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Genetics and molecular pathophysiology of normal pressure hydrocephalus. 正常压力脑积水的遗传学和分子病理生理学。
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-23 DOI: 10.3171/2024.5.JNS24980
Neel H Mehta, Eduardo A Maury, Zachary Buller, Phan Q Duy, Carla Fortes, Seth L Alper, E Zeynep Erson-Omay, Kristopher T Kahle

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by dilation of the cerebral ventricles without increased cerebral pressure. Patients typically present with cognitive impairment, gait abnormalities, and urinary incontinence. Despite current guidelines for diagnosis and surgical intervention, there is little consensus on the pathophysiology of iNPH. Familial cases and genomic studies of iNPH have recently suggested an underappreciated role of genetics in disease pathogenesis, implicating mechanisms ranging from dysregulated CSF dynamics to underlying neurodegenerative or neuroinflammatory processes. In this paper, the authors provide a brief review of genetic insights and candidate genes for iNPH, highlighting the continued importance of integrated genetic analysis and clinical studies to advance iNPH management.

特发性正常压力脑积水(iNPH)的特点是脑室扩张,但脑压不升高。患者通常表现为认知障碍、步态异常和尿失禁。尽管目前已有诊断和手术干预指南,但人们对 iNPH 的病理生理学仍缺乏共识。最近,对 iNPH 家族病例和基因组研究表明,遗传学在疾病发病机制中的作用未得到充分重视,其机制包括脑脊液动力学失调、潜在的神经退行性病变或神经炎症过程等。在本文中,作者简要回顾了 iNPH 的遗传学见解和候选基因,强调了综合遗传学分析和临床研究对于推进 iNPH 治疗的持续重要性。
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引用次数: 0
The impact of general anesthesia versus non-general anesthesia on thrombectomy outcomes by occlusion location: insights from the ETIS registry. 按闭塞位置划分的全身麻醉与非全身麻醉对血栓切除术结果的影响:ETIS 登记的启示。
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-23 DOI: 10.3171/2024.5.JNS24199
Mohammad Anadani, Benjamin Gory, Jean-Marc Olivot, Romain Bourcier, Arturo Consoli, Grégoire Boulouis, Kevin Janot, Raoul Pop, Jean-Philippe Desilles, Lina Hamoud, Mikael Mazighi, Bertrand Lapergue, Gaultier Marnat, Stefanos Finitsis

Objective: Identifying the optimal anesthetic technique for mechanical thrombectomy (MT) remains an unresolved issue. Prior research has not considered the influence of occlusion site when comparing general anesthesia (GA) with non-GA. This study evaluates the differential impacts of the anesthetic technique (GA vs non-GA) on outcomes according to the location of occlusion.

Methods: This is a retrospective analysis of the ETIS (Endovascular Treatment in Ischemic Stroke) registry. Patients with anterior circulation large-vessel occlusion treated with MT were included. Patients were divided into groups according to the location of occlusion. Inverse propensity score weighting analysis was used.

Results: Among 2783 patients included in the propensity score analysis, 669 (24%) received GA. In the total cohort, GA was not associated with favorable outcome, excellent outcome, successful reperfusion, or complete reperfusion. GA was associated with higher odds of parenchymal hemorrhage (OR 1.42, 95% 1.05-1.92) but not symptomatic intracranial hemorrhage. GA was associated with Alberta Stroke Program Early CT Score progression (OR 1.36, 95% CI 1.11-1.68). In the internal carotid artery occlusion group, GA was associated with higher odds of mortality (OR 1.94, 95% CI 1.15-3.27). In the M1 group, GA was associated with lower odds of complications (OR 0.41, 95% CI 0.19-0.92). In the M2 group, GA was associated with successful reperfusion (OR 2.79, 95% CI 1.02-7.64). In addition, the complication rate was lower with GA (2.7% vs 7%), although the association was not significant in adjusted analysis.

Conclusions: While GA and non-GA techniques did not differ significantly in functional outcomes, the influence of GA on angiographic and procedural safety outcomes was location dependent, underscoring the importance of a tailored anesthesia technique in MT procedures.

目的:确定机械血栓切除术(MT)的最佳麻醉技术仍是一个悬而未决的问题。之前的研究在比较全身麻醉(GA)与非全身麻醉时并未考虑闭塞部位的影响。本研究评估了麻醉技术(GA 与非 GA)根据闭塞部位对结果的不同影响:这是一项对 ETIS(缺血性卒中的血管内治疗)登记的回顾性分析。研究纳入了接受 MT 治疗的前循环大血管闭塞患者。根据闭塞位置将患者分为几组。采用反倾向评分加权分析:在纳入倾向得分分析的2783名患者中,有669人(24%)接受了GA治疗。在所有队列中,GA 与良好预后、出色预后、成功再灌注或完全再灌注无关。GA与较高的实质出血几率相关(OR 1.42,95% 1.05-1.92),但与症状性颅内出血无关。GA与阿尔伯塔省卒中计划早期CT评分进展有关(OR 1.36,95% CI 1.11-1.68)。在颈内动脉闭塞组,GA 与较高的死亡几率相关(OR 1.94,95% CI 1.15-3.27)。在 M1 组,GA 与较低的并发症几率相关(OR 0.41,95% CI 0.19-0.92)。在 M2 组,GA 与再灌注成功率相关(OR 2.79,95% CI 1.02-7.64)。此外,GA的并发症发生率较低(2.7% vs 7%),但在调整分析中相关性并不显著:结论:虽然GA和非GA技术在功能结果上没有显著差异,但GA对血管造影和手术安全性结果的影响取决于手术部位,这强调了在MT手术中采用量身定制的麻醉技术的重要性。
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引用次数: 0
Letter to the Editor. Concerning transposition for microvascular decompression in trigeminal neuralgia. 致编辑的信。关于三叉神经痛微血管减压转位术。
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-23 DOI: 10.3171/2024.5.JNS241160
Colby T Joncas, Guy M McKhann, Raymond F Sekula
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引用次数: 0
Letter to the Editor. VR-assisted medical education: combining traditional and innovative methods. 致编辑的信。虚拟现实辅助医学教育:传统与创新方法的结合。
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-23 DOI: 10.3171/2024.6.JNS241281
Ning Wang, Shuo Yang, Xiaodan Huang
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引用次数: 0
Impact of proton versus photon adjuvant radiotherapy on overall survival in the management of skull base and spinal chordomas: a National Cancer Database analysis. 质子与光子辅助放疗对治疗颅底和脊索瘤总生存期的影响:国家癌症数据库分析。
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-23 DOI: 10.3171/2024.5.JNS24511
Victor Gabriel El-Hajj, Abdul Karim Ghaith, Harry Hoang, Ryan H Nguyen, Neil Nazar Al-Saidi, Stephen P Graepel, Elias Atallah, Adrian Elmi-Terander, Eric J Lehrer, Paul D Brown, Mohamad Bydon

Objective: Chordomas are rare tumors that originate from undifferentiated remnants of the notochord. Currently, there are no established guidelines regarding the choice of adjuvant radiation modality for patients surgically treated for chordomas. Using a nationwide, multicenter database, the authors aimed to compare long-term survival outcomes associated with the use of proton or photon adjuvant therapy for the management of chordomas of skull base and spine.

Methods: The National Cancer Database (NCDB) was queried for chordoma cases from 2004 to 2017. Patient, tumor, and treatment characteristics were extracted from the database. The primary outcome was overall survival (OS). Kaplan-Meier survival analyses were conducted to investigate differences in outcome on propensity score-matched cohorts of patients treated with proton or photon adjuvant radiotherapy.

Results: Of the 3490 patients available, 424 met the inclusion criteria for this study. In the prematching analysis, patients receiving adjuvant photon therapy were significantly older (median age 57.0 vs 45.0 years, p < 0.001) and were more commonly male (61% vs 43%, p < 0.001) compared with those receiving proton therapy. Races were equally distributed among radiotherapy modalities (p = 0.64). Patients with chordomas of the mobile spine or sacrum were less likely to receive proton compared with photon therapy (37% vs 58%). Patients receiving proton therapy were more often represented among private insurance holders (69% vs 52%, p < 0.001) as well as in the highest income quartile (52% vs 40%, p = 0.008). Patients traveled farther to receive proton, as opposed to photon, therapy (median 59.0 vs 34.9 miles, p < 0.001). On postmatching Kaplan-Meier analysis encompassing all chordoma cases, no difference in OS between photon and proton therapy was revealed (HR 0.75, 95% CI 0.39-1.44; p = 0.39). A Kaplan-Meier analysis only including patients with skull base chordomas reached similar results (HR 0.83, 95% CI 0.31-2.22; p = 0.71). In patients with spine chordomas, however, a significant difference was found, as proton therapy exhibited a superior OS over photon therapy (HR 0.28, 95% CI 0.09-0.81; p = 0.012).

Conclusions: Based on this nationwide analysis, patients with private insurance and higher income were more likely to receive proton adjuvant radiotherapy, while those with spinal or sacral chordomas were less likely to receive this modality. Despite this disparity, an OS benefit was observed in patients with chordomas of the spine and sacrum who received adjuvant proton therapy, in comparison with a matched cohort of patients treated with photon therapy. Conversely, this advantageous outcome was not evident in cases of chordomas located at the skull base.

目的:脊索瘤是一种罕见的肿瘤,起源于未分化的脊索残基。目前,关于脊索瘤手术治疗患者辅助放射模式的选择还没有既定指南。作者利用一个全国性的多中心数据库,旨在比较使用质子或光子辅助疗法治疗颅底和脊柱脊索瘤的长期生存结果:方法:查询了2004年至2017年全国癌症数据库(NCDB)中的脊索瘤病例。从数据库中提取了患者、肿瘤和治疗特征。主要结果是总生存期(OS)。对接受质子或光子辅助放疗的患者进行了倾向评分匹配队列的Kaplan-Meier生存分析,以研究结果的差异:在3490名患者中,有424名符合本研究的纳入标准。在预匹配分析中,与接受质子治疗的患者相比,接受光子辅助治疗的患者年龄明显偏大(中位年龄为57.0岁对45.0岁,P<0.001),男性患者也更多(61%对43%,P<0.001)。放疗方式的种族分布相当(P = 0.64)。移动脊柱或骶骨脊索瘤患者接受质子治疗的比例低于光子治疗(37% 对 58%)。接受质子治疗的患者中,私人保险持有者(69% 对 52%,p < 0.001)和最高收入四分位数(52% 对 40%,p = 0.008)的比例更高。与光子治疗相比,患者接受质子治疗的路程更远(中位 59.0 英里对 34.9 英里,p < 0.001)。在对所有脊索瘤病例进行Kaplan-Meier分析后发现,光子疗法和质子疗法的OS没有差异(HR 0.75,95% CI 0.39-1.44;P = 0.39)。仅包括颅底脊索瘤患者的卡普兰-梅耶分析也得出了类似的结果(HR 0.83,95% CI 0.31-2.22;P = 0.71)。但在脊索瘤患者中,质子治疗的OS优于光子治疗(HR 0.28,95% CI 0.09-0.81;P = 0.012),因此发现了显著差异:根据这项全国性分析,拥有私人保险和较高收入的患者更有可能接受质子辅助放疗,而脊柱或骶骨脊索瘤患者接受这种治疗方式的可能性较低。尽管存在这种差异,但与接受光子治疗的匹配队列患者相比,接受质子辅助治疗的脊柱和骶骨脊索瘤患者在OS方面仍有获益。相反,在位于颅底的脊索瘤病例中,这种优势并不明显。
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引用次数: 0
Pre-stereotactic radiosurgery neutrophil-to-lymphocyte ratio predicts post-stereotactic radiosurgery survival of patients with brain metastases concurrently treated with immune checkpoint inhibitors. 立体定向放射手术前中性粒细胞与淋巴细胞比率可预测同时接受免疫检查点抑制剂治疗的脑转移患者立体定向放射手术后的生存率。
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-23 DOI: 10.3171/2024.5.JNS24259
Shoji Yomo, Kyota Oda, Kazuhiro Oguchi

Objective: Treatment with immune checkpoint inhibitors (ICIs) has shown clinical benefit for a wide range of cancer types. The neutrophil-to-lymphocyte ratio (NLR) reportedly correlates with survival time or progression-free survival in patients treated with ICIs. However, NLR has not yet been assessed in patients with brain metastases (BMs) receiving stereotactic radiosurgery (SRS) combined with concurrent ICIs. The authors investigated the predictive impact of NLR on the survival data of patients with BMs who received SRS with concurrent ICIs.

Methods: The clinical records of patients who had undergone SRS with concurrent ICIs for BMs between January 2015 and August 2023 were retrospectively analyzed. NLR was calculated using the data obtained from the last examination prior to SRS. The optimal NLR cutoff value was identified by receiver operating characteristic (ROC) curve analysis for time-to-event data (overall survival [OS] ≤ 18 months). OS and intracranial disease progression-free survival (IC-PFS) rates were compared between the two NLR groups.

Results: Of the 185 eligible patients included, 132 were male. The median (IQR) patient age was 69 (61-75) years. The primary cancers were lung, genitourinary, skin, breast, gastrointestinal, and others in 132, 23, 22, 2, 2, and 4 patients, respectively. The post-SRS median OS and IC-PFS times for the entire cohort were 18.4 (95% CI 14.0-23.1) months and 9.2 (95% CI 6.9-10.8) months, respectively. ROC curve analysis identified the optimal NLR cutoff value for 18-month OS to be 5.0 (area under the curve 0.64, Youden index 0.31). Kaplan-Meier analysis revealed that patients with high NLR (> 5) had a significantly shorter OS (median survival time 10.9 months for 48 patients vs 22.2 months for 137 patients, HR 2.0, 95% CI 1.3-3.0, p < 0.001). Similarly, a significant difference in median IC-PFS was noted: 4.8 months with high NLR versus 10.7 months with low NLR (HR 1.7, 95% CI 1.2-2.5, p = 0.003).

Conclusions: The authors found elevated pre-SRS NLR (> 5) to be associated with shorter OS and IC-PFS after SRS with concurrent ICIs for BMs. NLR is a simple, cost-effective, and widely accessible biomarker, which can thus be used for managing patients with BMs receiving SRS concurrently with ICIs. Further investigation in other large datasets is, however, required to validate these findings.

目的:免疫检查点抑制剂(ICIs)的治疗已显示出对多种癌症类型的临床疗效。据报道,中性粒细胞与淋巴细胞比率(NLR)与接受 ICIs 治疗的患者的生存时间或无进展生存期相关。然而,尚未对接受立体定向放射外科手术(SRS)并同时接受 ICIs 治疗的脑转移(BMs)患者的 NLR 进行评估。作者研究了 NLR 对接受 SRS 并同时接受 ICIs 的脑转移患者生存数据的预测影响:方法:回顾性分析了2015年1月至2023年8月期间因BMs接受SRS与同期ICIs治疗的患者的临床记录。使用 SRS 前最后一次检查获得的数据计算 NLR。通过对时间到事件数据(总生存期 [OS] ≤ 18 个月)的接收者操作特征(ROC)曲线分析,确定了最佳的 NLR 临界值。比较了两个 NLR 组的 OS 和颅内无疾病进展生存率(IC-PFS):在185名符合条件的患者中,132人为男性。患者年龄中位数(IQR)为 69(61-75)岁。132、23、22、2、2 和 4 名患者的原发癌症分别为肺癌、泌尿生殖系统癌、皮肤癌、乳腺癌、胃肠道癌和其他癌症。整个队列在SRS后的中位OS和IC-PFS时间分别为18.4(95% CI 14.0-23.1)个月和9.2(95% CI 6.9-10.8)个月。ROC曲线分析确定18个月OS的最佳NLR临界值为5.0(曲线下面积0.64,Youden指数0.31)。Kaplan-Meier 分析显示,NLR 高(> 5)的患者的 OS 明显较短(48 例患者的中位生存时间为 10.9 个月,137 例患者的中位生存时间为 22.2 个月,HR 2.0,95% CI 1.3-3.0,P < 0.001)。同样,IC-PFS 的中位数也有显著差异:高NLR为4.8个月,低NLR为10.7个月(HR 1.7,95% CI 1.2-2.5,p = 0.003):作者发现SRS前NLR升高(> 5)与SRS后较短的OS和IC-PFS相关,同时ICIs治疗BMs。NLR 是一种简单、经济、可广泛使用的生物标志物,因此可用于管理同时接受 SRS 和 ICIs 的 BMs 患者。然而,要验证这些发现,还需要在其他大型数据集中进行进一步的研究。
{"title":"Pre-stereotactic radiosurgery neutrophil-to-lymphocyte ratio predicts post-stereotactic radiosurgery survival of patients with brain metastases concurrently treated with immune checkpoint inhibitors.","authors":"Shoji Yomo, Kyota Oda, Kazuhiro Oguchi","doi":"10.3171/2024.5.JNS24259","DOIUrl":"https://doi.org/10.3171/2024.5.JNS24259","url":null,"abstract":"<p><strong>Objective: </strong>Treatment with immune checkpoint inhibitors (ICIs) has shown clinical benefit for a wide range of cancer types. The neutrophil-to-lymphocyte ratio (NLR) reportedly correlates with survival time or progression-free survival in patients treated with ICIs. However, NLR has not yet been assessed in patients with brain metastases (BMs) receiving stereotactic radiosurgery (SRS) combined with concurrent ICIs. The authors investigated the predictive impact of NLR on the survival data of patients with BMs who received SRS with concurrent ICIs.</p><p><strong>Methods: </strong>The clinical records of patients who had undergone SRS with concurrent ICIs for BMs between January 2015 and August 2023 were retrospectively analyzed. NLR was calculated using the data obtained from the last examination prior to SRS. The optimal NLR cutoff value was identified by receiver operating characteristic (ROC) curve analysis for time-to-event data (overall survival [OS] ≤ 18 months). OS and intracranial disease progression-free survival (IC-PFS) rates were compared between the two NLR groups.</p><p><strong>Results: </strong>Of the 185 eligible patients included, 132 were male. The median (IQR) patient age was 69 (61-75) years. The primary cancers were lung, genitourinary, skin, breast, gastrointestinal, and others in 132, 23, 22, 2, 2, and 4 patients, respectively. The post-SRS median OS and IC-PFS times for the entire cohort were 18.4 (95% CI 14.0-23.1) months and 9.2 (95% CI 6.9-10.8) months, respectively. ROC curve analysis identified the optimal NLR cutoff value for 18-month OS to be 5.0 (area under the curve 0.64, Youden index 0.31). Kaplan-Meier analysis revealed that patients with high NLR (> 5) had a significantly shorter OS (median survival time 10.9 months for 48 patients vs 22.2 months for 137 patients, HR 2.0, 95% CI 1.3-3.0, p < 0.001). Similarly, a significant difference in median IC-PFS was noted: 4.8 months with high NLR versus 10.7 months with low NLR (HR 1.7, 95% CI 1.2-2.5, p = 0.003).</p><p><strong>Conclusions: </strong>The authors found elevated pre-SRS NLR (> 5) to be associated with shorter OS and IC-PFS after SRS with concurrent ICIs for BMs. NLR is a simple, cost-effective, and widely accessible biomarker, which can thus be used for managing patients with BMs receiving SRS concurrently with ICIs. Further investigation in other large datasets is, however, required to validate these findings.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142043970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Transsylvian transopercular peri-central core hemispherotomy for treating epilepsy: anatomy, surgical technique, and clinical outcome. 用于治疗癫痫的经颞侧经小脑周围中央核心半球切开术:解剖、手术技术和临床效果。
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-16 DOI: 10.3171/2024.4.JNS24862
Hung Tzu Wen, Márcio Luis Soares Ferreira, Davi Jorge Fontoura Solla, Luiz Henrique Martins Castro, Manoel Jacobsen Teixeira, Carlos Gilberto Carlotti

Objective: The objective of this study was to display the anatomical landmarks, surgical technique, and clinical outcome of transsylvian transopercular peri-central core hemispherotomy (TTPH) for treating refractory epilepsy.

Methods: From 2011 to 2023, 26 patients (12 with Rasmussen syndrome, 8 with hemimegalencephaly/cortical malformations, and 6 with hypoxic-ischemic encephalopathy; mean [range] age 11.3 years [16 months to 35 years]; 13 females; and 13 with right-side pathology) underwent TTPH. The mean (range) follow-up was 88 (14-156) months. The intradural surgical time, use and amount of blood transfusion, postoperative fever, hospital stay, weight at surgery, and seizure onset to surgery interval are reported.

Results: TTPH consists of 1) sylvian fissure opening, 2) coagulation of the M2 and M3 branches, 3) frontoparietal opercula removal, 4) suprainsular resection, 5) insula removal, 6) selective amygdalohippocampectomy, 7) disconnection of the posterior temporal and occipital lobes using the tentorium and falx as landmarks, 8) intraventricular callosotomy, and 9) disconnection of the basal frontal lobe. In cortical malformation, the gray-white matter interface serves as a landmark. The average intradural operating time was 7 hours 18 minutes (3 hours 33 minutes to 13 hours 45 minutes); all patients were Engel class I; and 2 patients presented with procedure-related complications (meningitis and transient abducens nerve palsy). No patient required shunt surgery or reoperation.

Conclusions: TTPH offers anatomical landmarks as intraoperative guides and has achieved good seizure control and low complication rates.

研究目的本研究旨在展示经蝶骨经小脑中央周围核心半球切开术(TTPH)治疗难治性癫痫的解剖标志、手术技巧和临床疗效:从2011年到2023年,26名患者(12名患有拉斯穆森综合征,8名患有大脑半球/皮质畸形,6名患有缺氧缺血性脑病;平均年龄[范围]11.3岁[16个月到35岁];13名女性;13名患有右侧病变)接受了TTPH手术。平均(范围内)随访 88(14-156)个月。报告了硬膜外手术时间、输血次数和输血量、术后发热、住院时间、手术时体重以及癫痫发作到手术的间隔时间:TTPH包括:1)颅裂开放;2)M2和M3分支凝固;3)额顶叶厣切除;4)上脑室切除;5)岛叶切除;6)选择性杏仁核切除;7)以触角和镰为标志断开后颞叶和枕叶;8)脑室内胼胝体切开;9)断开额叶基底。在皮质畸形中,以灰白质界面为标志。硬脑膜内手术的平均时间为 7 小时 18 分钟(3 小时 33 分钟至 13 小时 45 分钟);所有患者均为恩格尔 I 级;2 名患者出现了与手术相关的并发症(脑膜炎和一过性外展神经麻痹)。没有患者需要进行分流手术或再次手术:TTPH提供了解剖标志作为术中指导,并实现了良好的癫痫控制和较低的并发症发生率。
{"title":"Transsylvian transopercular peri-central core hemispherotomy for treating epilepsy: anatomy, surgical technique, and clinical outcome.","authors":"Hung Tzu Wen, Márcio Luis Soares Ferreira, Davi Jorge Fontoura Solla, Luiz Henrique Martins Castro, Manoel Jacobsen Teixeira, Carlos Gilberto Carlotti","doi":"10.3171/2024.4.JNS24862","DOIUrl":"https://doi.org/10.3171/2024.4.JNS24862","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to display the anatomical landmarks, surgical technique, and clinical outcome of transsylvian transopercular peri-central core hemispherotomy (TTPH) for treating refractory epilepsy.</p><p><strong>Methods: </strong>From 2011 to 2023, 26 patients (12 with Rasmussen syndrome, 8 with hemimegalencephaly/cortical malformations, and 6 with hypoxic-ischemic encephalopathy; mean [range] age 11.3 years [16 months to 35 years]; 13 females; and 13 with right-side pathology) underwent TTPH. The mean (range) follow-up was 88 (14-156) months. The intradural surgical time, use and amount of blood transfusion, postoperative fever, hospital stay, weight at surgery, and seizure onset to surgery interval are reported.</p><p><strong>Results: </strong>TTPH consists of 1) sylvian fissure opening, 2) coagulation of the M2 and M3 branches, 3) frontoparietal opercula removal, 4) suprainsular resection, 5) insula removal, 6) selective amygdalohippocampectomy, 7) disconnection of the posterior temporal and occipital lobes using the tentorium and falx as landmarks, 8) intraventricular callosotomy, and 9) disconnection of the basal frontal lobe. In cortical malformation, the gray-white matter interface serves as a landmark. The average intradural operating time was 7 hours 18 minutes (3 hours 33 minutes to 13 hours 45 minutes); all patients were Engel class I; and 2 patients presented with procedure-related complications (meningitis and transient abducens nerve palsy). No patient required shunt surgery or reoperation.</p><p><strong>Conclusions: </strong>TTPH offers anatomical landmarks as intraoperative guides and has achieved good seizure control and low complication rates.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Assessing superficial temporal artery-middle cerebral artery anastomosis patency using FLOW 800 hemodynamics. 利用 FLOW 800 血液动力学评估颞浅动脉-大脑中动脉吻合术的通畅性。
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-16 DOI: 10.3171/2024.4.JNS24713
Karl L Sangwon, Matthew Nguyen, Daniel D Wiggan, Bruck Negash, Daniel A Alber, Xujin Chris Liu, Albert Liu, Corinne Rabbin-Birnbaum, Vera Sharashidze, Jacob Baranoski, Eytan Raz, Maksim Shapiro, Caleb Rutledge, Peter Kim Nelson, Howard Riina, Jonathan Russin, Eric K Oermann, Erez Nossek

Objective: The objective of this study was to investigate the use of indocyanine green videoangiography with FLOW 800 hemodynamic parameters intraoperatively during superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery to predict patency prior to anastomosis performance.

Methods: A retrospective and exploratory data analysis was conducted using FLOW 800 software prior to anastomosis to assess four regions of interest (ROIs; proximal and distal recipients and adjacent and remote gyri) for four hemodynamic parameters (speed, delay, rise time, and time to peak). Medical records were used to classify patients into flow and no-flow groups based on immediate or perioperative anastomosis patency. Hemodynamic parameters were compared using univariate and multivariate analyses. Principal component analysis was used to identify high risk of no flow (HRnf) and low risk of no flow (LRnf) groups, correlated with prospective angiographic follow-ups. Machine learning models were fitted to predict patency using FLOW 800 features, and the a posteriori effect of complication risk of those features was computed.

Results: A total of 39 cases underwent STA-MCA bypass surgery with complete FLOW 800 data collection. Thirty-five cases demonstrated flow after anastomosis revascularization and were compared with 4 cases with no flow after revascularization. Proximal and distal recipient speeds were significantly different between the no-flow and flow groups (proximal: 238.3 ± 120.8 and 138.5 ± 93.6, respectively [p < 0.001]; distal: 241.0 ± 117.0 and 142.1 ± 103.8, respectively [p < 0.05]). Based on principal component analysis, the HRnf group (n = 10) was characterized by high-flow speed (> 75th percentile) in all ROIs, whereas the LRnf group (n = 10) had contrasting patterns. In prospective long-term follow-up, 6 of 9 cases in the HRnf group, including the original no-flow cases, had no or low flow, whereas 8 of 8 cases in the LRnf group maintained robust flow. Machine learning models predicted patency failure with a mean F1 score of 0.930 and consistently relied on proximal recipient speed as the most important feature. Computation of posterior likelihood showed a 95.29% chance of patients having long-term patency given a lower proximal speed.

Conclusions: These results suggest that a high proximal speed measured in the recipient vessel prior to anastomosis can elevate the risk of perioperative no flow and long-term reduction of flow. With an increased dataset size, continued FLOW 800-based ROI metric analysis could be used to guide intraoperative anastomosis site selection prior to anastomosis and predict patency outcome.

研究目的本研究旨在探讨在颞浅动脉-大脑中动脉(STA-MCA)搭桥手术中,术中使用吲哚青绿视频血管造影和 FLOW 800 血流动力学参数来预测吻合术前的通畅情况:方法: 在吻合术前使用 FLOW 800 软件进行了一项回顾性和探索性数据分析,以评估四个感兴趣区(ROI;近端和远端受体以及邻近和远端回旋)的四个血液动力学参数(速度、延迟、上升时间和达到峰值的时间)。根据即时或围术期吻合口通畅情况,利用病历将患者分为有血流组和无血流组。使用单变量和多变量分析比较血液动力学参数。主成分分析用于识别无血流高风险组(HRnf)和无血流低风险组(LRnf),并与前瞻性血管造影随访相关联。利用FLOW 800特征拟合机器学习模型预测通畅率,并计算这些特征对并发症风险的后验效应:结果:共有 39 例患者接受了 STA-MCA 搭桥手术,并收集了完整的 FLOW 800 数据。35例在吻合口血管再通后出现血流,与4例在血管再通后无血流的病例进行了比较。无血流组和有血流组的近端和远端受体速度有显著差异(近端:分别为 238.3 ± 120.8 和 138.5 ± 93.6 [p < 0.001];远端:分别为 241.0 ± 117.0 和 142.1 ± 103.8 [p < 0.05])。根据主成分分析,HRnf 组(n = 10)在所有 ROI 中都具有高流速(> 75 百分位数)的特征,而 LRnf 组(n = 10)则具有相反的模式。在前瞻性长期随访中,HRnf 组的 9 个病例中有 6 个(包括原来的无血流病例)没有血流或血流较低,而 LRnf 组的 8 个病例中有 8 个保持了强劲的血流。机器学习模型预测通畅失败的平均 F1 得分为 0.930,并始终将近端受体速度作为最重要的特征。后验可能性计算显示,如果近端速度较低,患者长期通畅的几率为 95.29%:这些结果表明,吻合前在受体血管中测量到的高近端速度会增加围术期无血流和长期血流减少的风险。随着数据集规模的扩大,基于 FLOW 800 的持续 ROI 指标分析可用于指导吻合术前术中吻合部位的选择并预测通畅结果。
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引用次数: 0
Core outcomes in nerve surgery: development of a core outcome set for common peroneal (fibular) neuropathy. 神经外科核心成果:腓总神经病变核心成果集的开发。
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-16 DOI: 10.3171/2024.5.JNS24614
Thomas J Wilson, Zarina S Ali, Gavin A Davis, Nora F Dengler, Ketan Desai, Debora Garozzo, Fernando Guedes, Megan M Jack, Line G Jacques, Thomas Kretschmer, Mark A Mahan, Rajiv Midha, Willem Pondaag, Ross C Puffer, Lukas Rasulic, Wilson Z Ray, Elias Rizk, Carlos A Rodriguez-Aceves, Yuval Shapira, Brandon W Smith, Mariano Socolovsky, Robert J Spinner, Eric L Zager

Objective: Common peroneal (fibular) neuropathy is the most common mononeuropathy of the lower extremity. Despite this, there are surprisingly few studies on the topic, and a knowledge gap remains in the literature. As one attempts to address this knowledge gap, a core outcome set (COS) is needed to guide the planning phases of future studies to allow synthesis and comparability of these studies. The objective of this study was to develop the COS-common peroneal neuropathy (CoPe) using a modified Delphi approach.

Methods: A 5-stage approach was used to develop the COS-CoPe: 1) stage 1, consortium development; 2) stage 2, a literature review to identify potential outcome measures; 3) stage 3, a Delphi survey to develop consensus on outcomes for inclusion; 4) stage 4, a Delphi survey to develop definitions; and 5) stage 5, a consensus meeting to finalize COS and definitions. The study followed the COS-STAndards for Development (COS-STAD) recommendations.

Results: The Core Outcomes in Nerve Surgery (COINS) Consortium comprised 23 participants, all neurological surgeons, representing 13 countries. The final COS-CoPe consisted of 31 data points/outcomes covering domains of demographics, diagnostics, patient-reported outcomes, motor/sensory outcomes, and complications. Appropriate instruments, methods of testing, and definitions were set. The consensus minimum duration of follow-up was 12 months. The consensus optimal time points for assessment were preoperatively and 3, 6, 12, and 24 months postoperatively.

Conclusions: The COINS Consortium developed a consensus COS and provided definitions, methods of implementation, and time points for assessment. The COS-CoPe should serve as a minimum set of data that should be collected in all future neurosurgical studies on common peroneal neuropathy. Incorporation of this COS should help improve consistency in reporting, data synthesis, and comparability, and should minimize outcome reporting bias.

目的:腓总神经病是下肢最常见的单神经病:腓总神经病是下肢最常见的单神经病。尽管如此,有关该主题的研究却少得令人吃惊,文献中仍然存在知识空白。为了填补这一知识空白,我们需要一个核心结果集(COS)来指导未来研究的规划阶段,以便对这些研究进行综合和比较。本研究的目的是采用改良的德尔菲法制定 COS--常见腓总神经病(CoPe):方法:采用 5 个阶段的方法来开发 COS-CoPe:1) 第 1 阶段,联合开发;2) 第 2 阶段,文献综述,确定潜在的结果测量指标;3) 第 3 阶段,德尔菲调查,就纳入的结果达成共识;4) 第 4 阶段,德尔菲调查,制定定义;5) 第 5 阶段,共识会议,最终确定 COS 和定义。该研究遵循了 COS-STA 标准发展(COS-STAD)的建议:神经外科核心结果(COINS)联盟由 23 名参与者组成,他们都是神经外科医生,代表 13 个国家。最终的 COS-CoPe 包括 31 个数据点/结果,涵盖人口统计学、诊断学、患者报告结果、运动/感觉结果和并发症等领域。制定了适当的工具、检测方法和定义。一致同意最短随访时间为 12 个月。一致同意的最佳评估时间点为术前、术后 3、6、12 和 24 个月:COINS 联合会制定了共识 COS,并提供了定义、实施方法和评估时间点。COS-CoPe应作为今后所有有关腓总神经病变的神经外科研究应收集的最低数据集。纳入该 COS 应有助于提高报告、数据综合和可比性的一致性,并应最大限度地减少结果报告的偏差。
{"title":"Core outcomes in nerve surgery: development of a core outcome set for common peroneal (fibular) neuropathy.","authors":"Thomas J Wilson, Zarina S Ali, Gavin A Davis, Nora F Dengler, Ketan Desai, Debora Garozzo, Fernando Guedes, Megan M Jack, Line G Jacques, Thomas Kretschmer, Mark A Mahan, Rajiv Midha, Willem Pondaag, Ross C Puffer, Lukas Rasulic, Wilson Z Ray, Elias Rizk, Carlos A Rodriguez-Aceves, Yuval Shapira, Brandon W Smith, Mariano Socolovsky, Robert J Spinner, Eric L Zager","doi":"10.3171/2024.5.JNS24614","DOIUrl":"https://doi.org/10.3171/2024.5.JNS24614","url":null,"abstract":"<p><strong>Objective: </strong>Common peroneal (fibular) neuropathy is the most common mononeuropathy of the lower extremity. Despite this, there are surprisingly few studies on the topic, and a knowledge gap remains in the literature. As one attempts to address this knowledge gap, a core outcome set (COS) is needed to guide the planning phases of future studies to allow synthesis and comparability of these studies. The objective of this study was to develop the COS-common peroneal neuropathy (CoPe) using a modified Delphi approach.</p><p><strong>Methods: </strong>A 5-stage approach was used to develop the COS-CoPe: 1) stage 1, consortium development; 2) stage 2, a literature review to identify potential outcome measures; 3) stage 3, a Delphi survey to develop consensus on outcomes for inclusion; 4) stage 4, a Delphi survey to develop definitions; and 5) stage 5, a consensus meeting to finalize COS and definitions. The study followed the COS-STAndards for Development (COS-STAD) recommendations.</p><p><strong>Results: </strong>The Core Outcomes in Nerve Surgery (COINS) Consortium comprised 23 participants, all neurological surgeons, representing 13 countries. The final COS-CoPe consisted of 31 data points/outcomes covering domains of demographics, diagnostics, patient-reported outcomes, motor/sensory outcomes, and complications. Appropriate instruments, methods of testing, and definitions were set. The consensus minimum duration of follow-up was 12 months. The consensus optimal time points for assessment were preoperatively and 3, 6, 12, and 24 months postoperatively.</p><p><strong>Conclusions: </strong>The COINS Consortium developed a consensus COS and provided definitions, methods of implementation, and time points for assessment. The COS-CoPe should serve as a minimum set of data that should be collected in all future neurosurgical studies on common peroneal neuropathy. Incorporation of this COS should help improve consistency in reporting, data synthesis, and comparability, and should minimize outcome reporting bias.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Letter to the Editor. Tegmental tracts as key individual components from the medial forebrain bundle. 致编辑的信。被盖束是内侧前脑束的关键组成部分
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-16 DOI: 10.3171/2024.5.JNS241090
Alexandra Ramos-Márquez, Teo N Campo-Puerto, Diego Gómez-Amarillo, Fernando Hakim, Edgar G Ordóñez-Rubiano
{"title":"Letter to the Editor. Tegmental tracts as key individual components from the medial forebrain bundle.","authors":"Alexandra Ramos-Márquez, Teo N Campo-Puerto, Diego Gómez-Amarillo, Fernando Hakim, Edgar G Ordóñez-Rubiano","doi":"10.3171/2024.5.JNS241090","DOIUrl":"10.3171/2024.5.JNS241090","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1447-1449"},"PeriodicalIF":3.5,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
期刊
Journal of neurosurgery
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