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World neurosurgery 210건

  1. [해외논문]   Clinical Features and Surgical Management of Cerebellopontine Angle Cholesteatoma That Presented as Trigeminal Neuralgia  

    Kai, Ma (To whom correspondence should be addressed: Li Yongjie, M.D.) , Yongjie, Li
    World neurosurgery v.115 ,pp. e7 - e12 , 2018 , 1878-8750 ,

    초록

    Background It is difficult to differentiate patients with cerebellopontine angle (CPA) cholesteatoma and patients with primary trigeminal neuralgia just according to early symptoms. We aimed to explore the clinical characteristics, early diagnosis, and microneurosurgical techniques for CPA cholesteatoma that presented as trigeminal neuralgia. Methods The data of 26 patients who complained trigeminal neuralgia with CPA cholesteatoma between January 2009 and December 2015 were collected and studied retrospectively, they were diagnosed by magnetic resonance imaging preoperatively and confirmed by pathology postoperatively. All the tumors were resected through a retrosigmoidal approach. In 26 cases, 14 patients who underwent cholesteatoma resection and microvascular decompression were assigned to group A and 12 patients who underwent only cholesteatoma resection were assigned to group B. The clinical features and surgical results between groups A and B were compared. The complications and surgical results were followed up, and surgical techniques were summarized. Results All patients presented as trigeminal neuralgia at the same side of the cholesteatoma. There was no statistical difference between the 2 groups in clinical features and surgical results between groups A and B. All patients with cholesteatoma showed clear and significant imaging characteristics. The tumors were totally removed in 18 patients and subtotally removed in 8 patients. Pain relief was satisfactory in all patients. Surgical complications included transient aseptic meningitis in 2 patients, facial numbness in 2 patients, mild tinnitus in 2 patients, mild and facial weakness in 1 patient. No death, hematoma, or acute hydrocephalus were reported in this series. During the follow-up of 12–80 months, no patient experienced recurrence of pain or tumor. Conclusions Cholesteatoma of the cerebellopontine angle often presented as trigeminal neuralgia. Magnetic resonance imaging is helpful for early diagnosis according to its distinct signal. Surgical treatment is often the first choice, the neuralgia relief was satisfactory after operation. Microvascular decompression is recommended simultaneously if some offending vessels were founded during the surgical resection of the tumor. Highlights Secondary trigeminal neuralgia from cerebellopontine angle cholesteatoma and primary trigeminal neuralgia has similar symptoms. Early head MRI scan can provide help for early diagnosis. Cholesteatoma should be removed as far as possible without damaging the function. Microvascular decompression should be performed simultaneously for cases with vascular compression.

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  2. [해외논문]   Peak Timing for Complications After Adult Spinal Deformity Surgery  

    Daniels, Alan H. (Department of Orthopedics, Brown University, Providence, Rhode Island, USA ) , Bess, Shay (Department of Orthopedics, Denver International Spine Center, Presbyterian/St. Luke's, Rocky Mountain Hospital for Children, Denver, Colorado, USA ) , Line, Breton (Department of Orthopedics, Denver International Spine Center, Presbyterian/St. Luke's, Rocky Mountain Hospital for Children, Denver, Colorado, USA ) , Eltorai, Adam E.M. (Department of Orthopedics, Brown University, Providence, Rhode Island, USA ) , Reid, Daniel B.C. (Department of Orthopedics, Brown University, Providence, Rhode Island, USA ) , Lafage, Virginie (Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA ) , Akbarnia, Behrooz A. (San Diego Center for Spinal Disorders, San Diego, California, USA ) , Ames, Christopher P. (Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA ) , Boachie-Adjei, Oheneba (Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA ) , Burton, Douglas C. (Department of Orthopedics, University of Kansas Hospital, Kansas City, Kansas, USA ) , Deviren, Vedat (Department of Orthopedics, University of Californi) , Kim, Han Jo , Hart, Robert A. , Kebaish, Khaled M. , Klineberg, Eric O. , Gupta, Munish , Mundis Jr., Gregory M. , Hostin Jr., Richard A. , O'Brien Jr., Michael , Schwab Jr., Frank J. , Shaffrey Jr., Christopher I. , Smith Jr., Justin S.
    World neurosurgery v.115 ,pp. e509 - e515 , 2018 , 1878-8750 ,

    초록

    Background Overall complication rates for adult spinal deformity (ASD) surgery have been reported; however, little data exist on the peak timing associated with specific complications. This study quantifies the peak timing for multiple complication types in an ASD cohort at minimum 2-year follow-up. Methods Multicenter, prospective analysis of all complications after ASD surgery in a consecutively enrolled cohort was performed. Inclusion criteria were ASD, age ≥18 years, spinal fusion ≥4 levels, and minimum 2-year follow-up. Complications included major and minor and specific complication types. Peak timing of specific complications was identified and described. Regression analysis was performed to assess correlation between patient/surgical factors and complication timing. Results There were 280 patients who met the inclusion criteria. Mean follow-up time was 2.9 years (range, 2–5 years). Of the patients, 209 (74.6%) had at least 1 complication, accounting for 529 total complications (258 minor and 271 major). Both major and minor complications peaked at 24 months. Implant failure peaked at 12–24 and >24 months. There was a significant positive correlation between preoperative sagittal vertical axis and total complications at 6–12 months, major complications at 24 months, and reoperation. Body mass index was associated with total complications and implant failure at 12–24 and >24 months. Conclusions The peak timing of specific complications after ASD surgery is identifiable. Understanding when these complications are likely to occur may improve patient counseling, early diagnosis, and prophylactic interventions and may help inform future reimbursement models. Highlights After ASD surgery, 74.6% of patients experienced at least 1 complication. Overall, both major and minor complications peaked at Infection/neurologic complications peaked at PJK peaked at 24 months, and implant failure peaked at 12–24 and >24 months. BMI and preoperative SVA were associated with higher complication rates.

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  3. [해외논문]   Editorial Board  


    World neurosurgery v.115 ,pp. xvii - xvii , 2018 , 1878-8750 ,

    초록

    Background Overall complication rates for adult spinal deformity (ASD) surgery have been reported; however, little data exist on the peak timing associated with specific complications. This study quantifies the peak timing for multiple complication types in an ASD cohort at minimum 2-year follow-up. Methods Multicenter, prospective analysis of all complications after ASD surgery in a consecutively enrolled cohort was performed. Inclusion criteria were ASD, age ≥18 years, spinal fusion ≥4 levels, and minimum 2-year follow-up. Complications included major and minor and specific complication types. Peak timing of specific complications was identified and described. Regression analysis was performed to assess correlation between patient/surgical factors and complication timing. Results There were 280 patients who met the inclusion criteria. Mean follow-up time was 2.9 years (range, 2–5 years). Of the patients, 209 (74.6%) had at least 1 complication, accounting for 529 total complications (258 minor and 271 major). Both major and minor complications peaked at 24 months. Implant failure peaked at 12–24 and >24 months. There was a significant positive correlation between preoperative sagittal vertical axis and total complications at 6–12 months, major complications at 24 months, and reoperation. Body mass index was associated with total complications and implant failure at 12–24 and >24 months. Conclusions The peak timing of specific complications after ASD surgery is identifiable. Understanding when these complications are likely to occur may improve patient counseling, early diagnosis, and prophylactic interventions and may help inform future reimbursement models. Highlights After ASD surgery, 74.6% of patients experienced at least 1 complication. Overall, both major and minor complications peaked at Infection/neurologic complications peaked at PJK peaked at 24 months, and implant failure peaked at 12–24 and >24 months. BMI and preoperative SVA were associated with higher complication rates.

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  4. [해외논문]   Patterns, Predictors, and Outcomes of Postprocedure Delayed Hemorrhage Following Flow Diversion for Intracranial Aneurysm Treatment  

    White, Andrew C. (Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA ) , Kumpe, David A. (Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA ) , Roark, Christopher D. (Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA ) , Case, David E. (Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA ) , Seinfeld, Joshua (Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, USA)
    World neurosurgery v.115 ,pp. e97 - e104 , 2018 , 1878-8750 ,

    초록

    Objective To evaluate patterns, predictors, and outcomes of postprocedure delayed hemorrhage (PPDH) following flow diversion therapy for intracranial aneurysm treatment. Methods From 2012 to 2016, 50 patients with 52 aneurysms were treated with the Pipeline embolization device. Device placement was performed as a standalone therapy or with adjunctive coil embolization. Patients underwent dual antiplatelet therapy for 6 months after treatment. Medical comorbidities; aneurysm traits; and treatment factors, including platelet function testing, were studied. Statistical analysis was performed using cross-tabulation. Results Six PPDHs (12%) occurred 2–16 days (mean 6.8 days) after Pipeline placement, manifesting as 1 of 2 distinct patterns: convexity subarachnoid hemorrhage (cSAH) ( n = 4) or lobar intraparenchymal hemorrhage (IPH) ( n = 2). All PPDHs occurred ipsilateral to the device; 1 IPH occurred ipsilateral but in a different arterial territory. PPDH occurred in both treated anterior communicating artery aneurysms. Cases of PPDH demonstrated on average lower P2Y12 reaction unit values at the time of treatment. Platelet function testing at the time of hemorrhage was consistently hypertherapeutic. Patients with cSAH had only minimal worsening of modified Rankin Scale score at the time of discharge, whereas the 2 patients with IPH experienced significant deterioration. Conclusions PPDH is a poorly understood complication following flow diversion therapy that can result in significant morbidity. In our experience, nonaneurysmal cSAH does not result in poor clinical outcomes, whereas IPH leads to long-term deficits or death. As previously suggested, there appears to be a correlation between low P2Y12 reaction unit values and PPDH. Highlights PPDH is a poorly understood complication following PED placement that can result in significant morbidity. Nonaneurysmal cSAH does not result in poor clinical outcome, whereas IPH leads to long-term deficits or death. There appears to be a correlation between low PRU values and PPDH.

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  5. [해외논문]   Endoscopic Anterior Approach for Cervical Disc Disease (Disc Preserving Surgery)  

    Parihar, Vijay Singh (Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India ) , Yadav, Nishtha (Department of Radiology and Imaging, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India ) , Ratre, Shailendra (Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India ) , Dubey, Amitesh (Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India ) , Yadav, Yad Ram (Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India)
    World neurosurgery v.115 ,pp. e599 - e609 , 2018 , 1878-8750 ,

    초록

    Objective To report our experience of endoscopic disc removal by anterior approach for management of cervical myelopathy in 210 patients. Methods A retrospective study of 187 cases of single- and 23 cases of double-level disc disease was performed. Cases of myelopathy with or without unilateral or bilateral radiculopathy and unilateral radiculopathy with either soft or hard disc prolapse were included. Patients with ≥3 disc levels, unstable spine, infections, trauma, significant posterior compression, congenital canal stenosis, disc extending more than half the vertebral body height, and prior surgery at the same level were excluded. Results C5-6 ( n = 119 patients), C6-7 ( n = 58 patients), C4-5 ( n = 49 patients), C3-4 ( n = 6 patients), and C2-3 ( n = 1 patient) levels were represented. Visual analog scale and Nurick grading system were used to assess severity of neck and arm pain and functional outcomes, respectively. Preoperative mean visual analog scale scores for arm and neck pain were 6.7 and 3.2, respectively, which improved to 1.7 and 1.1 at 3 months after surgery. The average preoperative Nurick grade improved from 2.64 to 0.81 at 6 months postoperatively. Follow-up was 6–54 months. Conclusions Endoscopic anterior discectomy (disc preserving surgery) is an effective and safe alternative in cervical disc disease. Although there was reduction in disc height, clinical outcome was good at an average 29 months of follow-up. Long-term follow-up is required to assess any progressive disc degeneration and clinical results.

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  6. [해외논문]   Health Care–Associated Infections after Subarachnoid Hemorrhage  

    Abulhasan, Yasser B. (Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada ) , Alabdulraheem, Najayeb (Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada ) , Schiller, Ian (Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada ) , Rachel, Susan P. (Infection Prevention and Control Department, Montreal Neurological Institute and Hospital, McGill University Health Center, Montreal, Quebec, Canada ) , Dendukuri, Nandini (Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada ) , Angle, Mark R. (Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada ) , Frenette, Charles (Infectious Disease Department, McGill University Health Center, Montreal, Quebec, Canada)
    World neurosurgery v.115 ,pp. e393 - e403 , 2018 , 1878-8750 ,

    초록

    Objective Health care–associated infections (HAIs) after subarachnoid hemorrhage (SAH) are prevalent; however, data describing epidemiology of infection are limited. This study reports incidence rates, risk factors, and the resulting SAH patient-related outcomes. Methods We studied the incidence of HAIs acquired in the intensive care unit (ICU) over a 6-year period. We used Bayesian Model Averaging to identify risk factors associated with an increased risk of HAIs, particularly urinary tract infections (UTI), pneumonia, and ventriculostomy-associated infections (VAI). We also examined the impact of HAIs on risk of vasospasm, ICU and hospital length of stay, and discharge disposition and adjusted for other risk factors. Results Of 419 patients with SAH, 66 (15.8%) developed 79 HAI episodes. Mean HAI incidence rates (per 1000 ICU-days) were UTI, 7.1; pneumonia, 4.3; and VAI, 2.4. The admission characteristic associated with increased risk of overall HAI, UTI, and VAI was diabetes mellitus. Hunt and Hess grades III–V were associated with increased risk of overall HAI and VAI. Male gender, intraventricular hemorrhage, and blood glucose level (>10) were associated with increased risk of pneumonia, whereas the incidence was lower in the presence of steroids. HAI was associated with increased length of stay of 10 ICU-days and 22 hospital-days, but not vasospasm or poor discharge disposition. Conclusions HAIs are serious complications after SAH associated with prolonged ICU and hospital length of stay. Additional rigorous infection control measures aimed at patients with identifiable risk factors should trigger prevention, and early detection of nosocomial infections is warranted to further reduce the prevalence of HAIs. Highlights HAIs after SAH are associated with prolonged ICU and hospital length of stay. UTI, pneumonia, and VAI are prevalent after SAH. DM is a risk factor for developing HAIs, UTI, and VAI. Incidence of pneumonia after SAH was lower in the presence of low-dose steroids.

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  7. [해외논문]   Evaluation of Microsurgery for Managing Giant or Complex Cerebral Aneurysms: A Retrospective Study  

    Ota, Nakao (Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan ) , Matsukawa, Hidetoshi (Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan ) , Noda, Kosumo (Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan ) , Sato, Hirotaka (Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan ) , Hatano, Yuto (Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan ) , Hashimoto, Atsumu (Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan ) , Miyazaki, Takanori (Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan ) , Kondo, Tomomasa (Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan ) , Kinoshita, Yu (Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan ) , Saito, Norihiro (S) , Kamiyama, Hiroyasu , Tokuda, Sadahisa , Kamada, Kyousuke , Tanikawa, Rokuya
    World neurosurgery v.115 ,pp. e190 - e199 , 2018 , 1878-8750 ,

    초록

    Objective Surgical or endovascular treatment for giant or complex aneurysms is challenging. The aims of this study were to evaluate clinical outcomes and factors affecting the prognosis of giant or complex aneurysms and to better establish the role of microsurgery in the management strategy. Methods One hundred fifty-nine patients with surgically treated complex aneurysms were included. Thirty-two patients (20.1%) had giant aneurysms (≥25 mm) and 57 (35.8%) had large aneurysms (≥15 mm). Poor outcome was defined as modified Rankin Scale scores of 3–6. Results The mean aneurysm size was 17.0 mm (range, 1.6–47.5 mm). One hundred and sixteen aneurysms (80.0%) were in the anterior circulation and 43 (27.0%) were in the posterior circulation. One hundred and thirty-eight (86.8%) aneurysms were completely occluded without residual aneurysms. Nineteen (11.9%) had minor aneurysm remnants; 2 (1.3%) had incomplete occlusion. Two patients (1.3%) with giant basilar artery (BA) trunk aneurysms experienced rupture of the treated aneurysm and died. Bypass surgery was combined with microsurgery in 148 patients (93.1%). Perforating artery infarction was observed postoperatively in 42 patients (26.4%), and poor outcome was observed in 29 (18.2%). Male sex ( P = 0.016; adjusted odds ratio [OR], 4.524 [1.949–10.500]), perforating artery infarction ( P P = 0.003; adjusted OR, 56.333 [6.830–464.657]) were significantly related to poor outcome. The aneurysm size ( P = 0.017; adjusted OR, 1.064 [1.021–1.107]), C1 aneurysm location ( P = 0.042; adjusted OR, 2.591 [0.986–6.811]), and BA aneurysm location ( P = 0.033; adjusted OR, 12.956 [3.197–52.505]) were significantly related to perforating artery infarction. Conclusions Microsurgery with bypass is effective for many different complex aneurysms, except BA aneurysms. Highlights 159 patients with surgically treated complex aneurysms were included. 138 (86.8%) aneurysms were completely occluded without residual aneurysms. Perforating artery infarction was observed postoperatively in 42 patients (26.4%). Poor outcome was observed in 29 (18.2%). Male sex, perforating artery infarction, and BA aneurysm location were significantly related to poor outcome. The aneurysm size, C1 aneurysm, and BA aneurysm location were significantly related to perforating artery infarction.

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  8. [해외논문]   Reliability and Agreement of Different Spine Fracture Classification Systems: An Independent Intraobserver and Interobserver Study  

    Pishnamaz, Miguel (Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany ) , Balosu, Stephan (Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany ) , Curfs, Inez (Department of Orthopaedic Surgery and Traumatology, Spine Centre, University of Maastricht Medical Center, Maastricht, The Netherlands ) , Uhing, Daniel (Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany ) , Laubach, Markus (Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany ) , Herren, Christian (Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany ) , Weber, Christian (Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany ) , Hildebrand, Frank (Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany ) , Willems, Paul (Department of Orthopaedic Surgery and Traumatology, Spine Centre, University of Maastricht Medical Center, Maastricht, The Netherlands ) , Kobbe, Philipp (Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany)
    World neurosurgery v.115 ,pp. e695 - e702 , 2018 , 1878-8750 ,

    초록

    Objective Currently, no spinal classification system has achieved universal acceptance. Therefore, it is important to choose a reliable classification within clinical practice. The objective of this study was to determine and compare the intraobserver and interobserver agreement of the Load Sharing Classification (LSC), the Thoracolumbar Injury Classification System (TLICS), and the AOSpine Thoracolumbar Spine Injury Classification System. Methods In this web-based intraobserver and interobserver study (www.spine.hostei.com), plain radiographs and computed tomographic scans of traumatic thoracolumbar fractures (T12–L2) were evaluated. By use of a questionnaire, fractures were classified according to the LSC, the TLICS, and the AOSpine classification. Data were analyzed with SPSS (Version 21, 76 Chicago, Illinois, USA). Intraobserver and interobserver agreement was determined by the Cohen κ. Statistical significance was defined as P Results Data from 91 patients were classified twice by 7 board-certified spine surgeons. The intraobserver and interobserver reliability considering the LSC total score was noted as fair (intraobserver/interobserver reliability: κ = 0.26/0.22). Considering the resulting TLICS total score, a moderate intraobserver agreement (κ = 0.41) was noted, whereas the interobserver results presented only fair reliability (κ = 0.23). In contrast to the LSC and the TLICS, the AOSpine classification showed substantial agreement considering the fracture type (A;B;C) (intraobserver/interobserver reliability: κ = 0.71/0.61) and moderate agreement considering the fracture subtype (e.g., A0;A1;…;B1;…) (intraobserver/interobserver reliability: κ = 0.57/0.48). Conclusion In conclusion, the reliability of the AOSpine fracture classification is superior to the TLICS and the LSC. Therefore, this classification system could best be applied within clinical practice. Highlights Overall AOSpine classification showed superior results compared to TLICS and LSC. The AOSpine fracture subtypes showed moderate intraobserver reliability. The intraobserver agreement of the TLICS total score was also moderate. The LSC total score achieved only fair reliability. Each sub-quality alone of LSC and TLICS showed at least moderate intrarater agreement.

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  9. [해외논문]   The Effects of High-Dose Parathyroid Hormone Treatment on Fusion Outcomes in a Rabbit Model of Posterolateral Lumbar Spinal Fusion Alone and in Combination with Bone Morphogenetic Protein 2 Treatment  

    Holmes, Christina A. (Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ) , Ishida, Wataru (Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ) , Elder, Benjamin D. (Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA ) , Lo, Sheng-Fu Larry (Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ) , Chen, Yunchan Amy (Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ) , Kim, Edmond (Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ) , Locke, John (Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ) , Taylor, Maritza (Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ) , Witham, Timothy F. (Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA)
    World neurosurgery v.115 ,pp. e366 - e374 , 2018 , 1878-8750 ,

    초록

    Background Parathyroid hormone (PTH) (1–34) treatment reduces fracture risk in osteoporotic patients. Previously, we demonstrated in a rabbit model that low-dose PTH treatment resulted in increased fusion mass volume. As effects of PTH on bone are dose-dependent, we aimed to evaluate whether increasing dosage of PTH increases both volume and biomechanical stiffness of the resulting fusion masses and/or exhibits synergistic effects with low-dose bone morphogenetic protein 2 (BMP-2). Methods Posterolateral lumbar spinal fusion surgery was performed on 60 New Zealand White rabbits divided into 6 experimental groups: iliac crest autograft alone, autograft plus 20 μg/kg/day PTH, autograft plus 40 μg/kg/day PTH, BMP-2 alone, BMP-2 plus 20 μg/kg/day PTH, and BMP-2 plus 40 μg/kg PTH. Fusion was assessed at postoperative week 6 via manual palpation, volumetric computed tomography analysis, and 4-point bending biomechanical testing. Results All groups treated with BMP-2 fused. Increasing doses of PTH resulted in increased fusion mass volume compared with autograft alone. Autograft plus 40 μg/kg/day PTH yielded fusion mass volumes comparable to BMP-2. When the autograft groups were considered alone, increased mechanical stiffness was observed only in the 20 μg/kg/day group. No significant stiffness differences were observed between BMP-2 groups. Conclusions Treatment with the highest dose of PTH resulted in fusion mass volumes similar to those obtained with BMP-2. When the autograft groups were considered alone, significant increases in mechanical stiffness were observed at a dosage of 20 μg/kg/day, suggesting there may be an optimal dose of PTH in the rabbit model. Effects of BMP-2 on fusion were dominant. Highlights Effects of PTH (1–34) treatment on spinal fusion were tested with and without rhBMP-2. All rhBMP-2 groups fused and yielded significantly stiffer fusion masses. Treatment with 40 μg/kg PTH yielded fusion mass volumes comparable to rhBMP-2. When PTH (1–34) is combined with BMP-2, the fusion effects of rhBMP-2 are dominant.

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  10. [해외논문]   Cerebral Microbleeds Could Be Independently Associated with Intracranial Aneurysm Rupture: A Cross-Sectional Population-Based Study  

    Zhang, Xin (National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China ) , Yao, Zhi-Qiang (National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China ) , Karuna, Tamrakar (Department of Neurosurgery, CMS-Teaching Hospital, Bharatpur, Chitwan, Nepal ) , Duan, Chuan-Zhi (National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China ) , Wang, Xue-Min (Key Laboratory of) , Li, Xi-Feng , Yin, Jia-He , He, Xu-Ying , Guo, Shen-Quan , Chen, Yun-Chang , Liu, Wen-Chao
    World neurosurgery v.115 ,pp. e218 - e225 , 2018 , 1878-8750 ,

    초록

    Objective To determine whether the presence of cerebral microbleeds (CMBs) is independently associated with intracranial aneurysm rupture and to identify the time interval of CMB-related intracranial aneurysm rupture. Methods This cross-sectional study included 1847 patients with unruptured and ruptured intracranial aneurysms from January 2010 to November 2017. Clinical records and imaging, including T2-weighted gradient-recalled echo sequence magnetic resonance imaging that identified the presence of CMBs preoperatively, were evaluated. Univariate analysis and multivariate logistic regression were done to determine which parameters were independent factors for aneurysm rupture. The time interval of CMB-related intracranial aneurysm rupture was also evaluated. Results CMBs confirmed by magnetic resonance imaging were present in 142 patients (142/1847; 7.7%). Of 142 patients with CMBs, 56 patients (including 17 ruptured aneurysms) who received endovascular treatment and another 86 consecutive patients who did not receive embolization or surgery for various reasons were followed for 3–49 months. The incidence of CMB-related intracranial aneurysm rupture was 27.9% (24/86) during the follow-up period. The time interval of CMB-related intracranial aneurysm rupture was 3–27 months (median 9.5 months). Multivariate analyses showed CMBs were significantly correlated with intracranial aneurysm rupture (odds ratio = 1.6; 95% confidence interval, 1.1–2.4; P = 0.010). Conclusions CMBs were independently associated with intracranial aneurysm rupture. Patients with CMBs have a 60% increased risk of aneurysm rupture compared with patients without CMBs. Highlights The presence of CMBs is independently associated with subsequent intracranial aneurysm rupture. Patient with CMBs has 60% increased risk of aneurysm rupture. The time interval of CMB-related intracranial aneurysm rupture is 3–27 months. When CMBs are confirmed by MRI, patients with CMBs should be monitored. Early intervention is highly recommended if needed to prevent adverse events.

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