To characterize clinical and MRI features of Rathke’s cleft cysts (RCCs) with inflammatory change and assess their associations with endocrine and surgical outcomes.
Methods
We retrospectively reviewed 262 surgically treated RCCs at a single institution (1998–2023). All patients underwent preoperative MRI and endocrine testing. Postoperative pathology classified cases as with inflammatory change (Group A, n = 56) or without (Group B, n = 206). Group comparisons used standard statistics; key MRI signs were circumferential rim enhancement and mixed T2 signal.
Results
Compared with Group B, Group A had more impaired pituitary axes (mean 3.9 vs. 1.1; p < 0.001) and higher rates of diabetes insipidus (33.9 % vs. 1.5 %; p < 0.0001) and visual field defects (62.5 % vs. 31.6 %; p < 0.0001). Circumferential rim enhancement (71.4 % vs. 6.3 %; p < 0.0001) and mixed T2 signal (66.1 % vs. 6.8 %; p < 0.0001) were strongly associated with inflammatory change. Postoperative endocrine recovery was less frequent in Group A (21.7 % vs. 64.6 %; p < 0.0001), and reoperation for recurrence was more common (14.3 % vs. 2.4 %; p = 0.001). Two illustrative cases demonstrated concordance between inflammation severity, MRI features, and outcomes.
Conclusion
RCCs with inflammatory change are associated with severe preoperative pituitary dysfunction, poorer endocrine recovery, and higher recurrence. Simple MRI signs—especially circumferential rim enhancement and mixed T2 signal—may help identify inflammatory cases preoperatively and support consideration of earlier surgical intervention to preserve pituitary function.
目的探讨Rathke 's裂囊（RCCs）伴炎性改变的临床和MRI特征，并评价其与内分泌和手术结果的关系。方法回顾性分析1998-2023年间同一医院262例手术治疗的rcc病例。所有患者术前均行MRI和内分泌检查。术后病理分为有炎性改变（A组，n = 56）和无炎性改变（B组，n = 206）。组间比较采用标准统计；主要MRI征象为周缘增强和混合T2信号。ResultsCompared B组,A组有更多的受损垂体轴(平均3.9和1.1;p & lt; 0.001)和较高的尿崩症(33.9 % 1.5 vs %;p & lt; 0.0001)和视野缺陷(62.5 % 31.6 vs %;p & lt; 0.0001)。环缘增强（71.4 % vs. 6.3 %;p <； 0.0001）和混合T2信号（66.1 % vs. 6.8 %;p <； 0.0001）与炎症变化密切相关。A组术后内分泌恢复较少（21.7 % vs. 64.6 %;p <； 0.0001），复发再手术较多（14.3 % vs. 2.4 %;p = 0.001）。两个说明性的病例证明了炎症严重程度、MRI特征和结果之间的一致性。结论伴有炎性改变的rcc术前有严重的垂体功能障碍、较差的内分泌恢复、较高的复发率。简单的MRI征象——尤其是环缘增强和混合T2信号——可能有助于术前识别炎症病例，并支持考虑早期手术干预以保护垂体功能。
{"title":"Clinical and radiological features of Rathke’s cleft cysts with inflammatory change: Multivariable analysis of 262 surgically treated cases","authors":"Kosaku Amano , Kenta Masui , Yuichi Oda , Takashi Komori , Shihori Kimura , Kaoru Yamashita , Noriyoshi Takano , Yasufumi Seki , Daisuke Watanabe , Michio Otsuki , Atsuhiro Ichihara , Takakazu Kawamata","doi":"10.1016/j.clineuro.2025.109306","DOIUrl":"10.1016/j.clineuro.2025.109306","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize clinical and MRI features of Rathke’s cleft cysts (RCCs) with inflammatory change and assess their associations with endocrine and surgical outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 262 surgically treated RCCs at a single institution (1998–2023). All patients underwent preoperative MRI and endocrine testing. Postoperative pathology classified cases as with inflammatory change (Group A, n = 56) or without (Group B, n = 206). Group comparisons used standard statistics; key MRI signs were circumferential rim enhancement and mixed T2 signal.</div></div><div><h3>Results</h3><div>Compared with Group B, Group A had more impaired pituitary axes (mean 3.9 vs. 1.1; p < 0.001) and higher rates of diabetes insipidus (33.9 % vs. 1.5 %; p < 0.0001) and visual field defects (62.5 % vs. 31.6 %; p < 0.0001). Circumferential rim enhancement (71.4 % vs. 6.3 %; p < 0.0001) and mixed T2 signal (66.1 % vs. 6.8 %; p < 0.0001) were strongly associated with inflammatory change. Postoperative endocrine recovery was less frequent in Group A (21.7 % vs. 64.6 %; p < 0.0001), and reoperation for recurrence was more common (14.3 % vs. 2.4 %; p = 0.001). Two illustrative cases demonstrated concordance between inflammation severity, MRI features, and outcomes.</div></div><div><h3>Conclusion</h3><div>RCCs with inflammatory change are associated with severe preoperative pituitary dysfunction, poorer endocrine recovery, and higher recurrence. Simple MRI signs—especially circumferential rim enhancement and mixed T2 signal—may help identify inflammatory cases preoperatively and support consideration of earlier surgical intervention to preserve pituitary function.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109306"},"PeriodicalIF":1.6,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-31DOI: 10.1016/j.clineuro.2025.109308
Chung Mo Koo , In-Ho Jung , Sang Koo Lee
Objective
This study aimed to clarify how the choice of cranioplasty material influences the risk of postoperative periosteal fluid collection (PFC) and surgical site infection (SSI) through large-scale analysis.
Methods
A retrospective review was conducted on 434 patients who underwent cranioplasty over a ten-year period. Patients were grouped by implant material: autologous bone (n = 339), polyetheretherketone (PEEK; n = 39), polymethylmethacrylate (PMMA; n = 31), and titanium (n = 25). Multivariable logistic regression identified risk factors for PFC and SSI.
Results
PFC occurred in 22.1 % of cases overall, but was significantly more frequent with PEEK (56.4 %) and PMMA (51.6 %) than with autologous bone (16.8 %) and titanium (4.0 %) (p < 0.001). PEEK use increased the risk of PFC by 6.47-fold compared to autologous bone (OR: 6.47, p < 0.001), while PMMA also showed a significant risk (OR: 3.78, p < 0.001). Shunt operation (OR: 4.56, p = 0.001) and traumatic brain injury (OR: 3.28; p < 0.001) were further independent predictors. SSI occurred in 9.0 % overall, with no statistically significant difference between materials after multivariate adjustment (p = 0.915), but PFC was the strongest independent risk factor for SSI (OR: 10.93, p < 0.001).
Conclusion
Selection of cranioplasty material significantly affects the risk of PFC, which is strongly associated with subsequent SSI. PEEK and PMMA implants substantially increase PFC compared to autologous bone and titanium, while titanium demonstrates the lowest risk. These findings suggest that, in addition to patient-specific considerations, material properties and their impact on tissue integration must be central to clinical decision-making in cranioplasty.
目的通过大规模分析，探讨颅骨成形术材料的选择对术后骨膜积液（PFC）和手术部位感染（SSI）风险的影响。方法回顾性分析近10年434例颅骨成形术患者的临床资料。患者按种植材料分组：自体骨（ = 339）、聚醚醚酮（PEEK， = 39）、聚甲基丙烯酸甲酯（PMMA， = 31）、钛（ = 25）。多变量logistic回归确定了PFC和SSI的危险因素。结果spfc发生率为22.1% %，但PEEK组（56.4% %）和PMMA组（51.6% %）明显高于自体骨组（16.8% %）和钛组（4.0% %）（p <； 0.001）。与自体骨相比，PEEK的使用使PFC的风险增加了6.47倍（OR: 6.47, p <； 0.001），而PMMA也显示出显著的风险（OR: 3.78, p <； 0.001）。分流手术（OR: 4.56, p = 0.001）和外伤性脑损伤（OR: 3.28, p <； 0.001）是进一步的独立预测因素。SSI总体发生率为9.0 %，多因素调整后各材料间无统计学差异（p = 0.915），但PFC是SSI最强的独立危险因素（OR: 10.93, p <； 0.001）。结论颅骨成形术材料的选择显著影响PFC的发生风险，PFC与继发SSI密切相关。与自体骨和钛相比，PEEK和PMMA植入物显著增加了PFC，而钛的风险最低。这些发现表明，除了患者的特殊考虑外，材料特性及其对组织整合的影响必须是颅骨成形术临床决策的核心。
{"title":"Risk factors for periosteal fluid collection and surgical site infection based on cranioplasty material: Analysis of 434 cases","authors":"Chung Mo Koo , In-Ho Jung , Sang Koo Lee","doi":"10.1016/j.clineuro.2025.109308","DOIUrl":"10.1016/j.clineuro.2025.109308","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to clarify how the choice of cranioplasty material influences the risk of postoperative periosteal fluid collection (PFC) and surgical site infection (SSI) through large-scale analysis.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on 434 patients who underwent cranioplasty over a ten-year period. Patients were grouped by implant material: autologous bone (n = 339), polyetheretherketone (PEEK; n = 39), polymethylmethacrylate (PMMA; n = 31), and titanium (n = 25). Multivariable logistic regression identified risk factors for PFC and SSI.</div></div><div><h3>Results</h3><div>PFC occurred in 22.1 % of cases overall, but was significantly more frequent with PEEK (56.4 %) and PMMA (51.6 %) than with autologous bone (16.8 %) and titanium (4.0 %) (p < 0.001). PEEK use increased the risk of PFC by 6.47-fold compared to autologous bone (OR: 6.47, p < 0.001), while PMMA also showed a significant risk (OR: 3.78, p < 0.001). Shunt operation (OR: 4.56, p = 0.001) and traumatic brain injury (OR: 3.28; p < 0.001) were further independent predictors. SSI occurred in 9.0 % overall, with no statistically significant difference between materials after multivariate adjustment (p = 0.915), but PFC was the strongest independent risk factor for SSI (OR: 10.93, p < 0.001).</div></div><div><h3>Conclusion</h3><div>Selection of cranioplasty material significantly affects the risk of PFC, which is strongly associated with subsequent SSI. PEEK and PMMA implants substantially increase PFC compared to autologous bone and titanium, while titanium demonstrates the lowest risk. These findings suggest that, in addition to patient-specific considerations, material properties and their impact on tissue integration must be central to clinical decision-making in cranioplasty.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109308"},"PeriodicalIF":1.6,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-31DOI: 10.1016/j.clineuro.2025.109307
Ali Ebada, Ishav Y. Shukla, Nicholas Bever, Matthew Z. Sun
Introduction
The Social Deprivation Index (SDI) is a validated measure of neighborhood-level socioeconomic disadvantage. Its impact on perioperative outcomes following meningioma resection remains underexplored.
Methods
We retrospectively analyzed patients who underwent intracranial meningioma resection at a single tertiary academic institution from 2011 to 2023, stratified by SDI quartile (Q1 to Q4). Outcomes included baseline characteristics, operative parameters, complications, readmissions, and functional status.
Results
In our analysis of 887 patients, we found that higher SDI quartiles had greater comorbidity burden, with hypertension, COPD, and obesity more prevalent, as well as higher rates of non-White race and Hispanic ethnicity. The total number of comorbidities increased progressively from Q1 to Q4 (p = 0.001). Tumor grade, volume, and operative time were generally similar across quartiles, but ASA class III-IV status was more common in Q4 (p = 0.002), and skull base tumors were more frequent in higher quartiles (p = 0.010). Multivariable regression revealed that patients in Q2 and Q4 had significantly longer operative times compared to Q1 (p = 0.018; p = 0.031). Functional outcomes demonstrated an unexpected finding: patients in Q3 showed greater improvement in postoperative mRS compared to Q1 (p = 0.010). No significant differences were found in change in KPS, EBL, LOS, or hospital charges. On univariable and multivariable logistic regression, Q4 patients had significantly increased odds of non-neurological complications compared to Q1 (p = 0.016). In contrast, neurological complications and 30-, 60-, and 90-day readmissions did not differ significantly across quartiles.
Conclusion
SDI quartile was associated with comorbidity burden, ASA class, skull base tumor location, operative time, and risk of non-neurological complications after meningioma resection. SDI may serve as a prognostic marker to help identify vulnerable patients, guide perioperative planning, and improve recovery counseling after meningioma resection.
{"title":"The social deprivation index and perioperative outcomes following meningioma resection","authors":"Ali Ebada, Ishav Y. Shukla, Nicholas Bever, Matthew Z. Sun","doi":"10.1016/j.clineuro.2025.109307","DOIUrl":"10.1016/j.clineuro.2025.109307","url":null,"abstract":"<div><h3>Introduction</h3><div>The Social Deprivation Index (SDI) is a validated measure of neighborhood-level socioeconomic disadvantage. Its impact on perioperative outcomes following meningioma resection remains underexplored.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients who underwent intracranial meningioma resection at a single tertiary academic institution from 2011 to 2023, stratified by SDI quartile (Q1 to Q4). Outcomes included baseline characteristics, operative parameters, complications, readmissions, and functional status.</div></div><div><h3>Results</h3><div>In our analysis of 887 patients, we found that higher SDI quartiles had greater comorbidity burden, with hypertension, COPD, and obesity more prevalent, as well as higher rates of non-White race and Hispanic ethnicity. The total number of comorbidities increased progressively from Q1 to Q4 (p = 0.001). Tumor grade, volume, and operative time were generally similar across quartiles, but ASA class III-IV status was more common in Q4 (p = 0.002), and skull base tumors were more frequent in higher quartiles (p = 0.010). Multivariable regression revealed that patients in Q2 and Q4 had significantly longer operative times compared to Q1 (p = 0.018; p = 0.031). Functional outcomes demonstrated an unexpected finding: patients in Q3 showed greater improvement in postoperative mRS compared to Q1 (p = 0.010). No significant differences were found in change in KPS, EBL, LOS, or hospital charges. On univariable and multivariable logistic regression, Q4 patients had significantly increased odds of non-neurological complications compared to Q1 (p = 0.016). In contrast, neurological complications and 30-, 60-, and 90-day readmissions did not differ significantly across quartiles.</div></div><div><h3>Conclusion</h3><div>SDI quartile was associated with comorbidity burden, ASA class, skull base tumor location, operative time, and risk of non-neurological complications after meningioma resection. SDI may serve as a prognostic marker to help identify vulnerable patients, guide perioperative planning, and improve recovery counseling after meningioma resection.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109307"},"PeriodicalIF":1.6,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-31DOI: 10.1016/j.clineuro.2025.109305
Yilong Zheng , Yi Zhan Cai , Li Wei , Seyed Ehsan Saffari , Hwee Lan Ng , Hui Ping Oh , Wai-Yung Yu , Louis Chew Seng Tan , Wai Hoe Ng , Shermyn Xiumin Neo , Kai Rui Wan
Introduction
Deep brain stimulation (DBS) is an effective adjunctive therapy for Parkinson’s disease (PD), but there are few biomarkers for the prediction of treatment response. Here, we aimed to evaluate whether subthalamic nucleus (STN) volume could serve as a biomarker for predicting treatment response to STN DBS in PD.
Methods
This was a retrospective study of patients who underwent bilateral STN DBS for PD between 2008 and 2021 at our center. Preoperative T2-weighted MRI scans were used to quantify STN volumes, while outcomes were evaluated using both the Hoehn and Yahr scale and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) total and subcomponent scores at one-year follow-up. Univariate and multivariate linear regression analysis were applied to examine potential relationships between STN volume and clinical outcomes.
Results
Of 94 PD patients treated with DBS, 32 met the inclusion criteria for analysis. Our analysis revealed no significant association between STN volume and motor symptom improvement, as assessed by one-year changes in MDS-UPDRS Parts II (β=0.04; 95 % CI=-0.12–0.20; p = 0.590), III (β=0.07; 95 % CI=-0.35–0.48; p = 0.753), IV (β=-0.02; 95 % CI=-0.07–0.03; p = 0.430), and Hoehn and Yahr scale (β=0.01; 95 % CI=0.00–0.01; p = 0.136. Similarly, STN volume showed no association with MDS-UPDRS Part I total score (β=0.12; 95 % CI=-0.02–0.26; p = 0.096) for non-motor symptoms. However, we identified significant positive associations between STN volume and specific non-motor components, including the “anxious mood” (β=0.02; 95 % CI=0.00–0.04; p = 0.031) and the “pain and other sensation” (β=0.02; 95 % CI=0.00–0.04; p = 0.022) components, though these associations were not significant after adjusting for potential confounders.
Conclusions
In our cohort of patients who underwent bilateral STN DBS for PD, exploratory analyses revealed that larger STN volumes were significantly associated with an increased risk of developing affective symptoms approximately one year postoperatively. No significant association was observed between STN volume and improvement in motor outcomes. Further validation studies are warranted to corroborate the findings from this exploratory analysis.
脑深部电刺激（DBS）是治疗帕金森病（PD）的一种有效的辅助治疗方法，但很少有生物标志物可以预测治疗反应。在这里，我们旨在评估丘脑下核（STN）体积是否可以作为预测PD患者对STN DBS治疗反应的生物标志物。方法：这是一项回顾性研究，研究对象是2008年至2021年间在我们中心接受双侧STN DBS治疗PD的患者。术前t2加权MRI扫描用于量化STN体积，而在一年的随访中，使用Hoehn和Yahr量表和运动障碍学会统一帕金森病评定量表（MDS-UPDRS）总评分和子成分评分来评估结果。采用单因素和多因素线性回归分析来检验STN体积与临床结果之间的潜在关系。结果94例PD患者接受DBS治疗，32例符合纳入标准。我们的分析显示无显著联系STN体积和运动症状改善,评估的一年期的变化MDS-UPDRS第二部分(β= 0.04;95 % CI = -0.12 - -0.20; p = 0.590),3(β= 0.07;95 % CI = -0.35 - -0.48; p = 0.753),四(β= -0.02;95 % CI = -0.07 - -0.03; p = 0.430),和Hoehn Yahr规模(β= 0.01;95 % CI = 0.00 - -0.01; p = 0.136。同样，STN体积与非运动症状的MDS-UPDRS第一部分总分无关联（β=0.12; 95 % CI= -0.02-0.26; p = 0.096）。然而，我们发现STN体积与特定的非运动成分之间存在显著的正相关，包括“焦虑情绪”（β=0.02; 95 % CI= 0.00-0.04; p = 0.031）和“疼痛和其他感觉”（β=0.02; 95 % CI= 0.00-0.04; p = 0.022）成分，尽管在调整了潜在的混杂因素后，这些关联并不显著。在接受双侧STN DBS治疗PD的患者队列中，探索性分析显示，较大的STN容量与术后大约一年出现情感性症状的风险增加显著相关。未观察到STN体积与运动预后改善之间的显著关联。进一步的验证研究是必要的，以证实这一探索性分析的结果。
{"title":"Association between subthalamic nucleus volume and outcomes one year after bilateral subthalamic nucleus deep brain stimulation for Parkinson’s disease","authors":"Yilong Zheng , Yi Zhan Cai , Li Wei , Seyed Ehsan Saffari , Hwee Lan Ng , Hui Ping Oh , Wai-Yung Yu , Louis Chew Seng Tan , Wai Hoe Ng , Shermyn Xiumin Neo , Kai Rui Wan","doi":"10.1016/j.clineuro.2025.109305","DOIUrl":"10.1016/j.clineuro.2025.109305","url":null,"abstract":"<div><h3>Introduction</h3><div>Deep brain stimulation (DBS) is an effective adjunctive therapy for Parkinson’s disease (PD), but there are few biomarkers for the prediction of treatment response. Here, we aimed to evaluate whether subthalamic nucleus (STN) volume could serve as a biomarker for predicting treatment response to STN DBS in PD.</div></div><div><h3>Methods</h3><div>This was a retrospective study of patients who underwent bilateral STN DBS for PD between 2008 and 2021 at our center. Preoperative T2-weighted MRI scans were used to quantify STN volumes, while outcomes were evaluated using both the Hoehn and Yahr scale and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) total and subcomponent scores at one-year follow-up. Univariate and multivariate linear regression analysis were applied to examine potential relationships between STN volume and clinical outcomes.</div></div><div><h3>Results</h3><div>Of 94 PD patients treated with DBS, 32 met the inclusion criteria for analysis. Our analysis revealed no significant association between STN volume and motor symptom improvement, as assessed by one-year changes in MDS-UPDRS Parts II (β=0.04; 95 % CI=-0.12–0.20; p = 0.590), III (β=0.07; 95 % CI=-0.35–0.48; p = 0.753), IV (β=-0.02; 95 % CI=-0.07–0.03; p = 0.430), and Hoehn and Yahr scale (β=0.01; 95 % CI=0.00–0.01; p = 0.136. Similarly, STN volume showed no association with MDS-UPDRS Part I total score (β=0.12; 95 % CI=-0.02–0.26; p = 0.096) for non-motor symptoms. However, we identified significant positive associations between STN volume and specific non-motor components, including the “anxious mood” (β=0.02; 95 % CI=0.00–0.04; p = 0.031) and the “pain and other sensation” (β=0.02; 95 % CI=0.00–0.04; p = 0.022) components, though these associations were not significant after adjusting for potential confounders.</div></div><div><h3>Conclusions</h3><div>In our cohort of patients who underwent bilateral STN DBS for PD, exploratory analyses revealed that larger STN volumes were significantly associated with an increased risk of developing affective symptoms approximately one year postoperatively. No significant association was observed between STN volume and improvement in motor outcomes. Further validation studies are warranted to corroborate the findings from this exploratory analysis.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109305"},"PeriodicalIF":1.6,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-30DOI: 10.1016/j.clineuro.2025.109304
Felipe Ramirez-Velandia , Vitor Lauar Pimenta de Figueiredo , Vincenzo T.R. Loly , Natalia Anna Koc , Bruno Galelli Chieregatti , Rafael T. Tatit , Emmanuel O. Mensah , Mark Rotondo , João de Sá Brasil Lima , Jorge Rios-Zermeno , Johnny S. Sandhu , Rabih G. Twak , Christopher S. Ogilvy , Carlos E. Baccin
Objective
Evaluate through computational fluid dynamics (CFD) and fluid structure interaction (FSI) simulations basilar tip aneurysms (BTAs) hemodynamics at rest and during early (PLT1) and late (PLT2) phases of a sub-maximal handgrip (HG) maneuver.
Methods
Vascular segmentation used 3D rotational angiograms, and meshes were generated for accurate simulation. Time-averaged wall shear stress (TAWSS) at the aneurysm/parent vessel, oscillatory shear index (OSI), relative residence time (RRT), low and high shear stress area ratio (LSAR/HSAR), and wall deformation metrics (Von Mises stress, wall displacement, and strain) were calculated and compared.
Results
Seven patients (mean age: 60 ± 4.3 years; mean aneurysm size: 5.00 ± 1.76 mm) were included. 3 aneurysms were irregular, and 2 were ruptured. Ruptured BTAs were smaller (3.58 vs. 5.56 mm; p = 0.2009), had higher RRT (0.66 vs. 0.43 m²/N; p = 0.0276) and LSAR (5.11 % vs. 0 %; p = 0.0326). In unruptured BTAs, HG increased TAWSS (PLT1 +28.4 %, p = 0.0002; PLT2: +23.9 %, p = 0.0002), reduced RRT (PLT1 −21.7 %, p = 0.0009; PLT2: −18.6 %; p = 0.0016), increased HSAR (PLT1 +82.1 %, p = 0.0431, PLT2 +68.9 %, p = 0.0431), increased peak von Mises stress (PLT1 +18.6 %, p = 0.0223, PLT2 +31.9 %; p = 0.0087), maximum wall displacement (PLT1 +8.0 %, p = 0.0431; PLT2 +12.8 %, p = 0.0431) and maximum strain (PLT1 +7.13 %, p = 0.0201; PLT2 +11.8 %, p = 0.0043). Ruptured aneurysms showed similar trends with higher TAWSSR increases (PLT1 +31.6 %, p = 0.0225; PLT2 +28.2 %, p = 0.0391) and larger reductions in RRT (PLT1 −24.4 %, p = 0.0178; PLT2 −23.8 %, p = 0.0411).
Conclusion
In unruptured BTAs, PLT1 produced the greatest TAWSS increase and RRT reduction, whereas PLT2 led to maximal wall deformation. Ruptured aneurysms demonstrated greater TAWSSR increases and RRT reductions during simulation.
{"title":"Hemodynamic changes during simulation of sub-maximal handgrip maneuver in small basilar tip aneurysms: A computational fluid dynamics and one-way fluid-structure interaction analysis","authors":"Felipe Ramirez-Velandia , Vitor Lauar Pimenta de Figueiredo , Vincenzo T.R. Loly , Natalia Anna Koc , Bruno Galelli Chieregatti , Rafael T. Tatit , Emmanuel O. Mensah , Mark Rotondo , João de Sá Brasil Lima , Jorge Rios-Zermeno , Johnny S. Sandhu , Rabih G. Twak , Christopher S. Ogilvy , Carlos E. Baccin","doi":"10.1016/j.clineuro.2025.109304","DOIUrl":"10.1016/j.clineuro.2025.109304","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate through computational fluid dynamics (CFD) and fluid structure interaction (FSI) simulations basilar tip aneurysms (BTAs) hemodynamics at rest and during early (PLT1) and late (PLT2) phases of a sub-maximal handgrip (HG) maneuver.</div></div><div><h3>Methods</h3><div>Vascular segmentation used 3D rotational angiograms, and meshes were generated for accurate simulation. Time-averaged wall shear stress (TAWSS) at the aneurysm/parent vessel, oscillatory shear index (OSI), relative residence time (RRT), low and high shear stress area ratio (LSAR/HSAR), and wall deformation metrics (Von Mises stress, wall displacement, and strain) were calculated and compared.</div></div><div><h3>Results</h3><div>Seven patients (mean age: 60 ± 4.3 years; mean aneurysm size: 5.00 ± 1.76 mm) were included. 3 aneurysms were irregular, and 2 were ruptured. Ruptured BTAs were smaller (3.58 vs. 5.56 mm; p = 0.2009), had higher RRT (0.66 vs. 0.43 m²/N; p = 0.0276) and LSAR (5.11 % vs. 0 %; p = 0.0326). In unruptured BTAs, HG increased TAWSS (PLT1 +28.4 %, p = 0.0002; PLT2: +23.9 %, p = 0.0002), reduced RRT (PLT1 −21.7 %, p = 0.0009; PLT2: −18.6 %; p = 0.0016), increased HSAR (PLT1 +82.1 %, p = 0.0431, PLT2 +68.9 %, p = 0.0431), increased peak von Mises stress (PLT1 +18.6 %, p = 0.0223, PLT2 +31.9 %; p = 0.0087), maximum wall displacement (PLT1 +8.0 %, p = 0.0431; PLT2 +12.8 %, p = 0.0431) and maximum strain (PLT1 +7.13 %, p = 0.0201; PLT2 +11.8 %, p = 0.0043). Ruptured aneurysms showed similar trends with higher TAWSSR increases (PLT1 +31.6 %, p = 0.0225; PLT2 +28.2 %, p = 0.0391) and larger reductions in RRT (PLT1 −24.4 %, p = 0.0178; PLT2 −23.8 %, p = 0.0411).</div></div><div><h3>Conclusion</h3><div>In unruptured BTAs, PLT1 produced the greatest TAWSS increase and RRT reduction, whereas PLT2 led to maximal wall deformation. Ruptured aneurysms demonstrated greater TAWSSR increases and RRT reductions during simulation.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109304"},"PeriodicalIF":1.6,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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