Pub Date : 2026-03-01Epub Date: 2026-01-06DOI: 10.1016/j.clineuro.2026.109314
Jaeha Kim , Erin N. Walker , Nathan Yu , Sarah J. Snyder , Mackenzie L. Castellanos , Sami Almasri , Om H. Gandhi , Mikaeel Habib , Luis O. Tierradentro-García , Sarah Hamimi , Aaron Anandarajah , Adriana Castano , Abdullah Feroze , Patrick Connolly , Linda Bagley , Omar Choudhri
Background
Middle meningeal artery (MMA) embolization can serve as an adjunct to prevent recurrent subdural hematoma. Hybrid operating rooms (ORs) with biplane neuroangiography now allow MMA embolization and cSDH drainage to be performed in a single stage. This study compares this single-stage approach with the traditional staged workflow, where patients undergo cSDH drainage in a neurosurgical OR followed by delayed MMA embolization in a separate neuroangiography suite.
Methods
Clinical data were extracted for 51 patients who underwent both cSDH drainage and MMA embolization at our center. Demographic information and surgically relevant parameters were compared between patients treated with a single-stage approach and those treated with a staged approach to identify differences beyond the timing of the procedures. The primary outcome was radiographic improvement following treatment, defined by reduction in hematoma thickness and midline shift. Secondary outcomes included total procedure room time, anesthesia duration, and operative duration.
Results
No significant differences were identified in the demographic characteristics of patients undergoing the single-stage or two-stage approach. Baseline cSDH characteristics, as well as operation-relevant parameters, were comparable between the two groups. Postoperative midline shift and reduction in hematoma thickness improved and were comparable between groups. Total procedure room time, anesthesia duration, and operative duration were also similar.
Conclusion
Results from this study suggest that single-stage MMA embolization procedures performed in hybrid ORs may not always be more efficient than the two-stage approach. Further research is needed to comprehensively evaluate the optimal timing and approach for patients undergoing MMA embolization procedures for cSDH management.
{"title":"Single-session combined middle meningeal artery embolization and hematoma evacuation versus staged approaches in symptomatic chronic subdural hematoma treatment: A single-center experience","authors":"Jaeha Kim , Erin N. Walker , Nathan Yu , Sarah J. Snyder , Mackenzie L. Castellanos , Sami Almasri , Om H. Gandhi , Mikaeel Habib , Luis O. Tierradentro-García , Sarah Hamimi , Aaron Anandarajah , Adriana Castano , Abdullah Feroze , Patrick Connolly , Linda Bagley , Omar Choudhri","doi":"10.1016/j.clineuro.2026.109314","DOIUrl":"10.1016/j.clineuro.2026.109314","url":null,"abstract":"<div><h3>Background</h3><div>Middle meningeal artery (MMA) embolization can serve as an adjunct to prevent recurrent subdural hematoma. Hybrid operating rooms (ORs) with biplane neuroangiography now allow MMA embolization and cSDH drainage to be performed in a single stage. This study compares this single-stage approach with the traditional staged workflow, where patients undergo cSDH drainage in a neurosurgical OR followed by delayed MMA embolization in a separate neuroangiography suite.</div></div><div><h3>Methods</h3><div>Clinical data were extracted for 51 patients who underwent both cSDH drainage and MMA embolization at our center. Demographic information and surgically relevant parameters were compared between patients treated with a single-stage approach and those treated with a staged approach to identify differences beyond the timing of the procedures. The primary outcome was radiographic improvement following treatment, defined by reduction in hematoma thickness and midline shift. Secondary outcomes included total procedure room time, anesthesia duration, and operative duration.</div></div><div><h3>Results</h3><div>No significant differences were identified in the demographic characteristics of patients undergoing the single-stage or two-stage approach. Baseline cSDH characteristics, as well as operation-relevant parameters, were comparable between the two groups. Postoperative midline shift and reduction in hematoma thickness improved and were comparable between groups. Total procedure room time, anesthesia duration, and operative duration were also similar.</div></div><div><h3>Conclusion</h3><div>Results from this study suggest that single-stage MMA embolization procedures performed in hybrid ORs may not always be more efficient than the two-stage approach. Further research is needed to comprehensively evaluate the optimal timing and approach for patients undergoing MMA embolization procedures for cSDH management.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109314"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922889","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 : 2026-03-01Epub 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":"2026-03-01","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 : 2026-03-01Epub Date: 2026-01-03DOI: 10.1016/j.clineuro.2026.109311
Xin Zuo , Huan Zuo , Pengyu Zhu
Background
Renal dysfunction is common in ischemic ischemic ischemic stroke patients, but the prognostic value of dynamic creatinine trajectories remains unclear.
Methods
Using the MIMIC-IV database, we included 1998 ischemic ischemic stroke patients who had at least three creatinine measurements within 72 h of ICU admission. Latent growth mixture modeling (LGMM) was applied to identify creatinine trajectories. The primary outcome was 90-day in-hospital mortality. Cox regression, Kaplan–Meier survival analysis, and subgroup analyses were performed.
Results
Four distinct creatinine trajectories were identified: Class 1 (74.4 %) with stable low levels; Class 2 (20.9 %) with persistently moderate-to-high levels and a slight upward trend; Class 3 (2.2 %) with an initial increase followed by decline; and Class 4 (2.5 %) with high initial levels that decreased and then rose again. Significant differences in demographics, complications, and outcomes were observed across classes (all P < 0.05). In unadjusted and partially adjusted models, Classes 2–4 were associated with higher mortality, but after full adjustment only Class 2 remained significant (HR = 1.55, P < 0.001). Kaplan–Meier analysis confirmed significantly lower survival in non-Class 1 patients, most pronounced in Class 2. Subgroup analyses showed consistent results for Class 2 across sex, age, and comorbidity subgroups.
Conclusion
Early creatinine trajectories carry important prognostic value in ischemic stroke patients. The persistently moderate-to-high and gradually rising trajectory (Class 2) emerged as the strongest independent predictor of 90-day mortality, highlighting its potential role in risk stratification and clinical decision-making.
{"title":"Prognostic value of early creatinine trajectories in ischemic stroke patients: Insights from latent growth mixture modeling using MIMIC-IV","authors":"Xin Zuo , Huan Zuo , Pengyu Zhu","doi":"10.1016/j.clineuro.2026.109311","DOIUrl":"10.1016/j.clineuro.2026.109311","url":null,"abstract":"<div><h3>Background</h3><div>Renal dysfunction is common in ischemic ischemic ischemic stroke patients, but the prognostic value of dynamic creatinine trajectories remains unclear.</div></div><div><h3>Methods</h3><div>Using the MIMIC-IV database, we included 1998 ischemic ischemic stroke patients who had at least three creatinine measurements within 72 h of ICU admission. Latent growth mixture modeling (LGMM) was applied to identify creatinine trajectories. The primary outcome was 90-day in-hospital mortality. Cox regression, Kaplan–Meier survival analysis, and subgroup analyses were performed.</div></div><div><h3>Results</h3><div>Four distinct creatinine trajectories were identified: Class 1 (74.4 %) with stable low levels; Class 2 (20.9 %) with persistently moderate-to-high levels and a slight upward trend; Class 3 (2.2 %) with an initial increase followed by decline; and Class 4 (2.5 %) with high initial levels that decreased and then rose again. Significant differences in demographics, complications, and outcomes were observed across classes (all <em>P</em> < 0.05). In unadjusted and partially adjusted models, Classes 2–4 were associated with higher mortality, but after full adjustment only Class 2 remained significant (HR = 1.55, <em>P</em> < 0.001). Kaplan–Meier analysis confirmed significantly lower survival in non-Class 1 patients, most pronounced in Class 2. Subgroup analyses showed consistent results for Class 2 across sex, age, and comorbidity subgroups.</div></div><div><h3>Conclusion</h3><div>Early creatinine trajectories carry important prognostic value in ischemic stroke patients. The persistently moderate-to-high and gradually rising trajectory (Class 2) emerged as the strongest independent predictor of 90-day mortality, highlighting its potential role in risk stratification and clinical decision-making.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109311"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922893","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 : 2026-03-01Epub Date: 2025-12-23DOI: 10.1016/j.clineuro.2025.109290
Kimberly Han, Aryan Wadhwa, Felipe Ramirez-Velandia, Alejandro Enriquez-Marulanda, Justin Granstein, Philipp Taussky, Christopher S. Ogilvy
Objective
The fetal-type posterior communicating artery is a circle of Willis variant. Previous studies report lower complete occlusion rates (0–20 %) for fetal-type PComA (fPComA) aneurysms treated with flow diversion than non-fPComA aneurysms (70–75 %). This study evaluated the efficacy of Pipeline embolization devices (PED) in treating fPComA aneurysms and identified predictors of obliteration.
Methods
Retrospective analysis was performed on fPComA and non-fPComA aneurysms in patients treated from 2013 to 2023 with PED in the internal carotid artery covering the PComA origin. Demographic, fetal-type anatomy morphology, aneurysm characteristics, intervention technique, and outcome data (e.g., occlusion status at one year, complications, and retreatment rate) was collected. Aneurysm occlusion was assessed during angiographic follow-up. Univariate statistical analysis was performed to compare aneurysm occlusion rates.
Results
Among 96 patients treated for PComA aneurysms, 19 patients with a mean age of 61.6 ± 16.3 years had a fetal variant. Three patients were lost to follow-up. Flow diversion achieved complete or near-complete occlusion (>90 % angiographic obliteration) in 12 fetal variant cases (75 %) at one year, matching PED-treated non-fPComA aneurysm occlusion rate (75 %). Two patients with fPComA aneurysms experienced in-stent thrombosis resulting in minor strokes without permanent deficits. Distal PED tip placement in the proximal M1 segment was significantly associated with complete fPComA aneurysm occlusion (p = 0.049).
Conclusion
PED treatment for fPComA aneurysms in our cohort demonstrates a 75 % occlusion rate, exceeding rates of prior studies and matching non-fPComA cases. PED placement technique was significantly associated with this high occlusion rate. These findings highlight PED as a potentially safe and effective intervention for these aneurysms.
{"title":"Occlusion of posterior communicating artery aneurysms with a ‘fetal’ type circulation treated with flow diversion","authors":"Kimberly Han, Aryan Wadhwa, Felipe Ramirez-Velandia, Alejandro Enriquez-Marulanda, Justin Granstein, Philipp Taussky, Christopher S. Ogilvy","doi":"10.1016/j.clineuro.2025.109290","DOIUrl":"10.1016/j.clineuro.2025.109290","url":null,"abstract":"<div><h3>Objective</h3><div>The fetal-type posterior communicating artery is a circle of Willis variant. Previous studies report lower complete occlusion rates (0–20 %) for fetal-type PComA (fPComA) aneurysms treated with flow diversion than non-fPComA aneurysms (70–75 %). This study evaluated the efficacy of Pipeline embolization devices (PED) in treating fPComA aneurysms and identified predictors of obliteration.</div></div><div><h3>Methods</h3><div>Retrospective analysis was performed on fPComA and non-fPComA aneurysms in patients treated from 2013 to 2023 with PED in the internal carotid artery covering the PComA origin. Demographic, fetal-type anatomy morphology, aneurysm characteristics, intervention technique, and outcome data (e.g., occlusion status at one year, complications, and retreatment rate) was collected. Aneurysm occlusion was assessed during angiographic follow-up. Univariate statistical analysis was performed to compare aneurysm occlusion rates.</div></div><div><h3>Results</h3><div>Among 96 patients treated for PComA aneurysms, 19 patients with a mean age of 61.6 ± 16.3 years had a fetal variant. Three patients were lost to follow-up. Flow diversion achieved complete or near-complete occlusion (>90 % angiographic obliteration) in 12 fetal variant cases (75 %) at one year, matching PED-treated non-fPComA aneurysm occlusion rate (75 %). Two patients with fPComA aneurysms experienced in-stent thrombosis resulting in minor strokes without permanent deficits. Distal PED tip placement in the proximal M1 segment was significantly associated with complete fPComA aneurysm occlusion (p = 0.049).</div></div><div><h3>Conclusion</h3><div>PED treatment for fPComA aneurysms in our cohort demonstrates a 75 % occlusion rate, exceeding rates of prior studies and matching non-fPComA cases. PED placement technique was significantly associated with this high occlusion rate. These findings highlight PED as a potentially safe and effective intervention for these aneurysms.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109290"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839648","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 : 2026-03-01Epub 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":"2026-03-01","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 : 2026-03-01Epub 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":"2026-03-01","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 : 2026-03-01Epub 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":"2026-03-01","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}
Pub Date : 2026-03-01Epub Date: 2025-12-24DOI: 10.1016/j.clineuro.2025.109295
Shiva A. Nischal, Shaan Patel, Jayaratnam Jayamohan
{"title":"A comment on cohort structure in Chiari I malformation studies","authors":"Shiva A. Nischal, Shaan Patel, Jayaratnam Jayamohan","doi":"10.1016/j.clineuro.2025.109295","DOIUrl":"10.1016/j.clineuro.2025.109295","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109295"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839650","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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