Journal of neurosurgical sciences最新文献

{"title":"Microsurgery of Koos I-II vestibular schwannomas: a case series of 100 consecutive patients.","authors":"Luciano Mastronardi,&nbsp;Alberto Campione,&nbsp;Fabio Boccacci,&nbsp;Guglielmo Cacciotti,&nbsp;Ettore Carpineta,&nbsp;Carlo Giacobbo Scavo,&nbsp;Raffaelino Roperto,&nbsp;Giovanni Stati,&nbsp;Cristiana F Altamura,&nbsp;Amer A Alomari","doi":"10.23736/S0390-5616.23.06014-9","DOIUrl":"https://doi.org/10.23736/S0390-5616.23.06014-9","url":null,"abstract":"<p><strong>Background: </strong>Treatment of small vestibular schwannomas (VS) depends on size, growth pattern, age, symptoms, co-morbidities. Watchful waiting, stereotactic radiosurgery and microsurgery are three valid options of treatment.</p><p><strong>Methods: </strong>We reviewed clinical sheets, surgical data and results of 100 consecutive patients with Koos Grade I-II VS, operated at our department via a retrosigmoid microsurgical approach between September 2010 and July 2021. Extent of resection was assessed as total, near-total or subtotal. The course of facial nerve (FN) around the tumor was classified as anterior (A), anterior-inferior (AI), anterior-superior (AS) and dorsal (D). FN function was assessed according to House-Brackmann (HB) Scale and hearing level according to AAO-HNS Classification.</p><p><strong>Results: </strong>Mean tumor size was 1.52 cm. FN course was mainly AS (46.0%) in the overall cohort; in Koos I VS, FN was AS in 83.3%. Postoperative FN function was HB I in 97% and HB II in 3% of cases. Hearing preservation (AAO-HNS class A-B) was possible in 63.2% of procedures. Total/near-total removal was achieved in 98%. Postoperative mortality was zero. Transient complications were observed in 8% of patients; permanent complications never occurred. Tumor remnant progression was observed in one case, 5 years after subtotal removal.</p><p><strong>Conclusions: </strong>Microsurgery represents a valid option for management of VS, including Koos I-II grades, with an acceptable complication rate. In particular, in small VS long-term FN facial outcome, HP and total/near-total removal rate are favorable.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9615157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the quality of the information available on the internet for patients suffering with sciatica?","authors":"Marco Mancuso-Marcello,&nbsp;Andreas K Demetriades","doi":"10.23736/S0390-5616.20.05243-1","DOIUrl":"https://doi.org/10.23736/S0390-5616.20.05243-1","url":null,"abstract":"<p><strong>Background: </strong>Sciatica is a common neurological condition with a wide variety of clinical specialists and allied health professionals involved, and a broad range of treatment options. We sought to assess the quality of information available on the internet.</p><p><strong>Methods: </strong>An internet search for 'sciatica' was performed using 'Google'. The first fifty links were assessed using the DISCERN instrument, a validated questionnaire for health consumers and providers.</p><p><strong>Results: </strong>After exclusions, 44 websites were assessed. Only 37% of sites had clear aims and objectives; 79% provided relevant information; 81% did not provide clear sources of their information; 67% had no indication of when the information was compiled or updated; 63% clarified that more than one treatment option was available; only 28% described in moderate to extensive detail how the various treatment modalities might work; only 14% informed patients of potential risks and complications for each treatment. The biased and/or unbalanced websites amounted to 40%, offering greater detail about one treatment modality over others. Overall, 93% of assessed websites did not inform patients of the consequences/natural history if no treatment were undertaken; and 91% did not describe the potential impact of treatment and how it could affect quality of life.</p><p><strong>Conclusions: </strong>Despite the role that the internet plays in everyday life, information on the common and debilitating condition of sciatica is mostly of low-to-moderate quality, and with serious shortcomings. Healthcare stakeholders ought to be aware of the risks of misinformation and ensure that health-related internet website design and upkeep is guided by instruments such as DISCERN.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"67 3","pages":"355-359"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9549035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A single center experience in the management of progressive juvenile pilocytic astrocytoma.","authors":"Ieta Shams,&nbsp;Branavan Manoranjan,&nbsp;Rebecca Voth,&nbsp;Malavan Ragulojan,&nbsp;Olufemi Ajani,&nbsp;Blake Yarascavitch,&nbsp;Sheila K Singh,&nbsp;Adam J Fleming","doi":"10.23736/S0390-5616.21.05169-9","DOIUrl":"https://doi.org/10.23736/S0390-5616.21.05169-9","url":null,"abstract":"<p><strong>Background: </strong>Juvenile pilocytic astrocytoma (JPA) typically follows an indolent clinical course. The first-line treatment for most JPAs is surgical resection. However, a gross total resection may not be feasible for deep-seated lesions and/or infiltrative tumors, leading to multimodal treatment approaches that may be complicated by patient age and tumor location. Despite the prevalence of pediatric JPAs, there is no single approach to treating progressive disease.</p><p><strong>Methods: </strong>We investigated the multifaceted management of progressive JPAs through a retrospective analysis of JPAs treated at a single center over an 18-year period (1998-2016). All cases were categorized according to location, whether supratentorial or infratentorial, and for each case we calculated the number of interventions and the time between interventions.</p><p><strong>Results: </strong>We identified a total of 40 JPAs, (11 supratentorial, 29 infratentorial). Total number of interventions among all supratentorial JPA patients was 21 (average 2 interventions/patient). The total number of interventions among infratentorial JPAs was 40 (average 1.4 interventions/patient).</p><p><strong>Conclusions: </strong>Treatment of progressive JPA is variable and may require numerous surgeries and adjuvant therapies.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"67 3","pages":"311-316"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9903364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial neural networks can be effectively used to model changes of intracranial pressure (ICP) during spinal surgery using different noninvasive ICP surrogate estimators.","authors":"Abdulla Watad,&nbsp;Nicola L Bragazzi,&nbsp;Susanna Bacigaluppi,&nbsp;Howard Amital,&nbsp;Samaa Watad,&nbsp;Kassem Sharif,&nbsp;Bishara Bisharat,&nbsp;Anna Siri,&nbsp;Ala Mahamid,&nbsp;Hakim Abu Ras,&nbsp;Ahmed Nasr,&nbsp;Federico Bilotta,&nbsp;Chiara Robba,&nbsp;Mohammad Adawi","doi":"10.23736/S0390-5616.18.04299-6","DOIUrl":"https://doi.org/10.23736/S0390-5616.18.04299-6","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) techniques play a major role in anesthesiology, even though their importance is often overlooked. In the extant literature, AI approaches, such as artificial neural networks (ANNs), have been underutilized, being used mainly to model patient's consciousness state, to predict the precise number of anesthetic gases, the level of analgesia, or the need of anesthesiological blocks, among others. In the field of neurosurgery, ANNs have been effectively applied to the diagnosis and prognosis of cerebral tumors, seizures, low back pain, and also to the monitoring of intracranial pressure (ICP).</p><p><strong>Methods: </strong>A multilayer perceptron (MLP), which is a feedforward ANN, with hyperbolic tangent as activation function in the input/hidden layers, softmax as activation function in the output layer, and cross-entropy as error function, was used to model the impact of prone versus supine position and the use of positive end expiratory pressure (PEEP) on ICP in a sample of 30 patients undergoing spinal surgery. Different noninvasive surrogate estimations of ICP have been used and compared: namely, mean optic nerve sheath diameter (ONSD), noninvasive estimated cerebral perfusion pressure (NCPP), Pulsatility Index (PI), ICP derived from PI (ICP-PI), and flow velocity diastolic formula (FVDICP).</p><p><strong>Results: </strong>ONSD proved to be a more robust surrogate estimation of ICP, with a predictive power of 75%, whilst the power of NCPP, ICP-PI, PI, and FVDICP were 60.5%, 54.8%, 53.1%, and 47.7%, respectively.</p><p><strong>Conclusions: </strong>Our MLP analysis confirmed our findings previously obtained with regression, correlation, multivariate receiving operator curve (multi-ROC) analyses. ANNs can be successfully used to predict the effects of prone versus supine position and PEEP on ICP in patients undergoing spinal surgery using different noninvasive surrogate estimators of ICP.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"67 3","pages":"288-296"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9548266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The projected numbers of degenerative spine disease in Austria from 2017 to 2080: a perspective-based scenario analysis.","authors":"Wolfgang Hitzl,&nbsp;Christoph Schwartz,&nbsp;Stefan Zausinger,&nbsp;Peter A Winkler,&nbsp;Barbara Ladisich,&nbsp;Oliver SchÖffski,&nbsp;Alexander Romagna","doi":"10.23736/S0390-5616.21.05178-X","DOIUrl":"https://doi.org/10.23736/S0390-5616.21.05178-X","url":null,"abstract":"<p><strong>Background: </strong>Spinal surgery has to address the challenge of a dramatic increase of the growing number of older persons. The purpose of the present study was to project the numbers of surgically treated degenerative spine disease (DSD) in Austria from 2017 until 2080 to provide potential future scenarios that the Austrian Health system might have to face.</p><p><strong>Methods: </strong>Current numbers on demographic information from Austria as well as population projections for 2017-2080 were obtained from Statistics Austria (STAT). A lower/main/upper scenario reflecting low/main/high growth and ageing scenarios deducted from fertility, life expectancy and immigration calculations was used. Information on prevalence of surgically treated DSD was obtained from the Austrian Spine Register.</p><p><strong>Results: </strong>The population in Austria (evaluated in 2017) was 8.78 millions and is estimated to evolve to 7.86/10.0/13.1 millions by 2080. The total number of surgically treated DSD recorded in the Spine Register was 9300 and was estimated to be 9300/11200/13700 in 2080. The number of subjects with surgically treated DSD were expected to increase in the age-strata (main scenario), 100% corresponds to the number in each age and gender stratum: 0-40 years by (male/female) 2%/2%, 40-50 years -7%/-7%, 50-59 years -11%/-9%, 60-69 years 21%/16%, 70-79 years 51%/31%, 80-89 years 211%/129% and 90+years 698%/411%.</p><p><strong>Conclusions: </strong>Total numbers of subjects with DSD in Austria will increase from 2017 to 2080. The increase will be substantial in those aged 80+ and those aged 90+. The assumptions of this analysis were taken conservatively. Hence, the future socio-economic burden to society might be greater as projected by the study.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"67 3","pages":"317-323"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9546867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of extracranial-intracranial bypass revascularization procedure in acute stroke after endovascular failure: the EIRASP study protocol.","authors":"Alessia Fratianni,&nbsp;Giacomo Bertolini,&nbsp;Roberto Menozzi,&nbsp;Davide Cerasti,&nbsp;Silvia Lana,&nbsp;Francesca Bozzetti,&nbsp;Matteo Fantoni,&nbsp;Patrizia Ceccarelli,&nbsp;Paola Castellini,&nbsp;Sandra Rossi,&nbsp;Umberto Scoditti,&nbsp;Ermanno Giombelli","doi":"10.23736/S0390-5616.21.05564-8","DOIUrl":"https://doi.org/10.23736/S0390-5616.21.05564-8","url":null,"abstract":"<p><strong>Background: </strong>Intravenous thrombolysis and endovascular reperfusion represent nowadays the standard treatment for acute ischemic stroke. However, ineffective reperfusion may occur, representing a major negative prognostic factor on clinical outcome. Extracranial-intracranial (EC-IC) bypass revascularization procedure in an acute setting appears as a promising tool to increase reperfusion rates and improve clinical outcome in a highly selected population refractory or ineligible for standard reperfusion therapies.</p><p><strong>Methods: </strong>The Extracranial-Intracranial Revascularization for Acute Stroke - Parma (EIRASP) study is an observational, prospective, single-center, study (protocol 203/2020/OSS/AOUPR). Patients admitted for an acute ischemic anterior circulation stroke due to large vessels occlusion and refractory or ineligible for standard reperfusion therapies will be submitted to an extracranial-intracranial bypass revascularization procedure when fulfilling all clinical and radiological inclusion criteria. The primary outcome will be the functional outcome (modified Rankin Scale and NIHSS score) at 3 months after the surgical procedure. Secondary outcome will include the evaluation of clinical and surgical complications rates, quantitative monitoring of perfusion parameters, and further functional and survival rates.</p><p><strong>Results: </strong>Despite promising data regarding the feasibility and the favorable outcome of urgent EC-IC bypass revascularization procedure in selected patients suffering an acute ischemic stroke are emerging in literature, no studies to date have prospectively explored the real potential of this technique.</p><p><strong>Conclusions: </strong>The EIRASP study aims to provide further and stronger methodological evidence of the benefit of urgent EC-IC bypass revascularization procedure in acute ischemic stroke.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"67 3","pages":"273-279"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9547831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Hounsfield units in predicting fusion rates of patients undergoing anterior odontoid screw fixation following Anderson d'Alonzo type II and shallow type III fractures.","authors":"Jan Lodin,&nbsp;Aleš Hejčl,&nbsp;Martin Bolcha,&nbsp;Martin Sameš,&nbsp;Petr Vachata","doi":"10.23736/S0390-5616.20.05190-5","DOIUrl":"https://doi.org/10.23736/S0390-5616.20.05190-5","url":null,"abstract":"<p><strong>Background: </strong>Main objective of this study was to determine whether Hounsfield units (HU) measured in three areas of the axis correlate with successful fusion in patients with type II and shallow type III C2 fractures undergoing anterior odontoid screw osteosynthesis (AOSF).</p><p><strong>Methods: </strong>Forty-five patients with C2 fractures treated via AOSF were analyzed. Only bony fusion with bone trabeculations across the fracture line was considered a successful result. Preoperative HU values were measured in three zones- corpus, watershed and dens. Statistical analysis was performed to determine significant differences between HU of fused and unfused patients in all three zones of a complete and adjusted patient cohort.</p><p><strong>Results: </strong>Statistically significant differences of HU values were found between fused (corpus- 363.7, watershed- 327.9) and unfused (corpus- 279.5, watershed- 194.2) of the complete cohort and the adjusted cohort. Cut-off HU values in the watershed zone were calculated for the complete (250 and 300) and adjusted cohort (240 and 260), dividing patients into three groups of bone quality. Patients with high watershed bone quality (HU>300) achieved successful fusion in 84.62%, patients with low bone quality (HU<250) in 3.85% and patients with medium bone quality (HU 250-300) in 50%.</p><p><strong>Conclusions: </strong>Preoperative measurement of HU can be used to predict the probability of successful fusion in patients undergoing AOSF for type II and shallow type III C2 fractures. AOSF is a highly effective treatment modality in patients with watershed HU>300, whereas alternatives should be considered in patients with watershed HU<250.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"67 3","pages":"331-339"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9549034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new study protocol for in-vivo assessment of tumor diagnosis and microscopic tumor infiltration at the resection cavity in central nervous system tumors by a new miniature confocal endomicroscope (CONVIVO system).","authors":"Francesco Restelli,&nbsp;Elio Mazzapicchi,&nbsp;Bianca Pollo,&nbsp;Jacopo Falco,&nbsp;Giulio Bonomo,&nbsp;Emanuele LA Corte,&nbsp;Morgan Broggi,&nbsp;Marco Schiariti,&nbsp;Francesco DI Meco,&nbsp;Paolo Ferroli,&nbsp;Irene Tramacere,&nbsp;Francesco Acerbi","doi":"10.23736/S0390-5616.22.05906-9","DOIUrl":"https://doi.org/10.23736/S0390-5616.22.05906-9","url":null,"abstract":"<p><strong>Background: </strong>Confocal laser technology has been recently suggested as a promising method to obtain near real-time intraoperative histological data. We recently demonstrated the accuracy of a newly designed confocal endomiscroscope (CONVIVO) in offering an intraoperative diagnosis during high-grade gliomas (HGGs) removal in an ex vivo study. With this work we aim to perform a standardized, prospective and blinded-to-histological section study for evaluating the potentiality of CONVIVO in offering in-vivo data regarding histological diagnosis and presence of tumor at margins during resection of central nervous system (CNS) tumors.</p><p><strong>Methods: </strong>This prospective, observational, standardized, blinded-to-histological section, clinical trial was approved by the institutional review board in Carlo Besta Neurologic Institute IRCCS Foundation in Milan and is expected to last 24 months. 75 patients will be included, with at least 53 of them being HGGs based on the statistical sample size calculation. Main objectives will be the assessing of the concordance of tumor diagnoses between CONVIVO images and frozen section at the center of all tumor subtypes and the evaluation of the accuracy of CONVIVO in the identification of tumor tissue at the margins, compared to standard histology. For this purpose, \"virtual biopsies\" and physical biopsies will be performed directly on patient tumor tissue and surrounding brain parenchima during tumor resection, comparing the results of CONVIVO analysis and frozen and histological sections.</p><p><strong>Results: </strong>Despite promising preliminary data on ex vivo usefulness of CLE machines are emerging in literature, still few studies are available when looking at in vivo potentiality of CONVIVO. At this regard, this study will be the first work where a standardized, prospective, and blinded-to-histological section CONVIVO analysis will be performed in an in-vivo setting in neuro-oncological surgery.</p><p><strong>Conclusions: </strong>We hypothesize that this new technique may have a role in offering data regarding presence of tumor tissue, eventually giving an intraoperative diagnosis in neuro-oncological surgery, rendering more fluid the decision-making process in the operating room. Furthermore, the result of this study will provide a solid base for further expanding the clinical applications of confocal machines in neurosurgery.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"67 3","pages":"280-287"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9549235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of outcomes in traumatic brain injury: The IMPACT and CRASH prognostic models in a single neurosurgical center, Malaysia.","authors":"Jafri M Abdullah,&nbsp;Zamzuri Idris,&nbsp;Abdul R Ghani,&nbsp;Mei S Lim","doi":"10.23736/S0390-5616.21.05249-8","DOIUrl":"https://doi.org/10.23736/S0390-5616.21.05249-8","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) has recently become a major concern for public health care and a socioeconomic burden internationally. Prognostic models are mathematical models developed from specific populations which are used to predict the mortality and unfavorable outcomes especially in trauma centers. Hence, we formulate a study to perform an external validation of the IMPACT and CRASH prognostic models; the CRASH model to predict 14-day mortality and 6-month unfavorable outcome and the IMPACT model to estimate 6-month mortality and unfavorable outcome in a single center cohort of TBI patients in Malaysia.</p><p><strong>Methods: </strong>All patients with traumatic brain injury (mild, moderate, and severe) who were admitted to Queen Elizabeth Hospital from November 1, 2017, to January 31, 2019, were prospectively analyzed through a data collection sheet. The discriminatory power of the models was assessed as area under the receiver operating characteristic curve and calibration was assessed using the Hosmer-Lemeshow (H-L) goodness-of-fit test and Cox calibration regression analysis.</p><p><strong>Results: </strong>We analyzed 281 patients with significant TBI treated in a single neurosurgical center in Malaysia over a 2-year period. The overall observed 14-day mortality was 9.6%, a 6-month unfavorable outcome of 23.5%, and a 6-month mortality of 13.2%. Overall, both the CRASH and IMPACT models showed good discrimination with AUCs ranging from 0.88 to 0.94 and both models calibrating satisfactorily H-L GoF P>0.05 and calibration slopes >1.0 although IMPACT seemed to be slightly more superior compared to the CRASH model.</p><p><strong>Conclusions: </strong>The CRASH and IMPACT prognostic models displayed satisfactory overall performance in our cohort of TBI patients, but further investigations on factors contributing to TBI outcomes and continuous updating on both models remain crucial.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"67 3","pages":"367-373"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9548285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-robotized frameless stereotactic magnetic resonance guided laser interstitial thermal therapy for hypothalamic hamartoma.","authors":"Giuseppe DI Perna,&nbsp;Mattia Pacetti,&nbsp;Domenico Tortora,&nbsp;Lino Nobili,&nbsp;Armando Cama,&nbsp;Gianluca Piatelli,&nbsp;Alessandro Consales","doi":"10.23736/S0390-5616.21.05442-4","DOIUrl":"https://doi.org/10.23736/S0390-5616.21.05442-4","url":null,"abstract":"<p><p>Various strategies have been proposed for the treatment of gelastic seizures due to hypothalamic hamartomas (HH), advancing from surgical removal techniques toward functional disconnection strategies. One of the most recent procedure is the Magnetic Resonance guided Laser Interstitial Thermal Therapy (MRg-LITT), which has progressively proved to be a safe and effective technique for hamartomas ablation. In this paper, the authors' preliminary experience with the first two patients treated with this technique in Italy is presented, in order to underline the feasibility of a pure non robotized frameless technique (FS MRg-LITT) while confirming the procedure effectiveness on seizure control. Patients undergoing FS MRg-LITT for the treatment of HH related gelastic seizures since January 2020 were included. A two steps procedure was performed by using the neuronavigation system to define the entry point, the trajectories and to assess the accuracy. Visualase Laser Ablation System was then used for the MR guided ablation of the HH. A multidisciplinary (neurosurgeons, epileptologist, neuroradiologist) institutional board evaluated the patients both in the perioperative period and during follow-up. A total number of 2 pediatric patients were described. The mean operative time resulted to be 6 hours while the mean accuracy was 0.4 mm. No perioperative complications were reported. The mean length of stay was 4 days. Lastly, at 1-year follow-up both patients resulted to be seizure free and endocrinological functions were preserved. FS MRg-LITT for the treatment of HH-related epilepsy could represent an effective technique, being able to guarantee adequate level of accuracy and potentially extending the accessibility of MRg-LITT by lowering its costs and simplifying the overall procedure.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"67 3","pages":"380-391"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9903382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}