Aim: The aim of this study was to determine whether complications in lumbar fusion surgery can be estimated from pre- or postoperative levels of different laboratory values. In addition, based on the results, we aim to predict in which patients a postoperative laboratory analysis might be of profit and alter the postoperative management. Methods: We retrospectively collected data of patients undergoing lumbar fusion surgery in our departments between January 2014 and February 2015. The patients were divided into four groups: group A included patients with no complications, group B patients with at least one surgical complication, group C patients with at least one medical complication, and group D patients with both a surgical and a medical complication. Levels of pre- and postoperative creatinkinase (CK), hemoglobin (Hb), and C-reactive protein (CRP) were compared between the groups and analyzed for possible impact on outcome and complications. Results: Data of 105 consecutive patients (65 women [61.9%]) were analyzed operated at a median age of 73 years (range: 26–88 years). Group A included 59 patients (56.2%), group B 27 patients (25.7%), group C 28 patients (26.7%), and group D 9 patients (8.6%). Comparison of preoperative CRP levels revealed significant difference between the groups A and D (4.85 vs. 8.5 mg/L, p = 0.0441,), as well as postoperative CRP levels (105.82 vs. 178.46 mg/L, p = 0.0285), postoperative Hb levels (104.88 vs. 90.33 g/dL, p = 0.0198), and postoperative CK levels (321.31 vs. 688.22 IU/L, p = 0.0210). Grouping the results of groups B, C, and D together versus group A revealed significant different results for postoperative Hb levels (104.88 vs. 97.67 g/dL, p = 0.0336) and postoperative CK levels (321.31 vs. 497.58 IU/L, p = 0.0393). Conclusions: Patients with postoperative complications show significant higher pre- and postoperative CRP levels, higher CK levels, and lower postoperative Hb levels. Further analyses to underline the association of pre- and postoperative laboratory results with complication rate will be undertaken and presented. In addition, more patients will be included in the analyses to further specify our results.
Abstract Introduction Pediatric Neurosurgery as a subspeciality started to emerge during the late 1950s, with only a few dedicated pediatric neurosurgeons in the Western world. Over the last few decades, the awareness that children require subspecialized care by dedicated pediatric neurosurgeons and an interdisciplinary team has been growing worldwide, leading to an increase in pediatric neurosurgeons. Several studies have shown that subspecialized care for pediatric patients improves outcomes and is cost-effective. This survey aims to assess the current setting of pediatric neurosurgery and training of neurosurgical residents in pediatric neurosurgery in Switzerland. Methods We conducted an online survey by sending e-mail invitations in 2021 to all neurosurgical residents in Switzerland. The survey included questions regarding the participants' demographics, current workplace structures, the care of specific pediatric neurosurgical pathologies, and participants’ opinions of the Swiss training program for pediatric neurosurgery and possible improvement. We defined at the beginning of the survey that a pediatric neurosurgeon is a board-certified neurosurgeon with at least one year of dedicated pediatric neurosurgical fellowship training abroad. Results We received a total of 25 responses from residents, of which 20 (80%) were male. Twenty-two participants (88%) worked in one of seven major hospitals in Switzerland at the time of the survey, and four (16%) were interested in pursuing a fellowship in pediatric neurosurgery. Seven (35%) and five residents (25%) feel comfortable taking care on the ward of a craniosynostosis and hydrocephalus patient younger than 6 months, respectively. Twelve residents (60%) feel comfortable taking care of a pediatric brain tumor patient. The majority (n = 22, 88%) of all residents agree that a fellowship-trained pediatric neurosurgeon should treat children, while two (8%) residents state that any neurosurgeon with an interest in pediatric neurosurgery should be able to treat children. All residents (n = 25, 100%) agree that pediatric neurosurgery training and care in Switzerland needs to be improved. Conclusion Pediatric neurosurgery training in Switzerland is rather heterogeneous and not very well structured, with varying frequencies of children-specific neurosurgical pathologies. Most residents agreed that a subspecialized pediatric neurosurgeon should oversee the care of children in neurosurgery, while all agree that pediatric neurosurgical training and care should be improved in Switzerland.
Background: Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diseases, while burr-hole drainage is the most frequently used surgical treatment. Strong evidence exists that subdural drain (SDD) placement reduces recurrence rates. The insertion of a subperiosteal drain (SPD) was shown to lead to similar recurrence rates and less complications than SDD. The aim of this study is to provide a systematic review of the literature and conduct a meta-analysis of studies comparing SPD with SDD. Methods: Pubmed and Embase databases were searched using a systematic search strategy to identify studies on drain location up to December 2019. Primary outcome measure was recurrence, while secondary outcome measures were drain misplacement, morbidity, mortality, and clinical outcome. Besides randomized controlled trials (RCT), we included non-randomized prospective cohort studies, as well as retrospective cohort studies. A fixed effect model was used if low heterogeneity (I2<50%) was present, otherwise a random effect model was used. Results: Following removal of duplicates, we screened 1109 articles of which ten articles were included in our qualitative and quantitative analysis. One study was an RCT, three were non-randomized prospective cohort studies, and the remaining articles were retrospective cohort studies. In these ten articles, 1553 patients were treated with SPD and 1782 patients with SDD. Comparing the recurrence rate of cSDH a significant difference was found between SPD and SDD insertion (11.9% and 12.3%; RR 0.8, 95% CI 0.67-0.97, I2=0%, z=-2.27 p=0.02). SPD had significant lower rates of drain misplacement and parenchymal injuries (1.2% and 7.8%; RR 0.17, 95% CI 0.07-0.42, I2=0%, z=-3.4, p=0.0001), as well as morbidity (6.4% and 8.2%; RR 0.65, 95% CI 0.5-0.84, I2=44.5%, z=-3.32 p=0.0009). Mortality rates (5.0% and 4.6%; RR 0.83, 95% CI 0.6-1.14, I2=0%, z=-1.2, p=0.25) and favorable clinical outcome (89.6% and 88.9%; RR 1.1, 95% CI 0.89-1.24, I2=54.2%, t=0.98, p=0.40) were comparable in both groups. Conclusion: The insertion of SPD in cSDH showed lower rates of recurrence, drain misplacements and parenchymal injuries, as well as overall morbidity, while clinical outcome and mortality were comparable to SDD. Therefore, the insertion of SPD after surgical drainage of cSDH should be encouraged.
Aims: Medishield is a gel which forms a mechanical barrier by coating the nerve root thereby preventing it from pain mediators and reducing scar formation. In clinical trials the use of this gel has shown to reduce postoperative fibrosis as well as leg and back pain following lumbar discectomy. The aim of our study was to assess the MRI- signaling characteristics of Medishield at different time points in the early postoperative phase and differentiate it from common findings as epidural hematoma.
