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  • 1
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    National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study
    BMJ ; 2023
    In:  BMJ Open Vol. 13, No. 4 ( 2023-04), p. e068642-
    Details
    In: BMJ Open, BMJ, Vol. 13, No. 4 ( 2023-04), p. e068642-
    Kurzfassung: To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan. Design Retrospective study. Setting Six hundred and thirty-one primary care institutions in Japan. Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database. Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points). Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality. Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era.
    Materialart: Online-Ressource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2022-068642
    DOI: 10.1136/bmjopen-2022-068642.supp1
    DOI: 10.1136/bmjopen-2022-068642.supp2
    DOI: 10.1136/bmjopen-2022-068642.supp3
    Sprache: Englisch
    Verlag: BMJ
    Publikationsdatum: 2023
    ZDB Id: 2599832-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
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    Congenital dermal sinus and filar lipoma located in close proximity at the dural cul-de-sac mimicking limited dorsal myeloschisis
    Elsevier BV ; 2022
    In:  Interdisciplinary Neurosurgery Vol. 28 ( 2022-06), p. 101455-
    Details
    In: Interdisciplinary Neurosurgery, Elsevier BV, Vol. 28 ( 2022-06), p. 101455-
    Materialart: Online-Ressource
    ISSN: 2214-7519
    URL: Article
    DOI: 10.1016/j.inat.2021.101455
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2022
    ZDB Id: 2785532-6
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
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    Histopathological presence of dermal elements in resected margins of neural structures obtained from initial repair surgery for myelomeningocele
    Scientific Scholar ; 2023
    In:  Surgical Neurology International Vol. 14 ( 2023-01-06), p. 7-
    Details
    In: Surgical Neurology International, Scientific Scholar, Vol. 14 ( 2023-01-06), p. 7-
    Kurzfassung: Development of dermoid or epidermoid cysts in myelomeningocele (MMC) sites is generally thought to occur in a delayed fashion due to implantation of dermal elements during initial repair surgery. Another theory is that dermal and dermoid elements may already be present within dysplastic neural structures at birth. Methods: We experienced histopathological presence of dermal elements in resected tissues at initial repair surgery in four out of 18 cases with MMC who required resection of parts or margins of the neural structures to perform cord untethering. Since one of these cases has already been reported, we describe the clinicopathological findings for the remaining three cases. Results: In Case1, cryptic dermoid elements were discovered in the terminal filum-like structure (FT-LS) caudal to the open neural placode (NP). The FT-LS had histopathological characteristics similar to the retained medullary cord. In Case 2, dermoid elements were discovered in the caudal margin of the dysplastic conus medullaris. In Case 3, a thin squamous epithelial layer overlapped the rostral margin of the NP where the NP was located near the skin. Case 1 developed an epidermoid cyst at 1 year and 2 months of age, which was totally resected. Conclusion: Prenatally existing cryptic dermoid elements in the caudal portion of neural structures and remnants of dermal elements overlapping the rostral margin of the NP are associated with delayed occurrence of dermoid/ epidermoid cysts. Postoperative histopathological investigation of the resected specimens is recommended. Once dermal elements are revealed, repeated imaging examination and additional surgery should be considered.
    Materialart: Online-Ressource
    ISSN: 2152-7806
    URL: Article
    DOI: 10.25259/SNI_989_2022
    Sprache: Englisch
    Verlag: Scientific Scholar
    Publikationsdatum: 2023
    ZDB Id: 2567759-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
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    Surgical histopathology of a filar anomaly as an additional tethering element associated with closed spinal dysraphism of primary neurulation failure
    Scientific Scholar ; 2021
    In:  Surgical Neurology International Vol. 12 ( 2021-07-27), p. 373-
    Details
    In: Surgical Neurology International, Scientific Scholar, Vol. 12 ( 2021-07-27), p. 373-
    Kurzfassung: Closed spinal dysraphism of primary neurulation failure could be associated with filar anomalies, such as filar lipoma or thickened and tight filum terminale (TFT), resulting from impaired secondary neurulation. Retained medullary cord (RMC) is a remnant of the cavitary medullary cord originating from the secondary neurulation failure. Some filar lipomas are known to contain a central canal-like ependyma-lined lumen with surrounding neuroglial tissues (E-LC w/NGT), that is, a characteristic histopathology of RMC. To clarify the embryological background of these filar anomalies, we evaluated the histopathological findings. Methods: Among 41 patients with lesions of primary neurulation failure who underwent initial untethering surgery, the filum including cord-like structure (C-LS) was additionally resected in 10 patients (five dorsal and transitional lipomas; five limited dorsal myeloschisis). We retrospectively analyzed the clinical, neuroradiological, intraoperative, and histopathological findings. Results: Among 10 patients, two patients were diagnosed with RMC based on morphological features and intraoperative neurophysiological monitoring. The diagnosis of filar lipoma was made in six patients, since various amounts of fibroadipose tissue were histopathologically noted in the filum. Two patients were diagnosed with TFT, since the filum was composed solely of fibrocollagenous tissue. E-LC w/NGT was noted not only in both C-LSs of RMCs but also in two out of six fila both with filar lipomas and fila with TFTs. Conclusion: These findings provide further evidence for the idea that entities, such as filar lipoma, TFT, and RMC, can be considered consequences of a continuum of regression failure occurring during late secondary neurulation.
    Materialart: Online-Ressource
    ISSN: 2152-7806
    URL: Article
    DOI: 10.25259/SNI_340_2021
    Sprache: Englisch
    Verlag: Scientific Scholar
    Publikationsdatum: 2021
    ZDB Id: 2567759-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
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    Two cases of retained medullary cord running parallel to a terminal lipoma
    Scientific Scholar ; 2021
    In:  Surgical Neurology International Vol. 12 ( 2021-03-24), p. 112-
    Details
    In: Surgical Neurology International, Scientific Scholar, Vol. 12 ( 2021-03-24), p. 112-
    Kurzfassung: Retained medullary cord (RMC) is a newly defined entity believed to originate from the late arrest of secondary neurulation. Some RMCs contain varying amounts of lipomatous tissues, which need to be differentiated from spinal lipomas, such as filar and caudal lipomas (terminal lipomas). Case Description: We surgically treated two patients with a nonfunctional cord-like structure (C-LS) that was continuous from the cord and extended to the dural cul-de-sac, and ran parallel to the terminal lipoma. In both cases, untethering surgery was performed by resecting the C-LS with lipoma as a column, under intraoperative neurophysiological monitoring. Histopathological examination confirmed that the central canal-like ependyma-lined lumen with surrounding neuroglial and fibrocollagenous tissues, which is the central histopathological feature of an RMC, was located on the unilateral side of the resected column, while the fibroadipose tissues of the lipoma were located on the contralateral side. Conclusion: Our findings support the idea proposed by Pang et al . that entities such as RMC and terminal lipomas are members of a continuum of regression failure occurring during late secondary neurulation, and the coexistence of RMC and terminal lipoma is not a surprising finding. Therefore, it may be difficult in clinical practice to make a distinct diagnosis between these two entities.
    Materialart: Online-Ressource
    ISSN: 2152-7806
    URL: Article
    DOI: 10.25259/SNI_626_2020
    Sprache: Englisch
    Verlag: Scientific Scholar
    Publikationsdatum: 2021
    ZDB Id: 2567759-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
    Online-Ressource
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    Retained medullary cord and caudal lipoma with histopathological presence of terminal myelocystocele in the epidural stalk
    Scientific Scholar ; 2023
    In:  Surgical Neurology International Vol. 14 ( 2023-08-04), p. 279-
    Details
    In: Surgical Neurology International, Scientific Scholar, Vol. 14 ( 2023-08-04), p. 279-
    Kurzfassung: The retained medullary cord (RMC), caudal lipoma, and terminal myelocystocele (TMCC) are thought to originate from the failed regression spectrum during the secondary neurulation, and the central histopathological feature is the predominant presence of a central canal-like ependyma-lined lumen (CC-LELL) with surrounding neuroglial tissues (NGT), as a remnant of the medullary cord. However, reports on cases in which RMC, caudal lipoma, and TMCC coexist are very rare. Case Description: We present two patients with cystic RMC with caudal lipoma and caudal lipoma with an RMC component, respectively, based on their clinical, neuroradiological, intraoperative, and histopathological findings. Although no typical morphological features of TMCC were noted on neuroimaging, histopathological examination revealed that a CC-LELL with NGT was present in the extraspinal stalk, extending from the skin lesion to the intraspinal tethering tract. Conclusion: This histopathological finding indicates the presence of TMCC that could not be completely regressed and further supports the idea that these pathologies can be considered consequences of a continuum of regression failure during secondary neurulation.
    Materialart: Online-Ressource
    ISSN: 2152-7806 , 2229-5097
    URL: Article
    DOI: 10.25259/SNI_479_2023
    Sprache: Englisch
    Verlag: Scientific Scholar
    Publikationsdatum: 2023
    ZDB Id: 2567759-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
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    Retained Medullary Cord Associated with Terminal Myelocystocele and Intramedullary Arachnoid Cyst
    S. Karger AG ; 2022
    In:  Pediatric Neurosurgery Vol. 57, No. 3 ( 2022), p. 184-190
    Details
    In: Pediatric Neurosurgery, S. Karger AG, Vol. 57, No. 3 ( 2022), p. 184-190
    Kurzfassung: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 The retained medullary cord (RMC) is a newly defined entity of closed spinal dysraphism that is thought to originate from regression failure of the medullary cord during the last phase of secondary neurulation. The terminal myelocystocele (TMC) is an unusual type of closed spinal dysraphism, characterized by localized cystic dilatation of the terminal part of the central canal that then herniates through a posterior spinal bifida. The co-occurrence of RMC and TMC is extremely rare. 〈 b 〉 〈 i 〉 Case Presentation: 〈 /i 〉 〈 /b 〉 We treated a baby girl with a huge sacrococcygeal meningocele-like sac with two components. Untethering surgery and repair surgery for the sac revealed that RMC, associated with intramedullary arachnoid cyst (IMAC), was terminated at the bottom of the rostral cyst, forming the septum of the two cystic components, and the caudal cyst was TMC derived from the central canal-like ependymal lining lumen (CC-LELL) of the RMC at the septum. IMAC within the RMC communicated with TMC, and both contained xanthochromic fluid with the same properties. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 We speculated that the mass effect of the coexistent IMAC impeded the flow of cerebrospinal fluid in the CC-LELL within the RMC and eventually formed a huge TMC. In surgical strategies for such complex pathologies, it is important to identify the electrophysiological border between the functional cord and nonfunctional RMC and the severe RMC to untether the cord, as with a typical or simple RMC.
    Materialart: Online-Ressource
    ISSN: 1016-2291 , 1423-0305
    URL: Article
    DOI: 10.1159/000523976
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2022
    ZDB Id: 1483546-0
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
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    Refractory CSF leakage following untethering surgery performed 10 months after birth for enlarging terminal myelocystocele associated with OEIS complex
    Scientific Scholar ; 2021
    In:  Surgical Neurology International Vol. 12 ( 2021-12-30), p. 628-
    Details
    In: Surgical Neurology International, Scientific Scholar, Vol. 12 ( 2021-12-30), p. 628-
    Kurzfassung: Terminal myelocystocele (TMC) is an occult spinal dysraphism characterized by cystic dilatation of the terminal spinal cord in the shape of a trumpet (myelocystocele) filled with cerebrospinal fluid (CSF), which herniates into the extraspinal subcutaneous region. The extraspinal CSF-filled portion of the TMC, consisting of the myelocystocele and the surrounding subarachnoid space, may progressively enlarge, leading to neurological deterioration, and early untethering surgery is recommended. Case Description: We report a case of a patient with TMC associated with OEIS complex consisting of omphalocele (O), exstrophy of the cloaca (E), imperforate anus (I), and spinal deformity (S). The untethering surgery for TMC had to be deferred until 10 months after birth because of the delayed healing of the giant omphalocele and the respiration instability due to hypoplastic thorax and increased intra-abdominal pressure. The TMC, predominantly the surrounding subarachnoid space, enlarged during the waiting period, resulting in the expansion of the caudal part of the dural sac. Although untethering surgery for the TMC was uneventfully performed with conventional duraplasty, postoperative CSF leakage occurred, and it took three surgical interventions to repair it. External CSF drainage, reduction of the size of the caudal part of the dural sac and use of gluteus muscle flaps and collagen matrix worked together for the CSF leakage. Conclusion: Preoperative enlargement of the TMC, together with the surrounding subarachnoid space, can cause the refractory CSF leakage after untethering surgery because the expanded dural sac possibly increases its own tensile strength and impedes healing of the duraplasty. Early untethering surgery is recommended after recovery from the life-threatening conditions associated with OEIS complex.
    Materialart: Online-Ressource
    ISSN: 2152-7806
    URL: Article
    DOI: 10.25259/SNI_995_2021
    Sprache: Englisch
    Verlag: Scientific Scholar
    Publikationsdatum: 2021
    ZDB Id: 2567759-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
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    Ectopic dorsal root ganglion in cauda equina mimicking schwannoma in a child
    Scientific Scholar ; 2023
    In:  Surgical Neurology International Vol. 14 ( 2023-01-27), p. 33-
    Details
    In: Surgical Neurology International, Scientific Scholar, Vol. 14 ( 2023-01-27), p. 33-
    Kurzfassung: A heterotopic dorsal root ganglion (DRG) is sometimes observed in the vicinity of dysplastic neural structures during surgery for open spinal dysraphism; however, it is rarely associated with closed spinal dysraphism. Distinguish from neoplasms by preoperative imaging study is difficult. Although the embryopathogenesis of a heterotopic DRG has been speculated to be migration disorder of neural crest cells from primary neural tube, its details remain unelucidated. Case Description: We report a pediatric case with an ectopic DRG in cauda equina associated with a fatty terminal filum and bifid sacrum. The DRG mimicked a schwannoma in the cauda equina on preoperative magnetic resonance imaging. Laminotomy at L3 revealed that the tumor was entangled in the nerve roots, and small parts of the tumor were resected for biopsy. Histopathologically, the tumor consisted of ganglion cells and peripheral nerve fibers. Ki-67 immunopositive cells were observed at the periphery of the ganglion cells. These findings indicate the tumor comprised DRG tissue. Conclusion: We report detailed neuroradiological, intraoperative and histological findings and discuss the embryopathogenesis of the ectopic DRG. One should be aware of the possibility of ectopic or heterotopic DRGs when cauda equina tumors are observed in pediatric patients with neurulation disorders.
    Materialart: Online-Ressource
    ISSN: 2152-7806
    URL: Article
    DOI: 10.25259/SNI_1089_2022
    Sprache: Englisch
    Verlag: Scientific Scholar
    Publikationsdatum: 2023
    ZDB Id: 2567759-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 10
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    Severe type of segmental spinal dysgenesis with complete disconnection of the spinal cord and vertebra associated with open neural tube defect
    Scientific Scholar ; 2023
    In:  Surgical Neurology International Vol. 14 ( 2023-04-28), p. 149-
    Details
    In: Surgical Neurology International, Scientific Scholar, Vol. 14 ( 2023-04-28), p. 149-
    Kurzfassung: Severe type of segmental spinal dysgenesis (SSD) is a rare and complex anomaly in which the spinal cord completely disconnects at the portion of the spinal dysgenesis. Although closed spinal dysraphisms have been associated with SSD, to the best of our knowledge, the association between open neural tube defect (ONTD) and SSD is significantly rare, with only one case being reported to date. Case Description: We report a case of an infant with severe SSD and a disconnected spinal cord and spinal column at the thoracolumbar junction associated with myelomeningocele (MMC) in the lumbosacral region. The patient presented severe neurological deficits in the legs and impaired bowel function. The spinal column of L1–L3 was absent. The lower spinal segment consisted of neural placode at the L5–S1 level and no connecting structure between the upper and lower spinal cords. A repair surgery for MMC, including cord untethering and dura plasty, was performed. Histopathological findings revealed a neural placode consisting of a neuroglial tissue and leptomeninges. Conclusion: The management of severe SSD during the perinatal period is more challenging when it is associated with ONTD. We report detailed neuroradiological, intraoperative, and histological findings of such a case and discuss the embryopathogenesis of the associated ONTD and the treatment strategies.
    Materialart: Online-Ressource
    ISSN: 2152-7806 , 2229-5097
    URL: Article
    DOI: 10.25259/SNI_156_2023
    Sprache: Englisch
    Verlag: Scientific Scholar
    Publikationsdatum: 2023
    ZDB Id: 2567759-7
    Standort Signatur Einschränkungen Verfügbarkeit
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