Frontiers in Neurology最新文献

Objective: This study aimed to assess the utility of lumbar lamina and ligamentum flavum boundaries as anatomical landmarks for the precise localization and resection of lumbar intraspinal schwannomas using a minimally invasive tubular approach.

Methods: We conducted a retrospective analysis of 17 patients who underwent surgical resection between September 2021 and September 2023. Preoperative imaging was used to determine the optimal lamina landmarks relative to the tumor's poles or midpoint. The boundaries or specific sites of the ligamentum flavum subsequently guided the precise drilling of the bone window. We recorded intraoperative parameters, including retractor inclination angle, operative time, and blood loss. Patient outcomes were assessed during a two-year follow-up using the Oswestry Disability Index (ODI), MRI to evaluate resection, and X-ray to assess spinal stability.

Results: All tumors were successfully resected without neurological complications. The mean operative time was 119.7 ± 14.7 min, mean blood loss was 47.1 ± 11.9 mL, and the mean retractor angle was 6.3 ± 2.5°. After a mean follow-up of 30.9 ± 1.6 months, ODI scores showed significant improvement, decreasing from 31.5 ± 5.4% to 14.9 ± 3.4%. Postoperative MRI confirmed gross-total resection in all cases, and X-rays revealed no spinal instability.

Conclusion: The boundaries of the lumbar lamina and ligamentum flavum are reliable and effective anatomical landmarks. Utilizing these landmarks facilitates precise, minimally invasive resection and is correlated with favorable short-term outcomes.

Background: The efficacy of microsurgical treatment (MST) and endovascular treatment (EVT) in aneurysmal subarachnoid hemorrhage (aSAH) patients requiring external ventricular drainage (EVD) remains unclear. This study aims to comprehensively compare the outcomes of MST and EVT in this specific patient population.

Methods: We consecutively enrolled surgical patients with aSAH requiring EVD from the Chinese Multicenter Aneurysm Database (CMAD) between January 2017 and December 2020. A 1:1 propensity score matching (PSM) was performed to balance baseline differences between the MST and EVT groups. Outcomes and complications were then compared between the matched groups. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). The Kaplan-Meier survival curves were used to compare survival between the MST and EVT groups.

Results: A total of 197 aSAH patients met the inclusion criteria. After PSM, 45 patients who underwent MST were matched with 45 patients who received EVT. No significant differences were observed between the MST and EVT groups in terms of 2-year mortality (MST: 32.3%; EVT: 35.5%, p = 0.48), dependent survival at discharge (MST: 51.2%; EVT: 48.8%, OR 0.955, 95% CI 0.399-2.285, p = 0.917), or dependent survival at 2 years (MST: 70.8%; EVT: 29.2%, OR 1.080, 95% CI 0.253-4.607, p = 0.918). Compared with the EVT group, the MST group had a significantly higher incidence of intracranial infection (MST: 26.7%; EVT: 4.4%, OR 0.128, 95% CI 0.027-0.611, p = 0.010) and a lower incidence of pneumonia (MST: 22.2%; EVT: 42.2%, OR 2.558, 95% CI 1.021-6.409, p = 0.045).

Conclusion: In aSAH patients requiring EVD, EVT did not demonstrate clear advantages over MST in terms of survival or functional outcomes. MST was associated with a higher incidence of intracranial infection, whereas EVT showed a relatively higher rate of pneumonia during hospitalization. Given the retrospective design and limited sample size, these findings should be interpreted with caution.

Background: Trigeminal neuralgia (TGN) secondary to hydrocephalus is relatively uncommon in clinical practice. This study aimed to investigate the correlation between hydrocephalus and TGN and evaluate the efficacy of surgical intervention in alleviating TGN.

Methods: We conducted a retrospective analysis of three cases from our institution and performed a systematic literature review (PubMed search up to December 2024). The inclusion criteria were patients with concurrent hydrocephalus and TGN. Data were analyzed for demographic characteristics, treatment modalities, and outcomes.

Results: Among the 21 analyzed cases (including the 3 patients reported in our study), the mean age was 38 years (range: 22-64), with a balanced gender distribution (male-to-female ratio: 11:10). The etiologies included isolated hydrocephalus (n = 12 cases), Chiari I malformation (CIM) (n = 5), Dandy-Walker syndrome (DWS) (n = 2), and tumor-related cases (n = 2). Ventriculoperitoneal shunt (VPS) resulted in complete pain relief in 75% (n = 9/12) of hydrocephalus cases, while endoscopic third ventriculostomy (ETV) was effective in two cases. Microvascular decompression (MVD) showed variable efficacy, with better outcomes when combined with cerebrospinal fluid (CSF) diversion procedures.

Conclusion: Hydrocephalus may represent an underrecognized secondary cause of TGN. CSF diversion procedures (VPS/ETV) should be considered as first-line interventions, with MVD reserved for refractory cases. These findings support a multidisciplinary approach to diagnosis and management.

Introduction: Mild cognitive impairment in Parkinson's disease (PD-MCI) can affect several cognitive domains, including attention, working memory, executive functions, language, visuospatial skills, and episodic memory, resulting in a progressive reduction of autonomy and an increased risk of dementia. Cognitive training may help preserve cognitive abilities, especially when supported by innovative tools; nevertheless, standardized and engaging interventions are still lacking. The OPERA project aims to develop and evaluate the usability of PRoBio, a novel bio-cooperative platform that integrates virtual reality (VR), robotic assistance and physiological monitoring to deliver personalized cognitive rehabilitation for individuals with PD-MCI.

Methods and analysis: The OPERA project is a 13-months non-profit, multicentre clinical investigation structured in four phases. Phase 1 (month 2): focus group, involving 23 participants (10 people with PD (PwPD), 5 caregivers, 8 healthcare professionals) to explore usability, expectations and rehabilitation needs. Phase 2 (months 2-7): development of the PRoBio platform, by integrating the "Virtual Reality Rehabilitation System" (VRRS, by Khymeia Group) with the TIAGo robot (by PAL Robotics) to deliver personalized exercises to patients' cognitive profiles, while also monitoring their emotional and physiological state. Phase 3 (month 6): two living labs involving a total of 21 healthy subjects (13 volunteers and 8 rehabilitation professionals) to assess PRoBio's usability in a real setting, with emotional data collection and standardized usability questionnaires completion after use. Phase 4 (months 8-12): usability study assessing PRoBio's usability as the primary objective, involving 10 PD-MCI patients completing a 4-week cognitive rehabilitation program with pre/post clinical and neuropsychological assessments. Descriptive statistics and appropriate inferential tests (parametric or non-parametric) will be applied to usability data, pre/post intervention clinical measures, and physiological and performance data registered by the PRoBio platform (p < 0.05).

Conclusion: The present paper presents the methodological framework of the OPERA project, which brings together partners with complementary expertise to develop and evaluate the PRoBio platform, a novel bio-cooperative system for cognitive rehabilitation in patients with PD-MCI. By integrating VR, robotics and physiological feedback, PRoBio aims to enable personalized, adaptive interventions, offering a more engaging alternative to traditional rehabilitation approaches while advancing research in bidirectional human-robot interaction.

Introduction: Dystonia is a predominant and debilitating movement disorder associated with dyskinetic cerebral palsy (DCP). Although trihexyphenidyl (THP) is commonly used as a treatment, its efficacy often exhibits a plateau effect. The combination of dopaminergic and anticholinergic agents represents a rational therapeutic strategy; however, robust evidence for the combination of Madopar (levodopa/benserazide) and THP is lacking.

Methods: This retrospective cohort study compared THP monotherapy (n = 25) with combined Madopar + THP therapy (n = 24) in children with DCP and dystonia. Propensity score matching was used to balance the baseline characteristics. Various outcomes were analyzed at baseline and at both 8 and 16 weeks, including the Barry-Albright Dystonia Scale (BADS), Gross Motor Function Measure-88 (GMFM-88), Quality of Upper Extremity Skills Test (QUEST), and Cerebral Palsy Quality of Life Questionnaire (CP-QOL) measures. Parent-reported improvements in daily activities, drooling, speech, and sleep were also analyzed.

Results: Compared with the THP group, the Madopar + THP group demonstrated significantly greater reductions in dystonia severity at both 8 and 16 weeks (mean BADS change: -5.25 ± 1.45 vs. -2.52 ± 1.36 at 16 weeks, p < 0.001). Superior improvements were also observed in gross motor function (GMFM-88: 14.29 ± 3.39 vs. 8.56 ± 2.29), upper limb function (QUEST: 6.33 ± 1.43 vs. 3.24 ± 1.05), and quality of life (CP-QOL: 6.17 ± 2.12 vs. 3.24 ± 0.66, all p < 0.001). Notably, the combination therapy yielded markedly higher rates of parent-reported improvements in daily life (88% vs. 24%, p < 0.001) and easy of care (71% vs. 20%, p = 0.001) at 16 weeks. No serious adverse events were reported in either group.

Discussion: Compared with THP monotherapy, the combination of Madopar and THP is significantly more effective at alleviating dystonia and improving both motor function and quality of life in children with DCP. By leveraging low-dose synergy, this strategy effectively overcomes the efficacy ceiling of first-line monotherapy and translates into meaningful, patient-centered functional gains (including improvements in sleep and communication) without increasing the burden of adverse events.

Background: Migraine is a leading cause of disability worldwide, yet national-level epidemiological data are often lacking, hindering public health planning. This study aimed to provide the first comprehensive, population-based assessment of migraine epidemiology, comorbidity burden, and preventive treatment patterns in Israel.

Methods: We conducted a retrospective cohort study using electronic health records from Clalit Health Services (CHS), which insures over 50% of the Israeli population. 4,614,331 adults were included in the analysis. Patients with migraine were identified between 2000 and 2023 using physician-recorded ICD-9 codes or dispensed triptan prescription. Patients with migraine were matched 1:2 with non-migraine controls to assess comorbidities. We calculated point prevalence, annual incidence, and analyzed the preventive treatment landscape before and after the introduction of calcitonin gene related peptide (CGRP)-related migraine-specific preventive treatments.

Results: The study included 356,441 patients with migraine and 4,257,890 controls. Migraine disproportionately affected females (75.8%) and younger adults (mean age 30.7 ± 13.2 years). Observed prevalence was lower than global estimates across most age strata. Incidence peaked among women aged 18-24 at 7.5 cases per 1,000 individuals. Patients with migraine carried a substantial comorbidity burden compared with age- and sex-matched controls. The highest adjusted odds ratios (ORs) were observed for chronic pain and psychiatric diseases (ORs for low back pain 2.67, fibromyalgia 2.42, endometriosis 1.86, anxiety 2.02, and depression 1.81). Vascular and metabolic conditions (hypertension, dyslipidemia, atrial fibrillation, and cerebrovascular disease) were more frequent, and stroke risk was significantly elevated. A negative association was found with diabetes. The proportion of patients who used preventive medication was low (9.6 and 8.8%, in 2018 and 2022 respectively) and did not increase after the introduction of migraine-specific treatments. Preventive use was most common in young adults (18-24 age group) and middle-aged adults (45-54 age group).

Conclusion: This large national population-based study reveals a high comorbidity burden among patients with migraine and suggests significant underdiagnosis compared to global benchmarks. The use of preventive treatment remained strikingly low, including novel migraine-specific therapies. These findings underscore the need for improved migraine recognition, integrated multidisciplinary care, and policy-level strategies to reduce the burden of this disabling condition.

Introduction: Mild traumatic brain injury (mTBI) is a heterogeneous condition with long-term sequelae, yet diagnosis in the chronic stage remains limited by reliance on acute criteria and subjective reports. Objective biomarkers are needed, as current blood-based markers show diagnostic value primarily in the acute and subacute phases. Resting-state EEG (RS-EEG) can capture large-scale network disruptions through functional connectivity (FC) and microstate analysis, but its role in chronic mTBI is unclear.

Methods: We tested whether RS-EEG features distinguish chronic mTBI from controls and predict symptom burden. This observational case-control study included 44 participants (18 chronic mTBI, 26 controls). Source-reconstructed EEG was analyzed for spectral power, microstate metrics, and FC using the Multivariate Interaction Measure (MIM). Elastic Net and XGBoost models classified injury status and predicted symptom severity, with feature robustness evaluated across full and reduced electrode montages.

Results: Participants with mTBI showed no group differences in spectral power or microstate metrics but demonstrated significantly elevated FC across theta, beta, gamma, and broadband frequencies. Connectivity increases were stable across reduced montages and persisted up to 8 years post-injury. Classification models using MIM achieved AUCs of 0.79-0.89 for injury status and 0.82-0.87 for symptom severity, outperforming demographic models. Resting-state EEG FC provides a sensitive biomarker of chronic mTBI, distinguishing cases from controls and correlating with symptom severity.

Discussion: The persistence of network alterations years after injury suggests lasting changes in brain activity associated with chronic symptom burden. These findings support the use of RS-EEG-derived FC as a noninvasive and scalable biomarker of chronic mTBI.

Heat therapy (HT) has been shown to improve peripheral blood glucose regulation in some populations, yet its effects on brain glucose metabolism remain largely unexplored. The chronic benefits of HT may arise in part from upregulation of heat-shock proteins (HSPs). These proteins play a crucial role in the stress response and modulate diverse processes such as proteostasis and cell signaling pathways, including that of insulin signaling. Understanding the impact of HT on both peripheral and central glucose metabolism, including the effects of varying temperatures, is essential for elucidating potential mechanisms underlying its brain benefits. The Feasibility of Improving Glycemia to prevent Alzheimer's Disease (FIGHT-AD) study is a randomized controlled trial that aims to investigate changes in blood and brain glucose regulation following 10 weeks of HT. Specifically, we will examine the peripheral biomarker responses to warm and hot HT and assess how these responses relate to brain metabolic changes in both treatment groups. This trial will be the first to quantify the effect of HT on cerebral glucose metabolism in individuals at metabolic risk for Alzheimer's Disease (AD). The FIGHT-AD trial will provide critical data to inform the design of future clinical trials targeting metabolic and brain health through HT.

Clinical trial registration: clinicaltrials.gov, identifier NCT06023407.

Background: Intracranial and/or extracranial atherosclerotic stenosis is a common etiology of acute ischemic stroke (AIS). This study aimed to evaluate the impact of intracranial or extracranial atherosclerotic stenosis on early neurological deterioration (END), hemorrhagic transformation (HT) and 90-day clinical outcomes in patients receiving intravenous thrombolysis.

Methods: We retrospectively enrolled patients with AIS who received intravenous alteplase (0.9 mg/kg) at the First Affiliated Hospital of Kunming Medical University between February 2019 and August 2022. Data on demographics, stroke risk factors, laboratory results, and neuroimaging findings were collected. Atherosclerotic stenosis (AS) was defined as >50% intracranial or extracranial arteries. Logistic regression was performed to identify independent predictors of clinical outcomes. END was defined as an increase of ≥4 points in the National Institutes of Health Stroke Scale (NIHSS) score within 24 h after stroke onset. HT was defined as any newly detected intracranial hemorrhage on follow-up cranial CT performed within 7 days after symptom onset.

Results: A total of 185 AIS patients receiving intravenous thrombolysis were included in this study, with 88 (47.6%) in the IEAS group and 97 (52.4%) in the non-stenosis group. There was no significant association between the incidence of END and the presence of IEAS. Multivariable regression analysis revealed that baseline NIHSS was an independent risk factor for HT (OR = 1.120, 95% CI 1.038-1.209, p = 0.003), 90-day poor clinical outcome (OR = 1.198, 95% CI 1.105-1.298, p = 0.001) and 90-day death (OR = 1.384, 95% CI 1.179-1.625, p = 0.001). Although IEAS was not significantly associated with the incidence of END or HT, it was significantly correlated with 90-day poor clinical outcome (OR = 1.350, 95% CI 1.108-1.644, p = 0.003).

Conclusions: In this cohort, IEAS was not associated with END or HT but emerged as an independent predictor of poor 90-day functional outcome after intravenous thrombolysis for AIS.

Background: The expression of p53 protein is closely related to tumor prognosis and plays an important role in patients with pituitary neuroendocrine tumors (PitNETs). However, its evaluation currently relies on postoperative histopathological analysis. Developing a non-invasive method to predict p53 overexpression preoperatively may help support clinical judgment and facilitate individualized treatment strategies.

Methods: Clinical and imaging data from 186 patients with pathologically confirmed PitNETs were retrospectively collected. The cohort was divided into training and testing sets using stratified random sampling. Radiomic features were extracted from MRI sequences, and feature selection was performed using the intraclass correlation coefficient (ICC) and least absolute shrinkage and selection operator (LASSO). A radiomics score was calculated, and univariate and multivariate logistic regression analyses were used to identify independent clinical risk factors. A combined nomogram model incorporating clinical and radiomic features was constructed. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), precision-recall (PR) curve, calibration curve, and decision curve analysis (DCA).

Results: Four radiomic features and two clinical features were selected for model development. Age (odds ratio [OR] = 0.97, 95% confidence interval [CI]: 0.94-0.99, p = 0.01) and suprasellar invasion (OR = 0.47, 95% CI: 0.25-0.89, p = 0.02) were identified as independent predictors of p53 positivity. The combined clinical-radiomic model achieved good predictive performance with an AUC of 0.77 in the validation set, demonstrating favorable discrimination, calibration, and clinical utility.

Conclusion: The proposed MRI-based radiomics model, integrating clinical and imaging features, enables non-invasive preoperative prediction of p53 overexpression in PitNETs. This approach offers a promising tool for individualized risk stratification and personalized treatment planning in neurosurgical practice.