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1.
J Neurosurg ; 131(6): 1690-1701, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31786544

RESUMO

Neuroendovascular surgery and interventional neuroradiology both describe the catheter-based (most often) endovascular diagnosis and treatment of vascular lesions affecting the brain and spinal cord. This article traces the evolution of these techniques and their current role as the dominant and frequently standard approach for many of these conditions. The article also discusses the important changes that have been brought to bear on open cerebrovascular neurosurgery by neuroendovascular surgery and their effects on resident and fellow training and describes new concepts for clinical care.


Assuntos
Transtornos Cerebrovasculares/cirurgia , Procedimentos Endovasculares/métodos , Procedimentos Neurocirúrgicos/métodos , Encéfalo/irrigação sanguínea , Encéfalo/cirurgia , Transtornos Cerebrovasculares/diagnóstico , Procedimentos Endovasculares/tendências , Humanos , Procedimentos Neurocirúrgicos/tendências , Medula Espinal/irrigação sanguínea , Medula Espinal/cirurgia
2.
Spine (Phila Pa 1976) ; 44(23): E1356-E1361, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31725684

RESUMO

STUDY DESIGN: This was a retrospective observational study. OBJECTIVE: To assess the diagnostic value of procalcitonin (PCT) and neutrophil lymphocyte ratio (NLR) for predicting surgical site infection (SSI) in patients undergoing spinal instrumentation surgery, we analyzed a large consecutive cohort of patients who had undergone spinal instrumentation surgery. SUMMARY OF BACKGROUND DATA: Although PCT and NLR are commonly used as markers for bacterial infection, the diagnostic value of these factors for predicting SSI in the context of spinal instrumentation surgery has not been extensively investigated. METHODS: We retrospectively investigated 242 patients who underwent spinal instrumentation surgery and evaluated the significance of various postoperative measures for predicting SSI, including PCT and NLR. We then determined the diagnostic cut-off values for these markers in the prediction of SSI using receiver operating characteristic curve analysis. RESULTS: Among the 242 patients analyzed, 10 were diagnosed with infection. Even though univariate analysis showed that neutrophil percentage and NLR at 6 to 7 days postoperatively were significant predictors for SSI, PCT at 6 to 7 days postoperatively did not differ significantly between the SSI and non-SSI groups. The cut-off value used for neutrophil percentage at 6 to 7 days postoperatively was more than 69.0% [sensitivity, 80.0%; specificity, 70.0%; area under the curve, 0.737]. The cut-off value used for NLR at 6 to 7 days postoperatively was 3.87 (sensitivity, 70.0%; specificity, 73.2%; area under the curve, 0.688). CONCLUSION: Neutrophil percentage and NLR at 6 to 7 days postoperatively were more useful markers than PCT at 6 to 7 days postoperatively for early prediction of SSI in patients who had undergone spinal instrumentation surgery. Therefore, routine use of PCT as a predictor of postoperative infection is not supported by the results of this study. LEVEL OF EVIDENCE: 4.


Assuntos
Linfócitos/metabolismo , Procedimentos Neurocirúrgicos/efeitos adversos , Neutrófilos/metabolismo , Pró-Calcitonina/sangue , Doenças da Coluna Vertebral/sangue , Doenças da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/tendências , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia
3.
World Neurosurg ; 131: 328-338, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31658576

RESUMO

Glioblastomas are the most common malignant brain tumor and despite extensive research have a dismal prognosis. This review focuses on the current treatment paradigms of glioblastoma and highlights current advances in surgical approaches, imaging techniques, molecular diagnostics, and translational efforts. Several promising clinical trials in immunotherapy and personalized medicine are discussed and the importance of quality of life in the patients and their caregivers both during active treatment and survivorship is also commented on.


Assuntos
Neoplasias Encefálicas/terapia , Glioblastoma/terapia , Antineoplásicos/uso terapêutico , Neoplasias Encefálicas/diagnóstico , Ensaios Clínicos como Assunto , Fracionamento da Dose de Radiação , Feminino , Previsões , Glioblastoma/diagnóstico , Humanos , Imunoterapia/métodos , Imunoterapia/tendências , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/tendências , Masculino , Terapia de Alvo Molecular/tendências , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons/tendências , Medicina de Precisão/métodos , Medicina de Precisão/tendências , Qualidade de Vida , Fatores de Risco
4.
J Orthop Surg Res ; 14(1): 291, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481077

RESUMO

BACKGROUND: Therapeutic intervention has recently been actively performed for metastatic spine tumor even though spinal cord paralysis is not clearly observed, but there has been no report in which the degree of spinal cord compression by tumor was taken into consideration for the paralysis-preventing effect of treatment. Thus, we investigated the neurological outcome after treatment of patients with spinal cord compression in a state of impending paralysis. METHODS: A retrospective cohort study. The subjects were 88 patients with epidural spinal cord compression (ESCC) scale 1b or severer compression with American Spinal Injury Association (ASIA) E spinal metastasis. The neurological outcome after the therapeutic intervention was investigated at regular intervals until death. The therapeutic intervention was posterior decompression and stabilization in 18 patients, stabilization without posterior decompression in 15, and radiotherapy in 55 patients (3 groups). RESULTS: The ASIA aggravation group was comprised of 15 patients, and the severity of paralysis was ASIA A in 3, B in 3, C in 6, and D in 3. Paralysis appeared in 16.7% in the posterior decompression and stabilization group, 13.3% in the posterior stabilization without decompression group, and 18.8% in the radiotherapy group. In the transverse view, the incidence was high in cases with advancement to the intervertebral foramen and circumferential-type advancement, and paralysis developed in more than 20% of ESCC 1c or severer cases. Factors influencing neurological aggravation were investigated, but there was no significant factor. CONCLUSION: In ESCC 1b or severer cases with ASIA E spinal metastasis, paralysis aggravated after therapeutic intervention in 16.7% in the posterior decompression and stabilization group, 13.3% in the stabilization without decompression group, and 16.7% in the radiotherapy group. There was no significant factor influencing the development of paralysis.


Assuntos
Descompressão Cirúrgica/tendências , Espaço Epidural/cirurgia , Paralisia/cirurgia , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/métodos , Espaço Epidural/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Paralisia/diagnóstico por imagem , Paralisia/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
5.
World Neurosurg ; 132: 356-362, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31536810

RESUMO

The degree of primary resection of malignant brain gliomas (MBGs) has correlated positively with progression-free and overall survival. The indications for surgery and reoperation in MBG relapse remain controversial. Surgery will not be curative and should be followed by adjuvant treatment. We reviewed the reported studies with respect to repeat resection and the various methods of intraoperative radiotherapy for MBGs from the initial experience with high-energy linear accelerators in Japan to modern, integrated brachytherapy solutions using solid and balloon applicators. Because of the findings from our review, we have begun to research into the use of intraoperative balloon brachytherapy for recurrent MBGs.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirurgia , Glioma/radioterapia , Glioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Radioterapia/métodos , Terapia Combinada , História do Século XX , História do Século XXI , Humanos , Procedimentos Neurocirúrgicos/história , Procedimentos Neurocirúrgicos/tendências , Radioterapia/história , Radioterapia/tendências , Reoperação
7.
Stereotact Funct Neurosurg ; 97(3): 141-152, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31412334

RESUMO

The last two decades have seen a re-emergence of surgery for intractable psychiatric disease, in large part due to increased use of deep brain stimulation. The development of more precise, image-guided, less invasive interventions has improved the safety of these procedures, even though the relative merits of modulation at various targets remain under investigation. With an increase in the number and type of interventions for modulating mood/anxiety circuits, the need for biomarkers to guide surgeries and predict treatment response is as critical as ever. Electroencephalography (EEG) has a long history in clinical neurology, cognitive neuroscience, and functional neurosurgery, but has limited prior usage in psychiatric surgery. MEDLINE, Embase, and Psyc-INFO searches on the use of EEG in guiding psychiatric surgery yielded 611 articles, which were screened for relevance and quality. We synthesized three important themes. First, considerable evidence supports EEG as a biomarker for response to various surgical and non-surgical therapies, but large-scale investigations are lacking. Second, intraoperative EEG is likely more valuable than surface EEG for guiding target selection, but comes at the cost of greater invasiveness. Finally, EEG may be a promising tool for objective functional feedback in developing "closed-loop" psychosurgeries, but more systematic investigations are required.


Assuntos
Eletroencefalografia/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Transtornos Mentais/cirurgia , Psicocirurgia/métodos , Estimulação Encefálica Profunda/métodos , Estimulação Encefálica Profunda/tendências , Eletroencefalografia/tendências , Previsões , Humanos , Monitorização Neurofisiológica Intraoperatória/tendências , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Psicocirurgia/tendências
8.
World Neurosurg ; 130: e1000-e1003, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31306836

RESUMO

BACKGROUND: Ventriculoperitoneal shunt (VPS) placement is one of the most common neurosurgical procedures. VPSs are associated with high costs, which predominantly arise from relatively high complication and revision rates. It is reasonable to assume that revision rates in developing countries would be higher. In this study we report the single-institution revision rates and costs from a high-volume department in sub-Saharan Africa. METHODS: A pediatric neurosurgical database was studied in the extent of 5 years. The 30-day shunt failure rate, overall revision rate, and costs were calculated, and results were compared with previously published studies from developed countries. RESULTS: In the selected time period 1840 VPS surgeries were performed, of which 592 were shunt revisions (32.14%). The majority of revision surgeries was performed in the first year- 501 (representing 84.63%); second year, 64; third year, 21; fourth year, 6; and fifth year, 2. The overall shunt revision rate was 28.94% with a 30-day revision rate of 14.58%. During the course of the study, costs of VPS surgery, the shunt, and daily ward charges did not change significantly. The average total charge for VPS insertion was 60,000 KES (586 USD), VPS removal 30,000 KES (293 USD), and VPS revision 50,000 KES (489 USD). CONCLUSIONS: This retrospective study proves that VPSs, with their known complication risks, can be performed in a sub-Saharan missionary hospital with acceptable costs and results that are comparable with those achieved in some Western hospitals. Keys to those outcomes include high volume and a highly experienced team.


Assuntos
Custos Hospitalares , Pediatria/economia , Reoperação/economia , Derivação Ventriculoperitoneal/economia , África ao Sul do Saara/epidemiologia , Criança , Feminino , Seguimentos , Custos Hospitalares/tendências , Humanos , Tempo de Internação/tendências , Masculino , Procedimentos Neurocirúrgicos/economia , Procedimentos Neurocirúrgicos/tendências , Pediatria/tendências , Reoperação/tendências , Estudos Retrospectivos , Derivação Ventriculoperitoneal/tendências
9.
World Neurosurg ; 130: e822-e830, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295603

RESUMO

OBJECTIVE: In 2015, the Lancet Commission on Global Surgery highlighted the disparities in surgical care worldwide. The aim of the present study was to investigate the research productivity of low-income countries (LICs) and low- to middle-income countries (LMICs) in selected journals representing the worldwide neurosurgical data and their ability to report and communicate globally the existing differences between high-income countries (HICs) and LMICs. METHODS: We performed a retrospective bibliometric analysis using PubMed and Scopus databases to record all the reports from 2015 to 2017 by investigators affiliated with neurosurgical departments in LICs and LMICs. RESULTS: A total of 8459 reports by investigators self-identified as members of neurosurgery departments worldwide were identified. Of these, 6708 reports were included in accordance with our method in the final analysis. The systematic search resulted in 459 studies reported by LICs and LMICs. Of these, 334 reports were included for the full text evaluation. Of the 6708 reports, 303 (4.52%) had been reported with an LMIC affiliation and only 31 (0.46%) with an LIC. The leading countries were India with 182 (54.5% among LMICs and LICs; 2.71% overall), followed by Egypt at 66 (19.76% among the LMICs and LICs; 0.98% overall), with a large difference compared with other countries such as Uganda at 9 (2.69% among the LMICs and LICs) and Tunisia and Pakistan at 8 each (2.4% among the LMICs and LICs). A few reports studies had been generated by collaboration with HIC neurosurgeons. CONCLUSIONS: Our results have shown that research studies from LMICs are underrepresented. Understanding and discussing the reasons for this underrepresentation are necessary to start addressing the disparities in neurosurgical research and care capacity. Future engagements from international journals, more partnership collaboration from HICs, and tailored funding to support investigators, collaborations, and networks could be of help.


Assuntos
Bibliometria , Análise de Dados , Países em Desenvolvimento/economia , Procedimentos Neurocirúrgicos/economia , Pobreza/economia , Relatório de Pesquisa , Humanos , Procedimentos Neurocirúrgicos/tendências , Pobreza/tendências , Relatório de Pesquisa/tendências , Estudos Retrospectivos
10.
J Clin Neurosci ; 68: 174-178, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31324471

RESUMO

INTRODUCTION: Vestibular schwannomas are benign tumors of the 8th cranial nerve. Initial treatment options include active surveillance, surgery, and/or radiation therapy. We analyzed the United States National Cancer Database (NCDB) for patients with vestibular schwannomas and evaluated the initial management trends after diagnosis. METHODS: We queried the NCDB for patients with vestibular schwannomas, excluding patients who did not have schwannomas of the vestibulocochlear nerve. Categorical and continuous variables were analyzed, and multivariate Cox regression analyses were performed to investigate for predictors of initial local therapy at diagnosis. All statistical analyses were performed using commercially available software (SPSS, Version 22; SPSS Inc., Chicago, IL). RESULTS: A total of 28,446 patients met the inclusion criteria. In this cohort, 7351 (25.8%) underwent observation, 12,362 (43.5%) underwent surgical resection, 7785 (27.4%) underwent SRS, 824 (2.9%) underwent EBRT, and 124 (0.4%) underwent RT NOS. On multivariate analysis, younger age, increased distance to treating facility, Charlson/Deyo score of 1, primary payer insurance, facility location and facility type (academic or cancer center) (p < 0.001) were all factors that predicted patients undergoing initial definitive treatment. CONCLUSION: Age, distance to treating facility, Charlson/Deyo score, primary payer, facility location, and facility type are factors that influence initial treatment for patients with vestibular schwannoma. Clinical stratification systems are needed to identify which patients would benefit most from initial local therapy versus active surveillance.


Assuntos
Neuroma Acústico/terapia , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Adolescente , Adulto , Idoso , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Procedimentos Neurocirúrgicos/tendências , Radiocirurgia/estatística & dados numéricos , Radiocirurgia/tendências , Estados Unidos , Conduta Expectante/estatística & dados numéricos , Conduta Expectante/tendências , Adulto Jovem
11.
Spine (Phila Pa 1976) ; 44(23): E1369-E1378, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31343618

RESUMO

STUDY DESIGN: This is a retrospective analysis of national administrative hospital data. OBJECTIVE: This study examines national trends in the surgical management of lumbar spinal stenosis (LSS) in patients with and without coexisting scoliosis between 2010 and 2014. The study also examines revision rates for LSS procedures. SUMMARY OF BACKGROUND DATA: There is wide variability in the surgical management of patients with LSS, with and without coexisting spinal deformity. METHODS: Data were obtained from the Healthcare Cost and Utilization Project's National Inpatient Sample Database. International Classification of Diseases 9th revision- Clinical Modification codes were used to identify all patients with a primary diagnosis of lumbar spinal stenosis. These patients were divided into two groups: 1) LSS alone and 2) LSS with coexisting scoliosis. The two groups were examined for one of three surgical outcomes: 1) decompression alone (discectomy, laminectomy), 2) simple fusion, and 3) complex fusion (>three vertebrae or 360° fusion). The groups were then further examined for revision operations. National Inpatient Sample discharge weights were applied where relevant. RESULTS: In 2014 national estimates of discharged patients indicated 76,275 patients with a primary diagnosis of LSS (population rate, 23.9; in the elderly (65+) the age-adjusted population rate was 95.4). Of these patients, 88.5% were managed through primary surgery (34.6% decompression, 47.2% simple fusion, 5.7% complex fusion). Between 2010 and 2014, the percentage of decompression decreased from 47.5% to 34.6%, the percent of simple fusion increased from 35.3% to 47.2%, and the percent of complex fusion increased from 5.7% to 7.1% (P < 0.01). In patients with coexisting scoliosis, lumbar spinal stenosis was predominantly managed by simple fusion and complex fusion (15.5% decompression, 51.9% simple fusion, 27.3% complex fusion, in 2014). Revision rates were highest among patients without scoliosis managed with complex fusion (15.8% in 2014) compared with patients with scoliosis (8.8% in 2014). Patients with scoliosis who underwent decompression only had revision rates of 1.7% and 0.62% in 2010 and 2014, respectively. CONCLUSION: We observed a leveling-off of the rate of operation for patients with a primary diagnosis of LSS at around 88%. There was an increase in the rate of fusion and a decrease in the rate of decompression across all patient groups. We report no difference in revision rates between patients with and without scoliosis, except in those undergoing a complex fusion. LEVEL OF EVIDENCE: 3.


Assuntos
Descompressão Cirúrgica/tendências , Gerenciamento Clínico , Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos/tendências , Escoliose/cirurgia , Fusão Vertebral/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Descompressão Cirúrgica/economia , Discotomia/economia , Discotomia/tendências , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Lactente , Laminectomia/economia , Laminectomia/tendências , Masculino , Pessoa de Meia-Idade , Alta do Paciente/economia , Alta do Paciente/tendências , Estudos Retrospectivos , Escoliose/economia , Escoliose/epidemiologia , Fusão Vertebral/economia , Adulto Jovem
12.
World Neurosurg ; 130: e259-e271, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31207366

RESUMO

BACKGROUND: The Michigan Spine Surgery Improvement Collaborative is a statewide multicenter quality improvement registry. Because missing data can affect registry results, we used MSSIC to find demographic and surgical characteristics that affect the completion of patient-reported outcomes (PROs) at 90 days and 1 year. METHODS: A total of 24,404 patients who had lumbar surgery (17,813 patients) or cervical surgery (6591 patients) were included. Multivariate logistic regression models of patient disease were constructed to identify risk factors for failure to complete scheduled PRO surveys. RESULTS: Patients ≥65 years old and female patients were both more likely to respond at 90 days and 1 year. Increasing education was associated with greater response rate at 90 days and 1 year. Whites and African Americans had no differences in response rates. Calling provided the highest response rate at 90 days and 1 year. For cervical spine patients, only discharge to rehabilitation increased completion rates, at 90 days but not 1 year. For lumbar spine patients, spondylolisthesis or stenosis (vs. herniated disc) had a greater response rate at 1 year. Patients with leg (vs. back) pain had a greater response only at 1 year. Patients with multilevel surgery had an increased response at 1 year. Patients who underwent fusion were more likely to respond at 90 days, but not 1 year. Discharge to rehabilitation increased response at 90 days and 1 year. CONCLUSIONS: A multivariate analysis from a multicenter prospective database identified surgical factors that affect PRO follow-up, up to 1 year. This information can be helpful for imputing missing PRO data and could be used to strengthen data derived from large prospective databases.


Assuntos
Vértebras Cervicais/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos/tendências , Medidas de Resultados Relatados pelo Paciente , Doenças da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Estudos Prospectivos , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/epidemiologia , Fatores de Tempo
13.
World Neurosurg ; 130: e272-e293, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31207370

RESUMO

OBJECTIVE: To analyze a consecutive series of patients with middle cerebral artery (MCA) aneurysms who needed an adjunctive cerebral revascularization procedure to achieve aneurysm occlusion with preservation of flow through all MCA branches. METHODS: A total of 42 patients with 43 MCA aneurysms underwent 52 bypass procedures over 13 years. The location of the aneurysm were M1 trunk, M1 bifurcation, M2 and beyond. The bypasses performed included intracranial bypasses (resection with end to end anastomosis, end to side implantation, side to side anastomosis, and short interposition graft), extraintracranial bypasses (superficial temporal to middle cerebral artery anastomosis, and radial artery bypass graft, or saphenous vein graft), double bypasses, Y-grafts, and combined techniques. RESULTS: Forty-two of 43 aneurysms (98%) had patent bypasses at long-term follow-up. All 43 aneurysms were completely occluded at last follow-up. Six patients (14%) developed strokes related to the surgical treatment. At last follow-up, 36 patients had a modified Rankin score of 0-2, 5 patients had modified Rankin score 3-5, and 1 died. In this series, 31 (73.8%) patients improved, 8 (19%) patients had same functional status, and 3 (7.2%) patients deteriorated, including 1 patient who expired due to sepsis. The mean clinical follow-up duration was 39.3 months (0.4-124 months) and the mean radiological follow-up was 37 months (0.4-134 months). CONCLUSIONS: Cerebral revascularization is an important adjunct for treating MCA aneurysms and can be done safely. The article provides the insights we gained by rising through the learning curve.


Assuntos
Revascularização Cerebral/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Revascularização Cerebral/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/cirurgia , Procedimentos Neurocirúrgicos/tendências , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/tendências
14.
Spine (Phila Pa 1976) ; 44(13): 937-942, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205171

RESUMO

STUDY DESIGN: Retrospective, observational study. OBJECTIVE: To examine the costs associated with nonoperative management (diagnosis and treatment) of cervical radiculopathy in the year prior to anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: While the costs of operative treatment have been previously described, less is known about nonoperative management costs of cervical radiculopathy leading up to surgery. METHODS: The Humana claims dataset (2007-2015) was queried to identify adult patients with cervical radiculopathy that underwent ACDF. Outcome endpoint was assessment of cumulative and per-capita costs for nonoperative diagnostic (x-rays, computed tomographic [CT], magnetic resonance imaging [MRI], electromyogram/nerve conduction studies [EMG/NCS]) and treatment modalities (injections, physical therapy [PT], braces, medications, chiropractic services) in the year preceding surgical intervention. RESULTS: Overall 12,514 patients (52% female) with cervical radiculopathy underwent ACDF. Cumulative costs and per-capita costs for nonoperative management, during the year prior to ACDF was $14.3 million and $1143, respectively. All patients underwent at least one diagnostic test (MRI: 86.7%; x-ray: 57.5%; CT: 35.2%) while 73.3% patients received a nonoperative treatment. Diagnostic testing comprised of over 62% of total nonoperative costs ($8.9 million) with MRI constituting the highest total relative spend ($5.3 million; per-capita: $489) followed by CT ($2.6 million; per-capita: $606), x-rays ($0.54 million; per-capita: $76), and EMG/NCS ($0.39 million; per-capita: $467). Conservative treatments comprised of 37.7% of the total nonoperative costs ($5.4 million) with injections costs constituting the highest relative spend ($3.01 million; per-capita: $988) followed by PT ($1.13 million; per-capita: $510) and medications (narcotics: $0.51 million, per-capita $101; gabapentin: $0.21 million, per-capita $93; NSAIDs: 0.107 million, per-capita $47), bracing ($0.25 million; per-capita: $193), and chiropractic services ($0.137 million; per-capita: $193). CONCLUSION: The study quantifies the cumulative and per-capital costs incurred 1-year prior to ACDF in patients with cervical radiculopathy for nonoperative diagnostic and treatment modalities. Approximately two-thirds of the costs associated with cervical radiculopathy are from diagnostic modalities. As institutions begin entering into bundled payments for cervical spine disease, understanding condition specific costs is a critical first step. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais , Custos de Cuidados de Saúde , Formulário de Reclamação de Seguro/economia , Procedimentos Neurocirúrgicos/economia , Radiculopatia/economia , Radiculopatia/terapia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Estudos de Coortes , Bases de Dados Factuais/economia , Bases de Dados Factuais/tendências , Discotomia/economia , Discotomia/tendências , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Formulário de Reclamação de Seguro/tendências , Imagem por Ressonância Magnética/economia , Imagem por Ressonância Magnética/tendências , Masculino , Manipulação Quiroprática/economia , Manipulação Quiroprática/tendências , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/tendências , Modalidades de Fisioterapia/economia , Modalidades de Fisioterapia/tendências , Radiculopatia/diagnóstico por imagem , Estudos Retrospectivos , Fusão Vertebral/economia , Fusão Vertebral/tendências , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/tendências , Resultado do Tratamento
15.
Neurol India ; 67(2): 516-529, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31085870

RESUMO

The Achanta Lakshmipathi Neurosurgical Center (ALNC) and Post Graduate Institute of Neurological Surgery is a private teaching neurosurgical institution located in the VHS (Voluntary Health Services) Hospital Chennai. It has been a leader and trendsetter among the private academic neurosurgical training institutions, and because of its unique legacy, has influenced the progress of Neurosurgery in India. The center was the second neurosurgical Institute to be created by Prof. B Ramamurthi and has trained neurosurgeons in the unique ALNC school of Neurosurgery. The Institute has grown to become a centre of excellence in microsurgery, and spinal surgery and has become a training centre for neurosurgery since 1985. The unique humanitarian aspects of the Voluntary Health Services Hospital helped in bringing the best of Neurosurgery to all strata of society. Forty years after its inception, the ALNC continues its delivery of excellence in clinical neurosurgery and academics.


Assuntos
Neurocirurgiões/tendências , Neurocirurgia/educação , Neurocirurgia/tendências , Procedimentos Neurocirúrgicos/tendências , Academias e Institutos/tendências , Humanos , Índia , Internato e Residência/tendências
16.
Surg Innov ; 26(5): 633-635, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31068093

RESUMO

Although Ernst von Bergmann (1837-1907) is considered the father of neurosurgery in Germany, Fedor Krause (1857-1937) should be considered as its main founder. He was principally a general surgeon but he had a special interest in neurosurgery, a field in which he introduced many new techniques. He also fabricated innovative surgical methods for the treatment of patients with epilepsy.


Assuntos
Procedimentos Neurocirúrgicos/história , Procedimentos Neurocirúrgicos/tendências , Alemanha , História do Século XIX , História do Século XX
17.
World Neurosurg ; 128: e873-e883, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31082558

RESUMO

BACKGROUND: Thirty-day readmissions (30dRAs) and 90-day readmissions (90dRAs) are being increasingly scrutinized as quality metrics for hospital and provider performances. Little information regarding risk factors for 30dRA and 90dRA after elective cerebral aneurysm clipping (CAC) of unruptured cerebral aneurysms is available. We sought to characterize risk factors with a nationally representative administrative database. METHODS: The Nationwide Readmissions Database was used to identify patients who underwent elective CAC between 2010 and 2014. The outcomes of interest were unplanned readmissions occurring within 30 or 90 days of discharge. Binary logistic regression was used to identify variables related to patients' demographics, comorbidities, and index hospital admission that were associated with readmission. A Cochran-Mantel-Haenszel test was used to evaluate for changes in annual readmission rates. RESULTS: A total of 1123 patients met the inclusion criteria for 30dRA analysis and 946 patients were eligible for 90dRA analysis. The 5-year 30dRA and 90dRA readmission rates were 9.1% and 14.9%, respectively. The annual rate of readmission between 2010 and 2014 did not change. Greater Charlson Comorbidity Index (odds ratio [OR], 2.68; 95% confidence interval [CI], 1.14-6.28) and nonroutine discharge after the index admission (OR, 1.81; 95% CI, 1.04-3.14) were associated with greater odds of 30dRA. Charlson Comorbidity Index (OR, 3.45; 95% CI, 1.57-7.56) and treatment at a metropolitan teaching hospital (OR, 2.21; 95% CI, 1.06-4.60) were associated with increased odds of 90dRA. Wound infection was the most common reason for readmission. CONCLUSIONS: Readmission rates after elective CAC remained unchanged between 2010 and 2014, suggesting that improved methods for reducing unplanned readmissions after CAC are needed.


Assuntos
Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/tendências , Readmissão do Paciente/tendências , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Infecção da Ferida Cirúrgica/complicações , Infecção da Ferida Cirúrgica/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
18.
Stereotact Funct Neurosurg ; 97(1): 55-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30995653

RESUMO

BACKGROUND/AIMS: Postherpetic neuralgia (PHN) can be refractory to both medical and minimally invasive treatments. Its complex pathophysiology explains the numerous neurosurgical procedures that have been implemented through the years. Our objective was to summarize all available neurosurgical strategies for the management of resistant PHN and evaluate their respective safety and efficacy outcomes. METHODS: A comprehensive systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: A total of 38 studies comprising 811 patients with refractory PHN were included. The safety and efficacy of the following procedures were investigated: spinal cord stimulation (SCS), dorsal root entry zone (DREZ) lesioning, intrathecal drug delivery, caudalis DREZ lesioning, dorsal root ganglion (DRG) radiofrequency lesioning, peripheral nerve stimulation, gamma knife surgery, deep brain stimulation, cordotomy, percutaneous radiofrequency rhizotomy and Gasserian ganglion stimulation. CONCLUSIONS: There are several available neurosurgical approaches for recalcitrant PHN including neuromodulatory and ablative procedures. It is suggested that patients with resistant PHN undergo minimally invasive procedures first, including SCS, peripheral nerve stimulation or DRG radiofrequency lesioning. More invasive procedures should be reserved for refractory cases. Comparative studies are needed in order to construct a PHN neurosurgical management algorithm.


Assuntos
Neuralgia Pós-Herpética/cirurgia , Neurocirurgiões/tendências , Procedimentos Neurocirúrgicos/tendências , Cordotomia/métodos , Cordotomia/tendências , Humanos , Neuralgia Pós-Herpética/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Rizotomia/métodos , Rizotomia/tendências , Estimulação da Medula Espinal/métodos , Estimulação da Medula Espinal/tendências
19.
World Neurosurg ; 127: e950-e956, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30965167

RESUMO

BACKGROUND: Neurosurgery is a unique field, which would benefit greatly from increased global collaboration, furthering research efforts. ResearchGate is a social media platform geared toward scientists and researchers. OBJECTIVE: This study evaluated the use of ResearchGate for neurosurgical research collaboration and compared the ResearchGate score with more classic bibliometrics. ResearchGate is a unifying social platform that can strengthen global research collaboration (e.g., data sharing) in the neurosurgery community. METHODS: Publicly available metrics on 3718 neurosurgery clinical faculty and residents in Canada and the United States were obtained from the American Association of Neurological Surgeons Web site. The following metrics were collected: program name, clinician name, sex, attending (yes or no), resident (yes or no), postgraduate year (if resident), and ResearchGate profile (yes or no). ResearchGate score and its components and h index excluding self-citations were collected. Fellows were not included. RESULTS: Of the 3718 total individuals included, 1338 (36.0%) were present on ResearchGate, comprising 181 women (13.5%) and 1157 men (86.5%). Women and men were present in similar proportions (33.8% of women and 36.3% of men) (χ2 [1, N = 3718] = 1.26; P = 0.26). More faculty were present on ResearchGate than residents (62.4%) (χ2 [1, N = 3718] = 11.42; P = 0.001). A strong positive monotonic correlation between h index and ResearchGate score was shown (rs [1292] = 0.93; P < 0.0005). More than 400 international departments were determined. CONCLUSIONS: ResearchGate may be a useful platform to increase neurosurgical networking and research collaboration. Its novel bibliometrics are strongly correlated with more classic platforms.


Assuntos
Pesquisa Biomédica/métodos , Disseminação de Informação/métodos , Neurocirurgia/métodos , Mídias Sociais , Pesquisa Biomédica/tendências , Feminino , Humanos , Masculino , Neurocirurgiões/tendências , Neurocirurgia/tendências , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Mídias Sociais/tendências
20.
World Neurosurg ; 127: e1064-e1082, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30980984

RESUMO

BACKGROUND: Fat grafting has been described as an option to repair frontotemporal contour deformities (volumetric deficiency of bone and/or soft tissues) after neurosurgical/craniofacial surgical interventions. However, technical surgical descriptions have varied, with reports describing the bolus fat injection or the classical multilayer injection, but with no detailed descriptions concerning how and where the fat should be grafted. The purpose of this study was to assess the frontotemporal symmetry outcomes after a single fat-grafting procedure for postoperative frontotemporal contour deformity reconstructions using the anatomical fat-grafting approach. METHODS: A prospective analysis was conducted of consecutive patients (n = 106) who underwent anatomical fat grafting (Coleman's structural fat grafting technique using anatomical facial subunit and fat compartment principles) to reconstruct frontotemporal contour deformities after neurosurgical/craniofacial surgical interventions. A subjective assessment by a panel of external surgical professionals and laypersons was obtained to grade the frontotemporal symmetry. Objective ultrasound symmetry assessment was blindly performed preoperatively and at 3- and 12-month follow-up. RESULTS: There were significant (all P  <  0.05) postoperative subjective and objective frontotemporal symmetry enhancements (preoperative < postoperative) after anatomical fat grafting, with no differences (all P > 0.05) between the 3- and 12-month postoperative comparisons. Thirty-seven percent of patients required an additional fat grafting session for residual asymmetry after 12 months of follow-up. CONCLUSIONS: Patients with frontotemporal contour deformities presented improved subjective and objective frontotemporal symmetry after an anatomical fat grafting session.


Assuntos
Tecido Adiposo/transplante , Anormalidades Craniofaciais/diagnóstico , Anormalidades Craniofaciais/cirurgia , Craniotomia/métodos , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Craniotomia/tendências , Feminino , Seguimentos , Osso Frontal/anormalidades , Osso Frontal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/tendências , Estudos Prospectivos , Osso Temporal/anormalidades , Osso Temporal/cirurgia , Transplante de Tecidos/métodos , Resultado do Tratamento , Adulto Jovem
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