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- Almqvist Téran, Nicolas, et al.
(författare)
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Posterior Fossa Volume and Dimensions : Relation to Pathophysiology and Surgical Outcomes in Classic Trigeminal Neuralgia
- 2023
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Ingår i: World Neurosurgery. - : Elsevier. - 1878-8750 .- 1878-8769. ; 179, s. e397-e403
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: A small posterior fossa (PF) has been hypothesized to explain the increased incidence of trigeminal neuralgia (TN) in females and could make microvascular decompression (MVD) more challenging. The aim of this study was to investigate the association between the PF volume and dimensions in relation to biological sex, type of neurovascular conflict (NVC), and outcome after MVD in classic TN.METHODS: In this observational study, 84 patients with TN operated on with MVD with a preoperative head computed tomography(CT) scan were included. Eighty-two adults without TN who had undergone head CT for other reasons were included as controls. PF volume and dimensions (x-axis, y-axis, and z-axis) were evaluated on the CT scans. For the patients with TN, Barrow Neurological Institute (BNI) grade was evaluated 6 months after MVD.RESULTS: There was no difference in PF volume or dimensions between the patients with TN and controls. Women showed a smaller volume and narrower (x-axis) PF than men, but these differences did not manifest when comparing patients with TN and controls within each sex. Patients with an NVC involving the superior cerebellar artery had a narrower (x-axis) and shorter (y-axis) PF than did patients with an NVC resulting from other arteries. PF volume or dimensions were not associated with BNI grade after MVD.CONCLUSIONS: PF anatomy was related to the NVC type but did not differ between patients with TN and controls and was not related to the surgical outcome after MVD.
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- Bader, Sam Er. 1979-, et al.
(författare)
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A Validation Study of Kwon's Prognostic Scoring System for Chronic Subdural Haematoma
- 2022
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Ingår i: World Neurosurgery. - : Elsevier. - 1878-8750 .- 1878-8769. ; 165, s. e365-e372
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Surgery for chronic subdural haematoma (CSDH) is one of the most frequent operations in neurosurgical practice. CSDH afflicts the elderly population most. In 2018, Kwon and co-workers published the Kwon Scoring System (KSS), whereby six clinical and radiological factors are used to facilitate, and promote quality in, surgical decision-making and counselling of relatives. The aim of this study is to validate the KSS.METHOD: Patients operated on for unilateral CSDH at Orebro University Hospital, Sweden, between 2013 and 2019 constituted the study population. General data and the six outcome predictors according to the KSS were extracted from the electronic patient records. The pre-operative mRS score and the post-operative six-month mRS score were assessed.RESULTS: We identified 133 patients (69.2% male) with a median age of 80.2 years (IQR 72.6-85.9). The median GCS at admission was 15; 57.1% had motor deficits and 36.81% were disoriented. For 39.1% of the patients, the prognosis was a favourable outcome (mRS 0-1) at six months. The median KSS score was 9; 63.9% of the patients scored ≥ 9, and 36 (42.4%) of these patients actually achieved a favourable outcome. This corresponds to a prediction model sensitivity of 0.667 and specificity of 0.424. A ROC curve analysis of the model yielded an AUC of 0.62441.CONCLUSION: In our material, the KSS did not predict outcome precisely enough to base treatment decisions or counselling of relatives on the scores obtained.
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- Bartek, J, et al.
(författare)
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Predictors of recurrence and complications after chronic subdural hematoma surgery: a population-based study.
- 2017
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 106, s. 609-614
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Tidskriftsartikel (refereegranskat)abstract
- To investigate predictors of recurrence and moderate to severe complications after burr-hole surgery for chronic subdural hematoma (cSDH).A retrospective review was conducted in a Scandinavian single center population-based cohort of 759 adult cSDH patients operated with burr-hole surgery between January 1, 2005 and December 31, 2010. Possible predictors of recurrence and complications, assessed using a standardized reporting system of adverse events, were identified and analyzed in univariable analyses. Variables with a P value < 0.10 were included in a multivariable regression model.Recurrence was observed in 85 patients (11.2%), while moderate to severe complications were observed in 35 (4.6%) patients. Bilateral hematoma (OR 2.05, 95 % CI 1.25-3.35, P<0.01) and largest hematoma diameter in millimeters, (OR 1.05, 95 % CI 1.01-1.09, P<0.01) were independent predictors of recurrence in the multivariable model analysis. Glasgow Coma Score (GCS) of <13 (OR 6.06, 95 % CI 2.72-13.51, P<0.01) and Charlson Comorbidity Index (CCI) >1 (OR 2.28, 95 % CI 1.10-4.75, P=0.03) were independent predictors of moderate to severe complications.Recurrence after cSDH surgery is more often encountered in patients with radiological more extensive disease reflected by bilateral hematoma and large hematoma diameter. In contrary, moderate to severe complications are more often seen in patients in worse clinical condition, reflected by decreased level of consciousness and more comorbidities.
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