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Technical Feasibility of Delineating the Thalamic Gustatory Tract Using Tractography. 利用瓣膜成像技术划分丘脑咽喉瓣的技术可行性
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-21 DOI: 10.1227/neu.0000000000003227
Kazuki Sakakura, Nathan Pertsch, Julia Mueller, Alireza Borghei, Nicholas Rubert, Sepehr Sani

Background and objectives: Magnetic resonance-guided focused ultrasound (MRgFUS) has been increasingly performed in recent years as a minimally invasive treatment of essential tremor and tremor-dominant Parkinson disease. One of the side effects after treatment is dysgeusia. Some centers use tractography to facilitate the treatment planning. However, there have been no reports of identifying gustatory tracts so far. Our aim was to investigate the technical feasibility of isolating and visualizing the gustatory tracts, as well as to explore the relationship between the gustatory tract and the MRgFUS lesion using actual patient data.

Methods: We used 20 randomly selected individuals from the Human Connectome Project database to perform tractography of the gustatory tracts. We defined region of interest as the dorsal region of the brainstem, Brodmann area 43 associated with taste perception, and a sphere with a 3-mm radius centered around the ventral intermediate nucleus in the anterior commissure-posterior commissure plane. We also examined the position of the gustatory tract in relation with other tracts, including the medial lemniscus, the pyramidal tract, and the dentatorubrothalamic tract. In addition, using the data of real patients with essential tremor, we investigated the distance between MRgFUS lesions and the gustatory tract and its association with the development of dysgeusia.

Results: We delineated a mean of 15 streamlines of the gustatory tracts per subject in each hemisphere. There was no statistical difference in the localization of the gustatory tracts between the left and right cerebral hemispheres. The gustatory tract was located anteromedial to the medial lemniscus and posteromedial to the dentatorubrothalamic tract in the anterior commissure-posterior commissure plane. The distance from the MRgFUS lesion to the gustatory tract was significantly shorter in the case where dysgeusia occurred compared with nondysgeusia cases (P-value: .0068).

Conclusion: The thalamic gustatory tracts can be reliably visualized using tractography.

背景和目的:近年来,磁共振引导下聚焦超声(MRgFUS)作为一种微创疗法,越来越多地用于治疗本质性震颤和震颤为主的帕金森病。治疗后的副作用之一是发音障碍。一些中心使用束流成像技术来帮助制定治疗计划。然而,迄今为止还没有关于识别味觉束的报道。我们的目的是研究分离和观察味觉束的技术可行性,并利用实际患者数据探讨味觉束与 MRgFUS 病灶之间的关系:我们从人类连接组计划数据库中随机抽取了 20 名患者,对其进行了味觉束成像。我们将感兴趣区域定义为脑干背侧区域、与味觉感知相关的布罗德曼第43区,以及前会厌-后会厌平面上以腹侧中间核为中心、半径为3毫米的球体。我们还研究了味觉束与其他束的位置关系,包括内侧半月板、锥体束和齿状突触束。此外,我们还利用本质性震颤患者的真实数据,研究了 MRgFUS 病灶与味觉束之间的距离及其与发音障碍发生的关系:我们在每个半球为每个受试者平均绘制了 15 条味觉束流线。左右大脑半球的味觉束定位没有统计学差异。在前会幕-后会幕平面上,味觉束位于内侧半月板的前内侧和齿状突眼束的后内侧。发生口吃障碍的病例与未发生口吃障碍的病例相比,MRgFUS病灶到味觉束的距离明显较短(P值:.0068):结论:丘脑味觉束可以通过束成像技术可靠地显示出来。
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引用次数: 0
Vesalius and His Manikin: An Enduring Influence on Modern Anatomic Teaching. 维萨留斯和他的人体模型:对现代解剖学教学的持久影响。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-17 DOI: 10.1227/neu.0000000000003187
Thomas J On, Yuan Xu, Jubran H Jubran, Andrea L Castillo, Ali Tayebi Meybodi, Oscar Alcantar-Garibay, T Forcht Dagi, Mark C Preul

Anatomic teaching has long informed surgical knowledge, experience, and skills. One tool for teaching that emerged during the Renaissance was the fugitive anatomic sheet, which used flap layers to reveal different levels of anatomy. In 1538, Vogtherr introduced the first fugitive sheets, which included illustrations of male and female figures with a torso paper flap that, when lifted, revealed the internal organs in a cartoonish style. The popularity of these anatomic fugitive sheets spurred an increase in small print-and-sale workshops. In 1543, Vesalius included fugitive anatomic sheets in his books Fabrica and Epitome, containing large paper flapped models that could be created by cutting out and gluing images of human internal anatomy onto a base layer. Students could tack these manikins up to a nearby wall during dissection. Significant collaboration between Vesalius and his publisher occurred to coordinate the integration of large foldable sheets featuring the cutout models into his works. Vesalius's groundbreaking discoveries, his use of the most advanced printing techniques, and his innovative teaching style are fundamental aspects of the legacy of medical education. This article shows these remarkable fugitive anatomic sheets from the original publications of Fabrica and Epitome together for the first time. It explores the innovative concepts and applications of Vesalius's unique printings.

长期以来,解剖教学一直是外科知识、经验和技能的基础。文艺复兴时期出现的一种教学工具是逃逸解剖表,它使用瓣层揭示不同层次的解剖结构。1538 年,Vogtherr 推出了第一张逃逸解剖图谱,其中包括带有躯干纸瓣的男性和女性人物插图,掀开纸瓣后,内脏便以卡通风格显露出来。这些解剖图的流行刺激了小型印刷和销售作坊的增加。1543 年,维萨里在其著作《Fabrica》和《Epitome》中收录了 "解剖逃逸薄片",其中包含大型纸制襟翼模型,可通过剪下人体内部解剖图像并粘贴在底层上制作而成。在解剖过程中,学生可以将这些人体模型粘贴在附近的墙上。维萨里和他的出版商进行了大量合作,协调将以剪纸模型为特色的大型折叠纸张融入他的作品中。维萨里的开创性发现、他对最先进印刷技术的使用以及他创新的教学风格,都是医学教育遗产的基本方面。这篇文章首次将《Fabrica》和《Epitome》原始出版物中的这些非凡的逃逸解剖图谱放在一起展示。文章探讨了维萨里独特印刷术的创新理念和应用。
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引用次数: 0
Embolic Materials' Comparison in Meningeal Artery Embolization for Chronic Subdural Hematomas: Multicenter Propensity Score-Matched Analysis of 1070 Cases. 脑膜动脉栓塞治疗慢性硬膜下血肿的栓塞材料比较:对 1070 例病例的多中心倾向评分匹配分析。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-17 DOI: 10.1227/neu.0000000000003218
Mohamed M Salem, Ahmed Helal, Avi A Gajjar, Georgios S Sioutas, Jane Khalife, Okkes Kuybu, Kate Caroll, Alex Nguyen Hoang, Ammad A Baig, Mira Salih, Cordell Baker, Gustavo Cortez, Zack Abecassis, Juan F Ruiz Rodriguez, Jason M Davies, C Michael Cawley, Howard A Riina, Alejandro M Spiotta, Alexander A Khalessi, Brian M Howard, Ricardo Hanel, Omar Tanweer, Daniel A Tonetti, Adnan H Siddiqui, Michael J Lang, Elad I Levy, Christopher S Ogilvy, Visish M Srinivasan, Peter Kan, Bradley A Gross, Brian T Jankowitz, Michael R Levitt, Ajith J Thomas, Ramesh Grandhi, Jan-Karl Burkhardt

Background and objectives: Multiple preferences exist for embolic materials selection in middle meningeal artery embolization (MMAE) for chronic subdural hematoma with limited comparative literature data. Herein, we compare different embolic materials.

Methods: Consecutive patients undergoing MMAE for chronic subdural hematoma at 14 North-American centers (2018-2023) were classified into 3 groups: (a) particles, (b) Onyx, (c) n-butyl cyanoacrylate (n-BCA). The end points were unplanned rescue surgery, radiographic success (≥50% reduction in hematoma thickness at last imaging "minimum of 2 weeks"), and major complications. Initial unmatched analysis compared the 3 groups; subsequent propensity score matching (PSM) compared particles vs liquid embolics (groups b and c combined). Additional subgroup PSM analyses compared particles vs Onyx, particles vs n-BCA, and Onyx vs n-BCA. All matched analyses controlled for age, sex, concurrent surgery, previous surgery, hematoma thickness, midline shift, pretreatment antithrombotics, and baseline modified Rankin Scale.

Results: Eight hundred and seventy-two patients (median age 73 years, 72.9% males) underwent 1070 MMAE procedures. Onyx was most used (41.4%), then particles (40.3%) and n-BCA (15.5%). Surgical rescue rates were comparable between particles, Onyx, and n-BCA (9.8% vs 7% vs 11.7%, respectively, P = .14). Similarly, radiographic success (78.8% vs 79.3% vs 77.4%; P = .91) and major complications (2.4% vs 2.3% vs 2.5%; P = .83) were comparable. The PSM comparing particles vs liquid generated 128 matched pairs; general anesthesia and bilateral procedures were significantly higher in particles (37.8% vs 21.3%; P = .004 and 39.8% vs 27.3%; P = .034, respectively). No differences in surgical rescue, radiographic improvement, or major complications were noted (P > .05). Concurrently, PSM comparing particles vs Onyx, particles vs n-BCA, and Onyx vs n-BCA, resulted in 112, 42, and 40 matched pairs, respectively, without differences in surgical rescue, radiographic success, or major complications (P > .05).

Conclusion: We found no differences in radiological improvement, surgical rescue, or major complications between embolic materials in MMAE. Current randomized trials are exclusively using liquid embolics, and these data suggest that future trials involving particles are likely to produce similar outcomes.

背景和目的:在治疗慢性硬膜下血肿的脑膜中动脉栓塞术(MMAE)中,栓塞材料的选择存在多种偏好,但文献数据的比较却很有限。在此,我们对不同的栓塞材料进行了比较:将北美 14 个中心(2018-2023 年)因慢性硬膜下血肿接受 MMAE 的连续患者分为 3 组:(a) 颗粒,(b) Onyx,(c) 氰基丙烯酸正丁酯(n-BCA)。终点为非计划性抢救手术、放射学成功率(最后一次成像 "至少 2 周 "时血肿厚度减少≥50%)和主要并发症。最初的非匹配分析对 3 组进行了比较;随后的倾向评分匹配(PSM)对颗粒栓塞和液体栓塞(b 组和 c 组合并)进行了比较。其他亚组 PSM 分析比较了颗粒与 Onyx、颗粒与 n-BCA、Onyx 与 n-BCA。所有匹配分析都控制了年龄、性别、同期手术、既往手术、血肿厚度、中线移位、治疗前抗血栓药物和基线修正 Rankin 量表:872名患者(中位年龄73岁,72.9%为男性)接受了1070例MMAE手术。使用最多的是缟玛瑙(41.4%),然后是微粒(40.3%)和 n-BCA(15.5%)。颗粒、Onyx 和 n-BCA 的手术抢救率相当(分别为 9.8% vs 7% vs 11.7%,P = .14)。同样,放射学成功率(78.8% vs 79.3% vs 77.4%;P = .91)和主要并发症(2.4% vs 2.3% vs 2.5%;P = .83)也相当。颗粒与液体的 PSM 比较产生了 128 对匹配对;颗粒的全身麻醉率和双侧手术率明显更高(分别为 37.8% vs 21.3%; P = .004 和 39.8% vs 27.3%; P = .034)。在手术抢救、放射学改善或主要并发症方面没有发现差异(P > .05)。同时,比较颗粒与 Onyx、颗粒与 n-BCA、Onyx 与 n-BCA 的 PSM 结果分别为 112 对、42 对和 40 对配对,在手术抢救、放射学成功率或主要并发症方面均无差异(P > .05):我们发现不同栓塞材料在 MMAE 的放射学改善、手术抢救或主要并发症方面均无差异。目前的随机试验只使用液体栓塞剂,这些数据表明,未来涉及微粒的试验很可能会产生类似的结果。
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引用次数: 0
Predictive Power of the Fried Phenotype in Assessing Postoperative Outcomes in Patients Undergoing Craniotomy for Tumor Resection. 弗里德表型在评估开颅肿瘤切除术患者术后效果中的预测力
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-17 DOI: 10.1227/neu.0000000000003231
Sonora Andromeda Windermere, Kaitlyn Melnick, Sandra C Yan, Michelot Michel, Jonathan Munoz, Ghaidaa Ebrahim, Hayden Greene, Grace Hey, Muhammad Abdul Baker Chowdhury, Ashley P Ghiaseddin, Basma Mohammed, Maryam Rahman

Background and objectives: Compared with the modified Frailty Index-11 (mFI-11) frailty tool, reflective of patient comorbidities, the Fried phenotype weighs functional patient variables. This study examined using the Fried phenotype in predicting postoperative outcomes in craniotomy for patients with tumor.

Methods: This retrospective cohort analysis included patients with Current Procedural Terminology codes for supratentorial/infratentorial tumor resections and preoperative frailty scores. Chart review collected the remaining variables for the primary outcome, length of stay (LOS), and secondary outcomes, discharge disposition and postoperative complications. Basic descriptive statistics summarized patient demographics, clinical parameters, and postoperative outcomes. χ2 tests, t-tests, and ANOVA examined associations and mean differences. Logistic and Poisson regressions explored predictor-outcome relationships.

Results: Over 7 years, these 153 patients underwent Fried assessments. The Fried score was biased toward females being more frail (nonfrail 38.0% female, prefrail 50.0% female and frail 65.6% female, P = .027) but not by age, body mass index, or tumor type. The mFI-11 was biased by age (nonfrail 67.8 years vs frail 72.3 years, P < .001) and body mass index (nonfrail 27.5 vs frail 30.8, P < .001) but not sex or tumor type. The Fried score was significantly correlated with increased LOS's (odds ratio [OR] = 5.92, 95% CI = 1.66-21.13, P < .001) but the mFI-11 was not (OR = 0.82, 95% CI = 0.35-1.93, P = .64). The Fried phenotype was significantly correlated with discharge disposition location (P = .016), whereas the mFI-11 was not (P = .749). The Fried score was significantly correlated with postoperative complications (OR = 1.36, 95% CI = 1.08-1.71, P = .01), whereas the mFI-11 was not (OR = 1.10, 95% CI = 0.86-1.41, P = .44).

Conclusion: The Fried phenotype more accurately correlates with postoperative outcomes including LOS, discharge disposition location, and complications than does the mFI-11 score. These findings can be used to guide preoperative planning, inform consent, and potentially identify patients who may benefit from functional optimization in the preoperative period to improve postoperative outcomes.

背景和目的:与反映患者合并症的改良虚弱指数-11(mFI-11)虚弱工具相比,弗里德表型更重视患者的功能性变量。本研究探讨了使用弗里德表型预测肿瘤患者开颅手术的术后结果:这项回顾性队列分析纳入了当前程序术语代码为颅内/颅外肿瘤切除术和术前虚弱评分的患者。病历审查收集了主要结果、住院时间(LOS)和次要结果、出院处置和术后并发症的其余变量。基本描述性统计总结了患者的人口统计学特征、临床参数和术后结果。χ2检验、t检验和方差分析检验了相关性和平均差异。逻辑回归和泊松回归探讨了预测因子与结果之间的关系:7年间,153名患者接受了Fried评估。Fried评分偏向于女性更虚弱(非虚弱38.0%为女性,虚弱前50.0%为女性,虚弱65.6%为女性,P = .027),但与年龄、体重指数或肿瘤类型无关。mFI-11 与年龄(非体弱者 67.8 岁 vs 体弱者 72.3 岁,P < .001)和体重指数(非体弱者 27.5 vs 体弱者 30.8,P < .001)有关,但与性别或肿瘤类型无关。Fried 评分与 LOS 的增加有明显相关性(几率比 [OR] = 5.92,95% CI = 1.66-21.13,P < .001),但 mFI-11 则没有相关性(OR = 0.82,95% CI = 0.35-1.93,P = .64)。弗里德表型与出院处置地点有明显相关性(P = .016),而 mFI-11 则没有相关性(P = .749)。Fried评分与术后并发症有明显相关性(OR = 1.36,95% CI = 1.08-1.71,P = .01),而mFI-11则没有相关性(OR = 1.10,95% CI = 0.86-1.41,P = .44):结论:与 mFI-11 评分相比,Fried 表型与术后结果(包括 LOS、出院处置地点和并发症)的相关性更准确。这些研究结果可用于指导术前规划、告知同意意见,并有可能确定哪些患者可能受益于术前的功能优化以改善术后效果。
{"title":"Predictive Power of the Fried Phenotype in Assessing Postoperative Outcomes in Patients Undergoing Craniotomy for Tumor Resection.","authors":"Sonora Andromeda Windermere, Kaitlyn Melnick, Sandra C Yan, Michelot Michel, Jonathan Munoz, Ghaidaa Ebrahim, Hayden Greene, Grace Hey, Muhammad Abdul Baker Chowdhury, Ashley P Ghiaseddin, Basma Mohammed, Maryam Rahman","doi":"10.1227/neu.0000000000003231","DOIUrl":"https://doi.org/10.1227/neu.0000000000003231","url":null,"abstract":"<p><strong>Background and objectives: </strong>Compared with the modified Frailty Index-11 (mFI-11) frailty tool, reflective of patient comorbidities, the Fried phenotype weighs functional patient variables. This study examined using the Fried phenotype in predicting postoperative outcomes in craniotomy for patients with tumor.</p><p><strong>Methods: </strong>This retrospective cohort analysis included patients with Current Procedural Terminology codes for supratentorial/infratentorial tumor resections and preoperative frailty scores. Chart review collected the remaining variables for the primary outcome, length of stay (LOS), and secondary outcomes, discharge disposition and postoperative complications. Basic descriptive statistics summarized patient demographics, clinical parameters, and postoperative outcomes. χ2 tests, t-tests, and ANOVA examined associations and mean differences. Logistic and Poisson regressions explored predictor-outcome relationships.</p><p><strong>Results: </strong>Over 7 years, these 153 patients underwent Fried assessments. The Fried score was biased toward females being more frail (nonfrail 38.0% female, prefrail 50.0% female and frail 65.6% female, P = .027) but not by age, body mass index, or tumor type. The mFI-11 was biased by age (nonfrail 67.8 years vs frail 72.3 years, P < .001) and body mass index (nonfrail 27.5 vs frail 30.8, P < .001) but not sex or tumor type. The Fried score was significantly correlated with increased LOS's (odds ratio [OR] = 5.92, 95% CI = 1.66-21.13, P < .001) but the mFI-11 was not (OR = 0.82, 95% CI = 0.35-1.93, P = .64). The Fried phenotype was significantly correlated with discharge disposition location (P = .016), whereas the mFI-11 was not (P = .749). The Fried score was significantly correlated with postoperative complications (OR = 1.36, 95% CI = 1.08-1.71, P = .01), whereas the mFI-11 was not (OR = 1.10, 95% CI = 0.86-1.41, P = .44).</p><p><strong>Conclusion: </strong>The Fried phenotype more accurately correlates with postoperative outcomes including LOS, discharge disposition location, and complications than does the mFI-11 score. These findings can be used to guide preoperative planning, inform consent, and potentially identify patients who may benefit from functional optimization in the preoperative period to improve postoperative outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546563","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
Comparing Conservative and Early Surgical Treatments for Pyogenic Spondylodiskitis: An International Propensity Score-Matched Retrospective Outcome Analysis. 比较化脓性脊柱炎的保守治疗和早期手术治疗:国际倾向得分匹配回顾性结果分析。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-17 DOI: 10.1227/neu.0000000000003223
Jonathan Neuhoff, Andreas Kramer, Santhosh G Thavarajasingam, Rebecca K Sutherland, Hugh McCaughan, Ann-Kathrin Joerger, Maria Wostrack, Barrie Lyell, Olga Berkulian, Hariharan Subbiah Ponniah, Daniele S C Ramsay, Bernhard Meyer, Frank Kandziora, Ehab Shiban, Benjamin Davies, Andreas K Demetriades, Florian Ringel

Background and objectives: Pyogenic spinal infections pose therapeutic challenges, with the optimal treatment approach remaining contentious. This study aimed to compare outcomes of conservative vs early surgical treatment (SuT) modalities in primary pyogenic spondylodiskitis through an international cohort analysis.

Methods: A retrospective outcome analysis was conducted of 392 patients from the United Kingdom and Germany, treated between 2017 and 2022 with primary pyogenic spondylodiskitis. Patients were stratified by treatment modality. Propensity score matching, facilitated by a directed acyclic graph and principal component analysis, was used to balance risk factors between the compared patient cohorts. Primary outcome was mortality rate, while secondary outcomes included hospitalization duration, infection relapse, and neurological status at discharge.

Results: The study included 95 patients undergoing conservative treatment, primarily treated in the United Kingdom, and 297 receiving SuT, predominantly in Germany. The mortality rate was notably higher in the conservative group (P < .001), while the surgical cohort experienced a shorter hospitalization duration (P < .01). After propensity score matching, 2 comparable cohorts of 95 patients each emerged. Subsequent analysis revealed a markedly increased mortality in the conservative group (24.2% for conservative treatment vs 4.2% for SuT, P < .001). Neither relapse nor neurological status at discharge showed significant differences between the groups.

Conclusion: The study indicates that early surgical intervention may be more effective than conservative management in reducing mortality and hospital stay for patients with primary pyogenic spondylodiskitis. These findings highlight the need for prospective trials and more definitive treatment guidelines.

背景和目的:化脓性脊柱感染给治疗带来了挑战,最佳治疗方法仍存在争议。本研究旨在通过国际队列分析,比较原发性化脓性脊柱炎保守治疗与早期手术治疗(SuT)的疗效:对2017年至2022年间接受治疗的392名英国和德国原发性化脓性脊柱炎患者进行了回顾性结果分析。根据治疗方式对患者进行了分层。在有向无环图和主成分分析的帮助下,采用倾向评分匹配法来平衡比较患者队列之间的风险因素。主要结果是死亡率,次要结果包括住院时间、感染复发和出院时的神经状况:研究包括 95 名主要在英国接受保守治疗的患者和 297 名主要在德国接受 SuT 治疗的患者。保守治疗组的死亡率明显更高(P < .001),而手术治疗组的住院时间更短(P < .01)。经过倾向评分匹配后,出现了两个具有可比性的队列,各有 95 名患者。随后的分析表明,保守治疗组的死亡率明显升高(保守治疗组为 24.2%,SuT 组为 4.2%,P < .001)。两组患者的复发率和出院时的神经状况均无明显差异:研究表明,在降低原发性化脓性脊柱炎患者的死亡率和住院时间方面,早期手术干预可能比保守治疗更有效。这些发现凸显了进行前瞻性试验和制定更明确的治疗指南的必要性。
{"title":"Comparing Conservative and Early Surgical Treatments for Pyogenic Spondylodiskitis: An International Propensity Score-Matched Retrospective Outcome Analysis.","authors":"Jonathan Neuhoff, Andreas Kramer, Santhosh G Thavarajasingam, Rebecca K Sutherland, Hugh McCaughan, Ann-Kathrin Joerger, Maria Wostrack, Barrie Lyell, Olga Berkulian, Hariharan Subbiah Ponniah, Daniele S C Ramsay, Bernhard Meyer, Frank Kandziora, Ehab Shiban, Benjamin Davies, Andreas K Demetriades, Florian Ringel","doi":"10.1227/neu.0000000000003223","DOIUrl":"https://doi.org/10.1227/neu.0000000000003223","url":null,"abstract":"<p><strong>Background and objectives: </strong>Pyogenic spinal infections pose therapeutic challenges, with the optimal treatment approach remaining contentious. This study aimed to compare outcomes of conservative vs early surgical treatment (SuT) modalities in primary pyogenic spondylodiskitis through an international cohort analysis.</p><p><strong>Methods: </strong>A retrospective outcome analysis was conducted of 392 patients from the United Kingdom and Germany, treated between 2017 and 2022 with primary pyogenic spondylodiskitis. Patients were stratified by treatment modality. Propensity score matching, facilitated by a directed acyclic graph and principal component analysis, was used to balance risk factors between the compared patient cohorts. Primary outcome was mortality rate, while secondary outcomes included hospitalization duration, infection relapse, and neurological status at discharge.</p><p><strong>Results: </strong>The study included 95 patients undergoing conservative treatment, primarily treated in the United Kingdom, and 297 receiving SuT, predominantly in Germany. The mortality rate was notably higher in the conservative group (P < .001), while the surgical cohort experienced a shorter hospitalization duration (P < .01). After propensity score matching, 2 comparable cohorts of 95 patients each emerged. Subsequent analysis revealed a markedly increased mortality in the conservative group (24.2% for conservative treatment vs 4.2% for SuT, P < .001). Neither relapse nor neurological status at discharge showed significant differences between the groups.</p><p><strong>Conclusion: </strong>The study indicates that early surgical intervention may be more effective than conservative management in reducing mortality and hospital stay for patients with primary pyogenic spondylodiskitis. These findings highlight the need for prospective trials and more definitive treatment guidelines.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546554","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
Predicting Vasospasm and Early Mortality in Severe Traumatic Brain Injury: A Model Using Serum Cytokines, Neuronal Proteins, and Clinical Data. 预测严重创伤性脑损伤的血管痉挛和早期死亡率:使用血清细胞因子、神经元蛋白和临床数据的模型。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-11 DOI: 10.1227/neu.0000000000003224
Rima S Rindler, Henry Robertson, LaShondra De Yampert, Vivek Khatri, Pavlos Texakalidis, Sheila Eshraghi, Scott Grey, Seth Schobel, Eric A Elster, Nicholas Boulis, Jonathan A Grossberg

Background and objectives: Prediction of patient outcomes after severe traumatic brain injury (sTBI) is limited with current clinical tools. This study aimed to improve such prognostication by combining clinical data and serum inflammatory and neuronal proteins in patients with sTBI to develop predictive models for post-traumatic vasospasm (PTV) and mortality.

Methods: Fifty-three adult civilian patients were prospectively enrolled in the sTBI arm of the Surgical Critical Care Initiative (SC2i). Clinical, serum inflammatory, and neuronal protein data were combined using the parsimonious machine learning methods of least absolute shrinkage and selection operator (LASSO) and classification and regression trees (CART) to construct parsimonious models for predicting development of PTV and mortality.

Results: Thirty-six (67.9%) patients developed vasospasm and 10 (18.9%) died. The mean age was 39.2 years; 22.6% were women. CART identified lower IL9, lower presentation pulse rate, and higher eotaxin as predictors of vasospasm development (full data area under curve (AUC) = 0.89, mean cross-validated AUC = 0.47). LASSO identified higher Rotterdam computed tomography score and lower age as risk factors for vasospasm development (full data AUC 0.94, sensitivity 0.86, and specificity 0.94; cross-validation AUC 0.87, sensitivity 0.79, and specificity 0.93). CART identified high levels of eotaxin as most predictive of mortality (AUC 0.74, cross-validation AUC 0.57). LASSO identified higher serum IL6, lower IL12, and higher glucose as predictive of mortality (full data AUC 0.9, sensitivity 1.0, and specificity 0.72; cross-validation AUC 0.8, sensitivity 0.85, and specificity 0.79).

Conclusion: Inflammatory cytokine levels after sTBI may have predictive value that exceeds conventional clinical variables for certain outcomes. IL-9, pulse rate, and eotaxin as well as Rotterdam score and age predict development of PTV. Eotaxin, IL-6, IL-12, and glucose were predictive of mortality. These results warrant validation in a prospective cohort.

背景和目标:目前的临床工具对严重创伤性脑损伤(sTBI)后患者预后的预测有限。本研究旨在通过结合 sTBI 患者的临床数据、血清炎症蛋白和神经元蛋白来开发创伤后血管痉挛(PTV)和死亡率的预测模型,从而改善这种预后:53名成年平民患者前瞻性地加入了外科重症监护计划(SC2i)的创伤性脑损伤组。使用最小绝对收缩和选择算子(LASSO)以及分类和回归树(CART)等简易机器学习方法将临床、血清炎症和神经元蛋白数据结合起来,构建预测PTV发展和死亡率的简易模型:36例(67.9%)患者出现血管痉挛,10例(18.9%)患者死亡。平均年龄为 39.2 岁,22.6% 为女性。CART 确定了较低的 IL9、较低的脉搏率和较高的 eotaxin 是血管痉挛发生的预测因子(全数据曲线下面积 (AUC) = 0.89,平均交叉验证 AUC = 0.47)。LASSO 将较高的鹿特丹计算机断层扫描评分和较低的年龄确定为血管痉挛发生的风险因素(全数据 AUC 0.94,灵敏度 0.86,特异性 0.94;交叉验证 AUC 0.87,灵敏度 0.79,特异性 0.93)。CART 确定高水平的 eotaxin 最能预测死亡率(AUC 0.74,交叉验证 AUC 0.57)。LASSO 发现血清 IL6 较高、IL12 较低和葡萄糖较高可预测死亡率(全数据 AUC 0.9,灵敏度 1.0,特异性 0.72;交叉验证 AUC 0.8,灵敏度 0.85,特异性 0.79):结论:创伤性脑损伤后炎症细胞因子水平对某些结果的预测价值可能超过传统的临床变量。IL-9、脉搏率、Eotaxin以及鹿特丹评分和年龄可预测PTV的发生。Eotaxin、IL-6、IL-12 和葡萄糖可预测死亡率。这些结果需要在前瞻性队列中进行验证。
{"title":"Predicting Vasospasm and Early Mortality in Severe Traumatic Brain Injury: A Model Using Serum Cytokines, Neuronal Proteins, and Clinical Data.","authors":"Rima S Rindler, Henry Robertson, LaShondra De Yampert, Vivek Khatri, Pavlos Texakalidis, Sheila Eshraghi, Scott Grey, Seth Schobel, Eric A Elster, Nicholas Boulis, Jonathan A Grossberg","doi":"10.1227/neu.0000000000003224","DOIUrl":"https://doi.org/10.1227/neu.0000000000003224","url":null,"abstract":"<p><strong>Background and objectives: </strong>Prediction of patient outcomes after severe traumatic brain injury (sTBI) is limited with current clinical tools. This study aimed to improve such prognostication by combining clinical data and serum inflammatory and neuronal proteins in patients with sTBI to develop predictive models for post-traumatic vasospasm (PTV) and mortality.</p><p><strong>Methods: </strong>Fifty-three adult civilian patients were prospectively enrolled in the sTBI arm of the Surgical Critical Care Initiative (SC2i). Clinical, serum inflammatory, and neuronal protein data were combined using the parsimonious machine learning methods of least absolute shrinkage and selection operator (LASSO) and classification and regression trees (CART) to construct parsimonious models for predicting development of PTV and mortality.</p><p><strong>Results: </strong>Thirty-six (67.9%) patients developed vasospasm and 10 (18.9%) died. The mean age was 39.2 years; 22.6% were women. CART identified lower IL9, lower presentation pulse rate, and higher eotaxin as predictors of vasospasm development (full data area under curve (AUC) = 0.89, mean cross-validated AUC = 0.47). LASSO identified higher Rotterdam computed tomography score and lower age as risk factors for vasospasm development (full data AUC 0.94, sensitivity 0.86, and specificity 0.94; cross-validation AUC 0.87, sensitivity 0.79, and specificity 0.93). CART identified high levels of eotaxin as most predictive of mortality (AUC 0.74, cross-validation AUC 0.57). LASSO identified higher serum IL6, lower IL12, and higher glucose as predictive of mortality (full data AUC 0.9, sensitivity 1.0, and specificity 0.72; cross-validation AUC 0.8, sensitivity 0.85, and specificity 0.79).</p><p><strong>Conclusion: </strong>Inflammatory cytokine levels after sTBI may have predictive value that exceeds conventional clinical variables for certain outcomes. IL-9, pulse rate, and eotaxin as well as Rotterdam score and age predict development of PTV. Eotaxin, IL-6, IL-12, and glucose were predictive of mortality. These results warrant validation in a prospective cohort.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546562","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
Spine Stereotactic Radiosurgery Provides Long-Term Local Control and Overall Survival for Benign Intradural Tumors. 脊柱立体定向放射外科为良性硬膜内肿瘤提供长期局部控制和总体生存率
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-11 DOI: 10.1227/neu.0000000000003219
Suchet Taori, Samuel Adida, Michael R Kann, Shovan Bhatia, Roberta K Sefcik, Steven A Burton, John C Flickinger, Pascal O Zinn, Peter C Gerszten

Background and objectives: The role of radiosurgery in the treatment of benign intracranial tumors is well established. However, there are limited long-term follow-up studies on outcomes after stereotactic radiosurgery (SRS) for benign intradural spinal tumors. In this article, we report a large single-institution experience in using SRS to treat patients with benign intradural tumors of the spine.

Methods: Overall, 184 patients (55% female) and 207 benign intradural tumors were treated. The median patient age was 52 years (range: 19-93). Tumor histology included schwannoma (38%), meningioma (15%), neurofibroma (21%), hemangioma (9%), hemangioblastoma (8%), hemangiopericytoma (5%), and paraganglioma (4%). Thirty-four (16%) lesions underwent resection before radiosurgery. Twenty-three (11%) lesions were NF1-mutated. The median single-fraction margin dose was 14 Gy (range: 11-20), and the median multifraction margin dose was 21 Gy (range: 15-30).

Results: The median follow-up was 63 months (range: 1-258). At last follow-up, tumors volumetrically regressed (15%), remained stable (77%), or locally progressed (8%, median: 20 months [range: 3-161]) after SRS. The 1-, 5-, and 10-year local control rates were 97%, 92%, and 90%, respectively. On multivariable analysis, the absence of the NF1 mutation (P = .004, hazard ratio: 0.23, 95% CI: 0.08-0.63) and single-fraction SRS (P = .007, hazard ratio: 0.24, 95% CI: 0.08-0.68) correlated with improved local control. The median overall survival was 251 months (range: 1-258), and 1-, 5-, and 10-year overall survival rates were 95%, 85%, and 70%, respectively. For patients with pre-existing symptoms, tumor-associated pain and neurological deficits were noted to improve or remain stable in 85% and 87% of cases, respectively. Adverse radiation effects included delayed myelopathy (1%), acute pain flare (9%), dermatitis (0.5%), dysphagia (0.5%), and dysphonia (0.5%).

Conclusion: With long-term follow-up, spine radiosurgery is a safe and effective treatment for benign intradural tumors. In carefully selected patients, even with an NF1 mutation, SRS is associated with a high likelihood of local tumor control.

背景和目的:放射手术在治疗颅内良性肿瘤中的作用已得到公认。然而,对脊柱硬膜内良性肿瘤进行立体定向放射外科手术(SRS)治疗后的长期随访研究却很有限。在这篇文章中,我们报告了一个大型单机构使用 SRS 治疗脊柱硬膜内良性肿瘤患者的经验:方法:共治疗了 184 名患者(55% 为女性)和 207 个良性硬膜内肿瘤。患者年龄中位数为 52 岁(19-93 岁)。肿瘤组织学包括分裂瘤(38%)、脑膜瘤(15%)、神经纤维瘤(21%)、血管瘤(9%)、血管母细胞瘤(8%)、血管外细胞瘤(5%)和副神经节瘤(4%)。34个病灶(16%)在放射外科手术前进行了切除。23个病灶(11%)为NF1突变。单分次边缘剂量中位数为14 Gy(范围:11-20),多分次边缘剂量中位数为21 Gy(范围:15-30):中位随访时间为 63 个月(范围:1-258)。在最后一次随访中,SRS术后肿瘤体积消退(15%)、保持稳定(77%)或局部进展(8%,中位:20个月[范围:3-161])。1年、5年和10年的局部控制率分别为97%、92%和90%。在多变量分析中,无 NF1 突变(P = .004,危险比:0.23,95% CI:0.08-0.63)和单剂量 SRS(P = .007,危险比:0.24,95% CI:0.08-0.68)与局部控制率的改善相关。中位总生存期为251个月(范围:1-258),1年、5年和10年总生存率分别为95%、85%和70%。对于已有症状的患者,85%和87%的病例中肿瘤相关疼痛和神经功能缺损得到改善或保持稳定。放射不良反应包括延迟性脊髓病(1%)、急性疼痛发作(9%)、皮炎(0.5%)、吞咽困难(0.5%)和发音障碍(0.5%):结论:经过长期随访,脊柱放射手术是一种安全有效的硬膜内良性肿瘤治疗方法。结论:经过长期随访,脊柱放射手术是治疗硬膜内良性肿瘤的安全有效方法。对于经过严格筛选的患者,即使存在 NF1 基因突变,脊柱放射手术也能很好地控制局部肿瘤。
{"title":"Spine Stereotactic Radiosurgery Provides Long-Term Local Control and Overall Survival for Benign Intradural Tumors.","authors":"Suchet Taori, Samuel Adida, Michael R Kann, Shovan Bhatia, Roberta K Sefcik, Steven A Burton, John C Flickinger, Pascal O Zinn, Peter C Gerszten","doi":"10.1227/neu.0000000000003219","DOIUrl":"https://doi.org/10.1227/neu.0000000000003219","url":null,"abstract":"<p><strong>Background and objectives: </strong>The role of radiosurgery in the treatment of benign intracranial tumors is well established. However, there are limited long-term follow-up studies on outcomes after stereotactic radiosurgery (SRS) for benign intradural spinal tumors. In this article, we report a large single-institution experience in using SRS to treat patients with benign intradural tumors of the spine.</p><p><strong>Methods: </strong>Overall, 184 patients (55% female) and 207 benign intradural tumors were treated. The median patient age was 52 years (range: 19-93). Tumor histology included schwannoma (38%), meningioma (15%), neurofibroma (21%), hemangioma (9%), hemangioblastoma (8%), hemangiopericytoma (5%), and paraganglioma (4%). Thirty-four (16%) lesions underwent resection before radiosurgery. Twenty-three (11%) lesions were NF1-mutated. The median single-fraction margin dose was 14 Gy (range: 11-20), and the median multifraction margin dose was 21 Gy (range: 15-30).</p><p><strong>Results: </strong>The median follow-up was 63 months (range: 1-258). At last follow-up, tumors volumetrically regressed (15%), remained stable (77%), or locally progressed (8%, median: 20 months [range: 3-161]) after SRS. The 1-, 5-, and 10-year local control rates were 97%, 92%, and 90%, respectively. On multivariable analysis, the absence of the NF1 mutation (P = .004, hazard ratio: 0.23, 95% CI: 0.08-0.63) and single-fraction SRS (P = .007, hazard ratio: 0.24, 95% CI: 0.08-0.68) correlated with improved local control. The median overall survival was 251 months (range: 1-258), and 1-, 5-, and 10-year overall survival rates were 95%, 85%, and 70%, respectively. For patients with pre-existing symptoms, tumor-associated pain and neurological deficits were noted to improve or remain stable in 85% and 87% of cases, respectively. Adverse radiation effects included delayed myelopathy (1%), acute pain flare (9%), dermatitis (0.5%), dysphagia (0.5%), and dysphonia (0.5%).</p><p><strong>Conclusion: </strong>With long-term follow-up, spine radiosurgery is a safe and effective treatment for benign intradural tumors. In carefully selected patients, even with an NF1 mutation, SRS is associated with a high likelihood of local tumor control.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504928","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
The Low-Income and Middle-Income Countries' Perspective on Global Neurosurgery Collaborations. 低收入和中等收入国家对全球神经外科合作的看法。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-11 DOI: 10.1227/neu.0000000000003230
Nicolò Marchesini, Patrick Kamalo, Nikolaos Foroglou, Deborah Garozzo, Pablo Gonzalez-Lopez, Marcel Ivanov, Jesus Lafuente, Fatos Olldashi, Vincenzo Paternò, Ondra Petr, Krešimir Rotim, Jamil Rzaev, Jake Timothy, Magnus Tisell, Massimiliano Visocchi, Ahmed Negida, Enoch Uche, Lukas Rasulic, Andreas K Demetriades

Background and objectives: Access to neurosurgical care is limited in low-income and middle-income countries (LMICs) and in marginalized communities in high-income countries (HICs). International partnerships represent one possible means of addressing this issue. Insights from surgeons in HICs have been explored, but data from LMICs' counterparts are scarce. We aimed to study the perspectives of neurosurgeons and trainees from LMICs regarding global neurosurgery (GN) collaborations and interests, motivators, and challenges in participating.

Methods: An online survey was conducted targeting neurosurgeons and trainees from LMICs. The survey explored demographics, previous experiences, ongoing activities, interests, and barriers related to GN activities. Data were collected between July 2022 and December 2022 and analyzed.

Results: Responses involved 436 individuals. The most represented region (25%) was sub-Saharan Africa, and most respondents were male (87.8%) aged 35-49 years. Interest in GN was high, with 91% after its developments. Most respondents (96.1%) expressed interest in training, professional, or research experience in HICs, but only 18.1% could cover the expenses. A majority (73.2%) strongly agreed to return to their home country for work after HIC training. Ongoing HIC-LMIC partnerships were reported by 27.8% of respondents. Clinical exposure emerged as the most relevant motivating factor (87%), while financial concerns, lack of opportunities, and lack of program support were identified as important barriers. Funding and dedicated time were highlighted as the most crucial facilitators.

Conclusion: Understanding the perspectives of neurosurgeons and trainees from LMICs is essential to expanding HICs-LMICs collaborations and improving access to neurosurgical care worldwide. Financial support and targeted interventions are needed to address barriers and promote equitable partnerships in GN.

背景和目标:在低收入和中等收入国家(LMICs)以及高收入国家(HICs)的边缘化社区,获得神经外科治疗的机会有限。国际合作是解决这一问题的可行方法之一。高收入国家(HIC)外科医生的见解已经得到探讨,但低收入国家(LMIC)外科医生的数据却很少。我们的目的是研究低收入国家的神经外科医生和受训人员对全球神经外科(GN)合作的看法,以及参与合作的兴趣、动力和挑战:针对来自低收入国家的神经外科医生和受训人员进行了在线调查。调查内容包括人口统计学、以往经验、正在进行的活动、兴趣以及与全球网络活动相关的障碍。数据收集于 2022 年 7 月至 2022 年 12 月,并进行了分析:共收到 436 份回复。撒哈拉以南非洲地区的受访者最多(占 25%),大多数受访者为男性(87.8%),年龄在 35-49 岁之间。91%的受访者关注全球营养网络的发展。大多数受访者(96.1%)表示有兴趣到高收入国家进行培训、专业或研究体验,但只有 18.1%的受访者能够支付相关费用。大多数受访者(73.2%)强烈同意在接受了高收入国家的培训后回国工作。27.8%的受访者表示他们正在与低收入国家合作。临床经验是最重要的激励因素(87%),而财务问题、缺乏机会和缺乏计划支持则被认为是重要的障碍。结论:了解神经外科医生的观点,有助于他们更好地了解自己的工作:了解来自低收入与中等收入国家的神经外科医生和受训人员的观点,对于扩大低收入与中等收入国家之间的合作以及改善全球神经外科医疗服务的可及性至关重要。需要提供财政支持和有针对性的干预措施,以消除障碍并促进全球神经网络的公平合作。
{"title":"The Low-Income and Middle-Income Countries' Perspective on Global Neurosurgery Collaborations.","authors":"Nicolò Marchesini, Patrick Kamalo, Nikolaos Foroglou, Deborah Garozzo, Pablo Gonzalez-Lopez, Marcel Ivanov, Jesus Lafuente, Fatos Olldashi, Vincenzo Paternò, Ondra Petr, Krešimir Rotim, Jamil Rzaev, Jake Timothy, Magnus Tisell, Massimiliano Visocchi, Ahmed Negida, Enoch Uche, Lukas Rasulic, Andreas K Demetriades","doi":"10.1227/neu.0000000000003230","DOIUrl":"https://doi.org/10.1227/neu.0000000000003230","url":null,"abstract":"<p><strong>Background and objectives: </strong>Access to neurosurgical care is limited in low-income and middle-income countries (LMICs) and in marginalized communities in high-income countries (HICs). International partnerships represent one possible means of addressing this issue. Insights from surgeons in HICs have been explored, but data from LMICs' counterparts are scarce. We aimed to study the perspectives of neurosurgeons and trainees from LMICs regarding global neurosurgery (GN) collaborations and interests, motivators, and challenges in participating.</p><p><strong>Methods: </strong>An online survey was conducted targeting neurosurgeons and trainees from LMICs. The survey explored demographics, previous experiences, ongoing activities, interests, and barriers related to GN activities. Data were collected between July 2022 and December 2022 and analyzed.</p><p><strong>Results: </strong>Responses involved 436 individuals. The most represented region (25%) was sub-Saharan Africa, and most respondents were male (87.8%) aged 35-49 years. Interest in GN was high, with 91% after its developments. Most respondents (96.1%) expressed interest in training, professional, or research experience in HICs, but only 18.1% could cover the expenses. A majority (73.2%) strongly agreed to return to their home country for work after HIC training. Ongoing HIC-LMIC partnerships were reported by 27.8% of respondents. Clinical exposure emerged as the most relevant motivating factor (87%), while financial concerns, lack of opportunities, and lack of program support were identified as important barriers. Funding and dedicated time were highlighted as the most crucial facilitators.</p><p><strong>Conclusion: </strong>Understanding the perspectives of neurosurgeons and trainees from LMICs is essential to expanding HICs-LMICs collaborations and improving access to neurosurgical care worldwide. Financial support and targeted interventions are needed to address barriers and promote equitable partnerships in GN.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400853","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
Scoring System Assessing Risks of Growth in Sporadic Vestibular Schwannoma. 评估散发性前庭许旺瘤生长风险的评分系统
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-11 DOI: 10.1227/neu.0000000000003170
Daniela Stastna, Robert Macfarlane, Patrick Axon, Richard Mannion, Neil Donnelly, James R Tysome, Rajeev Mathews, Mathew Guilfoyle, Daniele Borsetto, Ronie Jayapalan, Indu Lawes, Juliette Buttimore, Manohar Bance

Background and objectives: Surveillance studies offer sparse knowledge of predictors of future growth in sporadic vestibular schwannomas (VS).Our aim was identification of these risk factors. We propose a scoring system to estimate the risk of growth in sporadic vestibular schwannoma.

Methods: This retrospective study is based on the demographic and radiological data of 615 adult patients under the surveillance for single VS in our center. Univariate analysis, multivariate regression, and Kaplan-Meier analysis were used when appropriate. The regression coefficient-based "VS score" was calculated based on Cox proportional-hazards regression.

Results: During surveillance, 285 tumors (46%) remained stable, 314 tumors (51%) grew, and 16 tumors (3%) shrank. The significant risks factors for future growth identified both in univariate and multivariate analyses were younger age at onset, cystic morphology, larger tumor volume, and cisternal location (as per Hannover grade). The proportion of growing tumors was 40%, 75%, and 96% among the homogeneous VS, primary cystic, and VS transformed to cystic, respectively. Moreover, tumor growth during the 1st year was significant predictor of continuous growth. Our "VS score" includes variables such as age, sex, morphology, and Hannover grade. The score extends between -3 and 6 points. Kaplan-Meier, confusion matrix, and receiver operating characteristic analysis proved high accuracy of our scoring model.

Conclusion: Our retrospective study revealed that younger age, cystic morphology, cisternal extent, larger volume, and growth during 1st year were strong predictors of future growth. Moreover, we propose a scoring system that accurately estimates the risks of future tumor growth.

背景和目的:监测研究对散发性前庭神经分裂瘤(VS)未来生长的预测因素知之甚少。我们提出了一个评分系统来估算散发性前庭神经分裂瘤的生长风险:这项回顾性研究基于本中心监测的 615 名单发前庭神经分裂瘤成年患者的人口统计学和放射学数据。在适当的时候采用单变量分析、多变量回归和卡普兰-梅耶分析。基于回归系数的 "VS 评分 "是根据 Cox 比例危险度回归计算得出的:在监测期间,285 个肿瘤(46%)保持稳定,314 个肿瘤(51%)增大,16 个肿瘤(3%)缩小。在单变量和多变量分析中发现,未来肿瘤生长的重要危险因素包括发病年龄较小、囊性形态、肿瘤体积较大和阴囊位置(根据汉诺威分级)。在同种VS、原发囊性VS和转化为囊性VS中,肿瘤生长的比例分别为40%、75%和96%。此外,肿瘤在第一年的生长情况也能显著预测肿瘤的持续生长。我们的 "VS 评分 "包括年龄、性别、形态和汉诺威分级等变量。得分范围在-3 到 6 分之间。Kaplan-Meier、混淆矩阵和接收者操作特征分析表明,我们的评分模型具有很高的准确性:我们的回顾性研究表明,较小的年龄、囊肿形态、囊腔范围、较大的体积以及第一年的生长情况是未来生长的有力预测因素。此外,我们还提出了一种能准确估计肿瘤未来生长风险的评分系统。
{"title":"Scoring System Assessing Risks of Growth in Sporadic Vestibular Schwannoma.","authors":"Daniela Stastna, Robert Macfarlane, Patrick Axon, Richard Mannion, Neil Donnelly, James R Tysome, Rajeev Mathews, Mathew Guilfoyle, Daniele Borsetto, Ronie Jayapalan, Indu Lawes, Juliette Buttimore, Manohar Bance","doi":"10.1227/neu.0000000000003170","DOIUrl":"https://doi.org/10.1227/neu.0000000000003170","url":null,"abstract":"<p><strong>Background and objectives: </strong>Surveillance studies offer sparse knowledge of predictors of future growth in sporadic vestibular schwannomas (VS).Our aim was identification of these risk factors. We propose a scoring system to estimate the risk of growth in sporadic vestibular schwannoma.</p><p><strong>Methods: </strong>This retrospective study is based on the demographic and radiological data of 615 adult patients under the surveillance for single VS in our center. Univariate analysis, multivariate regression, and Kaplan-Meier analysis were used when appropriate. The regression coefficient-based \"VS score\" was calculated based on Cox proportional-hazards regression.</p><p><strong>Results: </strong>During surveillance, 285 tumors (46%) remained stable, 314 tumors (51%) grew, and 16 tumors (3%) shrank. The significant risks factors for future growth identified both in univariate and multivariate analyses were younger age at onset, cystic morphology, larger tumor volume, and cisternal location (as per Hannover grade). The proportion of growing tumors was 40%, 75%, and 96% among the homogeneous VS, primary cystic, and VS transformed to cystic, respectively. Moreover, tumor growth during the 1st year was significant predictor of continuous growth. Our \"VS score\" includes variables such as age, sex, morphology, and Hannover grade. The score extends between -3 and 6 points. Kaplan-Meier, confusion matrix, and receiver operating characteristic analysis proved high accuracy of our scoring model.</p><p><strong>Conclusion: </strong>Our retrospective study revealed that younger age, cystic morphology, cisternal extent, larger volume, and growth during 1st year were strong predictors of future growth. Moreover, we propose a scoring system that accurately estimates the risks of future tumor growth.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546564","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
Predicting Futile Recanalization After Endovascular Thrombectomy for Patients With Stroke With Large Cores: The SNAP Score. 预测大核心脑卒中患者血管内血栓切除术后的无效再通路:SNAP 评分。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-11 DOI: 10.1227/neu.0000000000003220
Hidetoshi Matsukawa, Huanwen Chen, Sameh Samir Elawady, Conor Cunningham, Kazutaka Uchida, Mohammad-Mahdi Sowlat, Ilko Maier, Pascal Jabbour, Joon-Tae Kim, Stacey Quintero Wolfe, Ansaar Rai, Robert M Starke, Marios-Nikos Psychogios, Edgar A Samaniego, Adam Arthur, Shinichi Yoshimura, Hugo Cuellar, Jonathan A Grossberg, Ali Alawieh, Daniele G Romano, Omar Tanweer, Justin Mascitelli, Isabel Fragata, Adam Polifka, Joshua Osbun, Roberto Crosa, Charles Matouk, Min S Park, Michael R Levitt, Waleed Brinjikji, Mark Moss, Richard Williamson, Pedro Navia, Peter Kan, Reade De Leacy, Shakeel Chowdhry, Mohamad Ezzeldin, Alejandro M Spiotta

Background and objectives: We aimed to develop and validate a prediction score for futile recanalization (FR) for large vessel occlusion (LVO) presenting low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) for patients who underwent endovascular thrombectomy (EVT).

Methods: Patients with anterior circulation LVO with low ASPECTS (<6) who underwent successful EVT (modified treatment in cerebral ischemia score ≥2b) from Stroke Thrombectomy and Aneurysm Registry were retrospectively analyzed. FR was defined as 90-day modified Rankin Scale (mRS) scores ≥4 despite successful EVT. Multivariable logistic regression was used to identify independent predictors of FR, and they were used to create a clinical score. The performance of the score was assessed by receiver operating characteristic curve analyses.

Results: Of 219 patients, 170 and 49 patients were randomly assigned to the training and validation cohort, respectively. Independent predictors of FR identified in the training cohort were used to construct the SNAP score: site of occlusion (middle cerebral artery = 0, internal carotid artery = 1), National Institutes of Health Stroke Scale score at admission (≤10 = 0, 10 to 19 = 1, ≥20 = 2), age (<75 = 0, ≥75 = 2), and prestroke mRS score (0-3). Receiver operating characteristic curve analyses of the SNAP score in the training and validation cohorts showed areas under the curve of 0.79 (95% CI 0.72-0.86) and 0.79 (95% CI 0.65-0.92) for predicting FR, respectively. A SNAP score ≥5 had a positive predictive value of 92.1% [95% CI 78.8%-97.3%] for FR.

Conclusion: The SNAP score may be useful in predicting FR after EVT in low-ASPECTS patients with LVO. It can provide patients, family members, and physicians with reliable outcome expectations among patients with acute ischemic stroke with large infarcts.

背景和目的:我们的目的是为接受血管内血栓切除术(EVT)的大血管闭塞(LVO)患者制定并验证一个低阿尔伯塔卒中计划早期计算机断层扫描评分(ASPECTS)的徒劳再通畅(FR)预测评分:前循环 LVO 且 ASPECTS 较低的患者(结果:219 例患者中,170 例和 49 例患者的 ASPECTS 分别为 0.5 和 0.5:在 219 名患者中,分别有 170 名和 49 名患者被随机分配到训练组和验证组。在训练队列中确定的 FR 独立预测因子被用于构建 SNAP 评分:闭塞部位(大脑中动脉 = 0,颈内动脉 = 1)、入院时美国国立卫生研究院卒中量表评分(≤10 = 0,10 至 19 = 1,≥20 = 2)、年龄(结论:SNAP 评分可能有助于诊断前循环 LVO:SNAP 评分可能有助于预测 LVO 低ASPECTS 患者 EVT 后的 FR。它可以为患者、家属和医生提供对急性缺血性卒中合并大面积梗死患者的可靠预后预期。
{"title":"Predicting Futile Recanalization After Endovascular Thrombectomy for Patients With Stroke With Large Cores: The SNAP Score.","authors":"Hidetoshi Matsukawa, Huanwen Chen, Sameh Samir Elawady, Conor Cunningham, Kazutaka Uchida, Mohammad-Mahdi Sowlat, Ilko Maier, Pascal Jabbour, Joon-Tae Kim, Stacey Quintero Wolfe, Ansaar Rai, Robert M Starke, Marios-Nikos Psychogios, Edgar A Samaniego, Adam Arthur, Shinichi Yoshimura, Hugo Cuellar, Jonathan A Grossberg, Ali Alawieh, Daniele G Romano, Omar Tanweer, Justin Mascitelli, Isabel Fragata, Adam Polifka, Joshua Osbun, Roberto Crosa, Charles Matouk, Min S Park, Michael R Levitt, Waleed Brinjikji, Mark Moss, Richard Williamson, Pedro Navia, Peter Kan, Reade De Leacy, Shakeel Chowdhry, Mohamad Ezzeldin, Alejandro M Spiotta","doi":"10.1227/neu.0000000000003220","DOIUrl":"https://doi.org/10.1227/neu.0000000000003220","url":null,"abstract":"<p><strong>Background and objectives: </strong>We aimed to develop and validate a prediction score for futile recanalization (FR) for large vessel occlusion (LVO) presenting low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) for patients who underwent endovascular thrombectomy (EVT).</p><p><strong>Methods: </strong>Patients with anterior circulation LVO with low ASPECTS (<6) who underwent successful EVT (modified treatment in cerebral ischemia score ≥2b) from Stroke Thrombectomy and Aneurysm Registry were retrospectively analyzed. FR was defined as 90-day modified Rankin Scale (mRS) scores ≥4 despite successful EVT. Multivariable logistic regression was used to identify independent predictors of FR, and they were used to create a clinical score. The performance of the score was assessed by receiver operating characteristic curve analyses.</p><p><strong>Results: </strong>Of 219 patients, 170 and 49 patients were randomly assigned to the training and validation cohort, respectively. Independent predictors of FR identified in the training cohort were used to construct the SNAP score: site of occlusion (middle cerebral artery = 0, internal carotid artery = 1), National Institutes of Health Stroke Scale score at admission (≤10 = 0, 10 to 19 = 1, ≥20 = 2), age (<75 = 0, ≥75 = 2), and prestroke mRS score (0-3). Receiver operating characteristic curve analyses of the SNAP score in the training and validation cohorts showed areas under the curve of 0.79 (95% CI 0.72-0.86) and 0.79 (95% CI 0.65-0.92) for predicting FR, respectively. A SNAP score ≥5 had a positive predictive value of 92.1% [95% CI 78.8%-97.3%] for FR.</p><p><strong>Conclusion: </strong>The SNAP score may be useful in predicting FR after EVT in low-ASPECTS patients with LVO. It can provide patients, family members, and physicians with reliable outcome expectations among patients with acute ischemic stroke with large infarcts.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546561","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}
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Neurosurgery
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