OBJECTIVE:Gamma Knife radiosurgery (GKRS) for trigeminal neuralgia (TN) requires millimeter-scale accuracy because a single 4-mm collimator targets the cisternal trigeminal nerve (CTN). MRI is essential for CTN visualization but is vulnerable to geometric distortion, particularly near the skull base. This study evaluated whether CT-based MRI distortion correction produces geometrically relevant changes in CTN localization. METHODS:Forty adult patients with normal intracranial anatomy who underwent cranial MRI and CT were retrospectively analyzed. Bilateral CTN segmentations were performed on uncorrected and distortion-corrected MRI by two independent raters. Segmentation masks were exported to 3D Slicer to extract center-of-mass (CoM) coordinates. The primary endpoint was patient-level 3D Euclidean CoM shift between corrected and uncorrected MRI. Dice Similarity Coefficient (DSC), axis-specific displacement, threshold positivity, inter-rater reliability, and Bland-Altman agreement were also assessed. RESULTS:The mean patient-level 3D shift was 1.12 ± 0.34 mm. All patients had at least one side-rater observation exceeding 0.5 mm, and 28 of 40 patients (70.0%) had at least one observation exceeding 1.0 mm. Mean DSC was 0.84 ± 0.03, indicating high but incomplete volumetric overlap. Displacement was anisotropic, with absolute magnitudes ordered as |ΔY| > |ΔX| > |ΔZ|. Inter-rater reliability was excellent, with ICC(A,1) values ranging from 0.927 to 0.988. CONCLUSION:CT-based MRI distortion correction produces measurable, anatomically structured shifts in CTN localization. These shifts are non-negligible relative to the 4-mm GKRS collimator. Their clinical consequences remain unknown; dosimetric and outcome studies in treated cohorts are required to determine whether correction alters nerve dose coverage or clinical results.
OBJECTIVES:This review aimed to synthesise current evidence on neurodevelopmental, cognitive, and behavioural outcomes in children with non-syndromic craniosynostosis (NSC), and to examine the implications of these findings for clinical practice and family counselling. METHODS:A scoping review was conducted in accordance with PRISMA-ScR guidelines. A structured search of PubMed, Scopus, and Web of Science identified studies published between 2010 and 2025. Eligible studies included children with NSC and reported cognitive, behavioural, or socio-communicative outcomes. Thirteen studies met inclusion criteria and were analysed using a narrative synthesis approach. Given the heterogeneity of study designs, populations, and outcome measures, a formal meta-analysis was not performed. RESULTS:Across studies, children with NSC generally demonstrated cognitive functioning within the average range, but with a consistent pattern of subtle, domain-specific vulnerabilities, particularly in visuospatial processing, language, attention, and executive functions. Behavioural findings indicated increased rates of internalising symptoms, attentional difficulties, and subclinical autism-related traits. These differences were present across developmental stages and showed considerable inter-individual variability. Evidence did not support a global impairment profile, but rather a pattern of mild neurodevelopmental variability with potential functional implications. However, findings should be interpreted with caution given the methodological heterogeneity and variability in study populations and assessment approaches. CONCLUSION:NSC is linked to selective neurodevelopmental differences rather than global deficits, emphasizing the need for early identification, longitudinal monitoring, and multidisciplinary care. Clear communication with families is crucial for supporting adaptive development and informed clinical decisions. Additionally, integrating neurodevelopmental perspectives into routine craniofacial care is vital.
OBJECTIVE:To evaluate the patterns of use, perceived benefits, limitations, and needs related to intraoperative ultrasound (IOUS) in neurosurgical oncology practice in France. METHODS:A structured 24-item questionnaire was distributed to members of the French Neurosurgical Society (Club de Neuro-Oncologie - Société Française de Neurochirurgie). The survey explored demographics, IOUS usage patterns in cranial and spine tumor surgery, perceived utility, limitations, integration with neuronavigation, training, and interest in future research. RESULTS:108 neurosurgeons, predominantly from high-volume academic centers, completed the survey. IOUS was widely used for gliomas, metastases, and intramedullary tumors, primarily for lesion localization and residual tumor assessment. It was often combined with MRI-based neuronavigation. The highest perceived benefits were for tumor boundary delineation (mean 3.64 ± 1.02) and improved resection quality (mean 3.26 ± 1.08), while vascular assessment was rated lower (mean 2.02 ± 1.07). Main limitations included insufficient image quality (52.8%) and technical constraints (30.6%). Despite limited formal training (96.3%), most respondents expressed interest in dedicated IOUS training (85.2%) and multicenter studies (90.7%). CONCLUSION:IOUS is widely adopted in neurosurgical oncology and perceived as useful for improving tumor resection. Its benefits vary with surgical experience, and current limitations are primarily technical and educational. Future advancements and structured training may enhance its utility.
Spinal metastases represent a major event in the course of cancer, frequently resulting in pain, neurological impairment, reduced functional capacity, and diminished quality of life. Traditional assessment of these patients has largely relied on clinical examination, radiological findings, and prognostic scoring systems. However, these approaches may not fully capture the patient's experience of disease and treatment. Patient-reported outcome measures (PROMs) provide a standardized method for evaluating symptoms, functional status, and health-related quality of life from the patient's perspective. This chapter reviews the principal PROMs currently used in patients with spinal metastases, including generic instruments such as the Short Form-36 (SF-36), EuroQol-5 Dimension (EQ-5D), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), and the Brief Pain Inventory (BPI), as well as spine-specific tools including the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ) and the MD Anderson Symptom Inventory-Spine Tumor Module (MDASI-Spine) Particular attention is given to the Patient-Reported Outcomes Measurement Information System (PROMIS), an emerging instrument that combines strong psychometric performance with reduced respondent burden through computer adaptive testing. Current evidence suggests that PROMIS demonstrates validity and responsiveness comparable to established instruments while offering improved efficiency in clinical practice. PROMs are increasingly recognized as essential components of patient-centred care in spinal oncology. Their systematic integration into clinical research and routine practice may improve outcome assessment, support therapeutic decision-making, and ultimately enhance quality of life for patients with spinal metastases.
OBJECTIVE:IDH-wildtype glioblastoma exhibits substantial biological heterogeneity despite current molecular classification. Although dynamic malignant cell states have been described, molecular features that position tumors along these states remain incompletely defined. We investigated whether ZIC3 expression identifies a transcriptional state associated with clinical outcome in IDH-wildtype glioblastoma. METHODS:RNA sequencing and clinical data from The Cancer Genome Atlas glioblastoma cohort were analyzed after restriction to genomically confirmed IDH-wildtype tumors (n = 167). Survival analyses were performed in patients with available survival data (n = 161) using Cox proportional hazards regression and Kaplan-Meier analysis. Associations with MGMT promoter methylation, tumor microenvironment scores, differential expression, gene set enrichment, and single-cell RNA sequencing data were evaluated to characterize transcriptional programs associated with ZIC3 expression. RESULTS:Higher ZIC3 expression was associated with longer overall and progression-free survival and remained associated with a more favorable survival profile after adjustment for age, sex, radiotherapy, and temozolomide treatment. ZIC3 expression was not associated with MGMT promoter methylation or with ESTIMATE-derived stromal, immune, or composite scores. In the single-cell dataset, ZIC3-positive cells were more frequent in malignant tumor cells than in non-malignant cells. ZIC3-high tumors showed enrichment of neural lineage-associated and blood-brain barrier-related programs, whereas ZIC3-low tumors showed enrichment of hypoxia-related, glycolytic, and metabolic stress programs. Ordered heatmap analysis showed that lineage-associated genes and hypoxia-related genes varied inversely across tumors ordered by ZIC3 expression. CONCLUSIONS:ZIC3 expression appears to mark a developmental transcriptional axis in IDH-wildtype glioblastoma that links neural lineage-associated programs to hypoxia-adaptive tumor states.
Primary bone tumors are quite rare spine neoplasms. When they are isolated, to prevent neurological impairment and recurrence, the best treatment is en-bloc negative margins resection. These procedures are often challenging, and technical improvements such as robotics can help surgeons to achieve their goals. We report here the case of a young adult who presented with an inflammatory myofibroblastic tumor (IMT), arising from the rib cage, and involving T12 vertebral body. An en-bloc resection, involving the mass and a right hemi-vertebrectomy was decided in a tumor board. A two- step surgery was planned, requiring a multidisciplinary surgical team implying thoracic surgeons and neurosurgeons. Through robotic guidance, the hemivertebrectomy was lead via a minimal invasive safe and blood sparing approach. Here we describe the procedure.
INTRODUCTION:Psychiatric comorbidities are associated with worse postoperative outcomes after cervical spine surgery, yet the impact of Functional Neurological Disorder (FND), a neuropsychiatric condition characterized by involuntary neurologic symptoms, has not been investigated. The objective of this study was to evaluate the association between FND and perioperative and long-term complications following anterior cervical discectomy and fusion (ACDF). METHODS:The TriNetX United States Collaborative Network was used to examine adults (≥18 years) undergoing primary ACDF between 2004 and 2023. Patients were stratified into cohorts based on the presence or absence of FND prior to surgery. Patient demographics and comorbidities were 1:1 propensity score matched. The primary outcomes were complications within 90-days and 2 years after ACDF. RESULTS:89,338 patients underwent ACDF, and 502 (0.56%) had FND. After 1:1 matching, 501 FND and 501 control patients were analyzed. Within 90 days, FND was associated with higher odds of dysphagia (OR 2.05, 95% CI 1.37-3.07, p < 0.001), surgical site infection (SSI) (OR 2.84, 95% CI 1.34-5.86, p = 0.004), ED utilization (OR 1.92, 95% CI 1.38-2.67, p < 0.001), and hospitalization (OR 1.82, 95% CI 1.21-2.28, p = 0.001). At 2 years, FND patients had greater odds of pseudoarthrosis (OR 1.49, 95% CI 1.05-2.11, p = 0.026) and opioid use disorder (OR 2.36, 95% CI 1.11-5.01, p = 0.021). CONCLUSION:FND was associated with increased perioperative and long-term complications following ACDF, including dysphagia, SSI, pseudoarthrosis, and opioid use disorder. Preoperative identification of FND may enable targeted perioperative management and multidisciplinary follow-up to mitigate risk in this complex population. STUDY DESIGN:Retrospective cohort study.
Cervical dumbbell schwannomas are rare and heterogeneous tumors with complex surgical management. This single-center retrospective study aimed at evaluating the results of a standardized surgical approach and included patients who underwent surgery for a cervical dumbbell schwannoma between 2013 and 2026. All patients underwent initial posterior extradural intra-radicular surgery without instrumentation. The mean postoperative follow-up was 23.6 months (range: 2-90 months). Among the 26 patients included in the study, 12 had Schwannomatosis. The mean age at surgery was 61 years for sporadic and 37 years for Schwannomatosis patients (p = 0.02, unpaired t-test). The mean tumor volume was 11.9 cm3 (range: 1.5-80 cm3). The main indication for surgery was spinal cord compression (19 cases, 73%). Resection via exclusive intraradicular approach was possible in 94% of sporadic and 33% of Schwannomatosis patients (p = 0.03, Fisher's exact test), including 4 cases in which intradural resection was necessary due to a concomitant intradural tumor. Most patients reported an improvement in pain, sensory, and spinal cord compression symptoms, with two cases of worsening symptoms (8.3%). The complete resection rate was 84.6%. Of the four cases with incomplete resection, only one, in a Schwannomatosis patient, required early reoperation. Two cases (8%) of postoperative spinal instability were identified in the series, both in Schwannomatosis patients. Uninstrumented intraradicular resection of dumbbell schwannomas yields satisfactory functional and oncological outcomes in most cases, except for Schwannomatosis patients, diagnosed at a younger age and potentially requiring additional intradural approach for concomitant intracanalar tumors.
BACKGROUND:Revision surgery for recurrent lumbar disc herniation (RLDH) without instability is technically demanding because epidural scarring alters tissue planes. Biportal endoscopic revision discectomy may reduce access-related morbidity, but comparative evidence remains limited. OBJECTIVE:To compare biportal endoscopic revision discectomy with open microdiscectomy for RLDH without instability. METHODS:PubMed, Scopus, and ScienceDirect were searched from inception to 21 June 2026. Comparative adult studies were eligible. Random-effects meta-analyses calculated mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs). Risk of bias was assessed using the seven-domain ROBINS-I tool. Exploratory trial sequential analysis (TSA) was performed for conventionally significant outcomes. The protocol was registered in PROSPERO (CRD420261429196). RESULTS:Three retrospective studies including 208 patients were analyzed: 91 underwent biportal surgery and 117 underwent open microdiscectomy. Biportal surgery was associated with shorter hospital stay (MD, -1.54 days; 95% CI, -2.73 to -0.36; I2 = 83%) and slightly lower long-term back-pain scores (MD, -0.37 points; 95% CI, -0.66 to -0.07; I2 = 0%). TSA did not confirm firm evidence for hospital stay (DARIS = 503; final Z = 2.56; boundary not crossed), whereas the long-term back-pain Z-curve crossed the monitoring boundary (DARIS = 28; final Z = 2.46). No significant differences were found in operative time, long-term leg pain, MacNab outcome, recurrence, durotomy, or overall complications. All studies had serious overall risk of bias. CONCLUSIONS:Biportal endoscopic revision discectomy may offer recovery-related advantages, but current evidence remains preliminary and does not establish superiority, equivalence, or noninferiority.
INTRODUCTION:In IDH-mutant gliomas, the accumulation of 2-hydroxyglutarate (2-HG) induces widespread epigenetic disruption and drives gliomagenesis. L-2-hydroxyglutaric aciduria (L-2-HGA) is a metabolic disorder causing L-2-HG accumulation, resulting in myelin toxicity, and increased brain tumor risk. Gliomas arising in L-2-HGA remain poorly characterized. We report a new case of high-grade glioma in a L-2-HGA patient, including methylome profiling, and review previously published cases to clarify glioma characteristics and provide hypothesis regarding 2-HG-driven gliomagenesis. MATERIAL AND METHODS:A new case of high-grade glioma in a L-2-HGA patient was locally identified. A literature review was conducted following PRISMA guidelines. RESULTS:A 45-year-old L-2-HGA woman developed a diffuse anaplastic glioma harboring a TERTp C228T mutation, revealed by progressive neurological decline. Methylation profiling assigned the tumor to the "Diffuse pediatric-type high-grade gliomas" superfamily (score ≥0.9). Despite chemotherapy, the patient died 5 months post-diagnosis. Literature review yielded 20 documented cases of glioma in L-2-HGA patients, with a mean age at diagnosis of 18 ± 9.5 years. Tumor location was relatively stereotyped, with 75% in the temporal lobe or thalamus/basal ganglia. Molecular alterations typical of glioblastoma were observed (EGFR amplification, partial 10q loss) and the epigenetic profile was similar. Although some tumors misleadingly harbored the microscopic features of low-grade gliomas, the median overall survival was 6 months. CONCLUSION:Although gliomas associated with L-2HGA predominantly affect young patients, their characteristics differ from those of IDH-mutant gliomas. These tumors may possibly be related to diffuse pediatric-type high-grade glioma H3-wildtype and IDH-wildtype, which is consistent with their highly aggressive clinical course.
BACKGROUND:Advances in systemic therapies and stereotactic body radiotherapy have profoundly modified the prognosis of patients with spinal metastases, increasing the need for surgical strategies that minimize morbidity while maintaining oncological efficacy. This narrative review aimed to summarize the current evidence concerning minimally invasive surgery, navigation, and robotic-assisted spine surgery in contemporary metastatic spine care. METHODS:A narrative review of the literature was conducted using PubMed, ScienceDirect, and Cochrane databases up to May 2026. Original studies, systematic reviews, meta-analyses, and clinical series evaluating minimally invasive techniques, and image-guided technologies for spinal metastases, were included. RESULTS:Minimally invasive spine surgery provides a strong level of evidence, consistently demonstrating reduced blood loss, wound complications, infection rates, drainage requirements, and hospital length of stay compared with conventional open surgery while preserving neurological and mechanical outcomes. Earlier resumption of systemic therapies further supports its integration into multidisciplinary oncological care. Navigation and robotic assistance improve pedicle screw placement accuracy and facilitate complex minimally invasive procedures, particularly in anatomically distorted vertebrae. However, evidence supporting improvements in survival, neurological recovery, construct durability, local tumor control, or other patient-centered outcomes remains limited. CONCLUSIONS:Contemporary surgery for spinal metastases has evolved toward tailored, multidisciplinary treatment strategies focused on mechanical stabilization, neural decompression, and rapid reintegration into oncological care. While minimally invasive surgery has become the preferred posterior approach whenever technically feasible, navigation and robotic assistance currently represent precision-enhancing technologies whose principal benefit lies in improving surgical workflow and reproducibility. Future prospective studies should evaluate their impact on clinically meaningful outcomes beyond technical performance.
CONTEXT:Neurosurgical care in the South Pacific islands is highly centralized in a single tertiary referral center. The archipelagic geography of these territories imposes substantial transportation requirements for postoperative follow-up visits. This study aimed to estimate the economic and environmental burden associated with in-person neurosurgical follow-up consultations and to evaluate the potential of telemedicine as a cost-and carbon-saving alternative. METHODS:All consecutives patients who underwent a neurosurgical procedure in our department between February 1, 2024, and February 1, 2025, were screened. Patients residing more than 3 h away from the neurosurgical unit (defined as ≥ 200 km by road) or requiring air transportation, and who attended postoperative follow-up consultations were retrospectively included. All costs generated by in-person visits were estimated (in Euros and USD) using a micro-costing approach based on observed resource utilization and standardized unit costs. Carbon emissions were estimated using the ADEME (French Agency for Ecological Transition) database and focused on emissions related to patient transportation. Emissions were expressed in kilograms of carbon dioxide equivalent (kgCO2eq). RESULTS:One hundred patients were included, representing a total of 200 in-person follow-up visits. The estimated total financial cost of these in-person visits was 129,400 USD (111,631 Euro), which mean an average of 647 USD/558,15 Euro per patient, shared by the Public Health Office and families. The mean estimated carbon footprint is 138.4 kgCO2eq per patient. Depending on the mode of transport, the estimation varies from 90 to 732 kgCO2eq. CONCLUSION:Our findings indicate that geographical distance inherent to archipelagic settings generates a substantial financial and environmental burden for neurosurgical follow-up care. In this context, telemedicine represents a highly relevant strategy to reduce unnecessary travail, improve access to care, and achieve meaningful cost and carbon savings in remote island territories.
CONTEXT:Intracerebral hemorrhage (ICH) accounts for half of stroke attributable deaths and two thirds of DALYs loss. Past well designed trials (2005 STICH, 2013 STICH 2, 2019 MISTIE 3, 2024 ENRICH, 2024 SWITCH) did not demonstrate benefits of surgery, aside from ENRICH which suggested improved functional outcome thanks to minimal invasive surgery for lobar ICH, but not for deep seated thalamic ICH. Since 2020, retrospective studies suggest great functional benefit of minimal invasive surgery for brainstem ICH. MATERIALS AND METHODS:Review of weel designed trials and guidelines regarding surgery for supratentorial ICH. Then, medline based scoping review for minimal invasive surgery for brainstem ICH with data regarding functional outcome. RESULTS:12 studies, accounting for 457 patients operated on for brainstem ICH (mean age 47.7), reported mortality of 23.3%, and 28.4% of good functional outcome (mRS≤3). Four studies compared minimal invasive surgery (n = 162) to best medical care (n = 185), with mean admission GCS 4.3 ± 0.1 (surgery) versus 4.3 ± 0.4 (conservative, p = 1), mean age 52.8 ± 9.6 (surgery) versus 51.1 ± 5.5 (conservative, p = 0.045), and mean hematoma volume 9.8 ± 1.4 (surgery) versus 10.2 ± 2.1 (conservative, p < 0.039). They reported reduced mortality (16.6 ± 8.5% versus 47.7 ± 20.7%, p < 0.0001) and improved functional outcome (mRS≤3, 32.7% versus 8.1%, p < 0.0001) in surgery group compared to conservative group. CONCLUSION:There is marked discrepancy between results of previous well designed trials for surgical treatment of lobar or deep supratentorial ICH, and the enthusiastic results of these recent retrospective studies regarding minimal invasive surgery for brainstem ICH.
INTRODUCTION:Research on intracranial aneurysm (IAs) emphasizes the role of flow-induced and neuroinflammation-driven vascular remodelling in aneurysm progression and rupture. However, tissue access for histo-molecular analysis remains limited, particularly with the rise of endovascular techniques. This study aims to establish systematic criteria for IA tissue sampling and preservation in clinical practice. METHODS:In this retrospective study, adult patients undergoing IA surgery had systematic sampling of the aneurysmal wall, meninges, middle meningeal artery, and superficial temporal artery. Histological analysis was performed to assess tissue integrity, followed by pre-analysis using housekeeping genes expression to evaluate the feasibility of RT-qPCR analyses. Clinico-radiological data, including sampling-related complications were reviewed. A statistical comparison was made between ruptured and unruptured aneurysm groups. RESULTS:Aneurysms of the middle cerebral artery (MCA) accounted for over 60% in both groups. As expected, in ruptured cases, morbidity and mortality were significantly higher than in unruptured cases (p < 0.001; p = 0.043). No major complications could be directly attributed to sampling. Sampling success rates for the aneurysmal wall reached 97% in both groups, and around 80% for other tissues (STA, MMA, DM). Histopathological analysis of the aneurysmal wall was completed in 85% of unruptured cases and 83% of ruptured cases, indicating a depth limit of >3 mm for aneurysm sampling. Housekeeping gene expression was observed in all samples, without restriction based on aneurysm depth. CONCLUSION:This study proposed criteria for safe and reproducible MCA aneurysm tissue sampling in routine clinical practice. These findings could support the creation of a national French vascular biobank, fostering further translational research.
BACKGROUND:Cavum septum pellucidum (CSP) cysts are uncommon and usually asymptomatic midline lesions. While surgical management is well established in the presence of hydrocephalus, the indication for treatment in patients with symptoms but without hydrocephalus remains controversial. METHODS:We retrospectively reviewed three pediatric patients with lasting clinical manifestations and CSP cysts without hydrocephalus. They underwent a neuronavigation-assisted unilateral endoscopic fenestration between 2017 and 2024. Clinical and radiological outcomes were assessed, including interwall distance measured on MRI scans. RESULTS:All patients presented with headaches, associated with neurobehavioral symptoms in two cases. Interwall distance decreased in all patients, with a sustained mean reduction of 69.1% one year after the surgery. Clinical symptoms improved in all cases, with complete resolution of headaches. Mean follow-up was 2.8 years, with no recurrence. CONCLUSION:Unilateral neuronavigation-assisted endoscopic fenestration appears to be a safe and effective minimally invasive treatment option in selected pediatric patients with clinically manifest CSP cysts without hydrocephalus.
BACKGROUND:Spontaneous intracerebral hemorrhage (ICH) is a severe neurological emergency with high morbidity and mortality. Optimal management remains debated. METHODS:We retrospectively included consecutive patients with spontaneous ICH at Reims University Hospital (Jan 2020-Aug 2023). Secondary ICH and incomplete data were excluded. Patients were classified into medical management, surgical evacuation, external ventricular drainage, or surgery plus EVD. Primary outcome was 6-month functional status (mRS 0-3 favorable). Secondary outcomes included mortality, ventilation duration, length of stay, intracranial hypertension, and surgical complications. RESULTS:Among 289 patients (median age 72 years; 57% male), 253 (87%) received medical management, 15 (5%) EVD, 13 (4.5%) surgery, and 8 (3%) combined treatment. Surgical patients had more severe disease: lower GCS, larger hematomas, anisocoria, and higher ventilation rates. Overall 6-month mortality was 38%, with no significant differences between groups. Poor outcome (mRS >3) occurred in 58%, more frequent in surgical patients. Multivariate analysis identified older age, lower GCS, and larger hematoma volume as independent predictors. Surgery did not improve outcomes even in hematomas ≥30 mL. CONCLUSION:In this cohort, surgery was reserved for the most severe ICH but did not improve 6-month mortality or functional outcomes. Prognosis depended mainly on baseline severity and hematoma characteristics. Careful patient selection and prospective studies are needed to refine surgical indications in spontaneous ICH.
INTRODUCTION:Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord (SC) dysfunction. Conventional MRI, particularly T2-weighted imaging, depicts SC changes well but often fails to provide satisfactory clinico-radiological correlation. We assessed the value of quantitative perfusion MRI-specifically Golden-angle RAdial Sparse Parallel (GRASP) Dynamic Contrast-Enhanced (DCE) MRI. MATERIALS AND METHODS:Thirteen patients with chronic-onset DCM were enrolled. Clinical status was assessed using the modified Japanese Orthopaedic Association (mJOA) scale. Sagittal cervical SC T2-w 3D SPACE imaging and GRASP-DCE mapping were performed at baseline (M0) and 3 months postoperatively (M3). Semi-quantitative parameters-area under the curve (AUC60), wash-in (WI), and wash-out (WO)-were derived from time-signal intensity curves to compare regional perfusion pre- and postoperatively. Patients were divided into good (>30%) and poor (<30%) recovery groups based on postoperative mean mJOA Recovery Rate (RR). RESULTS:mJOA grade was mild in 4 patients, moderate in 7, and severe in 2. SC compression was multi-level in 4. Mean postoperative RRmJOA was 31.6% ± 58%. Mean M0 and M3 AUC60, WI, and WO values in the whole cord and compressed zone showed no significant difference across the whole population. However, in the 8 patients with RRmJOA >30%, mean whole-cord AUC60 was significantly higher at M0 than M3 (48.0 ± 7.8 vs. 39.7 ± 6.7; p = 0.024). Conversely, AUC60 and WI increased in the poor-recovery group. CONCLUSION:GRASP-DCE MRI offers valuable insight into SC perfusion. Divergent AUC60/WI patterns by recovery status suggest two distinct compensatory pathophysiological mechanisms, highlighting the complexity of disease and recovery.
INTRODUCTION:We conducted a systematic review and meta-analysis to compare the effectiveness of shunts with and without anti-siphon devices (ASDs) or other flow-regulating systems in preventing cerebrospinal fluid (CSF) overdrainage and its associated complications. METHODS:Following established guidelines, we searched PubMed, Embase, Scopus, Cochrane, and Web of Science for clinical studies evaluating adult patients diagnosed with NPH who underwent CSF shunting with ASDs or flow-regulating valves, and included a control group of patients with standard CSF shunts lacking such mechanisms. Non-English studies, conference abstracts, and case reports were ineligible. RESULTS:We included seven studies with 928 patients. Although most outcomes showed no statistically significant difference between the intervention and control groups, ASDs had reduced incidences of subdural hygroma (OR = 0.33; p = 0.0368) and subdural hematoma (RR = 0.35; p = 0.0014), indicating a clear benefit in preventing these adverse events. CONCLUSION:ASDs significantly reduced the development of subdural hygroma and subdural hematoma, playing a vital role in preventing neurological sequelae.
BACKGROUND:Considering the excitatory neurotransmitter role of glutamate in the central nervous system and the widespread use of monosodium glutamate (MSG) as a food additive, this study aimed to evaluate the effects of MSG on neural tube defect formation in chicken embryos. MATERIALS AND METHODS:In this study, fertile, specific pathogen free eggs were used. Dosage calculation was based on the provisional tolerable intake of MSG of 30 mg/kg body weight per day reported in the literature. Doses were calculated as Group A: saline, Group B: 30 mg/kg, Group C: 60 mg/kg. Monosodium glutamate was dissolved in sterile distilled water to the desired concentrations. RESULTS:The effects of MSG on neural tube development were evaluated in chicken embryos. In the control and low-dose (30 mg/kg) groups, the neural tube and notochord were largely intact, with only minor irregularities and a single neural tube defect observed. In contrast, embryos in the high-dose group (60 mg/kg) displayed neuroectodermal separation, luminal irregularities, and multiple neural tube defects with prominent openings. The difference in the incidence of neural tube defects between the groups was statistically significant (p = 0.021), indicating a dose-dependent adverse effect of MSG on neural tube development. CONCLUSIONS:MSG, a commonly used food additive, was found to impair neural tube development in chicken embryos in a dose-dependent manner, suggesting a potential risk during early embryogenesis.
