Pub Date : 2026-01-01Epub Date: 2025-11-16DOI: 10.1016/j.clineuro.2025.109247
Vishal V. Thakur , Jesse McClure , David Fletcher , Emily Melancon-Ricaurte , Luke Wilson , Dayton Miller , Tyler McGaughey , Dheeraj Gandhi , Huanwen Chen , Marco Colasurdo , Manish Ranjan , Nicholas Brandmeir , Sanjay Bhatia , Dhairya A. Lakhani
Background
The impact of steroid use in patients with chronic subdural hematoma (cSDH) treated with both surgical evacuation and middle meningeal artery embolization (MMAE) has not been previously reported. This study compares outcomes in this specific patient population.
Methods
We conducted a multi-institutional, multi-national, retrospective, propensity score–matched study using the TriNetX platform. Patients with cSDH who underwent both surgical evacuation and MMAE were included and stratified based on whether they received adjunctive steroid therapy. Primary outcomes included unplanned inpatient readmissions, need for repeat surgery, and six-month mortality.
Results
A total of 605 cSDH patients met the inclusion criteria, of whom 283 received adjunctive steroids. After propensity score matching, no significant differences were observed in the primary outcomes between patients who received steroids and those who did not. However, the steroid group exhibited non-significantly higher rates of inpatient readmission and mortality.
Conclusion
In patients with cSDH treated with a combination of surgical evacuation and MMAE, adjunctive steroid therapy was not associated with improved outcomes. These findings suggest that steroids may not confer a clear benefit in this setting and could potentially expose patients to unnecessary risks.
{"title":"Impact of adjunctive steroids on chronic subdural hematoma treated with surgery and MMAE: A propensity-matched study","authors":"Vishal V. Thakur , Jesse McClure , David Fletcher , Emily Melancon-Ricaurte , Luke Wilson , Dayton Miller , Tyler McGaughey , Dheeraj Gandhi , Huanwen Chen , Marco Colasurdo , Manish Ranjan , Nicholas Brandmeir , Sanjay Bhatia , Dhairya A. Lakhani","doi":"10.1016/j.clineuro.2025.109247","DOIUrl":"10.1016/j.clineuro.2025.109247","url":null,"abstract":"<div><h3>Background</h3><div>The impact of steroid use in patients with chronic subdural hematoma (cSDH) treated with both surgical evacuation and middle meningeal artery embolization (MMAE) has not been previously reported. This study compares outcomes in this specific patient population.</div></div><div><h3>Methods</h3><div>We conducted a multi-institutional, multi-national, retrospective, propensity score–matched study using the TriNetX platform. Patients with cSDH who underwent both surgical evacuation and MMAE were included and stratified based on whether they received adjunctive steroid therapy. Primary outcomes included unplanned inpatient readmissions, need for repeat surgery, and six-month mortality.</div></div><div><h3>Results</h3><div>A total of 605 cSDH patients met the inclusion criteria, of whom 283 received adjunctive steroids. After propensity score matching, no significant differences were observed in the primary outcomes between patients who received steroids and those who did not. However, the steroid group exhibited non-significantly higher rates of inpatient readmission and mortality.</div></div><div><h3>Conclusion</h3><div>In patients with cSDH treated with a combination of surgical evacuation and MMAE, adjunctive steroid therapy was not associated with improved outcomes. These findings suggest that steroids may not confer a clear benefit in this setting and could potentially expose patients to unnecessary risks.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109247"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To further assess the mid-long term effects of dihydroergotoxine mesylate (DHM) on salivation in patients with Parkinson’s disease (PD).
Methods
Thirty-nine participants were enrolled in a 24-week, open, self-controlled study. After baseline assessments of salivation, swallowing, and motor and cognitive function, the participants were given DHM. The primary outcome was the difference in the Sialorrhea Clinical Scale for Parkinson’s disease (SCS-PD) scores of salivation before and after treatment. The secondary outcomes included ≥ 30 % improvement in the SCS-PD score at each posttreatment visit and changes in the scores from other scales.
Results
A total of 39 participants were included in this study, and 4 participants dropped out. Finally, 35 patients completed all the visits. Salivation: After treatment for 1 week, the primary outcome, namely, the median SCS-PD score, decreased from 9.0 (IQR 5.0–12.0) at baseline to 7.0 (IQR 4.7–10.0) (P = 0.03). This effect persisted at 24 weeks, and the median score at 24 weeks was 5.0 (IQR 2.0–8.0) (P < 0.001 compared with baseline). For the Drooling Severity and Frequency Scale (DSFS) scale, the median baseline score was 6.0 (IQR 5.0–7.0). After two weeks of treatment, the median score decreased from baseline to 5.0 (IQR 4.0–6.0) (P < 0.001), and the median score at the final visit was 4.0 (IQR 3.7–6.0) (P < 0.001). The second term of the second part of the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS-2.2) showed a trend that was consistent with that of the DSFS scale, and significant differences started to emerge at 2 weeks after treatment was initiated. Within one week of treatment, 25.64 % of the patients had improved SCS-PD scores, reaching improvements of 30 % or more. At 2–12 weeks, the proportion of patients with improved SCS-PD scores exceeded 50 %, and this proportion reached 64.10 % at 24 weeks. Swallowing function: The Eating Assessment Tool-10 (EAT-10) revealed that the median scores at 4–24 weeks were 1.0 (IQR 0–3.0), 1.0 (IQR 0–2.2) and 1.0 (IQR 0–3.0), which were significantly different from the baseline score of 2.0 (IQR 0.7–4.0) (P < 0.05). After 2 weeks of treatment, the median score of the Swallowing Disturbance Questionnaire for Parkinson’s Disease (SDQ-PD) decreased from 22.0 (IQR 18.0–27.0) at baseline to 19.0 (IQR 17.0–23.2) (P = 0.001). However, motor and cognitive function did not significantly change in this study. Moreover, only 7.69 % of patients experienced mild and transient adverse effects.
Conclusion
DHM can significantly ameliorate salivation in PD patients over 24 weeks, with fewer adverse effects.
{"title":"Mid-long term efficacy of dihydroergotoxine mesylate in treatment of sialorrhea in Parkinson's disease","authors":"Huihui Jin , Ting Huang , Jing Wu , Yanan Zhu , Qing Gao , Youyong Tian","doi":"10.1016/j.clineuro.2025.109239","DOIUrl":"10.1016/j.clineuro.2025.109239","url":null,"abstract":"<div><h3>Purpose</h3><div>To further assess the mid-long term effects of dihydroergotoxine mesylate (DHM) on salivation in patients with Parkinson’s disease (PD).</div></div><div><h3>Methods</h3><div>Thirty-nine participants were enrolled in a 24-week, open, self-controlled study. After baseline assessments of salivation, swallowing, and motor and cognitive function, the participants were given DHM. The primary outcome was the difference in the Sialorrhea Clinical Scale for Parkinson’s disease (SCS-PD) scores of salivation before and after treatment. The secondary outcomes included ≥ 30 % improvement in the SCS-PD score at each posttreatment visit and changes in the scores from other scales.</div></div><div><h3>Results</h3><div>A total of 39 participants were included in this study, and 4 participants dropped out. Finally, 35 patients completed all the visits. Salivation: After treatment for 1 week, the primary outcome, namely, the median SCS-PD score, decreased from 9.0 (IQR 5.0–12.0) at baseline to 7.0 (IQR 4.7–10.0) (<em>P</em> = 0.03). This effect persisted at 24 weeks, and the median score at 24 weeks was 5.0 (IQR 2.0–8.0) (<em>P</em> < 0.001 compared with baseline). For the Drooling Severity and Frequency Scale (DSFS) scale, the median baseline score was 6.0 (IQR 5.0–7.0). After two weeks of treatment, the median score decreased from baseline to 5.0 (IQR 4.0–6.0) (<em>P</em> < 0.001), and the median score at the final visit was 4.0 (IQR 3.7–6.0) (<em>P</em> < 0.001). The second term of the second part of the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS-2.2) showed a trend that was consistent with that of the DSFS scale, and significant differences started to emerge at 2 weeks after treatment was initiated. Within one week of treatment, 25.64 % of the patients had improved SCS-PD scores, reaching improvements of 30 % or more. At 2–12 weeks, the proportion of patients with improved SCS-PD scores exceeded 50 %, and this proportion reached 64.10 % at 24 weeks. Swallowing function: The Eating Assessment Tool-10 (EAT-10) revealed that the median scores at 4–24 weeks were 1.0 (IQR 0–3.0), 1.0 (IQR 0–2.2) and 1.0 (IQR 0–3.0), which were significantly different from the baseline score of 2.0 (IQR 0.7–4.0) (<em>P</em> < 0.05). After 2 weeks of treatment, the median score of the Swallowing Disturbance Questionnaire for Parkinson’s Disease (SDQ-PD) decreased from 22.0 (IQR 18.0–27.0) at baseline to 19.0 (IQR 17.0–23.2) (<em>P</em> = 0.001). However, motor and cognitive function did not significantly change in this study. Moreover, only 7.69 % of patients experienced mild and transient adverse effects.</div></div><div><h3>Conclusion</h3><div>DHM can significantly ameliorate salivation in PD patients over 24 weeks, with fewer adverse effects.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109239"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-22DOI: 10.1016/j.clineuro.2025.109255
Xiaopeng Xue , Hongyi Liu , Mingjiang Sun , Xin Tong , Aihua Liu
Purpose
The angiographic efficacy of the Pipeline Embolization Device (PED) for unruptured, saccular fetal posterior communicating artery (PComA) aneurysms remains controversial, and available data on functional outcomes and complications are limited. This study aimed to assess the association between fetal PComA anatomy and PED treatment efficacy.
Methods
We retrospectively enrolled patients with unruptured, saccular PComA aneurysms treated with PED between January 2015 and December 2020. To mitigate confounding, inverse probability weighting based on propensity scores was applied, and covariate balance was evaluated using standardized mean differences. Sensitivity analyses included propensity score matching, multivariable regression, and a restricted analysis of patients with ≥ 12-month angiographic follow-up or treated with PED alone.
Results
Among 742 consecutive patients with 898 PED-treated aneurysms, 93 were PComA aneurysms, including 21 fetal-type cases. Incomplete occlusion rates were similar between fetal and non-fetal groups in both unadjusted and weighted analyses (22.2 % vs 23.2 %, P > 0.999; weighted 27.8 % vs 22.5 %, P = 0.713). There were no significant between-group differences in functional outcomes or overall complications. Consistent results were obtained in propensity score–matched and multivariable regression analyses, as well as in the sensitivity analysis restricted to patients treated with PED alone. Most fetal PComA vessels remained patent (94.4 %), and observed occlusions were clinically silent, likely due to collateral supply from the posterior cerebral artery (PCA).
Conclusion
Presence of a fetal PComA was not associated with worse angiographic or clinical prognosis following PED treatment. Consistent results in PED-only analysis suggest that adjunctive coiling did not substantially influence the main findings. Given the limited number of events, these results should be interpreted cautiously.
目的：管道栓塞装置（PED）对未破裂的囊状胎儿后交通动脉（PComA）动脉瘤的血管造影效果仍有争议，有关功能结局和并发症的可用数据有限。本研究旨在评估胎儿PComA解剖结构与PED治疗效果之间的关系。方法：我们回顾性招募了2015年1月至2020年12月期间接受PED治疗的未破裂的囊状PComA动脉瘤患者。为了减少混淆，应用基于倾向得分的逆概率加权，并使用标准化平均差异评估协变量平衡。敏感性分析包括倾向评分匹配、多变量回归和≥ 12个月血管造影随访或单独接受PED治疗的患者的限制性分析。结果：在连续742例经ped治疗的898例动脉瘤中，PComA动脉瘤93例，其中胎儿型21例。在未调整和加权分析中，胎儿组和非胎儿组的不完全闭塞率相似（22.2% % vs 23.2% %,P > 0.999；加权27.8 % vs 22.5 %,P = 0.713）。两组间在功能结局或总并发症方面无显著差异。在倾向评分匹配和多变量回归分析中，以及仅限PED患者的敏感性分析中，得到了一致的结果。大多数胎儿PComA血管保持通畅（94.4 %），临床观察到闭塞无症状，可能是由于大脑后动脉（PCA）的侧支供应所致。结论：胎儿PComA的存在与PED治疗后较差的血管造影或临床预后无关。仅ped分析的一致结果表明，辅助卷绕对主要结果没有实质性影响。鉴于事件数量有限，这些结果应谨慎解读。
{"title":"Association between fetal posterior communicating artery Anatomy and pipeline embolization device treatment efficacy: A propensity score–weighted cohort study","authors":"Xiaopeng Xue , Hongyi Liu , Mingjiang Sun , Xin Tong , Aihua Liu","doi":"10.1016/j.clineuro.2025.109255","DOIUrl":"10.1016/j.clineuro.2025.109255","url":null,"abstract":"<div><h3>Purpose</h3><div>The angiographic efficacy of the Pipeline Embolization Device (PED) for unruptured, saccular fetal posterior communicating artery (PComA) aneurysms remains controversial, and available data on functional outcomes and complications are limited. This study aimed to assess the association between fetal PComA anatomy and PED treatment efficacy.</div></div><div><h3>Methods</h3><div>We retrospectively enrolled patients with unruptured, saccular PComA aneurysms treated with PED between January 2015 and December 2020. To mitigate confounding, inverse probability weighting based on propensity scores was applied, and covariate balance was evaluated using standardized mean differences. Sensitivity analyses included propensity score matching, multivariable regression, and a restricted analysis of patients with ≥ 12-month angiographic follow-up or treated with PED alone.</div></div><div><h3>Results</h3><div>Among 742 consecutive patients with 898 PED-treated aneurysms, 93 were PComA aneurysms, including 21 fetal-type cases. Incomplete occlusion rates were similar between fetal and non-fetal groups in both unadjusted and weighted analyses (22.2 % vs 23.2 %, P > 0.999; weighted 27.8 % vs 22.5 %, P = 0.713). There were no significant between-group differences in functional outcomes or overall complications. Consistent results were obtained in propensity score–matched and multivariable regression analyses, as well as in the sensitivity analysis restricted to patients treated with PED alone. Most fetal PComA vessels remained patent (94.4 %), and observed occlusions were clinically silent, likely due to collateral supply from the posterior cerebral artery (PCA).</div></div><div><h3>Conclusion</h3><div>Presence of a fetal PComA was not associated with worse angiographic or clinical prognosis following PED treatment. Consistent results in PED-only analysis suggest that adjunctive coiling did not substantially influence the main findings. Given the limited number of events, these results should be interpreted cautiously.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109255"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-16DOI: 10.1016/j.clineuro.2025.109254
S. Dhanya Dedeepya , Vaishali Goel , Nivedita Nikhil Desai
{"title":"Comment on “Evaluation of preoperative cervical internal carotid artery diameter as a predictor of cerebral hyperperfusion syndrome following revascularization surgery”","authors":"S. Dhanya Dedeepya , Vaishali Goel , Nivedita Nikhil Desai","doi":"10.1016/j.clineuro.2025.109254","DOIUrl":"10.1016/j.clineuro.2025.109254","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109254"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-19DOI: 10.1016/j.clineuro.2025.109260
Miray Erdem
{"title":"Vestibular-evoked myogenic potentials and dizziness profiles in Parkinson’s disease: Commentary on a controlled study","authors":"Miray Erdem","doi":"10.1016/j.clineuro.2025.109260","DOIUrl":"10.1016/j.clineuro.2025.109260","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109260"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-16DOI: 10.1016/j.clineuro.2025.109257
Basel Musmar, Joanna M. Roy, Hammam Abdalrazeq, Anthony Yulin Chen, Mary-Katharine Pontarelli, Shray Patel, Stavropoula I. Tjoumakaris, Michael Reid Gooch, Robert H. Rosenwasser, Pascal Jabbour
Background and objectives
The effect of statins on outcomes following aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. While randomized controlled trials (RCTs) and meta-analyses have not demonstrated consistent benefits, a key limitation is that these studies did not specifically examine patients already on statins prior to hemorrhage. This study aims to address this gap using a propensity-score weighted analysis.
Methods
This retrospective cohort study included patients with aSAH treated between 2017 and 2023. Patients were grouped based on pre-admission statin use: 79 in the statin group and 284 in the non-statin group.
Results
A total of 363 patients were included, with 79 in the statin group and 284 in the non-statin group. After adjustment, statin use was associated with a significantly lower risk of symptomatic vasospasm (OR = 0.23; 95 % CI, 0.05–0.95; p = 0.04). Statin use was also associated with lower odds of CTA/DSA-confirmed vasospasm, though this was not statistically significant (OR = 0.11; 95 % CI, 0.009–1.36; p = 0.08). There were no significant differences between groups in the incidence of hydrocephalus, ventriculoperitoneal (VP) shunt placement, mortality, or favorable functional outcome at discharge and at 30 days.
Conclusion
Chronic statin use prior to aSAH was associated with a significant reduction in symptomatic vasospasm. These findings highlight the importance of considering pre-ictal statin therapy when evaluating the role of statins in this setting and support further investigation in appropriately stratified populations. Given the small event rates and wide confidence intervals, these findings should be interpreted cautiously and considered hypothesis-generating.
背景和目的：他汀类药物对动脉瘤性蛛网膜下腔出血（aSAH）后预后的影响尚不清楚。虽然随机对照试验（rct）和荟萃分析没有证明一致的益处，但一个关键的局限性是，这些研究没有专门检查出血前已经服用他汀类药物的患者。本研究旨在利用倾向得分加权分析来解决这一差距。方法：本回顾性队列研究纳入了2017年至2023年间接受aSAH治疗的患者。患者根据入院前他汀类药物的使用情况进行分组：他汀类药物组79例，非他汀类药物组284例。结果：共纳入363例患者，他汀类药物组79例，非他汀类药物组284例。调整后，他汀类药物的使用与症状性血管痉挛的风险显著降低相关（OR = 0.23; 95 % CI, 0.05-0.95; p = 0.04）。他汀类药物的使用也与CTA/ dsa证实的血管痉挛的几率较低相关，尽管这没有统计学意义（OR = 0.11; 95 % CI, 0.009-1.36; p = 0.08）。在脑积水发生率、脑室-腹膜（VP）分流器放置、死亡率或出院和30天的良好功能结局方面，两组间无显著差异。结论：aSAH前慢性使用他汀类药物与症状性血管痉挛的显著减少相关。这些发现强调了在评估他汀类药物在这种情况下的作用时考虑他汀类药物孕前治疗的重要性，并支持在适当分层的人群中进行进一步的研究。考虑到小事件发生率和宽置信区间，这些发现应谨慎解释，并考虑到假设生成。
{"title":"The effect of statins on clinical outcomes in patients with aneurysmal subarachnoid hemorrhage: A propensity-score weighted analysis","authors":"Basel Musmar, Joanna M. Roy, Hammam Abdalrazeq, Anthony Yulin Chen, Mary-Katharine Pontarelli, Shray Patel, Stavropoula I. Tjoumakaris, Michael Reid Gooch, Robert H. Rosenwasser, Pascal Jabbour","doi":"10.1016/j.clineuro.2025.109257","DOIUrl":"10.1016/j.clineuro.2025.109257","url":null,"abstract":"<div><h3>Background and objectives</h3><div>The effect of statins on outcomes following aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. While randomized controlled trials (RCTs) and meta-analyses have not demonstrated consistent benefits, a key limitation is that these studies did not specifically examine patients already on statins prior to hemorrhage. This study aims to address this gap using a propensity-score weighted analysis.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients with aSAH treated between 2017 and 2023. Patients were grouped based on pre-admission statin use: 79 in the statin group and 284 in the non-statin group.</div></div><div><h3>Results</h3><div>A total of 363 patients were included, with 79 in the statin group and 284 in the non-statin group. After adjustment, statin use was associated with a significantly lower risk of symptomatic vasospasm (OR = 0.23; 95 % CI, 0.05–0.95; p = 0.04). Statin use was also associated with lower odds of CTA/DSA-confirmed vasospasm, though this was not statistically significant (OR = 0.11; 95 % CI, 0.009–1.36; p = 0.08). There were no significant differences between groups in the incidence of hydrocephalus, ventriculoperitoneal (VP) shunt placement, mortality, or favorable functional outcome at discharge and at 30 days.</div></div><div><h3>Conclusion</h3><div>Chronic statin use prior to aSAH was associated with a significant reduction in symptomatic vasospasm. These findings highlight the importance of considering pre-ictal statin therapy when evaluating the role of statins in this setting and support further investigation in appropriately stratified populations. Given the small event rates and wide confidence intervals, these findings should be interpreted cautiously and considered hypothesis-generating.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109257"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-10DOI: 10.1016/j.clineuro.2025.109236
Jonathan Dallas , Michelle Lin , David J. Cote , Anadjeet S. Khahera , Li Ding , Frank J. Attenello , William J. Mack
Objective
The use of flow diversion (FD) has rapidly increased over the last decade, particularly for treatment of complex aneurysms not amenable to conventional coil embolization (CE). We aimed to compare national outcomes and healthcare utilization associated with FD and CE of unruptured aneurysms.
Methods
The National Inpatient Sample (2019–2022) was used to identify patients with unruptured intracranial aneurysms who underwent CE or FD (patients undergoing both FD+CE were classified as FD). Pediatric patients, non-elective admissions, and patients with subarachnoid hemorrhage were excluded. Variables included sociodemographics (e.g., age, race, gender), hospital factors (e.g., size, ownership, teaching status, location), and basic clinical variables in bivariate and multivariable regression. Outcomes included in-hospital mortality, stroke, discharge disposition (favorable/unfavorable), length of stay, and total cost of hospitalization.
Results
7370 patients were identified, of which 4280 were CE and 3090 were FD. Given the elective nature of intervention, rates of mortality (0.19 %), unfavorable discharge disposition (2.77 %), and stroke (0.83 %) were low. On multivariable analysis, use of flow diversion was not associated with unfavorable discharge (OR 0.80, P = 0.211) or stroke (OR 0.91, P = 0.753). FD trended toward, but did not reach, statistical significance for elevated length of stay (IRR 1.04, P = 0.150); however, it did lead to a significantly higher overall cost (ß=$1260.98, P = 0.049)
Conclusion
Nationally, short-term outcomes are similar between FD and CE, although use of FD does imbue a mildly higher hospitalization cost. Further work is needed to characterize large-scale, long-term outcome differences, particularly as FD use increases for more complex aneurysms not amenable to CE.
目的在过去十年中，分流术（FD）的使用迅速增加，特别是用于治疗传统线圈栓塞（CE）无法治疗的复杂动脉瘤。我们的目的是比较与未破裂动脉瘤FD和CE相关的国家结局和医疗保健利用。方法采用全国住院患者样本（2019-2022年），对接受CE或FD治疗的未破裂颅内动脉瘤患者进行鉴定（同时接受FD+CE治疗的患者归类为FD）。排除了儿科患者、非选择性入院患者和蛛网膜下腔出血患者。在双变量和多变量回归中，变量包括社会人口统计学（如年龄、种族、性别）、医院因素（如规模、所有权、教学状况、位置）和基本临床变量。结果包括住院死亡率、卒中、出院处置（有利/不利）、住院时间和住院总费用。结果共发现7370例患者，其中CE 4280例，FD 3090例。考虑到干预的选择性，死亡率（0.19 %）、不良出院处置（2.77 %）和卒中（0.83 %）均较低。在多变量分析中，使用分流与不良排放（OR 0.80, P = 0.211）或卒中（OR 0.91, P = 0.753）无关。FD趋向于延长住院时间，但未达到统计学意义（IRR 1.04, P = 0.150）；结论：在全国范围内，FD和CE的短期结局相似，尽管FD的使用确实会带来稍高的住院费用。需要进一步的工作来描述大规模的、长期的结果差异，特别是当FD用于不适合CE的更复杂的动脉瘤时。
{"title":"Short-term outcomes and hospitalization cost associated with flow diversion versus coil embolization for unruptured aneurysms: A national assessment","authors":"Jonathan Dallas , Michelle Lin , David J. Cote , Anadjeet S. Khahera , Li Ding , Frank J. Attenello , William J. Mack","doi":"10.1016/j.clineuro.2025.109236","DOIUrl":"10.1016/j.clineuro.2025.109236","url":null,"abstract":"<div><h3>Objective</h3><div>The use of flow diversion (FD) has rapidly increased over the last decade, particularly for treatment of complex aneurysms not amenable to conventional coil embolization (CE). We aimed to compare national outcomes and healthcare utilization associated with FD and CE of unruptured aneurysms.</div></div><div><h3>Methods</h3><div>The National Inpatient Sample (2019–2022) was used to identify patients with unruptured intracranial aneurysms who underwent CE or FD (patients undergoing both FD+CE were classified as FD). Pediatric patients, non-elective admissions, and patients with subarachnoid hemorrhage were excluded. Variables included sociodemographics (e.g., age, race, gender), hospital factors (e.g., size, ownership, teaching status, location), and basic clinical variables in bivariate and multivariable regression. Outcomes included in-hospital mortality, stroke, discharge disposition (favorable/unfavorable), length of stay, and total cost of hospitalization.</div></div><div><h3>Results</h3><div>7370 patients were identified, of which 4280 were CE and 3090 were FD. Given the elective nature of intervention, rates of mortality (0.19 %), unfavorable discharge disposition (2.77 %), and stroke (0.83 %) were low. On multivariable analysis, use of flow diversion was not associated with unfavorable discharge (OR 0.80, P = 0.211) or stroke (OR 0.91, P = 0.753). FD trended toward, but did not reach, statistical significance for elevated length of stay (IRR 1.04, P = 0.150); however, it did lead to a significantly higher overall cost (ß=$1260.98, P = 0.049)</div></div><div><h3>Conclusion</h3><div>Nationally, short-term outcomes are similar between FD and CE, although use of FD does imbue a mildly higher hospitalization cost. Further work is needed to characterize large-scale, long-term outcome differences, particularly as FD use increases for more complex aneurysms not amenable to CE.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109236"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145479113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-09DOI: 10.1016/j.clineuro.2025.109234
Alireza Minagar, Mohammad Ali Sahraian
Animal models have long been the foundation of biomedical research and experimentation. However, the utility of animal models in both research and preclinical testing of drugs has been challenged by the insufficiency and cost of such methods, including the fact that over 90 % of preclinically successful compounds ultimately fail in human trials, as well as concerns about irreproducibility, scalability, and ethics in animal studies; their limitations are increasingly recognized. Advances in artificial intelligence (AI) now offer a promising complementary approach through the creation of “virtual animals.” Recent examples include the U.S. Food and Drug Administration's AnimalGAN to predict toxicology outcomes in thousands of virtual rats, and Google DeepMind's virtual fruit fly, an anatomically accurate model that can reproduce locomotion and sensorimotor behavior. In these examples, AI systems may not replace, but rather support traditional experimentation, by increasing accuracy, reducing the number of animals needed for studies, and accelerating translational insight. Potential early applications in neurology and neurosurgery are just now emerging, such as neural-circuit simulation, prediction of neurotoxicity, and modeling of movement disorders. Legislative acts such as FDA Modernization Act 2.0, as well as European initiatives to implement the 3Rs, now include AI-based virtual testing as a possible evidentiary basis. Virtual organisms represent a potentially significant ethical and methodological shift that may influence the future of experimental neurology and drug development, while still upholding scientific rigor.
{"title":"From rodents to algorithms: The rise of virtual animals in drug development and neuroscience","authors":"Alireza Minagar, Mohammad Ali Sahraian","doi":"10.1016/j.clineuro.2025.109234","DOIUrl":"10.1016/j.clineuro.2025.109234","url":null,"abstract":"<div><div>Animal models have long been the foundation of biomedical research and experimentation. However, the utility of animal models in both research and preclinical testing of drugs has been challenged by the insufficiency and cost of such methods, including the fact that over 90 % of preclinically successful compounds ultimately fail in human trials, as well as concerns about irreproducibility, scalability, and ethics in animal studies; their limitations are increasingly recognized. Advances in artificial intelligence (AI) now offer a promising complementary approach through the creation of “virtual animals.” Recent examples include the U.S. Food and Drug Administration's AnimalGAN to predict toxicology outcomes in thousands of virtual rats, and Google DeepMind's virtual fruit fly, an anatomically accurate model that can reproduce locomotion and sensorimotor behavior. In these examples, AI systems may not replace, but rather support traditional experimentation, by increasing accuracy, reducing the number of animals needed for studies, and accelerating translational insight. Potential early applications in neurology and neurosurgery are just now emerging, such as neural-circuit simulation, prediction of neurotoxicity, and modeling of movement disorders. Legislative acts such as FDA Modernization Act 2.0, as well as European initiatives to implement the 3Rs, now include AI-based virtual testing as a possible evidentiary basis. Virtual organisms represent a potentially significant ethical and methodological shift that may influence the future of experimental neurology and drug development, while still upholding scientific rigor.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109234"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145479114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-03DOI: 10.1016/j.clineuro.2025.109226
Arevik Abramyan , Muhammad Afridi , Andrew Soliman , Gaurav Gupta , Daniela Perez Chadid , Emad Nourollah-Zadeh , Hai Sun , Sudipta Roychowdhury , Srihari Sundararajan
Background
Traditional surgical management of chronic and nonacute subdural hematomas (NASDH) is associated with high recurrence and often requires reoperation. Middle meningeal artery (MMA) embolization has emerged as a minimally invasive alternative. Most studies to date have used liquid or particle embolics, which carry risks of non-target embolization and neurologic complications. Coil-only embolization offers controlled, localized occlusion and may represent a safer, simpler option, though existing data are limited by small cohorts and inconsistent techniques.
Methods
We performed a retrospective review of all patients who underwent standalone coil MMA embolization for NASDH at our institution from 2022 to 2025. Short coils were deployed in a Y-configuration across anterior and posterior divisions or within the MMA trunk. Coil sizing was guided by the Spinosum Roentgen Index (S.R.I.).
Results
The study included 52 patients who underwent 71 procedures (mean age: 71 years). Embolization was performed upfront in 48 %, prophylactically post-surgery in 44 %, and as salvage in 8 %. Technical success was achieved in 97 %, with no procedural complications. Mean hematoma thickness decreased by 7.8 mm at one month and 13.6 mm at three months (both p < 0.001). Density declined by 12.5 HU and 22.5 HU, respectively (both p < 0.001). The S.R.I. correlated strongly with MMA diameter (p < 0.001) and reliably guided coil sizing. Mean fluoroscopy time was 5.8 min. Larger MMA diameter was associated with greater early density reduction (p = 0.010).
Conclusion
This study represents the largest single-center series of standalone coil embolization for NASDH. The technique demonstrated excellent safety, hematoma resolution, and procedural efficiency.
{"title":"Standalone short-coil embolization of the middle meningeal artery for subdural hematomas: Efficient, safe, and radiation-sparing","authors":"Arevik Abramyan , Muhammad Afridi , Andrew Soliman , Gaurav Gupta , Daniela Perez Chadid , Emad Nourollah-Zadeh , Hai Sun , Sudipta Roychowdhury , Srihari Sundararajan","doi":"10.1016/j.clineuro.2025.109226","DOIUrl":"10.1016/j.clineuro.2025.109226","url":null,"abstract":"<div><h3>Background</h3><div>Traditional surgical management of chronic and nonacute subdural hematomas (NASDH) is associated with high recurrence and often requires reoperation. Middle meningeal artery (MMA) embolization has emerged as a minimally invasive alternative. Most studies to date have used liquid or particle embolics, which carry risks of non-target embolization and neurologic complications. Coil-only embolization offers controlled, localized occlusion and may represent a safer, simpler option, though existing data are limited by small cohorts and inconsistent techniques.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of all patients who underwent standalone coil MMA embolization for NASDH at our institution from 2022 to 2025. Short coils were deployed in a Y-configuration across anterior and posterior divisions or within the MMA trunk. Coil sizing was guided by the Spinosum Roentgen Index (S.R.I.).</div></div><div><h3>Results</h3><div>The study included 52 patients who underwent 71 procedures (mean age: 71 years). Embolization was performed upfront in 48 %, prophylactically post-surgery in 44 %, and as salvage in 8 %. Technical success was achieved in 97 %, with no procedural complications. Mean hematoma thickness decreased by 7.8 mm at one month and 13.6 mm at three months (both p < 0.001). Density declined by 12.5 HU and 22.5 HU, respectively (both p < 0.001). The S.R.I. correlated strongly with MMA diameter (p < 0.001) and reliably guided coil sizing. Mean fluoroscopy time was 5.8 min. Larger MMA diameter was associated with greater early density reduction (p = 0.010).</div></div><div><h3>Conclusion</h3><div>This study represents the largest single-center series of standalone coil embolization for NASDH. The technique demonstrated excellent safety, hematoma resolution, and procedural efficiency.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109226"},"PeriodicalIF":1.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-22DOI: 10.1016/j.clineuro.2025.109209
Sang Seok Yeo , In Hee Cho
Purpose
Dizziness is a common clinical symptom that negatively affects balance, spatial orientation, and quality of life. While peripheral vestibular dysfunction has been widely studied, the central cortical mechanisms underlying dizziness remain poorly understood. Increasing evidence suggests that dizziness severity may alter multisensory integration and cortical compensation strategies. Therefore, the study aimed to investigate how the severity of dizziness influences cortical activation and postural stability using functional near-infrared spectroscopy (fNIRS) and center of pressure analysis during a tandem stance task.
Methods
Sixteen adults were divided into mild (n = 8) and moderate-to-severe (n = 8) dizziness groups based on dizziness handicap inventory and vertigo symptom scale–short form scores. Participants performed a tandem stance task under alternating eyes-open and eyes-closed conditions while cortical hemodynamics were recorded using fNIRS and postural sway was assessed using a force platform.
Results
Compared to the mild group, the moderate-to-severe dizziness group showed significantly increased oxyhemoglobin concentrations in the bilateral superior parietal lobule and the left superior temporal gyrus, suggesting increased cortical activation during postural control. Moreover, under eyes-closed conditions, the moderate-to-severe group demonstrated significantly greater postural sway in terms of sway length, ellipse surface, anteroposterior displacement, and average speed.
Conclusion
These findings suggest that greater dizziness severity is associated with increased neural compensation and reduced balance stability, particularly in the absence of visual input. fNIRS may serve as a valuable tool to assess cortical mechanisms in individuals with vestibular dysfunction.
{"title":"Cortical activation and postural instability according to dizziness severity: A functional near-infrared spectroscopy study","authors":"Sang Seok Yeo , In Hee Cho","doi":"10.1016/j.clineuro.2025.109209","DOIUrl":"10.1016/j.clineuro.2025.109209","url":null,"abstract":"<div><h3>Purpose</h3><div>Dizziness is a common clinical symptom that negatively affects balance, spatial orientation, and quality of life. While peripheral vestibular dysfunction has been widely studied, the central cortical mechanisms underlying dizziness remain poorly understood. Increasing evidence suggests that dizziness severity may alter multisensory integration and cortical compensation strategies. Therefore, the study aimed to investigate how the severity of dizziness influences cortical activation and postural stability using functional near-infrared spectroscopy (fNIRS) and center of pressure analysis during a tandem stance task.</div></div><div><h3>Methods</h3><div>Sixteen adults were divided into mild (n = 8) and moderate-to-severe (n = 8) dizziness groups based on dizziness handicap inventory and vertigo symptom scale–short form scores. Participants performed a tandem stance task under alternating eyes-open and eyes-closed conditions while cortical hemodynamics were recorded using fNIRS and postural sway was assessed using a force platform.</div></div><div><h3>Results</h3><div>Compared to the mild group, the moderate-to-severe dizziness group showed significantly increased oxyhemoglobin concentrations in the bilateral superior parietal lobule and the left superior temporal gyrus, suggesting increased cortical activation during postural control. Moreover, under eyes-closed conditions, the moderate-to-severe group demonstrated significantly greater postural sway in terms of sway length, ellipse surface, anteroposterior displacement, and average speed.</div></div><div><h3>Conclusion</h3><div>These findings suggest that greater dizziness severity is associated with increased neural compensation and reduced balance stability, particularly in the absence of visual input. fNIRS may serve as a valuable tool to assess cortical mechanisms in individuals with vestibular dysfunction.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109209"},"PeriodicalIF":1.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145360065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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