Journal of Clinical Neuroscience最新文献

{"title":"The effect of temporary CSF diversion modality on shunt-dependency following aneurysmal subarachnoid hemorrhage: A nationwide assessment","authors":"Michelle Lin,&nbsp;Jonathan Dallas,&nbsp;Li Ding,&nbsp;Vincent N. Nguyen,&nbsp;Devin Bageac,&nbsp;Benjamin Hopkins,&nbsp;Frank J. Attenello,&nbsp;William J. Mack","doi":"10.1016/j.jocn.2024.111008","DOIUrl":"10.1016/j.jocn.2024.111008","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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 <em>and</em> 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.</div></div><div><h3>Results</h3><div>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 &lt; 0.0001), even when controlling for APR-DRG illness severity and ECI.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"132 ","pages":"Article 111008"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894676","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}

{"title":"Evolving treatment paradigms of cerebral aneurysm stasis in flow diversion","authors":"Joshua H. Weinberg ,&nbsp;Max Gruber ,&nbsp;Nathan Ritchey,&nbsp;Landon Ehlers,&nbsp;Santino Cua,&nbsp;Amanda Zakeri,&nbsp;Ciaran Powers,&nbsp;Shahid Nimjee,&nbsp;Patrick Youssef","doi":"10.1016/j.jocn.2024.110996","DOIUrl":"10.1016/j.jocn.2024.110996","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>p</em> = 0.667), complete occlusion (<em>p</em> = 0.774) or progression of occlusion (<em>p</em> = 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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"132 ","pages":"Article 110996"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894719","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}

{"title":"The “make a flower bud and push at neck” technique: A safe and versatile technique for Woven EndoBridge treatment","authors":"Jun Tanabe ,&nbsp;Ichiro Nakahara ,&nbsp;Shoji Matsumoto ,&nbsp;Jun Morioka ,&nbsp;Tetsuya Hashimoto ,&nbsp;Junpei Koge ,&nbsp;Kenichiro Suyama ,&nbsp;Takeya Suzuki ,&nbsp;Akiko Hasebe ,&nbsp;Sadayoshi Watanabe","doi":"10.1016/j.jocn.2024.110942","DOIUrl":"10.1016/j.jocn.2024.110942","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"132 ","pages":"Article 110942"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780255","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}

{"title":"Vanishing Rathke’s cleft cyst","authors":"Charles Champeaux Depond ,&nbsp;Dahmane Elhairech ,&nbsp;Philippe Metellus","doi":"10.1016/j.jocn.2024.110986","DOIUrl":"10.1016/j.jocn.2024.110986","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"132 ","pages":"Article 110986"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824268","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}

{"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}

{"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}

{"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}

{"title":"Halo traction evaluation of craniocervical instability in hereditary connective tissue disorder patients: Case series","authors":"Hussain Bohra ,&nbsp;Joseph Maalouly ,&nbsp;Chopra Neha ,&nbsp;Charmian Stewart ,&nbsp;Ashish D. Diwan ,&nbsp;Gayani Petersingham ,&nbsp;Kevin Seex ,&nbsp;Prashanth J. Rao","doi":"10.1016/j.jocn.2024.110957","DOIUrl":"10.1016/j.jocn.2024.110957","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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 <em>t</em>-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.</div></div><div><h3>Results</h3><div>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, <em>p</em> &lt; 0.001), brainstem functions (71 % improvement, <em>p</em> &lt; 0.001), cerebellar functions (55 % improvement, <em>p</em> &lt; 0.001), hearing (63 % improvement, <em>p</em> &lt; 0.001), motor functions (51 % improvement,<!--> <em>p</em> &lt; 0.001), vision (60 % improvement, <em>p</em> &lt; 0.001), cardiovascular functions (46 % improvement, <em>p</em> &lt; 0.05), sensory and pain (53 % improvement, <em>p</em> &lt; 0.001), high cortical functions (54 % improvement, <em>p</em> &lt; 0.001), GI functions (52 % improvement, <em>p</em> &lt; 0.05), bladder functions (52 % improvement, <em>p</em> &lt; 0.05), and Modified Karnofsky score (30 % improvement, <em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"132 ","pages":"Article 110957"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791770","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}

{"title":"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","authors":"Alessandro Pesce ,&nbsp;Nadia Ciao ,&nbsp;Mauro Palmieri ,&nbsp;Salvo Martellucci ,&nbsp;Maurizio Salvati ,&nbsp;Manuele Casale ,&nbsp;Angelo Pompucci ,&nbsp;Gianpaolo Petrella","doi":"10.1016/j.jocn.2025.111051","DOIUrl":"10.1016/j.jocn.2025.111051","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Materials and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111051"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080235","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}

{"title":"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","authors":"Sujay Rajkumar ,&nbsp;Trent Kite ,&nbsp;Jay Desai ,&nbsp;Thomas Lucido ,&nbsp;David Mathieu ,&nbsp;Manjul Tripathi ,&nbsp;Navneet Singh ,&nbsp;Narendra Kumar ,&nbsp;Georgios Mantziaris ,&nbsp;Stylianos Pikis ,&nbsp;Jason P. Sheehan ,&nbsp;Rodney E. Wegner ,&nbsp;Matthew J. Shepard","doi":"10.1016/j.jocn.2024.110979","DOIUrl":"10.1016/j.jocn.2024.110979","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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 + ).</div></div><div><h3>Results</h3><div>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 &lt; 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 &gt; 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 &lt; 0.001). The area under the curve of the validation cohort using a logistic regression model was 0.77.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"132 ","pages":"Article 110979"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824263","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}