查看更多>>摘要：? 2021 The AuthorsBackground: Classic randomized controlled trials (RCTs) form the cornerstone for medical guidelines and protocols. However, in neurosurgery, RCTs are not always applicable to everyday clinical practice. Pragmatic controlled trials aim to incorporate real-life data with the preservation of the methodologic quality. This study is a systematic literature review of all pediatric neurosurgical RCTs published between 2000 and 2020 and an analysis of their pragmatism. Methods: An electronic database search was performed in PubMed, EMBASE, and the Cochrane Library to identify all relevant trials. Pragmatism was evaluated retrospectively on 9 domains: eligibility, recruitment, setting, organization, flexibility (delivery and adherence), follow-up, primary outcome, and primary analysis. Results: Of the 1862 studies included, 15 met the inclusion criteria. On average, studies scored between equally pragmatic/explanatory and rather pragmatic (M = 3.59, standard deviation [SD] = 0.56). Lowest ratings were seen for setting (M = 2.80, SD = 1.66) and eligibility (M = 3.20, SD = 1.66). Highest scores of pragmatism were given to analysis (M = 4.67, SD = 0.82) and intervention organization (M = 4.60, SD = 1.06). There was no significant difference between studies based on number of patients included, main subject, or publication year. Conclusions: Pediatric neurosurgical RCTs scored reasonably well on overall pragmatism. In the future, there will be a greater need for pragmatic controlled trials in pediatric neurosurgery to bridge the divide between real-life data and reliable methodological quality. There is an opportunity to develop further applications of pragmatism tailored to surgical interventions.
查看更多>>摘要：? 2022 Elsevier Inc.In this article, we aimed to describe some of the currently most challenging problems in neurosurgical management of hydrocephalus and how these can be reasons for inspiration for and development of research. We chose 4 areas of focus: 2 dedicated to improvement of current treatments (shunt implant surgery and endoscopic hydrocephalus surgery) and 2 dedicated to emerging future treatment principles (molecular mechanisms of cerebrospinal fluid secretion and hydrocephalus genetics).
查看更多>>摘要：? 2022 The Author(s)From a pathophysiological point of view, early neurosurgical treatment seems essential to prevent secondary brain injury and has been stated as the “time-is-brain” concept. However, the question immediately rises: “Is there an optimal time window for acute intracranial neurosurgical interventions?” In neurosurgery, treatment modality has been studied far more extensively than timing to surgery (“time-to-surgery”). The majority of acute intracranial neurosurgical interventions are carried out for traumatic brain injury and hemorrhagic or ischemic stroke. Current guidelines for traumatic brain injury, spontaneous intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, and middle cerebral artery infarction are reviewed and lessons learned from the randomized controlled trials mentioned are discussed. In acute intracranial neurosurgical interventions, “delayed consent” procedures could play an important role for this field of research. Whether there is an optimal time window for acute intracranial neurosurgical interventions seems difficult to be answered with randomized controlled trials referred to in the current guidelines. Observational designs, such as comparative effectiveness research, and special statistical techniques, may provide a better understanding in the optimal “time-to-surgery.”
查看更多>>摘要：? 2021 The Author(s)Objective: To explore the value and potential of qualitative research to neurosurgery and provide insight and understanding to this underused methodology. Methods: The definition of qualitative research is critically discussed and the heterogeneity within this field of inquiry explored. The value of qualitative research to the field of neurosurgery is articulated through its contribution to understanding complex clinical problems. Discussion: To resolve some of the misunderstanding of qualitative research, this paper discusses research design choices. We explore approaches that use qualitative techniques but are not, necessarily, situated within a qualitative paradigm in addition to how qualitative research philosophy aids researchers to conduct interpretive inquiry that can reveal more than simply what was said by participants. Common research designs associated with qualitative inquiry are introduced, and how complex analysis may contribute more in-depth insights is explained. Approaches to quality are discussed briefly to support improvements in qualitative methods and qualitative manuscripts. Finally, we consider the future of qualitative research in neurosurgery, and suggest how to move forward in the qualitative neurosurgical evidence base. Conclusions: There is enormous potential for qualitative research to contribute to the advancement of person-centered care within neurosurgery. There are signs that more qualitative research is being conducted and that neurosurgical journals are increasingly open to this methodology. While studies that do not engage fully within the qualitative paradigm can make important contributions to the evidence base, due regard should be given to immersive inquiry within qualitative paradigms to allow complex, in-depth, investigations of the human experience.
查看更多>>摘要：? 2021 Elsevier Inc.Objective: Our goal was to investigate the presence of surveys to assess neurosurgical educational content and to propose a novel standardized Neurosurgical Education Outcomes Survey (NEOS) with compatible statistical analyses. Methods: Google Scholar and PubMed were used to conduct a structured literature review for articles published between January 2000 and July 2021 and containing standardized methodology for assessing neurosurgical educational content. Results: Fifteen studies identified during the search assessed virtual and in-person educational content; however, the literature lacked a standardized assessment. A standardized NEOS was proposed before a comprehensive discussion of compatible statistical analyses. Conclusions: The NEOS may offer a viable option for comparing in-person and virtual content with respect to learner preferences and subjective and objective feedback. Future studies are needed to explore practical utility in enhancing the quality of neurosurgical educational content.
查看更多>>摘要：? 2021 Elsevier Inc.Background: As the art of neurosurgery evolves in the 21st century, more emphasis is placed on minimally invasive techniques, which require technical precision. Simultaneously, the reduction on training hours continues, and teachers of neurosurgery faces “double jeopardy”—with harder skills to teach and less time to teach them. Mixed reality appears as the neurosurgical educators’ natural ally: Virtual reality facilitates the learning of spatial relationships and permits rehearsal of skills, while augmented reality can make procedures safer and more efficient. Little wonder then, that the body of literature on mixed reality in neurosurgery has grown exponentially. Methods: Publications involving virtual and augmented reality in neurosurgery were examined. A total of 414 papers were included, and they were categorized according to study design and analyzed. Results: Half of the papers were published within the last 3 years alone. Whereas in the earlier half, most of the publications involved experiments in virtual reality simulation and the efficacy of skills acquisition, many of the more recent publication are proof-of-concept studies. This attests to the evolution of mixed reality in neurosurgery. As the technology advances, neurosurgeons are finding more applications, both in training and clinical practice. Conclusions: With parallel advancement in Internet speed and artificial intelligence, the utilization of mixed reality will permeate neurosurgery. From solving staff problems in global neurosurgery, to mitigating the deleterious effect of duty-hour reductions, to improving individual operations, mixed reality will have a positive effect in many aspects of neurosurgery.
查看更多>>摘要：? 2022 Elsevier Inc.Background: The emergence of C8 radiculopathy is a known complication following cervicothoracic osteotomies. However, the clinical profile of C8 radiculopathy is not well understood. The aim of this study was to investigate the rate of C8 radiculopathy after cervicothoracic osteotomies and to form a clinical profile describing the characteristics through a systematic review of the literature. Methods: An electronic database search for full-text English articles was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search yielded results on indications for cervicothoracic osteotomies, surgical approaches, mean follow-up time, and significant complications, including C8 radiculopathy. Results: Our literature search yielded 2135 articles, of which 12 qualified to be included in the analysis. The 12 articles comprised 451 patients undergoing various osteotomy approaches. The mean age of subjects was 51.0 years (range, 11.4–63.2 years), and the majority of patients were male (66%, n = 298). Ankylosing spondylitis was the most frequent indication for surgery (44.8%, n = 202). The number of patients with postoperative C8 radiculopathy was found to decrease over time (1997–2020) by showing statistical significance (r = ?0.65, P = 0.021). Conclusions: Of the 451 patients included in this study, 53 had C8 radiculopathy (11.8% of the total patient population). Moreover, the rate of C8 radiculopathy decreased over time in a statistically significant manner. An understanding of the factors associated with the incidence of C8 radiculopathy is essential for future improvement of patient outcomes.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Spinal cord injury (SCI) triggers a signalling cascade that produces oxidative stress and damages the spinal cord. Voltammetry is a clinically accessible technique to detect, monitor, and guide correction of this potentially reversible secondary injury mechanism. Voltammetry is well suited for clinical translation because the method is inexpensive, simple, rapid, and portable. Voltammetry relies on the measurement of anodic current from a reagent-free, electrochemical reaction on the surface of a small electrode. Methods: The present study tested the use of new disposable carbon nanotube based screen printed electrodes (CNT-SPE) for the voltammetric measurement of antioxidant current (AC). Spinal cord, cerebrospinal fluid, and plasma were obtained from Sprague-Dawley rats after SCI. Locomotor function after SCI was assessed by using the Basso, Beattie, Bresnahan (BBB) score. Results: The more severe SCI caused a decline in spinal cord AC419 at 10 minutes (P < 0.05), 4 hours (P < 0.0001), and 1 day (P < 0.01) after injury compared with sham controls. It also caused a decline in plasma AC375 at 1 (P < 0.001) and 3 days (P < 0.05) after injury compared with their pre-injury baseline. Spinal cord AC419 correlated with plasma AC375 (r = 0.49, P < 0.01) and BBB score (r = 0.66, P < 0.0001) at 1 day after SCI. Conclusions: AC measured by CNT-SPE demonstrated a time- and severity-dependent decline after SCI. Plasma AC could serve as a surrogate marker for spinal cord AC.
查看更多>>摘要：? 2022 Elsevier Inc.Objective: To perform measurements in normal brain imaging studies from the free edge of the falx cerebri to the genu and the body of the corpus callosum and perform a statistical analysis based on age, type of study, and sex highlighting potential surgical implication of these measurements. Methods: In 193 normal brain imaging studies, 3 anatomical points of the corpus callosum were used to measure the distance to the falx cerebri. Horos and RadiAnt DICOM Viewer software were used to perform the measurements. Statistical analysis of data was performed with Minitab18 software. Results: The results obtained in computed tomography (CT) studies were: distance A, mean 2.1065 cm; distance B, mean 2.2677 cm; distance C, mean 1.765 cm. The results obtained in magnetic resonance imaging studies were: distance A, mean 1.7148 cm; distance B, mean 2.1197 cm; distance C, mean 1.5321 cm. Statistically significant differences were obtained in measurements related to the type of study and in measurements made in CT studies related to age. Conclusions: There is a distance from the free edge of the falx cerebri to the genu and body of the corpus callosum of at least 1 cm in both CT and magnetic resonance imaging studies of normal brains. Statistically significant differences were found in the measurements in relation to the type of study and in relation to age in the measurements made in CT studies. These measurements could be important in determining the extent of bone resection in certain types of decompressive craniectomies.
查看更多>>摘要：? 2022 Elsevier Inc.Objective: This study aims to present the clinical characteristics and surgical treatment in patients with intracranial hemangioblastomas and to investigate risk factors for postoperative functional outcomes. Methods: Patients with intracranial hemangioblastomas who received surgical treatment in our institute between 2011 and 2020 were included. We retrospectively reviewed and analyzed the clinical characteristics, surgical treatment, and postoperative functional status. Risk factors for postoperative functional outcomes were further analyzed using univariate and multivariate analysis. Results: We identified 48 patients with 82 intracranial hemangioblastomas resected in this study. There were 22 females and 26 males, and the mean age was 39.3 ± 15.3 years. Total resection was achieved in all the cases. After primary surgery, immediate functional status was improved in 20 patients (41.7%), stable in 9 patients (18.8%), and worsened in 19 patients (39.6%). Forty-two patients (89.4%) had favorable functional status (Karnofsky Performance Scale ≥80) at long-term follow-up. Through univariate and multivariate analysis, body mass index, number of resected tumors per operation, and intraoperative blood loss were independent risk factors for the immediate functional outcome (P = 0.006, P = 0.023, P = 0.038, respectively). Preoperative hydrocephalus was significantly associated with unfavorable long-term functional status (P = 0.047). Conclusions: Generally, patients can benefit from surgical removal of intracranial hemangioblastomas with favorable functional outcomes. Body mass index, number of resected tumors per operation, and intraoperative blood loss can be used as risk factors for immediate functional outcomes after surgery, and preoperative hydrocephalus for long-term functional status.
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