cranial

颅骨
  • 文章类型: Journal Article
    目的:立体定向技术在神经外科中起着重要作用。开发具有高效工作流程和精确手术执行的小型化颅骨机器人是这些技术更广泛应用的重要一步。在这里,作者描述了他们使用美敦力隐形Autoguide小型化颅骨机器人的经验。
    方法:对2020年至2022年的75例病例进行回顾性分析。分析了使用StealthAutoguide机器人进行手术的患者的手术适应症和准确性,手术时间,和临床结果。结果定义如下:对于立体脑电图(SEEG),确定癫痫发作焦点且不需要任何修正或额外引线的电极放置模式;对于活检,获得诊断组织的病例百分比;对于激光间质热疗法(LITT),激光光纤放置足以消融的病例百分比。手术并发症定义为无症状或有症状的脑出血。新的神经缺陷,或需要电极,激光光纤,或活检针重新定位或翻修。
    结果:在75个标签上案例中使用了隐形自动引导机器人,包括40例SEEG癫痫病灶定位病例,19LITT案件,立体定向活检16例。活检入口处的平均真实目标误差(RTE)为1.48±0.84mm,1.36±0.89mm,适用于Visualase激光光纤放置,SEEG为1.24±0.72mm。活检针放置时,目标处的平均RTE为1.56±0.95mm,1.42±0.93mm,适用于Visualase激光光纤放置,SEEG电极放置1.31±0.87mm。单侧SEEG病例的手术时间平均为52分钟(平均6.5分钟/导联,平均8个电极)。双侧SEEG病例平均耗时105分钟(平均7.5分钟/铅,平均14个电极)。在SEEG人口中,没有修订或不成功的癫痫发作定位。活检,在100%的病例中获得了诊断组织。对于LITT,在100%的病例中,纤维放置足以进行消融.没有出现有症状或无症状的脑出血,并且不需要重新定位或更换激光光纤的情况,电极,或者活检针.一名患者在激光消融后出现短暂性颅神经III麻痹,并在10周内消退。机器人平台与作为站的隐形自动指南之间的通信失败需要取消1个程序。
    结论:MedtronicStealthAutoguide机器人系统在活检中用途广泛,SEEG,和激光消融适应症。设置和手术执行是高效的,具有高度的准确性和一致性。
    OBJECTIVE: Stereotactic techniques play an important role in neurosurgery. The development of a miniaturized cranial robot with an efficient workflow and accurate surgical execution is an important step in a broader application of these techniques. Herein, the authors describe their experience with the Medtronic Stealth Autoguide miniaturized cranial robot.
    METHODS: A retrospective review of 75 cases from 2020 to 2022 was performed. The patients who had undergone surgery utilizing the Stealth Autoguide robot were analyzed for surgical indication and accuracy, operative time, and clinical outcome. The outcomes were defined as follows: for stereoelectroencephalography (SEEG), the electrode placement pattern that identified the seizure focus and did not require any revision or additional leads; for biopsy, the percentage of cases in which diagnostic tissue was obtained; and for laser interstitial thermal therapy (LITT), the percentage of cases in which laser fiber placement was adequate for ablation. Surgical complications were defined as any asymptomatic or symptomatic intracerebral hemorrhage, new neurological deficit, or need for electrode, laser fiber, or biopsy needle repositioning or revision.
    RESULTS: The Stealth Autoguide robot was utilized in 75 on-label cases, including 40 SEEG cases for seizure focus localization, 19 LITT cases, and 16 stereotactic biopsy cases. The mean real target error (RTE) at the entry was 1.48 ± 0.84 mm for biopsy, 1.36 ± 0.89 mm for Visualase laser fiber placement, and 1.24 ± 0.72 mm for SEEG. The mean RTE at the target was 1.56 ± 0.95 mm for biopsy needle placement, 1.42 ± 0.93 mm for Visualase laser fiber placement, and 1.31 ± 0.87 mm for SEEG electrode placement. The surgical time for unilateral SEEG cases took an average 52 minutes (average 6.5 mins/lead, average 8 electrodes). Bilateral SEEG cases took an average 105 minutes (average 7.5 mins/lead, average 14 electrodes). In the SEEG population, there were no revised or unsuccessful seizure localizations. For biopsy, diagnostic tissue was obtained in 100% of cases. For LITT, fiber placement was adequate for ablation in 100% of cases. There were no cases of symptomatic or asymptomatic intracerebral hemorrhage, and no cases required repositioning or replacement of the laser fiber, electrode, or biopsy needle. One patient experienced transient cranial nerve III palsy following laser ablation that resolved in 10 weeks. A failure of communication between the robotic platform and the Stealth Autoguide as a station required the cancellation of 1 procedure.
    CONCLUSIONS: The Medtronic Stealth Autoguide robot system is versatile across biopsy, SEEG, and laser ablation indications. Setup and surgical execution are efficient with a high degree of accuracy and consistency.
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  • 文章类型: Observational Study
    背景:巨细胞动脉炎(GCA)表现出两种主要的表型——颅外(cGCA)和颅外(exGCA)。exGCA可能会被忽视。本研究旨在比较cGCA和exGCA的临床特征。
    方法:检索2015年1月至2023年7月在风湿病科接受治疗的患者的电子病历,以诊断为GCA。cGCA患者的临床特点,exGCA,并比较重叠的GCA表现。
    结果:在32例GCA患者中,20有cGCA,7有exGCA,5个有重叠表现。这些群体在人口统计学上没有显着差异,临床体征/症状,或实验室测试结果。重要的是,与使用cGCA的患者(中位4周,p=0.008)相比,使用exGCA和重叠GCA的联合组的开始治疗延迟(中位12周)有统计学意义.
    结论:我们的研究证实了exGCA的阴险性质,缺乏独特的临床症状,因此导致延迟治疗。
    BACKGROUND: Giant cell arteritis (GCA) presents two major phenotypes - cranial (cGCA) and extracranial (exGCA). exGCA may be overlooked. The study aimed to compare the clinical characteristics between cGCA and exGCA.
    METHODS: Electronic medical records of patients treated between January 2015 and July 2023 at the Department of Rheumatology were searched for the diagnosis of GCA. The clinical characteristics of patients with cGCA, exGCA, and overlapping GCA manifestations were compared.
    RESULTS: Out of 32 patients with GCA, 20 had cGCA, 7 had exGCA, and 5 had overlap manifestations. The groups did not differ significantly in demographics, clinical signs/symptoms, or laboratory test results. Importantly, the combined group of patients with exGCA and overlap GCA had a statistically significant delay in initiating treatment (median 12 weeks) compared to patients with cGCA (median 4 weeks; p = 0.008).
    CONCLUSIONS: Our study confirmed the insidious nature of exGCA, which lacks distinctive clinical symptoms and consequently leads to delayed treatment.
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  • 文章类型: Journal Article
    目的:脑静脉血栓形成(CVT)的预后仍然很困难。我们试图在国际队列中验证SI2NCAL2C评分。
    方法:SI2NCAL2C评分最初用于预测6个月时的不良结局(改良的Rankin量表(mRS)3-6),使用国际CVT联盟的数据,以及30天和1年时的死亡率。SI2NCAL2C评分使用9个变量:不存在任何女性特定的风险因素,脑出血,中枢神经系统感染,局灶性神经功能缺损,昏迷,年龄,血红蛋白水平较低,更高水平的葡萄糖,和癌症。ACTION-CVT研究是一项国际回顾性研究,纳入了27个中心的连续患者。在ACTION-CVT队列中,由于在6个月时间点缺乏随访,使用90天mRS验证了不良结局评分。使用接受者工作特征曲线下面积(AUC)和校准图评价模型性能。使用加法回归和预测均值匹配方法估算缺失数据。自举进行了1000次迭代。
    结果:有950名患者的死亡率数据,有587名接受ACTION-CVT的1,025名患者的不良结局数据。与国际CVT联盟相比,ACTION-CVT队列年龄较大,女性较少,临床表现更温和。30天死亡率为2.5%,一年死亡率为6.0%。90天,16.7%的结果不佳。SI2NCAL2C评分90天不良结局的AUC为0.74[95%CI0.69-0.79],30天死亡率为0.72[0.60-0.82],一年死亡率为0.82[0.76-0.88]。
    结论:SI2NCAL2C评分在国际外部验证队列中表现良好。SI2NCAL2C评分值得在不同人群和临床实施研究中进行其他验证研究。
    OBJECTIVE: Prognostication for cerebral venous thrombosis (CVT) remains difficult. We sought to validate the SI2NCAL2C score in an international cohort.
    METHODS: The SI2NCAL2C score was originally developed to predict poor outcome (modified Rankin Scale (mRS) 3-6) at 6 months, and mortality at 30 days and 1 year using data from the International CVT Consortium. The SI2NCAL2C score uses 9 variables: the absence of any female-sex-specific risk factors, intracerebral hemorrhage, central nervous system infection, focal neurological deficits, coma, age, lower level of hemoglobin, higher level of glucose, and cancer. The ACTION-CVT study was an international retrospective study that enrolled consecutive patients across 27 centers. The poor outcome score was validated using 90-day mRS due to lack of follow-up at the 6-month time-point in the ACTION-CVT cohort. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plots. Missing data were imputed using the additive regression and predictive mean matching methods. Bootstrapping was performed with 1000 iterations.
    RESULTS: Mortality data were available for 950 patients and poor outcome data were available for 587 of 1,025 patients enrolled in ACTION-CVT. Compared to the International CVT Consortium, the ACTION-CVT cohort was older, less often female, and with milder clinical presentation. Mortality was 2.5% by 30 days and 6.0% by one year. At 90-days, 16.7% had a poor outcome. The SI2NCAL2C score had an AUC of 0.74 [95% CI 0.69-0.79] for 90-day poor outcome, 0.72 [0.60-0.82] for mortality by 30 days, and 0.82 [0.76-0.88] for mortality by one year.
    CONCLUSIONS: The SI2NCAL2C score had acceptable to good performance in an international external validation cohort. The SI2NCAL2C score warrants additional validation studies in diverse populations and clinical implementation studies.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Journal Article
    背景:神经外科领域自成立以来一直代表着创新和技术集成的领域。因此,机器学习(ML)已经相对较快地应用于神经外科。通过文献计量回顾和聚类分析,我们寻求确定ML在神经外科中的趋势和新兴应用。
    方法:于2000年1月至2023年3月在WebofScience数据库中进行了文献计量分析。200种引用最多的出版物的完整数据集,包括标题,作者信息,journal,引用计数,关键词,每个出版物的摘要都在CiteSpace中进行了评估。CiteSpace被用来阐明出版物的特点,趋势,并使用Kamada-Kawai算法通过协作网络分析进行主题聚类。
    结果:我们的分析中包含了25个引用最多的标题。哈佛大学及其附属机构代表了顶级机构,贡献了近25%的文献出版物。世界神经外科杂志是最高的净引用数747(29%)。协作网络分析生成了12个独特的集群,其中最大的是机器学习,其次是特征重要性,和深部脑刺激。
    结论:这篇综述重点介绍了神经外科领域中与ML有关的最有影响力的文章。ML已应用于神经外科的几个子专业,以优化患者护理,特别关注结果预测因子,患者选择,和手术决策。
    The field of neurosurgery has consistently represented an area of innovation and integration of technology since its inception. As such, machine learning (ML) has found its way into applications within neurosurgery relatively rapidly. Through this bibliometric review and cluster analysis, we seek to identify trends and emerging applications of ML within neurosurgery.
    A bibliometric analysis was carried out in the Web of Science database on publications from January 2000 to March 2023. The full data set of the 200 most cited publications including title, author information, journal, citation count, keywords, and abstracts for each publication was evaluated in CiteSpace. CiteSpace was used to elucidate publication characteristics, trends, and topic clusters via collaborate network analysis using the Kamada-Kawai algorithm.
    The 25 most cited titles were included in our analysis. Harvard University and its affiliates represented the top institution, contributing nearly 25% of publications in the literature. WORLD NEUROSURGERY was the journal with the highest net citation count of 747 (29%). Collaborative network analysis generated 12 unique clusters, the largest of which was machine learning, followed by feature importance and deep brain stimulation.
    This review highlights the most impactful articles pertaining to ML in the field of neurosurgery. ML has been applied into several sub-specialties within neurosurgery to optimize patient care, with special attention to outcome predictors, patient selection, and surgical decision making.
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  • 文章类型: Journal Article
    在战争时期,神经外科已经取得了许多进步,帮助改善患者在恶劣情况下的预后。第一次世界大战引入了创伤早期手术的概念,前瞻性经营医院,和galeal缝线以及仔细清创技术。它为神经外科也成为医学专业奠定了基础。第二次世界大战带来了快速医疗后送的使用,移动神经外科,改进的复苏策略,颅骨修补术,早期椎板切除术和减压术。朝鲜战争和越南战争建立在第一次世界大战和第二次世界大战的概念上,帮助确定水密硬脑膜封闭的重要性,颅脑外伤后的外部引流系统,多学科护理,和感染预防策略。在后越南时期,我们已经看到了重大的技术进步,使神经外科医生能够比历史上大多数人想象的更远。继发性脑损伤的意义,血管损伤,自越南战争以来,多年来已经阐明了创伤性侮辱的潜在病理生理学,让我们的病人的护理有了很大的进步。历史上的每一场主要战争都为神经外科专业做出了巨大贡献,每个人都有自己的创新,最终形成指导方针,战略,和实践标准,使我们能够为患者提供最高标准的护理。
    Many strides have been made in neurosurgery during times of war, helping to improve the outcomes of patients in dire circumstances. World War I introduced the concepts of early operation for trauma, forward-operating hospitals, and galeal sutures as well as techniques for careful debridement. It laid the groundwork for neurosurgery to become a specialty within medicine as well. World War II brought about the use of expedited medical evacuation, mobile neurosurgical units, improved resuscitation strategies, cranioplasty, and early laminectomy with decompression. The Korean and Vietnam Wars built on concepts from World Wars I and II, helping to establish the importance of watertight dural closure, external drainage systems after cranial trauma, multidisciplinary care, and infection prevention strategies. In the post-Vietnam period, we have seen significant technological advances allowing neurosurgeons to move farther ahead than most throughout history could have imagined. The significance of secondary brain injury, vascular injury, and the underlying pathophysiology of traumatic insults has been elucidated over the years since the Vietnam War, allowing for great advances in the care of our patients. Each major war throughout history has contributed greatly to the specialty of neurosurgery, each with its own innovations culminating in guidelines, strategies, and standards of practice that allow us to deliver the highest standard of care to our patients.
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  • 文章类型: Journal Article
    背景:社交媒体已经不可逆转地影响了全球人际联系。这项研究旨在了解在特定条件社区中讨论的信息,叫做“subreddits,“在主要的社交媒体平台Reddit上,可以改善医疗提供者的教育。
    方法:从20221年6月1日起,对每个subreddit的“热”标签中排名前50位的Reddit帖子进行了追溯筛选。分析中包括了那些有这种情况或正在更好地了解这种情况的18岁及以上的人撰写的帖子。此外,根据redditors的主要问题,帖子被分为六类之一:社会建议,健康建议,提供健康教育或建议设备,个人经验/进步,研究人员招募患者进行研究,或其他人。
    结果:确定了15个子项中的65个帖子与颅神经外科主题有关,包括癫痫,创伤性脑损伤,中风,脑肿瘤/癌症,癫痫发作,脑积水,脑脊液漏,Chiari畸形,动脉瘤,松果体囊肿,共济失调,还有moyamoya.寻求健康建议是整个subreddits中最常见的信息寻求形式(53.6%),特别是与治疗相关的问题(41.0%)。来自r/癫痫和r/癫痫发作的Redditors占与抗癫痫给药或副作用有关的非手术治疗问题的84.6%。
    结论:颅脑神经外科疾病可以使患者不堪重负,给他们留下了未解决的问题。Reddit在医生办公室找不到的特定条件社区中提供匿名性和友情。访问互联网社区的便利性可能会鼓励redditors在线寻求健康信息。
    OBJECTIVE: Social media has irreversibly impacted global interpersonal connectivity. This study aims to understand how information discussed in condition-specific communities, called \"subreddits,\" on the major social media platform Reddit, can improve education by medical providers.
    METHODS: The top 50 Reddit posts in each subreddit\'s \"hot\" tab were retroactively screened from June 1, 2022. Posts written by those 18 and older who had the condition or were engaging in a better understanding of the condition were included in the analysis. In addition, posts were placed in 1 of 6 categories based on the redditors\' primary questions: social advice, health advice, providing health education or suggesting equipment, personal experience/progress, researchers recruiting patients for research, or others.
    RESULTS: We identified 605 posts within 15 subreddits related to cranial neurosurgical topics including epilepsy, traumatic brain injury, stroke, brain tumors/cancer, seizures, hydrocephalus, cerebrospinal fluid leaks, Chiari malformations, aneurysms, pineal cysts, ataxia, and moyamoya. Asking for health advice was the most common form of information seeking across subreddits (53.6%), specifically treatment-related questions (41.0%). Redditors from r/epilepsy and r/seizures constituted 84.6% of nonsurgical treatment questions relating to antiepileptic dosing or side effects.
    CONCLUSIONS: Cranial neurosurgical disease can overwhelm patients, leaving them with unaddressed questions. Reddit provides anonymity and camaraderie within condition-specific communities not found at the doctor\'s office. The ease of access to an Internet community may encourage redditors to seek health information online.
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  • 文章类型: Case Reports
    原发性颅内畸胎瘤为非生殖细胞肿瘤。它们是沿颅脊髓轴的罕见病变,他们的恶性转化极其罕见。一名50岁的男性患者出现一次全身性强直阵挛性癫痫发作(GTCS),没有任何神经缺陷.放射学成像显示松果体区域有较大的病变。他接受了病灶的大体完全切除。组织病理学检查是畸胎瘤伴腺癌恶性转化的代表。他接受了辅助放射治疗,临床效果良好。本病例突显了原发性颅内成熟畸胎瘤恶性转化的罕见性。
    Primary intracranial teratomas are nongerminomatous germ cell tumors. They are infrequent lesions along the craniospinal axis, with their malignant transformation extremely uncommon. A 50-year-old-male patient presented with one episode of generalized tonic-clonic seizure (GTCS), without any neurological deficit. Radiological imaging revealed a large lesion in the pineal region. He underwent gross total excision of the lesion. Histopathological examination was representative of teratoma with adenocarcinomatous malignant transformation. He underwent adjuvant radiation therapy and had an excellent clinical outcome. The present case highlights the rarity of malignant transformation of the primary intracranial mature teratoma.
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  • 文章类型: Journal Article
    背景嗜酸性肉芽肿(EG)属于朗格汉斯细胞组织细胞增生症(LCH)家族,被认为是一种良性疾病,通常见于15岁以下儿童。这里,作者描述了EG的异常定位和临床表现。
    方法:作者报告了一个9岁的女孩,其EG表现为斜坡的溶骨性病变。经蝶窦切除和组织学确认后,开始辅助化疗。表现出的体征和症状是体重减轻,偶发的鬼脸,和温和的类似弹道的运动。经过32个月的随访,患者的初始症状完全缓解,肿瘤无进一步生长.
    结论:尽管这些病变很少见,当遇到斜坡的溶骨性病变时,应将EG视为鉴别诊断。
    BACKGROUND: Eosinophilic granuloma (EG) belongs to the family of Langerhans cell histiocytosis (LCH) and is considered to be a benign disease typically found in children younger than 15 years of age. Here, the authors describe an EG of unusual localization and clinical presentation.
    METHODS: The authors report a 9-year-old girl with an EG presenting as an osteolytic lesion of the clivus. After transsphenoidal resection and histological confirmation, adjuvant chemotherapy was initiated. Presenting signs and symptoms were weight loss, episodic grimacing, and moderate ballism-like movements. After a follow-up-period of 32 months, the patient presented with a total resolution of initial symptoms and no further tumor growth.
    CONCLUSIONS: Although these lesions are rare, one should consider EG as a differential diagnosis when confronted with osteolytic lesions of the clivus.
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  • 文章类型: Journal Article
    这项研究的目的是引入一种新的计算机引导技术,用于对涉及前眶和前颅区域的颅面纤维发育不良进行减积和轮廓化。使用改良的针对患者的手术深度指南对六名涉及前眶和前颅区域的颅面纤维发育不良患者进行了计算机引导的轮廓绘制。执行虚拟计划以确定所需的骨去除量并构建患者特异性手术深度导向器。然后,该指南是使用快速原型打印的。在手术室,导游坐在适当的位置。根据计划的固定深度通过所创建的深孔插入植入钻,以创建深孔。最后,使用切割盘去除所产生的孔之间的骨头,骨凿子和外科毛刺。患者使用李克特量表评估对面部美学的满意度,和外科医生使用惠特克评定量表。所有患者的外科手术都很顺利。所有患者均对术后面部美学满意,并归类为I类Whitaker评定量表。用于前眶和前颅纤维发育不良轮廓重建的针对患者的手术指导技术可以被认为是一种精确的替代技术,可以克服不可预测的常规技术的缺点。需要进一步调查。
    The aim of this study was to introduce a new computer guided technique for debulking and contouring the craniofacial fibrous dysplasia involving the fronto-orbital and fronto-cranial regions. Computer-guided contouring was performed using a modified patient-specific surgical depth guide for six patients with craniofacial fibrous dysplasia involving the fronto-orbital and fronto-cranial regions. Virtual planning was performed to determine the desired amount of bone removal and construct the patient-specific surgical depth guide. Then, the guide was printed using rapid prototyping. In the surgical theatre, the guide was seated in position. Implant drills were inserted through the created depth holes according to the planned fixed depth to create depth holes. Finally, the bone in between the created holes was removed using cutting discs, bone chisels and surgical burs. Satisfaction with facial aesthetics was evaluated by the patients using a Likert scale, and by the surgeons using the Whitaker rating scale. The surgical procedures were uneventful for all the patients. All the patients were satisfied with the post-operative facial esthetics and categorized as category I Whitaker rating scale. Patient-specific surgical guide technique for recontouring of fronto-orbital and fronto-cranial fibrous dysplasia can be considered an accurate substitution technique that overcomes the drawbacks of the unpredictable conventional one. Further investigations are required.
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