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World neurosurgery
Elsevier
World neurosurgery

Elsevier

1878-8750

World neurosurgery/Journal World neurosurgeryAHCISCIISTP
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    Socioeconomic and Psychosocial Predictors of Magnetic Resonance Imaging After Cervical and Thoracic Spine Trauma in the United States

    Hagan M.J.Pertsch N.J.Leary O.P.Xi K....
    10页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Socioeconomic factors are known to influence outcomes after spinal trauma, but it is unclear how these factors affect health care utilization in acute care settings. We aimed to elucidate if sociodemographic and psychosocial factors are associated with obtaining magnetic resonance imaging (MRI), a costly imaging modality, after cervical or thoracic spine fracture. Methods: Data from the 2012–2016 American College of Surgeons National Trauma Data Bank were used. We assessed the relationship between receipt of MRI and patient-level sociodemographic and psychosocial factors as well as hospital characteristics while correcting for injury-specific characteristics. Multiple logistic regression was performed to assess for associations between these variables and MRI after spine trauma. Results: A total of 213,071 patients met the inclusion criteria, of whom 13.0% had an MRI (n = 27,757). After adjusting for confounders in multivariate regression, patients had increased odds of MRI if they were Hispanic (odds ratio [OR], 1.09; P = 0.001) or black (OR, 1.14; P < 0.001) or were diagnosed with major psychiatric disorder (OR, 1.06; P = 0.009), alcohol use disorder (OR, 1.05; P < 0.001), or substance use disorder (OR, 1.10; P < 0.001). Patients with Medicare (OR, 0.88; P < 0.001) or Medicaid (OR, 0.94; P < 0.011) were less likely to have an MRI than were those with private insurance, whereas patients treated in the Northeast (OR, 1.48; P < 0.001) or at for-profit hospitals (OR, 1.12; P < 0.001) were more likely. Conclusions: After adjusting for injury severity and spinal cord injury diagnosis, psychosocial comorbidities and for-profit hospital status were associated with higher odds of MRI, whereas public insurance was associated with lower odds. Results highlight potential biases in the provision of MRI as a costly imaging modality.
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    • NSTL
    • Elsevier

    Recurrences of Spheno-Orbital Meningiomas: Risk Factors and Management

    de Divitiis O.Corvino S.Strianese D.Iuliano A....
    9页
    查看更多>>摘要：? 2022Background: The extent of resection constitutes one of the most important predictive risk factors of recurrence for spheno-orbital meningiomas; although gross total resection represents the gold standard, it is not always achievable, with a consequent high rate of recurrence. Management of these tumors is a surgical challenge and is represented by maximal safe resection with preservation of function. The aim of the present study is to discuss the risk factors for recurrence and the best management of the recurrent tumors. Methods: Eighty patients operated on for spheno-orbital meningiomas were retrospectively reviewed. Two groups were identified: group 1 comprised 30 patients (37.5%) who experienced recurrence and group 2 comprised 50 patients with no recurrence from 5 to 28 years after the initial surgery. The analyzed factors in both groups include the involvement of the skull base structures, the extent of resection, and World Health Organization grade. In the recurrence group, the pattern of tumor regrowth, the entity of resection, and the management were also analyzed. Results: The invasion of the whole orbit, the involvement of the orbital apex, superior orbital fissure, infratemporal fossa, and sphenoidal-ethmoidal sinuses, and World Health Organization grade II are risk factors of recurrence. All 30 patients with recurrence underwent reoperation, 9 of whom had 2 or 3 reoperations. Overall, 70 of the 80 patients (88%) had tumor control and no progression after one or more reoperations. Conclusions: We suggest re-surgery for spheno-orbital meningioma recurrences to prevent worsening of visual function and proptosis. Because of their slow natural course, even multiple reoperations may be performed, resulting in long overall survival with stable symptoms and good quality of life.
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    • NSTL
    • Elsevier

    Workers’ Compensation Status and Outcomes Following Lumbar Surgery

    Karamian B.A.Mangan J.Siegel N.Lambrechts M.J....
    10页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: To determine the influence of preoperative workers’ compensation (WC) status on patient-reported outcome measures following lumbar decompression with or without fusion. Methods: All patients undergoing lumbar decompression with or without fusion at a single academic institution between 2013 and 2017 were identified. Patients were split into groups based on WC status: no workers’ compensation (NWC), WC), or retired. Intragroup analysis used paired t tests. Outcomes between groups were compared using Kruskal-Wallis H test. Multiple linear regression analysis determined if WC status was a predictor of change in patient-reported outcome measures. Subgroup analysis was conducted for WC patients who returned to work. Results: Of 571 included patients, 242 (43.4%) had NWC, 83 (14.5%) had WC, and 246 (43.1%) were retired. Comparing within groups, WC patients showed significant improvement in Short Form-12 Health Survey Physical Component Score, Oswestry Disability Index, visual analog scale (VAS) back pain, and VAS leg pain (all P < 0.001) after surgery. However, WC patients improved less than NWC or retired patients in Short Form-12 Health Survey Physical Component Score (P = 0.010), VAS back pain (P = 0.028), and VAS leg pain (P = 0.015). WC was an independent predictor of decreased improvement in Short Form-12 Health Survey Physical Component Score (β = ?4.31, P = 0.001), VAS back pain (β = 0.90, P = 0.034), and VAS leg pain (β = 1.50, P = 0.002) on multivariate analysis. WC patients who did not return to work was an independent predictor of decreased improvement in VAS back pain (β = 1.39, P = 0.016) and VAS leg pain (β = 2.11, P = 0.001). Conclusions: WC patients improve less than NWC patients. However, WC patients who return to work have similar VAS back and neck pain improvements as NWC patients.
      原文链接:
    • NSTL
    • Elsevier

    Surgical Management of Traumatic Brachial Plexus Injuries in the Pediatric Population

    Carlson Strother C.Joslyn-Eastman N.Loosbrok M.F.Pulos N....
    8页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: To evaluate demographics, treatment options, and outcomes of traumatic brachial plexus injuries in pediatric patients. Methods: Traumatic brachial plexus reconstructions in patients ≤17 years old were reviewed. Patients were stratified into pan-plexus and incomplete plexus injuries. Functional outcomes (modified British Medical Research Council grade) were reviewed after a minimum follow-up of 9 months. Results: Brachial plexus reconstruction was performed in 71 patients at a mean age of 13.9 years (range, 2–17 years). Approximately half of the patients had a pan–brachial plexus injury (n = 33, 46.5%) with 59.2% having at least 1 preganglionic avulsion injury. Among the 25 patients with pan–brachial plexus injuries who had >9 months of follow-up, 12 (48%), 24 (96%), and 17 (68%) had reconstruction surgery for shoulder, elbow, and grasp function, respectively. At last follow-up, 50%, 83%, and 29% of these patients had a modified British Medical Research Council grade ≥3 in shoulder abduction, elbow flexion, and grasp, respectively. Of the 31 patients with incomplete brachial plexus injuries, 28 (90%) underwent reconstruction for shoulder function, and 13 (42%) underwent surgery for elbow flexion. At last follow-up, 71% and 100% of patients had modified British Medical Research Council grade 3 in shoulder abduction and elbow flexion, respectively. Conclusions: Pediatric traumatic brachial plexus injuries are often high-energy injuries resulting in nerve root avulsions. Most patients were able to regain antigravity elbow flexion or stronger after brachial plexus reconstruction, and more than half had similar improvement in shoulder function. Treatment should be directed with goals of elbow flexion, shoulder stability/external rotation, and rudimentary grasp.
      原文链接:
    • NSTL
    • Elsevier

    A Promising Glycolysis- and Immune-Related Prognostic Signature for Glioblastoma

    Wang F.Liu X.Jiang H.Chen B....
    13页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Glioblastoma multiforme (GBM) is a malignant brain tumor with a poor prognosis. Aerobic glycolysis and an immunosuppressive microenvironment are potentially correlated with progression of GBM. However, the prognostic value of glycolysis–immune-related genes has not been studied in GBM. Methods: Using GBM-related data downloaded from Chinese Glioma Genome Atlas database, the overlapped differentially expressed genes were identified between the GBM patients with a different glycolysis status and immune score, which had also undergone functional enrichment. Univariate Cox regression analysis and LASSO (least absolute shrinkage and selection operator) Cox regression analysis were used for risk score construction. Multivariate Cox regression analysis and survival analysis determined the independent prognostic factors. Results: We found 277 overlapped differentially expressed genes between high glycolysis and low glycolysis, a high immune score and low immune score, and a combination of low glycolysis status and a low immune score and high glycolysis status and a high immune score. These were significantly enriched in 301 gene otology terms and 25 Kyoto Encyclopedia of Genes and Genomes pathways. Of these, 8 genes were found to be optimal for building a risk score. The risk score was an independent prognostic factor for GBM patients, and patients with a high score had a worse prognosis. Moreover, between the high- and low-risk GBM patients, 17 types of immune cells were differentially infiltrated, and 5 immune checkpoints were differentially expressed. Conclusions: The glycolysis–immune-related risk score using CACNG2, CSMD3, GABRA3, KCNIP2, KSR2, PTPRT, TNFRSF12A, and TNR was able to predict the prognosis of GBM patients relatively reliably.
      原文链接:
    • NSTL
    • Elsevier

    Establishing a Standardized Method for the Effective Intraoperative Collection and Biological Preservation of Brain Tumor Tissue Samples Using a Novel Tissue Preservation System: A Pilot Study

    Das A.Gunasekaran A.Stephens H.R.Mark J....
    14页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Glioblastoma (GB) is an aggressive tumor showing extensive intertumoral and intratumoral heterogeneity. Several possible reasons contribute to the historical inability to develop effective therapeutic strategies for treatment of GB. One such challenge is the inability to consistently procure high-quality biologically preserved specimens for use in molecular research and patient-derived xenograft model development. No scientifically derived standardized method exists for intraoperative tissue collection specifically designed with the fragility of RNA in mind. Methods: In this investigation, we set out to characterize matched specimens from 6 GB patients comparing the traditional handling and collection processes of intraoperative tissue used in most neurosurgical operating rooms versus an automated resection, collection, and biological preservation system (APS) which captures, preserves, and biologically maintains tissue in a prescribed and controlled microenvironment. Matched specimens were processed in parallel at various time points and temperatures, evaluating viability, RNA and protein concentrations, and isolation of GB cell lines. Results: We found that APS-derived GB slices stored in an APS modified medium remained viable and maintained high-quality RNA and protein concentration for up to 24 hours. Conclusions: Our results showed that primary GB cell cultures derived in this manner had improved growth over widely used collection and preservation methods. By implementing an automated intraoperative system, we also eliminated inconsistencies in methodology of tissue collection, handling and biological preservation, establishing a repeatable and standardized practice that does not require additional staff or a laboratory technician to manage it.
      原文链接:
    • NSTL
    • Elsevier

    Factors Associated With Patient-Reported Postsurgical Symptom Improvement in Adult Females with Chiari Malformation Type I: A Report from the Chiari1000 Dataset

    Labuda R.Loth D.Allen P.A.Loth F....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: The goal of this study was to assess if a broad array of factors is predictive of patient-reported surgical impact on symptoms. Methods: Sixty-five presurgical factors were selected from the self-report history questionnaires (12 variables, N = 653), standardized scales (14 variables, N = 494–581), and morphometric measurements from magnetic resonance imaging (39 variables, N = 137) data of adult women in the Chiari1000 dataset. The factors were tested independently to identify those that were either significantly different in terms of, or significantly related to, patient-reported surgical impact on symptoms (P < 0.05). These results were then used to build a forward selection regression model. Results: Overall, 74.4% of the patients reported either some level of improvement or complete resolution of symptoms. Independent testing identified 12 significant factors, including having a family member diagnosed with Chiari malformation type I (CMI), Ehlers-Danlos syndrome, migraines, duration of symptoms >2 years, multiple surgeries, symptom severity, depression, anxiety, stress, and loneliness. Depression showed the highest correlation (r = 0.36; P < 0.00001) with a negative outcome. The regression model produced an R2 = 0.346 and identified 5 factors with significant unique variance. Conclusions: The regression model accounted for more than a third of the surgical impact variance. Having a family member diagnosed with CMI contributed the largest unique variance to the model, suggesting that hereditary CMI may represent a unique subset of patients with poorer outcomes. Independent testing showed that psychological factors, such as depression and anxiety, were significant negative predictors, indicating that presurgical screening and treatment for these psychological conditions may improve outcomes.
      原文链接:
    • NSTL
    • Elsevier

    Can Posterior Midline Approach Provide Adequate Exposure for All Craniovertebral Junction Tumors?

    Varol E.Etli M.U.Avci F.Ramazanoglu A.F....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Introduction: The surgical treatment of craniovertebral junction (CVJ) lesions remains a difficult process requiring advanced experience. The aim of this study was to present our experience and the clinical results of a posterior and posterolateral approach used for CVJ lesions in our clinic, and to discuss these in light of current literature. Methods: Clinical, radiologic, and surgical aspects of 30 patients with CVJ tumors were retrospectively evaluated. Age, sex, symptoms, tumor localizations, pre- and postoperative neurologic examinations, performed surgical techniques, postoperative complications, and tumor pathologies were analyzed. The modified McCormick classification was used in the evaluation of the neurologic examination. Results: There were 30 patients (12 men, 18 women; mean age: 41.8 years). Hemilaminectomy was performed in 14 cases, and total laminectomy or laminoplasty in 16 cases; additional suboccipital craniectomy was performed in 6. Postoperative mortality was observed in 1 (3.3%) patient in the early postoperative period following tetraparesis, motor deficit in 2 (6.6%), cerebrospinal fluid leakage in 2 (6.6%), and wound site infection in 1 (3.3%). A tumor rest was detected in 2 patients (6.6%). Conclusions: A posterior or a posterolateral approach is a safe surgical technique that can provide total tumor resection for CVJ region lesions, including posterior, posterolateral, lateral, and anterolaterally located tumors. Isolated anterior and anterolateral tumors with small lateral extension may require a far lateral or extreme lateral approach combined with other cranial base techniques.
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    • NSTL
    • Elsevier

    Cumulative Incidence and Factors Associated With Subsequent Vertebral Compression Fractures: A Nationwide Population-based Study

    Kang C.-N.Kim J.Ryu J.-I.Kim Y....
    11页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Patients who experience vertebral compression fractures are vulnerable to subsequent vertebral compression fractures (SVCFs). The purpose of this nationwide population-based study was to determine the age-specific cumulative incidence and factors associated with SVCFs in South Korea. Methods: Diagnostic codes, medical costs, and comorbid diseases in patients who had a vertebral compression fracture in 2011 and 2012 were collected from the National Health Insurance Service database of South Korea from 2007 to 2018. Demographic data, mortality rate, medical cost, and frequency of vertebroplasty or kyphoplasty were compared between patients with an initial fracture (IF) and those with a subsequent fracture (SF). Results: The cumulative incidence of SVCFs over 4 years was 24.4% and increased rapidly within a few months after the IF. In 2011, SVCFs occurred in 17,004 patients, and the incidence rate per 100,000 people was 113.6 (84.9 in men vs. 138.5 in women). The odds ratio (OR) of SVCFs in units of 10 years was the highest in women in their 60s, at 2.89. However, in men in their 70s, the OR was the highest, at 2.51. The rates of vertebroplasty or kyphoplasty, medical expenses, and mortality rate were significantly higher in the SF group than in the IF group (P < 0.01). Conclusions: The age-specific cumulative incidence of SVCFs per 100,000 people was 113.6. SVCFs were more frequent among women, the elderly, and patients who underwent vertebroplasty or kyphoplasty. Women in their 60s or above and men in their 70s or above were at highest risk.
      原文链接:
    • NSTL
    • Elsevier

    Today WILL be a Good Day

    Benzel E.
    7页
      原文链接:
    • NSTL
    • Elsevier