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  • 1
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    Journal of Neurosurgery Publishing Group (JNSPG) ; 2021
    In:  Journal of Neurosurgery Vol. 135, No. 3 ( 2021-09), p. 893-903
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 135, No. 3 ( 2021-09), p. 893-903
    Kurzfassung: Traditional animal models of nerve injury use controlled crush or transection injuries to investigate nerve regeneration; however, a more common and challenging clinical problem involves closed traction nerve injuries. The authors have produced a precise traction injury model and sought to examine how the pathophysiology of stretch injuries compares with that of crush and transection injuries. METHODS Ninety-five late-adolescent (8-week-old) male mice underwent 1 of 7 injury grades or a sham injury (n 〉 10 per group): elastic stretch, inelastic stretch, stretch rupture, crush, primary coaptation, secondary coaptation, and critical gap. Animals underwent serial neurological assessment with sciatic function index, tapered beam, and von Frey monofilament testing for 48 days after injury, followed by trichrome and immunofluorescent nerve histology and muscle weight evaluation. RESULTS The in-continuity injuries, crush and elastic stretch, demonstrated different recovery profiles, with more severe functional deficits after crush injury than after elastic stretch immediately following injury (p 〈 0.05). However, animals with either injury type returned to baseline performance in all neurological assessments, accompanied by minimal change in nerve histology. Inelastic stretch, a partial discontinuity injury, produced more severe neurological deficits, incomplete return of function, 47% ± 9.1% (mean ± SD) reduction of axon counts (p 〈 0.001), and partial neuroma formation within the nerve. Discontinuity injuries, including immediate and delayed nerve repair, stretch rupture, and critical gap, manifested severe, long-term neurological deficits and profound axonal loss, coupled with intraneural scar formation. Although repaired nerves demonstrated axon regeneration across the gap, rupture and critical gap injuries demonstrated negligible axon crossing, despite rupture injuries having healed into continuity. CONCLUSIONS Stretch-injured nerves present unique pathology and functional deficits compared with traditional nerve injury models. Because of the profound neuroma formation, stretch injuries represent an opportunity to study the pathophysiology associated with clinical injury mechanisms. Further validation for comparison with human injuries will require evaluation in a large-animal model.
    Materialart: Online-Ressource
    ISSN: 0022-3085 , 1933-0693
    RVK:
    RVK:
    Sprache: Unbekannt
    Verlag: Journal of Neurosurgery Publishing Group (JNSPG)
    Publikationsdatum: 2021
    ZDB Id: 2026156-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
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    Journal of Neurosurgery Publishing Group (JNSPG) ; 2020
    In:  Journal of Neurosurgery Vol. 133, No. 4 ( 2020-10), p. 1103-1112
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 133, No. 4 ( 2020-10), p. 1103-1112
    Kurzfassung: Hypovitaminosis D is prevalent in neurocritical care patients, but the potential to improve patient outcome by replenishing vitamin D has not been investigated. This single-center, double-blinded, placebo-controlled, randomized (1:1) clinical trial was designed to assess the effect on patient outcome of vitamin D supplementation in neurocritical care patients with hypovitaminosis D. METHODS From October 2016 until April 2018, emergently admitted neurocritical care patients with vitamin D deficiency (≤ 20 ng/ml) were randomized to receive vitamin D3 (cholecalciferol, 540,000 IU) (n = 134) or placebo (n = 133). Hospital length of stay (LOS) was the primary outcome; secondary outcomes included intensive care unit (ICU) LOS, repeat vitamin D levels, patient complications, and patient disposition. Exploratory analysis evaluated specific subgroups of patients by LOS, Glasgow Coma Scale (GCS) score, and Simplified Acute Physiology Score (SAPS II). RESULTS Two-hundred seventy-four patients were randomized (intent-to-treat) and 267 were administered treatment within 48 hours of admission (as-treated; 61.2% of planned recruitment) and monitored. The mean age of as-treated patients was 54.0 ± 17.2 years (56.9% male, 77.2% white). After interim analysis suggested a low conditional power for outcome difference (predictive power 0.12), the trial was halted. For as-treated patients, no significant difference in hospital LOS (10.4 ± 14.5 days vs 9.1 ± 7.9 days, p = 0.4; mean difference 1.3, 95% CI −1.5 to 4.1) or ICU LOS (5.8 ± 7.5 days vs 5.4 ± 6.4 days, p = 0.4; mean difference 0.4, 95% CI −1.3 to 2.1) was seen between vitamin D3 and placebo groups, respectively. Vitamin D3 supplementation significantly improved repeat serum levels compared with placebo (20.8 ± 9.3 ng/ml vs 12.8 ± 4.8 ng/ml, p 〈 0.001) without adverse side effects. No subgroups were identified by exclusion of LOS outliers or segregation by GCS score, SAPS II, or severe vitamin D deficiency (≤ 10 ng/ml). CONCLUSIONS Despite studies showing that vitamin D can predict prognosis, supplementation in vitamin D–deficient neurocritical care patients did not result in appreciable improvement in outcomes and likely does not play a role in acute clinical recovery. Clinical trial registration no.: NCT02881957 (clinicaltrials.gov)
    Materialart: Online-Ressource
    ISSN: 0022-3085 , 1933-0693
    RVK:
    RVK:
    Sprache: Unbekannt
    Verlag: Journal of Neurosurgery Publishing Group (JNSPG)
    Publikationsdatum: 2020
    ZDB Id: 2026156-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
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    Journal of Neurosurgery Publishing Group (JNSPG) ; 2018
    In:  Neurosurgical Focus Vol. 44, No. 6 ( 2018-06), p. E10-
    In: Neurosurgical Focus, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 44, No. 6 ( 2018-06), p. E10-
    Kurzfassung: Meningiomas are among the most common intracranial pathological conditions, accounting for 36% of intracranial lesions treated by neurosurgeons. Although the majority of these lesions are benign, the classical categorization of tumors by histological type or World Health Organization (WHO) grade has not fully captured the potential for meningioma progression and recurrence. Many targeted treatments have failed to generate a long-lasting effect on these tumors. Recently, several seminal studies evaluating the genomics of intracranial meningiomas have rapidly changed the understanding of the disease. The importance of NF2 (neurofibromin 2), TRAF7 (tumor necrosis factor [TNF] receptor–associated factor 7), KLF4 (Kruppel-like factor 4), AKT1 , SMO (smoothened), PIK3CA (phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha), and POLR2 (RNA polymerase II subunit A) demonstrates that there are at least 6 distinct mutational classes of meningiomas. In addition, 6 methylation classes of meningioma have been appreciated, enabling improved prediction of prognosis compared with traditional WHO grades. Genomic studies have shed light on the nature of recurrent meningioma, distinct intracranial locations and mutational patterns, and a potential embryonic cancer stem cell–like origin. However, despite these exciting findings, the clinical relevance of these findings remains elusive. The authors review the key findings from recent genomic studies in meningiomas, specifically focusing on how these findings relate to clinical insights for the practicing neurosurgeon.
    Materialart: Online-Ressource
    ISSN: 1092-0684
    Sprache: Unbekannt
    Verlag: Journal of Neurosurgery Publishing Group (JNSPG)
    Publikationsdatum: 2018
    ZDB Id: 2026589-X
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
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    Universitas Sebelas Maret ; 2022
    In:  Journal of Physics: Theories and Applications Vol. 6, No. 1 ( 2022-03-28), p. 25-
    In: Journal of Physics: Theories and Applications, Universitas Sebelas Maret, Vol. 6, No. 1 ( 2022-03-28), p. 25-
    Kurzfassung: 〈 p class="AbstractEnglish" 〉 Bolus is a radiotherapy device used to increase the surface dose in the skin surface area when using electron or photon beams. The most commonly used bolus is a bolus made from plasticine, in addition to a plasticine bolus there is also a bolus made from silicone rubber which is currently being developed. This study aims to determine which bolus is more effectively used in radiotherapy, by comparing the absorbed dose, the value of Relative Electron Density (RED), and the transmission factor of each bolus. In this study, silicone rubber and plasticine boluses were made with dimensions of 12 cm x 12 cm, the variation of energy used in LINAC was 9 MeV and 12 MeV and the thickness variation of each bolus was 0.5 cm, 1.0 cm, 1, 5 cm and 2.0 cm. The RED value obtained from the plasticine bolus for a thickness of 0.5 cm is 0.837 g/cm3, a thickness of 1.0 cm is 1.011 g/cm3, a thickness of 1.5 cm is 1.06 g/cm3, and a thickness of 2.0 cm of 1.072 g/cm3, while for silicone rubber bolus for a thickness of 0.5 cm is 1.146 g/cm3, a thickness of 1.0 cm is 1.151 g/cm3, a thickness of 1.5 cm is 1.17 g/cm3, and a thickness of 1.5 cm is 1.17 g/cm3 2.0 cm is 1.193 g/cm3. From the results of the study for the RED value of each bolus, it can be concluded that the silicone rubber bolus has a RED value that is more consistent with the water density value compared to the plasticine bolus. Silicone rubber and plasticine boluses can also be said to be absorbent materials because the transmission factor value of both boluses is below 100%. From the results of the study, silicone rubber boluses were more able to reduce the range of absorbed doses compared to plasticine boluses. 〈 /p 〉
    Materialart: Online-Ressource
    ISSN: 2549-7324 , 2549-7316
    URL: Issue
    Sprache: Unbekannt
    Verlag: Universitas Sebelas Maret
    Publikationsdatum: 2022
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
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    Journal of Neurosurgery Publishing Group (JNSPG) ; 2017
    In:  Journal of Neurosurgery Vol. 127, No. 1 ( 2017-07), p. 1-7
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 127, No. 1 ( 2017-07), p. 1-7
    Kurzfassung: Hypovitaminosis D is highly prevalent among the general population. Studies have shown an association between hypovitaminosis D and multiple negative outcomes in critical care patients, but there has been no prospective evaluation of vitamin D in the neurological critical care population. The authors examined the impact of vitamin D deficiency on in-hospital mortality and a variety of secondary outcomes. METHODS The authors prospectively collected 25-hydroxy vitamin D levels of all patients admitted to the neurocritical care unit (NCCU) of a quaternary-care center over a 3-month period. Demographic data, illness acuity, in-hospital mortality, infection, and length of hospitalization were collected. Univariate and multivariable logistic regression were used to examine the effects of vitamin D deficiency. RESULTS Four hundred fifteen patients met the inclusion criteria. In-hospital mortality was slightly worse (9.3% vs 4.5%; p = 0.059) among patients with deficient vitamin D (≤ 20 ng/dl). There was also a higher rate of urinary tract infection in patients with vitamin D deficiency (12.4% vs 4.2%; p = 0.002). For patients admitted to the NCCU on an emergency basis (n = 285), higher Simplified Acute Physiology Score II (OR 13.8, 95% CI 1.7–110.8; p = 0.014), and vitamin D deficiency (OR 3.0, 95% CI 1.0–8.6; p = 0.042) were significantly associated with increased in-hospital mortality after adjusting for other factors. CONCLUSIONS In the subset of patients admitted to the NCCU on an emergency basis, vitamin D deficiency is significantly associated with higher in-hospital mortality. Larger studies are needed to confirm these findings and to investigate the role of vitamin D supplementation in these patients.
    Materialart: Online-Ressource
    ISSN: 0022-3085 , 1933-0693
    RVK:
    RVK:
    Sprache: Unbekannt
    Verlag: Journal of Neurosurgery Publishing Group (JNSPG)
    Publikationsdatum: 2017
    ZDB Id: 2026156-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
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    Journal of Neurosurgery Publishing Group (JNSPG) ; 2018
    In:  Journal of Neurosurgery Vol. 129, No. 3 ( 2018-09), p. 841-842
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 129, No. 3 ( 2018-09), p. 841-842
    Materialart: Online-Ressource
    ISSN: 0022-3085 , 1933-0693
    RVK:
    RVK:
    Sprache: Unbekannt
    Verlag: Journal of Neurosurgery Publishing Group (JNSPG)
    Publikationsdatum: 2018
    ZDB Id: 2026156-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
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    Journal of Neurosurgery Publishing Group (JNSPG) ; 2019
    In:  Journal of Neurosurgery Vol. 131, No. 3 ( 2019-09), p. 920-930
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 131, No. 3 ( 2019-09), p. 920-930
    Kurzfassung: Surgical treatment of pathological processes involving the ventral craniocervical junction (CCJ) traditionally involves anterior and posterolateral skull base approaches. In cases of bilateral extension, when lesions extend beyond the midline to the contralateral side, a unilateral corridor may result in suboptimal resection. In these cases, the lateral extent of the tumor will prevent extirpation of the lesion via anterior surgical approaches. The authors describe a unilateral operative corridor developed along an extreme lateral trajectory to the anterior aspect of the clival and upper cervical dura, allowing exposure and resection of tumor on the contralateral side. This approach is used when the disease involves the bone structures inherent to stability at the anterior CCJ. METHODS To achieve exposure of the ventral CCJ, an extreme lateral transcondylar transodontoid (ELTO) approach was performed with transposition of the ipsilateral vertebral artery, followed by drilling of the C1 anterior arch. Resection of the odontoid process allowed access to the contralateral component of lesions across the midline to the region of the extracranial contralateral vertebral artery, maximizing resection. RESULTS Exposure and details of the surgical procedure were derived from anatomical cadavers. At the completion of cadaveric dissection, morphometric measurements of the relevant anatomical landmarks were obtained. Illustrative case examples for approaching ventral CCJ chordomas via the ELTO approach are presented. CONCLUSIONS The ELTO approach provides a safe and direct surgical corridor to treat complex lesions at the ventral CCJ with bilateral extension through a single operative corridor. This approach can be combined with other lateral approaches or posterior infratemporal approaches to remove more extensive lesions involving the rostral clivus, jugular foramen, and temporal bone.
    Materialart: Online-Ressource
    ISSN: 0022-3085 , 1933-0693
    RVK:
    RVK:
    Sprache: Unbekannt
    Verlag: Journal of Neurosurgery Publishing Group (JNSPG)
    Publikationsdatum: 2019
    ZDB Id: 2026156-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
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    Journal of Neurosurgery Publishing Group (JNSPG) ; 2016
    In:  Neurosurgical Focus Vol. 41, No. 2 ( 2016-08), p. E3-
    In: Neurosurgical Focus, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 41, No. 2 ( 2016-08), p. E3-
    Kurzfassung: Spinal column tumors are rare in children and young adults, accounting for only 1% of all spine and spinal cord tumors combined. They often present diagnostic and therapeutic challenges. In this article, the authors review the current management of primary osseous tumors of the pediatric spinal column and highlight diagnosis, management, and surgical decision making.
    Materialart: Online-Ressource
    ISSN: 1092-0684
    Sprache: Unbekannt
    Verlag: Journal of Neurosurgery Publishing Group (JNSPG)
    Publikationsdatum: 2016
    ZDB Id: 2026589-X
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
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    Journal of Neurosurgery Publishing Group (JNSPG) ; 2019
    In:  Journal of Neurosurgery: Spine Vol. 31, No. 1 ( 2019-07), p. 93-102
    In: Journal of Neurosurgery: Spine, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 31, No. 1 ( 2019-07), p. 93-102
    Kurzfassung: The objective of this study was to investigate the effect of hospital type and patient transfer during the treatment of patients with vertebral fracture and/or spinal cord injury (SCI). METHODS The National Inpatient Sample (NIS) database was queried to identify patients treated in Utah from 2001 to 2011 for vertebral column fracture and/or SCI (ICD-9-CM codes 805, 806, and 952). Variables related to patient transfer into and out of the index hospital were evaluated in relation to patient disposition, hospital length of stay, mortality, and cost. RESULTS A total of 53,644 patients were seen (mean [± SEM] age 55.3 ± 0.1 years, 46.0% females, 90.2% white), of which 10,620 patients were transferred from another institution rather than directly admitted. Directly admitted (vs transferred) patients showed a greater likelihood of routine disposition (54.4% vs 26.0%) and a lower likelihood of skilled nursing facility disposition (28.2% vs 49.2%) (p 〈 0.0001). Directly admitted patients also had a significantly shorter length of stay (5.6 ± 6.7 vs 7.8 ± 9.5 days, p 〈 0.0001) and lower total charges ($26,882 ± $37,348 vs $42,965 ± $52,118, p 〈 0.0001). A multivariable analysis showed that major operative procedures (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.4–2.0, p 〈 0.0001) and SCI (HR 2.1, 95% CI 1.6–2.8, p 〈 0.0001) were associated with reduced survival whereas patient transfer was associated with better survival rates (HR 0.4, 95% CI 0.3–0.5, p 〈 0.0001). A multivariable analysis of cost showed that disposition (β = 0.1), length of stay (β = 0.6), and major operative procedure (β = 0.3) (p 〈 0.0001) affected cost the most. CONCLUSIONS Overall, transferred patients had lower mortality but greater likelihood for poor outcomes, longer length of stay, and higher cost compared with directly admitted patients. These results suggest some significant benefits to transferring patients with acute injury to facilities capable of providing appropriate treatment, but also support the need to further improve coordinated care of transferred patients, including surgical treatment and rehabilitation.
    Materialart: Online-Ressource
    ISSN: 1547-5654
    RVK:
    Sprache: Unbekannt
    Verlag: Journal of Neurosurgery Publishing Group (JNSPG)
    Publikationsdatum: 2019
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 10
    In: Journal of Neurosurgery: Pediatrics, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 24, No. 1 ( 2019-07), p. 1-8
    Kurzfassung: Large experiences with the treatment of pediatric arteriovenous malformations (AVMs) remain relatively rare, with limited data on presentation, treatment, and long-term functional outcomes. Because of the expected long lifespan of children, caregivers are especially interested in outcome measures that assess quality of life. The authors’ intention was to describe the long-term functional outcomes of pediatric patients who undergo AVM surgery and to identify predictors of sustained neurological deficits. METHODS The authors analyzed a 21-year retrospective cohort of pediatric patients with intracranial AVMs treated with microsurgery at two institutions. The primary outcome was a persistent neurological deficit at last follow-up. Secondary outcome measures included modified Rankin Scale (mRS) score and independent living. RESULTS Overall, 97 patients (mean age 11.1 ± 4.5 years; 56% female) were treated surgically for intracranial AVMs (mean follow-up 77.5 months). Sixty-four patients (66%) presented with hemorrhage, and 45 patients (46%) had neurological deficits at presentation. Radiologically, 39% of lesions were Spetzler-Martin grade II. Thirty-seven patients (38%) with persistent neurological deficits at last follow-up were compared with those without deficits; there were no differences in patient age, presenting Glasgow Coma Scale score, AVM size, surgical blood loss, or duration of follow-up. Multivariate analysis demonstrated that a focal neurological deficit on presentation, AVM size 〉 3 cm, and lesions in eloquent cortex were independent predictors of persistent neurological deficits at long-term follow-up. Overall, 92% of the children had an mRS score ≤ 2 on long-term follow-up. CONCLUSIONS Pediatric patients with AVMs treated with microsurgical resection have good functional and radiological outcomes. There is a high rate (38%) of persistent neurological deficits, which were independently predicted by preoperative deficits, AVMs 〉 3 cm, and lesions located in eloquent cortex. This information can be useful in counseling families on the likelihood of long-term neurological deficits after cerebral AVM surgery.
    Materialart: Online-Ressource
    ISSN: 1933-0707 , 1933-0715
    RVK:
    Sprache: Unbekannt
    Verlag: Journal of Neurosurgery Publishing Group (JNSPG)
    Publikationsdatum: 2019
    Standort Signatur Einschränkungen Verfügbarkeit
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