Filter

Refine by Publication

Refine by Date

—

Refine by Access

By Author

Refine By Subjects

  • Print
  • Save

Browse

You are looking at 1 - 10 of 39,823 items for

  • Refine by Access: all x
Clear All
Restricted access

Assessing the impact of obesity on full endoscopic spine surgery: surgical site infections, surgery durations, early complications, and short-term functional outcomes

Jannik Leyendecker, Braeden Benedict, Chayanne Gumbs, Peer Eysel, Jan Bredow, Albert Telfeian, Peter Derman, Osama Kashlan, Anubhav Amin, Sanjay Konakondla, Christoph P. Hofstetter, and John Ogunlade

OBJECTIVE

An increasing number of obese patients undergoing elective spine surgery has been reported. Obesity has been associated with a substantially higher number of surgical site infections and a longer surgery duration. However, there is a lack of research investigating the intersection of obesity and full endoscopic spine surgery (FESS) in terms of functional outcomes and complications. The aim of this study was to evaluate wound site infections and functional outcomes following FESS in obese patients.

METHODS

Patients undergoing lumbar FESS at the participating institutions from March 2020 to March 2023 for degenerative pathologies were included in the analysis. Patients were divided into obese (BMI > 30 kg/m2) and nonobese (BMI 18–30 kg/m2) groups. Data were collected prospectively using an approved smartphone application for 3 months postsurgery. Parameters included demographics, surgical details, a virtual wound checkup, the visual analog scale for back and leg pain, and the Oswestry Disability Index (ODI) as a functional outcome measure.

RESULTS

A total of 118 patients were included in the analysis, with 53 patients in the obese group and 65 in the nonobese group. Group homogeneity was satisfactory regarding patient age (obese vs nonobese: 55.5 ± 14.7 years vs 59.1 ± 17.1 years, p = 0.25) and sex (p = 0.85). No surgical site infection requiring operative revision was reported for either group. No significant differences for blood loss per level (obese vs nonobese: 9.7 ± 16.8 ml vs 8.0 ± 13.3 ml, p = 0.49) or duration of surgery per level (obese vs nonobese: 91.2 ± 57.7 minutes vs 76.8 ± 39.2 minutes, p = 0.44) were reported between groups. Obese patients showed significantly faster improvement regarding ODI (−3.0 ± 9.8 vs 0.7 ± 11.3, p = 0.01) and leg pain (−4.4 ± 3.2 vs −2.9 ± 3.7, p = 0.03) 7 days postsurgery. This effect was no longer significant 90 days postsurgery for either ODI (obese vs nonobese: −11.4 ± 11.4 vs −9.1 ± 9.6, p = 0.24) or leg pain (obese vs nonobese: −4.3 ± 3.9 vs −3.5 ± 3.8, p = 0.28).

CONCLUSIONS

The results highlight the effectiveness and safety of lumbar FESS in obese patients. Unlike with open spine surgery, obese patients did not experience significant increases in surgery time or postoperative complications. Interestingly, obese patients demonstrated faster early recovery, as indicated by significantly greater improvements in ODI and leg pain at 7 days after surgery. However, there was no difference in improvement between the groups at 90 days after surgery.

In Journal of Neurosurgery: Spine Publish Before Print

Restricted access

Association between hospital volume and in-hospital mortality in pediatric severe traumatic brain injury: a nationwide retrospective observational study in Japan

Shu Utsumi, Shingo Ohki, Takeshi Ueda, Shunsuke Amagasa, Mitsuaki Nishikimi, and Nobuaki Shime

OBJECTIVE

The objective of this study was to investigate the association between hospital volume and in-hospital mortality in pediatric patients with severe traumatic brain injury (TBI).

METHODS

This retrospective cohort study used data from the Japan Trauma Data Bank between 2010 and 2018, specifically those of pediatric patients with severe TBI (Glasgow Coma Scale [GCS] score < 9 and head Abbreviated Injury Scale score > 2). Hospital volume was defined as the number of pediatric patients with severe TBI throughout the study period. Hospital volume was categorized as low (reference category: 1–9 patients), middle (10–17 patients), or high (> 18 patients) volume. Multivariate mixed-effects logistic regression analysis was performed to determine the association between hospital volume categories and in-hospital mortality. Subgroup analyses were performed using data on craniotomy and the presence of severe torso injuries. In the sensitivity analyses, patients with a GCS score of 3, interhospital transfer, and major intensive care unit complications were excluded.

RESULTS

A total of 1148 pediatric patients with severe TBI, with a median age of 12 years (IQR 7–16 years), treated at 141 hospitals were included. In total, 236 patients (20.6%) died in the hospital. Multivariate analysis showed no significant association between hospital volume and in-hospital mortality (high volume: OR 1.15, 95% CI 0.80–1.64; middle volume: OR 0.89, 95% CI 0.62–1.26). Subgroup and sensitivity analyses showed similar results.

CONCLUSIONS

Hospital volume may not be associated with in-hospital mortality in pediatric patients with severe TBI.

In Journal of Neurosurgery: Pediatrics Publish Before Print

Restricted access

Clinical outcomes following stereotactic radiosurgery for cerebral cavernous malformations of the basal ganglia and thalamus

Raj Singh, Chloe Dumot, Georgios Mantziaris, Sam Dayawansa, Zhiyuan Xu, Stylianos Pikis, Selcuk Peker, Yavuz Samanci, Gokce D. Ardor, Ahmed M. Nabeel, Wael A. Reda, Sameh R. Tawadros, Khaled Abdel Karim, Amr M. N. El-Shehaby, Reem M. Emad Eldin, Darrah Sheehan, Kimball Sheehan, Ahmed H. Elazzazi, Nuria Martínez Moreno, Roberto Martínez Álvarez, Roman Liscak, Jaromir May, David Mathieu, Jean-Nicolas Tourigny, Manjul Tripathi, Akshay Rajput, Narendra Kumar, Rupinder Kaur, Piero Picozzi, Andrea Franzini, Herwin Speckter, Wenceslao Hernandez, Anderson Brito, Ronald E. Warnick, Juan Diego Alzate, Douglas Kondziolka, Greg N. Bowden, Samir Patel, and Jason P. Sheehan

OBJECTIVE

There are few reports of outcomes following stereotactic radiosurgery (SRS) for the management of cerebral cavernous malformations (CCMs) of the basal ganglia or thalamus. Therefore, the authors aimed to clarify these outcomes.

METHODS

Centers participating in the International Radiosurgery Research Foundation were queried for CCM cases managed with SRS from October 2001 to February 2021. The primary outcome of interest was hemorrhage-free survival (HFS) with a secondary outcome of symptomatic adverse radiation events (AREs). Assessment of the association of prognostic factors with HFS was conducted via Kaplan-Meier analysis and log-rank test. Chi-square tests were conducted to assess potential factors associated with the incidence of AREs.

RESULTS

Seventy-three patients were identified. The median patient age was 43.5 years (range 4.4–79.5 years). Fifty-nine (80.8%) patients had hemorrhage prior to SRS. The median treatment volume was 0.9 cm3 (range 0.07–10.1 cm3) with a median margin prescription dose (MPD) of 12 Gy (range 10–20 Gy). One-, 3-, 5-, and 10-year HFS were 93.0%, 89.9%, 89.9%, and 83.0%, respectively, with one hemorrhage-related death approximately 1 year after SRS and nearly 60% and 30% of patients having improvement or stability of symptoms, respectively. There was no correlation between lesion size or MPD and HFS. Seven (9.6%) patients experienced AREs (MPDs > 12 Gy in all cases). Lesion size > 1.0 cm3 was correlated with the incidence of an ARE (p = 0.019). Forty-two (93.3%) of 45 patients treated with an MPD ≤ 12 Gy experienced neither hemorrhage nor AREs following SRS versus 17 (60.7%) of 28 patients treated with an MPD > 12 Gy (p = 0.0006).

CONCLUSIONS

SRS is a reasonable treatment strategy and confers clinical stability or improvement and hemorrhage avoidance in patients harboring CCMs of the basal ganglia or thalamus. An MPD of approximately 12 Gy is recommended for the management of CCM.

In Journal of Neurosurgery Publish Before Print

Restricted access

Comparison of lumbar microdiscectomy and unilateral biportal endoscopic discectomy outcomes: a single-center experience

Mehmet İlker Özer and Oğuz Kağan Demirtaş

OBJECTIVE

Lumbar microdiscectomy (LMD) is still the gold-standard treatment for lumbar disc herniations with progressive neurological deficits that are refractory to conservative treatment. With improvement of endoscopic systems in recent years, endoscopic discectomy techniques have been developed as an alternative to LMD. The unilateral biportal endoscopic discectomy (UBE) technique is one of these endoscopic techniques, and its popularity has increased in recent years because it does not require high-cost specialized endoscopes, many microsurgical instruments are compatible with this system, and it is similar to LMD in terms of anatomical orientation. This study compared results between LMD and UBE techniques in patients with lumbar disc herniations performed by the same spine surgeons at a single center.

METHODS

The data of patients with lumbar disc herniation who were operated on with LMD and UBE techniques were retrospectively reviewed. The data obtained were statistically evaluated. The operative video of one of the patients who underwent UBE was edited for demonstration.

RESULTS

Between January 2021 and June 2022, 93 patients were operated on for lumbar disc herniation. LMD was performed in 39 patients, and UBE was performed in 54 patients. There were no significant differences in the complications, recurrence, postoperative back and leg pain, patient satisfaction rates, and quality of life index results of the patients in the two groups. The operation time was shorter in the LMD group. In the UBE group, estimated blood loss was lower and postoperative hospitalization was shorter.

CONCLUSIONS

Although LMD is still the gold-standard treatment for lumbar disc herniation, the results of UBE are comparable to those of LMD, and it may be a good alternative for spine surgeons who prefer minimally invasive surgery.

In Journal of Neurosurgery: Spine Publish Before Print

Restricted access

Conditioned recurrence-free survival following gross-total resection of nonfunctioning pituitary adenoma: a single-surgeon, single-center retrospective study

Jesse J. McClure, Ajay Chatrath, Trae R. Robison, and John A. Jane Jr.

OBJECTIVE

The authors sought to determine the time to recurrence after achieving gross-total resection of nonfunctioning pituitary adenoma (NFPA) in adult patients. The authors also sought to determine the rate of recurrence after increasing years of recurrence-free imaging.

METHODS

The authors performed a retrospective chart review of all adult patients who underwent gross-total resection of NFPA between September 2004 and January 2018 by the senior surgeon. The primary outcome of the study was time to recurrence, defined by imaging and/or clinical criteria.

RESULTS

The median follow-up time of the 148 patients who met the inclusion criteria was 91 months; 12 of these patients (8.1%) had recurrence. The median time to recurrence was 80 months. The range of time for these recurrences was 36–156 months. The probabilities of remaining recurrence free at 180 months after gross-total resection of NFPA and 12, 36, 60, 84, or 120 months of recurrence-free imaging were 82%, 84%, 86%, 88%, and 93%, respectively. The year-over-year odds of a recurrence increased linearly by 1.07%. There was no difference in recurrence-free imaging when patients were stratified by Knosp grade or tumor subtype. None of the patients with recurrence underwent repeat resection. When identified, patients were managed either conservatively or with radiosurgery.

CONCLUSIONS

Increased intervals of recurrence-free imaging were not associated with a decrease in risk of recurrence, which suggests that patients require life-long periodic imaging. If followed with periodic imaging, recurrence can be discovered before clinically symptomatic and successfully treated without repeat surgery.

In Journal of Neurosurgery Publish Before Print

Restricted access

The iterative implementation of a comprehensive enhanced recovery after surgery protocol in all spinal surgery in Korea: a comparative analysis of clinical outcomes and medical costs between primary spinal tumors and degenerative spinal diseases

Woon Tak Yuh, Jun-Hoe Kim, Junghoon Han, Tae-Shin Kim, Young Il Won, Yunhee Choi, Hyun Jung Noh, Chang-Hyun Lee, Chi Heon Kim, and Chun Kee Chung

OBJECTIVE

Most studies on the enhanced recovery after surgery (ERAS) protocol in spine surgery have focused on patients with degenerative spinal diseases (DSDs), resulting in a lack of evidence for a comprehensive ERAS protocol applicable to patients with primary spine tumors (PSTs) and other spinal diseases. The authors had developed and gradually adopted components of the comprehensive ERAS protocol for all spine surgical procedures from 2003 to 2011, and then the current ERAS protocol was fully implemented in 2012. This study aimed to evaluate the impact and the applicability of the comprehensive ERAS protocol across all spine surgical procedures and to compare outcomes between the PST and DSD groups.

METHODS

Adult spine surgical procedures were conducted from 2003 to 2021 at the Seoul National University Hospital Spine Center and data were retrospectively reviewed. The author divided the study periods into the developing ERAS (2003–2011) and post-current ERAS (2012–2021) periods, and outcomes were compared between the two periods. Surgical procedures for metastatic cancer, infection, and trauma were excluded. Interrupted time series analysis (ITSA) was used to assess the impact of the ERAS protocol on medical costs and clinical outcomes, including length of stay (LOS) and rates of 30-day readmission, reoperation, and surgical site infection (SSI). Subgroup analyses were conducted on the PST and DSD groups in terms of LOS and medical costs.

RESULTS

The study included 7143 surgical procedures, comprising 1494 for PSTs, 5340 for DSDs, and 309 for other spinal diseases. After ERAS protocol implementation, spine surgical procedures showed significant reductions in LOS and medical costs by 22% (p = 0.008) and 22% (p < 0.001), respectively. The DSD group demonstrated a 16% (p < 0.001) reduction in LOS, whereas the PST group achieved a 28% (p < 0.001) reduction, noting a more pronounced LOS reduction in PST surgical procedures (p = 0.003). Medical costs decreased by 23% (p < 0.001) in the DSD group and 12% (p = 0.054) in the PST group, with a larger cost reduction for DSD surgical procedures (p = 0.021). No statistically significant differences were found in the rates of 30-day readmission, reoperation, and SSI between the developing and post-current ERAS implementation periods (p = 0.65, p = 0.59, and p = 0.52, respectively).

CONCLUSIONS

Comprehensive ERAS protocol implementation significantly reduced LOS and medical costs in all spine surgical procedures, while maintaining comparable 30-day readmission, reoperation, and SSI rates. These findings suggest that the ERAS protocol is equally applicable to all spine surgical procedures, with a more pronounced effect on reducing LOS in the PST group and on reducing medical costs in the DSD group.

In Journal of Neurosurgery: Spine Publish Before Print

Restricted access

Localization of spinal dural arteriovenous fistulas from the spatial relationships of perimedullary vessels on standard MRI

Ali Moosavi, Paul Kalapos, Ephraim W. Church, Kevin M. Cockroft, and Krishnamoorthy Thamburaj

OBJECTIVE

The goal in this study was to explore the spatial relationship of perimedullary vessels visualized on MRI to localize the side and the site of spinal dural arteriovenous fistula (SDAVF).

METHODS

A retrospective analysis of 30 consecutive patients diagnosed with SDAVF on MRI was undertaken. Two experienced reviewers blinded to all reports and angiographic images analyzed T2-weighted as well as postcontrast T1-weighted sequences. A focal prominent zone of perimedullary vessels with lateralization to one side in the thecal space was evaluated to locate the side and the site of the fistula. Spinal digital subtraction angiography served as the gold standard technique.

RESULTS

Good interrater agreement (κ = 0.77) was shown for the diagnosis of SDAVF with perimedullary vessels on T2-weighted MRI. Flow voids on T2-weighted MRI demonstrated a sensitivity of 1.0 (95% CI 1.0–1.0) and an accuracy of 0.87 (95% CI 0.79–0.95) to identify the presence of fistula. The flow voids on T2-weighted MRI also demonstrated 0.88 (95% CI 0.71–1.03) sensitivity and 0.81 (95% CI 0.70–0.92) accuracy to identify the side of SDAVF. Furthermore, flow voids on T2-weighted MRI showed 0.87 (95% CI 0.71–1.03) sensitivity and 0.87 (95% CI 0.79–0.95) accuracy to identify the site of SDAVF within 3 vertebral levels above or below the actual site. Area under the receiver operating characteristic curve demonstrated significant results (0.87 [95% CI 0.73–1.0]; p < 0.001) for flow voids on T2-weighted MRI to identify the site of shunts within 3 vertebral levels in the cranial or caudal direction.

CONCLUSIONS

Spatial distribution of perimedullary vessels observed on standard MRI show promise to locate the side and the site of fistula in patients with SDAVF.

In Journal of Neurosurgery: Spine Publish Before Print

Restricted access

Neurosurgery trainee well-being in a pediatric neurosurgery hospital: baseline data to motivate toward implementing change

Maryam N. Shahin, V. Jane Horak, Hanna Kemeny, Mark W. Youngblood, Sandi K. Lam, and Jeffrey S. Raskin

OBJECTIVE

The aim of this study was to obtain aggregated baseline pediatric neurosurgery well-being data at a tertiary care institution.

METHODS

An institutional grant funded the completion of the Maslach Burnout Inventory (MBI) by 100% (n = 13) of the trainees during a 1-year period, including 1 pediatric neurosurgery fellow and 12 residents from 4 regional neurosurgery training programs. Aggregated and anonymized group results included frequency scores ranging from 0 (never) to 6 (every day). The mean ± SD group scores were compared to the general population of > 11,000 people in the human services professions. Burnout profiles were calculated on the basis of MBI scale scores by using established comparisons to standardized normal values. Burnout profile types include engaged, ineffective, overextended, disengaged, and burnout.

RESULTS

The mean ± SD score for emotional exhaustion was 2.6 ± 1.1 for trainees compared with 2.3 ± 1.2 in the comparison population. The mean ± SD score for depersonalization was 1.6 ± 1 compared with 1.7 ± 1.2 in the comparison population. The mean ± SD score for personal accomplishment was 4.9 ± 0.7 compared with 4.3 ± 0.9 in the comparison population. Profiles were classified as engaged (n = 6), ineffective (n = 3), overextended (n = 3), and burnout (n = 1).

CONCLUSIONS

Problematic profiles were present for more than half (7 [53.8%]) of pediatric neurosurgery trainees who cited higher emotional exhaustion than the general population of healthcare providers. Trainees scored lower in depersonalization and higher in personal accomplishment compared with the general population, which are both protective against burnout. Targeting factors that contribute to emotional exhaustion may have an impact on improving the overall well-being of pediatric neurosurgery trainees.

In Journal of Neurosurgery: Pediatrics Publish Before Print

Restricted access

Nomogram for preoperative estimation of symptomatic subdural hygroma risk in pediatric intracranial arachnoid cysts

Heng Zhao, Yufan Chen, Shuaiwei Tian, Baocheng Wang, Yang Zhao, and Jie Ma

OBJECTIVE

The occurrence and predictors of symptomatic subdural hygroma (SSH) subsequent to the fenestration of pediatric intracranial arachnoid cysts (IACs) are unclear. In this study, the authors aimed to investigate the likelihood of an SSH following IAC fenestration and the impact on operative efficacy with the ultimate goal of constructing a nomogram.

METHODS

The medical records of 1782 consecutive patients who underwent surgical treatment at the Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were reviewed. Among these patients, a training cohort (n = 1214) underwent surgery during an earlier period and was used for the development of a nomogram. The remaining patients formed the validation cohort (n = 568) and were used to confirm the performance of the developed model. The development of the nomogram involved the use of potential predictors, while internal validation was conducted using a bootstrap-resampling approach.

RESULTS

SSH was detected in 13.2% (160 of 1214) of patients in the training cohort and in 11.1% (63 of 568) of patients in the validation cohort. Through multivariate analysis, several factors including Galassi type, IAC distance to the basal cisterns, temporal bulge, midline shift, IAC shape in the coronal view, area of the stoma, and artery location near the stoma were identified as independent predictors of SSH. These 7 predictors were used to construct a nomogram, which exhibited a concordance statistic (C-statistic) of 0.826 and demonstrated good calibration. Following internal validation, the nomogram maintained good calibration and discrimination with a C-statistic of 0.799 (95% CI 0.665–0.841). Patients who had nomogram scores < 30 or ≥ 30 were considered to be at low and high risk of SSH occurrence, respectively.

CONCLUSIONS

The predictive model and derived nomogram achieved satisfactory preoperative prediction of SSH. Using this nomogram, the risk for an individual patient can be estimated, and the appropriate surgery can be performed in high-risk patients.

In Journal of Neurosurgery: Pediatrics Publish Before Print

Restricted access

Olfactory groove meningiomas: supraorbital keyhole versus orbitofrontal, frontotemporal, or bifrontal approaches

Evan D. Bander, Abhinav Pandey, Jenny Yan, Alexandra M. Giantini-Larsen, Alexandra Schwartz, Joshua Estin, Phillip E. Stieg, Rohan Ramakrishna, Apostolos John Tsiouris, and Theodore H. Schwartz

OBJECTIVE

Olfactory groove meningiomas (OGMs) often require surgical removal. The introduction of recent keyhole approaches raises the question of whether these tumors may be better treated through a smaller cranial opening. One such approach, the supraorbital keyhole craniotomy, has never been compared with more traditional open transcranial approaches with regard to outcome. In this study, the authors compared clinical, radiographic, and functional quality of life (QOL) outcomes between the keyhole supraorbital approach (SOA) and traditional transcranial approach (TTA) for OGMs. They sought to examine the potential advantages and disadvantages of open/TTA versus keyhole SOA for the resection of OGMs in a relatively case-matched series of patients.

METHODS

A retrospective, single-institution review of 57 patients undergoing a keyhole SOA or larger traditional transcranial (frontotemporal, pterional, or bifrontal) craniotomy for newly diagnosed OGMs between 2005 and 2023 was performed. Extent of resection, olfaction, length of stay (LOS), radiographic volumetric assessment of postoperative vasogenic and cytotoxic edema, and QOL (using the Anterior Skull Base Questionnaire) were assessed.

RESULTS

Thirty-two SOA and 25 TTA patients were included. The mean EOR was not significantly different by approach (TTA: 99.1% vs SOA: 98.4%, p = 0.91). Olfaction was preserved or improved at similar rates (TTA: 47% vs SOA: 43%, p = 0.99). The mean LOS was significantly shorter for SOA patients (4.1 ± 2.8 days) than for TTA patients (9.4 ± 11.2 days) (p = 0.002). The authors found an association between an increase in postoperative FLAIR cerebral edema and TTA (p = 0.031). QOL as assessed by the ASQB at last follow-up did not differ significantly between groups (p = 0.74).

CONCLUSIONS

The keyhole SOA was associated with a statistically significant decrease in LOS and less postoperative edema relative to traditional open approaches.

In Journal of Neurosurgery Publish Before Print