Delirium is a transient and acute syndrome of encephalopathy,characterized by disturbances in consciousness,orientation,cognition,perception,and emotional regulation,often accompanied by hallucinations,illusions,psych...Delirium is a transient and acute syndrome of encephalopathy,characterized by disturbances in consciousness,orientation,cognition,perception,and emotional regulation,often accompanied by hallucinations,illusions,psychomotor agitation,and restlessness.Postoperative delirium(POD),a common complication particularly in elderly patients,significantly impacts recovery by prolonging mechanical ventilation,neurosurgical intensive care unit stays,and overall hospitalization durations,while severely diminishing patients’quality of life after discharge.Despite its prevalence,POD remains underrecognized in clinical practice,with significant gaps in its diagnosis and management.This review explores the definition,diagnostic criteria,underlying pathogenesis,and associated risk factors of POD in neurosurgical patients,aiming to offer valuable insights for improving clinical diagnosis and therapeutic strategies.展开更多
Neurosurgical patients present complex clinical conditions with high nursing risks.Under traditional teaching models,nursing interns often exhibit challenges such as weak clinical reasoning,insufficient reflective cap...Neurosurgical patients present complex clinical conditions with high nursing risks.Under traditional teaching models,nursing interns often exhibit challenges such as weak clinical reasoning,insufficient reflective capabilities,and inadequate operational proficiency,which fail to meet clinical nursing demands.This study focuses on neurosurgical nursing interns as research subjects,systematically exploring the application value and implementation pathways of serious game pedagogy in cultivating clinical competencies.展开更多
Perioperative management of antiplatelet therapy involves a delicate balancing of the risk of periprocedural blood loss with the cardiovascular and thrombotic risk to the patient.Due to the unique nature of neurosurge...Perioperative management of antiplatelet therapy involves a delicate balancing of the risk of periprocedural blood loss with the cardiovascular and thrombotic risk to the patient.Due to the unique nature of neurosurgery,perioperative bleeding may have devastating consequences and cause major morbidity and mortality.The recommendation to discontinue aspirin prior to major neurosurgical procedures rests upon conventional practice,expert consensus with priority given to avoidance of any major bleed.On the contrary recent prospective data do not support the existence of additional bleeding risk in patients continuing aspirin compared to those who stop aspirin prior to procedure.Patients with cardiova-scular and metabolic comorbidities are increasingly encountered in the operation theatre these days.In these patients,prevention of myocardial injury after non-cardiac surgery(MINS)is an important focus for perioperative risk reduction.Prolonged(≥7 days)cessation of antiplatelets is one of the most important predictors of MINS.This complicated milieu of risks and benefits highlights the difficulty of practicing evidence-based medicine and minimizing harm in patients on aspirin needing neurosurgery.展开更多
BACKGROUND After approval for clinical use in 2017,early investigations of ultra-high-field abdominal magnetic resonance imaging(MRI)have demonstrated its feasibility as well as diagnostic capabilities in neuroimaging...BACKGROUND After approval for clinical use in 2017,early investigations of ultra-high-field abdominal magnetic resonance imaging(MRI)have demonstrated its feasibility as well as diagnostic capabilities in neuroimaging.However,there are no to few systematic reviews covering the entirety of its neurosurgical applications as well as the trends in the literature with regard to the aforementioned application.AIM To assess the impact of 7-Tesla MRI(7T MRI)on neurosurgery,focusing on its applications in diagnosis,treatment planning,and postoperative assessment,and to systematically analyze and identify patterns and trends in the existing literature related to the utilization of 7T MRI in neurosurgical contexts.METHODS A systematic search of PubMed was conducted for studies published between January 1,2017,and December 31,2023,using MeSH terms related to 7T MRI and neurosurgery.The inclusion criteria were:Studies involving patients of all ages,meta-analyses,systematic reviews,and original research.The exclusion criteria were:Pre-prints,studies with insufficient data(e.g.,case reports and letters),non-English publications,and studies involving animal subjects.Data synthesis involved standardized extraction forms,and a narrative synthesis was performed.RESULTS We identified 219 records from PubMed within our defined period,with no duplicates or exclusions before screening.After screening,125 articles were excluded for not meeting inclusion criteria,leaving 94 reports.Of these,2 were irrelevant to neurosurgery and 7 were animal studies,resulting in 85 studies included in our systematic review.Data were categorized by neurosurgical procedures and diseases treated using 7T MRI.We also analyzed publications by country and the number of 7T MRI facilities per country was also presented.Experi-mental studies were classified into comparison and non-comparison studies based on whether 7T MRI was compared to lower field strengths.CONCLUSION 7T MRI holds great potential in improving the characterization and understanding of various neurological and psychiatric conditions that may be neurosurgically treated.These include epilepsy,pituitary adenoma,Parkinson's disease,cerebrovascular diseases,trigeminal neuralgia,traumatic head injury,multiple sclerosis,glioma,and psychiatric disorders.Superiority of 7T MRI over lower field strengths was demonstrated in terms of image quality,lesion detection,and tissue characterization.Findings suggest the need for accelerated global distribution of 7T magnetic resonance systems and increased training for radiologists to ensure safe and effective integration into routine clinical practice.展开更多
BACKGROUND Mycoplasma hominis(M.hominis),which causes central nervous system infections in adults,is very rare.It is also relatively difficult to culture mycoplasma and culturing requires special media,resulting in a ...BACKGROUND Mycoplasma hominis(M.hominis),which causes central nervous system infections in adults,is very rare.It is also relatively difficult to culture mycoplasma and culturing requires special media,resulting in a high rate of clinical underdiagnosis.Therefore,clinicians often treat patients based on their own experience before obtaining pathogenic results and may ignore infections with atypical pathogens,thus delaying the diagnosis and treatment of patients and increasing the length of hospital stay and costs.CASE SUMMARY A 44-year-old man presented to the hospital complaining of recurrent dizziness for 1 year,which had worsened in the last week.After admission,brain magnetic resonance imaging(MRI)revealed a 7.0 cm×6.0 cm×6.1 cm lesion at the skull base,which was irregular in shape and had a midline shift to the left.Based on imaging findings,meningioma was our primary consideration.After lesion resection,the patient had persistent fever and a diagnosis of suppurative meningitis based on cerebrospinal fluid(CSF)examination.The patient was treated with the highest level of antibiotics(meropenem and linezolid),but the response was ineffective.Finally,M.hominis was detected by next-generation metagenomic sequencing(mNGS)in the CSF.Therefore,we changed the antibiotics to moxifloxacin 0.4 g daily combined with doxycycline 0.1 g twice a day for 2 wk,and the patient had a normal temperature the next day.CONCLUSION Mycoplasma meningitis after neurosurgery is rare.We can use mNGS to detect M.hominis in the CSF and then provide targeted treatment.展开更多
Since December 2019,an outbreak of coronavirus disease 2019(COVID-19)has.posed significant threats to the public health and life in China.Unlike the other 6 identified coronaviruscs,the SARS-Cov-2 has a high infectiou...Since December 2019,an outbreak of coronavirus disease 2019(COVID-19)has.posed significant threats to the public health and life in China.Unlike the other 6 identified coronaviruscs,the SARS-Cov-2 has a high infectious rate,a long incubation period and a variety of manifestations.In the absence of effective treatments for the virus,it becomes extremely urgent to develop scientific and standardized proposals for prevention and control of virus transmission.Hereby we focused on the surgical practice in Neurosurgery Department,Tongji Hospital,Wuhan,and drafted several recommendations based on the latest relevant guidelines and our experience.These recommendations have helped us until now to achieve'zero infection'of doctors and nurses in our department,we would like to share them with other medical staff of neurosurgery to fight 2019-nCoV infection.展开更多
BACKGROUND During skull base surgery,intraoperative internal carotid artery(ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia.Appropriate management of ICA inj...BACKGROUND During skull base surgery,intraoperative internal carotid artery(ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia.Appropriate management of ICA injury plays a crucial role in the prognosis of patients.Neurosurgeons have reported multiple techniques and management strategies;however,the literature on managing this complication from the anesthesiologist’s perspective is limited,especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.CASE SUMMARY We describe 4 cases of ICA injury during neurosurgery;there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma.After the onset of ICA injury,all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation.Three patients were transferred to the hybrid operating room,and one patient was transferred to the catheter operating room.Three patients underwent covered stent implantation,and one patient underwent embolization.All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation.After the neurosurgery,one patient was extubated and returned to the ward,and the other three were delayed tracheal extubation and returned to the intensive care unit.One patient died from serious neurological complications after 62 d in the hospital,but the other three showed good clinical outcomes.CONCLUSION ICA injury imposes a high risk of massive hemorrhage and subsequent infarction.Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons,anesthesiologists,and interventional neuroradiologists.Effective hemostatic methods,stable hemodynamics sufficient to ensure perfusion of vital organs,airway safety during transit,rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.展开更多
<strong>Background:</strong> <span "=""><span>Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous...<strong>Background:</strong> <span "=""><span>Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous study </span><span>that there were multiple predictors of postoperative outcome, including</span><span> American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A secondary analysis describing intraoperative and postoperative outcomes was undertaken in children aged between 6 and 10 years old included in the initial study. </span><b><span>Objective: </span></b><span>To describe intraoperative and postoperative outcomes in children aged between 6 and 10 years old included in the initial cohort in abdominal surgery, neurosurgery and orthopedics. </span><b><span>Methods: </span></b><span>The secondary analysis of postoperative outcomes in children aged between 6 and 10 years old w</span></span><span>as</span><span "=""><span> retrospectively included in the initial study of 594 patients. The study was approved by the Ethics Committee. </span><b><span>Results: </span></b><span>There were 88 patients with a mean age of 98.7 ±</span></span><span "=""> </span><span "=""><span>13.8 months. The most common surgical interventions were scoliosis in 23 patients (26.1%), limb tumor resection in 8 patients (9.1%), femoral osteotomy in 6 patients (6.8%), intracerebral tumor resection in 6 patients (6.8%), intestinal resection in 5 patients (5.6%), Chiari’s malformation in 4 patients (4.5%), pelvic osteotomy in 4 patients (4.5%) and renal transplantation in 4 patients (4.5%). Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3), and 13 (14.8%) were ASA grade 4. Twenty-two (25%) patients had intraoperative and/or postoperative complications (organ dysfunction or sepsis). Two patients (2.3%) had intraoperative hemorrhage, 1 patient (1.1%) had intraoperative difficult intubation, and 1 patient experienced intraoperative anaphy</span><span>laxis. Nine patients (10.2%) had postoperative neurologic failure, and 2</span><span> (2.3%) had postoperative cardio-circulatory failure. Three patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis, and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42</span></span><span "=""> </span><span>(47.7%) patients had intra-operative transfusion. There was 1 in-hospital death (1.1%). The median total length of hospital stay was 9 days [5</span><span "=""> </span><span>-</span><span "=""> </span><span "=""><span>16]. </span><b><span>Conclusion: </span></b><span>Twenty-five percent of the patients had intraoperative and/or postoperative complications, and most of them were ASA grade </span></span><span>3</span><span> 3. Integrating goal-directed therapies to optimize intraoperative management in these patients could be necessary to improve postoperative outcomes in surgical pediatric patients.展开更多
The coexistence of different water homeostasis abnormalities following neurosurgery represents a diagnostic and therapeutic challenge for intensive care units. This paper reports the case of a 13 year-old boy who unde...The coexistence of different water homeostasis abnormalities following neurosurgery represents a diagnostic and therapeutic challenge for intensive care units. This paper reports the case of a 13 year-old boy who underwent surgery for a suprasellar tumour and, immediately after surgery, developed a cerebral abscess, persistent diabetes insipidus (DI) as well as cerebral salt wasting syndrome (CSWS). The early onset of CSWS following DI has been associated with a poor prognosis and increased mortality. In cases in which these abnormalities coexist, the increased polyuria secondary to the rise in natriuresis associated with CSWS might be erroneously interpreted as a sign of poor control of the DI, thereby leading to therapeutic mistakes. Treatment basically consists of restoring electrolytes and the joint administration of desmopressin and fludrocortisone.展开更多
<strong>Background and Goal of Study:</strong> Intraoperative awareness is a serious but preventable complication of general anaesthesia. Bispectral index (BIS) is the most widely used method monitoring an...<strong>Background and Goal of Study:</strong> Intraoperative awareness is a serious but preventable complication of general anaesthesia. Bispectral index (BIS) is the most widely used method monitoring anaesthesia depth. BIS monitoring requires attachment of forehead sensors, which poses a challenge when the surgical field involves the forehead. We aimed to compare the gold standard forehead position of BIS sensors with an alternative position across the nasal dorsum for neurosurgical procedures.<strong> Materials and Methods: </strong>After ethical committee approval and informed consent were obtained, 62 patients were enrolled in this prospective observational study. Frontal and nasal BIS values were compared in all patients.<strong> Results and Discussion:</strong> The mean BIS value from frontal versus nasal sensors was 49 ± 22 and 49 ± 21 respectively (n: 62). These values were statistically correlated (ICC 0.78, p < 0.001) indicating that nasal BIS measurement does not present a disadvantage for routine use when needed. <strong>Conclusion:</strong> Our data reveal that for measuring anesthesia depth, BIS sensor placement on the nasal dorsum shows comparable efficiency in comparison to standard frontal展开更多
Enhanced recovery after surgery(ERAS)is a strategy of perioperative management aimed to accelerate the rehabilitation of patients through various optimized perioperative managements as well as ongoing adherence to a p...Enhanced recovery after surgery(ERAS)is a strategy of perioperative management aimed to accelerate the rehabilitation of patients through various optimized perioperative managements as well as ongoing adherence to a patient-focused,multidisciplinary,and multimodal approach.ERAS is a good reflection of the perioperative value-based care,which has been widely applied in many surgical fields and shown quick recovery and low morbidity when applied on patients.However,there is a lack of attention on ERAS in neurosurgery.This review aims to describe the current application status of ERAS in neurosurgery and to provide readers with the commonly accepted principles in the perioperative nursing of neurosurgery.展开更多
Objective:To explore the effect of detail nursing in neurosurgery.Methods:72 cases of neurosurgery patients in our hospital from July 2018 to June 2020 were selected as the research sample,and they were divided into d...Objective:To explore the effect of detail nursing in neurosurgery.Methods:72 cases of neurosurgery patients in our hospital from July 2018 to June 2020 were selected as the research sample,and they were divided into detail nursing group and routine nursing group,with 36 cases in each group.The retrospective analysis method was used to compare the effect of nursing intervention between the two groups.Results:The scores of anxiety(23.25±1.97*),depression(25.75±2.53*)and social activity ability(23.13±2.36*)in detail nursing group were higher than those in routine nursing group;The nursing satisfaction of detail nursing group was 35 cases(97.22%),significantly higher than that of routine nursing group 26 cases(72.22%),P<0.05,with statistical significance.Conclusion:Through the details of neurosurgery patients nursing means,to improve the prognosis of patients with recovery and improve the quality of life have significant effect,can reduce the complications of patients with prognosis,improve the patient's cognition of details of nursing,reduce the contradiction between doctors and patients,improve nursing satisfaction,has high clinical application and promotion value.展开更多
BACKGROUND： Han＇s acupoint nerve stimulator （HANS） has been frequently used to relieve pain by promoting the central nerve system＇s release of endogenous opioid peptides through electric stimulation to the body s...BACKGROUND： Han＇s acupoint nerve stimulator （HANS） has been frequently used to relieve pain by promoting the central nerve system＇s release of endogenous opioid peptides through electric stimulation to the body surface. OBJECTIVE： To investigate the pain-relieving effects of HANS, combined with patient-controlled analgesia, following neurosurgery, and to observe adverse reactions and effects. DESIGN, TIME AND SETTING： A randomized control observation was performed at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College （Ganzhou, Jiangxi Province, China） from January 2005 to February 2006. PARTICIPANTS： Forty patients, who were selected for craniotomy and required pain relief following surgery at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College （China）, were included in this study. METHODS： Forty patients underwent neurosurgery and were randomly divided into two groups： patient-controlled analgesia plus HANS （＋HANS, n = 20） and patient-controlled analgesia （-HANS, n = 20）. Both groups were well matched in baseline data. Automatic syringe infusion pump ZZB-150 was the product of Nantong Aipeng Medical Instruments Co., Ltd. （China）. Patient-controlled analgesia consisted of 100 mL 0.02% lappaconitine/0.02% metoclopramide. LH-402 HANS instrument was produced in Beijing （China）, with a serial number of 402183. The HANS instrumentation was used to stimulate the Hegu-Laogong acupoint on one side and Jiaogan, Shenmen penetrating Shen, Waifei, Naogan penetrating Pizhixia ear acupoints on the affected side for one hour, with 2-hour intervals. The disperse-dense wave was alternating, with a 2/100 Hz frequency of electrical stimulation. MAIN OUTCOME MEASURE： The scores of visual analogue scale and incidence of adverse reaction were observed in two groups following surgery. RESULTS： Compared with the HANS group, the visual analogue scale scores were remarkably lower in the ＋HANS group six hours after surgery （P 〈 0.01）, and the incidence rate of adverse reactions, such as nausea and vomiting, was also decreased （P 〈 0.05）.CONCLUSION： The application of HANS to induce body surface stimulation can enhance the effect of pain relief and reduce adverse reactions when used in combination with patient-controlled analgesia following neurosurgery. The effect of combined therapy is superior to patient-controlled analgesia alone.展开更多
Time:May 3-6,2020,Venue:Athens,Greece,Website:https://www.erasmus.gr/microsites/1179The 27th Congress of the European Society for Pediatric Neurosurgery(ESPN)will take place in Athens,Greece on May 3-6,2020.ESPN aims ...Time:May 3-6,2020,Venue:Athens,Greece,Website:https://www.erasmus.gr/microsites/1179The 27th Congress of the European Society for Pediatric Neurosurgery(ESPN)will take place in Athens,Greece on May 3-6,2020.ESPN aims to organize an outstanding scientific and educational congress to facilitate the spread and exchange of knowledge,skills and attitudes,between experts,researchers,clinicians and trainees,and to continue the development of pediatric neurosurgery in Europe.展开更多
The number of invasive procedures in medicine is increasing,as is the employment of new technological achievements.In the era of informationcommunication technology,one such achievement is also the telemedicine networ...The number of invasive procedures in medicine is increasing,as is the employment of new technological achievements.In the era of informationcommunication technology,one such achievement is also the telemedicine network.In Slovenia,it is known as the Telekap(TeleStroke) network,which was primarily designed for fast and efficient management of stroke patients.In the neurosurgical community,the system is frequently used also for conveying vital information regarding subarachnoid haemorrhage and trauma.Especially in neurosurgical emergencies,this communication system offers thorough information about the extent and location of bleeding and facilitates the preoperative planning of neurosurgical interventions.From our experience so far,the system should be expanded to other neuro-centres as well to all neurosurgery departments in order to facilitate patient management,their acute hospital care,and inter-speciality collaboration.展开更多
Functional neurosurgery is nowadays a recognized treatment for advanced Parkinson’s disease with pharmacologically uncontrolled symptoms. This procedure brings us the unique opportunity to deepen in the knowledge of...Functional neurosurgery is nowadays a recognized treatment for advanced Parkinson’s disease with pharmacologically uncontrolled symptoms. This procedure brings us the unique opportunity to deepen in the knowledge of PD’s physiopathology by recording patients’ neural activity, and possibly in the future it will let us select the appropriate target and the optimal chronic stimulation pattern.展开更多
Aim: To evaluate the anesthetic management of neurosurgical patients in University Hospital of Brazzaville. Materials and methods: We performed a transversal and descriptive study during the period from January to Jun...Aim: To evaluate the anesthetic management of neurosurgical patients in University Hospital of Brazzaville. Materials and methods: We performed a transversal and descriptive study during the period from January to June 2015 into operating room of the University Hospital of Brazzaville. 60 cases of anesthesia have been analyzed. Results: The neurosurgery represented 2.88% of the activity of the operating room in University Hospital of Brazzaville. The average age was 44.7 ± 18.36 years old. The sex ratio was 1.07. The scheduled interventions have concerned 83.4% of cases. Surgical indications were concerned the spine degenerative disease and spinal trauma in 40% and 18.3% of cases respectively. The patients classified ASA I and II were most represented in 40% and 46.7% of cases respectively. General anesthesia was used in 98.4% of cases. The peroperative complications were represented by arterial hypotension (31.7%), hemorrhage (11.7%), bradycardia (5%), difficult intubation (3.3%) and one case of peroperative cardiac arrest. The blood transfusion rate was 18.7%. The stay in ICU concerned 8.3% of the cases. We recorded three cases (5%) of death in our series. Conclusion: The neuroanesthesia knows an evolution in our country because of increasing number of neurosurgeons;it’s necessary to train medical staff in her practice.展开更多
During the COVID‑19 epidemic period,the front‑line antiepidemic departments have attracted much attention.However,to meet people’s daily needs for the diagnosis and treatment,emergency department and intensive care u...During the COVID‑19 epidemic period,the front‑line antiepidemic departments have attracted much attention.However,to meet people’s daily needs for the diagnosis and treatment,emergency department and intensive care unit are also the focus of work to control the source of infection,cut off the transmission route,and reduce the risk of novel coronavirus transmission while treating patients.In order to further strengthen the management,our department of neurosurgery took active measures in the emergency treatment for patients and summarized the coping strategies and relevant experience from the aspects of establishment of emergency observation wards,medical staff management,patients and family management,daily environment and object surface disinfection management,material management,and nursing quality management,hoping to provide reference for the nursing management of emergency wards after the outbreak of public health emergencies.展开更多
基金Supported by Science and Technology Program of Nantong City,No.Key003Nantong Young Medical Expert,No.46+2 种基金the Science and Technology Program of Nantong Health Committee,No.MA2019003,No.MA2021017,and No.MSZ2024038Science and Technology Program of Nantong City,No.JCZ2022040Kangda College of Nanjing Medical University,No.KD2021JYYJYB025,No.KD2022KYJJZD022,and No.KD2024KYJJ289.
文摘Delirium is a transient and acute syndrome of encephalopathy,characterized by disturbances in consciousness,orientation,cognition,perception,and emotional regulation,often accompanied by hallucinations,illusions,psychomotor agitation,and restlessness.Postoperative delirium(POD),a common complication particularly in elderly patients,significantly impacts recovery by prolonging mechanical ventilation,neurosurgical intensive care unit stays,and overall hospitalization durations,while severely diminishing patients’quality of life after discharge.Despite its prevalence,POD remains underrecognized in clinical practice,with significant gaps in its diagnosis and management.This review explores the definition,diagnostic criteria,underlying pathogenesis,and associated risk factors of POD in neurosurgical patients,aiming to offer valuable insights for improving clinical diagnosis and therapeutic strategies.
基金Humanities and Social Science Research Project of Sichuan Nursing Vocational College,“Strategies and Research on the Improvement of Clinical Reasoning and Reflection Ability of Nursing Students in Neurosurgery Internship through Serious Game Teaching Method”(Project No.:2023RWSY42)。
文摘Neurosurgical patients present complex clinical conditions with high nursing risks.Under traditional teaching models,nursing interns often exhibit challenges such as weak clinical reasoning,insufficient reflective capabilities,and inadequate operational proficiency,which fail to meet clinical nursing demands.This study focuses on neurosurgical nursing interns as research subjects,systematically exploring the application value and implementation pathways of serious game pedagogy in cultivating clinical competencies.
文摘Perioperative management of antiplatelet therapy involves a delicate balancing of the risk of periprocedural blood loss with the cardiovascular and thrombotic risk to the patient.Due to the unique nature of neurosurgery,perioperative bleeding may have devastating consequences and cause major morbidity and mortality.The recommendation to discontinue aspirin prior to major neurosurgical procedures rests upon conventional practice,expert consensus with priority given to avoidance of any major bleed.On the contrary recent prospective data do not support the existence of additional bleeding risk in patients continuing aspirin compared to those who stop aspirin prior to procedure.Patients with cardiova-scular and metabolic comorbidities are increasingly encountered in the operation theatre these days.In these patients,prevention of myocardial injury after non-cardiac surgery(MINS)is an important focus for perioperative risk reduction.Prolonged(≥7 days)cessation of antiplatelets is one of the most important predictors of MINS.This complicated milieu of risks and benefits highlights the difficulty of practicing evidence-based medicine and minimizing harm in patients on aspirin needing neurosurgery.
文摘BACKGROUND After approval for clinical use in 2017,early investigations of ultra-high-field abdominal magnetic resonance imaging(MRI)have demonstrated its feasibility as well as diagnostic capabilities in neuroimaging.However,there are no to few systematic reviews covering the entirety of its neurosurgical applications as well as the trends in the literature with regard to the aforementioned application.AIM To assess the impact of 7-Tesla MRI(7T MRI)on neurosurgery,focusing on its applications in diagnosis,treatment planning,and postoperative assessment,and to systematically analyze and identify patterns and trends in the existing literature related to the utilization of 7T MRI in neurosurgical contexts.METHODS A systematic search of PubMed was conducted for studies published between January 1,2017,and December 31,2023,using MeSH terms related to 7T MRI and neurosurgery.The inclusion criteria were:Studies involving patients of all ages,meta-analyses,systematic reviews,and original research.The exclusion criteria were:Pre-prints,studies with insufficient data(e.g.,case reports and letters),non-English publications,and studies involving animal subjects.Data synthesis involved standardized extraction forms,and a narrative synthesis was performed.RESULTS We identified 219 records from PubMed within our defined period,with no duplicates or exclusions before screening.After screening,125 articles were excluded for not meeting inclusion criteria,leaving 94 reports.Of these,2 were irrelevant to neurosurgery and 7 were animal studies,resulting in 85 studies included in our systematic review.Data were categorized by neurosurgical procedures and diseases treated using 7T MRI.We also analyzed publications by country and the number of 7T MRI facilities per country was also presented.Experi-mental studies were classified into comparison and non-comparison studies based on whether 7T MRI was compared to lower field strengths.CONCLUSION 7T MRI holds great potential in improving the characterization and understanding of various neurological and psychiatric conditions that may be neurosurgically treated.These include epilepsy,pituitary adenoma,Parkinson's disease,cerebrovascular diseases,trigeminal neuralgia,traumatic head injury,multiple sclerosis,glioma,and psychiatric disorders.Superiority of 7T MRI over lower field strengths was demonstrated in terms of image quality,lesion detection,and tissue characterization.Findings suggest the need for accelerated global distribution of 7T magnetic resonance systems and increased training for radiologists to ensure safe and effective integration into routine clinical practice.
文摘BACKGROUND Mycoplasma hominis(M.hominis),which causes central nervous system infections in adults,is very rare.It is also relatively difficult to culture mycoplasma and culturing requires special media,resulting in a high rate of clinical underdiagnosis.Therefore,clinicians often treat patients based on their own experience before obtaining pathogenic results and may ignore infections with atypical pathogens,thus delaying the diagnosis and treatment of patients and increasing the length of hospital stay and costs.CASE SUMMARY A 44-year-old man presented to the hospital complaining of recurrent dizziness for 1 year,which had worsened in the last week.After admission,brain magnetic resonance imaging(MRI)revealed a 7.0 cm×6.0 cm×6.1 cm lesion at the skull base,which was irregular in shape and had a midline shift to the left.Based on imaging findings,meningioma was our primary consideration.After lesion resection,the patient had persistent fever and a diagnosis of suppurative meningitis based on cerebrospinal fluid(CSF)examination.The patient was treated with the highest level of antibiotics(meropenem and linezolid),but the response was ineffective.Finally,M.hominis was detected by next-generation metagenomic sequencing(mNGS)in the CSF.Therefore,we changed the antibiotics to moxifloxacin 0.4 g daily combined with doxycycline 0.1 g twice a day for 2 wk,and the patient had a normal temperature the next day.CONCLUSION Mycoplasma meningitis after neurosurgery is rare.We can use mNGS to detect M.hominis in the CSF and then provide targeted treatment.
文摘Since December 2019,an outbreak of coronavirus disease 2019(COVID-19)has.posed significant threats to the public health and life in China.Unlike the other 6 identified coronaviruscs,the SARS-Cov-2 has a high infectious rate,a long incubation period and a variety of manifestations.In the absence of effective treatments for the virus,it becomes extremely urgent to develop scientific and standardized proposals for prevention and control of virus transmission.Hereby we focused on the surgical practice in Neurosurgery Department,Tongji Hospital,Wuhan,and drafted several recommendations based on the latest relevant guidelines and our experience.These recommendations have helped us until now to achieve'zero infection'of doctors and nurses in our department,we would like to share them with other medical staff of neurosurgery to fight 2019-nCoV infection.
文摘BACKGROUND During skull base surgery,intraoperative internal carotid artery(ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia.Appropriate management of ICA injury plays a crucial role in the prognosis of patients.Neurosurgeons have reported multiple techniques and management strategies;however,the literature on managing this complication from the anesthesiologist’s perspective is limited,especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.CASE SUMMARY We describe 4 cases of ICA injury during neurosurgery;there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma.After the onset of ICA injury,all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation.Three patients were transferred to the hybrid operating room,and one patient was transferred to the catheter operating room.Three patients underwent covered stent implantation,and one patient underwent embolization.All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation.After the neurosurgery,one patient was extubated and returned to the ward,and the other three were delayed tracheal extubation and returned to the intensive care unit.One patient died from serious neurological complications after 62 d in the hospital,but the other three showed good clinical outcomes.CONCLUSION ICA injury imposes a high risk of massive hemorrhage and subsequent infarction.Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons,anesthesiologists,and interventional neuroradiologists.Effective hemostatic methods,stable hemodynamics sufficient to ensure perfusion of vital organs,airway safety during transit,rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.
文摘<strong>Background:</strong> <span "=""><span>Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous study </span><span>that there were multiple predictors of postoperative outcome, including</span><span> American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A secondary analysis describing intraoperative and postoperative outcomes was undertaken in children aged between 6 and 10 years old included in the initial study. </span><b><span>Objective: </span></b><span>To describe intraoperative and postoperative outcomes in children aged between 6 and 10 years old included in the initial cohort in abdominal surgery, neurosurgery and orthopedics. </span><b><span>Methods: </span></b><span>The secondary analysis of postoperative outcomes in children aged between 6 and 10 years old w</span></span><span>as</span><span "=""><span> retrospectively included in the initial study of 594 patients. The study was approved by the Ethics Committee. </span><b><span>Results: </span></b><span>There were 88 patients with a mean age of 98.7 ±</span></span><span "=""> </span><span "=""><span>13.8 months. The most common surgical interventions were scoliosis in 23 patients (26.1%), limb tumor resection in 8 patients (9.1%), femoral osteotomy in 6 patients (6.8%), intracerebral tumor resection in 6 patients (6.8%), intestinal resection in 5 patients (5.6%), Chiari’s malformation in 4 patients (4.5%), pelvic osteotomy in 4 patients (4.5%) and renal transplantation in 4 patients (4.5%). Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3), and 13 (14.8%) were ASA grade 4. Twenty-two (25%) patients had intraoperative and/or postoperative complications (organ dysfunction or sepsis). Two patients (2.3%) had intraoperative hemorrhage, 1 patient (1.1%) had intraoperative difficult intubation, and 1 patient experienced intraoperative anaphy</span><span>laxis. Nine patients (10.2%) had postoperative neurologic failure, and 2</span><span> (2.3%) had postoperative cardio-circulatory failure. Three patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis, and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42</span></span><span "=""> </span><span>(47.7%) patients had intra-operative transfusion. There was 1 in-hospital death (1.1%). The median total length of hospital stay was 9 days [5</span><span "=""> </span><span>-</span><span "=""> </span><span "=""><span>16]. </span><b><span>Conclusion: </span></b><span>Twenty-five percent of the patients had intraoperative and/or postoperative complications, and most of them were ASA grade </span></span><span>3</span><span> 3. Integrating goal-directed therapies to optimize intraoperative management in these patients could be necessary to improve postoperative outcomes in surgical pediatric patients.
文摘The coexistence of different water homeostasis abnormalities following neurosurgery represents a diagnostic and therapeutic challenge for intensive care units. This paper reports the case of a 13 year-old boy who underwent surgery for a suprasellar tumour and, immediately after surgery, developed a cerebral abscess, persistent diabetes insipidus (DI) as well as cerebral salt wasting syndrome (CSWS). The early onset of CSWS following DI has been associated with a poor prognosis and increased mortality. In cases in which these abnormalities coexist, the increased polyuria secondary to the rise in natriuresis associated with CSWS might be erroneously interpreted as a sign of poor control of the DI, thereby leading to therapeutic mistakes. Treatment basically consists of restoring electrolytes and the joint administration of desmopressin and fludrocortisone.
文摘<strong>Background and Goal of Study:</strong> Intraoperative awareness is a serious but preventable complication of general anaesthesia. Bispectral index (BIS) is the most widely used method monitoring anaesthesia depth. BIS monitoring requires attachment of forehead sensors, which poses a challenge when the surgical field involves the forehead. We aimed to compare the gold standard forehead position of BIS sensors with an alternative position across the nasal dorsum for neurosurgical procedures.<strong> Materials and Methods: </strong>After ethical committee approval and informed consent were obtained, 62 patients were enrolled in this prospective observational study. Frontal and nasal BIS values were compared in all patients.<strong> Results and Discussion:</strong> The mean BIS value from frontal versus nasal sensors was 49 ± 22 and 49 ± 21 respectively (n: 62). These values were statistically correlated (ICC 0.78, p < 0.001) indicating that nasal BIS measurement does not present a disadvantage for routine use when needed. <strong>Conclusion:</strong> Our data reveal that for measuring anesthesia depth, BIS sensor placement on the nasal dorsum shows comparable efficiency in comparison to standard frontal
文摘Enhanced recovery after surgery(ERAS)is a strategy of perioperative management aimed to accelerate the rehabilitation of patients through various optimized perioperative managements as well as ongoing adherence to a patient-focused,multidisciplinary,and multimodal approach.ERAS is a good reflection of the perioperative value-based care,which has been widely applied in many surgical fields and shown quick recovery and low morbidity when applied on patients.However,there is a lack of attention on ERAS in neurosurgery.This review aims to describe the current application status of ERAS in neurosurgery and to provide readers with the commonly accepted principles in the perioperative nursing of neurosurgery.
文摘Objective:To explore the effect of detail nursing in neurosurgery.Methods:72 cases of neurosurgery patients in our hospital from July 2018 to June 2020 were selected as the research sample,and they were divided into detail nursing group and routine nursing group,with 36 cases in each group.The retrospective analysis method was used to compare the effect of nursing intervention between the two groups.Results:The scores of anxiety(23.25±1.97*),depression(25.75±2.53*)and social activity ability(23.13±2.36*)in detail nursing group were higher than those in routine nursing group;The nursing satisfaction of detail nursing group was 35 cases(97.22%),significantly higher than that of routine nursing group 26 cases(72.22%),P<0.05,with statistical significance.Conclusion:Through the details of neurosurgery patients nursing means,to improve the prognosis of patients with recovery and improve the quality of life have significant effect,can reduce the complications of patients with prognosis,improve the patient's cognition of details of nursing,reduce the contradiction between doctors and patients,improve nursing satisfaction,has high clinical application and promotion value.
文摘BACKGROUND： Han＇s acupoint nerve stimulator （HANS） has been frequently used to relieve pain by promoting the central nerve system＇s release of endogenous opioid peptides through electric stimulation to the body surface. OBJECTIVE： To investigate the pain-relieving effects of HANS, combined with patient-controlled analgesia, following neurosurgery, and to observe adverse reactions and effects. DESIGN, TIME AND SETTING： A randomized control observation was performed at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College （Ganzhou, Jiangxi Province, China） from January 2005 to February 2006. PARTICIPANTS： Forty patients, who were selected for craniotomy and required pain relief following surgery at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College （China）, were included in this study. METHODS： Forty patients underwent neurosurgery and were randomly divided into two groups： patient-controlled analgesia plus HANS （＋HANS, n = 20） and patient-controlled analgesia （-HANS, n = 20）. Both groups were well matched in baseline data. Automatic syringe infusion pump ZZB-150 was the product of Nantong Aipeng Medical Instruments Co., Ltd. （China）. Patient-controlled analgesia consisted of 100 mL 0.02% lappaconitine/0.02% metoclopramide. LH-402 HANS instrument was produced in Beijing （China）, with a serial number of 402183. The HANS instrumentation was used to stimulate the Hegu-Laogong acupoint on one side and Jiaogan, Shenmen penetrating Shen, Waifei, Naogan penetrating Pizhixia ear acupoints on the affected side for one hour, with 2-hour intervals. The disperse-dense wave was alternating, with a 2/100 Hz frequency of electrical stimulation. MAIN OUTCOME MEASURE： The scores of visual analogue scale and incidence of adverse reaction were observed in two groups following surgery. RESULTS： Compared with the HANS group, the visual analogue scale scores were remarkably lower in the ＋HANS group six hours after surgery （P 〈 0.01）, and the incidence rate of adverse reactions, such as nausea and vomiting, was also decreased （P 〈 0.05）.CONCLUSION： The application of HANS to induce body surface stimulation can enhance the effect of pain relief and reduce adverse reactions when used in combination with patient-controlled analgesia following neurosurgery. The effect of combined therapy is superior to patient-controlled analgesia alone.
文摘Time:May 3-6,2020,Venue:Athens,Greece,Website:https://www.erasmus.gr/microsites/1179The 27th Congress of the European Society for Pediatric Neurosurgery(ESPN)will take place in Athens,Greece on May 3-6,2020.ESPN aims to organize an outstanding scientific and educational congress to facilitate the spread and exchange of knowledge,skills and attitudes,between experts,researchers,clinicians and trainees,and to continue the development of pediatric neurosurgery in Europe.
文摘The number of invasive procedures in medicine is increasing,as is the employment of new technological achievements.In the era of informationcommunication technology,one such achievement is also the telemedicine network.In Slovenia,it is known as the Telekap(TeleStroke) network,which was primarily designed for fast and efficient management of stroke patients.In the neurosurgical community,the system is frequently used also for conveying vital information regarding subarachnoid haemorrhage and trauma.Especially in neurosurgical emergencies,this communication system offers thorough information about the extent and location of bleeding and facilitates the preoperative planning of neurosurgical interventions.From our experience so far,the system should be expanded to other neuro-centres as well to all neurosurgery departments in order to facilitate patient management,their acute hospital care,and inter-speciality collaboration.
文摘Functional neurosurgery is nowadays a recognized treatment for advanced Parkinson’s disease with pharmacologically uncontrolled symptoms. This procedure brings us the unique opportunity to deepen in the knowledge of PD’s physiopathology by recording patients’ neural activity, and possibly in the future it will let us select the appropriate target and the optimal chronic stimulation pattern.
文摘Aim: To evaluate the anesthetic management of neurosurgical patients in University Hospital of Brazzaville. Materials and methods: We performed a transversal and descriptive study during the period from January to June 2015 into operating room of the University Hospital of Brazzaville. 60 cases of anesthesia have been analyzed. Results: The neurosurgery represented 2.88% of the activity of the operating room in University Hospital of Brazzaville. The average age was 44.7 ± 18.36 years old. The sex ratio was 1.07. The scheduled interventions have concerned 83.4% of cases. Surgical indications were concerned the spine degenerative disease and spinal trauma in 40% and 18.3% of cases respectively. The patients classified ASA I and II were most represented in 40% and 46.7% of cases respectively. General anesthesia was used in 98.4% of cases. The peroperative complications were represented by arterial hypotension (31.7%), hemorrhage (11.7%), bradycardia (5%), difficult intubation (3.3%) and one case of peroperative cardiac arrest. The blood transfusion rate was 18.7%. The stay in ICU concerned 8.3% of the cases. We recorded three cases (5%) of death in our series. Conclusion: The neuroanesthesia knows an evolution in our country because of increasing number of neurosurgeons;it’s necessary to train medical staff in her practice.
文摘During the COVID‑19 epidemic period,the front‑line antiepidemic departments have attracted much attention.However,to meet people’s daily needs for the diagnosis and treatment,emergency department and intensive care unit are also the focus of work to control the source of infection,cut off the transmission route,and reduce the risk of novel coronavirus transmission while treating patients.In order to further strengthen the management,our department of neurosurgery took active measures in the emergency treatment for patients and summarized the coping strategies and relevant experience from the aspects of establishment of emergency observation wards,medical staff management,patients and family management,daily environment and object surface disinfection management,material management,and nursing quality management,hoping to provide reference for the nursing management of emergency wards after the outbreak of public health emergencies.
