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OBJECTIVE: Neuroanatomy comprehension is a keystone of understanding intracranial surgeries. Traditionally taught to students during ex cathedra courses, neuroanatomy is described as complex. Mixed reality (MxR) opens new perspectives in the learning process. This study aims to compare MxR-based courses with traditional ex cathedra lectures for neuroanatomy education. METHODS: Two lectures describing the neuroanatomy of the anterior circulation arteries ("Vascular Lecture" [VS]) and important white matter fiber tracts ("White Fibers Lecture" [WF]) were designed and delivered in ex cathedra and MxR-based formats with the same audio content. Ninety-one medical students were randomly assigned to group A (ex cathedra WF/MxR VS) or group B (MxR WF/ex cathedra VS). The MxR content was delivered via MxR goggles. Prior to each lecture, students took a 10-item multiple choice question (MCQ) pretest. After the lectures, students took a 20-item MCQ posttest (75% neuroanatomy, 25% clinical correlation). RESULTS: The pretest scores showed no statistical difference between groups. Median posttest scores increased by 14.3% after using the MxR-based format compared to the ex cathedra format (16.00 [13.0, 18.0] vs 14.0 [11.0, 17.0], respectively, p < 0.01). Regarding the VS, students scored 21.7% better using the MxR format compared to the ex cathedra format (14.0 [12.0, 16.0] vs 11.5 [10.0, 14.0], p < 0.001). Concerning the WF, the median score using MxR was 18.0 (17.0, 19.0), and the median score using the ex cathedra format was 17.0 (16.0, 18.0; p < 0.01). Students showed high motivation to learn neuroanatomy in the future using MxR (74%) rather than ex cathedra format (25%; p < 0.001). Mild discomfort using the MxR goggles was reported by 48.3% of participants. Most participants (95.5%) preferred the MxR-based teaching. CONCLUSIONS: Students acquired a better knowledge of the anatomy of the anterior circulation arteries and white fiber tracts using MxR-based teaching as compared to the standard ex cathedra format. The perception of lecture quality and learning motivation was better using MxR-based teaching despite some mild discomfort. The development of MxR-based solutions is promising to improve neuroanatomy education.
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Realidade Aumentada , Estudantes de Medicina , Humanos , Neuroanatomia/educação , Aprendizagem , CurrículoRESUMO
BACKGROUND: For recurrent glioblastoma (GB) patients, several therapy options have been established over the last years such as more aggressive surgery, re-irradiation or chemotherapy. Age and the Karnofsky Performance Status Scale (KPSS) are used to make decisions for these patients as these are established as prognostic factors in the initial diagnosis of GB. This study's aim was to evaluate preoperative patient comorbidities by using the age-adjusted Charlson Comorbidity Index (ACCI) as a prognostic factor for recurrent GB patients. METHODS: In this retrospective analysis we could include 123 patients with surgery for primary recurrence of GB from January 2007 until December 2016 (43 females, 80 males, mean age 57 years (range 21-80 years)). Preoperative age, sex, ACCI, KPSS and adjuvant treatment regimes were recorded for each patient. Extent of resection (EOR) was recorded as a complete/incomplete resection of the contrast-enhancing tumor part. RESULTS: Median overall survival (OS) was 9.0 months (95% CI 7.1-10.9 months) after first re-resection. Preoperative KPSS > 80% (P < 0.001) and EOR (P = 0.013) were associated with significantly improved survival in univariate analysis. Including these factors in multivariate analysis, preoperative KPSS < 80 (HR 2.002 [95% CI: 1.246-3.216], P = 0.004) and EOR are the only significant prognostic factor (HR 1.611 [95% CI: 1.036-2.505], P = 0.034). ACCI was not shown as a prognostic factor in univariate and multivariate analyses. CONCLUSION: For patients with surgery for recurrent glioblastoma, the ACCI does not add further information about patient's prognosis besides the well-established KPSS and extent of resection.
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Neoplasias Encefálicas , Glioblastoma , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/terapia , Comorbidade , Feminino , Glioblastoma/epidemiologia , Glioblastoma/cirurgia , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Social Media (SoMe) is becoming increasingly used in the medical community, and its use has been related with academic productivity. However, utilization of SoMe in the European neurosurgical community has not been assessed systematically. METHODS: An online search was undertaken to discover SoMe accounts of (1) national and related neurosurgical societies listed on the EANS website, (2) neurosurgical journals present on EANS website, (3) neurosurgery centers within EANS member countries, as listed on their website. SoMe accounts of Facebook, Twitter, YouTube, and Instagram were searched for journals and societies, and Twitter, Instagram, and Facebook for neurosurgery departments. The number of likes/followers/subscribers was recorded. RESULTS: Five (31%) neurosurgery journals had a SoMe presence. The highest number of followers, likes, and tweets was found for JNNP, and Journal of Neurological Surgery Part B had the most subscribers and video views. SoMe usage was identified for 11 national (28.2%) and 2 multi-national neurosurgical societies. From these, the French Society of Neurosurgery had the largest number of Facebook followers (> 2800) and Likes (> 2700), the Society of British Neurological Surgeons had the largest number of Twitter followers (> 2850), whereas EANS overall had the most followers on Twitter > 5100 and Facebook > 5450. A total of 87 SoMe neurosurgery center accounts were found on either Facebook, Instagram or Twitter, for 64 of 1000 centers (6.4%) in 22 of 40 different countries (55%). Of these 67% (n = 43/64) arose from 6 countries (England, Germany, Italy, Romania, Turkey, Ukraine). There were more Facebook accounts (n = 42) than Instagram accounts (n = 23) or Twitter accounts (n = 22). CONCLUSION: SoMe use amongst neurosurgical societies and departments in Europe is very limited. From our perspective, explanations are lacking for the correlated numbers to the market shares of SoMe in the respective countries. Further research, including a survey, to follow up on this important topic should be undertaken among EANS members.
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Neurocirurgia , Mídias Sociais , Europa (Continente) , Alemanha , Humanos , NeurocirurgiõesRESUMO
INTRODUCTION: Primary malignant spinal astrocytomas present rare oncological entities with limited median survival and rapid neurological deterioration. Evidence on surgical therapy, adjuvant treatment, and neurological outcome is sparse. We aim to describe the treatment algorithm and clinical features on patients with infiltrating intramedullary astrocytomas graded WHO II-IV. METHODS: The following is a multicentered retrospective study of patients treated for spinal malignant glioma WHO II-IV in five high-volume neurosurgical departments from 2008 to 2019. Pilocytic astrocytomas were excluded. We assessed data on surgical technique, perioperative neurological status, adjuvant oncological therapy, and clinical outcome. RESULTS: 40 patients were included (diffuse astrocytoma WHO II n = 11, anaplastic astrocytoma WHO III n = 12, WHO IV n = 17). Only 40% were functionally independent before surgery, most patients presented with moderate disability (47.5%). Most patients underwent a biopsy (n = 18, 45%) or subtotal tumor resection (n = 15, 37.5%), and 49% of the patients deteriorated after surgery. Patients with WHO III and IV tumors were treated with combined radiochemotherapy. Median overall survival (OS) was 46.5 months in WHO II, 25.7 months in WHO III, and 7.4 months in WHO IV astrocytomas. Preoperative clinical status and WHO significantly influenced the OS, and the extent of resection did not. CONCLUSION: Infiltrating intramedullary astrocytomas WHO II-IV present rare entities with dismal prognosis. Due to the high incidence of surgery-related neurological impairment, the aim of the surgical approach should be limited to obtaining the histological tissue via a biopsy or, tumor debulking in cases with rapidly progressive severe preoperative deficits.
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Astrocitoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Doenças do Sistema Nervoso/patologia , Procedimentos Neurocirúrgicos/mortalidade , Neoplasias da Medula Espinal/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Astrocitoma/patologia , Biomarcadores Tumorais/metabolismo , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/metabolismo , Procedimentos Neurocirúrgicos/efeitos adversos , Prognóstico , Estudos Retrospectivos , Neoplasias da Medula Espinal/patologia , Taxa de Sobrevida , Organização Mundial da Saúde , Adulto JovemRESUMO
OBJECTIVE: Surgical management of spinal metastases at the cervicothoracic junction (CTJ) is highly complex and relies on case-based decision-making. The aim of this multicentric study was to describe surgical procedures for metastases at the CTJ and provide guidance for clinical and surgical management. METHODS: Patients eligible for this study were those with metastases at the CTJ (C7-T2) who had been consecutively treated in 2005-2019 at 7 academic institutions across Europe. The Spine Instability Neoplastic Score, neurological function, clinical status, medical history, and surgical data for each patient were retrospectively assessed. Patients were divided into four surgical groups: 1) posterior decompression only, 2) posterior decompression and fusion, 3) anterior corpectomy and fusion, and 4) anterior corpectomy and 360° fusion. Endpoints were complications, surgical revision rate, and survival. RESULTS: Among the 238 patients eligible for inclusion this study, 37 were included in group 1 (15%), 127 in group 2 (53%), 18 in group 3 (8%), and 56 in group 4 (24%). Mechanical pain was the predominant symptom (79%, 189 patients). Surgical complications occurred in 16% (group 1), 20% (group 2), 11% (group 3), and 18% (group 4). Of these, hardware failure (HwF) occurred in 18% and led to surgical revision in 7 of 8 cases. The overall complication rate was 34%. In-hospital mortality was 5%. CONCLUSIONS: Posterior fusion and decompression was the most frequently used technique. Care should be taken to choose instrumentation techniques that offer the highest possible biomechanical load-bearing capacity to avoid HwF. Since the overall complication rate is high, the prevention of in-hospital complications seems crucial to reduce in-hospital mortality.
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Fusão Vertebral , Neoplasias da Coluna Vertebral , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Due to the aging society, the incidence of pyogenic spondylodiscitis is still rising. Although surgical treatment for spondylodiscitis in general is increasingly accepted, an optimal surgical strategy for treatment of pyogenic spinal infection has not yet been established. The aim of this study was to investigate the suitability of percutaneous posterior pedicle screw fixation for surgical treatment in patients with spondylodiscitis of the thoracolumbar spine. METHODS: We conducted a retrospective review of a consecutive cohort of patients undergoing surgical treatment for spondylodiscitis of the thoracolumbar spine between January 2017 and December 2019. We assessed intraoperative and clinical data, comparing for the classic open and the percutaneous approach. In total, we analyzed 125 cases (39 female, 86 male). The mean age was 69.49 years ± 12.63 years. RESULTS: Forty-seven (37.6%) patients were operated on by a percutaneous approach for pedicle screw fixation, and 78 (62.4%) received open surgery. There was no significant difference in the mean age of patients between both groups (p= 0.57). The time of surgery for percutaneous fixation was statistically significantly shorter (p= 0.03). Furthermore, the estimated intraoperative blood loss was significantly lower in the minimally invasive group (p < 0.001). No significant difference could be observed regarding the recurrence rate of spondylodiscitis and the occurrence of surgical site infections (p= 0.2 and 0.5, respectively). CONCLUSION: Percutaneous posterior pedicle screw fixation appears to be a feasible option for the surgical treatment of a selected patient group with spondylodiscitis of the thoracic and lumbar spine.
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Discite/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/efeitos adversos , Adulto , Idoso , Perda Sanguínea Cirúrgica , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgiaRESUMO
BACKGROUND: The combination of cervical spondylodiscitis and esophageal fistula is rare but life-threatening. Due to both the rarity of these conditions' coincidence and the complexity and heterogeneity of individual cases, there is no optimal treatment or management approach. The aims of this study are to obtain an overview of patients' outcomes and to discuss treatment options. METHOD: This study is a retrospective analysis of patients who presented with cervical spondylodiscitis and associated esophageal fistula between January 2010 and November 2018. We examined reports of 59 patients who suffered from cervical spondylodiscitis and included nine patients (15.25%) who had an esophageal fistula as the underlying cause. We assessed clinical findings, treatment, and outcome. RESULTS: Three of the nine patients were female, and the mean age of the sample was 64.56 years. Six of the patients had a history of esophagopharyngeal cancer and had undergone tumor resection followed by radiotherapy. Two of the remaining patients' fistulas were caused by an iatrogenic injury during cervical spine surgery and a swallowed toothpick; in the final case, the origin remained unclear. Five patients presented with tetraparesis or tetraplegia, and the other four patients were neurologically intact. In seven cases, dorsal instrumentation was initially performed. Three patients secondarily received a ventral approach for debridement, and one received explantation of the ventral implants. Two patients died during the hospital stay, and three were transferred to a palliative care unit. Thus, the spondylodiscitis and esophageal fistula were cured in only four patients. At discharge, two patients were neurologically intact, two others remained in tetraparesis. CONCLUSIONS: Cervical spondylodiscitis in association with an esophageal fistula carries high morbidity and high mortality. Because patients whose infections are not cured have high morbidity, we recommend using interdisciplinary and individual management, including definite surgical treatment of the discitis and fistula, in every case.
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Vértebras Cervicais/cirurgia , Discite/etiologia , Discite/cirurgia , Fístula Esofágica/complicações , Vértebras Torácicas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Desbridamento , Discite/diagnóstico por imagem , Neoplasias Esofágicas/complicações , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Neoplasias Faríngeas/complicações , Quadriplegia/etiologia , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/complicações , Vértebras Torácicas/diagnóstico por imagem , Resultado do TratamentoRESUMO
BACKGROUND: The benefit of an infection prevention bundle made up of five basic procedures to avoid surgical site infections (SSIs) following cranial surgery was evaluated. METHODS: Data from all patients with first time elective brain surgery from March 2014 till May 2016 were analyzed. In April 2015, an infection prevention bundle was implemented. The rate of SSIs after first time elective cranial surgery of patients operated 1 year before and 1 year after the implementation was compared. RESULTS: Of the 321 cases operated before the implementation of the infection prevention bundle, 13 cases (4%) developed a SSI. After the implementation, only 6 patients out of 288 were re-operated due to a SSI (2%). The most frequent etiological germ cultivated was Staphylococcus aureus. CONCLUSION: The implementation of a bundle of 5 basic infection prevention steps leads to a clinical relevant reduction of SSIs.
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Procedimentos Neurocirúrgicos/efeitos adversos , Infecções Estafilocócicas/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/normas , Crânio/cirurgiaRESUMO
PURPOSE: We analyzed the lumbosacral segmental geometry and clinical outcome in patients undergoing L5 corpectomy. METHODS: Fourteen consecutive patients who underwent L5 (n = 12) or L4 + 5 (n = 2) corpectomy at our department between January 2010 and April 2015 were included. All patients underwent a baseline physical and neurologic examination on admission. The diagnostic routine included MRI and CT scans and, if possible, an upright X-ray of the lumbar spine before and after surgery. The local lordosis angle [L4(L3)-S1] was measured. RESULTS: The most common pathology was infection (N = 7), followed by neoplastic disease (n = 3), pseudarthrosis (n = 2) after previous spinal fusion procedures and burst fractures (n = 2) of the L5 vertebral body. We observed seven complications (2 intraoperative; 5 postoperative) in five (36%) patients. Three patients needed revision surgery because of cage subsidence and/or dislodgement (21%). Additional anterior plating was used in two of the revision surgeries to secure the cage. Two spondylodiscitis patients (14%) with complications died of sepsis. Of the 12 remaining patients, 8 were available for follow-up. CONCLUSION: L5 corpectomy is a technically challenging but feasible procedure even though the overall complication rate can be as high as 36%. The radiologic and clinical outcome seems to be better in patients with a small lordosis angle between L4(L3) and S1, since an angle of >50 degrees seems to facilitate cage dislodgement. Anterior plating should be considered in these cases to prevent implant failure.
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Lordose/cirurgia , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fusão Vertebral/efeitos adversos , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: Spontaneous spinal cerebrospinal fluid (CSF) leaks are rare (5 per 100,000 per year). Treatment generally consists of conservative therapy or interventional therapy with epidural blood patching. Surgical treatment is conducted rarely, usually in cases when conservative or interventional treatment has failed. The aim of our case series was to assess the clinical outcome after surgery. METHODS: Our clinical database was reviewed for patients with spontaneous spinal CSF leaks who underwent surgical exploration between 2010 and 2013. Etiology, symptoms, preoperative imaging, type of required surgical method, intraoperative findings, and clinical outcome were reported. RESULTS: We identified five patients with a mean age of 62 years with spontaneous spinal CSF leaks who were treated surgically. Two patients received surgery after failure of interventional treatment. The origin of the CSF leak could be identified intraoperatively in three cases. Surgical technique in all cases consisted of an interlaminar fenestration or hemilaminectomy and a complete foraminotomy to explore the thecal sack and the exiting nerve roots and identify the CSF leak. After surgery, the preoperative symptoms improved in all patients. In one case, there was a relapse after 4 weeks. CONCLUSIONS: Preoperative identification of a CSF leak with MRI was positive in only one case. In all other cases, a post-myelography CT had to be performed. In all cases, the preoperative symptoms improved after surgery. Surgical treatment is an effective treatment of spontaneous cerebrospinal fluid leaks in cases of refractory symptoms after failed conservative or interventional treatment.
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Vazamento de Líquido Cefalorraquidiano/complicações , Vazamento de Líquido Cefalorraquidiano/cirurgia , Hipotensão Intracraniana/etiologia , Hipotensão Intracraniana/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Bases de Dados Factuais , Feminino , Foraminotomia , Cefaleia/etiologia , Humanos , Hipotensão Intracraniana/diagnóstico , Complicações Intraoperatórias/terapia , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: To date, there is growing consensus that PEEK material may be used for interbody fusion in spinal infections. Data supporting that claim are however restricted to a few very small clinical series. The aim of this study is to evaluate the outcome of surgical treatment of pyogenic spinal infections with PEEK cages in combination with posterior pedicel screw fixation. METHODS: Between 2006 and 2013, a total of 211 patients suffering from spondylodiscitis underwent surgical debridement and instrumentation. There were 52 cases where PEEK cages were used. Laboratory and physical examinations were assessed at a 3-month follow-up. Last follow-up was performed with at a minimum of 12 months after surgery via a telephone interview. RESULTS: Mean age at presentation was 67 years, with 19 (37 %) male patients and 33 (63 %) female. Distribution of the infection was lumbar in 29 (56 %%), thoracic in 3 (6 %) and cervical in 11 (21 %) cases. Nine patients (17 %) had concomitant non-contiguous spondylodiscitis. Epidural abscess was found in 17 patients (33 %); 48 (92 %%) had pain; neurological deficits were found in 20 patients (38 %). All patients in this series underwent surgical debridement with instrumentation of the spine. Postoperative intravenous antibiotics were administered for 15.4 ± 6.8 days followed by 2.9 ± 0.5 months of oral antibiotics. Complete resolution of the infection was achieved in all cases. Of the 28 patients with neurological deficits, 6 had full recovery and 10 had improved incompletely after surgery. One patient suffered from a pulmonary embolism postoperatively. There were no mortalities. CONCLUSIONS: Use of PEEK cages for interbody fusion is feasible and safe in patients suffering from a pyogenic spinal infection.
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Antibacterianos/uso terapêutico , Desbridamento/efeitos adversos , Discite/cirurgia , Abscesso Epidural/tratamento farmacológico , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/tratamento farmacológico , Fusão Vertebral/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Benzofenonas , Desbridamento/instrumentação , Desbridamento/métodos , Abscesso Epidural/etiologia , Feminino , Humanos , Cetonas/efeitos adversos , Cetonas/uso terapêutico , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/efeitos adversos , Polietilenoglicóis/uso terapêutico , Polímeros , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Resultado do TratamentoRESUMO
INTRODUCTION: MR-derived cerebral metabolic rate of oxygen utilization (CMRO(2)) has been suggested to be analogous to PET-derived CMRO(2) and therefore may be used for detection of viable tissue at risk for infarction. The purpose of this study was to evaluate MR-derived CMRO(2) mapping in acute ischemic stroke in relation to established diffusion- and perfusion-weighted imaging. METHODS: In 23 patients (mean age 63 ± 18.7 years, 11 women) with imaging findings for acute ischemic stroke, relative oxygen extraction fraction was calculated from quantitative transverse relaxation times (T2, T2*) and relative cerebral blood volume using a quantitative blood oxygenation level dependent (BOLD) approach in order to detect a local increase of deoxyhemoglobin. Relative CMRO(2) (rCMRO(2)) maps were calculated by multiplying relative oxygen extraction fraction (rOEF) by cerebral blood flow, derived from PWI. After co-registration, rCMRO(2) maps were evaluated in comparison with apparent diffusion coefficient (ADC) and time-to-peak (TTP) maps. Mean rCMRO(2) values in areas with diffusion-restriction or TTP/ADC mismatch were compared with rCMRO(2) values in the contralateral tissue. RESULTS: In tissue with diffusion restriction, mean rCMRO(2) values were significantly decreased compared to perfusion-impaired (17.9 [95 % confidence interval 10.3, 25.0] vs. 58.1 [95 % confidence interval 50.1, 70.3]; P < 0.001) and tissue in the contralateral hemisphere (68.2 [95 % confidence interval 61.4, 75.0]; P < 0.001). rCMRO(2) in perfusion-impaired tissue showed no significant change compared to tissue in the contralateral hemisphere (58.1 [95 % confidence interval 50.1, 70.3] vs. 66.7 [95 % confidence interval 53.4, 73.4]; P = 0.34). CONCLUSION: MR-derived CMRO(2) was decreased within diffusion-restricted tissue and stable within perfusion-impaired tissue, suggesting that this technique may be adequate to reveal different pathophysiological stages in acute stroke.
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Velocidade do Fluxo Sanguíneo , Circulação Cerebrovascular , Angiografia por Ressonância Magnética/métodos , Consumo de Oxigênio , Oxigênio/sangue , Acidente Vascular Cerebral/fisiopatologia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Acidente Vascular Cerebral/diagnósticoRESUMO
BACKGROUND: Recommendations for the operative treatment of spondylodiscitis are still a controversial issue. METHODS: A retrospective review identified 113 consecutive patients who underwent surgical debridement and instrumentation for spondylodiscitis between 2006 and 2010 at our department. RESULTS: The mean age at presentation was 65 years; 78 patients were male (69 %). Distribution of the inflammation was lumbar in 68 (60 %), thoracic in 19 (17 %) and cervical in 20 (18 %) cases. Six patients (5 %) had two concomitant non-contiguous spondylodiscitis foci in different segments of the spine. Epidural abscess was found in 33 patients (29 %). One hundred four patients (92 %) had pain. Neurological deficit was found in 40 patients (35 %). In the thoracic and lumbar cases, dorsal instrumentation alone was considered sufficient in 26 cases; additional interbody fusion from the posterior was performed in 44 cases. A 360° instrumentation was performed in 22 cases. In the cervical cases, only ventral spondylodesis and plating were performed in eight cases, only dorsal instrumentation in five and 360° instrumentation in seven. Postoperative intravenous antibiotics were administered for 14.4 ± 9.3 (mean ± SD) days followed by 3.2 ± 0.8 (mean ± SD) months of oral antibiosis. Complete healing of the inflammation was achieved in 111 (98 %) cases. Two patients died because of septic shock, both with fulminant endocarditis. Pain resolved in all cases. Neurological deficits were completely resolved in 20 patients, and 14 patients had a partial recovery. CONCLUSION: The results of our retrospective study show that surgical treatment of spondylodiscitis with a staged surgical approach (if needed) and a short 1-2-week period of intravenous antibiotics followed by 3 months of oral antibiotics is appropriate for most patients in whom conservative treatment has failed or is not advisable. Furthermore, surgical treatment of newly diagnosed spondylodiscitis might be recommended as an initial treatment option in many cases. Thereby the choice of fusion material (autologous bone, titanium, PEEK) seems less important.
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Desbridamento/métodos , Discite/cirurgia , Abscesso Epidural/cirurgia , Complicações Pós-Operatórias , Fusão Vertebral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Discite/tratamento farmacológico , Abscesso Epidural/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The presence of a calcified or ossified chronic cranial epidural hematoma (EDH) is rare and has been described in only a few case reports in the literature. Consequently, clear treatment strategies remain elusive and may entail conservative and surgical approaches. In this study, we performed a systematic review of reported cases to evaluate the clinical course and treatment options for these patients. A comprehensive systematic search of two databases was performed, and information on patient characteristics, symptomatology, and treatment was extracted from eligible articles. A total of 56 cases were included in our analyses. Forty patients were male, 16 were female, with an average age of 21.38 years at the time of diagnosis. Assumed etiology was previous trauma in 35 cases, previous cranial surgery in 17 patients, and birth trauma and epidural bleeding after the utilization of the Mayfield clamp in 1 case each. The origin remained unclear in two cases. The time between trauma or surgery and diagnostics ranged between one and a half weeks and 50 years, with a median of 4 years (SD 9.8 years). The symptoms were very heterogeneous, ranging from acute neurological deterioration to chronic symptoms. In 15 cases, patients were asymptomatic, and cranial imaging was performed as part of a new trauma or a screening for other disease. Forty-one patients received surgical treatment by craniotomy and hematoma evacuation, and 13 patients were treated conservatively. In two cases, the liquid hematoma portion was aspirated through a burr hole. The localization of calcified or ossified EDH was mainly supratentorial. Young male patients most commonly present with calcified or ossified EDH after trauma, according to the epidemiological trend of acute EDH. Clinical presentation varies from asymptomatic to severe neurological deficits and signs of increased intracranial pressure. There is no standardized treatment; decisions must be made on an individual basis.
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BACKGROUND: Neurosurgeons may resort to caffeine, alcohol, and various drugs to maintain peak performance as they grapple with work demands and escalated stress. The prevalence of this controversial strategy remains largely unexplored. METHODS: An anonymous survey of 23 questions formulated by our research group was distributed through personal contacts and neurosurgical societies. Inquiries revolved around the use of medications and other substances for job-related reasons. Data were analyzed via regression and descriptive statistics in python. RESULTS: In total, 215 neurosurgeons (43 residents) were included, with 213 disclosing their gender (94 females). Out of all, 9.3% were <30, 38.1% were 30-39, 44.6% were 40-59, and 7.9% were >60 years old. Most (70.7%) practiced in Europe, 18.6% in Asia, 6.5% in North and South America, and the rest in Africa or Australia. While 132 participants stated they consume caffeine to manage challenging schedules, drugs for cognitive and mood enhancement were utilized by 18 and 35 respectively. Alcohol was employed for stress relief by 28 with 4 reporting as heavy drinkers. Drugs posed a solution to sleep disorders for 82, and helped 8 others in strengthening their hand dexterity. Notably, 12 of those claiming drug use initiated it in medical school. Exercise, self-care activities, and relational support were the main alternatives sought. Ultimately, most responders recommended extending mental health assistance and raising awareness about drug use. CONCLUSIONS: Reflecting on our results on job-associated drug use by neurosurgeons, we propose the judicious use of pharmacological or nonpharmacological adjuncts, alongside the prioritization of neurosurgeons' well-being.
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BACKGROUND: Neurosurgery, an intricate and dynamic surgical specialty, faces challenges in attracting medical graduates. Despite its potential appeal, a decreasing trend in medical students opting for surgical specialties, including neurosurgery, is noted. This study aims to assess European medical students' perceptions of neurosurgery, focusing on South-East Europe, and address concerns about the declining interest in this field. METHODS: A comprehensive digital survey, comprising 33 questions, was distributed to 1115 medical students across 17 European countries. The survey, conducted over 9 months, gathered responses through European neurosurgical societies, the European Association of Neurosurgical Societies (EANS), and university channels. Statistical analysis utilized IBM Statistical Package for the Social Sciences, presenting data through counts, proportions, and χ2 tests. RESULTS: The study reveals that, over the survey period, 834 medical students completed the questionnaire, with a predominant representation from South-East Europe. While 43.2% of participants were considering a surgical career, neurosurgery emerged as the most preferred specialty (26.37%). Despite this interest, 80.2% reported insufficient knowledge about pursuing a neurosurgical career, with limited exposure during medical education. Concerns about work-life balance, heavy workload, and hierarchical structures were prominent among respondents. CONCLUSIONS: The findings underscore the need for targeted interventions to address concerns influencing medical students' decisions regarding neurosurgery. Improving neurosurgical education, dispelling misconceptions, and creating a supportive work environment are crucial steps to attract and retain diverse talented individuals in neurosurgery. These efforts will be vital in narrowing the gap between the demand for neurosurgeons and the number of medical graduates entering the field, ensuring a sustainable future for this essential surgical specialty.
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Escolha da Profissão , Neurocirurgia , Estudantes de Medicina , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Humanos , Neurocirurgia/educação , Masculino , Feminino , Inquéritos e Questionários , Europa (Continente) , Adulto , Grécia , Adulto Jovem , Sérvia , Turquia , Atitude do Pessoal de SaúdeRESUMO
Introduction: Meningitis is a rare but severe complication in patients with spondylodiscitis. Data about the incidence and clinical management are rare. Research question: Aim of this study was to assess the incidence, clinical course and outcome of patients suffering from meningitis due to spondylodiscitis. Material and methods: We performed a retrospective analysis of our prospective clinical database that included all patients suffering from spondylodiscitis between January 2010 and December 2019 were included. We assessed clinical findings, laboratory tests, treatment and outcome comparing patients with and without meningitis. Results: Out of 469 patients suffering from spondylodiscitis, 30 patients (14 female) were diagnosed with an associated meningitis (6.4%). The mean CSF cell count was 3375.85 ± 8486.78/µl (range 32-41500/µl). The mean age at presentation was 70.87 ± 8.84 yrs (range 48-88 yrs). Mean C-reactive protein (CRP) and white blood cell (WBC) counts at time of admission were statistically higher in patients with associated meningitis (CRP: 19.81 ± 12.56 mg/dl vs. 11.63 ± 11.08 mg/dl, p = 0.001; WBC: 14.67 ± 7.76 g/l vs. 10.88 ± 05.11 g/l, p = 0.005. Mortality was also higher, as 13.3% and 7.1% of patients with and without concomitant meningitis died, respectively. Conclusion: Bacterial meningitis due to spondylodiscitis is a rare but severe condition and is associated with higher morbidity and mortality rates. In patients with spondylodiscitis presenting with an altered state of consciousness an associated meningitis should be ruled out.
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BACKGROUND: Surgery for pyogenic Spondylodiscitis as an adjunct to antibiotic therapy is an established treatment. However, the technique and extent of surgical debridement remains a matter of debate. Some propagate diskectomy in all cases. Others maintain that stand-alone instrumentation is sufficient. METHODS: We reviewed charts of patients who underwent instrumentation for pyogenic Spondylodiscitis with a minimum follow-up of 1 year. Patients were stratified according to whether they underwent diskectomy plus instrumentation or posterior instrumentation alone. Outcome measures included the need for surgical revision due to recurrent epidural intraspinal infection, wound revision, and construct failure. RESULTS: In all, 257 patients who underwent surgery for pyogenic Spondylodiscitis were identified. Diskectomy and interbody procedure (group A) was performed in 102 patients, while 155 patients underwent instrumentation surgery for Spondylodiscitis without intradiskal debridement (group B). The mean age was 67 ± 12 years, and 102 patients (39.7%) were females. No significant differences were found in the need for epidural abscess recurrence therapy (group A [2.0%] and 5 cases in group B [3%; p = 0.83]) and construct failure (p = 0.575). The need for wound revisions showed a tendency toward higher rates in the posterior instrumentation-only group, which failed to reach significance (p = 0.078). CONCLUSIONS: Overall, intraspinal relapse of surgically treated pyogenic diskitis was low in our retrospective series. The choice of surgical technique was not associated with a significant difference. However, a somewhat higher rate of wound infections requiring revision in the group where no diskectomy was performed has to be weighed against a longer duration of surgery in an already ill patient population.
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Discite , Fusão Vertebral , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Masculino , Discite/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Discotomia/efeitos adversos , Antibacterianos/uso terapêutico , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Desbridamento/métodosRESUMO
Posterior fossa atypical teratoid rhabdoid tumor (ATRT) is a rare childhood tumor usually associated with a dismal prognosis. Although upfront surgical gross total resection (GTR) has classically been the first line of treatment, new multimodal treatments, including two-stage surgery, are showing promising results in terms of overall survival (OS) and complication rate. We present a case of a 9-month-old child treated with two-staged surgery and chemotherapy. When deemed risky, multimodal treatments, including staged surgeries, can be a safe alternative to reduce surgical mortality and morbidity. At 23 months old, the patient had normal global development and no major impact on quality of life. We, therefore, discuss the most recent advancements from a treatment perspective, including molecular targeting.
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Introduction: Surgical treatment for CCS in patients with an underlying cervical stenosis without instability remains controversial. Research question: The aim was to assess the incidence of concomitant discoligamentous injury (DLI) in patients with CCS and underlying degenerative cervical spinal stenosis and to determine the sensitivity of MRI by comparing intraoperative site inspection to preoperative imaging findings. Material and methods: We performed a retrospective analysis of our clinical prospective database. Fifty-one patients (39 male, 12 female) between January 2010 and June 2019 were included. Age, sex, neurological deficits, preoperative MRI, and surgical treatment were recorded. Sensitivity was determined by the quotient of patients in whom all levels of DLI were correctly identified on MRI and the total number of patients with intraoperatively confirmed DLI. Results: Mean age at surgery was 64.1 â± â11.3 (range 41-86). DLI was suspected in 33 (62.1%) patients based on MRI findings, which could be confirmed intraoperatively in 29 patients (56.9%). In 2 patients, DLI was detected intraoperatively that was not suspected in preoperative MRI; in 5 patients, another level was affected intraoperatively than was indicated by MRI. The overall specificity and sensitivity of preoperative MRI imaging to identify discoligamentous lesions of the cervical spine was 73% and 79%, respectively. Discussion and conclusion: The incidence of DLI in patients with traumatic CCS based on preexisting spinal stenosis was 60.78%, which is higher than previously reported. The sensitivity of MRI imaging to detect DLI of 79% suggests that these patients are at risk of missing traumatic DLI on imaging.