Pub Date : 2024-09-01Epub Date: 2023-03-02DOI: 10.3340/jkns.2023.0026
Yuwhan Chung, Jiwook Ryu, Seok Keun Choi
Surgical treatment of refractory and extensive cerebral venous sinus thrombosis (CVST) has limited applications. Here, we describe an open, direct sinus thrombectomy in the early phase of extensive CVST. A 49-year-old man with extensive CVST that occurred after the coronavirus disease 2019 (COVID-19) vaccination and affected the drainage of the Labbé vein presented with clinical deterioration and left temporal hemorrhagic infarction. Since the patient had extensive CVST, we determined that systemic anticoagulation and endovascular treatment were not suitable treatment options. Therefore, we decided on an emergency surgical treatment and performed direct surgical thrombectomy. We followed extended suboccipital approach and made multiple incisions on the sinuses, exposing the posterior superior sagittal sinus to the transverse sigmoid junction. Consequently, the clinical condition of the patient dramatically improved, resulting in a favorable outcome with a modified Rankin scale score of 0. Performing emergency open surgical thrombectomy was a technically feasible treatment option that recanalize obstructed sinuses. Importantly, the patient recovered with a good clinical outcome. Early maximal surgical thrombectomy can be an effective and lifesaving method to treat extensive CVST with hemorrhagic infarction.
{"title":"Surgical Thrombectomy for Extensive Cerebral Venous Sinus Thrombosis after COVID-19 Vaccination : A Novel Surgical Technique and Literature Review.","authors":"Yuwhan Chung, Jiwook Ryu, Seok Keun Choi","doi":"10.3340/jkns.2023.0026","DOIUrl":"10.3340/jkns.2023.0026","url":null,"abstract":"<p><p>Surgical treatment of refractory and extensive cerebral venous sinus thrombosis (CVST) has limited applications. Here, we describe an open, direct sinus thrombectomy in the early phase of extensive CVST. A 49-year-old man with extensive CVST that occurred after the coronavirus disease 2019 (COVID-19) vaccination and affected the drainage of the Labbé vein presented with clinical deterioration and left temporal hemorrhagic infarction. Since the patient had extensive CVST, we determined that systemic anticoagulation and endovascular treatment were not suitable treatment options. Therefore, we decided on an emergency surgical treatment and performed direct surgical thrombectomy. We followed extended suboccipital approach and made multiple incisions on the sinuses, exposing the posterior superior sagittal sinus to the transverse sigmoid junction. Consequently, the clinical condition of the patient dramatically improved, resulting in a favorable outcome with a modified Rankin scale score of 0. Performing emergency open surgical thrombectomy was a technically feasible treatment option that recanalize obstructed sinuses. Importantly, the patient recovered with a good clinical outcome. Early maximal surgical thrombectomy can be an effective and lifesaving method to treat extensive CVST with hemorrhagic infarction.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"578-585"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9363106","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}
Pub Date : 2024-09-01Epub Date: 2024-01-08DOI: 10.3340/jkns.2023.0195
Kyung Ah Kim, Hakseung Kim, Eun Jin Ha, Byung C Yoon, Dong-Joo Kim
In neurointensive care units (NICUs), particularly in cases involving traumatic brain injury (TBI), swift and accurate decision-making is critical because of rapidly changing patient conditions and the risk of secondary brain injury. The use of artificial intelligence (AI) in NICU can enhance clinical decision support and provide valuable assistance in these complex scenarios. This article aims to provide a comprehensive review of the current status and future prospects of AI utilization in the NICU, along with the challenges that must be overcome to realize this. Presently, the primary application of AI in NICU is outcome prediction through the analysis of preadmission and high-resolution data during admission. Recent applications include augmented neuromonitoring via signal quality control and real-time event prediction. In addition, AI can integrate data gathered from various measures and support minimally invasive neuromonitoring to increase patient safety. However, despite the recent surge in AI adoption within the NICU, the majority of AI applications have been limited to simple classification tasks, thus leaving the true potential of AI largely untapped. Emerging AI technologies, such as generalist medical AI and digital twins, harbor immense potential for enhancing advanced neurocritical care through broader AI applications. If challenges such as acquiring high-quality data and ethical issues are overcome, these new AI technologies can be clinically utilized in the actual NICU environment. Emphasizing the need for continuous research and development to maximize the potential of AI in the NICU, we anticipate that this will further enhance the efficiency and accuracy of TBI treatment within the NICU.
在神经重症监护病房(NICU),尤其是在涉及创伤性脑损伤(TBI)的病例中,由于患者病情瞬息万变,且存在继发性脑损伤的风险,因此迅速而准确的决策至关重要。在 NICU 中使用人工智能 (AI) 可以增强临床决策支持,并在这些复杂的情况下提供有价值的帮助。本文旨在全面回顾人工智能在新生儿重症监护室的应用现状和未来前景,以及实现这一目标必须克服的挑战。目前,人工智能在新生儿重症监护室的主要应用是通过分析入院前和入院期间的高分辨率数据进行结果预测。最近的应用包括通过信号质量控制和实时事件预测增强神经监测。此外,人工智能还能整合从各种措施中收集的数据,支持微创神经监测,以提高患者的安全性。然而,尽管最近人工智能在新生儿重症监护室的应用激增,但大多数人工智能应用仅限于简单的分类任务,因此人工智能的真正潜力在很大程度上尚未得到开发。新兴的人工智能技术,如通用医疗人工智能和数字双胞胎,蕴藏着通过更广泛的人工智能应用来提高高级神经重症护理的巨大潜力。如果能克服获取高质量数据和伦理问题等挑战,这些新的人工智能技术就能在重症监护室的实际环境中得到临床应用。我们强调需要不断研究和开发,以最大限度地发挥人工智能在新生儿重症监护室的潜力,我们预计这将进一步提高新生儿重症监护室内创伤性脑损伤治疗的效率和准确性。
{"title":"Artificial Intelligence-Enhanced Neurocritical Care for Traumatic Brain Injury : Past, Present and Future.","authors":"Kyung Ah Kim, Hakseung Kim, Eun Jin Ha, Byung C Yoon, Dong-Joo Kim","doi":"10.3340/jkns.2023.0195","DOIUrl":"10.3340/jkns.2023.0195","url":null,"abstract":"<p><p>In neurointensive care units (NICUs), particularly in cases involving traumatic brain injury (TBI), swift and accurate decision-making is critical because of rapidly changing patient conditions and the risk of secondary brain injury. The use of artificial intelligence (AI) in NICU can enhance clinical decision support and provide valuable assistance in these complex scenarios. This article aims to provide a comprehensive review of the current status and future prospects of AI utilization in the NICU, along with the challenges that must be overcome to realize this. Presently, the primary application of AI in NICU is outcome prediction through the analysis of preadmission and high-resolution data during admission. Recent applications include augmented neuromonitoring via signal quality control and real-time event prediction. In addition, AI can integrate data gathered from various measures and support minimally invasive neuromonitoring to increase patient safety. However, despite the recent surge in AI adoption within the NICU, the majority of AI applications have been limited to simple classification tasks, thus leaving the true potential of AI largely untapped. Emerging AI technologies, such as generalist medical AI and digital twins, harbor immense potential for enhancing advanced neurocritical care through broader AI applications. If challenges such as acquiring high-quality data and ethical issues are overcome, these new AI technologies can be clinically utilized in the actual NICU environment. Emphasizing the need for continuous research and development to maximize the potential of AI in the NICU, we anticipate that this will further enhance the efficiency and accuracy of TBI treatment within the NICU.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"493-509"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139377812","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}
Pub Date : 2024-09-01Epub Date: 2024-08-19DOI: 10.3340/jkns.2024.0154
Hee-Jin Yang
Journal of Korean Neurosurgical Society (JKNS), which has a history of over 50 years, has made great progress recently. In order to continue this progress in the future, we need to think about the strategies we will take and put them into practice. The progress of JKNS is an important opportunity to publicize the achievements of Korean neurosurgery to the world and for Korea to contribute further to global neurosurgery. We also need to think about and implement various measures to improve the inflow of papers of high quality from various countries and to establish an appropriate merit system for reviewers.
{"title":"How to Achieve Further Progress of Journal of Korean Neurosurgical Society (JKNS) - Improve the Impact Factor (IF) and Maintain It Continuously.","authors":"Hee-Jin Yang","doi":"10.3340/jkns.2024.0154","DOIUrl":"10.3340/jkns.2024.0154","url":null,"abstract":"<p><p>Journal of Korean Neurosurgical Society (JKNS), which has a history of over 50 years, has made great progress recently. In order to continue this progress in the future, we need to think about the strategies we will take and put them into practice. The progress of JKNS is an important opportunity to publicize the achievements of Korean neurosurgery to the world and for Korea to contribute further to global neurosurgery. We also need to think about and implement various measures to improve the inflow of papers of high quality from various countries and to establish an appropriate merit system for reviewers.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"489-492"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000111","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}
JongGyu Lee, Jong Un Lee, Kwang-Ryeol Kim, Dae-Hyun Kim
Malakoplakia is a rare chronic inflammatory disease that has been rarely reported in the genitourinary tract, gastrointestinal tract, adrenal glands, skin, lungs, bone, and endometrium. Central nervous system malakoplakia is extremely rare, and even then, it has only been reported in the cerebrum and cerebellum. A definite diagnosis of malakoplakia depends on microscopic detection of Michaelis-Gutmann bodies. We would like to present the case of a 61-year-old male who, after undergoing a liver transplant and receiving prolonged antibiotic treatment for Escherichia coli bacteremia, presented with quadriparesis and gait disturbance. The clinical and radiologic appearance of malakoplakia mimics that of malignant tumor. This is a condition with no established appropriate treatment and presents challenges due to its spinal cord location. However, this case presents a case of spinal cord malakoplakia and may provide newly differential diagnosis of an intramedullary mass in the spinal cord.
{"title":"Spinal Cord Malakoplakia Mimicking a Spinal Cord Tumor : The First Case Report.","authors":"JongGyu Lee, Jong Un Lee, Kwang-Ryeol Kim, Dae-Hyun Kim","doi":"10.3340/jkns.2024.0077","DOIUrl":"https://doi.org/10.3340/jkns.2024.0077","url":null,"abstract":"<p><p>Malakoplakia is a rare chronic inflammatory disease that has been rarely reported in the genitourinary tract, gastrointestinal tract, adrenal glands, skin, lungs, bone, and endometrium. Central nervous system malakoplakia is extremely rare, and even then, it has only been reported in the cerebrum and cerebellum. A definite diagnosis of malakoplakia depends on microscopic detection of Michaelis-Gutmann bodies. We would like to present the case of a 61-year-old male who, after undergoing a liver transplant and receiving prolonged antibiotic treatment for Escherichia coli bacteremia, presented with quadriparesis and gait disturbance. The clinical and radiologic appearance of malakoplakia mimics that of malignant tumor. This is a condition with no established appropriate treatment and presents challenges due to its spinal cord location. However, this case presents a case of spinal cord malakoplakia and may provide newly differential diagnosis of an intramedullary mass in the spinal cord.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080588","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}
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.
{"title":"Mechanical Thrombectomy for Hyperacute Vertebrobasilar Ischemic Stroke via Nondominant Vertebral Artery : Clinical Experience and Considerations.","authors":"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","doi":"10.3340/jkns.2024.0104","DOIUrl":"https://doi.org/10.3340/jkns.2024.0104","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080587","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":"Neovascularization in Outer Membrane of Chronic Subdural Hematoma : A Rationale for Middle Meningeal Artery Embolization.","authors":"Hadeel M Mansour, Bipin Chaurasia","doi":"10.3340/jkns.2024.0101","DOIUrl":"https://doi.org/10.3340/jkns.2024.0101","url":null,"abstract":"","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055813","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}
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.
{"title":"Importance of Preoperative Pupillary Reflex in Traumatic Optic Neuropathy.","authors":"Min Ho Lee, Tae-Kyu Lee","doi":"10.3340/jkns.2024.0083","DOIUrl":"https://doi.org/10.3340/jkns.2024.0083","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971252","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}
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。
{"title":"Optimizing Glioblastoma, IDH-wildtype Treatment Outcomes : A Radiomics and Support Vector Machine -Based Approach to Overall Survival Estimation.","authors":"Jiunn-Kai Chong, Priyanka Jain, Shivani Prasad, Navneet Kumar Dubey, Sanjay Saxena, Wen-Cheng Lo","doi":"10.3340/jkns.2024.0100","DOIUrl":"https://doi.org/10.3340/jkns.2024.0100","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889440","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}
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。
{"title":"Effect of Intraoperative Ventricular Opening on Recurrence Patterns Following Bis-Chloroethyl-Nitrosourea Wafer Implantation for Newly Diagnosed Glioblastoma.","authors":"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","doi":"10.3340/jkns.2024.0030","DOIUrl":"https://doi.org/10.3340/jkns.2024.0030","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855732","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}
Pub Date : 2024-08-01Epub Date: 2023-12-22DOI: 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.
{"title":"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.","authors":"Ja Ho Koo, Eui Hyun Hwang, Ji Hye Song, Yong Cheol Lim","doi":"10.3340/jkns.2023.0224","DOIUrl":"10.3340/jkns.2023.0224","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"531-540"},"PeriodicalIF":1.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138830153","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}