Journal of Clinical Neuroscience最新文献

Objective: To evaluate the accuracy, safety, and clinical outcomes of ventriculoperitoneal (VP) shunt placement using real-time three-dimensional (3D) robotic C-arm navigation in adults with hydrocephalus.

Methods: A retrospective review was conducted on 82 patients who underwent VP shunt placement in a hybrid operating room between September 2018 and December 2022. All procedures utilized intraoperative 3D robotic C-arm navigation for ventricular catheter placement. Data included demographics, operative details, postoperative imaging, and complications. Catheter tip position was graded, and patients were followed for at least three years.

Results: First-pass ventricular access was achieved in all cases. Optimal tip positioning (Grade 1) was observed in 79% of patients, Grade 2 in 20%, and Grade 3 in 1%. The mean operative time was 76.6 ± 20.6 min. Postoperative complications occurred in 7% of patients, primarily related to distal catheter issues; no cerebrospinal fluid-side revisions were required during follow-up.

Conclusion: Real-time 3D robotic C-arm navigation enables precise ventricular catheter placement with high first-pass success, and low complication rates. This technique may reduce mechanical shunt failure and warrants prospective comparative studies to confirm its benefits and cost-effectiveness.

Background: Cystic vestibular schwannomas (CyVS) have unique biological and morphological characteristics which presents the development of specialized Stereotactic Radiosurgery (SRS) treatment protocols. This retrospective study addresses the relationship between linear and volumetric parameters of CyVS treated with Gamma Knife (GKRS) radiosurgery and evaluates the long-term tumor control predictive ability of the cyst-to-tumor volume ratio (CVR).

Methods: Thirty-eight patients treated from 2012 to 2019 were included in the study. A Pearson analysis was performed to correlate the tumor diameter/volume with cyst diameter/volume. The CVR was evaluated as the ratio of the cyst volume to total tumor volume and classified as solid-dominant (<10 % cyst volume), mixed (10-50 % cyst volume), or cyst-dominant (>50 % cyst volume). Dosimetric analysis included conformity index (CI), gradient index (GI), target coverage and selectivity, as well as hearing outcomes assessed using the AAO-HNS and Gardner-Robertson scales. Local tumor control was evaluated using Kaplan-Meier survival analysis.

Results: The mean tumor diameter and volume was 20.0 +/- 6.2 mm and 5.25 +/- 3.51 cc, respectively. The mean cyst diameter and volume were 10.9 +/- 4.7 mm and 0.97 +/- 1.21 cc, respectively. There was strong correlation between tumor diameter and volume (r = 0.86, p < 0.0001) as well as between cyst diameter and volume (r = 0.85, p < 0.0001), indicating linear measures are appropriate substitutes for volumetric measurements in evaluating treatment response. Actuarial local control following GKRS was 84.8 %, with over 20 % of patients achieving a ≥ 20 % volume reduction at last follow-up.

Conclusion: These findings demonstrate that CVR serves as a useful imaging biomarker, supporting individualized radiosurgical planning and enabling reliable long-term management of patients with CyVS.

Background: Accurate prognostication in elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) remains challenging due to high morbidity and mortality. This study aimed to develop and externally validate interpretable machine learning (ML) models for predicting 12-month functional outcomes.

Methods: Data from 426 consecutive elderly aSAH patients at the primary center were randomly split into a training cohort (n = 298, 70%) and an internal test cohort (n = 128, 30%). An independent external validation cohort (n = 41) was obtained from a collaborating tertiary medical center. Features with multicollinearity (|Spearman ρ| > 0.8) were excluded. Predictive variables were identified using univariate/multivariate logistic regression and the Boruta algorithm. Eight ML models were trained using 5-fold cross-validation. Model performance was assessed on both internal and external validation cohorts using receiver operating characteristic (ROC) and precision-recall (PR) curves, along with calibration plots. Model interpretability was evaluated using SHapley Additive exPlanations (SHAP).

Results: The Multilayer Perceptron (MLP) model demonstrated superior performance, achieving ROC-AUCs of 0.913 (internal testing) and 0.912 (external validation), with favorable calibration in both cohorts. SHAP analysis identified the Hunt-Hess scale, age, total bleeding volume, delayed cerebral ischemia (DCI), modified Fisher scale, rebleeding, hydrocephalus, aneurysm multiplicity, and aneurysm length as key predictors. SHAP dependency plots facilitated individualized risk interpretation.

Conclusion: This study successfully developed and externally validated interpretable ML models that reliably predict long-term functional outcomes in elderly aSAH patients. These tools demonstrate robust generalizability across clinical settings and hold potential to support personalized clinical decision-making and optimize resource allocation in neurocritical care.

Background: While quantitative MRI (qMRI) metrics effectively describe preoperative compression in degenerative cervical myelopathy (DCM), their use in identifying determinants of postoperative anatomical decompression remains limited, particularly in patients with suboptimal clinical trajectories.

Methods: In this retrospective cohort study, we analyzed 40 patients (78 segments) who underwent postoperative MRI due to suboptimal clinical recovery or late neurological worsening. Using Generalized Estimating Equations (GEE) to account for clustered data, we identified determinants for changes in maximum canal compromise (ΔMCC), transverse area of the cervical canal (ΔTACC), maximum spinal cord compression (ΔMSCC), transverse area of the spinal cord (ΔTASC), and compression ratio (ΔCR). Models controlled for surgical approach, demographics, and preoperative severity.

Results: Surgical intervention significantly improved all qMRI parameters (p < 0.001). The posterior approach achieved markedly greater canal expansion (ΔTACC B = -34.86, p < 0.001) and better restoration of cord morphology (ΔCR B = -6.33, p = 0.020). However, actual spinal cord re-expansion (ΔMSCC, ΔTASC) was not significantly determined by the surgical approach (p > 0.10) but was primarily constrained by preoperative severity (B = -0.73 and B = -0.81, respectively; both p < 0.001). Notably, isolated anterior compression significantly limited axial cord area re-expansion (B = -15.39, p = 0.018). Patients with ASA III showed significantly less sagittal cord expansion compared to those with ASA II (p = 0.029), while advanced age showed a strong trend toward reduced canal expansion (p = 0.079). Longer intervals to postoperative MRI were associated with greater measured decompression (p < 0.05), suggesting morphometric stabilization after the acute postoperative phase.

Conclusions: In patients with suboptimal clinical recovery, a critical dissociation exists: spinal canal expansion is primarily determined by the surgical approach, whereas spinal cord re-expansion is constrained by preoperative severity and the specific compression pattern. These findings define the anatomical boundaries of surgical decompression and suggest that personalized planning must account for the "biological ceiling" of the cord. Quantitative MRI serves as an essential tool for establishing anatomical benchmarks in the postoperative assessment of DCM.

Introduction: This study explores the prevalence of anxiety and depression at various time points during the rehabilitation of intracerebral hemorrhage (ICH) patients, ascertains their sleep quality, and analyzes influencing factors regarding psychological conditions, family and society.

Methods: Multiple questionnaires were employed to assess the disease and psychological status of ICH patients at different time points following onset. Assessments were conducted upon hospital admission, as well as at 1, 3, 6, and 12 months (s) after onset. Simultaneously, data regarding the rehabilitation support provided by caregivers or family members were collected. The prevalence and correlation of psychological disorders in patients during rehabilitation were analyzed. A comprehensive discussion was made on the factors influencing psychological disorders in ICH patients. Our study accounted for patient-specific, family, and psychological factors at different time points.

Results: 524 ICH patients were ultimately enrolled in this study. Results showed that the prevalence of moderate-to-severe anxiety and depression gradually declined over one year post-discharge, while the sleep quality fluctuated, peaking at 1 and 6 months. Multivariate analysis identified several risk factors, encompassing male gender, low muscle strength, lack of exercise, unemployment (OR < 1), hypertension, lower family income (OR > 1), prolonged daily caregiving hours (OR > 1), caregivers' limited disease knowledge, and low caregiver enthusiasm (OR < 1). Psychological scores exhibited intercorrelations. For instance, anxiety and depression were strongly correlated at 1 month post-discharge (r = 0.730). Admission SSS (Somatic Symptom Scale) scores significantly predicted anxiety, while depression was linked to PSQI (Pittsburgh Sleep Quality Index), SSS, and Barthel Index scores. The sleep quality was influenced by HAMD (Hamilton Depression Scale) and Barthel scores. These findings highlighted that psychological issues in ICH patients, though prevalent, declined over time, affected by patient characteristics (physical function, socioeconomic status), caregiver dynamics, and multidimensional psychological interactions.

Conclusion: Following the onset of ICH, patients commonly exhibit varying degrees of anxiety, depression, and sleep quality. The prevalence of these conditions declines progressively throughout the rehabilitation period. Psychological and sleep-related outcomes are influenced by a combination of individual characteristics, familial circumstances, and multiple psychosocial factors, underscoring the need for comprehensive nursing care and multidimensional support.