Journal of Clinical Neuroscience最新文献

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BMX "Sidecar": Case series of novel intravascular catheter arrangement for treatment of cerebral aneurysms and shunting lesions. 小轮车“Sidecar”:治疗脑动脉瘤和分流性病变的新型血管内导管安排病例系列。
IF 1.8 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-10-10 DOI: 10.1016/j.jocn.2025.111665
Shreyas Honavar, Yifan Ren, Kevin Zhou, Behnam Shaygi, Julian Maingard, Calvin Gan, Justin M Moore, Lee-Anne Slater, Ronil V Chandra, Sara Protto, Ali Khabaza, Anousha Yazdabadi, Davor Pavlin-Premrl, Ash Jhamb, Hong Kuan Kok, Christen D Barras, Mark Brooks, Hamed Asadi
{"title":"BMX \"Sidecar\": Case series of novel intravascular catheter arrangement for treatment of cerebral aneurysms and shunting lesions.","authors":"Shreyas Honavar, Yifan Ren, Kevin Zhou, Behnam Shaygi, Julian Maingard, Calvin Gan, Justin M Moore, Lee-Anne Slater, Ronil V Chandra, Sara Protto, Ali Khabaza, Anousha Yazdabadi, Davor Pavlin-Premrl, Ash Jhamb, Hong Kuan Kok, Christen D Barras, Mark Brooks, Hamed Asadi","doi":"10.1016/j.jocn.2025.111665","DOIUrl":"https://doi.org/10.1016/j.jocn.2025.111665","url":null,"abstract":"<p><p>Neuroendovascular therapies have redefined the management of multiple intracranial pathologies and are now recognised as first-line treatments for cerebral aneurysms and shunting lesions. New advances and innovative technologies require development of equally advanced techniques to optimise their feasibility, safety and efficacy. We describe a novel catheter arrangement technique, termed \"Sidecar,\" intended to maximise value for the operator and minimise complications with the Benchmark BMX096 guide catheter (Penumbra Inc, Alameda, CA, USA). The 0.096″ internal diameter of this large bore access device enables operators to safely and efficiently treat a broad range of neurovascular pathologies while minimising risk and allowing intra-procedural digital subtraction angiograms to be acquired without losing the position of established microcatheters.</p>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"111665"},"PeriodicalIF":1.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274805","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}
引用次数: 0
Relapse risk before, during and after pregnancy in MOG antibody-associated disorder: a two-center retrospective study MOG抗体相关疾病在孕前、孕中和孕后的复发风险:一项双中心回顾性研究
IF 1.8 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-10-08 DOI: 10.1016/j.jocn.2025.111668
Angie H. Kim , Olivia Pasquale , Gabriela Romanow , Heather M. Tchen , Michael Levy , Ilya Kister
{"title":"Relapse risk before, during and after pregnancy in MOG antibody-associated disorder: a two-center retrospective study","authors":"Angie H. Kim ,&nbsp;Olivia Pasquale ,&nbsp;Gabriela Romanow ,&nbsp;Heather M. Tchen ,&nbsp;Michael Levy ,&nbsp;Ilya Kister","doi":"10.1016/j.jocn.2025.111668","DOIUrl":"10.1016/j.jocn.2025.111668","url":null,"abstract":"<div><h3>Background</h3><div>Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described inflammatory disorder of the central nervous system. Unlike other demyelinating disorders of the central nervous system, the impact of pregnancy and the postpartum period on MOGAD disease activity remains uncertain. A better understanding of pregnancy-related relapse risk in MOGAD is essential to inform management.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review of all patients followed in two large referral centers in the Northeastern United States with a confirmed diagnosis of MOGAD and at least one post-MOGAD onset pregnancy carried to the third trimester. Demographic, neurological, obstetric, and treatment-related data were extracted from electronic medical records, centered around the 12-month pre-pregnancy, pregnancy, and 12-month post-pregnancy periods, for each of which the annualized relapse rates (ARRs) were calculated.</div></div><div><h3>Results</h3><div>We identified 15 women diagnosed with MOGAD who had 22 post-MOGAD onset pregnancies. No relapses were observed during any of the 22 pregnancies, but 2 relapses were observed in the postpartum period in a single patient with a steroid-dependent relapsing course. The mean ARR was 0.26 ± 0.86 during the 12-month pre-pregnancy period, 0 during pregnancy, and 0.09 ± 0.42 in the 12-month postpartum period. Twelve of 22 pregnancies (55 %) were exposed to disease-modifying therapy (DMT) at conception, and 59 % were continued on DMT into the postpartum period. Obstetric complications were recorded in 5 of 22 pregnancies (22 %).</div></div><div><h3>Conclusions</h3><div>The two main findings of our retrospective study are: 1) the relapse risk is very low during pregnancy in women with MOGAD, and 2) postpartum relapse risk does not appear to be elevated in patients with a low pre-pregnancy relapse rate. Approximately half of the women in our series were receiving disease-modifying therapies during the postpartum period, which may have decreased relapse rates. Larger prospective studies are needed to validate our observations.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111668"},"PeriodicalIF":1.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258433","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}
引用次数: 0
The association of cognitive functions with functional outcomes during post-stroke recovery: A cross-sectional study 脑卒中后恢复期间认知功能与功能结局的关联:一项横断面研究。
IF 1.8 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-10-08 DOI: 10.1016/j.jocn.2025.111667
Thameesha Harini , Piyumi Madushani , Dewni Munasinghe , Yugan Maleesha , Kumarangi Vithanage , Asha Wettasinghe
{"title":"The association of cognitive functions with functional outcomes during post-stroke recovery: A cross-sectional study","authors":"Thameesha Harini ,&nbsp;Piyumi Madushani ,&nbsp;Dewni Munasinghe ,&nbsp;Yugan Maleesha ,&nbsp;Kumarangi Vithanage ,&nbsp;Asha Wettasinghe","doi":"10.1016/j.jocn.2025.111667","DOIUrl":"10.1016/j.jocn.2025.111667","url":null,"abstract":"<div><h3>Background</h3><div>Stroke is a major cause of disability and death worldwide, with survivors often facing long-term cognitive and physical impairments that hinder their balance, mobility and functional independence. Post-stroke cognitive impairments (PSCI) can severely affect the functional outcomes. This study aimed to evaluate the association of cognitive functions with balance, mobility, and functional independence in stroke survivors in Sri Lanka.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted at the National Hospital of Sri Lanka from March 2024 to February 2025, involving stroke survivors aged 40 years and above, in the 3–12 months post-stroke period. Cognitive function was assessed with Montreal Cognitive Assessment (MoCA), while balance, mobility and functional independence in basic and instrumental activities of daily living (ADL) were assessed with the Four-Stage Balance Test (FSBT), Timed Up and Go (TUG) test, Barthel Index (BI), and Lawton IADL scale, respectively. Multivariate multiple linear regression was used to identify the predictive ability of cognitive functions on other functional outcome measures in SPSS version 23 software.</div></div><div><h3>Results</h3><div>One hundred and seventeen stroke survivors (male; n = 75, female; n = 42), with a mean (SD) age of 60.4 (7.32) years, participated in the study. The prevalence of PSCI, rated at 70.1 % with 39 %, 30 % and 1.1 % of the cohort demonstrating mild, moderate and severe cognitive impairment, respectively. Improved global cognitive function was significantly associated with (p &lt; 0.01) all functional outcomes, with basic ADL independence having the highest effect size (η<sup>2</sup>p = 0.257), followed by instrumental ADL independence (η<sup>2</sup>p = 0.193), improved mobility (η<sup>2</sup>p = 0.077) and balance performance (η<sup>2</sup>p = 0.056). According to the domain-specific analysis, attention component is an indicator for basic ADL independence (β = 0.303, p = 0.005) while executive functions are associated with balance abilities (β = 0.439, p = 0.001).</div></div><div><h3>Conclusions</h3><div>Results confirm that cognitive functions following stroke is a significant associated factor for balance, mobility and functional independence in ADLs. These findings underscore the importance of incorporating targeted cognitive rehabilitation into the ongoing physical rehabilitation, optimising functional recovery and independence.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111667"},"PeriodicalIF":1.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258392","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}
引用次数: 0
Advancements and challenges in multiple sclerosis care in Uruguay: A comprehensive overview 乌拉圭多发性硬化症治疗的进展和挑战:全面概述。
IF 1.8 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-10-07 DOI: 10.1016/j.jocn.2025.111673
Valeria Rocha , Noelia Sorondo
{"title":"Advancements and challenges in multiple sclerosis care in Uruguay: A comprehensive overview","authors":"Valeria Rocha ,&nbsp;Noelia Sorondo","doi":"10.1016/j.jocn.2025.111673","DOIUrl":"10.1016/j.jocn.2025.111673","url":null,"abstract":"<div><div>Multiple sclerosis (MS) is a chronic neurological disorder that can lead to significant disability if untreated. Over the past years, Uruguay has made notable progress in MS care, including improved epidemiological understanding, better accessibility to high-efficacy disease-modifying therapies, and the formation of specialized workgroups dedicated to enhancing patient management. Despite these advancements, challenges remain. Access to diagnostics techniques, multidisciplinary care, and rehabilitation services still needs major improvements. Efforts to establish dedicated MS centers, expand telemedicine strategies, and bridge gaps between public and private healthcare systems are essential for improving patient outcomes. While obstacles persist, recent developments mark a promising era in Uruguay’s MS care, emphasizing the need to develop personalized treatment protocols, and enhance comprehensive care to improve quality of life for people with MS.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111673"},"PeriodicalIF":1.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251379","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}
引用次数: 0
Risk factors of unfavorable outcomes in patients with good-grade aneurysmal subarachnoid hemorrhage following endovascular treatment 血管内治疗后高级别动脉瘤性蛛网膜下腔出血患者不良结局的危险因素。
IF 1.8 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-10-07 DOI: 10.1016/j.jocn.2025.111663
Yiyuan Sun , Bo Huang , Zining Kuang , Xinzhu Li , Fangyuan Ren , Yuhan Sun , Guangdong Lu
{"title":"Risk factors of unfavorable outcomes in patients with good-grade aneurysmal subarachnoid hemorrhage following endovascular treatment","authors":"Yiyuan Sun ,&nbsp;Bo Huang ,&nbsp;Zining Kuang ,&nbsp;Xinzhu Li ,&nbsp;Fangyuan Ren ,&nbsp;Yuhan Sun ,&nbsp;Guangdong Lu","doi":"10.1016/j.jocn.2025.111663","DOIUrl":"10.1016/j.jocn.2025.111663","url":null,"abstract":"<div><h3>Background</h3><div>The prognosis of patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) has been extensively investigated. Notably, good-grade patients account for nearly 80 % of the whole aSAH population, and a subset of them also experience unfavorable outcomes. However, the underlying risk factors contributing to unfavorable outcomes in this subgroup warrant further exploration.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed consecutive patients with good-grade aSAH (World Federation of Neurological Societies [WFNS] grades I–III) who underwent endovascular treatment. Potential risk factors associated with unfavorable outcomes (defined as a modified Rankin Scale [mRS] score &gt; 2) were assessed using least absolute shrinkage and selection operator (LASSO) regression followed by stepwise logistic regression modeling.</div></div><div><h3>Results</h3><div>This study included 676 patients with a median age of 51 years (interquartile range: 52–68), of whom 64.8 % were female. The majority (92.2 %) presented with WFNS grades I-II. During follow-up, 46 patients (6.8 %) developed delayed cerebral ischemia (DCI), while 53 (7.8 %) exhibited unfavorable outcomes at 3 months. Through LASSO regression followed by stepwise logistic regression analysis, we identified five independent predictors of unfavorable outcomes in good-grade aSAH patients: age ≥ 70 years, WFNS grade III, aneurysm re-rupture, DCI occurrence, and pulmonary infection.</div></div><div><h3>Conclusions</h3><div>Age ≥ 70 years, WFNS grade III, re-rupture of aneurysm, incidence of DCI, and pulmonary infection are independent risk factors for unfavorable outcomes in patients with good-grade aSAH. These findings have implications for the prognostic prediction, risk stratification, and clinical decision-making for this patient population.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111663"},"PeriodicalIF":1.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251324","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}
引用次数: 0
An inverted U-shaped curve relationship between systemic immune-inflammation index and stroke in older adults: A population-based study 老年人全身免疫炎症指数与中风之间的倒u型曲线关系:一项基于人群的研究。
IF 1.8 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-10-07 DOI: 10.1016/j.jocn.2025.111671
Jinming Fan , Junzhu Zhang , Jiawen Chen , Yifei Hu , Wuqin Ma , Yajun Yuan , Benshuai Yu
{"title":"An inverted U-shaped curve relationship between systemic immune-inflammation index and stroke in older adults: A population-based study","authors":"Jinming Fan ,&nbsp;Junzhu Zhang ,&nbsp;Jiawen Chen ,&nbsp;Yifei Hu ,&nbsp;Wuqin Ma ,&nbsp;Yajun Yuan ,&nbsp;Benshuai Yu","doi":"10.1016/j.jocn.2025.111671","DOIUrl":"10.1016/j.jocn.2025.111671","url":null,"abstract":"<div><h3>Background</h3><div>The present research sought to examine potential links connecting the systemic immune-inflammation index (SII), an emerging biomarker of inflammatory status, with stroke among aging individuals.</div></div><div><h3>Materials and Methods</h3><div>Researchers performed a cross-sectional analysis utilizing datasets obtained from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2017 to 2020. Three distinct analytical approaches—multivariable regression, smoothing curve fitting, and threshold effect analyses—were systematically applied to investigate potential correlations between SII and stroke.</div></div><div><h3>Results</h3><div>When SII was analyzed as a categorical variable, the minimally adjusted model showed a reduction in stroke occurrence in the middle SII group compared to the lowest group according to logistic regression analysis (OR = 0.515, 95 % CI: 0.275–0.967, <em>p</em> = 0.039). Smoothed curve fitting and threshold effects analysis were performed after adjusting for age, race, education, heart disease, hypertension, hyper lipidaemia, diabetes and smoking status. The results showed that when SII was less than 0.894 (10<sup>6</sup>cells/µl), the risk of stroke increased by 181.3 % for each unit increase in SII (OR = 2.813, 95 % CI: 1.515–5.224, <em>p</em> = 0.001). Meanwhile, when SII was &gt; 0.894 (10<sup>6</sup> cells/μl), the risk of stroke was reduced by 65.1 % for every 1 unit increase in SII (OR = 0.349, 95 % CI: 0.135–0.902, <em>p</em> = 0.030).</div></div><div><h3>Conclusion</h3><div>An inverted U-shaped association exists between SII and stroke in older adults. Although this study is cross-sectional and cannot establish a definitive causal relationship between SII and stroke, it provides important evidence for future research to better identify high-risk populations for stroke.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111671"},"PeriodicalIF":1.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251304","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}
引用次数: 0
Laparoscopic insertion of ventriculoperitoneal shunts by neurosurgeons: An audit of a tertiary hospital practice 神经外科医生腹腔镜下脑室腹腔分流术的插入:对一家三级医院实践的审计。
IF 1.8 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-10-06 DOI: 10.1016/j.jocn.2025.111659
Rosalind L. Jeffree FRACS
{"title":"Laparoscopic insertion of ventriculoperitoneal shunts by neurosurgeons: An audit of a tertiary hospital practice","authors":"Rosalind L. Jeffree FRACS","doi":"10.1016/j.jocn.2025.111659","DOIUrl":"10.1016/j.jocn.2025.111659","url":null,"abstract":"<div><h3>Objective</h3><div>Since 2013, at the Royal Brisbane and Women’s Hospital (RBWH) some neurosurgeons have routinely used laparoscopy to insert the distal catheter during ventriculoperitoneal shunt surgery. The purpose of this study was to investigate the safety and outcomes of laparoscopic ventriculoperitoneal shunt insertion by neurosurgeons, compared with laparoscopic shunt insertion by general surgeons and traditional, open, minilaparotomy by neurosurgeons or general surgeons.</div></div><div><h3>Methods</h3><div>A retrospective audit was performed of all shunt surgery performed at RBWH over 9 years, collecting data from hospital and statewide electronic medical records and information systems.</div></div><div><h3>Results</h3><div>Of 1078 shunt operations, there were 546 during which the peritoneal catheter of a ventriculoperitoneal shunt was inserted or revised. Neurosurgeons alone performed 151 laparoscopic shunt operations, general surgeons performed 72 laparoscopic operations, neurosurgeons performed 307 open shunt operations and general surgeons performed 16 open shunt procedures.</div><div>Patients undergoing laparoscopic shunt insertion had a significantly lower risk of re-operation for malposition of the distal tubing (0 % vs 4 %, p &lt; 0.05). After laparoscopic insertion by neurosurgeons there were fewer overall complications at 6 weeks (13 %) compared to those operated on by general surgeons (28 %) or open (21 %), but this was not significant on multivariate analysis.</div><div>There was no significant difference between laparoscopic surgery by neurosurgeons, laparoscopic surgery by general surgeons or open surgery by neurosurgeons for infection (1.4%, 5.7%, 3.8%), distal obstruction (1.4%, 2.9%, 1.7%) or proximal complications (4.1%, 7.1%, 3.1%).On multivariate analysis, revision surgery was associated with increased distal complications, emergency surgery was associated with increased revision rate, programmable valves with reduced distal obstruction and antibiotic impregnated catheters with reduced infection.</div><div>Laparoscopic surgery took ∼10 min longer in theatre on average. Patients admitted for shunt surgery alone had shorter length of stay after laparoscopic surgery (3.8 days) than open surgery (5.5 days, p = 0.02).</div></div><div><h3>Conclusions</h3><div>In selected patients, it is safe for neurosurgeons to use laparoscopy for ventriculoperitoneal shunt insertion without involvement of a general surgeon. Laparoscopic surgery may also have other benefits for the patient.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111659"},"PeriodicalIF":1.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244399","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}
引用次数: 0
T2-based MRI vessel maps in pediatric epilepsy surgery: Quantitative validation and clinical case series 儿童癫痫手术中基于t2的MRI血管图:定量验证和临床病例系列。
IF 1.8 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-10-06 DOI: 10.1016/j.jocn.2025.111656
Bonnie Alexander , Aasheen Munshey , Sila Genc , Alison Wray , Wirginia Maixner , Michelle Wu , Tejas Venkataram , Hollie Byrne , Richard Beare , Joseph Y.-M. Yang
{"title":"T2-based MRI vessel maps in pediatric epilepsy surgery: Quantitative validation and clinical case series","authors":"Bonnie Alexander ,&nbsp;Aasheen Munshey ,&nbsp;Sila Genc ,&nbsp;Alison Wray ,&nbsp;Wirginia Maixner ,&nbsp;Michelle Wu ,&nbsp;Tejas Venkataram ,&nbsp;Hollie Byrne ,&nbsp;Richard Beare ,&nbsp;Joseph Y.-M. Yang","doi":"10.1016/j.jocn.2025.111656","DOIUrl":"10.1016/j.jocn.2025.111656","url":null,"abstract":"<div><h3>Background</h3><div>In pediatric epilepsy, T1-weighted brain MRI with Gadolinium (‘T1+Gd’) can be rendered to display vasculature and cortical morphology for surgical planning. T1+Gd images are not always available, and may not be preferable where patients have needle or procedural aversion, or allergies to contrast agent. We utilized T2-weighted (‘T2’) images to generate ‘T2 Vessel Maps’ that emulate the tissue and vessel intensities in T1+Gd images. We aimed to quantitatively validate T2 Vessel Maps with relation to T1+Gd versions, and qualitatively describe clinical utility of T2- and T1+Gd Vessel Maps.</div></div><div><h3>Methods</h3><div>The study design was a retrospective quantitative validation study and clinical case series. For the quantitative analysis, we retrospectively identified 16 epilepsy patients with operative photographs and T2 and T1+Gd images (age 1.0–18.1 years; 6 female). For the qualitative case series, we retrospectively identified 10 epilepsy patients with operative photographs and T2 Vessel Maps used in presurgical planning (0.4–18.1 years, 4 female). For the quantitative analysis, vessel segments were traced by raters on T2- and T1+Gd Vessel Maps, and traced on operative photographs as “ground truth”. Quantities of vessels captured by T2- and T1+Gd Vessel Maps were assessed using ratios of rater-traced vessel segments to ground truth, and rater-traced vessel segments on T2- vs. T1+Gd Maps. Linear mixed effects models were used to test effects of MRI modality and vessel type on ratios. For the case series, neurosurgeons were interviewed regarding utility of T2- and T1+Gd Vessel Maps.</div></div><div><h3>Results</h3><div>For the quantitative analysis, the ratio of rater-traced segments to ground truth was lower for T2- than T1+Gd Vessel Maps (estimate −0.137, 95 % CI [−0.180, −0.095], <em>t</em> = −6.30, <em>p</em> &lt; 0.001). The ratio of traced vessel segments for T2 vs T1+Gd Vessel Maps had mean = 0.752. No difference was found for vessel type (estimate −0.02, 95 % CI [−0.115, 0.067], <em>t</em> = −0.51, <em>p</em> = 0.610). For the case series, neurosurgeons described use, advantages and disadvantages of T2 and T1+Gd Vessel Maps. Usage was primarily in providing vessel and surface morphology landmarks for surgical planning. In most cases, vessels on T2 Vessel Maps were reported to be a good match with those on the cortical surface.</div></div><div><h3>Conclusion</h3><div>Whilst T2 Vessel Maps were found to capture fewer vessels than T1+Gd versions, they were reported useful in pediatric epilepsy surgery, avoiding the need for additional T1+Gd sequences.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111656"},"PeriodicalIF":1.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244391","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}
引用次数: 0
Impact of skull base cisterns invasion and extent of resection on the management of skull base intracranial epidermoid tumors 颅底池侵犯及切除程度对颅底颅内表皮样瘤治疗的影响。
IF 1.8 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-10-05 DOI: 10.1016/j.jocn.2025.111654
Samuel Moscovici , Nir Lavi , Andrew H. Kaye , Carlos Candanedo , José E. Cohen , Sergey Spektor
{"title":"Impact of skull base cisterns invasion and extent of resection on the management of skull base intracranial epidermoid tumors","authors":"Samuel Moscovici ,&nbsp;Nir Lavi ,&nbsp;Andrew H. Kaye ,&nbsp;Carlos Candanedo ,&nbsp;José E. Cohen ,&nbsp;Sergey Spektor","doi":"10.1016/j.jocn.2025.111654","DOIUrl":"10.1016/j.jocn.2025.111654","url":null,"abstract":"<div><h3>Background</h3><div>This study reports the authors’ experience with microsurgical resection of skull base epidermoid tumors, examining the relationship between the number of invaded intracranial subarachnoid cisterns (SC) and the extent of resection, recurrence and outcomes.</div></div><div><h3>Methods</h3><div>Data from 84 patients who underwent skull base epidermoid tumor resection between 2000 and 2022 were prospectively collected and retrospectively reviewed. Clinical presentations, imaging findings (including the number of invaded cisterns), and extent of resection were analyzed for their influence on postoperative complications and long-term outcomes, including progression-free survival (PFS), intervention-free survival (IFS), and overall survival (OS).</div></div><div><h3>Results</h3><div>A total of 84 patients were included (51 % female), with a mean age of 41.1 years. Headache was the most common symptom (39 %). The cerebellopontine angle (CPA) was the most frequently invaded cistern (71 %). The mean number of invaded cisterns was 5.8 (median: 4; range: 1–21), and the mean tumor volume was 26.1 cc (median: 18; range: 1–201.3). Gross total resection (GTR) was achieved in 40 patients (47.6 %), near-total resection (NTR) in 12 (14.3 %), subtotal resection (STR) in 22 (26.2 %), and partial resection (PR) in 10 (11.9 %). Patients with over 5 invaded cisterns had significantly lower GTR rates (p-value &lt; 0.001). Tumor volume was significantly associated with resection extent, tumors over 45 cc were more likely to recur (p-value = 0.004). Over a mean follow-up of 9.5 years, 32 patients (39 %) experienced tumor recurrence/regrowth. PFS was significantly longer after GTR (p &lt; 0.001). Thirteen patients (16 %) required reoperation due to recurrence. IFS did not differ significantly between the GTR and NTR (p = 0.114). Postoperative morbidity occurred in 40 patients (48 %), with no perioperative mortality.</div></div><div><h3>Conclusion</h3><div>Cisterns tumor invasion is more predictive of resection success than tumor volume. GTR prolongs PFS, although IFS remains similar between GTR and NTR. Epidermoid tumor management is challenging, and surgical complication rate is significant. Maximal safe resection is recommended.</div><div>Abbreviations: SC, Subarachnoid cistern; GTR, Gross total resection; NTR, Near total resection; STR, Subtotal resection; PR, Partial resection; PFS, Progression-free survival; IFS, Intervention-free survival; OS, Overall survival; CPA, Cerebellopontine angle; CSF, Cerebrospinal fluid; ITSTA, Infratranstentorial subtemporal approach; CD, Continuous drainage VPS, Ventriculo-peritoneal shunt; CPS, Cisto-peritoneal shunt; DVT, Deep vein thrombosis; SVT, Superficial vein thrombosis; CN, Cranial nerve.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111654"},"PeriodicalIF":1.8,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238696","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}
引用次数: 0
Adults are not just big kids: adults have higher reoperation and complication rates following lumbar laminectomy for tethered cord release 成年人不只是大孩子:成年人在腰椎椎板切除术后有更高的再手术率和并发症发生率
IF 1.8 4区 医学
Journal of Clinical Neuroscience Pub Date : 2025-10-03 DOI: 10.1016/j.jocn.2025.111664
Adeesya Gausper , Andrew Miller , Weston Wright , Justin K. Scheer , David Bonda , Tiffany G. Perry , Moise Danielpour , David L. Skaggs , Corey T. Walker , Alexander Tuchman
{"title":"Adults are not just big kids: adults have higher reoperation and complication rates following lumbar laminectomy for tethered cord release","authors":"Adeesya Gausper ,&nbsp;Andrew Miller ,&nbsp;Weston Wright ,&nbsp;Justin K. Scheer ,&nbsp;David Bonda ,&nbsp;Tiffany G. Perry ,&nbsp;Moise Danielpour ,&nbsp;David L. Skaggs ,&nbsp;Corey T. Walker ,&nbsp;Alexander Tuchman","doi":"10.1016/j.jocn.2025.111664","DOIUrl":"10.1016/j.jocn.2025.111664","url":null,"abstract":"<div><h3>Objective</h3><div>Tethered cord syndrome (TCS) is a neurological condition characterized by pathological tension on the spinal cord and is treated with surgical detethering. While traditionally considered a pediatric condition, TCS in adults likely differs in pathophysiology, clinical presentation, and surgical outcomes. This study aims to compare reoperation rates and early postoperative complications following tethered cord release (TCR) in pediatric and adult patients.</div></div><div><h3>Methods</h3><div>A retrospective study of the PearlDiver national insurance claims database was conducted. Patients who underwent lumbar laminectomy with release of tethered cord were identified and grouped into pediatric (&lt;18 years) and adult (≥18 years) cohorts. The primary outcome was rate of subsequent lumbar surgery within 2-years of index surgery, including repeat TCR, CSF leak repair, syrinx drainage, 3-column osteotomy, lumbar laminectomy, and lumbar fusion. Secondary outcomes included 90-day complication rates. Statistical significance was determined with chi-square analysis.</div></div><div><h3>Results</h3><div>5,780 pediatric and 1,670 adult patients were identified who underwent TCR. Average age at index surgery was 6.1 (± 4.9) years in the pediatric cohort and 41.6 (± 16.4) years in adults. The overall rate of subsequent lumbar surgery at 2-years following index surgery was significantly higher in adult patients (12.75 % vs 3.89 %, p &lt; 0.00001). The most common reoperation in both cohorts was CSF leak repair (7.66 % adult and 1.87 % pediatric patients at 2-years). Adult patients had a significantly higher 90-day complication rate (21.6 % vs 15.8 %, p &lt; 0.00001), and most complications in both cohorts were attributable to urinary tract infections.</div></div><div><h3>Conclusions</h3><div>Adult patients have nearly threefold increased risk of reoperation, over fourfold risk of CSF leak repair, and a higher rate of postoperative complications following TCR. These findings highlight the need for tailored surgical planning, patient counseling, and long-term follow-up in pediatric and adult patients undergoing TCR. It is important for surgeons to recognize the significantly higher rates of complications and reoperations in adults and to avoid applying pediatric outcomes to the adult population.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111664"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222791","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}
引用次数: 0
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