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Mechanical Thrombectomy for Hyperacute Vertebrobasilar Ischemic Stroke via Nondominant Vertebral Artery : Clinical Experience and Considerations. 通过非支配椎动脉治疗超急性椎基底动脉缺血性中风的机械取栓术:临床经验和注意事项。
IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-28 DOI: 10.3340/jkns.2024.0104
Gi Yun Lee, ChanHyang Yang, Chul-Hoo Kang, Joong Goo Kim, Jin-Deok Joo, You Nam Chung, Ji Soon Huh, Jeong Jin Park, Jin Pyeong Jeon, Jong-Kook Rhim

Objective: The dominant vertebral artery (VA) approach is primarily considered in mechanical thrombectomy (MT) for acute occlusion of the vertebrobasilar (VB) artery. As accessing the dominant artery is sometimes difficult, we present our experience treating acute VB stroke via a nondominant VA approach through a comparison with the dominant VA approach.

Methods: Among 2,785 patients diagnosed with hyperacute ischemic stroke between January 2014 and December 2022, 50 patients with VB ischemic stroke underwent recanalization therapy through either dominant, nondominant, or bilateral VA approach. We evaluated patient characteristics and clinical course, highlighting the pros and cons of the access routes.

Results: The patients with hyperacute VB ischemic stroke were predominantly male (72%), with a mean age of 68.12 years and an initial National Institutes of Health Stroke Scale (NIHSS) score mean of 17.1. Large-artery atherosclerosis (LAA, 48%) and cardio-embolism (CE, 36%) were the main etiologic factors in the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification. After thrombectomy, 45 (90%) cases had final modified thrombolysis in cerebral infarction (mTICI) score of 2b or higher. In summary, 41 patients were treated through the dominant VA, and 8 patients underwent the nondominant VA approach. However, there was no statistically significant difference in functional outcome or mortality between the two approaches.

Conclusion: In MT for VB occlusions, nondominant VA approach may be an option in situations when the vessel is accessible, stable, or less risky, as recanalization can be achieved without rescue balloon angioplasty and/or stenting.

目的:在治疗椎-基底动脉(VB)急性闭塞的机械取栓术(MT)中,主要考虑采用优势椎动脉(VA)入路。由于有时难以进入优势动脉,我们通过与优势椎动脉途径的比较,介绍了我们通过非优势椎动脉途径治疗急性椎基底动脉卒中的经验:在2014年1月至2022年12月期间确诊的2785名超急缺血性卒中患者中,50名VB缺血性卒中患者通过优势、非优势或双侧VA途径接受了再通治疗。我们评估了患者的特征和临床病程,强调了入路的利弊:超急性 VB 缺血性卒中患者主要为男性(72%),平均年龄为 68.12 岁,最初的美国国立卫生研究院卒中量表(NIHSS)平均评分为 17.1 分。大动脉粥样硬化(LAA,占 48%)和心肌栓塞(CE,占 36%)是 TOAST(急性中风治疗中的 Org 10172 试验)分类中的主要病因。血栓切除术后,45 例(90%)患者的脑梗塞改良溶栓术(mTICI)最终评分为 2b 或更高。总之,41 名患者通过优势 VA 方法进行了治疗,8 名患者通过非优势 VA 方法进行了治疗。然而,两种方法在功能预后或死亡率方面没有统计学意义上的显著差异:结论:在MT治疗VB闭塞时,如果血管通畅、稳定或风险较低,可以选择非显性VA入路,因为无需球囊血管成形术和/或支架植入术即可实现再通畅。
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引用次数: 0
Neovascularization in Outer Membrane of Chronic Subdural Hematoma : A Rationale for Middle Meningeal Artery Embolization. 慢性硬膜下血肿外膜的新生血管:脑膜中动脉栓塞术的原理。
IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-26 DOI: 10.3340/jkns.2024.0101
Hadeel M Mansour, Bipin Chaurasia
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引用次数: 0
Importance of Preoperative Pupillary Reflex in Traumatic Optic Neuropathy. 创伤性视神经病变术前瞳孔反射的重要性
IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-13 DOI: 10.3340/jkns.2024.0083
Min Ho Lee, Tae-Kyu Lee

Objective: Traumatic optic neuropathy (TON) refers to a pathological condition caused by direct or indirect injury to the optic nerves. In the case of patients with traumatic brain injury, adequate vision evaluation is difficult in many cases due to altered mentality. In order to address this problem, we investigated preoperative pupillary light reflex in TON patients as a predictive factor of surgical outcomes after optic nerve decompression.

Methods: From April 2020 to September 2022, we enrolled patients who were diagnosed with TON and underwent endoscopic optic nerve decompression at our institution. Vision and pupil reflex tests were performed by an ophthalmologist before and after surgery.

Results: Seven patients were enrolled. Their ages ranged from 9 to 78 years and all were male. Among the 7 patients, the patient whose pupillary light reflex was 6mm with sluggish and 7mm with fixated pupil before surgery showed no improvement in vision. Patients with some response to direct reflex or contralateral indirect reflex testing preoperative showed vision improvement postoperative.

Conclusion: Direct and indirect pupillary reflexes can be important factors determining treatment for TON. In unconscious patients with a fracture involving the optic canal, timely surgical intervention based on pupillary reflex can prevent permanent loss of vision.

目的:创伤性视神经病变(TON)是指视神经受到直接或间接损伤而引起的一种病理状态。对于脑外伤患者而言,由于精神状态的改变,很多情况下很难对视力进行充分评估。为了解决这一问题,我们研究了TON患者术前瞳孔对光反射作为视神经减压术后手术效果预测因素的情况:方法:2020 年 4 月至 2022 年 9 月,我们招募了在我院确诊为 TON 并接受内窥镜视神经减压术的患者。手术前后由眼科医生进行视力和瞳孔反射测试:结果:共招募了七名患者。他们的年龄从 9 岁到 78 岁不等,均为男性。在这 7 名患者中,手术前瞳孔对光反射为 6 毫米(迟钝)和 7 毫米(固定)的患者视力没有改善。术前对直接反射或对侧间接反射测试有一定反应的患者术后视力有所改善:结论:直接和间接瞳孔反射是决定治疗瞳孔强直的重要因素。对于视神经管骨折的昏迷患者,根据瞳孔反射进行及时的手术干预可以防止永久性视力丧失。
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引用次数: 0
Optimizing Glioblastoma, IDH-wildtype Treatment Outcomes : A Radiomics and Support Vector Machine -Based Approach to Overall Survival Estimation. 优化胶质母细胞瘤、IDH-野生型治疗结果:基于放射组学和支持向量机的总生存期估算方法
IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-05 DOI: 10.3340/jkns.2024.0100
Jiunn-Kai Chong, Priyanka Jain, Shivani Prasad, Navneet Kumar Dubey, Sanjay Saxena, Wen-Cheng Lo

Objective: Glioblastoma multiforme (GBM), particularly the IDH-wildtype type, represents a significant clinical challenge due to its aggressive nature and poor prognosis. Despite advancements in medical imaging and its modalities, survival rates have not improved significantly, demanding innovative treatment planning and outcome prediction approaches.

Methods: This study utilizes a Support Vector Machine (SVM) classifier using radiomics features to predict the overall survival (OS) of GBM, IDH-wildtype patients to short (< 12 Months) and long (>=12 Months) survivors. A dataset comprising multi-parametric MRI (mpMRI) scans from 574 patients was analyzed. Radiomic features were extracted from T1, T2, FLAIR, and T1-Gd sequences. Low variance features were removed, and Recursive Feature Elimination (RFE) was used to select the most informative features. The SVM model was trained using a k-fold cross-validation approach. Furthermore, clinical parameters such as age, gender, and MGMT promoter methylation status were integrated to enhance prediction accuracy.

Results: The model showed reasonable results in terms of cross-validated AUC of 0.84 (95% CI: 0.80-0.90) with (p-value < 0.001) effectively categorizing patients into short and long survivors. Log-rank test (Chi-square statistics) analysis for the developed model was 0.00029 along with the 1.20 Cohen's d effect size. Most importantly, clinical data integration further refined the survival estimates, providing a more fitted prediction that considers individual patient characteristics by Kaplan-Meier curve with p-value<0.0001.

Conclusion: The proposed method significantly enhances the predictive accuracy of OS outcomes in GBM, IDH-wildtype patients. By integrating detailed imaging features with key clinical indicators, this model offers a robust tool for personalized treatment planning, potentially improving OS.

目的:多形性胶质母细胞瘤(GBM),尤其是IDH-野生型,因其侵袭性强、预后差而成为临床上的一大难题。尽管医学成像及其模式取得了进步,但存活率并没有显著提高,这就需要创新的治疗规划和结果预测方法:本研究采用支持向量机(SVM)分类器,利用放射组学特征预测GBM、IDH-野生型患者的短期(<12个月)和长期(>=12个月)总生存期(OS)。分析数据集包括 574 名患者的多参数磁共振成像(mpMRI)扫描结果。从 T1、T2、FLAIR 和 T1-Gd 序列中提取了放射学特征。去除低方差特征,并使用递归特征消除(RFE)来选择信息量最大的特征。SVM 模型采用 k 倍交叉验证方法进行训练。此外,还整合了年龄、性别和 MGMT 启动子甲基化状态等临床参数,以提高预测的准确性:该模型的交叉验证AUC为0.84(95% CI:0.80-0.90),p值小于0.001,有效地将患者分为短存活期和长存活期。所开发模型的对数秩检验(卡方统计)分析结果为 0.00029,科恩效应大小为 1.20。最重要的是,临床数据整合进一步完善了生存期估计值,通过带有 p 值的 Kaplan-Meier 曲线提供了考虑到患者个体特征的更贴合的预测结果:结论:所提出的方法大大提高了GBM、IDH-野生型患者OS结果预测的准确性。通过将详细的成像特征与关键的临床指标相结合,该模型为个性化治疗计划提供了一个强大的工具,有可能改善 OS。
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引用次数: 0
Effect of Intraoperative Ventricular Opening on Recurrence Patterns Following Bis-Chloroethyl-Nitrosourea Wafer Implantation for Newly Diagnosed Glioblastoma. 为新诊断的胶质母细胞瘤植入双氯乙基亚硝基脲晶片后术中开腔对复发模式的影响
IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-01 DOI: 10.3340/jkns.2024.0030
Ryosuke Matsuda, Ryosuke Maeoka, Takayuki Morimoto, Tsutomu Nakazawa, Noriaki Tokuda, Masashi Kotsugi, Yasuhiro Takeshima, Kentaro Tamura, Shuichi Yamada, Fumihiko Nishimura, Young-Soo Park, Ichiro Nakagawa

Objective: To evaluate the effect of ventricular opening (VO) on recurrence patterns in patients with newly diagnosed glioblastoma (GBM) treated with bis-chloroethyl-nitrosourea (BCNU) wafer implantation.

Methods: This single-center retrospective study included 40 patients with newly diagnosed GBM who received BCNU wafer implantation after tumor resection between March 2013 and February 2022. The patients were categorized into two groups based on whether VO occurred during the GBM resection. While 18 patients had VO, 22 did not have VO. In cases with VO, the ventricular wall defect is closed with gelatin or oxidized regenerated cellulose and fibrin glue before BCNU wafer implantation. Recurrence patterns-classified as local, diffuse, distant, or multifocal-and time to recurrence were compared between patients with and without VO.

Results: The median follow-up period for the entire cohort was 32.2 months (interquartile range, 16.7-38 months). Median survival time was comparable between patients with VO and patients without VO (38 vs. 26 months, p=0.53). Recurrence occurred in 31/40 patients (77.5%) in entire cohort. The incidence of recurrence was comparable between patients with VO and patients without VO (14 [77.8%] vs. 17 [77.3%], p=1.0). No significant differences were seen between the two groups in time to recurrence (p=0.59) or recurrence patterns (p=0.35).

Conclusion: Ventricular opening during surgery with BCNU wafer implantation does not seem to influence the recurrence patterns. Ventricular opening does not induce distant recurrence if appropriate ventricular closure is performed.

目的评估脑室开放(VO)对接受双氯乙基亚硝基脲(BCNU)晶片植入治疗的新诊断胶质母细胞瘤(GBM)患者复发模式的影响:这项单中心回顾性研究纳入了40名新确诊的胶质母细胞瘤患者,他们都是在2013年3月至2022年2月期间接受肿瘤切除术后植入BCNU晶片的。根据 GBM 切除术中是否发生 VO 将患者分为两组。18名患者有VO,22名患者没有VO。对于有VO的病例,在植入BCNU片之前,先用明胶或氧化再生纤维素和纤维蛋白胶封闭室壁缺损。比较了有VO和无VO患者的复发模式(分为局部复发、弥漫复发、远处复发或多灶复发)和复发时间:整个组群的中位随访时间为32.2个月(四分位间范围为16.7-38个月)。有 VO 和无 VO 患者的中位生存时间相当(38 个月对 26 个月,P=0.53)。整个队列中有 31/40 例患者(77.5%)复发。有 VO 和无 VO 患者的复发率相当(14 [77.8%] vs. 17 [77.3%],P=1.0)。两组患者在复发时间(P=0.59)或复发模式(P=0.35)上无明显差异:结论:BCNU晶片植入手术中的心室开放似乎不会影响复发模式。结论:BCNU晶片植入手术中的心室开放似乎不会影响复发模式,如果进行了适当的心室关闭,心室开放不会诱发远处复发。
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引用次数: 0
Clinical and Angiographic Outcomes of Endovascular Treatment for Acute Intracranial Vertebral Artery Dissecting Aneurysms Using Double-Overlapping Stents : Low-Profile Visualized Intraluminal Support within Enterprise Stents. 使用双重叠支架对急性颅内椎动脉夹层动脉瘤进行血管内治疗的临床和血管造影结果 :企业支架内的低调可视化腔内支撑。
IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-01 Epub Date: 2023-12-22 DOI: 10.3340/jkns.2023.0224
Ja Ho Koo, Eui Hyun Hwang, Ji Hye Song, Yong Cheol Lim

Objective: The use of reconstructive treatment with a double-overlapping stents has proven to be effective and safe in the current treatment of intracranial vertebral artery dissecting aneurysms (VADAs). We employed a combination of overlapping stents, using low-profile visualized intraluminal support (LVIS) within the Enterprise stent. This combination was chosen to minimize the outward bulging of the inner LVIS by overlapping it with the Enterprise stent while maintaining flow diversion and stability. This study aimed to evaluate the clinical and angiographic outcomes following the use of double-overlapping stents with LVIS within the Enterprise stent for the treatment of VADAs.

Methods: From March 2016 to January 2022, total 28 patients with unruptured VADAs were treated with the double-overlapping stent technique using LVIS within an Enterprise stent in our institute. The Enterprise stent was deployed first, followed by the LVIS stent. Patient clinical and angiographic characteristics, procedural complications, and follow-up outcomes were retrospectively reviewed.

Results: All 28 patients (18 males and 10 females) were successfully treated with double-overlapping stent deployment. There were no procedural complications or new neurological deficits in any patient. Of the 28 patients, four VADAs had posterior inferior cerebellar artery involvement. Procedure-related parent artery occlusion did not occur during the angiographic follow-up conducted 6 to 12 months after the procedure. Out of 28 patients, 24 showed complete healing, three had focal residual stenosis or dilatation with residual sac and only one had a residual dissecting flap with aneurysm. All patients, including the four patients, did not require any additional procedures. The postoperative modified Rankin scale scores were 0-1 for all patients.

Conclusion: A double-overlapping stent, with a flow-diversion effect, is a safe and effective treatment for patients with VADAs. In particular, when using the LVIS stent within an Enterprise stent, it minimizes the bulging of the inner LVIS stent while maintaining flow diversion and stability. Therefore, both can be effectively utilized as overlapping stents.

目的:在目前治疗颅内椎动脉夹层动脉瘤(VADA)的方法中,使用双重叠支架进行重建治疗已被证明是有效且安全的。我们采用了重叠支架组合,在 Enterprise 支架内使用低调的可视腔内支撑(LVIS)。选择这种组合是为了在保持血流分流和稳定性的同时,通过与 Enterprise 支架重叠,最大限度地减少 LVIS 内部的外凸。本研究旨在评估在Enterprise支架内使用带LVIS的双重叠支架治疗VADAs后的临床和血管造影结果:方法:2016年3月至2022年1月,我院共对28例未破裂的VADA患者进行了企业支架内LVIS双重叠支架技术治疗。首先部署Enterprise支架,然后部署LVIS支架。对患者的临床和血管造影特征、手术并发症和随访结果进行了回顾性分析:结果:所有28名患者(18男10女)均成功接受了双重叠支架置入术。所有患者均未出现手术并发症或新的神经功能缺损。在28名患者中,有4名患者的小脑后下动脉受累。在术后6至12个月的血管造影随访中,没有发生与手术相关的母动脉闭塞。在 28 名患者中,24 人完全愈合,3 人有局灶性残余狭窄或扩张并伴有残囊,只有 1 人有带动脉瘤的残余剥离瓣。包括这四名患者在内的所有患者都无需进行任何其他手术。所有患者的术后改良Rankin量表(mRS)评分均为0-1分:结论:具有血流分流作用的双层重叠支架是治疗 VADA 患者的一种安全有效的方法。尤其是在企业支架内使用 LVIS 支架时,可最大限度地减少 LVIS 内支架的隆起,同时保持血流分流和稳定性。因此,这两种支架可作为重叠支架有效使用。
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引用次数: 0
Real-Time Visualization of Thrombus during Suction Thrombectomy : Contrast-in-Stasis Technique. 抽吸血栓切除术中血栓的实时可视化:Stasis技术的对比。
IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2023-11-03 DOI: 10.3340/jkns.2023.0158
Yoon-Soo Lee

This report introduces a simple method to visualize the captured thrombus in real-time during suction thrombectomy using "contrast-in-stasis technique". It enables visualization of the thrombus captured by a suction catheter as it is being retrieved through the tortuous course of the carotid artery eventually into the guiding catheter. It also offers visual identification of important findings such as fragmentation of thrombus into pieces or loss of thrombus during retrieval, and, therefore, helps clinicians to make further critical decisions during the procedure.

本报告介绍了一种简单的方法,在抽吸血栓切除术中使用“淤滞对比技术”实时显示捕获的血栓。当血栓通过颈动脉的曲折过程最终进入引导导管时,它能够使抽吸导管捕获的血栓可视化。它还提供了重要发现的视觉识别,如血栓碎片化或取回过程中血栓丢失,因此,有助于临床医生在手术过程中做出进一步的关键决定。
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引用次数: 0
A Potential Risk of Radiation-Induced Cavernous Malformations Following Adjuvant Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy. 颞叶间叶癫痫伽玛刀辅助放射治疗后辐射诱发海绵状畸形的潜在风险。
IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2023-11-07 DOI: 10.3340/jkns.2023.0203
Junhyung Kim, Joonho Byun, Do Heui Lee, Seok Ho Hong

Objective: Several clinical studies have explored the feasibility and efficacy of radiosurgical treatment for mesial temporal lobe epilepsy, but the long-term safety of this treatment has not been fully characterized. This study aims to report and describe radiation-induced cavernous malformation as a delayed complication of radiosurgery in epilepsy patients.

Methods: The series includes 20 patients with mesial temporal lobe epilepsy who underwent Gamma Knife radiosurgery (GKRS). The majority received a prescribed isodose of 24 Gy as an adjuvant treatment after anterior temporal lobectomy.

Results: In this series, we identified radiation-induced cavernous malformation in three patients, resulting in a cumulative incidence of 18.4% (95% confidence interval, 6.3% to 47.0%) at an 8-year follow-up. These late sequelae of vascular malformation occurred between 6.9 and 7.6 years after GKRS, manifesting later than other delayed radiation-induced changes, such as radiation necrosis. Neurological symptoms attributed to intracranial hypertension were present in those three cases involving cavernous malformation. Of these, two cases, which initially exhibited an insufficient response to radiosurgery, ultimately demonstrated seizure remission following the successful microsurgical resection of the cavernous malformation.

Conclusion: All things considered, the development of radiation-induced cavernous malformation is not uncommon in this population and should be acknowledged as a potential long-term complication. Microsurgical resection of cavernous malformation can be preferentially considered in cases where the initial seizure outcome after GKRS is unsatisfactory.

目的:一些临床研究已经探讨了放射外科治疗内侧颞叶癫痫的可行性和疗效,但这种治疗的长期安全性尚未完全确定。本研究旨在报告和描述放射性海绵状畸形作为癫痫患者放射外科手术的延迟并发症。方法:该系列包括20例接受伽玛刀放射外科治疗的内侧颞叶癫痫患者。大多数患者在前颞叶切除术后接受了24Gy的处方等剂量辅助治疗。结果:在本系列中,我们在三名患者中发现了辐射诱导的海绵状畸形,在八年的随访中,累积发病率为18.4%(95%置信区间,6.3~47.0%)。这些血管畸形的晚期后遗症发生在GKRS后6.9至7.6年之间,比其他延迟的辐射诱导变化(如辐射坏死)表现得晚。这三例海绵状畸形患者均出现颅内高压引起的神经系统症状。其中,两例最初对放射外科治疗反应不足,但在成功显微外科切除海绵状畸形后,癫痫发作最终得到缓解。结论:综合考虑,放射性海绵状畸形的发展在这一人群中并不罕见,应该被认为是一种潜在的长期并发症。在GKRS后最初癫痫发作结果不令人满意的情况下,可以优先考虑海绵状畸形的显微手术切除。
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引用次数: 0
Protein Requirement Changes According to the Treatment Application in Neurocritical Patients. 神经危重症患者蛋白质需要量随治疗应用的变化。
IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2023-11-21 DOI: 10.3340/jkns.2023.0176
Jungook Kim, Youngbo Shim, Yoon-Hee Choo, Hye Seon Kim, Young Ran Kim, Eun Jin Ha

Objective: Exploring protein requirements for critically ill patients has become prominent. On the other hand, considering the significant impact of coma therapy and targeted temperature management (TTM) on the brain as well as systemic metabolisms, protein requirements may plausibly be changed by treatment application. However, there is currently no research on protein requirements following the application of these treatments. Therefore, the aim of this study is to elucidate changes in patients' protein requirements during the application of TTM and coma therapy.

Methods: This study is a retrospective analysis of prospectively collected data from March 2019 to May 2022. Among the patients admitted to the intensive care unit, those receiving coma therapy and TTM were included. The patient's treatment period was divided into two phases (phase 1, application and maintenance of coma therapy and TTM; phase 2, tapering and cessation of treatment). In assessing protein requirements, the urine urea nitrogen (UUN) method was employed to estimate the nitrogen balance, offering insight into protein utilization within the body. The patient's protein requirement for each phase was defined as the amount of protein required to achieve a nitrogen balance within ±5, based on the 24-hour collection of UUN. Changes in protein requirements between phases were analyzed.

Results: Out of 195 patients, 107 patients with a total of 214 UUN values were included. The mean protein requirement for the entire treatment period was 1.84±0.62 g/kg/day, which is higher than the generally recommended protein supply of 1.2 g/kg/day. As the treatment was tapered, there was a statistically significant increase in the protein requirement from 1.49±0.42 to 2.18±0.60 in phase 2 (p<0.001).

Conclusion: Our study revealed a total average protein requirement of 1.84±0.62 g during the treatment period, which falls within the upper range of the preexisting guidelines. Nevertheless, a notable deviation emerged when analyzing the treatment application period separately. Hence, it is recommended to incorporate considerations for the type and timing of treatment, extending beyond the current guideline, which solely accounts for the severity by disease.

目的:探讨危重病人的蛋白质需要量已成为当务之急。另一方面,考虑到昏迷治疗和靶向温度管理(TTM)对大脑和全身代谢的重大影响,蛋白质需求可能会因治疗应用而改变。然而,目前还没有研究在应用这些处理后的蛋白质需求。因此,本研究的目的是阐明在应用TTM和昏迷治疗过程中患者蛋白质需求的变化。方法:对2019年3月至2022年5月前瞻性采集的数据进行回顾性分析。重症监护病房的患者包括接受昏迷治疗和TTM治疗的患者。患者的治疗期分为两个阶段(第一阶段:应用和维持昏迷治疗和TTM;第2阶段:逐渐减少和停止治疗)。在评估蛋白质需求时,采用尿尿素氮(UUN)方法来估计氮平衡,从而深入了解体内蛋白质的利用情况。根据24小时收集的UUN,将患者每个阶段的蛋白质需求量定义为在±5内达到氮平衡所需的蛋白质量。分析各期蛋白质需要量的变化。结果:195例患者中,纳入107例患者,共214个UUN值。整个处理期平均蛋白质需要量为1.84±0.62 g/kg/d,高于一般推荐的1.2 g/kg/d。随着治疗的逐渐减少,第二阶段蛋白质需求量从1.49±0.42增加到2.18±0.60,具有统计学意义(p < 0.001)。结论:我们的研究显示,在治疗期间,总平均蛋白质需要量为1.84±0.62g,处于现有指南的上限范围内。然而,在单独分析处理应用期时,出现了明显的偏差。因此,建议将治疗的类型和时机纳入考虑,超越目前仅考虑疾病严重程度的指南。
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引用次数: 0
Feasibility of Gamma Knife Radiosurgery for Brain Arteriovenous Malformations According to Nidus Type. 伽玛刀放射治疗脑动静脉畸形的可行性。
IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2023-10-30 DOI: 10.3340/jkns.2023.0177
Ja Ho Koo, Eui Hyun Hwang, Ji Hye Song, Yong Cheol Lim

Objective: Gamma Knife radiosurgery (GKRS) is an effective and noninvasive treatment for high-risk arteriovenous malformations (AVMs). Since differences in GKRS outcomes by nidus type are unknown, this study evaluated GKRS feasibility and safety in patients with brain AVMs.

Methods: This single-center retrospective study included patients with AVM who underwent GKRS between 2008 and 2021. Patients were divided into compact- and diffuse-type groups according to nidus characteristics. We excluded patients who performed GKRS and did not follow-up evaluation with magnetic resonance imaging or digital subtraction angiography within 36 months from the study. We used univariate and multivariate analyses to characterize associations of nidus type with obliteration rate and GKRS-related complications.

Results: We enrolled 154 patients (mean age, 32.14±17.17 years; mean post-GKRS follow-up, 52.10±33.67 months) of whom 131 (85.1%) had compact- and 23 (14.9%) diffuse-type nidus AVMs. Of all AVMs, 89 (57.8%) were unruptured, and 65 (42.2%) had ruptured. The mean Spetzler-Martin AVM grades were 2.03±0.95 and 3.39±1.23 for the compact- and diffuse-type groups, respectively (p<0.001). During the follow-up period, AVM-related hemorrhages occurred in four individuals (2.6%), three of whom had compact nidi. Substantial radiation-induced changes and cyst formation were observed in 21 (13.6%) and one patient (0.6%), respectively. The AVM complete obliteration rate was 46.1% across both groups. Post-GKRS complication and complete obliteration rates were not significantly different between nidus types. For diffuse-type nidus AVMs, larger AVM size and volume (p<0.001), lower radiation dose (p<0.001), eloquent area location (p=0.015), and higher Spetzler-Martin grade (p<0.001) were observed.

Conclusion: GKRS is a safe and feasible treatment for brain AVMs characterized by both diffuse- and compact-type nidi.

目的:伽玛刀放射外科(GKRS)是治疗高危动静脉畸形(AVMs)的一种有效且无创的治疗方法。由于结节类型的GKRS结果差异尚不清楚,本研究评估了脑动静脉畸形患者的GKRS可行性和安全性。方法:这项单中心回顾性研究包括2008年至2021年间接受GKRS的动静脉畸形病人。根据病灶特征将患者分为致密型和弥漫型。我们排除了在研究的36个月内进行GKRS且未进行MRI或DSA随访评估的患者。我们使用单变量和多变量分析来表征病灶类型与闭塞率和GKRS相关并发症的相关性。结果:我们纳入了154名患者(平均年龄32.14±17.17岁;GKRS后平均随访52.10±33.67个月),其中131人(85.1%)患有致密型和23人(14.9%)患有弥漫型nidus动静脉畸形。在所有AVM中,89例(57.8%)未破裂,65例(42.2%)破裂。紧凑型和弥漫型组的Spetzler-Martin AVM平均分级分别为2.03±0.95和3.39±1.23(P结论:GKRS是一种安全可行的治疗以弥漫型和紧凑型nidi为特征的脑AVM的方法。
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Journal of Korean Neurosurgical Society
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