Dexmedetomidine, an alpha-2 adrenoceptor agonist, and dexamethasone are known to prolong analgesia when used as adjuvants in peripheral nerve blocks. However, their comparative efficacy as perineural adjuvants in scalp nerve blocks (SNB) for awake craniotomy remains uncertain.
Methods
Fifty adults degree of postoperative sedation (18–65 years) undergoing awake craniotomy were randomized to receive SNB with 30 ml of 0.5 % ropivacaine plus dexmedetomidine 1 μg/kg (Group D, n = 25) or dexamethasone 8 mg (Group Z, n = 25), 20 min before skull pin fixation. The primary outcome was time to first rescue analgesia. Secondary outcomes included postoperative pain (numerical rating scale, NRS), 24-hour rescue analgesic consumption, onset of sensory block, perioperative hemodynamics during application of noxious stimulus, degree postoperative sedation, and incidence of any complications.
Results
The time to first rescue analgesia was significantly longer in Group D than in Group Z (14 [12–16] vs. 12.3 [9–13] h, P = 0.03). Rescue analgesic consumption was lower in Group D (1.64 ± 0.82 vs. 2.26 ± 0.89, P = 0.021). Pain scores were significantly reduced in Group D at 8 h (P = 0.01) and 12 h (P = 0.01). Group D also showed lower heart rate at skull pin fixation (P = 0.02), skin incision (P = 0.03), and closure (P = 0.001), and lower mean arterial pressure at dural (P = 0.001) and skin closure (P = 0.007). The onset of sensory block, sedation scores, and complications were comparable.
Conclusion
Perineural dexmedetomidine as an adjuvant to ropivacaine in SNB prolongs postoperative analgesia, reduces rescue analgesic requirements, and provides superior attenuation of the hemodynamic response to noxious stimulus as compared to dexamethasone, in the absence of any adverse effects.
背景：已知右美托咪定（一种α -2肾上腺素能受体激动剂）和地塞米松在周围神经阻滞中作为佐剂可延长镇痛时间。然而，在清醒开颅术中，它们作为头皮神经阻滞（SNB）的神经周佐剂的比较疗效仍不确定。方法:50成人术后镇静程度(18 - 65岁)接受开颅清醒被随机分配接受瑞士央行30 0.5毫升 % ropivacaine + dexmedetomidine 1 μg / kg (D组,n = 25)或地塞米松8 毫克(Z, n = 25),前20 分钟头骨销固定。主要观察指标为首次镇痛时间。次要结局包括术后疼痛（数值评定量表，NRS）、24小时抢救镇痛消耗、感觉阻滞的发生、应用有害刺激时围手术期血流动力学、术后镇静程度和任何并发症的发生率。结果：D组首次抢救镇痛时间明显长于Z组（14[12-16]比12.3 [9-13]h, P = 0.03）。D组抢救镇痛药用量较低（1.64 ± 0.82 vs. 2.26 ± 0.89,P = 0.021）。D组疼痛评分在8 h （P = 0.01）和12 h （P = 0.01）显著降低。D组还显示低心率在头骨销固定(P = 0.02),皮肤切口(P = 0.03),和关闭(P = 0.001),并降低平均动脉压在硬铝(P = 0.001)和皮肤(P = 0.007)关闭。感觉阻滞的发生、镇静评分和并发症具有可比性。结论：与地塞米松相比，神经周右美托咪定作为罗哌卡因在SNB中的辅助治疗延长了术后镇痛时间，减少了救援镇痛需求，并且在没有任何不良反应的情况下，对有害刺激的血流动力学反应提供了更好的衰减。临床试验注册-印度（CTRI） ID: CTRI/2024/01/062046。
{"title":"Comparison of the efficacy of dexmedetomidine and dexamethasone as adjuvants to ropivacaine for scalp nerve block in patients undergoing awake craniotomy: A randomized controlled trial","authors":"Leena Sharma , Ashwini Reddy , Rajeev Chauhan , Nidhi Panda , Ankur Luthra , Shyam Charan Meena , Rashi Sarna , Sushant Kumar Sahoo","doi":"10.1016/j.clineuro.2025.109223","DOIUrl":"10.1016/j.clineuro.2025.109223","url":null,"abstract":"<div><h3>Background</h3><div>Dexmedetomidine, an alpha-2 adrenoceptor agonist, and dexamethasone are known to prolong analgesia when used as adjuvants in peripheral nerve blocks. However, their comparative efficacy as perineural adjuvants in scalp nerve blocks (SNB) for awake craniotomy remains uncertain.</div></div><div><h3>Methods</h3><div>Fifty adults degree of postoperative sedation (18–65 years) undergoing awake craniotomy were randomized to receive SNB with 30 ml of 0.5 % ropivacaine plus dexmedetomidine 1 μg/kg (Group D, n = 25) or dexamethasone 8 mg (Group Z, n = 25), 20 min before skull pin fixation. The primary outcome was time to first rescue analgesia. Secondary outcomes included postoperative pain (numerical rating scale, NRS), 24-hour rescue analgesic consumption, onset of sensory block, perioperative hemodynamics during application of noxious stimulus, degree postoperative sedation, and incidence of any complications.</div></div><div><h3>Results</h3><div>The time to first rescue analgesia was significantly longer in Group D than in Group Z (14 [12–16] vs. 12.3 [9–13] h, P = 0.03). Rescue analgesic consumption was lower in Group D (1.64 ± 0.82 vs. 2.26 ± 0.89, P = 0.021). Pain scores were significantly reduced in Group D at 8 h (P = 0.01) and 12 h (P = 0.01). Group D also showed lower heart rate at skull pin fixation (P = 0.02), skin incision (P = 0.03), and closure (P = 0.001), and lower mean arterial pressure at dural (P = 0.001) and skin closure (P = 0.007). The onset of sensory block, sedation scores, and complications were comparable.</div></div><div><h3>Conclusion</h3><div>Perineural dexmedetomidine as an adjuvant to ropivacaine in SNB prolongs postoperative analgesia, reduces rescue analgesic requirements, and provides superior attenuation of the hemodynamic response to noxious stimulus as compared to dexamethasone, in the absence of any adverse effects.</div><div><strong>Clinical Trials Registry-India (CTRI) ID: CTRI/2024/01/062046</strong></div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109223"},"PeriodicalIF":1.6,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457680","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}
In idiopathic normal pressure hydrocephalus (iNPH), optimal valve pressure selection is critical. While indicators have been reported for ventriculoperitoneal shunts (VPS) and lumboperitoneal shunts (LPS), no peer-reviewed publications have reported on ventriculoatrial shunts (VAS).
Methods:
We retrospectively analyzed 54 iNPH patients treated using a SPVA-140 valve without antisiphon device between 2010 and 2017. Clinical outcomes (modified Rankin scale, iNPH grading scale), valve pressures, and complications were assessed. Optimal pressure was defined as the setting associated with maximal improvement in iNPH grading scale, and its correlation with preoperative height, body weight, body mass index, and cerebrospinal fluid pressure was examined.
Results:
The median follow-up was 3.3 years. Optimal pressure was 10–40 mmH₂O in 81.5 % of patients (10 mmH₂O in 29, 40 mmH₂O in 15). Median improvements were 1 on the modified Rankin scale and 3 on the iNPH grading scale, with a median of 4 valve adjustments. Subdural hematoma occurred in 46.3 % of patients but was managed conservatively without requiring surgical intervention; shunt malfunction developed in 3 patients. No correlation was observed between optimal pressure and preoperative height, body weight, body mass index, or cerebrospinal fluid pressure.
Conclusion:
Unlike VPS or LPS, optimal VAS pressure converges at low settings (10–40 mmH₂O) and is independent of body habitus. VAS may therefore be a particularly effective option in obese or elderly patients.
{"title":"Optimal valve pressure for ventriculoatrial shunt in idiopathic normal pressure hydrocephalus: A retrospective study of 54 cases","authors":"Ryosuke Takagi , Kiyoshi Takagi , Shuichiro Asano , Taishi Nakamura , Naoki Ikegaya , Kotaro Oshio , Katsumi Sakata , Kensuke Tateishi , Tetsuya Yamamoto","doi":"10.1016/j.clineuro.2025.109224","DOIUrl":"10.1016/j.clineuro.2025.109224","url":null,"abstract":"<div><h3>Background</h3><div>In idiopathic normal pressure hydrocephalus (iNPH), optimal valve pressure selection is critical. While indicators have been reported for ventriculoperitoneal shunts (VPS) and lumboperitoneal shunts (LPS), no peer-reviewed publications have reported on ventriculoatrial shunts (VAS).</div></div><div><h3>Methods<em>:</em></h3><div>We retrospectively analyzed 54 iNPH patients treated using a SPVA-140 valve without antisiphon device between 2010 and 2017. Clinical outcomes (modified Rankin scale, iNPH grading scale), valve pressures, and complications were assessed. Optimal pressure was defined as the setting associated with maximal improvement in iNPH grading scale, and its correlation with preoperative height, body weight, body mass index, and cerebrospinal fluid pressure was examined.</div></div><div><h3>Results<em>:</em></h3><div>The median follow-up was 3.3 years. Optimal pressure was 10–40 mmH₂O in 81.5 % of patients (10 mmH₂O in 29, 40 mmH₂O in 15). Median improvements were 1 on the modified Rankin scale and 3 on the iNPH grading scale, with a median of 4 valve adjustments. Subdural hematoma occurred in 46.3 % of patients but was managed conservatively without requiring surgical intervention; shunt malfunction developed in 3 patients. No correlation was observed between optimal pressure and preoperative height, body weight, body mass index, or cerebrospinal fluid pressure.</div></div><div><h3>Conclusion<em>:</em></h3><div>Unlike VPS or LPS, optimal VAS pressure converges at low settings (10–40 mmH₂O) and is independent of body habitus. VAS may therefore be a particularly effective option in obese or elderly patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109224"},"PeriodicalIF":1.6,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450978","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 : 2025-10-30DOI: 10.1016/j.clineuro.2025.109220
Ali Tarık Altunç , Doğukan Hazar Emre , Ayşegül Gündüz , Burç Çağrı Poyraz
Objectives
The aim of this study was to investigate the demographic, clinical, and etiological characteristics of patients diagnosed with catatonic disorder due to another medical condition.
Methods
A retrospective analysis was conducted on 18 patients diagnosed with catatonic disorder due to another medical condition in a tertiary care center between 2017 and 2024. Patient demographics, underlying medical conditions, clinical features, and treatment methods were documented.
Results
Eighteen patients met the inclusion criteria. The most frequent underlying conditions were neurodegenerative diseases (6/18), autoimmune encephalitis (4/18), and the use of antipsychotic medications (5/18), often in the presence of comorbid neurological disorders. Commonly observed symptoms included mutism, negativism, and rigidity. Benzodiazepines were the initial treatment in most cases (11/18). Among these 9/18 received lorazepam, 4/18 received alprazolam and 1/18 received clonazepam. Following benzodiazepine treatment, many patients required additional interventions such as electroconvulsive therapy (6/18), memantine (4/18), or amantadine (3/18). Overall, approximately 60 % of patients achieved full remission, whereas others showed only partial improvement.
Conclusions
Catatonic disorder due to another medical condition appears to present with diverse underlying causes and clinical manifestations. Although benzodiazepines are generally considered the first-line treatment, additional interventions were often needed. These findings underline the importance of clinical awareness and timely management, while further research is required to better understand prognostic factors and to guide treatment strategies.
{"title":"Clinical and etiological characteristics of catatonic disorder due to another medical condition: A retrospective study from a tertiary care center","authors":"Ali Tarık Altunç , Doğukan Hazar Emre , Ayşegül Gündüz , Burç Çağrı Poyraz","doi":"10.1016/j.clineuro.2025.109220","DOIUrl":"10.1016/j.clineuro.2025.109220","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of this study was to investigate the demographic, clinical, and etiological characteristics of patients diagnosed with catatonic disorder due to another medical condition.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 18 patients diagnosed with catatonic disorder due to another medical condition in a tertiary care center between 2017 and 2024. Patient demographics, underlying medical conditions, clinical features, and treatment methods were documented.</div></div><div><h3>Results</h3><div>Eighteen patients met the inclusion criteria. The most frequent underlying conditions were neurodegenerative diseases (6/18), autoimmune encephalitis (4/18), and the use of antipsychotic medications (5/18), often in the presence of comorbid neurological disorders. Commonly observed symptoms included mutism, negativism, and rigidity. Benzodiazepines were the initial treatment in most cases (11/18). Among these 9/18 received lorazepam, 4/18 received alprazolam and 1/18 received clonazepam. Following benzodiazepine treatment, many patients required additional interventions such as electroconvulsive therapy (6/18), memantine (4/18), or amantadine (3/18). Overall, approximately 60 % of patients achieved full remission, whereas others showed only partial improvement.</div></div><div><h3>Conclusions</h3><div>Catatonic disorder due to another medical condition appears to present with diverse underlying causes and clinical manifestations. Although benzodiazepines are generally considered the first-line treatment, additional interventions were often needed. These findings underline the importance of clinical awareness and timely management, while further research is required to better understand prognostic factors and to guide treatment strategies.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109220"},"PeriodicalIF":1.6,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145474554","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 : 2025-10-30DOI: 10.1016/j.clineuro.2025.109222
Maryam Zeinali , Farid Qoorchi Moheb Seraj , Clayton Rawson , Mohammed Azab , Michael Karsy
Introduction
Chordoma represents a central nervous system tumor with an incidence of 8.4 per 10 million individuals in the U.S. Current treatment options include surgical resection and radiotherapy. Despite recent studies demonstrating significant improvement in molecular understanding of disease, treatment options remain limited.
Objectives
To evaluate a database of high-throughput drug screening in conjunction with a systematic literature review of potential novel target sites.
Methods
A systematic review using terms "chordoma” AND “targeted therapy” OR “clinical trial” yielded 4560 articles, which were screened, and a total of 88 were included in the final analysis. Evaluation of the Chordoma Foundation high-throughput drug screening database was cross-referenced with published literature.
Results
Targeted therapies mostly involved receptor tyrosine kinase inhibitors. Cyclin-dependent kinase (CDK) inhibitors suppressed chordoma cell proliferation and brachyury expression in vitro and xenograft models. Epigenetic modulators showed therapeutic promise by altering chromatin states associated with brachyury overexpression. Genomic analyses showed recurrent alterations in TBXT, CDKN2A/B, PTEN, and chromatin remodeling genes such as SMARCB1 and PBRM1. Immunotherapeutic approaches had efficacy in preclinical models through PD-L1 blockade, NK, and CAR-T cell strategies. Vaccine-based therapies showed limited clinical benefit. RNA-based therapies represent emerging strategies that need more studies.
Conclusion
Biomarker-guided repurposing of therapies approved in other tumors remains the fastest path to redefining the treatment model, but chordoma rarity and low mutation burden limit the impact of genomics in target discovery. This analysis indicates several potential candidate drugs that may be rapidly deployable in a clinical trial setting.
{"title":"Systematic review of novel target therapies and clinical trials in chordoma","authors":"Maryam Zeinali , Farid Qoorchi Moheb Seraj , Clayton Rawson , Mohammed Azab , Michael Karsy","doi":"10.1016/j.clineuro.2025.109222","DOIUrl":"10.1016/j.clineuro.2025.109222","url":null,"abstract":"<div><h3>Introduction</h3><div>Chordoma represents a central nervous system tumor with an incidence of 8.4 per 10 million individuals in the U.S. Current treatment options include surgical resection and radiotherapy. Despite recent studies demonstrating significant improvement in molecular understanding of disease, treatment options remain limited.</div></div><div><h3>Objectives</h3><div>To evaluate a database of high-throughput drug screening in conjunction with a systematic literature review of potential novel target sites.</div></div><div><h3>Methods</h3><div>A systematic review using terms \"chordoma” AND “targeted therapy” OR “clinical trial” yielded 4560 articles, which were screened, and a total of 88 were included in the final analysis. Evaluation of the Chordoma Foundation high-throughput drug screening database was cross-referenced with published literature.</div></div><div><h3>Results</h3><div>Targeted therapies mostly involved receptor tyrosine kinase inhibitors. Cyclin-dependent kinase (CDK) inhibitors suppressed chordoma cell proliferation and brachyury expression in vitro and xenograft models. Epigenetic modulators showed therapeutic promise by altering chromatin states associated with brachyury overexpression. Genomic analyses showed recurrent alterations in TBXT, CDKN2A/B, PTEN, and chromatin remodeling genes such as SMARCB1 and PBRM1. Immunotherapeutic approaches had efficacy in preclinical models through PD-L1 blockade, NK, and CAR-T cell strategies. Vaccine-based therapies showed limited clinical benefit. RNA-based therapies represent emerging strategies that need more studies.</div></div><div><h3>Conclusion</h3><div>Biomarker-guided repurposing of therapies approved in other tumors remains the fastest path to redefining the treatment model, but chordoma rarity and low mutation burden limit the impact of genomics in target discovery. This analysis indicates several potential candidate drugs that may be rapidly deployable in a clinical trial setting.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109222"},"PeriodicalIF":1.6,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145430494","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 : 2025-10-29DOI: 10.1016/j.clineuro.2025.109219
Ali Ebada , Nicholas Bever , Ishav Y. Shukla , Jeffrey I. Traylor , Bingchun Wan , Robert D. Timmerman , Michael Dohopolski , Jill De Vis , Toral Patel , Ankur Patel , Samuel L. Barnett , Zabi Wardak , Tu Dan , Matthew Z. Sun
Introduction
Parasagittal meningiomas are challenging due to their proximity to the superior sagittal sinus and draining veins, often limiting gross total resection. Limited data exist on the efficacy of Gamma Knife Radiosurgery (GKSRS) in this progression-prone region. We evaluated the effectiveness of GKSRS in achieving tumor control.
Methods
A retrospective analysis was conducted at a single academic institution from 2015 to 2023, analyzing predictors of progression via univariable and multivariable Cox regression analyses.
Results
Thirty patients were included; 86.7 % underwent resection prior to GKSRS. At presentation, 47 % had primary and 53 % had recurrent tumors. Median tumor volume was 2.0 cm³ and diameter was 1.7 cm. Median follow-up was 33 months; mortality was 16.7 %. 80 % received single-fraction GKSRS; 20 % received five fractions. Median dose was 1500 cGy. At last follow-up, 80 % had local tumor control. One patient had pre-treatment edema; none developed post-treatment edema. Median progression-free survival (PFS) was 70.6 months. WHO grade I tumors had longer PFS than grade II/III (78.5 vs. 32.4 months, p = 0.011). Older age predicted progression on univariable (HR: 1.2, p = 0.028) and multivariable analysis (HR: 1.2, p = 0.036). Tumor volume, dose, extent of resection, and recurrence status were not significant predictors.
Conclusion
Our study provides evidence suggesting that GKSRS may be a safe and potentially effective treatment for select parasagittal meningiomas. The slightly lower control rate compared with other sites likely reflects the higher prevalence of WHO grade II tumors in this region. A nuanced interpretation of our findings, along with further multi-institutional validation, is necessary.
{"title":"Tumor control following gamma knife radiosurgery for parasagittal meningiomas: a single institution retrospective analysis","authors":"Ali Ebada , Nicholas Bever , Ishav Y. Shukla , Jeffrey I. Traylor , Bingchun Wan , Robert D. Timmerman , Michael Dohopolski , Jill De Vis , Toral Patel , Ankur Patel , Samuel L. Barnett , Zabi Wardak , Tu Dan , Matthew Z. Sun","doi":"10.1016/j.clineuro.2025.109219","DOIUrl":"10.1016/j.clineuro.2025.109219","url":null,"abstract":"<div><h3>Introduction</h3><div>Parasagittal meningiomas are challenging due to their proximity to the superior sagittal sinus and draining veins, often limiting gross total resection. Limited data exist on the efficacy of Gamma Knife Radiosurgery (GKSRS) in this progression-prone region. We evaluated the effectiveness of GKSRS in achieving tumor control.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted at a single academic institution from 2015 to 2023, analyzing predictors of progression via univariable and multivariable Cox regression analyses.</div></div><div><h3>Results</h3><div>Thirty patients were included; 86.7 % underwent resection prior to GKSRS. At presentation, 47 % had primary and 53 % had recurrent tumors. Median tumor volume was 2.0 cm³ and diameter was 1.7 cm. Median follow-up was 33 months; mortality was 16.7 %. 80 % received single-fraction GKSRS; 20 % received five fractions. Median dose was 1500 cGy. At last follow-up, 80 % had local tumor control. One patient had pre-treatment edema; none developed post-treatment edema. Median progression-free survival (PFS) was 70.6 months. WHO grade I tumors had longer PFS than grade II/III (78.5 vs. 32.4 months, p = 0.011). Older age predicted progression on univariable (HR: 1.2, p = 0.028) and multivariable analysis (HR: 1.2, p = 0.036). Tumor volume, dose, extent of resection, and recurrence status were not significant predictors.</div></div><div><h3>Conclusion</h3><div>Our study provides evidence suggesting that GKSRS may be a safe and potentially effective treatment for select parasagittal meningiomas. The slightly lower control rate compared with other sites likely reflects the higher prevalence of WHO grade II tumors in this region. A nuanced interpretation of our findings, along with further multi-institutional validation, is necessary.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109219"},"PeriodicalIF":1.6,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145413780","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}
Tremor-dominant Parkinson’s disease (td-PD) patients experience insufficient tremor relief following subthalamic nucleus (STN) deep brain stimulation (DBS). While ventral intermediate nucleus (VIM) DBS offers tremor benefit, it is generally less effective for broader motor symptoms. Recent advances, including DBS leads with more than four traditional contacts, are expected to enable stimulation of both targets. Although dual-targeting of STN and VIM has been reported via frontal or parietal approaches, no direct technical comparison exists between these strategies. This exploratory study aims to assess the feasibility of each approach and to compare the two approaches in the planning of DBS targeting both VIM and STN.
Methods
We analyzed 70 hemispheres with PD. Tentative targets for STN and VIM were established using direct and indirect methods. When the straight trajectory between the two targets (tentative trajectory, TT) intersected critical structures (e.g., ventricles, sulci, blood vessels), an adjusted trajectory was planned via either a frontal or parietal approach. STN was prioritized as the primary target, accepting deviations within 2 mm from the tentative STN (tSTN).
Results
All 70 TTs required adjustment to avoid critical structures. The mean distance from the adjusted STN target to tSTN was 1.63 mm (frontal) vs. 0.52 mm (parietal, p = 5.03 × 10⁻²⁷). The distance from the adjusted VIM target to the tentative VIM was 2.68 mm (frontal) vs. 1.53 mm (parietal, p = 2.32 × 10⁻²³).
Conclusions
Single-trajectory dual-target DBS is technically feasible via both approaches. The parietal approach yields significantly closer alignment with both tentative targets.
{"title":"An exploratory study on surgical planning of single trajectory deep brain stimulation of ventral intermediate nucleus and subthalamic nucleus","authors":"Kazuki Sakakura, Qianyi Pu, Nathan Pertsch, Sepehr Sani","doi":"10.1016/j.clineuro.2025.109213","DOIUrl":"10.1016/j.clineuro.2025.109213","url":null,"abstract":"<div><h3>Objective</h3><div>Tremor-dominant Parkinson’s disease (td-PD) patients experience insufficient tremor relief following subthalamic nucleus (STN) deep brain stimulation (DBS). While ventral intermediate nucleus (VIM) DBS offers tremor benefit, it is generally less effective for broader motor symptoms. Recent advances, including DBS leads with more than four traditional contacts, are expected to enable stimulation of both targets. Although dual-targeting of STN and VIM has been reported via frontal or parietal approaches, no direct technical comparison exists between these strategies. This exploratory study aims to assess the feasibility of each approach and to compare the two approaches in the planning of DBS targeting both VIM and STN.</div></div><div><h3>Methods</h3><div>We analyzed 70 hemispheres with PD. Tentative targets for STN and VIM were established using direct and indirect methods. When the straight trajectory between the two targets (tentative trajectory, TT) intersected critical structures (e.g., ventricles, sulci, blood vessels), an adjusted trajectory was planned via either a frontal or parietal approach. STN was prioritized as the primary target, accepting deviations within 2 mm from the tentative STN (tSTN).</div></div><div><h3>Results</h3><div>All 70 TTs required adjustment to avoid critical structures. The mean distance from the adjusted STN target to tSTN was 1.63 mm (frontal) vs. 0.52 mm (parietal, p = 5.03 × 10⁻²⁷). The distance from the adjusted VIM target to the tentative VIM was 2.68 mm (frontal) vs. 1.53 mm (parietal, p = 2.32 × 10⁻²³).</div></div><div><h3>Conclusions</h3><div>Single-trajectory dual-target DBS is technically feasible via both approaches. The parietal approach yields significantly closer alignment with both tentative targets.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109213"},"PeriodicalIF":1.6,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145413778","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 : 2025-10-26DOI: 10.1016/j.clineuro.2025.109215
Michelot Michel , Alan Nguyen , Shane Shahrestani , Edward Robinson , Andre E. Boyke , Simon A. Menaker , Keith L. Black , John S. Yu , Ray M. Chu
Objective
Navigated suction devices may enhance intraoperative efficiency and maximize safe resection of infiltrative gliomas by providing real-time anatomical guidance. However, their use and safety in high-grade glioma (HGG) surgery is unreported. We evaluated the safety and feasibility of a neuronavigation-integrated suction (NIS) device compared to conventional neuronavigation in patients undergoing resection for HGGs.
Methods
We utilized an NIS device in 33 HGG (WHO grade III/IV) resections. We retrospectively collected data on 174 HGG resections using standard neuronavigation during the same period, then performed propensity score matching (age, sex, prior treatment, tumor grade, tumor location, IDH status) to create 33 matched pairs (NIS vs. control, n = 66). Outcomes included extent of resection, operative time, estimated blood loss (EBL), complications, and length of stay (LOS).
Results
Baseline characteristics, including age (P = 0.299), sex (P = 0.319), tumor laterality (P = 0.196), anatomic location (P = 0.861), eloquent area (P = 0.769), tumor grade (P = 1.000), IDH mutation status (P = 0.415), prior resection (P = 0.602), and prior radiation therapy (P = 0.071), were comparable between groups. The NIS group had shorter operative times (193.7 ± 52.0 vs. 230.5 ± 69.2 min, P = 0.009). Intended GTR was more common with NIS (95 % vs. 65.2 %, P = 0.017). LOS was shorter in the NIS group (median 2.0 [1.75, 2.25] vs. 2.0 [1.5, 13.0] days, P = 0.030) with fewer postoperative complications (6.1 % vs. 30.3 %, P = 0.011). EBL (P = 0.418) and intraoperative complications (P = 0.314) were similar. Recurrence (57.6 %) and six-month mortality (21.2 %) were similar; there was no significant difference in median overall survival (control: 362 [110.5, 498.8] vs. NIS: 428 [177.5, 536] days, P = 0.237).
Conclusion
The NIS device was feasible to use in high-grade glioma surgery, and its use did not appear to compromise resection quality, complication rates, or oncologic outcomes. As neuronavigation and real-time intraoperative technologies advance, integrating such tools may further enhance surgical precision and patient outcomes for infiltrative gliomas. Future prospective, randomized studies should refine this technology and explore its broader impact on neurosurgical practice.
{"title":"Preliminary evaluation of a neuronavigation-integrated suction device for intracranial infiltrative high-grade glioma resection: A propensity score-matched analysis","authors":"Michelot Michel , Alan Nguyen , Shane Shahrestani , Edward Robinson , Andre E. Boyke , Simon A. Menaker , Keith L. Black , John S. Yu , Ray M. Chu","doi":"10.1016/j.clineuro.2025.109215","DOIUrl":"10.1016/j.clineuro.2025.109215","url":null,"abstract":"<div><h3>Objective</h3><div>Navigated suction devices may enhance intraoperative efficiency and maximize safe resection of infiltrative gliomas by providing real-time anatomical guidance. However, their use and safety in high-grade glioma (HGG) surgery is unreported. We evaluated the safety and feasibility of a neuronavigation-integrated suction (NIS) device compared to conventional neuronavigation in patients undergoing resection for HGGs.</div></div><div><h3>Methods</h3><div>We utilized an NIS device in 33 HGG (WHO grade III/IV) resections. We retrospectively collected data on 174 HGG resections using standard neuronavigation during the same period, then performed propensity score matching (age, sex, prior treatment, tumor grade, tumor location, IDH status) to create 33 matched pairs (NIS vs. control, n = 66). Outcomes included extent of resection, operative time, estimated blood loss (EBL), complications, and length of stay (LOS).</div></div><div><h3>Results</h3><div>Baseline characteristics, including age (P = 0.299), sex (P = 0.319), tumor laterality (P = 0.196), anatomic location (P = 0.861), eloquent area (P = 0.769), tumor grade (P = 1.000), IDH mutation status (P = 0.415), prior resection (P = 0.602), and prior radiation therapy (P = 0.071), were comparable between groups. The NIS group had shorter operative times (193.7 ± 52.0 vs. 230.5 ± 69.2 min, P = 0.009). Intended GTR was more common with NIS (95 % vs. 65.2 %, P = 0.017). LOS was shorter in the NIS group (median 2.0 [1.75, 2.25] vs. 2.0 [1.5, 13.0] days, P = 0.030) with fewer postoperative complications (6.1 % vs. 30.3 %, P = 0.011). EBL (P = 0.418) and intraoperative complications (P = 0.314) were similar. Recurrence (57.6 %) and six-month mortality (21.2 %) were similar; there was no significant difference in median overall survival (control: 362 [110.5, 498.8] vs. NIS: 428 [177.5, 536] days, P = 0.237).</div></div><div><h3>Conclusion</h3><div>The NIS device was feasible to use in high-grade glioma surgery, and its use did not appear to compromise resection quality, complication rates, or oncologic outcomes. As neuronavigation and real-time intraoperative technologies advance, integrating such tools may further enhance surgical precision and patient outcomes for infiltrative gliomas. Future prospective, randomized studies should refine this technology and explore its broader impact on neurosurgical practice.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109215"},"PeriodicalIF":1.6,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145399950","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 : 2025-10-26DOI: 10.1016/j.clineuro.2025.109218
Robert A. Riestenberg , Amir Goodarzi , Dylan Goodrich , Jared Clouse , Serena Ling , Mirna Lechpammer , Nina Schloemerkemper , Shuai Chen , Yichu Chen , Orin Bloch , Kiarash Shahlaie
Background and objectives
Glioblastoma (GBM) is the most common primary malignant brain tumor and is universally fatal. Human and laboratory studies have suggested lidocaine has anti-GBM efficacy. The objective of this study was to assess direct cytotoxicity as a possible mechanism of anti-GBM efficacy of lidocaine by quantifying the concentration of lidocaine in tumor tissue during resection.
Methods
Twelve patients with pathology-confirmed IDHwt GBM were included in this study. The study group received an intravenous bolus dose of 1.5 mg/kg IBW of lidocaine at induction of anesthesia followed by 2 mg/kg IBW/hr infusion. Craniotomy was performed in the standard fashion. Up to 3 fresh tumor specimens were collected hourly from each patient after confirmation of diagnosis by frozen section. Plasma samples were simultaneously collected. Lidocaine concentration was measured using mass spectroscopy. The maximum concentration of lidocaine (Cmax), time from bolus to maximum concentration (Tmax), and area under curve from 0 to 3 h (AUC) were calculated for each patient. Patients were followed for survival and adverse events.
Results
The median tumor specimen Cmax, Tmax, and AUC values were 333 ng/mL (range 226–555), 179 min (range 126–211), and 20,665 ng*min/mL (range 8003–55,426), respectively. Peak lidocaine concentration in tumor was reached in 6 of 11 cases (excluding one patient due to missing the 3rd sample). Median Cmax and Tmax for plasma samples were 1195 ng/mL (range 951–1475) and 191 min (range 156–211), respectively. Median overall survival was 308 days (95 % CI: 74–413). Two grade 3 adverse events occurred which were deemed to be unlikely related to the study intervention.
Conclusion
While lidocaine infiltrates tumor tissue when administered intravenously during GBM surgery, concentrations do not reach levels previously demonstrated to inhibit tumor growth in in vitro studies (roughly 2*108 ng/mL lidocaine). Alternative mechanisms may explain previously observed improved outcomes with lidocaine administration in human studies.
{"title":"Pharmacokinetics of lidocaine infusion during surgery for glioblastoma","authors":"Robert A. Riestenberg , Amir Goodarzi , Dylan Goodrich , Jared Clouse , Serena Ling , Mirna Lechpammer , Nina Schloemerkemper , Shuai Chen , Yichu Chen , Orin Bloch , Kiarash Shahlaie","doi":"10.1016/j.clineuro.2025.109218","DOIUrl":"10.1016/j.clineuro.2025.109218","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Glioblastoma (GBM) is the most common primary malignant brain tumor and is universally fatal. Human and laboratory studies have suggested lidocaine has anti-GBM efficacy. The objective of this study was to assess direct cytotoxicity as a possible mechanism of anti-GBM efficacy of lidocaine by quantifying the concentration of lidocaine in tumor tissue during resection.</div></div><div><h3>Methods</h3><div>Twelve patients with pathology-confirmed IDHwt GBM were included in this study. The study group received an intravenous bolus dose of 1.5 mg/kg IBW of lidocaine at induction of anesthesia followed by 2 mg/kg IBW/hr infusion. Craniotomy was performed in the standard fashion. Up to 3 fresh tumor specimens were collected hourly from each patient after confirmation of diagnosis by frozen section. Plasma samples were simultaneously collected. Lidocaine concentration was measured using mass spectroscopy. The maximum concentration of lidocaine (C<sub>max</sub>), time from bolus to maximum concentration (T<sub>max</sub>), and area under curve from 0 to 3 h (AUC) were calculated for each patient. Patients were followed for survival and adverse events.</div></div><div><h3>Results</h3><div>The median tumor specimen C<sub>max</sub>, T<sub>max</sub>, and AUC values were 333 ng/mL (range 226–555), 179 min (range 126–211), and 20,665 ng*min/mL (range 8003–55,426), respectively. Peak lidocaine concentration in tumor was reached in 6 of 11 cases (excluding one patient due to missing the 3rd sample). Median C<sub>max</sub> and T<sub>max</sub> for plasma samples were 1195 ng/mL (range 951–1475) and 191 min (range 156–211), respectively. Median overall survival was 308 days (95 % CI: 74–413). Two grade 3 adverse events occurred which were deemed to be unlikely related to the study intervention.</div></div><div><h3>Conclusion</h3><div>While lidocaine infiltrates tumor tissue when administered intravenously during GBM surgery, concentrations do not reach levels previously demonstrated to inhibit tumor growth in <em>in vitro</em> studies (roughly 2*10<sup>8</sup> ng/mL lidocaine). Alternative mechanisms may explain previously observed improved outcomes with lidocaine administration in human studies.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109218"},"PeriodicalIF":1.6,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145413710","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 : 2025-10-25DOI: 10.1016/j.clineuro.2025.109217
Dora R. Tabachnick , Samuel A. Tenhoeve , Clayton Rawson , Deondra Montgomery , Denise Baloi , Michael Karsy
Objective
Stroke remains a leading cause of morbidity and mortality in the United States, with hospital ownership potentially influencing patient outcomes. This study evaluated how government-owned (GO) versus private for-profit (PFP) hospitals affect the length of stay (LOS), in-hospital mortality, and discharge disposition of stroke patients.
Methods
This retrospective cohort study used National Inpatient Sample (NIS) data from 2019 to 2021 to identify patients with ischemic stroke affecting the internal carotid, middle cerebral, vertebral, or basilar arteries. Patients were stratified by hospital ownership type and differences in clinical characteristics and outcomes, including LOS, mortality, and discharge disposition, were analyzed. Multivariable regression models assessed the impact of hospital ownership on outcomes, adjusting for age, race, NIH Stroke Scale (NIHSS), functional status, and socioeconomic factors.
Results
A total of 116,280 stroke patients were included, with 59,755 (51.4 %) treated at GO hospitals and 56,525 (48.6 %) PFP hospitals. Multivariate analysis revealed a protective effect of PFP hospitals on mortality rates (OR 0.70, 95 % CI: 0.65–0.75, p < 0.001), and a shorter LOS (β = −0.33, 95 % CI: −0.47 to −0.19, p < 0.001) when controlling for disease severity via the NIHSS. Further, PFP hospitals had higher odds of discharge to a non-home disposition (OR 1.11, 95 % CI: 1.06–1.16, p < 0.001).
Conclusions
PFP hospitals were associated with shorter LOS and lower mortality rates among stroke patients, but also with a decreased likelihood of discharge to home. After adjusting for disease severity, these disparities persisted. Further research is needed to explore the mechanisms underlying these disparities in patient outcomes based on hospital ownership.
{"title":"The impact of hospital ownership on ischemic stroke outcomes: A National Inpatient Sample study","authors":"Dora R. Tabachnick , Samuel A. Tenhoeve , Clayton Rawson , Deondra Montgomery , Denise Baloi , Michael Karsy","doi":"10.1016/j.clineuro.2025.109217","DOIUrl":"10.1016/j.clineuro.2025.109217","url":null,"abstract":"<div><h3>Objective</h3><div>Stroke remains a leading cause of morbidity and mortality in the United States, with hospital ownership potentially influencing patient outcomes. This study evaluated how government-owned (GO) versus private for-profit (PFP) hospitals affect the length of stay (LOS), in-hospital mortality, and discharge disposition of stroke patients.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used National Inpatient Sample (NIS) data from 2019 to 2021 to identify patients with ischemic stroke affecting the internal carotid, middle cerebral, vertebral, or basilar arteries. Patients were stratified by hospital ownership type and differences in clinical characteristics and outcomes, including LOS, mortality, and discharge disposition, were analyzed. Multivariable regression models assessed the impact of hospital ownership on outcomes, adjusting for age, race, NIH Stroke Scale (NIHSS), functional status, and socioeconomic factors.</div></div><div><h3>Results</h3><div>A total of 116,280 stroke patients were included, with 59,755 (51.4 %) treated at GO hospitals and 56,525 (48.6 %) PFP hospitals. Multivariate analysis revealed a protective effect of PFP hospitals on mortality rates (OR 0.70, 95 % CI: 0.65–0.75, <em>p</em> < 0.001), and a shorter LOS (β = −0.33, 95 % CI: −0.47 to −0.19, <em>p</em> < 0.001) when controlling for disease severity via the NIHSS. Further, PFP hospitals had higher odds of discharge to a non-home disposition (OR 1.11, 95 % CI: 1.06–1.16, <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>PFP hospitals were associated with shorter LOS and lower mortality rates among stroke patients, but also with a decreased likelihood of discharge to home. After adjusting for disease severity, these disparities persisted. Further research is needed to explore the mechanisms underlying these disparities in patient outcomes based on hospital ownership.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109217"},"PeriodicalIF":1.6,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145413779","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}
Postoperative pneumocephalus after burr hole drainage for chronic subdural hematoma (CSDH) may delay brain re-expansion and worsen prognosis. This study assessed the "liquid–gas exchange" technique’s value in reducing intracranial air and promoting early brain re-expansion.
Method
A retrospective analysis included 147 CSDH patients who underwent single burr hole drainage (Jan 2021–Jul 2025). They were divided by intraoperative air evacuation: new technique group (n = 66) and conventional group (n = 81). Baseline characteristics (gender, age, medical history, antiplatelet/anticoagulant use, hematoma volume, bilaterality) were comparable (all P > 0.05). Surgical position, anesthesia type, postoperative pneumocephalus volume, symptomatic pneumocephalus, 1-week residual cavity volume, complications, and 3-month recurrence were compared.
Result
On postoperative day 1, pneumocephalus volume was lower in the new technique group (15.2 ± 8.1 mL vs. 32.5 ± 18.3 mL, P < 0.001). Tension pneumocephalus occurred in 12 conventional group cases (none in the new group, P = 0.003). At 1 week, residual cavity volume was smaller in the new group (24.5 ± 12.8 mL vs. 45.2 ± 18.5 mL, P < 0.001). Complications: 1 epilepsy case/group; no infections; 2 subdural bleeding cases (conventional group only, P = 0.643). At 3 months, 3 conventional group cases recurred (none in the new group, P = 0.115).
Conclusion
The "liquid–gas exchange" technique reduces postoperative pneumocephalus (especially symptomatic cases) and 1-week residual cavity volume, promoting early brain re-expansion and better prognosis, with high clinical value for wider use.
{"title":"Novel liquid-gas exchange technique to reduce postoperative pneumocephalus in chronic subdural hematoma","authors":"Li PingGen, X. Zheng, ZY Li, WJ Wu, WX Liu, GB Huang","doi":"10.1016/j.clineuro.2025.109216","DOIUrl":"10.1016/j.clineuro.2025.109216","url":null,"abstract":"<div><h3>Objective</h3><div>Postoperative pneumocephalus after burr hole drainage for chronic subdural hematoma (CSDH) may delay brain re-expansion and worsen prognosis. This study assessed the \"liquid–gas exchange\" technique’s value in reducing intracranial air and promoting early brain re-expansion.</div></div><div><h3>Method</h3><div>A retrospective analysis included 147 CSDH patients who underwent single burr hole drainage (Jan 2021–Jul 2025). They were divided by intraoperative air evacuation: new technique group (n = 66) and conventional group (n = 81). Baseline characteristics (gender, age, medical history, antiplatelet/anticoagulant use, hematoma volume, bilaterality) were comparable (all P > 0.05). Surgical position, anesthesia type, postoperative pneumocephalus volume, symptomatic pneumocephalus, 1-week residual cavity volume, complications, and 3-month recurrence were compared.</div></div><div><h3>Result</h3><div>On postoperative day 1, pneumocephalus volume was lower in the new technique group (15.2 ± 8.1 mL vs. 32.5 ± 18.3 mL, P < 0.001). Tension pneumocephalus occurred in 12 conventional group cases (none in the new group, P = 0.003). At 1 week, residual cavity volume was smaller in the new group (24.5 ± 12.8 mL vs. 45.2 ± 18.5 mL, P < 0.001). Complications: 1 epilepsy case/group; no infections; 2 subdural bleeding cases (conventional group only, P = 0.643). At 3 months, 3 conventional group cases recurred (none in the new group, P = 0.115).</div></div><div><h3>Conclusion</h3><div>The \"liquid–gas exchange\" technique reduces postoperative pneumocephalus (especially symptomatic cases) and 1-week residual cavity volume, promoting early brain re-expansion and better prognosis, with high clinical value for wider use.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109216"},"PeriodicalIF":1.6,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400009","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}
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