Clinical Neurology and Neurosurgery最新文献

{"title":"Neurological deficit due to vasospasm after brain tumour resection: A single centre retrospective cohort","authors":"Luis Patricio Maskin,&nbsp;Néstor Wainsztein,&nbsp;Alejandro Hlavnicka,&nbsp;Vladimir Ortega,&nbsp;Federico Rodríguez Lucci","doi":"10.1016/j.clineuro.2025.108805","DOIUrl":"10.1016/j.clineuro.2025.108805","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Neurological deficit secondary to cerebral vasospasm following tumour resection is a rare yet significant complication that can lead to considerable morbidity and mortality. Pathophysiological mechanisms underlying postoperative vasospasm are complex and multifactorial It is an underdiagnosed entity, with severe consequences. The main objective of this study is to describe the characteristics of patients with vasospasm after tumour resection in a referral centre.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of consecutive patients who presented post-surgical vasospasm between January 2017 and May 2024 at single institution. The demographic data, tumour features, surgical characteristics, vasospasm diagnosis and management were collected.</div></div><div><h3>Results</h3><div>twenty-two patients were enrolled, median age was 41 years, and 41 % were female. The location most frequent of lesions was in the sellar/suprasellar space (73 %), and pituitary tumours were the most common pathology. The average time to develop vasospasm was 3 days and mostly was diagnosed using transcranial Doppler (86 %). Almost all patients had the anterior circulation affected (91 %). All patients had pharmacological and supportive treatment, and more than half needed nimodipine. Incomplete recovery after vasospasm was reported in 13 patients (59 %), and 3 patients (14 %) died. No association was seen between outcome and the probable causative factors.</div></div><div><h3>Conclusions</h3><div>Cerebral vasospasm due to tumour resection is a rare but challenging complication with remarkably high morbidity and mortality in reported cases. A high index of suspicion is required for early diagnosis and prompt management. It should be considered in post-surgical patients with neurological impairment without obvious cause.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108805"},"PeriodicalIF":1.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445770","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}

{"title":"Geriatric patients undergo surgery less and have worse survival outcomes with intramedullary ependymoma: A surveillance, epidemiology, and end results database analysis","authors":"Taylor Furst,&nbsp;Muhammad I. Jalal,&nbsp;Prasanth Romiyo,&nbsp;Suyash Sau,&nbsp;Jonathan Stone,&nbsp;Tyler Schmidt","doi":"10.1016/j.clineuro.2025.108807","DOIUrl":"10.1016/j.clineuro.2025.108807","url":null,"abstract":"<div><h3>Objective</h3><div>Intramedullary ependymomas account for ∼50 % of all primary tumors in the spinal cord. Though gross total resection has become mainstay, other predictors of survival remain poorly characterized. The present study aims to perform a survival analysis and compare prognostic factors across pediatric, adult and geriatric cohorts.</div></div><div><h3>Methods</h3><div>The Surveillance, Epidemiology, and End Results database was employed to isolate cases of intramedullary ependymomas from 2000 to 2021. Cases were grouped based on age: 0–19 years=pediatric, 20–64 years=adult, 65 + years=geriatric. Kaplan Meier followed by multivariate cox regression analyses were used to identify survival trends. Univariate comparison analyses compared age cohorts.</div></div><div><h3>Results</h3><div>2045 cases were included. Geriatric patients demonstrate increased risk of mortality (pediatric vs geriatric: HR=0.23, CI [0.13–0.39], p &lt; 0.001; adult vs geriatric: HR=0.18, CI [0.15–0.23], p &lt; 0.001). Compared to adult patients (92.7 %), geriatric patients (85.2 %) underwent significantly less surgery (p &lt; 0.001). Sex did not influence pediatric or geriatric survival nor did surgery statistically impact pediatric survival, but otherwise surgery not performed, male patients and grade III tumors significantly worsened overall and age-specific survival. Surgery performed in a pediatric patient led to a longer mean survival of 19.8 months, which is clinically relevant despite not meeting statistical significance. Year of diagnosis did not impact overall (p = 0.79) nor age-specific survival (pediatric: p = 0.98, adult: p = 0.91, geriatric: p = 0.11).</div></div><div><h3>Conclusions</h3><div>Geriatric patients suffer from worse survival than those of younger age. Surgery decreases mortality, yet less geriatric patients are receiving surgical resection. No significant survival gains have been made over the last two decades among any age. Further study is needed to optimize medical management to compliment surgical resection and surgery should be considered more often in geriatric patients to improve survival.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"250 ","pages":"Article 108807"},"PeriodicalIF":1.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454231","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}

{"title":"Argatroban plus dual antiplatelet therapy: Preliminary evidence for managing early neurological deterioration after lacunar stroke","authors":"Haiqi Zhang,&nbsp;Aijuan Ma,&nbsp;Hongna Ma,&nbsp;Wansheng Chang,&nbsp;Hui Liu,&nbsp;Jianfei Chen,&nbsp;Jijun Yin,&nbsp;Feng Lin,&nbsp;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 (χ² = 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}

{"title":"Predictors of poor functional outcome after endovascular treatment in patients with poor-grade aneurysmal subarachnoid hemorrhage","authors":"Haiping Ling ,&nbsp;Tao Tao ,&nbsp;Wei Li ,&nbsp;Zong Zhuang ,&nbsp;Pengfei Ding ,&nbsp;Shijie Na ,&nbsp;Tao Liu ,&nbsp;Qingrong Zhang ,&nbsp;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> &lt; 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> &lt; 0.001), and external ventricular drainage (EVD) (44.1 % vs. 77.6 %, <em>p</em> &lt; 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 &lt; 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}

{"title":"Intraoperative aneurysm flow analysis predicts intracranial large and giant aneurysm occlusion after flow diversion","authors":"Yoshinari Osada ,&nbsp;Hiroyuki Sakata ,&nbsp;Masayuki Ezura ,&nbsp;Kenichi Sato ,&nbsp;Keisuke Sasaki ,&nbsp;Shunsuke Omodaka ,&nbsp;Atsushi Kanoke ,&nbsp;Hiroki Uchida ,&nbsp;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}

{"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 ,&nbsp;Davi Solla ,&nbsp;Guilherme Diogo Silva ,&nbsp;Luana Salles ,&nbsp;Douglas Sato ,&nbsp;Samira Pereira ,&nbsp;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}

{"title":"Impact of intradural abnormalities on symptoms and clinical outcomes in Chiari malformation","authors":"Qi-Shuai Yu ,&nbsp;Yi Wang ,&nbsp;Guang-Yu Qiao ,&nbsp;Xin-Guang Yu ,&nbsp;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 &lt; 0.001), syringomyelia (93.7 % vs. 67.0 %, p &lt; 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 &lt; 0.001) and gait instability (43.8 % vs. 6.0 %, p &lt; 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}

{"title":"A novel predictive model utilizing retinal microstructural features for estimating survival outcome in patients with glioblastoma","authors":"Rebekah Smith ,&nbsp;Ranjit Sapkota ,&nbsp;Bhavna Antony ,&nbsp;Jinger Sun ,&nbsp;Orwa Aboud ,&nbsp;Orin Bloch ,&nbsp;Megan Daly ,&nbsp;Ruben Fragoso ,&nbsp;Glenn Yiu ,&nbsp;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 &lt; 0.0001). Those with overall survival (OS)&lt; 15 months demonstrated thinner retinal nerve fiber layer and ganglion cell complex (p &lt; 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}

{"title":"Unilateral biportal endoscopic discectomy for lumbar disc herniation: Learning curve analysis with CUSUM analysis and clinical outcomes","authors":"Oğuz Kağan Demirtaş ,&nbsp;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}

{"title":"Ictal SPECT success rate using a single SPECT session protocol","authors":"Zheng-Yang Lee ,&nbsp;Kheng-Seang Lim ,&nbsp;Si-Lei Fong ,&nbsp;Kartini Rahmat ,&nbsp;Khine Yee Mon ,&nbsp;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> &lt; 0.001) and younger age (29.9 ± 11.8 vs 34.2 ± 11.9, <em>p</em> &lt; 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}