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World neurosurgery 210건

  1. [해외논문]   Aseptic Bone Flap Resorption after Cranioplasty with Autologous Bone: Incidence, Risk Factors, and Clinical Implications  

    Kim, Jang Hun (Department of Neurosurgery, Guro Hospital, Seoul, Republic of Korea ) , Kim, Jong Hyun (Department of Neurosurgery, Guro Hospital, Seoul, Republic of Korea ) , Kwon, Taek-Hyun (Department of Neurosurgery, Guro Hospital, Seoul, Republic of Korea ) , Chong, Kyuha (Department of Neurosurgery, Guro Hospital, Seoul, Republic of Korea ) , Hwang, Soon-Young (Biostatistical Consulting Laboratory, Medical Science Research Center, Korea University College of Medicine, Seoul, Republic of Korea ) , Yoon, Won Ki (Department of Neurosurgery, Guro Hospital, Seoul, Republic of Korea)
    World neurosurgery v.115 ,pp. e111 - e118 , 2018 , 1878-8750 ,

    초록

    Objectives Aseptic bone flap resorption (ABFR) is a known complication of cranioplasty (CP) with an autologous bone flap. The incidence of ABFR has been reported to be as high as 34.2% in the literature; however, it is underestimated in clinical fields. We retrospectively reviewed 13 years of clinical cases of patients who underwent CP after decompressive craniectomy (DC) to investigate the incidence and risk factors of ABFR. Methods Ninety-one patients who underwent DC and CP in Guro Hospital, Korea University Medical Center, were enrolled. ABFR was defined using serial brain computed tomography. To identify possible risk factors for ABFR, univariate and multivariate Cox regression and receiver operating characteristic curve analyses were performed. Results Of the 91 patients enrolled, ABFR was diagnosed in 32 patients (35.1%). Bone flap size, existence of a shunting system, and the DC-CP interval were significant in the univariate analysis. Bone flap size was statistically significant in the multivariate analysis ( P = 0.0189). The cutoff points of the DC-CP interval and bone flap size were 44 days and 110 cm 2 , respectively. Conclusions The incidence of ABFR was remarkably high. Bone flap size, the existence of a shunting system, and the DC-CP interval were shown to be potential risk factors of ABFR after CP. Highlights ABFR rate after autologous bone CP for DC patients was higher than expected. Large bone flap size was an independent risk factor for ABFR. Shunting system presence and a long interval between DC and CP were risk factors.

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  2. [해외논문]   Risk Factor Analysis for the Outcomes of Indirect Traumatic Optic Neuropathy with No Light Perception at Initial Visual Acuity Testing  

    Lai, I-Li (Department of Surgery, Chang Gung Memorial Hospital, LinKou, Taiwan ) , Liao, Han-Tsung (Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, LinKou, Taiwan)
    World neurosurgery v.115 ,pp. e620 - e628 , 2018 , 1878-8750 ,

    초록

    Background The optimal management of indirect traumatic optic neuropathy (TON) is controversial. We aimed to compare the differences in visual improvement by treatment option in patients presenting with TON and no light perception (NLP). We also wanted to identify any patient-related factors that might favor the use of steroid pulse therapy or optic nerve decompression (OND). Methods We retrospectively identified 46 consecutive patients with indirect TON treated at Chang Gung Memorial Hospital between 2007 and 2015. The outcome was the improvement in visual acuity by improvement rate and degree of improvement. Results Females had a better improvement rate than did males. Compared with delayed treatment, patients receiving steroid pulse therapy within 14 hours or receiving OND within 26 hours had a better improvement rate/degree. In patients with an initial intraocular pressure (IOP) of 17–23 mm Hg, the improvement rate/degree was significantly better than for patients with an IOP outside this range. For patients treated by OND, an initially normal IOP (11–21 mm Hg) suggested a significantly better prognosis in the improvement rate/degree. Conclusions For patients with indirect TON, initial NLP implies a poor prognosis, but steroid pulse therapy or OND are both feasible treatment options. These results emphasize the importance of timely treatment for patients with indirect TON and NLP. Females and patients with an initial IOP of 17–23 mm Hg were more likely to recover. The results of our study indicate that normal initial IOP (11–21 mm Hg) is good prognostic factor for patients with indirect TON treated with OND. Highlights This study focused on patients with indirect TON with initial no light perception. Earlier treatment brings better improvement in visual acuity. Initial IOP is important for overall and surgical outcome.

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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]   The Diagnostic Properties of Intraoperative Ultrasound in Glioma Surgery and Factors Associated with Gross Total Tumor Resection  

    Munkvold, Bodil Karoline Ravn (The Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway ) , Jakola, Asgeir Store (Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway ) , Reinertsen, Ingerid (Norwegian National Advisory Unit for Ultrasound and Image Guided Therapy, St. Olav's University Hospital, Trondheim, Norway ) , Sagberg, Lisa Millgå (Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway ) , rd (Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway ) , Unsgå (Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway) , rd, Geirmund , Solheim, Ole
    World neurosurgery v.115 ,pp. e129 - e136 , 2018 , 1878-8750 ,

    초록

    Objective In glioma operations, we sought to analyze sensitivity, specificity, and predictive values of intraoperative 3-dimensional ultrasound (US) for detecting residual tumor compared with early postoperative magnetic resonance imaging (MRI). Factors possibly associated with radiologic complete resection were also explored. Methods One hundred forty-four operations for diffuse supratentorial gliomas were included prospectively in an unselected, population-based, single-institution series. Operating surgeons answered a questionnaire immediately after surgery, stating whether residual tumor was seen with US at the end of resection and rated US image quality (e.g., good, medium, poor). Extent of surgical resection was estimated from preoperative and postoperative MRI. Results Overall specificity was 85% for “no tumor remnant” seen in US images at the end of resection compared with postoperative MRI findings. Sensitivity was 46%, but tumor remnants seen on MRI were usually small (median, 1.05 mL) in operations with false-negative US findings. Specificity was highest in low-grade glioma operations (94%) and lowest in patients who had undergone prior radiotherapy (50%). Smaller tumor volume and superficial location were factors significantly associated with gross total resection in a multivariable logistic regression analysis, whereas good ultrasound image quality did not reach statistical significance ( P = 0.061). Conclusions The specificity of intraoperative US is good, but sensitivity for detecting the last milliliter is low compared with postoperative MRI. Tumor volume and tumor depth are the predictors of achieving gross total resection, although ultrasound image quality was not. Highlights Compared to early postoperative MRI, the specificity of intraoperative US is high for evaluating “no tumor remnant” at the end of surgery. Sensitivity for detecting the last milliliter of tumor is low compared to postoperative MRI. Good US image quality was not a significant predictor with regard to achievement of radiological complete resection.

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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]   Safeness and Utility of Concomitant Intraoperative Monitoring with Intraoperative Magnetic Resonance Imaging in Children: A Pilot Study  

    Dias, Sandra (Clinical Neuroscience Center, Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland ) , Sarnthein, Johannes (Clinical Neuroscience Center, Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland ) , Jehli, Elisabeth (Clinical Neuroscience Center, Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland ) , Neidert, Marian Christoph (Clinical Neuroscience Center, Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland ) , Regli, Luca (Clinical Neuroscience Center, Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland ) , Bozinov, Oliver (Clinical Neuroscience Center, Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland)
    World neurosurgery v.115 ,pp. e637 - e644 , 2018 , 1878-8750 ,

    초록

    Background High-field intraoperative magnetic resonance imaging (MRI) has become increasingly available in neurosurgery centers. There is little experience with combined intraoperative MRI and intraoperative neurophysiologic monitoring (IONM). We report the first series, to our knowledge, of pediatric patients undergoing brain tumor surgery with 3T intraoperative MRI and IONM. Methods This pilot study included all consecutive children operated on for brain tumors between October 2013 and April 2016 in whom concomitant intraoperative MRI and somatosensory evoked potentials and motor evoked potentials were used. Neuromonitoring findings and related complications of all cases were retrospectively analyzed. Results During a 30-month period, 17 children (mean age 8.4 years; 3 girls) undergoing surgery met the study criteria. During intraoperative MRI, 483 IONM needles were left in place. Of these needles, 119 were located on the scalp, 94 were located above the chest, and 270 were located below the chest. Two complications with skin burns (first degree) were observed. In all patients, neuromonitoring was still reliable after MRI. In 1 case, a threshold increase for motor evoked potential stimulation (20 mA) was necessary after intraoperative MRI; in 2 cases, a reduction of 50% of the somatosensory evoked potential amplitude at the end of the surgery was observed compared with the values obtained before intraoperative MRI. Conclusions The combination of intraoperative MRI and IONM can be safely used in pediatric patients. IONM data acquisition after intraoperative MRI was feasible and remained reliable. Highlights Concomitant intraoperative MRI and IONM are safe in children. IONM data acquisition after intraoperative MRI is feasible. Neuromonitoring data acquisition remains reliable after MRI.

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

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

    초록

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

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

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

    초록

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

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

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  7. [해외논문]   Risk Factors, Additional Length of Stay, and Cost Associated with Postoperative Ileus Following Anterior Lumbar Interbody Fusion in Elderly Patients  

    Horowitz, Jason A. (Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA ) , Jain, Amit (Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, USA ) , Puvanesarajah, Varun (Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA ) , Qureshi, Rabia (Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA ) , Hassanzadeh, Hamid (Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA)
    World neurosurgery v.115 ,pp. e185 - e189 , 2018 , 1878-8750 ,

    초록

    Objective To identify independent risk factors, additional length of stay, and additional cost associated with postoperative ileus following anterior lumbar interbody fusion in elderly patients. Methods The PearlDiver Patient Records Database was queried for all Medicare patients ≥65 years of age undergoing 1- or 2-level primary elective anterior lumbar interbody fusion from 2005 to 2014. Independent risk factors, additional length of stay, and additional cost associated with postoperative ileus were evaluated with multivariate analysis. Results There were 13,139 patients identified, and 642 patients experienced postoperative ileus within 3 days after surgery. Multivariate analysis identified perioperative fluid or electrolyte imbalance (odds ratio = 4.03; 95% confidence interval, 3.37–4.80; P P P P Conclusions Patients with perioperative fluid and electrolyte imbalances were 4 times as likely to experience postoperative ileus. Fluid balance and electrolyte levels should be carefully monitored during the perioperative period in patients undergoing anterior lumbar interbody fusion as a potential means to reduce the incidence of postoperative ileus and the additional length of stay and cost burden associated with this complication. Highlights Postoperative ileus after ALIF was associated with additional LOS of 2.83 days and additional cost of $2349. Male sex and perioperative fluid and electrolyte imbalances were independent risk factors for postoperative ileus. Patients with perioperative fluid and electrolyte imbalances were 4 times as likely to experience postoperative ileus. Fluid balance and electrolytes should be carefully monitored during the perioperative period in patients undergoing ALIF.

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

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  8. [해외논문]   Number of Fractured Calvarial Bones Predicts Outcome in Traumatic Brain Injury Patients After Early Craniotomy  

    Wu, Xiaohua (Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China ) , He, Lingzhe (Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China ) , Shi, Feina (Department of Neurology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China ) , Dong, Fei (Department of Radiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China ) , Zeng, Qiang (Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China)
    World neurosurgery v.115 ,pp. e688 - e694 , 2018 , 1878-8750 ,

    초록

    Background Prognostic markers are important for neurosurgeons to evaluate the indications for aggressive surgical management. The purpose of this study was to investigate whether the number of fractured calvarial bones could predict the outcome in patients with traumatic brain injury (TBI) after early craniotomy. Methods TBI patients who underwent early craniotomy were reviewed. The number of fractured calvarial bones was recorded by referring to preoperative computed tomographic (CT) images. Accordingly, patients were assigned to no calvarial fracture group, single calvarial fracture group, and multiple calvarial fractures group. Good outcome was defined as Glasgow Outcome Scale scores of 4 and 5 at discharge. Logistic regression analyses were used to assess the effect of calvarial fracture on outcome. A receiver operating characteristic curve was generated for the final model. Results In all, a total of 141 patients were enrolled. Patients with no calvarial fracture had a significantly lower rate of good outcome (12.5%) than did those with a single calvarial fracture (62.2%, P P = 0.005). Binary logistic regression showed that the number of fractured calvarial bones was an independent imaging marker for predicting outcome ( P = 0.003) after adjustment for age, Glasgow Coma Scale score on admission, and decompressive craniectomy. The area under the curve of the final model was 0.863. Conclusions The number of fractured calvarial bones is an independent predictor of outcome in TBI patients after early craniotomy. No calvarial facture is associated with poor outcome in these patients. Highlights More than half of patients with traumatic brain injury had a single calvarial facture. No calvarial facture is associated with poor outcome in these patients. The number of fractured calvarial bones is an independent predictor of outcome.

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

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  9. [해외논문]   How to Deal with the Empty Space After Organ Removal for Transplantation: A Single Medical Center Experience  

    Sun, Ding-Ping (Section of Transplantation Medicine, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan ) , Lee, Ling-Hsien (Section of Transplantation Medicine, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan ) , Tian, Yu-Feng (Section of Transplantation Medicine, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan ) , Zheng, Hong-Xiang (Division of General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan ) , Kuo, Jinn-Rung (Division of General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan ) , Wang, Che-Chuan (Division of General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan)
    World neurosurgery v.115 ,pp. e299 - e304 , 2018 , 1878-8750 ,

    초록

    Objective Dealing with the empty space after organ removal for transplantation has not been investigated. Methods From January 28, 2005, to November 21, 2017, 111 organ donors were enrolled in this study. They were divided into 3 groups: no replacement, replaced with paper printed with organ graphics, or replaced with 3-dimensional (3D) printed simulated organs. The organs were removed at different periods. The donor's age, gender, etiology of admission, characteristics, clinical pictures, time interval between admission and date of donation, and time interval between donor coordinator consultations were evaluated. Results A total of 82 men and 29 women with mean age of 43 ± 15.1 years were enrolled. Overall, 329 organs and 126 corneas were transplanted. The major causes of brain death were traumatic brain injury (44.1%) and cerebrovascular disease (32.4%). Twelve donors initially presented with out-of-hospital cardiac arrest. Ten patients with solid cancers and 3 with septic shock donated both of their corneas. The mean time interval between donor coordinator and social worker consultation to organ donation was 3 (2–5 days) (median [interquartile range]). Periods I and II averaged 7–8 donors per year. Fourteen donors and 41 organs were replaced with 3D-printed simulated organs at the families' request in 1 year. Conclusions This is the first study to provide a replacement method dealing with the empty space after organ removal. We used 3D-printed simulated organs in addition to providing grief assistance and spiritual support. It also has the potential effect of increasing the organ donation rate. Highlights Keeping body integrity is an important predictor when considering organ donation in Asian societies. This is the first study to provide a replacement method dealing with the empty space after organ removal. Both a paper printed with organ graphics and 3D printer to print simulated organs can mimic organ integrity. These methods have supportive psychological effects on the family, and it may raise the organ donation rate potentially.

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  10. [해외논문]   Initial Experience with Intraoperative Phosphorous-32 Brachytherapy During Resection of Malignant Spinal Tumors  

    Dalle Ore, Cecilia L. (Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA ) , Ames, Christopher P. (Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA ) , Magill, Stephen T. (Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA ) , Deviren, Vedat (Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California, USA ) , Aghi, Manish K. (Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA ) , Lau, Darryl (Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA)
    World neurosurgery v.115 ,pp. e785 - e793 , 2018 , 1878-8750 ,

    초록

    Introduction Brachytherapy is a major adjuvant modality for neoplasms, but few have trialed its use for spinal tumors. This study examines perioperative and oncologic outcomes of patients with malignant spinal tumors who underwent resection with intraoperative phosphorous-32 (P32) brachytherapy. Methods Consecutive adult patients who underwent P32 brachytherapy during malignant spinal tumor resection were retrospectively identified from 2014 to 2015. Complications, tumor recurrence, and survival were reviewed. A comprehensive review of the literature was performed. Results A total of 8 patients were included. Average age was 54.3 years, and 25.0% were males. Tumor types included metastatic leiomyosarcoma, chordoma, multifocal recurrent ependymomas, breast metastasis, malignant meningioma, and myxofibrosarcoma. One-half of patients underwent en bloc tumor resection. P32 plaques were applied to 2 sites per patient for mean 13.1 minutes per site with a goal penetration of 10 Gy to 1-mm depth. Perioperative complications occurred in 3 patients (37.5%), including a persistent cerebral spinal fluid leak, deep infection requiring reoperation, and sacral insufficiency fracture. At a mean 25.6 months follow-up, local recurrence rate was 25.0%, and overall survival was 75.0%. Mean time to recurrence was 14.4 months. Survival at 6, 12, 18, and 24 months was 100.0%, 100.0%, 85.7%, and 71.4%, respectively. Conclusions The use of P32 is safe and feasible. P32 intraoperative brachytherapy does not seem to increase the rate of complications. The sample size of this series is small with heterogeneity in tumor type, but recurrence and survival outcomes seem promising compared with previous reports. Further clinical trials are needed. Highlights Intraoperative phosphorus-32 (P32) brachytherapy is practical and feasible. P32 brachytherapy is not associated with a significant increase in complications. Survival outcomes after P32 brachytherapy are promising.

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