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World neurosurgery 210건

  1. [해외논문]   The Art of Surgery: “Have We Strayed Too Far?”  

    Benzel, Ed
    World neurosurgery v.115 ,pp. xxii - xxiii , 2018 , 1878-8750 ,

    초록

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  2. [해외논문]   Pediatric Spinal Ependymomas: An Epidemiologic Study  

    Khalid, Syed I. (Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA ) , Kelly, Ryan (Georgetown University School of Medicine, Washington, D.C., USA ) , Adogwa, Owoicho (Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA ) , Carlton, Adam (Chicago Medical School, North Chicago, Illinois, USA ) , Woodward, Josha (Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA ) , Ahmed, Shahjehan (Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA ) , Khanna, Ryan (Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA ) , Bagley, Carlos (Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA ) , Cheng, Joseph (Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA ) , Shah, Sanjit (Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA ) , Mehta, Ankit I. (Chicago Medical School, North Chicago, Illinois, USA)
    World neurosurgery v.115 ,pp. e119 - e128 , 2018 , 1878-8750 ,

    초록

    Objective Pediatric intramedullary spinal cord ependymomas represent a rare central nervous system neoplasm with few available data regarding incidence and outcomes. To this end, large population-based studies are needed to assess the epidemiology and survival risk factors associated with these tumors in the hope of better understanding these tumors as well as improving outcomes. This retrospective study was undertaken to explore factors that may influence survival in pediatric patients with intramedullary spinal cord ependymomas. Methods Using the SEER (Surveillance Epidemiology and End Results) database, a prospective cancer registry, we retrospectively assessed survival in histologically confirmed spinal ependymomas in patients 17 years of age and younger. Survival was described with Kaplan-Meier curves, and a multivariate regression analysis was used to assess the association of several variables with survival, controlling for confounding variables. Results Invasive tumor extension ( P P = 0.028) correlated with better rates of survival. Age, gender, tumor size, tumor extension, the use and sequence of radiation therapy, or use of chemotherapy were not found to have a statistically significant association with survival outcomes. Conclusions Invasive ependymomas occurring in the spine have a worse prognosis, whereas higher tumor grades do not clearly show worse rates of survival. Early diagnosis and surgery seem to be associated with improved survival and outcomes, whereas radiation therapy and chemotherapy have an unclear role. Highlights Invasive ependymomas occurring in the pediatric spine have a worse prognosis. Higher tumor grades do not clearly show worse rates of survival. Early diagnosis and surgery seem to be associated with improved survival and outcomes. Radiation therapy and chemotherapy have an unclear role in the treatment of pediatric spinal ependymomas.

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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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  3. [해외논문]   Wireless Phone Use and Risk of Adult Glioma: Evidence from a Meta-Analysis  

    Wang, Peng (Department of Neurosurgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China ) , Hou, Chongxian (Department of Neurosurgery, Hokkaido University School of Medicine, Sapporo, Japan ) , Li, Yanwen (Department of Neurosurgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China ) , Zhou, Dong (Department of Neurosurgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China)
    World neurosurgery v.115 ,pp. e629 - e636 , 2018 , 1878-8750 ,

    초록

    Background Wireless phone use has been increasing rapidly and is associated with the risk of glioma. Many studies have been conducted on this association without reaching agreement. The aim of this meta-analysis was to determine the possible association between wireless phone use and risk of adult glioma. Methods Eligible studies were identified by searching PubMed and Embase up to July 2017. Random-effects or fixed-effects model was used to combine the results depending on the heterogeneity of the analysis. Publication bias was evaluated using Begg's funnel plot and Egger's regression asymmetry test. Subgroup analysis was performed to evaluate possible influence of these variables. Results Ten studies on the association of wireless phone use and risk of glioma were included. The combined odds ratio of adult gliomas associated with ever use of wireless phones was 1.03 (95% confidence interval [CI], 0.92–1.16) with high heterogeneity ( I 2 = 54.2%, P = 0.013). In subgroup analyses, no significant association was found between tumor location in the temporal lobe and adult glioma risk, with odds ratios of 1.26 (95% CI, 0.87–1.84), 0.93 (95% CI, 0.69–1.24), and 1.61 (95% CI, 0.78–3.33). A significant association with risk of glioma was found in long-term users (≥10 years) with odds ratio of 1.33 (95% CI, 1.05–1.67). Conclusions Ever use of wireless phones was not significantly associated with risk of adult glioma, but there could be increased risk in long-term users. Highlights Ever use of wireless phones was not significantly associated with risk of adult glioma. Long-term use of wireless phones could increase risk of adult glioma. One standard protocol is needed for large scale research on use of wireless phones.

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  4. [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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    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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  5. [해외논문]   Computed Tomography Angiography Evaluation of Risk Factors for Unstable Intracranial Aneurysms  

    Wang, Guang-xian (Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China ) , Gong, Ming-fu (Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China ) , Wen, Li (Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China ) , Liu, Lan-lan (Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China ) , Yin, Jin-bo (Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China ) , Duan, Chun-mei (Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China ) , Zhang, Dong (Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China)
    World neurosurgery v.115 ,pp. e27 - e32 , 2018 , 1878-8750 ,

    초록

    Objective To evaluate risk factors for instability in intracranial aneurysms (IAs) using computed tomography angiography (CTA). Methods A total of 614 consecutive patients diagnosed with 661 IAs between August 2011 and February 2016 were reviewed. Patients and IAs were divided into stable and unstable groups. Along with clinical characteristics, IA characteristics were evaluated by CTA. Multiple logistic regression analysis was used to identify the independent risk factors associated with unstable IAs. Receiver operating characteristic (ROC) curve analysis was performed on the final model, and optimal thresholds were obtained. Results Patient age (odds ratio [OR], 0.946), cerebral atherosclerosis (CA; OR, 0.525), and IAs located at the middle cerebral artery (OR, 0.473) or internal carotid artery (OR, 0.512) were negatively correlated with instability, whereas IAs with irregular shape (OR, 2.157), deep depth (OR, 1.557), or large flow angle (FA; OR, 1.015) were more likely to be unstable. ROC analysis revealed threshold values of age, depth, and FA of 59.5 years, 4.25 mm, and 87.8°, respectively. Conclusions The stability of IAs is significantly affected by several factors, including patient age and the presence of CA. IA shape and location also have an impact on the stability of IAs. Growth into an irregular shape, with a deep depth, and a large FA are risk factors for a change in IAs from stable to unstable. Highlights The morphological characteristics seen on CTA can distinguish UAs from SAs. IAs with an irregular shape, a deep depth and a large flow angle are more prone to instability. In older patients with CA, IAs at the middle cerebral artery or internal carotid artery tend to be more stable.

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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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  6. [해외논문]   The Recovery of Motor Strength after Posterior Percutaneous Endoscopic Cervical Foraminotomy and Discectomy  

    Lee, Urim (Department of Neurosurgery, Human Brain Function Laboratory, Seoul National University Hospital, Seoul, South Korea ) , Kim, Chi Heon (Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea ) , Chung, Chun Kee (Department of Neurosurgery, Human Brain Function Laboratory, Seoul National University Hospital, Seoul, South Korea ) , Choi, Yunhee (Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea ) , Yang, Seung Heon (Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea ) , Park, Sung Bae (Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea ) , Hwang, Sung Hwan (Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea ) , Jung, Jong-Myung (Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea ) , Kim, Kyoung-Tae (Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea)
    World neurosurgery v.115 ,pp. e532 - e538 , 2018 , 1878-8750 ,

    초록

    Objective Cervical radiculopathy infrequently presents with motor weakness. Motor weakness was improved in >90% of patients after anterior cervical discectomy and fusion or posterior cervical foraminotomy. Posterior percutaneous endoscopic cervical foraminotomy and discectomy (PECF) is an alternative surgical technique, but the outcome of motor weakness has not been reported. Our objective was to demonstrate the longitudinal outcomes of motor weakness after PECF. Methods A retrospective review of 106 consecutive patients was performed. Preoperative motor weakness was graded as mild (IV/V strength) or severe (less than III/V strength). The patients visited the outpatient clinic at 1, 3, 6, and 12 months after surgery and yearly thereafter. Improvement was defined as an improved weakness of more than 1 grade, and normalization was defined as the recovery of complete motor strength. Results Motor weakness preoperatively presented in 76 of 106 (72%) patients (49%, mild weakness; 23%, severe weakness). After PECF, the weakness improved in 72 of 76 (95%) patients and normalized in 65 of 76 (86%) patients. In the patients with mild weakness, the normalization rates were 48%, 81%, 90%, and 96% at postoperative months 1, 3, 6, and 12, respectively. In the patients with severe weakness, the improvement rates were 50%, 71%, 83%, 88%, and 92%, and the normalization rates were 8%, 38%, 58%, 58%, and 63% at postoperative months 1, 3, 6, 12, and 24, respectively. Conclusions Preoperative motor weakness was improved in 95% of the patients after PECF, but motor weakness was not normalized in 37% of the patients with severe weakness. Highlights Cervical radiculopathy infrequently presents with motor weakness. Weakness was improved in 95% of patients after endoscopic foraminotomy. However, the weakness was not normalized in 37% of patients with severe weakness. Old age more than 51 years and male sex were poor prognostic factors. This information may be helpful in selecting the desired surgical method.

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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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  7. [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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    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]   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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    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]   Aberrant Expression of Extracellular Signal-Regulated Kinase and 15-Hydroxyprostaglandin Dehydrogenase Indicates Radiation Resistance and Poor Prognosis for Patients with Clival Chordomas  

    Zhai, Yixuan (Beijing Neurosurgical Institute, Capital Medical University, Beijing, China ) , Bai, Jiwei (Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China ) , Wang, Shuai (Beijing Neurosurgical Institute, Capital Medical University, Beijing, China ) , Li, Mingxuan (Beijing Neurosurgical Institute, Capital Medical University, Beijing, China ) , Wang, Fei (Department of Neurosurgery, Provincial Hospital Affiliated to Anhui Medical University, Hefei, China ) , Li, Chuzhong (Beijing Neurosurgical Institute, Capital Medical University, Beijing, China ) , Zhang, Yazhuo (Beijing Neurosurgical Institute, Capital Medical University, Beijing, China)
    World neurosurgery v.115 ,pp. e146 - e151 , 2018 , 1878-8750 ,

    초록

    Objective To explore molecular markers of radiosensitivity and prognostic factors in patients with clival chordomas. Methods Retrospective review was performed of 35 patients. Mean follow-up interval was 66.37 months (range, 29–106 months). Kaplan-Meier method was used for survival analysis. Immunohistochemical staining was used to detect expression levels of extracellular signal-regulated kinase (ERK) and 15-hydroxyprostaglandin dehydrogenase ( HPGD ). Results Total resection was achieved in 12 cases, subtotal resection was achieved in 12 cases, and partial resection was achieved in 11 cases. Radiation-sensitive group comprised 17 cases, and radiation-resistant (RR) group comprised 18 cases. Five-year progression-free survival (PFS) rates in total resection and nontotal resection groups were 46.3% and 10.1%, respectively ( P = 0.005). Mean H-scores of ERK in radiation-resistant and radiation-sensitive groups were 110.38 and 82.98, respectively ( P = 0.043). Mean H-scores of HPGD in radiation-resistant and radiation-sensitive groups were 178.62 and 203.47, respectively ( P = 0.031). Mean PFS in low ERK expression group (58.61 months) was significantly longer than mean PFS in high ERK expression group (24.94 months) ( P = 0.022). Mean PFS in high HPGD expression group (39.54 months) was significantly longer than mean PFS in low HPGD expression group (9.5 months) ( P = 0.013). Conclusions Radical resection with protection of important structures is the most effective treatment of clival chordomas. High HPGD expression and low ERK expression were associated with radiation sensitivity and better prognosis. HPGD and ERK can be used as biomarkers to predict prognosis and guide treatment. Highlights Total resection and small tumor are favorable prognostic factors for patients with clival chordomas. HPGD and ERK expression is related to radiation sensitivity. HPGD and ERK can be used as biomarkers for predicting prognosis.

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  10. [해외논문]   Deep Brain Stimulation for Parkinson Disease in the Philippines: Outcomes of the Philippine Movement Disorder Surgery Center  

    Diestro, Jose Danilo B. (Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines ) , Vesagas, Theodor S. (Philippine Movement Disorder Surgery Center, Cardinal Santos Medical Center, San Juan City, Philippines ) , Teleg, Rosalia A. (Philippine Movement Disorder Surgery Center, Cardinal Santos Medical Center, San Juan City, Philippines ) , Aguilar, Jose A. (Philippine Movement Disorder Surgery Center, Cardinal Santos Medical Center, San Juan City, Philippines ) , Anlacan, Joseph P. (Philippine Movement Disorder Surgery Center, Cardinal Santos Medical Center, San Juan City, Philippines ) , Jamora, Roland Dominic G. (Philippine Movement Disorder Surgery Center, Cardinal Santos Medical Center, San Juan City, Philippines)
    World neurosurgery v.115 ,pp. e650 - e658 , 2018 , 1878-8750 ,

    초록

    Objective Deep brain stimulation (DBS) is an established treatment modality for Parkinson disease (PD). The first DBS for PD in the Philippines was performed at the Philippine Movement Disorder Surgery Center in 2006. There are no Philippine data on DBS for PD. We aim to determine the motor improvement and reduction in medication dosage of all patients with PD who underwent DBS at the Philippine Movement Disorder Surgery Center. Methods This is a retrospective study of all patients with PD ( n = 17) who underwent DBS from 2006 to 2016. The change in the Unified Parkinson's Disease Rating Scale (UPDRS) motor and levodopa equivalent dose were determined. Results There was a statistically significant reduction in the UPDRS motor in all patients off medication at 3 months (48.2%; P = 0.004), 1 year (47.3%; P = 0.026), 2 years (48.4%; P = 0.021), and 3 years (66.0%; P = 0.032) after DBS and on medication at 3 months (43.3%; P = 0.023), 6 months (24.7%; P = 0.053), and 1 year (38.1%; P = 0.033). A significant reduction in the dosage of PD medications was also seen until the second year of follow-up (52.3%; P Conclusions DBS for PD improves the UPDRS motor score in the off-medication and on-medication state, with the maximal benefit seen at 3 years after surgery and reduces PD medication dosage by half. Although the benefit from DBS is undeniable, the high cost of the procedure precludes more patients from benefitting from it. There is a need for government support to expand access to DBS. Highlights DBS for Parkinson Disease improves UPDRS motor scores in the off-medication state and halves the levodopa equivalent dose. The outcomes of the Philippine Movement Disorder Surgery Center are at par with other Asian and Western countries. The inequity in the distribution of health care contributes to low DBS use.

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