Brain & spine最新文献

{"title":"The crisis of the third day in intracranial pressure dynamics following traumatic brain injury, fact or fiction?","authors":"R D Singh, M W H Bolscher, J T J M van Dijck, R J G Vreeburg, I A M van Erp, V Lubrano, G C W de Ruiter, B Depreitere, S C Cannegieter, B Siegerink, T A van Essen, W C Peul","doi":"10.1016/j.bas.2024.104135","DOIUrl":"10.1016/j.bas.2024.104135","url":null,"abstract":"<p><strong>Introduction: </strong>In 1960, Lazorthes and Campman introduced the concept of a <i>'crisis of the third day',</i> which gained prominence in the field of traumatic brain injury (TBI), where it relates to neurological deterioration on the third day after injury. However, evidence regarding this phenomenon remains scarce.</p><p><strong>Research question: </strong>This study aimed to analyze posttraumatic intracranial pressure (ICP) patterns in a large European cohort to investigate the existence of a third-day crisis and its impact on 12-month functional outcomes.</p><p><strong>Materials and methods: </strong>Data were analyzed from the prospective Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Patients with TBI admitted to ICUs in 65 European centers who received ICP monitoring were included. ICP measurements, averaged per day, were analyzed using mixed models. The association between ICP peak timing and functional outcome was examined with multivariable logistic regression.</p><p><strong>Results: </strong>The study included 886 patients. Average ICP trajectories showed no significant changes over the first seven days post-injury, without elevation around the third day. Among 563 patients with ICP >20 during the first week, 45% reached their highest ICP after the third day. Elevated ICP (>20 mmHg) during the first week was associated with unfavorable 12-month outcomes, but the timing of ICP peak was not linked to functional outcomes.</p><p><strong>Discussion and conclusion: </strong>This multicenter study challenges the 'crisis of the third day' concept. No distinct ICP or TIL elevations were observed around the third day. Elevated ICP remains a prognostic indicator, but ICP peak timing does not correlate with functional outcomes.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"104135"},"PeriodicalIF":1.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why are clinical trials of deep brain stimulation terminated? An analysis of clinicaltrials.gov (new version).","authors":"Muhammad Daniyal Shafqat, Inibehe Ime Okon","doi":"10.1016/j.bas.2024.104137","DOIUrl":"10.1016/j.bas.2024.104137","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"104137"},"PeriodicalIF":1.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor \"Surgical management of Aneurysmal Subarachnoid Haemorrhage in a resource-constrained region: A Nigerian regional experience\".","authors":"Sadia Farhana","doi":"10.1016/j.bas.2024.104132","DOIUrl":"10.1016/j.bas.2024.104132","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"104132"},"PeriodicalIF":1.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11570724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postictal vertebral fractures: Incidence, risk factors, and clinical outcomes. A systematic review.","authors":"Salvador Manrique-Guzman, Ana Karen Perez-Vazquez, Claudia Lerma, Francisco R Revilla-Pacheco, Tenoch Herrada-Pineda, Jorge Francisco Sanchez Santa-Ana, Maria Jose Wilches-Davalos, Iliana Margarita Esquivel-Valdes, Caroline Larocque-Guzman, Tania Ivette Sanchez-Zacarias","doi":"10.1016/j.bas.2024.103929","DOIUrl":"10.1016/j.bas.2024.103929","url":null,"abstract":"<p><strong>Introduction: </strong>Vertebral fractures in postictal patients with no prior acute or chronic trauma history are rare but can lead to severe neurological complications if missed during the initial evaluation.</p><p><strong>Research question: </strong>What are the prevalence and risk factors associated with vertebral fractures? What are the characteristics of these fractures in terms of their location, severity, and clinical outcome?</p><p><strong>Materials and methods: </strong>A comprehensive literature search using MeSH terms was conducted. Data from previously published studies and three new cases from the authors' institution were collected. The variables included demographic information, seizure history, medical comorbidities, fracture characteristics, and treatment details. Descriptive statistics summarize the data. Inferential statistics (<i>t</i>-test, Mann-Whitney <i>U</i> test, chi-squared test, Fisher's exact test, and logistic regression) were used to identify the risk factors for vertebral fractures.</p><p><strong>Results: </strong>The review included nine studies with a total of 19 patients, and three additional unpublished cases from the authors' institution. The median patient age was 50 years, with male predominance. No significant differences were found between the groups in osteoporosis, seizure history, antiepileptic drug use, or alcohol or drug abuse. The most common sites of fracture were the midthoracic spine for compression fractures and thoracolumbar junction for burst fractures. Risk factors for fractures include greater muscle mass, lower bone mineral density, longer convulsions, and recurrent convulsions.</p><p><strong>Discussion: </strong>The mechanism of injury involved violent muscle contractions during seizures.</p><p><strong>Conclusion: </strong>This review summarizes the current knowledge and provides evidence for best practices in the management of seizure-induced vertebral fractures.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"103929"},"PeriodicalIF":1.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare primary dedifferentiated liposarcoma of the thoracic spine: A case report and literature review.","authors":"Christine Kögler, Bernhard W Ullrich, Klaus D Schaser, Alexander C Disch, Gunther O Hofmann, Felix Göhre, Christian Mawrin, Matthias Vogt","doi":"10.1016/j.bas.2024.103920","DOIUrl":"10.1016/j.bas.2024.103920","url":null,"abstract":"<p><strong>Introduction: </strong>Primary dedifferentiated liposarcomas of the spine mark a rare tumor entity.</p><p><strong>Research question and case description: </strong>We present a rare case of a primary dedifferentiated liposarcoma of the thoracic spine. A 36-year-old previously completely healthy woman presented with a sudden ascending paresthesia of both legs, persistently increasing over the course of two days before initial presentation.</p><p><strong>Case report: </strong>Computed tomography and magnetic resonance imaging revealed an expansively growing tumor mass extending from T5 to T6 and absolutely compressing the dural sac and spinal cord. The patient's neurological function completely recovered after emergency posterior decompression via laminectomy with intralesional tumor debulking. The tumor was histologically classified as primary grade 2 dedifferentiated liposarcoma (DDLPS) of the spine and after referral to a sarcoma center, the patient was treated with three courses of polychemotherapy (doxorubicin plus ifosfamide). Chemotherapy was followed by aggressive resection by en-bloc spondylectomy in cooperation with a spine tumor center. Subsequently, the patient also underwent radiation therapy.</p><p><strong>Results: </strong>The patient still undergoes structured tumor aftercare and is tumor- and metastasis-free 53 months after tumor resection.</p><p><strong>Discussion and conclusion: </strong>DDLPS rarely occur in the spine, with definitive resection of the tumor being the treatment of choice. Surgery should be accompanied by other (radio-) oncological treatment options in cases where only subtotal resection is possible. Also, referral of patients with primary sarcomas of the spine to specialized sarcoma centers is essential, so they can be provided with individual treatment options and structured interdisciplinary aftercare, that ensure the best possible outcome.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"103920"},"PeriodicalIF":1.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11570891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The concepts of Intra Spinal Pressure (ISP), Intra Thecal Pressure (ITP), and Spinal Cord Perfusion Pressure (SCPP) in acute, severe traumatic spinal cord injury: Narrative review.","authors":"Samira Saadoun, Hasan Asif, Marios C Papadopoulos","doi":"10.1016/j.bas.2024.103919","DOIUrl":"10.1016/j.bas.2024.103919","url":null,"abstract":"<p><p>There is increasing interest in monitoring pressure from the injured spinal cord to guide the management of patients with acute, severe traumatic spinal cord injuries (TSCI). This is analogous to monitoring intracranial pressure and cerebral perfusion pressure in traumatic brain injury (TBI). Here, we explore key concepts in this field and novel therapies that are emerging from these ideas. We argue that the Monro-Kellie doctrine, a fundamental principle in TBI, may also apply to TSCI as follows: The injured cord swells, initially displacing surrounding cerebrospinal fluid (CSF) that prevents a rise in spinal cord pressure; once the CSF space is exhausted, the spinal cord pressure at the injury site rises. The spinal Monro-Kellie doctrine allows us to define novel concepts to guide the management of TSCI based on principles employed in the management of TBI such as intraspinal pressure (ISP), intrathecal pressure (ITP), spinal cord perfusion pressure (SCPP), spinal pressure reactivity index (sPRx), and optimum SCPP (SCPP_opt). Draining lumbar CSF and expansion duroplasty are currently undergoing clinical trials as novel therapies for TSCI. We conclude that there is acknowledgement that blood pressure targets applied to all TSCI patients are inadequate. Current research aims to develop individualised management based on ISP/ITP and SCPP monitoring. These techniques are experimental. A key controversy is whether the spinal cord pressure is best measured from the injury site (ISP) or from the lumbar cerebrospinal fluid (ITP).</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"103919"},"PeriodicalIF":1.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fat beyond muscle: Assessing epimuscular fat of the lumbar spine and its association with vertebral level, demographics, BMI, and low back pain.","authors":"Jacopo A Vitale, Anne F Mannion, Daniel Haschtmann, Mario Ropelato, Tamás F Fekete, Frank S Kleinstück, Markus Loibl, Tina Haltiner, Fabio Galbusera","doi":"10.1016/j.bas.2024.103916","DOIUrl":"10.1016/j.bas.2024.103916","url":null,"abstract":"<p><strong>Introduction: </strong>Epimuscular fat (EF) has rarely been studied in the context of low back pain (LBP).</p><p><strong>Research question: </strong>This study aims to assess the presence and extent of EF in the lumbar muscles and its association with vertebral level in patients with low back disorders and to explore correlations between EF, demographics, BMI, and LBP.</p><p><strong>Material and methods: </strong>T2 axial MRIs from L1 to L5 were manually segmented to analyze the cross-sectional area (CSA) of EF (mm²), and fat infiltration (FI,%) of 40 patients (23 females, 17 males; mean age:65.9 years) with lumbar degenerative pathologies awaiting a surgical procedure. COMI, LBP, demographic, and clinical data were extracted from the institutional registry. Statistical analyses included Wilcoxon and Mann-Whitney tests for differences in EF between sides and sexes, the Friedman test for EF size differences among lumbar levels, and Spearman's correlation for associations, adjusted for BMI, age, and sex.</p><p><strong>Results: </strong>EF was found in 77.5% of subjects at L1, 92.5% at L2, 100% at L3 and L4, and 95.0% at L5. EF was significantly larger at L4 (253.1 ± 183.6 mm²) and L5 (220.2 ± 194.9 mm²) than at L1 (36.1 ± 37.8 mm²) and L2 (72.2 ± 84.4 mm²). No significant EF differences were found between sides and sexes. EF correlated strongly with BMI (r_s = 0.65,p < 0.001) and moderately with FI (r_s = 0.31,p = 0.04), though its correlation with FI was not significant after adjustment. EF did not correlate with COMI scores but correlated with LBP in the adjusted analysis (r_s:0.31,p = 0.04).</p><p><strong>Discussion and conclusion: </strong>EF is present across all lumbar levels, with higher concentrations at L4 and L5, and a significant correlation between EF and LBP intensity was observed. The present findings are limited to a specific subset of patients with lumbar degenerative disorders who are awaiting surgical procedures.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"103916"},"PeriodicalIF":1.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The application of medical ethics in the developing countries - A neurosurgical perspective.","authors":"Iftakher Hossain, Peter Hutchinson, Khandkar Kawsar, Angelos Kolias, Adriana Libório Dos Santos, Ignatius N Esene, Nqobile Thango, Ronnie Baticulon, Beata Laki, Ahmed Ammar","doi":"10.1016/j.bas.2024.103921","DOIUrl":"10.1016/j.bas.2024.103921","url":null,"abstract":"<p><strong>Introduction: </strong>Neurosurgery is one of the rapidly evolving specialities of medical science, where the neurosurgeons have to provide evidence-based interventions in life threatening conditions maintaining the ethical standards.</p><p><strong>Research question: </strong>This narrative review sheds light on the current hindrances of the ethical aspects of neurosurgical practice in low and middle-income countries (LMICs) and provide some feasible solutions for future.</p><p><strong>Material and methods: </strong>A literature search was conducted using PubMed, Scopus and ISI web of knowledge focused on articles in English with the words \"medical ethics\" together with the words \"neurosurgery\", \"ethical practice\", \"low and middle-income countries\", \"surgical innovation\", \"randomized clinical trials\" and \"outcome\" alone or in combination.</p><p><strong>Results: </strong>Due to the lack of neurosurgeons and essential infrastructures in LMICs, the practical application of medical ethics is more complicated in the field of neurosurgery. Main obstacles to conduct preclinical and clinical research in the LMICs are the lack of proper ethics committees, quality data, trained manpower and sufficient research funding. Implementation of randomized clinical trials (RCTs) is also difficult for the neurosurgeons working in LMICs.</p><p><strong>Discussion and conclusion: </strong>To improve the situation, socio-economic development, including educating the citizens of these countries about their rights, functional regulatory bodies like medical and dental councils, teaching the neurosurgeons about the internationally recognized medical ethics, quality control regulations by the ministry of health and welfare, and more funding for the health care sectors are urgently needed. Global collaboration is needed to help the LMICs to provide their patients international but \"customized\" standard care.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"103921"},"PeriodicalIF":1.9,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EANS Epilepsy surgery Brain Dissection Course Vienna 2024.","authors":"Karl Rössler, Dirk Van Roost, Olaf Schijns","doi":"10.1016/j.bas.2024.103924","DOIUrl":"https://doi.org/10.1016/j.bas.2024.103924","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"103924"},"PeriodicalIF":1.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11543639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronal alignment in normal individuals and moderate scoliosis: Normative values, variation with age and comparison with sagittal alignment.","authors":"Ahmed Gharbi, Ibrahim Obeid, Daniel Larrieu, Louis Boissière, Maxime Huneidi, Pablo Lamotte-Paulet, Mekki Tamir, Carlos Aleman, Yann Philippe Charles","doi":"10.1016/j.bas.2024.103917","DOIUrl":"10.1016/j.bas.2024.103917","url":null,"abstract":"<p><strong>Introduction: </strong>Global coronal alignment is mainly assessed by C7 plumbline and central sacral vertical line (CSVL), pelvic obliquity and shoulder alignment. A detailed analysis is mandatory when treating spinal deformity. It remains unclear to what extent mild scoliosis influences global coronal alignment.</p><p><strong>Research question: </strong>The objective was to define a comprehensive set of coronal alignment parameters and to investigate differences between individuals without spinal deformity and with mild scoliosis. The relationship between coronal and sagittal alignment and the influence of age were studied.</p><p><strong>Methods: </strong>Radiographs of 236 normal individuals (Group N) and 140 patients with scoliosis <35° (Group S) were prospectively collected. Coronal parameters were femoral head distance and angle, pelvic obliquity, Maloney angle, L4 and L5 inclinations, coronal T1 pelvic angle, C7-CSVL and odontoid CSVL offset, coracoid distance and angle. Sagittal cervical, spinopelvic, thoracolumbar and global parameters were measured.</p><p><strong>Results: </strong>There was no significant difference between groups N and S for coronal parameters, except for L4 and L5 inclinations with a mean difference of 3,3° (p < 0,001). Global coronal alignment kept constant throughout age groups in N and S groups. Sagittal parameters varied with age: C2-C7 lordosis (p < 0,001), T1-T12 kyphosis (p < 0,001), pelvic incidence (p < 0,001). There was no correlation between global coronal and sagittal alignment: R-values ranging from -0.2 to 0.2.</p><p><strong>Conclusion: </strong>Global coronal parameters were comparable in normal individuals and in scoliosis <35°. Coronal plane parameters were not influenced by age. Sagittal plane parameters varied significantly with age. There was no direct link between coronal et sagittal alignment.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"103917"},"PeriodicalIF":1.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}