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Background: Tuberculous meningitis (TBM) is a medical emergency, yet there are no standardized treatment guidelines for the medical or neurosurgical management of these patients and little data on neurocritical care. We conducted an international survey to understand current medical and neurosurgical TBM management and resource availability to provide baseline data needed for future multicenter trials addressing unanswered clinical research questions and the establishment of standardized guidelines.
Methods: An online survey of 77 questions covering medical and neurosurgical TBM management aimed at clinicians/nurses treating TBM was distributed as an anonymous link through email invitation, international organizations' membership distribution, and direct links on organizational webpages or social media. The survey remained open for 5 months. Data were summarized with frequencies and percentages.
Results: The survey had 222 responses from 43 countries representing 6 continents. Most respondents were from tertiary care facilities, with broad access to medical and neurosurgical resources. There was significant heterogeneity in general supportive care, and TBM-specific management demonstrated considerable divergence from current standard-of-care practices. The lack of standardized guidelines was identified as a major challenge in TBM management. General and neurocritical care were largely absent. Resources for bedside supportive care and noninvasive monitoring were broadly accessible.
Conclusions: These findings suggest that current TBM management could be improved by the establishment of internationally accepted treatment guidelines based on available evidence, and that numerous centers have resources available to participate in future multicenter trials, even for basic interventions, that may further improve patient outcomes globally.
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http://dx.doi.org/10.1093/ofid/ofaa445 | DOI Listing |
NMC Case Rep J
December 2024
Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
Hemifacial spasm (HFS) is a disorder that causes involuntary movements of the ipsilateral facial muscles because of vascular compression of the facial nerve. Microvascular decompression (MVD), a surgical procedure to detach the culprit vessel from the nerve is believed to be the most effective treatment for HFS. Nevertheless, in the rare case in which the vessel penetrates the nerve, positioning the vessel sufficiently far from the nerve is challenging.
View Article and Find Full Text PDFFront Hum Neurosci
December 2024
Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Background: Temporal lobe mass lesions are the most common intracranial space-occupying lesions in children, among various brain lobes. The temporal lobe is critically involved in higher cognitive functions, and surgical interventions often risk causing damage to these functions. If necessary interventions and prehabilitation can be conducted preoperatively, it might be possible to achieve a larger extent of lesion resection with minimal cognitive impairment.
View Article and Find Full Text PDFOper Neurosurg (Hagerstown)
December 2024
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Background And Objectives: The intraosseous subarcuate loop (SL) is a unique variant of the anterior inferior cerebellar artery (AICA), where a loop of the artery is trapped in the petrous bone's subarcuate fossa (SF). Recognizing this variant is crucial for planning cerebellopontine angle (CPA) surgeries; however, data regarding its frequency and management vary in the published literature. A cohort from a single center was studied using MRI to assess its prevalence, and the findings were compared with the existing literature.
View Article and Find Full Text PDFInt J Med Robot
December 2024
School of Mechanical Engineering, Tianjin University, Tianjin, China.
Background: In order to achieve spatial registration for surgical navigation, a spatial registration method based on point cloud and deep learning is proposed.
Methods: Neural networks are used to register medical image point clouds and patient surface point clouds to complete spatial registration of surgical navigation. An image processing method is designed to convert medical images into point clouds, and a structured light robot is used to extract patient surface point clouds.
Int J Surg
December 2024
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Background: The main reason restricting stroke patients from reintegrating into society is neurological deficits. Of particular interest is the potential Vagus Nerve Stimulation (VNS) potentially offers for sustaining improvement in neurological deficits. The goal of the present study is to provide a summary of the findings from research that has been carried out to elucidate the mechanisms and demonstrate the efficacy and safety of the clinical application of VNS, as well as to identify research gaps in the field, in order to offer references for subsequent further research and application.
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