查看更多>>摘要：? 2022 Elsevier LtdAn abnormal or absent superficial abdominal reflex (SAR) may be associated with an underlying spinal cord syrinx. The sensitivity of an abnormal or absent SAR and the relationship to Chiari malformation type I (CM-I) or syrinx morphology has not been studied. We aimed to describe the relationship between SAR abnormalities and syrinx size, location, and etiology. Children who underwent brain or c-spine MRI over 11 years were reviewed in this retrospective cohort study. Patients with idiopathic and CM-I–associated syringes (axial diameter ≥ 3 mm) were included. Clinical examination findings (including SAR) and imaging characteristics were analyzed. Of 271 patients with spinal cord syrinx, 200 had either CM-I–associated or idiopathic syrinx, and 128 of these patients had SAR-evaluation documentation. Forty-eight percent (62/128) had an abnormal or absent reflex. Abnormal/absent SAR was more common in patients with CM-I–associated syrinx (61%) compared with idiopathic syrinx (22%) (P < 0.0001). Abnormal/absent SAR was associated with wider syringes (P < 0.001), longer syringes (P < 0.05), and a more cranial location of the syrinx (P < 0.0001). Controlling for CM-I, scoliosis, age, sex, cranial extent of syrinx, and syrinx dimensions, CM-I was independently associated with abnormal or absent SAR (OR 4.2, 95% CI 1.4–14, P < 0.01). Finally, the sensitivity of SAR for identifying a patient with syrinx was 48.1%. An abnormal/absent SAR was present in most patients with CM-I–associated syrinx but in a minority of patients with idiopathic syrinx. This has implications for pathophysiology of CM-I–associated syrinx and in guiding clinical care of patients presenting with syrinx.
查看更多>>摘要：? 2022The incidence and effects of stenosis of the cerebral venous system are poorly understood. When noninvasive computed tomography venography (CTV) of the head and neck suggests complete internal jugular vein (IJV) occlusion, invasive catheter-directed venography can discordantly show venous patency. We compared CTV vs digital subtraction venography (DSV) in the evaluation of patency/occlusion in the suspected IJV and contralateral IJV. We queried the venous intervention database of our U.S. academic tertiary-care hospital to identify patients with complete or near-complete IJV occlusion per CTV from March 1, 2019 to March 1, 2020. We included patients with both noninvasive and invasive imaging of the target segment and the contralateral IJV. Four patients had suspected occlusion of the IJV at the skull base. Invasive catheter-directed venography consisted of DSV to assess direction of flow and vessel caliber, as well as manometry proximal and distal to areas of suspected stenosis. DSV showed patency in all 4 IJVs for which CTV had shown suspected occlusions. CTV findings of the contralateral IJVs were patency (n = 2), moderate stenosis (n = 1), and severe/critical stenosis (n = 1). Contralateral IJV caliber, measured by DSV, was concordant with CTV findings. Median mean-pressure gradients across the apparent occlusion and contralateral segments were 1 (range, 1–4) mmHg and 0 (range, 0–5) mmHg, respectively. Although noninvasive CTV may suggest absence of or attenuated flow within the IJV, this technique may be insufficient to establish complete occlusion. Catheter-directed venography can be used to evaluate patency, vessel caliber, and mean-pressure gradient.
查看更多>>摘要：? 2022Statins may improve outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH) but randomized controlled trials, including all patients with aSAH whatever their clinical severity, were negative. We studied whether pravastatin improved neurologic outcome in patients with early good neurological status, whose prognosis is related to secondary lesions as delayed cerebral ischemia (DCI). We conducted a single-center study of cases and historical controls in a neurocritical care unit. We included consecutive patients with aSAH from 2011 to 2016 with early good neurological status defined by a WFNS score ≤ 3 on the third day. Patients treated before 2014 with oral pravastatin (40 mg/day for 14 days) as a standard of care were matched using propensity score to patients treated after 2014 without pravastatin. Good neurologic outcome was defined by a Glasgow Outcome Scale ≥ 4 at neurocritical care unit discharge. We included 270 patients (135 patients with pravastatin), mostly treated with coiling (94.1%). Demographic, initial and subacute features were the same in the 2 groups. More patients experienced good outcome in the pravastatin group than in the control group (94.8% vs 74.2%; OR 7.16 95% CI [3.07 – 16.72], p < 0.001). There was no difference in the occurrence of DCI in the 2 groups. In our study, outcome on neurocritical care discharge was better in patients with early good neurological status treated with pravastatin. Another randomized controlled trial should be conducted on this subtype of population.
查看更多>>摘要：? 2022 The Author(s)Introduction: The use of extracranial internal carotid artery (ICA) stents after mechanical thrombectomy (MT) may be a source of morbidity and mortality. Studies comparing patients who received stenting to patients who do not receive stenting have a higher number of patients with failed intracranial reperfusion in the non-stenting cohort. In this study, we analyzed the impact of extracranial ICA stenting in tandem occlusion stroke in patients with successfully intracranial reperfusion. Methods: This monocentric, retrospective cohort observational study reviewed all consecutive MT patients from January 2013 to January 2018. All patients with occlusions in the anterior circulation due to ICA atherosclerotic plaque embolus, TOAST 1, and were successfully reperfusion of at least 50% of the initially occluded target territory were included. Patients with a concomitant extracranial, or tandem, ICA occlusion which required MT and permanent stenting (stenting cohort) were compared to patients with extracranial atheromatous ICA plaques, which did not require permanent carotid stenting but were treated only by MT (non-stenting cohort). The three endpoints of this analysis were mortality rate at 90 days, good functional outcome defined as modified rankin scale (mRS) scores 0-2 at 90 days and symptomatic ICH (sICH). Outcomes were reported as odds ratios (ORs), indicating the odds that the intervention would lead to increased mortality rate, an improvement of at least one point on the mRS in a shift analysis and decreased rate of sICH. Results: One hundred and two patients were included of which 42 were treated by MT and ICA stenting (stenting cohort) and 60 were treated by MT without stenting (non-stenting cohort). No significant differences observed as it relates to demographic data, stroke characteristics, symptom onset to groin puncture or groin puncture to final reperfusion time intervals. Univariate logistic regression showed a higher probability of mortality at 90 days in the stenting cohort than that in the non-stenting cohort (OR 2.78, 95% CI 1.21-7.25, P=0.03). Stenting was not associated with a significant difference in functional independence at 90 days or rate of sICH compared to the non-stenting cohort. Conclusion: Stroke patients with successful intracranial reperfusion after MT had a higher probability of mortality within 90 days when concomitant stenting of the extracranial ICA was performed compared those patients who did not receive stenting.
查看更多>>摘要：? 2022 Elsevier LtdAim: Assess role of ADC in differentiating benign and malignant skull lesions and to evaluate the added value of ADC over conventional MRI in facilitating the differentiation. Materials and methods: 53 patients (24 males, 29 females; age 3–75 years) were subjected to both conventional and Diffusion weighted (DWI) MR imaging. DWI was performed using a single-shot SE EPI sequence with b-values of 0& 1000 s/mm2 on 1.5 T MR scanner. Margins of the lesion, number, soft-tissue component, local extension, periosteal reaction and enhancement pattern were the parameters used for differentiating benign & malignant lesions by conventional MRI. ADC values (mean of 3 ROIs over solid component) were calculated. Conventional MRI characteristics and ADC value of lesions were evaluated & compared using statistical analysis. These findings were compared and correlated with histopathology of the skull lesions. Results: 24 malignant and 29 benign lesions were identified on HPE (Histopathological examination) in 53 patients. ADC cut-off value of 0.96 × 10?3 mm2/s obtained from ROC curve was found to have 75.47% accuracy, 87.5% sensitivity, 65.52% specificity, 67.74% PPV and 86.36% NPV for differentiating malignant from benign lesions. Statistically significant differences (p < 0.05) were seen in the mean ADC values of malignant (0.64 ± 0.42 × 10?3 mm2/s) and benign lesions (1.14 ± 0.56 × 10?3 mm2/s). The sensitivity, specificity, PPV and NPV in differentiating benign & malignant skull lesions were found to be 58.33%, 62.07%, 56% and 64.29% respectively, with diagnostic accuracy of 60.38% on using conventional MRI alone and 75%, 72.41%, 69.23% and 77.78% respectively, with diagnostic accuracy of 73.58% on using conventional MRI with ADC. Conclusion: ADC is a promising non-invasive parameter that facilitates differentiation between benign and malignant skull lesions. It is a robust biomarker to narrow differentials when conventional imaging features are indeterminate.
查看更多>>摘要：? 2022 Elsevier LtdTranscranial motor evoked potential (MEP) monitoring, intended to assess cerebral cortical ischemia, may produce false negative results when the stimulation inadvertently activates the deep, subcortical motor pathways. This study examined hand MEP onset latency as a potential means to differentiate superficial versus deep stimulus penetration in surgical patients monitored for cerebral ischemia. Intraoperative MEP data were prospectively collected from 40 patients treated for intracranial aneurysm or carotid stenosis. Onset latencies of hand MEP responses were measured over a range of stimulation intensities from both the contralateral and ipsilateral hand (crossover responses). At the threshold for superficial, cortical stimulation of the contralateral hand, the MEP latency was 26.9 ± 0.4 ms. MEP onset latencies measurements became shorter as stimulation intensities were increased. At the maximum intensity (when crossover response was usually generated), the contralateral hand MEP latency of 22.5 ± 0.3 ms was significantly shorter than at threshold stimulation (p < 0.001). Latency-stimulus intensity plots best fit a 3 parameter hyperbolic decay function (r2 = 0.85 ± 0.02) and revealed a narrow window of acceptable MEP stimuli to obtain superficial cortical activation. Our analysis refutes the utility of the crossover response in reliably gauging depth of activation. Additionally, we found that differentiation between long and short MEP onset latency times may serve as a dependable marker for depth of stimulation. Attention to hand MEP onset latency may reduce inadvertent stimulation of the deep corticospinal tract pathways and avoid false negative MEP recordings during cerebrovascular surgeries.
查看更多>>摘要：? 2022 Elsevier LtdPurpose: Obstructive sleep apnea syndrome (OSAS) has mostly been examined using in-laboratory polysomnography (Lab-PSG), which may overestimate severity. This study compared sleep parameters in different environments and investigated the association between the plasma levels of neurochemical biomarkers and sleep parameters. Methods: Thirty Taiwanese participants underwent Lab-PSG while wearing a single-lead electrocardiogram patch. Participants’ blood samples were obtained in the morning immediately after the recording. Participants wore the patch for the subsequent three nights at home. Sleep disorder indices were calculated, including the apnea-hypopnea index (AHI), chest effort index, and cyclic variation of heart rate index (CVHRI). The 23 eligible participants’ derived data were divided into the normal-to-moderate (N-M) group and the severe group according to American Association of Sleep Medicine (AASM) guidelines (Lab-PSG) and the recommendations of a previous study (Rooti Rx). Spearman's correlation was used to examine the correlations between sleep parameters and neurochemical biomarker levels. Results: The mean T-Tau protein level was positively correlated with the home-based CVHRI (r = 0.53, p < 0.05), whereas no significant correlation was noted between hospital-based CVHRI and the mean T-tau protein level (r = 0.25, p = 0.25). The home-based data revealed that the mean T-Tau protein level in the severe group was significantly higher than that in the N-M group (severe group: 24.75 ± 6.16 pg/mL, N-M group: 19.65 ± 3.90 pg/mL; p < 0.05). Furthermore, the mean in-hospital CVHRI was higher than the mean at-home values (12.16 ± 13.66 events/h). Conclusion: Severe OSAS patients classified by home-based CVHRI demonstrated the higher T-Tau protein level, and CVHRI varied in different sleep environments.
查看更多>>摘要：? 2022Objective: Indocyanine green (ICG) has been used in endoscopic surgery in the neurosurgical field, but it has been challenging to determine the associated efficiency due to limitations with visualization in the previous endoscopic system. A new endoscopic system was recently introduced; therefore, we summarize our experiences with the application and integration of the system. Methods: From March to June 2021, a newly introduced endoscopic system was used in 10 patients. (8 pituitary adenomas, and 2 tuberculum sellae meningiomas) and 12.5 mg of ICG was injected for each study. Results: Six pituitary adenomas, including one acromegaly, were well identified with ICG. However, two pituitary adenomas, presented with apoplexy and two meningiomas were not visualized with ICG. Conclusions: The ICG provides real-time information during endoscopic endonasal surgery. We suggest that the pituitary adenoma can be stained with an ICG using the fusion-fluorescence imaging endoscopic system. This approach will enhance the surgeon's ability to remove the tumor with preserve the normal gland more safely.
查看更多>>摘要：? 2022 Elsevier LtdObjectives: This study aims to investigate recurrence risk factors of simply coiled unruptured paraclinoid aneurysms based on a porous medium model (POM). Methods: Twenty unruptured coiled paraclinoid aneurysms with digital subtract angiography (DSA) follow-up were enrolled to analyze morphological and hemodynamic variables to predict recurrence. Results: Recurrent aneurysms have larger neck areas than stable aneurysms (34.43 ± 21.46 mm2 vs. 16.12 ± 7.10 mm2; p = 0.048). For hemodynamic variables, recurrent aneurysms had larger preoperative (16.40 ± 11.38 mm2 vs. 7.87 ± 3.75 mm2; p = 0.048) and postoperative inflow areas (14.07 ± 6.80 mm2 versus 6.73 ± 4.20 mm2; p = 0.021) than the stable group. Only the postoperative inflow area (p = 0.031, OR = 1.289; 95% CI 1.024–1.624) was an independent predictor of recurrence after multivariate regression analysis. The receiver operating characteristic (ROC) curve analysis efficiently predicted recurrence (AUC = 0.833, p = 0.021) with an inflow area cutoff value (9.15 mm2; sensitivity, 0.833; specificity, 0.857). Conclusions: Neck area along with pre- and postoperative inflow areas were associated with aneurysm recurrence. These findings suggest that a large postoperative inflow area independently predicts the recurrence of coiled paraclinoid aneurysms.
查看更多>>摘要：? 2022 Elsevier LtdObjectives: This study evaluated the association between subjective cognitive decline (SCD) and the quality of life (QoL). Methods: This nation-wide cross-sectional study investigated 177,882 adults (78,362 men, 99,520 women) who participated in the 2019 Korean Community Health Survey. Multiple sociodemographic and psychosocial variables were evaluated and compared between participants with (n = 37,614) and without SCD (n = 140,518); the Patient Health Questionnaire-9 (PHQ-9) was used to determine the presence of depression and QoL was assessed using the EuroQol five-dimension (EQ-5D) questionnaire. Results: Depression as defined by PHQ-9 scores ≥ 10 was reported significantly more often in the SCD group (9.2%) than in the non-SCD group (1.7%) (p < 0.001). The mean EQ-5D index scores were significantly lower in the SCD group (score 0.83) than in the non-SCD group (score 0.90; p < 0.001). The multivariate odds ratio (OR) for depression (PHQ9 ≥ 10) was3.11 (95% confidence interval [CI], 3.10–3.13) and the lowest quartile of the EQ-5D index scores was 1.88 (95% CI, 1.88–1.89) in the SCD group versus that in the non-SCD group. Participants in the SCD group were more likely to be physically active (OR, 1.32; 95% CI, 1.20–1.33) and have self-control (OR, 1.36; 95% CI, 1.34–1.37), daily activity (OR, 1.35; 95% CI, 1.33–1.36), pain (OR, 1.56; 95% CI, 1.56–1.57), and anxiety/depression (OR, 2.71; 95% CI, 2.68–2.73). Conclusion: Subjective cognitive decline is associated with depression and impaired quality of life, particularly if anxiety/depression is present.
NSTL
Elsevier