Clinical Neurology and Neurosurgery最新文献

Neurological manifestations and complications of Kikuchi-Fujimoto disease: A comprehensive systematic review

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-03-04 DOI: 10.1016/j.clineuro.2025.108818

H.Shafeeq Ahmed , Leroy D’Souza , Vibhav M S, Mohammed Sulaiman Sache

Background

Kikuchi-Fujimoto disease (KFD) is a self-limiting inflammatory condition primarily affecting young and pediatric patients of Asian descent. This systematic review aims to consolidate current knowledge on the neurological manifestations associated with KFD.

Methods

The present review followed the PRISMA guidelines and was registered on PROSPERO (CRD42024579757). PubMed, Scopus and CINAHL Ultimate were searched to identify relevant studies. We included case reports and case series detailing neurological manifestations and complications of KFD of any age/gender.

Results

The initial search identified 456 articles out of which seventy-five case reports and series were included, encompassing a total of 81 cases. The median age of the patients was 23 years (IQR: 15–30). Patients most frequently presented with fever, headache and signs of meningeal irritation. Most patients diagnosed with KFD showed signs of neurological complications at the initial presentation. Meningitis (commonly aseptic meningitis) was the most frequently reported neurological complication followed by encephalitis, encephalopathy and neuro-ophthalmological complications. All patients had lymphadenopathy and showed the characteristic histopathological picture for KFD on biopsy. Steroids and immunosuppressive agents remained the treatment of choice. Complication and symptom specific treatment for neurological findings was provided wherever deemed necessary. Almost every study reported an improvement in neurological complications post treatment.

Conclusion

Neurological manifestations and complications associated with KFD are diverse and have a significant impact on patients. The complications associated with KFD need to be promptly recognized and evaluated by clinicians. Further investigation into the long-term effects and treatment strategies for KFD is warranted.

{"title":"Neurological manifestations and complications of Kikuchi-Fujimoto disease: A comprehensive systematic review","authors":"H.Shafeeq Ahmed , Leroy D’Souza , Vibhav M S, Mohammed Sulaiman Sache","doi":"10.1016/j.clineuro.2025.108818","DOIUrl":"10.1016/j.clineuro.2025.108818","url":null,"abstract":"<div><h3>Background</h3><div>Kikuchi-Fujimoto disease (KFD) is a self-limiting inflammatory condition primarily affecting young and pediatric patients of Asian descent. This systematic review aims to consolidate current knowledge on the neurological manifestations associated with KFD.</div></div><div><h3>Methods</h3><div>The present review followed the PRISMA guidelines and was registered on PROSPERO (CRD42024579757). PubMed, Scopus and CINAHL Ultimate were searched to identify relevant studies. We included case reports and case series detailing neurological manifestations and complications of KFD of any age/gender.</div></div><div><h3>Results</h3><div>The initial search identified 456 articles out of which seventy-five case reports and series were included, encompassing a total of 81 cases. The median age of the patients was 23 years (IQR: 15–30). Patients most frequently presented with fever, headache and signs of meningeal irritation. Most patients diagnosed with KFD showed signs of neurological complications at the initial presentation. Meningitis (commonly aseptic meningitis) was the most frequently reported neurological complication followed by encephalitis, encephalopathy and neuro-ophthalmological complications. All patients had lymphadenopathy and showed the characteristic histopathological picture for KFD on biopsy. Steroids and immunosuppressive agents remained the treatment of choice. Complication and symptom specific treatment for neurological findings was provided wherever deemed necessary. Almost every study reported an improvement in neurological complications post treatment.</div></div><div><h3>Conclusion</h3><div>Neurological manifestations and complications associated with KFD are diverse and have a significant impact on patients. The complications associated with KFD need to be promptly recognized and evaluated by clinicians. Further investigation into the long-term effects and treatment strategies for KFD is warranted.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"251 ","pages":"Article 108818"},"PeriodicalIF":1.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Augmented reality in cranial surgery: Surgical planning and maximal safety in resection of brain tumors via head-mounted fiber tractography

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-03-03 DOI: 10.1016/j.clineuro.2025.108820

Muhammet Enes Gurses , Elif Gökalp , Jordan Spatz , Siyar Bahadir , Vratko Himic , Ricardo J. Komotar , Michael E. Ivan

Recent advancements in computer vision, enhanced augmented reality (AR) software and hardware are paving the way for AR to emerge as a promising and innovative tool for advancing and broadening neurosurgical pre-operative planning and intraoperative procedures. In this study, we describe the use of AR coupled with Magnetic Resonance (MR) and Diffusion Tensor Imaging (DTI) to map visual tracts around an occipital lesion, ensuring a safe resection without post-op complications. In a patient who underwent an elective craniotomy for the resection of an occipital brain tumor, preoperative MRI and Quicktome platform-based DTI MRI were uploaded onto the Medivis AR system. Pre-op and post-op fiber tractography was conducted using DSI Studio, and fiber volumes were compared. This technological setup was employed for pre-operative and intraoperative planning and further enhanced clinical decision-making for the actual tumor resection. The AR system and the preparation process are demonstrated via an illustrative video. The visual pathways were preserved during surgery consistent with the intraoperative visualization of these tracks on DTI using an AR headset. Clinically, postoperative visual field testing revealed no signs of visual loss. The volumes of the visual tracts were measured in preoperative and postoperative DTIs, showing that their volume was maintained. Our study highlights the feasibility in identifying preoperative tumor borders for incision planning and feasibility in preserving white matter tracts during tumor resection. AR FT–assisted surgery is safe and effective in planning the surgical approach for patients with brain tumors, thereby optimizing patient functional outcomes.

{"title":"Augmented reality in cranial surgery: Surgical planning and maximal safety in resection of brain tumors via head-mounted fiber tractography","authors":"Muhammet Enes Gurses , Elif Gökalp , Jordan Spatz , Siyar Bahadir , Vratko Himic , Ricardo J. Komotar , Michael E. Ivan","doi":"10.1016/j.clineuro.2025.108820","DOIUrl":"10.1016/j.clineuro.2025.108820","url":null,"abstract":"<div><div>Recent advancements in computer vision, enhanced augmented reality (AR) software and hardware are paving the way for AR to emerge as a promising and innovative tool for advancing and broadening neurosurgical pre-operative planning and intraoperative procedures. In this study, we describe the use of AR coupled with Magnetic Resonance (MR) and Diffusion Tensor Imaging (DTI) to map visual tracts around an occipital lesion, ensuring a safe resection without post-op complications. In a patient who underwent an elective craniotomy for the resection of an occipital brain tumor, preoperative MRI and Quicktome platform-based DTI MRI were uploaded onto the Medivis AR system. Pre-op and post-op fiber tractography was conducted using DSI Studio, and fiber volumes were compared. This technological setup was employed for pre-operative and intraoperative planning and further enhanced clinical decision-making for the actual tumor resection. The AR system and the preparation process are demonstrated via an illustrative video. The visual pathways were preserved during surgery consistent with the intraoperative visualization of these tracks on DTI using an AR headset. Clinically, postoperative visual field testing revealed no signs of visual loss. The volumes of the visual tracts were measured in preoperative and postoperative DTIs, showing that their volume was maintained. Our study highlights the feasibility in identifying preoperative tumor borders for incision planning and feasibility in preserving white matter tracts during tumor resection. AR FT–assisted surgery is safe and effective in planning the surgical approach for patients with brain tumors, thereby optimizing patient functional outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"251 ","pages":"Article 108820"},"PeriodicalIF":1.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Efficacy of spinal accessory nerve to suprascapular nerve transfer to restore shoulder function in brachial plexus injury: A systematic review and meta-analysis

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-03-01 DOI: 10.1016/j.clineuro.2025.108811

Jacob Vincent , Alan Mathew , Renuka Chintapalli

Introduction

Transfer of the spinal accessory nerve (SAN) to the suprascapular nerve (SSN) is a common surgical intervention employed for restoring shoulder function in both obstetric and traumatic brachial plexus injury (TBPI). Despite widespread use, there is a paucity of evidence surrounding the efficacy of this procedure.

Methods

A systematic search of the literature in the National Institutes of Health MEDLINE and Embase databases was performed in accordance with the PRISMA guidelines. Patients had to have a minimum postoperative follow-up of 6 months. Cohorts containing patients with obstetric brachial plexus injuries were excluded. We extracted data on shoulder abduction strength, measured using the British Medical Research Council (MRC) scale and range of motion (ROM) of shoulder abduction.

Results

Of the 298 studies screened, 12 with 311 total participants met our inclusion criteria. The average age of participants was 27.03 ± 3.05 years and the male:female ratio was 25.4:1. All patients underwent surgery following TBPI and average time-to surgery was 5.91 ± 1.52 months. 66.37 % of patients achieved a post-operative MRC grade of shoulder abduction of ≥M3 with a mean MRC score of 2.67 ± 1.02. Average post-operative shoulder abduction ROM was 56.97 degrees. Average follow-up time for all reported outcomes was 24.64 ± 7.47 weeks. Nine studies comprising 243 patients were included in the meta-analysis, which revealed a cumulative weighted effect size of 56.83 degrees (95 % CI = 52.31, 61.34).

Conclusion

These findings suggest that SAN-SSN transfer is an effective intervention for the restoration of shoulder function following TBPI.

{"title":"Efficacy of spinal accessory nerve to suprascapular nerve transfer to restore shoulder function in brachial plexus injury: A systematic review and meta-analysis","authors":"Jacob Vincent , Alan Mathew , Renuka Chintapalli","doi":"10.1016/j.clineuro.2025.108811","DOIUrl":"10.1016/j.clineuro.2025.108811","url":null,"abstract":"<div><h3>Introduction</h3><div>Transfer of the spinal accessory nerve (SAN) to the suprascapular nerve (SSN) is a common surgical intervention employed for restoring shoulder function in both obstetric and traumatic brachial plexus injury (TBPI). Despite widespread use, there is a paucity of evidence surrounding the efficacy of this procedure.</div></div><div><h3>Methods</h3><div>A systematic search of the literature in the National Institutes of Health MEDLINE and Embase databases was performed in accordance with the PRISMA guidelines. Patients had to have a minimum postoperative follow-up of 6 months. Cohorts containing patients with obstetric brachial plexus injuries were excluded. We extracted data on shoulder abduction strength, measured using the British Medical Research Council (MRC) scale and range of motion (ROM) of shoulder abduction.</div></div><div><h3>Results</h3><div>Of the 298 studies screened, 12 with 311 total participants met our inclusion criteria. The average age of participants was 27.03 ± 3.05 years and the male:female ratio was 25.4:1. All patients underwent surgery following TBPI and average time-to surgery was 5.91 ± 1.52 months. 66.37 % of patients achieved a post-operative MRC grade of shoulder abduction of ≥M3 with a mean MRC score of 2.67 ± 1.02. Average post-operative shoulder abduction ROM was 56.97 degrees. Average follow-up time for all reported outcomes was 24.64 ± 7.47 weeks. Nine studies comprising 243 patients were included in the meta-analysis, which revealed a cumulative weighted effect size of 56.83 degrees (95 % CI = 52.31, 61.34).</div></div><div><h3>Conclusion</h3><div>These findings suggest that SAN-SSN transfer is an effective intervention for the restoration of shoulder function following TBPI.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108811"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Letter to the editor: Sleep disturbances and associated factors in patients with Parkinson’s disease

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-03-01 DOI: 10.1016/j.clineuro.2025.108816

Rimsha Murtaza Sohu , Laila Murtaza Sohu

引用次数: 0

Predictive factors of poor surgical outcome in thoracic ossified ligamentum flavum: A multivariate analysis

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-03-01 DOI: 10.1016/j.clineuro.2025.108815

Madhusudhan Nagesh , Ajit Mishra , Andiperumal R. Prabhuraj , Bhushan Diwakar Thombre , Mathangi Krishnakumar , Manish Beniwal , Nishanth Sadashiva , Abhinith Shashidhar , Nupur Pruthi

Objective

Ossified ligamentum flavum (OLF) of the spine is a rare cause of compressive myelopathy. OLF is prevalent in Asian countries. Surgery is the only treatment option for symptomatic patients. The recovery after surgery depends upon multiple clinical and radiological factors and varies significantly. We report our series of surgically managed thoracic OLF and the factors predicting poor outcomes.

Methods

A retrospective study was conducted including 52 patients who underwent surgery for thoracic OLF. The pre-operative clinical status, radiology findings, intraoperative observations and complications were analyzed with post-op clinical outcomes. The mean follow-up period was 24 months (range 12–72).

Results

There were 35 males and 17 females with a mean age of 49.5 years (range: 30–75). The mean duration of symptoms was 13 months (range: 1 month to 5 years). The mean modified Japanese Orthopedic Association (mJOA) score was 5.8 preoperatively, 5.5 postoperatively and improved to 7.5 at the last follow-up. A good recovery rate (>50 %) was found in 18 patients, poor recovery (<50 %) in 24 patients, seven remained unchanged and three patients had worsened. In univariate analysis, the statistically significant factors for the recovery rate were the number of OLF levels, CT axial classification (tuberous type), associated OALL and cervical OPLL, T2W cord signal changes, ossification of dura mater, dural tear, and CSF leak. Dural tear and the number of OLF levels were the most predictive factors for the poor outcome on multivariate analysis.

Conclusion

Predictors of poor surgical outcomes are the extent of OLF involved and dural tear. The patient improves with rehabilitation despite the immediate postoperative deterioration.

目的脊柱黄韧带骨化（OLF）是压迫性脊髓病的罕见病因。黄韧带僵化症在亚洲国家非常普遍。对于有症状的患者，手术是唯一的治疗方法。手术后的恢复情况取决于多种临床和放射学因素，差异很大。我们报告了一系列经手术治疗的胸椎 OLF 患者的情况，以及预测不良预后的因素。分析了手术前的临床状况、放射学检查结果、术中观察结果和并发症，以及术后的临床结果。平均随访时间为 24 个月（12-72 个月）。结果男性 35 人，女性 17 人，平均年龄 49.5 岁（30-75 岁）。症状持续时间平均为 13 个月（1 个月至 5 年）。术前日本骨科协会（mJOA）平均评分为 5.8，术后评分为 5.5，最后一次随访时评分提高到 7.5。18名患者恢复良好（50%），24名患者恢复较差（50%），7名患者病情未变，3名患者病情恶化。在单变量分析中，OLF 层数、CT 轴向分类（结节型）、伴有 OALL 和颈椎 OPLL、T2W 脊髓信号改变、硬脑膜骨化、硬脑膜撕裂和 CSF 漏是影响痊愈率的重要因素。在多变量分析中，硬膜撕裂和 OLF 水平的数量是预测手术效果不佳的最主要因素。尽管患者术后即刻病情恶化，但通过康复治疗后病情会有所好转。

{"title":"Predictive factors of poor surgical outcome in thoracic ossified ligamentum flavum: A multivariate analysis","authors":"Madhusudhan Nagesh , Ajit Mishra , Andiperumal R. Prabhuraj , Bhushan Diwakar Thombre , Mathangi Krishnakumar , Manish Beniwal , Nishanth Sadashiva , Abhinith Shashidhar , Nupur Pruthi","doi":"10.1016/j.clineuro.2025.108815","DOIUrl":"10.1016/j.clineuro.2025.108815","url":null,"abstract":"<div><h3>Objective</h3><div>Ossified ligamentum flavum (OLF) of the spine is a rare cause of compressive myelopathy. OLF is prevalent in Asian countries. Surgery is the only treatment option for symptomatic patients. The recovery after surgery depends upon multiple clinical and radiological factors and varies significantly. We report our series of surgically managed thoracic OLF and the factors predicting poor outcomes.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted including 52 patients who underwent surgery for thoracic OLF. The pre-operative clinical status, radiology findings, intraoperative observations and complications were analyzed with post-op clinical outcomes. The mean follow-up period was 24 months (range 12–72).</div></div><div><h3>Results</h3><div>There were 35 males and 17 females with a mean age of 49.5 years (range: 30–75). The mean duration of symptoms was 13 months (range: 1 month to 5 years). The mean modified Japanese Orthopedic Association (mJOA) score was 5.8 preoperatively, 5.5 postoperatively and improved to 7.5 at the last follow-up. A good recovery rate (>50 %) was found in 18 patients, poor recovery (<50 %) in 24 patients, seven remained unchanged and three patients had worsened. In univariate analysis, the statistically significant factors for the recovery rate were the number of OLF levels, CT axial classification (tuberous type), associated OALL and cervical OPLL, T2W cord signal changes, ossification of dura mater, dural tear, and CSF leak. Dural tear and the number of OLF levels were the most predictive factors for the poor outcome on multivariate analysis.</div></div><div><h3>Conclusion</h3><div>Predictors of poor surgical outcomes are the extent of OLF involved and dural tear. The patient improves with rehabilitation despite the immediate postoperative deterioration.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108815"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143526597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bacterial DNA in patients with ruptured intracranial aneurysms: Investigating the potential role of periodontal and gut microbiota

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-03-01 DOI: 10.1016/j.clineuro.2025.108771

Nícollas Nunes Rabelo , Leonardo O. Brenner , Antonio Carlos Samaia da Silva Coelho , João Paulo Mota Telles , José Paulo de Oliveira Dourado , David Abraham Batista da Hora , Débora Pallos , Paulo Henrique Braz-Silva , Manoel Jacobsen Teixeira , Eberval Gadelha Figueiredo

Background and objectives

Chronic periodontal bacterial infections and disruptions in gut microbiota are responsible for systemic inflammation, which may contribute to the rupture of intracranial aneurysm. This study aimed to assess the presence of bacterial DNA from Fusobacterium nucleatum and Escherichia coli within arterial tissues of intracranial aneurysms.

Methodology

A comprehensive cross-sectional study was conducted, applying stringent inclusion and exclusion criteria to carefully select the study population from patients admitted to the Division of Neurosurgery at Hospital das Clínicas, University of São Paulo. Samples were collected post-aneurysm microsurgical clipping, preserving their integrity for subsequent DNA extraction. Polymerase chain reaction (PCR) techniques were employed to identify bacterial DNA within these samples.

Results

In total, 36 patient samples underwent a detailed analysis. The presence of Escherichia coli DNA exhibited a statistically significant correlation with the occurrence of ruptured intracranial aneurysms (Qualitative Odds Ratio [OR] 4.3 [1.01 – 23.4] and Quantitative OR 0.99 [0.99–1.0], Student's t-test [P = 0.9]). However, the presence of Fusobacterium nucleatum DNA did not demonstrate a statistically significant correlation with ruptured intracranial aneurysms (Qualitative OR 1.52 [0.4–6.1] and Quantitative OR 0.04 [0.01–5.22 ×108], Student's t-test [P = 0.78]).

Conclusion

The identification of Escherichia coli bacterial DNA in arterial tissues was positively associated with the occurrence of ruptured intracranial aneurysms, suggesting a potential role for these microorganisms in aneurysm pathogenesis and rupture. The development of therapeutic and prophylactic strategies can be established through future research endeavors.

背景和目的慢性牙周细菌感染和肠道微生物群紊乱是全身炎症的罪魁祸首，可能导致颅内动脉瘤破裂。本研究旨在评估颅内动脉瘤动脉组织中是否存在核酸镰刀菌和大肠埃希菌的细菌 DNA。方法采用严格的纳入和排除标准，从圣保罗大学 Clínicas 医院神经外科收治的患者中精心挑选研究对象，进行了一项全面的横断面研究。样本在动静脉瘤显微手术剪切后采集，保持样本的完整性，以便随后提取 DNA。聚合酶链反应（PCR）技术用于鉴定这些样本中的细菌 DNA。大肠埃希菌 DNA 的存在与颅内动脉瘤破裂的发生有显著的统计学相关性（定性比值比 [OR] 4.3 [1.01 - 23.4]，定量比值比 0.99 [0.99 - 1.0]，学生 t 检验 [P = 0.9]）。然而，核酸镰刀菌 DNA 的存在与颅内动脉瘤破裂并无统计学意义上的显著相关性（定性 OR 1.52 [0.4-6.1]，定量 OR 0.04 [0.01-5.22 ×108]，学生 t 检验 [P = 0.78]）。结论动脉组织中大肠埃希氏菌 DNA 的鉴定与颅内动脉瘤破裂的发生呈正相关，表明这些微生物在动脉瘤的发病和破裂过程中可能发挥作用。今后的研究工作将有助于制定治疗和预防策略。

{"title":"Bacterial DNA in patients with ruptured intracranial aneurysms: Investigating the potential role of periodontal and gut microbiota","authors":"Nícollas Nunes Rabelo , Leonardo O. Brenner , Antonio Carlos Samaia da Silva Coelho , João Paulo Mota Telles , José Paulo de Oliveira Dourado , David Abraham Batista da Hora , Débora Pallos , Paulo Henrique Braz-Silva , Manoel Jacobsen Teixeira , Eberval Gadelha Figueiredo","doi":"10.1016/j.clineuro.2025.108771","DOIUrl":"10.1016/j.clineuro.2025.108771","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Chronic periodontal bacterial infections and disruptions in gut microbiota are responsible for systemic inflammation, which may contribute to the rupture of intracranial aneurysm. This study aimed to assess the presence of bacterial DNA from Fusobacterium nucleatum and Escherichia coli within arterial tissues of intracranial aneurysms.</div></div><div><h3>Methodology</h3><div>A comprehensive cross-sectional study was conducted, applying stringent inclusion and exclusion criteria to carefully select the study population from patients admitted to the Division of Neurosurgery at Hospital das Clínicas, University of São Paulo. Samples were collected post-aneurysm microsurgical clipping, preserving their integrity for subsequent DNA extraction. Polymerase chain reaction (PCR) techniques were employed to identify bacterial DNA within these samples.</div></div><div><h3>Results</h3><div>In total, 36 patient samples underwent a detailed analysis. The presence of Escherichia coli DNA exhibited a statistically significant correlation with the occurrence of ruptured intracranial aneurysms (Qualitative Odds Ratio [OR] 4.3 [1.01 – 23.4] and Quantitative OR 0.99 [0.99–1.0], Student's t-test [P = 0.9]). However, the presence of Fusobacterium nucleatum DNA did not demonstrate a statistically significant correlation with ruptured intracranial aneurysms (Qualitative OR 1.52 [0.4–6.1] and Quantitative OR 0.04 [0.01–5.22 ×108], Student's t-test [P = 0.78]).</div></div><div><h3>Conclusion</h3><div>The identification of Escherichia coli bacterial DNA in arterial tissues was positively associated with the occurrence of ruptured intracranial aneurysms, suggesting a potential role for these microorganisms in aneurysm pathogenesis and rupture. The development of therapeutic and prophylactic strategies can be established through future research endeavors.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108771"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Spinal synovial cyst: A retrospective analysis of 204 cases

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-03-01 DOI: 10.1016/j.clineuro.2025.108806

Prabin Shrestha, Mani Ratnesh Sandhu, Juan Vivanco Suarez, Jangbo Lee, Satoshi Yamaguchi, Patrick Hitchon

Introduction

Several studies about spinal synovial cyst (SSC) have been conducted so far and yet many more things to be understood. The objective of this study is to further analyze SSC involving a larger number of cases.

Methods

This is a single center retrospective analysis of SSC over the period of 16 years . The cases included were intraspinal SSC of whole spine treated surgically or conservatively. Descriptive analysis of SSC at different spinal segments was done in terms of demography, symptoms and treatment

Results

Data of 204 cases of SSC were systematically collected of which 128 were female and 76 were male, the mean age being 61.37 ± 11.62 years. Females were significantly younger than males (p=0.012). Of them 196 were lumbar cyst (LSC) and eight were others (non-lumbar). The mean age was significantly lower (p=0.021) and mean body mass indedx (BMI) was significantly higher (p=0.016) in lumbar than in non-limbar cases. Neurogenic claudication (NC) was significantly associated with surgical treatment (p=<0.001). There was no significant difference between the type of surgery, whether fused or not, in terms of outcome and complications. However, symptomatology and surgeon’s choice significantly determined the type of surgery.

Conclusion

Younger females tend to develop SSC more than their counterparts, especially in the lower lumbar spine. Mean age and BMI were significantly different among spinal levels and high BMI is a risk factor for LSC. There is no significant difference in outcome and complications between the groups treated with and without fusion surgery.

{"title":"Spinal synovial cyst: A retrospective analysis of 204 cases","authors":"Prabin Shrestha, Mani Ratnesh Sandhu, Juan Vivanco Suarez, Jangbo Lee, Satoshi Yamaguchi, Patrick Hitchon","doi":"10.1016/j.clineuro.2025.108806","DOIUrl":"10.1016/j.clineuro.2025.108806","url":null,"abstract":"<div><h3>Introduction</h3><div>Several studies about spinal synovial cyst (SSC) have been conducted so far and yet many more things to be understood. The objective of this study is to further analyze SSC involving a larger number of cases.</div></div><div><h3>Methods</h3><div>This is a single center retrospective analysis of SSC over the period of 16 years . The cases included were intraspinal SSC of whole spine treated surgically or conservatively. Descriptive analysis of SSC at different spinal segments was done in terms of demography, symptoms and treatment</div></div><div><h3>Results</h3><div>Data of 204 cases of SSC were systematically collected of which 128 were female and 76 were male, the mean age being 61.37 ± 11.62 years. Females were significantly younger than males (<em>p=0.012</em>). Of them 196 were lumbar cyst (LSC) and eight were others (non-lumbar). The mean age was significantly lower (<em>p=0.021</em>) and mean body mass indedx (BMI) was significantly higher (<em>p=0.016</em>) in lumbar than in non-limbar cases. Neurogenic claudication (NC) was significantly associated with surgical treatment (p=<0.001). There was no significant difference between the type of surgery, whether fused or not, in terms of outcome and complications. However, symptomatology and surgeon’s choice significantly determined the type of surgery.</div></div><div><h3>Conclusion</h3><div>Younger females tend to develop SSC more than their counterparts, especially in the lower lumbar spine. Mean age and BMI were significantly different among spinal levels and high BMI is a risk factor for LSC. There is no significant difference in outcome and complications between the groups treated with and without fusion surgery.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108806"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ventricular opening in High-Grade Glioma surgery. Impact on surgical, functional outcomes, and survival rates. Experience in a Latin-American center

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-03-01 DOI: 10.1016/j.clineuro.2025.108819

Mauro Ruella , Guido Caffaratti , Florencia Yorio , Alejandro Muggeri , Francisco Marcó del Pont , Lucila Domecq , Ruben Mormandi , Andres Cervio

Objective

Analyze the impact of ventricular opening during surgery for High-Grade Glioma (HGG) on surgical, functional outcomes, and survival rates.

Materials and methods

Retrospective, single-center, analytical study of a cohort of patients who underwent surgery for HGG in an Argentine center between 2013 and 2023.

Patients with Grade IV supratentorial gliomas, 3 months of minimum follow-up, studied with pre and postoperative volumetric MRI were included. Subsequently, ventricular opening during surgery and its influence on prognosis were analyzed.

Results

A total 263 patients met the inclusion criteria, with a mean follow-up of 24.8 months. Mean age was 58.5 years with a predominance of male patients (63 %) and preoperative mean KPS was 80 (range 40–100).

Eighty-eight percent of tumors corresponded to Glioblastomas and the mean preoperative volume was 27.2 cm3.

Ventricular opening was identified in 80 patients (30.4 %) in correlation with the number of patients with ependymal invasion. This factor was associated with worse survival rates and risk of multicentricity in univariate analysis. However, when adjusted for covariables, there was a trend towards higher survival and slight increase in resection rates. Opening the ventricles was associated with a higher risk of leptomeningeal spread and complications such as hydrocephalus and CSF leak.

Conclusion

Ventricular opening during surgery for HGG did not show to represent an independent prognostic factor for survival rates. It could be considered when ependymal invasion is observed in favor of maximizing EOR. Conversely, it should be avoided as it carries a higher risk for complications and tumor spread.

{"title":"Ventricular opening in High-Grade Glioma surgery. Impact on surgical, functional outcomes, and survival rates. Experience in a Latin-American center","authors":"Mauro Ruella , Guido Caffaratti , Florencia Yorio , Alejandro Muggeri , Francisco Marcó del Pont , Lucila Domecq , Ruben Mormandi , Andres Cervio","doi":"10.1016/j.clineuro.2025.108819","DOIUrl":"10.1016/j.clineuro.2025.108819","url":null,"abstract":"<div><h3>Objective</h3><div>Analyze the impact of ventricular opening during surgery for High-Grade Glioma (HGG) on surgical, functional outcomes, and survival rates.</div></div><div><h3>Materials and methods</h3><div>Retrospective, single-center, analytical study of a cohort of patients who underwent surgery for HGG in an Argentine center between 2013 and 2023.</div><div>Patients with Grade IV supratentorial gliomas, 3 months of minimum follow-up, studied with pre and postoperative volumetric MRI were included. Subsequently, ventricular opening during surgery and its influence on prognosis were analyzed.</div></div><div><h3>Results</h3><div>A total 263 patients met the inclusion criteria, with a mean follow-up of 24.8 months. Mean age was 58.5 years with a predominance of male patients (63 %) and preoperative mean KPS was 80 (range 40–100).</div><div>Eighty-eight percent of tumors corresponded to Glioblastomas and the mean preoperative volume was 27.2 cm3.</div><div>Ventricular opening was identified in 80 patients (30.4 %) in correlation with the number of patients with ependymal invasion. This factor was associated with worse survival rates and risk of multicentricity in univariate analysis. However, when adjusted for covariables, there was a trend towards higher survival and slight increase in resection rates. Opening the ventricles was associated with a higher risk of leptomeningeal spread and complications such as hydrocephalus and CSF leak.</div></div><div><h3>Conclusion</h3><div>Ventricular opening during surgery for HGG did not show to represent an independent prognostic factor for survival rates. It could be considered when ependymal invasion is observed in favor of maximizing EOR. Conversely, it should be avoided as it carries a higher risk for complications and tumor spread.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108819"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effectiveness of mechanical thrombectomy for acute unilateral vertebral artery occlusion with patent basilar artery: Case series and literature review

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-03-01 DOI: 10.1016/j.clineuro.2025.108804

Takuya Wakabayashi , Takeshi Miyata , Takenori Ogura , Yuji Agawa , Yusuke Nakazawa , Wataru Shiraishi , Hideo Chihara , Takeru Umemura , Hiroaki Nakajima , Ryuta Tomoyose , Yoshitaka Tsujimoto , Taketo Hatano

Objective

Acute unilateral vertebral artery occlusion (VAO) with a patent basilar artery (BA) often results in neurological deterioration due to brainstem infarction from occluded VA perforators, despite comprehensive medical treatment. While recent studies show mechanical thrombectomy (MT) is effective for BA occlusion as well as anterior circulation occlusions, its role in acute unilateral VAO with patent BA remains unclear. This study aims to assess the effectiveness of MT for acute unilateral VAO with patent BA in patients presenting mild symptoms.

Methods

We retrospectively reviewed cases of acute VAO with patent BA treated at our institution from April 2016 to March 2023. Patients were assigned to two groups: the MT Group (undergoing MT for unilateral VAO) and the Control Group (receiving medical treatment, including intravenous tissue-plasminogen activator). Clinical and radiological outcomes were compared between groups to evaluate procedural feasibility and safety.

Results

Five cases (four males, one female) were included, with a median age of 71 years (IQR: 56–80) and a median NIHSS score of 6 at admission (IQR: 3–11). Three patients underwent MT, and two received conservative treatment. In the MT Group, two patients with successful recanalization experienced no complications or brainstem infarction. One patient with unsuccessful recanalization and both Control Group patients showed early neurological deterioration from brainstem infarction.

Conclusions

Acute unilateral VAO with patent BA frequently exacerbates symptoms due to brainstem perforator occlusion, worsening prognosis. Successful VA recanalization may prevent symptomatic brainstem infarction, potentially improving outcomes. Larger prospective studies are warranted.

{"title":"Effectiveness of mechanical thrombectomy for acute unilateral vertebral artery occlusion with patent basilar artery: Case series and literature review","authors":"Takuya Wakabayashi , Takeshi Miyata , Takenori Ogura , Yuji Agawa , Yusuke Nakazawa , Wataru Shiraishi , Hideo Chihara , Takeru Umemura , Hiroaki Nakajima , Ryuta Tomoyose , Yoshitaka Tsujimoto , Taketo Hatano","doi":"10.1016/j.clineuro.2025.108804","DOIUrl":"10.1016/j.clineuro.2025.108804","url":null,"abstract":"<div><h3>Objective</h3><div>Acute unilateral vertebral artery occlusion (VAO) with a patent basilar artery (BA) often results in neurological deterioration due to brainstem infarction from occluded VA perforators, despite comprehensive medical treatment. While recent studies show mechanical thrombectomy (MT) is effective for BA occlusion as well as anterior circulation occlusions, its role in acute unilateral VAO with patent BA remains unclear. This study aims to assess the effectiveness of MT for acute unilateral VAO with patent BA in patients presenting mild symptoms.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed cases of acute VAO with patent BA treated at our institution from April 2016 to March 2023. Patients were assigned to two groups: the MT Group (undergoing MT for unilateral VAO) and the Control Group (receiving medical treatment, including intravenous tissue-plasminogen activator). Clinical and radiological outcomes were compared between groups to evaluate procedural feasibility and safety.</div></div><div><h3>Results</h3><div>Five cases (four males, one female) were included, with a median age of 71 years (IQR: 56–80) and a median NIHSS score of 6 at admission (IQR: 3–11). Three patients underwent MT, and two received conservative treatment. In the MT Group, two patients with successful recanalization experienced no complications or brainstem infarction. One patient with unsuccessful recanalization and both Control Group patients showed early neurological deterioration from brainstem infarction.</div></div><div><h3>Conclusions</h3><div>Acute unilateral VAO with patent BA frequently exacerbates symptoms due to brainstem perforator occlusion, worsening prognosis. Successful VA recanalization may prevent symptomatic brainstem infarction, potentially improving outcomes. Larger prospective studies are warranted.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108804"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143526598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Aspirin plus rivaroxaban efficacy and safety in embolic stroke of undetermined source: A randomized, placebo-controlled, outcome assessor-blind, feasibility study

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-03-01 DOI: 10.1016/j.clineuro.2025.108813

Monireh Ghazaeian , Fatemeh Ramzanpour , Athena Sharifi-Razavi

Introduction

The high prevalence of patients with embolic stroke of undetermined source (ESUS), the considerable risk of ischemic stroke, and the need for novel antithrombotic strategies highlight ESUS as an important priority in stroke research in the coming years. This study is designed to investigate the effectiveness and safety of rivaroxaban along with aspirin in reducing stroke recurrence in patients with ESUS.

Materials and methods

The present study is a parallel-group, placebo-controlled, randomized, outcome-assessor blind, on patients in whom ESUS has recently (7–60 days) identified and had one risk factor of a potential embolic source. The recruited patients were randomly assigned to: rivaroxaban 2.5 mg two times daily plus ASA 80 mg once daily (intervention) or ASA 80 mg once daily plus placebo (control) (1:1 ratio). All patients were followed up every 3 months until 12 months. Any side effects or outcome events were recorded. The primary outcome was clarified as the rate of stroke recurrence and major bleeding occurrence.

Results

Forty-two patients with ESUS were recruited in this study (21 in each group). Stroke recurred in 3 patients in the comparator group and 1 patient in the intervention group (OR: 0.30; 95 % CI = 0.02–3.14, P = 0.31; RR= 0.33; 95 % CI = 0.03–2.95, P = 0.32). No major hemorrhagic event occurred in either group.

Conclusions

It seems reasonable to test, in a larger study, the effect of rivaroxaban (2.5 mg BID) plus aspirin on the prevention of stroke recurrence in patient with ESUS and a potential embolic source.

{"title":"Aspirin plus rivaroxaban efficacy and safety in embolic stroke of undetermined source: A randomized, placebo-controlled, outcome assessor-blind, feasibility study","authors":"Monireh Ghazaeian , Fatemeh Ramzanpour , Athena Sharifi-Razavi","doi":"10.1016/j.clineuro.2025.108813","DOIUrl":"10.1016/j.clineuro.2025.108813","url":null,"abstract":"<div><h3>Introduction</h3><div>The high prevalence of patients with embolic stroke of undetermined source (ESUS), the considerable risk of ischemic stroke, and the need for novel antithrombotic strategies highlight ESUS as an important priority in stroke research in the coming years. This study is designed to investigate the effectiveness and safety of rivaroxaban along with aspirin in reducing stroke recurrence in patients with ESUS.</div></div><div><h3>Materials and methods</h3><div>The present study is a parallel-group, placebo-controlled, randomized, outcome-assessor blind, on patients in whom ESUS has recently (7–60 days) identified and had one risk factor of a potential embolic source. The recruited patients were randomly assigned to: rivaroxaban 2.5 mg two times daily plus ASA 80 mg once daily (intervention) or ASA 80 mg once daily plus placebo (control) (1:1 ratio). All patients were followed up every 3 months until 12 months. Any side effects or outcome events were recorded. The primary outcome was clarified as the rate of stroke recurrence and major bleeding occurrence.</div></div><div><h3>Results</h3><div>Forty-two patients with ESUS were recruited in this study (21 in each group). Stroke recurred in 3 patients in the comparator group and 1 patient in the intervention group (OR: 0.30; 95 % CI = 0.02–3.14, P = 0.31; RR= 0.33; 95 % CI = 0.03–2.95, P = 0.32). No major hemorrhagic event occurred in either group.</div></div><div><h3>Conclusions</h3><div>It seems reasonable to test, in a larger study, the effect of rivaroxaban (2.5 mg BID) plus aspirin on the prevention of stroke recurrence in patient with ESUS and a potential embolic source.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108813"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0