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World neurosurgery 210건

  1. [해외논문]   Technical Nuances of Exposing Rat Common Carotid Arteries for Practicing Microsurgical Anastomosis  

    Tayebi Meybodi, Ali (To whom correspondence should be addressed: Mark C. Preul, M.D.) , Aklinski, Joseph , Gandhi, Sirin , Lawton, Michael T. , Preul, Mark C.
    World neurosurgery v.115 ,pp. e305 - e311 , 2018 , 1878-8750 ,

    초록

    Background Animal models are commonly used in training protocols for microsurgical vascular anastomosis. Rat common carotid arteries (CCAs) are frequently used for this purpose. Much attention has been paid to the technical details of various anastomosis configurations using these arteries. However, technical nuances of exposing rat CCAs have been understudied. The purpose of this study is to describe nuances of technique for safely and efficiently exposing rat CCAs in preparation for a vascular anastomosis. Methods Bilateral CCAs were exposed and prepared for anastomosis in 10 anesthetized Sprague-Dawley rats through a midline cervical incision. The exposed length of the CCA was measured. Additionally, technical nuances of exposure and surgically relevant anatomic details were recorded. Results The CCAs were exposed from the sternoclavicular joint to their bifurcation (average length, 19.1 ± 2.8 mm). Tenets important for a safe and efficient exposure of the CCAs included 1) generous subcutaneous dissection to expose the external jugular veins (EJVs), 2) avoiding injury to or compression of the EJVs, 3) superior mobilization of the salivary glands, 4) division of internal jugular veins, 5) opening the carotid sheath at its midlevel and from medial to lateral, and 6) avoiding injury to the vagus nerve or sympathetic trunk. Conclusions Using the principles introduced in this study, trainees may safely and efficiently expose rat CCAs in preparation for a bypass. Highlights Rat common carotid arteries are commonly used for bypass training purposes. Damage to target vessels is a major cause of early animal demise before the bypass begins. We describe the technical tenets of exposing rat common carotid arteries to minimize this problem.

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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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  2. [해외논문]   Preoperative and Postoperative Headache in Patients with Intracranial Tumors  

    Ravn Munkvold, Bodil Karoline (The Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway ) , Sagberg, Lisa Millgå (Norwegian National Advisory Unit for Ultrasound and Image Guided Therapy, St. Olav's University Hospital, Trondheim, Norway ) , rd (Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway ) , Jakola, Asgeir Store (Norwegian National Advisory Unit for Ultrasound and Image Guided Therapy, St. Olav's University Hospital, Trondheim, Norway) , Solheim, Ole
    World neurosurgery v.115 ,pp. e322 - e330 , 2018 , 1878-8750 ,

    초록

    Objective We sought to examine prevalence of headache in patients with histopathologically verified intracranial tumors scheduled for surgery and assess change in headache 1 and 6 months after surgical resection. Possible tumor-related and patient-related predictors for preoperative headache and early postoperative symptom relief were also explored. Methods The European Organization for Research and Treatment of Cancer has developed a quality-of-life questionnaire (EORTC QLQ-C30) with a brain cancer–specific module, QLQ-BN20, containing 20 questions rating symptoms the past week on an ordinal scale ranging from 1 to 4. Analyses are based on question 4 in this questionnaire. Results In this prospective population-based cohort study of 507 patients, we found that headache is a frequent symptom in patients with intracranial neoplasms. 52% reported some degree of preoperative headache, and the prevalence decreased to 43% and 30% 1 and 6 months postoperatively. 19% and 9% reported postoperative worsening or new headache 1 and 6 months after surgery. Younger age, female gender, and occipital tumor location were significant predictors for both preoperative headache and early postoperative relief. In addition, Karnofsky Performance Status Conclusions Headache is a common symptom in patients with intracranial tumors, especially in younger and female patients. Many patients experience improvement after surgery, and younger age, female gender, occipital tumor location, and functional dependence were identified as factors associated with early postoperative headache relief. Highlights Headache is a common symptom in patients with intracranial tumors, especially in younger and female patients. Occipital tumor location was identified as a tumor-related predictor for headache at baseline. Of patients with headache before surgical tumor resection, 60% and 70% reported improvement 1 and 6 months postoperatively. Occipital tumor location, younger, female, and KPS

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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]   Delayed Cerebral Ischemia and Vasospasm After Spontaneous Angiogram-Negative Subarachnoid Hemorrhage: An Updated Meta-Analysis  

    Lee, Si Un (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul, Korea ) , Hong, Eun Pyo (Department of Medical Genetics, Hallym University College of Medicine, Chuncheon, Korea ) , Kim, Bong Jun (Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea ) , Kim, Sung-Eun (Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, Korea ) , Jeon, Jin Pyeong (Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea)
    World neurosurgery v.115 ,pp. e558 - e569 , 2018 , 1878-8750 ,

    초록

    Objective To report clinical outcomes of delayed cerebral ischemia (DCI) and vasospasm in angiogram-negative subarachnoid hemorrhage (SAH) according to hemorrhage patterns, perimesencephalic hemorrhage (PMH) and non-PMH. Methods Online databases from January 1990 to December 2017 were systematically reviewed. A fixed-effects model was used to control heterogeneity. To resolve publication bias, the trim and fill method was used to estimate number of missing studies and adjusted odds ratio (OR). Subgroup analysis of data from studies that defined angiogram-negative subarachnoid hemorrhage by angiography repeated at least twice or computed tomography angiography was performed. Results Among 24 studies including 2083 patients, 23/985 patients (2.3%) with PMH and 144/1098 patients (13.1%) with non-PMH had DCI, indicating that patients with PMH experienced significantly lower DCI than patients with non-PMH (OR = 0.219; 95% confidence interval [CI], 0.144–0.334). Regarding vasospasm, 99/773 patients (12.8%) with PMH and 231/922 patients (25.1%) with non-PMH exhibited vasospasm, indicating that patients with PMH experienced significantly lower vasospasm than patients with non-PMH (OR = 0.445; 95% CI, 0.337–0.589). Funnel plots show asymmetry indicating possible publication bias. After trimming 10 studies for DCI and 7 for vasospasm, the adjusted ORs remained significant between PMH and lower risks of DCI and vasospasm. Subgroup analysis of 789 patients in 8 studies showed a lower risk of DCI (OR = 0.268; 95% CI, 0.151–0.473) and vasospasm (OR = 0.346; 95% CI, 0.221–0.538) in patients with PMH. Conclusions PMH showed a significantly lower risk of DCI and vasospasm than non-PMH. Clinical outcomes of angiogram-negative subarachnoid hemorrhage, based on meta-analysis of individual patient data, need to be investigated. Highlights This meta-analysis evaluated differences between PMH and non-PMH. Published data analyzed included recent studies that assessed DCI and vasospasm during follow-up. Subgroup analysis included studies that defined angiogram-negative SAH. PMH was associated with significantly lower incidence of DCI and vasospasm compared with non-PMH.

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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]   Effectiveness of Positron Emission Tomography/Computed Tomography as a Guide for Palliative Radiation Therapy for Spinal Metastases  

    Almeida, Neil D. (Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA ) , Adams, Crystal (Department of Neurological Surgery, George Washington University Hospital, Washington, DC, USA ) , Davis, Gregory L. (Department of Neurological Surgery, George Washington University Hospital, Washington, DC, USA ) , Starke, Robert M. (Department of Neurological Surgery, University of Miami, Miami, Florida, USA ) , Buro, Justin (Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA ) , Nasr, Nadim (Department of Radiation Oncology, Virginia Hospital Center, Arlington, Virginia, USA ) , McRae, Don (Department of Radiation Oncology, Virginia Hospital Center, Arlington, Virginia, USA ) , Cernica, George (Department of Radiation Oncology, Virginia Hospital Center, Arlington, Virginia, USA ) , Caputy, Anthony (Department of Neurological Surgery, George Washington University Hospital, Washington, DC, USA ) , Hong, Robert (Department of Radiation Oncology, Virginia Hospital Center, Arlington, Virginia, USA ) , Sherman, Jonathan (Department of Neurological Surgery, George W)
    World neurosurgery v.115 ,pp. e67 - e72 , 2018 , 1878-8750 ,

    초록

    Objective As back pain is the presenting symptom in 95% of patients with epidural spinal metastases, appropriately identifying and treating the most symptomatic levels can provide significant palliation. The purpose of this study was to analyze the ability of combined positron emission tomography (PET)/computed tomography (CT) to identify spinal metastases with high metabolic activity and guide radiotherapy. We sought to correlate improvement in back pain with reduction in standard uptake value (SUV) after treatment. Methods Retrospective review was performed of 72 patients with spinal metastases treated with stereotactic ablative radiation therapy at a single center between 2002 and 2014. PET/CT was used to calculate SUVs for spinal metastases, and treatment planning was based on PET/CT results. Preoperative and postoperative pain levels were assessed in all patients. Results Reduction in pain scores was found in 78% of treated patients. A significant reduction in pain was identified in patients with >5 metastases compared with fewer lesions ( P Conclusions PET/CT was shown to be a useful adjunct in radiation treatment planning with change in SUV correlating with symptomatic improvement. This study paves the way for future prospective studies to further assess utility and cost-effectiveness of this imaging modality in radiation treatment planning for spinal metastases. Highlights Symptomatic spinal metastases affect nearly 10% of all cancer patients with axial back pain being the primary symptom. Patients commonly present with multiple spinal metastases, and the pain generator can be difficult to localize. PET/CT can identify metastatic lesions with highest SUV correlating with highest metabolic activity. Lesions identified on PET/CT can be treated with stereotactic radiosurgery for palliative pain relief. PET/CT can also be used to monitor for tumor recurrence after treatment with radiosurgery.

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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]   Resident Traveling Fellowship in Pediatric Neurosurgery  


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

    초록

    Objective As back pain is the presenting symptom in 95% of patients with epidural spinal metastases, appropriately identifying and treating the most symptomatic levels can provide significant palliation. The purpose of this study was to analyze the ability of combined positron emission tomography (PET)/computed tomography (CT) to identify spinal metastases with high metabolic activity and guide radiotherapy. We sought to correlate improvement in back pain with reduction in standard uptake value (SUV) after treatment. Methods Retrospective review was performed of 72 patients with spinal metastases treated with stereotactic ablative radiation therapy at a single center between 2002 and 2014. PET/CT was used to calculate SUVs for spinal metastases, and treatment planning was based on PET/CT results. Preoperative and postoperative pain levels were assessed in all patients. Results Reduction in pain scores was found in 78% of treated patients. A significant reduction in pain was identified in patients with >5 metastases compared with fewer lesions ( P Conclusions PET/CT was shown to be a useful adjunct in radiation treatment planning with change in SUV correlating with symptomatic improvement. This study paves the way for future prospective studies to further assess utility and cost-effectiveness of this imaging modality in radiation treatment planning for spinal metastases. Highlights Symptomatic spinal metastases affect nearly 10% of all cancer patients with axial back pain being the primary symptom. Patients commonly present with multiple spinal metastases, and the pain generator can be difficult to localize. PET/CT can identify metastatic lesions with highest SUV correlating with highest metabolic activity. Lesions identified on PET/CT can be treated with stereotactic radiosurgery for palliative pain relief. PET/CT can also be used to monitor for tumor recurrence after treatment with radiosurgery.

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    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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  6. [해외논문]   Deep Sequencing of Small RNAs in Blood of Patients with Brain Arteriovenous Malformations  

    Chen, Yong (Department of Neurosurgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Sichuan, China ) , Li, Zhili (Department of Neurosurgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Sichuan, China ) , Shi, Yi (Key Laboratory of SiChuan Province in Human Disease Gene Study, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Sichuan, China ) , Huang, Guangfu (Department of Neurosurgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Sichuan, China ) , Chen, Longyi (Department of Neurosurgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Sichuan, China ) , Tan, Haibin (Department of Neurosurgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Sichuan, China ) , Wang, Zhenyu (Department of Neurosurgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Sichuan, China ) , Yin, Cheng (Department of Neurosurgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Sichuan, Chin) , Hu, Junting
    World neurosurgery v.115 ,pp. e570 - e579 , 2018 , 1878-8750 ,

    초록

    Background Deregulation of circulating microRNAs (miRNAs) is always associated with development and progression of human diseases. We aimed to assess whether patients with brain arteriovenous malformations (BAVMs) possess a distinct miRNA signature compared with healthy subjects. Methods Three patients with unruptured BAVMs and 3 normal control subjects were recruited as case and control groups. Peripheral blood was collected, and miRNA signature was obtained by next-generation sequencing, followed by comparative, functional, and network analyses. Quantitative reverse transcription polymerase chain reaction was performed to validate expression of specific miRNAs. Results Deep sequencing detected 246 differentially expressed miRNAs in blood samples of patients with BAVMs compared with normal control subjects. For the top 5 miRNAs, 946 target genes were predicted, and a BAVM-specific miRNA-target gene regulatory network was constructed. Functional annotation suggested that 15 of the predicted miRNA-targeted genes were involved in vascular endothelial growth factor signaling, in which 3 critical miRNAs were involved: miR-7-5p, miR-199a-5p, and miR-200b-3p. Conclusions We explored the miRNA expression signature of BAVMs, which will provide an important foundation for future studies on the regulation of miRNAs involved in BAVMs. Highlights We obtained the global miRNA expression profile in peripheral blood samples from BAVMs. Mitogen-activated protein kinase, Wnt, and VEGF signaling were involved in the process of BAVMs. miR-7-5p, miR-199a-5p, and miR-200b-3p may be potential diagnostic biomarkers of BAVMs.

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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]   Unplanned Intraoperative Extubations in Pediatric Neurosurgery: Analysis of Case Series to Increase Patient Safety  

    Wagner, Kathryn M. (Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA ) , Raskin, Jeffrey S. (Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA ) , Carling, Nicholas P. (Department of Pediatric Anesthesiology, Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA ) , Felberg, Mary A. (Department of Pediatric Anesthesiology, Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA ) , Kanjia, Megha K. (Department of Pediatric Anesthesiology, Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA ) , Pan, I-Wen (Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA ) , Luerssen, Thomas G. (Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, U) , Lam, Sandi
    World neurosurgery v.115 ,pp. e1 - e6 , 2018 , 1878-8750 ,

    초록

    Objective Unplanned intraoperative extubations (UIEs), rare but high-risk events. Unintentional extubations are used as quality improvement metrics in neonatal and pediatric intensive care units, but intraoperative events have received scant attention in the literature. Complexity of patient positioning and proximity of the operative field to anesthesia make neurosurgical procedures unique. UIEs prolong operative time, increase risk of adverse outcomes, including cardiopulmonary collapse, and potentially require additional procedures. Investigating each event is critical to prevention. We aimed to analyze occurrences of UIEs in the pediatric population. Methods We retrospectively reviewed UIE cases (12/2014–4/2017) in pediatric neurosurgical patients at a metropolitan pediatric Level I trauma center. Data were collected on patient demographics, procedure, operating room events before the event, and patient outcomes. Results Over 27 months, 5 UIEs in pediatric neurosurgical cases occurred, with an event rate of Conclusions Findings suggest an inverse correlation between patient age and UIE, with patient manipulation and anesthesia depth as risk factors. Meticulous attention to securing the endotracheal tube and streamlined communication between the surgical and anesthesia teams are critical for the goal of zero UIE occurrences.

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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]   In Situ Decompression to Spinal Cord During Anterior Controllable Antedisplacement Fusion Treating Degenerative Kyphosis with Stenosis: Surgical Outcomes and Analysis of C5 Nerve Palsy Based on 49 Patients  

    Yang, Haisong (To whom correspondence should be addressed: Jiangang Shi, M.D.) , Sun, Jingchuan , Shi, Jiangang , Yang, Yong , Guo, Yongfei , Zheng, Bing , Wang, Yuan
    World neurosurgery v.115 ,pp. e501 - e508 , 2018 , 1878-8750 ,

    초록

    Objective To observe outcomes of anterior controllable antedisplacement fusion (ACAF) in treatment of degenerative kyphosis with stenosis (DKS) and analyze probability of C5 nerve palsy. Methods From 2016 to 2017, a consecutive cohort of adults with DKS underwent ACAF. All patients underwent cervical radiography, computed tomography, and magnetic resonance imaging. Operative duration, blood loss, and hospital stay were estimated. Radiologic assessment included kyphotic correction, decompression width, and spinal canal area. Postoperative curvature of spinal cord was observed on sagittal magnetic resonance imaging. Japanese Orthopaedic Association score was used to evaluate neurologic status. C5 nerve palsy and other complications were recorded. Results The study included 49 patients. There was significant kyphosis correction postoperatively (−19.4° vs. 3.5°, P 2 . On sagittal magnetic resonance imaging, spinal cord curvature was classified into 5 types: type I, lordosis; type II, straight with no shifting; type III, straight with shifting; type IV, sigmoid; and type V, kyphosis. After ACAF, the spinal cord was maintained in good curvature with no shifting in all patients. No patient presented with C5 nerve palsy. Mean postoperative Japanese Orthopaedic Association score was significantly better than preoperatively (14.9 points vs. 9.0 points, P Conclusions ACAF provides in situ decompression and good curvature to the spinal cord. Good neurologic recovery is obtained with lower incidence of C5 nerve palsy when ACAF is used to treat DKS. Highlights ACAF provides good kyphotic correction, sufficient decompression, better outcomes, and fewer complications for DKS. ACAF results in in situ decompression and good curvature to the spinal cord. The incidence of C5 nerve palsy is very low. There is no spinal cord posterior shifting, no iatrogenic foraminal stenosis and no posterior column change during ACAF.

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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]   Strokectomy and Extensive Cerebrospinal Fluid Drainage for the Treatment of Space-Occupying Cerebellar Ischemic Stroke  

    Tartara, Fulvio (Neurosurgery Unit, Inter-Hospital Department of Neurological science Cremona-Mantua, Cremona, Italy ) , Bongetta, Daniele (Neurosurgery Unit, IRCCS Policlinico S. Matteo, Pavia, Italy ) , Colombo, Elena Virginia (Neurosurgery Unit, University Hospital, Parma, Italy ) , Bortolotti, Carlo (Neurosurgery Unit, Institute of Neurological Sciences and Bellaria Hospital, Bologna, Italy ) , Cenzato, Marco (Neurosurgery Unit, IRCCS Niguarda Ca 'Granda Hospital, Milan, Italy ) , Giombelli, Ermanno (Neurosurgery Unit, University Hospital, Parma, Italy ) , Gaetani, Paolo (Neurosurgery Unit, IRCCS Policlinico S. Matteo, Pavia, Italy ) , Zenga, Francesco (Neurosurgery Unit, City of Health and Science - Molinette Hospital, Turin, Italy ) , Pilloni, Giulia (Neurosurgery Unit, City of Health and Science - Molinette Hospital, Turin, Italy ) , Ciccone, Alfonso (Neurology Unit, Inter-Hospital Department of Neurological science Cremona-Mantua, Mantua, Italy ) , Sessa, Maria (Neurology Unit, Inter-Hospital Department of Neurological science Cremona-Mantua, Cremona, Italy)
    World neurosurgery v.115 ,pp. e80 - e84 , 2018 , 1878-8750 ,

    초록

    Background Cerebellar ischemia may lead to space-occupying edema, resulting in potentially fatal complications. Different surgical procedures are available to create space for the swollen ischemic brain; however, the type and timing of surgical treatments remain topics of debate in the literature. Here we report a case series of patients treated with a unilateral craniotomy to perform a cerebellar strokectomy and extensive cerebrospinal fluid (CSF) drainage without osteodural posterior fossa decompression. Methods We retrospectively analyzed the clinical and radiographic data of 11 patients with posterior fossa ischemia who underwent surgery at one of our institutions. A statistical analysis was performed to identify potential predictive factors for functional outcome. Results The mean patient age was 64.7 years. The involved vascular territory was the Posterior inferior cerebellar artery in 9 patients (82%) and the anterior inferior cerebellar artery/superior cerebellar artery in 2 patients (18%). The mean Glasgow Coma Scale score was 13.6 on admission, but 9.3 immediately before surgery. The surgical procedure was performed in a mean of 36.8 minutes after the radiologic diagnosis of space-occupying edema. Clinical outcome at 6 months was good (modified Rankin Scale [mRS] score ≤2) in 9 patients (82%). Surgery-related complications occurred in 2 patients (18%), and these was a single death (9%) not related to the procedure or posterior fossa compression. Matching patients with their mRS outcome evaluation, the sole variable significantly associated with good outcome was age at admission (62.1 vs. 76.5 years; P Conclusions Unilateral suboccipital craniotomy with strokectomy and extensive CSF drainage may allow for satisfactory decompression of the ischemic posterior fossa with acceptable morbidity and mortality rates, especially in younger patients. Highlights Cerebellar ischemia accounts for roughly 3% of brain strokes; its evolution may lead to space-occupying edema, resulting in potentially fatal complications such as obstructive acute hydrocephalus and brainstem compression. The aim of this study is to present a case series of cerebellar ischemia treated with a small unilateral cerebellar strokectomy and extensive cerebrospinal fluid (CSF) drainage without osteodural decompression. Monolateral suboccipital craniotomy with strokectomy and extensive CSF drainage may allow for sufficient decompression of the ischemic posterior fossa with acceptable morbidity and mortality rates.

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  10. [해외논문]   Clinical Significance of the Circle of Willis in Patients with Symptomatic Internal Carotid Artery Occlusion  

    Park, Byoung Joo (Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, Republic of Korea ) , Kim, Kang Min (Department of Neurosurgery, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Republic of Korea ) , Lee, Woong Jae (Department of Radiology, Chung-ang University Hospital, Seoul, Republic of Korea ) , Chun, In Kook (Department of Nuclear Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, Republic of Korea ) , Kim, Inkyeong (Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, Republic of Korea ) , Lee, Seung Jin (Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, Republic of Korea ) , Kim, Seongheon (Department of Neurology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, Republic)
    World neurosurgery v.115 ,pp. e585 - e591 , 2018 , 1878-8750 ,

    초록

    Background Despite improvements in medical treatment, many patients experience ischemic stroke owing to internal carotid artery occlusion. We retrospectively evaluated a novel method based on the arterial structure of the circle of Willis (CoW) to identify patients at a high risk of recurrent stroke. Methods The study enrolled 104 patients with symptomatic occlusion of the internal carotid artery. CoW integrity was evaluated by a quantitative scoring system based on conventional angiography. Patients were categorized into a good integrity ( n = 45) or poor integrity ( n = 59) group. Primary endpoint was early neurologic deterioration, recurrent ischemic stroke, or transient ischemic attack. Results History of ischemic stroke before initial presentation was more prevalent in the poor integrity group (22.2% vs. 47.5%, P = 0.01), and there were no differences between the 2 groups in terms of stroke risk factors. Overall estimated rate of the primary endpoint was 25.6% 2 years after angiography. It was 5.7% in the good integrity group and 39.8% in the poor integrity group ( P P = 0.01, hazard ratio = 6.60), use of a tissue plasminogen activator ( P = 0.00, hazard ratio = 6.10), and poor integrity of CoW ( P = 0.00, hazard ratio = 5.42) were risk factors for the primary endpoint. Patients in the poor integrity group with decreased vascular reserve experienced frequent primary endpoint events compared with patients in the good integrity group ( P = 0.00). Conclusions Patients with poor integrity of CoW are vulnerable to recurrent ischemic stroke and appear to require more aggressive treatment. Highlights We designed a novel method based on the integrity of CoW to evaluate cerebral collateral circulation. Patients with poor integrity of CoW showed a high risk of recurrent ischemic stroke after total occlusion of ICA. This study provides a perspective different from that of the current treatment strategy for ICA occlusion.

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