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Journal of clinical neuroscience
Churchill Livingstone
Journal of clinical neuroscience

Churchill Livingstone

0967-5868

Journal of clinical neuroscience/Journal Journal of clinical neuroscienceSSCISCIISTPAHCI
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    Association between surgical volume and outcomes after craniotomy for brain tumor removal: A South Korean nationwide cohort study

    Choi H.-R.Song I.-A.Oh T.K.
    7页
    查看更多>>摘要：? 2022 Elsevier LtdWe aimed to examine the effect of surgical volume on the 1-year mortality of patients who underwent craniotomy for brain tumor removal. In this nationwide population-based cohort study, data were extracted from the South Korean National Inpatient Database. The study included patients diagnosed with brain tumors who underwent craniotomy for brain tumor removal between January 1, 2010 and December 31, 2018. Multivariable Cox regression models were used to evaluate the associations between surgical volume and outcomes. A total of 9,849 patients were included in the analysis, of whom 957 (9.7%) were aged ≤ 18 years. One-year all-cause mortality occurred in 2,779 (28.2%) patients. The multivariable Cox regression model showed that an increase in case volume by 10 was associated with decreased 1-year all-cause mortality (hazard ratio [HR]: 0.98, 95% confidence interval [CI]: 0.97–0.99; P = 0.002), 1-year brain-cancer mortality (HR: 0.99, 95% CI: 0.98–0.99; P = 0.044), and 1-year other (non-brain cancer) mortality (HR: 0.95, 95% CI: 0.92–0.98; P = 0.001). Similar trends were observed in the subgroup analyses for both adult and pediatric patients. High surgical volumes were associated with decreased 1-year all-cause mortality after craniotomy for brain tumor removal. However, since the type and stage of the brain tumor and neurosurgeon-related factors were not considered, further study is needed to confirm our findings.
      原文链接:
    • NSTL
    • Elsevier

    Changes in intervertebral distraction: A possible factor for predicting dysphagia after anterior cervical spinal surgery

    Yi Y.-Y.Chen H.Xu H.-W.Zhang S.-B....
    7页
    查看更多>>摘要：? 2022 Elsevier LtdObjective: Dysphagia following anterior cervical spine surgery (ACSS) is common. This study aimed to determine if change in intervertebral distraction following ACSS is associated with early dysphagia. Methods: We retrospectively examined patients who underwent ACSS for myelopathy and/or radiculopathy in our institution. The Bazaz score and the Chinese version of the Swallowing-Quality of Life survey were used to assess postoperative swallowing function. Change in intervertebral distraction was defined as the difference between the preoperative and postoperative mean values of the anterior and posterior intervertebral distances at the surgical site. Potential risk factors examined included age, gender, body mass index, operative time, blood loss volume, level of surgery, as well as radiographic data including Cobb angle, T1 slope, sagittal vertical axis, and intervertebral distraction. Results: Among the 289 patients, the incidence of dysphagia was 58.1% 1 week after ACSS. Patients who underwent surgery involving C3/4 or involving three or more levels had worse Swallowing-Quality of Life and Bazaz scores. The optimal cutoff value for change in intervertebral distraction for predicting dysphagia 1 week after surgery was 6.10 mm. Change in intervertebral distraction ≥ 6.10 mm, surgery involving C3/4, and surgery involving three or more levels were significantly and independently associated with early dysphagia. Conclusion: A correlation between early dysphagia and change in intervertebral distraction ≥ 6.10 mm could be confirmed. In addition, patients undergoing ACSS involving C3-4 or multilevel surgery (≥3) must be monitored carefully postoperatively for dysfunctional swallowing.
      原文链接:
    • NSTL
    • Elsevier

    Distanct ischemic postconditioning in acute mild to moderate ischemic stroke: A randomized clinical study

    Wang Z.Dong H.Luan S.Liu J....
    5页
    查看更多>>摘要：? 2022 Elsevier LtdObjective: Distant ischemic postconditioning (DIPC) has been confirmed to have a neuroprotective effect in animal models of ischemia. However, there are only a few studies on its efficacy and safety in clinical applications. Method: We divided 86 patients with acute non-cardiogenic mild to moderate cerebral infarction into DIPC and control groups. Result: After 7 days of using different pressure DIPC therapies, the National Institutes of Health Stroke Scale (NIHSS) scores on the eighth day significantly decreased, and modified Rankin scale significantly increased in the DIPC group, compared to that before treatment. On the eight day of admission, the decrease in the NIHSS scores significantly differed between the two groups. However, there was no change in the early neurological deterioration and platelet aggregation rates between the two groups on the eighth day. Conclusion: These results demonstrate that DIPC can safely and effectively improve neurological deficits in acute stages of mild to moderate cerebral infarction without affecting the efficacy of antiplatelet drugs.
      原文链接:
    • NSTL
    • Elsevier

    Socioeconomic and demographic considerations of pediatric concussion recovery

    Pate J.Cummins I.Mooney J.Cooper K....
    6页
    查看更多>>摘要：? 2022 Elsevier LtdThe objective of this study was to investigate predictors of concussion recovery in children (5–12) versus adolescents (13–18) while identifying economic and demographic disparities in post-concussion care at a tertiary referral concussion clinic versus emergency department (ED). Race and insurance status were recorded for patients presenting to the concussion clinic (724) and ED (1,160) with an ICD-10 concussion diagnosis between 2018 and 2019. Secondly, a subset of patients from the concussion clinic group were included for retrospective cohort review based on documented recovery data. Overall, the concussion clinic saw more Caucasian patients (66.7%) than the ED (56.8%). Concussion clinic patients were more likely to have Private insurance than ED patients (67.2% vs. 55.3%) and less likely to have Medicaid and Self pay (p < 0.001). Children were more likely to be hospitalized after concussion diagnosis than adolescents (40.8% vs. 24.4%, p = 0.006). Attending public school was associated with a 1.8 times greater hazard ratio (HR) for shorter time to recovery compared to attending private school. Additionally, presence of a diagnosed psychiatric disorder was associated with a HR of 0.5, indicating a longer time to recovery (p < 0.001) than patients without a disorder. The present findings may support limitations on contact sports participation in young children given their higher hospitalization rate after concussion. Additionally, the study highlights potential barriers to care amongst youth concussion patients with those seen in specialized concussion clinics more likely to be White and have private insurance.
      原文链接:
    • NSTL
    • Elsevier

    Pseudobulbar affect in neurodegenerative diseases: A systematic review and meta-analysis

    Nabizadeh F.Nikfarjam M.Azami M.Sharifkazemi H....
    8页
    查看更多>>摘要：? 2022 Elsevier LtdBackground: Pseudobulbar affect (PBA) is characterized by uncontrolled episodes of crying and laughing which is associated with a variety of neurological diseases including traumatic brain injury, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), brain tumors, stroke, Parkinson's disease (PD), Alzheimer's disease (AD) and other dementias. However, there is a lack of exact estimated prevalence of PBA among neurological disorders. Aim: In this systematic review and meta-analysis study we aimed to assess the prevalence of PBA in four neurodegenerative diseases including ALS, MS, AD, and PD. Methods: PubMed, Scopus, and Web of Science were searched in July 2021 for studies that reported the prevalence of PBA in ALS, MS, AD, and PD patients. The mean point of PBA prevalence and odds ratios were calculated as effect size (ES) using the random-effect model with a 95% confidence interval (CI). Results: The summarized prevalence of PBA was of PBA in PD patients were ranged between 1% and 31% with an overall meta-analysis prevalence of 16.5% and high heterogeneity (I2: 98.7%, p: 0.000). Patients with ALS showed a PBA prevalence of 38.5%, which is higher than other neurodegenerative diseases (CI 95%: 31%-45%, I2: 61.4%, p: 0.034). Moreover, the prevalence of PBA in MS patients in the analysis was 23.3% ranging between 11% and 35% with high-level heterogeneity according to the I2 value (I2: 98.9%, p: 0.000). Also, our meta-analysis showed that the PBA prevalence in AD was 16.4% (CI 95%: 7%-25%) with high heterogeneity (I2: 97.8%, p: 0.000). Conclusion: This review showed that PBA is common in patients with neurodegenerative diseases including PD, AD, MS, and especially ALS. Due to the lack of proper recognition, medication and treatment would not be effective and sufficient. Therefore, it can dramatically lower the quality of life in PBA patients and decrease their social interactions.
      原文链接:
    • NSTL
    • Elsevier

    When less is more: Non-contrast head CT alone to work-up hypertensive intracerebral hemorrhage

    Chen C.Girgenti S.Mallick D.Marsh E.B....
    5页
    查看更多>>摘要：? 2022 The AuthorsHypertension is a common cause of intracerebral hemorrhage (ICH). The work up typically involves neuroimaging of the brain and blood vessels to determine etiology. However, extensive testing may be unnecessary for presumed hypertensive hemorrhages, and instead prolong hospital stay and increase costs. This study evaluates the predictive utility of hemorrhage location on the non-contrast head CT in determining hypertensive ICH. Patients presenting with non-traumatic ICH between March 2014 and June 2019 were prospectively enrolled. Hemorrhage etiology was determined based on previously defined criteria. Chi square and Student's t tests were used to determine the association between patient demographics, ICH severity, neuroimaging characteristics, and medical variables, with hypertensive etiology. Multivariable regression models and an ROC analysis determined utility of CT to accurately diagnose hypertensive ICH. Data on 380 patients with ICH were collected; 42% were determined to be hypertensive. Along with deep location on CT, black race, history of hypertension, renal disease, left ventricular hypertrophy, and higher admission blood pressure were significantly associated with hypertensive etiology, while atrial fibrillation and anticoagulation were associated with non-hypertensive etiologies. Deep location alone resulted in an area under the curve of 0.726. When history of hypertension was added, this improved to 0.771. Additional variables did not further improve the model's predictability. Hypertensive ICH is associated with several predictive factors. Using deep location and history of hypertension alone correctly identifies the majority of hypertensive ICH without additional work-up. This model may result in more efficient diagnostic testing without sacrificing patient care.
      原文链接:
    • NSTL
    • Elsevier

    Prognostic value of radial peripapillary capillary density for visual field outcomes in pituitary adenoma: A case-control study

    Tang Y.Jia W.Xue Z.Yuan L....
    7页
    查看更多>>摘要：? 2022Pituitary adenomas are known to cause optic chiasmal compression leading to visual field (VF) defects. Herein, we analysed the factors influencing early VF recovery following transsphenoidal surgery and explored the significance of retinal vessel density parameters in predicting prognoses. We collected data of 50 patients with pituitary adenoma and an abnormal VF prior to surgery. Patients were categorised into VF recovery (n = 25) and non-recovery (n = 25) groups within 1 week postoperatively. The VF, optic chiasm form, tumour volume, retinal thickness, and vessel density parameters were measured. The χ2 test was used for single-factor analyses, and odds ratios (ORs) for each factor were calculated. Logistic regression was implemented to determine interactions between radial peripapillary capillary (RPC) density and other factors. Tumour volume (≥5 cm3, OR = 5.09), duration of visual symptoms (≥6 months, OR = 6.00), preoperative VF (mean deviation [MD] < -10 dB, OR = 6.77), thin retinal nerve fibre layer (OR = 9.04), ganglion cell layer complex thickness (OR = 7.67), and RPC density (whole ≤ 48%; OR = 15.58; temporal ≤ 49.3%; OR = 14.64) were found to be risk factors for postoperative VF recovery. After adjusting for these factors, RPC density was a dependent factor affecting VF recovery in patients with pituitary adenoma. RPC density seemed to be a stronger indicator than preoperative MD, tumour volume, duration of visual symptoms, or retinal thickness for predicting early VF recovery following optic chiasm decompression, thus helping surgeons determine the optimal timing of surgery and formulate effective treatment plans.
      原文链接:
    • NSTL
    • Elsevier

    Intravenous thrombolysis prior to mechanical thrombectomy does not affect clinical or procedural outcomes in patients with large vessel occlusion acute ischemic stroke

    Platko S.Bensabeur F.Rotsching N.Wagner J....
    4页
    查看更多>>摘要：? 2022 Elsevier LtdMechanical thrombectomy (MT) has revolutionized the care of large vessel occlusion acute ischemic strokes (LVOAIS). However, the benefit of intravenous thrombolysis prior to MT remains unproven. Two recent trials showed equivocal results regarding the benefits of pre-MT intravenous thrombolysis in predominantly Asian populations. We evaluated clinical outcomes and procedural metrics for patients with LVOAIS who were treated with MT alone compared to those who were treated with both intravenous tPA and MT. In a retrospective study, LVOAIS patients treated with MT, with or without preceding intravenous thrombolysis, between January of 2017 and December of 2019 were identified. Patients were treated according to contemporary guidelines. Baseline demographic and clinical characteristics, procedural metrics, and clinical outcomes were collected. Among LVOAIS patients, those treated with intravenous thrombolysis and MT did not differ from those with MT alone on clinical outcomes at three months. Further, the two groups did not differ on thrombectomy procedure times, recanalization rates, and symptomatic intracranial hemorrhage rates. In our patients with LVOAIS, intravenous thrombolysis combined with MT offered no advantage compared to MT alone in clinical outcomes or recanalization rates. Our results are consistent with earlier studies in other populations. In addition, our results suggest that IV tPA does not impact the ease of clot removal by MT. Further studies will evaluate how newly available thrombolytic agents may benefit patients eligible for MT.
      原文链接:
    • NSTL
    • Elsevier

    Atlantoaxial stenosis after muscle-preserving selective laminectomy

    Aoyama R.Yamane J.Ninomiya K.Takahashi Y....
    7页
    查看更多>>摘要：? 2022 Elsevier LtdThere are few reports of degenerative atlantoaxial stenosis and new stenosis after cervical decompression. We experienced four cases of atlantoaxial stenosis after muscle-preserving selective laminectomy. We compared these four cases with no stenosis cases after long-term follow-up of selective laminectomy, as well as healthy subjects. A total of 1205 patients who underwent muscle-preserving selective laminectomy due to cervical disorders were included in this study. Postoperative atlantoaxial stenosis, which needed decompression, appeared in 4 cases, and 30 patients did not have radiological stenosis for more than 10 years after surgery. Twenty healthy volunteers were also used as controls. The radiographic parameters measured were C2-C7 angle, C2-C7 sagittal vertical axis (SVA), C2 slope, C7 slope, C2-C5 angle, C5-C7 angle, C1-C2 angle, and atlantodental interval (ADI). We measured the anterior-posterior (AP) diameters of the spinal cord (SC) and dural tube (Dura) at C1/C2 with sagittal MRI. In the cases of atlantoaxial stenosis, the AP of SC and Dura at C1/C2 were smaller preoperatively, and the residual space for SC (SAC) was also smaller. The preoperative ADI was significantly higher in patients with atlantoaxial stenosis, suggesting preoperative instability at C1/C2. Analysis of the ROC curve showed that patients with a preoperative SAC of less than 3.6 mm and an ADI of more than 1.35 mm were more likely to develop postoperative atlantoaxial stenosis. When we perform a muscle-preserving selective laminectomy, decompression of C1/C2 is suggested when the SAC at C1/C2 is less than 3.6 mm and the ADI is more than 1.35 mm.
      原文链接:
    • NSTL
    • Elsevier

    The 8-year single-center experience of telescoping flow diverter for complex intracranial aneurysms treatment

    Tang H.Shang C.Hua W.Lu Z....
    7页
    查看更多>>摘要：? 2022 Elsevier LtdObjective: Treatment of complex intracranial aneurysms (IAs) is still a challenging thing and this study aims to summarize the experience of telescoping flow diverters (FDs) in treating complex intracranial aneurysms. Method: Between April 2013 to November 2020, 381 IA cases treated by flow diverters (FD) were retrieved from the database of 4988 IA cases, and finally 20 cases treated by telescoping FDs were enrolled for further analysis. Result: Among 20 patients, 15 patients (75.0%) received Tubridge telescoping while 5 patients (25.0%) received PED telescoping. The technical success rate was 100%. The immediate occlusion results were: 7 cases of OKM grade A (35.0%), 11 cases of OKM grade B (55.0%), and 2 cases of OKM grade C (10.0%). No perioperative complications occurred. The clinical follow-up was available in 20 patients (100%) and the follow-up time was 6–96 months. One patient developed massive infarction and the other 19 patients were range between 0 and 2. The angiographic follow-up was available in 17 patients (85%) and the follow-up time was 6–27 months. The occlusion results were: 1 case of OKM grade B (5.9%), 6 cases of OKM grade C (35, 0.3%), and 10 cases of OKM grade D (58.8%). 2 patients (11.8%) developed occlusion of the patent artery. Conclusion: Telescoping flow diverters showed low perioperative complications and high IA occlusion rate when treating complex intracranial aneurysms in follow-up time, which provides an alternative manner beyond conventional strategy for neurosurgeons.
      原文链接:
    • NSTL
    • Elsevier