Journal of Clinical Neuroscience最新文献

{"title":"Development of a predictive grading system for postoperative ischemia following middle cerebral artery aneurysm clipping","authors":"Leon Lai ,&nbsp;Naquiya Murtaza Mohsin ,&nbsp;Hayder Al-Farttoosi ,&nbsp;Cyrus Raki ,&nbsp;Tarundeep Dhaliwal","doi":"10.1016/j.jocn.2024.110914","DOIUrl":"10.1016/j.jocn.2024.110914","url":null,"abstract":"<div><div>The current study presents a single-surgeon experience with microsurgical clipping of middle cerebral artery (MCA) aneurysms and introduces a grading system to predict postoperative ischaemia. A retrospective analysis of 222 patients with 251 MCA aneurysms treated between 2015 and 2024 was conducted. Key factors, including aneurysm size, dome morphology, neck location, calcification, and rupture status, were evaluated to identify predictors of radiological infarction. A scoring model was developed, assigning points for aneurysm neck distance from the internal carotid artery (&gt;20 mm: 1 point; 10–20 mm: 2 points; &lt;10 mm: 3 points), aneurysm size &gt; 7 mm (1 point), calcification (1 point), and rupture status (1 point). The grading system demonstrated a significant risk gradient, with infarction rates of 0 %, 3 %, 11 %, 35 %, and 83 % for grades 1 to 5, respectively (p &lt; 0.0001). Independent predictors of poor outcomes were identified as a short M1 segment (p = 0.002), aneurysm size &gt; 7 mm (p = 0.019), calcification (p &lt; 0.001), and rupture presentation (p = 0.002). Postoperative ischaemia occurred in 7 patients (23 %) with ruptured aneurysms and 18 patients (9 %) with unruptured aneurysms. This grading system provides a practical tool for stratifying risk and guiding treatment decisions. Further multi-centre studies are needed to validate its broader applicability.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110914"},"PeriodicalIF":1.9,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604949","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":"Exclusion criteria for intravenous thrombolysis in stroke Chameleons: An observational study","authors":"Alejandro M. Brunser ,&nbsp;Pablo M. Lavados ,&nbsp;Paula Muñoz-Venturelli ,&nbsp;Verónica V. Olavarría ,&nbsp;Eloy Mansilla ,&nbsp;Gabriel Cavada ,&nbsp;Maria Elena Trejo ,&nbsp;Pablo E. González","doi":"10.1016/j.jocn.2024.110913","DOIUrl":"10.1016/j.jocn.2024.110913","url":null,"abstract":"<div><h3>Background</h3><div>Stroke chameleons (SC), are often diagnosed too late in their course to benefit from intravenous thrombolysis (IVT) treatment in the Emergency Room (ER). It remains unclear what proportion of this patient population would be a candidate for IVT. We sought to identify the proportion of SC patients with contraindications to IVT and to delineate what those contraindications are.</div></div><div><h3>Methods</h3><div>All consecutive SC patients who presented to the ER<!--> <!-->at a single center in Santiago Chile were evaluated between December 2014 and October 2023.</div></div><div><h3>Results</h3><div>A total of 1193 S patients were evaluated, of which sixty-three (5.2 %, 95 %CI 4.1–6.6) were diagnosed as SC (mean age 59 ± 21.3 years, 32 (50.7 %) women). The median NIHSS was 1 (IQR 1–3) and 50 (79.3 %) patients had an<!--> <!-->NIHSS ≤ 3. Of the 63 SC patients, 14 (22.2 %) were determined to be IVT candidates. In the remaining 49 patients, 71 contraindications for IVT were present: 28 patients had 1 contraindication, 20 patients had 2 contraindications, and 1 patient had 3 contraindications. The most common contraindication was absence of deficits measurable by NIHSS or very mild deficits in 31 (49.2 %) patients. This was followed by being outside of the therapeutic window for thrombolysis in 30 (47.6 %) patients. Both of these contraindications were present in 14 (22.2 %) patients. The most common erroneous diagnoses that SC patients received on presentation the ER were metabolic encephalopathy (11, 17.4 %), seizure disorder (9, 14.2 %), and migraine (7, 11.2 %).</div></div><div><h3>Conclusions</h3><div>More than two thirds of SC patients presented to the ER with contraindications to IVT. The most frequent contraindications included deficits not measurable by NIHSS, extremely mild deficits, and being out of therapeutic window.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110913"},"PeriodicalIF":1.9,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604951","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":"Intravenous ketamine infusions in patients with depression and Epilepsy: Case series","authors":"Mariusz Stanisław Wiglusz,&nbsp;Zuzanna Chmielewska,&nbsp;Wiesław Jerzy Cubała","doi":"10.1016/j.jocn.2024.110908","DOIUrl":"10.1016/j.jocn.2024.110908","url":null,"abstract":"<div><h3>Background</h3><div>Mood disorders affect approximately one-third of individuals with epilepsy, posing an increased risk of suicide. There is an unquestionable need for more effective antidepressant treatment in this group of patients. This study explores the safety and tolerability of low-dose intravenous ketamine in six patients with comorbid depression and epilepsy. This report is limited to the post-hoc observation of six patients only. Thus, no causative conclusions are warranted, and prospective, large sample studies are needed to demonstrate the effect of ketamine on seizures, depression, and side effect profile along with the systematic outcome measures assessment.</div></div><div><h3>Methods</h3><div>Six patients diagnosed with major depressive disorder (MDD) or bipolar disorder I (BP-I) and concurrent epilepsy received a series of eight intravenous ketamine infusions alongside their standard antidepressant, mood stabilizer, and antiseizure medications.</div></div><div><h3>Results</h3><div>The observed side effects were mild and transient, with no exacerbation of epilepsy noted. No serious adverse events occurred. Four patients experienced a significant reduction in Montgomery–Åsberg Depression Rating Scale (MADRS) scores, two achieving full remission. Three patients reported a subjective decrease in seizure activity during the twelve-month follow-up.</div></div><div><h3>Conclusions</h3><div>Short-term intravenous ketamine treatment demonstrated favorable safety and tolerability profile with clinical efficacy in six patients with depression and epilepsy.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110908"},"PeriodicalIF":1.9,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604952","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":"MR diffusion tensor imaging applied to the spinal cord of patients with neuropathic pain secondary to herpes zoster infection","authors":"Adriano Yacubian Fernandes ,&nbsp;Fabio Eduardo Fernandes da Silva ,&nbsp;Pedro Tadao Hamamoto Filho ,&nbsp;Erich Talamoni Fonoff","doi":"10.1016/j.jocn.2024.110912","DOIUrl":"10.1016/j.jocn.2024.110912","url":null,"abstract":"<div><h3>Introduction</h3><div>Diffusion tensor imaging (DTI) has been increasingly utilized in the assessment of spinal cord pathologies for various clinical applications. DTI surpasses conventional MRI in delineating the microstructural integrity of the spinal cord, thereby serving as a potent, non-invasive modality sensitive to white matter pathologies. Postherpetic neuralgia (PHN) is acknowledged to be a consequence not only of peripheral nerve and root lesions but also of central nervous system abnormalities associated with such damage. Our premise posits that the manifestation of PHN may be linked to detectable spinal cord anomalies ascertained through DTI methodologies.</div></div><div><h3>Material and methods</h3><div>To study the spinal cord of the patients with post herpetic neuralgia (PHN) using DTI techniques, looking at the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) to compare the parameters of the patients that developed PHN with the parameters of the patients that presented herpes zoster (HZ) but didn’t present secondary neuralgia. Fifteen patients (two male and thirteen female) were studied. Ten patients presented PHN: nine female and one male; age from 54y to 83y (mean = 72,2). Five patients had HZ without chronic pain: four female and one male with age from 34y to 81y (mean = 60,8).</div></div><div><h3>Results</h3><div>For ADC, we found higher values among the patients, significant differences in C5, T8, and T9 levels. For FA, we found lower values among the patients, significant differences in T7, T8, and T9 levels. On ROC curves, we identified that D8 was the single level with significant area under the curve (AUC) for discriminating patients with pain. For ADC, the AUC was 0.960 (95 %CI 0.865–1.000), p = 0.005. For FA, the AUC was 0.920 (95 %CI 0.764–1.000), p = 0.010. The cutoff value for pain on ADC was 2455.08, with a sensibility of 90 % and specificity of 100 %. For FA, the cutoff value for not having pain was 395.05, with sensibility of 100 %, and specificity of 90 %.</div></div><div><h3>Conclusion</h3><div>This investigation highlights the potential for DTI parameters, specifically FA and ADC, to provide insight into the microstructural changes associated with PHN in patients following herpes zoster infection. Future research should continue to explore the implications of these findings in larger cohorts to further elucidate the pathogenesis of neuropathic pain in this population.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110912"},"PeriodicalIF":1.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592795","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":"Extended endoscopic endonasal trans-tubercular approach and radical resection of a giant calcified craniopharyngioma with pituitary stalk preservation – Technical nuances and steps","authors":"Aliasgar V. Moiyadi ,&nbsp;Prathamesh Pai ,&nbsp;Kaberi Kakati","doi":"10.1016/j.jocn.2024.110896","DOIUrl":"10.1016/j.jocn.2024.110896","url":null,"abstract":"<div><div>This case highlights the surgical steps and nuances in preserving the pituitary stalk to ensure good endocrinological outcomes during endoscopic craniopharyngioma resection.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110896"},"PeriodicalIF":1.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592796","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":"Spinal epidural abscess: Does social deprivation influence 1-year mortality?","authors":"Eamon P.G. Walsh ,&nbsp;Joseph F. Baker","doi":"10.1016/j.jocn.2024.110890","DOIUrl":"10.1016/j.jocn.2024.110890","url":null,"abstract":"<div><h3>Background</h3><div>Spinal epidural abscess are difficult to diagnose due to its non-specific clinical presentation. Spinal epidural abscess is identified late or missed in almost half of patients. To better assist clinicians in making this diagnosis there needs to be a better appreciation of at risk patient profile.</div></div><div><h3>Methods</h3><div>We identified all patients who were admitted to a tertiary referral centre with a diagnosis of spinal epidural abscess between February 2009 and January 2022. Demographic details, presentation details, past medical history, concurrent infection, and social factors were recorded for all patients. The primary aim of our study was to examine if there is a relationship between social deprivation and risk of mortality at one year in patients with spinal epidural abscess.</div></div><div><h3>Results</h3><div>There were 140 eligible patients associated with 146 hospital encounters for spinal epidural abscess. Eighteen patients died at ≤365 days post discharge, while 122 patients were alive at &gt;365 days post discharge. There were 86 males and 54 females. The average age was 59.9 years with an IQR of 19.3. There were 28 % Māori, 58 % European and 12 % of all other ethnicities. In the most deprived quantile there were 34.5 %, compared to 7.5 % in the least deprived quantile.</div><div>Multivariate stepwise regression analysis found that age, mean neutrophil count and congestive heart failure all showed a statistically significance association with mortality at one year. There was no association between one year mortality and these variables: deprivation status, rurality or Māori ethnicity.</div></div><div><h3>Conclusion</h3><div>Mortality at one year appears to be significantly associated with age, mean neutrophil count and congestive heart failure. There was no obvious association between deprivation and mortality at one year. Identifying patients at the greatest risk of mortality remains a complex challenge.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110890"},"PeriodicalIF":1.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cranial venous outflow insufficiency; rendered almost invisible to radiological imaging by circular reasoning. Rethinking normal craniocervical venous anatomy","authors":"J. Nicholas P. Higgins ,&nbsp;Robin J. Borchert ,&nbsp;Sarita Rao ,&nbsp;David J. Biddle ,&nbsp;Thomas Santarius ,&nbsp;Alexis J. Joannides","doi":"10.1016/j.jocn.2024.110882","DOIUrl":"10.1016/j.jocn.2024.110882","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Cranial venous outflow insufficiency, a model of brain dysfunction based on partial or intermittent obstruction to cranial venous drainage, is an attempt to explain a clinical phenotype characterised by multiple complex symptoms, including headache, fatigue and cognitive dysfunction, that can be responsible for long term neurological disability. This concept, however, has been received with some scepticism first, because its supposed symptoms seem mainly non-organic and, secondly, because its supposed lesions can be regarded as no more than variants of normal craniocervical venous anatomy. This reasoning, however, fails to appreciate that an understanding of normal venous anatomy has evolved, not from dedicated studies in healthy volunteers, but almost entirely from patients whose symptoms are assumed to be non-organic, or at least not referrable to the specifics of craniocervical venous anatomy. So, the reasoning is circular, and whilst this may not matter when frank venous thrombosis makes the diagnosis of venous disease clear, it might be frustrating attempts to understand the clinical expression of more subtle forms of cranial venous outflow compromise. Reassurance on this point, however, is only possible if it is inconceivable that the symptoms described by these patients could ever be referred back to the venous system, an assumption that has not been tested. The purpose of this study was to test this assumption by examining the clinical profile of patients who, by default, make a significant contribution to perceptions of normal venous anatomy, that is patients with MRI brain scans reported to be normal.</div></div><div><h3>Method</h3><div>Cross-sectional: we recorded the symptoms and diagnoses in 100 consecutive patients with MRI brain scans reported as normal.</div></div><div><h3>Results</h3><div>26 % complained of headache, 25 % of focal neurological symptoms, 15 % of dizziness. 13 % had seizure/collapse. 46 % of patients had no final diagnosis. 18 % were diagnosed with migraine, 7 % with functional neurological disorder and 6 % with epilepsy.</div></div><div><h3>Conclusions</h3><div>The clinical overlap between patients with brain MRI reported as normal and patients with known venous sinus disease, as documented in the literature, raises strong concerns regarding their role in defining normal craniocervical venous anatomy. Current assumptions regarding this anatomy, therefore, are probably unsafe, this inviting a re-evaluation of the clinicopathological significance of hitherto almost ignored configurations of cranial venous outflow, such as jugular venous narrowing or outflow asymmetry, and giving encouragement to explore a pathological substrate in cranial venous outflow insufficiency for a range of otherwise unexplained symptoms.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110882"},"PeriodicalIF":1.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592844","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":"Evaluating neurosurgical society award recipients: Realising inclusivity in neurosurgical awards.","authors":"Isnaria Rizki Hayati, Rikas Saputra, Yenni Lidyawati, Rizky Andana Pohan","doi":"10.1016/j.jocn.2024.110911","DOIUrl":"https://doi.org/10.1016/j.jocn.2024.110911","url":null,"abstract":"<p><p>This article evaluates disparities in neurosurgical awards, focusing on the underrepresentation of women and racial minorities. It underscores the need for transparent award selection processes and diverse judging panels to foster inclusivity. The article also highlights the importance of mentorship programs in addressing systemic biases. It calls for further research into institutional factors, including education and geographic disparities, that contribute to inequitable representation. By implementing these reforms, the field of neurosurgery can ensure a more diverse and innovative future, ultimately improving patient care and outcomes.</p>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":" ","pages":"110911"},"PeriodicalIF":1.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589747","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":"Repeat stereotactic radiosurgery in vestibular schwannoma patients: A systematic review and meta-analysis","authors":"Bardia Hajikarimloo ,&nbsp;Mohammad Amin Habibi ,&nbsp;Mohammadamin Sabbagh Alvani ,&nbsp;Amir Hessam Zare ,&nbsp;Salem M. Tos ,&nbsp;Jason P. Sheehan","doi":"10.1016/j.jocn.2024.110905","DOIUrl":"10.1016/j.jocn.2024.110905","url":null,"abstract":"<div><h3>Background</h3><div>Regarding the newly diagnosed vestibular schwannomas (VSs), active surveillance, microsurgical resection (MS), and stereotactic radiosurgery (SRS) are the leading treatment options. Although SRS is an effective intervention with a low incidence of complications, failure may occur occasionally. Several options, including repeat SRS, are considered salvage treatment after failure of the SRS. In this systematic review and <em>meta</em>-analysis study, we aimed to evaluate the efficacy and outcomes of repeat stereotactic radiosurgery (SRS) in progressive VS following the failure of the initial SRS.</div></div><div><h3>Method</h3><div>The electronic databases of PubMed/Medline, Scopus, Embase, and Web of Science (WOS) were searched from inception to August 23rd, 2024. Studies that evaluated the role of repeat SRS in the setting of VS were included. The risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions tool. The R program performed the <em>meta</em>-analyses, sensitivity analysis, publication bias, and <em>meta</em>-regression.</div></div><div><h3>Results</h3><div>A total of 11 studies encompassing 260 VS patients with repeat SRS were included in our study. The median time interval between initial and repeat SRSs ranged from tumor volume ranged from 43 to 62 months. Our analysis revealed a pooled tumor control of 91 % (95 % CI: 86 %-94 %). Regarding the radiological response, the pooled regression rate was 59 % (95 % CI: 52 %- 65 %), while the pooled progression rate was 9 % (95 % CI: 6 %- 14 %). Regarding the clinical outcomes, the pooled serviceable hearing preservation (SHP) rate was 36 % (95 % CI: 22 %-53 %), while worsened fifth cranial nerve (CN) and seventh CN rates were 12 % (95 % CI: 7 %- 19 %) and 8 % (95 % CI: 5 %- 12 %), respectively. In addition, the pooled adverse radiation effect (ARE) rate was 6 % (95 % CI: 3 %- 11 %).</div></div><div><h3>Conclusion</h3><div>Our results suggest that the repeat SRS following the failure of the initial SRS in VS is associated with favorable outcomes, including tumor control, SHP, and CN worsening concurrent with low ARE rates.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110905"},"PeriodicalIF":1.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586953","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":"Cost-effectiveness of the single-surgeon approach in microvascular decompression for trigeminal neuralgia","authors":"Peter Adidharma ,&nbsp;Mustaqim Prasetya ,&nbsp;Rezka Fadillah Yefri ,&nbsp;Randy Ramadhan ,&nbsp;Abrar Arham ,&nbsp;Takuro Inoue","doi":"10.1016/j.jocn.2024.110910","DOIUrl":"10.1016/j.jocn.2024.110910","url":null,"abstract":"<div><h3>Background</h3><div>Centralizing surgical cases to a dedicated surgeon (single-surgeon approach) has shown improved outcomes in various neurosurgical procedures, including microvascular decompression (MVD) for trigeminal neuralgia (TN). However, the cost-effectiveness of this approach in MVD for TN has not been conclusively demonstrated. This study aims to investigate the cost-effectiveness of the single-surgeon approach in MVD for TN compared to the conventional multi-surgeon approach.</div></div><div><h3>Methods</h3><div>A prospective cohort study was conducted from 2014 to 2020 (multi-surgeon approach 2014–2017; single-surgeon approach 2018–2020). Data on demographic and clinical characteristics, pain control, complications, hospital length of stay, and costs from the healthcare provider’s perspective (pre-operative, operative, post-operative, follow-up intervention, and complication-related) were documented. Pain-and-complication-specific quality-adjusted life years (PCQALY) were calculated using Kaplan-Meier favorable-pain-control and complication-free probability curves, followed by a cost-effectiveness analysis.</div></div><div><h3>Results</h3><div>Seventy-two patients were included (46 in the single-surgeon group, 26 in the multi-surgeon group). The single-surgeon approach yielded a higher 3-year PCQALY gain (2.8 vs. 1.6) and significantly shorter hospital stays (5.7 ± 3.5 days vs. 8.9 ± 3.9 days) despite higher total costs (USD 12,462 ± 5,577 vs. USD 9,128 ± 4,012) (p &lt; 0.05). The single-surgeon approach had a cost-effectiveness ratio of USD 4,491/PCQALY (vs. USD 5,635/PCQALY for the multi-surgeon approach), with an Incremental Cost-Effectiveness Ratio (ICER) of USD 2,887/PCQALY gained (0.65 times GDP/capita), indicating its cost-effectiveness according to World Health Organization criteria.</div></div><div><h3>Conclusion</h3><div>The single-surgeon approach is cost-effective despite its higher associated costs, due to its superior pain control and complication profile.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110910"},"PeriodicalIF":1.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586954","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}