Neurologia i neurochirurgia polska最新文献

Introduction: Approximately 21% of patients who undergo cervical laminoplasty for cervical spondylotic myelopathy (CSM) develop postoperative kyphotic deformity (KD). Radiologic parameters (RPs) on preoperative sagittal X-ray have consistently shown to be the strongest predictors for KD but their acquisition requires manual labor from specialists. Thus, the authors developed a novel artificial intelligence (AI) model to autonomously retrieve the predictors.

Material and methods: A total of 259 patients' sagittal X-rays were retrospectively obtained from the internal center between 2016 and 2024 for training. Patients with spinal deformities, prior surgical interventions, or tumors/malignancies within the cervical region were excluded. Data augmentation techniques were used to amplify the dataset, and a custom attention U-net architecture was used. Prospective enrollment of patients diagnosed with CSM over nine months at the internal and external center was performed for validation.

Results: A total of 28 (77.8%) patients with CSM were prospectively obtained. The mean age was 66.0 ± 10.5 years, and 20 (71.4%) were females. The mean duration for human extraction of all RPs among the 2 neurosurgeons was 116.2 ± 17.5 seconds, whereas AI performed the task in 0.7 ± 0.0 seconds (p < 0.001). No significant difference was observed between the AI-obtained RPs and the physicians' report RP values, except for the center of gravity of the head to the C7 sagittal vertical axis, which reported a significant mean difference (p = 0.049); however, the extent of the difference was minimal (2.3 ± 4.0 mm).

Conclusions: This study automated the extraction of RPs for postoperative KD following laminoplasty. The trained model is publicly available for software developers to implement on a standalone platform or as a plugin on a medical imaging viewer. The model thus incentivizes the development of a risk scoring system for KD that utilizes the AI-acquired RPs to improve the evidence-based practice when selecting the surgical approach.

Aim of the study: Clipping of the middle cerebral artery (MCA) aneurysms presents significant anatomical challenges, requiring precise occlusion while preserving the integrity of adjacent vessels. Narrowing or occlusion of MCA branches can lead to strokes and severe neurological deficits. Intraoperative transit time flowmetry (ITTF) provides quantitative real-time measurements of cerebral blood flow, potentially reducing ischemic complications. This study evaluates whether ITTF monitoring during unruptured MCA aneurysm clipping improves postoperative outcomes compared to a control group without ITTF.

Material and methods: A retrospective review of a prospectively maintained institutional database was performed. A retrospective cohort study was conducted involving two groups of patients who underwent clipping for unruptured MCA aneurysms between 2010 and 2019. The monitored group (n = 34) received intraoperative ITTF monitoring, while the control group (n = = 20) did not. Intraoperative flow measurements were performed before and after clip placement, allowing for real-time clip adjustment if flow restriction exceeded 25%. All patients were monitored using motor-evoked potentials and indocyanine green video angiography. Postoperative outcomes were assessed using the modified Rankin Scale (mRS) at 30 and 90 days.

Results: In the ITTF-monitored group, postoperative morbidity was 3% compared to 5% in the non-monitored group. Clip repositioning was required in two ITTF-monitored cases to restore blood flow, despite normal indocyanine green video angiography and motor evoked potential findings. The odds ratio for postoperative neurological deficits was 5.05 when comparing the ITTF-monitored group to a hypothetical non-monitored scenario (13.6% morbidity); however, this difference was not statistically significant.

Conclusions: Despite the lack of statistical significance, ITTF monitoring may still play a valuable role in enhancing surgical safety, as it enabled clip repositioning in two cases where standard modalities (ICG and MEPs) showed no abnormalities. Further research is needed to confirm its clinical benefit and define its role in intraoperative decision-making.

Aim of the study: To assess the impact of tobacco smoking on the onset of Huntington's disease (HD) and the progression of its motor and cognitive symptoms.

Clinical rationale of the study: HD is an incurable neurodegenerative disorder. Therefore, identifying lifestyle factors with an impact of its progression is of particular interest. Tobacco smoking influences the course of neurodegenerative disorders. It has been shown to be a risk factor for dementia, but, on the contrary, seems to have a protective role in Parkinson's disease.

Material and methods: This study used Periodic Dataset 4 of the Enroll-HD database, from which a cohort of 2,438 HD subjects (799 presymptomatic) with four consecutive annual visits (three years of observation) was extracted. Logistic regression models were used to assess the effect of lifetime smoking on progression to the symptomatic phase. In the premanifest, Cox proportional regression model was applied to estimate the hazard ratio of HD diagnosis for smokers and nonsmokers during the three-year observation period. Multivariate linear regression models were used to investigate the relationship between smoking and the progression of HD clinical measures.

Results: It was found that current female smokers were at a higher risk of progressing to the symptomatic phase of HD than nonsmokers [hazard ratio (HR): 1.35, p = 0.023, 95% confidence interval (CI): 1.04-1.56]. For the symptomatic HD cohort, regardless of sex, smoking was associated with faster progression of motor symptoms, as measured by the Total Motor Score (p = 0.035, 95% CI: 0.04-0.9), as well as cognitive impairment, as measured by the Stroop Word Reading test (p = 0.04, 95% CI: 0.1-0.9).

Conclusions and clinical implications: It was presented that lifetime and current smoking are environmental factors that may be associated with an increased risk of HD progression, particularly in female HD gene carriers. This supports the recommendation that HD mutation carriers avoid smoking.

Introduction: This study aimed to identify predictive factors for long-term incomplete nidus obliteration following stereotactic radiosurgery (SRS) for brain arteriovenous malformations (AVMs).

Material and methods: A systematic search across the PubMed, Web of Science, and Scopus databases identified observational studies reporting such factors. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The study protocol was registered through PROSPERO. Each eligible study's quality was assessed using the modified Newcastle-Ottawa Scale. Odds ratios (ORs) were calculated for dichotomous parameters.

Results: Two high-quality prospective cohort and three high-quality retrospective cohort studies were included, covering patients with complete (n = 638) and incomplete (n = 297) nidus obliteration. The mean age of the patients was 25.54 ± 12.81 years and the mean follow-up time was 95.98 ± 27.64 months. Predictors for incomplete obliteration of nidus included: AVM classified as Spetzler-Martin (SM) grade ≥ IV (odds ratio (OR) 10.57, 95% confidence interval (CI) 2.00-55.96, p = 0.006), the presence of multiple (> 1) feeding arteries (OR 6.47, 95% CI 2.20-19.10, p = 0.0007), nidus volume > 10 mL (OR 5.08, 95% CI 1.68-15.33, p = 0.004), and the occurrence of intranidal aneurysm (OR 3.33, 95% CI 1.10-10.08, p = 0.03). No statistically significant difference in proportions of patients with incomplete nidus obliteration was found between paediatric (≤ 18 years) and adult (> 18) patient cohorts (p = 0.95).

Conclusions: The following factors were found to be predictive for long-term incomplete nidus obliteration post-SRS for brain AVMs: SM grade equal to or higher than IV; the presence of multiple feeding arteries; AVM nidus volume exceeding 10 mL; and the occurrence of intranidal aneurysm. These findings will be beneficial in refining patient selection for radiosurgical treatment.