Acta Neurochirurgica最新文献

{"title":"Digital 3D exoscope is an effective tool for the surgery of falx and parasagittal meningiomas","authors":"Ville Vasankari,&nbsp;Sergio Garcia,&nbsp;Hrvoje Baric,&nbsp;Mika Niemelä,&nbsp;Martin Lehecka","doi":"10.1007/s00701-024-06419-x","DOIUrl":"10.1007/s00701-024-06419-x","url":null,"abstract":"<div><h3>Purpose</h3><p>Digital 3D exoscopes are promising tools for microneurosurgery. The results of exoscope-assisted resection of intracranial meningiomas have only been addressed in few case reports. We retrospectively compared the results of exoscope and microscope-assisted surgery of falx and parasagittal meningiomas.</p><h3>Methods</h3><p>We included all consecutive adult patients (<i>n</i> = 36) with falx or parasagittal meningioma who were operated with curative intention during an 8-year period by one senior neurosurgeon. The operations were performed either with a surgical microscope (<i>n</i> = 16; Zeiss Kinevo or Pentero 900) or a digital 3D exoscope (<i>n</i> = 20, Aesculap Aeos). We reviewed the pre- and postoperative radiological images, clinical examinations and surgical reports to assess clinical outcomes and complications. We also analyzed surgical videos.</p><h3>Results</h3><p>Gross-total resection (Simpson grade I-II) was achieved in approximately 90% of the patients in both groups (89% in exoscope and 92% in microscope group). The duration of the operation was slightly longer (117 vs. 88 min) in the exoscope group. Surgical outcomes were comparable, despite there being larger tumors (median diameter 53 vs. 38 mm) with higher grades (WHO Grade 2–3: 45% vs. 19%) in the exoscope group. Transient postoperative complications were more frequent in the exoscope group (40 vs. 25%) mainly related to the larger tumor size.</p><h3>Conclusion</h3><p>The digital 3D exoscope is an effective tool for performing surgery on falx and parasagittal meningiomas. The extent of removal, clinical results and complications seem to be comparable to surgical microscope even in large tumors. Larger prospective studies are required to confirm this result.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06419-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142938915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From spasms to smiles: how facial recognition and tracking can quantify hemifacial spasm severity and predict treatment outcomes","authors":"Ahmed Al Menabbawy,&nbsp;Lennart Ruhser,&nbsp;Ehab El Refaee,&nbsp;Martin E. Weidemeier,&nbsp;Marc Matthes,&nbsp;Henry W. S. Schroeder","doi":"10.1007/s00701-024-06407-1","DOIUrl":"10.1007/s00701-024-06407-1","url":null,"abstract":"<div><h3>Purpose</h3><p>Currently available grading and classification systems for hemifacial spasm either rely on subjective assessments or are excessively intricate. Here, we make use of facial recognition and facial tracking technologies towards accurately grouping patients according to severity and characteristics of the spasms.</p><h3>Methods</h3><p>A retrospective review of our prospectively maintained preoperative videos database for hemifacial spasm was done. Videos were analyzed using an Apple AR kit-based App. A facial mesh is automatically allocated to specific biometric facial points. Videos are analyzed using Blender software for measuring the amplitude and frequency of the spasms. Classification of the patients into groups was done using both divisive k-means and agglomerative hierarchical clustering. Correlation-Analysis with preoperative quality of Life (Qol) using SF-36 questionnaire and HFS-8 score was performed. Additionally, correlation with postoperative outcome was calculated.</p><h3>Results</h3><p>79 preoperative videos were included. Both up-bottom and bottom-up clustering approaches grouped the patients into 3 different clusters according to 4 variables (eye closure, mouth distance change, rate, and repetition of the spasms). Correlation of the groups with the Qol was done for 46/79 patients (58.2%). Spasms could be classified into mild, moderate clonic and severe tonic spasms. Patients with mild spasms showed better Qol scores. Moderate clonic spasms experienced best outcomes following microvascular decompression.</p><h3>Conclusion</h3><p>This novel classification using facial-tracking and augmented-reality is easy to use and apply. It quantifies the severity and type of the spasms and relates it to the quality of life of patients, postoperative outcome, and could guide our management strategy.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06407-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142938953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining the caudal limits of the endoscopic endonasal approach to the craniovertebral junction: anatomic study correlating radiographic measures","authors":"Mohammad Bilal Alsavaf,&nbsp;Moataz D. Abouammo,&nbsp;Jaskaran Singh Gosal,&nbsp;Govind S. Bhuskute,&nbsp;Chandrima Biswas,&nbsp;Guilherme Mansur,&nbsp;Kyle K. VanKoevering,&nbsp;Kyle C. Wu,&nbsp;Ricardo L. Carrau,&nbsp;Daniel M. Prevedello","doi":"10.1007/s00701-024-06389-0","DOIUrl":"10.1007/s00701-024-06389-0","url":null,"abstract":"<div><h3>Objective</h3><p>The endoscopic endonasal approach (EEA), has become the preferred alternative to traditional open and transoral approaches to the ventral craniovertebral junction (CVJ) region. However, preoperative prediction of the limitations of caudal reach remains challenging. This cadaveric study aimed to quantify the CVJ area of exposure and access afforded by the EEA, evaluate the accuracy of previously described radiographic anthropometric lines, and identify the lowest limit of the EEA corridor.</p><h3>Methods</h3><p>Endoscopic endonasal dissections of the CVJ were completed in 35 cadaveric specimens. The area of exposure (AoE) and caudal-most reach were measured using a navigation system. Radiographic measurements included the distance of the odontoid process from the hard palate, length of the hard palate, distance of the lowest point reached from the hard palate level, and angles such as the nasopalatine line (NPL) angle, nasoaxial line (NAxL) angle, nostril-hard palate line (NTL) angle, and rhinopalatine line (RPL) angle.</p><h3>Results</h3><p>The mean CVJ AoE was 931.22 ± 79.36 mm2. The NPL, NAxL, and RPL angles showed significant negative correlations with the distance of the odontoid process from the hard palate line (<i>r</i> = -0.521, <i>p</i> = 0.001; <i>r</i> = -0.538, <i>p</i> = 0.001; <i>r</i> = -0.500, <i>p</i> = 0.002, respectively), while the NTL angle did not (<i>r</i> = -0.241, <i>p</i> = 0.162). No significant correlation was found between achieved AoE via EEA and NPL, NAxL, NTL, or RPL (<i>p</i> &gt; 0.05). Importantly, hard palate length was the sole predictor of CVJ AoE variability (<i>r</i> = -0.416, <i>p</i> = 0.013), with shorter lengths associated with increased exposure. The mean distance of the lowest point reached in the AoE from the hard palate level was 9.47 ± 1.24 mm.</p><h3>Conclusions</h3><p>This anatomic study highlights the variability in CVJ anatomy and the limitations of using previously defined radiographic anthropometric lines for predicting the caudal limits of the EEA. Hard palate length emerged as the only reliable predictor of the surgical area of exposure via the endonasal corridor. Clinical studies are warranted to validate these findings and define the potential need for adjunctive surgical routes in managing complex CVJ pathologies.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06389-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142938952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer neuroscience and glioma: clinical implications","authors":"Manfred Westphal,&nbsp;Richard Drexler,&nbsp;Cecile Maire,&nbsp;Franz Ricklefs,&nbsp;Katrin Lamszus","doi":"10.1007/s00701-024-06406-2","DOIUrl":"10.1007/s00701-024-06406-2","url":null,"abstract":"<div><p>In recent years, it has been increasingly recognized that tumor growth relies not only on support from the surrounding microenvironment but also on the tumors capacity to adapt to – and actively manipulate – its niche. While targeting angiogenesis and modulating the local immune environment have been explored as therapeutic approaches, these strategies have yet to yield effective treatments for brain tumors and remain under refinement. More recently, the nervous system itself has been explored as a critical environmental support for cancer, with extensive neuro-tumoral interactions observed both intracranially and in extracranial sites containing neural components. In the brain, interactions between glioma cells as well as metastatic lesions with neural components have clinical implications for diagnostics, risk assessments, neurological sequelae, and the development of innovative therapeutics. Here, we review these neuro-tumoral dynamics, emphasizing aspects relevant to neurosurgical practice.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06406-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142919064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Disc degeneration in distal unfused segments: cause or consequence of adding-on after posterior fusion of lenke 3c, 5c, 6c adolescent idiopathic scoliosis?’","authors":"Ismail Emre Ketenci,&nbsp;Hakan Serhat Yanik,&nbsp;Mert Kahraman Marasli,&nbsp;Sevki Erdem","doi":"10.1007/s00701-024-06412-4","DOIUrl":"10.1007/s00701-024-06412-4","url":null,"abstract":"<div><h3>Background</h3><p>The aim of this study is to examine the association between adding-on (AO) and disc degeneration(DD) of distal unfused levels in Lenke 3 C, 5 C, 6 C adolescent idiopathic scoliosis (AIS) patients with a follow-up of at least two years by comparing preoperative and postoperative magnetic resonance imaging (MRI).</p><h3>Methods</h3><p>47 AIS patients (32 females and 15 males) with structural thoracolumbar/lumbar (TL/L) curves treated with long segment thoracolumbar fusion were retrospectively evaluated. Patients were divided into two groups according to the occurrence of the AO (AO and Non-AO groups). The unfused discs were graded using the MRI images according to the Pfirrmann grading method. The Scoliosis Research Society-22 (SRS-22) questionnaire and Visuel Analog Scale (VAS) were used to determine clinical outcomes.</p><h3>Results</h3><p>The frequency of AO was found to be 29.78%. Postoperative total Pfirrmann score was significantly associated with AO. L5-S1 disc in the AO group had a statistically significant higher Pfirrmann grade than the Non-AO group. No significant association was found between the VAS and SRS-22 scores related to AO, DD or other radiological outcomes.</p><h3>Conclusion</h3><p>Although patients with AO demonstrated higher postoperative Pfirmann scores, no impact on clinical scores was observed. Furthermore, patients with AO developed significantly higher DD in L5-S1 disc, even if it is not the segment adjacent to the fusion. L5-S1 disc, which is already susceptible to degeneration, was further compromised in the presence of AO.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142912995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How i do it: full-endoscopic transsacral approach for the treatment of extraforaminal L5/S1 disc herniation","authors":"Qingqing Xiao,&nbsp;Fuming Chu,&nbsp;Li Huang,&nbsp;Yue Li","doi":"10.1007/s00701-024-06410-6","DOIUrl":"10.1007/s00701-024-06410-6","url":null,"abstract":"<div><h3>Background</h3><p>For L5/S1 extraforaminal disc herniation, how to efficiently expose the herniated nucleus pulposus and reduce facet joint damage remain to be explored.</p><h3>Methods</h3><p>Lumbar discectomy was performed using a full-endoscopic transsacral approach, in which sacral ala and extraforaminal ligament were partially resected to expose the L5/S1 intervertebral disc. Methylene blue was used for disc staining, and the herniated nucleus pulposus was excised through the annular tear. The nerve root decompression was ensured by detecting from extraforaminal region to S1 vertebral outer edge.</p><h3>Conclusion</h3><p>The full-endoscopic transsacral approach for the therapy of L5/S1 extraforaminal disc herniation is safe and effective.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of cervical malignant spinal lesions: a retrospective study of cervical spine metastases and multiple myeloma cases","authors":"Hassan Allouch,&nbsp;Kais Abu Nahleh,&nbsp;Mahmoud Alkharsawi,&nbsp;Mootaz Shousha,&nbsp;Mohamed Alhashash,&nbsp;Ali Dhainy,&nbsp;Hany Faheem Mehany Gendy,&nbsp;Sándor Kónya,&nbsp;Heinrich Boehm","doi":"10.1007/s00701-024-06402-6","DOIUrl":"10.1007/s00701-024-06402-6","url":null,"abstract":"<div><h3>Purpose</h3><p>This study introduces a retrospective analysis of the surgical management of 213 consecutive cases of cervical spine metastases and Multiple Myeloma Cases.</p><h3>Materials and methods</h3><p>Retrospective analysis of prospectively collected data in a single surgical center of patients who underwent surgery for tumors of the cervical spine between 1994 and 2017. Exclusion criteria were intradural tumors and primary tumors. We analyzed epidemiological data, clinical presentation, radiological findings, and treatment methods.</p><h3>Results</h3><p>From a total of 213 patients, 125 (59%) were male and 88 (41%) were female. The mean age was 61 years (range: 5 to 88 years). The most common entity was lung cancer (19.5%). In 5% of the cases, staging detected no primary (CUP). In most patients, a combined approach (96 patients; anterior-posterior in 80 cases, posterior-anterior in 16 cases) was needed for surgery. From an anterior approach, only 49 patients were treated, while in 68 cases, a posterior approach alone was sufficient. In the atlantoaxial group, in the majority of patients, a transoral approach was performed (30 cases), mostly combined with posterior stabilization (27 patients). The average number of stabilized segments was 2.8 (range: 0–10). The mean postoperative follow-up was 14.2 ± 9.44 months.</p><h3>Conclusions</h3><p>Most cervical spine metastases and multiple myeloma cases can be treated with long-term control or cure of the lesion and preservation of neurological function. Anterior approaches provide adequate exposure to safely remove most of these lesions. Nevertheless, combined surgery with varying degrees of complexity is often required.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating optic system compression in sellar tumors: A novel application of quantitative pupillometry","authors":"Pavlina Lenga,&nbsp;Martin Grutza,&nbsp;Daniel Kühlwein,&nbsp;Johannes Walter,&nbsp;Sandro M. Krieg,&nbsp;Christopher Beynon","doi":"10.1007/s00701-024-06401-7","DOIUrl":"10.1007/s00701-024-06401-7","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;p&gt;Tumorous growths in the sellar region pose significant clinical challenges due to their proximity to critical visual structures such as the optic chiasm and optic nerves. Given their proximity to the optic system, these tumors are often diagnosed due to a progressive decrease in visual acuity. Thus, surgical intervention is crucial to prevent irreversible damage, as timely decompression can halt the progression of edema and subsequent optic atrophy. Although Quantitative Pupillometry (QP) has been employed in various clinical settings, its application in patients with sellar region neoplasms remains unexplored. This study aims to evaluate the utility of QP to enhance treatment approaches in patients undergoing surgical resection of these tumors.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Pupillometry assessments were conducted prospectively using the automated NPi 200® Pupillometer on 45 patients who underwent surgical resection of tumors in the sellar region at our institution. The Neurological Pupil Index (NPi) was measured pre- and post-operatively, with a focus on correlations with visual acuity and tumor volume. Concurrently, MRI findings were analyzed to assess optic chiasm compression.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Of the patients, 73.3% were diagnosed with pituitary tumors, 22.2% with tuberculum sellae meningiomas, and 4.4% with craniopharyngiomas. 66.7% of patients presented with decreased visual acuity, and 42.2% demonstrated paresis of the third cranial nerve (CN III). Compression of the optic chiasm was noted in 55.6% of cases. Patients with visual disturbances and CN III paresis exhibited significantly reduced NPi scores compared to unaffected individuals. In patients with pituitary adenomas, pathological NPIs were observed exclusively in cases of optic chiasm compression; compression of cranial nerve III (CN III) did not significantly affect the NPIs. Conversely, in patients with tuberculum sellae meningiomas, pathological NPIs were associated specifically with CN III compression, while optic chiasm compression tended to show a difference, however the results are not significant. Postoperatively, NPi values normalized among those who had presented with decreased visual acuity.&lt;/p&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;This study contributes to the field of skull base surgery by evaluating the utility of QP as a diagnostic tool for neurological assessment in patients with sellar region tumors. The findings suggest that QP may help in assessing the extent of tumor-related compression on the optic system. It particularly points to differences in the effects of optic chiasm and CN III compression, with observed variations in NPI scores corresponding to the type of compression in specific tumors, such as pituitary adenomas and tuberculum sellae meningiomas. By providing rapid and non-invasive assessments, QP supports enhanced correlation with clinical and radiological evaluations, potentially improving targeted interventions for these complex conditions","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06401-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142889866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International web-based survey of patients with non-hydrocephalic symptomatic pineal cysts","authors":"Jessica Harding,&nbsp;Riccardo Masina,&nbsp;Anna Hill,&nbsp;Ali Ansanipour,&nbsp;Amber Steele,&nbsp;Angelos Kolias,&nbsp;Thomas Santarius","doi":"10.1007/s00701-024-06403-5","DOIUrl":"10.1007/s00701-024-06403-5","url":null,"abstract":"<div><h3>Objectives</h3><p>To report the results of an international patient-reported survey that adds to the growing body of evidence surrounding the role of surgery in the management of a subset of patients with non-hydrocephalic symptomatic pineal cyst.</p><h3>Design</h3><p>An international web-based survey of health outcomes in patients with nhSPC.</p><h3>Subjects</h3><p>All survey participants who self-reported a diagnosis of symptomatic pineal cyst without hydrocephalus after radiological imaging.</p><h3>Methods</h3><p>The survey was developed in collaboration with the patient group Pineal Cyst UK. It was publicised and distributed via several online platforms and social media. Data collected included demographics, cyst size, symptom frequency and severity, number of appointments with healthcare professionals, treatment options trialled, and whether patients underwent surgery.</p><h3>Results</h3><p>543 participants (mean age 38.6 years, range 1–83) were included in the analysis, of which 82 (mean age 38.9 years, range 16–72) had undergone cyst resection. After a median period of 18.3 months between date of surgery and date of questionnaire completion, 72 (90%) of the surgical cohort reported overall improvement, and all symptoms improved overall, whereas no symptoms improved overall in the non-surgical cohort. Of the non-surgical cohort (<i>n</i> = 461), 269 participants received some form of conservative treatment, of whom 194 (72.1%) did not experience symptom improvement on any treatment offered.</p><h3>Conclusions</h3><p>A cohort of patients with nhSPC who participated in this international survey reports substantial and durable improvement in symptom severity and quality of life after pineal cyst resection.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06403-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142889867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and radiologic distinctions between familial cavernous malformation syndrome and cerebral amyloid angiopathy","authors":"KD Flemming,&nbsp;Jonathan Graff Radford,&nbsp;Ross Reichard,&nbsp;James Klaas,&nbsp;Sherri Braksick,&nbsp;Petrice Cogswell,&nbsp;Giuseppe Lanzino","doi":"10.1007/s00701-024-06400-8","DOIUrl":"10.1007/s00701-024-06400-8","url":null,"abstract":"<div><h3>Purpose</h3><p>Familial cerebral cavernous malformation syndrome (FCCM) is characterized by multiple hemorrhagic lesions and is sometimes mistaken for cerebral amyloid angiopathy (CAA).</p><h3>Methods</h3><p>We compared clinical and radiologic characteristics in patients with definite (<i>N</i> = 32) and presumed FCCM (<i>n</i> = 76) to patients with definite (<i>N</i> = 29) and probable CAA (<i>N</i> = 21).</p><h3>Results</h3><p>Patients with CAA were older (78.6 years CAA vs. 43.4 FCCM; <i>p</i> &lt; 0.0001), had cognitive complaints (66.0% CAA vs. 8.3% FCCM; <i>p</i> &lt; 0.0001), and less likely to have a family history (4.0% CAA vs. 50.9% FCCM; <i>p</i> &lt; 0.0001). FCCM patients were more likely to have at least 1 Zabramski type 2 lesion (0 CAA vs. 79.6% FCCM; <i>p</i> &lt; 0.0001). Presence of any subcortical white matter hemorrhagic lesion (23.0% CAA vs. 99.1% FCCM; <i>p</i> &lt; 0.0001), a lesion in either the basal ganglia, internal capsule or cerebellum (28.0% CAA vs 79.6% FCCM; <i>p</i> &lt; 0.0001) and a subcortical white matter to cortical ribbon distribution of hemorrhagic lesions ≥ 1.0 was predictive of FCCM (6.0% CAA vs 83.9% FCCM; <i>p</i> &lt; 0.0001). CAA patients more commonly had white matter disease, sulcal subarachnoid hemorrhage, and severely enlarged perivascular spaces in the centrum. However, none of the latter features were unique to CAA. FCCM patients meeting Boston 2.0 criteria for CAA (<i>n</i> = 14) had additional factors that helped distinguish them from CAA.</p><h3>Conclusions</h3><p>Patients with FCCM can be reliably distinguished from CAA by accurately applying the Boston 2.0 criteria, assessing hemorrhagic lesion distribution and types, and assessing for clinical features unique to FCCM. FCCM criteria are proposed. The frequent finding of leukoaraiosis and enlarged perivascular spaces in the centrum semiovale in FCCM patients deserves further investigation.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06400-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}