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Predicting postoperative length of stay: a feature selection approach to predictive modeling in lumbar fusion surgery. 预测术后住院时间:腰椎融合手术预测模型的特征选择方法。
IF 1.2 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2025-12-18 DOI: 10.23736/S0390-5616.25.06604-4
Aman Singh, Rohin Singh, Jag Lally, George Kassis, Omar Sbaih, Kevin Yoon, Suyash Sau, Taylor Furst, Gabrielle Santangelo, Jonathan J Stone

Predictive modeling has the potential to improve preoperative planning and resource allocation in lumbar fusion surgery. This study aimed to identify the 20 most important variables for predicting prolonged postoperative length of stay (pLOS) using machine learning (ML). The ACS-NSQIP database was queried for lumbar fusion procedures performed between 2012 and 2022, including ALIF, PlatIF, PLIF, and combined PLIF+PlatIF. Variable selection was performed using MUVR and Boruta, followed by hierarchical clustering and 5-fold cross-validation to ensure feature robustness. The 20 selected features were used to train multiple ML models, including tree-based classifiers (Random Forest, XGBoost, CatBoost, LightGBM), support vector classifiers, neural networks, ensemble methods, and logistic regression. A total of 114,892 patients were included. Eleven patient-specific and nine procedural variables were identified as most predictive of prolonged pLOS. Among patient factors, dialysis, congestive heart failure, and bleeding disorders were strongest predictors. Among procedural factors, osteotomy, billing of additional fusion codes, and longer operation time had the greatest impact. The neural network achieved the highest accuracy (71.2%), recall (79.4%), and F1-score (73.8%), though all models performed similarly, with minimal variation in classification metrics. These findings underscore that model choice plays a limited role once optimal features are selected - feature selection was the most critical determinant of predictive performance.

预测模型有潜力改善腰椎融合手术的术前计划和资源分配。本研究旨在利用机器学习(ML)确定预测术后延长住院时间(pLOS)的20个最重要的变量。在ACS-NSQIP数据库中查询了2012年至2022年间进行的腰椎融合手术,包括ALIF、PlatIF、PLIF和PLIF+PlatIF联合。使用MUVR和Boruta进行变量选择,然后进行分层聚类和5倍交叉验证以确保特征的鲁棒性。选择的20个特征用于训练多个ML模型,包括基于树的分类器(Random Forest, XGBoost, CatBoost, LightGBM),支持向量分类器,神经网络,集成方法和逻辑回归。共纳入114892例患者。11个患者特异性变量和9个程序变量被确定为最能预测延长pLOS的变量。在患者因素中,透析、充血性心力衰竭和出血性疾病是最强的预测因子。在手术因素中,截骨术、额外融合码计费和较长的手术时间影响最大。神经网络达到了最高的准确率(71.2%),召回率(79.4%)和f1得分(73.8%),尽管所有模型都表现相似,分类指标变化最小。这些发现强调,一旦选择了最优特征,模型选择的作用就有限了——特征选择是预测性能的最关键决定因素。
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引用次数: 0
Advantages of robotic spine surgery. 机器人脊柱手术的优势。
IF 1.2 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2025-12-18 DOI: 10.23736/S0390-5616.25.06687-1
Ismail Zaed, Andrea Cardia
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引用次数: 0
Predictors of 30-day readmission and prolonged length of hospital stay after spinal chondrosarcoma resection: insights from the National Cancer Database. 脊髓软骨肉瘤切除术后30天再入院和延长住院时间的预测因素:来自国家癌症数据库的见解
IF 1.2 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2025-12-10 DOI: 10.23736/S0390-5616.25.06677-9
Joseph Rajasekaran, Abdel-Hameed Al-Mistarehi, Avi N Albert, Abdul K Ghaith, Jawad M Khalifeh, A Daniel Davidar, Fnu Ruchika, Feras Fayez, Xinlan Yang, John Gross, Christian Meyer, Sang H Lee, Kristin J Redmond, Nicholas Theodore, Daniel Lubelski

Background: Spinal chondrosarcoma is a rare malignant tumor requiring complex resection due to its resistance to chemotherapy and radiation. This study aimed to identify predictors of both 30-day readmission and prolonged length of hospital stay (LOS) following surgical resection of spinal chondrosarcoma using data from the National Cancer Database (NCDB).

Methods: Using the NCDB, we conducted a retrospective analysis of adult patients diagnosed with spinal or sacral chondrosarcoma between 2004 and 2017 who underwent surgical resection. We collected patient demographics, tumor characteristics, and treatment details. Patients were grouped based on 30-day readmission. A separate analysis was conducted on LOS, defining prolonged LOS as >75th percentile. Multivariable analyses identified risk factors for each outcome.

Results: Of the 1971 patients in the 30-day readmission analysis, 114 (5.8%) experienced readmission. Of the 1392 patients included in the LOS analysis, 341 (24.5%) experienced prolonged LOS. The risk factors of prolonged LOS included age (OR=1.015; 95% CI, 1.006-1.024; P<0.001), male sex (OR=1.440; 95% CI, 1.076-1.926; P=0.014), tumor volume >11 cm3 (OR=1.001; 95% CI, 1.000-1.002; P=0.018), sacral/coccygeal tumors (OR=1.831; 95% CI, 1.162-2.844; P<0.001), and gross total resection (GTR) (OR=1.514; 95% CI, 1.068-2.146; P=0.020). Multivariate regression identified no significant predictors of 30-day readmission.

Conclusions: Tumor volume, sex, and other factors influence 30-day readmission and prolonged LOS. Prolonged LOS was further associated with sacral/coccygeal tumors and GTR, reflecting the complexity of surgical management.

背景:脊柱软骨肉瘤是一种罕见的恶性肿瘤,由于其对化疗和放疗的抵抗,需要复杂的切除。本研究旨在利用国家癌症数据库(NCDB)的数据,确定脊柱软骨肉瘤手术切除后30天再入院和延长住院时间(LOS)的预测因素。方法:使用NCDB,我们对2004年至2017年间诊断为脊柱或骶骨软骨肉瘤并接受手术切除的成年患者进行了回顾性分析。我们收集了患者的人口统计资料、肿瘤特征和治疗细节。患者按30天再入院时间分组。对LOS进行了单独的分析,将长期LOS定义为bbb75百分位数。多变量分析确定了每个结果的风险因素。结果:1971例患者在30天再入院分析中,114例(5.8%)再次入院。在纳入LOS分析的1392例患者中,341例(24.5%)经历了延长的LOS。延长LOS的危险因素包括年龄(OR=1.015; 95% CI, 1.006-1.024; P11 cm3 (OR=1.001; 95% CI, 1.000-1.002; P=0.018),骶骨/尾骨肿瘤(OR=1.831; 95% CI, 1.162-2.844),结论:肿瘤体积、性别等因素影响30天再入院和延长LOS。延长的LOS与骶骨/尾骨肿瘤和GTR进一步相关,反映了手术治疗的复杂性。
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引用次数: 0
Decompressive craniectomy for spontaneous supratentorial intracerebral hemorrhage: a systematic review and meta-analysis. 减压颅骨切除术治疗自发性幕上脑出血:一项系统回顾和荟萃分析。
IF 1.2 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2025-12-09 DOI: 10.23736/S0390-5616.25.06585-3
Renan M DA Costa, Ugo F Filho, Kíssia S Barbosa, André S Oliveira

Introduction: Spontaneous supratentorial intracerebral hemorrhage (SSICH) is a severe neurological condition associated with high morbidity and mortality, posing significant challenges to clinical management. Among the potential therapeutic strategies, decompressive craniectomy (DC) has been employed to reduce intracranial pressure and prevent secondary brain injury in various contexts, including traumatic brain injury (TBI) and spontaneous intracerebral hemorrhage (sICH). While its benefits are better established in some of these conditions, the specific role and efficacy of DC in the treatment of SSICH remain uncertain. In light of these uncertainties, we conducted a systematic review and meta-analysis to synthesize the available evidence and evaluate the impact of DC - alone or in combination with best medical treatment (BMT) - on clinical outcomes in patients with SSICH.

Evidence acquisition: A systematic search was conducted in the PubMed, Embase, and Cochrane databases. Eligible studies included patients aged 18 to 75 years with SSICH, with the intervention being DC alone or DC combined with BMT, and the control group receiving BMT alone. Studies had to report the outcomes of interest, particularly the primary outcome of mortality. No specific time restrictions were applied, and only randomized controlled trials (RCTs) and observational studies were eligible. The risk of bias in the only RCT included was assessed using version 2 of the Cochrane Risk of Bias tool (RoB-2), while the five observational studies were evaluated using the Risk of Bias in Non-randomized Studies of Interventions tool (ROBINS-I).

Evidence synthesis: A total of six studies were included, comprising 492 patients (224 treated with DC and 268 with BMT alone). Mortality at 30 days, 3 months, 6 months, and 12 months was lower in the intervention group (DC) compared to the control group (BMT alone). Subgroup analyses demonstrated statistical significance across all four timepoints. However, there were no statistically significant differences between groups regarding the incidence of overall infections, pneumonia and urinary tract infections.

Conclusions: Our study concludes that DC reduces mortality in patients with SSICH compared to BMT, although the choice between these treatments does not appear to significantly affect the risk of pneumonia or urinary tract infections. Despite these findings, further studies - particularly RCTs - are needed to provide more robust evidence on this topic.

自发性幕上脑出血(sich)是一种严重的神经系统疾病,具有很高的发病率和死亡率,对临床治疗提出了重大挑战。在潜在的治疗策略中,减压颅切除术(DC)已被用于降低颅内压和预防各种情况下的继发性脑损伤,包括创伤性脑损伤(TBI)和自发性脑出血(sICH)。虽然在某些情况下其益处得到了更好的证实,但DC在治疗重度脑出血中的具体作用和疗效仍不确定。鉴于这些不确定性,我们进行了系统回顾和荟萃分析,以综合现有证据并评估DC -单独或与最佳药物治疗(BMT)联合-对SSICH患者临床结局的影响。证据获取:在PubMed、Embase和Cochrane数据库中进行系统搜索。符合条件的研究包括18 - 75岁的SSICH患者,干预措施为DC单独或DC联合BMT,对照组单独接受BMT。研究必须报告感兴趣的结果,特别是死亡率的主要结果。没有特定的时间限制,只有随机对照试验(rct)和观察性研究符合条件。纳入的唯一一项RCT的偏倚风险使用Cochrane风险评估工具(rob2)进行评估,而5项观察性研究使用非随机干预研究的偏倚风险评估工具(ROBINS-I)进行评估。证据综合:共纳入6项研究,包括492例患者(224例DC治疗,268例BMT单独治疗)。干预组(DC)在30天、3个月、6个月和12个月的死亡率低于对照组(BMT)。亚组分析显示在所有四个时间点上具有统计学意义。然而,在总体感染、肺炎和尿路感染的发生率方面,两组之间没有统计学上的显著差异。结论:我们的研究得出结论,与BMT相比,DC降低了SSICH患者的死亡率,尽管这些治疗之间的选择似乎并未显著影响肺炎或尿路感染的风险。尽管有这些发现,需要进一步的研究——特别是随机对照试验——来提供关于这一主题的更有力的证据。
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引用次数: 0
Radiosurgical management of pathology-proven low-grade glioma: a systematic review across the pre- and post-molecular classification era. 病理证实的低级别胶质瘤的放射外科治疗:在分子分类前和后时代的系统回顾。
IF 1.2 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2025-12-09 DOI: 10.23736/S0390-5616.25.06656-1
Yuka Mizutani, Yusuke S Hori, Paul M Harary, Shreyas Annagiri, Ruchit Jain, Justin Liu, Muhammad Izhar, Deyaaldeen A Reesh, Fred C Lam, Sara C Emrich, Louisa Ustrzynski, Armine Tayag, David J Park, Steven D Chang

Introduction: Low-grade gliomas (LGGs) are slow-growing heterogeneous tumors that remain challenging when complete resection is not feasible. While maximal safe resection remains standard, the evolving World Health Organization (WHO) classification emphasizing molecular characteristics has shifted perspectives on adjuvant therapies. In this context, the role of stereotactic radiosurgery (SRS) continues to be explored. This systematic review synthesizes literature on radiosurgical management of pathology-proven LGGs across pre- and post-molecular classification eras.

Evidence acquisition: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Scopus, and Web of Science were searched in August 2024 for studies on pathology-proven LGGs treated with SRS. An additional search was performed to incorporate studies reporting molecular characteristics.

Evidence synthesis: Of the initially included eight studies, none reported molecular characteristics required by the 2021 World Health Organization classification, and an additional search identified one study reporting molecular characteristics, which was added to the review. Nine studies with 308 patients were included. Local control rates ranged from 66% to 94%. Several studies reported superior outcomes with surgery for recurrence, adjuvant rather than salvage SRS, and no prior radiotherapy. Adverse events were predominantly mild to moderate, including headache, dizziness, nausea, and transient neurological symptoms.

Conclusions: SRS offers a non-invasive management option for selected LGGs with durable control and acceptable safety. Prognosis appears to be influenced by treatment history, including prior radiotherapy and surgical management. Lack of molecular stratification highlights the need for studies focused on IDH (isocitrate dehydrogenase)-mutant LGGs to clarify the role of SRS in the molecular era.

低级别胶质瘤(LGGs)是一种生长缓慢的异质肿瘤,当完全切除不可行时仍然具有挑战性。虽然最大限度的安全切除仍然是标准,但不断发展的世界卫生组织(WHO)分类强调分子特征已经改变了对辅助治疗的看法。在这种情况下,立体定向放射外科(SRS)的作用继续被探索。本系统综述综合了前后分子分类时代病理证实的LGGs放射外科治疗的文献。证据获取:根据系统评价和荟萃分析的首选报告项目进行了系统评价。PubMed、Scopus和Web of Science于2024年8月检索了经病理证实的使用SRS治疗lgg的研究。进行了额外的搜索以纳入报道分子特征的研究。证据合成:在最初纳入的8项研究中,没有一项研究报告了2021年世界卫生组织分类所需的分子特征,另一项研究发现了一项报告了分子特征的研究,该研究被添加到综述中。9项研究共纳入308例患者。当地控制率从66%到94%不等。几项研究报告了手术治疗复发、辅助而非挽救性SRS、无放疗的优越结果。不良事件主要为轻至中度,包括头痛、头晕、恶心和短暂的神经系统症状。结论:SRS提供了一种非侵入性的治疗选择,具有持久控制和可接受的安全性。预后似乎受到治疗史的影响,包括先前的放疗和手术处理。由于缺乏分子分层,因此需要对IDH(异柠檬酸脱氢酶)突变的LGGs进行研究,以阐明SRS在分子时代的作用。
{"title":"Radiosurgical management of pathology-proven low-grade glioma: a systematic review across the pre- and post-molecular classification era.","authors":"Yuka Mizutani, Yusuke S Hori, Paul M Harary, Shreyas Annagiri, Ruchit Jain, Justin Liu, Muhammad Izhar, Deyaaldeen A Reesh, Fred C Lam, Sara C Emrich, Louisa Ustrzynski, Armine Tayag, David J Park, Steven D Chang","doi":"10.23736/S0390-5616.25.06656-1","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06656-1","url":null,"abstract":"<p><strong>Introduction: </strong>Low-grade gliomas (LGGs) are slow-growing heterogeneous tumors that remain challenging when complete resection is not feasible. While maximal safe resection remains standard, the evolving World Health Organization (WHO) classification emphasizing molecular characteristics has shifted perspectives on adjuvant therapies. In this context, the role of stereotactic radiosurgery (SRS) continues to be explored. This systematic review synthesizes literature on radiosurgical management of pathology-proven LGGs across pre- and post-molecular classification eras.</p><p><strong>Evidence acquisition: </strong>A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Scopus, and Web of Science were searched in August 2024 for studies on pathology-proven LGGs treated with SRS. An additional search was performed to incorporate studies reporting molecular characteristics.</p><p><strong>Evidence synthesis: </strong>Of the initially included eight studies, none reported molecular characteristics required by the 2021 World Health Organization classification, and an additional search identified one study reporting molecular characteristics, which was added to the review. Nine studies with 308 patients were included. Local control rates ranged from 66% to 94%. Several studies reported superior outcomes with surgery for recurrence, adjuvant rather than salvage SRS, and no prior radiotherapy. Adverse events were predominantly mild to moderate, including headache, dizziness, nausea, and transient neurological symptoms.</p><p><strong>Conclusions: </strong>SRS offers a non-invasive management option for selected LGGs with durable control and acceptable safety. Prognosis appears to be influenced by treatment history, including prior radiotherapy and surgical management. Lack of molecular stratification highlights the need for studies focused on IDH (isocitrate dehydrogenase)-mutant LGGs to clarify the role of SRS in the molecular era.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145708475","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
Increased preoperative levels of circulating erythrocytic hemoglobin might predict high-grade histology (WHO grade 2-3) in falcine and parasagittal meningiomas. 术前循环红细胞血红蛋白水平升高可能预示镰状和旁矢状脑膜瘤的高级别组织学(WHO分级2-3)。
IF 1.2 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2025-12-01 Epub Date: 2025-05-21 DOI: 10.23736/S0390-5616.24.06371-9
Filippo Gagliardi, Silvia Snider, Pierfrancesco DE Domenico, Matteo Braga, Lina R Barzaghi, Gianluca Nocera, Marcella Callea, Maria R Terreni, Pietro Mortini

Background: Falcine/parasagittal lesions account for the largest rate of high-grade (WHO grade 2-3) lesions. The ability to preoperatively estimate the tumors' grade and outcome would be of great value in customizing treatment.

Methods: This is a single-center, retrospective study designed to assess the pre-operative peripheral blood markers' diagnostic and prognostic role in patients harboring falcine (FM) and parasagittal (PM) high-grade meningiomas. N=116 patients undergoing surgical resection were included. A propensity score-matched analysis accounted for gender imbalances in low-grade (LG) vs. high-grade (HG) cohorts.

Results: Seventy-three (N.=73) FM (63%) and 43 PM (37%) lesions were included. Patients harboring HG lesions showed significantly higher Hb levels than LG (mean 14.5±1.40 vs. 13.5±1.16 g/dL, P<0.001). Multivariate analysis controlling for demographics, lesion characteristics, blood markers, and steroid dose confirmed preoperative Hb as an independent predictive value of lesion grade (OR 1.75, 95% CI:1.01-3.07, P=0.04). Accordingly, patients showing increased Hb levels >15.4 g/dL achieved shorter OS (60.4 months, 95% CI: 14.7-106.1 vs. 134.7 months, 95% CI: 111.2-158.2) compared to patients with lower Hb values, P<0.001. Data were confirmed in matched cohorts.

Conclusions: Increased levels of circulating erythrocytic hemoglobin might be independent predictors for high-grade histology and be associated with shorter overall survival in falcine and parasagittal meningiomas.

背景:镰状/旁矢状面病变占高级别(WHO 2-3级)病变的最大比例。术前评估肿瘤分级和预后的能力将对定制治疗具有重要价值。方法:这是一项单中心回顾性研究,旨在评估术前外周血标志物在镰状(FM)和旁矢状(PM)高级别脑膜瘤患者中的诊断和预后作用。纳入116例手术切除患者。倾向评分匹配分析解释了低级别(LG)与高级别(HG)队列中的性别不平衡。结果:包括73例FM(63%)和43例PM(37%)病变。与Hb值较低的患者相比,HG病变患者的Hb水平明显高于LG(平均14.5±1.40比13.5±1.16 g/dL, P15.4 g/dL的OS较短(60.4个月,95% CI: 14.7-106.1比134.7个月,95% CI: 111.2-158.2)。结论:循环红细胞血红蛋白水平升高可能是高级别组织学的独立预测因子,与镰状和旁矢状脑膜瘤较短的总生存期相关。
{"title":"Increased preoperative levels of circulating erythrocytic hemoglobin might predict high-grade histology (WHO grade 2-3) in falcine and parasagittal meningiomas.","authors":"Filippo Gagliardi, Silvia Snider, Pierfrancesco DE Domenico, Matteo Braga, Lina R Barzaghi, Gianluca Nocera, Marcella Callea, Maria R Terreni, Pietro Mortini","doi":"10.23736/S0390-5616.24.06371-9","DOIUrl":"10.23736/S0390-5616.24.06371-9","url":null,"abstract":"<p><strong>Background: </strong>Falcine/parasagittal lesions account for the largest rate of high-grade (WHO grade 2-3) lesions. The ability to preoperatively estimate the tumors' grade and outcome would be of great value in customizing treatment.</p><p><strong>Methods: </strong>This is a single-center, retrospective study designed to assess the pre-operative peripheral blood markers' diagnostic and prognostic role in patients harboring falcine (FM) and parasagittal (PM) high-grade meningiomas. N=116 patients undergoing surgical resection were included. A propensity score-matched analysis accounted for gender imbalances in low-grade (LG) vs. high-grade (HG) cohorts.</p><p><strong>Results: </strong>Seventy-three (N.=73) FM (63%) and 43 PM (37%) lesions were included. Patients harboring HG lesions showed significantly higher Hb levels than LG (mean 14.5±1.40 vs. 13.5±1.16 g/dL, P<0.001). Multivariate analysis controlling for demographics, lesion characteristics, blood markers, and steroid dose confirmed preoperative Hb as an independent predictive value of lesion grade (OR 1.75, 95% CI:1.01-3.07, P=0.04). Accordingly, patients showing increased Hb levels >15.4 g/dL achieved shorter OS (60.4 months, 95% CI: 14.7-106.1 vs. 134.7 months, 95% CI: 111.2-158.2) compared to patients with lower Hb values, P<0.001. Data were confirmed in matched cohorts.</p><p><strong>Conclusions: </strong>Increased levels of circulating erythrocytic hemoglobin might be independent predictors for high-grade histology and be associated with shorter overall survival in falcine and parasagittal meningiomas.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"453-462"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111001","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
Pycnogenol® improves retinal microcirculation and symptoms of optic nerve ischemic damage after sudden, reversible unilateral loss of vision: a pilot evaluation. 碧萝芷®改善视网膜微循环和视神经缺血性损伤后突然,可逆的单侧视力丧失的症状:试点评估。
IF 1.2 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2025-12-01 Epub Date: 2025-05-27 DOI: 10.23736/S0390-5616.24.06374-4
Gianni Belcaro, Maria R Cesarone, Claudia Scipione, Valeria Scipione, David Cox, Roberto Cotellese, Mark Dugall, Morio Hosoi, Marcello Corsi, Beatrice Feragalli, Corrado Gizzi, Patrizia Torino Rodrigues
<p><strong>Background: </strong>The aim of this pilot registry study was to investigate the use of Pycnogenol<sup>®</sup> (French maritime pine bark, standardized extract) in subjects 2 weeks after an episode of sudden loss of vision (SLV).</p><p><strong>Methods: </strong>Visual acuity, retinal edema, vasospasms, distal retinal circulation and blood flow at the Zinn-Haller circle (distal optic nerve) were examined over 4 weeks. In addition, symptoms of neurological alterations (ION: ischemic optic neuritis) associated with retinal flow decrease were monitored. One registry group used only the standard management (SM, control group), a second group used SM+ 150 mg Pycnogenol<sup>®</sup>/day (Pycno150) and another group used SM+100 mg Pycnogenol<sup>®</sup> /day (Pycno100).</p><p><strong>Results: </strong>Sixty subjects completed the study. 18 in the control group, 20 in the Pycno150 group and 22 subjects in the Pycno100 group. The registry groups were comparable at inclusion. No dropouts were observed in the two Pycnogenol<sup>®</sup> groups whereas 2 dropouts occurred in the SM group (due to the occurrence of a new, minor visual loss episode). No side effects or tolerability problems were observed during the registry study. After 4 weeks, the visual acuity score of the affected eye was significantly higher in the Pycno150 group compared to the Pycno100 group and both Pycnogenol<sup>®</sup> groups showed significantly higher acuity scores in comparison with controls using SM (P<0.05). In parallel, after 4 weeks, the retinal edema score was significantly lower in both Pycnogenol<sup>®</sup> groups compared to controls (P<0.05 vs. SM patients) and even lower (P<0.05) with the 150 mg Pycnogenol<sup>®</sup> dose compared to the 100 mg Pycnogenol<sup>®</sup> dose. After 4 weeks, retinal systolic and diastolic blood flow velocities of the affected eye were significantly higher in the two Pycnogenol<sup>®</sup> groups in comparison with controls using SM (P<0.05). The improvements in 150 mg Pycnogenol<sup>®</sup> group were significantly higher compared to the low-dose 100 mg/Pycnogenol<sup>®</sup> group (P<0.05). At the end of the study, blood flow velocity in the Zinn-Haller circle was significantly higher in both Pycnogenol<sup>®</sup> groups compared to the control group (P<0.05) and was higher (P<0.05) with the 150 mg Pycnogenol<sup>®</sup> dose compared to the 100 mg dose. ION symptoms (vision loss, visual field loss, loss of color vision, flashing lights) improved significantly in the Pycnogenol<sup>®</sup> groups compared to controls (P<0.05), with better improvements in the Pycno150 group compared to the Pycno100 group (P<0.05).</p><p><strong>Conclusions: </strong>The study showed a dose-dependent effect of Pycnogenol<sup>®</sup> on blood flow velocity increase, reduction of retinal edema, ION symptoms and increase in visual acuity. Pycnogenol<sup>®</sup> was shown to be effective and safe in improving retinal microcirculation after an episode o
背景:本试点注册研究的目的是调查碧萝芷酚®(法国海松皮,标准化提取物)在突然丧失视力(SLV)发作后2周的使用情况。方法:观察视力、视网膜水肿、血管痉挛、视网膜远端循环和锌-哈勒环(视神经远端)血流。此外,监测与视网膜血流减少相关的神经改变症状(ION:缺血性视神经炎)。一个注册组仅使用标准管理(SM,对照组),第二个组使用SM+ 150 mg碧萝芷®/天(Pycno150),另一个组使用SM+100 mg碧萝芷®/天(Pycno100)。结果:60名受试者完成了研究。对照组18例,Pycno150组20例,Pycno100组22例。登记组在纳入时具有可比性。在两个碧萝芷®组中没有观察到退出,而在SM组中有2例退出(由于出现新的轻微视力丧失发作)。在登记研究期间未观察到副作用或耐受性问题。4周后,碧萝芷150组患眼的视力评分明显高于碧萝芷100组,碧萝芷®两组的视力评分均明显高于使用SM (P®组的对照组,P®剂量组的对照组,100 mg碧萝芷®剂量组的对照组。4周后,两个碧萝芷®组患眼视网膜收缩和舒张血流速度显著高于使用SM的对照组(P®组显著高于低剂量100 mg/碧萝芷®组)(P®组显著高于对照组(P®剂量与100 mg剂量相比)。与对照组相比,碧萝芷酚®组的离子症状(视力丧失、视野丧失、色盲丧失、闪烁)明显改善(结论:研究显示碧萝芷酚®对血流速度增加、视网膜水肿减轻、离子症状和视力增加有剂量依赖性作用。碧萝芷®在SLV发作后改善视网膜微循环是有效和安全的。
{"title":"Pycnogenol® improves retinal microcirculation and symptoms of optic nerve ischemic damage after sudden, reversible unilateral loss of vision: a pilot evaluation.","authors":"Gianni Belcaro, Maria R Cesarone, Claudia Scipione, Valeria Scipione, David Cox, Roberto Cotellese, Mark Dugall, Morio Hosoi, Marcello Corsi, Beatrice Feragalli, Corrado Gizzi, Patrizia Torino Rodrigues","doi":"10.23736/S0390-5616.24.06374-4","DOIUrl":"10.23736/S0390-5616.24.06374-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The aim of this pilot registry study was to investigate the use of Pycnogenol&lt;sup&gt;®&lt;/sup&gt; (French maritime pine bark, standardized extract) in subjects 2 weeks after an episode of sudden loss of vision (SLV).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Visual acuity, retinal edema, vasospasms, distal retinal circulation and blood flow at the Zinn-Haller circle (distal optic nerve) were examined over 4 weeks. In addition, symptoms of neurological alterations (ION: ischemic optic neuritis) associated with retinal flow decrease were monitored. One registry group used only the standard management (SM, control group), a second group used SM+ 150 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt;/day (Pycno150) and another group used SM+100 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; /day (Pycno100).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sixty subjects completed the study. 18 in the control group, 20 in the Pycno150 group and 22 subjects in the Pycno100 group. The registry groups were comparable at inclusion. No dropouts were observed in the two Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups whereas 2 dropouts occurred in the SM group (due to the occurrence of a new, minor visual loss episode). No side effects or tolerability problems were observed during the registry study. After 4 weeks, the visual acuity score of the affected eye was significantly higher in the Pycno150 group compared to the Pycno100 group and both Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups showed significantly higher acuity scores in comparison with controls using SM (P&lt;0.05). In parallel, after 4 weeks, the retinal edema score was significantly lower in both Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups compared to controls (P&lt;0.05 vs. SM patients) and even lower (P&lt;0.05) with the 150 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; dose compared to the 100 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; dose. After 4 weeks, retinal systolic and diastolic blood flow velocities of the affected eye were significantly higher in the two Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups in comparison with controls using SM (P&lt;0.05). The improvements in 150 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; group were significantly higher compared to the low-dose 100 mg/Pycnogenol&lt;sup&gt;®&lt;/sup&gt; group (P&lt;0.05). At the end of the study, blood flow velocity in the Zinn-Haller circle was significantly higher in both Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups compared to the control group (P&lt;0.05) and was higher (P&lt;0.05) with the 150 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; dose compared to the 100 mg dose. ION symptoms (vision loss, visual field loss, loss of color vision, flashing lights) improved significantly in the Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups compared to controls (P&lt;0.05), with better improvements in the Pycno150 group compared to the Pycno100 group (P&lt;0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The study showed a dose-dependent effect of Pycnogenol&lt;sup&gt;®&lt;/sup&gt; on blood flow velocity increase, reduction of retinal edema, ION symptoms and increase in visual acuity. Pycnogenol&lt;sup&gt;®&lt;/sup&gt; was shown to be effective and safe in improving retinal microcirculation after an episode o","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"463-468"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150682","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
Correction to: Early growth response 1 promoted the invasion of glioblastoma multiforme by elevating HMGB1. 更正:早期生长反应1通过升高HMGB1促进多形性胶质母细胞瘤的侵袭。
IF 1.2 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2025-12-01 DOI: 10.23736/S0390-5616.25.06668-8
Kai Du, Xiaoyou Wu, Xiaofei Ji, Nan Liang, Zheng Li

This article was published in Volume 67, issue 4 of publishing year 2023, with a mistake in Figure 3. The correct Figure 3 is the one included in this erratum.

这篇文章发表在2023年出版的第67卷第4期,图3中有一个错误。正确的图3包含在这个勘误表中。
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引用次数: 0
The impact of hyperoxemia on mortality and neurological outcomes in traumatic brain injury: a systematic review and meta-analysis. 高氧血症对创伤性脑损伤患者死亡率和神经预后的影响:一项系统综述和荟萃分析。
IF 1.2 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2025-12-01 DOI: 10.23736/S0390-5616.25.06480-X
Anna Fornaciari, Rossella Zangari, Martina Polato, Elisa Gouvea Bogossian, Elena G Bignami, Frank Rasulo, Fabio S Taccone, Michele Salvagno

Introduction: Traumatic brain injury (TBI) is a critical condition where the management of oxygen levels plays a pivotal role in patient outcomes. While hypoxemia is known to worsen outcomes, the impact of hyperoxemia on mortality and neurological outcomes remains controversial. This systematic review and meta-analysis aims to evaluate the effects of hyperoxemia on these outcomes in TBI patients.

Evidence acquisition: This study followed PRISMA guidelines and was registered with PROSPERO (registration number: CRD42024537543). A comprehensive search was conducted across MEDLINE, Embase, and SCOPUS databases, identifying relevant studies on hyperoxemia and its impact on mortality and neurological outcomes in TBI patients. Both observational studies and randomized controlled trials were included, and data were synthesized and analyzed using a random-effects model.

Evidence synthesis: Fifteen studies including 38,718 patients were included in the qualitative synthesis, with 13 studies included in the quantitative meta-analysis. Hyperoxemia was not significantly associated with mortality (pooled OR=0.88 [0.66-1.16]; P=0.36; I2=86%) or with unfavorable neurological outcomes (pooled OR=1.04 [0.83-1.29]; P=0.75; I2=67%). Sensitivity analyses limited to studies with low or low/moderate risk of bias showed a statistically significant association between hyperoxemia and reduced mortality, although with high heterogeneity (OR=0.65 [0.48-0.88]; P=0.005; I2=82%). A subgroup analysis of studies assessing neurological outcome at 6 months suggested a trend toward improved functional outcomes with early moderate hyperoxemia (OR=1.32 [0.99-1.75]; P=0.06). An explorative meta-regression did not show a significant linear association between PaO2 thresholds and outcomes.

Conclusions: This systematic review and meta-analysis do not provide sufficient evidence to discourage the use of moderate hyperoxemia in TBI patients. Exploratory analyses suggesting potential benefits from early moderate hyperoxemia require further validation in selected patients. High-quality prospective studies are urgently needed to determine the optimal use of oxygen therapy in TBI.

简介:创伤性脑损伤(TBI)是一种危重疾病,其中氧水平的管理在患者预后中起着关键作用。虽然已知低氧血症会恶化预后,但高氧血症对死亡率和神经预后的影响仍存在争议。本系统综述和荟萃分析旨在评估高氧血症对TBI患者这些结果的影响。证据获取:本研究遵循PRISMA指南,并在PROSPERO注册(注册号:CRD42024537543)。在MEDLINE、Embase和SCOPUS数据库中进行了全面的检索,确定了高氧血症及其对TBI患者死亡率和神经预后影响的相关研究。包括观察性研究和随机对照试验,并使用随机效应模型对数据进行综合和分析。证据综合:15项研究包括38,718例患者纳入定性综合,13项研究纳入定量荟萃分析。高氧血症与死亡率无显著相关性(合并OR=0.88 [0.66-1.16]; P=0.36; I2=86%),与不良神经预后无显著相关性(合并OR=1.04 [0.83-1.29]; P=0.75; I2=67%)。局限于低或低/中等偏倚风险研究的敏感性分析显示,高氧血症与降低死亡率之间存在统计学上显著的关联,尽管存在高度异质性(or =0.65 [0.48-0.88]; P=0.005; I2=82%)。一项评估6个月神经预后的研究亚组分析显示,早期中度高氧血症患者的功能预后有改善的趋势(OR=1.32 [0.99-1.75]; P=0.06)。探索性元回归未显示PaO2阈值与预后之间存在显著的线性关联。结论:本系统综述和荟萃分析并没有提供足够的证据来阻止TBI患者使用中度高氧血症。探索性分析表明早期中度高氧血症的潜在益处需要在选定的患者中进一步验证。迫切需要高质量的前瞻性研究来确定氧治疗在TBI中的最佳应用。
{"title":"The impact of hyperoxemia on mortality and neurological outcomes in traumatic brain injury: a systematic review and meta-analysis.","authors":"Anna Fornaciari, Rossella Zangari, Martina Polato, Elisa Gouvea Bogossian, Elena G Bignami, Frank Rasulo, Fabio S Taccone, Michele Salvagno","doi":"10.23736/S0390-5616.25.06480-X","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06480-X","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic brain injury (TBI) is a critical condition where the management of oxygen levels plays a pivotal role in patient outcomes. While hypoxemia is known to worsen outcomes, the impact of hyperoxemia on mortality and neurological outcomes remains controversial. This systematic review and meta-analysis aims to evaluate the effects of hyperoxemia on these outcomes in TBI patients.</p><p><strong>Evidence acquisition: </strong>This study followed PRISMA guidelines and was registered with PROSPERO (registration number: CRD42024537543). A comprehensive search was conducted across MEDLINE, Embase, and SCOPUS databases, identifying relevant studies on hyperoxemia and its impact on mortality and neurological outcomes in TBI patients. Both observational studies and randomized controlled trials were included, and data were synthesized and analyzed using a random-effects model.</p><p><strong>Evidence synthesis: </strong>Fifteen studies including 38,718 patients were included in the qualitative synthesis, with 13 studies included in the quantitative meta-analysis. Hyperoxemia was not significantly associated with mortality (pooled OR=0.88 [0.66-1.16]; P=0.36; I<sup>2</sup>=86%) or with unfavorable neurological outcomes (pooled OR=1.04 [0.83-1.29]; P=0.75; I<sup>2</sup>=67%). Sensitivity analyses limited to studies with low or low/moderate risk of bias showed a statistically significant association between hyperoxemia and reduced mortality, although with high heterogeneity (OR=0.65 [0.48-0.88]; P=0.005; I<sup>2</sup>=82%). A subgroup analysis of studies assessing neurological outcome at 6 months suggested a trend toward improved functional outcomes with early moderate hyperoxemia (OR=1.32 [0.99-1.75]; P=0.06). An explorative meta-regression did not show a significant linear association between PaO<inf>2</inf> thresholds and outcomes.</p><p><strong>Conclusions: </strong>This systematic review and meta-analysis do not provide sufficient evidence to discourage the use of moderate hyperoxemia in TBI patients. Exploratory analyses suggesting potential benefits from early moderate hyperoxemia require further validation in selected patients. High-quality prospective studies are urgently needed to determine the optimal use of oxygen therapy in TBI.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"69 6","pages":"481-492"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029967","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
Microsurgery and endovascular therapy serve instrumental roles in multimodal management of giant cerebral aneurysms: a systematic review. 显微手术和血管内治疗在颅内巨动脉瘤的多模式治疗中起重要作用:系统综述。
IF 1.2 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2025-12-01 DOI: 10.23736/S0390-5616.25.06617-2
Saarang Patel, Mohammad F Khan, Nolan J Brown, Ryan Gensler, Redi Rahmani, Julian Gendreau, Joshua S Catapano, Michael T Lawton

Introduction: Giant intracranial aneurysms are rare vascular lesions consisting of cerebral aneurysms measuring ≥25 mm in diameter. Their formation is the result of multiple factors including their association with a unique genomic landscape, pathophysiologic processes associated with the pathognomonic, histopathological changes observed within the arterial wall, the physical effects of the cerebral vasculature's unique fluid dynamics, and slow growth rates. Because giant intracranial aneurysms are considered among the most complex to manage, we herein perform a systematic review of the extant evidentiary base found within the neurosurgical literature with the goal of profiling multimodality management strategies for these lesions. Additionally, we will highlight the importance of integrating neuroendovascular surgery into microsurgical treatment regimens for giant cerebral aneurysms.

Evidence acquisition: To this end, we performed a systematic review of the literature through the PubMed, Scopus and Web of Science databases according to PRISMA guidelines. By using predefined search terms, we intended to identify prior reports involving multimodality management of giant intracranial aneurysms. Specifically, we sought to highlight the integral role of both neuroendovascular and microsurgical interventions in treatment of these rare vascular lesions.

Evidence synthesis: Ten studies reporting outcomes for 91 patients met criteria for inclusion in the present meta-analysis. Within this cohort of patients, mean age varied from 39.0 to 60.1 years. Among the giant aneurysms in the present review, many were found extending off of the supraclinoid ICA, which is one of the most common sites for giant intracranial aneurysms to form. In 1988, Batjer described the earliest combined intervention included in the present study. Since then, two common approach type themes involved in multimodal management have evolved: combined strategies often consist of 1) an endovascular approach to vessel occlusion, such as embolization, and 2) a microsurgical method capable of eliminating the aneurysm following control of blood flow. In other words, achieving obliteration via clipping, bypass surgery, clip reconstruction, wrapping, and Hunterian ligation (among others). Review of the literature indicated an overall mortality rate associated with multimodal management of 5.4%. Radiographic obliteration rates were reported in three of ten studies. One of the studies reported an 82.9% rate of successful obliteration. Rates of good outcomes (mRS 0-2, GOS 4-5) ranged from 60% up to a maximum of 87.5%.

Conclusions: Combined, multimodality endovascular and microsurgical treatments appear to be most successful for the treatment of giant aneurysms because of their adaptability, the flexibility they confer, and the synergistic effect of combining the strengths of multiple modalities.

颅内巨动脉瘤是一种罕见的血管病变,由直径≥25mm的脑动脉瘤组成。它们的形成是多种因素的结果,包括它们与独特的基因组景观的关联、与病理表型相关的病理生理过程、动脉壁内观察到的组织病理变化、脑血管独特的流体动力学的物理效应以及缓慢的生长速度。由于巨大颅内动脉瘤被认为是最复杂的治疗方法之一,我们在此对神经外科文献中现有的证据基础进行了系统的回顾,目的是分析这些病变的多模式治疗策略。此外,我们将强调将神经血管内手术纳入巨型脑动脉瘤显微外科治疗方案的重要性。证据获取:为此,我们根据PRISMA指南,通过PubMed、Scopus和Web of Science数据库对文献进行了系统的综述。通过使用预定义的搜索词,我们打算识别先前涉及颅内巨动脉瘤多模式治疗的报告。具体来说,我们试图强调神经血管内和显微外科干预在治疗这些罕见血管病变中的整体作用。证据综合:10项研究报告了91例患者的结果,符合纳入本荟萃分析的标准。在这组患者中,平均年龄从39.0岁到60.1岁不等。在本综述中发现的巨动脉瘤中,许多都是在颈突上动脉外延伸,这是颅内巨动脉瘤最常见的形成部位之一。1988年,Batjer描述了本研究中最早的联合干预措施。从那时起,涉及多模式治疗的两种常见入路类型已经发展:联合策略通常包括1)血管内入路治疗血管闭塞,如栓塞,以及2)能够在控制血流后消除动脉瘤的显微外科方法。换句话说,通过夹闭、搭桥手术、夹闭重建、包裹和亨特氏结扎(以及其他)来实现闭塞。文献综述表明,与多模式管理相关的总死亡率为5.4%。10个研究中有3个报告了x线摄影湮没率。其中一项研究报告了82.9%的成功清除率。良好转归率(mRS 0-2, GOS 4-5)从60%到最高87.5%不等。结论:多模态血管内与显微外科联合治疗巨动脉瘤因其适应性、灵活性和多模态优势的协同效应而显得最为成功。
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引用次数: 0
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Journal of neurosurgical sciences
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