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World neurosurgery 210건

  1. [해외논문]   Prevalence of Incidental Clinoid Segment Saccular Aneurysms  

    Revilla-Pacheco, Francisco (To whom correspondence should be addressed: Francisco Revilla-Pacheco, M.D., Ph.D.) , Escalante-Seyffert, Marí , a Cecilia , Herrada-Pineda, Tenoch , Manrique-Guzman, Salvador , Perez-Zuniga, Irma , Rangel-Suarez, Sergio , Rubalcava-Ortega, Johnatan , Loyo-Varela, Mauro
    World neurosurgery v.115 ,pp. e244 - e251 , 2018 , 1878-8750 ,

    초록

    Introduction Clinoid segment aneurysms are cerebral vascular lesions recently described in the neurosurgical literature. They arise from the clinoid segment of the internal carotid artery, which is the segment limited rostrally by the dural carotid ring and caudally, by the carotid-oculomotor membrane. Even although clinoid segment aneurysms represent a common incidental finding in magnetic resonance studies, its prevalence has not been yet reported. Objective To determine the prevalence of incidental clinoid segment saccular aneurysms diagnosed by magnetic resonance imaging as well as their anatomic architecture and their association with smoking, arterial hypertension, age, and sex of patients. Methods A total of 500 patients were prospectively studied with magnetic resonance imaging time-of-flight sequence and angioresonance with contrast material, to search for incidental saccular intracranial aneurysms. The site of primary interest was the clinoid segment, but the presence of aneurysms in any other location was determined for comparison. The relation among the presence of clinoid segment aneurysms, demographic factors, and secondary diagnosis of arterial hypertension, smoking, and other vascular/neoplastic cerebral lesions was analyzed. Results We found a global prevalence of incidental aneurysms of 7% (95% confidence interval, 5–9), with a prevalence of clinoid segment aneurysms of 3% (95% confidence interval, 2–4). Univariate logistic regression analysis showed a statistically significant relationship among incidental aneurysms, systemic arterial hypertension ( P = 0.000), and smoking ( P = 0.004). Conclusions In the studied population, incidental clinoid segment aneurysms constitute the variety with highest prevalence. Highlights Description of prevalence of a particular variety of saccular aneurysms. Prevalence of clinoid segment aneurysms not previously described. Extended discussion of a complex anatomy area. Prevalence of incidental saccular intracranial aneurysm in a specific population. Remarks on anatomic detail are crucial to determining aneurysms that are born and grow intradurally.

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  2. [해외논문]   Stand-Alone Anterolateral Interbody Fusion Versus Extended Posterior Fusion for Symptomatic Adjacent-Segment Degeneration: A Retrospective Study of 2 Years' Follow-up  

    Tu, Zhiming (To whom correspondence should be addressed: Bing Wang, M.D., Ph.D.) , Li, Lei , Wang, Bing , Li, Yawei , Lv, Guohua , Dai, Yuliang
    World neurosurgery v.115 ,pp. e748 - e755 , 2018 , 1878-8750 ,

    초록

    Objective To evaluate the clinical and radiologic outcome of stand-alone anterolateral lumbar interbody fusion (ALLIF) using self-locked cages in comparison with extended posterior lumbar interbody fusion (PLIF) for symptomatic adjacent-segment degeneration (ASD) after posterior lumbar fusion. Methods This retrospective study enrolled 40 symptomatic patients with ASD who were treated with ALLIF ( n = 13) or extended PLIF ( n = 27) between January 2011 and January 2015. Evaluations were performed preoperatively, at 3, 12, and 24 months postoperatively. Clinical outcome measurements included visual analog scale scores for low-back and leg pain, Oswestry Disability Index score for function assessment, Short-Form 36 Questionnaire for quality of life, and modified Macnab criteria for patient satisfaction. Radiologic outcome measurements included fusion rate, cage subsidence, disc height, and lumbar lordosis. Results There were no significant differences in the baseline data for the ALLIF and PLIF groups ( P > 0.05). Mean operative time, blood loss, and length of hospital stay were significantly decreased for the ALLIF group ( P P P Conclusions Stand-alone ALLIF could achieve satisfactory safety and efficacy for the treatment of symptomatic ASD with less trauma and faster recovery, and it may serve as an alternative surgical treatment for symptomatic ASD with appropriate indication. Highlights This study focused on the treatments of symptomatic ASD and proposed a novel approach ALLIF. We evaluated the clinical and radiologic outcome of stand-alone ALLIF versus extended PLIF for symptomatic ASD. Stand-alone ALLIF achieves satisfactory safety and efficacy for symptomatic ASD with less trauma and faster recovery.

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

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

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  6. [해외논문]   A Comparative Analysis of the Usefulness of Survival Prediction Models for Patients with Glioblastoma in the Temozolomide Era: The Importance of Methylguanine Methyltransferase Promoter Methylation, Extent of Resection, and Subventricular Zone Location  

    Woo, Peter (Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China ) , Ho, Jason (Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, China ) , Lam, Sandy (Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China ) , Ma, Eric (Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China ) , Chan, Danny (Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, Hong Kong, China ) , Wong, Wai-Kei (Department of Neurosurgery, Princess Margaret Hospital, Hong Kong, China ) , Mak, Calvin (Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China ) , Lee, Michael (Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China ) , Wong, Sui-To (Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, China ) , Chan, Kwong-Yau (Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China ) , Poon, Wai-Sang (Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, Hong Kong, China)
    World neurosurgery v.115 ,pp. e375 - e385 , 2018 , 1878-8750 ,

    초록

    Objective Several survival prediction models for patients with glioblastoma have been proposed, but none is widely used. This study aims to identify the predictors of overall survival (OS) and to conduct an independent comparative analysis of 5 prediction models. Methods Multi-institutional data from 159 patients with newly diagnosed glioblastoma who received adjuvant temozolomide concomitant chemoradiotherapy (CCRT) were collected. OS was assessed by Cox proportional hazards regression and adjusted for known prognostic factors. An independent CCRT patient cohort was used to externally validate the 1) RTOG (Radiation Therapy Oncology Group) recursive partitioning analysis (RPA) model, 2) Yang RPA model, and 3) Wee RPA model, Chaichana model, and the RTOG nomogram model. The predictive accuracy for each model at 12-month survival was determined by concordance indices. Calibration plots were performed to ascertain model prediction precision. Results The median OS for patients who received CCRT was 19.0 months compared with 12.7 months for those who did not ( P 85% (HR, 0.59; 95% CI, 0.4–0.9). For 12-month OS prediction, the RTOG nomogram model was superior to the RPA models with a c-index of 0.70. Calibration plots for 12-month survival showed that none of the models was precise, but the RTOG nomogram performed relatively better. Conclusions The RTOG nomogram best predicted 12-month OS. Methylguanine methyltransferase promoter methylation status, subventricular zone tumor location, and volumetric extent of resection should be considered when constructing prediction models. Highlights MGMT promoter methylation, SVZ location and EOR ≥85% are independent predictors of OS. Only the RTOG nomogram model can be considered as accurate and relatively precise in predicting 12-month survival. Future prediction models should include MGMT promoter methylation, SVZ location, and volumetric EOR as covariates.

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

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  7. [해외논문]   A Novel Targeted Foraminoplasty Device Improves the Efficacy and Safety of Foraminoplasty in Percutaneous Endoscopic Lumbar Discectomy: Preliminary Clinical Application of 70 Cases  

    Ao, Shengxiang (To whom correspondence should be addressed: Yue Zhou, M.D.) , Wu, Junlong (Wenjie Zheng, M.D. ) , Zheng, Wenjie (To whom correspondence should be addressed: Yue Zhou, M.D.) , Zhou, Yue (Wenjie Zheng, M.D.)
    World neurosurgery v.115 ,pp. e263 - e271 , 2018 , 1878-8750 ,

    초록

    Objective Percutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream surgical technique for treating lumbar disc herniation (LDH); however, there is a steep learning curve with PELD, especially for puncture and foraminoplasty. In this study, we assessed the outcome and safety of a novel quantificational and targeted foraminoplasty device named ZESSYS for LDH. Methods From September to December of 2016, 70 patients with symptomatic LDH were enrolled in the study. The patients were assigned randomly to either the ZESSYS group or the conventional TESSYS group. We recorded the cannula introduction time, decompression time, radiation exposure time, intraoperative pain feeling score, visual analog scale, Oswestry Disability Index, and Macnab criteria score of the 2 groups. The mean follow-up period was 14 months. Results The average cannula introduction time (16.50 ± 3.29 minutes) and the radiation exposure time (40.71 ± 6.23 seconds) in the ZESSYS group were significantly reduced compared with the TESSYS group (cannula introduction time, 20.06 ± 3.37 minutes, P = 0.000; radiation exposure time, 49.20 ± 7.84 seconds, P = 0.000). Intraoperative pain feeling score in the ZESSYS group was significantly improved compared with the TESSYS group ( P = 0.021). There were no significant differences between the 2 groups for decompression time ( P = 0.617), Macnab criteria ( P = 0.769), or visual analog scale and Oswestry Disability Index scores at the same time point ( P > 0.05). No serious complication was observed in any patients in either group. Conclusions The novel targeted foraminoplasty technique with the specially designed double-cannulas is an effective and safe treatment for lumbar intervertebral disc herniation. It reduces the difficulty of PELD learning, minimizes radiation exposure, and decreases intraoperative pain associated with foraminoplasty. Highlights The novel device reduces the difficulties of the foraminoplasty portion of percutaneous endoscopic lumbar discectomy. The patented instrument of double-cannulas makes it safer and alleviates pain in puncture. By rotating double-cannulas, it is convenient to reach the decompression target and widen the foramen precisely.

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

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  8. [해외논문]   Transarterial Balloon-Assisted Glue Embolization of Pial Arteriovenous Fistulas  

    Ye, Ming (To whom correspondence should be addressed: Ming Ye, M.D.) , Zhang, Peng
    World neurosurgery v.115 ,pp. e761 - e767 , 2018 , 1878-8750 ,

    초록

    Objective Endovascular disconnection of pial arteriovenous fistulas (AVFs) is challenging. The aim of this study was to evaluate safety and effectiveness of transarterial balloon-assisted glue embolization for treating pial AVFs. Methods We retrospectively reviewed medical and imaging records of 8 patients with high-flow pial AVFs treated by transarterial balloon-assisted glue embolization from August 2011 to July 2017. Results There were 6 male patients and 2 female patients with age range of 1–48 years. Presentation was seizure in 4 patients, headache in 3 patients, and subarachnoid hemorrhage in 1 patient. Seven lesions were located in the supratentorial region. All lesions were single-channel fistulas associated with venous varix. Five lesions had a single feeder, and 3 had multiple feeders. All lesions were obliterated completely in single-session embolization with no procedure-related complications. Two patients experienced symptomatic thrombosis of drainage venous system after embolization. One patient fully recovered on discharge, and another patient fully recovered after 8 months. With a mean clinical follow-up of 12.1 months, all patients were free of pretreatment symptoms. Follow-up angiograms revealed durable occlusion of fistulas. Conclusions Transarterial balloon-assisted glue embolization is a feasible and effective option for treatment of high-flow pial AVFs. Highlights Balloon-assisted glue embolization is an effective therapeutic option for high-flow pial AVFs. The procedure requires an experienced clinician. The glue must be injected carefully under blank roadmap with appropriate antegrade rate. After the microcatheter is withdrawn, the balloon is kept inflated for 30 seconds to allow adequate glue polymerization. Proximal inflated balloon in a high-flow feeder makes glue injection more controllable and avoids distal migration of glue.

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

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  9. [해외논문]   Anterior Controllable Antedisplacement Fusion (ACAF) for Severe Cervical Ossification of the Posterior Longitudinal Ligament: Comparison with Anterior Cervical Corpectomy with Fusion (ACCF)  

    Yang, Haisong (To whom correspondence should be addressed: Jiangang Shi, M.D.) , Sun, Jingchuan , Shi, Jiangang , Shi, Guodong , Guo, Yongfei , Yang, Yong
    World neurosurgery v.115 ,pp. e428 - e436 , 2018 , 1878-8750 ,

    초록

    Objective Anterior cervical corpectomy and fusion (ACCF), in which a ventral constriction is resected, can decompress myelopathy and is considered the optimal treatment for ossification of the posterior longitudinal ligament (OPLL) up to now. However, its disadvantages are incomplete decompression, high surgery- and implant-related complication rates, and extremely surgical technique demanding. Our object was to introduce anterior controllable antedisplacement fusion (ACAF), a new surgical technique to treat OPLL, and compare it with ACCF. Methods ACAF was performed on 34 patients with spinal stenosis with myelopathy due to severe (occupying rate ≥50%) OPLL. Pre- and postoperatively, we measured decompression width and spinal canal area on cross-sectional computed tomography and morphology and anteroposterior diameter of the spinal cord at the most severely affected segment on cross-sectional magnetic resonance imaging and cross-sectional computed tomography. Japanese Orthopedic Association scoring was used to evaluate neurologic status. The ACAF group and a control group of 36 patients with ACCF were compared. Results Postoperatively, decompression width (17.9 ± 1.0 vs. 15.1 ± 0.8 mm; P 2 ; P P P = 0.04). Conclusions ACAF, providing adequate decompression of the spinal cord and good outcomes, is a well choice in the treatment of spinal stenosis due to severe OPLL. Highlights Anterior controllable antedisplacement fusion is a new surgical technique for severe OPLL. Vertebrae together with ossified mass are moved forward but not cutting directly. ACAF provided sufficient decompression, better outcomes, and fewer complications. ACAF may become a good option for patients with severe and multisegmental OPLL.

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  10. [해외논문]   Glioblastoma Survival Outcomes at a Tertiary Hospital in Appalachia: Factors Impacting the Survival of Patients Following Implementation of the Stupp Protocol  

    Urhie, Ogaga (West Virginia University School of Medicine, Morgantown, West Virginia, USA ) , Turner, Ryan (Department of Neurosurgery, West Virginia University Hospitals, Morgantown, West Virginia, USA ) , Lucke-Wold, Brandon (West Virginia University School of Medicine, Morgantown, West Virginia, USA ) , Radwan, Walid (Department of Neurosurgery, West Virginia University Hospitals, Morgantown, West Virginia, USA ) , Ahn, Janice (Department of Pathology and Neurology, West Virginia University Health Sciences Campus, Morgantown, West Virginia, USA ) , Gyure, Kymberly (Department of Pathology and Neurology, West Virginia University Health Sciences Campus, Morgantown, West Virginia, USA ) , Bhatia, Sanjay (Department of Neurosurgery, West Virginia University Hospitals, Morgantown, West Virginia, USA)
    World neurosurgery v.115 ,pp. e59 - e66 , 2018 , 1878-8750 ,

    초록

    Background Glioblastoma is a fatal brain cancer with low median and yearly survival rates. Standard of care for treating glioblastoma is gross total resection (GTR) coupled with the Stupp protocol, but various factors influence the interventions undertaken and survival achieved. As health disparities exist in rural areas, survival in these areas needs to be assessed to understand which factors detract from the successes of these standard medical interventions. Methods We retrospectively determined impact of age at diagnosis, number of lesions, the molecular marker O 6 -methylguanine methyltransferase (MGMT), extent of surgery, and completion of the Stupp protocol on survival in patients treated at West Virginia University Hospitals. We also compared our findings with a pre–Stupp protocol study done in West Virginia in 1996. Results Age MGMT gene methylated, having a unifocal tumor, receiving GTR, adhering to the Stupp protocol, and undergoing a treatment course of GTR followed by the Stupp protocol significantly increased survival. Comparison with the 1996 study showed that although overall median survival has not increased, all interventions involving GTR have resulted in a significantly higher survival. Conclusions We can serve our patient population by offering GTR to all adult patients with glioblastoma when no contraindications exist and ensuring that patients follow the Stupp protocol. After discharge, the Stupp protocol may not be followed or completed for a variety of reasons. In the future, we aim to assess these reasons and analyze other significant interventional and socioeconomic factors that influence survival. Highlights Survival in patients in West Virginia is significantly increased by many factors including adhering to the Stupp protocol. The other factors include age MGMT gene methylated, unifocal tumor, and GTR. Despite advances in glioblastoma management, median survival of patients in West Virginia has not increased since 1996. All interventions involving GTR have significantly enhanced survival since then. The fact that median survival has not increased warrants further investigation.

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