Neurochirurgie最新文献

Lies, damned lies, and statistical populations 谎言、该死的谎言和统计人口。

IF 1.5 4区医学

Neurochirurgie Pub Date : 2024-11-16 DOI: 10.1016/j.neuchi.2024.101610

Jean Raymond , Tim E. Darsaut

引用次数: 0

Staged ECA-RA-MCA bypass and interventional trapping: application of hybrid vascular reconstruction of ruptured complex tandem aneurysms 分期 ECA-RA-MCA 分流和介入捕捉：破裂的复杂串联动脉瘤混合血管重建的应用。

IF 1.5 4区医学

Neurochirurgie Pub Date : 2024-11-16 DOI: 10.1016/j.neuchi.2024.101615

Peixi Liu , Qingzhu An , Yuan Shi , Wei Zhu

引用次数: 0

Natural course of the acute unruptured intracranial vertebral artery dissections which show pearl-and-string sign 显示珍珠串征的急性未破裂颅内椎动脉断裂的自然病程。

IF 1.5 4区医学

Neurochirurgie Pub Date : 2024-11-14 DOI: 10.1016/j.neuchi.2024.101614

Yoo Sung Jeon , Jeong-Jin Park , Hong Gee Roh , Young Il Chun

{"title":"Natural course of the acute unruptured intracranial vertebral artery dissections which show pearl-and-string sign","authors":"Yoo Sung Jeon , Jeong-Jin Park , Hong Gee Roh , Young Il Chun","doi":"10.1016/j.neuchi.2024.101614","DOIUrl":"10.1016/j.neuchi.2024.101614","url":null,"abstract":"<div><h3>Introduction</h3><div>Ruptured vertebral artery dissections frequently exhibit pearl-and-string signs, a characteristic also observed in many unruptured dissections. This study examines the natural course of 50 unruptured acute vertebral artery dissections presenting with pearl-and-string signs and compares them to 10 ruptured dissections of the same morphological pattern.</div></div><div><h3>Methods</h3><div>We reviewed 633 radiology reports of head and neck imaging studies that included the keyword ‘dissection’. From these, 60 cases displaying pearl-and-string signs were identified from a total of 322 vertebral artery dissections. These cases were classified based on morphological characteristics, including fusiform versus bulbous dilatation, symmetry, degree of expansion, and the severity of stenosis at both ends of the dilation. The relationships between these factors and favorable anatomical recovery were then analyzed.</div></div><div><h3>Results</h3><div>Headaches were linked to subarachnoid hemorrhages in 10 cases with bulbous dilatations. In contrast, 50 unruptured cases had fusiform dilatations, with no subsequent hemorrhages except for two cases treated preventively. Most unruptured dissections (78.4%) improved on follow-up: 48.6% fully recovered, 29.7% retained smooth dilatation, 10.8% developed irregular stenotic segments, 8.1% became occluded, and 2.7% transformed into a saccular lesion. Smaller or hypoplastic vertebral arteries were more likely to occlude (p = 0.017). Mild distal stenosis was associated with improvement (p = 0.001).</div></div><div><h3>Conclusion</h3><div>Acute unruptured intracranial vertebral artery dissections with ‘pearl-and-string’ signs had benign courses, with most recovering spontaneously and no subsequent hemorrhages. Regular imaging follow-ups at one- to three-month intervals are recommended over immediate intervention.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 1","pages":"Article 101614"},"PeriodicalIF":1.5,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640290","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}

引用次数: 0

Understanding statistical populations and inferences 了解统计群体和推论。

IF 1.5 4区医学

Neurochirurgie Pub Date : 2024-11-12 DOI: 10.1016/j.neuchi.2024.101608

Jean Raymond , Tim E. Darsaut

{"title":"Understanding statistical populations and inferences","authors":"Jean Raymond , Tim E. Darsaut","doi":"10.1016/j.neuchi.2024.101608","DOIUrl":"10.1016/j.neuchi.2024.101608","url":null,"abstract":"<div><h3>Background</h3><div>The term population is frequently used in clinical research and statistics, but concepts are multiple and confusing. Populations are a roundabout way of conceiving classifications, generalizations and inductive inferences. When misapplied, the term can lead to serious errors in study design, analysis and interpretation.</div></div><div><h3>Methods</h3><div>We review various notions of populations, their relationship with statistical inferences, and whether they refer to persons, variables or theoretical constructions.</div></div><div><h3>Results</h3><div>There are design- and model-based statistical inferences. The simplest design-based inference is from a representative random sample to a <em>real definite population</em>, but it is rarely possible or even pertinent in clinical research. The term population rarely concerns patients. S<em>uper-populations</em> are theoretical postulates of statistical models that attempt to explain the distributions and relationships of variables. <em>Pseudo-populations</em> are mathematical constructs used to balance baseline characteristics to extract causal inferences from observational studies. <em>Statistical populations</em> are as numerous as variables. This leads to an explosion of entities, with much room for divergent analyses and manipulations. <em>Target populations</em> are to whom study results should apply. In the absence of a real population, they are erroneously assimilated to the eligibility criteria of study subjects. The inductive problem remains unsolved, for inferences from study subjects to future patients then depend on the meaning of words used in indefinite descriptions.</div></div><div><h3>Conclusion</h3><div>The term population often hides more than it reveals regarding problems of generalizations and inferences. Because the term leads to errors and misconceptions, it should rarely be used in clinical research.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 1","pages":"Article 101608"},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Neurosurgery in a Pacific archipelago: how to provide optimal care. Experience of the opening of a first-line neurosurgery department 太平洋群岛的神经外科：如何提供最佳护理。开设一线神经外科的经验。

IF 1.5 4区医学

Neurochirurgie Pub Date : 2024-11-08 DOI: 10.1016/j.neuchi.2024.101612

Paul Roblot , Kaïssar Farah , Lorenzo Mongardi , Thierry De Greslan , Alizee Gessen , Nora Rossetto , Stéphane Litrico , Jean-Rodolphe Vignes , Stéphane Fuentes

{"title":"Neurosurgery in a Pacific archipelago: how to provide optimal care. Experience of the opening of a first-line neurosurgery department","authors":"Paul Roblot , Kaïssar Farah , Lorenzo Mongardi , Thierry De Greslan , Alizee Gessen , Nora Rossetto , Stéphane Litrico , Jean-Rodolphe Vignes , Stéphane Fuentes","doi":"10.1016/j.neuchi.2024.101612","DOIUrl":"10.1016/j.neuchi.2024.101612","url":null,"abstract":"<div><h3>Introduction</h3><div>In the beginning of November 2023, the authors launched a neurosurgery department in Nouméa, New Caledonia. Emergency cranial surgeries are performed by orthopedic surgeons. All other cases are transferred to Australia or mainland France.</div><div>Opening a neurosurgery department matches the current needs of the population. The department opened 10 inpatient beds on February 1st, 2024.</div></div><div><h3>First neurosurgical experience</h3><div>During the first 3 months, 108 surgeries were performed: 32 cranial and 76 spinal. Surgical indications were mostly traumatic, degenerative, infectious, tumoral, vascular pathology, and cerebrospinal fluid resorption disorder.</div></div><div><h3>Patient characteristics</h3><div>There were 93 patients: 58 male, 35 female; median age, 53 years [IQR, 42 ; 65]. Median body mass index was 27.8 [23.4 ; 31.9]. Seven patients were admitted for spontaneous infection (7.5%). Eight (8.6%) were operated on for postoperative infection, including one cranial and one spinal infection initially managed elsewhere. These 15 patients had a median BMI of 31 [24.9 ; 34.4].</div></div><div><h3>Conclusion</h3><div>The permanent presence of two neurosurgeons seems justified. Some pathologies can be managed on-site, but transfers to centers in Australia or mainland France will remain necessary. We strongly recommend having such a first-line neurosurgery department in this type of isolated territory.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 1","pages":"Article 101612"},"PeriodicalIF":1.5,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607322","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}

引用次数: 0

Cerebral herniation, arterial ischemia and the Kernohan-Woltman notch phenomenon 脑疝、动脉缺血和克诺汉-沃尔特曼缺口现象。

IF 1.5 4区医学

Neurochirurgie Pub Date : 2024-11-08 DOI: 10.1016/j.neuchi.2024.101611

Rodrigo Carrasco Moro , José M. Pascual

引用次数: 0

Understanding the role of induction, intensions and extensions in pragmatic clinical research and practice 了解归纳、意图和延伸在实用临床研究和实践中的作用。

IF 1.5 4区医学

Neurochirurgie Pub Date : 2024-11-07 DOI: 10.1016/j.neuchi.2024.101609

Jean Raymond , Tim E. Darsaut

{"title":"Understanding the role of induction, intensions and extensions in pragmatic clinical research and practice","authors":"Jean Raymond , Tim E. Darsaut","doi":"10.1016/j.neuchi.2024.101609","DOIUrl":"10.1016/j.neuchi.2024.101609","url":null,"abstract":"<div><h3>Background</h3><div>Pragmatic clinical research methods are poorly understood, but essential to practice outcome-based medical or surgical care. Pragmatic research aims to verify the connections between medical knowledge and the reality of practice. Its methods can be understood by reviewing the problems of induction, as well as the related linguistic and mathematical notions of intensions and extensions.</div></div><div><h3>Methods</h3><div>We briefly review the source of problems with using inductive methods to gain knowledge, and the relationships between language, mathematics and reality. We discuss linguistic 'sense’ and ‘reference’, and the set-theory terms ‘intensions’ and ‘extensions’, which define the relationship between individuals and whichever pertinent collection these individuals comprise. Both concepts are essential to understand pragmatic medical research and evidence-based practice.</div></div><div><h3>Results</h3><div>Pragmatic clinical research can be explained in terms of testing (in reality) the repeatability of various inductive referential and inferential steps used in clinical practice - from reliability, diagnostic accuracy, and prognostic studies to pragmatic trials. All pragmatic studies aim to verify the relationship between the extensions of the notions of symptoms, diagnoses, prognoses, treatments, and outcomes. The concepts of intensions and extensions also serve to understand ‘statistical significance’ in analyzing trial results, as well as problems related to eligibility criteria and subgroup analyses. The results of clinical studies can be generalized to the extent that they have been tested in numerous and widely different individuals.</div></div><div><h3>Conclusion</h3><div>The notions of sense and reference, and of intensions and extensions, help explain the role pragmatic clinical research methods can play in optimizing care.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 1","pages":"Article 101609"},"PeriodicalIF":1.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Differences in internal carotid artery tortuosity in ruptured and unruptured anterior circulation aneurysms. A matched case-control study 前循环动脉瘤破裂与未破裂时颈内动脉迂曲度的差异。匹配病例对照研究。

IF 1.5 4区医学

Neurochirurgie Pub Date : 2024-11-07 DOI: 10.1016/j.neuchi.2024.101613

Noemi Cinti , Paul J. McKeegan , Peter J. Bazira , Aubrey Smith , Paul Maliakal , Mihai Danciut , Hamed Nejadhamzeeigilani

{"title":"Differences in internal carotid artery tortuosity in ruptured and unruptured anterior circulation aneurysms. A matched case-control study","authors":"Noemi Cinti , Paul J. McKeegan , Peter J. Bazira , Aubrey Smith , Paul Maliakal , Mihai Danciut , Hamed Nejadhamzeeigilani","doi":"10.1016/j.neuchi.2024.101613","DOIUrl":"10.1016/j.neuchi.2024.101613","url":null,"abstract":"<div><h3>Objective</h3><div>Tortuosity of the internal carotid artery is believed to contribute to the formation of intracranial aneurysms, although there is scant literature on its role as a risk factor for rupture specifically. Therefore, this study investigated the influence of cervical internal carotid artery (cICA) tortuosity on rupture of aneurysms of the anterior cerebral circulation.</div></div><div><h3>Methods</h3><div>Angiographic imaging studies from patients who underwent endovascular embolisation for anterior circulation aneurysms at a tertiary centre were identified. 83 patients with a history of aneurysmal rupture and subarachnoid haemorrhage (SAH group) were matched for age, aneurysm location and size, history of subarachnoid haemorrhage and hypertension to 83 subjects with unruptured aneurysms (control group). cICA tortuosity was assessed utilising subjective (kinks, loops or coils) and objective (tortuosity index) parameters.</div></div><div><h3>Results</h3><div>Subjective cICA tortuosity was identified in 33.7% and 56.6% of patients in the SAH and control groups respectively (OR 0.39 [95% CI 0.21–0.75]). Objective cICA tortuosity was present in 35.7% and 46.8% of SAH and control patients (OR 0.63 [95% CI 0.32–1.27]). OR values are suggestive of cICA tortuosity as a negative predictor of aneurysmal rupture, with more predictive power attributed to the subjective assessment, despite the limited statistical significance of the objective results.</div></div><div><h3>Conclusions</h3><div>This study demonstrated an increased presence of cICA tortuosity in unruptured aneurysms compared to ruptured aneurysms, suggesting it is unlikely to represent a risk factor for rupture. Further research in the form of longitudinal observational studies of untreated aneurysms would aid in investigating cICA tortuosity as a protective factor.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 1","pages":"Article 101613"},"PeriodicalIF":1.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607319","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}

引用次数: 0

Deformational plagiocephaly multi-group outpatient clinics reduce referral to visit times and visit length 畸形儿多组门诊减少了从转诊到就诊的时间和就诊时间。

IF 1.5 4区医学

Neurochirurgie Pub Date : 2024-11-06 DOI: 10.1016/j.neuchi.2024.101617

David Shepetovsky , Asaf Olshinka , Amir Kershenovich

{"title":"Deformational plagiocephaly multi-group outpatient clinics reduce referral to visit times and visit length","authors":"David Shepetovsky , Asaf Olshinka , Amir Kershenovich","doi":"10.1016/j.neuchi.2024.101617","DOIUrl":"10.1016/j.neuchi.2024.101617","url":null,"abstract":"<div><h3>Objective</h3><div>Deformational plagiocephaly (DP) is a well-recognized condition, affecting up to 20% of all babies. Its prevalence lead centers worldwide to create multi-group clinics and incorporate technology to decrease repetitive counselling, save clinic hours and shorten waiting times.</div><div>This paper describes the modalities incorporated in our craniofacial clinic since 2016 and their effect on our patient population.</div></div><div><h3>Methods</h3><div>Data were collected retrospectively between November 2016 and September 2022 and prospectively between April and May of 2024. This period was divided into eight bimesters constituting several different clinic modalities. Data included the number of patients, no-shows, referral to visit times (RVT), visit length (VL), satisfaction rates, and demographics of all patients visiting our clinic and those referred specifically for DP.</div></div><div><h3>Results</h3><div>A total of 1794 patients, reviewed retrospectively, were included, 202 were referred for DP. Mean RVT was 38.5 days for all patients. For DP patients, mean RVTs were (according to bimesters): 107 days (older triage system), 59 days (newer system, new monthly craniofacial clinic, additional clinic slots), 58 days (cranial orthosis program, first multi-group clinic), 52 days (online lecture), 35 days (end of Covid lockdown), 43 days (pre-recorded presentations), and 47 days (multi-group encounters). RVT decreased to 17 days in the prospective bimester, during which another 117 DP patients were seen. Mean VL averaged 22 min for the first six bimesters and then decreased to 11 and 7 min during the seventh and eighth bimesters respectively.</div></div><div><h3>Conclusion</h3><div>Multi-group encounters for DP are highly effective in reducing RVTs and VL.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 1","pages":"Article 101617"},"PeriodicalIF":1.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632178","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}

引用次数: 0

The current state of Spina Bifida in low- and middle-income countries: where does Africa stand? 中低收入国家脊柱裂现状：非洲的现状如何？

IF 1.5 4区医学

Neurochirurgie Pub Date : 2024-11-06 DOI: 10.1016/j.neuchi.2024.101616

Inibehe Ime Okon , Agbeniga Elijah Temitope , Ibukunolu Olufemi Ogundele , Usoro Akpan , Emem Okon Mbong , Omar Kasimieh , Bipin Chaurasia , Emmanuel James , Elkan Gbadebo , Fadele Kehinde Precious , Arwa Jader , Olalekan John Okesanya , Vishal Karmani , Michael Erhayanmen , Don Eliseo Lucero-Prisno III

{"title":"The current state of Spina Bifida in low- and middle-income countries: where does Africa stand?","authors":"Inibehe Ime Okon , Agbeniga Elijah Temitope , Ibukunolu Olufemi Ogundele , Usoro Akpan , Emem Okon Mbong , Omar Kasimieh , Bipin Chaurasia , Emmanuel James , Elkan Gbadebo , Fadele Kehinde Precious , Arwa Jader , Olalekan John Okesanya , Vishal Karmani , Michael Erhayanmen , Don Eliseo Lucero-Prisno III","doi":"10.1016/j.neuchi.2024.101616","DOIUrl":"10.1016/j.neuchi.2024.101616","url":null,"abstract":"<div><div>Spina bifida is a congenital neural tube defect that results in abnormal development of the spine and central nervous system. Infants born with this condition face a range of physical disabilities and associated complications. Although the global burden has declined in recent decades due to folic acid fortification and prenatal screening, spina bifida remains a significant public health challenge in many low- and middle-income countries (LMICs), particularly in sub-Saharan Africa. This research aimed to comprehensively assess the current epidemiological trends, clinical management practices, and socioeconomic impacts of spina bifida across African LMICs. Through a systematic analytical search of published literature from major medical databases covering the years 2000–2023, relevant data were extracted on the prevalence, risk factors, clinical presentations, treatment modalities, outcomes, and contextual barriers faced in preventing and caring for spina bifida in these settings. The findings were analyzed and synthesized to provide an overview of the contemporary landscape. The findings highlight the need for collaborative efforts between governments, healthcare providers, nongovernmental organizations, and international stakeholders to address the multifaceted challenges posed by spina bifida in LMICs, particularly within the African continent, and to promote equitable access to comprehensive care and support for affected individuals and their families.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 1","pages":"Article 101616"},"PeriodicalIF":1.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632176","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}

引用次数: 0