Long-term outcome after subarachnoid hemorrhage (SAH) is potentially linked to cytotoxic heme. Free heme is bound by hemopexin and rapidly scavenged by CD91. We hypothesized that heme scavenging in ...the brain would be associated with outcome after hemorrhage.
Using cerebrospinal fluid and tissue from patients with SAH and control individuals, the activity of the intracranial CD91-hemopexin system was examined using ELISA, ultrahigh performance liquid chromatography, and immunohistochemistry.
In control individuals, cerebrospinal fluid hemopexin was mainly synthesized intrathecally. After SAH, cerebrospinal fluid hemopexin was high in one third of cases, and these patients had a higher probability of delayed cerebral ischemia and poorer neurological outcome. The intracranial CD91-hemopexin system was active after SAH because CD91 positively correlated with iron deposition in brain tissue. Heme-hemopexin uptake saturated rapidly after SAH because bound heme accumulated early in the cerebrospinal fluid. When the blood-brain barrier was compromised after SAH, serum hemopexin level was lower, suggesting heme transfer to the circulation for peripheral CD91 scavenging.
The CD91-heme-hemopexin scavenging system is important after SAH and merits further study as a potential prognostic marker and therapeutic target.
Idiopathic intracranial hypertension (IIH) is a chronic condition characterized by raised intracranial pressure in the absence of a known etiology. IIH typically presents in overweight women of ...childbearing age. Surgical intervention for IIH involves diversion of cerebrospinal fluid, often by the placement of a shunt. Experience suggests higher shunt failure rates in patients with IIH than shunts placed for other etiologies. Here we sought to both establish and compare failure rates for IIH and non-IIH shunts and to examine association with body mass index (BMI).
This study was a single-center retrospective consecutive cohort over a 13-year period. There were 1264 non-IIH patients and 116 patients with IIH included in the study. This was a retrospective analysis of time to shunt failure using Kaplan-Meier methods for IIH and non-IIH shunts. Secondary analysis of BMI, shunt type, and sex on IIH shunt failure was also conducted.
The median time to failure of the initial IIH shunt was 22.9 months (interquartile range IQR, 4–55) compared with 57 months (IQR, 12–87) in non-IIH shunts (P < 0.001; 95% confidence interval, 58.6–233.6). In the IIH group, the median shunt survival for BMI above the healthy range (18.5–25 kg/m2) was 18 months relative to 44 months for those with a healthy BMI.
Our study suggests that in IIH, relative to hydrocephalus of other causes, shunts have higher failure rates and often require more frequent revisions. Higher shunt failure rates in patients with IIH may be associated with an unhealthy BMI.
Internal neurolysis (INL) is a surgical procedure where trigeminal nerve fibres are separated between the pons and porus trigeminus to relieve trigeminal neuralgia (TN). We report pain and functional ...outcomes to evaluate its safety and efficacy.
Prospective cohort of all patients undergoing retrosigmoid craniotomy and INL between 2015 and 2017 at University Hospital Southampton. Patients with type I (6) or type II (2) refractory TN and no clear neurovascular conflict were offered INL as an alternative to partial sensory rhizotomy. Barrow Pain Intensity Scale (BNI) and Brief Pain Inventory Facial scores (BPI-Facial) were assessed. Minimum follow-up was 2 years'.
Eight patients (7F:1M) underwent INL. Two had MS. Pre-operatively, all had severe pain (BNI grade V) and the median BPI-Facial score was 115 (range 79-123).. There were no unexpected complications. On last follow-up, six (75%) had no pain (BNI grade I), while two (25%) had recurred (at 5 and 27 months). Median BPI-Facial score for all patients on the last follow-up was 20 (range 18-91) reflecting dramatically improved quality of life and activities.
INL is a potentially safe and effective treatment for refractory TN. Long-term efficacy is unknown, but early results are promising.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract The inter-rater reliability, expressed as kappa score, k , of the Engel and International League Against Epilepsy (ILAE) classifications of epilepsy surgery seizure outcome has not ...previously been evaluated. In a consecutive series of 76 patients (40 male; 25 children), 75 undergoing resective and 1 disconnective surgery at a mean age of 27.5 years (13 months–62 years), one observer classified 88% ( n = 67) and a second observer classified 87% ( n = 66) of patients as either Engel I or II (free from or rare disabling seizures) after a median follow up of 36 months (range 12–92 months); comparably, both observers classified 84% ( n = 64) as ILAE 1–3. Correlation for Engel versus ILAE for observer 1 was 0.933 ( p < .0005) and for observer 2 was 0.931 ( p < .0005). Both ILAE ( k 0.81, 95% confidence intervals 0.69, 0.91) and Engel ( k 0.77, 95% CI 0.65, 0.87) classifications have very acceptable inter-rater reliability as well as significant correlation.
Long-term outcomes following occlusion of spinal dural arteriovenous fistula (SDAVF) are poorly understood and are based on small series reporting predominantly short-term outcomes. The degree and ...duration of improvement remain unclear. In this study, we analyzed long-term outcomes following occlusion in a cohort of patients with SDAVF.
This was a single-center cohort study of patients with SDAVF identified from a prospective database. Outcomes were assessed using a modified Aminoff and Logue Disability (ALD) Scale, the modified Rankin Scale (mRS), and patient-reported outcomes at presentation and long-term follow-up. Both angiographic recanalization and idiopathic functional recurrence rates were calculated.
Of the total of 67 patients with SAVDF identified, 59 were eligible for inclusion in this study. Fifty-seven of these 59 (97%) underwent occlusion. Twenty-two patients underwent initial embolization; 12 were occluded. Two patients recanalized. Eleven patients underwent surgery after attempted embolization; 10 were occluded. Thirty-seven patients treated by surgery only were occluded. The median duration of follow-up was 63 months (range, 12–240 months). After occlusion, the ALD gait and urinary scores improved by a median of 1 point. Although the median mRS score was unchanged, 49% of the patients experienced improvement, most by 1 point. There was no difference between the patients occluded by embolization or surgery, but those requiring both approaches had worse gait and urinary scores (P = 0.005 and 0.03, respectively). The duration of symptoms by itself had no effect on outcomes (P = 0.61). Following occlusion, 5 patients experienced an idiopathic late functional deterioration. Of 16 patients presenting with paraplegia, 13 (81%) improved, with a median mRS improvement of 1 point.
Following occlusion, patients with SDAVF experienced a modest improvement in symptoms, most commonly by 1 point on the ALD scale. Idiopathic late deterioration was seen in 9.1% of patients.
Abstract
Objective. To quantify the frequency and severity of nasal morbidity following endoscopic endonasal skull base surgery using patient-reported outcome measures. Methods. Retrospective review ...and follow-up of all patients who underwent endoscopic endonasal skull base surgery at University Hospital Southampton between January 2007 and December 2011. Demographic data were collated from case notes and patients were asked a standardised questionnaire by telephone interview. Statistical sub-analysis of pituitary and other anterior skull base pathology groups was performed using SPSS 1.8. Results. Out of 151 included patients, 85 had a pituitary pathology and the remaining had other anterior skull base pathologies. The mean age was 55.2 years, with 75 male and 76 female patients. Totally 124 patients were interviewed with a median follow-up of 15 months. Mild or no nasal crusting was reported by 77% of patients. In those experiencing crusting, more than 50% resolved within 4 weeks. The majority of patients reported no nasal blockage (52%), pain (83%) or nasal discharge (57%) post-operatively. Totally 71% reported no change in sense of smell post-operatively. The only statistically significant difference between the two pathology groups was that surgery on other anterior skull base pathology was associated with an increased rate of developing anosmia (p = 0.02). Conclusion. Endoscopic endonasal skull base surgery is associated with a low level of patient-reported post-operative nasal morbidity. There is no significant difference in frequency of crusting, blockage, pain or discharge between pituitary and other anterior skull base pathology groups. However, anterior skull base surgery would appear to be associated with an increased rate of anosmia post-operatively.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
External ventricular drain (EVD) dislodgement is common and leads to significant morbidity and mortality. Many securement techniques to prevent this are described. There are, however, no objective ...studies comparing them. This study aimed to determine the most secure method of securing an EVD.
A survey was distributed through the British Neurosurgical Trainee Research Collaborative to determine common EVD securement methods and select techniques for testing. Securement methods were tested in a pig cadaver model. Peak pull force before EVD failure was measured. Failure was defined as catheter displacement 1 cm from the insertion site, catheter fracture, or suture fracture.
Twenty-three neurosurgical units responded. Five basic EVD securement methods were in common use. These were tested in isolation and in combination so that in total 15 common methods were tested. The most secure method was a triple construct, consisting of an anchoring suture, sutures around a coil of the catheter, and either a soft plastic flange (25.85 N, 95% confidence interval 24.95 N–26.75 N) or a hard plastic flange (29.05 N, 95% confidence interval 25.69 N–32.41 N). Of the individual methods, single anchoring sutures, soft flanges, VentriFix, and staples were found to be the least secure, whereas multiple sutures and hard flanges were the most secure.
An anchoring suture followed by a coil of the catheter and finally a flange is the most secure method for securing EVDs. This simple technique can withstand up to 8.2 times the force of a single anchoring suture, is easily used, and decreases the likelihood of EVD dislodgement and associated complications.
The goal of this study was to externally validate the proposed Endoscopic Third Ventriculostomy Success Score (ETVSS), which predicts successful treatment for hydrocephalus on the basis of a child's ...individual characteristics.
The authors retrospectively identified 181 cases of consecutive endoscopic third ventriculostomy (ETV) performed in children at a single neurosurgery center in the United Kingdom. They compared actual success at both 6 and 36 months, with mean predicted probabilities for low, moderate, and high chance of success strata based on the ETVSS. Long-term success was calculated using Kaplan-Meier methods and comparisons were made by means of unpaired t-tests.
Overall, 166 primary ETVs were performed; ETV success was 72.9% at 6 and 64.5% at 36 months. At long-term follow-up, the mean predicted probability of success was significantly higher in those with a successful ETV (99 patients) than in those with a failed ETV (67 patients) (p = 0.001). The ETVSS accurately predicted outcome at 36 months; the low, medium, and high chance of success strata had mean predicted probabilities of success of 82%, 63%, and 36%, and actual success of 76%, 66%, and 42%, respectively. The overall complication rate was 6%.
The ETVSS closely predicted the overall long-term success rates in high-, moderate-, and low-risk groups. The results of this study suggest that the ETVSS will aid clinical decision making in predicting outcome of ETV.
Abstract only Introduction Dural arteriovenous fistulas (dAVFs) have been associated with rapidly progressive dementia in relatively young patients. However, the specific angioarchitecture and ...characteristics of these dAVFs remain to be fully described. To better understand the specific characteristics of dAVFs associated with cognitive impairment (dAVF‐CI), we utilized the CONDOR multicenter database, which provides a large cohort of dAVF available. By analyzing data from patients with dAVFs‐ CI, we aimed to identify the key features distinguishing these cases and elaborate on the pathophysiology of dAVF‐CI. Methods CONDOR is an international multicenter database comprising 1077 (dAVFs) from 14 international centers. We conducted a retrospective analysis of the CONDOR database, focusing on patients diagnosed with dAVFs‐CI. Propensity score matching analysis was performed to compare Borden type II and type III dAVFs with and without cognitive impairment as control groups. Only dAVFs with cortical venous drainage were included as this aggressive subtype can present with non‐hemorrhagic neurologic deficits. Additionally, logistic regression was then employed to identify significant characteristics associated with dAVF‐CI. Results A total of 60 patients with dAVF‐CI and 60 control dAVFs were included in the analysis. The patients with dAVF‐CI had a mean age of 58 ± 18 years. It was found that all cases of dAVF‐CI exhibited venous hypertension. Additionally, there was a significant association between sinus stenosis and dAVF‐CI (OR: 2.85, 95% CI: 1.16‐7.55, p = 0.027). Moreover, dAVF‐CI cases were characterized by the presence of multiple arteriovenous shunts, with more arterial feeders (OR 1.56, 95% CI 1.22‐2.05, p <0.001) and draining veins (OR 2.05, 95% CI 1.05‐4.46, p = 0.004) compared to the control dAVFs. Venous ectasia was also found to be associated with dAVF‐CI (OR 2.38, 95% CI 1.13‐5.11, p= 0.024). Finally, some patients in which successful dAVF closure was achieved had symptom resolution during follow‐up (OR 2.86, 95% CI 0.85‐9.56, p = 0.09). Conclusion dAVFs‐CI tend to occur in relatively young patients and are characterized by the presence of venous hypertension. The development of sinus stenosis and venous ectasia further hinders proper drainage, contributing to the persistence of venous hypertension. Venous hypertension may impair critical structures such as the thalamus or the cortex leading to rapid cognitive impairment. Successful treatment of dAVFs‐CI can potentially reverse symptoms. Nonetheless, some dAVF‐CI may have persistent symptoms due to chronic hypertension and infarction.
Abstract
A 60-year-old lady presented with intermittent headaches. Examination revealed striking marked unilateral tongue atrophy. Magnetic resonance imaging (MRI) revealed a cystic lesion in the ...hypoglossal canal and a provisional diagnosis of cystic hypoglossal schwannoma made. Annual surveillance scans showed stable appearances but surprisingly at 3 years they showed a significant reduction in the size of the lesion. Most patients with hypoglossal schwannomas present with ipsilateral hypoglossal nerve palsy; careful cranial nerve examination is vital in diagnosing such rare lesions. Little is known of their natural history, with most lesions undergoing surgery. This case highlights spontaneous regression following non-operative management.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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