Journal of neurological surgery. Part A, Central European neurosurgery最新文献

{"title":"Elevated HSPB1 Expression Is Associated with a Poor Prognosis in Glioblastoma Multiforme Patients.","authors":"Zhihua Wang, Zhaohua Fang, Yongping Gui, Bin Xi, Zhiping Xie","doi":"10.1055/s-0043-1777761","DOIUrl":"10.1055/s-0043-1777761","url":null,"abstract":"<p><strong>Background: </strong> Glioblastoma multiforme (GBM) is a highly aggressive form of brain cancer. This study investigated the clinical predictive value of heat shock protein β1 (HSPB1) in patients with GBM.</p><p><strong>Methods: </strong> A correlation was established between HSPB1 expression and GBM progression using data from The Cancer Genome Atlas (TCGA) dataset, Chinese Glioma Genome Atlas dataset, Gene Expression Omnibus dataset, and Human Protein Atlas database. A survival analysis was conducted and an HSPB1-based nomogram was constructed to evaluate the prognostic value of HSPB1 in patients with GBM.</p><p><strong>Results: </strong> Based on TCGA data mining, we discovered that HSPB1 was significantly elevated in patients with GBM and may reflect their response to immunotherapy. In survival analysis, it appeared to have a predictive role in the prognosis of patients with GBM. Five signaling pathways were significantly enriched in the high HSPB1 expression phenotype according to the gene set enrichment analysis. In addition, a significant association was found between HSPB1 expression and immune checkpoints, tumor immune infiltration, tumor immune microenvironment, and immune cell markers in glioma. Overall, our results suggest that HSPB1 may regulate the function of immune cells, serve as a new immunotherapy target, and predict the response to immunotherapy in patients with GBM.</p><p><strong>Conclusion: </strong> HSPB1 appears to serve as a potential predictor of the clinical prognosis and response to immunotherapy in patients with GBM. It may be possible to identify patients who are likely to benefit from immunotherapy by assessing the expression level of HSPB1.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"17-29"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498290","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":"Comparing Three-dimensional and Two-dimensional Preoperative Planning for Lumbar Transpedicular Screw Placement: A Retrospective Study.","authors":"Hüseyin Doğu, Anas Abdallah, Ali O Muçuoğlu, Nail Demirel, N Mehmet Elmadağ","doi":"10.1055/a-2175-3215","DOIUrl":"10.1055/a-2175-3215","url":null,"abstract":"<p><strong>Background: </strong> Transpedicular screw (TPS) misplacement is still a nightmare for spine surgeons. Preoperative planning is one of the methods that a surgeon could use to minimize this complication. This study aims to compare the efficacy of three-dimensional (3D) and two-dimensional (2D) preoperative planning in posterior lumbar TPSs placement performed using the freehand technique.</p><p><strong>Patients and methods: </strong> Patients who underwent posterior TPSs placement for degenerative lumbar spondylolisthesis or spinal stenosis using the freehand technique between November 2021 and October 2022 were evaluated retrospectively. In total, 33 and 30 patients who met the inclusion criteria were consecutively operated on with preoperative 2D and 3D planning, respectively. The patients were divided into the 2D preoperative planning group (2DG) and 3D preoperative planning group (3DG) and the two groups were compared.</p><p><strong>Results: </strong> Sixty-three patients were operated during the study period. There was no significant difference between the groups regarding blood transfusion, operation time, and radiation exposure. Although the accuracy of TPSs positioning was 94.2 and 96.5% in the 2DG and 3DG, respectively, the difference between the groups was not statistically significant. The upper facet joint violation rate was 12.8% (<i>n</i> = 20) in the 2DG versus 3.5% (<i>n</i> = 5) in the 3DG (<i>p</i> = 0.006). All L4 TPSs were inserted with their standard entry points without any modification (<i>p</i> < 0.0001; relative/risk ratio = 0.64). The modification rate was higher in L1, L2, and L5 TPSs (<i>p</i> < 0.0001; <i>χ</i> ² = 24.7).</p><p><strong>Conclusion: </strong> For patients with degenerative lumbar diseases, 3D preoperative planning in posterior lumbar instrumentation surgeries performed with the freehand technique decreased the upper facet joint violation rate.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10670382","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":"Stand-Alone Percutaneous Pedicle Screw Lumbar Fixation to Indirectly Decompress the Neural Elements in Spinal Stenosis: A Radiographic Assessment Case Series.","authors":"Roberto Gazzeri, Konstantinos Panagiotopoulos, Marcelo Galarza, Matteo Luigi Giuseppe Leoni, Umberto Agrillo","doi":"10.1055/s-0043-1777751","DOIUrl":"10.1055/s-0043-1777751","url":null,"abstract":"<p><strong>Background: </strong> The ideal surgical treatment of lumbar canal stenosis remains controversial. Although decompressive open surgery has been widely used with good clinical outcome, minimally invasive indirect decompression techniques have been developed to avoid the complications associated with open approaches. The purpose of this study was to evaluate the radiologic outcome and safety of the indirect decompression achieved with stand-alone percutaneous pedicle screw fixation in the surgical treatment of lumbar degenerative pathologies.</p><p><strong>Methods: </strong> Twenty-eight patients presenting with spinal degenerative diseases including concomitant central and/or lateral stenosis were treated with stand-alone percutaneous pedicle screw fixation. Radiographic measurements were made on axial and sagittal magnetic resonance (MR) images, performed before surgery and after a mean follow-up period of 25.2 months. Measurements included spinal canal and foraminal areas, and anteroposterior canal diameter.</p><p><strong>Results: </strong> Percutaneous screw fixation was performed in 35 spinal levels. Measurements on the follow-up MR images showed statistically significant increase in the cross-sectional area of the spinal canal and the neural foramen, from a mean of 88.22 and 61.05 mm² preoperatively to 141.52 and 92.18 mm² at final follow-up, respectively. The sagittal central canal diameter increased from a mean of 4.9 to 9.1 mm at final follow-up. Visual analog scale (VAS) pain score and Oswestry Disability Index (ODI) both improved significantly after surgery (<i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong> Stand-alone percutaneous pedicle screw fixation is a safe and effective technique for indirect decompression of the spinal canal and neural foramina in lumbar degenerative diseases. This minimally invasive technique may provide the necessary decompression in cases of common degenerative lumbar disorders with ligamentous stenosis.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"38-47"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138803788","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":"COVID-19 and Spontaneous Resolution of Lumbar Disk Prolapse: A Retrospective Cohort Study of Patients Awaiting Microdiscectomy.","authors":"Dana Hutton, Belal Mohamed, Khalid Mehmood, James Magro, Himanshu Shekhar, Anna Solth, Heinke Pulhorn, David Bennett, Mohamed Okasha","doi":"10.1055/a-2206-2718","DOIUrl":"10.1055/a-2206-2718","url":null,"abstract":"<p><strong>Background: </strong> Between individual patients with lumbar disk prolapse (LDP), the natural course of disease is significantly variable. Spontaneous resolution is reported to occur in up to 70% of cases. However, we currently cannot predict for whom and when this will occur. Neurosurgical intervention is indicated for LDP patients with nontolerable pain after at least 8 to 12 weeks of conservative management, or significant neurologic deficit. Channeling essential resources in the National Health Service (NHS) to fight the COVID-19 pandemic led to the postponement of most elective operations, including microdiskectomy. This left many LDP patients previously considered to be surgical candidates with conservative-only options in the interim. To our knowledge, we are the first center to report the specific impact of the peri- and postpandemic period on waiting list times, delayed elective microdiskectomy, and the incidence of spontaneous LDP resolution.</p><p><strong>Methods: </strong> Retrospective case series of a prospectively collected electronic departmental database identified LDP patients who would have been impacted by the COVID-19 pandemic at some point in their care pathway (March 2020-February 2022). Further information was obtained from electronic patient records.</p><p><strong>Results: </strong> In total, 139 LDP patients were listed for elective microdiskectomy at the time of postponement of elective surgery. Over a third of LDP patients (<i>n</i> = 47, 33.8%), in shared decision with the responsible neurosurgeon, had their rescheduled microdiskectomy canceled due to clinical improvement (14.1%), radiologic regression (6.5%), or both (12.2%).</p><p><strong>Conclusion: </strong> Our single-center retrospective analysis revealed that for over a third of LDP patients, the prolonged postpandemic waiting list times for elective microdiskectomy resulted in their surgery not taking place either due to spontaneous clinical improvement or proven radiologic regression. Considering this, a prolonged conservative approach to LDP may be appropriate in some patients, allowing time for natural resolution, while avoiding perioperative risks.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"30-37"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71521836","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":"Preoperative and Postoperative Midline Index Ratio and Pre- and Postoperative Variation of the Hematoma Thickness Accurately Predict Surgical Recurrence of Chronic Subdural Hematomas.","authors":"Federica Novegno, Giulia Fiorucci, Andrea Iaquinandi, Maurizio Salvati, Alessandro Pesce","doi":"10.1055/s-0044-1792142","DOIUrl":"https://doi.org/10.1055/s-0044-1792142","url":null,"abstract":"<p><strong>Background: </strong> Chronic subdural hematoma (cSDH) is a common pathology in daily practice of neurosurgery. Surgical management usually offers a significant clinical recovery. However, the recurrence rate is still high. Several studies have suggested various factors associated with hematoma recurrence with no univocal results. The aim of this study was to determine the prognostic value of early postoperative computed tomography (CT) examination to predict the need for reoperation.</p><p><strong>Methods: </strong> A retrospective review of 115 cSDH patients was performed. Clinical findings and pre- and early postoperative CT scan data were recorded. Univariable and bivariable analyses were performed to determine which of the studied factors were associated with an increased risk of reoperation. Their prognostic abilities were assessed using receiver operating characteristic curves.</p><p><strong>Results: </strong> Overall, 21 of 115 patients required a surgical revision. Among the comorbidities, diabetes mellitus represented the only factor related with hematoma recurrence (66.76 vs. 23.40%, <i>p</i> = 0.001). Preoperative hematoma density and postoperative residual hyperdensity on early CT scan emerged as significant predictors of cSDH recurrence (recurrence: 18/21, 85.7% vs. nonrecurrence: 17/94, 18.1%, <i>p</i> = 0.001). The ratios of post- and preoperative hematoma thickness (<i>P</i>) and post- and preoperative midline shift (<i>Q</i>) and their sum (<i>K</i>) were statistically higher in the recurrence group with cutoff values of 0.745, 0.555, and 1.135, respectively.</p><p><strong>Conclusions: </strong> Systematic early postoperative CT scan after cSDH evacuation may predict hematoma recurrence. In the present study, we found postoperative hyperdensity on CT scan and degree of hematoma variation after surgical evacuation to be the strongest predictors of the need for reoperation.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909710","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":"Efficacy of Subperiosteal Drains in Chronic Subdural Hematoma: A Prospective Randomized Single-Center Study.","authors":"Yavor Bozhkov, Julian Feulner, Michael Buchfelder, Max Kleiss, Sebastian Brandner, Thomas M Kinfe","doi":"10.1055/a-2418-3682","DOIUrl":"10.1055/a-2418-3682","url":null,"abstract":"<p><strong>Background: </strong> Chronic subdural hematomas (cSDHs) are most frequently treated by evacuation via a burr-hole craniostomy procedure. Subperiosteal drains have been introduced as alternatives to subdural ones, but only a few prospective studies have explored their efficacy. Thus, a prospective randomized trial was designed to assess their use.</p><p><strong>Methods: </strong> The study enrolled patients with newly diagnosed surgically amenable cSDH. These patients were randomized into two groups. The first group underwent cSDH evacuation via a single burr hole craniostomy procedure, followed by placement of a subperiosteal drain; the second group underwent the identical procedure without drain placement. Patient demographics, drain volumes, duration of drainage, cSDH recurrence, and postoperative outcomes were recorded.</p><p><strong>Results: </strong> Eighty-eight patients presenting with cSDH (12 with bilateral cSDHs) from a total of 100 surgical cases were enrolled. Nine patients (1 bilateral) were lost to follow-up. Of all remaining 90 procedures, 37 were carried out with drain placement and the remaining 53 without drain placement. There were five recurrent cases (13.5%) in the drain placement group and 17 (32.1%) in the group without drain placement. This resulted in a statistical significance (odds ratio [OR]: 0.33; <i>p</i> < 0.05) favoring the use of a drain.</p><p><strong>Conclusion: </strong> Subperiosteal drain placement can be used safely and effectively to treat cSDH in conjunction with a burr-hole craniostomy procedure, significantly reducing the rate of recurrence without any additional disadvantages.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289481","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":"Vertebral Endplate Cavities with Titanium Cages in Posterior Lumbar Interbody Fusion.","authors":"Tarek Elfiky, Yaser El Mansy, Martin N Stienen, Abdelrahman Sa'ed Alabsi, Mahmoud Nafady","doi":"10.1055/a-2389-7682","DOIUrl":"10.1055/a-2389-7682","url":null,"abstract":"<p><strong>Background: </strong> Vertebral endplate cavities (VECs) have been reported with the use of titanium (Ti) cages. Only few articles have recently demonstrated unfavorable radiographic changes in the form of cysts or cavities, which may predispose to nonunion.</p><p><strong>Methods: </strong> The aim was to assess the prevalence of VEC in posterior lumbar interbody fusion (PLIF) using Ti cages and to estimate their impact on fusion. The term \"cavity\" was used to describe the endplate changes. Computed tomography (CT) analysis of the VECs and fusion status following PLIFs with Ti cages was conducted by two observers. VECs were assessed according to the size, multiplicity, location, and presence of sclerosis.</p><p><strong>Results: </strong> Forty-two consecutive patients with surgeries conducted on 52 levels were enrolled. There were 20 males and 22 females. The mean age was 43.6 ± 10.89 years. The mean follow-up was 20.85 ± 8.49 months. Definite union was seen in 48 levels (92.3%) by observer 1 and in 40 levels (76.9%) by observer 2. The strength of agreement was moderate. The presence of VEC was observed in 9 levels (17.3%) by observer 1 and in 12 levels (23.1%) by observer 2. The strength of agreement was moderate. The majority of VECs in the endplates were less than 5 mm. The strength of agreement was high. The strength of agreement for location and multiplicity were moderate. The VEC was significantly correlated with the fusion status.</p><p><strong>Conclusions: </strong> Our study confirmed that VECs were observed following Ti cage placement after PLIF procedures. They tend to be small and might be associated with nonunion. Furthermore, it reflected the limited inter-rater reliability of the assessment of both the fusion status and VEC morphology after Ti PLIF cage placement.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995917","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":"Early-Onset Adjacent Vertebral Fractures after Balloon Kyphoplasty and SpineJack Kyphoplasty for the Management of Single-Level Thoracolumbar Vertebral Compression Fractures.","authors":"Ming-Hsuan Chung, Yun-Ju Yang, Yi-Chieh Wu, Guann-Juh Chen, Da-Tong Ju, Kuan-Nien Chou","doi":"10.1055/a-2418-7705","DOIUrl":"10.1055/a-2418-7705","url":null,"abstract":"<p><strong>Background: </strong> The aim of this study was to evaluate the risk factors contributing to early-onset adjacent level fractures (ALFs) occurring within 1 month following either balloon kyphoplasty (BKP) or SpineJack kyphoplasty (SJ) for the treatment of thoracolumbar vertebral compression fractures (TLVCFs).</p><p><strong>Methods: </strong> This retrospective analysis enrolled patients with single-level TLVCFs (T11-L2) who underwent either BKP or SJ between July 2013 and June 2019. We recorded the ALF occurrences within 1 month. Age, osteoporosis, severity and shape of TLVCFs, and surgical type were compared between patients with and without early-onset ALFs.</p><p><strong>Results: </strong> Altogether, 106 TLVCF patients were enrolled, comprising 64 BKP and 42 SJ cases. We observed 19 early-onset ALFs, with 9 and 10 cases in the BKP and SJ, respectively. Patients with early-onset ALFs have significantly more severe TLCVFs (severe vs. mild, 25 vs. 0%, <i>p</i> = 0.055), and wedge-shaped TLVCFs (26.47 vs. 2.63%, <i>p</i> = 0.002), older age (81.05 vs. 73.34 years, <i>p</i> < 0.001), and kyphoplasty performed within 1 month are risk factors for early-onset ALFs (26.92 vs. 9.26%, <i>p</i> = 0.018). Univariable analysis showed that kyphoplasty timing within 1 month (odds ratio [OR]: 0.193; <i>p</i> = 0.008), wedge-shaped TLVCFs (OR: 5.358; <i>p</i> = 0.036), and advanced age (OR: 1.119; <i>p</i> = 0.001) are significant risk factors for early-onset ALFs.</p><p><strong>Conclusions: </strong> The occurrence rate of early-onset ALFs between BKP or SJ techniques in treating TLVCFs does not differ. Preoperative wedge-shaped TLVCFs, advanced age, and early treatment within 1 month are the risk factors for early-onset ALFs following kyphoplasty for TLVCFs.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289480","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":"Vagal Nerve Stimulation in the Pediatric Population and Correlation between Family and Treatment Team Perspectives: Single-Center Experience.","authors":"Ibrahim Alnaami, Abdullah Algarni, Saeed A Alqahtani, Rawan M Alqahtani, Imtinan Al Jabbar, Wajd Alhadi, Bayan M Alnujaymi, Seham A Alahmari, Dina Asiri, Asma M AlQahtani, Mansour Y Otaif","doi":"10.1055/a-2344-8309","DOIUrl":"10.1055/a-2344-8309","url":null,"abstract":"<p><strong>Background: </strong> Vagal nerve stimulation (VNS) is an adjunctive therapy to pharmacologic treatment in patients with drug-resistant epilepsy. This study aimed to assess the efficacy of VNS therapy for seizure frequency reduction and improving the quality-of-life (QOL) measures in children with refractory epilepsy and to evaluate the correlation between the perspectives of families and those of the treating team.</p><p><strong>Methods: </strong> This was a prospective cohort study conducted at Abha Maternity and Children's Hospital, Saudi Arabia, from 2018 to 2022. A total of 21 pediatric patients who completed 1 year of follow-up after VNS implantation were included. Patients were aged between 2 and 14 years, with a mean age of 8.14 ± 3.92 years; 11 (52.4%) patients were females. Family and physician assessments were collected blinded to each other using the Clinical Global Impression of Improvement (CGI-I) scores and QOL assessments to evaluate the correlation between the families' and treating team's perspectives on VNS outcomes.</p><p><strong>Results: </strong> In this study, VNS showed significant efficacy in reducing the frequency of seizures. VNS significantly reduced the number of seizures per week from a baseline median of 35 to a median of 0.25 at the end of the follow-up period, representing a dramatic reduction of 99.3% (<i>p</i> < 0.001). The number of emergency department visits per year decreased from a baseline median of 12 to a median of 2, a reduction of 83.3% (<i>p</i> < 0.001), while the number of hospital admissions per year decreased from a baseline median of 3 to a median of 1, a 66.7% decrease (<i>p</i> < 0.001). The number of antiepileptic medications taken decreased from a median of four to three (<i>p</i> < 0.001). Notably, 28.57% of the patients achieved complete seizure freedom, and 38% exhibited significant improvement, with at least 50% reduction in seizure frequency. Importantly, none of the patients experienced an increase in seizure frequency following VNS treatment. The family and physician assessments showed varying degrees of alignment in perceptions, with \"concentration\" exhibiting a significant positive correlation (<i>r</i> = 0.498, <i>p</i> = 0.022), indicating noteworthy agreement, whereas verbal communication did not show a substantial correlation (<i>r</i> = - 0.062, <i>p</i> = 0.791), indicating a divergence of views.</p><p><strong>Conclusion: </strong> VNS is a promising and well-tolerated therapy for individuals with intractable seizures, offering clinical benefits and potential enhancements in various aspects of QOL. The varying perceptions between family and physician assessments highlight the importance of considering multiple perspectives when evaluating treatment outcomes.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321013","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":"Combined one-step hybrid treatment for a paediatric giant internal carotid artery aneurysm: a case report.","authors":"Giacomo Pavesi, Julian S Rechberger, Elena Millesi, Selene Marika Cavallo, Fabio Serpico, Adelaide Valluzzi, Stefano Vallone, Corrado Iaccarino, Stavros Dimitrias","doi":"10.1055/a-2479-5297","DOIUrl":"https://doi.org/10.1055/a-2479-5297","url":null,"abstract":"<p><p>Background Giant intracranial aneurysms (GIAs) require complex treatment strategies including clipping, coiling, stenting, parent artery occlusion, bypass, or combined procedures. Neurovascular hybrid operating rooms (h-OR) combine a conventional operating theatre with high-resolution digital subtraction angiography (DSA). We describe a one-step combined surgical and endovascular treatment in a h-OR for a paediatric internal carotid artery giant aneurysm that can be an optimal solution to manage challenging cases, such as giant aneurysms. Case Description An 11-year-old boy presented with rapid onset right hemiparesis and left eyelid ptosis. A three months history of headache associated with sporadic vomit was reported. A giant, unruptured, left internal carotid artery aneurysm (ICA) was detected on imaging. The patient underwent surgical trapping of the aneurysm. Intraoperative DSA showed residual backflow from the posterior communicating artery (PComA) and coils were placed to completely exclude the aneurysm. At 18 months follow up, the patient showed a complete recovery and MRI showed a progressive reduction of the sac aneurysm. Conclusions Due to their morphologic variability, intracranial giant aneurysms may require a different procedural strategy instead of direct clipping or coiling. The introduction of h-OR allows combined treatments to be performed simultaneously in the same room setting. The present case shows that combined treatment in a neurovascular h-OR can be an optimal solution to manage challenging cases, such as giant aneurysms, reducing operative time with the added benefit of selecting an appropriate strategy adjustment in a multidisciplinary effort.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716409","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}