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Uchida K, Shirakawa M, Sakakibara F, Sakai N, Iihara K, Imamura H, Ishii A, Matsumaru Y, Sakai C, Satow T, Yoshimura S. Sex differences in outcomes of carotid artery stenting. J Neurol Sci 2024; 461:123062. [PMID: 38797138 DOI: 10.1016/j.jns.2024.123062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE Existing evidence is inconclusive on whether women after carotid artery stenting (CAS) experience worse outcomes than men. METHODS The outcomes of women and men were compared using the data from nationwide retrospective registry between 2015 and 2019. The primary outcome was the incidence of ischemic stroke and all-cause death. Secondary outcomes included the incidence of ischemic stroke, all-cause death, acute occlusion, and acute myocardial infarction. Functional outcomes were the achieving an mRS score of 0-1 and 0-2. Outcomes were assessed at 30 days after CAS. RESULTS In total, 9792 patients (1330 women, 8862 men; mean age, 73.8 vs 73.5 years, p = 0.17) were analyzed. Symptomatic stenosis was common in men (52.0% vs. 55.1%; p = 0.03), while ≥50% stenosis after CAS was common in women (3.2% vs. 2.0%; p = 0.005). The primary outcome was no significantly difference in women and men (2.0% vs. 1.9%; adjusted odds ratio [aOR], 1.19; 95% confidence interval [95%CI], 0.75-1.88).The incidence of all-cause death was higher in women (0.9% vs. 0.5%; aOR, 2.45; 95%CI, 1.11-5.39). Functional outcomes were significantly less common in women than in men (mRS0-1, 72.6% vs. 74.8%; aOR, 0.77; 95%CI, 0.63-0.95; mRS0-2, 82.1% vs. 85.6%; aOR, 0.76; 95%CI, 0.60-0.95). CONCLUSIONS This study suggests that there was no significant sex differences in the incidence of ischemic stroke and all-cause death at 30 days. However, women have higher rate of all-cause death and poorer functional outcomes at 30 days than men.
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Affiliation(s)
- Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | | | - Nobuyuki Sakai
- Department of Neurosurgery, Seijinkai Shimizu Hospital, Kyoto, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akira Ishii
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Chiaki Sakai
- Department of Neurosurgery, Kyoto University, Kyoto, Japan
| | - Tetsu Satow
- Department of Neurosurgery, Kindai University, Osaka-Sayama, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
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Yasuda R, Kimura N, Miura Y, Mizutani H, Yago T, Miyazaki T, Ichikawa T, Toma N, Suzuki H. Three-dimensional Images Fusion Method Useful for Preoperative Simulation of Clipping Surgery for Cerebral Aneurysms. Neurol Med Chir (Tokyo) 2024; 64:175-183. [PMID: 38569917 PMCID: PMC11153840 DOI: 10.2176/jns-nmc.2023-0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/18/2023] [Indexed: 04/05/2024] Open
Abstract
This study aimed to introduce a three-dimensional (3D) images fusion method for preoperative simulation of aneurysm clipping. Consecutive unruptured aneurysm cases treated with surgical clipping from March 2021 to October 2023 were included. In all cases, preoperative images of plain computed tomography (CT), CT angiography, magnetic resonance imaging (MRI) 3D fluid-attenuated inversion recovery, 3D heavily T2-weighted images, and 3D rotational angiography were acquired and transported into a commercial software (Ziostation2 Plus, Ziosoft, Inc. Tokyo, Japan). The software provided 3D images of skull, arteries including aneurysms, veins, and brain tissue that were freely rotated, magnified, trimmed, and superimposed. Using the 3D images fusion method, two operators predicted clips to be used in the following surgery. The predicted clips and actually used ones were compared to give agreement scores for the following factors: (1) type of clips (simple or fenestrated), (2) shape of clips (straight, curved, angled, or bayonet), and (3) clipping strategy (single or multiple). The agreement score ranged from 0 to 3 because a score of 1 or 0 was given for agreement or disagreement on each factor. Interoperator reproducibility was also evaluated. During the study period, 44 aneurysms from 37 patients were clipped. All procedures were successfully completed, thanks to the precisely reproduced surgical corridors with the 3D images fusion method. Agreement in clip prediction was good with mean agreement score of 2.4. Interobserver reproducibility was also high with the kappa value of 0.79. The 3D images fusion method was useful for preoperative simulation of aneurysm clipping.
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Affiliation(s)
- Ryuta Yasuda
- Department of Neurosurgery, Mie University Graduate School of Medicine
| | - Naoto Kimura
- Department of Radiology, Mie University Hospital
| | - Yoichi Miura
- Department of Neurosurgery, Mie University Graduate School of Medicine
| | - Hisashi Mizutani
- Department of Neurosurgery, Mie University Graduate School of Medicine
| | - Tetsushi Yago
- Department of Neurosurgery, Mie University Graduate School of Medicine
| | - Takahiro Miyazaki
- Department of Neurosurgery, Mie University Graduate School of Medicine
| | - Tomonori Ichikawa
- Department of Neurosurgery, Mie University Graduate School of Medicine
| | - Naoki Toma
- Department of Neurosurgery, Mie University Graduate School of Medicine
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine
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3
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Uchida K, Sakakibara F, Sakai N, Iihara K, Imamura H, Ishii A, Matsumaru Y, Sakai C, Satow T, Yamada K, Shirakawa M, Yoshimura S. Real-World Outcomes of Carotid Artery Stenting in Symptomatic and Asymptomatic Patients With Carotid Artery Stenosis. JACC Cardiovasc Interv 2024; 17:1148-1159. [PMID: 38749596 DOI: 10.1016/j.jcin.2024.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/15/2024] [Accepted: 03/12/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND The effectiveness and safety of carotid artery stenting (CAS) are comparable to those of carotid endarterectomy in both symptomatic and asymptomatic patients with carotid artery stenosis, but real-world outcomes are not well-known. OBJECTIVES The purpose of this study was to investigate the real-world clinical outcomes of CAS in symptomatic and asymptomatic patients with carotid artery stenosis. METHODS We conducted a nationwide retrospective registry study of 156 centers between January 2015 and December 2019. We enrolled consecutive patients with CAS managed by certified specialists from the Japanese Society of Neuroendovascular Therapy. Outcomes between symptomatic and asymptomatic patients were compared. The primary outcome was a composite of ischemic stroke and all-cause death at 30 days after CAS. Secondary outcomes were ischemic stroke, all-cause death, intracranial hemorrhage (ICH), and procedural complications. RESULTS We analyzed 9,792 patients (symptomatic, n = 5,351; asymptomatic, n = 4,441). The mean age was 73.5 years, and men were dominant (86.4%). Embolism protection devices were used in 99% of patients. The primary outcome was not significantly different between the symptomatic and asymptomatic groups (120 [2.2%] vs 65 [1.5%]; adjusted OR: 1.30; 95% CI: 0.92-1.83). The incidences of symptomatic ICH, any ICH, acute in-stent occlusion, and hyperperfusion syndrome were significantly more prevalent in the symptomatic group (47 [0.9%] vs 8 [0.2%], aOR: 4.41 [95% CI: 1.68-11.6]; 73 [1.4%] vs 12 [0.3%], aOR: 3.56 [95% CI: 1.71-7.39]; 45 [0.8%] vs 19 [0.4%], aOR: 2.18 [95% CI: 1.08-4.40]; and 102 [1.9%] vs 36 [0.8%], aOR: 1.78 [95% CI: 1.17-2.71], respectively). Other secondary outcomes were not significantly different between the 2 groups. CONCLUSIONS The complication rate after specialist-involved CAS at 30 days was low in real-world practice.
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Affiliation(s)
- Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | | | - Nobuyuki Sakai
- Neurovascular Research and Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University, Kyoto, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Chiaki Sakai
- Neurovascular Research and Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tetsu Satow
- Department of Neurosurgery, Kindai University, Osaka-Sayama, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
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Nagai K, Akimoto J, Fukami S, Saito Y, Ogawa E, Takanashi M, Kuroda M, Kohno M. Efficacy of interstitial photodynamic therapy using talaporfin sodium and a semiconductor laser for a mouse allograft glioma model. Sci Rep 2024; 14:9137. [PMID: 38644422 PMCID: PMC11033255 DOI: 10.1038/s41598-024-59955-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/17/2024] [Indexed: 04/23/2024] Open
Abstract
To investigate the therapeutic potential of photodynamic therapy (PDT) for malignant gliomas arising in unresectable sites, we investigated the effect of tumor tissue damage by interstitial PDT (i-PDT) using talaporfin sodium (TPS) in a mouse glioma model in which C6 glioma cells were implanted subcutaneously. A kinetic study of TPS demonstrated that a dose of 10 mg/kg and 90 min after administration was appropriate dose and timing for i-PDT. Performing i-PDT using a small-diameter plastic optical fiber demonstrated that an irradiation energy density of 100 J/cm2 or higher was required to achieve therapeutic effects over the entire tumor tissue. The tissue damage induced apoptosis in the area close to the light source, whereas vascular effects, such as fibrin thrombus formation occurred in the area slightly distant from the light source. Furthermore, when irradiating at the same energy density, irradiation at a lower power density for a longer period of time was more effective than irradiation at a higher power density for a shorter time. When performing i-PDT, it is important to consider the rate of delivery of the irradiation light into the tumor tissue and to set irradiation conditions that achieve an optimal balance between cytotoxic and vascular effects.
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Affiliation(s)
- Kenta Nagai
- Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Jiro Akimoto
- Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan.
| | - Shinjiro Fukami
- Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Yuki Saito
- Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Emiyu Ogawa
- Faculty of Science and Technology, Keio University, Kanagawa, Japan
| | | | - Masahiko Kuroda
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
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5
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Sahara K, Shinno K, Sato K, Watari Y, Tamura T, Kudo E. A Case of Multiple Brain Tuberculomas in the Subarachnoid Cisterns: Recognition of Radiological Characteristics Regarding the Development of Paradoxical Response during Antituberculosis Treatment. NMC Case Rep J 2024; 11:93-98. [PMID: 38666034 PMCID: PMC11043798 DOI: 10.2176/jns-nmc.2023-0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/30/2024] [Indexed: 04/28/2024] Open
Abstract
Brain tuberculoma and its occurrence within the subarachnoid cisterns is rare in Japan. Serological and cerebrospinal fluid (CSF) examinations and imaging findings lack specificity; thus, preoperative diagnosis is often challenging. This report presents the case of a 70-year-old woman admitted to our hospital with a one-month history of low-grade fever and altered mental status. Based on the CSF analysis and her history of latent tuberculosis infection seven years ago, she was strongly suspected of suffering from tuberculous meningitis (TBM). Consequently, the patient was enrolled in a clinical trial for antituberculosis treatment (ATT). CSF soluble interleukin-2 receptor level decreased from 2,926 U/mL on day 1 to 225 U/mL 42 days after initiating ATT. Her condition improved after five weeks; however, contrast-enhanced T1-weighted magnetic resonance imaging (MRI) revealed multiple enhanced lesions within the basal subarachnoid cisterns 25 days after admission. As the number and size of these lesions increased, a biopsy confirmed brain tuberculoma diagnosis, and the treatment was continued. In conclusion, when intracisternal scattered mass lesions are identified during TBM treatment, we should consider the possibility of tuberculoma developments arising from a paradoxical response (PR) during the treatment. Serial MRIs are crucial in monitoring PR development in cisternal tuberculomas, an extension of severe TBM. Finally, a PR can be effectively managed by continuing ATT with adjunctive corticosteroids.
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Affiliation(s)
- Kazuma Sahara
- Department of Neurosurgery, Tokushima Prefectural Central Hospital, Tokushima, Tokushima, Japan
| | - Kiyohito Shinno
- Department of Neurosurgery, Tokushima Prefectural Central Hospital, Tokushima, Tokushima, Japan
| | - Kenta Sato
- Department of Neurology, Tokushima Prefectural Central Hospital, Tokushima, Tokushima, Japan
| | - Yuya Watari
- Department of Neurosurgery, Tokushima Prefectural Central Hospital, Tokushima, Tokushima, Japan
| | - Tetsuya Tamura
- Department of Neurosurgery, Tokushima Prefectural Central Hospital, Tokushima, Tokushima, Japan
| | - Eiji Kudo
- Department of Pathology, Tokushima Prefectural Central Hospital, Tokushima, Tokushima, Japan
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Gao C, Wei Y, Zhang X, Huang J, Nie M, Liu X, Yuan J, Wang D, Tian Y, Jiang W, An S, Sun J, Sha Z, Fan Y, Feng J, Liu M, Dong S, Wu D, Zhang J, Wang J, Jiang R. Craniocervical Manual Lymphatic Drainage Increases the Efficiency of Atorvastatin-Based Treatment of Chronic Subdural Hematoma. Transl Stroke Res 2023; 14:667-677. [PMID: 35907128 DOI: 10.1007/s12975-022-01062-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
The objective of this study is to explore whether craniocervical manual lymphatic drainage (cMLD) can promote hematoma absorption and increase the efficiency of atorvastatin-based conservative treatment in chronic subdural hematoma (CSDH) patients. All CSDH patients treated with atorvastatin-based therapy between October 2020 and February 2022 in our department were retrospectively screened for enrollment. The patients were divided into the control and cMLD groups according to whether cMLD was performed. Head CT or MR images in both groups were obtained before the treatment and 2 weeks and 4 weeks after the treatment. MR images of the deep cervical lymphatic nodes (dCLNs) in 23 patients were obtained in the cMLD group before and approximately 2 weeks after treatment. The volumes of the dCLNs and hematoma were calculated. The primary outcomes are the differences in hematoma volume reduction after 4 weeks of treatment. The secondary outcomes were (1) the differences in hematoma volume reduction between the patients in these two groups in the 2nd week, (2) the dCLN volume change in the cMLD group before and after 2 weeks of treatment, and (3) the percentage of patients who transitioned to surgery because of failure to the conservative treatment. A total of 106 consecutive patients were enrolled in this study for analysis; 54 patients received atorvastatin-based treatment (control group), and 52 were treated with both atorvastatin-based treatment and cMLD (cMLD group). At baseline, the mean hematoma volume was 76.53 ± 42.97 ml in the control group and 88.57 ± 49.01 ml in the cMLD group (p = 0.181). In the 4th week, the absolute number of hematoma reductions (20.79 ± 34.73 ml vs. 37.28 ± 28.24 ml, p = 0.009) and percentage of hematoma reductions (22.58% ± 60.01% vs. 46.43% ± 30.12%, p = 0.012) in the cMLD group were greater than those in the control group. After 2 weeks of treatment, the absolute number of hematoma reductions showed no difference in the two groups, while the percentage of hematoma reduction was higher in the cMLD group (18.18% ± 24.61% vs. 2.08% ± 25.72%, p = 0.001). One patient in cMLD and 8 patients in the control group were transitioned to receive surgical treatment. The dCLN volumes in 23 experimental patients increased significantly after 2 weeks of treatment in the cMLD group (p = 0.032). There were no severe side effects that needed to be reported. Combined with atorvastatin-based therapy, cMLD can promote hematoma absorption and decrease the surgery rate, which provides a new therapeutic strategy for CSDH.
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Affiliation(s)
- Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Yingsheng Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Xinjie Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Meng Nie
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Xuanhui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jiangyuan Yuan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Weiwei Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Shuo An
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jian Sun
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Zhuang Sha
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Yibing Fan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jiancheng Feng
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Mingqi Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Shiying Dong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Di Wu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China.
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China.
| | - Junping Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China.
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China.
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China.
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7
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Pichardo-Rojas PS, Dono A, Ballester LY, Esquenazi Y. Novel Postoperative Serum Biomarkers in Atypical Meningiomas: A Multicenter Study. Neurosurgery 2023; 93:599-610. [PMID: 36921247 PMCID: PMC10827320 DOI: 10.1227/neu.0000000000002457] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/18/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND There has been no known serum biomarker to predict the prognosis of atypical meningioma. OBJECTIVE To investigate the prognostic impact of serum biomarkers in patients newly diagnosed with resected intracranial atypical meningiomas. METHODS This study enrolled 523 patients with atypical meningioma who underwent surgical resection between 1998 and 2018 from 5 Asian institutions. Serum laboratory data within 1 week after surgery were obtained for analysis. Optimal cutoffs were calculated for each serum marker using the maxstat package of R. RESULTS Of 523 patients, 19.5% underwent subtotal resection and 29.8% were treated with adjuvant radiation therapy (ART). Among the 523 patients, 454 were included in the multivariate analysis for the progression/recurrence (P/R) rate excluding patients with incomplete histopathologic or laboratory data. On multivariate analysis, tumor size >5 cm, subtotal resection, and postoperative aspartate aminotransferase/alanine transaminase (De Ritis) ratio >2 were associated with higher P/R rates, whereas ART and postoperative platelet count >137 × 10 3 /μL were associated with lower P/R rates. In the subgroup of patients treated with ART, tumor size >5 cm and postoperative neutrophil-to-lymphocyte ratio >21 were associated with higher P/R rates. By contrast, postoperative De Ritis ratio >2 remained an adverse prognosticator in patients not treated with ART. CONCLUSION Postoperative De Ritis ratio, platelet count, and neutrophil-to-lymphocyte ratio were revealed as a novel serum prognosticator in newly diagnosed atypical meningiomas. Additional studies are warranted to validate its clinical significance and biological background.
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Affiliation(s)
- Pavel S. Pichardo-Rojas
- Vivian L. Smith Department of Neurosurgery, McGovern
Medical School, the University of Texas Health Science Center at Houston, TX
| | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery, McGovern
Medical School, the University of Texas Health Science Center at Houston, TX
| | - Leomar Y. Ballester
- Department of Pathology, The University of Texas MD
Anderson Cancer Center, Houston, Texas 77030, USA
- Department of Translational Molecular Pathology, The
University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, McGovern
Medical School, the University of Texas Health Science Center at Houston, TX
- Memorial Hermann Hospital-TMC, Houston, TX
- Center for Precision Health, School of Biomedical
Informatics, McGovern Medical School, the University of Texas Health Science Center
at Houston, TX
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8
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Takami T, Hara T, Hara M, Inui T, Ito K, Koyanagi I, Mizuno J, Mizuno M, Nakase H, Shimokawa N, Sugawara T, Suzuki S, Takahashi T, Takayasu M, Tani S, Hida K, Kim P, Arai H. Safety and Validity of Anterior Cervical Disc Replacement for Single-level Cervical Disc Disease: Initial Two-year Follow-up of the Prospective Observational Post-marketing Surveillance Study for Japanese Patients. Neurol Med Chir (Tokyo) 2022; 62:489-501. [PMID: 36223947 PMCID: PMC9726179 DOI: 10.2176/jns-nmc.2022-0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/14/2022] [Indexed: 11/29/2023] Open
Abstract
Anterior cervical disc replacement (ACDR) using cervical artificial disc (CAD) has the advantage of maintaining the range of motion (ROM) at the surgical level, subsequently reducing the postoperative risk of adjacent disc disease. Following the approval for the clinical use in Japan, a post-marketing surveillance (PMS) study was conducted for two different types of CAD, namely, Mobi-C (metal-on-plastic design) and Prestige LP (metal-on-metal design). The objective of this prospective observational multicenter study was to analyze the first 2-year surgical results of the PMS study of 1-level ACDR in Japan. A total of 54 patients were registered (Mobi-C, n = 24, MC group; Prestige LP, n = 30, PLP group). Preoperative neurological assessment revealed radiculopathy in 31 patients (57.4%) and myelopathy in 15 patients (27.8%). Preoperative radiological assessment classified the disease category as disc herniation in 15 patients (27.8%), osteophyte in 6 patients (11.1%), and both in 33 patients (61.1%). The postoperative follow-up rates at 6 weeks, 6 months, 1 year, and 2 years after ACDR were 92.6%, 87.0%, 83.3%, and 79.6%, respectively. In both groups, patients' neurological condition improved significantly after surgery. Radiographic assessment revealed loss of mobility at the surgical level in 9.5% of patients in the MC group and in 9.1% of patients in the PLP group. No secondary surgeries at the initial surgical level and no serious adverse events were observed in either group. The present results suggest that 1-level ACDR is safe, although medium- to long-term follow-up is mandatory to further verify the validity of ACDR for Japanese patients.
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Affiliation(s)
- Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University
| | | | - Masahito Hara
- Department of Neurosurgery, Aichi Medical University
| | | | - Kiyoshi Ito
- Department of Neurosurgery, Shinshu University School of Medicine
| | - Izumi Koyanagi
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital
| | - Junichi Mizuno
- Department of Minimally Invasive Spine Surgery Center, Shin-yurigaoka General Hospital
| | | | | | | | - Taku Sugawara
- Department of Spinal Surgery, Akita Cerebrospinal and Cardiovascular Center
| | - Shinsuke Suzuki
- Department of Spinal Surgery, Sendai East Neurosurgical Hospital
| | | | | | - Satoshi Tani
- Department of Minimally Invasive Spine Surgery Center, Shin-yurigaoka General Hospital
| | - Kazutoshi Hida
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital
| | - Phyo Kim
- Neurologic Surgery, Symphony Clinic
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University
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Okamoto T, Inoue Y, Oi Y, Taniyama I, Houri T, Teramukai S, Hashimoto N. Strategy of carotid artery stenting as first-line treatment and carotid endarterectomy for carotid artery stenosis: A single-center experience. Surg Neurol Int 2022; 13:513. [DOI: 10.25259/sni_820_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background:
The main surgical options for stenosis of the carotid artery are carotid endarterectomy (CEA) and carotid artery stenting (CAS). The number of CAS procedures performed in Japan greatly exceeds that of CEA procedures. In this study, we used data from a single center to examine CAS and CEA for carotid artery stenosis.
Methods:
The subjects were patients with carotid artery stenosis who underwent CAS or CEA between January 2012 and May 2020. CAS was the first-choice treatment. CEA was used in cases with vulnerable plaques, a relatively low risk of general anesthesia, and no anatomical features disadvantageous for endarterectomy.
Results:
A total of 140 cases (102 CAS and 38 CEA) were examined. There were more elderly patients in the CAS group. The CEA group had a higher rate of vulnerable plaques and only one case with an unfavorable anatomy for CEA. Major adverse events (stroke) occurred in two CAS cases. In multivariate logistic analysis, postoperative ischemic lesions were independently associated with age (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.01–1.26, P = 0.026) and vulnerable plaque (OR = 5.54, 95% CI: 1.48–20.70, P = 0.011) in the CAS group, but not in the CEA group.
Conclusion:
The results reflect the treatment algorithm at our hospital, indicating that triage is accurate. Thus, it is beneficial to assign cases based primarily on plaque vulnerability and anatomical risk for CEA, and to not hesitate to perform CEA simply because of old age. CAS as first-line treatment and CEA are effective and safe, which reflect the treatment situation in Japan.
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Affiliation(s)
- Takanari Okamoto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Yasuo Inoue
- Department of Neurosurgery, National Hospital Organization Maizuru Medical Center, Maizuru, Japan
| | - Yuta Oi
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Ichita Taniyama
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Takashi Houri
- Department of Neurosurgery, National Hospital Organization Maizuru Medical Center, Maizuru, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
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Fan Y, Wu D, Zhang X, Jiang W, Nie M, Liu X, Xiang T, Liu M, Chen Y, Feng D, Huang J, Gao C, Jiang R. The inflammatory cellular feature in the peripheral blood of chronic subdural hematoma patients. J Clin Lab Anal 2022; 36:e24706. [PMID: 36114782 PMCID: PMC9551118 DOI: 10.1002/jcla.24706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/17/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background Chronic subdural hematoma (CSDH) is a common neurosurgical disease with an increasing incidence. The absorption route of CSDH is not clear. Whether inflammatory factors enter the peripheral blood and cause systemic reactions is unknown. Methods We screened 105 CSDH patients and 105 control individuals. Their clinical characteristics and blood routine results were collected and compared. The blood routine changes of CSDH patients before and after treatment were compared. Age‐stratified analysis was performed due to age may affect the inflammatory markers. Results The white blood cell count, absolute neutrophil count, neutrophil percentage, neutrophil‐lymphocyte count ratio (NLR), and platelet to lymphocyte count ratio (PLR) of CSDH patients before treatment were within the normal range, while were significantly higher than the control individuals (p < 0.001). The absolute lymphocyte count and lymphocyte percentage of control individuals were higher than those of patients (p < 0.001). The inflammatory cells in patients of different age groups were similar. After the patient was cured, the white blood cell count, the absolute value and percentage of neutrophils decreased (p < 0.05), while the number of monocytes increased. Conclusions CSDH caused slight systemic inflammatory responses in the peripheral blood, implying that there is a non‐hematologic route for the absorption of hematoma.
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Affiliation(s)
- Yibing Fan
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City Tianjin Neurological Institute Tianjin China
| | - Di Wu
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City Tianjin Neurological Institute Tianjin China
| | - Xinjie Zhang
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City Tianjin Neurological Institute Tianjin China
| | - Weiwei Jiang
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City Tianjin Neurological Institute Tianjin China
| | - Meng Nie
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City Tianjin Neurological Institute Tianjin China
| | - Xuanhui Liu
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City Tianjin Neurological Institute Tianjin China
| | - Tangtang Xiang
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City Tianjin Neurological Institute Tianjin China
| | - Mingqi Liu
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City Tianjin Neurological Institute Tianjin China
| | - Yupeng Chen
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City Tianjin Neurological Institute Tianjin China
| | - Dongyi Feng
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City Tianjin Neurological Institute Tianjin China
| | - Jinhao Huang
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City Tianjin Neurological Institute Tianjin China
| | - Chuang Gao
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City Tianjin Neurological Institute Tianjin China
| | - Rongcai Jiang
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City Tianjin Neurological Institute Tianjin China
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