Publications by authors named "Pawel Sloniewski"

49 Publications

The Role of Stress Perception for Clinical Implications of Stress.

Mayo Clin Proc 2021 02;96(2):508-509

Neurosurgery Department, Medical University of Gdańsk, Poland.

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http://dx.doi.org/10.1016/j.mayocp.2020.12.004DOI Listing
February 2021

YouTube as a source of patient information for meningitis: A content-quality and audience engagement analysis.

Clin Neurol Neurosurg 2021 Mar 12;202:106483. Epub 2021 Jan 12.

Neurosurgery Department, Medical University of Gdansk, Dębinki 7, Gdansk, 80-952, Poland.

Objectives: Now that the internet is more accessible to an increasing number of populations worldwide, many rely on the internet for their information about their daily lives. This includes people concerned about their health to students to sometimes also doctors. Since YouTube is the second most visited website, our aim was to evaluate the content-quality of YouTube videos relating to meningitis.

Methods: We chose the first 30 videos for four different search phrases: meningitis, bacterial meningitis, viral meningitis, fungal meningitis and meningitis signs. The validated DISCERN scoring criteria was used to assess the videos by two raters independently. Qualitative data, quantitative data and the source of upload of each video were analyzed for video quality and audience engagement.

Results: Out of 150 videos, 84 videos met the inclusion criteria. The mean DISCERN score was 34.6 ± 9.76 (out of a total 75), which indicates that the quality of YouTube videos on meningitis is poor. There is an excellent reliability between the two raters. Videos had a higher audience engagement via a greater number of daily views and comments when they included the definition, symptoms, prognosis, animation, diagrams, and an anatomical explanation of the meninges (P < 0.0001 for all).

Conclusion: The quality of YouTube videos on meningitis is poor, however, we have listed the videos which may be most effective for patient education for reference. Our quality and engagement analysis may help content creators make better health content on meningitis.
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http://dx.doi.org/10.1016/j.clineuro.2021.106483DOI Listing
March 2021

Methods of analysis regarding strabismus videos on YouTube.

Strabismus 2021 Jan 8:1-2. Epub 2021 Jan 8.

Neurosurgery Department, Medical University of Gdansk , Gdansk.

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http://dx.doi.org/10.1080/09273972.2020.1871381DOI Listing
January 2021

WHO's impact on traditional media versus social media.

Int J Infect Dis 2021 02 5;103:242. Epub 2020 Dec 5.

Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland.

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http://dx.doi.org/10.1016/j.ijid.2020.12.002DOI Listing
February 2021

A commentary on coffee consumption for recovery of intestinal function after laparoscopic gynecological surgery: A randomized controlled trial (Int J Surg 2020; 82:130-5).

Int J Surg 2021 01 2;85:29. Epub 2020 Dec 2.

Neurosurgery Department, Medical University of Gdansk, Poland, Dębinki 7, Gdansk, 80-952, Poland.

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http://dx.doi.org/10.1016/j.ijsu.2020.11.023DOI Listing
January 2021

YouTube as a source of patient information for stroke: A content-quality and an audience engagement analysis.

J Stroke Cerebrovasc Dis 2020 Sep 30;29(9):105065. Epub 2020 Jun 30.

Neurosurgery Department, Medical University of Gdansk, Dębinki 7, Gdansk 80-952, Gdansk, Poland. Electronic address:

Background: Stroke is the second leading cause of death worldwide following ischemic heart disease, and the fifth in the United States. The video-sharing database, YouTube, is the second most popular visited website with more than 2 billion users, thus it's increasingly being used as a medium for delivering health information.

Aim: We aimed to evaluate the quality, reliability and audience engagement of stroke-related YouTube videos.

Methods: In October 2019 we conducted a search on YouTube using 5 keywords: stroke, brain attack, hemorrhagic stroke, ischemic stroke and transient ischemic attack. We selected the first 30 videos from each search query for further analysis. The validated DISCERN instrument was used (a score of 0-5 per question) to assess the videos by four independent raters. We then recorded qualitative data and quantitative data for each video.

Results: After sorting through 150 stroke videos, a total of 101 unique YouTube videos met our inclusion criteria. We found that the mean overall quality of YouTube videos according to DISCERN is of fair quality. Most videos (65.3%) were uploaded by hospitals, mentioned the symptoms of stroke (66.3%), had a doctor speaking (60.4%) and contained diagrams (20.8%).

Conclusion: YouTube is a useful source of gathering information about treatment choices for patients and their families as the quality of YouTube videos is fair. The audience engagement suggestions in our paper may help content creators improve the appeal of YouTube videos.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105065DOI Listing
September 2020

YouTube as a source of patient information for Coronavirus Disease (COVID-19): A content-quality and audience engagement analysis.

Rev Med Virol 2020 09 15;30(5):e2132. Epub 2020 Jun 15.

Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland.

YouTube is the second most popular website in the world and is increasingly being used as a platform for disseminating health information. Our aim was to evaluate the content-quality and audience engagement of YouTube videos pertaining to the SARS (severe acute respiratory syndrome)-CoV-2 virus which causes the Coronavirus Disease 2019 (COVID-19), during the early phase of the pandemic. We chose the first 30 videos for seven different search phrases: "2019 nCoV," "SARS CoV-2," "COVID-19 virus," "coronavirus treatment," "coronavirus explained," "what is the coronavirus" and "coronavirus information." Video contents were evaluated by two independent medical students with more than 5 years of experience using the DISCERN instrument. Qualitative data, quantitative data and upload source for each video was noted for a quality and audience engagement analysis. Out of the total 210 videos, 137 met our inclusion criteria and were evaluated. The mean DISCERN score was 31.33 out of 75 possible points, which indicates that the quality of YouTube videos on COVID-19 is currently poor. There was excellent reliability between the two raters (intraclass correlation coefficient = 0.96). 55% of the videos discussed prevention, 49% discussed symptoms and 46% discussed the spread of the virus. Most of the videos were uploaded by news channels (50%) and education channels (40%). The quality of YouTube videos on SARS-CoV-2 and COVID-19 is poor, however, we have listed the top-quality videos in our article as they may be effective tools for patient education during the pandemic.
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http://dx.doi.org/10.1002/rmv.2132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323134PMC
September 2020

Are online searches for the novel coronavirus (COVID-19) related to media or epidemiology? A cross-sectional study.

Int J Infect Dis 2020 Aug 12;97:386-390. Epub 2020 Jun 12.

Neurosurgery Department, Medical University of Gdansk, Dębinki 7, Gdansk, 80-952, Poland.

Background: Previous studies on the novel Coronavirus (COVID-19) have found strong correlations between online searches and the epidemiology of the disease.

Aim: Our aim was to determine if online searches for COVID-19 related to international media announcements or national epidemiology.

Methods: Searches for "coronavirus" were made on Google Trends from December 31, 2019 to April 13, 2020 for 40 European countries. The online COVID-19 searches for all countries were correlated with each other. COVID-10 epidemiology (i.e. incidence and mortality) was correlated with the national online searches. Major announcements by the World Health Organization (WHO) were taken into consideration with peaks in online searches. Correlations were made using Spearman's rank correlation coefficient.

Results: Overall, the online searches for COVID-19 were not correlated with the actual incidence and mortality of COVID-19. The mean Spearman correlation for incidence was 0.20 (range -0.66 to 0.76) and for mortality was 0.35 (range -0.75 to 0.85). Online searches in Europe were all strongly synchronized with each other; a mean Spearman correlation of 0.93 (range 0.62 to 0.99).

Conclusions: Online searches for COVID-19 in Europe are not correlated with epidemiology but strongly correlated with international WHO announcements. Our study challenges previous Google Trends studies and emphasizes the role of the WHO in raising awareness of a new disease.
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http://dx.doi.org/10.1016/j.ijid.2020.06.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290205PMC
August 2020

Telemedicine in neurosurgery during the novel coronavirus (COVID-19) pandemic.

Neurol Neurochir Pol 2020 22;54(2):207-208. Epub 2020 Apr 22.

ELearning Student's group, Medical University of Gdańsk, Dębinki 7, 81-952 Gdańsk, Poland.

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http://dx.doi.org/10.5603/PJNNS.a2020.0038DOI Listing
May 2020

YouTube as a source of information for narcolepsy: A content-quality and optimization analysis.

J Sleep Res 2021 Apr 21;30(2):e13053. Epub 2020 Apr 21.

Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland.

YouTube is the world's most popular video-sharing site that in recent years has become an important platform for patients in finding educational information about their disease. The purpose of this study was to assess the quality and reliability of narcolepsy-related YouTube videos. We searched the key terms "Narcolepsy", "Narcolepsy-cataplexy," "Narcolepsy excessive daytime sleepiness" and "Narcolepsy excessive drowsiness" on YouTube. 80 videos were analyzed as they meet the inclusion criteria. Quantitative and qualitative metrics were recorded and the videos were scored using the DISCERN instrument by two independent raters. Our findings show that the majority of videos contained clear information (84%), symptoms (78%) and patient experience (69%). Most videos were published by an educational channel not representing a hospital or clinic (41%) or by a patient suffering from the disease (25%). Videos containing animations had a statistically significant correlation between average daily views (p = .0004) and the video power index (p = .0048), suggesting that this feature increased the popularity among viewers. The mean DISCERN score was 27 ± 8, indicating that the quality of narcolepsy related-videos is poor. Therefore, patients that use YouTube as an educational tool are currently not attaining a comprehensive understanding of the disease. For this reason, we have indicated the top 5 videos that physicians can recommend to their patients. Our paper highlights the gaps of knowledge concerning narcolepsy information on YouTube. Therefore, this information can be used to create better educational content in the future.
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http://dx.doi.org/10.1111/jsr.13053DOI Listing
April 2021

YouTube as a Source of Patient Information for Hydrocephalus: A Content-Quality and Optimization Analysis.

World Neurosurg 2020 06 5;138:e469-e477. Epub 2020 Mar 5.

Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland.

Objective: YouTube is the second most popular Web site in the world and thus it is often used by patients to access health information regarding their condition(s). Our aim was to evaluate the content-quality of YouTube videos relating to hydrocephalus.

Methods: We chose the first 35 videos for 4 different search phrases: "water on the brain," "hydrocephalus," "pediatric hydrocephalus," and "adult hydrocephalus." Video contents were evaluated by 2 independent final-year medical students with >5 years of experience using the DISCERN criteria (scoring system from 1 to 5 per question). Qualitative data, quantitative data, and the upload source about each video were recorded for quality and optimization analysis.

Results: Of the total 140 videos, 63 met our inclusion criteria and were evaluated. The mean DISCERN score was 29.9 of a total of 75 possible points. This finding indicates that the quality of YouTube videos on hydrocephalus is poor. Reliability between the 2 raters was excellent (intraclass correlation coefficient = 0.96). Most videos had clear information (90%), a doctor speaking (70%), and described the symptoms (62%). Videos were most commonly uploaded by hospitals (44%) or by educational channels (43%). Our study found that videos that contained the results of treatment had a higher average daily view (P = 0.0229) than videos that did not.

Conclusions: The quality of YouTube videos on hydrocephalus is poor; however, we indicated the top-quality videos in our article because they may be effective tools for patient education. Our optimization analysis found that including diagrams and explaining the results of hydrocephalus treatment leads to higher audience engagement (in the form of likes, comments, and views).
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http://dx.doi.org/10.1016/j.wneu.2020.02.149DOI Listing
June 2020

Extent of anterior clinoidectomy for clipping of carotid-ophthalmic aneurysms predicted on three-dimensional computerised tomography angiography.

Neurol Neurochir Pol 2020 26;54(2):138-149. Epub 2020 Feb 26.

Neurosurgery Department, Medical University of Gdansk, Poland.

Aim Of Study: We aimed to verify the value of computerised tomography angiography (CTA) on predicting the extent of anterior clinoidectomy that is optimal for particular carotid-ophthalmic aneurysms (COAs).

Clinical Rationale For Study: The anterior clinoid process (ACP) often impedes the complex microsurgery of COA. Complete removal of the ACP ensures safe clipping; however, it also may increase the risk of severe complications. The probability of performing a successful partial anterior clinoidectomy could be evaluated by preoperative CTA.

Materials And Methods: 28 patients with either a ruptured (n=4) or unruptured COA were included in this prospective, single-centre, observational study. One aneurysm was giant, two were large, and the rest were smaller. Successful aneurysm clipping was the aim in all cases. The anterior clinoidectomy was preoperatively planned on multiplanar three-dimensional reconstructions of CTA images (3D-CTA) which resembled the typical view of a frontotemporal craniotomy. Finally, the predicted clinoidectomy was compared to the extent of the actual clinoidectomy.

Results: 21 aneurysms (75%) projected superolateral or superior. The ACP was completely and selectively resected in 25% (7 of 28) and 67.9% of patients (19 of 28) respectively. Optic nerve (ON) unroofing was always performed in the case of total anterior clinoidectomy, but accompanied only 8 of 19 selective clinoidectomies (p = 0.03). The extent of the actual clinoidectomy was predicted by the 3D-CTA-based preoperative planning in 17 of 27 cases (63.0%). Particularly, prediction of the osteotomy was correct in 85.7% of complete, 62.5% of selective lateral, and 57.1% of medial clinoidectomy. None of the radiological and clinical factors determined the correlation between the planned and the actual extent of ACP removal. There was one incomplete occlusion among 23 obtained follow-up CTAs.

Conclusions: The predictive value of 3D-CTA on the extent of anterior clinoidectomy still remains unsatisfactory; it is limited by the individual variability of COA and its surrounding structures.

Clinical Implications: Currently, the role of 3D-CTA planning is restricted to educational purposes only.
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http://dx.doi.org/10.5603/PJNNS.a2020.0017DOI Listing
July 2020

Reliability of diffusion tensor tractography of facial nerve in cerebello-pontine angle tumours.

Neurol Neurochir Pol 2020 20;54(1):73-82. Epub 2020 Jan 20.

Medical University of Gdańsk, Neurosurgery Department, Debinki 7, 81-952 Gdańsk, Poland.

Aim Of The Study: This study aimed to verify the accuracy of preoperative visualisation of the facial nerve (FN) by magnetic resonance-based (MR) diffusion tensor imaging-fibre tracking (DTI-FT) with neuronavigation system integration in patients with cerebello-pontine angle (CPA) tumours.

Clinical Rationale For The Study: Complete excision with preservation of the FN remains the critical goal of today's vestibular schwannoma (VS) surgery. DTI-FT of the FN with neuronavigation is yet to be fully evaluated, and could make surgery safer.

Materials And Methods: This was a prospective cohort study in which 38 consecutive patients with a CPA tumour (32 VSs, five meningiomas and one epidermoid cyst) were operated on via the retrosigmoid route from 2013 to 2019. The course of the FN was simulated before surgery using StealthViz and the images were transferred to the Medtronic S7 neuronavigation system. The FN location reconstructed by DTI-FT was verified during the surgery.

Results: MR acquisition was inappropriate in three patients (7.9%). DTI-FT correctly predicted the course of the FN in 31 of the 38 patients; the discordance rate was 18.4%. The accuracy of DTI-FT was 81.6% (95% CI: 65.67-92.26), sensitivity 88.57% (95% CI: 73.26-96.80) and positive predictive value was 91.18% (95% CI: 90.17-92.09). The reliability of the neuronavigation-integrated visualisation of the FN did not depend on the tumour size (p = 0.85), but the method was more accurate when the nerve was compact in shape (p = 0.03, area under curve (AUC) 0.87, 95% CI: 0.60-1.00) and in females (p = 0.04, AUC 0.78, 95% CI: 0.56-1.00). Following surgery, 86.5% of the patients presented with useful facial function (House-Brackmann grades I-III). Correct simulation of the FN did not prevent postoperative facial palsy (p = 0.35).

Conclusions: The accuracy of DTI-FT of the FN integrated with neuronavigation remains unsatisfactory. This method does not provide any clinical benefit over non-integrated DTI-FT in terms of nerve function preservation.

Clinical Implications: Due to the low reliability of the predictions, further technical advances in predicting the course of the FN are awaited by clinicians. However, DTI-FT images in the operating theatre would make tumour excision more comfortable for the surgeon.
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http://dx.doi.org/10.5603/PJNNS.a2020.0001DOI Listing
March 2020

Letter to the Editor. Dr. Dwight Parkinson's legacy.

J Neurosurg 2020 Jan 10:1-2. Epub 2020 Jan 10.

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http://dx.doi.org/10.3171/2019.11.JNS193002DOI Listing
January 2020

Can sectioning the posterior communicating artery be predicted with computed tomography angiography in the microsurgical clipping of basilar apex aneurysms?

Acta Neurochir (Wien) 2020 03 20;162(3):567-579. Epub 2019 Nov 20.

Neurosurgery Department, Medical University of Gdansk, Dębinki 7, 80-952, Gdansk, Poland.

Background: Microsurgical clipping is a viable option for managing high-riding basilar apex aneurysms (BAXs) using a transsylvian approach. Cutting the posterior communicating artery (PCoA) at the perforator-free zone provides sufficient exposure of BAX, although it is not always safe. The aim was to qualitatively predict sectioning of the interfering PCoA by using preoperative computed tomographic angiography (CTA).

Methods: A virtual trajectory from the lesser sphenoid wing to the neck of the aneurysm was simulated on CTA in 19 consecutive patients operated on BAX aneurysms from 2013 to 2018. The angles on CTA resembled the typical view through the extended pterional craniotomy. Next, the ipsilateral PCoA was tracked from the internal carotid to its end at the posterior cerebral artery in the trajectory.

Results: The opticocarotid and carotid-oculomotor window served as the corridors for entering the interpeduncular fossa in 16 patients (84.2%) and in 3 patients (15.8%), respectively. The PCoA was intentionally cut during nine surgeries and preserved in 10 of them. The PCoA was cut more often when positioned toward the cranial base and more medially in the corridor; both the Kernel density analysis and the data points representing the position of the PCoA supported this finding (p < 0.01). The CTA-based position of either ends of the PCoA in the trajectory did not differ between cut and not-cut groups (p = 0.19-0.96). Aneurysm projection, rupture, size, PCoA diameter, length, and other distances on CTA were not related to the sectioning of PCoA (p > 0.05).

Conclusions: The probability of PCoA sectioning is higher when the PCoA is positioned medially and closer to the cranial base. If the anatomical course of the PCoA is recognized beforehand, it can contraindicate surgery. Preoperative CTA-based planning facilitates the surgery of BAX aneurysms. Therefore, CTA can make microsurgical clipping planning more predictable for the neurosurgeon and safer for the patient.
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http://dx.doi.org/10.1007/s00701-019-04138-2DOI Listing
March 2020

Letter to the Editor Regarding "A Quality Analysis of Disk Herniation Videos on YouTube".

World Neurosurg 2019 10;130:570-572

Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland.

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http://dx.doi.org/10.1016/j.wneu.2019.05.171DOI Listing
October 2019

Neurosurgery residency burnout: what can prevent this?

Neurol Neurochir Pol 2019 2;53(5):392-395. Epub 2019 Oct 2.

Medical University of Gdansk, Dębinki 7, 80-952 Gdansk, Poland.

Burnout is an occupational phenomenon indicating that the work and the workplace are responsible. We here discuss how a supportive resident-mentor relationship, and a positive working environment, could help to prevent resident burnout. A positive resident-mentor relationship can be achieved by understanding the mentor, the mentee, and the generational differences of each individual. A positive working environment depends on a healthy work-life balance and the atmosphere in the department. The benefits of preventing burnout include not only happier physicians but also fewer medical errors and better medical care. The universal reminders and proven suggestions in our paper could help address the burnout problem among working physicians worldwide.
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http://dx.doi.org/10.5603/PJNNS.a2019.0043DOI Listing
November 2019

Letter to the Editor. Harvey Cushing's legacy.

J Neurosurg 2019 09 27;132(6):2011-2013. Epub 2019 Sep 27.

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http://dx.doi.org/10.3171/2019.6.JNS191711DOI Listing
September 2019

Modified bedside twist drill craniostomy for evacuation of chronic subdural haematoma.

Wideochir Inne Tech Maloinwazyjne 2019 Sep 18;14(3):442-450. Epub 2019 Feb 18.

Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland.

Introduction: Standard craniotomy (SC) and burr hole craniostomy (BHC) are regarded as the standard approaches to chronic subdural haematoma (CSDH). Bedside twist drill craniostomy (TDC), performed at the patient's bedside, was introduced as an alternative to the standard methods. However, clinical and radiological features of patients treated with TDC and BHC/SC have not been compared.

Aim: To demonstrate the specific features of CSDH that affect the surgeons' preferences when selecting patients for TDC.

Material And Methods: A retrospective analysis of 32 patients treated due to CSDH in the year 2017 at a single institution was performed. Baseline radiological characteristics, clinical status at admission, complication rate and clinical outcomes were compared between BHC/SC and TDC.

Results: Of the 32 patients, 5 (15.6%) were treated using TDC and 27 (84.4%) by SC or BHC. The duration of the TDC procedure was significantly shorter than the time of standard therapies (p < 0.01). There were no differences between TDC and BHC/SC in terms of baseline clinical characteristics, including age, gender, head trauma history, diabetes, hypertension, antiplatelet drug use, clinical manifestation and the Glasgow Coma Scale score (all p > 0.05). Patients treated with TDC had a significantly thicker haematoma (TDC vs. BHC/SC: mean 25.3 mm vs. 14.6 mm) (p < 0.01) and demonstrated a smaller midline shift (TDC vs. BHC/SC: mean 0.5 mm vs. 4.0 mm) (p = 0.01) compared to those treated with BHC/SC.

Conclusions: Twist drill craniostomy is a more effective method for CSDH evacuation compared to SC and BHC. This procedure is considered as the first line treatment for patients with a thicker and non-septated haematoma, and with a smaller midline shift.
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http://dx.doi.org/10.5114/wiitm.2019.83001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6748050PMC
September 2019

The "Optimum Volume" of Acrylic Cement Filling for Treating Vertebral Compression Fractures: A Morphometric Study of Thoracolumbar Vertebrae.

Adv Exp Med Biol 2019 ;1211:25-39

Second Department of Radiology, Medical University of Gdansk, Gdansk, Poland.

Percutaneous vertebroplasty is a treatment option in vertebral compression fractures (VCF). The aim of the study was to propose the mathematical calculation of the "optimum volume" of acrylic cement filling of the vertebral body, depending on the severity of a fracture. Two hundred computed tomography (CT) scans of vertebral columns in healthy adult Caucasians were analyzed. Vertebral body width (VBW), vertebral body depth (VBD), vertebral body height (VBH), and vertebral body volume (VBV) were measured. The "optimum volume" of cement injections in mild (25% collapse) and moderate (40% collapse) VCF were calculated. We found that moving caudally from Th to L, the mean values of the examined parameters increased: VBH from 22.6 to 26.0 mm, VBW from 34.0 to 39.5 mm, VBD from 28.1 to 30.9 mm, and VBV from 17.1 to 24.8 cm. The calculated hypothetical "optimum volume" of cement injection increased from 7.4 to 10.0 cm in mild VCF and from 5.9 to 7.8 cm in moderate VCF, with some variability depending on the vertebral level and gender. These values are akin to those present in other past studies. We conclude that morphometric measurements, based on CT images, are a reliable source of practical anatomical savvy, which may be of help in spine surgery.
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http://dx.doi.org/10.1007/5584_2019_417DOI Listing
November 2019

Does Spinal Cord Stimulation Due to Failed Back Surgery Syndrome Lead to Permanent Occupational Disability?

Neuromodulation 2020 Jul 24;23(5):653-659. Epub 2019 Jun 24.

Student Scientific Circle, Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland.

Objective: Spinal cord stimulation (SCS) is a recommended treatment method for patients afflicted by failed back surgery syndrome (FBSS). Although SCS is shown to be clinically effective, not many patients return to work (RTW). The aim of this study is to assess the RTW rate of these patients.

Materials And Methods: We prospectively evaluated 102 patients with FBSS, managed by low frequency SCS at a single institution in Poland. RTW rate was the main endpoint in the study. Additionally, we browsed the first 300 records in Google and extracted the suggested RTW time post-SCS implantation.

Results: Mean follow-up was 8.5 years. 79.4% of patients were actively working at the baseline. Fifteen patients were sick leave benefit claimants (15/81; 18.5%) and six were permanently disabled (6/81; 7.4%). In the follow-up, 40 did not change their work status. Only 2 of 21 patients resumed work and the total RTW rate was 9.5%. On the other hand, 38 of 81 patients (46.9%), who actively worked before SCS, gained disability status. Out of entire group, 20.6% (21 of 102) were not working at the baseline and 55.9% (57 of 102) were not working in the follow-up. Neither factor influenced RTW rate. In the second stage of the study, internet data search yielded a mean RTW time of 6.1 weeks.

Conclusions: Unlike the well-analyzed effectiveness of SCS, RTW remains an underutilized outcome measure. The RTW rate in our series was the second lowest in the reviewed literature. We demonstrated that half of the patients with an implanted SCS either did not resume their work or left their job.
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http://dx.doi.org/10.1111/ner.13014DOI Listing
July 2020

Morphometric Analysis of the Lumbar Vertebrae Concerning the Optimal Screw Selection for Transpedicular Stabilization.

Adv Exp Med Biol 2019;1133:83-96

Second Department of Radiology, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland.

Transpedicular stabilization is a frequently used spinal surgery for fractures, degenerative changes, or neoplastic processes. Improper screw fixation may cause substantial vascular or neurological complications. This study seeks to define detailed morphometric measurements of the pedicle (height, width, and surface area) in the aspects of screw length and girth selection and the trajectory of its implantation, i.e., sagittal and transverse angle of placement. The study was based on CT examinations of 100 Caucasian patients (51 women and 49 men) aged 27-75 with no anatomical, degenerative, or post-traumatic spine changes. The results were stratified by gender and body side, and they were counter compared with the available literature database. Pedicle height decreased from L1 to L4, ranging from 15.9 to 13.3 mm. Pedicle width increased from L1 to L5, extending from 6.1 to 13.2 mm. Pedicle surface area increased from L1 to L5, ranging from 63 to 140 mm. Distance from the point of entry into the pedicle to the anterior surface of the vertebral body, defining the maximum length of a transpedicular screw, varied from 54.0 to 50.2 mm. Variations concerning body sides were inappreciable. A transverse angle of screw trajectory extended from 20° to 32°, shifting caudally from L1 to L5, with statistical differences in the L3-L5 segments. A sagittal angle varied from 10° to 12°, without such definite relations. We conclude that the L1 and L2 segments display the most distinct morphometric similarities, while the greatest differences, in both genders, are noted for L3, L4, and L5. The findings enable the recommendation of the following screw diameters: 4 mm for L1-L2, 5 mm for L3, 6 mm for L4-L5, and the length of 50 mm. We believe the study has extended clinical knowledge on lumbar spine morphometry, essential in the training physicians engaged in transpedicular stabilization.
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http://dx.doi.org/10.1007/5584_2018_324DOI Listing
August 2019

Towards a new treatment paradigm for ruptured blood blister-like aneurysms of the internal carotid artery? A rapid systematic review.

J Neurointerv Surg 2016 May 19;8(5):488-94. Epub 2015 Mar 19.

Developmental Neurology, Medical University of Gdansk, Gdansk, Poland.

Background And Purpose: Owing to their peculiar features and rare occurrence, ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery are challenging by both surgical and endovascular approaches and their proper management is uncertain. We therefore aimed to define the currently optimal treatment of ruptured BBAs in terms of mortality, outcome, rebleeding, and recurrence.

Method: An in-depth search of electronic databases, gray literature and internet resources for ruptured BBAs was performed and complemented by data retrieval during neurosurgical congresses. Clinical and radiological characteristics, intervention details, outcomes, and the impact factor of the source journal were pooled.

Results: The pooled cohort comprised 311 patients. Neither surgical nor endovascular methods had an impact on clinical outcome, aneurysm regrowth, remote bleeding, or complication rate. By contrast, aneurysm clipping was a predictor of intraoperative bleeding (OR 6.5; 95% CI 1.2 to 34.3), and stent-assisted coiling increased the likelihood of a second treatment (OR 4.1; 95% CI 1.3 to 13.1), its conversion to another modality (OR 4.7; 95% CI 1.4 to 16.0), and incomplete aneurysm obliteration (OR 2.6; 95% CI 1.0 to 6.6). Higher impact journals were more likely to publish papers on endovascular techniques, particularly flow-diverter stents.

Conclusions: None of the methods is unequivocally superior. Considering its inefficiency, stent-assisted coiling should be undertaken with caution. A time-delimited systematic review is needed to establish the most accurate treatment for ruptured BBAs.
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http://dx.doi.org/10.1136/neurintsurg-2015-011665DOI Listing
May 2016

Colour contrasting between tissues predicts the resection in 5-aminolevulinic acid-guided surgery of malignant gliomas.

J Neurooncol 2015 May 22;122(3):575-84. Epub 2015 Feb 22.

Department of Neurosurgery, Medical University of Gdańsk, Dębinki 7, Gdańsk, Poland,

Due to the various intensities of 5-aminolevulinic acid (5-ALA) fluorescence, neurosurgeons tend to be uncertain about which tissues to resect. This study aimed to reveal the shortcomings of the human visual perception of fluorescence, particularly the factors guiding the tissue removal and the correlation of fluorescence with contrast enhancement (CE) on magnetic resonance imaging (MRI). Various colour features [CIE L*a*b* colour space, colour difference described by ΔE and contrast ratio (CR)] of total 206 noticed fluorescent areas and their surroundings were measured from the video recordings of 21 primary high grade glioma (HGG) surgeries. The position of a fluorescent region was related to the corecorded navigational image. Following early postoperative MRI, 17 additional regions of corresponding to CE remnants were identified, their colour features were compared to the resected CEs. The targeted video post-processing method was designed, based on the results. There were no complications attributed to 5-ALA use and the median survival was <10 months. 82.5 % of recognised fluorescent areas were removed. Colour spaces of the resected regions and their backgrounds did not overlap. Opposite to the separate colour components (p > 0.05), the distant background colour (p < 0.05) and higher CR and ΔE (p < 0.01) determined the resection of a fluorescent region. Noneloquent location and CR both independently increased the resection rate in logistic regression. However, greater area under the receiver operating characteristic curve (AUC) in case of CR (AUC = 0.78; 95 % CI 0.71-0.83) determined its dominant role in neurosurgeon's fluorescence perception. CE regions presented with a significantly more saturated shade of violet (consistently higher a* and b*) than other tumour parts (p < 0.05). Regions corresponding to tumour remnants had a significantly lower a* component value (p = 0.02) as well as a lower ΔE than the matched background (AUC = 0.73; 95 % CI 0.65-0.80). In order to increase the resection rate, ΔE > 60 was needed. These results directed essential improvements in the 5-ALA fluorescence visualisation toward enhanced resection rate. The conventional filtering, unadjusted to the 5-ALA colour space converted some background shades to colours resembling relevant fluorescence. This is one of the first studies to demonstrate that perceived colours, their contrasting and CR are of significance in the decision-making during HGG 5-ALA fluorescence-guided surgery. Irrespective of the shortcomings of conventional video filtering, further development of a tailored post-processed contrast stretching will allow to achieve safe and radical tumour resection.
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http://dx.doi.org/10.1007/s11060-015-1750-0DOI Listing
May 2015

The challenges of hypervolemic therapy in patients after subarachnoid haemorrhage.

Neurol Neurochir Pol 2014 13;48(5):328-36. Epub 2014 Oct 13.

Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland.

Purpose: The triple-H therapy is widely used for cerebral vasospasm (CV) prevention and treatment in patients after subarachnoid haemorrhage (SAH). However, this practice is based on low level evidence. Aim of this study was to evaluate errors in fluid administration, fluid balance monitoring and bedside charts completeness during a trial of triple-H therapy.

Materials And Methods: An audit of the SAH patient charts was performed. A total of 508 fluid measurements were performed in 41 patients (6 with delayed cerebral ischaemia; DCI) during 14 days of observation.

Results: Underestimating for intravenous drugs was the most frequent error (80.6%; 112), resulting in a false positive fluid balance in 2.4% of estimations. In 38.6% of the negative fluid balance cases, the physicians did not order additional fluids for the next 24h. In spite of that, the fluid intake was significantly increased after DCI diagnosis. The mean and median intake values were 3.5 and 3.8l/24h respectively, although 40% of the fluid balances were negative. The positive to negative fluid balance ratio was decreasing in the course of the 14 day observation.

Conclusions: This study revealed inconsistencies in the fluid orders as well as mistakes in the fluid monitoring, which illustrates the difficulties of fluid therapy and reinforces the need for strong evidence-based guidelines for hypervolemic therapy in SAH.
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http://dx.doi.org/10.1016/j.pjnns.2014.09.001DOI Listing
January 2015

Internal carotid artery anterior wall aneurysms.

J Neurosurg 2014 Jul 9;121(1):221-3. Epub 2014 May 9.

Medical University of Gdańsk, Gdańsk, Poland.

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http://dx.doi.org/10.3171/2014.1.JNS132871DOI Listing
July 2014

Effect of sevoflurane on cerebral perfusion pressure in patients with internal hydrocephalus.

Anaesthesiol Intensive Ther 2013 Oct-Dec;45(4):211-4

Department of Neuroanaesthesiology, Medical University of Gdańsk, Poland.

Background: Due to its confirmed neuroprotective properties, sevoflurane is one of a few anaesthetics used for neuroanaesthesia. Its effects on the cerebral and systemic circulations may be of particular importance in patientswith intracranial pathology. This study aimed to evaluate the effect of sevoflurane at concentrations lower than 1 MAC on cerebral perfusion pressure (CPP) in patients with internal hydrocephalus.

Methods: The study was conducted on14 patients with internal hydrocephalus, who underwent ventriculo-peritoneal shunt implantation. After inserting the catheter into the lateral cerebral ventricle, sevoflurane, at 1.1 and 2.2 vol%, was initiated at two successive 15-minute intervals. The intracranial pressure (ICP) was continuously measured; special attention was focused on the values prior to and at the end of each observation period. The following parameters were monitored: mean arterial pressure (MAP), CPP, heart rate, end-tidal CO₂ concentration, core body temperature, and the inspiratory and end-expiratory concentrations of sevoflurane.

Results: The HR and MAP decreased during successive observation intervals compared to baseline values. Likewise, the CPP decreased from 75.6 ± 2.8 mm Hg to 72.2 ± 2.6 mm Hg to 70.2 ± 0.8 mm Hg. The baseline value for ICP was 16.3 ± 0.6 mm Hg and increased to 17.7 ± 0.8 and 18.9 ± 0.5 mm Hg during the next observation periods.

Conclusions: Sevoflurane administered ata concentration below 1MAC to patients with internal hydrocephalus increases the ICP and decreases the MAP, which leads to adecrease in CPP. The CPP decrease is more dependent on depressing the systemic circulatory system than an increased ICP.
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http://dx.doi.org/10.5603/AIT.2013.0041DOI Listing
September 2014

Influence of variation in the catechol-O-methyltransferase gene on the clinical outcome after lumbar spine surgery for one-level symptomatic disc disease: a report on 176 cases.

Acta Neurochir (Wien) 2014 Feb 1;156(2):245-52. Epub 2013 Nov 1.

Department of Neurosurgery, Medical University of Gdansk, Debinki str. 7, 80-952, Gdansk, Poland,

Background: This study was aimed at the evaluation of the relationship between genetic polymorphisms of catechol-O-methyltransferase (COMT) (rs4680:A > G-Val158Met, rs6269:A > G, rs4633:C > T, rs4818:C > G) and pain sensitivity after lumbar discectomy.

Methods: All patients had one-level symptomatic disc herniation from L3 to S1. The primary data recorded included visual analogue pain scales assessing back and leg pain, Oswestry Disability Questionnaire assessing quality of life and pain intensity, received/filled pre- and postoperatively. Each subject was genotyped for single-nucleotide polymorphism in the COMT gene. Clinical outcome was measured by difference between pre- and postoperative values and those results were analyzed with genetics findings.

Results: Pain intensity was associated with the COMT polymorphism. Carriers of rs6269 AA, rs4633 TT, rs4818 CC, and rs4680 AA genotypes were characterized by the lowest preoperative scores related to pain intensity and lower pain intensity at 1 year after the surgery. The rs4633 CC, rs4680 GG genotypes demonstrated significant clinical improvement in VASBACK score at 1 year after the surgery. Patients with COMT haplotype associated with low metabolic activity of enzyme (A_C_C_G) showed better clinical outcome measured by ODI score and VASBACK score 1 year after surgery. We did not observe any significant correlation between leg pain and single-nucleotide polymorphisms in the COMT gene.

Conclusions: The results of our study indicate that polymorphism in the COMT gene may play an important role in the mechanism of pain perception, which may have a potential implication for clinical decision-making in the future.
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http://dx.doi.org/10.1007/s00701-013-1895-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898361PMC
February 2014

Evaluation of usefulness of scintigraphic imaging in diagnosis of intrathecal drug delivery system malfunction - a preliminary report.

Pol J Radiol 2013 Jul;78(3):21-7

Department of Nuclear Medicine, Medical University of Gdańsk, Gdańsk, Poland.

Background: Implantable intrathecal drug delivery systems (IDDS) are basic tool enabling chronic intrathecal pharmacotherapy. Lack of expected clinical results of IDDS therapy necessitates search for the cause with the help of diagnostic imaging methods among other things. Beside radiological techniques, it is also possible to visually assess IDDS systems by nuclear medicine methods. In this study we assess utility of radioisotopic methods in differential diagnosis of failure of therapy with IDDS systems.

Material/methods: Scintigraphic studies were performed in selected patients with neurological diseases associated with spasticity, who had IDDS system implanted and were unable to maintain satisfying clinical effect of inrathecally infused baclofen. After emptying the IDDS system of the drug, radiotracer (99mTc-DTPA) solution was injected into the pump reservoir. Subsequently, a series of scintigraphic images was registered, demonstrating passage and distribution of the infused radiotracer.

Results: In all investigated cases, scintigraphic study resulted in acquiring relevant additional diagnostic information. Normal or disrupted distribution of radiotracer in spinal canal allowed for a diagnosis drug resistance or demonstrated presence of arachnoid adhesions respectively. Early appearance of radiotracer in blood was considered a proof of leak. Our examinations had decisive influence on further patient treatment, allowing for diagnosis of drug resistance in one patient or complication related to IDDS system in three other cases including breakage of a catheter, pump malfunction and arachnoid adhesions.

Conclusions: Scintigraphic methods carry significant amount of information facilitating final diagnosis of the cause of IDDS therapy failure. They should become an important element complementing the diagnostic strategy in patients with suspected failure of intrathecal drug administration systems. Interpretation of radioisotopic studies, since they are purely functional, must be performed in strict relation to clinical data and radiological examinations as they carry indispensable, basic information regarding morphology.
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http://dx.doi.org/10.12659/PJR.889130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789929PMC
July 2013