Pub Date : 2025-02-01DOI: 10.1016/j.clineuro.2024.108708
Beatriz A. Anjos G. Veiga , Carolina Candeias da Silva , Roberta Arb Saba , Sonia Maria C.A. Silva , Henrique Ballalai Ferraz , Vanderci Borges
Purpose of this research
To study the association between ICBs and LIDs and to assess the predictors of ICBs in this sample.
Methods
We intentionally evaluated 90 Brazilian PD patients younger than 60 in one evaluation that included the application of Questionnaire for Impulsive Compulsive Disorders - Current Short (QUIP-CS), Barratt Impulsive Scale-11 (BIS-11), Beck Depression Inventory-II (BDI-II), Unified Parkinson's Disease Rating Scale parts III and IV, Unified Dyskinesia Rating Scale (UDysRS), and a cognitive assessment.
Results
ICB group had a longer PD duration (8.8 ± 5.2 y vs. 6.3 ± 3.3 y, p = 0.01), higher LEDDs (852.1 ± 381.8 mg vs.669.8 ± 404.4 mg, p = 0.03), higher BIS-11 scores (64.3 ± 12.7 vs. 58.6 ± 9.7, p = 0.01) and higher historical off-dystonia sub-scores (3.9 ± 5.0 vs. 2.0 ± 4.0, p = 0,05). LIDs did not increase ICB risk, older PD onset decreased, and impulsivity previous to PD increased ICB risk in both logistic models performed. MCI did not relate to ICBs.
Conclusion
In this study, LIDs did not increase ICB risk, older PD onset decreased, and impulsivity previous to PD increased ICB risk.
本研究的目的：研究ICBs与lid之间的关系，并评估该样本中ICBs的预测因素。方法：我们对90名年龄小于60岁的巴西PD患者进行了一次评估，包括使用冲动强迫症问卷-电流短量表（QUIP-CS）、Barratt冲动量表-11 （BIS-11）、Beck抑郁量表- ii （BDI-II）、统一帕金森病评定量表第三部分和第四部分、统一运动障碍评定量表（UDysRS）和认知评估。结果:正月十五组PD持续时间较长(8.8 ±5.2 y和6.3 ±3.3 y, p = 0.01),高LEDDs( 852.1±381.8 mg vs.669.8 ±404.4 mg, p = 0.03),更高的BIS-11分数(64.3 ± 12.7 vs 58.6 ± 9.7,p = 0.01)和更高的历史off-dystonia小分(3.9 ± 5.0 vs 2.0 ± 4.0,p = 0 05)。在两种逻辑模型中，盖子没有增加ICB风险，老年PD发病降低，PD之前的冲动性增加了ICB风险。MCI与ICBs无关。结论：在本研究中，盖子没有增加ICB风险，老年PD发病降低，而PD前的冲动性增加了ICB风险。
{"title":"Are impulsive compulsive behaviors associated with levodopa-induced dyskinesia? A Brazilian cross-sectional study","authors":"Beatriz A. Anjos G. Veiga , Carolina Candeias da Silva , Roberta Arb Saba , Sonia Maria C.A. Silva , Henrique Ballalai Ferraz , Vanderci Borges","doi":"10.1016/j.clineuro.2024.108708","DOIUrl":"10.1016/j.clineuro.2024.108708","url":null,"abstract":"<div><h3>Purpose of this research</h3><div>To study the association between ICBs and LIDs and to assess the predictors of ICBs in this sample.</div></div><div><h3>Methods</h3><div>We intentionally evaluated 90 Brazilian PD patients younger than 60 in one evaluation that included the application of Questionnaire for Impulsive Compulsive Disorders - Current Short (QUIP-CS), Barratt Impulsive Scale-11 (BIS-11), Beck Depression Inventory-II (BDI-II), Unified Parkinson's Disease Rating Scale parts III and IV, Unified Dyskinesia Rating Scale (UDysRS), and a cognitive assessment.</div></div><div><h3>Results</h3><div>ICB group had a longer PD duration (8.8 ± 5.2 y vs. 6.3 ± 3.3 y, p = 0.01), higher LEDDs (852.1 ± 381.8 mg vs.669.8 ± 404.4 mg, p = 0.03), higher BIS-11 scores (64.3 ± 12.7 vs. 58.6 ± 9.7, p = 0.01) and higher historical off-dystonia sub-scores (3.9 ± 5.0 vs. 2.0 ± 4.0, p = 0,05). LIDs did not increase ICB risk, older PD onset decreased, and impulsivity previous to PD increased ICB risk in both logistic models performed. MCI did not relate to ICBs.</div></div><div><h3>Conclusion</h3><div>In this study, LIDs did not increase ICB risk, older PD onset decreased, and impulsivity previous to PD increased ICB risk.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108708"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926781","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 : 2025-02-01DOI: 10.1016/j.clineuro.2025.108726
Harshal A. Shah , Laura Mittelman , Souvik Singha , Rosivel Galvez , Julianna Cavallaro , Beril Yaffe , Grace Huang , Justin W. Silverstein , Randy S. D’Amico
Supplementary motor area (SMA) syndrome is characterized by contralateral akinesia and mutism, and frequently occurs following resection of tumors involving the superior frontal gyrus. The frontal aslant tract (FAT), involved in functional connectivity of the supplementary area and other related large-scale brain networks, is implicated in the pathogenesis of, and recovery from, SMA syndrome. However, intraoperative neuromonitoring of the FAT is inconsistent and poorly reproducible, leading to a high rate of postoperative SMA syndrome. We report the cases of two patients harboring lesions of the superior frontal gyrus: one cavernoma and one low grade glioma. Connectome imaging revealed involvement of functional networks implicated in SMA syndrome, as well as displacement of the FAT. A connectome-guided awake craniotomy was performed in both cases, and a combinatorial approach using awake language mapping and connectome-imaging guidance facilitated gross total resection of both patient’s lesions without inducing SMA syndrome postoperatively. Functional and structural connectivity imaging through connectomics allows the identification of areas not traditionally considered eloquent, such as the SMA and FAT, and can help facilitate their preservation. Conserving the functional and structural connectivity of broader brain regions that are not traditionally deemed eloquent can improve patient outcomes.
{"title":"Connectome imaging to facilitate preservation of the frontal aslant tract","authors":"Harshal A. Shah , Laura Mittelman , Souvik Singha , Rosivel Galvez , Julianna Cavallaro , Beril Yaffe , Grace Huang , Justin W. Silverstein , Randy S. D’Amico","doi":"10.1016/j.clineuro.2025.108726","DOIUrl":"10.1016/j.clineuro.2025.108726","url":null,"abstract":"<div><div>Supplementary motor area (SMA) syndrome is characterized by contralateral akinesia and mutism, and frequently occurs following resection of tumors involving the superior frontal gyrus. The frontal aslant tract (FAT), involved in functional connectivity of the supplementary area and other related large-scale brain networks, is implicated in the pathogenesis of, and recovery from, SMA syndrome. However, intraoperative neuromonitoring of the FAT is inconsistent and poorly reproducible, leading to a high rate of postoperative SMA syndrome. We report the cases of two patients harboring lesions of the superior frontal gyrus: one cavernoma and one low grade glioma. Connectome imaging revealed involvement of functional networks implicated in SMA syndrome, as well as displacement of the FAT. A connectome-guided awake craniotomy was performed in both cases, and a combinatorial approach using awake language mapping and connectome-imaging guidance facilitated gross total resection of both patient’s lesions without inducing SMA syndrome postoperatively. Functional and structural connectivity imaging through connectomics allows the identification of areas not traditionally considered eloquent, such as the SMA and FAT, and can help facilitate their preservation. Conserving the functional and structural connectivity of broader brain regions that are not traditionally deemed eloquent can improve patient outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108726"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945794","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 : 2025-02-01DOI: 10.1016/j.clineuro.2025.108729
Anthony L. Mikula , Zach Pennington , Abdelrahman M. Hamouda , Ahmad Nassr , Brett Freedman , Arjun S. Sebastian , Benjamin D. Elder , Jeremy L. Fogelson
Objective
The purpose of this study was to evaluate the risk factors for loss of intraoperative correction, as measured by lumbar lordosis (LL), with an emphasis on rod characteristics.
Methods
A retrospective study identified patients at least 50 years of age who underwent instrumented fusion with an upper instrumented vertebrae (UIV) in the upper thoracic spine (T1-T6) or thoracolumbar junction (T10-L2) to the pelvis. Inclusion criteria included intraoperative x-rays that allowed for LL measurement, postop standing x-rays, and a minimum follow up of 24 months with the original rods still in place.
Results
One hundred and twelve patients (69 % women) were included with an average (SD) follow up of 58 months (29). Twenty-two patients (20 %) had a 10° change in LL from intraoperative to postoperative, and risk factors included a two-rod compared to multi rod (>2) construct (23 % vs 0 %, p = 0.04), male sex (34 % vs 13 %, p = 0.02), UIV near the thoracolumbar junction (28 % vs 8 %, p = 0.02), and higher L4-S1 intraoperative lordosis (41° vs 36°, p = 0.024). Forty-one patients (37 %) had a 10° change in LL at two years, and risk factors included male sex (60 % vs 26 %, p < 0.001) and a UIV near the thoracolumbar junction (48 % vs 21 %, p = 0.003).
Conclusions
Risk factors for loss of LL between intraoperative and postoperative alignment include two-rod constructs, male sex, lower UIV, and greater intraoperative LL. Multi-rod (3 +) constructs may be a modifiable surgical technique that better maintains the spinal alignment that was achieved in the operating room.
目的：本研究的目的是评估术中矫正丢失的危险因素，通过腰椎前凸（LL）来测量，重点是棒的特征。方法：一项回顾性研究确定了至少50岁的患者，他们在上胸椎（T1-T6）或胸腰椎连接处（T10-L2）与骨盆进行了固定化融合。纳入标准包括术中允许测量LL的x光片，术后站立x光片，以及至少24个月的原始杆仍在原位的随访。结果：纳入112例患者（69 %女性），平均（SD）随访58个月（29）。22例(20 %)有10°会从术中、术后的变化,和风险因素包括two-rod相比多杆(> 2)构造(23 % vs 0 % p = 0.04),男性(34 % vs 13 % p = 0.02),胸腰椎交界处附近UIV(28 % vs 8 % p = 0.02),和更高的L4-S1术中脊柱前弯症(41°vs 36°,p = 0.024)。41例患者（37 %）在两年内LL发生了10°的变化，危险因素包括男性（60 % vs 26 %,p ）。结论：术中和术后调整之间LL丢失的危险因素包括双棒结构、男性、较低的UIV和较大的术中LL。多棒（3 +）结构可能是一种可修改的手术技术，可以更好地维持在手术室中达到的脊柱对齐。
{"title":"Maintenance of intraoperative correction with multi-rod constructs in adult long construct spine fusion surgery","authors":"Anthony L. Mikula , Zach Pennington , Abdelrahman M. Hamouda , Ahmad Nassr , Brett Freedman , Arjun S. Sebastian , Benjamin D. Elder , Jeremy L. Fogelson","doi":"10.1016/j.clineuro.2025.108729","DOIUrl":"10.1016/j.clineuro.2025.108729","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to evaluate the risk factors for loss of intraoperative correction, as measured by lumbar lordosis (LL), with an emphasis on rod characteristics.</div></div><div><h3>Methods</h3><div>A retrospective study identified patients at least 50 years of age who underwent instrumented fusion with an upper instrumented vertebrae (UIV) in the upper thoracic spine (T1-T6) or thoracolumbar junction (T10-L2) to the pelvis. Inclusion criteria included intraoperative x-rays that allowed for LL measurement, postop standing x-rays, and a minimum follow up of 24 months with the original rods still in place.</div></div><div><h3>Results</h3><div>One hundred and twelve patients (69 % women) were included with an average (SD) follow up of 58 months (29). Twenty-two patients (20 %) had a 10° change in LL from intraoperative to postoperative, and risk factors included a two-rod compared to multi rod (>2) construct (23 % vs 0 %, p = 0.04), male sex (34 % vs 13 %, p = 0.02), UIV near the thoracolumbar junction (28 % vs 8 %, p = 0.02), and higher L4-S1 intraoperative lordosis (41° vs 36°, p = 0.024). Forty-one patients (37 %) had a 10° change in LL at two years, and risk factors included male sex (60 % vs 26 %, p < 0.001) and a UIV near the thoracolumbar junction (48 % vs 21 %, p = 0.003).</div></div><div><h3>Conclusions</h3><div>Risk factors for loss of LL between intraoperative and postoperative alignment include two-rod constructs, male sex, lower UIV, and greater intraoperative LL. Multi-rod (3 +) constructs may be a modifiable surgical technique that better maintains the spinal alignment that was achieved in the operating room.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108729"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945797","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 : 2025-02-01DOI: 10.1016/j.clineuro.2025.108719
Yusuf A. Rajabally , Young Gi Min
Diabetic polyneuropathy is the common neuropathy of diabetes. However, several inflammatory neuropathies may occur during diabetes. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) represents the most treatable example. There has been uncertainty about a higher risk of CIDP in subjects with diabetes. Contradicting earlier reports, subsequent epidemiological studies failed to confirm an association. However, more recent studies from different populations have shown a two-fold relative risk of concurrent diabetes with CIDP. Recognition of CIDP is important in diabetes as treatment response rates have been reported as comparable with or without diabetes. However, with diabetes, the clinical presentation of CIDP and the resulting disability may be more severe due to additional axonal loss from pre-existing diabetic polyneuropathy and delayed diagnosis. An association of nodo-paranodopathy has similarly been described with a three-fold relative risk of concurrent diabetes in seropositive subjects, particularly those harbouring anti-contactin 1 antibodies. Although rare, recognition of nodo-paranodopathy, with characteristic clinical features, in the context of diabetes is likewise important in view of treatment implications. Other inflammatory neuropathies in diabetes are the painful or painless, cervical, or lumbar, radiculoplexus neuropathies. These need distinguishing from variant, multifocal forms of CIDP, as are not treatable, although remit spontaneously over months or years. There are reports of possible association of Guillain-Barré syndrome (GBS), and particularly of greater GBS severity, with diabetes. Finally, vasculitic neuropathy may also occur in diabetes and requires early suspicion, urgent investigations and immunosuppressant treatment. As the worldwide prevalence of diabetes rises, prompt recognition of its concurrent inflammatory neuropathies, is essential.
{"title":"The overlap of diabetic and inflammatory neuropathies: Epidemiology, possible mechanisms, and treatment implications","authors":"Yusuf A. Rajabally , Young Gi Min","doi":"10.1016/j.clineuro.2025.108719","DOIUrl":"10.1016/j.clineuro.2025.108719","url":null,"abstract":"<div><div>Diabetic polyneuropathy is the common neuropathy of diabetes. However, several inflammatory neuropathies may occur during diabetes. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) represents the most treatable example. There has been uncertainty about a higher risk of CIDP in subjects with diabetes. Contradicting earlier reports, subsequent epidemiological studies failed to confirm an association. However, more recent studies from different populations have shown a two-fold relative risk of concurrent diabetes with CIDP. Recognition of CIDP is important in diabetes as treatment response rates have been reported as comparable with or without diabetes. However, with diabetes, the clinical presentation of CIDP and the resulting disability may be more severe due to additional axonal loss from pre-existing diabetic polyneuropathy and delayed diagnosis. An association of nodo-paranodopathy has similarly been described with a three-fold relative risk of concurrent diabetes in seropositive subjects, particularly those harbouring anti-contactin 1 antibodies. Although rare, recognition of nodo-paranodopathy, with characteristic clinical features, in the context of diabetes is likewise important in view of treatment implications. Other inflammatory neuropathies in diabetes are the painful or painless, cervical, or lumbar, radiculoplexus neuropathies. These need distinguishing from variant, multifocal forms of CIDP, as are not treatable, although remit spontaneously over months or years. There are reports of possible association of Guillain-Barré syndrome (GBS), and particularly of greater GBS severity, with diabetes. Finally, vasculitic neuropathy may also occur in diabetes and requires early suspicion, urgent investigations and immunosuppressant treatment. As the worldwide prevalence of diabetes rises, prompt recognition of its concurrent inflammatory neuropathies, is essential.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108719"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969893","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 : 2025-02-01DOI: 10.1016/j.clineuro.2025.108741
Julia Araújo de Moura , Leonardo Augusto da Costa Teixeira , Wesley Tanor , Ana Cristina Rodrigues Lacerda , Rinaldo André Mezzarane
Introduction
The prevalence of multiple sclerosis has been increased worldwide. However, no update on the prevalence of multiple sclerosis in Brazil has been conducted since 2015
Objective
The aim of the present review is to perform an update of the multiple sclerosis prevalence in Brazil as well as to analyze its current epidemiological profile
Methods
We searched for studies on the multiple sclerosis prevalence in Brazil. The databases researched were Medline (PubMed), Embase, Scielo, Scopus and Web of Science using the keywords “prevalence”, “prevalence study”, “incidence”, “epidemiology”, “multiple sclerosis” and “Brazil”
Results
Eleven studies were included for descriptive and quantitative analysis. The pooled prevalence of multiple sclerosis in Brazil estimates 14.5 cases per 100.000 inhabitants. It is more prevalent in white people (74 %) and female (76.3 %). The most prevalent clinical form is the relapsing-remitting form (80.2 %), followed by the secondary progressive form (13 %) and by the primary progressive form (6.8 %)
Conclusion
Although the prevalence of multiple sclerosis in Brazil varies substantially between regions, it is in accordance with what is known in the world. However, there is a lack of recent epidemiological studies of multiple sclerosis in Brazil and more studies are needed for better accuracy and comprehension of its prevalence.
简介：多发性硬化症的患病率在世界范围内呈上升趋势。然而，自2015年以来，没有对巴西多发性硬化症的患病率进行更新。目的：本综述的目的是对巴西多发性硬化症的患病率进行更新，并分析其当前的流行病学概况。使用关键词“患病率”、“患病率研究”、“发病率”、“流行病学”、“多发性硬化症”和“巴西”，检索Medline （PubMed）、Embase、Scielo、Scopus和Web of Science数据库。结果：纳入11项研究进行描述性和定量分析。巴西多发性硬化症的总患病率估计为每10万居民14.5例。它在白人（74% %）和女性（76.3% %）中更为普遍。最常见的临床形式是复发缓解型（80.2 %），其次是继发性进展型（13 %）和原发性进展型（6.8 %）结论：尽管巴西多发性硬化症的患病率在地区之间差异很大，但与世界上已知的情况一致。然而，巴西最近缺乏多发性硬化症的流行病学研究，需要更多的研究来更好地准确和理解其患病率。
{"title":"Prevalence of multiple sclerosis in Brazil: An updated systematic review with meta-analysis","authors":"Julia Araújo de Moura , Leonardo Augusto da Costa Teixeira , Wesley Tanor , Ana Cristina Rodrigues Lacerda , Rinaldo André Mezzarane","doi":"10.1016/j.clineuro.2025.108741","DOIUrl":"10.1016/j.clineuro.2025.108741","url":null,"abstract":"<div><h3>Introduction</h3><div>The prevalence of multiple sclerosis has been increased worldwide. However, no update on the prevalence of multiple sclerosis in Brazil has been conducted since 2015</div></div><div><h3>Objective</h3><div>The aim of the present review is to perform an update of the multiple sclerosis prevalence in Brazil as well as to analyze its current epidemiological profile</div></div><div><h3>Methods</h3><div>We searched for studies on the multiple sclerosis prevalence in Brazil. The databases researched were Medline (PubMed), Embase, Scielo, Scopus and Web of Science using the keywords “prevalence”, “prevalence study”, “incidence”, “epidemiology”, “multiple sclerosis” and “Brazil”</div></div><div><h3>Results</h3><div>Eleven studies were included for descriptive and quantitative analysis. The pooled prevalence of multiple sclerosis in Brazil estimates 14.5 cases per 100.000 inhabitants. It is more prevalent in white people (74 %) and female (76.3 %). The most prevalent clinical form is the relapsing-remitting form (80.2 %), followed by the secondary progressive form (13 %) and by the primary progressive form (6.8 %)</div></div><div><h3>Conclusion</h3><div>Although the prevalence of multiple sclerosis in Brazil varies substantially between regions, it is in accordance with what is known in the world. However, there is a lack of recent epidemiological studies of multiple sclerosis in Brazil and more studies are needed for better accuracy and comprehension of its prevalence.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108741"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001186","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 : 2025-02-01DOI: 10.1016/j.clineuro.2025.108753
Liang Zhang , Bo Han , Wenqing Jia
Purpose
Hemangioblastomas (HBs) occurring in the cervical spinal region are infrequently reported. Surgical resection of cervical HBs poses a significant challenge, and the long-term therapeutic outcomes remain unclear.
Methods
A comprehensive retrospective analysis was conducted to review the treatment outcomes of patients with cervical HBs from 2011 to 2021. Patients with detailed preoperative clinical and radiological information, as well as follow-up data, were included in this study.
Results
One hundred six adult patients were enrolled, with a mean age of 37.4 ± 15.6 years (range: 18–68 years), and a male predominance of 58.5 %. Thirty-two patients (30.2 %) had von Hippel-Lindau (VHL) disease. VHL-associated patients were younger (p = 0.023), had a shorter duration of symptoms (p = 0.004), and had smaller lesion size (p = 0.039) compared to the sporadic group. Fourteen patients (13.2 %) experienced immediate postoperative deterioration. During long-term follow-up, 35 patients (33.0 %) improved, 57 patients (53.8 %) remained stable. 8 patients (7.5 %) worsened compared to baseline, and 6 patients (5.7 %) died. A recurrent HBs (p = 0.027), ventral location (p = 0.046), and worsened immediately after surgery (p = 0.001) were statistically significant indicators for unfavorable outcomes in multivariate analysis.
Conclusion
Surgical resection of cervical spinal HBs can achieve favorable long-term outcomes in most cases, although neurological deterioration may occur immediately after surgery. Postoperative deficits occur in 13.2 % patients, and the incidence of respiratory insufficiency is relatively low. A recurrent HBs, ventral location, and worsened immediately after surgery were indicators for unfavorable outcomes.
{"title":"Long-term surgical outcomes and prognosis of cervical spinal hemangioblastomas","authors":"Liang Zhang , Bo Han , Wenqing Jia","doi":"10.1016/j.clineuro.2025.108753","DOIUrl":"10.1016/j.clineuro.2025.108753","url":null,"abstract":"<div><h3>Purpose</h3><div>Hemangioblastomas (HBs) occurring in the cervical spinal region are infrequently reported. Surgical resection of cervical HBs poses a significant challenge, and the long-term therapeutic outcomes remain unclear.</div></div><div><h3>Methods</h3><div>A comprehensive retrospective analysis was conducted to review the treatment outcomes of patients with cervical HBs from 2011 to 2021. Patients with detailed preoperative clinical and radiological information, as well as follow-up data, were included in this study.</div></div><div><h3>Results</h3><div>One hundred six adult patients were enrolled, with a mean age of 37.4 ± 15.6 years (range: 18–68 years), and a male predominance of 58.5 %. Thirty-two patients (30.2 %) had von Hippel-Lindau (VHL) disease. VHL-associated patients were younger (p = 0.023), had a shorter duration of symptoms (p = 0.004), and had smaller lesion size (p = 0.039) compared to the sporadic group. Fourteen patients (13.2 %) experienced immediate postoperative deterioration. During long-term follow-up, 35 patients (33.0 %) improved, 57 patients (53.8 %) remained stable. 8 patients (7.5 %) worsened compared to baseline, and 6 patients (5.7 %) died. A recurrent HBs (p = 0.027), ventral location (p = 0.046), and worsened immediately after surgery (p = 0.001) were statistically significant indicators for unfavorable outcomes in multivariate analysis.</div></div><div><h3>Conclusion</h3><div>Surgical resection of cervical spinal HBs can achieve favorable long-term outcomes in most cases, although neurological deterioration may occur immediately after surgery. Postoperative deficits occur in 13.2 % patients, and the incidence of respiratory insufficiency is relatively low. A recurrent HBs, ventral location, and worsened immediately after surgery were indicators for unfavorable outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108753"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022163","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 : 2025-02-01DOI: 10.1016/j.clineuro.2024.108686
Ritesh Karsalia , Austin J. Borja , Emily Xu , Ryan S. Gallagher , Jianbo Na , Scott D. McClintock , Paul J. Marcotte , Ali K. Ozturk , James M. Schuster , Jon J.W. Yoon , Neil R. Malhotra
Objective
The aim of this study was to assess for a “July Effect” by comparing exact matched patients undergoing single-level spinal fusions in July or in the latter half of the academic year.
Methods
Data from 2338 patients who underwent single-level, posterior-only lumbar fusion at a single, multicenter university hospital system were retrospectively reviewed.
The primary outcomes were 90-day unplanned hospital readmissions, Emergency Department (ED) evaluations, reoperations, non-home discharge, and all-cause mortality. The secondary outcomes assessed include length of hospital stay, main procedure time, procedure closure time, and total surgery duration. Outcomes of surgeries at the beginning (July) of the academic year were compared to those at the end of the year (April-June).
Results
Across 2338 patients, operative month had no effect on 90-day readmissions, ED visits, reoperations, mortality, or non-home discharge. Patients undergoing surgery in July vs April–June had a significantly longer mean procedure time, procedure closure time, and total duration of surgery, but not hospital length of stay. Among patients whom were exact matched, surgeries in July vs April–June had a significantly longer mean procedure closure time, but no significant differences in primary procedure time, total surgical duration, or length of stay in hospital.
Conclusions
Single level spinal fusion wound closure times are longer in July but postoperative morbidity and mortality are unchanged throughout the academic year. These findings support the current literature that teaching hospitals, and senior surgeons, provide adequate safeguards to ensure patient safety at all times.
{"title":"The \"July Effect\" scrutinized: A coarsened-exact match analysis of lumbar fusion outcomes during resident transition","authors":"Ritesh Karsalia , Austin J. Borja , Emily Xu , Ryan S. Gallagher , Jianbo Na , Scott D. McClintock , Paul J. Marcotte , Ali K. Ozturk , James M. Schuster , Jon J.W. Yoon , Neil R. Malhotra","doi":"10.1016/j.clineuro.2024.108686","DOIUrl":"10.1016/j.clineuro.2024.108686","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to assess for a “July Effect” by comparing exact matched patients undergoing single-level spinal fusions in July or in the latter half of the academic year.</div></div><div><h3>Methods</h3><div>Data from 2338 patients who underwent single-level, posterior-only lumbar fusion at a single, multicenter university hospital system were retrospectively reviewed.</div><div>The primary outcomes were 90-day unplanned hospital readmissions, Emergency Department (ED) evaluations, reoperations, non-home discharge, and all-cause mortality. The secondary outcomes assessed include length of hospital stay, main procedure time, procedure closure time, and total surgery duration. Outcomes of surgeries at the beginning (July) of the academic year were compared to those at the end of the year (April-June).</div></div><div><h3>Results</h3><div>Across 2338 patients, operative month had no effect on 90-day readmissions, ED visits, reoperations, mortality, or non-home discharge. Patients undergoing surgery in July vs April–June had a significantly longer mean procedure time, procedure closure time, and total duration of surgery, but not hospital length of stay. Among patients whom were exact matched, surgeries in July vs April–June had a significantly longer mean procedure closure time, but no significant differences in primary procedure time, total surgical duration, or length of stay in hospital.</div></div><div><h3>Conclusions</h3><div>Single level spinal fusion wound closure times are longer in July but postoperative morbidity and mortality are unchanged throughout the academic year. These findings support the current literature that teaching hospitals, and senior surgeons, provide adequate safeguards to ensure patient safety at all times.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108686"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827353","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 : 2025-02-01DOI: 10.1016/j.clineuro.2024.108690
Cláudia Santos Silva , Beatriz Nunes Vicente , Bárbara Martins , Ana Cláudia Fonseca , Pedro Coelho , Rafael Roque , Fábio Cota de Medeiros , Miguel Oliveira Santos , Mamede de Carvalho
Objective
To present cases of ptosis in HIV-1 patients on long-term antiretroviral therapy (ART) and review the existing literature.
Methods
Five HIV-1-positive patients with slowly progressive bilateral ptosis underwent a comprehensive diagnostic evaluation, including imaging studies, neurophysiological testing, muscle biopsy, and genetic analysis. A literature review was conducted.
Results
On clinical examination, all patients presented with bilateral symmetrical non-fatigable ptosis, three exhibited facial lipoatrophy and two also had mild multidirectional ophthalmoparesis and all had ocular abnormalities in Hess screen test. Additionally, one patient displayed proptosis, three had floppy lower eyelids, and four presented with exotropia. Anti-acetylcholine receptor antibodies were negative in all patients. Brain magnetic resonance imaging (MRI), motor unit potential analysis, and single-fiber electromyography were unremarkable. Orbital MRI revealed introrbital fat expansion in one patient, and limb muscle biopsies were inconclusive in two cases. Blood genetic testing for chronic progressive external ophthalmoplegia was negative in all patients. A total of 30 similar cases have been documented in the literature, with some studies reporting key findings such as muscle histology indicative of mitochondrial myopathy, MRI revealing patchy extraocular muscle hyperintensity, and muscle genetic testing identifying mitochondrial deoxyribonucleic acid (DNA) deletions. Ptosis surgical repair appears to be the most effective treatment.
Conclusion
HIV patients on long-term ART may develop ocular muscle involvement due to mitochondrial dysfunction, with bilateral ptosis being the primary manifestation. Diagnosis is challenging and requires the exclusion of other conditions. Ptosis surgery can significantly improve quality of life.
{"title":"Ptosis in human immunodeficiency virus-infected patients under long-term antiretroviral treatment","authors":"Cláudia Santos Silva , Beatriz Nunes Vicente , Bárbara Martins , Ana Cláudia Fonseca , Pedro Coelho , Rafael Roque , Fábio Cota de Medeiros , Miguel Oliveira Santos , Mamede de Carvalho","doi":"10.1016/j.clineuro.2024.108690","DOIUrl":"10.1016/j.clineuro.2024.108690","url":null,"abstract":"<div><h3>Objective</h3><div>To present cases of ptosis in HIV-1 patients on long-term antiretroviral therapy (ART) and review the existing literature.</div></div><div><h3>Methods</h3><div>Five HIV-1-positive patients with slowly progressive bilateral ptosis underwent a comprehensive diagnostic evaluation, including imaging studies, neurophysiological testing, muscle biopsy, and genetic analysis. A literature review was conducted.</div></div><div><h3>Results</h3><div>On clinical examination, all patients presented with bilateral symmetrical non-fatigable ptosis, three exhibited facial lipoatrophy and two also had mild multidirectional ophthalmoparesis and all had ocular abnormalities in Hess screen test. Additionally, one patient displayed proptosis, three had floppy lower eyelids, and four presented with exotropia. Anti-acetylcholine receptor antibodies were negative in all patients. Brain magnetic resonance imaging (MRI), motor unit potential analysis, and single-fiber electromyography were unremarkable. Orbital MRI revealed introrbital fat expansion in one patient, and limb muscle biopsies were inconclusive in two cases. Blood genetic testing for chronic progressive external ophthalmoplegia was negative in all patients. A total of 30 similar cases have been documented in the literature, with some studies reporting key findings such as muscle histology indicative of mitochondrial myopathy, MRI revealing patchy extraocular muscle hyperintensity, and muscle genetic testing identifying mitochondrial deoxyribonucleic acid (DNA) deletions. Ptosis surgical repair appears to be the most effective treatment.</div></div><div><h3>Conclusion</h3><div>HIV patients on long-term ART may develop ocular muscle involvement due to mitochondrial dysfunction, with bilateral ptosis being the primary manifestation. Diagnosis is challenging and requires the exclusion of other conditions. Ptosis surgery can significantly improve quality of life.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108690"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892742","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 : 2025-02-01DOI: 10.1016/j.clineuro.2025.108762
Ibrahim Mohammadzadeh , Behnaz Niroomand , Bardia Hajikarimloo , Mohammad Amin Habibi , Ali Mortezaei , Jina Behjati , Abdulrahman Albakr , Hamid Borghei-Razavi
Early prediction of recurrence in high-grade glioma (HGG) is critical due to its aggressive nature and poor prognosis. Distinguishing true recurrence from treatment-related changes, such as radionecrosis, is a major diagnostic challenge. Machine learning (ML) offers a novel approach, leveraging advanced algorithms to analyze complex imaging data with high precision. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and Google Scholar identified eligible studies. The sensitivity, specificity, accuracy, precision, F1 score, and the (area under the curve) AUC items were extracted from the included studies. After screening 1077 records, seven studies met the eligibility criteria for the systematic review, of which five were included in the meta-analysis. ML algorithm, particularly Support Vector Machines (SVM), demonstrated promising performance. A meta-analysis of five studies revealed a pooled sensitivity of 0.95 (95% CI: 0.84–0.99) and specificity of 0.80 (95% CI: 0.69–0.88). Additionally, the positive diagnostic likelihood ratio (DLR) was 4.75 (95% CI: 2.91–7.76), the negative DLR was 0.06 (95% CI: 0.02–0.21), and the diagnostic odds ratio was 80.97 (95% CI: 17.5–374.61). The diagnostic score was calculated as 4.39 (95% CI: 2.86–5.93), and the AUC was 0.86 (95% CI: 0.83–0.89). Subgroup analyses showed SVM-based models with higher sensitivity (0.98 vs. 0.87) and specificity (0.82 vs. 0.77) than non-SVM (p = 0.13). Comparing glioblastoma and Grade 3 tumors, sensitivities were 94 % vs. 97 %, and specificities were 79 % vs. 83 %, with no significant heterogeneity. These findings suggest that ML models, particularly SVM, offer promising diagnostic performance in distinguishing true tumor recurrence from treatment-related changes.
{"title":"Can we rely on machine learning algorithms as a trustworthy predictor for recurrence in high-grade glioma? A systematic review and meta-analysis","authors":"Ibrahim Mohammadzadeh , Behnaz Niroomand , Bardia Hajikarimloo , Mohammad Amin Habibi , Ali Mortezaei , Jina Behjati , Abdulrahman Albakr , Hamid Borghei-Razavi","doi":"10.1016/j.clineuro.2025.108762","DOIUrl":"10.1016/j.clineuro.2025.108762","url":null,"abstract":"<div><div>Early prediction of recurrence in high-grade glioma (HGG) is critical due to its aggressive nature and poor prognosis. Distinguishing true recurrence from treatment-related changes, such as radionecrosis, is a major diagnostic challenge. Machine learning (ML) offers a novel approach, leveraging advanced algorithms to analyze complex imaging data with high precision. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and Google Scholar identified eligible studies. The sensitivity, specificity, accuracy, precision, F1 score, and the (area under the curve) AUC items were extracted from the included studies. After screening 1077 records, seven studies met the eligibility criteria for the systematic review, of which five were included in the meta-analysis. ML algorithm, particularly Support Vector Machines (SVM), demonstrated promising performance. A meta-analysis of five studies revealed a pooled sensitivity of 0.95 (95% CI: 0.84–0.99) and specificity of 0.80 (95% CI: 0.69–0.88). Additionally, the positive diagnostic likelihood ratio (DLR) was 4.75 (95% CI: 2.91–7.76), the negative DLR was 0.06 (95% CI: 0.02–0.21), and the diagnostic odds ratio was 80.97 (95% CI: 17.5–374.61). The diagnostic score was calculated as 4.39 (95% CI: 2.86–5.93), and the AUC was 0.86 (95% CI: 0.83–0.89). Subgroup analyses showed SVM-based models with higher sensitivity (0.98 vs. 0.87) and specificity (0.82 vs. 0.77) than non-SVM (p = 0.13). Comparing glioblastoma and Grade 3 tumors, sensitivities were 94 % vs. 97 %, and specificities were 79 % vs. 83 %, with no significant heterogeneity. These findings suggest that ML models, particularly SVM, offer promising diagnostic performance in distinguishing true tumor recurrence from treatment-related changes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108762"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063988","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}
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