Clinical Neurology and Neurosurgery最新文献

{"title":"Characterization of complications associated with cranial perforator drills in neurosurgery","authors":"Shoaib A. Syed ,&nbsp;Evan Keister ,&nbsp;Leela Tickoo ,&nbsp;Griffin Thomas ,&nbsp;Maille McDermott ,&nbsp;Jan-Erik Schmidt ,&nbsp;Cassidy Werner ,&nbsp;John A. Boockvar ,&nbsp;Randy S. D’Amico","doi":"10.1016/j.clineuro.2025.109278","DOIUrl":"10.1016/j.clineuro.2025.109278","url":null,"abstract":"<div><h3>Background</h3><div>Cranial perforator drills are standard neurosurgical devices used for burr hole craniotomy, designed to automatically disengage at the inner table to minimize injury risk. Despite safety features, malfunctions such as disengagement failure may lead to injury. We systematically analyzed device malfunctions, patient impacts, and temporal trends over 10 years in order to increase operator vigilance for common modes and consequences of perforator malfunction and provide a basis for device refinement.</div></div><div><h3>Methods</h3><div>The Manufacturer and User Facility Device Experience (MAUDE) database was queried for medical device reports (MDRs) from 2015 to 2024 for cranial perforator drills. Report descriptions were manually reviewed and categorized by event type, device problems, patient impacts, and operational impacts.</div></div><div><h3>Results</h3><div>Out of 1857 reports, disengagement failure was most frequently reported (n = 1295/1857, 69.7 %), followed by component integrity issues (n = 447/1857, 24.1 %) power/stability failures (n = 225/1857, 12.1 %), device entrapment (n = 92/1857, 5.0 %), cutting inefficiency (n = 76/1857, 4.1 %), and thermal issues (n = 68/1857, 3.7 %). Nearly half of all MDRs (n = 866, 46.6 %) reported at least one patient impact. Among these, the most common were dural injury (n = 777/866, 89.7 %), leptomeningeal injury (n = 223/866, 25.8 %), parenchymal injury (n = 220/866, 25.4 %), and hemorrhage (n = 200/866, 23.1 %). Three reports described patient death, though only one was attributed to device malfunction.</div></div><div><h3>Conclusion</h3><div>Disengagement failure was the most commonly reported malfunction and frequently associated with meningeal and parenchymal injury. Other device problems were less frequent and often identified during testing rather than patient procedures. These findings highlight the need for heightened vigilance during use, structured training for device handling, and ongoing quality improvement to enhance patient safety.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109278"},"PeriodicalIF":1.6,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617424","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}

{"title":"Clinical predictors of overall survival in elderly oligodendroglioma patients: A Surveillance, Epidemiology, and End Results (SEER) database analysis","authors":"Sai Chandan Reddy,&nbsp;Toby Mao,&nbsp;Julian Gendreau,&nbsp;A. Karim Ahmed,&nbsp;Debraj Mukherjee","doi":"10.1016/j.clineuro.2025.109279","DOIUrl":"10.1016/j.clineuro.2025.109279","url":null,"abstract":"<div><h3>Objective</h3><div>Oligodendrogliomas are typically benign tumors that arise within the white matter tracts of the cerebral hemispheres. Surgical resection, radiotherapy (RT), and chemotherapy (CT) are utilized to prolong survival in patients diagnosed with these tumors. Older patients, however, suffer from various comorbidities that may make surgical resection less feasible and less effective in managing this disease. In this retrospective study, we assessed the survival outcomes for sexagenarian and older patients and the impact of surgical intervention, RT, and CT on overall survival (OS).</div></div><div><h3>Methods</h3><div>The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify all patients ≥ 60 years of age diagnosed with oligodendrogliomas between 2000 and 2020. The patient cohort was dichotomized into the sexagenarian (60–69 years of age) and older (≥ 70 years of age) patient subgroups. Demographic, clinical, and survival information was collected for these patients, and baseline comparison of the two groups of interest was conducted. Bivariate Kaplan-Meier analyses were used to assess the effects of gross total resection (GTR), RT, and CT on OS in sexagenarian and older patients. To adjust for confounding interactions between clinical predictors and OS, Cox proportional-hazards models were employed.</div></div><div><h3>Results</h3><div>852 oligodendroglioma patients were identified—564 sexagenarian patients and 288 older patients. Multivariable regression demonstrated that older patients were less likely to undergo CT compared to sexagenarian patients (OR: 0.534, 95 % CI: 0.395 – 0.720, p &lt; 0.001). Multivariable Cox proportional-hazards analysis found that sexagenarian patients in whom GTR was achieved had an increased likelihood of survival (HR: 0.699, 95 % CI: 0.517 – 0.946, p = 0.020). However, an analogous analysis found that GTR did not increase survival odds in older oligodendroglioma patients (HR: 0.813, 95 % CI: 0.571 – 1.157, p = 0.250).</div></div><div><h3>Conclusion</h3><div>In this retrospective study, we found that although sexagenarian and older oligodendroglioma patients were similarly offered GTR, only sexagenarian patients appeared to derive a survival benefit. These findings suggest that the role of aggressive surgical intervention in older patients may warrant further consideration.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109279"},"PeriodicalIF":1.6,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617342","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}

{"title":"Predicting short-term recurrence and identifying key risk factors in elderly glioma patients: Insights from a retrospective cohort study","authors":"Jie Zhang ,&nbsp;Tian Gan ,&nbsp;Wanyu Qiao ,&nbsp;Chen Luo ,&nbsp;Xian Xie ,&nbsp;Ye Yao","doi":"10.1016/j.clineuro.2025.109275","DOIUrl":"10.1016/j.clineuro.2025.109275","url":null,"abstract":"<div><h3>Background</h3><div>Glioma, a prevalent cancer in the elderly, is highly malignant, with a poor prognosis and frequent recurrence, causing significant burden on individuals and society. We aimed to develop pre- and postoperative models for predicting short-term recurrence in elderly glioma patients and investigate associated risk factors.</div></div><div><h3>Methods</h3><div>Based on our largest known sample size, we retrospectively assessed in great detail patients with gliomas who underwent initial surgical resection and were aged over 60 between 2010 and 2018. Finally, two eligible study cohorts comprising 447 and 463 patients were recruited to develop Logistic regression models and Cox models for predicting short and long-term recurrence or death, respectively. Subgroup analyses were performed based on key molecular markers (MGMT promoter methylation and IDH mutation status) and the IDH-wild-type glioblastoma subgroup.</div></div><div><h3>Results</h3><div>Preoperative and postoperative predictive models for short-term recurrence or death achieved an accuracy of 0.70 and 0.82, respectively. By utilizing the preoperative model, we effectively classified patients into high, medium, and low short-term recurrence risk groups, with median progression-free survival (PFS) durations of 125, 224, and 370 days, respectively. Several risk factors for short recurrence were identified, including tumors infiltrating the corpus callosum, preoperative muscle weakness and TP53 mutation. Long-term recurrence risk was associated with symptoms such as drowsiness, numbness or tingling, and diminished enjoyment of life, as determined from the MDASI-BT questionnaire. Subgroup analyses revealed that risk factors for recurrence were highly subtype-specific.</div></div><div><h3>Conclusion</h3><div>Both pre- and postoperative models successfully predict short-term recurrence in elderly glioma patients. Key clinical risk factors, such as tumors infiltrating the corpus callosum and various tumor-related symptoms were identified. Additionally, certain common postoperative physical and psychological symptom changes in the MDASI-BT may be predictive markers for long-term relapse. A crucial finding is that the factors associated with recurrence are distinct across molecular subtypes, underscoring the need for subtype-specific risk management.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109275"},"PeriodicalIF":1.6,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647522","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}

{"title":"Factors associated with venous thromboembolism in hospitalized traumatic brain injury patients with external ventricular drains: Retrospective cohort study","authors":"Phillip A. Bonney ,&nbsp;John H. Kanter ,&nbsp;Lucy Z. Kornblith ,&nbsp;Kristin Slown ,&nbsp;Michael A. Kohn ,&nbsp;Anthony M. DiGiorgio ,&nbsp;Phiroz E. Tarapore ,&nbsp;Michael C. Huang ,&nbsp;Geoffrey T. Manley","doi":"10.1016/j.clineuro.2025.109265","DOIUrl":"10.1016/j.clineuro.2025.109265","url":null,"abstract":"<div><h3>Introduction</h3><div>There are insufficient data to guide the use of venous thromboembolism (VTE) chemical prophylaxis in traumatic brain injury (TBI) patients, leading to substantial variation in practices. We investigated the effectiveness of our institution’s protocol—initiating enoxaparin 30 milligrams twice within 72 h of injury—in a cohort of severe TBI patients treated with external ventricular drains (EVD).</div></div><div><h3>Methods</h3><div>A retrospective cohort study of TBI patients from August 2019 to October 2023 was conducted. VTE was defined as pulmonary embolism (PE), lower extremity deep venous thrombosis (DVT), and/or upper extremity DVT. Logistic regression and time-to-event analyses were performed to identify risk factors for in-hospital VTE based on patient demographics, injury characteristics, and chemical prophylaxis data.</div></div><div><h3>Results</h3><div>We identified 129 TBI patients treated with EVDs. VTE occurred in 26 patients (20.2 %), consisting of isolated DVT in 16, isolated PE in 3, and both PE and DVT in 7. Overall mortality was 30 %, with no mortalities directly attributable to VTE. Obesity was associated with VTE (HR 3.4, 95 % CI 1.5–7.8, p = 0.009). Longer durations of EVD, mechanical ventilation, and intensive care unit (ICU) stays were associated with VTE (all p &lt; 0.001). Other variables including extracranial injury and adherence to chemical prophylaxis were examined but did not reach statistical significance.</div></div><div><h3>Conclusions</h3><div>Despite most patients receiving enoxaparin prophylaxis within 72 h of injury, VTE events were common in TBI patients treated with EVDs. Strategies including weight-based dosing and earlier initiation merit further consideration, though determining the neurological risks of increased dosing regimens remains a challenge.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109265"},"PeriodicalIF":1.6,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617486","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}

{"title":"Kümmell’s disease in benign vertebral compression fractures: Incidence, risk factors, and outcomes following percutaneous vertebroplasty","authors":"Majid Reza Farrokhi ,&nbsp;Seyed Reza Mousavi ,&nbsp;Seyed Ali Hosseini ,&nbsp;Reza Rafieossadat ,&nbsp;Sadegh Masjoodi ,&nbsp;Kamran Hosseini","doi":"10.1016/j.clineuro.2025.109262","DOIUrl":"10.1016/j.clineuro.2025.109262","url":null,"abstract":"<div><h3>Background</h3><div>Kümmell’s disease (KD) is a delayed consequence of vertebral compression fracture (VCF), usually after minor trauma. Its incidence and prognosis remain uncertain. Objective: To determine the incidence and predictors of KD in patients with benign vertebral VCF and to assess outcomes of percutaneous vertebroplasty (VP).</div></div><div><h3>Methods</h3><div>A retrospective cohort of 656 patients with insufficiency-type VCFs aged &gt; 20 years was analyzed in Shiraz (2004–2024). Logistic regression identified factors associated with KD. VP outcomes were evaluated using pre- and post-treatment Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. Statistical significance was set at p &lt; 0.05.</div></div><div><h3>Results</h3><div>Among 656 VCF patients (435 F, 221 M), 77 (11.7 %) had KD. KD patients were older (79.2 vs. 72.4), more often male (37.7 % vs. 24.9 %), and had lower BMI (22.3 vs. 23.1). KD was linked to prior CVA (45.5 % vs. 15.9 %), mild CRP elevation (23.1 vs. 22.3), and lower spine BMD (T-score −3.0 vs. −2.1). CVA history, elevated CRP, and osteoporosis were independent KD risk factors; higher BMI was protective. VP led to significant improvements in VAS, ODI, and kyphotic angle (all p &lt; 0.001); The operative outcomes and complication rates did not differ significantly between KD and non-KD patients.</div></div><div><h3>Conclusion</h3><div>We identified key clinical characteristics associated with KD, including osteoporosis, prior CVA, mild elevations in CRP levels, and advanced age. The increasing prevalence of KD, driven by an aging population and improved diagnostic modalities, suggests that it should no longer be viewed as a rare entity.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109262"},"PeriodicalIF":1.6,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617487","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}

{"title":"Cerebellar tonsil manipulation in Chiari malformation type I surgery: A systematic review and meta-analysis","authors":"Guilherme L.O. Lima ,&nbsp;Rui M.M. Deus ,&nbsp;João Victor Massud ,&nbsp;Derick Pedrosa Pachá ,&nbsp;José Vitor Mota da Silva ,&nbsp;Daniel Felipe Fernandes Paiva ,&nbsp;Roger Schmidt Brock ,&nbsp;Eberval Gadelha Figueiredo","doi":"10.1016/j.clineuro.2025.109264","DOIUrl":"10.1016/j.clineuro.2025.109264","url":null,"abstract":"<div><h3>Objective</h3><div>Posterior fossa decompression with duraplasty (PFDD) is a common Chiari malformation type I (CM-I) treatment, aiming to restore CSF flow and alleviate symptoms. When syringomyelia is present, PFDD is recommended. However, adding cerebellar tonsil manipulation (PFDTM) remains controversial. This systematic review evaluated whether PFDTM improves clinical outcomes compared to PFDD. Methods: Following PRISMA guidelines, we searched five databases for comparative cohort studies reporting postoperative outcomes using the Chicago Chiari Outcome Scale (CCOS). Ten studies involving 1527 patients (896 PFDTM, 631 PFDD) met the inclusion criteria. Studies involving only bone decompression or cranioplasty were excluded. Outcomes analyzed included CCOS scores, overall clinical improvement (Gestalt), syringomyelia resolution, CSF-related complications, and meningitis. Risk of bias and evidence certainty were assessed using validated tools. The protocol was registered with PROSPERO (CRD42024573279). Results: PFDTM was associated with a significantly higher CCOS score than PFDD (mean difference 0.58; 95 %CI: 0.37–0.78; p &lt; 0.00001) and greater Gestalt improvement (odds ratio 2.03; 95 %CI: 1.40–2.95; p = 0.0002). PFDTM was linked to a higher risk of meningitis (odds ratio 1.91; 95 %CI: 1.07–3.39; p = 0.03). No significant differences were observed for syringomyelia resolution or CSF-related complications. All outcomes were rated as low certainty of evidence. Conclusion: Cerebellar tonsil manipulation improves clinical outcomes in CM-I surgery but increases the risk of meningitis. These findings support its selective use based on patient-specific risk–benefit profiles.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109264"},"PeriodicalIF":1.6,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617343","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}

{"title":"Clinical and radiological outcomes of transverse process hooks versus pedicle screws at the upper instrumented vertebra in adult spinal deformity patients undergoing three-column osteotomy: A retrospective comparative study","authors":"Mohsen Rostami ,&nbsp;Sadegh Bagherzadeh ,&nbsp;Navid Moghadam ,&nbsp;Faramarz Roohollahi ,&nbsp;Cesar Carballo Cuello ,&nbsp;Jay Kumar ,&nbsp;Mark Greenberg ,&nbsp;Puya Alikhani","doi":"10.1016/j.clineuro.2025.109263","DOIUrl":"10.1016/j.clineuro.2025.109263","url":null,"abstract":"<div><h3>Background</h3><div>Proximal junctional kyphosis (PJK) and failure (PJF) are critical complications following adult spinal deformity (ASD) surgery. The use of transverse process hooks (TPH) at the upper instrumented vertebra (UIV) has been proposed as a “soft-landing” alternative to rigid pedicle screws (PS), but it remains controversial whether the implant choice or the magnitude of correction is the primary driver of PJK. This study aimed to determine if TPH fixation independently reduces the risk of junctional complications compared to PS in high-risk ASD patients undergoing three-column osteotomies (3CO).</div></div><div><h3>Methods</h3><div>A retrospective review of 132 ASD patients undergoing 3CO with spinopelvic fixation (70 TPH, 62 PS) and a minimum 2-year follow-up was performed. Demographics, surgical data, radiographic parameters, complications, and patient-reported outcomes (PROMs) were compared. A multivariate logistic regression was performed to identify independent predictors of PJK, controlling for patient factors and postoperative alignment.</div></div><div><h3>Results</h3><div>The TPH group had significantly lower rates of PJK (21.4 % vs. 37.0 %, p = 0.04) and PJF (17.1 % vs. 32.2 %, p = 0.04). While overall reoperation rates were similar (41.4 % vs. 45.1 %, p = 0.66), the reasons for revision differed: symptomatic PJF was the primary indication in the PS group, versus other mechanical failures (e.g., pseudarthrosis, rod fracture) in the TPH group. Crucially, multivariate logistic regression identified TPH use as an independent protective factor against PJK (Adjusted Odds Ratio = 0.329, p = 0.020), while postoperative alignment parameters, such as SVA and LL, were not significant predictors. PROMs were similar between groups.</div></div><div><h3>Conclusions</h3><div>In complex ASD surgery requiring 3CO, TPH fixation at the UIV is an independent protective factor against PJK. While TPH significantly reduces the risk of junctional failure, it appears to transfer mechanical stress elsewhere, leading to different modes of late construct failure without changing the overall reoperation rate.</div></div><div><h3>Clinical Relevance</h3><div>This study provides strong evidence that TPH at the UIV mitigates the risk of PJK independent of the magnitude of sagittal correction. This supports its use as a valuable strategy to reduce proximal junctional complications, though surgeons must remain vigilant for other potential modes of mechanical failure.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective comparative study.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109263"},"PeriodicalIF":1.6,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594798","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}

{"title":"Quality of sleep in chronic migraine patients treated with fremanezumab – 6 months follow-up","authors":"Aleksandar Stojanov ,&nbsp;Jelena Stojanov ,&nbsp;Gordana Djordjevic","doi":"10.1016/j.clineuro.2025.109261","DOIUrl":"10.1016/j.clineuro.2025.109261","url":null,"abstract":"<div><h3>Оbjective</h3><div>Sleep disturbances are frequent in patients with chronic migraine (CM). Monoclonal antibodies, such as fremanezumab, may offer better-tolerated and efficacious alternatives to traditional migraine pharmacological preventive therapies. The aim was to assess the quality of sleep (QoS) in patients with CM, during the follow-up period of 6 months, during which they were treated with fremanezumab once per month.</div></div><div><h3>Methods</h3><div>The study included 82 patients with CM and 80 healthy control subjects. The study included the application of the Pittsburgh Sleep Quality Index (PSQI), Hamilton scales for the assessment of anxiety (HAM-A) and depression (HAM-D), and the 6-item Headache Impact Test (HIT-6).</div></div><div><h3>Results</h3><div>The PSQI global score and all subscores in patients with CM were significantly higher than in the control group (p &lt; 0.01). We noticed a statistically significant difference between the results in the PSQI global score between the first and third testing points (p &lt; 0.01). Also, some subscores were statistically significantly better during the follow-up period. Patients with higher scores on HIT-6, HAM-A, and HAM-D had higher scores on PSQI. Higher scores on PSQI were also noticed in female patients, the elderly, and patients with higher body mass index (BMI) levels.</div></div><div><h3>Conclusion</h3><div>The prevalence of sleep disturbance in CM patients is relatively high before starting the effective prophylactic treatment. Fremanezumab therapy had a significant beneficial influence on the QoS of CM patients. High levels of sleep disturbance correlate with higher disease-related disability, anxiety, depression, and some characteristics of the disease.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109261"},"PeriodicalIF":1.6,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615756","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}

{"title":"Association between fetal posterior communicating artery Anatomy and pipeline embolization device treatment efficacy: A propensity score–weighted cohort study","authors":"Xiaopeng Xue ,&nbsp;Hongyi Liu ,&nbsp;Mingjiang Sun ,&nbsp;Xin Tong ,&nbsp;Aihua Liu","doi":"10.1016/j.clineuro.2025.109255","DOIUrl":"10.1016/j.clineuro.2025.109255","url":null,"abstract":"<div><h3>Purpose</h3><div>The angiographic efficacy of the Pipeline Embolization Device (PED) for unruptured, saccular fetal posterior communicating artery (PComA) aneurysms remains controversial, and available data on functional outcomes and complications are limited. This study aimed to assess the association between fetal PComA anatomy and PED treatment efficacy.</div></div><div><h3>Methods</h3><div>We retrospectively enrolled patients with unruptured, saccular PComA aneurysms treated with PED between January 2015 and December 2020. To mitigate confounding, inverse probability weighting based on propensity scores was applied, and covariate balance was evaluated using standardized mean differences. Sensitivity analyses included propensity score matching, multivariable regression, and a restricted analysis of patients with ≥ 12-month angiographic follow-up or treated with PED alone.</div></div><div><h3>Results</h3><div>Among 742 consecutive patients with 898 PED-treated aneurysms, 93 were PComA aneurysms, including 21 fetal-type cases. Incomplete occlusion rates were similar between fetal and non-fetal groups in both unadjusted and weighted analyses (22.2 % vs 23.2 %, P &gt; 0.999; weighted 27.8 % vs 22.5 %, P = 0.713). There were no significant between-group differences in functional outcomes or overall complications. Consistent results were obtained in propensity score–matched and multivariable regression analyses, as well as in the sensitivity analysis restricted to patients treated with PED alone. Most fetal PComA vessels remained patent (94.4 %), and observed occlusions were clinically silent, likely due to collateral supply from the posterior cerebral artery (PCA).</div></div><div><h3>Conclusion</h3><div>Presence of a fetal PComA was not associated with worse angiographic or clinical prognosis following PED treatment. Consistent results in PED-only analysis suggest that adjunctive coiling did not substantially influence the main findings. Given the limited number of events, these results should be interpreted cautiously.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109255"},"PeriodicalIF":1.6,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of ASL-MRI in detecting disease evolution including de-novo formation and post-treatment changes of intracranial dural arteriovenous fistula","authors":"Hiroaki Neki,&nbsp;Yoshinobu Kamio,&nbsp;Tomoya Oishi,&nbsp;Kazuhiko Kurozumi","doi":"10.1016/j.clineuro.2025.109258","DOIUrl":"10.1016/j.clineuro.2025.109258","url":null,"abstract":"<div><h3>Purpose</h3><div>Intracranial dural arteriovenous fistula (dAVF) is a pathologic shunt between dural arteries and veins. The indication for invasive treatment of intracranial dAVF is primarily determined by the bleeding risk based on the location of the shunt and venous drainage. DSA is still the gold standard for diagnosing dAVF, but its invasive nature limits its use for early detection of disease progression or recurrence during follow-up. This study evaluates the clinical utility of noninvasive pseudo-continuous arterial spin-labeling MRI (ASL-MRI) in intracranial dAVFs, particularly its potential to detect progression, recanalization and de-novo formation.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study including patients with intracranial dAVF who were diagnosed with DSA or treated at our institution between April 2016 and December 2023. The proportion of patients was determined based on ASL-MRI signal changes in the cerebral parenchyma and venous sinuses during follow-up. If bright signal intensity was observed on ASL-MRI, repeat DSA was performed.</div></div><div><h3>Results</h3><div>Of the 65 patients with intracranial dAVF, 54 (83.1 %) received early therapeutic intervention immediately after diagnosis, while the remaining (n = 11; 16.9 %) followed up with MRI. Of the 11 patients, four patients transitioned to treatment, cortical ASL-MRI hyperintensity was exhibited interval augmentation. Of the 58 patients, 63 treatment procedures were performed, ASL-MRI successfully detected two cases of recurrent dangerous dAVF and three cases of de-novo dAVF.</div></div><div><h3>Conclusion</h3><div>ASL-MRI is a minimally invasive diagnostic modality that is useful both before and after treatment, providing support in determining treatment timing, identifying new lesions, and conducting post-treatment follow-up assessments.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109258"},"PeriodicalIF":1.6,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562891","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}