Clinical neurology and neurosurgery Journal Impact Factor & Information

Publisher: Elsevier

Journal description

Current impact factor: 1.25

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 1.248
2012 Impact Factor 1.234
2011 Impact Factor 1.581
2010 Impact Factor 1.636
2009 Impact Factor 1.303
2008 Impact Factor 1.323
2007 Impact Factor 1.553
2006 Impact Factor 1.506
2005 Impact Factor 1.089
2004 Impact Factor 0.954
2003 Impact Factor 0.771
2002 Impact Factor 0.743
2001 Impact Factor 0.595
2000 Impact Factor 0.619
1999 Impact Factor 0.564
1998 Impact Factor 0.406
1997 Impact Factor 0.613
1996 Impact Factor 0.619
1995 Impact Factor 0.594
1994 Impact Factor 0.489
1993 Impact Factor 0.326
1992 Impact Factor 0.353

Impact factor over time

Impact factor

Additional details

5-year impact 1.58
Cited half-life 5.50
Immediacy index 0.23
Eigenfactor 0.01
Article influence 0.43
ISSN 1872-6968

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
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  • Conditions
    • Pre-print allowed on any website or open access repository
    • Voluntary deposit by author of authors post-print allowed on authors' personal website, or institutions open scholarly website including Institutional Repository, without embargo, where there is not a policy or mandate
    • Deposit due to Funding Body, Institutional and Governmental policy or mandate only allowed where separate agreement between repository and the publisher exists.
    • Permitted deposit due to Funding Body, Institutional and Governmental policy or mandate, may be required to comply with embargo periods of 12 months to 48 months .
    • Set statement to accompany deposit
    • Published source must be acknowledged
    • Must link to journal home page or articles' DOI
    • Publisher's version/PDF cannot be used
    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PubMed Central after 12 months
    • Publisher last contacted on 18/10/2013
  • Classification
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Minimally invasive craniopuncture has been used to treat intracerebral hemorrhage (ICH) for over 20 years in China. However, one-off total evacuation of hematoma cannot be achieved through this procedure because it is not an open surgery. This study is designed to identify factors that can increase the hematoma evacuation rate (ER) of this procedure and to evaluate the influence of ER on long-term outcome. A total of 309 patients with basal ganglia ICH treated by minimally invasive craniopuncture were analyzed retrospectively. Univariate and multivariate linear regression analyses were used to identify factors correlated with a high ER. The correlation between ER and long-term outcome was also analyzed by logistic regression and the Spearman correlation. A low hematoma mean CT number (β=-0.773, p<0.001) and postoperative cerebrospinal fluid (CSF) outflow (β=0.193, p<0.001) were found to be independent factors associated with a high ER. In patients with 30-50ml of hematoma, a high ER was correlated with a high Barthel index improvement (r=0.611, p<0.001) and a high modified Rankin scale decline (r=0.517, p<0.001). In patients with 50-80ml of hematoma, a high ER was a protective factor of case fatality (B=-2.297, p=0.005). The hematoma mean CT number can predict the efficiency of minimally invasive craniopuncture in patients with ICH. In patients with ventricular involvement, the tip of the puncture needle should be placed close to the tear in the ventricle rather than at the center of the hematoma to facilitate postoperative CSF outflow. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 07/2015; 134. DOI:10.1016/j.clineuro.2015.04.020
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    ABSTRACT: The 9-item Wearing-off Questionnaire (WOQ-9) is a useful tool for screening of wearing-off. We performed a validation study of the Japanese version of the WOQ-9 (JWOQ-9) using a cross-sectional design in Japanese Parkinson's disease (PD) patients diagnosed with sporadic PD and treated with levodopa. Subjects with severe dementia, uncontrolled psychiatric comorbidities, and previous PD neurosurgery were excluded. The wearing-off phenomenon was detected according to the JWOQ-9, and the results were compared with independent evaluations of wearing-off conducted by PD specialists blinded to the JWOQ-9 results. To validate the JWOQ-9, a sample size of at least 70 patients with wearing-off and 70 patients without wearing-off was required. Therefore, a total of 180 patients (101 patients with wearing-off and 79 patients without wearing-off) were enrolled. The sensitivity, specificity, positive predictive value, and negative predictive value of the JWOQ-9 were 94.1%, 39.2%, 66.4%, and 83.8%, respectively. Motor symptom questions demonstrated both moderate sensitivity (58.1-87.3%) and specificity (60.4-87.5%). In contrast, non-motor symptom questions demonstrated fair to moderate sensitivity (51.5-64.6%), with high specificity (80.0-94.1%). Like the original WOQ-9, the JWOQ-9 exhibits significant value for detecting possible wearing-off. The JWOQ-9 is a useful screening tool for detecting wearing-off of both motor and non-motor symptoms. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 07/2015; 134. DOI:10.1016/j.clineuro.2015.04.021
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    ABSTRACT: To investigate anti-collagen-type-IV serum antibodies (ACIVAbs) levels in patients with clinically isolated syndrome (CIS), and to determine their predictive value for conversion into multiple sclerosis (MS). Serum levels of IgM and IgG ACIVAbs in 40 untreated patients with CIS (13 male, mean age 34.85±11.4 years, range 16-58 years) were compared to those of 27 gender- and age-matched healthy controls. ACIVAbs were quantified using ELISA. Patients were followed for 5 years by clinical examination and MRI studies. Thirty two patients (80%) converted to MS (converted CIS, C-CIS group) while the rest 8 (20%) did not (non-converted CIS, NC-CIS). The C-CIS patients had significantly higher levels of IgG ACIVAb compared to NC-CIS while the IgM levels did not differ between C-CIS and NC-CIS. Conversion to MS occurred in 66% of patients with IgG ACIVAbs levels exceeding the 95th percentile found in controls. IgG ACIVAbs levels correlated positively with the serum levels of matrix metalloproteinases type 9 (r=0.37; p=0.003) and inversely with those of tissue inhibitor of metalloproteinases type 1 (r=-0.43; p=0.0008). High serum levels of IgG ACIVAbs in patients with CIS correlate strongly with increased risk of conversion to MS. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 06/2015; 133. DOI:10.1016/j.clineuro.2015.03.011
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    ABSTRACT: Aggressive surgery seems mandatory for poor-grade middle cerebral artery (MCA) aneurysm with associated intracerebral hemorrhage (ICH). However, primary decompressive craniectomy (DC) is controversial. We performed a case control study to define the role of primary DC. We analyzed data from the two cohorts: a multicenter prospective poor-grade aSAH registry study (AMPAS); and the National Clinical Research Center for Neurological Diseases (NCRC-ND) database of poor-grade patients. Outcome was assessed by modified Rankin Scale (mRS) and was dichotomized into favorable (mRS 0-3) and unfavorable outcome (mRS 4-6). We compared major complication rates, mortality and outcomes between primary DC and control groups. Twenty-four patients with primary DC were included in the study group. Fourteen patients without DC were included in the control group. Patients with younger age and lower Glasgow coma score (GCS) more often underwent primary DC. Major complications did not differ between the two groups. Fourteen (58%) patients had a favorable outcome, and the mortality was 29%. Primary DC appeared to have lower in-hospital mortality and have better outcome. Adjusting for age and admission GCS, primary DC was not significantly associated with decreased mortality and improved outcomes. Although primary DC does not increase postoperative complication and mortality risk, current results showed primary DC does not seem to be significantly associated with improved outcomes. However, more than one half of patients most benefit from primary DC. Further prospective controlled studies are warranted to clarify the issue. Copyright © 2015. Published by Elsevier B.V.
    Clinical neurology and neurosurgery 06/2015; 133. DOI:10.1016/j.clineuro.2015.03.009
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    ABSTRACT: Decompressive craniectomy (DC) has been regaining popularity in the field of neurosurgery because it can alleviate intracranial hypertension and brain swelling. Lumbar drainage (LD) is affective in managing numerous neurosurgical circumstances such as aneurysmal subarachnoid hemorrhage, refractory intracranial hypertension, cerebrospinal fluid (CSF) leakage and intraoperative brain relaxation. Sinking skin flap syndrome (SSFS) or paradoxical herniation (PH) is a rare complication and sporadically occurs in patients after DC. Hereby, we report for the first time that DC patients with LD can progress to SSFS or PH. We also evaluated the risk factors for the incidence of SSFS in DC patients with LD. We retrospectively assessed 37 patients who underwent DC and LD for cerebrovascular diseases from the First Hospital of Jilin University between January, 2007 and December, 2012. Nine (4 male and 5 female) of 37 patients experienced SSFS or PH following LD. At the last follow-up (mean 9 months, range 6-12 months), eight patients recovered completely due to timely conservative management and one patient died from PH. The mortality rate was 11% (1/9) from the complications of PH or SSFS. Further statistical analysis revealed that mean daily CSF volume was a risk factor for the incidence of SSFS in DC patients with LD. SSFS or PH can be identified in DC patients following LD. Patients that undergo DC and LD should be monitored more intensively. Most patients can completely recover with timely conservative management, bed rest, Trendelenburg position, sufficient intravenous fluid, and temporary clipping of the catheter. Copyright © 2015. Published by Elsevier B.V.
    Clinical neurology and neurosurgery 06/2015; 133. DOI:10.1016/j.clineuro.2015.03.010
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    ABSTRACT: The BrainSuite(®) is a highly integrated operating theater designed mainly for brain tumor surgery. The issues concerning its routine use in vascular neurosurgery have not been discussed in literature to date. We report our experience of surgical treatment of cerebral aneurysms in the BrainSuite(®), with a view to evaluating safety, feasibility, advantages, disadvantages, and contraindications. Retrospectively, we reviewed all the patients affected by ruptured and unruptured aneurysms that underwent craniotomy with clipping between January 2007 and May 2013 and a subsequent minimum 12-month follow up. Intraoperative DWI, MRA, and volumetric MRI were always performed in order to evaluate vessel patency and early ischemic lesions. The usefulness of navigation was also evaluated in terms of loss/gain of time and its effectiveness as a surgical aid to both the localization of small distal aneurysms and the preoperative planning of the clipping strategies to adopt. A total of 105 patients were included in this report. Of these, 39 and 66 were affected, respectively, by ruptured and unruptured aneurysms. The mean age was 56.1 and the male-to-female ratio was 1:2.9. The aneurysms affected, with progressively descending incidence, the MCA, ACoA, ICA bifurcation, PComA, A2, A1-A2, and C6 segment of the ICA in 40 (38.1%), 23 (22%), 15 (14.3%), 7 (6.6%), 7 (6.6%), 7 (6.6%), and 6 (5.8%) cases, respectively. The aneurysms were clipped and completely excluded from blood circulation in all cases and no difficulty was encountered in positioning and fixing the patients' heads, despite the particular head holder of the BrainSuite(®). MRI created no interference or problems in cases of carotid exposure at the neck, while harvesting of the lower-limb saphenous vein was not feasible due to the vicinity of the operating field to the magnet. Intraoperative angiography was never performed since an angiogram is not compatible with the BrainSuite. Intraoperative DWI, MRA, and volumetric MRI proved to be effective tools for post-clipping evaluation of the patency of the parent vessels and their collateral branches as well as of aneurismal occlusion. This was also checked doubly by availing also of intraoperative micro Doppler ultrasonography. Intraoperative DWI also permitted us to evaluate the presence of initial ischemic lesions as possible consequences of both direct arterial occlusion and early vasospasm related to surgical manipulation. Intraoperative navigation of brain aneurysm with 3D-model reconstructions may be of some use to younger surgeons when planning the clipping strategies and localizing the aneurysm particularly in cases, respectively, of large-complex aneurysms where the sac involves collateral branches and small aneurisms affecting both distal ACA and MCA aneurysms. The outcomes for patients, evaluated according to the GOS (Glasgow outcome score), associated significantly with the preoperative HH (Hunt and Hess) scale grading. Patients with high HH scores (IV and V) in particular showed the highest incidence of unfavorable outcome (GOS=1 or 2) CONCLUSIONS: The BrainSuite(®) theater is completely suited to brain aneurysm surgery but only in cases where a combined endovascular approach may be required. It provides some advantages and few limitations compared to a normally-equipped neurosurgical operating theater; our experience shows that the technological advances of this complex operating room are useful though not essential in aneurysm surgery. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 06/2015; 133. DOI:10.1016/j.clineuro.2015.03.007
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    ABSTRACT: Carotid stenosis is associated with hemodynamic cerebral ischemia. Diffusion-weighted MR imaging allows for the assessment of changes related to alterations in tissue integrity. The aim of this study was to investigate (a) whether white matter lesions (WML) and apparent diffusion coefficient (ADC) values differ between ipsilateral and contralateral hemispheres, (b) whether ADC values are related to WMLs and common vascular risk factors, and (c) whether ADC values differ after carotid endarterectomy (CEA) without a shunt in patients with unilateral internal carotid artery stenosis (ICAS). Twenty-five patients (16 men, 9 women; mean age of 68 years) with unilateral ICAS (≥70% carotid stenosis) were assessed with brain MRI before and after CEA, prospectively. Two experienced radiologists scored the WMLs. Bilateral ADC values in anterior and posterior periventricular WM, occipital WM, and thalamus were evaluated on preoperative and postoperative MRI. Differences in ADC values and WML scores between the two hemispheres were assessed and associations between ADC values, WML scores, and explanatory variables (e.g., age, sex, vascular risk factors) were analyzed. WMLs were significantly greater and ADC values were elevated in the ipsilateral cerebral WM. After CEA, ADC values rapidly decreased but remained higher than within the contralateral hemisphere. Ipsilateral hemispheric ADC values were associated with basal ganglia WMLs. No association between ADC values and vascular risk factors was found. ICAS is associated with increased diffusion in normal-appearing WM in comparison to more prominent chronic ischemic lesions. CEA has a partial effect on diffusion. These cerebral changes may be related to chronic low-grade ischemic damage that is induced by ICAS. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 06/2015; 133. DOI:10.1016/j.clineuro.2015.03.002
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    ABSTRACT: Evoked potentials and disability in multiple sclerosis: a different perspective to a neglected method. Because evoked potentials (EP) are reflections of the functional integrity of sensory-motor systems, they are expected to reflect the abnormality in patients with disabilities and handicaps and also be in correlation with scales. This assumption was tested. Patients with multiple sclerosis (MS) and myelopathy (M) and normal controls were investigated by EP, Multiple Sclerosis Walking Scale-12, timed 25-foot walk test and extended disability status scale (EDSS). EP results were converted to ordinal values, and correlations of these values with scales were calculated. Sensitivity and specificity analysis of EP parameters was also performed. Total EP scores revealed high rates of abnormality in both groups, but MS revealed a different correlation pattern from M. The SEP+MEP summed score showed high sensitivity and specificity for MS and this was also correlated with the MS-related disability-ambulation scales including EDSS. The most specific parameter was the minimum M latency in the MEP study. Four extremity recordings of EP with the use of more parameters than usual and ordinal expression of results seem to be benefical in MS. Although this study was cross sectional in nature, results indicated that EP might be useful in clinical follow up. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 06/2015; 133. DOI:10.1016/j.clineuro.2015.03.012
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    ABSTRACT: Symptomatic thoracic disc herniation (TDH) is an uncommon condition with significant treatment risks. To evaluate strategies to avoid and manage complications from thoracic disc surgery. All TDH cases by the senior author were retrospectively reviewed from 2000 to 2012. Complications were recorded, together with avoidance and management strategies. To reduce access-related morbidity, a thoracoscopic-tubular retractor approach was developed later in the series. 64 patients were treated for TDH, the majority undergoing an anterior minimally-invasive approach. Complications occurred in 15 patients (23%). Three patients with intercostal neuralgia persisting for >3 months had pain resolution after intercostal nerve blocks and radiofrequency lesioning. Five of the six patients with dural tears during anterior surgery had no further events following dural repair, lumbar drain insertion, and placement of chest tube to water seal. One case of persistent CSF leakage was successfully treated with a laparoscopically-mobilized omental flap. Preoperative metallic marker placement was effective at guiding correct-level surgery. For anterior operations, no pneumothorax occurred with routine chest tube placement. Our approach and techniques evolved based on early experience, allowing us to reduce surgical morbidity. The thoracoscopic-tubular retractor approach was associated with low morbidity (no complications among 13 cases other than temporary intercostal neuralgia). Several strategies may reduce morbidity from thoracic disc surgery: careful approach selection, preoperative level marking, use a tubular retractor with thoracoscopic guidance, rib resection at the mini-thoracotomy site, routine chest tube placement for anterior operations, and routine lumbar drain insertion in the event of a dural tear. Prospective comparative studies are needed to assess the efficacy of these techniques. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 06/2015; 133. DOI:10.1016/j.clineuro.2015.03.014
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    ABSTRACT: The last two decades of neurosurgery have seen flourishing use of the endonasal approach for the treatment of skull base tumors. Safe and effective resections of neoplasms requiring intracranial arterial dissection have been performed using this technique. Recently, there have been a growing number of case reports describing the use of the endonasal approach to surgically clip cerebral aneurysms. We review the use of these approaches in intracranial aneurysm clipping and analyze its advantages, limitations, and consider future directions. Three major electronic databases were queried using relevant search terms. Pertinent case studies of unruptured and ruptured aneurysms were considered. Data from included studies were analyzed. 8 case studies describing 9 aneurysms (4 ruptured and 5 unruptured) treated by the endonasal approach met inclusion criteria. All studies note the ability to gain proximal and distal control and successful aneurysm obliteration was obtained for 8 of 9 aneurysms. 1 intraoperative rupture occurred and was controlled, and delayed complications of cerebrospinal fluid leak, vasospasm, and hydrocephalus occurred in 1, 1, and 2 patients, respectively. Described limitations of this technique include aneurysm orientation and location, the need for lower profile technology, and challenges with handling intraoperative rupture. The endonasal approach for clipping of intracranial aneurysms can be an effective approach in only very select cases as demonstrated clinically and through cadaveric exploration. Further investigation with lower profile clip technology and additional studies need to be performed. Options of alternative therapy, limitations of this approach, and team experience must first be considered. Published by Elsevier B.V.
    Clinical neurology and neurosurgery 05/2015; 134:91-97. DOI:10.1016/j.clineuro.2015.04.018
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    ABSTRACT: To study microsurgical technique and prognostic factors influencing clinical outcomes in a series of 53 patients with sphenoid wing meningiomas (SWMs). The clinical materials of 53 patients with sphenoid wing meningiomas treated microsurgically between January 2008 and January 2012 were analyzed retrospectively. Follow-up period ranged from 6 to 62 months (median, 34 months). Clinical outcomes including postoperative quality of life and recurrence rate were evaluated. Univariate and multivariate statistical analysis were performed among factors that might influence postoperative quality of life. In our group, the mean age of patients was 49 years. Mean tumor size was 3.9cm. Total tumor resection was achieved in 38 cases (71.7%), subtotal in 10 cases (18.9%) and partial resection in 5 cases (9.4%). Within the follow-up period, ten patients (18.9%) had recurrence and three patients (5.7%) died. In univariate analysis, we found the postoperative Karnofshky Performance Score (KPS) improvement was determined by various factors, including extent of tumor resection, peritumoral edema, tumor blood supply, size, adhesion, encasement and preoperative KPS. However, multivariate analysis showed that complete resection, rich blood supply, adhesion to adjacent structure, encasement of neurovascular were independent predictive factors for worse postoperative KPS. With the improved requirement of postoperative quality of life in patients, intentional incomplete resection should be considered as an acceptable treatment option. Multivariate analysis confirmed that incomplete resection, poor blood supply, lack of adhesion or encasement of adjacent structure were independent predictive factors for favorable postoperative quality of life. An individual treatment strategy could help improved quality of life. Copyright © 2015. Published by Elsevier B.V.
    Clinical neurology and neurosurgery 05/2015; 134:85-90. DOI:10.1016/j.clineuro.2015.04.016
  • Clinical neurology and neurosurgery 04/2015; 134:72-74. DOI:10.1016/j.clineuro.2015.04.014
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    ABSTRACT: Intramedullary tumors account for 2-4% of all CNS neoplasms. Surgical resection is challenging because of aggravated neurological impairment in up to 64% of patients. We analyzed a consecutive series of patients with intramedullary tumors and focused on the extent of resection, functional outcome, and tumor recurrence. 53 patients (23 women and 30 men; mean age 46.3 years) were included who had undergone microsurgical resection for intramedullary spinal tumors. We reviewed the patient records for tumor size, edema, intratumoral hemorrhage, consistency, midline detection, resection method, extent of resection, histopathology, and recurrence. Outcome was measured by the Karnofsky Score (KPI), the McCormick score (MCS), and the Medical Research Council Neurological Performance Score (MRC-NPS). The most frequent diagnosis was ependymoma (37.7%), lymphoma (13.2%) and astrocytoma (11.3%). The majority of tumors were located in the thoracic spine (62.2%). Gross total resection was achieved in 73.6% and most successful in patients with ependymal histology (p<0.01). Tumor recurrence - observed in 11.3% - was significantly associated with age >65 years, astrocytic histology, higher tumor grades, and higher Ki-67 labeling. At follow-up, MCS and MRC-NPS showed significantly better results than prior to resection (p<0.001), and pain and sensory deficits had improved in 67.9% and 64.2% of patients, respectively. Microsurgical resection improved the neurological status significantly. Pain and sensory deficits showed higher improvement rates than paresis and vegetative dysfunction. Our data help identify patients at risk of tumor recurrence and classify the course of postoperative neurological performance. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 04/2015; 134:60-66. DOI:10.1016/j.clineuro.2015.04.006
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    ABSTRACT: Primary aim is to compare the diagnostic value of contrast-enhanced 3D GRE T1-weighted sequences with unenhanced MR venography and conventional magnetic resonance imaging (MRI), in detection of dural venous sinus (DVS) and cortical venous thrombosis; secondary aim is to determine the relationship between DVS thrombosis/site and gender, age, infarction or hemorrhage. We retrospectively reviewed conventional MR images, unenhanced MR venography and immediate post-contrast 3D GRE T1-weighted MR images in 30 patients (17 male and 13 female, 21-70 years old, mean age 40.1) with clinically suspected DVS thrombosis. MR examinations had been performed with 1.5T or 3T MR Scanners. DVSs were evaluated in 10 sub-segments, including cortical veins. Each set of MR images were examined separately, blinded to the final diagnosis. Associated findings were also noted and sensitivity, specificity and accuracy of each MRI technique were calculated. Final diagnosis of cortical venous and/or dural sinus thrombosis was established in 24 (80%) of 30 cases and 67 (22.3%) out of 300 segments. For detection of the thrombotic segment, sensitivity, specificity, and accuracy were 83.6%, 95.3%, and 92.7% by conventional MR sequences, 89.6%, 91.8%, and 91.3% by unenhanced MR venography, and 92.5%, 100%, and 98.3% by contrast-enhanced 3D GRE T1-weighted sequence, respectively. Infarction and hemorrhage were more frequent in cases with cortical venous thrombosis, while gender and age had no significant relation with DVS thrombosis or its site. Conventional MR sequences and unenhanced MR venography were helpful due to additional information they provided in some cases with isolated cortical venous thrombosis, with hyperintense thrombus material and with associated hemorrhage or infarction. Contrast-enhanced 3D GRE T1-weighted MRI is the most accurate imaging method for the detection of DVS and/or cortical venous thrombosis. Infarction and hemorrhage were more frequent in cases with cortical venous thrombosis. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 04/2015; 134:44-54. DOI:10.1016/j.clineuro.2015.04.013
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    ABSTRACT: Hydrocephalus associated with different types of intracranial arteriovenous malformations (AVMs) has been scarcely studied. In the present report we investigate this association with posterior fossa AVMs (pfAVMs). We hypothesized that there is an increased risk of hydrocephalus and required permanent cerebrospinal fluid (CSF) shunt in patients with pfAVMs that may be linked to the increased risk of bleeding of these lesions. We also review the factors associated with this increased risk of hemorrhagic presentation and we assess how it affects management strategies and functional outcomes in these patients. Out of a prospective registry of 374 patients with brain AVMs diagnosed in our center from 1993 to 2013, 60 (16%) had a pfAVM. We described these patients' demographics, their AVM characteristics, clinical presentation, and hydrocephalus incidence and compared the results with those of the supratentorial AVM (spAVM) patients recorded during the same period. Out of the 60 patients with pfAVMs, 10 (16.7%) presented AVMs located in the brainstem. Hemorrhagic presentation (49/60; 82%) was significantly higher in pfAVMs than in spAVMs (122/314; 38.8%; p<0.05). Hydrocephalus was a common complication in pfAVM patients who had a statistically significant higher need for both temporary external ventricular drain (EVD) (6.7 vs. 20%; p<0.05) and permanent CSF shunts (3.5 vs. 20%; p<0.05). The initial mortality was high (12/60; 20.3%) and half of these patients died before any treatment option could be offered. However, out of those who survived, 70% (42/60) had already shown good clinical outcome at the 6-month follow-up. Hemorrhagic presentation and hydrocephalus have a higher incidence in pfAVM patients, which initially results in more neurological deficits and an elevated mortality even before receiving any treatment. However, a large number of survivors present good functional outcomes at early follow-up, justifying an aggressive management strategy with microsurgery as the first treatment option in most cases, and radiosurgery as an alternative, especially in brainstem AVMs. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 04/2015; 134. DOI:10.1016/j.clineuro.2015.04.003
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    ABSTRACT: Felix Platter is one of the pioneer anatomists and physicians of the 16th century who described various human diseases including meningioma. In this historical article, we present the details of Platter's life and his pioneering work on meningioma. In 1614, Dr. Platter described the first case of meningioma. He described the tumor as a round, fleshy mass shaped like an acorn and as large as a medium-sized apple, and full of holes. The tumor was covered with its own membrane, had no connection with the matters of the brain, and left behind a cavity after removal. This first clear description of an intracranial tumor is most consistent with encapsulated meningioma. The succeeding scholar, Harvey Cushing, coined the term "meningioma" for this tumor; neurosurgeons today describe the tumor as "parasagittal or falcine meningioma." In addition to his contribution to meningioma study, Dr. Platter was also the first to describe Dupuytren's disease, hypertrophy of the thalamus, and the retina as the sensory organ of the eye. He contributed to the germ theory of disease and gave substantial accounts of mental illnesses, gynecological disorders, and certain dermatological conditions. Dr. Platter published numerous accounts on various diseases. In 1614 he reported the case of meningioma in the book entitled "Platerus Observations in Hominis". Additionally, Dr. Platter published his work, 'Praxeos Medicae,' which contains his most important contribution on psychiatry and his classification of psychiatric diseases. Because of his many contributions to neuroscience, particularly his identification of meningioma, Dr. Platter should be highly credited as a pioneer in the field of neurosurgery. Copyright © 2015. Published by Elsevier B.V.
    Clinical neurology and neurosurgery 04/2015; 134. DOI:10.1016/j.clineuro.2015.02.018
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    ABSTRACT: Laminoplasty (LP) and laminectomy with fusion (LCF) are acceptable surgical options for cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). This study focused on evaluating cervical range of motion (ROM) on a three-dimensional basis as well as neurological outcomes after LP and LCF. This prospective cohort study consisted of 38 patients undergoing LP (n=20) or LCF (n=18) from December 2010 to December 2012. Before surgery and at the 3rd, 6th, 12th month follow-up, patients were assessed with three-dimensional cervical ROM, Japanese Orthopaedic Association (JOA) scores, Visual Analogue Scale (VAS) and complications. The patients in both groups had significant ROM loss after surgery in six directions of motion. At the 12th month follow-up, the LP group preserved more ROM than LCF in all directions except bilateral rotations. Major reduction was observed in extension, as with only 59.8% and 54.3% ROM preserved in LP and LCF groups. However, the most preserved ROM was witnessed in rotation, especially in the LP group (90.8%). For JOA and VAS, both groups showed significant improvements postoperatively, and the difference between the two groups was not statistically significant. Patients with OPLL had an obvious reduction in active cervical ROM following LP and LCF. Major reduction was observed in extension, and less impact was detected on rotation. Compared with LCF, LP had better ROM preserved. Both LP and LCF provided patients with significant neurological improvement. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 04/2015; 134. DOI:10.1016/j.clineuro.2015.04.004
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    ABSTRACT: We aimed to compare the clinical outcomes of anterior approaches (anterior cervical corpectomy with fusion, cervical discectomy with fusion) and posterior approaches (laminectomy, laminoplasty) in multilevel cervical spondylotic myelopathy (MCSM) patients using a systematic meta-analysis. PubMed, Embase, Scopus, and the Cochrane library were searched for literatures up to March 27, 2015 without language restriction. The reference lists of selected articles were also screened. Heterogeneity was identified using Q test and I(2) statistic. A fixed effect model was used for homogeneous data and a random effects model for heterogeneous data. Weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CIs) were calculated. Subgroup analysis was conducted according to the cause of MCSM. Seventeen articles were selected. Higher post-Japanese Orthopedic Association (JOA, P=0.002) and shorter length of stay (P=0.004) were found in anterior approaches group compared with posterior approaches. Moreover, operation time was shorter (P<0.00001) and neurological recovery rate was higher (P=0.005) in ossification of posterior longitudinal ligament patients underwent posterior approaches. Complication rate of posterior approaches was lower in spinal stenosis subgroup (P<0.0001). MCSM patients performed anterior approaches showed superior post-JOA and shorten length of stay. However, the outcomes such as operation time and complication rate are associated with the cause of MCSM. Therefore, the favorable surgical strategy for MCSM still needs more studies. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 04/2015; 134. DOI:10.1016/j.clineuro.2015.04.011
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    ABSTRACT: This study aimed at determining the frequency of abnormal finger flexion, Hoffman's and extensor plantar (Babinski) response in healthy adults and to determine the sensitivity and specificity of these tests as markers of spinal cord compression in symptomatic patients. Patients attending the neurosurgery clinic with neck related complaints formed the case group. The control group consisted of consenting patient attenders and volunteers drawn from the students and faculty of our institute. All subjects underwent examination of the finger flexion, Hoffman's and plantar reflexes and an MRI as per standard protocol. The frequency of the reflexes in the control group, sensitivity and specificity of the reflexes to detect cord compression in the case group were computed. The frequency of the reflexes in healthy controls were finger flexion - 1%, Hoffman's - 0.3% and Babinski sign - 0%. None of the controls with positive reflexes had any abnormality on MR imaging. A combination of the three reflexes had a sensitivity of 91.7%, specificity of 87.5%, PPV of 95.7% and NPV of 77.8% in detecting spinal cord compression. A combination of finger flexion, Hoffman's and plantar reflexes could be used effectively as a marker of spinal cord compression in symptomatic individuals. They cannot, however, be depended on as screening tests in asymptomatic individuals. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 04/2015; 40. DOI:10.1016/j.clineuro.2015.04.009