Clinical Neurology and Neurosurgery最新文献

Clinical significance of thalamic FASI finding in neurofibromatosis type 1: Deepening the cognitive relevance with advanced approaches 1型神经纤维瘤病丘脑FASI发现的临床意义：与先进方法加深认知相关性

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-12-16 DOI: 10.1016/j.clineuro.2025.109287

Gül Yücel , Nur Yücel Ekici

引用次数: 0

Relative influence of paraspinal muscularity and underlying bone quality on proximal junctional kyphosis and failure mode in patients undergoing thoracolumbar instrumented fusion 椎旁肌肉和潜在骨质量对胸腰椎内固定融合患者近端关节后凸和失败模式的相对影响。

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-12-15 DOI: 10.1016/j.clineuro.2025.109286

Zach Pennington , Anthony L. Mikula , Abdelrahman Hamouda , Derrick Obiri-Yeboah , Michael L. Martini , Andrew J. Grossbach , Gabriella L. Paganucci , Ahmad N. Nassr , Brett A. Freedman , Arjun Sebastian , Jeremy L. Fogelson , Benjamin D. Elder

Objective

To assess paraspinal muscularity and bone quality contribution to PJK risk.

Methods

Defining PJK as ≥ 10° increase in proximal junctional angle from first upright radiograph, thoracolumbopelvic fusion patients experiencing PJK were compared to controls. Baseline radiographic parameters, bone quality in CT Hounsfield units (HU), and paraspinal musculature cross-sectional area (CSA) at L3 and the UIV. Patients were subdivided into type 1–3 PJK based upon the Yagi-Boachie scale. Time-dependent analyses with univariable Cox proportional hazards model were performed.

Results

206 patients were included (59.7 % female; median age 67.1); 26.9 % experienced PJK – 52.5 % type 1, 27.8 % type 2, and 19.7 % type 3. Univariable comparisons showed PJK patients had lower HU at the UIV (137 vs 151; p = 0.047) and UIV+ 1 (137 vs 151; p = 0.028); mean multifidus CSA (p = 0.21) was also nonsignificantly smaller. Average HU were lower in type 2 PJK patients relative to non-PJK and type 1 PJK (p < 0.001). Type 2 failure was predicted by UIV/UIV+ 1, UIV, and UIV+ 1 average HU (all p < 0.01) while type 1 failure was predicted by UIV multifidus CSA (p = 0.03); average HU did not predict type 1 failure.

Conclusions

Poor bone quality may be the strongest predictor of PJK; however, subanalysis by PJK type suggests it only increases the odds of bony or implant/bone interface failure. Decreased multifidus CSA appears to confer risk for type 1 (discoligamentous) PJK, suggesting PJK failure mode is dictated by the interplay of UIV bony and soft tissue integrity.

目的：评价椎旁肌肉和骨质量对PJK风险的影响。方法：将PJK定义为第一次直立x线片近端关节角增加≥ 10°，将经历PJK的胸腰盂融合患者与对照组进行比较。基线x线摄影参数，CT Hounsfield单元（HU）的骨质量，L3和UIV的棘旁肌肉横截面积（CSA）。根据Yagi-Boachie量表将患者细分为1-3型PJK。采用单变量Cox比例风险模型进行时间相关分析。结果：纳入206例患者（59.7 %为女性，中位年龄67.1岁）；26.9 %经历PJK， 52.5 % 1型，27.8 % 2型，19.7 % 3型。单变量比较显示，PJK患者在UIV时的HU较低（137 vs 151, p = 0.047）和UIV+ 1 (137 vs 151, p = 0.028)；平均多裂肌CSA （p = 0.21）也无显著性差异。2型PJK患者的平均HU低于非PJK和1型PJK （p ）结论：骨质量差可能是PJK的最强预测因子；然而，PJK类型的亚分析表明，它只会增加骨或种植体/骨界面失效的几率。多裂肌CSA降低似乎会增加1型（双韧带）PJK的风险，这表明PJK的失败模式是由紫外线照射下骨和软组织完整性的相互作用决定的。

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引用次数: 0

Influence of surgical technique, interbody characteristics, and radiographic parameters on fusion rates across the disc space and posterolateral elements following transforaminal lumbar interbody fusion 手术技术、椎间特征和影像学参数对经椎间孔腰椎椎间融合术后椎间盘间隙和后外侧元素融合率的影响

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-12-14 DOI: 10.1016/j.clineuro.2025.109285

Zach Pennington , Abdelrahman Hamouda , Omar Hafz , Anthony L. Mikula , Michelle J. Clarke , William E. Krauss , Brett A. Freedman , Melvin D. Helgeson , Ahmad N. Nassr , Arjun S. Sebastian , Jeremy L. Fogelson , Benjamin D. Elder

Objective

To evaluate predictors of fusion across the disc space and posterolaterally following transforaminal lumbar interbody fusion (TLIF).

Methods

Patients who underwent 1- or 2-level TLIF for degenerative pathologies were examined for fusion across the disc space, posterolateral fusion, and circumferential radiographic fusion. Multivariable logistic regression was used to identify independent predictors of the primary and secondary outcomes.

Results

278 unique patients (328 unique levels) were included (median age 66.2 yr; 58.3 % female) 25.9 % had complete circumferential fusion, 69.6 % had fusion across the disc space and 71 % had unilateral posterolateral fusion. Fusion across the disc space was less likely with a minimally invasive [versus open] approach (OR 0.39; 95 % CI [0.16, 0.95]; p = 0.04) or bullet [versus banana] cage (OR 0.18; [0.09, 0.38]; p < 0.001). Posterolateral fusion was also less likely with an MIS approach (OR 0.10; [0.03, 0.30]; p < 0.001) or bullet cage (OR 0.14; [0.06, 0.30]; p < 0.001) but was significantly more likely with BMP use (OR 2.97; [1.14, 7.74]; p = 0.026). Circumferential fusion was predicted by BMP use (OR 3.29; [1.48; 7.35]; p = 0.004), use of a bullet cage (OR 0.19; [0.04, 0.87] p = 0.033), and use of a longer interbody device (OR 1.15; [1.01, 1.30]; p = 0.032). Cage material was not predictive in any of the multivariable analyses.

Conclusion

The minority of patients experience circumferential fusion following TLIF. Use of a minimally invasive approach or a bullet-type cage lowers the odds of successful fusion both posterolaterally and across the disc space. BMP increases fusion odds due to improved odds of posterolateral fusion.

目的：评价经椎间孔腰椎椎体间融合术（TLIF）后跨椎间盘间隙和后外侧融合的预测因素。方法：因退行性病变接受1或2节段TLIF的患者检查椎间盘间隙融合、后外侧融合和周向放射融合。采用多变量逻辑回归来确定主要和次要结局的独立预测因子。结果：278例独特的患者（328个独特的水平）被纳入研究（中位年龄66.2 岁；58.3% %女性），25.9 %为全周融合术，69.6 %为跨椎间盘间隙融合术，71 %为单侧后外侧融合术。微创[与开放]入路相比（OR 0.39; 95 % CI [0.16, 0.95]; p = 0.04）或子弹[与香蕉]笼子相比(OR 0.18; [0.09, 0.38]； p 结论：少数患者在TLIF后经历了周向融合。采用微创入路或子弹式椎笼可降低后外侧和整个椎间盘间隙成功融合的几率。由于后外侧融合几率的提高，BMP增加了融合几率。

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引用次数: 0

ABCC2 as a drug target for post-stroke recovery: Evidence from Mendelian randomization and colocalization analyses ABCC2作为脑卒中后恢复的药物靶点：来自孟德尔随机化和共定位分析的证据。

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-12-11 DOI: 10.1016/j.clineuro.2025.109284

Jiawei Gui , Zhanghua Qi , Keqi Wan , Xiangli Dong , Guohua Yu , Lang Shuai , Jun Wang , Weiming Sun

Background

Ischemic stroke imposes a substantial burden due to long-term neurological disability and high mortality. Despite advancements in acute treatment, therapeutic strategies for post-stroke recovery remain limited.

Methods

We conducted a two-sample Mendelian randomization (MR) using summary statistics of post-stroke functional outcome from the Genetics of Ischemic Stroke Functional Outcome (GISCOME) network and cis-expression quantitative trait loci (cis-eQTLs) of druggable genes from the eQTLGen Consortium. Bayesian colocalization analysis was performed to assess the shared genetic architecture between gene expression and post-stroke functional outcome. Follow-up analyses included phenome-wide association analysis, collider bias evaluation, protein-protein interaction (PPI) network construction, functional enrichment analysis, and drug candidate prediction via Connectivity Map (CMap) analysis.

Results

Two-sample MR identified 15 genes associated with post-stroke functional outcome, of which five were validated in unadjusted models. Summary-data-based MR (SMR) analysis further confirmed three genes, with ABCC2 demonstrating strong colocalization evidence (PPH4 = 0.843) with post-stroke functional outcome. Results of phenome-wide association analysis showed that ABCC2 was associated with direct bilirubin. Functional analyses showed that ABCC2 expression signatures were enriched in coagulation regulation and lipid efflux pathways. CMap analysis predicted candidate drugs that modulate ABCC2-related gene expression signatures.

Conclusions

This study provides genetic evidence supporting ABCC2 as a druggable target for post-stroke recovery. Our findings offer insights into the underlying mechanisms and highlight the potential for drug repurposing, providing a scientific basis for future therapeutic development in ischemic stroke rehabilitation.

背景：缺血性脑卒中由于长期的神经功能障碍和高死亡率，给患者带来了沉重的负担。尽管在急性治疗方面取得了进展，但中风后恢复的治疗策略仍然有限。方法：我们使用来自缺血性卒中功能结局遗传（GISCOME）网络的脑卒中后功能结局和来自eQTLGen联盟的可用药基因的顺式表达数量性状位点（顺式- eqtls）的汇总统计数据进行了两样本孟德尔随机化（MR）。采用贝叶斯共定位分析来评估基因表达与脑卒中后功能预后之间的共享遗传结构。随访分析包括全现象关联分析、对撞机偏倚评估、蛋白蛋白相互作用（PPI）网络构建、功能富集分析和通过连接图（CMap）分析预测候选药物。结果：双样本MR鉴定出15个与卒中后功能结局相关的基因，其中5个在未调整的模型中得到验证。基于汇总数据的MR （SMR）分析进一步证实了三个基因，其中ABCC2表现出强大的共定位证据（PPH4 = 0.843）与卒中后功能结局有关。全表型关联分析结果显示ABCC2与胆红素直接相关。功能分析表明，ABCC2在凝血调节和脂质外排途径中表达特征丰富。CMap分析预测了调节abcc2相关基因表达特征的候选药物。结论：本研究为ABCC2作为脑卒中后恢复的药物靶点提供了遗传学证据。我们的发现提供了对潜在机制的见解，并强调了药物再利用的潜力，为未来缺血性卒中康复治疗的发展提供了科学基础。

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引用次数: 0

Re-calculated idiopathic intracranial hypertension prevalence rates with corrected age-filtering techniques 用校正年龄过滤技术重新计算特发性颅内高压患病率。

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-12-07 DOI: 10.1016/j.clineuro.2025.109283

Guei-Chiuan Chen, Joshua Wang

引用次数: 0

Bone modifying agents and multikinase inhibitors as treatments for chordoma: A TriNetX-based retrospective cohort study 骨修饰剂和多激酶抑制剂治疗脊索瘤：一项基于trinetx的回顾性队列研究

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-12-03 DOI: 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.

脊索瘤是一种罕见的恶性肿瘤，起源于脊索的胚胎残余，最常影响中轴骨骼。尽管在手术切除和放射治疗方面取得了进展，但全身治疗的选择仍然有限。骨修饰剂（bma），包括唑来膦酸和地诺单抗，以及多激酶抑制剂（MKIs），如lenvatinib和cabozantinib，已经成为基于临床前模型的潜在靶向治疗方法。然而，评估其在脊索瘤患者中的结果的比较真实世界的数据是缺乏的。方法采用TriNetX研究网络进行回顾性队列研究。脊索瘤患者（ICD-10-CM C41.0, C41.2, C41.4）根据接受唑来膦酸，地诺单抗或多激酶抑制剂（MKIs）分为治疗组。倾向评分匹配用于调整基线混杂因素。诊断后5年评估的结果包括全因死亡率、病理性骨折、脊髓压迫和骨坏死。计算了95% %置信区间的风险比。结果与地诺单抗相比，唑来膦酸与更高的5年死亡风险相关，但与更低的骨坏死风险相关。涉及mki的比较显示死亡率没有差异。所有队列均未报告病理性骨折。不同治疗间脊髓压迫无差异。结论：本研究强调了脊索瘤患者接受bma治疗（特别是denosumab和MKIs）在生存和骨骼相关结局方面的潜在差异。这些初步发现强调需要前瞻性研究来更好地确定这种罕见恶性肿瘤的最佳全身治疗方法。

{"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}

引用次数: 0

Efficacy, safety, and predictors of vagus nerve stimulation in children with drug-resistant epilepsy: A single-center prospective study 迷走神经刺激治疗儿童耐药癫痫的疗效、安全性和预测因素：一项单中心前瞻性研究

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-12-02 DOI: 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.

目的评价迷走神经刺激（VNS）治疗儿童药物难治性癫痫（DRE）的安全性和有效性，并探讨影响其疗效的关键预测因素。方法2016年10月至2020年7月进行前瞻性单中心研究。经VNS治疗的54例患儿随访24个月。分别于2、6、12、18、24个月评价VNS的有效性和安全性。采用Kaplan-Meier单变量生存分析和Cox回归分析确定治疗反应的预测因素。结果在第2、6、12、18和24个月时，VNS的有效性（癫痫发作频率降低≥50 %）分别为29.6 %、20.4 %、39.6 %、76.0 %和75.0 %。癫痫发作自由率分别为0 %、0 %、3.8 %、8.0 %和10.4 %。lenox - gastaut综合征患者24个月有效率为67.7% %。神经发育评分和生活质量也有显著改善（p <； 0.05）。Cox回归发现癫痫发作和异常神经成像（CT/MRI）是18个月和24个月VNS反应的独立阴性预测因子。不良事件是短暂的，可耐受的，有5例（9.3 %）短暂性声音嘶哑，3例（5.6 %）咳嗽，3例（5.6 %）食欲下降，2例（3.7 %）皮肤刺激，2例（3.7 %）局部皮肤感染，1例（1.8 %）月经周期紊乱。结论vns是一种有效、安全的儿童DRE长期治疗方法，且随着时间的推移具有累积效益。缺席癫痫发作和异常神经影像学发现的存在是不良反应的关键预测因素，这可能为临床决策提供有关患者选择的信息。对于表现出这些特征的DRE患儿，建议在开始VNS治疗时要谨慎。

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引用次数: 0

Anomaly changes in the functional connectome of post-operative neurosurgical patients: A case series 神经外科术后患者功能连接体的异常改变：一个病例系列。

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-11-28 DOI: 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.

目的：神经导航与叠加映射工具的使用使关键纤维束的可视化和改善围手术期计划成为可能。然而，这些方法的局限性在于它们依赖于静态的潜在脑图谱，特别是在患有脑肿瘤的神经外科患者中。一种能够确定和量化脑区域连通性的工具可以改进手术切除的方法。方法：我们利用机器学习成像平台Quicktome™生成个性化的功能包和束，动态适应围手术期的变化。连接体是由扩散张量成像和静息状态函数磁共振成像相结合得出的。从4例颅内肿瘤患者的功能性MRI中生成基质，并比较术前和术后的包裹值。对个体相关性和区域强度进行量化。低连接区和超连接区被标记为异常。结果：我们报告了4例患者的病例系列，以说明异常基质与术后神经系统变化的相关性。这些症状包括：术后谵妄与显著性网络连通性低下有关；与背侧注意网络低连通性相关的视觉半忽视以及表达性失语症解决后语言网络的可量化改善。术前、术后配对相关值差异均有统计学意义。结论：我们展示了一种新的方法来量化功能连接组异常与术后神经变化相关的程度。这与术后预后、专科治疗服务的提供有关，并可作为外科教育和术前计划的有用工具。

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引用次数: 0

Critique on “Identifying poor prognostic factors in patients with spontaneous spinal epidural hematoma: Insights from 47 cases at a single institution” 《确定自发性脊髓硬膜外血肿患者的不良预后因素：来自单一机构47例病例的见解》评论

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-11-27 DOI: 10.1016/j.clineuro.2025.109280

Muhammad Muaz , Vineet Kumar

引用次数: 0

Delayed diagnosis in postoperative bacterial meningitis: A retrospective study in the skull base neoplasm surgery 术后细菌性脑膜炎的延迟诊断：颅底肿瘤手术的回顾性研究

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-11-27 DOI: 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.

背景与目的术后细菌性脑膜炎（PBM）是颅底肿瘤手术后的一种严重并发症，早期诊断是一个挑战，由于目前的诊断方法依赖于临床症状和脑脊液分析的不确定性，早期诊断至关重要，但往往被延误。本研究旨在通过比较术后7天内诊断（及时感染诊断，TID）和7天以上诊断（延迟感染诊断，DID）患者的临床和实验室差异，确定PBM延迟诊断的相关因素，并改进早期发现策略。方法和结果本回顾性研究纳入了2019年1月至2024年8月我院颅底肿瘤手术后诊断为PBM的372例患者。患者分为TID组和DID组。多因素分析发现，第一次腰椎穿刺与手术之间的时间、肿瘤位于后窝、多核细胞比例是两组间不同的独立因素。结论与TID病例相比，DID组患者多为开颅手术及肿瘤后部定位，早期症状及脑脊液表现较轻，抗生素治疗后感染持续时间较长。该研究强调了仅仅依赖脑脊液初始结果的局限性，并强调了对疑似PBM的临床警惕、围手术期管理和个性化诊断策略的必要性。

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引用次数: 0