Pub Date : 2025-12-31DOI: 10.1016/j.clineuro.2025.109308
Chung Mo Koo , In-Ho Jung , Sang Koo Lee
Objective
This study aimed to clarify how the choice of cranioplasty material influences the risk of postoperative periosteal fluid collection (PFC) and surgical site infection (SSI) through large-scale analysis.
Methods
A retrospective review was conducted on 434 patients who underwent cranioplasty over a ten-year period. Patients were grouped by implant material: autologous bone (n = 339), polyetheretherketone (PEEK; n = 39), polymethylmethacrylate (PMMA; n = 31), and titanium (n = 25). Multivariable logistic regression identified risk factors for PFC and SSI.
Results
PFC occurred in 22.1 % of cases overall, but was significantly more frequent with PEEK (56.4 %) and PMMA (51.6 %) than with autologous bone (16.8 %) and titanium (4.0 %) (p < 0.001). PEEK use increased the risk of PFC by 6.47-fold compared to autologous bone (OR: 6.47, p < 0.001), while PMMA also showed a significant risk (OR: 3.78, p < 0.001). Shunt operation (OR: 4.56, p = 0.001) and traumatic brain injury (OR: 3.28; p < 0.001) were further independent predictors. SSI occurred in 9.0 % overall, with no statistically significant difference between materials after multivariate adjustment (p = 0.915), but PFC was the strongest independent risk factor for SSI (OR: 10.93, p < 0.001).
Conclusion
Selection of cranioplasty material significantly affects the risk of PFC, which is strongly associated with subsequent SSI. PEEK and PMMA implants substantially increase PFC compared to autologous bone and titanium, while titanium demonstrates the lowest risk. These findings suggest that, in addition to patient-specific considerations, material properties and their impact on tissue integration must be central to clinical decision-making in cranioplasty.
目的通过大规模分析，探讨颅骨成形术材料的选择对术后骨膜积液（PFC）和手术部位感染（SSI）风险的影响。方法回顾性分析近10年434例颅骨成形术患者的临床资料。患者按种植材料分组：自体骨（ = 339）、聚醚醚酮（PEEK， = 39）、聚甲基丙烯酸甲酯（PMMA， = 31）、钛（ = 25）。多变量logistic回归确定了PFC和SSI的危险因素。结果spfc发生率为22.1% %，但PEEK组（56.4% %）和PMMA组（51.6% %）明显高于自体骨组（16.8% %）和钛组（4.0% %）（p <； 0.001）。与自体骨相比，PEEK的使用使PFC的风险增加了6.47倍（OR: 6.47, p <； 0.001），而PMMA也显示出显著的风险（OR: 3.78, p <； 0.001）。分流手术（OR: 4.56, p = 0.001）和外伤性脑损伤（OR: 3.28, p <； 0.001）是进一步的独立预测因素。SSI总体发生率为9.0 %，多因素调整后各材料间无统计学差异（p = 0.915），但PFC是SSI最强的独立危险因素（OR: 10.93, p <； 0.001）。结论颅骨成形术材料的选择显著影响PFC的发生风险，PFC与继发SSI密切相关。与自体骨和钛相比，PEEK和PMMA植入物显著增加了PFC，而钛的风险最低。这些发现表明，除了患者的特殊考虑外，材料特性及其对组织整合的影响必须是颅骨成形术临床决策的核心。
{"title":"Risk factors for periosteal fluid collection and surgical site infection based on cranioplasty material: Analysis of 434 cases","authors":"Chung Mo Koo , In-Ho Jung , Sang Koo Lee","doi":"10.1016/j.clineuro.2025.109308","DOIUrl":"10.1016/j.clineuro.2025.109308","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to clarify how the choice of cranioplasty material influences the risk of postoperative periosteal fluid collection (PFC) and surgical site infection (SSI) through large-scale analysis.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on 434 patients who underwent cranioplasty over a ten-year period. Patients were grouped by implant material: autologous bone (n = 339), polyetheretherketone (PEEK; n = 39), polymethylmethacrylate (PMMA; n = 31), and titanium (n = 25). Multivariable logistic regression identified risk factors for PFC and SSI.</div></div><div><h3>Results</h3><div>PFC occurred in 22.1 % of cases overall, but was significantly more frequent with PEEK (56.4 %) and PMMA (51.6 %) than with autologous bone (16.8 %) and titanium (4.0 %) (p < 0.001). PEEK use increased the risk of PFC by 6.47-fold compared to autologous bone (OR: 6.47, p < 0.001), while PMMA also showed a significant risk (OR: 3.78, p < 0.001). Shunt operation (OR: 4.56, p = 0.001) and traumatic brain injury (OR: 3.28; p < 0.001) were further independent predictors. SSI occurred in 9.0 % overall, with no statistically significant difference between materials after multivariate adjustment (p = 0.915), but PFC was the strongest independent risk factor for SSI (OR: 10.93, p < 0.001).</div></div><div><h3>Conclusion</h3><div>Selection of cranioplasty material significantly affects the risk of PFC, which is strongly associated with subsequent SSI. PEEK and PMMA implants substantially increase PFC compared to autologous bone and titanium, while titanium demonstrates the lowest risk. These findings suggest that, in addition to patient-specific considerations, material properties and their impact on tissue integration must be central to clinical decision-making in cranioplasty.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109308"},"PeriodicalIF":1.6,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882392","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 : 2025-12-31DOI: 10.1016/j.clineuro.2025.109307
Ali Ebada, Ishav Y. Shukla, Nicholas Bever, Matthew Z. Sun
Introduction
The Social Deprivation Index (SDI) is a validated measure of neighborhood-level socioeconomic disadvantage. Its impact on perioperative outcomes following meningioma resection remains underexplored.
Methods
We retrospectively analyzed patients who underwent intracranial meningioma resection at a single tertiary academic institution from 2011 to 2023, stratified by SDI quartile (Q1 to Q4). Outcomes included baseline characteristics, operative parameters, complications, readmissions, and functional status.
Results
In our analysis of 887 patients, we found that higher SDI quartiles had greater comorbidity burden, with hypertension, COPD, and obesity more prevalent, as well as higher rates of non-White race and Hispanic ethnicity. The total number of comorbidities increased progressively from Q1 to Q4 (p = 0.001). Tumor grade, volume, and operative time were generally similar across quartiles, but ASA class III-IV status was more common in Q4 (p = 0.002), and skull base tumors were more frequent in higher quartiles (p = 0.010). Multivariable regression revealed that patients in Q2 and Q4 had significantly longer operative times compared to Q1 (p = 0.018; p = 0.031). Functional outcomes demonstrated an unexpected finding: patients in Q3 showed greater improvement in postoperative mRS compared to Q1 (p = 0.010). No significant differences were found in change in KPS, EBL, LOS, or hospital charges. On univariable and multivariable logistic regression, Q4 patients had significantly increased odds of non-neurological complications compared to Q1 (p = 0.016). In contrast, neurological complications and 30-, 60-, and 90-day readmissions did not differ significantly across quartiles.
Conclusion
SDI quartile was associated with comorbidity burden, ASA class, skull base tumor location, operative time, and risk of non-neurological complications after meningioma resection. SDI may serve as a prognostic marker to help identify vulnerable patients, guide perioperative planning, and improve recovery counseling after meningioma resection.
{"title":"The social deprivation index and perioperative outcomes following meningioma resection","authors":"Ali Ebada, Ishav Y. Shukla, Nicholas Bever, Matthew Z. Sun","doi":"10.1016/j.clineuro.2025.109307","DOIUrl":"10.1016/j.clineuro.2025.109307","url":null,"abstract":"<div><h3>Introduction</h3><div>The Social Deprivation Index (SDI) is a validated measure of neighborhood-level socioeconomic disadvantage. Its impact on perioperative outcomes following meningioma resection remains underexplored.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients who underwent intracranial meningioma resection at a single tertiary academic institution from 2011 to 2023, stratified by SDI quartile (Q1 to Q4). Outcomes included baseline characteristics, operative parameters, complications, readmissions, and functional status.</div></div><div><h3>Results</h3><div>In our analysis of 887 patients, we found that higher SDI quartiles had greater comorbidity burden, with hypertension, COPD, and obesity more prevalent, as well as higher rates of non-White race and Hispanic ethnicity. The total number of comorbidities increased progressively from Q1 to Q4 (p = 0.001). Tumor grade, volume, and operative time were generally similar across quartiles, but ASA class III-IV status was more common in Q4 (p = 0.002), and skull base tumors were more frequent in higher quartiles (p = 0.010). Multivariable regression revealed that patients in Q2 and Q4 had significantly longer operative times compared to Q1 (p = 0.018; p = 0.031). Functional outcomes demonstrated an unexpected finding: patients in Q3 showed greater improvement in postoperative mRS compared to Q1 (p = 0.010). No significant differences were found in change in KPS, EBL, LOS, or hospital charges. On univariable and multivariable logistic regression, Q4 patients had significantly increased odds of non-neurological complications compared to Q1 (p = 0.016). In contrast, neurological complications and 30-, 60-, and 90-day readmissions did not differ significantly across quartiles.</div></div><div><h3>Conclusion</h3><div>SDI quartile was associated with comorbidity burden, ASA class, skull base tumor location, operative time, and risk of non-neurological complications after meningioma resection. SDI may serve as a prognostic marker to help identify vulnerable patients, guide perioperative planning, and improve recovery counseling after meningioma resection.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109307"},"PeriodicalIF":1.6,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882447","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 : 2025-12-31DOI: 10.1016/j.clineuro.2025.109305
Yilong Zheng , Yi Zhan Cai , Li Wei , Seyed Ehsan Saffari , Hwee Lan Ng , Hui Ping Oh , Wai-Yung Yu , Louis Chew Seng Tan , Wai Hoe Ng , Shermyn Xiumin Neo , Kai Rui Wan
Introduction
Deep brain stimulation (DBS) is an effective adjunctive therapy for Parkinson’s disease (PD), but there are few biomarkers for the prediction of treatment response. Here, we aimed to evaluate whether subthalamic nucleus (STN) volume could serve as a biomarker for predicting treatment response to STN DBS in PD.
Methods
This was a retrospective study of patients who underwent bilateral STN DBS for PD between 2008 and 2021 at our center. Preoperative T2-weighted MRI scans were used to quantify STN volumes, while outcomes were evaluated using both the Hoehn and Yahr scale and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) total and subcomponent scores at one-year follow-up. Univariate and multivariate linear regression analysis were applied to examine potential relationships between STN volume and clinical outcomes.
Results
Of 94 PD patients treated with DBS, 32 met the inclusion criteria for analysis. Our analysis revealed no significant association between STN volume and motor symptom improvement, as assessed by one-year changes in MDS-UPDRS Parts II (β=0.04; 95 % CI=-0.12–0.20; p = 0.590), III (β=0.07; 95 % CI=-0.35–0.48; p = 0.753), IV (β=-0.02; 95 % CI=-0.07–0.03; p = 0.430), and Hoehn and Yahr scale (β=0.01; 95 % CI=0.00–0.01; p = 0.136. Similarly, STN volume showed no association with MDS-UPDRS Part I total score (β=0.12; 95 % CI=-0.02–0.26; p = 0.096) for non-motor symptoms. However, we identified significant positive associations between STN volume and specific non-motor components, including the “anxious mood” (β=0.02; 95 % CI=0.00–0.04; p = 0.031) and the “pain and other sensation” (β=0.02; 95 % CI=0.00–0.04; p = 0.022) components, though these associations were not significant after adjusting for potential confounders.
Conclusions
In our cohort of patients who underwent bilateral STN DBS for PD, exploratory analyses revealed that larger STN volumes were significantly associated with an increased risk of developing affective symptoms approximately one year postoperatively. No significant association was observed between STN volume and improvement in motor outcomes. Further validation studies are warranted to corroborate the findings from this exploratory analysis.
脑深部电刺激（DBS）是治疗帕金森病（PD）的一种有效的辅助治疗方法，但很少有生物标志物可以预测治疗反应。在这里，我们旨在评估丘脑下核（STN）体积是否可以作为预测PD患者对STN DBS治疗反应的生物标志物。方法：这是一项回顾性研究，研究对象是2008年至2021年间在我们中心接受双侧STN DBS治疗PD的患者。术前t2加权MRI扫描用于量化STN体积，而在一年的随访中，使用Hoehn和Yahr量表和运动障碍学会统一帕金森病评定量表（MDS-UPDRS）总评分和子成分评分来评估结果。采用单因素和多因素线性回归分析来检验STN体积与临床结果之间的潜在关系。结果94例PD患者接受DBS治疗，32例符合纳入标准。我们的分析显示无显著联系STN体积和运动症状改善,评估的一年期的变化MDS-UPDRS第二部分(β= 0.04;95 % CI = -0.12 - -0.20; p = 0.590),3(β= 0.07;95 % CI = -0.35 - -0.48; p = 0.753),四(β= -0.02;95 % CI = -0.07 - -0.03; p = 0.430),和Hoehn Yahr规模(β= 0.01;95 % CI = 0.00 - -0.01; p = 0.136。同样，STN体积与非运动症状的MDS-UPDRS第一部分总分无关联（β=0.12; 95 % CI= -0.02-0.26; p = 0.096）。然而，我们发现STN体积与特定的非运动成分之间存在显著的正相关，包括“焦虑情绪”（β=0.02; 95 % CI= 0.00-0.04; p = 0.031）和“疼痛和其他感觉”（β=0.02; 95 % CI= 0.00-0.04; p = 0.022）成分，尽管在调整了潜在的混杂因素后，这些关联并不显著。在接受双侧STN DBS治疗PD的患者队列中，探索性分析显示，较大的STN容量与术后大约一年出现情感性症状的风险增加显著相关。未观察到STN体积与运动预后改善之间的显著关联。进一步的验证研究是必要的，以证实这一探索性分析的结果。
{"title":"Association between subthalamic nucleus volume and outcomes one year after bilateral subthalamic nucleus deep brain stimulation for Parkinson’s disease","authors":"Yilong Zheng , Yi Zhan Cai , Li Wei , Seyed Ehsan Saffari , Hwee Lan Ng , Hui Ping Oh , Wai-Yung Yu , Louis Chew Seng Tan , Wai Hoe Ng , Shermyn Xiumin Neo , Kai Rui Wan","doi":"10.1016/j.clineuro.2025.109305","DOIUrl":"10.1016/j.clineuro.2025.109305","url":null,"abstract":"<div><h3>Introduction</h3><div>Deep brain stimulation (DBS) is an effective adjunctive therapy for Parkinson’s disease (PD), but there are few biomarkers for the prediction of treatment response. Here, we aimed to evaluate whether subthalamic nucleus (STN) volume could serve as a biomarker for predicting treatment response to STN DBS in PD.</div></div><div><h3>Methods</h3><div>This was a retrospective study of patients who underwent bilateral STN DBS for PD between 2008 and 2021 at our center. Preoperative T2-weighted MRI scans were used to quantify STN volumes, while outcomes were evaluated using both the Hoehn and Yahr scale and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) total and subcomponent scores at one-year follow-up. Univariate and multivariate linear regression analysis were applied to examine potential relationships between STN volume and clinical outcomes.</div></div><div><h3>Results</h3><div>Of 94 PD patients treated with DBS, 32 met the inclusion criteria for analysis. Our analysis revealed no significant association between STN volume and motor symptom improvement, as assessed by one-year changes in MDS-UPDRS Parts II (β=0.04; 95 % CI=-0.12–0.20; p = 0.590), III (β=0.07; 95 % CI=-0.35–0.48; p = 0.753), IV (β=-0.02; 95 % CI=-0.07–0.03; p = 0.430), and Hoehn and Yahr scale (β=0.01; 95 % CI=0.00–0.01; p = 0.136. Similarly, STN volume showed no association with MDS-UPDRS Part I total score (β=0.12; 95 % CI=-0.02–0.26; p = 0.096) for non-motor symptoms. However, we identified significant positive associations between STN volume and specific non-motor components, including the “anxious mood” (β=0.02; 95 % CI=0.00–0.04; p = 0.031) and the “pain and other sensation” (β=0.02; 95 % CI=0.00–0.04; p = 0.022) components, though these associations were not significant after adjusting for potential confounders.</div></div><div><h3>Conclusions</h3><div>In our cohort of patients who underwent bilateral STN DBS for PD, exploratory analyses revealed that larger STN volumes were significantly associated with an increased risk of developing affective symptoms approximately one year postoperatively. No significant association was observed between STN volume and improvement in motor outcomes. Further validation studies are warranted to corroborate the findings from this exploratory analysis.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109305"},"PeriodicalIF":1.6,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882391","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 : 2025-12-30DOI: 10.1016/j.clineuro.2025.109304
Felipe Ramirez-Velandia , Vitor Lauar Pimenta de Figueiredo , Vincenzo T.R. Loly , Natalia Anna Koc , Bruno Galelli Chieregatti , Rafael T. Tatit , Emmanuel O. Mensah , Mark Rotondo , João de Sá Brasil Lima , Jorge Rios-Zermeno , Johnny S. Sandhu , Rabih G. Twak , Christopher S. Ogilvy , Carlos E. Baccin
Objective
Evaluate through computational fluid dynamics (CFD) and fluid structure interaction (FSI) simulations basilar tip aneurysms (BTAs) hemodynamics at rest and during early (PLT1) and late (PLT2) phases of a sub-maximal handgrip (HG) maneuver.
Methods
Vascular segmentation used 3D rotational angiograms, and meshes were generated for accurate simulation. Time-averaged wall shear stress (TAWSS) at the aneurysm/parent vessel, oscillatory shear index (OSI), relative residence time (RRT), low and high shear stress area ratio (LSAR/HSAR), and wall deformation metrics (Von Mises stress, wall displacement, and strain) were calculated and compared.
Results
Seven patients (mean age: 60 ± 4.3 years; mean aneurysm size: 5.00 ± 1.76 mm) were included. 3 aneurysms were irregular, and 2 were ruptured. Ruptured BTAs were smaller (3.58 vs. 5.56 mm; p = 0.2009), had higher RRT (0.66 vs. 0.43 m²/N; p = 0.0276) and LSAR (5.11 % vs. 0 %; p = 0.0326). In unruptured BTAs, HG increased TAWSS (PLT1 +28.4 %, p = 0.0002; PLT2: +23.9 %, p = 0.0002), reduced RRT (PLT1 −21.7 %, p = 0.0009; PLT2: −18.6 %; p = 0.0016), increased HSAR (PLT1 +82.1 %, p = 0.0431, PLT2 +68.9 %, p = 0.0431), increased peak von Mises stress (PLT1 +18.6 %, p = 0.0223, PLT2 +31.9 %; p = 0.0087), maximum wall displacement (PLT1 +8.0 %, p = 0.0431; PLT2 +12.8 %, p = 0.0431) and maximum strain (PLT1 +7.13 %, p = 0.0201; PLT2 +11.8 %, p = 0.0043). Ruptured aneurysms showed similar trends with higher TAWSSR increases (PLT1 +31.6 %, p = 0.0225; PLT2 +28.2 %, p = 0.0391) and larger reductions in RRT (PLT1 −24.4 %, p = 0.0178; PLT2 −23.8 %, p = 0.0411).
Conclusion
In unruptured BTAs, PLT1 produced the greatest TAWSS increase and RRT reduction, whereas PLT2 led to maximal wall deformation. Ruptured aneurysms demonstrated greater TAWSSR increases and RRT reductions during simulation.
{"title":"Hemodynamic changes during simulation of sub-maximal handgrip maneuver in small basilar tip aneurysms: A computational fluid dynamics and one-way fluid-structure interaction analysis","authors":"Felipe Ramirez-Velandia , Vitor Lauar Pimenta de Figueiredo , Vincenzo T.R. Loly , Natalia Anna Koc , Bruno Galelli Chieregatti , Rafael T. Tatit , Emmanuel O. Mensah , Mark Rotondo , João de Sá Brasil Lima , Jorge Rios-Zermeno , Johnny S. Sandhu , Rabih G. Twak , Christopher S. Ogilvy , Carlos E. Baccin","doi":"10.1016/j.clineuro.2025.109304","DOIUrl":"10.1016/j.clineuro.2025.109304","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate through computational fluid dynamics (CFD) and fluid structure interaction (FSI) simulations basilar tip aneurysms (BTAs) hemodynamics at rest and during early (PLT1) and late (PLT2) phases of a sub-maximal handgrip (HG) maneuver.</div></div><div><h3>Methods</h3><div>Vascular segmentation used 3D rotational angiograms, and meshes were generated for accurate simulation. Time-averaged wall shear stress (TAWSS) at the aneurysm/parent vessel, oscillatory shear index (OSI), relative residence time (RRT), low and high shear stress area ratio (LSAR/HSAR), and wall deformation metrics (Von Mises stress, wall displacement, and strain) were calculated and compared.</div></div><div><h3>Results</h3><div>Seven patients (mean age: 60 ± 4.3 years; mean aneurysm size: 5.00 ± 1.76 mm) were included. 3 aneurysms were irregular, and 2 were ruptured. Ruptured BTAs were smaller (3.58 vs. 5.56 mm; p = 0.2009), had higher RRT (0.66 vs. 0.43 m²/N; p = 0.0276) and LSAR (5.11 % vs. 0 %; p = 0.0326). In unruptured BTAs, HG increased TAWSS (PLT1 +28.4 %, p = 0.0002; PLT2: +23.9 %, p = 0.0002), reduced RRT (PLT1 −21.7 %, p = 0.0009; PLT2: −18.6 %; p = 0.0016), increased HSAR (PLT1 +82.1 %, p = 0.0431, PLT2 +68.9 %, p = 0.0431), increased peak von Mises stress (PLT1 +18.6 %, p = 0.0223, PLT2 +31.9 %; p = 0.0087), maximum wall displacement (PLT1 +8.0 %, p = 0.0431; PLT2 +12.8 %, p = 0.0431) and maximum strain (PLT1 +7.13 %, p = 0.0201; PLT2 +11.8 %, p = 0.0043). Ruptured aneurysms showed similar trends with higher TAWSSR increases (PLT1 +31.6 %, p = 0.0225; PLT2 +28.2 %, p = 0.0391) and larger reductions in RRT (PLT1 −24.4 %, p = 0.0178; PLT2 −23.8 %, p = 0.0411).</div></div><div><h3>Conclusion</h3><div>In unruptured BTAs, PLT1 produced the greatest TAWSS increase and RRT reduction, whereas PLT2 led to maximal wall deformation. Ruptured aneurysms demonstrated greater TAWSSR increases and RRT reductions during simulation.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109304"},"PeriodicalIF":1.6,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882389","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}
Digital subtraction angiography (DSA), the standard for postoperative evaluation following flow diverter (FD) implantation, is invasive and associated with potential complications. Although time-of-flight magnetic resonance angiography (TOF-MRA) is effective, normal blood flow may be misinterpreted as T1-weighted hyperintense thrombi. T1 volumetric isotropic turbo spin-echo acquisition black-blood magnetic resonance imaging (T1-VISTA-BB MRI) can differentiate thrombus from blood flow. We evaluate the utility of T1-VISTA-BB MRI for postoperative evaluation following FD implantation.
Methods
This retrospective study included 52 patients who underwent FD implantation alone. Scheduled DSA was performed at 6 and 12 months postoperatively. MRI examinations, including TOF-MRA and T1-VISTA-BB MRI, were defined as the most recent scans acquired within a specified time window relative to each DSA. The concordance with DSA was assessed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and diagnostic accuracy were calculated for each modality.
Results
At 6-month, T1-VISTA-BB MRI demonstrated significantly higher specificity (T1-VISTA-BB MRI vs TOF-MRA: 97.2 vs. 77.8 %, p = 0.028) and PPV (T1-VISTA-BB MRI vs TOF-MRA: 92.3 vs. 57.9 %, p = 0.049) compared with TOF-MRA. At 12-month, no significant differences were found between the two modalities.
Conclusions
T1-VISTA-BB MRI demonstrated significantly higher specificity and PPV compared with TOF-MRA at 6 months following FD implantation. This finding suggests it may serve as a useful and less invasive complementary tool to DSA for early postoperative evaluation. However, this advantage was not observed at the 12-month follow-up. Further studies involving larger cohorts and longer follow-up periods are required to validate these findings.
{"title":"Usefulness of T1 volumetric isotropic turbo spin-echo acquisition black-blood magnetic resonance imaging for follow-up evaluation after flow diverter implantation","authors":"Eisuke Tsukagoshi , Hiroki Sato , Takuma Maeda , Tomoyoshi Kuribara , Kazuki Fukumoto , Takahiko Taniguchi , Masataka Yoshimura , Hiroki Kurita , Shinya Kohyama","doi":"10.1016/j.clineuro.2025.109303","DOIUrl":"10.1016/j.clineuro.2025.109303","url":null,"abstract":"<div><h3>Background</h3><div>Digital subtraction angiography (DSA), the standard for postoperative evaluation following flow diverter (FD) implantation, is invasive and associated with potential complications. Although time-of-flight magnetic resonance angiography (TOF-MRA) is effective, normal blood flow may be misinterpreted as T1-weighted hyperintense thrombi. T1 volumetric isotropic turbo spin-echo acquisition black-blood magnetic resonance imaging (T1-VISTA-BB MRI) can differentiate thrombus from blood flow. We evaluate the utility of T1-VISTA-BB MRI for postoperative evaluation following FD implantation.</div></div><div><h3>Methods</h3><div>This retrospective study included 52 patients who underwent FD implantation alone. Scheduled DSA was performed at 6 and 12 months postoperatively. MRI examinations, including TOF-MRA and T1-VISTA-BB MRI, were defined as the most recent scans acquired within a specified time window relative to each DSA. The concordance with DSA was assessed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and diagnostic accuracy were calculated for each modality.</div></div><div><h3>Results</h3><div>At 6-month, T1-VISTA-BB MRI demonstrated significantly higher specificity (T1-VISTA-BB MRI vs TOF-MRA: 97.2 vs. 77.8 %, p = 0.028) and PPV (T1-VISTA-BB MRI vs TOF-MRA: 92.3 vs. 57.9 %, p = 0.049) compared with TOF-MRA. At 12-month, no significant differences were found between the two modalities.</div></div><div><h3>Conclusions</h3><div>T1-VISTA-BB MRI demonstrated significantly higher specificity and PPV compared with TOF-MRA at 6 months following FD implantation. This finding suggests it may serve as a useful and less invasive complementary tool to DSA for early postoperative evaluation. However, this advantage was not observed at the 12-month follow-up. Further studies involving larger cohorts and longer follow-up periods are required to validate these findings.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109303"},"PeriodicalIF":1.6,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882446","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 : 2025-12-29DOI: 10.1016/j.clineuro.2025.109302
Emilija Cvetkovska , Bekim Adjami , Bojan Boskovski , Marija Babunovska , Milena Stevanovic , Marija Cvetanovska , Igor Kuzmanovski , Vineet Punia
Objective
We investigated the incidence, risk factors, and management of post-viral encephalitis epilepsy (PEE) in a nationwide cohort in North Macedonia. Additionally, we conducted a comprehensive literature search on PEE.
Methods
Data were obtained from the electronic National Health System (eNHS), encompassing all patients diagnosed with viral encephalitis (VE) in 2016. Patients with pre-existing epilepsy diagnoses were excluded. Clinical, neuroimaging, and EEG data were collected and analyzed, and participants were followed for seven years.
Results
Of 1660,584 individuals registered in the eNHS in 2016, 68 were confirmed to have VE (incidence: 4.1/100,000). Among these, six patients died during hospitalization, and the remaining 62 were included in the study cohort. Acute symptomatic seizures (ASyS) occurred in 39 % of patients, with focal to bilateral tonic-clonic seizures (FBTCS) being the most common seizure type. Over the seven-year follow-up period, 11 patients (18 %) developed PEE, with 73 % of cases diagnosed within the first year. Significant risk factors for PEE included ASyS, younger age, and epileptiform abnormalities on EEG. By the end of the follow-up, seven patients with PEE (64 %) remained on antiseizure medications (ASMs).
Conclusions
Our results confirm ASyS and highlight acute electro-clinical findings and young age as risk factors for PEE. There is a need for evidence-based clinical pathways and care protocols for patients at risk.
{"title":"Incidence, risk factors and management practices in post-viral encephalitis epilepsy: A long-term, nationwide population-based study and review of literature","authors":"Emilija Cvetkovska , Bekim Adjami , Bojan Boskovski , Marija Babunovska , Milena Stevanovic , Marija Cvetanovska , Igor Kuzmanovski , Vineet Punia","doi":"10.1016/j.clineuro.2025.109302","DOIUrl":"10.1016/j.clineuro.2025.109302","url":null,"abstract":"<div><h3>Objective</h3><div>We investigated the incidence, risk factors, and management of post-viral encephalitis epilepsy (PEE) in a nationwide cohort in North Macedonia. Additionally, we conducted a comprehensive literature search on PEE.</div></div><div><h3>Methods</h3><div>Data were obtained from the electronic National Health System (eNHS), encompassing all patients diagnosed with viral encephalitis (VE) in 2016. Patients with pre-existing epilepsy diagnoses were excluded. Clinical, neuroimaging, and EEG data were collected and analyzed, and participants were followed for seven years.</div></div><div><h3>Results</h3><div>Of 1660,584 individuals registered in the eNHS in 2016, 68 were confirmed to have VE (incidence: 4.1/100,000). Among these, six patients died during hospitalization, and the remaining 62 were included in the study cohort. Acute symptomatic seizures (ASyS) occurred in 39 % of patients, with focal to bilateral tonic-clonic seizures (FBTCS) being the most common seizure type. Over the seven-year follow-up period, 11 patients (18 %) developed PEE, with 73 % of cases diagnosed within the first year. Significant risk factors for PEE included ASyS, younger age, and epileptiform abnormalities on EEG. By the end of the follow-up, seven patients with PEE (64 %) remained on antiseizure medications (ASMs).</div></div><div><h3>Conclusions</h3><div>Our results confirm ASyS and highlight acute electro-clinical findings and young age as risk factors for PEE. There is a need for evidence-based clinical pathways and care protocols for patients at risk.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109302"},"PeriodicalIF":1.6,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899337","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 : 2025-12-26DOI: 10.1016/j.clineuro.2025.109294
Luciano Falcão , Pedro Antonio Lopes Gomes, Rafael Andrade Sampaio Silva, Kenzo Ogasawara, João Victor Pereira Gonzalez, André Nishizima, Victor Arthur Ohannesian, Lara Souza Magalhães, Davi J. Fontoura Solla
{"title":"Corrigendum to: “Assessing glibenclamide’s efficacy on functional recovery in aneurysmal subarachnoid hemorrhage: A meta-analysis of randomized controlled trials”","authors":"Luciano Falcão , Pedro Antonio Lopes Gomes, Rafael Andrade Sampaio Silva, Kenzo Ogasawara, João Victor Pereira Gonzalez, André Nishizima, Victor Arthur Ohannesian, Lara Souza Magalhães, Davi J. Fontoura Solla","doi":"10.1016/j.clineuro.2025.109294","DOIUrl":"10.1016/j.clineuro.2025.109294","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109294"},"PeriodicalIF":1.6,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882390","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 : 2025-12-26DOI: 10.1016/j.clineuro.2025.109292
Razan R. Faraj , Rommi Kashlan , Hithardhi Duggireddy , Ryan S. Chung , David J. Cote , Robert G. Briggs , Reem A. Dawoud , Angela P. Mihalic , Gabriel Zada , Jonathan A. Grossberg
Objective
With the recent change to pass/fail USMLE Step 1 assessment and increasing reliance on other metrics of applicant ability, neurosurgery residency programs face challenges in evaluating the academic potential of applicants. This study examines the relative contributions of first-author publications, research year completion, and total publication volume to match success.
Methods
Data were drawn from the Texas STAR (Seeking Transparency in Applications to Residency) survey between 2022 and 2025, including 2674 U.S. MD applicants and a detailed 2025 sub-cohort (n = 58) with authorship data. Logistic regression models, Chi-squared tests, and t-tests were used to examine associations between publication patterns and match outcomes. Covariates included Step 2 CK score (categorized), geographic connection, and away rotation participation.
Results
When mutually adjusted, first-author publication count was strongly predictive of match success (OR=2.76 per additional first-authored paper, 95 % CI: 1.82–4.67, p < 0.001), while total publication count was negatively associated with matching when controlling for authorship (OR=0.64, 95 % CI: 0.46–0.84, p < 0.001). Completion of a research year was associated with a significantly higher number of first-author publications (mean=3.96 vs. 2.53, p = 0.0023), but not with greater total publication volume (mean=8.04 vs. 6.41, p = 0.07). A greater number of research experiences was inversely associated with match success (OR=0.53 per experience, 95 % CI: 0.38–0.68, p < 0.001).
Conclusion
First-authored papers better predict match success than total publication count in neurosurgery residency applications. Dedicated research years appear to support meaningful productivity rather than sheer volume. These findings delineate how research experience is weighted in neurosurgery residency selection and may be helpful for medical students applying into neurosurgery.
{"title":"Redefining research productivity in neurosurgery residency applications through the predictive value of authorship order and research year engagement","authors":"Razan R. Faraj , Rommi Kashlan , Hithardhi Duggireddy , Ryan S. Chung , David J. Cote , Robert G. Briggs , Reem A. Dawoud , Angela P. Mihalic , Gabriel Zada , Jonathan A. Grossberg","doi":"10.1016/j.clineuro.2025.109292","DOIUrl":"10.1016/j.clineuro.2025.109292","url":null,"abstract":"<div><h3>Objective</h3><div>With the recent change to pass/fail USMLE Step 1 assessment and increasing reliance on other metrics of applicant ability, neurosurgery residency programs face challenges in evaluating the academic potential of applicants. This study examines the relative contributions of first-author publications, research year completion, and total publication volume to match success.</div></div><div><h3>Methods</h3><div>Data were drawn from the Texas STAR (Seeking Transparency in Applications to Residency) survey between 2022 and 2025, including 2674 U.S. MD applicants and a detailed 2025 sub-cohort (n = 58) with authorship data. Logistic regression models, Chi-squared tests, and t-tests were used to examine associations between publication patterns and match outcomes. Covariates included Step 2 CK score (categorized), geographic connection, and away rotation participation.</div></div><div><h3>Results</h3><div>When mutually adjusted, first-author publication count was strongly predictive of match success (OR=2.76 per additional first-authored paper, 95 % CI: 1.82–4.67, p < 0.001), while total publication count was negatively associated with matching when controlling for authorship (OR=0.64, 95 % CI: 0.46–0.84, p < 0.001). Completion of a research year was associated with a significantly higher number of first-author publications (mean=3.96 vs. 2.53, p = 0.0023), but not with greater total publication volume (mean=8.04 vs. 6.41, p = 0.07). A greater number of research experiences was inversely associated with match success (OR=0.53 per experience, 95 % CI: 0.38–0.68, p < 0.001).</div></div><div><h3>Conclusion</h3><div>First-authored papers better predict match success than total publication count in neurosurgery residency applications. Dedicated research years appear to support meaningful productivity rather than sheer volume. These findings delineate how research experience is weighted in neurosurgery residency selection and may be helpful for medical students applying into neurosurgery.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109292"},"PeriodicalIF":1.6,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862562","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 : 2025-12-25DOI: 10.1016/j.clineuro.2025.109293
Ahmed Abdelwahab , Hasna Loulida , Mohammad Mahdi Bagheri Asl , Marwa Abdelrasoul , Qian Chang Gallo , Erick Lemon , Sami Al Kasab , Nathan C. Rowland , Alejandro M. Spiotta , Istvan Takacs
Objectives
Current commercial stereotactic frames have several limitations and are geometrically complex. They utilize imaginary, physically unreachable reference points, and they are expensive. We designed a three-dimensional, low-cost, and easy-to-assemble frame that can both visualize and physically reach the reference point at (0, 0, 0). Our frame allows simultaneous bilateral targeting via distinct trajectories, thereby reducing operative time while providing wider facial exposure for airway protection.
Methods
In a prospective phantom experiment (August–October 2025), five operators each performed five passes at four radiopaque intracranial targets (100 attempts). Before every pass, the frame was physically re-zeroed to the reference point. For each attempt, we recorded the three-dimensional Euclidean target registration error (TRE) and the signed axis-specific offsets. Linear mixed-effects modelling with operator and target location as random factors, intraclass correlation, and Bland-Altman agreement were utilized for statistical analyses.
Results
All 100 trajectories contacted their intended target. Mean±SD TRE was 0.19 ± 0.07 mm. Every attempt fell within 1 mm of the target (100 %, 95 %CI 96.4–100 %). Axis-wise biases were negligible (Δx = 0.01 mm, Δy = -0.01 mm, Δz = -0.01 mm; all p > 0.33). Bland-Altman limits of agreement were ±0.23 mm (x), ±0.24 mm (y), and ±0.24 mm (z) with no trend across the measurement range. Mixed-effects modelling attributed 12.5 % of the residual variance to operators, 7.1 % to target location, and 80.4 % to unexplained (within-trial) error; the adjusted ICC was 0.20, indicating low between-operator variability relative to total variance. Neither repetition order (p = 0.38) nor location (p = 0.08) influenced TRE. The mean setup-to-trajectory time was under 10 min per operator.
Conclusion
Our stereotactic system delivered reproducible, near-millimeter accuracy in phantom testing while simplifying setup, reducing operative time, and eliminating expensive software dependency. These findings justify advancing to cadaveric studies and early clinical trials to broaden access to frame-based stereotaxy for urgent procedures, such as external ventricular drain placement, across diverse healthcare environments.
{"title":"Development of a stereotactic frame for neurosurgery targeting: A prospective pre-clinical study","authors":"Ahmed Abdelwahab , Hasna Loulida , Mohammad Mahdi Bagheri Asl , Marwa Abdelrasoul , Qian Chang Gallo , Erick Lemon , Sami Al Kasab , Nathan C. Rowland , Alejandro M. Spiotta , Istvan Takacs","doi":"10.1016/j.clineuro.2025.109293","DOIUrl":"10.1016/j.clineuro.2025.109293","url":null,"abstract":"<div><h3>Objectives</h3><div>Current commercial stereotactic frames have several limitations and are geometrically complex. They utilize imaginary, physically unreachable reference points, and they are expensive. We designed a three-dimensional, low-cost, and easy-to-assemble frame that can both visualize and physically reach the reference point at (0, 0, 0). Our frame allows simultaneous bilateral targeting via distinct trajectories, thereby reducing operative time while providing wider facial exposure for airway protection.</div></div><div><h3>Methods</h3><div>In a prospective phantom experiment (August–October 2025), five operators each performed five passes at four radiopaque intracranial targets (100 attempts). Before every pass, the frame was physically re-zeroed to the reference point. For each attempt, we recorded the three-dimensional Euclidean target registration error (TRE) and the signed axis-specific offsets. Linear mixed-effects modelling with operator and target location as random factors, intraclass correlation, and Bland-Altman agreement were utilized for statistical analyses.</div></div><div><h3>Results</h3><div>All 100 trajectories contacted their intended target. Mean±SD TRE was 0.19 ± 0.07 mm. Every attempt fell within 1 mm of the target (100 %, 95 %CI 96.4–100 %). Axis-wise biases were negligible (Δx = 0.01 mm, Δy = -0.01 mm, Δz = -0.01 mm; all p > 0.33). Bland-Altman limits of agreement were ±0.23 mm (x), ±0.24 mm (y), and ±0.24 mm (z) with no trend across the measurement range. Mixed-effects modelling attributed 12.5 % of the residual variance to operators, 7.1 % to target location, and 80.4 % to unexplained (within-trial) error; the adjusted ICC was 0.20, indicating low between-operator variability relative to total variance. Neither repetition order (p = 0.38) nor location (p = 0.08) influenced TRE. The mean setup-to-trajectory time was under 10 min per operator.</div></div><div><h3>Conclusion</h3><div>Our stereotactic system delivered reproducible, near-millimeter accuracy in phantom testing while simplifying setup, reducing operative time, and eliminating expensive software dependency. These findings justify advancing to cadaveric studies and early clinical trials to broaden access to frame-based stereotaxy for urgent procedures, such as external ventricular drain placement, across diverse healthcare environments.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109293"},"PeriodicalIF":1.6,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862522","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}
Autonomic nervous system disruptions following mild traumatic brain injury (MTBI) may play a role in elevated mortality risk. However, the relationship between MTBI-related autonomic dysfunction and mental health in the general population remains understudied. This study examined autonomic dysfunction and mental health symptoms among individuals reporting previous MTBI within a community sample. This population-based cross-sectional study was implemented among adults residing in Ulaanbaatar, Mongolia. Heart rate variability (HRV) analysis served as a non-invasive method for evaluating autonomic nervous system functioning. Mental health parameters including anxiety, depression, sleep disturbances, and quality of life were measured using validated instruments: Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), and the brief version of World Health Organization Quality of Life (WHOQOL-BREF). The study enrolled 177 individuals (74 % female) averaging 39.85 ± 9.82 years. Sixteen individuals reported experiencing MTBI previously. After adjusting for age and sex, the population prevalence was 2.4 %. Elevated body temperature, increased heart rate, and higher anxiety levels were observed among MTBI-exposed participants relative to unexposed individuals, while HRV indices showed reductions. Regression analysis indicated associations between MTBI and reduced HRV measures. The results demonstrate that pNN50 and RMSSD were predicted by marital status, LF/HF ratio, and MTBI-exposed history (r2 = 0.33, P = 0.017 and r2 = 0.37, P = 0.005, respectively). In conclusion, individuals with MTBI history demonstrated reduced HRV and elevated anxiety relative to individuals without MTBI history. These findings indicate potential persistent effects of MTBI on autonomic function, mental health, and quality of life.
{"title":"Heart rate variability in adults with mild traumatic brain injury: a population-based cross-sectional study","authors":"Enkhjin Bat-Erdene , Enkhnaran Tumurbaatar , Gantsetseg Tumur-Ochir , Battuvshin Lkhagvasuren , Tsolmon Jadamba , Hiroaki Adachi","doi":"10.1016/j.clineuro.2025.109289","DOIUrl":"10.1016/j.clineuro.2025.109289","url":null,"abstract":"<div><div>Autonomic nervous system disruptions following mild traumatic brain injury (MTBI) may play a role in elevated mortality risk. However, the relationship between MTBI-related autonomic dysfunction and mental health in the general population remains understudied. This study examined autonomic dysfunction and mental health symptoms among individuals reporting previous MTBI within a community sample. This population-based cross-sectional study was implemented among adults residing in Ulaanbaatar, Mongolia. Heart rate variability (HRV) analysis served as a non-invasive method for evaluating autonomic nervous system functioning. Mental health parameters including anxiety, depression, sleep disturbances, and quality of life were measured using validated instruments: Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), and the brief version of World Health Organization Quality of Life (WHOQOL-BREF). The study enrolled 177 individuals (74 % female) averaging 39.85 ± 9.82 years. Sixteen individuals reported experiencing MTBI previously. After adjusting for age and sex, the population prevalence was 2.4 %. Elevated body temperature, increased heart rate, and higher anxiety levels were observed among MTBI-exposed participants relative to unexposed individuals, while HRV indices showed reductions. Regression analysis indicated associations between MTBI and reduced HRV measures. The results demonstrate that pNN50 and RMSSD were predicted by marital status, LF/HF ratio, and MTBI-exposed history (r2 = 0.33, P = 0.017 and r2 = 0.37, P = 0.005, respectively). In conclusion, individuals with MTBI history demonstrated reduced HRV and elevated anxiety relative to individuals without MTBI history. These findings indicate potential persistent effects of MTBI on autonomic function, mental health, and quality of life.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109289"},"PeriodicalIF":1.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839649","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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