Clinical Neurology and Neurosurgery最新文献

{"title":"Imaging monitoring of Balamuthia granulomatous amoebic encephalitis","authors":"Jinzhi Mei ,&nbsp;Fang Sheng ,&nbsp;Chenmei Zhang ,&nbsp;Xiaorong Chen","doi":"10.1016/j.clineuro.2025.108917","DOIUrl":"10.1016/j.clineuro.2025.108917","url":null,"abstract":"<div><div>Balamuthia granulomatous amoebic encephalitis (GAE) is a rare and highly lethal infectious disease affecting the central nervous system, caused by the Balamuthia amoeba. This article reports the case of a child with normal immune function and no apparent epidemiological risk factors. In the initial stages, routine blood tests, cerebrospinal fluid cell tests, biochemical tests, and metagenomic next-generation sequencing (mNGS) were all normal. Surgical removal of the abscess and subsequent pathological diagnosis revealed a chronic granuloma. mNGS analysis of the brain abscess fluid identified Balamuthia mandrillaris (BM), leading to the diagnosis of Balamuthia GAE, after which antiparasitic treatment was initiated. This case underscores the importance of sustained imaging surveillance in suspected cases of Balamuthia GAE.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108917"},"PeriodicalIF":1.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143879490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between adiponectin and lipids in Parkinson’s disease","authors":"Mayu Sugata,&nbsp;Hiroshi Kataoka,&nbsp;Kazuma Sugie","doi":"10.1016/j.clineuro.2025.108919","DOIUrl":"10.1016/j.clineuro.2025.108919","url":null,"abstract":"<div><h3>Objectives</h3><div>There is increasing evidence linking Parkinson’s disease (PD) to lipids, such as the presence of lipids in the core of Lewy bodies in PD brains or high-molecular-weight adiponectin (APN) in phosphorylated α-synuclein-positive Lewy bodies. This study aimed to verify whether APN levels are associated with neurodegenerative diseases. The association between APN and body weight was also investigated.</div></div><div><h3>Materials and methods</h3><div>The following parameters were measured using venous blood sampling: HDL–C, LDL-C, glucose, and lipids, including APN.</div></div><div><h3>Results</h3><div>PD patients receiving dopaminergic treatments had significant higher APN than that of de-novo PD, progressive supranuclear palsy (PSP) or multiple system atrophy- parkinsonian type (MSA-P). Multivariate analysis using ANCOVA revealed a significant difference in APN levels between treated PD patients and de-novo PD patients (adjusted mean difference of −4.273 μg/ml, p = 0.037]), or PSP patients (adjusted mean difference of −4.756 μg/ml, p = 0.034]). BMIs were mildly higher in de-novo PD patients compared to treated PD patients (adjusted mean difference of 1.686, p = 0.074]). After adjustment, APN levels were positively correlated with HDL-cholesterol (HDL-C) in patients with PD (regression coefficient=0.479, P &lt; 0.001), but not total cholesterol, or LDL-C. This correlation was not evident in patients with MSA-P, or PSP.</div></div><div><h3>Conclusions</h3><div>APN likely plays a role in the composition of lipid rafts, particularly in patients with treated PD. The correlation between APN and HDL-C may be a marker that differentiates PD from MSA-P, or PSP.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108919"},"PeriodicalIF":1.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of FcRn inhibitors in patients with Myasthenia gravis: An updated systematic review and meta‑analysis","authors":"Muzamil Akhtar ,&nbsp;Mehmood Akhtar ,&nbsp;Hanzala Ahmed Farooqi ,&nbsp;Ayesha Maryam ,&nbsp;Anam Muzammil ,&nbsp;Ummara Hanif ,&nbsp;Zoya Athar ,&nbsp;Syed Muhammad Hassan ,&nbsp;Zarak Khan","doi":"10.1016/j.clineuro.2025.108910","DOIUrl":"10.1016/j.clineuro.2025.108910","url":null,"abstract":"<div><h3>Background</h3><div>Myasthenia gravis (MG) is a chronic, complex autoimmune disorder characterized by the production of autoantibodies that destroy neuromuscular junctions. Blocking the neonatal Fc receptors (FcRn) enhances IgG catabolism, offering a novel therapeutic approach.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and the Cochrane Library were searched up to February 2025, for RCTs evaluating FcRn inhibitors in MG. A random effects model to calculate pooled risk ratios (RR) and mean differences with 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>873 patients from 8 randomized control trials (RCTs) were analyzed. Compared to placebo, FcRn inhibitors significantly reduced Myasthenia Gravis Activities of Daily Living (MG-ADL) scores (MD of −1.45 [95 % CI, −1.91 to −0.99]; P &lt; 0.00001), Quantitative Myasthenia Gravis( QMG) scores (MD = −2.33 [95 % CI, −3.57 to −1.09]; P = 0.0002), and Myasthenia Gravis Composite (MGC) scores (MD = −2.96 [95 % CI, −4.29 to −1.63]; P &lt; 0.0001). The FcRn inhibitors improved MG-ADL responder rates (RR = 1.60 [95 % CI, 1.27–2.02]; P &lt; 0.0001), and Myasthenia Gravis Quality of Life (MGQoL15r) scores (MD = −2.18 [95 % CI, −3.35 to −1.00]; P = 0.0003). Serious adverse events were lower with the FcRn inhibitors (32/519) than the placebo (39/397). Subgroup analysis revealed that Rozanolixizumab and Nipocalimab improved MG-ADL scores, but had inferior responder rates. Additionally, Rozanolixizumab significantly improved MGC scores but had more adverse events.</div></div><div><h3>Conclusion</h3><div>FcRn inhibitors demonstrated good efficacy and safety in MG, with efgartigimod and nipocalimab showing strong efficacy without added risk. Further research is required to evaluate long-term outcomes and optimize treatment.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108910"},"PeriodicalIF":1.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of perioperative nutritional supplementation on outcomes of spine surgery: A systematic review and meta-analysis","authors":"Ahmad Sharif ,&nbsp;Alison Reilly ,&nbsp;Ojas Bhagra ,&nbsp;Karthik Papisetty ,&nbsp;Hamzah Magableh ,&nbsp;Asimina Dominari ,&nbsp;Karim Rizwan Nathani ,&nbsp;Maliya Delawan ,&nbsp;Mohamad Bydon","doi":"10.1016/j.clineuro.2025.108916","DOIUrl":"10.1016/j.clineuro.2025.108916","url":null,"abstract":"<div><h3>Objective</h3><div>Malnutrition, characterized by a total serum lymphocyte count less than 1500 cells/mm³ and serum albumin levels below 3.5 g/dL, is linked to delayed wound healing and a higher incidence of surgical site infections (SSIs). This meta-analysis evaluates the impact of perioperative nutritional supplementation on clinical outcomes in spine surgery.</div></div><div><h3>Methods</h3><div>A systematic review of the published literature was conducted. Outcomes of interest included postoperative complications such as wound complications, SSI, and deep vein thrombosis (DVT). Estimated blood loss, operative time, and duration of hospital stay were also investigated.</div></div><div><h3>Results</h3><div>Five studies with 554 patients were included. A total of 221 patients (39.90 %) were in the intervention group, compared to 333 patients (60.10 %) in the control group. The intervention groups received nutritional supplementation at different timeframes, including preoperatively or postoperatively. A significantly lower rate of total complications (OR: 0.32, CI: [0.12, 0.89], p = 0.04) and wound-related complications (OR: 0.34, CI: [0.20, 0.60], p &lt; 0.01) was observed in the intervention group when compared to the control group. A trend towards fewer SSIs was observed (OR: 0.35, CI: [0.02, 7.19], p = 0.39). There were also fewer DVT events in the intervention group (OR: 0.62, CI: [0.04, 8.90], p = 0.52).</div></div><div><h3>Conclusions</h3><div>Patients receiving perioperative nutritional supplementation had significantly lower overall and wound-related complication rates compared to patients who did not receive nutritional supplementation perioperatively. This analysis highlights the value of nutritional supplementation as part of the perioperative care and optimization efforts in patients undergoing spine surgery.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108916"},"PeriodicalIF":1.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural history and predictors of growth in conservatively managed non-functioning pituitary macroadenomas: A volumetric study of 232 tumors","authors":"Yeong Jin Kim,&nbsp;Kyung-Sub Moon,&nbsp;Sue Jee Park,&nbsp;Tae-Young Jung,&nbsp;In-Young Kim,&nbsp;Shin Jung","doi":"10.1016/j.clineuro.2025.108920","DOIUrl":"10.1016/j.clineuro.2025.108920","url":null,"abstract":"<div><h3>Background</h3><div>Although patients with clinically non-functioning pituitary macroadenomas (NFPMAs) are typically monitored without immediate therapeutic intervention, their natural course remains unclear. This study aimed to characterize growth dynamics in conservatively managed NFPMAs and identify clinical predictors of tumor progression using volumetric MRI analysis.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 232 patients with NFPMAs who underwent at least two high-resolution MRI scans over a minimum follow-up of 12 months without therapeutic intervention. Tumor volumes were assessed using semi-automated segmentation. Progression was defined as a ≥ 20 % increase in volume. Clinical and radiological variables were evaluated to identify predictors of growth.</div></div><div><h3>Results</h3><div>Over a median follow-up of 37 months, 110 tumors (47.4 %) demonstrated significant growth. The median initial tumor volume was 1.9 cm³ , with median absolute and relative annual growth rates of 0.13 cm³ /year and 5.47 %/year, respectively. Multivariate Cox regression identified larger initial tumor volume (HR 1.140, 95 % CI 1.005–1.081; <em>p</em> = 0.027) and female sex (HR 1.594, 95 % CI 1.076–2.361; <em>p</em> = 0.020) as independent predictors. A tumor volume threshold of 2.5 cm³ was associated with increased growth risk. Among age-matched groups, females exhibited greater volumetric growth than males.</div></div><div><h3>Conclusion</h3><div>Approximately half of NFPMAs exhibit slow but measurable growth over time. Tumor volume at diagnosis and female sex are significant predictors of progression. These findings underscore the importance of individualized surveillance strategies, particularly for female patients with larger baseline tumors, and provide clinically relevant data to inform long-term management of NFPMAs.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108920"},"PeriodicalIF":1.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors for recurrent ischemic stroke in patients with watershed infarct induced by intracranial artery stenosis","authors":"Zhenzhen Li ,&nbsp;Xinwei Liu ,&nbsp;Huiling Sun ,&nbsp;Xiaozong Jiang ,&nbsp;Yiting Zhang ,&nbsp;Lifan Ji ,&nbsp;Luyao Zhang ,&nbsp;Meng Wang ,&nbsp;Mengmeng Gu ,&nbsp;Shuo Li ,&nbsp;Yuqiao Zhang ,&nbsp;Yukai Liu ,&nbsp;Hongchao Shi ,&nbsp;Teng Jiang ,&nbsp;Yanping Mei ,&nbsp;Lin Zhu ,&nbsp;Junshan Zhou ,&nbsp;Qiwen Deng","doi":"10.1016/j.clineuro.2025.108897","DOIUrl":"10.1016/j.clineuro.2025.108897","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Symptomatic intracranial artery stenosis (sICAS) is strongly associated with an elevated risk of recurrent ischemic stroke, yet the underlying risk factors remain elusive. In this present study, we aimed to investigate the risk factors and predictive value of imaging features for recurrent ischemic stroke in patients with watershed infarction caused by ICAS.</div></div><div><h3>Methods</h3><div>We prospectively collected clinical information and imaging data from patients with watershed infarction caused by ICAS. The primary outcome was recurrent ischemic cerebrovascular events in the same territory within 1 year. The original magnetic resonance images (MRI) were post-processed by the Fast-processing of ischemic stroke (F-Stroke) software to compute the perfusion parameters. The assessment of white matter hyperintensity (WMH) was performed in accordance with the Fazekas scale. Binary logistic regression analysis was performed to explore the association of imaging characteristics and recurrent ischemic stroke. Subsequently, we performed ROC curve analyses to determine their discriminatory capacity for ischemic stroke recurrence.</div></div><div><h3>Results</h3><div>A total of 139 patients were successfully enrolled in the present study. The recurrence rate in the total population was 18.71 %. Compared with patients without recurrent ischemic stroke, those who experienced recurrence had a higher proportion of prior ischemic stroke history (25.66 % vs. 53.85 %) and severe WMH (30.77 % vs. 7.97 %), as well as higher baseline NIHSS scores and volume of Tmax &gt; 4 s. Logistic regression analysis revealed that both the volume of Tmax &gt; 4 s and severe WMH significantly influenced the risk of recurrent ischemic stroke occurrence. Furthermore, ROC curve analyses demonstrated that the discriminatory capacity of the volume of Tmax &gt; 4 s (AUC = 0.64, 95 %CI = 0.51–0.77, <em>P</em> = 0.029) was marginally superior to WMH scores (AUC = 0.62, 95 %CI = 0.49–0.75, <em>P</em> = 0.066). Whereas, the combination of the volume of Tmax &gt; 4 s and the WMH scores showed better discriminatory capacity (AUC = 0.73, 95 %CI = 0.61–0.85, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>MR-guiding cerebral hypoperfusion and severe WMH is susceptible to recurrence of ischemic stroke, thereby serving as valuable predictors for recurrence in patients with watershed infarction caused by ICAS.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108897"},"PeriodicalIF":1.8,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping glioblastoma-induced neurological deficits: A brain atlas","authors":"Yeong Chul Yun ,&nbsp;Sabine Wolf ,&nbsp;Katharina Holz ,&nbsp;Freya Garhöfer ,&nbsp;Anja Hohmann ,&nbsp;Philipp Vollmuth ,&nbsp;Karl-Olof Lövblad ,&nbsp;Martin Bendszus ,&nbsp;Heinz-Peter Schlemmer ,&nbsp;Felix Sahm ,&nbsp;Sabine Heiland ,&nbsp;Wolfgang Wick ,&nbsp;Johann M.E. Jende ,&nbsp;Varun Venkataramani ,&nbsp;Felix T. Kurz","doi":"10.1016/j.clineuro.2025.108911","DOIUrl":"10.1016/j.clineuro.2025.108911","url":null,"abstract":"<div><h3>Background</h3><div>Identifying radiological characteristics and brain regions associated with neurological deficits in glioblastoma patients can improve diagnostic evaluation and understanding of the disease’s impact on neurological function.</div></div><div><h3>Methods</h3><div>The retrospective study included 527 newly diagnosed glioblastoma patients. Eligibility criteria included pathologically confirmed IDH-wild type glioblastoma, availability of pre- and post-contrast MRIs, and detailed neurological examination reports. Contrast-enhancing tumors (CET) and non-contrast-enhancing lesions (NEL) were segmented from 3 Tesla MRI scans. Lesion volumes from patients without neurological deficits compared with symptomatic patients using either the Mann-Whitney test or Kruskal-Wallis test. Voxel-wise lesion-symptom mapping was conducted using Fisher-exact-test followed by random permutation analysis (ADIFFI) to identify brain regions with higher occurrences of deficit-associated lesions.</div></div><div><h3>Results</h3><div>Location of CET and NEL within the brain were associated with specific neurological deficits. Larger CET and NEL volumes were associated with increased neurological deficits (CET: rs = 0.15, p = 0.0006; NEL: rs = 0.22, p &lt; 0.0001). Lesion volumes were smaller in patients without neurological deficits (CET: 4.97 ± 0.69 ml vs. 20.0 ± 0.9 ml, p &lt; 0.0001). Epilepsy-associated lesions were also smaller (CET: 4.59 ± 0.55 ml vs. 22.0 ± 0.9 ml, p &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>The study highlights that neurological and epilepsy status at pre-treatment provide estimates of glioblastoma lesion volumes and locations. The correlation between lesion volumes and neurological deficits underscores the significance of comprehensive radiological assessments in glioblastoma patients. These findings support the use of detailed lesion-symptom mapping to guide clinical management and prognosis evaluation in glioblastoma.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"253 ","pages":"Article 108911"},"PeriodicalIF":1.8,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The current state of academic neurosurgery: A national survey assessing academic neurosurgical capacity and perceived needs","authors":"Max A. Saint-Germain ,&nbsp;Michelle Odonkor ,&nbsp;Shaan Bhandarkar ,&nbsp;Neil Mahto ,&nbsp;Jiaqi Liu ,&nbsp;A. Karim Ahmed ,&nbsp;Debraj Mukherjee","doi":"10.1016/j.clineuro.2025.108913","DOIUrl":"10.1016/j.clineuro.2025.108913","url":null,"abstract":"<div><h3>Background</h3><div>While inequities in the provision of neurosurgical care exist worldwide, the specific challenges in academic neurosurgical capacity remain inadequately understood. We sought to evaluate current neurosurgical capacity in United States academic tertiary care centers with neurosurgical residency programs and assess perceived needs in their respective practice settings.</div></div><div><h3>Methods</h3><div>An online survey regarding human resources, medications, equipment, and infrastructure was distributed to all 117 residency programs in the US. Institutions were categorized using the Area Deprivation Index (ADI), a tool quantifying socioeconomic disadvantage, into low (0–50) or high (51–100) groups.</div></div><div><h3>Results</h3><div>Responses from 37 institutions were recorded (59 % low ADI, 41 % high ADI). Common limitations included shortages of floor beds (84 %), nurses (81 %), and Neurocritical Care Unit (NCCU) beds (77 %). The least available equipment were intraoperative MRI (49 % total, Low ADI: 59 %, High ADI: 33 %, p = 0.18) and exoscopes (51 % total, Low ADI: 59 %, High ADI:40 %, p = 0.32). The most desired change in human resources was more operating room (OR) nurses (86 %, Low ADI: 77 %, High ADI: 100 %, p = 0.07) and the most common desired infrastructural changes were for more ORs (81 % total, Low ADI: 73 %, High ADI: 93 %, p = 0.2), floor beds (70 % total, Low ADI:59 %, High ADI:87 %, p = 0.14) and NCCU beds (70 % total, Low ADI: 68 %, High ADI:73 %, p = 1.0).</div></div><div><h3>Conclusions</h3><div>Academic centers across the US may face challenges related to advanced equipment, infrastructure, and personnel. More deprived programs may experience greater limitations. Interventions to address these limitations may be necessary, but further research is needed to comprehensively and objectively assess neurosurgical capacity.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"253 ","pages":"Article 108913"},"PeriodicalIF":1.8,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tension pneumosella following transsphenoidal surgery: A systematic review","authors":"Nicolai Blasdel ,&nbsp;Kwadwo Darko ,&nbsp;Michael Farid ,&nbsp;Sean O’Leary ,&nbsp;Rylie Ju ,&nbsp;Mahmoud Elguindy ,&nbsp;Umaru Barrie","doi":"10.1016/j.clineuro.2025.108898","DOIUrl":"10.1016/j.clineuro.2025.108898","url":null,"abstract":"<div><h3>Objective</h3><div>Endoscopic endonasal transsphenoidal surgery (EETS) is a common first-line approach for resection of sellar lesions such as pituitary adenomas. While these procedures are largely successful, rare or unexpected complications can occur. One such complication is tension pneumosella (TP). Here, we conducted a systematic review of the literature to provide recommendations on how best to identify, manage and prevent TP post-EETS.</div></div><div><h3>Methods</h3><div>A systematic review was conducted using PubMed, Google Scholar, Embase, Cochrane and Web of Science electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to critically assess primary articles discussing TP following EETS.</div></div><div><h3>Results</h3><div>Eleven articles published between 1995 and 2023 detailing twelve (12) cases of TP, primarily following transsphenoidal surgery for pituitary tumors (9 cases) or Rathke cleft cysts (2 cases) were included. Common symptoms included headaches (7 cases) and visual disturbances (2 cases). TP onset ranged from two days to thirteen years after surgery, with CSF leaks, sellar defects, and inadequate packing as risk factors. Endoscopic decompression and surgical repair were the most common treatments (9 cases), while the remaining three patients were managed conservatively with antibiotics; all cases with favorable outcomes.</div></div><div><h3>Conclusions</h3><div>Our review highlights TP as a rare yet important consideration to be aware of and its variable presentation following EETS. In patients with symptomatic TP, endoscopic decompression and repair of the sellar floor with fat packing of the sphenoid sinus is acceptable. Incidentally discovered TP on postoperative scans in otherwise asymptomatic patients can be conservatively managed.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"253 ","pages":"Article 108898"},"PeriodicalIF":1.8,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a predictive machine learning model for postoperative long-term diabetes insipidus following transsphenoidal surgery for sellar lesions","authors":"Simon G. Ammanuel,&nbsp;Manasa H. Kalluri,&nbsp;Jesse D. Montoure,&nbsp;Benjamin Lee,&nbsp;Garret P. Greeneway,&nbsp;Paul S. Page,&nbsp;Azam S. Ahmed,&nbsp;Mustafa K. Baskaya","doi":"10.1016/j.clineuro.2025.108899","DOIUrl":"10.1016/j.clineuro.2025.108899","url":null,"abstract":"<div><h3>Objective</h3><div>Diabetes Insipidus (DI) is a common complication that occurs following transsphenoidal surgery for sellar lesions. DI is usually transient but can be permanent in select patients. Prior studies have described preoperative risk factors for developing postoperative DI. However, no predictive risk score has been created to risk stratify these patients.</div></div><div><h3>Methods</h3><div>A single-center retrospective review from 2017 – 2022 was performed, reviewing all patients who underwent transsphenoidal surgery for resection of a sellar lesion. Longterm DI was defined as a patient who met DI criteria for at least six months and required desmopressin therapy. Baseline patient, operative, and radiographic characteristics were obtained. A machine learning method (Risk-SLIM) was utilized to create a risk stratification score to identify patients at high risk for DI.</div></div><div><h3>Results</h3><div>In total, 252 patients were identified to have sellar lesions treated with transsphenoidal surgery. Of these, 27 (10.7 %) patients developed long-term DI and required desmopressin therapy. The DI after Transsphenoidal Surgery score (DITSS) was created with an area under the curve of 0.81 and a calibration error (CAL) error of 7.3 %. Predicative factors were tumor pathology, Tumor size, patient age, and endoscopic approach. The probability of developing DI requiring long-term desmopressin therapy ranged from &lt; 1 % for a score of 0 and &gt; 95 % for a score of 10</div></div><div><h3>Conclusions</h3><div>The DITSS model is a concise and accurate tool to assist in clinical decision-making for risk stratifying which patients undergoing transsphenoidal surgery for sellar lesions may go on to develop DI.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"253 ","pages":"Article 108899"},"PeriodicalIF":1.8,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}