Brain & spine最新文献_第6页

Asleep motor mapping in resected low-grade gliomas -a population based multicenter study 手术切除的低级别胶质瘤的睡眠运动定位——基于人群的多中心研究

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2025-12-23 DOI: 10.1016/j.bas.2025.105918

Sophia M. Leiss , Margret Jensdottir , Ole Solheim , Alba Corell , Anna Lipatnikova , Sasha Gulati , Klas Holmgren , Francesco Latini , Ruby Mahesparan , Peter Milos , Alice Neimantaite , Henrietta Nittby Redebrandt , Lars Kjelsberg Pedersen , Rickard L. Sjöberg , Björn Sjögren , Gregor Tomasevic , Erik Thurin , Maria Zetterling , Jiri Bartek Jr. , Asgeir S. Jakola

Introduction

Maximal safe resection is established goal of WHO grade 2 low-grade gliomas (LGG). Asleep motor mapping offers an alternative to awake surgery for tumors near motor areas and has been shown to be safe and effective in expert centers.

Research question

We aimed to identify predictors of postoperative motor deficits, and describe patient selection and intraoperative mapping techniques across Scandinavian centers.

Material and methods

We retrospectively analyzed patients (≥18) with WHO grade 2 gliomas who underwent asleep motor mapping across multiple Scandinavian neurosurgical centers. Clinical, surgical, and imaging data were extracted from medical records. The primary outcome was registered permanent postoperative motor deficits at 3 months. Associations with pre-, intraoperative, and radiological variables - including diffusion-weighted imaging (DWI) changes - were assessed using univariate and multivariate logistic regression.

Results

We included 74 patients from eight institutions. Median age was 48 years, 38 (51.4 %) were female and median preoperative tumor volume was 43.2 ml. 13 (17.6 %) patients achieved gross-total resection and median postoperative volume was 7.8 ml. Permanent postoperative motor deficits occurred in 19 cases (25.7 %), and 5 (6.8 %) were considered major deficits. In univariate analysis, preoperative motor deficits (p = 0.009), postoperative DWI changes (p = 0.022), and age (p = 0.043) were significantly associated with new or worsened permanent deficits. Only DWI changes and age was confirmed in penalized multivariate logistic regression.

Discussion and conclusion

Postoperative motor deficits were common despite use of asleep motor mapping. Preoperative motor deficits and diffusion-weighted imaging changes are predictors of permanent motor deficits in this setting.

最大限度的安全切除是WHO 2级低级别胶质瘤（LGG）的既定目标。睡眠运动映射为运动区域附近肿瘤的清醒手术提供了另一种选择，并且在专家中心被证明是安全有效的。研究问题：我们旨在确定术后运动障碍的预测因素，并描述斯堪的纳维亚中心的患者选择和术中绘图技术。材料和方法我们回顾性分析了在斯堪的纳维亚多个神经外科中心接受睡眠运动测绘的WHO 2级胶质瘤患者（≥18例）。从医疗记录中提取临床、手术和影像学数据。主要结果是术后3个月出现永久性运动障碍。使用单变量和多变量逻辑回归评估术前、术中和影像学变量（包括弥散加权成像（DWI）变化）的相关性。结果纳入来自8家医院的74例患者。中位年龄为48岁，女性38例（51.4%），术前肿瘤中位体积为43.2 ml。13例（17.6%）患者实现了全切，术后中位体积为7.8 ml。19例（25.7%）患者出现永久性术后运动功能障碍，5例（6.8%）患者被认为是主要功能障碍。在单因素分析中，术前运动缺陷（p = 0.009）、术后DWI改变（p = 0.022）和年龄（p = 0.043）与新的或恶化的永久性缺陷显著相关。在惩罚多因素逻辑回归中，只有DWI变化和年龄被证实。讨论与结论尽管使用了睡眠运动测图，术后运动功能障碍仍是常见的。术前运动障碍和弥散加权成像改变是永久性运动障碍的预测因素。

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引用次数: 0

Surgical outcomes in Chiari malformation type I: A quality review from a Scandinavian medium-volume neurosurgical center I型Chiari畸形的手术结果：来自斯堪的纳维亚中等容量神经外科中心的质量评价

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2025-12-23 DOI: 10.1016/j.bas.2025.105919

Einar Naveen Møen , Babisha Mathivannan , Rupavathana Mahesparan

Background

Chiari malformation type 1 (CM-I) is characterized by caudal herniation of the cerebellar tonsils through the foramen magnum. Surgical decompression is generally indicated in patients with significant or progressive symptoms, or in clinically relevant or progressing syringomyelia. As CM-I surgery is relatively infrequent in medium-volume neurosurgical centers, outcome data from such settings remain limited. This study evaluates surgical outcomes following CM-I decompression at a Scandinavian medium-sized neurosurgical center.

Research question

What are the outcomes of CM-I surgery at the Department of Neurosurgery, Haukeland University Hospital?

Material and methods

We performed a retrospective case series of patients with CM-I treated at our department between 2014 and 2023. The primary outcome was the Chicago Chiari Outcome Scale (CCOS) at the last follow-up. Secondary outcomes were 30-day surgical quality indicators.

Results

Forty patients comprised of 29 (72.5 %) adults and 11 (27.5 %) pediatric patients. Clinical improvement (CCOS ≥13) was observed in 78 %. The observed 30-day quality indicators were reoperations in three patients (7.5 %), infections in two patients (5.0 %), and readmission in seven patients (18 %). Complications within 30 days occurred in six patients (15 %). The most frequent complication was new-onset hydrocephalus, which occurred in four patients (10 %). The median hospital length of stay was 5.5 days. There was no mortality.

Discussion and conclusion

Most patients demonstrated clinical improvement, but complication rates exceeded benchmarks. Hydrocephalus was the most frequent issue. We discuss possible interventions to further strengthen CM-I care in our department, with an emphasis on hydrocephalus management.

chiari畸形1型（CM-I）的特征是通过枕骨大孔的小脑扁桃体尾侧突出。手术减压通常适用于有明显或进展性症状的患者，或临床相关或进展性脊髓空洞患者。由于CM-I手术在中等容量的神经外科中心相对较少，因此来自此类设置的结果数据仍然有限。本研究评估了斯堪的纳维亚中型神经外科中心CM-I减压后的手术效果。研究问题：在豪克兰大学医院神经外科进行CM-I手术的结果如何？材料和方法我们对2014年至2023年在我科治疗的CM-I患者进行了回顾性病例系列研究。最后一次随访时的主要转归是芝加哥Chiari转归量表（CCOS）。次要结局为30天手术质量指标。结果40例患者中，成人29例（72.5%），儿科11例（27.5%）。78%的患者临床改善（CCOS≥13）。观察到的30天质量指标为再手术3例（7.5%），感染2例（5.0%），再入院7例（18%）。6例（15%）患者在30天内出现并发症。最常见的并发症是新发脑积水，发生在4例患者中（10%）。住院时间中位数为5.5天。没有死亡。讨论与结论大多数患者的临床改善，但并发症发生率高于基准。脑积水是最常见的问题。我们讨论可能的干预措施，以进一步加强CM-I护理在我科，重点是脑积水的管理。

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引用次数: 0

Application and performance of deep learning models for the automated diagnosis of cervical central spinal stenosis on MRI: a systematic review 深度学习模型在MRI颈椎椎管狭窄自动诊断中的应用与性能综述

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2025-12-18 DOI: 10.1016/j.bas.2025.105902

Vasileios Mougios , Robin Peretzke , Alexandra Ertl , Martin Dugas , Klaus Maier Hein , Peter Neher , Sebastian Ille , Sandro Krieg , Pavlina Lenga

Introduction

Cervical central spinal stenosis (CCSS) is a leading cause of adult spinal cord dysfunction. Magnetic resonance imaging (MRI) is the reference standard, but reporting is time-consuming and subject to inter-observer variability. Artificial intelligence (AI)—especially deep-learning—may enable automated, consistent assessment.

Research question

Evaluation of performance metrics of AI models for diagnosing CCSS.

Material and methods

Following PRISMA 2020, we searched PubMed, Cochrane, Embase, IEEE Xplore, and Web of Science (2015–July 2025) for studies training and evaluating AI models using MRI to diagnose or grade CCSS. We excluded studies limited to foraminal stenosis, non-MRI modalities, thoracic/lumbar levels, segmentation-only or image-enhancement tools without diagnostic output, and studies focused solely on non-stenotic cervical pathologies. Data were extracted on MRI protocol, model type, data splits and external validation, stenosis classification, and diagnostic performance.

Results

Ten studies (2019–2025) met inclusion criteria, predominantly single-centre and retrospective. Most models used T2-weighted axial and/or sagittal MRI; CNNs (e.g., ResNet-50, EfficientNet) and Transformer-based architectures were common. Sensitivities ranged roughly 0.67–1.00 and specificities 0.42–0.97 across models, with many reporting AUCs ≥0.90 and accuracies ≥0.85. Only one study reported true external test performance. Reporting of confidence intervals, processing time, and explainability (e.g., Grad-CAM) was inconsistent.

Discussion and conclusion

Deep-learning shows promising diagnostic performance for automated CCSS assessment on MRI and could reduce variability and reporting time. However, generalisability remains uncertain due to small, retrospective, largely single-centre cohorts and scarce external validation. Standardized reporting (e.g., CLAIM) and prospective, multi-centre validation is needed before routine clinical deployment.

颈椎中枢性椎管狭窄症（CCSS）是成人脊髓功能障碍的主要原因。磁共振成像（MRI）是参考标准，但报告是耗时的，并受到观察者之间的差异。人工智能（AI）——尤其是深度学习——可能会实现自动化、一致的评估。研究问题：人工智能模型诊断CCSS的性能指标评价。材料和方法在PRISMA 2020之后，我们检索了PubMed， Cochrane, Embase， IEEE explore和Web of Science（2015 - 2025年7月），以研究训练和评估使用MRI诊断或分级CCSS的AI模型。我们排除了局限于椎间孔狭窄、非mri模式、胸/腰椎水平、仅分段或无诊断输出的图像增强工具的研究，以及仅关注非狭窄性颈椎病变的研究。根据MRI方案、模型类型、数据分割和外部验证、狭窄分类和诊断性能提取数据。结果10项研究（2019-2025）符合纳入标准，主要是单中心和回顾性研究。大多数模型使用t2加权轴位和/或矢状位MRI；cnn（例如，ResNet-50, EfficientNet）和基于transformer的架构很常见。各模型的敏感性范围约为0.67-1.00，特异性范围约为0.42-0.97，许多报告auc≥0.90，准确性≥0.85。只有一项研究报告了真实的外部测试性能。报告置信区间、处理时间和可解释性（例如，Grad-CAM）不一致。深度学习在MRI的CCSS自动评估中表现出良好的诊断性能，可以减少变异性和报告时间。然而，由于规模小，回顾性，主要是单中心队列和缺乏外部验证，通用性仍然不确定。在常规临床部署之前，需要标准化报告（例如索赔）和前瞻性多中心验证。

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引用次数: 0

Patterns of care and outcomes following external ventricular drain placement: Insights from the England HES administrative data set 室外引流放置后的护理模式和结果：来自英格兰HES管理数据集的见解

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2025-12-16 DOI: 10.1016/j.bas.2025.105906

Daniel Thompson , Adam Wahba , Adam Williams , Peter Hutchinson , Adel Helmy , David Cromwell

Objectives

To evaluate the outcomes of patients undergoing external ventricular drain (EVD) insertion in England, focusing on the timing of EVD relative to index neurosurgical procedures, and to assess the implications for benchmarking and performance monitoring between neurosurgical centres.

Methods

We conducted a retrospective cohort study using Hospital Episode Statistics. Adult patients (≥16 years) undergoing EVD insertion between April 2013 and March 2020. Outcomes included 90-day mortality, length of stay (LOS), and emergency readmission within 30 days. Multivariable logistic regression was used for mortality and readmission, with adjustment for age, admission method, comorbidity (RCS Charlson index), and neurosurgical clinical category. A quantile regression model was performed with LOS as the outcome.

Results

The cohort comprised 10,239 patients. Crude 90-day mortality was 26.7 % overall, highest in the EVD-only group (43.2 %) and lowest when EVD was performed with an index procedure (19.7 %). Mortality rose with age, comorbidity, emergency admission, and was highest in Oncology, Vascular, and General & Trauma categories. The final risk-adjustment model showed good discrimination (AUC 0.71) and reduced apparent inter-unit variation in mortality.

Conclusions

Our findings demonstrate that treating all EVD insertions as a single cohort obscures clinically meaningful differences in patient trajectories and leads to misleading comparisons of outcomes. Although the absence of detailed severity markers in administrative data means that conclusions about quality of care must be interpreted cautiously, this study illustrates how carefully constructed, clinically meaningful cohorts can transform the interpretation of common neurosurgical procedures.

目的评估英国接受外脑室引流术（EVD）插入的患者的预后，重点关注EVD的时间相对于指数神经外科手术，并评估对神经外科中心之间的基准和性能监测的影响。方法采用医院事件统计进行回顾性队列研究。2013年4月至2020年3月期间接受EVD植入的成年患者（≥16岁）。结果包括90天死亡率、住院时间（LOS）和30天内的紧急再入院。死亡率和再入院采用多变量logistic回归，调整了年龄、入院方式、合并症（RCS Charlson指数）和神经外科临床分类。以LOS为结果建立分位数回归模型。结果该队列包括10239例患者。总的90天粗死亡率为26.7%，仅EVD组最高（43.2%），当EVD采用指数手术时最低（19.7%）。死亡率随年龄、合并症、急诊入院而上升，肿瘤、血管和一般创伤类别的死亡率最高。最终的风险调整模型具有良好的辨别能力（AUC为0.71），降低了单位间死亡率的明显差异。我们的研究结果表明，将所有EVD插入物作为一个单一队列处理会模糊患者轨迹的临床意义差异，并导致结果的误导性比较。虽然在行政数据中缺乏详细的严重程度标记意味着必须谨慎地解释有关护理质量的结论，但本研究说明了如何精心构建具有临床意义的队列可以改变对常见神经外科手术的解释。

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引用次数: 0

Basic microsurgical skills can be taught to novices with video material only - a prospective multicenter laboratory study 基本的显微外科技能可以教授给新手视频材料-一个前瞻性的多中心实验室研究

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2025-12-16 DOI: 10.1016/j.bas.2025.105910

Andrei Schildt , Anni Pohjola , Ville Vasankari , Jenni Määttä , Anna Seidlová , Martin Májovský , Norbert Svoboda , David Netuka , Ahmad Hafez , Martin Lehecka

Introduction

The increasing use of educational video materials has provided an alternative to traditional apprenticeship-models in surgical education. We aim to evaluate if video materials are as effective as hands-on tutoring in teaching basic microsuturing skills. Additionally, we want to see if the magnification device (microscope vs. exoscope) affects learning outcomes.

Research question

Is video-based instruction an effective alternative to hands-on tutoring in teaching basic microsuturing skills to novices?

Materials and methods

We designed an 8-h training program with videos to teach basic microsuturing skills to novices. Thirty medical students from two large medical universities in Europe (Helsinki and Prague) were randomised to receive either video instructions only (n = 20) or hands-on tutoring and video instruction (n = 10). Participants were further assigned to using either an exoscope (n = 15) or a microscope (n = 15) in their training. We assessed skill acquisition using a standardized microsuturing test task. All tasks were recorded and scored based task speed, quality of the suturing and the number of errors.

Results

All groups demonstrated significant improvement in suturing speed, qualitative assessment, and fewer errors. Video instructions only produced non-inferior results to hands-on tutoring in the improvement in speed, error count and quality of sutures. No significant differences were found when comparing microscope and exoscope users.

Discussion and conclusion

Video-based instruction and hands-on tutoring seem equally effective in teaching basic microsuturing to surgical novices, irrespective of the magnification device used. Video-materials can be utilized in microsurgical laboratory training of novices as a more resource-efficient teaching method compared to hands-on tutoring.

越来越多的教育视频材料的使用为传统的外科教育学徒模式提供了另一种选择。我们的目的是评估视频材料在教授基本微缝合技能方面是否与实践辅导一样有效。此外，我们想看看放大设备（显微镜和外窥镜）是否会影响学习成果。研究问题：在向新手教授基本的微缝合技术时，视频教学是否能有效替代实践辅导？材料和方法我们设计了一个8小时的视频培训计划，向新手教授基本的微缝合技术。来自欧洲两所大型医科大学（赫尔辛基和布拉格）的30名医学生被随机分为两组，一组只接受视频教学（n = 20），另一组接受实践辅导和视频教学（n = 10）。参与者在训练中被进一步分配使用外窥镜（n = 15）或显微镜（n = 15）。我们使用标准化的微缝合测试任务评估技能习得。记录所有任务并根据任务速度、缝合质量和错误次数进行评分。结果两组在缝合速度、定性评估、错误发生率等方面均有显著提高。在速度、失误数和缝合质量方面，视频指导的效果不逊于实际指导。当比较显微镜和外窥镜使用者时，没有发现显着差异。讨论与结论：无论使用何种放大设备，视频教学和实践指导在向外科新手教授基础微缝合方面似乎同样有效。视频材料可以作为一种更有效的教学方法应用于显微外科实验室新手的培训中。

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引用次数: 0

Urodynamic outcomes and prognostic determinants following endovascular treatment of spinal dural arteriovenous fistulas 硬脊膜动静脉瘘血管内治疗后的尿动力学结果和预后决定因素

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2025-12-16 DOI: 10.1016/j.bas.2025.105913

Richard Voldřich , Norbert Svoboda , Zuzana Kachlířová , Lucie Bartáková , František Charvát , David Netuka

Introduction

The prognosis of untreated spinal dural arteriovenous fistulas (SDAVFs) is unfavorable. Current outcome scales used to assess the effect of surgery or endovascular treatment (EVT) rely largely on patient-reported symptoms and may underestimate actual impairment. Moreover, prognostic factors remain debated and conclusions in the literature are inconsistent.

Research question

The aim was to quantify urological outcomes after SDAVF embolization using specialized urodynamic testing, compare these objective findings with subjective outcomes derived from traditional scales, and identify prognostic factors associated with unfavorable clinical results.

Methods

In this single-center retrospective study, all patients underwent EVT as first-line therapy. Clinical status was assessed using Aminoff-Logue scale (ALS), compared with preoperative data, and correlated with angiographic findings. Urodynamic testing was performed to objectively evaluate bladder function.

Results

Twent-four patients met the inclusion criteria. Urodynamic testing was performed in 14 (58 %) patients. The most frequent abnormal finding was bladder hyposensitivity (79 %), followed by pathological post-void residual volume (64 %) and elevated bladder capacity (50 %). Six (43 %) patients reported no subjective urological symptoms (ALS = 0); urodynamic testing revealed two or more pathological parameters in all of them. EVT failure and subsequent surgery predicted gait deterioration (p = 0.011) as well as detrusor overactivity (p = 0.001). Symptom duration over one year (p = 0.038) and fistula location above the T9 level (p = 0.021) were negative prognostic factors for bladder function.

Conclusion

The results suggest a potential underestimation of urological impairment when relying on subjective scales and highlight the need for standardized urodynamic testing. They also emphasize the importance of early treatment of SDAVF.

未经治疗的硬脊膜动静脉瘘（SDAVFs）预后不良。目前用于评估手术或血管内治疗（EVT）效果的结果量表主要依赖于患者报告的症状，可能低估了实际损害。此外，预后因素仍有争议，文献中的结论也不一致。研究问题：目的是通过专门的尿动力学测试量化SDAVF栓塞后的泌尿系统结果，将这些客观结果与传统量表得出的主观结果进行比较，并确定与不良临床结果相关的预后因素。方法在这项单中心回顾性研究中，所有患者均接受EVT作为一线治疗。临床状态采用ALS量表（Aminoff-Logue scale， ALS）评估，与术前数据进行比较，并与血管造影结果相关联。尿动力学测试客观评价膀胱功能。结果4例患者符合纳入标准。14例（58%）患者行尿动力学检查。最常见的异常表现是膀胱低敏感性（79%），其次是病理性空后残留体积（64%）和膀胱容量升高（50%）。6例（43%）患者报告无主观泌尿系统症状（ALS = 0）；尿动力学检查显示两种或两种以上的病理参数。EVT衰竭和随后的手术预示着步态恶化（p = 0.011）和逼尿肌过度活动（p = 0.001）。症状持续1年以上（p = 0.038）和瘘管位置高于T9水平（p = 0.021）是影响膀胱功能的负向预后因素。结论依赖主观量表可能低估了泌尿系统功能障碍，并强调了标准化尿动力学测试的必要性。他们还强调了早期治疗SDAVF的重要性。

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引用次数: 0

The mFI-11 frailty index as a predictor of surgical outcomes in elderly patients with brain metastases mFI-11衰弱指数作为老年脑转移患者手术预后的预测指标

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2025-12-15 DOI: 10.1016/j.bas.2025.105912

Stefanie Quach , Roland Coras , Florian Weissinger , Matthias Simon , Tunc Faik Ersoy

Introduction

The vulnerability towards disease but also treatment in elderly patients has been referred to as frailty and can be measured using frailty indices, which assess functional health and comorbidities. Frailty has been shown to correlate with survival and functional outcomes in brain tumor patients.

Research question

Does frailty, assessed by the 11-item modified Frailty Index (mFI-11), provide useful prognostic information in elderly patients undergoing brain metastasis surgery?

Material and methods

A retrospective analysis of 139 patients aged ≥60 years who underwent brain metastasis resection (2015–2019) was conducted. Frailty was assessed using the mFI-11.

Results

Increasing frailty correlated with poorer median overall survival (mFI 0: 13.8 months [95 %-CI: 8.7–18.9] vs. mFI 1–2l: 8.7 [5.8–11.6] vs. mFI≥3: 2.8 [0.9–4.6], p = 0.001) and functional outcome (postoperative KPS 80–100 %, mFI 0: 27/36 [75.0 %] vs. mFI 1–2: 44/64 [68.8 %] vs. mFI≥3: 13/38 [34.2 %], p < 0.001). Age was less prognostic. In the multivariate analyses, mFI-11 and age were not independently predictive, while KPS was. Frailty was not associated with major complications.

Discussion

While frailty correlates with outcome, functional health rather than comorbidities and age is prognostic. The mFI-11's predictive ability may be largely due to its inclusion of a functional health assessment.

Conclusion

Functional health (KPS) is a much stronger predictor of survival and functional outcome in the elderly than the presence of comorbidities and age, i.e. age per se and comorbidities without impact on the patient's functional health status (i.e. well-treated) should not deter from surgery. Frailty is not a predictor of complications.

老年患者对疾病和治疗的脆弱性被称为脆弱性，可以使用脆弱性指数来衡量，脆弱性指数评估功能健康和合并症。虚弱已被证明与脑肿瘤患者的生存和功能预后相关。由11项修正的衰弱指数（mFI-11）评估的衰弱是否能为老年脑转移手术患者提供有用的预后信息？材料与方法对2015-2019年139例年龄≥60岁行脑转移切除术的患者进行回顾性分析。使用mFI-11评估虚弱程度。结果衰弱加重与较差的中位总生存期（mFI 0: 13.8个月[95% -CI: 8.7 - 18.9] vs. mFI 1 - 21: 8.7 [5.8-11.6] vs. mFI≥3:2.8 [0.9-4.6],p = 0.001）和功能结局（术后KPS 80 - 100%， mFI 0: 27/36 [75.0%] vs. mFI 1-2: 44/64 [68.8%] vs. mFI≥3:13 /38 [34.2%],p < 0.001）相关。年龄对预后的影响较小。在多变量分析中，mFI-11和年龄不能独立预测，而KPS可以。虚弱与主要并发症无关。虽然虚弱与预后相关，但功能健康而不是合并症和年龄是预后因素。mFI-11的预测能力可能主要是由于它包含了功能健康评估。结论功能健康（KPS）比合并症和年龄更能预测老年人的生存和功能结局，即年龄本身和合并症不影响患者的功能健康状态（即治疗良好）不应阻止手术。虚弱并不是并发症的前兆。

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引用次数: 0

Size of decompressive craniectomy as prognostic factor in space-occupying ischemic cerebellar stroke –a multicentric retrospective study 减压颅骨切除术大小作为占位性缺血性脑卒中的预后因素——一项多中心回顾性研究

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2025-12-14 DOI: 10.1016/j.bas.2025.105911

Silvia Hernández-Durán , Johannes Walter , Daniel Dubinski , Obada T. Alhalabi , Milos Arsenovic , Daniel Cantre , Nazife Dinc , Judith Dremel , Nima Etminan , Thomas M. Freiman , Kiarash Ferdowssian , Erdem Güresir , Katharina A.M. Hackenberg , Motaz Hamed , Andreas Kramer , Christopher Krämer , Beate Kranawetter , Tim Lampmann , Anne Neumeister , Artem Rafaelian , Sae-Yeon Won

Introduction

In cases of space-occupying cerebellar ischemic strokes, guidelines recommend suboccipital decompressive surgery (SDC). While in supratentorial hemispheric stroke, the size of the bone flap has been the subject of many studies and ample debate, no studies have been conducted to determine the optimal size of the bone flap to be removed in SDC.

Research question

To determine the optimal size of SDC in ischemic cerebellar stroke.

Methods

This is a multicentric retrospective study of patients undergoing SDC for ischemic cerebellar stroke. SDC size was determined in two perpendicular planes on early postoperative CT scans: (a) maximal lateral extension (L) and (b) maximal craniocaudal extension (CC) in cm. The primary endpoint was functional outcome according to modified Rankin Scale (mRS) at three months. Secondary outcome was mortality at three months, as well as surgical complications.

Results

A total of 88 patients were included in the final analysis. The mean L diameter of the SDC analyzed was 7 cm (SD 1.5), whereas the mean CC diameter was 4.4 cm (SD .8). When dichotomizing patients based on a threshold of L ≥ 6.5 cm, favorable outcome was more likely in the group with L ≥ 6.5 cm (OR = 3.23, 95%CI 1.02–10.56, p = .045). No statistically significant differences were observed in mortality at three months (OR = .66, 95%CI .24–1.78, p = .40).

Conclusions

In ischemic cerebellar stroke, a suboccipital craniectomy with a maximum lateral diameter of ≥6.5 cm appears to yield better functional outcomes than smaller ones. Prospective studies are needed to confirm these results.

在占位性缺血性脑卒中病例中，指南推荐采用枕下减压手术（SDC）。虽然在幕上半球中风中，骨瓣的大小一直是许多研究和充分争论的主题，但尚未进行研究以确定SDC中要切除的骨瓣的最佳大小。研究问题：确定缺血性小脑卒中中SDC的最佳大小。方法对缺血性小脑卒中患者行SDC的多中心回顾性研究。术后早期CT扫描在两个垂直平面上确定SDC的大小：(a)最大侧伸(L)和(b)最大颅侧伸（CC）（cm）。主要终点是三个月时根据改良Rankin量表（mRS）的功能结局。次要结局是3个月时的死亡率，以及手术并发症。结果共纳入88例患者。SDC的平均L直径为7 cm (SD 1.5)， CC的平均直径为4.4 cm （SD .8）。当以L≥6.5 cm为阈值对患者进行二分类时，L≥6.5 cm组更有可能获得良好的结果（OR = 3.23, 95%CI 1.02-10.56, p = 0.045）。3个月死亡率无统计学差异（OR = 0.66, 95%CI = 0.24 - 1.78, p = 0.40）。结论缺血性小脑卒中，最大外侧直径≥6.5 cm的枕下颅骨切除术功能预后优于较小外侧直径的枕下颅骨切除术。需要前瞻性研究来证实这些结果。

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引用次数: 0

Decreased skull growth in positional plagiocephaly patients undergoing helmet therapy 接受头盔治疗的位置性斜头畸形患者颅骨生长减少

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2025-12-14 DOI: 10.1016/j.bas.2025.105909

Maximilian Lindemann , Donjetë Januzi , Sabine Borowski , Anne Neumeister , Denise Löschner , Daniel Dubinski , Peter Huppke , Christian Senft , Peter Baumgarten

Introduction

Helmet treatment is a worldwide acknowledged method to improve motor function, quality of life and aesthetics in patients with plagiocephaly.

Research question

The objective of this study is to assess percentile escape in head circumference in newborns receiving helmet therapy (HMT) for plagiocephaly.

Material and methods

All patients underwent HMT over 124.32 days on average (SD = 72.56), with 3D scans (Rodin4D neo) taken of their heads before, during and after the treatment. Eight participants were excluded due to insufficient data. Ten patients were excluded for either craniosynostosis or discontinuation of helmet therapy.

“German Health Interview and Examination Survey for Children and Adolescents” (KiGGS study) served as reference for the assessment of head circumference growth. Percentiles were calculated using the LMS-method.

Results

Out of 272 patients (94 females, 178 males), 238 had suitable parameters for the LMS-method. The average age at the onset of therapy was 5.99 (SD = 2.23) months, concluding at 10.06 months (SD = 3.01). The median percentile before HMT was 50.00 (SD = 39.5), which decreased significantly to 25.00 (SD = 33.84) after HMT (p < 0.001). Only 59 patients showed percentile adherence during the treatment. The mean difference in head circumference was 21.51 mm (SD = 14.81), ranging from −44.4 mm to 69.1 mm. Clinical examination revealed that the patients exhibit developmental progress consistent with respective ages.

Discussion and conclusion

Significant decrease in head circumferential growth was observed following HMT. Even though patients did not show clinical signs of raised ICP, to ascertain the clinical relevance of this percentile escape, conducting longer follow-ups involving a larger cohort of patients is crucial.

头盔治疗是世界公认的改善斜头畸形患者运动功能、生活质量和美观的方法。研究问题：本研究的目的是评估接受头盔治疗（HMT）的新生儿头围的百分位数逃逸。材料和方法所有患者接受HMT治疗的平均时间为124.32天（SD = 72.56），在治疗前、治疗中和治疗后分别对患者头部进行3D扫描（Rodin4D neo）。8名受试者因资料不足被排除。10例患者因颅缝闭塞或停止头盔治疗而被排除在外。“德国儿童和青少年健康访谈和检查调查”（KiGGS研究）作为评估头围生长的参考。百分位数采用lms法计算。结果272例患者（女94例，男178例）中，238例符合lms法的参数。平均开始治疗年龄5.99 （SD = 2.23）个月，平均开始治疗年龄10.06个月（SD = 3.01）。治疗前中位数为50.00 (SD = 39.5)，治疗后中位数为25.00 (SD = 33.84) （p < 0.001）。只有59名患者在治疗期间表现出百分位数的依从性。头围的平均差异为21.51 mm (SD = 14.81)，范围为- 44.4 mm至69.1 mm。临床检查显示患者表现出与各自年龄相符的发育进展。讨论与结论HMT后头部周向生长明显减少。即使患者没有表现出ICP升高的临床症状，为了确定这一百分位数的临床相关性，进行更长时间的随访，包括更大的患者队列是至关重要的。

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引用次数: 0

Ruptured fusiform callosomarginal artery aneurysm treated by excision and end-to-end reconstruction – Case report, technical considerations and review of literature 通过切除和端到端重建治疗破裂的梭状胼胝体边缘动脉动脉瘤-病例报告，技术考虑和文献回顾

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2025-12-14 DOI: 10.1016/j.bas.2025.105908

Jiri Dostal , Vladimir Priban , Filip Heidenreich , Petr Kasik , Radek Tupy , Jan Mracek

Background

Aneurysms of the callosomarginal artery (CMA), a major branch of the pericallosal artery, are rare and typically located at the CMA-pericallosal bifurcation. These distal anterior cerebral artery (DACA) aneurysms comprise 1.5 %–9 % of all intracranial aneurysms and are usually saccular. Fusiform aneurysms in this location are exceedingly uncommon and present unique management challenges due to their morphology and location. This report describes the management of a ruptured fusiform CMA aneurysm and discusses key technical aspects of microsurgical planning and reconstruction.

Case description

A 60-year-old smoker presented with a one-week history of severe headache, nausea, and vomiting. Imaging revealed a ruptured fusiform aneurysm of the distal callosomarginal artery. Given the aneurysm's location and morphology, open surgical treatment was chosen. The aneurysm was excised, and after careful mobilization, the affected vessel was reconstructed with a tension-free end-to-end anastomosis. Histological and microbiological analysis of the aneurysm and abnormal arachnoid showed no signs of mycotic origin. A cardiological evaluation ruled out infective endocarditis. Postoperative recovery was uneventful, and follow-up angiography confirmed complete aneurysm resection with vessel patency. The patient was started on lifelong antiplatelet therapy and remained asymptomatic with full functional recovery at the one and two year follow-up.

Conclusion

While endovascular options are expanding, distal aneurysms in small-caliber vessels remain inaccessible in most cases. Direct microsurgical vessel reconstruction offers a durable and definitive treatment option in carefully selected cases. Microsurgical training and expertise in vascular reconstruction are essential for managing complex vascular lesions that fall beyond the reach of endovascular therapy.

胼胝体边缘动脉（callosomar边缘动脉，CMA）是胼胝体周围动脉的主要分支，其动脉瘤非常罕见，通常位于CMA-胼胝体周围动脉分叉处。这些远端大脑前动脉（DACA）动脉瘤占所有颅内动脉瘤的1.5% - 9%，通常呈囊状。梭状动脉瘤在这个位置是非常罕见的，由于其形态和位置提出了独特的管理挑战。本报告描述了梭状CMA动脉瘤破裂的处理，并讨论了显微手术计划和重建的关键技术方面。病例描述：一名60岁的吸烟者，有一周的严重头痛、恶心和呕吐史。影像学显示胼胝体边缘动脉远端梭状动脉瘤破裂。鉴于动脉瘤的位置和形态，选择开放手术治疗。动脉瘤被切除，经过仔细的活动，受影响的血管重建无张力端到端吻合。动脉瘤和异常蛛网膜的组织学和微生物学分析显示没有真菌起源的迹象。心脏学评估排除了感染性心内膜炎。术后恢复顺利，随访血管造影证实动脉瘤完全切除，血管通畅。患者开始终身抗血小板治疗，并在1年和2年的随访中保持无症状和完全功能恢复。结论虽然血管内选择范围扩大，但大多数情况下小口径血管远端动脉瘤仍无法进入。直接显微外科血管重建为精心挑选的病例提供了持久和明确的治疗选择。在血管重建方面的显微外科训练和专业知识对于处理超出血管内治疗范围的复杂血管病变至关重要。

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引用次数: 0