Journal of neurosurgical sciences最新文献

{"title":"Clear neuroimaging margin at the brain-tumor interface is associated with gross total resection and longer survival in non-enhancing diffuse gliomas.","authors":"Anand A Dharia, Domenico A Gattozzi, Joseph S Domino, Adam G Rouse, Roukoz B Chamoun","doi":"10.23736/S0390-5616.24.06221-0","DOIUrl":"10.23736/S0390-5616.24.06221-0","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to determine whether the presence of distinct glioma margins on preoperative imaging is correlated with improved intraoperative identification of tumor-brain interfaces and overall improved surgical outcomes of non-enhancing gliomas.</p><p><strong>Methods: </strong>This is a retrospective study of all primary glioma resections at our institution between 2000-2020. Tumors with contrast enhancement or with final pathology other than diffuse infiltrative glial neoplasm (WHO II or WHO III) were excluded. Tumors were stratified into two groups: those with distinct radiographical borders between tumor and brain, and those with ill-defined radiographical margins. Multivariate analysis was performed to determine the impact of clear preoperative margins on the primary outcome of gross-total resection.</p><p><strong>Results: </strong>Within the study period, 59 patients met inclusion criteria, of which 31 (53%) had distinct margins. These patients were predominantly younger (37.6 vs. 48.1 years, P=0.007). Tumor and other patient characteristics were similar in both cohorts, including gender, laterality, size, location, tumor type, grade, and surgical adjuncts utilized (P>0.05). Multivariate regression identified that distinct preoperative margins correlated with increased rates of gross total resection (P=0.02). Distinct margins on preoperative neuroimaging also correlated positively with surgeon identification of intra-operative margins (P<0.0001), fewer deaths over the study period (P=0.01), and longer overall survival (P=0.03).</p><p><strong>Conclusions: </strong>Distinct glioma-parenchyma margins on preoperative imaging are associated with improved surgical resection for diffuse gliomas, as distinct margins may correlate with distinguishable glioma-brain interfaces intraoperatively. Further prospective studies may discover additional clinical uses for these findings.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"245-252"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175505","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":"Assessing the predictive value of the Risk Analysis Index for short-term outcomes in acute spinal cord injury surgery.","authors":"Evan Courville, Kranti C Rumalla, Joshua Marquez, Joanna M Roy, Meic H Schmidt, Christian A Bowers","doi":"10.23736/S0390-5616.24.06189-7","DOIUrl":"10.23736/S0390-5616.24.06189-7","url":null,"abstract":"<p><strong>Background: </strong>Acute traumatic spinal cord injury (tSCI) requires rapid surgical intervention to maximize neurological function. Older patients comprise an increasingly larger proportion of SCI patients annually, necessitating accurate preoperative risk stratification tools. This study utilized a frailty-based preoperative risk stratification score to predict adverse events following non-elective neurosurgical intervention for acute tSCI patients.</p><p><strong>Methods: </strong>The National Inpatient Sample (NIS) was queried for acute tSCI patients aged ≥18 who underwent spine surgery in 2019-2020. The Risk Analysis Index (RAI) was implemented with crosstabulation, to analyze frailty scores with the following binary outcome measures: overall complications, non-home discharge (NHD), extended length of stay (eLOS) (>75^th percentile), and mortality. Area Under the Receiver Operating Characteristic (AUROC) analysis assessed the discriminative threshold of RAI compared to the modified 5-item Frailty Index (mFI-5) for NHD and 30-day mortality.</p><p><strong>Results: </strong>A total of 9995 SCI patients underwent non-elective spine surgery. There were 1525 perioperative complications (15.3%) and 510 (5.1%) mortalities. An increasing RAI score was significantly associated with increasing postoperative mortality rates: RAI 0-20 (1.5%, N.=45), RAI 21-30 (3.4%, N.=110), RAI 31-40 (6.8%, N.=115), and RAI>41 (11.8%, N.=240) (P<0.001). RAI demonstrated superior discrimination compared to the mFI-5 for mortality and NHD with a C-statistic >0.72.</p><p><strong>Conclusions: </strong>Increasing frailty, as measured by RAI, was a reliable predictor of non-home discharge and 30-day mortality for SCI patients who underwent non-elective spinal surgery and RAI demonstrated superior discrimination compared to the mFI-5 for NHD and mortality.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"276-283"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446319","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":"Limits and usefulness of intraoperative evoked potentials during laminoplasty.","authors":"Rossella Rispoli, Christian Lettieri, Giada Pauletto, Gabriele Valiante, Yan Tereshko, Barbara Cappelletto","doi":"10.23736/S0390-5616.23.06077-0","DOIUrl":"10.23736/S0390-5616.23.06077-0","url":null,"abstract":"<p><strong>Background: </strong>Over the past 10 years, intraoperative neurophysiological monitoring (IONM) has been widely performed during surgery for treating spondylotic cervical myelopathy. Our study considers the predictive value of IONM during laminoplasty, regarding, first, the adequacy of spinal cord decompression and, second, the long-term neuro-functional outcome.</p><p><strong>Methods: </strong>We considered 38 patients with the diagnosis of degenerative cervical myelopathy who underwent an open-door laminoplasty. All patients were evaluated preoperatively, and at three and 12 months postoperatively, with the Japanese Orthopedic Association (JOA) point scale. Upper and lower limb somatosensory and motor evoked potentials (SSEPs and MEPs) were recorded preoperatively and intraoperatively.</p><p><strong>Results: </strong>During surgery, three of 38 patients showed a deterioration of SSEPs and MEPs compared to baseline values. Surgery was then converted from laminoplasty to laminectomy, resulting in the gradual restoration of the evoked potentials. The neurophysiological parameter significantly associated with a better clinical outcome was the latency of lower limbs MEPs. The 12 patients who had a more prominent reduction of the MEPs latency at the end of surgery showed a higher post-surgical JOA score, increasing ≥30% compared to baseline values at the 3- and 12-month follow-up.</p><p><strong>Conclusions: </strong>Though not a predictor of clinical outcome, the IONM was essential to evaluate the effectiveness of spinal cord decompression. Reduced latency of lower limbs MEPs may predict a better clinical outcome. We suggest that IONM in patients with degenerative cervical myelopathy should be routine. It is necessary to conduct larger studies to clarify the predictive value of IONM.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"260-267"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136397766","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":"O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) PET as a potential selection tool for second surgery in glioblastoma patients.","authors":"Orazio S Santonocito, Gianluca Grimod, Anna L DI Stefano, Francesco Pieri, Mariagrazia Nizzola, Nicola Mazzuca, Francesco Pasqualetti, Riccardo Morganti, Vanna Zucchi, Carlo Gambacciani","doi":"10.23736/S0390-5616.23.06019-8","DOIUrl":"10.23736/S0390-5616.23.06019-8","url":null,"abstract":"<p><strong>Background: </strong>Treatment-related changes still represent a diagnostic challenge in the management of patients with suspect of recurrent glioblastoma. The specificity of conventional MRI in detecting recurrence remains limited. Brain PET imaging provides information on tumor metabolism and can contribute to improving the diagnostic accuracy of cerebral neoplasms. We performed a retrospective analysis to evaluate the clinical value of O-(2-¹⁸F-fluoroethyl)-L-tyrosine (¹⁸F-FET) PET in the diagnosis of glioblastoma recurrence.</p><p><strong>Methods: </strong>A retrospective analysis on patients considered suitable for salvage surgery for recurrence glioblastoma was performed. ¹⁸F-FET-PET was performed to investigate gadolinium enhancement suspected for recurrence. Static and kinetic ¹⁸F-FET parameters were analyzed and related to O-6-methylguanine-DNA methyltransferase (MGMT) status.</p><p><strong>Results: </strong>Forty-two of the 51 patients who underwent ¹⁸F-FET-PET were re-operated. In each case, neuropathological diagnosis of tumor recurrence was confirmed. pMGMT hypermethylation was detected in 21 patients. Mean tumor-to-brain ratios (TBR) max was 3.87 (range 2.6-6.0). Static and kinetic ¹⁸F-FET parameters were similar according to MGMT status.</p><p><strong>Conclusions: </strong>¹⁸FET-PET can be a reliable tool to improve the selection of patients suitable for salvage surgery for glioblastoma recurrence.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"253-259"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138830111","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":"Frailty predicts non-home discharge in anterior lumbar interbody fusion patients.","authors":"Derek B Asserson, Danielle A Alaouieh, Joanna M Roy, Meic H Schmidt, Christian A Bowers","doi":"10.23736/S0390-5616.24.06179-4","DOIUrl":"10.23736/S0390-5616.24.06179-4","url":null,"abstract":"<p><strong>Background: </strong>Anterior lumbar interbody fusion (ALIF) is a well-established surgical approach in the treatment of degenerative pathology, trauma, infection, and neoplasia of the spine. This study sought to assess the usefulness of frailty as a predictor of non-home discharge (NHD) for patients who undergo the procedure.</p><p><strong>Methods: </strong>Patient cases were extracted from the American College of Surgeons's National Surgical Quality Improvement Program database from 2012 to 2020. Univariable and receiver operating characteristic curve analyses were used to compare the 5-item Modified Frailty Index (mFI-5) to the Revised Risk Analysis Index (RAI-rev) in relation to NHD.</p><p><strong>Results: </strong>Simple linear regression demonstrated that increasing frailty was associated with an increased likelihood of NHD among 25,317 patients (mFI-5 odds ratio: 2.13, 3.23, 8.4; RAI-rev odds ratio: 3.22, 9.6, 23.6 [P<0.001 for all]). In each instance, a Cochran-Armitage trend test was significant (P<0.001), indicating a linear association of increasing odds. The RAI-rev resulted in a C-statistic of 0.722, compared to 0.628 for the mFI-5, and was shown to have superior discriminative ability with a DeLong Test (P<0.001).</p><p><strong>Conclusions: </strong>Frailty, as measured by mFI-5 and RAI-rev, was associated with an increased likelihood of NHD in patients who underwent ALIF. This finding supports recent literature on the promising utility of these indices, especially the RAI-rev, in preoperative decision-making across multiple facets of neurosurgery.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"284-289"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140049690","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":"Pre-surgical planning with extended reality in neurosurgery: a survey-based study describing a preliminary experience in Italy.","authors":"Alessio Iacoangeli, Sergio Capelli, Andrea Held, Matteo Barba, Alessandra Marasi, Alessandro DE Benedictis, Maurizio Iacoangeli, Davide Locatelli, Marco M Fontanella, Carlo G Giussani, Davide Luglietto, Maria C Rossi Espagnet, Carlo E Marras","doi":"10.23736/S0390-5616.24.06355-0","DOIUrl":"10.23736/S0390-5616.24.06355-0","url":null,"abstract":"<p><strong>Background: </strong>Extended reality (XR) systems play an increasingly role in preoperative planning in different surgical fields including neurosurgery. Considering educational purposes, not all residents have the same opportunities to learn and deal with XR. Thus, the authors sought to evaluate the perspectives of an Italian sample of neurosurgical trainees on XR, and to size the impact of these developing technologies on the learning curve of a small group of residents coming from different Italian Institutions.</p><p><strong>Methods: </strong>A 23-question cross-sectional survey was administered to 32 neurosurgery residents nationwide to evaluate their perspectives and experience on XR in a neurosurgical setting. A specific 20-question survey was administered to a pilot group of 5 trainees, working at the Bambino Gesù Children's Hospital, to evaluate their experience with daily-use of XR and to probe its impact on their learning curve a period of 3 months.</p><p><strong>Results: </strong>The majority of the interviewed perceived XR as effective in simulating the real surgical scenario both in terms of anatomy and surgical trajectory. These results also reflect the subjective perception of the five trainee-pilot group which report a progressive confidence on the surgical case management.</p><p><strong>Conclusions: </strong>This preliminary study suggests XR as an effective tool which can positively influence trainees' education. There is a broad perception of its beneficial impact even in contexts where XR is not frequently available. Further and larger studies are necessary in our country to better understand and standardize these results.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"236-244"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408734","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":"Pycnogenol® improves retinal microcirculation and symptoms of optic nerve ischemic damage after sudden, reversible unilateral loss of vision: a pilot evaluation.","authors":"Gianni Belcaro, Maria R Cesarone, Claudia Scipione, Valeria Scipione, David Cox, Roberto Cotellese, Mark Dugall, Morio Hosoi, Marcello Corsi, Beatrice Feragalli, Corrado Gizzi, Patrizia Torino Rodrigues","doi":"10.23736/S0390-5616.24.06374-4","DOIUrl":"https://doi.org/10.23736/S0390-5616.24.06374-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The aim of this pilot registry study was to investigate the use of Pycnogenol&lt;sup&gt;®&lt;/sup&gt; (French maritime pine bark, standardized extract) in subjects 2 weeks after an episode of sudden loss of vision (SLV).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Visual acuity, retinal edema, vasospasms, distal retinal circulation and blood flow at the Zinn-Haller circle (distal optic nerve) were examined over 4 weeks. In addition, symptoms of neurological alterations (ION: ischemic optic neuritis) associated with retinal flow decrease were monitored. One registry group used only the standard management (SM, control group), a second group used SM+ 150 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt;/day (Pycno150) and another group used SM+100 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; /day (Pycno100).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sixty subjects completed the study. 18 in the control group, 20 in the Pycno150 group and 22 subjects in the Pycno100 group. The registry groups were comparable at inclusion. No dropouts were observed in the two Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups whereas 2 dropouts occurred in the SM group (due to the occurrence of a new, minor visual loss episode). No side effects or tolerability problems were observed during the registry study. After 4 weeks, the visual acuity score of the affected eye was significantly higher in the Pycno150 group compared to the Pycno100 group and both Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups showed significantly higher acuity scores in comparison with controls using SM (P&lt;0.05). In parallel, after 4 weeks, the retinal edema score was significantly lower in both Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups compared to controls (P&lt;0.05 vs. SM patients) and even lower (P&lt;0.05) with the 150 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; dose compared to the 100 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; dose. After 4 weeks, retinal systolic and diastolic blood flow velocities of the affected eye were significantly higher in the two Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups in comparison with controls using SM (P&lt;0.05). The improvements in 150 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; group were significantly higher compared to the low-dose 100 mg/Pycnogenol&lt;sup&gt;®&lt;/sup&gt; group (P&lt;0.05). At the end of the study, blood flow velocity in the Zinn-Haller circle was significantly higher in both Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups compared to the control group (P&lt;0.05) and was higher (P&lt;0.05) with the 150 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; dose compared to the 100 mg dose. ION symptoms (vision loss, visual field loss, loss of color vision, flashing lights) improved significantly in the Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups compared to controls (P&lt;0.05), with better improvements in the Pycno150 group compared to the Pycno100 group (P&lt;0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The study showed a dose-dependent effect of Pycnogenol&lt;sup&gt;®&lt;/sup&gt; on blood flow velocity increase, reduction of retinal edema, ION symptoms and increase in visual acuity. Pycnogenol&lt;sup&gt;®&lt;/sup&gt; was shown to be effective and safe in improving retinal microcirculation after an episode o","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150682","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":"Ventriculo-atrial shunt and European regulations: a delicate balance.","authors":"Luca Massimi, Marco Obersnel, Paolo Frassanito, Federico Bianchi, Gianpiero Tamburrini","doi":"10.23736/S0390-5616.25.06465-3","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06465-3","url":null,"abstract":"<p><strong>Background: </strong>European regulations on medical devices have been introduced to improve medical standards. However, these changes are leading to the transient lack of medical tools with possible disadvantages. Herein, the problem is addressed for the first time in neurosurgery with regards to ventriculo-atrial shunt (VAS).</p><p><strong>Methods: </strong>Children undergoing VAS in the 2020-2022 period at a single Institution were enrolled. Patients receiving VAS with Pudenz cardiac catheter (distal slit \"valves\") were assigned to group A (2020-2021) while those with VAS harboring proximal adjustable valve to group B (2021-2022, Pudenz no more available). The complications leading to shunt malfunction within 2 years from VAS were analyzed.</p><p><strong>Results: </strong>Twenty-four children belonged to group A (M/F ratio: 2.4; mean age: 42.5 months) and 18 to group B (MF/ratio: 1.8, mean age: 48.1 months). Statistically significant differences were found about: 1) patients needing shunt revision: 7 cases (29%) in group A vs. 11 cases (61%) in group B; 2) number of shunt revisions: 8 in group A vs. 16 in group B; 3) number of children with mechanical complications: 2 (8.3%) in group A vs. 7 (39%) in group B; 4) number of mechanical complications: 2 (group A) vs. 9 (group B). No differences in other complications or placement-to-revision time were detected.</p><p><strong>Conclusions: </strong>The lack of simple surgical tools (Pudenz catheter) may make VAS more prone to mechanical complications. Prospective and multicenter trials are needed to produce scientific evidence. In the meantime, a multidisciplinary discussion on the European regulation (including Doctors and Manufacturers) is welcome.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150686","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":"Increased preoperative levels of circulating erythrocytic hemoglobin might predict high-grade histology (WHO grade 2-3) in falcine and parasagittal meningiomas.","authors":"Filippo Gagliardi, Silvia Snider, Pierfrancesco DE Domenico, Matteo Braga, Lina R Barzaghi, Gianluca Nocera, Marcella Callea, Maria R Terreni, Pietro Mortini","doi":"10.23736/S0390-5616.24.06371-9","DOIUrl":"https://doi.org/10.23736/S0390-5616.24.06371-9","url":null,"abstract":"<p><strong>Background: </strong>Falcine/parasagittal lesions account for the largest rate of high-grade (WHO grade 2-3) lesions. The ability to preoperatively estimate the tumors' grade and outcome would be of great value in customizing treatment.</p><p><strong>Methods: </strong>This is a single-center, retrospective study designed to assess the pre-operative peripheral blood markers' diagnostic and prognostic role in patients harboring falcine (FM) and parasagittal (PM) high-grade meningiomas. N=116 patients undergoing surgical resection were included. A propensity score-matched analysis accounted for gender imbalances in low-grade (LG) vs. high-grade (HG) cohorts.</p><p><strong>Results: </strong>Seventy-three (N.=73) FM (63%) and 43 PM (37%) lesions were included. Patients harboring HG lesions showed significantly higher Hb levels than LG (mean 14.5±1.40 vs. 13.5±1.16 g/dL, P<0.001). Multivariate analysis controlling for demographics, lesion characteristics, blood markers, and steroid dose confirmed preoperative Hb as an independent predictive value of lesion grade (OR 1.75, 95% CI:1.01-3.07, P=0.04). Accordingly, patients showing increased Hb levels >15.4 g/dL achieved shorter OS (60.4 months, 95% CI: 14.7-106.1 vs. 134.7 months, 95% CI: 111.2-158.2) compared to patients with lower Hb values, P<0.001. Data were confirmed in matched cohorts.</p><p><strong>Conclusions: </strong>Increased levels of circulating erythrocytic hemoglobin might be independent predictors for high-grade histology and be associated with shorter overall survival in falcine and parasagittal meningiomas.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111001","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":"Optimal MGMT promoter methylation cut-off to predict better survival in glioblastoma patients undergoing gross-total resection.","authors":"Claudia Fanizzi, Petra Bintintan-Socaciu, Elena Pirola, Giorgio Fiore, Ilaria Carnicelli, Leonardo Tariciotti, Andrea Parlangeli, Elena Scagliotti, Silvia M Tabano, Gianluca Lopez, Stefano Ferrero, Stefania Navone, Laura Guarnaccia, Giovanni Marfia, Manuela Caroli, Marco Locatelli","doi":"10.23736/S0390-5616.25.06421-5","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06421-5","url":null,"abstract":"<p><strong>Background: </strong>O6-Methylguanine-DNA methyltransferase (MGMT) promoter percentage of methylation in gliomas has been proved to be the most important predictive factor in temozolomide (TMZ) response. Nevertheless, an agreement about the cut-off to discriminate between a \"methylated\" and \"unmethylated\" status has not been reached yet. Many reports have analyzed the correlation between methylated status cut-off and survival, but they lacked sample homogeneity. Our aim was to calculate a clinical significant cut-off considering a homogenous group of patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 96 patients who underwent a complete removal of glioblastoma in our Institution. All the patients underwent to radiation therapy plus concomitant TMZ and twelve cycles of adjuvant TMZ as described by Stupp. Receiver operating characteristic (ROC) curve analysis was performed and 21% was determined as the optimal cut-off.</p><p><strong>Results: </strong>The median OS was significantly higher in methylated patients compared to unmethylated ones (median 48 months vs 22 months respectively 95% CI 30-42 vs. 15-19, P<0.001). No difference was observed for PFS. The multivariate analysis with Cox regression model identified MGMT methylation status as an independent predictive factor for OS (P<0.001).</p><p><strong>Conclusions: </strong>We confirmed the prognostic role of MGMT methylation status even in a highly selective group of patients with the best outcome. We calculated a cut-off of 21% to be highly predictable of survival.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986544","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}