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World neurosurgery
Elsevier
World neurosurgery

Elsevier

1878-8750

World neurosurgery/Journal World neurosurgeryAHCISCIISTP
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    Utility of Augmented Reality and Virtual Reality in Spine Surgery: A Systematic Review of the Literature

    Sumdani H.Aguilar-Salinas P.Avila M.J.Barber S.R....
    10页
    查看更多>>摘要：? 2021Background: Augmented reality (AR), virtual reality (VR), and mixed reality (MR) are emerging technologies that are starting to be translated into clinical practice. Limited data are available regarding these tools in use during live surgery of the spine. Our objective was to systematically collect, analyze, and interpret the existing data regarding AR, VR, and MR use in spine surgery on living people. Methods: A systematic review was conducted using the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The PubMed, PubMed Central, Cochrane Reviews, and Embase databases were searched. Combinations and variations of the phrases “augmented reality,” “virtual reality,” and spine surgery using both “AND” and “OR” configurations were used to find relevant studies. The references of the included reports from the systematic review were also screened for possible inclusion as a part of a manual review. The included studies were full-text publications written in English that had included any spine surgery on live persons with the use of VR or AR. Results: A total of 1566 unique reports were found, and 15 full-text publications met the criteria for the present study. The total number of patients from all studies was 241, with a weighted average age of 50.37 years. Surgical procedures using AR, VR, and/or MR were diverse and spanned from simple discectomy to intradural spinal tumor resection. All patients experienced improvement in their symptoms present at clinical presentation. The highest complication rate reported in the studies was 6.1% and was for suboptimal pedicle screw placement. No complications led to clinical sequelae. Conclusions: The systematically collected, analyzed, and interpreted data of existing peer-reviewed full-text articles showed favorable metrics regarding surgical efficacy, pedicle screw target accuracy, radiation exposure, clinical outcomes, and disability and pain for patients with spinal pathology treated with the help of AR, VR, and/or MR.
      原文链接:
    • NSTL
    • Elsevier

    Olfactory Stem Cells for the Treatment of Spinal Cord Injury—A New Pathway to the Cure?

    Rovekamp M.von Glinski A.Volkenstein S.Dazert S....
    9页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Because full functional recovery after spinal cord injury (SCI) remains a major challenge, stem cell therapies represent promising strategies to improve neurologic functions after SCI. The olfactory mucosa (OM) displays an attractive source of multipotent cells for regenerative approaches and is easily accessible by biopsies because of its exposed location. The regenerative capacity of the resident olfactory stem cells (OSCs) has been demonstrated in animal as well as clinical studies. This study aims to demonstrate the feasibility of isolation, purification and cultivation of OSCs. Methods: OM specimens were taken dorso-posterior from nasal middle turbinate. OSCs were isolated and purified using the neurosphere assay. Differentiation capacity of the OSCs in neural lineage and their behavior in a plasma clot matrix were investigated. Results: Our study demonstrated that OSCs differentiated into neural lineage and were positive for GFAP as well as β-III tubulin. Furthermore, OSCs were viable and proliferated in a plasma clot matrix. Conclusions: Because there are no standard methods for purification, characterization, and delivery of OSCs to the injury site, which is a prerequisite for the clinical approval, this study focuses on the establishment of appropriate methods and underlines the high potential of the OM for autologous cell therapeutic approaches.
      原文链接:
    • NSTL
    • Elsevier

    Clinical Outcomes of Uniportal and Biportal Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression in Patients with Lumbar Spinal Stenosis: A Retrospective Pair-Matched Case-Control Study

    Hua W.Liao Z.Chen C.Feng X....
    12页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: To compare the clinical outcomes of uniportal and biportal lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) in patients with lumbar spinal stenosis. Methods: A retrospective pair-matched case-control analysis of 72 patients with lumbar spinal stenosis was performed. According to the surgical procedure used, the patients were classified into 2 groups: 1) uniportal LE-ULBD and 2) biportal LE-ULBD. Clinical outcomes were assessed using the visual analog scale score, Oswestry Disability Index score, and Macnab criteria, and the results were compared between the groups. Results: All patients were successfully treated with either uniportal or biportal LE-ULBD. The surgical duration in the biportal LE-ULBD group was significantly shorter than in the uniportal LE-ULBD group (P < 0.001). The time to ambulation and the length of hospitalization in the 2 groups were not significantly different. The visual analog scale and Oswestry Disability Index scores improved significantly after surgery in both groups (P < 0.001). Based on the Macnab criteria, 33 (91.7%) patients in the uniportal LE-ULBD group and 34 (94.4%) patients in the biportal LE-ULBD group were rated as having an excellent or good outcome. Additionally, intraoperative epineurium injury was observed in both the LE-ULBD groups. Conclusions: Both uniportal and biportal LE-ULBD procedures are safe and effective for treating patients with lumbar spinal stenosis. It is more feasible to decompress the spinal canal during biportal LE-ULBD than during uniportal LE-ULBD.
      原文链接:
    • NSTL
    • Elsevier

    Dual-Device Neuromodulation in Epilepsy

    Freund B.Grewal S.S.Middlebrooks E.H.Moniz-Garcia D....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Current methods of neuromodulation have been shown to reduce seizures in patients with drug-resistant epilepsy, and in a small percentage of patients it has rendered them seizure-free when surgical resection is not feasible. While polytherapy with antiseizure medication is not uncommon, dual neurostimulation has received limited attention. We set out to identify trends and changes in the use of dual neurostimulation to understand choosing device combinations. Methods: We reviewed the Mayo Clinic database in Florida of patients who underwent vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS) from October 1998 through September 2021. The prevalence of active VNS with DBS or RNS was considered dual therapy. Results: In total, 131 patients (71 female) underwent 164 VNS-associated procedures, 28 received RNS, and 8 received DBS (6 anterior thalamic DBS; 2 thalamic centromedian nucleus DBS). Active dual stimulation occurred in 3 of 28 patients who received RNS and 8 of 8 patients who received DBS (P = 0.006), mean duration of 28 and 16.3 months, respectively. Patients who received VNS-DBS were more likely to have a previous response to VNS (P = 0.025) and were unresponsive to more antiseizure medications (P = 0.020). The VNS-RNS group had focal seizures more likely to have electroclinical localization (P = 0.005) and more frequently underwent invasive electroencephalographic monitoring (P = 0.026). Conclusions: The ability to localize was the primary decision-maker in prompting RNS versus DBS. RNS surgery was more likely to be preceded by invasive electroencephalographic monitoring. Previous VNS responsiveness was more prominent in patients with DBS. Dual therapy was safe. Prospective multicenter studies of dual-device neuromodulation are needed.
      原文链接:
    • NSTL
    • Elsevier

    Optimizing Postoperative Adjuvant Therapy in Elderly Patients with Newly Diagnosed Glioblastoma: Single-Institution Audit of Clinical Outcomes from a Tertiary-Care Comprehensive Cancer Center in India

    Chatterjee A.Bhadane M.Manjali J.J.Dasgupta A....
    9页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: There is lack of consensus regarding optimal adjuvant therapy in elderly glioblastoma (GBM). We have been treating elderly (≥60 years) GBM patients with normofractionated or hypofractionated radiotherapy (RT) plus temozolomide (TMZ) based on Karnofsky performance status (KPS). Herein we report clinical outcomes in this cohort treated at our institute using this approach. Methods: Medical records of elderly GBM patients (≥60 years) treated between 2013 and 2017 with either normofractionated RT (59.4?60 Gy/30?33 fractions/6?6.5 weeks) or hypofractionated RT (35 Gy/10 fractions/2 weeks) plus TMZ were reviewed retrospectively. Outcomes of interest included progression-free survival (PFS), overall survival (OS), and ≥grade 3 myelotoxicity. Time-to-event outcomes were analyzed with Kaplan-Meier methods, compared using log-rank test, and reported as point estimates with 95% confidence interval (CI). Results: The normofractionated cohort (n = 126) was characterized by a higher proportion of patients younger than age 65 years, KPS ≥70, methylated O6-methylguanine DNA methyltransferase (MGMT), and receiving adjuvant TMZ including extended adjuvant TMZ (>6 cycles) compared with the hypofractionated cohort (n = 20), confirming selection bias. At a median follow-up of 13 months, 1-year Kaplan-Meier estimates of PFS and OS were 43% (95% CI: 36%?52%) and 56% (95% CI: 48%?64%), yielding median PFS and OS of 11.0 months and 13.1 months, respectively. Higher KPS, methylated MGMT, normofractionated RT, and extended adjuvant TMZ emerged as favorable prognostic factors. TMZ was well tolerated with a low risk of ≥grade 3 myelotoxicity. Conclusions: Our single-institution clinical audit confirms poor survival in elderly GBM with suboptimal performance status but demonstrates acceptably fair outcomes in patients with preserved KPS comparable with the nonelderly cohort.
      原文链接:
    • NSTL
    • Elsevier

    Validation of the Elderly Traumatic Brain Injury Score: Observational Case Control Study

    Bobeff E.J.Stawiski K.Stanislawska P.A.Posmyk B.J....
    9页
    查看更多>>摘要：? 2022 The AuthorsBackground: Traumatic brain injury (TBI) poses a particular health risk for the elderly. The recently developed elderly TBI (eTBI) score combines the prognostic information of the risk factors characteristic of the geriatric population. We aimed to determine its validity and reliability on an independent sample. Methods: We present a retrospective analysis of 506 consecutive patients after TBI aged ≥65 years. The previously described nomogram and the eTBI score were used. The primary outcome measure was mortality or vegetative state at 30 days after hospital admission. Results: Mortality or vegetative state rate was 21.3%. The nomogram and eTBI Score showed similar predictive performance with accuracy of 83.8% (95% confidence interval 80.2%?87%) and 84.4% (95% confidence interval 80.8%?87.6%), respectively. On the basis of the Youden index and C4.5 algorithm, we divided patients according to the 3-tier pattern into low-, high-, and medium-risk groups. The outcome prediction in the first 2 groups was correct in 93.1% (survival in the low-risk group) and 94.4% (mortality in the high-risk group). Patients included in the medium-risk group usually required surgical treatment (85.3%) and were characterized by increased mortality or vegetative state (55%). Among patients with eTBI ≥5 (n = 221), there was no difference in outcome between those treated conservatively and surgically. Conclusions: This is the first study confirming the validity of the eTBI Score and its close association with outcome of geriatric population after TBI. The novel 3-tier risk stratification scheme was applicable to both conservatively and surgically treated patients.
      原文链接:
    • NSTL
    • Elsevier

    The Addition of Radiofrequency Tumor Ablation to Kyphoplasty May Reduce the Rate of Local Recurrence in Spinal Metastases Secondary to Breast Cancer

    Ragheb A.Vanood A.Fahim D.K.
    8页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Approximately 10% of all cancer patients develop spinal metastases. When a symptomatic compression fracture occurs without associated deformity or neurologic deficit, it can be treated with kyphoplasty with or without radiofrequency ablation (RFA). Treatment with kyphoplasty is well established but does not address the underlying oncologic disease. Methods: Retrospective medical chart analysis of breast cancer patients (n = 23) with metastatic spinal fractures (n = 50 vertebral levels) who underwent RFA and kyphoplasty was undertaken. Key variables of interest included: fracture location, pain levels, and local recurrence. Local recurrence data were compared to published rates of recurrence in breast cancer–related metastatic spinal fractures treated with vertebroplasty or kyphoplasty alone. Data were analyzed using χ2 and t test statistical analyses. Results: The mean preoperative pain level for this cohort was 6.9 on a 10-point visual analogue scale. Significant reductions in pain levels were observed postoperatively, at discharge (3.5; P < 0.05), at 1-month follow-up (2.8; P < 0.05), at 3-month follow-up (1.1; P < 0.05), and at 6-month follow-up (0.7 P < 0.05). Compared with published data of breast cancer patients with metastatic spinal fractures treated with vertebroplasty or kyphoplasty alone, the addition of RFA resulted in reduced local tumor recurrence (2% vs. 14%; P < 0.05). Average length of follow-up was 39 months. Conclusions: The results suggest that the addition of RFA to kyphoplasty may reduce local tumor recurrence while providing similar pain relief benefits. The extrapolation of this added benefit to metastases from other primary cancers should be examined in future studies.
      原文链接:
    • NSTL
    • Elsevier

    Clinical Diagnosis and Treatment Analyses on SMARCB1 (Integrase Interactor 1)–Deficient Sinonasal Carcinoma: Case Series with Systematic Review of the Literature

    Wang R.Wang L.Fang J.Zhong Q....
    15页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: This study aims to improve the understanding of SMARCB1 (integrase interactor 1)–deficient sinonasal carcinoma (SDSC) by analyzing its clinical features, treatment strategies, and prognosis. Methods: Sixty-nine patients were included in this research: 15 new cases from Beijing Tongren Hospital and 54 previously reported cases. We analyzed and summarized patients' epidemiologic data, clinical features, and treatment regimens. Main outcomes were overall survival (OS) and recurrence-free survival (RFS). Univariate and multivariate analyses were performed using a Cox regression model for OS and RFS. Results: SDSC was more common in men than women with a median age of 52 years (range, 21–89 years). Epistaxis (40.0%) and headache (36.7%) were the major symptoms. The most common affected paranasal sinus was the ethmoid sinus (58.0%). For TNM stage, 66.7% cases were first diagnosed as T4N0M0. The tumor cells were complete loss of integrase interactor 1 in all cases by immunohistochemical analysis. However, 72.5% patients were first misdiagnosed initially. The 1-year, 3-year, and 5-year OS and RFS were 85.3%, 51.8%, 47.8%; and 56.8%, 38.2%, and 35.3%, respectively. The RFS of comprehensive treatment based on surgery was better than that of systemic therapy without surgery (P < 0.05). In addition, the OS and RFS of surgery with chemoradiotherapy was better than that of surgery with radiotherapy (P < 0.05). Univariate and multivariate analysis identified treatment modality as an independent prognostic factor for patients with SDSC. Conclusions: Immunohistochemical analysis of SDSC during initial biopsy can prevent delays in diagnosis and treatment. Radical surgery resection combined with chemoradiotherapy may be the preferred treatment modality.
      原文链接:
    • NSTL
    • Elsevier

    Venous Thromboembolism Risk and Outcomes Following Decompressive Craniectomy in Severe Traumatic Brain Injury: An Analysis of the Nationwide Inpatient Sample Database

    Ali A.B.Khawaja A.M.Reilly A.Tahir Z....
    15页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Traumatic brain injury (TBI) is a risk factor for venous thromboembolism (VTE). The risk of VTE after decompressive craniectomy (DC) and its effects on the outcomes are unknown. We assessed the incidence of VTE, associated risk factors, and effects on the outcomes. Methods: Using the National Inpatient Sample database, the hospitalizations of patients aged ≥18 years with a severe TBI diagnosis from 2004 to 2014 were extracted. The outcome was discharge status without mortality. Multivariable logistic and linear regressions were used. Results: Of the 349,165 TBI hospitalizations, 23,813 (6.82%) had undergone DC and 14,175 (4.06%) had developed VTE. The VTE incidence was higher after DC compared with no DC (6.14% vs. 3.91%; P < 0.0001). DC (odds ratio [OR], 1.29; P < 0.005) was an independent predictor for the development of VTE. Age (OR, 1.26; P < 0.005), chronic lung disease (OR, 1.58; P < 0.05), electrolyte imbalance (OR, 1.43; P < 0.05), liver disease (OR, 0.10; P < 0.05), urinary tract infection (OR, 1.56; P < 0.05), pneumonia (OR, 2.03; P < 0.0001), and sepsis (OR, 1.57; P < 0.05) were significantly associated with the development of VTE. Obesity (OR, 2.09; P > 0.05) and spine injury (OR, 2.03; P > 0.05) showed a trend toward significance. VTE was associated with worse discharge outcomes (OR, 1.40; P < 0.05), longer lengths of stay (OR, 1.01; P < 0.00001), and higher costs (P < 0.0001). Conclusions: Our study showed an independent association between DC and an increased risk of VTE for patients with severe TBI. The development of VTE after DC increased the proportion of poor outcomes, prolonged the length of stay, and increased the hospitalization costs. Older patients with obesity, an electrolyte imbalance, chronic lung disease, spine injury, and infections were at a greater risk of VTE after DC. These risk factors could help in considering VTE prophylaxis for these patients.
      原文链接:
    • NSTL
    • Elsevier

    Mental Health as a Predictor of Preoperative Expectations for Pain and Disability Following Lumbar Fusion

    Jacob K.C.Patel M.R.Park G.J.Cha E.D.K....
    7页
    查看更多>>摘要：? 2022Objective: To evaluate impact of preoperative mental health on expectations in patients undergoing transforaminal, anterior, or lateral lumbar interbody fusion. Methods: Demographics, perioperative characteristics, duration of preoperative symptoms, and preoperative mental health scores were collected. Pain and disability were recorded using preoperative visual analog scale (VAS) for back and leg pain and Oswestry Disability Index scores. Patients’ expectations were recorded. Preoperative mental health was recorded using Patient Health Questionnaire-9 (PHQ-9), 12-Item Short Form Health Survey (SF-12) mental component score (MCS), and Veterans RAND 12-Item Health Survey (VR-12) MCS. PHQ-9 scores were categorized by severity of depressive symptoms. Simple linear regression evaluated impact of preoperative mental health on patient expectations for pain and disability; multiple linear regression evaluated the same while accounting for preoperative scores. Results: In 181 patients, PHQ-9 and increasing severity of depressive symptoms significantly predicted VAS back pain expectations (P ≤ 0.006); significance was lost after accounting for preoperative VAS back pain. All mental health outcomes significantly predicted VAS leg pain expectations (P ≤ 0.040); only PHQ-9 retained significance after accounting for preoperative VAS leg pain. All mental health scores significantly predicted ODI expectations (P < 0.001); none retained significance after accounting for preoperative ODI. PHQ-9, SF-12, and VR-12 significantly predicted all ODI domains except personal care and pain intensity (P ≤ 0.045). PHQ-9 significantly predicted patient expectations for lifting, walking, standing, sleeping, sex life, and social life. SF-12 MCS significantly predicted expectations for lifting, walking, standing, sleeping, and social life after accounting for preoperative domain scores. VR-12 MCS significantly predicted expectations for lifting, walking, standing, sleeping, sex life, and social life (P ≤0.050, all), even after accounting for preoperative scores. Conclusions: Mental health scores impact expectations regarding improvement in more active areas of a patient's life. Poor mental health scores may be associated with lower expectations for preoperative symptom improvement.
      原文链接:
    • NSTL
    • Elsevier