Duration of Vasodilatory Action After Intra-arterial Infusions of Calcium Channel Blockers in Animal Model of Cerebral Vasospasm.

BACKGROUND: In medically refractory vasospasm, invasive intervention may be required. A commonly used approach is intra-arterial (IA) drug infusion. Although calcium channel blockers (CCBs) have been widely applied in this setting, studies comparing their efficacies and durations of action have been few. This study was performed to compare attributes of three CCBs (nicardipine, nimodipine, and verapamil), focusing on duration of the vasodilatory action based on angiography. METHODS: Vasospasm was produced in New Zealand white rabbits (N = 22) through experimentally induced subarachnoid hemorrhage and confirmed in each via conventional angiography, grouping them by IA-infused drug. After chemoangioplasty, angiography was performed hourly for 5 h to compare dilated and vasospastic arterial diameters. Drug efficacy, duration of action, and changes in mean arterial pressure (relative to baseline) were analyzed by group. RESULTS: Effective vasodilation was evident in all three groups immediately after IA drug infusion. The vasodilative effects of nimodipine and nicardipine peaked at 1 h and were sustained at 2 h, returning to initial vasospastic states at 3 h. In verapamil recipients, effects were more transient by comparison, entirely dissipating at 1 h. Only the nicardipine group showed a significant 3-h period of lowered blood pressure. CONCLUSIONS: Although nimodipine and nicardipine proved longer acting than verapamil in terms of vasodilation, their effects were not sustained beyond 2 h after IA infusion. Further study is required to confirm the vasodilatory duration of IA CCB based on perfusion status, and an effort should be made to find new alternative to extend the duration.

Augmentation of Supratemporal Hollowing With Silicone Block During Autologous Cranioplasty After Decompressive Craniectomy With Additional Temporalis Resection.

ABSTRACT: Decompressive craniectomy is a potentially life-saving neurosurgical procedure. In cases of insufficient decompression, uncontrolled intracranial pressure even after sufficient decompression, or when the intracranial pressure is increased due to external factors such as intramuscular hematoma in the temporal muscle, additional temporalis resection may be necessary. However, the hollowing of the supratemporal fossa that occurs after additional temporalis resection can create a major cosmetic problem. Several alternatives are available to fill the hollowing of the supratemporal fossa during cranial reconstruction, but each has a disadvantage, whether it is expensive or difficult to shape for bilateral symmetry. The author solved the cosmetic problem by using a properly carved silicone block to fill the supratemporal fossa while conducting cranioplasty, and here reports it with a literature review.

Tight versus standard blood pressure control on the incidence of myocardial infarction and stroke: an observational retrospective cohort study in the general ambulatory setting.

BACKGROUND: The 2017 American College of Cardiology and American Heart Association guideline defined hypertension as blood pressure (BP) ≥ 130/80 mmHg compared to the traditional definition of ≥140/90 mmHg. This change raised much controversy. We conducted this study to compare the impact of tight (TBPC) versus standard BP control (SBPC) on the incidence of myocardial infarction (MI) and stroke. METHODS: We retrospectively identified all hypertensive patients in an ambulatory setting based on the diagnostic code for 1 year at our institution who were classified by the range of BP across 3 years into 2 groups of TBPC (< 130 mmHg) and SBPC (130-139 mmHg). We compared the incidence of new MI and stroke between the 2 groups across a 2-year follow-up. Multivariate analysis was done to identify independent predictors for the incidence of new MI and stroke. RESULTS: Of 5640 study patients, the TBPC group showed significantly less incidence of stroke compared to the SBPC group (1.5% vs. 2.7%, P < 0.010). No differences were found in MI incidence between the 2 groups (0.6% vs. 0.8%, P = 0.476). Multivariate analysis showed that increased age independently increased the incidence of both MI (OR 1.518, 95% CI 1.038-2.219) and stroke (OR 1.876, 95% CI 1.474-2.387), and TBPC independently decreased the incidence of stroke (OR 0.583, 95% CI 0.374-0.910) but not of MI. CONCLUSIONS: Our observational study suggests that TBPC may be beneficial in less stroke incidence compared to SBPC but it didn't seem to affect the incidence of MI. Our study is limited by its retrospective design with potential confounders.

Reduction and monosegmental fusion for lumbar spondylolisthesis with a long tab percutaneous pedicle screw system: "swing" technique.

OBJECTIVEWith the development of minimally invasive procedures, percutaneous pedicle screw systems have been used to attempt to correct spondylolisthesis. No previous studies have reported on reduction measures using long tab percutaneous pedicle screws for spondylolisthesis. Additional intraoperative correction has been proposed with the "swing" technique. This study was conducted to compare the efficacy of standard minimally invasive transforaminal interbody fusion (MIS-TLIF) with the efficacy of MIS-TLIF with the "swing" technique (MIS-TLIF and swing) in lumbar spondylolisthesis.METHODSThis was a matched-control study and included 30 consecutive patients who were followed up for 6 months after surgery. Of those patients, 15 were treated with operative reduction via MIS-TLIF with the "swing" technique, whereas the other 15 were treated with the standard MIS-TLIF procedure. The swing technique is a new reduction procedure for use with long tab percutaneous screws. In the swing technique, the entire system is swung back and forth several times after all constructs are placed. Only patients with Meyerding grade I or II lumbar spondylolisthesis were included in the study (18 with grade I and 12 with grade II). Perioperative and clinical outcomes, radiological parameters (Meyerding grade, percentage of slip, slip correction rate, segmental lordosis, and lumbar lordosis) were compared between groups at 6 months after surgery.RESULTSDemographic data did not differ significantly between the 2 groups. Postoperative clinical outcomes showed significant improvement in both groups. Postoperative radiological parameters showed that the degree of spondylolisthesis (swing: 4.7% vs standard: 8.9%) and reduction rate (swing: 77.3% vs standard: 57.1%) favored the swing group. The swing technique effectively decreased the degree of spondylolisthesis (swing: 24.1% to 4.7% vs standard: 21.8% to 8.9%). No complications related to the procedure were reported.CONCLUSIONSMIS-TLIF with the "swing" technique with long tab percutaneous pedicle screws is a safe and effective reduction method for monosegmental spondylolisthesis. This technique cannot only alleviate symptoms but also achieve nearly completely reduction of slippage.

Comparison of re-biopsy with preceded MRI and re-biopsy without preceded MRI in patients with previous negative biopsy and persistently high PSA.

PURPOSE: To retrospectively compare re-biopsy with preceded magnetic resonance imaging (MRI) and re-biopsy without preceded MRI. MATERIALS AND METHODS: Between January 2007 and May 2011, 669 patients (mean 64 years; range 38-91 years) underwent a re-biopsy because of previous negative biopsy (median 1; 1-5) and persistently high prostate-specific antigen (PSA 10.6 ng/ml; 2.5-997.1 ng/ml). 3T MRI using a phased-array coil was performed in 171 (MRI group) but not in 498 (non-MRI group) prior to re-biopsy. Transrectal ultrasound-guided biopsy was performed in both MRI and non-MRI groups. MRI and non-MRI groups were compared in terms of cancer detection rate [(number of cancer-proven patients/number of patients in MRI or non-MRI group) × 100] and positive core rate [(number of cancer-positive cores/number of cores in MRI or non-MRI group) × 100] using Fisher exact test. Odds ratio and 95% confidence interval were also obtained. Pathologic diagnosis of the biopsy was considered standard reference. RESULTS: Of 669 patients, 129 (19.3%) were diagnosed with adenocarcinoma. The cancer detection rates of MRI and non-MRI groups were 33.3% (57/171) and 14.5% (72/498), respectively (p < 0.001). The positive core rates of these groups were 9.2% (167/1 818) and 3.2% (179/5 631), respectively (p < 0.001). The odd ratios of cancer detection rate and positive core rate were 3.0 (95% confidence interval 2.0-4.4) and 3.1 (2.5-3.8), respectively. CONCLUSION: Re-biopsy with preceded MRI yields higher cancer detection rate and positive core rate than re-biopsy without preceded MRI. MRI should be considered prior to re-biopsy in patients with previous negative biopsy and persistently high PSA.

Interval from prostate biopsy to radical prostatectomy does not affect immediate operative outcomes for open or minimally invasive approach.

Traditionally, urologists recommend an interval of at least 4 weeks after prostate biopsy before radical prostatectomy. The aim of our study was to evaluate whether the interval from prostate biopsy to radical prostatectomy affects immediate operative outcomes, with a focus on differences in surgical approach. The study population of 1,848 radical prostatectomy patients was divided into two groups according to the surgical approach: open or minimally invasive. Open group included perineal and retropubic approach, and minimally invasive group included laparoscopic and robotic approach. The cut-off of the biopsy-to-surgery interval was 4 weeks. Positive surgical margin status, operative time and estimated blood loss were evaluated as endpoint parameters. In the open group, there were significant differences in operative time and estimated blood loss between the <4-week and ≥4-week interval subgroups, but there was no difference in positive margin rate. In the minimally invasive group, there were no differences in the three outcome parameters between the two subgroups. Multivariate analysis revealed that the biopsy-to-surgery interval was not a significant factor affecting immediate operative outcomes in both open and minimally invasive groups, with the exception of the interval ≥4 weeks as a significant factor decreasing operative time in the minimally invasive group. In conclusion, performing open or minimally invasive radical prostatectomy within 4 weeks of prostate biopsy is feasible for both approaches, and is even beneficial for minimally invasive radical prostatectomy to reduce operative time.

Deep Learning Method for Precise Landmark Identification and Structural Assessment of Whole-Spine Radiographs.

This study measured parameters automatically by marking the point for measuring each parameter on whole-spine radiographs. Between January 2020 and December 2021, 1017 sequential lateral whole-spine radiographs were retrospectively obtained. Of these, 819 and 198 were used for training and testing the performance of the landmark detection model, respectively. To objectively evaluate the program's performance, 690 whole-spine radiographs from four other institutions were used for external validation. The combined dataset comprised radiographs from 857 female and 850 male patients (average age 42.2 ± 27.3 years; range 20-85 years). The landmark localizer showed the highest accuracy in identifying cervical landmarks (median error 1.5-2.4 mm), followed by lumbosacral landmarks (median error 2.1-3.0 mm). However, thoracic landmarks displayed larger localization errors (median 2.4-4.3 mm), indicating slightly reduced precision compared with the cervical and lumbosacral regions. The agreement between the deep learning model and two experts was good to excellent, with intraclass correlation coefficient values >0.88. The deep learning model also performed well on the external validation set. There were no statistical differences between datasets in all parameters, suggesting that the performance of the artificial intelligence model created was excellent. The proposed automatic alignment analysis system identified anatomical landmarks and positions of the spine with high precision and generated various radiograph imaging parameters that had a good correlation with manual measurements.

Body mass index and survival in patients with renal cell carcinoma: a clinical-based cohort and meta-analysis.

Growing evidence suggests that obesity, an established cause of renal cell cancer (RCC), may also be associated with a better prognosis. To evaluate the association between RCC survival and obesity, we analyzed a large cohort of patients with RCC and undertook a meta-analysis of the published evidence. We collected clinical and pathologic data from 1,543 patients who underwent nephrectomy for RCC between 1994 and 2008 with complete follow-up through 2008. Patients were grouped according to BMI (kg/m(2) ): underweight <18.5, normal weight 18.5 to <23, overweight 23 to <25 and obese ≥25. We estimated survival using the Kaplan-Meier method and Cox proportional hazard models to examine the impact of BMI on overall survival (OS) and cancer-specific survival (CSS) with adjustment for covariates. We performed a meta-analysis of BMI and OS, CSS and recurrence-free survival (RFS) from all relevant studies using a random-effects model. The 5-year CSS increased from 76.1% in the lowest to 92.7% in the highest BMI category. A multivariate analysis showed higher OS [hazard ratio (HR) = 0.45; 95% CI: 0.29-0.68) and CSS (HR = 0.47; 95% CI: 0.29-0.77] in obese patients than in normal weight patients. The meta-analysis further corroborated that high BMI significantly improved OS (HR = 0.57; 95% CI: 0.43-0.76), CSS (HR = 0.59; 95% CI: 0.48-0.74) and RFS (HR = 0.49; 95% CI: 0.30-0.81). Our study shows that preoperative BMI is an independent prognostic indicator for survival among patients with RCC.

Development and characterization of a bladder cancer xenograft model using patient-derived tumor tissue.

Most of the cancer xenograft models are derived from tumor cell lines, but they do not sufficiently represent clinical cancer characteristics. Our objective was to develop xenograft models of bladder cancer derived from human tumor tissue and characterize them molecularly as well as histologically. A total of 65 bladder cancer tissues were transplanted to immunodeficient mice. Passagable six cases with clinico-pathologically heterogeneous bladder cancer were selected and their tumor tissues were collected (012T, 025T, 033T, 043T, 048T, and 052T). Xenografts were removed and processed for the following analyses: (i) histologic examination, (ii) short tandem repeat (STR) genotyping, (iii) mutational analysis, and (iv) array-based comparative genomic hybridization (array-CGH). The original tumor tissues (P 0) and xenografts of passage 2 or higher (≥P2) were analyzed and compared. As a result, hematoxylin and eosin staining revealed the same histologic architecture and degree of differentiation in the primary and xenograft tumors in all six cases. Xenograft models 043T_P2 and 048T_P2 had completely identical STR profiles to the original samples for all STR loci. The other models had nearly identical STR profiles. On mutational analysis, four out of six xenografts had mutations identical to the original samples for TP53, HRAS, BRAF, and CTNNB1. Array-CGH analysis revealed that all six xenograft models had genomic alterations similar to the original tumor samples. In conclusion, our xenograft bladder cancer model derived from patient tumor tissue is expected to be useful for studying the heterogeneity of the tumor populations in bladder cancer and for evaluating new treatments.

Influence of body mass index, smoking, and blood pressure on survival of patients with surgically-treated, low stage renal cell carcinoma: a 14-year retrospective cohort study.

The association of body mass index, smoking, and blood pressure, which are related to the three well-established risk factors of renal cell carcinoma, and survival in patients with renal cell carcinoma is not much studied. Our objective was to evaluate this association. A cohort of 1,036 patients with low stage (pT1 and pT2) renal cell carcinoma who underwent radical or partial nephrectomy were enrolled. We retrospectively reviewed medical records and collected survival data. The body mass index, smoking status, and blood pressure at the time of surgery were recorded. Patients were grouped according to their obesity grade, smoking status, and hypertension stage. Survival analysis showed a significant decrease in overall (P = 0.001) and cancer-specific survival (P < 0.001) with being underweight, with no differences of smoking status or perioperative blood pressure. On multivariate analysis, perioperative blood pressure ≥ 160/100 mmHg (HR, 2.642; 95% CI, 1.221-5.720) and being underweight (HR, 4.320; 95% CI, 1.557-11.984) were independent predictors of overall and cancer-specific mortality, respectively. Therefore, it is concluded that being underweight and perioperative blood pressure ≥ 160/100 mmHg negatively affect cancer-specific and overall survival, respectively, while smoking status does not influence survivals in patients with renal cell carcinoma.

Vasodilatory effects of tadalafil in an animal model of cerebral vasospasm: Comparative analysis with oral nimodipine.

OBJECTIVES: Cerebral vasospasm is one of the most fatal complications after spontaneous aneurysmal subarachnoid hemorrhage. Although various treatments have been tried for the treatment of cerebral vasospasm so far, the effect is insignificant or temporary except for oral nimodipine. Phosphodiesterase isozyme type 5 inhibitor, which is used to treat erection dysfunction, recently has been known to have a cerebrovascular vasodilation. It is thought that this will be effective in cerebral vasospasm, and the effect will be compared and analyzed with oral nimodipine through an animal model of cerebral vasospasm. MATERIAL AND METHODS: A total of 40 rabbits were used to make subarachnoid hemorrhage model and were divided into three groups - a control group, nimodipine group, and tadalafil group. The cerebral vessels were angiographically measured before and on the third day of subarachnoid hemorrhage. Then vertebrobasilar arteries were harvested and evaluated. Under the microscope, lumen area and media area were measured for each group and were compared. RESULTS: Angiographically, tadalafil group showed significant vasodilation compared with the control group (p < 0.01). Histologically, tadalafil showed a similar effect on lumen and on media area to that of nimodipine group compared with the control group. CONCLUSIONS: Cerebral vasospasm could leave neurologic deficit or sequelae even after proper treatment. Therefore, prevention is important. Tadalafil showed preventive effect against cerebral vasospasm and vasodilative effect similar to that of nimodipine. Therefore, tadalafil could be considered an alternative preventive treatment of cerebral vasospasm.

Forced suction thrombectomy in patients with acute ischemic stroke using the SOFIA Plus device.

OBJECTIVE: Stent retrieval thrombectomy has recently been the standard treatment for acute ischemic stroke with large artery occlusion. However, the development of catheters for suction thrombectomy has recently led to results comparable to that of stent retrieval thrombectomy (SRT). This study aimed to analyze the safety and efficacy of forced suction thrombectomy (FST) using the SOFIA Plus (MicroVention Terumo, Tustin, CA, USA) device. METHODS: We included patients with acute ischemic stroke who underwent FST using the SOFIA Plus device at our institution. Medical records and angiographic data were reviewed, and the results of this study were compared with those of other FST studies. RESULTS: A total of 35 patients were included in this study. The occlusion sites were the internal carotid artery terminal (4), M1 segment (20), and posterior circulation (11). Of the 35 patients, FST was performed in only 21 (60%) patients, and the remaining 14 (40%) patients underwent SRT and FST. In all cases, the recanalization rate was 100%, and the average time from groin puncture to recanalization was 21±4.94 min. In particular, the average time required to reach the SOFIA Plus lesions from the groin puncture was 10.44±5.06 min and about 67% of the FST patients were recanalized at the first attempt. Three-months modified Rankin Scale (mRS) score of ≤2 was observed in 52% of the patients. CONCLUSIONS: Forced suction thrombectomy using the SOFIA Plus yielded a high recanalization rate within a shorter time. In particular, the recanalization rate was higher than that reported in previous studies using other types of suction devices.

Coexisting posterior reversible encephalopathy syndrome and ischemic hepatopathy: A case report.

Posterior reversible encephalopathy syndrome (PRES) is acute neurologic symptoms with specific radiologic findings. This unique case shows coexisting PRES with acute liver injury, which could suggest common pathophysiologic process.

A 4D Printable Shape Memory Vitrimer with Repairability and Recyclability through Network Architecture Tailoring from Commercial Poly(ε-caprolactone).

Vitrimers have shown advantages over conventional thermosets via capabilities of dynamic network rearrangement to endow repairability as well as recyclability. Based on such characteristics, vitrimers have been studied and have shown promises as a 3D printing ink material that can be recycled with the purpose of waste reduction. However, despite the brilliant approaches, there still remain limitations regarding requirement of new reagents for recycling the materials or reprintability issues. Here, a new class of a 4D printable vitrimer that is translated from a commercial poly(ε-caprolactone) (PCL) resin is reported to exhibit self-healability, weldability, reprocessability, as well as reprintability. Thus, formed 3D-printed vitrimer products show superior heat resistance in comparison to commercial PCL prints, and can be repeatedly reprocessed or reprinted via filament extrusion and a handheld fused deposition modeling (FDM)-based 3D printing method. Furthermore, incorporation of semicrystalline PCL renders capabilities of shape memory for 4D printing applications, and as far as it is known, such demonstration of FDM 3D-printed shape memory vitrimers has not been realized yet. It is envisioned that this work can fuel advancement in 4D printing industries by suggesting a new material candidate with all-rounded capabilities with minimized environmental challenges.

Initial Findings from a High Genetic Risk Prostate Cancer Clinic.

OBJECTIVE: To improve prostate cancer screening for high-risk men, we developed an early detection clinic for patients at high genetic risk of developing prostate cancer. Despite the rapidly growing understanding of germline variants in driving aggressive prostate cancer and the increased availability of genetic testing, there is little evidence surrounding how best to screen these men. METHODS: We are reporting on the first 45 patients enrolled, men between the ages of 35-75, primarily with known pathogenic germline variants in prostate cancer susceptibility genes. Screening consists of an intake lifestyle survey, PSA, DRE, and SelectMDx urine assay. A biopsy was recommended for any of the following indications: 1) abnormal DRE, 2) PSA above threshold, or 3) SelectMDx above threshold. The primary outcomes were number needed to screen, and number needed to biopsy to diagnose a patient with prostate cancer. RESULTS: Patients enrolled in the clinic included those with BRCA1 (n=7), BRCA2 (n=16), Lynch Syndrome (n=6), and CHEK2 (n = 4) known pathogenic germline variants. The median age and PSA were 58 (range 35-71) and 1.4 ng/ml (range 0.1-11.4 ng/ml), respectively. 12 patients underwent a prostate needle biopsy and there were 4positive biopsies for prostate cancer. CONCLUSION: These early data support the feasibility of opening a dedicated clinic for men at high genetic risk of prostate cancer. This early report on the initial enrollment of our long-term study will help optimize early detection protocols and provide evidence for personalized prostate cancer screening in men with key pathogenic germline variants.

Association of midline prostatic cysts and lower urinary tract symptoms: A case-control analysis of 606 transrectal ultrasound findings.

OBJECTIVE: To evaluate the association between midline prostatic cysts (MPCs) and lower urinary tract symptoms (LUTS). METHODS: A total of 606 patients who underwent transrectal ultrasound of the prostate (TRUS) were retrospectively reviewed. Patients were divided into two groups based on the presence of MPCs for comparison. We used the International Prostate Symptom Score (IPSS) as a LUTS parameter. Multivariate analysis was performed to find out independent predictors for moderate to severe LUTS. An MPC subgroup analysis was done to look for linear correlation between the size of MPCs and LUTS. RESULTS: Patients with no MPCs were of higher age, had more history of diabetes, were taking more urological medications, and had more IPSS storage symptoms. No significant differences were found in body mass index, total IPSS, voiding IPSS, bother score, total prostate-specific antigen level, and the prostate size. Multivariate analysis revealed age, history of diabetes, taking urological medications, and the prostate size as independent predictors of moderate to severe LUTS. The presence of MPCs was not an independent factor. Subgroup analysis failed to show significant correlation between the size of MPCs and the LUTS scores. CONCLUSIONS: The presence of MPCs is not an independent factor for moderate to severe LUTS, and the size of the MPCs does not have any correlation to LUTS scores either.

Primary biliary cholangitis presenting as acute ischemic stroke: A rare association.

Primary biliary cholangitis is associated with hyperlipidemia, but studies show that the condition does not increase cardiovascular risks. The case presents acute ischemic stroke with no underlying risk factors and subsequent new diagnosis of primary biliary cholangitis, which can suggest possible association between primary biliary cholangitis and acute stroke.

The Assessment of Geometric Reliability of Conventional Trajectory of Ventriculostomy in a Three Dimensional Virtual Model and Proposal of a New Trajectory.

Ventriculostomy is a common neurosurgery procedure performed for many purposes. Kocher's point is most often used as the ventriculostomy entry point. But the accuracy of a cannula's trajectory into the ventricles from entry at Kocher's point is controversial. In this paper we attempt to evaluate the accuracy of the conventional sagittal trajectory, which uses Kocher's point, and evaluate a new trajectory by creating virtual ventriculostomy simulations from computed tomography images of the brain. About 66 patients without brain and skull pathology in radiography were included. Three dimensional images were constructed using thin sliced brain computed tomography images, and a virtual ventriculostomy was performed toward the previous used surface landmark. And the path of ideal ventricular catheter was simulated. The anterior surface landmarks included the ipsilateral medial canthus, the contralateral medial canthus, and the midpoint between bilateral medial canthi. The lateral surface landmark was the external auditory canal. The sagittal trajectory of the three surface landmarks located in the frontal horn of ipsilateral ventricle was 0% for the ipsilateral medial canthus, 87.88% for the midpoint between bilateral medial canthi and 26.52% for the contralateral medial canthus. The anterior surface target of ideal sagittal trajectory, which connects the Kocher's point with the central axis of ipsilateral ventricle, is contralaterally 6.7 mm away from midline. It was found that the conventional sagittal trajectory is inaccurate. The anterior target of surface landmark for the ideal sagittal trajectory is medial one third of the distance between the midline and the contralateral medial canthus.

Comparison of Fusion Rate between Demineralized Bone Matrix versus Autograft in Lumbar Fusion : Meta-Analysis.

The demineralized bone matrix (DBM) as the bone graft material to increase the fusion rate was widely used in spinal fusion. The current study aimed to compare the fusion rate of DBM to the fusion rate of autograft in lumbar spine fusion via meta-analysis of published literature. After systematic search, comparative studies were selected according to eligibility criteria. Checklist (risk of bias assessment tool for non-randomized study) was used to evaluate the risk of bias of the included nonrandomized controlled studies. The corresponding 95% confidence interval (95% CI) were calculated. We also used subgroup analysis to analyze the fusion rate of posterolateral lumbar fusion and lumbar interbody fusion. Eight studies were finally included in this meta-analysis. These eight studies included 581 patients. Among them, 337 patients underwent spinal fusion surgery using DBM (DBM group) and 204 patients underwent spinal fusion surgery with mainly autologous bone and without using DBM (control group). There was no significant differences of fusion rate between the two groups in posterolateral fusion analysis (risk ratio [RR], 1.03; 95% CI, 0.90-1.17; p=0.66) and interbody fusion analysis (RR, 1.13; 95% CI, 0.91-1.39; p=0.27). Based on the available evidence, the use of DBM with autograft in posterolateral lumbar spine fusion and lumbar interbody fusion showed a slightly higher fusion rate than that of autograft alone; however, there was no statistically different between two groups.

Ten-Year Experience of Dural Reconstruction Using a Collagen Matrix Inlay Graft in Posterior Fossa Surgery: A Propensity Score-Matched Study.

BACKGROUND: Considering that primary watertight dural closure is not always possible following posterior fossa surgery, several methods of dural reconstruction were proposed to reduce the risk of cerebrospinal fluid (CSF) leakage. This study aimed to evaluate the efficacy of collagen matrix inlay graft compared with other techniques in a propensity score-matched cohort. METHODS: Between 2000 and 2019, 176 consecutive patients who underwent posterior fossa surgery were enrolled. Of these, 103 patients underwent dural reconstruction with collagen matrix inlay graft (inlay group). After propensity score matching, 67 pairs were derived. The primary outcome was the development of CSF leakage. Pseudomeningocele and surgical site infection were also investigated. RESULTS: Median follow-up period was 53.9 months. None of the patients in the inlay group had CSF leakage; however, leakage was evident in 5 patients (6.8%) who underwent dural reconstruction without a collagen matrix inlay graft (no-inlay group; P = 0.011). Pseudomeningocele was noted in 1 (1.4%) patient in the no-inlay group, while surgical site infection was noted in 3 (3.0%) patients in the inlay group and 4 (5.5%) patients in the no-inlay group. None of the surgical site infections were related to the use of the inlay graft. After propensity score matching, CSF leakage was still prevalent in the no-inlay group (P = 0.042). CONCLUSIONS: Dural reconstruction using a collagen matrix inlay graft efficiently reduces CSF leakage after posterior fossa surgery and does not increase the risk of postoperative infection and inflammation. It seems to be a feasible option for dural reconstruction.