Pub Date : 2024-10-03DOI: 10.1016/j.clineuro.2024.108580
Muhammad Shakir , Hammad Atif Irshad , Zayan Alidina , Taha Shaikh , Dahir Ashfaq , Zuhaib Ali , Sonia Pirzada , Adnan I. Qureshi , Ajith Thomas , Peter Kan , Farhan Siddiq
Objective
To compare outcomes of middle meningeal artery embolization (MMAE) alone versus combined with conventional surgery in the management of chronic subdural hematoma (cSDH).
Methods
A systematic literature search was performed on PubMed, Google Scholar, Scopus, and CINAHL, followed by a meta-analysis comparing recurrence rates, surgical rescue, mortality, in-hospital complications, and length of hospital stay was conducted. Mean differences and risk ratios were pooled using a random effects model, with subgroup analysis performed using Cochrane RevMan 5.4.1 software.
Results
A total of 23 studies including 302,168 patients (62.5 % male, 37.5 % female) were analyzed, with most studies published between 2017 and 2024. Among these patients, 299,195 (99.0 %) were treated with conventional surgery, whereas 3113 underwent MMAE. MMAE patients showed a significantly lower recurrence rate compared to conventional surgery, with a 0.35 times lower risk of recurrence (95 % CI: 0.24–0.51, p<0.01). However, adjunctive MMAE was associated with a longer hospital stay (SMD: 2.61 [95 % CI: 2.46–2.76], p<0.01), though MMAE alone had a shorter stay compared to adjunctive MMAE. Additionally, MMAE demonstrated a lower risk of surgical rescue (0.29 times, p<0.01). While no significant difference was found in-hospital complications (RR: 1.01, 95 % CI 0.90–1.14, p=0.84) and mortality rates (RR: 0.88, 95 % CI 0.69–1.14, p=0.34).
Conclusion
MMAE stand-alone or adjunctive with conventional surgery presents a promising alternative to conventional surgery alone for chronic subdural hematomas due to lower recurrence and surgical rescue risk. Further prospective studies are needed to study the efficacy of this new approach.
{"title":"Middle meningeal artery embolization alone versus combined with conventional surgery in the management of chronic subdural hematoma: A systematic review and meta-analysis","authors":"Muhammad Shakir , Hammad Atif Irshad , Zayan Alidina , Taha Shaikh , Dahir Ashfaq , Zuhaib Ali , Sonia Pirzada , Adnan I. Qureshi , Ajith Thomas , Peter Kan , Farhan Siddiq","doi":"10.1016/j.clineuro.2024.108580","DOIUrl":"10.1016/j.clineuro.2024.108580","url":null,"abstract":"<div><h3>Objective</h3><div>To compare outcomes of middle meningeal artery embolization (MMAE) alone versus combined with conventional surgery in the management of chronic subdural hematoma (cSDH).</div></div><div><h3>Methods</h3><div>A systematic literature search was performed on PubMed, Google Scholar, Scopus, and CINAHL, followed by a meta-analysis comparing recurrence rates, surgical rescue, mortality, in-hospital complications, and length of hospital stay was conducted. Mean differences and risk ratios were pooled using a random effects model, with subgroup analysis performed using Cochrane RevMan 5.4.1 software.</div></div><div><h3>Results</h3><div>A total of 23 studies including 302,168 patients (62.5 % male, 37.5 % female) were analyzed, with most studies published between 2017 and 2024. Among these patients, 299,195 (99.0 %) were treated with conventional surgery, whereas 3113 underwent MMAE. MMAE patients showed a significantly lower recurrence rate compared to conventional surgery, with a 0.35 times lower risk of recurrence (95 % CI: 0.24–0.51, p<0.01). However, adjunctive MMAE was associated with a longer hospital stay (SMD: 2.61 [95 % CI: 2.46–2.76], p<0.01), though MMAE alone had a shorter stay compared to adjunctive MMAE. Additionally, MMAE demonstrated a lower risk of surgical rescue (0.29 times, p<0.01). While no significant difference was found in-hospital complications (RR: 1.01, 95 % CI 0.90–1.14, <em>p</em>=0.84) and mortality rates (RR: 0.88, 95 % CI 0.69–1.14, <em>p</em>=0.34).</div></div><div><h3>Conclusion</h3><div>MMAE stand-alone or adjunctive with conventional surgery presents a promising alternative to conventional surgery alone for chronic subdural hematomas due to lower recurrence and surgical rescue risk. Further prospective studies are needed to study the efficacy of this new approach.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108580"},"PeriodicalIF":1.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-03DOI: 10.1016/j.clineuro.2024.108585
Amjad Almansi , Shahd Alqato , Mazen Negmeldin Aly Yassin , Lama Hossam Taher , Suhel.F. Batarseh , Abdulqadir J. Nashwan
Introduction
Recently, transradial access (TRA) for mechanical thrombectomy in acute ischemic stroke has been proposed as an alternative due to potential advantages such as reduced access site complications. However, its safety and efficacy compared to the traditional transfemoral access (TFA) remain debated.
Methods
We conducted a comprehensive search on PubMed, Scopus, Web of Science, Cochrane Library, and Embase from inception to May 15, 2024. We included all randomized controlled trials and observational studies. The primary outcome was successful recanalization, defined as achieving Thrombolysis in Cerebral Infarction (TICI) grades 2b–3. Secondary outcomes included complete recanalization (TICI grade 3), achieving TICI 2c or higher, functional outcomes (modified Rankin Score (mRS) at discharge and 90 days, mRS 0–2 at 90 days, National Institutes of Health Stroke Scale (NIHSS) at discharge, Length of hospital stay (LOS)), procedural efficiency (access-to-perfusion time, first-pass reperfusion, mean number of passes, crossover to alternate approach), and safety/survival outcomes (access site complications, symptomatic intracranial hemorrhage, in-hospital and 90-day mortality). This study was registered in PROSPERO (CRD42023462293).
Results
The meta-analysis included 13 studies with a combined total of 4759 patients. No statistically significant difference was found between TRA and TFA for successful recanalization (RR = 1.00 [95 % CI, 0.97–1.04], P = 0.88). Analysis also showed no significant difference in favorable functional outcomes between groups (RR = 0.88, [95 % CI, 0.71–1.09], P = 0.25) with significant heterogeneity (P = 0.008, I² = 71 %), which was resolved by excluding the study of Phillips et al., 2020 (P = 0.58, I² = 0 %), then favoring TFA over TRA (RR = 0.80, [95 % CI, 0.70–0.92], P = 0.002). TFA also had a statistically significant lower risk of crossover to TRA (RR = 1.68, [95 % CI, 0.99–2.86], P = 0.05). Overall, TRA was associated with a significantly shorter length of stay (MD = −1.49, 95 % CI [-2.93 to −0.05], P = 0.04, I² = 75 %), though sensitivity analysis showed a non-significant mean difference still favoring TRA (MD = −0.59; 95 % CI: [-1.28 to −0.10], P = 0.09, I² = 0 %). There was no difference between TRA and TFA regarding complete recanalization, achieving TICI 2c or higher, procedural efficiency, functional outcomes, safety, and survival.
Conclusion
Our updated meta-analysis demonstrates that TRA is comparable to TFA, except for a higher proportion of patients achieving mRS 0–2 at 90 days with TFA, lower crossover rates with TFA, and possibly a shorter length of stay (LOS) with TRA. Further research, particularly randomized studies, is needed to confirm these findings due to the observational nature of included studies.
{"title":"Transradial versus transfemoral artery access in mechanical thrombectomy for acute ischemic stroke: An updated systematic review and meta-analysis","authors":"Amjad Almansi , Shahd Alqato , Mazen Negmeldin Aly Yassin , Lama Hossam Taher , Suhel.F. Batarseh , Abdulqadir J. Nashwan","doi":"10.1016/j.clineuro.2024.108585","DOIUrl":"10.1016/j.clineuro.2024.108585","url":null,"abstract":"<div><h3>Introduction</h3><div>Recently, transradial access (TRA) for mechanical thrombectomy in acute ischemic stroke has been proposed as an alternative due to potential advantages such as reduced access site complications. However, its safety and efficacy compared to the traditional transfemoral access (TFA) remain debated.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search on PubMed, Scopus, Web of Science, Cochrane Library, and Embase from inception to May 15, 2024. We included all randomized controlled trials and observational studies. The primary outcome was successful recanalization, defined as achieving Thrombolysis in Cerebral Infarction (TICI) grades 2b–3. Secondary outcomes included complete recanalization (TICI grade 3), achieving TICI 2c or higher, functional outcomes (modified Rankin Score (mRS) at discharge and 90 days, mRS 0–2 at 90 days, National Institutes of Health Stroke Scale (NIHSS) at discharge, Length of hospital stay (LOS)), procedural efficiency (access-to-perfusion time, first-pass reperfusion, mean number of passes, crossover to alternate approach), and safety/survival outcomes (access site complications, symptomatic intracranial hemorrhage, in-hospital and 90-day mortality). This study was registered in PROSPERO (CRD42023462293).</div></div><div><h3>Results</h3><div>The meta-analysis included 13 studies with a combined total of 4759 patients. No statistically significant difference was found between TRA and TFA for successful recanalization (RR = 1.00 [95 % CI, 0.97–1.04], P = 0.88). Analysis also showed no significant difference in favorable functional outcomes between groups (RR = 0.88, [95 % CI, 0.71–1.09], P = 0.25) with significant heterogeneity (P = 0.008, I² = 71 %), which was resolved by excluding the study of Phillips et al., 2020 (P = 0.58, I² = 0 %), then favoring TFA over TRA (RR = 0.80, [95 % CI, 0.70–0.92], P = 0.002). TFA also had a statistically significant lower risk of crossover to TRA (RR = 1.68, [95 % CI, 0.99–2.86], P = 0.05). Overall, TRA was associated with a significantly shorter length of stay (MD = −1.49, 95 % CI [-2.93 to −0.05], P = 0.04, I² = 75 %), though sensitivity analysis showed a non-significant mean difference still favoring TRA (MD = −0.59; 95 % CI: [-1.28 to −0.10], P = 0.09, I² = 0 %). There was no difference between TRA and TFA regarding complete recanalization, achieving TICI 2c or higher, procedural efficiency, functional outcomes, safety, and survival.</div></div><div><h3>Conclusion</h3><div>Our updated meta-analysis demonstrates that TRA is comparable to TFA, except for a higher proportion of patients achieving mRS 0–2 at 90 days with TFA, lower crossover rates with TFA, and possibly a shorter length of stay (LOS) with TRA. Further research, particularly randomized studies, is needed to confirm these findings due to the observational nature of included studies.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108585"},"PeriodicalIF":1.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-03DOI: 10.1016/j.clineuro.2024.108584
Joshua H. Weinberg , Kevin Liu , Ashlee M. Asada , Mara Bahri , Kareem El Naamani , Amanda Zakeri , Jessica Zakeri , Stavropoula Tjoumakaris , Pascal Jabbour , James W. Rocco , Kyle VanKoevering , Stephen Yang , Matthew Old , Ciaran Powers , Shahid Nimjee , Patrick Youssef
Introduction
Carotid blowout syndrome (CBS) is a potentially life-threatening complication of head and neck cancer and associated treatment. In this study, we assess the safety and efficacy of deconstructive and reconstructive procedures with a focus on CBS recurrence.
Methods
We conducted a multicenter retrospective analysis of a prospectively maintained database and identified 80 consecutive neurointerventions for CBS from 2016 to 2020. Patients were divided into 2 groups: deconstructive embolization (68 patients) and reconstructive stenting (12 patients). A comparative analysis was performed between the two groups.
Results
The CBS recurrence rate was 23.8 % with 84.2 % of recurrences occurring within 90 days of the primary event. The median time to rebleeding was 8.0 days (IQR: 2.0 – 28.5) with a mortality rate of 26.3 %. There was no significant difference in rates of peri-operative ischemic stroke (1.5 % vs. 0 %, p=0.672) or peri-operative mortality (1.5 % vs. 0 %, p=0.670). CBS recurrence was significantly higher in the reconstructive group (58.3 % vs. 17.6 %, p=0.002). On multivariate analysis, reconstructive stenting independently predicted rebleeding (adjusted hazard ratio 8.31, 95 % CI: 2.34–29.59, p=0.001). There was no significant association between CBS recurrence and pre-operative (p=0.600) or post-operative (p=0.275) anticoagulant/antiplatelet use.
Conclusion
CBS remains a challenging and potentially catastrophic complication of head and neck cancers. Reconstructive procedures, including stenting, predicted CBS recurrence independent of bleeding site or tumor invasion. Postoperative surveillance based on time intervals to CBS recurrence and engineering advancements including improved vessel reconstruction devices have the potential to reduce rehemorrhage rates and improve patient outcomes. Further clinical investigations amongst larger cohorts are needed.
简介颈动脉爆裂综合征（CBS）是头颈部癌症及相关治疗的一种潜在威胁生命的并发症。在这项研究中，我们以 CBS 复发为重点，评估了解构和重建手术的安全性和有效性：我们对前瞻性维护的数据库进行了多中心回顾性分析，确定了 2016 年至 2020 年间 80 例连续的 CBS 神经介入治疗。患者分为两组：解构性栓塞术（68 例）和重建性支架植入术（12 例）。对两组患者进行了对比分析：CBS的复发率为23.8%，其中84.2%的复发发生在原发后90天内。再出血的中位时间为 8.0 天（IQR：2.0 - 28.5），死亡率为 26.3%。围手术期缺血性中风率（1.5% 对 0%，P=0.672）或围手术期死亡率（1.5% 对 0%，P=0.670）无明显差异。重建组的 CBS 复发率明显更高（58.3% 对 17.6%，P=0.002）。多变量分析显示，重建支架可独立预测再出血（调整后危险比为 8.31，95 % CI：2.34-29.59，p=0.001）。CBS复发与术前（P=0.600）或术后（P=0.275）使用抗凝剂/抗血小板之间无明显关联：结论：CBS仍然是头颈部癌症的一种具有挑战性和潜在灾难性的并发症。重建手术（包括支架植入术）可预测 CBS 复发，与出血部位或肿瘤侵犯无关。根据CBS复发的时间间隔进行术后监测，以及包括改良血管重建装置在内的工程技术进步，都有可能降低再出血率并改善患者预后。还需要在更大的群体中开展进一步的临床研究。
{"title":"Endovascular intervention for carotid blowout syndrome and predictors of recurrence: A retrospective and multicenter cohort study","authors":"Joshua H. Weinberg , Kevin Liu , Ashlee M. Asada , Mara Bahri , Kareem El Naamani , Amanda Zakeri , Jessica Zakeri , Stavropoula Tjoumakaris , Pascal Jabbour , James W. Rocco , Kyle VanKoevering , Stephen Yang , Matthew Old , Ciaran Powers , Shahid Nimjee , Patrick Youssef","doi":"10.1016/j.clineuro.2024.108584","DOIUrl":"10.1016/j.clineuro.2024.108584","url":null,"abstract":"<div><h3>Introduction</h3><div>Carotid blowout syndrome (CBS) is a potentially life-threatening complication of head and neck cancer and associated treatment. In this study, we assess the safety and efficacy of deconstructive and reconstructive procedures with a focus on CBS recurrence.</div></div><div><h3>Methods</h3><div>We conducted a multicenter retrospective analysis of a prospectively maintained database and identified 80 consecutive neurointerventions for CBS from 2016 to 2020. Patients were divided into 2 groups: deconstructive embolization (68 patients) and reconstructive stenting (12 patients). A comparative analysis was performed between the two groups.</div></div><div><h3>Results</h3><div>The CBS recurrence rate was 23.8 % with 84.2 % of recurrences occurring within 90 days of the primary event. The median time to rebleeding was 8.0 days (IQR: 2.0 – 28.5) with a mortality rate of 26.3 %. There was no significant difference in rates of peri-operative ischemic stroke (1.5 % vs. 0 %, p=0.672) or peri-operative mortality (1.5 % vs. 0 %, p=0.670). CBS recurrence was significantly higher in the reconstructive group (58.3 % vs. 17.6 %, <em>p</em>=0.002). On multivariate analysis, reconstructive stenting independently predicted rebleeding (adjusted hazard ratio 8.31, 95 % CI: 2.34–29.59, <em>p</em>=0.001). There was no significant association between CBS recurrence and pre-operative (<em>p</em>=0.600) or post-operative (<em>p</em>=0.275) anticoagulant/antiplatelet use.</div></div><div><h3>Conclusion</h3><div>CBS remains a challenging and potentially catastrophic complication of head and neck cancers. Reconstructive procedures, including stenting, predicted CBS recurrence independent of bleeding site or tumor invasion. Postoperative surveillance based on time intervals to CBS recurrence and engineering advancements including improved vessel reconstruction devices have the potential to reduce rehemorrhage rates and improve patient outcomes. Further clinical investigations amongst larger cohorts are needed.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108584"},"PeriodicalIF":1.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-02DOI: 10.1016/j.clineuro.2024.108577
Sahin Kenan Deniz , Hatice Turgut , Fatih Deveci̇ , Hüseyin Kaya , Ismail Kursad Gokce , Ramazan Ozdemir , Selami Cagatay Onal
Objective
Despite advances, myelomeningocele remains a major cause of mortality and disability. This study aims to analyze factors influencing mortality and suggest ways to reduce it.
Methods
We reviewed 173 patients who underwent surgery for myelomeningocele from January 2010 to December 2021. Variables affecting mortality were categorized into patient-related and indirectly related factors. Data were collected through patient file reviews and phone interviews with parents.
Results
Mortality is influenced by multiple factors: female gender (3.2-fold increase), paraplegia (3.1-fold increase), absence of tethered cord release surgery (9.4-fold increase), scoliosis (4.2-fold increase), and renal failure (5.28-fold increase). Defect size and father's education level also significantly impact mortality. The overall mortality rate was 20.8 %, with hydrocephalus being the leading cause.
Conclusion
Mortality and disability in myelomeningocele patients remain high, with over 50 % of deaths being preventable. Effective management could significantly improve mortality rates. Long-term studies are crucial for advancing research in this field.
{"title":"Long-term mortality outcomes and mortality predictors in patients with myelomeningocele","authors":"Sahin Kenan Deniz , Hatice Turgut , Fatih Deveci̇ , Hüseyin Kaya , Ismail Kursad Gokce , Ramazan Ozdemir , Selami Cagatay Onal","doi":"10.1016/j.clineuro.2024.108577","DOIUrl":"10.1016/j.clineuro.2024.108577","url":null,"abstract":"<div><h3>Objective</h3><div>Despite advances, myelomeningocele remains a major cause of mortality and disability. This study aims to analyze factors influencing mortality and suggest ways to reduce it.</div></div><div><h3>Methods</h3><div>We reviewed 173 patients who underwent surgery for myelomeningocele from January 2010 to December 2021. Variables affecting mortality were categorized into patient-related and indirectly related factors. Data were collected through patient file reviews and phone interviews with parents.</div></div><div><h3>Results</h3><div>Mortality is influenced by multiple factors: female gender (3.2-fold increase), paraplegia (3.1-fold increase), absence of tethered cord release surgery (9.4-fold increase), scoliosis (4.2-fold increase), and renal failure (5.28-fold increase). Defect size and father's education level also significantly impact mortality. The overall mortality rate was 20.8 %, with hydrocephalus being the leading cause.</div></div><div><h3>Conclusion</h3><div>Mortality and disability in myelomeningocele patients remain high, with over 50 % of deaths being preventable. Effective management could significantly improve mortality rates. Long-term studies are crucial for advancing research in this field.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108577"},"PeriodicalIF":1.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-02DOI: 10.1016/j.clineuro.2024.108582
Adam S. Levy , Tiffany Eatz , Ana Sakellakis , Tyler Warner , Alexis Morell , Martín Merenzon , Dominique Higgins , Muhammet Enes Gurses , Ricardo Jorge Komotar , Michael E. Ivan
Background
The incidence of brain metastases from gastric origin is less than 1% in those with primary gastric cancer. Given this exceedingly rare presentation, there is limited literature describing the outcomes of their neurosurgical treatment. We wish to identify the role of surgical intervention for brain lesions in metastatic gastric cancer via institutional case series and systematic review.
Methods
This study was divided into two sections: (1) a retrospective, single-center patient series assessing outcomes of neurosurgical treatment modalities in patients with malignancy arising from the stomach with brain metastases and (2) a systematic review abiding by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines between the years of 1980 and 2021 assessing outcomes of patients with primary stomach cancer with metastasis to the brain treated with surgery.
Results
Four patients with gastric brain metastases were treated at our institution, and 16 patients were identified in literature from a total of 9 studies and case reports. The mean age at the time of stomach cancer diagnosis was 57.3 years, with a mean time to brain metastases of 14.8 months. The primary gastric cancer was most commonly adenocarcinoma (70%). Patients most presented with single lesions (58%) and were treated with multimodal neurosurgical intervention (65%). Mean overall survival following neurosurgery was 12.45 months.
Conclusion
Brain metastases from gastric origin are extremely rare. Surgical resection of metastatic brain lesions should be considered as a treatment modality in surgical candidates. Future attention should be given to the effect of adjuvant therapies and surgical techniques on survival and quality of life.
背景：在原发性胃癌患者中，胃源性脑转移的发生率不到 1%。鉴于这种极为罕见的表现形式，描述其神经外科治疗效果的文献十分有限。我们希望通过机构病例系列和系统综述来确定手术干预对转移性胃癌脑部病变的作用：本研究分为两部分：（1）回顾性单中心患者系列研究，评估胃部恶性肿瘤脑转移患者神经外科治疗方式的疗效；（2）根据系统综述和荟萃分析首选报告项目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）指南，对1980年至2021年间原发性胃癌脑转移患者的手术治疗效果进行系统综述：我院共收治了4例胃癌脑转移患者，并从9项研究和病例报告中找到了16例患者。确诊胃癌时的平均年龄为 57.3 岁，发生脑转移的平均时间为 14.8 个月。原发性胃癌最常见的是腺癌（70%）。患者多为单发病灶（58%），并接受多模式神经外科干预治疗（65%）。神经外科手术后的平均总生存期为12.45个月：结论：胃源性脑转移瘤极为罕见。结论：胃源性脑转移瘤极为罕见，手术切除转移性脑病灶应作为手术候选者的一种治疗方式。未来应关注辅助疗法和手术技术对生存期和生活质量的影响。
{"title":"Surgically treated brain metastases of gastric origin: a case series and systematic review","authors":"Adam S. Levy , Tiffany Eatz , Ana Sakellakis , Tyler Warner , Alexis Morell , Martín Merenzon , Dominique Higgins , Muhammet Enes Gurses , Ricardo Jorge Komotar , Michael E. Ivan","doi":"10.1016/j.clineuro.2024.108582","DOIUrl":"10.1016/j.clineuro.2024.108582","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of brain metastases from gastric origin is less than 1% in those with primary gastric cancer. Given this exceedingly rare presentation, there is limited literature describing the outcomes of their neurosurgical treatment. We wish to identify the role of surgical intervention for brain lesions in metastatic gastric cancer via institutional case series and systematic review.</div></div><div><h3>Methods</h3><div>This study was divided into two sections: (1) a retrospective, single-center patient series assessing outcomes of neurosurgical treatment modalities in patients with malignancy arising from the stomach with brain metastases and (2) a systematic review abiding by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines between the years of 1980 and 2021 assessing outcomes of patients with primary stomach cancer with metastasis to the brain treated with surgery.</div></div><div><h3>Results</h3><div>Four patients with gastric brain metastases were treated at our institution, and 16 patients were identified in literature from a total of 9 studies and case reports. The mean age at the time of stomach cancer diagnosis was 57.3 years, with a mean time to brain metastases of 14.8 months. The primary gastric cancer was most commonly adenocarcinoma (70%). Patients most presented with single lesions (58%) and were treated with multimodal neurosurgical intervention (65%). Mean overall survival following neurosurgery was 12.45 months.</div></div><div><h3>Conclusion</h3><div>Brain metastases from gastric origin are extremely rare. Surgical resection of metastatic brain lesions should be considered as a treatment modality in surgical candidates. Future attention should be given to the effect of adjuvant therapies and surgical techniques on survival and quality of life.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108582"},"PeriodicalIF":1.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-02DOI: 10.1016/j.clineuro.2024.108576
Chuanjun Huang , Xin Liu , Guozhen Zhao , Wei Qian , Yan Zhang , Wei Zhang , Yangqing Zhu , Yu Zou
Background
Brainstem hemorrhage accounts for a relatively small proportion of spontaneous intracerebral hemorrhages (∼10 %) but tends to occur earlier in life and has poorer prognosis. Numerous studies support the therapeutic potential of minimally invasive hematoma evacuation for intracerebral hemorrhage; however, there have been few assessments of the benefits for brainstem hemorrhage.
Methods
We evaluated the safety and efficacy of a minimally invasive approach under neuroendoscopic guidance with pneumatic arm fixation for removing the hematoma in severe brainstem hemorrhage patients. 14 patients diagnosed with primary brainstem hemorrhage and treated by neuroendoscopy-assisted evacuation at Suzhou Ninth Hospital affiliated to Soochow University were included in the study. Relevant clinical and prognostic date were collected and analyzed.
Results
Hematoma volume ranged from 8 to 13 mL according to preoperative CT, while GCS at admission ranged from 4 to 6. The average operative time was 157 min and average intraoperative blood loss was 86 mL. All patients achieved satisfactory hematoma evacuation (over 90 %) according to immediate postoperative CT. Postoperative intensive care unit stay averaged 9.5 days and respiratory support averaged 7.5 days. 11 patients required tracheotomy due to pulmonary infection and absence of pharyngeal reflexes. 9 patients achieved satisfactory functional recovery (GOS score of 4 and 3), while 5 remained in a vegetative state (GOS score of 2).
Conclusion
Neuroendoscopy provides excellent direct visualization of brainstem hematomas for safe and reliable evacuation. Patients with a new PPH score of 2 or 3 are more likely to benefit from surgical treatment. Large-scale studies are required to identify patients most likely to benefit from this technique.
{"title":"Neuroendoscopic surgery for brainstem hemorrhage: Technical notes and preliminary clinical results","authors":"Chuanjun Huang , Xin Liu , Guozhen Zhao , Wei Qian , Yan Zhang , Wei Zhang , Yangqing Zhu , Yu Zou","doi":"10.1016/j.clineuro.2024.108576","DOIUrl":"10.1016/j.clineuro.2024.108576","url":null,"abstract":"<div><h3>Background</h3><div>Brainstem hemorrhage accounts for a relatively small proportion of spontaneous intracerebral hemorrhages (∼10 %) but tends to occur earlier in life and has poorer prognosis. Numerous studies support the therapeutic potential of minimally invasive hematoma evacuation for intracerebral hemorrhage; however, there have been few assessments of the benefits for brainstem hemorrhage.</div></div><div><h3>Methods</h3><div>We evaluated the safety and efficacy of a minimally invasive approach under neuroendoscopic guidance with pneumatic arm fixation for removing the hematoma in severe brainstem hemorrhage patients. 14 patients diagnosed with primary brainstem hemorrhage and treated by neuroendoscopy-assisted evacuation at Suzhou Ninth Hospital affiliated to Soochow University were included in the study. Relevant clinical and prognostic date were collected and analyzed.</div></div><div><h3>Results</h3><div>Hematoma volume ranged from 8 to 13 mL according to preoperative CT, while GCS at admission ranged from 4 to 6. The average operative time was 157 min and average intraoperative blood loss was 86 mL. All patients achieved satisfactory hematoma evacuation (over 90 %) according to immediate postoperative CT. Postoperative intensive care unit stay averaged 9.5 days and respiratory support averaged 7.5 days. 11 patients required tracheotomy due to pulmonary infection and absence of pharyngeal reflexes. 9 patients achieved satisfactory functional recovery (GOS score of 4 and 3), while 5 remained in a vegetative state (GOS score of 2).</div></div><div><h3>Conclusion</h3><div>Neuroendoscopy provides excellent direct visualization of brainstem hematomas for safe and reliable evacuation. Patients with a new PPH score of 2 or 3 are more likely to benefit from surgical treatment. Large-scale studies are required to identify patients most likely to benefit from this technique.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108576"},"PeriodicalIF":1.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.clineuro.2024.108570
Alshaimaa M. Aboulfotooh, Haytham Rizk, Omar El Serafy, Sandra M. Ahmed, Nourhan M. Soliman
Introduction
Lacunar stroke (LS) subtype accounts for a quarter of ischemic strokes. Intravenous thrombolysis (IVT) is known to improve overall stroke outcomes. Very few studies have focused on the outcome of IVT in lacunar strokes. Aim: To detect the outcome of IVT in LS patients compared to non-thrombolysed LS patients.
Methods
Fifty patients presenting with LS received the standard protocol of IVT (Group I). They were compared to fifty matched LS patients who presented beyond the time window and were selected as the control group (Group II). Clinical outcome was measured using NIHSS within 24 h, NIHSS at discharge, and MRS after 3 months. Risk factors that could have affected clinical outcomes were compared in the thrombolysis group.
Results
The short-term clinical outcome of Group I showed statistically significant improvement of NIHSS after 24 hrs compared to Group II (mean NIHSS = 5.52±3.89 and 7.44±1.82 respectively), as well as on discharge (mean NIHSS = 3.88±3.50 and 5.78±2.97) respectively. For long-term outcomes, 94 % of GroupⅠ reached MRS 0, 1, and 2 (n = 47/50) versus 74 % (n = 36/50) in Group II. Longer door-to-needle time, severe WMCs (Fazekas score), and pneumonia were shown to be significant predictor factors for the worst outcome.
Conclusion
IVT has improved short- and long-term outcomes in LS patients. Longer door-to-needle time, severe WMCs, and pneumonia were shown to be significant predictor factors for the worst outcome.
简介腔隙性中风（LS）亚型占缺血性中风的四分之一。众所周知，静脉溶栓（IVT）可改善中风的总体预后。目的：与非溶栓治疗的 LS 患者相比，检测 IVT 对 LS 患者的治疗效果：50名LS患者接受了IVT标准方案（I组）。将这些患者与超过时间窗且被选为对照组（II 组）的 50 名匹配的 LS 患者进行比较。临床结果通过 24 小时内的 NIHSS、出院时的 NIHSS 和 3 个月后的 MRS 进行测量。比较了溶栓组中可能影响临床结果的风险因素：第一组的短期临床结果显示，与第二组相比，24 小时后 NIHSS（平均值分别为 5.52±3.89 和 7.44±1.82）以及出院时 NIHSS（平均值分别为 3.88±3.50 和 5.78±2.97）均有显著改善。就长期结果而言，Ⅰ组有94%的患者达到MRS 0、1和2（n = 47/50），而Ⅱ组为74%（n = 36/50）。结果表明，较长的进针时间、严重的WMC（Fazekas评分）和肺炎是预测最坏结果的重要因素：IVT改善了LS患者的短期和长期预后。结论：IVT 可改善 LS 患者的短期和长期预后，而较长的门到针时间、严重的 WMCs 和肺炎则是预测最差预后的重要因素。
{"title":"Outcome of intravenous thrombolysis in acute ischemic stroke patients with small vessel disease","authors":"Alshaimaa M. Aboulfotooh, Haytham Rizk, Omar El Serafy, Sandra M. Ahmed, Nourhan M. Soliman","doi":"10.1016/j.clineuro.2024.108570","DOIUrl":"10.1016/j.clineuro.2024.108570","url":null,"abstract":"<div><h3>Introduction</h3><div>Lacunar stroke (LS) subtype accounts for a quarter of ischemic strokes. Intravenous thrombolysis (IVT) is known to improve overall stroke outcomes. Very few studies have focused on the outcome of IVT in lacunar strokes. <em>Aim:</em> To detect the outcome of IVT in LS patients compared to non-thrombolysed LS patients<em>.</em></div></div><div><h3>Methods</h3><div>Fifty patients presenting with LS received the standard protocol of IVT (Group I). They were compared to fifty matched LS patients who presented beyond the time window and were selected as the control group (Group II). Clinical outcome was measured using NIHSS within 24 h, NIHSS at discharge, and MRS after 3 months. Risk factors that could have affected clinical outcomes were compared in the thrombolysis group.</div></div><div><h3>Results</h3><div>The short-term clinical outcome of Group I showed statistically significant improvement of NIHSS after 24 hrs compared to Group II (mean NIHSS = 5.52±3.89 and 7.44±1.82 respectively), as well as on discharge (mean NIHSS = 3.88±3.50 and 5.78±2.97) respectively. For long-term outcomes, 94 % of GroupⅠ reached MRS 0, 1, and 2 (n = 47/50) versus 74 % (n = 36/50) in Group II. Longer door-to-needle time, severe WMCs (Fazekas score), and pneumonia were shown to be significant predictor factors for the worst outcome.</div></div><div><h3>Conclusion</h3><div>IVT has improved short- and long-term outcomes in LS patients. Longer door-to-needle time, severe WMCs, and pneumonia were shown to be significant predictor factors for the worst outcome<strong>.</strong></div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108570"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.clineuro.2024.108581
Ahro Kim, Jee Hyun Kwon, Chan-Hyuk Lee, Wook-Joo Kim
Objectives
Atrial fibrillation (AF) is one of the notorious risk factors in acute ischemic stroke (AIS), and the use of anticoagulants has been shown to be effective in preventing ischemic stroke in AF patients. Therefore, identifying AF in AIS patients has become increasingly important. However, the impact of brain imaging and cardiac indices on the development of new AF after stroke remains unclear.
Methods
A consecutive series of AIS patients who were admitted to the Ulsan University Hospital between January 2013 and December 2019 were identified. Patients with relevant ischemic brain lesions on MRI were included, and those without echocardiography data were excluded. We included and classified the AF patients who had the disease prior to or during hospitalization or met the criteria for cryptogenic stroke (CS). Differences in baseline characteristics, stroke risk factors, stroke severity, insular lesion, and echocardiographic data were investigated among each group.
Results
A total of 850 patients were enrolled in the study, comprising 231 patients with AF detected after stroke (AFDAS), 287 patients with known AF (KAF), and 350 patients with CS. Compared with KAF, patients with AFDAS had a lower prevalence of underlying coronary heart disease and stroke history. They had greater right insular cortex lesions and lesser left atrial enlargement in unadjusted analysis. Following adjusted analysis, the involvement of the right insular cortex was found to be associated with the AFDAS patient group (odds ratio, 1.57). When compared to the CS group, AFDAS patients were older, experienced more severe initial strokes, and had similar rates of pre-stroke anticoagulation prescription. Additionally, they demonstrated a higher prevalence of both insular lesions, increased left atrium volume index, reduced ejection fraction, and elevated e/e′ ratio. After adjustment, age, initial stroke severity, insular involvement, left atrium volume index, ejection fraction, and e/e′ ratio were found to be significant.
Conclusions
These results suggest that the right insular cortex lesion on acute stroke may be a cause of AFDAS.
{"title":"Brain lesion and echocardiogenic predictors of newly detected atrial fibrillation in acute ischemic stroke","authors":"Ahro Kim, Jee Hyun Kwon, Chan-Hyuk Lee, Wook-Joo Kim","doi":"10.1016/j.clineuro.2024.108581","DOIUrl":"10.1016/j.clineuro.2024.108581","url":null,"abstract":"<div><h3>Objectives</h3><div>Atrial fibrillation (AF) is one of the notorious risk factors in acute ischemic stroke (AIS), and the use of anticoagulants has been shown to be effective in preventing ischemic stroke in AF patients. Therefore, identifying AF in AIS patients has become increasingly important. However, the impact of brain imaging and cardiac indices on the development of new AF after stroke remains unclear.</div></div><div><h3>Methods</h3><div>A consecutive series of AIS patients who were admitted to the Ulsan University Hospital between January 2013 and December 2019 were identified. Patients with relevant ischemic brain lesions on MRI were included, and those without echocardiography data were excluded. We included and classified the AF patients who had the disease prior to or during hospitalization or met the criteria for cryptogenic stroke (CS). Differences in baseline characteristics, stroke risk factors, stroke severity, insular lesion, and echocardiographic data were investigated among each group.</div></div><div><h3>Results</h3><div>A total of 850 patients were enrolled in the study, comprising 231 patients with AF detected after stroke (AFDAS), 287 patients with known AF (KAF), and 350 patients with CS. Compared with KAF, patients with AFDAS had a lower prevalence of underlying coronary heart disease and stroke history. They had greater right insular cortex lesions and lesser left atrial enlargement in unadjusted analysis. Following adjusted analysis, the involvement of the right insular cortex was found to be associated with the AFDAS patient group (odds ratio, 1.57). When compared to the CS group, AFDAS patients were older, experienced more severe initial strokes, and had similar rates of pre-stroke anticoagulation prescription. Additionally, they demonstrated a higher prevalence of both insular lesions, increased left atrium volume index, reduced ejection fraction, and elevated e/e′ ratio. After adjustment, age, initial stroke severity, insular involvement, left atrium volume index, ejection fraction, and e/e′ ratio were found to be significant.</div></div><div><h3>Conclusions</h3><div>These results suggest that the right insular cortex lesion on acute stroke may be a cause of AFDAS.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108581"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388580","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}
To explore the clinicopathological and radiological characteristics associated with false-positive and false-negative results in the identification of isocitrate dehydrogenase (IDH) mutations in gliomas using the T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign.
Methods
In 1515 patients with cerebral gliomas, tumor location, restricted diffusion using diffusion-weighted imaging, and the T2-FLAIR mismatch sign were retrospectively analyzed using preoperative magnetic resonance imaging. Moreover, both the false-positive and false-negative results of the T2-FLAIR mismatch sign were obtained. Univariate and multivariate logistic analyses were performed to evaluate the risk factors associated with false-positive and false-negative results.
Results
The overall false-positive rate was 3.5 % (53/1515), and its independent risk factors were the patient’s age (adjusted odds ratio [OR], 0.977; 95 % confidence interval [CI], 0.957, 0.997; P = 0.027) and non-restricted diffusion (adjusted OR, 1.968; 95 % CI, 1.060, 3.652; P = 0.032). The overall false-negative rate was 39.7 % (602/1515); its independent risk factors were the patient’s age (adjusted OR, 1.022; 95 % CI, 1.005, 1.038; P = 0.008), 1p/19q co-deletion (adjusted OR, 3.334; 95 % CI, 1.913, 5.810; P < 0.001), and telomerase reverse transcriptase promoter mutation (adjusted OR, 2.004; 95 % CI, 1.181, 3.402; P = 0.010). For the mismatch sign in idiopathic IDH, the area under the receiver operating characteristic curve (AUC) was 0.602. The combined AUC for the T2-FLAIR mismatch sign and risk factors was 0.871.
Conclusions
Clinicopathological and radiological characteristics can lead to the misinterpretation of IDH status in gliomas based on the T2-FLAIR mismatch sign. However, this can be avoided if careful attention is paid.
{"title":"Clinicopathological and radiological characteristics of false-positive and false-negative results in T2-FLAIR mismatch sign of IDH-mutated gliomas","authors":"Yuying Zang , Limei Feng , Fei Zheng , Xinyao Shi , Xuzhu Chen","doi":"10.1016/j.clineuro.2024.108579","DOIUrl":"10.1016/j.clineuro.2024.108579","url":null,"abstract":"<div><h3>Purpose</h3><div>To explore the clinicopathological and radiological characteristics associated with false-positive and false-negative results in the identification of isocitrate dehydrogenase (IDH) mutations in gliomas using the T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign.</div></div><div><h3>Methods</h3><div>In 1515 patients with cerebral gliomas, tumor location, restricted diffusion using diffusion-weighted imaging, and the T2-FLAIR mismatch sign were retrospectively analyzed using preoperative magnetic resonance imaging. Moreover, both the false-positive and false-negative results of the T2-FLAIR mismatch sign were obtained. Univariate and multivariate logistic analyses were performed to evaluate the risk factors associated with false-positive and false-negative results.</div></div><div><h3>Results</h3><div>The overall false-positive rate was 3.5 % (53/1515), and its independent risk factors were the patient’s age (adjusted odds ratio [OR], 0.977; 95 % confidence interval [CI], 0.957, 0.997; <em>P</em> = 0.027) and non-restricted diffusion (adjusted OR, 1.968; 95 % CI, 1.060, 3.652; <em>P</em> = 0.032). The overall false-negative rate was 39.7 % (602/1515); its independent risk factors were the patient’s age (adjusted OR, 1.022; 95 % CI, 1.005, 1.038; <em>P</em> = 0.008), 1p/19q co-deletion (adjusted OR, 3.334; 95 % CI, 1.913, 5.810; <em>P</em> < 0.001), and telomerase reverse transcriptase promoter mutation (adjusted OR, 2.004; 95 % CI, 1.181, 3.402; <em>P</em> = 0.010). For the mismatch sign in idiopathic IDH, the area under the receiver operating characteristic curve (AUC) was 0.602. The combined AUC for the T2-FLAIR mismatch sign and risk factors was 0.871.</div></div><div><h3>Conclusions</h3><div>Clinicopathological and radiological characteristics can lead to the misinterpretation of IDH status in gliomas based on the T2-FLAIR mismatch sign. However, this can be avoided if careful attention is paid.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108579"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142421548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1016/j.clineuro.2024.108574
Linjing Du , Jing Cai , Jingjing Zhou , Jiahui Yu , Xueni Yang , Xing Chen , Xiuqun Xu , Xiaomei Zhang
Objective
In this study, we investigated the fear of disease progression in Chinese PBT patients and examined the correlation between sociodemographic, clinical, and psychological variables of patients with the fear of progression (FoP). Additionally, the study also evaluated the subjective experience of FoP in patients with primary brain tumors (PBT).
Methods
A mixed-methods study was conducted between March 2022 and December 2023, consisting of two phases: a quantitative approach in phase I, and a qualitative approach in phase II. In phase I, 305 patients with PBT filled in several questionnaires. An analysis was performed to identify potential predictors associated with FoP. In phase II, semi-structured interviews were conducted with 16 participants whose FoP scores were ≥ 34 in phase I to obtain information on their personal experiences with FoP.
Results
The results of the quantitative study showed that 192 (63 %) patients experienced high levels of FoP. The mean score of fear of progression was (34.02±6.78). Young age, high disease uncertainty, low social support, high negative coping and low positive coping are important factors affecting FoP in PBT patients. Qualitative research focused on three themes: triggers, coping styles, and the help needed.
Conclusion
Enhanced screening and assessment of FoP is essential to identify dysfunctionin PBT. Meanwhile, the implications of these predictors for enhanced healthcare professional education and patient self-management may help healthcare providers implement relevant interventions promptly and help patients reduce their FoP. However, due to limitations such as sample, reporting bias, and specific mechanisms between predictors and FOPs that have not yet been explored in depth, further exploration is needed in the future.
{"title":"Current status and influencing factors of fear disease progression in Chinese primary brain tumor patients: A mixed methods study","authors":"Linjing Du , Jing Cai , Jingjing Zhou , Jiahui Yu , Xueni Yang , Xing Chen , Xiuqun Xu , Xiaomei Zhang","doi":"10.1016/j.clineuro.2024.108574","DOIUrl":"10.1016/j.clineuro.2024.108574","url":null,"abstract":"<div><h3>Objective</h3><div>In this study, we investigated the fear of disease progression in Chinese PBT patients and examined the correlation between sociodemographic, clinical, and psychological variables of patients with the fear of progression (FoP). Additionally, the study also evaluated the subjective experience of FoP in patients with primary brain tumors (PBT).</div></div><div><h3>Methods</h3><div>A mixed-methods study was conducted between March 2022 and December 2023, consisting of two phases: a quantitative approach in phase I, and a qualitative approach in phase II. In phase I, 305 patients with PBT filled in several questionnaires. An analysis was performed to identify potential predictors associated with FoP. In phase II, semi-structured interviews were conducted with 16 participants whose FoP scores were ≥ 34 in phase I to obtain information on their personal experiences with FoP.</div></div><div><h3>Results</h3><div>The results of the quantitative study showed that 192 (63 %) patients experienced high levels of FoP. The mean score of fear of progression was (34.02±6.78). Young age, high disease uncertainty, low social support, high negative coping and low positive coping are important factors affecting FoP in PBT patients. Qualitative research focused on three themes: triggers, coping styles, and the help needed.</div></div><div><h3>Conclusion</h3><div>Enhanced screening and assessment of FoP is essential to identify dysfunctionin PBT. Meanwhile, the implications of these predictors for enhanced healthcare professional education and patient self-management may help healthcare providers implement relevant interventions promptly and help patients reduce their FoP. However, due to limitations such as sample, reporting bias, and specific mechanisms between predictors and FOPs that have not yet been explored in depth, further exploration is needed in the future.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108574"},"PeriodicalIF":1.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364666","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}
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