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Validity of D-penicillamine in experimental cerebral vasospasm therapy d -青霉胺在实验性脑血管痉挛治疗中的有效性
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-28 DOI: 10.1016/j.inat.2023.101917
Ersin Haciyakupoglu , Evren Yüvrük , Sebahattin Haciyakupoglu , Milos Arsenovic , Erol Akgül , Dervis Mansuri Yilmaz , Sait Polat

Background

Cerebral vasospasm is a reversible vessel constriction following subarachnoid hemorrhage. Immunoreactive and inflammatory mechanisms induce long-term vasoconstriction and vessel dilatation inhibition. We hypothesized that D-penicillamine depresses this process given that it reduces the concentration of free oxygen (O2) radicals. We evaluated the effects of D-penicillamine on cerebral vasospasm in rabbits induced with subarachnoid hemorrhage, achieved by autologous blood injection in the basal cistern.

Materials and methods

Four experimental groups were studied: Group 1: basilar angiography, Group 2: basilar angiography + D-penicillamine, Group 3: subarachnoid hemorrhage (SAH), and Group 4: SAH + D-penicillamine. Vessel diameter and cerebral vasospasm were evaluated angiographically in each group. Vascular degeneration was studied by electron microscopy of the basilar artery. Free O2 radicals were investigated based on measurements of the levels of vascular superoxide dismutase and malondialdehyde. Myasthenia gravis–like side effects of D-penicillamine application were analyzed by electromyography and electron microscopy of the orbicularis oculi muscle.

Results

We detected a 9.03% decrease in basilar artery constriction in Group 4 compared with Group 3. In addition, levels of free O2 radicals were reduced in Groups 2 and 4. Application of D-penicillamine resulted in the prevention of basilar artery wall degeneration, without myasthenia gravis–like side effects.

Conclusion

Our study indicated that D-penicillamine application induced vasodilatation and had anti-inflammatory effects.

背景:脑血管痉挛是蛛网膜下腔出血后可逆的血管收缩。免疫反应和炎症机制诱导长期血管收缩和血管扩张抑制。我们假设d -青霉胺抑制这一过程,因为它降低了游离氧(O2)自由基的浓度。本研究通过自体基底池注血,观察d -青霉胺对兔蛛网膜下腔出血所致脑血管痉挛的影响。材料与方法实验分为四组:第一组:基底动脉造影,第二组:基底动脉造影+ d -青霉胺,第三组:蛛网膜下腔出血,第四组:SAH + d -青霉胺。各组血管造影检查血管直径和脑血管痉挛情况。电镜观察基底动脉血管变性。通过测量血管超氧化物歧化酶和丙二醛的水平来研究游离氧自由基。采用眼轮匝肌肌电图和电镜分析d -青霉胺应用后的重症肌样副作用。结果与3组相比,4组基底动脉收缩减少9.03%。此外,第2组和第4组的自由基水平均有所降低。应用d -青霉胺可预防基底动脉壁变性,无重症肌无力样副作用。结论应用d -青霉胺可使大鼠血管舒张,具有抗炎作用。
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引用次数: 0
Endovascular treatment with Onyx of arterio-venous fistula around the transverse sinus presenting with ocular symptoms. Case report 横窦周围动静脉瘘的Onyx血管内治疗伴有眼部症状。病例报告
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-27 DOI: 10.1016/j.inat.2023.101932
N. Velinov , M. Petrov , T. Sakelarova , P. Yordanov , I. Martinov , N. Gabrovsky

Introduction

Dural arterio-venous fistulas /DAVF/ are rare vascular malformations that represent around 10-15% of all intracranial vascular malformations. The DAVF could be asymptomatic or produce a variety of symptoms – headache, pulsatile tinnitus, characteristic bruit over the site of the fistula, ocular symptoms – chemosis, proptosis, or other neurological symptoms due to intracerebral haemorrhage of the DAVF. We present a rare clinical case of a transverse sinus DAVF with ipsilateral ocular symptoms and maybe the first case to our knowledge occluded with Onyx.

Clinical case:

A 46-year-old male patient presented with headache, redness of the left eye and left-sided proptosis. The symptoms started after a heavy physical exertion two months ago. MRI scan and DSA confirmed the presence of a DAVF located around the left transverse sinus with venous ectasia and retrograde flow up to the left cavernous sinus. Transarterial endovascular embolization of the DAVF with Onyx was performed with complete resolution of the symptoms of the patient.

Discussion

The more posteriorly located the DAVF the less likely is to present with ocular symptoms. Sometimes these are the first signs of the presence of a DAVF and especially of higher grade DAVF that could lead to intracerebral haemorrhage. The Borden Grade 2 and 3 DAVF risk of intracerebral haemorrhage is 17% and 46%, respectively. Cognard Grade IIa+b around 40% and all grades III-V - 80-100%. The high risk of intracranial haemorrhage and the ocular symptoms are indication for treatment.

Conclusion

Transarterial embolization of DAVF with Onyx is safe, with high initial occlusion rate (55-85%). Ocular symptoms of DAVF have a benign course after successful embolization.

硬脑膜动静脉瘘是一种罕见的血管畸形,约占颅内血管畸形的10-15%。DAVF可能无症状或产生多种症状-头痛,搏动性耳鸣,瘘管部位特征性瘀伤,眼部症状-由DAVF脑出血引起的化学反应,突出或其他神经系统症状。我们在此报告一罕见的横窦性深静脉瘘伴同侧眼部症状的临床病例,据我们所知,这可能是第一例玛瑙阻塞的病例。临床病例:男,46岁,以头痛、左眼发红、左侧突出为主要表现。这些症状是两个月前剧烈运动后出现的。MRI扫描和DSA证实了位于左侧横窦周围的DAVF,伴有静脉扩张和向左侧海绵窦逆行流动。经动脉血管内栓塞与Onyx的DAVF进行了完全解决患者的症状。讨论越后位的动眼窝越不容易出现眼部症状。有时这些是DAVF存在的第一个迹象,特别是可能导致脑出血的高级别DAVF。Borden 2级和3级DAVF脑出血风险分别为17%和46%。Cognard等级IIa+b约40%,所有等级III-V - 80-100%。颅内出血的高风险和眼部症状是治疗的适应症。结论Onyx经动脉栓塞治疗DAVF是安全的,初始闭塞率高(55 ~ 85%)。栓塞成功后,眼部症状呈良性发展。
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引用次数: 0
Outcome predictors in a series of 40 patients after surgery for low-grade gliomas 40例低级别胶质瘤术后患者的预后预测
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-25 DOI: 10.1016/j.inat.2023.101920
M. Dobran, M. Capece, D. Aiudi, E. Carrassi, M.R. Fasinella, M. Lorenzetti, A. Di Rienzo, M. Iacoangeli

Objective

Low grade gliomas (LGGs) account for 15 % of primary brain tumors. The paper has the aim to identifying prognostic factors affecting overall survival (OS) and progression-free survival (PFS), and to evaluate the outcome of patients.

Methods

A total of 40 patients undergoing surgery for cerebral LGG (WHO grades I and II) at Our Institute were enrolled in the retrospective study. Inclusion criteria were: histological diagnosis of LGG, availability of complete clinical-instrumental documentation and follow-up data. For each patient, the following were analyzed: the clinical parameters in the preoperative and postoperative phases, the histological variant of the tumor, the extent of surgical resection (EOR) and any use of intraoperative methods, the Mib-1/Ki-67 proliferation index, the administration of adjuvant chemotherapy and/or radiotherapy and the occurrence of any complications.

Results

The cohort included 14 males and 26 females. The independent predictors of OS at multivariate analysis were: age, pre-operative KPS, Ki67/Mib-1, EOR and adjuvant chemotherapy. With regard to PFS, statistical significance on multivariate analysis was observed for pre-operative KPS, Ki67/Mib-1, EOR, post-operative tumor volume and radiotherapy. An EOR < 80 % was confirmed as negative prognostic factor for both OS and PFS. Lastly, the pre-operative tumor volume and the use of Intra-operative Electrophysiological Monitoring were significantly associated with EOR.

Conclusion

In this study, according to the literature, several prognostic factors determining the outcome of LGG patients, both in terms of OS and PFS, were confirmed. Knowing the impact of these parameters in terms of prognosis would guide the choice of treatment, which will necessarily be multidisciplinary and tailored.

目的低级别胶质瘤(LGGs)占原发性脑肿瘤的15%。本文旨在确定影响总生存期(OS)和无进展生存期(PFS)的预后因素,并评估患者的预后。方法回顾性分析我院收治的40例WHO分级为1级和2级的脑性LGG手术患者。纳入标准是:LGG的组织学诊断,完整的临床仪器文件的可用性和随访数据。对每位患者进行以下分析:术前和术后临床参数、肿瘤组织学变异、手术切除程度(EOR)及术中方法使用情况、mb -1/Ki-67增殖指数、辅助化疗和/或放疗的使用情况及并发症的发生情况。结果男性14例,女性26例。多因素分析OS的独立预测因子为:年龄、术前KPS、Ki67/Mib-1、EOR和辅助化疗。PFS方面,术前KPS、Ki67/ mb -1、EOR、术后肿瘤体积、放疗等多因素分析均有统计学意义。EOR <80%被证实为OS和PFS的负面预后因素。最后,术前肿瘤体积和术中电生理监测的使用与EOR显著相关。在本研究中,根据文献,确定了几个决定LGG患者预后的预后因素,无论是OS还是PFS。了解这些参数对预后的影响将指导治疗的选择,这将是必要的多学科和量身定制。
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引用次数: 0
Management of pituitary adenoma: Preliminary experience with endoscopic endonasal transphenoidal surgery in a developing country. Example of Senegal about 180 cases 垂体腺瘤的处理:在发展中国家进行鼻内窥镜经蝶窦手术的初步经验。以塞内加尔为例,大约180例
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-25 DOI: 10.1016/j.inat.2023.101903
Maguette Mbaye , Mbaye Thioub , Demba Diedhiou , Lounceny Fatoumata Barry , Hugues Ghislain Atakla , El Hadj Cheikh Ndiaye Sy , Daouda Wague , Alioune Badara Thiam , Ndaraw Ndoye , Momar Code Ba

Introduction

Endoscopic endonasal transsphenoidal surgery is currently the gold-standard therapeutic approach for pituitary adenomas. Although being spread worldwide, the endoscopic endonasal approach for pituitary adenomas is recently implemented in Senegal.

This study aimed to report our results and the complications observed in the context of an under-equipped facility.

Materials and methods

We conducted a retrospective study including all patients with a pituitary adenoma treated who underwent endonasal transsphenoidal resection under a single endoscopic approach from January 2014 to May 2022, in the Neurosurgery Department of Fann National Hospital Centre, Dakar. All patients were assessed according to clinical, radiological, and endocrinological criteria. They all were operated by the same team with an average follow-up of 24 months.

Results

In this series of 180 patients, including 57.7 % women and 42.3% men with a mean age of 44.8 years (extremes of 18 and 76 years), the visual deficit was the most frequent onset symptom (69.4 %), followed by clinical forms of hormone hypersecretion (30.5 %). Twelve cases of pituitary apoplexy and 1 case of incidentaloma were reported. The most frequent tumors were non-functional tumors (61.6 %). Among the functional adenomas, the most frequent was prolactinoma (15.5 %). Regarding tumor size, 75 % were macroadenomas, 15.5 % were microadenomas, and 9.5 % were giants. Cavernous sinus invasion (Knosp grade ≥ 3) and suprasellar extension were noted in 14.4 % and 53.3 %, respectively. The resection was total in 80 % of cases, subtotal in 18.8 %, and partial in 1.2 %. Partial improvement of sight was observed in 91.1% and endocrine hypersecretion remission in 76.6 %. As for complications, the most frequent was transient diabetes insipidus (32.7 %).

Conclusion

Despite the scanty resources, our results are similar to the best-reported series and strengthen scientific evidence on the efficacy and safety of performing this technique in an under-equipped setting context.

内镜下经鼻蝶窦手术是目前治疗垂体腺瘤的金标准方法。虽然在世界范围内广泛传播,但鼻内窥镜入路治疗垂体腺瘤最近在塞内加尔实施。本研究旨在报告我们的结果和在设备不足的设施中观察到的并发症。材料和方法我们进行了一项回顾性研究,包括2014年1月至2022年5月在达喀尔Fann国家医院中心神经外科接受鼻内经蝶窦切除术的所有垂体腺瘤患者。所有患者均根据临床、放射学和内分泌学标准进行评估。所有患者均由同一组进行手术,平均随访时间为24个月。结果180例患者中,女性占57.7%,男性占42.3%,平均年龄44.8岁(18岁和76岁极值),视力障碍是最常见的发病症状(69.4%),其次是临床表现的激素分泌过多(30.5%)。本文报告垂体中风12例,偶发瘤1例。最常见的肿瘤为非功能性肿瘤(61.6%)。在功能性腺瘤中,以泌乳素瘤最为常见(15.5%)。就肿瘤大小而言,75%为大腺瘤,15.5%为微腺瘤,9.5%为巨腺瘤。海绵窦侵犯(Knosp等级≥3)和鞍上延伸分别占14.4%和53.3%。80%的病例全部切除,18.8%的病例部分切除,1.2%的病例部分切除。91.1%患者视力部分改善,76.6%患者内分泌分泌亢进缓解。并发症以一过性尿崩症最为常见(32.7%)。尽管资源匮乏,但我们的结果与最佳报道系列相似,并加强了在设备不足的环境中实施该技术的有效性和安全性的科学证据。
{"title":"Management of pituitary adenoma: Preliminary experience with endoscopic endonasal transphenoidal surgery in a developing country. Example of Senegal about 180 cases","authors":"Maguette Mbaye ,&nbsp;Mbaye Thioub ,&nbsp;Demba Diedhiou ,&nbsp;Lounceny Fatoumata Barry ,&nbsp;Hugues Ghislain Atakla ,&nbsp;El Hadj Cheikh Ndiaye Sy ,&nbsp;Daouda Wague ,&nbsp;Alioune Badara Thiam ,&nbsp;Ndaraw Ndoye ,&nbsp;Momar Code Ba","doi":"10.1016/j.inat.2023.101903","DOIUrl":"https://doi.org/10.1016/j.inat.2023.101903","url":null,"abstract":"<div><h3>Introduction</h3><p>Endoscopic endonasal transsphenoidal surgery is currently the gold-standard therapeutic approach for pituitary adenomas. Although being spread worldwide, the endoscopic endonasal approach for pituitary adenomas is recently implemented in Senegal.</p><p>This study aimed to report our results and the complications observed in the context of an under-equipped facility.</p></div><div><h3>Materials and methods</h3><p>We conducted a retrospective study including all patients with a pituitary adenoma treated who underwent endonasal transsphenoidal resection under a single endoscopic approach from January 2014 to May 2022, in the Neurosurgery Department of Fann National Hospital Centre, Dakar. All patients were assessed according to clinical, radiological, and endocrinological criteria. They all were operated by the same team with an average follow-up of 24 months.</p></div><div><h3>Results</h3><p>In this series of 180 patients, including 57.7 % women and 42.3% men with a mean age of 44.8 years (extremes of 18 and 76 years), the visual deficit was the most frequent onset symptom (69.4 %), followed by clinical forms of hormone hypersecretion (30.5 %). Twelve cases of pituitary apoplexy and 1 case of incidentaloma were reported. The most frequent tumors were non-functional tumors (61.6 %). Among the functional adenomas, the most frequent was prolactinoma (15.5 %). Regarding tumor size, 75 % were macroadenomas, 15.5 % were microadenomas, and 9.5 % were giants. Cavernous sinus invasion (Knosp grade ≥ 3) and suprasellar extension were noted in 14.4 % and 53.3 %, respectively. The resection was total in 80 % of cases, subtotal in 18.8 %, and partial in 1.2 %. Partial improvement of sight was observed in 91.1% and endocrine hypersecretion remission in 76.6 %. As for complications, the most frequent was transient diabetes insipidus (32.7 %).</p></div><div><h3>Conclusion</h3><p>Despite the scanty resources, our results are similar to the best-reported series and strengthen scientific evidence on the efficacy and safety of performing this technique in an under-equipped setting context.</p></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"36 ","pages":"Article 101903"},"PeriodicalIF":0.4,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S221475192300186X/pdfft?md5=9c7895f4c0db399f8c306ce6b664d8b7&pid=1-s2.0-S221475192300186X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138466386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Deep multi-task learning structure for segmentation and classification of supratentorial brain tumors in MR images 脑幕上肿瘤MR图像分割分类的深度多任务学习结构
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-25 DOI: 10.1016/j.inat.2023.101931
Shirin Kordnoori , Maliheh Sabeti , Mohammad Hossein Shakoor , Ehsan Moradi

Identification of brain tumors border and determination of their possible pathology in MR images is an important step in pre-operation analyzing of this serious medical condition. Manual segmentation and classification of brain tumors could be challenge full in neurosurgical practice because of vast differences between brain tumors characteristic such as shape, border irregularity, consistency and etc. as well as interobserver variations. To solve this problem, some automatic methods have been proposed for brain tumors segmentation or classification during recent years, but an intelligence-based method for simultaneous identification of tumor type and tumor border in MR images has not proposed till now. Here, we have planned a unique automatic model includes a common encoder for feature representation, one decoder for segmentation and a multi-layer perceptron for classification of three common primary brain tumors (meningiomas, gliomas and pituitary adenomas) in brain MR images. The proposed model was examined on a brain tumor images dataset and the output were evaluated in both multi-task and single-task learning model. The multi-task learning model gains significant improvement in simultaneous classification and segmentation of brain tumors with promising accuracy of 97% for each task. So, this model could serve as a primary screening tool for early diagnosis of common primary brain tumors in general practice with a high success rate.

在mri图像中识别脑肿瘤边界并确定其可能的病理是术前分析这一严重疾病的重要步骤。由于脑肿瘤在形状、边界不规则性、一致性等特征上存在巨大差异,且观察者之间存在差异,因此在神经外科实践中,人工对脑肿瘤进行分割和分类是一个很大的挑战。为了解决这一问题,近年来已经提出了一些脑肿瘤的自动分割或分类方法,但目前还没有提出一种基于智能的MR图像中肿瘤类型和肿瘤边界的同时识别方法。在这里,我们计划了一个独特的自动模型,包括一个用于特征表示的通用编码器,一个用于分割的解码器和一个用于脑MR图像中三种常见原发性脑肿瘤(脑膜瘤,胶质瘤和垂体腺瘤)分类的多层感知器。在一个脑肿瘤图像数据集上测试了该模型,并在多任务和单任务学习模型下对输出结果进行了评估。多任务学习模型在脑肿瘤的同时分类和分割方面取得了显著的进步,每个任务的准确率有望达到97%。因此,该模型可作为临床常见原发性脑肿瘤早期诊断的初级筛查工具,成功率高。
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引用次数: 0
Penetrating intracranial injury through temporal bone with a retained stab: A case report and literature review 颞骨穿透性颅内损伤伴残留刺伤1例报告并文献复习
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-25 DOI: 10.1016/j.inat.2023.101930
Endris Hussen Ali MD, NEUROSURGERY RESIDENT , Milena Gebreegziabher Haile MD, NEUROSURGEON

Background

An instrument that penetrates the dura mater and the thickness of the skull bone is considered to have produced a penetrating craniocerebral injury. Nonmissile penetrants and missiles are two types of penetrating agents. Nonmissile penetrants can travel at low speeds or at high speeds (>100 m/s). It might stay inside the skull or come out of another place. One item that can inflict piercing injuries on civilians is a knife. Although the precise frequency of penetrating head injuries in the general population is unknown, current estimates suggest that bullets account for 4.6 % of these injuries, while puncture wounds from stabs, nails, and other trauma account for 0.4 %. Unlike European reports, Reportedly, male assailants in South Africa are much more likely to have suffered a single head-stab wound. The frontal bone is the most frontal, thickest, and most accessible section of the skull for assailants; nevertheless, the orbit and squamous portion of the temporal bone are thinner, more fragile, and more appealing to skilled attackers.

Case presentation

This is a 29-year-old male patient referred to our hospital after being referred from the primary hospital. He sustained a stab injury to the left temporal area of the head, bleeding from the scalp, and loss of consciousness. The stab is retained in the brain, with its tip visible in the left temporal area (Fig. 1). GCS is 10/15; the pupils are midsized and non-reactive bilaterally, and he had a left-side preference. On a brain CT scan, there is a left temporal area foreign body seen penetrating through the scalp, skull temporal bone, temporal lobe, and occipital lobe of the brain with a stab tip at the edge of the left tentorium cerebelli, and there is an associated left massive acute subdural hematoma and intraventricular hemorrhage extending from the lateral ventricle to the fourth ventricle (Fig. 2). We did left-side decompressive craniectomy, expansile duraplasty, and removed a foreign body (stab) safely (Fig. 3), and postoperatively, the patient was discharged with stable vital signs and no neurologic deficit with improved GCS 15/15.

Conclusion

The main idea is to wait to remove the knife until after a thorough investigation has been completed and the interdisciplinary team is ready to remove the instrument using suitable techniques. Removing the penetrating object should allow the knife to follow its original path. It’s important to avoid making any rocking motions during the extraction process that could endanger vital neurovascular structures at risk at the knife's tip.

穿透硬脑膜和颅骨厚度的器械被认为造成了穿透性颅脑损伤。非导弹渗透剂和导弹是两种类型的渗透剂。非导弹渗透物能以低速或高速(100米/秒)行进。它可能会留在头骨内或从其他地方出来。有一种物品可以对平民造成刺穿性伤害,那就是刀。虽然一般人群中穿透性头部损伤的确切频率尚不清楚,但目前的估计表明,子弹占这些损伤的4.6%,而刺伤、钉子和其他创伤的刺伤占0.4%。与欧洲的报道不同,据报道,南非的男性袭击者更有可能只有一处头部刺伤。额骨是攻击者最正面、最厚、最容易接近的头骨部分;然而,颞骨的眼眶和鳞状部分更薄,更脆弱,更吸引熟练的攻击者。病例介绍:这是一名29岁男性患者,由基层医院转诊至我院。他头部左侧颞区被刺伤,头皮出血,失去知觉。刺伤留在大脑中,其尖端在左侧颞区可见(图1)。GCS为10/15;瞳孔大小中等,双侧无反应,患者偏左。在脑部CT扫描中,可见左侧颞区异物穿透头皮、颅骨颞骨、颞叶和枕叶,其尖端位于左侧小脑幕边缘,并伴有左侧大量急性硬膜下血肿和脑室内出血,从侧脑室延伸至第四脑室(图2)。我们进行了左侧减压颅骨切除术,扩张硬脑膜成形术,安全取出异物(刺)(图3),术后出院,患者生命体征稳定,无神经功能缺损,GCS 15/15改善。结论主要的想法是等到彻底的调查完成,跨学科团队准备好使用合适的技术取出仪器后再取出刀。移开刺穿的物体应该让刀沿着原来的路径移动。在拔牙过程中,一定要避免晃动,以免危及刀尖处的重要神经血管结构。
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引用次数: 0
Predicting the radiological outcome of cerebral aneurysm treatment with machine learning algorithms; a systematic review and diagnostic meta-analysis 用机器学习算法预测脑动脉瘤治疗的放射预后系统回顾和诊断荟萃分析
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-25 DOI: 10.1016/j.inat.2023.101929
Mohammad Amin Habibi , Hanieh Amani , Mohammad Sina Mirjani , Ayoob Molla

Background

Up now, several model were proposed for predicting the outcome of treating brain aneurysm. This study aims to investigate the performance of Machine learning (ML) in predicting the outcome of intracranial aneurysm after endovascular or microsurgical management.

Method

This systematic review and meta-analysis was prepared with adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. The electronic databases of PubMed/Medline, Embase, Scopus, and Web of Science were systematically reviewed up to 5th June 2023. All statistical analysis was done by STATA/mp V.20.

Results

Recent studies have utilized ML models to forecast the results of cerebral aneurysm treatment. The models exhibit a sensitivity of 0.88 and a specificity of 0.80, with the latter revealing substantial variability across the various studies. Meanwhile, the sensitivity remained consistent. The models displayed a positive DLR (PLR) of 4.5 and a negative DLR (NLR) of 0.15. The aggregate diagnostic score determined that heterogeneity was negligible, with a value of 3.41. However, the diagnostic odds ratio 30.29 indicated noteworthy heterogeneity among the studies. The pooled AUC of 0.90 showcased the ML's ability to predict cerebral aneurysm treatment outcomes accurately.

Conclusion

Predicting treatment outcomes in patients with intracranial aneurysms non-invasively is a promising approach with good diagnostic performance. However, further studies are required to improve the accuracy of ML algorithms, as the pooled metrics had a wide confidence interval. This will not only enhance the reliability of the predictions but also facilitate the integration of these algorithms into daily clinical practice.

目前,已经提出了几种预测脑动脉瘤治疗结果的模型。本研究旨在探讨机器学习(ML)在预测颅内动脉瘤在血管内或显微手术治疗后的预后方面的表现。方法遵循PRISMA (Preferred Reporting Items for systematic reviews and meta-analysis)指南进行系统评价和荟萃分析。截止到2023年6月5日,对PubMed/Medline、Embase、Scopus、Web of Science等电子数据库进行系统综述。所有统计分析均采用STATA/mp V.20进行。结果近年来已有研究利用ML模型预测脑动脉瘤治疗结果。该模型的敏感性为0.88,特异性为0.80,后者揭示了各种研究之间的实质性差异。同时,敏感性保持一致。模型的阳性DLR (PLR)为4.5,阴性DLR (NLR)为0.15。综合诊断评分表明异质性可以忽略不计,其值为3.41。然而,诊断优势比为30.29,表明研究之间存在显著的异质性。合并的AUC为0.90,表明ML能够准确预测脑动脉瘤的治疗结果。结论无创预测颅内动脉瘤治疗效果是一种有前景的方法,具有良好的诊断效果。然而,由于汇集的指标具有较宽的置信区间,因此需要进一步的研究来提高ML算法的准确性。这不仅将提高预测的可靠性,而且有助于将这些算法整合到日常临床实践中。
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引用次数: 0
Landscape of epilepsy research: Analysis and future trajectory 癫痫研究的前景:分析与未来轨迹
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-24 DOI: 10.1016/j.inat.2023.101879
Manisha Sharma , Satyajit Anand , Rajeev Pourush

Epilepsy is a neurological condition characterized by temporary disruptions in the brain's electrical activity. This disorder can significantly impact the quality of life for those affected, leading to limitations on driving and employment opportunities. The seriousness of epilepsy is further emphasized by the risk of SUDEP (sudden unexpected death in epilepsy). Additionally, individuals with epilepsy commonly experience memory problems and emotional disorders. In this article, we present a bibliometrix analysis of epilepsy research, examining influential articles, keywords, authors, institutions, and countries. Our analysis focuses on research articles published from 2015 to 2023.The findings of our analysis reveal that China and India are the leading countries in terms of epilepsy publications and total citations. Furthermore, we propose a framework that encompasses technology, enablers, and barriers, providing valuable insights into the future trajectory of epilepsy research. Various factors can contribute to the development of epilepsy, including neurotransmitter imbalances, tumors, strokes, brain damage resulting from illnesses or injuries, or a combination of these causes. To gather scientific papers related to epilepsy seizures, we employed the Scopus database and extracted information such as titles, authors, contributing institutes, source journals, times cited, and countries. For data analysis, we used the R package (Bibliometricx R package), VOSviewer, and SciMAT facilitated co-authorship and co-occurrence analyses, allowing us to visualize the results. By shedding light on the current state of epilepsy research and identifying emerging trends, the aim of this study is to provide guidance for future investigations in understanding, managing, and treating epilepsy more effectively.

癫痫是一种神经系统疾病,其特征是大脑电活动的暂时性中断。这种疾病会严重影响患者的生活质量,导致驾驶和就业机会受到限制。癫痫的严重性还体现在 SUDEP(癫痫猝死)的风险上。此外,癫痫患者通常会出现记忆问题和情绪障碍。在本文中,我们对癫痫研究进行了文献计量分析,研究了有影响力的文章、关键词、作者、机构和国家。我们的分析侧重于2015年至2023年发表的研究文章。分析结果表明,中国和印度在癫痫论文发表量和总被引次数方面居于领先地位。此外,我们还提出了一个包含技术、推动因素和障碍的框架,为癫痫研究的未来发展轨迹提供了宝贵的见解。各种因素都可能导致癫痫的发生,包括神经递质失衡、肿瘤、中风、疾病或外伤导致的脑损伤,或这些原因的综合作用。为了收集与癫痫发作相关的科学论文,我们使用了 Scopus 数据库,并提取了标题、作者、投稿机构、来源期刊、引用次数和国家等信息。在数据分析方面,我们使用了 R 软件包(Bibliometricx R 软件包)、VOSviewer 和 SciMAT 来进行共同作者和共同出现分析,从而使结果可视化。本研究的目的是通过揭示癫痫研究的现状和确定新趋势,为今后更有效地了解、管理和治疗癫痫的研究提供指导。
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引用次数: 0
Thoracolumbar junction fracture and long instrumented fusion, a trial on a standardized surgical technique with long term clinical outcomes 胸腰椎节段骨折和长内固定融合,一项具有长期临床结果的标准化手术技术试验
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-24 DOI: 10.1016/j.inat.2023.101928
Mehdi Mahmoodkhani , Nima Najafi Babadi , Majid Rezvani , Ali Nasrollahizadeh , Arman Sourani , Mina Foroughi , Sadegh Baradaran Mahdavi , Donya Sheibani Tehrani , Roham Nik Khah

Aim

To investigate the role of fusion construct properties, vertebral column reconstruction (VCR) techniques, steroid therapy, laminectomy versus ligamentotaxis in treatment of thoracolumbar junction fractures (TLJF).

Methods

A non-randomized clinical trial was conducted. All the eligible patients with TLJF (T12-L2) were operated with a standardized long fusion protocol and followed. Fusion rate, hardware failure, sagittal imbalance and functional outcome were identified as the primary outcome. P < 0.05 was defined as significant.

Results

Ninety-nine long fusions were reviewed in the final analysis. The mean age was 35.7 ± 13.80 years with 79.8 % male predominance. Fifty-eight percent of the patients were neurological intact. Fifty-six percent underwent concurrent laminectomy and VCR using autografts while the remaining 43.4 % received ligamentotaxis. The patients follow up (median = 25 months) showed 93.9 % solid fusion rate, 70.7 % activity independency, 1% hardware failure, 10.1 % sagittal imbalance and 4 % wound complications. Sagittal imbalance was associated with steroid therapy (p = 0.006), laminectomy (p = 0.003) and preoperative neurological deficits (p = 0.0001) and age (p = 0.049). Interestingly, Steroid therapy was associated with improved neurological and functional outcomes in impaired patients (p < 0.05). Laminectomy was associated with favorable functional outcome (OR = 9.7, CI: 2.09–45.67).

Conclusion

Our standardized long fusion protocol was associated with significant outcomes with low morbidities. Autograft mixture yield to a robust union in and over fusion construct. Methylprednisolone therapy in non-intact patients was associated with improved clinical outcomes but simultaneously, has negative impact on sagittal imbalance. Laminectomy and steroid therapy should be carefully considered in impaired patients due to their negative impact on sagittal balance.

目的探讨融合结构特性、脊柱重建(VCR)技术、类固醇治疗、椎板切除术与韧带趋紧术在治疗胸腰椎交界部骨折(TLJF)中的作用。方法采用非随机临床试验。所有符合条件的TLJF (T12-L2)患者均采用标准化的长融合方案进行手术并随访。融合率、硬体失效、矢状面不平衡和功能结果被确定为主要预后。P & lt;0.05为显著性。结果对99例长融合进行了回顾性分析。平均年龄35.7±13.80岁,男性占79.8%。58%的患者神经系统完好。56%的患者同时接受了椎板切除术和自体移植物VCR,其余43.4%的患者接受了韧带平滑术。患者随访25个月,固性融合率93.9%,活动独立性70.7%,硬体失败1%,矢状面失衡10.1%,伤口并发症4%。矢状面失衡与类固醇治疗(p = 0.006)、椎板切除术(p = 0.003)、术前神经功能缺损(p = 0.0001)和年龄(p = 0.049)有关。有趣的是,类固醇治疗与受损患者的神经和功能预后改善相关(p <0.05)。椎板切除术与良好的功能预后相关(OR = 9.7, CI: 2.09-45.67)。结论:我们的标准化长融合方案具有显著的预后和低发病率。自体移植物混合物在融合和过度融合结构中产生健壮的结合。甲基强的松龙治疗非完整患者与改善临床结果相关,但同时对矢状面失衡有负面影响。由于椎板切除术和类固醇治疗对矢状面平衡的负面影响,应仔细考虑受损患者。
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引用次数: 0
Eagle syndrome an overlooked cause of internal carotid artery dissection, Case series 鹰综合征是颈内动脉夹层的一个被忽视的原因,病例系列
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-22 DOI: 10.1016/j.inat.2023.101873
Abeer Sabry Safan , Mohamed A. Atta , Isra Eltazi , Gayane Melikyan , Ahmed El Sotouhy , Yahia Imam

Background

Eagle syndrome is a rare condition with a prevalence estimated at 4%, with 0.16% exhibiting symptoms of Eagle’s syndrome resulting from an elongated styloid process or a calcified stylohyoid ligament, compressing over nearby vessels and nerves. Symptoms range from simple headache, neck pain, and odynophagia to cerebral ischemia. Since it can be an incidental finding, management is controversial and ranges from conservative treatment to surgical intervention, including internal carotid stenting and styloidectomy.

Clinical presentation

We report two cases of Eagle’s syndrome. Case one (Vascular variant): 44 years old presented with left-sided weakness with Magnetic Resonance Imaging and an angiogram of the brain showing a right middle cerebral artery hemispheric infarct with a right internal carotid artery (ICA) dissection and elongated styloid processes more on the left. The patient’s condition improved with supportive care. He was treated with aspirin, atorvastatin, and an intensive 16-week rehabilitation program. Case two (Classic variant): 41 years old presented with refractory occipital headache and neck pain without vascular insult. Magnetic resonance of both patients showed a long styloid process.

Conclusions

Eagle’s Syndrome is a rare entity and perhaps overlooked as an anatomical variant that ought to be considered a possible etiology in atraumatic ICA dissection in patients with no discernable risk factors. As observed in case one, with atraumatic ICA dissection and unremarkable connective tissue disease work-up, highlighting anatomical variant, as an etiology to his ischemic stroke. Styloidectomy should be considered to avert risk of recurrent IC dissections in such patients with atraumatic IC dissection and classic eagle’s syndrome with refractory orofacial pain syndromes exacerbated by head movement or yawning.

背景:deagle综合征是一种罕见的疾病,患病率估计为4%,其中0.16%表现出由茎突拉长或茎突舌骨韧带钙化导致的Eagle综合征症状,压迫附近的血管和神经。症状从单纯的头痛、颈部疼痛、咽痛到脑缺血。由于它可能是偶然发现的,治疗是有争议的,从保守治疗到手术干预,包括颈内动脉支架置入和茎突切除术。我们报告2例鹰氏综合征。病例一(血管变异):44岁,表现为左侧虚弱,磁共振成像和脑血管造影显示右侧大脑中动脉半球性梗死,右侧颈内动脉剥离,左侧茎突延长。病人的病情在支持性护理下得到改善。他接受了阿司匹林、阿托伐他汀和为期16周的强化康复治疗。病例二(经典变异):41岁,顽固性枕头头痛和颈部疼痛,无血管损伤。两例患者的磁共振显示茎突长。结论西格勒综合征是一种罕见的疾病,作为一种解剖变异可能被忽视,在无明显危险因素的非外伤性颈内动脉夹层患者中应考虑其可能的病因。正如病例1所观察到的,无创伤性ICA解剖和无显著结缔组织疾病检查,突出解剖变异,作为缺血性中风的病因。对于非外伤性IC夹层和典型鹰氏综合征合并难治性口面部疼痛综合征的患者,应考虑行茎突切除术,以避免复发性IC夹层的风险,这些患者会因头部运动或打哈欠而加重。
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引用次数: 0
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Interdisciplinary Neurosurgery: Advanced Techniques and Case Management
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