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Injury Characteristics and Risk Factors of Sport-Related Concussion Among High School Athletes in School-Sponsored Sports. 参加学校赞助体育运动的高中运动员的损伤特征和运动相关脑震荡的风险因素。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 DOI: 10.1227/neu.0000000000003250
Annabelle Shaffer, Helen Kemprecos, Zelda Moran, Aaron T Anderson, Adam Tarr, John Flannell, Graham Huesmann, Tracey M Wszalek, Jerrad Zimmerman, Paul M Arnold

Background and objectives: Over a million sport-related concussions (SRC) affect children annually in the United States, posing a significant public health concern. Limited data exist on the premorbid risk factors and injury characteristics of SRCs in high school athletes. This study aims to understand acute SRC injury characteristics and describe premorbid risk factors in high school athletes.

Methods: Athletes (aged 14-19 years) from 19 central Illinois high schools participating in school-sponsored sports from 2009 to 2023 were included. Sports Concussion Assessment Tool evaluations were performed as part of preseason and postinjury evaluations. Injury characteristics, such as mechanism, setting, and symptoms, were described using all SRCs in the study period. Odds ratios (OR) were computed to determine risk factors using athletes with a baseline Sports Concussion Assessment Tool before SRC and nonconcussed athletes.

Results: In total, 4360 athletes were included (3953 without SRC; 407 with ≥1 SRC of whom 168 had a previous baseline). Overall, 24.2% of SRCs occurred in female athletes, and most SRCs occurred in competitions while playing American football (52.3%), soccer (20.4%), and basketball (7.6%). Blow/hit to the head was the most common mechanism. Headache was the most severe symptom (2.55 ± 1.51 [SD]), and symptoms of emotionality and nervousness/anxiety were significantly more severe in female athletes (P < .05). Students with previous concussions (OR 2.64 95% CI [1.81, 3.78]), previous hospitalization for head injury (OR 3.19 95% CI [1.9, 5.14]), headache/migraine disorders (OR 2.23 95% CI [1.29, 3.66]), and learning disabilities (OR 2.69 95% CI [1.47, 4.61]) had greater odds of SRC (P < .05). Lower odds of SRC were seen in athletes identifying as Black or African American (vs White) (OR 0.54 95% CI [0.32, 0.86]) and those attending larger (vs smaller) schools (OR 0.64 95% CI [0.46, 0.88]).

Conclusion: Understanding SRC risk factors and characteristics in high school athletes is critical for developing prevention and management programs, guiding neurosurgeons in mitigating SRC risk, and informing return-to-play decisions.

背景和目标:在美国,每年有超过一百万名儿童受到与运动相关的脑震荡(SRC)的影响,这是一个重大的公共卫生问题。有关高中运动员发生 SRC 前的风险因素和损伤特征的数据十分有限。本研究旨在了解高中运动员的急性SRC损伤特征,并描述其发病前的风险因素:研究对象包括伊利诺伊州中部 19 所高中的运动员(14-19 岁),他们在 2009 年至 2023 年期间参加了学校主办的运动会。作为季前赛和受伤后评估的一部分,对运动脑震荡评估工具进行了评估。研究期间的所有 SRC 都对损伤特征(如机制、环境和症状)进行了描述。通过计算比值比 (OR),以确定在 SRC 前使用运动脑震荡评估工具进行基线评估的运动员和非脑震荡运动员的风险因素:共纳入了 4360 名运动员(3953 人未接受过 SRC;407 人接受过≥1 次 SRC,其中 168 人曾接受过基线评估)。总体而言,24.2%的SRC发生在女运动员身上,大多数SRC发生在美式足球(52.3%)、足球(20.4%)和篮球(7.6%)比赛中。头部受到打击/撞击是最常见的发病机制。头痛是最严重的症状(2.55 ± 1.51 [标码]),女性运动员的情绪化和紧张/焦虑症状明显更严重(P < .05)。曾有脑震荡(OR 2.64 95% CI [1.81,3.78])、曾因头部受伤住院(OR 3.19 95% CI [1.9,5.14])、头痛/偏头痛(OR 2.23 95% CI [1.29,3.66])和学习障碍(OR 2.69 95% CI [1.47,4.61])的学生出现 SRC 的几率更高(P < .05)。黑人或非裔美国人(vs 白人)(OR 0.54 95% CI [0.32,0.86])以及就读于较大(vs 较小)学校(OR 0.64 95% CI [0.46,0.88])的运动员发生 SRC 的几率较低:了解高中运动员的 SRC 风险因素和特征对于制定预防和管理计划、指导神经外科医生降低 SRC 风险以及为重返赛场决策提供信息至关重要。
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引用次数: 0
Use of Antibacterial Envelopes in Neuromodulation Surgeries With Implantable Device Insertion: A Systematic Review and Meta-Analysis. 在植入可植入设备的神经调控手术中使用抗菌包膜:系统回顾与元分析》。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 DOI: 10.1227/neu.0000000000003242
Helen Michaela de Oliveira, Lucas Mendes Barbosa, Fernanda Valeriano Zamora, Bruna Oliveira de Paula, Guilherme Oliveira de Paula, Julie G Pilitsis, Pablo Ramon Fruett da Costa

Background and objectives: Neuromodulation is an advanced therapeutic intervention for managing various neurological, psychiatric, and functional disorders. However, a significant challenge is the risk of infections at the device implantation site. Previous studies have shown that antibacterial envelopes used in cardiovascular surgeries significantly reduce infection risk. It is postulated that similar benefits could occur in neurosurgeries involving implant insertion, but the literature lacks studies analyzing this efficacy. This study aimed to evaluate the effectiveness of antibacterial envelopes in reducing infection rates associated with neuromodulation implants.

Methods: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases up to August 2024 for clinical trials comparing the use of antibacterial impregnated envelopes in patients undergoing neuromodulation-related implant insertion. This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Statistical analyses were performed using R version 4.3.2. Risk of bias was assessed using the Risk Of Bias In Nonrandomized Studies-of Interventions tool, and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation assessment. The study was registered in Prospective Register of Systematic Reviews.

Results: Four studies, comprising 1242 patients, were included, of whom 704 (56.7%) received antibacterial envelopes. The pooled analysis showed that the odds of infection were 77% lower in patients using the antibacterial envelope compared with the control group (odds ratios = 0.23; 95% CI = 0.10-0.51; P < .001; I2 = 2%).

Conclusion: The use of an antibacterial envelope significantly reduces the odds of infection in patients undergoing neuromodulation-related implant insertion by 77%. These findings underscore the potential of antibacterial envelopes to improve postoperative outcomes.

背景和目的:神经调控是一种先进的治疗干预手段,可用于治疗各种神经、精神和功能性疾病。然而,一个重大挑战是装置植入部位的感染风险。先前的研究表明,心血管手术中使用的抗菌包膜可显著降低感染风险。据推测,神经外科手术中的植入物植入也会产生类似的益处,但文献中缺乏对这种功效的分析研究。本研究旨在评估抗菌包膜在降低神经调控植入物相关感染率方面的效果:我们系统地检索了 PubMed、Embase 和 Cochrane Central Register of Controlled Trials 数据库(截止到 2024 年 8 月)中关于比较在接受神经调控相关植入物的患者中使用抗菌浸渍包膜的临床试验。本研究遵循《系统综述和元分析首选报告项目》指南。统计分析使用 R 4.3.2 版本进行。使用 "非随机干预研究中的偏倚风险 "工具对偏倚风险进行了评估,并使用 "建议评估、开发和评价分级 "对证据质量进行了评估。该研究已在前瞻性系统综述注册中心注册:结果:共纳入了四项研究,包括 1242 名患者,其中 704 人(56.7%)接受了抗菌包膜治疗。汇总分析显示,与对照组相比,使用抗菌包膜的患者感染几率降低了 77%(几率比 = 0.23;95% CI = 0.10-0.51;P < .001;I2 = 2%):结论:使用抗菌包膜可将接受神经调控相关植入物插入手术的患者的感染几率大幅降低 77%。这些发现强调了抗菌包膜改善术后效果的潜力。
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引用次数: 0
Letter: Use of Andexanet Alfa Before Urgent Neurosurgical and Neurointerventional Procedures: An Unresolved Issue. 信在紧急神经外科和神经介入手术前使用 Andexanet Alfa:一个悬而未决的问题
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 DOI: 10.1227/neu.0000000000003254
Senta Frol, Gustavo M Cortez, Janja Pretnar-Oblak, George Ntaios, Adnan H Siddiqui, Elad I Levy
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引用次数: 0
MicroRNA Analysis in Meningiomas with Different Degrees of Tissue Stiffness: A Potential Tool for Effective Preoperative Planning. 不同组织僵硬度脑膜瘤的微RNA分析:有效术前规划的潜在工具
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 DOI: 10.1227/neu.0000000000003222
Milos Duba, Dagmar Al Tukmachi, Tetiana Samoilenko, Marek Vecera, Michaela Ruckova, Tereza Vankova, Lenka Radova, Milos Kerkovsky, Marek Dostal, Tereza Koprivova, Ivana Roskova, Andrej Mrlian, Ondrej Hrdy, Jaroslav Duba, Leos Kren, Martin Smrcka, Ondrej Slaby, Pavel Fadrus, Jiri Sana

Background and objectives: Meningioma, the most common primary intracranial tumor, presents challenges in surgical treatment because of varying tissue stiffness. This study explores the molecular background of meningioma stiffness, a critical factor in surgical planning and prognosis, focusing on the utility of microRNAs (miRNAs) as diagnostic biomarkers of tissue stiffness.

Methods: Patients with meningiomas treated surgically at the University Hospital Brno were included in this study. Total RNA, isolated from tumor tissue samples, underwent quality control and small RNA sequencing to analyze miRNA expression. Differentially expressed miRNAs were identified, and their association with tumor stiffness was assessed.

Results: This study identified specific miRNAs differentially expressed in meningiomas with different stiffness levels. Key miRNAs, such as miR-31-5p and miR-34b-5p, showed significant upregulation in stiffer meningiomas. These findings were validated using reverse transcription-quantitative polymerase chain reaction, revealing a potential link between miRNA expression and tumor consistency. The expression of miR-31-5p was most notably associated with the stiffness of the tumor tissue (sensitivity = 71% and specificity = 83%).

Conclusion: This research highlights the potential of miRNAs as biomarkers for determining meningioma tissue stiffness. Identifying specific miRNAs associated with tumor consistency could improve preoperative planning and patient prognosis. These findings pave the way for further exploration of miRNAs in the clinical assessment of meningiomas.

背景和目的:脑膜瘤是最常见的原发性颅内肿瘤,由于组织僵硬度不同,给手术治疗带来了挑战。脑膜瘤僵硬度是影响手术计划和预后的关键因素,本研究探讨了脑膜瘤僵硬度的分子背景,重点研究了微小核糖核酸(miRNA)作为组织僵硬度诊断生物标志物的效用:研究对象包括在布尔诺大学医院接受手术治疗的脑膜瘤患者。从肿瘤组织样本中分离出的总 RNA 经过质量控制和小 RNA 测序,以分析 miRNA 的表达。结果发现了表达不同的 miRNA,并评估了它们与肿瘤硬度的关系:结果:这项研究发现了在不同硬度水平的脑膜瘤中表达不同的特定 miRNA。miR-31-5p和miR-34b-5p等关键miRNA在硬度较高的脑膜瘤中表现出显著的上调。反转录定量聚合酶链反应验证了这些发现,揭示了 miRNA 表达与肿瘤一致性之间的潜在联系。miR-31-5p的表达与肿瘤组织的僵硬程度最明显相关(敏感性=71%,特异性=83%):这项研究凸显了 miRNA 作为生物标记物确定脑膜瘤组织硬度的潜力。确定与肿瘤一致性相关的特定 miRNA 可改善术前计划和患者预后。这些发现为进一步探索 miRNA 在脑膜瘤临床评估中的应用铺平了道路。
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引用次数: 0
Cerebellopontine Angle Meningiomas: A Multi-Institutional Cohort Study. 小脑脑膜瘤:多机构队列研究
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 DOI: 10.1227/neu.0000000000003258
Neel H Mehta, Ruchit V Patel, Saksham Gupta, Harshit Arora, Noah L Nawabi, Rayha Karanth, Samantha Sadler, Lila Medeiros, Rohan Jha, Velina S Chavarro, Joshua D Bernstock, Timothy R Smith, Omar Arnaout

Background and objectives: Cerebellopontine angle (CPA) meningiomas present challenges given their proximity to neurovascular structures. Postoperative complications and persistent symptoms can debilitate patients, and our ability to predict recovery course remains variable. Here, we examine the presentation, management, and outcomes of patients with CPA meningiomas.

Methods: We retrospectively reviewed CPA meningiomas resected at Mass General Brigham, using descriptive statistics and logistic regression to identify predictors of progression or recurrence.

Results: In total, 95 patients were identified (median age 59.1 years, 82.1% female) who presented most commonly with hearing loss (49.5%), ataxia (42.1%), and headaches (29.5%). The retrosigmoid (78.9%) or transmastoid retrosigmoid (17.9%) approaches were most frequently used for resection, with gross total resection (GTR) achieved in 62.1% of patients: Simpson grade 1 (32.6%), grade 2 (17.9%), and grade 3 (11.6%). Smaller tumor size (t = 3.17, P = .002) is associated with GTR. For tumors with intracanalicular invasion, drilling the internal auditory canal (IAC) was also associated with GTR (χ2 = 21.8, P < .001). Among cases with invasion, GTR was achieved in 88.5% of cases when the IAC was drilled vs 11.8% of cases when the IAC was not drilled. The cranial nerve VII/VIII complex was frequently inferior (45.6%) or superior (19.1%) to the meningioma. Postoperative hearing loss was stable (38.7%) or improved (54.8%) in most of patients at the final clinical follow-up (median: 39.4 months). 25.3% of patients had progression/recurrence, with some difference between World Health Organization grade 1 (median: 3.0 years, IQR: 2.9 years) and World Health Organization grade 2 (median: 1.6 years, IQR: 2.8 years) tumors. After multivariate adjustment, Simpson grade I (P = .02), Simpson grade II (P = .01), or being of older age (P = .003) were associated with lower odds of progression/recurrence.

Conclusion: GTR remains critical to achieve optimal symptom control and reduce progression/recurrence rates for CPA meningiomas. Drilling the IAC is an important predictor of GTR in tumors with intracanalicular invasion.

背景和目的:小脑视角脑膜瘤(CPA)由于靠近神经血管结构而具有挑战性。术后并发症和持续症状会使患者变得虚弱,而我们预测康复过程的能力仍然参差不齐。在此,我们研究了CPA脑膜瘤患者的表现、管理和预后:我们回顾性研究了在布里格姆综合医院切除的CPA脑膜瘤,使用描述性统计和逻辑回归来确定进展或复发的预测因素:共发现 95 名患者(中位年龄 59.1 岁,82.1% 为女性),他们最常见的症状是听力下降(49.5%)、共济失调(42.1%)和头痛(29.5%)。切除时最常采用的是后蝶鞍(78.9%)或经蝶鞍后蝶鞍(17.9%)入路,62.1%的患者实现了大体全切除(GTR):辛普森 1 级(32.6%)、2 级(17.9%)和 3 级(11.6%)。肿瘤体积较小(t = 3.17,P = .002)与 GTR 相关。对于有耳内侵犯的肿瘤,钻孔内耳道(IAC)也与 GTR 相关(χ2 = 21.8,P < .001)。在有侵犯的病例中,88.5% 的病例在钻孔 IAC 后达到了 GTR,而未钻孔 IAC 的病例只有 11.8%。颅神经 VII/VIII 复合体经常位于脑膜瘤的下方(45.6%)或上方(19.1%)。在最后的临床随访中(中位数:39.4个月),大多数患者术后听力损失稳定(38.7%)或有所改善(54.8%)。25.3%的患者肿瘤进展/复发,世界卫生组织1级肿瘤(中位数:3.0年,IQR:2.9年)和世界卫生组织2级肿瘤(中位数:1.6年,IQR:2.8年)之间存在一定差异。经过多变量调整后,辛普森分级 I 级(P = .02)、辛普森分级 II 级(P = .01)或年龄较大(P = .003)与较低的进展/复发几率相关:结论:GTR对于实现最佳症状控制和降低CPA脑膜瘤的恶化/复发率仍然至关重要。在有脑室内侵犯的肿瘤中,IAC钻孔是预测GTR的一个重要指标。
{"title":"Cerebellopontine Angle Meningiomas: A Multi-Institutional Cohort Study.","authors":"Neel H Mehta, Ruchit V Patel, Saksham Gupta, Harshit Arora, Noah L Nawabi, Rayha Karanth, Samantha Sadler, Lila Medeiros, Rohan Jha, Velina S Chavarro, Joshua D Bernstock, Timothy R Smith, Omar Arnaout","doi":"10.1227/neu.0000000000003258","DOIUrl":"https://doi.org/10.1227/neu.0000000000003258","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cerebellopontine angle (CPA) meningiomas present challenges given their proximity to neurovascular structures. Postoperative complications and persistent symptoms can debilitate patients, and our ability to predict recovery course remains variable. Here, we examine the presentation, management, and outcomes of patients with CPA meningiomas.</p><p><strong>Methods: </strong>We retrospectively reviewed CPA meningiomas resected at Mass General Brigham, using descriptive statistics and logistic regression to identify predictors of progression or recurrence.</p><p><strong>Results: </strong>In total, 95 patients were identified (median age 59.1 years, 82.1% female) who presented most commonly with hearing loss (49.5%), ataxia (42.1%), and headaches (29.5%). The retrosigmoid (78.9%) or transmastoid retrosigmoid (17.9%) approaches were most frequently used for resection, with gross total resection (GTR) achieved in 62.1% of patients: Simpson grade 1 (32.6%), grade 2 (17.9%), and grade 3 (11.6%). Smaller tumor size (t = 3.17, P = .002) is associated with GTR. For tumors with intracanalicular invasion, drilling the internal auditory canal (IAC) was also associated with GTR (χ2 = 21.8, P < .001). Among cases with invasion, GTR was achieved in 88.5% of cases when the IAC was drilled vs 11.8% of cases when the IAC was not drilled. The cranial nerve VII/VIII complex was frequently inferior (45.6%) or superior (19.1%) to the meningioma. Postoperative hearing loss was stable (38.7%) or improved (54.8%) in most of patients at the final clinical follow-up (median: 39.4 months). 25.3% of patients had progression/recurrence, with some difference between World Health Organization grade 1 (median: 3.0 years, IQR: 2.9 years) and World Health Organization grade 2 (median: 1.6 years, IQR: 2.8 years) tumors. After multivariate adjustment, Simpson grade I (P = .02), Simpson grade II (P = .01), or being of older age (P = .003) were associated with lower odds of progression/recurrence.</p><p><strong>Conclusion: </strong>GTR remains critical to achieve optimal symptom control and reduce progression/recurrence rates for CPA meningiomas. Drilling the IAC is an important predictor of GTR in tumors with intracanalicular invasion.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558369","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
Comprehensive Surgical Management of Thoracic Schwannomas: A Retrospective Multicenter Study on 98 Lesions. 胸部许旺瘤的综合外科治疗:98例病变的多中心回顾性研究
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 DOI: 10.1227/neu.0000000000003259
Giuseppe Corazzelli, Sergio Corvino, Maria Marvulli, Valentina Cioffi, Alessandro D'Elia, Vincenzo Meglio, Roberto Tafuto, Ciro Mastantuoni, Maria Rosaria Scala, Francesco Ricciardi, Salvatore Di Colandrea, Settimio Leonetti, Pasqualino De Marinis, Sergio Paolini, Vincenzo Esposito, Alfonso Fiorelli, Gualtiero Innocenzi, Oreste de Divitiis, Raffaele de Falco, Antonio Bocchetti

Background and objectives: The optimal surgical management of thoracic schwannomas (TSs) remains contentious, with various approaches proposed. Video-assisted thoracoscopic surgery (VATS) and combined VATS with neurosurgical procedures have shown promise, particularly for Eden type IV and III lesions. However, unanimous consent on the most effective surgical intervention and understanding of prognostic factors for tumor recurrence needs to be improved. The aim of this study was to elucidate the optimal surgical approach according to the Eden type and investigate predictive factors for TS recurrence.

Methods: This retrospective, multicentric, observational study analyzed 98 surgically treated patients with TS from 2011 to 2023, assessing preoperative and 6-month follow-up clinical (recurrences, pain, and myelopathy recovery) and surgical parameters (operative time, intraoperative blood loss, extent of resection). Surgical procedures included thoracic laminectomy or hemilaminectomy for type I, laminectomy or thoracic transpedicular (TPD) approach for type II, laminectomy alone or combined laminectomy with VATS for type III, and VATS or thoracotomy (open thoracotomy [OT]) for type IV. Descriptive and deductive analyses were conducted between and within the 4 cohorts, with multivariate analysis assessing the contribution of predictor variables.

Results: No significant differences were found between hemilaminectomy and laminectomy for all analyzed parameters for type I. Type II lesions treated with TPD exhibited similar outcomes to laminectomy, albeit with longer procedure times. Type III lesions benefited from combined approaches compared with neurosurgical-only approaches. Video-assisted thoracoscopic surgery emerged as more favorable than OT for type IV lesions. Multivariate analysis revealed that patient sex, tumor location, extent of resection, and pathology significantly influenced recurrence rates.

Conclusion: For Eden type III TSs, neurosurgical and VATS combined surgery achieved better outcomes than neurosurgery alone; for Eden type IV TSs, VATS achieved better results than OT. For Eden types I and II, hemilaminectomy and bilateral laminectomy and laminectomy and TPD achieved similar outcomes, respectively.

背景和目的:胸椎裂孔瘤(TSs)的最佳手术治疗方法仍存在争议,提出了多种方法。视频辅助胸腔镜手术(VATS)和联合 VATS 与神经外科手术已显示出前景,特别是对于伊甸园 IV 型和 III 型病变。然而,关于最有效的手术干预的一致意见以及对肿瘤复发预后因素的了解还有待提高。本研究旨在根据伊甸园类型阐明最佳手术方法,并调查 TS 复发的预测因素:这项回顾性、多中心、观察性研究分析了2011年至2023年接受手术治疗的98例TS患者,评估了术前和6个月随访的临床(复发、疼痛和脊髓病恢复)和手术参数(手术时间、术中失血量、切除范围)。手术方法包括:I型采用胸椎椎板切除术或半椎板切除术;II型采用椎板切除术或胸椎经椎管(TPD)方法;III型采用单独椎板切除术或与VATS联合椎板切除术;IV型采用VATS或开胸(开胸手术[OT])。在 4 个队列之间和队列内部进行了描述性和演绎性分析,并通过多变量分析评估了预测变量的作用:在所有分析参数中,半椎板切除术与椎板切除术在I型病变方面无明显差异。与单纯神经外科方法相比,联合方法对III型病变更有利。对于 IV 型病变,视频辅助胸腔镜手术比 OT 更为有利。多变量分析显示,患者性别、肿瘤位置、切除范围和病理学对复发率有显著影响:结论:对于伊甸园III型TS,神经外科和VATS联合手术比单独神经外科手术取得更好的疗效;对于伊甸园IV型TS,VATS手术比OT手术取得更好的疗效。对于伊甸园 I 型和 II 型 TS,半椎板切除术和双侧椎板切除术以及椎板切除术和 TPD 分别取得了相似的疗效。
{"title":"Comprehensive Surgical Management of Thoracic Schwannomas: A Retrospective Multicenter Study on 98 Lesions.","authors":"Giuseppe Corazzelli, Sergio Corvino, Maria Marvulli, Valentina Cioffi, Alessandro D'Elia, Vincenzo Meglio, Roberto Tafuto, Ciro Mastantuoni, Maria Rosaria Scala, Francesco Ricciardi, Salvatore Di Colandrea, Settimio Leonetti, Pasqualino De Marinis, Sergio Paolini, Vincenzo Esposito, Alfonso Fiorelli, Gualtiero Innocenzi, Oreste de Divitiis, Raffaele de Falco, Antonio Bocchetti","doi":"10.1227/neu.0000000000003259","DOIUrl":"https://doi.org/10.1227/neu.0000000000003259","url":null,"abstract":"<p><strong>Background and objectives: </strong>The optimal surgical management of thoracic schwannomas (TSs) remains contentious, with various approaches proposed. Video-assisted thoracoscopic surgery (VATS) and combined VATS with neurosurgical procedures have shown promise, particularly for Eden type IV and III lesions. However, unanimous consent on the most effective surgical intervention and understanding of prognostic factors for tumor recurrence needs to be improved. The aim of this study was to elucidate the optimal surgical approach according to the Eden type and investigate predictive factors for TS recurrence.</p><p><strong>Methods: </strong>This retrospective, multicentric, observational study analyzed 98 surgically treated patients with TS from 2011 to 2023, assessing preoperative and 6-month follow-up clinical (recurrences, pain, and myelopathy recovery) and surgical parameters (operative time, intraoperative blood loss, extent of resection). Surgical procedures included thoracic laminectomy or hemilaminectomy for type I, laminectomy or thoracic transpedicular (TPD) approach for type II, laminectomy alone or combined laminectomy with VATS for type III, and VATS or thoracotomy (open thoracotomy [OT]) for type IV. Descriptive and deductive analyses were conducted between and within the 4 cohorts, with multivariate analysis assessing the contribution of predictor variables.</p><p><strong>Results: </strong>No significant differences were found between hemilaminectomy and laminectomy for all analyzed parameters for type I. Type II lesions treated with TPD exhibited similar outcomes to laminectomy, albeit with longer procedure times. Type III lesions benefited from combined approaches compared with neurosurgical-only approaches. Video-assisted thoracoscopic surgery emerged as more favorable than OT for type IV lesions. Multivariate analysis revealed that patient sex, tumor location, extent of resection, and pathology significantly influenced recurrence rates.</p><p><strong>Conclusion: </strong>For Eden type III TSs, neurosurgical and VATS combined surgery achieved better outcomes than neurosurgery alone; for Eden type IV TSs, VATS achieved better results than OT. For Eden types I and II, hemilaminectomy and bilateral laminectomy and laminectomy and TPD achieved similar outcomes, respectively.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558370","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
Comparative Outcomes of Unilateral vs Bilateral Revascularization in Moyamoya Disease: A Multicenter Retrospective Study. Moyamoya 病单侧血管重建与双侧血管重建的疗效比较:一项多中心回顾性研究
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-28 DOI: 10.1227/neu.0000000000003243
Basel Musmar, Joanna M Roy, Hammam Abdalrazeq, Anand Kaul, Elias Atallah, Kareem El Naamani, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan A Grossberg, Adam A Dmytriw, Aman B Patel, Mirhojjat Khorasanizadeh, Christopher S Ogilvy, Ajith J Thomas, Andre Monteiro, Adnan Siddiqui, Gustavo M Cortez, Ricardo A Hanel, Guilherme Porto, Alejandro M Spiotta, Anthony J Piscopo, David M Hasan, Mohammad Ghorbani, Joshua Weinberg, Shahid M Nimjee, Kimon Bekelis, Mohamed M Salem, Jan-Karl Burkhardt, Akli Zetchi, Charles Matouk, Brian M Howard, Rosalind Lai, Rose Du, Rawad Abbas, Georgios S Sioutas, Abdelaziz Amllay, Alfredo Munoz, Nabeel A Herial, Stavropoula I Tjoumakaris, Michael Reid Gooch, Robert H Rosenwasser, Pascal Jabbour

Background and objectives: Moyamoya disease (MMD) is characterized by progressive steno-occlusion of the internal carotid arteries, leading to compensatory collateral vessel formation. The optimal surgical approach for MMD remains debated, with bilateral revascularization potentially offering more comprehensive protection but involving more extensive surgery compared to unilateral revascularization. This study aims to compare bilateral revascularization and unilateral revascularization short-term safety profile in the treatment of MMD.

Methods: This multicenter retrospective study included patients with MMD who underwent surgical revascularization at 13 academic institutions. Patients were categorized into unilateral and bilateral revascularization groups. Data collected included demographics, clinical characteristics, and outcomes. Propensity score matching was used to balance baseline characteristics. Statistical analyses were conducted using Stata (V.17.0; StataCorp).

Results: A total of 497 patients were included, including 90 who had bilateral revascularization and 407 who had unilateral revascularization. Bilateral revascularization was associated with more perioperative asymptomatic strokes (10% vs 2.4%; odds ratio [OR] 4.41, 95% CI 1.73 to 11.19, P = .002) and higher rates of excellent functional outcomes (modified Rankin Scale 0-1) at discharge (92.2% vs 79.1%; OR 3.12, 95% CI 1.39 to 7, P = .006). After propensity score matching, 57 matched pairs were analyzed. There was a higher rate, though not statistically significant difference, of perioperative stroke in the bilateral revascularization group (15.7% vs 8.7%; OR 1.95, 95% CI 0.61 to 6.22, P = .26). No significant differences were noted in modified Rankin scale 0 to 1 and 0 to 2 scores at discharge, National Institute of Health Stroke Scale at discharge, intraoperative complications, or length of hospital stay. The follow-up stroke rates were also not significantly different (OR 0.40, 95% CI 0.11 to 1.39, P = .15).

Conclusion: This study found no significant differences between bilateral and unilateral revascularization in MMD. Patients who had bilateral revascularization had higher tendency of perioperative stroke, though not statistically significant. Further prospective studies are needed to validate these results.

背景和目的:莫亚莫亚病(MMD)的特点是颈内动脉进行性狭窄闭塞,导致代偿性侧支血管形成。治疗 MMD 的最佳手术方法仍存在争议,双侧血管重建术可能提供更全面的保护,但与单侧血管重建术相比,需要进行更广泛的手术。本研究旨在比较双侧血管重建术和单侧血管重建术治疗多发性硬化症的短期安全性:这项多中心回顾性研究纳入了在 13 家学术机构接受手术血管重建的 MMD 患者。患者被分为单侧和双侧血管重建组。收集的数据包括人口统计学、临床特征和结果。采用倾向评分匹配法平衡基线特征。统计分析使用Stata(V.17.0;StataCorp)进行:结果:共纳入497例患者,其中90例为双侧血管再通,407例为单侧血管再通。双侧血管再通与更多的围手术期无症状中风(10% vs 2.4%;比值比 [OR] 4.41,95% CI 1.73 至 11.19,P = .002)和更高的出院时优良功能预后率(改良 Rankin 量表 0-1)相关(92.2% vs 79.1%;比值比 3.12,95% CI 1.39 至 7,P = .006)。经过倾向评分匹配后,对 57 对匹配者进行了分析。双侧血管重建组围手术期中风发生率较高,但差异无统计学意义(15.7% vs 8.7%; OR 1.95, 95% CI 0.61 to 6.22, P = .26)。在出院时改良 Rankin 量表 0 至 1 级和 0 至 2 级评分、出院时美国国立卫生研究院卒中量表、术中并发症或住院时间方面无明显差异。随访卒中发生率也无明显差异(OR 0.40,95% CI 0.11 至 1.39,P = .15):结论:本研究发现,在 MMD 患者中,双侧血管再通与单侧血管再通之间没有明显差异。结论:本研究发现,双侧和单侧血管再通在 MMD 患者中无明显差异,但双侧血管再通患者围术期中风的发生率较高,但无统计学意义。需要进一步的前瞻性研究来验证这些结果。
{"title":"Comparative Outcomes of Unilateral vs Bilateral Revascularization in Moyamoya Disease: A Multicenter Retrospective Study.","authors":"Basel Musmar, Joanna M Roy, Hammam Abdalrazeq, Anand Kaul, Elias Atallah, Kareem El Naamani, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan A Grossberg, Adam A Dmytriw, Aman B Patel, Mirhojjat Khorasanizadeh, Christopher S Ogilvy, Ajith J Thomas, Andre Monteiro, Adnan Siddiqui, Gustavo M Cortez, Ricardo A Hanel, Guilherme Porto, Alejandro M Spiotta, Anthony J Piscopo, David M Hasan, Mohammad Ghorbani, Joshua Weinberg, Shahid M Nimjee, Kimon Bekelis, Mohamed M Salem, Jan-Karl Burkhardt, Akli Zetchi, Charles Matouk, Brian M Howard, Rosalind Lai, Rose Du, Rawad Abbas, Georgios S Sioutas, Abdelaziz Amllay, Alfredo Munoz, Nabeel A Herial, Stavropoula I Tjoumakaris, Michael Reid Gooch, Robert H Rosenwasser, Pascal Jabbour","doi":"10.1227/neu.0000000000003243","DOIUrl":"https://doi.org/10.1227/neu.0000000000003243","url":null,"abstract":"<p><strong>Background and objectives: </strong>Moyamoya disease (MMD) is characterized by progressive steno-occlusion of the internal carotid arteries, leading to compensatory collateral vessel formation. The optimal surgical approach for MMD remains debated, with bilateral revascularization potentially offering more comprehensive protection but involving more extensive surgery compared to unilateral revascularization. This study aims to compare bilateral revascularization and unilateral revascularization short-term safety profile in the treatment of MMD.</p><p><strong>Methods: </strong>This multicenter retrospective study included patients with MMD who underwent surgical revascularization at 13 academic institutions. Patients were categorized into unilateral and bilateral revascularization groups. Data collected included demographics, clinical characteristics, and outcomes. Propensity score matching was used to balance baseline characteristics. Statistical analyses were conducted using Stata (V.17.0; StataCorp).</p><p><strong>Results: </strong>A total of 497 patients were included, including 90 who had bilateral revascularization and 407 who had unilateral revascularization. Bilateral revascularization was associated with more perioperative asymptomatic strokes (10% vs 2.4%; odds ratio [OR] 4.41, 95% CI 1.73 to 11.19, P = .002) and higher rates of excellent functional outcomes (modified Rankin Scale 0-1) at discharge (92.2% vs 79.1%; OR 3.12, 95% CI 1.39 to 7, P = .006). After propensity score matching, 57 matched pairs were analyzed. There was a higher rate, though not statistically significant difference, of perioperative stroke in the bilateral revascularization group (15.7% vs 8.7%; OR 1.95, 95% CI 0.61 to 6.22, P = .26). No significant differences were noted in modified Rankin scale 0 to 1 and 0 to 2 scores at discharge, National Institute of Health Stroke Scale at discharge, intraoperative complications, or length of hospital stay. The follow-up stroke rates were also not significantly different (OR 0.40, 95% CI 0.11 to 1.39, P = .15).</p><p><strong>Conclusion: </strong>This study found no significant differences between bilateral and unilateral revascularization in MMD. Patients who had bilateral revascularization had higher tendency of perioperative stroke, though not statistically significant. Further prospective studies are needed to validate these results.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504918","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
Academic Neurosurgery Gender and Authorship Trends in the United States. 美国学术神经外科的性别和作者趋势。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-28 DOI: 10.1227/neu.0000000000003252
Kathryn N Kearns, Kristina P Kurker, Alexandria C Marino, Patricia Zhao, Purushotham Ramanathan, Mark E Shaffrey, John A Jane, Min S Park

Background and objectives: Women represent ∼20% of the national neurosurgical resident cohort but only ∼10% of academic neurosurgeons in the United States. Recognizing that the publication of scientific literature contributes to academic advancement, we measured authorship trends of academic neurosurgeons to query publication differences as an explanation for the discrepancy of female representation in academic positions.

Methods: Physician data were obtained from program and individual physician webpages. Annual total, first author, and senior author publications were recorded for each neurosurgeon from 1980 to 2020. Mean publication number as a function of the year relative to residency graduation was calculated for all, first author, and senior author publications for all timepoints with >50 individuals. The mean first years of publication were compared using unpaired 2-tailed t-tests. The slope of publication for the senior author and all publications was calculated using individual best-fit lines from years 0 to 10 relative to residency graduation.

Results: Overall, 1601 faculty members were evaluated (female = 167 [10.4%], male = 1434 [89.6%]). First-author publication for female members peaked at 0.60 publications/year, and for male members at 0.80 publications/year, both at -1 year from graduation (P = .038). Female first publication occurred earlier (-2.4 vs 1.45 years; P < .00001). The mean increase in all publications/year from years 0 to 10 was 0.25 for women and 0.28 for men (P = .68). The increase in senior publications/year was 0.11 for women and 0.13 for men (P = .39). The ratio of total publications to the Scopus h-index was 3.08 for women and 3.62 for men (P = .07).

Conclusion: These data suggest that women publish earlier but have fewer first-author publications at -1 year, the timepoint of peak publication for both genders. There was no significant gender difference in rates of the first author and all publications over the years 0 to 10. The ratio of publications to the h-index did not differ significantly but showed a trend suggesting that women produce higher-impact articles and may need fewer publications to achieve the same change in the h-index.

背景和目标:女性占全国神经外科住院医师总数的 20%,但只占美国学术神经外科医师总数的 10%。我们认识到科学文献的发表有助于学术进步,因此我们测量了学术神经外科医生的作者趋势,以质疑发表文章的差异,并以此解释女性在学术职位中代表性的差异:医生数据来自项目和医生个人网页。记录了每位神经外科医生从 1980 年到 2020 年的年度总论文数、第一作者论文数和资深作者论文数。计算了所有时间点上超过 50 人的所有、第一作者和资深作者发表论文的平均数量与住院医师毕业年份的函数关系。使用非配对双尾 t 检验比较了发表论文的第一年平均值。资深作者和所有论文的发表斜率是用相对于住院医师毕业的 0 至 10 年的个人最佳拟合线来计算的:共有 1601 名教职员工接受了评估(女性 = 167 [10.4%],男性 = 1434 [89.6%])。女性教职员工的第一作者论文发表高峰为 0.60 篇/年,男性教职员工的第一作者论文发表高峰为 0.80 篇/年,均为毕业后 -1 年(P = .038)。女性首次发表论文的时间更早(-2.4 年 vs 1.45 年;P < .00001)。从 0 年到 10 年,女性发表论文的平均年增长率为 0.25,男性为 0.28(P = .68)。高级发表论文数量的年均增长女性为 0.11 篇,男性为 0.13 篇(P = .39)。论文总数与 Scopus h 指数之比,女性为 3.08,男性为 3.62(P = .07):这些数据表明,女性发表论文的时间较早,但在-1年(男女两性发表论文的高峰时间点)发表的第一作者论文较少。在 0 到 10 年间,第一作者和所有出版物的发表率没有明显的性别差异。发表论文与 h 指数的比率没有明显差异,但呈现出一种趋势,表明女性发表的文章影响更大,可能需要更少的论文来实现 h 指数的相同变化。
{"title":"Academic Neurosurgery Gender and Authorship Trends in the United States.","authors":"Kathryn N Kearns, Kristina P Kurker, Alexandria C Marino, Patricia Zhao, Purushotham Ramanathan, Mark E Shaffrey, John A Jane, Min S Park","doi":"10.1227/neu.0000000000003252","DOIUrl":"https://doi.org/10.1227/neu.0000000000003252","url":null,"abstract":"<p><strong>Background and objectives: </strong>Women represent ∼20% of the national neurosurgical resident cohort but only ∼10% of academic neurosurgeons in the United States. Recognizing that the publication of scientific literature contributes to academic advancement, we measured authorship trends of academic neurosurgeons to query publication differences as an explanation for the discrepancy of female representation in academic positions.</p><p><strong>Methods: </strong>Physician data were obtained from program and individual physician webpages. Annual total, first author, and senior author publications were recorded for each neurosurgeon from 1980 to 2020. Mean publication number as a function of the year relative to residency graduation was calculated for all, first author, and senior author publications for all timepoints with >50 individuals. The mean first years of publication were compared using unpaired 2-tailed t-tests. The slope of publication for the senior author and all publications was calculated using individual best-fit lines from years 0 to 10 relative to residency graduation.</p><p><strong>Results: </strong>Overall, 1601 faculty members were evaluated (female = 167 [10.4%], male = 1434 [89.6%]). First-author publication for female members peaked at 0.60 publications/year, and for male members at 0.80 publications/year, both at -1 year from graduation (P = .038). Female first publication occurred earlier (-2.4 vs 1.45 years; P < .00001). The mean increase in all publications/year from years 0 to 10 was 0.25 for women and 0.28 for men (P = .68). The increase in senior publications/year was 0.11 for women and 0.13 for men (P = .39). The ratio of total publications to the Scopus h-index was 3.08 for women and 3.62 for men (P = .07).</p><p><strong>Conclusion: </strong>These data suggest that women publish earlier but have fewer first-author publications at -1 year, the timepoint of peak publication for both genders. There was no significant gender difference in rates of the first author and all publications over the years 0 to 10. The ratio of publications to the h-index did not differ significantly but showed a trend suggesting that women produce higher-impact articles and may need fewer publications to achieve the same change in the h-index.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504917","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
Stereotactic Radiosurgery Dose Reduction for Melanoma Brain Metastases Patients on Immunotherapy or Target Therapy: A Single-Center Experience. 减少接受免疫疗法或靶向疗法的黑色素瘤脑转移患者的立体定向放射手术剂量:单中心经验。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-28 DOI: 10.1227/neu.0000000000003239
Salem M Tos, Georgios Mantziaris, Ahmed Shaaban, Stylianos Pikis, Chloe Dumot, Jason P Sheehan

Background and objectives: Better local control but higher rates of adverse radiation events (ARE) have been reported when combining American Society for Radiation Oncology (ASTRO)-guideline-suggested dose (SD) stereotactic radiosurgery (SRS) with immunotherapy or targeted therapy for melanoma brain metastases. The objective of this study is to explore the efficacy and safety of lower prescription doses compared with ASTRO guidelines for single-fraction SRS for patients with melanoma metastases who are concurrently receiving immunotherapy or targeted therapy.

Methods: We conducted a retrospective, single-center study on 194 patients who underwent SRS between 2009 and 2022. After propensity score matching, 71 patients with 292 metastases were included in the ASTRO-SD (20-24 Gy for <2 cm, 18 Gy for ≥2 to <3 cm) group and 33 patients with 292 metastases in the reduced dose (RD, <20 Gy for <2 cm, <18 Gy for ≥2 to <3 cm) group.

Results: The median diameter (5.4 vs 5.2 mm, P = .6), prescription volume (0.2 vs 0.2 cm3, P = .2), and radiographic follow-up (11 vs 12 months, P = .2) were similar in the 2 groups. The cumulative incidence of progressing metastases was significantly higher in the SD compared with the RD group (P = .018). Higher prescription volumes and ASTRO-suggested radiation doses were associated with local progression in multivariable analysis. Radiographic AREs were significantly more common in the SD compared with the RD group (8.6% vs 3.1%, P = .005). BRAF and other tyrosine kinase inhibitors' concurrent use, higher prescription volumes, and ASTRO-suggested radiation doses were associated with an increased risk of radiographic ARE.

Conclusion: This study provides evidence that RD SRS could offer reduced toxicity rates, while maintaining high local control as compared with the current guideline-SDs for the treatment of melanoma brain metastases.

背景和目的:有报道称,将美国放射肿瘤学会(ASTRO)指南建议剂量(SD)立体定向放射手术(SRS)与免疫疗法或靶向疗法联合治疗黑色素瘤脑转移时,局部控制效果更好,但放射不良事件(ARE)发生率更高。本研究的目的是探讨与ASTRO指南相比,对同时接受免疫疗法或靶向疗法的黑色素瘤转移患者采用较低处方剂量进行单次分次SRS治疗的疗效和安全性:我们对 2009 年至 2022 年期间接受 SRS 治疗的 194 例患者进行了一项回顾性单中心研究。经过倾向评分匹配后,71 名患者的 292 个转移灶被纳入 ASTRO-SD(20-24 Gy)结果:两组患者的中位直径(5.4 vs 5.2 mm,P = .6)、处方量(0.2 vs 0.2 cm3,P = .2)和放射学随访(11 vs 12个月,P = .2)相似。与 RD 组相比,SD 组的进展转移累积发生率明显更高(P = .018)。在多变量分析中,较高的处方量和ASTRO建议的放射剂量与局部进展有关。与 RD 组相比,SD 组的影像学 AREs 明显更常见(8.6% vs 3.1%,P = .005)。BRAF和其他酪氨酸激酶抑制剂的同时使用、较高的处方量和ASTRO建议的放射剂量与放射学ARE风险增加有关:本研究提供的证据表明,与目前治疗黑色素瘤脑转移的指南-标准相比,RD SRS 可以降低毒性,同时保持较高的局部控制率。
{"title":"Stereotactic Radiosurgery Dose Reduction for Melanoma Brain Metastases Patients on Immunotherapy or Target Therapy: A Single-Center Experience.","authors":"Salem M Tos, Georgios Mantziaris, Ahmed Shaaban, Stylianos Pikis, Chloe Dumot, Jason P Sheehan","doi":"10.1227/neu.0000000000003239","DOIUrl":"https://doi.org/10.1227/neu.0000000000003239","url":null,"abstract":"<p><strong>Background and objectives: </strong>Better local control but higher rates of adverse radiation events (ARE) have been reported when combining American Society for Radiation Oncology (ASTRO)-guideline-suggested dose (SD) stereotactic radiosurgery (SRS) with immunotherapy or targeted therapy for melanoma brain metastases. The objective of this study is to explore the efficacy and safety of lower prescription doses compared with ASTRO guidelines for single-fraction SRS for patients with melanoma metastases who are concurrently receiving immunotherapy or targeted therapy.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center study on 194 patients who underwent SRS between 2009 and 2022. After propensity score matching, 71 patients with 292 metastases were included in the ASTRO-SD (20-24 Gy for <2 cm, 18 Gy for ≥2 to <3 cm) group and 33 patients with 292 metastases in the reduced dose (RD, <20 Gy for <2 cm, <18 Gy for ≥2 to <3 cm) group.</p><p><strong>Results: </strong>The median diameter (5.4 vs 5.2 mm, P = .6), prescription volume (0.2 vs 0.2 cm3, P = .2), and radiographic follow-up (11 vs 12 months, P = .2) were similar in the 2 groups. The cumulative incidence of progressing metastases was significantly higher in the SD compared with the RD group (P = .018). Higher prescription volumes and ASTRO-suggested radiation doses were associated with local progression in multivariable analysis. Radiographic AREs were significantly more common in the SD compared with the RD group (8.6% vs 3.1%, P = .005). BRAF and other tyrosine kinase inhibitors' concurrent use, higher prescription volumes, and ASTRO-suggested radiation doses were associated with an increased risk of radiographic ARE.</p><p><strong>Conclusion: </strong>This study provides evidence that RD SRS could offer reduced toxicity rates, while maintaining high local control as compared with the current guideline-SDs for the treatment of melanoma brain metastases.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504929","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
Laparoscopic-Assisted Peritoneal Access in Ventriculoperitoneal Shunt Placement: Systematic Review and Meta-Analysis. 腹腔镜辅助腹膜入路在脑室腹腔分流术中的应用:系统回顾与元分析》。
IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-28 DOI: 10.1227/neu.0000000000003213
Sunny Abdelmageed, Prottusha Sarkar, Nathan A Shlobin, Daniel G Davila, Matthew B Potts

Background and objectives: The most common treatment of hydrocephalus is ventriculoperitoneal (VP) shunting. Peritoneal access is commonly conducted through an open laparotomy, but laparoscopic peritoneal access is gaining popularity. Many studies have reported the benefits of minimally invasive laparoscopic peritoneal access, but there is no consensus on its use. We conducted a systematic review and meta-analysis to compare open laparotomy vs laparoscopic peritoneal access in VP shunting.

Methods: A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 3 databases. Twelve studies included only adults, 3 included only pediatric patients, and 3 included both adults and pediatric patients.

Results: Compared with open laparotomy, laparoscopic peritoneal access was associated with a reduction in distal shunt failure (6.1% vs 2.2%, P = .01), operative time (69.4 vs 56.3 minutes, P < .001), and length of stay (LOS) (9.6 vs 7.3 days, P < .001). There were no differences in proximal shunt failure, total shunt failure, intraoperative complications, or infection rate. In the pediatric population, laparoscopic access was associated with a reduced LOS (7.8 vs 5.9 days, P < .001). Heterogeneity was high but explained by the varying study populations and techniques.

Conclusion: Laparoscopic peritoneal access for VP shunt insertion is associated with improved outcomes, including reduced distal shunt failure, reduced operative time, and reduced hospital LOS, when compared with open laparotomy and should be considered for shunt insertion. Additional studies are necessary to further determine the benefit of laparoscopic access, especially in the pediatric population.

背景和目的:脑积水最常见的治疗方法是脑室腹腔分流术(VP)。腹膜入路通常通过开腹手术进行,但腹腔镜腹膜入路正越来越受欢迎。许多研究报告了微创腹腔镜腹膜入路的好处,但对其使用还没有达成共识。我们进行了一项系统性回顾和荟萃分析,比较开腹手术与腹腔镜腹膜入路在 VP 分流中的应用:方法:根据《系统综述和荟萃分析首选报告项目》指南,我们使用 3 个数据库进行了系统检索。12项研究仅包括成人患者,3项研究仅包括儿童患者,3项研究同时包括成人和儿童患者:结果:与开腹手术相比,腹腔镜腹膜入路可减少远端分流失败(6.1% vs 2.2%,P = .01)、手术时间(69.4 分钟 vs 56.3 分钟,P < .001)和住院时间(LOS)(9.6 天 vs 7.3 天,P < .001)。在近端分流失败、总分流失败、术中并发症或感染率方面没有差异。在儿童患者中,腹腔镜入路可缩短患者的住院时间(7.8 天 vs 5.9 天,P < .001)。异质性很高,但研究人群和技术的不同可以解释这一点:结论:与开腹手术相比,腹腔镜腹膜入路插入VP分流管可改善预后,包括减少分流管远端失败、缩短手术时间和缩短住院时间,因此应考虑将腹腔镜腹膜入路用于插入分流管。有必要进行更多研究,以进一步确定腹腔镜入路的益处,尤其是在儿科人群中。
{"title":"Laparoscopic-Assisted Peritoneal Access in Ventriculoperitoneal Shunt Placement: Systematic Review and Meta-Analysis.","authors":"Sunny Abdelmageed, Prottusha Sarkar, Nathan A Shlobin, Daniel G Davila, Matthew B Potts","doi":"10.1227/neu.0000000000003213","DOIUrl":"https://doi.org/10.1227/neu.0000000000003213","url":null,"abstract":"<p><strong>Background and objectives: </strong>The most common treatment of hydrocephalus is ventriculoperitoneal (VP) shunting. Peritoneal access is commonly conducted through an open laparotomy, but laparoscopic peritoneal access is gaining popularity. Many studies have reported the benefits of minimally invasive laparoscopic peritoneal access, but there is no consensus on its use. We conducted a systematic review and meta-analysis to compare open laparotomy vs laparoscopic peritoneal access in VP shunting.</p><p><strong>Methods: </strong>A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 3 databases. Twelve studies included only adults, 3 included only pediatric patients, and 3 included both adults and pediatric patients.</p><p><strong>Results: </strong>Compared with open laparotomy, laparoscopic peritoneal access was associated with a reduction in distal shunt failure (6.1% vs 2.2%, P = .01), operative time (69.4 vs 56.3 minutes, P < .001), and length of stay (LOS) (9.6 vs 7.3 days, P < .001). There were no differences in proximal shunt failure, total shunt failure, intraoperative complications, or infection rate. In the pediatric population, laparoscopic access was associated with a reduced LOS (7.8 vs 5.9 days, P < .001). Heterogeneity was high but explained by the varying study populations and techniques.</p><p><strong>Conclusion: </strong>Laparoscopic peritoneal access for VP shunt insertion is associated with improved outcomes, including reduced distal shunt failure, reduced operative time, and reduced hospital LOS, when compared with open laparotomy and should be considered for shunt insertion. Additional studies are necessary to further determine the benefit of laparoscopic access, especially in the pediatric population.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504923","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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