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Safety and Efficacy of Tiny (≤3 mm) Unruptured Middle Cerebral Artery Aneurysm Treatment: An Analysis of the NeuroVascular Quality Initiative-Quality Outcomes Database Cerebral Aneurysm Registry. 微小(≤3 毫米)未破裂大脑中动脉动脉瘤治疗的安全性和有效性:神经血管质量倡议--质量结果数据库脑动脉瘤注册分析》(NeuroVascular Quality Initiative-Quality Outcomes Database Cerebral Aneurysm Registry)。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-21 DOI: 10.1227/neu.0000000000003283
Varun Padmanaban, Thaddeus Harbaugh, Junjia Zhu, Shouhao Zhou, Sameer A Ansari, Jay U Howington, Daniel H Sahlein, Juan G Tejada, D Andrew Wilkinson, Scott D Simon, Kevin M Cockroft, Ephraim W Church

Background and objectives: Improved imaging modalities have led to an increased detection of intracranial aneurysms, many of which are small. There is uncertainty in the appropriate management of tiny aneurysms. The objective of this study was to use a large, multi-institutional NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to assess the frequency, safety, and efficacy of treatment of tiny, unruptured middle cerebral artery (MCA) aneurysms.

Methods: The NeuroVascular Quality Initiative-Quality Outcomes Database registry was queried for patients with tiny unruptured MCA aneurysms who underwent treatment. Tiny size was defined as an aneurysm with a maximum dimension of ≤3 mm. Demographics, aneurysm characteristics, and treatment safety were queried. Outcomes included modified Rankin Score (mRS) at discharge and the last follow-up as well as aneurysm occlusion status at discharge.

Results: Of 674 treated, unruptured MCA aneurysms, 57 (8.5%) were tiny. The mean aneurysm width was 2.2 mm, and the mean patient age was 55.9 years. Most aneurysms were treated with microsurgery (61.4%, 35/57). The overall intraoperative complication rate was 5.3% (3/57), and the postoperative complication rate was 10.5% (6/57). 10.5% (6/57) of patients were discharged to rehabilitation. At discharge, 42 (87.5%) of the treated aneurysms had complete occlusion. In the subgroup of patients with recorded follow-up data, 48.3% (14/29) had a mRS of 0 at discharge and 46.9% (15/32) had an mRS of 0 at the last follow-up (median follow-up 166 days).

Conclusion: Treatment of tiny, unruptured MCA aneurysms is efficacious but may have a high rate of complications. Physicians should be cautious when deciding to treat tiny, unruptured MCA aneurysms.

背景和目的:成像模式的改进使颅内动脉瘤的检出率有所提高,其中许多动脉瘤都很小。对微小动脉瘤的适当处理还存在不确定性。本研究的目的是利用大型、多机构神经血管质量倡议-质量结果数据库(NVQI-QOD)来评估治疗微小、未破裂的大脑中动脉(MCA)动脉瘤的频率、安全性和疗效:方法:对神经血管质量倡议-质量结果数据库注册表中接受治疗的微小未破裂 MCA 动脉瘤患者进行查询。微小动脉瘤的定义是最大尺寸≤3 毫米的动脉瘤。调查内容包括人口统计学、动脉瘤特征和治疗安全性。结果包括出院时和最后一次随访时的改良Rankin评分(mRS)以及出院时的动脉瘤闭塞状态:结果:在674个接受治疗的未破裂MCA动脉瘤中,有57个(8.5%)是微小动脉瘤。动脉瘤平均宽度为 2.2 毫米,患者平均年龄为 55.9 岁。大多数动脉瘤采用显微手术治疗(61.4%,35/57)。术中并发症总发生率为 5.3%(3/57),术后并发症发生率为 10.5%(6/57)。10.5%(6/57)的患者出院后进行了康复治疗。出院时,42 例(87.5%)接受治疗的动脉瘤完全闭塞。在有随访数据记录的患者分组中,48.3%(14/29)的患者出院时mRS为0,46.9%(15/32)的患者在最后一次随访时mRS为0(中位随访166天):结论:治疗微小、未破裂的 MCA 动脉瘤疗效显著,但并发症发生率较高。结论:治疗微小、未破裂的 MCA 动脉瘤疗效显著,但并发症发生率较高。医生在决定治疗微小、未破裂的 MCA 动脉瘤时应谨慎行事。
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引用次数: 0
Decoding Glioblastoma Heterogeneity: Neuroimaging Meets Machine Learning. 解码胶质母细胞瘤的异质性:神经影像学与机器学习的结合。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-21 DOI: 10.1227/neu.0000000000003260
Jawad Fares, Yizhou Wan, Roxanne Mayrand, Yonghao Li, Richard Mair, Stephen J Price

Recent advancements in neuroimaging and machine learning have significantly improved our ability to diagnose and categorize isocitrate dehydrogenase (IDH)-wildtype glioblastoma, a disease characterized by notable tumoral heterogeneity, which is crucial for effective treatment. Neuroimaging techniques, such as diffusion tensor imaging and magnetic resonance radiomics, provide noninvasive insights into tumor infiltration patterns and metabolic profiles, aiding in accurate diagnosis and prognostication. Machine learning algorithms further enhance glioblastoma characterization by identifying distinct imaging patterns and features, facilitating precise diagnoses and treatment planning. Integration of these technologies allows for the development of image-based biomarkers, potentially reducing the need for invasive biopsy procedures and enabling personalized therapy targeting specific pro-tumoral signaling pathways and resistance mechanisms. Although significant progress has been made, ongoing innovation is essential to address remaining challenges and further improve these methodologies. Future directions should focus on refining machine learning models, integrating emerging imaging techniques, and elucidating the complex interplay between imaging features and underlying molecular processes. This review highlights the pivotal role of neuroimaging and machine learning in glioblastoma research, offering invaluable noninvasive tools for diagnosis, prognosis prediction, and treatment planning, ultimately improving patient outcomes. These advances in the field promise to usher in a new era in the understanding and classification of IDH-wildtype glioblastoma.

异柠檬酸脱氢酶(IDH)-野生型胶质母细胞瘤具有明显的肿瘤异质性,这对有效治疗至关重要。神经成像技术,如弥散张量成像和磁共振放射组学,提供了对肿瘤浸润模式和代谢特征的非侵入性洞察,有助于准确诊断和预后。机器学习算法通过识别独特的成像模式和特征,进一步加强了胶质母细胞瘤的特征描述,有助于精确诊断和治疗规划。通过整合这些技术,可以开发基于图像的生物标记物,从而减少对侵入性活检程序的需求,并实现针对特定促肿瘤信号通路和耐药机制的个性化治疗。虽然已经取得了重大进展,但要解决剩余的挑战并进一步改进这些方法,持续创新至关重要。未来的发展方向应侧重于完善机器学习模型、整合新兴成像技术以及阐明成像特征与潜在分子过程之间复杂的相互作用。本综述强调了神经成像和机器学习在胶质母细胞瘤研究中的关键作用,它们为诊断、预后预测和治疗计划提供了宝贵的无创工具,最终改善了患者的预后。该领域的这些进展有望开创一个了解和分类 IDH 野生型胶质母细胞瘤的新时代。
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引用次数: 0
So the Bone Flap Hit the Floor, Now What? An In Vitro Comparison of Cadaveric Bone Flap Decontamination Procedures. 骨瓣落地了,现在怎么办?尸体骨瓣去污程序的体外比较。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-21 DOI: 10.1227/neu.0000000000003289
Alexis Marion, Simon Lévesque, Charles Touchette, Samuelle-Ariane Villeneuve, Béatrice Huppé-Gignac, Philippe Martin, Christine Arsenault, Christian Iorio-Morin

Background and objectives: Over the course of their career, 66% of neurosurgeons will witness someone accidentally dropping a bone flap on the floor during a craniotomy procedure. Although this event is rare, it can have significant consequences for the patient, and little literature is available to guide management of this complication. Our objective was to compare 5 bone flap decontamination protocols for efficacy in reducing bacterial load, with the goal of safely reimplanting the dropped flap.

Methods: Cadaveric human bone flaps were contaminated with common operating room (OR) contaminant bacteria. The bone flaps were then subject to 1 of 5 decontamination protocols: washing in saline, mechanical debridement, washing in antibiotics, washing in alcoholic chlorhexidine antiseptic, and flash decontamination in autoclave. Inoculum from the flaps was then used to grow bacteria in petri dishes, and bacterial load after decontamination was assessed. Some flaps were physically dropped on an OR floor to simulate and evaluate a real-life contamination.

Results: The observed contamination from a flap dropped on an OR floor can be significant (up to 1070 colony-forming units cultured per flap). All protocols tested decreased bacterial load of the bone flaps to different degrees: saline by 95.7%, mechanical debridement by 97.5%, antibiotic bath by 99.5%, alcoholic chlorhexidine by 99.9%, and flash sterilization by 100.0%. Flash sterilization led to significant alterations in the flap's physical appearance.

Conclusion: In the event of the accidental fall of a bone flap, decontamination by rinsing in an alcohol-chlorhexidine solution followed by 3 successive washes in saline seemed to provide the best balance between effectiveness, safety, and complexity of the method.

背景和目的:在神经外科医生的职业生涯中,有 66% 的医生会目睹有人在开颅手术过程中不小心将骨瓣掉在地上。虽然这种情况很少见,但它可能会给患者带来严重后果,而且几乎没有文献可以指导对这种并发症的处理。我们的目的是比较五种骨瓣去污方案在减少细菌负荷方面的效果,从而安全地重新植入掉落的骨瓣:方法:尸体人体骨瓣受到手术室常见杂菌的污染。然后对骨瓣进行以下五种去污方案中的一种:生理盐水清洗、机械清创、抗生素清洗、洗必泰酒精消毒剂清洗和高压灭菌器快速去污。然后用皮瓣上的接种物在培养皿中培养细菌,并对去污后的细菌量进行评估。一些皮瓣被实际掉落在手术室地板上,以模拟和评估现实生活中的污染情况:结果:从掉落在手术室地板上的皮瓣观察到的污染可能很严重(每个皮瓣最多可培养出 1070 个菌落形成单位)。所有测试方案都在不同程度上减少了骨瓣上的细菌量:生理盐水减少 95.7%,机械清创减少 97.5%,抗生素浴减少 99.5%,酒精洗必泰减少 99.9%,闪光灭菌减少 100.0%。闪光灭菌会导致皮瓣外观的明显改变:结论:在骨瓣意外脱落的情况下,先用酒精-洗必泰溶液冲洗,再用生理盐水连续冲洗 3 次,似乎能在有效性、安全性和方法的复杂性之间取得最佳平衡。
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引用次数: 0
Letter: Application and Safety of Externally Controlled Metronomic Drug Delivery to the Brain by an Implantable Smart Pump in a Sheep Model. 信:在绵羊模型中通过植入式智能泵向大脑输送外部控制的元组学药物的应用和安全性
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-19 DOI: 10.1227/neu.0000000000003285
Mingsheng Huang, Yiheng Liu
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引用次数: 0
The Management of Symptomatic Moyamoya Disease in Pediatric Patients: A Systematic Review and Meta-Analysis. 小儿无症状莫亚莫亚病的治疗:系统回顾与元分析》。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-14 DOI: 10.1227/neu.0000000000003277
Ataollah Shahbandi, Shahab Aldin Sattari, Tej D Azad, Yuanxuan Xia, Kurt Lehner, Wuyang Yang, James Feghali, Rebecca A Reynolds, S Hassan A Akbari, Mari L Groves, Risheng Xu, Justin M Caplan, Chetan Bettegowda, Alan R Cohen, Judy Huang, Rafael J Tamargo, L Fernando Gonzalez

Background and objectives: The optimal management strategy for pediatric patients with symptomatic moyamoya disease (MMD) is not well established. This systematic review and meta-analysis compares surgical vs conservative management and direct/combined bypass (DB/CB) vs indirect bypass (IB) for pediatric patients with symptomatic MMD.

Methods: MEDLINE and PubMed were searched from inception to March 17, 2024. For analysis of surgical vs conservative treatment, the primary and secondary outcomes were follow-up ischemic stroke and intracranial hemorrhagic events, respectively. For analysis of DB/CB vs IB, the primary outcome was follow-up ischemic stroke, and secondary outcomes included follow-up transient ischemic attack, new or worsened seizures, symptomatic improvement, modified Rankin Scale score ≤2, and Matsushima grade A at the last follow-up.

Results: Twenty-two included studies yielded 1091 patients, with a median follow-up duration of 35.7 months. Regarding surgical vs conservative management, 428 patients were analyzed. Surgical treatment was associated with lower odds of ischemic stroke (odds ratios [OR] = 0.33 [95% CI, 0.11-0.97], P = .04), and intracranial hemorrhagic events tended to be lower with surgery (OR = 0.25 [0.06-1.03], P = .05). Regarding DB/CB techniques vs IB, 875 patients were analyzed. The groups had similar rates of ischemic stroke (OR = 0.79 [0.31-1.97], P = .61), transient ischemic attack (OR = 1.27[0.46-3.55], P = .64), new or worsened seizures (OR = 1.05[0.3-3.65], P = .93), symptomatic improvement (OR = 2.45[0.71-8.45], P = .16), and follow-up modified Rankin Scale ≤2 (OR = 1.21 [0.16-8.85], P = .85). CB was associated with higher Matsushima grade A relative to IB (OR = 3.44 [1.32-9.97], P = .01).

Conclusion: Surgical revascularization yielded more favorable clinical outcomes than conservative management in this meta-analysis. Clinical outcomes were similar between DB/CB vs IB techniques. Surgical flow augmentation, either by DB/CB or IB, seems to benefit pediatric patients with symptomatic MMD.

背景和目的:无症状莫亚莫亚氏病(MMD)儿科患者的最佳治疗策略尚未明确。本系统综述和荟萃分析比较了手术与保守治疗、直接/联合分流术(DB/CB)与间接分流术(IB)对无症状莫亚莫亚氏病儿科患者的治疗效果:方法:检索了从开始到 2024 年 3 月 17 日的 MEDLINE 和 PubMed。对于手术治疗与保守治疗的分析,主要和次要结果分别为随访缺血性中风和颅内出血事件。对于 DB/CB 与 IB 的分析,主要结果是随访缺血性卒中,次要结果包括随访短暂性脑缺血发作、新的或恶化的癫痫发作、症状改善、修改后的 Rankin 量表评分≤2,以及最后一次随访时的松岛 A 级:22项研究共纳入1091名患者,中位随访时间为35.7个月。在手术治疗与保守治疗方面,共分析了 428 例患者。手术治疗与较低的缺血性卒中几率相关(几率比 [OR] = 0.33 [95% CI, 0.11-0.97],P = .04),手术治疗往往降低颅内出血事件(OR = 0.25 [0.06-1.03],P = .05)。关于DB/CB技术与IB技术,共分析了875名患者。两组患者发生缺血性中风(OR = 0.79 [0.31-1.97],P = .61)、短暂性脑缺血发作(OR = 1.27[0.46-3.55],P = .64)、新的或恶化的癫痫发作(OR = 1.05[0.3-3.65],P = .93)、症状改善(OR = 2.45[0.71-8.45],P = .16)和随访修正的 Rankin 量表≤2(OR = 1.21 [0.16-8.85],P = .85)。相对于 IB,CB 与较高的松岛 A 级相关(OR = 3.44 [1.32-9.97],P = .01):结论:在这项荟萃分析中,与保守治疗相比,手术血管重建的临床疗效更佳。DB/CB与IB技术的临床效果相似。无论是通过 DB/CB 还是 IB 进行手术血流增强,似乎都能为有症状的 MMD 儿科患者带来益处。
{"title":"The Management of Symptomatic Moyamoya Disease in Pediatric Patients: A Systematic Review and Meta-Analysis.","authors":"Ataollah Shahbandi, Shahab Aldin Sattari, Tej D Azad, Yuanxuan Xia, Kurt Lehner, Wuyang Yang, James Feghali, Rebecca A Reynolds, S Hassan A Akbari, Mari L Groves, Risheng Xu, Justin M Caplan, Chetan Bettegowda, Alan R Cohen, Judy Huang, Rafael J Tamargo, L Fernando Gonzalez","doi":"10.1227/neu.0000000000003277","DOIUrl":"10.1227/neu.0000000000003277","url":null,"abstract":"<p><strong>Background and objectives: </strong>The optimal management strategy for pediatric patients with symptomatic moyamoya disease (MMD) is not well established. This systematic review and meta-analysis compares surgical vs conservative management and direct/combined bypass (DB/CB) vs indirect bypass (IB) for pediatric patients with symptomatic MMD.</p><p><strong>Methods: </strong>MEDLINE and PubMed were searched from inception to March 17, 2024. For analysis of surgical vs conservative treatment, the primary and secondary outcomes were follow-up ischemic stroke and intracranial hemorrhagic events, respectively. For analysis of DB/CB vs IB, the primary outcome was follow-up ischemic stroke, and secondary outcomes included follow-up transient ischemic attack, new or worsened seizures, symptomatic improvement, modified Rankin Scale score ≤2, and Matsushima grade A at the last follow-up.</p><p><strong>Results: </strong>Twenty-two included studies yielded 1091 patients, with a median follow-up duration of 35.7 months. Regarding surgical vs conservative management, 428 patients were analyzed. Surgical treatment was associated with lower odds of ischemic stroke (odds ratios [OR] = 0.33 [95% CI, 0.11-0.97], P = .04), and intracranial hemorrhagic events tended to be lower with surgery (OR = 0.25 [0.06-1.03], P = .05). Regarding DB/CB techniques vs IB, 875 patients were analyzed. The groups had similar rates of ischemic stroke (OR = 0.79 [0.31-1.97], P = .61), transient ischemic attack (OR = 1.27[0.46-3.55], P = .64), new or worsened seizures (OR = 1.05[0.3-3.65], P = .93), symptomatic improvement (OR = 2.45[0.71-8.45], P = .16), and follow-up modified Rankin Scale ≤2 (OR = 1.21 [0.16-8.85], P = .85). CB was associated with higher Matsushima grade A relative to IB (OR = 3.44 [1.32-9.97], P = .01).</p><p><strong>Conclusion: </strong>Surgical revascularization yielded more favorable clinical outcomes than conservative management in this meta-analysis. Clinical outcomes were similar between DB/CB vs IB techniques. Surgical flow augmentation, either by DB/CB or IB, seems to benefit pediatric patients with symptomatic MMD.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668640","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
Predictive Value of Neurosurgery Applicant Metrics on Resident Academic Productivity. 神经外科申请人指标对住院医师学术生产力的预测价值。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-11 DOI: 10.1227/neu.0000000000003251
Lauren Banko, Nathan Riesenburger, Ruchit V Patel, Courtney Gilligan, G Rees Cosgrove, E Antonio Chiocca, Mark R Proctor, Akash J Patel, Wenya Linda Bi

Background and objectives: Scholarship has been critical to neurosurgery. As grades and board examinations become pass-fail, finding metrics to distinguish applicants coupled with an emphasis on research has led to growth of reported academic output among neurosurgery applicants. We aimed to evaluate applicant factors that associate with an academically productive neurosurgery resident.

Methods: Applicant characteristics were extracted from Electronic Residency Application Service archives from 2 geographically distinct neurosurgical programs for the 2014 to 2015 match cycle. Publications during residency were quantified, and residency careers were examined. Factors associated with residency publications were examined using univariate and multivariate regressions.

Results: A total of 228 United States (US) applicants to neurosurgery were assessed (89% of US neurosurgery applicants), with 173 matching across 93 programs. The average publication number of matched applicants was higher at 6.6 (median: 4, range: 0-43) that of than unmatched applicants (mean: 2.9, median: 1, range: 0-51). A total of 93.1% of publications were substantiated on PubMed review. Matched candidates published 19.3 manuscripts (median: 13, range: 0-120) on average during residency. On univariate analysis, factors associated with higher residency publications included taking a non-degree-granting extra year for research in medical school, consistently high clerkship grades, depth of preresidency research involvement, number of coresidents, program R25 status, and academic output of neurosurgery department leadership. After multivariate correction, the training environment played an outsized role in predicting resident academic output, with program R25 status significantly associated with resident academic output (odds ratio: 1.25, P = .012). Taking an extra research year in medical school approached but was not significant (odds ratio: 1.19, P = .099). Twelve matched international medical school graduates (IMGs) were also assessed (75% of matched IMG neurosurgery applicants). IMGs exhibited higher total publications and conference abstracts than US matched applicants and also published more during residency.

Conclusion: Cultivating an environment that promotes research endeavors is critical for neurosurgical resident academic growth. Preresidency publication number does not predict publication potential during residency.

背景和目的:奖学金对神经外科至关重要。随着成绩和委员会考试成为及格-不及格考试,找到区分申请人的指标以及对研究的重视导致神经外科申请人的学术成果报告增加。我们旨在评估与神经外科住院医师学术成果相关的申请人因素:从两个地理位置不同的神经外科项目的电子住院医师申请服务档案中提取了2014至2015年匹配周期的申请人特征。对住院医师实习期间发表的论文进行量化,并对住院医师的职业生涯进行考察。使用单变量和多变量回归分析了与住院实习期间发表论文相关的因素:共评估了228名美国神经外科申请人(占美国神经外科申请人的89%),其中173人与93个项目匹配。匹配申请人的平均发表论文数量为 6.6 篇(中位数:4 篇,范围:0-43),高于未匹配申请人(平均:2.9 篇,中位数:1 篇,范围:0-51)。共有 93.1% 的论文在 PubMed 上得到证实。匹配的候选人在住院实习期间平均发表了 19.3 篇文章(中位数:13 篇,范围:0-120 篇)。通过单变量分析,与住院医师发表更多论文相关的因素包括:在医学院学习期间参加了一年不授予学位的额外研究、实习成绩一直很高、住院前参与研究的深度、核心住院医师的数量、项目 R25 状态以及神经外科领导的学术成果。经过多变量校正后,培训环境在预测住院医师的学术成果方面发挥了重要作用,R25项目状态与住院医师的学术成果显著相关(几率比:1.25,P = .012)。在医学院多读一年研究课程与住院医师的学术产出关系密切,但并不显著(几率比:1.19,P = .099)。12 名匹配的国际医学院毕业生(IMG)也接受了评估(占匹配的 IMG 神经外科申请人的 75%)。与美国匹配的申请者相比,IMG 发表的论文和会议摘要总数更高,在住院实习期间发表的论文也更多:结论:营造一个促进研究工作的环境对神经外科住院医师的学术成长至关重要。住院实习前的论文数量并不能预测住院实习期间的论文潜力。
{"title":"Predictive Value of Neurosurgery Applicant Metrics on Resident Academic Productivity.","authors":"Lauren Banko, Nathan Riesenburger, Ruchit V Patel, Courtney Gilligan, G Rees Cosgrove, E Antonio Chiocca, Mark R Proctor, Akash J Patel, Wenya Linda Bi","doi":"10.1227/neu.0000000000003251","DOIUrl":"https://doi.org/10.1227/neu.0000000000003251","url":null,"abstract":"<p><strong>Background and objectives: </strong>Scholarship has been critical to neurosurgery. As grades and board examinations become pass-fail, finding metrics to distinguish applicants coupled with an emphasis on research has led to growth of reported academic output among neurosurgery applicants. We aimed to evaluate applicant factors that associate with an academically productive neurosurgery resident.</p><p><strong>Methods: </strong>Applicant characteristics were extracted from Electronic Residency Application Service archives from 2 geographically distinct neurosurgical programs for the 2014 to 2015 match cycle. Publications during residency were quantified, and residency careers were examined. Factors associated with residency publications were examined using univariate and multivariate regressions.</p><p><strong>Results: </strong>A total of 228 United States (US) applicants to neurosurgery were assessed (89% of US neurosurgery applicants), with 173 matching across 93 programs. The average publication number of matched applicants was higher at 6.6 (median: 4, range: 0-43) that of than unmatched applicants (mean: 2.9, median: 1, range: 0-51). A total of 93.1% of publications were substantiated on PubMed review. Matched candidates published 19.3 manuscripts (median: 13, range: 0-120) on average during residency. On univariate analysis, factors associated with higher residency publications included taking a non-degree-granting extra year for research in medical school, consistently high clerkship grades, depth of preresidency research involvement, number of coresidents, program R25 status, and academic output of neurosurgery department leadership. After multivariate correction, the training environment played an outsized role in predicting resident academic output, with program R25 status significantly associated with resident academic output (odds ratio: 1.25, P = .012). Taking an extra research year in medical school approached but was not significant (odds ratio: 1.19, P = .099). Twelve matched international medical school graduates (IMGs) were also assessed (75% of matched IMG neurosurgery applicants). IMGs exhibited higher total publications and conference abstracts than US matched applicants and also published more during residency.</p><p><strong>Conclusion: </strong>Cultivating an environment that promotes research endeavors is critical for neurosurgical resident academic growth. Preresidency publication number does not predict publication potential during residency.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624585","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
Brain Abscess Causes Brain Damage With Long-Lasting Focal Cerebral Hypoactivity that Correlates With Abscess Size: A Cross-Sectional 18F-Fluoro-Deoxyglucose Positron Emission Tomography Study. 脑脓肿导致脑损伤,并伴有与脓肿大小相关的长期局灶性脑缺氧:18F-氟-脱氧葡萄糖正电子发射断层扫描横断面研究。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-11 DOI: 10.1227/neu.0000000000003268
Ebba Gløersen Müller, Daniel Dahlberg, Bjørnar Hassel, Mona-Elisabeth Revheim, James Patrick Connelly

Background and objectives: Bacterial brain abscesses may have long-term clinical consequences, eg, mental fatigue or epilepsy, but long-term structural consequences to the brain remain underexplored. We asked if brain abscesses damage brain activity long term, if the extent of such damage depends on the size of the abscess, and if the abscess capsule, which is often left in place during neurosurgery, remains a site of inflammation, which could explain long-lasting symptoms in patients with brain abscess.

Methods: 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT), electroencephalography, and MRI were performed 2 days to 9 years after neurosurgery for bacterial brain abscess.

Results: FDG-PET/CT revealed hypometabolism in the neocortex or cerebellum overlying the previous bacterial abscess in 38 of 40 patients. The larger the abscess, the greater was the extent of the subsequent hypometabolism (r = 0.63; p = 3 × 10-5). In 9 patients, the extent of subsequent hypometabolism seemed to coincide with the extent of peri-abscess edema in the acute phase. Follow-up MRI after ≥1 year in 9 patients showed focal tissue loss and gliosis. In 13 patients with abnormal electroencephalography recordings, abnormalities extended beyond the cerebral lobe affected by the abscess, indicating damage to wider brain networks. The abscess capsule had an FDG signal indicating inflammation only during the first week after neurosurgical pus drainage.

Conclusion: The bigger a brain abscess is allowed to grow, the more extensive is the long-term focal reduction in brain activity. This finding emphasizes the need for rapid neurosurgical intervention. The abscess capsule does not display long-lasting inflammation and probably does not explain long-term symptoms after brain abscess.

背景和目的:细菌性脑脓肿可能会造成长期的临床后果,如精神疲劳或癫痫,但对大脑结构造成的长期后果仍未得到充分研究。我们想知道脑脓肿是否会对大脑活动造成长期损害,这种损害的程度是否取决于脓肿的大小,以及在神经外科手术中经常被留在原位的脓肿囊是否仍然是炎症部位,这可能是脑脓肿患者出现长期症状的原因。方法:在细菌性脑脓肿神经外科手术后 2 天至 9 年进行 2-[18F]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描(FDG-PET/CT)、脑电图和核磁共振成像检查:结果:40 名患者中有 38 人的 FDG-PET/CT 显示,先前细菌性脓肿上覆盖的新皮层或小脑代谢减低。脓肿越大,后续代谢减低的程度越高(r = 0.63;p = 3×10-5)。在 9 例患者中,后续代谢减低的程度似乎与急性期脓肿周围水肿的程度一致。9 名患者≥1 年后的随访核磁共振成像显示局灶性组织缺失和胶质增生。在13名脑电图记录异常的患者中,异常范围超出了受脓肿影响的脑叶,表明更广泛的大脑网络受到了损害。脓肿囊只有在神经外科手术排脓后的第一周才出现 FDG 信号,表明存在炎症:结论:脑脓肿长得越大,大脑活动的长期局灶性减退就越广泛。结论:脑脓肿长得越大,大脑活动的长期局灶性减退就越广泛,这一发现强调了迅速进行神经外科干预的必要性。脓肿囊并不显示长期炎症,因此可能无法解释脑脓肿后的长期症状。
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引用次数: 0
Outcomes of Radiosurgery for WHO Grade 2 Meningiomas: The Role of Ki-67 Index in Guiding the Tumor Margin Dose. 放射外科治疗 WHO 2 级脑膜瘤的疗效:Ki-67指数在指导肿瘤边缘剂量中的作用
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-11 DOI: 10.1227/neu.0000000000003255
Ying Meng, Kenneth Bernstein, Elad Mashiach, Brandon Santhumayor, Nivedha Kannapadi, Jason Gurewitz, Matija Snuderl, Donato Pacione, Chandra Sen, Bernadine Donahue, Joshua S Silverman, Erik Sulman, John Golfinos, Douglas Kondziolka

Background and objectives: The management of World Health Organization (WHO) grade 2 meningiomas is complicated by their diverse clinical behaviors. Stereotactic radiosurgery (SRS) can be an effective management option. Literature on SRS dose selection is limited but suggests that a higher dose is better for tumor control. We characterize the predictors of post-SRS outcomes that can help guide planning and management.

Methods: We reviewed a cohort of consecutive patients with pathologically-proven WHO grade 2 meningiomas who underwent SRS at a single institution between 2011 and 2023.

Results: Ninety-nine patients (median age 62 years) underwent SRS, 11 of whom received hypofractionated SRS in 5 fractions. Twenty-two patients had received previous irradiation. The median follow-up was 49 months. The median overall survival was 119 months (95% CI 92-NA) with estimated 5- and 10-year survival of 83% and 27%, respectively. The median progression-free survival (PFS) was 40 months (95% CI 32-62), with 3- and 5-year rates at 54% and 35%, respectively. The median locomarginal PFS was 63 months (95% CI 51.8-NA) with 3- and 5-year rates at 65% and 52%. Nine (9%) patients experienced adverse events, 2 Common Terminology Criteria for Adverse Events grade 3 and 7 grade 2, consisting of worsening neurologic deficit from edema. In the single-session cohort, Ki-67 significantly predicted both overall survival and intracranial PFS. Tumors with Ki-67 >10% had 2.17 times the risk of locomarginal progression compared with Ki-67 ≤10% (P = .018) adjusting for covariates. Sex, prescription dose, tumor volume, and location also predicted tumor control. In tumors with Ki-67 >10%, margin dose ≥14 Gy was associated with significantly better tumor control but not for tumors with Ki-67 ≤10%.

Conclusion: The management of WHO grade 2 meningiomas requires a multimodality approach. This study demonstrates the value of a targeted SRS approach in patients with limited disease and further establishes predictive biomarkers that can guide planning through a personalized approach.

背景和目的:世界卫生组织(WHO)2 级脑膜瘤的临床表现多种多样,因此其治疗非常复杂。立体定向放射手术(SRS)是一种有效的治疗方法。有关 SRS 剂量选择的文献有限,但表明剂量越大,肿瘤控制效果越好。我们分析了 SRS 术后结果的预测因素,这些因素有助于指导计划和管理:我们回顾了 2011 年至 2023 年期间在一家医疗机构接受 SRS 治疗的病理证实为 WHO 2 级脑膜瘤的连续患者队列:99名患者(中位年龄62岁)接受了SRS治疗,其中11人接受了5次分割的低分量SRS治疗。22名患者曾接受过放射治疗。中位随访时间为49个月。中位总生存期为119个月(95% CI 92-NA),估计5年和10年生存率分别为83%和27%。无进展生存期(PFS)中位数为 40 个月(95% CI 32-62),3 年和 5 年生存率分别为 54% 和 35%。局部无进展生存期中位数为 63 个月(95% CI 51.8-NA),3 年和 5 年生存率分别为 65% 和 52%。9名患者(9%)发生了不良事件,其中2例为不良事件通用术语标准3级,7例为2级,包括水肿导致的神经功能缺损恶化。在单次治疗队列中,Ki-67可显著预测总生存期和颅内PFS。与 Ki-67 ≤10% 的肿瘤相比,Ki-67 >10% 的肿瘤局部进展风险是 Ki-67 ≤10% 的 2.17 倍(P = .018),调整协变量后,Ki-67 ≤10% 的肿瘤局部进展风险是 Ki-67 ≤10% 的 2.17 倍(P = .018)。性别、处方剂量、肿瘤体积和位置也可预测肿瘤控制情况。在Ki-67>10%的肿瘤中,边缘剂量≥14 Gy与明显较好的肿瘤控制率相关,但与Ki-67≤10%的肿瘤无关:结论:WHO 2级脑膜瘤的治疗需要采用多模式方法。这项研究证明了有针对性的SRS方法在局限性疾病患者中的价值,并进一步确定了可通过个性化方法指导计划的预测性生物标志物。
{"title":"Outcomes of Radiosurgery for WHO Grade 2 Meningiomas: The Role of Ki-67 Index in Guiding the Tumor Margin Dose.","authors":"Ying Meng, Kenneth Bernstein, Elad Mashiach, Brandon Santhumayor, Nivedha Kannapadi, Jason Gurewitz, Matija Snuderl, Donato Pacione, Chandra Sen, Bernadine Donahue, Joshua S Silverman, Erik Sulman, John Golfinos, Douglas Kondziolka","doi":"10.1227/neu.0000000000003255","DOIUrl":"https://doi.org/10.1227/neu.0000000000003255","url":null,"abstract":"<p><strong>Background and objectives: </strong>The management of World Health Organization (WHO) grade 2 meningiomas is complicated by their diverse clinical behaviors. Stereotactic radiosurgery (SRS) can be an effective management option. Literature on SRS dose selection is limited but suggests that a higher dose is better for tumor control. We characterize the predictors of post-SRS outcomes that can help guide planning and management.</p><p><strong>Methods: </strong>We reviewed a cohort of consecutive patients with pathologically-proven WHO grade 2 meningiomas who underwent SRS at a single institution between 2011 and 2023.</p><p><strong>Results: </strong>Ninety-nine patients (median age 62 years) underwent SRS, 11 of whom received hypofractionated SRS in 5 fractions. Twenty-two patients had received previous irradiation. The median follow-up was 49 months. The median overall survival was 119 months (95% CI 92-NA) with estimated 5- and 10-year survival of 83% and 27%, respectively. The median progression-free survival (PFS) was 40 months (95% CI 32-62), with 3- and 5-year rates at 54% and 35%, respectively. The median locomarginal PFS was 63 months (95% CI 51.8-NA) with 3- and 5-year rates at 65% and 52%. Nine (9%) patients experienced adverse events, 2 Common Terminology Criteria for Adverse Events grade 3 and 7 grade 2, consisting of worsening neurologic deficit from edema. In the single-session cohort, Ki-67 significantly predicted both overall survival and intracranial PFS. Tumors with Ki-67 >10% had 2.17 times the risk of locomarginal progression compared with Ki-67 ≤10% (P = .018) adjusting for covariates. Sex, prescription dose, tumor volume, and location also predicted tumor control. In tumors with Ki-67 >10%, margin dose ≥14 Gy was associated with significantly better tumor control but not for tumors with Ki-67 ≤10%.</p><p><strong>Conclusion: </strong>The management of WHO grade 2 meningiomas requires a multimodality approach. This study demonstrates the value of a targeted SRS approach in patients with limited disease and further establishes predictive biomarkers that can guide planning through a personalized approach.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624582","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
Neurosurgery Fellowships and the Residencies That Enfold Them: A Nationwide Correlational Analysis. 神经外科研究员和支持他们的住院医生:一项全国性的相关分析。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-08 DOI: 10.1227/neu.0000000000003272
Raahim Bashir, Grahame C Gould, Jonathan P Miller

Background and objectives: Accredited neurosurgery fellowship training is available in 10 subspecialties and can sometimes be completed during the postgraduate year (PGY)-7 residency year. However, it is not clear whether there are sufficient residency graduates to fill the number of positions available, and residency curriculum structure to support enfolded training is evolving.

Methods: Detailed information about the 117 accredited neurosurgery residency programs and the 282 accredited neurosurgery fellowships was obtained from the Accreditation Council for Graduate Medical Education and Committee on Advanced Subspecialty Training, respectively. Information about residency chief year structure (PGY-6 vs PGY-7) was obtained electronically from each program. An analysis was performed to correlate residency and fellowship training characteristics at each program.

Results: The total number of neurosurgery fellowship positions available per year (352) is much higher than the total number of residency positions (237). Eighty-eight (75%) institutions with a neurosurgery residency offer at least 1 fellowship, and 51 of these have more fellowships than graduating residents. The resident complement at each program correlates with the number of fellowships offered (r2 = .56, P < .05), and the average institutional resident complement where fellowships are offered is greater than 2 per year. Thirty-eight residencies (32%) use a PGY-6 chief model (allowing for enfolded fellowships), and these programs offer significantly more fellowship programs on average than those using a traditional PGY-7 chief model (3.0 vs 2.1, P < .05). For most subspecialties, a minority of fellowships are offered in programs with a PGY-6 chief model.

Conclusion: The number of accredited neurosurgery subspecialty fellowship slots in the United States far exceeds the number of graduating neurosurgery residents. There is no standard for residency curriculum or enfolded fellowships, but smaller programs offer fewer opportunities for subspecialty training. There may be advantages to a uniform approach that standardizes subspecialty training across programs and matches fellowship availability to demand.

背景和目标:目前有 10 个亚专科提供经认可的神经外科研究员培训,有时可在研究生年(PGY)-7 实习年期间完成。然而,目前尚不清楚是否有足够的住院医师培训毕业生来填补现有的职位数量,而且支持住院医师培训的课程结构也在不断发展:方法:我们分别从毕业后医学教育认证委员会(Accreditation Council for Graduate Medical Education)和高级亚专科培训委员会(Committee on Advanced Subspecialty Training)获得了117个经认证的神经外科住院医师培训项目和282个经认证的神经外科奖学金的详细信息。每个项目都以电子方式提供了有关住院实习主任年级结构(PGY-6 与 PGY-7)的信息。对每个项目的住院医师和研究员培训特点进行了相关分析:结果:每年可提供的神经外科研究员职位总数(352 个)远高于住院医师职位总数(237 个)。88所(75%)设有神经外科住院医师培训项目的院校至少提供一个研究金名额,其中51所院校的研究金名额多于毕业住院医师人数。每个项目的住院医师编制与提供的研究金数量相关(r2 = .56,P < .05),提供研究金的机构住院医师编制平均每年超过 2 人。38家住院医师培训机构(32%)采用了PGY-6主任模式(允许包含研究金),这些机构平均提供的研究金项目明显多于采用传统PGY-7主任模式的机构(3.0 vs 2.1,P < .05)。对于大多数亚专科而言,采用PGY-6主任模式的项目只提供少数研究金项目:结论:美国经认可的神经外科亚专科奖学金名额远远超过神经外科住院医师的毕业人数。住院医师课程或住院研究金没有标准,但规模较小的项目提供的亚专科培训机会较少。采用统一的方法将各项目中的亚专科培训标准化并使研究金名额与需求相匹配可能会有好处。
{"title":"Neurosurgery Fellowships and the Residencies That Enfold Them: A Nationwide Correlational Analysis.","authors":"Raahim Bashir, Grahame C Gould, Jonathan P Miller","doi":"10.1227/neu.0000000000003272","DOIUrl":"https://doi.org/10.1227/neu.0000000000003272","url":null,"abstract":"<p><strong>Background and objectives: </strong>Accredited neurosurgery fellowship training is available in 10 subspecialties and can sometimes be completed during the postgraduate year (PGY)-7 residency year. However, it is not clear whether there are sufficient residency graduates to fill the number of positions available, and residency curriculum structure to support enfolded training is evolving.</p><p><strong>Methods: </strong>Detailed information about the 117 accredited neurosurgery residency programs and the 282 accredited neurosurgery fellowships was obtained from the Accreditation Council for Graduate Medical Education and Committee on Advanced Subspecialty Training, respectively. Information about residency chief year structure (PGY-6 vs PGY-7) was obtained electronically from each program. An analysis was performed to correlate residency and fellowship training characteristics at each program.</p><p><strong>Results: </strong>The total number of neurosurgery fellowship positions available per year (352) is much higher than the total number of residency positions (237). Eighty-eight (75%) institutions with a neurosurgery residency offer at least 1 fellowship, and 51 of these have more fellowships than graduating residents. The resident complement at each program correlates with the number of fellowships offered (r2 = .56, P < .05), and the average institutional resident complement where fellowships are offered is greater than 2 per year. Thirty-eight residencies (32%) use a PGY-6 chief model (allowing for enfolded fellowships), and these programs offer significantly more fellowship programs on average than those using a traditional PGY-7 chief model (3.0 vs 2.1, P < .05). For most subspecialties, a minority of fellowships are offered in programs with a PGY-6 chief model.</p><p><strong>Conclusion: </strong>The number of accredited neurosurgery subspecialty fellowship slots in the United States far exceeds the number of graduating neurosurgery residents. There is no standard for residency curriculum or enfolded fellowships, but smaller programs offer fewer opportunities for subspecialty training. There may be advantages to a uniform approach that standardizes subspecialty training across programs and matches fellowship availability to demand.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605832","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
Diagnostic Accuracy of Optic Nerve Sheath Diameter Measurement by Ultrasonography for Noninvasive Estimation of Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review and Meta-Analysis. 用超声波测量视神经鞘直径对创伤性脑损伤患者颅内高压进行无创评估的诊断准确性:系统回顾与元分析》。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-08 DOI: 10.1227/neu.0000000000003273
Maria José Uparela-Reyes, Sebastian Ordoñez-Cure, Johana Moreno-Drada, Lina María Villegas-Trujillo, Oscar Andrés Escobar-Vidarte

Background and objectives: Intracranial hypertension (IH) is associated with an unfavorable outcome in traumatic brain injury (TBI), and management strategies guided by intracranial pressure monitoring improve prognosis. Owing to the limitations of using invasive devices, measurement of optic nerve sheath diameter (ONSD) by ultrasonography is an alternative noninvasive method. However, its accuracy has not been validated in patients with TBI, so we aim to determine the diagnostic accuracy of measuring ONSD by ultrasonography in patients with TBI to estimate IH, compared with invasive monitoring.

Methods: Systematic review of electronic databases and manual literature review from inception to June 2023. The analysis included diagnostic accuracy studies of ultrasonographic measurement of ONSD compared with invasive monitoring published in any language and with patients of any age. A qualitative synthesis was performed describing the clinical and methodological characteristics, strengths, limitations, and quality of evidence. In addition, a bivariate random effects model meta-analysis and a hierarchical summary receiver operating characteristics model were performed for the pediatric and adult population separately.

Results: Five hundred and forty eight patients of 688 in 16 eligible studies were adults and 120 were children. Pooled sensitivity and specificity of ONSD measurement by ultrasonography were 84% (95% CI, 76%-89%) and 83% (95% CI, 73%-90%), respectively. During the sensitivity analysis, these parameters exhibited consistent values. Pooled area under the curve was 0.91 for adults and 0.76 for children. Optimal threshold for estimating IH was 5.76 mm for adults and 5.78 mm for children.

Conclusion: Measurement of ONSD by ultrasonography is a reliable, low-cost, and safe alternative for the estimation of IH with TBI in adults. More robust studies are needed to overcome the high risk of bias and heterogeneity for this analysis.

背景和目的:颅内高压(IH)与创伤性脑损伤(TBI)的不良预后有关,通过颅内压监测指导的管理策略可改善预后。由于使用侵入性设备的局限性,通过超声波测量视神经鞘直径(ONSD)是一种替代性无创方法。然而,其准确性尚未在创伤性脑损伤患者中得到验证,因此我们旨在确定在创伤性脑损伤患者中通过超声波测量视神经鞘直径以估测 IH 的诊断准确性,并与有创监测进行比较:方法:对电子数据库进行系统回顾,并对从开始到 2023 年 6 月的文献进行人工回顾。分析包括以任何语言发表的、针对任何年龄段患者的超声波测量ONSD与有创监测相比的诊断准确性研究。研究人员对这些研究的临床和方法学特征、优势、局限性和证据质量进行了定性综合。此外,还针对儿童和成人人群分别进行了双变量随机效应模型荟萃分析和分层汇总接收者操作特征模型:在16项符合条件的研究中,688名患者中有548名是成人,120名是儿童。通过超声波检查测量 ONSD 的汇总敏感性和特异性分别为 84%(95% CI,76%-89%)和 83%(95% CI,73%-90%)。在敏感性分析中,这些参数显示出一致的数值。成人和儿童的汇总曲线下面积分别为 0.91 和 0.76。成人估计 IH 的最佳阈值为 5.76 毫米,儿童为 5.78 毫米:结论:通过超声波测量 ONSD 是一种可靠、低成本且安全的替代方法,可用于估计成人 TBI IH。要克服该分析的高偏倚风险和异质性,还需要更多可靠的研究。
{"title":"Diagnostic Accuracy of Optic Nerve Sheath Diameter Measurement by Ultrasonography for Noninvasive Estimation of Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review and Meta-Analysis.","authors":"Maria José Uparela-Reyes, Sebastian Ordoñez-Cure, Johana Moreno-Drada, Lina María Villegas-Trujillo, Oscar Andrés Escobar-Vidarte","doi":"10.1227/neu.0000000000003273","DOIUrl":"https://doi.org/10.1227/neu.0000000000003273","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intracranial hypertension (IH) is associated with an unfavorable outcome in traumatic brain injury (TBI), and management strategies guided by intracranial pressure monitoring improve prognosis. Owing to the limitations of using invasive devices, measurement of optic nerve sheath diameter (ONSD) by ultrasonography is an alternative noninvasive method. However, its accuracy has not been validated in patients with TBI, so we aim to determine the diagnostic accuracy of measuring ONSD by ultrasonography in patients with TBI to estimate IH, compared with invasive monitoring.</p><p><strong>Methods: </strong>Systematic review of electronic databases and manual literature review from inception to June 2023. The analysis included diagnostic accuracy studies of ultrasonographic measurement of ONSD compared with invasive monitoring published in any language and with patients of any age. A qualitative synthesis was performed describing the clinical and methodological characteristics, strengths, limitations, and quality of evidence. In addition, a bivariate random effects model meta-analysis and a hierarchical summary receiver operating characteristics model were performed for the pediatric and adult population separately.</p><p><strong>Results: </strong>Five hundred and forty eight patients of 688 in 16 eligible studies were adults and 120 were children. Pooled sensitivity and specificity of ONSD measurement by ultrasonography were 84% (95% CI, 76%-89%) and 83% (95% CI, 73%-90%), respectively. During the sensitivity analysis, these parameters exhibited consistent values. Pooled area under the curve was 0.91 for adults and 0.76 for children. Optimal threshold for estimating IH was 5.76 mm for adults and 5.78 mm for children.</p><p><strong>Conclusion: </strong>Measurement of ONSD by ultrasonography is a reliable, low-cost, and safe alternative for the estimation of IH with TBI in adults. More robust studies are needed to overcome the high risk of bias and heterogeneity for this analysis.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605871","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
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Neurosurgery
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