Abstract:
BACKGROUND:The effect of frailty on outcomes after angiogram-negative subarachnoid hemorrhages (ANSAH) is currently unknown. We investigated frailty's effects on ANSAH outcomes, including mortality and in-hospital complications. METHODS:Patients from 2014 to 2018 with non-traumatic subarachnoid hemorrhage and cerebral angiograms with an unidentifiable hemorrhage source were retrospectively reviewed. The cohort was divided into non-frail (modified frailty index [mFI] = 0) and frail (mFI ≥1) groups based on pre-hemorrhage characteristics. Primary outcomes were mortality rate and discharge location. Multivariate logistic regression analyses determined predictors of ANSAH severity and primary endpoints. Receiver operating characteristic curves were used to discriminate risks for primary endpoints comparing mFI, Hunt and Hess and Fisher scores, and age. RESULTS:We included 75 patients with a mean age of 55.4 ± 1.5 years, comprising 42 (56%) women, and 41 (54.7%) with perimesencephalic bleeds. A total of 32 of 75 (42.7%) patients were classified as frail. Frail individuals were 6.2 times less likely to be discharged home (odds ratio [OR] = 0.16; 95% confidence interval [CI]: 0.05-0.5; P = 0.001) and all mortalities occurred in frail patients (12.5% [n = 4 of 32]; P = 0.030). The only independent predictor of mortality was higher mFI (OR = 5.4; 95% CI: 1.5-19.1; P = 0.009), and lower mFI best predicted discharge home (OR = 0.39; 95% CI: 0.17-0.88; P = 0.023). Receiver operating characteristic analysis showed that mFI best predicted both mortality (area under the curve = 0.9718; P = 0.002) and discharge home (area under the curve = 0.7998; P < 0.001). CONCLUSIONS:Frail ANSAH patients have poorer outcomes and increased mortality compared with non-frail patients. Although prospective study is needed, this information significantly impacts our understanding of ANSAH outcomes and frailty should be used for prognostication as it was a better predictor than Hunt and Hess or Fisher scores.
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
McIntyre M,Gandhi C,Dragonette J,Schmidt M,Cole C,Santarelli J,Lehrer R,Al-Mufti F,Bowers CAdoi
10.1016/j.wneu.2019.10.003subject
Has Abstractpub_date
2020-02-01 00:00:00pages
e181-e188eissn
1878-8750issn
1878-8769pii
S1878-8750(19)32618-Xjournal_volume
134pub_type
杂志文章abstract:BACKGROUND AND OBJECTIVE:High-field intraoperative magnetic resonance imaging (ioMRI) is becoming increasingly available in neurosurgery centers, where it has to be combined with intraoperative neurophysiologic monitoring (IONM). IONM needle electrodes remain on the patient during ioMRI and may cause image distortions ...
journal_title:World neurosurgery
pub_type: 临床试验,杂志文章
doi:10.1016/j.wneu.2016.05.097
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVE:A possible risk factor for premature facet joint degeneration or adjacent segment degeneration after surgical treatment of spine fractures is facet joint violation (FV) during insertion of pedicle screws. The aim of this study was to determine risk factors for FV in the thoracic and lumbar spine after minimal...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.01.138
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVE:Preoperative embolization may facilitate skull base meningioma resection, but its safety and efficacy in the Onyx era have not been investigated. In this retrospective cohort study, we evaluated the outcomes of preoperative embolization of skull base meningiomas using Onyx as the primary embolysate. METHODS:...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.04.208
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Symptomatic cerebral vasospasm has been reported in a low percentage of patients with moderate or severe traumatic brain injury (TBI) as defined by Glasgow Coma Scale (GCS) score. We present a case of mild TBI (GCS score 14) complicated by early and severe symptomatic cerebral vasospasm. CASE DESCRIPTION:A ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.03.039
更新日期:2017-05-01 00:00:00
abstract:OBJECTIVE:Reducing complications from unruptured aneurysms (UAs) treatment is important. We clarify the criteria for achieving safe and complete treatment for UAs ≤10 mm by clipping or coil embolization. METHODS:This study included 59 newly treated UAs in the past 2 years. We prospectively decided on criteria to recom...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.04.005
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:An awake throughout (AT) approach for awake craniotomy is mostly under utilized. The purpose of this study was to review the efficacy of the technique at our tertiary care center. The primary objective was to identify the incidence of perioperative complications. The secondary objective was to review the pat...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.03.127
更新日期:2019-06-01 00:00:00
abstract::Endoscopic endonasal transsphenoidal surgery for pituitary tumors has been the standard therapy for decades. This approach offers surgeons an effective, safe, and wide exposure to the pituitary gland, with a relatively low mortality rate and acceptable complication rates. However, severe complications, including cereb...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2015.04.043
更新日期:2015-11-01 00:00:00
abstract:BACKGROUND:Incomplete penetration of a burr hole sometimes occurs when performing a craniotomy in elderly patients due to osteoporosis. Completion of the burr hole takes more time and may sometimes cause tearing of the dura mater. We have introduced a small bone piece method that can easily and reliably recover an inco...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.06.080
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Intracranial extraskeletal mesenchymal chondrosarcomas (MCSs) are rare tumors accounting for <0.16% of intracranial tumors. They are usually described as occurring in the age group of 20-30 years and are commonly found in the frontoparietal region arising from the falx and surrounding dura. We describe 3 cas...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.08.049
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:Acute bilateral isolated foot drop due to lumbar disk prolapse with canal stenosis is rare with only 3 cases reported in literature. Our patient was managed using the percutaneous full endoscopic technique. This is mainly to highlight the ease of access and patient outcome with preoperative and postoperative...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.11.128
更新日期:2018-02-01 00:00:00
abstract::Most neurovascular innovations have been introduced by using case series followed by observational studies. A better approach would be a pragmatic randomized trial. Two important aspects of trial design, patient selection and randomized allocation, remain poorly understood. We discuss the role trial methodology can pl...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2018.06.127
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:Anatomical barriers (e.g., pedicles, narrow foramina) can hinder direct access to, and removal of, disc fragments that have migrated far downward. Using transforaminal full-endoscopic lumbar discectomy (FELD), we devised a modified technique, the suprapedicular retrocorporeal approach, for herniations in whic...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.08.038
更新日期:2020-11-01 00:00:00
abstract:PURPOSE:In this study we report an uncommon endoscopic endonasal image of an atrophic optic nerve as seen after surgical removal of a suprasellar meningioma. The peculiarity of this case is the long-lasting underestimated ocular symptomatology of the patient who reported a 15-year history of impairment of vision on her...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.02.032
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:White matter volume loss may be an anatomic driver in the development of clinical symptoms in cervical spondylotic myelopathy (CSM). Considerably less attention has been devoted to gray matter (GM) injury. Newly developed atlas-based mapping techniques may allow evaluation of GM cord volume alterations in CS...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.10.109
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:The number of patients with a history of clipping of recurrent aneurysms after coil embolization has increased. The aim of this article was to report the feasibility of CT angiography using a commercial metal artifact reduction algorithm (Smart Metal Artifact Reduction [MAR]) for patients who underwent clipp...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.04.133
更新日期:2019-07-01 00:00:00
abstract::Recent advances in neuroimaging demonstrated many markedly improved images hitherto unavailable, specifically the areas that lie deep in the brain. The anatomic images of the deep brain structure taken in vivo using 7.0 T magnetic resonance imaging (MRI) and the molecular images using high resolution research tomograp...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2012.10.020
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:A critical step in the far lateral approach (FLA) is exposure of the V3 segment of the vertebral artery, located deep in the suboccipital triangle (SOT). Safe exposure of the SOT is achieved by means of a plane-by-plane dissection, which carries the risk of devascularization. A suitable alternative is to lif...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.02.090
更新日期:2018-05-01 00:00:00
abstract:INTRODUCTION:Established guidelines for radiologic surveillance after microsurgical treatment of intracranial aneurysms are lacking in the literature because of small sample sizes, poor definitions, and heterogeneous use of imaging modalities. We aimed to propose clinically meaningful definitions for postoperative aneu...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.06.110
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:Syringomyelia due to intracranial hypotension is rarely described. As a consequence, intracranial hypotension is less recognized as a potential cause of syringomyelia or mistaken with Chiari type 1 malformation. The pathogeny is poorly understood, and we lack diagnostic and therapeutic strategies for this pa...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2016.04.062
更新日期:2016-07-01 00:00:00
abstract:OBJECTIVE:Although hearing impairment after microvasuclar decompression (MVD) for hemifacial spasm (HFS) is not common, its occurrence could detrimentally affect the patient's surgical outcome. The object of this study is to address the optimal approaches for reducing postoperative hearing problems after MVD for HFS. ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.09.053
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Anterior sacral meningocele (ASM) is characterized by a herniation of the dural sac through a bony defect of the anterior sacral wall. Symptoms of ASMs are usually directly related to their mass effect on the adjacent pelvic structures, often causing chronic constipation and urinary disturbances. The low-dys...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.04.105
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVE:To describe percutaneous balloon compression (PBC) of the trigeminal rootlets as treatment for trigeminal neuralgia (TN), including history, operative techniques, outcomes, side effects, and some recent findings increasing the likelihood of a positive outcome. METHODS:PBC is indicated in patients with TN in ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2012.03.014
更新日期:2013-02-01 00:00:00
abstract:OBJECTIVE:Middle cerebral artery aneurysms (MCAAs) are regularly treated by both microsurgical clipping and endovascular coiling. We performed a systematic meta-analysis to compare the safety and efficacy of these 2 methods. METHODS:Literature was reviewed for all studies reporting angiographic occlusion and/or functi...
journal_title:World neurosurgery
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.wneu.2015.05.073
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:The sellar spine is a rare, bony growth that typically arises from the dorsum sellae. Few cases have been described in the literature thus far, and most are asymptomatic and incidentally found. We describe the case of a 19-year-old female in whom a sellar spine was noted to be associated with pituitary gland...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.03.046
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:The supraorbital keyhole approach (SKA) and pterional approach (PA) have been recommended for clipping intracranial aneurysms (IAs). We conducted a meta-analysis to systematically and comprehensively compare the clinical outcomes between the 2 approaches. METHODS:We retrieved potential academic studies that...
journal_title:World neurosurgery
pub_type: 杂志文章,meta分析
doi:10.1016/j.wneu.2019.11.134
更新日期:2020-03-01 00:00:00
abstract:OBJECTIVE:Neuroendoscopy is increasingly being used in the management of intraventricular brain tumors. The role of endoscopy in diagnostic biopsy is well established. Expansion of these techniques may allow for definitive resection of intraventricular tumors. We report the feasibility and outcomes of endoscopic resect...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2015.11.052
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:Surgical treatment of meningiomas next to venous sinuses is difficult because of their irregular growth patterns and infiltration into the venous sinuses, making gross total resection impossible in some patients. We evaluated the postoperative clinical and neurologic course of this tumor subgroup. METHODS:T...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.05.025
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the parameters related to the high risk of preoperative seizures in infants (1 year or younger) with ruptured intracranial aneurysms. METHODS:Infants with ruptured intracranial aneurysms treated at our institution from January 2012 to January 2018 were retrospectively analyzed. Seventeen similar ...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2018.07.049
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:We aimed to evaluate the combined effect of ellagic acid (EA) and temozolomide (TEM) on the cadherin switch and angiogenesis in the C6 glioma cell line. METHODS:A total of 100 μM EA and 100 μM TEM were applied to rat C6 glioma cells for 24, 48, and 72 hours. Cell proliferation was detected by 5-bromo-2'-deox...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.08.228
更新日期:2019-12-01 00:00:00
abstract:OBJECTIVE:Ruptured blister aneurysms of the internal carotid artery are challenging to treat because of their difficult diagnosis and the fragility of the wall structure. Here, we sought to clarify the efficacy of extracranial-intracranial bypass followed by trapping (bypass/trapping) for ruptured blister aneurysms. M...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.01.081
更新日期:2020-04-01 00:00:00