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1.
Syst Rev ; 13(1): 73, 2024 Feb 23.
Article in English | MEDLINE | ID: mdl-38396006

ABSTRACT

BACKGROUND: Frailty in patients undergoing craniotomy may affect perioperative outcomes. There have been a number of studies published in this field; however, evidence is yet to be summarized in a quantitative review format. We conducted a systematic review and meta-analysis to examine the effects of frailty on perioperative outcomes in patients undergoing craniotomy surgery. METHODS: Our eligibility criteria included adult patients undergoing open cranial surgery. We searched MEDLINE via Ovid SP, EMBASE via Ovid SP, Cochrane Library, and grey literature. We included retrospective and prospective observational studies. Our primary outcome was a composite of complications as per the Clavien-Dindo classification system. We utilized a random-effects model of meta-analysis. We conducted three preplanned subgroup analyses: patients undergoing cranial surgery for tumor surgery only, patients undergoing non-tumor surgery, and patients older than 65 undergoing cranial surgery. We explored sources of heterogeneity through a sensitivity analysis and post hoc analysis. RESULTS: In this review of 63,159 patients, the pooled prevalence of frailty was 46%. The odds ratio of any Clavien-Dindo grade 1-4 complication developing in frail patients compared to non-frail patients was 2.01 [1.90-2.14], with no identifiable heterogeneity and a moderate level of evidence. As per GradePro evidence grading methods, there was low-quality evidence for patients being discharged to a location other than home, length of stay, and increased mortality in frail patients. CONCLUSION: Increased frailty was associated with increased odds of any Clavien-Dindo 1-4 complication. Frailty measurements may be used as an integral component of risk-assessment strategies to improve the quality and value of neurosurgical care for patients undergoing craniotomy surgery. ETHICS AND DISSEMINATION: Formal ethical approval is not needed, as primary data were not collected. SYSTEMATIC REVIEW REGISTRATION: PROSPERO identification number: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=405240.


Subject(s)
Frailty , Adult , Humans , Retrospective Studies , Prevalence , Patients , Craniotomy/adverse effects , Observational Studies as Topic
2.
J Clin Neurosci ; 81: 397-400, 2020 Nov.
Article in English | MEDLINE | ID: mdl-33222949

ABSTRACT

We present a case of a 42-year-old male presenting with persistent hiccups and a Horner's syndrome, among other symptoms and signs of hypothalamic and brainstem dysfunction. He had a biopsy-proven diffuse infiltrative large primary CNS B-cell lymphoma involving the left fronto-temporal hemisphere, diencephalon and brainstem. The aim of this case report is to highlight key clinical and neuro-anatomical correlations that bring light to the art of the clinical examination.


Subject(s)
Brain Neoplasms/pathology , Hiccup/etiology , Horner Syndrome/etiology , Lymphoma, B-Cell/pathology , Adult , Brain Neoplasms/complications , Humans , Lymphoma, B-Cell/complications , Male
3.
Neurospine ; 17(1): 174-183, 2020 Mar.
Article in English | MEDLINE | ID: mdl-32252167

ABSTRACT

OBJECTIVE: To determine the effect of anterior plating on postoperative dysphagia (POD) among adult patients undergoing elective anterior cervical discectomy and fusion (ACDF) for cervical spondylosis and determine the potential role of demographic and clinical characteristics in the development of POD. METHODS: Consecutive adults undergoing an elective, single-level, ACDF were randomly assigned to receive a stand-alone CoRoent Cage or a CoRoent Cage with a Helix, or HelixMini plate. Patients with a history of cervical spine surgery were excluded. M. D. Anderson Dysphagia Inventory and Bazaz questionnaires were completed at regular intervals for 12 months postoperatively. RESULTS: Twenty-five patients were recruited over a 2-year period, with 8 allocated to receive a stand-alone cage, 5 to receive a cage and Helix Mini plate, and 12 to receive a cage and Helix plate. The POD rate was 68% at 48 hours, before falling to 16% at 6 and 12 months. A longer retraction time was observed in the Helix plate group compared to the stand-alone cage group (7.88; 95% confidence interval, 0.12-15.63; p = 0.046), although there was no difference in the incidence or severity of dysphagia between cohorts at any timepoint. With the exception of body mass index, there was no difference in patients with and without dysphagia, and each of the interventions was equally efficacious with respect to clinical and radiological endpoints. CONCLUSION: Dysphagia is a common consequence of ACDF and, while the placement of a large plate results in longer retraction time, it was not associated with higher rates of dysphagia. Further research is required to identify both patient-specific and surgical contributors to this complication.

4.
World Neurosurg ; 138: e267-e274, 2020 06.
Article in English | MEDLINE | ID: mdl-32105880

ABSTRACT

OBJECTIVE: This study sought to 1) describe the use K-wireless pedicle screw insertion among adults (age ≥18 years) undergoing a minimally invasive fusion and 2) perform a systematic review (SR) of all studies that describe a navigated, K-wireless technique with 3-dimensional fluoroscopy. METHODS: Patients undergoing a minimally invasive fusion requiring pedicle screw fixation for any indication were prospectively enrolled in the observational component of this study. An assessment of pedicle breach was performed independently and in duplicate based on a modification of the Belmont grading scale. Articles for the SR were identified from a structured search of Medline from inception to May 8, 2019, without restriction of language. RESULTS: A total of 82 pedicle screws were placed in 20 patients who underwent surgery between January and June 2014. There was no significant difference in mean operative time between the cases included in this study and a matched cohort of 20 patients undergoing surgery with 2-dimensional fluoroscopy and K-wire-assisted pedicle screw placement (95 ± 13 vs. 87 ± 20 minutes, respectively; P > 0.05). There were 2 major pedicle breaches (Belmont grade 3) in a single patient, yielding a major breach rate of 2.44%. A total of 6 papers that described the placement of 700 pedicle screws in 160 patients between May 2011 and March 2017 were included in the SR. The overall breach rate was 7.00% (n = 37). CONCLUSIONS: Percutaneous pedicle screws can be placed accurately and safely using 3-dimensional navigation without the use of K-wires and may confer benefits to patients and clinicians by reducing K-wire-associated complications and radiation exposure.


Subject(s)
Minimally Invasive Surgical Procedures/methods , Neuronavigation/methods , Pedicle Screws , Spinal Fusion/methods , Aged , Bone Wires , Female , Fluoroscopy/methods , Humans , Lumbar Vertebrae/surgery , Male , Middle Aged , Observational Studies as Topic , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Spinal Fusion/adverse effects , Spinal Fusion/instrumentation
5.
CNS Oncol ; 8(1): CNS31, 2019 03.
Article in English | MEDLINE | ID: mdl-30727742

ABSTRACT

AIM: Evaluation of the Nativis Voyager®, an investigational medical device, as monotherapy for recurrent glioblastoma (rGBM). MATERIALS & METHODS: A total of 15 patients with rGBM were treated with one of two Voyager ultra-low radio frequency energy cognates: A1A or A2HU. Safety and clinical utility were assessed every 2-4 months. RESULTS: Median overall survival was 8.04 months in the A1A arm and 6.89 months in the A2HU arm. No serious adverse events associated with Voyager were reported. No clinically relevant trends were noted in clinical laboratory parameters or physical exams. CONCLUSION: The data suggest that the Voyager is safe and feasible for the treatment of rGBM.


Subject(s)
Brain Neoplasms/therapy , Glioblastoma/therapy , Magnetic Field Therapy , Neoplasm Recurrence, Local/therapy , Adult , Aged , Australia , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/mortality , Feasibility Studies , Female , Glioblastoma/diagnostic imaging , Glioblastoma/mortality , Humans , Magnetic Field Therapy/instrumentation , Male , Middle Aged , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/mortality , Treatment Outcome
6.
J Neurol Surg A Cent Eur Neurosurg ; 78(4): 358-367, 2017 Jul.
Article in English | MEDLINE | ID: mdl-27652803

ABSTRACT

Objectives To evaluate the feasibility, safety, clinical, and radiologic outcomes of a minimally invasive direct lateral-approach corpectomy (MIDLaC) for decompression and stabilization of symptomatic metastatic spinal cord compression (MSCC). Methods A retrospective study on a prospective cohort was conducted. Nineteen patients were consecutively treated with MIDLaC and posterior pedicle screw fixation between May 2012 and July 2014. Demographic information and radiologic outcomes including sagittal deformity correction and vertebral body height were recorded. Operative variables (operative duration, blood loss) and clinical variables (Tokuhashi score, mortality, complication rate, pain visual analogue scale [VAS], opioid usage, and Frankel grade) were recorded and analyzed. Results All nineteen patients (mean age: 67.6 ± 12.7 years) successfully underwent MIDLaC with excellent neural decompression. Operative duration was 188.4 ± 30.3 minutes for single-level MIDLaC and 327.2 ± 71.9 minutes for multilevel surgery (p < 0.0001). Mean blood loss per spinal level was 390.8 mL with a decrease to 102.3 mL excluding renal cell MSCC. A total of 47.4% of patients had a Tokuhashi score of 0 to 8. There was one approach-related complication and one perioperative mortality. The overall complication rate was 15.8% (n = 3) with no postoperative wound infections. Kaplan-Meier survival estimates at 6 months were 0.50. Overall, 31.6% of patients improved by one or more Frankel grades, and no patients demonstrated worsening neurology postoperatively. VAS was significantly improved postoperatively (p < 0.05). Vertebral body height was significantly increased (+7.6 ± 8.1 mm; p = 0.002), with improvements in lumbar lordosis (8.3 ± 7.3 degrees) and thoracic kyphosis (2.4 ± 7.1 degrees) postoperatively. Conclusion MIDLaC is a safe and feasible palliative approach in the management of MSCC with encouraging early clinical outcomes. Further prospective studies are required to define the role of MIDLaC in the management of MSCC vis-à-vis other mini-open or minimally invasive techniques.


Subject(s)
Decompression, Surgical/methods , Lumbar Vertebrae/surgery , Spinal Cord Compression/surgery , Spinal Neoplasms/surgery , Thoracic Vertebrae/surgery , Adult , Aged , Aged, 80 and over , Feasibility Studies , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures , Neurosurgical Procedures , Pedicle Screws , Retrospective Studies , Spinal Cord Compression/etiology , Spinal Neoplasms/complications , Spinal Neoplasms/secondary , Spinal Neoplasms/therapy , Treatment Outcome
7.
Spine (Phila Pa 1976) ; 39(3): E228-30, 2014 Feb 01.
Article in English | MEDLINE | ID: mdl-24153167

ABSTRACT

STUDY DESIGN: A case report. OBJECTIVE: To present a patient who underwent a minimally invasive transforaminal lumbar interbody fusion who postoperatively developed paraplegia as a rare complication of a Kirschner wire (K-wire). SUMMARY OF BACKGROUND DATA: The few complications of K-wires that have been reported include, dural tears and damage to intra-abdominal structures. METHODS: A case report of a rare complication of a K-wire is reported and the relevant literature was then reviewed. RESULTS: An 85-year-old female with an anterolisthesis at L4-L5 underwent a minimally invasive transforaminal lumbar interbody fusion. Postoperatively she developed paraplegia. A subdural hematoma from T12 to the sacrum was found and evacuated. It is proposed that this rare complication is a result of a K-wire. CONCLUSION: Care must be taken with the use of K-wires and additional measures should be carried out such as the marking of its position and radiological confirmation of depth. LEVEL OF EVIDENCE: 5.


Subject(s)
Bone Wires/adverse effects , Lumbar Vertebrae/diagnostic imaging , Minimally Invasive Surgical Procedures/adverse effects , Paraplegia/diagnostic imaging , Postoperative Complications/diagnostic imaging , Aged, 80 and over , Female , Humans , Lumbar Vertebrae/surgery , Minimally Invasive Surgical Procedures/instrumentation , Paraplegia/etiology , Postoperative Complications/etiology , Radiography , Spinal Fusion/adverse effects , Spinal Fusion/instrumentation
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