Neurosurgical Review最新文献

Cerebral cavernous malformations (CCMs) are vascular lesions in the brain, presenting risks of intracerebral hemorrhage (ICH) and non-hemorrhagic focal neurological deficit (NH-FND). Currently, no effective medical therapy exists for CCMs, and treatment options limited to surgical resection and stereotactic radiosurgery. Beta-blockers, particularly propranolol, have shown promise in treating similar vascular conditions and may have therapeutic potential for CCMs. We conducted a systematic search of PubMed, Web of Science, EMBASE, Cochrane Central, and ClinicalTrials.gov (March 2024) for randomized clinical trials (RCTs) and cohort studies comparing neurological outcomes in adult patients with CCMs treated with beta-blockers versus controls. Meta-analysis was performed using Review Manager 5.4. The primary outcomes were the incidence of new-onset ICH and NH-FND attributable to CCMs. Five studies (1 RCT and 4 cohort studies; n = 1,553 participants) met the inclusion criteria. Beta-blocker exposure was associated with significantly lower odds of new-onset ICH or NH-FND attributable to CCMs (OR 0.52; 95% CI 0.35-0.77; p = 0.001), with low heterogeneity (I² = 35%). Subgroup analysis showed a reduced incidence of new ICH alone (OR 0.60; 95% CI 0.39-0.91; p = 0.02). In propranolol-specific analyses, the reduction in the primary outcome was not statistically significant (OR 0.33; 95% CI 0.08-1.38; p = 0.13). Beta-blocker therapy was associated with improved neurological outcomes in patients with CCMs, with a significant reduction in the risk of new-onset ICH and NH-FND. However, propranolol alone did not demonstrate a statistically significant benefit, potentially due to subtherapeutic dosing and adverse effects. The evidence suggests other beta-blockers may also be beneficial, but further research is needed to clarify their roles and optimal regimen.

In patients with large vestibular schwannomas (VS), surgery is the primary treatment despite risks such as facial nerve dysfunction. Intra-operative monitoring with transcranial motor evoked potentials (TcMEP) helps predict facial nerve outcome but may lead to subtotal resections and later recurrence. This study compares TcMEP thresholds, facial nerve outcome, recurrence rate and progression-free survival in Koos grade 4 vestibular schwannomas. Fifty-five surgically treated patients with Koos grade 4 VS (2015-2024) were included in this retrospective study. All underwent facial nerve TcMEP monitoring. House-Brackmann (HB) scores were assessed postoperatively, and at 6 weeks, 6 months and 1 year. Progression-free survival was analyzed with Kaplan-Meier curves. Postoperatively, 58% showed a decline in facial nerve function. After one year, 83% had good function (HB I-II). A TcMEP threshold increase < 20 mA correlated with good outcomes. In 84% (47/55), a small residual tumor remained (mean 0.4 cc; range 0-7.9 cc). Median growth-free survival was 76 months after subtotal resection (STR) and not reached after near-total resection (NTR). We conclude that TcMEP-guided surgery for large vestibular schwannomas provides good facial nerve outcomes, small acceptable remnants and a low long-term recurrence risk. As fewer than half of residual tumors show growth within 8 years, routine postoperative radiotherapy is not recommended; a watchful-waiting strategy is preferred.

Transient neurological events (TNEs) frequently occur after direct revascularization in adult moyamoya disease, often due to acute alterations in cerebral hemodynamics. Cortical venous redness has been linked to perioperative hemodynamic alterations; therefore, we investigated whether changes in cortical venous redness, quantified as red signal intensity (R intensity) around the anastomosis site, could predict TNE occurrence. In this retrospective study, we analyzed 52 hemispheres from 42 patients who underwent combined revascularization surgery for moyamoya disease. Cortical venous R intensity was measured pre- and post-anastomosis using exoscope images. The change in R intensity of the cortical vein, normalized to adjacent cortical surface (ΔNR), was calculated as the ratio of post- to pre-anastomosis values. Associations between ΔNR and TNE occurrence were evaluated using logistic regression analysis. TNEs occurred in 21 of 52 hemispheres (40.4%), with a median onset of 4 days (interquartile range [IQR], 2-6) following revascularization and duration of 6 days (IQR, 3-8). ΔNR was identified as an independent predictor of TNEs via Firth penalized logistic regression; a 0.1-unit increase in ΔNR was associated with a 7.58-fold higher odds of developing TNEs (p < 0.001). Increased ΔNR was independently associated with TNE occurrence post-revascularization for moyamoya disease. Quantitative assessment of cortical venous redness may serve as a potentially useful marker for predicting TNEs.

Background: The cerebrospinal fluid (CSF) metabolites could potentially direct reflecting the biochemical processes involved in central nervous system metabolism. This study aims to delineate the potential causal relationships between CSF metabolites and Glioblastoma (GBM) using Mendelian Randomization (MR) analysis.

Methods: This research employs a two-sample MR framework, utilizing genetic instrumental variables derived from GWAS datasets corresponding to CSF and plasma metabolites, and GBM. Data from separate samples for the exposure and outcome were analyzed using specialized R packages designed for two-sample MR and Bayesian weighted MR analyses.

Results: Significant causal relationships were identified between GBM and several CSF metabolites through two-sample MR analysis mainly using the IVW method. Notably, associations were observed with 3-methoxytyramine sulfate (OR 1.039, 95% CI 1.010 to 1.070, p-value 0.009), caffeine (OR 1.132, 95% CI 1.021 to 1.255, p-value 0.018), dimethyl sulfone (OR 1.087, 95% CI 1.002 to 1.178, p-value 0.043), fructose (OR 0.985, 95% CI 0.969 to 0.998, p-value 0.049), and phenol sulfate (OR 1.074, 95% CI 1.020 to 1.131, p-value 0.007). An inverse causal relationship was also observed between CSF fructose levels (as exposure) and GBM (OR 0.255, 95% CI 0.089 to 0.725, p-value = 0.010), suggesting protective effects. These findings were substantiated through Bayesian MR analysis.

Conclusion: The study highlights significant links between specific CSF metabolites and GBM, suggesting that these metabolites may influence tumor biology and could serve as potential biomarkers for GBM diagnosis and progression.