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World neurosurgery
Elsevier
World neurosurgery

Elsevier

1878-8750

World neurosurgery/Journal World neurosurgeryAHCISCIISTP
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    Long-Term Follow-up of Patients Managed Conservatively for Acute Traumatic CSF Rhinorrhea

    Abraham A.P.Singh M.Reji K.K.Nair S....
    8页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Conservative management of acute traumatic cerebrospinal fluid rhinorrhea (TCR) results in cessation of the leak in most patients. The objective of this study was to estimate the incidence of recurrent cerebrospinal fluid (CSF) rhinorrhea and meningitis in these patients on long-term follow-up and to determine the risk factors associated with them. Methods: Data on 50 patients with acute TCR who were successfully treated with conservative management between 2013 and 2015 and had long-term follow-up was retrieved from our head injury database. Patient variables were analyzed to determine the risk factors associated with recurrence of CSF rhinorrhea and meningitis. Results: All patients in our series developed CSF rhinorrhea within 48 hours of trauma. The mean duration of follow-up was 6.3 ± 1.3 years. CSF rhinorrhea recurred in 16 (32%) patients, 15 (93.8%) of whom developed it within 3 years of trauma. Meningitis occurred in 5 (10%) patients and 1 died. Sphenoid sinus fractures and features of raised intracranial pressure on computerized tomography of the brain at admission were significantly associated with the development of meningitis. There were no risk factors identified for the recurrence of CSF rhinorrhea. Conclusions: Patients with acute TCR in whom rhinorrhea subsides with conservative therapy have the highest risk for recurrence of leak or meningitis within 3 years of the trauma. Therefore, we recommend that these patients be counselled about the need for periodic follow-up for several years.
      原文链接:
    • NSTL
    • Elsevier

    Asymptomatic Moyamoya Disease in a North American Adult Cohort

    Lai P.M.R.Gomez-Paz S.Patel N.J.Frerichs K.U....
    8页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: The natural history of asymptomatic adult moyamoya disease (MMD) is unclear, and the benefit of treatment remains controversial. This study aimed to investigate the natural history of asymptomatic MMD in a North American cohort and to evaluate risk factors associated with and the effects of treatment on disease progression. Methods: Medical records from 3 institutions of consecutive adult patients with MMD diagnosed between 1984 and 2018 were retrospectively reviewed. Patients with unilateral or bilateral asymptomatic MMD were evaluated for subsequent development of infarction or hemorrhage. Multivariate Cox proportional hazards regression assessed risk factors associated with infarction or hemorrhage, adjusting for age, sex, race, initial Suzuki grade, hypertension, hyperlipidemia, diabetes, obesity, presence of aneurysms, smoking status, aspirin, and statin use at diagnosis. Results: We identified 106 hemispheres with asymptomatic MMD in 97 patients with mean 5.1 years (interquartile range, 1.0–7.9 years) of follow-up. Of 106 hemispheres, 59 were treated medically, and 47 were treated with revascularization with direct or indirect bypasses. The medical and surgical cohorts had a 1.9% and 1.3% annual rate of radiographic infarction or hemorrhage per hemisphere, respectively. Cox regression for radiographic events, including early postoperative events, showed no significant difference between the treatment groups (adjusted hazard ratio 0.34 [95% confidence interval 0.05–2.5]). Conclusions: We found an overall 1.7% annual rate of radiographic infarction or hemorrhage in asymptomatic MMD hemispheres. Although we did not find a benefit to surgical treatment within the study period, asymptomatic patients with expected long-term survival may benefit from surgery given the sustained long-term benefits after surgery despite an initial postoperative risk.
      原文链接:
    • NSTL
    • Elsevier

    Multiparametric Monitoring of Early Pathophysiological Changes in a Porcine Model of Sequential Focal and Global Cerebral Ischemia

    Mader M.M.-D.Heimann A.Kempski O.Wobker G....
    9页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Large animal models of cerebral ischemia have the potential to increase the translational value of stroke research. This study aims to measure early changes of brain tissue oxygen pressure (ptiO2) and cerebral blood flow (CBF) to characterize a porcine model of sequential middle cerebral artery occlusion (MCAO) and common carotid artery occlusion (CCAO). Methods: Eight juvenile German Landrace pigs received unilateral MCAO via a frontotemporal approach under continuous intraparenchymal multiparametric monitoring. Insufficient reduction (i.e., <50% in both ptiO2 and CBF) was followed by additional bilateral CCAO. Neurodegenerative changes were detected by Fluoro-Jade B (FJB) staining. Results: Only 1 of 8 animals demonstrated a decrease of >50% in both ptiO2 and CBF after MCAO. Additional CCAO in 7 pigs led to a significant reduction of both ipsilateral and contralateral ptiO2 (P < 0.01) but not of CBF. There was no difference in ptiO2 and FJB positive area between hemispheres in this group. Measurement of ptiO2 correlated negatively with the FJB positive area (P < 0.05). Conclusions: Intraparenchymal multiparametric measurements of acute changes in ptiO2 and CBF were variable after MCAO. Bilateral CCAO led to a consistent decrease in ptiO2 and correlated with early degenerative histologic changes, but CBF did not. Real-time procedural ptiO2 monitoring could provide useful guidance in large animal ischemia models. Feasibility in the context of global cerebral hypoperfusion is demonstrated.
      原文链接:
    • NSTL
    • Elsevier

    Sarcopenia Diagnosed Using Masseter Muscle Diameter as a Survival Correlate in Elderly Patients with Glioblastoma

    Morshed R.A.Young J.S.Casey M.Wang E.J....
    16页
    查看更多>>摘要：? 2022 The Author(s)Background: Elderly patients with glioblastoma (GBM) have a worse prognosis than do younger patients. The present study aimed to identify the patient, treatment, and imaging features, including measures of sarcopenia, associated with worse survival and 90-day postoperative mortality for elderly patients with GBM. Methods: A single-center retrospective study was conducted of patients aged ≥79 years at surgery who had undergone biopsy or resection of a World Health Organization grade IV GBM at the initial diagnosis. Imaging features of sarcopenia were collected, including the masseter and temporalis muscle diameters. Multivariate analyses were performed to identify factors associated with survival and 30-day complications. Results: The cohort included 110 patients with a mean age of 82.8 years at surgery and a median preoperative Karnofsky performance scale score of 80. The majority of patients underwent a surgical resection (66.4%) while a minority underwent biopsy (33.6%). Adjuvant chemo- and/or radiation therapy were used in 72.5% of the cohort. On multivariate analysis, age (hazard ratio [HR], 7.97; 95% confidence interval [CI], 1.63–36.3), adjuvant therapy (RT or TMZ vs. none: HR, 0.12; 95% CI, 0.05–0.3; RT plus TMZ vs. none: HR, 0.05; 95% CI, 0.02–0.14), surgical resection (HR, 0.46; 95% CI, 0.24–0.9), multifocality (HR, 2.7; 95% CI, 1.14–6.4), and masseter diameter (HR, 0.12; 95% CI, 0.02–0.78) were associated with survival. Masseter diameter was the only factor associated with 90-day mortality after surgical resection (P = 0.044). Conclusions: GBM patients over the age of 79 have acceptable outcomes after resection, followed by adjuvant chemotherapy and RT. In addition to the treatment factors that predicted for survival, a decreased masseter diameter on preoperative imaging, a marker of sarcopenia, was associated with shorter overall survival and 90-day mortality after surgical resection.
      原文链接:
    • NSTL
    • Elsevier

    Negative Remodeling of Carotid Canal during Spontaneous Disease Progression in Moyamoya Disease

    Shiro T.Yamamoto S.Hamada S.Maruyama K....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: This study was designed to observe the changes in the carotid canal over time by measuring the carotid canal diameter longitudinally in adult patients with moyamoya disease in whom disease stage progressed spontaneously. Methods: Of 70 adult patients with moyamoya disease, 10 adult patients on 15 sides with spontaneous progression of the disease stage during conservative follow-up were included in this study. Another 10 moyamoya cases on 15 sides were selected as the controls without disease progression. All patients were followed up for at least 60 months after the progression of disease stage was confirmed. In addition, 5 patients who underwent microvascular decompression were included as healthy controls. The carotid canal diameter was measured with bone window computed tomography (CT) and source images of time-of-flight magnetic resonance angiography at initial presentation, and then were serially monitored with the latter. Results: There was a significant correlation between the values obtained from CT and magnetic resonance imaging (R2 = 0.992, P < 0.001). The carotid canal diameter in moyamoya disease at initial presentation was 4.29 ± 0.61 mm, being smaller than 5.20 ± 0.51 mm in healthy controls (P < 0.01). In response to disease progression, the carotid canal diameter started to decrease at 6 months after disease progression was confirmed, and reduced to about 85% of the original level during 60 months (P < 0.01). The phenomenon was not observed in patients without disease progression. Conclusions: The carotid canal diameter can decrease in response to disease progression even in adult moyamoya disease. “Negative” bone remodeling may play a key role in this unique phenomenon.
      原文链接:
    • NSTL
    • Elsevier

    Diagnosis of Middle Cerebral Artery Stenosis Using Transcranial Doppler Images Based on Convolutional Neural Network

    Mei Y.-J.Hu R.-T.Lin J.Xu H.-Y....
    8页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: The purpose of this study was to explore the diagnostic value of convolutional neural networks (CNNs) in middle cerebral artery (MCA) stenosis by analyzing transcranial Doppler (TCD) images. Methods: Overall, 278 patients who underwent cerebral vascular TCD and cerebral angiography were enrolled and classified into stenosis and non-stenosis groups based on cerebral angiography findings. Manual measurements were performed on TCD images. The patients were divided into a training set and a test set, and the CNN architecture was used to classify TCD images. The diagnostic accuracies of manual measurements, CNNs, and TCD parameters for MCA stenosis were calculated and compared. Results: Overall, 203 patients without stenosis and 75 patients with stenosis were evaluated. The sensitivity, specificity, and area under the curve (AUC) for manual measurements of MCA stenosis were 0.80, 0.83, and 0.81, respectively. After 24 iterations of the running model in the training set, the sensitivity, specificity, and AUC of the CNNs in the test set were 0.84, 0.86, and 0.80, respectively. The diagnostic value of CNNs differed minimally from that of manual measurements. Two parameters of TCD, peak systolic velocity and mean flow velocity, were higher in patients with stenosis than in those without stenosis; however, their diagnostic values were significantly lower than those of CNNs (P < 0.05). Conclusions: The diagnostic value of CNNs for MCA stenosis based on TCD images paralleled that of manual measurements. CNNs could be used as an auxiliary diagnostic tool to improve the diagnosis of MCA stenosis.
      原文链接:
    • NSTL
    • Elsevier

    Stereotactic IntraCerebral Underwater Blood Aspiration (SCUBA) Improves Survival Following Intracerebral Hemorrhage as Compared with Predicted Mortality

    Shapiro S.D.Alkayyali M.Reynolds A.Reilly K....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Recent publications on minimally invasive surgery (MIS) for hematoma evacuation have suggested survival benefits in select patients. Since 2015, our center has been performing an MIS technique using continuous irrigation with aspiration through an endoscope (stereotactic intracerebral underwater blood aspiration [SCUBA]). It is unknown how these patient outcomes compare with intracerebral hemorrhage (ICH) score predictions. Our aim is to determine if SCUBA patients had better 30-day mortality than predicted by their presenting ICH score. Methods: Retrospective review of consecutively admitted patients who underwent SCUBA between December 2015 and March 2019. Operative criteria for MIS evacuation included supratentorial hematoma volume ≥15 mL, age >18, National Institutes of Health Stroke Scale score ≥6, and modified Rankin Scale (mRS) score ≤3. Demographic, radiographic, and clinical data were collected prospectively. The prespecified primary outcome was observed 30-day mortality of SCUBA patients compared with predicted mortality by ICH score on presentation. Results: One-hundred and fifteen patients underwent SCUBA for hematoma evacuation. Initial mean ICH volume was 51.4 mL (standard deviation 33.9 mL), with a median National Institutes of Health Stroke Scale score of 17 and ICH score of 2. At 1 month, 12 of the 115 SCUBA patients had passed away (30-day mortality rate 10.4%). This was significantly lower than the predicted mortality of 35.1% when calculated using the presenting ICH score (χ2 (1, N = 115) = 9.5, P < 0.0001), equating to an absolute risk reduction of 24.7%. Conclusions: This study suggests that minimally invasive hematoma evacuation with the SCUBA technique for ICH may reduce predicted 30-day mortality, with a number needed to treat of 4 to prevent 1 mortality.
      原文链接:
    • NSTL
    • Elsevier

    Association of PI3K-Akt Pathway-Related Gene Polymorphisms with Symptomatic Intracranial Atherosclerotic Stenosis with Hypertension in a Chinese Han Population

    Zhang L.Feng X.Yu F.Liu Z....
    14页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: PI3K-Akt signaling has been proved to be closely related to atherosclerosis, and hypertension has been shown to be an important risk factor for atherosclerosis. Studies have shown that genetic susceptibility is important in the etiology of symptomatic intracranial atherosclerotic stenosis (sICAS). However, few candidate genes have been identified. In the present study, we explored latent connections between single nucleotide polymorphisms (SNPs) of PI3K-Akt–related genes and sICAS with hypertension in Han Chinese subjects. Methods: Eight genes related to the PI3K-Akt pathway in 400 patients with sICAS and 1007 healthy controls of Han nationality were sequenced, and further subgroup analysis stratified by the presence of hypertension was performed. The χ2 test and multiple logistic regression in dominant, recessive, and additive models were used to evaluate the association between the SNPs and the risk of sICAS with hypertension. When linkage disequilibrium was found in different loci of the same gene, tagSNP represents the SNP in the haplotype block. Results: We found 4 common variants of 1 candidate gene differently distributed between those with sICAS with and without hypertension. Among these 4 common variations, INSR (insulin receptor) rs3745551 was significantly related to the risk of sICAS with hypertension after multiple regression analysis, with the T allele more prevalent in sICAS with hypertension. Conclusions: The variant of the INSR rs3745551 loci might be crucial to the pathogenesis of sICAS with hypertension in Chinese Han populations. Furthermore, the C allele at this locus might be a potentially harmful variant in sICAS with hypertension.
      原文链接:
    • NSTL
    • Elsevier

    Survival and Recurrence Outcomes Following Adjuvant Radiotherapy for Grade 2 Intracranial Meningiomas: 13-Year Experience in a Tertiary-Care Center

    Rebchuk A.D.Alam A.Hounjet C.D.Chaharyn B.M....
    9页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: We sought to evaluate overall survival (OS) and local recurrence (LR) in patients with grade 2 meningiomas treated with adjuvant radiotherapy compared to surgery alone at time of diagnosis. Methods: All patients at the authors’ institution between 2007 and 2020 were retrospectively reviewed. OS, LR, and treatment toxicities were assessed. Sensitivity analyses were performed for patients with initial gross total resection (GTR) and subtotal resection (STR). Kaplan-Meier analyses and log-rank test for significance were used to compare surgery alone and adjuvant radiotherapy groups. Results: We included 189 patients with mean age 57.4 ± 14.6 years. Patients were 64% female, and median follow-up was 64 (interquartile range: 20?96) months. At initial treatment, 21 patients received adjuvant radiotherapy and 168 received surgery alone. There was no significant difference for OS (hazard ratio = 1.3 [95% confidence interval 0.4?4.5], P = 0.92) overall or when limited to GTR (P = 0.38) or STR (P = 0.85). There was no significant difference in LR overall (P = 0.75) or when restricted to GTR (P = 0.77) or STR (P = 0.20). No patient had radiotherapy stopped or altered because of side effects; however, 71.4% reported tolerable side effects during the treatment period and 14.3% reported chronic side effects persisting longer than 12 months post treatment. Conclusions: In a large retrospective cohort, we found no survival or local recurrence benefit to adjuvant radiotherapy in treatment of grade 2 meningiomas. Sensitivity analysis limited to initial GTR and STR also failed to demonstrate any OS or LR benefit with adjuvant radiotherapy. In our experience, there is limited utility to upfront adjuvant radiotherapy following initial surgical resection in the treatment of grade 2 meningiomas.
      原文链接:
    • NSTL
    • Elsevier

    In Vivo Preclinical Quantitative Flow Analysis of Arterial Anastomosis Using a Microvascular Anastomotic Coupler and Clinical Application for Extracranial-to-Intracranial Bypass

    Cole T.S.Gandhi S.Catapano J.S.Fredrickson V.L....
    8页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Although several commercially available sutureless anastomotic techniques are available, they are not routinely used in neurosurgery. We performed an in vivo flow analysis of end-to-end anastomosis using a microvascular coupler device in rats. We report our first clinical use of the microvascular anastomotic coupler. Methods: Bilateral rat common carotid arteries (CCAs) were exposed, and a microvascular coupler was used to perform 8 anastomoses. A microflow probe provided quantitative measurement of blood-flow volume. Flow augmentation was assessed with end-to-side anastomoses connecting the distal CCA to the jugular vein (JV). A patient with chronic dominant hemisphere atherosclerotic ischemic disease and progressive symptoms refractory to medical management underwent end-to-end cerebral artery bypass using the microvascular coupler. Results: Mean preanastomosis flow in the rat CCA was 3.95 ± 0.45 mL/min; this flow was maintained at 3.99 ± 0.24 mL/min on final measurements 54–96 minutes postanastomosis. Total occlusion time for each rat CCA was 12–19 minutes. After end-to-side anastomosis, with proximal and distal JV patent, CCA flow increased 477% to 22.8 ± 3.70 mL/min (P = 0.04, proximal; P = 0.01, distal). After in vivo testing, we successfully used the coupler clinically in a superficial temporal artery–to–middle cerebral artery bypass for dominant hemisphere flow augmentation. Conclusions: In vivo quantitative flow analysis demonstrated no flow difference between an unaltered artery and artery with end-to-end anastomosis using a microvascular coupler in rats. A 1-mm coupled anastomosis achieved a 4-fold flow increase with low-resistance venous outflow in rats, simulating increased arterial demand. The coupler was successfully used for extracranial-to-intracranial bypass in a patient.
      原文链接:
    • NSTL
    • Elsevier