Month: July 2025

Posted on

Predecompression and postdecompression cognitive and affective changes in Chiari malformation type I

J Neurosurg 143:4–12, 2025

This prospective study found that patients with Chiari malformation type I commonly experience cognitive and psychiatric impairments, particularly in executive function and visuospatial memory. Following posterior fossa decompression surgery, 89% showed significant improvement in cognitive and/or psychiatric symptoms, highlighting the cerebellum’s role in these functions.

• Chiari malformation type I (CM-I) patients often have unrecognized cognitive and psychiatric symptoms, including deficits in executive function, visuospatial memory, and increased depression, anxiety, and related symptoms.

• This prospective study assessed 54 CM-I patients with cognitive or psychiatric complaints before and after posterior fossa decompression (PFD) surgery.

• Preoperatively, patients performed worse than normative samples in executive function and visuospatial memory, and reported more psychiatric symptoms across all measured domains.

• Six months after surgery, 89% of patients showed clinically significant improvements (>1 SD) in cognitive and/or psychiatric domains.

• Improvements were most notable in visuospatial memory and psychiatric symptoms such as depression and anxiety, which normalized to levels seen in the general population.

• Patients with the most severe preoperative deficits experienced the greatest postoperative improvements.

• The findings support a key role for the cerebellum in cognitive and psychiatric dysfunction and suggest that some symptoms in CM-I are potentially treatable with targeted cerebellar intervention.

• Limitations include lack of a control group and focus on symptomatic, self-reporting patients, so results may not generalize to all CM-I cases.

Posted on

Prediction of Shunt Malfunction Using Automated Ventricular Volume Analysis and Radiomics

Neurosurgery 97:242–249, 2025

Automated ventricular volume analysis using convolutional neural networks and radiomics, combined with clinical features, improves accuracy in diagnosing hydrocephalus and shunt malfunction from CT scans, outperforming traditional 2D methods and enabling earlier, more reliable detection without requiring prior imaging.

• Automated ventricular volume analysis and radiomics were used to predict shunt malfunction and diagnose hydrocephalus from CT scans.

• Traditional 2D measurements are less sensitive than 3D volumetric analysis for detecting ventricular changes.

• A convolutional neural network (CNN) segmented ventricles, and volumes were compared to age- and sex-matched normative data.

• Volumetric analysis alone achieved up to 73% accuracy (AUC 0.772) for detecting pathology; combining radiomics and clinical data improved accuracy significantly.

• The best model (support vector machine) using selected radiomics features and clinical data reached an AUC of 0.92–0.93 and F1-score of 0.848.

• Automated segmentation is time-efficient, reduces observer variability, and may improve early and accurate diagnosis.

• Limitations include single-institution data, scanner variability, and need for external validation.

• Future work should expand datasets and improve model generalizability, including to MRI and other manufacturers.

Posted on

Cerebellopontine Angle Meningiomas: A Multi-Institutional Cohort Study

Neurosurgery 97:105–111, 2025

This multi-institutional study of 95 cerebellopontine angle meningioma cases found that gross total resection, especially with internal auditory canal drilling for intracanalicular invasion, improves symptom control and reduces recurrence. Most patients experienced stable or improved hearing, with postoperative complications and recurrence rates detailed.

• Cerebellopontine angle (CPA) meningiomas are challenging due to their proximity to neurovascular structures and present commonly with hearing loss, ataxia, and headaches.

• Gross total resection (GTR) was achieved in 62.1% of 95 patients; smaller tumor size and drilling the internal auditory canal (IAC) for tumors with intracanalicular invasion were associated with higher GTR rates.

• Most patients had stable or improved hearing postoperatively; only a minority experienced worsening.

• Postoperative complications included cranial nerve dysfunction, CSF leak, and hydrocephalus, but there were no perioperative deaths.

• Tumor progression or recurrence occurred in 25.3% of patients, with higher rates in WHO grade 2 tumors; Simpson grade I/II resection and older age reduced recurrence risk.

• Extent of resection (EOR) is not reliably predicted by tumor size alone; other anatomical factors are important.

• Adjuvant radiation was mainly used for higher-grade tumors with subtotal resection, but most progression cases were managed with observation or salvage therapy.

• Surgical resection is effective for symptom control and reducing recurrence, especially with GTR and appropriate IAC management.

Proudly powered by WordPress