Notes

Klf2-Vav1-Rac1 axis promotes axon rejuvination following peripheral lack of feeling injuries.
open decompressive surgery with some advantages and higher cost-effectiveness. Fusion surgery and mobility preserving surgery only have a marginal role in the treatment of DLSS without instability.
Acute subdural haematomas (ASDH) are found frequently following traumatic brain injury (TBI) and they are considered the most lethal type of mass lesions. The decision to perform a procedure to evacuate ASDH and the approach, either via craniotomy or decompressive craniectomy (DC), remains controversial.

We reviewed a prospectively collected series of 343 moderate to severe TBI patients in whom ASDH was the main lesion (ASDH volumes ≥10cc). Patients with early comfort measures (early mortality prediction >50% and not ICP monitored), bilateral ASDH or the presence of another intracranial haematoma with volumes exceeding two times the volume of the ASDH were excluded. Among them, 112 were managed conservatively, 65 underwent ASDH evacuation by craniotomy and 166 by DC (103 pre-emptive DC, 63 obligatory DC). We calculated the average treatment effect by propensity score (PS) analysis using the following covariates age, year, hypoxia, shock, pupils, major extracranial injury, motor score, MLS, ASDH volume,m patient´s own height, hypoxia, early deterioration, pupillary abnormalities, basal cistern effacement, compliance to ICP monitoring guidelines and type of surgical approach (craniotomy and pre-emptive DC are associated with better outcome). Patients with an intermediate or worse risk of unfavourable outcome according to their baseline characteristics might achieve better than expected outcome if they undergo pre-emptive DC.
When differences in patient's baseline characteristics are balanced by PS, the variables associated with long-term outcome are year, age, falls from patient´s own height, hypoxia, early deterioration, pupillary abnormalities, basal cistern effacement, compliance to ICP monitoring guidelines and type of surgical approach (craniotomy and pre-emptive DC are associated with better outcome). Patients with an intermediate or worse risk of unfavourable outcome according to their baseline characteristics might achieve better than expected outcome if they undergo pre-emptive DC.
Malignant ependymomas are rare cancerous tumors that are associated with increased morbidity and mortality in the affected patients. Lately, there has been a lot of controversy about the correct way to manage and predict the survival outcome of these patients. We aim in this retrospective cohort study to develop novel nomograms that can better predict the overall survival (OS) and cancer-specific survival (CSS) of these patients.

This is a retrospective cohort study that was conducted through the Surveillance, Epidemiology, and End Results databases (SEER) between 1998 and 2016. Patients were excluded if they had an unknown diagnosis, unknown cause of death or those with survival duration less than a month. We used penalized regression models with the highest timedependent area under the ROC curve (AUC) and most stable calibrations to construct the nomograms. By searching the SEER database and applying the eligibility criteria, we identified 3391 patients for the final analysis.

Nine penalized regression models were developed of which two models including adaptive elastic-net was selected for both OS and CSS. The model incorporated age, sex, year of diagnosis, site, race, radiation, chemotherapy, surgery, and type for the construction of nomograms. We aimed in this population-based cohort study to develop novel prediction tools that can help physicians estimate the survival of malignant ependymoma patients and provide better care.

Our nomograms appear to have high accuracy and applicability, which we hope that can predict the survival and improve the treatment and prognosis of these patients.
Our nomograms appear to have high accuracy and applicability, which we hope that can predict the survival and improve the treatment and prognosis of these patients.
This population study aims to assess the impact of the implementation of the original Stupp protocol on overall survival in patients with new-diagnosed supratentorial primary GBM.

The Surveillance, Epidemiology, and End Results (SEER) database was used to study the survival of histologically confirmed adult supratentorial GBM patients diagnosed between 1998 and 2016. Kaplan-Meier, and a univariate and propensity-score weighted multivariate Cox proportional hazard model adjusted for age at diagnosis, sex, race, marital status and extent of resection was used to assess the survival of patients prior to implementation of the Stupp protocol in 2005 (Pre-Stupp) and following implementation of the Stupp Protocol until 2016 (Post Stupp).

6,390 patients satisfied inclusion exclusion criteria. Median survival times were 13 months for the Pre-Stupp and 15 months for Post-Stupp groups (p<0.001). The 1-,2-, 5- and 10- year survival rates for the Pre-Stupp group were 51, 18, 5 and 2% respectively compared to 59, 27, 8 and 4% on the Post-Stupp group. Propensity-score weighted analysis showed a lower mortality risk for patients who underwent concomitant chemoradiation during the Post-Stupp era [HR 0.77, 95% CI 0.62-0.94]. There was a 42 percent relative reduction in the risk of death for patients treated during the Post-Stupp era.

This population-based propensity-score study with long-term follow-up suggests that the implementation of the Stupp protocol in 2005 had a positive impact on the survival of patients with supratentorial GBM. This "real-world" analysis validates the results of the original randomized control trial on which this protocol is based.
This population-based propensity-score study with long-term follow-up suggests that the implementation of the Stupp protocol in 2005 had a positive impact on the survival of patients with supratentorial GBM. This "real-world" analysis validates the results of the original randomized control trial on which this protocol is based.
Lesions of the craniovertebral junction are difficult to access, which is due to the anatomical features and high concentration of vital structures in the area. The transoral access has been most commonly used for anterior approach to treat craniovertebral junction pathology. This method has consistently shown a high complication rate and difficulties in-patient rehabilitation. In this study we analyzed the benefits of surgical treatment of the craniovertebral junction area pathology with the transnasal approach.

Four patients with C2 odontoid process invagination and brain stem compression were treated with the transnasal endoscopic resection of the pathological process combined with simultaneous occipital-cervical stabilization (OCS). Surgical procedure, anatomical findings, complications and rehabilitation period were assessed.

Transnasal treatment of C2 odontoid process lesions was applied successfully in all four cases. An modified extended transnasal approach was used. This approach is characterizC2 odontoid process invagination, a combination of transnasal resection and OCS shows excellent preliminary results. This method should be favorable over the transoral approach in certain cases, as it provides a better direct access to lesion of the craniovertebral junction and allows for more complex combined procedures.
C2 vertebral body fractures are relatively rare fractures with no defined management protocol and outcomes. The aim of the study is to evaluate the clinical and radiological outcomes of C2 body fratecures.

The study was conducted at the Department of Neurosurgery, Nizam's Iinstitute of Medical Sciences, Hyderabad, India, following clearance from the Institutional Ethical Committee. The data of all patients with traumatic C2 body fracture who were managed in our department between Jan'2008 to Jan'2019 was retrieved from the database. Functional status of the patients was assessed by Neck disability index while pain was assessed by VAS at follow up after at least 6 months. Fusion and regional kyphotic angles (O-C2 and C2-C7) were assessed for radiological outcome.

There were a total of 16 patients with isolated C2 body fractures in the defined time period. The male (n=11) female (n=5) distribution was 2.21. Ten patients had road traffic accidents while the remaining 6 had history of fall from height. Onlractures requiring fragment retrival or restitution of alignment if facets were fractured.
Management of spontaneous intracerebral hemorrhage (ICH) remains controversial despite efforts to produce high level evidence in the past few years. We systematically examined the pooled literature data on the natural history and surgical management of ICH.

A systematic review was performed using the PubMed and Embase databases, encompassing English, full-text articles, reporting treatment outcomes for the conservative and surgical management of ICH.

A total of 91 studies met the eligibility criteria (total of 16,411 ICH cases). The most common locations for an ICH were the basal ganglia for both the conservative (68.7%) and surgical cohorts (58.4%). Patients in the non-operative group (40.5%) were older (mean age 62.9 years; range 12.0-94.0), had a higher Glasgow Coma Scale (GCS) score at presentation (mean GCS 10.2; range 3-15) and lower ICH volume (mean 36.9 mL). When managed non-operatively, a favorable functional outcome was encountered in 25.7% (95% CI 16.9-34.5) of patients, with a 22.2% (95% CI 16.6-27.8) mortality rate. Patients who underwent surgery (59.5%) were younger (mean age 58.8 years; range 12.0-94.0), had a lower GCS at presentation (mean GCS 8.2; range 3-15) and larger ICH volume (mean 58.3 mL; range 8.2-140.0). Craniotomy with hematoma evacuation was the preferred surgical technique (38.6%). Cyclophosphamide A favorable functional outcome was encountered in 29.8% (95% CI 23.8-35.8) of operated patients, with a 21.3% (95% CI 16.3-26.3) mortality rate.

For many ICH cases, the reviewed literature allows to define surgical and conservative candidates. However, there are still some ICH-cases where management remains controversial.
For many ICH cases, the reviewed literature allows to define surgical and conservative candidates. However, there are still some ICH-cases where management remains controversial.
Gliomas are the most common malignant tumors in the central nervous system originating from brain glial cells. Although characterized as highly invasive and highly malignant, few molecular targeting therapies have been developed. Ubiquitin Specific Protease 33 (USP33), a gene encoding a deubiquinating enzyme important in a variety of processes, including Slit-dependent cell migration and beta-2 adrenergic receptor signaling, participates in the development of several malignant tumors, however, its role in the development of glioma has not been evaluated.

Real-time quantitative PCR was performed to examine the expression of USP33 in glioma tissues and cell lines. Immunohistochemistry was performed to determine USP33 expressions in glioma tissue microarray. Transwell assay was performed to analyze the effect of USP33 on glioma cell line migration. The Kaplan-Meier method and log rank test were applied to evaluate the prognostic value of USP33 expression. Univariate and multivariate Cox proportional hazard regression models were used to identify the independent prognostic factors associated with OS or DFS.
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