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World neurosurgery 210건

  1. [해외논문]   Surgical Treatment of Large or Giant Fusiform Middle Cerebral Artery Aneurysms: A Case Series  

    Xu, Feng (Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China ) , Xu, Bin (Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China ) , Huang, Lei (Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China ) , Xiong, Ji (Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China ) , Gu, Yuxiang (Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China ) , Lawton, Michael T. (Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital & Medical Center, Phoenix, Arizona, USA)
    World neurosurgery v.115 ,pp. e252 - e262 , 2018 , 1878-8750 ,

    초록

    Background Management of large or giant fusiform middle cerebral artery (MCA) aneurysms represents a significant challenge. Objective To describe the authors' experience in the treatment of large or giant fusiform MCA aneurysm by using various surgical techniques. Methods We retrospectively reviewed a database of aneurysms treated at our division between 2015 and 2017. Results Overall, 20 patients (11 males, 9 females) were identified, with a mean age of 40.7 years (range, 13–65 years; median, 43 years). Six patients (30%) had ruptured aneurysms and 14 (70%) had unruptured aneurysms. The mean aneurysm size was 19 mm (range, 10–35 mm). The aneurysms involved the prebifurcation in 5 cases, bifurcation in 4 cases, and postbifurcation in 11 cases. The aneurysms were treated by clip reconstruction ( n = 5), clip wrapping ( n = 1), proximal occlusion or trapping ( n = 4), and bypass revascularization ( n = 10). Bypasses included 7 low-flow superficial temporal artery–MCA bypasses, 2 high-flow extracranial-intracranial bypasses, and 1 intracranial-intracranial bypass (reanastomosis). Bypass patency was 90%. Nineteen aneurysms (95%) were completely obliterated, and no rehemorrhage occurred during follow-up. There was no procedural-related mortality. Clinical outcomes were good (modified Rankin Scale score ≤2) in 18 of 20 patients (90%) at the last follow-up. Conclusions Surgical treatment strategy for large or giant fusiform MCA aneurysms should be determined on an individual basis, based on aneurysm morphology, location, size, and clinical status. Favorable outcomes can be achieved by various surgical techniques, including clip reconstruction, wrap clipping, aneurysm trapping, aneurysm excision followed by reanastomosis, and partial trapping with bypass revascularization. Highlights Management of large or giant fusiform middle cerebral artery (MCA) aneurysms represents a significant challenge. Treatment strategies should be tailored on a case-by-case basis. Nondissecting fusiform aneurysm may be amenable to clip reconstruction and wrap-clipping. Giant fusiform dissecting aneurysms cannot usually be clipped and require alternative treatment modalities.

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  2. [해외논문]   Burr-Hole Craniostomy with T-Tube Drainage as Surgical Treatment for Chronic Subdural Hematoma  

    Lu, Wenchao (To whom correspondence should be addressed: Wenchao Lu) , Wang, Hui , Wu, Tao , Sheng, Xudong , Ding, Zhibin , Xu, Gangzhu
    World neurosurgery v.115 ,pp. e756 - e760 , 2018 , 1878-8750 ,

    초록

    Objective We sought to investigate the effect of burr-hole craniostomy with T-tube drainage to treat chronic subdural hematoma (CSDH). Methods Eighty-seven patients with CSDH who were recruited from January 2012 to June 2017 at the Department of Neurosurgery, The First Affiliated Hospital of Xi'an Medical University, were divided into 2 groups according to the method of drainage: T-tube drainage system ( n = 45) and conventional subdural drainage system ( n = 42). Retrospective analysis of clinical data and efficacy was performed between the 2 groups. Results There were no significant differences in age, preoperative Markwalder grade scale, preoperative hematoma volume, hospitalization days, and discharge Markwalder grade scale between the 2 groups ( P > 0.05). The incidence of postoperative complications and hematoma recurrence in the group of patients with T-tube drainage was significantly reduced when compared with conventional subdural drainage systems ( P Conclusions Both methods were effective in the treatment of CSDH; however, we found a lower overall surgical complication rate following treatment with burr-hole craniostomy and T-tube drainage. This indicates that it may be a better therapeutic option for management of CSDH. Highlights T-tube and conventional drainage systems are equally effective in treating CSDH. T-tube drainage systems result in decreased rates of complications and recurrence. T-tube drainage systems may be a better option for treatment of CSDH.

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  3. [해외논문]   Surgical Resection and Adjuvant Radiation Therapy in the Treatment of Skull Base Chordomas  

    Sanusi, Olabisi (Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA ) , Arnaout, Omar (Brigham and Women's, Harvard School of Medicine, Boston, Massachusetts, USA ) , Rahme, Rudy J. (Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA ) , Horbinski, Craig (Department of Neurological Surgery and Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA ) , Chandler, James P. (Department of Neurological Surgery and Otolaryngology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA)
    World neurosurgery v.115 ,pp. e13 - e21 , 2018 , 1878-8750 ,

    초록

    Objective Chordomas are rare tumors of notochordal origin that are known to be locally aggressive and are often treated with surgical resection followed by adjuvant radiation therapy (RT). The accepted standard of treatment for chordomas of the mobile spine, which includes en-bloc resection with wide margins, cannot be easily applied to the chordomas of the skull base because of their proximity to critical neurovascular structures. We describe our experience with the role of surgery and adjuvant RT in the treatment of chordomas over 16 years. Methods We performed a retrospective chart review on patients with diagnoses of clival chordoma between the years 2000 and 2015 at Northwestern Memorial Hospital. We reviewed presenting symptoms, tumor location and size, extent of resection, complications, recurrence, adjuvant treatment, and follow-up duration. Results A total of 20 patients underwent 32 surgeries. Of the 20 initial surgeries, 80% underwent gross total resection, and 20% had subtotal resection. The mean follow-up time was 60.75 months. Mean tumor volume was 23.07 cm 3 . Most common presenting signs and symptoms were headaches (70%), cranial nerve palsies (45%), and diplopia (55%). Diplopia was defined as complaints of double vision without any objective evidence of a cranial nerve palsy. Median time to progression was 57 months, and median overall survival was 136 months. Initial tumor volume and the need for a second dose of RT either as sole or as adjuvant treatment of a recurrence had a statistically significant effect on progression-free survival ( P = 0.009, 0.009). None of the factors studied had a statistically significant effect on overall survival. Conclusions The treatment of chordomas remain challenging and requires multimodal treatment strategies spanning different specialties. Initial tumor size and need for second dose of RT for recurrence appear to play a significant role in progression-free survival. Adjuvant RT after gross total resection may play a role in improved progression-free and overall survival in patients with clival chordomas. Highlights The treatment of chordomas remain challenging and requires multi-modal treatment strategies spanning different specialties. Initial tumor size independent of extent of resection appears to be important in chordoma progression. Adjuvant radiation after gross total resection may play a role in patient overall survival.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  4. [해외논문]   Contents  


    World neurosurgery v.115 ,pp. i - xvi , 2018 , 1878-8750 ,

    초록

    Objective Chordomas are rare tumors of notochordal origin that are known to be locally aggressive and are often treated with surgical resection followed by adjuvant radiation therapy (RT). The accepted standard of treatment for chordomas of the mobile spine, which includes en-bloc resection with wide margins, cannot be easily applied to the chordomas of the skull base because of their proximity to critical neurovascular structures. We describe our experience with the role of surgery and adjuvant RT in the treatment of chordomas over 16 years. Methods We performed a retrospective chart review on patients with diagnoses of clival chordoma between the years 2000 and 2015 at Northwestern Memorial Hospital. We reviewed presenting symptoms, tumor location and size, extent of resection, complications, recurrence, adjuvant treatment, and follow-up duration. Results A total of 20 patients underwent 32 surgeries. Of the 20 initial surgeries, 80% underwent gross total resection, and 20% had subtotal resection. The mean follow-up time was 60.75 months. Mean tumor volume was 23.07 cm 3 . Most common presenting signs and symptoms were headaches (70%), cranial nerve palsies (45%), and diplopia (55%). Diplopia was defined as complaints of double vision without any objective evidence of a cranial nerve palsy. Median time to progression was 57 months, and median overall survival was 136 months. Initial tumor volume and the need for a second dose of RT either as sole or as adjuvant treatment of a recurrence had a statistically significant effect on progression-free survival ( P = 0.009, 0.009). None of the factors studied had a statistically significant effect on overall survival. Conclusions The treatment of chordomas remain challenging and requires multimodal treatment strategies spanning different specialties. Initial tumor size and need for second dose of RT for recurrence appear to play a significant role in progression-free survival. Adjuvant RT after gross total resection may play a role in improved progression-free and overall survival in patients with clival chordomas. Highlights The treatment of chordomas remain challenging and requires multi-modal treatment strategies spanning different specialties. Initial tumor size independent of extent of resection appears to be important in chordoma progression. Adjuvant radiation after gross total resection may play a role in patient overall survival.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  5. [해외논문]   Unilateral versus Bilateral Pedicle Screw Fixation Combined with Transforaminal Lumbar Interbody Fusion for the Treatment of Low Lumbar Degenerative Disc Diseases: Analysis of Clinical and Radiographic Results  

    Chen, De-jian (To whom correspondence should be addressed: Zongmiao Wan, M.D.) , Yao, Cong , Song, Quanwei , Tang, Benyu , Liu, Xuqiang , Zhang, Bin , Dai, Min , Nie, Tao , Wan, Zongmiao
    World neurosurgery v.115 ,pp. e516 - e522 , 2018 , 1878-8750 ,

    초록

    Objective To compare the clinical and radiographic results of unilateral pedicle screw fixation (UPSF) and bilateral pedicle screw fixation (BPSF) after unilateral transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degenerative disc diseases (DDDs). Methods A total of 63 patients who underwent UPSF or BPSF combined with unilateral TLIF at L4-L5 or L5-S1 in our hospital between 2014 and 2016 were included in this analysis. The perioperative outcomes and radiographic results were recorded at preoperative and postoperative follow-up. Fusion rates were determined according to the Bridwell–Lenke grading system. Clinical outcomes were evaluated using the visual analog scale, Oswestry Disability Index, and lumbar Japanese Orthopedic Association score. Results According to the perioperative assessment, the duration of operation, intraoperative and postoperative blood loss, duration of pain medication use, and hospital costs were significantly ( P P P Conclusions UPSF techniques with TLIF can attain similar clinical efficiency as BPSF techniques in treating single-level low lumbar DDD, but with fewer surgical injuries and at lower cost. BPSF with TLIF likely causes more degeneration at the cranial adjacent segment compared with UPSF techniques. The long-term results require more study. Highlights UPSF has less trauma compared with BPSF. UPSF with TLIF can attain similar clinical efficiency as BPSF techniques at final postoperative follow-up. The clinical outcomes of UPSF were poorer than BPSF groups at 1 month postoperative. UPSF has a smaller impact on the cranial adjacent vertebral level compared with BPSF.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  6. [해외논문]   The Effect of Underlying Liver Disease on Perioperative Outcomes Following Craniotomy for Tumor: An American College of Surgeons National Quality Improvement Program Analysis  

    Goel, Nicholas J. (Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA ) , Abdullah, Kalil G. (Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA ) , Choudhri, Omar A. (Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA ) , Kung, David K. (Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA ) , Lucas, Timothy H. (Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA ) , Chen, H. Isaac (Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA)
    World neurosurgery v.115 ,pp. e85 - e96 , 2018 , 1878-8750 ,

    초록

    Background The association between underlying liver disease and poor surgical outcomes has been well documented across a wide variety of surgical disciplines. However, little is known about the importance of liver disease in neurosurgery. In this report, we assess the independent effect of liver disease on perioperative outcomes in patients undergoing craniotomy for tumor. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for patients undergoing craniotomy for tumor from 2006 to 2015. Presence and severity of underlying liver disease was assessed with the aspartate aminotransferase-to-platelet ratio index and the Model for End-Stage Liver Disease-Sodium scores, computed from preoperative laboratory values. Results Among 11,897 patients, mild and advanced disease was identified in 2.4% and 1.9% of patients, respectively. Rates of 30-day mortality were 4.5% and 15.8% in these patients, compared with 3.1% in patients with healthy livers. The 30-day complication rate was 40.3%, 28.0%, and 19.8% in patients with advanced, mild, and no liver disease, respectively. In multivariate analysis, the presence of any liver disease (mild or advanced) was independently associated with mortality (OR = 2.46; 95% confidence interval [CI], 1.68–3.59; P P = 0.001), and length of hospital stay over 10 days (OR, 1.35; 95% CI, 1.07–1.70; P = 0.012), when compared with 13 covariates. Liver disease showed the strongest independent association with mortality of all risk factors analyzed. Conclusions Liver disease is an independent predictor of poor 30-day outcomes following craniotomy for tumor. Consideration of underlying liver function can have a role in surgical decision making and postoperative care for these patients. Highlights Underlying liver disease was discovered in 4.3% of patients undergoing craniotomy. Liver disease independently predicts greater morbidity and length of hospital stay. Among 13 risk factors, liver disease is the strongest predictor of 30-day mortality.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  7. [해외논문]   Intracranial Arterial Fenestration and Risk of Aneurysm: A Systematic Review and Meta-Analysis  

    Guo, Xiang (Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China ) , Gao, Lingyun (Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China ) , Shi, Zhitao (Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China ) , Liu, Deguo (Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China ) , Wang, Yuhong (Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China ) , Sun, Zhanguo (Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China ) , Chen, Yueqin (Department of Medical Imaging, the Affiliated Hospital of Jining Medical University, Jining, China ) , Chen, Weijian (Department of Medical Imaging, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China ) , Yang, Yunjun (Department of Medical Imaging, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China)
    World neurosurgery v.115 ,pp. e592 - e598 , 2018 , 1878-8750 ,

    초록

    Background Previous studies have been inconsistent regarding risk for intracranial aneurysm related to intracranial arterial fenestration. We conducted a meta-analysis to examine the association between intracranial arterial fenestration and risk of aneurysm. Methods We performed a systematic review of PubMed and Embase through August 2017 for potentially relevant articles. Summary odds ratios with 95% confidence intervals were pooled using a random-effects model. Results Of 446 articles found, 7 were selected for meta-analysis. Pooled odds ratios revealed an increased risk of aneurysm owing to fenestration of 1.50 (95% confidence interval, 0.61–3.71; P = 0.38). Subgroup analyses based on the population presenting with various indications suggested that pooled odds ratios indicated a significant increase in risk for aneurysm of 2.43 (95% confidence interval, 1.04–5.69; P = 0.04). Conclusions Our findings indicate that intracranial arterial fenestration may be associated with increased risk for aneurysm formation. Highlights Pooled OR indicated a significantly increased aneurysm risk owing to fenestration. There was no significant relationship between fenestration and aneurysm in patients with sSAH. Fenestration may be a marker of aneurysm formation in the general population.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  8. [해외논문]   Radiologic Anatomy of the Lumbar Interlaminar Window and Surgical Considerations for Lumbar Interlaminar Endoscopic and Microsurgical Disc Surgery  

    Sakç (Department of Radiology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey ) , ı, Zakir (Department of Neurosurgery, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey ) , Ö (Department of Radiology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey ) , nen, Mehmet Reş (Department of Radiology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey ) , id (Department of Neurosurgery, Nobiom Center, Istanbul, Turkey ) , Fidan, Elif (Department of Neurosurgery, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey) , Yaş , ar, Yunus , Uluğ , , Hikmet , Naderi, Sait
    World neurosurgery v.115 ,pp. e22 - e26 , 2018 , 1878-8750 ,

    초록

    Objective The interlaminar window is the most important corridor during both interlaminar approaches to intervertebral discs. The aim of this study was to measure radiologic parameters related to endoscopic and microsurgical interlaminar discectomy. Methods Measured parameters included lateral recess line (LRL) width, distance between LRL and endplates of upper intervertebral disc, superior and lateral angles of interlaminar window, interlaminar height, and interpedicular distance via optimized coronal oblique projection computed tomography images. Measurements were performed at L2, L3, L4, and L5 levels. Results LRL was found to be 16.3 ± 3.4 mm, 17.3 ± 3.3 mm, 21.7 ± 3.4 mm, and 27.7 ± 4.0 mm at L2, L3, L4, and L5. The distances between LRL and both upper endplates decreased from L2 to L5. Distance between LRL and upper endplate of same vertebra and between LRL and lower endplate of upper vertebra was measured. Interlaminar window height decreased from L2 to L5 levels (from 14.0 ± 4.1 mm to 11.1 ± 2.4 mm). Conclusions This study showed that width of LRL increases in lower lumbar segments, and height of interlaminar window increases in upper lumbar segments. This study also revealed that intervertebral disc is located cranial to LRL at L2-3, L3-4, and L4-5 levels and is located caudal to LRL at L5-S1 level. The results of this study may help surgical planning in both endoscopic and microscopic interlaminar surgery. Highlights Lumbar endoscopic discectomy has been popular in recent years. Successful results after L5-S1 endoscopic interlaminar discectomy led surgeons to explore the procedure for other IVD levels. Position of interlaminar window should be taken into account during microdiscectomy and interlaminar endoscopic discectomy.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  9. [해외논문]   Risk Factors for In-Hospital Seizures and New-Onset Epilepsy in Coil Embolization of Aneurysmal Subarachnoid Hemorrhage  

    Nathan, Suresh K. (To whom correspondence should be addressed: Parthasarathy D. Thirumala, M.D., M.S.) , Brahme, Indraneel S. , Kashkoush, Ahmed I. , Anetakis, Katherine , Jankowitz, Brian T. , Thirumala, Parthasarathy D.
    World neurosurgery v.115 ,pp. e523 - e531 , 2018 , 1878-8750 ,

    초록

    Objective This study aimed to determine risk factors for inpatient seizures and long-term epilepsy in patients receiving coil embolization for aneurysm-associated subarachnoid hemorrhage. Methods A retrospective chart review was conducted for patients admitted to the University of Pittsburgh Medical Center from 2010 to 2014 for subarachnoid hemorrhage. Only patients with coil embolization were included. Variables such as subdural hematoma, cerebral infarction, postoperative vasospasm, cerebral edema, and mass effect were collected. After discharge, patients were followed up to determine whether epilepsy had developed. The χ 2 test was used to assess univariate associations. Multivariable associations were assessed with a binary logistic regression model. Results The study included 175 patients, of whom 16 (9.1%) of the patients had seizures while they were inpatients. Five out of 73 patients met the criteria for epilepsy at follow-up. None of the patients with epilepsy after discharge had electrographic seizures while hospitalized. Vasospasm (odds ratio [OR] 6.88, 95% confidence interval [CI] 1.81–26.25), and Hunt and Hess grade 5 (OR 26.16, 95% CI 3.95–173.49) were significantly associated with in-hospital seizures in a multivariable analysis. Epileptiform discharges on electroencephalogram (EEG) were significantly associated with mass effect findings on brain imaging (OR 3.5, CI 1.05–11.69). Conclusion Hunt and Hess grade 5 and vasospasm are independent risk factors for in-hospital seizures. In addition, mass effect is an independent risk factor for epileptiform discharges on EEG. Patients with these risk factors may benefit from continuous EEG. Our results may indicate that there is no association between electrographic seizures and development of epilepsy. Highlights Hunt and Hess grade 5 and vasospasm are risk factors for in-hospital seizures. Mass effect is a risk factor for epileptiform discharges on electroencephalogram (EEG). Patients with Hunt and Hess grade 5 and vasospasm, mass effect, would benefit from EEG.

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  10. [해외논문]   Transmuscular Ultrasonography of the Placement of Thoracolumbar Pedicle Screws: A Cadaveric Study  

    Xie, Cheng-Long (Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China ) , Huang, Qi-Shan (Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China ) , Wu, Long (Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China ) , Xu, Lei (Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China ) , Dou, Hai-Cheng (Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China ) , Wang, Xiang-Yang (Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China ) , Lin, Zhong-Ke (Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Chi)
    World neurosurgery v.115 ,pp. e360 - e365 , 2018 , 1878-8750 ,

    초록

    Background Transpedicular screw fixation has a biomechanical advantage of improving fusion rates. In posterior thoracolumbar immobilization, a large number of screws cause perforation to the pedicle or vertebral body. Radiography and computed tomography (CT) have been used to minimize this complication. The ability of ultrasound (US) to detect the pedicle breach during placement of the screw is unknown. The aim of this study was to evaluate the sensitivity of US for detecting breaches. Methods A B-type transducer was used to scan 216 titanium pins inserted into cadaveric pedicles. Of the pins, 180 were intentionally misplaced: 90 pins breached the lateral wall of the pedicle, and 90 pins pierced the anterior wall of the vertebral body. US images were reviewed by 3 examiners blinded to both the procedure and the corresponding CT findings. The perforation length of pins was measured by 3 radiologists on CT images. Results CT data were divided into 2 groups. In group 1 (perforation length 0–2 mm), sensitivity of US for detecting lateral wall and anterior wall perforation was 80.95% and 76.42%, respectively; in group 2 (perforation length 2–4 mm), sensitivity was 94.79% and 91.93%. Overall sensitivity of US to detect lateral wall and anterior wall perforation was 89.63% and 86.30%, respectively. The sensitivity of US for detecting perforation was greater in the lateral wall than in the anterior wall. Sensitivity of US was greater in group 2 than group 1 for both lateral and anterior perforation. Conclusions US can be applied to detect perforation of ≤4 mm. Use of US may improve patient safety. Highlights A transpedicular screw protruding >2 mm can cause damage to nearby blood vessels, spinal cord, or nerve roots. US can detect the pedicle screw protruding from the cortical bone of the vertebra. Pins protruding >1 mm from the cortical bone of the vertebra can be detected by US. The sensitivity of US for detecting perforation was greater in the lateral wall than in the anterior wall.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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