The global patient-reported outcomes for multiple sclerosis initiative: bridging the gap between clinical research and care – updates at the 2023 plenary event

Significant advancements have been achieved in delineating the progress of the Global PROMS (PROMS) Initiative. The PROMS Initiative, a collaborative endeavor by the European Charcot Foundation and the Multiple Sclerosis International Federation, strives to amplify the influence of patient input on MS care and establish a cohesive perspective on Patient-Reported Outcomes (PROs) for diverse stakeholders. This initiative has established an expansive, participatory governance framework launching four dedicated working groups that have made substantive contributions to research, clinical management, eHealth, and healthcare system reform. The initiative prioritizes the global integration of patient (For the purposes of the Global PROMS Initiative, the term “patient” refers to the people with the disease (aka People with Multiple Sclerosis – pwMS): any individual with lived experience of the disease. People affected by the disease/Multiple Sclerosis: any individual or group that is affected by the disease: E.g., family members, caregivers will be also engaged as the other stakeholders in the initiative). insights into the management of MS care. It merges subjective PROs with objective clinical metrics, thereby addressing the complex variability of disease presentation and progression. Following the completion of its second phase, the initiative aims to help increasing the uptake of eHealth tools and passive PROs within research and clinical settings, affirming its unwavering dedication to the progressive refinement of MS care. Looking forward, the initiative is poised to continue enhancing global surveys, rethinking to the relevant statistical approaches in clinical trials, and cultivating a unified stance among ‘industry’, regulatory bodies and health policy making regarding the application of PROs in MS healthcare strategies

Extended Retrosigmoid Craniotomy and Clip Occlusion of a Petrosal Tentorial Dural Arteriovenous Fistula (Type 5): Operative Video

Univ Calif San Francisco, Dept Neurosurg, San Francisco, CA 94143 USAUniv Fed Sao Paulo, Dept Neurocirurgia Vasc, Sao Paulo, BrazilUniv Fed Fluminense, Fac Med, Niteroi, RJ, BrazilUniv Calif San Francisco, Ctr Cerebrovasc Res, San Francisco, CA 94143 USAUniv Fed Sao Paulo, Dept Neurocirurgia Vasc, Sao Paulo, BrazilWeb of Scienc

"Million dollar nerve” magnetic resonance neurography: first normal and pathological findings

Objectives: To evaluate prospectively the feasibility of magnetic resonance neurography (MRN) in identifying the anatomical characteristics of thenar muscular branch (TMB) of the median nerve, also known as the “million dollar nerve”, in patients and controls. Methods: Thirteen patients affected by carpal tunnel syndrome (CTS) and four healthy controls had their hands scanned on a 3T MR imaging scanner for TMB visualization. Median nerve anatomical variations were classified into four groups according to the Poisel’s classification system modified by Lanz. TMB signal intensity and diameter were assessed for the diagnosis of neuropathy. Results: TMB was successfully identified in all patients and subjects by using MRN. The most suitable pulse sequences to identify and measure nerve diameter were 3D DW-PSIF and T2-FS-TSE. The axial oblique and sagittal oblique planes are complementary in demonstrating its entire course. TMB had mostly an extraligamentous course with radial side origin (93.8%, each). All patients experienced increased T2 signal intensity (P < 0.001) and thickened nerves. Mean TMB diameters were 1.27 ± 0.21 mm (range, 1.02–1.74 mm) and 0.87 ± 0.16 mm (0.73–1.08 mm) (P = 0.008) in the patient and control groups, respectively. Conclusion: MRN is a reliable imaging technique for identification and anatomical characterization of TMB in patients affected by CTS. This innovative imaging workup may therefore be included in the preoperative evaluation of patients scheduled for carpal tunnel release, especially in CTS with TMB involvement or even in isolated TMB neuropathySimObjectives: To evaluate prospectively the feasibility of magnetic resonance neurography (MRN) in identifying the anatomical characteristics of thenar muscular branch (TMB) of the median nerve, also known as the “million dollar nerve”, in patients and controls. Methods: Thirteen patients affected by carpal tunnel syndrome (CTS) and four healthy controls had their hands scanned on a 3T MR imaging scanner for TMB visualization. Median nerve anatomical variations were classified into four groups according to the Poisel’s classification system modified by Lanz. TMB signal intensity and diameter were assessed for the diagnosis of neuropathy. Results: TMB was successfully identified in all patients and subjects by using MRN. The most suitable pulse sequences to identify and measure nerve diameter were 3D DW-PSIF and T2-FS-TSE. The axial oblique and sagittal oblique planes are complementary in demonstrating its entire course. TMB had mostly an extraligamentous course with radial side origin (93.8%, each). All patients experienced increased T2 signal intensity (P < 0.001) and thickened nerves. Mean TMB diameters were 1.27 ± 0.21 mm (range, 1.02–1.74 mm) and 0.87 ± 0.16 mm (0.73–1.08 mm) (P = 0.008) in the patient and control groups, respectively. Conclusion: MRN is a reliable imaging technique for identification and anatomical characterization of TMB in patients affected by CTS. This innovative imaging workup may therefore be included in the preoperative evaluation of patients scheduled for carpal tunnel release, especially in CTS with TMB involvement or even in isolated TMB neuropathy