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Although aneurysm treatment capacity has expanded worldwide, outcomes after aneurysmal subarachnoid hemorrhage (aSAH) remain strongly influenced by neurocritical care (NCC) delivery, referral pathways, and access to specialized treatment. Contemporary data describing real-world aSAH care in resource-limited healthcare systems remain scarce. We aimed to characterize treatment patterns, NCC delivery, complications, and outcomes in a large Brazilian public referral center. This retrospective cohort study included consecutive adults with confirmed aSAH admitted between June 2018 and March 2022 to a high-volume Brazilian tertiary referral center. Only patients admitted within five days of symptom onset were included. Demographic, clinical, radiological, treatment, complication, and outcome data were extracted from institutional records. Primary outcomes were in-hospital mortality and 3-month functional outcome assessed by the modified Rankin Scale (mRS). Seventy-four patients were included. Disease severity was high, with 45% presenting WFNS grades 4-5, 73% modified Fisher grade 4 hemorrhage, and 64% hydrocephalus. Endovascular treatment was performed in 73% of cases, and median time from admission to aneurysm treatment was 1 day. Despite early treatment capability, only 28% of patients were admitted to an ICU within 48 h, while 38% never received ICU care. Delayed cerebral ischemia occurred in 43%, radiologic vasospasm in 58%, ventriculitis in 22%, and infectious complications in 57%. External ventricular drainage was required in 42%, and vasoactive drugs were used in 85%. In-hospital mortality was 42%, and 66% had unfavorable 3-month outcomes (mRS 4-6). This real-world cohort highlights the substantial neurocritical care burden of aSAH in a middle-income public healthcare system. Despite timely access to definitive aneurysm treatment, patients experienced frequent neurological and systemic complications, emphasizing that contemporary aSAH care extends well beyond aneurysm occlusion.
Women remain severely underrepresented in neurosurgery, constituting approximately 7% of the global neurosurgical workforce. Global disparities in women neurosurgeons are shaped by interconnected systems of infrastructure, governance, and education that differ substantially between high income countries (HICs) and low- and middle-income countries (LMICs). While HICs have formalized residency pathways, institutional mentorship frameworks, and professional societies dedicated to gender equity, LMICs face systemic barriers including inadequate surgical infrastructure, limited training capacity, scarce mentorship, and insufficient gender equity policies. Moreover, the brain drain phenomenon disproportionately affects female physicians from LMICs, who migrate to HICs seeking better compensation, safer working conditions, and professional advancement, thereby reducing local neurosurgical capacity. However, comparisons of a country's economic status and global gender gap index-a measure of gender disparity-to its female neurosurgical workforce have revealed that disparities remain in HICs and there are lessons to be learned from progress in LMICs. Africa demonstrates the highest proportional representation of women neurosurgeons globally at approximately 15% yet has wide inter-country variability and the smallest neurosurgical workforce in the world, making percentages heavily influenced by the presence of even a few women neurosurgeons. Underrepresentation becomes self-reinforcing: women lack advocates and mentors to advance through training pathways and into leadership positions without women in surgical leadership. National Surgical, Obstetric, and Anesthesia Plans (NSOAP) are country-led building blocks aimed at strengthening surgical systems and offer a structured framework to address these inequities systematically.
Telesurgery has emerged as a transformative approach to address geographic disparities in surgical care, particularly in urology. However, robust real-world evidence specifically focused on renal procedures remains limited. We conducted this systematic review and single-arm meta-analysis to evaluate the safety, feasibility, and perioperative outcomes of remote robot-assisted renal surgery. We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from inception to July 1, 2026. Studies reporting robot-assisted telesurgery for renal procedures (partial nephrectomy, radical nephrectomy, or renal cyst decortication) were included. The Joanna Briggs Institute (JBI) Case Series Checklist was used for quality assessment. A single-arm meta-analysis with random-effects models was performed to pool surgical success rates, operative time, estimated blood loss (EBL), length of hospital stay (LOS), warm ischemia time (WIT), and network parameters. Subgroup analyses were conducted by sample size, study design, and robotic platform. Sensitivity analyses using the leave-one-out method were performed to test the robustness of the pooled estimates. Eight studies comprising 98 patients were included. All studies were of moderate-to-high methodological quality (JBI scores: 8-10/10). The pooled surgical success rate was 100%, with a local surgeon take-over rate of 2.1% (2/98). No Clavien-Dindo grade III or IV complications were reported. The pooled estimates were: operative time 99.52 min (95% CI: 77.10-121.94; I² = 92.5%), EBL 28.30 mL (95% CI: 18.18-38.41; I² = 87.9%), LOS 5.31 days (95% CI: 3.29-7.33; I² = 98.0%), and WIT (for partial nephrectomy) 21.14 min (95% CI: 17.76-24.53; I² = 0.6%). Network parameters remained below the 200-300 ms safety threshold, with a mean round-trip time of 51.79 ms (95% CI: 1.25-102.34) and maximum latency of 128.26 ms (95% CI: 95.38-161.13). Subgroup analyses by robotic platform revealed significant between-group differences for operative time (p = 0.000) and EBL (p = 0.000), but not for LOS (p = 0.703). Sensitivity analyses confirmed the robustness of the pooled estimates for operative time and EBL, whereas the LOS estimate was sensitive to the inclusion of studies reporting extreme values. Remote robot-assisted renal surgery demonstrates high technical success rates, low complication rates, and favorable perioperative outcomes, with network parameters well within established safety thresholds. These findings support the clinical implementation of telesurgery for appropriately selected renal surgery patients, particularly in underserved regions. However, the substantial heterogeneity observed highlights the need for large-scale, prospective comparative studies with standardized outcome definitions and longer follow-up.
This study aimed to evaluate the role and optimal timing of radiotherapy following intensive chemotherapy in infants with medulloblastoma (MB), and to explore whether molecular subtyping may inform radiotherapy timing strategies. We conducted a retrospective cohort study including 105 children aged < 3 years with MB treated at Beijing Shijitan Hospital, Capital Medical University, between 2013 and 2023. Clinical data were collected to compare clinical characteristics and survival outcomes across different radiotherapy strategies. Among 105 infants with MB, 67 (63.8%) were classified as SHH, 18 (17.1%) as Group 3, and 20 (19.0%) as Group 4, with no WNT cases identified. The SHH subgroup demonstrated significantly better survival than the Non-SHH subgroup (comprising Group 3 and Group 4), with 3-year overall survival (OS) of 80.2% versus 46.0% and progression-free survival (PFS) of 62.6% versus 30.4% (both P < 0.001). Patients were stratified into chemotherapy-only, upfront radiotherapy, and salvage radiotherapy groups based on treatment timing. In SHH patients, upfront radiotherapy did not confer additional survival benefit over chemotherapy alone (P = 0.658), whereas salvage radiotherapy was associated with longer observed OS (P = 0.005). In contrast, in the Non-SHH subgroup, chemotherapy alone was associated with a high progression rate (85.7%), and radiotherapy was associated with improved survival outcomes. Real-world data demonstrate distinct differences between SHH and Non-SHH infant MBs in survival outcomes and radiotherapy strategies. The SHH subtype showed favorable survival with systemic chemotherapy, whereas the Non-SHH subtype exhibited limited disease control with chemotherapy alone, suggesting a more critical role for radiotherapy in this population.
Evidence on romosozumab use in very old adults managed in FLS remains limited. In this descriptive real-world cohort, patients receiving romosozumab had a higher baseline fracture risk phenotype than those receiving antiresorptive therapies, reflecting indication-based prescribing in routine care. Monthly romosozumab showed high 12-month scheduled-treatment completion, whereas completion was lower with daily administered teriparatide. These findings, although exploratory, support the use of romosozumab as a practical option for patients at very high risk. To describe baseline treatment-allocation profiles and 12-month scheduled-treatment completion among older adults initiating romosozumab and other osteoporosis therapies in routine fracture liaison service (FLS) care and to explore clinical, functional, laboratory, and densitometric trajectories over follow-up. Retrospective, single-center observational cohort study (Hospital Universitario de Navarra FLS, 2022-2024). Patients at imminent fracture risk (≥ 1 fragility fracture within 24 months before baseline) initiating romosozumab were identified; for each, one patient initiating denosumab, zoledronic acid, and teriparatide was selected by calendar time (same month ± 3 months). Outcomes were assessed at 3 and 12 months. Between-group comparisons used Kruskal-Wallis tests (continuous variables) and Fisher-Freeman-Halton exact tests (categorical variables); when significant, Dwass-Steel-Critchlow-Fligner pairwise tests were performed with Holm-Bonferroni correction. Given the small sample size and non-random treatment allocation, analyses were considered descriptive and hypothesis-generating. Sixty-eight patients were included (n = 17/group). Baseline profiles differed across treatments, consistent with indication-based prescribing; estimated fracture risk (FRAX/QFracture) was higher in anabolic-treated groups. At 12 months, scheduled-treatment completion was 100% among evaluable patients receiving denosumab, romosozumab, and zoledronic acid versus 52.9% with teriparatide; romosozumab versus teriparatide remained significant after Holm adjustment (p = 0.016). Incident fractures and adverse drug reactions were infrequent, and no significant between-group differences were observed in mortality, emergency visits, admissions, falls, fractures, or adverse drug reactions over follow-up. Treatment sequencing at 12 months differed significantly, with heterogeneous post-index regimens after romosozumab and after teriparatide. In this descriptive older adults FLS cohort, romosozumab recipients represented a higher-risk phenotype but showed broadly similar 12-month clinical trajectories compared with other therapies; monthly romosozumab showed high 12-month treatment completion and broadly similar short-term clinical trajectories to other treatment pathways, supporting its use in routine practice. Larger studies are required to determine comparative effectiveness and safety.
Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is effective in treating essential tremor (ET) with an adequate safety profile. The aim of the study was to evaluate the real-world safety and efficacy of staged bilateral MRgFUS thalamotomy in ET and its impact on patient's quality of life (QoL) and patient-reported outcomes (PROs). This prospective cohort study included patients with ET who underwent staged bilateral thalamotomy. The primary endpoint was the change in the total Clinical Rating Scale for Tremor (CRST) score from baseline (prior to the first thalamotomy) to after the second treatment. Secondary endpoints included CRST subscales, QoL scales assessed using QoL in ET questionnaire (QUEST), EuroQol-5 Dimension-5-level questionnaire (EQ-5D-5L), and patient-reported outcomes (PROs). Adverse events (AEs) were documented. Fifty-five patients were included. The CRST total score improved 66.6% from baseline to 6 months after staged bilateral thalamotomy. QUEST score improved by 35.3 points. After the second treatment, 60% of patients reported having at most a mild tremor and 69.2% considered that their tremor was "much improved" or "very much improved." Six-months after staged bilateral thalamotomy, 15 (45,4%) patients had at least one adverse event, sensory disturbances being the most frequent (27.3%), followed by instability (12.1%) and dysarthria (12.1%). All AEs were mild, except in one case in which the patient showed moderate perioral paresthesia. Staged bilateral MRgFUS thalamotomy provides significant improvement in tremor severity, functional outcomes, and QoL among patients with ET, although controlled studies should be conducted to confirm these results. The safety profile is adequate, although AEs are slightly higher than after the unilateral treatment. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Real-world longitudinal data documenting the diagnostic impact of DNA methylation array (MA) profiling in pediatric ependymoma remain sparse. We report a single-center retrospective analysis evaluating MA-driven reclassification, molecular subgroup distribution, and long-term survival outcomes in a national pediatric referral cohort. Sixty-three pediatric patients with a histological ependymoma diagnosis treated at Motol and Homolka University Hospital (2010-2025) were included. DNA methylation profiling, RNA sequencing, copy number variation and t-SNE analysis were performed. Survival was estimated by the Kaplan-Meier method. MA confirmed ependymoma in 48 patients (76.2%) and reclassified 15 (23.8%) as non-ependymoma entities, including newly described tumor types. The reclassification rate was 36.1% in the pre-2019 cohort versus 7.4% post-2019. Posterior fossa group A (PFA) ependymoma was the predominant subgroup (n = 26). Ten-year overall survival (OS) was 69.6% and event-free survival (EFS) 47.7%. Gross total resection was the only factor significantly associated with improved survival (OS 75% vs. 40%, p = 0.017). Chromosome 1q gain, identified exclusively in PFA patients, was associated with a high relapse rate despite standard therapy. MA-driven reclassification affected nearly one quarter of patients, with substantially higher rates in the pre-molecular era, confirming that integrated molecular diagnosis is indispensable in all pediatric CNS tumors referred with a histological diagnosis of ependymoma.
Hemorrhagic transformation (HT) remains a major complication limiting the clinical utility of intravenous thrombolysis with alteplase in acute ischemic stroke (AIS) patients. Dl-3-N-butylphthalide (dl-NBP), a neuroprotective agent, which has beneficial effects on post-ischemic microcirculation, oxidative stress, and blood-brain barrier integrity, may potentially mitigate this risk. Using propensity score matching (1:1), this study analyzed 1,541 AIS patients of the prospective Dalian Single-center Study on Intravenous Thrombolysis for Ischaemic Stroke (DATIS) cohort treated at Central Hospital of Dalian University of Technology. Patients were stratified into combination therapy (alteplase + dl-NBP, n = 674) and monotherapy (alteplase alone, n = 674) groups. Dl-NBP (25 mg in 100 ml, 0.9% saline) was administered within 12 h after admission and followed by twice-daily doses of the same fomulation during hospitalization in the combination therapy group. Primary outcomes included the incidence of HT assessed post-thrombolysis and symptomatic intracranial hemorrhage (sICH) defined as radiographic hemorrhage occurring within 7 days post-thrombolysis and accompanied by clinical deterioration or an increase in NIHSS score ≥ 4 points. Neurological deficits at admission and at discharge were assessed using the National Institutes of Health Stroke Scale (NIHSS). After propensity score matching (674 patients combination therapy vs. 674 patients monotherapy), baseline characteristics were balanced (p > 0.05 for all influence variables). The alteplase + dl-NBP combination therapy group demonstrated significantly lower HT rates (2.2% vs. 6.7%, p < 0.001) and sICH incidence (0.9% vs. 3.4%, p < 0.001) than the alteplase monotherapy group. Multivariate analysis identified dl-NBP adjuvant as protective against HT (OR = 0.32, 95%CI: 0.18-0.58), while fasting glucose (OR = 1.10) and high-density lipoprotein levels (OR = 2.25) were independent risk factors. The percentage of patients exhibiting NIHSS improvements during hospitalization was significantly increased in combination therapy group compared with monotherapy group (60.8 vs. 55.3%, p = 0.041). Hospitalization costs were slightly higher in the combination therapy group (¥20,781 vs. ¥19,771, p < 0.001). Early adjunctive dl-NBP administration in addition to alteplase-induced thrombolysis significantly reduces hemorrhagic complications. To our knowledge, this is the first large-scale real-world study to demonstrate that dl-NBP reduces the risk of post-thrombolytic brain hemorrhage, supporting its antioxidant benefits in a clinical setting.
This study aimed to evaluate the effectiveness and safety of vosoritide in Chinese children with achondroplasia (ACH) in a real-world setting. A total of 26 children diagnosed with ACH and treated with vosoritide were enrolled in the study. Clinical indicators such as height, sitting height, and body mass index (BMI), as well as laboratory indicators including bone age and insulin-like growth factor level, were collected and analyzed before and after treatment. Improvements in height standard deviation score (SDS), sitting height/height ratio, and BMI were evaluated. Statistical differences were analyzed across different age and sex groups. Adverse reactions during the treatment were also monitored. Among the 17 patients assessed at 12 months, height SDS (based on general population growth charts) improved from - 4.7 ± 0.1 at baseline to - 4.3 ± 0.2 at 12 months (P < 0.001). With continued treatment, annual growth velocity (AGV) significantly increased, reaching 8.7 ± 1.4 cm/year in 12 patients who remained under follow-up after 18 months of treatment. Furthermore, BMI SDS exhibited a continuous decline. The sitting height/height ratio decreased during the treatment, indicating an optimization of body proportions. Additionally, growth improvement was found in both age (below five years old and above five years old) and sex (male and female) groups. Except for the total procollagen I intact N-terminal (TP1NP), which significantly increased at 12 months of treatment compared to baseline, other biochemical indicators (including insulin-like growth factor, alkaline phosphatase, and osteocalcin) showed no significant differences after the treatment. Vosoritide exerts significant growth-promoting effects and favorable safety in Chinese children with ACH. It improves height SDS and body proportions, demonstrating consistent effectiveness across various age groups and sex groups. Early diagnosis and timely initiation of vosoritide treatment can significantly alter the growth trajectory of these children.
Diffuse midline glioma (DMG) is a high-grade malignant brain tumor. The 5-year survival rate for DMG remains close to zero. It is a rare and highly aggressive tumor, which is more common in children than in adults. We here report our retrospective study of 210 cases of DMG. Surgical tumor samples were analyzed by routine histopathology and immunohistochemistry for H3 K27M, ATRX, p53, OLIG2 and Ki-67. The most frequent anatomic locations in patients were the thalamus and brainstem. During follow-up, 169/210 patients (80.5%) died from the disease, with a median survival time of 11 months (range: 0 to 87 months). Kaplan-Meier analysis indicated that the prognosis of adult patients was better than that of the pediatric cohort (P = 0.006). Multivariable Cox regression identified male sex, spinal cord tumor location, and a Ki-67 index of ≤ 10% as independent favorable prognostic factors. Also, meta-analysis indicated that the prognosis of adult patients was better than that of the pediatric cohort (P = 0.002), patients with brainstem tumors had a worse prognosis compared to those with tumors in other locations (P = 0.003). We highlight the aggressive nature of DMG and the critical role of clinical and molecular markers in prognosis. These findings demonstrate substantial clinicopathological heterogeneity in H3 K27M-altered DMG and support the combined consideration of age, tumor location, and proliferative activity in future prognostic stratification. Prospective multicenter validation and more comprehensive molecular profiling are required.
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Tirofiban, a glycoprotein IIb/IIIa receptor inhibitor, has shown promise in acute ischemic stroke (AIS) without medium- or large-vessel occlusion. The RESCUE BT2 trial demonstrated improved functional outcomes with IV tirofiban versus aspirin, but was conducted predominantly in Han Chinese populations, limiting generalizability to U.S. practice. This study evaluated the safety, operational feasibility, and exploratory clinical associations of a RESCUE BT2-based tirofiban protocol at a U.S. comprehensive stroke center. This retrospective single-center cohort study compared patients treated with tirofiban per RESCUE BT2 protocol (Nov 2023-June 2025) with a historical standard care cohort meeting similar eligibility criteria (Jan 2021-Oct 2023). Primary outcomes focused on safety, including any intracranial hemorrhage (ICH), symptomatic ICH, extracranial bleeding, thrombocytopenia, and mortality. Exploratory clinical outcomes included NIHSS trajectories, discharge modified Rankin Scale (mRS), discharge disposition, hospital length of stay, and available 90-day mRS. Multivariate regression models adjusted for baseline severity, early therapies, and neurological severity at the clinical decision point. Propensity score matching and/or multiple imputation were conducted as sensitivity analyses, and the results were interpreted as exploratory. Seventy-four patients were included (32 tirofiban, 42 standard care). No patients in the tirofiban group developed symptomatic or asymptomatic ICH, and no thrombocytopenia was observed. Extracranial bleeding occurred in 3 patients (9.4%). In adjusted exploratory analyses, tirofiban was associated with lower discharge NIHSS (β = -2.199; 95% CI, -3.850 to -0.548; p = 0.011), greater NIHSS improvement from the decision point to discharge (β = 2.815; 95% CI, 1.173-4.456; p = 0.001), and a favorable shift in discharge mRS (OR 0.274; 95% CI, 0.087-0.86; p = 0.027). In propensity-matched analysis, the direction of effect for discharge mRS was consistent but did not reach statistical significance. 90-day mRS analyses were limited by substantial differential missingness; complete-case and propensity-matched analyses were non-significant, and multiple-imputation results were sensitive to model assumptions. Implementation of a RESCUE BT2-based IV tirofiban protocol in a U.S. comprehensive stroke center was feasible and demonstrated a favorable safety profile in carefully selected AIS patients. Exploratory associations with improved neurological trajectories warrant prospective evaluation in larger multicenter studies.
Connexin-43 (Cx43), GAP-43 and actin are involved in cellular communication and cytoskeletal dynamics in gliomas, yet their clinical relevance remains largely unclear. We investigated their expression and association with survival and tumor characteristics in IDH-mutant and IDH-wildtype gliomas. 134 adult patients operated for newly diagnosed gliomas WHO grades 2-4 in our center were included. Immunohistochemical expression of Cx43, GAP-43 and actin was assessed. Several clinical parameters, including progression-free (PFS) and overall survival (OS), were acquired from our institutional database. In IDH-wildtype tumors, higher Cx43 expression was associated with prolonged OS (p = 0.032). Whereas IDH-mutant gliomas showed significantly lower expression of Cx43 (p = 0.029) compared to IDH-wildtype tumors. Actin expression correlated with prognostically unfavorable higher WHO grade (p < 0.001), IDH-wildtype status (p < 0.001), preoperative contrast enhancement in MRI (p = 0.009) and decreased functional status (p < 0.001). Consequently, stronger actin expression was significantly associated with shorter PFS (7.2 vs. 17.4 months, p < 0.001) and OS (17.1 vs. 81.5 months, p < 0.001). Incidentally diagnosed tumors exhibited reduced GAP-43 expression (p = 0.012). None of the proteins was associated with perioperative complications. Upregulated actin expression is strongly linked to more aggressive glioma behavior and reduced survival. Higher Cx43 expression could sustain an onco-protective role in prognostically unfavorable IDH-wildtype tumors. These findings provide clinically relevant translational evidence for the role of cytoskeletal and connectivity-associated proteins in glioma biology.
Thierry de Martel was a pioneer of French neurosurgery and a decorated World War I veteran. During World War II, he organized and modernized neurosurgical care for French soldiers at the American and Laennec Hospitals in Paris. As the German army advanced in June 1940, de Martel, aged 64, sought to join a last-ditch resistance effort. Disillusioned by France's military defeat and political collapse and burdened by the death of his only son in World War I, he took his own life on June 14, 1940, the day German troops entered Paris. This article reconstructs the final weeks of de Martel's life through archival materials, medical records, and eyewitness accounts, offering a unique historical perspective on the ethical, emotional, and professional dilemmas faced by physicians during wartime. De Martel's final act was both a protest and a legacy-a message of surgical precision, patriotic despair, and moral clarity. His story resonates today as a testament to the enduring tension between duty to life and devotion to country.
Minimally invasive robotic-assisted cranial neurosurgery represents an evolving paradigm in the surgical management of intracranial tumors. The integration of robotic exoscopic platforms into neurosurgical workflows has demonstrated potential benefits in operative ergonomics, visualization, and microsurgical precision. Frontal convexity meningiomas, among the most common supratentorial extra-axial neoplasms, may represent an ideal candidate lesion for this approach given their superficial location and well-defined arachnoid planes. We present the case of a 23-year-old man who presented after a sports-related head injury complicated by loss of consciousness and a generalized tonic-clonic seizure. Neuroimaging revealed a well-circumscribed, homogeneously enhancing left frontal convexity lesion measuring 2.50 × 3.0 cm, with perilesional edema and a dural tail, consistent with meningioma. A neuronavigation-guided robot-assisted minimally invasive craniotomy was performed using the RoboticScope exoscope (BHS Technologies, Innsbruck, Austria) through a 4 cm incision and a 3 cm diameter craniotomy. Microsurgical subarachnoid dissection enabled circumferential tumor delineation with preservation of cortical anatomy and superior sagittal sinus venous drainage, achieving Simpson grade I gross total resection. Histopathology confirmed World Health Organization (WHO) grade I fibrous meningioma. This case demonstrates that robot-assisted minimally invasive craniotomy using a robotic exoscope system is a safe and effective approach for frontal convexity meningiomas, offering enhanced visualization, reduced brain retraction, and favorable surgical outcomes. Further prospective studies are warranted to establish standardized protocols for robotic exoscopic platforms in minimally invasive cranial neurosurgery.
There is limited real-world evidence on the diagnosis, treatment, and outcomes of refractory status epilepticus (RSE) in Latin America. This study describes the clinical characteristics, management, and outcomes of RSE in a tertiary neurological intensive care unit (NICU) in Mexico. We conducted a retrospective cohort study of adults (≥ 18 years) with RSE admitted from 2010 to 2022. All patients were initially analyzed as a single cohort; a prespecified secondary analysis stratified patients by preexisting epilepsy and identified those with new-onset RSE (NORSE). Patients were identified via electronic medical records and met the International League Against Epilepsy (ILAE) definition. Clinical, imaging, laboratory, and EEG data were collected. Outcomes included seizure cessation, functional status at NICU discharge (mRS), and prognostic scores (STESS and END-IT). Statistical analysis involved descriptive measures, chi-square/Fisher's exact tests, t-test or Mann-Whitney U test, and multinomial logistic regression. Significance was set at p < 0.05. We analyzed 102 patients with RSE; 52.9% were women, median age 34 (26-44) years. Preexisting epilepsy was present in 70.6%, and 29.4% had NORSE. Most common etiologies were infections (23.5%), structural/vascular (22.5%), and treatment-related (16.7%). EEG most commonly showed slowing; interictal epileptiform discharges appeared in 27.7%. Treatment was heterogeneous; 82.4% required third-line therapy. Median hospitalization was 21.5 days, with mechanical ventilation averaging 8 days. Resolution occurred in 87.3%. One patient underwent surgery, without complications. Preexisting epilepsy was significantly associated with prior SE (p = 0.011), resolution (p = 0.001), unfavorable mRS (p = 0.046), and higher STESS (p = 0.001) and END-IT (p = 0.021) scores. END-IT also correlated with third-line treatment (p < 0.001). This study offers real-world insights into RSE in a resource-limited setting, highlighting preventable causes, management complexity, and high care demands. Despite limitations, favorable outcomes are often achievable.
Brain metastases (BM) cause substantial morbidity and reduced survival in metastatic breast cancer (MBC). Therapeutic advances may have altered BM incidence and outcomes across subtypes. Real-world data are crucial to assess these trends and guide BM-specific clinical trials. Here, we report BM data from the Austrian Study Group for Medical Tumor Therapy MBC registry. Patients with known hormone receptor (HR) and HER2 status and sufficient outcome data were included. Logistic regression was used to assess the risk of BM. Overall survival (OS) was estimated using Kaplan-Meier methods and compared by log-rank tests. Multivariable Cox models with BM as a time-dependent variable and competing-risk analyses were applied. Among 2775 patients, 477 (17.2%) developed BM during the metastatic course; 56 patients (2.0%) had brain-only disease at first metastatic diagnosis. Compared with luminal MBC, BM risk was higher in HR-/HER2+ (OR 3.57), HR+/HER2+ (OR 4.43), and triple-negative breast cancer (TNBC; OR 2.91). At a median follow-up of 77 months, BM were associated with significantly shorter OS (HR 4.23; p < 0.001). TNBC showed the shortest BM-free survival (7.1 months) and poorest OS after BM diagnosis (4.7 months). Brain-only disease was associated with improved OS compared to concurrent extracranial disease (HR 0.58; p = 0.001). Use of whole brain radiotherapy declined over time, while neurosurgery or focal radiotherapy were associated with longer OS. Receptor discordance included HR loss (14.5%) and HER2 gain (9.8%). BM remain frequent and prognostically relevant in MBC, underscoring the need for improved risk stratification and subtype-specific therapies.
Endoscopic spine surgery (ESS) has expanded rapidly, but existing spine registries do not consistently capture ESS-specific technical variables, ultra-early recovery trajectories, selective imaging validation, or dissemination-related learning-curve effects. This review synthesizes established spine registry models, contemporary consensus initiatives, and digital follow-up approaches to propose a candidate ESS-specific registry framework and preliminary Minimum Data Set (MDS) for future validation. A structured narrative review was conducted on national and multinational spine registries, relevant consensus initiatives, and digital follow-up models. Sources were reviewed with emphasis on governance, data architecture, workflow design, patient-reported outcome measures (PROMs) integration, follow-up structure, data linkage, validation strategies, and implementation feasibility. Established registries provide a methodological foundation for benchmarking, complication surveillance, longitudinal PROM capture, and real-world evidence generation. However, ESS requires modular augmentation of existing registry infrastructures to capture approach-specific operative details, early recovery, selective imaging phenotypes, and governance-controlled maturity indicators. The proposed candidate MDS is organized into 4 domains: (1) baseline case-mix and phenotyping, (2) procedure-specific technical and perioperative variables, (3) selective quantitative imaging and morphometric validation, and (4) structured longitudinal outcome surveillance. The framework prioritizes an essential core dataset while separating recommended, optional, research-oriented, and governance-controlled modules, including digitally enabled early follow-up, opioid-related outcomes, radiation exposure, advanced imaging, and learning-curve variables. A candidate ESS-specific registry framework may support harmonized data capture, real-world evidence generation, quality feedback, and future registry-based research. Formal Delphi consensus, multicenter feasibility testing, and staged integration into existing spine registry infrastructures are required before broader implementation.
Endoscopic hematoma evacuation is an established minimally invasive treatment for spontaneous intracerebral hemorrhage (ICH), yet real-world data encompassing diverse hemorrhage locations, elderly patients, and antithrombotic use remain limited. We retrospectively reviewed 136 consecutive patients who underwent endoscopic hematoma evacuation for spontaneous ICH at a single stroke center in Japan (April 2018-February 2026) using a dilated burr-hole approach with the Neuroport transparent sheath. Surgical indications followed the Japanese Stroke Society guidelines. The primary outcome was favorable functional outcome (modified Rankin Scale [mRS] 0-3) at 90 days. Median age was 72 years (IQR 62-83); 21% were on antithrombotic agents. Hemorrhage locations included putamen (43%), thalamus with IVH (18%), subcortical (15%), cerebellum (13%), isolated IVH (10%), and caudate (1.5%). Median hematoma evacuation rate was 90% (IQR 81-96%). Favorable outcome was achieved in 32% overall; by location: putamen 36%, cerebellum 56%, thalamus with IVH 17%, and subcortical 25%. Ninety-day mortality was 15%. No postoperative rebleeding requiring surgical intervention or re-operations occurred. In multivariate logistic regression, higher admission GCS (OR 1.40; p=0.004), younger age (OR 0.95 per year; p=0.005), smaller hematoma volume (OR 0.82 per 10 mL; p=0.030), lower premorbid mRS (OR 0.46; p=0.010), and non-thalamic location were independent predictors of favorable outcome. Endoscopic hematoma evacuation demonstrates high technical efficacy (median 90% evacuation) with no rebleeding or re-operations across diverse ICH locations in a real-world elderly population. These findings complement randomized trial data and support endoscopic surgery as a viable minimally invasive strategy for spontaneous ICH.