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Does Every Subdural Hematoma Patient Need an Embolization? 是否每位硬膜下血肿患者都需要栓塞治疗?
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-16 DOI: 10.1007/s00062-024-01425-z
Jens Fiehler, Matthias Bechstein
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引用次数: 0
Is Neuroradiology Complementary to Histopathology in Central Nervous System Tumors with an Alteration of the BCOR Gene? 在 BCOR 基因发生改变的中枢神经系统肿瘤中,神经放射学是否是组织病理学的补充?
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-06-01 Epub Date: 2023-12-21 DOI: 10.1007/s00062-023-01367-y
A Nikoghosyan, R Sciot, S A Jacobs, B F J Verhaaren
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引用次数: 0
Freiburg Neuropathology Case Conference : A 54-Years-Old Patient with Fatigue, Headaches, and Personality Changes. 弗莱堡神经病理学病例会议:一名 54 岁的患者,伴有疲劳、头痛和性格改变。
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-16 DOI: 10.1007/s00062-024-01419-x
M Frosch, A J Braun, J Grauvogel, M Prinz, H Urbach, D Erny, C A Taschner
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引用次数: 0
Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions: Results of an International Multicentric Study 中血管闭塞血管内治疗中全身麻醉与意识镇静的疗效比较:一项国际多中心研究的结果
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-30 DOI: 10.1007/s00062-024-01415-1
Răzvan Alexandru Radu, Vincent Costalat, Michele Romoli, Basel Musmar, James E. Siegler, Sherief Ghozy, Jane Khalife, Hamza Salim, Hamza Shaikh, Nimer Adeeb, Hugo H. Cuellar-Saenz, Ajith J. Thomas, Ramanathan Kadirvel, Mohamad Abdalkader, Piers Klein, Thanh N. Nguyen, Jeremy J. Heit, Robert W. Regenhardt, Joshua D. Bernstock, Aman B. Patel, James D. Rabinov, Christopher J. Stapleton, Nicole M. Cancelliere, Thomas R. Marotta, Vitor Mendes Pereira, Kareem El Naamani, Abdelaziz Amllay, Stavropoula I. Tjoumakaris, Pascal Jabbour, Lukas Meyer, Jens Fiehler, Tobias D. Faizy, Helena Guerreiro, Anne Dusart, Flavio Bellante, Géraud Forestier, Aymeric Rouchaud, Charbel Mounayer, Anna Luisa Kühn, Ajit S. Puri, Christian Dyzmann, Peter T. Kan, Marco Colasurdo, Gaultier Marnat, Jérôme Berge, Xavier Barreau, Igor Sibon, Simona Nedelcu, Nils Henninger, Takahiro Ota, Shogo Dofuku, Leonard L. L. Yeo, Benjamin YQ Tan, Anil Gopinathan, Juan Carlos Martinez-Gutierrez, Sergio Salazar-Marioni, Sun..

Background

Optimal anesthetic strategy for the endovascular treatment of stroke is still under debate. Despite scarce data concerning anesthetic management for medium and distal vessel occlusions (MeVOs) some centers empirically support a general anesthesia (GA) strategy in these patients.

Methods

We conducted an international retrospective study of MeVO cases. A propensity score matching algorithm was used to mitigate potential differences across patients undergoing GA and conscious sedation (CS). Comparisons in clinical and safety outcomes were performed between the two study groups GA and CS. The favourable outcome was defined as a modified Rankin Scale (mRS) 0–2 at 90 days. Safety outcomes were 90-days mortality and symptomatic intracranial hemorrhage (sICH). Predictors of a favourable outcome and sICH were evaluated with backward logistic regression.

Results

After propensity score matching 668 patients were included in the CS and 264 patients in the GA group. In the matched cohort, either strategy CS or GA resulted in similar rates of good functional outcomes (50.1% vs. 48.4%), and successful recanalization (89.4% vs. 90.2%). The GA group had higher rates of 90-day mortality (22.6% vs. 16.5%, p < 0.041) and sICH (4.2% vs. 0.9%, p = 0.001) compared to the CS group. Backward logistic regression did not identify GA vs CS as a predictor of good functional outcome (OR for GA vs CS = 0.95 (0.67–1.35)), but GA remained a significant predictor of sICH (OR = 5.32, 95% CI 1.92–14.72).

Conclusion

Anaesthetic strategy in MeVOs does not influence favorable outcomes or final successful recanalization rates, however, GA may be associated with an increased risk of sICH and mortality.

背景中风血管内治疗的最佳麻醉策略仍存在争议。尽管有关中远端血管闭塞(MeVO)麻醉管理的数据很少,但一些中心经验性地支持对这些患者采用全身麻醉(GA)策略。我们对 MeVO 病例进行了国际回顾性研究,采用倾向评分匹配算法来减少接受全身麻醉和有意识镇静(CS)的患者之间的潜在差异。对GA和CS两个研究组的临床和安全性结果进行了比较。良好结果的定义是 90 天后修改后的 Rankin 量表(mRS)为 0-2。安全性结果为90天死亡率和症状性颅内出血(sICH)。结果经过倾向评分匹配后,668 名患者被纳入 CS 组,264 名患者被纳入 GA 组。在匹配队列中,无论是 CS 还是 GA,良好功能预后率(50.1% vs. 48.4%)和成功再通率(89.4% vs. 90.2%)均相似。与 CS 组相比,GA 组的 90 天死亡率(22.6% 对 16.5%,P = 0.041)和 sICH(4.2% 对 0.9%,P = 0.001)较高。后向逻辑回归并未发现 GA vs CS 是良好功能预后的预测因素(GA vs CS 的 OR = 0.95 (0.67-1.35)),但 GA 仍是 sICH 的重要预测因素(OR = 5.32,95% CI 1.92-14.72)。
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引用次数: 0
Endovascular Thrombectomy for Large Ischemic Strokes with ASPECTS 0–2: a Meta-analysis of Randomized Controlled Trials 针对 ASPECTS 0-2 大面积缺血性脑卒中的血管内血栓切除术:随机对照试验的 Meta 分析
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-30 DOI: 10.1007/s00062-024-01414-2
Laurens Winkelmeier, Máté Maros, Fabian Flottmann, Christian Heitkamp, Gerhard Schön, Götz Thomalla, Jens Fiehler, Uta Hanning

Purpose

Randomized controlled trials (RCTs) demonstrated a treatment effect of endovascular thrombectomy in acute ischemic stroke with large infarct, commonly defined as an Alberta Stroke Program Early CT Score (ASPECTS) of 3–5. However, data on endovascular thrombectomy in patients with very low ASPECTS of 0–2 remain scarce.

Methods

We conducted a systematic review and meta-analysis of RCTs comparing endovascular thrombectomy versus medical treatment alone in acute ischemic anterior circulation stroke with very large infarct, defined as ASPECTS of 0–2. The primary outcome was the shift toward better functional outcomes on the 90-day modified Rankin Scale (mRS). Random effects meta-analysis was performed using the generic inverse variance method.

Results

Literature research identified four RCTs which evaluated the treatment effect of endovascular thrombectomy for large infarcts and provided a subgroup analysis of the mRS shift in patients with ASPECTS of 0–2. The pooled analysis showed a significant shift toward better 90-day mRS scores in favor of endovascular thrombectomy (pooled odds ratio, 1.62, 95% confidence interval, 1.29–2.04, P < 0.001).

Conclusion

This meta-analysis suggests a treatment effect of endovascular thrombectomy in specific patients with very low ASPECTS of 0–2, challenging the use of ASPECTS for treatment selection in acute ischemic stroke due to large vessel occlusion. An individual patient meta-analysis of RCTs would strengthen evidence in the treatment of patients with ASPECTS of 0–2.

Graphic abstract

目的 随机对照试验(RCT)显示,血管内血栓切除术对急性缺血性卒中大面积梗死(通常定义为阿尔伯塔卒中计划早期 CT 评分(ASPECTS)3-5 分)有治疗效果。方法我们进行了一项系统性回顾和荟萃分析,比较了在急性缺血性前循环卒中伴有大面积梗死(定义为 ASPECTS 为 0-2)时进行血管内血栓切除术与单纯药物治疗的 RCT。主要结果是 90 天改良 Rankin 量表(mRS)的功能转归更好。结果文献研究确定了四项RCT研究,这些研究评估了血管内血栓切除术对大面积心梗的治疗效果,并对ASPECTS为0-2的患者的mRS变化进行了亚组分析。结论该荟萃分析表明,血管内血栓切除术对 ASPECTS 为 0-2 的极低患者有治疗效果,这对使用 ASPECTS 选择大血管闭塞所致急性缺血性卒中的治疗方法提出了挑战。对 RCT 进行个体患者荟萃分析将加强 ASPECTS 为 0-2 的患者的治疗证据。
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引用次数: 0
Advanced diffusion MRI provides evidence for altered axonal microstructure and gradual peritumoral infiltration in GBM in comparison to brain metastases 与脑转移瘤相比,高级弥散核磁共振成像为 GBM 的轴突微结构改变和瘤周逐渐浸润提供了证据
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-29 DOI: 10.1007/s00062-024-01416-0
U. Würtemberger, A. Rau, M. Diebold, L. Becker, M. Hohenhaus, J. Beck, P. C. Reinacher, D. Erny, M. Reisert, H. Urbach, T. Demerath

Purpose

In contrast to peritumoral edema in metastases, GBM is histopathologically characterized by infiltrating tumor cells within the T2 signal alterations. We hypothesized that depending on the distance from the outline of the contrast-enhancing tumor we might reveal imaging evidence of gradual peritumoral infiltration in GBM and predominantly vasogenic edema around metastases. We thus investigated the gradual change of advanced diffusion metrics with the peritumoral zone in metastases and GBM.

Methods

In 30 patients with GBM and 28 with brain metastases, peritumoral T2 hyperintensity was segmented in 33% partitions based on the total volume beginning at the enhancing tumor margin and divided into inner, middle and outer zones. Diffusion Tensor Imaging (DTI)-derived fractional anisotropy and mean diffusivity as well as Diffusion Microstructure Imaging (DMI)-based parameters Dax-intra, Dax-extra, V‑CSF and V-intra were employed to assess group-wise differences between inner and outer zones as well as within-group gradients between the inner and outer zones.

Results

In metastases, fractional anisotropy and Dax-extra were significantly reduced in the inner zone compared to the outer zone (FA p = 0.01; Dax-extra p = 0.03). In GBM, we noted a reduced Dax-extra and significantly lower intraaxonal volume fraction (Dax-extra p = 0.008, V‑intra p = 0.006) accompanied by elevated axial intraaxonal diffusivity in the inner zone (p = 0.035). Between-group comparison of the outer to the inner zones revealed significantly higher gradients in metastases over GBM for FA (p = 0.04) as well as the axial diffusivity in the intra- (p = 0.02) and extraaxonal compartment (p < 0.001).

Conclusion

Our findings provide evidence of gradual alterations within the peritumoral zone of brain tumors. These are compatible with predominant (vasogenic) edema formation in metastases, whereas our findings in GBM are in line with an axonal destructive component in the immediate peritumoral area and evidence of tumor cell infiltration with accentuation in the tumor’s vicinity.

目的与转移瘤的瘤周水肿不同,GBM 的组织病理学特征是 T2 信号改变内有浸润的肿瘤细胞。我们假设,根据与造影剂增强肿瘤轮廓的距离,我们可能会发现 GBM 肿瘤周围逐渐浸润的成像证据,而转移瘤周围主要是血管源性水肿。方法 在 30 例 GBM 患者和 28 例脑转移瘤患者中,根据从增强肿瘤边缘开始的总体积,将瘤周 T2 高密度划分为 33% 的区域,并分为内区、中区和外区。采用弥散张量成像(DTI)得出的分数各向异性和平均扩散率以及基于弥散微结构成像(DMI)的参数Dax-intra、Dax-extra、V-CSF和V-intra来评估内外区之间的组间差异以及内外区之间的组内梯度。结果在转移瘤中,与外区相比,内区的分数各向异性和 Dax-extra 明显降低(FA p = 0.01;Dax-extra p = 0.03)。在 GBM 中,我们注意到内区的 Dax-extra 减少,轴内体积分数明显降低(Dax-extra p = 0.008,V-intra p = 0.006),同时轴内扩散性升高(p = 0.035)。外区与内区的组间比较显示,转移瘤的 FA 梯度(p = 0.04)以及轴内(p = 0.02)和轴外(p < 0.001)的轴向扩散性均明显高于 GBM。这些变化与转移瘤的主要(血管源性)水肿形成相一致,而我们在 GBM 中的发现则与紧邻瘤周区域的轴突破坏性成分以及肿瘤细胞浸润的证据相一致,并且在肿瘤附近更为突出。
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引用次数: 0
Association of Imaging-based Predictors with Outcome in Different Treatment Options for Intracerebral Hemorrhage. 脑出血不同治疗方案中基于成像的预测因素与预后的关系
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-26 DOI: 10.1007/s00062-024-01406-2
R. Krzyżewski, B. Kwinta, Krzysztof Stachura, Tadeusz J Popiela, R. Pułyk, Agnieszka Słowik, Jerzy Gąsowski, K. Kliś
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引用次数: 0
Thalamo-mesencephalic Branches of the Posterior Cerebral Artery: a 3D Rotational Angiography Study. 大脑后动脉的丘脑-间脑分支:三维旋转血管造影研究。
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-26 DOI: 10.1007/s00062-024-01418-y
Maximilian Rauch, Joachim Berkefeld, Madleen Klonowski, E. Hattingen, S. Weidauer
{"title":"Thalamo-mesencephalic Branches of the Posterior Cerebral Artery: a 3D Rotational Angiography Study.","authors":"Maximilian Rauch, Joachim Berkefeld, Madleen Klonowski, E. Hattingen, S. Weidauer","doi":"10.1007/s00062-024-01418-y","DOIUrl":"https://doi.org/10.1007/s00062-024-01418-y","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"5 12","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140652983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Answer to: Complications During Ozone Therapy as a Result of Malpractice and Lack of Guidelines. 回答:臭氧治疗过程中的并发症是渎职和缺乏指导造成的。
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-23 DOI: 10.1007/s00062-024-01411-5
Daniel S. Marín-Medina, Adriana P Ortega-Quintero
{"title":"Answer to: Complications During Ozone Therapy as a Result of Malpractice and Lack of Guidelines.","authors":"Daniel S. Marín-Medina, Adriana P Ortega-Quintero","doi":"10.1007/s00062-024-01411-5","DOIUrl":"https://doi.org/10.1007/s00062-024-01411-5","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"57 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of Flow Reduction Efficacy of Nominal and Oversized Flow Diverters Using a Novel Measurement-assisted in Silico Method. 使用一种新颖的硅胶辅助测量方法,比较标称导流板和超大导流板的减流效果。
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-23 DOI: 10.1007/s00062-024-01404-4
B. Csippa, Levente Sándor, Gábor Závodszky, I. Szikora, György Paál
{"title":"Comparison of Flow Reduction Efficacy of Nominal and Oversized Flow Diverters Using a Novel Measurement-assisted in Silico Method.","authors":"B. Csippa, Levente Sándor, Gábor Závodszky, I. Szikora, György Paál","doi":"10.1007/s00062-024-01404-4","DOIUrl":"https://doi.org/10.1007/s00062-024-01404-4","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"51 17","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Clinical Neuroradiology
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