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1دورية أكاديمية
المؤلفون: Julien Spitaels, Justin Moore, Nathalie Zaidman, Isabel Fernandes Arroteia, Geoffrey Appelboom, Sami Barrit, Sébastien Carlot, Viviane De Maertelaer, Sergio Hassid, Olivier De Witte
المصدر: Scientific Reports, Vol 12, Iss 1, Pp 1-8 (2022)
الوصف: Abstract Various surgical methods to prevent postoperative cerebrospinal fluid (CSF) leaks during transsphenoidal surgery have been reported. However, comparative studies are scarce. We aimed to compare the efficacy of a fibrin-coated collagen fleece (TachoSil) versus a dural sealant (DuraSeal) to prevent postoperative CSF leakage. We perform a retrospective study comparing two methods of sellar closure during endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenoma resection: TachoSil patching versus DuraSeal packing. Data concerning diagnosis, reconstruction technique, and surgical outcomes were analyzed. The primary endpoint was postoperative CSF leak rate. We reviewed 198 consecutive patients who underwent 219 EETS for pituitary adenoma from February 2007 and July 2018. Intraoperative CSF leak occurred in 47 cases (21.5%). A total of 33 postoperative CSF leaks were observed (15.1%). A reduction of postoperative CSF leaks in the TachoSil application group compared to the conventional technique using Duraseal was observed (7.7% and 18.2%, respectively; p = 0.062; Pearson exact test) although non-statistically significant. Two patients required lumbar drainage, and no revision repair was necessary to treat postoperative CSF rhinorrhea in Tachosil group. Fibrin-coated collagen fleece patching may be a valuable method to prevent postoperative cerebrospinal fluid (CSF) leaks during EETS for pituitary adenoma resection.
وصف الملف: electronic resource
العلاقة: https://doaj.org/toc/2045-2322Test
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2دورية أكاديمية
المصدر: Minimally Invasive Surgery, Vol 2012 (2012)
الوصف: We describe a percutaneous or minimally invasive approach to apply an augmentation of pedicle fenestrated screws by injection of the PMMA bone cement through the implant and determine the safety and efficiency of this technique in a clinical series of 15 elderly osteoporotic patients. Clinical outcome and the function were assessed using respectively the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI). Peri- and post-operative complications were monitored during a minimum of 2 years of follow-up. Radiographic follow-up was based on plain fluoroscopic control at 3, 6 and 12 months and every year. In this approach, four steps were considered with care: optimal positioning of the screws, correct alignment of the screw heads, waiting time before the injection of cement, fluoroscopic control of the cement injection. Using these precautions, only 2 minor complications occurred. VAS scores and ODI questionnaires showed a statistically significant improvement up to 13.3 months postoperatively. No radiological complications were observed. Based on this experience, PMMA augmentation technique through the novel fenestrated screws provided an effective and long lasting fixation in osteoporotic patients. Applying this procedure through percutaneous or minimally invasive approach under fluoroscopic control seems to be safe.
وصف الملف: electronic resource
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3كتاب
المؤلفون: Geoffrey Appelboom, Adam Jacoby, Matthew Piazza, E. Sander Connolly
مصطلحات موضوعية: Angioplasty, Various Techniques and Challenges in Treatment of Congenital and Acquired Vascular Stenoses
الإتاحة: https://doi.org/10.5772/29159Test
https://mts.intechopen.com/articles/show/title/evidence-based-invasive-treatments-for-cerebral-vasospasm-following-aneurysmal-subarachnoid-hemorrhaTest -
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المؤلفون: Sandrine Dufort, Géraldine Le Duc, Steven D. Chang, Lucie Sancey, Camille Verry, Stéphane Roux, Olivier Tillement, François Lux, Elke Bräuer-Krisch, Emmanuel L. Barbier, Michael Zhang, Geoffrey Appelboom
المساهمون: NanoH-sas, Stanford University Medical Center, Service de radiothérapie- CHU de Grenoble, CHU Grenoble, [GIN] Grenoble Institut des Neurosciences (GIN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Formation, élaboration de nanomatériaux et cristaux (FENNEC), Institut Lumière Matière [Villeurbanne] (ILM), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), European Synchrotron Radiation Facility (ESRF), Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Laboratoire de Physique de l'ENS Lyon (Phys-ENS), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Univers, Transport, Interfaces, Nanostructures, Atmosphère et environnement, Molécules (UMR 6213) (UTINAM), Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), ANR-19-P3IA-0003,MIAI,MIAI @ Grenoble Alpes(2019), École normale supérieure - Lyon (ENS Lyon)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon
المصدر: Journal of Clinical Neuroscience
Journal of Clinical Neuroscience, 2019, 67, pp.215-219. ⟨10.1016/j.jocn.2019.05.065⟩
Journal of Clinical Neuroscience, Elsevier, 2019, 67, pp.215-219. ⟨10.1016/j.jocn.2019.05.065⟩مصطلحات موضوعية: Male, Radiation-Sensitizing Agents, Gadolinium, chemistry.chemical_element, Contrast Media, [SDV.CAN]Life Sciences [q-bio]/Cancer, Theranostic Nanomedicine, 03 medical and health sciences, 0302 clinical medicine, Physiology (medical), Glioma, medicine, Temozolomide, Animals, [SDV.IB.BIO]Life Sciences [q-bio]/Bioengineering/Biomaterials, Radiosensitizers, business.industry, Brain Neoplasms, Contralateral hemisphere, Washout, General Medicine, Chemoradiotherapy, medicine.disease, Magnetic Resonance Imaging, Rats, Inbred F344, Rats, 9l glioma, Neurology, chemistry, Theranostic, Chemoradiation, 030220 oncology & carcinogenesis, Nanoparticles, Surgery, Radiotherapy treatment, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], [SDV.IB]Life Sciences [q-bio]/Bioengineering, Neurology (clinical), business, Nuclear medicine, Glioblastoma, 030217 neurology & neurosurgery, Median survival, medicine.drug
الوصف: International audience; We formulated an ultra-small, gadolinium-based nanoparticle (AGuIX) with theranostic properties to simultaneously enhance MRI tumor delineation and radiosensitization in a glioma model. The 9L glioma cells were orthotopically implanted in 10-week-old Fischer rats. The intra-tumoral accumulation of AGuIX was quantified using MRI T1-maps. Rats randomized to intervention cohorts were subsequently treated with daily temozolomide for five consecutive days before radiotherapy treatment. Collectively, a series of 32 rats were divided into untreated (n = 7), temozolomide-only (n = 7), temozolomide and MRT (n = 9), AGuIX and MRT (n = 7), and triple therapy (temozolomide, AGuIX NPs, and MRT; n = 9) cohorts. AGuIX nanoparticles achieved a maximum intra-tumoral concentration (expressed as concentration of Gd3+) at 1 h after intravenous injection, reaching a mean of 227.9 ± 60 lM. This was compared to concentrations of 10.5 ± 9.2 lM and 62.9 ± 24.7 lM in the contralateral hemisphere and cheek, respectively. There was a slower washout in the intra-tumor region, with sustained tumor-to-contralateral ratio of AGuIX, up to 14-fold, for each time point. The combination of AGuIX or temozolomide with MRT improved the median survival time (40 days) compared to the MeST of control rats (25 days) (p < 0.002). There was a trend towards further increased survival when the three treatments were combined (MeST of 46 days). This study demonstrated the selective accumulation of AGuIX in high grade glioma, as well as the potential survival benefits when combined with chemoradiation.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1788100d4a72df2893cccaab0d3a02fdTest
https://hal.science/hal-02337558Test -
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المؤلفون: Steven D. Chang, Scott G. Soltys, Layton Lamsam, Matthew K. Schoen, Swapnil Mehta, Michael Zhang, John K. Adler, Geoffrey Appelboom
المصدر: World Neurosurgery. 113:e399-e407
مصطلحات موضوعية: Male, medicine.medical_treatment, Radiosurgery, Hypesthesia, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Trigeminal neuralgia, Cyberknife, medicine, Humans, Paresthesia, Trigeminal Nerve, Dosing, Radiation Injuries, Radiometry, Radiation treatment planning, Aged, Retrospective Studies, Trigeminal nerve, Anthropometry, business.industry, Dose-Response Relationship, Radiation, Hypoesthesia, Middle Aged, Trigeminal Neuralgia, medicine.disease, Trigeminal Nerve Diseases, Case-Control Studies, 030220 oncology & carcinogenesis, Anesthesia, Female, Surgery, Neurology (clinical), Brainstem, medicine.symptom, business, 030217 neurology & neurosurgery, Brain Stem
الوصف: CyberKnife stereotactic radiosurgery (SRS) for trigeminal neuralgia (TGN) administers nonisometric, conformational high-dose radiation to the trigeminal nerve with risk of subsequent hypoesthesia.We performed a retrospective, single-institution review of 66 patients with TGN treated with CyberKnife SRS to compare outcomes from 2 distinct treatment periods: standard dosing (n = 38) and reduced dosing (n = 28). Standard and reduced dosing permitted a maximum brainstem dose of 45 Gy and 25 Gy, respectively, each with a prescription dose of 60 Gy. Primary and secondary outcomes were Barrow Neurologic Institute pain and numbness scores. Maximum brainstem dose, prepontine nerve length, and treatment history were recorded for their predictive contributions by logistic regression.After matching, patients in the standard dosing and reduced dosing groups were followed for a median of 25 months and 19.5 months, respectively. Mean trigeminal nerve length was 8.55 mm in the standard dosing group and 9.46 mm in the reduced dosing group. Baseline rates of poorly controlled pain were 97% and 88%, respectively, which improved to 23.4% and 8.3%, respectively (P0.001 for both). The baseline rates of bothersome numbness were null in both groups, and increased to 25% in the standard group (P = 0.006) and to 21% in the reduced group (P = 0.07). Regression analyses suggested that reduced brainstem exposure (P = 0.01), as well as a longer trigeminal nerve (P = 0.01), were predictive of durable pain control.These outcomes demonstrate that a lower maximum brainstem dose can provide excellent pain control without affecting facial numbness. Longer nerves may achieve better long-term outcomes and help optimize individual plans.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::20bf05343f6cfaf78ffe4c3eabbd6203Test
https://doi.org/10.1016/j.wneu.2018.02.042Test -
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المؤلفون: William Gold, Daniel Kabat, Brett E. Youngerman, Hannah E. Goldstein, Blake Taylor, Geoffrey Appelboom, Edward Sander Connolly
المصدر: Neurosurgery. 79:356-369
مصطلحات موضوعية: Male, medicine.medical_specialty, Longitudinal study, medicine.medical_treatment, Neurosurgery, Psychological intervention, Patient Readmission, Neurosurgical Procedures, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Interquartile range, medicine, Humans, Longitudinal Studies, 030212 general & internal medicine, Craniotomy, Aged, Retrospective Studies, Hospital readmission, business.industry, Incidence, Incidence (epidemiology), Retrospective cohort study, Middle Aged, Quality Improvement, Emergency medicine, Female, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery
الوصف: BACKGROUND Reducing the rate of 30-day hospital readmission has become a priority in healthcare quality improvement policy, with a focus on better characterizing the reasons for unplanned readmission. In neurosurgery, however, peer-reviewed analyses describing the patterns of readmission have been limited in their number and generalizability. OBJECTIVE To determine the incidence, timing, and causes of 30-day readmission after neurosurgical procedures. METHODS We conducted a retrospective longitudinal study from 2009 to 2012 using the Statewide Planning And Research Cooperative System, which collects patient-level details for all admissions and discharges within New York. We identified patients readmitted within 30 days of initial discharge. The rate of, reasons for, and time to readmission were determined overall and within 4 subgroups: craniotomies, cranial surgery without craniotomy, spine, and neuroendovascular procedures. RESULTS There were 163 743 index admissions, of whom 14 791 (9.03%) were readmitted. The most common reasons for unplanned readmission were infection (29.52%) and medical complications (19.22%). Median time to readmission was 11 days, with hemorrhagic strokes and seizures occurring earlier, and medical complications and infections occurring later. Readmission rates were highest among patients undergoing cerebrospinal fluid shunt revision and malignant tumor resection (15.57%-22.60%). Spinal decompressions, however, accounted for the largest volume of readmissions (33.13%). CONCLUSION Many readmissions may be preventable and occur at predictable time intervals. The causes and timing of readmission vary significantly across neurosurgical subgroups. Future studies should focus on detecting specific complications in select cohorts at predefined time points, which may allow for interventions to lower costs and reduce patient morbidity. ABBREVIATIONS CSF, cerebrospinal fluidIQR, interquartile rangeSPARCS, Statewide Planning And Research Cooperative System.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9a248137d5563cf6895692ad5a1dedc8Test
https://doi.org/10.1227/neu.0000000000001110Test -
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المصدر: Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy ISBN: 9783030169237
مصطلحات موضوعية: medicine.medical_specialty, business.industry, medicine.medical_treatment, Disease, Microsurgery, medicine.disease, Radiosurgery, Natural history, medicine, Intracranial Arteriovenous Malformations, Embolization, Radiology, business, Complication, Stroke
الوصف: Cerebral arteriovenous malformations (AVMs) are vascular lesions consisting of abnormal connections between arteries and veins with no intermediate capillary network. With an annual spontaneous rupture rate of approximately 2–4%, they represent a significant source of hemorrhagic stroke and neurologic morbidity and mortality in young patients. The current treatment paradigms for AVMs include microsurgery, stereotactic radiosurgery (SRS), and embolization, all of which aim to abolish the risk of hemorrhage by obliterating the AVM nidus. Stereotactic radiosurgery is a minimally invasive and effective treatment option that is particularly suitable for small- to medium-sized AVMs located in deep or eloquent brain regions. Obliteration is achieved in 70–80% of cases, following a latency period of approximately 1–3-year posttreatment. SRS carries a unique complication profile including a sustained risk of hemorrhage during the latency period, as well as adverse radiation effects with associated neurologic deficits. AVM lesions vary widely in their natural histories and their suitability for treatment with SRS, based on characteristics such as size, location, and rupture status. For large AVMs, adjunct techniques such as endovascular embolization or volume and dose staging may be utilized to make the lesions appropriate targets for SRS. In the case of unruptured AVMs, early data from recent prospective trials have suggested that conservative medical management may result in better short-term outcomes than interventional treatment. Thus, the risks and complications associated with SRS therapy for individual AVMs must be carefully balanced against the morbidities associated with the natural history of the disease. Here we discuss the salient clinical and pathophysiologic indications for the use of SRS, review data on treatment efficacy and outcomes, and profile the major complications.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::3089983b3b53cbc0fac3b20e7f2215beTest
https://doi.org/10.1007/978-3-030-16924-4_13Test -
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المؤلفون: ByoungJun Han, Geoffrey Appelboom, Bryan A. Lieber, Blake Taylor, E. Sander Connolly, Nitin Agarwal, James E. Han
المصدر: World Neurosurgery. 89:126-132
مصطلحات موضوعية: Male, medicine.medical_specialty, Multivariate analysis, Databases, Factual, Population, 030204 cardiovascular system & hematology, Neurosurgical Procedures, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Adrenal Cortex Hormones, Risk Factors, Internal medicine, Odds Ratio, Humans, Medicine, Prospective Studies, cardiovascular diseases, Risk factor, Prospective cohort study, education, Aged, Venous Thrombosis, education.field_of_study, business.industry, Confounding, Odds ratio, Middle Aged, medicine.disease, United States, Surgery, Pulmonary embolism, Venous thrombosis, Multivariate Analysis, Female, Neurology (clinical), Pulmonary Embolism, business, 030217 neurology & neurosurgery
الوصف: Venous thromboembolism (VTE) is a major preventable cause of morbidity and mortality in hospitalized patients and is a widely accepted measure for quality of care. Prolonged corticosteroid therapy, which is common in neurosurgical patients, has been associated with VTE. Using a national database, we sought to determine whether corticosteroid use for10 days was an independent risk factor for deep venous thrombosis (DVT) and pulmonary embolism (PE).The well-validated American College of Surgeons National Surgical Quality Improvement Program database was queried to evaluate the rates of VTE during the period 2006-2013 in patients undergoing neurosurgical procedures. A multivariate regression model was constructed to assess the effect of prolonged corticosteroid use on the occurrence of PE and DVT by postoperative day 30.Of 94,620 patients identified, 565 (0.60%) developed PE and 1057 (1.12%) developed DVT within 30 days after surgery. In the multivariate model, patients receiving corticosteroids were significantly more likely to have PE (odds ratio = 1.47, 95% confidence interval = 1.13-1.90, P = 0.004) and DVT (odds ratio = 1.55, 95% confidence interval = 1.28-1.87, P0.001). Other factors independently associated with development of PE and DVT included the presence of malignancy, longer hospitalization, certain infections (including pneumonia and urinary tract infections), and stroke with a neurologic deficit.In the neurosurgical population, prolonged courses of corticosteroids are associated with an increased risk of developing postoperative DVT and PE, even when controlling for potential confounders.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9474c243a218ef9996fe5270cd8f8d61Test
https://doi.org/10.1016/j.wneu.2016.01.033Test -
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المؤلفون: Geoffrey Appelboom, Nolan R. Williams, Kevin K. Kumar, Layton Lamsam, Sherman C. Stein, Arthur L. Caplan, Casey H. Halpern, Mahendra T. Bhati
المصدر: Journal of neurology, neurosurgery, and psychiatry. 90(4)
مصطلحات موضوعية: Ablation Techniques, medicine.medical_specialty, Obsessive-Compulsive Disorder, Deep brain stimulation, medicine.medical_treatment, Deep Brain Stimulation, Radiosurgery, Neurosurgical Procedures, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Obsessive compulsive, Internal medicine, medicine, Humans, Adverse effect, Treatment resistant, Radiofrequency Ablation, business.industry, 030227 psychiatry, Clinical trial, Psychiatry and Mental health, Treatment Outcome, Meta-analysis, Surgery, Observational study, Neurology (clinical), business, 030217 neurology & neurosurgery
الوصف: BackgroundThe safety and efficacy of neuroablation (ABL) and deep brain stimulation (DBS) for treatment refractory obsessive-compulsive disorder (OCD) has not been examined. This study sought to generate a definitive comparative effectiveness model of these therapies.MethodsA EMBASE/PubMed search of English-language, peer-reviewed articles reporting ABL and DBS for OCD was performed in January 2018. Change in quality of life (QOL) was quantified based on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the impact of complications on QOL was assessed. Mean response of Y-BOCS was determined using random-effects, inverse-variance weighted meta-analysis of observational data.FindingsAcross 56 studies, totalling 681 cases (367 ABL; 314 DBS), ABL exhibited greater overall utility than DBS. Pooled ability to reduce Y-BOCS scores was 50.4% (±22.7%) for ABL and was 40.9% (±13.7%) for DBS. Meta-regression revealed no significant change in per cent improvement in Y-BOCS scores over the length of follow-up for either ABL or DBS. Adverse events occurred in 43.6% (±4.2%) of ABL cases and 64.6% (±4.1%) of DBS cases (pInterpretationOverall, ABL utility was greater than DBS, with ABL showing a greater per cent improvement in Y-BOCS than DBS. These findings help guide success thresholds in future clinical trials for treatment refractory OCD.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d476cea916178df42dcad1affecd524cTest
https://pubmed.ncbi.nlm.nih.gov/30679237Test -
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المؤلفون: Amanda M. Carpenter, June Lu, Brad E. Zacharia, Catherine Richards, Robert A. Solomon, Geoffrey Appelboom, E. Sander Connolly, Samuel S. Bruce, Kerry A. Vaughan, William Gold, Zachary L. Hickman
المصدر: Stroke. 45:1447-1452
مصطلحات موضوعية: Adult, Male, Microsurgery, medicine.medical_specialty, New York, Logistic regression, Outcome (game theory), Tertiary Care Centers, Aneurysm, Outcome Assessment, Health Care, medicine, Performed Procedure, Humans, Good outcome, Stroke, Advanced and Specialized Nursing, Academic Medical Centers, business.industry, Endovascular Procedures, Intracranial Aneurysm, medicine.disease, Surgery, Patient Outcome Assessment, Logistic Models, Elective Surgical Procedures, Emergency medicine, Female, Neurology (clinical), Neurosurgery, Principal diagnosis, Cardiology and Cardiovascular Medicine, business
الوصف: Background and Purpose— Unruptured intracranial aneurysm repair is the most commonly performed procedure for the prevention of hemorrhagic stroke. Despite efforts to regionalize care in high-volume centers, overall results have improved little. This study aims to determine the effectiveness in improving outcomes of previous efforts to regionalize unruptured intracranial aneurysm repair to high-volume centers and to recommend future steps toward that goal. Methods— Using data obtained via the New York Statewide Planning and Research Cooperative System, this study included all patients admitted to any of the 10 highest volume centers in New York state between 2005 and 2010 with a principal diagnosis of unruptured intracranial aneurysm who were treated either by microsurgical or endovascular repair. Mixed-effects logistic regression was used to determine the degree to which hospital-level and patient-level variables contributed to observed variation in good outcome, defined as discharge to home, between hospitals. Results— Of 3499 patients treated during the study period, 2692 (76.9%) were treated at the 10 highest volume centers, with 2198 (81.6%) experiencing a good outcome. Good outcomes varied widely between centers, with 44.6% to 91.1% of clipped patients and 75.4% to 92.1% of coiled patients discharged home. Mixed-effects logistic regression revealed that procedural volume accounts for 85.8% of the between-hospital variation in outcome. Conclusions— There is notable interhospital heterogeneity in outcomes among even the largest volume unruptured intracranial aneurysm referral centers. Although further regionalization may be needed, mandatory participation in prospective, adjudicated registries will be necessary to reliably identify factors associated with superior outcomes.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::70369501dbf85e8671e700d8ec2148c6Test
https://doi.org/10.1161/strokeaha.113.004412Test
النص الكامل