Clinical Neurology and Neurosurgery最新文献

{"title":"Placebo-controlled efficacy of 5-HT3 antagonists for postoperative nausea and vomiting prophylaxis in supratentorial craniotomies: A systematic review and comparative meta-analysis of randomized clinical trials","authors":"Marcio Yuri Ferreira ,&nbsp;Gabriel Scarpioni Barbosa ,&nbsp;João Damásio da Costa Neto ,&nbsp;Gustavo de Oliveira Almeida ,&nbsp;Silvio Porto Junior ,&nbsp;André Melo de Faria ,&nbsp;Leonardo Dozza de Sousa ,&nbsp;Leonardo Januario Campos Cardoso ,&nbsp;Stefeson Gomes Cabral Junior ,&nbsp;João Paulo Liute Scarramal ,&nbsp;Luis F. Fabrini Paleare ,&nbsp;Marcelo Porto Sousa ,&nbsp;Anthony Hong ,&nbsp;Ana B. Santos ,&nbsp;Fernando G.F. Oliveira ,&nbsp;Raphael Bertani","doi":"10.1016/j.clineuro.2024.108569","DOIUrl":"10.1016/j.clineuro.2024.108569","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative nausea and vomiting (PONV) are common and distressing complications following neurosurgical procedures, affecting up to 73 % of patients undergoing craniotomy. Therefore, we aimed to assess the placebo-controlled efficacy of 5-HT3 antagonists to prevent PONV following supratentorial craniotomies.</div></div><div><h3>Methods</h3><div>We searched Medline, Web of Science, and Embase databases following PRISMA guidelines for RCTs comparing the outcomes of prophylactic use of 5-HT3 antagonists with placebo to prevent PONV following supratentorial craniotomy. We pooled odds ratios (OR) with 95 % confidence intervals with a random-effects model. I² statistics was used to assess heterogeneity.</div></div><div><h3>Results</h3><div>Five RCTs, comprising 347 patients, of which 145 received a placebo, were included. The analysis identified a lower likelihood of early postoperative vomiting in 5-HT3 antagonists group (OR=0.47; 95 % CI: 0.24–0.91, p&lt;0.05; I²=7 %), a lower likelihood of vomit within the 24-h period in 5-HT3 antagonists group (OR=0.27; 95 % CI: 0.15–0.48, p&lt;0.01; I²=40 %), a lower likelihood of nausea within the 24-h period in 5-HT3 antagonists group (OR=0.47; 95 % CI: 0.28–0.72, p&lt;0.01; I²=34 %), and a lower likelihood of rescue interventions in 5-HT3 antagonists group (OR = 0.18; 95 % CI: 0.10–0.34; I² = 0 %. Subgroup analyses focusing on ondansetron also identified a lower likelihood of nausea and vomiting within the 24-h period in the 5-HT3 antagonist group.</div></div><div><h3>Conclusion</h3><div>This systematic review and meta-analysis identified that 5-HT3 antagonists are effective in preventing PONV in the postoperative period following supratentorial craniotomy when compared to placebo. Our findings provide synthesized and robust evidence derived from randomized studies to support the use of 5-HT3 antagonists in clinical practice.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108569"},"PeriodicalIF":1.8,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379179","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 superficial middle cerebral vein compression on peritumoral brain edema of the sphenoid wing meningioma","authors":"Akinari Yamano,&nbsp;Masahide Matsuda,&nbsp;Hidehiro Kohzuki,&nbsp;Eiichi Ishikawa","doi":"10.1016/j.clineuro.2024.108575","DOIUrl":"10.1016/j.clineuro.2024.108575","url":null,"abstract":"<div><h3>Objective</h3><div>Sphenoid wing meningiomas (SWMs) often cause occlusion or stenosis of the superficial middle cerebral vein (SMCV) by tumor compression. This study aimed to analyze the correlation between SMCV compression and peritumoral brain edema (PTBE) in SWM patients and to clarify the importance of surgical preservation of the SMCV in SWM surgery.</div></div><div><h3>Methods</h3><div>This retrospective study included 31 patients who underwent surgery for SWM at our institution from April 2011 to March 2022. Patient demographics, tumor characteristics, PTBE size, and SMCV patency before and after surgery were evaluated using preoperative and postoperative MRI or digital subtraction angiography.</div></div><div><h3>Results</h3><div>Of the 31 patients, 24 (77.4 %) exhibited PTBE, with varying degrees of severity: mild (32.3 %), moderate (25.8 %), and severe (41.9 %). Preoperative MRI showed SMCV patency in 14 patients (45.2 %) and SMCV compression in 17 patients (54.8 %). There was a significant association between PTBE severity and SMCV compression (p = 0.002). Postoperatively, SMCV recanalization was observed in 4 out of 16 patients (25.0 %) with preoperative SMCV compression. These patients had significantly smaller tumors (p = 0.013) and larger preoperative PTBE volumes (p = 0.042) compared to those without recanalization.</div></div><div><h3>Conclusions</h3><div>Our study demonstrates a significant correlation between SMCV compression and severe PTBE in SWM patients. A subset of patients showed postoperative SMCV recanalization, particularly those with smaller tumors and more pronounced PTBE. These findings highlight the importance of SMCV preservation during SWM surgery to potentially improve postoperative outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108575"},"PeriodicalIF":1.8,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327455","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":"Risk factors for acute symptomatic seizure in children with cerebral sinovenous thrombosis: Experience from a tertiary center","authors":"Gül Yücel ,&nbsp;Ahmet Kadir Arslan ,&nbsp;Bilge Özgör ,&nbsp;Murat Çağlar Şahin ,&nbsp;Yurday Öncül ,&nbsp;Sevgi Demiröz Taşolar ,&nbsp;Arzu Akyay ,&nbsp;Serdal Güngör","doi":"10.1016/j.clineuro.2024.108571","DOIUrl":"10.1016/j.clineuro.2024.108571","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the risk factors for acute symptomatic seizure (ASS) in children with Cerebral Sinovenous Thrombosis (CSVT) and to evaluate the effect of ASS on outcome.</div></div><div><h3>Methods</h3><div>Cross-sectional, single-center, hospital-based retrospective analysis of 42 children with neuroimaging-confirmed CSVT recorded between December 2009 and January 2023. ASS was defined as a seizure occurring within 7 days after CSVT. Predictors for ASS were analyzed by univariate and multivariate logistic regression. Functional outcomes were evaluated using the Pediatric Stroke Outcome Measure (PSOM).</div></div><div><h3>Results</h3><div>The average age of the 42 patients included in the study sample was 105.36 ± 63.1 months. Almost one-third (28.6 %) of patients with CSVT developed ASS. In univariate analysis, factors associated with seizure risk were young age, low Glasgow Coma Scale at admission, long hospital stay, headache, change of consciousness, focal neurological findings, cerebral hemorrhage, motor deficit and high D-dimer level (<em>p</em>=0.018, <em>p</em>&lt;0.001, <em>p=</em> 0.016, <em>p=</em> 0.001, <em>p=</em>0.014, <em>p</em>&lt;0.001, <em>p&lt;</em>0.001, <em>p</em>=0.019 and <em>p</em>=0.013, respectively). In multivariate analysis young age, focal neurological findings and D-dimer levels were potential predictors of ASS (p=0.004, p=0.003, p=0.036, respectively). Receiver operating characteristic (ROC) analysis for D-dimer diagnostic accuracy in patients with CSVT revealed D-dimer &gt; 498 ng/mL (AUC=0.743). In both cohorts, PSOM scores at last follow-up were worse in those with acute seizures compared to those without (<em>p</em>&lt;0.001).</div></div><div><h3>Conclusion</h3><div>Acute seizures occurred in approximately one-third of our cohort. Young age, focal neurological findings, and high D-dimer levels are potential predictors of ASS in children. Children with ASS had worse outcomes than those without.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108571"},"PeriodicalIF":1.8,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319294","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":"Middle meningeal artery embolization versus conventional management for patients with chronic subdural hematoma: An umbrella review","authors":"Pemla Jagtiani ,&nbsp;Mert Karabacak ,&nbsp;Paritosh Coomar ,&nbsp;Konstantinos Margetis","doi":"10.1016/j.clineuro.2024.108572","DOIUrl":"10.1016/j.clineuro.2024.108572","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Conventional surgical modalities, including twist drill craniotomy, burr hole evacuation, and craniotomy, are the standard surgical interventions for chronic subdural hematomas (cSDH). More recently, treatment of cSDH with middle meningeal artery embolization (MMAE) is being explored. The comparative effectiveness of MMAE versus conventional surgical modalities remains controversial. The objective of this study is to analyze various postoperative outcomes in an umbrella review of existing meta-analysis comparing MMAE and conventional management in patients with cSDH.</div></div><div><h3>Methods</h3><div>A systematic literature search was executed with defined criteria across PubMed, Scopus, and Web of Science databases. Data was analyzed utilizing the <em>metaumbrella</em> R package, employing equivalent Hedges’ g values. The quality assessment of each meta-analysis was carried out using AMSTAR2, assigning scores within the range of 0–11. The credibility of the evidence was determined by applying the Ioannidis criteria.</div></div><div><h3>Results</h3><div>This umbrella review study included five meta-analyses. Upon pooling the meta-analyses, MMAE was associated with fewer reoperations and recurrence, supported by a weak level of evidence (class IV). Conversely, findings related to other postoperative outcomes did not reach statistical significance.</div></div><div><h3>Conclusion</h3><div>Our umbrella review offers a comprehensive summary investigating MMAE and conventional management for the treatment of cSDH. MMAE had fewer reoperations and recurrence, but they were classified as being of weak significance. These findings underscore insufficient evidence within the existing literature, emphasizing the imperative need for additional research in this area.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108572"},"PeriodicalIF":1.8,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314936","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":"The effect of fibromyalgia syndrome on female patients diagnosed with chronic migraine","authors":"Alper Mengi ,&nbsp;Bengi Gül Türk ,&nbsp;Ugur Uygunoglu","doi":"10.1016/j.clineuro.2024.108573","DOIUrl":"10.1016/j.clineuro.2024.108573","url":null,"abstract":"<div><h3>Objective</h3><div>To compare pain, quality of life, sleep, anxiety and depression, central sensitization, and functionality between chronic migraine (CM) patients with comorbid fibromyalgia syndrome (FMS) and patients with CM alone.</div></div><div><h3>Method</h3><div>Thirty three female patients with CM and thirty three female patients with CM+FMS were enrolled in the study. Demographic and clinical characteristics of the patients were recorded. FM was diagnosed based on the 2016 American College of Rheumatology diagnostic criteria. All participants were evaluated with Allodynia Symptom Checklist, Short Form-36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6) questionnaires, and Central Sensitization Inventory (CSI). FM patients were also evaluated with Fibromyalgia Impact Questionnaire (FIQ).</div></div><div><h3>Results</h3><div>The average number of headache days was significantly higher in patients with CM+FMS (p = 0.006). Among migraine accompanying symptoms, the number of patients with phonophobia was significantly higher in patients with CM+FMS (p = 0.008). While CSI score was 39.0 ± 11.7 in CM patients, it was 52.2 ± 9.2 in CM+FMS patients. CSI scores were higher in CM+FMS patients (p &lt; 0.001). SF-36 sub-cores, including physical function, energy/fatigue, emotional well-being, and general health scores, were lower in CM+FMS patients (p &lt; 0.05). Sleep duration was significantly lower and use of medication to sleep was more common in same group (p &lt; 0.05). FIQ score in CM+FMS patients was associated with quality of life scores, sleep quality, anxiety, and central sensitization scores (p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>In patients with chronic migraine, FMS comorbidity negatively affects the quality of life and significantly increases central sensitization.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108573"},"PeriodicalIF":1.8,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314816","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":"Improvement in cranial nerve palsies following treatment of intracranial aneurysms with flow diverters: Institutional outcomes, systematic review and study-level meta-analysis","authors":"Nanthiya Sujijantarat ,&nbsp;Joseph P. Antonios ,&nbsp;Daniela Renedo ,&nbsp;Andrew B. Koo ,&nbsp;Joseph O. Haynes ,&nbsp;Bushra Fathima ,&nbsp;Jasmine W. Jiang ,&nbsp;Astrid C. Hengartner ,&nbsp;Apurv H. Shekhar ,&nbsp;Abdelaziz Amllay ,&nbsp;Kamil W. Nowicki ,&nbsp;Ryan M. Hebert ,&nbsp;Emily J. Gilmore ,&nbsp;Kevin N. Sheth ,&nbsp;Joseph T. King Jr ,&nbsp;Charles C. Matouk","doi":"10.1016/j.clineuro.2024.108555","DOIUrl":"10.1016/j.clineuro.2024.108555","url":null,"abstract":"<div><h3>Background</h3><div>Cranial nerve (CN) palsies are rare presenting symptoms of intracranial aneurysms. Our objectives were to report our institutional outcomes and study-level meta-analysis summarizing rates of improvement and identifying factors associated with recovery from CN symptoms after flow diversion.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of our institutional database for patients with intracranial aneurysms presenting with CN palsies who underwent treatment with flow diversion between 2015 and 2023. Systematic review of the literature was performed using Medline, EMBASE, Cochrane, as well as manual citation searches. Random effects meta-analysis was used.</div></div><div><h3>Results</h3><div>Thirteen of 136 studies were included in the meta-analysis and were combined with our institutional data. The pooled rate of improvement in any CN palsies following flow diversion was 71 % (95 %CI, 60 %-82 %, n=322). Patients presenting with CN II deficits were less likely to improve following treatment compared to other CN deficits (pooled OR [pOR] 0.32, 95 %CI, 0.16–0.63, n=224). The pooled rate of clinical improvement was 53 % in CNII deficits (95 %CI, 42 %-65 %, n=80) and 80 % in other CN deficits (95 %CI, 71 %-88 %, n=106). An increased rate of improvement was associated with acute intervention (pOR 9.12, 95 % CI, 2.26–36.73, n = 71) and radiographic aneurysm occlusion (pOR 5.29, 95 %CI, 1.66–16.90, n=118).</div></div><div><h3>Conclusions</h3><div>Flow diversion improves CN palsy outcomes in patients with symptomatic intracranial aneurysms. The lower rate of improvement in visual acuity compared to other CN deficits may point to a different mechanism of injury or potential recoverability in these patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108555"},"PeriodicalIF":1.8,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359090","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":"Development of a model to predict the risk of multi-drug resistant organism infections in ruptured intracranial aneurysms patients with hospital-acquired pneumonia in the neurological intensive care unit","authors":"Zhiyao Wang ,&nbsp;Yujia Huang ,&nbsp;Xiaoguang Liu ,&nbsp;Wenyan Cao ,&nbsp;Qiang Ma ,&nbsp;Yajie Qi ,&nbsp;Mengmeng Wang ,&nbsp;Xin Chen ,&nbsp;Jing Hang ,&nbsp;Luhang Tao ,&nbsp;Hailong Yu ,&nbsp;Yuping Li","doi":"10.1016/j.clineuro.2024.108568","DOIUrl":"10.1016/j.clineuro.2024.108568","url":null,"abstract":"<div><h3>Objective</h3><div>This study was developed to explore the incidence of multi-drug resistant organism (MDRO) infections among ruptured intracranial aneurysms(RIA) patient with hospital-acquired pneumonia(HAP) in the neurological intensive care unit (NICU), and to establish risk factors related to the development of these infections.</div></div><div><h3>Methods</h3><div>We collected clinical and laboratory data from 328 eligible patients from January 2018 to December 2022. Bacterial culture results were used to assess MDRO strain distributions, and risk factors related to MDRO infection incidence were identified through logistic regression analyses. These risk factors were further used to establish a predictive model for the incidence of MDRO infections, after which this model underwent internal validation.</div></div><div><h3>Results</h3><div>In this study cohort, 26.5 % of RIA patients with HAP developed MDRO infections (87/328). The most common MDRO pathogens in these patients included Multidrug-resistant Klebsiella pneumoniae (34.31 %) and Multidrug-resistant Acinetobacter baumannii (27.45 %). Six MDRO risk factors, namely, diabetes (P = 0.032), tracheotomy (P = 0.004), history of mechanical ventilation (P = 0.033), lower albumin levels (P &lt; 0.001), hydrocephalus (P &lt; 0.001) and Glasgow Coma Scale (GCS) score ≤8 (P = 0.032) were all independently correlated with MDRO infection incidence. The prediction model exhibited satisfactory discrimination (area under the curve [AUC], 0.842) and calibration (slope, 1.000), with a decision curve analysis further supporting the clinical utility of this model.</div></div><div><h3>Conclusions</h3><div>In summary, risk factors and bacterial distributions associated with MDRO infections among RIA patients with HAP in the NICU were herein assessed. The developed predictive model can aid clinicians to identify and screen high-risk patients for preventing MDRO infections.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108568"},"PeriodicalIF":1.8,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314818","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":"Early and long-term outcome of surgical versus conservative management for intracranial cerebral cavernous malformation: Meta-analysis of reconstructed time-to-event data","authors":"Gustavo da Fontoura Galvão ,&nbsp;Gabriel Verly ,&nbsp;Pablo Valença ,&nbsp;Flávio Sampaio Domingues ,&nbsp;Marcello Reis da Silva ,&nbsp;Jorge Marcondes","doi":"10.1016/j.clineuro.2024.108567","DOIUrl":"10.1016/j.clineuro.2024.108567","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral cavernous malformations (CCMs) present challenges in clinical management due to a lack of definitive evidence from clinical trials. Surgical intervention and observational management are commonly used, yet their efficacy and long-term outcomes remain controversial.</div></div><div><h3>Objective</h3><div>This meta-analysis evaluates the effectiveness of surgical intervention versus conservative management in patients with symptomatic CCMs over various time frames to determine optimal treatment strategies.</div></div><div><h3>Methods</h3><div>A systematic review and reconstructed time-to-event meta-analysis were conducted, following PRISMA guidelines. Data from selected studies comparing surgical intervention to conservative management for CCMs were analyzed using pooled patient data from Kaplan-Meier curves. New focal neurological deficit (FND) or intracranial hemorrhage (ICH) were the outcome metrics.</div></div><div><h3>Results</h3><div>Four eligible studies, comprising 290 patients, were included. Surgical intervention showed 43 events over a mean time to FND/ICH of 6.372 years (95 % CI: 3.536–8.005), while observational management had 48 events with a significantly longer mean time of 10.992 years (95 % CI: 6.070–8.005). No significant difference was found at 2 years (p = 0.910), but at 5 and 10 years, surgical intervention had more events and shorter mean times (p &lt; 0.0001). Sensitivity analysis for previously bleeding CCMs showed no significant difference in events (p = 0.131).</div></div><div><h3>Conclusion</h3><div>This meta-analysis suggests observational management may achieve favorable long-term outcomes for symptomatic CCMs. Despite ongoing controversies, the findings highlight the need for further research, particularly randomized controlled trials, to refine treatment strategies and optimize patient care.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108567"},"PeriodicalIF":1.8,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323279","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":"Association between reduced left ventricular ejection fraction and functional outcomes in acute stroke: Systematic review and meta-analysis","authors":"Bruno Felipe Santos de Oliveira,&nbsp;Cárita Victória Carvalho de Santana,&nbsp;Rafaela Góes Bispo,&nbsp;Jamary Oliveira-Filho","doi":"10.1016/j.clineuro.2024.108566","DOIUrl":"10.1016/j.clineuro.2024.108566","url":null,"abstract":"<div><h3>Introduction</h3><div>Left ventricular ejection fraction (LVEF) is a measure of cardiac function and often reduced LVEF is indicative of cardiomyopathy/heart failure. The current study evaluated whether reduced LVEF is associated with poor outcomes and mortality in acute stroke.</div></div><div><h3>Methods</h3><div>Articles that compared poor outcomes (modified Rankin scale 3–6) or mortality in people with reduced LVEF compared to preserved LVEF in acute ischemic stroke were searched in the following databases: MEDLINE/PubMed, Embase, Scopus, Biomed central, and Cochrane Library. The last search was on March 17, 2024. The results obtained were pooled in meta-analyses.</div></div><div><h3>Results</h3><div>A total of 28933 participants were enrolled from 17 articles. Reduced left ventricular ejection fraction was independently associated with poor outcomes at 90 days (OR:2.38 CI95 % 1.52;3.71; I² = 71 %), the same was observed for death at 90 days (OR:3.15 CI 95 % 1.43; 6.96; I² = 60 %).</div></div><div><h3>Conclusion</h3><div>Reduced LVEF is associated with poor functional outcomes and death within 3 months after acute ischemic stroke compared to the setting in which LVEF is preserved.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108566"},"PeriodicalIF":1.8,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323280","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":"The surgical management of third ventricle region tumors","authors":"Chloe Verducci ,&nbsp;Dayna C. Sloane ,&nbsp;Rob Hand ,&nbsp;Shawn Choe ,&nbsp;Ignacio Jusue-Torres ,&nbsp;Rachyl M. Shanker ,&nbsp;Miri Kim ,&nbsp;Atul K. Mallik ,&nbsp;Anand V. Germanwala ,&nbsp;Douglas E. Anderson","doi":"10.1016/j.clineuro.2024.108564","DOIUrl":"10.1016/j.clineuro.2024.108564","url":null,"abstract":"<div><h3>Objectives</h3><div>The goal of this study was to characterize the largest known cohort of patients presenting with different tumor pathologies in the third ventricle region to better understand outcomes of surgical management.</div></div><div><h3>Methods</h3><div>All patients undergoing surgical intervention on tumors in or encroaching upon the third ventricle at Loyola University Medical Center between the years 1986–2021 were reviewed. Information recorded included presenting symptoms, pre- and post-operative interventions, tumor pathology, operative technique, extent of resection (EOR), and approach of operation. The primary clinical outcome was Karnofsky Performance Status (KPS) score.</div></div><div><h3>Results</h3><div>Ninety-seven patients underwent 123 operations. Forty-six (47.4 %) patients were female, and the median age at operation was 39 years. Eighty-seven (70.7 %) operations were open, and 36 (29.3 %) were endoscopic. Gross total resection (GTR) was achieved in 34.4 % of operations, near-total resection (NTR) in 31.5 %, subtotal resection in 25.0 %, and biopsy alone in 9.3 %. Median KPS increased pre- to postoperatively, regardless of surgical technique. Adjusting for preoperative KPS, age, and operation number, regression analysis demonstrated a trend that lesser EOR is associated with lower KPS at most recent follow-up (p=0.031 for NTR vs GTR, p=0.022 for biopsy vs GTR). There was no statistically significant association between the most recent KPS and either open or endoscopic surgical technique, with or without adjusting for the previously stated factors (p=0.26). There was no association between postoperative complication rates or age with either surgical technique.</div></div><div><h3>Conclusions</h3><div>Here, we characterize a large cohort of patients presenting for neurosurgical evaluation of tumors in the region of the third ventricle. Our results demonstrate a trend that a more aggressive resection may yield better KPS outcomes. Additionally, both open and endoscopic techniques lead to a similar improvement in clinical outcome and rates of complication. While ultimate surgical approach and technique is determined by individual tumor characteristics, patient health status, and surgeon expertise, ability to resect the tumor in its entirety should be taken into consideration.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108564"},"PeriodicalIF":1.8,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323281","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}