Spinal Versus General Anesthesia for Lumbar Decompression or Sequestrectomy in Patients Over 75 Years.

BACKGROUND CONTEXT: Decompression or sequestrectomy in the lumbar spine can be performed under general (GA) or regional anesthesia. In elderly patients, it is still not clear, which procedure should be chosen. OBJECTIVE: To demonstrate that spinal anesthesia (SA) is a safe choice for lumbar decompression or sequestrectomy in elderly patients. DESIGN: Retrospective clinical single-center study. PATIENTS SAMPLE: We included 154 patients with ages over 75 years after lumbar decompression or sequestrectomy. The mean age of the patients was 81 years. OUTCOME MEASURES: Perioperative data (blood loss, dural tear, operative and perioperative time, delirium, urinary retention, and hospital stay) and the postoperative 1-year follow-up (visual analog scale and complication rate). PATIENTS AND METHODS: Data were retrospectively collected from patients that underwent lumbar decompression or sequestrectomy between January 2019 and December 2020. The data from the GA and SA groups were compared. RESULTS: SA was performed in 56 patients whereas 98 patients received a GA. There was no clinically relevant difference between both groups with comparable complication rates. The time of surgery, blood loss, perioperative time, and hospital stay time were significantly less in the SA group. CONCLUSIONS: SA and GA are both safe and reliable procedures for lumbar decompression or sequestrectomy in elderly patients with no clinically relevant difference.

SORG algorithm to predict 3- and 12-month survival in metastatic spinal disease: a cross-sectional population-based retrospective study.

PURPOSE: In this study, we wished to compare statistically the novel SORG algorithm in predicting survival in spine metastatic disease versus currently used methods. METHODS: We recruited 40 patients with spinal metastatic disease who were operated at Geneva University Hospitals by the Neurosurgery or Orthopedic teams between the years of 2015 and 2020. We did an ROC analysis in order to determine the accuracy of the SORG ML algorithm and nomogram versus the Tokuhashi original and revised scores. RESULTS: The analysis of data of our independent cohort shows a clear advantage in terms of predictive ability of the SORG ML algorithm and nomogram in comparison with the Tokuhashi scores. The SORG ML had an AUC of 0.87 for 90 days and 0.85 for 1 year. The SORG nomogram showed a predictive ability at 90 days and 1 year with AUCs of 0.87 and 0.76 respectively. These results showed excellent discriminative ability as compared with the Tokuhashi original score which achieved AUCs of 0.70 and 0.69 and the Tokuhashi revised score which had AUCs of 0.65 and 0.71 for 3 months and 1 year respectively. CONCLUSION: The predictive ability of the SORG ML algorithm and nomogram was superior to currently used preoperative survival estimation scores for spinal metastatic disease.

Current state of social media utilization in neurosurgery amongst European Association of Neurosurgical Societies (EANS) member countries.

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.

Augmented reality-assisted roadmaps during periventricular brain surgery.

Visualizing major periventricular anatomical landmarks intraoperatively during brain tumor removal is a decisive measure toward preserving such structures and thus the patient's postoperative quality of life. The aim of this study was to describe potential standardized preoperative planning using standard landmarks and procedures and to demonstrate the feasibility of using augmented reality (AR) to assist in performing surgery according to these "roadmaps." The authors have depicted stepwise AR surgical roadmaps applied to periventricular brain surgery with the aim of preserving major cognitive function. In addition to the technological aspects, this study highlights the importance of using emerging technologies as potential tools to integrate information and to identify and visualize landmarks to be used during tumor removal.

MRI-Compatible and Conformal Electrocorticography Grids for Translational Research.

Intraoperative electrocorticography (ECoG) captures neural information from the surface of the cerebral cortex during surgeries such as resections for intractable epilepsy and tumors. Current clinical ECoG grids come in evenly spaced, millimeter-sized electrodes embedded in silicone rubber. Their mechanical rigidity and fixed electrode spatial resolution are common shortcomings reported by the surgical teams. Here, advances in soft neurotechnology are leveraged to manufacture conformable subdural, thin-film ECoG grids, and evaluate their suitability for translational research. Soft grids with 0.2 to 10 mm electrode pitch and diameter are embedded in 150 µm silicone membranes. The soft grids are compatible with surgical handling and can be folded to safely interface hidden cerebral surface such as the Sylvian fold in human cadaveric models. It is found that the thin-film conductor grids do not generate diagnostic-impeding imaging artefacts (<1 mm) nor adverse local heating within a standard 3T clinical magnetic resonance imaging scanner. Next, the ability of the soft grids to record subdural neural activity in minipigs acutely and two weeks postimplantation is validated. Taken together, these results suggest a promising future alternative to current stiff electrodes and may enable the future adoption of soft ECoG grids in translational research and ultimately in clinical settings.

Introduction of a novel connection clip for the ultrasonic aspirator for subcortical continuous motor mapping.

Introduction: A connection clip to the ultrasonic aspirator handpiece was introduced for simultaneous resection and mapping of corticospinal motor tract (CST) (Kombos et al., 2001). Research question: To report retrospectively the use of this clip in cerebral surgery with CST mapping. Material and methods: Eight women and four men were included (mean: 55.8 years, SD 17.3 years). The ultrasonic aspirator handpiece was stimulated every second (5 biphasic pulses, 0.4 â€‹ms per phase, max 14 â€‹mA). Motor evoked potentials (MEPs) (Taniguchi et al., 1993), with transcranial and direct cortical stimulation, were alternated with CST mapping. The distances between the stimulus locations to the CST (diffusion tensor imaging based fibre tractography) were determined postoperatively. Muscle strength was evaluated pre-operatively, at discharge and 3 months. Results: Motor mapping thresholds ranged between 2 and 13 â€‹mA, in 12 consecutive patients (7 post-central, 5 insular). The distance of the stimulation site to the CST was fitted (y â€‹= â€‹0.63x+2.33, R2 â€‹= â€‹0.33; x, mA; y, mm), approximating the rule of thumb of 1 â€‹mA indicating 1 â€‹mm (R2 â€‹= â€‹0.22). One patient presented with a deterioration of motor function (wrist, M4+). No intraoperative seizures were observed. Discussion: The concept that 1 â€‹mA corresponds to 1 â€‹mm from the CST, was roughly observed within this low current range. This rule must be applied, integrating the confidence limits, when getting close to the CST, in conjunction with MEPs. Conclusion: The standardization of this clip, for continuous stimulation of the ultrasonic aspirator with simultaneous tissue resection, made the guided surgical flow smoother, more refined and very natural.

BDNF-promoted increases in proximal dendrites occur via CREB-dependent transcriptional regulation of cypin.

Alterations in dendrite branching and morphology are present in many neurodegenerative diseases. These variations disrupt postsynaptic transmission and affect neuronal communication. Thus, it is important to understand the molecular mechanisms that regulate dendritogenesis and how they go awry during disease states. Previously, our laboratory showed that cypin, a mammalian guanine deaminase, increases dendrite number when overexpressed and decreases dendrite number when knocked down in cultured hippocampal neurons. Here, we report that exposure to brain-derived neurotrophic factor (BDNF), an important mediator of dendrite arborization, for 72 h but not for 24 h or less increases cypin mRNA and protein levels in rat hippocampal neurons. BDNF signals through cypin to regulate dendrite number, since knocking down cypin blocks the effects of BDNF. Furthermore, BDNF increases cypin levels via mitogen-activated protein kinase and transcription-dependent signaling pathways. Moreover, the cypin promoter region contains putative conserved cAMP response element (CRE) regions, which we found can be recognized and activated by CRE-binding protein (CREB). In addition, exposure of the neurons to BDNF increased CREB binding to the cypin promoter and, in line with these data, expression of a dominant negative form of CREB blocked BDNF-promoted increases in cypin protein levels and proximal dendrite branches. Together, these studies suggest that BDNF increases neuronal cypin expression by the activation of CREB, increasing cypin transcription leading to increased protein expression, thus identifying a novel pathway by which BDNF shapes the dendrite network.