The Efficacy of Anterior Cervical Corpectomy and Fusion and Posterior Total Laminectomy on Cervical Spinal Cord Injury and Quality of Life.

This study is aimed at investigating the efficacy of anterior cervical corpectomy and fusion and posterior total laminectomy in the treatment of cervical spinal cord injury and assessing the impact of the two approaches on cervical spine function and patient quality of life. Retrospectively analyze the clinical data from 180 patients with cervical spinal cord injury who were admitted to the First Affiliated Hospital of Hebei North University from June 2019 to June 2021. The patients were divided into an anterior approach group (n = 89, treated with anterior cervical corpectomy and fusion) and a posterior approach group (n = 91, treated with posterior total laminectomy). The amount of blood loss in the posterior approach group was larger compared to the anterior approach group. Patients in the posterior approach group had higher wound diameters and operation times compared to the anterior approach group, as well as the operation cost. The visual analogue scale (VAS) scores of patients in the posterior approach group were significantly higher than in the anterior approach group one month after operation. The Japanese Orthopaedic Association (JOA), neck disability index (NDI), and American Spinal Injury Association (ASIA) scores of patients in both groups at 1, 6, and 9 months after surgery were higher compared to those before surgery, yet no significant differences were observed between the two groups. Also, no significant difference was observed in the incidence of complication and the quality of life between the two groups before and after treatment. Anterior cervical corpectomy and fusion and posterior total laminectomy can effectively restore the cervical nerve function in the treatment of cervical spinal cord injury. However, anterior subtotal vertebral resection is associated with improved perioperative indicators compared to posterior total laminectomy. Clinically, surgical methods can be selected according to imaging findings, the general condition of patients, and individual economic status.

A clinical retrospective study of percutaneous dilatational tracheostomy without guide wire for critically ill patients.

OBJECTIVE: This study aimed to introduce a novel tracheostomy method, the non-guide-wire percutaneous dilatational tracheostomy (NGPDT) technique, and evaluate its effectiveness for critically ill patients undergoing neurosurgery under special conditions. METHODS: The clinical data of 48 critically ill patients who underwent NGPDT under special conditions with controlled steps were analyzed retrospectively. The patients' demographic, preoperative state of illness, and diagnosis data were collected. Moreover, their intraoperative and postoperative variables were accessed, e.g., operation times, bleeding, saturation of pulse oxygen (SPO2), and early and late complications related to NGPDT. RESULTS: The mean patient age was 47.7 ± 13.7 years. The mean GCS (Glasgow Coma Scale) was 8.1 ± 2.9, and the mean BMI (Body Mass Index) was 25.2 ± 5.6. There were 38 patients with an endotracheal tube. The mean duration of onset to NGPDT was 4.0 ± 1.3 days. The mean operation time was 4.2 ± 1.9 min. There were 41 patients with mild intraoperative bleeding, 5 with moderate bleeding, and 2 with severe bleeding as well as 46 with mild postoperative bleeding and 2 with moderate bleeding. Additionally, 41 patients required complete extubation after NGPDT. The mean duration of incision healing was 4.8 ± 3.1 days. There was 1 patient with a decrease of SPO2 ≥ 10%. Three patients presented with a transient violent cough at the primary tracheostomy stage; however, no patients suffered from pneumothorax, subcutaneous emphysema, false passage, or surgery-related death during this procedure. CONCLUSION: Overall, NGPDT with controlled steps is a fast, safe, and microinvasive procedure. It mildly stimulates the trachea with a low rate of complications.

Synchronized and integrated prehospital treatment for acute cervical spinal cord injury.

OBJECTIVE: To explore the effect of synchronized and integrated prehospital treatment strategies for on-site first aid, rescue transport and prehospital first aid in patients with acute cervical spinal cord injury. METHODS: A prospective non-randomized controlled study was designed to include patients with acute cervical spinal cord injury. A total of 50 patients were included in a Control group (before the implementation of synchronized and integrated prehospital treatment), and 50 patients were included in an Observation Group (after the implementation of synchronized and integrated prehospital treatment). We compared the timeliness of prehospital treatment, the proportion of patients received methylprednisolone treatment within 3 h after injury, the changes in Japanese Orthopaedic Association (JOA) score during transport, the incidence of adverse events, the clinical outcomes, the number of prehospital deaths, the case number of paralysis and the recovery of postoperative neural function between the two groups. RESULTS: Compared with the Control group, the Observation group showed significantly shorter time from injury to admission, from injury to receiving methylprednisolone pulse therapy, as well as from injury to receiving dehydrating agents and diuretics (all P<0.001). The proportion of patients received methylprednisolone treatment within 3 h after injury was significantly higher in the Observation group than that in the Control group (P<0.05). There was no significant change in the JOA score in the Observation group before and after the transport, while the score was significantly lower in the Control group after the transport (P<0.001). The JOA score was higher in the Observation group than that in the Control group at admission (P<0.001). The Observation group also showed decreased incidences of adverse events, mortality, and paralysis rate (all P<0.05) as well as better recovery of postoperative neural function (P<0.001) when compared with the Control group. CONCLUSION: Synchronized and integrated prehospital treatment has a significant effect in patients with acute cervical spinal cord injury through shortening the admission time, reducing the risk of adverse events, and improving the rescue effect and the prognosis of neural function.

Presurgical Thalamus and Brainstem Shifts Predict Distal Motor Function Recovery After Anatomic Hemispherectomy.

BACKGROUND: Anatomic hemispherectomy is an effective surgical treatment for patients with hemispherical intractable epilepsy. Different degrees of brain shifting have been observed, but whether these shifts can predict motor function recovery is unknown. The aim of this study was to analyze the correlation between brain shift ratios of different brain areas and motor function before and after surgery. METHODS: Medical records and magnetic resonance imaging of 23 patients who underwent anatomic hemispherectomy from 2006 to 2013 at a single center were retrospectively reviewed. Proximal and distal muscle strengths of both arms and legs were measured before and after surgery to determine motor function outcomes. Brain shift ratios of frontal lobe, temporal lobe, parieto-occipital lobe, thalamus, brainstem, and cerebellum were measured before and after surgery to test which shifts could effectively predict motor function outcomes. RESULTS: Fifteen patients (65.2%) showed different degrees of presurgical brain shifting. Brain shift ratios of all measured brain areas were generally increased after anatomic hemispherectomy. After surgery, 13 patients (56.5%) exhibited improved proximal muscle strength, whereas 10 (43.5%) in distal. Significant correlations were found only between muscle strength improvements of distal arms or legs and presurgical brain shift ratios of thalamus or brainstem (all P < 0.05). Distal muscle strength improvements also correlated with age at seizure onset. CONCLUSIONS: Patients with hemispherical intractable epilepsy with larger presurgical shifts of thalamus and brainstem exhibited improved muscle strength, especially in distal muscles, after anatomic hemispherectomy. This result was more likely in patients who were older at the time of seizure onset. These presurgical shifts of thalamus and brainstem may be used for predicting motor function recovery after hemispherectomy for a subset of patients, which is beneficial for surgical planning.

Treatment for patients with recurrent intractable epilepsy after primary hemispherectomy.

BACKGROUND: Hemispherectomy is useful for treating patients with intractable epilepsy caused by diffuse unilateral hemispheric disease. Few patients develop recurrent seizures after hemispherectomy, but managing epilepsy by medical means alone is challenging for these patients, and it is also difficult to determine the treatment options and assess the need for reoperation. OBJECTIVE: To present the treatment strategies and outcomes of patients who developed recurrent intractable epilepsy after initial hemispherectomies that were performed at a single institution by a single surgeon between 2004 and 2014. METHOD: The preoperative medical records, operative reports, imaging findings, and follow-up data for patients with recurrent epilepsy who underwent hemispherectomy for intractable epilepsy between 2004 and 2014 at Sanbo Brain Hospital Capital Medical University were retrospectively reviewed. The baseline characteristics, cause of seizures, imaging findings, electrophysiological findings, primary surgery-related complications, treatments for recurrent epilepsy and long-term seizure outcomes were evaluated. A reduction of seizure frequency greater than 90% was considered a favorable outcome. RESULTS: In the cohort of 17 patients who suffered recurrent epilepsy after primary hemispherectomy, 11 had undergone reoperative surgery, whereas 6 patients took medication alone. No major complications occurred in this series. At the last follow-up, favorable outcome was noted in 10 (91%) patients who underwent reoperative surgery and in 1 (17%) patient who received only medication for treatment (Table 1, p = 0.005). Patients with malformation of cortical development tended to have worse seizure outcomes. CONCLUSIONS: Reoperative hemispherectomy is an effective and safe treatment for patients who still have seizures after primary hemispherectomy for epilepsy caused by unilateral cortical lesion.

Asymmetry of Cerebral Peduncles for Predicting Motor Function Restoration in Young Patients Before Hemispherectomy.

OBJECTIVE: Hemispherectomy has been used successfully for patients with medically intractable epilepsy. However, it is difficult to predict postoperative motor function. The aim of the present study was to analyze whether the preoperative asymmetry of cerebral peduncles could be used to predict motor function restoration before hemispherectomy for young patients with medically intractable epilepsy. METHODS: The clinical record and magnetic resonance imaging data of 53 patients were analyzed retrospectively. The correlation between preoperative cerebral peduncle asymmetry ratio (pCPAR) and pre- and postoperative changes in motor function was evaluated, as well as the influencing factors for pCPAR, such as duration and etiology factors. The restoration of motor function was defined as changes in pre- and postoperative hemiparesis. RESULTS: The pCPARs of patients with improved and unchanged hemiparesis were significantly greater than that of worsened patients. Patients with a pCPAR of more than 1.5 had an obvious restorative capacity of motor function of the intact hemisphere, and these patients had a lower risk of worsening hemiparesis. The duration in the improved/unchanged and worsened groups was 5.84 ± 3.85 years and 2.67 ± 2.03 years, respectively. Furthermore, there were more patients with no-progressive pathology in the group in whom pCPAR was more than 1.5. CONCLUSIONS: pCPAR is a useful and objective indicator for predicting the restoration of motor function in pediatric patients with medically intractable epilepsy before hemispherectomy. Most patients with nonprogressive pathology and a duration of more than 5 years presented with greater pCPARs, exhibited better restoration of motor function, and had less risk of worsening hemiparesis.

Timing and type of hemispherectomy for Rasmussen's encephalitis: Analysis of 45 patients.

OBJECTIVE: To describe the surgery outcomes of RE patients in one centerto identify the indication for surgical treatment that results in the most favorable outcome. METHOD: Forty-five RE patients from a single center were retrospectively reviewed. Preoperative evaluations included assessments of clinical manifestations, cognitive status, a physical examination, MRI, positron emission tomography (PET), electroencephalography (EEG), and magnetoencephalography (MEG). The surgical outcomes included seizure outcome, neurological function, EEG, a cognitive evaluation, and antiepileptic drug withdrawal. RESULTS: A total of 45 children (29 male) with RE were included in this study. The mean follow-up period from the first operation was 31.7months (range 6-96). The patients who underwent anatomical hemispherectomy or hemisphere disconnection had better seizure outcomes without greater perioperative complications compared with the patients who underwent functional hemispherectomy. Reoperative hemispherectomy was a safe and effective treatment for patients with postoperative epilepsy recurrence. After the last surgery, 34 patients (74.4%) were evaluated as Engel class I. Most of the patients had favorable neurological outcomes. Analysis revealed that the patientswith IQs greater 70 who underwent operations were more likely to suffer from IQ declines but were also more likely to have higher IQs in the future. SIGNIFICANCE: Compared with functional hemispherectomy and hemisphere disconnection, anatomical hemispherectomy elicited better seizure outcomes with an acceptable level of complications. Early stage operations might lead to better cognitive status, but they are associated with a high risk of IQ decline.