Pub Date : 2024-10-03DOI: 10.1227/neu.0000000000003210
Donald Detchou
{"title":"Letter: Consensus-Based Development of a Global Registry for Traumatic Brain Injury: Establishment, Protocol, and Implementation.","authors":"Donald Detchou","doi":"10.1227/neu.0000000000003210","DOIUrl":"https://doi.org/10.1227/neu.0000000000003210","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365839","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 : 2024-10-03DOI: 10.1227/neu.0000000000003202
Ali Aamir, M Marzia Noor, Sabrina Rahman, Robert Ahmed Khan, Md Moshiur Rahman
{"title":"Letter: Collaborative Initiatives in Neurosurgery Research and Publications Between High-Income and Low/Middle-Income Countries: A Bibliometric Analysis.","authors":"Ali Aamir, M Marzia Noor, Sabrina Rahman, Robert Ahmed Khan, Md Moshiur Rahman","doi":"10.1227/neu.0000000000003202","DOIUrl":"https://doi.org/10.1227/neu.0000000000003202","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365838","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 : 2024-10-03DOI: 10.1227/neu.0000000000003209
Joshua A Cuoco, Mark R Witcher
{"title":"In Reply: Spinal Intradural Arachnoid Cysts in Adults: An Institutional Experience and Literature Review.","authors":"Joshua A Cuoco, Mark R Witcher","doi":"10.1227/neu.0000000000003209","DOIUrl":"https://doi.org/10.1227/neu.0000000000003209","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372426","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 : 2024-10-03DOI: 10.1227/neu.0000000000003203
Alice Jacqueline Jelmoni, Delia Cannizzaro, Daniel Uralov, Francesca Totis, Adrian Safa, Ismail Zaed, Asra Al Fauzi, Tariq Khan, Ignatius N Esene, Angelos Kolias, Claire Karekezi, Peter Hutchinson, Franco Servadei
{"title":"In Reply: Collaborative Initiatives in Neurosurgery Research and Publications Between High-Income and Low/Middle-Income Countries: A Bibliometric Analysis.","authors":"Alice Jacqueline Jelmoni, Delia Cannizzaro, Daniel Uralov, Francesca Totis, Adrian Safa, Ismail Zaed, Asra Al Fauzi, Tariq Khan, Ignatius N Esene, Angelos Kolias, Claire Karekezi, Peter Hutchinson, Franco Servadei","doi":"10.1227/neu.0000000000003203","DOIUrl":"10.1227/neu.0000000000003203","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365836","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}
Background and objectives: Recent advances in flow diverter (FD) therapy for intracranial aneurysms have highlighted the need to evaluate risk factors for in-stent stenosis (ISS), a potentially serious complication. This meta-analysis aims to identify risk factors associated with an increased risk of ISS after FD treatment.
Methods: PubMed, Web of Science, Embase, and SCOPUS databases were systematically searched for studies reporting ISS rates and risk factors after FD therapy for intracranial aneurysms. Odds ratios were calculated using random-effects models to assess potential risk factors associated with ISS.
Results: Ten studies involving 2350 patients with 2441 aneurysms were included. Younger age (P = .006) and male sex (P = .003) were associated with higher ISS risk. Smoking also increased the risk (P = .02). Aneurysm location in the posterior circulation (P < .00001) and fusiform morphology (P < .00001) were significant risk factors for ISS, as were ruptured aneurysms (P = .05). Hypertension, hyperlipidemia, diabetes, allergies, and alcohol abuse, as well as aneurysm size, neck width, and parent artery diameter, did not affect ISS risk. Procedural factors like balloon angioplasty, multiple FDs, or FD/coil combinations were not significantly associated with ISS.
Conclusion: This meta-analysis identified both nonmodifiable (younger age, male sex) and modifiable (smoking) patient factors, as well as high-risk aneurysm characteristics (posterior circulation, fusiform, ruptured), associated with an increased risk of ISS after FD treatment. These findings highlight the importance of tailored monitoring and management approaches for optimizing outcomes in FD therapy.
背景和目的:颅内动脉瘤血流分流术(FD)治疗的最新进展凸显了评估支架内狭窄(ISS)风险因素的必要性,支架内狭窄是一种潜在的严重并发症。本荟萃分析旨在确定与 FD 治疗后 ISS 风险增加相关的风险因素:方法:系统检索了 PubMed、Web of Science、Embase 和 SCOPUS 数据库中报告颅内动脉瘤 FD 治疗后 ISS 发生率和风险因素的研究。使用随机效应模型计算了比值比,以评估与ISS相关的潜在风险因素:结果:共纳入 10 项研究,涉及 2350 名患者和 2441 个动脉瘤。年轻(P = .006)和男性(P = .003)与较高的 ISS 风险相关。吸烟也会增加风险(P = .02)。动脉瘤位于后循环(P < .00001)和纺锤形形态(P < .00001)是导致 ISS 的重要危险因素,破裂的动脉瘤也是如此(P = .05)。高血压、高脂血症、糖尿病、过敏和酗酒以及动脉瘤大小、颈部宽度和母动脉直径都不会影响 ISS 风险。球囊血管成形术、多个FD或FD/线圈组合等手术因素与ISS无显著相关性:这项荟萃分析确定了非可改变因素(年轻、男性)和可改变因素(吸烟),以及高风险动脉瘤特征(后循环、纺锤形、破裂),这些因素与 FD 治疗后 ISS 风险增加有关。这些发现凸显了量身定制的监测和管理方法对于优化 FD 治疗效果的重要性。
{"title":"Risk Factors for In-Stent Stenosis After Flow Diverter Treatment of Intracranial Aneurysms: A Systematic Review and Meta-Analysis of 2350 Patients.","authors":"Arevik Abramyan, Sudipta Roychowdhury, Natalia Tarasova, Georgios Sioutas, Mena Samaan, Sherry Mangla, Srihari Sundararajan, Gaurav Gupta","doi":"10.1227/neu.0000000000003193","DOIUrl":"10.1227/neu.0000000000003193","url":null,"abstract":"<p><strong>Background and objectives: </strong>Recent advances in flow diverter (FD) therapy for intracranial aneurysms have highlighted the need to evaluate risk factors for in-stent stenosis (ISS), a potentially serious complication. This meta-analysis aims to identify risk factors associated with an increased risk of ISS after FD treatment.</p><p><strong>Methods: </strong>PubMed, Web of Science, Embase, and SCOPUS databases were systematically searched for studies reporting ISS rates and risk factors after FD therapy for intracranial aneurysms. Odds ratios were calculated using random-effects models to assess potential risk factors associated with ISS.</p><p><strong>Results: </strong>Ten studies involving 2350 patients with 2441 aneurysms were included. Younger age (P = .006) and male sex (P = .003) were associated with higher ISS risk. Smoking also increased the risk (P = .02). Aneurysm location in the posterior circulation (P < .00001) and fusiform morphology (P < .00001) were significant risk factors for ISS, as were ruptured aneurysms (P = .05). Hypertension, hyperlipidemia, diabetes, allergies, and alcohol abuse, as well as aneurysm size, neck width, and parent artery diameter, did not affect ISS risk. Procedural factors like balloon angioplasty, multiple FDs, or FD/coil combinations were not significantly associated with ISS.</p><p><strong>Conclusion: </strong>This meta-analysis identified both nonmodifiable (younger age, male sex) and modifiable (smoking) patient factors, as well as high-risk aneurysm characteristics (posterior circulation, fusiform, ruptured), associated with an increased risk of ISS after FD treatment. These findings highlight the importance of tailored monitoring and management approaches for optimizing outcomes in FD therapy.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361855","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 : 2024-10-02DOI: 10.1227/neu.0000000000003184
Pui Man Rosalind Lai, Maggie Beazer, Kai U Frerichs, Nirav J Patel, M Ali Aziz-Sultan, Rose Du
Background and objectives: The management of moyamoya disease during pregnancy and recommendations for the mode of delivery remain controversial. We investigated factors associated with neurologic events during pregnancy in women with moyamoya disease and its association with prepregnancy surgical revascularization.
Methods: We performed a literature search from January 1, 1970, through September 30, 2021, using Embase, Web of Science, Medline, and Cochrane to identify cases of moyamoya disease with pregnancy. Primary outcome was neurologic events during pregnancy and were subcategorized into antepartum, intrapartum (within 24 hours of delivery), and postpartum events. Univariate and multivariate regression analyses using pooled results were performed to assess risk factors associated with neurologic events.
Results: Fifty-two relevant studies with 182 individuals diagnosed with moyamoya before pregnancy, and 229 pregnancies were included in the study. 59% underwent surgical revascularization before pregnancy. Of the 229 pregnancies, 22 (9.6%) patients had ischemic events and 3 (1.3%) had hemorrhagic events. In addition, there were 7 (3%) seizures and 4 (1.7%) other neurologic events not associated with ischemia or hemorrhage. There were fewer neurologic events during pregnancy in patients treated with surgery than those without surgery (11% surgical vs 24% medical, P = .009). Multivariable regression analysis demonstrated prior surgical revascularization as the only factor associated with lower number of neurologic events during pregnancy (odds ratio 0.42 [95% CI 0.19-0.96]). Mode of delivery (vaginal vs cesarean section) was not associated with a difference in overall intrapartum and postpartum neurologic events.
Conclusion: We found that prior revascularization surgery was the only factor associated with fewer neurologic events during pregnancy in women with moyamoya disease. Mode of delivery was not associated with increased neurologic events during or after delivery.
{"title":"Association Between Moyamoya Revascularization Surgery and Neurologic Events During Pregnancy: Systematic Review.","authors":"Pui Man Rosalind Lai, Maggie Beazer, Kai U Frerichs, Nirav J Patel, M Ali Aziz-Sultan, Rose Du","doi":"10.1227/neu.0000000000003184","DOIUrl":"10.1227/neu.0000000000003184","url":null,"abstract":"<p><strong>Background and objectives: </strong>The management of moyamoya disease during pregnancy and recommendations for the mode of delivery remain controversial. We investigated factors associated with neurologic events during pregnancy in women with moyamoya disease and its association with prepregnancy surgical revascularization.</p><p><strong>Methods: </strong>We performed a literature search from January 1, 1970, through September 30, 2021, using Embase, Web of Science, Medline, and Cochrane to identify cases of moyamoya disease with pregnancy. Primary outcome was neurologic events during pregnancy and were subcategorized into antepartum, intrapartum (within 24 hours of delivery), and postpartum events. Univariate and multivariate regression analyses using pooled results were performed to assess risk factors associated with neurologic events.</p><p><strong>Results: </strong>Fifty-two relevant studies with 182 individuals diagnosed with moyamoya before pregnancy, and 229 pregnancies were included in the study. 59% underwent surgical revascularization before pregnancy. Of the 229 pregnancies, 22 (9.6%) patients had ischemic events and 3 (1.3%) had hemorrhagic events. In addition, there were 7 (3%) seizures and 4 (1.7%) other neurologic events not associated with ischemia or hemorrhage. There were fewer neurologic events during pregnancy in patients treated with surgery than those without surgery (11% surgical vs 24% medical, P = .009). Multivariable regression analysis demonstrated prior surgical revascularization as the only factor associated with lower number of neurologic events during pregnancy (odds ratio 0.42 [95% CI 0.19-0.96]). Mode of delivery (vaginal vs cesarean section) was not associated with a difference in overall intrapartum and postpartum neurologic events.</p><p><strong>Conclusion: </strong>We found that prior revascularization surgery was the only factor associated with fewer neurologic events during pregnancy in women with moyamoya disease. Mode of delivery was not associated with increased neurologic events during or after delivery.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361853","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 : 2024-10-02DOI: 10.1227/neu.0000000000003200
Pavel S Pichardo-Rojas, Francisco A Rodriguez-Elvir, Amir Hjeala-Varas, Roberto Sanchez-Velez, Emma Portugal-Beltrán, Aldo Barrón-Lomelí, Priscilla I Freeman, Antonio Dono, Ryan Kitagawa, Yoshua Esquenazi
Background and objective: Traumatic acute subdural hematoma (ASDH) is a medical emergency that requires prompt neurosurgical intervention. Urgent surgical evacuation may be performed with craniotomy (CO) and decompressive craniectomy (DC). However, a meta-analysis evaluating confounders, pooled functional outcomes, and mortality analyses at different time points has not been performed.
Methods: A systematic search was conducted until August 28, 2023. We identified studies performing ASDH evacuation with CO or DC. Outcomes included Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), GOS-Extended, mortality, procedure-related complications, and reoperation. Variables were assessed using risk ratio (RR) and mean difference.
Results: Among 684 published articles, we included the Randomized Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation of ASDH (RESCUE-ASDH) trial, 4 propensity score-matched (PSM) cohorts, and 13 observational cohort studies. A total of 8886 patients underwent CO or DC. GCS at admission in unmatched cohorts was significantly worse in the DC group (mean difference = 2.20 [95% CI = 1.86-2.55], P < .00001). GOS-Extended scores were similar among CO and DC (RR = 1.10 [95% CI = 0.85-1.42], P = .49), including the RESCUE-ASDH trial. GOS at the last follow-up in unmatched cohorts significantly favored CO (RR = 1.66 [95% CI = 1.02-2.70], P = .04). Similarly, while short-term mortality favored CO over DC (RR = 0.69 [95% CI = 0.51-0.93], P = .02), both the RESCUE-ASDH trial and the PSM-cohorts yielded similar mortality rates among groups (P > .05). Mortality at the last follow-up in unmatched patients favored CO (RR = 0.60 [95% CI = 0.47-0.77], P < .0001). Procedure-related complications (RR = 0.74 [0.50-1.09], P = .12) and reoperation rates (RR = 0.74 [0.50-1.09], P = .12) were similar.
Conclusion: Patients with ASDH undergoing DC across unmatched cohorts had a worse GCS at admission. Although ASDH mortality was lower in the CO group, these findings are derived from unmatched cohorts, potentially confounding previous analyses. Notably, population-matched studies, such as the RESCUE-ASDH trial and PSM cohorts, showed similar effectiveness in mortality and functional outcomes between CO and DC. Reoperation and complication rates were comparable among surgical approaches. Considering the prevalence of unmatched cohorts, our findings highlight the need of future clinical trials to validate the findings of the RESCUE-ASDH trial.
背景和目的:外伤性急性硬膜下血肿(ASDH)是一种急症,需要及时进行神经外科干预。可通过开颅手术(CO)和减压开颅手术(DC)进行紧急手术清除。然而,尚未进行过一项荟萃分析,评估不同时间点的混杂因素、汇总功能结果和死亡率分析:方法:我们在 2023 年 8 月 28 日前进行了系统检索。我们确定了使用 CO 或 DC 进行 ASDH 后送的研究。结果包括格拉斯哥昏迷量表(GCS)、格拉斯哥结果量表(GOS)、GOS-扩展、死亡率、手术相关并发症和再次手术。采用风险比(RR)和平均差对变量进行评估:在已发表的 684 篇文章中,我们纳入了 ASDH 患者颅骨切除术的随机评估试验(RESCUE-ASDH)、4 个倾向评分匹配(PSM)队列和 13 个观察性队列研究。共有 8886 名患者接受了 CO 或 DC 治疗。在非匹配队列中,DC 组入院时的 GCS 明显更差(平均差异 = 2.20 [95% CI = 1.86-2.55],P < .00001)。包括 RESCUE-ASDH 试验在内,CO 和 DC 的 GOS-Extended 评分相似(RR = 1.10 [95% CI = 0.85-1.42],P = .49)。在非匹配队列中,最后一次随访时的 GOS 显著优于 CO(RR = 1.66 [95% CI = 1.02-2.70],P = .04)。同样,虽然短期死亡率CO优于DC(RR = 0.69 [95% CI = 0.51-0.93],P = .02),但RESCUE-ASDH试验和PSM队列的各组死亡率相似(P > .05)。未配对患者最后一次随访时的死亡率倾向于 CO(RR = 0.60 [95% CI = 0.47-0.77],P < .0001)。手术相关并发症(RR = 0.74 [0.50-1.09],P = .12)和再手术率(RR = 0.74 [0.50-1.09],P = .12)相似:结论:在非匹配队列中接受 DC 治疗的 ASDH 患者入院时的 GCS 较差。虽然CO组的ASDH死亡率较低,但这些发现来自非匹配队列,可能会混淆之前的分析。值得注意的是,人群匹配研究(如 RESCUE-ASDH 试验和 PSM 队列)显示,CO 和 DC 在死亡率和功能预后方面的效果相似。不同手术方法的再手术率和并发症发生率相当。考虑到非匹配队列的普遍性,我们的研究结果强调了未来临床试验验证 RESCUE-ASDH 试验结果的必要性。
{"title":"Surgical Management of Acute Subdural Hematoma: A Meta-Analysis.","authors":"Pavel S Pichardo-Rojas, Francisco A Rodriguez-Elvir, Amir Hjeala-Varas, Roberto Sanchez-Velez, Emma Portugal-Beltrán, Aldo Barrón-Lomelí, Priscilla I Freeman, Antonio Dono, Ryan Kitagawa, Yoshua Esquenazi","doi":"10.1227/neu.0000000000003200","DOIUrl":"10.1227/neu.0000000000003200","url":null,"abstract":"<p><strong>Background and objective: </strong>Traumatic acute subdural hematoma (ASDH) is a medical emergency that requires prompt neurosurgical intervention. Urgent surgical evacuation may be performed with craniotomy (CO) and decompressive craniectomy (DC). However, a meta-analysis evaluating confounders, pooled functional outcomes, and mortality analyses at different time points has not been performed.</p><p><strong>Methods: </strong>A systematic search was conducted until August 28, 2023. We identified studies performing ASDH evacuation with CO or DC. Outcomes included Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), GOS-Extended, mortality, procedure-related complications, and reoperation. Variables were assessed using risk ratio (RR) and mean difference.</p><p><strong>Results: </strong>Among 684 published articles, we included the Randomized Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation of ASDH (RESCUE-ASDH) trial, 4 propensity score-matched (PSM) cohorts, and 13 observational cohort studies. A total of 8886 patients underwent CO or DC. GCS at admission in unmatched cohorts was significantly worse in the DC group (mean difference = 2.20 [95% CI = 1.86-2.55], P < .00001). GOS-Extended scores were similar among CO and DC (RR = 1.10 [95% CI = 0.85-1.42], P = .49), including the RESCUE-ASDH trial. GOS at the last follow-up in unmatched cohorts significantly favored CO (RR = 1.66 [95% CI = 1.02-2.70], P = .04). Similarly, while short-term mortality favored CO over DC (RR = 0.69 [95% CI = 0.51-0.93], P = .02), both the RESCUE-ASDH trial and the PSM-cohorts yielded similar mortality rates among groups (P > .05). Mortality at the last follow-up in unmatched patients favored CO (RR = 0.60 [95% CI = 0.47-0.77], P < .0001). Procedure-related complications (RR = 0.74 [0.50-1.09], P = .12) and reoperation rates (RR = 0.74 [0.50-1.09], P = .12) were similar.</p><p><strong>Conclusion: </strong>Patients with ASDH undergoing DC across unmatched cohorts had a worse GCS at admission. Although ASDH mortality was lower in the CO group, these findings are derived from unmatched cohorts, potentially confounding previous analyses. Notably, population-matched studies, such as the RESCUE-ASDH trial and PSM cohorts, showed similar effectiveness in mortality and functional outcomes between CO and DC. Reoperation and complication rates were comparable among surgical approaches. Considering the prevalence of unmatched cohorts, our findings highlight the need of future clinical trials to validate the findings of the RESCUE-ASDH trial.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361856","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}