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World neurosurgery
Elsevier
World neurosurgery

Elsevier

1878-8750

World neurosurgery/Journal World neurosurgeryAHCISCIISTP
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    Meeting Patient Expectations and Achieving a Minimal Clinically Important Difference for Back Disability, Back Pain, and Leg Pain May Provide Predictive Utility for Achieving Patient Satisfaction Among Lumbar Decompression Patients

    Jacob K.C.Patel M.R.Collins A.P.Park G.J....
    8页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Our study evaluates minimum clinically important difference (MCID) achievement for back pain/leg pain/disability and meeting preoperative expectations as predictors of patient satisfaction after minimally invasive lumbar decompression (MIS-LD) surgery. Methods: Single/multilevel MIS-LD procedures were identified. Patient-reported outcome measures (preoperative/postoperative), expectations (preoperative), and satisfaction (postoperative) were collected for visual analog scale (VAS) back/VAS leg/Oswestry Disability Index (ODI). Student's t-test assessed patient-reported outcome measure improvement from preoperative baseline. Correlations between outcome and satisfaction scores were evaluated using the Pearson correlation coefficient and categorized according to strength of relationship. MCID achievement and meeting expectations were evaluated as predictors of postoperative patient satisfaction with simple linear regression. Comparison of meeting expectations or achieving MCID as predictors of satisfaction scores was performed using a post hoc Suest test comparison of standardized β-coefficients. Results: A total of 329 patients were included. All outcomes improved from baselines (P < 0.001, all) at all postoperative time points and demonstrated strong and negative correlations with satisfaction scores (P < 0.001, all). Majority of patients had their expectations met for ODI/VAS back/VAS leg and achieved MCID for ODI/VAS back/VAS leg at all time points and overall. Both MCID achievement and meeting preoperative expectations demonstrated significant associations with satisfaction scores at all time points for ODI/VAS back/VAS leg. Post hoc analysis of predictors of patient satisfaction in pain and disability demonstrated that MCID achievement was an equivalent predictor to meeting patient preoperative expectations at all postoperative time points. Conclusion: Pain/disability improved after MIS-LD; improvement was strongly correlated with postoperative satisfaction. Meeting expectations/MCID achievement is associated with satisfaction. MCID achievement was equivalent to meeting expectations in predicting satisfaction at all postoperative time points for pain/disability.
      原文链接:
    • NSTL
    • Elsevier

    The Clinical Utility of Surgical Histopathology in Predicting Seizure Outcomes in Patients with Rasmussen Encephalitis Undergoing Hemispherectomy

    Bingaman J.R.Sundar S.J.Hsieh J.K.Lu E....
    9页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: The objectives of this study were to determine the relationship between the severity of pathology and seizure outcomes in patients who underwent hemispherectomy for Rasmussen encephalitis (RE) and to investigate which clinical factors correlated with severity of pathology. Methods: In this retrospective cohort study, we collected and reviewed pathology and clinical variables. We ascertained seizure outcomes using Engel's classification, and Pardo stages were used to grade pathology. Results: We included 29 unique patients who underwent 34 hemispherectomy procedures for analysis. There was no statistically significant correlation between Pardo stage and seizure outcome (P = 1). Increasing duration of epilepsy (β = 0.011, P = 0.02) and duration of hemiparesis (β = 0.024, P = 0.01) were significantly associated with a more severe Pardo stage. In contrast, the presence of epilepsia partialis continua had a negative relationship with Pardo stage (β = ?0.49, P = 0.04). Twenty-six (89.75%) patients were Engel class I at the last follow-up, including all 5 patients who underwent redo hemispherectomy in our cohort. Conclusions: Consistent with the progressive nature of RE, more severe pathology was associated with a longer duration of epilepsy and longer duration of hemiparesis, while the presence of epilepsia partialis continua was associated with less severe pathology. Results from this series suggest the degree of cortical involvement with RE as assessed on surgical histopathology does not correlate with seizure outcome after hemispherectomy, which appears to be more dependent on surgical technique/complete disconnection.
      原文链接:
    • NSTL
    • Elsevier

    Young Neurosurgeons and Technology: Survey of Young Neurosurgeons Section of Italian Society of Neurosurgery (Società Italiana di Neurochirurgia, SINch)

    Zoli M.Bongetta D.Raffa G.Somma T....
    21页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Technological advancement in neurosurgery is a continuous process aimed at improving existing devices and implementing innovative ones. Recently, artificial intelligence (AI)-derived technologies (i.e., machine learning and virtual or augmented reality) have been entering this field, promising to significantly change its future. The acquisition of technological skills should be a goal of training for young neurosurgeons. The aim of this study is the analysis of competence and attitude toward intraoperative devices of young neurosurgeons. Methods: An online electronic survey was sent to 256 members of the Young Neurosurgeons Section of the Italian Society of Neurosurgery (Società Italiana di Neurochirurgia, SINch), inquiring about their competences and attitude toward surgical technologies and AI-derived devices. Results: A total of 152 neurosurgeons participated in the survey. Most participants reported sufficient skills in autonomously setting up and using the optic neuronavigator (93.4% and 92.1%, respectively), advanced microscope (80.3% and 76.3%), magnetic neuronavigator (75% and 72.4%), ultrasonography (63.2% and 60.5%) and high-definition endoscope (55.3% and 46%). Most (92.1%) considered operative devices useful and 89.5% reported a high motivation to acquire technological skills. AI-derived devices have already been used by 56.6% of participants but only 31.6% received proper dedicated training. Conclusions: Italian young neurosurgeons have acquired technical skills sufficient for the autonomous use of the most common operative devices, reporting a positive attitude toward technology with high motivation to learn and awareness of their potential harmfulness. A promising number of participants had already used AI-derived technologies, although only a few had received focused training for these devices.
      原文链接:
    • NSTL
    • Elsevier

    Surgical and Endovascular Treatment of Saccular Posterior Inferior Cerebellar Artery Aneurysms: Systematic Review and Meta-Analysis

    Ali A.M.S.Hannan C.J.Islim A.I.Mascitelli J.R....
    10页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: The optimal treatment modality for saccular aneurysms of the posterior inferior cerebellar artery (PICA) remains unclear. A previous meta-analysis on the topic included a heterogenous study population, limiting the conclusions that can be drawn from its results. The aim of this study was to perform a systematic review and meta-analysis to compare outcomes of microsurgical and endovascular treatment (EVT) of these aneurysms. Methods: A search of 4 online databases was performed for studies describing the management of saccular PICA aneurysms. The primary outcome was complete aneurysm occlusion. Data were also collected on neurologic outcomes, cranial nerve palsies, and requirement for re-treatment. A random effects model was used for calculation of pooled proportions. Our protocol was registered with PROSPERO (CRD42021232784). Results: A total of 17 studies were included in the final analysis, reporting the treatment outcomes of 455 aneurysms, with a mean follow-up of 20 months. The pooled occlusion rates were 94.8% (95% confidence interval [CI] 90.6%–97.8%) for surgical treatment and 69.1% (95% CI 55.0%–81.7%) for EVT. Pooled rates of good neurologic outcome (modified Rankin scale score ≤2, Glasgow Outcome Scale score ≥4) at last follow-up were 78.1% (95% CI 67.4%–87.1%) for surgery and 77.6% (95% CI 67.9%–86.0%) for EVT. Conclusions: This meta-analysis demonstrates that in the treatment of saccular PICA aneurysms, microsurgical clipping results in superior angiographic outcomes, similar functional outcomes, but higher rates of lower cranial nerve palsy compared with EVT. Further studies are required to assess the duration and severity of cranial nerve palsies following surgical treatment, and long-term aneurysm occlusion and the requirement for re-intervention following EVT.
      原文链接:
    • NSTL
    • Elsevier

    Soft Gasket Seal Reconstruction After Endoscopic Endonasal Transtuberculum Resection of Craniopharyngiomas

    Albonette-Felicio T.Martinez-Perez R.Vankoevering K.Hardesty D.A....
    6页
    查看更多>>摘要：? 2021Background: The expanded endoscopic endonasal approach (EEA) is currently well accepted for a variety of ventral skull base tumors. Such an approach often results in a transdural defect and intraoperative cerebrospinal fluid (CSF) leak, and adequate reconstruction is necessary to prevent postoperative CSF leak and its complications. Reconstruction is usually performed using a variety of materials along with the nasoseptal flap. Objective: This work's aim is to describe a new reconstructive technique called the “soft gasket seal” (SGS) in detail and compare it with the standard reconstructive technique at our institution for craniopharyngiomas operated via transtuberculum EEA. Methods: A retrospective chart review was achieved to identify patients who underwent transtubercular EEA for craniopharyngioma between 2010 and 2018, by the same neurosurgical and otolaryngology team using either the SGS or standard reconstructive technique. Results: Of 36 patients who met criteria and were considered for analysis, 15 of them underwent SGS reconstruction and 21 had standard reconstruction. There were 16 female (44%) and 20 male (56%) patients. The median age was 42.2 ± 20.9 years. The rate of postoperative CSF leak in the group of patients treated with the standard technique was 14.2% and 6.6% in the SGS group (odds ratio 0.43 [confidence interval 95% 0.007–6.15], P = 0.62). Conclusions: The SGS technique provides a simple reconstructive technique in conjunction with the nasoseptal flap, showing a tendency of lower complications when compared with our standard technique while avoiding donor site morbidity. Such results are encouraging, but further studies are necessary to confirm these findings.
      原文链接:
    • NSTL
    • Elsevier

    Bibliometric and Visualized Analysis of Neuropathic Pain Using Web of Science and CiteSpace for the Past 20 Years

    Xu Z.Zhu Y.Hu Y.Huang M....
    14页
    查看更多>>摘要：? 2021 Elsevier Inc.Objective: The purpose of our bibliometric analysis was to explore the disciplinary hotspots and collaborative networks in research on neuropathic pain (NPP) during in the past 20 years. Methods: The studies related to NPP were obtained from Web of Science database. Global publications on NPP were analyzed for different factors, including the number of reports, citation rates, authors, institutions, countries and regions, journals, funding, and relevant partnerships and topic hotspots. Results: From 2001 to 2020, 6905 studies related to NPP research were reported worldwide. The number of publications had increased continually during the past 20 years. Pain was the most productive and most frequently co-cited journal. Ralf Baron was the most productive and influential author. The most productive country and institution were the United States and Harvard University, respectively. Investigators and institutions from the United States, Japan, and China were the core research forces. We found broad and close cooperation in the field worldwide. The top authors and top institutions had collaborated relatively closely with others. Conclusions: The research of NPP is a well-developed and prospective field of medical study. The journals Pain, European Journal of Pain, and Molecular Pain showed more interested in this field. The United States, Harvard University, and Ralf Baron were the top country, institution, and author, respectively. Global research collaboration was extensive, with the top institutions and authors cooperating with others.
      原文链接:
    • NSTL
    • Elsevier

    Price Transparency in Neurosurgery: Challenges and Opportunities in the Online Publishing of Treatment Prices to Enable Cost-Conscious and Value-Based Practice

    Srivatsa S.Khan H.A.Benzel E.C.Benzil D.L....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: There is a paucity of evidence describing the price information that is publicly available to patients wishing to undergo neurosurgical procedures. We sought to investigate the public availability and usefulness of price estimates for non-emergent, elective neurosurgical interventions. Methods: Google was used to search for price information related to 15 procedures in 8 major U.S. health care markets. We recorded price information that was published for each procedure and took note of whether itemized prices, potential discounts, and cross-provider price comparisons were available. Results: Online searches yielded 2356 websites, of which 228 (9.7%) offered geographically relevant price information for neurosurgical procedures. Although accounting for only 16.4% of total search results, price transparency websites provided most treatment price estimates (74.1% of all estimates), followed by clinical sites (19.3%), and other related sites (5.3%). The number of websites providing price information varied significantly by city and procedure. websites rarely divulged data sources, specified how prices were estimated, indicated how frequently price estimates were updated, offered itemized breakdowns of prices, or indicated whether price estimates encompassed the full spectrum of possible health care charges. Conclusions: Under 10% of websites queried yield geographically relevant price information for non-emergent neurosurgical imaging and operative procedures. Even when this information is publicly available, its usefulness to patients may be limited by various factors, including obscure data sources and methods, as well as sparse information on discounts and bundled price estimates. Inconsistent availability and clarity of price information likely impede patients' ability to discern expected costs of treatment and engage in cost-conscious, value-based neurosurgical decision-making.
      原文链接:
    • NSTL
    • Elsevier

    Complex Wound Closure in Adult Spinal Deformity Surgery Reduces Complications in High-Risk Patients

    Gadot R.Anand A.Verla T.Muir M....
    7页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Adult spinal deformity (ASD) surgery is becoming increasingly prevalent. Soft tissue defects arising from revision closure and impaired healing can predispose to wound complications including dehiscence and infection. Soft tissue coverage with local muscle flaps has been shown to minimize wound complications in high-risk patients. In this study we evaluate the role of complex wound closure in preventing wound complications in high-risk spinal deformity patients. Methods: The authors retrospectively reviewed charts of patients who underwent ASD surgery. Patients were stratified into muscle flap advancement (by neurosurgery or plastic surgery) closure versus primary approximation by neurosurgery. Relevant patient and operative factors were collected and summarized using descriptive statistics. Outcomes of interest included wound complication and revision surgery. Results: Ninety-four cases met inclusion criteria including 56 wounds closed by neurosurgery and 38 wounds closed by plastic surgery (PRS). Of the neurosurgery wounds, 31 and 25 were closed by primary approximation and muscular flap advancement, respectively. Patients operated on by PRS were higher risk than all patients operated on only by neurosurgery (P = 0.0037) but were not significantly higher risk than the neurosurgery performed flap cohort (P = 0.4914). In subgroup analysis, despite similar levels of risk, the PRS population experienced lower rates of any wound complication (P = 0.028) and specifically dehiscence (P = 0.029) compared with the neurosurgery performed flap closure cohort. Conclusions: Prophylactic involvement of plastic surgery in ASD surgery wound closure may improve wound outcomes in higher risk patients. A multidisciplinary approach with plastic and spine surgeons may lessen the risk of wound complications in high-risk spine surgeries.
      原文链接:
    • NSTL
    • Elsevier

    Posterior Communicating Artery-incorporated Internal Carotid-Posterior Communicating Artery Aneurysms Prone to Recur After Coil Embolization

    Yasuda R.Miura Y.Suzuki Y.Tsuji M....
    7页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: The objective was to clarify predisposing factors of recurrence after coil embolization for internal carotid-posterior communicating artery (IC-Pcom) aneurysms. Methods: The medical records were retrospectively reviewed and patients harboring IC-Pcom aneurysms treated with coil embolization between June 2004 and June 2020 were identified. Aneurysms whose 3-dimensional images were available, whose initial treatment was performed during the study period, and whose follow-up term was more than 1 year were included. Information of the patients, the aneurysms and Pcoms, the initial treatment, and angiographic outcomes were collected. The IC-Pcom aneurysms were divided into Pcom-incorporated when their neck mainly rode on the Pcom or non-Pcom-incorporated when their neck mainly rode on the internal carotid artery or the classification was equivocal. Relationship between these factors and recurrence was analyzed. Results: Fifty-seven IC-Pcom aneurysms from 55 patients were recruited. Fifteen of the 57 aneurysms were categorized into Pcom-incorporated. Eighteen of the 57 aneurysms recurred. Mean follow-up term was 74.3 months and mean duration between the initial treatment and recurrence was 47.9 months. On univariate analyses, ruptured (P = 0.004), fetal-type Pcom (P = 0.002), and Pcom-incorporated (P < 0.001) were significantly correlated with recurrence. Multivariate analysis demonstrated that Pcom-incorporated aneurysms were significantly associated with recurrence (P < 0.001) along with ruptured (P = 0.027). Kaplan-Meier estimate demonstrated that cumulative recurrence-free rate was significantly lower in Pcom-incorporated aneurysms compared with non-Pcom-incorporated aneurysms (log-rank P < 0.001). Conclusions: Pcom-incorporated IC-Pcom aneurysms were susceptible to recur after coil embolization, especially when ruptured and the incorporated Pcom was fetal-type.
      原文链接:
    • NSTL
    • Elsevier

    Using Preoperative and Intraoperative Factors to Predict the Risk of Surgical Site Infections After Lumbar Spinal Surgery: A Machine Learning–Based Study

    Liao W.-J.Li M.-P.Zhang Y.Luo K....
    8页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: To develop a model based on machine learning to predict surgical site infection (SSI) risk in patients after lumbar spinal surgery (LSS). Methods: Patients who developed postoperative SSI after LSS in the First Affiliated Hospital of Nanchang University between December 2010 and December 2019 were retrospectively reviewed. Preoperative and intraoperative variables, including age, diabetes mellitus, hypertension, body mass index, previous spinal surgery history, surgical duration, number of fused segments, blood loss, and surgical procedure were analyzed. Six machine learning algorithms—logistic regression, multilayer perceptron, decision tree, random forest, gradient boosting machine, and extreme gradient boosting—were used to build prediction models. The performance of the models was evaluated using the area under the curve, accuracy, precision, sensitivity, and F1 score. A web predictor was developed based on the best-performing model. Results: The study included 288 patients who underwent LSS, of whom 144 developed SSI and 144 did not develop SSI. The extreme gradient boosting model offers the best predictive performance among these 6 models (area under the curve = 0.923, accuracy = 0.860, precision = 0.900, sensitivity = 0.834, F1 score = 0.864). An extreme gradient boosting model–based web predictor was developed to predict SSI in patients after LSS. Conclusions: This study developed a machine learning model and a web predictor for predicting SSI in patients after LSS, which may help clinicians screen high-risk patients, provide personalized treatment, and reduce the incidence of SSI after LSS.
      原文链接:
    • NSTL
    • Elsevier