Journal of neurosurgical sciences最新文献

Introduction: Idiopathic normal pressure hydrocephalus (iNPH) increases with age but is still underdiagnosed and undertreated. In the last decade, iNPH research has expanded into understanding broader contributions to iNPH, the role of cerebrospinal fluid (CSF), and imaging biomarkers to aid early detection, help diagnosis and differentiation from iNPH mimics, and aid with outcome prediction.

Evidence acquisition: We performed a literature search on the PubMed database. English language articles published between 2015-2024 were included. The strategies focused on iNPH and specific terms related to the topics of this review.

Evidence synthesis: We first addressed the ambiguity of current classification terminology and reviewed the newly proposed classification system. This review has shown that prevalence is higher than previously reported. We have reviewed imaging and found numerous highly sensitive and specific imaging markers to aid diagnosis and differentiate from common mimics. CSF biomarkers have revealed that amyloid β and tau levels were lower in iNPH patients, which helped with differentiation from iNPH mimics, and that other emerging inflammatory markers need to be studied further. We also found numerous promising genetic markers in familial iNPH involved in cilial dysfunction, neuroinflammation, and neurodegeneration. Literature also reported the frequent presence of spinal stenosis, and studies reported better iNPH outcomes when these were addressed.

Conclusions: This has shown that there is a need for the development of a structured and standardized classification system, iNPH assessment protocol with standardized testing, and standardized biomarkers to aid diagnosis and treatment, and that this needs an interdisciplinary team approach.

Introduction: Idiopathic normal pressure hydrocephalus (iNPH) is characterized by the clinical triad of gait, cognitive, and urinary dysfunction associated with ventriculomegaly on neuroimaging. Clinical evaluation before and after CSF removal via large volume lumbar puncture (the "tap test") is used to determine a patient's potential to benefit from shunt placement. Although clinical guidelines for iNPH exist, a standardized protocol detailing the procedural methodology of the tap test is lacking.

Evidence acquisition: Using PRISMA guidelines, a systematic review of PubMed and Embase identifying studies of the tap test in iNPH was performed, centered on four clinical questions (volume of CSF to remove, type of needle for lumbar puncture, which clinical assessments to utilize, and timing of assessments). A modified Delphi approach was then applied to develop a consensus standardized tap test protocol for the evaluation of idiopathic normal pressure hydrocephalus.

Evidence synthesis: Two hundred twenty-two full-text articles encompassing a total of 80,322 participants with iNPH met eligibility and were reviewed. Variations in the tap test protocol resulted in minimal concordance among studies. A standardized protocol of the tap test was iteratively developed over a two-year period by members of the International Parkinson and Movement Disorders Society Normal Pressure Hydrocephalus Study Group until expert consensus was reached.

Conclusions: The literature shows significant variability in the procedural methodology of the tap test. The proposed protocol was subsequently developed to standardize clinical management, improve patient outcomes, and better align future research in idiopathic normal pressure hydrocephalus.

Background: The aim of this study was to propose our classification about unilateral thalamic gliomas, and to describe relationship between the classification and clinical characteristics including symptoms, surgical approaches and survival, which should contribute to the treatment and the prognostic prediction of unilateral thalamic gliomas.

Methods: A total of 66 adult unilateral thalamic glioma patients with pathologic confirmation between January 2010 and December 2018 were retrospectively investigated.

Results: Unilateral thalamic gliomas could be divided into quadrigeminal cistern and ventricle extension type (type Q), lateral type (type L) and anterior type (type A) according to tumor location, extensive polarity and location of ipsilateral posterior limb of internal capsule. Each subtype of QLA classification could match with one kind of corresponding approach. Preoperative symptoms including headache, dyskinesia, aphasia, hydrocephalus and KPS scores, and pathological features including H3K27M mutation and P53 expression were correlated with QLA classification. Further analysis confirmed that type Q tumors had a higher rate of total resection and a significantly longer survival time compared to type L and type A tumors, with similar improved and deteriorated rates of symptoms. Univariate and multivariate analysis demonstrated QLA classification was remarkedly associated with overall survival and could be considered as an independent prognostic factor in patients with unilateral thalamic gliomas.

Conclusions: Unilateral thalamic glioma could be divided into 3 subtypes by imaging characteristics, symptoms and survival. QLA classification could predict tumor resection and the prognosis and could contribute to the planning of therapeutic strategy in patients with unilateral thalamic gliomas.

Introduction: For the accurate diagnosis of idiopathic normal pressure hydrocephalus (iNPH) an accurate neuroimaging is essential. Disproportionately enlarged subarachnoid-space hydrocephalus (DESH) is a key neuroradiological feature and novel imaging techniques, including voxel-based morphometry and AI-assisted analyses are emerging as powerful tools to investigate iNPH pathophysiology. Converging evidence also suggests a role for dopaminergic dysfunction in iNPH. Molecular imaging of the dopamine transporter (DaT) enables the investigation of dopaminergic function and holds potential for advancing differential diagnosis and guiding treatment decisions in iNPH.

Evidence acquisition: A comprehensive literature search was conducted using MeSH key words. Studies assessing the role of structural and functional neuroimaging in iNPH. The evidence was summarized, and key results were provided.

Evidence synthesis: DESH is crucial for accurate diagnosis and treatment planning. Advanced structural and functional imaging techniques are expanding our understanding of iNPH pathophysiology. Only few functional imaging studies have directly examined the dopaminergic dysfunction in iNPH and severe methodological limitations exist in both clinical classification and imaging processing. Nonetheless, evidence supports the presence of dopaminergic dysfunction in iNPH, which may be linked to specific clinical symptoms, aid in differential diagnosis, and be reversed with shunt surgery treatment.

Conclusions: This review covers the structural and functional imaging data in iNPH, providing a comprehensive outlook of the current knowledge, highlighting the limitations and possible future perspectives.

This review advocates for a shift from traditional symptom-based diagnosis of idiopathic normal pressure hydrocephalus (iNPH) to a deeper investigation into its underlying pathophysiological mechanisms, particularly the role of altered cerebral hydrodynamics as an important pathological hallmark. We explore the heterogeneity of iNPH, emphasizing its frequent overlap and cooccurrence with neurodegenerative conditions like Alzheimer and Parkinson disease, and subcortical vascular encephalopathy, complicating diagnosis and treatment strategies. The lumbar infusion test emerges as a useful diagnostic tool, offering quantitative insights into CSF outflow resistance that should be considered as a useful biomarker related to cerebral hydrodynamics and iNPH pathophysiology. Furthermore, we propose the hypothesis that shunt placement, by regulating brain fluid mechanics, may also serve as a form of neuromodulation, potentially enhancing neuronal function and mitigating clinical symptoms. This review advocates for an interdisciplinary, physics-based and patient-centered approach that emphasizes early detection, accurate diagnostics, and personalized treatment plans to enhance patient outcomes and quality of life, particularly in the aging population.

Background: In laboratory-based neuroanatomical studies, surgical freedom, the most important metric of instrument maneuverability, has been based on Heron's formula. Inaccuracies and limitations hinder this study design's applicability. A new methodology, volume of surgical freedom (VSF), may produce a more realistic qualitative and quantitative representation of a surgical corridor.

Methods: Overall, 297 data set measurements assessing surgical freedom were completed for cadaveric brain neurosurgical approach dissections. Heron's formula and VSF were calculated specifically to different surgical anatomical targets. Quantitative accuracy and the results of an analysis of human error were compared.

Results: Heron's formula for irregularly shaped surgical corridors resulted in overestimation of the respective areas (minimum overestimation 31.3%). In 92% (188/204) of data sets reviewed for influence of offset, areas calculated on the basis of measured data points were larger than areas calculated on the basis of the translated best-fit plane points (mean [SD] overestimation of 2.14% [2.62%]). Variability in the probe length attributable to human error was small (mean [SD] calculated probe length 190.26 mm [5.57 mm]).

Conclusions: VSF is an innovative concept that can develop a model of a surgical corridor producing better assessment and prediction of the ability to maneuver and manipulate surgical instruments. VSF corrects for deficits in Heron's method by generating the correct area for an irregular shape using the shoelace formula, adjusting the data points to account for offset, and attempting to correct for human error. VSF produces 3-dimensional models and, therefore, is a preferable standard for assessing surgical freedom.

Background: High-mobility group AT-hook protein 2 (HMGA2) is a gene regulatory protein that is correlated with metastatic potential and poor prognosis. It has been shown that HMGA2 is overexpressed in various tumors such as lung cancer or pancreatic cancer. The invasive character and highly aggressive structure of glioblastoma let us to investigate HMGA2 expression in the border zone of the tumor more closely. We compared HMGA2 expression between glioblastoma and normal brain tissue. In addition, we analyzed and compared HMGA2 expression in the border and center zones of tumors. Correlation tests between HMGA expression and clinical parameters such as MGMT-status and survival were performed.

Methods: Samples from 23 patients with WHO grade 4 glioblastomas were analyzed for HMGA2 expression using quantitative real-time polymerase chain reaction (qPCR) and immunohistochemistry (IHC) and correlated with clinical parameters. The areas from the tumor center and border were analyzed separately. Two normal brain tissue specimens were used as the controls.

Results: Our results confirm that HMGA2 is higher expressed in glioblastoma compared to healthy brain tissue (qPCR, P=0.013; IHC, P=0.04). Moreover, immunohistochemistry revealed significantly higher HMGA2 expression in the border zone of the tumor than in the tumor center zone (P=0.012). Survival analysis revealed a tendency for shorter survival when HMGA2 was highly expressed in the border zone.

Conclusions: The results reveal an overexpression of HMGA2 in the border zone of glioblastomas; thus, the expression cluster of HMGA2 seems to be heterogenous and thorough borough surgical resection of the vital and aggressive border cells might be important to inhibit the invasive character of the tumor.