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Neurosurgical Review Apr 2021Brainstem hemangioblastomas are benign, highly vascular tumors located in the mesencephalon, pons, and medulla oblongata. Although surgical resection is currently... (Meta-Analysis)
Meta-Analysis
Brainstem hemangioblastomas are benign, highly vascular tumors located in the mesencephalon, pons, and medulla oblongata. Although surgical resection is currently considered the main therapeutic option for symptomatic lesions, evidence supporting the application of microsurgery has not been systematically assessed. This meta-analysis aims to evaluate the safety and efficacy of surgical treatment for brainstem hemangioblastomas. A comprehensive search of the PubMed, Embase, and Web of Science databases was performed to identify all English language publications reporting the outcomes of surgical treatment for brainstem hemangioblastomas. Studies from January 1990 to July 2019 with ≥ 10 cases were included. We analyzed the surgical outcomes, including gross total resection, mortality, neurological morbidity, and functional outcome according to the McCormick Scale or Karnofsky Performance Scale. Thirteen studies with 473 cases were included. The pooled proportion of gross total resection was 98% (95% confidence interval (CI), 94-100%). Overall mortality and neurological morbidity were 4 (95% CI, 2-6%) and 13% (95% CI, 7-20%), respectively. Favorable functional outcomes at the last follow-up were achieved in 85% (95% CI, 78-92%) of all patients. Improved or stable functional outcomes at long-term follow-up were achieved in 94% (95% CI, 89-97%) of patients. This meta-analysis revealed that surgical treatment for brainstem hemangioblastomas is technically feasible and effective with lasting patient benefits and cure.
Topics: Adult; Brain Stem Neoplasms; Female; Hemangioblastoma; Humans; Karnofsky Performance Status; Male; Microsurgery; Middle Aged; Neurosurgical Procedures; Observational Studies as Topic; Retrospective Studies; Treatment Outcome
PubMed: 32356022
DOI: 10.1007/s10143-020-01305-3 -
Neurochemical Research Apr 2020Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) has been proposed as a treatment strategy for gait disorder in patients with Parkinson's disease (PD).... (Meta-Analysis)
Meta-Analysis
Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) has been proposed as a treatment strategy for gait disorder in patients with Parkinson's disease (PD). We thus performed a systematic review and meta-analysis of randomized and nonrandomized controlled trials to assess the effect of this treatment on gait disorder in patients with PD. We systematically searched PubMed, Cochrane, Web of Knowledge, Wan Fang and WIP for randomized and nonrandomized controlled trials (published before July 29, 2014; no language restrictions) comparing PPN-DBS with other treatments. We assessed pooled data using a random effects model and a fixed effects model. Of 130 identified studies, 14 were eligible and were included in our analysis (N = 82 participants). Compared to those presurgery, the Unified Parkinson Disease Rating Scale (UPDRS) 27-30 scores for patients were lowered by PPN-DBS [3.94 (95% confidence interval, CI = 1.23 to 6.65)]. The UPDRS 13 and 14 scores did not improve with levodopa treatment [0.43 (- 0.35 to 1.20); 0.35 (- 0.50 to 1.19)], whereas the UPDRS 27-30 scores could be improved by the therapy [1.42 (95% CI 0.34 to 2.51)]. The Gait and Falls Questionnaire and UPDRS 13 and 14 scores showed significant improvements after PPN-DBS under the medication-off (MED-OFF) status [15.44 (95% CI = 8.44 to 22.45); 1.57 (95% CI = 0.84 to 2.30); 1.34 (95% CI = 0.84 to 1.84)]. PPN-DBS is a potential therapeutic target that could improve gait and fall disorders in patients with PD. Our findings will help improve the clinical application of DBS in PD patients with gait disorder.
Topics: Clinical Trials as Topic; Deep Brain Stimulation; Gait Disorders, Neurologic; Humans; Parkinson Disease; Pedunculopontine Tegmental Nucleus
PubMed: 31950450
DOI: 10.1007/s11064-020-02962-y -
Neurological Sciences : Official... Dec 2019The main purpose of this study was to systematically evaluate the accuracy of neuromelanin-sensitive magnetic resonance imaging (NM-MRI) in Parkinson's disease (PD)... (Meta-Analysis)
Meta-Analysis
The main purpose of this study was to systematically evaluate the accuracy of neuromelanin-sensitive magnetic resonance imaging (NM-MRI) in Parkinson's disease (PD) diagnosis using a meta-analysis method. In PubMed, Web of Science, Embase, and Google Scholar, the literatures were searched for the diagnostic value of neuromelanin-sensitive magnetic resonance imaging in PD. The literatures were screened in the light of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data analysis was processed by Stata 12.0 software to obtain meta-analysis, heterogeneity analysis, and publication bias. Meta-analysis results showed by using NM-MRI observed substantia nigra pars compacta (SNpc) on PD, the pooled diagnostic sensitivity and specificity were 0.82 (95% CI, 0.74-0.87) and 0.82 (95% CI, 0.73-0.89), respectively. And the pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 4.58 (95% CI, 3.08-6.82) and 0.22 (95% CI, 0.16-0.31), respectively. Moreover, subgroup analysis according to the measurement criteria of SNpc showed the SNpc volume should be used as good a marker for diagnosing PD. Finally, Fagan test demonstrated that when PLR was equal to 5, the posterior probability is significantly enhanced to 53%, compared with prior probability (20%). As for NLR (0.22), the prior probability is 20%, while the posterior probability remarkably dropped to 5%. In conclusion, SNpc signal detected by NM-MRI exhibited high sensitivity and specificity for diagnosis of PD, which was a high-performance imaging diagnostic method for PD. We recommend NM-MRI imaging technology to be widely used in Parkinson's diagnosis.
Topics: Humans; Magnetic Resonance Imaging; Melanins; Neuroimaging; Parkinson Disease; Substantia Nigra
PubMed: 31392640
DOI: 10.1007/s10072-019-04014-y -
Journal of Neurointerventional Surgery Dec 2019Perimesencephalic subarachnoid hemorrhage (PMSAH) is a benign subtype with distinct clinical-radiologic features. Digital subtraction angiography (DSA) remains the gold...
BACKGROUND
Perimesencephalic subarachnoid hemorrhage (PMSAH) is a benign subtype with distinct clinical-radiologic features. Digital subtraction angiography (DSA) remains the gold standard investigation for exclusion of a macrovascular cause, although increasingly more clinicians rely solely on CT angiography (CTA). The primary aim of this systematic review was to evaluate the current literature regarding the negative predictive value of CTA.
METHODS
A systematic search in concordance with the PRISMA checklist was performed for studies published between 2000 and 2018. Studies with ≥10 adult patients diagnosed on a non-contrast brain CT with a PMSAH, who underwent a negative CTA and were subsequently subject to a DSA, were included. Simple pooled analysis was performed to inform the negative predictive value (95% CI) of CTA and the risk of DSA- and CTA-related complications.
RESULTS
Eighteen studies (669 patients) were included. All patients were subject to at least one DSA, the first one mostly performed within 24 hours of CTA (68.6%). 144 patients (21.5%) underwent a second DSA and a third repeat DSA was performed in one patient. The overall negative predictive value of CTA was 99.0% (95% CI 97.8% to 99.5%). The risk of complications following DSA and CTA were 1.35% (3/222) and 0% (0/41), respectively.
CONCLUSIONS
Undertaking a DSA after a negative CTA may not add any further diagnostic value in patients with PMSAH and may lead to net harm. This observation needs to be validated in a large-scale prospective multicenter study with complete case ascertainment and robust data on CTA and DSA complications.
Topics: Adult; Aged; Angiography, Digital Subtraction; Checklist; Computed Tomography Angiography; Female; Humans; Male; Mesencephalon; Middle Aged; Prospective Studies; Subarachnoid Hemorrhage
PubMed: 31273072
DOI: 10.1136/neurintsurg-2019-015051 -
Clinical Neurology and Neurosurgery May 2019Isolated perimesencephalic subarachnoid hemorrhage is an uncommon, distinct subtype of subarachnoid hemorrhage with a more benign prognosis. A negative computed... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Isolated perimesencephalic subarachnoid hemorrhage is an uncommon, distinct subtype of subarachnoid hemorrhage with a more benign prognosis. A negative computed tomographic angiogram has been shown to be reliable in excluding aneurysmal rupture as the underlying etiology. However, some studies continue advocating for more imaging to determine a vascular cause in perimesencephalic subarachnoid hemorrhage. The objective of this study is to evaluate the evidence for use and utility of repeat angiographic imaging after a negative computed tomographic angiogram in patients with perimesencephalic subarachnoid hemorrhage.
PATIENTS AND METHODS
Retrospective institutional analysis of patients with perimesencephalic subarachnoid hemorrhage was performed from 2014 to 2017 for number and types of follow-up angiographic imaging studies performed. Updated meta-analysis of literature was performed from 2014 onwards to assess the utility of follow-up imaging after a negative initial angiographic study.
RESULTS
The institutional review revealed no utility of additional imaging after a negative computed tomographic angiogram in 6 patients with isolated perimesencephalic subarachnoid hemorrhage. Literature review and metaanalysis of 13 studies with 588 patients revealed a vascular etiology in 3 patients with isolated perimesencephalic subarachnoid hemorrhage from a single study- 2 aneurysms and 1 patient with vasculitis.
CONCLUSIONS
Use of repeat angiographic imaging after a negative computed tomographic angiogram for perimesencephalic subarachnoid hemorrhage patients remains not uncommon, despite previous meta-analysis. Review of the more recent literature is consistent with previously published meta-analysis and shows limited benefits despite frequent use. In patients with a strictly defined perimesencephalic subarachnoid hemorrhage pattern and clinical picture consistent with perimesencephalic subarachnoid hemorrhage, an initial negative computed tomographic angiogram should be adequate and repeated follow-up studies can be avoided.
Topics: Cerebral Angiography; Follow-Up Studies; Humans; Intracranial Hemorrhages; Mesencephalon; Neuroimaging; Subarachnoid Hemorrhage
PubMed: 30974309
DOI: 10.1016/j.clineuro.2019.03.006 -
Neuroscience and Biobehavioral Reviews Jun 2019The monoamine hypothesis of depression, namely that the reduction in synaptic serotonin and dopamine levels causes depression, has prevailed in past decades. However,...
The monoamine hypothesis of depression, namely that the reduction in synaptic serotonin and dopamine levels causes depression, has prevailed in past decades. However, clinical and preclinical studies have identified various cortical and subcortical regions whose altered neural activities also regulate depressive-like behaviors, independently from the monoamine system. Our systematic review indicates that neural activities of specific brain regions and associated neural circuitries are adaptively altered after chronic stress in a specific direction, such that the neural activity in the infralimbic cortex, lateral habenula and amygdala is upregulated, whereas the neural activity in the prelimbic cortex, hippocampus and monoamine systems is downregulated. The altered neural activity dynamics between monoamine systems and cortico-limbic systems are reciprocally interwoven at multiple levels. Furthermore, depressive-like behaviors can be experimentally reversed by counteracting the altered neural activity of a specific neural circuitry at multiple brain regions, suggesting the importance of the reciprocally interwoven neural networks in regulating depressive-like behaviors. These results promise for reshaping altered neural activity dynamics as a therapeutic strategy for treating depression.
Topics: Animals; Biogenic Monoamines; Cerebral Cortex; Depression; Depressive Disorder; Disease Models, Animal; Humans; Limbic System; Neural Pathways; Neurons; Stress, Psychological; Ventral Tegmental Area
PubMed: 30917923
DOI: 10.1016/j.neubiorev.2019.03.014 -
Neurobiology of Disease Aug 2019Animal studies have demonstrated that the pedunculopontine nucleus (PPN) is involved in the control of posture and gait, and that it is also a key structure in...
BACKGROUND
Animal studies have demonstrated that the pedunculopontine nucleus (PPN) is involved in the control of posture and gait, and that it is also a key structure in controlling basic non-motor functions such as sleep, attention and arousal. In this systematic review we aimed to evaluate all available studies assessing the role of PPN on cognition, nocturnal sleep and alertness in humans. Finally, we attempted to define a model in which PPN acts as an interface structure between motor control and behavior.
METHODS
A systematic search of the computerized databases MEDLINE and PubMed was conducted to identify papers on PPN and cognitive functions, sleep and alertness. Key search terms included: 'PPN', 'arousal', 'sleep', 'cognition', 'memory', 'language', 'attention', 'alertness', 'PPN-DBS', 'Parkinson's and PPN', 'Parkinson's and PPN-DBS'.
RESULTS
Twelve studies met our inclusion criteria and were included. All of them involved PD patients implanted with unilateral or bilateral PPN-DBS, most patients had concomitant DBS of another anatomical structure (subthalamic nucleus or Zona incerta). There is a lack of consistent evidences confirming the effect of PPN-DBS on specific cognitive functions, alertness or sleep in PD. There is heterogeneity between and within surgical centres of study protocols especially regarding DBS targeting, parameters of stimulation and experimental methods. Moreover, the available studies are limited by the small sample size and the short follow-up time. It has been suggested that low frequency stimulation (25 Hz) has a better effect compared to the high frequency one (60-80 Hz) on alertness, however this needs to be confirmed in further studies.
CONCLUSIONS
PPN-DBS is a promising but yet an experimental procedure. PD represents an encouraging pathological model for future studies aiming to shade light on the role of PPN in cognition, attention and alertness in humans.
Topics: Cognition; Humans; Pedunculopontine Tegmental Nucleus; Sleep; Subthalamic Nucleus
PubMed: 30710676
DOI: 10.1016/j.nbd.2019.01.022 -
Ultrasound in Medicine & Biology Mar 2019A systematic review and meta-analysis were conducted to evaluate the diagnostic accuracy of substantia nigra hyper-echogenicity by transcranial sonography (TCS) for the... (Meta-Analysis)
Meta-Analysis
A systematic review and meta-analysis were conducted to evaluate the diagnostic accuracy of substantia nigra hyper-echogenicity by transcranial sonography (TCS) for the diagnosis of Parkinson's disease (PD). PubMed, Embase and the Cochrane Library were electronically searched from inception to June 2018 for all relevant studies. The methodological quality of each study was evaluated by two independent reviewers, who used the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Articles reporting information sufficient to calculate the sensitivity and specificity of TCS to diagnose PD were included. Statistical analysis included data pooling, heterogeneity testing, sensitivity analyses and forest meta-regression. Thirty-nine studies (3123 participants with PD) were analyzed. The pooled sensitivity and specificity of TCS were 0.84 (95% confidence interval: 0.81-0.87) and 0.85 (0.80-0.88), respectively, for differentiating PD from normal controls or participants with other parkinsonian syndromes. In the secondary outcome, PD participants exhibited a significant increase in substantia nigra areas than either normal controls (0.14 [0.12-0.16], p < 0.0001) or participants with other parkinsonian syndromes (0.11 [0.08-0.13], p < 0.0001). This meta-analysis revealed the high diagnostic performance of TCS in differentiating patients with PD from both normal controls and participants with other parkinsonian syndromes.
Topics: Diagnosis, Differential; Parkinson Disease; Reproducibility of Results; Sensitivity and Specificity; Substantia Nigra; Ultrasonography, Doppler, Transcranial
PubMed: 30612821
DOI: 10.1016/j.ultrasmedbio.2018.11.010 -
Neuroscience and Biobehavioral Reviews Dec 2017The locus coeruleus (LC), the major origin of noradrenergic modulation of the central nervous system, innervates extensive areas throughout the brain and is implicated... (Review)
Review
The locus coeruleus (LC), the major origin of noradrenergic modulation of the central nervous system, innervates extensive areas throughout the brain and is implicated in a variety of autonomic and cognitive functions. Alterations in the LC-noradrenergic system have been associated with healthy ageing and neuropsychiatric disorders including Parkinson's disease, Alzheimer's disease and depression. The last decade has seen advances in imaging the structure and function of the LC, and this paper systematically reviews the methodology and outcomes of sixty-nine structural and functional MRI studies of the LC in humans. Structural MRI studies consistently showed lower LC signal intensity and volume in clinical groups compared to healthy controls. Within functional studies, the LC was activated by a variety of tasks/stimuli and had functional connectivity to a range of brain regions. However, reported functional LC location coordinates were widely distributed compared to previously published neuroanatomical locations. Methodological and demographic factors potentially contributing to these differences are discussed, together with recommendations to optimize the reliability and validity of future LC imaging studies.
Topics: Humans; Image Processing, Computer-Assisted; Locus Coeruleus; Magnetic Resonance Imaging
PubMed: 29107830
DOI: 10.1016/j.neubiorev.2017.10.023 -
World Neurosurgery Dec 2017Tumors arising from the pineal region account for approximately 1% of intracranial neoplasms. We present a case of a previously healthy 5-year-old boy with an acute... (Review)
Review
BACKGROUND
Tumors arising from the pineal region account for approximately 1% of intracranial neoplasms. We present a case of a previously healthy 5-year-old boy with an acute onset of headache. A magnetic resonance imaging (MRI) scan showed a pineal mass with aqueduct compression. The patient was scheduled for tumor resection. An endoscopic third ventriculostomy was performed in advance for the treatment of hydrocephalus. Afterwards, MRI showed a relevant regression of the pineal mass without specific treatment. Consequently, surgery was cancelled and further MRI follow-up showed a regression of the mass and a constant tumor mass over a period of 30 months. Spontaneous regression of malignant tumors is a rare phenomenon with an incidence of 1 of 60,000-100,000 cases. Only a few cases with spontaneous regression of pineal tumors have been reported.
METHODS
We performed a systematic literature review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines on spontaneously regressing pineal lesions and found 13 cases in the literature.
RESULTS
Six hypotheses for explaining tumor regression were found, comprising treatment with steroids, effects of diagnostic irradiation, treatment of hydrocephalus, pineal apoplexy, surgical trauma, and immunologic mechanisms. None of these mechanisms was evidentiary. However, in all reported cases, some kind of treatment (e.g. treatment of hydrocephalus, application of steroids, and so on) has been performed before tumor regression.
CONCLUSIONS
The clinician has to bear in mind that regression of pineal tumors might be triggered by use of steroids, for example, and in cases of improvement of the patient's presenting symptoms, new MRI scans should be performed.
Topics: Brain Neoplasms; Cerebral Aqueduct; Child, Preschool; Consciousness Disorders; Diffusion Magnetic Resonance Imaging; Headache; Humans; Hydrocephalus; Magnetic Resonance Imaging; Male; Neoplasm Regression, Spontaneous; Pineal Gland; Pinealoma; Ventriculostomy; Vomiting
PubMed: 28844909
DOI: 10.1016/j.wneu.2017.08.106