BACKGROUND:Postoperative delirium (POD) is a common complication in neurosurgical patients, leading to worse outcomes. However, effective super-early prediction models incorporating preoperative frailty remain unclear. METHODS:A secondary analysis of 800 adults undergoing elective craniotomy at Beijing Tiantan Hospital (2017-2018) was conducted. POD was assessed using CAM-ICU on postoperative days 1-3. Preoperative frailty was measured by the 5-factor modified Frailty Index (mFI-5).Four models: super-early (only preoperative variables), early (additionally adding intraoperative variables) and respectively further integrating mFI-5, were developed by logistic regression. Model performance was evaluated by the area under receiver operating characteristic curve (AUC), calibration curves and decision curve analysis (DCA).The incremental value of adding frailty was evaluated by net reclassification improvement (NRI) and integrated discrimination improvement (IDI). SHAP analysis assessed feature importance. RESULTS:POD occurred in 157 patients (19.6%). Multivariate analysis identified four preoperative variables (age, educational level, nature of the intracranial lesions, and supratentorial lesions) and three intraoperative variables(operation duration, blood loss and hypotension) as independent risk factors. The early model with frailty had the highest AUC(0.843, 95% CI: 0.810-0.875), but the super-early model with mFI-5 also achieved an AUC of 0.813 (95% CI: 0.777-0.849), comparable to the early model without frailty (AUC: 0.804, 95% CI: 0.768-0.840; P = 0.582).Calibration curves demonstrated good agreement between predicted and observed POD risks, and DCA confirmed the clinical utility of all four models. Adding mFI-5 significantly improved both models and SHAP confirmed frailty as the top predictor. CONCLUSIONS:Preoperative frailty substantially enhances POD prediction. An super-early model integrating mFI-5 enables timely risk stratification before surgery, supporting proactive delirium prevention.

Objectives The spread of carbapenem-resistant Gram-negative bacteria (CR-GNB) related to nosocomial infections is an important public health challenge, and polymyxins have become the last line of defence against CR-GNB. In this study, we aimed to compare the efficacy and safety of different polymyxins. Methods This retrospective cohort study included neurocritical care patients with CR-GNB pneumonia. The efficacy and safety were compared in original and inverse probability of treatment weighting cohorts. A subgroup analysis was further conducted to explore the impact of augmented renal clearance status at baseline on treatment efficacy. Results Of the 331 patients included, 90 received colistin sulphate, 187 received polymyxin B, and 54 received colistin methanesulfonate sodium. Compared with colistin sulphate, colistin methanesulfonate sodium significantly reduced the clinical failure rate on Day 7 (20.8% versus 37.2%, P = 0.034) and 28-day mortality rate (6.2% versus 16.9%, P = 0.013) and improved the microbiological eradication rate on Day 28 (94.8% versus 84.2%, P = 0.013). The colistin methanesulfonate sodium group also had a lower mortality rate (6.2% versus 15.7%, P = 0.005) and clinical failure rate on Day 28 (17.1% versus 27.4%, P = 0.020) than the polymyxin B group. However, colistin methanesulfonate sodium was more nephrotoxic than colistin sulphate and polymyxin B (P = 0.001 and P = 0.004, respectively). Subgroup analysis revealed no statistical difference in clinical failure rate and mortality risk between the three groups. Conclusions For CR-GNB pneumonia in neurocritical care patients, intravenous colistin methanesulfonate sodium may provide a useful treatment option, but vigilance is warranted for nephrotoxicity.

Nosocomial infection caused by carbapenem-resistant gram-negative bacteria (CR-GNB) is a common problem in neurocritical care patients. Clinical evidence suggests that polymyxins have benefits for CR-GNB pneumonia. This study compared the efficacy and safety of different colistin sulfate regimens in CR-GNB pneumonia. Among 133 neurocritical care patients with CR-GNB pneumonia in the intensive care unit (ICU), 24 received nebulized colistin sulfate alone (NC group); 38 received intravenous colistin sulfate alone (IV group); and 71 received nebulized plus intravenous colistin sulfate (NCIV group). After inverse probability of treatment weighting (IPTW), clinical failure rates on days 7 and 14 were significantly higher in the IV group than in the NC group (38.3% vs. 20.5%, P = 0.017 and 32.1% vs. 15.3%, P = 0.004, respectively) and the NCIV group (38.3% vs. 24.7%, P = 0.023 and 32.1% vs. 14.2%, P = 0.015, respectively). Moreover, the IV group also reported a lower microbiological eradication rate on day 14 (P = 0.031) and longer ICU (P = 0.020) and hospital stays (P = 0.037) than the NCIV group. No significant difference in mortality risk and nephrotoxicity among the groups. In multivariable analysis, intravenous colistin sulfate was an independent factor associated with higher clinical failure on day 14 (adjusted odds ratio = 5.92, 95% CI = 1.14-30.84, P = 0.035). Our study suggested that nebulized colistin sulfate with concurrent intravenous administration may be an effective and safe option for CR-GNB pneumonia.

To explore the effect of brain cognitive compensation on the pathogenesis of postoperative delirium (POD) in the frontal glioma patients. Eighty-four adult patients with unilateral frontal glioma who underwent elective craniotomy and 37 healthy controls were recruited. Primary outcomes were POD during postoperative 1–7 days, as assessed by Confusion Assessment Method. Cognition before surgery was measured by the battery of neuropsychological tests. Then we evaluated gray matter volume (GMV) and white matter integrity (i.e. fractional anisotropy (Casey et al.)) by presurgical voxel-based morphometry and diffusion tensor imaging. We investigated the association between presurgical structural index of potential compensatory brain regions with POD incidence and severity. POD occurred in 13 of 67 subjects (19.4

PurposeAccurate differentiation between glioma recurrence and radiation necrosis is critical for the management of patients suspected of glioma recurrence following radiation therapy. This study aims to develop a deep learning-based methodology for automated discrimination between glioma recurrence and radiation necrosis using routine magnetic resonance imaging (MRI) scans.MethodWe retrospectively investigated 234 patients who underwent radiotherapy after glioma resection and presented with suspected recurrent lesions during follow-up MRI examinations. Routine 3D-MRI scans, including T1-weighted, T2-weighted, and contrast-enhanced T1 (T1ce) sequences, were acquired for each patient. Among the analyzed cases, 192 (82.1%) were pathologically confirmed as glioma recurrence, while 42 (17.9%) were diagnosed as radiation necrosis. Various Convolutional Neural Network (CNN) models were employed to learn radiological features indicative of glioma recurrence and radiation necrosis from the MRI scans. Performance evaluation metrics, such as sensitivity, specificity, accuracy, and area under the curve (AUC), were used to assess the models’ performance.ResultAmong the evaluated CNN models, ResNet10 demonstrated the highest sensitivity (0.78), specificity (0.94), accuracy (0.91), and an AUC value of 0.83. Additionally, the MresNet model achieved the highest specificity (0.980) but exhibited a relatively lower sensitivity (0.56). Another evaluated CNN model, Vgg16, showed a sensitivity of 0.56, specificity of 0.94, accuracy of 0.88, and an AUC value of 0.70.ConclusionThe proposed ResNet10 CNN model demonstrates promising performance on routine MRI scans, rendering it highly applicable in clinical settings. These findings contribute to enhancing the diagnostic accuracy for distinguishing between glioma recurrence and radiation necrosis using routine MRI.

OBJECTIVES:Delirium is a significant health concern in acute stroke patients. We aim to systematically summarize existing evidence to conduct a meta-analysis to quantify the occurrence and risk factors for delirium after acute stroke. METHOD:PubMed, EMBASE and MEDLINE were searched from inception to Feb. 2023 for prospective observational studies that reported the incidence or prevalence of post-stroke delirium and/or evaluated potential risk factors. The search strategy was created using controlled vocabulary terms and text words for stroke and delirium. We performed a meta-analysis of the estimates for occurrence and risk factors using random-effects models. Meta-regression and subgroup meta-analyses were conducted to explore the sources of heterogeneity. Study quality and quality of evidence were assessed using the customized Newcastle-Ottawa Scale and GRADE, respectively. RESULTS:Forty-nine studies that enrolled 12383 patients were included. The pooled occurrence rate of post-stroke delirium was 24.4 % (95 %CI, 20.4 %-28.9 %, I2=96.2 %). The pooled occurrence of hyperactive, hypoactive, and mixed delirium was 8.5 %, 5.7 % and 5.0 %, respectively. Study location, delirium assessment method and stroke type independently affected the heterogeneity of the pooled estimate of delirium. Statistically significant risk factors were older age, low education level, cigarette smoking, alcohol drinking, atrial fibrillation, lower ADL level, higher pre-stroke mRS score, premorbid cognitive impairment or dementia, aphasia, total anterior circulation impairment, higher National Institute of Health Stroke Scale score and infection. CONCLUSIONS:Delirium affected 1 in 4 acute stroke patients, although reported rates may depend on assessment method and stroke type. Timely prevention, recognition and intervention require prioritizing patients with dominant risk factors.

Although structural and functional damage to the brain is considered to be an important neurobiological mechanism of postoperative delirium (POD), alterations in the visual cortical network related to this vulnerability have not yet been determined. In this study, we investigated the impact of alterations in the visual network (VN), as measured by structural and functional magnetic resonance imaging (MRI), on the development of POD. Thirty-six adult patients with frontal glioma who underwent elective craniotomy were recruited. The primary outcome was POD 1–7 days after surgery, as assessed by the Confusion Assessment Method. Cognition before surgery was measured by a battery of neuropsychological tests. Then, we evaluated preoperative and postoperative gray matter volume (GMV) and functional connectivity (FC) alterations by voxel-based morphometry and resting-state functional MRI (rs-fMRI) between the POD and non-POD groups. Multiple logistic regression models were used to investigate the associations between neuroimaging biomarkers and the occurrence of POD. Compared to those in the non-POD group, a decreased GMV in the fusiform gyrus (0.181 [0.018] vs. 0.207 [0.022], FDRp = 0.001) and decreased FC between the fusiform gyrus and VN (0.351 [0.153] vs. 0.610 [0.197], GFRp < 0.001) were observed preoperatively in the POD group, and increased FC between the fusiform gyrus and ventral attentional network (0.538 [0.180] vs. 0.452 [0.184], GFRp = < 0.001) was observed postoperatively in the POD group. According to our multiple logistic regression analysis, age (Odds ratio [OR]: 1.141 [1.015 to 1.282], P = 0.03) and preoperative fusiform-VN FC (OR 0.001 [0.001 to 0.067], P = 0.01) were significantly related to risk of POD. Our findings suggested that preoperative functional disconnectivity between fusiform and VN might be highly involved in the development of POD. These findings may allow for the discovery of additional underlying mechanisms.

Published data on whether post-stroke delirium (PSD) is an independent predictor of outcomes in patients with acute stroke are inconsistent and have not yet been synthesized and quantified via meta-analyses. This systematic review and meta-analysis followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The study protocol involved a search of the PubMed, Embase, PsycINFO, and Medline databases from 1946 to November 1, 2023, of which prospective observational and case–control studies were included. The quality of the included studies was rated using the Newcastle Ottawa Scale. Pooled effect estimates calculated using a random-effects model were expressed as the odds ratios (ORs), hazard ratios (HRs), and standardized mean differences (SMDs) with 95

OBJECTIVE Patients with frontal gliomas often experience executive dysfunction (EF-D) before surgery, and the changes in brain plasticity underlying this effect remain obscure. In this study, the authors aimed to assess whole-brain structural and functional alterations by using structural MRI and resting-state functional MRI (rs-fMRI) in frontal glioma patients with or without EF-D. METHODS Fifty-seven patients with frontal gliomas were admitted prospectively to the authors' institution and assigned to one of two groups: 1) the normal executive function (EF-N) group and 2) the EF-D group, based on patient results for the Trail Making Test, Part B and Stroop Color-Word Test, Part C. Twenty-nine baseline-matched healthy controls were also recruited. All participants underwent multimodal MRI examination. Cortical surface thickness, surface-based resting-state activity (fractional amplitude of low-frequency fluctuation [fALFF] and regional homogeneity [ReHo]), and edge-based network functional connectivity (FC) were measured with FreeSurfer and fMRIPrep. The correlation between altered MRI parameters and executive function (EF) was assessed using Pearson correlation and receiver operating characteristic (ROC) analysis. RESULTS Demographic characteristics (sex, age, and education level) and clinical characteristics (location, volume, grade of tumor, and preoperative epilepsy) were not significantly different between the groups, but the Karnofsky Performance Scale score was worse in the EF-D group. There was no significant difference in cortical surface thickness between the EF-D and EF-N groups. In both low-grade and high-grade glioma patients the fALFF value (permutation test + threshold-free cluster enhancement, p value after family-wise error correction < 0.05) and ReHo value (t-test, p < 0.001) of the left precuneus cortex in the EF-D group were greater than those in the EF-N group, which were negatively correlated with EF (p < 0.05) and enabled prediction of EF (area under the ROC curve 0.826 for fALFF and 0.855 for ReHo, p < 0.001). Compared with the EF-N group, the FCs between the default mode network (DMN) from DMN node to DMN node (DMN-DMN) and from the DMN to the central executive network (DMN-CEN) in the EF-D group were increased significantly (network-based statistics corrected p < 0.05) and negatively correlated with EF (Pearson correlation, p < 0.05). CONCLUSIONS Apart from local disruption, the abnormally activated DMN in the resting state is related to EF-D in frontal glioma patients. DMN activity should be considered during preoperative planning and postoperative neurorehabilitation for frontal glioma patients to preserve EF. Clinical trial registration no.: NCT03087838 (ClinicalTrials.gov).

目的 探讨术后谵妄(postoperative delirium,POD)与术后神经认知障碍(postoperative neurocognitive disorder,p-NCD)的相关性.方法 系统检索PubMed、Embase和the Cochrane Library,查找建库至2022年1月1日关于POD与p-NCD相关性的研究,应用CMA V3统计软件进行Meta分析,采用双侧检验,应用随机效应模型计算比值比(odds ratio,OR)及95％CI,使用漏斗图和Egger's检验评价发表偏倚.结果 纳入11项研究,共计5 326例患者,参与者年龄＞60岁.Meta分析显示POD与p-NCD显著相关(OR2.308,95％CI 1.555～3.426,P＜0.001).亚组分析发现,POD与术后注意力下降(OR 1.671,95％CI 1.044～2.674,P＜0.05)以及记忆力下降(OR 1.483,95％CI 1.115～1.974,P＜0.05)显著相关.风险轨迹研究显示,除术后第3个月外,POD与术后 1 个月(OR 2.841,95％CI 2.179～3.706,P＜0.001)、2个月(OR 2.095,95％CI 1.182～3.714,P＜0.05)、6个月(OR 1.516,95％CI 0.404～5.691,P＜0.001)、12个月(OR 3.319,95％CI 2.378～4.632,P＜0.001)p-NCD风险均显著相关.结论 POD与p-NCD密切相关.

Controversies persist regarding the benefits of surgery in elderly patients with meningiomas. The objective of this study was to develop decision-making scale to clarify the necessity for surgical intervention and provide clinical consultation for this special population. This retrospective cohort study was conducted at a single center and included 478 elderly patients (≥ 65 years) who underwent meningioma resection. Follow-up was recorded to determine recurrence and mortality rates. Univariate and multivariate analyses were performed to identify significantly preoperative factors, and prognostic prediction models were developed with determined cutoff values for the prognostic index (PI). Model discrimination was evaluated using Kaplan-Meier curves based on the PI stratification, which categorized patients into low- and high-risk groups. A decision-making tree was then established based on the risk stratification from both models. Among all patients analyzed (n = 478), 62 (13.0%) experience recurrence and 47 (10.0%) died during the follow-up period. Significantly preoperative parameters from both models included advanced age, aCCI, recurrent tumor, motor cortex involvement, male sex, peritumoral edema, and tumor located in skull base (all P < 0.05). According to the classification of PI from the two models, the decision-making tree provided four recommendations that can be used for clinical consultation. Surgery is not recommended for patients assigned to the high-risk group in both models. Patients who meet the low-risk criteria in any model may undergo surgical intervention, but the final decision should depend on the surgeon's expertise.

Although every glioma patient varies in tumor size, location, histological grade and molecular biomarkers, non-tumoral morphological abnormalities are commonly detected by a statistical comparison among patient groups, missing the information of individual morphological alterations. In this study, we introduced an individual-level structural abnormality detection method for glioma patients and proposed several abnormality indexes to depict individual atrophy patterns. Forty-five patients with a glioma in the frontal lobe and fifty-one age-matched healthy controls participated in the study. Individual structural abnormality maps (SAM) were generated using patients' preoperative T1 images, by calculating the degree of deviation of voxel volume in each patient with the normative model built from healthy controls. Based on SAM, a series of individual abnormality indexes were computed, and their relationship with glioma characteristics was explored. The results demonstrated that glioma patients showed unique non-tumoral atrophy patterns with overlapping atrophy regions mainly located at hippocampus, parahippocampus, amygdala, insula, middle temporal gyrus and inferior temporal gyrus, which are closely related to the human cognitive functions. The abnormality indexes were associated with several molecular biomarkers including isocitrate dehydrogenase (IDH) mutation, 1p/19q co-deletion and telomerase reverse transcriptase (TERT) promoter mutation. Our study provides an effective way to access the individual-level non-tumoral structural abnormalities in glioma patients, which has the potential to significantly improve individualized precision medicine.

Background: Evidence of brain cognitive compensation in the pathogenesis of postoperative delirium (POD) is currently lacking. The present study was conducted in frontal glioma patients to investigate the impact of premorbid cognition-related brain structural compensation on POD.Methods: Eighty-four adult patients with unilateral frontal glioma who underwent elective craniotomy were recruited. Primary outcomes were POD incidence and severity. Cognition before surgery was measured by the battery of neuropsychological tests. Then we evaluated gray matter volume (GMV) and white matter integrity (i.e. fractional anisotropy [FA]) by presurgical voxel-based morphometry and diffusion tensor imaging. We investigated the association between presurgical structural index of potential compensatory brain regions with POD incidence and severity.Findings: Whatever the tumor was located in left or right side, the GMV in the contralateral dorsal lateral prefrontal cortex (DLPFC) was significantly positive correlated with presurgical cognition, and negative correlated with incidence and severity of POD. Additionally, partial correlation analysis after controlling for the confounders revealed that the FA value in the genu of the corpus callosum (gCC) was significantly positively correlated with the GMV in the contralateral DLPFC and preoperative cognition, and negatively correlated with incidence and severity of POD.Interpretation: Compensation of contralateral DLPFC could decrease the risk of POD in frontal glioma patients. POD may depend upon whether an individual engenders the sufficient cognitive compensation response to the underlying neural injury.Trial Registration Details: The study was registered at ClinicalTrials.gov (NCT_05375409) Funding Information: This work was supported by the National Natural Science Foundation of China (81801042) and Beijing Hospital Authority Youth Programme (20190504).Declaration of Interests: No competing interests were declared by all authors.Ethics Approval Statement: This prospective cohort study was conducted in the neurosurgical department in Beijing Tiantan Hospital, Capital Medical University, Beijing, China from September 2018 to December 2020. The study was was approved by the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University, Beijing, China (KY2017-018-02). We obtained written informed consent from each participant.

Meningioangiomatosis (MA) is a disease that is extremely rarely reported. Sporadic MA is occasionally combined with meningioma or other lesions (identified as non-pure MA). This retrospective study investigated the difference between pure MA and non-pure MA by exploring clinical manifestations, histopathology characteristics, and outcomes of MA after surgery. We reviewed the medical records of 36 histopathologically confirmed MA patients (18 pure MA and 18 non-pure MA) who received surgery at our institution between 2012 and 2021. We compared differences in demographic, clinical, imaging, pathological features, and surgical outcomes between pure MA and non-pure MA through descriptive statistics. Compared to non-pure MA, pure MA presented with a more prominent male predilection (5:1 vs. 1.57:1, P = 0.264), a higher seizure incidence (83.3% vs 50.0%, P = 0.038), a more seizure type of GTCS (14/15 vs 5/9, P = 0.047), a less prominent enhancement on MRI (27.8% vs 88.9%, P < 0.001) and a preference of temporal and frontal lobe (100% vs 44.4%, P < 0.001). The differences in clinical characteristics between pure MA and non-pure MA demonstrate their disparate biological natures. Pure MA seems to be a non-neoplastic lesion, while non-pure MA is commonly combined with meningioma, which is a neoplastic lesion. A correct differential diagnosis can be achieved via a triad of the type of seizure, the location of lesion and the radiological presentation. MA is curable and the prognosis is excellent as most patients are free of seizure and recurrence after surgical treatment.

Purpose : The conventional examination of molecular characteristics for glioma requires surgical removal and could not be used in the surgery planning. The aim is to develop a method previewing glioma malignancy with regular structural MRI images. Methods: 52 glioma patients in frontal lobe (mean age 43.2±9.3 years, 34 male) and 117 healthy controls (mean age 32.6±9.8 years, 83 male) participated in the study. All patients underwent neurocognitive test and molecular examinations, including 1p/19q co-deletion, isocitrate dehydrogenase (IDH) mutation, telomerase reverse transcriptase (TERT) promoter mutation and O 6 -methylguanine-DNA methyltransferase (MGMT) promotor methylation. A series of individual structural abnormality indexes based on preoperative structural MRI were proposed and explored the associations with these clinical indicators. Results: Individual structural abnormality maps displayed that bilateral hippocampus, parahippocampus, insula, putamen and thalamus were constantly affected by glioma regardless of the histological grade, tumor hemisphere and molecular status. Higher grade glioma patients suffered more structural abnormalities, especially in the contralateral hemisphere and non-tumor regions. The molecular indicators, including IDH1 mutation, 1p/19q co-deletion, TERT promoter mutations and MGMT promoter methylation, as well as neurocognitive performance were all significantly correlated to individual structural abnormality indexes. Conclusion: Our proposed individual structural abnormality indexes show great potentials to access the glioma pathological, neurocognitive and molecular indicators, which is very helpful for neurosurgeons to determine the personalized treatment strategies.

BackgroundMaintenance of postoperative long-term independence has value for older adults who undergo surgical procedures. However, independence has barely caught attention for the elderly with meningiomas. Preventing postoperative long-term independence decline in this population necessitates the identification of the factors related to this outcome and minimizing their implications. Therefore, we assessed the independence evolution and identified potential determinants and population.Materials and MethodsFrom 2010 to 2016, elderly meningioma patients (≥65 years old) undergoing operation at Beijing Tiantan Hospital were included in our study. The primary outcome was 3-year (i.e., long-term) postoperative independence measured by Karnofsky performance scale (KPS) score. We used univariate and multivariate analyses to determine the risk factors for postoperative long-term independence, and nomogram was established.ResultsA total of 470 patients were included eligibly. The distribution in each KPS was significantly different before and 3 years after resection (P < 0.001). Especially in patients with preoperative KPS 80 and 70, only 17.5 and 17.3% of the patients kept the same KPS after 3 years, and the remaining patients experienced significant polarization. The most common remaining symptom cluster correlated with postoperative long-term independence included fatigue (R = −0.795), memory impairment (R = −0.512), motor dysfunction (R = −0.636) and communication deficits (R = −0.501). Independent risk factors for postoperative long-term non-independence included: advanced age (70–74 vs. 65–69 OR: 2.631; 95% CI: 1.545–4.481 and ≥75 vs. 65–69 OR: 3.833; 95% CI: 1.667–8.812), recurrent meningioma (OR: 7.791; 95% CI: 3.202–18.954), location in the skull base (OR: 2.683; 95% CI: 1.383–5.205), tumor maximal diameter >6 cm (OR: 3.089; 95% CI: 1.471–6.488), nerves involved (OR: 3.144; 95% CI: 1.585–6.235), high risk of WHO grade and biological behavior (OR: 2.294; 95% CI: 1.193–4.408), recurrence during follow-up (OR: 10.296; 95% CI: 3.253–32.585), lower preoperative KPS (OR: 0.964; 95% CI: 0.938–0.991) and decreased KPS on discharge (OR: 0.967; 95% CI: 0.951–0.984) (P < 0.05). The discrimination and calibration of the nomogram revealed good predictive ability (C-index: 0.810).ConclusionElderly meningioma patients might present significant polarization trend in maintaining long-term independence after surgery. Our findings will be helpful for guiding surgical management for the elderly with meningioma and provide proposals for early functional rehabilitation.

STUDY OBJECTIVE:To determine the association between postoperative delirium (POD) and cognitive outcomes at least 1 month after surgery in elderly patients, and synthesize the dynamic risk trajectory of cognition impairment after POD. DESIGN:Meta-analysis searching PubMed, Cochrane and EMBASE from inception to November 1, 2020. The terms postoperative delirium, delirium after surgery, postsurgical delirium, postoperative cogniti*, postoperative cognitive dysfunction, postoperative cognition decline, cognitive decline, cognitive impair* and dement* were searched alone or in combination. MEASUREMENTS:Inclusion criteria were prospective cohort studies investigating the association between POD and cognitive outcomes in patients aged ≥60 years underwent surgery. The primary outcome was the association between POD and cognitive outcomes at 1 or more months after surgery. We considered cognitive outcomes measured up to 12 months after surgery as short-term and beyond 12 months as long-term. Two authors performed the study screening, data extraction and quality assessments. Effect sizes were calculated as Hedges g or Odds ratio (OR) based on random- and fixed-effects models. Meta-regression was conducted to analyze the role of potential contributors to heterogeneity. MAIN RESULTS:Eighteen studies were included. Our result showed a significant and medium association between POD and cognitive outcomes after at least 1 month postoperatively (g = 0.61 95% CI 0.43-0.79; I2 = 65.1%), indicating that patients with POD were associated with worse cognitive outcomes. The association of POD with short- and long-term cognitive impairment were also both significant (short-term: g = 0.46 95% CI 0.24-0.68; I2 = 53.1%; and long-term: g = 0.82 95% CI 0.57-1.06; I2 = 57.1%). A multivariate meta-regression suggested that age and measure of delirium were significant sources of heterogeneity. POD was also associated with the significant risk for dementia (OR = 6.08 95% CI 3.80-9.72; I2 = 0) as well as attention (OR = 1.74 95% CI 1.13-2.68; I2 = 0), executive (OR = 1.33 95% CI 1.00-1.80; I2 = 0) and memory impairment (OR = 1.59 95% CI 1.20-2.10; I2 = 43.0%). Additionally, our results showed that the risk trajectory for cognitive decline associated with POD within five years after surgery revealed exponential growth. CONCLUSIONS:This is the first meta-analysis quantifying the association between POD and cognitive outcomes. Our results showed that POD was significantly associated with worse cognitive outcomes, including short- and long-term cognitive outcomes following surgery.

Background: For atypical meningiomas (AMs), the combination of gross total resection (GTR) and adjuvant radiotherapy (ART) is still a controversial therapeutic strategy to improve prognosis. This study analyzed the factors influencing the prognosis on AM patients treated with GTR + ART by investigating both clinical characteristics and the change in microRNA (miRNA) expression.Materials and Methods: Adult AM patients who were admitted to the Tiantan hospital from 2008 to 2015 and underwent GTR + ART were included. Patients who suffered recurrence within 3 years after operation were considered radioresistant, while the others were considered radiosensitive. Clinical characterizations were compared between these two groups. The microRNA (miRNA) expression was detected via miRNA microarray in 10 patients, five from the radiosensitive group and from the radioresistant group.Results: A total of 55 cases were included in this study. No significant difference was found in the clinical characteristics (gender, age, tumor location, tumor size, peritumoral brain edema, and Ki-67 index) between radiosensitive and radioresistant patients. We found seven significantly upregulated miRNAs (miR-4286, miR-4695-5p, miR-6732-5p, miR-6855-5p, miR-7977, miR-6765-3p, miR-6787-5p) and seven significantly downregulated miRNAs (miR-1275, miR-30c-1-3p, miR-4449, miR-4539, miR-4684-3p, miR-6129, miR-6891-5p) in patients resistant to radiotherapy. The differentially expressed miRNAs were enriched mostly in the fatty acid metabolic pathways (hsa00061, hsa01212) and transforming growth factor beta signaling pathway (hsa04350).Conclusion: For AM patients treated with GTR + ART, the changes in miRNA expression discovered in this study may be a potential predictor of individual sensitivity to adjuvant radiotherapy. Further research is needed regarding the predictive power and mechanism by which these miRNAs influence prognosis.

Background: Chordoid gliomas (CGs) are rare neuroepithelial tumors, which commonly arise from the anterior part of the third ventricle. Most studies on CGs included only one or two cases. To better understand the disease, we report 14 patients with pathologically confirmed CGs. Method: The clinical characteristics, including radiological and histological examination, operative records, and prognoses were analyzed and reviewed. Result: The case series included six male and eight female patients with an average age of 44.4 years. The most common preoperative symptom was headache (64.3%) and visual deterioration (57.1%). Radiological results showed that the third ventricle (12/14) was the most common site of the brain involved, and the lesions presented with solid (n = 9, 64.3%) or cystic-solid (n = 5, 35.7%) appearance. All patients were misdiagnosed as non-CG tumors. The operation approach was mainly determined by tumor location, thus trans-callosal approach (9/14) and trans-laminar terminalis approach were commonly used. Gross total resection (GTR) was achieved in all cases and none of them received any adjuvant therapy postoperatively. The most frequent postoperative complications were diabetes insipidus, electrolyte disturbance, hypopituitarism, cognitive dysfunction, and obstructive hydrocephalus. During an average follow-up period of 40.1 months, 2 cases (14.3%) were died of refractory hypopituitarism and pulmonary embolism, respectively. The preoperative symptoms and postoperative complications were all significantly improved in other 12 patients, and MRI showed no tumor recurrence. Conclusion: According to our experience, we recommend GTR as the primary goal, which is associated with improved rates of tumor control and without increasing rates of postoperative complications. (C) 2020 Published by Elsevier Ltd.

We evaluated the association between the timing of tracheostomy and clinical outcomes in patients with infratentorial lesions. We performed a retrospective observational cohort study in a neurosurgical intensive care unit (ICU) at a tertiary academic medical center from January 2014 to December 2018. Consecutive adult patients admitted to the ICU who underwent resection of infratentorial lesions as well as tracheostomy were included for analysis. Early tracheostomy was defined as performed on postoperative days 1-10 and late tracheostomy on days 10-20 after operation. Univariate and multivariate analyses were used to compare the characteristics and outcomes between both cohorts. A total of 143 patients were identified, and 96 patients received early tracheostomy. Multivariable analysis identified early tracheostomy as an independent variable associated with lower occurrence of pneumonia (odds ratio, 0.25; 95% CI, 0.09-0.73;p = 0.011), shorter stays in ICUs (hazard ratio, 0.4; 95% CI, 0.3-0.6;p = 0.03), and earlier decannulation (hazard ratio, 0.5; 95% CI, 0.4-0.8;p = 0.003). However, no significant differences were observed between the early and late tracheostomy groups regarding hospital mortality (p > 0.999) and the modified Rankin scale after 6 months (p = 0.543). We also identified postoperative brainstem deficits, including cough, swallowing attempts, and extended tongue as well as GCS < 8 at ICU admission as the risk factors independently associated with patients underwent tracheostomy. There is a significant association between early tracheostomy and beneficial clinical outcomes or reduced adverse event occurrence in patients with infratentorial lesions.