1.
World Neurosurg. 2020 Jan 23. pii: S1878-8750(20)30112-1. doi: 10.1016/j.wneu.2020.01.094. [Epub ahead of print]
Use of Pheno Room, Augmented Reality and 3-rod Technique for 3-dimensional Correction of Adolescent Idiopathic Scoliosis.
McClendon J1, Almekkawi AK2, Abi-Aad KR2, Maiti T3.
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Abstract
This is a surgical video that showcases the surgical repair of a young male patient with idiopathic scoliosis in a hybrid OR with the utilization of a new imaging modality ARTIS PHENO (Siemens Medical Solutions, Pennsylvania, USA) and augmented reality. This is a case of a 17-year-old male patient with idiopathic scoliosis, patient underwent scoliosis repair in hybrid OR with segment reality surgical planning. The use of augmented reality helped in visualization of proper screw trajectory, and the use of ARTIS PHENO helped in identification of correct screw placement, and rod fixation. Intraoperative use of new imaging modalities as augmented reality imaging and ARTIS PHENO shows to decrease surgical complication and time.
Copyright © 2020. Published by Elsevier Inc.
KEYWORDS:
3-rod technique; ARTIS PHENO; Augmented reality; Intraoperative imaging; scoliosis
PMID: 31982598 DOI: 10.1016/j.wneu.2020.01.094
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Select item 319825972.
World Neurosurg. 2020 Jan 23. pii: S1878-8750(20)30111-X. doi: 10.1016/j.wneu.2020.01.093. [Epub ahead of print]
Perioperative complications and prognosis of curative surgical resection for spinal metastases in elderly patients.
Yonezawa N1, Murakami H2, Demura S3, Kato S3, Yoshioka K4, Shinmura K3, Yokogawa N3, Shimizu T3, Oku N3, Kitagawa R3, Handa M3, Annen R3, Kurokawa Y3, Tsuchiya H3.
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KEYWORDS:
complication; corpectomy; elderly patients; hemivertebrectomy; spinal metastasis; spondylectomy; survival analysis
PMID: 31982597 DOI: 10.1016/j.wneu.2020.01.093
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Select item 319825963.
World Neurosurg. 2020 Jan 23. pii: S1878-8750(20)30032-2. doi: 10.1016/j.wneu.2020.01.025. [Epub ahead of print]
Experimental Study of Nerve Transfer to Restore Diaphragm Function.
Ding W1, Jiang J2, Xu L3.
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Abstract
OBJECTIVE:
Diaphragmatic paralysis following phrenic nerve injury is an infrequent but serious condition. The destruction of respiratory function after unilateral phrenic nerve injury has been the subject of many investigations.
METHODS:
In this study, we used a rat model of complete paralysis of the unilateral diaphragm to observe the changes of pulmonary function.
RESULTS:
It is found that in the young rats of complete paralysis of the unilateral diaphragm, the vital capacity and total lung capacity show compensation after 4 weeks, and contralateral phrenic nerve transfer can enhance pulmonary function. However, in the aged rats, respiratory function parameters do not show compensation until 16 weeks after injury.
CONCLUSION:
These findings suggest that contralateral phrenic nerve end-to-side anastomosis is a promising therapeutic strategy. In general, our results suggest that this surgical method may hold great potential to be a secure, feasible, and effective technique to rescue diaphragmatic function.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
brachial plexus injury; contralateral phrenic nerve transfer; end-to-side anastomosis; phrenic nerve injury
PMID: 31982596 DOI: 10.1016/j.wneu.2020.01.025
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Select item 319817874.
World Neurosurg. 2020 Jan 22. pii: S1878-8750(20)30106-6. doi: 10.1016/j.wneu.2020.01.088. [Epub ahead of print]
Correlation between pain and nerve growth factor receptor expression in patients with endometriosis diagnosed by transvaginal color ultrasound and magnetic resonance.
Mu L1, Wang M2, Yu Y3.
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Abstract
This article explores the diagnosis of deep invasive endometriosis through retrospective data analysis, including deep infiltration and magnetic resonance imaging. The literature retrospectively collected 21 patients with deep invasive endometriosis who were admitted from 2012 to 2018. The patient was confirmed to have pain and nerve growth factor receptor expression levels after the operation and underwent vaginal color ultrasound and magnetic resonance imaging before surgery. The diagnostic results of color Doppler ultrasound and magnetic resonance imaging were retrospectively analyzed and compared with the surgical results, and the cumulative site and anatomical abnormalities of the diagnosis of deep invasive endometriosis were analyzed to determine the NGF receptor table. . Through research, it has been found that deep invasive endometriosis mainly involves the uterine fibula ligament, vagina, uterus rectum, rectum, ureter, etc. The patient's pain is related to the expression level of nerve growth factor receptor, and its magnetic resonance mainly manifests as signals And structural obstacles, irregular thickening of the affected area. Or nodular formation, deformation of adjacent tissues and organs. Through the research and demonstration of deep invasive endometriosis, transvaginal color ultrasound and magnetic resonance imaging can not only accurately locate the expression levels of pain and nerve growth factor receptors, but also show the extent of the lesions, thereby studying pain and nerve growth Factor receptor expression, which is an important method for preoperative examination and postoperative follow-up.
Copyright © 2020. Published by Elsevier Inc.
KEYWORDS:
disease diagnosis; magnetic resonance; nerve growth factor; receptor table; transvaginal colour ultrasound
PMID: 31981787 DOI: 10.1016/j.wneu.2020.01.088
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Select item 319817865.
World Neurosurg. 2020 Jan 22. pii: S1878-8750(20)30107-8. doi: 10.1016/j.wneu.2020.01.089. [Epub ahead of print]
Radiologic Characteristics of Anterior Transarticular Crossing Screw Placement for Atlantoaxial Joint Instability.
Liu Q1, Yang Z1, Lin J1, Liu Y2, Huang Z1, Liu J1, Ji W3, Jiang H3.
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Abstract
OBJECTIVE:
The feasibility of anterior transarticular crossing screw (ATCS) was confirmed in cadaveric specimen and it has been used in clinic. However, no study has ever documented the morphometric characteristics of ATCS. This study was to determine the morphometric characteristics of ATCS in C1-C2 fixation.
METHODS:
A total of 100 patients without abnormality of C1-2 were enrolled. The range of screw lateral angles (LA) and the screw lengths of ATCS on coronal images were measured on multiplanar CT images, as well as the screw incline angles (IA) in sagittal plane. The ideal trajectory was designed as toward to the posterosuperior points of opposite C1 lateral mass, which would have the longest screw length.
RESULTS:
The LA were relatively small in males compared with females, which were 31.4° to 45.3° in males and 32.6° to 46.0° in females. In the sagittal plane, the IA were ranged from 41.0° to 68.4° in males and from 44.4° to 68.1° in females. The overall screw lengths were longer in males than that in females, with 34.7 mm to 44.8 mm in males and 32.2 mm to 39.6 mm in females. In the ideal path, the LA and IA were 38.4° and 41.0° in males and 39.6° and 44.4° in females, and the screw lengths were 44.8 mm in males and 39.6 mm in females, respectively.
CONCLUSIONS:
This study provide the range of screw angles and lengths of ATCS, which will help surgeons to perform ATCS safely and accurately.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Atlantoaxial Joint; Computed Tomography; Crossing Screw; Morphometric Characteristics
PMID: 31981786 DOI: 10.1016/j.wneu.2020.01.089
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Select item 319817856.
World Neurosurg. 2020 Jan 22. pii: S1878-8750(20)30109-1. doi: 10.1016/j.wneu.2020.01.091. [Epub ahead of print]
The modified iliac screw-An anatomical comparison and technical guide.
von Glinski A1, Yilmaz E2, Ishak B3, Haymann E3, Ramey W4, Jack A4, Iwanaga J5, Oskouian RJ4, Tubbs RS6, Chapman J4.
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PMID: 31981785 DOI: 10.1016/j.wneu.2020.01.091
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Select item 319817847.
World Neurosurg. 2020 Jan 22. pii: S1878-8750(20)30105-4. doi: 10.1016/j.wneu.2020.01.087. [Epub ahead of print]
Evaluation of the Prognosis of Neuroglioma Based on Dynamic Magnetic Resonance Enhancement.
Li F1, Zhang Y2, Wang N3, Song C1, Gao Y1, Diao X1, Zhang H4.
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Abstract
This article explores the diagnostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the prognosis of gliomas, and judges the relevant factors affecting the prognosis of gliomas. for reference. patient. This article used Cox proportional hazards model to retrospectively analyze clinical data of 81 complete neuroglioma patients from the same neurosurgery medical team from January 2012 to November 2018, including magnetic resonance dynamic imaging data. In order to determine the prognostic factors, P <0.05 was used as the statistical standard, and the survival curve of statistically significant factors was drawn by Kaplan-Meier method. The results showed that Cox proportional hazard model analysis showed that preoperative KPS score, age, tumor pathological grade, postoperative radiotherapy, temozolomide use, and Ki-67 expression had an impact on the prognosis of patients with neuroglioma. Multivariate analysis and MRI imaging data showed that age, tumor grade, preoperative KPS score, postoperative radiotherapy, and Ki-67 expression were prognostic factors for patients with glioma. The older the age, the higher the pathological grade, the higher the Ki-67 expression level, the lower the KPS score before surgery, and the worse the prognosis. Postoperative radiotherapy and appropriate temozolomide chemotherapy will help improve the prognosis of patients with neuroglioma.
Copyright © 2020. Published by Elsevier Inc.
KEYWORDS:
chemotherapy; glioma; prognosis analysis; radiotherapy; surgery
PMID: 31981784 DOI: 10.1016/j.wneu.2020.01.087
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Select item 319817838.
World Neurosurg. 2020 Jan 22. pii: S1878-8750(20)30110-8. doi: 10.1016/j.wneu.2020.01.092. [Epub ahead of print]
Split Cord Malformation presentation, management and surgical outcome.
Alnefaie N1, Alharbi A2, Alamer O2, Khairy I3, Khairy S4, Saeed MA4, Azzubi M4.
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Abstract
BACKGROUND:
Split cord malformation (SCM) is a rare anomaly characterized by a split along the midline of the cord, which divides it into two symmetrical or nonsymmetrical entities . SCM surgical indications and outcomes are still debatable, the signs and symptoms are generally nonspecific, and commonly associated with other anomalies and deficits.
METHODOLOGY:
We retrospectively searched our hospital database for patients with SCM between the years 1998 and 2018 at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Descriptive statistics were used to present categorical data as percentages and frequencies.
RESULTS:
A total of 25 patients were included in this series. The mean age of patients at the time of diagnosis was 4.4 years. A total of 18(72%) patients underwent surgical correction. The mean difference between the age at diagnosis and the age at correction was 7 months. All cases underwent intraoperative neurophysiological monitoring. Postoperative complications were minimal. CSF leakage was noted in 2 patients, transient urinary retention was noted in one patient and transient unilateral leg paresis was noted in one patient. The majority of the patients, 15 (83%), were discharged within 19 days after surgery, and 81% showed improvement postoperatively. Over the long-term follow up, none of the patients developed new urological or neurological deficits.
CONCLUSION:
The majority of SCM patients present during childhood. Postoperative complications following SCM corrective surgery are generally minimal, and the overall outcomes, mainly including partial or complete symptomatic improvement and/or symptom stability and hydronephrosis resolution, were favorable.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
SCM; diastematomyelia; diplomyelia; spine dysraphism; split cord malformation
PMID: 31981783 DOI: 10.1016/j.wneu.2020.01.092
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Select item 319723469.
World Neurosurg. 2020 Jan 20. pii: S1878-8750(19)33150-X. doi: 10.1016/j.wneu.2019.12.118. [Epub ahead of print]
Microsurgical clipping compared to new and most advanced endovascular techniques in the treatment of unruptured middle cerebral artery aneurysms: a meta-analysis in the modern era.
Toccaceli G1, Diana F2, Cagnazzo F3, Cannizzaro D4, Lanzino G5, Barbagallo GMV1, Certo F1, Bortolotti C6, Signorelli F7, Peschillo S1.
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Abstract
OBJECTIVE:
Analyzing occlusion, complications rate and clinical results in unruptured saccular middle cerebral artery aneurysms (MCAAs) comparing clipping to the most advance and newer endovascular techniques.
METHODS:
We conducted a literature research from January 2009 to December 2018 to evaluating the efficacy and safety of microsurgical clipping or endovascular treatment with new devices (such as Flow-diverter or WEB) in patients with unruptured MCAAs. We extracted data involved: study and intervention features, occlusion rate; time of occlusion assessment and clinical outcome. RESULTS: A total of 29 studies and 1552 patients with unruptured saccular MCAAs were included in our analysis (464 patients included in endovascular group, 1088 patients in surgical group). Overall, the rate of long-term complete/near complete occlusion was 78.1% (311/405, 95%CI=69%-87.1%,) and 95.7% (113/118, 95%CI=92%-99.3%,)after endovascular and surgical treatments, respectively (p= .001). Long-term complete occlusion rate was 60% (153/405, 95%CI=45%-74%) and 95% (112/118, 95%CI=90%-98%) after endovascular and surgical treatments, respectively (p= .001). The overall rate of treatment-related complications was 5.6% (33/464, 95%CI=3.6%-7.7%) and 2.9% (37/1088, 95%CI=0.8%-5%) among the endovascular and surgical groups, respectively (p= .001). Endovascular treatments were associated with higher rates of good neurological outcome (283/293=97%, 95%CI=95%-98%, vs 570/716=84%, 95%CI=67%-98%, p=.001). No difference was found for the mortality rate (3/464=1.5%, 95%CI=0.4%- 2.6%, vs 1/1088, 95%CI=0.1%-0.6%, p=.5).
CONCLUSION:
Treatment-related complication and mortality are comparable among these techniques, the risk of aneurysm rupture appears very low for both strategies. Endovascular approach seems to increase the probability of good functional outcome after treatment, compared to surgery.
Copyright © 2019 Elsevier Inc. All rights reserved.
KEYWORDS:
Aneurysms; Endovascular; Flow Diverter; Middle Cerebral Artery Aneurysms; Stent-assisted coiling; Surgery; WEB
PMID: 31972346 DOI: 10.1016/j.wneu.2019.12.118
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Select item 3195859210.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30102-9. doi: 10.1016/j.wneu.2020.01.084. [Epub ahead of print]
The College of Surgeons of East, Central and Southern Africa: Successes and Challenges in Standardizing Neurosurgical Training.
Henderson F Jr1, Abdifatah K2, Qureshi M3, Perry A4, Graffeo CS4, Haglund MM5, Olunya DO2, Mogere E2, Okanga B6, Copeland WR 3rd7.
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Abstract
BACKGROUND:
The College of Surgeons of East, Central, and Southern Africa (COSECSA) is a regional accrediting body for general and specialty surgical training programs that has recently expanded to include neurosurgery. As neurosurgical services expand in Sub-Saharan Africa, the structure of training and accreditation has become a vital issue.
METHODS:
We review the founding and current structures of COSECSA neurosurgical training, identifying accomplishments as well as challenges facing the expansion of neurosurgical training in this region.
RESULTS:
The COSECSA model has succeeded in several countries to graduate qualified neurosurgeons, but challenges remain. Programs must balance the long duration of training required to promote surgical excellence against an overwhelming clinical need that seeks immediate solutions.
CONCLUSION:
Harnessing global collaboration, rapidly expanding local infrastructure, and a robust multi-national training curriculum, COSECSA has emerged as a leader in the effort to train neurosurgeons, and is anticipated to dramatically improve upon the markedly unmet need for neurosurgical care in Sub-Saharan Africa.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
global neurosurgery; history of neurosurgery; low and middle income countries; resident education; sub-Saharan Africa
PMID: 31958592 DOI: 10.1016/j.wneu.2020.01.084
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Select item 3195859111.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30100-5. doi: 10.1016/j.wneu.2020.01.082. [Epub ahead of print]
Risk factors for outcomes following microvascular decompression for trigeminal neuralgia.
Shi J1, Qian Y1, Han W1, Dong B1, Mao Y1, Cao J1, Guan W1, Zhou Q2.
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Abstract
BACKGROUND:
Microvascular decompression (MVD) is the most effective long-term surgical treatment for trigeminal neuralgia (TN) patients. The risk factors for poor pain control following MVD surgery are not fully understood.
METHODS:
A total of one hundred eighty-four patients were enrolled from patients with typical TN who underwent MVD at our institution between 1/3/2008 and 1/3/2016. The data were collected using electronic operative records and case notes and were retrospectively analyzed. Patients were followed up at the outpatient department or by telephone at a minimum of three months and at a maximum of forty-eight months.
RESULTS:
184 patients were enrolled in the study; 72.3% of patients achieved freedom from pain after MVD, 27.7% experienced poor pain control, with follow-up at a minimum of 3 months and at a maximum of 48 months. Risk factors for poor pain control after MVD according to binary logistic regression and ROC analysis included younger age (OR: 0.90; 95% CI: 0.82-0.99; P = 0.028; AUC=0.774); poor preoperative pain control (BNI score > IV) (OR: 52.03; 95% CI: 6.44-420.16, P < 0.001; AUC=0.858); intraoperatively detected multivessel compression (OR: 2.49; 95% CI: 3.10-46.59, P < 0.001; AUC=0.871). Furthermore, combined compression of the superior cerebellar artery (SCA) and the petrosal vein (PV) was an independent risk factor predicting a poor outcome following MVD (OR: 5.69; 95% CI: 33.78-2579.03, P < 0.001; AUC=0.812).
CONCLUSIONS:
Younger patients with TN had worse long-term pain outcomes following MVD. Additional factors associated with postoperative recurrence included poor preoperative pain control (BNI score > IV) and multivessel compression. Furthermore, SCA combined with PV was confirmed to be associated with a worse outcome.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
microvascular decompression; risk factors; trigeminal neuralgia
PMID: 31958591 DOI: 10.1016/j.wneu.2020.01.082
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Select item 3195859012.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30099-1. doi: 10.1016/j.wneu.2020.01.081. [Epub ahead of print]
Optimal timing of extracranial-intracranial bypass with microsurgical trapping for ruptured blister aneurysms of the internal carotid artery.
Endo H1, Fujimura M2, Shimizu H3, Endo T4, Omodaka S5, Inoue T4, Sato K6, Niizuma K7, Tominaga T5.
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Abstract
OBJECTIVE:
Ruptured blister aneurysms of the internal carotid artery are challenging to treat because of their difficult diagnosis and the fragility of the wall structure. Here, we sought to clarify the efficacy of extracranial-intracranial bypass followed by trapping (bypass/trapping) for ruptured blister aneurysms.
METHODS:
A retrospective study identified 45 patients with ruptured blister aneurysms between 1998 and 2017. Our principle was to attempt bypass/trapping as early as possible after diagnosis (early surgery). If early diagnosis was difficult, patients underwent elective surgery in the later stage when aneurysms were detected (elective surgery). Patient characteristics, radiological findings, clinical course, and outcomes were analyzed.
RESULTS:
Forty-three patients were treated by bypass/trapping. Twenty-eight patients were classified as early surgery and 15 as elective surgery. Two patients experienced fatal rebleeding and did not undergo surgery. All 15 patients in the elective surgery group showed rebleeding and/or aneurysmal growth while awaiting surgery. In the elective surgery group, there were 10 aneurysms missed initially by catheter angiography. In the early surgery group, 9 patients were assessed by vessel wall magnetic resonance imaging (MRI), which showed circumferential enhancement along the aneurysm wall, most of which was shown as only a small bulge in the angiography. Postoperative rebleeding did not occur in any of the patients.
CONCLUSIONS:
Bypass/trapping is effective to prevent rebleeding. Early surgery may be beneficial, as most patients in the elective surgery group showed rebleeding or aneurysmal growth. Vessel wall MRI is a useful adjunct for early diagnosis and may contribute to prompt early surgery.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Blister aneurysm; bypass; internal carotid artery; timing of surgery; wall imaging
PMID: 31958590 DOI: 10.1016/j.wneu.2020.01.081
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Select item 3195858913.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30098-X. doi: 10.1016/j.wneu.2020.01.080. [Epub ahead of print]
Dural tears in percutaneous biportal endoscopic spine surgery: Anatomical location and management.
Park HJ1, Kim SK2, Lee SC3, Kim W4, Han S4, Kang SS5.
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Abstract
OBJECTIVE:
To determine the rate and anatomical location of dural tears associated with spinal surgery using a percutaneous biportal technique (PBES). We aimed to investigate the relationship between dural tears and the type of procedure and type of instrument used.
METHODS:
We retrospectively analyzed 643 PBES cases by reviewing medical charts, operative records, and operative videos. Incidental durotomy was identified in 29 cases. We analyzed the size and anatomical location of dural tears, as well as the surgical instrument that caused the tear, and the technique used to seal the tear.
RESULTS:
The dural tear incidence was 4.5% (29/643 cases). Tears in the exiting nerve area (two cases, 6.9%) were mainly caused by curettage, while tears in the thecal sac area (18 cases, 62.1%) were associated with electric drill and forceps use, and use of a Kerrison punch in the traversing nerve area (nine cases, 31%). Twelve cases of dural tear were treated with in-hospital monitoring and bed rest. Fourteen cases were treated using a fibrin sealant. Two cases were treated with a non-penetrating titanium clip, and one was converted to microscopic surgery. One case of postoperative meningocele after conservative treatment required endoscopic revision surgery to close the dural tear.
CONCLUSIONS:
Most cases of incidental dural tear during PBES were treated with an endoscopic procedure. The incidence of dural tear was no higher than that was associated with microscopic surgery. Our management strategy for incidental dural tears in biportal endoscopic spinal surgery is safe and effective.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
dural tear; endoscopic spinal surgery; fibrin sealant; nonpenetrating titanium clip; percutaneous biportal endoscopic surgery
PMID: 31958589 DOI: 10.1016/j.wneu.2020.01.080
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Select item 3195858814.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30096-6. doi: 10.1016/j.wneu.2020.01.078. [Epub ahead of print]
Initial experience with transradial access for cerebrovascular procedures: is it feasible and safe?
Styczen H1, Maus V2, Tsogkas I3, Meila D4, Bester M5, Buhk JH5, Psychogios MN3.
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Abstract
BACKGROUND:
Despite the proven benefit of transradial access over transfemoral access in cardiac procedures, the transition for cerebrovascular procedures has only been slowly enforced. Here we present our experience with transradial access in cerebral diagnostic angiographies and neurointerventional procedures.
METHODS:
We performed a retrospective analysis of patients who underwent transradial access for cerebrovascular procedures in 3 German centers between February 2017 and May 2019. Demographics, technical features and complications were evaluated.
RESULTS:
Transradial access was successful in 40/45 (89%) endovascular procedures. Selected catheterization of the intended vessels was obtained in 95% (40/42) of cases. The rate of procedure-related vascular complications was 2% (1/45).
CONCLUSION:
In this small retrospective series transradial access proved to be safe and efficient. In the future, it is planned to further promote it as a standard access alternative for a larger number of patients.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
cerebral angiography; endovascular therapy; radial access; radial artery; transradial
PMID: 31958588 DOI: 10.1016/j.wneu.2020.01.078
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Select item 3195858715.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30097-8. doi: 10.1016/j.wneu.2020.01.079. [Epub ahead of print]
The Magnetic Resonance Imaging Research of Thoracic Inlet Parameters at Cervical and Cervicothoracic Spine in Degenerative Cervical Spondylosis.
Li W1, Li F2, Yang X2, Yu S2, Chen W2, Chen Q2.
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Abstract
OBJECTIVE:
The purpose of this study was to examine the thoracic inlet angle (TIA) as well as its related parameters on cervical and cervical-thoracic vertebra in patients with degenerative cervical spondylosis (DCS) and explore the association of TIA, tilt angle of neck (NT), and tilt angle of the first thoracic spine (T1S) with cervical degeneration score.
METHODS:
The patients with DCS were included from January, 2014 to December, 2017. The relavant parameters were assessed on T2-weighted MRI. The association of cervical parameters with cervical degeneration score was examined by multiple linear regression model.
RESULTS:
204 patients were eligible and enrolled, in which the mean age was 55-56 years, 126 of them were males. Male had significantly higher thoracic inlet parameters than females (all P<0.05). Thoracic inlet parameters were positively correlated with age (all P<0.05). After adjustment for age and gender, the significant association between TIA and cervical or cervical-thoracic spine degeneration scores was not observed in all vertebras. Meanwhile, male had higher height of each vertebra (VH) and height of each inter-vertebral disc (IVDH) than females. Only VH of C7, T1, T2 and IVDH of C6/C7, T1/T2, T2/T3 was significantly and positively associated with TIA (all P<0.05).
CONCLUSION:
Age was positively correlated with thoracic inlet parameters in DCS patients. Males had significantly higher thoracic inlet parameters than females, due to higher VH and IVDH in males. However, TIA was not associated with the level of cervical disc degeneration. But the clinical relevance of these findings has not been established.
Copyright © 2020. Published by Elsevier Inc.
KEYWORDS:
Cervical and Cervicothoracic spine; Cervical degeneration score; Degenerative cervical spondylosis; Magnetic resonance imaging; Thoracic inlet angle
PMID: 31958587 DOI: 10.1016/j.wneu.2020.01.079
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Select item 3195858616.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30104-2. doi: 10.1016/j.wneu.2020.01.086. [Epub ahead of print]
Infant Fistula-type Arteriovenous Malformation with Cerebellar Hemorrhage Developed into Nidus-type in Adolescence: A Case Report.
Yamada E1, Ito Y2, Nakai Y3, Uemura K3, Ishikawa E4, Matsumura A4.
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Abstract
Although arteriovenous malformation (AVM) has been considered to be a congenital vascular malformation, morphological differences associated with age have been indicated in the literature. We report a case of infant fistula-type AVM that developed into nidus-type AVM 15 years later. This is the first report to document morphological changes of AVM over time in one case. The present case suggests the possibly that AVM morphology may change with age, and is an important when considering the history of AVM.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Arteriovenous malformation; fistula type AVM; infancy; recurrent
PMID: 31958586 DOI: 10.1016/j.wneu.2020.01.086
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Select item 3195858517.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30103-0. doi: 10.1016/j.wneu.2020.01.085. [Epub ahead of print]
PRACTICAL APPLICATION OF NETWORKS IN NEUROSURGERY: COMBINED 3D PRINTING, NEURONAVIGATION, AND PRE-OPERATIVE SURGICAL PLANNING.
Romero-Garcia R1, Erez Y2, Oliver G3, Owen M4, Merali S5, Poologaindran A5, Morris RC4, Price SJ4, Santarius T4, Suckling J5, Hart MG6.
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Abstract
BACKGROUND:
A plethora of cutting edge neuroimaging analyses have been developed and published yet they have not hitherto been realized as improvements in neurosurgical outcomes. In this paper we propose a novel interface between neuroimaging and neurosurgery for aiding translational research. Our objective is to create a method for applying advanced neuroimaging and network analysis findings to neurosurgery, and illustrate its application through the presentation of two detailed case vignettes.
METHODS:
This interface comprises a combination of network visualization, 3D printing, and ex-vivo neuronavigation to enable pre-operative planning according to functional neuroanatomy. Clinical cases were selected from a prospective cohort study.
RESULTS:
The first case vignette describes a low grade glioma with potential language and executive function network involvement that underwent a successful complete resection of the lesion with preservation of network features. The second case describes a low grade glioma in an apparently non-eloquent location that underwent a subtotal resection but demonstrated unexpected and significant impairment in executive function post-operatively that subsequently abated during follow-up. In both examples the neuroimaging and network data highlight the complexity of the surrounding functional neuroanatomy at the individual level, beyond that which can be perceived on standard structural sequences.
CONCLUSIONS:
The described interface has widespread applications for translational research including pre-operative planning, neurosurgical training, and detailed patient counseling. A protocol for assessing its effectiveness and safety is proposed. Finally, recommendations for effective translation of findings from neuroimaging to neurosurgery are discussed, with the aim of making clinically meaningful improvements to neurosurgical practice.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
connectome; functional connectivity; imaging; networks; tractography
PMID: 31958585 DOI: 10.1016/j.wneu.2020.01.085
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Select item 3195491618.
World Neurosurg. 2020 Jan 16. pii: S1878-8750(20)30092-9. doi: 10.1016/j.wneu.2020.01.074. [Epub ahead of print]
Thoracic dural arteriovenous fistula presenting with isolated pseudobulbar palsy mimicking brainstem lesion: A case report.
Sasaki K1, Inoue T2, Nishijima Y3, Inoue T3, Suzuki S3, Endo T1, Ezura M3, Uenohara H3, Tominaga T4.
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Abstract
BACKGROUND:
Spinal dural arteriovenous fistulas (DAVF) are usually associated with neurological dysfunction adjacent to the shunt point; however, the symptoms are uncommon far from the site of fistula. To our knowledge, this is the first report of a patient with rapidly progressive isolated pseudobulbar palsy due to thoracic DAVF.
CASE DESCRIPTIONS:
We report a patient with thoracic DAVF presenting with remote symptoms of brainstem congestion. The patient was a 36-year-old man who presented with a sudden history of vomiting, dysphagia, and flaccid weakness in the four limbs. Intracranial magnetic resonance (MR) imaging at a local hospital demonstrated T2 signal hyper-intensity within the medulla, and he was referred to our hospital for a suspected brainstem lesion. However, cervical MR imaging revealed a dilated and tortuous perimedullary venous plexus, and spinal angiography revealed DAVF in T5/6 with a feeding artery from the intercostal artery. Following obliteration of the fistula, the progression of the disease was stopped and the symptoms improved.
CONCLUSION:
Although rare, thoracic DAVF may present symptoms resembling brainstem infarction. Prompt surgical intervention is necessary for patients with thoracic DAVF presenting with rapidly progressive pseudobulbar palsy.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
dural arteriovenous fistula; medulla; pseudobulbar palsy; thoracic spine
PMID: 31954916 DOI: 10.1016/j.wneu.2020.01.074
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Select item 3195491519.
World Neurosurg. 2020 Jan 16. pii: S1878-8750(20)30053-X. doi: 10.1016/j.wneu.2020.01.045. [Epub ahead of print]
Tremor caused by Dandy-Walker syndrome concomitant with syringomyelia: A case report and literature review.
Wang Y1, Guo S1, Xu L2, Geng Y1, Shi Z1, Lei B3, Ma Y3, Wang M4.
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Abstract
BACKGROUND:
Dandy-Walker Syndrome (DWS) is a rare congenital brain malformation characterized by underdevelopment of cerebellar vermis and cystic enlargement of the 4th ventricle and enlargement of posterior fossa. The co-occurrence of DWS and syringomyelia in adult is very rare.
CASE DESCRIPTION:
we reported a 19 years old male presented with 2-year history of tremor. Magnetic Resonance Imaging (MRI) showed cystic dilation of the fourth ventricle, hypoplasia of the cerebellar vermis and syringomyelia. Posterior fossa decompression and spinal cord ostomy were performed. Tremor was markedly improved and the fourth ventricular and the syringomyelia were reduced in size postoperatively.
CONCLUSIONS:
Tremor can be a clinical manifestation in patients of DWS concomitant with syringomyelia in adult. Spinal cord ostomy combined posterior fossa decompression may be an effective approach for alleviation of symptoms and syringomyelia.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Dandy-Walker syndrome; posterior fossa decompression; spinal cord ostomy; syringomyelia; tremor
PMID: 31954915 DOI: 10.1016/j.wneu.2020.01.045
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Select item 3195491420.
World Neurosurg. 2020 Jan 16. pii: S1878-8750(20)30067-X. doi: 10.1016/j.wneu.2020.01.059. [Epub ahead of print]
Microsurgical Nuances of Clipping a Large Thrombosed Aneurysm with Intraoperative Dome Incision and Ultrasonic Aspiration.
Gomez-Paz S1, Putman CM2, Thomas AJ1, Ogilvy CS3.
Author information
Abstract
We present the case of a 64-year-old male with a 5-day history of headaches. An MRA revealed a 15 x 15 mm diameter aneurysm in the left middle cerebral artery arising in the region of the M1 M2 bifurcation. Angiography revealed the lesion arose from the M2 vessel that contained a large amount of thrombus. A follow-up MRA at two months revealed an enlargement of the lesion (16 x 17 mm), while a follow-up angiogram showed a decreased in the filling component of the lesion, suggesting further thrombosis. Given its rapid growth, endovascular and surgical options were considered and microsurgery was decided upon. The aneurysm was accessed through the Sylvian fissure, and the M2 vessel was identified at the neck of the lesion where it entered and excited. We performed an intra-aneurysmal thrombus evacuation to make the lesion clippable.1,2 We used a #11 blade and opened the dome away from the neck. Through this 3-4 mm incision, we inserted the tip of the ultrasonic aspirator device and used it to evacuate the thrombus in a circumferential fashion. This allowed for wall-to-wall apposition when deploying the aneurysm clip. A Sugita 15 mm clip was used to obliterate the lesion. Both microvascular ultrasound and intraoperative angiography were used to confirm patency and flow distal to the aneurysm. In the following operative video, we narrate the case and the essential details of this approach. Neither IRB nor patient consent was required for the report of this case with no identifiable patient information.
Copyright © 2020. Published by Elsevier Inc.
KEYWORDS:
Middle cerebral artery; large aneurysm; microsurgery; operative surgical procedure; thrombosed aneurysm; ultrasonic aspiration
PMID: 31954914 DOI: 10.1016/j.wneu.2020.01.059
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World Neurosurg. 2020 Jan 23. pii: S1878-8750(20)30112-1. doi: 10.1016/j.wneu.2020.01.094. [Epub ahead of print]
Use of Pheno Room, Augmented Reality and 3-rod Technique for 3-dimensional Correction of Adolescent Idiopathic Scoliosis.
McClendon J1, Almekkawi AK2, Abi-Aad KR2, Maiti T3.
Author information
Abstract
This is a surgical video that showcases the surgical repair of a young male patient with idiopathic scoliosis in a hybrid OR with the utilization of a new imaging modality ARTIS PHENO (Siemens Medical Solutions, Pennsylvania, USA) and augmented reality. This is a case of a 17-year-old male patient with idiopathic scoliosis, patient underwent scoliosis repair in hybrid OR with segment reality surgical planning. The use of augmented reality helped in visualization of proper screw trajectory, and the use of ARTIS PHENO helped in identification of correct screw placement, and rod fixation. Intraoperative use of new imaging modalities as augmented reality imaging and ARTIS PHENO shows to decrease surgical complication and time.
Copyright © 2020. Published by Elsevier Inc.
KEYWORDS:
3-rod technique; ARTIS PHENO; Augmented reality; Intraoperative imaging; scoliosis
PMID: 31982598 DOI: 10.1016/j.wneu.2020.01.094
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Select item 319825972.
World Neurosurg. 2020 Jan 23. pii: S1878-8750(20)30111-X. doi: 10.1016/j.wneu.2020.01.093. [Epub ahead of print]
Perioperative complications and prognosis of curative surgical resection for spinal metastases in elderly patients.
Yonezawa N1, Murakami H2, Demura S3, Kato S3, Yoshioka K4, Shinmura K3, Yokogawa N3, Shimizu T3, Oku N3, Kitagawa R3, Handa M3, Annen R3, Kurokawa Y3, Tsuchiya H3.
Author information
KEYWORDS:
complication; corpectomy; elderly patients; hemivertebrectomy; spinal metastasis; spondylectomy; survival analysis
PMID: 31982597 DOI: 10.1016/j.wneu.2020.01.093
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Select item 319825963.
World Neurosurg. 2020 Jan 23. pii: S1878-8750(20)30032-2. doi: 10.1016/j.wneu.2020.01.025. [Epub ahead of print]
Experimental Study of Nerve Transfer to Restore Diaphragm Function.
Ding W1, Jiang J2, Xu L3.
Author information
Abstract
OBJECTIVE:
Diaphragmatic paralysis following phrenic nerve injury is an infrequent but serious condition. The destruction of respiratory function after unilateral phrenic nerve injury has been the subject of many investigations.
METHODS:
In this study, we used a rat model of complete paralysis of the unilateral diaphragm to observe the changes of pulmonary function.
RESULTS:
It is found that in the young rats of complete paralysis of the unilateral diaphragm, the vital capacity and total lung capacity show compensation after 4 weeks, and contralateral phrenic nerve transfer can enhance pulmonary function. However, in the aged rats, respiratory function parameters do not show compensation until 16 weeks after injury.
CONCLUSION:
These findings suggest that contralateral phrenic nerve end-to-side anastomosis is a promising therapeutic strategy. In general, our results suggest that this surgical method may hold great potential to be a secure, feasible, and effective technique to rescue diaphragmatic function.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
brachial plexus injury; contralateral phrenic nerve transfer; end-to-side anastomosis; phrenic nerve injury
PMID: 31982596 DOI: 10.1016/j.wneu.2020.01.025
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Select item 319817874.
World Neurosurg. 2020 Jan 22. pii: S1878-8750(20)30106-6. doi: 10.1016/j.wneu.2020.01.088. [Epub ahead of print]
Correlation between pain and nerve growth factor receptor expression in patients with endometriosis diagnosed by transvaginal color ultrasound and magnetic resonance.
Mu L1, Wang M2, Yu Y3.
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Abstract
This article explores the diagnosis of deep invasive endometriosis through retrospective data analysis, including deep infiltration and magnetic resonance imaging. The literature retrospectively collected 21 patients with deep invasive endometriosis who were admitted from 2012 to 2018. The patient was confirmed to have pain and nerve growth factor receptor expression levels after the operation and underwent vaginal color ultrasound and magnetic resonance imaging before surgery. The diagnostic results of color Doppler ultrasound and magnetic resonance imaging were retrospectively analyzed and compared with the surgical results, and the cumulative site and anatomical abnormalities of the diagnosis of deep invasive endometriosis were analyzed to determine the NGF receptor table. . Through research, it has been found that deep invasive endometriosis mainly involves the uterine fibula ligament, vagina, uterus rectum, rectum, ureter, etc. The patient's pain is related to the expression level of nerve growth factor receptor, and its magnetic resonance mainly manifests as signals And structural obstacles, irregular thickening of the affected area. Or nodular formation, deformation of adjacent tissues and organs. Through the research and demonstration of deep invasive endometriosis, transvaginal color ultrasound and magnetic resonance imaging can not only accurately locate the expression levels of pain and nerve growth factor receptors, but also show the extent of the lesions, thereby studying pain and nerve growth Factor receptor expression, which is an important method for preoperative examination and postoperative follow-up.
Copyright © 2020. Published by Elsevier Inc.
KEYWORDS:
disease diagnosis; magnetic resonance; nerve growth factor; receptor table; transvaginal colour ultrasound
PMID: 31981787 DOI: 10.1016/j.wneu.2020.01.088
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Select item 319817865.
World Neurosurg. 2020 Jan 22. pii: S1878-8750(20)30107-8. doi: 10.1016/j.wneu.2020.01.089. [Epub ahead of print]
Radiologic Characteristics of Anterior Transarticular Crossing Screw Placement for Atlantoaxial Joint Instability.
Liu Q1, Yang Z1, Lin J1, Liu Y2, Huang Z1, Liu J1, Ji W3, Jiang H3.
Author information
Abstract
OBJECTIVE:
The feasibility of anterior transarticular crossing screw (ATCS) was confirmed in cadaveric specimen and it has been used in clinic. However, no study has ever documented the morphometric characteristics of ATCS. This study was to determine the morphometric characteristics of ATCS in C1-C2 fixation.
METHODS:
A total of 100 patients without abnormality of C1-2 were enrolled. The range of screw lateral angles (LA) and the screw lengths of ATCS on coronal images were measured on multiplanar CT images, as well as the screw incline angles (IA) in sagittal plane. The ideal trajectory was designed as toward to the posterosuperior points of opposite C1 lateral mass, which would have the longest screw length.
RESULTS:
The LA were relatively small in males compared with females, which were 31.4° to 45.3° in males and 32.6° to 46.0° in females. In the sagittal plane, the IA were ranged from 41.0° to 68.4° in males and from 44.4° to 68.1° in females. The overall screw lengths were longer in males than that in females, with 34.7 mm to 44.8 mm in males and 32.2 mm to 39.6 mm in females. In the ideal path, the LA and IA were 38.4° and 41.0° in males and 39.6° and 44.4° in females, and the screw lengths were 44.8 mm in males and 39.6 mm in females, respectively.
CONCLUSIONS:
This study provide the range of screw angles and lengths of ATCS, which will help surgeons to perform ATCS safely and accurately.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Atlantoaxial Joint; Computed Tomography; Crossing Screw; Morphometric Characteristics
PMID: 31981786 DOI: 10.1016/j.wneu.2020.01.089
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Select item 319817856.
World Neurosurg. 2020 Jan 22. pii: S1878-8750(20)30109-1. doi: 10.1016/j.wneu.2020.01.091. [Epub ahead of print]
The modified iliac screw-An anatomical comparison and technical guide.
von Glinski A1, Yilmaz E2, Ishak B3, Haymann E3, Ramey W4, Jack A4, Iwanaga J5, Oskouian RJ4, Tubbs RS6, Chapman J4.
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PMID: 31981785 DOI: 10.1016/j.wneu.2020.01.091
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Select item 319817847.
World Neurosurg. 2020 Jan 22. pii: S1878-8750(20)30105-4. doi: 10.1016/j.wneu.2020.01.087. [Epub ahead of print]
Evaluation of the Prognosis of Neuroglioma Based on Dynamic Magnetic Resonance Enhancement.
Li F1, Zhang Y2, Wang N3, Song C1, Gao Y1, Diao X1, Zhang H4.
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Abstract
This article explores the diagnostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the prognosis of gliomas, and judges the relevant factors affecting the prognosis of gliomas. for reference. patient. This article used Cox proportional hazards model to retrospectively analyze clinical data of 81 complete neuroglioma patients from the same neurosurgery medical team from January 2012 to November 2018, including magnetic resonance dynamic imaging data. In order to determine the prognostic factors, P <0.05 was used as the statistical standard, and the survival curve of statistically significant factors was drawn by Kaplan-Meier method. The results showed that Cox proportional hazard model analysis showed that preoperative KPS score, age, tumor pathological grade, postoperative radiotherapy, temozolomide use, and Ki-67 expression had an impact on the prognosis of patients with neuroglioma. Multivariate analysis and MRI imaging data showed that age, tumor grade, preoperative KPS score, postoperative radiotherapy, and Ki-67 expression were prognostic factors for patients with glioma. The older the age, the higher the pathological grade, the higher the Ki-67 expression level, the lower the KPS score before surgery, and the worse the prognosis. Postoperative radiotherapy and appropriate temozolomide chemotherapy will help improve the prognosis of patients with neuroglioma.
Copyright © 2020. Published by Elsevier Inc.
KEYWORDS:
chemotherapy; glioma; prognosis analysis; radiotherapy; surgery
PMID: 31981784 DOI: 10.1016/j.wneu.2020.01.087
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Select item 319817838.
World Neurosurg. 2020 Jan 22. pii: S1878-8750(20)30110-8. doi: 10.1016/j.wneu.2020.01.092. [Epub ahead of print]
Split Cord Malformation presentation, management and surgical outcome.
Alnefaie N1, Alharbi A2, Alamer O2, Khairy I3, Khairy S4, Saeed MA4, Azzubi M4.
Author information
Abstract
BACKGROUND:
Split cord malformation (SCM) is a rare anomaly characterized by a split along the midline of the cord, which divides it into two symmetrical or nonsymmetrical entities . SCM surgical indications and outcomes are still debatable, the signs and symptoms are generally nonspecific, and commonly associated with other anomalies and deficits.
METHODOLOGY:
We retrospectively searched our hospital database for patients with SCM between the years 1998 and 2018 at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Descriptive statistics were used to present categorical data as percentages and frequencies.
RESULTS:
A total of 25 patients were included in this series. The mean age of patients at the time of diagnosis was 4.4 years. A total of 18(72%) patients underwent surgical correction. The mean difference between the age at diagnosis and the age at correction was 7 months. All cases underwent intraoperative neurophysiological monitoring. Postoperative complications were minimal. CSF leakage was noted in 2 patients, transient urinary retention was noted in one patient and transient unilateral leg paresis was noted in one patient. The majority of the patients, 15 (83%), were discharged within 19 days after surgery, and 81% showed improvement postoperatively. Over the long-term follow up, none of the patients developed new urological or neurological deficits.
CONCLUSION:
The majority of SCM patients present during childhood. Postoperative complications following SCM corrective surgery are generally minimal, and the overall outcomes, mainly including partial or complete symptomatic improvement and/or symptom stability and hydronephrosis resolution, were favorable.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
SCM; diastematomyelia; diplomyelia; spine dysraphism; split cord malformation
PMID: 31981783 DOI: 10.1016/j.wneu.2020.01.092
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Select item 319723469.
World Neurosurg. 2020 Jan 20. pii: S1878-8750(19)33150-X. doi: 10.1016/j.wneu.2019.12.118. [Epub ahead of print]
Microsurgical clipping compared to new and most advanced endovascular techniques in the treatment of unruptured middle cerebral artery aneurysms: a meta-analysis in the modern era.
Toccaceli G1, Diana F2, Cagnazzo F3, Cannizzaro D4, Lanzino G5, Barbagallo GMV1, Certo F1, Bortolotti C6, Signorelli F7, Peschillo S1.
Author information
Abstract
OBJECTIVE:
Analyzing occlusion, complications rate and clinical results in unruptured saccular middle cerebral artery aneurysms (MCAAs) comparing clipping to the most advance and newer endovascular techniques.
METHODS:
We conducted a literature research from January 2009 to December 2018 to evaluating the efficacy and safety of microsurgical clipping or endovascular treatment with new devices (such as Flow-diverter or WEB) in patients with unruptured MCAAs. We extracted data involved: study and intervention features, occlusion rate; time of occlusion assessment and clinical outcome. RESULTS: A total of 29 studies and 1552 patients with unruptured saccular MCAAs were included in our analysis (464 patients included in endovascular group, 1088 patients in surgical group). Overall, the rate of long-term complete/near complete occlusion was 78.1% (311/405, 95%CI=69%-87.1%,) and 95.7% (113/118, 95%CI=92%-99.3%,)after endovascular and surgical treatments, respectively (p= .001). Long-term complete occlusion rate was 60% (153/405, 95%CI=45%-74%) and 95% (112/118, 95%CI=90%-98%) after endovascular and surgical treatments, respectively (p= .001). The overall rate of treatment-related complications was 5.6% (33/464, 95%CI=3.6%-7.7%) and 2.9% (37/1088, 95%CI=0.8%-5%) among the endovascular and surgical groups, respectively (p= .001). Endovascular treatments were associated with higher rates of good neurological outcome (283/293=97%, 95%CI=95%-98%, vs 570/716=84%, 95%CI=67%-98%, p=.001). No difference was found for the mortality rate (3/464=1.5%, 95%CI=0.4%- 2.6%, vs 1/1088, 95%CI=0.1%-0.6%, p=.5).
CONCLUSION:
Treatment-related complication and mortality are comparable among these techniques, the risk of aneurysm rupture appears very low for both strategies. Endovascular approach seems to increase the probability of good functional outcome after treatment, compared to surgery.
Copyright © 2019 Elsevier Inc. All rights reserved.
KEYWORDS:
Aneurysms; Endovascular; Flow Diverter; Middle Cerebral Artery Aneurysms; Stent-assisted coiling; Surgery; WEB
PMID: 31972346 DOI: 10.1016/j.wneu.2019.12.118
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Publication type
Select item 3195859210.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30102-9. doi: 10.1016/j.wneu.2020.01.084. [Epub ahead of print]
The College of Surgeons of East, Central and Southern Africa: Successes and Challenges in Standardizing Neurosurgical Training.
Henderson F Jr1, Abdifatah K2, Qureshi M3, Perry A4, Graffeo CS4, Haglund MM5, Olunya DO2, Mogere E2, Okanga B6, Copeland WR 3rd7.
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Abstract
BACKGROUND:
The College of Surgeons of East, Central, and Southern Africa (COSECSA) is a regional accrediting body for general and specialty surgical training programs that has recently expanded to include neurosurgery. As neurosurgical services expand in Sub-Saharan Africa, the structure of training and accreditation has become a vital issue.
METHODS:
We review the founding and current structures of COSECSA neurosurgical training, identifying accomplishments as well as challenges facing the expansion of neurosurgical training in this region.
RESULTS:
The COSECSA model has succeeded in several countries to graduate qualified neurosurgeons, but challenges remain. Programs must balance the long duration of training required to promote surgical excellence against an overwhelming clinical need that seeks immediate solutions.
CONCLUSION:
Harnessing global collaboration, rapidly expanding local infrastructure, and a robust multi-national training curriculum, COSECSA has emerged as a leader in the effort to train neurosurgeons, and is anticipated to dramatically improve upon the markedly unmet need for neurosurgical care in Sub-Saharan Africa.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
global neurosurgery; history of neurosurgery; low and middle income countries; resident education; sub-Saharan Africa
PMID: 31958592 DOI: 10.1016/j.wneu.2020.01.084
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Select item 3195859111.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30100-5. doi: 10.1016/j.wneu.2020.01.082. [Epub ahead of print]
Risk factors for outcomes following microvascular decompression for trigeminal neuralgia.
Shi J1, Qian Y1, Han W1, Dong B1, Mao Y1, Cao J1, Guan W1, Zhou Q2.
Author information
Abstract
BACKGROUND:
Microvascular decompression (MVD) is the most effective long-term surgical treatment for trigeminal neuralgia (TN) patients. The risk factors for poor pain control following MVD surgery are not fully understood.
METHODS:
A total of one hundred eighty-four patients were enrolled from patients with typical TN who underwent MVD at our institution between 1/3/2008 and 1/3/2016. The data were collected using electronic operative records and case notes and were retrospectively analyzed. Patients were followed up at the outpatient department or by telephone at a minimum of three months and at a maximum of forty-eight months.
RESULTS:
184 patients were enrolled in the study; 72.3% of patients achieved freedom from pain after MVD, 27.7% experienced poor pain control, with follow-up at a minimum of 3 months and at a maximum of 48 months. Risk factors for poor pain control after MVD according to binary logistic regression and ROC analysis included younger age (OR: 0.90; 95% CI: 0.82-0.99; P = 0.028; AUC=0.774); poor preoperative pain control (BNI score > IV) (OR: 52.03; 95% CI: 6.44-420.16, P < 0.001; AUC=0.858); intraoperatively detected multivessel compression (OR: 2.49; 95% CI: 3.10-46.59, P < 0.001; AUC=0.871). Furthermore, combined compression of the superior cerebellar artery (SCA) and the petrosal vein (PV) was an independent risk factor predicting a poor outcome following MVD (OR: 5.69; 95% CI: 33.78-2579.03, P < 0.001; AUC=0.812).
CONCLUSIONS:
Younger patients with TN had worse long-term pain outcomes following MVD. Additional factors associated with postoperative recurrence included poor preoperative pain control (BNI score > IV) and multivessel compression. Furthermore, SCA combined with PV was confirmed to be associated with a worse outcome.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
microvascular decompression; risk factors; trigeminal neuralgia
PMID: 31958591 DOI: 10.1016/j.wneu.2020.01.082
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Select item 3195859012.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30099-1. doi: 10.1016/j.wneu.2020.01.081. [Epub ahead of print]
Optimal timing of extracranial-intracranial bypass with microsurgical trapping for ruptured blister aneurysms of the internal carotid artery.
Endo H1, Fujimura M2, Shimizu H3, Endo T4, Omodaka S5, Inoue T4, Sato K6, Niizuma K7, Tominaga T5.
Author information
Abstract
OBJECTIVE:
Ruptured blister aneurysms of the internal carotid artery are challenging to treat because of their difficult diagnosis and the fragility of the wall structure. Here, we sought to clarify the efficacy of extracranial-intracranial bypass followed by trapping (bypass/trapping) for ruptured blister aneurysms.
METHODS:
A retrospective study identified 45 patients with ruptured blister aneurysms between 1998 and 2017. Our principle was to attempt bypass/trapping as early as possible after diagnosis (early surgery). If early diagnosis was difficult, patients underwent elective surgery in the later stage when aneurysms were detected (elective surgery). Patient characteristics, radiological findings, clinical course, and outcomes were analyzed.
RESULTS:
Forty-three patients were treated by bypass/trapping. Twenty-eight patients were classified as early surgery and 15 as elective surgery. Two patients experienced fatal rebleeding and did not undergo surgery. All 15 patients in the elective surgery group showed rebleeding and/or aneurysmal growth while awaiting surgery. In the elective surgery group, there were 10 aneurysms missed initially by catheter angiography. In the early surgery group, 9 patients were assessed by vessel wall magnetic resonance imaging (MRI), which showed circumferential enhancement along the aneurysm wall, most of which was shown as only a small bulge in the angiography. Postoperative rebleeding did not occur in any of the patients.
CONCLUSIONS:
Bypass/trapping is effective to prevent rebleeding. Early surgery may be beneficial, as most patients in the elective surgery group showed rebleeding or aneurysmal growth. Vessel wall MRI is a useful adjunct for early diagnosis and may contribute to prompt early surgery.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Blister aneurysm; bypass; internal carotid artery; timing of surgery; wall imaging
PMID: 31958590 DOI: 10.1016/j.wneu.2020.01.081
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Select item 3195858913.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30098-X. doi: 10.1016/j.wneu.2020.01.080. [Epub ahead of print]
Dural tears in percutaneous biportal endoscopic spine surgery: Anatomical location and management.
Park HJ1, Kim SK2, Lee SC3, Kim W4, Han S4, Kang SS5.
Author information
Abstract
OBJECTIVE:
To determine the rate and anatomical location of dural tears associated with spinal surgery using a percutaneous biportal technique (PBES). We aimed to investigate the relationship between dural tears and the type of procedure and type of instrument used.
METHODS:
We retrospectively analyzed 643 PBES cases by reviewing medical charts, operative records, and operative videos. Incidental durotomy was identified in 29 cases. We analyzed the size and anatomical location of dural tears, as well as the surgical instrument that caused the tear, and the technique used to seal the tear.
RESULTS:
The dural tear incidence was 4.5% (29/643 cases). Tears in the exiting nerve area (two cases, 6.9%) were mainly caused by curettage, while tears in the thecal sac area (18 cases, 62.1%) were associated with electric drill and forceps use, and use of a Kerrison punch in the traversing nerve area (nine cases, 31%). Twelve cases of dural tear were treated with in-hospital monitoring and bed rest. Fourteen cases were treated using a fibrin sealant. Two cases were treated with a non-penetrating titanium clip, and one was converted to microscopic surgery. One case of postoperative meningocele after conservative treatment required endoscopic revision surgery to close the dural tear.
CONCLUSIONS:
Most cases of incidental dural tear during PBES were treated with an endoscopic procedure. The incidence of dural tear was no higher than that was associated with microscopic surgery. Our management strategy for incidental dural tears in biportal endoscopic spinal surgery is safe and effective.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
dural tear; endoscopic spinal surgery; fibrin sealant; nonpenetrating titanium clip; percutaneous biportal endoscopic surgery
PMID: 31958589 DOI: 10.1016/j.wneu.2020.01.080
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Select item 3195858814.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30096-6. doi: 10.1016/j.wneu.2020.01.078. [Epub ahead of print]
Initial experience with transradial access for cerebrovascular procedures: is it feasible and safe?
Styczen H1, Maus V2, Tsogkas I3, Meila D4, Bester M5, Buhk JH5, Psychogios MN3.
Author information
Abstract
BACKGROUND:
Despite the proven benefit of transradial access over transfemoral access in cardiac procedures, the transition for cerebrovascular procedures has only been slowly enforced. Here we present our experience with transradial access in cerebral diagnostic angiographies and neurointerventional procedures.
METHODS:
We performed a retrospective analysis of patients who underwent transradial access for cerebrovascular procedures in 3 German centers between February 2017 and May 2019. Demographics, technical features and complications were evaluated.
RESULTS:
Transradial access was successful in 40/45 (89%) endovascular procedures. Selected catheterization of the intended vessels was obtained in 95% (40/42) of cases. The rate of procedure-related vascular complications was 2% (1/45).
CONCLUSION:
In this small retrospective series transradial access proved to be safe and efficient. In the future, it is planned to further promote it as a standard access alternative for a larger number of patients.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
cerebral angiography; endovascular therapy; radial access; radial artery; transradial
PMID: 31958588 DOI: 10.1016/j.wneu.2020.01.078
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Select item 3195858715.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30097-8. doi: 10.1016/j.wneu.2020.01.079. [Epub ahead of print]
The Magnetic Resonance Imaging Research of Thoracic Inlet Parameters at Cervical and Cervicothoracic Spine in Degenerative Cervical Spondylosis.
Li W1, Li F2, Yang X2, Yu S2, Chen W2, Chen Q2.
Author information
Abstract
OBJECTIVE:
The purpose of this study was to examine the thoracic inlet angle (TIA) as well as its related parameters on cervical and cervical-thoracic vertebra in patients with degenerative cervical spondylosis (DCS) and explore the association of TIA, tilt angle of neck (NT), and tilt angle of the first thoracic spine (T1S) with cervical degeneration score.
METHODS:
The patients with DCS were included from January, 2014 to December, 2017. The relavant parameters were assessed on T2-weighted MRI. The association of cervical parameters with cervical degeneration score was examined by multiple linear regression model.
RESULTS:
204 patients were eligible and enrolled, in which the mean age was 55-56 years, 126 of them were males. Male had significantly higher thoracic inlet parameters than females (all P<0.05). Thoracic inlet parameters were positively correlated with age (all P<0.05). After adjustment for age and gender, the significant association between TIA and cervical or cervical-thoracic spine degeneration scores was not observed in all vertebras. Meanwhile, male had higher height of each vertebra (VH) and height of each inter-vertebral disc (IVDH) than females. Only VH of C7, T1, T2 and IVDH of C6/C7, T1/T2, T2/T3 was significantly and positively associated with TIA (all P<0.05).
CONCLUSION:
Age was positively correlated with thoracic inlet parameters in DCS patients. Males had significantly higher thoracic inlet parameters than females, due to higher VH and IVDH in males. However, TIA was not associated with the level of cervical disc degeneration. But the clinical relevance of these findings has not been established.
Copyright © 2020. Published by Elsevier Inc.
KEYWORDS:
Cervical and Cervicothoracic spine; Cervical degeneration score; Degenerative cervical spondylosis; Magnetic resonance imaging; Thoracic inlet angle
PMID: 31958587 DOI: 10.1016/j.wneu.2020.01.079
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Select item 3195858616.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30104-2. doi: 10.1016/j.wneu.2020.01.086. [Epub ahead of print]
Infant Fistula-type Arteriovenous Malformation with Cerebellar Hemorrhage Developed into Nidus-type in Adolescence: A Case Report.
Yamada E1, Ito Y2, Nakai Y3, Uemura K3, Ishikawa E4, Matsumura A4.
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Abstract
Although arteriovenous malformation (AVM) has been considered to be a congenital vascular malformation, morphological differences associated with age have been indicated in the literature. We report a case of infant fistula-type AVM that developed into nidus-type AVM 15 years later. This is the first report to document morphological changes of AVM over time in one case. The present case suggests the possibly that AVM morphology may change with age, and is an important when considering the history of AVM.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Arteriovenous malformation; fistula type AVM; infancy; recurrent
PMID: 31958586 DOI: 10.1016/j.wneu.2020.01.086
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Select item 3195858517.
World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30103-0. doi: 10.1016/j.wneu.2020.01.085. [Epub ahead of print]
PRACTICAL APPLICATION OF NETWORKS IN NEUROSURGERY: COMBINED 3D PRINTING, NEURONAVIGATION, AND PRE-OPERATIVE SURGICAL PLANNING.
Romero-Garcia R1, Erez Y2, Oliver G3, Owen M4, Merali S5, Poologaindran A5, Morris RC4, Price SJ4, Santarius T4, Suckling J5, Hart MG6.
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Abstract
BACKGROUND:
A plethora of cutting edge neuroimaging analyses have been developed and published yet they have not hitherto been realized as improvements in neurosurgical outcomes. In this paper we propose a novel interface between neuroimaging and neurosurgery for aiding translational research. Our objective is to create a method for applying advanced neuroimaging and network analysis findings to neurosurgery, and illustrate its application through the presentation of two detailed case vignettes.
METHODS:
This interface comprises a combination of network visualization, 3D printing, and ex-vivo neuronavigation to enable pre-operative planning according to functional neuroanatomy. Clinical cases were selected from a prospective cohort study.
RESULTS:
The first case vignette describes a low grade glioma with potential language and executive function network involvement that underwent a successful complete resection of the lesion with preservation of network features. The second case describes a low grade glioma in an apparently non-eloquent location that underwent a subtotal resection but demonstrated unexpected and significant impairment in executive function post-operatively that subsequently abated during follow-up. In both examples the neuroimaging and network data highlight the complexity of the surrounding functional neuroanatomy at the individual level, beyond that which can be perceived on standard structural sequences.
CONCLUSIONS:
The described interface has widespread applications for translational research including pre-operative planning, neurosurgical training, and detailed patient counseling. A protocol for assessing its effectiveness and safety is proposed. Finally, recommendations for effective translation of findings from neuroimaging to neurosurgery are discussed, with the aim of making clinically meaningful improvements to neurosurgical practice.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
connectome; functional connectivity; imaging; networks; tractography
PMID: 31958585 DOI: 10.1016/j.wneu.2020.01.085
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Select item 3195491618.
World Neurosurg. 2020 Jan 16. pii: S1878-8750(20)30092-9. doi: 10.1016/j.wneu.2020.01.074. [Epub ahead of print]
Thoracic dural arteriovenous fistula presenting with isolated pseudobulbar palsy mimicking brainstem lesion: A case report.
Sasaki K1, Inoue T2, Nishijima Y3, Inoue T3, Suzuki S3, Endo T1, Ezura M3, Uenohara H3, Tominaga T4.
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Abstract
BACKGROUND:
Spinal dural arteriovenous fistulas (DAVF) are usually associated with neurological dysfunction adjacent to the shunt point; however, the symptoms are uncommon far from the site of fistula. To our knowledge, this is the first report of a patient with rapidly progressive isolated pseudobulbar palsy due to thoracic DAVF.
CASE DESCRIPTIONS:
We report a patient with thoracic DAVF presenting with remote symptoms of brainstem congestion. The patient was a 36-year-old man who presented with a sudden history of vomiting, dysphagia, and flaccid weakness in the four limbs. Intracranial magnetic resonance (MR) imaging at a local hospital demonstrated T2 signal hyper-intensity within the medulla, and he was referred to our hospital for a suspected brainstem lesion. However, cervical MR imaging revealed a dilated and tortuous perimedullary venous plexus, and spinal angiography revealed DAVF in T5/6 with a feeding artery from the intercostal artery. Following obliteration of the fistula, the progression of the disease was stopped and the symptoms improved.
CONCLUSION:
Although rare, thoracic DAVF may present symptoms resembling brainstem infarction. Prompt surgical intervention is necessary for patients with thoracic DAVF presenting with rapidly progressive pseudobulbar palsy.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
dural arteriovenous fistula; medulla; pseudobulbar palsy; thoracic spine
PMID: 31954916 DOI: 10.1016/j.wneu.2020.01.074
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Select item 3195491519.
World Neurosurg. 2020 Jan 16. pii: S1878-8750(20)30053-X. doi: 10.1016/j.wneu.2020.01.045. [Epub ahead of print]
Tremor caused by Dandy-Walker syndrome concomitant with syringomyelia: A case report and literature review.
Wang Y1, Guo S1, Xu L2, Geng Y1, Shi Z1, Lei B3, Ma Y3, Wang M4.
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Abstract
BACKGROUND:
Dandy-Walker Syndrome (DWS) is a rare congenital brain malformation characterized by underdevelopment of cerebellar vermis and cystic enlargement of the 4th ventricle and enlargement of posterior fossa. The co-occurrence of DWS and syringomyelia in adult is very rare.
CASE DESCRIPTION:
we reported a 19 years old male presented with 2-year history of tremor. Magnetic Resonance Imaging (MRI) showed cystic dilation of the fourth ventricle, hypoplasia of the cerebellar vermis and syringomyelia. Posterior fossa decompression and spinal cord ostomy were performed. Tremor was markedly improved and the fourth ventricular and the syringomyelia were reduced in size postoperatively.
CONCLUSIONS:
Tremor can be a clinical manifestation in patients of DWS concomitant with syringomyelia in adult. Spinal cord ostomy combined posterior fossa decompression may be an effective approach for alleviation of symptoms and syringomyelia.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Dandy-Walker syndrome; posterior fossa decompression; spinal cord ostomy; syringomyelia; tremor
PMID: 31954915 DOI: 10.1016/j.wneu.2020.01.045
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Select item 3195491420.
World Neurosurg. 2020 Jan 16. pii: S1878-8750(20)30067-X. doi: 10.1016/j.wneu.2020.01.059. [Epub ahead of print]
Microsurgical Nuances of Clipping a Large Thrombosed Aneurysm with Intraoperative Dome Incision and Ultrasonic Aspiration.
Gomez-Paz S1, Putman CM2, Thomas AJ1, Ogilvy CS3.
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Abstract
We present the case of a 64-year-old male with a 5-day history of headaches. An MRA revealed a 15 x 15 mm diameter aneurysm in the left middle cerebral artery arising in the region of the M1 M2 bifurcation. Angiography revealed the lesion arose from the M2 vessel that contained a large amount of thrombus. A follow-up MRA at two months revealed an enlargement of the lesion (16 x 17 mm), while a follow-up angiogram showed a decreased in the filling component of the lesion, suggesting further thrombosis. Given its rapid growth, endovascular and surgical options were considered and microsurgery was decided upon. The aneurysm was accessed through the Sylvian fissure, and the M2 vessel was identified at the neck of the lesion where it entered and excited. We performed an intra-aneurysmal thrombus evacuation to make the lesion clippable.1,2 We used a #11 blade and opened the dome away from the neck. Through this 3-4 mm incision, we inserted the tip of the ultrasonic aspirator device and used it to evacuate the thrombus in a circumferential fashion. This allowed for wall-to-wall apposition when deploying the aneurysm clip. A Sugita 15 mm clip was used to obliterate the lesion. Both microvascular ultrasound and intraoperative angiography were used to confirm patency and flow distal to the aneurysm. In the following operative video, we narrate the case and the essential details of this approach. Neither IRB nor patient consent was required for the report of this case with no identifiable patient information.
Copyright © 2020. Published by Elsevier Inc.
KEYWORDS:
Middle cerebral artery; large aneurysm; microsurgery; operative surgical procedure; thrombosed aneurysm; ultrasonic aspiration
PMID: 31954914 DOI: 10.1016/j.wneu.2020.01.059
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