World neurosurgery最新文献

{"title":"Development and validation of a risk prediction model for pseudarthrosis after transforaminal lumbar interbody fusion: A retrospective analysis.","authors":"Zhanwei Wang, Jianjie Wang, Chen Jin, Xuqiang Zhan, Yi Li, Qingzhi Xiang, Kaiwei Wang, Haofei Ni, Tao Dai, Yan Yu, Ning Xie","doi":"10.1016/j.wneu.2024.10.021","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.021","url":null,"abstract":"<p><strong>Background: </strong>Pseudarthrosis is a common complication of transforaminal lumbar interbody fusion (TLIF) that can affect the long-term prognosis and increase revision surgery risk. Therefore, it is crucial to investigate the risk factors associated with pseudarthrosis and develop a predictive model.</p><p><strong>Methods: </strong>Patients who underwent TLIF at a single hospital between January 2019 and June 2021 were included. Each patient's fusion status was determined based on thin-section lumbar spine CT scans performed at least one year postoperatively. A nomogram was subsequently established to predict the probability of pseudarthrosis based on the results of least absolute shrinkage and selection operator (LASSO) and multivariable analysis. Receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA) were applied to evaluate the prediction effect and clinical value of the model.</p><p><strong>Results: </strong>In total, 284 patients (131 men [46.1 %]; mean [standard deviation, SD] age, 63.0[12.1] years) were included in the analysis (mean [SD] follow-up, 19.2[9.2] months). The incidence of pseudarthrosis was 13.4% (38/284). In LASSO and multivariable analysis, independent risk factors for pseudarthrosis included: history of smoking (odds ratio [OR]:2.966, 95% confidence interval [CI]: 1.135-7.750, P=0.027), osteoporosis (OR=6.362, 95% CI: 2.433-16.636, P<0.001), and the change of mean disc height (ΔMDH) (OR=2.401, 95% CI: 1.638-3.519, P<0.001). The areas under the curves (AUC) in the training and validation cohorts were 0.870 and 0.809, respectively.</p><p><strong>Conclusions: </strong>History of smoking, osteoporosis, and ΔMDH are all independent risk factors of pseudarthrosis following TLIF surgery; a nomogram based on these may help predict the probability of pseudarthrosis.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersection of Care: Navigating Patient-Hospital Relationships in Neurosurgery.","authors":"Eesha Yaqoob, Nimirta Sahitia, Dua Abbas Zaidi, Shiza Aftab, Fatima Sajid, Shahzad Ali Khan, Bipin Chaurasia, Saad Javed","doi":"10.1016/j.wneu.2024.10.077","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.077","url":null,"abstract":"<p><strong>Background: </strong>This study explores the vital elements of patient satisfaction in hospital settings, with an emphasis on the aspects of service quality and patient-hospital interaction. It looks at how patients perceive several aspects of service quality, such as assurance, tangibility, empathy, responsiveness, and consistency.</p><p><strong>Methodology: </strong>A descriptive cross-sectional study was conducted among 80 Neurosurgery in-patients at the Pakistan Institute of Medical Sciences (PIMS), using convenience sampling. Data collection was done after obtaining consent from each patient. A self-administered questionnaire was used to collect demographic data, and patient satisfaction with the outpatient clinic experience. Data were entered and analyzed in Statistical Package for the Social Sciences, version 25. A chi-square test was used to examine associations between outcome variables and factors related to patient satisfaction.</p><p><strong>Results: </strong>The majority of the patients were males, 46 (57.5%). The mean age of the patients was 48.73 ± 18.428 years. The waiting time at the hospital also varies, with 77.5% of patients experiencing 0-hour wait time, and the mean waiting time being 38.44 minutes. A positive correlation was found between the following variables: travel time in minutes (χ2 = 0.012, p > 0.05) ; gender (χ2 = 0.037, p < 0.05) ; and the number of hospital visits per month (χ2 = 0.016, p > 0.05) and patient interaction in a health care setting.</p><p><strong>Conclusion: </strong>The study emphasizes the value of excellent patient-hospital interactions and the importance of communication, empathy, and trust-building in promoting these outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of machine learning models in predicting factors associated with the need for permanent shunting in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion.","authors":"Ehsan Alimohammadi, Seyed Reza Bagheri, Farid Moradi, Alireza Abdi, Michael T Lawton","doi":"10.1016/j.wneu.2024.10.078","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.078","url":null,"abstract":"<p><strong>Objective: </strong>To assess the efficacy of machine learning models (MLMs) in identifying factors associated with the need for permanent ventricular shunt placement in patients experiencing intracerebral hemorrhage (ICH) who require emergency cerebrospinal fluid (CSF) diversion.</p><p><strong>Methods: </strong>A retrospective review was performed on patients with ICH requiring urgent CSF diversion who were admitted to our facility between July 2009 and May 2023. A binary logistic regression analysis was carried out to determine independent predictors linked to the development of shunt-dependent hydrocephalus following ICH. Five different machine learning models-random forest (RF), support vector machine (SVM), k-nearest neighbor (k-NN), logistic regression (LR), and Adaptive Boosting (AdaBoost)-were utilized to predict the need for permanent shunting in those with spontaneous ICH necessitating emergency CSF diversion. Additionally, RF techniques were applied to identify the factors affecting the need for permanent ventricular shunt placement in these patients.</p><p><strong>Results: </strong>A total of 578 patients were included in the analysis. Shunt-dependent hydrocephalus occurred in 121 individuals (20.9%). In the multivariate analysis, the Graeb Score, the length of time the external ventricular drain (EVD) was in place, and an elevated intracranial pressure (ICP) greater than 30 mm Hg were significant predictors for the need for permanent CSF diversion (p<0.05). All predictive models showed commendable performance, with RF achieving the highest accuracy (0.921), followed by SVM (0.906), k-NN (0.889), LR (0.881), and AdaBoost (0.823). RF also excelled over the other models in terms of sensitivity and specificity, with a sensitivity of 0.912 and specificity of 0.892. The area under the curve (AUC) values for RF, SVM, k-NN, LR, and AdaBoost were recorded at 0.903, 0.820, 0.804, 0.801, and 0.798, respectively.</p><p><strong>Conclusion: </strong>This research demonstrates that machine learning models can effectively predict the need for permanent CSF diversion in patients with ICH who underwent EVD placement for urgent CSF diversion, offering important prognostic insights that could facilitate early intervention and lead to potential cost reductions.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accounts of Spine and Paraspinal Disease while Playing Golf.","authors":"Ben Carnovale, Raj Swaroop Lavadi, Aditi Choudhary, Avi A Gajjar, Rohit Prem Kumar, Joseph S Hudson, Manan Shah, D Kojo Hamilton, Nitin Agarwal","doi":"10.1016/j.wneu.2024.10.072","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.072","url":null,"abstract":"<p><strong>Background and objectives: </strong>The twisting motion associated with the golf swing puts the intervertebral discs and the paraspinal musculature under stress. The objective of this study was to characterize the spinal and paraspinal pathologies associated with golf and their outcomes.</p><p><strong>Methods: </strong>The National Electronic Injury Surveillance System (NEISS) was queried for emergency department visits between 2003-2023 for golf-related injuries with body part codes \"neck\", \"upper trunk\", and \"lower trunk\", which includes the cervical, thoracic, and lumbar spine, respectively. Narratives were screened for relevance and reports related to spinal and paraspinal injuries were included. Weighted survey analysis was utilized to construct national estimates. Injury and diagnosis trends were analyzed using binomial logistic regression, and time trends were analyzed with a linear model. P-value of < 0.05 was considered significant.</p><p><strong>Results: </strong>A total of 1441 relevant samples led to a national estimate of 69,153 emergency department visits for golf-related spinal-/paraspinal injuries between 2003-2023. The weighted mean age of those injured was 52.8 years, and the majority were male (85%, 95% CI 83-87). Strain was the most diagnosed injury (57.5%, 95% CI 54-61). Those aged > 55 years constituted more injuries than any other age group (50.1%, 95% CI 47-53). Injuries in the lumbar region accounted for most cases (76.9%, 95% CI 74-80). Injury frequency did not change over the years (p= 0.54), although the age of injury did increase over time (p < 0.001).</p><p><strong>Conclusion: </strong>Golf-associated paraspinal injuries are more common than neurological injuries, necessitating study into their mechanisms and onset.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender Differences in Perception of Neurosurgery as a Career Choice in Pakistan: A Nationwide Cross-Sectional Survey.","authors":"Aiman Idrees, Aqeeb Ur Rehman, Muhammad Hammad Khan, Noor Atiq, Ali Tanvir, Syeda Fatima Abid, Syed Muhammad Bin Atif, Zunaira Amjad, Ali Mohsin, Bhavya Pahwa, Usama Ejaz, Brandon Lucke-Wold","doi":"10.1016/j.wneu.2024.09.141","DOIUrl":"10.1016/j.wneu.2024.09.141","url":null,"abstract":"<p><strong>Background: </strong>A low neurosurgeon-to-patient ratio persists to be a problem in many developing nations including Pakistan. Concurrent gender disparities further exacerbate the challenges posed by the already limited workforce. An understanding of the perceptions of neurosurgery among female early career doctors is crucial in the evolution of the field in terms of both, workforce strength and inclusivity.</p><p><strong>Methods: </strong>A cross-sectional study was conducted across public and private medical schools of Pakistan. A close-ended self-administered questionnaire was employed to assess subject-reported challenges and perceptions regarding neurosurgery. Statistical analysis was performed using SPSS, version 28, and P < 0.05 was considered significant. The influence of these perceptions on the choice of neurosurgery as a career was determined by binary logistic regression analysis.</p><p><strong>Results: </strong>Of the 387 responses received from over 45 institutions across the country, 55.6% were females and 44.4% were male respondents. Compared to men, women were more likely to opt out of neurosurgery due to fear of problems with parenting (P < 0.001), absence of daycare facilities (P < 0.001), lack of female role models (P = 0.001), fear of gender discrimination (P < 0.001), and the mental (P = 0.04) and physical distress (P = 0.008) associated with neurosurgery. Binary logistic regression revealed that these concerns were responsible for an increased likelihood of opting out of neurosurgery among female medical students and intern doctors.</p><p><strong>Conclusions: </strong>Significant differences exist in how male and female medical students perceive neurosurgery as a career choice. Interventions including availability of daycare facilities for children, creation of inclusive workplace environment, and promotion of mentorship programs catering to women can help bridge this gap and contribute to evolution of the field of neurosurgery in the developing world.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"T2 Hyperintensities in Children with Neurofibromatosis Type 1.","authors":"Yong Han, Hangzhou Wang, Yulun Huang","doi":"10.1016/j.wneu.2024.10.001","DOIUrl":"10.1016/j.wneu.2024.10.001","url":null,"abstract":"<p><strong>Objective: </strong>Areas of increased signal intensity, known as T2 hyperintensities (T2Hs), observed on T2-weighted magnetic resonance imaging (MRI) scans, are linked to a spectrum of brain abnormalities in children with neurofibromatosis type 1 (NF1). Defining the radiological characteristics that distinguish non-neoplastic from neoplastic T2Hs in children with NF1 is crucial. Then, we could identify lesions that were most likely to require oncologic surveillance.</p><p><strong>Methods: </strong>We conducted a single-center retrospective review of all available brain MRIs from 98 children with NF1 and 50 healthy pediatric controls. All T2Hs identified on MRI were characterized based on location, imaging features, and the presence of lesion-related symptoms. Subsequently, all T2Hs were classified using newly established criteria and categorized into 3 distinct groups: low-risk tumor lesions, medium-risk tumor lesions, and high-risk tumor lesions. Lesions deemed to be high-risk will be recommended for surgical treatment.</p><p><strong>Results: </strong>T2Hs were present in 61 (62.2%) individuals of the NF1 cohort. T2Hs were a highly sensitive (100%; 95% confidence interval 92.9%-100.0%) and specific (62.2%; 95% confidence interval 51.9%-71.8%) marker for the diagnosis of NF1. In children aged 4-10, the detection rate of T2Hs is significantly higher than in children under 4 years old and those aged between 10 and 18 (P < 0.05). T2Hs were most frequently located in basal ganglia, cerebellar hemispheres, and brainstem. During the follow-up process, none of the lesions categorized as low-risk or medium-risk tumor lesions progressed to high-risk tumor lesions. Seven patients had high-risk tumor lesions and underwent surgical treatment. The pathological assessment identified 5 cases of glioma among the 7 patients, along with 1 case of gliosis and 1 case of vascular dysplasia.</p><p><strong>Conclusions: </strong>Low-risk and medium-risk tumor lesions can both be classified as unidentified bright objects . Unidentified bright objects constituted the majority of T2Hs in children with NF1. High-risk tumor lesions should be considered as probable tumors. With the application of standardized radiologic criteria, a high prevalence of probable brain tumors will be identified in this at-risk population of children, which underscores the importance of vigilant and appropriate oncological surveillance to ensure timely detection and intervention for these tumors.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mixed Gangliocytoma-Pituitary Adenoma: A Systematic Review of Diagnostic Features, Clinical Management, and Surgical Outcomes.","authors":"Kishore Balasubramanian, Romulo Augusto Andrade de Almeida, Abdurrahman F Kharbat, Ali S Haider, Ian F Dunn, Christopher S Graffeo","doi":"10.1016/j.wneu.2024.10.051","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.051","url":null,"abstract":"<p><strong>Objective: </strong>Mixed gangliocytoma-pituitary adenomas (MGPAs) are very rare sellar neoplasms. Contemporary understanding of their natural history, clinical characteristics, optimal management strategies, and prototypical outcomes remains poorly understood.</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, EMBASE, Web of Science, and Cochrane were searched to include studies of patients with histologically confirmed Mixed Gangliocytomas (MGPAs). Clinical features, management strategies, and outcomes were analyzed.</p><p><strong>Results: </strong>33 studies reporting 78 patients met study criteria and were included. Median age at diagnosis was 47 years, with a female predominance (71%). Common presenting symptoms included headache (49%), acromegaly (43%), and visual disturbance (20%). Growth hormone (GH) and prolactin were the most commonly elevated hormones. Magnetic resonance imaging (MRI) identified local infiltration in 86% of patients, most frequently in the cavernous sinus. Transsphenoidal resection was the primary treatment strategy, which achieved a gross total resection (GTR) in 43%. Postoperative pituitary function was normal in 92%. Median follow-up was 21 months, during which time 14% of patients required secondary intervention for persistent hormonal hypersecretion. Following these secondary interventions and as of last follow-up, radiographic and/or biochemical control was confirmed in all patients, with an overall survival rate of 97%.</p><p><strong>Conclusion: </strong>MGPAs are rare, slow-growing tumors that present with a combination of endocrinological and neurological symptoms. MGPAs are optimally managed with transsphenoidal resection, which appears to achieve favorable rates of symptomatic relief and local control, despite the high incidence of local infiltration and relatively low attendant GTR rate.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Growing Chronic Subdural Hematoma with Niveau Formation Showing an Enhanced Subdural Hyperintense Band on Magnetic Resonance Diffusion-weighted Imaging Over Time.","authors":"Akifumi Izumihara","doi":"10.1016/j.wneu.2024.10.076","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.076","url":null,"abstract":"<p><p>This case report describes an 84-year-old female patient with a growing chronic subdural hematoma (CSDH) that showed an enhanced subdural hyperintense band (SHB) on magnetic resonance (MR) diffusion-weighted imaging over time, indicating that it reflects fresh bleeding from the outer membrane covering the hematoma. The presence of SHB on MR diffusion-weighted imaging of CSDH, possibly reflecting hemorrhagic diathesis of the outer membrane, might be a predictor of enlargement of CSDH.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of bevacizumab combined with temozolomide in the treatment of glioma a systematic review and meta-analysis of clinical trials.","authors":"Chuheng Wang, Linan Duan, Yao Zhao, Yubo Wang, Yunqian Li","doi":"10.1016/j.wneu.2024.10.071","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.071","url":null,"abstract":"<p><strong>Objective: </strong>Glioma is the most common malignant brain tumor in neurosurgery. Bevacizumab (BEV) is a monoclonal antibody that inhibits tumors by inhibiting vascular endothelial growth factor and reducing tumor angiogenesis. To evaluate the efficacy and safety of BEV combined with temozolomide (TMZ) in glioma, we performed a meta-analysis.</p><p><strong>Methods: </strong>PubMed, Embase, The Cochrane Library, and Web of Science databases were searched for randomized controlled trials comparing survival outcomes between TMZ combined with BEV and TMZ alone as well as cohort studies were included in our study. The primary outcome measures analyzed were overall survival (OS) and progression-free survival (PFS).</p><p><strong>Results: </strong>A total of six randomized controlled trials and four cohort studies with a total of 2515 patients were included in our meta-analysis. The results of meta-analysis suggested that there were no significant improvements in overall survival, but the combination of TMZ and BEV prolonged progression-free survival, improved overall response rate (ORR), and increased the incidence of some adverse reactions, compared with TMZ alone. Subgroup analysis suggested sex, recursive partitioning analysis (RPA) grade, MGMT gene status and radiotherapy combination did not affect the improvement of OS with the combination of the two drugs, and RPA grade did not affect the improvement of PFS with the combination of the two drugs.</p><p><strong>Conclusions: </strong>The combination of TMZ and BEV can improve PFS as well as ORR in patients and has no benefit on OS. At the same time, the adverse reactions during the combination of the two drugs were acceptable.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunoprofile of radiological Chronic Subdural Hematoma subtypes.","authors":"Anders Schack, Thorbjørn Søren Rønn Jensen, Tina Binderup, Kåre Fugleholm","doi":"10.1016/j.wneu.2024.10.081","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.10.081","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the immunological profile of Chronic Subdural Hematoma (CSDH) subtypes based on their radiological appearances, with a focus on comparing the membranous CSDH to other subtypes.</p><p><strong>Methods: </strong>We prospectively analyzed 170 CSDH cases from 138 patients, categorizing them into 'Membranous' and 'Other' subtypes based on computed tomography scans. Samples were collected from the subdural fluid and systemic blood and analyzed for a panel of inflammatory markers. Demographic data, clinical characteristics, and time since trauma were also assessed.</p><p><strong>Results: </strong>Time since trauma to diagnostic CT was significantly longer for the 'membranous' subtype (p=0.001). 'Membranous' CSDH exhibited a distinct immunoprofile, including lower hemoglobin levels (p=0.0002) and higher concentrations of MMP-9 (p=0.005) and IL-8 (p<0.0001). Additionally, 'Membranous' CSDH showed elevated levels of IP-10, MIG, and uPAR compared to 'Other' subtypes, with significant correlations between IP-10 and MCP-1 (p=0.013), MIG (p=0.002), and uPAR (p=0.006). IL-8 levels also correlated significantly with MCP-1 (p=0.02), suggesting distinct inflammatory pathways in the 'Membranous' subtype CONCLUSIONS: This study demonstrates that CSDH subtypes, particularly the 'Membranous' subtype, possess a distinct immunological profile. These findings provide novel insights into CSDH pathophysiology. The unique inflammatory landscape of 'Membranous' CSDH, marked by elevated MMP-9 and IL-8 levels, may contribute to its chronic nature.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}