Neurosurgical focus最新文献

筛选
英文 中文
A propensity score-matched cost-effectiveness analysis of magnetic resonance-guided laser interstitial thermal therapy versus craniotomy for brain tumor radiation necrosis. 磁共振引导下激光间质热疗与开颅手术治疗脑肿瘤放射性坏死的倾向得分匹配成本效益分析。
IF 3.3 2区 医学
Neurosurgical focus Pub Date : 2024-11-01 DOI: 10.3171/2024.8.FOCUS24417
Jia-Shu Chen, Alexander F Haddad, Jason E Chung, Oliver Y Tang, Winson S Ho, Shawn L Hervey-Jumper, Manish K Aghi
{"title":"A propensity score-matched cost-effectiveness analysis of magnetic resonance-guided laser interstitial thermal therapy versus craniotomy for brain tumor radiation necrosis.","authors":"Jia-Shu Chen, Alexander F Haddad, Jason E Chung, Oliver Y Tang, Winson S Ho, Shawn L Hervey-Jumper, Manish K Aghi","doi":"10.3171/2024.8.FOCUS24417","DOIUrl":"10.3171/2024.8.FOCUS24417","url":null,"abstract":"<p><strong>Objective: </strong>Radiation necrosis is becoming an increasingly prevalent complication in patients with brain tumors given the growing utility of stereotactic radiosurgery in modern treatment paradigms. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a new minimally invasive modality that has exhibited an efficacy comparable to craniotomy in treating radiation necrosis. No studies to date have compared their cost-effectiveness despite the significant additional expenses associated with MRgLITT use. This study aimed to evaluate the cost-effectiveness of MRgLITT versus craniotomy in patients with comparable presentations of radiation necrosis.</p><p><strong>Methods: </strong>The National Inpatient Sample (NIS) was queried from 2011 to 2020 for patients with radiation necrosis and treated using craniotomy or MRgLITT. Admission charges and costs were inflation adjusted to 2020 $US. Surgical cohorts were propensity score-matched according to demographic, clinical, and admission characteristics. Multivariable linear and logistic regression analyses identified associations between type of intervention and outcomes. A semi-Markov model was created to simulate treatment with craniotomy versus MRgLITT. Cost, transition probabilities, and health state utilities were derived from the NIS, individual patient outcomes from multiple institutions, and prospectively collected quality-of-life data from a single institution and verified against other studies. Monte Carlo simulation and probabilistic sensitivity analysis were used to evaluate the cost-effectiveness between the two modalities.</p><p><strong>Results: </strong>In the designated study period, 2869 patients had been admitted with brain tumor radiation necrosis and were managed with neurosurgical intervention. After propensity score matching, MRgLITT, relative to craniotomy, was independently associated with a shorter length of stay (LOS; β = -1.81, p = 0.002), lower odds of complications (OR 0.18, p = 0.033), and higher odds of home discharge (OR 3.05, p = 0.041), but there was no difference in total admission costs between the two modalities (β = $6229, p = 0.081). On Monte Carlo simulation, patients treated with MRgLITT had a lower probability of disease (radiation necrosis or tumor) recurrence (13.5% vs 22.0%, p < 0.001) but an equivalent mortality risk (22.8% vs 22.3%, p = 0.429) compared to the patients treated with craniotomy at the 1-year follow-up. Over a 4-year time horizon, MRgLITT had an incremental cost of -$25,685 and incremental effectiveness of 0.14 quality-adjusted life-year (QALY), resulting in an incremental cost-effectiveness ratio of -$183,464 per QALY relative to craniotomy.</p><p><strong>Conclusions: </strong>MRgLITT was a more cost-effective treatment strategy than craniotomy in the management of patients with brain tumor radiation necrosis. The cost-effectiveness of MRgLITT may be attributed to a shorter LOS, lower complication odds, and hig","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562481","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}
引用次数: 0
Development of a murine laser interstitial thermotherapy system. 开发小鼠激光间质热疗系统。
IF 3.3 2区 医学
Neurosurgical focus Pub Date : 2024-11-01 DOI: 10.3171/2024.8.FOCUS24452
Matthew Frain, Nagheme Thomas, Sandra C Yan, Aida Karachi, Farhad Dastmalchi, Ghaidaa Ebrahim, Didier Rajon, Richard Tyc, Catherine Flores, Anjali Chauhan, Elias Sayour, Duane A Mitchell, Frank J Bova, Maryam Rahman
{"title":"Development of a murine laser interstitial thermotherapy system.","authors":"Matthew Frain, Nagheme Thomas, Sandra C Yan, Aida Karachi, Farhad Dastmalchi, Ghaidaa Ebrahim, Didier Rajon, Richard Tyc, Catherine Flores, Anjali Chauhan, Elias Sayour, Duane A Mitchell, Frank J Bova, Maryam Rahman","doi":"10.3171/2024.8.FOCUS24452","DOIUrl":"10.3171/2024.8.FOCUS24452","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to develop a murine system for the delivery of laser interstitial thermotherapy (LITT) with probe-based thermometry as a model for human glioblastoma treatment to investigate thermal diffusion in heterogeneous brain tissue.</p><p><strong>Methods: </strong>First, the tissue heating properties were characterized using a diode-pumped solid-state near-infrared laser in a homogeneous tissue model. The laser was adapted for use with a repurposed stereotactic surgery frame utilizing a micro laser probe and Hamilton syringe. The authors designed and manufactured a stereotactic frame attachment to work as a temperature probe stabilizer. Application of this novel design was used as a precise method for real-time thermometry at known distances from the thermal ablative center mass during murine LITT studies.</p><p><strong>Results: </strong>Temperature measurements were achieved during LITT that verified the direct thermometry capability of the system without the need for MR-based thermal monitoring. Application of multiple stereotactic design iterations led to an accurately reproducible surgical laser ablation procedure. Histological staining confirmed precise thermal ablation and controllable lesion size based on time and temperature control. Treatment of a syngeneic intracranial glioma model highly resistant to conventional therapy resulted in a modest survival benefit.</p><p><strong>Conclusions: </strong>The authors have successfully developed a murine model system of LITT with direct in situ thermometry for investigation into the effects of thermal ablation and combinatorial treatments in murine brain tumor models.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562490","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}
引用次数: 0
Indication-based analysis of laser interstitial thermal therapy: a propensity score-matched comparison of outcomes for brain tumor versus epilepsy indications. 基于适应症的激光间质热疗分析:脑肿瘤与癫痫适应症疗效的倾向得分匹配比较。
IF 3.3 2区 医学
Neurosurgical focus Pub Date : 2024-11-01 DOI: 10.3171/2024.8.FOCUS24441
Andrew M Miller, Shane Shahrestani, Michelot Michel, John S Yu, Adam Mamelak
{"title":"Indication-based analysis of laser interstitial thermal therapy: a propensity score-matched comparison of outcomes for brain tumor versus epilepsy indications.","authors":"Andrew M Miller, Shane Shahrestani, Michelot Michel, John S Yu, Adam Mamelak","doi":"10.3171/2024.8.FOCUS24441","DOIUrl":"10.3171/2024.8.FOCUS24441","url":null,"abstract":"<p><strong>Objective: </strong>Laser interstitial thermal therapy (LITT) is a minimally invasive procedure used to ablate abnormal tissue in a targeted fashion. It is most commonly used to treat epileptic foci, brain tumors, and radiation necrosis. This study aimed to compare immediate postoperative outcomes between these indications.</p><p><strong>Methods: </strong>This study analyzed clinical data from the Nationwide Readmissions Database (NRD) from 2016 to 2019 and identified 2234 patients who underwent LITT procedures using ICD-10 codes. The authors analyzed patient demographics, complications, discharge disposition, readmission rates, and mortality. Following propensity score matching, 317 patients treated for epilepsy and 323 patients treated for brain tumors were compared.</p><p><strong>Results: </strong>The mean ages were similar (epilepsy: 45.7 vs tumor: 49.0 years, p = 0.55), as were the proportions of female patients (epilepsy: 45.4% vs tumor: 52.9%, p = 0.83), all-payer costs (p = 0.81), income quartiles (p = 0.58), insurance types (p = 0.70), frailty rates (p = 0.85), and comorbid disease burdens as assessed by ECI score (p = 0.73). No significant differences were observed in rates of hemorrhage (p = 0.1), pulmonary embolism (p = 0.32), or infection (p = 0.16). However, the tumor cohort had higher rates of deep vein thrombosis (3.4% vs < 3.15%, p = 0.045), nonroutine discharge (26.6% vs 16.4%, p = 0.04), and 1-year hospital readmission (32.5% vs 18.6%, p = 0.006). One-year mortality rates were similar (tumor: 3.4% vs epilepsy: < 3.15%, p = 0.08).</p><p><strong>Conclusions: </strong>While postoperative complications and 1-year mortality rates were similar among patients undergoing LITT for epilepsy and brain tumors, the tumor cohort experienced higher rates of deep vein thrombosis, nonroutine discharge, and 1-year hospital readmission.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562496","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}
引用次数: 0
An analysis of functional outcomes following laser interstitial thermal therapy for recurrent high-grade glioma. 激光间质热疗治疗复发性高级别胶质瘤后的功能效果分析。
IF 3.3 2区 医学
Neurosurgical focus Pub Date : 2024-11-01 DOI: 10.3171/2024.8.FOCUS24460
Bradley Wilhelmy, Riccardo Serra, Chixiang Chen, Mark Mishra, Dario Rodrigues, Neeraj Badjatia, Melissa Motta, Alexander Ksendzovsky, Graeme F Woodworth
{"title":"An analysis of functional outcomes following laser interstitial thermal therapy for recurrent high-grade glioma.","authors":"Bradley Wilhelmy, Riccardo Serra, Chixiang Chen, Mark Mishra, Dario Rodrigues, Neeraj Badjatia, Melissa Motta, Alexander Ksendzovsky, Graeme F Woodworth","doi":"10.3171/2024.8.FOCUS24460","DOIUrl":"10.3171/2024.8.FOCUS24460","url":null,"abstract":"<p><strong>Objective: </strong>Laser interstitial thermal therapy (LITT) is an emerging tool for treating a variety of focal brain lesions, including recurrent high-grade glioma (HGG). While the efficacy and uses of LITT have been well studied, the impact of this treatment on patient functional outcomes has not been analyzed in detail. This study sought to better define the role of LITT in treating patients with recurrent HGG, examining which patients exhibit good functional outcomes after LITT, and to determine risk factors for worsening neurological function.</p><p><strong>Methods: </strong>The medical records of patients treated with LITT for recurrent HGG at a single tertiary care center were retrospectively reviewed. Functional status was assessed using the Karnofsky Performance Scale (KPS). Demographic, clinical, and radiological data were examined for associations with change in KPS score assessed 4-6 weeks following surgery.</p><p><strong>Results: </strong>Forty-seven patients were included in the study with histopathologically confirmed recurrent HGG. The mean age was 57 years, and 21 (45%) patients were female. The pre-LITT KPS scores were as follows: 100 in 4 (9%) patients, 90 in 15 (32%) patients, 80 in 10 (21%) patients, 70 in 13 (28%) patients, and 60 in 5 (11%) patients. Overall, 59% of patients showed a stable or improved KPS score after undergoing LITT. Tumor volume was the sole predictor of decreased KPS score after LITT. Notably, tumor location including eloquent location, preoperative KPS score, and other comorbidities were not independently associated with change in functional status.</p><p><strong>Conclusions: </strong>The majority of patients undergoing LITT for recurrent HGG had a favorable functional outcome at the initial follow-up visit. The treated tumor volume was inversely and independently associated with post-LITT functional outcome. This information may help guide patient selection and treatment optimization in the setting of LITT-based approaches for recurrent HGG.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562486","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}
引用次数: 0
Introduction. Calibrating the utility of laser interstitial thermal therapy in neurosurgery: a once-novel surgical treatment finds it place in the armamentarium. 导言。校准激光间质热疗法在神经外科手术中的应用:一种曾经新颖的外科疗法找到了自己的用武之地。
IF 3.3 2区 医学
Neurosurgical focus Pub Date : 2024-11-01 DOI: 10.3171/2024.9.FOCUS23741
Robert J Bollo, Winson S Ho, Ido Strauss, Sherise D Ferguson, Sarah T Menacho
{"title":"Introduction. Calibrating the utility of laser interstitial thermal therapy in neurosurgery: a once-novel surgical treatment finds it place in the armamentarium.","authors":"Robert J Bollo, Winson S Ho, Ido Strauss, Sherise D Ferguson, Sarah T Menacho","doi":"10.3171/2024.9.FOCUS23741","DOIUrl":"https://doi.org/10.3171/2024.9.FOCUS23741","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562500","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}
引用次数: 0
Leveraging machine learning for preoperative prediction of supramaximal ablation in laser interstitial thermal therapy for brain tumors. 利用机器学习术前预测脑肿瘤激光间质热疗中的超轴消融。
IF 3.3 2区 医学
Neurosurgical focus Pub Date : 2024-11-01 DOI: 10.3171/2024.8.FOCUS24434
Cameron A Rivera, Shovan Bhatia, Venkat Uppalapati, Chandler N Berke, Martin A Merenzon, Lekhaj C Daggubati, Adam S Levy, Ashish H Shah, Ricardo J Komotar, Michael E Ivan
{"title":"Leveraging machine learning for preoperative prediction of supramaximal ablation in laser interstitial thermal therapy for brain tumors.","authors":"Cameron A Rivera, Shovan Bhatia, Venkat Uppalapati, Chandler N Berke, Martin A Merenzon, Lekhaj C Daggubati, Adam S Levy, Ashish H Shah, Ricardo J Komotar, Michael E Ivan","doi":"10.3171/2024.8.FOCUS24434","DOIUrl":"10.3171/2024.8.FOCUS24434","url":null,"abstract":"<p><strong>Objective: </strong>Maximizing safe resection in neuro-oncology has become paramount to improving patient survival and outcomes. Laser interstitial thermal therapy (LITT) offers similar survival benefits to traditional resection, alongside shorter hospital stays and faster recovery times. The extent of ablation (EOA) achieved using LITT is linked to patient outcomes, with greater EOA correlating with improved outcomes. However, the preoperative predictors for achieving supramaximal ablation (EOA ≥ 100%) are not well understood. By leveraging machine learning (ML) techniques, this study aimed to identify these predictors to enhance patient selection and therefore outcomes. The objective was to explore preoperative predictors for supramaximal EOA using ML in patients with glioblastoma.</p><p><strong>Methods: </strong>A retrospective study was conducted on the medical records of 254 patients undergoing LITT from 2013 to 2023 at a single tertiary center. Cohort criteria included age ≥ 18 years, diagnosis of glioblastoma, single-trajectory ablation, and a complete dataset. The study assessed preoperative clinical and radiographic factors, using EOA ≥ 100% as the endpoint. Five ML models were used: logistic regression, random forest (RF), gradient boosting, Gaussian naive Bayes, and support vector machine. Training and testing cohorts were subsequently assessed across ML models with fivefold cross-validation. Models were optimized using hyperparameter tuning. Performance was primarily quantified using the area under the curve (AUC) of the receiver operating characteristic curve.</p><p><strong>Results: </strong>The final cohort consisted of 72 patients. Among the ML models, RF achieved the highest AUC (mean ± SD 0.94 ± 0.06). The leading models identified that lower preoperative volume, history of prior radiation therapy, history of prior craniotomy, preoperative neurological deficits, history of preoperative seizures, and distance from intracranial heat sinks were predictive of successful ablations in patients. Additionally, RF had the best mean metrics: accuracy 0.88, precision 0.87, specificity 0.87, and sensitivity 0.89.</p><p><strong>Conclusions: </strong>This is the first study to investigate the role of ML for optimizing ablation volumes in LITT. These ML models suggest that low preoperative volumes, previous craniotomy, previous radiation therapy, no previous neurological deficits, larger catheter-heat sink distance, and the presence of preoperative seizures are important prognostic factors for predicting successful supramaximal ablations with LITT.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562468","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}
引用次数: 0
Evaluating laser interstitial thermal therapy for newly diagnosed, deep-seated, large-volume glioblastoma: survival and outcome analysis. 对新诊断的深部大体积胶质母细胞瘤进行激光间质热疗评估:生存率和疗效分析。
IF 3.3 2区 医学
Neurosurgical focus Pub Date : 2024-11-01 DOI: 10.3171/2024.8.FOCUS24457
Adham M Khalafallah, Khushi H Shah, Maxon V Knott, Chandler N Berke, Ashish H Shah, Ricardo J Komotar, Michael E Ivan
{"title":"Evaluating laser interstitial thermal therapy for newly diagnosed, deep-seated, large-volume glioblastoma: survival and outcome analysis.","authors":"Adham M Khalafallah, Khushi H Shah, Maxon V Knott, Chandler N Berke, Ashish H Shah, Ricardo J Komotar, Michael E Ivan","doi":"10.3171/2024.8.FOCUS24457","DOIUrl":"10.3171/2024.8.FOCUS24457","url":null,"abstract":"<p><strong>Objective: </strong>Laser interstitial thermal therapy (LITT) has emerged as an alternative for treating glioblastoma (GBM) in patients deemed unsuitable for resection due to deep-seated or eloquent location, age, or comorbidities. However, its safety and efficacy in large-volume, deep-seated, newly diagnosed GBM (nGBM) tumors remain insufficiently studied. Therefore, the authors aimed to assess the outcomes of LITT in the treatment of deep-seated, large-volume nGBM.</p><p><strong>Methods: </strong>A retrospective analysis of patients with nGBM who underwent LITT between February 2013 and August 2023 was conducted. Patients with deep-seated tumor volume ≥ 10 cm3 treated with LITT were compared to patients with deep-seated tumor volume < 10 cm3. Demographic, perioperative, and follow-up data were collected and compared among both groups. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to evaluate the impact of various clinical and treatment-related factors on patient survival.</p><p><strong>Results: </strong>A total of 33 patients in the study group (mean ± SD age 65.7 ± 10.2 years, 58% male) with mean tumor volume 36.0 ± 21.6 cm3 were compared to 23 controls (mean age 67.0 ± 12.5 years, 61% male) with mean tumor volume 5.2 ± 2.7 cm3. There were no significant differences in hospital length of stay (p = 0.494), temporary neurological deficits and edema within 30 days (p = 0.705 and p > 0.999, respectively), 30-day readmissions (p = 0.139), < 30-day complications (p = 0.918), complications between 30 days and 3 months (p = 0.903), and new motor and speech deficits within 3 months (p = 0.883 and p > 0.999, respectively) between the study and control groups. Kaplan-Meier analysis did not reveal any statistically significant difference in overall survival (OS) between groups (p = 0.227). Multivariate analysis indicated that tumor volume did not significantly affect the hazard ratio for individuals undergoing LITT (HR 1.16, 95% CI 0.83-3.29, p = 0.150).</p><p><strong>Conclusions: </strong>This pilot study suggests that LITT is safe for treating patients with large-volume, deep-seated nGBM compared to those with small-volume tumor. Although there appears to be improved OS in patients with smaller lesions with greater EOA, significance was not achieved in this cohort.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562493","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}
引用次数: 0
Letter to the Editor. Management and long-term neurological outcomes of sdAVF. 致编辑的信。sdAVF 的管理和长期神经功能预后。
IF 3.3 2区 医学
Neurosurgical focus Pub Date : 2024-11-01 DOI: 10.3171/2024.6.FOCUS24391
Lara Brunasso, Rina Di Bonaventura, Carmelo Lucio Sturiale, Alessio Albanese
{"title":"Letter to the Editor. Management and long-term neurological outcomes of sdAVF.","authors":"Lara Brunasso, Rina Di Bonaventura, Carmelo Lucio Sturiale, Alessio Albanese","doi":"10.3171/2024.6.FOCUS24391","DOIUrl":"https://doi.org/10.3171/2024.6.FOCUS24391","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562467","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}
引用次数: 0
Stereotactic robot-assisted MRI-guided laser interstitial thermal therapy thalamotomy for medically intractable Holmes tremor: a pilot study and literature review. 立体定向机器人辅助核磁共振成像引导的激光间质热疗丘脑切开术治疗药物难治性霍姆斯震颤:一项试点研究和文献综述。
IF 3.3 2区 医学
Neurosurgical focus Pub Date : 2024-11-01 DOI: 10.3171/2024.8.FOCUS24444
Mickael Aubignat, Mélissa Tir, Martial Ouendo, Salem Boussida, Jean-Marc Constans, Michel Lefranc
{"title":"Stereotactic robot-assisted MRI-guided laser interstitial thermal therapy thalamotomy for medically intractable Holmes tremor: a pilot study and literature review.","authors":"Mickael Aubignat, Mélissa Tir, Martial Ouendo, Salem Boussida, Jean-Marc Constans, Michel Lefranc","doi":"10.3171/2024.8.FOCUS24444","DOIUrl":"10.3171/2024.8.FOCUS24444","url":null,"abstract":"<p><strong>Objective: </strong>Holmes tremor (HT) is a complex syndrome characterized by resting, postural, and kinetic tremors. HT significantly impacts patients' quality of life (QOL) and daily activities. Conventional pharmacological treatments for HT often yield inconsistent results. Emerging surgical treatments such as deep brain stimulation and various thalamotomy techniques show promise but come with challenges, including adverse events (AEs) and potential tremor recurrence. This study aimed to evaluate the clinical outcomes of unilateral MRI-guided laser interstitial thermal therapy (MRIgLITT) thalamotomy in patients with medically intractable HT, focusing on tremor reduction, QOL, and AE incidence, and provide a comprehensive review of the literature on thalamotomy techniques for HT.</p><p><strong>Methods: </strong>Five patients with medically intractable HT underwent unilateral MRIgLITT thalamotomy between June 2020 and January 2023. Tremor severity was assessed using the Fahn-Tolosa-Marin Tremor Rating Scale (TRS) at baseline and at 3 and 12 months postoperatively. QOL was measured using the Quality of Life in Essential Tremor (QUEST) questionnaire and 39-item Parkinson's Disease Questionnaire (PDQ-39). Subjective patient-rated improvement was evaluated using the Patient Global Impression of Clinical Status (PGI-C) scale at 12 months. Cognitive performance was assessed using the Mini-Mental State Examination (MMSE) before the procedure and at 12 months postoperatively. AEs were monitored throughout the follow-up period.</p><p><strong>Results: </strong>The mean patient age was 50.2 ± 22.37 years, with a mean tremor duration of 5.8 ± 4.55 years. Significant tremor reduction was observed in the treated hand, with mean TRS scores decreasing from 19.00 ± 4.36 at baseline to 11.20 ± 4.44 (p = 0.043) at 3 months and 13.40 ± 5.94 (p = 0.042) at 12 months, indicating a relative reduction of 41.05% and 29.47%, respectively. A significant effect was observed on the QUEST scale at 3 months (p = 0.043), but this effect was no longer present at 12 months. No significant effect was found on the PDQ-39 QOL scale. The PGI-C scale showed a high mean subjective improvement of 88.60% ± 8.36% at 12 months. One patient experienced severe AEs, including dysarthria, hemiparesis, and swallowing difficulties, which required prolonged hospitalization and multidisciplinary rehabilitation, but regressed within 3 months. Cognitive performance, as measured by the MMSE, remained stable (p = 0.785).</p><p><strong>Conclusions: </strong>Unilateral MRIgLITT thalamotomy showed promise as a treatment for medically intractable HT, providing significant tremor reduction with a favorable safety profile. However, the potential for tremor recurrence and minimal functional improvement in fine motor skills highlight the need for long-term follow-up and further research. Larger, multicenter studies are necessary to validate these findings.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562483","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}
引用次数: 0
Editorial. Factors that influence functional recovery after MR-guided laser interstitial thermal therapy for recurrent high-grade gliomas. 社论。影响磁共振引导激光间质热疗治疗复发性高级别胶质瘤后功能恢复的因素。
IF 3.3 2区 医学
Neurosurgical focus Pub Date : 2024-11-01 DOI: 10.3171/2024.8.FOCUS24607
Sarah T Menacho
{"title":"Editorial. Factors that influence functional recovery after MR-guided laser interstitial thermal therapy for recurrent high-grade gliomas.","authors":"Sarah T Menacho","doi":"10.3171/2024.8.FOCUS24607","DOIUrl":"https://doi.org/10.3171/2024.8.FOCUS24607","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562492","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}
引用次数: 0
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
相关产品
×
本文献相关产品
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信