Neurocritical Care最新文献

{"title":"Impact of Minimally Invasive Surgery on Midline Shift and Outcomes in Large Supratentorial Spontaneous Intracerebral Hemorrhage: Post Hoc Analysis of MISTIE III.","authors":"Wendy C Ziai, Anusha Yarava, Joshua B Gruber, Yunke Li, Nathan Walborn, Nick Rizzutti, Meghan Hildreth, Issam Awad, Daniel F Hanley","doi":"10.1007/s12028-025-02371-5","DOIUrl":"https://doi.org/10.1007/s12028-025-02371-5","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgery (MIS) for large supratentorial intracerebral hemorrhage (ICH) addresses primary brain injury by reducing mass effect, causing midline shift (MLS). We investigated the relationship between MIS, MLS, and functional outcomes in a large clinical trial.</p><p><strong>Methods: </strong>We conducted a post hoc analysis of patients with qualified computed tomography (CT) images from the phase 3 Minimally Invasive Surgery Plus Alteplase for Intracerebral Haemorrhage Evacuation trial. The exposure was MLS at the pineal gland (PG) and septum pellucidum (SP) on CT scans at diagnosis, end of treatment (EOT), and hospital discharge. The primary outcome was 30-day mortality. Secondary outcomes were mortality and modified Rankin scale score at day 365. We performed multivariable logistic regression and mediation analyses, adjusted for demographics, ICH characteristics, and treatment.</p><p><strong>Results: </strong>Participants had a median age of 62 years and a median ICH volume of 44 mL, and 61% were male. Thirty-day mortality was 12%. MLS on EOT CT was significantly lower in surgical patients compared with medical patients. EOT MLS in day 30 surgical survivors was also significantly lower compared with that in medically treated survivors and nonsurvivors. The odds of 30-day mortality on adjusted analyses were significantly increased by 1 mm in MLS at both the PG and SP (PG: odds ratio 1.22, 95% confidence interval 1.06-1.41; SP: odds ratio 1.22, 95% confidence interval 1.10-1.36). Thresholds of MLS change < 3 mm (SP) and < 5 mm (PG) were associated with mortality reduction. The association of MIS with 30-day mortality was mediated fully by change in either the SP or PG MLS from diagnostic to EOT CT. Change in MLS was significantly associated with one-year mortality and, for SP, with one-year good functional outcome (modified Rankin scale scores 0-3).</p><p><strong>Conclusions: </strong>MIS for ICH significantly reduces MLS. This reduction in MLS significantly mediates reduction in 30-day mortality with MIS and is associated with both short-term and long-term outcomes.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender Disparities in Morbidity and Mortality Following Traumatic Brain Injury Surgical Procedures.","authors":"Monique Mitchell, Khaled M Taghlabi, Bilal Moiz, Samad Ganni, Kishore Balasubramanian, Kiran Sankarappan, Marcelo Costa, Sidra Ganni, Barbara Buccilli, Wellingson Paiva, Raphael Bertani, Amir H Faraji","doi":"10.1007/s12028-025-02377-z","DOIUrl":"https://doi.org/10.1007/s12028-025-02377-z","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a Major contributor to morbidity and mortality in the United States. Although prior research has suggested potential gender differences in TBI outcomes, limited data exist on surgical cohorts. This study aimed to evaluate gender-based disparities in postoperative complications and 30-day outcomes following surgical management of TBI using a large national surgical registry.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using the 2023 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Adults (≥ 18 years) who underwent surgical intervention for TBI were identified using Current Procedural Terminology codes. Patients were stratified by gender, and comparisons were made using Wilcoxon rank-sum and χ² tests. Multivariate logistic regression was conducted to assess independent predictors of 30-day morbidity and mortality.</p><p><strong>Results: </strong>Of the 2,519 patients, 64.8% were Male and 35.2% were female. Female patients were significantly older (70.9 ± 14.6 vs. 67.2 ± 16.0 years, p < 0.001) and had higher rates of hypertension (65.1% vs. 58.1%, p < 0.001), bleeding disorders (25.5% vs. 19.4%, p < 0.001), and frailty (modified frailty index ≥ 2 in 31.0% vs. 28.6%, p < 0.001). Additionally, postoperative urinary tract infections (odds ratio [OR] 2.35, 95% confidence interval [CI] 1.56-3.55, p < 0.001), transfusion requirement (OR 1.67, 95% CI 1.34-2.08, p < 0.001), and 30-day morbidity (OR 1.29, 95% CI 1.10-1.52, p = 0.002) were significantly higher in female patients. Multivariate analysis confirmed female gender as an independent predictor of 30-day morbidity (OR 1.31, 95% CI 1.02-1.68, p = 0.034). No significant difference in 30-day mortality between male and female patients was observed (OR 1.08, 95% CI 0.87-1.33, p = 0.493).</p><p><strong>Conclusions: </strong>Female patients undergoing surgical treatment for TBI experience significantly higher postoperative morbidity despite comparable mortality. Increased age, comorbidity burden, and complication rates in female patients underscore the need for gender-specific perioperative strategies. Limitations include the 30-day follow-up window and retrospective design. These findings support further investigation into tailored interventions to mitigate gender disparities in neurosurgical care.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Features and Outcomes in Adult Patients with Autoimmune Encephalitis Requiring Intensive Care: A Retrospective Cohort Study.","authors":"Lixia Qin, Kexin Chen, Yiwen Zhou, Wei Wang, Wei Lu, Hainan Zhang","doi":"10.1007/s12028-025-02374-2","DOIUrl":"https://doi.org/10.1007/s12028-025-02374-2","url":null,"abstract":"<p><strong>Background: </strong>This study aims to explore the predictors of poor outcomes by analyzing the clinical characteristics and prognosis of adult patients with severe forms of autoimmune encephalitis (AE) requiring intensive care unit (ICU) admission.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 134 adult patients diagnosed with definite or possible AE and admitted to the neurology ICU between January 2015 and December 2023. Neurological outcomes at 6 and 12 months were assessed using the modified Rankin scale (mRS). The study further analyzed the relationship between their clinical characteristics, auxiliary examinations, and prognosis.</p><p><strong>Results: </strong>A total of 134 adult patients with AE requiring ICU admission were included. The 6- and 12-month survival rates were 91.8% and 91.5%, respectively. At 6 months, 72.4% (97 of 134) of patients had favorable outcomes (mRS score ≤ 2), whereas 27.6% (37 of 134) had poor outcomes (mRS score ≥ 3). Compared with the favorable group, patients in the poor outcome group were older (42.92 vs. 30.71 years, p = 0.002), had a higher incidence of tumors (24.3% vs. 4.1%, p < 0.001), and were more likely to require mechanical ventilation (67.6% vs. 26.8%, p < 0.001). They also had lower Glasgow Coma Scale scores on ICU admission (p = 0.006), higher Acute Physiology and Chronic Health Evaluation II scores (p = 0.006), elevated cerebrospinal fluid glucose (p = 0.004) and protein levels (p = 0.029), higher autoantibody seronegativity (32.4% vs. 13.4%, p = 0.011), lower glucocorticoid use (p = 0.038), and longer ICU stays (p = 0.031). Multivariate logistic regression identified age (p = 0.001), presence of tumor (p = 0.03), mechanical ventilation (p = 0.025), antibody negativity (p = 0.042), and ICU length of stay (p = 0.000) as independent predictors of poor prognosis.</p><p><strong>Conclusions: </strong>These factors may help identify high-risk patients with AE early, enabling timely and targeted interventions to improve outcomes.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 for: \"Risk Factors for Early Poor Outcomes in in-Hospital Intracranial Hemorrhage: A Retrospective Cohort Study\".","authors":"Ali Ansari","doi":"10.1007/s12028-025-02356-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02356-4","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Commentary on \"Impact of Low-Dose Ketamine Infusion on Intracranial Pressure and Hemodynamics in Septic Shock Patients\": A Valuable Step with Opportunities for Further Refinement.","authors":"Essamedin M Negm, Hossam Tharwat Ali","doi":"10.1007/s12028-025-02362-6","DOIUrl":"https://doi.org/10.1007/s12028-025-02362-6","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To the Editorial Office of Neurocritical Care: Commentary on \"Impact of Low-Dose Ketamine Infusion on Intracranial Pressure and Hemodynamics in Septic Shock Patients\": A Valuable Step with Opportunities for Further Refinement.","authors":"Niloufar Dadashpour, Majid Golestanieraghi","doi":"10.1007/s12028-025-02363-5","DOIUrl":"https://doi.org/10.1007/s12028-025-02363-5","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Response to Commentary.","authors":"Ofer Sadan, Feras Akbik","doi":"10.1007/s12028-025-02360-8","DOIUrl":"10.1007/s12028-025-02360-8","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Commentary by Dr. Ofer Sadan and Dr. Feras Akbik.","authors":"Cappi Lay, Hae Young Baang","doi":"10.1007/s12028-025-02359-1","DOIUrl":"https://doi.org/10.1007/s12028-025-02359-1","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Prospective Trial of Cerebrospinal Fluid Filtration After Aneurysmal Subarachnoid Hemorrhage via Lumbar Catheter Extension (PILLAR-XT).","authors":"Spiros L Blackburn, Marc A Babi, Andrew W Grande, Omar A Choudhri, Erik F Hauck, Christopher P Kellner, Michael C Giordano, Shivanand P Lad, Aaron R McCabe","doi":"10.1007/s12028-025-02380-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02380-4","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered Neurocritical Care Management of Patients with Severe Traumatic Brain Injury Following Changed Positions of the Zero-Reference Points for Intracranial and Arterial Pressure Measurement.","authors":"Linus Réen, Hannes Wikström, Edward Visse, David Cederberg, Peter Siesjö, Niklas Marklund","doi":"10.1007/s12028-025-02366-2","DOIUrl":"https://doi.org/10.1007/s12028-025-02366-2","url":null,"abstract":"<p><strong>Background: </strong>Many traumatic brain injury (TBI) treatment protocols, including the Lund concept, advocate the highest point of the subarachnoid space (typically the vertex) as the zero-reference point for intracranial pressure (ICP) and the level of the right atrium as the zero-reference point for mean arterial blood pressure (MAP). In 2017, at the Department of Neurosurgery in Lund, Sweden, the zero-reference points for ICP and MAP were both changed to the external auditory meatus (EAM), thus altering the calculated cerebral perfusion pressure (CPP) levels. We hypothesized that the ICP and MAP levels obtained from the different zero-reference points resulted in altered neurocritical care management and/or patient outcome.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of ICP, CPP, MAP, medical management, mortality, and outcome in two different patient cohorts with severe TBI treated at the Department of Neurosurgery, Skåne University Hospital, Lund, Sweden, between 2013 and 2016 and 2018 and 2022.</p><p><strong>Results: </strong>We collected more than 31,000 measurements from 49 patients between 2013 and 2016 and 53 patients between 2018 and 2022. Age and injury severity were similar in both groups. Mortality and treatment outcome according to the Glasgow Outcome Scale - Extended were similar. Mean ICP levels were higher (p < 0.0001) after the reference point was changed to the EAM. The use of clonidine (65% vs. 49%; p = 0.17) and metoprolol (50% vs. 13%; p = 0.0002) decreased, and the use of norepinephrine increased (42% vs. 98%; p < 0.0001) after changing the reference points.</p><p><strong>Conclusions: </strong>Higher ICP levels were observed when the reference point was changed to the EAM. The use of metoprolol was reduced, and there was a significant increase in the use of norepinephrine. These results show the impact of zero-reference point placement, which should be reported in TBI studies analyzing ICP and CPP management.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}