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Yuan S, Lu X, Zang L, Mei Y, Fan N, Du P. Percutaneous Transforaminal Endoscopic Discectomy for Adjacent Segment Disease versus Lumbar Disc Herniation in Elderly Patients. J Pain Res 2024; 17:2257-2265. [PMID: 38947133 PMCID: PMC11214761 DOI: 10.2147/jpr.s457225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 06/21/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose Percutaneous transforaminal endoscopic discectomy (PTED) was used as a minimally invasive treatment option for lumbar disc herniation (LDH). However, studies focusing on the clinical outcomes of PTED for elderly patients with adjacent segment disease (ASD) were limited. This study aims to compare the clinical outcomes of PTED between ASD and LDH in elderly patients. Patients and Methods This retrospective study enrolled 39 patients with ASD and 39 patients with LDH. Both groups had undergone PTED in Beijing Chaoyang Hospital from July 4, 2016 to July 30, 2021. Visual analog scale for back pain (VAS-BP) and leg pain (VAS-LP) and Oswestry disability index (ODI) were used to value the clinical outcomes of patients preoperatively, immediately postoperatively, 12, and 24 months postoperatively, and at final follow-up. Patients' satisfaction was evaluated based on the MacNab criteria. Results All operations were completed. The excellent or good clinical outcomes at final follow-up was demonstrated by 87.15% (34/39) and 89.74% (35/39) in ASD and non-ASD patients, respectively. Clinical improvement was observed immediately postoperatively in both groups and sustained stability during the postoperative follow-up. The ASD group demonstrated significantly longer hospital stays (p = 0.02) and operative time (p < 0.01) than the non-ASD group. Conclusion PTED is an effective and minimally invasive treatment option for revision surgery of ASD, especially for elderly patients. However, the long-term prognosis of PTED treating ASD still needs further exploration.
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Affiliation(s)
- Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Xuanyu Lu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Yuqi Mei
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China
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Bonert M, Berzins A, Begum H, Schittenhelm J, Lu JQ, Juergens RA, Swaminath A, Cutz JC, Naqvi AH. Neuroanatomical location of brain metastases from solid tumours based on pathology: An analysis of 511 patients with a comparison to the provided clinical history. PLoS One 2023; 18:e0294154. [PMID: 37943775 PMCID: PMC10635465 DOI: 10.1371/journal.pone.0294154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
Brain metastases are a frequent occurrence in neuropathology practices. The literature on their neuroanatomical location is frequently derived from radiological analyses. This work examines brain metastases through the lens of pathology specimens. All brain surgical pathology reports for cases accessioned 2011-2020 were retrieved from a laboratory. Specimens were classified by neuroanatomical location, diagnosis and diagnostic category with a hierarchical free text string-matching algorithm (HFTSMA) and also subsequently audited. All reports classified as probable metastasis were reviewed by a pathologist. The provided history was compared to the final categorization by a pathologist. The cohort had 4,625 cases. The HFTSMA identified 854 cases (including metastases from a definite primary, metastases from primary not known and improperly classified cases). 514/854 cases had one definite primary site per algorithm and on report review 538/854 cases were confirmed as such. The 538 cases originated from 511 patients. Primaries from breast, gynecologic tract, and gastrointestinal tract not otherwise specified were most frequently found in the cerebellum. Kidney metastases were most frequently found in the occipital lobe. Lung, metastatic melanoma and colorectal primaries were most commonly found in the frontal lobe. The provided clinical history predicted the primary in 206 cases (40.3%), was discordant in 17 cases (3.3%) and non-contributory in 280 cases (54.8%). The observed distribution of the metastatic tumours in the brain is dependent on the primary site. In the majority (54.8%) of cases, the provided clinical history was non-contributory; this suggests surgeon-pathologist communication may have the potential for optimization.
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Affiliation(s)
- Michael Bonert
- Anatomical Pathology, Pathology and Molecular Medicine, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Canada
| | - Alison Berzins
- Anatomical Pathology, Pathology and Molecular Medicine, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Canada
| | - Housne Begum
- McMaster University, Hamilton, and Health Services Management, Toronto Metropolitan University, Toronto, Canada
| | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tübingen, Germany
| | - Jian-Qiang Lu
- Neuropathology, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Rosalyn A. Juergens
- Medical Oncology, Oncology, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Anand Swaminath
- Radiation Oncology, Oncology, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Jean-Claude Cutz
- Anatomical Pathology, Pathology and Molecular Medicine, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Canada
| | - Asghar H. Naqvi
- Anatomical Pathology, Pathology and Molecular Medicine, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Canada
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Sugii N, Matsuda M, Tsurubuchi T, Ishikawa E. Hemorrhagic Complications After Brain Tumor Biopsy: Risk-Reduction Strategies Based on Safer Biopsy Targets and Techniques. World Neurosurg 2023; 176:e254-e264. [PMID: 37207726 DOI: 10.1016/j.wneu.2023.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Brain tumor biopsies are essential for pathologic diagnosis. However, hemorrhagic complications after biopsies may occur, leading to suboptimal outcomes. This study aimed to evaluate the associated factors of hemorrhagic complications after brain tumor biopsies and propose countermeasures. METHODS We retrospectively collected data on 208 consecutive patients with brain tumors (malignant lymphoma or glioma) who underwent a biopsy from 2011-2020. We evaluated factors and microbleeds (MBs) in the tumor plus relative cerebral/tumoral blood flow (rCBF) at the biopsy site on preoperative magnetic resonance imaging (MRI). RESULTS Postoperative all and symptomatic hemorrhage occurred in 21.6% and 9.6% of patients. In univariate analysis, a needle biopsy was significantly associated with the risk of all and symptomatic hemorrhages compared to techniques that allow adequate hemostatic manipulation (i.e., open and endoscopic biopsies). Multivariate analyses revealed that a needle biopsy and gliomas of World Health Organization (WHO) grade III/IV were significantly associated with postoperative all and symptomatic hemorrhages. Multiple lesions were also an independent risk factor for symptomatic hemorrhages. On preoperative MRI, abundant MBs in the tumor and MBs at the biopsy sites, in addition to high rCBF, were significantly associated with postoperative all and symptomatic hemorrhages. CONCLUSIONS We recommend the following measures to prevent hemorrhagic complications: consider biopsy techniques that allow adequate hemostatic manipulation preferentially; perform more careful hemostasis in cases of suspected gliomas of WHO grade III/IV, multiple lesions, and abundant MBs in the tumors; and, if there are multiple candidate biopsy sites, select areas with lower rCBF and no MBs as a biopsy target.
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Affiliation(s)
- Narushi Sugii
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Sun Z, Li Z, Guo Y, Li W, Chen X, Li S, Shen J, Qi L, Zhao Y, Li C, Zhu D, Zhu J, Liu B. Evaluation of Adjacent Segment With Pre-Existing Degeneration Using the Cerebrospinal Fluid Occlusion Sign on MRI Before Posterior Lumbar Fusion: A Multi-Center Observational Cohort Study. Global Spine J 2023; 13:745-751. [PMID: 33823627 DOI: 10.1177/21925682211007116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To evaluate whether pre-existing adjacent spinal canal stenosis (SCS) is associated with short-term outcomes after lumbar fusion surgery. METHODS We included patients with lumbar spinal stenosis treated surgically between July 2015 and December 2017 at 4 centers. All patients had the same pathology, with L4-S1 as the culprit sections. Patients were divided into 2 groups based on the cerebrospinal fluid occlusion sign on MRI at the adjacent L3/4 level. Patients without SCS (grade 0) and with mild SCS (grade 1) were classified into the non-stenosis (NS) and mild stenosis (MS) groups, respectively. All patients underwent PLIF and completed at least 1-year follow-up. The incidence of adjacent segment degeneration (ASDeg) and clinical outcomes were compared between the 2 groups. RESULTS A total of 308 patients (NS, 156; MS, 152) met the inclusion criteria. The incidence of ASDeg in the NS group (n = 40, 25.6%) was significantly lower than that in the MS group (n = 74, 48.7%; P < .001). The most frequent type of ASDeg in the 2 groups was the SCS-aggravated type. No significant difference was observed in adjacent segment disease incidence between the 2 groups (P = .243). The NS group had better outcomes according to the clinical function scores (P < .05). CONCLUSIONS The cerebrospinal fluid occlusion sign on MRI is valuable for evaluating the adjacent segment with pre-existing degeneration. Patients with mild SCS in adjacent segments were more likely to have ASDeg, and the most frequent type of ASDeg was the SCS-aggravated type at early follow-up.
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Affiliation(s)
- Zhuoran Sun
- Orthopaedic Department of 48432Peking University Third Hospital, Beijing, China
| | - Zhuofu Li
- Orthopaedic Department of 48432Peking University Third Hospital, Beijing, China
| | - Yang Guo
- Orthopaedic Department of 48432Peking University Third Hospital, Beijing, China
| | - Weishi Li
- Orthopaedic Department of 48432Peking University Third Hospital, Beijing, China
| | - Xin Chen
- Orthopaedic Department of 34732Peking Union Medical College Hospital, Beijing, China
| | - Shugang Li
- Orthopaedic Department of 34732Peking Union Medical College Hospital, Beijing, China
| | - Jianxiong Shen
- Orthopaedic Department of 34732Peking Union Medical College Hospital, Beijing, China
| | - Longtao Qi
- Orthopaedic Department of 66482Peking University First Hospital, Beijing, China
| | - Yao Zhao
- Orthopaedic Department of 66482Peking University First Hospital, Beijing, China
| | - Chunde Li
- Orthopaedic Department of 66482Peking University First Hospital, Beijing, China
| | - Di Zhu
- Orthopaedic Department of 105738Beijing Tiantan Hospital, Beijing, China
| | - Jichao Zhu
- Orthopaedic Department of 105738Beijing Tiantan Hospital, Beijing, China
| | - Baoge Liu
- Orthopaedic Department of 105738Beijing Tiantan Hospital, Beijing, China
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Long-term utility and complication profile of open craniotomy for biopsy in patients with idiopathic encephalitis. J Clin Neurosci 2016; 37:69-72. [PMID: 27979652 DOI: 10.1016/j.jocn.2016.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
Neurosurgeons are often asked to perform open biopsy for diagnosis of encephalitis after medical investigations are non-diagnostic. These patients may be critically ill with multiple comorbidities. Patients and their families often request data regarding the success rates and complication profile of biopsy, but minimal literature exists in this area. Retrospective chart review of all patients undergoing open brain biopsy (burr hole or craniotomy) for encephalitis refractory to medical diagnosis between January 2009 and December 2013 was undertaken. Pathology records and outpatient follow-up were reviewed to determine most recent clinical status of each patient. A total of 59 patients were included with mean follow up of 20months. The average age at biopsy was 55years. The most common unconfirmed diagnoses leading to biopsy were vasculitis (44%), neoplasm (27%), infection (12%), autoimmune (12%), amyloidosis (5%). Tissue pathology was diagnostic in 42% of all cases. Overall, biopsy confirmed the preoperative diagnosis in 46% of cases and refuted the preoperative leading diagnosis in 25% of cases. At last follow-up, the tissue pathology resulted in a medical treatment change in 25% of cases. There was a 14% major neurological complication rate (postoperative stroke, hemorrhage, or neurological deficit) and 9% cardiopulmonary complication rate (delayed extubation and re-intubation) attributable to surgical intervention. In this limited series, diagnostic utility of biopsy in patients with idiopathic encephalitis is less than 50% and the major complication rate is 23%. Patients and providers must be counseled accordingly and weigh the risks and benefits of open biopsy for encephalitis cautiously.
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Rodrigo-Paradells V, Bances-Florez L, Villagrasa-Compaired FJ, Calatayud-Pérez JB. [Brain biopsy is not minor surgery]. Neurocirugia (Astur) 2015; 27:149. [PMID: 26589665 DOI: 10.1016/j.neucir.2015.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 06/30/2015] [Indexed: 11/19/2022]
Affiliation(s)
| | - Luciano Bances-Florez
- Servicio de Neurocirugía, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España
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Gracia I, Perelló L, Valero R, Hervías A, Perdomo J, Pujol R, González J, Hurtado P, de Riva N, Tercero FJ, Carrero E, Ferrer E, Fàbregas N. Eficacia diagnóstica y manejo posoperatorio de los pacientes sometidos a biopsia cerebral en un hospital universitario. Neurocirugia (Astur) 2015; 26:23-31. [DOI: 10.1016/j.neucir.2014.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 04/16/2014] [Accepted: 06/10/2014] [Indexed: 01/22/2023]
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