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World neurosurgery
Elsevier
World neurosurgery

Elsevier

1878-8750

World neurosurgery/Journal World neurosurgeryAHCISCIISTP
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    Analysis of Risk Factors Related to Acute Subarachnoid Hemorrhage After Spinal Surgery

    Jiang H.Meng Y.Zhao J.Gao R....
    7页
    查看更多>>摘要：? 2021 Elsevier Inc.Objective: Subarachnoid hemorrhage (SAH) is a rare complication secondary to cerebrospinal fluid (CSF) leakage during spinal surgery, but the specific cause of bleeding is still unclear. In this retrospective single-center study, we studied cases of acute SAH after spinal surgery to identify the related risk factors for bleeding. Methods: A total of 441 patients with CSF leakage who underwent spinal surgery from 2011 to 2020 were retrospectively analyzed. According to whether postoperative SAH occurred, the patients were divided into the SAH group and the control group. By comparing the demographic data, past history, imaging data, intraoperative findings, perioperative complications, and treatment conditions in the 2 groups to identify the risk factors for SAH, we aimed to provide guidance for the prevention of SAH after spinal surgery. Results: In our study, the incidence of CSF during spinal surgery is 3.04%, and the rate for SAH associated with spine operation is 0.16%. In the SAH group, 17 patients (73.9%) had preoperative hypertension, and 3 patients (13.0%) had diabetes. The intraoperative CSF leakage was approximately 118.4 ± 56.9 mL. The mean postoperative drainage was 15.4 ± 5.8 mL/hour. Compared with the SAH group, the control group had 123 patients (29.4%) with hypertension before the operation and 40 patients (9.6%) with diabetes. The intraoperative CSF leakage was approximately 76.3 ± 23.0 mL, and the mean postoperative continuous drainage was 9.7 ± 2.1 mL/hour. Binary logistic regression analysis showed that hypertension, intraoperative CSF leakage, and postoperative CSF continuous drainage speed were related to SAH. Conclusions: The rapid leakage of CSF caused by rupture of the dural sac during surgery and the rapid drainage of CSF after surgery were closely related to the occurrence of SAH. In addition, hypertension was a factor related to SAH during spinal surgery.
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    • NSTL
    • Elsevier

    Large practice variations in diagnosis and treatment of delayed cerebral ischemia after subarachnoid hemorrhage

    van den Berg R.Coutinho J.M.Horn J.Vandertop W.P....
    9页
    查看更多>>摘要：? 2022 The AuthorsBackground: Delayed cerebral ischemia (DCI) contributes to poor outcomes after subarachnoid hemorrhage (SAH). The pathophysiology of DCI is not fully understood, which has hindered the adoption of a uniform definition. Furthermore, a reliable diagnostic test and an effective evidence-based treatment are lacking. This could lead to variations in care. Methods: A web-based survey on the variations in the definition, diagnosis, and treatment of DCI was designed and sent to 314 intensivists, neurologists, and neurosurgeons of all 9 hospitals in the Netherlands who care for patients with SAH. The responders were categorized into physicians responsible for the coordination of SAH care and those who were not. For questions on the definition and diagnosis, only the responses from the coordinating physicians were evaluated. For the treatment questions, all the responses were evaluated. Results: The response rate was 34% (106 of 314). All 9 hospitals were represented. Of the responses, 27 did not provide answers for the definition, diagnosis, or treatment questions; 79 responses were used for analysis. Signs of vasospasm were required by 21 of the 47 coordinating physicians (44%) when considering DCI. Of the 47 coordinating physicians, 24 (51%) did not use a diagnostic test results for a positive diagnosis of DCI. When patients were discharged within 21 days, 33 of the 73 responders (45%) did not provide a prescription for nimodipine continuation. Finally, all but one hospital had treated DCI with hypertension induction. Conclusions: We found large variations in the definition, diagnosis, and treatment of DCI in the Netherlands. In the absence of evidence-based treatment, standardization of management seems warranted in an effort to optimize DCI care.
      原文链接:
    • NSTL
    • Elsevier

    Identification of Key Biomarkers and Immune Infiltration in Sporadic Vestibular Schwannoma Basing Transcriptome-Wide Profiling

    Shi J.Lu D.Gu R.Xu Y....
    10页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Vestibular schwannoma is a common intracranial tumor, with 95% of the cases being sporadic vestibular schwannoma (SVS). The purpose of this study was identifying genes responsible for inflammation in SVS and clarifying its underlying immune mechanisms. Methods: Transcriptional sequencing datasets (GSE141801 and GSE108237) from the Gene Expression Omnibus database were used in this study. The candidate modules closely related to SVS and hub genes were screened out by weighted gene coexpression network analysis. Τhe sensitivity and specificity of the hub genes for SVS prediction were evaluated by receiver operating characteristic curve analysis. The CIBERSORT algorithm was subsequently applied to analyze the immune infiltration between SVS and controls. Finally, biological signaling pathways involved in the hub genes were identified via gene set enrichment analysis. Results: A total of 39 significantly enriched in myelination and collagen-containing extracellular matrix DEGs were identified at the screening step. Three hub genes (MAPK8IP1, SLC36A2, and OR2AT4) were identified, which mainly enriched in pathways of melanogenesis, GnRH, and calcium signaling pathways. Compared with normal nerves, SVS tissue contained a higher proportion of T cells, monocytes, and activated dendritic cells, whereas proportions of M2 macrophages were lower. Conclusions: The integrated analysis revealed the pattern of immune cell infiltration in SVS and provided a crucial molecular foundation to enhance understanding of SVS. Hub genes MAPK8IP1, SLC36A2, and OR2AT4 are potential biomarkers and therapeutic targets to facilitate the accurate diagnosis, prognosis, and therapy of SVS.
      原文链接:
    • NSTL
    • Elsevier

    Research Progress of Atlantoaxial Osteoarthritis: A Narrative Literature Review

    Yin M.Ding X.Liu S.Ma J....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: To consolidate the current literature related to atlantoaxial osteoarthritis (AAOA) and improve systematic understanding of this clinical syndrome among spine surgeons. Methods: A comprehensive literature search was performed using PubMed, Ovid MEDLINE, and EMBASE databases and the following search terms: (“C1-C2” OR “C1-2” OR “atlantoaxial” OR “atlanto-axial” OR “C2” OR “C1” OR “atlas” OR “axis”) AND (“osteoarthritis”). All articles of any study design addressing AAOA were considered for inclusion. Two authors independently read article titles and abstracts, and the full text of included relevant articles. Results: There were 54 articles reviewed and consolidated in this narrative review. These articles are roughly divided into the following 5 subcategories: epidemiology and etiology, clinical presentation, radiographic findings, conservative treatment, and surgical indications and treatment options. Conclusions: AAOA is a clinically common but often overlooked syndrome characterized by persistent occipitocervical pain. The most common cause of AAOA is joint degeneration, which is closely related to age and occupation. AAOA is initially managed with conservative treatment. Atlantoaxial fusion is an option for patients with severe pain who are unresponsive to conservative treatment.
      原文链接:
    • NSTL
    • Elsevier

    Glutamic Acid and Total Creatine as Predictive Markers for Epilepsy in Glioblastoma by Using Magnetic Resonance Spectroscopy Before Surgery

    Tanaka K.Nagashima H.Fujita Y.Tanaka H....
    10页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Epilepsy in glioblastoma patients significantly reduces their quality of life; however, little is known about the association between predicting epilepsy and metabolites in tumors. In this study, we used 3.0-T magnetic resonance imaging and 1H-magnetic resonance spectroscopy (MRS) to quantify metabolite concentrations in patients with varying epilepsy histories. Methods: Fifty-one patients with glioblastoma underwent pretreatment 3.0-T MRI/1H-MRS scanning. Single-voxel (1.5 cm3) MRS, in an enhanced lesion, was acquired using a double-echo point-resolved spectroscopic sequence with chemical-shift selective water suppression. MRS data were quantified with linear combination model (LC-Model) software. We compared the MRS data between groups with and without epilepsy during the postoperative course (EP). Results: The ratios of glutamate (Glu) and glutamate + glutamine (Glx) to total creatine (Glu/tCr and Glx/tCr) in the tumor were associated with epilepsy history. The receiver operating characteristic curve analysis showed that a Glu/tCr value of 1.81 was 70% sensitive and 90% specific for the prediction of EP (area under curve: 0.82). In the analysis excluding patients with preoperative epilepsy, a Glu/tCr value of 1.81 was 75% sensitive and 88% specific for the prediction (area under curve: 0.87). Conclusions: Intratumoral metabolite concentrations measured using pretreatment 3.0-T MRI/1H-MRS changed characteristically in the group with EP. Our study suggests that the Glu/tCr ratio in tumors has adequate reliability in predicting EP. Pretreatment MRS is a minimally invasive and simple procedure that can provide useful information on glioblastoma patients.
      原文链接:
    • NSTL
    • Elsevier

    Trends in the Neurosurgical Workforce and Implications in Providing for an Aging Population

    Singh R.Parikh P.P.De La Pena N.M.Bhandarkar A.R....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: The United States is projected to face increasing physician-workforce shortages. However, the shortage in the neurosurgical workforce has not yet been characterized. In the present study, we outlined the current state of the neurosurgical workforce by quantifying the divide between the number of practicing neurosurgeons and the U.S. population. Methods: The Medicare Physician National Medicare database was queried from 2014 to 2019 to obtain the numbers of practicing neurosurgeons, which were compared with the population counts from the U.S. Census data. Results: From 2014 to 2019, the total increase in neurosurgeons per capita was 9.4%. The Northeast neurosurgeons per capita rate (NPCR) increased by 17.1%, the South NPCR by 3.4%, the Midwest NPCR by 13.3%, and the West NPCR by 12.5%. In all regions, except for the West, the surgeon per capita ratio had decreased from 2017 to 2019. The greatest increase in the number of surgeons was 2018 to 2019 (n = 214). In 2014, the states with the lowest NPCRs were Vermont, Arkansas, and New Mexico. In 2019, these included Nevada, New Mexico, and Vermont. As of 2020, 56.6% of the neurosurgeons had practiced for >20 years. Conclusions: Although the national NPCR has slowly increased during the past 5 years, a more recent decrease occurred within the last 3 years. Additionally, with almost 57% of surgeons having been practicing for >20 years, concern exists regarding whether current practices can sustain increasing patient needs. The results from the present study indicate that further investigation is warranted regarding the factors contributing to this shortage and the steps that can be taken to increase the production of well-trained neurosurgeons.
      原文链接:
    • NSTL
    • Elsevier

    Biomechanical Evaluation and Preliminary Clinical Results of Anterolateral Screw Fixation for Oblique Lumbar Interbody Fusion Surgery

    Fang G.Chen S.Zhuang W.Huang W....
    9页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: The most common complication of oblique lumbar interbody fusion (OLIF) is endplate fracture/subsidence. The aim of this study was to evaluate biomechanical stability in patients undergoing OLIF surgery with anterolateral screw fixation (ASF). Methods: Based on a previously validated model technique, L4-L5 functional surgical models corresponding to the ASF and bilateral pedicle screw fixation (BPSF) methods were created. Finite element models were developed to compare the biomechanics of the ASF and BPSF groups. We retrospectively analyzed 18 patients with lumbar degenerative diseases who underwent OLIF with ASF in Shenzhen Hospital of Southern Medical University from April 2020 to April 2021. Intraoperative and postoperative complications were observed. Results: Compared with the BPSF model, the maximum stresses of the L4 inferior endplate and L5 superior endplate were greatly increased in the ASF model. The contact surface between the vertebrae and screw (CSVS) in the ASF model produced nearly 100% more stress than the BPSF model at all moments. In clinical practice, after a 12-month follow-up, 7 adverse events were observed, including 3 cases of left thigh pain/numbness, 3 cases of cage subsidence, and 1 case of screw loosening. Conclusions: OLIF surgery with ASF could not reduce the maximum stresses on the endplate and CSVS, which may be a potential risk factor for cage subsidence and screw loosening.
      原文链接:
    • NSTL
    • Elsevier

    Intraoperative Navigation in Spine Surgery: Effects on Complications and Reoperations

    Shuman W.H.Valliani A.A.Chapman E.K.Martini M.L....
    8页
    查看更多>>摘要：? 2022 Elsevier Inc.Introduction: Intraoperative navigation during spine surgery improves pedicle screw placement accuracy. However, limited studies have correlated the use of navigation with clinical factors, including operative time and safety. In the present study, we compared the complications and reoperations between surgeries with and without navigation. Methods: The National Surgical Quality Improvement Project database was queried for posterior cervical and lumbar fusions and deformity surgeries from 2011 to 2018 and divided by navigation use. Patients aged >89 years, patients with deformity aged <25 years, and patients undergoing surgery for tumors, fractures, infections, or nonelective indications were excluded. The demographics and perioperative factors were compared via univariate analysis. The outcomes were compared using multivariable logistic regression adjusting for age, sex, body mass index, American Society of Anesthesiologists class, surgical region, and multiple treatment levels. The outcomes were also compared stratifying by revision status. Results: Navigation surgery patients had had higher American Society of Anesthesiologists class (P < 0.0001), more multiple level surgeries (P < 0.0001), and longer operative times (P < 0.0001). The adjusted analysis revealed that navigated lumbar surgery had lower odds of complications (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.77–0.90; P < 0.0001), blood transfusion (OR, 0.79; 95% CI, 0.72–0.87; P < 0.0001), and wound debridement and/or drainage (OR, 0.66; 95% CI, 0.44–0.97; P = 0.04) compared with non-navigated lumbar surgery. Navigated cervical fusions had increased odds of transfusions (OR, 1.53; 95% CI, 1.06–2.23; P = 0.02). Navigated primary fusion had decreased odds of complications (OR, 0.91; 95% CI, 0.85–0.98; P = 0.01). However, no differences were found in revisions (OR, 0.89; 95% CI, 0.69–1.14; P = 0.34). Conclusions: Navigated surgery patients experienced longer operations owing to a combination of the time required for navigation, more multilevel procedures, and a larger comorbidity burden, without differences in the incidence of infection. Fewer complications and wound washouts were required for navigated lumbar surgery owing to a greater proportion percentage of minimally invasive cases. The combined use of navigation and minimally invasive surgery might benefit patients with the proper indications.
      原文链接:
    • NSTL
    • Elsevier

    Exoscopic En Bloc Carotid-Sparing Total Temporal Bone Resection: Feasibility Study and Operative Technique

    Rindler R.S.Soriano R.M.Elsherbini M.M.Kim B....
    8页
    查看更多>>摘要：? 2021 Elsevier Inc.Objective: To delineate the steps of exoscopic en bloc carotid artery–sparing total temporal bone resection for malignancies involving the temporal bone in a cadaveric model. Methods: Dissections were performed on 3 right-sided (3 sides) formalin-fixed, latex-injected cadaveric specimens. An exoscopic en bloc carotid artery–sparing total temporal bone resection was performed on each cadaver. In the past 4 years, 8 patients have undergone exoscope-assisted internal carotid artery–sparing total temporal bone resection with the technique described in this report. As an example, we present a representative case of a patient in whom this technique was used. Results: Exoscope-assisted en bloc total temporal bone resections were performed on 3 right-sided cadaveric specimens. The following steps were described to circumferentially expose the petrous temporal bone: infratemporal fossa exposure, temporal craniotomy for subtemporal middle fossa approach to the petrous bone, retrosigmoid craniotomy, and transjugular approach. Finally, 3 skull base osteotomies were performed to liberate anterior, medial, posterior attachments of the petrous bone for en bloc removal. Possible extensions of these dissections as indicated by tumor pathology were described. A case illustration and operative video utilizing these techniques is presented. Conclusions: Exoscope-assisted en bloc carotid artery-sparing total temporal bone resection is a feasible technique for management of malignancies with temporal bone invasion.
      原文链接:
    • NSTL
    • Elsevier

    Middle Cerebral Artery Aneurysm Trial (MCAAT): A Randomized Care Trial Comparing Surgical and Endovascular Management of MCA Aneurysm Patients

    Darsaut T.E.Keough M.B.Boisseau W.Findlay J.M....
    6页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: Whether the best management of middle cerebral artery (MCA) aneurysm patients is surgical or endovascular remains uncertain, with little evidence to guide decision-making. A randomized care trial offering MCA aneurysm patients a 50% chance of surgical and a 50% chance of endovascular management may optimize outcomes in the presence of uncertainty. Methods: The Middle Cerebral Artery Aneurysm Trial (MCAAT) is an investigator-initiated, multicenter, parallel group, prospective, 1:1 randomized controlled clinical trial. All adult patients with MCA aneurysms, ruptured or unruptured, amenable to surgical and endovascular treatment can be included. The composite primary outcome is “Treatment Success”: (i) occlusion or exclusion of the aneurysm using the allocated treatment modality; (ii) no intracranial hemorrhage during follow-up; (iii) no retreatment of the target aneurysm during follow-up, (iv) no residual aneurysm on angiographic follow-up; and (v) independence (mRS <3) at 1 year. The trial tests 2 versions of the same hypothesis (one for ruptured and one for unruptured MCA aneurysm patients): Surgical management will lead to a 15% absolute increase in the proportion of patients reaching Treatment Success from 55% to 70% (ruptured) or from 75% to 90% (unruptured aneurysm patients) compared with endovascular treatment (any method). In this pragmatic trial, outcome evaluations are by treating physicians, except for 1-year angiographic results which will be core lab assessed. The trial will be monitored by an independent data safety monitoring committee to assure safety of participants. MCAAT is registered at clinicaltrials.gov: NCT05161377. Conclusions: Patients with MCA aneurysms can be optimally managed within a care trial protocol.
      原文链接:
    • NSTL
    • Elsevier