bluuebunny/crossref_metadata_2025 huggingface dataset:
A scoping review of nursing interventions for reducing the negative impacts of domestic violence among women
Authors: Yosep Iyus , Mardhiyah Ai , Hazmi Helmy , Fitria Nita , Lukman Mamat , Yamin Ahmad , Pahria Tuti
Published: November 2024

Background

Incidences of domestic violence against women are increasingly every years. Domestic violence has the negative impacts on physical problems, psychological problems, and can even cause death. Nurses have a role for providing interventions to reduce the impact of domestic violence on women.

Aim

The purpose of this study is to explore methods of nursing interventions in reducing the traumatic effect of domestic violence among women.

Method

This study used a scoping review method. The literature used in this study from CINAHL, PubMed, and Scopus databases. Search articles used the keywords domestic violence, impact, women, and victims. PRISMA Extension for Scoping Reviews are used for selecting articles. The inclusion criteria for the articles in this study were that the sample was female victims of sexual violence, randomized control trial or quasi-experimental research design, and last 10 years for publications period (2013–2022).

Result

From three databases, we found 579 articles. After elimination-based inclusion and exclusion criteria, we found 10 articles discussing the effect of nursing interventions in reducing the impact of domestic violence on female victims. Most of the studies from USA and the range of respondents in the articles is 112–1250 respondents. The methods used in providing nursing interventions are classified into three, namely self-management programs, counseling programs, social support programs. The activities carried out in nursing interventions in the form of psychoeducation, relaxation, meditation, and also discussions about solving problems encountered. All articles show that nursing interventions are effective in reducing the impact of domestic violence on women.

Conclusion

Nurses have an important role to provide comprehensive nursing care to victims of domestic violence by paying attention to various aspects, namely physical, psychological, and spiritual aspects to improve safety and comfort of patients.

Implication for Nursing

This study is the basis for nurses to provide comprehensive nursing care to reduce the impact of domestic violence among women victims of domestic violence.
An online survey of perspectives towards the impact of the covid-19 pandemic amongst caregivers of adolescents with ASD
Authors: Tawankanjanachot Nadlada , Melville Craig , Truesdale Maria , Kidd Lisa
Published: November 2024

Background

The coronavirus disease (COVID-19) pandemic has had a negative impact on the health and mental health of adolescents and adolescents with autism spectrum disorders (ASD) and their caregivers, have been disproportionally affected. The purpose of this study was to investigate the impact of COVID-19 on Thai caregivers and adolescents with ASD.

Methods

This study used an online survey with closed and free text questions to investigate how the pandemic had impacted on social skills development and psychological variables, and perceived needs for support. The survey link was shared to parents via the Yuwaprasart Withayopathum Child and Adolescent Hospital and the social media platforms of known ASD stakeholder networks in Thailand. Binary logistic regression was used to investigate the relationships between sociodemographic characteristics, service use, and social skills problems experienced by adolescents during the pandemic. Content analysis was applied to analyse free-text data.

Results

A total of 376 caregivers of adolescents with ASD aged 10–19 years completed the survey, of which 364 were included in the analysis. In total, 38.7% of caregivers reported that during the pandemic the social skills of their adolescent family member had worsened. Most families reported that they were able to continue to access support from healthcare and educational services, albeit in different ways than pre-pandemic, during the acute stages of the pandemic which benefited the maintenance of ASD symptoms and social skills. Factors identified as reducing the odds of a worsening in social skills during the pandemic included; regular access to treatment for adolescents (odds ratio [OR] = 0.55, confidence interval 95% (CI) 0.32–0.98, p = 0.044), caregivers feeling that they had sufficient support from hospitals (OR = 0.46, 95% CI 0.26–0.81, p = 0.007) and older age of adolescents (OR = 0.53, CI 0.29–0.99, p = 0.047). The qualitative free text comments showed that the caregivers felt that greater information on managing adolescent behaviours, opportunities for adolescents to practice social skills, and the provision of greater emotional support and material assistance from healthcare professionals during the pandemic would have helped them to care for the adolescents with ASD.

Conclusion

Regular access to services, support from hospitals during the pandemic and older age in adolescence may have helped prevent the worsening of the social skills problems of adolescents with ASD.
Developing an educational resource for people experiencing eating disorders during the menopause transition: A qualitative co-design study
Authors: Sharp Gemma , Fernando Anne Nileshni , Davis Susan R. , Randhawa Alisha
Published: November 2024

Background

The pronounced changes in reproductive hormones, such as oestradiol and progesterone, that occur during the menopause transition can contribute to increased risk of eating disorder onset or exacerbate a pre-existing eating disorder. Despite this heightened risk, there is a lack of available education and support that takes into consideration the unique challenges of experiencing an eating disorder during the menopause transition. This research aimed to qualitatively explore the perspectives of people with a lived experience of an eating disorder during the menopause transition, and to co-design a support option that addressed their unmet needs.

Methods

A Double Diamond co-design process was followed involving four phases: discover, define, develop, and deliver. Seventeen women in Australia with a lived experience of an eating disorder during the menopause transition participated in online workshops across the four phases to identify their unmet health educational needs in experiencing an eating disorder during this transition, develop potential solutions and ultimately deliver a prototype solution in the final phase. All online workshops were recorded, transcribed verbatim and analysed using qualitative thematic analysis. The findings from the previous phase informed the next leading to the prototype creation.

Results

Qualitative thematic analysis identified six major themes across the four phases; lack of awareness of the intersection of menopause and eating disorders, lack of education, limited and stigmatising services, learning from lived experience, resource impact and resource development.

Conclusions

Findings from this study provided preliminary acceptability of a novel online resource to address the unmet educational needs of people experiencing an eating disorder during the menopause transition. Overall positive feedback on the potential for the resource to improve knowledge and empower treatment-seeking was provided by women with lived experience.
Health-Related Quality of Life and Financial Burden in Ethiopian Patients With Chronic Myeloid Leukemia Receiving Tyrosine Kinase Inhibitors: A Cross-Sectional Study
Authors: Tadesse Fisihatsion , Sparano Francesco , Gebremedhin Amha , Abubeker Abdulaziz , Piciocchi Alfonso , Cipriani Marta , Krepper Daniela , Gemechu Lalise , Mulu Atalay , Asres Getahun , Efficace Fabio
Published: November 2024

PURPOSE

Health-related quality of life (HRQoL) is now an important goal of therapy for patients with chronic myeloid leukemia (CML). However, there is paucity of data for patients living in low-income countries (LICs) and on factors associated with their HRQoL profile. The primary objective was to compare the HRQoL of patients with CML living in an LIC (Ethiopia) with that of patients living in a high-income country (HIC).

METHODS

Adult patients with CML treated with tyrosine kinase inhibitors in Ethiopia were considered eligible for this study. To assess their HRQoL and symptom burden, eligible patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the EORTC Quality of Life Questionnaire Chronic Myeloid Leukemia 24 (QLQ-CML24). A matched case-control analysis was applied to compare the HRQoL profile of the herein-recruited Ethiopian cohort with a sample of patients with CML from an HIC (Italy).

RESULTS

Overall, 395 Ethiopian patients were enrolled between February 2021 and June 2021. Except for dyspnea and satisfaction with care, the Ethiopian patients reported lower HRQoL and functioning and higher symptom burden compared with patients with CML living in an HIC. A remarkable proportion of Ethiopian patients (n = 353, 89.4%) reported financial toxicity (FT). Compared with patients without FT, those with FT reported a higher prevalence of clinically important problems and symptoms across all the QLQ-C30 scales. For example, the prevalence of clinically important impairment of social functioning was almost sixfold higher for patients with FT compared with those without FT (41.8%, 7.1%, respectively).

CONCLUSION

Our results indicate that the HRQoL profile of patients with CML living in Ethiopia may be worse across several important functional and symptom domains than that of their peers living in an HIC. In addition, FT is highly prevalent among these patients and it is associated with poorer HRQoL outcomes.
Teleophthalmology Through Online Mentorship Over a 20-Year Period: Education and Capacity Building
Authors: Huemmer Sarah E. , Patnaik Jennifer L. , Ybarra Susan , Congdon Nathan , Cherwek David H. , Wilson Matthew W.
Published: November 2024

PURPOSE

Telemedicine is widely used for diabetic retinopathy, retinopathy of prematurity, and other ophthalmic diseases. However, there is limited research on the use of teleophthalmology in retinoblastoma. The goal of this study was to explore how Orbis Cybersight affected the capacity for treatment and management of children with retinoblastoma through online mentorship and to assess the efficacy of online mentoring through disease-specific knowledge change over time.

METHODS

A retrospective review of Orbis Cybersight retinoblastoma consultations from 2004 to 2023 was conducted. Each participant was scored from 0 to 39 points on the basis of information provided throughout the consultation. These points were separated into six categories: patient history, clinical findings, grouping/staging, diagnostic findings, treatment plan, and patient and ocular outcomes. Data were analyzed by linear regression models to identify changes over time.

RESULTS

Among 653 patients from 38 different mentees, significant improvement in total points over time was observed (β = .012 [SE, 0.004];
P
= .009). The mean score for total points at first consult was 17.7 (standard deviation [SD], 3.5) and at fifth consult was 19.8 (SD, 5.2). Three management categories showed significant improvement: clinical findings (
P
= .005), grouping/staging (
P
< .0001), and patient and ocular outcomes (
P
= .002). However, there was a significant decline in patient history points over time (
P
= .0006).

CONCLUSION

Mentorship via Orbis Cybersight improved retinoblastoma disease-specific knowledge and management over a 20-year period. Tele-education provides an opportunity for disease-specific capacity building in low- and middle-income countries for the treatment of retinoblastoma.
Surgical Castration as an Alternative to Improve Systemic Treatment for Advanced Prostate Cancer: A Window of Opportunity for Developing Countries
Authors: Monteiro Fernando Sabino Marques , Sasse Andre Deeke , Araujo Denizar Vianna , McKay Rana R. , da Trindade Karine Martins , Soares Andrey , Alves João Ricardo , Valverde Douglas Andreas , Bastos Diogo Assed , James Nicholas D. , Herchenhorn Daniel
Published: November 2024

PURPOSE

The Brazilian Public Health System (BPHS) serves approximately 71,730 patients with prostate cancer (PC) every year for which androgen deprivation therapy (ADT) is the primary treatment for patients with advanced hormone-sensitive prostate cancer (aHSPC). Androgen receptor pathway inhibitors (ARPIs) are not accessible through the BPHS. Using the BPHS as a model, this study assesses the long-term economic effect of surgical versus medical castration in aHSPC treatment to strategize cost reduction and the incorporation of ARPI in developing countries.

PATIENTS AND METHODS

Data of patients with aHSPC (ie, TxN1M0 ineligible for local treatment or TxNxM1) from the BPHS database were analyzed from January 1, 2011, to December 31, 2021, using the TECHTRIALS artificial intelligence platform. The main outcomes were quantitative and descriptive analyses as well as a cost analysis of surgical versus chemical castration.

RESULTS

Of the 274,519 patients with aHSPC who received active treatment during the 11-year study period, 90% (n = 246,683) underwent chemical castration and 10% (n = 27,836) underwent bilateral subcapsular orchiectomy (BSO). The median duration of chemical castration was 28 months. The BPHS spent an estimated total of $665,552,091.40 US dollars (USD) on chemical castration and $5,939,348.47 USD on BSO, respectively. The cost per patient was $2,698 USD and $213.37 USD for chemical castration and BSO, respectively. Hypothetically, if all patients with aHSPC had undergone BSO, the total direct cost for the BPHS would have been $42,774,832.20 USD, saving $622,777,259.20 USD over 11 years, making it possible to offer low-dose abiraterone to 65% of aHSPC patients.

CONCLUSION

On the basis of this extensive financial analysis from the world's largest public health system database, BSO appears to be a valuable alternative to chemical castration for treating aHSPC. In resource-limited environments, the cost savings from using BSO may allow access to drugs that will improve survival such as ARPIs.
Efficacy and Safety of Biosimilar Cetuximab Versus Innovator Cetuximab in Indian Patients With Head and Neck Cancer: A Multicenter, Randomized, Double-Blind, Phase III Trial
Authors: Prabhash Kumar , Deshmukh Chetan , Malhotra Hemant , Sharma Atul , Jain Minish , Dhamne Nilesh , Nagarakar Rajnish , Ganesan Prasantha , Mahobia Vijay K. , Das Chandan K. , Kumar Rejnish , Shivanna Prakash S. , Avaronnan Manu P. , Chaithanya Puligundla K. , Chaudhary Vaibhav , Singh Kartar , Aagre Suhas , Ravishankar Bellala , Mehta Dhruv , Shilpa Kandipalli , Maniar Vashishth , Chatterjee Koushik , Majumdar Saroj D. , Dana Rohitashwa , Noronha Vanita , Menon Nandini , Sharma Akhilesh , Pawar Roshan , Shahavi Vinayaka , Yadav Rajiv , Aiwale Amol
Published: November 2024

PURPOSE

Squamous cell carcinoma of the head and neck (SCCHN) is the sixth most common cancer, with approximately 225,419 new cases with over 125,000 deaths annually in India. This trial compared the efficacy and safety of biosimilar cetuximab versus innovator cetuximab (IC) in combination with platinum-based chemotherapy in patients with recurrent locoregional or metastatic SCCHN.

METHODS

This phase III trial is a multicenter, randomized, double-blind and parallel group study performed in Indian patients with recurrent locoregional or metastatic SCCHN. Patients were randomly assigned in 2:1 ratio to receive biosimilar cetuximab and IC in combination with cisplatin and fluorouracil via intravenous infusions. The primary end points were disease control rate (DCR) and overall response rate (ORR) as per response evaluation criteria in solid tumors version 1.1. The secondary end points included pharmacokinetics (PK), immunogenicity, safety, and tolerability.

RESULTS

Of 180 patients enrolled, 120 patients received biosimilar cetuximab and 60 patients received IC treatment. No significant statistical difference was observed in the primary outcomes between two groups. Treatment difference in DCR and ORR response was found to be –5.21 (90% CI, –8.94 to –1.48) and –4.79 (90% CI, –19.42 to 9.84), respectively, indicating noninferiority to reference product. The incidence of treatment-emergent adverse events (AEs; biosimilar cetuximab: 89.2%
v
IC: 91.7%;
P
= .8364) and serious AEs (biosimilar cetuximab: 23.3%
v
IC: 13.3%;
P
= .0603) and PK parameters were comparable between treatment groups. The immunogenicity findings showed higher incidence of anticetuximab antibodies in the biosimilar cetuximab group compared with the IC group at the end of Study.

CONCLUSION

The findings of this study demonstrated noninferiority along with comparable PK, safety, and immunogenicity of biosimilar cetuximab and IC in patients with recurrent or metastatic SCCHN.
Brain Circuitry of Consciousness: A Review of Current Models and a Novel Synergistic Model With Clinical Application
Authors: Gammel Theresa C. , Alkadaa Leor N. , Saadon Jordan R. , Saluja Sabir , Servider John , Cleri Nathaniel A. , Egnor Michael , Davis Raphael P. , Huang Chuan , Saalmann Yuri B. , Mofakham Sima , Mikell Charles B.
Published: November 2024

How consciousness arises in the brain has important implications for clinical decision-making. We summarize recent findings in consciousness studies to provide a toolkit for clinicians to assess deficits in consciousness and predict outcomes after brain injury. Commonly encountered disorders of consciousness are highlighted, followed by the clinical scales currently used to diagnose them. We review recent evidence describing the roles of the thalamocortical system and brainstem arousal nuclei in supporting awareness and arousal and discuss the utility of various neuroimaging studies in evaluating disorders of consciousness. We explore recent theoretical progress in mechanistic models of consciousness, focusing on 2 major models, the global neuronal workspace and integrated information theory, and review areas of controversy. Finally, we consider the potential implications of recent research for the day-to-day decision-making of clinical neurosurgeons and propose a simple “three-strikes” model to infer the integrity of the thalamocortical system, which can guide prognosticating return to consciousness.
Initial Patient Satisfaction With Telemedicine in Neurosurgery Outpatient Clinic During the Early COVID-19 Pandemic
Authors: Kozel Olivia A. , Baskaran Archit B. , Manjunath Anusha , Goel Chirag , Jones Michael R. , Gibson William , Jahromi Babak S. , Tate Matthew C. , Dahdaleh Nader S. , Rosenow Joshua M.
Published: November 2024

BACKGROUND:

Throughout the COVID-19 pandemic, the medical community has been saturated by the necessity for telemedicine, or “telehealth”, appointments. With limited prior exposure, the many challenges that accompany telehealth visits have affected how physicians conduct daily tasks and how patients perceive healthcare experiences. In the early stages of the COVID-19 pandemic, telemedicine was new to most neurosurgical patients. This study seeks to evaluate the overall neurosurgical patient experience with telemedicine.

OBJECTIVE:

To assess overall neurosurgical patient satisfaction with telemedicine to build an understanding of the effectiveness of these encounters for future planning.

METHODS:

After a telemedicine appointment, patients received an electronic survey. Survey questions focused on demographic information, encounter type, medical history questions, and overall satisfaction with telemedicine. Responses for the survey questions were formulated using a 5-point Likert scale.

RESULTS:

Two hundred seventy patients were seen via telemedicine by 1 of 4 providers included in this study. 43 patients returned the surveys, with a completion rate of 16%. Patients indicated higher scores for overall satisfaction and quality of appointment. Of note, 23% of participants responded that they would be willing to pay out of pocket for a telemedicine appointment, while 77% responded they would not be willing to pay out of pocket.

CONCLUSION:

Our survey results show patients felt comfortable discussing healthcare issues using telehealth, that appropriate levels of care were received, and they would be willing to use telehealth again. Future efforts will be necessary to educate providers and patients about the utilization of technological devices, ensure patient access to telehealth, and standardize ethical guidelines.
Improving Surgical Outcomes in Middle Cranial Fossa Cerebrospinal Fluid Leak Repair
Authors: Ng Jia Hui , Bala Arul , Hendriks Thomas , Kuthubutheen Jafri
Published: November 2024

BACKGROUND:

Spontaneous cerebrospinal fluid (CSF) leaks of the temporal bone occur in the absence of known iatrogenic or traumatic injury and without underlying congenital malformation. Holistic treatment of the condition requires meticulous perioperative evaluation of the patient to mitigate underlying risk factors. Similarly, surgery for CSF leaks requires careful consideration of all potential routes of CSF leakage to improve short- and long-term surgical outcomes.

OBJECTIVE:

To describe our surgical technique in this article, which addresses most of the potential routes of spontaneous CSF otorrhea. Perioperative management of the patients is also described.

METHODS:

A total of 65 patients underwent CSF leak repair using a middle cranial fossa approach and the techniques described in this paper. Their surgical outcomes are described.

RESULTS:

Preoperatively, all patients had either biochemically proven beta trace protein–positive CSF otorrhea or the presence of an encephalocele on preoperative imaging. Using this technique, all patients had short-term successful repair of their CSF leak, whereas a long-term success rate of 87.7% was achieved. No major complications were encountered.

CONCLUSION:

Holistic treatment of spontaneous CSF leaks of the temporal bone, together with using a surgical approach that considers all potential routes of CSF leakage, may help to improve long- and short-term surgical outcomes.
Emergent Revascularization After Transposition of an Unexpected Intraosseous Anomalous Subarcuate Loop During Vestibular Schwannoma Surgery: A Case Report
Authors: Sakata Kiyohiko , Hashimoto Aya , Yoshitake Hidenobu , Kajiwara Sosho , Orito Kimihiko , Nakamura Hideo , Morioka Motohiro
Published: November 2024

BACKGROUND AND IMPORTANCE:

The presence of an anomalous anteroinferior cerebellar artery (AICA) embedded within the subarcuate fossa increases the difficulty of cerebellopontine angle (CPA) tumor surgery. Iatrogenic injury of posterior fossa arteries can result in serious morbidity.

CLINICAL PRESENTATION:

A 70-year-old man presented with right-sided hearing loss and facial dysesthesia. Magnetic resonance imaging showed a tumor with solid and cystic components and 35-mm maximum diameter in the right CPA. The AICA traveled just dorsal to the tumor and was well-developed because the ipsilateral vertebral artery and posteroinferior cerebellar artery (PICA) were aplastic. During surgery, we unexpectedly encountered an anomalous loop of the AICA-PICA which was embedded in the subarcuate fossa. This loop was mobilized using an ultrasonic bone curette to enable further tumor resection. However, it occluded immediately after mobilization and required open thrombectomy and end-to-end anastomosis. After revascularization, near-complete tumor resection was achieved without causing facial nerve dysfunction or brainstem/cerebellar infarction. Pathological examination of the resected anomalous loop showed abnormal focal hypertrophy of the adventitia and the presence of external elastic lamina.

CONCLUSION:

Mobilization of an anomalous AICA-PICA loop embedded within the subarcuate fossa during VS resection can result in arterial occlusion which requires thrombectomy and revascularization. Surgeons should be aware of this vascular anomaly and be prepared to deal with its ramifications.
Severe Vertebrobasilar Vasospasm After Iatrogenic Rupture of a Posterior Fossa Epidermoid Cyst: A Case Report of a Rare Complication Managed With Endovascular Intervention
Authors: Housley Steven B. , Jacoby Wady T. , Farkash Zoe , Monteiro Andre , Lim Jaims , Davies Jason M. , Levy Elad I.
Published: November 2024

BACKGROUND AND IMPORTANCE:

Aseptic meningitis and hydrocephalus have been reported after intracranial epidermoid cyst rupture. We present a rare case of clinically symptomatic vasospasm after iatrogenic rupture.

CLINICAL PRESENTATION:

A middle-aged woman presenting with headache, facial paresthesia, and dizziness was found to have a 5-cm posterior fossa epidermoid cyst on magnetic resonance imaging. Resection was achieved through suboccipital craniectomy and C1 laminectomy. On postoperative day (POD) 1, the patient became unresponsive. After ventriculostomy placement for developing hydrocephalus, she failed to improve. Digital subtraction angiography revealed severe vertebrobasilar vasospasm, which was treated successfully with intra-arterial verapamil and milrinone. She experienced multiple episodes of recurrent vasospasm, all successfully treated with verapamil-milrinone. After ventriculoperitoneal shunt placement on POD 31, her condition stabilized; she was discharged to a rehabilitation center on POD 38.

CONCLUSION:

This successful treatment of rare, clinically symptomatic vasospasm postiatrogenic epidermoid cyst rupture may help guide treatment in similar scenarios.
Glymphatics for the Neurosurgeon
Authors: Treffy Randall W. , Eraky Akram M. , Hussain Omar , Hedayat Hirad S.
Published: November 2024

The glymphatic system is a recently described open vascular system within the brain that allows cerebrospinal fluid to flow into brain parenchyma through perivascular spaces and clears interstitial solutes into the traditional closed vascular system. Although it was initially difficult to study, new evidence suggests that the glymphatic system plays a pivotal role in the pathophysiology of multiple diseases of the central nervous system including traumatic brain injury, hydrocephalus, dementia, and malignancy. In this review, we cover the basics of cerebrospinal fluid dynamics and explore the role of the glymphatic system in traumatic brain injury, post subarachnoid hemorrhage hydrocephalus, normal pressure hydrocephalus, and malignancy. We believe that further understanding of the glymphatic system will lead to new and better therapeutic options for these diseases moving forward.
Scalp Incisions With Stairstep Pericranial Edges to Minimize Sequalae from Poor Wound Healing in Supratentorial Brain Tumor Surgery: A Technical Note With Early Results
Authors: Popp Nicholas , Singhal Ishan , Laing Brandon , Krucoff Kate B. , Krucoff Max O.
Published: November 2024

BACKGROUND AND OBJECTIVES:

Wound healing problems are especially prevalent in craniotomies for intra-axial brain tumors as patients often require radiation, chemotherapy, and chronic steroids. Although newer techniques such as minimally invasive approaches and routine vancomycin powder use have helped overall complication rates, poor skin healing remains a frustratingly persistent cause of morbidity. Therefore, here we describe the novel technique of elevating and closing a stairstep pericranial edge offset from the skin incision to protect hardware and support wound healing, and we report early outcomes using this technique.

METHODS:

Ninety-one consecutive patients underwent supratentorial, intra-axial brain tumor surgery with a single surgeon at a single institution using this technique. Patient demographics, pathology, adjuvant interventions, and other independent risk factors were analyzed.

RESULTS:

No wound-related complications requiring readmission, intravenous antibiotics, or reoperation were encountered at a median 3-month follow-up. There were also no surgical site infections, dehiscences, or cerebrospinal fluid leaks. Fifty-one patients (57.3%) had postoperative radiotherapy, 85 patients (93.4%) had perioperative steroids, and 56 patients (61.5%) had postoperative chemotherapy. Six patients (6.5%) were placed on a short course of oral antibiotics perioperatively due to concerns with initial scalp healing (ie, excessive scabbing at follow-up), none of whom progressed to infection or required further intervention. These are the cases where this technique is felt to have been most helpful by potentially preventing worse sequelae. One patient developed a shunt infection during this interval that required removal unrelated to the craniotomy site.

CONCLUSION:

Here we outline in detail the principles, design, and execution of incisions and closures with stairstep pericranial edges in supratentorial brain surgery. This technique was designed in consultation with plastic surgeons to provide an intact, vascularized layer of pericranium beneath the healing skin and over the bone graft/hardware to optimize wound healing conditions and prevent morbid sequelae in inevitable cases of poor initial healing. Early results are promising.
Diagonal Earlobe Crease (Frank's Sign): a New Clinical Sign to Look for in Patients With Ruptured and Unruptured Intracranial Aneurysms? Patient Series
Authors: Chavez-Herrera Victor Ramzes , Velazquez-Castillo Joel Abraham , Hernandez-Gonzalez Flavio , Cervantes-Gonzalez Josue Alejandro , Cruz-Rosales Juan Luis , Sandoval-Bonilla Bayron Alexander , Soto-Rubio Diego Tonathiu , Perez-Carrillo Cristian Alberto , Garcia-Lopez Rabindranath
Published: November 2024

BACKGROUND AND IMPORTANCE:

Diagonal earlobe crease (DELC, Frank's sign) and intracranial arterial aneurysms (IAA) have a pronounced association with atherosclerosis. Therefore, detecting DELC in patients with IAA could be potential for clinical and research use.

CLINICAL PRESENTATION:

During a 2-month period, we diagnosed 20 patients with intracranial arterial aneurysms. Sixteen (80%) were positive for DELC, 12 were female, and 4 were male (ages ranging from 32 to 68 years and a mean of 52 years). Eleven were unruptured and 5 were ruptured. We highlight cases 1, 7, and 8.

CONCLUSION:

The interesting tight association of DELC and IAAs to atherosclerosis and the overwhelming presence of DELC in patients with IAAs could lead to potentially associated DELC with the development, growth, and rupture of IAAs. As a result, important clinical and research information could be found.
Lateral Compression is the Strongest Independent Predictor of Aneurysm Occlusion After Endovascular Treatment of Intracranial Aneurysms With the Woven EndoBridge Device
Authors: Delgado Almandoz Josser E. , Kayan Yasha , Copelan Alexander Z. , Ertelt Ashley M. , Scholz Jill M.
Published: November 2024

BACKGROUND AND OBJECTIVES:

The effect of lateral compression (LC) of the Woven EndoBridge (WEB) device on intracranial aneurysm (IA) occlusion and retreatment has not been studied in depth. This study aims to determine the effect of LC on aneurysm occlusion and retreatment after endovascular treatment with WEB.

METHODS:

We retrospectively reviewed IAs treated with WEB at our institution between February 5th, 2019, and March 31st, 2022. LC was determined in the immediate postdetachment angiogram by measuring the mean implanted WEB width at the equator in two orthogonal projections and subtracting it from the nominal WEB width. LC was then converted to the percentage of nominal WEB width (percent LC [%LC]). Independent predictors of complete and adequate aneurysm occlusion at follow-up and retreatment were determined using multivariate logistic regression analysis. Optimal %LC thresholds were determined using receiver operating characteristic analysis.

RESULTS:

One hundred and fifty-five IAs were included, with a mean size of 6.4 mm, a mean neck of 3.6 mm, and a mean time to last follow-up of 15.5 months. At last follow-up, complete and adequate aneurysm occlusion was present in 98 (63.2%) and 139 (89.7%) IAs, respectively. Twelve IAs were retreated (7.7%). %LC was the strongest independent predictor of complete and adequate aneurysm occlusion at first and last follow-up and an independent predictor of aneurysm retreatment. Optimal %LC thresholds for complete and adequate aneurysm occlusion at first follow-up were >17.1% and >15.7%, respectively. Compared with IAs in which these thresholds were not attained, IAs in which these thresholds were attained had significantly higher rates of complete (31% vs 68%, P-value <.0001) and adequate occlusion (81% vs 96%, P-value .004) at first follow-up. The optimal %LC threshold for aneurysm retreatment was ≤15.6%. IAs with ≤15.6% LC had a significantly higher rate of retreatment (15%) than IAs with >15.6% LC (4%, P-value .025).

CONCLUSION:

LC is the strongest independent predictor of aneurysm occlusion in IAs treated with WEB.
Explantation and Simultaneous Explantation-Reimplantation of Spinal Cord Stimulation Paddle Electrodes: Complication Rate and Predisposing Factors
Authors: Kuparinen Xenia , Ahmed Haji Omar Abdirisak , Vartiainen Nuutti , Marjamaa Johan , Gröndahl Joonatan , Kivisaari Riku , Resendiz-Nieves Julio
Published: November 2024

BACKGROUND AND OBJECTIVES:

Spinal cord stimulation (SCS) is an effective treatment for chronic pain that does not respond to conservative treatment. Nonetheless, up to 38% of all implanted SCS electrodes are explanted, and while the risks involved in the surgical implantation of SCS paddle electrodes are well documented, there is scarce information about SCS explantations and their associated complications. We aimed to document the complication rate and identify their predisposing factors in SCS paddle electrode explantations and simultaneous explantation-reimplantations.

METHODS:

We retrospectively reviewed the outcomes and the characteristics of all patients who underwent explantation of surgically implanted SCS paddle electrodes at the Helsinki University Hospital Department of Neurosurgery between February 2005 and October 2020.

RESULTS:

One hundred thirty-one explantations were performed on 106 patients. The complication rate was 18.3% (24 operations). Major complications occurred during 5 operations (3.8%). No permanent neurological deficits were recorded. Smoking predisposed patients to postoperative complications (P = .023). On average, patients who suffered complications required a day longer hospitalization (2.22 vs 2.92, P = .011). Patients who had repeated explantations (3 or more) suffered significantly more complications than patients who had only 1 or 2 operations (62.5% vs 15.4%, P = .005).

CONCLUSION:

Our results suggest that the explantation of the SCS paddle electrode is a relatively safe surgical procedure. Although severe complications occurred, they were successfully managed. Repeated explantations should be treated cautiously as they seem to increase the complication rate considerably.
Mini-Craniotomy With Endoscopic Approach for Acute Subdural Hematoma Evacuation in a Patient With Complex Scalp Flap Defect: A Case Report
Authors: Kundishora Adam Joseph , Sundaresan Vinaik Mootha , Boroumand Sam , Hodges Sarah E. , Omay Sacit Bulent
Published: November 2024

BACKGROUND AND IMPORTANCE:

Acute subdural hematoma (aSDH) is one of the most common pathologies resulting from head trauma. Surgical management often involves a large craniotomy for hematoma evacuation. Prior complex cranial reconstructive surgery can complicate incision planning or limit craniotomy size.

CLINICAL PRESENTATION:

In this report, we describe a 61-year-old woman with a history of squamous cell carcinoma of the scalp, which previously required complex flap reconstruction and left a residual skull defect, who presented with an aSDH after a fall. Prior surgery and poorly vascularized skin significantly limited the available area for craniotomy. We used a mini-craniotomy with endoscopic adjunct to achieve appropriate visualization and complete evacuation of the hematoma.

CONCLUSION:

In cases of aSDH in which a mini-craniotomy is desirable and the potential location of the incision is limited, an endoscopic approach should be considered.
The Significance of Venous Outflow Obstruction in Dural Arteriovenous Fistulas
Authors: Evans Lachlan R. , Khanijou Visnu , Gauden Andrew J. , Kavar Bhadrakant , Davidson Andrew S. , Yan Bernard , Bush Steve , Dowling Richard , Laidlaw John D. , Mitchell Peter J. , Adamides Alexios A.
Published: November 2024

BACKGROUND AND OBJECTIVES:

The association between venous outflow obstruction (VOO) and cranial dural arteriovenous fistulas (DAVF) is well established; however, its impact on the natural history remains unclear. This article aims to characterize its clinical significance and further describe the natural history of DAVF.

METHODS:

A retrospective cohort study was performed at a tertiary neurosurgical center. Cohort characteristics were described with a focus on patients with VOO. Annualized event rates and risk factors for hemorrhage and nonhemorrhagic neurological events (NHNE) were also investigated.

RESULTS:

The cohort consisted of 108 patients, 74 of which had follow-up greater than 1 month including 24 low-grade (Cognard I-IIa) fistulas (21.7 lesion-years) and 50 high-grade (Cognard IIb-V) fistulas (60 lesion-years). 18 patients with concurrent VOO were identified; most (83.3%) were high-grade DAVF and had obstruction of the direct draining sinus. Annualized rates of hemorrhage and NHNE for high-grade DAVF were 4.6% and 10.6%, respectively. Those high-grade lesions presenting with hemorrhage had a 10.9% annual rate of recurrent hemorrhage, while those presenting with NHNE had a 22.3% annual rate of subsequent NHNE. Fifteen high-grade DAVF with VOO (15.7 lesion-years) had annualized hemorrhage and NHNE rates of 6.4% and 31.9%, respectively. High radiological grade, an aggressive index presentation, and the presence of VOO were the predictors of hemorrhage and NHNE (P < .05).

CONCLUSION:

This study reports a novel association between VOO and a more aggressive clinical course. DAVF with high-grade angiographic features, an aggressive index presentation, or VOO should be considered for early treatment.
Operative Strategies for Aplastic Circle of Willis Arteries on CTA in Meningioma Surgery: A Case Report
Authors: Tabor Joanna K. , Pappajohn Alexandros F. , Lei Haoyi , O'Brien Joseph , Fulbright Robert K. , Morales-Valero Saul F. , Moliterno Jennifer
Published: November 2024

BACKGROUND AND IMPORTANCE:

Meningiomas frequently involve critical neurovascular structures. Preoperative imaging with computed tomography angiography (CTA) can help understand the relationship of tumor with neurovascular structures. Although CTA was useful in preoperative planning and less invasive, we present a unique case in which it mistakenly represents a hypoplastic anterior cerebral artery as aplastic and thus displays poor sensitivity in the Circle of Willis.

CLINICAL PRESENTATION:

A 66-year-old woman presented with new onset seizures and MRI demonstrated a sphenoid wing meningioma with tumor involvement of the internal carotid artery and right M1 artery. On preoperative CTA, a right A1 artery was not appreciated. However, a hypoplastic right A1 artery was identified during careful dissection guided by micro-Doppler and found to be encased within the tumor. All arteries were preserved, and a near-total resection was achieved with a small remnant of tumor at the supraclinoid internal carotid artery.

CONCLUSION:

Although CTAs can be useful in understanding vascular anatomy and its association with tumors, they are not ideal for providing information about hypoplastic arterial segments. Seemingly aplastic arteries on CTA may very well be present, albeit hypoplastic. While we recognize the usefulness of a less invasive modality of CTA to help guide surgical strategy, we underscore recognizing this potential pitfall and recommend the use of the microvascular Doppler during careful dissection when working within tumor in the location of a seemingly aplastic artery.
Second-Generation Wide-Field Visualization Devices for 5-ALA–Induced Fluorescence and Concepts for Validation in Neurosurgery—A Systematic Review
Authors: Özdemir Zeynep , Suero Molina Eric , Hellwig Sönke J. , Stepp Herbert , Stummer Walter
Published: November 2024

BACKGROUND AND OBJECTIVES:

Fluorescence-guided resection (FGR) of malignant gliomas with five-aminolevulinic acid (5-ALA) is an established method using surgical microscopes equipped with filter systems for observing fluorescence. Over the past decade, new technologies have been introduced for the same purpose, with available publications evaluating their clinical efficacy based on varying criteria. This study aims to review technologies and concepts of validation in the context of 5-ALA–mediated FGR.

METHODS:

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was performed to identify devices capable of detecting 5-ALA–induced fluorescence. Articles found eligible for this review were analyzed, focusing on the methods of validation used for novel devices. A qualitative analysis is presented.

RESULTS:

Using predefined eligibility criteria, 22 studies were analyzed. Publications on the following visualization devices were reviewed: FL400 (Leica Microsystems), Aeos (Aesculap), BLUE400 and BLUE400 AR Filter System (Carl Zeiss Meditec AG), Endoscope with D-Light C (Karl Storz), Fiberscope N-4L (Machida), ORBEYE 4K 3D Digital Video Microscope (Olympus), and several customized surgical loupe systems. In many cases, validation seemed unstandardized, with inherent biases and limited reproducibility.

CONCLUSION:

This review illustrates the significance of device validation within the framework of FGR. It emphasizes the criticality of validating devices in accordance with established standard, i.e. the BLUE400 filter system, which was employed in the approval studies of 5-ALA. Furthermore, standardized concepts of validation are required to assess whether new devices are, in fact, a reliable or superior alternative in the field of FGR. Published guidelines should be considered when performing future studies.
Phase 1, Dose Escalation, Nonrandomized, Open-Label, Clinical Trial Evaluating the Safety and Preliminary Efficacy of Allogenic Adipose-Derived Mesenchymal Stem Cells for Recurrent Glioblastoma: A Clinical Trial Protocol
Authors: Ramos-Fresnedo Andres , Al-Kharboosh Rawan , Twohy Erin L. , Basil Aleeshba N. , Szymkiewicz Ewa C. , Zubair Abba C. , Trifiletti Daniel M. , Durand Nisha , Dickson Dennis W. , Middlebrooks Erik H. , Abarbanel David N. , Tzeng Stephany Y. , Almeida Joao Paulo , Chaichana Kaisorn L. , Green Jordan J. , Sherman Wendy J. , Quiñones-Hinojosa Alfredo
Published: November 2024

BACKGROUND AND OBJECTIVES:

Despite standard of care with maximal safe resection and chemoradiation, glioblastoma (GBM) is the most common and aggressive type of primary brain cancer. Surgical resection provides a window of opportunity to locally treat gliomas while the patient is recovering and before initiating concomitant chemoradiation. The objective was to assess the safety and establish the maximum tolerated dose of adipose-derived mesenchymal stem cells (AMSCs) for the treatment of recurrent GBM. Secondary objectives were to assess the toxicity profile and long-term survival outcomes of patients enrolled in the trial. In addition, biospecimens will be collected to explore the local and systemic responses to this therapy.

METHODS:

We will conduct a phase 1, dose-escalated, nonrandomized, open-label, clinical trial of patients with GBM who are undergoing surgical resection for recurrence. Up to 18 patients will receive intracavitary application of AMSCs encapsulated in fibrin glue during surgical resection. All patients will be followed for up to 5 years for safety and survival data. Adverse events will be recorded using the CTCAE V5.0.

EXPECTED OUTCOMES:

This study will explore the maximum tolerated dose of AMSCs along with the toxicity profile of this therapy in patients with recurrent GBM. In addition, preliminary long-term survival and progression-free survival outcome analysis will be used to power further randomized studies. Finally, cerebrospinal fluid and blood will be obtained throughout the treatment period to investigate circulating molecular and inflammatory tumoral/stem cell markers and explore the mechanism of action of the therapeutic intervention.

DISCUSSION:

This prospective translational study will determine the initial safety and toxicity profile of local delivery of AMSCs for recurrent GBM. It will also provide additional survival metrics for future randomized trials.
Removal of Spinal Calcified Meningiomas With Piezosurgery: Technical Note on a New Application of a Known Device
Authors: Rispoli Rossella , Pizzolitto Stefano , Cappelletto Barbara
Published: November 2024

BACKGROUND AND IMPORTANCE:

Ossified spinal meningiomas are a rare form of spinal tumor. The removal in narrow surgical space is challenging because of their hard consistency and strong adhesion to the neural tissue. These meningiomas are often located in the upper thoracic spine, and sometimes, even the identification of the correct intraoperative level is difficult.

CLINICAL PRESENTATION:

We describe the clinical findings, surgical strategies, and histological findings of a patient with a thoracic ossified meningioma.

DISCUSSION:

We discuss the technical points, safety, and efficacy of the piezosurgery device in reducing the calcified mass.

CONCLUSION:

The device has the potential to reduce the operating time and enhance surgical safety when removing ossified meningiomas.
A Case of Sellar Arachnoid Cyst Operated Using the Endoscopic Supraorbital Keyhole Approach
Authors: Yamashiro Kei , Higashiguchi Saeko , Wakako Akira , Omi Tatsuo , Hayakawa Motoharu , Hirose Yuichi
Published: November 2024

BACKGROUND AND IMPORTANCE:

In recent years, sellar arachnoid cysts (ACs) have been increasingly treated using an endoscopic transnasal approach. It is important to connect the subarachnoid space with the AC to prevent recurrence; however, a high frequency of postoperative cerebrospinal fluid (CSF) leakage has been reported with the endoscopic transnasal approach, and the suitability of the endoscopic transnasal approach for treating sellar ACs is questionable to begin with.

CLINICAL PRESENTATION:

A man in his 40s underwent surgery for a sellar AC compressing the optic chiasm. The normal pituitary gland was compressed dorsally by the cyst, and an endoscopic supraorbital keyhole approach was adopted to reduce the risk of postoperative CSF leakage. A small incision was made in the right eyebrow, and a small craniotomy was performed. A rigid scope was used to approach the cyst and incise the arachnoid membrane of the prechiasmatic cistern and the anterior wall of the cyst. Postoperatively, the cyst shrank, and the preoperative visual field defects improved. The duration of the endoscopic manipulation was approximately 40 minutes.

DISCUSSION:

The endoscopic supraorbital keyhole approach eliminates the need to incise the dura mater of the anterior skull base and reduces the risk of CSF leakage compared with the transnasal approach. In addition, cumbersome dural reconstruction using fat and fascia is not required during the supraorbital keyhole approach, which reduces operation time.

CONCLUSION:

The endoscopic supraorbital keyhole approach may be more suitable than the transnasal approach for surgery of sellar ACs.