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The effect of temporary CSF diversion modality on shunt-dependency following aneurysmal subarachnoid hemorrhage: A nationwide assessment 临时脑脊液分流方式对动脉瘤性蛛网膜下腔出血后分流依赖的影响:一项全国性评估。
IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.111008
Michelle Lin, Jonathan Dallas, Li Ding, Vincent N. Nguyen, Devin Bageac, Benjamin Hopkins, Frank J. Attenello, William J. Mack

Background

Aneurysmal subarachnoid hemorrhage (aSAH) carries a high economic cost and clinical morbidity in the United States. Beyond prolonged admissions and poor post-injury functional status, there is an additional cost of chronic shunt-dependent hydrocephalus for many aSAH patients. Adjuvant lumbar drain (LD) placement has been hypothesized to promote clearance of subarachnoid blood from the cisternal space, with an ultimate effect of decreasing shunt placement rates. In this nationwide database study, we aim to evaluate outcomes associated with different forms of temporary bedside cerebrospinal fluid (CSF) diversion in the aSAH patient cohort.

Methods

Inpatient admissions were queried from the National Inpatient Sample (NIS; 2016–2020). Inclusion criteria included adult patients presenting with non-traumatic SAH that underwent treatment with either non-elective clip ligation or coil embolization of their underlying aneurysms and received either an external ventricular drain (EVD), lumbar drain (LD), or both (EVD + LD) for temporary CSF diversion during that admission. Outcome variables evaluated included inpatient mortality, bacterial meningitis, length of stay, discharge disposition, and need for shunt placement.

Results

A total of 5505 admissions met inclusion criteria, of which 18.42 % required permanent CSF diversion. The majority of patients received EVD alone (4842, 87.96 %). The remaining patients were split between LD alone (366, 6.65 %) or EVD + LD placement (297, 5.4 %). Patients receiving LD alone tended to be healthier, with lower rates of extreme APR-DRG subclass, Elixhauser Comorbidity Index (ECI), and NIS SAH Severity Score (NIS-SSS). Patients in the EVD + LD cohort had higher rates of shunt placement (OR 1.624, p = 0.0009) and higher rates of bacterial meningitis (OR 8.715, p < 0.0001), even when controlling for APR-DRG illness severity and ECI.

Conclusion

Our study found higher rates of permanent CSF diversion, longer lengths of stay, and higher rates of bacterial meningitis in patients receiving both EVD and LD placement. Due to limitations inherent to nationwide database studies, these results should be interpreted cautiously. Further studies are needed to clarify whether adjuvant temporary CSF diversion with LD placement in the aSAH cohort for intent of minimizing chronic shunt-dependence is efficacious.
背景:动脉瘤性蛛网膜下腔出血(aSAH)在美国具有很高的经济成本和临床发病率。除了住院时间延长和损伤后功能状态差外,许多aSAH患者还需要额外的慢性分流依赖性脑积水费用。辅助腰椎引流管(LD)放置被认为可以促进池腔蛛网膜下腔血液的清除,并最终降低分流管放置率。在这项全国性的数据库研究中,我们旨在评估不同形式的临时床边脑脊液(CSF)转移在aSAH患者队列中的相关结果。方法:对全国住院患者样本(NIS;2016 - 2020)。纳入标准包括非外伤性SAH的成年患者,这些患者在入院期间接受了非选择性夹扎或螺旋栓塞治疗,并接受了外脑室引流(EVD)、腰椎引流(LD)或两者(EVD + LD)进行临时脑脊液分流。评估的结果变量包括住院死亡率、细菌性脑膜炎、住院时间、出院处置和分流器放置的需要。结果:5505例患者符合纳入标准,其中18.42%需要永久性脑脊液分流。以单纯EVD患者为主(4842例,87.96%)。其余患者分为单纯LD组(366例,6.65%)和EVD + LD组(297例,5.4%)。单独接受LD治疗的患者更健康,APR-DRG极端亚类、Elixhauser合并症指数(ECI)和NIS SAH严重程度评分(NIS- sss)的发生率更低。EVD + LD队列患者有更高的分流器放置率(OR 1.624, p = 0.0009)和更高的细菌性脑膜炎发生率(OR 8.715, p)。结论:我们的研究发现EVD和LD同时放置的患者永久性脑脊液分流率更高,住院时间更长,细菌性脑膜炎发生率更高。由于全国性数据库研究固有的局限性,这些结果应谨慎解释。需要进一步的研究来阐明在aSAH队列中,为了减少慢性分流依赖而放置LD的辅助暂时性脑脊液分流是否有效。
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引用次数: 0
Evolving treatment paradigms of cerebral aneurysm stasis in flow diversion 血流转移中脑动脉瘤淤滞治疗模式的演变。
IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110996
Joshua H. Weinberg , Max Gruber , Nathan Ritchey, Landon Ehlers, Santino Cua, Amanda Zakeri, Ciaran Powers, Shahid Nimjee, Patrick Youssef

Introduction

Flow diversion is an effective first-line treatment for intracranial aneurysms; however, the rate of incomplete occlusion is not insignificant. Data in neuroendovascular literature is limited regarding the implications of persistent incomplete occlusion despite flow diversion.

Methods

We conducted a retrospective analysis of a prospectively maintained database and identified 125 consecutive patients with treatment naïve intracranial aneurysms who underwent flow diversion with the PED from April 2014 − November 2022. Patients were divided into 3 groups based on the duration of stasis: venous, capillary, and no stasis. Comparative and multivariate analyses were performed between the three groups.

Results

At latest follow-up, complete occlusion occurred in 69.6 % and 82.4 % showed progression of occlusion. Retreatment was required in 2.4 %. There was no significant difference in retreatment (p = 0.667), complete occlusion (p = 0.774) or progression of occlusion (p = 0.848) at latest follow up. No patients experienced subarachnoid hemorrhage post-treatment. On multivariate analysis, hypertension was a negative predictor for complete occlusion (p = 0.006) and progression of occlusion (p = 0.017), while duration of stasis was noncontributory. The mean latest follow up was 12.55 months.

Conclusion

Flow diversion is a safe and effective first line treatment for intracranial aneurysms with a relatively low complication rate. Hypertension was a negative predictor of complete occlusion and progression of occlusion, while the degree of occlusion post-flow diversion may not be predictive of future rupture risk and the Raymond Roy Occlusion classification may not apply. The degree of stasis after initial treatment was not predictive of future occlusion, retreatment, nor aneurysm rupture risk. However, stasis degree may be worth additional analysis given this studies sample size, lack of long-term follow-up, and the lack of predictive factors in current literature to guide post-flow diversion management.
导言:分流是治疗颅内动脉瘤的有效一线治疗方法;然而,不完全闭塞率并非微不足道。尽管血流转移,但神经血管内文献中关于持续不完全闭塞的影响的数据有限。方法:我们对前瞻性维护的数据库进行了回顾性分析,并确定了2014年4月至2022年11月期间125例连续接受PED分流治疗naïve颅内动脉瘤患者。根据瘀血持续时间将患者分为静脉、毛细血管、无瘀血3组。对三组患者进行比较分析和多变量分析。结果:最近一次随访时,69.6%的患者完全咬合,82.4%的患者咬合进展。需要再治疗的占2.4%。最后随访时两组再治疗(p = 0.667)、完全咬合(p = 0.774)和咬合进展(p = 0.848)无显著差异。治疗后无蛛网膜下腔出血。在多变量分析中,高血压是完全闭塞(p = 0.006)和闭塞进展(p = 0.017)的负相关预测因子,而停滞期的持续时间则不是影响因素。平均最新随访时间为12.55个月。结论:分流术是治疗颅内动脉瘤安全有效的一线治疗方法,并发症发生率较低。高血压是完全闭塞和闭塞进展的负预测因子,而血流转移后的闭塞程度可能不能预测未来的破裂风险,雷蒙德罗伊闭塞分类可能不适用。初始治疗后的停滞程度不能预测未来的闭塞、再治疗或动脉瘤破裂的风险。然而,鉴于本研究的样本量,缺乏长期随访,以及目前文献中缺乏指导分流后管理的预测因素,停滞程度可能值得进一步分析。
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引用次数: 0
The “make a flower bud and push at neck” technique: A safe and versatile technique for Woven EndoBridge treatment “制作花蕾并推脖子”技术:编织内桥治疗的安全而通用的技术。
IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110942
Jun Tanabe , Ichiro Nakahara , Shoji Matsumoto , Jun Morioka , Tetsuya Hashimoto , Junpei Koge , Kenichiro Suyama , Takeya Suzuki , Akiko Hasebe , Sadayoshi Watanabe

Purpose

The safety and efficacy of Woven EndoBridge (WEB) treatment has been proven. However, only a few standard techniques for safe and versatile WEB deployment have been described in the literature. In this study, we introduce the “make a flower bud and push at neck” technique to achieve safety and versatility during WEB treatment, referred to simply as the “flower bud” technique.

Methods

Consecutive patients who underwent WEB treatment between January 2021 and October 2023 were included. We dichotomized the techniques of WEB deployment into two: the “flower bud” technique and the ordinary unsheath technique. Patient demographics, clinical characteristics of the aneurysms, and treatment results were compared between the two techniques to evaluate the safety and versatility of the “flower bud” technique.

Results

Of 100 aneurysms, 96 were eligible in the study. The “flower bud” technique was applied in 79 aneurysms (82.3 %), and the ordinary unsheath technique was applied in 17 aneurysms (17.7 %). The aneurysm location significantly differed between both techniques. The degree of parent artery-aneurysm (PA) angle and the proportion of the PA angle ≥ 45° were significantly higher in the “flower bud” technique than in the ordinary unsheath technique (P = 0.024 and P = 0.009, respectively). Effective angiographical results and low morbidity/mortality rate were similar in the techniques, although intraoperative rupture was experienced in one aneurysm treated using the ordinary unsheath technique.

Conclusion

The “make a flower bud and push at neck” technique could be safer and more versatile in treating cerebral aneurysms by WEB compared to the ordinary unsheath technique.
目的:证实了Woven EndoBridge (WEB)治疗的安全性和有效性。然而,文献中只描述了一些用于安全和通用WEB部署的标准技术。在这项研究中,我们介绍了“制作花蕾并在颈部推”技术,以实现WEB治疗过程中的安全性和通用性,简称“花蕾”技术。方法:纳入2021年1月至2023年10月期间连续接受WEB治疗的患者。我们将WEB部署技术分为两种:“花蕾”技术和普通的脱鞘技术。比较两种技术的患者人口统计、动脉瘤的临床特征和治疗结果,以评估“花苞”技术的安全性和通用性。结果:100个动脉瘤中,96个符合研究条件。“花苞”技术应用于动脉瘤79例(82.3%),普通无鞘技术应用于动脉瘤17例(17.7%)。动脉瘤的位置在两种技术之间有显著差异。“花苞”技术的载瘤动脉-动脉瘤(PA)夹角程度和PA夹角≥45°的比例均显著高于普通无鞘技术(P = 0.024和P = 0.009)。有效的血管造影结果和低发病率/死亡率在技术上是相似的,尽管在术中使用普通的无鞘技术治疗动脉瘤时经历了一次破裂。结论:“造花芽推颈”技术治疗脑动脉瘤比普通开鞘技术更安全、更通用。
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引用次数: 0
Vanishing Rathke’s cleft cyst 消失的 Rathke 裂囊。
IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110986
Charles Champeaux Depond , Dahmane Elhairech , Philippe Metellus
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引用次数: 0
Benefits and risks of antiplatelet therapy after bypass surgery for moyamoya disease: A meta-analysis 烟雾病搭桥手术后抗血小板治疗的获益和风险:一项荟萃分析
IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110956
Junchen Si , Xiaokui Kang , Zhongchen Li, Jiheng Hao, Liyong Zhang

Background

Bypass surgery is a leading treatment strategy for moyamoya disease. Antiplatelet therapy (APT) has the potential to prevent thrombosis and possibly enhance bypass graft patency. However, the efficacy and safety of APT following bypass surgery remain debatable. This study aims to assess the clinical outcomes of APT after bypass surgery.

Methods

A systematic review was conducted to evaluate the impact and associated complications of APT after bypass surgery. Electronic databases, including PubMed, Embase, and the Cochrane Library, were searched from their inception to September 1, 2023. The primary outcome was bypass patency.

Results

This meta-analysis included five articles, encompassing 480 patients who underwent APT post-surgery and 423 patients who did not receive APT. Statistical analysis revealed that APT significantly increased bypass vessel patency (Odds Ratio [OR] 2.58; 95 % Confidence Interval [CI] 1.51–4.43; P = 0.0006), decreased the likelihood of transient cerebral ischemic events (OR 0.55; 95 % CI 0.32–0.95; P = 0.03), and enhanced patient functional outcomes (OR 1.88; 95 % CI 1.29–2.74; P = 0.001). However, no substantial differences were observed in postoperative stroke risk (OR 0.89; 95 % CI 0.49–1.63; P = 0.72), seizures (OR 1.43; 95 % CI 0.61–3.37; P = 0.41), or cerebral hemorrhage (OR 0.69; 95 % CI 0.28–1.71; P = 0.42) between the two groups.

Conclusions

The current evidence indicates that APT after bypass surgery enhances bypass vessel patency, reduces the risk of transient cerebral ischemic events, and improves functional outcomes in patients. However, it does not decrease the incidence of postoperative stroke and does not elevate the risks of cerebral hemorrhage and seizures.
背景:搭桥手术是烟雾病的主要治疗策略。抗血小板治疗(APT)有可能预防血栓形成,并可能提高搭桥通畅。然而,旁路手术后APT的有效性和安全性仍有争议。本研究旨在评估搭桥术后APT的临床效果。方法:系统评价搭桥术后APT的影响及相关并发症。电子数据库,包括PubMed, Embase和Cochrane图书馆,从其成立到2023年9月1日进行了检索。主要结果为旁路通畅。结果:本荟萃分析纳入5篇文章,包括480例术后接受APT治疗的患者和423例未接受APT治疗的患者。统计分析显示,APT可显著增加旁路血管通畅(优势比[OR] 2.58;95%置信区间[CI] 1.51-4.43;P = 0.0006),降低了短暂性脑缺血事件的可能性(OR 0.55;95% ci 0.32-0.95;P = 0.03),增强了患者的功能结局(OR 1.88;95% ci 1.29-2.74;p = 0.001)。然而,术后卒中风险无显著差异(OR 0.89;95% ci 0.49-1.63;P = 0.72),癫痫发作(OR 1.43;95% ci 0.61-3.37;P = 0.41)或脑出血(or 0.69;95% ci 0.28-1.71;P = 0.42)。结论:目前的证据表明,旁路手术后APT可以增强旁路血管的通畅,降低短暂性脑缺血事件的风险,改善患者的功能结局。然而,它不会降低术后中风的发生率,也不会增加脑出血和癫痫发作的风险。
{"title":"Benefits and risks of antiplatelet therapy after bypass surgery for moyamoya disease: A meta-analysis","authors":"Junchen Si ,&nbsp;Xiaokui Kang ,&nbsp;Zhongchen Li,&nbsp;Jiheng Hao,&nbsp;Liyong Zhang","doi":"10.1016/j.jocn.2024.110956","DOIUrl":"10.1016/j.jocn.2024.110956","url":null,"abstract":"<div><h3>Background</h3><div>Bypass surgery is a leading treatment strategy for moyamoya disease. Antiplatelet therapy (APT) has the potential to prevent thrombosis and possibly enhance bypass graft patency. However, the efficacy and safety of APT following bypass surgery remain debatable. This study aims to assess the clinical outcomes of APT after bypass surgery.</div></div><div><h3>Methods</h3><div>A systematic review was conducted to evaluate the impact and associated complications of APT after bypass surgery. Electronic databases, including PubMed, Embase, and the Cochrane Library, were searched from their inception to September 1, 2023. The primary outcome was bypass patency.</div></div><div><h3>Results</h3><div>This <em>meta</em>-analysis included five articles, encompassing 480 patients who underwent APT post-surgery and 423 patients who did not receive APT. Statistical analysis revealed that APT significantly increased bypass vessel patency (Odds Ratio [OR] 2.58; 95 % Confidence Interval [CI] 1.51–4.43; P = 0.0006), decreased the likelihood of transient cerebral ischemic events (OR 0.55; 95 % CI 0.32–0.95; P = 0.03), and enhanced patient functional outcomes (OR 1.88; 95 % CI 1.29–2.74; P = 0.001). However, no substantial differences were observed in postoperative stroke risk (OR 0.89; 95 % CI 0.49–1.63; P = 0.72), seizures (OR 1.43; 95 % CI 0.61–3.37; P = 0.41), or cerebral hemorrhage (OR 0.69; 95 % CI 0.28–1.71; P = 0.42) between the two groups.</div></div><div><h3>Conclusions</h3><div>The current evidence indicates that APT after bypass surgery enhances bypass vessel patency, reduces the risk of transient cerebral ischemic events, and improves functional outcomes in patients. However, it does not decrease the incidence of postoperative stroke and does not elevate the risks of cerebral hemorrhage and seizures.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"132 ","pages":"Article 110956"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791764","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}
引用次数: 0
The doctor-patient perception mismatch: Improving approaches to assessing outcomes after ischemic stroke treated with reperfusion therapy 医患感知不匹配:改进评估缺血性卒中再灌注治疗后预后的方法。
IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110981
Jane Khalife , Mary Penckofer , Michael J. Dubinski , Danielle C. Brown , Kenyon Sprankle , Taryn Hester , Marta Olive Gadea , Federica Rizzo , Marc Ribo , H.Christian Schumacher , Jesse M. Thon , Tudor G. Jovin , Manisha Koneru , Khalid A. Hanafy
The long-term effects of ischemic stroke on cognition and mental health are not reflected in traditional outcome metrics, like the modified Rankin Scale (mRS) for functional independence. Consequently, this may lead to mismatches in perceptions of overall recovery, despite otherwise qualifying as having good functional outcomes (mRS 0–2). In our multicenter, multinational analysis, we aim to describe the prevalence of, and factors associated with, patient-reported cognitive impairment despite achieving good functional outcomes. Acute ischemic stroke patients at Cooper University Hospital (2021–2024) and Hospital Vall d’Hebron in Barcelona, Spain (2020–2021) treated with reperfusion therapy and achieved 90-day mRS 0–2 were surveyed with the previously-validated PROMIS Global-10 scale for physical health (PROMIS-PH) and mental health (PROMIS-MH). The primary outcome was the rate of fair or poor PROMIS-MH scores ( 11). Univariable and multivariable linear regressions for PROMIS-MH scores were performed. Of 157, 90-day mRS 0–2 patients, the mean age was 68 (standard deviation 15) years, and 61 % were male. Fair or poor PROMIS-MH scores were reported in 43 % of patients. Clinical factors independently associated with PROMIS-MH scores in a multivariable linear regression include: sex, tobacco use, PROMIS-PH score, and National Institutes of Health Stroke Scale at 3-day follow-up. Despite achieving favorable post-stroke mRS, there is a high prevalence of patient-reported cognitive impairment, underscoring an important gap in post-stroke care. The emphasis in post-stroke care should extend beyond the scope of traditional metrics, and should encompass evaluations and interventions targeting additional domains significant to overall patient recovery, especially patient-reported cognitive symptoms.
缺血性卒中对认知和心理健康的长期影响并没有反映在传统的结局指标中,如功能独立性的改良Rankin量表(mRS)。因此,这可能导致对整体恢复的看法不匹配,尽管在其他方面具有良好的功能结果(mRS 0-2)。在我们的多中心、多国分析中,我们的目标是描述患者报告的认知障碍的患病率和相关因素,尽管取得了良好的功能结果。在库珀大学医院(2021-2024)和西班牙巴塞罗那Vall d'Hebron医院(2020-2021)接受再灌注治疗并达到90天mRS 0-2的急性缺血性卒中患者,使用先前验证的PROMIS Global-10身体健康量表(promise - ph)和精神健康量表(promise - mh)进行调查。主要结局是promise - mh评分公平或差的比率(≤11)。对promise - mh评分进行单变量和多变量线性回归。在157例90天mRS 0-2患者中,平均年龄为68岁(标准差15),61%为男性。43%的患者报告了一般或较差的promise - mh评分。在多变量线性回归中,与promise - mh评分独立相关的临床因素包括:性别、吸烟、promise - ph评分和3天随访时的美国国立卫生研究院卒中量表。尽管获得了良好的脑卒中后mRS,但患者报告的认知障碍患病率很高,这强调了脑卒中后护理的重要差距。卒中后护理的重点应超越传统指标的范围,并应包括针对对患者整体康复有重要意义的其他领域的评估和干预措施,特别是患者报告的认知症状。
{"title":"The doctor-patient perception mismatch: Improving approaches to assessing outcomes after ischemic stroke treated with reperfusion therapy","authors":"Jane Khalife ,&nbsp;Mary Penckofer ,&nbsp;Michael J. Dubinski ,&nbsp;Danielle C. Brown ,&nbsp;Kenyon Sprankle ,&nbsp;Taryn Hester ,&nbsp;Marta Olive Gadea ,&nbsp;Federica Rizzo ,&nbsp;Marc Ribo ,&nbsp;H.Christian Schumacher ,&nbsp;Jesse M. Thon ,&nbsp;Tudor G. Jovin ,&nbsp;Manisha Koneru ,&nbsp;Khalid A. Hanafy","doi":"10.1016/j.jocn.2024.110981","DOIUrl":"10.1016/j.jocn.2024.110981","url":null,"abstract":"<div><div>The long-term effects of ischemic stroke on cognition and mental health are not reflected in traditional outcome metrics, like the modified Rankin Scale (mRS) for functional independence. Consequently, this may lead to mismatches in perceptions of overall recovery, despite otherwise qualifying as having good functional outcomes (mRS 0–2). In our multicenter, multinational analysis, we aim to describe the prevalence of, and factors associated with, patient-reported cognitive impairment despite achieving good functional outcomes. Acute ischemic stroke patients at Cooper University Hospital (2021–2024) and Hospital Vall d’Hebron in Barcelona, Spain (2020–2021) treated with reperfusion therapy and achieved 90-day mRS 0–2 were surveyed with the previously-validated PROMIS Global-10 scale for physical health (PROMIS-PH) and mental health (PROMIS-MH). The primary outcome was the rate of fair or poor PROMIS-MH scores (<span><math><mrow><mo>≤</mo></mrow></math></span> 11). Univariable and multivariable linear regressions for PROMIS-MH scores were performed. Of 157, 90-day mRS 0–2 patients, the mean age was 68 (standard deviation 15) years, and 61 % were male. Fair or poor PROMIS-MH scores were reported in 43 % of patients. Clinical factors independently associated with PROMIS-MH scores in a multivariable linear regression include: sex, tobacco use, PROMIS-PH score, and National Institutes of Health Stroke Scale at 3-day follow-up. Despite achieving favorable post-stroke mRS, there is a high prevalence of patient-reported cognitive impairment, underscoring an important gap in post-stroke care. The emphasis in post-stroke care should extend beyond the scope of traditional metrics, and should encompass evaluations and interventions targeting additional domains significant to overall patient recovery, especially patient-reported cognitive symptoms.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"132 ","pages":"Article 110981"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807338","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}
引用次数: 0
Deep learning-assistance significantly increases the detection sensitivity of neurosurgery residents for intracranial aneurysms in subarachnoid hemorrhage 深度学习辅助显著提高神经外科住院医师对蛛网膜下腔出血颅内动脉瘤的敏感度。
IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110971
Lukas Goertz , Stephanie T. Jünger , David Reinecke , Niklas von Spreckelsen , Rahil Shahzad , Frank Thiele , Kai Roman Laukamp , Marco Timmer , Roman Johannes Gertz , Carsten Gietzen , Kenan Kaya , Jan-Peter Grunz , Marc Schlamann , Christoph Kabbasch , Jan Borggrefe , Lenhard Pennig

Objective

The purpose of this study was to evaluate the effectiveness of a deep learning model (DLM) in improving the sensitivity of neurosurgery residents to detect intracranial aneurysms on CT angiography (CTA) in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods

In this diagnostic accuracy study, a set of 104 CTA scans of aSAH patients containing a total of 126 aneurysms were presented to three blinded neurosurgery residents (a first-year, third-year, and fifth-year resident), who individually assessed them for aneurysms. After the initial reading, the residents were given the predictions of a dedicated DLM previously established for automated detection and segmentation of intracranial aneurysms. The detection sensitivities for aneurysms of the DLM and the residents with and without the assistance of the DLM were compared.

Results

The DLM had a detection sensitivity of 85.7%, while the residents showed detection sensitivities of 77.8%, 86.5%, and 87.3% without DLM assistance. After being provided with the DLM’s results, the residents’ individual detection sensitivities increased to 97.6%, 95.2%, and 98.4%, respectively, yielding an average increase of 13.2%. The DLM was particularly useful in detecting small aneurysms. In addition, interrater agreement among residents increased from a Fleiss κ of 0.394 without DLM assistance to 0.703 with DLM assistance.

Conclusions

The results of this pilot study suggest that deep learning models can help neurosurgeons detect aneurysms on CTA and make appropriate treatment decisions when immediate radiological consultation is not possible.
研究目的本研究旨在评估深度学习模型(DLM)在提高神经外科住院医师在动脉瘤性蛛网膜下腔出血(aSAH)患者的 CT 血管造影(CTA)中检测颅内动脉瘤的灵敏度方面的有效性:在这项诊断准确性研究中,三位神经外科盲人住院医师(一年级、三年级和五年级住院医师)共接受了104例蛛网膜下腔出血患者的CTA扫描,其中包含126个动脉瘤。初次阅读后,住院医师们得到了先前为自动检测和分割颅内动脉瘤而建立的专用 DLM 的预测结果。结果比较了 DLM 和住院医师在 DLM 协助下和没有 DLM 协助下对动脉瘤的检测灵敏度:结果:DLM 的检测灵敏度为 85.7%,而住院医师在没有 DLM 辅助的情况下,检测灵敏度分别为 77.8%、86.5% 和 87.3%。在获得 DLM 的结果后,居民的个人检测灵敏度分别提高到 97.6%、95.2% 和 98.4%,平均提高了 13.2%。DLM 对检测小动脉瘤特别有用。此外,住院医师之间的判读一致性从无 DLM 辅助时的 0.394 Fleiss κ 提高到有 DLM 辅助时的 0.703:这项试点研究的结果表明,深度学习模型可以帮助神经外科医生在 CTA 上检测动脉瘤,并在无法立即进行放射会诊时做出适当的治疗决定。
{"title":"Deep learning-assistance significantly increases the detection sensitivity of neurosurgery residents for intracranial aneurysms in subarachnoid hemorrhage","authors":"Lukas Goertz ,&nbsp;Stephanie T. Jünger ,&nbsp;David Reinecke ,&nbsp;Niklas von Spreckelsen ,&nbsp;Rahil Shahzad ,&nbsp;Frank Thiele ,&nbsp;Kai Roman Laukamp ,&nbsp;Marco Timmer ,&nbsp;Roman Johannes Gertz ,&nbsp;Carsten Gietzen ,&nbsp;Kenan Kaya ,&nbsp;Jan-Peter Grunz ,&nbsp;Marc Schlamann ,&nbsp;Christoph Kabbasch ,&nbsp;Jan Borggrefe ,&nbsp;Lenhard Pennig","doi":"10.1016/j.jocn.2024.110971","DOIUrl":"10.1016/j.jocn.2024.110971","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to evaluate the effectiveness of a deep learning model (DLM) in improving the sensitivity of neurosurgery residents to detect intracranial aneurysms on CT angiography (CTA) in patients with aneurysmal subarachnoid hemorrhage (aSAH).</div></div><div><h3>Methods</h3><div>In this diagnostic accuracy study, a set of 104 CTA scans of aSAH patients containing a total of 126 aneurysms were presented to three blinded neurosurgery residents (a first-year, third-year, and fifth-year resident), who individually assessed them for aneurysms. After the initial reading, the residents were given the predictions of a dedicated DLM previously established for automated detection and segmentation of intracranial aneurysms. The detection sensitivities for aneurysms of the DLM and the residents with and without the assistance of the DLM were compared.</div></div><div><h3>Results</h3><div>The DLM had a detection sensitivity of 85.7%, while the residents showed detection sensitivities of 77.8%, 86.5%, and 87.3% without DLM assistance. After being provided with the DLM’s results, the residents’ individual detection sensitivities increased to 97.6%, 95.2%, and 98.4%, respectively, yielding an average increase of 13.2%. The DLM was particularly useful in detecting small aneurysms. In addition, interrater agreement among residents increased from a Fleiss κ of 0.394 without DLM assistance to 0.703 with DLM assistance.</div></div><div><h3>Conclusions</h3><div>The results of this pilot study suggest that deep learning models can help neurosurgeons detect aneurysms on CTA and make appropriate treatment decisions when immediate radiological consultation is not possible.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"132 ","pages":"Article 110971"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824251","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}
引用次数: 0
Halo traction evaluation of craniocervical instability in hereditary connective tissue disorder patients: Case series Halo牵引评价遗传性结缔组织疾病患者颅颈不稳定:病例系列。
IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110957
Hussain Bohra , Joseph Maalouly , Chopra Neha , Charmian Stewart , Ashish D. Diwan , Gayani Petersingham , Kevin Seex , Prashanth J. Rao

Introduction

Craniocervical instability (CCI) is a condition commonly found in patients with connective tissue disorders such as Ehlers-Danlos Syndrome (EDS), leading to various symptoms. Assessing patients for surgical fusion as a treatment for CCI is challenging due to the complex nature of EDS-related symptoms. This study aimed to evaluate the role of pre-fusion halo-vest traction in alleviating symptoms and determining suitable candidates for fusion surgeries.

Methods

EDS patients (n = 21) with neurological symptoms underwent insertion of halo-vest traction between 2019 and 2024. Patients completed a CCI Questionnaire before and after the halo-vest traction, reporting symptoms related to headache, vision, hearing, equilibrium, and function. Symptom groups were assigned scores based on patient responses, with one point for each affirmative answer. Before and after scores were analyzed using paired Student’s t-test. Patients experiencing over 50 % improvement in the majority of symptoms were considered for definitive fusion surgery. 16 out of 21 patients subsequently underwent fusion for CCI.

Results

The average age of the patients was 35 years, with a female-to-male ratio of 20:1, consistent with existing literature. Significant improvements were observed in various symptom groups after halo-vest traction, including headache (57 % improvement, p < 0.001), brainstem functions (71 % improvement, p < 0.001), cerebellar functions (55 % improvement, p < 0.001), hearing (63 % improvement, p < 0.001), motor functions (51 % improvement, p < 0.001), vision (60 % improvement, p < 0.001), cardiovascular functions (46 % improvement, p < 0.05), sensory and pain (53 % improvement, p < 0.001), high cortical functions (54 % improvement, p < 0.001), GI functions (52 % improvement, p < 0.05), bladder functions (52 % improvement, p < 0.05), and Modified Karnofsky score (30 % improvement, p < 0.05).

Conclusion

Halo-vest traction proved to be a simple and effective method for evaluating patients for surgery while providing symptomatic relief in EDS-related CCI cases. It allows surgeons to monitor patients with a now post halo stable craniocervical junctions (CCJ) before committing to surgery.
颅颈不稳定性(CCI)是结缔组织疾病(如ehers - danlos综合征(EDS))患者中常见的一种疾病,可导致各种症状。由于eds相关症状的复杂性,评估手术融合作为CCI治疗的患者具有挑战性。本研究旨在评估融合前halo-vest牵引在缓解症状和确定融合手术合适人选方面的作用。方法:2019年至2024年期间,有神经系统症状的EDS患者(n = 21)接受了halo-vest牵引。患者在halo-vest牵引前后完成CCI问卷,报告头痛、视力、听力、平衡和功能相关症状。根据患者的反应给症状组打分,每个肯定答案得一分。使用配对学生t检验对前后得分进行分析。大多数症状改善超过50%的患者可考虑进行最终融合手术。21例患者中有16例随后行CCI融合术。结果:患者平均年龄35岁,男女比例为20:1,与已有文献一致。光晕背心牵引后,各症状组均有显著改善,包括头痛(改善57%)。结论:光晕背心牵引被证明是一种简单有效的评估患者手术的方法,同时可缓解eds相关CCI病例的症状。它允许外科医生在手术前监测患者的后光晕稳定颅颈连接(CCJ)。
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引用次数: 0
Improvement of the vestibular functions as measured by video head Impulse test in patients undergoing ventriculoperitoneal shunt surgery for Idiopathic normal pressure Hydrocephalus: Moving Forward in a yet unexplored territory
IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2025.111051
Alessandro Pesce , Nadia Ciao , Mauro Palmieri , Salvo Martellucci , Maurizio Salvati , Manuele Casale , Angelo Pompucci , Gianpaolo Petrella

Introduction

Idiopathic Normal pressure hydrocephalus (iNPH) is the most common form of reversible dementia in the elderly. Few were investigated about CSF dynamic disturbances and brainstem functions, though it could be a potentially interesting and yet “unexplored” territory. The objective was to evaluate high-frequency VOR through VHIT before and after ventriculoperitoneal (VPS) shunting.

Materials and Methods

We investigated a total of 9 patients suffering a confirmed from iNPH diagnosis. Patients underwent video Head Impulse Test (vHIT) before and 10 days after VPS. The VOR measurement was performed focusing on the horizontal semicircular canals (HSC) and on both sides. The PR and saccadic profiles were investigated through vHIT. For each patient, we recorded age, sex, and comorbidities.

Results

Our preliminary results showed a generally reduced gain in the pre-operative phase (average gain on both sides: 0.66 ± 0.14) and an increase in gain in the post-operative phase, detectable at the first re-evaluation (average gain at the first post-operative −-operative: 0.79 ± 0.11) and an increased PR preoperatively (average PR on both sides 44.8 ± 28.25) with a reduction in PR postoperatively (average PR on both sides 27.57 ± 21.88). Such results, despite the small cohort, were significant. Furthermore, an interesting age-related effect was outlined for PR and saccades profile.

Conclusions

The increase in VOR gain is a constant finding as is the reduction in saccade amplitude. The saccadic organization seems to increase after VPS in most patients. Chemical-physical and hydrodynamic variations of the cerebrospinal fluid may explain the parameters change and the improvement of the vestibular function.
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引用次数: 0
The 5-factor modified frailty index as a prognostic factor following stereotactic radiosurgery for metastatic disease to the brain from non-small cell lung cancer: A multi-center cohort analysis 非小细胞肺癌脑转移性疾病立体定向放射治疗后的预后因素:一项多中心队列分析
IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110979
Sujay Rajkumar , Trent Kite , Jay Desai , Thomas Lucido , David Mathieu , Manjul Tripathi , Navneet Singh , Narendra Kumar , Georgios Mantziaris , Stylianos Pikis , Jason P. Sheehan , Rodney E. Wegner , Matthew J. Shepard

Background

Non-small cell lung cancer (NSCLC) patients often develop brain metastases (BMs), complicating management. We have shown that increasing frailty is associated with decreased overall survival (OS) and central nervous system progression free survival (PFS) for patients undergoing stereotactic radiosurgery (SRS) to BMs. Leveraging the International Radiosurgery Research Foundation, we sought to expand upon these findings, in NSCLC specifically.

Methods

Across four institutions, 193 patients with (≥1) NSCLC derived BMs with minimum 3 months of clinical/radiographic follow-up were analyzed. Primary outcomes included OS and PFS. Patients were stratified utilizing the mFI-5 into pre-frail (0–1), frail (2), and severely frail (3 + ).

Results

Increased frailty was associated with diminished OS (frail hazard ratio (HR) = 2.49, 95 % CI [1.61–3.85]; severely frail HR = 2.65, 95 % CI [1.57–4.45]). The 6-month post-SRS survival rate was 86.1 %, 69.5 % and 54.5 % for pre-frail, frail and severely frail patients, respectively (p < 0.001). Frailty was not significantly predictive of time to PFS on multivariate Cox Proportional Hazards analysis although there was a trend towards diminished PFS with increasing frailty (median PFS was 18.4, 8.0, and 7.4 months for pre-frail, frail, and severely frail, respectively (p = 0.11). As age > 65 was also predictive of shorter OS (HR = 1.78, 95 % CI [1.23–2.56]). We generated a novel scoring system incorporating age and frailty status. The median survival of patients that scored 0, 1, 2, and 3 points were 21.1, 18.3, 8.9, and 5.6 months, respectively (p < 0.001). The area under the curve of the validation cohort using a logistic regression model was 0.77.

Conclusions

Our results indicate that the MFI-5 is a promising metric with application at the point of care to provide decision support for patients with NSCLC derived BMs.
背景:非小细胞肺癌(NSCLC)患者经常发生脑转移(BMs),使治疗变得复杂。我们的研究表明,对于接受立体定向放射手术(SRS)治疗脑转移灶的患者来说,体弱程度的增加与总生存期(OS)和中枢神经系统无进展生存期(PFS)的降低有关。借助国际放射外科研究基金会,我们试图扩大这些研究结果的范围,特别是在 NSCLC 领域:方法:我们对四家医疗机构的 193 名(≥1 例)NSCLC 肿瘤患者进行了分析,这些患者至少接受了 3 个月的临床/放射学随访。主要结果包括OS和PFS。根据 mFI-5 将患者分为前期虚弱(0-1)、虚弱(2)和严重虚弱(3 + ):结果:虚弱程度的增加与OS的降低有关(虚弱危险比(HR)=2.49,95 % CI [1.61-3.85];严重虚弱HR=2.65,95 % CI [1.57-4.45])。虚弱前、虚弱和严重虚弱患者的 SRS 后 6 个月生存率分别为 86.1%、69.5% 和 54.5%(P 65 也是较短 OS 的预测因子(HR = 1.78,95 % CI [1.23-2.56]))。我们建立了一个包含年龄和虚弱状态的新型评分系统。得分为 0、1、2 和 3 分的患者的中位生存期分别为 21.1、18.3、8.9 和 5.6 个月(P 结论:我们的结果表明,MFI-5 可预测更短的生存期(HR = 1.78,95 % CI [1.23-2.56]):我们的研究结果表明,MFI-5 是一种很有前景的指标,可应用于护理点,为 NSCLC 患者提供决策支持。
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引用次数: 0
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Journal of Clinical Neuroscience
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