Background: In an era characterized by rapid progression in neurosurgical technologies, traditional tools such as the non-navigated two-dimensional intraoperative ultrasound (nn-2D-IOUS) risk being overshadowed. Against this backdrop, this study endeavors to provide a comprehensive and rigorous assessment of the clinical efficacy and surgical relevance of nn-2D-IOUS, specifically in the context of glioma resections. Methods: This retrospective study undertaken at a single center evaluated 99 consecutive, non-selected patients diagnosed with both high-grade and low-grade gliomas. The primary objective was to assess the proficiency of nn-2D-IOUS in generating satisfactory image quality, identifying residual tumor tissue, and its influence on the extent of resection. To validate these results, early postoperative MRI data served as the reference standard. Results: The nn-2D-IOUS exhibited a high level of effectiveness, successfully generating good quality images in 79% of the cases evaluated. With a sensitivity rate of 68% and a perfect specificity of 100%, nn-2D-IOUS unequivocally demonstrated its utility in intraoperative tumor detection. Notably, in cases where total tumor removal was the surgical objective, a resection exceeding 95% of the initial tumor volume was achieved in 86% of patients. Additionally, in cases where residual tumor was not detected by nn-2D-IOUS, the mean volume of undetected tumor tissue was remarkably minimal, averaging at 0.29 cm3. Conclusion: Our study provides compelling evidence supporting the invaluable role and efficacy of nn-2D-IOUS in glioma surgery. The results underscore the potential of harnessing traditional, cost-effective technologies such as nn-2D-IOUS to achieve enhanced surgical outcomes, even in the face of more advanced alternatives. These insights carry significant implications, particularly for resource-constrained settings, emphasizing the importance of optimizing the use of existing tools to improve patient care in a practical and efficient manner.
Background
Brain dural arteriovenous fistulas(bDAVFs) are anomalous connections between dural arteries and cerebral veins or sinuses. Cerebral venous thrombosis(CVT) often precedes or coincides with bDAVFs and is considered a risk factor for these vascular malformations. Recently, vaccine-induced thrombotic thrombocytopenia causing CVTs has been associated with COVID-19 vaccines. Concurrently with the start of massive vaccination in our region, we have observed a fivefold increase in the average incidence of bDAVFs.
Objective
To raise awareness of the potential involvement of COVID-19 vaccines in the pathogenesis of bDAVF.
Methods
A retrospective review of demographic, clinical, radiological, COVID-19 infection and vaccination data of patients diagnosed with bDAVFs between 2011-2021 was conducted. Patients were divided into two cohorts according to their belonging to pre- or post-COVID-19 vaccination times. Cohorts were compared for bDAVFs incidences and demographic and clinical features.
Results
Twenty-one bDAVFs were diagnosed between 2011- 2021, 7 of which were diagnosed in 2021. The mean age was 57.7 years, and 62% were males. All cases except one were treated; of them, 85% were exclusively managed with surgery. All treated cases were successfully occluded. The incidence in 2021 was significantly higher than that in the prevaccination period (1.72 vs 0.35/100,000/year;p=0.036; 95%Confidence Interval=0.09-2.66). Cohorts were not different in age, sex, hemorrhagic presentation, dural sinus thrombosis or presence of prothrombotic or cardiovascular risk factors.
Conclusion
The significant increase in the incidence of bDAVF following general vaccination policies against COVID-19 observed in our region suggests a potential correlation between these two facts. Our findings need confirmation from larger cohorts and further pathogenic research.
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