A nomogram risk prediction model for poor outcome of primary brainstem hemorrhage based on clinical data and radiographic features.

OBJECTIVE: Primary brainstem hemorrhage (PBSH) is a devastating acute neurological disorder with a poor prognosis. This study aimed to identify risk factors associated with poor outcomes in PBSH patients and develop a novel nomogram for predicting prognosis, with external validation. METHODS: A total of 379 patients with PBSH were included in the training cohort. The primary outcome of interest was a modified Rankin Scale score (mRS) of 4-6 at 90 days post-onset. Multivariable logistic regression was used to construct a nomogram based on relevant variables. Model performance was tested in the training cohort and externally validated for discriminatory ability, calibration, and clinical utility at a separate institution. The nomogram was also compared to the ICH score in terms of predictive ability. RESULTS: The poor outcome rate at 90 days was 57.26% (217/379) in the training cohort and 61.27% (106/173) in the validation cohort. Multivariable logistic regression analysis identified age, Glasgow Coma Scale (GCS) score, and hematoma size as significant risk factors for poor outcomes. Nomograms based on these variables demonstrated good discrimination, with an area under the curve (AUC) of 0.855 and 0.836 in the training and validation cohorts, respectively. Furthermore, the nomogram showed superior predictive value to the ICH score for the 90-day outcome in both cohorts. CONCLUSION: This study developed and externally validated a nomogram risk prediction model for predicting poor outcomes at 90 days in patients with PBSH, using age, GCS score, and hematoma size as predictors. The nomogram demonstrated good discrimination, calibration, and clinical validity, serving as a valuable assessment and decision-making tool.

A retrospective study to examine the association of different pear-shaped balloons with efficacy and postoperative complications in percutaneous balloon compression for trigeminal neuralgia.

Percutaneous balloon compression is a safe and effective therapeutic modality for trigeminal neuralgia. It is widely recognized that the pear-shaped balloon is the key to the success of the procedure. This study aimed to analyze the effect of different pear-shaped balloons on the duration of the treatment outcome. In addition, the relationship between individual variables and the duration and severity of complications was analyzed. The clinical data and intraoperative radiographs of 132 patients with trigeminal neuralgia were reviewed. We classify pear-shaped balloons into type A, type B, and type C balloons depending on the size of their heads. The collected variables were correlated with prognosis by univariate and multivariate analyses. The efficiency of the procedure was 96.9%. There was no significant difference in pain relief rates between the different pear-shaped balloons. Median pain-free survival time was longer for type B and C balloons, which were significantly different from type A balloons. In addition, pain duration also was a risk factor for recurrence. There was no significant difference in the duration of numbness between the different types of pear-shaped balloons, but type C balloons resulted in longer-lasting masticatory muscle weakness. Duration of compression and balloon shape can also significantly influence the severity of complications. Different pear-shaped balloons have been shown to have a significant effect on the efficacy and complications of the PBC procedure, with type B balloons (head ratio: 10-20%) appearing to be the ideal pear shape. However, its clinical application remains to be validated.

Changes in cerebral hemodynamics in patients with posttraumatic diffuse brain swelling after external intraventricular drainage.

PURPOSE: To investigate the changes of cerebral hemodynamics pre- and post-ventricular drainage in patients with posttraumatic acute diffuse brain swelling. METHODS: Twenty-four cases of traumatic diffuse brain swelling were analyzed retrospectively. Patients in nonsurgical group were treated by medicine therapy. Patients in surgical group were treated by external ventricular drainage plus medicine therapy. The first CT perfusion scan was completed within 4-5 h after trauma and scanned again after 7 days. The changes of perfusion parameters in area-of-interest in two groups were analyzed and compared before and after treatment. RESULTS: Compared with the nonsurgical group, the value of cerebral blood volume, cerebral blood flow and mean transit time in bilateral frontal temporoparietal grey matter, basal ganglia, cerebellum, and brain stem at pre- and post-therapy were increased significantly (p < 0.05) in surgical group, and consequently the prognosis of patients undergoing surgery was also better than that of nonsurgical group. CONCLUSION: External ventricular drainage can improve cerebral perfusion and increase survival quality for the patients with posttraumatic acute diffuse brain swelling.

Stereotactic hematoma puncture and drainage for primary pontine hemorrhage: Clinical outcomes and predictive model.

Primary pontine hemorrhage (PPH) is a particularly grave form of hemorrhagic stroke, characterized by its significant mortality rate. stereotactic hematoma puncture and drainage is a procedure that has been shown to improve the prognosis of patients with PPH. However, there are currently no established criteria for selecting patients for this procedure. We contrasted the clinical outcomes of PPH patients treated with stereotactic hematoma puncture and drainage with those who received conservative treatment in this study. We conducted logistic regression analysis to identify the risk factors associated with postoperative mortality. A mortality risk nomogram was then constructed using these risk factors. A total of 127 conservatively treated patients and 96 patients who underwent stereotactic hematoma puncture and drainage were included in this study. In the surgical group, the 30-day mortality rate stood at 28.1%, significantly lower than the 43.3% observed in the control group (p = 0.02). Age, along with the Glasgow Coma Scale (GCS) score and hematoma size, were identified as independent risk factors associated with death within 30 days post-surgery. The mortality risk nomogram was well calibrated and discriminatory, with a c-index of 0.878 (95% CI 0.80-0.95) as validated by bootstrapping, and a c-index of 0.849. This study provides a predictive model for selecting patients who are most likely to benefit from stereotactic hematoma puncture and drainage. The results of this study could be helpful to neurosurgeons in their decision-making process. However, further external validation is necessary to confirm these findings.

Endoscopy-assisted cerebral falx incision via unilateral approach for treatment of dissymmetric bilateral frontal contusion.

OBJECTIVE: To investigate the clinical features and treatment strategy of dissymmetric bilateral frontal contusion, and to summarize our experience in treating these patients by minimally invasive surgery. METHODS: Over the past 3 years, we have treated a total of 31 patients with dissymmetric bilateral frontal contusion using endoscopy-assisted unilateral cerebral falx incision. Other 30 patients treated by routine bilateral approaches within the same period were taken as control. RESULTS: Seventeen cases (54.8%) in the unilateral operation group survived and were in good condition, 8 (25.8%) had moderate disability, 4 (12.9%) had severe disability, 1 (3.2%) was in vegetative state, and 1 (3.2%) died. Compared with the control group, the Glasgow Outcome Scale score was not significantly different in the unilateral operation group, but the operation time, blood transfusion volume, the length of hospital stay, the incidences of mental disorder and olfactory nerve injury were greatly reduced in the unilateral operation group. CONCLUSIONS: Endoscopy-assisted unilateral cerebral falx incision can shorten the operation time, reduce surgical trauma and complications in treatment of patients with dissymmetric bilateral frontal contusion. It can obviously diminish the chance of delayed intracerebral hematoma and subsequently minimize the incidences of subfalcial and centrencephalic herniation.

Intracranial pressure monitoring for special patterns of frontal lobe contusions.

OBJECTIVE: To study the effect and indications of intracranial pressure (ICP) monitoring for frontal lobe contusion patients. METHODS: During January 2005-December 2008, 34 cases of frontal lobe contusion received ICP monitoring in our department (monitoring group). Different treatment protocols were adopted according to the results of ICP. Meanwhile 46 cases of same type of head-injured patients who did not undergo ICP monitoring served as control group. RESULTS: We found that ICP elevated dramatically within 24 hours after head injury if the contusions were located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or dispersed in bilateral lobe. After half a year follow-up and on the basis of Glasgow Coma Scale assessment, the monitoring group showed better outcome than the control group with good recovery in 24 cases (70.6%) , moderate disability in 7 cases (20.6%), severe disability in 2 (5.88%) and death in 1 (2.94%). The outcome of control group displayed good condition in 25 cases (54.3%), moderate disabilities in 8 (17.4%), severe disability in 7 (15.2%), and death in 6 (13.0%). CONCLUSIONS: Frontal lobe contusions are vulnerable and complex head injuries, especially when the contusions are located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or diffused in bilateral lobes. These patients should undergo ICP monitoring regardless of their consciousness status. If ICP elevates over 25 mm Hg, the craniotomy is mandatory and will markedly reduce the mortality and disability of these patients.

Up-regulation of circular RNA hsa_circ_01844 induces apoptosis and suppresses proliferation and migration of glioblastoma cells.

BACKGROUND: Previous studies have demonstrated that various circular RNAs are involved in the malignant proliferation of cancers, such as liver cancer, lung cancer, breast cancer, and others. The potential role of circular RNAs in glioblastoma, however, is still uncertain. In this study, we aimed to study the potential role of hsa_circ_01844 in glioblastoma. METHODS: Using reverse transcription-polymerase chain reaction (RT-PCR) method, hsa_circ_01844 expression was measured in five glioblastoma samples and five normal brain samples. To evaluate the potential function of hsa_circ_01844 in glioblastoma, hsa_circ_01844 was overexpressed in glioblastoma cell lines (U251 and U87 cells). Using these two cell lines, in vitro experiments including the flow cytometry assay, 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide assay, Transwell assay, and cell apoptosis assay were performed to investigate the role of hsa_circ_01844 in glioblastoma. Student t test and one-way analysis of variance were used for statistical analysis. RESULTS: The expression of circular RNA hsa_circ_01844 was lower in glioblastoma tissues when compared with the normal brain tissues by RT-PCR method (0.034 ±â€Š0.036 vs. 1.630 ±â€Š0.891, P < 0.001). Using two glioblastoma cell lines, we found that overexpression of hsa_circ_01844 in glioblastoma cells suppressed their proliferation, colony formation, migration, and increased the apoptotic rate compared with empty vector group and blank control group (all P < 0.05). CONCLUSION: Hsa_circ_01844 shows decreased expression in glioblastoma and its overexpression induces apoptosis and inhibits proliferation, migration, and invasion of glioblastoma cells.

Using computerized tomography perfusion to measure cerebral hemodynamics following treatment of traumatic brain injury in rabbits.

The present study aimed to investigate the use of computerized tomography (CT) perfusion for evaluating cerebral hemodynamics following traumatic brain injury (TBI) in rabbits. The animals were randomly assigned into four groups (n=10 animals/group): i) Control, ii) TBI, iii) TBI + common decompression and iv) TBI + controlled decompression groups. A TBI model was established in rabbits using epidural balloon inflation. In the groups receiving intervention, animals were provided common decompression or controlled decompression treatments. Conventional CT and CT perfusion scanning were performed, with cerebral hemodynamic indices, including regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV) and mean transit time (MTT) being measured. Blood-brain barrier (BBB) permeability was evaluated using Evans blue staining. Compared with those in the control group, rCBF and rCBV values of the bilateral temporal lobes and basal ganglion in the TBI, TBI + common decompression and TBI + controlled decompression groups were significantly lower, whereas the MTT values were markedly prolonged and Evans blue dye content was greatly increased (P<0.01). Controlled decompression was demonstrated to be more potent than common decompression for preventing TBI-induced decline in rCBF and rCBV values in the bilateral temporal lobes and basal ganglion, as well as reversing TBI-induced extension of MTT in the bilateral temporal lobes (P<0.01 vs. TBI group). However, neither common nor controlled decompression could reduce TBI-induced increase in BBB permeability. In conclusion, these findings indicate that CT perfusion may be used to monitor cerebral hemodynamics following TBI in rabbits. Controlled decompression was deduced to be more potent than common decompression for preventing abnormalities in cerebral hemodynamics after TBI.

Clinical experience of the management for the most severely head-injured patients with GCS score of 3.

OBJECTIVE: To summarize the therapeutic experience of 24 patients of traumatic head injuries with GCS score of 3. METHODS: Twenty-four most severely head-injured patients with GCS score of 3 who were admitted to our department from Jan 1995 to Mar 1998 were retrospectively analyzed. RESULTS: Twelve cases (50.0%) survived, of which 7 cases (29.2%) had good recovery or moderate disability and 5 cases with severe deficits (20.8%), and the other 12 died (50.0%) after therapy. CONCLUSIONS: The prognosis of most severely head-injured patients with GCS score of 3 could be improved by early intracranial hematoma removal with large decompressive craniotomies, early moderate hypothermia therapy, early assistant ventilation and effective prevention and treatment of complications.

Controlled decompression for the treatment of severe head injury: a preliminary study.

AIM: Fast direct decompression surgery for treatment of severe head injury often results in intraoperative and postoperative complications. Controlled decompression may help prevent these complications. This preliminary study aims to compare the effects of controlled and conventional decompression in patients with severe head injury. MATERIAL AND METHODS: A total of 128 patients with severe head injury were included. Patients were allocated to receive either controlled decompression surgery (n = 64) or conventional decompressive craniectomy (n = 64). Controlled decompression comprised controlled ventricular drainage and controlled hematoma evacuation. The occurrence of delayed hematoma, acute brain swelling, and postoperative cerebral infarction were recorded. RESULTS: Significantly lower proportion of patients in the controlled decompression group had intraoperative acute brain swelling compared to patients in the decompressive craniectomy group (9.4% vs 26.6%, P = 0.011). Intraoperative acute encephalocele occurred in 3 of 13 patients (23.1%) who had delayed hematoma in the controlled decompression group compared with 11 of 18 patients (61.1%) in the decompressive craniectomy group. There was no significant between group difference in the incidence of delayed hematoma or postoperative cerebral infarction. CONCLUSION: Controlled decompression may reduce or delay intraoperative acute brain swelling by delaying hematoma formation in patients with severe head injury.

Surgical management of traumatic interhemispheric subdural hematoma.

AIM: To review our experience in the surgical treatment of TISH, and to analyze prognostic factors. MATERIAL AND METHODS: Clinical and imaging data, surgical modalities, and outcomes of 21 patients with TISH who were treated with microsurgery were analyzed retrospectively. Prognostic factors for outcome were analyzed by univariate analysis. RESULTS: Long-term follow up with outcome assessment according to the Glasgow Outcome Scale (GOS) showed good recovery in 16 cases, moderate disability in two cases, severe disability in one case, and death in two cases. During surgery the origin of bleeding could be identified in all 21 cases. A rupture of the distal anterior cerebral artery or veins in the interhemispheric fissure was seen more frequently in patients with whole interhemispheric fissure hematoma, while hemorrhage from brain tissue laceration was seen more frequently in patients with more localized hematomas. The outcome in patients with an identified rupture of a vessel was better than in those with cortical laceration. Preoperative GCS score and thickness of the interhemispheric hematoma were correlated with outcome (P=0.001 and P=0.004, respectively). CONCLUSION: Outcome after surgical treatment for TISH can be good, and careful surgical planning and microsurgical techniques to preserve venous drainage are essential.