Evaluation of PHASES Score for Predicting Rupture of Intracranial Aneurysms: Significance of Aneurysm Size

BACKGROUND

Recent data have identified that certain risk factors for rupture differ between small and larger intracranial aneurysms (IAs). Such differing risk factors make up 5 out of the 6 predictor variables used in the PHASES score, which raises the question on whether IA size has a significant effect on the score's performance.

METHODS

Patients who were diagnosed with an IA incidentally or due to a subarachnoid hemorrhage between 2015 and 2023 were selected for potential inclusion. The median IA size of the cohort was chosen as the cutoff point to categorize small and large (6 mm). The PHASES score was calculated for all patients, and a receiver operating characteristic curve analysis was performed to evaluate the classification accuracy of PHASES in predicting rupture for small and large IAs.

RESULTS

A total of 677 IAs were included. Among the IAs, 400 (58.9%) presented as UIAs and 279 (41.0%) as subarachnoid hemorrhage. The average PHASES score was 2.9 and 6.5 for small (n = 322) and large (n = 355) IAs, respectively. The PHASES score performed significantly lower for predicting rupture in smaller IAs (area under the curve: 0.634) compared with the larger (area under the curve: 0.741) (P = 0.00083).

CONCLUSIONS

PHASES was shown to underperform on small IAs. The decision to treat small unruptured IAs remains highly controversial, and the development of a new score to estimate the annual rupture rate while accounting for IA morphology is of great need. Our findings can help encourage future researchers to develop such a score.

Long-Term Outcomes After Stereotactic Radiosurgery for Pediatric Brain Arteriovenous Malformations: A Systematic Review

BACKGROUND

The long-term outcomes after stereotactic radiosurgery (SRS) for pediatric brain arteriovenous malformations (AVMs) remain poorly understood given the paucity of longitudinal studies. A systematic review was conducted to pool cumulative incidences for all outcomes.

METHODS

PubMed, Embase, and Web of Science were queried to systematically extract potential references. The articles relating to AVMs treated via SRS were required to be written in English, involve pediatric patients (<18 years of age), and include a mean follow-up period of >5 years. Individual patient data were obtained to construct a pooled Kaplan-Meier plot on obliteration rates over time.

RESULTS

Among the 6 studies involving 1315 pediatric patients averaging a follow-up period of 86.6 months (range, 6-276), AVM obliteration was observed in 66.1% with cumulative probabilities of 48.28% (95% confidence interval [CI], 41.89-54.68), 76.11% (95% CI, 67.50-84.72), 77.48% (95% CI, 66.37-88.59) over 3, 5, and 10 years, respectively. The cumulative incidence of post-SRS hemorrhage, tumors, cysts, and de novo seizures was 7.2%, 0.3%, 1.6%, and 1.5%, respectively. The cumulative incidence of radiation-induced necrosis, edema, radiologic radiation-induced changes (RICs), symptomatic RICs, and permanent RICs were 8.0%, 1.4%, 28.0%, 8.7%, and 4.9%, respectively.

CONCLUSIONS

Studies assessing long-term outcomes after SRS are moderate in quality and retrospective. Thus, interpretation with caution is advised given the variable degree of loss to follow-up, which suggests that complication rates may be higher than the values stated in the literature. Future prospective studies are needed to validate these findings.

Dural metastasis of prostate carcinoma mimicking intracranial hematoma: a case report and literature review

Dural metastases of prostate adenocarcinoma are an extremely rare complication and may mimic intracranial hematoma. Preoperatively diagnosis may be difficult due to similarities in symptoms and radiological appearance. We present a 65-year-old man admitted to the ED with a history of headache, nausea, vomiting, vertigo, diplopia, as well as numbness of his left lower extremity. Past medical history confirmed metastatic prostate cancer disease. After computed tomography and contrast computed tomography, the consulting radiologist diagnosed a chronic subdural hematoma. After burr hole trephination and dural opening, tumorous mass was detected. Histopathologic samples were taken. Histopathological examination was consistent with metastatic adenocarcinoma of the prostate. Although rare, dural metastases need to be included in oncological patients presenting in the ED with symptoms and radiological imaging suggesting hematoma. Both neurooncological and neurosurgical consultations are essential in order to apply the best treatment strategy.

Predictors for spinal deformity following resection of intramedullary tumor via posterior approach: a systematic review and meta-analysis

PURPOSE

The present study aimed to identify the clinical predictive factors for worsened spinal deformity (SD) following surgical resection via posterior approach for primary intramedullary tumors.

METHODS

A systematic search was performed using PubMed, Web of Science, and Scopus databases to extract potential references. Observational studies reporting predictive factors for worsened SD following surgical resection via posterior approach for primary intramedullary tumors were included. The odds ratio (OR) was calculated for dichotomous parameters.

RESULTS

Four retrospective cohort studies were included in the meta-analysis. They were comprised of two groups of patients; those who developed SD (n = 87) and those who did not (n = 227). For patients with IMSCTs, age under 25 years as well as age under 13 years were the demographic variables associated with postoperative SD (odds ratio [OR] 3.92; p = 0.0002 and OR 4.22; p = 0.003). In both the fusion and the non-fusion subgroups, preoperative spinal deformity strongly predicted postoperative SD (OR 11.94; p < 0.001), with the risk highly elevated among the non-fusion patients (OR 24.64; p < 0.0002). Thoracolumbar junction involvement was also found to be a predictor of postoperative SD for patients with IMSCT (OR 2.89; p = 0.02).

CONCLUSION

This study highlights the importance of considering age, preoperative spinal deformity, and thoracolumbar junction involvement as predictors of postoperative spinal deformity following surgical resection for IMSCT. These findings may provide guidance for the management of these patients, including the development of preoperative planning strategies and the selection of the most appropriate surgical approach for high-risk patients.

The impact of the COVID-19 pandemic on the number of brain tumor surgeries in Poland: A national database study

BACKGROUND

The coronavirus disease (COVID-19) pandemic has greatly affected the treatment of most medical conditions. In particular, the treatment of seriously ill patients had to be adjusted due to the limited availability of in-hospital procedures.

OBJECTIVES

The aim of this study was to evaluate the effects of COVID-19-related changes on neuro-oncological surgeries in the Polish medical system.

MATERIAL AND METHODS

Data from the period of 2010-2020 were collected from National Health Insurance database for 2 diagnosis-related groups: A11 (complex intracranial procedures) and A12 (large intracranial procedures). The total number of procedures and diagnoses per year, trend changes and changes in procedures grouped by medical type were analyzed, including resections/biopsies, malignant/stable (nonmalignant) lesions, elective/acute procedures, and length of stay.

RESULTS

Mean yearly numbers of 7177 (standard deviation (SD) = 760) procedures and 5934 (SD = 1185) diagnoses were recorded. Both numbers were growing up to 9.1% per year until 2018. From 2018, a 3.1% decrease in the number of procedures was observed, with a significantly larger decrease of 10.5% observed in 2020 (p < 0.001). The number of diagnoses decreased in 2019 by 2.7%, and by 9.2% in 2020 (p = 0.706), with a statistically significant change in the annual growth rate (p = 0.044). The number of resections decreased by 11.5% in 2020 (p = 0.204), with a significant change in the annual growth rate (p < 0.001). The number of biopsies decreased by 2.5% in 2020 (p = 0.018), with the annual decrement in 2019/2020 also being significant (p = 0.004). Decreases were observed in 2019 and 2020 for the number of malignant (0.5% and 6.3%, respectively) and nonmalignant (5.4% and 12.9%, respectively) tumors (p = 0.233 and p = 0.682 for absolute values, and p = 0.008 and p = 0.004 for the annual growth rates, respectively). The number of acute procedures in 2020 further decreased by 9.8% from 5.5% decrease in 2019 (p = 0.004), and the number of elective procedures decreased by 11.8% (p = 0.009). The annual growth rates for both acute and elective procedures were statistically significant (p < 0.001 and p < 0.001).

CONCLUSIONS

The decrease in the number of neuro-oncological surgeries appeared to be much lower than the 20% decrease observed for general oncological surgeries in Poland during the COVID-19 pandemic. This seems to have resulted from postponing the treatment of less critical cases (i.e., nonmalignant and elective) and focusing on the treatment of the most precarious patients.

Predictors for cervical kyphotic deformity following laminoplasty: a systematic review and meta-analysis

OBJECTIVE

Laminoplasty is a common treatment for cervical spondylotic myelopathy (CSM) and for ossification of the posterior longitudinal ligament (OPLL). However, approximately 21% of patients undergoing laminoplasty develop cervical kyphotic deformity (KD). Because of the high prevalence rate of KD, several studies have sought to identify predictors for this complication, but the findings remain highly inconsistent. Therefore, the authors performed a systematic review and meta-analysis to establish reliable preoperative predictors of KD.

METHODS

PubMed, Scopus, and Web of Science databases were used to systematically extract potential references. The first phase of screening required the studies to be written in the English language, involve patients treated for CSM and/or OPLL via laminoplasty, and report postoperative cervical KD. The second phase required the studies to provide more than 10 patients and include a control group. The mean difference (MD) and odds ratio (OR) were calculated for continuous and dichotomous parameters. Study quality was evaluated using the Newcastle-Ottawa Scale. CSM and OPLL patients were further assessed by performing subgroup analyses.

RESULTS

Thirteen studies comprising patients who developed cervical KD (n = 296) and no KD (n = 1254) after receiving cervical laminoplasty for CSM or OPLL were included in the meta-analysis. All studies were retrospective cohorts and were rated as high quality. In the combined univariate analysis of CSM and OPLL patients undergoing laminoplasty, statistically significant predictors for postoperative KD included age (MD 2.22, 95% CI 0.16-4.27, p = 0.03), preoperative BMI (MD 0.85, 95% CI 0.06-1.63, p = 0.04), preoperative C2-7 range of flexion (MD 10.42, 95% Cl 4.24-16.59, p = 0.0009), preoperative C2-7 range of extension (MD -4.59, 95% CI -6.34 to -2.83, p < 0.00001), and preoperative center of gravity of the head to the C7 sagittal vertical axis (MD 26.83, 95% CI 9.13-44.52, p = 0.003). Additionally, among CSM patients, males were identified as having a greater risk for postoperative KD (OR 1.73, 95% CI 1.02-2.93, p = 0.04).

CONCLUSIONS

The findings from this study currently provide the largest and most reliable review on preoperative predictors for cervical KD after laminoplasty. Given that several of the included studies identified optimal cutoff points for the variables that are significantly associated with KD, further investigation into the development of a preoperative risk scoring system that can accurately predict KD in the clinical setting is encouraged. PROSPERO registration no.: CRD42022299795 (https://www.crd.york.ac.uk/PROSPERO/).

Telovelar versus transvermian approach to tumors of the fourth ventricle and their impact on postoperative neurological complications: A multicenter study

Background

Tumors of the fourth ventricle are exceedingly rare; however, such lesions are formidable due to the severe postoperative neurological complications (pNCs) which often occur. The adoption of the telovelar approach over the transvermian was created to supposedly mitigate the pNCs; however, there is a lack of sufficient data supporting this theory.

Methods

Records from six hospitals were reviewed for patients surgically treated for a single tumor within the 4^th ventricle from 2016 to 2022. The pNCs which had 10 or more occurrences among the patients were individually assessed as the dependent variable in a binary logistic regression model against covariates which included the surgical approach.

Results

This study of 67 patients confirms no significant differences in risk for pNCs between the transvermian and telovelar approach. Rather, multivariate analysis identified neurophysiological monitoring (IONM) as a protective factor for postoperative speech and swallowing defects (odds ratio [OR]: 0.076, 95% confidence interval [CI] 0.011-0.525). Furthermore, intraoperative external ventricular drainage (EVD) was a protective factor for postoperative gait and focal motor defects (OR: 0.075, 95% CI 0.009-0.648) and for postoperative hydrocephalus (OR: 0.020, 95% CI 0.002-0.233). A univariate meta-analysis pooling the present study's patients and an additional 304 patients from the three additional studies in the literature confirms no significant differences in risk between the transvermian and telovelar approach for pNCs.

Conclusion

Intraoperative adjuncts including IONM and EVD may play a significant role in the postoperative outcome. Despite the present study's sample size being a major limitation, the findings may provide great value to neurosurgeons given the scarcity of the current literature.

Evaluation of Movement Restriction of Spinal Orthoses Using Inertial Measurement Units

Despite the frequent use of orthopedic braces or spine stabilizers in diseases such as kyphosis, lordosis, and scoliosis, as well as in the case of injuries and rehabilitation after surgeries, there is no clear evidence of their proper stabilization of the spine while carrying out daily activities. This study sought to assess the spine's mobility while wearing three different orthopedic braces while performing basic tasks. Ten healthy subjects were enrolled. Three Inertial Measurement Units (IMUs) were attached superficially along the spine at approximate levels: cervical (C7), between thoracic (T8) and lumbar (L3), and sacrum. The angle between sensors was monitored to provide data on the sagittal profile. In addition, the displacement of the spine's longitudinal axis was measured (rotation). There are three types of orthopedic braces: the semi-rigid Hohmann corset, the Jewett brace, and the Thoracolumbar Fixed Spinal Orthosis (TLSO). Four tasks were monitored: standing, sitting, walking, and picking up an item from the floor with one hand. All braces provided a similar level of stability in both the sagittal plane and rotational axis while lifting an object. On the other hand, while walking and sitting, the TLSO was the only orthosis providing a statistically significant rigidity in the sagittal plane. When performing a more voluntary task, the measured rigidity of softer braces was significantly increased when compared with more involuntary tasks. A certain degree of motion restriction with spinal orthoses may come from the feedback pressure, which stimulates paraspinal muscles to contract and thus increases the overall rigidity of the trunk.

Relevance of Routine Postoperative CT Scans Following Aneurysm Clipping-A Retrospective Multicenter Analysis of 423 Cases

AIM

Postoperative head computed tomography (POCT) is routinely performed in numerous medical institutions, mainly to identify possible postsurgical complications. This study sought to assess the clinical appropriateness of POCT in asymptomatic and symptomatic patients after ruptured or unruptured aneurysm clipping.

METHODS

This is a retrospective multicenter study involving microsurgical procedures of ruptured (RA) and unruptured intracranial aneurysm (UA) surgeries performed in the Centers associated with the Pomeranian Department of the Polish Society of Neurosurgeons. A database of surgical procedures of intracranial aneurysms from 2017 to 2020 was created. Only patients after a CT scan within 24 h were included.

RESULTS

A total of 423 cases met the inclusion criteria for the analysis. Age was the only significant factor associated with postoperative blood occurrence on POCT. A total of 37 (8.75%) cases of deterioration within 24 h with urgent POCT were noted, 3 (8.1%) required recraniotomy. The highest number necessary to predict (NNP) one recraniotomy based on patient deterioration was 50 in the RA group.

CONCLUSION

We do not recommend POCTs in asymptomatic patients after planned clipping. New symptom onset requires radiological evaluation. Simultaneous practice of POCT after ruptured aneurysm treatment within 24 h is recommended.

Association of long-term outcome of long cervical fusion with sagittal balance: the significance of T1 slope minus cervical lordosis

INTRODUCTION

Retrospective study to assess correlation between the sagittal alignment of the cervical spine and the long-term outcomes of long cervical fusion due to cervical spondylotic myelopathy (CSM), with the emphasis on T1 slope minus cervical lordosis (T1S-CL).

SUMMARY OF BACKGROUND DATA

Growing evidence shows that the sagittal profile can play a major role in the outcomes of treatment, but the role of its correction is yet to be established.

MATERIAL AND METHODS

We conducted a retrospective analysis of 54 patients treated for CSM from 2006 to 2012. The neck pain-related disability was measured using NDI, the myelopathy was measured with the mJOA and Nurick scales. Six years after the surgery, standardised X-ray measurements were obtained, including C2-C7 lordosis (CL), C2-C7 sagittal vertical alignment (SVAC2-C7), T1 slope (T1S), and T1S minus CL (T1S-CL). The patients were divided based on the T1S-CL into two groups, using the threshold value of 16.5 degrees.

RESULTS

A statistically significant improvement was noted in the mean NDI, mJOA, and median Nurick scale during the initial two years in both groups. The better aligned group had a better outcome measured with NDI at all follow-ups. The mJOA was significantly better in the better aligned group, but only preoperatively; at all follow-ups, the difference was not significant. T1S-CL had the strongest correlation with the NDI at the final follow-up.

CONCLUSIONS

T1S-CL is an effective prognostic factor of the long term outcome after long cervical fusion in CSM treatment.

Casemix, management, and mortality of patients rreseceiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study

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.

Risk factors for postoperative cerebellar mutism syndrome in pediatric patients: a systematic review and meta-analysis

OBJECTIVE

A review article assessing all the risk factors reported in the literature for postoperative cerebellar mutism syndrome (pCMS) among children remains absent. The authors sought to perform a systematic review and meta-analysis to evaluate this issue.

METHODS

PubMed, Embase, and Web of Science were queried to systematically extract potential references. The articles relating to pCMS were required to be written in the English language, involve pediatric patients (≤ 18 years of age), and provide extractable data, which included a comparison group of patients who did not develop pCMS. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale. Data were pooled using RevMan 5.4, and publication bias was assessed by visual inspection for funnel plot asymmetry. The study protocol was registered through PROSPERO (ID: CRD42021256177).

RESULTS

Overall, 28 studies involving 2276 patients were included. Statistically significant risk factors identified from univariate analysis were brainstem invasion (OR 4.28, 95% CI 2.23-8.23; p < 0.0001), fourth ventricle invasion (OR 12.84, 95% CI 4.29-38.44; p < 0.00001), superior cerebellar peduncle invasion (OR 6.77, 95% CI 2.35-19.48; p = 0.0004), diagnosis of medulloblastoma (OR 3.26, 95% CI 1.93-5.52; p < 0.0001), medulloblastoma > 50 mm (OR 8.85, 95% CI 1.30-60.16; p = 0.03), left-handedness (OR 6.57, 95% CI 1.25-34.44; p = 0.03), and a vermis incision (OR 5.44, 95% CI 2.09-14.16; p = 0.0005). On the other hand, a tumor located in the cerebellar hemisphere (OR 0.23, 95% CI 0.06-0.92; p = 0.04), cerebellar hemisphere compression (OR 0.23, 95% CI 0.11-0.45; p < 0.0001), and intraoperative imaging (OR 0.36, 95% CI 0.18-0.72; p = 0.004) reduced the risk of pCMS.

CONCLUSIONS

This study provides the largest and most reliable review of risk factors associated with pCMS. Although some risk factors may be dependent on one another, the data may be used by surgeons to better identify patients at risk for pCMS and for intervention planning.

Acute Stroke Care during COVID-19: National Data

(1) Background: The pandemic of COVID-19 and subsequent lockdown strategies had a profound impact on many aspects of everyday life. During this time the world faced the unprecedented crisis of healthcare disrupting timely care delivery. This study was designed to evaluate the impact of the pandemic on the acute treatment of stroke in Poland. (2) Methods: The national data on hospitalizations with stroke as a primary diagnosis were obtained from the National Health Fund of Poland. Poisson regression was used to determine the significance of the change in hospital admissions. The differences between proportions were analyzed using the “N-1” Chi-squared test. (3) Results: During the COVID-19 period, the number of hospitalizations dropped by 8.28% with a monthly nadir of 22.02 in April. On a monthly scale during 2020, the greatest decrease was 22.02%. The thrombolysis ratio was also affected, with the highest monthly drop of 15.51% in November. The overall number of in-hospital deaths did not change. (4) Conclusions: The pandemic caused a serious disruption of the acute care of stroke. There is no evidence that the quality of care was seriously compromised.

YouTube as a Source of Patient Information for Meningiomas: A Content Quality and Audience Engagement Analysis

YouTube (YT) has become a popular health information reservoir. In this study, we aimed to evaluate the content and quality of YT videos as a source of patient information for meningiomas. A YT search was conducted for the following terms: “meningioma”, “meningiomas”, “meningeal tumor”, and “psammoma”. A total of 119 videos were examined by five independent raters, using validated quality criteria, including the Quality Criteria for Consumer Health Information (DISCERN), the Journal of the American Medical Association instrument (JAMA), and the Global Quality Score (GQS). The mean DISCERN score was 35.6 points, while the mean GQS and JAMA scores were 2.4 and 1.8, respectively. The majority of the videos were produced in the United States (37.82%). Moreover, 47.9% of the evaluated videos were graded as “poor” and only 9.24% were “good”. Statistically higher scores in all three scoring systems were associated with the following information: tumor localization, clinical manifestations, indications for surgery, treatment options, risks, adjuvant therapies, results, follow up, diagrams, and those that featured a doctor as the speaker. Misleading information was presented in 35 productions. Our findings show that the overall quality of YT on the topic of meningiomas is defective, and requires further improvement and evaluation.

Impact of COVID-19 on incidence and treatment of intracranial aneurysms in Poland: a national study

INTRODUCTION

The COVID-19 pandemic greatly disrupted the national healthcare system in Poland, resulting in the implementation of new protocols allowing only patients with severe diagnoses to receive immediate treatment. Given that an intracranial aneurysm (IA) is regarded as one of the most severe diagnoses, we planned to assess whether the current protocol has successfully provided the standard treatment for IAs.

MATERIAL AND METHODS

Data on all IA cases treated from 2015 to 2020 was extracted from the JGP (a homogeneous group of patients) catalogue provided by the National Health Index of Poland (NFZ, Narodowy Fundusz Zdrowia). Poisson regression was used to determine the significance of the change in hospital admissions, and differences between proportions were analysed using the "N-1" Chi-squared test.

RESULTS

A total of 21,801 IA patients treated during 2015-2020 were included in this study. The overall number of hospitalisations due to IAs fell in the open surgery group, but not in the endovascular cohort. Mortality rates following IA treatment increased significantly by 21% in 2020 compared to preceding years. The demographics changed as well; the patients were significantly younger during the pandemic.

CONCLUSIONS

Our findings show that the current strategy for optimal care for patients diagnosed with IAs in Poland during the pandemic is failing to maintain high quality treatment. New methods to improve the current plan should be implemented to address future crises.

Predictors for complete surgical resection of posterior fossa neurenteric cysts: A case report and meta-analysis

Background

Incomplete resection of neurenteric cysts (NCs) has been associated with increased recurrence rates in patients compared to complete resection (CR) and information on intracranial NCs appearance on diagnostic imaging is scarce. We sought to identify factors associated with CR and provide the largest up-to-date review of NCs appearances on various diagnostic images.

Methods

Data from Medline, EMBASE, and Web of Science were extracted. Univariate and multivariate logistic regression models were used to analyze factors associated with CR.

Results

A total of 120 publications reporting 162 original cases on posterior fossa NCs met the inclusion criteria for analysis. Eighty-nine (55.6%) of the patients were female, the mean (SD) age of the patients' during operation was 34.3 (16.9) years, and CR was achieved in 98 (60%) of patients. Univariate analysis identified male sex as a statistically significant predictor for complete reaction (OR 2.13, 95% Cl 1.10-4.11, P = 0.02). The retrosigmoid approach (OR 1.89, 95% Cl 0.98-3.63, P = 0.06), far lateral approach (OR 0.46, 95% Cl 0.21-1.02, P = 0.06), and pediatric patient (OR 2.45, 95% Cl 0.94-6.56, P = 0.07) may be possible predictors for CR, however, they were not statistically significant. NCs are mainly hypodense on CT (32 [61.5%]), varied greatly in intensity on T1WI, hyperintense on T2WI magnetic resonance imaging (98 [67.1%]), and hyperintense on fluid-attenuated inversion recovery (17 [63.0%]).

Conclusion

We recommend utilizing various diagnostic imaging tests to help reduce misdiagnoses when identifying intracranial NCs. For patient safety, CR should be achieved when possible, to reduce risk of additional operations due to recurrence.

YouTube as a source of patient information on brain aneurysms: a content-quality and audience engagement analysis

INTRODUCTION

The internet allows patients to access a vast amount of health information. We aimed to evaluate the credibility of YouTube videos that members of the public are accessing on brain aneurysms, and to evaluate what characteristics drive audience engagement.

MATERIAL AND METHODS

The first 50 videos for each of the following search terms were taken for analysis: 'brain aneurysm', 'cerebral aneurysm' and 'intracranial aneurysm'. The quality of each video was evaluated by two neurosurgeons and two medical students independently using the Journal of the American Medical Association (JAMA) and the DISCERN instruments. Qualitative and quantitative video data was analysed for quality and audience engagement. Inter-rater agreement was ascertained.

RESULTS

Out of a total of 150 videos, 70 met the inclusion criteria. The mean total DISCERN score was 36.5 ± 8.4 (out of 75 points), indicating that the videos were of poor quality. The mean JAMA score was 2.7 ± 0.7 (out of 4 points). Inter-rater agreement between the four raters was excellent (intraclass correlation coefficient 0.90 for DISCERN and 0.93 for JAMA). Most videos were uploaded by hospitals (50%) or educational health channels (30%). Videos had a higher number of average daily views when they included animation (P = 0.0093) and diagrams (P = 0.0422).

CONCLUSIONS

YouTube is a poor source of patient information on brain aneurysms. Our quality and audience engagement analysis may help content creators (i.e. hospital staff and physicians) to create more holistic, educational and engaging medical videos concerning brain aneurysms. Physicians could usefully refer their patients to the highest quality videos that we have found.

Does the choice of drug in pharmacologic cardioversion correlate with the guidelines? Systematic review

BACKGROUND

Atrial fibrillation (AF) is the most common sustained arrhythmia, the most common cause of supraventricular tachycardia in the global population and the most common arrhythmia requiring treatment in an emergency department.

OBJECTIVES

To systematically review recent literature and quantify the correlation between the choice of pharmacological cardioversion (PCV) drug and the national or international guidelines.

MATERIAL AND METHODS

A systematic review was performed in accordance with the PRISMA statement methodology. The PubMed search engine was used to search for articles regardless of type or language and published in the last 6 years (May 2014-May 2020). In addition, we searched for AF guidelines and recommendations published online by cardiology and emergency medicine societies.

RESULTS

The search strategy returned a total of 2615 abstracts. A total of 2598 full texts were screened; 2540 full texts were excluded with reasons and 58 articles from 32 countries were included in the analysis. In 17 of the 58 articles (29%), we noted discrepancies with the AF guidelines, specifically regarding the PCV drug used, the patients' comorbidities and the contraindications associated with the PCV drug. The most common clinical situation for the use of a contraindicated drug was when ibutilide was administered to patients with heart failure. The analysis did not reveal any statistically significant correlations, although the correlation between the sample size and guideline adherence was close to statistical significance (p < 0.06).

CONCLUSION

Our systematic analysis revealed substantial non-adherence to AF treatment guidelines.

YouTube as a source of patient information for meningitis: A content-quality and audience engagement analysis

OBJECTIVES

Now that the internet is more accessible to an increasing number of populations worldwide, many rely on the internet for their information about their daily lives. This includes people concerned about their health to students to sometimes also doctors. Since YouTube is the second most visited website, our aim was to evaluate the content-quality of YouTube videos relating to meningitis.

METHODS

We chose the first 30 videos for four different search phrases: meningitis, bacterial meningitis, viral meningitis, fungal meningitis and meningitis signs. The validated DISCERN scoring criteria was used to assess the videos by two raters independently. Qualitative data, quantitative data and the source of upload of each video were analyzed for video quality and audience engagement.

RESULTS

Out of 150 videos, 84 videos met the inclusion criteria. The mean DISCERN score was 34.6 ± 9.76 (out of a total 75), which indicates that the quality of YouTube videos on meningitis is poor. There is an excellent reliability between the two raters. Videos had a higher audience engagement via a greater number of daily views and comments when they included the definition, symptoms, prognosis, animation, diagrams, and an anatomical explanation of the meninges (P < 0.0001 for all).

CONCLUSION

The quality of YouTube videos on meningitis is poor, however, we have listed the videos which may be most effective for patient education for reference. Our quality and engagement analysis may help content creators make better health content on meningitis.

YouTube as a source of patient information for Coronavirus Disease (COVID-19): A content-quality and audience engagement analysis

YouTube is the second most popular website in the world and is increasingly being used as a platform for disseminating health information. Our aim was to evaluate the content‐quality and audience engagement of YouTube videos pertaining to the SARS (severe acute respiratory syndrome)‐CoV‐2 virus which causes the Coronavirus Disease 2019 (COVID‐19), during the early phase of the pandemic. We chose the first 30 videos for seven different search phrases: “2019 nCoV,” “SARS CoV‐2,” “COVID‐19 virus,” “coronavirus treatment,” “coronavirus explained,” “what is the coronavirus” and “coronavirus information.” Video contents were evaluated by two independent medical students with more than 5 years of experience using the DISCERN instrument. Qualitative data, quantitative data and upload source for each video was noted for a quality and audience engagement analysis. Out of the total 210 videos, 137 met our inclusion criteria and were evaluated. The mean DISCERN score was 31.33 out of 75 possible points, which indicates that the quality of YouTube videos on COVID‐19 is currently poor. There was excellent reliability between the two raters (intraclass correlation coefficient = 0.96). 55% of the videos discussed prevention, 49% discussed symptoms and 46% discussed the spread of the virus. Most of the videos were uploaded by news channels (50%) and education channels (40%). The quality of YouTube videos on SARS‐CoV‐2 and COVID‐19 is poor, however, we have listed the top‐quality videos in our article as they may be effective tools for patient education during the pandemic.

Are online searches for the novel coronavirus (COVID-19) related to media or epidemiology? A cross-sectional study

BACKGROUND

Previous studies on the novel Coronavirus (COVID-19) have found strong correlations between online searches and the epidemiology of the disease.

AIM

Our aim was to determine if online searches for COVID-19 related to international media announcements or national epidemiology.

METHODS

Searches for "coronavirus" were made on Google Trends from December 31, 2019 to April 13, 2020 for 40 European countries. The online COVID-19 searches for all countries were correlated with each other. COVID-10 epidemiology (i.e. incidence and mortality) was correlated with the national online searches. Major announcements by the World Health Organization (WHO) were taken into consideration with peaks in online searches. Correlations were made using Spearman's rank correlation coefficient.

RESULTS

Overall, the online searches for COVID-19 were not correlated with the actual incidence and mortality of COVID-19. The mean Spearman correlation for incidence was 0.20 (range -0.66 to 0.76) and for mortality was 0.35 (range -0.75 to 0.85). Online searches in Europe were all strongly synchronized with each other; a mean Spearman correlation of 0.93 (range 0.62 to 0.99).

CONCLUSIONS

Online searches for COVID-19 in Europe are not correlated with epidemiology but strongly correlated with international WHO announcements. Our study challenges previous Google Trends studies and emphasizes the role of the WHO in raising awareness of a new disease.

YouTube as a source of information for narcolepsy: A content-quality and optimization analysis

YouTube is the world's most popular video-sharing site that in recent years has become an important platform for patients in finding educational information about their disease. The purpose of this study was to assess the quality and reliability of narcolepsy-related YouTube videos. We searched the key terms "Narcolepsy", "Narcolepsy-cataplexy," "Narcolepsy excessive daytime sleepiness" and "Narcolepsy excessive drowsiness" on YouTube. 80 videos were analyzed as they meet the inclusion criteria. Quantitative and qualitative metrics were recorded and the videos were scored using the DISCERN instrument by two independent raters. Our findings show that the majority of videos contained clear information (84%), symptoms (78%) and patient experience (69%). Most videos were published by an educational channel not representing a hospital or clinic (41%) or by a patient suffering from the disease (25%). Videos containing animations had a statistically significant correlation between average daily views (p = .0004) and the video power index (p = .0048), suggesting that this feature increased the popularity among viewers. The mean DISCERN score was 27 ± 8, indicating that the quality of narcolepsy related-videos is poor. Therefore, patients that use YouTube as an educational tool are currently not attaining a comprehensive understanding of the disease. For this reason, we have indicated the top 5 videos that physicians can recommend to their patients. Our paper highlights the gaps of knowledge concerning narcolepsy information on YouTube. Therefore, this information can be used to create better educational content in the future.

Comparison of colour difference formulas to best distinguish resected areas of malignant brain tumours from their background using 5-aminolevulinic acid fluorescence

BACKGROUND

Fluorescence-guided surgery (FGS) with 5-aminolevulinic acid (5-ALA) has been proven to assist neurosurgeons to achieve a more complete brain tumour resection. However, 5-ALA-guided surgery is limited since it is often difficult to distinguish the colour difference between the resected areas of malignant brain tumours from their background. Our aim was to evaluate which colour difference formula was optimal to distinguish between malignant brain tumours and the background healthy tissue using 5-ALA fluorescence.

MATERIALS AND METHODS

Thirty-seven patients with a primary or secondary malignant brain tumour ingested 5-ALA before the surgery. A 400 nm light was used to excite the fluorescence. Surgical videos were recorded for all the patients and a total of 183 samples were obtained from the fluorescent areas and their respective backgrounds. Three colour differences formulas - contrast ratio (CR), CIELab (ΔE*) and CIEDE2000 - were applied to the videos and compared using hot-cold maps. Baseline demographics, the tumour's location, the tumour's side, and tumour's World Health Organization (WHO) grade was also analysed for correlations relating to the fluorescence. Chi-square and the Student's t-test were used for univariate relations. The three channels of the CIELAB colour space (L*, a* and b*) were analysed together and separately (since L* of fluorescent areas was significantly higher than the background).

RESULTS

ΔE* resulted in good discrimination of a* and b*, and moderate but acceptable discrimination of L*. CIEDE2000 distinguished differences in a* and b*, although not in L*. The CR distinguished only L*, whereas the probability of discriminating a* and b* channels failed. Neither age, sex, tumour location, tumour size nor the WHO grade influenced the a*, b* and L* colour values (p > 0.05). Colour differences measured by ΔE* and CIEDE2000 correlated together (r = 0.99, p < 0.01), whereas CR correlated only with ΔE* (r = 0.21, p = 0.01) but not with CIEDE2000 (r = 0.07, p = 0.32).

CONCLUSIONS

ΔE* obtained the best colour discrimination between the resected areas of malignant brain tumours and the background when compared to CR and CIEDE2000. Therefore, ΔE* may be the best formula to help neurosurgeons distinguish the colour differences when operating malignant brain tumours with 5-ALA fluorescence.

YouTube as a Source of Patient Information for Hydrocephalus: A Content-Quality and Optimization Analysis

OBJECTIVE

YouTube is the second most popular Web site in the world and thus it is often used by patients to access health information regarding their condition(s). Our aim was to evaluate the content-quality of YouTube videos relating to hydrocephalus.

METHODS

We chose the first 35 videos for 4 different search phrases: "water on the brain," "hydrocephalus," "pediatric hydrocephalus," and "adult hydrocephalus." Video contents were evaluated by 2 independent final-year medical students with >5 years of experience using the DISCERN criteria (scoring system from 1 to 5 per question). Qualitative data, quantitative data, and the upload source about each video were recorded for quality and optimization analysis.

RESULTS

Of the total 140 videos, 63 met our inclusion criteria and were evaluated. The mean DISCERN score was 29.9 of a total of 75 possible points. This finding indicates that the quality of YouTube videos on hydrocephalus is poor. Reliability between the 2 raters was excellent (intraclass correlation coefficient = 0.96). Most videos had clear information (90%), a doctor speaking (70%), and described the symptoms (62%). Videos were most commonly uploaded by hospitals (44%) or by educational channels (43%). Our study found that videos that contained the results of treatment had a higher average daily view (P = 0.0229) than videos that did not.

CONCLUSIONS

The quality of YouTube videos on hydrocephalus is poor; however, we indicated the top-quality videos in our article because they may be effective tools for patient education. Our optimization analysis found that including diagrams and explaining the results of hydrocephalus treatment leads to higher audience engagement (in the form of likes, comments, and views).

Can sectioning the posterior communicating artery be predicted with computed tomography angiography in the microsurgical clipping of basilar apex aneurysms?

BACKGROUND

Microsurgical clipping is a viable option for managing high-riding basilar apex aneurysms (BAXs) using a transsylvian approach. Cutting the posterior communicating artery (PCoA) at the perforator-free zone provides sufficient exposure of BAX, although it is not always safe. The aim was to qualitatively predict sectioning of the interfering PCoA by using preoperative computed tomographic angiography (CTA).

METHODS

A virtual trajectory from the lesser sphenoid wing to the neck of the aneurysm was simulated on CTA in 19 consecutive patients operated on BAX aneurysms from 2013 to 2018. The angles on CTA resembled the typical view through the extended pterional craniotomy. Next, the ipsilateral PCoA was tracked from the internal carotid to its end at the posterior cerebral artery in the trajectory.

RESULTS

The opticocarotid and carotid-oculomotor window served as the corridors for entering the interpeduncular fossa in 16 patients (84.2%) and in 3 patients (15.8%), respectively. The PCoA was intentionally cut during nine surgeries and preserved in 10 of them. The PCoA was cut more often when positioned toward the cranial base and more medially in the corridor; both the Kernel density analysis and the data points representing the position of the PCoA supported this finding (p < 0.01). The CTA-based position of either ends of the PCoA in the trajectory did not differ between cut and not-cut groups (p = 0.19-0.96). Aneurysm projection, rupture, size, PCoA diameter, length, and other distances on CTA were not related to the sectioning of PCoA (p > 0.05).

CONCLUSIONS

The probability of PCoA sectioning is higher when the PCoA is positioned medially and closer to the cranial base. If the anatomical course of the PCoA is recognized beforehand, it can contraindicate surgery. Preoperative CTA-based planning facilitates the surgery of BAX aneurysms. Therefore, CTA can make microsurgical clipping planning more predictable for the neurosurgeon and safer for the patient.

Extent of anterior clinoidectomy for clipping of carotid-ophthalmic aneurysms predicted on three-dimensional computerised tomography angiography

AIM OF STUDY

We aimed to verify the value of computerised tomography angiography (CTA) on predicting the extent of anterior clinoidectomy that is optimal for particular carotid-ophthalmic aneurysms (COAs).

CLINICAL RATIONALE FOR STUDY

The anterior clinoid process (ACP) often impedes the complex microsurgery of COA. Complete removal of the ACP ensures safe clipping; however, it also may increase the risk of severe complications. The probability of performing a successful partial anterior clinoidectomy could be evaluated by preoperative CTA.

MATERIALS AND METHODS

28 patients with either a ruptured (n=4) or unruptured COA were included in this prospective, single-centre, observational study. One aneurysm was giant, two were large, and the rest were smaller. Successful aneurysm clipping was the aim in all cases. The anterior clinoidectomy was preoperatively planned on multiplanar three-dimensional reconstructions of CTA images (3D-CTA) which resembled the typical view of a frontotemporal craniotomy. Finally, the predicted clinoidectomy was compared to the extent of the actual clinoidectomy.

RESULTS

21 aneurysms (75%) projected superolateral or superior. The ACP was completely and selectively resected in 25% (7 of 28) and 67.9% of patients (19 of 28) respectively. Optic nerve (ON) unroofing was always performed in the case of total anterior clinoidectomy, but accompanied only 8 of 19 selective clinoidectomies (p = 0.03). The extent of the actual clinoidectomy was predicted by the 3D-CTA-based preoperative planning in 17 of 27 cases (63.0%). Particularly, prediction of the osteotomy was correct in 85.7% of complete, 62.5% of selective lateral, and 57.1% of medial clinoidectomy. None of the radiological and clinical factors determined the correlation between the planned and the actual extent of ACP removal. There was one incomplete occlusion among 23 obtained follow-up CTAs.

CONCLUSIONS

The predictive value of 3D-CTA on the extent of anterior clinoidectomy still remains unsatisfactory; it is limited by the individual variability of COA and its surrounding structures.

CLINICAL IMPLICATIONS

Currently, the role of 3D-CTA planning is restricted to educational purposes only.

Tractography-guided surgery of brain tumours: what is the best method to outline the corticospinal tract?

BACKGROUND

Diffusion tensor imaging (DTI) is the imaging technique used in vivo to visualise white matter pathways. The cortico-spinal tract (CST) belongs to one of the most often delineated tracts preoperatively, although the optimal DTI method has not been established yet. Considering that various regions of interests (ROIs) could be selected, the reproducibility of CST tracking among different centres is low. We aimed to select the most reliable tractography method for outlining the CST for neurosurgeons.

MATERIALS AND METHODS

Our prospective study consisted of 32 patients (11 males, 21 females) with a brain tumour of various locations. DTI and T1-weighed image series were acquired prior to the surgery. To draw the CST, the posterior limb of the internal capsule (PLIC) and the cerebral peduncle (CP) were defined as two main ROIs. Together with these main ROIs, another four cortical endpoints were selected: the frontal lobe (FL), the supplementary motor area (SMA), the precentral gyrus (PCG) and the postcentral gyrus (POCG). Based on these ROIs, we composed ten virtual CSTs in DSI Studio. The fractional anisotropy, the mean diffusivity, the tracts' volume, the length and the number were compared between all the CSTs. The degree of the CST infiltration, tumour size, the patients' sex and age were examined.

RESULTS

Significant differences in the number of tracts and their volume were observed when the PLIC or the CP stood as a single ROI comparing with the two- ROI method (all p < 0.05). The mean CST volume was 40054U (SD ± 12874) and the number of fibres was 259.3 (SD ± 87.3) when the PLIC was a single ROI. When the CP was a single ROI, almost a half of fibres (147.6; SD ± 64.0) and half of the CST volume (26664U; SD ± 10059U) was obtained (all p < 0.05). There were no differences between the various CSTs in terms of fractional anisotropy, mean diffusivity, the apparent diffusion coefficient, radial diffusivity and the tract length (p > 0.05). The CST was infiltrated by a growing tumour or oedema in 17 of 32 patients; in these cases, the mean and apparent diffusion of the infiltrated CST was significantly higher than in uncompromised CSTs (p = 0.04). CST infiltration did not alter the other analysed parameters (all p > 0.05).

CONCLUSIONS

A universal method of DTI of the CST was not developed. However, we found that the CP or the PLIC (with or without FL as the second ROI) should be used to outline the CST.

Does Spinal Cord Stimulation Due to Failed Back Surgery Syndrome Lead to Permanent Occupational Disability?

OBJECTIVE

Spinal cord stimulation (SCS) is a recommended treatment method for patients afflicted by failed back surgery syndrome (FBSS). Although SCS is shown to be clinically effective, not many patients return to work (RTW). The aim of this study is to assess the RTW rate of these patients.

MATERIALS AND METHODS

We prospectively evaluated 102 patients with FBSS, managed by low frequency SCS at a single institution in Poland. RTW rate was the main endpoint in the study. Additionally, we browsed the first 300 records in Google and extracted the suggested RTW time post-SCS implantation.

RESULTS

Mean follow-up was 8.5 years. 79.4% of patients were actively working at the baseline. Fifteen patients were sick leave benefit claimants (15/81; 18.5%) and six were permanently disabled (6/81; 7.4%). In the follow-up, 40 did not change their work status. Only 2 of 21 patients resumed work and the total RTW rate was 9.5%. On the other hand, 38 of 81 patients (46.9%), who actively worked before SCS, gained disability status. Out of entire group, 20.6% (21 of 102) were not working at the baseline and 55.9% (57 of 102) were not working in the follow-up. Neither factor influenced RTW rate. In the second stage of the study, internet data search yielded a mean RTW time of 6.1 weeks.

CONCLUSIONS

Unlike the well-analyzed effectiveness of SCS, RTW remains an underutilized outcome measure. The RTW rate in our series was the second lowest in the reviewed literature. We demonstrated that half of the patients with an implanted SCS either did not resume their work or left their job.

Dural adhesion as a cause of late clip slippage from the medial cerebral artery aneurysm

BACKGROUND

A properly placed clip may slip off the aneurysm during the postoperative period. Many factors have been attributed to this complication, although clip adherence to the dural stitch has not been reported.

MATERIALS AND METHODS

Following the single occurrence of such unusual complication, 64 similar medial cerebral artery (MCA) aneurysms were retrospectively investigated at a single institution. Clip adherence to the dura demonstrated in early postoperative computed tomography (CT) was a presumed factor of a late clip migration in this study.

RESULTS

In the series, there were 4 (6.3%) aneurysm remnants and 1 slipped clip that firmly adhered to the dura. In this particular case, the revision surgery revealed the spring coil firmly adhering to the dura in the previous suture line. Neither the occurrence of an aneurysm neck remnant nor clip slippage were related to the clip's adherence to the dura in the analysis of the entire group (p > 0.05). On the contrary, application of a fenestrated clip did contribute to that finding in multivariate analysis (p < 0.01). Unlike the rest, two surgeons unintentionally tended to position the clip close to the dura (p < 0.01). The clip-to-dura distance measured in the follow-up CT angiography 1 year after the surgery differed from that in the postoperative CT in 83.8% of the cases and decreased by an average of 0.5 mm.

CONCLUSIONS

Clip-to-dura adherence should be regarded as a normal finding in the postoperative CT following MCA aneurysm clipping. Surgeons should consider the possibility of clip head protrusion into the dural stitch line.

Frontal aslant tract projections to the inferior frontal gyrus

BACKGROUND

Frontal aslant tract (FAT) is a white matter bundle connecting the pre-supplementary motor area (pre-SMA) and the supplementary motor area (SMA) with the inferior frontal gyrus (IFG). The purpose of the present study was to evaluate the anatomical variability of FAT.

MATERIALS AND METHODS

Total number of fibres and the lateralisation index (LI) were calculated. We attempted to find factors contributing to the diversity of FAT regarding IFG terminations to the pars opercularis (IFG-Op) and to the pars triangularis (IFG-Tr). Magnetic resonance imaging of adult patients with diffusion tensor imaging (DTI) with total number of 98 hemispheres composed a cohort. V-shaped operculum was the most common (60.5%).

RESULTS

Total number of FAT fibres had widespread and unimodal distribution (6 to 1765; median: 160). Left lateralisation was noted in 64.3% of cases and was positively correlated with total number of FAT fibres and the bundle projecting to IFG-Op (p < 0.01). LI correlated with total number of FAT fibres (r = 0.43, p < 0.01). FAT projected predominantly to IFG-Op (88.9%; 88 of 99). Only in 3 (3.1%) cases more fibres terminated in IFG-Tr than in IFG-Op. Total number of FAT fibres and number of fibres terminating at IFG-Op did not correlate with the ratio of fibre numbers: FAT/IFG-Op, FAT/IFG-Tr and IFG-Op/IFG-Tr (p > 0.05). The greater total number of fibres to IFG-Tr was, the higher were the ratios of IFG-Tr/ /FAT (r = 0.57, p < 0.01) and IFG-Tr/IFG-Op (r = 0.32, p = 0.04).

CONCLUSIONS

Among the IFG, the major termination of FAT is IFG-Op. Whereas the IFG-Tr projection seems to be related to the expansion of the entire FAT bundle regardless of side, domination and handedness. Nevertheless, FAT features a significant anatomical variability which cannot be explained in terms of DTI findings.

Intracranial region of the vertebral artery: morphometric study in the context of clinical usefulness

BACKGROUND

The aim of this study was to analyse the morphometry of the intracranial segment of the vertebral artery in the context of clinical usefulness. The results were compared with published data available in full-text archived medical journals.

MATERIALS AND METHODS

More than 100 digital subtraction angiography (DSA) and 3-dimensional (3D) angio-computed tomography (CT) examinations were used to measure the following parameters: the whole and partial length of V4 in characteristic anatomical points, the diameter in three places (on the level of foramen magnum, in point of exit to the posterior inferior cerebellar artery, and in the vertebro-basilar junction), the angle of connection to the vertebral arteries, and all anatomical variations including fenestration, duplication, dolichoectasia or absent artery.

RESULTS

The left V4 section was predominant over the right artery, which is manifested by length, width, cases of ectasia and fewer cases of hypoplasia. The incidences of V4 ectasia were identified more often than those documented in the accessible literature, and they were found in the natural location of formation of saccular aneurysms.

CONCLUSIONS

The presented knowledge of anatomical variation and abnormali-ties of vertebral circulation can improve the accuracy and "safety" of the surgical procedures in this region, help to determine the range of surgical approach and avoid associated complications. The radiological examinations using 3D CT, DSA reveal unlimited observation of anatomical structures in contrast to studies based on cadavers, and can complement the morphometry in anatomical preparations.

Is the Keros classification alone enough to identify patients with the 'dangerous ethmoid'? An anatomical study

CONCLUSION

By means of three-dimensional display of the critical measurements, the authors suggest a novel definition of 'dangerous ethmoid'. Parallel to Keros type III, the proposed determining factors include: olfactory fossa width >6 mm, its distance to the medial nasal concha (turbinate) <20 mm and to the orbit interval of <10 mm. Clinical evaluation of these preliminary criteria based only on radiological data is required and underway.

OBJECTIVES

Detailed pre-operative assessment of sinus computer tomography (CT) scans reduces the frequency of severe complications in patients undergoing endoscopic sinus surgery (ESS). The authors aimed to identify a sub-set of anatomical features pre-disposing to major post-operative complications.

METHOD

Sinus computer tomography (CT) scans of patients of a single institution qualified for ESS were examined. Besides the Keros classification, authors focused on the anatomic measurements as follows: the olfactory fossa depth, width, and its distance from the medial nasal concha and the medial wall of the orbit (referred to as 'critical measurements'). The sample comprised 120 consecutive CT exams, without clinical validation.

RESULTS

Keros type I, II, and III was noted in 9.2%, 75.8%, and 15.0% of cases, respectively. Despite some statistically significant correlations, it was not possible to identify the patient age, sex, and side of body clearly correlating with the critical measurements.