 03 Hradec Králové, Czech Republic;
- Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, 190 00 Prague, Czech Republic
- Correspondence:
| | - Aleš Hejčl
- Department of Neurosurgery, Masaryk Hospital Ústí nad Labem, J. E. Purkinje University, 401 13 Ústí nad Labem, Czech Republic; (A.H.); (T.R.); (J.L.); (M.S.); (P.V.)
- International Clinical Research Center, St. Anne’s University Hospital, 656 91 Brno, Czech Republic
- Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, 117 20 Prague, Czech Republic
| | - Jan Krejsek
- Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University in Prague, 500 03 Hradec Králové, Czech Republic;
| | - Tomáš Radovnický
- Department of Neurosurgery, Masaryk Hospital Ústí nad Labem, J. E. Purkinje University, 401 13 Ústí nad Labem, Czech Republic; (A.H.); (T.R.); (J.L.); (M.S.); (P.V.)
| | - Inka Matuchová
- Biomedical Centre, Masaryk Hospital Ústí nad Labem, 401 13 Ústí nad Labem, Czech Republic; (I.M.); (E.H.)
- Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University in Prague, 500 03 Hradec Králové, Czech Republic;
- Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, 190 00 Prague, Czech Republic
| | - Jan Lodin
- Department of Neurosurgery, Masaryk Hospital Ústí nad Labem, J. E. Purkinje University, 401 13 Ústí nad Labem, Czech Republic; (A.H.); (T.R.); (J.L.); (M.S.); (P.V.)
| | - Jan Špička
- Department of Clinical Biochemistry, Masaryk Hospital Ústí nad Labem, 401 13 Ústí nad Labem, Czech Republic;
| | - Martin Sameš
- Department of Neurosurgery, Masaryk Hospital Ústí nad Labem, J. E. Purkinje University, 401 13 Ústí nad Labem, Czech Republic; (A.H.); (T.R.); (J.L.); (M.S.); (P.V.)
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University in Prague, 110 00 Prague, Czech Republic
| | - Jan Procházka
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, Masaryk Hospital Ústí nad Labem, J. E. Purkinje University, 401 13 Ústí nad Labem, Czech Republic;
| | - Eva Hanuljaková
- Biomedical Centre, Masaryk Hospital Ústí nad Labem, 401 13 Ústí nad Labem, Czech Republic; (I.M.); (E.H.)
- Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, 190 00 Prague, Czech Republic
| | - Petr Vachata
- Department of Neurosurgery, Masaryk Hospital Ústí nad Labem, J. E. Purkinje University, 401 13 Ústí nad Labem, Czech Republic; (A.H.); (T.R.); (J.L.); (M.S.); (P.V.)
- Department of Neurosurgery, Faculty of Medicine and University Hospital in Pilsen, Charles University in Prague, 301 00 Pilsen, Czech Republic
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Lodin J, Hejčl A, Bolcha M, Sameš M, Vachata P. Utility of Hounsfield units in predicting fusion rates of patients undergoing anterior odontoid screw fixation following Anderson d'Alonzo type II and shallow type III fractures. J Neurosurg Sci 2021; 67:331-339. [PMID: 33393749 DOI: 10.23736/s0390-5616.20.05190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Main objective of this study was to determine whether Hounsfield units (HU) measured in three areas of the axis correlate with successful fusion in patients with type II and shallow type III C2 fractures undergoing anterior odontoid screw osteosynthesis (AOSF). METHODS Forty-five patients with C2 fractures treated via AOSF were analyzed. Only bony fusion with bone trabeculations across the fracture line was considered a successful result. Preoperative HU values were measured in three zones- corpus, watershed and dens. Statistical analysis was performed to determine significant differences between HU of fused and unfused patients in all three zones of a complete and adjusted patient cohort. RESULTS Statistically significant differences of HU values were found between fused (corpus- 363.7, watershed- 327.9) and unfused (corpus- 279.5, watershed- 194.2) of the complete cohort and the adjusted cohort. Cut-off HU values in the watershed zone were calculated for the complete (250 and 300) and adjusted cohort (240 and 260), dividing patients into three groups of bone quality. Patients with high watershed bone quality (HU >300) achieved successful fusion in 84.62%, patients with low bone quality (HU <250) in 3.85% and patients with medium bone quality (HU 250-300) in 50%. CONCLUSIONS Preoperative measurement of HU can be used to predict the probability of successful fusion in patients undergoing AOSF for type II and shallow type III C2 fractures. AOSF is a highly effective treatment modality in patients with watershed HU >300, whereas alternatives should be considered in patients with watershed HU <250.
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Affiliation(s)
- Jan Lodin
- Neurosurgical Department, J.E. Purkyne of Masaryk Hospital Krajská Zdravotní a.s., Ústí nad Labem, Czech Republic -
| | - Aleš Hejčl
- Neurosurgical Department, J.E. Purkyne of Masaryk Hospital Krajská Zdravotní a.s., Ústí nad Labem, Czech Republic
| | - Martin Bolcha
- Neurosurgical Department, J.E. Purkyne of Masaryk Hospital Krajská Zdravotní a.s., Ústí nad Labem, Czech Republic
| | - Martin Sameš
- Neurosurgical Department, J.E. Purkyne of Masaryk Hospital Krajská Zdravotní a.s., Ústí nad Labem, Czech Republic
| | - Petr Vachata
- Neurosurgical Department, J.E. Purkyne of Masaryk Hospital Krajská Zdravotní a.s., Ústí nad Labem, Czech Republic
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Kelbich P, Radovnický T, Selke-Krulichová I, Lodin J, Matuchová I, Sameš M, Procházka J, Krejsek J, Hanuljaková E, Hejčl A. Can Aspartate Aminotransferase in the Cerebrospinal Fluid Be a Reliable Predictive Parameter? Brain Sci 2020; 10:brainsci10100698. [PMID: 33019758 PMCID: PMC7600957 DOI: 10.3390/brainsci10100698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 11/21/2022] Open
Abstract
Brain ischemia after central nervous system (CNS) bleeding significantly influences the final outcome of patients. Catalytic activities of aspartate aminotransferase (AST) in the cerebrospinal fluid (CSF) to detect brain ischemia were determined in this study. The principal aim of our study was to compare the dynamics of AST in 1956 CSF samples collected from 215 patients within a 3-week period after CNS hemorrhage. We compared concentrations of the AST catalytic activities in the CSF of two patient groups: survivors (Glasgow Outcome Score (GOS) 5–3) and patients in a vegetative state or dead (GOS 2–1). All statistical evaluations were performed using mixed models and the F-test adjusted by Kenward and Roger and the Bonferroni adjustment for multiple tests. The significantly higher catalytic activities of AST in the CSF from patients with the GOS of 2–1 when compared to those who survived (GOS 5–3, p = 0.001) were found immediately after CNS haemorrhage. In the further course of time, the difference even increased (p < 0.001). This study confirmed the key association between early signs of brain damage evidenced as an elevated AST activity and the prediction of the final patient’s clinical outcome. The study showed that the level of AST in the CSF could be the relevant diagnostic biomarker of the presence and intensity of brain tissue damage.
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Affiliation(s)
- Petr Kelbich
- Biomedical Centre, Masaryk Hospital Usti nad Labem, 400 11 Usti nad Labem, Czech Republic; (I.M.); (E.H.)
- Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University in Prague, 500 03 Hradec Kralove, Czech Republic;
- Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, 190 00 Prague, Czech Republic
- Correspondence:
| | - Tomáš Radovnický
- Department of Neurosurgery, Masaryk Hospital Usti nad Labem, J. E. Purkinje University, 400 11 Usti nad Labem, Czech Republic; (T.R.); (J.L.); (M.S.); (A.H.)
| | - Iva Selke-Krulichová
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic;
| | - Jan Lodin
- Department of Neurosurgery, Masaryk Hospital Usti nad Labem, J. E. Purkinje University, 400 11 Usti nad Labem, Czech Republic; (T.R.); (J.L.); (M.S.); (A.H.)
| | - Inka Matuchová
- Biomedical Centre, Masaryk Hospital Usti nad Labem, 400 11 Usti nad Labem, Czech Republic; (I.M.); (E.H.)
- Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University in Prague, 500 03 Hradec Kralove, Czech Republic;
- Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, 190 00 Prague, Czech Republic
| | - Martin Sameš
- Department of Neurosurgery, Masaryk Hospital Usti nad Labem, J. E. Purkinje University, 400 11 Usti nad Labem, Czech Republic; (T.R.); (J.L.); (M.S.); (A.H.)
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University, 110 00 Prague, Czech Republic
| | - Jan Procházka
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, Masaryk Hospital Usti nad Labem, J. E. Purkinje University, 400 11 Usti nad Labem, Czech Republic;
| | - Jan Krejsek
- Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University in Prague, 500 03 Hradec Kralove, Czech Republic;
| | - Eva Hanuljaková
- Biomedical Centre, Masaryk Hospital Usti nad Labem, 400 11 Usti nad Labem, Czech Republic; (I.M.); (E.H.)
- Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, 190 00 Prague, Czech Republic
| | - Aleš Hejčl
- Department of Neurosurgery, Masaryk Hospital Usti nad Labem, J. E. Purkinje University, 400 11 Usti nad Labem, Czech Republic; (T.R.); (J.L.); (M.S.); (A.H.)
- International Clinical Research Center, St. Anne’s University Hospital, 656 91 Brno, Czech Republic
- Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, 117 20 Prague, Czech Republic
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Bartoš R, Lodin J, Marek T, Sameš M, Němcová V, Liščák R. Combined treatment of a medulla oblongata hemangioblastoma via permanent cysto-cisternal drainage and (postponed) gamma knife radiosurgery: a case report and review of the literature. Int J Neurosci 2020; 132:1-5. [PMID: 32881600 DOI: 10.1080/00207454.2020.1819267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/22/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hemangioblastomas are histologically benign tumors with a variable degree of morbidity and mortality based on various factors, including their anatomical location. The following paper illustrates a unique approach of combined therapy of a brainstem hemangioblastoma (HB) not associated with von Hippel-Lindau disease (vHLd) located in the medulla oblongata. CASE DESCRIPTION A 21-year-old preschool teacher presented with vertigo, followed by dysphagia, trouble coughing, tongue paresis and headache and vomiting. Magnetic resonance imaging (MRI) revealed a large cystic lesion with a small intramural nodule located in the left anterolateral medulla oblongata directly behind the vertebral artery. The diagnosis of hemangioblastoma was supported by digital subtraction angiography. CONCLUSION Combined therapy consisted primarily of acute surgical fenestration and permanent drainage of the cystic portion of the tumor, due to symptomatic expansion. Follow-up stereotactic gamma knife radiosurgery was performed after 2 years for minor progression of the tumor nodule. To the best of our knowledge, this is the first time such approach has been described in the literature for this pathology.
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Affiliation(s)
- Robert Bartoš
- Department of Neurosurgery, Masaryk Hospital, Ústí nad Labem, Czech Republic
- Department of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Lodin
- Department of Neurosurgery, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - Tomas Marek
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Martin Sameš
- Department of Neurosurgery, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - Veronika Němcová
- Department of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Roman Liščák
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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Vachata P, Bolcha M, Lodin J, Sameš M. Atlanto-occipital dissociation. Rozhl Chir 2020; 99:22-28. [PMID: 32122136 DOI: 10.33699/pis.2020.99.1.22-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Atlanto-occipital dissociation (AOD) is a rare and unstable injury of the craniocervical junction, associated with very high morbidity and mortality. The most common cause of this injury is high energy trauma with hyperextension of the cranium, such as car accidents. Due to specific anatomical predispositions, children and young adults are the frequently affected populations. Improving pre-hospital and early emergency care has resulted in a higher sensitivity of AOD diagnosis. METHODS A retrospective analysis of all patients with cervical spine trauma, treated at the Masaryk Hospital Trauma Center between 2008 and 2018, identified 7 patients with AOD. The cohort consisted of 5 males and 2 females, with a mean age of 19,6 years and with the age range 9 to 35 years. All cases occurred as a result of a car accident. RESULTS All patients in the cohort had findings of a highly unstable C0-C1 injury on their CT scans on admission. Four patients died early, while undergoing CPR in the emergency department. Two patients were in severe neurological states, with lesions of the upper cervical spinal cord and medulla oblongata on MRI. These patients were treated with external halo fixation and died within 3 days of the trauma. Only one patient with a new progressive neurological deficit was successfully treated using acute occipitocervical stabilization and fusion. CONCLUSION The increasing incidence of AOD requires an early diagnosis, which minimizes the risk of successive clinical deterioration. The diagnostic method of choice is the C1-condyle interval (CCI) CT assessment along with cervical spine MRI. Standard treatment of stable patients with unstable AOD injuries consists in posterior occipitocervical stabilization and fusion of C0-C2.
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Hejčl A, Lodin J, Cihlář F, Sameš M. Spontaneous Subarachnoid Hemorrhage in a Patient with a Co-Existent Posterior Communicating Artery Aneurysm and Cervical Spine Aneurysm Associated with Ventral Arterio-Venous Fistula. Brain Sci 2020; 10:brainsci10020070. [PMID: 32012860 PMCID: PMC7071443 DOI: 10.3390/brainsci10020070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/19/2020] [Accepted: 01/23/2020] [Indexed: 12/31/2022] Open
Abstract
Severe spontaneous subarachnoid hemorrhage (SAH) is predominantly caused by aneurysm rupture, with non-aneurysmal vascular lesions representing only a minority of possible causes. We present the case of a 58-year old lady with a coincidental posterior communicating artery (PCom) aneurysm and a high cervical spine arterio-venous fistula associated with a small ruptured aneurysm. After the emergency clipping of the PCom aneurysm, additional diagnostic procedures—repeated digital subtraction angiography and spinal magnetic resonance imaging, revealed the actual cause of the SAH, a type-A ventral intradural fistula at cervical level C2/3. The fistula was treated micro surgically via a ventral approach using C3 somatectomy and C2-4 stabilization after the initial failure of endovascular therapy. Furthermore, the patient was treated for complications associated with severe SAH, including acute hydrocephalus and meningitis. In cases where the SAH pattern and perioperative findings do not suggest an intracranial aneurysm as the source of SAH, further diagnostic investigation is warranted to discover the real cause. Patients with severe non-aneurysmal SAH require a similar algorithm in diagnosing the cause of the hemorrhage as well as complex conditions such as ruptured aneurysms.
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Affiliation(s)
- Aleš Hejčl
- Department of Neurosurgery, J.E. Purkinje University, Masaryk Hospital, Sociální péče 12A, 40113 Ústí nad Labem, Czech Republic (M.S.)
- International Clinical Research Center, St. Anne’s University Hospital, 38975 Brno, Czech Republic
- Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, Vídeňská 1083, 14220 Prague, Czech Republic
- Correspondence: ; Tel.: +420-777-232-793; Fax: +420-477-112-880
| | - Jan Lodin
- Department of Neurosurgery, J.E. Purkinje University, Masaryk Hospital, Sociální péče 12A, 40113 Ústí nad Labem, Czech Republic (M.S.)
| | - Filip Cihlář
- Department of Radiology, J. E. Purkinje University, Masaryk Hospital, 40113 Ústí nad Labem, Czech Republic;
| | - Martin Sameš
- Department of Neurosurgery, J.E. Purkinje University, Masaryk Hospital, Sociální péče 12A, 40113 Ústí nad Labem, Czech Republic (M.S.)
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Vachata P, Brusakova S, Lodin J, Sames M. Masseteric nerve supercharge bypass in primary reconstruction of facial nerve. Acta Neurochir (Wien) 2019; 161:1089-1094. [PMID: 30980244 DOI: 10.1007/s00701-019-03901-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/28/2019] [Indexed: 11/25/2022]
Abstract
Facial paralysis is a severe disease and presents a formidable treatment challenge. A wide variety of surgical procedures are available with limited evidence. Major risk factors of suboptimal recovery include the duration of paralysis as well as higher age. In this paper, we demonstrate reconstruction of the facial nerve via an intratemporal end-to-end anastomosis and concomitant transfer of an intact masseteric nerve to the side of facial nerve trunk. The supercharge (reverse end-to-side) transfer resulted in preservation of target muscles and faster recovery. Masseteric supercharge bypass may be an acceptable surgical technique to restore muscle function in potentially higher risk cases.
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Affiliation(s)
- Petr Vachata
- Department of Neurosurgery, Masaryk Hospital, J. E, Purkyně University, Socialni pece 3316/12A, 40113, Usti nad Labem, Czech Republic.
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 30100, Pilsen, Czech Republic.
| | - Stepanka Brusakova
- Department of Neurology, Masaryk Hospital, Socialni pece 3316/12A, 40113, Usti nad Labem, Czech Republic
| | - Jan Lodin
- Department of Neurosurgery, Masaryk Hospital, J. E, Purkyně University, Socialni pece 3316/12A, 40113, Usti nad Labem, Czech Republic
| | - Martin Sames
- Department of Neurosurgery, Masaryk Hospital, J. E, Purkyně University, Socialni pece 3316/12A, 40113, Usti nad Labem, Czech Republic
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Humhej I, Ibrahim I, Lodin J, Sameš M, Čižmář I. Image Possibilities of the Peripheral Nerve Tumor Using Magnetic Resonance Imaging - Case Report. Acta Chir Plast 2019; 60:9-13. [PMID: 30939878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Magnetic resonance imaging (MRI) plays a crucial role in the diagnosis and morphological analysis of peripheral nerve tumours (PNTs). In recent years, a number of novel MRI sequences such as MR neurography (MRN), diffusion tensor imaging (DTI) or MR tractography (MRT) have emerged extending the range of conventional MRI techniques. These advanced sequences are able to provide detailed information concerning PNTs structure, including the course and function of individual neural fascicles. This data can then be utilized in tailoring a suitable surgical procedure, reducing the risks of postoperative neurological deficit. The following case report of a median nerve tumour demonstrates the range and practicality of current MRI techniques. With continuing advancement and perfection of these MRI techniques, we can expect their integration into standard diagnostic protocols of PNTs.
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Sejkorová A, Cihlář F, Hejčl A, Lodin J, Vachata P, Sameš M. Microsurgery and endovascular treatment of posterior inferior cerebellar artery aneurysms. Neurosurg Rev 2015; 39:159-68; discussion 168. [DOI: 10.1007/s10143-015-0659-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 05/01/2015] [Accepted: 06/27/2015] [Indexed: 11/28/2022]
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