Pub Date : 2024-10-21DOI: 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.
{"title":"Technical Feasibility of Delineating the Thalamic Gustatory Tract Using Tractography.","authors":"Kazuki Sakakura, Nathan Pertsch, Julia Mueller, Alireza Borghei, Nicholas Rubert, Sepehr Sani","doi":"10.1227/neu.0000000000003227","DOIUrl":"https://doi.org/10.1227/neu.0000000000003227","url":null,"abstract":"<p><strong>Background and objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>The thalamic gustatory tracts can be reliably visualized using tractography.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546565","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}
Pub Date : 2024-10-17DOI: 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.
{"title":"Vesalius and His Manikin: An Enduring Influence on Modern Anatomic Teaching.","authors":"Thomas J On, Yuan Xu, Jubran H Jubran, Andrea L Castillo, Ali Tayebi Meybodi, Oscar Alcantar-Garibay, T Forcht Dagi, Mark C Preul","doi":"10.1227/neu.0000000000003187","DOIUrl":"https://doi.org/10.1227/neu.0000000000003187","url":null,"abstract":"<p><p>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.</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":"142546566","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}
Pub Date : 2024-10-17DOI: 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。
{"title":"Embolic Materials' Comparison in Meningeal Artery Embolization for Chronic Subdural Hematomas: Multicenter Propensity Score-Matched Analysis of 1070 Cases.","authors":"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","doi":"10.1227/neu.0000000000003218","DOIUrl":"https://doi.org/10.1227/neu.0000000000003218","url":null,"abstract":"<p><strong>Background and objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</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":"142546555","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}
Pub Date : 2024-10-17DOI: 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}
Pub Date : 2024-10-17DOI: 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.
{"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}
Pub Date : 2024-10-11DOI: 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.
{"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}
Pub Date : 2024-10-11DOI: 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.
{"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}
Pub Date : 2024-10-11DOI: 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.
{"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}
Pub Date : 2024-10-11DOI: 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.
{"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}
Pub Date : 2024-10-11DOI: 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.
{"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}