bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Intraoperative MRI in Resection of High-Grade Glioma Using 5-ALA: A Single-Center Case Series
Authors: Zakaria Rasheed , Suki Dima , Weinberg Jeffrey S. , Prabhu Sujit S.
Published: November 2024

BACKGROUND AND OBJECTIVES:

Outcomes in high-grade glioma (HGG) remain poor despite maximal safe tumor resection. Although intraoperative MRI (iMRI) or 5-aminolevulinic acid (5-ALA) individually has demonstrated clinical benefit, their combined use has not been evaluated extensively. We sought to evaluate the benefit of combined use of iMRI and 5-ALA in patients with HGG who underwent craniotomy and tumor resection.

METHODS:

We identified 54 patients who underwent 5-ALA–guided resection of intracranial HGG. iMRI was used in 33 cases. Intraoperative ultrasound and frameless neuronavigation with tractography were used for all cases. Using standard MRI sequences, the extent of resection (EOR) of T1-weighted contrast-enhancing (T1WCE) tumor and fluid-attenuated inversion-recovery (FLAIR) signal tumor were calculated.

RESULTS:

There were no significant differences in EOR of T1WCE tumor, volume of residual T1WCE tumor, and volume of residual FLAIR signal abnormality between the 5-ALA and iMRI + 5-ALA groups. Although the number of patients with complete resection did not differ significantly, more patients in the iMRI + 5-ALA group achieved resection of >53.21% of the FLAIR signal abnormality (20/31 vs 5/21, Pearson χ2, P = .004), which is known to be a predictor of improved prognosis. No significant differences in overall survival or progression-free survival between the groups and no association between EOR and clinical outcomes were observed, which may be due to the size of this study. There was no difference in new neurological deficit between the groups at 30 days after surgery.

CONCLUSION:

Surgery with 5-ALA alone is as effective as surgery with 5-ALA and iMRI at achieving maximal safe resection, when combined with adjuncts. Our findings suggest that the role and interaction of these technologies needs to be further studied in larger, prospective studies to understand whether their utility is complementary or additive, particularly their influence on EOR of FLAIR signal abnormality and subsequent clinical outcomes.
Improving Quality Metrics in Neurosurgery: A Spinal Surgery 3-Year Case Review
Authors: Feller Christina Nicoll , Bodenbach Erin M. , Kolinski Julie M. , Sinson Grant P.
Published: November 2024

BACKGROUND AND OBJECTIVES:

Despite the known importance of accurate clinical documentation as a companion to quality patient care, this is not often prioritized in practice and leads to a variety of downstream consequences. Inaccurate documentation leads to missed opportunities in full, accurate coding. In turn, it also negatively influences hospital and physician quality ranking, medical center profiling, and revenue captured. The aim of this study is to highlight the opportunity for continuous improvement in clinical documentation and the significance accurate clinical documentation has on outcome measures, such as expected length of stay (eLOS).

METHODS:

A single-center retrospective chart review took place for patients undergoing spinal surgery from 2019 to 2021. Based on Vizient's diagnosis-related group risk model for eLOS, 192 charts spanning 10 unique diagnosis-related groups were reviewed to identify ICD-10 diagnosis and procedure codes that were not coded or not clearly documented by a physician. A new eLOS for each patient was recalculated with the addition of the newly identified variables and then compared with the original eLOS.

RESULTS:

Overall, there was a significant difference between the original eLOS and new eLOS when the newly identified variables were added (P < .001). Of 192 patient charts, 89.5% had at least one new variable contributing to eLOS, with an average of 2.60 (0, 12) new variables. This resulted in an average increase in eLOS of 2.869 days (−0.160, 35.129). Compared with the observed LOS, the new eLOS was significantly different (P < .001), whereas the original LOS was not (P = .5661).

CONCLUSION:

Incomplete documentation and coding can misrepresent the quality of patient care provided and the complexity of their cases. This represents an opportunity for improvement for both the clinicians, clinical documentation improvement specialists, and coders to improve quality metrics and hospital rankings.
Internal Carotid Artery Injury in Endoscopic Endonasal Surgery: The Value of Intraoperative Magnetic Resonance Imaging
Authors: Ajlan Abdulrazag , Babateen Emad M. , Alqurashi Ashwag
Published: November 2024

BACKGROUND AND IMPORTANCE:

Internal carotid artery (ICA) injury is a devastating complication of endoscopic endonasal surgery. We report a case of completely resected clival chordoma using endoscopic endonasal surgery despite intraoperative ICA injury. Intraoperative MRI (iMRI) was used to localize the bleeding site, confirm resection degree and ICA patency distal to the injury site, and rule out intraoperative ischemia.

CLINICAL PRESENTATION:

A 16-year-old girl presented with right-sided facial paresthesia and was diagnosed with a large, invasive skull base lytic lesion centered in the clivus. The patient's neurological examination was normal, except for decreased sensation on the right side of the face. During tumor resection, massive bleeding occurred from the ICA paraclival segment, which was by applying direct pressure using hemostatic agents. Partial tumor resection, no clear signs of ischemic injury, and a patent flow distal to the ICA injury site were observed using iMRI. These findings helped in the decision to proceed with surgery and complete gross total resection. Postoperative angiography immediately performed after surgery revealed a pseudoaneurysm that was successfully embolized with coils. After discharge with no new neurological deficits, the postoperative imaging showed complete resection and no evidence of ischemic stroke in the injured ICA distribution.

CONCLUSION:

Although not commonly used to detect skull base lesions, iMRI was valuable in our chordoma case and enabled the surgical team to proceed with a complete surgical resection. It provided real-time evaluation of the injury and possible complications. Thus, iMRI should be considered for high-risk skull base ICA injuries.
Application of Delta T1 Maps for Quantitative and Objective Assessment of Extent of Resection and Survival Prediction in Glioblastoma
Authors: Laing Brandon R. , Prah Melissa A. , Best Benjamin J. , Krucoff Max O. , Mueller Wade M. , Schmainda Kathleen M.
Published: November 2024

BACKGROUND AND OBJECTIVES:

Gross-total resection and low residual tumor volume (RTV) have been associated with increased survival in glioblastoma. Largely because of the subjectivity involved, the determination of gross-total resection and RTV remains difficult in the postoperative setting. In response, the objective of this study is to evaluate the clinical efficacy of an easy-to-use MRI metric, called delta T1 (dT1), to quantify the extent of resection (EOR) and RTV, in comparison with radiologist impression, to predict overall survival (OS) in patients with glioblastoma.

METHODS:

Fifty-nine patients who underwent resection of glioblastoma were retrospectively identified. dT1 images, automatically created from the difference between calibrated post- and precontrast T1-weighted images, were used to quantify EOR and RTV. Kaplan–Meier survival estimates were determined for EOR categories, an RTV cutoff of 5 cm3 and radiologist interpretation of EOR. Multivariate Cox proportional hazard regression analysis was used to evaluate RTV and EOR along with effects related to sex, Karnofsky Performance Scale, O[6]-methylaguanine-DNA methyltransferase (MGMT), and age on OS.

RESULTS:

Kaplan–Meier analysis revealed a statistically significant difference in median OS for a dT1-determined RTV cutoff of 5 cm3 (P = .0024, hazard ratio = 2.18 [1.232-3.856]), but not for radiological impression (P = .666) or dT1-determined EOR (P = .0803), which was limited to a comparison between partial and subtotal resections. Furthermore, when covariates were accounted for in multivariate Cox regression, significant differences in OS were retained for dT1-determined RTV. In addition, a significantly strong yet short-term effect of MGMT methylation status on OS was revealed for each RTV and EOR model.

CONCLUSION:

The utility of dT1 maps to quantify EOR and RTV in glioblastoma and predict survival suggests an emerging role for dT1s with relevance for intraoperative MRI, neuronavigation, and postoperative disease surveillance.
Machine Learning–Driven Prognostication in Traumatic Subdural Hematoma: Development of a Predictive Web Application
Authors: Karabacak Mert , Margetis Konstantinos
Published: November 2024

BACKGROUND AND OBJECTIVES:

Our focus was on creating an array of machine learning (ML) models to predict unfavorable in-hospital outcomes after acute traumatic subdural hematoma (atSDH). Our subsequent aim was to deploy these models in an accessible web application, showcasing their practical value.

METHODS:

Data from the American College of Surgeons Trauma Quality Program database were used to identify patients with atSDH. In-hospital mortality was the primary outcome of interest. Secondary outcomes were (1) nonhome discharges, (2) prolonged length of stay (LOS), (3) prolonged length of stay in the intensive care unit (ICU-LOS), and (4) major complications. Feature selection was performed with least absolute shrinkage and selection operator algorithm. Five ML algorithms, including TabPFN, TabNET, XGBoost, LightGBM, and Random Forest, were used along with the Optuna optimization library for hyperparameter tuning.

RESULTS:

There were 104 055 patients included in the analysis for the outcome mortality, 82 988 for the outcome nonhome discharges, 104 207 for the outcome prolonged LOS, 62 543 for the outcome prolonged ICU-LOS, and 100 241 for the outcome major complications. The models with the highest area under receiver operating characteristic curve (AUROC) values included TabPFN for mortality and major complications, and LightGBM for nonhome discharges, prolonged LOS, and ICU-LOS. The TabPFN model for the primary outcome of our study, in-hospital mortality, showed an AUROC of 0.934. The models with the highest AUROC values were integrated into an application to predict the outcomes of interest.

CONCLUSION:

Our findings show that ML tools aid in predicting various outcomes for patients with atSDH. We developed a web application that has the potential to integrate the developed models into clinical practice.
Clinical Characteristics and Outcome of Patients With Intraoperative Aneurysm Rupture: A Retrospective Cohort Study From Nepal
Authors: Sharma Mohan R. , Bohara Sandeep , Shrestha Dipendra K. , Joshi Deepak R. , Singh Shreejana , Lamsal Ritesh , Acharya Subhash P. , Kafle Prakash , Pradhanang Amit B. , Sedain Gopal , Farrokhi Farrokh , Grant Gerald A.
Published: November 2024

BACKGROUND AND OBJECTIVES:

Intraoperative aneurysm rupture (IAR) is a significant complication during microsurgical clipping of cerebral aneurysms. The timing of rupture during surgery, morphology of the aneurysm, and strategies to mitigate risk are the key factors that influence the outcome.

METHODS:

Consecutive patients with the diagnosis of ruptured cerebral aneurysms were retrospectively reviewed at a single University Hospital in Kathmandu, Nepal. Variables analyzed included age, sex, presenting symptoms, Hunt and Hess grades, the location of aneurysms, the timing of surgery, and intraoperative rupture status. Outcomes were assessed at 6 months after surgery.

RESULTS:

A total of 199 patients with 231 ruptured cerebral aneurysms from July 2014 to December 2022 were reviewed. Surgery was performed within 3 days in 60 (30.1%) patients. Twenty aneurysms ruptured intraoperatively in 20 patients (10% per patient and 8.6% per aneurysm). Patients with IAR were significantly younger (mean age 52 years) than those without IAR (mean age 58 years) (P < .001, 95% CI: 3.72-8.28). There was no difference in IAR rate in early vs late surgery. Anterior communicating artery complex aneurysms were noted as the most common. However, posterior inferior cerebellar and posterior cerebral artery aneurysms had the highest IAR rate, albeit with the smallest total number. Rupture during dissection was noted in 10 (50%) and during clipping in 9 (45%) procedures. Strategies for handling IAR included direct definitive clip application in 9, temporary clip-aided permanent clipping in 8, and trapping of the parent vessel in 1 patient. Although postoperative complications were significantly higher in the IAR group (P < .000129), the neurological outcomes using the modified Rankin scale in 6 months were similar (P = .877).

CONCLUSION:

The demographic and clinical characteristics and rates of IAR in our patient population are similar to those in the contemporary literature. In patients with IAR, the outcome is not worse than those without IAR.
Reversal of Middle Cerebral Artery Stenosis by Minimally Invasive Intracerebral Hematoma Evacuation
Authors: Senol Yigit Can , Asghariahmadabad Mona , Haddad Alexander , Smith Wade S. , Savastano Luis E.
Published: November 2024

BACKGROUND AND IMPORTANCE:

Acute intracerebral hematomas are known to induce significant mass effects within the brain, leading to critical complications such as cerebral midline shift, herniation, and increased intracranial pressure. The timing and efficacy of intracerebral hematoma evacuation remain subjects of ongoing debate in current literature.

CLINICAL PRESENTATION:

In our case report, we present a 74-year-old female patient diagnosed with basal ganglia hematoma. The resultant mass effect from the intracerebral hematoma led to middle cerebral artery (MCA) stenosis. Notably, early-stage minimally invasive hematoma evacuation was pivotal in facilitating successful revascularization of the MCA.

CONCLUSION:

Our case underscores the significance of prompt identification and management of MCA stenosis arising from intracerebral hematoma. Early intervention through minimally invasive hematoma evacuation proved instrumental in achieving successful MCA revascularization. These findings emphasize the critical role of timely interventions in mitigating potential complications associated with intracerebral hematoma.
Trends in the Treatment of Pediatric Hydrocephalus Since 2014: Understanding the Role of the 2014 Hydrocephalus Guidelines
Authors: Larrew Thomas , Corrigan Corinne , Bauer David F.
Published: November 2024

BACKGROUND AND OBJECTIVES:

The management of hydrocephalus has significantly changed over the past decade. Endoscopic third ventriculostomy has become more prevalent, and shunt surgery has become more protocolized through research efforts by the Hydrocephalus Clinical Research Network. In 2014, the Pediatric Hydrocephalus Guidelines were first published, providing a cohesive source for clinical guidance. We planned to investigate national trends in the management of pediatric hydrocephalus after the publication of the 2014 Pediatric Hydrocephalus Guidelines as guidelines act as a compilation of historic and recent literature in a scientific field.

METHODS:

A multipronged approach was used to evaluate changes in the treatment of pediatric hydrocephalus since 2014. First, we queried the Pediatric Health Information System between 2013 and 2018 to identify national trends in shunt procedures for hydrocephalus. To assess the recommendation in the guidelines to use antibiotic-impregnated catheters (AICs) in shunts, national sales records of AICs were obtained from 2 large neurosurgical device companies.

RESULTS:

A total of 11,179 shunt procedures were performed within the Pediatric Health Information System database in the study period. In the preguideline publication period (2013-2014), there was a shunt revision-to-placement ratio of 1.63 while in the postguideline publication period (2015-2018), there was a ratio of 0.84 (P < .0001). National sales data revealed that antibiotic-impregnated drain sales increased from 2% to 77% since publication.

CONCLUSION:

Findings from this investigation suggest progress in pediatric hydrocephalus management since 2014. The shunt revision-to-placement ratio improved, and the use of AICs increased over this period. Improved outcomes are likely associative findings rather than causative with the guidelines representing a culmination of widespread changes in hydrocephalus care such as increased use of endoscopic third ventriculostomies, protocolized care, and image-guided shunt placement. Further research into the impact of clinical practice guidelines is needed to better understand the impact of this tool on surgeons and patient care.
Bridging the Global Technology Gap in Neurosurgery: Disparities in Access to Advanced Tools for Brain Tumor Resection
Authors: Valerio Jose E. , Ramirez-Velandia Felipe , Fernandez-Gomez Maria Paula , Rea Noe S. , Alvarez-Pinzon Andres M.
Published: November 2024

BACKGROUND AND OBJECTIVES:

The advent of advanced technologies has brought unprecedented precision and efficacy to neurosurgical procedures for brain tumor resection. Despite the remarkable progress, disparities in technology access across different nations persist, creating significant challenges in providing equitable neurosurgical care. The purpose of the following work was to comprehensively analyze the existing disparities in access to innovative neurosurgical technologies and the impact of such disparities on patient outcomes and research. We seek to shed light on the extent of the problem, the underlying causes, and propose strategies for mitigating these disparities.

METHODS:

A systematic review of published articles, including clinical studies, reports, and healthcare infrastructure assessments, was conducted to gather data on the availability and utilization of advanced neurosurgical technologies in various countries.

RESULTS:

Disparities in technology access in neurosurgery are evident, with high-income countries benefiting from widespread implementation, while low- and middle-income countries face significant challenges in technology adoption. These disparities contribute to variations in surgical outcomes and patient experiences. The root causes of these disparities encompass financial constraints, inadequate infrastructure, and insufficient training and expertise.

CONCLUSION:

Disparities in access to advanced neurosurgical technology remain a critical concern in global neurosurgery. Bridging this gap is essential to ensure that all patients, regardless of their geographic location, can benefit from the advancements in neurosurgical care. A concerted effort involving governments, healthcare institutions, and the international community is required to achieve this goal, advancing the quality of care for patients with brain tumors worldwide.
Endoscopic Repair of Cerebrospinal Fluid Leak
Authors: Schwartz Lindsey , Mohiuddin Ismail , Rajendran Sibi , Huang Meng
Published: November 2024

BACKGROUND AND IMPORTANCE:

The evolution of endoscopic techniques in spine has allowed novel approaches to various pathologies. We describe the use of endoscopy for repair of refractory cerebrospinal fluid (CSF) leak after lumbar puncture (LP).

CLINICAL PRESENTATION:

A 31-year-old female presented with refractory postural headaches after undergoing LP. The patient underwent 4 total epidural blood patches (EBPs) with minimal symptomatic relief. The LP opening pressure was found to be 18 cm of water, inconsistent with underlying pseudotumor cerebri. A myelogram demonstrated persistent CSF leak and contrast accumulation within the dorsal epidural space at L2-3. Endoscopic exploration was ultimately performed, which demonstrated well-placed EBPs; however, continuous CSF egressed from a pinhole site. This was repaired with coagulation using a radiofrequency probe, DuraSeal (Integra LifeSciences) and DuraGen (Integra LifeSciences). Postoperatively, the patient noted resolution of debilitating intracranial hypotension symptoms and was able to return to work.

CONCLUSION:

Postdural puncture headaches occur in about 1/3 of patients after LP. Symptoms are often debilitating and can include nausea, neck pain, dizziness, tinnitus, visual changes, and hearing loss. Multiple pharmacological and invasive treatments, such as EBP, have been used historically with success, but Postdural puncture headaches refractory to these interventions can put patients at risk for serious complications including seizures and subdural hematomas. We present the first reported case of an endoscopic approach to repair refractory CSF leak in the lumbar spine. Our approach highlights the potential of minimally invasive endoscopic techniques in the repair of refractory CSF leak from the puncture site after LP.
Machine Learning for Individualized Risk Estimation in Anterior Lumbar Interbody Fusion
Authors: Karabacak Mert , Jagtiani Pemla , Schupper Alexander J. , Carr Matthew T. , Steinberger Jeremy , Margetis Konstantinos
Published: November 2024

BACKGROUND AND OBJECTIVES:

Although the anterior approach to the spine for anterior lumbar interbody fusion (ALIF) has been shown to be an effective procedure, there are different surgical risks compared with conventional posterior fusion. ALIF patients could potentially receive more personalized care plans that minimize the risk of negative outcomes by forecasting short-term postoperative results before the surgical procedure. The objective of this research was to evaluate the performance of machine learning (ML) algorithms in predicting short-term unfavorable postoperative outcomes after ALIF and to develop an easy-to-use and readily available instrument for this purpose.

METHODS:

Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified ALIF patients and used 6 ML algorithms to build models predicting postoperative outcomes. These models were then incorporated into an open-access web application.

RESULTS:

The analysis included 8304 ALIF patients. The LightGBM models achieved area under the receiver operating characteristic scores of 0.735 for prolonged length of stay and 0.814 for nonhome discharges. The random forest models achieved area under the receiver operating characteristics of 0.707 for 30-day readmissions and 0.701 for major complications. These top-performing models were integrated into a web application for individualized patient predictions.

CONCLUSION:

ML techniques show promise in predicting postoperative outcomes for ALIF surgeries. As data in spinal surgery expand, these predictive models could significantly improve risk assessment and prognosis. We present an accessible predictive tool for ALIF surgeries to achieve the goals mentioned above.
Focused Ultrasound as Rescue Treatment of Essential Tremor After Deep Brain Stimulation: 2 Case Reports
Authors: Gonzalez Antonio , Tardáguila Manel , Ispierto Lourdes , Muñoz Jorge , Gea Mireia , Jaumà Serge , Plans Gerard , Álvarez Ramiro , Vilas Rolán Dolores
Published: November 2024

BACKGROUND AND IMPORTANCE:

Approximately 25% to 55% of patients with essential tremor will eventually develop medication-refractory tremor. Currently, the standard surgical treatment for this condition is deep brain stimulation (DBS) of the ventralis intermedius nucleus of the thalamus and, more recently, the posterior subthalamic area. However, MRI-guided focused ultrasound (FUS) thalamotomy has shown promising results in improving tremor in patients with refractory essential tremor.

CLINICAL PRESENTATION:

We present 2 cases of patients with a disabling action tremor, recurring after DBS. A 55-year-old right-handed male and a 52-year-old woman presented with bilateral medically refractory action tremor, which began in their second decade of life. Both underwent bilateral DBS-ventralis intermedius, with the first patient showing a good initial response but the second patient showing a suboptimal response within the first year after DBS. In both cases, the DBS system was removed and the patients subsequently underwent left-sided FUS thalamotomy with a dramatic improvement of their tremor.

CONCLUSION:

These cases demonstrate the feasibility of performing FUS thalamotomy as a rescue treatment for disabling tremor after DBS.
Directional Deep Brain Stimulation Lead Rotation in the Early Postoperative Period
Authors: Dang Huy Q. , Reyes Gabriel , Devara Ethan , Giridharan Nisha , Allam Anthony K. , Banks Garrett P. , Viswanathan Ashwin , Shofty Ben , Sheth Sameer A.
Published: November 2024

BACKGROUND AND OBJECTIVES:

Directional deep brain stimulation (DBS) enables treatment optimization by current steering using segmented leads. Identification of the lead's rotational orientation is critical to guide programming decisions. Orientation is often assessed during or immediately after implant, but the degree of lead rotation in the following weeks is not well appreciated. Our objective was to measure the degree of DBS lead rotational orientation changes within the first few weeks after surgery.

METHODS:

We retrospectively reviewed the clinical records of patients who were implanted with segmented DBS leads at our institution. All included patients had at least 1 immediate postoperative computed tomography (CT) (CT1) and another CT at least 1 week later (CT2). We assessed lead rotational orientation angles on CT1 and CT2 and calculated the degrees of rotation change between the scans. We also assessed for any effect of the time interval between scans by calculating the correlation between CT1-CT2 latency and degrees of lead rotation.

RESULTS:

We assessed a total of 75 DBS lead orientations for 38 patients. The average change in lead orientation between CT1 and CT2 was 8.6° (median = 2.9°, range = 0.11-168.2°). Only 8 percent of patients (3/38) were found to have a significant change in orientation (>30°); however, when it occurred, it occurred bilaterally. There was no correlation between CT1-CT2 latency and lead rotation (r(74) = 0.04, P = .73).

CONCLUSION:

Our study finds that changes in lead orientation occurring over the first few weeks after surgery are rare. Thus, for most patients, the immediate postoperative CT is adequate for determining the orientation angles for clinical programming. However, if programming is found to be difficult, a repeat CT scan could be beneficial for a minority of patients.
How to Avoid and Handle Problems in the Placement of Cement-Augmented Fenestrated Percutaneous Pedicle Screws?
Authors: Padilla-Lichtenberger Fernando , Landriel Federico , Guiroy Alfredo , Casimiro Miguel , Silva Álvaro , Hem Santiago
Published: November 2024

BACKGROUND AND OBJECTIVES:

Pedicle screws with a central cannula and fenestrations allow cement augmentation, providing lower risk for screw loosening and pullout, especially in these patients with poor bone quality. This study aims to offer suggestions for resolving issues and reducing complications associated with the use of cement-augmented fenestrated pedicle screws.

METHODS:

A retrospective study was conducted across multiple centers on patients who received fenestrated pedicle screws with cement augmentation (CAFPS). Using 2-dimensional fluoroscopy guidance, we placed over 800 screws in 137 patients. Based on our analysis of common challenges and complications, 10 tips were compiled, that we believe are crucial for successfully implementing this technique, regardless of the brand or instrument used.

RESULTS:

The 10 tips included the following: (1) Indications of cement-augmented fenestrated pedicle screws; (2) use the K-wire blunt end in osteoporotic vertebrae; (3) know the longitude and diameter of the screw, by the measurement of the vertebrae to treat; (4) do not go bicortical; (5) clean the way of the screws fenestrae with saline; (6) protecting screw extensors with gauze; (7) measuring time and volume; (8) gently and smoothly introduce the cement; (9) do not panic. The presence of cement in the posterosuperior area adjacent to the pedicle does not necessarily indicate a leakage into the canal; and (10) fenestrated screw removal.

CONCLUSION:

The implementation of these tips could enhance technique performance and minimize complications in cement-augmented fenestrated pedicle screw placement.
Intraoperative Intermittent Pneumatic Compression Reduces Incidence of Venous Thromboembolism in Patients Undergoing Craniotomy: Study Protocol of a Randomized Multicenter, Single-Blind Trial
Authors: Scheer Maximilian , Schenk Grit , Taute Bettina , Richter Michael , Hlavac Michael , Gempt Jens , Krammer Matthias , Shiban Ehab , Sabel Michael , Stein Marco , Wienke Andreas , Höllig Anke , Strauss Christian , Rampp Stefan , Prell Julian
Published: November 2024

BACKGROUND AND OBJECTIVE:

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complication in craniotomy patients. The duration of surgery has been identified as a risk factor for the development of VTE. In a pilot study, the use of intermittent pneumatic venous compression (IPC) dramatically reduced the incidence of VTE. Despite randomization, a significant difference in the duration of surgery between the groups limited the validity of this result. The study was underpowered to compensate for this problem. We now present the protocol of a multicenter trial.

METHODS:

All patients receive medical compression stockings and low-molecular-weight heparin from the first postoperative day. The therapy group receives IPC stockings intraoperatively. Postoperatively, all patients receive lower-extremity duplex sonography to detect/exclude DVT within the first 7 postoperative days. Contrast-enhanced chest CT is the gold standard for the detection of PE and is performed in cases of clinical suspicion of PE.

EXPECTED OUTCOMES:

The incidence of VTE is the primary end point. The distinction between symptomatic and asymptomatic, etiologies, influence of lesion type, duration of surgery, and mortality will be evaluated as secondary end points. The pilot study showed a VTE incidence of 26% in the control group vs 7% in the treatment group. To avoid overly optimistic treatment effect assumptions, we assume VTE rates of 9% and 24% in the treatment and control groups, respectively, and thus calculated a number of 127 patients per treatment group.

DISCUSSION:

If this trial shows that intraoperative IPC reduces the risk of VTE to the extent observed in our pilot study (number needed to treat: 5.24), the potential benefit to neurosurgical patients would be significant. The results would potentially influence treatment guidelines by providing the high-quality evidence needed to make robust recommendations.
Durotomy During Outpatient Lumbar Discectomy Should Not Preclude Same-Day Discharge: A Case Series
Authors: Golubovsky Joshua L. , Spadola Michael , Wathen Connor , Malhotra Neil R. , Welch William C. , Marcotte Paul
Published: November 2024

BACKGROUND AND OBJECTIVES:

With advances in surgical techniques over the past 40 years, single-level lumbar hemilaminectomy and microdiscectomy (HLMD) has become a standard outpatient surgery. Incidental durotomy is a common complication of lumbar decompression surgeries and often precludes same-day discharge based on preexisting paradigms, involving bedrest that have no empirical support, but often lead to increased complications in available evidence-based studies. Limited data exist regarding the safety of same-day discharge after lumbar decompression involving an incidental durotomy. The objective of this study was to establish the safety of same-day discharge after repair of incidental durotomy after single-level lumbar HLMD.

METHODS:

This study involved a retrospective review of the electronic medical record for all adult patients undergoing single-level lumbar hemilaminectomy and microdiscectomy by a single surgeon at our institution from 2013 through 2021. Descriptive statistics were used for data analysis.

RESULTS:

346 lumbar single-level HLMD were performed during this time frame by a single surgeon. There were 17 incidental durotomies (4.9%), all primarily repaired. Of the 17 patients with incidental durotomy, all but 5 returned home on postoperative day 0, with the 5 who remained inpatient staying for reasons unrelated to the dural tear. Patients had no durotomy-associated complications, readmissions, or reoperations regardless of same-day discharge home.

CONCLUSION:

Same-day discharge after primary repair of incidental durotomy in single-level lumbar HLMD seems to be safe and may significantly improve health care costs associated with HLMD. This investigation should be expanded to other one-level to two-level lumbar decompression surgeries and minimally invasive and endoscopic approaches.
A Novel Combined Microsurgical and Endovascular Approach for Type II Endoleak Embolization Through Direct Puncture of a Lumbar Segmental Artery: A Technical Case Instruction
Authors: Nguyen Vincent N. , Rennert Robert C. , Sternbach Sarah , Cavaleri Jonathon , Abedi Aidin , Atai Nadia A. , Han Sukgu , Russin Jonathan J.
Published: November 2024

BACKGROUND AND IMPORTANCE:

Despite the advances in endovascular aortic repair techniques, type II endoleaks with aneurysm sac expansion remain frequent and challenging problems.

CLINICAL PRESENTATION:

An elderly gentleman underwent a combined microsurgical and endovascular procedure to address a type 2 endoleak and the growth of a recurrent abdominal aortic aneurysm caused by direct puncture of a lumbar segmental artery. The patient tolerated the procedure well and was discharged without complications. Follow-up imaging revealed no further endoleak and a smaller aneurysm size.

CONCLUSION:

This unique case presents a novel multidisciplinary surgical strategy for treating complex, recurrent aortic aneurysms with type II endoleaks. The approach is tailored to the individual patient and has shown effectiveness. Long-term follow-up data will be crucial for assessing the efficacy and durability of this approach.
Parental Leave in Neurosurgery: A US Cross-Sectional Study
Authors: Sanusi Olabisi , Kalu Richard U. , Obayashi James , Beird Nathan , Williamson Theresa , Geltzeiler Mathew , Nahed Brian V. , Rodriguez Maria I.
Published: November 2024

BACKGROUND AND OBJECTIVES:

The Accreditation Council for Graduate Medical Education implemented a minimum of 6 weeks parental leave for residents in July 2022. The implementation and impact have not previously been studied in neurosurgery. Our primary study objectives were to determine whether an institution had a parental leave policy and quantify the Family and Medical Leave Act (FMLA) and total parental leave (TPL) time taken by neurosurgeons.

METHODS:

We conducted a cross-sectional survey (August 2023 to December 2023) of neurosurgeons (residents and faculty) in Accreditation Council for Graduate Medical Education–accredited programs. We elicited demographic information, experience with parental leave, and career satisfaction. Association between continuous variables was evaluated using Pearson's correlation. Data distribution was evaluated using the Shapiro–Wilks test. Central tendency comparison was performed using one-way analysis of variance, Kruskal–Wallis, or Mann–Whitney U tests.

RESULTS:

There were 147 anonymous survey respondents (response rate 15.7%), with an average age of 41 years. The majority (72.2% and 73%) were female and married. The mean age of first pregnancy was 32 years. On average, female residents and faculty took more TPL (7.7 weeks vs 9.0 weeks) and FMLA (6.0 weeks vs 6.8 weeks) than men (resident TPL:2.0 weeks, FMLA: 1.5 weeks. faculty TPL: 2.1 weeks, FMLA: 1.6 weeks). There was a significant difference between how much parental leave leadership believe residents have vs amount of FMLA (P-value = .004) and TPL (P-value = .001) residents took. There was a correlation between age and the amount of TPL (Pearson's R −0.307, P-value = .009).

CONCLUSION:

Our survey demonstrates that neurosurgeons, in general, took less than the minimum suggested leave. Departmental leadership perceived that residents took more leave than they reported. This study highlights an opportunity to increase support for parental leave among neurosurgeons.
Outcomes of Management of Progressive Radiosurgery-Treated Brain Metastasis With Resection Followed by Pathology-Informed Management: A Retrospective Study
Authors: Bhatia Rohini K. , George Jessica , Siu Catherine , Lee Emerson , Redmond Kristin J. , Baker Brock , Jackson Christopher M. , Bettegowda Chetan , Mukherjee Debraj , Hobbs Robert F. , Weingart Jon , Lim Michael , Kleinberg Lawrence
Published: November 2024

BACKGROUND AND OBJECTIVES:

In patients treated with stereotactic radiosurgery (SRS) for brain metastases, follow-up imaging demonstrating progression may result from treatment effect/radionecrosis (RN) or tumor progression. We report long-term outcomes for a cohort of patients who demonstrated radiological progression on serial imaging after initial radiation and who underwent resection, at which point histology informed further management.

METHODS:

A retrospective chart review identified 76 patients with an associated 82 brain lesions between 2009 and 2022, that were initially treated with SRS, and then demonstrated suspicious imaging developing through at least 2 scan time points with either pathologic confirmation of tumor or RN.

RESULTS:

Of the 82 lesions, 55 lesions (67.1%) were found to be tumor and were treated with repeat radiation and 27 (32.9%) were found to have pathologically confirmed RN and conservatively managed. 14/27 lesions ultimately found to be radionecrotic required steroids preoperatively due to neurological symptoms. None of these lesions required further intervention with median postsurgery follow-up of 24.4 months (range 1-104 months). There were 55 instances (in 51 patients) of confirmed recurrent/progressive tumor who we treated with repeat aggressive radiation with either Cs-131 brachytherapy (12 [21.8%]) or SRS (43 [78.2%]). Among patients treated with reirradiation, the median follow-up to local failure was 15.2 months (95% CI 7.3-26.6 months). The 2-year local control rate was 79.5% (95% CI 68.3%-92.5%).

CONCLUSION:

These results support resection of radiosurgery-treated lesions with progression continuing through serial imaging, and this pathology-informed management results in excellent control of both RN and tumor progression after radiosurgery.
Nasoseptal Flap Enhancement on Early Postoperative MRI Does Not Predict 3-Month Enhancement nor Postoperative Cerebrospinal Fluid Leak Risk
Authors: Pahlevani Mehrdad , Mukhaelyan Artak , Angel Keila , Mallari Regin Jay , Griffiths Chester , Kelly Daniel F. , Barkhoudarian Garni
Published: November 2024

BACKGROUND AND OBJECTIVES:

The nasoseptal flap (NSF) has been a versatile reconstructive option for extended endonasal skull base surgery, significantly decreasing postoperative cerebrospinal fluid (CSF) leakage rates. One failure mechanism of concern is NSF necrosis. It has been postulated that immediate postoperative MRI flap enhancement can predict flap necrosis. This retrospective study analyzes NSF enhancement to assess for flap viability and CSF leakage.

METHODS:

Patients from 2012 to 2020 who underwent extended endoscopic endonasal surgery with NSF reconstruction were assessed. Immediate postoperative MRI and delayed 3-month MRI were compared for NSF enhancement. Enhancement was graded as no enhancement, partial, or complete enhancement. Patient demographics, tumor type, intraoperative CSF leak grade, and postoperative CSF leakage were assessed based on flap enhancement patterns.

RESULTS:

Of 713 patients who underwent endoscopic endonasal surgery, 64 required NSF reconstruction. On the immediate postoperative MRI, 45 patients (70%) had complete flap enhancement, 9 (14%) had partial, and 10 (16%) no enhancement. On the 3-month MRI, 59 patients (92%) had complete flap enhancement and 5 (8%) had partial enhancement. There was significant improvement of flap enhancement between immediate postoperative and 3-month MRI (P = .002). All patients with no initial enhancement had complete enhancement at 3 months. Of those with partial enhancement, 2 remained partial and 7 had complete enhancement at 3 months. Overall, 44 patients (69%) had no change between MRI scans, 17 (27%) improved, and 3 (5%) had decreased enhancement. There was no correlation between intraoperative CSF leak rates and flap enhancement. Four patients had postoperative CSF leaks, 2 having complete immediate enhancement, 1 partial, and 1 without enhancement (P = .85).

CONCLUSION:

Overall, immediate postoperative MRI NSF enhancement (or lack thereof) did not predict enhancement at the 3-month MRI and did not correlate with postoperative CSF leakage. Hence, one should not rely solely on postoperative flap enhancement to assess the viability of the dural reconstruction.
Ανάπτυξη και μελέτη νέων φωτοχημικών οργανικών μετασχηματισμών και εφαρμογές τους
Authors: Κωνσταντίνου Κωνσταντίνος
Published: November 2024

Η Οργανική Φωτοχημεία είναι ένας συναρπαστικός και ταχέως εξελισσόμενος τομέας που συνδυάζει τη μελέτη των χημικών αντιδράσεων που προκαλούνται από το φως με τη σύνθετη συμπεριφορά των οργανικών μορίων. Εμφανίστηκε στις αρχές του 20ου αιώνα, μέσω του έργου του Giacomo Ciamician, αλλά παρέμεινε αναξιοποίητη για σχεδόν έναν αιώνα. Ωστόσο, τα τελευταία δεκαπέντε χρόνια, ο τομέας αυτός έχει γνωρίσει την αναγέννηση, ιδιαίτερα με την εμφάνιση της φωτοοξειδοαναγωγικής κατάλυσης με τη χρήση καταλυτών μετάλλων μετάπτωσης, όπως το ιρίδιο και το ρουθήνιο. Η Φωτοκατάλυση περιλαμβάνει την απορρόφηση φωτός, που οδηγεί στην ενεργοποίηση καταλυτών που διευκολύνουν χημικούς μετασχηματισμούς. Οι διάφορες πηγές φωτός, όπως το ηλιακό φως, οι λαμπτήρες υδραργύρου και οι λαμπτήρες LED, είναι κρίσιμες για αυτές τις αντιδράσεις. Ιδιαίτερα, οι λαμπτήρες LED προσφέρουν σημαντικά πλεονεκτήματα λόγω της ενεργειακής τους απόδοσης και της ικανότητας εκπομπής φωτός σε συγκεκριμένα μήκη κύματος. Σημαντικές εξελίξεις στη Φωτοκατάλυση περιλαμβάνουν τη χρήση μικρών οργανικών μορίων ως φωτοκαταλύτες, τα οποία είναι φιλικά προς το περιβάλλον και οικονομικά αποδοτικά. Αυτά τα μόρια έχουν χρησιμοποιηθεί σε μια σειρά μετασχηματισμών, όπως οι ασύμμετρες α-αλκυλιώσεις, οι [2+2] κυκλοπροσθήκες και οι αντιδράσεις απαλογόνωσης. Επιπλέον, η ανάπτυξη καταλυτικών συστημάτων στη φωτοοξειδοαναγωγική χημεία έχει επιτρέψει τον αποδοτικό σχηματισμό δεσμών άνθρακα-άνθρακα και άνθρακα-ετεροατόμου. Στη διδακτορική αυτή διατριβή, εξετάζονται νέοι φωτοχημικοί μετασχηματισμοί με τη χρήση μικρών οργανικών μορίων ως φωτοκαταλύτες. Ο στόχος είναι η ανάπτυξη πράσινων και βιώσιμων μεθοδολογιών που ελαχιστοποιούν τη χρήση βαρέων μετάλλων και μειώνουν τον περιβαλλοντικό αντίκτυπο. Η έρευνα επικεντρώνεται στην φωτοχημική προσθήκη αμινοαλογονωμένων ενώσεων σε ολεφίνες, την οξείδωση βορονικών οξέων σε αλκοόλες και φαινόλες με τη χρήση μοριακού οξυγόνου και την αξιοποίηση αποβλήτων πολυστυρενίου με τη μετατροπή τους σε βενζοϊκό οξύ.
Formacja chrześcijańska młodzieży w mediach społecznościowych. Studium teologiczno-pastoralne na podstawie badań maturzystów w archidiecezji przemyskiej
Authors: Fląder Maciej
Published: November 2024

The contemporary context of preaching the Gospel requires newer and newer means to make it fully resonate. The technological development of the modern world is changing the character of communication. Communicating becomes easier, information is available at our fingertips, and the society formed in this process is beginning to be called the information society. New means and technological possibilities have provided new opportunities for the spread of revealed truths. In the new culture, the Church can more effectively proclaim the doctrine of salvation and explain its position on contemporary theological issues. It also provides an opportunity to lead dialogue with the world. New technologies are also a great tool for evangelisation, offering Christ to other nations and giving them the opportunity to get to know Him personally. As noted by St. John Paul II, especially young people quickly adapt to the culture of computers and their language, which is why it is their task to use new tools in an increasingly broader and more intense dialogue between people.
Czas żupanów, czas czechmanów. Strój polski w źródłach archeologicznych, ikonograficznych i pisanych
Authors: Grupa Małgorzata
Published: November 2024

The book Czas żupanów czas czechmanów is the result of over 30 years of the author’s work related to, among others, exploring the issues of funeral culture in modern times – archaeological research conducted in churches in Poland, analysis of historic material and its conservation and reconstruction. The comparison of archaeological sources, obtained primarily from crypts and graves under the churches’ floors, with available iconography and previous literature, allowed for a detailed description of previously unknown details of men's clothing on the territory of the Polish-Lithuanian Commonwealth, as well as verification of their dating. As a result of painstaking conservation and reconstruction work, new, unique elements of clothing were identified, i.e. czechmans, also known as żupans. The richly illustrated publication significantly expands the existing knowledge about the male nobility clothing of the Sarmatian period, known as the so-called Polish costume.
Młyny wodne w dolinie Bzury od XIX do XXI wieku
Authors: Jagiełło Daria
Published: November 2024

The book presented for evaluation goes beyond the standards of historical monument narratives, which focus primarily on the analysis of the material of a historical object. The deep embedding of water milling and the cultural landscape in the sphere of non-material heritage – on the level of awareness and felt by the local community – shows that they create mental maps evaluating space and are also the key to the codes of meaning of sentences and words, which translate into the identity bond of these communities. An excerpt from the first review The book has a great cognitive and documentary value. In the course of the conducted research, the author gathered valuable materials on a group of objects that are outside the mainstream of interest to historians, conservators, local governments and investors. Such "invisible" and underestimated heritage disappears irretrievably as a result of gradual changes and many years of neglect. An excerpt from the second review
Spór o panteizm. Droga Spinozy do filozofii i kultury niemieckiej
Authors: Piórczyński Józef
Published: November 2024

Spór, w którym głównymi antagonistami byli Jacobi i Mendelssohn, dotyczył pierwotnie tego, czy Lessing był spinozystą. Usiłowania rozstrzygnięcia tej kwestii prowadziły z natury rzeczy do zasadniczego sporu o filozofię Spinozy. Najpierw dyskusja między Mendelssohnem a Jacobim przebiegała w formie listów i rozpraw przekazywanych sobie nawzajem. Z chwilą publikacji testów Jacobiego „O nauce Spinozy w listach do Pana Mojżesza Mendelssohna” spór staje się publiczny, uruchamiając świadomość i podświadomość niemiecką zakorzenioną w panteizmie i angażując „całe uczone i lubujące się w estetyzmie Niemcy” (M. Grunwald, XIX w.) „Autor próbuje odpowiedzieć na dwa pytania. Po pierwsze, w jaki dokładnie sposób przebiegała recepcja myśli Spinozy w Niemczech w ostatnich dziesięcioleciach XVIII w., po drugie zaś, jaki wpływ miała ona na przemiany filozofii niemieckiej tego okresu. Obie kwestie można bez wahania określić jako fundamentalne dla rozumienia sytuacji, która zaistniała w filozofii niemieckiej u schyłku epoki oświecenia i z której wyrósł idealizm niemiecki – myśl z jednej strony wieńcząca niemieckie oświecenie, z drugiej zaś otwierająca nowe, już ściśle współczesne perspektywy w filozofii. Z uwagi na to, że klasyczna filozofia niemiecka należy do najważniejszych źródeł myśli współczesnej, wartość książki Józefa Piórczyńskiego nie sprowadza się do czysto historycznego sprawozdania z pewnego interesującego epizodu w dziejach myśli niemieckiej XVIII stulecia, lecz polega nadto na dostarczeniu pewnych istotnych wątków pozwalających lepiej zrozumieć szereg faktów, które zaważyły na tym, czym stała się filozofia na przełomie XVIII i XIX w., i które wciąż do pewnego stpnia określają horyzonty współczesnego myślenia. Praca ma zatem również znaczenie stricte filozoficzne” (fragment recenzji wydawniczej).