British Journal of Neurosurgery最新文献

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Effectiveness of intraoperative table modification for achieving lumbar lordosis in multilevel lumbar fusion surgery: a propensity score-matched study. 在多节段腰椎融合手术中,术中改变手术台面治疗腰椎前凸的有效性:一项倾向评分匹配的研究。
IF 1 4区 医学
British Journal of Neurosurgery Pub Date : 2025-06-01 Epub Date: 2023-07-16 DOI: 10.1080/02688697.2023.2233640
Hong Kyung Shin, Han Ga Wi Nam, Il Choi, Jin Hoon Park, Sung Woo Roh, Sang Ryong Jeon
{"title":"Effectiveness of intraoperative table modification for achieving lumbar lordosis in multilevel lumbar fusion surgery: a propensity score-matched study.","authors":"Hong Kyung Shin, Han Ga Wi Nam, Il Choi, Jin Hoon Park, Sung Woo Roh, Sang Ryong Jeon","doi":"10.1080/02688697.2023.2233640","DOIUrl":"10.1080/02688697.2023.2233640","url":null,"abstract":"<p><strong>Background: </strong>In multilevel posterior lumbar interbody fusion (PLIF) with posterior screw fixation, obtaining sufficient lumbar lordosis (LL) is difficult, especially in patients with osteoporosis. We performed intraoperative table modification (TM) using gravitational dropping of the patient's lumbar spine, to improve restoration of LL.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of patients who underwent three- or four-level PLIF between 2005 and 2019. One hundred eleven patients were enrolled, with 96 patients receiving non-TM-PLIF and 15 patients receiving TM-PLIF. Radiological parameters, including segmental lordosis (SL), LL, sacral slope (SS), pelvic incidence, and pelvic tilt, were measured. Clinical outcomes were measured using a visual analogue scale (VAS) for the back and leg preoperatively and at the last follow-up. Additionally, the correlation between the bone mineral density (BMD) and the radiological parameters was calculated for TM-PLIF. We performed propensity score matching between the groups to control the baseline difference.</p><p><strong>Results: </strong>We found a statistically better correction between immediate and last follow-up postoperative SL (p = 0.04), as well as between preoperative and last follow-up SL (p < 0.01) in the TM-PLIF group compared to that in the non-TM-PLIF group. VAS for the back and leg were not significantly different between the two groups. Additionally, the efficacy of lordosis correction in the TM-PLIF group showed a statistically significant negative correlation between BMD and the SS change both before and after the surgery (rho = -0.60, p = 0.02).</p><p><strong>Conclusion: </strong>Whilst further study is required to conclusively establish its efficacy, TM-PLIF (table modification using gravitational dropping) shows potential advantages for restoring and maintaining LL in multilevel lumbar fusion, particularly in cases with low BMD.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"303-311"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10157046","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
Sequential rupture of two concomitant cerebral aneurysms. 两个并发的脑动脉瘤连续破裂。
IF 1 4区 医学
British Journal of Neurosurgery Pub Date : 2025-06-01 Epub Date: 2023-07-12 DOI: 10.1080/02688697.2023.2233607
Joseph Yoon, Ryan Goh, Craig Winter
{"title":"Sequential rupture of two concomitant cerebral aneurysms.","authors":"Joseph Yoon, Ryan Goh, Craig Winter","doi":"10.1080/02688697.2023.2233607","DOIUrl":"10.1080/02688697.2023.2233607","url":null,"abstract":"<p><p>The diagnosis of multiple cerebral aneurysms in patients with a spontaneous aneurysmal subarachnoid haemorrhage is not uncommon. The incidence of rupture from a second aneurysm, whilst the patient is recovering from a first bleed is however extremely rare. We report a 21-year-old female with a WFNS grade 1 subarachnoid haemorrhage secondary to a ruptured 5mm right posterior communicating artery aneurysm which was secured with clipping. Sixteen days later, whilst an in-patient, she suffered a second SAH from a left anterior choroidal artery aneurysm which was subsequently coiled. Comparison of digital subtraction angiography showed an almost doubling of the aneurysm from 2.7x2 mm to 4.4x2.3 mm. We review the literature of previously reported simultaneous and sequential aneurysmal subarachnoid haemorrhage and add to the sparse literature on this rare phenomena.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"375-379"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129508","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
Drop metastasis from the extradural to the intradural space in spinal Ewing's sarcoma - a novel case report. 脊椎骨尤文氏肉瘤从硬膜外转移到硬膜内-一个新病例报告。
IF 1 4区 医学
British Journal of Neurosurgery Pub Date : 2025-06-01 Epub Date: 2023-09-18 DOI: 10.1080/02688697.2023.2258205
Alaa Al-Mohammad, Edward W Dyson, Vittorio M Russo, Antonino Russo
{"title":"Drop metastasis from the extradural to the intradural space in spinal Ewing's sarcoma - a novel case report.","authors":"Alaa Al-Mohammad, Edward W Dyson, Vittorio M Russo, Antonino Russo","doi":"10.1080/02688697.2023.2258205","DOIUrl":"10.1080/02688697.2023.2258205","url":null,"abstract":"<p><p>Spinal Ewing's Sarcoma is a rare tumour predominantly affecting children and adolescents. We describe the case of an 18-year-old male patient who first presented with a primary extradural cervical Ewing's sarcoma tumour, and 5 years later had a recurrence with thoracolumbar and lumbosacral intradural extramedullary Ewing's sarcoma tumours. Both presentations were successfully treated by surgical resection and adjuvant chemo- and radiotherapy, and he remains disease-free at 12 months follow-up. This is the first reported case of seeding of tumour from an extradural primary Ewing's sarcoma to intradural metastases. Total surgical resection of his initial cervical tumour, performed at another centre, was complicated by a dural tear and CSF leak. Thus, we propose that isolated drop metastasis via CSF fistula is the most likely mechanism for tumour spread in this case. Thus, clinicians may wish to counsel patients on the possibility of such spread if a CSF leak is encountered, and potentially increase the frequency of imaging surveillance of the whole spine in this context.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"388-391"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10314130","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
Ventriculo-inferior-venacaval shunt salvage via endovascular surgery. 通过血管内手术挽救脑室-下腔静脉分流。
IF 1 4区 医学
British Journal of Neurosurgery Pub Date : 2025-06-01 Epub Date: 2023-07-09 DOI: 10.1080/02688697.2023.2233619
Megan E H Still, Rachel S F Moor, Amanda N Stanton, Justin D Hilliard, Benjamin N Jacobs, Lance S Governale
{"title":"Ventriculo-inferior-venacaval shunt salvage via endovascular surgery.","authors":"Megan E H Still, Rachel S F Moor, Amanda N Stanton, Justin D Hilliard, Benjamin N Jacobs, Lance S Governale","doi":"10.1080/02688697.2023.2233619","DOIUrl":"10.1080/02688697.2023.2233619","url":null,"abstract":"<p><strong>Introduction: </strong>Hydrocephalus treatment can be very challenging. While some hydrocephalic patients can be treated endoscopically, many will require ventricular shunting. Frequent shunt issues over a lifetime is not uncommon. Although most shunt malfunctions are of the ventricular catheter or valve, distal failures occur as well. A subset of patients will accumulate non-functioning distal drainage sites.</p><p><strong>Case description: </strong>We present a 27-year-old male with developmental delay who was shunted perinatally for hydrocephalus from intraventricular hemorrhage of prematurity. After failure of the peritoneum, pleura, superior vena cava (SVC), gallbladder, and endoscopy, an inferior vena cava (IVC) shunt was placed minimally-invasively via the common femoral vein. We believe this is only the eighth reported ventriculo-inferior-venacaval shunt. IVC occlusion years later was successfully treated with endovascular angioplasty and stenting followed by anticoagulation. To our knowledge, a ventriculo-inferior-venacaval shunt salvaged by endovascular surgery has not been previously described in the literature.</p><p><strong>Conclusion: </strong>After failure of the peritoneum, pleura, SVC, gallbladder, and endoscopy, IVC shunt placement is an option. Subsequent IVC occlusion can be rescued by endovascular angioplasty and stenting. Anticoagulation after stenting (and potentially after initial IVC placement) is advised.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"380-382"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9767047","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
Atypical teratoid rhabdoid tumour in the third ventricle of a young adult - a rare presentation. 年轻人第三脑室的非典型畸胎瘤样横纹肌样肿瘤-罕见的表现。
IF 1 4区 医学
British Journal of Neurosurgery Pub Date : 2025-06-01 Epub Date: 2023-07-26 DOI: 10.1080/02688697.2023.2239919
Ram Kishan Nekkanti, Easwer Hariharan Venkat, Gowtham Matham, Akhilesh Gowda G B, Rajalakshmi Poyuran
{"title":"Atypical teratoid rhabdoid tumour in the third ventricle of a young adult - a rare presentation.","authors":"Ram Kishan Nekkanti, Easwer Hariharan Venkat, Gowtham Matham, Akhilesh Gowda G B, Rajalakshmi Poyuran","doi":"10.1080/02688697.2023.2239919","DOIUrl":"10.1080/02688697.2023.2239919","url":null,"abstract":"<p><strong>Introduction: </strong>Atypical teratoid/rhabdoid tumours (AT/RT) are malignant CNS tumours predominantly seen in infants and children. Adult AT/RTs have a predilection for mid-line structures, such as the pineal and pituitary glands. We report a case of AT/RT in a young adult, with its origin from the third ventricle. This is the first documented case of adult AT/RT in the third ventricle.</p><p><strong>Case presentation: </strong>A 20-year-old male presented with acute onset headache and vomiting. MRI showed a lesion involving the optic chiasm, hypointense on T1, and heterogeneously hyperintense on T2, with stippled post-contrast enhancement. He underwent a right peri-coronal parasagittal craniotomy, transforaminal and sub choroidal approach with gross total tumour resection. Histopathological report was ATRT, WHO grade 4, with loss of SMARCB1 (INI1) protein. He later underwent a ventriculo-peritoneal shunt placement for postoperative hydrocephalus and was later given adjuvant chemoradiotherapy. No recurrence was noted on follow up MRI.</p><p><strong>Conclusion: </strong>AT/RTs are not limited to the paediatric age group, and their incidence among adults is being increasingly reported. Occurrence of AT/RT in the third ventricle of a young adult male has never been reported in the past. It merits consideration as a differential diagnosis of any midline lesion with malignant appearance in adults.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"383-387"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10247908","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
Suspected abusive head trauma in children - when do they really need to be transferred to a neurosurgical unit? 疑似虐待性头部创伤的儿童——他们什么时候真的需要转到神经外科?
IF 1 4区 医学
British Journal of Neurosurgery Pub Date : 2025-06-01 Epub Date: 2023-08-26 DOI: 10.1080/02688697.2023.2249094
Aled Lester, Zoe James, Dmitri Sastin, Chirag Patel, Anthony Jesurasa, Paul Leach
{"title":"Suspected abusive head trauma in children - when do they really need to be transferred to a neurosurgical unit?","authors":"Aled Lester, Zoe James, Dmitri Sastin, Chirag Patel, Anthony Jesurasa, Paul Leach","doi":"10.1080/02688697.2023.2249094","DOIUrl":"10.1080/02688697.2023.2249094","url":null,"abstract":"<p><strong>Objectives: </strong>Transferring paediatric patients with suspected abusive head trauma (AHT) to paediatric neurosurgical centres, disrupts safeguarding investigations. Therefore, it is desirable that suspected AHTs are transferred only when clinically necessary. The aim of this study was to describe referral patterns of patients referred to a tertiary paediatric neurosurgical centre with suspected AHT, with the view of informing future transfer of AHT patients.</p><p><strong>Design: </strong>A retrospective review was performed of all suspected AHT patients referred to the University Hospital of Wales between 2012 and 2021.</p><p><strong>Methods: </strong>Rates of surgery, intubation and ventilation, radiological findings and presenting GCS were compared between referred patients and those transferred for neurosurgical care. Variables were compared between the transferred and the non-transferred groups. For categorical variables, Chi-squared tests were performed, with Fisher's exact test used where the expected count was less than 5. Odds ratios (OR) for neurosurgical transfer with radiological or clinical features at presentation were calculated.</p><p><strong>Results: </strong>A total of 76 patients were referred, of which 18 were transferred for neurosurgical care. Of these, six were intubated and ventilated. Only one transferred patient required surgery, with the remainder receiving supportive care. Amongst the transferred group, 77.8% had SDHs and 68.6% had a GCS ≥ 13 at presentation. Patients with a GCS ≥ 13 and SDHs, bilateral haematomas or a history of vomiting were significantly more likely to be transferred (OR = 4.27, 95%CI 1.01-18.00, <i>p</i> = .05).</p><p><strong>Conclusions: </strong>Most transferred patients with suspected AHT did not receive surgical intervention. We suggest that patients should be transferred when it is likely that they will require surgery, otherwise they should stay locally in order to complete their safeguarding investigations. Immediate transfer may not be necessary for AHT patients with a GCS ≥ 13 and either vomiting, SDHs or bilateral haematomas, provided they are unlikely to require emergency surgery.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"392-395"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10450894","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
Effectiveness of subtemporal decompression for the management of slit ventricle syndrome. 颞下减压治疗狭缝脑室综合征的疗效。
IF 1 4区 医学
British Journal of Neurosurgery Pub Date : 2025-06-01 Epub Date: 2023-11-28 DOI: 10.1080/02688697.2023.2282076
Laura Kehoe, John Caird, Darach Crimmins
{"title":"Effectiveness of subtemporal decompression for the management of slit ventricle syndrome.","authors":"Laura Kehoe, John Caird, Darach Crimmins","doi":"10.1080/02688697.2023.2282076","DOIUrl":"10.1080/02688697.2023.2282076","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the effectiveness of subtemporal decompression in the management of slit ventricle syndrome.</p><p><strong>Methods: </strong>We conducted a retrospective review of all patients with slit ventricle syndrome (SVS) who underwent subtemporal decompression (STD) at our centre between 2010 and 2021. Cases were identified using the hospital database. Medical records for each patient were reviewed, including operative and radiological reports.</p><p><strong>Results: </strong>Fifteen patients underwent STD for the management of SVS. Median age at time of STD was 9.18 years. Aetiology of hydrocephalus consisted of spinal dysraphism (5), idiopathic (4), post-infectious (1), post-haemorrhagic (3), secondary to tumour (1), and craniofacial anomalies (1). Median age at first shunt insertion was 3.4 months. Median pre-operative period assessed, from initial shunt insertion to STD, was 4.54 (interquartile range [IQR] 3.12-10.47) years. Twelve patients underwent ≥1 shunt revision prior to STD. All patients had a diagnosis of SVS at time of STD. Presenting symptoms, for the admission in which STD was performed, included nausea (9), vomiting (8), lethargy (8), headache (12), irritability (5), and visual disturbances (6). One third underwent shunt revision at the time of STD. Two patients developed post-operative complications requiring further surgery (meningitis requiring shunt revision: 1; wound debridement: 1). Three patients developed uncomplicated post-operative pyrexia, which was managed with antibiotics. Median duration of post-operative follow-up was 5.4 (IQR 1.73-8.54) years. Eleven patients underwent ≥1 shunt related procedure following STD. Wilcoxon signed-rank test demonstrated a significant difference in number of shunt related procedures before (median = 5, IQR 1-8) and after (median = 3, IQR 0-5) STD (<i>Z</i> = -2.083, <i>p</i> = .037). All patients reported subjective symptom improvement post-operatively. Thirteen patients experienced symptom recurrence at a median duration of 10 months post-operatively.</p><p><strong>Conclusions: </strong>STD was associated with a reduction in the amount of shunt related procedures required in this group of patients with SVS. Further study is required to confirm this association.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"340-346"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138443954","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
Robotically facilitated parafasicular microsurgery to a brain arteriovenous malformation in a paediatric patient. 机器人促进了筋膜旁显微手术治疗小儿脑动静脉畸形。
IF 1 4区 医学
British Journal of Neurosurgery Pub Date : 2025-06-01 Epub Date: 2023-08-31 DOI: 10.1080/02688697.2023.2239902
Ahmed Abougamil, Harishchandra L Srinivasan, Carlos E Fiandeiro, Robin D C Kumar, Steven Bibby, Thomas C Booth, Harutomo Hasegawa, Daniel C Walsh
{"title":"Robotically facilitated parafasicular microsurgery to a brain arteriovenous malformation in a paediatric patient.","authors":"Ahmed Abougamil, Harishchandra L Srinivasan, Carlos E Fiandeiro, Robin D C Kumar, Steven Bibby, Thomas C Booth, Harutomo Hasegawa, Daniel C Walsh","doi":"10.1080/02688697.2023.2239902","DOIUrl":"10.1080/02688697.2023.2239902","url":null,"abstract":"<p><strong>Purpose: </strong>We report what we believe is the first application of robotically constrained image-guided surgery to approach a fistulous micro-arteriovenous malformation in a highly eloquent location. Drawing on institutional experience with a supervisory-control robotic system, a series of steps were devised to deliver a tubular retractor system to a deeply situated micro-arteriovenous malformation. The surgical footprint of this procedure was minimised along with the neurological morbidity. We hope that our contribution will be of assistance to others in integrating such systems given a similar clinical problem.</p><p><strong>Clinical presentation: </strong>A right-handed 9-year old girl presented to her local emergency department after a sudden onset of severe headache accompanied by vomiting. An intracranial haemorrhage centred in the right centrum semiovale with intraventricular extension was evident and she was transferred urgently to the regional paediatric neurosurgical centre, where an external ventricular drain (EVD) was sited. A digital subtraction angiogram demonstrated a small right hemispheric arteriovenous shunt irrigated by peripheral branches of the middle cerebral artery & a robotically facilitated parafasicular microsurgical approach was performed to disconnect the arteriovenous malformation.</p><p><strong>Conclusion: </strong>We describe the successful microsurgical <i>in-situ</i> disconnection of a deeply-situated, fistulous micro-AVM via a port system itself delivered directly to the target with a supervisory-control robotic system. This minimised the surgical disturbance along a relatively long white matter trajectory and demonstrates the feasibility of this approach for deeply located arteriovenous fistulae or fistulous AVMs.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"289-295"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10126094","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
Natural history of post-operative non-functioning pituitary adenomas - a single centre cohort analysis. 术后无功能垂体腺瘤的自然病史-单中心队列分析。
IF 1 4区 医学
British Journal of Neurosurgery Pub Date : 2025-06-01 Epub Date: 2023-11-24 DOI: 10.1080/02688697.2023.2284789
Salman T Shaikh, Saad Moughal, Mohamed Wael, Paul Nix, Atul Tyagi, Nick Phillips, Asim Sheikh
{"title":"Natural history of post-operative non-functioning pituitary adenomas - a single centre cohort analysis.","authors":"Salman T Shaikh, Saad Moughal, Mohamed Wael, Paul Nix, Atul Tyagi, Nick Phillips, Asim Sheikh","doi":"10.1080/02688697.2023.2284789","DOIUrl":"10.1080/02688697.2023.2284789","url":null,"abstract":"<p><strong>Purpose: </strong>To study behaviour of endonasally operated non-functioning pituitary adenomas (NFPA) and propose a cost-effective stratified follow-up regimen.</p><p><strong>Methods: </strong>A single centre retrospective cohort analysis from June 2009 till December 2019. All endonasally operated pituitary adenomas were identified with sub-analysis of the NFPA's. Patients of all age groups with radiological follow-up more than 30 months were included. Patients with any kind of cranial intervention performed < within 30 months of surgery were excluded. The post-operative MRI for this cohort was evaluated until either any intervention was performed or until the last follow-up. The maximal tumour diameter in any plane (mm) was measured from the MRI scans. The annual growth rate and the statistical relationship between age, sex, IHC, Ki-67, resection %, residual tumour was calculated.</p><p><strong>Results: </strong>Out of 610 pituitary adenomas identified in the dataset, 116 patients met the inclusion criteria. Follow-up period ranged from 30 to 142 months (mean 78.5 months). A strong relationship existed between predicting tumour progression with first post-operative residue size (<i>p</i> = .001). A statistically significant relationship was found to be present between tumour growth and a residue of less than 10 mm diameter and 11-20 mm in diameter (Log rank <i>p</i> value .0216). On average, each patient with a residue < 5mm had MRI scans costing 976 £.</p><p><strong>Conclusion: </strong>Based on statistical analysis and internal validation of the growth rate of the residue, we have proposed MRI follow-up scans. These recommendations have the potential to save more than 300 £per patient towards MRI costs and can lay down a marker for defining time interval of serial scans for post-operative NFPA's.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"360-365"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138298347","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
Predicting metalwork following posterior fixation of thoracolumbar fractures. 预测胸腰椎骨折后路固定后的金属加工。
IF 1 4区 医学
British Journal of Neurosurgery Pub Date : 2025-06-01 Epub Date: 2023-08-22 DOI: 10.1080/02688697.2023.2249550
See Yung Phang, Cullen McCulloch, Christopher Barrett
{"title":"Predicting metalwork following posterior fixation of thoracolumbar fractures.","authors":"See Yung Phang, Cullen McCulloch, Christopher Barrett","doi":"10.1080/02688697.2023.2249550","DOIUrl":"10.1080/02688697.2023.2249550","url":null,"abstract":"<p><strong>Objectives: </strong>Surgical fusion through posterior instrumentation and pedicle screw placement is a long established method for stabilising traumatic spinal fractures. Post-surgical complications include infection and metal work failure, the most common aetiology of which is pedicle screw fracture. Metal work failure rates vary from 15% to 60%. Research relating to factors which predict metal work failure in post-traumatic thoracolumbar spinal fixation is lacking. This study aimed to identify potential risk factors for metalwork failure in patients who had posterior fixation for traumatic thoracolumbar spine fractures.</p><p><strong>Methods: </strong>This retrospective cohort analysis was conducted by interrogating the hospital database for neurosurgical post-traumatic thoracolumbar fixation cases between 2015 and 2018 with at least 2 years follow up. Data was collected through electronic medical notes and PACS. Nineteen different patient factors (gender, age, mechanism of injury, presence of concomitant injury spinal or extra-spinal injury, pedicle cross-sectional area, pedicle cancellous bone density, pedicle total bone density, vertebral body bone density, erector spinae muscle density and lumbar spine subcutaneous fat thickness, Charlson comorbidity index, fracture location, surgical approach, long/short segment fixation, whether decompression was done, whether the index level was fixed, and presence of wound infection) were compared.</p><p><strong>Results: </strong>We identified 92 patients with 97 operations, and 9 cases of metal work failure. Two factors were statistically significantly associated with metal work failure: Post-operative wound infection (<i>p</i> = 0.029) and lumbar spine fat thickness (<i>p</i> = 0.024). The relative risk calculated in patients with a wound infection was 3.76. Lumbar spine fat thickness was on average 11.9 mm greater than patients not experiencing metal work failure.</p><p><strong>Conclusions: </strong>This study has identified two factors associated with increased rates of metal work failure: Post-operative wound infection and lumbar spine fat thickness. When assessing surgical candidates these factors may be incorporated into surgical planning.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"326-332"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10053777","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
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