Purpose To report the learning curve of full-endoscopic lumbar discectomy for a surgeon naive to endoscopic surgery but trained in open microdiscectomy. Methods From July 2006 to July 2009, 57 patients underwent full-endoscopic lumbar discectomy and 66 underwent open microdiscectomy. The clinical results were evaluated with a visual analog scale (VAS) and the Oswestry Disability Index (ODI). Spearman's coefficient of rank correlation (rho) was used to assess the learning curves for the transforaminal and interlaminar procedures of full-endoscopic lumbar discectomy. Results After full-endoscopic lumbar discectomy, the VAS and ODI results of the patients followed up were comparable with those of open microdiscectomy. A steep learning curve was observed for the transforaminal procedure, but not the interlaminar procedure. Conclusions The learning curve of the transforaminal approach was steep and easy to learn, while the learning curve of the interlaminar approach was flat and hard to master.

Background The objective of this study was to investigate the clinical feasibility of near-infrared spectroscopy (NIRS) for the detection of delayed cerebral ischemia (DCI) in patients with poor-grade subarachnoid hemorrhage (SAH) treated with coil embolization. Methods Cerebral regional oxygen saturation (rSO 2 ) was continuously monitored via two-channel NIRS for 14 days following SAH. The rSO 2 levels according to DCI were analyzed by using the Mann–Whitney U -test. A receiver operating characteristic curve was generated on the basis of changes in rSO 2 by using the rSO 2 level on day 1 as a reference value to determine the optimal cutoff value for identifying DCI. Results Twenty-four patients with poor-grade SAH were included (DCI, n = 8 [33.3%]; non-DCI, n = 16 [66.7%]). The rSO 2 levels of patients with DCI were significantly lowered from 6 to 9 days compared with those in without DCI. The rSO 2 level was 62.55% (58.30–63.40%) on day 6 in patients with DCI versus 65.40% (60.90–68.70%) in those without DCI. By day 7, it was 60.40% (58.10–61.90%) in patients with DCI versus 64.25% (62.50–67.10%) those without DCI. By day 8, it was 58.90% (56.50–63.10%) in patients with DCI versus 66.05% (59.90–69.20%) in those without DCI, and by day 9, it was 60.85% (58.40–65.20%) in patients with DCI versus 65.80% (62.70–68.30%) in those without DCI. A decline of greater than 14.5% in the rSO 2 rate yielded a sensitivity of 92.86% (95% confidence interval: 66.1–99.8%) and a specificity of 88.24% (95% confidence interval: 72.5–96.7%) for identifying DCI. A decrease by more than 14.7% of the rSO 2 level indicates a sensitivity of 85.7% and a specificity of 85.7% for identifying DCI. Conclusions Near-infrared spectroscopy shows some promising results for the detection of DCI in patients with poor-grade SAH. Further studies involving a large cohort of the SAH population are required to confirm our results. Supplementary Information The online version contains supplementary material available at 10.1007/s12028-021-01223-2.

No abstract

Background. The impact of renal impairment (RI) on the outcomes of patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) was relatively limited and contradictory. We performed a systematic review and meta-analysis to investigate this. Aims. We registered a protocol on September 2020 and searched MEDLINE, EMBASE, and Google Scholar accordingly. RI was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Predefined outcomes included functional independence (defined as a modified Rankin Scale of 0, 1, or 2) at 3 months, successful reperfusion, mortality, and symptomatic intracerebral hemorrhage (sICH). Summary of review. Eleven studies involving 3453 patients were included. For the unadjusted outcomes, RI was associated with fewer functional independence (odds ratio (OR), 0.49; 95% confidence interval (CI), 0.39–0.62) and higher mortality (OR, 2.55; 95% CI, 2.03–3.21). RI was not associated with successful reperfusion (OR, 0.80; 95% CI 0.63–1.00) and sICH (OR, 1.41; 95% CI, 0.95–2.10). For the adjusted outcomes, results derived from a multivariate meta-analysis were consistent with the respective unadjusted outcomes: functional independence (OR, 0.59; 95% CI, 0.45–0.77), mortality (OR, 2.23, 95% CI, 1.45–3.43), and sICH (OR, 1.34; 95% CI, 0.85–2.10). Conclusions. We presented the first systematic review to demonstrate that RI is associated with fewer functional independence and higher mortality. Future EVT studies should publish complete renal eGFR data to facilitate prognostic studies and permit eGFR to be analyzed in a continuous variable. Systematic Review Registration: PROSPERO CRD42020191309