Journal of neurosurgical sciences最新文献

{"title":"All-cause and tumor-specific mortality trends in elderly primary central nervous system lymphoma (PCNSL) patients: a surveillance, epidemiology, and end results (SEER) analysis.","authors":"Taylor Furst, Haydn Hoffman, Lawrence S Chin","doi":"10.23736/S0390-5616.19.04785-4","DOIUrl":"10.23736/S0390-5616.19.04785-4","url":null,"abstract":"<p><strong>Background: </strong>Recent primary central nervous system lymphoma (PCNSL) literature indicates that younger patients benefit from improved survival; however, this benefit is not shared by those 70+ years of age. The purpose of this study was to examine mortality trends in PCNSL patients 70+ years of age to better understand why improved prognosis has not yet reached this rapidly growing population subset.</p><p><strong>Methods: </strong>Two thousand seventy-five cases (1973-2012, age at diagnosis 70+ years) within the Surveillance, Epidemiology, and End Results (SEER) database were included in Kaplan-Meier and multivariate Cox Regression analyses. Variables include age at diagnosis, decade of diagnosis (1=1973-1982, 2=1983-1992, 3=1993-2002, 4=2003-2012), sex, race and surgery.</p><p><strong>Results: </strong>Before stratification, both univariate and multivariate analyses agreed that patients aged 70-74 years at diagnosis lived the longest, while those 85+ years lived the shortest (median±SD; 6.0±0.5 months vs. 2.0±0.2 months, respectively, P<0.0005); women lived longer than men (5.0±0.3 months vs. 4.0±0.3 months, respectively, P=0.01); patients who received surgery (6.0±0.5 months) lived longer than those who did not (contraindicated=1.0±0.5 months, P<0.0005; not performed=4.0±0.3 months, P<0.0005). Univariate analysis showed decade 4 lived longer than only decade 3 (4.0±0.3 vs. 4.0±0.5, respectively, P=0.008), while multivariate analysis showed decade 4 lived longer than both 2 (5.0±0.8 months, P=0.03) and 3 (P<0.0005). Following stratification, decade and sex no longer influenced survival. Race did not influence survival.</p><p><strong>Conclusions: </strong>Minimal clinically meaningful improvements in elderly PCNSL patient all-cause and tumor-specific mortality have been made since 1973, while the best predictors of longevity include younger age and surgery.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68828481","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":"Pycnogenol® improves cognitive function in post-stroke patients: a 6 month-study.","authors":"Gianni Belcaro, Mark Dugall, Morio Hosoi, Beatrice Feragalli, Roberto Cotellese, Aristide Saggino, Maria Rosaria Cesarone, Edmondo Ippolito, Umberto Cornelli, Andrea Ledda, David B Cox","doi":"10.23736/S0390-5616.22.05855-6","DOIUrl":"10.23736/S0390-5616.22.05855-6","url":null,"abstract":"<p><strong>Background: </strong>This pilot study in post-stroke patients evaluated the effects of supplementation with Pycnogenol^® on alterations in cognitive functions (COFU) over a period of 6 months, starting 4 weeks after the stroke.</p><p><strong>Methods: </strong>The effects of supplementation - possibly acting on residual brain edema, on global cognitive function, attention and on mental performance - were studied. A control group used standard management (SM) and the other group added Pycnogenol^®, 150 mg daily to SM.</p><p><strong>Results: </strong>38 post-stroke patients completed the 6-month-study, 20 in the Pycnogenol^® group and 18 in the control group. No side effects were observed with the supplement. The tolerability was very good. The patients included into the two groups were comparable for age, sex and clinical distribution. There were 2 dropouts in the control group, due to non-medical problems. Main COFU parameters (assessed by a cognitive questionnaire) were significantly improved (all single items) with the supplement compared to controls (P<0.05). Additional observations indicate that Pycnogenol^® patients experienced significantly less mini-accidents (including falls) than controls (P<0.05). The incidences of (minor) psychotic episodes or conflicts and distress and other problems including rare occurrence of minor hallucinations, were lower with the supplementation than in controls (P<0.05). Single observations concerning daily tasks indicated a better effect of Pycnogenol^® compared to controls (P<0.05). Plasma free radicals also decreased significantly with the supplement in comparison to controls (P<0.05). Globally, supplemented subjects had a better recovery than controls.</p><p><strong>Conclusions: </strong>In post-stroke subjects, Pycnogenol^® supplementation resulted in better recovery outcome and faster COFU 'normalization' after the stroke in comparison with SM; it can be considered a safe, manageable post-stroke, adjuvant management possibly reducing local brain edema. Nevertheless, more patients and a longer period of evaluation are needed to confirm these results.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139650923","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":"Effects of percutaneous kyphoplasty combined with zoledronic acid injection on osteoporotic vertebral compression fracture and bone metabolism indices.","authors":"Hongchi Yi, Tao Chen, Jiming Gan, Zhuoqian Dong, Dun Liu, Yuanzhi Zheng, Huijun Ning, Qingzhong Wei","doi":"10.23736/S0390-5616.20.05117-6","DOIUrl":"10.23736/S0390-5616.20.05117-6","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic vertebral compression fracture (OVCF) is usually treated by percutaneous kyphoplasty (PKP) which has limitations. We aimed to evaluate the effects of PKP combined with zoledronic acid (ZOL) injection on OVCF and bone metabolism indices.</p><p><strong>Methods: </strong>A total of 600 OVCF patients admitted from June 2015 to June 2020 were randomly divided into group A (PKP alone), group B (PKP combined with ZOL 1 month later) and group C (PKP concurrently combined with ZOL) (N.=200). Before as well as 1 month (before ZOL treatment in group B) and 1 year after PKP, the pain degree, physical function and self-care ability in daily life were assessed, the height and kyphosis Cobb angle of vertebral body with compression fracture and bone mineral densities (BMDs) at different parts were measured, the clinical efficacy, adverse reactions and recurrence of vertebral fractures during 3 years of follow-up were observed, and the serum levels of BAP, BGP, β-CTx and TP1NP were detected.</p><p><strong>Results: </strong>Compared with groups A and B, group C had significantly reduced visual analogue scale (VAS) and Oswestry disability index (ODI) scores and raised activity of daily living (ADL) score 1 month after PKP (P<0.05). Groups A-C had successively lowered VAS and ODI scores and elevated ADL Score 1 year after PKP (P<0.05). Compared with before PKP, the height of vertebral body with compression fracture significantly increased, and the kyphosis Cobb angle decreased in the three groups 1 month and 1 year after PKP (P<0.05). In group A, the height was lower whereas the angle was larger 1 year after PKP than those 1 month after PKP (P<0.05). One month after PKP, the height was significantly higher and the angle was smaller in group C than those of groups A and B (P<0.05). One year after PKP, the height significantly increased and the angle decreased successively in groups A-C (P<0.05). BMDs at different parts were significantly higher in group C than those of groups A and B 1 month after PKP (P<0.05). One year after PKP, BMDs were highest in group C and lowest in group A (P<0.05). The overall response rate was significantly higher in group C than that in group A (P<0.05). The recurrence rate of fractures was significantly higher in group A than those of groups B and C (P<0.05). The BAP, BGP, β-CTx and TP1NP levels were significantly lower in group C than those of groups A and B 1 month after PKP (P<0.05), and declined successively in groups A-C 1 year after PKP (P<0.05).</p><p><strong>Conclusions: </strong>PKP concurrently combined with ZOL exert the most significant therapeutic effects on OVCF, with the lowest recurrence rate of fractures. It relieves pain and improves the physical function and self-care ability in daily life probably by reducing bone metabolism indices, increasing BMD, and maintaining the height and kyphosis Cobb angle of recovered vertebral body.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38691543","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":"Visualization of volume of tissue activated modeling in a clinical planning system for deep brain stimulation.","authors":"Barbara Carl, Miriam Bopp, Benjamin SAß, Josefine Waldthaler, Lars Timmermann, Christopher Nimsky","doi":"10.23736/S0390-5616.19.04827-6","DOIUrl":"10.23736/S0390-5616.19.04827-6","url":null,"abstract":"<p><strong>Background: </strong>Pathway activating models try to describe stimulation spread in deep brain stimulation (DBS). Volume of tissue activated (VTA) models are simplified model variants allowing faster and easier computation. Our study aimed to investigate, how VTA visualization can be integrated into a clinical workflow applying directional electrodes using a standard clinical DBS planning system.</p><p><strong>Methods: </strong>Twelve patients underwent DBS, using directional electrodes for bilateral subthalamic nucleus (STN) stimulation in Parkinson's disease. Preoperative 3T magnetic resonance imaging was used for automatic visualization of the STN outline, as well as for fiber tractography. Intraoperative computed tomography was used for automatic lead detection. The Guide XT software, closely integrated into the DBS planning software environment, was used for VTA calculation and visualization.</p><p><strong>Results: </strong>VTA visualization was possible in all cases. The percentage of VTA covering the STN volume ranged from 25% to 100% (mean: 60±25%) on the left side and from 0% to 98% (51±30%) on the right side. The mean coordinate of all VTA centers was: 12.6±1.2 mm lateral, 2.1±1.2 mm posterior, and 2.3±1.4 mm inferior in relation to the midcommissural point. Stimulation effects can be compared to the VTA visualization in relation to surrounding structures, potentially facilitating programming, which might be especially beneficial in case of suboptimal lead placement.</p><p><strong>Conclusions: </strong>VTA visualization in a clinical planning system allows an intuitive adjustment of the stimulation parameters, supports programming, and enhances understanding of effects and side effects of DBS.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37619994","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":"Giant calcified thoracic disk herniations: ossification of PLL or autonomous entity?","authors":"Giuseppe D'Aliberti, Fabio Villa, Pietro Giorgi, Francesco M Crisà, Giulia Gribaudi, Lara Mastino, Anna M Auricchio, Marco Cenzato, Giuseppe Talamonti","doi":"10.23736/S0390-5616.20.04938-3","DOIUrl":"10.23736/S0390-5616.20.04938-3","url":null,"abstract":"<p><strong>Background: </strong>Giant calcified thoracic disk herniation (GCTD) is an uncommon event, which requires surgical treatment in less than 1% of patients. GCDTs are a specific subgroup of herniated thoracic disks occupying more than 40% of the spinal canal showing calcifications associated with a certain degree of ossification. In this paper, we are reporting our whole experience in the surgical management of GCTDs through anterior approaches. We believe that they present characteristics that associate them to the circumscribed type of ossified posterior longitudinal ligament (OPLL) with a possible common pathophysiology consisting in the dural violation.</p><p><strong>Methods: </strong>Twenty-three consecutive patients with GCDTs were managed through anterior approaches during the period 1996-2019 at the Niguarda Hospital, Milan, Italy. Clinical data, radiological features, surgical reports, histological findings, and outcomes were reviewed.</p><p><strong>Results: </strong>There was no mortality, whereas permanent morbidity consisted of 1 case of worsened paraparesis due to accidental spinal cord contusion. One patient required reoperation to repair a postoperative cerebrospinal fluid (CSF) leakage. All patients underwent postoperative MRI which showed excellent decompression of cord and dural sac in all cases. Histological study of en-bloc removed GCTD showed typical calcification patterns of the PLL.</p><p><strong>Conclusions: </strong>GCDTs may be assimilated to the so-called \"circumscribed type\" of OPLL. The GCDTs may show the same radiological CT and MRI pattern of OPLL. The anterior accesses now represent the standard of care for GCTDs. The use of operative microscope and intraoperative monitoring is mandatory. The risk of CSF leakage can be markedly reduced by meticulous reconstruction of the dura and the placement of spinal drainage. Adequate exposition may sometimes require one or two levels of corpectomy with consequent vertebral body reconstruction and fixation of anterior column of the spine.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38211574","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":"Long-term efficacy of spinal cord stimulation for chronic primary neuropathic pain in the contemporary era: a systematic review and meta-analysis.","authors":"Kaneez Fatima, Syed O Javed, Aqsa Saleem, Shayan Marsia, Ramsha Zafar, Komal Noorani, Sahlish Kumar, Sara M Ali, Iqra Ismail, Insiya Hashim, Fatima A Ganatra","doi":"10.23736/S0390-5616.23.05930-1","DOIUrl":"10.23736/S0390-5616.23.05930-1","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal cord stimulation (SCS) is a modern neuromodulation technique extensively proven to be an effective modality for treatment of chronic neuropathic pain. It has been mainly studied for complex regional pain syndrome (CRPS) and failed back surgery syndrome (FBSS) and recent data almost uniformly establishes its statistically significant positive therapeutic results. It has also been compared with other available treatment modalities across various studies. However, long term data on maintenance of its efficacious potential remains less explored. Few studies have reported data on long follow-up times (>= 12 months) and have compared its efficacy with other treatment options for chronic pain, respectively. Our study pools and analyzes the available data and compares SCS with other treatment options. It also analyzes the efficacy of SCS in long term management of patients with chronic pain.</p><p><strong>Evidence acquisition: </strong>We reviewed all the data available on MEDLINE, Embase and Cochrane CENTRAL using a search strategy designed to fit our pre-set inclusion and exclusion criteria. Both single-arm and double-arm studies were included. The primary outcome was defined as decrease of visual analogue scale (VAS) by >50% at 6, 12 and/or 24 months after SCS.</p><p><strong>Evidence synthesis: </strong>According to the pooled data of double-arm studies, SCS has unanimously proven its superiority over other treatment options at 6 months follow-up; however it fails to prove statistically significant difference in results at longer treatment intervals. Dorsal root ganglion stimulation, a relatively recent technique with the same underlying physiologic mechanisms as SCS, showed far more promising results than SCS. Single-arm studies show around 70% patients experiencing greater than 50% reduction in their VAS scores at 6 and 12 months.</p><p><strong>Conclusions: </strong>SCS is a viable option for management of chronic neuropathic pain secondary to FBSS and CRPS. However, data available for its long term efficacy remains scarce and show no further statistically significant results.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9154039","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":"Inhalational anesthesia during intraoperative monitoring of visual evoked potentials: taboo or option?","authors":"Evgeny A Levin, Anna G Vasyatkina, Ilya S Zykov, Roman S Kiselev","doi":"10.23736/S0390-5616.23.06112-X","DOIUrl":"10.23736/S0390-5616.23.06112-X","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10580378","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":"Postoperative stereotactic radiosurgery and hypofractionated radiotherapy for brain metastases using Gamma Knife and CyberKnife: a dual-center analysis.","authors":"Jens Kübler, Michael Wester-Ebbinghaus, Frederik Wenz, Florian Stieler, Bastian Bathen, Sabine K Mai, Robert Wolff, Daniel Hänggi, Oliver Blanck, Frank A Giordano","doi":"10.23736/S0390-5616.20.04830-4","DOIUrl":"10.23736/S0390-5616.20.04830-4","url":null,"abstract":"<p><strong>Background: </strong>Postoperative stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (hFSRT) to tumor cavities is emerging as a new standard of care after resection of brain metastases. Both Gamma Knife (GK) and CyberKnife (CK) are modalities commonly used for stereotactic radiotherapy, but fractional schemes are not consistent. The objective of this study was to evaluate outcomes in patients receiving postoperative stereotactic radiotherapy of resected brain metastases (BM) using different fractionation schedules and modalities in two large centers.</p><p><strong>Methods: </strong>Patients with newly diagnosed BM who underwent postoperative SRS or hFSRT with either GK or CK at two large cancer centers were retrospectively evaluated. We analyzed local control (LC), regional control (RC) and overall survival (OS).</p><p><strong>Results: </strong>From April 14^th to May 18^th, 2020, 79 patients with 81 resection cavities were treated. Forty-seven patients (59.5%) received GK and 32 patients (40.5%) received CK treatment. Fifty-four cavities (66.7%) were treated with hFSRT and 27 (33.3%) with SRS. The most common hFSRT and SRS scheme was 3x10 Gy and 1x16 Gy, respectively. Median OS was 11.7 months with survival rates of 44.7% at 1 year and 18.5% at 2 years. LC was 83.3% after 1 year. Median time to regional progression was 12.0 months with RC rates of 61.1% at 6 months and 41.0% at 12 months. There was no difference in OS, LC or RC between GK and CK treatments or SRS and hFSRT.</p><p><strong>Conclusions: </strong>Both SRS and hFSRT provide high local control rates in resected BM regardless of the applied modality.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37619995","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 diabetes insipidus occurrence after endoscopic endonasal removal of sellar lesions using MRI-based radiomics and machine learning.","authors":"Ciro Mastantuoni, Lorenzo Ugga, Domenico Solari, Serena D'Aniello, Gaia Spadarella, Renato Cuocolo, Filippo F Angileri, Luigi M Cavallo","doi":"10.23736/S0390-5616.23.06162-3","DOIUrl":"https://doi.org/10.23736/S0390-5616.23.06162-3","url":null,"abstract":"<p><strong>Background: </strong>Pituitary adenomas and craniopharyngiomas are the most common lesions of the sellar region. These tumors are responsible for invasion or compression of crucial neurovascular structures. The involvement of the pituitary stalk warrants high rates of both pre- and post- operative diabetes insipidus. The aim of our study was to assess the accuracy of machine learning analysis from preoperative MRI of pituitary adenomas and craniopharyngiomas for the prediction of DI occurrence.</p><p><strong>Methods: </strong>All patients underwent MRI exams either on a 1.5- or 3-T MR scanner from two Institutions, including coronal T2-weighted (T2-w) and contrast-enhanced T1-weighted (CE T1-w) Turbo Spin Echo sequences. Feature selection was carried out as a multi-step process, with a threshold of 0.75 to identify robust features. Further feature selection steps included filtering based on feature variance (threshold >0.01) and pairwise correlation (threshold <0.80). A Bayesian Network model was trained with 10-fold cross validation employing SMOTE to balance classes exclusively within the training folds.</p><p><strong>Results: </strong>Thirty patients were included in this study. In total 2394 features were extracted and 1791 (75%) resulted stable after ICC analysis. The number of variant features was 1351 and of non-colinear features was 125. Finally, 10 features were selected by oneR ranking. The Bayesian Network model showed an accuracy of 63% with a precision of 77% for DI prediction (0.68 area under the precision-recall curve).</p><p><strong>Conclusions: </strong>We assessed the accuracy of machine learning analysis of texture-derived parameters from preoperative MRI of pituitary adenomas and craniopharyngiomas for the prediction of DI occurrence.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575532","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":"Monocentric experience of transforaminal endoscopic lumbar discectomy and foraminotomy outcomes: pushing the indications and avoiding failure. Report of 200 cases.","authors":"Alessandro Grieco, Letizia Dell'aglio, Jacopo Del Verme, Domenico Billeci, Roberto Zanata, Giuseppe Canova, Enrico Giordan","doi":"10.23736/S0390-5616.23.06105-2","DOIUrl":"https://doi.org/10.23736/S0390-5616.23.06105-2","url":null,"abstract":"<p><strong>Background: </strong>This paper reports the results of the treatment of our first 200 cases of lumbar disc herniation and foraminal stenosis using full-endoscopic transforaminal lumbar discectomy (FETLD). We analyzed outcomes and radiological parameters to overcome failure and inappropriate indications and also highlighted the red flags for surgeons coming to this field as well as the pathways to success.</p><p><strong>Methods: </strong>Data on endoscopic procedures were retrospectively analyzed between October 2018 and March 2023. We abstracted sex, age, leg pain by NPRS, postoperative satisfaction according to the MacNaab score, postoperative surgical complications/adverse events (≤30 days), and history of any previous surgery. Furthermore, we measured different radiological parameters to determine the grade of stenosis or discopathy.</p><p><strong>Results: </strong>Once the learning curve was completed, patients' satisfaction increased to 94%, with only a small percentage (6%) of patients unsatisfied 30 days after the operation. Perioperatively, 33.5% of the patients experienced mild to moderate transitory paresthesia. Univariate analysis showed a tendency toward a higher risk of failure in those patients with degenerative listhesis (odds ratio [OR] 4.8, 95% CI 0.97-23.9, P=0.055) as well as those with severely degenerated discs (OR 8.7, 95% CI 0.96-79.4, P=0.054). Conversely, the chances of failure seemed to be lower in patients with severe foraminal stenosis.</p><p><strong>Conclusions: </strong>FETLD proved its efficacy in treating several degenerative spine conditions or was useful for avoiding previous scarring in patients already operated on to the same extent. Therefore, FETLD can be safely used in patients with comorbidities, the elderly, and when the invasiveness of an open technique is not suitable.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521128","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}