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Measurement of CSF flow and brain motion in Chiari malformation type I subjects undergoing posterior fossa decompression surgery.
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-07 DOI: 10.3171/2024.11.JNS241509
Grace McIlvain, Brice Williams, Mohamad Motaz Al Samman, Saeed Mohsenian, Daniel L Barrow, Francis Loth, John N Oshinski

Objective: Radiologically, Chiari malformation type I (CM-I) is characterized by cerebellar tonsil herniation of at least 5 mm through the foramen magnum. In symptomatic cases, posterior fossa decompression (PFD) surgery is often performed and improves symptoms in approximately 75% of patients. However, the surgery involves risks, and identifying which candidates will benefit from surgery is important. It has previously been shown that the amount of tonsillar descent does not correlate with symptom severity or surgical outcomes. The authors hypothesized that using advanced neuroimaging methods to directly measure CSF flow and brain motion will give insights regarding which patients have the greatest likelihood of cerebral dynamic improvements from surgery.

Methods: Here, the authors evaluated 108 CM-I patients (age 19-70 years), 61 of whom underwent PFD surgery. The authors used phase-contrast MRI to measure CSF flow/stroke volume and cine displacement encoding with stimulated echoes (DENSE) imaging to measure brain motion, with a goal to predict postsurgical cerebral dynamic improvements from presurgical images.

Results: The authors found that CSF stroke volume increased after PFD surgery by 28.9% (p = 0.014), brainstem motion decreased after surgery by 17.3% (p = 0.002), and cerebellum motion decreased 45.2% (p < 0.001). Notably, the amount of CSF flow increase after surgery had no relationship to tonsillar descent (R = 0.059, p = 0.767) but did relate to the amount of presurgical CSF flow (R = -0.518, p = 0.005). Likewise, improvements to brain motion were better predicted by the amount of presurgical motion (brainstem, R = -0.638, p < 0.001; cerebellum, R = -0.878, p < 0.001) than by tonsillar descent (brainstem, R = -0.312, p = 0.093; cerebellum, R = -0.620, p < 0.001).

Conclusions: Here, the authors found that presurgical measures of cerebral dynamics were more descriptive of improvements to CSF flow and brain motion after PFD surgery than the conventional measure of presurgical tonsillar descent. These expanded quantitative assessments to determine which patients may benefit from surgery could improve the overall quality of patient care.

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引用次数: 0
The efficacy of combining pulsed radiofrequency with low-temperature continuous radiofrequency for the treatment of primary trigeminal neuralgia: a randomized controlled trial.
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-07 DOI: 10.3171/2024.10.JNS241274
Chunmei Zhao, Hao Ren, Niti Shrestha, Lan Meng, Ying Shen, Fang Luo

Objective: Pulsed radiofrequency (PRF) combined with low-temperature continuous radiofrequency (CRF) might be a novel technique for relieving trigeminal neuralgia (TN). This study aimed to evaluate the efficacy and safety of high-voltage PRF combined with low-temperature CRF in primary TN.

Methods: This randomized controlled trial was performed between December 2, 2020, and October 26, 2022. Eligible patients with TN were randomly assigned at a 1:1 ratio to receive either PRF with a voltage of 70 V at 42°C for 600 seconds followed by CRF at 60°C for 270 seconds (PRF+CRF group) or PRF with a voltage of 70 V at 42°C for 600 seconds (PRF group). The primary outcome was the response rate to treatment after 12 months. The secondary outcomes were the proportion of responders at 1 day, 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months following the procedure and the 11-point numeric rating scale (NRS) scores at 1 day, 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months following the procedure. Adverse events associated with surgery were also observed.

Results: A total of 169 patients with TN were screened, and 146 patients were randomized. The groups were well balanced across baseline characteristics. The percentage of responders at 12 months after surgery was significantly greater in the PRF+CRF group compared with the PRF group (83.6% [61/73] vs 67.1% [49/73], risk ratio 1.2 [95% CI 1.0-1.5], absolute difference 16.5%; p = 0.021). There was a higher proportion of responders after 1 day, 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months (ratio difference 16.5%, 35.6%, 16.4%, 12.3%, 12.3%, 12.3%, and 15.1%, respectively; all p < 0.05). Moreover, lower NRS scores were observed in the PRF+CRF group at 1 day, 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months following the procedure (all p < 0.05). Postoperative facial numbness scores were higher in the PRF+CRF group at 1 day, 1 week, 2 weeks, 1 month, and 2 months (all p < 0.05). Overall, 5.5% of patients in the PRF+CRF group and no patients in the PRF group reported masseter muscle weakening. No other complications, such as anesthesia dolorosa and corneal anesthesia, were observed in either group.

Conclusions: High-voltage PRF combined with low-temperature (60°C) CRF could provide a significant improvement compared with high-voltage PRF alone. Clinical trial registration no.: NCT04174443 (ClinicalTrials.gov).

{"title":"The efficacy of combining pulsed radiofrequency with low-temperature continuous radiofrequency for the treatment of primary trigeminal neuralgia: a randomized controlled trial.","authors":"Chunmei Zhao, Hao Ren, Niti Shrestha, Lan Meng, Ying Shen, Fang Luo","doi":"10.3171/2024.10.JNS241274","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241274","url":null,"abstract":"<p><strong>Objective: </strong>Pulsed radiofrequency (PRF) combined with low-temperature continuous radiofrequency (CRF) might be a novel technique for relieving trigeminal neuralgia (TN). This study aimed to evaluate the efficacy and safety of high-voltage PRF combined with low-temperature CRF in primary TN.</p><p><strong>Methods: </strong>This randomized controlled trial was performed between December 2, 2020, and October 26, 2022. Eligible patients with TN were randomly assigned at a 1:1 ratio to receive either PRF with a voltage of 70 V at 42°C for 600 seconds followed by CRF at 60°C for 270 seconds (PRF+CRF group) or PRF with a voltage of 70 V at 42°C for 600 seconds (PRF group). The primary outcome was the response rate to treatment after 12 months. The secondary outcomes were the proportion of responders at 1 day, 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months following the procedure and the 11-point numeric rating scale (NRS) scores at 1 day, 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months following the procedure. Adverse events associated with surgery were also observed.</p><p><strong>Results: </strong>A total of 169 patients with TN were screened, and 146 patients were randomized. The groups were well balanced across baseline characteristics. The percentage of responders at 12 months after surgery was significantly greater in the PRF+CRF group compared with the PRF group (83.6% [61/73] vs 67.1% [49/73], risk ratio 1.2 [95% CI 1.0-1.5], absolute difference 16.5%; p = 0.021). There was a higher proportion of responders after 1 day, 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months (ratio difference 16.5%, 35.6%, 16.4%, 12.3%, 12.3%, 12.3%, and 15.1%, respectively; all p < 0.05). Moreover, lower NRS scores were observed in the PRF+CRF group at 1 day, 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months following the procedure (all p < 0.05). Postoperative facial numbness scores were higher in the PRF+CRF group at 1 day, 1 week, 2 weeks, 1 month, and 2 months (all p < 0.05). Overall, 5.5% of patients in the PRF+CRF group and no patients in the PRF group reported masseter muscle weakening. No other complications, such as anesthesia dolorosa and corneal anesthesia, were observed in either group.</p><p><strong>Conclusions: </strong>High-voltage PRF combined with low-temperature (60°C) CRF could provide a significant improvement compared with high-voltage PRF alone. Clinical trial registration no.: NCT04174443 (ClinicalTrials.gov).</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575881","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. Endoscopic transorbital approaches: the lateral orbital rim trade-off.
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-07 DOI: 10.3171/2024.10.JNS242554
Sergio Corvino
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引用次数: 0
Predictors of dural venous sinus pressure gradient in patients with idiopathic intracranial hypertension.
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-07 DOI: 10.3171/2024.10.JNS241749
Arbaz A Momin, Basel Musmar, Kareem El Naamani, Nikolaos Mouchtouris, Dwight Mitchell Self, Matthews Lan, Keenan Piper, Caitlin Ritz, Stavropoula I Tjoumakaris, Pascal M Jabbour, M Reid Gooch

Objective: Growing evidence suggests that venous outflow obstruction from venous sinus stenosis (VSS) may lead to increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH). There is a paucity of evidence examining clinical predictors of elevated cerebral venous pressure gradient (CVPG) from VSS in patients with IIH. In this study, the authors examined predictors of elevated CVPG, determined the sensitivity and specificity of common presenting symptoms of IIH, and identified the optimal opening pressure threshold on lumbar puncture (LP) to determine which patients should undergo venous manometry (VM).

Methods: Patient demographics, presenting symptoms, complications, and opening pressure on LP were collected. Venous pressure gradient across a stenotic dural venous sinus and maximum venous pressure values were recorded from cerebral venograms. VM was considered positive when the CVPG was ≥ 8 mm Hg between two contiguous segments of a dural venous sinus. Sensitivity, specificity, and multivariable logistic regression analysis was performed.

Results: The predominant patient population was young (mean age 38.9 years), obese (BMI ≥ 30; 83.8%), and female (95.0%). Sensitivity and specificity for papilledema were 74% and 70% (area under the curve [AUC] 0.71, 95% CI 0.63-0.80), and 70% and 63% (AUC 0.66, 95% CI 0.57-0.75) for pulsatile tinnitus. Vision changes demonstrated a sensitivity of 80% and specificity of 50% (AUC 0.63, 95% CI 0.54-0.72). VSS seen on magnetic resonance venography (MRV) demonstrated a sensitivity of 90% and specificity of 53% (AUC 0.71, 95% CI 0.63-0.79). Youden's index analysis identified an opening pressure ≥ 25 cm H2O on LP (AUC 0.72, 95% CI 0.60-0.83) as an optimal threshold for predicting elevated CVPG.

Conclusions: Predictors of elevated CVPG on VM include childbearing age, African American race, papilledema, pulsatile tinnitus, obesity (BMI ≥ 30), focal VSS with unilateral dominance in venous drainage seen on MRV, or an opening pressure on LP ≥ 25 cm H2O.

{"title":"Predictors of dural venous sinus pressure gradient in patients with idiopathic intracranial hypertension.","authors":"Arbaz A Momin, Basel Musmar, Kareem El Naamani, Nikolaos Mouchtouris, Dwight Mitchell Self, Matthews Lan, Keenan Piper, Caitlin Ritz, Stavropoula I Tjoumakaris, Pascal M Jabbour, M Reid Gooch","doi":"10.3171/2024.10.JNS241749","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241749","url":null,"abstract":"<p><strong>Objective: </strong>Growing evidence suggests that venous outflow obstruction from venous sinus stenosis (VSS) may lead to increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH). There is a paucity of evidence examining clinical predictors of elevated cerebral venous pressure gradient (CVPG) from VSS in patients with IIH. In this study, the authors examined predictors of elevated CVPG, determined the sensitivity and specificity of common presenting symptoms of IIH, and identified the optimal opening pressure threshold on lumbar puncture (LP) to determine which patients should undergo venous manometry (VM).</p><p><strong>Methods: </strong>Patient demographics, presenting symptoms, complications, and opening pressure on LP were collected. Venous pressure gradient across a stenotic dural venous sinus and maximum venous pressure values were recorded from cerebral venograms. VM was considered positive when the CVPG was ≥ 8 mm Hg between two contiguous segments of a dural venous sinus. Sensitivity, specificity, and multivariable logistic regression analysis was performed.</p><p><strong>Results: </strong>The predominant patient population was young (mean age 38.9 years), obese (BMI ≥ 30; 83.8%), and female (95.0%). Sensitivity and specificity for papilledema were 74% and 70% (area under the curve [AUC] 0.71, 95% CI 0.63-0.80), and 70% and 63% (AUC 0.66, 95% CI 0.57-0.75) for pulsatile tinnitus. Vision changes demonstrated a sensitivity of 80% and specificity of 50% (AUC 0.63, 95% CI 0.54-0.72). VSS seen on magnetic resonance venography (MRV) demonstrated a sensitivity of 90% and specificity of 53% (AUC 0.71, 95% CI 0.63-0.79). Youden's index analysis identified an opening pressure ≥ 25 cm H2O on LP (AUC 0.72, 95% CI 0.60-0.83) as an optimal threshold for predicting elevated CVPG.</p><p><strong>Conclusions: </strong>Predictors of elevated CVPG on VM include childbearing age, African American race, papilledema, pulsatile tinnitus, obesity (BMI ≥ 30), focal VSS with unilateral dominance in venous drainage seen on MRV, or an opening pressure on LP ≥ 25 cm H2O.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575879","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. A revision of the classic high-, moderate-, and low-contact sport categorization of risk for head and neck injuries. 致编辑的信。修订经典的高、中、低接触运动头颈部受伤风险分类。
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-07 DOI: 10.3171/2024.12.JNS242524
Scott L Zuckerman, Grant H Rigney, Jacob Jo, Allen K Sills, David O Okonkwo, Nicholas Theodore, Gavin A Davis
{"title":"Letter to the Editor. A revision of the classic high-, moderate-, and low-contact sport categorization of risk for head and neck injuries.","authors":"Scott L Zuckerman, Grant H Rigney, Jacob Jo, Allen K Sills, David O Okonkwo, Nicholas Theodore, Gavin A Davis","doi":"10.3171/2024.12.JNS242524","DOIUrl":"https://doi.org/10.3171/2024.12.JNS242524","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575860","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
Deep learning-based segmentation of the trigeminal nerve and surrounding vasculature in trigeminal neuralgia.
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-07 DOI: 10.3171/2024.10.JNS241060
Kyra M Halbert-Elliott, Michael E Xie, Bryan Dong, Oishika Das, Xihang Wang, Christopher M Jackson, Michael Lim, Judy Huang, Vivek S Yedavalli, Chetan Bettegowda, Risheng Xu

Objective: Preoperative workup of trigeminal neuralgia (TN) consists of identification of neurovascular features on MRI. In this study, the authors apply and evaluate the performance of deep learning models for segmentation of the trigeminal nerve and surrounding vasculature to quantify anatomical features of the nerve and vessels.

Methods: Six U-Net-based neural networks, each with a different encoder backbone, were trained to label constructive interference in steady-state MRI voxels as nerve, vasculature, or background. A retrospective dataset of 50 TN patients at the authors' institution who underwent preoperative high-resolution MRI in 2022 was utilized to train and test the models. Performance was measured by the Dice coefficient and intersection over union (IoU) metrics. Anatomical characteristics, such as surface area of neurovascular contact and distance to the contact point, were computed and compared between the predicted and ground truth segmentations.

Results: Of the evaluated models, the best performing was U-Net with an SE-ResNet50 backbone (Dice score = 0.775 ± 0.015, IoU score = 0.681 ± 0.015). When the SE-ResNet50 backbone was used, the average surface area of neurovascular contact in the testing dataset was 6.90 mm2, which was not significantly different from the surface area calculated from manual segmentation (p = 0.83). The average calculated distance from the brainstem to the contact point was 4.34 mm, which was also not significantly different from manual segmentation (p = 0.29).

Conclusions: U-Net-based neural networks perform well for segmenting trigeminal nerve and vessels from preoperative MRI volumes. This technology enables the development of quantitative and objective metrics for radiographic evaluation of TN.

{"title":"Deep learning-based segmentation of the trigeminal nerve and surrounding vasculature in trigeminal neuralgia.","authors":"Kyra M Halbert-Elliott, Michael E Xie, Bryan Dong, Oishika Das, Xihang Wang, Christopher M Jackson, Michael Lim, Judy Huang, Vivek S Yedavalli, Chetan Bettegowda, Risheng Xu","doi":"10.3171/2024.10.JNS241060","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241060","url":null,"abstract":"<p><strong>Objective: </strong>Preoperative workup of trigeminal neuralgia (TN) consists of identification of neurovascular features on MRI. In this study, the authors apply and evaluate the performance of deep learning models for segmentation of the trigeminal nerve and surrounding vasculature to quantify anatomical features of the nerve and vessels.</p><p><strong>Methods: </strong>Six U-Net-based neural networks, each with a different encoder backbone, were trained to label constructive interference in steady-state MRI voxels as nerve, vasculature, or background. A retrospective dataset of 50 TN patients at the authors' institution who underwent preoperative high-resolution MRI in 2022 was utilized to train and test the models. Performance was measured by the Dice coefficient and intersection over union (IoU) metrics. Anatomical characteristics, such as surface area of neurovascular contact and distance to the contact point, were computed and compared between the predicted and ground truth segmentations.</p><p><strong>Results: </strong>Of the evaluated models, the best performing was U-Net with an SE-ResNet50 backbone (Dice score = 0.775 ± 0.015, IoU score = 0.681 ± 0.015). When the SE-ResNet50 backbone was used, the average surface area of neurovascular contact in the testing dataset was 6.90 mm2, which was not significantly different from the surface area calculated from manual segmentation (p = 0.83). The average calculated distance from the brainstem to the contact point was 4.34 mm, which was also not significantly different from manual segmentation (p = 0.29).</p><p><strong>Conclusions: </strong>U-Net-based neural networks perform well for segmenting trigeminal nerve and vessels from preoperative MRI volumes. This technology enables the development of quantitative and objective metrics for radiographic evaluation of TN.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575852","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
Effect of deep brain stimulation on nonmotor symptoms in essential tremor.
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-07 DOI: 10.3171/2024.11.JNS241990
Anthony E Bishay, Alexander T Lyons, Daniel R S Habib, Natasha C Hughes, Isabel Long, Michael Zargari, Helen Qian, Danika Paulo, Jessica E Summers, Rui Li, Steven Bishay, Douglas P Terry, Benoit M Dawant, Tyler J Ball, Peter E Konrad, Dario J Englot, Kaltra Dhima, Sarah K Bick

Objective: Essential tremor (ET) is a prevalent movement disorder that also includes nonmotor symptoms such as anxiety, depression, and cognitive impairment. Deep brain stimulation (DBS) is an established treatment for ET, yet its impact on nonmotor symptoms remains unclear. This study aims to describe neuropsychological outcomes following ventral intermediate nucleus (VIM) DBS in a large cohort of patients with ET and identify factors associated with changes in depression and cognitive function.

Methods: A retrospective cohort study of patients who had undergone VIM DBS was performed. Inclusion criteria were ET diagnosis, surgery between October 2007 and March 2020, and available pre- and post-DBS neuropsychological testing results. Neuropsychological measures included the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and cognitive measures assessing attention, executive function, language, memory, and visuospatial function. Post-DBS tremor improvement was graded, and active electrode coordinates and stimulation parameters were identified. Statistical analyses included descriptive statistics, t-tests to compare pre- and postoperative scores at the group level, and one-way analysis of variance to compare variables among patients who improved, were stable, or worsened in psychiatric and cognitive characteristics after DBS.

Results: One hundred thirty-nine patients met the study inclusion criteria. BDI-II scores significantly decreased postoperatively (9.82 ± 6.77 vs 8.29 ± 6.18, p < 0.001, Cohen's d = 0.176), whereas BAI scores remained unchanged. Both language (p = 0.003, Cohen's d = 0.259) and memory (p < 0.001, Cohen's d = 0.336) domains showed statistically significant small-magnitude declines following surgery, whereas attention, executive function, and visuospatial function were unchanged. Patients with improved depression (14.3%) following VIM DBS had significantly higher BDI-II scores preoperatively (p < 0.001, ω2 = 0.226). Patients with worsened language (18.7%) had higher preoperative language scores (p < 0.001, ω2 = 0.058). Patients with worsened memory (15.1%) had higher BAI scores preoperatively (p = 0.002, ω2 = 0.079). Preoperative scores were similar between patients with improved and worsened overall cognition postsurgery. Patients with improved overall cognition had improvements in attention, language, and visuospatial function.

Conclusions: VIM DBS for ET did not result in large-magnitude neuropsychological changes. There were statistically significant, though likely not clinically meaningful, small-magnitude improvements in depression and worsening in language and memory scores. Associations were found between multiple preoperative mood and cognitive scores and post-DBS neuropsychological changes. These findings can help inform clinical decision-making and patient counseling for DBS.

{"title":"Effect of deep brain stimulation on nonmotor symptoms in essential tremor.","authors":"Anthony E Bishay, Alexander T Lyons, Daniel R S Habib, Natasha C Hughes, Isabel Long, Michael Zargari, Helen Qian, Danika Paulo, Jessica E Summers, Rui Li, Steven Bishay, Douglas P Terry, Benoit M Dawant, Tyler J Ball, Peter E Konrad, Dario J Englot, Kaltra Dhima, Sarah K Bick","doi":"10.3171/2024.11.JNS241990","DOIUrl":"https://doi.org/10.3171/2024.11.JNS241990","url":null,"abstract":"<p><strong>Objective: </strong>Essential tremor (ET) is a prevalent movement disorder that also includes nonmotor symptoms such as anxiety, depression, and cognitive impairment. Deep brain stimulation (DBS) is an established treatment for ET, yet its impact on nonmotor symptoms remains unclear. This study aims to describe neuropsychological outcomes following ventral intermediate nucleus (VIM) DBS in a large cohort of patients with ET and identify factors associated with changes in depression and cognitive function.</p><p><strong>Methods: </strong>A retrospective cohort study of patients who had undergone VIM DBS was performed. Inclusion criteria were ET diagnosis, surgery between October 2007 and March 2020, and available pre- and post-DBS neuropsychological testing results. Neuropsychological measures included the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and cognitive measures assessing attention, executive function, language, memory, and visuospatial function. Post-DBS tremor improvement was graded, and active electrode coordinates and stimulation parameters were identified. Statistical analyses included descriptive statistics, t-tests to compare pre- and postoperative scores at the group level, and one-way analysis of variance to compare variables among patients who improved, were stable, or worsened in psychiatric and cognitive characteristics after DBS.</p><p><strong>Results: </strong>One hundred thirty-nine patients met the study inclusion criteria. BDI-II scores significantly decreased postoperatively (9.82 ± 6.77 vs 8.29 ± 6.18, p < 0.001, Cohen's d = 0.176), whereas BAI scores remained unchanged. Both language (p = 0.003, Cohen's d = 0.259) and memory (p < 0.001, Cohen's d = 0.336) domains showed statistically significant small-magnitude declines following surgery, whereas attention, executive function, and visuospatial function were unchanged. Patients with improved depression (14.3%) following VIM DBS had significantly higher BDI-II scores preoperatively (p < 0.001, ω2 = 0.226). Patients with worsened language (18.7%) had higher preoperative language scores (p < 0.001, ω2 = 0.058). Patients with worsened memory (15.1%) had higher BAI scores preoperatively (p = 0.002, ω2 = 0.079). Preoperative scores were similar between patients with improved and worsened overall cognition postsurgery. Patients with improved overall cognition had improvements in attention, language, and visuospatial function.</p><p><strong>Conclusions: </strong>VIM DBS for ET did not result in large-magnitude neuropsychological changes. There were statistically significant, though likely not clinically meaningful, small-magnitude improvements in depression and worsening in language and memory scores. Associations were found between multiple preoperative mood and cognitive scores and post-DBS neuropsychological changes. These findings can help inform clinical decision-making and patient counseling for DBS.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-15"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575854","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. The minipterional craniotomy: a versatile approach for interpeduncular lesions.
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-07 DOI: 10.3171/2024.11.JNS242880
Saul Almeida da Silva, Carlos Gilberto Carlotti, Eberval Gadelha Figueiredo
{"title":"Letter to the Editor. The minipterional craniotomy: a versatile approach for interpeduncular lesions.","authors":"Saul Almeida da Silva, Carlos Gilberto Carlotti, Eberval Gadelha Figueiredo","doi":"10.3171/2024.11.JNS242880","DOIUrl":"https://doi.org/10.3171/2024.11.JNS242880","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575874","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. Coagulopathy in TBI: the emerging role of biomarkers.
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-02-28 DOI: 10.3171/2024.11.JNS242747
Marios G Lampros, George A Alexiou, Spyridon Voulgaris
{"title":"Letter to the Editor. Coagulopathy in TBI: the emerging role of biomarkers.","authors":"Marios G Lampros, George A Alexiou, Spyridon Voulgaris","doi":"10.3171/2024.11.JNS242747","DOIUrl":"https://doi.org/10.3171/2024.11.JNS242747","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527844","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
Involved but not essential: cognitive activity in periventricular nodules and neuropsychological outcomes following their ablation.
IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-02-28 DOI: 10.3171/2024.10.JNS241541
Yosefa A Modiano, Oscar Woolnough, Ryan M McCormack, Kathryn Snyder, Ellery Wheeler, Samden D Lhatoo, Nuria Lacuey, Sandipan Pati, Katherine Harris, Jay Gavvala, Jessica A Johnson, Nitin Tandon

Objective: Periventricular nodular heterotopia (PVNH) is a malformation of cortical development with high rates of epilepsy. The extent to which nodules participate in normal cerebral functions in addition to pathological processes is unclear. The authors assessed the functional utility (i.e., cognitive impacts) of surgically ablated epileptogenic PVNH tissue via comprehensive neuropsychological testing.

Methods: The sample included 32 patients with PVNH who underwent presurgical neuropsychological evaluation and a subsample of 16 patients who underwent MR-guided laser interstitial thermal therapy (MRgLITT) of nodules, with postsurgical neuropsychological testing. In 11 patients in whom intracranial recordings were performed, reading and naming tasks were tested to determine if there was task-related activation within the nodules. Postoperative changes were assessed at the domain level and across individual tests by using reliable change indices, with consideration of spatial distribution and hemisphere of surgery as potential modifiers of postoperative change.

Results: Task-related activation during reading or naming was seen in 53% of electrodes localized within nodules that were later ablated; however, no related postsurgical language impacts were observed. No significant declines occurred following MRgLITT in any domain level z-scores. For single tests, the authors found substantial evidence in favor of the null hypothesis in 18/21 tests. Significant decline was seen only in spatial learning. A substantial association with laterality was identified in the perceptual reasoning index.

Conclusions: The functionality of PVNH tissue was evaluated by direct recordings and changes in cognitive assessments following MRgLITT ablation of epileptogenic nodules. Despite language-related activity seen in these nodules, no pattern of change was observed within any cognitive domain. The only significant decline observed was in spatial learning, whereas perceptual reasoning improved for individuals with surgery in the nondominant hemisphere. These results offer strong evidence against the role of epileptogenic PVNH in cognitive functions. This work speaks to the need for caution in assigning causality to activations seen in functional imaging without evidence from lesional methods.

目的:脑室周围结节性异位(PVNH)是一种皮质发育畸形,癫痫发病率很高。除了病理过程外,结节在多大程度上参与正常脑功能尚不清楚。作者通过综合神经心理学测试评估了手术消融的致痫性 PVNH 组织的功能效用(即对认知的影响):样本包括 32 名接受了手术前神经心理学评估的 PVNH 患者,以及 16 名接受了磁共振引导下结节激光间质热疗(MRgLITT)并接受了手术后神经心理学测试的患者。对 11 名进行了颅内记录的患者进行了阅读和命名任务测试,以确定结节内是否存在与任务相关的激活。使用可靠的变化指数评估了术后在领域水平和单项测试中的变化,并考虑了空间分布和手术半球作为术后变化的潜在调节因素:结果:在后来被消融的结节内定位的电极中,53%的电极在阅读或命名过程中出现了与任务相关的激活;但是,没有观察到相关的术后语言影响。MRgLITT 术后,任何领域的 z 分数都没有明显下降。在单项测试中,作者发现有 18/21 项测试存在支持零假设的实质性证据。只有空间学习能力出现显著下降。在感知推理指数中,发现了与侧位的实质性关联:结论:在 MRgLITT 消融致痫结节后,通过直接记录和认知评估的变化评估了 PVNH 组织的功能。尽管在这些结节中发现了与语言相关的活动,但在任何认知领域中都没有观察到变化模式。唯一观察到的明显下降是在空间学习方面,而在非优势半球进行手术的患者的感知推理能力有所提高。这些结果有力地证明了致痫性 PVNH 在认知功能中的作用。这项研究表明,在没有病变方法证据的情况下,对功能成像中的激活进行因果关系归因需要谨慎。
{"title":"Involved but not essential: cognitive activity in periventricular nodules and neuropsychological outcomes following their ablation.","authors":"Yosefa A Modiano, Oscar Woolnough, Ryan M McCormack, Kathryn Snyder, Ellery Wheeler, Samden D Lhatoo, Nuria Lacuey, Sandipan Pati, Katherine Harris, Jay Gavvala, Jessica A Johnson, Nitin Tandon","doi":"10.3171/2024.10.JNS241541","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241541","url":null,"abstract":"<p><strong>Objective: </strong>Periventricular nodular heterotopia (PVNH) is a malformation of cortical development with high rates of epilepsy. The extent to which nodules participate in normal cerebral functions in addition to pathological processes is unclear. The authors assessed the functional utility (i.e., cognitive impacts) of surgically ablated epileptogenic PVNH tissue via comprehensive neuropsychological testing.</p><p><strong>Methods: </strong>The sample included 32 patients with PVNH who underwent presurgical neuropsychological evaluation and a subsample of 16 patients who underwent MR-guided laser interstitial thermal therapy (MRgLITT) of nodules, with postsurgical neuropsychological testing. In 11 patients in whom intracranial recordings were performed, reading and naming tasks were tested to determine if there was task-related activation within the nodules. Postoperative changes were assessed at the domain level and across individual tests by using reliable change indices, with consideration of spatial distribution and hemisphere of surgery as potential modifiers of postoperative change.</p><p><strong>Results: </strong>Task-related activation during reading or naming was seen in 53% of electrodes localized within nodules that were later ablated; however, no related postsurgical language impacts were observed. No significant declines occurred following MRgLITT in any domain level z-scores. For single tests, the authors found substantial evidence in favor of the null hypothesis in 18/21 tests. Significant decline was seen only in spatial learning. A substantial association with laterality was identified in the perceptual reasoning index.</p><p><strong>Conclusions: </strong>The functionality of PVNH tissue was evaluated by direct recordings and changes in cognitive assessments following MRgLITT ablation of epileptogenic nodules. Despite language-related activity seen in these nodules, no pattern of change was observed within any cognitive domain. The only significant decline observed was in spatial learning, whereas perceptual reasoning improved for individuals with surgery in the nondominant hemisphere. These results offer strong evidence against the role of epileptogenic PVNH in cognitive functions. This work speaks to the need for caution in assigning causality to activations seen in functional imaging without evidence from lesional methods.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":3.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527841","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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