Piotr Zieliński

An end-to-end autonomous artificial intelligence–based system was developed and validated at five international stroke centers to enable rapid, standardized quantification of rupture-relevant brain aneurysm and parent artery morphology metrics directly from CT angiography.

Neuroplastyczność jest powszechnie uznawana za zjawisko korzystne. Nie należy jej jednak interpretować dogmatycznie, skoro w piśmiennictwie wspomina się także o negatywnej plastyczności. Podejmując interdyscyplinarny dialog między naukami humanistycznymi a medycyną, przypominamy myśl francuskiej filozofki Catherine Malabou. Oskarżyła ona medycynę o skupianie się wyłącznie na pozytywnych aspektach plastyczności mózgu. Poszukujemy zatem przykładów klinicznych odniesień do negatywnego wymiaru neuroplastyczności, szczególnie w obszarze neurologii i neurochirurgii. Znaczący postęp w technikach neurochirurgicznych pozwala obecnie na usuwanie coraz większej frakcji guza, co skutkuje dłuższym czasem przeżycia pacjentów, jednak jakość ich życia nie zawsze jest zadowalająca. Można obserwować zmiany tożsamości dostrzegalne przez samych pacjentów i przez ich bliskich. Neurochirurg polega na neuroplastyczności jako strategii rehabilitacyjnej, jednak jej efekt nie jest w pełni przewidywalny. Zachęcamy zatem klinicystów i humanistów do dyskusji nad etycznymi implikacjami tego fenomenu.

Background/Objectives: Low back pain (LBP) is a leading cause of disability and work absenteeism worldwide. Lumbar facet joint degeneration is a common source of chronic LBP, and when conservative treatment fails, interventional procedures may be indicated. Cryodenervation is a minimally invasive option that remains less extensively studied. This study aims to evaluate clinical outcomes, cost–utility, and return-to-work rates following lumbar facet joint cryodenervation. Methods: A retrospective study included 42 professionally active patients treated with lumbar facet joint cryoablation between 2020 and 2022 at a tertiary neurosurgical center. All patients had facet-mediated LBP confirmed by a positive diagnostic medial branch block. Pain (VAS), disability (ODI), and work status were assessed before and after treatment. ODI scores were converted to SF-6D utilities to estimate quality-adjusted life years (QALYs). Cost data were obtained from institutional records. Results: Mean ODI improved from 48.5 ± 12.8 to 36.6 ± 17.8, and mean VAS from 7.0 ± 1.7 to 3.8 ± 2.0. Mean SF-6D increased from 0.53 to 0.59, corresponding to a gain of 0.0103 QALYs over four months (annualized 0.0309). The mean procedure cost was 1905 PLN, resulting in approximately 185,000 PLN per QALY, which is within the national cost-effectiveness threshold. Overall, 58.5% of patients returned to work, with the highest rate in those aged 30–39 years (83.3%). Conclusions: Lumbar facet cryoablation provides meaningful pain relief and functional improvement at a favorable cost-effectiveness profile. Younger patients show higher return-to-work rates. Larger prospective studies are required to confirm these findings.

Purpose: Moyamoya disease (MMD) is a chronic cerebrovascular disorder characterized by progressive arterial stenosis and fragile collateral formation, elevating stroke risk. Revascularization is the standard treatment, yet up to 27% of patients experience ischemic events within a year due to bypass insufficiency. While digital subtraction angiography (DSA) remains the gold standard for assessing bypass function, it is invasive and time-consuming. This study evaluates ultrasonography (US) as a noninvasive, cost-effective tool to assess bypass capacity post-revascularization in MMD. Methods: A systematic search was conducted following PRISMA guidelines. PubMed, Web of Science, and Scopus were searched for studies reporting US parameters with control imaging confirming bypass capacity. Study quality was assessed using the Newcastle–Ottawa Scale. Mean difference (MD) values were calculated using random-effects models. High bypass capacity was defined as good patency or favorable collateral development. Results: Eight cohort studies comprising 264 MMD patients and 301 operated hemispheres were included, with 180 demonstrating high bypass capacity. Within two weeks post-surgery, increased superficial temporal artery (STA) peak systolic velocity (PSV, MD = 28.26, p < 0.0001), mean flow velocity (MFV, MD = 22.97, p = 0.03), end-diastolic velocity (EDV, MD = 33.45, p < 0.0001), and decreased resistance index (RI, MD = –0.09, p = 0.006) were predictive. External carotid artery (ECA) EDV (MD = 13.92, p = 0.04) was also significant. At 3–6 months, elevated EDV in both STA (MD = 8.13, p = 0.006) and ECA (MD = 8.71, p = 0.0002) remained predictive. In the indirect subgroup, lower anterior cerebral artery (ACA) MFV within 0–3 months predicted favorable outcomes (MD = –64.98, p = 0.001). Conclusions: Changes in STA and ECA US parameters measured following revascularization surgery predict high bypass capacity. Decreased ACA MFV suggests effective revascularization after indirect surgery. Ultrasound modality offers a valuable, noninvasive tool for postoperative assessment in MMD.

Cerebral vasospasm (CVS) is a severe complication associated with significant morbidity and in-hospital mortality. While well characterized in aSAH, its occurrence following AVM-related hemorrhage remains less understood. To address this gap, a meta-analysis adhering to PRISMA guidelines was conducted, with two independent authors searching PubMed, Scopus, and Web of Science from inception to July 2024, seeking studies on CVS risk factors following AVM-related hemorrhage. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Dichotomous variables were pooled into an overriding odds ratio (OR) with a 95% confidence interval (CI), while continuous variables were analyzed using the mean difference (MD) with a 95% CI, both using a random-effects model. Out of 2360 screened articles, 4 studies met the inclusion criteria, totaling 7483 AVM-related hemorrhage patients, 958 of whom developed CVS. All studies were rated high quality, according to NOS. A total of 10 extractable demographic, behavioral, clinical, and radiographic variables reported in the literature were assessed. The following CVS risk factors were statistically significant: younger age (MD = -4.99; 95% CI [-9.40 to -0.57]; p = 0.03), female sex (OR = 1.72; 95% CI [1.50–1.98]; p < 0.00001), and intraventricular hemorrhage (OR = 1.24; 95% CI [1.04–1.48]; p = 0.02). Subarachnoid hemorrhage was close to significance (OR = 1.17; 95% CI [1.00–1.36]; p = 0.05). This is the first systematic review and meta-analysis to identify risk factors for CVS in the context of AVM-related hemorrhage. The presented findings may aid clinicians in recognizing high-risk individuals. Further research is warranted to develop a reliable risk scoring system that can predict AVM-associated CVS in clinical settings and to further explore the differences between CVS following aSAH and AVM-related hemorrhage.

Intracranial aneurysms often remain asymptomatic until rupture, causing aneurysmal subarachnoid hemorrhage (aSAH). aSAH frequently leads to cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI), significantly increasing the risk of severe neurological deficits and mortality. Identifying reliable biomarkers, such as lipid peroxidation metabolites (LPMs), is crucial for early prediction and timely intervention. This study summarizes current knowledge on LPMs as potential biomarkers for CVS and DCI after aSAH. A systematic review was conducted following PRISMA guidelines. Two independent authors searched PubMed, Web of Science, and Scopus for articles studying the association between non-enzymatic and enzymatic lipid metabolites and CVS or DCI after aSAH. Quality and risk of bias were evaluated using the Newcastle-Ottawa Scale. Extracted data included metabolite concentrations, biological sample types, timing of collection, patient demographics, clinical severity of aSAH, Fisher’s grade, DCI definition, and relationship to DCI. Of 519 records screened, 17 studies were included. Lipid metabolites were measured in blood (5 studies), cerebrospinal fluid (11 studies), and urine (2 studies). F2-isoprostanes (F2-IsoPs), studied in 7 articles, were linked to increased DCI risk, with elevated levels observed within three days post-aSAH. Isofurans (IsoFs) predicted DCI risk between days 5 and 8 post-aSAH, while elevated cholesteryl ester hydroperoxide (CEOOH) levels on day 2 linked to symptomatic vasospasm. Enzymatic arachidonic acid (AA) metabolites, including 6-keto-prostaglandin F1-α, prostaglandin D2, and leukotriene C4, were also associated with early DCI risk. To the best of our knowledge, this review is the first to comprehensively assess all LPMs in relation to CVS and DCI. Elevated concentrations of F2-IsoPs and enzymatic AA derivatives may serve as biomarkers for DCI prediction in aSAH. These findings highlight the need to explore the potential of LPMs, paving the way for risk stratification and timely interventions to improve patient outcomes and aid researchers in developing predictive scoring systems for DCI. Clinical trial number Not applicable.

Purpose Facet joint violation (FJV) is an underreported consequence of screw placement in spine surgery, significantly impacting load-bearing capability of the level. Rates of FJV range from 6.3 to 100% due to variability in surgical techniques, navigation methods, and FJV definitions. This study identifies FJV predictors during lumbar fusion in minimally invasive spine surgery (MISS) and open procedures. Methods Literature review was performed according to PRISMA guidelines. PubMed, Web of Science and Scopus were searched using keywords “MIS”, “minimally invasive”, “percutaneous”, “endoscopic”, “open”, “conventional”, “traditional”, “lumbar fusion”, “spine fusion”, “FJV”, “facet joint violation”. The quality of studies was evaluated using the Newcastle-Ottawa Scale (NOS). Odds ratio (OR) for dichotomous values and mean difference (MD) for continuous values were calculated. Patients were divided into minimally invasive spine surgery (MISS) and open subgroups. Results Seven retrospective studies reporting 1155 patients and 2309 screws were identified, among which 412 violated the facet joint. Body Mass Index (BMI) ≥ 30 predicted FJV, particularly in the MISS subgroup (OR = 3.73, p < 0.0001). Screw placement at L4 level was associated with lower risk (OR = 0.64, p = 0.0003), while L5 level increased the risk of FJV (OR = 1.85, p < 0.0003). Lower pedicle screw angle (PSA) was another FJV predictor (MD= -5.82, p = 0.0002). In the MIS subgroup, 3D navigation decreased the FJV risk (OR = 0.39, p = 0.001). Conclusion BMI ≥ 30, screw placement at L5, and a lower PSA increase the risk of FJV during lumbar interbody fusion. Screw placement at L4 and the use of 3D navigation in MISS are associated with a decreased FJV risk. These findings provide valuable insights for optimizing surgical techniques and reducing FJV incidence in lumbar spine instrumentation.

This study aimed to assess the quality of YouTube (YT) videos providing medical information on cervical spine fractures; secondly, a comparison of two timeframes has been conducted. Using Google Chrome with privacy settings to minimize personalization, two searches were conducted on 20 July 2021 and the second one on 10 April 2024 using various terms related to cervical spine injuries. Videos were evaluated using the DISCERN (Quality Criteria for Consumer Health Information), GQS (Global Quality Score), and JAMA scoring systems. In total, 91 videos were included. Mechanisms of injury were the most frequent video content (n = 66), and postoperative pain occurred the least (n = 6). The mean DISCERN score of 43.26 (std = 11.25), mean GQS of 2.67 (std = 0.74), and mean JAMA score was 2.2 (std = 0.68). Inclusion of treatment options had an odd ratio of 21.72 for a better-quality video. The largest number of videos was provided by physicians (n = 24). In DISCERN, risks of treatment were graded lowest = 1.9. Newer videos achieved higher scores in the DISCERN, GQS, and JAMA scoring systems reaching 52.5, 3, and 2.75, respectively. These scores suggest inadequate information provision in the videos, hindering patients’ understanding of their condition. Due to insufficient information presented in current videos, patients are not fully informed.

Dural metastases of prostate adenocarcinoma are an extremely rare complication and may mimic intracranial hematoma. Preoperatively diagnosis may be difficult due to similarities in symptoms and radiological appearance. We present a 65-year-old man admitted to the ED with a history of headache, nausea, vomiting, vertigo, diplopia, as well as numbness of his left lower extremity. Past medical history confirmed metastatic prostate cancer disease. After computed tomography and contrast computed tomography, the consulting radiologist diagnosed a chronic subdural hematoma. After burr hole trephination and dural opening, tumorous mass was detected. Histopathologic samples were taken. Histopathological examination was consistent with metastatic adenocarcinoma of the prostate. Although rare, dural metastases need to be included in oncological patients presenting in the ED with symptoms and radiological imaging suggesting hematoma. Both neurooncological and neurosurgical consultations are essential in order to apply the best treatment strategy.

Acute coronary syndrome (ACS) and stroke are the leading causes of mortality and long-term morbidity across the world. Post-hospital rehabilitation (PHR) is strongly recommended in both groups. The purpose was assessment of awareness of the PHR need in patients after ACS and after ischaemic stroke (IS). The study included 60 patients (17 F, 43 M), 62 ± 13.6 years of age, admitted to hospital due to ACS (n=30 pts) or IS (n=30 pts). A cross-sectional survey was carried out in order to evaluate awareness of the PHR need through a questionnaire composed of 14 one-choice answer questions. There was no significant correlation between place of residence and willingness to participate in the PHR programme: 69.2% (n=9) of the pts living in rural areas and 80.9% (n=38) living in the city declared their willingness to partcipate. The majority of patients declared that PHR is needed (87.5% of pts with basic educational level, 63.2% with vocational education, 61.1% with technical education, 80% with university education level). 43.3% (n=13) of pts after ACS and 66.7% (n=20) pts after IS declared they had been informed about the possibility of PHR. Altogether, 46.7% (n=14) of pts after ACS and 33.3% (n=10) after stroke understood it to be a stay in a spa; only 10% (n=3) of pts after ACS and 33.3% (n=10) after IS understood it correctly. 30% (n=9) pts after ACS and 13.3% (n=4) after IS saw it as a change in lifestyle and 13.3% (n=4) pts after ACS and 20% (n=6) after IS declared they did not know what PHR was. Type of place of residence and educational level had no association with the PHR need. Patients after IS were more aware than those after ACS. Increased independence was the main expectation in both groups. The majority of patients perceived PHR to consist of treatment in a spa. Too few patients were informed about the possibility of PHR.