Prospective Assessment of a Symptomatic Cerebral Vasospasm Predictive Neural Network Model

Publication date: October 2016
Source:World Neurosurgery, Volume 94
Author(s): Travis M. Dumont
IntroductionThe author introduced a symptomatic cerebral vasospasm (SCV) prediction model built with freeware based on a 91-patient dataset. In a prospective test group of 22 patients at the same hospital, this model outperformed logistic regression models in vasospasm prediction on the basis of the same datasets. One of the model's limitations was a question of reproducibility in other centers. In this report, the author describes his experience with the prospective use of the model at a different hospital with a different population setting.MethodsPatient data of 25 consecutive cases of aneurysm rupture were prospectively assessed by the model to predict SCV. The prediction was then compared with actual outcome. For the purpose of this report, SCV is defined as a delayed focal decline in neurological examination correlated with an area of radiographic vasospasm. This serves as the primary end point of the predictive model. Each case prediction is reported, along with strength of prediction, which is built into the model. The model's positive predictive value, negative predictive value, and sensitivity and specificity are reported.ResultsThirty patients are included in the analysis. Seven patients (23%) were diagnosed with SCV. The model predicted 10 patients would have SCV (positive predictive value 70%). The model predicted 20 patients would not have SCV (negative predictive value 100%). The sensitivity of the model was 100%, and the specificity of the model was 87%.DiscussionThe present analysis displays the predictive value of a neural network to model symptomatic cerebral vasospasm.



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Endovascular Treatment of 48 Early Branch Aneurysms of the Middle Cerebral Artery

Publication date: October 2016
Source:World Neurosurgery, Volume 94
Author(s): Chuan-Chuan Wang, Wan-Ling Wen, Zheng-Zhe Feng, Yi Xu, Bo Hong, Jian-Min Liu, Qing-Hai Huang
ObjectiveTo evaluate the feasibility of endovascular treatment (EVT) for early branch aneurysms (EBAs) of the middle cerebral artery (MCA).MethodsWe reviewed 211 MCA aneurysms that received EVT between January 2012 and December 2014. The EBAs were identified according to their special patterns on cerebral angiography. The angiographic features, clinical outcomes, and angiographic results were investigated.ResultsForty-eight EBAs (22.7%) in 47 patients were identified among the MCA aneurysms. The treatments were successful in all EBAs, including coiling in 23 aneurysms, balloon-assisted coiling in 4, and stent-assisted coiling in 21. Immediate angiograms showed complete occlusion in 15 aneurysms, residual neck in 18, and residual aneurysm in 15. A procedure-related complication occurred in 1 patient (2.1%) who experienced rebleeding during treatment, and no neurologic function was insulted. Thirty-nine patients underwent angiographic follow-up (mean, 8.2 months), which showed 36 aneurysms were not aggravated, 3 had minor recanalization, and none showed major recanalization. The clinical follow-up (mean, 22.8 months) of all patients demonstrated no neurologic deterioration or rebleeding; however, 1 patient died of unexplained cerebral hemorrhage.ConclusionsPreliminary experience demonstrates that EVT for EBAs is feasible and safe. Direct comparison of clipping and coiling is warranted.



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An Evidence-Based Stepwise Surgical Approach to Cervical Spondylotic Myelopathy: A Narrative Review of the Current Literature

Publication date: October 2016
Source:World Neurosurgery, Volume 94
Author(s): Majid Reza Farrokhi, Fariborz Ghaffarpasand, Mehdi Khani, Mehrnaz Gholami
ObjectiveCervical spondylotic myelopathy (CSM) is the most common progressive degenerative disease of the spine in the geriatric population. The aim of the current review is to provide an evidence-based stepwise surgical approach to CSM according to the recent literature.MethodsWe searched for evidence regarding the surgical approach to CSM in medical databases with articles dated from 1985 to 2016.ResultsIn patients with effective cervical lordosis (fewer than 3 levels of ventral disease), anterior cervical discectomy and fusion (ACDF) or arthroplasty is preferred. Patients with more than 3 levels of compression are generally treated by laminoplasty, especially with preserved lordotic curvature. In patients with straightened spine who have less than 3 involved levels, ACDF with a plate is recommended, whereas patients with more than 3 involved levels with instability should undergo posterior decompression and fusion. In young patients who have a stable cervical spine, laminoplasty is recommended and in old patients with ankylosed spine, only laminectomy should be performed. Patients with mild cervical kyphosis (kyphotic angle ≤10°) should be managed in the same way as patients with straightened spine. However, in severe kyphosis, cervical traction is recommended. If the kyphosis is reducible, further posterior decompression and fusion is adequate. In patients with irreducible kyphosis, if the number of involved levels is less than 2, ACDF is adequate, but if it is more than 2 levels, anterior cervical corpectomy and fusion should be performed using cervical magnetic resonance imaging for evaluation of the patency of the subarachnoid space (SAS). With patent SAS, only posterior fusion is adequate, whereas in closed SAS, posterior decompression with posterior fusion is required. These approaches are based on the most recent evidence.ConclusionsThis article provides a stepwise evidence-based surgical approach for the management and treatment of patients with CSM.



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Predictors of Dysgeusia in Patients With Oropharyngeal Cancer Treated With Chemotherapy and Intensity Modulated Radiation Therapy.

Predictors of Dysgeusia in Patients With Oropharyngeal Cancer Treated With Chemotherapy and Intensity Modulated Radiation Therapy.

Int J Radiat Oncol Biol Phys. 2016 May 17;

Authors: Sapir E, Tao Y, Feng F, Samuels S, El Naqa I, Murdoch-Kinch CA, Feng M, Schipper M, Eisbruch A

Abstract
OBJECTIVE(S): Dysgeusia is a significant factor reducing quality of life and worsening dysphagia in patients receiving chemoradiation therapy for head and neck cancer. The factors affecting dysgeusia severity are uncertain. We investigated the effects on patient-reported dysgeusia of doses to the oral cavity, salivary output (required to dissolve food particles), and patient-reported xerostomia.
METHODS AND MATERIALS: Seventy-three patients with stage III to IV oropharyngeal cancer (OPC) (N=73) receiving definitive intensity modulated radiation therapy concurrently with chemotherapy participated in a prospective, longitudinal study of quality of life (QOL), including assessment of patient-reported gustatory function by taste-related questions from the Head and Neck QOL instrument (HNQOL) and the University of Washington Head and Neck-related QOL instrument (UWQOL), before therapy and periodically after treatment. At these intervals, patients also completed a validated xerostomia-specific questionnaire (XQ) and underwent unstimulated and stimulated major salivary gland flow rate measurements.
RESULTS: At 1, 3, 6, and 12 months after treatment, dysgeusia improved over time: severe dysgeusia was reported by 50%, 40%, 22%, and 23% of patients, respectively. Significant associations were found between patient-reported severe dysgeusia and radiation dose to the oral cavity (P=.005) and tongue (P=.019); normal tissue complication probability for severe dysgeusia at 3 months showed mean oral cavity D50 doses 53 Gy and 57 Gy in the HNQOL and WUQOL questionnaires, respectively, with curve slope (m) of 0.41. Measured salivary output was not statistically significantly correlated with severe taste dysfunction, whereas patient-reported XQ summary scores and xerostomia while eating scores were correlated with severe dysgeusia in the UWQOL tool (P=.04).
CONCLUSIONS: Taste impairment is significantly correlated with mean radiation dose to the oral cavity. Patient-reported xerostomia, but not salivary output, was correlated with severe dysgeusia in 1 of the 2 QOL questionnaires. Reduction in oral cavity doses is likely to improve dysgeusia.

PMID: 27473816 [PubMed - as supplied by publisher]

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Facial onset sensory and motor neuronopathy.

Facial onset sensory and motor neuronopathy.

Neurol Sci. 2016 Jul 29;

Authors: Zheng Q, Chu L, Tan L, Zhang H

Abstract
Facial onset sensory and motor neuronopathy (FOSMN) is a recently defined slowly progressive motor neuron disorder. It is characterized by facial onset sensory abnormalities which may spread to the scalp, neck, upper trunk and extremities, followed by lower motor neuron deficits. Bulbar symptoms, such as dysarthria and dysphagia, muscle weakness, cramps and fasciculations, can present later in the course of the disease. We search the PubMed database for articles published in English from 2006 to 2016 using the term of "Facial onset sensory and motor neuronopathy". Reference lists of the identified articles were selected and reviewed. Only 38 cases of FOSMN have been reported in the Pubmed database since it was first reported in 2006. Typically, FOSMN present with slowly evolving numbness of the face followed by neck and arm weakness. Reduced or absent of corneal reflexes and blink reflex is the main pathognomonic features of FOSMN. In this review, we summarize the epidemiology, clinical presentation, auxiliary examination, and treatment of all the reported cases of FOSMN. Moreover, we discuss the pathogenesis of this rare disorder. In addition, we propose diagnostic criteria for FOSMN.

PMID: 27473302 [PubMed - as supplied by publisher]

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Vesicular stomatitis.

Vesicular stomatitis.

Vet Rec. 2016 Jul 30;179(5):119-20

Authors: Timoney P

Abstract
More than 800 premises in eight states in the USA have recently reported cases of vesicular stomatitis in their horses. Here, Peter Timoney, of the Gluck Equine Research Center in Kentucky, discusses this zoonotic disease in more detail.

PMID: 27474058 [PubMed - in process]

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Vesicular stomatitis.

Vesicular stomatitis.

Vet Rec. 2016 Jul 30;179(5):119-20

Authors: Timoney P

Abstract
More than 800 premises in eight states in the USA have recently reported cases of vesicular stomatitis in their horses. Here, Peter Timoney, of the Gluck Equine Research Center in Kentucky, discusses this zoonotic disease in more detail.

PMID: 27474058 [PubMed - in process]

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