Journal of neurosurgery最新文献

{"title":"Letter to the Editor. Exploring the impact of cranioplasty timing in TBI.","authors":"K Syed Ali Munavar","doi":"10.3171/2024.10.JNS242460","DOIUrl":"https://doi.org/10.3171/2024.10.JNS242460","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":3.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor. Is autologous muscle better than Teflon in MVD for trigeminal neuralgia?","authors":"Zihao Zhang, Qingpei Hao, Wentao Zheng, Ruen Liu","doi":"10.3171/2024.9.JNS242271","DOIUrl":"https://doi.org/10.3171/2024.9.JNS242271","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comprehensive multicenter analysis of clinical, molecular, and imaging characteristics and outcomes of H3 K27-altered diffuse midline glioma in adults.","authors":"Yongsik Sim, Andrew C McClelland, Kaeum Choi, Kyunghwa Han, Yae Won Park, Sung Soo Ahn, Jong Hee Chang, Se Hoon Kim, Sharon Gardner, Seung-Koo Lee, Rajan Jain","doi":"10.3171/2024.8.JNS241180","DOIUrl":"https://doi.org/10.3171/2024.8.JNS241180","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to comprehensively investigate the clinical, molecular, and imaging characteristics and outcomes of H3 K27-altered diffuse midline glioma (DMG) in adults.</p><p><strong>Methods: </strong>Retrospective chart and imaging reviews were performed in 111 adult patients with H3 K27-altered DMG from two tertiary institutions. Clinical, molecular, imaging, and survival characteristics were analyzed. Characteristics were compared between adult and 365 pediatric patients from a previous multicenter meta-analysis dataset. Cox analyses were performed to determine predictors of overall survival (OS) in adult patients.</p><p><strong>Results: </strong>The median (range) age of adult patients was 40 (18-75) years, and 64 males and 47 females were included. Adults had a higher male proportion (57.7% vs 45.3%, p = 0.023), lower proportion of histological grade 4 (41.4% vs 74.0%, p < 0.001), and different tumor locations (p < 0.001) compared with pediatric patients; adults commonly showed a thalamus location (41.5%) followed by the spinal cord (27.0%), whereas pediatric patients predominantly showed a pons location (64.9%). The OS of adults was longer than that of pediatric patients (30.3 vs 12.0 months, p < 0.001, log-rank test). Older age at diagnosis (HR 0.96, p = 0.001), histologically lower grade (HR 0.25, p = 0.003), and gross-total resection of nonenhancing tumor (HR 0.15, p = 0.003) were independent favorable prognostic factors.</p><p><strong>Conclusions: </strong>Adult patients with H3 K27-altered DMG showed distinct clinical, histological, and imaging characteristics compared to pediatric counterparts, with a significantly better prognosis. The authors' results suggest that aggressive surgery should be pursued when deemed feasible for better survival outcomes.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging thrombolysis versus direct endovascular treatment in acute vertebrobasilar artery complex occlusion.","authors":"Feng Zhang, Pan Zhang, Jinghui Zhong, Lulu Xiao, Yingjie Xu, Dezhi Liu, Yongjun Jiang, Li Wu, Zheng Dai, Juehua Zhu, Zhixin Huang, Xinfeng Liu, Wen Sun","doi":"10.3171/2024.8.JNS24648","DOIUrl":"https://doi.org/10.3171/2024.8.JNS24648","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular treatment (EVT) is an effective treatment for patients with acute vertebrobasilar artery complex occlusion (VBAO). However, the benefit of bridging thrombolysis prior to EVT remains controversial. The purpose of the present study is to explore the best treatment strategy between bridging treatment (BT) and direct EVT in patients with acute VBAO.</p><p><strong>Methods: </strong>Patients with acute VBAO who underwent EVT within 24 hours of estimated occlusion in a nationwide retrospective registry at 65 stroke centers in 15 provinces in China from December 2015 to June 2022 were retrospectively analyzed. The outcomes of the BT and direct EVT groups were compared using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). The primary outcome was favorable functional outcome, defined as a 90-day modified Rankin Scale (mRS) score of 0-3. Secondary outcomes included 90-day functional independence (mRS score 0-2), mRS score shift, in-hospital mortality, successful reperfusion, and symptomatic intracranial hemorrhage (sICH). In addition, a meta-analysis integrating currently available evidence was performed to make a systematic comparison between the two treatment strategies.</p><p><strong>Results: </strong>A total of 2353 patients were ultimately included; 447 of these patients received BT and 1906 received direct EVT. In both the original cohort and in the 1:1 PSM analysis, patients in the BT group had a significantly higher rate of favorable functional outcome (adjusted odds ratio [aOR] 1.41, 95% CI 1.14-1.76 for the original cohort and aOR 1.44, 95% CI 1.07-1.92 for 1:1 PSM). Regarding secondary outcomes, patients with BT had a significantly lower rate of in-hospital mortality (aOR 0.67, 95% CI 0.51-0.88 for the original cohort and aOR 0.69, 95% CI 0.48-0.99 for 1:1 PSM) and a shift toward better outcomes on the mRS (aOR 1.35, 95% CI 1.12-1.63 for the original cohort and aOR 1.31, 95% CI 1.03-1.69 for 1:1 PSM). However, there were no significant differences in functional independence, successful reperfusion, and sICH between the two groups. A meta-analysis, which included 22 studies involving 6579 patients, also revealed the superiority of BT over direct EVT on favorable functional outcome (OR 1.19, 95% CI 1.03-1.37, I2 = 0.00%; p = 0.02).</p><p><strong>Conclusions: </strong>This matched-control study and meta-analysis suggest that compared with direct EVT, BT may be associated with better functional outcomes in patients with acute VBAO treated within 24 hours of estimated occlusion.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between meningioma consistency and surgical outcomes.","authors":"Ishan Shah, Ryan S Chung, Kevin Liu, David J Cote, Robert G Briggs, Gage Guerra, David Gomez, Max Yang, Jeffrey J Feng, Alex Renn, Mark S Shiroishi, Kyle Hurth, Racheal Peterson, Gabriel Zada","doi":"10.3171/2024.8.JNS241066","DOIUrl":"https://doi.org/10.3171/2024.8.JNS241066","url":null,"abstract":"<p><strong>Objective: </strong>Tumor consistency, or fibrosity, affects the ability to optimally resect meningiomas, especially with recent trends evolving toward minimally invasive approaches. The authors' team previously validated a practical 5-point scale for intraoperative grading of meningioma consistency. The impact of meningioma consistency on surgical management and outcomes, however, has yet to be explored. This study aimed to determine associations between meningioma consistency and presenting symptoms, tumor characteristics, and postoperative outcomes.</p><p><strong>Methods: </strong>A total of 209 surgically resected meningiomas were intraoperatively assigned a consistency grade according to a previously validated 5-point scale, ranging from extremely soft, suctionable tumors (grade 1) to firm/calcified tumors (grade 5). Presenting symptoms, tumor characteristics, postoperative complications, and surgical outcomes for these patients were prospectively collected. Tumor consistency was analyzed in three categories (grades 1 and 2, grade 3, and grades 4 and 5), using ANOVA, chi-square or Fisher's exact tests, and univariable logistic regression to evaluate associations between consistency and perioperative characteristics.</p><p><strong>Results: </strong>The study cohort included 209 patients, of whom 48 (23%) were males with a mean age of 55.0 ± 13.7 years. Meningioma consistency distribution was as follows: grades 1 and 2 (n = 23, 11.0%), grade 3 (n = 88, 42.1%), and grades 4 and 5 (n = 98, 46.9%). The majority of meningiomas were skull base tumors (n = 144, 68.9%). Higher-consistency tumors were associated with lower rates of gross-total resection (OR 0.24, 95% CI 0.13-0.46; p < 0.001), increased invasiveness (OR 4.73, 95% CI 1.53-14.60; p = 0.007), tumor recurrence following resection (OR 3.30, 95% CI 1.25-8.66; p = 0.016), reoperation (OR 3.08, 95% CI 1.16-8.14; p = 0.024), and increased complication rates (OR 2.08, 95% CI 1.05-4.15; p = 0.037). No significant associations were identified with preoperative symptoms, tumor size (mean 4.04 ± 1.50 cm), or duration of surgery (mean 4.26 ± 1.60 hours) (all p > 0.05).</p><p><strong>Conclusions: </strong>Tumor consistency is associated with important meningioma characteristics and perioperative outcomes. A prior knowledge pertaining to meningioma consistency and tumor characteristics using advanced imaging is a priority and may provide surgeons with meaningful data to guide resection strategy and anticipate postoperative outcomes and complications.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repetitive and extensive focused ultrasound-mediated bilateral frontal blood-brain barrier opening for Alzheimer's disease.","authors":"Byoung Seok Ye, Kyung Won Chang, Sungwoo Kang, Seun Jeon, Jin Woo Chang","doi":"10.3171/2024.8.JNS24989","DOIUrl":"https://doi.org/10.3171/2024.8.JNS24989","url":null,"abstract":"<p><strong>Objective: </strong>Focused ultrasound (FUS)-mediated blood-brain barrier (BBB) opening is safe and potentially beneficial in patients with Alzheimer's disease (AD) for the removal of amyloid-beta (Aβ) plaques. However, the optimal BBB opening intervals and number of treatment sessions for clinical improvement remain undefined. Therefore, the aim of this study was to evaluate the safety and benefits of repeated and more extensive BBB opening alone.</p><p><strong>Methods: </strong>In this open-label prospective study, 6 patients with AD were enrolled from June 2022 to July 2023. FUS-mediated BBB opening was performed three times at 2-month intervals targeting the bilateral frontal lobes. 18F-florbetaben positron emission tomography (FBB-PET) was performed before the first procedure and after the third procedure. Patients were administered neuropsychological and neuropsychiatric evaluations.</p><p><strong>Results: </strong>All 6 participants completed the study without any acute treatment-related adverse events. An extensive area of BBB opening (mean 43.1 cm3), more than twice as large as the opening volume (mean 20 cm3) in the authors' previous study, was confirmed by contrast-enhanced MRI. FBB-PET scans demonstrated a 14.9-Centiloid average decrease in Aβ plaques in 4 of the 6 participants (67%), but the Aβ plaques increased in 2 participants after BBB opening, compared with baseline. No significant changes were observed in the Korean version of the Mini-Mental State Examination in either group. Caregiver-Administered Neuropsychiatric Inventory scores improved in 5 of 6 participants (83%), indicating an improvement in neuropsychiatric symptoms.</p><p><strong>Conclusions: </strong>This study confirmed the safety and efficacy of more frequent and extensive bilateral frontal BBB opening over multiple sessions in patients with AD. Furthermore, this is the first clinical trial to demonstrate improvement in neuropsychiatric symptoms through BBB opening alone, without concurrent administration of antibody medications.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness analysis of deep brain stimulation versus treatment as usual for treatment-resistant obsessive-compulsive disorder.","authors":"Ricardo A Najera, Katherine E Kabotyanski, Nicole C McLaughlin, Sean T Gregory, Adrish Anand, Ben Shofty, Nicole R Provenza, Eric A Storch, Wayne K Goodman, Sameer A Sheth","doi":"10.3171/2024.7.JNS232642","DOIUrl":"https://doi.org/10.3171/2024.7.JNS232642","url":null,"abstract":"<p><strong>Objective: </strong>Deep brain stimulation (DBS) is an effective neurosurgical option for patients with treatment-resistant obsessive-compulsive disorder (OCD). Despite being more costly than neuroablative procedures of comparable efficacy, DBS has gained popularity over the years for its reversibility and adjustability. Although the cost-effectiveness of DBS has been investigated extensively in movement disorders, few economic analyses of DBS for psychiatric disorders exist. In this study, the authors present the first cost-effectiveness analysis of DBS for treatment-resistant OCD in the United States.</p><p><strong>Methods: </strong>The authors developed four decision analytical models to compare the cost-effectiveness of DBS with treatment as usual (TAU) for OCD, varying either the device type (i.e., nonrechargeable or rechargeable) or the time horizon (i.e., 3 or 5 years) in each model. Treatment response and complication rates were based on a literature review. Published algorithms were used to convert Yale-Brown Obsessive Compulsive Scale scores into utility scores reflecting improvements in quality of life. Costs were approached from the healthcare sector perspective and were drawn primarily from Medicare facility and physician reimbursement rates. For each model, a Monte Carlo simulation (n = 100,000) and probabilistic sensitivity analysis were performed to estimate the incremental cost-effectiveness ratio (ICER) in US dollars per quality-adjusted life year (QALY).</p><p><strong>Results: </strong>Data from 249 and 265 treatment-resistant OCD patients from the published literature who received DBS and had sufficient follow-up in 3- and 5-year models, respectively, were included. When conventional US willingness-to-pay (WTP) thresholds were used, nonrechargeable DBS models were less cost-effective (3-year ICER: $108,431/QALY; 5-year ICER: $203,202/QALY) and rechargeable DBS models were more cost-effective (3-year ICER: $49,363/QALY; 5-year ICER: $41,495/QALY) than TAU. At a WTP threshold of $100,000/QALY, rechargeable DBS devices were moderately more cost-effective than TAU at 3 and 5 years in 100% of iterations. At a WTP threshold of $50,000/QALY, rechargeable DBS devices were definitively more cost-effective than TAU at 3 and 5 years in 54% and 89% of iterations, respectively. When using WHO WTP conventions, 3- and 5-year nonrechargeable models were cost-effective in 100% and 84% of iterations, and 3- and 5-year rechargeable models were highly cost-effective in 99% and 100% of iterations, respectively.</p><p><strong>Conclusions: </strong>Rechargeable DBS models were cost-effective for treatment-resistant OCD compared with TAU. Nonrechargeable DBS models may be cost-effective, especially with improvement in battery longevity and changes in accepted WTP thresholds.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor. Microelectrode recording and brain hemorrhage: is the evidence convincing?","authors":"Quintino Giorgio D'Alessandris, Alessandro Izzo, Manuela D'Ercole, Nicola Montano","doi":"10.3171/2024.10.JNS242474","DOIUrl":"https://doi.org/10.3171/2024.10.JNS242474","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial. Cost-effectiveness analysis as a tool for achieving equitable access to deep brain stimulation for patients with obsessive-compulsive disorder.","authors":"Somnath Das, J Nicole Bentley","doi":"10.3171/2024.9.JNS241710","DOIUrl":"https://doi.org/10.3171/2024.9.JNS241710","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors for traumatic cerebral contusion volume, expansion, and outcomes.","authors":"Parker D Smith, Ishav Shukla, Faraaz Azam, Daniel Trautmann, Evan Gee, Madison Korb, Michael Pitonak, Srivats Srinivasan, James P Caruso, Christie Caldwell, Kristen Hall, Mazin Al Tamimi, Joan Reisch, Nicole M Bedros, Salah G Aoun","doi":"10.3171/2024.8.JNS241051","DOIUrl":"https://doi.org/10.3171/2024.8.JNS241051","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic hemorrhagic cerebral contusions are a well-established cause of morbidity and mortality in neurosurgery. This study aimed to determine prognostic factors for long-term functional outcomes and longitudinal contusion volume changes in traumatic brain injury (TBI) patients.</p><p><strong>Methods: </strong>Data from 285 patients with traumatic cerebral contusions were retrospectively reviewed to identify variables predictive of initial contusion volume, contusion expansion on short-term follow-up imaging, and functional outcomes according to the modified Rankin Scale (mRS). Predictors of these variables were identified using a stepwise logistic regression analysis.</p><p><strong>Results: </strong>Older age, larger initial contusion volumes, and lower presenting Glasgow Coma Scale (GCS) scores were associated with worse functional outcomes (mRS score ≥ 3). Patients with contusion volumes ≥ 15 ml at presentation had lower GCS scores and longer ICU stays (in days). Older age (OR 1.043, CI 1.024-1.063), need for a craniotomy or craniectomy (OR 2.562, CI 1.010-6.502), longer ICU stay (OR 1.092, CI 1.034-1.154), and lower total GCS score (OR 0.781, CI 0.729-0.836) were associated with worse functional outcomes. Additionally, lower admission GCS verbal score was a significant predictor of larger initial contusion volume (OR 0.779, 95% CI 0.667-0.911) and contusion expansion during hospitalization (OR 0.649, 95% CI 0.497-0.847).</p><p><strong>Conclusions: </strong>Functional outcomes in traumatic cerebral contusion patients may be associated with age and admission GCS score, and verbal GCS score may predict initial contusion volume and contusion expansion. These findings supplement an evolving understanding of factors that influence outcomes in patients with cerebral contusions, and further study into the utility of GCS to guide these decisions could help to guide the clinical management of these highly complex patients.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}