Neurosurgical Review最新文献

{"title":"Diagnostic and predictive value of radiomics-based machine learning for intracranial aneurysm rupture status: a systematic review and meta-analysis.","authors":"Jianguo Zhong, Yu Jiang, Qiqiang Huang, Shaochun Yang","doi":"10.1007/s10143-024-03086-5","DOIUrl":"10.1007/s10143-024-03086-5","url":null,"abstract":"<p><p>Currently, the growing interest in radiomics within the clinical practice has prompted some researchers to differentiate the rupture status of intracranial aneurysm (IA) by developing radiomics-based machine learning models. However, systematic evidence supporting its performance remains scarce. The purpose of this meta-analysis and systematic review is to assess the diagnostic performance of radiomics-based machine learning for the early detection of IA rupture and to offer evidence-based recommendations for the application of radiomics in this area. PubMed, Cochrane, Embase, and Web of Science databases were searched systematically up to March 2, 2024. The Radiomics Quality Score (RQS) was employed to assess the risk of bias in all included primary studies. We separately discussed the diagnostic or predictive performance of machine learning for IA rupture status based on task type (diagnosis or prediction).  We finally included 15 original studies covering 9,111 IA cases. In the validation cohort, radiomics demonstrated a sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, as well as SROC curve of 0.84 (95% CI: 0.76-0.90), 0.82 (95% CI: 0.77-0.86), 4.7 (95% CI: 3.7-5.8), 0.19 (95% CI: 0.13-0.29), and 24 (95% CI: 15-40), respectively, for the diagnostic task of aneurysm rupture status. Only 2 studies (3 models) addressed predictive tasks, with sensitivity and specificity ranging from 0.77 to 0.89 and from 0.69 to 0.87, respectively. Radiomics-based machine learning exhibits promising accuracy for early identification of IA rupture status, whereas evidence for its predictive capability is limited. Further research is needed to validate predictive models and provide insights for developing specialized strategies to prevent aneurysm rupture.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"845"},"PeriodicalIF":2.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating efficacy and safety of laser interstitial thermal therapy in patients with newly diagnosed and recurrent glioblastoma: a systematic review and meta-analysis.","authors":"Hussain Sohail Rangwala, Muhammad Ashir Shafique, Muhammad Saqlain Mustafa, Ritesh Kumar, Janta Devi, Burhanuddin Sohail Rangwala, Syed Muhammad Sinaan Ali, Adarsh Raja, Javed Iqbal, Mirha Ali, Abdul Haseeb","doi":"10.1007/s10143-024-03077-6","DOIUrl":"10.1007/s10143-024-03077-6","url":null,"abstract":"<p><p>Glioblastoma (GB), the most common malignant brain tumour, has a poor prognosis despite advances in treatment. Standard management involves surgery followed by chemoradiotherapy. MRI-guided laser interstitial thermal therapy (LITT) is a minimally invasive technique that may offer an option for select patients with specific clinical profiles. While preclinical studies suggest that LITT could disrupt the blood-brain barrier (BBB) to enhance drug delivery, this has yet to be definitively demonstrated in clinical settings. Adhering to the PRISMA guidelines, various databases were searched until March 2024. Eligible studies focused on LITT for supratentorial GB in adults and evaluated its safety and efficacy. Data extraction covered various study characteristics, and statistical analysis was performed using the OpenMeta Analyst software. Quality assessment was performed using the Newcastle-Ottawa Scale. Fifteen studies were analyzed, mainly employing the Neuroblate-Monteris system in the US, as retrospective single-centre trials. Treatment involved LITT in 239 patients with tumours typically in deep-seated areas. Median OS ranged from 4.9 to 32.3 months, and PFS from two to 5.9 months. Most patients received adjuvant therapy, primarily radiation and temozolomide. While LITT showed efficacy in improving OS (10.21, 95% CI 9.05-11.37), PFS (3.94, 95% CI 3.20-4.69), and tumor volume reduction (18.23, 95% CI 14.591-21.860), complications odd-ration(OR) = 0.336 (95% CI, 0.188-0.484) and mortality rates OR = 0.033 (95% CI, 0.009-0.058 were notable. LITT shows promise for treating both newly diagnosed and recurrent GB cases in non-surgical candidates, linked to improved OS, PFS, reduced tumor volume, and shorter hospital stays. However, higher complication and mortality rates were noted, emphasising the need for additional well-designed prospective multicentre trials.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"846"},"PeriodicalIF":2.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624603","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":"Risk assessment for rupture of brain arteriovenous malformations using high-resolution black-blood magnetic resonance imaging: a single-center case series.","authors":"José Maria de Campos Filho, Alice Giotta Lucifero, Juan Carlos Ahumada-Vizcaíno, José Ernesto Chang Mulato, Victor Hugo Rocha Marussi, Christiane Monteiro de Siqueira Campos, Marcos Devanir Silva da Costa, Hugo Leonardo Dória-Netto, Raphael Wuo-Silva, Feres Chaddad-Neto","doi":"10.1007/s10143-024-03084-7","DOIUrl":"https://doi.org/10.1007/s10143-024-03084-7","url":null,"abstract":"<p><strong>Objective: </strong>Chronic inflammation's role in the pathogenesis, development, and rupture of vascular malformations is undebated. Advanced magnetic resonance imaging techniques with vessel wall studies, specifically Black Blood (bbMRI), may offer insights into vascular wall instability and predict rupture. This case series aims to assess bbMRI as a predictive diagnostic tool for brain arteriovenous malformations (bAVMs) rupture, suggesting early treatment.</p><p><strong>Material and methods: </strong>A prospective study included demographic, clinical, and neuroimaging data from a consecutive series of patients with ruptured or unruptured bAVMs, regardless of age or gender, between October 2018 and March 2024. All patients underwent MRI brain resonance with Black Blood study. Those with impaired renal function were excluded. Statistical analyses tested sample homogeneity. Univariate and multivariate logistical regressions assessed bbMRI as a rupture predictor for bAVMs, with a p-value set at < 0.05.</p><p><strong>Results: </strong>Ninety patients were retrieved: 64 with unruptured and 26 with ruptured bAVMs. The mean age was 31.9 years, and 55 were female. Admission symptoms were headache, neurological deficits, and seizure in 49, 21, and 19 cases, respectively. bbMRI showed wall enhancement in 56 cases, with 19 in the ruptured and 37 unruptured groups. Univariate and multivariate analyses revealed a significant correlation between bbMRI wall enhancement and bAVM rupture (p:0.033; p:0.047).</p><p><strong>Conclusion: </strong>bbMRI may be a useful and feasible diagnostic implement to determine vessel inflammation and the bAVMs prone to rupture. Additional studies are needed to confirm the positive bbMRI as a predictive factor for bAVMs rupture.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"840"},"PeriodicalIF":2.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624697","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":"Evaluation of training models for intraventricular neuroendoscopy.","authors":"Sebastian Senger, Magomed Lepshokov, Thomas Tschernig, Guiseppe Cinalli, Joachim Oertel","doi":"10.1007/s10143-024-03082-9","DOIUrl":"10.1007/s10143-024-03082-9","url":null,"abstract":"<p><p>Structured surgical education has become increasingly important in recent years. Intraventricular neuroendoscopic procedures have been widely established. However, training surgical skills with these techniques is crucial for young residents due to the potential harm to adjacent tissue. Therefore, we evaluated two different training models. Participants in two different international workshops were trained on a prefixed cadaver model and on a living murine intraabdominal model. Crucial neuroendoscopic techniques such as membrane perforation and tissue biopsy were performed. A blinded questionnaire evaluated both models. Sixty-three participants were trained on the animal model. Forty of these were trained on the cadaver model. The training effect was evaluated almost equally, with 8.5/10 for the animal model and 8.9/10 for the cadaver model. The tissue properties were rated higher regarding realism in the animal model, whereas the anatomic realism was rated higher in the cadaver model. The animal model is a valid alternative to cadaver models for teaching endoscopic neurosurgical skills. This model benefits from the simulation of real surgical tissue properties, including bleeding. The low costs and availability of this technique make it more ubiquitous and can help train further generations of neurosurgeons.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"844"},"PeriodicalIF":2.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute and chronic hypopituitarism following traumatic brain injury: a systematic review and meta-analysis.","authors":"Ghaith S Aljboor, Aoun Tulemat, Ali Ridha Al-Saedi, Mugurel Petrinel Radoi, Corneliu Toader, Toma Marius Papacocea","doi":"10.1007/s10143-024-03088-3","DOIUrl":"10.1007/s10143-024-03088-3","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) is associated with various endocrine abnormalities, including pituitary axis dysfunction. Understanding the prevalence and temporal patterns of these dysfunctions is crucial for effective clinical management. This study aimed to systematically review the literature and conduct a meta-analysis to determine the prevalence of pituitary axis dysfunction following TBI, assess temporal patterns across different post-injury durations, and identify potential contributing factors. A comprehensive search was conducted across multiple electronic databases between 1st of January 2000 until 31st March 2024. Studies reporting the prevalence of pituitary axis dysfunction post-TBI were included. Pooled estimates with 95% confidence intervals (CIs) were calculated using random-effects models in the R statistical software. Subgroup analyses were performed based on duration post-TBI (< 3 months, 3-6 months, 6-12 months, > 12 months) to explore temporal variations. Heterogeneity was assessed using the I^2 statistic. A total of 52 studies were included in the meta-analysis, encompassing 7367 participants. The pooled estimate for the prevalence of any pituitary axis dysfunction post-TBI was 33% (95% CI [28%; 37%]). Subgroup analysis by duration revealed varying prevalence rates: < 3 months (40%, 95% CI [27%; 53%]), 3-6 months (31%, 95% CI [15%; 47%]), 6-12 months (26%, 95% CI [19%; 33%]), and > 12 months (32%, 95% CI [26%; 38%]). Prevalence of multiple axes affection was 7% (95% CI [6%; 9%]), with varying rates across durations. Specific axes affection varied: Growth Hormone (GH) deficiency was 18% (95% CI [14%; 21%]), adrenocorticotropic hormone (ACTH) deficiency was 10% (95% CI [8%; 13%]), pituitary-gonadal axis hormones deficiency was 16% (95% CI [12%; 19%]), and thyroid-stimulating hormone (TSH) deficiency was 6% (95% CI [5%; 7%]). This meta-analysis highlights a significant prevalence of pituitary axis dysfunction following TBI, with temporal variations observed across different post-injury durations. The findings underscore the importance of tailored clinical management strategies based on the duration and type of dysfunction. Further research addressing potential contributing factors is warranted to enhance understanding and management of these conditions.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"841"},"PeriodicalIF":2.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial angioleiomyoma mimicking meningioma: an uncommon tumor with favorable outcome and frequent GJA4 mutation.","authors":"Leihao Ren, Hexuan Wang, Jian Zhang, Tianqi Wu, Jiaojiao Deng, Lingyang Hua, Haixia Cheng, Hiroaki Wakimoto, Qing Xie, Ye Gong","doi":"10.1007/s10143-024-03079-4","DOIUrl":"https://doi.org/10.1007/s10143-024-03079-4","url":null,"abstract":"<p><p>Intracranial angioleiomyoma (IALM) is a rare neoplasm mimicking meningioma. We aimed to explore the clinical and molecular characteristics of IALMs. We included 40 patients with IALMs who had tumor resection at our center from 2009 to 2022. Clinicopathological and radiological characteristics were extracted and analyzed thoroughly. GJA4 mutation status was detected and correlated with clinical characteristics. IALMs accounted for about 10% of all angioleiomyoma and had a significant male predominance compared to extracranial angioleiomyoma (p=0.04). However, there was no age difference between extracranial angioleiomyomas and IALMs. In our IALM cohort, orbital (35%) were the most common tumor location, followed by tentorium (25.0%), cavernous sinuous (17.5%). Vision decrease, diplopia and exophthalmos (40%) were the most common symptom. The radiological characteristics of ILAMs were similar to meningiomas; 20 patients (57.1%) in our cohort were misdiagnosed as meningioma preoperatively. Gross total resection was achieved in all patients. The postoperative pathology showed median Ki-67 index was 1% (range: 0-10%). Vision improvement or exophthalmos relief was achieved in 12 of 16 patients (75.0%). During the long-term follow-up (mean 70.3 months, range 30 - 128 months), no patient experienced tumor recurrence or died of tumor progression, indicating that IALM was clinically benign. GJA4 mutation (p. Gly41Cys) was detected in 17 (42.5%) patients. Of note, the correlations analysis revealed that orbital and cavernous sinus areas (64.7%) were the leading location that harbor GJA4 mutations. Tumors with mutant GJA4 were associated with positive progesterone receptor (PR) expression (p=0.02). This first large case series demonstrated that IALM predominantly affected males, was located in the cavernous sinus and orbital areas, and often manifested visual impairment and diplopia. IALM had favorable outcome. Notably, IALMs frequently exhibited a GJA4 mutation, which was linked to the cavernous sinus and orbital locations, as well as PR expression.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"842"},"PeriodicalIF":2.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624628","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":"The dural attachment length predict prognosis in patients with recurrent meningiomas.","authors":"Gengzhao Ye, Qingqing Lin, Xiyue Wu, Honghai You","doi":"10.1007/s10143-024-03076-7","DOIUrl":"https://doi.org/10.1007/s10143-024-03076-7","url":null,"abstract":"<p><p>To investigate the prognostic factors of recurrent meningioma patients who underwent reoperation, so as to make relevant recommendations for the treatment. A retrospective analysis was performed on 73 patients with recurrent meningioma. Patients' clinical data were obtained from their medical records. Progression-free Survival (PFS) was defined as the interval from the date of surgery to the date of tumor recurrence, or to the date of the last imaging review. Overall survival (OS) was defined as the time from the date of surgery to death from any cause, or to the date of the last follow-up. The multivariate COX regression showed that dural attachment length (HR = 1.238, 95%CI1.011-1.516, P = 0.039) and WHO grade (HR = 2.184, 95%CI1.135-4.203, P = 0.019) were independent risk factors for tumor progression. The factors associated with survival in multivariate regression analysis were preoperative Karnofsky Performance Scale (KPS) (HR = 0.951, 95%CI0.923-0.979, P = 0.001), dural attachment length (HR = 1.520, 95%CI1.124-2.057, P = 0.007) and WHO grade (HR = 4.829, 95%CI1.891-12.331, P = 0.001). The dural attachment length (OR = 1.843, 95%CI1.236-2.748, P = 0.003) was the only risk factor associated with postoperative pulmonary infection. No correlation was observed between Simpson's grade and either PFS or OS. The dural attachment length is closely related to the prognosis of recurrent meningioma, which should be given importance during the perioperative assessment.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"843"},"PeriodicalIF":2.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624713","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":"Focused ultrasound for treatment of epilepsy: a systematic review and meta-analysis of preclinical and clinical studies.","authors":"Alireza Soltani Khaboushan, Rasa Zafari, Mohammadmahdi Sabahi, MirHojjat Khorasanizadeh, Mohammad Amin Dabbagh Ohadi, Oliver Flouty, Manish Ranjan, Konstantin V Slavin","doi":"10.1007/s10143-024-03078-5","DOIUrl":"10.1007/s10143-024-03078-5","url":null,"abstract":"<p><p>Various preclinical and clinical studies have demonstrated the neuromodulatory and ablative effects of focused ultrasound (FUS). However, the safety and efficacy of FUS in clinical settings for treating epilepsy have not been well established. This study aims to provide a systematic review of all preclinical and clinical studies that have used FUS for the treatment of epilepsy. A systematic search was conducted using Scopus, Web of Science, PubMed, and Embase databases. All preclinical and clinical studies reporting outcomes of FUS in the treatment of epilepsy were included in the systematic review. Random-effect meta-analysis was performed to determine safety in clinical studies and seizure activity reduction in preclinical studies. A total of 24 articles were included in the study. Meta-analysis demonstrated that adverse events occurred in 13% (95% CI = 2-57%) of patients with epilepsy who underwent FUS. The frequency of adverse events was higher with the use of FUS for lesioning (36%, 95% CI = 4-88%) in comparison to neuromodulation (5%, 95% CI = 0-71%), although this difference was not significant (P = 0.31). Three-level meta-analysis in preclinical studies demonstrated a reduced spike rate in neuromodulating FUS compared to the control group (P = 0.02). According to this systematic review and meta-analysis, FUS can be considered a safe and feasible approach for treating epileptic seizures, especially in drug-resistant patients. While the efficacy of FUS has been demonstrated in several preclinical studies, further research is necessary to confirm its effectiveness in clinical practice and to determine the adverse events.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"839"},"PeriodicalIF":2.5,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142636037","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":"Systematic assessment of early brain injury severity at admission with aneurysmal subarachnoid hemorrhage.","authors":"Sheri Tuzi, Beate Kranawetter, Dorothee Mielke, Veit Rohde, Vesna Malinova","doi":"10.1007/s10143-024-03081-w","DOIUrl":"10.1007/s10143-024-03081-w","url":null,"abstract":"<p><p>Early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH) has been increasingly recognized as a risk factor for delayed cerebral ischemia (DCI). While several clinical and radiological EBI biomarkers have been identified, no tool for systematic assessment of EBI severity has been established so far. This study aimed to develop an EBI grading system based on clinical signs and neuroimaging for estimation of EBI severity at admission. This is a retrospective observational study assessing imaging parameters (intracranial blood amount, global cerebral edema (GCE)), and clinical signs (persistent loss of consciousness [LOC]) representative for EBI. The intracranial blood amount was semi-quantitatively assessed. One point was added for GCE and LOC, respectively. All points were summed up resulting in an EBI grading ranging from 1 to 5. The estimated EBI severity was correlated with progressive GCE requiring decompressive hemicraniectomy (DHC), DCI-associated infarction, and outcome according to the modified Rankin scale (mRS) at 3-month-follow up. A consecutive cohort including 324 aSAH-patients with a mean age of 55.9 years, was analyzed. The probability of developing progressive GCE was 9% for EBI grade 1, 28% for EBI grade 2, 43% for EBI grade 3, 61% for EBI grade 4, and 89% for EBI grade 5. The EBI grading correlated significantly with the need for DHC (r = 0.25, p < 0.0001), delayed infarction (r = 0.30, p < 0.0001), and outcome (r = 0.31, p < 0.0001). An EBI grading based on clinical and imaging parameters allowed an early systematic estimation of EBI severity with a higher EBI grade associated not only with a progressive GCE but also with DCI and poor outcome.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"838"},"PeriodicalIF":4.6,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valproate-induced hyperammonemic encephalopathy in neurosurgical patients: Our experience and systematic literature review.","authors":"Sivaraman Kumarasamy, Noufal Basheer, Amol Raheja, Vivek Tandon, Rajinder Kumar Laythalling, Shashank Sharad Kale","doi":"10.1007/s10143-024-03054-z","DOIUrl":"10.1007/s10143-024-03054-z","url":null,"abstract":"<p><p>Sodium valproate is used for the management of seizures, status epilepticus, chronic pain syndrome, bipolar, and other affective disorders. Even with an acceptable safety profile, severe idiosyncratic reactions can occur with valproate use. A rare, serious, and life-threatening side effect of valproate is valproate-induced hyperammonemic encephalopathy (VHE). We intend to analyze the clinical presentation, diagnosis, treatment options, and outcome of VHE in neurosurgical patients and review the pertinent literature on this rare sequelae. We retrospectively reviewed patients who developed VHE following valproate use, either for the treatment of epilepsy or for seizure prophylaxis in our centre. We analyzed the demographic details, clinical presentation, diagnosis, management, and outcomes. A total of four patients with a mean age of 26.3 ± 5.1 (range 19 - 32 years). Valproate was prescribed for primary seizure prophylaxis in 2 patients (50%). The commonest etiology for valproate prescription was for brain tumors (3, 75%) followed by drug-refractory epilepsy (DRE) (1, 25%). None of the patients were documented to have urea cycle disorder. The mean daily prescribed dosage of valproate was 1250 ± 559 mg and the mean duration of administration was 13 ± 13.3 months (range 4 months - 36 months). The mean serum NH3 level was 136,5 ± 44.2 µmol/L (range 107 - 212.8) and all patients (4, 100%) had hyperammonemia with a mortality rate of 50% (2 patients). The hyperammonemia was treated by stopping the valproate use (4, 100%) and dialysis (2, 50%). Normalization of ammonia levels led to clinical improvement in 50% (2 patients). Neurological deterioration in the postoperative period is a diagnostic challenge. VHE is a rare and life-threatening sequelae of Valproate-associated Hyperammonemia (VAH) in neurosurgical patients. A high index of suspicion is required due to its ambiguous presentation. Early diagnosis and prompt treatment can change the course of this life-threatening sequelae.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"836"},"PeriodicalIF":2.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584045","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}