Portomesenteric vein thrombosis in patients undergoing sleeve gastrectomy: An updated meta-analysis of 101,865 patients

Background: Portomesenteric vein thrombosis (PMVT) is a rare but potentially fatal complication of sleeve gastrectomy (SG). The rising prevalence of SG has led to a surge in the occurrence of PMVT, while the associated risk factors have not been fully elucidated.Objectives: This study aims to determine the incidence and risk factors of PMVT in patients undergoing SG.Methods: A comprehensive literature search was performed in PubMed (MEDLINE) and EMBASE databases. Proportion and regression meta-analyses were conducted.Results: A total of 75 studies and 101,865 patients undergoing SG and 355 patients with PMVT were identified. At a mean follow-up of 14.4 (SD: 16.3) months the incidence of PMVT was found to be 0.48% (95%CI: 0.39-0.60%). The majority of the population presented with abdominal pain (91.8%) at an average of 22.4 days postoperatively and PMV was mainly diagnosed with CT scan (96.0%). Hematologic abnormalities predisposing to thrombophilia were identified in 34.9% of the population. Age (p=0.02) and center volume (p &lt;0.0001) were significantly associated with PMVT, while gender, BMI, hematologic abnormality, prior history of deep vein thrombosis or pulmonary embolism, type of prophylactic anticoagulation, and duration of prophylactic anticoagulation were not associated with the incidence of PMVT in meta-regression analyses. Treatment included therapeutic anticoagulation in 93.4% and the mortality rate was 4/355 (1.1%).Conclusion: PMVT is a rare complication of sleeve gastrectomy with an incidence rate &lt;1% that is associated with center volume and age but is not affected by the duration or type of thromboprophylaxis administered postoperatively.<br/

External hydrocephalus associated with dural sigmoid sinus arteriovenous fistula: a case report

External hydrocephalus (EH) is a recognised sub-type of hydrocephalus associated with macrocephaly in infancy. EH is characterised by the enlargement of subarachnoid spaces (so-called subarachnomegaly) with a normal ventricular system on brain imaging. EH is traditionally considered benign and self-limiting, yet its pathophysiology remains puzzling. Mounting evidence for an association between EH and hydrovenous disorders reshapes our understanding of this condition and its management. To our knowledge, we report the first association between EH and dural arteriovenous fistula (dAVF) in a 17-months-old boy. As dAVF may be a life-threatening condition, early diagnosis and optimal treatment are critical. This case epitomises the intricacies of EH’s aetiology and associated conditions requiring careful management. Therefore, we recommend considering MR angiography in EH’s workup and long-term follow-up. Our experience supports the ongoing reconsideration of EH’s presumed benignity.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Complete Corpus Callosotomy for Refractory Epilepsy in Children

Corpus callosotomy is an interhemispheric disconnection by callosal commissural fiber ablation. Its rationale is the disruption of ictal spread to prevent seizure generalization. The objective pursued is alleviation of intractable, debilitating, and injurious manifestations of generalized epilepsy.1 Eight decades of experience support this procedure's safety and effectiveness for appropriately selected patients with drug-resistant epilepsy not amenable to optimal resection; particularly, favorable outcomes for tonic or atonic seizures with drop attacks have been reported.2,3 Children may benefit more than adults from callosotomy for improved daily function, psychosocial adjustment, and family satisfaction.4 A meta-analysis found a better seizure reduction from total than partial callosotomy (88.2% vs. 58.6% of worthwhile reduction) comprising drop-attacks (77.8% vs. 45.4%) with an increased but transient (i.e. resolution within 6 weeks) risk of significant disconnection syndromes (12.5% vs. none).5 Here, we present the illustrative case of a 4-year-old boy with Lennox-Gastaut syndrome who underwent open single-stage complete callosotomy. Video 1 shows the microscope-assisted interhemispheric approach aided by stereotactic navigation. We showcase critical steps such as dissection of cingulate gyri and anterior and then posterior callosotomy while highlighting crucial anatomic landmarks. This procedure may be accessible for epilepsy surgeons worldwide in resource-constrained environments6 while serving as a basis for promising high-technology development (e.g. endoscopic, radiosurgical, laser interstitial thermal therapy, or magnetic resonance−guided focused ultrasound callosotomies). In this video article, we aim to provide a streamlined and stepwise approach to this rare but important epilepsy surgery.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Surgery of brainstem cavernomas

info:eu-repo/semantics/nonPublishe

Life-threatening intracranial subdural hematoma following spinal surgery: A case report

Introduction: We report a case of a Kernohan notch phenomenon caused by an acute life-threatening intracranial subdural hematoma due to a cerebrospinal fluid (CSF) leak following lumbar surgery. Case report: A 71-year-old patient underwent decompressive lumbar surgery for refractory neurogenic claudication. Intraoperatively, a dural tear was noted and repaired. Two days later, the patient presented a sudden loss of consciousness following a CSF outflow in the subfascial lumbar drain. A head CT revealed an acute intracranial subdural hematoma with mass effect. A craniotomy was performed to evacuate the hematoma. The lumbar operative site was inspected and revealed a CSF leakage due to a dural defect which was subsequently repaired. The patient subsequently developed a Kernohan's notch phenomenon which partially recovered after two months of rehabilitation. Conclusion: We report a rare and dramatic case of Kernohan notch phenomenon due to an acute intracranial subdural hematoma occurring in the setting of a CSF leak following lumbar spine surgery. This case demonstrates the need to be aware of this potentially fatal complication after spine surgery and the importance of early diagnosis and appropriate treatment.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

COVID-19 Impact on Neurosurgical Practice: Lockdown Attitude and Experience of a European Academic Center

info:eu-repo/semantics/publishe

Safety profile of an intracranial multimodal monitoring bolt system for neurocritical care: a single-center experience.

Intracranial multimodality monitoring (iMMM) is increasingly used in acute brain-injured patients; however, safety and reliability remain major concerns to its routine implementation.info:eu-repo/semantics/publishe

Origami-inspired soft fluidic actuation for minimally invasive large-area electrocorticography.

Acknowledgements: L.C. acknowledges funding from the U.K. Engineering and Physical Sciences Research Council Centre for Doctoral Training in Sensor Technologies for a Healthy and Sustainable Future (EP/S023046/1). M.L.B. and D.V. acknowledge funding from the University of Bologna (RFO programme 2021–2022). A.C.L. acknowledges funding from the University of Cambridge Borysiewicz Fellowship program. B.J.W. acknowledges funding from the Engineering and Physical Sciences Research Council Centre for Doctoral Training in Sensor Technologies and Applications (EP/L015889/1). J.G.T. is supported by the National Institute for Health Research Invention for Innovation award (NIHR203355). M.M. is supported by the Biotechnology and Biological Sciences Research Council (BB/T009314/1). D.G.B. is supported by Health Education England and the National Institute for Health Research HEE/NIHR ICA Program Clinical Lectureship (CL-2019-14-004). S.E.H. acknowledge funding from the National Institute of Health Research (NIHR) (G112655) and is the Laureate of the Helaers Research Prize for Neurosurgery. C.M.P. acknowledges funding from the U.K. Engineering and Physical Sciences Research Council IAA award, and the Biotechnology and Biological Sciences Research Council David Phillips Fellowship (BB/T009314/1). The devices were built in the laboratory for prototyping soft neuroprosthetic technologies, funded by the Sir Jules Thorn charitable trust (233838).Electrocorticography is an established neural interfacing technique wherein an array of electrodes enables large-area recording from the cortical surface. Electrocorticography is commonly used for seizure mapping however the implantation of large-area electrocorticography arrays is a highly invasive procedure, requiring a craniotomy larger than the implant area to place the device. In this work, flexible thin-film electrode arrays are combined with concepts from soft robotics, to realize a large-area electrocorticography device that can change shape via integrated fluidic actuators. We show that the 32-electrode device can be packaged using origami-inspired folding into a compressed state and implanted through a small burr-hole craniotomy, then expanded on the surface of the brain for large-area cortical coverage. The implantation, expansion, and recording functionality of the device is confirmed in-vitro and in porcine in-vivo models. The integration of shape actuation into neural implants provides a clinically viable pathway to realize large-area neural interfaces via minimally invasive surgical techniques

Neura: a specialized large language model solution in neurology

Large language models’ (LLM) ability in natural language processing holds promise for diverse applications, yet their deployment in fields such as neurology faces domain-specific challenges. Hence, we introduce Neura: a scalable, explainable solution to specialize LLM. Blindly evaluated on a select set of five complex clinical cases compared to a cohort of 13 neurologists, Neura achieved normalized scores of 86.17% overall, 85% for differential diagnoses, and 88.24% for final diagnoses (55.11%, 46.15%, and 70.93% for neurologists) with rapid response times of 28.8 and 19 seconds (9 minutes and 37.2 seconds and 8 minutes and 51 seconds for neurologists) while consistently providing relevant, accurately cited information. These findings support the emerging role of LLM-driven applications to articulate human-acquired and integrated data with a vast corpus of knowledge, augmenting human experiential reasoning for clinical and research purposes