World neurosurgery最新文献

{"title":"Deep Learning-based Segmentation of Cervical Posterior Longitudinal Ligament Ossification in CT Images and Assessment of Spinal Cord Compression: A Two-center Study.","authors":"Baiyang Jiang, Jiayang Yan, Shaochun Xu, Qianxi Jin, Gang Xiang, Qingyang Yu, Yimin Huang, Chao Zheng, Xiao Hu, Li Fan, Yi Xiao, Xiang Wang, Shiyuan Liu","doi":"10.1016/j.wneu.2024.123567","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.123567","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to develop a fully automated, CT-based deep learning（DL） model to segment ossified lesions of the posterior longitudinal ligament (OPLL) and to measure the thickness of the ossified material and calculate the cervical spinal cord compression factor.</p><p><strong>Materials and methods: </strong>A total of 307 patients were enrolled, with 260 patients from Shanghai Changzheng Hospital, And 47 patients from the Traditional Chinese Medicine Hospital of Southwest Medical University. CT images were used to manually segment the OPLL by four experienced radiologists. The DL model employing a 3D U-Net framework was developed to segment the OPLLs. The system also measures the thickness of the ossified material at its thickest point and the diameter of the spinal canal at the corresponding level. Segmentation performance was evaluated using the Dice Similarity Coefficient (DSC), Average Surface Distance (ASD), and Intra-Class Correlation (ICC) between ground truth and segmentation volumes. Concordance between the radiologists' and the DL system's measurements of the ossified material thickness, residual spinal canal diameter at maximum compression, and cervical spinal cord compression coefficient was assessed in a randomly selected subset of 30 cases from the training set using ICCs and Bland-Altman plots.</p><p><strong>Results: </strong>The DL system demonstrated average DSC of 0.81, 0.75, and 0.71 for the training, internal validation, and external test sets, respectively. The mean ASD was 1.30 for the training set, 2.35 for the internal validation set, and 2.63 for the external test set. The intraclass correlation coefficient (ICC) values of 0.958 for the thickness of the ossified material and 0.974 for the residual canal diameter measurement.</p><p><strong>Conclusions: </strong>The proposed DL model effectively detects and separates ossification foci in OPLL on CT images. It exhibits comparable performance to radiologists in quantifying spinal cord compression metrics.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123567"},"PeriodicalIF":1.9,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of intravenous alteplase before endovascular thrombectomy on outcome after unsuccessful recanalization in the DIRECT-MT trial.","authors":"Lining Chen, Yina Wu, Jinbiao Yao, Qiaowei Wu, Guang Zhang, Shancai Xu, Pengfei Yang, Yongwei Zhang, Lei Zhang, Zifu Li, Pengfei Xing, Hongjian Shen, Huaizhang Shi, Jianmin Liu, Chenghua Xu, Pei Wu","doi":"10.1016/j.wneu.2024.123569","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.123569","url":null,"abstract":"<p><strong>Background: </strong>There are still some patients with acute anterior circulation large vessel occlusion stroke (LVOS) experienced unsuccessful recanalization after endovascular thrombectomy. The efficacy of intravenous alteplase before thrombectomy for such patients is unknown. We performed this study to investigate whether prior intravenous alteplase could affect the outcome of patients with unsuccessful recanalization.</p><p><strong>Methods: </strong>This is a post-hoc analysis of the DIRECT-MT trial. Patients with final extended thrombolysis in cerebral infarction (mTICI) score of 0-2a were included. Patients with successful recanalization (mTICI 2b-3) or could not be assessed for mTICI were excluded. The primary outcome was the 90-day modified Rankin scale (mRS) score, while secondary outcomes included 90-day functional independence (mRS 0-2), recanalization (modified arterial occlusive lesion) rates at 24-72h by CTA, infarction volume on CT, rates of symptomatic intracranial hemorrhage (SICH) and asymptomatic intracranial hemorrhage (aSICH).</p><p><strong>Results: </strong>Among 656 randomized patients, 92 patients with unsuccessful recanalization were included, of which 55 patients underwent endovascular thrombectomy alone (EVT-group) and 37 patients underwent endovascular thrombectomy preceded by intravenous alteplase (combination group). No statistically significant difference in the 90-day mRS score was observed between the two groups (Adjusted cOR=1.65; 95%CI, 0.76 to 3.59). The volume of infarction, the proportion of 90-day functional independence, recanalization rates at 24-72 h, rates of SICH and rates of aSICH were similar in both groups.</p><p><strong>Conclusion: </strong>We found no evidence that prior intravenous alteplase could affect the clinical or imaging outcome in patients with acute anterior circulation LVOS and unsuccessful recanalization after endovascular thrombectomy.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123569"},"PeriodicalIF":1.9,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855662","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":"Diffuse intrinsic pontine glioma and CAR-T therapy: An Emerging Frontier.","authors":"Tomasz Tykocki","doi":"10.1016/j.wneu.2024.123579","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.123579","url":null,"abstract":"<p><p>This study explores the integration of chimeric antigen receptor T-cell (CAR-T) therapy with convection enhanced delivery (CED) as a novel approach for treating diffuse intrinsic pontine glioma (DIPG), a highly aggressive pediatric brain tumor with limited treatment options. Preliminary clinical results indicate that CED improves CAR-T cell distribution within the tumor microenvironment, leading to promising anti-tumor responses. However, challenges such as catheter-related complications and potential on-target/off-tumor toxicity remain. Ongoing research is essential to optimize these strategies and address ethical considerations surrounding patient safety and equitable access to innovative therapies. The aim is to assess the safety, efficacy, and distribution of CAR-T cells delivered directly to the tumor site via CED, thereby enhancing therapeutic outcomes while minimizing systemic side effects.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123579"},"PeriodicalIF":1.9,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855661","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":"Opiate Use Patterns Following Surgery for High Grade Glioma.","authors":"Grace Hey, Phuong Deleyrolle, Abeer Dagra, Tuo Lin, Derek Li, Kaitlyn Melnick, Nina McGrew, Muhammad Abdul Baker Chowdhury, Shahd Mohamed, Michael Goutnik, Si Chen, Ashley Ghiaseddin, Maryam Rahman","doi":"10.1016/j.wneu.2024.11.090","DOIUrl":"10.1016/j.wneu.2024.11.090","url":null,"abstract":"<p><strong>Introduction: </strong>Opiate drugs are commonly prescribed for postoperative pain relief following craniotomy. The aim of this study was to assess opiate use in patients undergoing craniotomy for high-grade glioma and to identify risk factors contributing to prolonged opiate use.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on adult patients undergoing craniotomy for high-grade glioma between January 2016 and January 2020. Medical records were assessed for history of pain syndrome, and alcohol, nicotine, and other substance use. Opiate length of utilization and dose measured by morphine equivalent dose (MED) was collected. Statistical analyses were conducted using R Statistical Software (v4.1.2; R Core Team 2021).</p><p><strong>Results: </strong>A total of 295 patients met inclusion criteria, with 26.4% undergoing biopsy and 73.6% undergoing craniotomy for resection. The average immediate postoperative MED/day was 20.3 (SD 21.5) and average duration of outpatient opiate use was 15.1 days (SD 63.1 days). Male sex and history of tobacco use were associated with increased MED/day in the postoperative period. A stratified analysis showed that, for patients undergoing craniotomy, MED/day was significantly increased with male sex and history of tobacco use. For patients undergoing biopsy, MED/day was significantly increased with history of other substance use. History of pain syndrome significantly increased the odds of opiate prescription renewal. Age significantly reduced the odds of opiate prescription renewal.</p><p><strong>Conclusions: </strong>Postoperative opiate use in this cohort is modest. Increased opiate use is associated with comorbidities known to modulate pain perception. Prospective studies should be conducted to provide more robust data.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123507"},"PeriodicalIF":1.9,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740644","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":"Simultaneous Traumatic Fractures of the Atlas and Axis: Presentation, Management, and Outcomes from a Series of 103 Consecutive Patients.","authors":"Michael Brendan Cloney, Thomas J Buell, David A Paul, T Jayde Nail, Hanish Polavarapu, Mohamed-Ali Jawad-Makki, Samuel Adida, David O Okonkwo","doi":"10.1016/j.wneu.2024.123580","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.123580","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous fractures of C1 and C2 are increasingly common, but contemporary series are limited in their evaluation.</p><p><strong>Methods: </strong>All patients with traumatic fractures of both C1 and C2 admitted to an academic trauma center from 2012 to 2022 were retrospectively analyzed. Multivariable regression was used to identify characteristics relevant to management and outcomes.</p><p><strong>Results: </strong>103 patients were identified, most of whom (52.4%) were age ≥80 years, suffered ground-level falls (80.6%), and had minor associated injuries (median Injury Severity Score 1), but had a 28.2% 1-year mortality rate. Landells Type 1 fractures were the most common C1 fracture (50.5%), and dens fractures were the most common C2 fracture (74.8%). Most patients did not undergo MRI, but ligamentous injury was seen in 54.8% of those who did. Fourteen patients (13.6%) had surgery upfront, and 7 (6.8%) had surgery after a trial of nonoperative management. Selection for upfront surgery was associated with neurologic deficits (p=0.010) and age (p=0.026). Dens fracture patients tended to have C2 as their lower instrumented vertebra (p=0.0902), and hangman's fracture patients tended to have C3 as theirs (p=0.0714). Upfront surgery decreased the odds of bony nonunion (p=0.0281). 91.7% of patients with bony nonunion with flexion-extension films had fibrous nonunion.</p><p><strong>Conclusion: </strong>Simultaneous atlantoaxial fractures commonly occur in elderly patients after ground level falls with minor associated injuries. Surgical selection is driven by neurologic deficits and age, and C2 fracture type may influence procedure choice. Surgery decreases the odds of bony nonunion, and fibrous nonunion is common in its absence.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123580"},"PeriodicalIF":1.9,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855663","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":"Conventional radiotherapy timing and wound complication avoidance after surgery for metastatic spine disease. A LatAm modified Delphi study.","authors":"Federico Landriel, Kevin White, Fernando Padilla Lichtenberger, Alfredo Guiroy, Alisson Teles, Eduardo Laos Plasier, Jerônimo Buzetti Milano, Marcelo Risso, Nelson Astur, Oscar González, Ratko Yurac, Rodolfo Páez, William Teixeira, Maximiliano Toscano, Santiago Hem","doi":"10.1016/j.wneu.2024.123575","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.123575","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123575"},"PeriodicalIF":1.9,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839823","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":"Treatment of Unruptured Large and Giant Paraclinoid Aneurysms in Japan at the Time of Flow Diverter Introduction: A Nationwide, Multicenter Survey by the Japanese Society on Surgery for Cerebral Stroke.","authors":"Kazuya Kanemaru, Hideyuki Yoshioka, Koji Hashimoto, Nobuo Senbokuya, Hajime Arai, Miki Fujimura, Kensuke Suzuki, Ko Matsuda, Nobuyuki Saka, Ryo Nishikawa, Yuichi Murayama, Jun C Takahashi, Tooru Inoue, Shinichi Yoshimura, Teiji Tominaga, Hiroyuki Kinouchi","doi":"10.1016/j.wneu.2024.123571","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.123571","url":null,"abstract":"<p><strong>Background and objectives: </strong>Large or giant paraclinoid aneurysms have been treated with various strategies, including clipping, coiling, and parent artery occlusion (PAO). In addition, flow diverters (FDs) have been introduced for the management of these aneurysms. The aim of this study was to examine the management of unruptured large/giant paraclinoid aneurysms in Japan when FDs were being introduced by a nationwide survey.</p><p><strong>Methods: </strong>A total of 576 unruptured large/giant paraclinoid aneurysms treated in Japan between January 2012 and December 2016 were retrospectively studied.</p><p><strong>Results: </strong>Half of the large paraclinoid aneurysms were treated by coiling (50.3%), whereas giant aneurysms were occluded mainly by PAO (51.4%). A high nearly complete occlusion rate was achieved with clipping (94.1%), coiling (85.9%), PAO (82.4%), and FDs (77.6%). Coiling had higher risks of recurrence (28.3%) and retreatment (20.3%). Major procedure-related complications were observed in 9.7%. Ischemic complications were common in PAO (9.5%), with cranial nerve symptoms common in clipping (10.9%). All treatment modalities achieved good clinical outcomes (93.5-96.6%). Although not significant, pre-existing visual disturbance improved most frequently by clipping (53.7%), but also worsened most frequently by clipping (24.4%). Consequently, FD achieved a high occlusion rate with minimal complication and retreatment rates.</p><p><strong>Conclusion: </strong>All treatment modalities offer high rates of complete occlusion and good clinical outcomes. Coiling has the disadvantage of high rates of recurrence and retreatment. Clipping and PAO have the disadvantage of a high rate of major procedure-related complications; however, PAO can provide comparable treatment outcomes even in cases with refractory giant aneurysms. FDs are the optimal choice for the management for large/giant paraclinoid aneurysms due to its safety and efficacy.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123571"},"PeriodicalIF":1.9,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839827","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":"Correlation between coagulation parameters and dense fibrin band configuration in tough intracerebral hematoma in anticoagulated patients.","authors":"Sadahiro Nomura, Hirokazu Sadahiro, Takao Inoue, Kazutaka Sugimoto, Natsumi Fujii, Kohei Haji, Hideyuki Ishihara","doi":"10.1016/j.wneu.2024.123565","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.123565","url":null,"abstract":"<p><strong>Objective: </strong>Patients receiving anticoagulation therapy develop intracerebral hematomas, which are difficult to evacuate during endoscopic surgery. Insufficient thrombin activation results in the gradual conversion of fibrinogen to fibrin, forming dense fibrin bands (FBs) that harden the hematoma. We aimed to investigate the factors contributing to hematoma hardness.</p><p><strong>Methods: </strong>Eleven men and 11 women (age range: 41-84 years) with hypertensive intracerebral hematomas underwent surgery between 2016 and 2018. Hematoma hardness was measured intraoperatively as the maximum breaking point under compression (Newton [N]) using a bar-type tester. Hematoma samples were graded based on histological FB density. The relationships between hardness, FB grade, and hematological parameters were assessed in patients with and without anticoagulation therapy.</p><p><strong>Results: </strong>Hematomas were categorized as non-hard (0-3.0 N, n = 16) or hard (3.0-7.0 N, n = 6). Hardness was strongly correlated with FB grade (r = 0.76) and prothrombin time-international normalized ratio (PT-INR) (r = 0.75) and moderately correlated with activated partial thromboplastin time (APTT) (r = 0.65). Three patients with hematoma receiving warfarin and one receiving factor Xa inhibitor demonstrated significantly higher FB grade (p = 0.008) and increased hematoma hardness (6.0 ± 1.4 N) compared with those without anticoagulation treatment (1.3 ± 1.2 N, p = 0.00001). Receiver operating characteristic curve analysis indicated that a PT-INR of 1.81 and an APTT of 32.3 s may predict hard hematomas.</p><p><strong>Conclusion: </strong>Tough hematomas were histologically characterized by high FB density. Preoperative PT-INR and APTT may predict the presence of tough hematomas.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123565"},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830079","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":"Chloroma of the Cerebellopontine Angle: A Rare Presentation.","authors":"Gabriel S Eli, Matheus H Taborda, Bernardo Ca Teixeira","doi":"10.1016/j.wneu.2024.11.099","DOIUrl":"10.1016/j.wneu.2024.11.099","url":null,"abstract":"<p><p>This article presents a case study of a 7-year-old female patient with a history of acute myelogenous leukemia, previously treated with chemotherapy. The patient developed acute right peripheral facial paralysis and right upper limb weakness, leading to the discovery of an extra-axial solid lesion at the right cerebellopontine angle. This lesion extended into adjacent structures with notable contrast enhancement and restricted diffusion on magnetic resonance imaging, indicative of chloroma, an extramedullary solid mass composed of myeloid precursor cells. The article discusses the clinical presentation and radiological findings, emphasizing the importance of magnetic resonance imaging in diagnosis. It details typical imaging characteristics of cerebellopontine angle chloromas and differentiates them from other intracranial tumors.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123516"},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755657","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":"Middle Meningeal Artery Embolization in Chronic Subdural Hematoma in Post Shunted Normal Pressure Hydrocephalus.","authors":"Michael Meggyesy, Yuanxuan Xia, Gwendolyn Williams, Ryan Lee, Enoch Kim, Dipankar Biswas, Risheng Xu, Fernando Gonzalez, Mark Luciano","doi":"10.1016/j.wneu.2024.123576","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.123576","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123576"},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830081","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}