World Neurosurg
-
Intraoperative photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA) is a widely adopted technique to enhance the extent of resection during high-grade glioma (HGG) surgery. Recent updates to the package insert for 5-ALA in Japan now allow its use in combination with drugs that may induce photosensitivity, such as talaporfin sodium (TS). TS is employed in intraoperative photodynamic therapy (PDT) and has been shown to improve overall survival. The combination of 5-ALA with TS is expected to offer further benefits. However, the safety of this combination had not been established. This study reports on the safety of 5-ALA-PDD with TS-PDT in the treatment of recurrent HGG. ⋯ The combined use of 5-ALA-PDD and TS-PDT for HGG surgery did not increase the risk of serious adverse events in our study. Further investigations with a larger number of cases are needed for a more accurate assessment of its safety and efficacy.
-
A plethora of studies has substantiated the remarkable clinical efficacy of anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylotic myelopathy.1,2 This procedure effectively removes the posterior osteophytes and protruding nucleus pulposus, achieving direct decompression of the spinal cord and effectively alleviating compression symptoms. Concurrently, by distracting the intervertebral space, ACDF contributes to the restoration of the physiological curvature of the cervical spine. However, several pressing issues remain to be addressed during the surgical process. ⋯ Assisted by 3D microscopy, ACDF surgery offers a high-definition visual field that enhances precision, thereby reducing procedural risks and improving clinical outcomes. This technology alleviates the physical strain on surgeons, fosters collaborative teamwork, and facilitates educational exchanges. With a relatively short learning curve, 3D microscopy significantly enhances the safety and efficiency of ACDF procedures.
-
Early brain injury is the leading cause of poor outcomes in spontaneous subarachnoid hemorrhage (sSAH). Plasma D-dimer levels and acute cerebral ischemia have been highlighted as relevant findings in early brain injury; however, their correlation has not been substantially investigated. ⋯ High plasma D-dimer levels correlated with the appearance of acute ischemic lesions on diffusion-weighted imaging and were dose-dependently associated with worse neurological grades, more severe hemorrhage, and worse outcomes.
-
To identify LGBTQ+ diversity, equity, and inclusion (DEI) publications and contextualize the current frequency of the literature across subspecialty surgical fields. ⋯ This systematic review provides objective data to contextualize DEI literature across surgical subspecialties. Overall, this review highlights the lack of LGBTQ+ DEI literature in neurosurgery and advocates for correcting this gap for the benefit of both surgeons and patients. Understanding the current numbers and evaluating progress in other surgical fields might provide solutions.
-
Redundant nerve roots (RNRs) seen in conjunction with lumbar spinal stenosis (LSS) are well-described radiographic findings. Several studies suggest their presence may be a negative prognostic indicator of postoperative outcome. Our hypothesis was that severe RNR (informally known as the spaghetti sign [SS]) can serve as a reliable marker of LSS that would benefit from surgical decompression. We sought to evaluate a grading scale for RNR, characterize the association with stenosis, and investigate the clinical implications of RNR. ⋯ The study demonstrated that there is a significant association between SS and severe LSS and that presence of RNR is not a negative prognostic indicator for postoperative outcomes.