Journal of Clinical Neuroscience最新文献_第7页

Questionnaire format of modified frailty index as a predictor for 30-day readmission and length of stay in elderly patients undergoing multi-level lumbar interbody fusion 改进的衰弱指数问卷形式对行多段腰椎椎体间融合术的老年患者30天再入院和住院时间的预测。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110959

Sofia Eva Olsson , Kendall Montgomery , Olaide Ajayi

Background

Frailty is a spectrum describing a demographic more likely to experience adverse events such as falls, disability, and hospital admission which can be quantified by the modified frailty index (mFI). Several studies have associated increased mFI score with higher rates of hospital readmission and length of stay (LOS). This study tests the predictive value of a frailty questionnaire based on the mFI on LOS and 30-day readmission rates.

Methods

This retrospective chart review included all patients aged 60 or older who underwent multi-level LIF by 13 surgeons at a single institution. Patients were classified as frail (mFI > 1) or non-frail (mFI ≤ 1). Statistical analysis was performed on Microsoft Excel and included t-testing, linear correlations, and analysis of variance.

Results

A total of 213 patients were included in the study with an average frailty score of 2.26. Frail patients had significantly increased LOS (P < 0.001) with no significant difference between vertebral levels (P = 0.27). Linear correlations between frailty score and LOS or readmission rate were positive in all cases with variable strength dependent on number of levels fused. Conclusions

The frailty questionnaire is an effective method of predicting LOS and risk of 30-day post-operative readmission in elderly patients undergoing multi-level LIF. The questionnaire format will allow for increased ease of obtaining frailty scores, so that improved pre-operative decision-making can be made among clinicians and patients alike. Future studies may be performed to identify the best method of interpreting frailty scores and may be expanded to a multi-institutional level.

背景：虚弱是一个谱，描述了更容易经历跌倒、残疾和住院等不良事件的人群，可以通过修改后的虚弱指数（mFI）来量化。一些研究表明，mFI评分的增加与再入院率和住院时间（LOS）的增加有关。本研究测试了基于mFI的衰弱问卷对LOS和30天再入院率的预测价值。方法：本回顾性图表回顾包括所有在同一机构接受13位外科医生多级LIF的60岁及以上患者。将患者分为体弱（mFI≤1）和非体弱（mFI≤1）。在Microsoft Excel上进行统计分析，包括t检验、线性相关和方差分析。结果：共纳入213例患者，衰弱评分平均为2.26分。体弱患者的LOS明显增加(P

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引用次数: 0

Predicting the biomechanical behavior of lumbar intervertebral Discs: A comparative finite element analysis of a novel artificial disc design 预测腰椎间盘的生物力学行为：一种新型人工椎间盘设计的比较有限元分析。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110960

Ashutosh Khanna , Pushpdant Jain , C.P. Paul

Osseointegration along with better mimicry of natural bone behaviour addresses the long-term performance of artificial intervertebral disc prosthesis. Here the effect of a novel artificial intervertebral disc geometry on stress, deformation and strain on lumbar segments to restore movement of the spine was investigated. The process involved, using CT image data, and solid modelling, simulation-driven design and finite element (FE) analysis, hexahedral mesh sensitivity analysis, implant placements. The range of motion (ROM) was calculated using an ANSYS deformation probe. The intact lumbar spine model established was compared with two implants, replacement at segment L4-L5 level, and biomechanical results were compared using axial loads of 500 N, 800 N, 1000 N and 10Nm moment. The two lumbosacral FE models, a novel implant Titanium Conix (TIC) and another FDA approved SB Charite™ (SBC) implant were considered. Novel TIC implant geometry exhibited comparable ROM values in four physiological motions, which were comparable to as required for restoring natural motion. The result shows that the proposed TIC observed the deformation during flexion, extension, bending and twist as 3.43 mm, 3.19 mm, 3.33 mm and 3.48 mm respectively. Similarly strain of 0.01 during flexion, 0.02 during extension, 0.01 during bending and 0.02 during twist. The implants designed in this study demonstrate the suitability of titanium alloy in endplates and annulus. The FE models in the study with their biomechanical parameters can be considered before clinical implementation of any implants, pre-surgery evaluations, implant placement simulations, postsurgical response, follow-up revisions, implant customization and manufacturing.

骨结合以及更好地模仿天然骨骼的行为可以解决人工椎间盘假体的长期性能问题。本文研究了新型人工椎间盘几何形状对腰椎节段应力、变形和应变的影响，以恢复脊柱的运动。研究过程包括使用 CT 图像数据、实体建模、模拟驱动设计和有限元（FE）分析、六面体网格敏感性分析、植入物放置。使用 ANSYS 变形探针计算运动范围 (ROM)。将所建立的完整腰椎模型与两种植入物进行比较，在 L4-L5 节段进行置换，并使用 500 N、800 N、1000 N 和 10Nm 力矩的轴向载荷对生物力学结果进行比较。两种腰骶部 FE 模型，一种是新型植入物 Titanium Conix（TIC），另一种是经 FDA 批准的 SB Charite™ （SBC）植入物。新型 TIC 植入体的几何形状在四种生理运动中表现出相似的 ROM 值，与恢复自然运动所需的 ROM 值相当。结果显示，拟议的 TIC 在屈曲、伸展、弯曲和扭转时的变形分别为 3.43 毫米、3.19 毫米、3.33 毫米和 3.48 毫米。同样，屈曲时的应变为 0.01，伸展时的应变为 0.02，弯曲时的应变为 0.01，扭转时的应变为 0.02。本研究中设计的植入体证明了钛合金在内板和椎环中的适用性。研究中的有限元模型及其生物力学参数可在临床使用任何种植体、手术前评估、种植体植入模拟、手术后反应、后续修正、种植体定制和制造之前加以考虑。

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引用次数: 0

Early-onset stroke-like migraine attacks after radiation therapy syndrome: A case report and review of the literature 放射治疗综合征后早发性卒中样偏头痛：1例报告及文献复习。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110983

Ariana Chow , Gabrielle E.A. Hovis , Farinaz Ghodrati , Maya Harary , Khashayar Mozaffari , Anjali Pradhan , John Hegde , Isaac Yang

Purpose

Stroke-like migraine attacks after radiation therapy (SMART) syndrome is characterized by migraines, seizures, and stroke-like symptoms following brain irradiation. Diagnosis consists of clinical signs, history of brain irradiation, and radiographic evaluation. The latency to onset varies widely among individual patients, ranging from 1 to 35 years. Herein, we review the literature and present a case of SMART syndrome with an onset of five months after stereotactic radiosurgery for a benign meningioma.

Methods

A systematic review of the literature was conducted in line with the PRISMA guidelines. The PubMed, Cochrane, and Web of Science databases were searched for cases of SMART syndrome with reported time of onset and radiation dosage. Finally, we report the presentation, history, radiographic findings, and clinical outcomes of a 48-year-old female with suspected SMART syndrome.

Results

Of 101 articles reviewed, 23 articles were selected for inclusion in the present study. A total of 27 cases were identified. The mean age at presentation was 43 years (range: 11–70), and 71.4 % of patients were male. The mean latency to onset was 11.2 years after radiation. Based on case descriptions, none of the patients were definitively treated with single fraction radiosurgery.

Conclusion

SMART syndrome may present with variations in latency to onset, radiation dose, outcome, and clinical course. The present case of SMART syndrome highlights the variety in clinical presentation of this disease. Further work should be considered to better determine whether clinical and radiographic criteria for diagnosing SMART syndrome diagnosis are sufficient to encompass patients with a non-traditional presentation.

目的：放射治疗后中风样偏头痛发作（SMART）综合征的特征是脑部照射后出现偏头痛、癫痫发作和中风样症状。诊断包括临床症状、脑部照射史和放射学评估。不同患者的发病潜伏期差异很大，从 1 年到 35 年不等。在此，我们回顾了相关文献，并介绍了一例在立体定向放射手术治疗良性脑膜瘤后五个月发病的 SMART 综合征患者：方法：根据 PRISMA 指南对文献进行了系统回顾。我们在 PubMed、Cochrane 和 Web of Science 数据库中搜索了 SMART 综合征病例，并报告了发病时间和放射剂量。最后，我们报告了一名 48 岁女性疑似 SMART 综合征患者的表现、病史、放射学检查结果和临床疗效：结果：在查阅的 101 篇文章中，有 23 篇文章被选入本研究。共发现 27 个病例。患者的平均发病年龄为 43 岁（范围：11-70 岁），71.4% 的患者为男性。平均发病潜伏期为辐射后 11.2 年。根据病例描述，所有患者均未明确接受单次放射外科治疗：结论：SMART 综合征的发病潜伏期、放射剂量、治疗效果和临床过程可能存在差异。本例 SMART 综合征突显了这种疾病临床表现的多样性。应考虑进一步开展工作，以更好地确定诊断 SMART 综合征的临床和放射学标准是否足以涵盖非传统表现的患者。

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引用次数: 0

Acute subdural hematomas in nonagenarians and centenarians 九十岁及百岁老人的急性硬膜下血肿。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110997

Richard Cook, Laura Zima, Ryan Kitagawa

Background

There is minimal literature on the outcomes of acute traumatic subdural hematoma (SDH) in patients 90 years of age or older. This study aims to characterize the presentation and acute outcomes of patients in this population, particularly for surgical candidates.

Methods

Patients 90 years of age or older with acute SDH between 2013–2023 were analyzed (n = 117). Multivariable binomial logistic regression assessed associations with favorable outcome, defined as a discharge to a non-hospice facility with a Glasgow Coma Scale (GCS) of 14 or greater. Nominal data was analyzed via Wilcoxon rank-sum test and categorical data was analyzed via Chi-squared test.

Results

For this patient population mortality was 7.7%. 86.3% of all patients had favorable outcome. Eight patients underwent surgery, with two resulting in mortality.. However, 62.5% of patients who underwent surgery had a favorable outcome. Patients undergoing surgery had longer average length of stay (P = 0.002), greater in-hospital mortality (P = 0.013), and younger age (P = 0.008) compared to non-surgical patients. Prior independence (OR 7.07, 95% CI 1.33–37.45, P = 0.022) and higher GCS at arrival (OR 1.67, 95% CI 1.11–2.49, P = 0.013) were associated with favorable outcomes.

Conclusion

86.3% of patients 90 years of age or older with acute subdural hematomas had a favorable outcome in our series. Prior independence and higher GCS at arrival were associated with favorable discharge. Several patients had good outcomes after craniotomy for acute SDH, indicating there are some patients in this age group who should be considered for surgery.

背景：关于90岁以上患者急性外伤性硬膜下血肿（SDH）预后的文献很少。本研究旨在描述这一人群中患者的表现和急性预后，特别是手术候选人。方法：分析2013-2023年间90岁及以上急性SDH患者（n = 117）。多变量二项逻辑回归评估了与良好预后的关联，良好预后的定义为格拉斯哥昏迷评分（GCS）为14或更高，从非临终关怀机构出院。名义资料采用Wilcoxon秩和检验，分类资料采用卡方检验。结果：本组患者死亡率为7.7%。86.3%的患者预后良好。8名患者接受了手术，其中2人死亡。然而，62.5%接受手术的患者有良好的结果。与非手术患者相比，接受手术的患者平均住院时间更长（P = 0.002），住院死亡率更高（P = 0.013），年龄更小（P = 0.008）。先前的独立性（OR 7.07, 95% CI 1.33-37.45, P = 0.022）和到达时较高的GCS （OR 1.67, 95% CI 1.11-2.49, P = 0.013）与良好的结果相关。结论：在我们的研究中，86.3%的90岁以上急性硬膜下血肿患者预后良好。先前的独立性和到达时较高的GCS与良好的出院有关。有几例急性SDH患者开颅手术后预后良好，提示该年龄组的一些患者应考虑手术治疗。

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引用次数: 0

Association between the triglycerides and glucose index and critically ill stroke in non-obese population: An observational study on eICU database 非肥胖人群中甘油三酯和血糖指数与重症中风之间的关系：电子重症监护室数据库观察性研究。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110980

Jie Shu , Rui Zheng

Background

Both the triglyceride glucose (TyG) index and stroke are associated with insulin resistance (IR). Studies have shown that TyG is associated with stroke. However, the relationship between TyG index and stroke in non-obese population remains unclear. This study investigated the association between TyG and the prognosis of severe stroke in non-obese individuals.

Methods

This was a retrospective observational study. TyG was determined at baseline and stroke mortality was assessed at follow-up. All data were extracted from the eICU Collaborative Research Database. Hospital and intensive care unit (ICU) mortality rates were determined as endpoints. Smoothing curves were performed to estimate the relationship between TyG and stroke mortality. Multivariate logistic regression analysis and restricted cubic spline regression were used to evaluate the independent effect of TyG on stroke mortality.

Results

A total of 1946 eligible subjects were included. The hospital and ICU mortality rates were 10.6 % and 5.3 %, respectively. In univariate analysis, for per unit increase in TyG, the odds ratio (OR) for in-hospital mortality and ICU mortality of stroke were 1.85 (95 %CI 1.50–2.28) and 2.08 (95 %CI 1.58–2.75), respectively. After fully adjusting for confounding factors, the OR for in-hospital mortality and ICU mortality of stroke were 8.64 (95 %CI 4.25–17.55) and 9.30 (95 %CI 3.73–23.20), respectively. The restricted cubic spline regression model indicated a linear increase in hospital and ICU mortality with rising TyG index. Subgroup analysis showed consistent effect sizes and directions across different subgroups, demonstrating the stability of the findings.

Conclusion

In the non-obese population, an increase in TyG was related to higher stroke mortality. TyG may have clinical significance in identifying poor prognosis of stroke patients.

背景：甘油三酯葡萄糖（TyG）指数和中风都与胰岛素抵抗（IR）有关。研究表明，TyG 与中风有关。然而，在非肥胖人群中，TyG 指数与中风之间的关系仍不清楚。本研究调查了非肥胖人群中 TyG 与严重脑卒中预后之间的关系：这是一项回顾性观察研究。基线测定 TyG，随访评估卒中死亡率。所有数据均来自 eICU 合作研究数据库。以医院和重症监护室（ICU）死亡率为终点。采用平滑曲线估算TyG与中风死亡率之间的关系。采用多变量逻辑回归分析和限制性立方样条回归评估TyG对中风死亡率的独立影响：结果：共纳入了 1946 名符合条件的受试者。住院死亡率和重症监护室死亡率分别为 10.6% 和 5.3%。在单变量分析中，TyG 每增加一个单位，脑卒中住院死亡率和重症监护室死亡率的几率比（OR）分别为 1.85（95 %CI 1.50-2.28）和 2.08（95 %CI 1.58-2.75）。完全调整混杂因素后，脑卒中院内死亡率和 ICU 死亡率的 OR 分别为 8.64（95 %CI 4.25-17.55）和 9.30（95 %CI 3.73-23.20）。限制性三次样条回归模型显示，随着 TyG 指数的升高，住院死亡率和 ICU 死亡率呈线性增长。亚组分析显示，不同亚组的效应大小和方向一致，表明研究结果具有稳定性：结论：在非肥胖人群中，TyG 的升高与中风死亡率的升高有关。结论：在非肥胖人群中，TyG 的升高与中风死亡率的升高有关。TyG 在识别预后不良的中风患者方面可能具有临床意义。

{"title":"Association between the triglycerides and glucose index and critically ill stroke in non-obese population: An observational study on eICU database","authors":"Jie Shu , Rui Zheng","doi":"10.1016/j.jocn.2024.110980","DOIUrl":"10.1016/j.jocn.2024.110980","url":null,"abstract":"<div><h3>Background</h3><div>Both the triglyceride glucose (TyG) index and stroke are associated with insulin resistance (IR). Studies have shown that TyG is associated with stroke. However, the relationship between TyG index and stroke in non-obese population remains unclear. This study investigated the association between TyG and the prognosis of severe stroke in non-obese individuals.</div></div><div><h3>Methods</h3><div>This was a retrospective observational study. TyG was determined at baseline and stroke mortality was assessed at follow-up. All data were extracted from the eICU Collaborative Research Database. Hospital and intensive care unit (ICU) mortality rates were determined as endpoints. Smoothing curves were performed to estimate the relationship between TyG and stroke mortality. Multivariate logistic regression analysis and restricted cubic spline regression were used to evaluate the independent effect of TyG on stroke mortality.</div></div><div><h3>Results</h3><div>A total of 1946 eligible subjects were included. The hospital and ICU mortality rates were 10.6 % and 5.3 %, respectively. In univariate analysis, for per unit increase in TyG, the odds ratio (OR) for in-hospital mortality and ICU mortality of stroke were 1.85 (95 %CI 1.50–2.28) and 2.08 (95 %CI 1.58–2.75), respectively. After fully adjusting for confounding factors, the OR for in-hospital mortality and ICU mortality of stroke were 8.64 (95 %CI 4.25–17.55) and 9.30 (95 %CI 3.73–23.20), respectively. The restricted cubic spline regression model indicated a linear increase in hospital and ICU mortality with rising TyG index. Subgroup analysis showed consistent effect sizes and directions across different subgroups, demonstrating the stability of the findings.</div></div><div><h3>Conclusion</h3><div>In the non-obese population, an increase in TyG was related to higher stroke mortality. TyG may have clinical significance in identifying poor prognosis of stroke patients.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"132 ","pages":"Article 110980"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824244","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

Characteristics of reported industry payments to neurosurgeons from 2019 to 2022: The impact of COVID-19

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2025.111089

Aladine A. Elsamadicy , James Cross , Benjamin C. Reeves , Annabelle Shaffer , Laura S. McGuire , William C. Welch , Paul M. Arnold , Joshua M. Rosenow , on behalf of the AANS/CNS Drugs Device Committee

Objective

Neurosurgeons have long held financial relationships with pharmaceutical and surgical device companies. While industry partnerships drive innovation, there is concern that these collaborations may negatively influence patient care. In response, stakeholders have called for increased monitoring of these relationships. This study aims to provide an up-to-date review of the industry payments to neurosurgeons and how COVID-19 has impacted these payments.

Methods

A retrospective study was performed using data from the Center of Medicare and Medicaid Services Open Payments Database (1/1/19–12/31/23). Neurosurgeons were identified using the taxonomy code, 207T00000X. Data collected included the number of payments, purpose, total value, and mean value per year.

Results

From 2019 to 2023, 362,270 industry payments were made to 7,846 unique neurosurgeons for a total of $479,072,106. The most common types of payments were for food and beverage (72.7 %), travel and lodging (15.2 %), consulting fees (5.85 %), royalties and licensing (3.02 %), and services other than consulting (1.86 %), while the largest contributors to total payment value were payments for royalties and licensing (57.6 %), consulting fees (14.5 %), acquisitions (12.8 %), services other than consulting (5.00 %), and travel and lodging (3.89 %). Overall, the total amount paid to neurosurgeons decreased during the COVID-19 years (2020–2021) compared to 2019 but rose again in 2022.

Conclusion

Neurosurgeons maintain an active financial partnership with industry. Similar to prior reports, payments related to product development comprised the majority of payment value, while payments for food and beverage were the most common. The years of COVID-19, particularly 2020, had a substantial impact on the number, value amount, and subcategory distribution of industry payments made to neurosurgeons. Future investigations of these financial ties on practice, research, and innovation are warranted.

{"title":"Characteristics of reported industry payments to neurosurgeons from 2019 to 2022: The impact of COVID-19","authors":"Aladine A. Elsamadicy , James Cross , Benjamin C. Reeves , Annabelle Shaffer , Laura S. McGuire , William C. Welch , Paul M. Arnold , Joshua M. Rosenow , on behalf of the AANS/CNS Drugs Device Committee","doi":"10.1016/j.jocn.2025.111089","DOIUrl":"10.1016/j.jocn.2025.111089","url":null,"abstract":"<div><h3>Objective</h3><div>Neurosurgeons have long held financial relationships with pharmaceutical and surgical device companies. While industry partnerships drive innovation, there is concern that these collaborations may negatively influence patient care. In response, stakeholders have called for increased monitoring of these relationships. This study aims to provide an up-to-date review of the industry payments to neurosurgeons and how COVID-19 has impacted these payments.</div></div><div><h3>Methods</h3><div>A retrospective study was performed using data from the Center of Medicare and Medicaid Services Open Payments Database (1/1/19–12/31/23). Neurosurgeons were identified using the taxonomy code, 207T00000X. Data collected included the number of payments, purpose, total value, and mean value per year.</div></div><div><h3>Results</h3><div>From 2019 to 2023, 362,270 industry payments were made to 7,846 unique neurosurgeons for a total of $479,072,106. The most common types of payments were for food and beverage (72.7 %), travel and lodging (15.2 %), consulting fees (5.85 %), royalties and licensing (3.02 %), and services other than consulting (1.86 %), while the largest contributors to total payment value were payments for royalties and licensing (57.6 %), consulting fees (14.5 %), acquisitions (12.8 %), services other than consulting (5.00 %), and travel and lodging (3.89 %). Overall, the total amount paid to neurosurgeons decreased during the COVID-19 years (2020–2021) compared to 2019 but rose again in 2022.</div></div><div><h3>Conclusion</h3><div>Neurosurgeons maintain an active financial partnership with industry. Similar to prior reports, payments related to product development comprised the majority of payment value, while payments for food and beverage were the most common. The years of COVID-19, particularly 2020, had a substantial impact on the number, value amount, and subcategory distribution of industry payments made to neurosurgeons. Future investigations of these financial ties on practice, research, and innovation are warranted.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111089"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080204","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

Transradial versus transfemoral access in middle meningeal artery embolization for chronic subdural hematoma: A systematic review and meta-analysis

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2025.111094

Mohamed Elfil , Hazem S. Ghaith , Ahmed Elmashad , Zaid Najdawi , Mohammad Aladawi , Islam Ashor , Pankajavalli Ramakrishnan , Elie Dancour , Gurmeen Kaur , Chirag D. Gandhi , Fawaz Al-Mufti

Background

Chronic subdural hematoma (cSDH) is increasingly prevalent in the elderly and traditionally treated with surgical interventions. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive therapy to reduce recurrence rates. Transfemoral access (TFA) is the conventional route for neuroendovascular procedures, but transradial access (TRA) offers potential advantages, including reduced access-site complications, earlier ambulation, and shorter hospital stays.

Objective

The aim of this systematic review and meta-analysis was to compare the safety and efficacy of TRA versus TFA for MMAE in cSDH patients.

Methods

This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and involved a comprehensive search of four databases to identify studies comparing TRA and TFA in MMAE. Outcomes included hematoma recurrence, hospital length of stay, procedural duration, access-site complications, and overall complications.

Results

Four studies met the inclusion criteria. There were no significant differences between TRA and TFA in hematoma recurrence (Relative Risk (RR) 0.65, 95 % Confidence Interval [CI] 0.09–4.85), hospital length of stay (Mean Difference [MD] 0.10 days, 95 % CI −0.11–0.31), procedural duration (MD 0.04 h, 95 % CI −0.49–0.56), access-site complications (RR 0.24, 95 % CI 0.04–1.40), or overall complications (RR 0.76, 95 % CI 0.33–1.75).

Conclusion

TRA demonstrates comparable safety and efficacy to TFA for MMAE in cSDH patients. Although current evidence is limited to observational studies, these findings support the feasibility of TRA as an access route. Future large-scale studies are necessary to validate these results and optimize procedural strategies.

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引用次数: 0

Arteriovenous malformations treated by stereotactic radiosurgery – Review of an Australian single centre’s experience 立体定向放射外科治疗动静脉畸形-回顾澳大利亚单一中心的经验。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110961

Daniel Morris , Janet R. Williams , Belinda Vangelov , Robert I. Smee

Linear accelerator (LINAC) stereotactic radiosurgery (SRS) is a specialised treatment used for various brain conditions, including arteriovenous malformations (AVMs). This paper investigates the obliteration rate of AVMs treated by the LINAC-based facility at Prince of Wales Hospital, defines factors influencing obliteration rate, time to obliteration and complications post-SRS. A retrospective audit review of patient notes sourced from electronic medical records was conducted. During the study period 219 patients received treatment, of which the final status of 136 AVMs was known. Overall obliteration rate was 75.7 %, with obliteration rates of 5 %, 30 % and 46 % at one, three and four years, respectively. Post analysis, a radiosurgery dose of

\geq

18 Gray (Gy) was predictive of achieving obliteration (Odds Ratio (OR) 4.2, 95 % Confidence Interval (CI) 1.61–10.83, p = 0.003) whilst a nidus size of 3–6 cm was less likely of achieving obliteration (OR 0.2, CI 0.10–0.57, p = 0.001). Multivariate analysis showed a radiosurgery dose of

\geq

18 Gy remained predictive (OR 4.7, CI 1.69–13.25, p = 0.003) and a nidus size of 3–6 cm remained less likely to achieve obliteration (OR 0.2, CI 0.10–0.57, p = 0.001). Females were predictive of developing temporary complications post-SRS in multivariate analysis (OR 2.8, CI 1.24–6.13, p = 0.013), and having > 1 SRS session was predictive of developing permanent complications post-SRS (OR 7.1, CI 2.44–20.53, p < 0.001). The obliteration rate achieved from our study and the predictive nature to achieve obliteration with a radiosurgery dose of

\geq

18 Gy is comparable to existing literature including that using the Gamma-Knife system.

直线加速器（LINAC）立体定向放射外科（SRS）是一种专门用于各种脑部疾病的治疗方法，包括动静脉畸形（avm）。本文调查了威尔士亲王医院linac设施治疗的avm的闭塞率，定义了影响闭塞率、闭塞时间和srs后并发症的因素。对来自电子病历的病人记录进行了回顾性审计审查。在研究期间，219例患者接受了治疗，其中136例avm的最终状态已知。总湮没率为75.7%，1年、3年和4年的湮没率分别为5%、30%和46%。分析后，放射手术剂量≥18格雷（Gy）可预测实现闭塞（优势比（OR） 4.2, 95%可信区间（CI） 1.61-10.83, p = 0.003），而病灶大小为3-6厘米的不太可能实现闭塞（OR 0.2, CI 0.10-0.57, p = 0.001）。多因素分析显示，放疗剂量≥18 Gy仍然具有预测作用（OR 4.7, CI 1.69-13.25, p = 0.003），病灶大小为3-6 cm仍然不太可能实现闭塞（OR 0.2, CI 0.10-0.57, p = 0.001）。在多变量分析中，女性可预测SRS后出现的暂时性并发症（OR为2.8,CI 1.24-6.13, p = 0.013），而SRS治疗的bbb1期可预测SRS后出现的永久性并发症（OR为7.1,CI 2.44-20.53, p = 0.013）

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引用次数: 0

T-shaped myofascial incision for Chiari I malformation surgery without dural closure in children: Technical note t型肌筋膜切口用于无硬脑膜闭合的儿童Chiari I型畸形手术：技术说明。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110970

Arthur R. Kurzbuch, Jayaratnam Jayamohan, Shailendra Magdum

Background

Like in all posterior fossa surgeries the avoidance of cerebrospinal fluid (CSF) leaks is of paramount importance for foramen magnum decompression in Chiari I malformation in children. The present technical note decribes the experience with the creation of a T-shaped myofascial cuff to reduce the risk of postoperative CSF leaks.

Methods

The medical records of 98 children were evaluated. They underwent foramen magnum decompression without dural closure using a T-shaped myofascial cuff whose incision lines run completely within the fascia and the muscles not extending beyond their attachment line to the bone.

Results

There were 2 CSF leaks and no infections in 98 operated patients. The follow-up was between 4 and 48 months.

Conclusions

The placement of a T-shaped myofascial cuff allows for watertight closure of the muscles and the fascia which is likely to reduce the rate of CSF leaks in pediatric Chiari I patients operated on without closure of the dura.

背景：与所有后窝手术一样，避免脑脊液（CSF）泄漏对于儿童Chiari I型畸形的大孔减压至关重要。目前的技术说明描述了创建一个t形肌筋膜袖的经验，以减少术后脑脊液泄漏的风险。方法：对98例患儿的病历资料进行分析。患者采用t型肌筋膜袖进行枕骨大孔减压术，不闭合硬脑膜，切口线完全在筋膜内，肌肉不超出与骨的附着线。结果：98例手术患者发生脑脊液渗漏2例，无感染。随访时间为4至48个月。结论：t型肌筋膜袖的放置允许肌肉和筋膜的水密闭合，这可能会减少儿童Chiari I患者在不闭合硬脑膜的情况下手术的脑脊液泄漏率。

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引用次数: 0

Subthalamic nucleus versus globus pallidus internus deep brain stimulation in the treatment of dystonia: A systematic review and meta-analysis of safety and efficacy 丘脑下核与内白球脑深部刺激治疗肌张力障碍：安全性和有效性的系统回顾和荟萃分析。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110958

Obai Yousef , Abdallah Abbas , Maickel Abdelmeseh , Ruaa Mustafa Qafesha , Yehia Nabil , Amr Elrosasy , Ahmed Negida , Brian D Berman

Objective

This systematic review and meta-analysis aimed to compare the efficacy and safety of deep brain stimulation (DBS) targeting subthalamic nucleus (STN) versus the globus pallidus internus (GPI) in the treatment of dystonia.

Methods

A comprehensive search strategy was implemented up to July 2024, across five databases, identifying studies relevant to STN-DBS and GPI-DBS in dystonia. Eligibility criteria included randomized controlled trials (RCTs) and observational studies comparing the two interventions. Two independent reviewers conducted the screening and data extraction. The risk of bias was assessed using RoB-2 for RCTs and the Newcastle-Ottawa Scale for cohort studies. Statistical analysis involved meta-analysis using Review Manager, with heterogeneity assessed by I² and Chi-square tests. Subgroup and sensitivity analyses were performed.

Results

Five studies, involving 154 patients, were included. No significant difference was found between STN-DBS and GPI-DBS in Burke-Fahn-Marsden Dystonia Rating Scale motor and disability (BFMDRS-M and BFMDRS-D) scores at 1 months, 6 and 12 months. STN-DBS showed significant improvement in mental health (SMD = 0.43, 95 % CI: [0.05, 0.8], P = 0.03). STN-DBS also showed significant improvement in Hamilton Anxiety Rating Scale (HAMA) (SMD = −2.7, 95 % CI: [-5.38, −0.02], P = 0.05). No significant difference was found in Hamilton Depression Rating Scale (HAMD) scores.

Conclusions

Both STN-DBS and GPI-DBS can improve motor symptoms in dystonia, with STN-DBS potentially resulting in more superior mental health benefits. Future research should address long-term outcomes, and regional effectiveness, and include diverse populations to enhance generalizability.

目的：本系统综述和荟萃分析旨在比较针对丘脑下核（STN）和内苍白球（GPI）的深部脑刺激（DBS）治疗肌张力障碍的疗效和安全性。方法：到2024年7月，在五个数据库中实施综合搜索策略，确定与肌张力障碍中STN-DBS和GPI-DBS相关的研究。入选标准包括随机对照试验（rct）和比较两种干预措施的观察性研究。两名独立审稿人进行了筛选和数据提取。随机对照试验采用rob2评估偏倚风险，队列研究采用纽卡斯尔-渥太华量表评估偏倚风险。统计分析采用Review Manager进行meta分析，采用I2检验和卡方检验评估异质性。进行亚组分析和敏感性分析。结果：纳入5项研究，共154例患者。STN-DBS和GPI-DBS在1个月、6个月和12个月时伯克-法恩-马斯登肌张力障碍评定量表（BFMDRS-M和BFMDRS-D）的运动和残疾评分无显著差异。STN-DBS对心理健康有显著改善（SMD = 0.43, 95% CI: [0.05, 0.8], P = 0.03）。STN-DBS在汉密尔顿焦虑评定量表（HAMA）上也有显著改善（SMD = -2.7, 95% CI: [-5.38, -0.02], P = 0.05）。汉密顿抑郁评定量表（HAMD）得分差异无统计学意义。结论：STN-DBS和GPI-DBS均可改善肌张力障碍患者的运动症状，其中STN-DBS可能带来更优越的心理健康益处。未来的研究应着眼于长期结果和区域有效性，并包括不同的人群以提高普遍性。

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