Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Calcium phosphate cement cranioplasty decreases the rate of CSF leak and wound infection compared to titanium mesh cranioplasty: retrospective study of 672 patients.
World Neurosurg. 2016 Feb 24;
Authors: Foster KA, Shin SS, Prabhu B, Fredrickson A, Sekula RF
PMID: 26921704 [PubMed - as supplied by publisher]
Disseminated intravascular coagulation in secondary glioblastoma due to excessive intraoperative bleeding - case report and review of the literature.
World Neurosurg. 2016 Feb 24;
Authors: Pinggera D, Kerschbaumer J, Innerhofer N, Woehrer A, Freyschlag CF, Thomé C
Abstract
BACKGROUND: Disseminated intravascular coagulation (DIC) describes a pathological activation of coagulation mechanisms, leading to thrombi in various organs with contribution to multiple organ failure. In clinical practice, diagnosis of DIC can often be made by laboratory values, including prolonged coagulation times, thrombocytopenia or high levels of fibrin degradation products. DIC is frequently observed after neurotrauma, but rarely occurs in patients with primary brain tumors. There are only few case reports of DIC in patients with primary brain tumors, all sharing the highly elevated mortality. We report the case of a young patient presenting with secondary glioblastoma, who developed multi-organ failure induced by DIC following extensive intraoperative bleeding.
CASE DESCRIPTION: A 30-year-old patient was admitted in poor general condition with insomnia, severe headache and vomiting. She had undergone surgery for secondary glioblastoma twice. MRI revealed a left temporoparietal mass lesion with indication for resection. Surgery then was complicated by diffuse intraoperative bleeding due to a high content of microvascular proliferation as shown in the histopathological workup. Subsequently, an uncontrollable multi-organ failure developed, causing the patient`s death four days after surgery.
CONCLUSIONS: Although a rare complication, in excessive intraoperative bleeding, especially in surgery for brain tumors located next to the ventricular system, disseminated intravascular coagulation should be kept in mind as a possible diagnosis.
PMID: 26921703 [PubMed - as supplied by publisher]
Radiological surveillance of untreated unruptured intracranial aneurysms: A single surgeon's experience.
World Neurosurg. 2016 Feb 24;
Authors: Teo M, St George EJ
Abstract
BACKGROUND: The management of untreated unruptured intracranial aneurysms remains controversial, the natural history is still not well understood and many patients are not routinely followed up. We present a single surgeon's data on radiological surveillance of these lesions.
METHODS: 94 patients with 152 unruptured intracranial aneurysms, with a mean follow up time of 3.4years from the time of diagnosis, underwent surveillance using CTA, MRA or DSA. Aneurysm growth was defined as an increase in one or more dimensions above the measurement error. Statistical analysis was performed.
RESULTS: Of 152 aneurysms, 126 (83%) were less than 7mm, 25 (16%) were 7-12mm and 1 aneurysm was 13-24mm. 18 of 152 (12%) cerebral aneurysms in 17 patients grew larger. 7% (9/126) of aneurysm <7mm, and 36% (9/25) of aneurysm 7-12mm enlarged. Spontaneous aneurysmal rupture occurred in 4 of 152 (2.6%) of aneurysms, ie 4/94 patients (4%), with an average initial aneurysm size of 5.7mm. The risk of aneurysm rupture per patient-year was 5% with growth, 0.2% without growth and there was a 24-fold increase in aneurysmal rupture risk for growing aneurysm (p=0.005). 15% (16/109) of aneurysms in group 1(no previous SAH), compared to 5% (2/43) of group 2 (previous SAH) aneurysms showed evidence of growth during the study period (p=0.0424).
CONCLUSIONS: These results support imaging follow up of patients with untreated unruptured intracranial aneurysms, including those with aneurysms smaller than the current treatment threshold of 7mm. Apart from the initial size, aneurysm growth is also associated with an increased risk of SAH and therefore growing aneurysms warrant treatment. The data also demonstrated that incidental aneurysms, in patients without previous SAH, do not behave less aggressively, contrary to current opinion.
PMID: 26921702 [PubMed - as supplied by publisher]
Postoperative stereotactic radiosurgery (SRS) utilizing 5 Gy X 5 sessions in the management of brain metastases.
World Neurosurg. 2016 Feb 24;
Authors: Abuodeh Y, Ahmed KA, Naghavi AO, Venkat PS, Sarangkasiri S, Johnstone PA, Etame AB, Yu HM
Abstract
BACKGROUND: Multiple regimens for stereotactic radiosurgery to the post-operative bed have shown a high local control rate and a low toxicity profile with no decrease in overall survival with the omission of whole brain radiation therapy.
METHODS: In this retrospective analysis, we evaluate our experience with post-operative SRS using a uniform regimen of 25 Gy in 5 sessions.
RESULTS: Between April 2011 to May 2014, a total of 75 patients treated to 77 metastatic brain lesions with post-operative stereotactic radiosurgery in 5 sessions. The median PTV was 13.8 cm3 (1.93-128.43 cm3) with a median follow up for all lesions of 9.5 months (range 1.2-38.2 months). Kaplan-Meier estimates of local control at 1 and 2 years were 88.8% and 83.9%, respectively. On univariate analysis, a trend in decreased survival with multiple brain lesions was noted (HR=2 (95% CI 0.87-4.53), p=0.10). There was a trend towards decreased local control with radioresistant tumors (HR=3.23 (0.7-22.6), p=0.14) and PTV volume ≥ 17 cm3 (HR= 3.07 (0.73-15.23), p=0.12). Two (3%) patients developed radionecrosis, one of them required craniotomy.
CONCLUSION: SRS with a dose of 25 Gy in 5 sessions is associated with excellent local control at the resection site with minimal toxicity in the postoperative settings in our patient population. Further investigation is required to determine if dose escalation to the post-operative cavity of radioresistant tumors improves outcomes.
PMID: 26921701 [PubMed - as supplied by publisher]
Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Expandable Technology: A Clinical and Radiographic Analysis of 50 Patients.
World Neurosurg. 2016 Feb 24;
Authors: Kim CW, Doerr TM, Luna IY, Joshua G, Shen SR, Fu X, Wu AM
Abstract
OBJECTIVE: Interbody cage implantation during minimally invasive surgery for transforaminal lumbar interbody fusion (MIS TLIF) presents challenges. Expandable cages when collapsed facilitate insertion; subsequent expansion in situ optimizes endplate contact. This report describes clinical and radiographic outcomes of MIS TLIF with an expandable cage.
METHODS: Researchers retrospectively analyzed prospective data from 50 patients (62 operative levels) when an expandable interbody spacer was combined with transpedicular posterior stabilization. Clinical outcomes, fusion rates, incidence of reoperation, and device-related complications were obtained from clinical and radiographic records.
RESULTS: Mean patient age was 58.1 years (56.2% female). In all, 76% (38/50) underwent single-level fusion, and 24% (12/50) two-level fusion. Average operative time was 239 ± 87 minutes for single-level and 350 ± 75 minutes for two-level procedures; average hospital stay overall was 2.5 ± 1.7 days, with no intraoperative complications reported. Mean visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores decreased significantly from preoperative to all postoperative assessment times (6, 12, and 24 months) (P < 0.05). Intervertebral disc height (8 ± 3 vs 11 ± 2 mm) increased significantly, with increases sustained over 24 months (P < 0.05). Postoperative radiographs showed no evidence of cage migration, subsidence, or collapse and suggested fusion at all operative levels by 12 months and 24 months (93%, 54/58; 97%, 28/29), respectively.
CONCLUSIONS: An expandable interbody cage led to significant improvement in clinical and radiographic outcomes following MIS TLIF, including intervertebral disc height restoration and high fusion rates, with no evidence of device-related complications.
PMID: 26921700 [PubMed - as supplied by publisher]
The Efficacy of Antibacterial Prophylaxis against the Development of Meningitis after Craniotomy: a Meta-analysis.
World Neurosurg. 2016 Feb 24;
Authors: Alotaibi AF, Hulou MM, Vestal M, Alkholifi F, Asgarzadeh M, Cote DJ, Bi WL, Dunn IF, Mekary RA, Smith TR
Abstract
BACKGROUND: Prophylactic antibiotics are widely used before craniotomy to prevent postoperative infections.
OBJECTIVE: A systematic review and meta-analysis was conducted to examine the effect of prophylactic antibiotics on post-craniotomy meningitis.
METHODS: PubMed, EMBASE, and Cochrane databases were searched through October 2014 for randomized controlled trials (RCTs) that evaluated the effect of prophylactic antibiotics on post-craniotomy meningitis. Pooled effect estimates were calculated using fixed- and random-effects models.
RESULTS: Seven studies with 2365 patients were included in the final analysis. All studies were randomized controlled trials with different antibiotic regimens. Prophylactic antibiotic use reduced the rate of post-neurosurgical meningitis, with a pooled Peto Odds ratio of 0.34 (95% CI: 0.18; 0.63). Cochran's Q test indicated no significant heterogeneity among studies (I(2) =0%; P-for heterogeneity =0.44). Subgroup analysis based on gram-negative coverage, blinding design, and study quality demonstrated no statistically significant difference among these groups (P > 0.05 for all). A meta-regression on surgery duration (P=0.52) and on antibiotics duration (P=0.59) did not show significant differences in the results among studies.
CONCLUSION: This meta-analysis shows that prophylactic antibiotic use significantly decreases post-craniotomy meningitis infections.
PMID: 26921699 [PubMed - as supplied by publisher]
The Negative Impact of Anemia on Outcome from Traumatic Brain Injury.
World Neurosurg. 2016 Feb 24;
Authors: Litofsky NS, Martin S, Diaz J, Ge B, Petroski G, Miller DC, Barnes SL
PMID: 26921698 [PubMed - as supplied by publisher]
