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World neurosurgery
Elsevier
World neurosurgery

Elsevier

1878-8750

World neurosurgery/Journal World neurosurgeryAHCISCIISTP
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    Postcooling But Not Precooling Benefits Motor Recovery by Suppressing Cell Death After Surgical Spinal Cord Injury in Rats

    Li N.Chau C.Y.C.Liu J.Yao M....
    9页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: Surgical spinal cord injury (SSCI) is often inevitable in patients with intramedullary lesions. Although regional hypothermia (RH) has been demonstrated neuroprotective, the value of priming RH in SSCI has never been studied. Herein, the authors investigated the impact of pre- and post-RH on neurologic recovery in a clinically relevant model. Methods: An SSCI model was established at T10. RH was conducted by focal 4oC saline perfusion; room temperature (RT) saline was used as controls. Animals were randomized into 6 groups: SHAM?RT/RH, Pre?RT/RH, and Post?RT/RH. Motor and sensory functions were evaluated using the Basso, Beattie, and Bresnahan rating scale and Plantar test 2 weeks after surgery. TUNEL assay and Fluoro-Jade C staining were conducted to examine the cell death, and the alterations of apoptotic markers including total and cleaved casepase 3, Bcl-2, and Bax, as well as the pyroptotic proteins including NLRP3, ASC, and caspase 1, were determined. Results: RH perfusion successfully created an intramedullary hypothermia approximately at 24oC, while RT controls remained above 30oC. Animals receiving postinjury RH had the least cell death and the best motor performance, while pre-RH showed the most dead cells and worst hind limb movements. Immunoblotting depicted that post-RH suppressed both apoptotic and pyroptotic death as the cleaved/total caspase 3, Bcl-2/Bax ratio, and NLRP3/ASC/caspase 1 signaling were inhibited. Priming cooling, on the contrary, elevated pyroptosis and did not affect apoptosis significantly. Conclusions: Priming RH before surgical incision could not be supported as it caused excessive cell death. In contrast, instant introduction of RH is beneficial in rescuing neurologic function.
      原文链接:
    • NSTL
    • Elsevier

    A Year of Pandemic—Comparison of Depression Among Neurosurgeons After the Advent of the COVID-19 Vaccine

    Sharif S.Amin F.Hafiz M.Costa F....
    13页
    查看更多>>摘要：? 2021 Elsevier Inc.Objective: To determine factors associated with anxiety and depression among neurosurgeons after vaccination during the coronavirus disease 2019 (COVID-19) pandemic. Methods: An online survey was completed by neurosurgeons worldwide over 4 weeks. Depression in neurosurgeons was assessed by the 20-item self-reporting questionnaire. Results: A total of 534 responses were received and analyzed. Almost half of the respondents were from Asia (50.9%), followed by Europe (38.8%). The majority of the respondents were <40 years old (88%), and almost two thirds were trainees (62.2%). Half of the respondents worked in departments with <40 beds (50.7%), and the majority were practicing in the private sector (72.5%). Most of the respondents (85.8%) had COVID-19–positive colleagues in their department, and 64% had exposure to a COVID-19–positive colleague, family member, and/or patient. More than half of the respondents were exposed to infected patients and/or colleagues, and almost half (43.1%) underwent COVID-19 testing when exposed. Nearly half of the respondents underwent COVID-19 testing more than twice (52.4%). Of respondents, 83% had received at least the first dose of the vaccine. The odds of depression among vaccinated respondents were found to be significantly less than among unvaccinated respondents in the univariable model. Conclusions: Among health care workers, neurosurgeons are one of the groups indirectly affected by the pandemic. Adaptation to the new normal and advent of vaccines is speculated to control psychological distress among all groups of health care workers, including neurosurgeons. We found that odds of depression among vaccinated people were lower than among people who were not vaccinated.
      原文链接:
    • NSTL
    • Elsevier

    Practice Variation in Perioperative Steroid Dosing for Brain Tumor Patients: An International Survey

    Jessurun C.A.C.Hulsbergen A.F.C.Lamba N.Nandoe Tewarie R.D.S....
    11页
    查看更多>>摘要：? 2021 The Author(s)Objective: Steroids are commonly used to treat peritumoral edema and increased intracranial pressure in patients with brain tumors. Despite widespread use of steroids, relatively little evidence is available about their optimal perioperative dosing scheme. This study aimed to increase insight into practice variation of perioperative steroid dosing and tapering schedules used in the neurosurgical community. Methods: An electronic survey comprising 27 questions regarding steroid dosing, tapering schedules, and adverse events was administered to neurosurgeons between December 6, 2019, and June 1, 2020. The survey was distributed through the European Association of Neurosurgical Societies and social media platforms. Collected data were assessed for quantitative and qualitative analysis. Results: The survey obtained 175 responses from 55 countries across 6 continents, including 30 from low- or middle-income countries; 152 (87%) respondents completed all questions. Of respondents, 130 (80%) indicated prescribing perioperative steroids. Reported doses ranged from 2 to 64 mg/day in schedules ranging from 1 to 4 times daily. The most prescribed steroid was dexamethasone in doses of 16 mg/day (n = 49; 31%), 12 mg/day (n = 31; 20%), and 8 mg/day (n = 18; 12%). No significant association was found between prescribed dose and physician and institutional characteristics. Conclusions: Steroids are commonly prescribed perioperatively in patients with brain tumors. However, there is great practice variation in dosing and schedules among neurosurgeons. Future investigation in a prospective and preferably randomized manner is needed to identify an optimal dosing scheme and implement international/national guidelines for steroid use.
      原文链接:
    • NSTL
    • Elsevier

    MiRNA-181d Expression Correlates in Tumor versus Plasma of Glioblastoma Patients—the Base of a Preoperative Stratification Tool for Local Carmustine Wafer Use

    Sippl C.Quiring A.Teping F.Schulz-Schaeffer W....
    10页
    查看更多>>摘要：? 2021 Elsevier Inc.Objective: Patients with a low micro-RNA-181d (miRNA-181d) level in glioblastoma tissue benefit most of carmustine wafer use. The study compares preoperative miRNA-181d plasma and tumor expression. This may form the base to decide, from a preoperative blood test, if carmustine wafer implantation is recommendable. Methods: A total of 60 patients suffering from glioblastoma treated between 2018 and 2020 were enrolled prospectively. Preoperatively, blood was drawn and the plasma was isolated. Tumor specimens were collected. Blood samples from 30 healthy individuals served as a reference. MiRNA-181d expression in plasma and tumor were acquired as fold change, using quantitative reverse transcription-polymerase chain reaction. Results were correlated with relevant demographic, clinical, and histopathologic aspects of the cohort. Further factors like tumor volume as well as blood panel results were considered. The Cancer Genome Atlas analysis was performed to investigate specific miRNA-181d-protein interactions to elude how miRNA-181 impact therapy response to carmustine. Results: Patients with glioblastoma showed a significant overexpression of miRNA-181d compared with healthy individuals (P = 0.029). There was a significant correlation between miRNA-181d expression in tumor tissue and plasma (P = 0.001, R = 0.51). The sensitivity of low miRNA-181d expression in plasma predicting low miRNA-181d tumor expression was 76.6%. Tumor volume, preoperative medication, and items of blood panel analysis did not influence the prognostic value of plasma miRNA-181d expression. The Cancer Genome Atlas analysis revealed 8 potential protein targets to be regulated by miRNA-181d. Conclusion: miRNA-181d seems to be a potential molecular marker that can reliably be detected in blood samples of patients with glioblastoma. It should therefore prospectively be evaluated as a potential preoperative prognostic marker regarding carmustine wafer implantation.
      原文链接:
    • NSTL
    • Elsevier

    Posterior 3-Column Osteotomy for Treatment of Congenital Kyphosis with Multiple Thoracolumbar/Lumbar Anterior Unsegmented Vertebrae: A Comparison Between Patients with Increasing Number of Anterior Unsegmented Vertebrae

    Mao S.Ma Y.Zhu Z.Liu Z....
    12页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: A 3-column osteotomy is sometimes challenging in congenital kyphosis (CK) with many anterior unsegmented vertebrae (AUVs). This study compared surgical outcomes of single-level 3-column osteotomy and associated complications in CK with increasing number of AUVs. Methods: We retrospectively reviewed 25 consecutive patients with AUVs in CK who underwent surgery at a mean age of 16.2 ± 10.3 years. Patients were stratified into 2 groups according to the number of AUVs: 3 AUVs and ≥4 AUVs. Osteotomy types, surgical outcomes, and related complications were analyzed and compared between groups. Results: The 3 AUVs group comprised 13 patients, and the ≥4 AUVs group comprised 12 patients. Pedicle subtraction osteotomy, grade 4 osteotomy, vertebral column resection, and vertebral column decancellation accounted for 15.4%, 38.5%, 46.1%, and 0% of procedures in the 3 AUVs group and 8.3%, 0%, 83.3%, and 8.3% of procedures in the ≥4 AUVs group. Preoperative focal kyphosis, which was significantly higher in the ≥4 AUVs group (82.9° ± 28° vs. 59.7° ± 9.4°, P = 0.010), was corrected in both groups postoperatively. The ≥4 AUVs group had significantly higher remaining kyphosis (33.6° ± 13.4° vs. 15.1° ± 9.1°, P < 0.001) with a significantly lower correction rate (61.2% ± 13.6% vs. 75.0% ± 15.6%, P = 0.001). The complication rate, mainly involving vertebral subluxation and proximal junctional kyphosis, was significantly higher in the ≥4 AUVs group than the 3 AUVs group (8/12 vs. 1/13, P = 0.004). Conclusions: Posterior single-level 3-column osteotomy can achieve satisfactory kyphosis correction in CK with 3 AUVs. Decreasing kyphosis correction and increasing surgery-related complications are prone to develop when treating CK with ≥4 AUVs.
      原文链接:
    • NSTL
    • Elsevier

    Can the Risk of Postoperative Cerebrospinal Fluid Leakage Be Predicted for Patients Undergoing Cervical Spine Surgery? Development and Evaluation of a New Predictive Nomogram

    Huang S.Liang T.Sun X.Chen L....
    9页
    查看更多>>摘要：? 2022 The AuthorsObjective: Previous studies have retrospectively analyzed the likely causes of cerebrospinal fluid leakage (CSFL) during cervical spine surgery and the management of CSFL after its occurrence. In the present study, we aimed to develop and validate a nomogram for the risk of CSFL in Chinese patients who had undergone cervical decompression and internal fixation (CDIF) surgery. Methods: We performed a retrospective analysis of patients who had undergone CDIF surgery. Of the 1286 included patients, 54 were in the CSFL group and 1232 were in the normal group. The patients were randomly divided into training and validation tests. The risk assessment for CSFL included 21 characteristics. The feature selection for the CSFL model was optimized using the least absolute shrinkage and selection operator regression model in the training test. Multivariate logistic regression analysis was performed to construct the model according to the selected characteristics. The clinical usefulness of the predictive model was assessed using the C-index, calibration curve, and decision curve analysis with identification and calibration. Results: The risk prediction nomogram included the diagnosis, revision surgery, ossification of the posterior longitudinal ligament, cervical instability, and a history of malignancy in the training test. The model demonstrated high predictive power, with a C-index of 0.914 (95% confidence interval, 0.876–0.951) and an area under the curve of 0.914. The results of the decision curve analysis demonstrated the clinical usefulness of the CSFL risk nomogram when the probability threshold for CSFL was 1%–62%. Conclusions: Our proposed nomogram for CSFL risk includes the diagnosis, revision surgery, ossification of the posterior longitudinal ligament, cervical instability, and a history of malignancy. The nomogram can be used to evaluate the risk of CSFL for patients undergoing CDIF surgery.
      原文链接:
    • NSTL
    • Elsevier

    TTF-1: A Well-Favored Addition to the Immunohistochemistry Armamentarium as a Diagnostic Marker of SEGA

    Dutta R.Sharma M.C.Suri V.Sarkar C....
    8页
    查看更多>>摘要：? 2021Background: Subependymal giant cell astrocytoma (SEGA) is a World Health Organization grade 1 neoplasm, which, due to its dubious morphologic features, may be misdiagnosed as a high-grade tumor at times. This tumor shows binary immunoexpression including both glial and neural markers, leading to a state of diagnostic quandary. Recent evidences have surmised the diagnostic utility of thyroid transcription factor 1 (TTF-1), spurring us to study the practicality of this marker in distinguishing SEGAs from its mimics. Methods: In this study, TTF-1 immunohistochemistry using clone 8G7G3/1 (1:50) was performed in 38 cases of SEGA, 30 cases of central neurocytoma, 10 cases each of intraventricular glioblastoma and ependymoma, and 5 cases of cortical tubers. Additionally, serine/threonine-protein kinase B-Raf (BRAFV600E) mutation, a common genetic alteration in pediatric low-grade-glial tumors with neuronal-differentiation, was analyzed using Ventana immunohistochemistry platform. Results: TTF-1 immunopositivity was seen in all 38 cases (100%) of SEGAs, with 20 cases (52.6%) showing diffuse (>50% of tumor area) expression while focal (<50%) immunopositivity was seen in 18 cases (47.3%). None of the cases demonstrated serine/threonine-protein kinase B-Raf immunolabeling. Barring 2 cases of neurocytoma (6.6%), all other cases including ependymoma, glioblastoma, and cortical tubers were immunonegative for TTF-1. Conclusions: The congruous finding of TTF-1 expression in SEGA and cells of the developing neuroepithelium in the medial ganglionic eminence hint toward a primogenitor cell with neoplastic potential in the presence of impelling factors.
      原文链接:
    • NSTL
    • Elsevier

    The Anterolateral Cervical Atlanto-Occipital Plexus: A Novel Finding with Application to Skull Base and Spine Surgery and Pain Disorders of the Head and Neck

    Tubbs R.S.Yang S.Iwanaga J.Olewnik L....
    7页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: We have described a novel nerve plexus of the upper neck. By exploring how the individual components of this specific anterolateral nerve plexus communicate with each other, patient care could be improved regarding the preoperative diagnosis, intraoperative navigation, and minimally invasive treatment. Methods: Using a surgical microscope, 11 adult cadaveric heads (22 cadaveric hemi-sides) were dissected. The region of the junction between the atlanto-occipital and craniocervical junctions was explored, specifically, the innervation of this region via adjacent nerve connections. Branches from these regional nerve sources were analyzed for interconnections, and, when found, these branches were documented and measured. Results: A delicate nerve plexus was found overlying the anterolateral C1–C2 junction in all specimens. The plexus was contributed by the sympathetic trunk, vagus nerve, hypoglossal nerve, and C1 and C2 ventral rami. We termed this plexus the anterolateral cervical atlanto-occipital (ALCAO) plexus. On all but 2 cadaveric hemi-sides (91%), the C2 ventral ramus provided the most input into the plexus, with 1–2 branches. On 2 cadaveric hemi-sides, the C1 ventral ramus was the primary contributor and, on average, this nerve contributed 1–2 branches to the plexus. For 8 cadaveric hemi-sides (36.4%), the C1 fibers that are known to travel with the hypoglossal nerve and be distributed to the geniohyoid and thyrohyoid muscles arose from C1 nerve fibers that first traversed the ALCAO plexus. The sympathetic trunk contributed 1–4 lateral branches, with most of these arising superiorly from the superior cervical ganglion. The vagus nerve contributed 1–2 lateral branches and the hypoglossal nerve contributed 1–2 anteromedial branches. This plexus was located more or less lateral to the sympathetic trunk and superior cervical ganglion and medial to the transverse process of C1 and C2. The plexus innervated the rectus capitis lateralis, rectus capitis anterior, and lateral atlanto-occipital joint and, on 4 cadaveric hemi-sides, the atlantoaxial joint. Additionally, small branches were seen traveling to the anterior atlantoaxial and anterior atlanto-occipital membranes on 55% and 77.2% of the cadaveric hemi-sides, respectively. On 6 hemi-sides, very small branches from the ALCAO plexus ended in the periosteum over the anterolateral aspect of the anterior arch and transverse process of the C1 vertebra. Conclusions: It is important to recognize that the course of these interneural connections varies and could result in unforeseen complications during surgical procedures. A comprehensive knowledge of these neural connections will be useful when considering surgery and evaluating pathology of the neck and skull base.
      原文链接:
    • NSTL
    • Elsevier

    Endoscopic High Occipital Interhemispheric Transtentorial Approach for Lesions in the Anterosuperior Cerebellum, Upper Fourth Ventricle, and Upper Dorsal Brain Stem

    Tanikawa M.Sakata T.Yamada H.Kawase-Kamikokura H....
    7页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: The occipital transtentorial route is considered the most suitable for surgical treatment of lesions arising from the anterosuperior cerebellum, upper fourth ventricle, and upper dorsal brain stem. Therefore, this study examined the feasibility and effectiveness of the endoscopic high occipital interhemispheric transtentorial approach (EHOTA) for lesions in these areas, in achieving results comparable to the endoscopic occipital interhemispheric transtentorial approach (EOTA). EOTA has recently been reported to be an effective procedure for pineal region tumors, having several advantages that include minimal invasiveness with a small entrance limiting the retraction of the occipital lobe, the elimination of blind spots, and the facilitation of fine manipulation due to the bright, magnified panoramic view. Methods: By using 30 clinical datasets of venous-phase head computed tomography angiogram, measurements on images were performed and differences between EOTA and EHOTA were identified. In addition, the feasibility of EHOTA was verified with 5 cadaver heads. Results: Although the operative field via EHOTA was considered significantly deeper and less maneuverable than with the procedure via EOTA, beneficial angles for manipulation in the superior cerebellum and the fourth ventricle were obtained in EHOTA, on account of their becoming more obtuse. Using EHOTA, it was possible to reach those regions and effectively manipulate all 10 sides of the 5 cadaveric heads, as well as a case with anterosuperior cerebellar cavernous angioma. conclusions: EHOTA, which has the same advantages as EOTA, could prove to be an efficacious procedure for lesions in the anterosuperior cerebellum, upper fourth ventricle, and upper dorsal brain stem.
      原文链接:
    • NSTL
    • Elsevier

    “The Circle” Predicts Extent of Fusion for Surgical Correction of Cervical Spinal Kyphotic Deformities: Proof of Concept

    Li D.Nockels R.P.
    7页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: Correction of kyphotic deformities of the spine is a common problem faced by spine surgeons. Unfortunately, there are no clear published guidelines available regarding the extent of spinal fusion required to achieve and maintain lasting deformity correction. We aim to share a set of novel radiographic parameters (“the Circle”) that can be used as a guideline for determining the extent of fusion required in surgical correction of spinal kyphotic deformity. Methods: A Google forms survey was distributed among spine surgeons and trainees to evaluate differences in recommended extent of posterior-approach fusions for cervical spinal kyphotic deformities before and after introduction to the Circle. Extent of fusion before and after use of the Circle were qualitatively and quantitatively analyzed. Data were anonymized and stored in a secure database. Results: Twenty-seven neurosurgical attendings (n = 14), residents (n = 9), and fellows (n = 3) responded to the survey. Variance between predicted upper and lower instrumented vertebrae, and length of construct, was statistically significantly decreased after application of the Circle in almost all cases. Respondents rated the ease of use of the Circle an average of 4.2 out of 5 (5 = the most ease). The majority of participants (92 [6%]; n = 25 of 27) stated that they would or would likely use the Circle as a radiographic tool in the surgical planning for correction of cervical spinal kyphotic deformities in the future. Conclusions: The Circle is a novel set of radiographic parameters that may be used to educate and guide surgical plans and extent of fusion when aiming to correct spinal kyphotic deformities.
      原文链接:
    • NSTL
    • Elsevier