Brain & spine最新文献_第2页

Temporal muscle measurements as predictor for outcome in a cohort of IDH-wildtype glioblastoma patients 颞肌测量作为idh野生型胶质母细胞瘤患者队列预后的预测因子

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2025.105914

H. Pinson , C. De Rudder , L. De Backer , A. Van Sinay , T. Boterberg , G. Hallaert

Background

Temporal muscle thickness has been suggested as an independent prognostic marker for glioblastoma patient outcome. Various cohort studies show however conflicting results. This study therefore aims to reevaluate the prognostic value of different types of temporal muscle measurements in glioblastoma patients.

Methods

A retrospective cohort study was performed including 137 patients diagnosed with IDH-wildtype glioblastoma. Temporal muscle thickness (TMT) and volume (TMV) were measured on preoperative MR-imaging. Next, these measurements were used in a multivariate Cox survival analysis to identify their possible prognostic value. These results were compared to the literature after systematic review of the Medline database.

Results

TMT has a moderate to strong linear correlation with total muscle volume (Pearson r = 0.6; P < 0.001). Glioblastoma patients “at risk for sarcopenia” show similar outcome compared to controls (median overall survival time: 13 months vs 11 months; P = 0.775). In a covariate Cox regression model, none of the temporal muscle measurements (TMT, TMV or sex-specific cut-off points) showed prognostic value for outcome in glioblastoma patients.

Conclusion

Temporal muscle measurements show no independent relation to clinical outcome in IDH-wildtype glioblastoma patients. There seems adequate linear correlation of temporal muscle thickness and overall muscle volume. The literature on temporal muscle measurements lacks methodological consistency and should be interpreted with caution.

背景颞肌厚度已被认为是胶质母细胞瘤患者预后的独立预后指标。然而，各种队列研究显示出相互矛盾的结果。因此，本研究旨在重新评估不同类型颞肌测量在胶质母细胞瘤患者中的预后价值。方法对137例idh野生型胶质母细胞瘤患者进行回顾性队列研究。术前mri测量颞肌厚度（TMT）和体积（TMV）。接下来，将这些测量结果用于多变量Cox生存分析，以确定其可能的预后价值。这些结果在Medline数据库的系统回顾后与文献进行了比较。结果stmt与总肌肉体积呈中等至强线性相关（Pearson r = 0.6; P < 0.001）。与对照组相比，“有肌肉减少风险”的胶质母细胞瘤患者表现出相似的结果（中位总生存时间：13个月vs 11个月；P = 0.775）。在协变量Cox回归模型中，颞肌测量（TMT、TMV或性别特异性截断点）均未显示出胶质母细胞瘤患者预后的价值。结论颞肌测量与idh野生型胶质母细胞瘤患者的临床预后无独立关系。颞肌厚度和整体肌肉体积似乎有足够的线性相关性。关于颞肌测量的文献缺乏方法学上的一致性，应谨慎解释。

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引用次数: 0

Cortical structural variations and scoliosis risk: insights from a large-scale Mendelian randomization analysis 皮质结构变异和脊柱侧凸风险：来自大规模孟德尔随机化分析的见解

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105936

Hanjun Ma , Ju Liao , Mingxuan Liu , Zonglong He , Qi Wei , Qunqiang Luo

Introduction

Scoliosis is a complex condition that may be influenced by neurobiological factors, including brain structure.

Research question

Does a causal relationship exist between brain structure and scoliosis, and if so, which brain structural imaging-derived phenotypes (IDPs) are implicated?

Material and methods

We conducted a bidirectional Mendelian randomization (MR) analysis to evaluate potential causal relationships between brain structural IDPs and scoliosis. Instrumental variables were selected from genome-wide association studies, and causal estimates were derived primarily using inverse variance weighted (IVW) analysis, complemented by other sensitivity analyses.

Results

In the forward MR analysis, 27 brain structural IDPs showed positive associations with scoliosis risk, whereas 37 showed negative associations. Notably, increased grey matter volume in the left middle frontal gyrus (MFG) showed the strongest association (IDP code: IDP_T1_FAST_ROIs_L_mid_front_gyrus; IVW OR = 2.238, 95 % CI: 1.534–3.264, P = 2.911 × 10⁻⁵; P_FDR = 0.049), and it remained significant after FDR correction. In the reverse MR analysis, scoliosis was associated with 55 brain structural traits, but none remained significant after FDR correction.

Discussion and conclusion

These findings provide evidence supporting a potential causal role of specific brain structures in scoliosis susceptibility, particularly the left MFG, a region associated with postural control. Further studies are needed to replicate these associations and clarify their clinical relevance.

脊柱侧凸是一种复杂的疾病，可能受到包括脑结构在内的神经生物学因素的影响。研究问题：脑结构和脊柱侧凸之间是否存在因果关系？如果存在因果关系，哪些脑结构成像衍生表型（IDPs）与之相关？材料和方法我们进行了双向孟德尔随机化（MR）分析，以评估脑结构性IDPs与脊柱侧凸之间的潜在因果关系。工具变量从全基因组关联研究中选择，因果估计主要使用逆方差加权（IVW）分析，辅以其他敏感性分析。结果在正向MR分析中，27例脑结构IDPs与脊柱侧凸风险呈正相关，37例与脊柱侧凸风险负相关。值得注意的是，左侧额叶中回（MFG）灰质体积增加表现出最强的相关性（IDP代码：IDP_T1_FAST_ROIs_L_mid_front_gyrus； IVW OR = 2.238, 95% CI: 1.534 ~ 3.264, P = 2.911 × 10−5;P_FDR = 0.049）， FDR校正后仍具有显著性。在反向MR分析中，脊柱侧凸与55个脑结构特征相关，但在FDR校正后没有一个保持显著性。讨论和结论这些发现提供了证据，支持特定大脑结构在脊柱侧凸易感性中的潜在因果作用，特别是与姿势控制相关的左侧MFG区域。需要进一步的研究来重复这些关联并阐明其临床相关性。

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引用次数: 0

Surgical selection and outcomes: Unilateral hemilaminectomy vs. total laminectomy for spinal tumors 手术选择和结果：单侧半椎板切除术与全椎板切除术治疗脊柱肿瘤

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105944

Almir Džurlić , Bekir Rovčanin , Džan Ahmed Jesenković , Azra Grebo , Lamija Terzić , Adi Ahmetspahić , Edin Hajdarpašić , Mirza Pojskić , Ibrahim Omerhodžić

Introduction

Spinal tumor surgery mandates complete removal with preserved neurological function and stability. Total Laminectomy (TL) provides access but risks complications (pain, deformity) from extensive tissue removal. The safer, tissue-sparing Unilateral Hemilaminectomy (UHL) is limited by concerns about complete resection via its narrower corridor.

Research question

This study was comparing the clinical and radiological characteristic between unilateral TL and total laminectomy UHL and they clinical outcomes and complications.

Material and methods

This was a retrospective cohort study comparing UHL and TL for intradural/extradural spinal tumors. We analyzed consecutive patients operated between January 2018 and December 2024, excluding those with confounding factors. Surgical approach was selected based on tumor location and intraoperative needs. Data on patient demographics, pre/postoperative neurological status, surgical parameters, and tumor characteristics were collected. Primary outcomes were postoperative neurological status and complications rate. Statistical analysis compared variables between groups using appropriate tests, with significance at p = 0.05.

Results

Baseline characteristics were similar between groups, and the overall postoperative complication rate was low (6.3 %) and comparable. The postoperative KPS score between UHL and TL showed improvement, without significant difference between them. Both approaches yielded significant improvements in functional status and neurological recovery from preoperative baselines.

Discussion and conclusion

Our findings indicate that the tissue-sparing UHL approach can achieve similar functional outcomes and complication rates as TL for similarly sized tumors. This supports UHL as a safe and effective option, although the final surgical approach must remain individualized based on specific tumor complexity and radiological findings.

脊柱肿瘤手术要求完全切除并保留神经功能和稳定性。全椎板切除术（TL）提供了手术途径，但存在大面积组织切除带来的并发症（疼痛、畸形）的风险。更安全、保留组织的单侧半椎板切除术（UHL）由于其狭窄的通道不能完全切除而受到限制。研究问题本研究比较单侧TL和全椎板切除术UHL的临床和影像学特点及其临床结局和并发症。材料和方法这是一项回顾性队列研究，比较UHL和TL治疗硬膜内/硬膜外脊柱肿瘤。我们分析了2018年1月至2024年12月期间连续手术的患者，排除了混杂因素。根据肿瘤位置和术中需要选择手术入路。收集患者人口统计学、术前/术后神经状态、手术参数和肿瘤特征的数据。主要结果是术后神经系统状况和并发症发生率。统计学分析采用适当的检验比较组间变量，p = 0.05为显著性。结果两组患者基线特征相似，总体术后并发症发生率低（6.3%），具有可比性。UHL与TL术后KPS评分均有改善，两者无显著差异。两种方法均能显著改善患者的功能状态和术前基线的神经恢复。讨论和结论我们的研究结果表明，对于类似大小的肿瘤，保留组织的UHL入路可以获得与TL相似的功能结果和并发症发生率。这支持UHL作为一种安全有效的选择，尽管最终的手术方法必须根据特定的肿瘤复杂性和放射学发现保持个体化。

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引用次数: 0

Implementation of 3D printing technology for complex spine revision cases that require multilevel anterior spinal support: Over 5-year experience in six cases and costs assessment 在复杂脊柱翻修病例中实施3D打印技术，需要多水平脊柱前路支持：超过5年的6例经验和成本评估

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105929

J. Magré , M.S. Ramselaar , K. Willemsen , H. Weinans , T.P.C. Schlösser , M.C. Kruyt

Introduction

The anterior column of the spine is crucial for stability. In a dystrophic spine, the loss of multisegmental anterior spinal support can have devastating consequences. Since posterior instrumentation alone cannot take over the weight bearing capacity of the anterior column, structural anterior support must be created. Long bone struts are at risk for failure of engraftment and pseudoarthrosis. Patient-specific anterior support using 3D printing technology may be a better solution in these patients.

Research question

Are patient-specific approaches using 3D printing technology a viable treatment option for multilevel anterior spinal support?

Material and methods

Five patients received a custom-made anterior paravertebral titanium spinal strut prosthesis; one patient received a 3D shaped structural allograft. Cost assessment was made based on hours spent and production costs. Clinical outcomes were extracted from the medical records.

Results

All six implantations went uneventful with adequate fit of the prostheses and allograft. The mean surgery time was 219 min, and mean blood loss was 850 ml. No implant subsidence or loosening occurred during follow-up (0.5–8 years). Complications observed were partial bronchial compression in one patient and a postoperative infection in another. The first cases were most costly due to the hours spent on design and regulatory compliance. These costs declined for subsequent cases.

Discussion and conclusion

Custom-made prostheses appear to be a viable treatment option for multi-level anterior spinal support. No implant failure was observed up to 8 years postoperative. Close collaboration between an in-house 3D lab and the surgical team was essential for implementing custom-made prosthesis in clinical care.

脊柱前柱对脊柱的稳定性至关重要。在营养不良的脊柱中，多节段脊柱前支撑的丧失可能会造成毁灭性的后果。由于单纯后路内固定不能取代前柱的承重能力，因此必须建立结构性的前路支撑。长骨支柱有植入失败和假关节的危险。在这些患者中，使用3D打印技术的患者特异性前路支持可能是更好的解决方案。研究问题：针对患者使用3D打印技术进行多节段脊柱前路支持是否可行？材料与方法5例患者采用定制的椎旁前路钛脊柱支撑假体；一名患者接受了3D形状的同种异体结构移植。成本评估是根据花费的小时数和生产成本进行的。从医疗记录中提取临床结果。结果6例移植均顺利进行，假体与同种异体移植吻合良好。平均手术时间219 min，平均失血量850 ml，随访0.5 ~ 8年无种植体下沉、松动。观察到的并发症是1例患者部分支气管受压，另1例患者术后感染。由于在设计和法规遵从性上花费的时间，第一个案例的成本最高。这些费用在随后的案件中有所下降。讨论与结论定制假体似乎是一种可行的治疗选择，多段前路脊柱支持。术后8年未见种植体失败。内部3D实验室和外科团队之间的密切合作对于在临床护理中实施定制假体至关重要。

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引用次数: 0

Treatment strategies for incomplete burst fractures (AO Spine A3) at the thoracolumbar junction -results of a nationwide German survey 胸腰椎连接处不完全爆裂骨折（AO脊柱A3）的治疗策略——德国一项全国性调查的结果

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2025.105903

G. Gaudin , D. Laue , L. Wurm , C. Jaeger , K.J. Schnake

Introduction

Incomplete burst fractures (A3 AO Spine) of the thoracolumbar junction (TLJ) are among the most common injuries of the thoracolumbar spine. Various treatment strategies are still the subject of controversial debate among spine surgeons.

Research question

What are the current treatment trends for incomplete burst fractures at the TLJ within the German Spine Society.

Methods

An online survey was conducted via the email distribution list of the German Spine Society (DWG). Ten representative cases with A3 fractures of varying severity at the TLJ were demonstrated. Five radio-morphological parameters were displayed for each of the ten cases.

Results

131 spine surgeons responded. In 41 % of cases a dorsal approach was recommended, a dorsoventral approach in 33 % and conservative treatment in 26 %. Immobilizing pain was the decisive reason for conversion from an initially recommended conservative treatment to surgery in 46 %. The monosegmental endplate angle (EPA) was the most important parameter for surgical treatment recommendation (p < 0.05), with a significant threshold of 12°. The combination of vertebral body destruction (VD) > 50 % and EPA >12° increased the recommendation for a combined posterior and anterior procedure significantly (p = 0.048).

Discussion and conclusion

To our knowledge, there are no comparable surveys that provide an overview of the current treatment strategy for A3 fractures. The most common treatment recommendation is posterior stabilization. Local kyphosis and immobilizing pain are significant triggers for surgery.

胸腰椎交界处（TLJ）的不完全性爆裂骨折（A3 AO脊柱）是胸腰椎最常见的损伤之一。各种治疗策略仍然是脊柱外科医生争论的主题。研究问题：在德国脊柱学会的TLJ，目前不完全爆裂骨折的治疗趋势是什么？方法通过德国脊柱学会（DWG）电子邮件分发列表进行在线调查。报告了10例具有代表性的TLJ处不同程度的A3骨折。每10例均显示5个放射形态学参数。结果131名脊柱外科医生回应。41%的病例推荐背侧入路，33%的病例推荐背侧入路，26%的病例推荐保守治疗。固定疼痛是46%患者从最初推荐的保守治疗转为手术治疗的决定性原因。单节段终板角度（EPA）是推荐手术治疗的最重要参数（p < 0.05），显著阈值为12°。椎体破坏（VD） >； 50%和EPA >；12°的组合显著提高了后路和前路联合手术的推荐率（p = 0.048）。讨论和结论据我们所知，目前还没有可比较的调查对A3型骨折的治疗策略进行概述。最常见的治疗建议是后路稳定。局部后凸和固定疼痛是手术的重要诱因。

{"title":"Treatment strategies for incomplete burst fractures (AO Spine A3) at the thoracolumbar junction -results of a nationwide German survey","authors":"G. Gaudin , D. Laue , L. Wurm , C. Jaeger , K.J. Schnake","doi":"10.1016/j.bas.2025.105903","DOIUrl":"10.1016/j.bas.2025.105903","url":null,"abstract":"<div><h3>Introduction</h3><div>Incomplete burst fractures (A3 AO Spine) of the thoracolumbar junction (TLJ) are among the most common injuries of the thoracolumbar spine. Various treatment strategies are still the subject of controversial debate among spine surgeons.</div></div><div><h3>Research question</h3><div>What are the current treatment trends for incomplete burst fractures at the TLJ within the German Spine Society.</div></div><div><h3>Methods</h3><div>An online survey was conducted via the email distribution list of the German Spine Society (DWG). Ten representative cases with A3 fractures of varying severity at the TLJ were demonstrated. Five radio-morphological parameters were displayed for each of the ten cases.</div></div><div><h3>Results</h3><div>131 spine surgeons responded. In 41 % of cases a dorsal approach was recommended, a dorsoventral approach in 33 % and conservative treatment in 26 %. Immobilizing pain was the decisive reason for conversion from an initially recommended conservative treatment to surgery in 46 %. The monosegmental endplate angle (EPA) was the most important parameter for surgical treatment recommendation (p < 0.05), with a significant threshold of 12°. The combination of vertebral body destruction (VD) > 50 % and EPA >12° increased the recommendation for a combined posterior and anterior procedure significantly (p = 0.048).</div></div><div><h3>Discussion and conclusion</h3><div>To our knowledge, there are no comparable surveys that provide an overview of the current treatment strategy for A3 fractures. The most common treatment recommendation is posterior stabilization. Local kyphosis and immobilizing pain are significant triggers for surgery.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105903"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885159","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

Comparison of two clustering methods on surgical patients with adult spinal deformity: Importance of the variable choice on the obtained results and their interpretation 成人脊柱畸形手术患者两种聚类方法的比较：变量选择对所得结果的重要性及其解释

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2025.105904

Daniel Larrieu , Alice Baroncini , Anouar Bourghli , Javier Pizones , Frank S. Kleinstueck , Ahmet Alanay , Ferran Pellisé , Yann Philippe Charles , Louis Boissiere , Cecile Roscop , Ibrahim Obeid , European Spine Study Group

Introduction

Clustering techniques can reveal patterns in complex datasets and enable further statistical analysis, but outcomes may vary based on variable selection.

Research question

Does the choice of input variables affect clustering results in patients undergoing surgery for adult spinal deformity (ASD)?

Materials and methods

Hierarchical clustering was applied using two variable sets: C16 (16 variables including demographic, radiographic and quality-of-life metrics) and C12 (12 primarily radiographic variables).

Results

Data from 784 patients were analyzed. Both C16 and C12 identified three clusters. In Cluster 1, C16 included younger idiopathic scoliosis patients (age 29.42 ± 11.69 years), while C12 grouped slightly older patients (35.77 ± 15.44 years) with similar sagittal alignment and Cobb angles, but C16 had better quality of life (inverse ODI: 82.24 ± 11.90 vs 74.50 ± 16.90). Cluster 2 included patients with sagittal malalignment and moderate disability, showing similar demographics and ODI, but differing in radiographic features such as Cobb angle (41.39° vs 36.40°), coronal balance (22.12 mm vs 18.66 mm), and lumbar lordosis index (0.77 vs 0.71). Cluster 3 captured patients with severe sagittal malalignment and greater disability. Here, C12 showed more pronounced malalignment (global tilt: 47.45° vs 39.81°), but better quality of life (inverse ODI: 45.94 vs 41.41). The PCA revealed that clustering was driven by quality-of-life metrics in C16 and by radiological parameters in C12.

Discussion and conclusion

both algorithms identified similar cluster numbers and profiles, but the dominant clustering variables differed, highlighting the need to align variable selection with specific study goals.

聚类技术可以揭示复杂数据集中的模式，并进行进一步的统计分析，但结果可能因变量选择而异。研究问题：输入变量的选择是否会影响成人脊柱畸形（ASD）手术患者的聚类结果？材料和方法采用两个变量集进行分层聚类：C16（包括人口统计学、放射学和生活质量指标在内的16个变量）和C12（12个主要放射学变量）。结果分析了784例患者的资料。C16和C12都确定了三个簇。在第1组中，C16组为较年轻的特发性脊柱侧凸患者（年龄29.42±11.69岁），而C12组为年龄稍大的患者（35.77±15.44岁），矢状位对齐和Cobb角相似，但C16组的生活质量更好（ODI逆比：82.24±11.90 vs 74.50±16.90）。聚类2包括矢状面排列失调和中度残疾的患者，具有相似的人口统计学特征和ODI，但影像学特征不同，如Cobb角（41.39°vs 36.40°）、冠状面平衡（22.12 mm vs 18.66 mm）和腰椎前凸指数（0.77 vs 0.71）。第3组患者矢状面严重错位，残疾程度较高。在这里，C12表现出更明显的失调（全球倾斜：47.45°对39.81°），但生活质量更好（反向ODI: 45.94对41.41）。主成分分析显示，C16的生活质量指标和C12的放射参数驱动了聚类。讨论和结论：两种算法识别出相似的聚类数量和特征，但主要聚类变量不同，突出了需要将变量选择与特定的研究目标结合起来。

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引用次数: 0

Organizational management of moderate and severe paediatric traumatic brain injury: results from a European survey 中度和重度儿科创伤性脑损伤的组织管理：来自欧洲一项调查的结果

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2025.105921

Sarah Hornshøj Pedersen , Radek Frič , Shruti Agrawal , Chiara Robba , Aurelia Peraud , Miroslav Gjurasin , Ondra Petr , Marianne Juhler , Bart Depreitere , European Association of Neurosurgical Societies (EANS) (Sections of Trauma and Critical Care and Pediatric Neurosurgery), the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) and the European Society of Intensive Care Medicine (ESICM)

Introduction

Management of moderate/severe paediatric traumatic brain injury (mspTBI) varies across Europe. The decline in case numbers perceived in many regions raises concerns about maintaining high-quality, sustainable care.

Research question

This study aimed to examine the organization of mspTBI management in Europe, focusing on expertise availability, guideline adherence, neuromonitoring use, and clinician's confidence in care delivery through a survey.

Material and methods

A 34-question survey was distributed to European neurosurgical and intensive care communities. Only hospitals treating children with mspTBI were included. Centres were stratified by their catchment population size and their access to dedicated expertise.

Results

Seventy-six institutions from 23 countries responded. Most centres reported a mspTBI case load of less than 20 children per year. Access to paediatric anesthesiology was significantly associated with centre size (p = 0.001), while access to paediatric neurosurgery, intensive or neurointensive care was not. Most centres (96 %) reported adherence to (inter)national guidelines. Intracranial pressure (78.7 %) and transcranial Doppler (70.7 %) were the most frequently available/used neuromonitoring modalities. Confidence in managing mspTBI was significantly higher in centres with paediatric neurosurgeons and, for older children, paediatric neuro-intensivists.

Discussion

This first European survey examining organizational management of mspTBI reveals a low overall caseload and uneven access to paediatric expertise. Confidence in managing mspTBI correlates with availability of paediatric subspecialists. Guidelines are widely applied, independent of expert availability, but are alone insufficient to ensure treatment confidence. This finding underscores the need for improved guidelines and better access to paediatric neurotrauma expertise.

欧洲各地对中度/重度儿童创伤性脑损伤（mspTBI）的处理各不相同。许多地区病例数的下降引起了对维持高质量、可持续护理的关注。研究问题：本研究旨在考察欧洲mspTBI管理的组织，通过一项调查，重点关注专业知识的可用性、指南的依从性、神经监测的使用和临床医生对护理服务的信心。材料和方法在欧洲神经外科和重症监护社区进行了一项34题的调查。仅包括治疗mspTBI儿童的医院。各中心按其集水区人口规模和获得专门知识的机会进行分层。结果来自23个国家的76家机构参与了调查。大多数中心报告的mspTBI病例每年少于20名儿童。儿科麻醉学的可及性与中心大小显著相关（p = 0.001），而儿科神经外科、重症监护或神经重症监护的可及性与中心大小无关。大多数中心（96%）报告遵守了（国际）国家指南。颅内压（78.7%）和经颅多普勒（70.7%）是最常用的神经监测方式。在有儿科神经外科医生的中心和有儿科神经强化医生的中心，对mspTBI治疗的信心明显更高。这是欧洲第一次调查mspTBI的组织管理，揭示了低总体病例量和获得儿科专业知识的不平衡。管理mspTBI的信心与儿科专科医生的可用性相关。指南被广泛应用，独立于是否有专家，但仅凭指南不足以确保治疗的可信度。这一发现强调了改进指南和更好地获得儿科神经创伤专业知识的必要性。

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引用次数: 0

Mapping motor cortex “hand knob” metrics to symptom hemidominance in Parkinson's disease: from width comparison to machine learning 将帕金森病的运动皮质“把手”指标映射到症状偏优：从宽度比较到机器学习

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105933

Friedrich Erhart , Konstantin Hölzl , Agnes Langer , Christof Brücke , Josa M. Frischer , Gregor Kasprian , Karl Rössler , Klaus Novak

Introduction

Parkinson's disease typically shows unilateral symptom dominance. Even though general neurodegeneration is well-documented, side-specific cortex affection has not been exhaustively studied.

Research question

Specifically, we hypothesize that symptom hemidominance in Parkinson's disease might be associated with motor cortex “hand knob” size. To that end, we retrospectively analyzed 47 Parkinson's patients via structured morphometry, that had undergone standardized MRI for later deep brain stimulation surgery. Additionally, 25 control patients imaged with the same technical setup but without Parkinson's disease were investigated.

Material and methods

Main dimensions of the “hand knob” (e.g. width and length) and compound measures (e.g. area and volume) were registered. Data analysis ranged from classical statistics for e.g. width comparison to advanced machine learning algorithms for integrated multivariable computation (e.g. t-SNE, Random Forest, Neural Networks and Naïve Bayes).

Results

Left “hand knob” width appeared smaller in patients with right symptom hemidominance in exploratory univariable analyses (p = 0.026, uncorrected). In the control group this was not the case (p = 0.235). Complementary “hand knob” computations showed similar outcomes. All machine learning models concordantly suggested that integrated multivariable “hand knob” metrics can predict symptom side differences.

Discussion and conclusion

Symptom hemidominance and “hand knob” parameters seem to possibly be connected. Specific cortical motor morphology dynamics of the “hand knob” might exist in hemidominant Parkinson's – for which we provide hitherto overlooked, indicative evidence based on a simple yet fundamental imaging inquiry complemented with advanced machine learning. The hypothesis-generating insights presented here shall inspire further research of cortical motor structures in Parkinson's.

帕金森病典型表现为单侧显性症状。尽管一般的神经退行性变有充分的证据，但侧特异性皮层的影响尚未得到详尽的研究。研究问题：具体来说，我们假设帕金森病的症状半显性可能与运动皮质“把手”大小有关。为此，我们通过结构形态测量法回顾性分析了47名帕金森病患者，这些患者在随后的深部脑刺激手术中接受了标准化的MRI。此外，25名对照患者也接受了同样的技术设置，但没有帕金森病。材料和方法记录“把手”的主要尺寸（如宽度和长度）和复合尺寸（如面积和体积）。数据分析的范围从用于宽度比较的经典统计到用于集成多变量计算的高级机器学习算法（例如t-SNE、随机森林、神经网络和Naïve贝叶斯）。结果探索性单变量分析显示，右侧症状偏倚患者左侧“把手”宽度较小（p = 0.026，未经校正）。在对照组中，情况并非如此（p = 0.235）。互补的“把手”计算显示了类似的结果。所有机器学习模型一致表明，综合多变量“把手”指标可以预测症状方面的差异。讨论与结论症状优势与“旋钮”参数之间可能存在联系。“把手”的特定皮质运动形态学动力学可能存在于半显性帕金森症中——我们提供了迄今为止被忽视的指示性证据，这些证据基于简单而基本的成像调查，并辅以先进的机器学习。这里提出的假设产生的见解将启发帕金森皮质运动结构的进一步研究。

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引用次数: 0

Overall survival following treatment of central nervous system meningeal melanocytomas: Insights from the national cancer database (NCDB) 中枢神经系统脑膜黑素细胞瘤治疗后的总生存率：来自国家癌症数据库（NCDB）的见解

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2025.105922

Victor Gabriel El-Hajj , Jad El Choueiri , Flavio Vasella , Victor E. Staartjes , Mohamad Bydon , Adrian Elmi-Terander

Introduction

Central nervous system (CNS) melanocytomas are rare, pigmented tumors derived from leptomeningeal melanocytes. Although generally benign, they can exhibit locally aggressive behavior and recur. Despite increasing recognition, data on their clinical outcomes and optimal management remain limited.

Research question

This study aimed to evaluate the survival outcomes of patients with CNS melanocytomas, using a large national registry, and to explore the prognostic relevance of tumor location and treatment modalities.

Methods

We queried the National Cancer Database (NCDB) for cases of CNS melanocytomas diagnosed between 2004 and 2017. Patient demographics, tumor characteristics, treatment details, and survival outcomes were collected. Kaplan-Meier survival analysis was used to study overall survival (OS).

Results

A total of 143 patients with CNS melanocytomas were identified, including 58 spinal (40.6 %), 49 intracranial (34.3 %), 36 tumors of unspecified location (25.2 %). The median age at diagnosis was 59 years, with males comprising 48.3 % of the cohort. Gross total resection (GTR) was reported in 28 patients (19.6 %), while adjuvant radiotherapy was performed in 51 patients (35.7 %). The 1- and 5-year OS rates were approximately 80 % and 50 %, respectively. There were no significant differences in OS based on sex, age, tumor location, extent of resection, or use of adjuvant radiotherapy (p ≥ 0.05).

Discussion and conclusion

Despite advances in surgical techniques and radiation therapy, the optimal management of CNS melanocytomas remains an area of ongoing investigation. Since our findings failed to demonstrate a survival benefit from GTR or the use of adjuvant radiotherapy, future prospective studies should focus on refining treatment indications.

中枢神经系统（CNS）黑色素细胞瘤是一种罕见的源自小脑膜黑色素细胞的色素瘤。虽然通常是良性的，但它们可以表现出局部的攻击性行为并复发。尽管越来越多的认识，数据的临床结果和最佳管理仍然有限。研究问题：本研究旨在评估中枢神经系统黑素细胞瘤患者的生存结果，使用大型国家登记处，并探讨肿瘤位置和治疗方式与预后的相关性。方法：我们查询国家癌症数据库（NCDB） 2004年至2017年诊断的中枢神经系统黑色素细胞瘤病例。收集患者人口统计资料、肿瘤特征、治疗细节和生存结果。采用Kaplan-Meier生存分析研究总生存期（OS）。结果共检出中枢神经系统黑色素细胞瘤143例，其中脊柱肿瘤58例（40.6%），颅内肿瘤49例（34.3%），肿瘤位置不详36例（25.2%）。诊断时的中位年龄为59岁，男性占队列的48.3%。28例（19.6%）患者行全切除（GTR）， 51例（35.7%）患者行辅助放疗。1年和5年的总生存率分别约为80%和50%。不同性别、年龄、肿瘤位置、切除程度、辅助放疗的OS差异无统计学意义（p≥0.05）。讨论和结论尽管手术技术和放射治疗取得了进步，但中枢神经系统黑素细胞瘤的最佳治疗仍然是一个正在研究的领域。由于我们的研究结果未能证明GTR或使用辅助放疗对生存有好处，未来的前瞻性研究应侧重于改进治疗指征。

{"title":"Overall survival following treatment of central nervous system meningeal melanocytomas: Insights from the national cancer database (NCDB)","authors":"Victor Gabriel El-Hajj , Jad El Choueiri , Flavio Vasella , Victor E. Staartjes , Mohamad Bydon , Adrian Elmi-Terander","doi":"10.1016/j.bas.2025.105922","DOIUrl":"10.1016/j.bas.2025.105922","url":null,"abstract":"<div><h3>Introduction</h3><div>Central nervous system (CNS) melanocytomas are rare, pigmented tumors derived from leptomeningeal melanocytes. Although generally benign, they can exhibit locally aggressive behavior and recur. Despite increasing recognition, data on their clinical outcomes and optimal management remain limited.</div></div><div><h3>Research question</h3><div>This study aimed to evaluate the survival outcomes of patients with CNS melanocytomas, using a large national registry, and to explore the prognostic relevance of tumor location and treatment modalities.</div></div><div><h3>Methods</h3><div>We queried the National Cancer Database (NCDB) for cases of CNS melanocytomas diagnosed between 2004 and 2017. Patient demographics, tumor characteristics, treatment details, and survival outcomes were collected. Kaplan-Meier survival analysis was used to study overall survival (OS).</div></div><div><h3>Results</h3><div>A total of 143 patients with CNS melanocytomas were identified, including 58 spinal (40.6 %), 49 intracranial (34.3 %), 36 tumors of unspecified location (25.2 %). The median age at diagnosis was 59 years, with males comprising 48.3 % of the cohort. Gross total resection (GTR) was reported in 28 patients (19.6 %), while adjuvant radiotherapy was performed in 51 patients (35.7 %). The 1- and 5-year OS rates were approximately 80 % and 50 %, respectively. There were no significant differences in OS based on sex, age, tumor location, extent of resection, or use of adjuvant radiotherapy (p ≥ 0.05).</div></div><div><h3>Discussion and conclusion</h3><div>Despite advances in surgical techniques and radiation therapy, the optimal management of CNS melanocytomas remains an area of ongoing investigation. Since our findings failed to demonstrate a survival benefit from GTR or the use of adjuvant radiotherapy, future prospective studies should focus on refining treatment indications.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105922"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885101","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

Intracranial primary collision tumours: A comprehensive systematic review on preoperative radiological accuracy and neuro-oncological insights 颅内原发性碰撞瘤：术前放射学准确性和神经肿瘤学见解的综合系统综述

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105943

Saqiba Jadoon , Mary Solou , Ahmad A. Moussa , Athanasios Zisakis

Background

Intracranial collision tumours, characterized by the coexistence of two histologically distinct neoplasms within the same anatomical region without histological transition or metastatic interaction, are rare in neuro-oncology. Their atypical imaging appearance often mimics solitary lesions, posing diagnostic challenges.

Research question

How accurately can preoperative neuroimaging identify both components of intracranial collision tumours, and what factors influence detection?

Methods

A systematic review was conducted following PRISMA guidelines and registered with PROSPERO (CRD420251008646). Included studies were adult case reports and series, including histologically confirmed intracranial collision lesions with preoperative neuroimaging. Tumour-to-tumour metastasis, synchronous, composite, or recurrent tumours were excluded.

Results

A total of 67 published cases were analysed, with a male-to-female ratio of 28:38 and a mean age of 52.4 years (SD = 15.95), ranging from 18 to 87 years. Meningioma was the most prevalent tumour type (65.7 %), commonly paired with glioblastoma (26.9 %). The sellar region was the most frequent location (34.3 %), followed by the two frontal lobes (31.3 %). Preoperative diagnosis correctly identified both lesions in only 26.9 % of cases. Detection rates varied by anatomical location (p = 0.0095), whereas no clear association was observed with tumour pair type (p = 0.1351). Surgical resection was the primary treatment, frequently combined with chemo-radiotherapy. Recurrence occurred in 17.9 %, especially in high-grade tumour components such as glioblastoma. Mean survival was 8.6 months, with 11.9 % mortality. No statistically significant survival differences were observed between tumour pair types (p = 0.149).

Conclusion

Intracranial collision tumours remain diagnostically challenging. Improved neuroimaging and molecular understanding are crucial to enhance early diagnosis and optimize clinical management.

颅内碰撞瘤的特点是在同一解剖区域内共存两种组织学上不同的肿瘤，没有组织学转移或转移性相互作用，在神经肿瘤学中很少见。它们的非典型影像学表现通常与孤立病变相似，给诊断带来了挑战。研究问题：术前神经影像学对颅内碰撞肿瘤两种成分的识别准确度如何？哪些因素影响检测？方法按照PRISMA指南进行系统评价，并在PROSPERO注册（CRD420251008646）。纳入的研究包括成人病例报告和系列，包括术前神经影像学组织学证实的颅内碰撞病变。排除肿瘤间转移、同步、复合或复发肿瘤。结果共分析已发表病例67例，男女比例为28:38，平均年龄52.4岁（SD = 15.95），年龄范围18 ~ 87岁。脑膜瘤是最常见的肿瘤类型（65.7%），通常伴有胶质母细胞瘤（26.9%）。鞍区是最常见的部位（34.3%），其次是两个额叶（31.3%）。术前诊断正确识别两个病变的病例仅为26.9%。检出率因解剖位置而异（p = 0.0095），而与肿瘤对类型无明显关联（p = 0.1351）。手术切除为主要治疗方法，常与放化疗联合。复发率为17.9%，尤其是恶性肿瘤成分，如胶质母细胞瘤。平均生存8.6个月，死亡率11.9%。肿瘤对类型间生存率差异无统计学意义（p = 0.149）。结论颅内碰撞瘤的诊断仍具有挑战性。提高神经影像学和对分子的认识对于提高早期诊断和优化临床管理至关重要。

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引用次数: 0