Neurological Functional Status Research Articles

Association of stent thrombectomy and conventional treatment with neuroprotection, complications, anxiety, and depression in acute ischemic stroke patients

BACKGROUND Acute ischemic stroke (AIS) is an abrupt blood flow cessation to a specific brain region within a vascular zone, causing a subsequent decline in neurological capabilities. Stent thrombectomy is a recently established technique for treating AIS. It provides the benefits of being a relatively simple and safe procedure, capable of partially enhancing a patient’s condition. However, some patients may experience endothelial damage and recurrent thrombosis, with clinical outcomes that are not always satisfactory. Hence, the efficacy of this method remains unclear. AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection, complications, and short-term prognosis in patients diagnosed with AIS. METHODS This study assigned 90 patients with AIS to the observation and control groups (n = 45 patients) from December 2020 to December 2022. Stent thrombectomy was conducted in the observation group, whereas routine treatment was provided to the control group. The study assessed the therapeutic outcomes of two groups, including a comparison of their neurological function, living ability, anxiety and depression status, plaque area, serum inflammatory factors, serum Smur100 β protein, neuron-specific enolase (NSE), homocysteine (Hcy), and vascular endothelial function. Additionally, the incidence of complications was calculated and analyzed for each group. RESULTS The total effective rate of treatment was 77.78% and 95.56% in the control and observation groups, respectively. After 8 weeks of treatment, the scores on the National Institutes of Health Stroke Scale, Hamilton Anxiety Scale, and Hamilton Depression Scale decreased remarkably; the Barthel index increased remarkably, with better improvement effects of the scores in the observation group (P < 0.05); total cholesterol, triglyceride, C-reactive protein, and plaque area lessened remarkably, with fewer patients in the observation group (P < 0.05); S-100β protein, NSE, and Hcy levels lessened remarkably, with fewer patients in the observation group (P < 0.05); serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably, whereas the endothelin-1 level decreased, with better improvement effect in the observation group (P < 0.05). Complications occurred in 8.88% of patients in the observation group compared with 33.33% in the control group. CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen. Additionally, it has effectively improved the neurological function, daily activities, and vascular endothelial function of patients, while reducing the incidence of complications and improving short-term prognosis.

AB049. Surgery for symptomatic spinal metastases-when, what and how?

Spine is the most common site for metastases in the skeletal system. Longer lifespans of patients with common cancers are translating into increasing incidence of patients with symptomatic spinal metastases. Surgery for spinal metastases offers immediate neurological decompression with stabilization and preservation of quality-of-life parameters. The objectives of the study were to assess the effect of pre-operative neurological condition, timing, and type of surgery on postoperative neurological function and long-term outcome as well as to analyze the various sources of primary in cases of symptomatic spinal metastases and the spinal level involved in terms of postoperative neurological function and ambulation. A retrospective analysis of all operated cases of symptomatic spinal metastases at our institute over a period of 5 years was performed. Parameters such as neurological presentation, timing of surgery, source of primary, and radiological features of the metastases were assessed and compared with the type of surgery performed, post-operative neurological function, and long-term outcome. The in-house hospital information system was to collect data. A total of 94 patients were operated on for symptomatic spinal metastases, the dorsal spine was the most common location and hematological malignancies were the most common primary overall and among men whereas breast was the most common primary in females. Overall, 64.8% of the patients had neurological motor deficits of which 72% had an improvement in motor power. We found that patients with a pre-operative motor power of 3/5 or more likely to have an improvement in post-operative neurological function and ambulatory status. Surgery for symptomatic spinal metastases plays a vital role in preserving the quality of life of the patients. Patients with preoperative motor power of 3/5, spastic tone, and features of mechanical back pain alone have good ambulatory outcomes post-spine surgery.

Mechanical Thrombectomy in Ischemic Stroke with a Large Infarct Core: A Meta-Analysis of Randomized Controlled Trials.

Background/Objectives: Endovascular treatment (EVT) is recommended for acute ischemic stroke due to large-vessel occlusion (LVO) and an Alberta Stroke Program Early CT Score (ASPECTS) ≥ 6. Randomized controlled trials (RCTs) have recently become available on EVT effects in people with LVO-related large core stroke (ASPECTS 0-5). Here, we provide an updated meta-analysis of the EVT effect on functional neurological status in people with large-core stroke. Methods: The study followed the PRISMA guidelines. PubMed, EMBASE and Cochrane Central were searched for RCTs comparing EVT vs. best medical treatment (BMT) in large-core LVO stroke. The primary outcome was functional independence at 90 days (modified Rankin Scale; mRS 0-2). The secondary outcomes were symptomatic intracranial hemorrhage (sICH), good functional outcome (mRS 0-3) and excellent functional outcome (mRS 0-1). EVT vs. BMT was compared through random effect meta-analysis. Heterogeneity was assessed with the I2 and Q test and risk of bias reported according to the RoB2 tool. Results: Six RCTs were included (n = 1656 patients). All studies had a moderate risk of bias, with blinding bias due to the nature of the intervention, potential allocation bias and incomplete outcome reporting. Functional independence was significantly more frequent in the EVT vs. BMT group (OR = 2.47, 95% CI = 1.52-4.03, p < 0.001). sICH rates (OR = 1.77, 95% CI = 1.01-3.11, p = 0.04) and good functional outcome (OR = 2.20; 95% CI = 1.72-2.81, p < 0.001) were more frequent in the EVT vs. BMT group, while the rates of mRS 0-1 did not differ. Conclusions: In patients with large-core stroke and LVO, EVT plus BMT as compared to BMT alone carries a significant increase in independent ambulation and good functional outcome at 3 months despite the marginal increase in sICH.

3R Nursing Combined with Dietary and Nutritional Interventions Enhances Self-care Ability in Elderly Patients with Vascular Dementia.

Vascular dementia (VD) is an extremely common neurological dysfunction in the elderly population, and greatly affects the patient's ability to take care of themselves. Recent research suggests that VD patients need more targeted and individualized nursing during treatment, so as to enhance cognitive function and therapeutic efficacy. The objective of this study is to observe the effect of reminiscence, reality, and remotivation (3R) nursing combined with dietary and nutritional interventions on elderly patients with VD, so as to provide clinical evidence for the management of VD in older adults. 120 elderly VD patients admitted between December 2022 and December 2023 were selected, including 64 cases receiving 3R nursing combined with dietary and nutritional interventions (the research group) and 56 cases receiving routine nursing (the control group). The two groups were compared in terms of neurological function, self-care ability, and nutritional status before and after nursing, as well as nursing compliance. After the completion of the care, patients' quality of life and family satisfaction were investigated. In comparison with the control group, the research group displayed higher scores on the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), greater self-care ability, and higher levels of nutritional proteins and grip strength (p < 0.05). In addition, patients in the research group displayed greater nursing compliance and quality of life of patients, as well as higher family satisfaction (p < 0.05). 3R nursing combined with dietary and nutritional interventions can effectively improve the neurological function of VD patients and enhance their self-care ability.

Predicting brain edema and outcomes after thrombectomy in stroke: Frontal delta/alpha ratio as an optimal quantitative EEG index

ObjectiveWe aimed to determine whether quantitative electroencephalography (QEEG) measures have predictive value for cerebral edema (CED) and clinical outcomes in acute ischemic stroke (AIS) patients with anterior circulation large vessel occlusion who underwent mechanical thrombectomy (MT). MethodsA total of 105 patients with AIS in the anterior circulation were enrolled in this prospective study. The occurrence and severity of CED were assessed through computed tomography conducted 24 h after MT. Clinical outcomes were evaluated based on early neurological deterioration (END) and 3-month functional status, as measured by the modified Rankin scale (mRS). Electroencephalography (EEG) recordings were performed 24 h after MT, and QEEG indices were calculated from the standard 16 electrodes and 2 frontal channels (F3-C3, F4-C4). The delta/alpha ratio (DAR), the (delta + theta) / (alpha + beta) ratio (DTABR), and relative delta power were averaged over all electrodes (global) and the F3-C3 and F4-C4 channels (frontal). The predictive effect and value of QEEG indices for CED and clinical outcomes were assessed using ordinal and logistic regression models, as well as receiver operating characteristic (ROC) curves. ResultsSignificantly, both global and frontal DAR were found to be associated with the severity of CED, END, and poor functional outcomes at 90 days, while global and frontal DTABR and relative delta power were not associated with outcomes. In ROC analysis, the best predictive effect was observed in frontal DAR, with an area under the curve of approximately 0.80. It exhibited approximately 75% sensitivity and 71% specificity for radiological and clinical outcomes when a threshold of 3.3 was used. ConclusionsQEEG techniques may be considered an efficient bedside monitoring method for assessing treatment efficacy, identifying patients at higher risk of severe CED and END, and predicting long-term functional outcomes. SignificanceQEEG can help identify patients at risk of severe neurological complications that can impact long-term functional recovery in AIS patients who underwent MT.

Advanced perioperative assessment of neurological function in acute Stanford A aortic dissection

Objective Acute Stanford Type A aortic dissection (AAAD) is a critical condition in vascular surgery, and total aortic arch replacement surgery is the preferred method to save patients’ lives. In recent years, as clinical research has advanced, there has been a growing realization of the close association between poor postoperative outcomes in patients and neurological functional deficits. Neurological function monitoring is a medical technique used to evaluate and monitor the functional status of the nervous system. Methods This monitoring involves the assessment of various aspects of the nervous system, including but not limited to nerve conduction velocity, neuromuscular function, electroencephalographic activity, and sensory nerve transmission. Neurological function monitoring has broad clinical applications and can be used to diagnose and monitor many neurological disorders, helping physicians understand patients’ neurological functional status and guide treatment plans. During the postoperative recovery process, neurological function monitoring can assist physicians in assessing the potential impact of surgery on the nervous system and monitor the recovery of patients’ neurological function. Results Studies have shown that neurological function monitoring holds promise in predicting neurological functional prognosis and interventions for patients with aortic dissection. Conclusion Therefore, the primary objective of this study is to evaluate the effectiveness and reliability of various intraoperative neurological monitoring techniques, neuroimaging examinations, and biomarkers in predicting and assessing postoperative neurological outcomes in patients undergoing AAAD surgery.

Spiritual interventions: Improving the lives of colorectal cancer survivors-A systematic literature review.

To systematically review the types of spiritual interventions available for colorectal cancer survivors and determine if they improve their lives. Systematic review. A thorough literature search was conducted in July 2023 using PRIMO, PubMed/Medline, Cochrane, CINAHL, Scopus, and EMBASE. As an extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist, the Synthesis Without Meta-Analysis reporting guideline was employed. A narrative synthesis was used to analyse the data. Thirty-five articles were analysed for this study. The findings suggest that psychoeducational intervention, cognitive behavioural therapy intervention, mindfulness intervention, social intervention, and spiritual counselling improved CRC survivor's coping skills, boosted self-esteem, lessened anxiety, instilled hope, enhanced daily functioning, improved survival rates, improved neurological functional status and quality of life (QoL). There is proof that spiritual interventions help CRC patients and improve their QoL. It has been discovered that spiritual intervention is helpful in the diagnosis, management, and treatment of CRC conditions. CRC survivors may have impairments in their physical ability and daily functioning as a result of many symptoms, such as pain, bowel dysfunction, and exhaustion. Furthermore, individuals may encounter difficulties in several aspects of their psychological, emotional, social, and role functioning due to the presence of dread symptoms. Therefore, these study will help CRC survivors To implement spiritual interventions in the management of their long-term care. To cultivate problem-solving abilities, foster self-assurance, and enhance self-awareness. To alleviate symptoms, enhance everyday functioning, and improve QoL. No financial incentives were used to compensate patients or members of the public for this review.

Application value of intraoperative electrophysiological monitoring in cerebral eloquent area glioma surgery: a retrospective cohort study

IntroductionSurgery for gliomas involving eloquent areas is a very challenging microsurgical procedure. Maximizing both the extent of resection (EOR) and preservation of neurological function have always been the focus of attention. Intraoperative neurophysiological monitoring (IONM) is widely used in this kind of surgery. The purpose of this study was to evaluate the efficacy of IONM in eloquent area glioma surgery.MethodsSixty-eight glioma patients who underwent surgical treatment from 2014 to 2019 were included in this retrospective cohort study, which focused on eloquent areas. Clinical indicators and IONM data were analysed preoperatively, two weeks after surgery, and at the final follow-up. Logistic regression, Cox regression, and Kaplan‒Meier analyses were performed, and nomograms were then established for predicting prognosis. The diagnostic value of the IONM indicator was evaluated by the receiver operating characteristic (ROC) curve.ResultsIONM had no effect on the postoperative outcomes, including EOR, intraoperative bleeding volume, duration of surgery, length of hospital stay, and neurological function status. However, at the three-month follow-up, the percentage of patients who had deteriorated function in the monitored group was significantly lower than that in the unmonitored group (23.3% vs. 52.6%; P < 0.05). Logistic regression analysis showed that IONM was a significant factor in long-term neurological function (OR = 0.23, 95% CI (0.07–0.70). In the survival analysis, long-term neurological deterioration indicated worsened overall survival (OS) and progression-free survival (PFS). A prognostic nomogram was established through Cox regression model analysis, which could predict the probability 3-year survival rate. The concordance index was 0.761 (95% CI 0.734–0.788). The sensitivity and specificity of IONM evoked potential (SSEP and TCeMEP) were 0.875 and 0.909, respectively. In the ROC curve analysis, the area under the curve (AUC) for the SSEP and TCeMEP curves was 0.892 (P < 0.05).ConclusionsThe application of IONM could improve long-term neurological function, which is closely related to prognosis and can be used as an independent prognostic factor. IONM is practical and widely available for predicting postoperative functional deficits in patients with eloquent area glioma.

Clinical efficacy analysis of surgical treatment for spinal metastasis under the multidisciplinary team using the NOMS decision system combined with the revised Tokuhashi scoring system: a randomized controlled study

ObjectiveDespite advancements in spinal metastasis surgery techniques and the rapid development of multidisciplinary treatment models, we aimed to explore the clinical efficacy of spinal metastasis surgery performed by a combined NOMS decision system-utilizing multidisciplinary team and Revised Tokuhashi scoring system, compared with the Revised Tokuhashi scoring system.MethodsClinical data from 102 patients with spinal metastases who underwent surgery at three affiliated hospitals of Zunyi Medical University from December 2017 to June 2022 were analysed. The patients were randomly assigned to two groups: 52 patients in the treatment group involving the combined NOMS decision system-utilizing multidisciplinary team and Revised Tokuhashi scoring system (i.e., the combined group), and 50 patients in the treatment group involving the Revised Tokuhashi scoring system only (i.e., the revised TSS-only group). Moreover, there were no statistically significant differences in preoperative general data or indicators between the two groups. Intraoperative and postoperative complications, average hospital stay, mortality rate, and follow-up observation indicators, including the visual analogue scale (VAS) score for pain, Eastern Cooperative Oncology Group (ECOG) performance status, Karnofsky Performance Status (KPS) score, negative psychological assessment score (using the Self-Rating Anxiety Scale, [SAS]), and neurological function recovery score (Frankel functional classification) were compared between the two groups.ResultsAll 102 patients successfully completed surgery and were discharged. The follow-up period ranged from 12 to 24 months, with an average of (13.2 ± 2.4) months. The patients in the combined group experienced fewer complications such as surgical wound infections 3 patients(5.77%), intraoperative massive haemorrhage 2 patients(3.85%), cerebrospinal fluid leakage 2 patients(3.85%), deep vein thrombosis 4 patients(7.69%),and neurological damage 1 patient(1.92%), than patients in the revised TSS-only group (wound infections,11 patients(22%); intraoperative massive haemorrhage, 8 patients(16%);cerebrospinal fluid leakage,5 patients(10%);deep vein thrombosis,13 patients (26%); neurological damage,2 patients (4%). Significant differences were found between the two groups in terms of surgical wound infections, intraoperative massive haemorrhage, and deep vein thrombosis (P < 0.05). The average postoperative hospital stay in the combined group (7.94 ± 0.28 days) was significantly shorter than that in the revised TSS-only group (10.33 ± 0.30 days) (P < 0.05). Long-term follow-up (1 month, 3 months, 6 months, and 1 year postoperatively) revealed better clinical outcomes in the combined group than in the revised TSS-only group in terms of VAS scores, overall KPS%, neurological function status Frankel classification, ECOG performance status, and SAS scores.(P < 0.05).ConclusionA multidisciplinary team using the NOMS combined with the Revised Tokuhashi scoring system for spinal metastasis surgery showed better clinical efficacy than the sole use of the Revised Tokuhashi scoring system. This personalized, precise, and rational treatment significantly improves patient quality of life, shortens hospital stay, reduces intraoperative and postoperative complications, and lowers mortality rates.

Improvement in the Nutritional and Clinical Status of Patients with Acute Cerebral Infarction Combined with Dysphagia by Enhanced Recovery After Surgery Care

Compared with acute cerebral infarction alone, the nutritional status of patients with acute cerebral infarction and dysphagia is significantly worse, which not only negatively impacts clinical treatment, but also contributes to the poor prognosis of patients. In traditional clinical treatment, more focus is placed on improving the neurological function of patients with acute cerebral infarction combined with dysphagia, often neglecting their nutritional status, leading to unsatisfactory prognosis. In this study, we explored the influence of enhanced recovery after surgery care on the neurological function and nutritional status of patients with acute cerebral infarction combined with dysphagia after thrombolytic therapy. It was found that the use of enhanced recovery after surgery care improved neurological function and nutritional status and reduced blood pressure and stress responses, while promoting the recovery of patients’ muscle strength. Therefore, enhanced recovery after surgery care has high application value in the future clinical treatment of acute cerebral infarction combined with dysphagia.

Scales for assessing neurological disorders and degenerative changes in the cervical spine. Literature review

More than sixty scales have been developed for the diagnosis and treatment of degenerative pathology of the cervical spine from the perspective of neurological syndromes. The use of most of these in clinical practice is limited. The purpose of this study is to highlight the most popular scales for assessing degenerative changes of the cervical spine from the perspective of neurological syndromes in the diagnosis and determination of treatment tactics for single-segment stenosis of the spinal canal at the cervical level. The current clinical guidelines “Degenerative Spine Diseases” 2021 use the Neck Disability Index, the Visual Analog Scale, and the Frankel Grade among all scales. MEDLINE (PubMed) and Google Scholar were searched from 1972 to 2023 using the key words “cervical spine degeneration”. The initial search identified more than 13,000 articles. This review included 52 studies in which the analysis of clinical and neurological data was carried out using scoring scales for assessing neurological syndromes and functional status in degenerative spinal stenoses at the cervical level. The validity, reliability, and applicability of the scales in clinical practice were analyzed and compared. Based on the analysis of literature data, the most rational scales to use from the standpoint of validity, reliability, and time consumption are the Visual Analog Scale for pain assessment, the Neck Disability Index for assessing cervical radiculopathy, the European Myelopathy Score to assess cervical myelopathy, the Neck Pain and Disability Scale to assess functional outcomes, and the Hospital Anxiet y and Depression Scale for mental status assessment.

Surgery for Symptomatic Spinal Metastases – When, What, and How?

Abstract Background: Spine is the most common site for metastases in the skeletal system. Longer lifespans of patients with common cancers are translating into increasing incidence of patients with symptomatic spinal metastases. Surgery for spinal metastases offers immediate neurological decompression with stabilization and preservation of quality-of-life parameters. Objectives: To assess the effect of pre operative neurological condition, timing, and type of surgery on post operative neurological function and long-term outcome. To analyze the various sources of primary in cases of symptomatic spinal metastases and the spinal level involved in terms of post operative neurological function and ambulation. Material and Methods: A retrospective analysis of all operated cases of symptomatic spinal metastases at our institute over a period of 5 years was performed. Parameters such as neurological presentation, timing of surgery, source of primary, radiological features of the metastases were assessed and compared with the type of surgery performed, post operative neurological function and long-term outcome. The in house hospital information system was to collect data. Results: A total of ninety-four patients were operated for symptomatic spinal metastases, the dorsal spine was the most common location and haematological malignancies were the most common primary overall and among men whereas breast was the most common primary in females. Overall, 64.8% of the patients had neurological motor deficit of which 72% had an improvement in motor power. We found that patients with a pre operative motor power of 3/5 or more likely to have in improvement in post operative neurological function and ambulatory status. Conclusion: Surgery for symptomatic spinal metastases plays a vital role in preserving the quality of life of the patients. Patients with preoperative motor power of 3/5, spastic tone and features of mechanical back pain alone have good ambulatory outcomes post spine surgery.

Aconitum coreanum alleviates cerebral ischemic stroke through the PI3K/Akt signaling pathway in gerbils model

Cerebral ischemic stroke (CIS) is a kind of acute cerebrovascular disease with fast onset, low-cure rate, and high case-fatality rate. The application of Aconitum coreanum on CIS was recorded in many ancient books in China with it mechanism and effective components unclear. This study aimed to analyze the potential mechanism and effetvie components of A. coreanum on treating CIS. Neurological function score, cerebral infarction rate, and inflammatory indicators were applied to evaluate the efficacy of A. coreanum on gerbils with CIS. The prototype compounds in A. coreanum which were absorbed into blood was analyzed and identified by Ultra high performance liquid chromatography-Q exactive focus-Mass spectrometer (UPLC-QE-MS). And bioinformatics analysis was used to predict their potential targets or pathways of action. Western blotting and immunofluorescence were adopted to validate the targets or pathway with high relation. After treatment with A. coreanum, the neurological function status of gerbils with CIS was significantly improved, the ischemic area of the brain and the levels of inflammatory indicators significantly reduced. 22 prototype compounds in A. coreanum absorbed into blood were identified mainly including C-20 and C-19 diterpenoid alkaloids. Gene ontology (GO) function enrichment analysis illustrated that A. coreanum acted on protein phosphorylation, receptor complexes, protein kinase activity, and inflammatory response to impove CIS. The kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis results revealed that PI3K/Akt signaling pathway was a key pathway. Western blotting and immunofluorescence validated that A. coreanum acted on PI3K/Akt signaling pathway. In conclusion, A. coreanum improved the inflammantory condition in CIS by acting on PI3K/Akt signaling pathway and the effective components were the diterpenoid alkaloids in it.

Results of Phase III Clinical Trial: a Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel Group Study of the Efficacy and Safety of Direkord in Ischemic Stroke Patients in Early Recovery Period

Direkord is an original drug containing the active substance of dicholine succinate, which improves the sensitivity of insulin receptors in neurons to insulin. The aim of this work was to evaluate the efficacy and safety of the drug in ischemic stroke patients in the early recovery period. In total, 160 patients after the first ischemic stroke in the carotid system, confirmed by computed or magnetic resonance imaging, with a stroke duration from 3 weeks to 2 months, mean age 63.2±8.4 years, were randomized into two treatment groups. The first group (n=80) received Direkord intramuscularly at a dose of 600 mg/day for two weeks; the second group (n=80) received a placebo. Treatment response was defined as an improvement in neurological status, functional status, and cognitive function of the patients: at least a two-fold decrease in the total NIHSS score, the total Barthel score ≥ 95, and the total MoCA score ≥ 26. The analysis of the primary endpoint of the study using exact Fisher’s test showed that Direkord was statistically significantly superior to the placebo (p=0.017) in the number of patients who responded to the therapy — 23.7 and 8.7% of patients in groups, respectively. The secondary end point analysis revealed a statistically significant superiority of Direkord over the placebo in reducing neurological deficits on the NIHSS scale (p=0.004), on the Rankin scale (p=0.0357), and on the CGI-I (p&lt;0.001) and PGI-I (p&lt;0.001) global clinical impression scales. Direkord has a good safety profile; thus, no statistically significant differences were found with the placebo in any of the safety parameters, including the number of adverse events, vital signs, laboratory parameters, and ECG. Overall, Direkord is statistically significantly more effective than placebo in recovering function and daily activities after ischemic stroke.

Abstract 17479: Angiographic Factors Influencing Treatment Decisions in Pediatric Brain Arteriovenous Malformation (pAVM): Insights From Cart Analysis

Introduction: Pediatric cerebral AVM (pAVM) are the most common cause of hemorrhagic stroke in children. Their optimal management approach remains controversial. Determining the angiographic factors that impact outcomes for the various treatment strategies is crucial. Hypothesis: To identify angiographic factors for modality-treatment decision-making Methods: Cross-sectional study of patients diagnosed with pAVM at a pediatric stroke center between 2016 and 2021. Patients’ demographics, angiographic characteristics (volume, location, nidal aneurysms, non-plexiform rapid fistulas, venous drainage, and nidus diffuseness), treatment, and clinical outcomes were collected. Classification and Regression Tree Analysis (CART) was used to identify impactful angiographic factors, multivariate regression was applied to evaluate their significance in treatment decision-making. Results: Thirty-seven consecutive patients were included, 25 were male, with a median age of 10.3 years (IQR 7.9-13.3). Median follow-up was 30.3 months (IQR 8.6-53.8). Twenty patients presented with a ruptured pAVM. Endovascular embolization was the most common treatment (19, 51.4%), followed by radiosurgery (14, 37.8%), and observation (8, 21.6%). Twenty-seven patients (81.8%) had improved or stable functional neurologic status at last follow-up, and six (18.2%) declined (none of them by more than one point on the mRS). Only one patient had post-treatment hemorrhage during follow-up.The angiographic features associated with specific treatments were: the presence of non-plexiform rapid fistulas (endovascular in 94.0% of patients p=0.01), basal ganglia or pons location (excluded from endovascular in 86% of patients p=0.30), absence of a nidal aneurysm (radiation in 98% p=0.03). CART did not identify other potentially impactful angiographic factors. Conclusions: Our study shows generally favorable outcomes and low complication rates in pAVM patients who underwent multimodal treatment. The presence of non-plexiform rapid fistulas and nidal aneurysms should be considered when determining the appropriate treatment approach. Further prospective confirmatory analyses are warranted.

Developing and Validating a New Model to Predict the Risk of Poor Neurological Status of Acute Ischemic Stroke After Intravenous Thrombolysis.

The objective of this study was to develop and validate a predictive model for the risk of poor neurological status in in-hospital patients with acute ischemic stroke (AIS) after intravenous thrombolysis. This 2-center retrospective study included patients with AIS treated at the Advanced Stroke Center of the Second Hospital of Hebei Medical University and Baoding No.1 Central Hospital between January 2018 and January 2020). The neurological function status at day 7 of AIS onset was used as the endpoint of the study, which was evaluated using the National Institute of Health Stroke Scale (NIHSS) score. A total of 878 patients were included in the study and divided into training (n=652) and validation (n=226) sets. Seven variables were selected as predictors to establish the risk model: age, NIHSS before thrombolysis (NIHSS1), NIHSS 24 hours after thrombolysis (NIHSS3), high-density lipoprotein, antiplatelet, cerebral computed tomography after thrombolysis (CT2), and lower extremity venous color Doppler ultrasound. The risk prediction model achieved good discrimination (the areas under the Receiver Operating Characteristic curve in the training and validation sets were 0.9626 and 0.9413, respectively) and calibration (in the training set Emax=0.072, Eavg=0.01, P=0.528, and in the validation set Emax=0.123, Eavg=0.019, P=0.594, respectively). The decision curve analysis showed that the model could achieve a good net benefit. The prediction model obtained in this study showed good discrimination, calibration, and clinical efficacy. This new nomogram can provide a reference for predicting the risk of poor neurological status in patients with acute ischemic stroke after intravenous thrombolysis.

OTHER-06 EPIDEMIOLOGY OF BRAIN AND SPINE TUMOURS – A SINGLE CENTRE DESCRIPTIVE RETROSPECTIVE STUDY

Abstract Brain and spine tumours are of significant public health concern and lead to severe morbidities and mortalities. The incidence is on the rise, ranking as the fifth (5th) leading cause of cancer-related deaths in Africa. Treatment and prognosis depend on age, tumour location, functional neurological status, extent of tumour resection and histological subtype of tumour. This study aims to describe the patient demographics, clinical presentation, and histological subtypes of central nervous system (CNS) tumours in the Korle-Bu Teaching Hospital. A retrospective review of the medical records and histopathology reports (reports presented to the unit) of all patients with CNS tumours operated upon in the Neurosurgical Unit, Department of Surgery, Korle-Bu Teaching Hospital over the past 17years (2007-2023) was collated. The patients without definitive histopathological diagnosis were excluded from the study. Epidemiological data retrieved include clinical presentation, histological subtype, patient age and sex and the spatial distribution. A total of 327 tumour were recorded in the Neurosurgery unit: 85.3% were Brain Tumours. 178 (54.4%) were females and 149 (45.6%) males. Overall Meningiomas were the commonest CNS tumour encountered forming 32.1% followed by Gliomas, Glioneuronal and Neuronal tumours with 29.4% then Tumours of the Sella region, 19.6%. The commonest Meningioma subtype was Meningothelial (33%). Of the Gliomas, Low grade gliomas formed 69%. The commonest symptom for brain cases were headaches (59.1%) followed by visual impairment (33.0%). Of the spine cases, the prevalent symptom was paraparesis (46.2%) followed with low back pain and bowel and bladder dysfunction at 23.1% respectively. We concluded that Low grade tumours predominate in our setting. It is prudent that we channel efforts towards prompt diagnosis and treatment of such cases.

Clinical outcomes and prognostic factors in the surgical treatment of spinal dural arteriovenous fistulas: a retrospective study of 118 patients

Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal vascular malformations (AVMs), constituting approximately 70% of all spinal AVMs. The impact of various clinical and radiologic features on the outcomes in patients with SDAVFs is still controversial. The purpose of the study is to investigate the clinical outcomes and prognostic factors in patients with surgically treated SDAVFs in a single center. A retrospective review was performed for all patients with SDAVFs from January 2013 to September 2021 who underwent surgery at our institution. Medical records and pre- and postoperative imaging data were analyzed. Neurological function status was evaluated by modified Aminoff-Logue Scale (mALS). Student’s t-test, Wilcoxon rank sum test, χ2 test and logistic regression were used to find significant prognostic factors. P values < 0.05 were considered significant. One hundred and eighteen patients were ultimately included in the study. By comparing preoperative and postoperative mALS, 69 (58.5%) patients experienced improvement, and 49 (41.5%) patients showed no improvement (worse or unchanged). Wilcoxon rank sum test showed that there was a difference between the improvement group and the no improvement group in preoperative mALS Micturition score and preoperative mALS Defecation score. The logistic regression revealed that preoperative mALS Gait score was associated with clinical improvement after surgery in patients with SDAVFs. Surgical treatment of SDAVFs is a safe and effective procedure and can lead to symptom improvement or stabilization in most patients. Preoperative neurological function status was the only factor associated with clinical prognosis.

The effect of butylphthalide on improving the neurological function of patients with acute anterior circulation cerebral infarction after mechanical thrombectomy.

Butylphthalide can improve blood circulation in patients with acute cerebral infarction. Complement 3a receptor 1 (C3aR1) is involved in the regulation of innate immune response and pathogen monitoring, which is closely related to the pathophysiological processes of breast cancer, neurogenesis and lipid catabolism. Our study explored the therapeutic effect of butylphthalide on improving the neurological function of patients with acute anterior circulation cerebral infarction after mechanical thrombectomy, and evaluated the correlation between serum C3aR1 and butylphthalide on improving the neurological function after mechanical thrombectomy. 288 patients with acute anterior circulation cerebral infarction who were admitted to our hospital from January 2019 to November 2022 and were treated with mechanical thrombectomy for the first time were included in this retrospective study and divided into the butylphthalide group and control group that they received treatment methods. The National Institutes of Health Stroke Scale (NIHSS) scale was used to evaluate the patient neurological function treatment efficacy, and the modified Rankin Scale (mRS) scale was used to measure the patient neurological function status 3 months after surgery. Enzyme-linked immunosorbent assay method was used to determine the content of C3aR1 in serum. Two weeks after thrombus removal, the NIHSS efficacy of the butylphthalide group and the control group were 94.44% and 72.22%, respectively. The butylphthalide group was significantly higher than the control group (P < .001). Three months after the operation, the mRS score of the butylphthalide group was significantly lower than that of the control group (P = .001), and the excellent and good rate was significantly higher than that of the control group (P < .001). The serum C3aR1 level of the butylphthalide group was significantly lower than that of the control group 2 weeks after operation and 3 months after operation (P < .001). The serum C3aR1 was positively correlated with the efficacy of NIHSS (R = 0.815, P = .004), which was positively correlated with mRS score (R = 0.774, P = .007). Butylphthalide can improve the therapeutic effect of neurological function in patients with acute anterior circulation cerebral infarction after mechanical thrombus removal. The patient serum C3aR1 is related to the patient neurotherapy efficacy and neurological function status, and its level can reflect the patient neurological function recovery to a certain extent.

Surgical outcomes among spinal tuberculosis patients: a study from a provincial reference hospital in Indonesia

Link of Video Abstract: https://youtu.be/_5_xwPSsNFc Introduction: Spinal tuberculosis is one of the most common forms of extrapulmonary tuberculosis, which can cause a significant loss of functional ability and decrease in quality of life. Surgery has become an integral component in the current management of spinal tuberculosis that could improve neurological deficits and functional status, yet it may expose patients to surgical site infection (SSI). The aim of the study was to observe the incidence of SSI and improved neurological deficits and functional status post-surgery among patients with spinal tuberculosis. Methods: The medical records (n=91) were collected retrospectively from patients admitted between January 2019 and June 2022. Characteristic data collected in this study included age, gender, education, occupation, domicile, history of smoking, history of pulmonary tuberculosis, presence of comorbidity. Patients were contacted for history of SSI, postoperative neurological deficits, and functional status assessments through interview using Frankel Grade and Barthel Index instruments, respectively. Results: The results revealed that only two percent of the total patients developed SSI. Number of patients with Frankel Grade E increased from 0 to 72 (79.1%), and only three patients (3.3%) had persistent Frankel Grade B after the surgery. Sixty-eight patients (74.7%) who underwent the surgery enjoyed independent state of functional status, whereas prior to the surgery, the number was smaller (n=18, 19.8%). The favorable surgical outcomes were found predominantly in female patients (83.9%), 17–25-year-old patients (93.3%), and those having no history of smoking (82.5%–84.2%) and comorbid disease (81.9%–83.3%). The recovery was mostly observed 1–2 years post-surgery (87.2%). Conclusion: Spinal surgery for patients with spinal tuberculosis improves neurological deficits and functional status. The risk of contracting SSI after the surgery is considered to be low.