bluuebunny/crossref_metadata_2025 huggingface dataset:
Health-related quality of life following adolescent sports-related concussion or fracture: a prospective cohort study
Authors: Russell Kelly , Selci Erin , Black Brian , Ellis Michael J.
Published: February 2019

OBJECTIVE

The longitudinal effects of sports-related concussion (SRC) in adolescents on health-related quality of life (HRQOL) remain poorly understood. Hence, the authors established two objectives of this study: 1) compare HRQOL outcomes among adolescents with an acute SRC or a sports-related extremity fracture (SREF) who were followed up until physician-documented clinical recovery; and 2) identify the clinical variables associated with worse HRQOL among adolescent SRC patients.

METHODS

The authors conducted a prospective cohort study of adolescents with acute SRC and those with acute SREF who underwent clinical assessment and follow-up at tertiary subspecialty clinics. Longitudinal patient-reported HRQOL was measured at the time of initial assessment and at each follow-up appointment by using the adolescent version (age 13–18 years) of the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale and Cognitive Functioning Scale.

RESULTS

A total of 135 patients with SRC (60.0% male; mean age 14.7 years; time from injury to initial assessment 6 days) and 96 patients with SREF (59.4% male; mean age 14.1 years; time from injury to initial assessment 8 days) participated in the study. At the initial assessment, the SRC patients demonstrated significantly worse cognitive HRQOL and clinically meaningful impairments in school and overall HRQOL compared to the SREF patients. Clinical variables associated with a worse HRQOL among SRC patients differed by domain but were significantly affected by the patients’ initial symptom burden and the development of delayed physician-documented clinical recovery (> 28 days postinjury). No persistent impairments in HRQOL were observed among SRC patients who were followed up until physician-documented clinical recovery.

CONCLUSIONS

Adolescent SRC is associated with temporary impairments in HRQOL that have been shown to resolve in patients who are followed up until physician-documented clinical recovery. Future studies are needed to identify the clinicopathological features that are associated with impaired HRQOL and to assess whether the initiation of multidisciplinary, targeted rehabilitation strategies would lead to an improvement in HRQOL.
Limitations of patient experience reports to evaluate physician quality in spine surgery: analysis of 7485 surveys
Authors: Agarwal Nitin , Faramand Andrew , Bellon Johanna , Borrebach Jeffrey , Hamilton D. Kojo , Okonkwo David O. , Kanter Adam S.
Published: February 2019

OBJECTIVE

The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) is a standardized patient experience survey that is used to evaluate the quality of care delivered by physicians. The authors sought to determine which factors influenced CG-CAHPS scores for spine surgery, and compare them to their cranial-focused cohorts.

METHODS

A retrospective study of prospectively obtained data was performed to evaluate CG-CAHPS scores. Between May 2013 and May 2017, all patients 18 years of age or older with an outpatient encounter with a neurosurgeon (5 spine-focused neurosurgeons and 20 cranial-focused neurosurgeons) received a CG-CAHPS survey. Three domains were assessed: overall physician rating, likelihood to recommend, and physician communication. Statistical analyses were performed using chi-square tests.

RESULTS

Seven thousand four hundred eighty-five patient surveys (2319 spine and 5166 cranial) were collected from patients presenting to the outpatient offices of an attending neurosurgeon. Analysis of the overall physician rating showed that 81.1% of spine neurosurgeons received a “top-box” score (answers of “yes, definitely”), whereas 86.2% of cranial neurosurgeons received a top-box response (p < 0.001). A similar difference was observed with the domains of “likelihood to recommend” and “physician communication.” Overall physician rating was also significantly influenced by the general and mental health of the patients surveyed (p < 0.001). For spine surgeons seeing patients at more than one facility, the scores with respect to location were also significantly different in all domains for each individual provider (p < 0.001).

CONCLUSIONS

Overall, spine-focused neurosurgeon ratings differed significantly from those of cranial-focused neurosurgical subspecialty providers. Office location also affected provider ratings for spine neurosurgeons. These results suggest that physician ratings obtained via patient experience surveys may be representative of factors aside from just the quality of physician care provided. This information should be considered as payers, government, and health systems design performance programs based on patient experience scores.
Surgical treatment of a thoracic ventral intradural arachnoid cyst associated with syringomyelia: case report
Authors: Haimoto Shoichi , Nishimura Yusuke , Ginsberg Howard J.
Published: February 2019

The pathogenesis of thoracic ventral intradural spinal arachnoid cyst (ISAC) is unknown due to its extremely low incidence. In addition, its surgical treatment is complicated because of the ventral location, large craniocaudal extension, and frequent coexistence of syringomyelia. The optimal surgical strategy for thoracic ventral ISAC remains unclear and continues to be a matter of debate. In this report, the authors describe an extremely rare case presenting with a compressive thoracic ventral ISAC associated with syringomyelia that was successfully treated with a simple cyst-pleural shunt. The patient’s medical history revealed bacterial spinal meningitis along with an extensive spinal epidural abscess, suggesting the incidence of extensive adhesive arachnoiditis (AA) to be a plausible cause for this pathology. Thoracic ventral ISAC reportedly occurs secondary to AA and is commonly associated with syringomyelia. Placement of a cyst-pleural shunt is an effective, safe, and uncomplicated surgical strategy, which can provide sufficient cyst drainage regardless of the coexistence of AA, and thus should be considered as primary surgical treatment. Syrinx drainage could be reserved for a later attempt in case the cyst-pleural shunt fails to reduce the extent of syringomyelia.
A comprehensive biomechanical analysis of sacral alar iliac fixation: an in vitro human cadaveric model
Authors: Cunningham Bryan W. , Sponseller Paul D. , Murgatroyd Ashley A. , Kikkawa Jun , Tortolani P. Justin
Published: February 2019

OBJECTIVE

The objective of the current study was to quantify and compare the multidirectional flexibility properties of sacral alar iliac fixation with conventional methods of sacral and sacroiliac fixation by using nondestructive and destructive investigative methods.

METHODS

Twenty-one cadaveric lumbopelvic spines were randomized into 3 groups based on reconstruction conditions: 1) S1–2 sacral screws; 2) sacral alar iliac screws; and 3) S1–iliac screws tested under unilateral and bilateral fixation. Nondestructive multidirectional flexibility testing was performed using a 6-degree-of-freedom spine simulator with moments of ± 12.5 Nm. Flexion-extension fatigue loading was then performed for 10,000 cycles, and the multidirectional flexibility analysis was repeated. Final destructive testing included an anterior flexural load to construct failure. Quantification of the lumbosacral and sacroiliac joint range of motion was normalized to the intact spine (100%), and flexural failure loads were reported in Newton-meters.

RESULTS

Normalized value comparisons between the intact spine and the 3 reconstruction groups demonstrated significant reductions in segmental flexion-extension, lateral bending, and axial rotation motion at L4–5 and L5–S1 (p < 0.05). The S1–2 sacral reconstruction group demonstrated significantly greater flexion-extension motion at the sacroiliac junction than the intact and comparative reconstruction groups (p < 0.05), whereas the sacral alar iliac group demonstrated significantly less motion at the sacroiliac joint in axial rotation (p < 0.05). Absolute value comparisons demonstrated similar findings. Under destructive anterior flexural loading, the S1–2 sacral group failed at 105 ± 23 Nm, and the sacral alar iliac and S1–iliac groups failed at 119 ± 39 Nm and 120 ± 28 Nm, respectively (p > 0.05).

CONCLUSIONS

Along with difficult anatomy and weak bone, the large lumbosacral loads with cantilever pullout forces in this region are primary reasons for construct failure. All reconstructions significantly reduced flexibility at the L5–S1 junctions, as expected. Conventional S1–2 sacral fixation significantly increased sacroiliac motion under all loading modalities and demonstrated significantly higher flexion-extension motion than all other groups, and sacral alar iliac fixation reduced motion in axial rotation at the sacroiliac joint. Based on comprehensive multidirectional flexibility testing, the sacral alar iliac fixation technique reduced segmental motion under some loading modalities compared to S1–iliac screws and offers potential advantages of lower instrumentation profile and ease of assembly compared to conventional sacroiliac instrumentation techniques.
Repeated recurrence of thoracic spine stenosis following decompression alone for ossification of the ligamentum flavum: case report
Authors: Barath Abhijeet S. , Wu Osmond C. , Patel Mohit , Kasliwal Manish K.
Published: February 2019

Ossification of the ligamentum flavum (OLF) is a well-recognized but rare cause of thoracic myelopathy. Its subtle and variable clinical presentation often makes the diagnosis challenging. The treatment of symptomatic OLF requires surgical intervention, with the most common surgical procedure being a posterior decompression with or without instrumentation. Recurrence of ossification and stenosis after surgery is rare and usually occurs at the same intervertebral level. Multiple recurrences of ossification and stenosis are exceptionally rare. The authors report the case of OLF in a 60-year-old man who experienced recurrence of ossification and stenosis twice after posterior decompression surgeries alone. The patient was ultimately treated with revision decompression and instrumented fusion. The authors also present a pertinent review of the literature.
Two-year mortality and functional outcomes in combat-related penetrating brain injury: battlefield through rehabilitation
Authors: Larkin M. Benjamin , Graves Erin K. M. , Boulter Jason H. , Szuflita Nicholas S. , Meyer R. Michael , Porambo Michael E. , Delaney John J. , Bell Randy S.
Published: February 2019

OBJECTIVE

There are limited data concerning the long-term functional outcomes of patients with penetrating brain injury. Reports from civilian cohorts are small because of the high reported mortality rates (as high as 90%). Data from military populations suggest a better prognosis for penetrating brain injury, but previous reports are hampered by analyses that exclude the point of injury. The purpose of this study was to provide a description of the long-term functional outcomes of those who sustain a combat-related penetrating brain injury (from the initial point of injury to 24 months afterward).

METHODS

This study is a retrospective review of cases of penetrating brain injury in patients who presented to the Role 3 Multinational Medical Unit at Kandahar Airfield, Afghanistan, from January 2010 to March 2013. The primary outcome of interest was Glasgow Outcome Scale (GOS) score at 6, 12, and 24 months from date of injury.

RESULTS

A total of 908 cases required neurosurgical consultation during the study period, and 80 of these cases involved US service members with penetrating brain injury. The mean admission Glasgow Coma Scale (GCS) score was 8.5 (SD 5.56), and the mean admission Injury Severity Score (ISS) was 26.6 (SD 10.2). The GOS score for the cohort trended toward improvement at each time point (3.6 at 6 months, 3.96 at 24 months, p > 0.05). In subgroup analysis, admission GCS score ≤ 5, gunshot wound as the injury mechanism, admission ISS ≥ 26, and brain herniation on admission CT head were all associated with worse GOS scores at all time points. Excluding those who died, functional improvement occurred regardless of admission GCS score (p < 0.05). The overall mortality rate for the cohort was 21%.

CONCLUSIONS

Good functional outcomes were achieved in this population of severe penetrating brain injury in those who survived their initial resuscitation. The mortality rate was lower than observed in civilian cohorts.
In vitro and in vivo testing of a novel local nicardipine delivery system to the brain: a preclinical study
Authors: Bayerl Simon H. , Ghori Adnan , Nieminen-Kelhä Melina , Adage Tiziana , Breitenbach Jörg , Vajkoczy Peter , Prinz Vincent
Published: February 2019

OBJECTIVE

The management of patients with aneurysmal subarachnoid hemorrhage (aSAH) remains a highly demanding challenge in critical care medicine. Despite all efforts, the calcium channel antagonist nimodipine remains the only drug approved for improving outcomes after aSAH. However, in its current form of application, it provides less than optimal efficacy and causes dose-limiting hypotension in a substantial number of patients. Here, the authors tested in vitro the release dynamics of a novel formulation of the calcium channel blocker nicardipine and in vivo local tolerance and tissue reaction using a chronic cranial window model in mice.

METHODS

To characterize the release kinetics in vitro, dissolution experiments were performed using artificial cerebrospinal fluid over a time period of 21 days. The excipients used in this formulation (NicaPlant) for sustained nicardipine release are a mixture of two completely degradable polymers. A chronic cranial window in C57BL/6 mice was prepared, and NicaPlant slices were placed in proximity to the exposed cerebral vasculature. Epifluorescence video microscopy was performed right after implantation and on days 3 and 7 after surgery. Vessel diameter of the arteries and veins, vessel permeability, vessel configuration, and leukocyte–endothelial cell interaction were quantified by computer-assisted analysis. Immunofluorescence staining was performed to analyze inflammatory reactions and neuronal alterations.

RESULTS

In vitro the nicardipine release profile showed an almost linear curve with about 80% release at day 15 and full release at day 21. In vivo epifluorescence video microscopy showed a significantly higher arterial vessel diameter in the NicaPlant group due to vessel dilatation (21.6 ± 2.6 µm vs 17.8 ± 1.5 µm in controls, p < 0.01) confirming vasoactivity of the implant, whereas the venous diameter was not affected. Vessel dilatation did not have any influence on the vessel permeability measured by contrast extravasation of the fluorescent dye in epifluorescence microscopy. Further, an increased leukocyte–endothelial cell interaction due to the implant could not be detected. Histological analysis did not show any microglial activation or accumulation. No structural neuronal changes were observed.

CONCLUSIONS

NicaPlant provides continuous in vitro release of nicardipine over a 3-week observation period. In vivo testing confirmed vasoactivity and lack of toxicity. The local application of this novel nicardipine delivery system to the subarachnoid space is a promising tool to improve patient outcomes while avoiding systemic side effects.
Rupture risk of small unruptured cerebral aneurysms
Authors: Ikawa Fusao , Morita Akio , Tominari Shinjiro , Nakayama Takeo , Shiokawa Yoshiaki , Date Isao , Nozaki Kazuhiko , Miyamoto Susumu , Kayama Takamasa , Arai Hajime , _ _
Published: February 2019

OBJECTIVE

The annual rupture rate of small (3–4 mm) unruptured cerebral aneurysms (UCAs) is 0.36% per year, however, the proportion of small ruptured aneurysms < 5 mm is 35%. This discrepancy is explained by the hypothesis that most acute subarachnoid hemorrhage (SAH) is from recently formed, unscreened aneurysms, but this hypothesis is without definitive proof. The authors aimed to clarify the actual number of screened, ruptured small aneurysms and risk factors for rupture.

METHODS

The Unruptured Cerebral Aneurysm Study Japan, a project of the Japan Neurosurgical Society, was designed to clarify the natural course of UCAs. From January 2001 through March 2004, 6697 UCAs among 5720 patients were prospectively registered. At registration, 2839 patients (49.6%) had 3132 (46.8%) small UCAs of 3–4 mm. The registered, treated, and rupture numbers of these small aneurysms and the annual rupture rate were investigated. The rate was assessed per aneurysm. The characteristics of patients and aneurysms were compared to those of larger unruptured aneurysms (≥ 5 mm). Cumulative rates of SAH were estimated per aneurysm. Risk factors underwent univariate and multivariate analysis.

RESULTS

Treatment and rupture numbers of small UCAs were 1132 (37.1% of all treated aneurysms) and 23 (20.7% of all ruptured aneurysms), respectively. The registered, treated, rupture number, and annual rupture rates were 1658 (24.8%), 495 (16.2%), 11 (9.9%), and 0.30%, respectively, among 3-mm aneurysms, and 1474 (22.0%), 637 (20.9%), 12 (10.8%), and 0.45%, respectively, among 4-mm aneurysms. Multivariate risk-factor analysis revealed that a screening brain checkup (hazard ratio [HR] 4.1, 95% confidence interval [CI] 1.2–14.4), history of SAH (HR 10.8, 95% CI 2.3–51.1), uncontrolled hypertension (HR 5.2, 95% CI 1.8–15.3), and location on the anterior communicating artery (ACoA; HR 5.0, 95% CI 1.6–15.5) were independent predictors of rupture.

CONCLUSIONS

Although the annual rupture rate of small aneurysms was low, the actual number of ruptures was not low. Small aneurysms that ruptured during follow-up could be detected, screened, and managed based on each risk factor. Possible selection criteria for treating small UCAs include a history of SAH, uncontrolled hypertension, location on the ACoA, and young patients. Further large prospective and longitudinal trials are needed.

Clinical trial registration no.: C000000418 (https://www.umin.ac.jp/ctr)
Blood-brain barrier disruption in humans using an implantable ultrasound device: quantification with MR images and correlation with local acoustic pressure
Authors: Asquier Nicolas , Bouchoux Guillaume , Canney Michael , Martin Cyril , Law-Ye Bruno , Leclercq Delphine , Chapelon Jean-Yves , Lafon Cyril , Idbaih Ahmed , Carpentier Alexandre
Published: February 2019

OBJECTIVE

One of the goals in this study was to set up a semiautomatic method to estimate blood-brain barrier disruption obtained in patients with glioblastoma by using an implantable, unfocused, ultrasound device. Another goal was to correlate the probability of significant ultrasound-induced signal enhancement (SUISE) with local acoustic pressure in the brain.

METHODS

Gd-enhanced MR images acquired before and after ultrasound treatments were analyzed prospectively. The image sets were segmented, normalized, and coregistered to evaluate contrast enhancement. The volume of SUISE was calculated with voxels labeled as gray or white matter, in a cylindrical region of interest, and with enhancement above a given threshold. To validate the method, the resulting volumes of SUISE were compared to qualitative grades previously assigned by 3 clinicians for 40 ultrasound treatments in 15 patients. A parametric study was performed to optimize the algorithm prediction of the qualitative grades. The 3D acoustic field in the brain was estimated from measurements in water combined with simulations accounting for ultrasound attenuation in brain and overlaid on each MR image to correlate local acoustic pressure with the probability of SUISE (defined as enhancement > 10%).

RESULTS

The algorithm predicted grade 2 or 3 and grade 3 openings with areas under the receiver operating characteristic curve of 0.831 and 0.995, respectively. The probability of SUISE was correlated with local acoustic pressure (R2 = 0.98) and was 3.33 times higher for gray matter than for white matter.

CONCLUSIONS

An algorithm for evaluating blood-brain barrier disruption was validated and can be used for future clinical trials to further understand and quantify this technique in humans.

Clinical trial registration no.: NCT02253212 (clinicaltrials.gov)
Efficacy of antiseizure prophylaxis in chronic subdural hematoma: a cohort study on routinely collected health data
Authors: Lavergne Pascal , Labidi Moujahed , Brunet Marie-Christine , Lessard Bonaventure Paule , Zetchi Akli , Carrondo Cottin Sylvine , Simonyan David , Turmel André
Published: February 2019

OBJECTIVE

Chronic subdural hematoma (CSDH) is a common neurosurgical condition that can result in significant morbidity. The incidence of epileptic events associated with CSDH reported in the literature varies considerably and could potentially increase morbidity and mortality rates. The effectiveness of antiepileptic prophylaxis for this indication remains unclear. The primary objective of this study was to assess the relevance of anticonvulsant prophylaxis in reducing seizure events in patients with CSDH.

METHODS

All consecutive cases of CSDH from January 1, 2005, to May 30, 2014, at the Hôpital de l’Enfant-Jésus in Quebec City were retrospectively reviewed. Sociodemographic data, antiepileptic prophylaxis use, incidence of ictal events, and clinical and radiological outcome data were collected. Univariate analyses were done to measure the effect of antiepileptic prophylaxis on ictal events and to identify potential confounding factors. Multivariate logistic regression was performed to evaluate factors associated with epileptic events.

RESULTS

Antiepileptic prophylaxis was administered in 28% of the patients, and seizures occurred in 11%. Univariate analyses showed an increase in the incidence of ictal events in patients receiving prophylaxis (OR 5.92). Four factors were identified as being associated with seizures: septations inside the hematoma, membranectomy, antiepileptic prophylaxis, and a new deficit postoperatively. Antiepileptic prophylaxis was not associated with seizures in multivariate analyses.

CONCLUSIONS

Antiepileptic prophylaxis does not seem to be effective in preventing seizures in patients with CSDH. However, due to the design of this study, it is difficult to conclude definitively about the usefulness of this prophylactic therapy that is widely prescribed for this condition.
Change in the angle of the anterior genu is associated with occlusion rate after Pipeline flow diversion
Authors: Awad Al-Wala , Kilburg Craig , Karsy Michael , Couldwell William T. , Taussky Philipp
Published: February 2019

OBJECTIVE

The Pipeline embolization device (PED) is a self-expanding mesh stent that diverts blood flow away from an aneurysm; it has been successfully used to treat aneurysms of the proximal internal carotid artery (ICA). PEDs have a remarkable ability to alter regional blood flow along the tortuous segments of the ICA and were incidentally found to alter the angle of the anterior genu after treatment. The authors quantified these changes and explored their implications as they relate to treatment effect.

METHODS

The authors retrospectively reviewed cases of aneurysms treated with a PED between the ophthalmic and posterior communicating arteries from 2012 through 2015. The angles of the anterior genu were measured on the lateral projections of cerebral angiograms obtained before and after treatment with a PED. The angles of the anterior genu of patients without aneurysms were used as normal controls.

RESULTS

Thirty-eight patients were identified who had been treated with a PED; 34 (89.5%) had complete obliteration and 4 (10.5%) had persistence of their aneurysm at last follow-up (mean 11.3 months). After treatment, 32 patients had an increase, 3 had a decrease, and 3 had no change in the angle of the anterior genu. The average measured angle of the anterior genu was 36.7° before treatment and 44.3° after treatment (p < 0.0001). The average angle of the anterior genu of control patients was 43.32° (vs 36.7° for the preoperative angle in the patients with aneurysms, p < 0.057). The average change in the angle of patients with postoperative Raymond scores of 1 was 9.10°, as compared with 1.25° in patients with postoperative Raymond scores > 1 (p < 0.001).

CONCLUSIONS

Treatment with a PED significantly changes the angle of the anterior genu. An average change of 9.1° was associated with complete obliteration of treated aneurysms. These findings have important implications for the treatment and management of cerebral aneurysm.
Low rates of complications after spinopelvic fixation with iliac screws in 260 adult patients with a minimum 2-year follow-up
Authors: Nguyen James H. , Buell Thomas J. , Wang Tony R. , Mullin Jeffrey P. , Mazur Marcus D. , Garces Juanita , Taylor Davis G. , Yen Chun-Po , Shaffrey Christopher I. , Smith Justin S.
Published: February 2019

OBJECTIVE

Recent literature describing complications associated with spinopelvic fixation with iliac screws in adult patients has been limited but has suggested high complication rates. The authors’ objective was to report their experience with iliac screw fixation in a large series of patients with a 2-year minimum follow-up.

METHODS

Of 327 adult patients undergoing spinopelvic fixation with iliac screws at the authors’ institution between 2010 and 2015, 260 met the study inclusion criteria (age ≥ 18 years, first-time iliac screw placement, and 2-year minimum follow-up). Patients with active spinal infection were excluded. All iliac screws were placed via a posterior midline approach using fluoroscopic guidance. Iliac screw heads were deeply recessed into the posterior superior iliac spine. Clinical and radiographic data were obtained and analyzed.

RESULTS

Twenty patients (7.7%) had iliac screw–related complication, which included fracture (12, 4.6%) and/or screw loosening (9, 3.5%). No patients had iliac screw head prominence that required revision surgery or resulted in pain, wound dehiscence, or poor cosmesis. Eleven patients (4.2%) had rod or connector fracture below S1. Overall, 23 patients (8.8%) had L5–S1 pseudarthrosis. Four patients (1.5%) had fracture of the S1 screw. Seven patients (2.7%) had wound dehiscence (unrelated to the iliac screw head) or infection. The rate of reoperation (excluding proximal junctional kyphosis) was 17.7%. On univariate analysis, an iliac screw–related complication rate was significantly associated with revision fusion (70.0% vs 41.2%, p = 0.013), a greater number of instrumented vertebrae (mean 12.6 vs 10.3, p = 0.014), and greater postoperative pelvic tilt (mean 27.7° vs 23.2°, p = 0.04). Lumbosacral junction–related complications were associated with a greater mean number of instrumented vertebrae (12.6 vs 10.3, p = 0.014). Reoperation was associated with a younger mean age at surgery (61.8 vs 65.8 years, p = 0.014), a greater mean number of instrumented vertebrae (12.2 vs 10.2, p = 0.001), and longer clinical and radiological mean follow-up duration (55.8 vs 44.5 months, p < 0.001; 55.8 vs 44.6 months, p < 0.001, respectively). On multivariate analysis, reoperation was associated with longer clinical follow-up (p < 0.001).

CONCLUSIONS

Previous studies on iliac screw fixation have reported very high rates of complications and reoperation (as high as 53.6%). In this large, single-center series of adult patients, iliac screws were an effective method of spinopelvic fixation that had high rates of lumbosacral fusion and far lower complication rates than previously reported. Collectively, these findings argue that iliac screw fixation should remain a favored technique for spinopelvic fixation.
PROMIS Physical Function for prediction of postoperative pain, narcotics consumption, and patient-reported outcomes following minimally invasive transforaminal lumbar interbody fusion
Authors: Patel Dil V. , Bawa Mundeep S. , Haws Brittany E. , Khechen Benjamin , Block Andrew M. , Karmarkar Sailee S. , Lamoutte Eric H. , Singh Kern
Published: February 2019

OBJECTIVE

This study aimed to determine if the preoperative Patient-Reported Outcomes Measurement Information System, Physical Function (PROMIS PF) score is predictive of immediate postoperative patient pain and narcotics consumption or long-term patient-reported outcomes (PROs) following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

METHODS

A prospectively maintained database was retrospectively reviewed. Patients who underwent primary, single-level MIS TLIF for degenerative pathology were identified and grouped by their preoperative PROMIS PF scores: mild disability (score 40–50), moderate disability (score 30–39.9), and severe disability (score 20–29.9). Postoperative pain was quantified using the visual analog scale (VAS), and narcotics consumption was quantified using Oral Morphine Equivalents. PROMIS PF, Oswestry Disability Index (ODI), 12-Item Short-Form Health Survey, Physical Component Summary (SF-12 PCS), and VAS back and leg pain were collected preoperatively and at 6-week, 3-month, 6-month, and 12-month follow-up. Preoperative PROMIS PF subgroups were tested for an association with demographic and perioperative characteristics using 1-way ANOVA or chi-square analysis. Preoperative PROMIS PF subgroups were tested for an association with immediate postoperative pain and narcotics consumption in addition to improvements in PROMIS PF, ODI, SF-12 PCS, and VAS back and leg pain by using linear regression controlling for statistically different demographic characteristics.

RESULTS

A total of 130 patients were included in this analysis. Patients were grouped by their preoperative PROMIS PF scores: 15.4% had mild disability, 63.8% had moderate disability, and 20.8% had severe disability. There were no significant differences among the subgroups in terms of age, sex, smoking status, and comorbidity burden. Patients with greater disability were more likely to be obese and to have workers’ compensation insurance. There were no differences among subgroups in regard to operative levels, operative time, estimated blood loss, and hospital length of stay. Patients with greater disability reported higher VAS pain scores and narcotics consumption for postoperative day 0 and postoperative day 1. Patients with greater preoperative disability demonstrated lower PROMIS PF, ODI, SF-12 PCS, and worse VAS pain scores at each postoperative time point.

CONCLUSIONS

Patients with worse preoperative disability, as assessed by PROMIS PF, experienced increased pain and narcotics consumption, along with less improvement in long-term PROs. The authors conclude that PROMIS PF is an efficient and accurate instrument that can quickly assess patient disability in the preoperative period and predict both short-term and long-term surgical outcomes.
Transvenous embolization of thalamic arteriovenous malformation under transient cardiac standstill
Authors: Rangel-Castilla Leonardo , Shallwani Hussain , Siddiqui Adnan H.
Published: February 2019

Transvenous embolization (TE) has been increasingly applied for arteriovenous malformation (AVM) treatment. Transient cardiac standstill (TCS) has been described in cerebrovascular surgery but is uncommon for endovascular embolization. The authors present a patient with a ruptured thalamic AVM in whom both techniques were applied simultaneously. Surgery was considered, but the patient refused. Transarterial embolization was performed with an incomplete result. The deep-seated draining vein provided sole access to the AVM. A microcatheter was advanced into the draining vein. Under TCS, achieved with rapid ventricular pacing, complete AVM embolization was obtained. One-year magnetic resonance imaging and cerebral angiography demonstrated no residual AVM.

The video can be found here: https://youtu.be/CAzb9md_xBU.
Stent-assisted coil embolization of MCA aneurysm via a trans-posterior communicating artery access
Authors: Joshi Krishna C. , Heiferman Daniel M. , Beer-Furlan André , Lopes Demetrius K.
Published: February 2019

External carotid artery (ECA) to internal carotid artery (ICA) bypass is a well-established procedure for the treatment of chronic ischemic diseases of the carotid artery. Rarely de novo aneurysms can develop at the site of anastomosis. The treatment of these aneurysms can be very challenging due to various factors, including the presence of graft, previous craniotomy, atherosclerotic vessels, and lack of direct access. In this video the authors report and discuss the management of a right middle cerebral artery (MCA) wide-necked de novo aneurysm by stent-assisted coiling through a retrograde trans-posterior communicating artery access.

The video can be found here: https://youtu.be/MBKolPvOErU.
CTA-guided outflow-targeted embolization of direct carotid-cavernous fistula
Authors: Liao Chih-Hsiang , Chen Wen-Hsien , Liao Nien-Chen , Tsuei Yuang-Seng
Published: February 2019

This video presents a case of new-onset visual blurring, diplopia, and conjunctival injection after head injury. CTA of the brain revealed a direct carotid-cavernous fistula (dCCF) of the right side. Careful evaluation of CTA source images revealed that the fistula point was at the ventromedial aspect of the right cavernous internal carotid artery (ICA), about 3.6 × 3.6 mm2 in size, with 3 main outflow channels (2 intracranial and 1 extracranial) (CTA-guided concept). DSA of the brain also confirmed the diagnosis but was unable to locate the fistula point in a large-sized dCCF. Through a transfemoral artery approach, 3 microcatheters were navigated to each peripheral channel to initiate outflow-targeted embolization. Intracranial refluxes were blocked first to avoid cerebral hemorrhages, followed by the extracranial outflow. During embolization, accidental dislodge of one coil into the sphenoparietal vein occurred, but no attempt of coil retrieval was made. Complete obliteration of the dCCF was achieved, and the patient recovered well without new neurological deficits. 4D MRA at the 3-month follow-up showed no residual dCCF.

The video can be found here: https://youtu.be/LH2lNVRZSPk.
Transarterial embolization of an internal maxillary artery arteriovenous fistula presenting with pulsatile tinnitus
Authors: Brinjikji Waleed , Cloft Harry J. , Lanzino Giuseppe , Rangel-Castilla Leonardo , Morris Pearse P.
Published: February 2019

Arteriovenous fistulae of the internal maxillary artery are exceedingly rare, with less than 30 cases reported in the literature. Most of these lesions are congenital, iatrogenic, or posttraumatic. The most common presentation of internal maxillary artery fistulae is pulsatile tinnitus and headache. Because these lesions are single-hole fistulae, they can be easily cured with endovascular techniques. The authors present a case of a patient who presented to their institution with a several-year history of pulsatile tinnitus who was found to have an internal maxillary artery arteriovenous fistula, which was treated endovascularly with transarterial coil and Onyx embolization.

The video can be found here: https://youtu.be/fDZVMMwpwRc.
Combined reconstructive and deconstructive endovascular approach for bilateral vertebral artery dissection with subarachnoid hemorrhage
Authors: Cherian Jacob , Madaelil Thomas P. , Tong Frank , Howard Brian M. , Cawley C. Michael , Grossberg Jonathan A.
Published: February 2019

The video highlights a challenging case of bilateral vertebral artery dissection presenting with subarachnoid hemorrhage. The patient was found to have a critical flow-limiting stenosis in his dominant right vertebral artery and a ruptured pseudoaneurysm in his left vertebral artery. A single-stage endovascular treatment with stent reconstruction of the right vertebral artery and coil embolization sacrifice of the left side was performed. The case highlights the rationale for treatment and potential alternative strategies.

The video can be found here: https://youtu.be/e0U_JE2jISw.
Introduction: Endovascular Neurosurgery
Authors: Levy Elad I. , Munich Stephan A. , Rosenwasser Robert H. , Kan Peter , Thompson B. Gregory
Published: February 2019

Remarkable developments in the field of endovascular neurosurgery have been witnessed in the last decade. The success of endovascular therapy for ischemic stroke treatment is now irrefutable, making it an accepted standard of care. Endovascular treatment of cerebral aneurysms is no longer limited to primary coiling but now includes options such as stent or balloon assistance and flow diversion and applications utilizing neck reconstruction, intrasaccular, and bifurcation-specific devices. Balloons, liquid embolic agents, and flow-directed catheters have revolutionized the treatment of arteriovenous malformations and fistulae. The ongoing development of endovascular tools has led to novel and expanding approaches (for example, transvenous arteriovenous malformation embolization and transradial access). With improved technology, transposterior communicating artery access and other endovascular strategies are being applied successfully across the anterior and posterior circulations and to lesions once deemed only surgically approachable. Yet, we would be remiss to attribute the successes of endovascular strategies only to the development of their tools. Improvements in both noninvasive and angiographic imaging (such as three-dimensional road map guidance) have provided a greater understanding of pathologic entities and allowed the pursuit of endovascular cures.

In this issue of Neurosurgical Focus, we present a wide range of endovascular strategies for a variety of neurovascular pathologies. We hope this video supplement will not only demonstrate the applicability of tried-and-true endovascular strategies to difficult clinical situations but also highlight new and developing endovascular technologies. We thank the authors for their outstanding contributions.
Weight Gain of Seaweed Kappaphycus alvarezii (Rhodophyta, Solierisceae) and Sargassum polycystum (Paeophyta, Sargassaceae) Mix Cultured at Different Planting Distances
Authors: Syamsuddin Rajuddin , Bohari Ridwan , NA aparuddin
Published: February 2019

This study was conducted to analyze the weight of Kappaphycus alvarezzi and Sargassum polycystum mixcultured at different planting distances. Statistical analyses showed that planting distance was significantly influence the growth of K.alvarezzi and S. polycystum. Difference in weight gain between both species be due to the difference in their morphology which affect water motion and nutrient uptake. Higher weight gain of S. polycycstum was obtained at wider planting distance (35 cm). High , and at 30 cm for K.alvarezii. K.alvarezii was more susceptible to competition for the environmental factors compared to S. polycycstum. Higher weight gain of K.alvarezii obtained in this mix-culture with S.polycystum compared to the K.alvarezii which was singly cultured by previously several workers.
Prevenção da Mucosite Oral em Pacientes submetidos à Quimioterapia
Authors: Valduga Francielli , Oltramari Elenusa , Lemes Letícia Tainá de Oliveira , Mattos Carlos Eduardo de , Stefenon Letícia , Mozzini Carolina Barreto
Published: February 2019

Introdução: A quimioterapia é uma das formas de tratar o câncer, na qual utilizam-se drogas como o 5-fluorouracil (5-FU), maior causador da mucosite oral. Essa complicação é a causa mais comum de dor. Objetivo: Avaliar o grau de mucosite oral durante os dez dias após cada ciclo de quimioterapia, segundo a autopercepção de cada paciente e o nível de dor relatada com o uso das duas substâncias estudo: chá de malva e clorexidina 0,12%. Método: Os pacientes foram randomizados por sorteio para a realização de bochechos com 10 ml da substância determinada, três vezes ao dia, durante o período de infusão da quimioterapia. Em cada ciclo, utilizou-se uma das substâncias. Durante os dez dias após a quimioterapia, os pacientes responderam a um questionário com perguntas fechadas sobre a sua dor e a autopercepção da sua mucosa oral. Resultados: Nos ciclos utilizando o chá de malva, a autopercepção do paciente pareceu ser melhor, com sua mucosite oral sendo de graus 1 e 2. Contudo, nos ciclos utilizando clorexidina 0,12%, os pacientes apresentaram menos dor. Conclusão: Tanto nos ciclos em que foi utilizado a clorexidina 0,12% quanto naqueles onde foi utilizado o chá de malva, a maioria dos pacientes referiu apresentar mucosite oral. Porém, quando utilizado o chá de malva, a frequência de mucosite foi em menores graus. A clorexidina 0,12% pareceu apresentar menos sintomatologia dolorosa, apesar da diferença, comparando as duas substâncias, ter sido pequena.
Estado Nutricional de Idosos Oncológicos por meio de Diferentes Métodos
Authors: Oliveira Lucivalda Pereira Magalhães , Anunciação Taise Andrade da , Costa Maria Lúcia Varjão da
Published: February 2019

Introdução: O estado nutricional e a localização do tumor são essenciais na avaliação do idoso com câncer, pois relacionam-se com morbimortalidade e impactam diretamente na sobrevida. Objetivo: Avaliar o estado nutricional segundo a mini avaliação nutricional, índice de massa corporal e circunferência da panturrilha, identificar o grau de concordância entre esses parâmetros e verificar a associação entre o estado nutricional e os diferentes tipos de câncer. Método: Estudo transversal, com pacientes idosos oncológicos internados em um hospital de referência em Salvador, Bahia. Na coleta dos dados, utilizou-se a mini avaliação nutricional (versão reduzida), questionário estruturado para coleta de dados clínicos e perfil sociodemográfico, e antropométricos. Realizaram-se análise descritiva, teste de qui--quadrado (x²) e teste Kappa. Resultados: Observou-se que 41%, 54,3% e 74,3% dos pacientes apresentavam estado nutricional adequado segundo a mini avaliação nutricional, índice de massa corporal e circunferência da panturrilha, respectivamente, com uma concordância moderada (Kappa=0,59) entre índice de massa corporal e mini avaliação nutricional. Os maiores comprometimentos do estado nutricional foram observados nos pacientes com diagnóstico de câncer de cabeça e pescoço. Conclusão: Neste estudo, a mini avaliação nutricional foi mais sensível para identificar inadequação no estado nutricional quando comparada com o índice de massa corporal e circunferência da panturrilha; observou-se ainda associação entre o estado nutricional e a localização do tumor. Provavelmente, os parâmetros subjetivos da mini avaliação nutricional justificam o diagnóstico de desnutrição mais precoce, favorecendo a intervenção nutricional.
Câncer de Pulmão em Indivíduos não Fumantes: Padrões Epidemiológicos, Clínicos e de Sobrevida baseados no Gênero
Authors: Zamboni Mauro Musa , Monteiro Andreia Salarini , Siqueira Alessandra de Sá Earp , Duarte Ricardo Luiz de Menezes
Published: February 2019

Introdução: O tabagismo é o fator de risco predominante para o desenvolvimento do câncer de pulmão (CP). Contudo, um aumento recente de CP em não fumantes é proeminente em alguns países. Objetivo: O objetivo deste estudo foi verificar as características epidemiológicas e de sobrevida em não fumantes com CP. Método: Coorte histórica de não fumantes com CP diagnosticados de 2000 a 2009. A sobrevivência global foi comparada usando o teste Log-rank e a análise de regressão de Cox foi usada para identificar fatores prognósticos independentes. Resultados: Um total de 254 pacientes com LC não fumantes foram estudados (mediana de idade: 65,5 anos, 66,5% de mulheres). O tipo histológico mais comum foi o adenocarcinoma (65,7% nas mulheres e 60,0% nos homens) e a maioria tinha estadiamento avançado (III-IV) (79,6% nas mulheres e 92,8% nos homens). Um total de 9,9% dos pacientes foi tratado com cirurgia (13,1% em mulheres e 3,6% em homens). As taxas de sobrevida global de 1, 3 e 5 anos foram, respectivamente: 37,2%, 14,2% e 9,5%. A sobrevida global mediana foi de 8,3 meses. As mulheres tiveram melhor sobrevida do que os homens (9,6 vs. 6,9 meses, p=0,023). O tratamento não cirúrgico (p<0,001), o performance status 2-4 (p=0,038) e os estádios III-IV (p<0,001) foram associados com uma sobrevida global pior. Conclusão: Encontrou-se uma maior ocorrência de adenocarcinoma, estadiamento avançado e tratamento não cirúrgico. As mulheres tiveram uma sobrevida maior do que os homens. Em razão da baixa sobrevida global, esses dados reforçam a importância do diagnóstico precoce do CP em não fumantes.
Aspectos Fonoaudiológicos em Pacientes Diagnosticados com Meningioma antes e após o Tratamento Cirúrgico
Authors: Costa Caroline Sousa , Scarpel Renata D’Arc , Jesus Ana Terra Brito de
Published: February 2019

Introdução: Os meningiomas estão entre as neoplasias intracranianas primárias mais frequentes e, entre as deficiências neurológicas causadas, estão as alterações fonoaudiológicas, principalmente os déficits de deglutição e comunicação. Com isso, estudos que identifiquem precocemente as alterações fonoaudiológicas são necessários para uma adequada intervenção terapêutica. Este estudo tem como objetivo descrever os aspectos fonoaudiológicos em pacientes diagnosticados com  meningioma antes e após o tratamento cirúrgico. Relato dos casos: Participaram da pesquisa seis indivíduos diagnosticados com meningioma internados em um hospital geral de Salvador - BA. Os participantes foram submetidos à avaliação fonoaudiológica antes e após a ressecção do tumor, com aplicação do Protocolo de avaliação clínica fonoaudiológica à beira leito. No momento pré-cirúrgico, as alterações fonoaudiológicas ocorreram em um número pequeno de casos, estando relacionadas principalmente a déficits leves de motricidade orofacial e disfagia de leve a moderada. Já no período pós-operatório, as alterações fonoaudiológicas foram frequentes, principalmente quanto à deglutição, com involução da Escala funcional de ingestão por via oral e necessidade de terapia fonoaudiológica em todos os casos. Conclusão: Conclui-se que o meningioma pode acarretar diferentes alterações fonoaudiológicas, principalmente quanto à deglutição, sendo mais frequente no momento pós-cirúrgico em razão da manipulação dos vasos e nervos, e mais preocupante em regiões cranianas posteriores.
Dia Mundial sem Tabaco e Dia Nacional de Combate ao Fumo Catálogo de Campanhas 1997-2017
Authors: Cardoso Andréa Ramalho Reis
Published: February 2019

Esta publicação realiza um resumo histórico das campanhas (Dia Mundial sem Tabaco e Dia Nacional de Controle do Tabagismo), coordenadas pelo Instituto Nacional de Câncer José Gomes de Alencar (INCA/MS), que, desde o final da década de 1980, sob a ótica da promoção da saúde, é o responsável pela gestão e governança do controle do tabagismo no Brasil coordenando um conjunto de ações nacionais específicas que compõem o Programa Nacional de Controle do Tabagismo (PNCT).