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T : 목차정보

World neurosurgery 210건

  1. [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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    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.

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  2. [해외논문]   Endoscopic Endonasal Clipping of Anterior Circulation Aneurysm: Surgical Techniques and Results  

    Xiao, Li-Min (To whom correspondence should be addressed: Er-Ming Zeng, M.D.) , Tang, Bin (Tao Hong, M.D. ) , Xie, Shen-Hao (To whom correspondence should be addressed: Er-Ming Zeng, M.D.) , Huang, Guan-lin (Tao Hong, M.D.) , Wang, Zhi-Gang , Zeng, Er-Ming , Hong, Tao
    World neurosurgery v.115 ,pp. e33 - e44 , 2018 , 1878-8750 ,

    초록

    Background Endoscopic endonasal clipping of intracranial aneurysms may use microsurgical techniques as an alternative to the transcranial approach. Here we report a series of patients who underwent microsurgical clipping of anterior circulation aneurysms via an endoscopic endonasal approach (EEA). Methods This retrospective chart review included all the patients who underwent standard binostril EEA for aneurysm clipping. Surgical outcomes and complications are noted. The rationality and limitations of this procedure are discussed. Results Seven patients with 12 aneurysms of the anterior circulation underwent EEA for clipping. These 12 aneurysms consisted of 5 anterior communicating artery (AComA) aneurysms, 4 paraclinoid aneurysms, 1 ophthalmic artery aneurysm, and 2 aneurysm located in the cavernous segment of internal carotid artery (ICA). Nine of the 12 aneurysms were successfully clipped. One giant paraclinoid aneurysm could not be clipped during operation and was coiled in second endovascular stage. The 2 aneurysms located in the cavernous segment of ICA were not clipped intentionally in a single-stage procedure, after weighing the surgical benefit against the difficulty of surgical exposure and feasibility. The proximal control of ICA was achieved in all cases. There was no death, no cerebrospinal fluid leak, or other complications. All patients recovered completely. Conclusions EEA can provide direct access for microsurgical clipping of strictly selected anterior circulation aneurysms. All the principles of cerebrovascular surgery must be followed. These procedures require a long learning curve. Only teams with adequate experience in microvascular and endoscopic skull base surgeries should attempt this approach for treating aneurysms. Highlights Seven patients with 12 aneurysms (among the largest series) of the anterior circulation underwent clipping via an EEA. Nine of the 12 aneurysms were successfully clipped. There were no deaths and no CSF leak or other complications. The EEA can provide direct access for microsurgical clipping of rare and strictly selected anterior circulation aneurysms.

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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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  3. [해외논문]   Clinical Experience of Autologous Blood Transfusion in Neurosurgery: Prospective Study in Central India  

    Patil, Harshad (Department of Neurosurgery, Bansal Hospital, Bhopal, Madhya Pradesh, India ) , Garg, Nitin (Department of Neurosurgery, Bansal Hospital, Bhopal, Madhya Pradesh, India ) , Navakar, Deepa (Department of Anaesthesia, Bansal Hospital, Bhopal, Madhya Pradesh, India ) , Banabokade, Laxmikant (Department of Anaesthesia, Bansal Hospital, Bhopal, Madhya Pradesh, India)
    World neurosurgery v.115 ,pp. e539 - e543 , 2018 , 1878-8750 ,

    초록

    Objective To evaluate the benefits of intraoperative autologous blood transfusion in intracranial procedures and to conserve precious homologous blood due to shortage of donor and associated complications. Methods This was a prospective study performed at Bansal Hospital, Bhopal. Predetermined autologous blood was collected in a well-labeled bag containing citrate phosphate dextrose adenine solution after induction of general anesthesia. Then appropriate amount of crystalloid solution was transfused in to the body. All collected autologous blood was transfused back to the patient at the end of the surgery or during the surgery if excessive blood loss occurred. Demographic data, hemodynamic changes (mean arterial pressure, heart rate) before and after donation, complications, and any additional homologous blood requirement were noted. Pre- and postoperative hemoglobin and hematocrit values were compared. Results In total, 32 patients were included in this study. In our study, mean age was 48.87 years; male-to-female ratio was 1:1.4. The mean amount of autologous blood collected was 461 mL, and the mean amount of blood loss during surgery was 1048 mL. In our study, there was no statistically significant difference was found in mean arterial pressure and heart rate before and after autologous blood collection ( P > 0.05). When we compared pre- and postoperative mean hemoglobin and hematocrit levels, there was a statistically significant difference present ( P Conclusions Autologous blood transfusion is a safe, effective, and affordable method of blood transfusion in patients undergoing intracranial surgery. Complications associated with homologous blood transfusion can be avoided with autologous blood transfusion. Highlights Autologous blood transfusion is a safe and affordable method of blood transfusion. Complications associated with homologous blood transfusion can be avoided with autologous blood transfusion. Autologous blood collection is easy to achieve for scheduled neurosurgical procedures and should be used more widely.

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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]   Predictive Modeling of Length of Hospital Stay Following Adult Spinal Deformity Correction: Analysis of 653 Patients with an Accuracy of 75% within 2 Days  

    Safaee, Michael M. (Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA ) , Scheer, Justin K. (Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA ) , Ailon, Tamir (Department of Neurosurgery, The University of British Columbia, Vancouver, British Columbia, Canada ) , Smith, Justin S. (Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA ) , Hart, Robert A. (Department of Orthopedic Surgery, Oregon Health & Science University, Portland, Oregon, USA ) , Burton, Douglas C. (Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA ) , Bess, Shay (Denver International Spine Clinic, Presbyterian St. Luke's Medical Center, Rocky Mountain Hospital for Children, Denver, Colorado, USA ) , Neuman, Brian J. (Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA ) , Passias, Peter G. (Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York, USA ) , Miller, Emily (Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA) , Shaffrey, Christopher I. , Schwab, Frank , Lafage, Virginie , Klineberg, Eric O. , Ames, Christopher P.
    World neurosurgery v.115 ,pp. e422 - e427 , 2018 , 1878-8750 ,

    초록

    Background Length of stay (LOS) after surgery for adult spinal deformity (ASD) is a critical period that allows for optimal recovery. Predictive models that estimate LOS allow for stratification of high-risk patients. Methods A prospectively acquired multicenter database of patients with ASD was used. Patients with staged surgery or LOS >30 days were excluded. Univariable predictor importance ≥0.90, redundancy, and collinearity testing were used to identify variables for model building. A generalized linear model was constructed using a training dataset developed from a bootstrap sample; patients not randomly selected for the bootstrap sample were selected to the training dataset. LOS predictions were compared with actual LOS to calculate an accuracy percentage. Results Inclusion criteria were met by 653 patients. The mean LOS was 7.9 ± 4.1 days (median 7 days; range, 1–28 days). Following bootstrapping, 893 patients were modeled (653 in the training model and 240 in the testing model). Linear correlations for the training and testing datasets were 0.632 and 0.507, respectively. The prediction accuracy within 2 days of actual LOS was 75.4%. Conclusions Our model successfully predicted LOS after ASD surgery with an accuracy of 75% within 2 days. Factors relating to actual LOS, such as rehabilitation bed availability and social support resources, are not captured in large prospective datasets. Predictive analytics will play an increasing role in the future of ASD surgery, and future models will seek to improve the accuracy of these tools. Highlights LOS is a critical period of recovery after ASD surgery. Predictive modeling allows for complex assessment and prediction of LOS. There are 40 variables that can predict LOS with 75% accuracy within 2 days. No such model for ASD surgery currently exists. Future work will allow for point-of-care assessment to assess LOS preoperatively.

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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]   Long-Term Clinical and Radiologic Postoperative Outcomes After C1-C2 Pedicle Screw Techniques for Pediatric Atlantoaxial Rotatory Dislocation  

    Wu, Xinjie (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China ) , Li, Yafeng (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China ) , Tan, Mingsheng (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China ) , Yi, Ping (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China ) , Yang, Feng (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China ) , Tang, Xiangsheng (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China ) , Hao, Qingying (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China)
    World neurosurgery v.115 ,pp. e404 - e421 , 2018 , 1878-8750 ,

    초록

    Background Although C1-C2 pedicle screw techniques have been extensively reported in pediatric series, reports on their use have examined only small series with short follow-up periods. The aim of this study was to report pediatric patients with atlantoaxial rotatory dislocation treated with these techniques with a minimum 5-year follow-up. Methods Retrospective review was performed of 27 pediatric patients with atlantoaxial rotatory dislocation who underwent C1-C2 pedicle screw fixation between 2004 and 2012. Clinical and radiographic outcomes were collected and compared with a control group. Results Follow-up period was 60–142 months (mean 84 months). Torticollis was completely corrected postoperatively in all but 1 patient. All patients experienced significant pain relief and improvement in range of motion, and 6 patients with neurologic deficits experienced significant improvement postoperatively. Both atlantodental interval and space available for the cord were significantly improved compared with preoperative values. At final follow-up, curvature was lordotic in 20 cases and straight in 7 cases. Compared with the control group, range of motion of the patient group was not significantly different in any direction except in flexion and rotation. Mean anteroposterior diameters of the spinal canal at C1 and C2 levels were not significantly different from the control group. Conclusions C1-C2 pedicle screw techniques are safe and effective for treatment of atlantoaxial rotatory dislocation and result in no obvious limitation on growth in older children. Highlights Pediatric patients with AARD were treated with C1-C2 pedicle screw techniques and followed for a minimum of 5 years. Compensation for ROM was achieved after atlantoaxial fusion via joint remodeling or increased ligamentous laxity. C1-C2 pedicle screw techniques do not result in obvious limitation on growth.

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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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  6. [해외논문]   Endoscopic Transseptal Approach with Bilateral Nasoseptal Flap in Challenging Skull-Base Tumors  

    Kim, Do Hyun (Department of Otolaryngology‒Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Hong, Yong-Kil (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Jeun, Sin-Soo (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Park, Jae-Sung (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Kim, Soo Whan (Department of Otolaryngology‒Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Cho, Jin Hee (Department of Otolaryngology‒Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Park, Yong Jin (Department of Otolaryngology‒Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Kim, Sung Won (D)
    World neurosurgery v.115 ,pp. e178 - e184 , 2018 , 1878-8750 ,

    초록

    Objective We sought to examine the utility of an endoscopic transseptal approach and creation of a bilateral nasoseptal flap using a 2-nostrils/4-hands technique in patients with challenging skull-base tumors. Methods The medical records of patients operated on via an endoscopic transseptal approach between 2009 and 2017 were retrospectively reviewed. Two patients with ossifying fibroma, 2 with orbital hemangioma, 2 with trigeminal nerve schwannoma, and 1 patient each with juvenile angiofibroma, meningioma, and myxofibrosarcoma were included in the study. The surgical technique and endoscopic anatomy are presented. Results The mean age of the 4 male and 5 female patients was 39.9 ± 14.8 years. By using this technique, all 7 tumors were resected with minimal nasal morbidity after a mean follow-up of 15.2 ± 9.4 months. Conclusions The endoscopic transseptal approach, by creation of a bilateral nasoseptal flap using a 2-nostrils/4-hands technique, improves surgical visualization and increases instrument maneuverability. Surgical access to challenging skull-base tumors is therefore afforded. The procedure also reduces nasal morbidity by preserving the lacrimal apparatus and anterior maxilla structures and avoiding septal perforation and traumatic nose traction. Highlights The approach improves visualization and increases instrument maneuverability. Surgical access to challenging skull-base tumors is afforded. The procedure also reduces nasal morbidity.

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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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  7. [해외논문]   Long-Term Follow-Up of Patients with Metastatic Epidural Spinal Cord Compression from Solid Tumors Submitted for Surgery Followed by Radiation Therapy  

    Pessina, Federico (Department of Neurosurgical Oncology and Neurosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Navarria, Pierina (Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Carta, Giulio Alberto (Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , D'Agostino, Giuseppe Roberto (Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Clerici, Elena (Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Nibali, Marco Conti (Department of Neurosurgical Oncology and Neurosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Costa, Francesco (Department of Neurosurgical Oncology and Neurosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Fornari, Maurizio (Department of Neurosurgical Oncology and Neurosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Scorsetti, Marta (Department of Radiotherapy and R)
    World neurosurgery v.115 ,pp. e681 - e687 , 2018 , 1878-8750 ,

    초록

    Objective To evaluate the outcome of patients with epidural spinal cord compression from different solid tumors treated with a combined approach, surgery plus radiotherapy (RT), with a follow-up longer than 10 years. Methods Ninety-seven patients treated between 2002 and 2009 were included. Surgical treatment was performed in patients with good performance status, limited metastatic disease, life expectancy longer than 3 months, and progressive neurologic deficit and/or intractable pain. RT was performed delivering a median total dose of 30 Gy in 10 fractions. Clinical outcome was evaluated using the modified visual analog scale for pain, the Frankel scale for neurologic deficit, and magnetic resonance imaging before treatment, after treatment, and every 3 months thereafter. Results Palliative decompression was performed in 27% of patients, tumor curettage (debulking) was performed in 51%, and total vertebrectomy was performed in 22%, followed by RT in 78% of cases. Pain remission was obtained in 98% of patients, and recovery of neurologic function was obtained in 51%. The median follow-up time was 135 months (range, 96–209 months). The 5- and 10-year local control rates were 82.8% and 82.8%, respectively. The median and 5- and 10-year progression-free survival rates were 12 months, 16.9%, and 11.3%, respectively; the median and 5- and 10-year overall survival rates were 18 months, 21.3%, and 12%, respectively. On univariate and multivariate analysis, factors recorded as conditioning survival were the performance status and the presence of other metastases at the time of vertebral treatment ( P Conclusions Our update confirmed that surgery plus RT is a safe and feasible treatment with limited morbidity. In selected patients with favorable prognostic factors, the combined treatment may significantly impact on survival. Highlights Spinal cord compression is a frequent source of morbidity in cancer patients. A multimodal approach is recommended to choose the most appropriate treatment. Safety and feasibility of surgery plus radiotherapy is confirmed with a long follow-up.

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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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  8. [해외논문]   Editorial Board  


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

    초록

    Objective To evaluate the outcome of patients with epidural spinal cord compression from different solid tumors treated with a combined approach, surgery plus radiotherapy (RT), with a follow-up longer than 10 years. Methods Ninety-seven patients treated between 2002 and 2009 were included. Surgical treatment was performed in patients with good performance status, limited metastatic disease, life expectancy longer than 3 months, and progressive neurologic deficit and/or intractable pain. RT was performed delivering a median total dose of 30 Gy in 10 fractions. Clinical outcome was evaluated using the modified visual analog scale for pain, the Frankel scale for neurologic deficit, and magnetic resonance imaging before treatment, after treatment, and every 3 months thereafter. Results Palliative decompression was performed in 27% of patients, tumor curettage (debulking) was performed in 51%, and total vertebrectomy was performed in 22%, followed by RT in 78% of cases. Pain remission was obtained in 98% of patients, and recovery of neurologic function was obtained in 51%. The median follow-up time was 135 months (range, 96–209 months). The 5- and 10-year local control rates were 82.8% and 82.8%, respectively. The median and 5- and 10-year progression-free survival rates were 12 months, 16.9%, and 11.3%, respectively; the median and 5- and 10-year overall survival rates were 18 months, 21.3%, and 12%, respectively. On univariate and multivariate analysis, factors recorded as conditioning survival were the performance status and the presence of other metastases at the time of vertebral treatment ( P Conclusions Our update confirmed that surgery plus RT is a safe and feasible treatment with limited morbidity. In selected patients with favorable prognostic factors, the combined treatment may significantly impact on survival. Highlights Spinal cord compression is a frequent source of morbidity in cancer patients. A multimodal approach is recommended to choose the most appropriate treatment. Safety and feasibility of surgery plus radiotherapy is confirmed with a long follow-up.

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    원문보기
    무료다운로드 유료다운로드

    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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  9. [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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  10. [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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