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World neurosurgery
Elsevier
World neurosurgery

Elsevier

1878-8750

World neurosurgery/Journal World neurosurgeryAHCISCIISTP
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    Epidemiological Pattern of Traumatic Brain Injury in the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

    Damara F.A.Muchamad G.R.Anton A.Ramdhani A.N....
    12页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Although the incidence of traumatic brain injury (TBI) has decreased since the beginning of the coronavirus disease 2019 (COVID-19) pandemic and severe acute respiratory syndrome coronavirus 2 is still evolving, the number of TBI cases has still greatly increased in multiple countries. In the present systematic review and meta-analysis, we evaluated the epidemiological characteristics of patients with TBI before and during the COVID-19 pandemic. Methods: We conducted a systematic literature search of original studies, short reports, and research letters from databases on studies that contained data about the severity, mortality, presence of neurological deficits, radiological diagnosis, cause of injury, and type of management of TBI during a specified period within the pandemic compared with before the pandemic. Results: A total of 18,490 subjects from 13 studies were included in the present study. The results of the meta-analysis showed a higher TBI mortality rate during the COVID-19 pandemic in the low-to-middle income countries (odds ratio, 1.65; 95% confidence interval, 1.12–2.41; P < 0.05; I2 = 40.8%; P = 0.18). The proportion of subdural hemorrhage was decreased, and the proportion of subarachnoid hemorrhage was increased in low- to middle-income and high-income countries, respectively. The proportion of assaults as the cause of TBI had increased during the pandemic (odds ratio, 1.40; 95% confidence interval, 1.06–1.86; P = 0.02; I2 = 20.8%; P = 0.28). We did not find any significant differences in the incidence of surgical intervention for TBI during the pandemic. Conclusions: Our results have indicated that during the COVID-19 pandemic, the TBI mortality rate had increased in low- to middle-income countries. The rate of assault as the cause of TBI had also increased during the pandemic.
      原文链接:
    • NSTL
    • Elsevier

    Systemic Administration of Allogeneic Cord Blood Mononuclear Cells in Adults with Severe Acute Contusion Spinal Cord Injury: Phase 1/2a Pilot Clinical Study–Safety and Primary Efficacy Evaluation

    Smirnov V.A.Radaev S.M.Morozova Y.V.Ryabov S.I....
    20页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Phase 1 of the SUBSCI I/IIa (Systemic Umbilical Cord Blood Administration in Patients with Acute Severe Contusion Spinal Cord Injury) study focused on safety and primary efficacy of multiple systemic infusions of allogeneic unrelated human umbilical cord blood mononuclear cells in patients with severe acute spinal cord contusion having severe neurologic deficit. The primary end point was safety. The secondary end point was the restoration of motor and sensory function in lower limbs within a 1-year period. Methods: Ten patients with acute contusion spinal cord injury (SCI) and American Spinal Injury Association (ASIA) level A/B deficit were enrolled into phase 1. Patients were treated with 4 infusions of group-matched and rhesus-matched cord blood samples after primary surgery within 3 days after SCI. All patients were followed up for 12 months after SCI. Safety was assessed using adverse events classification depending on severity and relation to cell therapy. Primary efficacy was assessed using dynamics of deficit (ASIA scale). Results: The overall number of adverse events reached 419 in 10 patients. Only 2 were estimated as possibly related to cell therapy, and the remaining 417 were definitely unrelated. Both adverse events were mild and clinically insignificant. No signs of immunization were found in participants. Analysis of clinical outcomes also showed that cell therapy promotes significant functional restoration of motor function. Conclusions: The data obtained suggest that systemic administration of allogeneic, non–human leukocyte antigen–matched human umbilical cord blood is safe and shows primary efficacy in adults with severe acute contusion SCI and ASIA level A/B deficit.
      原文链接:
    • NSTL
    • Elsevier

    Improved Sagittal Alignment Is Associated with Early Postoperative Neck Disability and Pain-Related Patient-Reported Outcomes Following Posterior Cervical Decompression and Fusion for Myelopathy

    Pinter Z.W.Salmons H.I.Townsley S.E.Michalopoulos G.D....
    10页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: To compare patient-reported outcomes measures (PROMs) following posterior cervical decompression and fusion (PCDF) based on changes in perioperative cervical sagittal alignment. Methods: We reviewed patients who underwent PCDF from C2 to T2 between the years 2015 and 2020. C2 sagittal vertical axis (SVA) and C2–C7 lordosis were assessed preoperatively and 1-year postoperatively. Neck Disability Index (NDI) and visual analog scale (VAS) Neck scores were collected preoperatively, 3 months' postoperatively, and 1-year postoperatively. PROMs were compared based on perioperative radiographic parameters. Results: Eighty-five patients were included in this study. Patients with preoperative C2 SVA <40 mm had a larger improvement in VAS Neck pain scores at 3 months' postoperatively (–4.9 vs. –3.0, P = 0.03) and a larger decrease in NDI scores at 1-year postoperatively (7.2 vs. 3.1, P = 0.04) than patients with C2 SVA ≥40 mm. Patients with postoperative C2 SVA <40 mm demonstrated lower VAS Neck pain scores at 3 months' postoperatively (2.0 vs. 3.4, P = 0.049). The cohort of patients with a decrease of C2 SVA by ≥5 mm demonstrated lower NDI at 3 months' postoperatively but not at 1-year postoperatively in comparison with patients whose C2 SVA increased or remained unchanged (11.7 vs. 23.8 vs. 18.2; P < 0.001). Patients in whom both C2 SVA and C2–C7 lordosis improved demonstrated superior NDI (P < 0.001) and VAS Neck (P = 0.007) at 3 months' but not at 1-year postoperatively. Conclusions: In a uniform cohort of patients undergoing PCDF from C2 to T2, improvements in C2 SVA and C2–C7 lordosis were associated with improved early postoperative PROMs.
      原文链接:
    • NSTL
    • Elsevier

    Clinical Trials in Spinal Tumors: A Two-Decade Review

    Chapman E.K.Valliani A.A.Shuman W.H.Martini M.L....
    15页
    查看更多>>摘要：? 2021 Elsevier Inc.Objective: Clinical trials are essential for assessing the advancements in spine tumor therapeutics. The purpose of the present study was to characterize the trends in clinical trials for primary and metastatic tumor treatment during the past 2 decades. Methods: The ClinicalTrials.gov database was queried using the search term “spine” for all interventional studies from 1999 to 2020 with the categories of “cancer,” “neoplasm,” “tumor,” and/or “metastasis.” The tumor type, phase data, enrollment numbers, and home institution country were recorded. The sponsor was categorized as an academic institution, industry, government, or other and the intervention type as procedure, drug, device, radiation therapy, or other. The frequency of each category and the cumulative frequency during the 20-year period were calculated. Results: A total of 106 registered trials for spine tumors were listed. All, except for 2, that had begun before 2008 had been completed. An enrollment of 51–100 participants (29.8%) was the most common, and most were phase II studies (54.4%). Most of the studies had examined metastatic tumors (58.5%), and the number of new trials annually had increased 3.4-fold from 2009 to 2020. Most of the studies had been conducted in the United States (56.4%). The most common intervention strategy was radiation therapy (32.1%), although from 2010 to 2020, procedural studies had become the most frequent (2.4/year). Most of the studies had been sponsored by academic institutions (63.2%), which during the 20-year period had sponsored 3.2-fold more studies compared with the industry partners. Conclusions: The number of clinical trials for spine tumor therapies has rapidly increased during the past 15 years, owing to studies at U.S. academic medical institutions investigating radiosurgery for the treatment of metastases. Targeted therapies for tumor subtypes and sequelae have updated international best practices.
      原文链接:
    • NSTL
    • Elsevier

    The Role of Parenteral Dantrolene in the Contemporary Management of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review

    Ortiz M.Nunna R.S.Ravipati K.Tran A....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Cerebral vasospasm remains a significant source of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage. Dantrolene has shown promise in several animal studies in the treatment of cerebral vasospasm. The present study seeks to critically review the evidence of its use in human subjects, aiming to 1) describe the forms and dosages used, 2) describe its safety profile, and 3) describe its effectiveness in treating cerebral vasospasm. Methods: A systematic review of intra-arterial dantrolene use in cerebral vasospasm was performed. A total of 86 articles were identified across all databases, 6 of which were ultimately included in the present study. Primary outcomes included a description of the form and dosage of dantrolene prescribed, the incidence of adverse effects after dantrolene use, and its efficacy for the treatment of cerebral vasospasm. Results: Study designs included 2 randomized controlled trials (33.3%), 2 case series (33.3%), and 2 case reports (33.3%). Both the intra-arterial and intravenous administration of dantrolene has been performed with varying dose regimens. Although there exists limited clinical information regarding side effects, a case of liver toxicity was reported. All existing studies reported benefit in vasospasm measured either by transcranial Doppler or digital subtraction angiography. The level of evidence was low, consisting largely of retrospective studies that had a high likelihood of bias. Conclusions: Dantrolene is a promising new therapeutic agent in the treatment of cerebral vasospasm. Although existing reports of its use are encouraging, high-quality prospective randomized trials are necessary for recommendations pertaining to dose, route, indications, and efficacy.
      原文链接:
    • NSTL
    • Elsevier

    Long-Term Outcomes of Endoscopic Cyst Fenestration for Rathke Cleft Cyst

    Toda M.Yamada H.Ueda R.Ozawa H....
    7页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: We sought to elucidate the long-term surgical outcomes and incidence of recurrence and reoperation of endoscopic endonasal cyst fenestration for Rathke cleft cyst (RCC). Methods: A retrospective review of the chart and operation record of RCC surgical cases between January 2008 and August 2021 at our institution was conducted. Patient characteristics, intraoperative findings, and postoperative follow-up outcomes were evaluated. Results: A total of 27 patients were analyzed, with a median postoperative follow-up period of 52 months (range, 1–150 months). Preoperative symptoms were visual dysfunction (59%), headache (41%), and pituitary dysfunction (22%). Endoscopic cyst fenestration was performed in all patients. Ten (37%) patients had intraoperative cerebrospinal fluid leakage. Among them, the only patient in whom sellar floor reconstruction was not performed experienced a repair operation due to postoperative cerebrospinal fluid leakage. No patients experienced postoperative hypopituitarism. Preoperative headache, visual dysfunction, and pituitary hormone disorder improved in 73%, 75%, and 67% of patients, respectively. Although postoperative cyst regrowth was observed in 8 patients (30%), no patient experienced worsening or novel symptoms and none required reoperation. Conclusions: Patients with a symptomatic RCC can be effectively treated with endoscopic endonasal cyst fenestration. Reversal of the presenting symptoms resulted, including headache, visual dysfunction, and pituitary hormone dysfunction, in the majority of patients. In our series, appropriate reconstruction of the sellar floor reduced the risk of postoperative cerebrospinal fluid leakage without impacting cyst regrowth. This simple technique appears to effectively disrupt cyst progression in most cases, even after a relatively long-term follow-up period.
      原文链接:
    • NSTL
    • Elsevier

    Anterior Transarticular Crossing Screw Placement for Atlantoaxial Instability in Children: Computed Tomography?Based Study

    Liu Q.Lin J.Yin Y.Liu Y....
    7页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: The feasibility of anterior transarticular crossing screw (ATCS) fixation for atlantoaxial instability was confirmed in adults. However, atlantoaxial instability is more common in children. Therefore this study was aimed to ascertain the pediatric morphometric characteristics of ATCS in C1-2. Methods: Morphometric analysis was conducted on computed tomography scan in 87 pediatric patients who were divided into groups based on ages (1?6 years, 7?10 years, and 11?16 years). Measurements were taken in sagittal and axial planes of computed tomography imaging to determine the range of screw lateral angles, incline angles, and screw lengths. Results: The overall screw lengths were relatively longer in males than females. For those aged 1?6 years, the screw lengths were 25.5?32.8 mm in males and 24.2?31.3 mm in females, respectively. The screw lengths showed no difference in the 7- to 10-year group between sexes, while the incline angle was larger in females than males. And the screw lengths were 33.5?43.2 mm in males and 31.2?40.4 mm in females in the 11- to 16-year group. The screw lengths were increased with age, yet the lateral angles were decreased. We also found that the epiphyseal closure of odontoid reached 93.6% when the age was older than 7 years old. Therefore ATCS was recommended for children older than 7 years. Conclusions: The overall screw lengths and lateral angles of ATCS were larger in male children than those in females, but the incline angles were larger in females. ATCS is feasible in children, particularly those aged 7 years or older.
      原文链接:
    • NSTL
    • Elsevier

    Decompressive Craniectomy for Malignant Ischemic Stroke: An Institutional Experience of 145 Cases in a Brazilian Medical Center

    Bem Junior L.S.Veiga Silva A.C.Ferreira Neto O.D.C.Alencar Neto J.F.D....
    7页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Malignant ischemic stroke (MIS) occurs in a subgroup of patients with cerebrovascular accident who sustain massive or significant cerebral infarction. It is characterized by neurological deterioration owing to progressive edema, raised intracranial pressure, and cerebral herniation. Decompressive craniectomy (DC) is a surgical technique that can be used to treat select cases of this condition in the presence of medically refractory intracranial hypertension. This study aimed to identify prognostic factors associated with clinical outcome, including timing of the procedure, and postoperative mortality. Methods: We analyzed surgical characteristics associated with prognosis in 145 patients who underwent DC secondary to MIS between 2013 and 2018, assessing clinical outcome at discharge and 6 and 12 months after discharge. Our inclusion criteria were DC secondary to MIS in adult patients with raised intracranial pressure signs. Results: Our analysis showed that although patients from cities >100 km from the neurosurgical center had a worse prognosis, only the surgical head side (left vs. right, P = 0.001), hospitalization length (P < 0.001), and earlier timing of procedure (P < 0.001) were statistically relevant in having worse outcomes. Conclusions: Patients in whom more time passed from presentation to the neurosurgical procedure, owing to living in a distant city or taking more time to be seen by a specialist, tended to have a worse prognosis. The timing of procedure, surgical side, and hospitalization length were independent predictors in determining the prognosis of patients who underwent DC after an MIS.
      原文链接:
    • NSTL
    • Elsevier

    The Impact of American Society of Anesthesiologists Status on Cost of Care and Length of Stay Following Posterior Cervical Decompression and Fusion

    Chapman E.K.Scherschinski L.Gal J.S.Shuman W.H....
    7页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: Increased posterior cervical decompression and fusion (PCDF) procedures over the past decade have raised the prospect of bundled payment plans. The American Society of Anesthesiologists (ASA) Physical Status Classification system may enable accurate estimation of health care costs, length of stay (LOS), and other postoperative outcomes in patients undergoing PCDF. Methods: Low (I and II) versus high (III and IV) ASA class was used to evaluate 971 patients who underwent PCDF between 2008 and 2016 at a single institution. Demographics were compared using univariate analysis. Cost of care, LOS, and postoperative complications were compared using multivariable logistic and linear regression, controlling for sex, age, length of surgery, and number of segments fused. Results: The high ASA class cohort was older (mean age 62 years vs. 55 years, P < 0.0001) and had higher Elixhauser comorbidity index scores (P < 0.0001). ASA class was independently associated with longer LOS (2.1 days, 95% confidence interval [CI] 1.3–2.9, P < 0.0001) and higher cost ($2936, 95% CI $1457–$4415, P < 0.0001). Patients with high ASA class were more likely to have a nonhome discharge (3.9, 95% CI 2.8–5.6, P < 0.0001), delayed extubation (3.2, 95% CI 1.4–7.3, P = 0.006), intensive care unit stay (2.4, 95% CI 1.5 3.7, P = 0.0001), in-hospital complications (1.5, 95% CI 1.0–2.2, P = 0.03), and 30-day (3.2, 95% CI 1.5–6.8, P = 0.003) and 90-day (3.2, 95% CI 1.8–5.7, P = 0.0001) readmission. Conclusions: High ASA class is strongly associated with increased costs, LOS, and adverse outcomes following PCDF and could be useful for preoperative prediction of these outcomes.
      原文链接:
    • NSTL
    • Elsevier

    Comparison of Anatomic Exposure After Petrosectomy Using Anterior Transpetrosal and Endoscopic Endonasal Approaches: Experimental Cadaveric Study

    Loymak T.Tungsanga S.Abramov I.Sarris C.E....
    12页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Transcranial anterior petrosectomy (AP) is a classic approach; however, it is associated with adverse consequences. The endoscopic endonasal approach (EEA) has been developed as an alternative. We describe surgical techniques for AP and EEA and compare the anatomic exposures of each. Methods: Ten cadaveric heads (20 sides) were dissected. Specimens were divided into 4 groups: 1) AP, 2) EEA for medial petrosectomy (MP), 3) EEA for inferior petrosectomy (IP), and 4) EEA for inferomedial petrosectomy (IMP). Outcomes were areas of exposure, angles of attack to neurovascular structures, and bone resection volumes. Results: AP had a greater area of exposure than did MP and IP (P = 0.30, P < 0.01) and had a higher angle of attack to the distal part of the facial nerve–vestibulocochlear nerve (cranial nerve [CN] VII/VIII) complex than did IP and IMP (P < 0.01). MP had a lower angle of attack than IMP to the midpons (P = 0.04) and to the anterior inferior cerebellar artery (P < 0.01). Compared with IMP, IP had a lower angle of attack to the proximal part of the CN VII/VIII complex (P < 0.01) and the flocculus (P < 0.01). The bone resection volume in AP was significantly less than that in MP, IP, and IMP (P < 0.01). Conclusions: AP and all EEA techniques had specific advantages for each specific area. We suggest AP for the ventrolateral pons and the anterior superior internal auditory canal, MP for the midline clivus, IP for the ventrolateral brainstem, and IMP to enhance the lateral corridor of the abducens nerve.
      原文链接:
    • NSTL
    • Elsevier