Journal of Clinical Neuroscience最新文献

英文中文

Primary intracranial melanoma presenting as tentorium meningioma

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-14 DOI: 10.1016/j.jocn.2025.111120

Hailiang Tang , Haixia Cheng , Juefeng Xu (1) , Ming Xu , Jian Xu , Ping Zhong

引用次数: 0

Outcomes of awake surgery for recurrent glioblastoma: A single-institution retrospective analysis

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-13 DOI: 10.1016/j.jocn.2025.111113

Sho Osawa , Daisuke Kawauchi , Makoto Ohno , Yasuji Miyakita , Masamichi Takahashi , Shunsuke Yanagisawa , Shohei Fujita , Takahiro Tsuchiya , Junya Matsumi , Tetsufumi Sato , Yoshitaka Narita

Background

Awake surgery facilitates maximal safe resection of brain tissue in cases of glioma, but its effectiveness for recurrent glioblastoma (GBM) remains unestablished. In this study, we investigate the safety, success rate of mapping, and surgical outcomes of awake surgery for recurrent GBM.

Methods

This study included glioma cases that underwent awake surgery at our hospital between March 2010 and February 2023 and met the following criteria: (1) cases with a pathologic diagnosis of glioblastoma or astrocytoma, isocitrate dehydrogenase-mutant, WHO grade 4 at recurrence, and (2) cases in which this was the second surgery in the course of treatment. We retrospectively analyzed the clinical features, mapping response, resection rate, postoperative complications, overall survival (OS), and progression-free survival (PFS).

Results

Forty-one cases were analyzed. The median age was 47 years, and 24 patients (58.5 %) were male. Awake mapping was successfully completed in 35 cases (85.4 %). A positive response to mapping was observed in 20 cases (48.8 %), which limited resection in 15 cases (36.6 %). The extent of resection was gross total resection in 20 cases (48.8 %), subtotal resection in 11 cases (26.8 %), partial resection in 8 cases (19.5 %), and biopsy in 2 cases (4.9 %). Acute-phase neurological deficits developed in 10 cases (24.4 %), but sequelae or symptom exacerbations were observed in 2 cases (4.9 %). The median post-recurrence OS and PFS were 18.7 months and 7.2 months, respectively.

Conclusions

Awake mapping for recurrent GBM demonstrated a low complication rate and facilitated tumor resection without exacerbating neurological symptoms. Awake surgery for recurrent GBM may contribute to prolonged survival.

{"title":"Outcomes of awake surgery for recurrent glioblastoma: A single-institution retrospective analysis","authors":"Sho Osawa , Daisuke Kawauchi , Makoto Ohno , Yasuji Miyakita , Masamichi Takahashi , Shunsuke Yanagisawa , Shohei Fujita , Takahiro Tsuchiya , Junya Matsumi , Tetsufumi Sato , Yoshitaka Narita","doi":"10.1016/j.jocn.2025.111113","DOIUrl":"10.1016/j.jocn.2025.111113","url":null,"abstract":"<div><h3>Background</h3><div>Awake surgery facilitates maximal safe resection of brain tissue in cases of glioma, but its effectiveness for recurrent glioblastoma (GBM) remains unestablished. In this study, we investigate the safety, success rate of mapping, and surgical outcomes of awake surgery for recurrent GBM.</div></div><div><h3>Methods</h3><div>This study included glioma cases that underwent awake surgery at our hospital between March 2010 and February 2023 and met the following criteria: (1) cases with a pathologic diagnosis of glioblastoma or astrocytoma, isocitrate dehydrogenase-mutant, WHO grade 4 at recurrence, and (2) cases in which this was the second surgery in the course of treatment. We retrospectively analyzed the clinical features, mapping response, resection rate, postoperative complications, overall survival (OS), and progression-free survival (PFS).</div></div><div><h3>Results</h3><div>Forty-one cases were analyzed. The median age was 47 years, and 24 patients (58.5 %) were male. Awake mapping was successfully completed in 35 cases (85.4 %). A positive response to mapping was observed in 20 cases (48.8 %), which limited resection in 15 cases (36.6 %). The extent of resection was gross total resection in 20 cases (48.8 %), subtotal resection in 11 cases (26.8 %), partial resection in 8 cases (19.5 %), and biopsy in 2 cases (4.9 %). Acute-phase neurological deficits developed in 10 cases (24.4 %), but sequelae or symptom exacerbations were observed in 2 cases (4.9 %). The median post-recurrence OS and PFS were 18.7 months and 7.2 months, respectively.</div></div><div><h3>Conclusions</h3><div>Awake mapping for recurrent GBM demonstrated a low complication rate and facilitated tumor resection without exacerbating neurological symptoms. Awake surgery for recurrent GBM may contribute to prolonged survival.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111113"},"PeriodicalIF":1.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403662","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

Letter to the Editor Response.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-12 DOI: 10.1016/j.jocn.2025.111107

Neil D Almeida, Julia Rupp, Babar Gulzar, Tyler V Schrand, Venkatesh Madhugiri, Mengyu Fang, Rohil Shekher, Victor Goulenko, Divya Goyal, Shefalika Prasad, Michael T Milano, Dheerendra Prasad

引用次数: 0

Suspected wernicke encephalopathy with hemorrhage after total gastrectomy: A fatal case in a non-alcoholic patient

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-12 DOI: 10.1016/j.jocn.2025.111116

Sabahattin Yuzkan , Huseyin Ekin Ergin , Ahmet Peker , Yunus Emre Senturk

引用次数: 0

Performance evaluation of ChatGPT-4.0 and Gemini on image-based neurosurgery board practice questions: A comparative analysis

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-11 DOI: 10.1016/j.jocn.2025.111097

Alana M. McNulty , Harshitha Valluri , Avi A. Gajjar, Amanda Custozzo, Nicholas C. Field, Alexandra R. Paul

Introduction

Artificial intelligence (AI) has gained significant attention in medicine, particularly in neurosurgery, where its potential is frequently discussed and occasionally feared. Large language models (LLMs), such as ChatGPT-4.0 (OpenAI) and Gemini (Google DeepMind), have shown promise in text-based tasks but remain underexplored in image-based domains, which are essential for neurosurgery. This study evaluates the performance of ChatGPT-4.0 and Gemini on image-based neurosurgery board practice questions, focusing on their ability to interpret visual data, a critical aspect of neurosurgical decision-making.

Methods

A total of 250 image-based questions selected from two neurosurgical review textbooks were obtained. Each question was presented to both ChatGPT-4.0 and Gemini in its original format, including images such as MRI scans, pathology slides, and surgical visuals. The models were tasked with answering the questions, and their accuracy was determined based on the number of correct responses.

Results

ChatGPT-4.0 correctly answered 84 questions (33.6 %), significantly outperforming Gemini, which answered only 1 question correctly (0.4 %) (p < 0.0001). ChatGPT-4.0 provided correct answers for 17.7 % of questions from The Comprehensive Neurosurgery Board Preparation Book and 50.0 % from Neurosurgery Board Review. Gemini exhibited a 17.8 % “inability response” rate, explicitly stating it could not interpret images. The performance gap between the two models was significant (p < 0.0001), highlighting their limitations in handling complex visual data.

Conclusions

While ChatGPT-4.0 demonstrated some capacity to interpret image-based neurosurgery board questions, both models exhibited significant limitations, particularly in processing and analyzing complex visual data. These findings emphasize the need for targeted advancements in AI to improve visual interpretation in neurosurgical education and practice.

{"title":"Performance evaluation of ChatGPT-4.0 and Gemini on image-based neurosurgery board practice questions: A comparative analysis","authors":"Alana M. McNulty , Harshitha Valluri , Avi A. Gajjar, Amanda Custozzo, Nicholas C. Field, Alexandra R. Paul","doi":"10.1016/j.jocn.2025.111097","DOIUrl":"10.1016/j.jocn.2025.111097","url":null,"abstract":"<div><h3>Introduction</h3><div>Artificial intelligence (AI) has gained significant attention in medicine, particularly in neurosurgery, where its potential is frequently discussed and occasionally feared. Large language models (LLMs), such as ChatGPT-4.0 (OpenAI) and Gemini (Google DeepMind), have shown promise in text-based tasks but remain underexplored in image-based domains, which are essential for neurosurgery. This study evaluates the performance of ChatGPT-4.0 and Gemini on image-based neurosurgery board practice questions, focusing on their ability to interpret visual data, a critical aspect of neurosurgical decision-making.</div></div><div><h3>Methods</h3><div>A total of 250 image-based questions selected from two neurosurgical review textbooks were obtained. Each question was presented to both ChatGPT-4.0 and Gemini in its original format, including images such as MRI scans, pathology slides, and surgical visuals. The models were tasked with answering the questions, and their accuracy was determined based on the number of correct responses.</div></div><div><h3>Results</h3><div>ChatGPT-4.0 correctly answered 84 questions (33.6 %), significantly outperforming Gemini, which answered only 1 question correctly (0.4 %) (p < 0.0001). ChatGPT-4.0 provided correct answers for 17.7 % of questions from The Comprehensive Neurosurgery Board Preparation Book and 50.0 % from Neurosurgery Board Review. Gemini exhibited a 17.8 % “inability response” rate, explicitly stating it could not interpret images. The performance gap between the two models was significant (p < 0.0001), highlighting their limitations in handling complex visual data.</div></div><div><h3>Conclusions</h3><div>While ChatGPT-4.0 demonstrated some capacity to interpret image-based neurosurgery board questions, both models exhibited significant limitations, particularly in processing and analyzing complex visual data. These findings emphasize the need for targeted advancements in AI to improve visual interpretation in neurosurgical education and practice.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111097"},"PeriodicalIF":1.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387242","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

Assessment of age-related variation in cervical neuroforaminal dimensions

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-08 DOI: 10.1016/j.jocn.2025.111095

Kai Nguyen , Zachary Brandt , David Shin , Rohan Kubba , Ethan Vyhmeister , Jacob Razzouk , Christopher Shaffrey , Wayne Cheng , Olumide Danisa

Radiographic parameters for diagnosing cervical neuroforaminal stenosis (CNFS) are not well described. To develop definitive criteria for diagnosis of CNFS, a standardized baseline of average neuroforaminal dimensions must first be established. Thus, the aim of this study was to: (1) use computed tomography (CT) of patients without neck pain or spinal pathology to establish mean cervical neuroforaminal dimensions (CNFD) across multiple age groups and (2) assess differences in CNFD by age. Cervical CT scans of 1,457 asymptomatic patients were reviewed to measure CNFD, defined as follows: axial width, craniocaudal height, and area. Patients were divided into four groups based on age: 18–35, 36–50, 51–64, and 65 + years. Statistical analyses were used to assess differences in CNFD according to age group. Mean overall CNFD for the 18–35 year-old cohort were 6.43 mm for width, 9.28 mm for height, and 58.85 mm² for area. For the 36–50 year-old cohort, dimensions were 5.89 mm for width, 8.63 mm for height, and 52.78 mm² for area. For the 51–64 year-old cohort, dimensions were 5.29 mm for width, 8.52 mm for height, and 48.93 mm² for area. Finally, the 65 + year-old cohort had dimensions of 5.09 mm for width, 8.16 mm for height, and 45.91 mm² for area. Significant differences in CNFD were observed between age groups, with dimensions decreasing in size from the younger to older age groups. In the studied population, CNFD decreased progressively with age. The results of our study may have utility in the diagnosis of CNFS.

{"title":"Assessment of age-related variation in cervical neuroforaminal dimensions","authors":"Kai Nguyen , Zachary Brandt , David Shin , Rohan Kubba , Ethan Vyhmeister , Jacob Razzouk , Christopher Shaffrey , Wayne Cheng , Olumide Danisa","doi":"10.1016/j.jocn.2025.111095","DOIUrl":"10.1016/j.jocn.2025.111095","url":null,"abstract":"<div><div>Radiographic parameters for diagnosing cervical neuroforaminal stenosis (CNFS) are not well described. To develop definitive criteria for diagnosis of CNFS, a standardized baseline of average neuroforaminal dimensions must first be established. Thus, the aim of this study was to: (1) use computed tomography (CT) of patients without neck pain or spinal pathology to establish mean cervical neuroforaminal dimensions (CNFD) across multiple age groups and (2) assess differences in CNFD by age. Cervical CT scans of 1,457 asymptomatic patients were reviewed to measure CNFD, defined as follows: axial width, craniocaudal height, and area. Patients were divided into four groups based on age: 18–35, 36–50, 51–64, and 65 + years. Statistical analyses were used to assess differences in CNFD according to age group.Mean overall CNFD for the 18–35 year-old cohort were 6.43 mm for width, 9.28 mm for height, and 58.85 mm<sup>2</sup> for area. For the 36–50 year-old cohort, dimensions were 5.89 mm for width, 8.63 mm for height, and 52.78 mm<sup>2</sup> for area. For the 51–64 year-old cohort, dimensions were 5.29 mm for width, 8.52 mm for height, and 48.93 mm<sup>2</sup> for area. Finally, the 65 + year-old cohort had dimensions of 5.09 mm for width, 8.16 mm for height, and 45.91 mm<sup>2</sup> for area. Significant differences in CNFD were observed between age groups, with dimensions decreasing in size from the younger to older age groups. In the studied population, CNFD decreased progressively with age. The results of our study may have utility in the diagnosis of CNFS.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111095"},"PeriodicalIF":1.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350527","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 utility of the 5-Item frailty index in assessing the risk of complications and mortality following surgical management of non-traumatic subarachnoid hemorrhage

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-08 DOI: 10.1016/j.jocn.2025.111111

Qais AbuHasan , Jakob V.E. Gerstl , Chady Omara , Harshit Arora , Muhieddine Labban , Abdullah H. Feroze , Timothy R. Smith , Mohammad A. Aziz-Sultan

The modified 5-item frailty index (mFI-5), an index of reduced physiological reserve, has risen as a predictor of complications following surgical procedures. We examined the association of mFI-5 and surgical outcomes following the management of nontraumatic subarachnoid hemorrhage (nSAH). We queried the American College of Surgeons National Surgical Quality Improvement Program database for patients who received surgical management of nSAH between 2006 and 2021. We computed the mFI-5 by granting a point for each of 1) congestive heart failure, 2) hypertension requiring medications, 3) diabetes, 4) chronic obstructive pulmonary disease or pneumonia within 30 days before surgery, and 5) dependent functional status. Our 30-day endpoints were minor complications (Clavien-Dindo: 1 & 2), major complications (Clavien-Dindo: 3 & 4), and mortality. Using the Chi-squared test, we compared baseline patient demographics and comorbidities between patients with a mFI-5 ≥ 2, patients with a mFI-5 = 1, and non-frail patients. Then, we fitted a multivariable logistic regression adjusting for patient demographics, comorbidities, operative time, and frailty status. The cohort included 1,139 patients, of which 33.7 % were men and 2.9 % had a bleeding diathesis. After adjusting for covariates, mFI-5 ≥ 2 was independently associated with minor complications (1.93, 95 %CI: 1.31–2.84, p = 0.001), major complications (aOR: 1.62, 95 %CI: 1.10–2.37, p = 0.015), and mortality (aOR: 2.90, 95 %CI: 1.66–5.08, p = 0.003). The mFI-5 can be independently used by surgeons for risk stratification and postoperative planning.

{"title":"The utility of the 5-Item frailty index in assessing the risk of complications and mortality following surgical management of non-traumatic subarachnoid hemorrhage","authors":"Qais AbuHasan , Jakob V.E. Gerstl , Chady Omara , Harshit Arora , Muhieddine Labban , Abdullah H. Feroze , Timothy R. Smith , Mohammad A. Aziz-Sultan","doi":"10.1016/j.jocn.2025.111111","DOIUrl":"10.1016/j.jocn.2025.111111","url":null,"abstract":"<div><div>The modified 5-item frailty index (mFI-5), an index of reduced physiological reserve, has risen as a predictor of complications following surgical procedures. We examined the association of mFI-5 and surgical outcomes following the management of nontraumatic subarachnoid hemorrhage (nSAH). We queried the American College of Surgeons National Surgical Quality Improvement Program database for patients who received surgical management of nSAH between 2006 and 2021. We computed the mFI-5 by granting a point for each of 1) congestive heart failure, 2) hypertension requiring medications, 3) diabetes, 4) chronic obstructive pulmonary disease or pneumonia within 30 days before surgery, and 5) dependent functional status. Our 30-day endpoints were minor complications (Clavien-Dindo: 1 & 2), major complications (Clavien-Dindo: 3 & 4), and mortality. Using the Chi-squared test, we compared baseline patient demographics and comorbidities between patients with a mFI-5 ≥ 2, patients with a mFI-5 = 1, and non-frail patients. Then, we fitted a multivariable logistic regression adjusting for patient demographics, comorbidities, operative time, and frailty status. The cohort included 1,139 patients, of which 33.7 % were men and 2.9 % had a bleeding diathesis. After adjusting for covariates, mFI-5 ≥ 2 was independently associated with minor complications (1.93, 95 %CI: 1.31–2.84, p = 0.001), major complications (aOR: 1.62, 95 %CI: 1.10–2.37, p = 0.015), and mortality (aOR: 2.90, 95 %CI: 1.66–5.08, p = 0.003). The mFI-5 can be independently used by surgeons for risk stratification and postoperative planning.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111111"},"PeriodicalIF":1.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349439","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

Direct transfer to angiosuite vs conventional workup for stroke: A systematic review and meta-analysis

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-08 DOI: 10.1016/j.jocn.2025.111110

Ali Mortezaei , Mohammadreza Alizadeh , Mohammad Mirahmadi Eraghi , Sogand Sheikholeslami , Taimur Hasan , Ramin Shahidi , Visish M. Srinivasan , Jan-Karl Burkhardt , Redi Rahmani

Background

Reducing the stroke time metric in patients with stroke who underwent thrombectomy is associated with good functional recovery. We compared direct transfer to angiosuite (DTAS) vs conventional workup (CWU) in patients who underwent endovascular treatment due to large vessel occlusion (LVO).

Methods

A systematic search was conducted in four electronic databases. The continuous outcomes were analyzed using the standardized mean difference (SMD) and 95 % CI, while the binary outcomes were analyzed using the odds ratio (OR) and 95 % confidence interval (CI).

Results

We included a total of 3145 patients, which 1168 patients were in DTAS group and 1977 were in CWU group. DTAS showed a significantly higher likelihood of 90-day mRS0-1 (OR 1.6, p = 0.002) and mRS0-2 (OR 1.47, p < 0.0001), successful reperfusion (OR 1.53, 95 % CI 1.1 to 2.1, p = 0.0122), and lower door-to-puncture (SMD −4.36, 95 % CI −7.4 to −1.3, p = 0.0096) than CWU. There was no significant difference between the two triage protocols in 90-day mortality (OR 0.98, 95 % CI 0.6 to 1.64, p = 0.94) and symptomatic intracranial hemorrhage (OR 0.78, p = 0.14). The proportion of patients who were triaged to DTAS with non-LVO on diagnostic angiography in angiosuite was 5.76 % (95 % CI 1.8 % to 11.4 %). There was a significant difference between randomized trials versus observational studies in 90-day mRS0-2 (OR 1.91 vs 1.16, p = 0.0042), 90-day mortality (OR 0.62 vs 1.27, p = 0.12), and door-to-puncture time (SMD −1.25 vs −5.53, p = 0.027).

Conclusion

DTAS is a feasible, safe, and cost-effective triage approach for managing patients with acute stroke due to LVO.

{"title":"Direct transfer to angiosuite vs conventional workup for stroke: A systematic review and meta-analysis","authors":"Ali Mortezaei , Mohammadreza Alizadeh , Mohammad Mirahmadi Eraghi , Sogand Sheikholeslami , Taimur Hasan , Ramin Shahidi , Visish M. Srinivasan , Jan-Karl Burkhardt , Redi Rahmani","doi":"10.1016/j.jocn.2025.111110","DOIUrl":"10.1016/j.jocn.2025.111110","url":null,"abstract":"<div><h3>Background</h3><div>Reducing the stroke time metric in patients with stroke who underwent thrombectomy is associated with good functional recovery. We compared direct transfer to angiosuite (DTAS) vs conventional workup (CWU) in patients who underwent endovascular treatment due to large vessel occlusion (LVO).</div></div><div><h3>Methods</h3><div>A systematic search was conducted in four electronic databases. The continuous outcomes were analyzed using the standardized mean difference (SMD) and 95 % CI, while the binary outcomes were analyzed using the odds ratio (OR) and 95 % confidence interval (CI).</div></div><div><h3>Results</h3><div>We included a total of 3145 patients, which 1168 patients were in DTAS group and 1977 were in CWU group. DTAS showed a significantly higher likelihood of 90-day mRS0-1 (OR 1.6, p = 0.002) and mRS0-2 (OR 1.47, p < 0.0001), successful reperfusion (OR 1.53, 95 % CI 1.1 to 2.1, p = 0.0122), and lower door-to-puncture (SMD −4.36, 95 % CI −7.4 to −1.3, p = 0.0096) than CWU. There was no significant difference between the two triage protocols in 90-day mortality (OR 0.98, 95 % CI 0.6 to 1.64, p = 0.94) and symptomatic intracranial hemorrhage (OR 0.78, p = 0.14). The proportion of patients who were triaged to DTAS with non-LVO on diagnostic angiography in angiosuite was 5.76 % (95 % CI 1.8 % to 11.4 %). There was a significant difference between randomized trials versus observational studies in 90-day mRS0-2 (OR 1.91 vs 1.16, p = 0.0042), 90-day mortality (OR 0.62 vs 1.27, p = 0.12), and door-to-puncture time (SMD −1.25 vs −5.53, p = 0.027).</div></div><div><h3>Conclusion</h3><div>DTAS is a feasible, safe, and cost-effective triage approach for managing patients with acute stroke due to LVO.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111110"},"PeriodicalIF":1.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350532","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

Investigation of blood carnitine levels in hydrocephalus patients

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-08 DOI: 10.1016/j.jocn.2025.111098

Ebru Temiz , Ismail Koyuncu , Murat Tiken , Kadir Egi , Sukru Akmese , Gulyara Cigdem , Huseyin Taskiran , Mehmet Enes

Hydrocephalus is a complex neurological disorder that severely impacts the central nervous system. It is a multifactorial disease causing significant neurological deterioration and death in children. Despite numerous studies on hydrocephalus, its pathophysiology remains unclear. This study aims to identify possible changes in carnitine metabolism by comparing the carnitine profiles of children with hydrocephalus to those of healthy children. Additionally, the study seeks to determine the potential use of carnitine derivatives in the diagnosis and treatment of hydrocephalus. Blood samples from 32 hydrocephalic patients and 25 healthy individuals were analyzed. The carnitine profile (C0, C2, C4, etc.) was measured using LC-MS/MS. Statistical analyses of the data were performed using the MetaboAnalyst 5.0 program. The results showed that 23 carnitines were significantly lower in the hydrocephalus group compared to the control group. According to the MetaboAnalyst VIP score, C12 was identified as having high potential as a distinguishing marker. ROC analysis indicated that C12 had a specificity of 100% and a sensitivity of 80%. These findings suggest reduced carnitine profile with hydrocephalus pathology. Therefore, further research should be conducted to explore the addition of carnitine to hydrocephalus treatment protocols.

{"title":"Investigation of blood carnitine levels in hydrocephalus patients","authors":"Ebru Temiz , Ismail Koyuncu , Murat Tiken , Kadir Egi , Sukru Akmese , Gulyara Cigdem , Huseyin Taskiran , Mehmet Enes","doi":"10.1016/j.jocn.2025.111098","DOIUrl":"10.1016/j.jocn.2025.111098","url":null,"abstract":"<div><div>Hydrocephalus is a complex neurological disorder that severely impacts the central nervous system. It is a multifactorial disease causing significant neurological deterioration and death in children. Despite numerous studies on hydrocephalus, its pathophysiology remains unclear. This study aims to identify possible changes in carnitine metabolism by comparing the carnitine profiles of children with hydrocephalus to those of healthy children. Additionally, the study seeks to determine the potential use of carnitine derivatives in the diagnosis and treatment of hydrocephalus. Blood samples from 32 hydrocephalic patients and 25 healthy individuals were analyzed. The carnitine profile (C0, C2, C4, etc.) was measured using LC-MS/MS. Statistical analyses of the data were performed using the MetaboAnalyst 5.0 program. The results showed that 23 carnitines were significantly lower in the hydrocephalus group compared to the control group. According to the MetaboAnalyst VIP score, C12 was identified as having high potential as a distinguishing marker. ROC analysis indicated that C12 had a specificity of 100% and a sensitivity of 80%. These findings suggest reduced carnitine profile with hydrocephalus pathology. Therefore, further research should be conducted to explore the addition of carnitine to hydrocephalus treatment protocols.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111098"},"PeriodicalIF":1.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372481","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

Expanded applications of knotless tissue control devices in neurosurgical cranial and spinal applications

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-08 DOI: 10.1016/j.jocn.2025.111108

Samuel A. Tenhoeve , Clayton Rawson , Dora R. Tabachnick , Mohammed A. Azab , Omowumi Oladipo , Michael Karsy

Objectives

Effective wound closure is essential to neurosurgical procedures. Historical rates of neurosurgical wound complications range from 7 to 14 %. Knotless suturing with barbed sutures may offer effective closure rates but has had limited evaluation of safety in neurosurgical applications.

Methods

Consecutive patients undergoing cranial, spinal, and peripheral nerve neurosurgical procedures from 12/2022 until 7/2024 were included in a quality improvement initiative. A retrospective review of demographics, past medical history, and operative and postoperative variables was undertaken. The primary outcome of interest was wound complications, including surgical site infection (SSI), dehiscence, or CSF leak. A cost analysis of suture treatment was also compared. A comparison to historical control rates (7%) was performed (one-sample proportional z-test).

Results

A total of 195 consecutive patients were identified, with 10 wound-related complications including 3 superficial dehiscence treated with washout, 2 pseudomeningoceles, 2 cerebrospinal fluid leaks with meningitis, and 1 each of deep dehiscence with washout, superficial dehiscence with antibiotics, and epidural hematoma. A total of 53 (27.2 %) underwent cranial, 140 (71.8 %) spine, and 3 (1.0 %) peripheral nerve procedures. Ten patients (5.1 %) had incision complications with no difference to historical controls (p = 0.3). Cost analysis showed a range 0.35–3.03X cost differences using the knotless suture technique for different neurosurgical applications.

Conclusion

Knotless suture techniques can be an effective closure method for a variety of neurosurgical techniques comparable to expected wound complication rates. We expand on the potential applications of this technology compared with prior studies. Further studies will be necessary to confirm these findings.

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