Journal of neurosurgery
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Journal of neurosurgery · Jan 2025
Association between meningioma consistency and surgical outcomes.
Tumor consistency, or fibrosity, affects the ability to optimally resect meningiomas, especially with recent trends evolving toward minimally invasive approaches. The authors' team previously validated a practical 5-point scale for intraoperative grading of meningioma consistency. The impact of meningioma consistency on surgical management and outcomes, however, has yet to be explored. This study aimed to determine associations between meningioma consistency and presenting symptoms, tumor characteristics, and postoperative outcomes. ⋯ Tumor consistency is associated with important meningioma characteristics and perioperative outcomes. A prior knowledge pertaining to meningioma consistency and tumor characteristics using advanced imaging is a priority and may provide surgeons with meaningful data to guide resection strategy and anticipate postoperative outcomes and complications.
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Journal of neurosurgery · Jan 2025
Repetitive and extensive focused ultrasound-mediated bilateral frontal blood-brain barrier opening for Alzheimer's disease.
Focused ultrasound (FUS)-mediated blood-brain barrier (BBB) opening is safe and potentially beneficial in patients with Alzheimer's disease (AD) for the removal of amyloid-beta (Aβ) plaques. However, the optimal BBB opening intervals and number of treatment sessions for clinical improvement remain undefined. Therefore, the aim of this study was to evaluate the safety and benefits of repeated and more extensive BBB opening alone. ⋯ This study confirmed the safety and efficacy of more frequent and extensive bilateral frontal BBB opening over multiple sessions in patients with AD. Furthermore, this is the first clinical trial to demonstrate improvement in neuropsychiatric symptoms through BBB opening alone, without concurrent administration of antibody medications.
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Journal of neurosurgery · Jan 2025
Bridging thrombolysis versus direct endovascular treatment in acute vertebrobasilar artery complex occlusion.
Endovascular treatment (EVT) is an effective treatment for patients with acute vertebrobasilar artery complex occlusion (VBAO). However, the benefit of bridging thrombolysis prior to EVT remains controversial. The purpose of the present study is to explore the best treatment strategy between bridging treatment (BT) and direct EVT in patients with acute VBAO. ⋯ This matched-control study and meta-analysis suggest that compared with direct EVT, BT may be associated with better functional outcomes in patients with acute VBAO treated within 24 hours of estimated occlusion.
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Journal of neurosurgery · Jan 2025
Risk factors of short-term poor functional outcomes and long-term durability of ruptured large or giant intracranial aneurysms.
Aneurysmal subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality rates. In particular, functional outcomes of SAH caused by large or giant (≥ 10 mm) ruptured intracranial aneurysms are worsened by high procedure-related complication rates. However, studies describing the risk factors for poor functional outcomes specific to ruptured large/giant aneurysms are sparse. In addition, high recurrence and rebleeding rates following treatment of such aneurysms remain a concern. This study aimed to clarify the specific risk factors for poor short-term outcomes and long-term durability of SAH due to ruptured large/giant intracranial aneurysms using a multicenter observational database in Japan. ⋯ Increasing aneurysm size was identified as a risk factor for poor functional outcomes after SAH due to large/giant aneurysms and was affected by the interaction with other conventional risk factors. Endovascular therapy was more likely to be associated with better short-term outcomes; however, a higher delayed rebleeding rate after 1 year was a concern.
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Journal of neurosurgery · Jan 2025
A comprehensive multicenter analysis of clinical, molecular, and imaging characteristics and outcomes of H3 K27-altered diffuse midline glioma in adults.
The objective was to comprehensively investigate the clinical, molecular, and imaging characteristics and outcomes of H3 K27-altered diffuse midline glioma (DMG) in adults. ⋯ Adult patients with H3 K27-altered DMG showed distinct clinical, histological, and imaging characteristics compared to pediatric counterparts, with a significantly better prognosis. The authors' results suggest that aggressive surgery should be pursued when deemed feasible for better survival outcomes.