Neurosurgery最新文献

{"title":"Brachial Plexus Lipoma Causing Neurological Impairment: A Case Series and Systematic Review.","authors":"Nathaniel B Dusseau, Adham M Khalafallah, Kyle Y Xu, S Shelby Burks, Allan D Levi","doi":"10.1227/neu.0000000000003432","DOIUrl":"https://doi.org/10.1227/neu.0000000000003432","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lipomas are benign adipocyte tumors that typically present as painless, firm nodules. In rare cases, lipomas may grow near the brachial plexus (BP) and compress various peripheral nerves. This can manifest as upper extremity motor and/or sensory deficits, numbness, tingling, or burning sensations. Surgical intervention of a brachial plexus lipoma (BPL) may be challenging because of variability in location and size. This study reviews previously reported cases of BPL causing neurological impairment and presents 5 additional cases, focusing on operative details and patient outcomes.</p><p><strong>Methods: </strong>A systematic review of PubMed, Scopus, and World of Science was performed to identify all previously reported cases of BP lipomas resulting in neurological deficit. A retrospective review of a neurosurgeon's prospectively collected database was conducted to identify all patients operated on for BPL. Patient demographics, tumor characteristics, presentation, surgical notes, and outcomes were collected for both reviews.</p><p><strong>Results: </strong>Our literature review yielded 13 articles presenting at least one case meeting the eligibility criteria, resulting in 22 eligible patients. The surgeon's database provided an additional 5 patients meeting the criteria. Of the 27 total cases, 15 were men and 12 were women. The average age was 46.5 with a range of 25 to 70. All patients had upper extremity motor and/or sensory dysfunction preoperatively. Tumors were found in various regions, with the involvement of the supraclavicular fossa reported in 52% of cases. Gross tumor resection was achieved in all but 2 of the 27 operations. Four patients had a nonconventional lipoma type on histology. Sixteen patients experienced complete resolution of neurological symptoms.</p><p><strong>Conclusion: </strong>BP lipomas are rare but can cause a wide range of neurological symptoms depending on their size and location. A thorough patient examination and imaging studies are essential for creating a successful surgical plan for tumor resection.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the Crossroads: A 10-Year Population Study on Access to Care Among Patients With Brain Tumor.","authors":"Zerubabbel K Asfaw, Tirone Young, John Durbin, Lewis Tomalin, Isabelle M Germano","doi":"10.1227/neu.0000000000003439","DOIUrl":"https://doi.org/10.1227/neu.0000000000003439","url":null,"abstract":"<p><strong>Background and objectives: </strong>Health care disparities are introduced at various points along the patient care continuum. This study explores disparities in initial health care access for patients with brain tumor (BT) in New York City (NYC) and New York State (NYS), comparing emergency department (ED) and elective admissions (EA).</p><p><strong>Methods: </strong>Using 2010-2020 data from the Statewide Planning and Research Cooperative System of NYS, patients were identified through relevant billing codes. Demographic, socioeconomic, and health care access variables were examined using univariate analysis and logistic mixed effects regression. The data were dichotomized by care location-NYC or NYS- and entry care site, ED vs EA.</p><p><strong>Results: </strong>The cross-sectional study included 48 135 patients. Over the decade, there was a significant decrease in the percentage of patients with BT admitted through the ED (P < .001) without differences between the 2 cohorts. The NYC cohort (24 283 patients) had a higher proportion of younger, affluent individuals, racial/ethnic minorities, and publicly insured patients (P < .001). Male sex and older age were significantly associated with ED admissions in both cohorts (P < .05). Black, Hispanic/Latinx patients, and those with public health insurance were more likely to be admitted through ED (P < .001). Residing in census tracts within the lowest 3 quartiles was positively associated with ED admission in the NYC but not the NYS cohort (P < .001).</p><p><strong>Conclusion: </strong>Racial minorities with public insurance who reside in urban areas of low median household income are more likely to access BT care through ED rather than EA. Additional studies are needed to evaluate the impact of proximity to a hospital on access to care in rural areas. This study highlights the opportunities for policy and health care delivery changes to address current inequities.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Tracheostomy Timing After Traumatic Complete Spinal Cord Injury: A Comparative Analysis of Ultraearly, Early, and Delayed Practice.","authors":"Ahmad Essa, Husain Shakil, Armaan K Malhotra, Avery B Nathens, Jetan Badhiwala, Eva Y Yuan, Yingshi He, Francois Mathieu, Michael C Sklar, Jefferson R Wilson, Christopher D Witiw","doi":"10.1227/neu.0000000000003430","DOIUrl":"https://doi.org/10.1227/neu.0000000000003430","url":null,"abstract":"<p><strong>Background and objectives: </strong>Tracheostomy is crucial for managing airway and respiratory complications in spinal cord injury (SCI) patients, with recent studies linking its timing to respiratory outcomes. The aim of this study was to determine the association between adverse events and tracheostomy timing in complete traumatic cervical SCI patients.</p><p><strong>Methods: </strong>This multicenter retrospective observational cohort study used data from the Trauma Quality Improvement Program between 2010 and 2020 and included all complete traumatic cervical SCI patients who underwent spine surgery and tracheostomy. Tracheostomy timing was categorized into ultraearly (≤3 days), early (4-7 days), and delayed (>7 days) after surgery. The primary outcome was the occurrence of major in-hospital complications (HC). Secondary outcomes included immobility complications (IC), surgical site infections, hospital and intensive care unit (ICU) length of stay (LOS), and duration of mechanical ventilation. A secondary analysis directly compared the ultraearly and early tracheostomy groups.</p><p><strong>Results: </strong>Among 2907 patients analyzed, 307 (10.6%) underwent ultraearly, 1034 (35.5%) early, and 1566 (53.9%) delayed tracheostomy. Adjusted multivariable analyses revealed significant reductions in HC and IC by 33% to 47% and 28% to 32%, respectively, for the ultraearly and early tracheostomy groups compared with the delayed group. In addition, both ultraearly and early groups experienced similar shorter hospital and ICU stays, and shorter ventilation durations compared with the delayed group. Secondary analysis with a direct comparison between the ultraearly and early groups showed a significant reduction of 3 days in ICU LOS in the ultraearly group. However, there were no significant differences in HC, IC, surgical site infections, hospital LOS, or ventilation duration between the ultraearly and early groups.</p><p><strong>Conclusion: </strong>Our findings indicate that ultraearly and early tracheostomy provide comparable benefits with delayed tracheostomy. If confirmed in prospective studies, this flexibility in tracheostomy timing would allow more thorough patient assessments, ensuing goal-concordant care and making informed decisions without compromising the advantages of early intervention.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines Update for the Role of Emerging Therapies in the Management of Patients With Metastatic Brain Tumors.","authors":"Yuhao Shi, Erik P Sulman","doi":"10.1227/neu.0000000000003438","DOIUrl":"https://doi.org/10.1227/neu.0000000000003438","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of the Crankshaft Phenomenon in Thoracic Congenital Early-Onset Scoliosis Patients Followed Until Skeletal Maturity.","authors":"Guanfeng Lin, Chenkai Li, You Du, Yiwei Zhao, Shengru Wang, Yang Yang, Nan Wu, Qianyu Zhuang, Jianxiong Shen, Jianguo Zhang","doi":"10.1227/neu.0000000000003429","DOIUrl":"https://doi.org/10.1227/neu.0000000000003429","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patients who undergo posterior spinal fusion (PSF) surgery before puberty are at high risk of experiencing the crankshaft phenomenon. Currently, there are no studies reporting the incidence of crankshaft phenomenon in a highly homogeneous cohort of patients with thoracic congenital early-onset scoliosis (CEOS) who were followed up to skeletal maturity. The aim of this study was to reveal the real incidence and identify the risk factors associated with the crankshaft phenomenon in CEOS patients who underwent pedicle screw fixation and PSF before the pubertal growth spurt and to explore surgical strategies aimed to prevent this phenomenon.</p><p><strong>Methods: </strong>Patients who underwent pedicle screw fixation and PSF before the pubertal growth spurt and were followed up until skeletal maturity were enrolled. Coronal and sagittal radiological parameters were evaluated before surgery, immediately after surgery and at the final follow-up. The incidence and risk factors of the crankshaft phenomenon were evaluated according to different parameters.</p><p><strong>Results: </strong>Eighty-one patients (31 men and 50 women) were enrolled, with a mean follow-up time of 97.36 ± 33.03 months (60-192 months). The mean age was 7.24 ± 2.53 years (2-10 years) preoperatively and 15.40 ± 2.07 years (14-25 years) at the last follow-up. The overall incidence of the crankshaft phenomenon was 32.10% (26/81), and 12 of the patients (46.15%) required revision surgery. The incidence of the crankshaft phenomenon significantly increased with the age 5 years and younger (odds ratio = 3.402, P = .038) and number of fused segments <5 (odds ratio = 3.662, P = .028).</p><p><strong>Conclusion: </strong>The incidence of the crankshaft phenomenon may have been underestimated before this point, and skeletal maturity could determine the real incidence of the crankshaft phenomenon. The incidence could be as high as 32.10% in thoracic CEOS populations. A younger age (≤5 years old) and short segmental fusion (<5 segments) can help predict the crankshaft phenomenon in thoracic CEOS patients.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Gender Differences in Outcomes in Patients Treated for Thoracolumbar Burst Fractures Without Neurological Deficits: Prospective International Multicenter Study.","authors":"Arnold E Obungu, Julie L Chan","doi":"10.1227/neu.0000000000003424","DOIUrl":"https://doi.org/10.1227/neu.0000000000003424","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Recovery After Surgery Protocol for Microvascular Decompression in Trigeminal Neuralgia: A Retrospective Matched Cohort Study.","authors":"Mohammadmahdi Sabahi, Hadi Sultan, Shadi Bsat, Abdulrahman Albakr, Badih Adada, Hamid Borghei-Razavi","doi":"10.1227/neu.0000000000003442","DOIUrl":"https://doi.org/10.1227/neu.0000000000003442","url":null,"abstract":"<p><strong>Background and objectives: </strong>Microvascular decompression (MVD) is an effective surgical treatment of trigeminal neuralgia, especially when medical therapy does not result in adequate pain control. Despite its efficacy, improvements can be made in the perioperative period to reduce hospital length of stay, enhance patient experience, improve outcomes, and reduce costs. An enhanced recovery after surgery (ERAS) protocol was implemented for patients, and a retrospective cohort study was used to compare outcomes with non-ERAS MVD patients.</p><p><strong>Methods: </strong>In this matched cohort analysis, a total of 240 patients were initially included. After 1:1 propensity score matching, 130 patients were selected for the main analysis, with comorbidities and demographic factors controlled for in the comparison.</p><p><strong>Results: </strong>ERAS-treated patients had significantly reduced hospital length of stay (P < .001) compared with the control group with a mean of 1.46 and 2.95 days, respectively. In addition, ERAS patients had similar postoperative Barrow Neurological Institute pain scores to non-ERAS patients, with significantly lower verbal pain scores (P = .03). Patients in the ERAS group experienced significantly lower rates of transient postoperative subjective hearing alteration (P = .03) compared with controls. In a subanalysis of patients in the ERAS group who were discharged at 24 hours, these patients reported lower postoperative verbal pain levels (P = .003) compared with non-ERAS patients. An analysis of covariance comparing postoperative pain scores (Barrow Neurological Institute and verbal pain) between the ERAS and non-ERAS groups controlled for length of stay, age, duration of symptoms, and preoperative pain scores and found no significant difference between the ERAS and non-ERAS groups.</p><p><strong>Conclusion: </strong>Implementation of this ERAS protocol for MVD has significantly reduced the length of stay with similar, if not improved, pain levels and rates of transient postoperative subjective hearing alteration compared with non-ERAS patients.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender Differences in Outcomes in Patients Treated for Thoracolumbar Burst Fractures Without Neurological Deficits: Prospective International Multicenter Study.","authors":"Charlotte Dandurand, Marcel F Dvorak, Cumhur F Öner, Dimitri Hauri, Klaus Schnake, Alexander R Vaccaro, Lorin M Benneker, Gregory D Schroeder, Shanmuganathan Rajasekaran, Mohammad El-Skarkawi, Rishi M Kanna, Eugen Cezar Popescu, Jin Wee Tee, Andrei Fernandes Joaquim, Harvinder Singh Chhabra, Ulrich Spiegl, Richard J Bransford","doi":"10.1227/neu.0000000000003408","DOIUrl":"https://doi.org/10.1227/neu.0000000000003408","url":null,"abstract":"<p><strong>Background and objectives: </strong>Exploring gender differences in outcomes after spinal surgery is essential. We aimed to assess gender differences in patients treated for thoracolumbar burst fractures without neurological deficit regarding Oswestry Disability Index (ODI) improvement. Secondarily, we assessed baseline characteristics, treatment selection, and other patient-reported outcomes.</p><p><strong>Methods: </strong>Data were prospectively collected. The primary end point was defined as time to achieve minimal clinically important difference (MCID) in ODI. In an exploratory analysis, we defined improvement in ODI as reaching minimal disability.</p><p><strong>Results: </strong>Genders had similar baseline characteristics, injury characteristics, and treatment selection and timing.Surgically treated women showed a faster achievement of MCID in ODI (14 days, 95% CI 14.0-28.0 vs 28 days, 95% CI 15.0-34.0, P = .009). On multivariable modeling, nonoperatively treated women had a lower chance of achieving improvement in the ODI than nonoperatively treated men (hazard ratio 0.55, 95% CI: 0.32-0.96, P = .036).Women had a longer median time to achieve minimal disability (102.0 days, 95% CI: 76.0; 131.0 vs 62.0 days, 95% CI: 51.0; 72.0, P = .008). Nonoperative women had a longer median time to achieve minimal disability (130.0 days, 95% CI: 82.0-185.0 vs 61.0 days, 95% CI: 47.0-76.0, P = .048). On multivariable modeling, nonoperative women had a lower chance for achieving minimal disability than nonoperatively treated men (hazard ratio 0.55, 95% CI 0.31-0.98 P = .042).</p><p><strong>Conclusion: </strong>This novel study reports gender differences in thoracolumbar burst fractures in neurologically intact patient. Women do worse with nonoperative management than men. In addition, women do better with operative than nonoperative management in achieving MCID, whereas this was not observed in men. Thus, women benefit to a greater extent from surgical management than do men. These results highlight the importance of personalized treatment that incorporates gender. Future studies should assess gender differences in other traumatic spinal pathologies.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: Validation and Comparison of Common Thoracolumbar Injury Classification Treatment Algorithms and a Novel Modification.","authors":"Mohamed M Aly","doi":"10.1227/neu.0000000000003435","DOIUrl":"https://doi.org/10.1227/neu.0000000000003435","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Cerebral Perfusion Pressure in Brain Injury: Physiological Relationships and Outcome.","authors":"Adam I Pelah, Agnieszka Kazimierska, Marek Czosnyka, Gregory W J Hawryluk","doi":"10.1227/neu.0000000000003411","DOIUrl":"https://doi.org/10.1227/neu.0000000000003411","url":null,"abstract":"<p><strong>Background and objectives: </strong>The priority for measuring and optimizing physiological metrics in brain injury care remains to be determined. Calculating and targeting optimal cerebral perfusion pressure (CPPopt) is an emerging treatment paradigm, but its association with other parameters and outcome is uncertain. A previous analysis of 22 patients found that brain tissue oxygenation (PbtO2) peaked when CPP values were near CPPopt. This study sought to validate those findings using a distinct, larger cohort. It also studied the relationship between CPPopt and physiological parameters related to intracranial dynamics and with neurological outcome.</p><p><strong>Methods: </strong>PbtO2, intracranial pressure (ICP), and arterial blood pressure data were collected during a 15-year period from 432 brain injury patients at 4 cooperating trauma centers. CPPopt was retrospectively computed.</p><p><strong>Results: </strong>The median age was 36 years (n = 316), the median admission Glasgow coma score was 6 (n = 323), and 75% of the patients were men (n = 324). In aggregate data, PbtO2 peaked at CPP values near CPPopt (+/- 2 mm Hg). Proportion of out-of-range ICP measurements (>22 mm Hg) and positive pressure reactivity index were higher in dying and unfavorable outcome groups, and increased with worsening outcome. Time spent near CPPopt was significantly higher in dying patients but not in patients with unfavorable outcome. Time near CPPopt was, however, correlated with improving outcome. Proportion of out-of-range PbtO2 (<20 mm Hg) was not associated with outcome or mortality.</p><p><strong>Conclusion: </strong>The results verify CPPopt as physiologically significant and that in aggregate data achievement of CPPopt is associated with optimized PbtO2. Compliance with the ICP treatment threshold was, though, the only modifiable physiological variable associated with both functional outcome and mortality. Our results support optimization of ICP with highest priority. Further study is required in patients in whom CPPopt is specifically targeted.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}