Brain & spine最新文献

{"title":"Less is more - Retrospective analysis of the two-incision implantation technique for hypoglossal nerve stimulation and comparison of respiratory sensing lead curves against the three-incision technique","authors":"Nikhil Thakur ,&nbsp;Valentin Krüger ,&nbsp;Marcus Czabanka ,&nbsp;Johanna Quick-Weller","doi":"10.1016/j.bas.2024.104155","DOIUrl":"10.1016/j.bas.2024.104155","url":null,"abstract":"<div><h3>Introduction</h3><div>Breathing-synchronized hypoglossal-nerve stimulation is a treatment option for suitable patients with severe obstructive-sleep-apnoea. The classical implantation technique requires three incisions: submental to place the stimulating-electrode on terminal branches of the hypoglossal-nerve, sub-clavicular to place the impulse generator, and on the lateral chest-wall to place a breathing-sensor lead. A two-incision-technique has been propagated and widely adopted whereby the respiratory-sensing-lead is placed deeper to the IPG-pocket.</div></div><div><h3>Research question</h3><div>Our department switched to the 2-incision-technique in May 2021 and we set out to compare the two methods concerning the generated respiratory-sensing-curves.</div></div><div><h3>Material and method</h3><div>Cases operated between October 2020 and September 2022 were included. Parameters included age, gender, BMI, OR time, positioning of the detection-lead, and preoperative Apnoea-Hypopnoea Index (AHI). The generated respiratory-sensing curves were categorized by an independent expert blinded to the surgical-technique regarding conduciveness to optimal stimulation.</div></div><div><h3>Result</h3><div>21 patients were included. 5 were operated with the 3-incision-technique. Women were underrepresented. There were no further significant differences in patient characteristics. The expert-opinion on the respiratory-sensing-curves did not vary between groups. Mean OR-time was marginally less in the 2-incision group without being statistically significant.</div></div><div><h3>Conclusion</h3><div>The 2-incision-technique generates respiratory-sensing curves at par with those generated with 3-incision-implants. The limited patient data collected in this analysis suggests that OR-time can be reduced using the 2-incision-technique. There were no cases of postoperative complications in our cohort. It can be postulated that a 2-incision-implant has a lower risk of infection due to the reduced wound-surface.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104155"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030357","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 first EANS vascular and skull base hands-on course in East Africa: Review from the global and humanitarian neurosurgical committee initiative","authors":"Magalie Cadieux ,&nbsp;Andreas K. Demetriades ,&nbsp;Lukas Rasulic ,&nbsp;Nicephorus Rutabasibwa ,&nbsp;Alpha Kinghomella ,&nbsp;Aingaya Kaale ,&nbsp;Boaz Yonah ,&nbsp;Christian Preuss-Hernández ,&nbsp;Roger Härtl ,&nbsp;Nicolò Marchesini ,&nbsp;Magnus Tisell ,&nbsp;Ondra Petr","doi":"10.1016/j.bas.2025.104210","DOIUrl":"10.1016/j.bas.2025.104210","url":null,"abstract":"<div><h3>Introduction</h3><div>Cerebrovascular pathologies in East Africa have a poorly known prevalence and incidence. The treatment remains sparse. When they apply, microneurosurgical techniques are prioritized over endovascular procedures due to lack of resources. Considering an increasing number of neurosurgeons in East Africa, the EANS Global Humanitarian Committee (GHC) has endorsed the creation of the Vascular and Skull base Hands-on Neurosurgery Course.</div></div><div><h3>Research question</h3><div>What are essential elements to extend knowledge to sub-Suharan neurosurgeons on cerebrovascular pathologies?</div></div><div><h3>Material and methods</h3><div>In November 2023 was held the first course in collaboration with the Muhimbili Orthopaedic Institute (MOI) in Dar es Salaam, Tanzania. The course consisted of lectures from international and local faculty in the morning with surgical cases in the afternoon. Plus/delta type of feedback was obtained at the end. Challenges and proposed improvement based on comments are reported.</div></div><div><h3>Results</h3><div>The course lasted over five days and each day had a different theme of neurovascular or skull base neurosurgery. There was a total of 32 presenting faculty and ten surgical cases. For this first edition, a total of 39 healthcare workers were in attendance. The participants felt that the hands-on portion was very useful (56%) and wished to have more cases for more exposure. Comments from the plus/delta feedback emphasized on having in-person faculty rather than virtually.</div></div><div><h3>Discussion and conclusion</h3><div>The first edition of the EANS Vascular and Skull base Hands-on Neurosurgery Course in East Africa successfully run in Dar es Salaam. Subsequent editions should focus on more targeted in-person lectures better adapted to LMICs.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104210"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747766","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 effect of a transforaminal epidural injection in patients with lumbar disc herniation is not correlated with the presence of type II modic changes","authors":"E.J.A. Verheijen ,&nbsp;N.R.E. van der Vlist ,&nbsp;E.C. Bartels ,&nbsp;O.B.H.A.M. van Haagen ,&nbsp;C.L.A. Vleggeert-Lankamp","doi":"10.1016/j.bas.2025.104222","DOIUrl":"10.1016/j.bas.2025.104222","url":null,"abstract":"<div><h3>Introduction</h3><div>Transforaminal epidural steroid injections (TEI) have been suggested to alleviate symptoms in patients with lumbar disc herniation (LDH) through its anti-inflammatory effect. However, treatment effect varies among patients and reliable predictors are lacking. Modic changes (MC) are also associated with inflammatory processes and, therefore, we hypothesize that MC may be correlated with outcome after TEI.</div></div><div><h3>Research question</h3><div>To investigate the correlation between the presence of MC at the level of LDH and the effect of TEI.</div></div><div><h3>Material and methods</h3><div>Patients with unilateral lumbar radiculopathy secondary to LDH undergoing TEI were included. MC was graded by two independent assessors. Outcome measures included leg pain, back pain, disability and patient-received recovery at baseline, 30 min, 2 weeks and 6 weeks after treatment. Multivariate analysis was performed for all outcomes and for dichotomized scores using a cutoff of ≥30% improvement. A p-value of ≤0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>A total of 88 patients were included of whom 52.3% demonstrated MC. The vast majority was classified as type II (94%). The presence of MC was not correlated with any outcome measure when correcting for age, gender, duration of symptoms and the use of analgesics, nor for dichotomized scores.</div></div><div><h3>Discussion and conclusion</h3><div>The findings indicate that type II MC is not associated with outcome within six weeks after TEI. Therefore, type II MC cannot be used as a predictor for TEI outcome. Future studies should include longer follow-up and investigate the correlation between the type of MC and the effect of TEI.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104222"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535133","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":"Tumor resting-state fMRI connectivity to extralesional brain is associated with cognitive performance in glioma patients","authors":"Chuh-Hyoun Na ,&nbsp;Hans Clusmann ,&nbsp;Martin Wiesmann ,&nbsp;Kerstin Jütten ,&nbsp;Verena Mainz","doi":"10.1016/j.bas.2025.104202","DOIUrl":"10.1016/j.bas.2025.104202","url":null,"abstract":"<div><h3>Introduction</h3><div>Functional coupling of the tumor to extralesional brain areas and the pretherapeutic cognitive performance status have each independently been identified as prognostically relevant in glioma patients. It is however unclear, whether tumor-connectivity correlates with cognitive performance or the cognitive outcome.</div></div><div><h3>Research question</h3><div>To investigate potential associations between pre- and postoperative resting-state fMRI connectivity (FC) and cognitive functions in glioma patients compared to healthy controls.</div></div><div><h3>Material and methods</h3><div>18 patients and 18 age-matched, healthy controls underwent resting-state fMRI and neuropsychological testing pre- and 4.5 months (mean) postoperatively. FC of the tumor to extralesional brain (Tu-EL) was determined, as well as FC of extralesional brain (EL) and the contralesional hemisphere (conEL). Groups were compared with regard to behavioral and FC measures.</div></div><div><h3>Results</h3><div>Patients showed deficits in all cognitive domains tested. While postoperative performance tended to be worse, deterioration was not statistically significant between timepoints. EL FC did not differ between groups, but conEL FC (p &lt; .045) was increased in patients as compared to controls. Tu-EL FC was significantly associated with worse attention performance (p &lt; .001), and, by trend (p &lt; .058), with worse attentional outcome in patients.</div></div><div><h3>Discussion and conclusion</h3><div>Intrinsic functional coupling to the rest of the brain was associated with worse cognitive performance and might relate to pathological tumor-neuron interaction on the macroscale, reflecting the invasive nature of diffusely infiltrating glioma. Deepening our understanding of FC measures at the connectomic level in the context of cancer neuroscience may aid in identifying neurophysiological correlates of cognitive impairment and in prognosticating cognitive outcome in glioma patients.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104202"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143356981","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":"Intraoperative classification of CNS lymphoma and glioblastoma by AI-based analysis of Stimulated Raman Histology (SRH)","authors":"Pierre Scheffler ,&nbsp;Jakob Straehle ,&nbsp;Amir El Rahal ,&nbsp;Daniel Erny ,&nbsp;Boris Mizaikoff ,&nbsp;Ioannis Vasilikos ,&nbsp;Marco Prinz ,&nbsp;Volker A. Coenen ,&nbsp;Julia Kühn ,&nbsp;Florian Scherer ,&nbsp;Dieter Henrik Heiland ,&nbsp;Oliver Schnell ,&nbsp;Roland Roelz ,&nbsp;Jürgen Beck ,&nbsp;Peter C. Reinacher ,&nbsp;Nicolas Neidert","doi":"10.1016/j.bas.2025.104187","DOIUrl":"10.1016/j.bas.2025.104187","url":null,"abstract":"<div><h3>Introduction</h3><div>Early diagnosis is important to differentiate central nervous system lymphomas (CNSL) from the main differential diagnosis, glioblastoma (GBM), because of different primary treatment modalities for these entities. Due to neurological deficits, diagnostic stereotactic biopsies often need to be performed urgently. In this setting the availability of an intraoperative neuropathological assessment is limited.</div></div><div><h3>Research question</h3><div>This study uses AI-based analysis of Stimulated Raman Histology (SRH) to establish a classifier distinguishing CNSL from glioblastoma in an intraoperative setting.</div></div><div><h3>Material and methods</h3><div>We collected 126 intraoperative SRH images from 40 patients diagnosed with CNSL. These SRH images were divided into patches, measuring 224 x 224 pixels each. Additionally, we used a comparative dataset of 87 SRH images from 31 patients with GBM as a control group to train and validate a neural network based on the CTransPath architecture. Two distinct diagnostic categories were established: “Lymphoma” and “Glioblastoma\".</div></div><div><h3>Results</h3><div>Our model demonstrated an accuracy rate of 92.5% in distinguishing between lymphoma and glioblastoma. Analysis of our test dataset showed a sensitivity of 84.2% and a specificity of 100% in the detection of CNSL, demonstrating performance comparable to standard intraoperative histopathological analysis.</div></div><div><h3>Discussion and conclusion</h3><div>The use of AI-driven analysis of SRH images holds promise for intraoperative tissue examination of stereotactic biopsies with suspected CNSL en par with the current gold standard. This study could improve the management of these cases especially in the emergency setting when conventional intraoperative neuropathological evaluation is unavailable.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104187"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377344","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":"BOOTStrap-SCI: Beyond One option of treatment for spinal trauma and spinal cord injury: Consensus-based stratified protocols for pre-hospital care and emergency room (part I)","authors":"Nicolò Marchesini ,&nbsp;Andreas K. Demetriades ,&nbsp;Oscar Alves ,&nbsp;Riya Mandar Dange ,&nbsp;Harold Mauricio Choco ,&nbsp;Edinson Dussan Lozada ,&nbsp;Dumar Javier Figueredo Sanabria ,&nbsp;Angélica Gamboa ,&nbsp;Luz Llined Mendoza Victoria ,&nbsp;Enoc Noscue Montealegre ,&nbsp;Jonathan A. Pardo Carranza ,&nbsp;Jonathan Velásquez Quintero ,&nbsp;Andrès M. Rubiano ,&nbsp;the BOOTStraP-SCI Study Group","doi":"10.1016/j.bas.2025.104251","DOIUrl":"10.1016/j.bas.2025.104251","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal trauma (STx), with or without spinal cord injury (SCI), represents a significant global health burden, particularly in low- and middle-income countries (LMICs). Existing guidelines often rely on tools and resources that are not always universally available, especially in less resourced settings, contributing to disparities in care and outcomes. A pragmatic, resource-adapted approach may help optimize management in these contexts.</div></div><div><h3>Research question</h3><div>This study aimed to develop resource-adapted protocols for pre-hospital and emergency room management of STx and <span>SCI</span>, addressing challenges specific to LMICs while supported by clinical evidence and expert based practices.</div></div><div><h3>Material and methods</h3><div>A multidisciplinary Delphi consensus combined international evidence-based guidelines with expert opinions. Iterative discussions and voting by healthcare providers from LMICs and high-income countries (HICs) ensured the development of context-sensitive protocols. These were tailored to varying levels of training, resource availability, and healthcare infrastructure.</div></div><div><h3>Results</h3><div>The resulting protocols address key areas of pre-hospital and emergency management, including initial resuscitation, immobilization, clinical interventions, and timely referral. These protocols emphasize adaptability, providing structured plus flexible guidance for optimizing care according to specific contexts from low to high resourced clinical settings.</div></div><div><h3>Discussion and conclusion</h3><div>The proposed protocols are not intended as gold-standard guidelines but as adaptable frameworks to guide management of STx/SCI in contexts with different availability of resources. By addressing disparities in resource availability and clinical competencies, they can serve as a foundation for local adaptations and improvements in care. Future research should evaluate their implementation and impact on outcomes.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104251"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and prognostic value of navigated transcranial magnetic stimulation to assess motor function in patients with acute traumatic spinal cord injury","authors":"Maximilian Schwendner ,&nbsp;Marianne Kanaris ,&nbsp;Anthony M. DiGiorgio ,&nbsp;Michael C. Huang ,&nbsp;Geoffrey T. Manley ,&nbsp;Phiroz E. Tarapore","doi":"10.1016/j.bas.2025.104229","DOIUrl":"10.1016/j.bas.2025.104229","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic spinal cord injuries (SCI) represent a profoundly life-altering diagnosis.</div></div><div><h3>Research question</h3><div>The aim of this study was to evaluate the diagnostic and prognostic value of navigated transcranial magnetic stimulation (nTMS) in assessing motor function in the management of patients with acute SCI.</div></div><div><h3>Material and methods</h3><div>nTMS motor mapping of both upper extremities (UE) and lower extremities (LE) was performed in patients suffering from acute traumatic SCI. Data from intraoperative neuromonitoring (IONM) and patient outcomes, including American Spinal Injury Association Impairment Scale (AISA) scores, were analyzed.</div></div><div><h3>Results</h3><div>The patients had a mean age of 68.9 ± 15.6 years (range: 28–94 years). Preoperatively, 7 patients (35.0%) were classified as AISA A or B, and 13 (65.0%) were classified as AISA C or D. At follow-up, 5 patients (25.0%) had improved.</div><div>In all patients motor evoked potentials (MEPs) were elicited. MEPs of UE muscles were observed in 38 (61.3%) muscles in IONM and 41 (66.1%) muscles in TMS. MEPs of LE muscles were observed in 5 (19.2%) and 7 (26.9%) muscles, respectively. e</div><div>Combining the results of IONM and nTMS, a sensitivity of 0.852 and a specificity of 0.889 for motor function of the tested muscle at follow-up was achieved for upper extremity muscles. For lower extremity muscles, a sensitivity of 0.571 and a specificity of 1.00 was achieved.</div></div><div><h3>Discussion and conclusion</h3><div>nTMS in patients with acute SCI provides an objective assessment of motor system integrity. Despite a relatively low sensitivity, potentially due to decreased excitability, this technique exhibited excellent specificity in predicting short-term and long-term motor outcomes.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104229"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619254","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":"Optimizing microvascular decompression for trigeminal Neuralgia: Addressing vertebrobasilar ectasia challenges – A technical note","authors":"Pavlina Lenga ,&nbsp;Carola Wieckhusen ,&nbsp;Mohammad Mehdi Hajiabadi ,&nbsp;Andreas Unterberg ,&nbsp;Sandro M. Krieg ,&nbsp;Rezvan Ahmadi","doi":"10.1016/j.bas.2025.104264","DOIUrl":"10.1016/j.bas.2025.104264","url":null,"abstract":"<div><h3>Introduction</h3><div>Trigeminal neuralgia (TN) can be due vertebrobasilar ectasia (VBE), where elongated, tortuous arteries compress the trigeminal nerve, making surgical management challenging.</div></div><div><h3>Research question</h3><div>Does a refined microvascular decompression (MVD) technique using a “Teflon cloud” interposition offer sustained symptom relief and medication discontinuation in VBE-induced TN?</div></div><div><h3>Materials and methods</h3><div>Three patients with VBE-induced TN were treated between 2017 and 2024. Diagnosis was confirmed by MRI/MRA. MVD with a “Teflon cloud” was performed to cushion the nerve without extensive arterial manipulation. Postoperative outcomes were tracked over an 8-month follow-up.</div></div><div><h3>Results</h3><div>All patients showed immediate, complete relief of TN symptoms, with no recurrences. They discontinued TN-related medications within three months, and no significant complications occurred.</div></div><div><h3>Discussion and conclusion</h3><div>These findings suggest that interposition-based MVD using a Teflon cloud effectively addresses TN in the context of VBE by providing stable nerve decompression and minimizing vascular manipulation. A refined MVD with a “Teflon cloud” interposition provides safe, sustained relief for VBE-induced TN, warranting further investigation in larger patient cohorts.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104264"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143904128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidimensional outcome after endovascular or microsurgical occlusion of ruptured intracranial aneurysms – Comparative analysis of a prospective Swiss multicenter study","authors":"Vincens Kälin ,&nbsp;Martin N. Stienen ,&nbsp;Olivia Zindel-Geisseler ,&nbsp;Noemi Dannecker ,&nbsp;Yannick Rothacher ,&nbsp;Ladina Schlosser ,&nbsp;Julia Velz ,&nbsp;Martina Sebök ,&nbsp;Noemi Eggenberger ,&nbsp;Adrien May ,&nbsp;Philippe Bijlenga ,&nbsp;Ursula Guerra-Lopez ,&nbsp;Rodolfo Maduri ,&nbsp;Daniele Starnoni ,&nbsp;Valérie Beaud ,&nbsp;Alessio Chiappini ,&nbsp;Thomas Robert ,&nbsp;Sara Bonasia ,&nbsp;Stefania Rossi ,&nbsp;Johannes Goldberg ,&nbsp;Luca Regli","doi":"10.1016/j.bas.2025.104262","DOIUrl":"10.1016/j.bas.2025.104262","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite advances in cerebral aneurysm treatment, information on detailed outcomes remains limited. We compared complications and multidimensional outcomes in alert aneurysmal subarachnoid hemorrhage (aSAH) patients (GCS ≥13) who received clipping or coiling after individualized decisions were made through multidisciplinary board discussions.</div></div><div><h3>Research question</h3><div>Are there significant differences in multidimensional outcomes between clipping and coiling treatments for alert aSAH patients when treatment selection is individualized?</div></div><div><h3>Material and methods</h3><div>Within the prospective MoCA-DCI study (ClinicalTrials.gov identifier: NCT03032471), patients with a GCS of 13–15 72h post-aSAH in six neurovascular centers underwent neuropsychological (Montreal Cognitive Assessment; MoCA), neurological (National Institutes of Health Stroke Scale; NIHSS), headache (visual analog scale; VAS), disability (modified Rankin Scale; mRS) and health-related quality of life (EuroQol Five Dimensions; EQ5D) assessments within 72h, 14 days and three months after aSAH. We compared these multidimensional outcomes and complications for clipped and coiled patients.</div></div><div><h3>Results</h3><div>Of 126 patients (mean age 53.8 years; 63.9 % female), 84 were coiled and 42 clipped. MoCA scores for clipped vs coiled patients were 23(7) vs 23(8; p = 0.250), 25(8) vs 28(5; p = 0.346), and 27(4) vs 28(5; p = 0.481). Normal cognition (MoCA ≥26) was achieved within 72h by 28.6 % of coiled and 40.5 % of clipped patients (p = 0.179). Complication rates were similar, though surgical patients had higher intraprocedural rupture rates (p = 0.027). Clipped patients reported higher headaches at three months (p = 0.013), while NIHSS, mRS and EQ5D showed no differences.</div></div><div><h3>Discussion and conclusion</h3><div>After interdisciplinary selection of the most appropriate treatment, similar favorable outcomes can be achieved in alert aSAH patients.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104262"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The transformative power of telemedicine in delivering effective neurosurgical care in low and middle-income countries: A review","authors":"Pearl Ohenewaa Tenkorang ,&nbsp;Wireko Andrew Awuah ,&nbsp;Krishitha Meenu Mannan ,&nbsp;Subham Roy ,&nbsp;Princess Afia Nkrumah Boateng ,&nbsp;Olivia Asiedu ,&nbsp;Marjidah Tahiru ,&nbsp;Arjun Ahluwalia ,&nbsp;Nana Osei Owusu Bediako ,&nbsp;Kwadwo Darko","doi":"10.1016/j.bas.2025.104269","DOIUrl":"10.1016/j.bas.2025.104269","url":null,"abstract":"<div><h3>Introduction</h3><div>Telemedicine has been integrated into healthcare systems for over two decades, with the COVID-19 pandemic accelerating its adoption across various medical fields, including neurosurgery. Low- and middle-income countries (LMICs) face significant challenges such as a shortage of neurosurgeons and inadequate healthcare infrastructure. Teleneurosurgery offers a crucial solution to these challenges, improving access to specialized care and enhancing patient outcomes in resource-constrained settings.</div></div><div><h3>Research Question</h3><div>How has teleneurosurgery been used to enhance access to specialized neurological care and improve patient outcomes in low- and middle-income countries?</div></div><div><h3>Methods</h3><div>This narrative review employed a comprehensive search strategy to assess the role of telemedicine in neurosurgery within Low- and middle-income countries. Literature was searched across PubMed, EMBASE, and Scopus, using specific search terms related to teleneurosurgery, virtual consultations, and remote monitoring. Various study designs, including clinical trials, cohort studies, and case reports, were included, while isolated abstracts and unpublished studies were excluded. The review synthesizes the evidence to inform best practices in resource-limited environments.</div></div><div><h3>Results</h3><div>Through remote consultations, pre-operative assessments and post-operative follow-up, telemedicine has become an essential tool to improve patient outcomes and increase access to neurosurgical care, particularly in underserved regions. The ability to conduct virtual assessments and provide specialized care remotely reduces the need for patients to travel long distances, thereby reducing the burden on already strained healthcare systems.</div></div><div><h3>Discussion and Conclusion</h3><div>Despite its growing adoption, low- and middle-income countries continue to face challenges such as limited internet connectivity, regulatory barriers, and infrastructure deficiencies. However, mobile health solutions, international collaborations, and capacity-building initiatives are helping to overcome these obstacles. The future of teleneurosurgery in low- and middle-income countries is promising, but sustained investment in technology, training, and regulatory frameworks is essential to maximize its impact and address disparities in neurosurgical care.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104269"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}