Abstract:
BACKGROUND:Lack of risk stratification among patients with varying severities of compound head injury has resulted in too-inconsistent and conflicting results to support any management strategy over another. The purpose of this study was to validate a new clinico-radiological grading scheme with implications on outcome and the need for surgical debridement. METHODS:Patients who sustained an external compound head injury with no serious systemic injury and no pre-established infection and who continued the entire treatment were studied prospectively for their proposed grade of compound injury in relation to infective complications, unfavorable Glasgow Outcome Scale (GOS), delayed seizures, mortality, and hospital stay for 3 months. Appropriate univariate and multivariate analyses were performed. RESULTS:Among a total of 344 patients, 182 (53%) had no dural violation or midline shift (Grade 1), 56 (16%) had cerebrospinal fluid leak or pneumocephalus (Grade 2), 34 (10%) had exposed brain (Grade 3), 47 (14%) had midline shift (Grade 4), and 25 (7%) had both exposed brain and midline shift (Grade 5). Each successive grade of compound injury had significant incremental impact on all the outcome measures studied. Infective complications in Grades 1 to 5 were noted among 7%, 9%, 27%, 28%, and 36% of patients, respectively (P < 0.001). There was a significant difference in unfavorable GOS (23% vs. 56%, odds ratio [OR] 4.3, P < 0.001) and mortality (17% vs. 42%, OR 3.5, P < 0.001) between Grades 1-2 and Grades 3-5. Delayed seizures were noted in 4%, 4%, 9%, 13%, and 16% of patients in Grades 1-5 (P = 0.04). The median hospital stay was 1, 3, 6, 6, and 8 days, respectively (P < 0.001). All patients in Grades 4-5 (72) underwent surgery. Only 32 of 182 (18%) patients in Grade 1, 9 of 56 (16%) patients in Grade 2, and 23 of 34 (68%) patients in Grade 3 underwent surgical debridement, whereas the rest were managed conservatively. Patients who were managed conservatively had significantly lower infective complications (3% vs. 25%, OR 9.67, P < 0.001) in Grade 1, and (2% vs. 44%, OR 36.8, P = 0.002) in Grade 2, compared with those who underwent surgical debridement. In multivariate analysis, the proposed grade had significant independent association with infection (P < 0.001), unfavorable GOS (P = 0.01), delayed seizures (P = 0.001), and hospital stay (P < 0.001), and each successive grade had significant incremental impact on both infective complications and unfavourable GOS, independent of GCS and other prognostic factors. CONCLUSION:The new grading scheme appears to be of practical clinical significance. It shows significant statistical associations with the rates of infection, unfavorable neurologic outcome, delayed seizures, mortality, and duration of hospital stay. The incremental impact of each successive grade on infective complications and unfavorable GOS was independent of GCS and other prognostic factors. Conservative management had significantly lower infection compared to surgical debridement, at least in patients with Grades 1 and 2.
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
Dhandapani S,Sarda AC,Kapoor A,Salunke P,Mathuriya SN,Mukherjee KKdoi
10.1016/j.wneu.2015.05.058subject
Has Abstractpub_date
2015-11-01 00:00:00pages
1244-50issue
5eissn
1878-8750issn
1878-8769pii
S1878-8750(15)00655-5journal_volume
84pub_type
杂志文章abstract::Surgical treatment of large paraclinoid aneurysms remains technically challenging due to the adjacent bony anatomy and neurovascular structures. Endovascular retrograde suction decompression using a double-lumen balloon catheter facilitates clip ligation of the aneurysm. Video 1 demonstrates a large paraclinoid aneury...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.03.109
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:Vertebroplasty and kyphoplasty are minimally invasive techniques used to treat vertebral compression fractures. The etiology of vertebral compression fractures varies among patients. Although osteoporosis and trauma are major etiologic factors in patients with a vertebral compression fracture, unexpected res...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.10.116
更新日期:2019-02-01 00:00:00
abstract:INTRODUCTION:COVID-19 has affected the global provision of neurosurgical services. We sought to review the impact of COVID-19 on the neurosurgical services in Africa. METHODS:A cross-sectional survey was distributed to African neurosurgeons seeking to review demographics, national and neurosurgical preparedness, and c...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.11.004
更新日期:2020-11-25 00:00:00
abstract:BACKGROUND:Laser interstitial thermal therapy (LITT) is an alternative, less-invasive, and, in some circumstances, effective treatment for patients with intracranial pathology including epilepsy and some tumors. For intracranial lesions in eloquent areas, resection by conventional craniotomy proves often to be a challe...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.09.074
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND:Spinal myxopapillary ependymoma (SME), generally considered a benign entity, can exhibit brain and whole-spine metastases as well as local recurrence after surgery. However, the presence of preoperative retrograde intracranial dissemination at the time of diagnosis is very rare. CASE DESCRIPTION:We report a...
journal_title:World neurosurgery
pub_type:
doi:10.1016/j.wneu.2020.08.169
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Neurosurgical educators strive to identify the best applicants, yet formal study of resident selection has proved difficult. We conducted a systematic review to answer the following question: What objective and subjective preresidency factors predict resident success? METHODS:PubMed, ProQuest, Embase, and t...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2017.11.078
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Lumbar puncture is a common procedure that can be safely performed in most patients. Certain populations may have increased risk for complications following lumbar puncture, but the significance of basilar invagination is often underappreciated. CASE DESCRIPTION:A 45-year-old woman with basilar invagination...
journal_title:World neurosurgery
pub_type:
doi:10.1016/j.wneu.2020.02.040
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVE:To evaluate whether the postoperative neutrophil-to-lymphocyte ratio (NLR) is a prognostic marker for patients with intracerebral hemorrhage (ICH) undergoing surgical hematoma evacuation. METHODS:This retrospective cohort study was conducted to identify patients with ICH who underwent hematoma evacuation bet...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.10.154
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Despite the development of neuroendovascular treatment, device-related complications requiring surgical procedures remain. We report a case requiring surgical retrieval of a filter protection device in carotid artery stenting (CAS) with an open-cell stent, due to stent deformation, and review past reports on...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2018.10.214
更新日期:2019-02-01 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:INTRODUCTION:Stereotactic radiosurgery (SRS), particularly Gamma Knife radiosurgery (GKRS) is an established treatment option for residual and recurrent pituitary adenoma tumors. It helps in the preservation of surrounding normal neuronal, vascular, and hormone-producing structures and causes fewer neurologic deficits....
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.03.094
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVE:Basilar perforator aneurysms (BPAs) are rare lesions that present a therapeutic challenge. We present 4 cases of ruptured BPAs treated either conservatively or by flow diverter deployment and review the literature. METHODS:Patients (age 78, 59, 53, and 62 years) presented with World Federation of Neurologica...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2016.10.038
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVE:The purpose of the present study was to assess for gender-based differences in the usage and cost of maximal nonoperative therapy before spinal fusion surgery in patients with symptomatic lumbar stenosis or spondylolisthesis. METHODS:A large insurance database was queried for patients with symptomatic lumbar...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.08.131
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Patients with an aneurysmal subarachnoid hemorrhage (aSAH) and World Federation of Neurosurgical Societies (WFNS) grade I on admission are generally considered to have a good clinical outcome. OBJECTIVE:The objective of this study was to assess the actual clinical outcome of WFNS grade I aSAH patients, and ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.06.157
更新日期:2018-10-01 00:00:00
abstract::The field of neurosurgery has a rich and fascinating history. The development of the specialty in Hawaii has been particularly unique, given the state's remote location, indigenous population, and military presence. The life of Dr. Ralph B. Cloward, Hawaii's most noted neurosurgeon, has received some attention in the ...
journal_title:World neurosurgery
pub_type: 传,历史文章,杂志文章,评审
doi:10.1016/j.wneu.2017.10.065
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVE:To investigate whether the preoperative presence of degenerative spondylolisthesis (DS) worsens the outcome of patients undergoing decompression alone for degenerative lumbar stenosis. METHODS:We conducted a comprehensive search in the PubMed, Embase, and Cochrane Library databases. All comparative studies w...
journal_title:World neurosurgery
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.wneu.2018.11.246
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the efficiency of a comprehensive treatment strategy for patients with Enneking stage 3 thoracic aggressive vertebral hemangioma (AVH). METHODS:A retrospective analysis of radiographic and clinical outcomes was performed for 17 patients who received treatment for Enneking stage 3 thoracic AVH acc...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.10.158
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Acute complex C2 vertebral body fracture specifically does not involve the odontoid process or C2 pars interarticularis. External stabilization can be effective but may prolong healing and increase morbidity. Many traditional surgical techniques can achieve internal stabilization at the expense of normal cer...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.06.047
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:Microscopic training is essential for development of neurosurgical skills. A range of models is reported in the literature for this purpose, including live animals, exvivo, and synthetic material. Among the factors involved in selection and development of a training station, cost is a decisive one. METHODS:...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.06.089
更新日期:2019-10-01 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:We developed a method for fabricating a three-dimensional hollow and elastic aneurysm model useful for surgical simulation and surgical training. In this article, we explain the hollow elastic model prototyping method and report on the effects of applying it to presurgical simulation and surgical training. M...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2013.10.032
更新日期:2015-03-01 00:00:00
abstract:OBJECTIVE:To evaluate safety and effectiveness of the application of piezosurgery in en bloc laminectomy for the treatment of multilevel thoracic ossification of ligamentum flavum (MTOLF). METHODS:Forty-one cases who had MTOLF and underwent en bloc laminectomy from January 2012 to January 2017 were reviewed and divide...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.03.200
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:The pterion is an H-shaped suture complex. This study's goal was to determine the location of its external and internal surfaces and extension and emphasize and discuss its surgical importance. METHODS:Fifty dried adult human skulls were obtained from the Department of Anatomy. A 2-mm drill bit was placed ex...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.01.198
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVE:This study was designed to assess the impact of public health policy in Australia in response to the coronavirus disease identified in 2019 (COVID-19) pandemic on the delivery of neurosurgical services. Being essential services, we postulated that there would not be a decrease in elective and emergency neuros...
journal_title:World neurosurgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.wneu.2020.05.136
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Given the genetic and proteomic advances of the past decade, understanding of the molecular etiopathogenesis of several complex diseases is increasing. Intervertebral disc disease (IVDD) is no different from other complex diseases where both environmental and genetic constituents are considered causes. This ...
journal_title:World neurosurgery
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.wneu.2011.07.014
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:Rhabdoid meningioma (RM) is a rare subtype of meningioma, classified as World Health Organization grade III with a poor prognosis. Here we present our experience on RM and review relevant literature in an attempt to investigate the clinical features, treatment, and prognosis of these tumors. METHODS:Twelve ...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2012.08.002
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND:Colloid cysts of the third ventricle are benign congenital lesions. They are at times totally asymptomatic or may be detected in the evaluation for headache, neurologic disturbances, or psychiatric disturbances. They may sometimes cause grave consequences such as coma or even sudden death. The radiologic app...
journal_title:World neurosurgery
pub_type:
doi:10.1016/j.wneu.2020.05.164
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVE:The aims of this study were to evaluate the risk factors for muscle injury in patients undergoing posterior lumbar spinal surgery and the clearance of postoperative biochemical changes following lumbar fusion and secondarily to evaluate the timing for monitoring postoperative biochemical serum levels and pote...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.05.197
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Diverse clinical manifestations have characterized reports of central nervous system involvement in Behcet disease. There is a limited number of published case reports of neuro-Behcet disease mimicking brain tumor. CASE DESCRIPTION:We present a rare case of neuro-Behcet disease exhibiting mixed systemic and...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.09.035
更新日期:2020-01-01 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