Clinical Neurology and Neurosurgery最新文献_第3页

Argatroban plus dual antiplatelet therapy: Preliminary evidence for managing early neurological deterioration after lacunar stroke

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-19 DOI: 10.1016/j.clineuro.2025.108786

Haiqi Zhang, Aijuan Ma, Hongna Ma, Wansheng Chang, Hui Liu, Jianfei Chen, Jijun Yin, Feng Lin, Zhangyong Xia

Background

This study aimed to evaluate the efficacy and safety of argatroban combined with dual antiplatelet therapy (DAPT) in managing early neurological deterioration (END) following stroke and to determine whether argatroban offers superior outcomes compared to DAPT alone.

Methods

Patients presenting with END after stroke between October 2022 and April 2024 were included and classified into two groups based on their treatment regimen during hospitalization: the argatroban group (argatroban + DAPT) and the control group (DAPT only). Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at admission and on days 7, 14, and 90 ± 7 post-stroke. Functional outcomes were evaluated using the modified Rankin Scale (mRS), with scores of 0–2 indicating favorable prognosis based on follow-up records. The argatroban group comprised 30 patients, while the control group included 50 patients.

Results

At 7 and 14 days post-treatment, The argatroban group demonstrated a statistically significant reduction in the NIHSS score compared to the control group (2.84 ± 1.32 vs. 3.56 ± 1.49, p = 0.024). Moreover, the reduction in NIHSS scores over the treatment period was significantly greater in the argatroban group than in the control group (p = 0.017). There were significant differences in the distribution of mRS scores at 90 ± 7 days between the two groups (χ² = 6.162, p = 0.041), although the proportion of favorable outcome with mRS = 0–2 did not reach statistically significance (70 % vs. 62 %; p = 0.47). Gingival bleeding occurred in one patient (3.33 %) in the argatroban group, whereas no cases of bleeding or complications such as gastrointestinal hemorrhage, cerebral hemorrhage, or hepatic/renal dysfunction were observed in either group during the treatment and follow-up period. Conclusions: Early administration of argatroban combined with DAPT was both safe and effective in improving clinical outcomes for patients with END after stroke. The argatroban group demonstrated superior efficacy compared to the control group.

{"title":"Argatroban plus dual antiplatelet therapy: Preliminary evidence for managing early neurological deterioration after lacunar stroke","authors":"Haiqi Zhang, Aijuan Ma, Hongna Ma, Wansheng Chang, Hui Liu, Jianfei Chen, Jijun Yin, Feng Lin, Zhangyong Xia","doi":"10.1016/j.clineuro.2025.108786","DOIUrl":"10.1016/j.clineuro.2025.108786","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the efficacy and safety of argatroban combined with dual antiplatelet therapy (DAPT) in managing early neurological deterioration (END) following stroke and to determine whether argatroban offers superior outcomes compared to DAPT alone.</div></div><div><h3>Methods</h3><div>Patients presenting with END after stroke between October 2022 and April 2024 were included and classified into two groups based on their treatment regimen during hospitalization: the argatroban group (argatroban + DAPT) and the control group (DAPT only). Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at admission and on days 7, 14, and 90 ± 7 post-stroke. Functional outcomes were evaluated using the modified Rankin Scale (mRS), with scores of 0–2 indicating favorable prognosis based on follow-up records. The argatroban group comprised 30 patients, while the control group included 50 patients.</div></div><div><h3>Results</h3><div>At 7 and 14 days post-treatment, The argatroban group demonstrated a statistically significant reduction in the NIHSS score compared to the control group (2.84 ± 1.32 vs. 3.56 ± 1.49, <em>p</em> = 0.024). Moreover, the reduction in NIHSS scores over the treatment period was significantly greater in the argatroban group than in the control group (<em>p</em> = 0.017). There were significant differences in the distribution of mRS scores at 90 ± 7 days between the two groups (χ<sup>2</sup> = 6.162, <em>p</em> = 0.041), although the proportion of favorable outcome with mRS = 0–2 did not reach statistically significance (70 % vs. 62 %; <em>p</em> = 0.47). Gingival bleeding occurred in one patient (3.33 %) in the argatroban group, whereas no cases of bleeding or complications such as gastrointestinal hemorrhage, cerebral hemorrhage, or hepatic/renal dysfunction were observed in either group during the treatment and follow-up period. <em>Conclusions</em>: Early administration of argatroban combined with DAPT was both safe and effective in improving clinical outcomes for patients with END after stroke. The argatroban group demonstrated superior efficacy compared to the control group.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108786"},"PeriodicalIF":1.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479848","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}

引用次数: 0

Corrigendum to "Correlation of pre-operative and post-operative retinal nerve fibre layer thickness with visual outcome following decompression of pituitary macroadenoma" [Clin. Neurol. Neurosurg. 244 (2024) 108446].

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-18 DOI: 10.1016/j.clineuro.2025.108765

Soumya S Nair, Arla Sai Varsha, Ajay Hegde, Bharath Raju, Raghavendra Nayak, Girish Menon, Sudha Menon

引用次数: 0

Predictors of poor functional outcome after endovascular treatment in patients with poor-grade aneurysmal subarachnoid hemorrhage

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-18 DOI: 10.1016/j.clineuro.2025.108792

Haiping Ling , Tao Tao , Wei Li , Zong Zhuang , Pengfei Ding , Shijie Na , Tao Liu , Qingrong Zhang , Chunhua Hang

Objective

Endovascular treatment (EVT) is considered an effective treatment for patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). Although the prognosis of these patients seems to have improved in recent years, it is generally still considered poor. We analyzed our data to determine potential predictors of poor prognosis in these patients.

Methods

We retrospectively analyzed data from patients with poor-grade aSAH who underwent EVT at our institution between November 2018 and June 2023. The data included patient baseline clinical characteristics, treatment modalities, imaging features, postoperative complications, and functional neurological outcomes. At six months, outcomes were assessed using the modified Rankin scale (mRS) and dichotomized into good (mRS 0–2) and poor (mRS 3–6) groups. Multivariate analysis was performed to identify predictors of outcome, and the discriminative ability of the model was assessed using the area under the receiver operating characteristic curve (ROC).

Results

The study included 117 poor-grade aSAH patients who underwent EVT. Fifty-eight (49.6 %) patients had poor outcomes. Univariate analysis suggested that older age (p = 0.003), higher Hunt–Hess (H-H) grade (15.3 % vs. 46.6 %, p < 0.001), posterior circulation aneurysms (15.3 % vs.31.0 %, p = 0.050)hydrocephalus (39.0 % vs. 63.8 %, p = 0.010), intraventricular hematoma (IVH) (69.5 % vs. 87.9 %, p = 0.023), ventricular casting (8.5 % vs. 43.1 %, p < 0.001), and external ventricular drainage (EVD) (44.1 % vs. 77.6 %, p < 0.001) were associated with poor outcomes. Multivariate analysis revealed that older age, higher H-H grade, and ventricular casting were predictors of poor outcomes with good discriminative ability (ROC=0.81, 95 % CI 0.73–0.89; p < 0.001).

Conclusions

Older age, higher H-H grade, and ventricular casting are associated with poor outcomes in patients with poor-grade aSAH. In this study, 50.4 % of patients achieved good outcomes, suggesting that early individualized treatment should be aggressively pursued for poor-grade aSAH patients to avoid rebleeding from ruptured aneurysms and potentially poor outcomes.

{"title":"Predictors of poor functional outcome after endovascular treatment in patients with poor-grade aneurysmal subarachnoid hemorrhage","authors":"Haiping Ling , Tao Tao , Wei Li , Zong Zhuang , Pengfei Ding , Shijie Na , Tao Liu , Qingrong Zhang , Chunhua Hang","doi":"10.1016/j.clineuro.2025.108792","DOIUrl":"10.1016/j.clineuro.2025.108792","url":null,"abstract":"<div><h3>Objective</h3><div>Endovascular treatment (EVT) is considered an effective treatment for patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). Although the prognosis of these patients seems to have improved in recent years, it is generally still considered poor. We analyzed our data to determine potential predictors of poor prognosis in these patients.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from patients with poor-grade aSAH who underwent EVT at our institution between November 2018 and June 2023. The data included patient baseline clinical characteristics, treatment modalities, imaging features, postoperative complications, and functional neurological outcomes. At six months, outcomes were assessed using the modified Rankin scale (mRS) and dichotomized into good (mRS 0–2) and poor (mRS 3–6) groups. Multivariate analysis was performed to identify predictors of outcome, and the discriminative ability of the model was assessed using the area under the receiver operating characteristic curve (ROC).</div></div><div><h3>Results</h3><div>The study included 117 poor-grade aSAH patients who underwent EVT. Fifty-eight (49.6 %) patients had poor outcomes. Univariate analysis suggested that older age (p = 0.003), higher Hunt–Hess (H-H) grade (15.3 % vs. 46.6 %, <em>p</em> < 0.001), posterior circulation aneurysms (15.3 % vs.31.0 %, <em>p</em> = 0.050)hydrocephalus (39.0 % vs. 63.8 %, <em>p</em> = 0.010), intraventricular hematoma (IVH) (69.5 % vs. 87.9 %, p = 0.023), ventricular casting (8.5 % vs. 43.1 %, <em>p</em> < 0.001), and external ventricular drainage (EVD) (44.1 % vs. 77.6 %, <em>p</em> < 0.001) were associated with poor outcomes. Multivariate analysis revealed that older age, higher H-H grade, and ventricular casting were predictors of poor outcomes with good discriminative ability (ROC=0.81, 95 % CI 0.73–0.89; p < 0.001).</div></div><div><h3>Conclusions</h3><div>Older age, higher H-H grade, and ventricular casting are associated with poor outcomes in patients with poor-grade aSAH. In this study, 50.4 % of patients achieved good outcomes, suggesting that early individualized treatment should be aggressively pursued for poor-grade aSAH patients to avoid rebleeding from ruptured aneurysms and potentially poor outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"251 ","pages":"Article 108792"},"PeriodicalIF":1.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intraoperative aneurysm flow analysis predicts intracranial large and giant aneurysm occlusion after flow diversion

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-17 DOI: 10.1016/j.clineuro.2025.108782

Yoshinari Osada , Hiroyuki Sakata , Masayuki Ezura , Kenichi Sato , Keisuke Sasaki , Shunsuke Omodaka , Atsushi Kanoke , Hiroki Uchida , Hidenori Endo

Objectives

Incompletely occluded flow-diverter (FD)-treated aneurysms are at risk of rupture and thromboembolic complications; however, intraoperative prediction of FD treatment outcomes has not yet been established. In this study, we investigated the association between intraoperative aneurysm flow analysis, using optical flow imaging, and FD treatment outcomes.

Materials and methods

This retrospective study included patients with large unruptured internal carotid artery aneurysms (≥ 10 mm) who underwent FD treatment. During the procedure, a flow analysis method using optical flow digital subtraction angiography (DSA) was used to measure the flow within the aneurysm sac by calculating the mean aneurysm flow amplitude (MAFA) before and after stent deployment. Occlusion was assessed using the O’Kelly-Marotta (OKM) grading scale on DSA 12 months after FD. The patients were divided into a nearly complete occlusion group (OKM grades C and D) and an incomplete occlusion group (OKM grades A and B).

Results

Eleven patients with 11 aneurysms (mean age, 67.5 [standard deviation, 8.3] years; 10 women, 88.9 %) were treated with FD. Nearly complete occlusion was observed in 6/11 (54.5 %) patients at 12-month follow-up imaging. The nearly complete occlusion group had significantly lower pre-MAFA and post-MAFA values than the incomplete occlusion group (P = 0.023 and P = 0.008, respectively). There was no difference in the MAFA ratio between the two groups (P = 0.315)

Conclusions

Aneurysm flow analysis before and after FD deployment is a simple and beneficial approach to predict treatment outcomes, which would indicate the need for intraoperative strategy changes, such as adding FD layers or intrasaccular coils.

{"title":"Intraoperative aneurysm flow analysis predicts intracranial large and giant aneurysm occlusion after flow diversion","authors":"Yoshinari Osada , Hiroyuki Sakata , Masayuki Ezura , Kenichi Sato , Keisuke Sasaki , Shunsuke Omodaka , Atsushi Kanoke , Hiroki Uchida , Hidenori Endo","doi":"10.1016/j.clineuro.2025.108782","DOIUrl":"10.1016/j.clineuro.2025.108782","url":null,"abstract":"<div><h3>Objectives</h3><div>Incompletely occluded flow-diverter (FD)-treated aneurysms are at risk of rupture and thromboembolic complications; however, intraoperative prediction of FD treatment outcomes has not yet been established. In this study, we investigated the association between intraoperative aneurysm flow analysis, using optical flow imaging, and FD treatment outcomes.</div></div><div><h3>Materials and methods</h3><div>This retrospective study included patients with large unruptured internal carotid artery aneurysms (≥ 10 mm) who underwent FD treatment. During the procedure, a flow analysis method using optical flow digital subtraction angiography (DSA) was used to measure the flow within the aneurysm sac by calculating the mean aneurysm flow amplitude (MAFA) before and after stent deployment. Occlusion was assessed using the O’Kelly-Marotta (OKM) grading scale on DSA 12 months after FD. The patients were divided into a nearly complete occlusion group (OKM grades C and D) and an incomplete occlusion group (OKM grades A and B).</div></div><div><h3>Results</h3><div>Eleven patients with 11 aneurysms (mean age, 67.5 [standard deviation, 8.3] years; 10 women, 88.9 %) were treated with FD. Nearly complete occlusion was observed in 6/11 (54.5 %) patients at 12-month follow-up imaging. The nearly complete occlusion group had significantly lower pre-MAFA and post-MAFA values than the incomplete occlusion group (<em>P</em> = 0.023 and <em>P</em> = 0.008, respectively). There was no difference in the MAFA ratio between the two groups (<em>P</em> = 0.315)</div></div><div><h3>Conclusions</h3><div>Aneurysm flow analysis before and after FD deployment is a simple and beneficial approach to predict treatment outcomes, which would indicate the need for intraoperative strategy changes, such as adding FD layers or intrasaccular coils.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108782"},"PeriodicalIF":1.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Autoantibody profile (MOG-IgG-positivity, AQP4-IgG-positivity, and double-seronegativity) as an outcome predictor after optic neuritis

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-17 DOI: 10.1016/j.clineuro.2025.108787

Laís Maria Gomes de Brito Ventura , Davi Solla , Guilherme Diogo Silva , Luana Salles , Douglas Sato , Samira Pereira , Dagoberto Callegaro

Background

Optic neuritis (ON) is the leading cause of optic neuropathy among young adults. Approximately 45 % of these patients have autoantibodies, and their possible clinical and prognostic implications have not been completely elucidated.

Objective

We aimed to assess the visual outcome and its predictors in a cohort of patients with optic neuritis as a clinically isolated syndrome according to their antibody profile: AQP4-IgG-positivity, MOG-IgG-positivity, and double-seronegativity (SN).

Methods and material

This cohort study used partial retrospective data collection from the neuroimmunology outpatient clinic of the University of São Paulo Hospital, including consecutive cases of isolated inflammatory ON. All samples were tested for MOG and AQP4 antibodies using in-house cell-based assays in live HEK-293 cells. This study was conducted following the STROBE guidelines.

Results

Forty-seven consecutive patients were included in this study. The number of patients with visual acuity (VA) worse than 20/200 during acute attacks was similar among the three groups. However, severe long-term disability (20/200) was less frequent in patients with MOG-IgG (AQP4-IgG group: 58 %, MOG-IgG group: 15 %, SN group: 54 %; p = 0.029). After adjusting for age and attack severity, MOG-IgG status was associated with a 30.9 % higher relative VA improvement (95 %CI 7.5 – 54.3 %, p = 0.011) than the other subgroups.

Conclusions

Severe visual acuity disability was less frequent in the MOG-IgG group than in the AQP4-IgG and SN groups. Positivity for these antibodies was the only predictor of long-term VA in patients with isolated ON (single or recurrent).

{"title":"Autoantibody profile (MOG-IgG-positivity, AQP4-IgG-positivity, and double-seronegativity) as an outcome predictor after optic neuritis","authors":"Laís Maria Gomes de Brito Ventura , Davi Solla , Guilherme Diogo Silva , Luana Salles , Douglas Sato , Samira Pereira , Dagoberto Callegaro","doi":"10.1016/j.clineuro.2025.108787","DOIUrl":"10.1016/j.clineuro.2025.108787","url":null,"abstract":"<div><h3>Background</h3><div>Optic neuritis (ON) is the leading cause of optic neuropathy among young adults. Approximately 45 % of these patients have autoantibodies, and their possible clinical and prognostic implications have not been completely elucidated.</div></div><div><h3>Objective</h3><div>We aimed to assess the visual outcome and its predictors in a cohort of patients with optic neuritis as a clinically isolated syndrome according to their antibody profile: AQP4-IgG-positivity, MOG-IgG-positivity, and double-seronegativity (SN).</div></div><div><h3>Methods and material</h3><div>This cohort study used partial retrospective data collection from the neuroimmunology outpatient clinic of the University of São Paulo Hospital, including consecutive cases of isolated inflammatory ON. All samples were tested for MOG and AQP4 antibodies using in-house cell-based assays in live HEK-293 cells. This study was conducted following the STROBE guidelines.</div></div><div><h3>Results</h3><div>Forty-seven consecutive patients were included in this study. The number of patients with visual acuity (VA) worse than 20/200 during acute attacks was similar among the three groups. However, severe long-term disability (20/200) was less frequent in patients with MOG-IgG (AQP4-IgG group: 58 %, MOG-IgG group: 15 %, SN group: 54 %; p = 0.029). After adjusting for age and attack severity, MOG-IgG status was associated with a 30.9 % higher relative VA improvement (95 %CI 7.5 – 54.3 %, p = 0.011) than the other subgroups.</div></div><div><h3>Conclusions</h3><div>Severe visual acuity disability was less frequent in the MOG-IgG group than in the AQP4-IgG and SN groups. Positivity for these antibodies was the only predictor of long-term VA in patients with isolated ON (single or recurrent).</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108787"},"PeriodicalIF":1.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of intradural abnormalities on symptoms and clinical outcomes in Chiari malformation

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-17 DOI: 10.1016/j.clineuro.2025.108788

Qi-Shuai Yu , Yi Wang , Guang-Yu Qiao , Xin-Guang Yu , Yi-Heng Yin

Purpose

This study aims to investigate the impact of intradural abnormalities on symptoms and clinical outcomes in Chiari malformation.

Methods

A retrospective study was conducted on 189 patients with Chiari malformation who underwent posterior fossa decompression with duraplasty or tonsillectomy. Intradural abnormalities were categorized as arachnoid abnormalities, foramen of Magendie (FoM) obstruction, and tonsillar abnormalities. Clinical outcomes were assessed using the symptoms improvements, Chicago Chiari Outcome Scale (CCOS), complications and re-operation.

Results

A total of 189 patients with Chiari malformation were included in the study. 79.4 % of the patients were female, with a mean age of 45.0 ± 10.7 years (range: 16–62 years). Common intradural abnormalities included arachnoid adhesions (68.3 %), obstruction of the foramen of Magendie (FoM) (50.3 %), and tonsillar hypertrophy (38.6 %). Obstruction of FoM was more frequently observed in patients with Valsalva provoked headaches (53.7 % vs. 12.8 %, p < 0.001), syringomyelia (93.7 % vs. 67.0 %, p < 0.001). CCOS scores (12.5 ± 2.3 vs. 13.3 ± 2.0, p = 0.027) and improved (53.7 % vs. 78.7 %, p = 0.001) were lower in the obstruction group. Tonsillar abnormalities were associated with higher incidence of Valsalva provoked headaches (61.6 % vs. 15.5 %, p < 0.001) and gait instability (43.8 % vs. 6.0 %, p < 0.001).

Conclusions

Intradural abnormalities, particularly obstruction of FoM and tonsillar abnormalities, are correlated with symptoms and clinical outcomes in Chiari malformation.

{"title":"Impact of intradural abnormalities on symptoms and clinical outcomes in Chiari malformation","authors":"Qi-Shuai Yu , Yi Wang , Guang-Yu Qiao , Xin-Guang Yu , Yi-Heng Yin","doi":"10.1016/j.clineuro.2025.108788","DOIUrl":"10.1016/j.clineuro.2025.108788","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to investigate the impact of intradural abnormalities on symptoms and clinical outcomes in Chiari malformation.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on 189 patients with Chiari malformation who underwent posterior fossa decompression with duraplasty or tonsillectomy. Intradural abnormalities were categorized as arachnoid abnormalities, foramen of Magendie (FoM) obstruction, and tonsillar abnormalities. Clinical outcomes were assessed using the symptoms improvements, Chicago Chiari Outcome Scale (CCOS), complications and re-operation.</div></div><div><h3>Results</h3><div>A total of 189 patients with Chiari malformation were included in the study. 79.4 % of the patients were female, with a mean age of 45.0 ± 10.7 years (range: 16–62 years). Common intradural abnormalities included arachnoid adhesions (68.3 %), obstruction of the foramen of Magendie (FoM) (50.3 %), and tonsillar hypertrophy (38.6 %). Obstruction of FoM was more frequently observed in patients with Valsalva provoked headaches (53.7 % vs. 12.8 %, p < 0.001), syringomyelia (93.7 % vs. 67.0 %, p < 0.001). CCOS scores (12.5 ± 2.3 vs. 13.3 ± 2.0, p = 0.027) and improved (53.7 % vs. 78.7 %, p = 0.001) were lower in the obstruction group. Tonsillar abnormalities were associated with higher incidence of Valsalva provoked headaches (61.6 % vs. 15.5 %, p < 0.001) and gait instability (43.8 % vs. 6.0 %, p < 0.001).</div></div><div><h3>Conclusions</h3><div>Intradural abnormalities, particularly obstruction of FoM and tonsillar abnormalities, are correlated with symptoms and clinical outcomes in Chiari malformation.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108788"},"PeriodicalIF":1.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A novel predictive model utilizing retinal microstructural features for estimating survival outcome in patients with glioblastoma

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-17 DOI: 10.1016/j.clineuro.2025.108790

Rebekah Smith , Ranjit Sapkota , Bhavna Antony , Jinger Sun , Orwa Aboud , Orin Bloch , Megan Daly , Ruben Fragoso , Glenn Yiu , Yin Allison Liu

Purpose

Glioblastoma is a highly aggressive brain tumor with poor prognosis despite surgery and chemoradiation. The visual sequelae of glioblastoma have not been well characterized. This study assessed visual outcomes in glioblastoma patients through neuro-ophthalmic exams, imaging of the retinal microstructures/microvasculature, and perimetry.

Methods

A total of 19 patients with glioblastoma (9 male, 10 female, average age at diagnosis 69 years) were enrolled. Tumor characteristic, neuro-ophthalmic exam data, Optical Coherence Tomography (OCT) and OCT-Angiography data of all patient eyes were analyzed using Microsoft Excel and a Machine Learning algorithm.

Results

Best-corrected visual acuity ranged from 20/20 – 20/50. Occipital tumors showed worse visual fields than frontal tumors (mean deviation −14.9 and −0.23, respectively, p < 0.0001). Those with overall survival (OS)< 15 months demonstrated thinner retinal nerve fiber layer and ganglion cell complex (p < 0.0001) and enlarged foveal avascular zone starting from 4 months post-diagnosis (p = 0.006). There was no significant difference between eyes ipsilateral and contralateral to radiation fields (average doses were 1370 cGy and 1180 cGy, respectively, p = 0.42). A machine learning algorithm using retinal microstructure and visual fields predicted patients with long (≥15 months) progression-free and overall survival with 78 % accuracy.

Conclusion

Glioblastoma patients frequently present with visual field defects despite normal visual acuity. Patients with poor survival duration demonstrated significant retinal thinning and decreased microvascular density. A machine learning algorithm predicted survival though further validation is warranted.

{"title":"A novel predictive model utilizing retinal microstructural features for estimating survival outcome in patients with glioblastoma","authors":"Rebekah Smith , Ranjit Sapkota , Bhavna Antony , Jinger Sun , Orwa Aboud , Orin Bloch , Megan Daly , Ruben Fragoso , Glenn Yiu , Yin Allison Liu","doi":"10.1016/j.clineuro.2025.108790","DOIUrl":"10.1016/j.clineuro.2025.108790","url":null,"abstract":"<div><h3>Purpose</h3><div>Glioblastoma is a highly aggressive brain tumor with poor prognosis despite surgery and chemoradiation. The visual sequelae of glioblastoma have not been well characterized. This study assessed visual outcomes in glioblastoma patients through neuro-ophthalmic exams, imaging of the retinal microstructures/microvasculature, and perimetry.</div></div><div><h3>Methods</h3><div>A total of 19 patients with glioblastoma (9 male, 10 female, average age at diagnosis 69 years) were enrolled. Tumor characteristic, neuro-ophthalmic exam data, Optical Coherence Tomography (OCT) and OCT-Angiography data of all patient eyes were analyzed using Microsoft Excel and a Machine Learning algorithm.</div></div><div><h3>Results</h3><div>Best-corrected visual acuity ranged from 20/20 – 20/50. Occipital tumors showed worse visual fields than frontal tumors (mean deviation −14.9 and −0.23, respectively, p < 0.0001). Those with overall survival (OS)< 15 months demonstrated thinner retinal nerve fiber layer and ganglion cell complex (p < 0.0001) and enlarged foveal avascular zone starting from 4 months post-diagnosis (p = 0.006). There was no significant difference between eyes ipsilateral and contralateral to radiation fields (average doses were 1370 cGy and 1180 cGy, respectively, p = 0.42). A machine learning algorithm using retinal microstructure and visual fields predicted patients with long (≥15 months) progression-free and overall survival with 78 % accuracy.</div></div><div><h3>Conclusion</h3><div>Glioblastoma patients frequently present with visual field defects despite normal visual acuity. Patients with poor survival duration demonstrated significant retinal thinning and decreased microvascular density. A machine learning algorithm predicted survival though further validation is warranted.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108790"},"PeriodicalIF":1.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463794","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}

引用次数: 0

Unilateral biportal endoscopic discectomy for lumbar disc herniation: Learning curve analysis with CUSUM analysis and clinical outcomes 单侧双侧内窥镜椎间盘切除术治疗腰椎间盘突出症：通过 CUSUM 分析和临床结果进行学习曲线分析

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-01 DOI: 10.1016/j.clineuro.2025.108755

Oğuz Kağan Demirtaş , Mehmet İlker Özer

Background

The evolution of spinal surgery has significantly benefited from advances in medical technology. From the introduction of the microscope to spinal surgery by Gazi Yaşargil in 1967 to Kambin's fully endoscopic series in the late 20th century, minimally invasive techniques have continually evolved. One of the latest developments, Unilateral Biportal Endoscopy (UBE), has gained popularity due to its effectiveness and the use of standard arthroscopic instruments, facilitating anatomical orientation for surgeons familiar with microsurgery. Despite its advantages, UBE presents challenges during the learning phase, necessitating a thorough understanding of its learning curve. This study aims to evaluate the learning curve of unilateral biportal endoscopic (UBE) discectomy for the treatment of lumbar disc herniation using CUSUM and risk-adjusted CUSUM (RA-CUSUM) analyses and to share the challenges encountered in the learning process and clinical outcomes.

Method

This retrospective study is based on data from patients treated between March 2022 and March 2023. The study included patients with lumbar disc herniation treated via UBE, excluding those with other spinal conditions or previous endoscopic fusions. Data collected included demographics, surgical details, and clinical outcomes, such as VAS, ODI scores, complication rate, recurrence rate, and MacNab criteria.

Results

117 patients (126 levels) were included, with a mean age of 46.02 years and a male predominance (62 %). The mean operation time was 77.93 minutes, with significant postoperative improvements in VAS and ODI scores. The overall complication rate was 10.3 %, with a recurrence rate of 5.1 %. CUSUM analysis indicated that the learning curve for UBE was completed after 43 cases, while RA-CUSUM suggested proficiency after 23 cases.

Conclusion

UBE discectomy is an effective minimally invasive technique with a learning curve. Using CUSUM and RA-CUSUM analyses, our study provides insights into the learning process and highlights the need for gradual case selection and surgical considerations to achieve proficiency. This technique is considered a promising alternative for surgeons looking to expand their spinal surgery spectrum.

{"title":"Unilateral biportal endoscopic discectomy for lumbar disc herniation: Learning curve analysis with CUSUM analysis and clinical outcomes","authors":"Oğuz Kağan Demirtaş , Mehmet İlker Özer","doi":"10.1016/j.clineuro.2025.108755","DOIUrl":"10.1016/j.clineuro.2025.108755","url":null,"abstract":"<div><h3>Background</h3><div>The evolution of spinal surgery has significantly benefited from advances in medical technology. From the introduction of the microscope to spinal surgery by Gazi Yaşargil in 1967 to Kambin's fully endoscopic series in the late 20th century, minimally invasive techniques have continually evolved. One of the latest developments, Unilateral Biportal Endoscopy (UBE), has gained popularity due to its effectiveness and the use of standard arthroscopic instruments, facilitating anatomical orientation for surgeons familiar with microsurgery. Despite its advantages, UBE presents challenges during the learning phase, necessitating a thorough understanding of its learning curve. This study aims to evaluate the learning curve of unilateral biportal endoscopic (UBE) discectomy for the treatment of lumbar disc herniation using CUSUM and risk-adjusted CUSUM (RA-CUSUM) analyses and to share the challenges encountered in the learning process and clinical outcomes.</div></div><div><h3>Method</h3><div>This retrospective study is based on data from patients treated between March 2022 and March 2023. The study included patients with lumbar disc herniation treated via UBE, excluding those with other spinal conditions or previous endoscopic fusions. Data collected included demographics, surgical details, and clinical outcomes, such as VAS, ODI scores, complication rate, recurrence rate, and MacNab criteria.</div></div><div><h3>Results</h3><div>117 patients (126 levels) were included, with a mean age of 46.02 years and a male predominance (62 %). The mean operation time was 77.93 minutes, with significant postoperative improvements in VAS and ODI scores. The overall complication rate was 10.3 %, with a recurrence rate of 5.1 %. CUSUM analysis indicated that the learning curve for UBE was completed after 43 cases, while RA-CUSUM suggested proficiency after 23 cases.</div></div><div><h3>Conclusion</h3><div>UBE discectomy is an effective minimally invasive technique with a learning curve. Using CUSUM and RA-CUSUM analyses, our study provides insights into the learning process and highlights the need for gradual case selection and surgical considerations to achieve proficiency. This technique is considered a promising alternative for surgeons looking to expand their spinal surgery spectrum.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108755"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143180749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ictal SPECT success rate using a single SPECT session protocol 使用单次 SPECT 会话方案的直肠 SPECT 成功率

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-01 DOI: 10.1016/j.clineuro.2025.108766

Zheng-Yang Lee , Kheng-Seang Lim , Si-Lei Fong , Kartini Rahmat , Khine Yee Mon , Chong-Tin Tan

Introduction

Ictal single-photon emission computed tomography (SPECT) provides additional information on the localisation of the epileptogenic zone. However, ictal SPECT is labour-intensive and expensive. We have developed a more affordable protocol with a single SPECT radiotracer session during a 48-hour video-EEG monitoring (VEM). This study aimed to determine the success rate of ictal SPECT with a single SPECT session (HMPAO or ECD).

Methods

This retrospective observational study included all VEM cases performed in the University Malaya Medical Centre, Kuala Lumpur, Malaysia from 1st January 2011 to 30th April 2024, with SPECT as part of the pre-surgical evaluation.

Results

A total of 189 cases were included. The mean age was 33.3 years old (range 9–68), and 105 (55.6 %) were male. The mean baseline seizure frequency before VEM was 21.8 per month. The mean number of seizures recorded during a 48-hour VEM was 10.9. A total of 44 (23.3 %) patients had ictal SPECT with a single SPECT session. Ictal SPECT was significantly associated with a higher number of seizures during 48-hour VEM (31.5 ± 58.7 vs 4.4 ± 6.3, p < 0.001) and younger age (29.9 ± 11.8 vs 34.2 ± 11.9, p < 0.05). On multivariate analysis, only the number of seizures during 48-hour VEM was a significant predictor for ictal SPECT (95 % CI, 1.03–1.12; odds ratio, 1.073; p = 0.002). Those with at least three seizures during VEM had a ≥ 30 % chance of having ictal SPECT and ≥ 40 % in those with six or more seizures.

Conclusion

A single SPECT session on day 3 of VEM can be a cost-effective option, particularly in those patients with multiple seizures in the first 48 hours of monitoring following a fast medication taper.

{"title":"Ictal SPECT success rate using a single SPECT session protocol","authors":"Zheng-Yang Lee , Kheng-Seang Lim , Si-Lei Fong , Kartini Rahmat , Khine Yee Mon , Chong-Tin Tan","doi":"10.1016/j.clineuro.2025.108766","DOIUrl":"10.1016/j.clineuro.2025.108766","url":null,"abstract":"<div><h3>Introduction</h3><div>Ictal single-photon emission computed tomography (SPECT) provides additional information on the localisation of the epileptogenic zone. However, ictal SPECT is labour-intensive and expensive. We have developed a more affordable protocol with a single SPECT radiotracer session during a 48-hour video-EEG monitoring (VEM). This study aimed to determine the success rate of ictal SPECT with a single SPECT session (HMPAO or ECD).</div></div><div><h3>Methods</h3><div>This retrospective observational study included all VEM cases performed in the University Malaya Medical Centre, Kuala Lumpur, Malaysia from 1st January 2011 to 30th April 2024, with SPECT as part of the pre-surgical evaluation.</div></div><div><h3>Results</h3><div>A total of 189 cases were included. The mean age was 33.3 years old (range 9–68), and 105 (55.6 %) were male. The mean baseline seizure frequency before VEM was 21.8 per month. The mean number of seizures recorded during a 48-hour VEM was 10.9. A total of 44 (23.3 %) patients had ictal SPECT with a single SPECT session. Ictal SPECT was significantly associated with a higher number of seizures during 48-hour VEM (31.5 ± 58.7 vs 4.4 ± 6.3, <em>p</em> < 0.001) and younger age (29.9 ± 11.8 vs 34.2 ± 11.9, <em>p</em> < 0.05). On multivariate analysis, only the number of seizures during 48-hour VEM was a significant predictor for ictal SPECT (95 % CI, 1.03–1.12; odds ratio, 1.073; <em>p</em> = 0.002). Those with at least three seizures during VEM had a ≥ 30 % chance of having ictal SPECT and ≥ 40 % in those with six or more seizures.</div></div><div><h3>Conclusion</h3><div>A single SPECT session on day 3 of VEM can be a cost-effective option, particularly in those patients with multiple seizures in the first 48 hours of monitoring following a fast medication taper.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108766"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association between vestibular evoked myogenic potentials and different dizziness status in Parkinson's disease: A controlled study 帕金森病患者前庭诱发肌源性电位与不同头晕状态的关系：一项对照研究。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-01 DOI: 10.1016/j.clineuro.2024.108711

Xingyue Li , Xiaoyan Du , Rui Zhao , Hongheng Du , Libo Zhao

Objective

This study compared ocular and cervical vestibular evoked myogenic potentials (oVEMP and cVEMP) among individuals with Parkinson's disease (PD) without dizziness, with nonspecific dizziness (dizziness without orthostatic hypotension), or with dizziness combined with orthostatic hypotension.

Materials and methods

We prospectively analyzed 30 of each of the three types of individuals who were admitted to Yongchuan Hospital of Chongqing Medical University (Chongqing, China) between June 2022 and April 2023. The three groups received oVEMP and cVEMP measurements using an electromyography-evoked potential system. For oVEMP, the N10 latency, P16 latency, and amplitude were compared between the three groups and the reference values. For cVEMP, the P13 latency, N23 latency, and amplitude were compared between the three groups and the reference values. Overall characteristics of oVEMP and cVEMP were also assessed using a previously published scoring scale originally developed for individuals with multiple sclerosis between the three groups included. The correlation between VEMP parameters (the latency and amplitude) and VEMP scores were simultaneously analyzed using Pearson’s bivariate correlation analysis.

Results

When compared with reference values, the oVEMP and cVEMP parameters of all three groups were found to be slightly different from the reference values. When the three groups included were compared with each other, in terms of oVEMP, the average amplitude in the left eye was significantly higher in those with nonspecific dizziness than in the other two groups. In terms of cVEMP, the average N23 latency on both the right and left sides of the neck and average amplitude on the right side of the neck were significantly higher in those with nonspecific dizziness than in the other two groups. Scores for oVEMP and cVEMP were also significantly higher for those with nonspecific dizziness than for the other two groups. There were no significant differences in oVEMP and cVEMP parameters, and scores for oVEMP and cVEMP between patients with dizziness combined with orthostatic hypotension and those without dizziness. In terms of correlation analysis, the N23 latency of left neck (r = 0.509, p < 0.001), the N23 latency of right neck (r = 0.495, p < 0.001), and the amplitude of right neck (r = 0.304, p = 0.004) correlated positively with cVEMP score.

Conclusions

Patients with PD without dizziness, with dizziness attributable to orthostatic hypotension, and with nonspecific dizziness may be all associated with vestibular dysfunction. The VEMP scores were highest in patients with nonspecific dizziness, so vestibular function is more severely affected in patients with nonspecific dizziness. The VEMP especially cVEMP may be useful for early diagnosis of nonspecific dizziness in PD.

目的：本研究比较无头晕、非特异性头晕（头晕无体位性低血压）、头晕合并体位性低血压的帕金森病患者眼部和颈部前庭诱发肌源性电位（oVEMP和cvpp）。材料与方法：对2022年6月至2023年4月重庆医科大学永川医院收治的三种类型患者各30例进行前瞻性分析。三组接受肌电诱发电位系统测量oVEMP和cemp。oVEMP的N10潜伏期、P16潜伏期、振幅与参考值比较。将cemp的P13潜伏期、N23潜伏期、振幅与参考值进行比较。oVEMP和cemp的总体特征也使用先前发表的评分量表进行评估，该评分量表最初是为三组间的多发性硬化症患者开发的。采用Pearson双变量相关分析，同时分析VEMP参数（潜伏期和振幅）与VEMP评分之间的相关性。结果：与参考值比较，三组患者的oVEMP和cemp参数均与参考值略有差异。当三组比较时，在oVEMP方面，非特异性头晕患者的左眼平均振幅明显高于其他两组。在cemp方面，非特异性头晕组的左右颈部平均N23潜伏期和右侧平均振幅均显著高于其他两组。非特异性头晕患者的oVEMP和cemp得分也明显高于其他两组。头晕合并体位性低血压患者与无头晕患者的oVEMP、cemp参数及oVEMP、cemp评分均无显著差异。相关性分析方面，左颈部N23潜伏期（r = 0.509,p ）结论：PD患者无头晕、体位性低血压所致头晕、非特异性头晕均可能与前庭功能障碍相关。非特异性头晕患者VEMP评分最高，说明非特异性头晕患者前庭功能受到的影响更为严重。VEMP尤其是cemp可能对PD非特异性头晕的早期诊断有用。

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引用次数: 0