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| 4. |
- 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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| 7. |
- 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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| 9. |
- 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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| 11. |
- Bartek, Jiri, et al.
(författare)
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The role of angiotensin converting enzyme inhibitor in patients with chronic subdural hematoma: a Scandinavian population-based multicenter study.
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 113
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the role of angiotensin converting enzyme (ACE) inhibitors in recurrence of chronic subdural hematoma (cSDH) after burr-hole surgery.A retrospective review was conducted in a Scandinavian multicenter population-based cohort of 1252 adult cSDH patients operated with burr-hole surgery between January 1, 2005 and December 31, 2010. The risk of cSDH recurrence was assessed in users of ACE inhibitors, users of angiotensin II receptor blockers (ARB) and those without ACE inhibitor treatment (no ACE inhibitor group) using univariable and multivariable regression analyses.There were 98 users (7.8%) of ACE inhibitors, and 63 users (5%) of ARBs only. The recurrence rate in the ACE inhibitor group was 16.3% (n=16), compared to 13.3% (n=153) in the no ACE inhibitor group (p=0.39) and 14.3% (n=9) in the ARB group (p=0.73). When comparing groups, age (p=0.01), Charlson comorbidity Index (p=0.01), the use of platelet inhibitors (p=0.001) and use of anticoagulants (p=0.01) differed between the ACE inhibitor and the no ACE inhibitor group. Only age differed (p=0.03) between the ACE inhibitor and ARB groups. In the analyses adjusted for differences in baseline characteristics, ACE inhibitor treatment did not influence risk for recurrence (OR 1.2, 95 % CI 0.7-2.2 p=0.46).Use of ACE inhibitors was not associated with risk of recurrence following burrhole surgery for cSDH in this population based study..
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| 12. |
- Basma, Jaafar, et al.
(författare)
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Minimizing Collateral Brain Injury Using a Protective Layer of Fibrin Glue : Technical Note
- 2015
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 84:6, s. 2030-2036
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Neurosurgical procedures expose the brain surface to a constant risk of collateral injury. We describe a technique where the brain surface is covered with a protective layer of fibrin glue and discuss its advantages. METHODS: A thin layer of fibrin glue was applied on the brain surface after its exposure in 34 patients who underwent different craniotomies for tumoral and vascular lesions. Data of 35 more patients who underwent standard microsurgical technique were collected as a control group. Cortical and pial injuries were evaluated using an intra-operative visual scale. Eventual abnormal signals at the early postoperative T2-weighted fluid-attenuated inversion recovery (T2FLAIR) magnetic resonance imaging (MRI) sequences were evaluated in oncological patients. RESULTS: Total pial injury was noted in 63% of cases where fibrin glue was not used. In cases where fibrin glue was applied, a significantly lower percentage of 26% (P < 0.01) had pial injuries. Only 9% had injuries in areas covered with fibrin glue (P < 0.0001). Early postoperative T2FLAIR MRI confirmed the differences of altered signal around the surgical field in the two populations. CONCLUSION: We propose beside an appropriate and careful microsurgical technique the possible use of fibrin glue as alternative, safe, and helpful protection during complex microsurgical dissections. Its intrinsic features allow the neurosurgeon to minimize the cortical manipulation preventing minor collateral brain injury.
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| 13. |
- Bergenheim, Tommy, et al.
(författare)
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Percutaneous retrogasserian balloon compression for trigeminal neuralgia : review of critical technical details and outcomes
- 2013
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 79:2, s. 359-368
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe percutaneous balloon compression (PBC) of the trigeminal rootlets as treatment for trigeminal neuralgia (TN), including history, operative techniques, outcomes, side effects, and some recent findings increasing the likelihood of a positive outcome.METHODS: PBC is indicated in patients with TN in whom microvascular decompression is considered less suitable. The procedure is simplified by the use of biplanar fluoroscopy, although it is usually carried out with C-arm fluoroscopy to facilitate the introduction of the needle and the visualization of the inflated catheter. In the right position, a clearly defined pear shape usually appears after injection of 0.5-0.7 mL of contrast material. The balloon is kept inflated for 1.5-3 minutes. It is crucial to obtain a pear shape because this probably is the most significant factor for obtaining good, long-lasting pain relief.RESULTS: An analysis of 100 consecutive PBC procedures showed an initial success rate of 90% and a median pain-free time without medication of 28 months. Subdividing these patients into primary TN (n = 77) and TN secondary to multiple sclerosis (a = 23), the median pain-free times were 33 months and 24 months (P = 0.2), indicating that the outcome may depend on the preoperative conditions.CONCLUSIONS: Complications and side effects include cardiovascular stress during the procedure, local hemorrhages in the cheek, postoperative sensory disturbance, masseter weakness, infections, and transitory diplopia after surgery. Measures to minimize side effects are proposed. With meticulous technique, PBC is a straightforward, effective, and fast procedure that compares well with other percutaneous therapies for TN.
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| 14. |
- Blomstedt, Patric, et al.
(författare)
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Deep Brain Stimulation in the Treatment of Obsessive-Compulsive Disorder
- 2013
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 80:6, s. E245-E253
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Deep brain stimulation (DBS) has emerged as a treatment for severe cases of therapy-refractory obsessive-compulsive disorder (OCD), and promising results have been reported. The literature might, however, be somewhat unclear, considering the different targets used, and due to repeated inclusion of individual patients in multiple publications. The aim of this report was to review the literature on DBS for OCD. METHODS: The modern literature concerning studies conducted on DBS in the treatment of OCD was reviewed. RESULTS: The results of DBS in OCD have been presented in 25 reports with 130 patients, of which, however, only 90 contained individual patients. Five of these reports included at least 5 individual patients not presented elsewhere. Sixty-eight of these patients underwent implantation in the region of the internal capsule/ventral striatum, including the nucleus accumbens. The target in this region has varied between groups and over time, but the latest results from bilateral procedures in this area have shown a 50% reduction of OCD scores, depression, and anxiety. The subthalamic nucleus has been suggested as an alternative target. Although beneficial effects have been demonstrated, the efficacy of this procedure cannot be decided, because only results after 3 months of active stimulation have been presented so far. CONCLUSIONS: DBS is a promising treatment for therapy-refractory OCD, but the published experience is limited and the method is at present an experimental therapy.
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| 17. |
- Campanella, Fabio, et al.
(författare)
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Localizing Memory Functions in Brain Tumor Patients : Anatomical Hotspots over 260 Patients
- 2018
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Ingår i: World Neurosurgery. - : Elsevier. - 1878-8750 .- 1878-8769. ; 120, s. e690-e709
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Memory complaints are common in patients after brain tumor, but is difficult to map memory functions during awake surgery, to preserve them. Thus we analyzed one of the largest data sets on clinical, surgical, and anatomical correlates of memory in patients with brain tumor to date, providing anatomical hotspots for short and long-term memory functions. METHODS: A total of 260 patients with brain tumor (130 high-grade gliomas; 76 low-grade gliomas [LGG]; 54 meningiomas) were tested on 2 commonly used short-term memory (Digit Span Forward and Corsi Spatial Span) and 2 long-term memory tasks (Narrative Memory and Delayed Recall of Rey Figure). Patients were evaluated before and immediately after surgery and (for LGG) after 4 months and data analyzed by means of analysis of covariance and the voxel-based lesion-symptom mapping technique. RESULTS: As expected, patients with high-grade gliomas were already impaired before surgery, whereas patients with meningioma were largely unimpaired. Patients with LGG were unimpaired before surgery, but showed significant performance drop immediately after, with good recovery within few months. Voxel-based lesion-symptom mapping analyses identified specific anatomical correlates for verbal memory tasks, whereas visuospatial tasks provided good sensitivity to cognitive damage but failed to show anatomical specificity. Anatomical hotspots identified were in line with both previous functional magnetic resonance imaging and clinical studies on other neurological populations. CONCLUSIONS: Verbal memory tasks revealed a set of specific anatomical hotspots that might be considered eloquent for verbal memory functions, unlike visuospatial tasks, suggesting that commonly used spatial memory tasks might not be optimal to localize the damage, despite an otherwise good sensitivity to cognitive damage.
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| 18. |
- Campanella, Fabio, et al.
(författare)
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Long-Term Cognitive Functioning and Psychological Well-Being in Surgically Treated Patients with Low-Grade Glioma
- 2017
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 103, s. 799-808.e9
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this work is to provide an in-depth investigation of the impact of low-grade gliomas (LGG) and their surgery on patients' cognitive and emotional functioning and well-being, carried out via a comprehensive and multiple-measure psychological and neuropsychological assessment.Patients and Methods: Fifty surgically treated patients with LGG were evaluated 40 months after surgery on their functioning over 6 different cognitive domains, 3 core affective/emotional aspects, and 3 different psychological well-being measures to obtain a clearer picture of the long-term impact of illness and surgery on their psychological and relational world. Close relatives were also involved to obtain an independent measure of the psychological dimensions investigated.Results: Cognitive status was satisfactory, with only mild short-term memory difficulties. The affective and well-being profile was characterized by mild signs of depression, good satisfaction with life and psychological well-being, and good personality development, with patients perceiving themselves as stronger and better persons after illness. However, patients showed higher emotional reactivity, and psychological well-being measures were negatively affected by epileptic burden. Well-being was related to positive affective/emotional functioning and unrelated to cognitive functioning. Good agreement between patients and relatives was found.Conclusions: In the long-term, patients operated on for LGG showed good cognitive functioning, with no significant long-term cognitive sequelae for the extensive surgical approach. Psychologically, patients appear to experience a deep psychological change and maturation, closely resembling that of so-called posttraumatic growth, which, to our knowledge, is for the first time described and quantified in patients with LGG.
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| 22. |
- Drewes, Christina, et al.
(författare)
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Perioperative and postoperative quality of life in glioma patients - A longitudinal cohort study.
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 117
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Tidskriftsartikel (refereegranskat)abstract
- Few studies assess patient-reported quality of life (QoL) in glioma patients undergoing surgery, and even fewer provide longitudinal data. Accordingly, there is little knowledge about the changes of QoL over time in glioma patients. We sought to explore peri- and postoperative development of generic QoL during the first six months after primary glioma surgery.136 adult patients undergoing primary surgery for high-grade (HGG) or low-grade (LGG) glioma were prospectively included in this explorative, longitudinal study. Patient-reported QoL was measured with the generic tool EQ-5D 3L preoperatively and at 1 and 6 months after surgery.At group level, there was no difference in EQ-5D index values in patients with HGG compared to patients with LGG at baseline or at 1 month. At 6 months, EQ-5D index values in HGG patients had deteriorated significantly (p<0.001), but remained stable in LGG patients. Individual level QoL development was more diverse. American Society of Anesthesiology class ≥3, resection grades other than gross total resection (GTR) and HGG were identified as independent predictors for negative development of QoLbetween 1 and 6 months after surgery.At group level, development of generic QoL between baseline and 1 and 6 months postoperatively seems to follow the natural disease trajectories of LGG and HGG, with deterioration in HGG patients at 6 months. Individual development of QoL is heterogeneous. HGG, resection grades other than GTR and preoperative comorbidity are predictors of postoperative QoL-impairment.
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| 24. |
- Eleftheriou, Andreas, et al.
(författare)
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Optical Coherence Tomography Revealing Ganglion Cell Loss in Idiopathic Normal Pressure Hydrocephalus
- 2021
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Ingår i: World Neurosurgery. - : Elsevier Science. - 1878-8750 .- 1878-8769. ; 149, s. E1061-E1066
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although there may theoretically be a disturbance in the eye or the visual pathways due to abnormal cerebrospinal fluid (CSF) dynamics in idiopathic normal pressure hydrocephalus (iNPH), it has not been studied systemically. Optical coherence tomography (OCT) is a noninvasive, reproducible procedure for quantitative and qualitative analysis of retinal morphology. METHODS: OCT was used to study the eye fundus before and after a CSF tap test in patients with iNPH compared with healthy individuals (HIs). Twelve patients with iNPH (6 females and 6 males) with a median age of 76 years (64-84 years) and 21 HIs (11 females and 10 males) with a median age of 73 years (64-79 years) were included. The patients underwent neurological, cognitive, and physiotherapeutic evaluation. Brain magnetic resonance imaging, CSF tap test via lumbar puncture, and subsequently CSF analysis were performed. OCT was performed before and after CSF removal. HIs underwent OCT once. RESULTS: The patients had significantly reduced retinal ganglion cell layer thickness 71 mu m (56-81 mu m) compared with the HIs, 79.5 mu m (72-90 mu m) (P = 0.001), but no sig -ificant changes were observed before or after the CSF tap test. All patients improved in motor function in a 10-m walk test after the CSF tap test. The median CSF pressure was 15 and 1 cm H2O, respectively, before and after lumbar puncture with removal of median 43.5 mL CSF. CONCLUSIONS: This pilot study shows OCT findings that differ from HIs and implies a rational for becoming a valuable tool in the diagnosis of iNPH. Further studies are warranted to elucidate the pathology of the retina in iNPH.
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| 29. |
- Jakobsson, Johan, et al.
(författare)
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Long-Term Functional Outcome and Quality of Life After Surgical Evacuation of Spontaneous Supratentorial Intracerebral Hemorrhage: Results from a Swedish Nationwide Cohort
- 2022
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 70
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate long-term survival, neurologic outcome, and quality of life in patients with spontaneous supratentorial intracerebral hemorrhage (ICH) treated with craniotomy and hematoma evacuation. Methods: A nationwide multicenter retrospective analysis of 341 patients who underwent craniotomy and evacuation of supratentorial ICH between January 1, 2011, and December 31, 2015, was performed. Baseline characteristics associated with 6-month mortality and long-term mortality were investigated. Survivors received a questionnaire about their state of health from which EuroQol 5D (EQ-5D) and modified Rankin scale (mRS) were obtained. Predictors of mortality, unfavorable outcome, and life quality were analyzed. Results: The mean follow-up time was 55.2 months. Predictors of 6-month mortality in multiple regression analysis were age ≥75 years, previous myocardial infarction, lower level of consciousness, and mechanical ventilation. Predictors of long-term mortality were higher age and mechanical ventilation. At follow-up, 49.5% of survivors had a favorable neurologic outcome (mRS ≤3). Predictors of an unfavorable functional outcome were higher age and ICH volume ≥50 mL. The mean EQ-5D health index was 0.719, and the mean EQ-5D visual analog scale score was 53.9. In multiple regression, only a higher mRS score was significantly associated with worse life quality. Conclusions: Knowledge about survival, functional outcome, and life quality as well as their predictors in this specific patient group is previously primarily described in short-term follow-up. This multicenter study provides novel information in the long-term perspective, which is important for improved surgical decision-making and prognostication.
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| 30. |
- Jakobsson, Max, et al.
(författare)
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Prediction of Objectively Measured Physical Activity and Self-Reported Disability Following Lumbar Fusion Surgery.
- 2019
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 121
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the predictive value of preoperative fear-avoidance factors (self-efficacy for exercise, pain catastrophizing, kinesiophobia, and depression), walking capacity, and traditional predictor variables for predicting postoperative changes in physical activity level and disability 6 months after lumbar fusion surgery in patients with chronic low back pain (LBP). METHODS: We prospectively enrolled 118 patients scheduled for lumbar fusion surgery for motion-elicited chronic LBP with degenerative changes in 1-3 segments of the lumbar spine. Associations between the predictors and the dependent variables were investigated with multiple linear regression analysis. Dependent variables were physical activity level as objectively measured with a triaxial accelerometer and disability as measured with the Oswestry Disability Index. RESULTS: Preoperative physical activity level (β=-0.349; P < 0.001) and self-efficacy for exercise (β= 0.176; P= 0.021) were significant predictors of the postoperative change in physical activity. Preoperative disability (β=-0.790; P < 0.001), self-efficacy for exercise (β= 0.152; P= 0.024), and pain catastrophizing (β= 0.383; P= 0.033) were significant predictors for the change in the Oswestry Disability Index. CONCLUSIONS: Patients with low levels of preoperative physical activity were more likely to increase their level of physical activity after lumbar fusion surgery, especially when their self-efficacy for exercise was high. However, most of these patients still had low levels of physical activity after surgery, and they may therefore need extra support in increasing their postoperative physical activity levels.
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| 31. |
- Jervaeus, Anna, et al.
(författare)
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Does the Time Trade-off Method Reflect Health-Related Quality of Life? : A Mixed Methods Analysis of Preference Measures 10 Years After Aneurysmal Subarachnoid Hemorrhage
- 2019
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 126, s. 11-20
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate if the time trade-off (TTO) method reflects health-related quality of life (HRQoL) 10 years after an aneurysmal subarachnoid hemorrhage (aSAH).Methods: A cross-sectional study with a mixed-methods approach was used to follow up 208 patients treated for aSAH. Data were collected with intramethod mixing; the quantitative data consisted of the EQ-5D-3L instrument and a TTO question, and the qualitative data comprised motivations to the TTO answer. The quantitative data were analyzed statistically and comparisons were made between participants willing to trade off years and those not willing to trade off years. The qualitative data were merged in a matrix and analyzed with manifest content analysis.Results: Participants willing to trade off years scored significantly lower HRQoL, and the correlation between EQ-5Dindex and EQ VAS to TTO values were rs = 0.369 (P < 0.001) and rs = 0.345 (P < 0.001), respectively. In the content analysis, 4 categories emerged: perceived full health or satisfactory life; adaptability and managing strategies; the importance of hope and meaning in life; and unacceptable changes do not make life worth living. The results showed that several reasons other than health status were evident when expressing the willingness to trade off or not trade off life-years.Conclusions: Individuals willing to trade off years showed significantly poorer HRQoL; however the TTO method did not seem to fully reflect HRQoL. Most participants did not want to trade off years, despite their living with severe disability, making it difficult to fully rely on the TTO method in evaluation of medical outcome.
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| 32. |
- Jirlow, Unni, et al.
(författare)
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Evaluation of Miethke M.scio Device Implantation for Intracranial Pressure Monitoring in Patients with Cerebrospinal Fluid Disorders
- 2023
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Ingår i: World Neurosurgery. - : Elsevier. - 1878-8750 .- 1878-8769. ; 179, s. E63-E74
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with complex shunt-related problems and varying diagnoses of cerebrospinal fluid (CSF) disturbance can present with headache and clinical symptoms that may be difficult to relate to underdrainage or overdrainage. Telemetric intracranial pressure (ICP) monitoring may assist in evaluating individual patients and assessing shunt function and adjustment. We report a case series of patients receiving a Miethke M.scio sensor.METHODS: Between June 2016 and August 2021, 14 patients older than 18 years with different diagnoses underwent ventriculoperitoneal shunt surgery and received a Miethke M.scio sensor.RESULTS: Patients had idiopathic intracranial hyper-tension (n = 3), obstructive hydrocephalus caused by tumors (n = 4), and malformations (n = 5). Headaches (71%) and visual impairment (50%) were the most common symptoms before surgery and 65% of the symptoms were improved after surgery. In total, 25 measurements were made and 11 of these led to changes in the shunt settings. Postoperative measurements were taken in 8 patients and the most common indication of ICP measurement was headache and/or control of the shunt settings.CONCLUSIONS: The Miethke M.scio is a safe and valuable device to use in shunt-treated patients, in particular those expected to need assessment of ICP monitoring postoperatively. Repeated ICP measurements can also assist in personalized adjustment of the shunt setting to optimize CSF flow in this diverse patient group. Future studies should include a standardized protocol with ICP measurements correlated to the symptoms and cause of CSF disturbances to provide better understanding of the dynamics of the ICP in each patient.
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| 33. |
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| 34. |
- Kemani, Mike K., et al.
(författare)
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Fear of Movement Is Related to Low Back Disability During a Two-Year Period in Patients Who Have Undergone Elective Lumbar Spine Surgery
- 2020
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 137
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate change in fear of movement and the relationship of fear of movement and pain intensity to low back disability and general health-related quality of life over a 2-year period. Methods: Consecutive patients scheduled for lumbar spine surgery were included. In addition to clinical background variables, back pain intensity, fear of movement, low back disability, and general health-related quality of life were assessed at baseline, 1 year, and 2 years after surgery. Linear mixed-effects models were used to analyze data. Results: In total, 348 patients were included in the final analyses. There was a significant reduction in fear of movement and a significant interaction between fear of movement and low back disability across assessments, showing that greater levels of fear of movement were related to greater levels of disability over the 2-year period. Similarly, greater levels of back pain intensity were related to lower levels of general health-related quality of life during this period. Conclusions: We found that greater levels of fear of movement were related to greater levels of low back disability, following lumbar spine surgery, in a longitudinal study. This shows the need to address fear of movement in prehabilitation/rehabilitation pre- or postsurgically to improve health outcomes for patients who undergo lumbar spine surgery. © 2020 Elsevier Inc.
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| 35. |
- Khaki, D., et al.
(författare)
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Differences in Presentation, Radiological Features, and Outcomes in Traumatic Versus Spontaneous Acute Subdural Hematomas-A Single-Institution Population-Based Study
- 2022
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 164
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Spontaneous acute subdural hematoma (sASDH) is a rare neurosurgical condition, with the literature mainly consisting of case reports. In the present study, we compared sASDH with traumatic ASDH (tASDH) to determine the differences in presentation, radiological features, and outcomes in a population-based setting. METHODS: All adult patients (age >= 18 years) who had undergone surgery for ASDH (n = 266), either spontaneous or traumatic, from 2010 to 2020 were included retrospectively. The cohort was divided into 2 groups for comparative analysis: sASDH group (n = 24) versus tASDH group (n = 242). RESULTS: Of the 266 patients, 24 (9.0%) had presented with sASDH. The sASDH group had a mean age of 66.2 years, and sudden headache was the most common presenting symptom (83.3%). The sASDH group had a higher Glasgow coma scale score at presentation compared with the tASDH group (Glasgow coma scale scores, 10 and 8, respectively; P < 0.01). The outcomes, assessed using the Glasgow outcome scale (GOS), revealed a greater incidence of more favorable outcomes (GOS score 4-5) for the sASDH group (72.7%) than for the tASDH group (41.5%). CONCLUSIONS: In the present population-based study of surgically evacuated ASDH cases, 9% were spontaneous without previous trauma. The outcomes (GOS scores) were significantly more favorable for those with sASDH than for those with tASDH. In one half of the patients with sASDH, arterial bleeding was noted perioperatively, although the preoperative radiological examinations revealed no abnormalities for most patients. However, the lack of sufficient examinations such as computed tomography angiography made it difficult to establish the most common etiology of bleeding in those with sASDH. Further research is warranted to determine the reference standard method for the investigation of sASDH.
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| 36. |
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| 37. |
- Kihlström Burenstam Linder, Lars, et al.
(författare)
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Patient-Specific Titanium-Reinforced Calcium Phosphate Implant for the Repair and Healing of Complex Cranial Defects
- 2019
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Ingår i: World Neurosurgery. - : ELSEVIER SCIENCE INC. - 1878-8750 .- 1878-8769. ; 122, s. E399-E407
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The reconstruction of complex cranial defects is challenging and is associated with a high complication rate. The development of a patient-specific, titanium-reinforced, calcium phosphate-based (CaP-Ti) implant with bone regenerative properties has previously been described in 2 case studies with the hypothesis that the implant may improve clinical outcome. OBJECTIVE: To identify whether the introduction of CaP-Ti implant has the potential to improve clinical outcome. METHODS: A retrospective review of all patients having undergone CaP-Ti cranioplasty was conducted. Comprehensive clinical data were collected from the hospital computer database and patient records. Bone formation and osseointegration were analyzed in a single retrieval specimen. RESULTS: Fifty patients, with 52 cranial defects, met the inclusion criteria. The patient cohort displayed a previous failure rate of 64% (32/50) with autologous bone, alloplastic materials, or both. At a median follow-up time of 25 months, the explantation rate due to either early postoperative infection or persistent wound dehiscence was 1.9% (1/53) or 3.8% (2/53), respectively. Surgical intervention with local wound revision was required in 2 patients without the need of implant removal. One patient had a brain tumor recurrence, and the implant was explanted 31 months after implantation. Histologic examination showed that the entire implant was partly yet evenly transformed into vascularized compact bone. CONCLUSION: In the present study the CaP-Ti implant appears to have improved the clinical outcomes in a cohort of patients with a high rate of previous cranioplasty failures. The bone regenerative effect may in particular have an impact on the long-term success rate of the implant.
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| 38. |
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| 39. |
- Lilford, Robert D., et al.
(författare)
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Increased Incidence and Mortality of Civilian Penetrating Traumatic Brain Injury in Sweden : A Single-Center Registry-Based Study
- 2024
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Ingår i: World Neurosurgery. - : Elsevier. - 1878-8750 .- 1878-8769. ; 182, s. e493-e505
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPenetrating trauma to the head and neck has increased during the past decade in Sweden. The aim of this study was to characterize these injuries and evaluate the outcomes for patients treated at a tertiary trauma center.MethodsSwedish trauma registry data were extracted on patients with head and neck injuries admitted to Karolinska University Hospital (Stockholm, Sweden) between 2011 and 2019. Outcome information was extracted from hospital records, with the primary endpoints focusing on the physiological outcome measures and the secondary endpoints on the surgical and radiological outcomes.ResultsOf 1436 patients with penetrating trauma, 329 with penetrating head and neck injuries were identified. Of the 329 patients, 66 (20%) had suffered a gunshot wound (GSW), 240 (73%) a stab wound (SW), and 23 (7%) an injury from other trauma mechanisms (OTMs). The median age for the corresponding 3 groups of patients was 25, 33, and 21 years, respectively. Assault was the primary intent, with 54 patients experiencing GSWs (81.8%) and 158 SWs (65.8%). Patients with GSWs had more severe injuries, worse admission Glasgow coma scale, motor, scores, and a higher intubation rate at the injury site. Most GSW patients underwent major surgery (59.1%) as the initial procedure and were more likely to have intracranial hemorrhage (21.2%). The 30-day mortality was 45.5% (n = 30) for GSWs, 5.4% (n = 13) for SWs, and 0% (n = 0) for OTMs. There was an annual increase in the incidence and mortality for GSWs and SWs.ConclusionsBetween 2011 and 2019, an increasing annual trend was found in the incidence and mortality from penetrating head and neck trauma in Stockholm, Sweden. GSW patients experienced more severe injuries and intracranial hemorrhage and underwent more surgical interventions compared with patients with SWs and OTMs.
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| 40. |
- Lönnemark, Olle, et al.
(författare)
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Cranioplasty in Brain Tumor Surgery : A Single-Center Retrospective Study Investigating Cranioplasty Failure and Tumor Recurrence
- 2023
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Ingår i: World Neurosurgery. - : Elsevier. - 1878-8750 .- 1878-8769. ; 170, s. e313-e323
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Cranioplasty with synthetic implant can be performed to restore function and form of the skull after resection of malignancy infiltrating the bone. The aim of this study was to examine the rate of implant failure and tumor recurrence in patients undergoing nonautologous cranioplasty and tumor resection.METHODS: In this retrospective single-center study, 48 patients were identified who had undergone cranioplasty with synthetic implants after tumor resection between 2010 and 2020. The medical records were analyzed to investigate patient demographics, surgery data, cranioplasty failure rates, and rate of tumor recurrence.RESULTS: Cranioplasty failed in 8 patients. The median time to implant failure was 220 days with most failures occurring within 1 year (5 of 8). There was no significant difference in rate or time to failure between the different cranioplasty materials (P = 0.39). Low body mass index (P < 0.05), previous craniectomy/cranioplasty (P < 0.05), previous radiation therapy to the brain/skull (P < 0.05), and skin closure with sutures (P < 0.05) were associated with an increased risk of implant failure. Tumors recurred in 15 patients.CONCLUSIONS: Cranioplasty surgery with synthetic implants carries a relatively high risk of failure, regardless of type of cranioplasty material used. Skin closure with staples may be beneficial in these patients.
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| 41. |
- Maduri, Rodolfo, et al.
(författare)
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Image Merge Tailored Access Resection (IMTAR) of Spinal Intradural Tumors. Technical Report of 13 Cases.
- 2017
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 98, s. 594-602
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Standard translaminar approaches for intradural extramedullary (IDEM) tumors require extensive soft tissue dissection and partial facet removal. Ventral lesions may necessitate wider bone resection with subsequent possible spinal instability. Any manipulation of an already compromised spinal cord may lead to neurological injury. We describe an image-guided minimal access technique for IDEM tumor resection.METHODS: Retrospective chart review of 13 consecutive patients after institutional ethics committee approval. We superimpose preoperative magnetic resonance imaging data with intraoperative 3-dimensional fluoroscopic images, allowing to simultaneously visualize osseous anatomy and the soft tissue lesion using appropriate windowing. We then plan optimal angle of trajectory to the tumor, which defines the skin incision and the transmuscular trajectory. A tubular retractor is placed to span the tumor. Microsurgical tumor resection is then carried out using this angle of approach.RESULTS: Thirteen patients (mean age. 57 years; male-to-female ratio, 10:3) were operated on during 28 months. Gross total resection was achieved in all patients. Neurological improvement occurred in 12 of the 13 patients. There was no neurological deficit outside of the expected sensory loss due to intentional nerve root sacrifice. No mechanical pain nor tumor recurrence were noted during the follow-up (mean, 16 months; range, 2-30 months).CONCLUSIONS: Image merge tailored access resection appears to be at least equivalent in terms of tumor resection, blood loss, and complications to other tubular techniques. It may reduce risks of neurological deficit and spine instability. Image merge tailored access resection is a novel application of merging intraoperative fluoroscopic images with preoperative magnetic resonance images for tailored IDEM resection.
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| 42. |
- Magnéli, Sara, et al.
(författare)
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Cystoventricular Drainage of Intracranial Arachnoid Cysts in Adults
- 2021
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Ingår i: World Neurosurgery. - : Elsevier. - 1878-8750 .- 1878-8769. ; 152, s. e297-e301
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Intracranial arachnoid cysts (ACs) are generally benign fluid-filled cysts with a prevalence of 0.5%-2.7%. They can be treated through craniotomy with cyst removal, endoscopic fenestration, or cystoperitoneal or ventriculoperitoneal shunting. However, the outcome of these treatments has not been completely satisfactory. Cystoventricular shunting was described as an alternative method for the treatment of intracranial ACs in children in 2003. In the present report, we have described the outcomes of cystoventricular shunting in adults with symptomatic intracranial ACs.METHODS: A total of 24 patients with symptomatic ACs underwent cystoventricular drainage from 2012 to 2019. The most common symptom preoperatively was headache, followed by dysphasia, motor weakness, memory loss, seizures, and balance disturbances. After radiological evaluation, a ventricular catheter was placed in the AC and another in one of the lateral ventricles and connected extracranially after subgaleal tunneling using a straight metal connector.RESULTS: At 3-6 months of postoperative follow-up, 21% of patients were asymptomatic and 42% showed improvement in clinical symptoms. No patient had experienced impairment or progression of symptoms postoperatively. Three patients had required revision of the catheters and one patient had developed a postoperative superficial skin infection without signs of deeper infection.CONCLUSIONS: Cystoventricular drainage seems to be an effective, reliable, and safe procedure to treat intracranial ACs when fenestration to the basal cisterns is not possible.
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| 43. |
- Mathiesen, T, et al.
(författare)
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Meningiomas engaging major venous sinuses
- 2014
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 81:1, s. 116-124
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Tidskriftsartikel (refereegranskat)
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| 44. |
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| 45. |
- Michaëlsson, Isak, et al.
(författare)
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Circulating Brain-Injury Markers After Surgery for Craniosynostosis
- 2023
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 173
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Historically, there have been few quantitative methods for effectively evaluating outcomes after surgery for craniosynostosis. In this prospective study, we assessed a novel approach for detecting possible postsurgery brain injury in patients with craniosynostosis. Methods: We included consecutive patients operated on for sagittal (pi-plasty or craniotomy combined with springs) or metopic (frontal remodeling) synostosis at the Craniofacial Unit at Sahlgrenska University Hospital, Gothenburg, Sweden, from January 2019 to September 2020. Plasma concentrations of the brain-injury biomarkers neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and tau were measured immediately before induction of anesthesia, immediately before and after surgery, and on the first and the third postoperative days using single-molecule array assays. Results: Of the 74 patients included, 44 underwent craniotomy combined with springs for sagittal synostosis, 10 underwent pi-plasty for sagittal synostosis, and 20 underwent frontal remodeling for metopic synostosis. Compared with baseline, GFAP level showed a maximal significant increase at day 1 after frontal remodeling for metopic synostosis and pi-plasty (P = 0.0004 and P = 0.003, respectively). By contrast, craniotomy combined with springs for sagittal synostosis showed no increase in GFAP. For neurofilament light, we found a maximal significant increase at day 3 after surgery for all procedures, with significantly higher levels observed after frontal remodeling and pi-plasty compared with craniotomy combined with springs (P < 0.001). Conclusions: These represent the first results showing significantly increased plasma levels of brain-injury biomarkers after surgery for craniosynostosis. Furthermore, we found that more extensive cranial vault procedures resulted in higher levels of these biomarkers relative to less extensive procedures.
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| 46. |
- Naesström, Matilda, et al.
(författare)
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Deep Brain Stimulation in the Bed Nucleus of Stria Terminalis in Obsessive-Compulsive Disorder : 1-Year Follow-up
- 2021
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Ingår i: World Neurosurgery. - : Elsevier. - 1878-8750 .- 1878-8769. ; 149, s. e794-e802
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Tidskriftsartikel (refereegranskat)abstract
- Background: Deep brain stimulation (DBS) is under investigation as a treatment for therapy-refractory obsessive-compulsive disorder (OCD). As a crucial part of the anxiety circuit, the bed nucleus of stria terminalis (BNST) has been proposed as a target for DBS in OCD. Here, we investigate clinical outcomes and safety of DBS in the BNST in a series of 11 participants with severe therapy-refractory OCD.Methods: Eleven consecutive participants diagnosed with refractory OCD were treated with BNST DBS and completed follow-up. The primary outcome was a change in scores of the Yale Brown Obsessive Compulsive Scale (YBOCS) at 1 year after surgery. Secondary outcomes included changes in scores of the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Global Assessment of Functioning.Results: At baseline, the mean ± SD YBOCS score was 33 ± 3.0, MADRS score was 29 ± 4.5, and GAF score was 49 ± 5.4. One year after DBS, mean ± SD YBOCS score was 20 ± 4.8 (38% improvement (range 10%−60%) P < 0.01), MADRS score was 21 ± 5.8 (27% improvement, range 4%−74%, P < 0.01), and Global Assessment of Functioning score was 55 ± 6.5 (12% improvement, range 4%−29%, P < 0.05). Of the 11 participants, 6 were considered responders (decrease in YBOCS ≥35%) and 4 partial responders (decrease in YBOCS 25%−34%). Surgical adverse events included 1 case of skin infection leading to reimplantation. The most common transient stimulation-related side effects were anxiety and insomnia.Conclusions: BNST DBS is a promising therapy in severe therapy-refractory OCD. Our results are in line with previous publications regarding effect and safety profile. Nevertheless, DBS for OCD remains an investigational therapy and should therefore be performed in multidisciplinary clinical studies.
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| 47. |
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| 48. |
- Pyykko, Okko T., et al.
(författare)
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Incidence, Comorbidities, and Mortality in Idiopathic Normal Pressure Hydrocephalus
- 2018
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Ingår i: World Neurosurgery. - : ELSEVIER SCIENCE INC. - 1878-8750 .- 1878-8769. ; 112, s. E624-E631
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Tidskriftsartikel (refereegranskat)abstract
- OBJECT: To investigate the incidence, comorbidities, mortality, and causes of death in idiopathic normal pressure hydrocephalus (iNPH). METHODS: A cohort of 536 patients with possible NPH from a defined population with a median follow-up time of 5.1 years, (range 0.04-19.9 years) was included in the study. Patients were evaluated by brain imaging and intraventricular pressure monitoring, with a brain biopsy specimen immunostained against amyloid-beta and hyper-phosphorylated tau. Hospital records were reviewed for vascular diseases and type 2 diabetes mellitus (T2DM). Death certificates and yearly population of the catchment area were obtained from national registries. RESULTS: A total of 283 patients had a clinical diagnosis of iNPH, leading to a median annual incidence of 1.58 iNPH patients per 100,000 inhabitants (range, 0.8-4.5). Alzeimer disease-related brain biopsy findings were less frequent in iNPH patients than in non-iNPH patients (P < 0.05). An overrepresentation of hypertension (52% vs. 33%, P < 0.001) and T2DM (23% vs. 13%, P = 0.002) was noted in iNPH patients. Age (hazard ratio [HR] 1.04/year, 95% confidence interval [CI] 1.03-1.06, P< 0.001) and T2DM (HR 1.63, 95% CI 1.23-2.16, P < 0.001) increased the risk of death in the iNPH patients and in the total population. iNPH was associated with decreased risk of death (HR 0.63, 95% CI 0.50-0.78, P < 0.001). The most frequent causes of death were cardiovascular and cerebrovascular disease. Dementia as a cause of death was more common in non-iNPH patients (27% vs. 10%, P < 0.001). CONCLUSIONS: Hypertension and T2DM are common in iNPH and the latter causes excess mortality in the affected patients.
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| 49. |
- Ravn Munkvold, Bodil Karoline, et al.
(författare)
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Pre- and postoperative headache in patients with intracranial tumors.
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 115
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Tidskriftsartikel (refereegranskat)abstract
- We sought to examine prevalence of headache in patients with histopathologically verified intracranial tumors scheduled for surgery, and assess change in headache 1 and 6 months after surgical resection. Possible tumor and patient related predictors for preoperative headache and early postoperative symptom relief were also explored.The European Organization for Research and Treatment of Cancer (EORTC) has developed a quality of life questionnaire (EORTC QLQ-C30) with a brain cancer specific module, QLQ-BN20, containing 20 questions rating symptoms the past week on an ordinal scale ranging from 1-4. Analyses are based on question 4 in this questionnaire.In this prospective population based cohort study of 507 patients we found that headache is a frequent symptom in patients with intracranial neoplasms. 52% reported some degree of preoperative headache, and the prevalence dropped to 43% and 30% 1 and 6 months postoperatively. 19% and 9% reported postoperative worsening or new headache 1 and 6 months after surgery. Younger age, female gender and occipital tumor location were significant predictors for both preoperative headache and early postoperative relief. Additionally, Karnofsky Performance Status (KPS) below 70 was a predictor for headache relief 1 month after surgery. No independent risk factors for worsening or new headache after surgery were identified.Headache is a common symptom in patients with intracranial tumors, especially in younger and female patients. Many patients experience improvement after surgery, and younger age, female gender, occipital tumor location and functional dependence were identified as factors associated with early postoperative headache relief.
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| 50. |
- Ravn Munkvold, Bodil Karoline, et al.
(författare)
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The diagnostic properties of intraoperative ultrasound in glioma surgery and factors associated with gross total tumor resection.
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 115
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Tidskriftsartikel (refereegranskat)abstract
- In glioma operations, we sought to analyze sensitivity, specificity and predictive values of intraoperative 3D ultrasound (US) for detecting residual tumor compared to early postoperative MR imaging. Factors possibly associated with radiological complete resection were also explored.144 operations for diffuse supratentorial gliomas were included prospectively in an unselected, population-based single institution series. Operating surgeons filled out a questionnaire immediately after surgery, stating if residual tumor was seen with US at the end of resection and rated US image quality (good, medium, poor). Extent of surgical resection was estimated from pre- and postoperative MRI images.Overall specificity was 85% for "no tumor remnant" seen in US images at the end of resection as compared to postoperative MRI findings. Sensitivity was 46%, but tumor remnants seen on MRI were usually small (median 1.05 ml) in operations with false negative US findings. Specificity was highest in low-grade glioma operations (94%), and lowest in patients who had previously undergone radiotherapy (50%). Smaller tumor volume and superficial location were factors significantly associated with gross total resection in a multivariable logistic regression analysis, while good ultrasound image quality did not reach statistical significance (p = 0.061).The specificity of intraoperative US is rather good, but sensitivity for detecting the last milliliter is low compared to postoperative MRI. Tumor volume and tumor depth are the predictors of achieving gross total resection, while ultrasound image quality was not.
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