Frontiers in Neurology最新文献

{"title":"Evolving understanding of Guillain-Barré syndrome pathophysiology and the central role of the classical complement pathway in axonal injury.","authors":"Kenneth C Gorson","doi":"10.3389/fneur.2025.1572949","DOIUrl":"10.3389/fneur.2025.1572949","url":null,"abstract":"<p><p>Guillain-Barré syndrome (GBS) is a rare, frequently postinfectious neuromuscular emergency and the leading cause of acute paralytic neuropathy worldwide. GBS incidence varies considerably across geographic regions, owing predominantly to different infectious exposures. In GBS, antecedent infection leads to production of immunoglobulin G and immunoglobulin M antibodies that cross-react with the myelin sheath and axons of peripheral nerves. These antibodies activate the classical complement pathway, which plays a key role in peripheral nerve injury regardless of autoantibody binding to myelin or axons as a target. The heterogeneous clinical presentation and progression of GBS symptoms have long been attributed to binary axonal and demyelinating neurophysiologic classifications; however, evolving evidence indicates that these pathophysiologic processes overlap. Intravenous immunoglobulin and plasma exchange, the current standard-of-care therapies in GBS, both reduce autoantibody levels and complement activation, thereby aiming to address this convergence of pathophysiology. However, these therapies only partially decrease antibody levels and complement activity and require extended courses of treatment (5 days for intravenous immunoglobulin and 7-14 days for plasma exchange), limiting their effectiveness in addressing acute neuronal damage during the active phase of disease. Given its evolutionary role in antibody binding and activating the classical complement pathway, the complement component C1q has been proposed as a therapeutic target in GBS. The clinical trial program of the C1q inhibitor ANX005, including placebo-controlled, double-blind phase 1b and phase 3 trials in GBS, provides insight into the pathophysiology of GBS and the efficacy of C1q inhibition regardless of neurophysiologic classification or geographic location.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1572949"},"PeriodicalIF":2.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of high-frequency rTMS treatment on brain activity in PSCI patients: a TMS-EEG study.","authors":"Xinxin Song, Jianming Fu, Yunhai Yao, Yuhong Shu, Zhongli Wang, Xuting Chen, Lianjie Ma, Fang Shen, Xiaolin Sun, Xiaoqing Ma, Ting Zhang, Rujue Jin, Ming Zeng, Xudong Gu","doi":"10.3389/fneur.2025.1582437","DOIUrl":"10.3389/fneur.2025.1582437","url":null,"abstract":"<p><strong>Objectives: </strong>This study employed Transcranial Magnetic Stimulation combined with Electroencephalography (TMS-EEG) to examine the impacts of high-frequency repetitive transcranial magnetic stimulation (rTMS) on brain activity and cognitive function in patients with post-stroke cognitive impairment (PSCI), focusing on changes in connectivity of the left dorsolateral prefrontal cortex (DLPFC) across different frequency bands.</p><p><strong>Methods: </strong>Twenty subacute PSCI patients were recruited for a 20-day rTMS treatment, consisting of 10 days of sham stimulation followed by 10 days of actual stimulation. Clinical function scale data and TMS-EEG data were collected before treatment (Pre), after sham stimulation (Sham), and after rTMS treatment (TMS) to analyze transcranial magnetic stimulation evoked potentials (TEP), time-frequency, and functional connectivity. Additionally, a <i>post hoc</i> subgroup analysis was conducted to assess the impact of education level, time since onset, and lesion size on cognitive score improvement.</p><p><strong>Results: </strong>Compared to the Pre and Sham conditions, cognitive function and daily living ability scores significantly improved post-rTMS. Although the TEP patterns in the Pre and Sham conditions were similar, rTMS enhanced the early TEP amplitude in the left DLPFC, slowed gamma oscillations, increased connectivity in the theta and alpha bands in the bilateral DLPFC, and altered the connectivity patterns between the left DLPFC and other brain regions. Changes in theta-band wPLI were significantly positively correlated with improvements in MMSE scores (<i>r</i> = 0.465, <i>p</i> = 0.039) and MoCA scores (<i>r</i> = 0.493, <i>p</i> = 0.027). Patients with higher education levels exhibited significant cognitive improvement (<i>p</i> = 0.039), while patients with a time since onset of 60-180 days showed a significant decline in cognitive improvement (<i>p</i> = 0.024).</p><p><strong>Conclusion: </strong>High-frequency rTMS effectively modulated connectivity patterns between the left DLPFC and other brain regions in PSCI patients, enhancing cognitive functions. Changes in wPLI within the theta frequency band may serve as a potential biomarker for cognitive function improvement in PSCI patients. Education level and time since onset may have a certain impact on cognitive improvement in PSCI patients.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1582437"},"PeriodicalIF":2.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical daily rhythms of seizure in different subtypes of temporal lobe epilepsy.","authors":"Shuxian Gong, Zhongyuan Long, Dongyan Ji, Qiang Guo, Tianpeng Zhang, Shaochun Li, Xiaofeng Yang, Lisen Sui","doi":"10.3389/fneur.2025.1599236","DOIUrl":"10.3389/fneur.2025.1599236","url":null,"abstract":"<p><strong>Introduction: </strong>The relationship between circadian rhythms and seizures in temporal lobe epilepsy (TLE) has been well recognized, but it remains poorly understood how the interaction between the endogenous clock system and seizures may affect seizure patterns and patient management. This study investigates the circadian rhythm patterns of clinical seizures in TLE, with a focus on different subtypes and clinical variables.</p><p><strong>Methods: </strong>We retrospectively analyzed the seizure rhythms of patients diagnosed with TLE who were admitted to the video-EEG ward. Patients were categorized based on clinical data, including mesial, lateral, mesio-lateral, and temporal pole types, as well as left, right, and bilateral temporal lobe involvement. Seizure onset times, frequency, and duration were recorded for each patient.</p><p><strong>Results: </strong>Our findings indicate that TLE patients exhibit notable seizure rhythms, with the peak times of seizure frequency and duration differing across subtypes and age groups. Notably, patients with mesial and mesio-lateral temporal lobe epilepsy showed peak seizure durations between 23:00 and 24:00, while seizure frequency peaked between 19:00 and 20:00 for right temporal lobe patients and between 19:00 and 22:00 for left temporal lobe patients. Additionally, children and adults had distinct seizure rhythms, with children peaking between 21:00 and 24:00, while adults had a peak frequency between 19:00 and 22:00.</p><p><strong>Discussion: </strong>These findings highlight the variability of seizure rhythms in TLE and underscore the need for personalized treatment strategies that consider circadian factors, potentially leading to better seizure management and therapeutic interventions.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1599236"},"PeriodicalIF":2.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Downward gazing behavior after stroke can enhance postural control even in the absence of visual input.","authors":"Yogev Koren, Simona Bar-Haim, Noy Goldhamer, Lior Shmuelof","doi":"10.3389/fneur.2025.1593221","DOIUrl":"10.3389/fneur.2025.1593221","url":null,"abstract":"<p><strong>Background: </strong>Recent reports have revealed that downward gazing, a common behavior among persons with stroke, enhances postural control. The mechanism underlying this phenomenon is currently unknown. In this study, we attempt to provide evidence to support the hypothesis that this effect is primarily derived from altered retinal input caused by gazing down. We also hypothesized that the effect of downward gazing on sway will be more pronounced in subjects with impaired balance control following stroke.</p><p><strong>Methods: </strong>We quantified standing postural sway of 20 healthy participants and 20 persons with stroke who were instructed to stand as still as possible under different conditions: while gazing forward and gazing down, with their eyes open and eyes closed.</p><p><strong>Results: </strong>Both the horizontal gaze angle and the lack of visual input had a negative effect on participants' ability to attenuate their body sway. Yet, the effect of gaze angle was constant regardless of the presence or absence of visual input. Also, people with stroke were more sensitive to the effect of gaze angle.</p><p><strong>Discussion: </strong>The results of this study indicate that downward gazing enhances postural control even in the absence of visual input and do not support our main hypothesis. Nonetheless, the effect of downward gazing on postural control was greater in unstable people (persons with stroke) than that observed in healthy adults, supporting our secondary hypothesis, which might explain less stable individuals' tendency to gaze down while walking.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1593221"},"PeriodicalIF":2.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive therapeutics for neurotrauma: a mechanistic overview.","authors":"James D O'Leary, Bevan S Main, Mark P Burns","doi":"10.3389/fneur.2025.1560777","DOIUrl":"10.3389/fneur.2025.1560777","url":null,"abstract":"<p><p>Traumatic brain injury is a leading cause of death and a major risk factor for the development of both memory and motor disorders. To date, there are no proven interventions to improve patient outcome after neurotrauma. A promising avenue of treatment has emerged in the use of non-invasive therapies for recovery after brain injury. A number of non-invasive brain stimulation techniques have been developed, such as transcranial direct current stimulation, transcranial magnetic stimulation and vagus nerve stimulation, as well as low intensity ultrasound stimulation and photobiomodulation therapy. However, standardized treatment regimens have not been developed. There is a clear need to better understand the underlying mechanisms of non-invasive therapeutics on brain injury pathology so as to more effectively guide treatment strategy. Here we review the current literature of non-invasive therapies in preclinical neurotrauma and offer insight into the potential mechanism of action and novel targets for the treatment of traumatic brain injury.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1560777"},"PeriodicalIF":2.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of hydrops MRI in differentiating between Menière's disease and vestibular migraine: a prospective study.","authors":"Anja Bernaerts, Morgana Sluydts, Vincent Liégeois, Catherine Blaivie, Floris L Wuyts, Joost van Dinther, Andrzej Zarowski, Filip Deckers, Bert De Foer","doi":"10.3389/fneur.2025.1582754","DOIUrl":"10.3389/fneur.2025.1582754","url":null,"abstract":"<p><strong>Objective: </strong>We investigated the effectiveness of delayed post-gadolinium (Gd) three-dimensional (3D) sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) fluid-attenuated inversion recovery (FLAIR) sequence to differentiate between Menière's disease (MD) and vestibular migraine (VM) in a prospective study.</p><p><strong>Methods: </strong>A total of 31 patients-15 with MD (10 with definite MD and 5 with probable MD) and 16 with VM (9 with definite VM, 7 with probable VM)-were prospectively enrolled between January 2019 and December 2022. The female-to-male ratio in the MD group was 7:8, while in the VM group, it was 14:2. All patients underwent a 3D SPACE FLAIR sequence and a 3D SPACE T2 sequence 4 h after intravenous (IV) injection of a single dose of gadobutrol (1.0 mmoL/mL). Cochlear endolymphatic hydrops (CEH), vestibular endolymphatic hydrops (VEH), and asymmetrical perilymphatic enhancement (PLE) were assessed.</p><p><strong>Results: </strong>None of the VM patients showed signs of CEH, VEH, or increased PLE. However, in the MD group, only two patients had normal CEH, one patient had normal VEH, and six patients demonstrated equal PLE in both ears. The logistic regression analysis using both VEH and CEH correctly predicted all cases of MD and VM, achieving 100% diagnostic accuracy for both conditions. However, using only CEH, VEH, or PLE as diagnostic criteria resulted in misclassifications: two patients were incorrectly classified as having VM based on CEH, one based on VEH, and six based on PLE. These results highlight the superior diagnostic power of the combination of CEH and VEH in logistic regression analysis.</p><p><strong>Conclusion: </strong>The combination of CEH and VEH allows for 100% accurate identification of VM and MD. This approach facilitates a reliable differential diagnosis of MD and VM when used in the appropriate clinical setting.</p><p><strong>Clinical relevance statement: </strong>This study demonstrates that hydrops magnetic resonance imaging (MRI) can accurately differentiate MD from VM. Therefore, hydrops MRI can obviate the need for trial medication in cases with clinically ambiguous findings.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1582754"},"PeriodicalIF":2.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the capability of the corneal blink reflex to display neurological changes following subconcussive head impacts.","authors":"Osamudiamen S Ogbeide, Madeleine K Nowak, Lillian Klemsz, Dena Garner, Keisuke Kawata","doi":"10.3389/fneur.2025.1589577","DOIUrl":"10.3389/fneur.2025.1589577","url":null,"abstract":"<p><strong>Introduction: </strong>This study examines the capability of detecting neurological changes caused by subconcussive head impacts by analyzing the blink reflex of an individual when they encounter puffs of air as a stimulus.</p><p><strong>Methods: </strong>Following attrition and technical issues, 26 participants (15 females, 11 males: age ± SD; 21.3 ± 2.11 years) with at least 5 years of soccer heading experience were included in the final analysis. Participants performed 10 soccer headers with soccer balls projected at a speed of 30 mph. Parameters related to blink reflex, including blink latency, differential latency, number of oscillations, delta 30, and excursions, were assessed by the EyeStat device at pre-heading baseline, and 2-h and 24-h post-heading.</p><p><strong>Results: </strong>Significant declines in blink reflex parameters were observed at specific post-heading timepoints compared to baseline. At 24-h post-heading, significant reductions were detected in the overall blink latency (<i>p</i> = 0.0255), the blink latencies of the right eye (<i>p</i> = 0.0411), ipsilateral latency (<i>p</i> = 0.0314) and contralateral latency (<i>p</i> = 0.0434). At 2-h post-heading, significant declines were observed in the overall delta 30 value (<i>p</i> = 0.0053) and delta 30 of the right eye (<i>p</i> = 0.0260). Both delta 30 values returned to baseline by the 24-h post-heading timepoint. No significant changes in the differential latency, number of oscillations, and excursion of the eye were found.</p><p><strong>Discussion: </strong>These findings suggest changes in the latency and delta 30 of a blink reflex is a viable measure of detection for neurological changes when monitoring subconcussive head impacts.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1589577"},"PeriodicalIF":2.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality risk in patients with myasthenia gravis.","authors":"Mohamed Khateb, Shahar Shelly","doi":"10.3389/fneur.2025.1586031","DOIUrl":"10.3389/fneur.2025.1586031","url":null,"abstract":"<p><strong>Introduction: </strong>Although some reports link Myasthenia Gravis to higher mortality, the evidence remains contradictory and unclear. Real-life data is limited primarily due to challenges in selecting control groups and mitigating bias. Additionally, a revised mortality assessment should be conducted due to recent advancements in Myasthenia Gravis treatments over the past decade, including new biological therapies and the impact of the COVID-19 pandemic from 2020 to 2023.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of all patients diagnosed with Myasthenia Gravis at our tertiary center between 2000 and 2023, extracting mortality and clinical features compared to two age- and sex-matched control groups of neurological or rheumatologic patients.</p><p><strong>Results: </strong>We identified 436 Myasthenic patients and 2,616 controls (1308 in each control group). Myasthenia Gravis mortality was 14% at 5 years (61/422) and 21% at 10 years (87/422). Mortality was significantly higher than control groups (<i>p</i> < 0.001). Intubations during myasthenic crisis were linked to higher mortality (<i>p</i> = 0.002). Bulbar weakness at presentation showed higher mortality but did not reach clinical significance. We compared the mean age at death in MG patients to national life expectancy benchmarks using a one-sample Z-test, revealing significantly younger age at death in both males (78.3 vs. 81.6 years, <i>p</i> = 0.009) and females (76.5 vs. 85.2 years, <i>p</i> < 0.00001). Patients with normal thymic pathology showed better outcomes and lower mortality after thymic removal (<i>p</i> < 0.0001). The primary cause of death was linked to infections, significantly correlated with chronic steroid use.</p><p><strong>Discussion: </strong>In conclusion, patients with Myasthenia Gravis had higher mortality rates. Thymic removal reduced mortality, while intubation is associated with increased mortality risk.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1586031"},"PeriodicalIF":2.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sphenopalatine ganglion stimulation for the treatment of trigeminal neuropathic pain.","authors":"Paweł Sokal, Sara Kierońska-Siwak, Marcin Rusinek, Magdalena Jabłońska, Antoni Nehring, Oskar Puk, Damian Palus, Renata Jabłońska","doi":"10.3389/fneur.2025.1535102","DOIUrl":"10.3389/fneur.2025.1535102","url":null,"abstract":"<p><strong>Introduction: </strong>Unlike idiopathic trigeminal neuralgia, which can be treated with conventional neurosurgical methods such as microvascular decompression, radiofrequency rhizotomy of the Gasser ganglion, or stereotactic radiosurgery, trigeminal neuropathic pain (TNP) presents a major challenge for neurosurgeons. Injury to the trigeminal system resulting in chronic refractory pain can be treated with neuromodulation methods, such as peripheral nerve stimulation, motor cortex stimulation, or deep brain stimulation. Sphenopalatine ganglion (SPG) stimulation has been successfully applied in patients with cluster headaches and migraine. This study aimed to evaluate the response of patients with TNP to permanent percutaneous SPG stimulation.</p><p><strong>Methods: </strong>We studied six patients treated with SPG stimulation for TNP. All patients had previously been treated with RF rhizotomy, microvascular decompression, or stereoradiosurgery without a satisfactory long-term therapeutic effect and had recurrent, mostly constant TNP. An electrode lead was implanted in the pterygopalatine fossa of all patients to stimulate the SPG under guidance of neuronavigation with an implantable pulse generator inserted after a two-week trial period.</p><p><strong>Results: </strong>Preoperatively, the mean visual analog scale score was 9. Two weeks after the trial stimulation, it decreased to 3.6 in six patients. In four patients, the score further decreased to 3.0 after 6 months and 2.25 after 12 months, accompanied by an improvement in health status, as measured by the 36-Item Short Form Health Survey questionnaire. In two patients, the electrodes were externalized through eroded skin after 3 months, and stimulators were removed.</p><p><strong>Discussion: </strong>The preliminary results of this pilot study are encouraging. Pain relief after the trial stimulation was found to be notable. The treatment procedure was safe, and the stimulation effect was durable. SPG stimulation is an attractive alternative to other neuromodulation methods.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1535102"},"PeriodicalIF":2.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The determination of the boundaries and prediction the radicality of glioblastoma resection using MRI and CT perfusion.","authors":"Rustam Talybov, Tatiana Trofimova, Vadim Mochalov, Sergey Karasev, Vladislava Gorshkova, Tatiana Kleschevnikova, Irina Karasyova, Artem Batalov, Natalia Zakharova, Elena Gaijsina, Igor Pronin","doi":"10.3389/fneur.2025.1572845","DOIUrl":"10.3389/fneur.2025.1572845","url":null,"abstract":"<p><strong>Background: </strong>Preoperative identification of diffuse glioma boundaries remains an unsolved problem of modern neurooncology. The main problem is the heterogeneity of the tumor being manifested by simultaneous presence of both contrast-enhancing and non-contrasting but hyperperfused regions on imaging. Perfusion technologies are known to be a reliable tool in identifying areas with intact BBB and increased proliferative activity of vascular endothelium.</p><p><strong>Aim: </strong>The purpose of this study is to evaluate the impact of MRI and CT perfusion data in preoperative planning of surgical resection in order to achieve the maximum volume of cytoreduction and to prolong relapse-free period.</p><p><strong>Methods: </strong>The study included 74 patients with the morphologically and immunohistochemically verified diagnosis of \"glioblastoma NOS.\" The patients were divided into 2 groups depending on the perfusion data and the extent of tumor resection. Group 1 of patients had a surgery with the preoperative use of perfusion techniques and the resection of the contrast-enhancing and hyperperfused portion of the tumor (<i>n</i> = 42), group 2 of patients had a surgery with preoperative use of perfusion techniques and resection of only the contrast-enhancing component of the tumor (<i>n</i> = 32).</p><p><strong>Results: </strong>The results of the study show that the surgery directed to the resection of contrast-positive and hyperperfused tumor portions has an advantage when compared with surgery aimed at removing only the contrast-enhancing part of the tumor. In group 1, the median relapse-free period was 15 months, while the relapse-free survival in 6 and 12 months was 92 and 55% which exceeded the results in the second group, in which the median was 9 months, and the relapse-free survival in 6 and 12 months was 66 and 9% (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Our study shows that the use of perfusion techniques in preoperative planning of the resection volume has a favorable potential and high diagnostic value. Perfusion tools may be contribute to the most objective assessment of all tumor components. The prolongation of the relapse-free period was achieved by taking into account the factor as the resection of both the contrast-enhanced component and the contrast-negative component with high vascular permeability detected by perfusion techniques.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1572845"},"PeriodicalIF":2.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}