Neutrophil to lymphocyte ratio is a prognosis factor for post-operative pneumonia in aneurysmal subarachnoid hemorrhage patients

Background:Although a variety of risk factors of pneumonia after clipping or coiling of the aneurysm(post-operative pneumonia[POP])in patients with aneurysmal subarachnoid hemorrhage(aSAH)have been studied,the predictive model of POP after aSAH has still not been well established.Thus,the aim of this study was to assess the feasibility of using admission neutrophil to lymphocyte ratio(NLR)to predict the occurrence of POP in aSAH patients.Methods:We evaluated 711 aSAH patients who were enrolled in a prospective observational study and collected admission blood cell counts data.We analyzed available demographics and baseline variables for these patients and analyzed the correlation of these factors with POP using Cox regression.After screening out the prognosis-related factors,the predictive value of these factors for POP was further assessed.Results:POP occurred in 219 patients(30.4%)in this cohort.Patients with POP had significantly higher NLR than those without(14.11±8.90vs.8.80±5.82,P<0.001).Multivariate analysis revealed that NLR remained a significant factor independently associated with POP following aSAH after adjusting for possible confounding factors,including the age,World Federation of Neurosurgical Societies(WFNS)grade,endovascular treatment,and ventilator use.And the predictive value of NLR was significantly increased after WFNS grade was combined with NLR(NLRvs.WFNS grade×NLR,P=0.011).Conclusions:Regardless of good or poor WNFS grade,patients having NLR>10 had significantly worse POP survival rate than patients having NLR≤10.NLR at admission might be helpful as a predictor of POP in aSAH patients.

The prevalence of freezing of gait in Parkinson’s disease and in patients with different disease durations and severities

Background:The prevalence rates of freezing of gait(FOG)in Parkinson’s disease(PD)vary widely,ranging from 14.0 to 55.1%.Our aim is to calculate the overall prevalence of FOG in all PD patients with different disease durations and severities.Methods:Using Medline/PubMed/Embase,we carried out a systematic literature search for studies reporting the PD and clinically relevant FOG.Results:After primary screening,a total of 35 studies were identified and further analyzed for inclusion into the analysis,and 29 studies fulfilled the quality criteria and included in this meta-analysis.The overall prevalence of FOG in PD was 39.9%(95%CI 35.3-44.5%).The FOG identified by the freezing of gait questionnaire item 3 may be more prevalent(43.8%,95%CI 38.5-49.1%)than the FOG identified by the Unified Parkinson’s Disease Rating Scale item 14(36.0%,95%CI 29.0-43.1%).Disease duration and severity are both the clinical features associated with the FOG.The highest FOG prevalence rate in PD patients was seen in patients with disease durations≥10 years,at 70.8%,followed that of PD patients with disease durations≥5 years(53.3%),and PD patients with disease durations<5 years(22.4%).FOG presented in 28.4%of PD patients with Hoehn and Yahr staging(H&Y)score≤2.5,and in 68.4%of PD patients with H&Y score≥2.5.Conclusion:This meta-analysis confirms that the prevalence of FOG in PD is considerable,and highlights the need for accurate identification of FOG in PD.

Application of Keyhole Microneurosurgery in China

INTRODUCTIONMicroneurosurgery made its debut in the early 1960s. It became popular in the medical field and became a primary operation method in neurosurgery since it improved the efficacy of neurosurgery with a less surgery-related injury. Over the past five decades, the accumulation of experience of microsurgery, improvement of microsurgery techniques, refined micro-instruments, and advanced preoperative diagnostic imaging allowed the evolution of microneurosurgery techniques and further reduced surgery-related trauma.

Twist drill craniostomy for traumatic acute subdural hematoma in the elderly: case series and literature review

Background:A large craniotomy is usually the first choice for removal of traumatic acute subdural hematoma (TASDH).To date,few studies have reported that TASDH could be successfully treated by twist drill craniostomy (TDC) alone or combined with instillation of urokinase.We aimed to define the TDC for the elderly with TASDH and performed literature review.Case presentation:A total of 7 TASDH patients,who were presented and treated by TDC in this retrospective study between January 2009 and May 2017,consisted of 5 men and 2 women,ranging in age from 65 to 89 (average,78.9) years.The patients' baseline characteristics,including age,sex,medical history,received ventriculoperitoneal shunt for hydrocephalus or not,reason for avoiding or refusing large craniotomy,preoperative Glasgow Coma Scale (GCS),suffered from cerebral herniation or not,the location of TASDH,imaging characteristics of TASDH in CT scan,injury/surgery time interval,midline shift,preoperative neurologic deficit,operation time,and infusions of urokinase or not,were collected.The postoperative GCS,postoperative neurologic deficit,rebleeding or not,intracranial infection,and modified Rankin Scale (mRS) at 6 months after surgery were analyzed to access the safety and efficacy of evacuation with TDC.The results showed that the mean time interval from injury to TDC was 68.6 min (30-120 min).The mean distance of midline shift was 14.6 mm (10-20 mm).The preoperative GCS in all patients ranged from 4 to 13(median,9).The mean duration of the operation was 14.4 min (6-19 min).Postoperative CT scan showed that hematoma evacuation rate was more than 70% in all cases.There were no cases of acute rebleeding and intracranial infection after TDC.No cases presented with chronic SDH at the ipsilateral side within 6 months after being treated by TDC alone or combined with instillation of urokinase.Favorable outcomes were shown in all cases (mRS scores 0-2) at 6 months after surgery.Conclusions:TASDH in the elderly could be safely and effectively treated by TDC alone or combined with instillation of urokinase,which was a possible alternative for the elderly.

Can admission lipoprotein-associated phospholipase A2 predict the symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage?

Background:Inflammation has been believed to be related to the development of cerebral vasospasm following aneurysmal subarachnoid hemorrhage(aSAH).A potential biomarker for vascular inflammation that is well recognized is the lipoprotein-associated phospholipase A2(Lp-PLA2).However,whether Lp-PLA2 can predict the occurrence of symptomatic cerebral vasospasm(SCV)in aSAH patients is still unknown.Thus,this study aimed to assess the value of Lp-PLA2 for predicting SCV in patients with aSAH.Methods:Between March 2017 and April 2018,we evaluated 128 consecutive aSAH patients who were admitted in the First Affiliated Hospital of Fujian Medical University.Their Lp-PLA2 level was obtained within 24 h of the initial bleeding.Factors might be related to SCV were analyzed.Results:Compared to patients without SCV,those with SCV(9.4%,12/128)had significantly higher Lp-PLA2 level.Multivariate logistic analysis revealed that worse modified Fisher grade(OR=10.08,95%CI=2.04–49.86,P=0.005)and higher Lp-PLA2 level(OR=6.66,95%CI=1.33–3.30,P=0.021)were significantly associated with SCV,even after adjustment for confounders.Based on the best threshold,Lp-PLA2 had a sensitivity of 83.3%and a specificity of 51.7%for predicting SCV,as shown by the receiver operating characteristic curve analysis.In the poor World Federation of Neurosurgical Societies grade patient sub-group,patients with Lp-PLA2>200μg/L had significantly higher SCV rate than that of patients having Lp-PLA2≤200μg/L.Conclusion:The admission Lp-PLA2 level might be a helpful predictor for SCV in aSAH.

Systemic inflammatory response index improves the prediction of postoperative pneumonia following meningioma resection

Meningiomas are common tumors of the central nervous system,[1,2]and surgery is an effective treatment for meningiomas.Postoperative pneumonia(POP)is one of the common complications after meningioma resection.Even with the improvement of surgical techniques and postoperative care,the incidence of POP has still not been significantly improved.Exploring new predictive indicators can help to screen high-risk POP patients,intervene early,and improve patient prognosis.

Patient-specific ventricular puncture trajectory plane and puncture trajectory: a novel method of frontal ventricular puncture

Ventricular puncture is a common neurosurgical procedure,which is usually performed freehand using body surface anatomic landmarks as targeting references.[1,2]However,it is reported that the failure rate of freehand lateral ventricle puncture could be as high as 43%in traumatic brain injury cases if body surface anatomic landmarks are used as targeting references,[3]and the occurrence of hemorrhages associated with ventricular puncture could reach 16.2%.[4]Classic puncture sites,such as Kocher point,are helpful in improving the success rate of ventricular puncture.However,it is still risky to perform freehand puncture with classic puncture sites.Several causes could lead to this issue,including the following:(1)Individual patients have different conditions;a puncture approach suitable for all patients might not be possible.(2)Selection of puncture approach is largely dependent on the judgment of the surgeon,because the puncture approach does not usually fall on the coronal,sagittal,or axial images of the regular computed tomography(CT)scan;surgeons need to use spatial imagination based on CT images to design the ventricular puncture trajectory(VPT),which could lead to errors.(3)In freehand puncture,directional deviations could occur easily without the guidance of a frame as a fixed space reference to the puncture path.

The classification of intracranial aneurysm neck: a single center research experience

There is associating with incidence of unfavorable outcomes compared to microsurgical clippings. We are in order to investigate the outcomes of microsurgical clipping for intracranial aneurysms and determine the ideal clipping methods for different aneurysm subtypes. Method: Retrospectively analyzed the clinical characteristics and follow-up data (completely recorded) of 123 patients with 128 aneurysms were treated. 20 cases were treated as control group from October 2013 to December 2013. Since January 2014, aneurysms were classified base on the 20 cases of aneurysm imaging data. 103 patients were treated as experimental group, the classification of aneurysms previously proposed was used to estimate the way of surgery, and the guiding value of the genotype was verified according to the intraoperative findings. The proposed aneurysm classification is based on the virtual surface of the aneurysm and the parent artery, the aneurysm neck was classified as follows: subtype I, the curved surface of the neck is a single curved surface;subtype II, the neck is hyperboloid;subtype III, neck is a three-curved surface. Aneurysms were divided into further subtypes according to the ratio of the width of the aneurysm neck surface and the length of the artery circumference: subtype A, the ratio of the aneurysm neck surface to the parent artery was not more than 0.5;subtype B, more than 0.5. There are some clamping methods include simple, sliding, interlocking and hybrid. Results: In the control group, patients did not undergo a suitable clipping scheme without classification of aneurysm neck (unclassed clipping). While causing the occurrence of occlusion adverse events, including neck residual, Tumor artery stenosis, electrophysiological changes, the lack of blood supply and so on. The experimental[page1image12073600]group was analyzed by using a predetermined clipping scheme (classed clipping), and the use of aneurysms clamps was approximately the same as expected. Compared the preoperative assessment with the actual situation, the consistency of the control group was 50% and the experimental group was 96%. Adverse events of classed clipping is 2%, another is 60%. There is a significant difference between the two groups (P < 0.05).Classed clipping of subject IA and IB are simple (mean 1.2 and 1.3 clips);classed clipping of subject IIA is simple and interlocking(mean 1.2 clips);classed clipping of subject IIB is sliding and hybrid(mean 2.05 clips);classed clipping of subject IIIA and IIIB are hybrid(mean 2.3 clips). Conclusion: There is a higher consistency in surgery through the above classification of preoperative assessment of clipping. There was no adverse event of intracranial aneurysm clipping in the clipping mode selected by the above classification, and satisfactory surgical clipping rate was achieved and no recurrence was found.

Risk factors of acute coagulation dysfunction after aneurysmal subarachnoid hemorrhage

Background: Although coagulopathy have been proved to be a contributor to a poor outcome of aneurysmal subarachnoid hemorrhage (aSAH), the risk factors for triggering coagulation abnormalities have not been studied after aneurysm clipping. Methods: We investigated risk factors of coagulopathy and analyzed the relationship between acute coagulopathy and outcome after aneurysm clipping. The clinical data of 137 patients with ruptured CA admitted to our institution was collected and retrospectively reviewed. Patient demographic data (age, sex), smoking, alcohol use, hypertension, diabetes, Hunt-Hess grade, Fisher grade, operation time, intraoperative total infusion volume, intraoperative blood loss, intraoperative transfusion, intraoperative hemostatic drug treatment, calcium reduction (preoperative free calcium concentration–postoperative free calcium concentration) were recorded. Coagulation was assessed within 24 h. Postoperative hemorrhage and infarction, deep venous thrombosis (DVT), and mortality were analyzed. Results: Coagulopathy was detected in a total of 51 cases (group I), while not in 86 cases (group II). Univariable analysis demonstrated that age, smoking, alcohol use, intraoperative total infusion volume, intraoperative blood loss, intraoperative transfusion, and calcium reduction (≥1.2 mg/dl) were related to coagulopathy. Non-conditional logistic regression analysis showed that age [OR, 1.037 (95% CI, 1.001–1.074);p=0.045] and calcium reduction (≥1.2 mg/dl) [OR, 5.509 (95% CI, 1.900–15.971);p=0.002] were considered as the risk factors for coagulopathy. Hunt-Hess grade [OR, 2.641 (95% CI, 1.079–6.331);p=0.033] and operation time [OR, 0.107 (95% CI, 1.012–0.928);p=0.043] were considered as the risk factors for hypocoagulopathy. There were 6 cases (11.7%) with cerebral infarction in group I, while 6 cases (6.98%) in group II (χ2=0.918, p=0.338). There were 4 cases (7.84%) with rebleeding in group I, while 5 cases (5.81%) in group II (χ2=0.215, p=0.643). The mortality was 9.80% (5/51) in group I, while 1.16% (1/86) in group II (χ2=5.708, p=0.017). DVT was not detected in all cases. Conclusions: In conclusion, age (≥65 years) and calcium reduction (≥1.2 mg/dl) were considered as the risk factors for coagulopathy and have been proved to be associated with higher mortality after aneurysm clipping.