Journal of neurosurgical sciences最新文献

{"title":"Geographic trends in the utilization of frailty as a preoperative decision-making tool in neurosurgery.","authors":"Joanna M Roy, Syed F Kazim, Kavelin Rumalla, Meic H Schmidt, Christian A Bowers","doi":"10.23736/S0390-5616.23.06104-0","DOIUrl":"10.23736/S0390-5616.23.06104-0","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"774-775"},"PeriodicalIF":1.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764235","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":"Primary intradural extramedullary lesions: a longitudinal study of 212 patients and analysis of predictors of functional outcome.","authors":"Manoharan D Sudhan, Guru D Satyarthee, Leve Joseph, Aanchal Kakkar, Mehar C Sharma","doi":"10.23736/S0390-5616.20.05147-4","DOIUrl":"10.23736/S0390-5616.20.05147-4","url":null,"abstract":"<p><strong>Background: </strong>Primary intradural extramedullary (IDEM) lesions are rare, with an incidence of about 1/100,000 person-years. The aim of this study was to investigate their demographic, clinical, imaging, management, histopathological and outcome parameters. Another objective was to evaluate the various predicting factors leading to long-term favorable outcomes, thereby answering the controversial question: when to operate?</p><p><strong>Methods: </strong>This study observed 212 patients of primary IDEM lesions and followed-up for a mean of 53.80 months. The patient's outcome using McCormick grade at follow-up was correlated with age, sex, duration of symptoms, preoperative McCormick grade, tumor location and extent, extradural spread, extent of excision, vascularity, WHO grade and histopathological tumor type.</p><p><strong>Results: </strong>Benign nerve sheath tumors were the commonest lesions (47.17% schwannoma, 4.72% Neurofibroma), followed in incidence by meningioma (19.34%). There was predominance of males (57.08%), except in meningiomas (male: female ratio 1:2.15). Pain was the commonest initial symptom (51.88%). Limb weakness was the most common presenting complaint (88.68%). Gross total excision was achieved in 81.60% of cases and 70.75% of patients improved following surgery. The significant factors predicting favorable outcome included preoperative McCormick grade (P=0.001), the vertical extent of the tumor (P=0.027), histopathological tumor type (P=0.023) and WHO grading (P=0.015); and extent of excision had an odds ratio of 1: 2.5.</p><p><strong>Conclusions: </strong>Significant predictors of functional outcome following surgery in IDEM lesions included preoperative McCormick grade, extent of the tumor, tumor type, WHO grading and extent of resection. The authors recommend surgery with the intent of complete tumor excision, before the onset of substantial symptoms, for better outcome.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"707-717"},"PeriodicalIF":1.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38691544","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":"Improving neurosurgical research through a trainee-led research community.","authors":"Ismail Zaed, Francesco Marchi, Delia Cannizzaro, Andrea Cardia","doi":"10.23736/S0390-5616.23.06078-2","DOIUrl":"10.23736/S0390-5616.23.06078-2","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"773-774"},"PeriodicalIF":1.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9615159","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":"Application of double-stent assisted coil embolization in intracranial vertebral artery dissecting aneurysms with mass effect.","authors":"Long-Jiang Zhou, Wei Wang, Li-Li Wen, Qi Wu, Zhen-Sheng Liu, Xiao-Yu Tang, Wei Cai, Xiao-Ming Zhou, Wei-Zhen He, Xin Zhang","doi":"10.23736/S0390-5616.22.05599-0","DOIUrl":"10.23736/S0390-5616.22.05599-0","url":null,"abstract":"<p><strong>Background: </strong>Unruptured intracranial vertebral artery dissecting aneurysms (IVADAs) with mass effect have an extremely poor natural course, and treatment of these aneurysms remains a challenge for endovascular and surgical strategies. The aim of this study was to analyze the role of double-stent-assisted coil embolization in preventing rupture and bleeding of intracranial vertebral artery dissecting aneurysm with brainstem compression by reducing mass effect and preventing the recurrence of the aneurysm.</p><p><strong>Methods: </strong>A total of 25 patients (mean age, 56.04±13.0 years) with unruptured IVADAs with mass effect received dual-stent-assisted coil embolization. The baseline characteristics, the change of aneurysm size on MR, the rate of retreatment, and the improvement rate of clinical symptoms and signs were analyzed retrospectively.</p><p><strong>Results: </strong>All patients completed the surgical procedures successfully. No aneurysm bleeding or perforating artery occlusion occurred during the perioperative and follow-up periods. The initial maximum diameter of the aneurysm on MR was 17.5±3.6 mm. One year after treatment, the maximum diameter of the aneurysm on MR was 15.8±4.9 mm. The reduction rate of the maximum diameter of the aneurysm was 10.7±12.7%. The change of the maximum diameter before and after treatment of aneurysm was statistically significant (P<0.001). In terms of the improvement rate of clinical symptoms, 15 cases were completely improved (60.0%), 6 cases were partially improved (24.0%), and the total clinical improvement rate was 84%. Four cases (16.0%) showed no improvement or even had aggravation of clinical symptoms. In 5 cases (20.0%), aneurysms recurred. Among 4 cases involving posterior inferior cerebellar artery origin, 3 cases had the recurrence (75%). 5 recurred cases were treated with single-stent-assisted coil embolization. No residual aneurysm and recurrence were found on the follow-up angiography.</p><p><strong>Conclusions: </strong>The double-stent-assisted coil embolization procedure is very safe and reliable. It can effectively prevent the aneurysm from continuing to grow and rupture and thereby reduce the clinical symptoms caused by the mass effect.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"1 1","pages":"727-732"},"PeriodicalIF":1.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68828409","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":"Bartolomeo Panizza (1785-1867) and his contribution to the discovery of the visual cortex.","authors":"Paolo Perrini, Davide T DI Carlo, Arianna Fava, Nicola Montemurro","doi":"10.23736/S0390-5616.22.05696-X","DOIUrl":"10.23736/S0390-5616.22.05696-X","url":null,"abstract":"<p><p>Bartolomeo Panizza (1785-1867) was an eminent anatomist and a pupil of Antonio Scarpa (1752-1832) at the University of Pavia. In 1855, before the revolutionary studies of Paul Broca (1824-1880) on aphasia that supported the theory of cortical localizations, Panizza delivered a lecture in Milan on the anatomy of the visual system, Osservazioni sul Nervo Ottico (\"Observations on the optic nerve\"). This lecture contains the first description of the cortical projection of the visual pathways in the occipital lobe, anticipating the revolutionary studies performed by Hermann Munk (1839-1912) in the late 19^th century. The findings of Panizza questioned the assumption of the French physiologist, Marie-Jean-Pierre Flourens (1794-1867) who was defending the holistic concept of cerebral equipotentiality, which was widely accepted among the scientific community in the early 19^th century. The present essay highlights the life and the scientific studies of Bartolomeo Panizza, with emphasis on the issue of cerebral localization that was simmering in the scientific community at that time.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"767-772"},"PeriodicalIF":1.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9425642","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":"Can clinicians correctly predict intracranial pressure state based on clinical symptoms alone in shunted patients?","authors":"Sogha Khawari, Anand Pandit, Laurence Watkins, Ahmed Toma, Lewis Thorne","doi":"10.23736/S0390-5616.23.06065-4","DOIUrl":"https://doi.org/10.23736/S0390-5616.23.06065-4","url":null,"abstract":"<p><strong>Background: </strong>Clinicians are well-versed in the classical symptoms of low vs. high intracranial pressure (ICP). However, symptoms may not be as predictable of ICP state in shunted patients with chronic symptoms. In this study, we assess whether clinicians can predict high vs. low ICP state in chronically symptomatic shunted patients without any diagnostic clues.</p><p><strong>Methods: </strong>A detailed retrospective analysis was performed on 259 patients undergoing ICP monitoring. A total of 17 patients who had a ventriculoperitoneal shunt were identified, with a suspected chronic abnormal ICP state based only on clinical symptoms. Patients with investigations guiding towards a likely pressure state were excluded, e.g., imaging or ophthalmological findings suggestive of ICP state.</p><p><strong>Results: </strong>Clinical suspicion of ICP state was incorrect in 16 out of 17 cases (P<0.05). The symptoms described by patients were suggestive of abnormal ICP states; however, 13 out of 17 cases demonstrated ICP within the normal range (-1.3 to 5.3 mmHg). Three patients with occipital headaches worse on standing, typical of low-pressure symptoms, were in fact shown to have ICP above 10.0 mmHg.</p><p><strong>Conclusions: </strong>This study casts doubt on the utility of classic symptoms in diagnosing abnormal ICP state in chronically symptomatic shunted patients with equivocal adjuncts. Additionally, it highlights the importance of ICP monitoring for this patient group.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138299275","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":"Accuracy of predicted postoperative segmental lumbar lordosis in spinal fusion using an intraoperative robotic planning and guidance system.","authors":"Ghani Haider, Vaibhavi Shah, Thomas Johnstone, Nicolai Maldaner, Martin Stienen, Anand Veeravagu","doi":"10.23736/S0390-5616.23.06142-8","DOIUrl":"https://doi.org/10.23736/S0390-5616.23.06142-8","url":null,"abstract":"<p><strong>Background: </strong>Restoring lumbar lordosis is one of the main goals in lumbar spinal fusion surgery. The Mazor X-Align^TM software allows for the prediction of postoperative segmental lumbar lordosis based on preoperative imaging. There is limited data on the accuracy of this preoperative prediction, especially in patients undergoing short segment lumbar fusion. The objective of our study was to determine the accuracy of predicted postoperative segmental lumbar lordosis using the Mazor X-Align^TM software in patients requiring short segmental fusion.</p><p><strong>Methods: </strong>Retrospective analysis of adult patients undergoing pedicle screw spinal instrumentation of not more than four levels using the Mazor X^TM Robot (Medtronic Inc., Minneapolis, MN, USA) between July 2017 to June 2020. The robotic guidance software, Mazor X-Align^TM (Medtronic Inc., Minneapolis, MN, USA) was used to calculate the predicted segmental lumbar lordosis based on preoperative CT-imaging and the plan was executed under intraoperative robotic guidance. Predicted segmental lumbar lordosis was compared to achieved segmental lumbar lordosis on 1-month postoperative x-rays using the Cobb angle methodology.</p><p><strong>Results: </strong>A total of 15 patients (46.6% female) with a mean age of 61.5±10.9 years were included. All patients underwent posterior lumbo-sacral spinal fusion with the Mazor X^TM robotic system with 11 patients (73.3%) undergoing anterior column reconstruction prior to posterior fixation. Instrumentation was performed across a mean of 2.6 levels per case. Preoperative, the mean segmental lumbar lordosis was 30.2±13.6 degrees. The mean planned segmental lumbar lordosis was 35.5±17.0 degrees while the mean achieved segmental lumbar lordosis was 35.8±16.7 degrees. There was no significant mean difference between the planned and achieved segmental lumbar lordosis (P=0.334).</p><p><strong>Conclusions: </strong>The Mazor X^TM intraoperative robotic planning and guidance is accurate in predicting postoperative segmental lumbar lordosis after short segmental fusion. Our findings may assure surgical decision making and planning.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138299274","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":"Limits and usefulness of intraoperative evoked potentials during laminoplasty.","authors":"Rossella Rispoli, Christian Lettieri, Giada Pauletto, Gabriele Valiante, Yan Tereshko, Barbara Cappelletto","doi":"10.23736/S0390-5616.23.06077-0","DOIUrl":"https://doi.org/10.23736/S0390-5616.23.06077-0","url":null,"abstract":"<p><strong>Background: </strong>Over the past 10 years, intraoperative neurophysiological monitoring (IONM) has been widely performed during surgery for treating spondylotic cervical myelopathy. Our study considers the predictive value of IONM during laminoplasty, regarding, first, the adequacy of spinal cord decompression and, second, the long-term neuro-functional outcome.</p><p><strong>Methods: </strong>We considered 38 patients with the diagnosis of degenerative cervical myelopathy who underwent an open-door laminoplasty. All patients were evaluated preoperatively, and at three and 12 months postoperatively, with the Japanese Orthopedic Association (JOA) point scale. Upper and lower limb somatosensory and motor evoked potentials (SSEPs and MEPs) were recorded preoperatively and intraoperatively.</p><p><strong>Results: </strong>During surgery, three of 38 patients showed a deterioration of SSEPs and MEPs compared to baseline values. Surgery was then converted from laminoplasty to laminectomy, resulting in the gradual restoration of the evoked potentials. The neurophysiological parameter significantly associated with a better clinical outcome was the latency of lower limbs MEPs. The 12 patients who had a more prominent reduction of the MEPs latency at the end of surgery showed a higher post-surgical JOA score, increasing ≥30% compared to baseline values at the 3- and 12-month follow-up.</p><p><strong>Conclusions: </strong>Though not a predictor of clinical outcome, the IONM was essential to evaluate the effectiveness of spinal cord decompression. Reduced latency of lower limbs MEPs may predict a better clinical outcome. We suggest that IONM in patients with degenerative cervical myelopathy should be routine. It is necessary to conduct larger studies to clarify the predictive value of IONM.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136397766","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 have we learned in fluorescein-guided resection of brain metastases? An update after 79 consecutive cases.","authors":"Jacopo Falco, Morgan Broggi, Emanuele Rubiu, Francesco Restelli, Bianca Pollo, Marco Schiariti, Paola Lanteri, Mario Stanziano, Emanuele LA Corte, Elio Mazzapicchi, Ignazio G Vetrano, Paolo Ferroli, Francesco Acerbi","doi":"10.23736/S0390-5616.23.06134-9","DOIUrl":"https://doi.org/10.23736/S0390-5616.23.06134-9","url":null,"abstract":"<p><strong>Background: </strong>Cerebral metastasis (CM) is the most common malignancy affecting the brain. Individualized treatment of CM still represents a challenge for neuro-oncological teams: in patient eligible for surgery, complete tumor removal is the most relevant predictor of overall survival (OS) and neurological outcome. The development of surgical microscopes harboring specific filter able to elicit the fluorescent response from sodium fluorescein (SF) has facilitated fluorescein-guided microsurgery and the identification of pathological tumor tissue, especially at the tumor margins. In this study, we analyzed the effect of SF on the visualization and resection of a large monoinstitutional cohort of CM.</p><p><strong>Methods: </strong>Surgical database of FLUOCERTUM study (Besta Institute, Milan, Italy) was retrospectively reviewed to find CM surgically removed with a fluorescein-guided technique from March 2016 to December 2022. SF was intravenously injected (5 mg/kg) immediately after induction of general anesthesia. Tumors were removed using a microsurgical technique with the YELLOW560 filter (Carl Zeiss Meditec, Oberkochen, Germany). In the most recent cases, biopsies at the tumor margins were performed to evaluate the ability of fluorescein to discriminate between fluorescent and nonfluorescent tissue at the lesion borders.</p><p><strong>Results: </strong>Seventy-nine patients were included; most of them showed a bright, diffuse fluorescent staining that markedly enhanced tumor visibility; 11 melanomas presented a specific faint enhancement of the black pigmented central nodule with high fluorescence at tumor boundaries. Only in a minimal percentage of cases (N.=4-5.1%), fluorescein enhancement was tenuous, thus not providing a significant help during tumor resection. Altogether, in more than 90% of cases, SF was considered useful in the identification of tumoral tissue and in achieving a high rate of CM resection; thus, gross total resection was achieved in 96.2% (N.=76) of patients and in no case the detection of tumor remnants was an unexpected event. The resulted sensitivity and specificity of fluorescein in identifying tumor tissue at the tumor margin was 88.9% with a predictive positive value of 88.9%. No adverse event was registered during the postoperative course.</p><p><strong>Conclusions: </strong>The use of SF is a valuable method for safe fluorescence-guided tumor resection. Our data showed a positive effect of fluorescein-guided surgery on intraoperative visualization during resection of CM, suggesting a role in improving the extent of resection of these lesions.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136397767","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 cautionary tale: frailty predicts mortality after deep brain stimulation and the risk analysis index has an unparalleled classification threshold.","authors":"Katie Roster,&nbsp;Addi Moya,&nbsp;Oluwafemi P Owodunni,&nbsp;Evan N Courville,&nbsp;Meic Schmidt,&nbsp;Christian A Bowers","doi":"10.23736/S0390-5616.23.06007-1","DOIUrl":"10.23736/S0390-5616.23.06007-1","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"67 5","pages":"665-667"},"PeriodicalIF":1.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10643295","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}