首页期刊导航|Journal of neurosurgical sciences.
期刊信息/Journal information
Journal of neurosurgical sciences.
Minerva medica.
Journal of neurosurgical sciences.

Minerva medica.

0390-5616

Journal of neurosurgical sciences./Journal Journal of neurosurgical sciences.
正式出版
收录年代

    Invasiveness has no influence on the rate of incidental duroto-mies in surgery for multisegmental lumbar spinal canal stenosis (=>=3 levels) with and without fusion: analysis from the German Spine Registry data (DWG-Register)

    Vinas-Rios JMRauschmann MSellei RSanchez-Rodriguez JJ...
    6页
    查看更多>>摘要：BACKGROUND: Nowadays, perioperative complications as dural tear (DT) with subsequent neurological deficits are documented in independent registers. However, the relationship of these complications with the grade of invasiveness (>=3 levels) is still unclear. The aim of this study was to evaluate perioperative complications, particularly DT with subsequent neurological deficits, between patients undergoing laminotomy and decompression and decompression and fusion in >=3 levels. METHODS: Retrospective analysis of the data pool of the DWG register based on cases described by 10 clinics between January 2012 and December 2016 was performed. Surgically treated LSS in >=3 segments were divided into decompression with or without instrumentation and fusion. Cases with intraoperative DT in both subgroups were analysed for risk factor occurrence. The Surgical Invasive Index (SU) was used. RESULTS: DT occurred in 102/941 (10.8%) patients. Difference in DT between groups was non-significant. The likelihood of DT increased by 2.12-fold with previous spinal surgery at the same level and by 1.9-fold for BMI 30-34 and >35 in comparison with BMI 26-29, respectively. Postoperative deep wound infection was increased by 2.39-fold after DTthan without. Significance in outcomes between patients with/without DT was not found. The invasiveness index explained 48% of the variation in blood loss and 51% of the variation in surgery duration CONCLUSIONS: The rate of incidental DT during decompression for LSS with and without fusion in >=3 levels was associated with BMI and previous surgery at the same spinal level. Invasivness (SII) is valid rather for variables proper to surgery such as bledding and Op-time but no with incidence for DT and subsequent CSF-leackage.
      原文链接:
    • NSTL
    • Edizioni Minerva Medica

    Preliminary results of a novel pure endoscopic procedure in the treatment of degenerative lumbar spinal disorders:.double endoscopic technique

    Tacconi LBobicchio P
    6页
    查看更多>>摘要：BACKGROUND: With increased experience and the availability of new technical instrumentations, the surgical endoscopic indications for lumbar spinal pathologies have moved from simple prolapsed disk to canal stenosis. The available endoscopes come in two different sizes (10 mm and 6.3 mm in diameter); however, one is too bulky to use inside the spinal canal and the other is too small to achieve a fast bone decompression. In order to overcome such problems, we developed and used a different surgical technique called: double endoscopic technique. METHODS: Using this approach, we operated and prospectively collected clinical information on 17 patients (Group A) suffering from a mixed (ligament-bone hypertrophy and prolapsed disk) single segmental lumbar canal stenosis. At a median of 13 months from surgery, all the patients in this group had a very good outcome with an improvement of the VAS and ODI. RESULTS: These clinical results were compared with those from another group of patients who had undergone surgery in the same unit but using standard MIS technique (Group B). Both groups were similar in terms of number, age, symptoms and stenosis location. We compared the pre-and postoperative VAS and ODI values, the amount of postoperative pain killers used during the first week postsurgery, the length of in-hospital stays as well as the blood loss during surgery. CONCLUSIONS: Although our aim was only to present a novel surgical endoscopic technique, the results, with all the study limitations including small numbers and short follow-up, have shown that this procedure is safe and effective, yielding an outcome comparable to the standard MIS approach. Furthermore, it is less disruptive towards the involved anatomy, it gives less postoperative pain, it requires a smaller skin incision, and the blood loss is negligible. Thus, this technique may guarantee a faster clinical recovery.
      原文链接:
    • NSTL
    • Edizioni Minerva Medica

    Association between preoperative serum lactate concentrate with tumor cell proliferative index in primary brain tumor

    Aldecoa IGonzalez JGarcia-Orellana MBelda I...
    5页
    查看更多>>摘要：BACKGROUND: Elevated preoperative lactate levels have been reported in patients admitted for resection of brain tumors. As histologic type and tumor grade have also been linked to lactate concentration, we hypothesized that preoperative lactate concentration in patients with brain tumors may be associated with tumor proliferation. We describe the relationship between preoperative plasma lactate levels, and the cell proliferation marker Ki-67 in brain tumor surgery. METHODS: In this cross-sectional study, records of patients who underwent craniotomy between June 2017 and February 2018 at our Hospital were reviewed to select glioma and meningioma cases in which lactate concentrations in plasma and degree of cell proliferation were registered. Bivariable and linear regression analyses were used to assess the association between lactate concentrations and the Ki-67 Index. RESULTS: Lactate concentrations in plasma and Ki-67 Index were available in 55 patients. Meningioma cases had a mean concentration of 1.2 (0.1) mmol/L compared to diffuse astrocytic and oligodendroglial tumors cases with 1.7 (0.1) mmol/L (P<0.01). Both variables had a low positive correlation in meningiomas (Spearman's r, 0.29; 95% CI, -0.10-0.61; P=0.13) and a high correlation in gliomas (Spearman's r, 0.64; 95% CI, 0.33-0.82; P< 0.01). The pooled analysis showed a high correlation index (Spearman's r, 0.61; 95% CI, 0.40-0.76; P< 0.01). A linear regression model showed that the Ki-67 Index explained 43% of the variation in lactate (P<0.01). CONCLUSIONS: Brain tumors with higher rates of cell proliferation have higher plasma lactate levels. In this scenario, lactate concentrations may not only reflect systemic perfusion.
      原文链接:
    • NSTL
    • Edizioni Minerva Medica

    Development of cerebrospinal fluid fistula after incidental durotomy in spinal decompression surgery

    Hohenberger CBrawanski ABriindl EUllrich OW...
    7页
    查看更多>>摘要：BACKGROUND: Incidental durotomy (ID) during spinal surgery is a risk factor for the development of cerebrospinal fluid (CSF) fistula. The rates of ID with or without consecutive CSF fistula vary according to the extent of the surgical procedure. Revision surgery has the highest rates of dural tears. However, not every case of ID leads to CSF fistula requiring revision surgery. The objective of this study was to analyze the predictors for the development of CSF fistula after ID. METHODS: This retrospective study included 6024 consecutive patients who had been surgically treated for degenerative spinal disease at our clinic over the past 15 years. Patients who had undergone surgical revision for CSF fistula were assigned to the CSF fistula group. A matched 3:1 control group (ID group) was formed of patients with ID but without CSF fistula. Charts, surgical reports, and radiographic data were reviewed and statistically analyzed for demographics, duration of symptoms, comorbidities, surgical strategy, and pre- and postoperative neurological performance. RESULTS: The 15-year incidence of CSF fistula in the overall population was 0.36% (N.=22). The following locations were affected: N.=18 lumbar (81.8%), N.=2 cervical (9.1%), and N.=2 thoracic (9.1%). The extent of ID was similar in both groups. The two groups did not significantly differ with regard to the intraoperative management of dural repair with primary suturing (P=0.345), dural patches, sealant, or collagen matrix (P=0.228; P=0.081; P=0.081). In the postoperative period, bed rest in supine position for 48 hours (P=0.037) and laxative therapy (P=0.034) were the most beneficial treatment modalities for preventing CSF fistula. Patients with CSF fistula were hospitalized significantly longer (21 days vs. 10 days in the control group; P< 0.001). CONCLUSIONS: This large test group showed a low incidence of postoperative CSF fistula after intraoperative ID. Bed rest and laxative treatment were important approaches to preventing CSF fistula.
      原文链接:
    • NSTL
    • Edizioni Minerva Medica

    From paradigm to paradox: divergency between intracranial pressure and intracranial pulse pressure during atmospheric pressure fall. A case study

    Herbowski L
    9页
    查看更多>>摘要：BACKGROUND: The main objectives are to determine relation between intracranial pressure (ICP) and its amplitude and to ascertain meteorological variables as possible confounding factors. This is a retrospective observational study of a patient with suspicion of normotensive hydrocephalus. METHODS: The intracranial pressure, the blood pressure, atmospheric pressure and geomagnetic activity were continuously monitored capturing extraordinary sudden and unexpected atmospheric pressure fall. The physiological changes exceptionally observed during sudden weather changes were described by means of statistical parameters. The data from 73 consecutive hourly measurements was eligible for this analysis. It contained 1022 data points corresponding to all recorded parameters, both climate and physiological ones. RESULTS: After initial stable period, the atmospheric pressure started to decrease from 767 mmHg to 746 mmHg. In parallel, the mean ICP ncreased significantly from 4 mmHg to 14 mmHg. Thus, the mean ICP changed inversely during atmospheric pressure drop. Whereas mean intracranial pressure increased by 10 mmHg during atmospheric pressure fall, the intracranial amplitude decreased by 5 mmHg. On timescale of several dozen hours in this study, the short-term periodic diurnal variations of ICP and blood pressure were displayed. The association between diurnal atmospheric pressure oscillation and geomagnetic activity variation was observed. Both intracranial and blood pressure variations differed significantly between day and night. CONCLUSIONS: This study shows that increasing ICP is associated with its paradoxically decreasing amplitude under the influence of sudden and unexpected barometric pressure fall. This study suggests that abrupt changes in atmospheric pressure might impact ICP.
      原文链接:
    • NSTL
    • Edizioni Minerva Medica

    Effect of antibiotic therapy on proton MR spectroscopy findings in human pyogenic brain abscesses

    Vecera ZKrejci TKrajca JKanta M...
    5页
    查看更多>>摘要：BACKGROUND: This work aims to determine how antibiotic therapy influences MR spectroscopic findings in patients undergoing treatment ' for pyogenic brain abscess. METHODS: This prospective, single center study included all patients who received treatment for brain abscesses at the Neurosurgery Department of University Hospital Ostrava between 2012-2017. Preoperative MR imaging was carried out on all patients including diffusion-weighted imaging and in vivo single-voxel proton spectroscopy with intermediate echo time. The following factors were evaluated: duration of antibiotic therapy, characteristics of MR imaging and spectra findings and culture results. RESULTS: MR spectroscopy findings characteristic of brain abscesses, i.e. the resonances of at least one of the metabolites concerned (amino acids, acetate, alanine and succinate), were observed in 23 patients who had undergone antibiotic therapy for less than 72 hours beforehand (median 7 hours; IQR 30 hours). The 20 patients who underwent antibiotic therapy for longer than this (the median time was 336 hours with an IQR of 284 hours) showed no abscess-specific metabolites, only nonspecific lactate and/or lipid resonance (P<0.0005). These results were further compared with culture findings of pus samples taken intraoperatively: a significantly higher rate of positive culture (78.2%) was determined in cases where antibiotics were administered less than 72 hours before MRS (P< 0.0005). CONCLUSIONS: Prolonged antibiotic therapy can influence MRS findings in pyogenic brain abscesses — a fact which is certainly necessary to take into account in its differential diagnosis. The disappearance of the characteristic metabolites can be indirectly interpreted as an indicator of successful antibiotic therapy in cases where surgical intervention is not possible. Further study in this field is required to confirm the results of this study.
      原文链接:
    • NSTL
    • Edizioni Minerva Medica

    Clinical and radiological outcomes following open door laminoplasty: a single center evolution of the technique

    Signorelli FTrevisi GBianchi FAnile C...
    8页
    查看更多>>摘要：BACKGROUND: The aim of the present study was to compare and describe clinical and radiological outcomes after two different variants of open door laminoplasty for cervical spondylotic myelopathy (CSM). METHODS: Fifty-five patients underwent cervical laminoplasty for CSM. Between 2005 to 2009,32 patients underwent open-door laminoplasty (Group A) performed with a monolateral exposure with contralateral "green stick" laminar fracture: A technical variant consisting in bilateral exposure, spinous process removal and symmetrical muscular closure was applied in the other 23 (Group B), from 2009 to 2016. A retrospective analysis of surgical results between the two groups was performed. RESULTS: In group B, the mean operative time was longer, and the mean volume of intraoperative blood loss was much higher than in group A. Both differences were not significant (P=0.1601 and P=0.0884, respectively). The average hospitalization was non-significantly longer in group B (7.3±1.8 vs. 6.5±1.6 d; P=0.0947). Postoperatively, axial neck pain was more severe in group A at last follow-up than preoperatively (P>0.05). mJOA scores and Nurick grades improved significantly in both groups at last follow-up; in group A, the mean recovery rates were 41.5% by mJOA scores and 29.4% by Nurick grades, whereas in group B they were 52.7% and 36.8%, respectively. CONCLUSIONS: Applying some few variations to a standard monolateral approach, although slightly more time and blood consuming, could reduce the incidence of long-term axial symptoms and, in our experience, are not burdened by worsening of outcomes. A prospective, multicen-tric study with a longer follow-up should be conducted in order to confirm our findings.
      原文链接:
    • NSTL
    • Edizioni Minerva Medica

    Investigation of key miRNAs and their target genes involved in cell apoptosis during intervertebral disc degeneration development using bioinformatics methods

    Zhang HZhang MMeng LGuo M...
    8页
    查看更多>>摘要：BACKGROUND: The aim of this study was to identify important miRNAs and their target genes involved in cell apoptosis in intervertebral disc degeneration (IDD) patients. METHODS: The dataset, GSE63492, was obtained from the gene expression omnibus platform. After preprocessing, the differentially expressed miRNAs (DEMs) and their target genes were identified using the Limma package and miRWalk2.0 database, respectively. The clusterProfiler package in R was used to perform functional enrichment analysis of these target genes. Subsequently, protein-protein interaction (PPI) network and subnet clusters of the coregulated genes were conducted using the STRING database and MCODE, respectively. Further, the co-regulatory network of the key miRNAs and PPI networks were visualized using Cytoscape. Finally, cell apoptosis-related pathways and the genes enriched in these pathways were identified. RESULTS: The genes targeted by the upregulated (hsa-miR-302c-5p, hsa-miR-631, hsa-let-7f-1-3p, hsa-miR-3675-3p, and hsa-miR-585-3p) and downregulated miRNAs (hsa-miR-185-5p, hsa-miR-486-5p, hsa-miR-4306, and hsa-miR-4674) were interrelated with cell apoptosis-related pathways. MAPK1 and MAPK3 were targeted by hsa-miR-185-5p, while GSK3B was targeted hsa-miR-4306, hsa-miR-486-5p, hsa-miR-185-5p, hsa-let-7f-1-3p, and hsa-miR-631. Besides, MAPK3 and VEGFA were regulated by hsa-miR-3675-3p and hsa-miR-631, respectively. CONCLUSIONS: The expression of GSK3B may be coregulated by miR-4306, miR-185-5p, miR-486-5p, hsa-let-7f-1-3p, and miR-631 and may affect IDD development. Besides, miR-185-5p and miR-3675-3p may control nucleus pulposus (NP) cell apoptosis through the MAPK signaling pathway in IDD patients. VEGFA expression may be regulated by miR-631, and help maintain NP cell survival in IDD patients. Our findings may help guide further research into the role of miRNAs in IDD progression.
      原文链接:
    • NSTL
    • Edizioni Minerva Medica

    Sexual discrimination in neurosurgery: a questionnaire-based nationwide study amongst women neurosurgeons in Bulgaria

    Enchev YBrady ZArif SEncheva E...
    6页
    查看更多>>摘要：BACKGROUND: The aim of this qualitative, descriptive, cross-sectional study was to identify potential factors influencing the progression of female neurosurgeons in Bulgaria. METHODS: The study was conducted nationally, by sending out an online (SurveyMonkey?) questionnaire with 30 questions over a 3-month period to 15 registered female neurosurgeons in practice including residents/trainees and specialists from state universities, private universities and regional hospitals in Bulgaria. The questionnaire covered basic demographics, level of academic achievement and aspects of personal and professional experience, along with questions on the perceived barriers that female neurosurgeons nationally encountered during their clinical and academic career. These results were compared with similar studies conducted in other countries following a literature search on PubMed. RESULTS: Eleven out of fifteen respondents returned the completed survey, covering 10 institutions which included 8 university clinics and two regional clinics, achieving a response rate of 73.3%. No questionnaires were excluded. The factors negatively influencing the clinical and academic professional development and progression in the field included lack of mentors and other female role models, perceived bias regarding remuneration and leave, as well as a lack of support with regards to work-life balance and difficulty progressing in the academic fields. CONCLUSIONS: Although there is an ever increasing and growing awareness of the factors negatively impacting women progression in neurosurgery worldwide, there are still significant gaps and biases that hinder career progression amongst female neurosurgical communities and highlight a need for potential practices to be established in the workplace to counteract this.
      原文链接:
    • NSTL
    • Edizioni Minerva Medica

    Artificial intelligence-enhanced intraoperative neurosurgical workflow: current knowledge and future perspectives

    Tariciotti LPalmisciano PGiordano MRemoli G...
    12页
    查看更多>>摘要：INTRODUCTION: Artificial intelligence (AI) and machine learning (ML) augment decision-making processes and productivity by supporting surgeons over a range of clinical activities: from diagnosis and preoperative planning to intraoperative surgical assistance. We reviewed the literature to identify current AI platforms applied to neurosurgical perioperative and intraoperative settings and describe their role in multiple subspecialties. EVIDENCE ACQUISITION: A systematic review of the literature was conducted following the PRISMA guidelines. PubMed, EMBASE, and Scopus databases were searched from inception to December 31st, 2020. Original articles were included if they: presented AI platforms implemented in perioperative, intraoperative settings and reported ML models' performance metrics. Due to the heterogeneity in neurosurgical applications, a qualitative synthesis was deemed appropriate. The risk of bias and applicability of predicted outcomes were assessed using the PROBAST tool. EVIDENCE SYNTHESIS: Forty-one articles were included. All studies evaluated a supervised learning algorithm. A total of 10 ML models were described; the most frequent were neural networks (N.=15) and tree-based models (N.=13). Overall, the risk of bias was medium-high, but applicability was considered positive for all studies. Articles were grouped into four categories according to the subspecialty of interest: neuro-oncology, spine, functional and other. For each category, different prediction tasks were identified. CONCLUSIONS: In this review, we summarize the state-of-art applications of AI for the intraoperative augmentation of neurosurgical workflows across multiple subspecialties. ML models may boost surgical team performances by reducing human errors and providing patient-tailored surgical plans, but further and higher-quality studies need to be conducted.
      原文链接:
    • NSTL
    • Edizioni Minerva Medica