Clinical Neurology and Neurosurgery最新文献

Objective: To determine the normal inter-uncinate distance (IUD) across subaxial disc spaces and compare that to the width dimensions of currently marketed cervical disc arthroplasty (CDA) devices.

Methods: Cervical spine CT scans from a convenience sample of 50 healthy patients (29 males, 21 females), aged 23-28 years, for negative trauma evaluations were utilized. The normative reference values on the SEP of subaxial vertebrae (C4-C7) were obtained by measuring the IUD across two different reference points: uncinate base (A1, A2, A3) and between the uncinate process tips (B1, B2, B3) on coronal reconstructions at three disc-space depths (anterior-1/3rd, ½-point, posterior-1/3rd).

Results: The mean-IUD at posterior-1/3rd-base (A3) was the limiting width at all levels, which only increased from 11.3 ± 2 mm at C4-13.4 ± 2.9 mm at C7. A1 and A2 were both greater than 14 mm in the majority at all levels; C4-50%, C5-56%, C6-72%, C7-90%; whereas A1 and A2 were rarely > 17 mm (most contacted CDA-width): C4-2%, C5-4%, C6-16%, 44%-C7. There was no statistically significant difference in mean-A3 at any of the levels (all p > 0.05), based on sex or BMI category.

Conclusion: IUD increases from cephalad to caudad and reduces from anterior to posterior at each level. For the vast majority (regardless of gender/BMI), the IUD is at least 14 mm, especially in the most commonly CDA-treated disc spaces (C5-6, C6-7), suggesting that 14 mm could serve as "one-width" for all CDAs, especially if the primary goal of the surgical technique is to significantly reduce the need for bony resection/burring to create a proper width-fit of the implant.

Background: Electrocardiographic (EKG) abnormalities are frequently observed in patients with acute ischemic stroke (AIS), yet their prognostic significance in patients treated with intravenous thrombolysis remains incompletely understood. While brain-heart interactions have been well described in intracerebral hemorrhage, fewer data exist regarding the impact of EKG abnormalities on functional outcomes after AIS.

Methods: We conducted a multicenter retrospective cohort study of consecutive AIS patients treated with intravenous thrombolytic therapy at Southern Illinois Healthcare (2017-2024) and the University of Oklahoma Health Sciences Center (2022-2024). Demographic characteristics, vascular risk factors, baseline modified Rankin Scale (mRS), stroke severity (NIHSS), treatment metrics, and EKG findings on admission were collected. Multivariable logistic regression models were constructed to evaluate the association between EKG abnormalities and in-hospital mortality, favorable functional outcome (mRS 0-2 at 30 days), and severe disability or death (mRS 5-6 at 30 days), adjusting for age, sex, vascular risk factors, baseline mRS, stroke severity, and thrombectomy. Statistical significance was set at p < 0.05.

Results: Among 473 thrombolysis-treated AIS patients, 307 (65%) demonstrated at least one EKG abnormality on admission. The most common abnormality was QTc prolongation (61%), followed by ectopic beats (26%), and atrial fibrillation/flutter (16%). Patients with EKG abnormalities were older, had higher baseline NIHSS scores, and more frequently had preexisting cardiac history (p < 0.05 for all). In adjusted analyses, atrial fibrillation/flutter on admission was independently associated with increased odds of in-hospital mortality (OR:2.37 95% CI: 1.13-5.59, p = 0.034) and reduced likelihood of favorable functional outcome (OR: 0.47 95%CI: 0.23-0.96, p = 0.038). No other EKG abnormality retained independent prognostic value after multivariable adjustment.

Conclusions: In AIS patients treated with thrombolytic therapy, admission EKG abnormalities are common and reflect a higher burden of systemic and neurological disease. Atrial fibrillation/flutter independently predicts worse functional outcomes and higher mortality, emphasizing its role as a poor prognostic marker in AIS.

Introduction: Spontaneous intracranial hypotension (SIH) is frequently caused by cerebrospinal fluid leak throughout dural tear in spinal nerve sheath which effects in disruption of intracranial homeostasis. We present a method of sealing that defect with epidural blood patch which is administrated via intervertebral foramen using computer tomography (CT) guidance to maximize the procedure accuracy.

Methods: The method involves sealing CSF fistulae in spinal nerve sheaths using route via intervertebral foramen under constant CT guidance with patient's own venous blood.

Results: Technique has been used in the group of 9 patients. Clinical symptoms for spontaneous intracranial hypotension ended up in all patients. Also, follow-up MRI scans performed at 1 months after procedure showed a normalization of radiological image.

Conclusion: Our study shows safe and effective way of sealing dural defects in spinal nerve sheath which was the cause of SIH.

Pre-injury antiplatelet therapy is common in traumatic brain injury (TBI) and may worsen outcomes after traumatic intracranial hemorrhage (tICH). Desmopressin (DDAVP) is used off-label to enhance platelet function, but evidence is mixed. To evaluate clinical outcomes after DDAVP for antiplatelet reversal in adults with tICH. We searched PubMed/MEDLINE, Embase, and Scopus (2000-2025). Eligible studies enrolled adults with TBI and acute tICH on aspirin and/or a P2Y12 inhibitor who received DDAVP and reported clinical outcomes. Of 57 records screened, 13 full texts were assessed, and 3 retrospective cohorts met our inclusion criteria. Heterogeneity in design, dosing/timing, and outcome definitions precluded from performing a meta-analysis.Three cohorts comprising a total of 5841 patients were included: a large multicenter registry comparing DDAVP, platelets, both, or no reversal; a two-center cohort comparing DDAVP+platelets vs no reversal; and a single-center mild-TBI cohort comparing DDAVP vs no DDAVP. In mild TBI, DDAVP was associated with lower hematoma expansion (adjusted OR ≈0.26). Across multicenter analyses, DDAVP conferred no mortality benefit; platelet transfusion ± DDAVP was associated with longer ICU/hospital length of stay and more complications than no reversal. Thrombotic events were infrequent and not clearly increased with DDAVP. Evidence for DDAVP in antiplatelet-associated tICH is limited and heterogeneous. A radiographic benefit with reduced hematoma expansion was seen in mild TBI, but consistent improvements in survival or functional outcomes were not found. Reviewed studies showed no clear advantage in platelets transfusion. Our review mostly found that TBI-specific randomized trials with standardized hematoma expansion definitions, prespecified repeat-CT windows, and safety monitoring are needed to definitively clarify the role of DDAVP in antiplatelet-associated tICH and to guide evidence-based clinical practice.

Background: The transradial approach (TRA) has been increasingly adopted in the neurointervention field owing to its advantages, including fewer puncture site complications and earlier ambulation. Although the right radial artery is conventionally used, the left TRA demonstrates clinical advantages in coronary intervention. However, the number of reports on the neurointervention using the left TRA remains limited, and its clinical utility has not been clearly established. We evaluated the efficacy of the left TRA in carotid artery stenting (CAS) using a Simmons guiding sheath (SGS).

Materials and methods: We retrospectively examined a prospective database of consecutive patients who underwent left TRA-CAS with a 6-French SGS between March 2022 and August 2025 at our institution. SGSs were formed within the aortic arch, using three novel techniques that we developed in this study. Subsequent outcome measures, including catheterization success, procedural outcomes, and procedure-related complications, were evaluated.

Results: Overall, 63 patients (31 right and 34 left carotid artery stenoses) underwent left TRA-CAS. The SGS was successfully formed and inserted into the intended common carotid artery in 63/65 (96.9%) procedures. In two cases, crossover was necessary because of significant radial artery spasm. All patients were successfully treated with favorable carotid lumen dilatation; none experienced major adverse events or radial artery occlusion.

Conclusion: Left TRA-CAS using the 6-French SGS was successfully performed with a high success rate and without serious complications, suggesting its effectiveness and safety.

Objectives: Inferior petrosal sinus sampling (IPSS) is important for confirming Cushing's Disease (CD). Due to lack of corticotropin releasing hormone (CRH) availability, desmopressin/DDAVP is being used as the alternative stimulating agent but has limited data regarding testing cutoffs.

Design: We compared the stimulation profiles of desmopressin and CRH in patients with CD.

Methods: Data from the multi-center Registry of Adenomas of the PItuitary and Related Disorders (RAPID) was evaluated. 93 patients with CD confirmed by pathology or biochemical remission that underwent IPSS testing prior to surgical resection (desmopressin [n = 57], CRH [n = 36] or both [n = 1]). IPSS stimulation using desmopressin or CRH according to individual institutions. Central:peripheral normalized adrenocorticotropin hormone (ACTH) ratio at baseline and post-stimulation were analyzed.

Results: No difference in demographic, surgical, or follow-up remission characteristics were seen between desmopressin or CRH patients. ACTH ratio increased earlier and were significantly higher after CRH stimulation at 2 min compared with desmopressin (130 ± 177.8 vs. 33.5 ± 45.0 pg/mL, p = 0.0002). ACTH ratio increased on average 6.3X after 2 min with CRH stimulation and 2.7X with either agent at 5 min. 72/93 (77%) patients showed > 2X ACTH ratio from baseline. A total of 51/57 (89%) and 33/36 (91.7%) of patients showed > 3X post-stimulation ACTH ratio with desmopressin or CRH, respectively.

Conclusions: CRH showed a more robust stimulation response than desmopressin for ACTH ratio during IPSS at 2 min but both agents showed similar effect at 5 min. Elevations of ACTH of 2.7X after desmopressin stimulation at 2-5 min may help identify sellar sources of ACTH.

Objective: to assess axillary nerve reinnervation when utilizing either a radial nerve branch to triceps muscle (RB) or through using the medial pectoral nerve (MP) as donors for patients with partial brachial plexus injuries.

Methods: We performed a retrospective study with 55 patients who received treatment for partial brachial plexus injuries. The patients were divided into RB (n = 29) or MP (n = 26) groups based on donor nerve used to reinnervate the axillary nerve. The shoulder abduction and its external rotation were assessed after a minimum of 18 months after surgery by using the Medical Research Council (MRC) scale for muscle strength and goniometer to measure range of motion. Outcomes were categorized into specific criteria (abduction ≥ 45°, external rotation ≥ 90°, and strength ≥ MRC grade 3). Statistical analysis included comparing variables using Student's t test or the Wilcoxon test and categorical variables using chi square test while logistic regression was used to study the impact of donor nerve on dichotomized outcomes.

Results: The findings showed that both groups were demographically comparable. Shoulder abduction strength ≥ 3 on the MRC scale was achieved in 75.9% of the RB group and 76.9% of the MP group, with median abduction angles of 55° and 45°, respectively (p > 0.4). The RB group exhibited higher external rotation strength and range (with median strength of 3 and median angle of 90°) compared to MP group (median strength of 1, and median angle of 10°; with p = 0.03 for both comparisons).The analysis with logistic regression showed that utilizing a radial nerve branch raised the chances of attaining a strength level ≥ 3 by 3 times (odds ratio 3.58) with a confidence interval ranging from 1;19-11;50; however it did not impact achieving external rotation ≥ 90°.

Conclusions: axillary nerve reinnervation with the radial nerve branch provides better external rotation strength and range of motion when compared with medial pectoral nerve transfer, while both approaches provide similar shoulder abduction results. The medial pectoral nerve should only be used when the radial nerve branch is unavailable as a donor.

Background: Accurate subthalamic nucleus (STN) targeting for deep brain stimulation depends on magnetic resonance imaging (MRI) geometric fidelity, yet the impact of MRI distortion correction on STN coordinates remains unclear. We evaluated whether CT-based MRI distortion correction systematically alters anatomically defined STN target coordinates.

Methods: This retrospective study included 30 adults with normal intracranial imaging who underwent 1-mm axial T2-weighted MRI and 1-mm brain CT within 2 days. MRI datasets were processed in BrainLab Elements to generate corrected and uncorrected image sets. Bilateral STN targets were independently identified on both datasets by two blinded raters using the intersection of the Bejjani line and the medial STN border. Analyses used per-patient means of bilateral measurements. The primary outcome was the three-dimensional Euclidean distance between corrected and uncorrected coordinates.

Results: Mean Euclidean distance was 1.655 ± 0.299 mm and exceeded the prespecified 1.0 mm threshold in all patients (30/30, 100%; p < 0.001). Absolute shifts were greatest along the lateral and anteroposterior axes, with mean |Δx| of 1.062 ± 0.274 mm, mean |Δy| of 1.013 ± 0.194 mm, and mean |Δz| of 0.732 ± 0.135 mm. Signed differences showed a consistent directional pattern, indicating lateral, posterior, and inferior displacement of uncorrected targets relative to corrected targets. Distortion was nonuniform across axes (Friedman χ² = 33.97, p < 0.001), with X ≈ Y > Z.

Conclusions: CT-based MRI distortion correction produced substantial, systematic shifts in STN target coordinates. Corrected and uncorrected workflows should not be considered interchangeable in STN deep brain stimulation planning.