Abstract:
OBJECTIVE:Ventriculostomy-related infection (VRI) is associated with potential serious morbidity, extended hospitalization duration, increased health care costs, and mortality. We assessed the effectiveness of a pragmatic risk-stratification pathway for external ventricular drain (EVD) management, allowing for surgical decision making, in reducing the rate of VRIs. METHODS:Two studies were performed concurrently. A retrospective audit of EVD infection rates and outcomes in our unit across 3 hospitals was conducted from January to December 2014. The second prospective study compared the same variables during the implementation of the EVD pathway across the 3 sites from January 2015 to December 2016. RESULTS:The number of patients requiring EVDs increased from 2014 to 2016 (165 vs. 189 vs. 197 patients, respectively), with a significant increase in patients with intraventricular hemorrhage (P = 0.009). Despite increasing risk, overall EVD infections decreased during the implementation period, from 4.8% (8/165) in 2014 to 3.7% in 2015 (7/189) and 2.0% in 2016 (4/197, P = 0.33). In 2 sites (site 1, 2.0% vs. 2.1% vs. 1.9%, and site 2, 4.7% vs. 5.0% vs. 5.3%), transition to the EVD risk-stratification pathway maintained already low infection rates; in site 3, EVD infections decreased from 6.8% (5/73) to 3.9% (4/102) and 0% (0/86, P = 0.06). CONCLUSIONS:The introduction of a pragmatic evidence-based risk-stratification pathway, in which different options for EVD management are incorporated, results in low EVD infection rates across a multisite institutional practice. Our results are comparable to published protocols involving the implementation of standard care bundles and/or antibacterial EVDs alone, in reducing VRIs.
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
Thien A,Soh S,Lock C,Han JX,Chen MW,Srivatsava S,Rao JP,Ang BT,Seow WT,Keong NCdoi
10.1016/j.wneu.2019.11.070subject
Has Abstractpub_date
2020-03-01 00:00:00pages
e126-e136eissn
1878-8750issn
1878-8769pii
S1878-8750(19)32908-0journal_volume
135pub_type
杂志文章abstract:BACKGROUND AND IMPORTANCE:Lesions located lateral to the lower brainstem, such as proximal posterior inferior cerebellar artery (PICA) aneurysms, are surgically challenging. We report a case of a patient with a left proximal PICA aneurysm that was successfully clipped via a so-called "extended" suboccipital subtonsilla...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.06.019
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:Based on our experience with the endoscopic endonasal approach (EEA) and transorbital approach (TOA) for middle cranial fossa tumors, we evaluated the efficacy and limitations of visualization and the clinical outcomes associated with the approaches depending on the surgical corridors. In addition, we determ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.11.090
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVE:Recurrent World Health Organization (WHO) grade II and III meningiomas have traditionally been treated by surgery alone, but early literature suggests that adjuvant stereotactic radiosurgery may greatly improve outcomes. We present the long-term tumor control and safety of a hypofractionated stereotactic radi...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.04.019
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:Anterior cervical diskectomy and fusion with plate-screw construct has been gradually applied for multilevel cervical spondylotic myelopathy in recent years. However, long cervical plate was associated with complications including breakage or loosening of plate and screws, trachea-esophageal injury, neurovas...
journal_title:World neurosurgery
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.wneu.2017.05.045
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:The coexistence of a gangliocytoma and a pituitary adenoma is a rare event that has been reported in only case reports. The knowledge of its diagnosis and treatment is extremely limited. CASE DESCRIPTION:We present a rare case of intrasellar-suprasellar gangliocytoma and nonfunctioning pituitary adenoma. Th...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.05.064
更新日期:2017-10-01 00:00:00
abstract:OBJECTIVE:Unilateral hemilaminectomy, which is used to remove spinal cord tumors, is simpler than laminoplastic laminotomy and affords certain biomechanical advantages. However, both incomplete tumor removal and inadvertent infliction of spinal cord damage attributable to the narrow surgical corridor remain of concern....
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.11.073
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Determining the risks of treatment of unruptured intracranial aneurysms is critical in the decision-making process of management. Most studies have reported the results for endovascular or surgical management. Our objective was to better delineate the risk estimates for unruptured intracranial aneurysms trea...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.03.005
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:To investigate potential risk factors for cerebral hyperperfusion syndrome (CHS) after surgery in patients with moyamoya disease (MMD) using phase-contrast magnetic resonance imaging (MRI). METHODS:The study included 84 adult patients (89 brain hemispheres) with MMD who underwent surgery. Preoperative phase-...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.04.191
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Infection and skin fistula are well-known complications after cranioplasty leading to reconstruction exposure and usually requiring new surgical procedure with poor condition for cutaneous closure. We describe 2 cases using muscle forehead flap (MFF) to treat skin fistula and cranioplasty exposure. CASE DES...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.10.184
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVE:To elucidate the role of endoscopic third ventriculostomy (ETV) in patients with secondary and idiopathic communicating hydrocephalus (HCP). METHODS:A series of 36 patients with communicating HCP (21 men and 15 women) were treated by ETV between November 2007 and February 2010. The patients age ranged from 1...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2011.06.038
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:After showing the success of mechanical thrombectomy (MT) in treating large-vessel occlusion stroke, the target population has been expanded to include patients with smaller and more distal vessels including the M2 segment of the middle cerebral artery. We compared the procedural and clinical outcomes of pat...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.04.175
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVE:Dorsal longitudinal T-myelotomy is a long-established operation to treat severe spastic paraplegia. The present study aimed to report this surgical technique and investigate the efficacy of T-myelotomy for spasticity relief. METHODS:All cases undergoing T-myelotomy for treatment of intractable spastic parapl...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.05.008
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Diastatic skull fractures (DSFs) in children are difficult to detect in skull radiographs before they develop into growing skull fractures; therefore, little information is available on this topic. However, recent advances in 3-dimensional (3D) computed tomography (CT) imaging technology have enabled more ac...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.08.107
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVE:To evaluate a new surgical tool combining suction and monopolar neurostimulation (stimulation sucker) for cerebellopontine angle (CPA) tumors. The usefulness for continuous (time) and dynamic (space) facial nerve mapping was studied. METHODS:Patients operated on with the stimulation sucker for a CPA tumor be...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.07.286
更新日期:2018-11-01 00:00:00
abstract:BACKGROUND:Multiple sclerosis (MS) is a common autoimmune and neurodegenerative disease of the central nervous system characterized by inflammatory demyelination, axonal degeneration, and neuronal loss. The exact pathogenesis of MS remains uncertain; however, studies have shown that the development of MS is influenced ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.04.027
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:Resection of a vestibular schwannoma may result in facial paralysis and hearing loss on the side of the tumor. We evaluated clinical, audiologic, and intraoperative events and radiologic parameters in a case of contralateral side sensorineural hearing loss. We also performed a literature search using PubMed....
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2018.05.245
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:Reports of cerebral aneurysm and aneurysm rupture during pregnancy are rare in the literature. Aneurysms might rupture and cause intracranial hemorrhage during or after pregnancy. Aneurysmal subarachnoid hemorrhage during pregnancy presents a challenge regarding treatment and management. No institution has r...
journal_title:World neurosurgery
pub_type:
doi:10.1016/j.wneu.2020.04.238
更新日期:2020-08-01 00:00:00
abstract:OBJECTIVE:Nearly 9.2% of vestibular schwannomas (VS) recur. We evaluate the association of cell proliferative markers like MIB with recurrence in VS. METHODS:Retrospective data of 144 consecutive patients who underwent surgical excision for sporadic VS between January 2010 and July 2015 were collected. Comparison betw...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.09.039
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Spinal tuberculosis is the most common form of tuberculosis affecting bone and often needs surgical treatment. Single anterior, single posterior, and combined anterior and posterior approaches are the 3 most commonly used approaches in surgical treatment. Clinically, the choice of optimal surgical approach r...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2020.12.023
更新日期:2020-12-11 00:00:00
abstract:OBJECTIVE:A 63-year-old woman presented with diplopia resulting from abducens paralysis. Examination revealed a giant cavernous aneurysm supplied by the internal carotid artery (ICA) and primitive trigeminal artery (PTA) via the vertebrobasilar system. METHODS:After evaluation of balloon test occlusion (BTO) at the di...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2010.06.029
更新日期:2010-10-01 00:00:00
abstract:BACKGROUND:Ossified posterior longitudinal ligament (OPLL) of the cervical spine can lead to spinal stenosis and become clinically symptomatic. The optimal approach in addressing OPLL is a debated topic and dependent on factors such as preoperative lordosis and levels affected. METHODS:In this study, we retrospectivel...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2021.01.046
更新日期:2021-01-19 00:00:00
abstract:BACKGROUND:Trigeminal neuralgia (TGN) is a debilitating disorder, and in patients for whom medical management is not sufficient, there are several therapeutic options. Microvascular decompression (MVD) for TGN has been shown to be highly effective; however, pain does recur after MVD in some patients. Therapeutic option...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.05.147
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:Intrathecal disc herniation is a rare but serious condition that has the potential to generate devastating neurologic deficits. We present a case of a 56-year-old man who developed cauda equina syndrome after several episodes of severe Valsalva maneuver. CASE DESCRIPTION:The patient was found to have develo...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.06.024
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To examine the occurrence of traumatic intracranial hemorrhage (tICH) and outcome in patients with minor head injury and assess the probable risk factors. METHODS:Patients with minor head injury who visited our hospital from January 2015 to July 2017 were registered consecutively, and enrolled patients were ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.06.044
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:Sex has been known to significantly affect postoperative complications and length of stay after elective anterior cervical fusions. Current evidence on lumbar spine surgery is limited. METHODS:The 2012-2016 American College of Surgeons National Surgical Quality Improvement Program database was queried using...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.08.097
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Pituitary ependymoma is exceptionally rare. Its etiology, clinical presentation, radiologic feature, and treatment strategy are still a matter of debate. Only 7 human cases with limited data were reported in the English literature, and now we described another case of pituitary ependymoma. We also systematic...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2017.10.134
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Fungal infection is a rare pathology in the sphenoid sinus, and extension into the pituitary fossa with visual loss has only been described in a few reports in the literature. Following publication of a recent report of pituitary abscess by Candida glabrata, we describe our own experience with a similar path...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.04.054
更新日期:2018-07-01 00:00:00
abstract:OBJECTIVE:Classical trigeminal neuralgia (cTN) is rarely caused by ectatic vertebrobasilar artery compression of the trigeminal nerve. These patients present a surgical challenge and often are not considered for microvascular decompression (MVD) due to assumed risk. METHODS:A review of patients who were surgically tre...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.06.145
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To determine the optimal proximal fusion level after long instrumented fusion to the sacrum for lumbar degenerative flat back. METHODS:Data from 70 patients with lumbar degenerative flat back were reviewed retrospectively. Three groups were designated according to the upper instrumented vertebrae (UIV): grou...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.03.051
更新日期:2017-10-01 00:00:00
abstract:OBJECTIVE:To integrate 3-dimensional (3D) intraoperative ultrasound (iUS) data in spinal navigation. METHODS:In 11 patients with intradural spinal tumors, 3D-iUS was performed before and after tumor resection. Intraoperative computed tomography (iCT) was used for automatic patient registration for spinal navigation; f...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.07.188
更新日期:2019-11-01 00:00:00