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Grading the damage: Prognostic significance of diffuse axonal injury severity and hemorrhagic lesions in traumatic brain injury outcomes 损伤分级:弥漫性轴索损伤严重程度和出血性病变在创伤性脑损伤结果中的预后意义
IF 2 Q1 Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.wnsx.2025.100539
Nanci Estefanía Bayas-Almeida , Fabricio González-Andrade

Background

Diffuse axonal injury (DAI) is a key determinant of prognosis in traumatic brain injury (TBI), yet the interaction between DAI severity and associated hemorrhagic lesions is not well defined, especially in low- and middle-income countries (LMICs).

Methods

We conducted a retrospective cohort study of 283 adults with moderate-to-severe TBI admitted to a tertiary hospital in Ecuador (2019–2023). DAI severity was graded anatomically using CT or MRI, and patients were stratified by the presence of hemorrhagic lesions. Demographic, clinical, metabolic, and radiological variables were collected. Outcomes were evaluated at 6 months with the Glasgow Outcome Scale–Extended (GOS-E). Logistic and ordinal regression models identified predictors of mortality and disability.

Results

Of 283 patients, 141 had isolated DAI and 142 had DAI with hemorrhage. Baseline demographics were similar. Patients with hemorrhagic lesions had lower median Glasgow Coma Scale scores (6 vs 9, p < 0.001), more frequent hyperglycemia (15.5 % vs 7.1 %, p = 0.045), and greater surgical needs (77.5 % vs 16.3 %, p < 0.001). Complications, including pneumonia and central nervous system infections, were more frequent in the hemorrhagic group (63.9 % vs 45.7 %, p < 0.001). At 6 months, functional outcomes were significantly worse with hemorrhage (median GOS-E 7 vs 8, p < 0.001). Multivariable regression identified Grade III DAI as the strongest predictor of mortality (OR 20.02, 95 % CI 7.99–50.15) and disability (OR 71.59, 95 % CI 23.11–221.77). Hemorrhagic lesions predicted poor functional recovery (OR 2.08, 95 % CI 1.24–3.48) but not mortality.

Conclusions

DAI grading is the most powerful prognostic factor in severe TBI, while hemorrhagic lesions primarily worsen disability. In LMICs, CT-based assessment remains essential for prognostic stratification and guiding rehabilitation strategies.
背景弥漫性轴索损伤(DAI)是创伤性脑损伤(TBI)预后的关键决定因素,但DAI严重程度与相关出血性病变之间的相互作用尚未明确,特别是在低收入和中等收入国家(LMICs)。方法对2019-2023年在厄瓜多尔一家三级医院住院的283例成人中重度TBI患者进行回顾性队列研究。利用CT或MRI对DAI的严重程度进行解剖分级,并根据是否存在出血性病变对患者进行分层。收集了人口学、临床、代谢和放射学变量。6个月时用格拉斯哥结局扩展量表(GOS-E)评估结果。逻辑回归和有序回归模型确定了死亡率和致残率的预测因子。结果283例患者中,分离性DAI 141例,合并出血DAI 142例。基线人口统计数据相似。出血性病变患者的格拉斯哥昏迷评分中位数较低(6比9,p < 0.001),高血糖发生率较高(15.5%比7.1%,p = 0.045),手术需求较大(77.5%比16.3%,p < 0.001)。并发症,包括肺炎和中枢神经系统感染,在出血性组更常见(63.9% vs 45.7%, p < 0.001)。6个月时,出血患者的功能结局明显更差(GOS-E中位数为7比8,p < 0.001)。多变量回归发现III级DAI是死亡率(OR 20.02, 95% CI 7.99-50.15)和致残(OR 71.59, 95% CI 23.11-221.77)的最强预测因子。出血性病变预示着较差的功能恢复(OR 2.08, 95% CI 1.24-3.48),但与死亡率无关。结论dai分级是重型TBI最重要的预后因素,而出血性病变主要加重残疾。在中低收入国家,基于ct的评估对于预后分层和指导康复策略仍然至关重要。
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引用次数: 0
The effect of pre-stroke physical activity on the initial volume and growth of the brain infarct and the rate of recanalization: A post-hoc analysis of the rescue brain trial 脑卒中前体育活动对脑梗死的初始体积和生长以及再通率的影响:一项对抢救脑试验的事后分析
IF 2 Q1 Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.wnsx.2025.100534
B. Douma , M. Ferrigno , E. Drumez , B. Lapergue , C. Rosso , E. Meseguer , M.L. Chadenat , M. Obadia , C. Hirel , D.L. Duong , C. Cordonnier , P. Amarenco , F. Pico

Background

– Pre-stroke physical activity is known to influence stroke severity and long-term outcomes. However, its effects on infarct volume and vascular recanalization remain unclear. Using data from the RESCUE BRAIN trial, we aimed to determine whether the beneficial effects of physical activity before stroke are associated with smaller infarct volumes at presentation, reduced infarct growth over 24 h, and/or increased rates of arterial recanalization.

Methods

This study is a post-hoc analysis of the RESCUE BRAIN trial, a multicenter, randomized, open-label, controlled trial. Patients for whom information on activity habits was available at the time of randomization were included in this analysis. Hierarchical ascendant clustering was used to define physical activity clusters based on intensity (none, walking, walking and sports), frequency (0, 1, 1–3, >3 times per week), and duration (0, <30, 30–60, >60 min). We examined the associations between physical activity clusters and baseline infarct volume and change in infarct volume over 24 h, site of arterial occlusion, and successful recanalization (including intravenous thrombolysis and mechanical thrombectomy).

Results

A total of 151 patients (mean ± standard deviation age 66.3 ± 15.9 years; 47.0 % male) were included. Patients with high levels of pre-stroke physical activity were younger and had a lower prevalence of hypertension (p = 0.02) and atrial fibrillation (p = 0.03). At baseline, infarct volume was unexpectedly larger in the walking and sports cluster (p = 0.01), but there was no significant difference between the three physical activity groups regarding the change in infarct volume at 24 h. We also found no evidence of a difference in baseline cerebral artery occlusion or recanalization rates.

Conclusion

This study suggests that pre-stroke physical activity does not affect the change in infarct volume or recanalization rates, despite its impact on the initial infarct size. These findings may suggest that the effects of physical activity may not operate through reducing infarcts volume or improving reperfusion, but rather through other mechanisms.
背景-中风前的身体活动已知会影响中风的严重程度和长期预后。然而,其对梗死面积和血管再通的影响尚不清楚。使用RESCUE BRAIN试验的数据,我们旨在确定卒中前身体活动的有益效果是否与出现时较小的梗死面积、24小时内减少的梗死面积和/或增加的动脉再开通率有关。方法:本研究是对RESCUE BRAIN试验的事后分析,这是一项多中心、随机、开放标签、对照试验。在随机化时可获得活动习惯信息的患者被纳入本分析。采用分层上升聚类来定义基于强度(无、步行、步行和运动)、频率(每周0、1、1 - 3次)和持续时间(0、30、30 - 60、60分钟)的体育活动聚类。我们研究了体力活动簇与基线梗死体积、24小时内梗死体积变化、动脉闭塞部位和成功再通(包括静脉溶栓和机械取栓)之间的关系。结果-共纳入151例患者(平均±标准差年龄66.3±15.9岁,男性47.0%)。卒中前身体活动水平高的患者更年轻,高血压(p = 0.02)和房颤(p = 0.03)的患病率更低。在基线时,步行和运动组的梗死体积出乎意料地大(p = 0.01),但在24小时内,三个体育运动组的梗死体积变化没有显著差异。我们也没有发现基线脑动脉闭塞或再通率差异的证据。结论:这项研究表明,中风前的身体活动并不影响梗死体积或再通率的变化,尽管它对初始梗死面积有影响。这些发现可能表明,体育活动的作用可能不是通过减少梗死面积或改善再灌注来实现的,而是通过其他机制。
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引用次数: 0
Additive manufacturing for neurosurgical training: Development of patient-specific intracranial aneurysm flexible biomodels 神经外科训练的增材制造:患者特异性颅内动脉瘤柔性生物模型的开发
IF 2 Q1 Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.wnsx.2025.100538
Lorena Maria Dering , Eduardo Burkot Hungria , Jorge Luis Novak Filho , Matheus Kahakura Franco Pedro , André Giacomelli Leal , Mauren Abreu de Souza

Background

Additive manufacturing (AM) technologies have revolutionized the fabrication of three-dimensional objects by sequentially adding material layers based on digital representations. In addition to the production of medical equipment and implants, AM can reproduce precise anatomical models for the visualization of organs and structures, called 3D biomodels. The use of biomodels has the advantages of reducing costs, facilitating communication between doctor and patient, and is also a useful tool for simulation and surgical training.

Methods

Five rotational angiography exams of patients with aneurysms were selected. Based on these images, the modeling and 3D printing of biomodels of flexible aneurysms were customized, each model was evaluated based on manufacturing methodology, morphological fidelity compared to digital models, and usability in surgical training.

Results

Five IA biomodels, malleable and hollow, were obtained. On average, the production time was 176 min, with an average material cost of US$0.60. In their morphometric analysis, conducted using Geomagic Wrap® software, the biomodels did not demonstrate significant differences in relation to the three-dimensional image of the exam. In the software metrics, the differences between the printed aneurysms and their digital model did not exceed 0.57 mm. The surgical simulation with the biomodels performed by neurosurgeons still in-training and experienced neurosurgeons were positive, validating their use for resident training.

Conclusions

The 3D intracranial aneurysm biomodels, produced with flexible resin by 3D printing, demonstrate potential as valuable educational tools for training new professionals in clinical settings.
增材制造(AM)技术通过基于数字表示顺序添加材料层,彻底改变了三维物体的制造。除了生产医疗设备和植入物外,增材制造还可以复制精确的解剖模型,用于器官和结构的可视化,称为3D生物模型。生物模型的使用具有降低成本、方便医患沟通的优点,也是模拟和手术训练的有用工具。方法选择5例动脉瘤患者进行旋转血管造影检查。基于这些图像,定制柔性动脉瘤生物模型的建模和3D打印,根据制造方法,与数字模型相比的形态保真度以及手术训练中的可用性对每个模型进行评估。结果获得5个具有延展性和中空的IA生物模型。平均生产时间为176分钟,平均材料成本为0.60美元。在使用Geomagic Wrap®软件进行的形态计量学分析中,生物模型与检查的三维图像没有显着差异。在软件测量中,打印出的动脉瘤与其数字模型之间的差异不超过0.57 mm。由仍在训练中的神经外科医生和经验丰富的神经外科医生进行的生物模型手术模拟是积极的,验证了它们在住院医师培训中的应用。结论:通过3D打印柔性树脂制作的三维颅内动脉瘤生物模型,在临床培训新专业人员方面具有潜在的教育价值。
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引用次数: 0
Minimally invasive surgery outcomes for intradural extramedullary tumors: a systematic review and meta-analysis 硬膜内髓外肿瘤的微创手术结果:系统回顾和荟萃分析
IF 2 Q1 Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.wnsx.2025.100544
Ahmer Nasir Baig , Tabinda Tahir , Mohammad Hamza Bajwa , Faiza Urooj , Aimen Tameezuddin , Saqib Kamran Bakhshi , Muhammad Shahzad Shamim

Introduction

Traditionally, spinal intradural-extramedullary (ID-EM) tumors have been accessed via open surgery which involves significant tissue dissection, prolonged time of surgery and painful recovery. Advanced techniques of minimally invasive surgery (MIS) aim to reduce these risks and complications while achieving similar goals of surgery.

Objectives

To evaluate and compare surgical, functional, and complication-related outcomes in patients with ID-EM spine tumors receiving surgery through open approaches and MIS.

Methods

Following PRISMA guidelines and registered under PROSPERO (#CRD42022302574), a systematic literature search was conducted across PubMed, EBSCO, and the Cochrane Library. Eligible studies included retrospective cohorts and case series that provided comparative data on MIS and open surgical approaches for IDEM tumor excision. Meta-analysis utilized the Mantel-Haenszel random-effects model for pooled data.

Results

We reviewed 426 articles and included 16 for qualitative and quantitative analysis. On meta-analysis, a total of 804 patients (372 MIS and 432 open surgery) were included. MIS showed a significant reduction in operative time, intraoperative blood loss, and length of hospital stay. Gross total resection rates were comparable between the two approaches. MIS also resulted in fewer postoperative complications, including cerebrospinal fluid leaks and the need for spinal fusion.

Conclusion

MIS for IDEM tumors provides surgical and recovery benefits compared to traditional open surgery, including shorter operative times, reduced blood loss, and fewer postoperative complications. Although both methods achieve similar tumor resection rates, MIS is linked to enhanced patient outcomes and shorter hospital stays, underscoring its role as a viable alternative in managing IDEM tumors. Future research should aim to optimize MIS techniques to improve patient safety and outcomes further.
传统上,脊髓硬膜内-髓外(ID-EM)肿瘤是通过开放手术切除的,这涉及到大量的组织剥离、手术时间延长和痛苦的恢复。微创手术(MIS)的先进技术旨在降低这些风险和并发症,同时达到与手术相似的目标。目的评价和比较经开放入路和MIS手术治疗的ID-EM脊柱肿瘤患者的手术、功能和并发症相关结局。方法遵循PRISMA指南,在PROSPERO (#CRD42022302574)下注册,对PubMed、EBSCO和Cochrane图书馆进行系统文献检索。符合条件的研究包括回顾性队列和病例系列,提供MIS和开放手术入路用于IDEM肿瘤切除的比较数据。荟萃分析采用Mantel-Haenszel随机效应模型对汇总数据进行分析。结果共纳入文献426篇,其中16篇进行定性和定量分析。在荟萃分析中,共纳入804例患者(372例MIS和432例开放手术)。MIS显示手术时间、术中出血量和住院时间显著减少。两种入路的总切除率相当。MIS还减少了术后并发症,包括脑脊液泄漏和脊柱融合的需要。结论与传统开放手术相比,mis治疗IDEM肿瘤具有手术和恢复方面的优势,包括手术时间缩短,出血量减少,术后并发症减少。虽然这两种方法的肿瘤切除率相似,但MIS与改善患者预后和缩短住院时间有关,强调了其作为治疗IDEM肿瘤的可行替代方案的作用。未来的研究应旨在优化MIS技术,以进一步提高患者的安全性和预后。
{"title":"Minimally invasive surgery outcomes for intradural extramedullary tumors: a systematic review and meta-analysis","authors":"Ahmer Nasir Baig ,&nbsp;Tabinda Tahir ,&nbsp;Mohammad Hamza Bajwa ,&nbsp;Faiza Urooj ,&nbsp;Aimen Tameezuddin ,&nbsp;Saqib Kamran Bakhshi ,&nbsp;Muhammad Shahzad Shamim","doi":"10.1016/j.wnsx.2025.100544","DOIUrl":"10.1016/j.wnsx.2025.100544","url":null,"abstract":"<div><h3>Introduction</h3><div>Traditionally, spinal intradural-extramedullary (ID-EM) tumors have been accessed via open surgery which involves significant tissue dissection, prolonged time of surgery and painful recovery. Advanced techniques of minimally invasive surgery (MIS) aim to reduce these risks and complications while achieving similar goals of surgery.</div></div><div><h3>Objectives</h3><div>To evaluate and compare surgical, functional, and complication-related outcomes in patients with ID-EM spine tumors receiving surgery through open approaches and MIS.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines and registered under PROSPERO (#CRD42022302574), a systematic literature search was conducted across PubMed, EBSCO, and the Cochrane Library. Eligible studies included retrospective cohorts and case series that provided comparative data on MIS and open surgical approaches for IDEM tumor excision. Meta-analysis utilized the Mantel-Haenszel random-effects model for pooled data.</div></div><div><h3>Results</h3><div>We reviewed 426 articles and included 16 for qualitative and quantitative analysis. On meta-analysis, a total of 804 patients (372 MIS and 432 open surgery) were included. MIS showed a significant reduction in operative time, intraoperative blood loss, and length of hospital stay. Gross total resection rates were comparable between the two approaches. MIS also resulted in fewer postoperative complications, including cerebrospinal fluid leaks and the need for spinal fusion.</div></div><div><h3>Conclusion</h3><div>MIS for IDEM tumors provides surgical and recovery benefits compared to traditional open surgery, including shorter operative times, reduced blood loss, and fewer postoperative complications. Although both methods achieve similar tumor resection rates, MIS is linked to enhanced patient outcomes and shorter hospital stays, underscoring its role as a viable alternative in managing IDEM tumors. Future research should aim to optimize MIS techniques to improve patient safety and outcomes further.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100544"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endovascular management of arterial-encasing meningiomas: A case report and review of treatment strategies 动脉包膜脑膜瘤的血管内治疗:1例报告及治疗策略回顾
IF 2 Q1 Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.wnsx.2025.100533
Mario Benvenutti-Regato , Hannia M. Macias-Cruz , Hector R. Martínez , Carlos D. Acevedo-Castillo , Omar R. Ortega-Ruiz , Uriel A. Bautista-Coronado , Jose A. Moran-Guerrero , Rogelio E. Flores-Salcido , Misael Salazar-Alejo , Jose A. Figueroa-Sanchez

Introduction

Skull base meningiomas pose significant surgical challenges due to their proximity to and encasement of critical neurovascular structures, particularly the internal carotid artery (ICA). While surgical resection remains the standard of care, complete excision may be limited by the risk of vascular injury. Endovascular approaches such as stenting and angioplasty have emerged as potential adjuncts to mitigate ischemic complications.

Methods

A review using Scopus, Medline, and Web of Science was conducted according to PRISMA guidelines to evaluate the use of endovascular stenting and angioplasty in patients with intracranial meningiomas encasing arteries. Inclusion criteria targeted cases with symptomatic encasement treated with endovascular procedures.

Results

Among 114 studies, three patients presented with skull base meningiomas involving the ICA, with symptoms including hemiparesis, aphasia, proptosis, and visual deficits. Endovascular strategies included: (1) ICA stenting for high-grade stenosis with favorable long-term patency; (2) preoperative angioplasty to reduce perioperative ischemic risk; and (3) postoperative stenting for vasospasm due to vessel kinking. Additionally, we report the case of a 71-year-old woman with a meningioma encasing the ICA, managed with endovascular stenting and radiotherapy. No ischemic events or tumor progression were observed at 12-month follow-up.

Discussion

The reviewed cases highlight the potential of endovascular strategies to maintain vascular integrity and prevent ischemia in tumors with arterial encasement. This strategy may reduce intraoperative complications and expand resection options. Current evidence is limited to isolated reports, underscoring the need for prospective studies to validate efficacy and safety.
颅底脑膜瘤由于其靠近并包裹着关键的神经血管结构,特别是颈内动脉(ICA),给外科手术带来了重大挑战。虽然手术切除仍然是标准的治疗方法,但完全切除可能受到血管损伤风险的限制。血管内入路如支架置入术和血管成形术已成为减轻缺血性并发症的潜在辅助手段。方法采用Scopus、Medline和Web of Science,根据PRISMA指南评价颅内脑膜瘤包膜动脉患者血管内支架置入术和血管成形术的应用。纳入标准针对经血管内手术治疗的症状性包膜病例。结果在114例研究中,3例患者表现为颅底脑膜瘤累及ICA,症状包括偏瘫、失语、突出和视力缺陷。血管内策略包括:(1)ICA支架置入术治疗高度狭窄,长期通畅;(2)术前血管成形术降低围手术期缺血风险;(3)因血管扭结引起血管痉挛的术后支架置入。此外,我们报告一例71岁女性脑膜瘤包围ICA,处理血管内支架置入和放疗。在12个月的随访中未观察到缺血性事件或肿瘤进展。回顾的病例强调了血管内策略在维持血管完整性和防止动脉闭塞肿瘤缺血方面的潜力。该策略可减少术中并发症,扩大切除选择范围。目前的证据仅限于孤立的报告,强调需要前瞻性研究来验证有效性和安全性。
{"title":"Endovascular management of arterial-encasing meningiomas: A case report and review of treatment strategies","authors":"Mario Benvenutti-Regato ,&nbsp;Hannia M. Macias-Cruz ,&nbsp;Hector R. Martínez ,&nbsp;Carlos D. Acevedo-Castillo ,&nbsp;Omar R. Ortega-Ruiz ,&nbsp;Uriel A. Bautista-Coronado ,&nbsp;Jose A. Moran-Guerrero ,&nbsp;Rogelio E. Flores-Salcido ,&nbsp;Misael Salazar-Alejo ,&nbsp;Jose A. Figueroa-Sanchez","doi":"10.1016/j.wnsx.2025.100533","DOIUrl":"10.1016/j.wnsx.2025.100533","url":null,"abstract":"<div><h3>Introduction</h3><div>Skull base meningiomas pose significant surgical challenges due to their proximity to and encasement of critical neurovascular structures, particularly the internal carotid artery (ICA). While surgical resection remains the standard of care, complete excision may be limited by the risk of vascular injury. Endovascular approaches such as stenting and angioplasty have emerged as potential adjuncts to mitigate ischemic complications.</div></div><div><h3>Methods</h3><div>A review using Scopus, Medline, and Web of Science was conducted according to PRISMA guidelines to evaluate the use of endovascular stenting and angioplasty in patients with intracranial meningiomas encasing arteries. Inclusion criteria targeted cases with symptomatic encasement treated with endovascular procedures.</div></div><div><h3>Results</h3><div>Among 114 studies, three patients presented with skull base meningiomas involving the ICA, with symptoms including hemiparesis, aphasia, proptosis, and visual deficits. Endovascular strategies included: (1) ICA stenting for high-grade stenosis with favorable long-term patency; (2) preoperative angioplasty to reduce perioperative ischemic risk; and (3) postoperative stenting for vasospasm due to vessel kinking. Additionally, we report the case of a 71-year-old woman with a meningioma encasing the ICA, managed with endovascular stenting and radiotherapy. No ischemic events or tumor progression were observed at 12-month follow-up.</div></div><div><h3>Discussion</h3><div>The reviewed cases highlight the potential of endovascular strategies to maintain vascular integrity and prevent ischemia in tumors with arterial encasement. This strategy may reduce intraoperative complications and expand resection options. Current evidence is limited to isolated reports, underscoring the need for prospective studies to validate efficacy and safety.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100533"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Serum pentraxin-3 and plaque burden predict unexplained early neurological deterioration in branch atheromatous disease 血清戊曲霉素-3和斑块负荷预测分支动脉粥样硬化疾病不明原因的早期神经功能恶化
IF 2 Q1 Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.wnsx.2025.100530
Zhiyong Cao , Xiaoming Guo , Mei Ding , Zhuo Chen , Lei Wang , Qi Fang

Objective

Pentraxin-3 (PTX-3), an inflammatory biomarker, is associated with atherosclerosis-related cerebral infarction. Plaque burden is a known predictor of poor prognosis in cerebral infarction. This study aimed to determine whether serum PTX-3 levels and plaque burden are independent risk factors for unexplained early neurological deterioration (END) in patients with branch atheromatous disease (BAD).

Methods

This prospective observational cohort study included 289 consecutive BAD patients. END was evaluated within 72 h after acute ischemic stroke onset. Univariate and multivariate regression analyses were used to assess the relationships between PTX-3, plaque burden, and END. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive performance of PTX-3, plaque burden, and their combination for unexplained END.

Results

Among the 289 patients, 82 (28.4 %) developed END. END was associated with higher PTX-3, oxLDL, and LDL levels; older age; hypertension; higher NIHSS scores after END; and greater plaque burden. After adjusting for confounders, both the highest PTX-3 quartile (OR = 1.256, 95 % CI: 1.032–29.930) and plaque burden (OR = 1.568, 95 % CI: 0.918–2.926) were independent predictors of END. The ROC analysis demonstrated that the combination of PTX-3(AUC = 0.742, 95 % CI: 0.680–0.804) and plaque burden (AUC = 0.758, 95 % CI: 0.697–0.818) yielded the highest predictive value (AUC = 0.785, 95 % CI: 0.727–0.844, p < 0.001).

Conclusions

Elevated serum PTX-3 levels and increased plaque burden were independently associated with unexplained END in BAD patients. Their combination showed superior predictive performance, indicating potential clinical utility for risk stratification.
目的:penttraxin -3 (PTX-3)是一种炎症生物标志物,与动脉粥样硬化相关性脑梗死有关。斑块负荷是脑梗死预后不良的已知预测因子。本研究旨在确定血清PTX-3水平和斑块负担是否是分支动脉粥样硬化(BAD)患者不明原因早期神经功能恶化(END)的独立危险因素。方法本前瞻性观察队列研究纳入289例连续BAD患者。急性缺血性卒中发作后72小时内评估END。采用单因素和多因素回归分析来评估PTX-3、斑块负担和END之间的关系。生成受试者工作特征(ROC)曲线,以评估PTX-3、斑块负担及其组合对不明原因END的预测性能。结果289例患者中有82例(28.4%)发生END。END与较高的PTX-3、oxLDL和LDL水平相关;老年;高血压;END后NIHSS评分较高;更大的斑块负担。调整混杂因素后,PTX-3最高四分位数(OR = 1.256, 95% CI: 1.032-29.930)和斑块负担(OR = 1.568, 95% CI: 0.918-2.926)是END的独立预测因子。ROC分析显示,PTX-3(AUC = 0.742, 95% CI: 0.680-0.804)和斑块负担(AUC = 0.758, 95% CI: 0.697-0.818)联合使用的预测值最高(AUC = 0.785, 95% CI: 0.727-0.844, p < 0.001)。结论BAD患者血清PTX-3水平升高和斑块负担增加与原因不明的END独立相关。它们的组合显示出优越的预测性能,表明潜在的临床应用风险分层。
{"title":"Serum pentraxin-3 and plaque burden predict unexplained early neurological deterioration in branch atheromatous disease","authors":"Zhiyong Cao ,&nbsp;Xiaoming Guo ,&nbsp;Mei Ding ,&nbsp;Zhuo Chen ,&nbsp;Lei Wang ,&nbsp;Qi Fang","doi":"10.1016/j.wnsx.2025.100530","DOIUrl":"10.1016/j.wnsx.2025.100530","url":null,"abstract":"<div><h3>Objective</h3><div>Pentraxin-3 (PTX-3), an inflammatory biomarker, is associated with atherosclerosis-related cerebral infarction. Plaque burden is a known predictor of poor prognosis in cerebral infarction. This study aimed to determine whether serum PTX-3 levels and plaque burden are independent risk factors for unexplained early neurological deterioration (END) in patients with branch atheromatous disease (BAD).</div></div><div><h3>Methods</h3><div>This prospective observational cohort study included 289 consecutive BAD patients. END was evaluated within 72 h after acute ischemic stroke onset. Univariate and multivariate regression analyses were used to assess the relationships between PTX-3, plaque burden, and END. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive performance of PTX-3, plaque burden, and their combination for unexplained END.</div></div><div><h3>Results</h3><div>Among the 289 patients, 82 (28.4 %) developed END. END was associated with higher PTX-3, oxLDL, and LDL levels; older age; hypertension; higher NIHSS scores after END; and greater plaque burden. After adjusting for confounders, both the highest PTX-3 quartile (OR = 1.256, 95 % CI: 1.032–29.930) and plaque burden (OR = 1.568, 95 % CI: 0.918–2.926) were independent predictors of END. The ROC analysis demonstrated that the combination of PTX-3(AUC = 0.742, 95 % CI: 0.680–0.804) and plaque burden (AUC = 0.758, 95 % CI: 0.697–0.818) yielded the highest predictive value (AUC = 0.785, 95 % CI: 0.727–0.844, p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Elevated serum PTX-3 levels and increased plaque burden were independently associated with unexplained END in BAD patients. Their combination showed superior predictive performance, indicating potential clinical utility for risk stratification.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100530"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Seizure control after surgical resection of low-grade Gliomas: A Regional retrospective analysis 低级别胶质瘤手术切除后癫痫控制:区域回顾性分析
IF 2 Q1 Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.wnsx.2025.100548
Saqib Kamran Bakhshi , Rabeet Tariq , Faiza Urooj , Safwan Masood , Farhan Arshad Mirza , Syed Ather Enam

Introduction

Seizures occur in 60–75 % of patients with low-grade gliomas (LGGs). 60–90 % of patients attain seizure freedom after resection. Seizure control varies with histopathology, the extent of resection (EOR), and the type of seizures. There is an inconsistency in the literature regarding the utility of anti-epileptic drugs (AED) after tumor resection. We aimed to determine factors associated with seizure control in patients after LGG resection.

Methods

We conducted a retrospective cohort study using the medical records of all patients who underwent LGG resection at our center from 2018 to 2021. 77 patients fulfilled the selection criteria and were contacted via phone calls to collect information about their seizure control as per Engel Classification. The data was analyzed using SPSSv21.

Results

The mean age was 34.9 ± 11.3 years, and there was male predominance (62; 80.5 %). Generalized seizures were the most common type (54; 70 %), and Levetiracetam was the most commonly prescribed AED (60; 77.9 %). The median duration of pre-operative AED use was 4 (IQR: 1–24) months. The frontal lobe was the most common location of tumor (36; 46.8 %). Most of the patients had their surgery under general anesthesia (51; 61.4 %), while 29 (37.7 %) underwent awake craniotomy. Nearly half of the patients had a gross total resection (31; 40.3 %), and another 15 (19.5 %) had near-total resection. Sixteen patients (20.8 %) had their AEDs stopped within the first 6 months post-operatively (at variable intervals), and all of them had Engel Class IA to ID control at the time of follow-up (p = 0.008). The 12 patients with Grade I glioma also had optimum seizure control (p = 0.032).

Conclusion

Pilocytic Astrocytomas have better seizure control as compared to Grade II Astrocytomas and Oligodendrogliomas. Further studies are required with larger samples to establish guidelines on achieving adequate postoperative seizure control in LGG patients.
60 - 75%的低级别胶质瘤(LGGs)患者会发生癫痫发作。60 - 90%的患者在切除后获得癫痫发作自由。癫痫控制因组织病理学、切除程度(EOR)和癫痫发作类型而异。关于肿瘤切除后抗癫痫药物(AED)的应用,文献存在不一致的地方。我们的目的是确定与LGG切除术后患者癫痫控制相关的因素。方法利用2018年至2021年在我中心接受LGG切除术的所有患者的医疗记录进行回顾性队列研究。77名患者符合选择标准,并通过电话联系,根据恩格尔分类收集他们的癫痫控制信息。使用SPSSv21对数据进行分析。结果患者平均年龄34.9±11.3岁,男性居多(62%;80.5%)。全局性发作是最常见的类型(54;70%),左乙拉西坦是最常用的AED(60; 77.9%)。术前AED使用的中位时间为4个月(IQR: 1-24)。额叶是最常见的肿瘤部位(36;46.8%)。全麻手术51例(61.4%),清醒开颅29例(37.7%)。近一半的患者进行了总切除(31例,40.3%),另外15例(19.5%)进行了近全切除。16例(20.8%)患者在术后前6个月内(不同时间间隔)停用aed,随访时均为Engel IA级至ID级控制(p = 0.008)。12例I级胶质瘤患者也有最佳的癫痫发作控制(p = 0.032)。结论毛细胞型星形细胞瘤比二级星形细胞瘤和少突胶质细胞瘤有更好的癫痫控制。进一步的研究需要更大的样本来建立在LGG患者中实现足够的术后癫痫控制的指导方针。
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引用次数: 0
Gazi Yaşargil: A minimalist genius in neurosurgery in parallel with the minimalism movement in art Gazi yaargil:神经外科领域的极简主义天才,同时也是艺术领域的极简主义运动
IF 2 Q1 Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.wnsx.2025.100537
Ali İhsan Ökten , Saygı Uygur
Prof. Dr. Gazi Yaşargil passed away at the age of 100 with the title of “Neurosurgeon of the Century”, leaving numerous invented neurosurgical instruments and techniques as well as trained neurosurgeons behind as his legacy. What mattered most to Yaşargil was finishing a surgery without causing harm to normal tissue. To this end, he introduced microscope into neurosurgery for the first time and developed many instruments to enhance his new techniques. Yaşargil's minimalist studies dating back to 1960s paved the road to modern, more advanced minimally invasive techniques. Notably, emergence of minimalist art movement coincides with Yaşargil's initial studies. Even though art, science and philosophy are distinct disciplines, it cannot be denied that they influence, pass through, and converge with each other throughout the history. One can observe how movements from different disciplines are embraced by others, fostering mutual empowerment while allowing each to pursue its own course. Similar pattern is apparent in minimalist art movement and minimally invasive surgical approaches. The idea of telling more with less by avoiding unnecessary materials and minimizing the number of objects to enhance the expression in minimalist art, has transformed into performing surgery with minimal harm through less invasive techniques that optimally preserve normal tissue and promote rapid patient recovery. Gazi Yaşargil pioneered the development of minimally invasive techniques in neurosurgery, simultaneously, with the emergence of the minimalist art movement, science and art reunited after a long hiatus.
Gazi yaargil教授逝世,享年100岁,被誉为“世纪神经外科医生”,留下了许多发明的神经外科仪器和技术以及训练有素的神经外科医生作为他的遗产。对ya阿吉尔来说,最重要的是在不伤害正常组织的情况下完成手术。为此,他首次将显微镜引入神经外科,并开发了许多仪器来加强他的新技术。yaargil的极简主义研究可以追溯到20世纪60年代,为现代更先进的微创技术铺平了道路。值得注意的是,极简主义艺术运动的出现与yaargil最初的研究不约而同。尽管艺术、科学和哲学是不同的学科,但不可否认的是,它们在历史上是相互影响、相互贯通、相互融合的。人们可以观察到不同学科的运动是如何被其他学科所接受的,在允许每个学科追求自己的道路的同时,促进相互赋权。类似的模式在极简艺术运动和微创手术入路中也很明显。通过避免不必要的材料和减少物体的数量来增强极简主义艺术的表达,用更少的材料讲述更多的想法已经转变为通过更小的侵入性技术以最小的伤害进行手术,最佳地保护正常组织并促进患者快速康复。Gazi yaargil开创了神经外科微创技术的发展,同时,随着极简主义艺术运动的出现,科学与艺术在长时间的中断后重新统一。
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引用次数: 0
Comment on: Examining the correlation between hemoglobin-red blood cell distribution width ratio and hospital mortality in spontaneous intracerebral hemorrhage 点评:探讨自发性脑出血患者血红蛋白-红细胞分布宽度比与住院死亡率的关系
IF 2 Q1 Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.wnsx.2025.100536
Parth Aphale, Shashank Dokania, Himanshu Shekhar
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引用次数: 0
Professor Mahmut Gazi Yaşargil (1925–2025): The pioneer and architect of modern neurosurgery Mahmut Gazi yaargil教授(1925-2025):现代神经外科的先驱和建筑师
IF 2 Q1 Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.wnsx.2025.100501
Cumhur Kaan Yaltırık , Murat Şakir Ekşi
Through his work on microsurgical tools and techniques, Professor Mahmut Gazi Yaşargil revolutionized neurosurgery by making it a safer and more successful area of brain surgery. Mahmut Gazi Yaşargil, a Turkish-born neurosurgeon, died in Switzerland in 2025 after being born in 1925. The medical world recognized him as the “Father of Modern Neurosurgery” because he devoted his life to precision, education, and the upbringing of future surgeons. This article examines his life history, scientific discoveries, academic achievements, and his lasting impact on neurosurgery practices around the world.
通过他在显微外科手术工具和技术方面的工作,Mahmut Gazi yaargil教授彻底改变了神经外科,使其成为更安全、更成功的脑外科领域。出生于土耳其的神经外科医生马哈茂特·加齐·亚·阿吉尔出生于1925年,于2025年在瑞士去世。医学界公认他为“现代神经外科之父”,因为他毕生致力于精确、教育和培养未来的外科医生。本文考察了他的生平、科学发现、学术成就以及他对世界各地神经外科实践的持久影响。
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引用次数: 0
期刊
World Neurosurgery: X
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