Neurosurgery
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Comparative Study
Clinicopathological and Prognostic Characteristics in Extra-Axial Chordomas: An Integrative Analysis of 86 Cases and Comparison With Axial Chordomas.
Currently, clinical characteristics and prognostic factors of extra-axial chordoma (EAC) remain poorly understood. ⋯ These data suggest potentially distinct biological behaviors between EAC and AC and may provide useful information to better understand the prognostic characteristics and improve the outcome prediction of EAC patients.
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Current outcomes prediction tools are largely based on and limited by regression methods. Utilization of machine learning (ML) methods that can handle multiple diverse inputs could strengthen predictive abilities and improve patient outcomes. Inpatient length of stay (LOS) is one such outcome that serves as a surrogate for patient disease severity and resource utilization. ⋯ An ML ensemble model predicts LOS with good performance on internal and external validation, and yields clinical insights that may potentially improve patient outcomes. This systematic ML method can be applied to a broad range of clinical problems to improve patient care.
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Randomized Controlled Trial
Postoperative Rigid Cervical Collar Leads to Less Axial Neck Pain in the Early Stage After Open-Door Laminoplasty-A Single-Blinded Randomized Controlled Trial.
Cervical collars are used after laminoplasty to protect the hinge opening, reduce risks of hinge fractures, and avoid spring-back phenomena. However, their use may lead to reduced range of motion and worse neck pain. ⋯ The use of a rigid collar after laminoplasty leads to less axial neck pain in the first 2 wk after surgery. However, there is no additional benefit with regards to range of motion, quality of life, and complication risk.
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Fluorescence-guided surgery is a rapidly growing field that has produced some of the most important innovations in surgical oncology in the past decade. These intraoperative imaging technologies provide information distinguishing tumor tissue from normal tissue in real time as the surgery proceeds and without disruption of the workflow. Many of these fluorescent tracers target unique molecular or cellular features of tumors, which offers the opportunity for identifying pathology with high precision to help surgeons achieve their primary objective of a maximal safe resection. ⋯ In this review, we provide an "in-text glossary" of the fundamental principles of fluorescence with examples of direct applications to fluorescence-guided brain surgery. We offer a detailed discussion of the various advantages and limitations of the most commonly used intraoperative imaging agents, including 5-aminolevulinic acid, indocyanine green, and fluorescein, with a particular focus on the photophysical properties of these specific agents as they provide a framework through which to understand the new agents that are entering clinical trials. To this end, we conclude with a survey of the fluorescent properties of novel agents that are currently undergoing or will soon enter clinical trials for the intraoperative imaging of brain tumors.
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Multicenter Study
Malignant Meningioma: An International Multicentre Retrospective Study.
In contrast to benign meningiomas, malignant meningiomas (MM) are rare and associated with an unfavourable prognosis. Reports on MM concern fairly small cohorts, often comprising less than 30 cases. ⋯ This large series confirms the poor prognosis associated with MM, the treatment of which remains challenging. Patients under 65-yr-old with primary MM may live longer after complete resection and postoperative radiotherapy. Even with aggressive treatments, local control remains difficult to achieve.