Pub Date : 2025-01-24DOI: 10.3171/2024.8.JNS241079
Derek J Doss, Abhijeet Gummadavelli, Graham W Johnson, Ghassan S Makhoul, Jared S Shless, Camden E Bibro, Monica L Jacobs, Hakmook Kang, Kevin F Haas, Sarah K Bick, Douglas P Terry, Benoit M Dawant, Catie Chang, Victoria L Morgan, Dario J Englot
Objective: Epilepsy is a common neurological disease affecting nearly 1% of the global population, and temporal lobe epilepsy (TLE) is the most common type. Patients experience recurrent seizures and chronic cognitive deficits that can impact their quality of life, ability to work, and independence. These cognitive deficits often extend beyond the temporal lobe and are not well understood. It has been proposed in the extended network inhibition hypothesis that repeated spread of seizure activity to the ascending reticular activating system (ARAS) may contribute to these deficits. Disease duration has been associated with other network changes in patients with TLE, but few studies have investigated the relationship between disease duration, ARAS connectivity, and cognitive deficits in TLE. Furthermore, epilepsy surgery can result in seizure freedom and cognitive improvement in some patients, but it is unclear how the surgery affects ARAS connectivity.
Methods: Resting-state functional MRI data were collected for patients with TLE (preoperatively in 40 and postoperatively in 25), and for 40 age-matched healthy controls. Functional connectivity was computed between all regions. Functional connectivity and segregation, a graph-theory measure of network isolation, were compared across the age spectrum in patients and controls. These same measures were evaluated as a function of epilepsy duration by controlling for age using a linear model built on healthy control data.
Results: The authors found that increases in epilepsy duration were associated with greater segregation of the ARAS and decreased functional connectivity between the pedunculopontine tegmental nucleus and the frontoparietal association cortex. Furthermore, patients with impaired neurocognitive function were noted to have longer epilepsy duration and higher ARAS segregation compared to patients with spared neurocognition. After surgery, completely seizure-free patients demonstrated ARAS connectivity patterns that resembled those found in controls, whereas patients with residual seizures had persistent abnormal connectivity.
Conclusions: These findings suggest that recurrent seizures may contribute to isolation of critical subcortical activating structures, possibly impacting cognitive function. Furthermore, some ARAS functional connectivity abnormalities can be reversed if seizure freedom is achieved after epilepsy surgery. These results provide support for the extended network inhibition hypothesis, may lend insight into the progressive effect of recurrent seizures on arousal networks, and may lead to improved interventions to halt or reverse network impairments in patients with TLE.
{"title":"Impact of disease duration and surgical intervention on arousal networks in temporal lobe epilepsy.","authors":"Derek J Doss, Abhijeet Gummadavelli, Graham W Johnson, Ghassan S Makhoul, Jared S Shless, Camden E Bibro, Monica L Jacobs, Hakmook Kang, Kevin F Haas, Sarah K Bick, Douglas P Terry, Benoit M Dawant, Catie Chang, Victoria L Morgan, Dario J Englot","doi":"10.3171/2024.8.JNS241079","DOIUrl":"10.3171/2024.8.JNS241079","url":null,"abstract":"<p><strong>Objective: </strong>Epilepsy is a common neurological disease affecting nearly 1% of the global population, and temporal lobe epilepsy (TLE) is the most common type. Patients experience recurrent seizures and chronic cognitive deficits that can impact their quality of life, ability to work, and independence. These cognitive deficits often extend beyond the temporal lobe and are not well understood. It has been proposed in the extended network inhibition hypothesis that repeated spread of seizure activity to the ascending reticular activating system (ARAS) may contribute to these deficits. Disease duration has been associated with other network changes in patients with TLE, but few studies have investigated the relationship between disease duration, ARAS connectivity, and cognitive deficits in TLE. Furthermore, epilepsy surgery can result in seizure freedom and cognitive improvement in some patients, but it is unclear how the surgery affects ARAS connectivity.</p><p><strong>Methods: </strong>Resting-state functional MRI data were collected for patients with TLE (preoperatively in 40 and postoperatively in 25), and for 40 age-matched healthy controls. Functional connectivity was computed between all regions. Functional connectivity and segregation, a graph-theory measure of network isolation, were compared across the age spectrum in patients and controls. These same measures were evaluated as a function of epilepsy duration by controlling for age using a linear model built on healthy control data.</p><p><strong>Results: </strong>The authors found that increases in epilepsy duration were associated with greater segregation of the ARAS and decreased functional connectivity between the pedunculopontine tegmental nucleus and the frontoparietal association cortex. Furthermore, patients with impaired neurocognitive function were noted to have longer epilepsy duration and higher ARAS segregation compared to patients with spared neurocognition. After surgery, completely seizure-free patients demonstrated ARAS connectivity patterns that resembled those found in controls, whereas patients with residual seizures had persistent abnormal connectivity.</p><p><strong>Conclusions: </strong>These findings suggest that recurrent seizures may contribute to isolation of critical subcortical activating structures, possibly impacting cognitive function. Furthermore, some ARAS functional connectivity abnormalities can be reversed if seizure freedom is achieved after epilepsy surgery. These results provide support for the extended network inhibition hypothesis, may lend insight into the progressive effect of recurrent seizures on arousal networks, and may lead to improved interventions to halt or reverse network impairments in patients with TLE.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033434","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}
Objective: An MRI protocol for germinoma surveillance after complete remission has not been established. Moreover, the standard treatment for recurrent or refractory germinoma has not been determined. In this study, the authors explored the imaging characteristics of recurrent germinoma and discuss their institution's experience with multidisciplinary treatment of this malignancy.
Methods: The medical records of 16 patients (14 male, 2 female) with recurrent germinoma and 62 patients (52 male, 10 female) without recurrence who were treated at the authors' institution between 1989 and 2023 were retrospectively examined. Data including diagnostic imaging, tumor markers, treatment at diagnosis and recurrence, and overall survival were collected from patients' medical records and statistically analyzed.
Results: No patients with recurrence received craniospinal irradiation (CSI) as an initial therapy, and local irradiation was a significant risk factor of recurrence (p = 0.0072). The period between the start of first-line treatment and confirmation of the first recurrence ranged from 4.2 to 272 months (median 66.8 months). Among the recurrences, 13 tumors occurred outside the radiation field, including 6 cases of spinal cord/canal recurrence. One-third of patients did not exhibit elevated tumor marker levels in the serum. Fourteen patients had contrast-enhanced recurrent lesions. In the 2 patients with non-contrast-enhanced lesions, recurrence was detected by high signal intensity on diffusion-weighted imaging (DWI) and elevated tumor marker levels in CSF. Fifteen patients received chemotherapy for the first recurrence, and 14 received radiation therapy, with 9 receiving CSI. The patients who received CSI survived without further recurrence during the study period. However, the median progression-free survival and overall survival after the first recurrence among patients who did not undergo CSI were 12.2 and 37.4 months, respectively, which were shorter than those for patients treated with CSI (both p < 0.01, log-rank test).
Conclusions: Spinal MRI for surveillance in patients with recurrent germinoma, especially for those who do not receive CSI, is recommended. DWI might be useful for detecting recurrent germinoma. Aggressive treatment at the time of recurrence is crucial, and even if remission is achieved with chemotherapy, CSI for consolidation is important to prevent further recurrence.
{"title":"Imaging characteristics and treatment of recurrent germinoma.","authors":"Ryosuke Dowaki, Fumiyuki Yamasaki, Yasuyuki Kinoshita, Yosuke Watanabe, Ushio Yonezawa, Akira Taguchi, Shumpei Onishi, Iori Ozono, Nobutaka Horie","doi":"10.3171/2024.8.JNS241097","DOIUrl":"https://doi.org/10.3171/2024.8.JNS241097","url":null,"abstract":"<p><strong>Objective: </strong>An MRI protocol for germinoma surveillance after complete remission has not been established. Moreover, the standard treatment for recurrent or refractory germinoma has not been determined. In this study, the authors explored the imaging characteristics of recurrent germinoma and discuss their institution's experience with multidisciplinary treatment of this malignancy.</p><p><strong>Methods: </strong>The medical records of 16 patients (14 male, 2 female) with recurrent germinoma and 62 patients (52 male, 10 female) without recurrence who were treated at the authors' institution between 1989 and 2023 were retrospectively examined. Data including diagnostic imaging, tumor markers, treatment at diagnosis and recurrence, and overall survival were collected from patients' medical records and statistically analyzed.</p><p><strong>Results: </strong>No patients with recurrence received craniospinal irradiation (CSI) as an initial therapy, and local irradiation was a significant risk factor of recurrence (p = 0.0072). The period between the start of first-line treatment and confirmation of the first recurrence ranged from 4.2 to 272 months (median 66.8 months). Among the recurrences, 13 tumors occurred outside the radiation field, including 6 cases of spinal cord/canal recurrence. One-third of patients did not exhibit elevated tumor marker levels in the serum. Fourteen patients had contrast-enhanced recurrent lesions. In the 2 patients with non-contrast-enhanced lesions, recurrence was detected by high signal intensity on diffusion-weighted imaging (DWI) and elevated tumor marker levels in CSF. Fifteen patients received chemotherapy for the first recurrence, and 14 received radiation therapy, with 9 receiving CSI. The patients who received CSI survived without further recurrence during the study period. However, the median progression-free survival and overall survival after the first recurrence among patients who did not undergo CSI were 12.2 and 37.4 months, respectively, which were shorter than those for patients treated with CSI (both p < 0.01, log-rank test).</p><p><strong>Conclusions: </strong>Spinal MRI for surveillance in patients with recurrent germinoma, especially for those who do not receive CSI, is recommended. DWI might be useful for detecting recurrent germinoma. Aggressive treatment at the time of recurrence is crucial, and even if remission is achieved with chemotherapy, CSI for consolidation is important to prevent further recurrence.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033429","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}
Jean-Luc K Kabangu, Amanda Hernandez, Delaney Graham, John E Dugan, Sonia V Eden
Objective: This study aimed to investigate the extent of gender disparities in financial interactions between neurosurgeons and the medical device industry, examining the differences in the number, amount, and types of payments made to male and female neurosurgeons.
Methods: Utilizing data from the Centers for Medicare & Medicaid Services Open Payments database covering 2016-2022, the authors conducted a comprehensive analysis of industry payments to neurosurgeons. This methodology included univariate and multivariate analyses to examine the disparities in payments, with a focus on identifying significant differences in compensation across genders.
Results: An analysis of 24,074 industry transactions totaling $388,916,456.88 underscored pronounced gender disparities, with female neurosurgeons involved in merely 2.47% of these transactions and receiving just 0.91% of the overall financial value. The data revealed significant discrepancies in compensation between genders across all contributing companies. Male neurosurgeons engaged in a higher average number of annual transactions compared with their female counterparts (4.60 vs 2.75, p < 0.001), across various financial interactions. This included a greater participation in royalties and licenses (1.49 vs 0.31, p < 0.001), consulting fees (2.16 vs 1.63, p = 0.024), and acquisitions (0.01 vs 0.00, p = 0.006). On average, female neurosurgeons were compensated $16,303.66, starkly lower than the $75,523.20 average received by their male counterparts (p < 0.005). This gap was especially significant in royalties and licenses, where females earned an average of $5168.57 compared with $61,898.47 for males (p = 0.004). Additionally, in acquisitions, female neurosurgeons received no payments at all, whereas males averaged $2153.43 (p = 0.042). Several of these disparities remained significant even after accounting for potential confounding factors, highlighting a systematic bias in compensation and industry engagement against female neurosurgeons.
Conclusions: The study underscores a significant gender-based disparity in the financial interactions between neurosurgeons and the medical device industry. These disparities highlight the need for systemic changes to address the underlying factors contributing to inequity in compensation and industry collaboration opportunities. Implementing equitable compensation structures, mentorship programs, and inclusive policies is a crucial step toward achieving gender parity in neurosurgery and ensuring the field benefits from the diverse skills and perspectives of all its members.
目的:本研究旨在调查神经外科医生和医疗器械行业之间财务互动的性别差异程度,检查支付给男性和女性神经外科医生的数量,金额和类型的差异。方法:利用医疗保险和医疗补助服务中心开放支付数据库2016-2022年的数据,作者对神经外科医生的行业支付进行了全面分析。该方法包括单变量和多变量分析,以检查薪酬差异,重点是确定性别之间薪酬的显著差异。结果:对24,074笔行业交易的分析,总计388,916,456.88美元,强调了明显的性别差异,女性神经外科医生只参与了2.47%的交易,只获得了0.91%的整体经济价值。数据显示,在所有提供薪酬的公司中,性别之间的薪酬存在显著差异。在各种金融互动中,男性神经外科医生的年平均交易量高于女性同行(4.60 vs 2.75, p < 0.001)。这包括更多地参与版税和许可(1.49 vs 0.31, p < 0.001)、咨询费(2.16 vs 1.63, p = 0.024)和收购(0.01 vs 0.00, p = 0.006)。女性神经外科医生的平均薪酬为16,303.66美元,明显低于男性同行的平均薪酬75,523.20美元(p < 0.005)。这一差距在版税和授权方面尤为明显,女性的平均收入为5168.57美元,而男性为61889.47美元(p = 0.004)。此外,在收购中,女性神经外科医生根本没有收到任何报酬,而男性平均为2153.43美元(p = 0.042)。即使在考虑了潜在的混杂因素后,其中一些差异仍然显著,突出了对女性神经外科医生在薪酬和行业参与方面的系统性偏见。结论:该研究强调了神经外科医生和医疗器械行业之间在财务互动方面存在显著的性别差异。这些差异突出了系统变革的必要性,以解决导致薪酬和行业合作机会不平等的潜在因素。实施公平的薪酬结构、指导计划和包容性政策是实现神经外科性别平等的关键一步,并确保该领域受益于所有成员的不同技能和观点。
{"title":"Gender disparities in industry payments to neurosurgeons: a comprehensive analysis of Centers for Medicare & Medicaid Services Open Payments data (2016-2022).","authors":"Jean-Luc K Kabangu, Amanda Hernandez, Delaney Graham, John E Dugan, Sonia V Eden","doi":"10.3171/2024.8.JNS24792","DOIUrl":"https://doi.org/10.3171/2024.8.JNS24792","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the extent of gender disparities in financial interactions between neurosurgeons and the medical device industry, examining the differences in the number, amount, and types of payments made to male and female neurosurgeons.</p><p><strong>Methods: </strong>Utilizing data from the Centers for Medicare & Medicaid Services Open Payments database covering 2016-2022, the authors conducted a comprehensive analysis of industry payments to neurosurgeons. This methodology included univariate and multivariate analyses to examine the disparities in payments, with a focus on identifying significant differences in compensation across genders.</p><p><strong>Results: </strong>An analysis of 24,074 industry transactions totaling $388,916,456.88 underscored pronounced gender disparities, with female neurosurgeons involved in merely 2.47% of these transactions and receiving just 0.91% of the overall financial value. The data revealed significant discrepancies in compensation between genders across all contributing companies. Male neurosurgeons engaged in a higher average number of annual transactions compared with their female counterparts (4.60 vs 2.75, p < 0.001), across various financial interactions. This included a greater participation in royalties and licenses (1.49 vs 0.31, p < 0.001), consulting fees (2.16 vs 1.63, p = 0.024), and acquisitions (0.01 vs 0.00, p = 0.006). On average, female neurosurgeons were compensated $16,303.66, starkly lower than the $75,523.20 average received by their male counterparts (p < 0.005). This gap was especially significant in royalties and licenses, where females earned an average of $5168.57 compared with $61,898.47 for males (p = 0.004). Additionally, in acquisitions, female neurosurgeons received no payments at all, whereas males averaged $2153.43 (p = 0.042). Several of these disparities remained significant even after accounting for potential confounding factors, highlighting a systematic bias in compensation and industry engagement against female neurosurgeons.</p><p><strong>Conclusions: </strong>The study underscores a significant gender-based disparity in the financial interactions between neurosurgeons and the medical device industry. These disparities highlight the need for systemic changes to address the underlying factors contributing to inequity in compensation and industry collaboration opportunities. Implementing equitable compensation structures, mentorship programs, and inclusive policies is a crucial step toward achieving gender parity in neurosurgery and ensuring the field benefits from the diverse skills and perspectives of all its members.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006979","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}
Pub Date : 2025-01-17DOI: 10.3171/2024.8.JNS241276
Tim E Darsaut, Nicolas Lecaros, Pierre-Olivier Comby, Roland Jabre, Daniela Iancu, Daniel Roy, Alain Weill, Michel W Bojanowski, Chiraz Chaalala, Gilles El Hage, Alain Bilocq, Eric Truffer, J Max Findlay, Jeremy L Rempel, Michael M C Chow, Cian J O'Kelly, Robert A Ashforth, Owen Stechishin, Thomas Gaberel, Charlotte Barbier, Fuat Arikan, Ignacio Arrese, Rosario Sarabia, David J Altschul, Miguel Chagnon, Justine Zehr, Jai J S Shankar, François Proust, Guylaine Gevry, Jean Raymond
Objective: Many patients with ruptured intracranial aneurysms (RIAs) underrepresented or excluded from previous randomized controlled trials (RCTs) comparing surgery with endovascular treatment (EVT) are still considered for surgical clipping, but the best management of these patients remains unknown.
Methods: The International Subarachnoid Aneurysm Trial-2 was a randomized trial comparing surgical versus EVT of RIAs considered for surgical clipping, despite the results of previous RCTs, and also eligible for EVT. The primary endpoint was death or dependency according to the modified Rankin Scale score (mRS score > 2) at 1 year. Secondary endpoints included 1-year angiographic results and length of hospital stay. The primary hypothesis was that endovascular management would decrease the number of poor outcomes (mRS score > 2) from 30% to 23%, necessitating 1896 patients. The trial was interrupted after 10 years because of slow recruitment. Primary analysis was by intent-to-treat. There was no blinding.
Results: From November 2012 to December 2022, 270 patients were recruited at 6 North American and European centers. After exclusions, 263 patients were randomly allocated to receive surgery (n = 133) or EVT (n = 130). There were 12 crossovers (9 from surgery to EVT). The primary outcome was reached in 40 of 133 surgical patients (30%, 95% CI 23%-38%) compared with 35 of 130 EVT patients (27%, 95% CI 20%-35%) (p = 0.572). Residual aneurysms at 1 year were less frequent with surgery (10/118 [8%, 95% CI 5%-15%]) than EVT (22/109 [20%, 95% CI 14%-29%]) (p = 0.015). Additional procedures (ventricular drainage and decompressive craniotomy, p < 0.05) and hospitalization > 20 days were more frequent in the surgery group (69/133 [52%, 95% CI 43%-60%]) than in the EVT group (38/130 [29%, 95% CI 22%-38%]) (p < 0.001).
Conclusions: This prematurely interrupted trial showed more frequent additional procedures and longer hospitalizations but better 1-year angiographic results with surgery. The primary clinical outcome, death or dependency at 1 year, was similar for EVT and surgery.
目的:许多颅内动脉瘤破裂(RIAs)患者未被充分代表或被排除在先前比较手术与血管内治疗(EVT)的随机对照试验(rct)中,但仍考虑手术夹持,但这些患者的最佳治疗方法尚不清楚。方法:国际蛛网膜下腔动脉瘤试验-2是一项比较手术与EVT的随机试验,尽管之前的随机对照试验结果,但考虑手术夹闭的RIAs也符合EVT的条件。根据修改的Rankin量表评分(mRS评分bb0.2),主要终点是1年时的死亡或依赖。次要终点包括1年血管造影结果和住院时间。我们的主要假设是,血管内治疗可以将不良预后(mRS评分bb0.2)的数量从30%减少到23%,需要1896例患者。由于招募缓慢,试验在10年后中断。主要分析是意向治疗。没有致盲。结果:从2012年11月到2022年12月,在北美和欧洲的6个中心招募了270名患者。排除后,263例患者随机分配接受手术(n = 133)或EVT (n = 130)。有12个交叉(9个从手术到EVT)。133例手术患者中有40例达到主要结局(30%,95% CI 23%-38%), 130例EVT患者中有35例达到主要结局(27%,95% CI 20%-35%) (p = 0.572)。术后1年残留动脉瘤发生率(10/118 [8%,95% CI 5%-15%])低于EVT (22/109 [20%, 95% CI 14%-29%]) (p = 0.015)。手术组(69/133 [52%,95% CI 43%-60%])比EVT组(38/130 [29%,95% CI 22%-38%]) (p < 0.001)更频繁地进行额外手术(脑室引流和开颅减压,p < 0.05)和住院20天(p < 0.05)。结论:这项过早中断的试验显示更多的额外手术和更长的住院时间,但手术的1年血管造影结果更好。EVT和手术的主要临床结局,1年死亡或依赖,相似。
{"title":"A randomized trial comparing endovascular and surgical management of ruptured intracranial aneurysms excluded from previous trials.","authors":"Tim E Darsaut, Nicolas Lecaros, Pierre-Olivier Comby, Roland Jabre, Daniela Iancu, Daniel Roy, Alain Weill, Michel W Bojanowski, Chiraz Chaalala, Gilles El Hage, Alain Bilocq, Eric Truffer, J Max Findlay, Jeremy L Rempel, Michael M C Chow, Cian J O'Kelly, Robert A Ashforth, Owen Stechishin, Thomas Gaberel, Charlotte Barbier, Fuat Arikan, Ignacio Arrese, Rosario Sarabia, David J Altschul, Miguel Chagnon, Justine Zehr, Jai J S Shankar, François Proust, Guylaine Gevry, Jean Raymond","doi":"10.3171/2024.8.JNS241276","DOIUrl":"https://doi.org/10.3171/2024.8.JNS241276","url":null,"abstract":"<p><strong>Objective: </strong>Many patients with ruptured intracranial aneurysms (RIAs) underrepresented or excluded from previous randomized controlled trials (RCTs) comparing surgery with endovascular treatment (EVT) are still considered for surgical clipping, but the best management of these patients remains unknown.</p><p><strong>Methods: </strong>The International Subarachnoid Aneurysm Trial-2 was a randomized trial comparing surgical versus EVT of RIAs considered for surgical clipping, despite the results of previous RCTs, and also eligible for EVT. The primary endpoint was death or dependency according to the modified Rankin Scale score (mRS score > 2) at 1 year. Secondary endpoints included 1-year angiographic results and length of hospital stay. The primary hypothesis was that endovascular management would decrease the number of poor outcomes (mRS score > 2) from 30% to 23%, necessitating 1896 patients. The trial was interrupted after 10 years because of slow recruitment. Primary analysis was by intent-to-treat. There was no blinding.</p><p><strong>Results: </strong>From November 2012 to December 2022, 270 patients were recruited at 6 North American and European centers. After exclusions, 263 patients were randomly allocated to receive surgery (n = 133) or EVT (n = 130). There were 12 crossovers (9 from surgery to EVT). The primary outcome was reached in 40 of 133 surgical patients (30%, 95% CI 23%-38%) compared with 35 of 130 EVT patients (27%, 95% CI 20%-35%) (p = 0.572). Residual aneurysms at 1 year were less frequent with surgery (10/118 [8%, 95% CI 5%-15%]) than EVT (22/109 [20%, 95% CI 14%-29%]) (p = 0.015). Additional procedures (ventricular drainage and decompressive craniotomy, p < 0.05) and hospitalization > 20 days were more frequent in the surgery group (69/133 [52%, 95% CI 43%-60%]) than in the EVT group (38/130 [29%, 95% CI 22%-38%]) (p < 0.001).</p><p><strong>Conclusions: </strong>This prematurely interrupted trial showed more frequent additional procedures and longer hospitalizations but better 1-year angiographic results with surgery. The primary clinical outcome, death or dependency at 1 year, was similar for EVT and surgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006848","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}
Objective: Studies have demonstrated the effectiveness of hydrogel-coated coils (HGCs) to achieve the composite endpoint of decreased recanalization rates and greater safety. Herein, the authors aimed to assess the true ability of second-generation HGCs to prevent recanalization.
Methods: This randomized controlled study, the HYBRID (Hydrocoil Versus Bare Platinum Coil in Recanalization Imaging Data) trial, comparing HGCs with bare platinum coils (BPCs), was conducted in 43 Japanese institutions. The aneurysm diameter range was 7-20 mm. HGCs were used in 4 patients in the BPC arm, and at least one HGC was used in each patient in the HGC arm, excluding 3 patients. Additionally, an HGC length ≥ 50% of the length of all the coils used was strongly recommended. The primary endpoint was recanalization 1 year after embolization, according to core laboratory evaluation. Angiographic change was also classified as further thrombosis, unchanged, or recanalization. Changes in cases with both initial and 1-year posttreatment angiographic images were compared. In the post hoc analysis, major recanalization was defined as any change, from complete occlusion or a neck remnant at the end of the procedure to body filling (BF) on the 1-year posttreatment angiogram or any increase in the size of BF in patients with BF at the end of the procedure, and its rate was compared between the two treatment arms.
Results: Recruitment ended when 432 patients were randomized; 217 and 215 patients were allocated to the HGC and BPC arms, respectively. The recanalization rates in the HGC and BPC arms were 3.3% and 7.1%, respectively (risk difference -3.8%, 95% CI -8.6 to 0.5), with no statistically significant difference (p = 0.083). Regarding aneurysm occlusion within 1 year, there was significantly more thrombosis and less recanalization in the HGC group (p = 0.043). The major recanalization rates were 2.3% and 6.6% in the HGC and BPC arms, respectively, with a significant difference between the two (p = 0.036).
Conclusions: The study results did not confirm the effectiveness of second-generation HGCs using recanalization imaging data. However, these coils may induce more thrombosis and less recanalization for medium-sized cerebral aneurysms. Clinical trial registration no.: UMIN000006748 (www.umin.ac.jp/ctr/).
目的:研究证明了水凝胶涂层线圈(HGCs)在降低再通率和提高安全性方面的有效性。在此,作者旨在评估第二代hgc防止再通的真正能力。方法:这项随机对照研究,即HYBRID (Hydrocoil vs Bare Platinum Coil in reanalization Imaging Data)试验,在43家日本机构进行了hgc与裸铂线圈(BPCs)的比较。动脉瘤直径范围7 ~ 20mm。BPC组有4例患者使用了HGC, HGC组中除3例患者外,每位患者至少使用了1例HGC。此外,强烈建议HGC长度≥所使用线圈长度的50%。根据核心实验室评估,主要终点是栓塞后1年的再通。血管造影改变也可分为进一步血栓形成、未改变或再通。比较治疗初期和治疗后1年血管造影图像的变化。在事后分析中,主要再通被定义为任何变化,从手术结束时完全闭塞或颈部残留到治疗后1年血管造影上的体充盈(BF),或BF患者在手术结束时BF大小的任何增加,并在两个治疗组之间比较其发生率。结果:招募结束时,432名患者被随机化;分别有217名和215名患者被分配到HGC组和BPC组。HGC组和BPC组再通率分别为3.3%和7.1%(风险差-3.8%,95% CI -8.6 ~ 0.5),差异无统计学意义(p = 0.083)。在动脉瘤闭塞1年内,HGC组血栓形成明显增多,再通率明显降低(p = 0.043)。HGC组和BPC组的主要再通率分别为2.3%和6.6%,两者差异有统计学意义(p = 0.036)。结论:研究结果并没有证实第二代hgc使用再通成像数据的有效性。然而,对于中等大小的脑动脉瘤,这些线圈可能会导致更多的血栓形成和更少的再通。临床试验注册号:: UMIN000006748 (www.umin.ac.jp/ctr/)。
{"title":"Hydrogel coils in intracranial aneurysm treatment: a multicenter, prospective, randomized open-label trial.","authors":"Hirotoshi Imamura, Nobuyuki Sakai, Chiaki Sakai, Akio Hyodo, Yasushi Ito, Yuji Matsumaru, Shigeru Miyachi, Shinichi Yoshimura, Makoto Sasaki, Toshinori Hirai, Hiroyuki Kinouchi, Susumu Miyamoto, Yasushi Okada, Masaki Komiyama, Kuniaki Ogasawara, Kazunori Toyoda, Takashi Daimon, Masayuki Ezura, Ichiro Nakahara, Akira Ishii, Yasushi Matsumoto, Kenichiro Tanabe","doi":"10.3171/2024.8.JNS232369","DOIUrl":"https://doi.org/10.3171/2024.8.JNS232369","url":null,"abstract":"<p><strong>Objective: </strong>Studies have demonstrated the effectiveness of hydrogel-coated coils (HGCs) to achieve the composite endpoint of decreased recanalization rates and greater safety. Herein, the authors aimed to assess the true ability of second-generation HGCs to prevent recanalization.</p><p><strong>Methods: </strong>This randomized controlled study, the HYBRID (Hydrocoil Versus Bare Platinum Coil in Recanalization Imaging Data) trial, comparing HGCs with bare platinum coils (BPCs), was conducted in 43 Japanese institutions. The aneurysm diameter range was 7-20 mm. HGCs were used in 4 patients in the BPC arm, and at least one HGC was used in each patient in the HGC arm, excluding 3 patients. Additionally, an HGC length ≥ 50% of the length of all the coils used was strongly recommended. The primary endpoint was recanalization 1 year after embolization, according to core laboratory evaluation. Angiographic change was also classified as further thrombosis, unchanged, or recanalization. Changes in cases with both initial and 1-year posttreatment angiographic images were compared. In the post hoc analysis, major recanalization was defined as any change, from complete occlusion or a neck remnant at the end of the procedure to body filling (BF) on the 1-year posttreatment angiogram or any increase in the size of BF in patients with BF at the end of the procedure, and its rate was compared between the two treatment arms.</p><p><strong>Results: </strong>Recruitment ended when 432 patients were randomized; 217 and 215 patients were allocated to the HGC and BPC arms, respectively. The recanalization rates in the HGC and BPC arms were 3.3% and 7.1%, respectively (risk difference -3.8%, 95% CI -8.6 to 0.5), with no statistically significant difference (p = 0.083). Regarding aneurysm occlusion within 1 year, there was significantly more thrombosis and less recanalization in the HGC group (p = 0.043). The major recanalization rates were 2.3% and 6.6% in the HGC and BPC arms, respectively, with a significant difference between the two (p = 0.036).</p><p><strong>Conclusions: </strong>The study results did not confirm the effectiveness of second-generation HGCs using recanalization imaging data. However, these coils may induce more thrombosis and less recanalization for medium-sized cerebral aneurysms. Clinical trial registration no.: UMIN000006748 (www.umin.ac.jp/ctr/).</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006981","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}
Paulina Majewska, Ragnhild Holden Helland, Alexandros Ferles, André Pedersen, Ivar Kommers, Hilko Ardon, Frederik Barkhof, Lorenzo Bello, Mitchel S Berger, Tora Dunås, Marco Conti Nibali, Julia Furtner, Shawn L Hervey-Jumper, Albert J S Idema, Barbara Kiesel, Rishi Nandoe Tewarie, Emmanuel Mandonnet, Domenique M J Müller, Pierre A Robe, Marco Rossi, Tommaso Sciortino, Tom Aalders, Michiel Wagemakers, Georg Widhalm, Aeilko H Zwinderman, Philip C De Witt Hamer, Roelant S Eijgelaar, Lisa Millgård Sagberg, Asgeir Store Jakola, Erik Thurin, Ingerid Reinertsen, David Bouget, Ole Solheim
Objective: The extent of resection (EOR) and postoperative residual tumor (RT) volume are prognostic factors in glioblastoma. Calculations of EOR and RT rely on accurate tumor segmentations. Raidionics is an open-access software that enables automatic segmentation of preoperative and early postoperative glioblastoma using pretrained deep learning models. The aim of this study was to compare the prognostic value of manually versus automatically assessed volumetric measurements in glioblastoma patients.
Methods: Adult patients who underwent resection of histopathologically confirmed glioblastoma were included from 12 different hospitals in Europe and North America. Patient characteristics and survival data were collected as part of local tumor registries or were retrieved from patient medical records. The prognostic value of manually and automatically assessed EOR and RT volume was compared using Cox regression models.
Results: Both manually and automatically assessed RT volumes were a negative prognostic factor for overall survival (manual vs automatic: HR 1.051, 95% CI 1.034-1.067 [p < 0.001] vs HR 1.019, 95% CI 1.007-1.030 [p = 0.001]). Both manual and automatic EOR models showed that patients with gross-total resection have significantly longer overall survival compared with those with subtotal resection (manual vs automatic: HR 1.580, 95% CI 1.291-1.932 [p < 0.001] vs HR 1.395, 95% CI 1.160-1.679 [p < 0.001]), but no significant prognostic difference of gross-total compared with near-total (90%-99%) resection was found. According to the Akaike information criterion and the Bayesian information criterion, all multivariable Cox regression models showed similar goodness-of-fit.
Conclusions: Automatically and manually measured EOR and RT volumes have comparable prognostic properties. Automatic segmentation with Raidionics can be used in future studies in patients with glioblastoma.
目的:胶质母细胞瘤的切除范围(EOR)和术后残余肿瘤(RT)体积是影响肿瘤预后的重要因素。EOR和RT的计算依赖于精确的肿瘤分割。Raidionics是一个开放获取的软件,可以使用预训练的深度学习模型自动分割术前和术后早期的胶质母细胞瘤。本研究的目的是比较人工和自动评估的体积测量在胶质母细胞瘤患者中的预后价值。方法:来自欧洲和北美12家不同医院的经组织病理学证实的胶质母细胞瘤切除术的成年患者。患者特征和生存数据作为当地肿瘤登记的一部分收集或从患者医疗记录中检索。采用Cox回归模型比较人工和自动评估的EOR和RT体积的预后价值。结果:人工和自动评估的RT体积都是总生存期的负面预后因素(人工vs自动:HR 1.051, 95% CI 1.034-1.067 [p < 0.001] vs HR 1.019, 95% CI 1.007-1.030 [p = 0.001])。手工和自动EOR模型均显示,与次全切除术患者相比,总生存率明显更长(手工与自动:HR 1.580, 95% CI 1.291-1.932 [p < 0.001] vs HR 1.395, 95% CI 1.160-1.679 [p < 0.001]),但未发现总切除与近全切除术(90%-99%)的预后差异显著。根据赤池信息准则和贝叶斯信息准则,各多变量Cox回归模型的拟合优度相近。结论:自动和手动测量EOR和RT体积具有相似的预后特性。放射电子学的自动分割可用于胶质母细胞瘤患者的未来研究。
{"title":"Prognostic value of manual versus automatic methods for assessing extents of resection and residual tumor volume in glioblastoma.","authors":"Paulina Majewska, Ragnhild Holden Helland, Alexandros Ferles, André Pedersen, Ivar Kommers, Hilko Ardon, Frederik Barkhof, Lorenzo Bello, Mitchel S Berger, Tora Dunås, Marco Conti Nibali, Julia Furtner, Shawn L Hervey-Jumper, Albert J S Idema, Barbara Kiesel, Rishi Nandoe Tewarie, Emmanuel Mandonnet, Domenique M J Müller, Pierre A Robe, Marco Rossi, Tommaso Sciortino, Tom Aalders, Michiel Wagemakers, Georg Widhalm, Aeilko H Zwinderman, Philip C De Witt Hamer, Roelant S Eijgelaar, Lisa Millgård Sagberg, Asgeir Store Jakola, Erik Thurin, Ingerid Reinertsen, David Bouget, Ole Solheim","doi":"10.3171/2024.8.JNS24415","DOIUrl":"https://doi.org/10.3171/2024.8.JNS24415","url":null,"abstract":"<p><strong>Objective: </strong>The extent of resection (EOR) and postoperative residual tumor (RT) volume are prognostic factors in glioblastoma. Calculations of EOR and RT rely on accurate tumor segmentations. Raidionics is an open-access software that enables automatic segmentation of preoperative and early postoperative glioblastoma using pretrained deep learning models. The aim of this study was to compare the prognostic value of manually versus automatically assessed volumetric measurements in glioblastoma patients.</p><p><strong>Methods: </strong>Adult patients who underwent resection of histopathologically confirmed glioblastoma were included from 12 different hospitals in Europe and North America. Patient characteristics and survival data were collected as part of local tumor registries or were retrieved from patient medical records. The prognostic value of manually and automatically assessed EOR and RT volume was compared using Cox regression models.</p><p><strong>Results: </strong>Both manually and automatically assessed RT volumes were a negative prognostic factor for overall survival (manual vs automatic: HR 1.051, 95% CI 1.034-1.067 [p < 0.001] vs HR 1.019, 95% CI 1.007-1.030 [p = 0.001]). Both manual and automatic EOR models showed that patients with gross-total resection have significantly longer overall survival compared with those with subtotal resection (manual vs automatic: HR 1.580, 95% CI 1.291-1.932 [p < 0.001] vs HR 1.395, 95% CI 1.160-1.679 [p < 0.001]), but no significant prognostic difference of gross-total compared with near-total (90%-99%) resection was found. According to the Akaike information criterion and the Bayesian information criterion, all multivariable Cox regression models showed similar goodness-of-fit.</p><p><strong>Conclusions: </strong>Automatically and manually measured EOR and RT volumes have comparable prognostic properties. Automatic segmentation with Raidionics can be used in future studies in patients with glioblastoma.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006991","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}
Pub Date : 2025-01-17DOI: 10.3171/2024.10.JNS242548
Vengalathur Ganesan Ramesh
{"title":"Letter to the Editor. Trigeminal nerve morphology and trigeminal neuralgia.","authors":"Vengalathur Ganesan Ramesh","doi":"10.3171/2024.10.JNS242548","DOIUrl":"https://doi.org/10.3171/2024.10.JNS242548","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":3.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006984","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}
Pub Date : 2025-01-17DOI: 10.3171/2024.8.JNS241295
Douglas L Brockmeyer, David D Limbrick, Cormac O Maher, Gerald A Grant
{"title":"Primary rhombencephalopathy: introduction of a new paradigm for the evaluation and management of craniocervical hindbrain pathology.","authors":"Douglas L Brockmeyer, David D Limbrick, Cormac O Maher, Gerald A Grant","doi":"10.3171/2024.8.JNS241295","DOIUrl":"https://doi.org/10.3171/2024.8.JNS241295","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006988","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}
Pub Date : 2025-01-17DOI: 10.3171/2024.8.JNS232831
Nallammai Muthiah, Zachary C Gersey, Laura Le, Hussein Abdallah, Hussam Abou-Al-Shaar, S Tonya Stefko, Gabrielle R Bonhomme, Can Kocasarac, Eric W Wang, Carl H Snyderman, Paul A Gardner, Georgios A Zenonos
Objective: Skull base chordomas (SBCs) often present with cranial nerve (CN) VI deficits. Studies have not assessed the prognosis and predictive factors for CN VI recovery among patients presenting with CN VI deficits.
Methods: The medical records of patients who underwent resection for primary chordoma from 2001 to 2020 were reviewed. Those presenting with CN VI palsy were identified. The extent of CN VI deficit was determined to be partial or complete based on the Scott-Kraft score. The change in deficit from baseline was recorded within 3 days of surgery and at the 6-month follow-up. The postoperative course was followed until partial and/or complete deficit recovery. Univariate logistic regression models were created to predict improvement or resolution of CN VI deficit.
Results: A total of 113 patients with primary SBC were identified, 34 of whom presented with CN VI deficits: 24 (73%) with partial and 9 (27%) with complete deficits. The extent of deficit in 1 patient was unable to be determined. The median duration of deficit preoperatively was 3.6 months, and CN VI was most commonly radiographically abutted at the prepontine cistern and Dorello's canal. Twenty-three (68%) patients experienced at least partial CN VI recovery (mean 61 days, range 2-174 days). Nineteen (56%) patients experienced complete CN VI recovery (mean 162 days, range 2-469 days). No patients whose CN VI deficit worsened immediately after surgery achieved improvement in CN VI function at 6 months (p = 0.001). Preoperative partial (relative to complete) CN VI deficit was associated with greater odds of CN VI deficit improvement by 6 months (OR 7.7, p = 0.028). Factors not associated with deficit resolution included duration of deficit, CN VI involvement by tumor, total segments abutted by tumor, sex, age at diagnosis, gross-total resection, tumor volume, and adjuvant radiation therapy, although this analysis may have been underpowered to detect small differences.
Conclusions: Overall, 68% of patients achieved at least partial recovery in CN VI function after endoscopic skull base surgery. Among patients with partial CN VI palsy at baseline, 83% achieved CN VI recovery within 6 months and 75% achieved complete recovery within 14 months. For patients who presented with a complete CN VI deficit, within those same time frames, 33% and 11% achieved partial and complete recovery, respectively. Complete preoperative CN VI deficit was associated with lower odds of CN VI recovery by 6 months. The duration of preoperative deficit does not predict functional CN VI recovery.
{"title":"Skull base chordomas presenting with abducens nerve deficits: clinical characteristics and predictive factors for deficit improvement or resolution.","authors":"Nallammai Muthiah, Zachary C Gersey, Laura Le, Hussein Abdallah, Hussam Abou-Al-Shaar, S Tonya Stefko, Gabrielle R Bonhomme, Can Kocasarac, Eric W Wang, Carl H Snyderman, Paul A Gardner, Georgios A Zenonos","doi":"10.3171/2024.8.JNS232831","DOIUrl":"https://doi.org/10.3171/2024.8.JNS232831","url":null,"abstract":"<p><strong>Objective: </strong>Skull base chordomas (SBCs) often present with cranial nerve (CN) VI deficits. Studies have not assessed the prognosis and predictive factors for CN VI recovery among patients presenting with CN VI deficits.</p><p><strong>Methods: </strong>The medical records of patients who underwent resection for primary chordoma from 2001 to 2020 were reviewed. Those presenting with CN VI palsy were identified. The extent of CN VI deficit was determined to be partial or complete based on the Scott-Kraft score. The change in deficit from baseline was recorded within 3 days of surgery and at the 6-month follow-up. The postoperative course was followed until partial and/or complete deficit recovery. Univariate logistic regression models were created to predict improvement or resolution of CN VI deficit.</p><p><strong>Results: </strong>A total of 113 patients with primary SBC were identified, 34 of whom presented with CN VI deficits: 24 (73%) with partial and 9 (27%) with complete deficits. The extent of deficit in 1 patient was unable to be determined. The median duration of deficit preoperatively was 3.6 months, and CN VI was most commonly radiographically abutted at the prepontine cistern and Dorello's canal. Twenty-three (68%) patients experienced at least partial CN VI recovery (mean 61 days, range 2-174 days). Nineteen (56%) patients experienced complete CN VI recovery (mean 162 days, range 2-469 days). No patients whose CN VI deficit worsened immediately after surgery achieved improvement in CN VI function at 6 months (p = 0.001). Preoperative partial (relative to complete) CN VI deficit was associated with greater odds of CN VI deficit improvement by 6 months (OR 7.7, p = 0.028). Factors not associated with deficit resolution included duration of deficit, CN VI involvement by tumor, total segments abutted by tumor, sex, age at diagnosis, gross-total resection, tumor volume, and adjuvant radiation therapy, although this analysis may have been underpowered to detect small differences.</p><p><strong>Conclusions: </strong>Overall, 68% of patients achieved at least partial recovery in CN VI function after endoscopic skull base surgery. Among patients with partial CN VI palsy at baseline, 83% achieved CN VI recovery within 6 months and 75% achieved complete recovery within 14 months. For patients who presented with a complete CN VI deficit, within those same time frames, 33% and 11% achieved partial and complete recovery, respectively. Complete preoperative CN VI deficit was associated with lower odds of CN VI recovery by 6 months. The duration of preoperative deficit does not predict functional CN VI recovery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006949","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}
Albert A Sufianov, Nargiza A Garifullina, Aleksandr N Zyryanov, Andrey G Shapkin, Luis A B Borba, Matias Baldoncini, Rinat A Sufianov
Objective: The purpose of this study was to present a newly designed 3D-printed personalized model (3D PPM) of a radiofrequency needle guide with a maxillary fixation for gasserian ganglion (GG) puncture.
Methods: Implementation of 3D CT-guided radiofrequency therapy of the GG with and without use of 3D PPM was analyzed. The following parameters were assessed: radiation time, dose area product, air kerma reference point, pain severity during the puncture needle insertion, prosopalgia regression degree (according to visual analog scale) and the severity of facial numbness (according to the Barrow Neurological Institute scale) in the early postoperative period, and postpuncture complications.
Results: Pain severity reduction was equivalent in both groups, and postoperative facial numbness was not observed. A statistically significant difference in radiation exposure parameters was revealed: radiation time was 181.67 ± 2.99 and 310.50 ± 18.46 seconds (p < 0.001); dose area product was 950.97 ± 115.41 and 1545.48 ± 135.04 µGy*m2 (p < 0.005); and the air kerma reference point was 114.53 ± 16.81 and 190.88 ± 17.48 mGy (p < 0.005) in groups 1 and 2, respectively. The severity of pain during a puncture needle insertion was assessed as mild in 62.5% and 25%, moderate in 37.5% and 41.6%, and severe in 0% and 33.3% of patients in groups 1 and 2, respectively. No serious perioperative complications were observed.
Conclusions: The use of 3D PPM allows for controlled needle insertion, reducing the radiation dose to the patient and medical staff, reducing pain during a puncture needle insertion into the area of the foramen ovale, and minimizing the risk of postoperative complications.
{"title":"Designing and clinical application of a 3D-printed personalized model of a radiofrequency needle guide with a maxillary fixator for puncture of the gasserian ganglion for trigeminal neuralgia treatment.","authors":"Albert A Sufianov, Nargiza A Garifullina, Aleksandr N Zyryanov, Andrey G Shapkin, Luis A B Borba, Matias Baldoncini, Rinat A Sufianov","doi":"10.3171/2024.8.JNS24196","DOIUrl":"https://doi.org/10.3171/2024.8.JNS24196","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to present a newly designed 3D-printed personalized model (3D PPM) of a radiofrequency needle guide with a maxillary fixation for gasserian ganglion (GG) puncture.</p><p><strong>Methods: </strong>Implementation of 3D CT-guided radiofrequency therapy of the GG with and without use of 3D PPM was analyzed. The following parameters were assessed: radiation time, dose area product, air kerma reference point, pain severity during the puncture needle insertion, prosopalgia regression degree (according to visual analog scale) and the severity of facial numbness (according to the Barrow Neurological Institute scale) in the early postoperative period, and postpuncture complications.</p><p><strong>Results: </strong>Pain severity reduction was equivalent in both groups, and postoperative facial numbness was not observed. A statistically significant difference in radiation exposure parameters was revealed: radiation time was 181.67 ± 2.99 and 310.50 ± 18.46 seconds (p < 0.001); dose area product was 950.97 ± 115.41 and 1545.48 ± 135.04 µGy*m2 (p < 0.005); and the air kerma reference point was 114.53 ± 16.81 and 190.88 ± 17.48 mGy (p < 0.005) in groups 1 and 2, respectively. The severity of pain during a puncture needle insertion was assessed as mild in 62.5% and 25%, moderate in 37.5% and 41.6%, and severe in 0% and 33.3% of patients in groups 1 and 2, respectively. No serious perioperative complications were observed.</p><p><strong>Conclusions: </strong>The use of 3D PPM allows for controlled needle insertion, reducing the radiation dose to the patient and medical staff, reducing pain during a puncture needle insertion into the area of the foramen ovale, and minimizing the risk of postoperative complications.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006976","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}