Clinical Neurology and Neurosurgery最新文献_第4页

Clinical and radiographic outcomes after subduro-peritoneal shunt insertion in adults 成人腹膜下分流术后的临床和影像学结果。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108613

Tarik Alp Sargut , Emmanouil Verigos , David Wasilewski , Anton Früh , Ahmad Almahozi , Joan Alsolivany , Kiarash Ferdowssian , Simon Bayerl , Peter Vajkoczy , Judith Roesler

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.

背景：硬膜下积液主要包括脑脊液、炎性积液、出血性积液或感染性积液。虽然这些积液可通过保守或手术措施治疗，如钻孔抽液或开颅手术，但由于其复发率较高，临床医生可能会采用植入腹膜下分流术。虽然这种治疗方法在儿科人群中广泛使用，但其在成人中的疗效和安全性却鲜有报道：该项目是一项回顾性病例系列研究，共收集了 25 例在 2008 年 12 月至 2021 年 6 月间接受腹膜下分流术（SDPS）的成人患者。适应症包括外伤、肿瘤切除术或骨瓣再植术后出现的无症状硬膜下积液。一般情况下，均使用可调节瓣膜。所有患者都接受了术前和术后计算机断层扫描（CT）。我们评估了患者的术后临床疗效以及放射学标准，包括中线移位、额角宽度和收集体积。此外，我们还分析了与分流相关的并发症：结果：意识障碍是最常见的症状。我们报告称，SDP 分流术后硬膜下积液的体积和宽度明显缩小。此外，中线移位也明显减少。60%（15 人）的患者临床症状有所改善，只有 12%（3 人）的患者病情恶化。并发症包括12%的患者（3例）出现感染，1例患者出现瓣膜功能障碍：我们的研究表明，成人 SDPS 是消除或减少硬膜下积液的有效治疗方法，能改善大多数患者的临床疗效。因此，应该在这一患者群体中更广泛地使用。不过，还需要进一步的研究来验证这种治疗方法，并确定符合条件的患者。

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引用次数: 0

Real world experience with cladribine tablets in the management of relapsing multiple sclerosis in Qatar 卡塔尔使用克拉利宾片治疗复发性多发性硬化症的实际经验

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108615

Beatriz Garcia Cañibano , Lina Okar , Yahya Zakarya Baniamer , Dirk Deleu

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.

目的在真实世界环境中研究克拉利宾片（CladT）治疗复发性多发性硬化症（RMS）30 个月的安全性和有效性。方法在卡塔尔进行的单中心回顾性观察研究（2018 年 1 月至 2023 年 2 月）。结果纳入了46例患者（平均随访22个月）；34例（74%）为女性，22例（48%）为疾病修饰疗法（DMT）新患者，16例（35%）从平台DMT转入，8例（17%）从高效（HE）DMD转入。平均年龄为（26.7±7.2）岁，平均病程为（7.2±6.0）年。使用CladT治疗的常见原因是多发性硬化症活动（91%）、怀孕计划（17%）、AE（20%）、依从性（9%）。44/46（96%）人接受了第二年的CladT治疗。治疗后第 1-5 年的年复发率（ARR）分别从 1.02（基线）降至 0.1、0、0.1、0.1 和 0.1；87.5%-100% 的患者在这些时间内没有复发，而基线为 21%。第 2 年无复发；第 1-5 年分别有 78%、100%、84%、80% 和 100% 的患者无 GD+ MRI 病灶，基线时为 31%。大多数临床AE为轻度（1例中度，无重度AE）；12例感染Covid-19（无住院治疗）。结论在我们的回顾性研究中，无论之前是否接受过治疗，CladT似乎都是有效和安全的，这与其他支持早期使用CladT治疗RRMS的实际数据一致。

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引用次数: 0

Association of serum glucose/potassium index levels with poor long-term prognosis in patients with Aneurysmal Subarachnoid Hemorrhage 动脉瘤性蛛网膜下腔出血患者血清葡萄糖/钾指数水平与长期预后不良的关系。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108609

Claudia Cruzalegui-Bazán , Arturo Durán-Pecho , David Botello-Gonzales , José Luis Acha-Sánchez , Miguel Cabanillas-Lazo

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.

简介据报道，葡萄糖/钾指数（GPI）是动脉瘤性蛛网膜下腔出血（aSAH）患者院内并发症的预测生物标志物：目的：确定2018-2021年期间在秘鲁一家转诊医院确诊的动脉瘤性蛛网膜下腔出血患者出院后3-6个月GPI与功能预后之间的关联：我们利用二级数据库对秘鲁一家转诊医院 2018-2021 年期间的 aSAH 患者进行了一项回顾性队列观察研究。我们评估了 GPI 值与出院后 3 米至 6 个月的运动功能之间的关系，根据良好和不良结果的分类，使用了具有对数链接函数和稳健方差的泊松族广义线性模型。结果：212 名患者被纳入分析。在出院后 3 个月和 6 个月，分别有 21.1% 和 19.3% 的患者预后不佳。多变量分析显示，GPI 与出院后 3 个月（RR=0.999；95 %CI=0.979-1.018）或 6 个月（RR=0.979；95 %CI=0.979-1.020）的不良预后无关。另一方面，Splines 图显示 GPI 与修改后的 Rankin 之间没有相关性：结论：尽管 GPI 对预后院内并发症很有用，但其与功能预后的关系尚无定论。

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引用次数: 0

Endovascular Thrombectomy after 24 Hours for Patients with Acute Ischemic Stroke Due to Large Vessel Occlusion: A Systematic Review and Meta-Analysis of Outcomes 大血管闭塞导致急性缺血性卒中患者 24 小时后进行血管内血栓切除术：结果的系统回顾和荟萃分析。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108610

Muhammad Shakir , Hammad Atif Irshad , Bilal Ahmed Lodhi , Zuhaib Ali , Fizza Zubair , Muhammad Umar Mahar , Illiyun Banani , Amna Wajahat , Inamullah Khan , Farhan Siddiq , Adnan I. Qureshi

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.

目的评估血管内血栓切除术（EVT）在因大血管闭塞导致的急性缺血性卒中（AIS）晚期（>24 小时）患者中的作用：根据 PRISMA 指南，使用 PubMed、CINAHL、Scopus 和 Google Scholar 数据库（截至 2024 年）进行了一项系统性综述。采用纽卡斯尔-渥太华量表（NOS）进行质量评估。结果分析采用单臂荟萃分析（Sidik-Jonkman模型）和双臂荟萃分析（Mantel-Haenszel模型），比较24小时内和24小时后的EVT，并报告汇总风险比。分析使用 STATA 18.0 版和 Review Manager 5.4.1 版进行，并使用 pResults：本综述纳入了 35 项研究，共 15,086 名患者。与24小时内接受EVT治疗的患者相比，24小时后接受EVT治疗的患者出现症状性脑出血（sICH）的比例为4.78%（95% CI：3.20%-6.58%），风险比（RR）为0.85（95% CI：0.44-1.64）。功能独立（90 天 mRS 0-2）的汇总百分比为 35.73 %（95 % CI- 27.26 %，44.64 %），风险比为 0.85（95 % CI：0.34，2.09）。90天死亡率为22.30%（95% CI：16.12%，29.09%），风险比为1.08（95% CI：0.73，1.61）。24小时后接受EVT治疗的脑出血（ICH）总比例为12.23%（95% CI：5.47-20.86）：结论：24小时后接受EVT治疗的患者与24小时内接受治疗的患者具有相似的安全性和有效性。结果表明，24 小时后进行 EVT 是一种可行的治疗方案，与早期干预具有相似的益处。

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引用次数: 0

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? 血红蛋白、白蛋白、淋巴细胞和血小板（HALP）评分是预测接受机械血栓切除术的大脑中动脉梗塞患者死亡率的新型生物标志物吗？

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108598

Deniz Kamaci Sener , Cemile Haki , Suleyman Bekircavusoglu , Suat Kamisli , Kaya Sarac

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.

背景血红蛋白、白蛋白、淋巴细胞和血小板（HALP）评分是一种易于计算的参数，可显示全身炎症和营养状况。方法122例急性缺血性脑卒中（AIS）患者因大脑中动脉（MCA）M1闭塞接受了MT或MT和组织浆细胞酶原激活剂（tPA）治疗。研究人员计算了HALP评分，并对人口统计学数据、改良Rankin量表（mRS）评分和死亡状况进行了回顾性分析。使用接收者操作特征曲线（ROC）评估了 HALP 评分在预测 90 天内死亡率方面的有效性。HALP 的最佳临界值为 13.10。结果 HALP 评分为 13.10 会增加 90 天内死亡的风险，并与较高的大动脉血栓形成发生率相关。心肌栓塞和高脂血症在 HALP 分数较高（>13）的患者中更为常见。除 HALP 评分外，住院时间、24 小时美国国立卫生研究院卒中量表评分（NIHSS）、插管天数、急性生理评估和慢性健康评估（APACHE）II 评分以及症状到胃肠道时间也是 90 天内死亡率的显著危险因素。低 HALP 评分表明预后较差。因此，HALP 评分与存活率之间存在一定的关系。

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引用次数: 0

Factors affecting the collateral ingrowth from the superficial temporal artery after Encephalo-Duro-Arterio-Synangiosis in adult patients with Moyamoya disease 影响 Moyamoya 病成年患者颞浅动脉侧枝生长的因素。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108611

Felipe Ramirez-Velandia , Omar Alwakaa , Alejandro Enriquez-Marulanda , Aryan Wadhwa , Jean Filo , Kimberly Han , Samuel D. Pettersson , Thomas B. Fodor , Evan Paul McNeil , Michael Young , Sandeep Muram , Max Shutran , Philipp Taussky , Christopher S. Ogilvy

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。

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引用次数: 0

Intravenous versus oral tranexamic acid in elderly transforaminal lumbar interbody fusion patients: A prospective cohort study 经椎间孔腰椎融合术老年患者静脉注射与口服氨甲环酸的比较：前瞻性队列研究。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-21 DOI: 10.1016/j.clineuro.2024.108607

Xu Li , Yan Yin , Mohan Wen , Xiangjun Lu , Ru-Jie Qin , You Lv

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.

背景：氨甲环酸（TXA氨甲环酸（TXA）可有效减少术中失血和输血率。然而，在脊柱手术中，手术层次的数量会显著影响术中和术后出血，尤其是在老年人中，这也是围手术期输血率居高不下的原因之一。为了验证经椎间孔腰椎椎体间融合术（TLIF）老年患者应用 TXA 不同方法的安全性和有效性，我们开展了一项前瞻性队列研究：共有 958 名接受 TLIF 的患者被随机分配到术前 2 小时口服 2 克 TXA 或术前 30 分钟静脉注射 15 毫克/千克 TXA 或对照组。样本根据融合节段的数量进一步分为三类（一级融合、二级融合和三级融合）。主要结果是总失血量和输血率。次要结果包括术中失血量、术后失血量、引流量、拔除引流管前的时间、围手术期输血量、住院时间、血栓事件和其他不良事件：336名患者接受了静脉注射TXA，314名患者接受了口服TXA。两组患者的人口统计学因素相似。在一级融合手术队列中，三组患者在总失血量、输血率或引流量方面的差异无统计学意义（P > 0.05）。在两级和三级融合手术中，与对照组相比，使用 TXA 的患者围手术期出血量明显减少（P < 0.01）。有趣的是，静脉注射组和口服组的引流量存在明显差异（P = 0.026），特别是在两级和三级融合手术中：结论：对于接受 TLIF 手术的老年患者，静脉注射和口服 TXA 均安全有效。与静脉注射相比，口服 TXA 更经济、无创伤，有望用于临床。

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引用次数: 0

Predictors of survival after aneurysmal subarachnoid hemorrhage: The long-term observational cohort study 动脉瘤性蛛网膜下腔出血后存活的预测因素：长期观察队列研究

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-20 DOI: 10.1016/j.clineuro.2024.108605

Svenja Odensass , Meltem Gümüs , Maryam Said , Jan Rodemerk , Marvin Darkwah Oppong , Yan Li , Yahya Ahmadipour , Philipp Dammann , Karsten Henning Wrede , Ulrich Sure , Ramazan Jabbarli

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.

目的尽管近年来神经重症监护技术不断进步，但动脉瘤性蛛网膜下腔出血（SAH）患者的死亡率仍然相当高。在这项长期单中心观察性队列研究中，我们旨在分析 SAH 后死亡率的发生率、发生时间和预测因素。结果992例患者中有179例在初始治疗期间死亡，33例在随访期间死亡，总死亡率为21.4%。在超过 119 个测试变量中，我们在最终的多变量 Cox 回归分析中确定了以下独立预测因素：年龄 55 岁（p<0.0001）；世界神经外科学会联合会（WFNS）入院分级 IV 级或 V 级（p=0.025）；Hijdra 总分≥15 分（p=0.003）；颅内压（ICP）升高（p<0.0001）；延迟性脑缺血（DCI）（p<0.0001）。在中位生存期为 14 天的情况下，暴露于所有这五种风险因素的病例死亡率为 75%，而在中位生存期为 15-25 天的情况下，不存在这些特征的病例死亡率为 2.5%。在潜在的可预防不良事件中，初始治疗期间出现的 ICP 增高和 DCI 也对患者的长期随访生存具有重要的临床意义。进一步优化 ICP 和 DCI 管理可能有助于降低 SAH 后的死亡率。

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引用次数: 0

Predicting thenar motor branch anatomy for a safer carpal tunnel release 预测腕骨运动分支解剖结构，实现更安全的腕管松解术。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-19 DOI: 10.1016/j.clineuro.2024.108606

Ellie Moeller, Chloe C. Krasnoff, Brynn A. Hathaway, Srdjan Kamenko, Samantha Burch, Jourdan Carboy, Joel S. Solomon

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.

目的：正中神经腕运动支（TMB）的解剖变异使其在手掌中的位置更偏向尺侧，这可能会增加腕管松解术中对神经造成先天性损伤的风险。本研究探讨了正中神经桡侧运动支（TMB）尺侧起源的普遍性，并探讨了手术时掌侧固有肌的外观是否可以在观察 TMB 本身之前预测 TMB 的异常起源：方法：对接受腕管松解手术的患者进行前瞻性研究，记录TMB沿正中神经圆周的起始点，以及是否存在遮挡腕横韧带远端的内在肌肉：对 41 只手进行了评估。11只手（26.8%）显示有腕横肌。腕横肌最常见的来源是正中神经的桡侧神经（56.1%）。约 20% 的神经的 TMB 起源于其前中线附近。从统计学角度看，TMB的尺侧起源较多与腕横肌的存在有显著关系：本研究引入了一种新的分类系统，用于进一步定义 TMB 的解剖变异。当腕横肌缺失时，TMB极有可能起源于正中神经的桡侧。如果存在腕横肌，则 TMB 的起源难以预测，而且比通常所见的更有可能来自正中神经的尺侧。在这种情况下，应尝试在完成韧带分割之前确定 TMB。

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引用次数: 0

Profile of antiplatelet regimens for emergent carotid stenting in tandem occlusion. Systematic review and meta-analysis 串联闭塞情况下紧急颈动脉支架植入术的抗血小板方案简介。系统回顾和荟萃分析。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-19 DOI: 10.1016/j.clineuro.2024.108595

Gianluca De Rubeis , Luca Prosperini , Stefano Badia , Sebastiano Fabiano , Luca Bertaccini , Andrea Wlderk , Francesca Romana Pezzella , Valeria Caso , Luca Saba , Enrico Pampana

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.

目的：研究串联闭塞的脑卒中患者在接受机械血栓切除术（MT）后紧急进行颈动脉支架植入术的最佳抗血小板治疗方案（APTR）：在Pubmed/OVID/Cochran's CENTRAL数据库中对2015年至2022年的研究进行了文献检索。记录了患者特征、抗血小板方案类型、mTICI、90 天-mRS、急性支架内血栓形成（AIST）、死亡率、颅内出血（ICH）和样本量。排除标准为：非英语文献、样本量小于 5 例患者、接受过其他抗凝剂/抗血小板治疗、在一个研究臂中 100% 植入支架。研究采用 MINORS/GRADE 进行评估。采用随机效应模型进行了元分析和元回归。研究结果包括结果：共检索到 524 项研究。应用排除标准后，最终纳入 19/534 项研究（3.6%），涉及 880 名患者（每篇文章 46.3 名患者）。mRS的I^2和Q's Cochrane分别为86.4%和132.5，死亡的I^2和Q's Cochrane分别为19.9%和17.5，急性支架内血栓形成的I^2和Q's Cochrane分别为0%和9.4，颅内出血的I^2和Q's Cochrane分别为62.1%和39.7。阿司匹林亚组患者的功能独立率（mRS≤2）明显低于DAPT亚组患者（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）。与阿司匹林相比，DAPT能明显降低死亡率（8.6% [CI95 % 5.3 %-11.9 %] vs. 16.7 % [CI95 11.1 %-22.2 %]; p=0.0012）。抗 GPIIb/IIIa 与 DAPT 相比，有增加死亡率概率的趋势（OR 1.88[CI95 % 0.93-3.86]，P=0.08。在治疗组中，AIST 和 ICH 之间无明显差异：结论：DAPT可增加mRS评分≤2分的机会，并降低死亡率。

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引用次数: 0