Neurosurgery最新文献

{"title":"Commentary: CNS-CLIP: Transforming a Neurosurgical Journal Into a Multimodal Medical Model.","authors":"Chris B Lamprecht, Mac Lyerly, Brandon Lucke-Wold","doi":"10.1227/neu.0000000000003298","DOIUrl":"10.1227/neu.0000000000003298","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e123-e124"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785659","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":"Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines Update for the Role of Emerging Therapies in the Management of Patients With Metastatic Brain Tumors.","authors":"Kristin Huntoon, J Bradley Elder, Guilherme Finger, D Ryan Ormond, Navid Redjal, Mark E Linskey, Jeffrey J Olson","doi":"10.1227/neu.0000000000003383","DOIUrl":"10.1227/neu.0000000000003383","url":null,"abstract":"<p><strong>Background: </strong>Patients with metastatic brain tumors (MBTs) require a multidisciplinary team-based approach to select the best diagnostic, surgical, and radiation interventions.</p><p><strong>Objective: </strong>The aim of this guideline was to provide an update of the evidence-based recommendations of the guideline produced in 2019 regarding the use of emerging therapies for adult patients with MBTs.</p><p><strong>Methods: </strong>PubMed and Embase were searched from January 1, 2016, through May 3, 2022, using search strategies pertinent to the therapeutic topics: targeted agents, immune-modulating agents, interstitial modalities, radiosensitizers, laser interstitial thermal therapy, and magnetic resonance imaging-guided focused ultrasound. The search results were screened using pre-established exclusion/inclusion criteria. Evidence tables were constructed using these data, and the recommendations from the 2019 version were left unchanged, updated or, where appropriate, new recommendations were formulated.</p><p><strong>Results: </strong>Of 6403 qualifying abstracts, 162 met the inclusion criteria and were included in the evidence tables. They provided 8 class I recommendations, 3 class II recommendations, and 17 class III recommendations. In three instances, there was insufficient evidence to support a recommendation. The proliferation of qualifying literature since the end of 2015 was greatest regarding the topics related to targeted therapy and immunotherapy of MBTs. Fewer were available for laser interstitial thermal therapy and radiosensitizers, but enough information was available to formulate recommendations on these two topics. For interstitial modalities and magnetic resonance imaging-guided focused ultrasound, insufficient qualifying data were identified to create recommendations.</p><p><strong>Conclusion: </strong>This systematic review provides evidence-based recommendations for adult patients with MBTs regarding the use of therapies beyond standard surgical, radiation, and cytotoxic chemotherapy.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1172-1177"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649813","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":"In Reply: Delineating Neurosurgery Resident Development: Insights From a Ten-Year National ACGME Milestones and Learning Trajectories.","authors":"Syed I Khalid, Yoon Soo Park, Fady T Charbel, Sean O Hogan","doi":"10.1227/neu.0000000000003418","DOIUrl":"10.1227/neu.0000000000003418","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e140-e141"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710889","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":"Injury Characteristics and Risk Factors of Sport-Related Concussion Among High School Athletes in School-Sponsored Sports.","authors":"Annabelle Shaffer, Helen Kemprecos, Zelda Moran, Aaron T Anderson, Adam Tarr, John Flannell, Graham Huesmann, Tracey M Wszalek, Jerrad Zimmerman, Paul M Arnold","doi":"10.1227/neu.0000000000003250","DOIUrl":"10.1227/neu.0000000000003250","url":null,"abstract":"<p><strong>Background and objectives: </strong>Over a million sport-related concussions (SRC) affect children annually in the United States, posing a significant public health concern. Limited data exist on the premorbid risk factors and injury characteristics of SRCs in high school athletes. This study aims to understand acute SRC injury characteristics and describe premorbid risk factors in high school athletes.</p><p><strong>Methods: </strong>Athletes (aged 14-19 years) from 19 central Illinois high schools participating in school-sponsored sports from 2009 to 2023 were included. Sports Concussion Assessment Tool evaluations were performed as part of preseason and postinjury evaluations. Injury characteristics, such as mechanism, setting, and symptoms, were described using all SRCs in the study period. Odds ratios (OR) were computed to determine risk factors using athletes with a baseline Sports Concussion Assessment Tool before SRC and nonconcussed athletes.</p><p><strong>Results: </strong>In total, 4360 athletes were included (3953 without SRC; 407 with ≥1 SRC of whom 168 had a previous baseline). Overall, 24.2% of SRCs occurred in female athletes, and most SRCs occurred in competitions while playing American football (52.3%), soccer (20.4%), and basketball (7.6%). Blow/hit to the head was the most common mechanism. Headache was the most severe symptom (2.55 ± 1.51 [SD]), and symptoms of emotionality and nervousness/anxiety were significantly more severe in female athletes ( P < .05). Students with previous concussions (OR 2.64 95% CI [1.81, 3.78]), previous hospitalization for head injury (OR 3.19 95% CI [1.9, 5.14]), headache/migraine disorders (OR 2.23 95% CI [1.29, 3.66]), and learning disabilities (OR 2.69 95% CI [1.47, 4.61]) had greater odds of SRC ( P < .05). Lower odds of SRC were seen in athletes identifying as Black or African American (vs White) (OR 0.54 95% CI [0.32, 0.86]) and those attending larger (vs smaller) schools (OR 0.64 95% CI [0.46, 0.88]).</p><p><strong>Conclusion: </strong>Understanding SRC risk factors and characteristics in high school athletes is critical for developing prevention and management programs, guiding neurosurgeons in mitigating SRC risk, and informing return-to-play decisions.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1272-1281"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558371","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":"Use of Antibacterial Envelopes in Neuromodulation Surgeries With Implantable Device Insertion: A Systematic Review and Meta-Analysis.","authors":"Helen Michaela de Oliveira, Lucas Mendes Barbosa, Fernanda Valeriano Zamora, Bruna Oliveira de Paula, Guilherme Oliveira de Paula, Julie G Pilitsis, Pablo Ramon Fruett da Costa","doi":"10.1227/neu.0000000000003242","DOIUrl":"10.1227/neu.0000000000003242","url":null,"abstract":"<p><strong>Background and objectives: </strong>Neuromodulation is an advanced therapeutic intervention for managing various neurological, psychiatric, and functional disorders. However, a significant challenge is the risk of infections at the device implantation site. Previous studies have shown that antibacterial envelopes used in cardiovascular surgeries significantly reduce infection risk. It is postulated that similar benefits could occur in neurosurgeries involving implant insertion, but the literature lacks studies analyzing this efficacy. This study aimed to evaluate the effectiveness of antibacterial envelopes in reducing infection rates associated with neuromodulation implants.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases up to August 2024 for clinical trials comparing the use of antibacterial impregnated envelopes in patients undergoing neuromodulation-related implant insertion. This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Statistical analyses were performed using R version 4.3.2. Risk of bias was assessed using the Risk Of Bias In Nonrandomized Studies-of Interventions tool, and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation assessment. The study was registered in Prospective Register of Systematic Reviews.</p><p><strong>Results: </strong>Four studies, comprising 1242 patients, were included, of whom 704 (56.7%) received antibacterial envelopes. The pooled analysis showed that the odds of infection were 77% lower in patients using the antibacterial envelope compared with the control group (odds ratios = 0.23; 95% CI = 0.10-0.51; P < .001; I2 = 2%).</p><p><strong>Conclusion: </strong>The use of an antibacterial envelope significantly reduces the odds of infection in patients undergoing neuromodulation-related implant insertion by 77%. These findings underscore the potential of antibacterial envelopes to improve postoperative outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1193-1199"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558374","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":"Neurological Surgery Manpower Training and Density in Islamic Republic of Iran: A Population Study.","authors":"Bizhan Aarabi, Seyed Mahmood Tabatabaei, Majid Reza Farrokhi, Hosseinali Khalili, Farideh Nejat, Fariborz Samini, Noori Akhtar-Danesh","doi":"10.1227/neu.0000000000003253","DOIUrl":"10.1227/neu.0000000000003253","url":null,"abstract":"<p><strong>Background and objectives: </strong>Significant disparities in worldwide neurosurgical training and workforce distribution are prominent primarily in low-income and middle-income countries. Although Iran is considered a lower middle-income country, neurosurgical density and distribution in Iran has surpassed the recommended ratio of 1 neurosurgeon for every 100 000 population. The objective was to determine neurological surgery density and distribution in Iran and the factors significant in the relative success in training and allocation of neurosurgeons in Iran.</p><p><strong>Methods: </strong>Review of PubMed and administration of site surveys of multiple data sources including Neurosurgical Society of Iran, Iranian Board of Neurological Surgery, Medical Council of Islamic Republic of Iran, Universities of Medical Sciences in Iran, and Ministry of Health and Higher Education of Iran.</p><p><strong>Results: </strong>Over the 72-year period from 1952 to 2024, 1200 neurosurgeons have been trained and distributed in 31 provinces in Iran, attaining a ratio of 1.4/100 000 population. All but 40 neurosurgeons were trained after 1981, which coincided with the Iran-Iraq War. Decentralization of medical and neurosurgical residency training programs, resolving the immediate need for neurosurgeons managing penetrating traumatic brain and spinal cord injuries during the 1980 to 1988 Iran-Iraq War, and active participation of legislative and executive branches of government in solving health care disparities were major factors in meeting the needs of the country. At the present time, more than 555 neurosurgeons are practicing in Tehran Province, a proportion of 3.8 neurosurgeons for every 100 000 population, which indicates an element of disparity in density distribution across Iranian land.</p><p><strong>Conclusion: </strong>Legislative initiatives and government support of public health care delivery and decentralization of medical and residency training programs after the Iran-Iraq War and introduction of the Ministry of Health and Medical Education are considered the main reasons for the relative success in meeting the neurosurgical demand and manpower density. Still, further adjustment of distribution of manpower is needed.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1440-1452"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468511","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 Outcomes of Unilateral vs Bilateral Revascularization in Moyamoya Disease: A Multicenter Retrospective Study.","authors":"Basel Musmar, Joanna M Roy, Hammam Abdalrazeq, Anand Kaul, Elias Atallah, Kareem El Naamani, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan A Grossberg, Adam A Dmytriw, Aman B Patel, Mirhojjat Khorasanizadeh, Christopher S Ogilvy, Ajith J Thomas, Andre Monteiro, Adnan Siddiqui, Gustavo M Cortez, Ricardo A Hanel, Guilherme Porto, Alejandro M Spiotta, Anthony J Piscopo, David M Hasan, Mohammad Ghorbani, Joshua Weinberg, Shahid M Nimjee, Kimon Bekelis, Mohamed M Salem, Jan-Karl Burkhardt, Akli Zetchi, Charles Matouk, Brian M Howard, Rosalind Lai, Rose Du, Rawad Abbas, Georgios S Sioutas, Abdelaziz Amllay, Alfredo Munoz, Nabeel A Herial, Stavropoula I Tjoumakaris, Michael Reid Gooch, Robert H Rosenwasser, Pascal Jabbour","doi":"10.1227/neu.0000000000003243","DOIUrl":"10.1227/neu.0000000000003243","url":null,"abstract":"<p><strong>Background and objectives: </strong>Moyamoya disease (MMD) is characterized by progressive steno-occlusion of the internal carotid arteries, leading to compensatory collateral vessel formation. The optimal surgical approach for MMD remains debated, with bilateral revascularization potentially offering more comprehensive protection but involving more extensive surgery compared to unilateral revascularization. This study aims to compare bilateral revascularization and unilateral revascularization short-term safety profile in the treatment of MMD.</p><p><strong>Methods: </strong>This multicenter retrospective study included patients with MMD who underwent surgical revascularization at 13 academic institutions. Patients were categorized into unilateral and bilateral revascularization groups. Data collected included demographics, clinical characteristics, and outcomes. Propensity score matching was used to balance baseline characteristics. Statistical analyses were conducted using Stata (V.17.0; StataCorp).</p><p><strong>Results: </strong>A total of 497 patients were included, including 90 who had bilateral revascularization and 407 who had unilateral revascularization. Bilateral revascularization was associated with more perioperative asymptomatic strokes (10% vs 2.4%; odds ratio [OR] 4.41, 95% CI 1.73 to 11.19, P = .002) and higher rates of excellent functional outcomes (modified Rankin Scale 0-1) at discharge (92.2% vs 79.1%; OR 3.12, 95% CI 1.39 to 7, P = .006). After propensity score matching, 57 matched pairs were analyzed. There was a higher rate, though not statistically significant difference, of perioperative stroke in the bilateral revascularization group (15.7% vs 8.7%; OR 1.95, 95% CI 0.61 to 6.22, P = .26). No significant differences were noted in modified Rankin scale 0 to 1 and 0 to 2 scores at discharge, National Institute of Health Stroke Scale at discharge, intraoperative complications, or length of hospital stay. The follow-up stroke rates were also not significantly different (OR 0.40, 95% CI 0.11 to 1.39, P = .15).</p><p><strong>Conclusion: </strong>This study found no significant differences between bilateral and unilateral revascularization in MMD. Patients who had bilateral revascularization had higher tendency of perioperative stroke, though not statistically significant. Further prospective studies are needed to validate these results.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1364-1373"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504918","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":"CNS-CLIP: Transforming a Neurosurgical Journal Into a Multimodal Medical Model.","authors":"Anton Alyakin, David Kurland, Daniel Alexander Alber, Karl L Sangwon, Danxun Li, Aristotelis Tsirigos, Eric Leuthardt, Douglas Kondziolka, Eric Karl Oermann","doi":"10.1227/neu.0000000000003297","DOIUrl":"10.1227/neu.0000000000003297","url":null,"abstract":"<p><strong>Background and objectives: </strong>Classical biomedical data science models are trained on a single modality and aimed at one specific task. However, the exponential increase in the size and capabilities of the foundation models inside and outside medicine shows a shift toward task-agnostic models using large-scale, often internet-based, data. Recent research into smaller foundation models trained on specific literature, such as programming textbooks, demonstrated that they can display capabilities similar to or superior to large generalist models, suggesting a potential middle ground between small task-specific and large foundation models. This study attempts to introduce a domain-specific multimodal model, Congress of Neurological Surgeons (CNS)-Contrastive Language-Image Pretraining (CLIP), developed for neurosurgical applications, leveraging data exclusively from Neurosurgery Publications.</p><p><strong>Methods: </strong>We constructed a multimodal data set of articles from Neurosurgery Publications through PDF data collection and figure-caption extraction using an artificial intelligence pipeline for quality control. Our final data set included 24 021 figure-caption pairs. We then developed a fine-tuning protocol for the OpenAI CLIP model. The model was evaluated on tasks including neurosurgical information retrieval, computed tomography imaging classification, and zero-shot ImageNet classification.</p><p><strong>Results: </strong>CNS-CLIP demonstrated superior performance in neurosurgical information retrieval with a Top-1 accuracy of 24.56%, compared with 8.61% for the baseline. The average area under receiver operating characteristic across 6 neuroradiology tasks achieved by CNS-CLIP was 0.95, slightly superior to OpenAI's Contrastive Language-Image Pretraining at 0.94 and significantly outperforming a vanilla vision transformer at 0.62. In generalist classification, CNS-CLIP reached a Top-1 accuracy of 47.55%, a decrease from the baseline of 52.37%, demonstrating a catastrophic forgetting phenomenon.</p><p><strong>Conclusion: </strong>This study presents a pioneering effort in building a domain-specific multimodal model using data from a medical society publication. The results indicate that domain-specific models, while less globally versatile, can offer advantages in specialized contexts. This emphasizes the importance of using tailored data and domain-focused development in training foundation models in neurosurgery and general medicine.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1227-1235"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785594","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":"Initial Symptom Severity and Recovery of Sport-Related Concussion in Team Versus Individual Sport Athletes.","authors":"Connor C Long, John E Dugan, Jacob Jo, Kristen L Williams, Soren Jonzzon, Douglas P Terry, Aaron M Yengo-Kahn, Scott L Zuckerman","doi":"10.1227/neu.0000000000003225","DOIUrl":"10.1227/neu.0000000000003225","url":null,"abstract":"<p><strong>Background and objectives: </strong>Recovery after sport-related concussion is variable, and potential differences between team vs individual sport athletes are not fully understood. In a cohort of athletes with concussions, we sought to compare these groups across (1) symptom severity score, (2) individual symptom cluster scores, and (3) recovery metrics.</p><p><strong>Methods: </strong>A retrospective, cohort study of 13 to 23-year-old athletes treated at a regional sport concussion center between November 2017 and April 2022 was conducted. Athletes were categorized into team vs individual sport athletes, with additional classification of individual sports based on strong vs minimal team elements (ie, the degree of interdependence displayed by athletes). The primary outcomes were symptom severity score, measured by either the Sport Concussion Assessment Tool-5th Edition or the Immediate Post-Concussion Assessment and Cognitive Testing, and physical, cognitive, emotional, and sleep symptom cluster scores. Secondary outcomes were recovery metrics, including time to return-to-learn, symptom resolution, and return-to-play.</p><p><strong>Results: </strong>Of the 1051 athletes, 954 (90.8%) were in team sports and 97 (9.2%) in individual sports. In multivariable linear regression, individual sport athletes had higher emotional symptom severity compared with team sport athletes (β = 0.09 [0.01, 0.17], P = .034) when adjusting for sex, attention-deficit/hyperactivity disorder, psychological disorders, time to clinic, on-field evaluation, and Immediate Post-Concussion Assessment and Cognitive Testing vs Sport Concussion Assessment Tool-5 th Edition scale. There were no significant differences in return-to-learn ( P = .104), symptom resolution ( P = .941), or return-to-play ( P = .279) on univariate regressions.</p><p><strong>Conclusion: </strong>In the current single-center, pilot study of athletes with a sport-related concussion, individual sport athletes exhibited more emotional symptoms than team sport athletes. These preliminary data lend early support that individual sport athletes may be more at risk of emotional symptoms than team sport athletes after a sport-related concussion. Clinicians may use these findings to identify athletes who may be particularly vulnerable to emotional symptoms.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1261-1271"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471057","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":"Subthalamic Nucleus Deep Brain Stimulation for Meige Syndrome: Long-Term Outcomes and Analysis of Prognostic Factors.","authors":"Wentao Zheng, Qingpei Hao, Xi Chen, Yezu Liu, Zihao Zhang, Zhangyu Li, Jianyao Mao, Liwei Zhou, Sifang Chen, Guowei Tan, Ruen Liu","doi":"10.1227/neu.0000000000003228","DOIUrl":"10.1227/neu.0000000000003228","url":null,"abstract":"<p><strong>Background and objectives: </strong>The aim of this study was to explore the impacts of subthalamic nucleus deep brain stimulation (STN-DBS) on both motor and nonmotor symptoms in individuals with Meige syndrome, as well as further investigates prognostic factors for long-term postoperative outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed a consecutive cohort of patients with intractable Meige syndrome who underwent STN-DBS at our center from January 2016 to July 2023. Motor function, quality of life, neuropsychological status, and mood state were evaluated with standardized scales at baseline and every 3 to 6 months thereafter. Univariate and multivariate linear regression analyses were used to determine independent risk factors that affect long-term motor function after STN-DBS.</p><p><strong>Results: </strong>Fifty-five patients were ultimately analyzed with a mean follow-up of 62.1 ± 25.7 months. At the final postoperative assessment, movement and disability scores of the Burke-Fahn-Marsden Dystonia Rating Scale demonstrated improvements of 61% ( P < .001) and 57% ( P < .001), respectively. Postoperative scores on the 36-item Short-Form General Health Survey showed significant improvement from baseline. Global cognitive function and neuropsychological status remained stable during continuous neurostimulation. Multivariate linear regression analysis revealed that longer disease duration (standardized β coefficient = -0.294, 95% CI -0.039 to -0.007, P = .006), older age at surgery (standardized β coefficient = -0.382, 95% CI -0.014 to -0.004, P = .001), and smaller volume of tissue activated within the sensorimotor subregion of STN (standardized β coefficient = 0.309, 95% CI 0.001-0.004, P = .004) were independently correlated with poorer long-term motor performance.</p><p><strong>Conclusion: </strong>Bilateral STN-DBS is an effective, safe, and promising treatment option for Meige syndrome, which can improve motor function and quality of life without cognitive and mood side effects. Early diagnosis, prompt intervention, and accurate lead placement in the dorsolateral STN are crucial to optimize long-term therapeutic outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1282-1289"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471058","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}