Abstract:
BACKGROUND:Operative skills are key to neurosurgical resident training. They should be acquired in a structured manner and preferably starting early in residency. The aim of this study was to test the hypothesis that the outcome and complication rate of anterior cervical discectomy and fusion with or without instrumentation (ACDF(I)) is not inferior for supervised residents as compared to board-certified faculty neurosurgeons (BCFN). METHODS:This was a retrospective single-center study of all consecutive patients undergoing ACDF(I)-surgery between January 2011 and August 2014. All procedures were dichotomized into two groups according to the surgeon's level of experience: teaching cases (postgraduate year (PGY)-2 to PGY-6 neurosurgical residents) and non-teaching cases operated by BCFN. The primary study endpoint was patients' clinical outcome 4 weeks after surgery, categorized into a binary responder and non-responder variable. Secondary endpoints were complications, need for re-do surgery, and clinical outcome until the last follow-up. RESULTS:After exclusion of six cases because of incomplete data, a total of 287 ACDF(I) operations were enrolled into the study, of which 82 (29.2 %) were teaching cases and 199 (70.8 %) were non-teaching cases. Teaching cases required a longer operation time (131 min (95 % confidence interval (CI) 122-141 min) vs. 102 min (95-108 min; p < 0.0001) and were associated with a slightly higher estimated blood loss (84 ml (95 % CI 56-111 ml) vs. 57 ml (95 % CI 47-66 ml); p = 0.0017), while there was no difference in the rate of intraoperative complications (2.4 vs. 1.5 %; p = 0.631). Four weeks after surgery, 92.7 and 93 % of the patients had a positive response to surgery (p = 1.000), respectively. There was no difference in the postoperative complication rate (4.9 vs. 3.0 %; p = 0.307). Around 30 % of the study patients were followed up in outpatient clinics for more than once up until a mean period of 6.4 months (95 % CI 5.3-7.6 months). At the last follow-up, the clinical outcome was similar with a 90 % responder rate for both groups (p = 0.834). In total, five patients from the teaching group and eight patients from the non-teaching group required re-do surgery (p = 0.602). CONCLUSIONS:Short- and mid-term outcomes and complication rates following microscopic ACDF(I) were comparable for patients operated on by supervised neurosurgical residents or by senior surgeons. Our data thus indicate that a structured neurosurgical education of operative skills does not lead to worse outcomes or increase the complication rates after ACDF(I). Confirmation of the results by a prospective study is desired.
journal_name
Acta Neurochir (Wien)journal_title
Acta neurochirurgicaauthors
Stienen MN,Joswig H,Jucker D,Hildebrandt G,Schaller K,Gautschi OPdoi
10.1007/s00701-015-2396-6subject
Has Abstractpub_date
2015-09-01 00:00:00pages
1395-404issue
8eissn
0001-6268issn
0942-0940journal_volume
157pub_type
杂志文章abstract:BACKGROUND:The external ventricular drain (EVD) placement is one of the most common neurosurgical procedures. This operation is performed by freehand technique in the majority of cases; therefore, the operator's experience plays an important role in success and possible morbidity of this procedure. OBJECTIVE:To evalua...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-020-04671-5
更新日期:2021-01-06 00:00:00
abstract:BACKGROUND:Intra-operative monitoring of the position of the central sulcus (CS) is indispensable to properly treat a peri-motor cortex lesion. Noninvasive preoperative studies for identification of CS are also needed for choosing the optimal operative procedure. Magneto-encephalography (MEG) has recently been introduc...
journal_title:Acta neurochirurgica
pub_type: 临床试验,杂志文章
doi:10.1007/s00701-003-0213-0
更新日期:2004-04-01 00:00:00
abstract:BACKGROUND:Brainstem cavernous malformations (CM) carry high risks of hemorrhage and neurologic morbidity. While much is published on physical effects of brainstem CM, very little is known about these patients' quality of life. This study aimed to assess the quality of life PROMIS-29 health domains of brainstem CM pati...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-019-04075-0
更新日期:2019-12-01 00:00:00
abstract::Oculomotor nerve palsy due to a venous varix arising from flow anomalies caused by a dural arteriovenous fistula (AVF) is a rare phenomenon. We report a case of surgical third nerve palsy with a rare underlying AVF as the cause and discuss in detail the patho-anatomy and its significance. A tentorial dural AVF mimicki...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-010-0819-y
更新日期:2010-12-01 00:00:00
abstract:BACKGROUND:The effect of anterior cervical discectomy without fusion (ACD), ACD with fusion by stand-alone cage (ACDF) or with arthroplasty (ACDA) on cervical sagittal alignment is not known and is the subject of this study. METHODS:A total of 142 adult patients with single-level cervical disease were at random alloca...
journal_title:Acta neurochirurgica
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00701-017-3312-z
更新日期:2017-12-01 00:00:00
abstract::Twenty operated cases of angiographically unrecognized microaneurysm (AUM) have been analysed with special reference to intra-operative observations and clipping-technique. Among the patients with intracranial aneurysms that the authors' facility has operated upon, the incidence of asymptomatic incidental AUM that was...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01808877
更新日期:1997-01-01 00:00:00
abstract:INTRODUCTION:Desmoid-type fibromatosis (DTF) frequently arises in patients with neuromuscular choristoma (NMC). We hypothesize that NMC-associated DTF occurs in soft tissues innervated by the NMC-affected nerve, and arises from CTNNB1-mutated (myo) fibroblasts within or directly adjacent to the NMC. MATERIALS AND METH...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-019-04178-8
更新日期:2020-05-01 00:00:00
abstract:BACKGROUND:Cerebrospinal fluid (CSF) shunting is a highly effective treatment for idiopathic normal pressure hydrocephalus (iNPH). However, secondary deterioration can occur at a later time. Thus, the current study aimed to evaluate the incidence rate and causes of secondary deterioration. METHODS:A retrospective anal...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-020-04475-7
更新日期:2020-10-01 00:00:00
abstract::The objective of this study is to investigate the effect at the season of the time of surgery on the survival of brain tumor patients. The population studied consisted of 101 patients (39 males and 62 females), gathered from a geographically large area in northern Finland (from 64 degrees N to 70 degrees N), aged betw...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-009-0438-7
更新日期:2009-11-01 00:00:00
abstract::Subdural collections or hematomas are frequently observed after shunt placement [7-9, 13], but rarely after ETV [6]. A review of literature revealed 7 cases [1, 5, 6, 10, 12], of which only 1 was symptomatic [5]. We will discuss the causes, management, and methods of prevention of this complication and we will present...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-005-0715-z
更新日期:2006-05-01 00:00:00
abstract:BACKGROUND:Dystonia has been treated well using deep brain stimulation at the globus pallidus internus (GPi DBS). Dystonia can be categorized as two basic types of movement, phasic-type and tonic-type. Cervical dystonia is the most common type of focal dystonia, and sequential differences in clinical outcomes between p...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-015-2646-7
更新日期:2016-01-01 00:00:00
abstract::The application of gallium-67 (67Ga) citrate has not been reported for the detection of an intracranial germinoma. The purpose of this report is to further evaluate the effectiveness of 67Ga scintigraphy in neurohypophyseal germinomas. 67Ga studies in five male patients with histologically verified intracranial pure g...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s007010070109
更新日期:2000-01-01 00:00:00
abstract::To evaluate the operative mortality and morbidity of definitive intracranial microsurgical aneurysm obliteration as a function of timing of early operative intervention and as a function of clinical condition at the acute state, we retrospectively review 164 consecutive patients who underwent surgery within 72 hours f...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01728872
更新日期:1982-01-01 00:00:00
abstract::Due to the limited absorptive capacity of the pleural cavity, infants and young children are not generally ideal candidates for ventriculopleural shunts. We report using chest cavities as alternate for temporary diversion of CSF in a young child. Venous access to the cervical region could not be utilized because of sc...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01400595
更新日期:1992-01-01 00:00:00
abstract::The influence of moderately reduced arterial oxygen tension (aPO2 of about 45 Torr) on the metabolism and the blood flow of the brain was tested in 20 anaesthetized, artificially ventilated normotensive, normocapnic beagle dogs. It is demonstrated that the decrease in systemic oxygen delivery to the brain is countered...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01402057
更新日期:1978-01-01 00:00:00
abstract:BACKGROUND:Clinical management after epidural steroid injections (ESI) of patients with radiculopathy secondary to a cervical disc herniation (CDH) is uncertain. This study aims to determine whether short-term arm pain alleviation following computed tomography-guided 'indirect' cervical ESI can predict the 1-month outc...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-016-2997-8
更新日期:2017-02-01 00:00:00
abstract::A simple technique of stereotactic craniotomy and intraoperative lesion localisation that uses the Brown-Robert-Wells (BRW) stereotactic frame is presented. The method optimises craniotomy placement and facilitates localisation of small intracerebral lesions. Using the system, 16 patients have had resection of intracr...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01405428
更新日期:1990-01-01 00:00:00
abstract::Regional cerebral blood flow (rCBF) was measured, using the xenon-133 intracarotid injection technique in 10 patients with an acute ischaemic stroke, involving the cerebral cortex, before and after intravenous injection of a single dose of nimodipine (Bay e 9736). After nimodipine application in all patients a dose de...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01728883
更新日期:1982-01-01 00:00:00
abstract::This report describes a rare case of a distal anterior choroidal artery aneurysm which developed intraventricular haemorrhage without subarachnoid haemorrhage as shown on computerized tomographic (CT) scan. A 69-year-old hypertensive man suddenly became unconscious. An emergency CT scan showed a severe intraventricula...
journal_title:Acta neurochirurgica
pub_type: 杂志文章,评审
doi:10.1007/s007010050082
更新日期:1998-01-01 00:00:00
abstract::Malignant glioma presenting as an intracerebral haematoma is very rare. Two patients having malignant gliomas, initially presenting as intraparenchymal haematomas, are discussed. One patient survived, but the other patient rapidly deteriorated and died. ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01407682
更新日期:1979-01-01 00:00:00
abstract::Intracranial clear-cell meningioma (CCM) is rarely reported in the literature since it has to be distinguished from other subtypes of meningioma. Most of the CCMs are intraspinal, according to the related literature. We report a case of occipital parietal CCM in a 6-year-old child, review all the 35 intracranial CCMs ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章,评审
doi:10.1007/s00701-009-0236-2
更新日期:2009-04-01 00:00:00
abstract:INTRODUCTION:In low-grade glioma (LGG) surgery, intraoperative differentiation between tumor and most likely tumor-free brain tissue can be challenging. Intraoperative ultrasound can facilitate tumor resection. The aim of this study is to evaluate the accuracy of linear array ultrasound in comparison to conventional in...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-014-2314-3
更新日期:2015-02-01 00:00:00
abstract::The authors describe a case of a post-traumatic subdural haematoma with an unusual evolution in two phases, one slow, the other very rapid. The rapidity of the evolution was caused by the rupture of a cortical dural artery, shown angiographically. ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01401797
更新日期:1979-01-01 00:00:00
abstract::We report a patient who suffered drop attacks during head reclination. Computer tomography of the cervical spine demonstrated a stenotic right vertebral artery at C4/5. However, Doppler ultrasonography of the vertebral artery showed no abnormality. Angiography confirmed complete occlusion of the left vertebral and a s...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-008-1502-4
更新日期:2008-04-01 00:00:00
abstract:BACKGROUND:As an effective treatment for post-craniotomy epidural haematomas (EDHs), a novel method of urokinase instillation using a closed suction drain is presented and the procedure feasibility and outcomes assessed. METHOD:A closed system, comprising a closed suction drain with a three-spring 200 mL evacuator, fl...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-007-1487-4
更新日期:2008-04-01 00:00:00
abstract::The article presents an autosomal dominant Currarino syndrome with incomplete penetrance in three out of four members of the same family. The mother had only a bony sacral defect and no other signs. In the older daughter, the syndrome was completely developed with presacral cystic teratoma, a sacral defect and abdomin...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-009-0220-x
更新日期:2009-09-01 00:00:00
abstract::27 cases of cranioplasty with autogenous bone grafts stored in a deep-freezer and autoclaved before use are reported. The results of follow-up for an average period of one year were satisfactory from the standpoint of brain protection and cosmetic reconstruction. A small area of absorption of grafted bone was observed...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01402184
更新日期:1990-01-01 00:00:00
abstract:BACKGROUND:Meticulous haemostasis is one of the most important factors during microneurosurgical resection of brain arteriovenous malformation (AVM). Controlling major arterial feeders and draining veins with clips and bipolar coagulation are well-established techniques, while managing with bleeding from deep tiny vess...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-017-3138-8
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:Paragangliomas are tumors that arise from the paraganglion system, which is a component of the neuroendocrine system. Approximately 10% are located in the extra-adrenal paraganglion system. Paragangliomas of the spine, however, are rare. They usually present as an intradural tumor in the cauda equina. There ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-009-0362-x
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:The type of paraclinoid aneurysm has been used to decide management methods. Our aim was to assess the relation of the types of paraclinoid aneurysms and outcomes after endovascular treatment and the efficiency of present endovascular techniques. METHODS:A retrospective analysis was performed on patients wi...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-013-1830-x
更新日期:2013-11-01 00:00:00