Pub Date : 2024-10-22DOI: 10.1016/j.clineuro.2024.108609
Introduction
The glucose/potassium index (GPI) has been reported as a predictor biomarker of in-hospital complications in patients with aneurysmal subarachnoid hemorrhage (aSAH).
Objectives
To determine the association between GPI and functional outcome at 3 to 6 months after discharge in patients diagnosed with aSAH in a Peruvian referral hospital during 2018 - 2021.
Materials and Methods
We conducted a retrospective cohort observational study with a secondary database in patients with aSAH during 2018-2021 in a Peruvian referral hospital. We evaluated the relationship between GPI values and motor functionality from 3 to 6 months post-discharge, using a Poisson family generalized linear model with Log link function and robust variance according to categorization of good and poor outcome. We considered a value of p<0.05 as statistically significant. We used restricted cubic splines with five nodes to evaluate the linear correlation between the 2 main variables.
Results
212 patients were included in the analysis. 21.1% and 19.3% had poor outcome at 3 and 6 months after discharge, respectively. Multivariate analysis showed that GPI was not associated with poor outcome at 3 (RR=0.999; 95%CI=0.979-1.018) or 6 months after discharge (RR=0.979; 95%CI=0.979-1.020). On the other hand, Splines plots showed no correlation between GPI and modified Rankin.
Conclusions
Despite the usefulness of GPI to prognosticate in-hospital complications, its association with functional outcome is inconclusive.
{"title":"Association of serum glucose/potassium index levels with poor long-term prognosis in patients with Aneurysmal Subarachnoid Hemorrhage","authors":"","doi":"10.1016/j.clineuro.2024.108609","DOIUrl":"10.1016/j.clineuro.2024.108609","url":null,"abstract":"<div><h3>Introduction</h3><div>The glucose/potassium index (GPI) has been reported as a predictor biomarker of in-hospital complications in patients with aneurysmal subarachnoid hemorrhage (aSAH).</div></div><div><h3>Objectives</h3><div>To determine the association between GPI and functional outcome at 3 to 6 months after discharge in patients diagnosed with aSAH in a Peruvian referral hospital during 2018 - 2021.</div></div><div><h3>Materials and Methods</h3><div>We conducted a retrospective cohort observational study with a secondary database in patients with aSAH during 2018-2021 in a Peruvian referral hospital. We evaluated the relationship between GPI values and motor functionality from 3 to 6 months post-discharge, using a Poisson family generalized linear model with Log link function and robust variance according to categorization of good and poor outcome. We considered a value of p<0.05 as statistically significant. We used restricted cubic splines with five nodes to evaluate the linear correlation between the 2 main variables.</div></div><div><h3>Results</h3><div>212 patients were included in the analysis. 21.1% and 19.3% had poor outcome at 3 and 6 months after discharge, respectively. Multivariate analysis showed that GPI was not associated with poor outcome at 3 (RR=0.999; 95%CI=0.979-1.018) or 6 months after discharge (RR=0.979; 95%CI=0.979-1.020). On the other hand, Splines plots showed no correlation between GPI and modified Rankin.</div></div><div><h3>Conclusions</h3><div>Despite the usefulness of GPI to prognosticate in-hospital complications, its association with functional outcome is inconclusive.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496308","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 : 2024-10-22DOI: 10.1016/j.clineuro.2024.108613
Background
Subdural collections consist amongst others of cerebrospinal, inflammatory, haemorrhagic or infective fluid. While these accumulations can be treated with conservative or surgical measures, such as burr hole evacuation or craniotomy, clinicians may resort to implantation of a subduro-peritoneal shunt, due to their high recurrence rates. While this treatment option is widely used in the pediatric population, its efficacy and safety in adults is scarcely reported.
Methods
This project is a retrospective case series of 25 adult patients, who underwent subduro-peritoneal shunt (SDPS) implantation between December 2008 and June 2021. The indications included symptomatic subdural collections following trauma, tumor resection or bone flap reimplantation. In general, adjustable valves were used. All patients received a pre- and postoperative computed tomography (CT) scan. We evaluated patients’ postoperative clinical outcomes as well as radiographic criteria, including midline shift, frontal horn width and collection volume. Additionally, we analyzed shunt-related complications.
Results
Impaired consciousness was the commonest presenting symptom. We report a significant reduction in volume and width of the subdural collection after SDP shunt implantation. Furthermore, the midline shift decreased significantly. While 60 % (N=15) of the patients improved clinically, only 12 % (N=3) deteriorated. Complications comprised infection in 12 % (N=3) of patients and valve dysfunction in 1 patient.
Conclusions
Our study shows that SDPS in adults is an effective treatment to eliminate or reduce subdural collections, that improves clinical outcomes in the majority of patients. Hence, it should be utilised more widely in this patient population. However, further studies are necessary to validate the treatment and identify eligible patients.
{"title":"Clinical and radiographic outcomes after subduro-peritoneal shunt insertion in adults","authors":"","doi":"10.1016/j.clineuro.2024.108613","DOIUrl":"10.1016/j.clineuro.2024.108613","url":null,"abstract":"<div><h3>Background</h3><div>Subdural collections consist amongst others of cerebrospinal, inflammatory, haemorrhagic or infective fluid. While these accumulations can be treated with conservative or surgical measures, such as burr hole evacuation or craniotomy, clinicians may resort to implantation of a subduro-peritoneal shunt, due to their high recurrence rates. While this treatment option is widely used in the pediatric population, its efficacy and safety in adults is scarcely reported.</div></div><div><h3>Methods</h3><div>This project is a retrospective case series of 25 adult patients, who underwent subduro-peritoneal shunt (SDPS) implantation between December 2008 and June 2021. The indications included symptomatic subdural collections following trauma, tumor resection or bone flap reimplantation. In general, adjustable valves were used. All patients received a pre- and postoperative computed tomography (CT) scan. We evaluated patients’ postoperative clinical outcomes as well as radiographic criteria, including midline shift, frontal horn width and collection volume. Additionally, we analyzed shunt-related complications.</div></div><div><h3>Results</h3><div>Impaired consciousness was the commonest presenting symptom. We report a significant reduction in volume and width of the subdural collection after SDP shunt implantation. Furthermore, the midline shift decreased significantly. While 60 % (N=15) of the patients improved clinically, only 12 % (N=3) deteriorated. Complications comprised infection in 12 % (N=3) of patients and valve dysfunction in 1 patient.</div></div><div><h3>Conclusions</h3><div>Our study shows that SDPS in adults is an effective treatment to eliminate or reduce subdural collections, that improves clinical outcomes in the majority of patients. Hence, it should be utilised more widely in this patient population. However, further studies are necessary to validate the treatment and identify eligible patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1016/j.clineuro.2024.108615
Objectives
To study the 30-month safety and effectiveness of Cladribine tablets (CladT) in relapsing multiple sclerosis (RMS) months in a real-world setting.
Methods
Retrospective single-centre observational study in Qatar (January 2018–Feb 2023). Clinical and MRI data, lymphocyte counts and adverse events (AE) were recorded for patients with RMS who received at least one course of CladT.
Results
Forty-six patients were included (mean follow-up 22 months); 34 (74 %) were female, 22 (48 %) were disease-modifying therapy (DMT) naïve, 16 (35 %) had switched from platform DMT and 8 (17 %) from high efficacy (HE) DMD. Mean age was 26.7±7.2 y, mean disease duration was 7.2±6.0 y. Common reasons for treatment with CladT were MS activity (91 %), pregnancy planning (17 %), AE (20 %), compliance (9 %). 44/46 ( 96 %) received the year 2 course of CladT. Annualised relapse rate (ARR) fell from 1.02 (baseline) to 0.1, 0, 0.1, 0.1 and 0.1 for years 1–5 post-treatment, respectively; 87.5–100 % were free of relapses at these times, vs. 21 % at baseline. There were no relapses in year 2; 78 %, 100 %, 84 %, 80 % and 100 %, respectively, were free of GD+ MRI lesions at years 1–5, vs. 31 % at baseline. Most clinical AE were mild (1 moderate, no severe AE); 12 contracted Covid-19 (no hospitalisations). Grade 3 lymphopenia occurred in 5 patients.
Conclusions
CladT appeared to be effective and safe in our retrospective study, irrespective of prior treatments, consistent with other real world data that support the early use of CladT in the management of RRMS.
{"title":"Real world experience with cladribine tablets in the management of relapsing multiple sclerosis in Qatar","authors":"","doi":"10.1016/j.clineuro.2024.108615","DOIUrl":"10.1016/j.clineuro.2024.108615","url":null,"abstract":"<div><h3>Objectives</h3><div>To study the 30-month safety and effectiveness of Cladribine tablets (CladT) in relapsing multiple sclerosis (RMS) months in a real-world setting.</div></div><div><h3>Methods</h3><div>Retrospective single-centre observational study in Qatar (January 2018–Feb 2023). Clinical and MRI data, lymphocyte counts and adverse events (AE) were recorded for patients with RMS who received at least one course of CladT.</div></div><div><h3>Results</h3><div>Forty-six patients were included (mean follow-up 22 months); 34 (74 %) were female, 22 (48 %) were disease-modifying therapy (DMT) naïve, 16 (35 %) had switched from platform DMT and 8 (17 %) from high efficacy (HE) DMD. Mean age was 26.7±7.2 y, mean disease duration was 7.2±6.0 y. Common reasons for treatment with CladT were MS activity (91 %), pregnancy planning (17 %), AE (20 %), compliance (9 %). 44/46 ( 96 %) received the year 2 course of CladT. Annualised relapse rate (ARR) fell from 1.02 (baseline) to 0.1, 0, 0.1, 0.1 and 0.1 for years 1–5 post-treatment, respectively; 87.5–100 % were free of relapses at these times, vs. 21 % at baseline. There were no relapses in year 2; 78 %, 100 %, 84 %, 80 % and 100 %, respectively, were free of GD+ MRI lesions at years 1–5, vs. 31 % at baseline. Most clinical AE were mild (1 moderate, no severe AE); 12 contracted Covid-19 (no hospitalisations). Grade 3 lymphopenia occurred in 5 patients.</div></div><div><h3>Conclusions</h3><div>CladT appeared to be effective and safe in our retrospective study, irrespective of prior treatments, consistent with other real world data that support the early use of CladT in the management of RRMS.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1016/j.clineuro.2024.108610
Objective
To evaluate the role of endovascular thrombectomy in patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion in the very late window (>24 hours).
Methods
A systematic review was conducted according to PRISMA guidelines using PubMed, CINAHL, Scopus, and Google Scholar databases till 2024. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). Outcomes were analyzed with a single-arm meta-analysis (Sidik-Jonkman model) and a double-arm meta-analysis (Mantel-Haenszel model) to compare EVT within and after 24 hours, reporting pooled risk ratios. Analysis was performed using STATA version 18.0 and Review Manager version 5.4.1, with p<0.05 considered significant.
Results
This review included 35 studies with 15,086 patients. The frequency of symptomatic intracerebral hemorrhage (sICH) in patients treated with EVT after 24 hours was 4.74% (CI: 3.20%-6.58%), with a risk ratio (RR) of 0.85 (CI: 0.44-1.64) compared to EVT patients treated within 24 hours. The pooled percentage for functional independence (90 day mRS 0-2) was 35.73% (CI- 27.26%, 44.64%) with an overall pooled risk ratio of 0.85 (CI: 0.34, 2.09). The frequency of the 90-day mortality rate was 22.30% (CI: 16.12%, 29.09%), with an overall pooled risk ratio of 1.80(CI: 0.73, 1.61). The overall frequency of intracerebral hemorrhage (ICH) was 12.23% (CI: 5.47-20.86) following EVT after 24 hours.
Conclusion
Patients treated with EVT after 24 hours have comparable safety and effectiveness to those treated within 24 hours. The outcomes suggest that EVT after 24 hours is a viable treatment option, offering similar benefits to earlier intervention.
{"title":"Endovascular Thrombectomy after 24 Hours for Patients with Acute Ischemic Stroke Due to Large Vessel Occlusion: A Systematic Review and Meta-Analysis of Outcomes","authors":"","doi":"10.1016/j.clineuro.2024.108610","DOIUrl":"10.1016/j.clineuro.2024.108610","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the role of endovascular thrombectomy in patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion in the very late window (>24<!--> <!-->hours).</div></div><div><h3>Methods</h3><div>A systematic review was conducted according to PRISMA guidelines using PubMed, CINAHL, Scopus, and Google Scholar databases till 2024. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). Outcomes were analyzed with a single-arm meta-analysis (Sidik-Jonkman model) and a double-arm meta-analysis (Mantel-Haenszel model) to compare EVT within and after 24<!--> <!-->hours, reporting pooled risk ratios. Analysis was performed using STATA version 18.0 and Review Manager version 5.4.1, with p<0.05 considered significant.</div></div><div><h3>Results</h3><div>This review included 35 studies with 15,086 patients. The frequency of symptomatic intracerebral hemorrhage (sICH) in patients treated with EVT after 24<!--> <!-->hours was 4.74% (CI: 3.20%-6.58%), with a risk ratio (RR) of 0.85 (CI: 0.44-1.64) compared to EVT patients treated within 24<!--> <!-->hours. The pooled percentage for functional independence (90 day mRS 0-2) was 35.73% (CI- 27.26%, 44.64%) with an overall pooled risk ratio of 0.85 (CI: 0.34, 2.09). The frequency of the 90-day mortality rate was 22.30% (CI: 16.12%, 29.09%), with an overall pooled risk ratio of 1.80(CI: 0.73, 1.61). The overall frequency of intracerebral hemorrhage (ICH) was 12.23% (CI: 5.47-20.86) following EVT after 24<!--> <!-->hours.</div></div><div><h3>Conclusion</h3><div>Patients treated with EVT after 24<!--> <!-->hours have comparable safety and effectiveness to those treated within 24<!--> <!-->hours. The outcomes suggest that EVT after 24<!--> <!-->hours is a viable treatment option, offering similar benefits to earlier intervention.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496310","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 : 2024-10-22DOI: 10.1016/j.clineuro.2024.108598
Background
The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, easily calculated parameter, indicating systemic inflammation and nutritional status
Introduction
In this study, we used the HALP score in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT) to predict 90-day mortality.
Method
122 patients with AIS who underwent either MT or MT and tissue plasminogen activator (tPA) for middle cerebral artery (MCA) M1 occlusion. The HALP score was calculated, demographic data, modified Rankin Scale (mRS) score, and mortality status in retrospectively reviewed. The effectiveness of the HALP score in predicting mortality within 90 days was assessed using the receiver operating characteristic ( ROC) curves. The optimal cutoff value for HALP was 13.10.
Results
A HALP score <13.10 increased the risk of death within 90 days and was associated with a higher incidence of large artery thrombosis. Cardioembolism and hyperlipidemia were more common in patients with high (>13) HALP scores. In addition to the HALP score, the length of hospital stay, 24-h National Institutes of Health Stroke Scale score (NIHSS), number of days of intubation, acute physiologic assessment and chronic health evaluation (APACHE) II score, and symptom-to-groin time were statistically significant risk factors for mortality within 90 days.
Discussion
The HALP score is an easily calculated, inexpensive, and noninvasive parameter that can be used to predict mortality in patients with MCA M1 occlusion undergoing reperfusion therapy. Low HALP scores indicate a poor prognosis. Thus, there is a relationship between the HALP score and survival.
{"title":"Is the hemoglobin, albumin, lymphocyte, and platelet (HALP) score a novel biomarker for predicting mortality in patients with middle cerebral artery infarctions undergoing mechanical thrombectomy?","authors":"","doi":"10.1016/j.clineuro.2024.108598","DOIUrl":"10.1016/j.clineuro.2024.108598","url":null,"abstract":"<div><h3>Background</h3><div>The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, easily calculated parameter, indicating systemic inflammation and nutritional status</div></div><div><h3>Introduction</h3><div>In this study, we used the HALP score in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT) to predict 90-day mortality.</div></div><div><h3>Method</h3><div>122 patients with AIS who underwent either MT or MT and tissue plasminogen activator (tPA) for middle cerebral artery (MCA) M1 occlusion. The HALP score was calculated, demographic data, modified Rankin Scale (mRS) score, and mortality status in retrospectively reviewed. The effectiveness of the HALP score in predicting mortality within 90 days was assessed using the receiver operating characteristic ( ROC) curves. The optimal cutoff value for HALP was 13.10.</div></div><div><h3>Results</h3><div>A HALP score <13.10 increased the risk of death within 90 days and was associated with a higher incidence of large artery thrombosis. Cardioembolism and hyperlipidemia were more common in patients with high (>13) HALP scores. In addition to the HALP score, the length of hospital stay, 24-h National Institutes of Health Stroke Scale score (NIHSS), number of days of intubation, acute physiologic assessment and chronic health evaluation (APACHE) II score, and symptom-to-groin time were statistically significant risk factors for mortality within 90 days.</div></div><div><h3>Discussion</h3><div>The HALP score is an easily calculated, inexpensive, and noninvasive parameter that can be used to predict mortality in patients with MCA M1 occlusion undergoing reperfusion therapy. Low HALP scores indicate a poor prognosis. Thus, there is a relationship between the HALP score and survival.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539200","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 : 2024-10-22DOI: 10.1016/j.clineuro.2024.108611
Background
Multiple factors have been proposed to affect the vessel ingrowth from the superficial temporal artery (STA) after Encephalo-Duro-Arterio-Synangiosis (EDAS).
Methods
This retrospective single-center analyses included patients with Moyamoya Disease (MMD) undergoing EDAS from January 1st, 2013, to December 31st, 2023. Evaluated variables included demographic characteristics, clinical presentation, technical details, modified Rankin Scale (mRS) scores, and radiographic outcomes. Univariate and multivariate analysis was performed to identify factors favoring the ingrowth of collaterals from the STA.
Results
Forty adult patients with MMD, most commonly females (77.5 %) with a median age of 48, underwent 56 EDAS. The most common initial presentations were ischemic events (75.0 %), followed by hemorrhagic events (27.5 %) and seizures (7.5 %). Digital angiography performed at a median of 13.7 months post-procedure revealed collateral growth from the STA in 78.6 % of cases, with a Matsushima grade A identified in 35.7 % of the revascularized hemispheres. Univariate analysis showed more collaterals in patients with a larger preoperative STA diameter (p=0.035), higher Suzuki grades (p=0.021) and longer angiographic follow-ups (p=0.048). Patients with occlusion of the internal carotid artery (ICA; p<0.01), middle cerebral artery (MCA; p<0.01), or anterior cerebral artery (ACA; p<0.01) also had more collateral ingrowth. Multivariate analysis revealed that ICA occlusion (OR=6.54; 95 % CI=1.03–41.48) and ACA occlusion (OR=6.52; 95 % CI=1.02–41.67) as predictors of collateral ingrowth from the STA.
Conclusion
ICA and ACA occlusion were associated with success after EDAS. Longer follow-ups and larger STA demonstrated significant association on univariate analysis, but lost significance after adjusting for other procedural characteristics.
背景:有多种因素被认为会影响颞浅动脉(STA)血管在脑-室-动脉-同步血管形成术(EDAS)后的生长:这项回顾性单中心分析纳入了2013年1月1日至2023年12月31日期间接受EDAS治疗的Moyamoya病(MMD)患者。评估变量包括人口统计学特征、临床表现、技术细节、改良Rankin量表(mRS)评分和放射学结果。研究人员进行了单变量和多变量分析,以确定有利于STA络脉生长的因素:40名MMD成年患者接受了56次EDAS检查,其中女性患者居多(77.5%),中位年龄为48岁。最常见的首发症状是缺血性事件(75.0%),其次是出血性事件(27.5%)和癫痫发作(7.5%)。术后中位 13.7 个月时进行的数字血管造影显示,78.6% 的病例出现了 STA 侧支生长,35.7% 的血管再通半球达到了松岛 A 级。单变量分析显示,术前 STA 直径较大(P=0.035)、铃木分级较高(P=0.021)和血管造影随访时间较长(P=0.048)的患者侧支较多。颈内动脉(ICA;P结论:ICA和ACA闭塞患者的血管随访时间更长:ICA和ACA闭塞与EDAS术后的成功率有关。单变量分析显示,随访时间越长、STA越大的患者与EDAS的成功率越相关,但在调整了其他手术特征后,两者的相关性降低。
{"title":"Factors affecting the collateral ingrowth from the superficial temporal artery after Encephalo-Duro-Arterio-Synangiosis in adult patients with Moyamoya disease","authors":"","doi":"10.1016/j.clineuro.2024.108611","DOIUrl":"10.1016/j.clineuro.2024.108611","url":null,"abstract":"<div><h3>Background</h3><div>Multiple factors have been proposed to affect the vessel ingrowth from the superficial temporal artery (STA) after Encephalo-Duro-Arterio-Synangiosis (EDAS).</div></div><div><h3>Methods</h3><div>This retrospective single-center analyses included patients with Moyamoya Disease (MMD) undergoing EDAS from January 1st, 2013, to December 31st, 2023. Evaluated variables included demographic characteristics, clinical presentation, technical details, modified Rankin Scale (mRS) scores, and radiographic outcomes. Univariate and multivariate analysis was performed to identify factors favoring the ingrowth of collaterals from the STA.</div></div><div><h3>Results</h3><div>Forty adult patients with MMD, most commonly females (77.5 %) with a median age of 48, underwent 56 EDAS. The most common initial presentations were ischemic events (75.0 %), followed by hemorrhagic events (27.5 %) and seizures (7.5 %). Digital angiography performed at a median of 13.7 months post-procedure revealed collateral growth from the STA in 78.6 % of cases, with a Matsushima grade A identified in 35.7 % of the revascularized hemispheres. Univariate analysis showed more collaterals in patients with a larger preoperative STA diameter (p=0.035), higher Suzuki grades (p=0.021) and longer angiographic follow-ups (p=0.048). Patients with occlusion of the internal carotid artery (ICA; p<0.01), middle cerebral artery (MCA; p<0.01), or anterior cerebral artery (ACA; p<0.01) also had more collateral ingrowth. Multivariate analysis revealed that ICA occlusion (OR=6.54; 95 % CI=1.03–41.48) and ACA occlusion (OR=6.52; 95 % CI=1.02–41.67) as predictors of collateral ingrowth from the STA.</div></div><div><h3>Conclusion</h3><div>ICA and ACA occlusion were associated with success after EDAS. Longer follow-ups and larger STA demonstrated significant association on univariate analysis, but lost significance after adjusting for other procedural characteristics.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496304","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 : 2024-10-21DOI: 10.1016/j.clineuro.2024.108607
Background
Tranexamic acid (TXA) can effectively reduce intraoperative blood loss and transfusion rates. However, in spinal surgery, the number of surgical levels can significantly influence intraoperative and postoperative bleeding, particularly among the elderly, contributing to the persistently high rate of transfusion during the perioperative period. To verify the safety and efficacy of different application methods of TXA in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF), a prospective cohort study was conducted.
Methods
A total of 958 patients undergoing TLIF were randomly assigned to receive 2 g of oral TXA two hours before surgery or 15 mg/kg of intravenous TXA 30 min before surgery, or to a control group. The samples were further divided into three categories based on the number of fused segments (one-level fusion, two-level fusion, and three-level fusion). The primary outcomes were the total blood loss and transfusion rate. Secondary outcomes included intraoperative blood loss, postoperative blood loss, drainage volume, time until drain removal, perioperative transfusion volume, length of stay, thrombotic events, and other adverse events.
Results
336 patients received intravenous TXA and 314 patients were received oral TXA. Patient demographic factors were similar between groups. In the one-level fusion surgery cohort, comparisons across the three groups revealed no statistically significant disparities in total blood loss, transfusion rates, or drainage volumes (P > 0.05). In both two-level and three-level fusion surgeries, patients administered with TXA experienced a notably reduced perioperative bleeding compared to the control group (P < 0.01). Interestingly, a significant disparity was observed in the drainage volumes between the intravenous and oral administration groups (P = 0.026), specifically within the context of two and three-level fusion procedures.
Conclusion
In elderly patients undergoing TLIF surgery, both intravenous and oral administrations of TXA are safe and effective. Oral TXA, being more economical and non-invasive compared to intravenous injection, holds promise for clinical use.
{"title":"Intravenous versus oral tranexamic acid in elderly transforaminal lumbar interbody fusion patients: A prospective cohort study","authors":"","doi":"10.1016/j.clineuro.2024.108607","DOIUrl":"10.1016/j.clineuro.2024.108607","url":null,"abstract":"<div><h3>Background</h3><div>Tranexamic acid (TXA) can effectively reduce intraoperative blood loss and transfusion rates. However, in spinal surgery, the number of surgical levels can significantly influence intraoperative and postoperative bleeding, particularly among the elderly, contributing to the persistently high rate of transfusion during the perioperative period. To verify the safety and efficacy of different application methods of TXA in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF), a prospective cohort study was conducted.</div></div><div><h3>Methods</h3><div>A total of 958 patients undergoing TLIF were randomly assigned to receive 2 g of oral TXA two hours before surgery or 15 mg/kg of intravenous TXA 30 min before surgery, or to a control group. The samples were further divided into three categories based on the number of fused segments (one-level fusion, two-level fusion, and three-level fusion). The primary outcomes were the total blood loss and transfusion rate. Secondary outcomes included intraoperative blood loss, postoperative blood loss, drainage volume, time until drain removal, perioperative transfusion volume, length of stay, thrombotic events, and other adverse events.</div></div><div><h3>Results</h3><div>336 patients received intravenous TXA and 314 patients were received oral TXA. Patient demographic factors were similar between groups. In the one-level fusion surgery cohort, comparisons across the three groups revealed no statistically significant disparities in total blood loss, transfusion rates, or drainage volumes (<em>P</em> > 0.05). In both two-level and three-level fusion surgeries, patients administered with TXA experienced a notably reduced perioperative bleeding compared to the control group (<em>P</em> < 0.01). Interestingly, a significant disparity was observed in the drainage volumes between the intravenous and oral administration groups (<em>P</em> = 0.026), specifically within the context of two and three-level fusion procedures.</div></div><div><h3>Conclusion</h3><div>In elderly patients undergoing TLIF surgery, both intravenous and oral administrations of TXA are safe and effective. Oral TXA, being more economical and non-invasive compared to intravenous injection, holds promise for clinical use.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-20DOI: 10.1016/j.clineuro.2024.108605
Objective
Despite recent advances in neuro-intensive care, there is still considerable mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). In this long-term monocentric observational cohort study, we aimed to analyze the rates, timing, and predictors of mortality after SAH.
Methods
All consecutive SAH cases treated between January 2003 and June 2016 were included. Patients’ demographic characteristics, previous medical history, SAH-related parameters, and available post-treatment follow-up data were collected and evaluated as potential mortality predictors in univariate and multivariate analyses.
Results
Of 992 patients, 179 died during the initial treatment and 33 during the follow-up time reaching an overall mortality rate of 21.4 %. Of over 119 tested variables, we identified the following independent predictors in the final multivariate Cox regression analysis: age >55 years (p<0.0001); World Federation of Neurosurgical Societies (WFNS) admission grade IV or V (p=0.025); Hijdra sum score ≥15 points (p=0.003); intracranial pressure (ICP) increase (p<0.0001); and delayed cerebral ischemia (DCI) (p<0.0001). Being exposed to all five risk factors resulted in the case fatality rate of 75 % within a median survival of 14 days, compared to 2.5 % within a median of 1525 days when none of these features were present.
Conclusions
The initial impact of aneurysmal bleeding is amongst the major mortality causes after SAH. Of potentially preventable adverse events, ICP increase and DCI occurring during initial treatment also present eminent clinical relevance for patients’ survival in the long-term follow-up. Further ICP and DCI management optimization might help to decrease the mortality rate after SAH.
{"title":"Predictors of survival after aneurysmal subarachnoid hemorrhage: The long-term observational cohort study","authors":"","doi":"10.1016/j.clineuro.2024.108605","DOIUrl":"10.1016/j.clineuro.2024.108605","url":null,"abstract":"<div><h3>Objective</h3><div>Despite recent advances in neuro-intensive care, there is still considerable mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). In this long-term monocentric observational cohort study, we aimed to analyze the rates, timing, and predictors of mortality after SAH.</div></div><div><h3>Methods</h3><div>All consecutive SAH cases treated between January 2003 and June 2016 were included. Patients’ demographic characteristics, previous medical history, SAH-related parameters, and available post-treatment follow-up data were collected and evaluated as potential mortality predictors in univariate and multivariate analyses.</div></div><div><h3>Results</h3><div>Of 992 patients, 179 died during the initial treatment and 33 during the follow-up time reaching an overall mortality rate of 21.4 %. Of over 119 tested variables, we identified the following independent predictors in the final multivariate Cox regression analysis: age >55 years (p<0.0001); World Federation of Neurosurgical Societies (WFNS) admission grade IV or V (p=0.025); Hijdra sum score ≥15 points (p=0.003); intracranial pressure (ICP) increase (p<0.0001); and delayed cerebral ischemia (DCI) (p<0.0001). Being exposed to all five risk factors resulted in the case fatality rate of 75 % within a median survival of 14 days, compared to 2.5 % within a median of 1525 days when none of these features were present.</div></div><div><h3>Conclusions</h3><div>The initial impact of aneurysmal bleeding is amongst the major mortality causes after SAH. Of potentially preventable adverse events, ICP increase and DCI occurring during initial treatment also present eminent clinical relevance for patients’ survival in the long-term follow-up. Further ICP and DCI management optimization might help to decrease the mortality rate after SAH.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.clineuro.2024.108606
Purpose
Anatomic variations of the thenar motor branch of the median nerve (TMB) that place the nerve more ulnarly in the palm can increase the risk for iatrogenic injury to the nerve during carpal tunnel release. This study examines the prevalence of an origin of the TMB that is more ulnar than its typical branching from the radial aspect of the median nerve and explores whether the appearance of the palmar intrinsic muscles at surgery can predict an unusual TMB origin prior to visualizing the TMB itself.
Methods
A prospective study of patients undergoing carpal tunnel release surgery was undertaken to document the take-off point of the TMB along the circumference of the median nerve and the presence or absence of intrinsic muscle obscuring the distal transverse carpal ligament.
Results
Forty-one hands were evaluated. Eleven (26.8 %) demonstrated transverse carpal muscle. The most common origin of the TMB was from the radial aspect of the median nerve (56.1 %). In approximately 20 % of nerves, the TMB originated near its anterior midline. There was a statistically significant relationship between the TMB originating more ulnarly and the presence of transverse carpal muscle.
Conclusions
This study introduces a new classification system for further defining anatomic variations of the TMB. When transverse carpal muscle is absent, the TMB is highly likely to arise from the radial aspect of the median nerve. In the presence of transverse carpal muscle, the origin of the TMB is unpredictable and is significantly more likely to arise from the median nerve more ulnarly than is typically seen. Under these circumstances, attempts should be made to identify the TMB prior to completing ligament division.
{"title":"Predicting thenar motor branch anatomy for a safer carpal tunnel release","authors":"","doi":"10.1016/j.clineuro.2024.108606","DOIUrl":"10.1016/j.clineuro.2024.108606","url":null,"abstract":"<div><h3>Purpose</h3><div>Anatomic variations of the thenar motor branch of the median nerve (TMB) that place the nerve more ulnarly in the palm can increase the risk for iatrogenic injury to the nerve during carpal tunnel release. This study examines the prevalence of an origin of the TMB that is more ulnar than its typical branching from the radial aspect of the median nerve and explores whether the appearance of the palmar intrinsic muscles at surgery can predict an unusual TMB origin prior to visualizing the TMB itself.</div></div><div><h3>Methods</h3><div>A prospective study of patients undergoing carpal tunnel release surgery was undertaken to document the take-off point of the TMB along the circumference of the median nerve and the presence or absence of intrinsic muscle obscuring the distal transverse carpal ligament.</div></div><div><h3>Results</h3><div>Forty-one hands were evaluated. Eleven (26.8 %) demonstrated transverse carpal muscle. The most common origin of the TMB was from the radial aspect of the median nerve (56.1 %). In approximately 20 % of nerves, the TMB originated near its anterior midline. There was a statistically significant relationship between the TMB originating more ulnarly and the presence of transverse carpal muscle.</div></div><div><h3>Conclusions</h3><div>This study introduces a new classification system for further defining anatomic variations of the TMB. When transverse carpal muscle is absent, the TMB is highly likely to arise from the radial aspect of the median nerve. In the presence of transverse carpal muscle, the origin of the TMB is unpredictable and is significantly more likely to arise from the median nerve more ulnarly than is typically seen. Under these circumstances, attempts should be made to identify the TMB prior to completing ligament division.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.clineuro.2024.108595
Aim
To investigate the optimum antiplatelet therapy regimen (APTR) for emergent carotid artery stenting following mechanical thrombectomy (MT) in stroke patients with tandem occlusion.
Methods
A literature search was performed on Pubmed/OVID/Cochran's CENTRAL database for studies from 2015 to 2022. Patient characteristics, antiplatelet regimen type, mTICI, 90 days-mRS, acute in-stent thrombosis (AIST), mortality, intracranial hemorrhage (ICH), and sample size were recorded. Exclusion criteria were non-English literature, sample size < 5 patients, other anticoagulant/antiplatelet therapy, and 100 % stent insertion in one study arm. The studies were assessed using MINORS/GRADE. Meta-analysis and meta-regression with a random effects model were performed. The outcomes were: 90 days-mRS, death, AIST and ICH
Results
Five-hundred-twenty-four studies were retrieved. After applying the exclusion criteria, the final population included 19/534 studies (3.6 %) for 880 patients (46.3 per article). I^2 and Q’s Cochrane were 86.4 % and 132.5 for mRS, 19.9 % and 17.5 for death, 0 % and 9.4 for acute in-stent thrombosis and 62.1 % and 39.7 for intra-cranial haemorrhages, respectively.
Patients in the aspirin subgroup had a significantly lower rate of functional independence (mRS≤2) than those in the DAPT subgroup (47 % [CI95 % 42.0 %-52.0 %] vs. 61.9 % [CI95 % 50.8–72.9]; p=0.0007;OR 0.75[CI95 % 0.56–1.01], p=0.06). DAPT significantly decreased the death rate compared with aspirin (8.6 % [CI95 % 5.3 %-11.9 %] vs. 16.7 % [CI95 11.1 %-22.2 %]; p=0.0012). Anti-GPIIb/IIIa demonstrated a trend of increasing the probability of mortality versus DAPT (OR 1.88[CI95 % 0.93–3.86], p=0.08.
No significant differences were observed between AIST and ICH in the treatment groups.
Conclusion
DAPT may increases the chance of obtaining an mRS score ≤2 and reduces mortality.
{"title":"Profile of antiplatelet regimens for emergent carotid stenting in tandem occlusion. Systematic review and meta-analysis","authors":"","doi":"10.1016/j.clineuro.2024.108595","DOIUrl":"10.1016/j.clineuro.2024.108595","url":null,"abstract":"<div><h3>Aim</h3><div>To investigate the optimum antiplatelet therapy regimen (APTR) for emergent carotid artery stenting following mechanical thrombectomy (MT) in stroke patients with tandem occlusion.</div></div><div><h3>Methods</h3><div>A literature search was performed on Pubmed/OVID/Cochran's CENTRAL database for studies from 2015 to 2022. Patient characteristics, antiplatelet regimen type, mTICI, 90 days-mRS, acute in-stent thrombosis (AIST), mortality, intracranial hemorrhage (ICH), and sample size were recorded. Exclusion criteria were non-English literature, sample size < 5 patients, other anticoagulant/antiplatelet therapy, and 100 % stent insertion in one study arm. The studies were assessed using MINORS/GRADE. Meta-analysis and meta-regression with a random effects model were performed. The outcomes were: 90 days-mRS, death, AIST and ICH</div></div><div><h3>Results</h3><div>Five-hundred-twenty-four studies were retrieved. After applying the exclusion criteria, the final population included 19/534 studies (3.6 %) for 880 patients (46.3 per article). I^2 and Q’s Cochrane were 86.4 % and 132.5 for mRS, 19.9 % and 17.5 for death, 0 % and 9.4 for acute in-stent thrombosis and 62.1 % and 39.7 for intra-cranial haemorrhages, respectively.</div><div>Patients in the aspirin subgroup had a significantly lower rate of functional independence (mRS≤2) than those in the DAPT subgroup (47 % [CI95 % 42.0 %-52.0 %] vs. 61.9 % [CI95 % 50.8–72.9]; p=0.0007;OR 0.75[CI95 % 0.56–1.01], p=0.06). DAPT significantly decreased the death rate compared with aspirin (8.6 % [CI95 % 5.3 %-11.9 %] vs. 16.7 % [CI95 11.1 %-22.2 %]; p=0.0012). Anti-GPIIb/IIIa demonstrated a trend of increasing the probability of mortality versus DAPT (OR 1.88[CI95 % 0.93–3.86], p=0.08.</div><div>No significant differences were observed between AIST and ICH in the treatment groups.</div></div><div><h3>Conclusion</h3><div>DAPT may increases the chance of obtaining an mRS score ≤2 and reduces mortality.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496311","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}