World Neurosurg
-
Conservative management of acute traumatic cerebrospinal fluid rhinorrhea (TCR) results in cessation of the leak in most patients. The objective of this study was to estimate the incidence of recurrent cerebrospinal fluid (CSF) rhinorrhea and meningitis in these patients on long-term follow-up and to determine the risk factors associated with them. ⋯ Patients with acute TCR in whom rhinorrhea subsides with conservative therapy have the highest risk for recurrence of leak or meningitis within 3 years of the trauma. Therefore, we recommend that these patients be counselled about the need for periodic follow-up for several years.
-
Observational Study
Application of Causal Inference Methods in the Analysis of Observational Neurosurgical Data: G-Formula and Marginal Structural Model.
When using observational data to estimate the causal effects of a treatment on clinical outcomes, we need to adjust for confounding. In the presence of time-dependent confounders that are affected by previous treatment, adjustments cannot be made via the conventional regression approach or propensity score-based methods, but requires sophisticated methods called g-methods. We aimed to introduce g-methods to estimate the causal effects of treatment strategies defined by treatment at multiple time points, such as treat 2 days versus treat only day 1 versus never-treat. ⋯ Both g-formula and inverse probability-weighted marginal structural models can correctly estimate the effect of the treatment strategy under 3 identifiability assumptions, which conventional regression analysis cannot. G-methods may assist in estimating the effect of treatment strategy defined by treatment at multiple time points.
-
Glioblastoma multiforme (GBM) is a malignant brain tumor with a poor prognosis. Aerobic glycolysis and an immunosuppressive microenvironment are potentially correlated with progression of GBM. However, the prognostic value of glycolysis-immune-related genes has not been studied in GBM. ⋯ The glycolysis-immune-related risk score using CACNG2, CSMD3, GABRA3, KCNIP2, KSR2, PTPRT, TNFRSF12A, and TNR was able to predict the prognosis of GBM patients relatively reliably.
-
Adjacent segmental degeneration (ASD) is the long-term complication of transforaminal lumbar interbody fusion (TLIF) combined with pedicle screw fixation. Both osteoporosis and whole-body vibration (WBV) can alter the biomechanics of adjacent segments. However, the effect of pedicle screw fixation on ASD in an osteoporotic spine after TLIF under WBV was unknown. ⋯ In an osteoporotic spine after TLIF, removal of pedicle screw fixation can mitigate ASD in the upper adjacent segment but has no apparent influence on the lower adjacent segment under WBV.
-
Increasing patient age has been associated with worse outcomes after pituitary adenoma resection in previous studies, but the prognostic value of frailty compared with advancing age on pituitary adenoma resection outcomes has not been clearly evaluated. ⋯ Increasing frailty, and not advancing age, was an independent predictor for major complications, unplanned readmissions, eLOS, and nonhome discharge after pituitary adenoma resection, suggesting frailty to be superior to age in preoperative risk stratification in this patient population.