World neurosurgery最新文献

{"title":"Endoport-Assisted Endoscopic Technique for Evacuating Severe Intraventricular Hemorrhage with Cast Third Ventricle Hematoma in an Underwater Field: A Technical Note.","authors":"Jun Mo, Huimin Shen, Tian Yang, Dan Xu, Ruxin Xing, Bo Wang, Yili Chen","doi":"10.1016/j.wneu.2024.10.101","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.101","url":null,"abstract":"<p><strong>Objective: </strong>The authors describe a two-stage strategy utilizing the endoport-assisted endoscopic technique for the evacuation of severe intraventricular hemorrhage (IVH) with a cast third ventricle, and discuss potential pitfalls in the implementation of this method in clinical practice.</p><p><strong>Methods: </strong>Patients with severe IVH (Graeb score > 6) and a cast third ventricle who present to our center from 2021 to 2023 were treated in two-stage surgical strategy utilizing the endoport-assisted endoscopic technique.</p><p><strong>Results: </strong>A total of 9 patients with mean age of 55 years were included in the study. The preoperative mean Graeb score was 9, and postoperative mean Graeb score was 3, with a 72% evacuation rate for the entire ventricles. The median duration for EVD drainage was observed to be 6 days. In terms of 90-day modified Rankin Scale (mRS) scores, a favorable outcome (mRS 1-3) was demonstrated in 78% of the patients, while the remaining 22% presented with a poor outcome (mRS 4-6). There were no complications related to the surgery itself in any of the reported cases.</p><p><strong>Conclusion: </strong>The endoport-assisted two-stage endoscopic technique marks a significant advancement in treating severeIVH with a cast third ventricle. By combining dry and underwater approaches, it provides an innovative solution for effectively and safely clearing hematomas in both lateral and third ventricles. This technique addresses the crucial need for early cerebrospinal fluid circulation restoration, potentially improving outcomes for patients with these complex cases.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569722","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":"Breaking barriers: the value of international medical graduates in US neurosurgery.","authors":"Lea Scherschinski, Michael T Lawton","doi":"10.1016/j.wneu.2024.10.130","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.130","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565000","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":"Severe Traumatic Brain Injury Outcomes In Patients With Premorbid Psychiatric Illness.","authors":"Justin N Passman, Nathaniel A Cleri, Jermaine Robertson, Jordan R Saadon, Claire Polizu, Xuwen Zheng, Vaibhav Vagal, Sima Mofakham, Charles B Mikell","doi":"10.1016/j.wneu.2024.10.096","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.096","url":null,"abstract":"<p><strong>Objective: </strong>Individuals with psychiatric illnesses (PI) have increased rates of traumatic brain injury (TBI). Nonetheless, the influence of underlying PI on TBI outcomes is poorly understood.</p><p><strong>Methods: </strong>We analyzed the medical records of 633 adult-severe TBI (sTBI) patients admitted to our institution between 2010-2021. We identified patients with premorbid PI (Psych(+) group, n=129) and a subset with only a substance use disorder (SUD(+) group, n=60) and compared them to patients without PI (Psych(-) group, n=480). Outcome measures included discharge Glasgow Coma Scale (GCS), length of stay (LOS), in-hospital survival, and Glasgow Outcome Scale-Extended (GOS-E).</p><p><strong>Results: </strong>The Psych(+) group had increased in-hospital survival (69.8% v. 55.0%, P=0.003) and fewer patients with severe (3-8) discharge-GCS (28.7% v. 46.0%, P<0.001). The SUD(+) group had increased in-hospital survival (70.0% v. 55.0%, P=0.028) and fewer patients with severe discharge-GCS (28.3% v. 46.0%, P=0.009). However, the Psych(+) (21.0 v. 10.0 days, P<0.001) and SUD(+) (16.0 v. 10.0 days, P=0.011) groups had longer LOS. The Psych(+) group had a higher mean GOS-E at discharge (2.7 v. 2.4, P=0.004), six-months (3.8 v. 3.0, P=0.006) and one-year (3.4 v. 2.3, P=0.027). The SUD(+) group also had a higher mean GOS-E at discharge (2.8 v. 2.4, P=0.034), six months (3.8 v. 3.0, P=0.035), and one year (3.5 v. 2.3, P=0.008). Additionally, there were no significant differences in injury severity or CT scan findings.</p><p><strong>Conclusions: </strong>Individuals with PI and SUD appeared to have better outcomes but more complicated hospital stays following sTBI. Future studies should investigate the mechanisms underlying these outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565009","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":"Which Prognostic Model Best Predicts Poor Prognosis in Patients with Spinal Metastases? A Comparative Analysis of 8 Scoring Systems.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Chong-Suh Lee","doi":"10.1016/j.wneu.2024.09.123","DOIUrl":"10.1016/j.wneu.2024.09.123","url":null,"abstract":"<p><strong>Background: </strong>Existing scoring system's comparative effectiveness in identifying patients with poor prognosis (i.e., <6 months survival) has not been thoroughly explored.</p><p><strong>Methods: </strong>We compared the predictive performance of 8 prognostic scoring systems (Tomita, modified Tokuhashi, modified Bauer, Rades, Oncological Spinal Prognostic Index, Lei, New England Spinal Metastasis Score, and the skeletal oncology research group [SORG] nomogram) with the area under the curve (AUC) from receiver operating characteristic curves and evaluated the predictive accuracy for 6-month survival across different primary tumor origins, and 1-month survival. Logistic regression was used to identify factors associated with 6-month survival.</p><p><strong>Results: </strong>Six hundred forty one patients with spinal metastasis treated between 1994 and 2022 were included. The SORG nomogram showed best performance with low discriminative power in predicting 6-month survival (AUC [95% confidence interval {CI}]: 0.664 [0.584-0.744]). Logistic regression analysis identified significant factors influencing 6-month survival, including primary cancer type in Lei's classification, preoperative Frankel grades C and D, or grades A and B compared with grade E, preoperative white blood cell, preoperative albumin, and preoperative chemotherapy. For 1-month survival predictions, both the SORG nomogram (AUC [95% CI]: 0.750 [0.648-0.851]) and modified Tokuhashi score (AUC [95% CI]: 0.667 [0.552-0.781]) showed significance, albeit with moderate to low discriminative power.</p><p><strong>Conclusions: </strong>This study shows that most scoring systems have low discriminative power, with only the SORG nomogram having moderate power for predicting poor prognosis. Recent and future advances in treatment, laboratory markers, and our understanding of tumor biology should be incorporated into prognostic models to improve their accuracy.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476109","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 Low-Temperature Ice Saline Bone Cement in Percutaneous Vertebroplasty.","authors":"Youzhi An, Zhaoxin Luan, Zhen Zhang, Lili Li, Xuelin Lin","doi":"10.1016/j.wneu.2024.10.005","DOIUrl":"10.1016/j.wneu.2024.10.005","url":null,"abstract":"<p><strong>Objective: </strong>Percutaneous vertebroplasty uses the traditional method of bone cement filler to inject bone cement, which solidifies easily. We have established a new method to delay the solidification of bone cement (low-temperature ice saline bone cement) and compared the advantages of the new method and the traditional method of injecting bone cement.</p><p><strong>Methods: </strong>Eighty-two patients with osteoporotic vertebral compression fracture were divided into 2 groups by a retrospective study method: 40 patients in group A were treated with the traditional method and 42 patients in group B were treated with the new method. The leakage rate of bone cement, postoperative visual analog scale score, amount of bone cement in each vertebral body, operation time of bone cement, and number of bone cement fillers used were compared between the 2 groups.</p><p><strong>Results: </strong>There was no significant difference in the bone cement leakage rate, postoperative visual analog scale score, the amount of bone cement in each vertebral body, and the number of bone cement fillers used between the 2 groups; the operation time of bone cement in the 2 groups was statistically significant, and the operation time in group B was significantly longer than that in group A.</p><p><strong>Conclusions: </strong>Low-temperature ice saline water bone cement has significant advantages in multiple vertebral fractures, a relatively large amount of bone cement injected into each vertebral body, and a long operation time, which is more suitable for beginners.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476175","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":"Federated Learning for Predicting Postoperative Remission of Patients with Acromegaly: A Multicentered study.","authors":"Wentai Zhang, Xueyang Wu, He Wang, Ruopei Wu, Congcong Deng, Qian Xu, Xiaohai Liu, Xuexue Bai, Shuangjian Yang, Xiaoxu Li, Ming Feng, Qiang Yang, Renzhi Wang","doi":"10.1016/j.wneu.2024.10.091","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.091","url":null,"abstract":"<p><strong>Background: </strong>Decentralized federated learning (DFL) may serve as a useful framework for machine learning (ML) tasks in multicentered studies, maximizing the use of clinical data without data sharing. We aim to propose the first workflow of DFL for ML tasks in multicentered studies, which can be as powerful as those using centralized data.</p><p><strong>Methods: </strong>A DFL workflow was developed with four steps: registration, local computation, model update, and inspection. A total of 598 participants with acromegaly from PUMCH, and 120 participants from XWH were enrolled. The cohort from PUMCH was further split into five centers. Nine clinical features were incorporated into ML-based models trained based on four algorithms: LR, GBDT, SVM, and DNN. The area under the curve (AUC) of receiver operating characteristic curves was used to evaluate the performance of the models.</p><p><strong>Results: </strong>Models trained based on DFL workflow performed better than most models in LR (P<0.05), all models in DNN, SVM, and GBDT (P<0.05). Models trained on DFL workflow performed as powerful as models trained on centralized data in LR, DNN, and SVM (P>0.05).</p><p><strong>Conclusions: </strong>We demonstrate that the DFL workflow without data sharing should be a more appropriate method in ML tasks in multicentered studies. And the DFL workflow should be further exploited in clinical researches in other departments and it can encourage and facilitate multicentered studies.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565002","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":"Surgical Strategy and Decision Making in Recurrent Atlanto-Axial Dislocations: The Role of Traction.","authors":"Kavin K Devani, Souvik Singha, Pulkit Purohit, Nupur Pruthi","doi":"10.1016/j.wneu.2024.10.099","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.099","url":null,"abstract":"<p><strong>Objective: </strong>To analyse patients with recurrent atlantoaxial dislocation and give a criterion of an ideal patient who can benefit from redo surgery.</p><p><strong>Methods: </strong>This retrospective study was conducted in a tertiary care centre, which included 20 patients who failed atlantoaxial surgery from January 2013 to June December 2021. They were evaluated using X-ray, CT, and MRI examinations, and their clinical data were accessed from the hospital's medical records department and the picture archiving and communication system. They were given a trial of traction to look for clinical and/or radiological improvement. Those showing clinical and/or radiological improvement underwent redo fixation. The operative steps involved removing joint capsules, denuding articular cartilage and joint preparation followed by reduction of basilar invagination by the combination of spacer and/or bone graft and putting screws in C1/Occiput and C2. A strut graft was placed between Occiput/ C1 and C2.</p><p><strong>Results: </strong>The mean change in mJOAS and Nurick grade following the first surgery was statistically significant (1.00 ± 0.73, p-value 0.002 and -0.15 ± 0.27, p-value 0.046, respectively). On similar paths, the mean change in mJOAS and Nurick grade following the second surgery was also statistically significant (4.25 ± 0.32, p-value <0.001 and -1.2 ± 0.11, p-value <0.001, respectively). Improper usage of constructs (31.57%), inadequate/no joint preparation (42.10%/57.90%) and poor choice of graft (100%) were the leading causes of failure of index surgery.</p><p><strong>Conclusions: </strong>The best candidates who can benefit after re-do surgery are the ones who exhibit either clinical and/or radiological improvement on the trial of traction, as the pathological C1-C2 joints are either not fused or have undergone pseudoarthrosis. Those patients who do not exhibit significant clinical or radiological improvement post-trial of traction should not be offered subsequent surgical intervention.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565011","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":"Meningioma En Plaque associated with Cerebrospinal Fluid Rhinorrhea: A Systematic Review of Literature with Case Presentation.","authors":"Moataz D Abouammo, Mohammad Bilal Alsavaf, Chandrima Biswas, Maithrea S Narayanan, Guilherme Mansur, Rodrigo D Gehrke, Mahmoud F Abdelaziz, Magdy E Saafan, Hossam S Elsherif, Kyle C Wu, Kyle K VanKoevering, Daniel M Prevedello, Ricardo L Carrau","doi":"10.1016/j.wneu.2024.10.100","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.100","url":null,"abstract":"<p><strong>Background: </strong>Meningiomas are the most frequently diagnosed benign intracranial tumors. However, meningioma en plaque (MEP) is a rare subset accounting for 2.5% of all meningiomas and is characterized by flat, carpet-like proliferation along the dura, typically arising in the spheno-orbital region; therefore, causes proptosis, decreased visual acuity, and orbital pain. We present a unique case of MEP presenting with cerebrospinal fluid (CSF) rhinorrhea and conduct a systematic review of literature.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a systematic search was conducted in PubMed and Embase databases. Keywords and standardized index terms related to MEP were used. The search was performed without restriction on the publication date. Screening, data extraction, and quality assessment were carried out. Data on demographics, clinical presentations, management modalities, and treatment outcomes were analyzed.</p><p><strong>Results: </strong>The search yielded 487 titles, with 36 studies eligible for inclusion. A total of 530 patients with MEP were reported, with a mean age of 50.1±11.62 years. Proptosis was the most common symptom (95%), followed by visual impairment (57.3%), orbital pain (38.3%), ophthalmoplegia (28.6%), and headache (23%). Our patient represented the only case with a spontaneous CSF leak. Surgical resection was performed in 85%, adjuvant radiotherapy in 15.7%, and one patient received primary radiotherapy, while 8 patients were closely followed up with no intervention.</p><p><strong>Conclusion: </strong>MEP associated with spontaneous CSF rhinorrhea is extremely rare and poses diagnostic and therapeutic challenges. Conservative management for select cases of MEP can be a good choice, refraining the patient from surgical complications, especially for difficult-access skull base areas.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565005","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":"Epidemiology of Spinal Cord Injury and Associated Mortality, Past and Present. Is There a Difference?","authors":"Teleale F Gebeyehu, Eric R Mong, Sara Thalheimer, Alexander R Vaccaro, James Harrop","doi":"10.1016/j.wneu.2024.10.009","DOIUrl":"10.1016/j.wneu.2024.10.009","url":null,"abstract":"<p><strong>Background: </strong>The demographics of the population with spinal cord injury (SCI) have been dynamic over time, especially as a result of aging. This study investigated the patterns of SCI admissions by age in the United States over the past decade.</p><p><strong>Methods: </strong>Data were evaluated (2010-2021), from the National Spinal Cord Injury Model Systems records. Patients were compared based on age (<70 and ≥70 years), analysis of mortality, neurologic level of injury, neurologic improvement, mortality by American Spinal Injury Association (ASIA) grade, and neurologic level of injury. Patients older than 70 years were defined as elderly.</p><p><strong>Results: </strong>The mean age of the 8137 patients reviewed was 42.6 years (range, 15-88 years). The mean admission rate per year was 678 (range, 378-758). For the elderly versus the younger cohort, the incidence of falls decreased by 5% versus 3.3%, vehicle accidents increased by 3% versus 14%, high tetraplegia increased by 14.7% versus 22.5%, and low tetraplegia decreased by 12% versus 5.7%. In the elderly, ASIA grades A, B, and C decreased significantly, whereas ASIA grade D increased by 23.8%. In the younger cohort, ASIA grade A and B injuries increased, whereas grades C and D increased, all <5%. Overall, 32.1% of those with ASIA grade A and 68% with ASIA grade B injuries improved within 1-2 years after injury. In-hospital and 1-year mortality decreased by 14.5% and 35.4%, respectively, in the elderly.</p><p><strong>Conclusions: </strong>The incidence of SCI increased. High cervical and incomplete injuries increased, whereas complete SCIs declined. In-hospital and 1-year mortality decreased. There was recovery in select cases of complete SCIs within 1 year.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476187","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":"Pediatric Traumatic Brain Injury: Public Health Challenges and Optimizing Outcomes through Risk Stratification and Trauma Scoring Systems.","authors":"Foad Kazemi, Alan R Cohen","doi":"10.1016/j.wneu.2024.10.128","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.128","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565007","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}