Pub Date : 2026-04-01Epub Date: 2026-01-19DOI: 10.1016/j.clineuro.2026.109323
Thiago Oscar Goulart , Amanda Sanae Esaki , João Brainer Clares de Andrade , Millene Rodrigues Camilo , Daniel Giansante Abud , Octávio Marques Pontes-Neto
Background
Contrast-associated acute kidney injury (CA-AKI) is a frequent complication after mechanical thrombectomy (MT). Cerebral small vessel disease (CSVD) reflects cerebral microvascular dysfunction driven by systemic vascular risk factors that also affect renal integrity, and may therefore serve as a surrogate marker of renal vulnerability.
Methods
We prospectively included 351 patients with anterior circulation large-vessel occlusion who underwent MT. Baseline non-contrast CT was used to derive the modified small vessel disease (mSVD) score and the Brain Frailty Score (BFS). CA-AKI was defined as ≥ 0.5 mg/dL or ≥ 25 % increase in serum creatinine within 48–72 h after MT. Multivariable logistic regression, Firth penalized models, and XGBoost machine learning identified independent predictors.
Results
CA-AKI occurred in 42 patients (12.0 %). Affected patients were older (68 vs. 62 years), had higher glucose (143 vs. 118 mg/dL), elevated systolic pressure, and more pronounced CSVD features. Severe BFS (score=3) independently predicted CA-AKI (OR=5.13; 95 % CI 1.46–91.28; p = 0.039) after adjustment for age, glucose, and recanalization, whereas mSVD and individual imaging markers were not significant. The final model showed good discrimination and calibration (AUC=0.73; Brier=0.08) and remained stable in sensitivity analyses. In Firth regression, BFS remained significant (OR=4.26; 95 % CI 1.23–22.54). XGBoost achieved an AUC= 0.84, confirming the consistent predictive relevance of vascular, metabolic, and imaging factors across models.
Conclusions
BFS predicts CA-AKI after thrombectomy, outperforming both conventional CSVD scoring and individual imaging markers. These findings support the concept of Systemic Microvasculature Frailty,
in which cerebral microangiopathy reflects global endothelial vulnerability with acute renal implications.
造影剂相关急性肾损伤（CA-AKI）是机械取栓（MT）后常见的并发症。脑血管病（CSVD）反映了全身血管危险因素驱动的脑微血管功能障碍，也影响肾脏完整性，因此可以作为肾脏易感性的替代标志物。方法前瞻性纳入351例行MT的前循环大血管闭塞患者。采用基线非对比CT计算改良小血管病变（mSVD）评分和脑衰弱评分（BFS）。CA-AKI定义为MT后48-72 小时内血清肌酐升高≥ 0.5 mg/dL或≥ 25 %。多变量logistic回归、Firth惩罚模型和XGBoost机器学习确定了独立预测因子。结果42例患者发生sca - aki（12.0 %）。受影响的患者年龄较大（68岁对62岁），血糖升高（143对118 mg/dL），收缩压升高，CSVD特征更明显。在调整年龄、血糖和再通后，严重BFS（评分=3）独立预测CA-AKI (OR=5.13; 95 % CI 1.46-91.28; p = 0.039)，而mSVD和个体影像学标志物无统计学意义。最终模型具有良好的判别性和定标性（AUC=0.73; Brier=0.08），在敏感性分析中保持稳定。在第五次回归中，BFS仍然显著（OR=4.26; 95 % CI 1.23-22.54）。XGBoost实现了AUC= 0.84，证实了不同模型中血管、代谢和成像因素的一致预测相关性。结论sbfs预测取栓后CA-AKI，优于常规CSVD评分和个体影像学指标。这些发现支持了系统性微血管衰弱的概念，其中脑微血管病变反映了急性肾影响的整体内皮易感性。
{"title":"Systemic Microvasculature Frailty: Brain frailty score predicts contrast-associated acute kidney injury after thrombectomy for stroke","authors":"Thiago Oscar Goulart , Amanda Sanae Esaki , João Brainer Clares de Andrade , Millene Rodrigues Camilo , Daniel Giansante Abud , Octávio Marques Pontes-Neto","doi":"10.1016/j.clineuro.2026.109323","DOIUrl":"10.1016/j.clineuro.2026.109323","url":null,"abstract":"<div><h3>Background</h3><div>Contrast-associated acute kidney injury (CA-AKI) is a frequent complication after mechanical thrombectomy (MT). Cerebral small vessel disease (CSVD) reflects cerebral microvascular dysfunction driven by systemic vascular risk factors that also affect renal integrity, and may therefore serve as a surrogate marker of renal vulnerability.</div></div><div><h3>Methods</h3><div>We prospectively included 351 patients with anterior circulation large-vessel occlusion who underwent MT. Baseline non-contrast CT was used to derive the modified small vessel disease (mSVD) score and the Brain Frailty Score (BFS). CA-AKI was defined as ≥ 0.5 mg/dL or ≥ 25 % increase in serum creatinine within 48–72 h after MT. Multivariable logistic regression, Firth penalized models, and XGBoost machine learning identified independent predictors.</div></div><div><h3>Results</h3><div>CA-AKI occurred in 42 patients (12.0 %). Affected patients were older (68 vs. 62 years), had higher glucose (143 vs. 118 mg/dL), elevated systolic pressure, and more pronounced CSVD features. Severe BFS (score=3) independently predicted CA-AKI (OR=5.13; 95 % CI 1.46–91.28; p = 0.039) after adjustment for age, glucose, and recanalization, whereas mSVD and individual imaging markers were not significant. The final model showed good discrimination and calibration (AUC=0.73; Brier=0.08) and remained stable in sensitivity analyses. In Firth regression, BFS remained significant (OR=4.26; 95 % CI 1.23–22.54). XGBoost achieved an AUC= 0.84, confirming the consistent predictive relevance of vascular, metabolic, and imaging factors across models.</div></div><div><h3>Conclusions</h3><div>BFS predicts CA-AKI after thrombectomy, outperforming both conventional CSVD scoring and individual imaging markers. These findings support the concept of <strong>Systemic Microvasculature Frailty</strong>,</div><div>in which cerebral microangiopathy reflects global endothelial vulnerability with acute renal implications.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109323"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146036637","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 : 2026-04-01Epub Date: 2026-01-20DOI: 10.1016/j.clineuro.2026.109325
Lei Zhang , Hong Yao , Xuelin Liang , Canfang Hu , Guojun Luo
Background
Parkinson's disease (PD) is characterized by motor and non-motor symptoms with oculomotor dysfunction being a notable feature. This study aimed to determine the oculomotor function in patients with PD using video-oculography (VOG) and to identify the association between physiologic parameters and PD.
Methods
The study enrolled 45 patients diagnosed with PD at onset and 45 age- and gender-matched healthy controls from July 2019 to July 2023. All participants underwent VOG testing. Eye movement parameters, including velocity, latency, gain, and accuracy, were quantified. The presence of square-wave jerks (SWJs) and abnormal tracking patterns was also assessed. Binary logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate the associations between VOG testing parameters and PD.
Results
Patients with PD demonstrated a significantly higher SWJ rate, reduced pursuit gain, prolonged saccade latency, and slower saccade velocity compared to controls (P < 0.05). SWJs, decreased pursuit gain, and prolonged saccade latency were closely related to PD based on logistic regression analysis. The combined detection index incorporating these 3 parameters yielded an area under the ROC curve of 0.836 (95 % CI: 0.752–0.920; P < 0.001) with 77.8 % sensitivity and 82.2 % specificity.
Conclusion
Assessment of oculomotor function using VOG demonstrated notable abnormalities in patients with PD, especially with respect to fixation stability, smooth pursuit, and saccadic control. A combined index incorporating SWJs, pursuit gain, and saccade latency significantly improved PD screening precision.
{"title":"Association between oculomotor function testing parameters and Parkinson’s disease","authors":"Lei Zhang , Hong Yao , Xuelin Liang , Canfang Hu , Guojun Luo","doi":"10.1016/j.clineuro.2026.109325","DOIUrl":"10.1016/j.clineuro.2026.109325","url":null,"abstract":"<div><h3>Background</h3><div>Parkinson's disease (PD) is characterized by motor and non-motor symptoms with oculomotor dysfunction being a notable feature. This study aimed to determine the oculomotor function in patients with PD using video-oculography (VOG) and to identify the association between physiologic parameters and PD.</div></div><div><h3>Methods</h3><div>The study enrolled 45 patients diagnosed with PD at onset and 45 age- and gender-matched healthy controls from July 2019 to July 2023. All participants underwent VOG testing. Eye movement parameters, including velocity, latency, gain, and accuracy, were quantified. The presence of square-wave jerks (SWJs) and abnormal tracking patterns was also assessed. Binary logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate the associations between VOG testing parameters and PD.</div></div><div><h3>Results</h3><div>Patients with PD demonstrated a significantly higher SWJ rate, reduced pursuit gain, prolonged saccade latency, and slower saccade velocity compared to controls (<em>P</em> < 0.05). SWJs, decreased pursuit gain, and prolonged saccade latency were closely related to PD based on logistic regression analysis. The combined detection index incorporating these 3 parameters yielded an area under the ROC curve of 0.836 (95 % CI: 0.752–0.920; <em>P</em> < 0.001) with 77.8 % sensitivity and 82.2 % specificity.</div></div><div><h3>Conclusion</h3><div>Assessment of oculomotor function using VOG demonstrated notable abnormalities in patients with PD, especially with respect to fixation stability, smooth pursuit, and saccadic control. A combined index incorporating SWJs, pursuit gain, and saccade latency significantly improved PD screening precision.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109325"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146075666","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 : 2026-04-01Epub Date: 2026-01-22DOI: 10.1016/j.clineuro.2026.109326
Alejandro N. Santos , Seevakan Chidambaram , Bashar Dawoud , Sai Sanikommu , John Laidlaw , Timothy Kleinig , Bruce C.V. Campbell , Christopher P. Kellner , Amal Abou-Hamden
Background
Intracerebral hemorrhage (ICH) is a critical stroke subtype with high morbidity and mortality, and current surgical interventions offer limited improvements. Minimally invasive surgery (MIS) and 3D-printed models are gaining traction for training neurosurgeons in safer, more effective ICH removal techniques.
Methods
During the 2024 APSC, a hands-on workshop on MIS ICH removal used 3D-printed models derived from patient CT scans. These models replicated neuroanatomy, vascularity, and tissue properties to provide realistic tactile feedback. Physicians completed a survey rating anatomical accuracy, haptics, and educational value.
Results
A total of 6 specialized neurosurgeons completed the survey. The majority rated the models highly for anatomical accuracy and realism. On a scale of 1–5, the mean score for anatomical accuracy was 4.77, with 83.3 % of participants agreeing that the models closely resembled real-life surgical conditions. Haptic feedback was rated similarly, with 66.7 % of respondents considering it high quality. Additionally, 83.3 % of participants agreed that the models improved visualization and surgical planning compared to 2D imaging. The models enhanced the understanding of neuroanatomical relationships, with a mean score of 4.79, and 100 % of participants indicated that they should be integrated into neurosurgical training programs. Furthermore, 82 % of participants believed that 3D-printed models should supplement traditional surgical training methods, such as lectures and cadaveric dissections.
Conclusions
This patient-specific, perfused 3D-printed endoscopic ICH evacuation training platform was feasible to implement in a hands-on workshop and was rated favorably by a small cohort of participants (n = 6). These results reflect perceived realism and perceived educational utility rather than demonstrated educational effectiveness. Larger studies incorporating objective performance metrics are needed before conclusions about training effectiveness or generalizability can be made.
{"title":"Educational impact of 3D-printed models in enhancing endoscopic intracerebral hemorrhage removal: An international survey based on the EVACUATE trial","authors":"Alejandro N. Santos , Seevakan Chidambaram , Bashar Dawoud , Sai Sanikommu , John Laidlaw , Timothy Kleinig , Bruce C.V. Campbell , Christopher P. Kellner , Amal Abou-Hamden","doi":"10.1016/j.clineuro.2026.109326","DOIUrl":"10.1016/j.clineuro.2026.109326","url":null,"abstract":"<div><h3>Background</h3><div>Intracerebral hemorrhage (ICH) is a critical stroke subtype with high morbidity and mortality, and current surgical interventions offer limited improvements. Minimally invasive surgery (MIS) and 3D-printed models are gaining traction for training neurosurgeons in safer, more effective ICH removal techniques.</div></div><div><h3>Methods</h3><div>During the 2024 APSC, a hands-on workshop on MIS ICH removal used 3D-printed models derived from patient CT scans. These models replicated neuroanatomy, vascularity, and tissue properties to provide realistic tactile feedback. Physicians completed a survey rating anatomical accuracy, haptics, and educational value.</div></div><div><h3>Results</h3><div>A total of 6 specialized neurosurgeons completed the survey. The majority rated the models highly for anatomical accuracy and realism. On a scale of 1–5, the mean score for anatomical accuracy was 4.77, with 83.3 % of participants agreeing that the models closely resembled real-life surgical conditions. Haptic feedback was rated similarly, with 66.7 % of respondents considering it high quality. Additionally, 83.3 % of participants agreed that the models improved visualization and surgical planning compared to 2D imaging. The models enhanced the understanding of neuroanatomical relationships, with a mean score of 4.79, and 100 % of participants indicated that they should be integrated into neurosurgical training programs. Furthermore, 82 % of participants believed that 3D-printed models should supplement traditional surgical training methods, such as lectures and cadaveric dissections.</div></div><div><h3>Conclusions</h3><div>This patient-specific, perfused 3D-printed endoscopic ICH evacuation training platform was feasible to implement in a hands-on workshop and was rated favorably by a small cohort of participants (n = 6). These results reflect perceived realism and perceived educational utility rather than demonstrated educational effectiveness. Larger studies incorporating objective performance metrics are needed before conclusions about training effectiveness or generalizability can be made.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109326"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146075668","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 : 2026-04-01Epub Date: 2026-01-28DOI: 10.1016/j.clineuro.2026.109335
Aman Advani , Ahad Jawaid
{"title":"Comment on: “Usefulness of T1 volumetric isotropic turbo spin-echo acquisition black-blood magnetic resonance imaging for follow-up evaluation after flow diverter implantation”","authors":"Aman Advani , Ahad Jawaid","doi":"10.1016/j.clineuro.2026.109335","DOIUrl":"10.1016/j.clineuro.2026.109335","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109335"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146075669","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}
Anti–leucine-rich glioma-inactivated protein 1 (LGI-1) autoimmune encephalitis is a rare but increasingly recognized cause of seizures and cognitive decline. Most cases occur in middle-aged or elderly adults, whereas very late-onset presentations above 80 years are exceptionally uncommon and may mimic neurodegenerative, metabolic or cerebrovascular conditions, contributing to diagnostic delays.
Case presentation
We report an 84-year-old woman who presented with progressive somnolence, speech disturbance, and focal motor seizures. MRI demonstrated bilateral temporal lobe T2 hyperintensities, while EEG revealed temporal epileptiform discharges. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed hypermetabolism in the temporal lobes and basal ganglia. Serum testing confirmed the presence of LGI-1 antibodies. The patient received a 7-day course of intravenous methylprednisolone followed by clinical monitoring. Rapid neurological improvement was observed within the first week, and no escalation to second-line immunotherapy was required. Over a four-year follow-up period, she remained clinically stable without relapse.
Conclusion
This case expands the upper age spectrum of anti-LGI-1 encephalitis and emphasizes the importance of considering autoimmune etiologies in elderly patients presenting with new-onset seizures and cognitive impairment. Neuroimaging and electrophysiological findings play a crucial role in diagnosis, particularly when classical faciobrachial dystonic seizures are absent. Timely corticosteroid therapy may provide sustained remission even in very late-onset cases, highlighting the potential efficacy of conservative immunotherapeutic strategies.
{"title":"Anti-LGI-1 autoimmune encephalitis: Insights from literature and a very late-onset case report","authors":"Cansu Sarıkaya , Bengül Fatma Gölge , Canan Aykut Bingöl , Berrin Aktekin, Rana Karabudak","doi":"10.1016/j.clineuro.2026.109336","DOIUrl":"10.1016/j.clineuro.2026.109336","url":null,"abstract":"<div><h3>Background</h3><div>Anti–leucine-rich glioma-inactivated protein 1 (LGI-1) autoimmune encephalitis is a rare but increasingly recognized cause of seizures and cognitive decline. Most cases occur in middle-aged or elderly adults, whereas very late-onset presentations above 80 years are exceptionally uncommon and may mimic neurodegenerative, metabolic or cerebrovascular conditions, contributing to diagnostic delays.</div></div><div><h3>Case presentation</h3><div>We report an 84-year-old woman who presented with progressive somnolence, speech disturbance, and focal motor seizures. MRI demonstrated bilateral temporal lobe T2 hyperintensities, while EEG revealed temporal epileptiform discharges. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed hypermetabolism in the temporal lobes and basal ganglia. Serum testing confirmed the presence of LGI-1 antibodies. The patient received a 7-day course of intravenous methylprednisolone followed by clinical monitoring. Rapid neurological improvement was observed within the first week, and no escalation to second-line immunotherapy was required. Over a four-year follow-up period, she remained clinically stable without relapse.</div></div><div><h3>Conclusion</h3><div>This case expands the upper age spectrum of anti-LGI-1 encephalitis and emphasizes the importance of considering autoimmune etiologies in elderly patients presenting with new-onset seizures and cognitive impairment. Neuroimaging and electrophysiological findings play a crucial role in diagnosis, particularly when classical faciobrachial dystonic seizures are absent. Timely corticosteroid therapy may provide sustained remission even in very late-onset cases, highlighting the potential efficacy of conservative immunotherapeutic strategies.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109336"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146075670","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 : 2026-04-01Epub Date: 2026-02-07DOI: 10.1016/j.clineuro.2026.109339
Maria Luisa Machado Assis , David S. Sabsevitz , Kiran S. Merchant , Michelle DeDeo , Alfredo Quinones-Hinojosa , Kaisorn L. Chaichana , William T. Crowe , Elird Bojaxhi , John Woeste , Shaun E. Gruenbaum , Ilana I. Logvinov , Marie L. De Ruyter , Kevin T. Riutort , Benjamin F. Gruenbaum
Background
Awake craniotomy (AC) is the gold standard for tumor resections in eloquent brain regions requiring surgical precision. Traditional AC uses pins to immobilize the head, which may contribute to scalp injury, discomfort, and hemodynamic fluctuations. We evaluated perioperative outcomes of AC performed with and without pin fixation at a single tertiary center.
Methods
We conducted a retrospective cohort study of adults undergoing AC between October 2018 and June 2023. Outcomes included head movement and movement-related workflow disruptions, anesthetic dosing, hemodynamics, operative duration, and postoperative recovery.
Results
Head movement was greater in unpinned cases (p < 0.001), although disruptive movements were uncommon (Grade 4: 6 %; no Grade 5 events). Propofol dosing was higher in pinned patients (3.2 ± 1.9 vs 2.4 ± 2.2 mg/kg/hr; p = 0.029), while dexmedetomidine dosing was similar between groups. RASS scores were comparable overall, with sex-based differences observed. Unpinned AC was associated with smaller increases in systolic blood pressure (17.5 ± 24.1 vs 25.4 ± 24.7 mmHg; p = 0.021), shorter operative duration (151.7 ± 56.3 vs 184.2 ± 74.7 min; p = 0.001), and similar ICU length of stay (p = 0.649).
Conclusions
Unpinned AC was associated with greater head movement but rare clinically disruptive events, alongside modest differences in anesthetic requirements, hemodynamics, and operative duration. These findings suggest potential workflow and comfort benefits in carefully selected patients rather than major safety differences. Prospective multicenter studies with standardized protocols are warranted to better define patient selection and validate these observations.
{"title":"Implications of cranial pinning during awake craniotomy on anesthetic requirements: A retrospective cohort study","authors":"Maria Luisa Machado Assis , David S. Sabsevitz , Kiran S. Merchant , Michelle DeDeo , Alfredo Quinones-Hinojosa , Kaisorn L. Chaichana , William T. Crowe , Elird Bojaxhi , John Woeste , Shaun E. Gruenbaum , Ilana I. Logvinov , Marie L. De Ruyter , Kevin T. Riutort , Benjamin F. Gruenbaum","doi":"10.1016/j.clineuro.2026.109339","DOIUrl":"10.1016/j.clineuro.2026.109339","url":null,"abstract":"<div><h3>Background</h3><div>Awake craniotomy (AC) is the gold standard for tumor resections in eloquent brain regions requiring surgical precision. Traditional AC uses pins to immobilize the head, which may contribute to scalp injury, discomfort, and hemodynamic fluctuations. We evaluated perioperative outcomes of AC performed with and without pin fixation at a single tertiary center.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adults undergoing AC between October 2018 and June 2023. Outcomes included head movement and movement-related workflow disruptions, anesthetic dosing, hemodynamics, operative duration, and postoperative recovery.</div></div><div><h3>Results</h3><div>Head movement was greater in unpinned cases (p < 0.001), although disruptive movements were uncommon (Grade 4: 6 %; no Grade 5 events). Propofol dosing was higher in pinned patients (3.2 ± 1.9 vs 2.4 ± 2.2 mg/kg/hr; p = 0.029), while dexmedetomidine dosing was similar between groups. RASS scores were comparable overall, with sex-based differences observed. Unpinned AC was associated with smaller increases in systolic blood pressure (17.5 ± 24.1 vs 25.4 ± 24.7 mmHg; p = 0.021), shorter operative duration (151.7 ± 56.3 vs 184.2 ± 74.7 min; p = 0.001), and similar ICU length of stay (p = 0.649).</div></div><div><h3>Conclusions</h3><div>Unpinned AC was associated with greater head movement but rare clinically disruptive events, alongside modest differences in anesthetic requirements, hemodynamics, and operative duration. These findings suggest potential workflow and comfort benefits in carefully selected patients rather than major safety differences. Prospective multicenter studies with standardized protocols are warranted to better define patient selection and validate these observations.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109339"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164445","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}
Successful recanalization is not achieved in approximately 20 % of stroke patients who underwent mechanical thrombectomy, possibly due to the characteristics of the underlying thrombus. This study aimed to identify the most appropriate thrombectomy strategy based on the preoperative imaging features of the thrombus.
Methods
We retrospectively evaluated the data of 70 patients who underwent mechanical thrombectomy. Thrombus density was assessed using non-contrast computed tomography (ΔCT values) and CT angiography (thrombus permeability). Difficult-to-retrieve thrombi were categorized based on the cutoff values (ΔCT <10 Hounsfield units and/or thrombus permeability <9 Hounsfield units). Favorable outcomes (modified Rankin scale score of 0–2) and successful recanalization (Thrombolysis in Cerebral Infarction grade 2b or 3) were evaluated. We also analyzed the interaction between thrombus imaging features and thrombectomy strategy (stent retriever (SR) alone vs. combined strategy) and its effect on recanalization.
Results
Patients with favorable outcomes and successful recanalization had statistically higher ΔCT values and thrombus permeability. Multiple logistic analyses identified difficult-to-retrieve thrombi as independently associated with fewer favorable outcome (odds ratio: 0.12 [0.03–0.36], p < 0.001). The combined strategy demonstrated significantly greater effectiveness in achieving successful recanalization for difficult-to-retrieve thrombi compared with the SR-alone strategy (84.2 % vs. 50 %, odds ratio: 5.33, 95 % CI: 1.14–24.90, p = 0.038). However, normal thrombi demonstrated comparable responses with both strategies (92.3 % vs. 100 %, p = 0.394).
Conclusion
Given its procedural simplicity and cost-effectiveness, the SR-alone strategy may be effective for normal thrombi, whereas the combined strategy may be preferable for difficult-to-retrieve thrombi.
{"title":"Optimal strategy for mechanical thrombectomy based on the preoperative imaging features of the thrombus","authors":"Hiroyuki Sakata , Masayuki Ezura , Ryosuke Tashiro , Shunsuke Omodaka , Kenichi Sato , Kuniyasu Niizuma , Hidenori Endo","doi":"10.1016/j.clineuro.2026.109322","DOIUrl":"10.1016/j.clineuro.2026.109322","url":null,"abstract":"<div><h3>Objective</h3><div>Successful recanalization is not achieved in approximately 20 % of stroke patients who underwent mechanical thrombectomy, possibly due to the characteristics of the underlying thrombus. This study aimed to identify the most appropriate thrombectomy strategy based on the preoperative imaging features of the thrombus.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated the data of 70 patients who underwent mechanical thrombectomy. Thrombus density was assessed using non-contrast computed tomography (ΔCT values) and CT angiography (thrombus permeability). Difficult-to-retrieve thrombi were categorized based on the cutoff values (ΔCT <10 Hounsfield units and/or thrombus permeability <9 Hounsfield units). Favorable outcomes (modified Rankin scale score of 0–2) and successful recanalization (Thrombolysis in Cerebral Infarction grade 2b or 3) were evaluated. We also analyzed the interaction between thrombus imaging features and thrombectomy strategy (stent retriever (SR) alone vs. combined strategy) and its effect on recanalization.</div></div><div><h3>Results</h3><div>Patients with favorable outcomes and successful recanalization had statistically higher ΔCT values and thrombus permeability. Multiple logistic analyses identified difficult-to-retrieve thrombi as independently associated with fewer favorable outcome (odds ratio: 0.12 [0.03–0.36], p < 0.001). The combined strategy demonstrated significantly greater effectiveness in achieving successful recanalization for difficult-to-retrieve thrombi compared with the SR-alone strategy (84.2 % vs. 50 %, odds ratio: 5.33, 95 % CI: 1.14–24.90, p = 0.038). However, normal thrombi demonstrated comparable responses with both strategies (92.3 % vs. 100 %, p = 0.394).</div></div><div><h3>Conclusion</h3><div>Given its procedural simplicity and cost-effectiveness, the SR-alone strategy may be effective for normal thrombi, whereas the combined strategy may be preferable for difficult-to-retrieve thrombi.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109322"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017332","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 : 2026-04-01Epub Date: 2026-01-29DOI: 10.1016/j.clineuro.2026.109337
Felipe M. Ferreira , Lorena S. Viana , Savio Batista , Theja Yelam , Raul G. Nogueira , Alhamza R. Al-Bayati , Jason W. Allen , Charlie C. Park , Nirav Bhatt , Michael R. Frankel , Diogo C. Haussen
Introduction
Carotid web (CaW) is notably prevalent among young patients with cryptogenic stroke. Data investigating its occurrence in asymptomatic individuals remains scarce. We evaluated the prevalence of CaWs in a cohort of trauma patients.
Methods
Cross sectional retrospective analysis of consecutive patients who underwent thin-cut neck CT angiograms between October 2015 and August 2018 at a Level 1 Trauma Center. The scans were independently reviewed by two fellowship-trained vascular neurologists who were blinded to demographics and clinical information, and all CaW were reviewed by a fellowship-trained neurointerventionist.
Results
A total of 1157 CTAs in consecutive trauma patients were identified within the study period, and 998 were included. The median age was 39 years [IQR 27.0 – 55.0], 621 (61.3 %) were males, and 626 (62.7 %) were identified as Black or African Americans. 912 (91.4 %) patients had one CTA and 86 (8.6 %) patients had 2 or more CTAs available for review. 1320 (66.1 %) normal carotid bulbs were observed while 16 carotids were found to have a CaW (0.8 % of all carotids) in 15 patients (1.5 % of patients), in which 1 patient had bilateral webs. The lesion involved the postero-lateral carotid bulb wall in 46.7 % of cases, followed by posterior involvement in 33.3 %, postero-medial in 13.3 %, and anterior in 6.7 %. The mean web length was 2.6 ± 0.9 millimeters. Atherosclerotic lesions were otherwise identified in 484 carotid bulbs (24.2 % of all carotid arteries), affecting 394 patients (39.5 %)
Conclusion
Incidental CaW were identified in 1.5 % of trauma patients undergoing CTA. Incidental CaW may be more common than previously recognized and underscore the need for further studies to determine its clinical relevance.
{"title":"Incidental carotid webs in trauma patients","authors":"Felipe M. Ferreira , Lorena S. Viana , Savio Batista , Theja Yelam , Raul G. Nogueira , Alhamza R. Al-Bayati , Jason W. Allen , Charlie C. Park , Nirav Bhatt , Michael R. Frankel , Diogo C. Haussen","doi":"10.1016/j.clineuro.2026.109337","DOIUrl":"10.1016/j.clineuro.2026.109337","url":null,"abstract":"<div><h3>Introduction</h3><div>Carotid web (CaW) is notably prevalent among young patients with cryptogenic stroke. Data investigating its occurrence in asymptomatic individuals remains scarce. We evaluated the prevalence of CaWs in a cohort of trauma patients.</div></div><div><h3>Methods</h3><div>Cross sectional retrospective analysis of consecutive patients who underwent thin-cut neck CT angiograms between October 2015 and August 2018 at a Level 1 Trauma Center. The scans were independently reviewed by two fellowship-trained vascular neurologists who were blinded to demographics and clinical information, and all CaW were reviewed by a fellowship-trained neurointerventionist.</div></div><div><h3>Results</h3><div>A total of 1157 CTAs in consecutive trauma patients were identified within the study period, and 998 were included. The median age was 39 years [IQR 27.0 – 55.0], 621 (61.3 %) were males, and 626 (62.7 %) were identified as Black or African Americans. 912 (91.4 %) patients had one CTA and 86 (8.6 %) patients had 2 or more CTAs available for review. 1320 (66.1 %) normal carotid bulbs were observed while 16 carotids were found to have a CaW (0.8 % of all carotids) in 15 patients (1.5 % of patients), in which 1 patient had bilateral webs. The lesion involved the postero-lateral carotid bulb wall in 46.7 % of cases, followed by posterior involvement in 33.3 %, postero-medial in 13.3 %, and anterior in 6.7 %. The mean web length was 2.6 ± 0.9 millimeters. Atherosclerotic lesions were otherwise identified in 484 carotid bulbs (24.2 % of all carotid arteries), affecting 394 patients (39.5 %)</div></div><div><h3>Conclusion</h3><div>Incidental CaW were identified in 1.5 % of trauma patients undergoing CTA. Incidental CaW may be more common than previously recognized and underscore the need for further studies to determine its clinical relevance.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109337"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118116","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 : 2026-03-20DOI: 10.1016/j.clineuro.2026.109404
Austin A Kennemer, Gregory Glauser, Anisha Sonti, Sindhu Kosuru, Mary Pat Harnegie, Michael L Kelly, David Ben-Israel
Objective: To evaluate and compare the prognostic utility of the Marshall and Rotterdam computed tomography (CT) scoring systems for predicting mortality in patients with traumatic brain injury (TBI).
Methods: A systematic review was conducted in accordance with PRISMA guidelines. The protocol was registered with PROSPERO (registration number: CRD42024610218). Studies published between 2012 and 2024 involving hospitalized TBI patients that reported both Marshall and Rotterdam CT scores from initial head CT imaging were included. Extracted data included patient demographics, injury severity, mortality outcomes, and measures of predictive accuracy, including area under the receiver operating characteristic curve (AUC).
Results: Twenty-two studies met inclusion criteria, including prospective and retrospective designs. Several studies identified a threshold score of ≥ 4 for both scales that was associated with significantly higher mortality. Across studies, both scoring systems demonstrated statistically significant discrimination for mortality prediction. Reported AUC values ranged from 0.58 to 0.92 for the Marshall score and from 0.63 to 0.93 for the Rotterdam score.
Conclusions: Both Marshall and Rotterdam CT scoring systems effectively differentiate survivors from non-survivors following TBI. While Rotterdam occasionally demonstrated marginally higher AUC values, overall prognostic performance was similar between the two systems.
{"title":"Prognostic utility of Marshall and Rotterdam CT scores for mortality prediction in traumatic brain injury: A systematic review.","authors":"Austin A Kennemer, Gregory Glauser, Anisha Sonti, Sindhu Kosuru, Mary Pat Harnegie, Michael L Kelly, David Ben-Israel","doi":"10.1016/j.clineuro.2026.109404","DOIUrl":"https://doi.org/10.1016/j.clineuro.2026.109404","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate and compare the prognostic utility of the Marshall and Rotterdam computed tomography (CT) scoring systems for predicting mortality in patients with traumatic brain injury (TBI).</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines. The protocol was registered with PROSPERO (registration number: CRD42024610218). Studies published between 2012 and 2024 involving hospitalized TBI patients that reported both Marshall and Rotterdam CT scores from initial head CT imaging were included. Extracted data included patient demographics, injury severity, mortality outcomes, and measures of predictive accuracy, including area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Twenty-two studies met inclusion criteria, including prospective and retrospective designs. Several studies identified a threshold score of ≥ 4 for both scales that was associated with significantly higher mortality. Across studies, both scoring systems demonstrated statistically significant discrimination for mortality prediction. Reported AUC values ranged from 0.58 to 0.92 for the Marshall score and from 0.63 to 0.93 for the Rotterdam score.</p><p><strong>Conclusions: </strong>Both Marshall and Rotterdam CT scoring systems effectively differentiate survivors from non-survivors following TBI. While Rotterdam occasionally demonstrated marginally higher AUC values, overall prognostic performance was similar between the two systems.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"266 ","pages":"109404"},"PeriodicalIF":1.6,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497611","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 : 2026-03-20DOI: 10.1016/j.clineuro.2026.109397
Kiarash Ferdowssian, Mareen Pigorsch, István Kiss, Karim Morsi, Martin Ďuriš, Dalibor Sila, Seyed Ali Naghibi-Saber, Johannes Tilgner, Slawomir Moszko, Mihaela Ciolpan, Lars Wessels, Nils Hecht, Peter Vajkoczy, Stefan A Rath, Markus Lenski
Purpose: Robot-assisted, monoplane C-arm angiography systems designed for hybrid operating rooms represent an alternative approach to neuroendovascular procedures. Conversely, non-computer-assisted monoplane systems or conventional biplane systems in angiography suites are widely established. This study aims to evaluate the effectiveness, safety and efficiency of a robotic C-arm angiography system in performing neuroendovascular interventions, including cerebrovascular digital subtraction angiography (DSA), embolization of the middle meningeal artery (MMA) in subdural hematoma, and mechanical thrombectomy for vessel occlusion.
Methods: All patients undergoing DSA, MMA embolization, or mechanical thrombectomy between July 2020 and December 2024 were retrospectively included. Procedures were performed using a monoplane robotic C-arm system (ARTIS pheno, Siemens Healthineers, Munich, Germany) in a hybrid operating room. Clinical data, procedural details, and imaging outcomes were analyzed. Radiation exposure was assessed by fluoroscopy time, air kerma, and dose-area product (DAP).
Results: A total of 49 procedures were analyzed, including 28 DSAs, 6 MMA embolizations, and 15 mechanical thrombectomies. DSA and MMA embolization (EMMA grade ≥2) achieved 100% procedural success, while mechanical thrombectomies achieved successful reperfusion (mTICI ≥2b) in 93.3% of cases. Median procedure durations were 34.0 (IQR 18.0-45.0) minutes for DSA, 70.0 (IQR 28.0-126.0) minutes for MMA embolization, and 84.0 (IQR 67.0-106.0) minutes for mechanical thrombectomy. Median fluoroscopy times were 5.2 (IQR 2.9-11.5) minutes (DSA), 21.3 (IQR 8.8-36.5) minutes (MMA embolization), and 21.2 (IQR 18.5-42.9) minutes (mechanical thrombectomy). Median DAPs were 7262.5 (IQR 3867.8-11570.8) µGy·m² (DSA), 16135.5 (IQR 8244.2-18216.2) µGy·m² (MMA embolization), and 9875.2 (IQR 6524.3-18455.5) µGy·m² (mechanical thrombectomy). Additional 3D-angiography or cone-beam CT (CBCT) was associated with higher radiation exposure.
Conclusion: Basic neuroendovascular procedures can be safely and efficiently performed using a monoplane robotic C-arm in a hybrid operating room, achieving procedural success and radiation exposure levels comparable to conventional biplane systems.
{"title":"Neuroendovascular procedures in the hybrid operating room using a monoplane robotic C-arm - feasibility study.","authors":"Kiarash Ferdowssian, Mareen Pigorsch, István Kiss, Karim Morsi, Martin Ďuriš, Dalibor Sila, Seyed Ali Naghibi-Saber, Johannes Tilgner, Slawomir Moszko, Mihaela Ciolpan, Lars Wessels, Nils Hecht, Peter Vajkoczy, Stefan A Rath, Markus Lenski","doi":"10.1016/j.clineuro.2026.109397","DOIUrl":"https://doi.org/10.1016/j.clineuro.2026.109397","url":null,"abstract":"<p><strong>Purpose: </strong>Robot-assisted, monoplane C-arm angiography systems designed for hybrid operating rooms represent an alternative approach to neuroendovascular procedures. Conversely, non-computer-assisted monoplane systems or conventional biplane systems in angiography suites are widely established. This study aims to evaluate the effectiveness, safety and efficiency of a robotic C-arm angiography system in performing neuroendovascular interventions, including cerebrovascular digital subtraction angiography (DSA), embolization of the middle meningeal artery (MMA) in subdural hematoma, and mechanical thrombectomy for vessel occlusion.</p><p><strong>Methods: </strong>All patients undergoing DSA, MMA embolization, or mechanical thrombectomy between July 2020 and December 2024 were retrospectively included. Procedures were performed using a monoplane robotic C-arm system (ARTIS pheno, Siemens Healthineers, Munich, Germany) in a hybrid operating room. Clinical data, procedural details, and imaging outcomes were analyzed. Radiation exposure was assessed by fluoroscopy time, air kerma, and dose-area product (DAP).</p><p><strong>Results: </strong>A total of 49 procedures were analyzed, including 28 DSAs, 6 MMA embolizations, and 15 mechanical thrombectomies. DSA and MMA embolization (EMMA grade ≥2) achieved 100% procedural success, while mechanical thrombectomies achieved successful reperfusion (mTICI ≥2b) in 93.3% of cases. Median procedure durations were 34.0 (IQR 18.0-45.0) minutes for DSA, 70.0 (IQR 28.0-126.0) minutes for MMA embolization, and 84.0 (IQR 67.0-106.0) minutes for mechanical thrombectomy. Median fluoroscopy times were 5.2 (IQR 2.9-11.5) minutes (DSA), 21.3 (IQR 8.8-36.5) minutes (MMA embolization), and 21.2 (IQR 18.5-42.9) minutes (mechanical thrombectomy). Median DAPs were 7262.5 (IQR 3867.8-11570.8) µGy·m² (DSA), 16135.5 (IQR 8244.2-18216.2) µGy·m² (MMA embolization), and 9875.2 (IQR 6524.3-18455.5) µGy·m² (mechanical thrombectomy). Additional 3D-angiography or cone-beam CT (CBCT) was associated with higher radiation exposure.</p><p><strong>Conclusion: </strong>Basic neuroendovascular procedures can be safely and efficiently performed using a monoplane robotic C-arm in a hybrid operating room, achieving procedural success and radiation exposure levels comparable to conventional biplane systems.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"266 ","pages":"109397"},"PeriodicalIF":1.6,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497623","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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