Brain & spine最新文献

{"title":"Kinematic limitations during stair ascent and descent in patients with adult spinal deformity","authors":"Marc Fakhoury ,&nbsp;Rami Rachkidi ,&nbsp;Karl Semaan ,&nbsp;Krystel Abi Karam ,&nbsp;Maria Saadé ,&nbsp;Elma Ayoub ,&nbsp;Celine Chaaya ,&nbsp;Ali Rteil ,&nbsp;Elena Jaber ,&nbsp;Elio Mekhael ,&nbsp;Nabil Nassim ,&nbsp;Mohamad Karam ,&nbsp;Julien Abinahed ,&nbsp;Ismat Ghanem ,&nbsp;Abir Massaad ,&nbsp;Ayman Assi","doi":"10.1016/j.bas.2024.104153","DOIUrl":"10.1016/j.bas.2024.104153","url":null,"abstract":"<div><h3>Background</h3><div>Adults with spinal deformity (ASD) are known to have spinal malalignment, which can impact their quality of life and their autonomy in daily life activities. Among these tasks, ascending and descending stairs is a common activity of daily life that might be affected.</div></div><div><h3>Research question</h3><div>What are the main kinematic alterations in ASD during stair ascent and descent?</div></div><div><h3>Methods</h3><div>112 primary ASD patients and 34 controls filled HRQoL questionnaires and underwent biplanar X-from which spino-pelvic radiographic parameters were calculated. Patients were divided into 3 groups: 44 with sagittal malalignment (ASD-Sag: PT &gt; 25°, SVA&gt;5 cm or PI-LL&gt;10°), 42 with isolated thoracic hyperkyphosis (ASD-HyperTK: TK &gt; 60°), 26 with isolated frontal spine deformity (ASD-Front: Cobb&gt;20°). All participants underwent 3D motion analysis of the whole body while ascending and descending a stair step from which kinematic waveforms were extracted.</div></div><div><h3>Results</h3><div>During stair ascent, ASD-Sag exhibited an increased thorax flexion (20 vs 5°), a decreased lumbar lordosis L1L3-L3L5 (7 vs 14°), and an increased ROM of lumbo-pelvic joint (15 vs 10°, all p &lt; 0.05), compared to controls. Similar compensations were shown while descending the stairstep. ASD-HyperTK had similar kinematic limitations as ASD-Sag but to a lesser extent. ASD-Front had normal kinematic patterns. PCS-SF36 correlated to thorax flexion (r = −0.45) and ODI was correlated to pelvic tilt ROM (r = 0.46).</div></div><div><h3>Discussion and conclusion</h3><div>ASD subjects with sagittal malalignment tend to ascend and descend stairs with increased thorax flexion, making them more prone to falls. Compensation mechanisms occur at the head and lumbo-pelvic levels to maintain balance and avoid falling forward.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104153"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar disc space height in relation to neural foraminal dimensions and patient characteristics: A morphometric analysis from L1-S1 using computed tomography","authors":"David Shin ,&nbsp;Ethan Vyhmeister ,&nbsp;Daniel Im ,&nbsp;Andrew Fay ,&nbsp;Owen Faehner ,&nbsp;Andrew Cabrera ,&nbsp;Alexander Bouterse ,&nbsp;Lauren Seo ,&nbsp;Derran Bedward ,&nbsp;Mei Carter ,&nbsp;Davis Carter ,&nbsp;Jacob Razzouk ,&nbsp;Omar Ramos ,&nbsp;Nathaniel Wycliffe ,&nbsp;Wayne Cheng ,&nbsp;Olumide Danisa","doi":"10.1016/j.bas.2024.104162","DOIUrl":"10.1016/j.bas.2024.104162","url":null,"abstract":"<div><h3>Introduction</h3><div>The normative relationship between lumbar intervertebral disc space height (DSH) and neuroforaminal dimensions (NFD) has yet to be defined.</div></div><div><h3>Research question</h3><div>The purpose of this study was to investigate the relationship between lumbar DSH and NFD using computed tomography (CT), accounting for influences of patient demographic and anthropometric characteristics.</div></div><div><h3>Materials and methods</h3><div>We analyzed CT imaging of 350 female and 350 male patients. Anterior, middle, and posterior DSH were measured. NFD were defined as sagittal anterior-to-posterior (AP) width, axial AP width, foraminal height, and area. Statistical analyses were performed to assess associations among DSH, NFD, and patient height, weight, body mass index, sex, and ethnicity.</div></div><div><h3>Results</h3><div>Irrespective of disc level, mean anterior, middle, and posterior DSH were 7.98 mm (n = 3500), 8.16 mm (n = 3500), and 4.09 mm (n = 3500). DSH measurements demonstrated increasing, linear trends moving caudally from L1-L2 to L5-S1, while NFD demonstrated a unimodal distribution pattern with largest NFD at L3-L4 and smallest NFD at L1-2 and L5-S1. Male patients demonstrated larger DSH compared to female patients from L1-S1. Asian patients demonstrated taller DSH across all levels L1-S1.</div></div><div><h3>Discussion and conclusion</h3><div>This study describes 38,500 CT-based L1-S1 DSH and NFD in young patients without spinal pathology. DSH follows an increasing trend moving caudally from L1-S1, while NFD demonstrate a unimodal distribution clustered at L3-L4. NFD are not moderately or strongly associated with DSH. DSH is influenced by sex and ethnicity but is not moderately or strongly influenced by patient height, weight, and BMI.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104162"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11700277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decompressive craniectomy following subarachnoid hemorrhage: A prospective Swedish multicenter study","authors":"Bryndís Baldvinsdóttir ,&nbsp;Erik Kronvall ,&nbsp;Elisabeth Ronne-Engström ,&nbsp;Per Enblad ,&nbsp;Paula Klurfan ,&nbsp;Johanna Eneling ,&nbsp;Peter Lindvall ,&nbsp;Helena Aineskog ,&nbsp;Steen Friðriksson ,&nbsp;Mikael Svensson ,&nbsp;Peter Alpkvist ,&nbsp;Jan Hillman ,&nbsp;Ola G. Nilsson","doi":"10.1016/j.bas.2025.104218","DOIUrl":"10.1016/j.bas.2025.104218","url":null,"abstract":"<div><h3>Introduction</h3><div>Decompressive craniectomy (DC) in patients with severe aneurysmal subarachnoid hemorrhage (aSAH) can be a life-saving procedure. The aim of this nationwide prospective study was to investigate the use of DC in aSAH patients in Sweden.</div></div><div><h3>Research question</h3><div>To explore the risk factors and functional outcome associated with DC in patients with aSAH.</div></div><div><h3>Material and methods</h3><div>Patients treated for aSAH at all neurosurgical centers in Sweden during a 3.5-year period (2014–2018) were prospectively registered. Clinical, radiological and treatment-related factors with regard to DC were analyzed using Chi-Square and logistic regression analysis. Functional outcome was assessed by the extended Glasgow outcome scale one year after the bleeding.</div></div><div><h3>Results</h3><div>During the study period, 1037 patients were treated for aSAH. Thirty-five patients (3.4%) underwent DC. At one year follow-up, 25 of these (71%) had unfavorable functional outcome. Multivariate logistic regression analysis revealed that poor clinical grade before aneurysm treatment, middle cerebral artery (MCA) aneurysm, edema on the initial computed tomography (CT), and adverse events during aneurysm occlusion were independent and significant risk factors for performing DC.</div></div><div><h3>Discussion and conclusion</h3><div>DC is relatively uncommon in aSAH patients and is related to increased risk of unfavorable outcome. However, favorable functional outcome was seen in 29% of patients with DC. Adverse events during aneurysm occlusion were significant risk factors for DC.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104218"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the Scandinavian neurotrauma committee guidelines – A retrospective study in region Örebro county","authors":"Samuel Jara Josefsson ,&nbsp;Dhanisha Trivedi ,&nbsp;Patrick Vigren ,&nbsp;András Büki","doi":"10.1016/j.bas.2025.104231","DOIUrl":"10.1016/j.bas.2025.104231","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic Brain Injury (TBI) is a global health concern and a leading cause of trauma-related death worldwide. Computed tomography (CT) scan is the gold standard for screening for intracranial bleeding following TBI. Most cases of TBI are mild, with negative CT scans. Different instruments and guidelines are employed to better predict which patients need a CT scan and to minimise unnecessary radiation exposure and save resources. One such instrument is the Scandinavian Neurotrauma Committee guidelines.</div></div><div><h3>Research question</h3><div>To validate and examine adherence to the Scandinavian Neurotrauma Committee guidelines in Region Örebro County.</div></div><div><h3>Material and methods</h3><div>We executed a retrospective study with review of patient records and data analysis. Descriptive and comparative statistics were used, along with binary logistic regression analysis to account for confounding factors.</div></div><div><h3>Results</h3><div>A total of 505 cases were reviewed. Sensitivity of the guidelines was measured at 95% with specificity at 29%. The positive and negative predictive values were 0.77 and 0.69, respectively. A total of 17 false negative cases were found. One case required surgery, during which a chronic subdural hematoma was identified. Adherence to guidelines was 56%, with the lack of analysis of S100B primarily accounting for non-adherence. A total of 54 CT scans were performed outside of guideline indications.</div></div><div><h3>Discussion and conclusions</h3><div>The guidelines can effectively predict which patients need a CT scan. Increased adherence could potentially decrease the number of CT scans, while inclusion of older age limit as an independent rule-in law for CT scans would increase patient safety.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104231"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sagittal changes in the dens significantly slowed after 12 years of age","authors":"Zhi-Jun Sha ,&nbsp;Sheng-Yu Fu ,&nbsp;Zhao-Rui Wang ,&nbsp;Hai-Feng Hang ,&nbsp;Ai-Bing Huang","doi":"10.1016/j.bas.2025.104233","DOIUrl":"10.1016/j.bas.2025.104233","url":null,"abstract":"<div><h3>Introduction</h3><div>The odontoid process is an important component of the upper cervical, and the process of ossification for odontoid does not cease completely until skeletal maturity.</div></div><div><h3>Research question</h3><div>The aim of the study was to obtain the inclination parameters of the dens in many healthy children and to analyze the trends and variations in the inclination of the dens.</div></div><div><h3>Material and methods</h3><div>All the CT data obtained from our hospital was reviewed for next measurement. Posterior edge of odontoid angle (PEOA), anterior edge of odontoid angle (AEOA), odontoid retroflection angle (ORA), posterior dens angulation angle (PDAA), screw insertion angle (SIA), and pB-C2 line were measured and analyzed.</div></div><div><h3>Results</h3><div>A total of 219 patients were divided into 6 groups based on age at an interval of 3 years. The mean values of PEOA and PDAA dropped dramatically with age up to the ten to twelve-year group and then decreased slightly until 18 years old. Moreover, the AEOA and ORA declined gradually from birth to adulthood. These parameters were statistical significance within different age groups. However, the SIA was largely unchanged from birth to 18 years old and appeared to be independent of age. In contrast, the PB-C2 line has a distinguish distribution, with an increase up to the nine to twelve-year age group and then gradually decreased until 18 years old.</div></div><div><h3>Discussion and conclusion</h3><div>The inclination of dens was constantly changing during pediatric growth, but the trends were different. These developmental changes slow down significantly after the age of 12 years.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104233"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional outcome after surgical treatment for spontaneous intracerebral hemorrhages: Development of the HeMAtOma score","authors":"Magnus Sættem ,&nbsp;Ola Lønn Jenssen ,&nbsp;Øystein Vesterli Tveiten ,&nbsp;Stephanie Schipmann ,&nbsp;Rupavathana Mahesparan","doi":"10.1016/j.bas.2025.104240","DOIUrl":"10.1016/j.bas.2025.104240","url":null,"abstract":"<div><h3>Background</h3><div>Spontaneous intracerebral hemorrhage (sICH) is a critical medical emergency associated with significant morbidity and mortality. The role of surgical intervention in improving functional outcomes remains a subject of debate.</div></div><div><h3>Objective</h3><div>This study evaluates the functional outcomes of patients undergoing surgical treatment for sICH and identifies risk factors predictive of poor outcomes.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 100 patients treated surgically for sICH at Haukeland University Hospital between 2013 and 2022 was conducted. Baseline characteristics and clinical outcomes were collected. Functional outcomes were assessed using the modified Rankin Scale (mRS) at three months post-surgery. Independent risk factors for unfavorable outcomes (mRS ≥4) were identified through logistic regression.</div></div><div><h3>Results</h3><div>The mean age was 65.5 years (56 % males). At three months, 54 % of patients had an unfavorable outcome, including a 23 % mortality rate. Independent risk factors for poor outcomes included age ≥60 years (OR 7.8, 95 % CI 1.684–36.3, p = 0.009), oral anticoagulant use (OR 10.4, 95 % CI 1.495–72.665, p = 0.018), and hemorrhage location in the basal ganglia (OR 18.5, 95 % CI 3.398–100.717, p &lt; 0.001) or motor cortex (OR 8.6, 95 % CI 2.134–34.973, p = 0.003). These factors formed the basis of a new scoring system—the HeMAtOma score—which demonstrated good discriminatory ability (AUC 0.688) for predicting outcomes.</div></div><div><h3>Conclusion</h3><div>Functional outcomes following surgical treatment for sICH remain poor in many cases. The HeMAtOma score provides a practical tool for predicting surgical outcomes, aiding clinical decision-making in emergency settings. Future prospective studies are needed to validate the score.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104240"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of government-issued lockdowns during the COVID-19 pandemic on traumatic brain injuries in Tyrol, Austria","authors":"Victoria Schön ,&nbsp;Alina Farbmacher ,&nbsp;Lukas Grassner ,&nbsp;Barbara Klein ,&nbsp;Claudius Thomé ,&nbsp;Daniel Pinggera","doi":"10.1016/j.bas.2024.104159","DOIUrl":"10.1016/j.bas.2024.104159","url":null,"abstract":"<div><h3>Introduction</h3><div>In February 2020, COVID-19 infections started to spread in Austria. This was followed by governmental actions and constraints such as lockdowns, quarantine protocols, and a ban on outdoor sports. The goal of this study was to investigate the influence of these measures on the number of traumatic brain injuries (TBI) in the state of Tyrol.</div></div><div><h3>Methods</h3><div>The incidence of TBI during lockdowns and restrictions of outdoor activities in 2020 and 2021 were compared with corresponding periods in previous years. The data was retrospectively collected and analyzed.</div></div><div><h3>Results</h3><div>During the first lockdown in the winter of 2020/2021, there was a notably lower incidence of moderate and severe TBIs compared to the corresponding period in 2019/2020 (p = 0.016). Similarly, there was a reduction in TBIs from sports accidents during this period (p = 0.010). However, when comparing other lockdown periods to the previous years, no differences were observed.</div></div><div><h3>Conclusion</h3><div>The various governmental measures restricting mobility aimed to contain the COVID-19 pandemic but showed little influence on the number of TBI cases. Only a lockdown in the accident-prone winter months has influenced the incidence of TBIs.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104159"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and natural development of thoracolumbar kyphosis in achondroplasia: A systematic review and meta-analysis","authors":"Chady Omara ,&nbsp;Rania A. Mekary ,&nbsp;Carmen L.A. Vleggeert-Lankamp","doi":"10.1016/j.bas.2024.104177","DOIUrl":"10.1016/j.bas.2024.104177","url":null,"abstract":"<div><h3>Introduction</h3><div>Thoracolumbar kyphosis (TLK) is a frequently reported spinal deformity in achondroplasia, which in combination with the characteristic narrow spinal canal in achondroplasia predisposes for symptomatic spinal stenosis. There is however no consensus on the optimal treatment, due to limited data on diagnostic criteria, the natural development and the prevalence of TLK.</div></div><div><h3>Research question</h3><div>This study aims to assess the prevalence, natural development, and diagnostic criteria for pathological TLK in individuals with achondroplasia.</div></div><div><h3>Material and methods</h3><div>A systematic review and meta-analysis were conducted. Studies involving achondroplasia patients, which reported TLK measurement methods were included. The primary outcome was the pooled prevalence of TLK, stratified by age.</div></div><div><h3>Results</h3><div>Eight studies, encompassing 852 patients, met the inclusion criteria. Pathological TLK was most frequently defined as a Cobb angle of 20° or greater, between T10 and L2. TLK was present in 87% (95% CI 80%–91%) of patients under two years old, decreasing to 33% (24%–43%) at age three, 26% (19%–35%) between five and ten years, and 23% (16%–31%) in patients aged 10–20 years.</div></div><div><h3>Discussion and conclusion</h3><div>Pathological TLK in achondroplasia, defined as a Cobb angle of 20° or greater, appears primarily in early childhood and often resolves by walking age. However, approximately one-fourth of cases persist into adulthood, with factors such as developmental motor delay and vertebral wedging contributing to this persistence. Routine clinical and radiological evaluations during childhood, along with conservative management, are recommended to mitigate the need for surgery during adulthood.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104177"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the spatiotemporal dynamics of vascular injury and regeneration following experimental Spinal Cord Injury","authors":"Christian J. Entenmann ,&nbsp;Emily J. von Bronewski ,&nbsp;Lilly Waldmann ,&nbsp;Lea Meyer ,&nbsp;Katharina Kersting ,&nbsp;Laurens T. Roolfs ,&nbsp;Lasse M. Schleker ,&nbsp;Melina Nieminen-Kelhä ,&nbsp;Irina Kremenetskaia ,&nbsp;Frank L. Heppner ,&nbsp;Michael G. Fehlings ,&nbsp;Peter Vajkoczy ,&nbsp;Vanessa Hubertus","doi":"10.1016/j.bas.2025.104191","DOIUrl":"10.1016/j.bas.2025.104191","url":null,"abstract":"<div><h3>Introduction</h3><div>The loss of vasculature in Spinal Cord Injury (SCI) contributes to secondary injury, expanding the injury to unharmed spinal cord (SC) regions. Understanding these mechanisms is crucial for developing therapeutic interventions.</div></div><div><h3>Research question</h3><div>Comprehensive analysis of the temporospatial dynamics of vascular injury and regeneration following SCI.</div></div><div><h3>Materials and methods</h3><div>Adult C57BL/6J mice were subjected to clip-compression SCI (Th 6/7, 5g, 60s, n = 20) or sham injury (laminectomy, n = 4), and sacrificed at 1, 3, 7, 14, and 28 days (d) post-injury following intracardial fluorescein isothiocyanate (FITC)-Lectin perfusion. Histological analysis (CD31, FITC-Lectin, Ki-67, IgG, TER-119) assessed vascular changes, permeability, and proliferation within the injury epicenter (region 0 (R0), ± 0,5 mm) and two adjacent SC regions (R1: ± 1 mm, R2: ± 2.5 mm).</div></div><div><h3>Results</h3><div>Perfusion loss (FITC-Lectin+/CD31+), was most severe in R0 and R1 at d3 (p &lt; 0.01). Significant vascular loss in R2 started at d3 (p = 0.043). Perfusion was restored at d28 in R0 and R1, and at d7 in R2. Vessel density (CD31⁺) returned to baseline quicker (R0: d3, R1 and R2: d14). Vascular proliferation (CD31+/Ki-67+) manifested across all regions at d3 (p &lt; 0.01), and most notably in R2 (p &lt; 0.01). Vascular permeability for IgG remained disrupted until d3 in R0 and R1 and until d14 in R2.</div></div><div><h3>Discussion and conclusion</h3><div>Vascular injury is most severe initially and spreads to the surrounding SC regions. Gradual vascular regeneration occurs early and up to a considerable distance from the injury epicenter, highlighting the potential of early therapeutic interventions targeted at vascular repair and regeneration.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104191"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic aspiration alone or Ommaya placement and aspiration followed by stereotactic radiosurgery for cystic brain metastasis: A systematic review and meta-analysis","authors":"David R. Peters ,&nbsp;Alfredo Conti ,&nbsp;Marc Levivier ,&nbsp;Luis Schiappacasse ,&nbsp;Mohamed Faouzi ,&nbsp;Mioara Florentina Trandafirescu ,&nbsp;Constantin Tuleasca","doi":"10.1016/j.bas.2025.104184","DOIUrl":"10.1016/j.bas.2025.104184","url":null,"abstract":"<div><h3>Introduction</h3><div>Cystic brain metastases (BMs) are often more challenging to treat than solid BMs. Stereotactic cyst aspiration for volume reduction followed by stereotactic radiosurgery (SRS) is an alternative treatment modality that may benefit patients with large cystic BMs not favorable for SRS alone nor microsurgical resection.</div></div><div><h3>Research question</h3><div>Here, we perform a systematic review and meta-analysis of stereotactic aspiration alone or reservoir (Ommaya) placement plus aspiration followed by SRS for cystic BMs.</div></div><div><h3>Material and methods</h3><div>Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed articles published between 1968 and December 31^−th, 2022. We retained 10 studies reporting 280 patients.</div></div><div><h3>Results</h3><div>Overall rate of tumor control for combined treatment of Ommaya placement plus aspiration plus SRS was 81.2% (62.5–99.9%, p &lt; 0.001) and for stereotactic aspiration plus SRS was 64.7% (46.1–83.3%, p &lt; 0.001). Overall rate of further intervention for combined treatment of Ommaya placement plus aspiration plus SRS was 15.8% (p = 0.08) and for stereotactic aspiration plus SRS was 14.8% (5.3–24.4%, p = 0.002). Overall complication rate for combined treatment of Ommaya placement plus aspiration plus SRS was 12.8% (2.3–23.3%, p = 0.01) and for stereotactic aspiration plus SRS was 1.5% (p = 0.12).</div></div><div><h3>Discussion and conclusion</h3><div>Combined treatment of Ommaya placement plus cyst aspiration plus SRS in cystic BMs yields better local control as compared to stereotactic aspiration plus SRS, with similar rate of further intervention between procedures. Aspiration of the cyst plus SRS should be considered for patients with cystic metastases not able to undergo open surgery or upfront SRS.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104184"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}