Pub Date : 2025-12-03DOI: 10.1016/j.clineuro.2025.109282
Kamal Shaik , Spencer Rasmussen , Rudy Rahme , Michael Karsy
Introduction
Chordomas are rare malignant tumors arising from embryonic remnants of the notochord, most commonly affecting the axial skeleton. Although advances have been made in surgical resection and radiation therapy, systemic treatment options remain limited. Bone-modifying agents (BMAs), including zoledronic acid and denosumab, as well as multikinase inhibitors (MKIs) like lenvatinib and cabozantinib, have emerged as potential targeted therapies based on preclinical models. However, comparative real-world data evaluating their outcomes in chordoma patients is lacking.
Methods
A retrospective cohort study was conducted using the TriNetX Research Network. Patients with chordoma (ICD-10-CM C41.0, C41.2, C41.4) were stratified into treatment groups based on receipt of zoledronic acid, denosumab, or multikinase inhibitors (MKIs). Propensity score matching was used to adjust for baseline confounders. Outcomes evaluated at 5 years post-diagnosis included all-cause mortality, pathologic fracture, spinal cord compression, and osteonecrosis. Risk ratios with 95 % confidence intervals were calculated.
Results
Compared to denosumab, zoledronic acid was associated with a higher 5-year mortality risk, but a lower osteonecrosis risk. Comparisons involving MKIs showed no difference in mortality. No pathologic fractures were reported across cohorts. Spinal cord compression was not different among treatments.
Conclusion
This study highlights potential differences in survival and skeletal-related outcomes among chordoma patients treated with BMAs, specifically denosumab and MKIs. These preliminary findings underscore the need for prospective studies to better define optimal systemic therapies for this rare malignancy.
{"title":"Bone modifying agents and multikinase inhibitors as treatments for chordoma: A TriNetX-based retrospective cohort study","authors":"Kamal Shaik , Spencer Rasmussen , Rudy Rahme , Michael Karsy","doi":"10.1016/j.clineuro.2025.109282","DOIUrl":"10.1016/j.clineuro.2025.109282","url":null,"abstract":"<div><h3>Introduction</h3><div>Chordomas are rare malignant tumors arising from embryonic remnants of the notochord, most commonly affecting the axial skeleton. Although advances have been made in surgical resection and radiation therapy, systemic treatment options remain limited. Bone-modifying agents (BMAs), including zoledronic acid and denosumab, as well as multikinase inhibitors (MKIs) like lenvatinib and cabozantinib, have emerged as potential targeted therapies based on preclinical models. However, comparative real-world data evaluating their outcomes in chordoma patients is lacking.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the TriNetX Research Network. Patients with chordoma (ICD-10-CM C41.0, C41.2, C41.4) were stratified into treatment groups based on receipt of zoledronic acid, denosumab, or multikinase inhibitors (MKIs). Propensity score matching was used to adjust for baseline confounders. Outcomes evaluated at 5 years post-diagnosis included all-cause mortality, pathologic fracture, spinal cord compression, and osteonecrosis. Risk ratios with 95 % confidence intervals were calculated.</div></div><div><h3>Results</h3><div>Compared to denosumab, zoledronic acid was associated with a higher 5-year mortality risk, but a lower osteonecrosis risk. Comparisons involving MKIs showed no difference in mortality. No pathologic fractures were reported across cohorts. Spinal cord compression was not different among treatments.</div></div><div><h3>Conclusion</h3><div>This study highlights potential differences in survival and skeletal-related outcomes among chordoma patients treated with BMAs, specifically denosumab and MKIs. These preliminary findings underscore the need for prospective studies to better define optimal systemic therapies for this rare malignancy.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109282"},"PeriodicalIF":1.6,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682450","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}
Pub Date : 2025-12-02DOI: 10.1016/j.clineuro.2025.109281
Yuanxiang Zeng , Qiao Zeng , Xiaoling Peng , Ping Liang , Li Jiang , Xuan Zhai , Yue Hu
Objective
To evaluate the safety and effectiveness of vagus nerve stimulation (VNS) in treating drug-refractory epilepsy (DRE) in children and to identify key predictive factors influencing its efficacy.
Methods
This was a prospective, single-center study conducted from October 2016 to July 2020. A total of 54 children treated with VNS were followed for 24 months. The effectiveness and safety of VNS were assessed at 2, 6, 12, 18, and 24 months. Kaplan–Meier univariate survival analysis and Cox regression analysis were used to identify predictors of treatment response.
Results
At 2, 6, 12, 18, and 24 months, the effectiveness of VNS (defined as a ≥50 % reduction in seizure frequency) was 29.6 %, 20.4 %, 39.6 %, 76.0 % and 75.0 %, respectively. Seizure freedom rates were 0 %, 0 %, 3.8 %, 8.0 % and 10.4 %, respectively. The effectiveness rate for patients with Lennox–Gastaut syndrome at 24 months was 67.7 %. Significant improvements were also observed in neurodevelopmental scores and quality of life (p < 0.05). Cox regression identified absence seizures and abnormal neuroimaging (CT/MRI) as independent negative predictors of VNS response at 18 and 24 months. Adverse events were transient and tolerable, with 5 (9.3 %) cases of transient hoarseness, 3 (5.6 %) of cough, 3 (5.6 %) of decreased appetite, 2 (3.7 %) of skin irritation, 2 (3.7 %) of localized skin infection, and 1 (1.8 %) of menstrual cycle disturbance.
Conclusion
VNS is an effective and safe long-term therapy for pediatric DRE, with cumulative benefits over time. The presence of absence seizures and abnormal neuroimaging findings were key predictors of a less favorable response, which may inform clinical decision-making regarding patient selection. Caution is advised when initiating VNS therapy in children with DRE exhibiting these characteristics.
{"title":"Efficacy, safety, and predictors of vagus nerve stimulation in children with drug-resistant epilepsy: A single-center prospective study","authors":"Yuanxiang Zeng , Qiao Zeng , Xiaoling Peng , Ping Liang , Li Jiang , Xuan Zhai , Yue Hu","doi":"10.1016/j.clineuro.2025.109281","DOIUrl":"10.1016/j.clineuro.2025.109281","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the safety and effectiveness of vagus nerve stimulation (VNS) in treating drug-refractory epilepsy (DRE) in children and to identify key predictive factors influencing its efficacy.</div></div><div><h3>Methods</h3><div>This was a prospective, single-center study conducted from October 2016 to July 2020. A total of 54 children treated with VNS were followed for 24 months. The effectiveness and safety of VNS were assessed at 2, 6, 12, 18, and 24 months. Kaplan–Meier univariate survival analysis and Cox regression analysis were used to identify predictors of treatment response.</div></div><div><h3>Results</h3><div>At 2, 6, 12, 18, and 24 months, the effectiveness of VNS (defined as a ≥50 % reduction in seizure frequency) was 29.6 %, 20.4 %, 39.6 %, 76.0 % and 75.0 %, respectively. Seizure freedom rates were 0 %, 0 %, 3.8 %, 8.0 % and 10.4 %, respectively. The effectiveness rate for patients with Lennox–Gastaut syndrome at 24 months was 67.7 %. Significant improvements were also observed in neurodevelopmental scores and quality of life (p < 0.05). Cox regression identified absence seizures and abnormal neuroimaging (CT/MRI) as independent negative predictors of VNS response at 18 and 24 months. Adverse events were transient and tolerable, with 5 (9.3 %) cases of transient hoarseness, 3 (5.6 %) of cough, 3 (5.6 %) of decreased appetite, 2 (3.7 %) of skin irritation, 2 (3.7 %) of localized skin infection, and 1 (1.8 %) of menstrual cycle disturbance.</div></div><div><h3>Conclusion</h3><div>VNS is an effective and safe long-term therapy for pediatric DRE, with cumulative benefits over time. The presence of absence seizures and abnormal neuroimaging findings were key predictors of a less favorable response, which may inform clinical decision-making regarding patient selection. Caution is advised when initiating VNS therapy in children with DRE exhibiting these characteristics.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109281"},"PeriodicalIF":1.6,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682451","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}
Pub Date : 2025-11-28DOI: 10.1016/j.clineuro.2025.109277
Vratko Himic , Roxanne C. Mayrand , Zachary C. Gersey , Adham M. Khalafallah , Victor M. Lu , Sima Vazquez , Long Di , Daniel M. Aaronson , Ashish H. Shah , Ricardo J. Komotar , Michael E. Ivan
Purpose
The use of neuronavigation with superimposed mapping tools has enabled visualization of key fiber tracts and improved peri-operative planning. However, a limitation of these approaches is their reliance on a static underlying brain atlas, particularly in neurosurgical patients with brain tumors. A tool that enables qualification and quantification of brain region connectivity could refine approaches to surgical resection.
Methods
We utilized a machine learning imaging platform, Quicktome™, to generate individualized functional parcels and tracts that dynamically adapt to perioperative change. The connectome was derived from a combination of diffusion tensor imaging and resting-state function magnetic resonance imaging. Matrices were generated from the functional MRI of four patients with intracranial neoplasms and the pre- and post-operative parcellation values were compared. The individual correlation and strength of regions were quantified. Hypo- and hyper-connected regions were marked as anomalous.
Results
We present a case series of four patients to illustrate the correlation of the anomaly matrices with post-operative neurological changes. These include: post-operative delirium originating associated with salience network hypoconnectivity; visual hemineglect linked to hypoconnectivity in the dorsal attention network; and quantifiable improvements in the language network following the resolution of expressive aphasia. All differences between pre-and post-operative paired correlation values were statistically significant.
Conclusion
We demonstrate a novel approach to quantifying the extent to which anomalies in the functional connectome correlate with post-operative neurological changes. This has relevance in post-operative prognostication, provision of specialist therapy services, and could serve as a useful tool in surgical education and pre-operative planning.
{"title":"Anomaly changes in the functional connectome of post-operative neurosurgical patients: A case series","authors":"Vratko Himic , Roxanne C. Mayrand , Zachary C. Gersey , Adham M. Khalafallah , Victor M. Lu , Sima Vazquez , Long Di , Daniel M. Aaronson , Ashish H. Shah , Ricardo J. Komotar , Michael E. Ivan","doi":"10.1016/j.clineuro.2025.109277","DOIUrl":"10.1016/j.clineuro.2025.109277","url":null,"abstract":"<div><h3>Purpose</h3><div>The use of neuronavigation with superimposed mapping tools has enabled visualization of key fiber tracts and improved peri-operative planning. However, a limitation of these approaches is their reliance on a static underlying brain atlas, particularly in neurosurgical patients with brain tumors. A tool that enables qualification and quantification of brain region connectivity could refine approaches to surgical resection.</div></div><div><h3>Methods</h3><div>We utilized a machine learning imaging platform, Quicktome™, to generate individualized functional parcels and tracts that dynamically adapt to perioperative change. The connectome was derived from a combination of diffusion tensor imaging and resting-state function magnetic resonance imaging. Matrices were generated from the functional MRI of four patients with intracranial neoplasms and the pre- and post-operative parcellation values were compared. The individual correlation and strength of regions were quantified. Hypo- and hyper-connected regions were marked as anomalous.</div></div><div><h3>Results</h3><div>We present a case series of four patients to illustrate the correlation of the anomaly matrices with post-operative neurological changes. These include: post-operative delirium originating associated with salience network hypoconnectivity; visual hemineglect linked to hypoconnectivity in the dorsal attention network; and quantifiable improvements in the language network following the resolution of expressive aphasia. All differences between pre-and post-operative paired correlation values were statistically significant.</div></div><div><h3>Conclusion</h3><div>We demonstrate a novel approach to quantifying the extent to which anomalies in the functional connectome correlate with post-operative neurological changes. This has relevance in post-operative prognostication, provision of specialist therapy services, and could serve as a useful tool in surgical education and pre-operative planning.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109277"},"PeriodicalIF":1.6,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654039","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}
Pub Date : 2025-11-27DOI: 10.1016/j.clineuro.2025.109280
Muhammad Muaz , Vineet Kumar
{"title":"Critique on “Identifying poor prognostic factors in patients with spontaneous spinal epidural hematoma: Insights from 47 cases at a single institution”","authors":"Muhammad Muaz , Vineet Kumar","doi":"10.1016/j.clineuro.2025.109280","DOIUrl":"10.1016/j.clineuro.2025.109280","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109280"},"PeriodicalIF":1.6,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682348","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}
Pub Date : 2025-11-27DOI: 10.1016/j.clineuro.2025.109276
Hai Peng , Ruofei Yuan , Yue Zheng , Pinan Liu , Peng Li
Background and objectives
Postoperative bacterial meningitis (PBM), a severe complication after skull base tumor surgery, poses a challenge in early diagnosis, which is crucial yet often delayed due to the inconclusive nature of current diagnostic methods relying on clinical symptoms and CSF analysis. This study aimed to identify factors associated with delayed PBM diagnosis and improve early detection strategies by comparing clinical and laboratory differences between patients diagnosed within 7 days (Timely Infection Diagnosis, TID) and those diagnosed more than 7 days (Delayed Infection Diagnosis, DID) after surgery.
Methods and results
This retrospective study included 372 patients diagnosed with PBM after skull base tumor surgery at our institution from January 2019 to August 2024. Patients were divided into TID and DID groups. Multivariate analysis identified time between first lumbar puncture and surgery, tumor located in posterior fossa, and multinucleated cell ratio as independent factors differing between the groups.
Conclusion
Compared to TID cases, patients in DID group consist more of craniotomy and posterior tumor location, and they showed less severe early symptoms and CSF findings but had longer infection duration following antibiotic treatment. The study highlights the limitations of relying solely on initial CSF results and emphasizes the need for clinical vigilance, perioperative management, and individualized diagnostic strategies in suspected PBM.
{"title":"Delayed diagnosis in postoperative bacterial meningitis: A retrospective study in the skull base neoplasm surgery","authors":"Hai Peng , Ruofei Yuan , Yue Zheng , Pinan Liu , Peng Li","doi":"10.1016/j.clineuro.2025.109276","DOIUrl":"10.1016/j.clineuro.2025.109276","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Postoperative bacterial meningitis (PBM), a severe complication after skull base tumor surgery, poses a challenge in early diagnosis, which is crucial yet often delayed due to the inconclusive nature of current diagnostic methods relying on clinical symptoms and CSF analysis. This study aimed to identify factors associated with delayed PBM diagnosis and improve early detection strategies by comparing clinical and laboratory differences between patients diagnosed within 7 days (Timely Infection Diagnosis, TID) and those diagnosed more than 7 days (Delayed Infection Diagnosis, DID) after surgery.</div></div><div><h3>Methods and results</h3><div>This retrospective study included 372 patients diagnosed with PBM after skull base tumor surgery at our institution from January 2019 to August 2024. Patients were divided into TID and DID groups. Multivariate analysis identified time between first lumbar puncture and surgery, tumor located in posterior fossa, and multinucleated cell ratio as independent factors differing between the groups.</div></div><div><h3>Conclusion</h3><div>Compared to TID cases, patients in DID group consist more of craniotomy and posterior tumor location, and they showed less severe early symptoms and CSF findings but had longer infection duration following antibiotic treatment. The study highlights the limitations of relying solely on initial CSF results and emphasizes the need for clinical vigilance, perioperative management, and individualized diagnostic strategies in suspected PBM.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109276"},"PeriodicalIF":1.6,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617425","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}
Pub Date : 2025-11-27DOI: 10.1016/j.clineuro.2025.109278
Shoaib A. Syed , Evan Keister , Leela Tickoo , Griffin Thomas , Maille McDermott , Jan-Erik Schmidt , Cassidy Werner , John A. Boockvar , Randy S. D’Amico
Background
Cranial perforator drills are standard neurosurgical devices used for burr hole craniotomy, designed to automatically disengage at the inner table to minimize injury risk. Despite safety features, malfunctions such as disengagement failure may lead to injury. We systematically analyzed device malfunctions, patient impacts, and temporal trends over 10 years in order to increase operator vigilance for common modes and consequences of perforator malfunction and provide a basis for device refinement.
Methods
The Manufacturer and User Facility Device Experience (MAUDE) database was queried for medical device reports (MDRs) from 2015 to 2024 for cranial perforator drills. Report descriptions were manually reviewed and categorized by event type, device problems, patient impacts, and operational impacts.
Results
Out of 1857 reports, disengagement failure was most frequently reported (n = 1295/1857, 69.7 %), followed by component integrity issues (n = 447/1857, 24.1 %) power/stability failures (n = 225/1857, 12.1 %), device entrapment (n = 92/1857, 5.0 %), cutting inefficiency (n = 76/1857, 4.1 %), and thermal issues (n = 68/1857, 3.7 %). Nearly half of all MDRs (n = 866, 46.6 %) reported at least one patient impact. Among these, the most common were dural injury (n = 777/866, 89.7 %), leptomeningeal injury (n = 223/866, 25.8 %), parenchymal injury (n = 220/866, 25.4 %), and hemorrhage (n = 200/866, 23.1 %). Three reports described patient death, though only one was attributed to device malfunction.
Conclusion
Disengagement failure was the most commonly reported malfunction and frequently associated with meningeal and parenchymal injury. Other device problems were less frequent and often identified during testing rather than patient procedures. These findings highlight the need for heightened vigilance during use, structured training for device handling, and ongoing quality improvement to enhance patient safety.
颅穿孔钻是标准的神经外科设备，用于钻孔开颅，设计在内表自动脱离，以尽量减少受伤的风险。尽管有安全功能，但脱离失败等故障可能会导致伤害。我们系统地分析了设备故障、患者影响和10年来的时间趋势，以提高操作员对常见模式和穿孔器故障后果的警惕性，并为设备改进提供基础。方法查询2015 - 2024年颅穿支钻的制造商和用户设施器械体验（MAUDE）数据库的医疗器械报告（mdr）。报告描述是手动审查的，并按事件类型、设备问题、患者影响和操作影响进行分类。ResultsOut 1857报告,脱离失败是最常报道(69.7 n = 1295/1857, %),紧随其后的是组件完整性问题(24.1 n = 447/1857, %)电力/稳定失败(12.1 n = 225/1857, %),设备截留(5.0 n = 92/1857, %),切割效率低下(4.1 n = 76/1857, %),和热的问题(3.7 n = 68/1857, %)。近一半的mdr （n = 866,46.6 %）报告了至少一个患者的影响。其中,最常见的是硬膜损伤(89.7 n = 777/866, %),leptomeningeal受伤(25.8 n = 223/866, %),实质损伤(25.4 n = 220/866, %),和出血(23.1 n = 200/866, %)。三份报告描述了患者的死亡，但只有一份报告归因于设备故障。结论脱离失败是最常见的功能障碍，常伴有脑膜和脑实质损伤。其他设备问题不太常见，通常是在测试期间而不是在患者过程中发现的。这些发现强调了在使用过程中需要提高警惕，对器械操作进行有组织的培训，并持续改进质量以提高患者安全。
{"title":"Characterization of complications associated with cranial perforator drills in neurosurgery","authors":"Shoaib A. Syed , Evan Keister , Leela Tickoo , Griffin Thomas , Maille McDermott , Jan-Erik Schmidt , Cassidy Werner , John A. Boockvar , Randy S. D’Amico","doi":"10.1016/j.clineuro.2025.109278","DOIUrl":"10.1016/j.clineuro.2025.109278","url":null,"abstract":"<div><h3>Background</h3><div>Cranial perforator drills are standard neurosurgical devices used for burr hole craniotomy, designed to automatically disengage at the inner table to minimize injury risk. Despite safety features, malfunctions such as disengagement failure may lead to injury. We systematically analyzed device malfunctions, patient impacts, and temporal trends over 10 years in order to increase operator vigilance for common modes and consequences of perforator malfunction and provide a basis for device refinement.</div></div><div><h3>Methods</h3><div>The Manufacturer and User Facility Device Experience (MAUDE) database was queried for medical device reports (MDRs) from 2015 to 2024 for cranial perforator drills. Report descriptions were manually reviewed and categorized by event type, device problems, patient impacts, and operational impacts.</div></div><div><h3>Results</h3><div>Out of 1857 reports, disengagement failure was most frequently reported (n = 1295/1857, 69.7 %), followed by component integrity issues (n = 447/1857, 24.1 %) power/stability failures (n = 225/1857, 12.1 %), device entrapment (n = 92/1857, 5.0 %), cutting inefficiency (n = 76/1857, 4.1 %), and thermal issues (n = 68/1857, 3.7 %). Nearly half of all MDRs (n = 866, 46.6 %) reported at least one patient impact. Among these, the most common were dural injury (n = 777/866, 89.7 %), leptomeningeal injury (n = 223/866, 25.8 %), parenchymal injury (n = 220/866, 25.4 %), and hemorrhage (n = 200/866, 23.1 %). Three reports described patient death, though only one was attributed to device malfunction.</div></div><div><h3>Conclusion</h3><div>Disengagement failure was the most commonly reported malfunction and frequently associated with meningeal and parenchymal injury. Other device problems were less frequent and often identified during testing rather than patient procedures. These findings highlight the need for heightened vigilance during use, structured training for device handling, and ongoing quality improvement to enhance patient safety.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109278"},"PeriodicalIF":1.6,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617424","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}
Pub Date : 2025-11-27DOI: 10.1016/j.clineuro.2025.109279
Sai Chandan Reddy, Toby Mao, Julian Gendreau, A. Karim Ahmed, Debraj Mukherjee
Objective
Oligodendrogliomas are typically benign tumors that arise within the white matter tracts of the cerebral hemispheres. Surgical resection, radiotherapy (RT), and chemotherapy (CT) are utilized to prolong survival in patients diagnosed with these tumors. Older patients, however, suffer from various comorbidities that may make surgical resection less feasible and less effective in managing this disease. In this retrospective study, we assessed the survival outcomes for sexagenarian and older patients and the impact of surgical intervention, RT, and CT on overall survival (OS).
Methods
The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify all patients ≥ 60 years of age diagnosed with oligodendrogliomas between 2000 and 2020. The patient cohort was dichotomized into the sexagenarian (60–69 years of age) and older (≥ 70 years of age) patient subgroups. Demographic, clinical, and survival information was collected for these patients, and baseline comparison of the two groups of interest was conducted. Bivariate Kaplan-Meier analyses were used to assess the effects of gross total resection (GTR), RT, and CT on OS in sexagenarian and older patients. To adjust for confounding interactions between clinical predictors and OS, Cox proportional-hazards models were employed.
Results
852 oligodendroglioma patients were identified—564 sexagenarian patients and 288 older patients. Multivariable regression demonstrated that older patients were less likely to undergo CT compared to sexagenarian patients (OR: 0.534, 95 % CI: 0.395 – 0.720, p < 0.001). Multivariable Cox proportional-hazards analysis found that sexagenarian patients in whom GTR was achieved had an increased likelihood of survival (HR: 0.699, 95 % CI: 0.517 – 0.946, p = 0.020). However, an analogous analysis found that GTR did not increase survival odds in older oligodendroglioma patients (HR: 0.813, 95 % CI: 0.571 – 1.157, p = 0.250).
Conclusion
In this retrospective study, we found that although sexagenarian and older oligodendroglioma patients were similarly offered GTR, only sexagenarian patients appeared to derive a survival benefit. These findings suggest that the role of aggressive surgical intervention in older patients may warrant further consideration.
{"title":"Clinical predictors of overall survival in elderly oligodendroglioma patients: A Surveillance, Epidemiology, and End Results (SEER) database analysis","authors":"Sai Chandan Reddy, Toby Mao, Julian Gendreau, A. Karim Ahmed, Debraj Mukherjee","doi":"10.1016/j.clineuro.2025.109279","DOIUrl":"10.1016/j.clineuro.2025.109279","url":null,"abstract":"<div><h3>Objective</h3><div>Oligodendrogliomas are typically benign tumors that arise within the white matter tracts of the cerebral hemispheres. Surgical resection, radiotherapy (RT), and chemotherapy (CT) are utilized to prolong survival in patients diagnosed with these tumors. Older patients, however, suffer from various comorbidities that may make surgical resection less feasible and less effective in managing this disease. In this retrospective study, we assessed the survival outcomes for sexagenarian and older patients and the impact of surgical intervention, RT, and CT on overall survival (OS).</div></div><div><h3>Methods</h3><div>The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify all patients ≥ 60 years of age diagnosed with oligodendrogliomas between 2000 and 2020. The patient cohort was dichotomized into the sexagenarian (60–69 years of age) and older (≥ 70 years of age) patient subgroups. Demographic, clinical, and survival information was collected for these patients, and baseline comparison of the two groups of interest was conducted. Bivariate Kaplan-Meier analyses were used to assess the effects of gross total resection (GTR), RT, and CT on OS in sexagenarian and older patients. To adjust for confounding interactions between clinical predictors and OS, Cox proportional-hazards models were employed.</div></div><div><h3>Results</h3><div>852 oligodendroglioma patients were identified—564 sexagenarian patients and 288 older patients. Multivariable regression demonstrated that older patients were less likely to undergo CT compared to sexagenarian patients (OR: 0.534, 95 % CI: 0.395 – 0.720, p < 0.001). Multivariable Cox proportional-hazards analysis found that sexagenarian patients in whom GTR was achieved had an increased likelihood of survival (HR: 0.699, 95 % CI: 0.517 – 0.946, p = 0.020). However, an analogous analysis found that GTR did not increase survival odds in older oligodendroglioma patients (HR: 0.813, 95 % CI: 0.571 – 1.157, p = 0.250).</div></div><div><h3>Conclusion</h3><div>In this retrospective study, we found that although sexagenarian and older oligodendroglioma patients were similarly offered GTR, only sexagenarian patients appeared to derive a survival benefit. These findings suggest that the role of aggressive surgical intervention in older patients may warrant further consideration.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109279"},"PeriodicalIF":1.6,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617342","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}
Pub Date : 2025-11-27DOI: 10.1016/j.clineuro.2025.109275
Jie Zhang , Tian Gan , Wanyu Qiao , Chen Luo , Xian Xie , Ye Yao
Background
Glioma, a prevalent cancer in the elderly, is highly malignant, with a poor prognosis and frequent recurrence, causing significant burden on individuals and society. We aimed to develop pre- and postoperative models for predicting short-term recurrence in elderly glioma patients and investigate associated risk factors.
Methods
Based on our largest known sample size, we retrospectively assessed in great detail patients with gliomas who underwent initial surgical resection and were aged over 60 between 2010 and 2018. Finally, two eligible study cohorts comprising 447 and 463 patients were recruited to develop Logistic regression models and Cox models for predicting short and long-term recurrence or death, respectively. Subgroup analyses were performed based on key molecular markers (MGMT promoter methylation and IDH mutation status) and the IDH-wild-type glioblastoma subgroup.
Results
Preoperative and postoperative predictive models for short-term recurrence or death achieved an accuracy of 0.70 and 0.82, respectively. By utilizing the preoperative model, we effectively classified patients into high, medium, and low short-term recurrence risk groups, with median progression-free survival (PFS) durations of 125, 224, and 370 days, respectively. Several risk factors for short recurrence were identified, including tumors infiltrating the corpus callosum, preoperative muscle weakness and TP53 mutation. Long-term recurrence risk was associated with symptoms such as drowsiness, numbness or tingling, and diminished enjoyment of life, as determined from the MDASI-BT questionnaire. Subgroup analyses revealed that risk factors for recurrence were highly subtype-specific.
Conclusion
Both pre- and postoperative models successfully predict short-term recurrence in elderly glioma patients. Key clinical risk factors, such as tumors infiltrating the corpus callosum and various tumor-related symptoms were identified. Additionally, certain common postoperative physical and psychological symptom changes in the MDASI-BT may be predictive markers for long-term relapse. A crucial finding is that the factors associated with recurrence are distinct across molecular subtypes, underscoring the need for subtype-specific risk management.
{"title":"Predicting short-term recurrence and identifying key risk factors in elderly glioma patients: Insights from a retrospective cohort study","authors":"Jie Zhang , Tian Gan , Wanyu Qiao , Chen Luo , Xian Xie , Ye Yao","doi":"10.1016/j.clineuro.2025.109275","DOIUrl":"10.1016/j.clineuro.2025.109275","url":null,"abstract":"<div><h3>Background</h3><div>Glioma, a prevalent cancer in the elderly, is highly malignant, with a poor prognosis and frequent recurrence, causing significant burden on individuals and society. We aimed to develop pre- and postoperative models for predicting short-term recurrence in elderly glioma patients and investigate associated risk factors.</div></div><div><h3>Methods</h3><div>Based on our largest known sample size, we retrospectively assessed in great detail patients with gliomas who underwent initial surgical resection and were aged over 60 between 2010 and 2018. Finally, two eligible study cohorts comprising 447 and 463 patients were recruited to develop Logistic regression models and Cox models for predicting short and long-term recurrence or death, respectively. Subgroup analyses were performed based on key molecular markers (MGMT promoter methylation and IDH mutation status) and the IDH-wild-type glioblastoma subgroup.</div></div><div><h3>Results</h3><div>Preoperative and postoperative predictive models for short-term recurrence or death achieved an accuracy of 0.70 and 0.82, respectively. By utilizing the preoperative model, we effectively classified patients into high, medium, and low short-term recurrence risk groups, with median progression-free survival (PFS) durations of 125, 224, and 370 days, respectively. Several risk factors for short recurrence were identified, including tumors infiltrating the corpus callosum, preoperative muscle weakness and TP53 mutation. Long-term recurrence risk was associated with symptoms such as drowsiness, numbness or tingling, and diminished enjoyment of life, as determined from the MDASI-BT questionnaire. Subgroup analyses revealed that risk factors for recurrence were highly subtype-specific.</div></div><div><h3>Conclusion</h3><div>Both pre- and postoperative models successfully predict short-term recurrence in elderly glioma patients. Key clinical risk factors, such as tumors infiltrating the corpus callosum and various tumor-related symptoms were identified. Additionally, certain common postoperative physical and psychological symptom changes in the MDASI-BT may be predictive markers for long-term relapse. A crucial finding is that the factors associated with recurrence are distinct across molecular subtypes, underscoring the need for subtype-specific risk management.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109275"},"PeriodicalIF":1.6,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647522","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}
Pub Date : 2025-11-26DOI: 10.1016/j.clineuro.2025.109265
Phillip A. Bonney , John H. Kanter , Lucy Z. Kornblith , Kristin Slown , Michael A. Kohn , Anthony M. DiGiorgio , Phiroz E. Tarapore , Michael C. Huang , Geoffrey T. Manley
Introduction
There are insufficient data to guide the use of venous thromboembolism (VTE) chemical prophylaxis in traumatic brain injury (TBI) patients, leading to substantial variation in practices. We investigated the effectiveness of our institution’s protocol—initiating enoxaparin 30 milligrams twice within 72 h of injury—in a cohort of severe TBI patients treated with external ventricular drains (EVD).
Methods
A retrospective cohort study of TBI patients from August 2019 to October 2023 was conducted. VTE was defined as pulmonary embolism (PE), lower extremity deep venous thrombosis (DVT), and/or upper extremity DVT. Logistic regression and time-to-event analyses were performed to identify risk factors for in-hospital VTE based on patient demographics, injury characteristics, and chemical prophylaxis data.
Results
We identified 129 TBI patients treated with EVDs. VTE occurred in 26 patients (20.2 %), consisting of isolated DVT in 16, isolated PE in 3, and both PE and DVT in 7. Overall mortality was 30 %, with no mortalities directly attributable to VTE. Obesity was associated with VTE (HR 3.4, 95 % CI 1.5–7.8, p = 0.009). Longer durations of EVD, mechanical ventilation, and intensive care unit (ICU) stays were associated with VTE (all p < 0.001). Other variables including extracranial injury and adherence to chemical prophylaxis were examined but did not reach statistical significance.
Conclusions
Despite most patients receiving enoxaparin prophylaxis within 72 h of injury, VTE events were common in TBI patients treated with EVDs. Strategies including weight-based dosing and earlier initiation merit further consideration, though determining the neurological risks of increased dosing regimens remains a challenge.
目前还没有足够的数据来指导在创伤性脑损伤（TBI）患者中使用静脉血栓栓塞（VTE）化学预防，导致实践存在很大差异。我们研究了我们机构方案的有效性——在损伤后72 小时内两次开始使用30毫克依诺肝素——在一组接受心室外引流（EVD）治疗的严重TBI患者中。方法对2019年8月至2023年10月TBI患者进行回顾性队列研究。VTE被定义为肺栓塞（PE）、下肢深静脉血栓形成（DVT）和/或上肢DVT。根据患者人口统计学、损伤特征和化学预防数据，进行Logistic回归和时间-事件分析，以确定院内静脉血栓栓塞的危险因素。结果129例TBI患者接受evd治疗。26例（20.2% %）发生静脉血栓栓塞，其中16例为孤立性DVT， 3例为孤立性PE， 7例PE和DVT同时发生。总死亡率为30 %，没有直接归因于静脉血栓栓塞的死亡。肥胖与静脉血栓栓塞相关（HR 3.4, 95 % CI 1.5-7.8, p = 0.009）。EVD、机械通气和重症监护病房（ICU）住院时间较长与VTE相关（p均为 <； 0.001）。其他变量包括颅外损伤和化学预防依从性进行了检查，但没有达到统计学意义。结论尽管大多数患者在损伤后72 h内接受依诺肝素预防治疗，但evd治疗的TBI患者中VTE事件很常见。尽管确定增加剂量方案的神经系统风险仍然是一个挑战，但包括体重给药和早期开始治疗在内的策略值得进一步考虑。
{"title":"Factors associated with venous thromboembolism in hospitalized traumatic brain injury patients with external ventricular drains: Retrospective cohort study","authors":"Phillip A. Bonney , John H. Kanter , Lucy Z. Kornblith , Kristin Slown , Michael A. Kohn , Anthony M. DiGiorgio , Phiroz E. Tarapore , Michael C. Huang , Geoffrey T. Manley","doi":"10.1016/j.clineuro.2025.109265","DOIUrl":"10.1016/j.clineuro.2025.109265","url":null,"abstract":"<div><h3>Introduction</h3><div>There are insufficient data to guide the use of venous thromboembolism (VTE) chemical prophylaxis in traumatic brain injury (TBI) patients, leading to substantial variation in practices. We investigated the effectiveness of our institution’s protocol—initiating enoxaparin 30 milligrams twice within 72 h of injury—in a cohort of severe TBI patients treated with external ventricular drains (EVD).</div></div><div><h3>Methods</h3><div>A retrospective cohort study of TBI patients from August 2019 to October 2023 was conducted. VTE was defined as pulmonary embolism (PE), lower extremity deep venous thrombosis (DVT), and/or upper extremity DVT. Logistic regression and time-to-event analyses were performed to identify risk factors for in-hospital VTE based on patient demographics, injury characteristics, and chemical prophylaxis data.</div></div><div><h3>Results</h3><div>We identified 129 TBI patients treated with EVDs. VTE occurred in 26 patients (20.2 %), consisting of isolated DVT in 16, isolated PE in 3, and both PE and DVT in 7. Overall mortality was 30 %, with no mortalities directly attributable to VTE. Obesity was associated with VTE (HR 3.4, 95 % CI 1.5–7.8, p = 0.009). Longer durations of EVD, mechanical ventilation, and intensive care unit (ICU) stays were associated with VTE (all p < 0.001). Other variables including extracranial injury and adherence to chemical prophylaxis were examined but did not reach statistical significance.</div></div><div><h3>Conclusions</h3><div>Despite most patients receiving enoxaparin prophylaxis within 72 h of injury, VTE events were common in TBI patients treated with EVDs. Strategies including weight-based dosing and earlier initiation merit further consideration, though determining the neurological risks of increased dosing regimens remains a challenge.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109265"},"PeriodicalIF":1.6,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617486","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号