Clinical Neurology and Neurosurgery最新文献

Objectives: Language is a critical aspect of human cognition and function, and its preservation is a priority for neurosurgical interventions in the left frontal operculum. However, identification of language areas can be inconsistent, even with electrical mapping. The use of multimodal structural and functional neuroimaging in conjunction with intraoperative neuromonitoring may augment cortical language area identification to guide the resection of left frontal opercular lesions.

Methods: Structural and functional connectome scans were generated using a machine learning software to reparcellate a validated schema of the Human Connectome Project Multi-Modal Parcellation (HCP-MMP) atlas based on individual structural and functional connectivity identified through anatomic, diffusion, and resting-state functional MRI (rs-fMRI). Structural connectivity imaging was analyzed to determine at-risk parcellations and seed-based analysis of regions of interest (ROIs) was performed to identify functional relationships.

Results: Two patients with left frontal lesions were analyzed, one with a WHO Grade IV gliosarcoma, and the other with an intracerebral abscess. Individual patterns of functional connectivity were identified by functional neuroimaging revealing distinct relationships between language network parcellations. Multimodal, connectome-guided resections with intraoperative neuromonitoring were performed, with both patients demonstrating intact or improved language function relative to baseline at follow-up. Follow-up imaging demonstrated functional reorganization observed between Brodmann areas 44 and 45 and other parcellations of the language network.

Conclusion: Preoperative visualization of structural and functional connectivity of language areas can be incorporated into a multimodal operative approach with intraoperative neuromonitoring to facilitate the preservation of language areas during intracranial neurosurgery. These modalities may also be used to monitor functional recovery.

Objective: The prevalence of ischemic stroke in young adults has increased dramatically. However, factors associated with prognosis in this cohort have not been well studied. This study primary aimed to construct and validate a nomogram for predicting stroke recurrence and to achieve risk stratification of young adults after acute ischemic stroke (AIS).

Methods: In this retrospective, multicenter study, we identified AIS patients aged 18-50 years in Tianjin Huanhu Hospital (training cohort) and The Affiliated Hospital of Chengde Medical College (validation cohort) from September 2019 to September 2021, respectively. Demographics and clinical characteristics data were systematically collected. A stepwise Cox proportional hazards regression analysis was used to identify the independent predictors of stroke recurrence in the training cohort and employed to construct the best-fit nomogram. Patients were stratified into low-, medium-, and high-risk groups based on the total points. Receiver operating characteristic (ROC) analysis and calibration curves were used to assess the discrimination and calibration of the nomogram. The discriminate value of risk stratification was verified using Kaplan-Meier curves, and external validation was performed with the validation cohort.

Results: A total of 467 young adult AIS patients were enrolled in this study. The overall prevalence of young adults in AIS patients was 13.3 % (95 % confidence interval, 12.2 %-14.5 %). Hyperlipidemia (Hazard ratio, 2.4 [1.2-4.9]), current smoking (5.9 [2.7-12.8]), stroke subtype (small-vessel occlusion, 3.7 [1.8-7.6]; stroke of undetermined cause/ others, 14.5 [3.0-70.2]), and stenosis (11.4 [4.5-28.9]) were significant independent predictors of stroke recurrence. A nomogram was constructed with the above predictors and achieved a satisfactory prediction in the validation cohort. Patients were classified into low-, medium-, and high-risk groups based on the total points with the cutoff value of 110.8 and 185.2. The log-rank test showed significant discrimination among the Kaplan-Meier curves of different risk groups (P < 0.001).

Conclusion: The nomogram can satisfactory prediction of stroke recurrence-free rate in young adult patients and achieved risk stratification, may help to personalize management of patients.

Background: Malnutrition is a predictor of poor surgical outcomes, but its specific effects in spinal epidural abscess (SEA) are understudied. This study aims to assess the association between nutritional status and post-operative outcomes.

Methods: We conducted a retrospective cohort study using the 2011-2022 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database to identify adult SEA patients who underwent spinal surgery. The study population was divided into two groups: Nourished (preoperative serum albumin values ≥ 3.5 g/dL) and Malnourished (preoperative serum albumin values < 3.5 g/dL). Multivariable logistic regression analyses were performed to identify factors associated with extended length of stay (LOS), adverse events (AEs), non-routine discharge (NRD), 30-day unplanned reoperation, and mortality.

Results: 1462 patients were identified and stratified by nutrition status: 300 Nourished (20.5 %) and 1162 Malnourished (79.5 %). Patients in the Malnourished cohort had a significantly higher incidence of severe medical AEs (Nourished: 42.7 % vs. Malnourished: 55.9, p < 0.001). The Malnourished cohort also had significantly increased LOS (Nourished: 11.0 ± 7.4 days vs. Malnourished: 16.0 ± 11.8 days, p< 0.001), NRD (Nourished: 50.3 % vs. Malnourished: 72.5%, p < 0.001), 30-day mortality (Nourished: 2.0% vs. Malnourished: 4.8 %, p = 0.031), and 30-day reoperation (Nourished: 9.3 % vs. Malnourished: 16.5 %, p = 0.002). On multivariable analysis, malnourishment was an independent predictor of extended LOS [OR: 2.47 (CI: 1.65-3.71), p< 0.001], AEs [OR: 1.41 (CI: 1.08-1.83), p = 0.011], and NRD [OR: 1.93 (CI: 1.44-2.58), p < 0.001], but not 30-day unplanned reoperation or mortality.

Conclusion: Our study suggests that malnourishment may be associated with worse post-surgical outcomes for SEA patients.

Background: At present, although some studies have offered certain insights into the genetic factors related to unruptured intracranial aneurysms (uIAs), the potential genetic targets associated with uIAs remain largely unknown. Thus, this research adopted Mendelian randomization (MR) analysis to study two genome-wide association studies on uIAs, aiming to determine the reliable genetic susceptibility and potential therapeutic targets for uIAs.

Methods: This study summarizes the data of expression quantitative trait loci (eQTL) as exposure data. The outcome data of uIAs were derived from the study by Bakker et al. and the FinnGen Biobank (version R10). The reliable genetic susceptibility and potential therapeutic targets of uIAs were identified by means of Mendelian randomization (MR) methods, with the inverse variance weighting (IVW) method as the primary analytical approach. Simultaneously, sensitivity and pleiotropy analyses were carried out, and the results were visualized. Subsequently, drug predictions and molecular docking were conducted for the potential gene targets to verify their reliability.

Results: The MR analysis of the training cohort identified 100 targets related to uIAs. Then, these 100 gene targets and eQTL data were verified by MR Analysis again with the testing cohort. Finally, 7 gene targets were selected, namely MTMR3, SERINC1, CITED2, NKX3-1, ATOX1, MYADM and SLC20A1-DT.GO/KEGG enrichment analysis confirmed that the 7 gene targets mainly participate in the process Biological functions and pathways such as art development, cellular response to hypoxia, male Gonad development, RNA polymerase II specific DNA binding transcription factor binding, DNA binding transcription factor binding, Mineral absorption, Inositol phase metabolism, Photoshatidylinositol signaling system, etc.The protein-protein interaction（PPI） network describes the interactions between seven gene targets and related proteins.The molecular docking diagram shows good binding between candidate drugs and proteins related to gene targets.

Conclusions: The study identified 7 reliable gene susceptibility and potential therapeutic targets associated with uIAs, offering new insights for clinical diagnosis and treatment of uIAs, and suggesting novel research directions for understanding the etiology and molecular mechanisms of uIAs.

Purpose: Hemangioblastomas (HBs) occurring in the cervical spinal region are infrequently reported. Surgical resection of cervical HBs poses a significant challenge, and the long-term therapeutic outcomes remain unclear.

Methods: A comprehensive retrospective analysis was conducted to review the treatment outcomes of patients with cervical HBs from 2011 to 2021. Patients with detailed preoperative clinical and radiological information, as well as follow-up data, were included in this study.

Results: One hundred six adult patients were enrolled, with a mean age of 37.4 ± 15.6 years (range: 18-68 years), and a male predominance of 58.5 %. Thirty-two patients (30.2 %) had von Hippel-Lindau (VHL) disease. VHL-associated patients were younger (p = 0.023), had a shorter duration of symptoms (p = 0.004), and had smaller lesion size (p = 0.039) compared to the sporadic group. Fourteen patients (13.2 %) experienced immediate postoperative deterioration. During long-term follow-up, 35 patients (33.0 %) improved, 57 patients (53.8 %) remained stable. 8 patients (7.5 %) worsened compared to baseline, and 6 patients (5.7 %) died. A recurrent HBs (p = 0.027), ventral location (p = 0.046), and worsened immediately after surgery (p = 0.001) were statistically significant indicators for unfavorable outcomes in multivariate analysis.

Conclusion: Surgical resection of cervical spinal HBs can achieve favorable long-term outcomes in most cases, although neurological deterioration may occur immediately after surgery. Postoperative deficits occur in 13.2 % patients, and the incidence of respiratory insufficiency is relatively low. A recurrent HBs, ventral location, and worsened immediately after surgery were indicators for unfavorable outcomes.

Objective: To explore the anatomical and clinical factors that affect the radiographic exposure time in radial artery cerebral angiography and to establish a model.

Method: A total of 210 patients who underwent radial artery cerebral angiography at this center from September 2021 to May 2022 were selected, and their anatomical and clinical factors were analyzed to evaluate the correlation between these factors and the duration of radiographic exposure. A related neural network prediction model was established.

Results: (1) Hypertension (p = 0.014), the presence of a double subclavian innominate artery curve (p＜0.001) and a proximal left common carotid artery loop (p = 0.014) increased the fluoroscopy time. (2) Age (p = 0.002), diameter of the aortic arch (p < 0.001), width of the innominate artery (brachiocephalic artery) (p < 0.001), and angle between the innominate artery and aortic arch (p = 0.042) were positively correlated with the fluoroscopy time. (3) The length of the innominate artery was negatively correlated with the fluoroscopy time (p = 0.024). (4) The accuracy of the neural network model was 80.0 % with the training set and 76.9 % with the test set, indicating a relatively high prediction accuracy. The ROC curve analysis showed an area under the curve (AUC) of 0.821, indicating its good predictive performance.

Conclusion: Age, hypertension, double curvature of the subclavian and innominate arteries, proximal left common carotid artery loop, diameter of the aortic arch, width and length of the innominate artery, and angle between the innominate artery and aortic arch can affect the fluoroscopy time for cerebral angiography in TRA.

Objective: Cerebrovascular diseases are often associated with the development of depression, but few studies have assessed this association with brain arteriovenous malformations (bAVMs). We aim to explore the association of brain arteriovenous malformation(bAVM) with new onset depression at follow-up.

Methods: We performed a retrospective cohort study on adult bAVMs patients using an institutional bAVM database. Patients with hereditary hemorrhagic telangiectasia(HHT), incomplete data or a confirmed diagnosis of depression before their bAVM diagnosis were excluded. The outcome of interest was diagnosis of depression at follow-up. Self-reported depression without an established diagnosis were not counted. Patient demographics, socioeconomic status, clinical and bAVM characteristics were analyzed in a multivariable logistic regression against the outcome variable.

Results: Among 752 adult bAVM patients with complete data, 660 (87.8 %) had no depression at the time of their bAVM diagnosis and were included as the final cohort. There were 250(37.9 %) ruptured bAVMs. Mean follow-up time was 9.60 years, during which 187(28.3 %) had a new diagnosis of depression. Multivariable analysis found that white race(OR=1.75,CI=[1.21,2.57],p = 0.004), female(OR=1.49,CI=[1.04,2.14],p = 0.031), ADI quantile 2(OR=1.85,CI=[1.21,2.85],p = 0.005) and quantile 3(OR=2.05,CI=[1.22,3.42],p = 0.006), occipital lobe involvement(OR=1.66,CI=[1.05,2.60],p = 0.028), follow-up mRS≥ 2(OR=1.69,CI=[1.14,2.52],p = 0.010), bAVM obliteration (OR=1.46,CI=[1.02,2.11],p = 0.040), and follow-up seizures(OR=1.70,CI=[1.14,2.55],p = 0.009) were significant factors associated with new-onset diagnosis of depression at follow-up.

Conclusion: We characterized the probability of new-onset depression at follow-up in patients with bAVMs. More than 25 % of patients developed depression in this study. White female, suboptimal socioeconomic status, occipital lobe, poor outcome, follow-up seizures, and definitive management with bAVM obliteration was associated with depression. Identification of these features may provide guidance in early preventive measures.

Background: Early detection of cognitive impairment in patients with acute stroke could improve dementia treatment; however, such testing is uncommon. This study aimed to assess cognitive testing feasibility in patients with acute stroke and identify patient characteristics associated with testing ability.

Methods: 291 patients with suspected acute stroke were admitted to our hospital between December 2016 and May 2017. Of these, 280 were diagnosed with stroke (median [interquartile range] age 73 [63-81] years; 70 % male; 11 % with prior cognitive decline) and included in the study. Patients able or unable to complete three cognitive function tests were classified as the testable or untestable group, respectively.

Results: Among the 280 patients, 72 % completed all three cognitive tests a mean of 4 [3-5] days after onset. Significant differences were found between the testable and untestable groups, particularly in age (70 [61-80] vs. 77 [69-84], p < 0.0001), Informant Questionnaire on Cognitive Decline in the Elderly score (78 [78-83] vs. 84 [78-96], p = 0.012), and National Institutes of Health Stroke Scale (NIHSS) score at onset (3 [1-6] vs. 13 [4-18], p < 0.0001). Advanced age, a higher NIHSS score, and pre-stroke cognitive decline were independent risk factors for the inability to undergo testing.

Conclusions: Cognitive testing was feasible in 72 % of patients with acute stroke, particularly those who were younger, had normal pre-stroke cognitive function, and experienced mild strokes. Early cognitive assessment may enable timely dementia detection and treatment.

Background: The estimated incidence of chronic subdural hematomas (cSDH) in the general population is projected to nearly double over the next decade, likely making it the most commonly treated cranial neurosurgical condition in adults by 2030. We investigated the outcomes of middle meningeal artery embolization (MMAe) as either a primary or adjunctive treatment for cSDH in nonagenarian patients.

Methods: We retrospectively reviewed all patients 90 years of age or older treated with middle meningeal artery embolization for cSDH from 2018 to 2024 at two academic institutions. Statistical analysis was performed on patient demographics, baseline functional status, intervention, cSDH size, recurrence rate, reintervention rate, and follow-up functional status.

Results: Twenty-one patients aged 90 or older were identified who were treated with MMAe for cSDH. Hematoma thickness ranged from 10mm to 34mm with a mean midline shift of 4.6mm. Eighteen patients were treated with MMAe alone, while three patients underwent surgery followed by MMAe. A total of 20 patients had radiological follow up, with no evidence of growth or recurrence in 95 % of the patients. There was one recurrent cSDH in our cohort in the setting of new trauma after hospital discharge. There was one complication related to the MMAe procedure which was a femoral artery pseudoaneurysm that resolved without further treatment. Median baseline mRS was 3 prior to MMAe and median follow-up mRS after treatment was 2.

Conclusion: MMAe is a safe and efficacious treatment for nonagenarian patients with cSDH, and shows promise as a potential primary treatment modality.

Objective: Nutritional and immune status have been recognized as important factors influencing the prognosis of acute ischemic stroke. This study aims to evaluate the prognostic value of the Prognostic Nutritional Index (PNI) in predicting 30-day mortality in patients with acute ischemic stroke.

Methods: A retrospective cohort study was conducted in a tertiary care hospital emergency department. Patients diagnosed with acute ischemic stroke between January 1, 2019, and January 1, 2024, were included. PNI was calculated using serum albumin levels and total lymphocyte count. Data on demographics, clinical parameters, laboratory results, and 30-day mortality were collected from electronic medical records and patient follow-up via phone calls. Appropriate statistical tests were applied based on the data distribution, and p-values < 0.05 were considered statistically significant.

Results: A total of 169 patients were included in the study, with a mean age of 74.2 ± 10.5 years, and 55 % were male. Of these patients, 25 (14.8 %) did not survive within the 30-day follow-up period. PNI was significantly lower in deceased patients compared to survivors (p < 0.001). The area under the receiver operating characteristic (AUROC) curve was 0.831, indicating good predictive accuracy for 30-day mortality. The optimal PNI cut-off of 37.21 demonstrated a sensitivity of 72.0 % and a specificity of 81.2 %.

Conclusion: The PNI is a reliable predictor of 30-day mortality in acute ischemic stroke patients. Lower PNI values were associated with higher mortality, highlighting the importance of nutritional and immune status in stroke outcomes. PNI could be used in clinical practice to help identify high-risk patients and inform more appropriate treatment decisions.