Journal of neurosurgery最新文献

{"title":"Early multimodal neurointerventional and neurosurgical management of penetrating craniocerebral injuries: wartime experience from Ukraine.","authors":"Andrii Sirko, Yurii Cherednychenko, Ehsan Dowlati, Rocco A Armonda","doi":"10.3171/2024.10.JNS241938","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241938","url":null,"abstract":"<p><strong>Objective: </strong>The war in Ukraine has resulted in a large number of penetrating head wounds with concomitant neurovascular injuries. The aim of this report was to review these patients and demonstrate a multimodal treatment approach used for these complex injuries. This entails a combination of early endovascular and open surgical treatment for optimal outcome.</p><p><strong>Methods: </strong>This is a prospective study from a single civilian clinical center near the combat frontlines in Dnipro, Ukraine (Mechnikov Dnipropetrovsk Regional Clinical Hospital [MDRCH]). All injuries were sustained during Russia's invasion. Data were collected for a 28-month period from February 24, 2022, to June 24, 2024. The patients with intracranial neurovascular injuries were evaluated and their management and outcomes were documented and analyzed.</p><p><strong>Results: </strong>Within the study period, 1310 patients with head and neck injuries underwent invasive angiography and, of these, 20 patients (1.5%) were diagnosed with intracranial arterial traumatic injury including traumatic intracranial aneurysms or arteriovenous fistulas. On admission, the Glasgow Coma Scale score ranged from 5 to 15 (median 10). A total of 15 patients (75.0%) were diagnosed with traumatic intracranial aneurysm(s), 2 (10.0%) with traumatic direct carotid cavernous fistulas, and 3 patients (15.0%) had traumatic dural arteriovenous fistulas. In 8 patients (40.0%), there was concurrent damage to the paranasal sinuses. Autologous tissue was used for skull base reconstruction in all cases. Endovascular intervention was performed in 14 patients (70.0%). Surgical intervention immediately followed angiography or endovascular intervention in 14 patients (70.0%). The length of stay at the MDRCH ranged from 3 to 20 days (mean 8.6 days). The Glasgow Coma Scale score at the time of discharge ranged from 8 to 15 (median 13). There was 1 death (5.0%) due to sequelae of severe vasospasm. The Glasgow Outcome Scale score at 1 month after the injury in the other 19 patients ranged from 2 to 5 (median 4).</p><p><strong>Conclusions: </strong>Early angiographic diagnosis of traumatic neurovascular complications after penetrating head injury allows for their effective management and treatment. The authors propose early comprehensive endovascular and surgical intervention for penetrating craniocerebral injuries. This case series demonstrates that this approach may optimize outcomes in wartime neurovascular injuries.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527827","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":"Safety and therapeutic impact of stereotactic biopsy in very elderly patients with brain tumors.","authors":"Louise Deboeuf, Maximilien Riche, Henri Malaizé, Pauline Marijon, Karima Mokhtari, Franck Bielle, Suzanne Tran, Lucia Nichelli, Julian Jacob, Mehdi Touat, Khê Hoang-Xuan, Caroline Houillier, Florence Laigle-Donadey, David Reinecke, Maximilian I Ruge, Ahmed Idbaih, Bertrand Mathon","doi":"10.3171/2024.10.JNS241948","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241948","url":null,"abstract":"<p><strong>Objective: </strong>There is a lack of data regarding the benefit-risk ratio and therapeutic value of brain biopsy in very elderly patients with brain tumors. This study aimed to evaluate the safety of stereotactic biopsy in patients aged ≥ 80 years and assess the impact of the procedure on subsequent therapeutic management and overall survival (OS).</p><p><strong>Methods: </strong>The authors retrospectively analyzed the medical records of all patients aged ≥ 80 years who underwent stereotactic biopsy for a newly diagnosed intracerebral tumor during a 15-year period at a single institution.</p><p><strong>Results: </strong>During the period, 2350 stereotactic brain biopsies were performed, with 209 biopsies (8.9%) in 208 patients aged ≥ 80 years. Histological diagnosis was obtained in 96.2% of cases. Biopsy results differed from the suspected diagnosis in 23 patients (11.1%). After biopsy, 1.9% of the patients experienced persistent neurological deficit. After histopathological diagnosis, 80.7% of the cases received adjuvant treatment. Only a Karnofsky Performance Status (KPS) score ≥ 70% was a significant predictor of receiving complete adjuvant treatment (OR 24.3, 95% CI 7.0-84.1; p < 0.001). The median OS from biopsy was 5.6 months (IQR 2.4-13.5 months). Grade 4 glioma, KPS score < 70%, and tumor contrast enhancement on MRI predicted a shorter OS. Receiving complete first-line adjuvant therapy predicted a longer OS. In patients with grade 4 glioma, those exhibiting a methylated O 6-methylguanine-DNA methyltransferase (MGMT) promoter demonstrated significantly prolonged survival compared with patients with an unmethylated MGMT promoter (p < 0.001).</p><p><strong>Conclusions: </strong>Stereotactic biopsy for very elderly patients with brain tumors has a high diagnostic yield and a favorable safety profile, ultimately impacting patients' therapeutic management and OS. Nonetheless, it is crucial to consider the patient's prebiopsy condition. Specifically, a KPS score ≥ 70% was identified as a key factor in the decision-making process for biopsy in this population.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527849","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":"Predecompression and postdecompression cognitive and affective changes in Chiari malformation type I.","authors":"Luke C Henry, Michael M McDowell, Tina L Stephenson, J Bret Crittenden, Amy L Byrd, Ricardo J Fernández-de Thomas, Yue-Fang Chang, Kamil W Nowicki, Rohit Mantena, Peter L Strick, Robert M Friedlander","doi":"10.3171/2024.8.JNS241363","DOIUrl":"https://doi.org/10.3171/2024.8.JNS241363","url":null,"abstract":"<p><strong>Objective: </strong>The role of the cerebellum in cognitive function and psychiatric symptoms is poorly understood and particularly understudied in patients with cerebellar pathologies such as Chiari malformation type I (CM-I). Additionally, it is unclear if interventions targeted toward the cerebellum might impact these life-altering symptoms. The authors sought to characterize pre- and postoperative cognitive and psychiatric function in CM-I patients as evidence for targeted cerebellar treatment for some cognitive and psychiatric conditions.</p><p><strong>Methods: </strong>This prospective study included surgical patients with CM-I who reported cognitive or psychiatric dysfunction. Patients completed a preoperative assessment and a parallel assessment 6 months following surgery. Neuropsychological evaluations included a 90-minute standardized assessment of cognitive function across multiple domains and a self-reported assessment of psychiatric symptoms. This clinical sample consisted of 54 patients (mean age 34.17 years, median 14.15 years). Any patient demonstrating preoperative performance below 3.5 SDs within any cognitive domain was excluded (n = 1). All patients underwent preoperative neuropsychological assessment comprising standard clinical tests of processing speed, attention, memory, executive function, and psychiatric symptoms.</p><p><strong>Results: </strong>Preoperatively, CM-I patients performed significantly worse than a representative normative sample on measures of executive function and visuospatial memory and reported more psychiatric symptoms across all domains. On postoperative assessment, 89% of patients showed clinically significant improvements (> 1 SD) in cognitive and/or psychiatric domains.</p><p><strong>Conclusions: </strong>The authors demonstrate significant, often unrecognized, impairments in cognitive function and psychiatric symptoms in a cohort of CM-I patients. Following targeted surgical posterior fossa decompression, these symptoms improved, suggesting that at least in a subgroup of symptomatic CM-I patients, these symptoms may be treatable. This study highlights the potential role of the cerebellum in cognitive and psychiatric dysfunction.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472572","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":"Comparative meta-analysis of microsurgery versus endovascular therapy and bypass versus nonbypass techniques for blister-like aneurysms: enigmas of the supraclinoid internal carotid artery.","authors":"Nolan J Brown, Zach Pennington, Saarang Patel, Ali Tafreshi, Julian Gendreau, Redi Rahmani, Joshua S Catapano, Michael T Lawton","doi":"10.3171/2024.8.JNS232241","DOIUrl":"https://doi.org/10.3171/2024.8.JNS232241","url":null,"abstract":"<p><strong>Objective: </strong>Blister aneurysms of the internal carotid artery (ICA) have high associated mortality rates and are challenging due to their friable wall and poorly defined neck. Microsurgical and endovascular treatment options have been suggested, including bypass of the parent vessel to exclude the aneurysm. The goal of this study was to evaluate the safety and efficacy of microsurgical versus endovascular interventions. Additionally, for patients treated with open surgery, the outcomes of bypass were compared to nonbypass techniques.</p><p><strong>Methods: </strong>Three databases were systematically queried for primary studies comparing microsurgery to endovascular therapy and assessing bypass versus nonbypass treatment modalities for blister aneurysms of the ICA. All relevant studies published between 2000 and 2023 were eligible for inclusion. All articles were screened against title and abstract by 2 authors, as were those eligible for full-text assessment. Ultimately, relevant data from all included studies were pooled for meta-analysis in which the Mantel-Haenszel method with random-effects modeling was used.</p><p><strong>Results: </strong>Among the 504 cases reported across 24 studies, 182 (35.1%) blister aneurysms of the ICA were surgically treated, whereas 337 (64.9%) involved endovascular treatment. There were 235 (46.6%) female patients in the cohort. Functional outcomes were comparable between groups, with 83% of surgically treated patients and 85% of endovascularly treated patients achieving a favorable outcome (p > 0.05). Among the 7 studies (178 patients) comparing bypass to nonbypass microsurgery, rates of postoperative bleeding, ischemic infarct, vasospasm, recurrence, favorable outcomes, and mortality were comparable for bypass (n = 54, 30.3%) and nonbypass groups (n = 124, 69.7%).</p><p><strong>Conclusions: </strong>Blister aneurysms of the ICA are rare intracranial aneurysms that are difficult to treat with microsurgical and endovascular techniques. Considering only patients treated with open surgery, there appears to be no significant difference in complication profile or functional outcomes between patients undergoing bypass or alternative microsurgical techniques. However, it must be noted that the complex nature of bypass procedures means that much of the data granularity is lost on meta-analysis, suggesting that additional investigations comparing bypass to other open microsurgical techniques may be merited. Similarly, future studies should determine the limitations of dual antiplatelet therapy in endovascular treatment and the efficacy of different numbers and types of overlapping, flow-diverting devices.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472569","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":"Regression modeling with convolutional neural network for predicting extent of resection from preoperative MRI in giant pituitary adenomas: a pilot study.","authors":"Biren Khimji Patel, Leonardo Tariciotti, Lorenzo DiRocco, Antonio Mandile, Samir Lohana, Alejandra Rodas, Youssef M Zohdy, Justin Maldonado, Silvia M Vergara, Erion Jr De Andrade, Juan M Revuelta Barbero, Camilo Reyes, C Arturo Solares, Tomas Garzon-Muvdi, Gustavo Pradilla","doi":"10.3171/2024.10.JNS241527","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241527","url":null,"abstract":"<p><strong>Objective: </strong>Giant pituitary adenomas (GPAs) are challenging skull base tumors due to their size and proximity to critical neurovascular structures. Achieving gross-total resection (GTR) can be difficult, and residual tumor burden is commonly reported. This study evaluated the ability of convolutional neural networks (CNNs) to predict the extent of resection (EOR) from preoperative MRI with the goals of enhancing surgical planning, improving preoperative patient counseling, and enhancing multidisciplinary postoperative coordination of care.</p><p><strong>Methods: </strong>A retrospective study of 100 consecutive patients with GPAs was conducted. Patients underwent surgery via the endoscopic endonasal transsphenoidal approach. CNN models were trained on DICOM images from preoperative MR images to predict EOR, using a split of 80 patients for training and 20 for validation. The models included different architectural modules to refine image selection and predict EOR based on tumor-contained images in various anatomical planes. The model design, training, and validation were conducted in a local environment in Python using the TensorFlow machine learning system.</p><p><strong>Results: </strong>The median preoperative tumor volume was 19.4 cm3. The median EOR was 94.5%, with GTR achieved in 49% of cases. The CNN model showed high predictive accuracy, especially when analyzing images from the coronal plane, with a root mean square error of 2.9916 and a mean absolute error of 2.6225. The coefficient of determination (R2) was 0.9823, indicating excellent model performance.</p><p><strong>Conclusions: </strong>CNN-based models may effectively predict the EOR for GPAs from preoperative MRI scans, offering a promising tool for presurgical assessment and patient counseling. Confirmatory studies with large patient samples are needed to definitively validate these findings.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472573","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. Considering Chiari malformation type I decompression for disorders of thought.","authors":"Annie I Drapeau, Anthony M Kaufmann","doi":"10.3171/2024.10.JNS242051","DOIUrl":"https://doi.org/10.3171/2024.10.JNS242051","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472570","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":"Temporal dynamics of ICP, CPP, PRx, and CPPopt in relation to outcome in spontaneous intracerebral hemorrhage.","authors":"Rozerin Kevci, Anders Hånell, Timothy Howells, Andreas Fahlström, Anders Lewén, Per Enblad, Teodor Svedung Wettervik","doi":"10.3171/2024.10.JNS241038","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241038","url":null,"abstract":"<p><strong>Objective: </strong>There is a paucity of studies on the optimal thresholds for neurointensive care (NIC) targets such as intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in spontaneous intracerebral hemorrhage (sICH). There is also a need to clarify the role of cerebral pressure autoregulatory disturbances (pressure reactivity index [PRx]) and to determine if the autoregulatory CPP target (optimal CPP [CPPopt]) is superior to traditional fixed CPP targets in sICH. In this study, the authors aimed to explore the role of ICP, PRx, CPP, and CPPopt insults in sICH patients treated in the NIC unit.</p><p><strong>Methods: </strong>In this observational study, 184 adults with sICH with intracerebral hemorrhage (ICH) volume above 10 ml who received > 12 hours of ICP monitoring during the first 7 days at the authors' NIC unit, Uppsala University Hospital, Sweden, between 2010 and 2019 (10 years) were included. Demographic characteristics, admission status, radiological examination, and clinical outcome were evaluated. Favorable outcome was defined as conscious at discharge, while unfavorable outcome as unconscious or deceased. ICP, CPP, PRx, and CPPopt during the first 7 days were analyzed in relation to outcome.</p><p><strong>Results: </strong>In total, 138 (75%) patients recovered favorably at discharge. Lower percentage of good monitoring time with ICP above 25 mm Hg was independently associated with favorable outcome. CPP above 80 mm Hg was frequent and independently associated with favorable outcome. Median PRx did not differ between the outcome groups, but there was a trend toward worse outcome when PRx exceeded +0.5. Furthermore, when PRx was analyzed together with the concurrent ICP and CPP values, higher values increased the ICP and CPP interval associated with unfavorable outcome. Lastly, there was no independent correlation between CPP deviation from CPPopt and outcome.</p><p><strong>Conclusions: </strong>Avoiding ICP elevations above 20 to 25 mm Hg and maintaining CPP above 80 mm Hg may be beneficial in sICH patients with large bleeding volume who require NIC. PRx was not independently associated with outcome, but higher values appeared to narrow the safe zones of ICP and CPP.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472575","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":"Near and frank dehiscence of the superior semicircular canal: a comparative analysis of clinical outcome.","authors":"Hong-Ho Yang, Cheikh Mballo, Isaac Yang, Quinton S Gopen","doi":"10.3171/2024.9.JNS241347","DOIUrl":"https://doi.org/10.3171/2024.9.JNS241347","url":null,"abstract":"<p><strong>Objective: </strong>Superior canal dehiscence is a pathological aperture of the otic capsule overlying the superior semicircular canal. Currently, two disease subtypes are recognized by experts: frank dehiscence (FD) and near dehiscence (ND). This investigation compares the clinical manifestation and surgical outcomes between patients with FDs and those with NDs, in hopes of delineating their distinctions in pathophysiology and optimal management strategies.</p><p><strong>Methods: </strong>The authors conducted a cohort study of consecutive middle cranial fossa repairs performed at their institution between 2011 and 2022. FDs were defined as clear dehiscence of the otic capsule, and NDs were defined as focal dehiscence or very thin bony labyrinth (< 0.1 mm) on CT imaging. Multivariable regression models were constructed to assess the relationship of dehiscence subtype with audiometric and symptomatologic baseline presentation and postrepair outcomes. Models were adjusted for demographics, history factors, and follow-up duration.</p><p><strong>Results: </strong>Among 421 repairs included, 100 (24%) were for NDs and 321 (76%) were for FDs. At 250 Hz, FDs and NDs had a comparable baseline air-bone gap (ABG) (adjusted mean 23.8 dB vs 11.1 dB; adjusted β [aβ] 12.8, 95% CI -0.4 to 25.9) and exhibited a similar degree of narrowing postrepair (-11.7 vs -5.5; aβ -6.2, 95% CI -16.8 to 4.5). At 500 Hz, FDs had a wider baseline ABG (15.4 vs 6.4; aβ 9.1, 95% CI 4.3-13.8) but exhibited numerically greater narrowing postrepair (-6.1 vs 1.1; aβ -7.2, 95% CI -11.4 to -3.0). Despite similar baseline symptomatology, patients with FDs reported lower resolution rates of hearing loss (adjusted OR [aOR] 0.43, 95% CI 0.20-0.94) and higher postoperative onset rates of dizziness (aOR 5.12, 95% CI 1.06-24.76) and vertigo (aOR 8.56, 95% CI 1.11-66.16). Resolution rates for autophony and hyperacusis were similarly high (> 60%) among both cohorts.</p><p><strong>Conclusions: </strong>Compared to patients with NDs, those with FDs presented with a wider low-frequency ABG but similar symptom profile at baseline. Postsurgery, patients with FDs demonstrated numerically greater ABG narrowing but reported higher rates of dizziness, vertigo, and persistent hearing loss. Nevertheless, surgery yielded objective and subjective benefits among both patients with FDs and those with NDs.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472571","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":"Risk factors for unruptured intracranial aneurysms in asymptomatic patients with autosomal dominant polycystic kidney disease: who needs screening? A systematic review and meta-analysis.","authors":"Brandon A Nguyen, Brooke Halpin, Vita Olson, Dillon Putzler, Maged Ghoche, Maria José Pachón-Londoño, Evelyn L Turcotte, Seyed Farzad Maroufi, Diana Segovia, Devi P Patra, Fredric B Meyer, Zhen Wang, Bernard R Bendok","doi":"10.3171/2024.9.JNS241175","DOIUrl":"https://doi.org/10.3171/2024.9.JNS241175","url":null,"abstract":"<p><strong>Objective: </strong>Patients with autosomal dominant polycystic kidney disease (ADPKD) have been identified to have a significantly increased risk of developing intracranial aneurysms (IAs). These patients are diagnosed at younger ages and are also at increased risk for IA rupture. The objective of this systematic review and meta-analysis was to identify risk factors associated with IA detection during screening of asymptomatic ADPKD patients.</p><p><strong>Methods: </strong>The authors searched for studies reporting the prevalence of IA among patients with ADPKD screened using MRA, CTA, or DSA on PubMed, Embase, Google Scholar, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov prior to August 2023 by using individualized standardized search strategies. Eligibility of all retrieved studies was assessed according to the PRISMA guidelines. Risk of bias of the included observational studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using a random-effects model.</p><p><strong>Results: </strong>Twenty-four observational studies involving 5907 patients with ADPKD were identified for quantitative analysis. The authors observed an overall prevalence of IA of 12.6%. They identified several risk factors for IA with statistically significantly increased odds for unruptured IA (UIA) detection, including female sex (18 studies, OR 1.63, 95% CI 1.37-1.94, I2 = 0%), family history of either IA or subarachnoid hemorrhage (SAH) (12 studies, OR 2.17, 95% CI 1.68-2.81, I2 = 0%), family history of SAH (3 studies, OR 2.67, 95% CI 1.25-5.71, I2 = 66.0%), stage 3 or greater chronic kidney disease (CKD) (4 studies, OR 2.55, 95% CI 1.84-3.54, I2 = 0%), and hypertension (13 studies, OR 1.41, 95% CI 1.04-1.91, I2 = 34%). Age > 45 years, family history of ADPKD, smoking status, and presence of liver cysts did not reach statistical significance as risk factors during this meta-analysis.</p><p><strong>Conclusions: </strong>The results of the authors' meta-analysis suggest increased risk of UIA detection in screening of ADPKD patients who are female, have a family history of IA or SAH, have hypertension, or have moderate or more severe CKD. Given the increased prevalence of IA in ADPKD patients with these risk factors, these patients may stand to benefit from screening for IA early in treatment or at time of diagnosis, even if neurologically asymptomatic.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416682","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 of lower tumor mutation burden with rapid local progression in patients with brain metastases.","authors":"Poojan D Shukla, Minh P Nguyen, Austin Lui, Tony Catalan, Jacob S Young, Mitchel S Berger, Philip V Theodosopoulos, Shawn L Hervey-Jumper, Laura A Huppert, Manish K Aghi, Harish N Vasudevan, Ramin A Morshed","doi":"10.3171/2024.9.JNS241391","DOIUrl":"https://doi.org/10.3171/2024.9.JNS241391","url":null,"abstract":"<p><strong>Objective: </strong>Tumor mutational burden (TMB) has been proposed as a prognostic biomarker in patients with metastatic cancer, as well as in patients who receive immune checkpoint inhibitor (ICI) therapy. However, the role of TMB as a biomarker for progression after resection of brain metastases, as well as perioperative ICI treatment response, is less defined. This study examined the impact of TMB on local CNS progression events in patients who underwent resection of a brain metastasis, as well as in those who received postoperative ICI treatment.</p><p><strong>Methods: </strong>This was a single-center, retrospective cohort study of adult patients with clinical and molecular data available who underwent resection of a brain metastasis from 2019 to 2022. TMB was derived from next-generation sequencing based on a Clinical Laboratory Improvement Amendments (CLIA)-certified clinical oncogene panel. Local progression was the primary endpoint. Kaplan-Meier curves and Cox proportional hazards regression analysis were used to assess the relationship between the primary endpoint and TMB. Thresholds for high and low TMB were obtained from recursive partitioning analysis (RPA).</p><p><strong>Results: </strong>The cohort consisted of 82 patients with multiple primary cancer types with a median follow-up time of 7 months. Twelve patients (15%) experienced local progression. According to RPA, a threshold for low TMB (< 5.2 mutations/Mb) was identified, which was associated with more rapid local progression (p < 0.001) according to the Kaplan-Meier analysis. On multivariate Cox proportional hazards regression analysis, low TMB was associated with shorter freedom from local recurrence (HR 13.6, 95% CI 1.80-103, p = 0.011). Among the patients who received postoperative ICI (n = 34), low TMB trended toward shorter freedom from local recurrence on Kaplan-Meier analysis (p = 0.062).</p><p><strong>Conclusions: </strong>Lower TMB was associated with shorter freedom from local recurrence in resected CNS metastases. Among patients who receive postoperative ICI treatment, lower TMB also trended toward more rapid local progression.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416816","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}