Pub Date : 2026-02-01Epub Date: 2025-11-27DOI: 10.1016/j.clineuro.2025.109276
Hai Peng , Ruofei Yuan , Yue Zheng , Pinan Liu , Peng Li
Background and objectives
Postoperative bacterial meningitis (PBM), a severe complication after skull base tumor surgery, poses a challenge in early diagnosis, which is crucial yet often delayed due to the inconclusive nature of current diagnostic methods relying on clinical symptoms and CSF analysis. This study aimed to identify factors associated with delayed PBM diagnosis and improve early detection strategies by comparing clinical and laboratory differences between patients diagnosed within 7 days (Timely Infection Diagnosis, TID) and those diagnosed more than 7 days (Delayed Infection Diagnosis, DID) after surgery.
Methods and results
This retrospective study included 372 patients diagnosed with PBM after skull base tumor surgery at our institution from January 2019 to August 2024. Patients were divided into TID and DID groups. Multivariate analysis identified time between first lumbar puncture and surgery, tumor located in posterior fossa, and multinucleated cell ratio as independent factors differing between the groups.
Conclusion
Compared to TID cases, patients in DID group consist more of craniotomy and posterior tumor location, and they showed less severe early symptoms and CSF findings but had longer infection duration following antibiotic treatment. The study highlights the limitations of relying solely on initial CSF results and emphasizes the need for clinical vigilance, perioperative management, and individualized diagnostic strategies in suspected PBM.
{"title":"Delayed diagnosis in postoperative bacterial meningitis: A retrospective study in the skull base neoplasm surgery","authors":"Hai Peng , Ruofei Yuan , Yue Zheng , Pinan Liu , Peng Li","doi":"10.1016/j.clineuro.2025.109276","DOIUrl":"10.1016/j.clineuro.2025.109276","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Postoperative bacterial meningitis (PBM), a severe complication after skull base tumor surgery, poses a challenge in early diagnosis, which is crucial yet often delayed due to the inconclusive nature of current diagnostic methods relying on clinical symptoms and CSF analysis. This study aimed to identify factors associated with delayed PBM diagnosis and improve early detection strategies by comparing clinical and laboratory differences between patients diagnosed within 7 days (Timely Infection Diagnosis, TID) and those diagnosed more than 7 days (Delayed Infection Diagnosis, DID) after surgery.</div></div><div><h3>Methods and results</h3><div>This retrospective study included 372 patients diagnosed with PBM after skull base tumor surgery at our institution from January 2019 to August 2024. Patients were divided into TID and DID groups. Multivariate analysis identified time between first lumbar puncture and surgery, tumor located in posterior fossa, and multinucleated cell ratio as independent factors differing between the groups.</div></div><div><h3>Conclusion</h3><div>Compared to TID cases, patients in DID group consist more of craniotomy and posterior tumor location, and they showed less severe early symptoms and CSF findings but had longer infection duration following antibiotic treatment. The study highlights the limitations of relying solely on initial CSF results and emphasizes the need for clinical vigilance, perioperative management, and individualized diagnostic strategies in suspected PBM.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109276"},"PeriodicalIF":1.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617425","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 : 2026-02-01Epub Date: 2025-11-26DOI: 10.1016/j.clineuro.2025.109265
Phillip A. Bonney , John H. Kanter , Lucy Z. Kornblith , Kristin Slown , Michael A. Kohn , Anthony M. DiGiorgio , Phiroz E. Tarapore , Michael C. Huang , Geoffrey T. Manley
Introduction
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).
Methods
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.
Results
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 < 0.001). Other variables including extracranial injury and adherence to chemical prophylaxis were examined but did not reach statistical significance.
Conclusions
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.
目前还没有足够的数据来指导在创伤性脑损伤（TBI）患者中使用静脉血栓栓塞（VTE）化学预防，导致实践存在很大差异。我们研究了我们机构方案的有效性——在损伤后72 小时内两次开始使用30毫克依诺肝素——在一组接受心室外引流（EVD）治疗的严重TBI患者中。方法对2019年8月至2023年10月TBI患者进行回顾性队列研究。VTE被定义为肺栓塞（PE）、下肢深静脉血栓形成（DVT）和/或上肢DVT。根据患者人口统计学、损伤特征和化学预防数据，进行Logistic回归和时间-事件分析，以确定院内静脉血栓栓塞的危险因素。结果129例TBI患者接受evd治疗。26例（20.2% %）发生静脉血栓栓塞，其中16例为孤立性DVT， 3例为孤立性PE， 7例PE和DVT同时发生。总死亡率为30 %，没有直接归因于静脉血栓栓塞的死亡。肥胖与静脉血栓栓塞相关（HR 3.4, 95 % CI 1.5-7.8, p = 0.009）。EVD、机械通气和重症监护病房（ICU）住院时间较长与VTE相关（p均为 <； 0.001）。其他变量包括颅外损伤和化学预防依从性进行了检查，但没有达到统计学意义。结论尽管大多数患者在损伤后72 h内接受依诺肝素预防治疗，但evd治疗的TBI患者中VTE事件很常见。尽管确定增加剂量方案的神经系统风险仍然是一个挑战，但包括体重给药和早期开始治疗在内的策略值得进一步考虑。
{"title":"Factors associated with venous thromboembolism in hospitalized traumatic brain injury patients with external ventricular drains: Retrospective cohort study","authors":"Phillip A. Bonney , John H. Kanter , Lucy Z. Kornblith , Kristin Slown , Michael A. Kohn , Anthony M. DiGiorgio , Phiroz E. Tarapore , Michael C. Huang , 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 < 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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2025-12-14DOI: 10.1016/j.clineuro.2025.109285
Zach Pennington , Abdelrahman Hamouda , Omar Hafz , Anthony L. Mikula , Michelle J. Clarke , William E. Krauss , Brett A. Freedman , Melvin D. Helgeson , Ahmad N. Nassr , Arjun S. Sebastian , Jeremy L. Fogelson , Benjamin D. Elder
Objective
To evaluate predictors of fusion across the disc space and posterolaterally following transforaminal lumbar interbody fusion (TLIF).
Methods
Patients who underwent 1- or 2-level TLIF for degenerative pathologies were examined for fusion across the disc space, posterolateral fusion, and circumferential radiographic fusion. Multivariable logistic regression was used to identify independent predictors of the primary and secondary outcomes.
Results
278 unique patients (328 unique levels) were included (median age 66.2 yr; 58.3 % female) 25.9 % had complete circumferential fusion, 69.6 % had fusion across the disc space and 71 % had unilateral posterolateral fusion. Fusion across the disc space was less likely with a minimally invasive [versus open] approach (OR 0.39; 95 % CI [0.16, 0.95]; p = 0.04) or bullet [versus banana] cage (OR 0.18; [0.09, 0.38]; p < 0.001). Posterolateral fusion was also less likely with an MIS approach (OR 0.10; [0.03, 0.30]; p < 0.001) or bullet cage (OR 0.14; [0.06, 0.30]; p < 0.001) but was significantly more likely with BMP use (OR 2.97; [1.14, 7.74]; p = 0.026). Circumferential fusion was predicted by BMP use (OR 3.29; [1.48; 7.35]; p = 0.004), use of a bullet cage (OR 0.19; [0.04, 0.87] p = 0.033), and use of a longer interbody device (OR 1.15; [1.01, 1.30]; p = 0.032). Cage material was not predictive in any of the multivariable analyses.
Conclusion
The minority of patients experience circumferential fusion following TLIF. Use of a minimally invasive approach or a bullet-type cage lowers the odds of successful fusion both posterolaterally and across the disc space. BMP increases fusion odds due to improved odds of posterolateral fusion.
目的：评价经椎间孔腰椎椎体间融合术（TLIF）后跨椎间盘间隙和后外侧融合的预测因素。方法：因退行性病变接受1或2节段TLIF的患者检查椎间盘间隙融合、后外侧融合和周向放射融合。采用多变量逻辑回归来确定主要和次要结局的独立预测因子。结果：278例独特的患者（328个独特的水平）被纳入研究（中位年龄66.2 岁；58.3% %女性），25.9 %为全周融合术，69.6 %为跨椎间盘间隙融合术，71 %为单侧后外侧融合术。微创[与开放]入路相比（OR 0.39; 95 % CI [0.16, 0.95]; p = 0.04）或子弹[与香蕉]笼子相比(OR 0.18; [0.09, 0.38]； p 结论：少数患者在TLIF后经历了周向融合。采用微创入路或子弹式椎笼可降低后外侧和整个椎间盘间隙成功融合的几率。由于后外侧融合几率的提高，BMP增加了融合几率。
{"title":"Influence of surgical technique, interbody characteristics, and radiographic parameters on fusion rates across the disc space and posterolateral elements following transforaminal lumbar interbody fusion","authors":"Zach Pennington , Abdelrahman Hamouda , Omar Hafz , Anthony L. Mikula , Michelle J. Clarke , William E. Krauss , Brett A. Freedman , Melvin D. Helgeson , Ahmad N. Nassr , Arjun S. Sebastian , Jeremy L. Fogelson , Benjamin D. Elder","doi":"10.1016/j.clineuro.2025.109285","DOIUrl":"10.1016/j.clineuro.2025.109285","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate predictors of fusion across the disc space and posterolaterally following transforaminal lumbar interbody fusion (TLIF).</div></div><div><h3>Methods</h3><div>Patients who underwent 1- or 2-level TLIF for degenerative pathologies were examined for fusion across the disc space, posterolateral fusion, and circumferential radiographic fusion. Multivariable logistic regression was used to identify independent predictors of the primary and secondary outcomes.</div></div><div><h3>Results</h3><div>278 unique patients (328 unique levels) were included (median age 66.2 yr; 58.3 % female) 25.9 % had complete circumferential fusion, 69.6 % had fusion across the disc space and 71 % had unilateral posterolateral fusion. Fusion across the disc space was less likely with a minimally invasive [versus open] approach (OR 0.39; 95 % CI [0.16, 0.95]; p = 0.04) or bullet [versus banana] cage (OR 0.18; [0.09, 0.38]; p < 0.001). Posterolateral fusion was also less likely with an MIS approach (OR 0.10; [0.03, 0.30]; p < 0.001) or bullet cage (OR 0.14; [0.06, 0.30]; p < 0.001) but was significantly more likely with BMP use (OR 2.97; [1.14, 7.74]; p = 0.026). Circumferential fusion was predicted by BMP use (OR 3.29; [1.48; 7.35]; p = 0.004), use of a bullet cage (OR 0.19; [0.04, 0.87] p = 0.033), and use of a longer interbody device (OR 1.15; [1.01, 1.30]; p = 0.032). Cage material was not predictive in any of the multivariable analyses.</div></div><div><h3>Conclusion</h3><div>The minority of patients experience circumferential fusion following TLIF. Use of a minimally invasive approach or a bullet-type cage lowers the odds of successful fusion both posterolaterally and across the disc space. BMP increases fusion odds due to improved odds of posterolateral fusion.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109285"},"PeriodicalIF":1.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780594","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 : 2026-02-01Epub Date: 2025-11-27DOI: 10.1016/j.clineuro.2025.109278
Shoaib A. Syed , Evan Keister , Leela Tickoo , Griffin Thomas , Maille McDermott , Jan-Erik Schmidt , Cassidy Werner , John A. Boockvar , Randy S. D’Amico
Background
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.
Methods
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.
Results
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.
Conclusion
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.
颅穿孔钻是标准的神经外科设备，用于钻孔开颅，设计在内表自动脱离，以尽量减少受伤的风险。尽管有安全功能，但脱离失败等故障可能会导致伤害。我们系统地分析了设备故障、患者影响和10年来的时间趋势，以提高操作员对常见模式和穿孔器故障后果的警惕性，并为设备改进提供基础。方法查询2015 - 2024年颅穿支钻的制造商和用户设施器械体验（MAUDE）数据库的医疗器械报告（mdr）。报告描述是手动审查的，并按事件类型、设备问题、患者影响和操作影响进行分类。ResultsOut 1857报告,脱离失败是最常报道(69.7 n = 1295/1857, %),紧随其后的是组件完整性问题(24.1 n = 447/1857, %)电力/稳定失败(12.1 n = 225/1857, %),设备截留(5.0 n = 92/1857, %),切割效率低下(4.1 n = 76/1857, %),和热的问题(3.7 n = 68/1857, %)。近一半的mdr （n = 866,46.6 %）报告了至少一个患者的影响。其中,最常见的是硬膜损伤(89.7 n = 777/866, %),leptomeningeal受伤(25.8 n = 223/866, %),实质损伤(25.4 n = 220/866, %),和出血(23.1 n = 200/866, %)。三份报告描述了患者的死亡，但只有一份报告归因于设备故障。结论脱离失败是最常见的功能障碍，常伴有脑膜和脑实质损伤。其他设备问题不太常见，通常是在测试期间而不是在患者过程中发现的。这些发现强调了在使用过程中需要提高警惕，对器械操作进行有组织的培训，并持续改进质量以提高患者安全。
{"title":"Characterization of complications associated with cranial perforator drills in neurosurgery","authors":"Shoaib A. Syed , Evan Keister , Leela Tickoo , Griffin Thomas , Maille McDermott , Jan-Erik Schmidt , Cassidy Werner , John A. Boockvar , 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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2025-12-02DOI: 10.1016/j.clineuro.2025.109281
Yuanxiang Zeng , Qiao Zeng , Xiaoling Peng , Ping Liang , Li Jiang , Xuan Zhai , Yue Hu
Objective
To evaluate the safety and effectiveness of vagus nerve stimulation (VNS) in treating drug-refractory epilepsy (DRE) in children and to identify key predictive factors influencing its efficacy.
Methods
This was a prospective, single-center study conducted from October 2016 to July 2020. A total of 54 children treated with VNS were followed for 24 months. The effectiveness and safety of VNS were assessed at 2, 6, 12, 18, and 24 months. Kaplan–Meier univariate survival analysis and Cox regression analysis were used to identify predictors of treatment response.
Results
At 2, 6, 12, 18, and 24 months, the effectiveness of VNS (defined as a ≥50 % reduction in seizure frequency) was 29.6 %, 20.4 %, 39.6 %, 76.0 % and 75.0 %, respectively. Seizure freedom rates were 0 %, 0 %, 3.8 %, 8.0 % and 10.4 %, respectively. The effectiveness rate for patients with Lennox–Gastaut syndrome at 24 months was 67.7 %. Significant improvements were also observed in neurodevelopmental scores and quality of life (p < 0.05). Cox regression identified absence seizures and abnormal neuroimaging (CT/MRI) as independent negative predictors of VNS response at 18 and 24 months. Adverse events were transient and tolerable, with 5 (9.3 %) cases of transient hoarseness, 3 (5.6 %) of cough, 3 (5.6 %) of decreased appetite, 2 (3.7 %) of skin irritation, 2 (3.7 %) of localized skin infection, and 1 (1.8 %) of menstrual cycle disturbance.
Conclusion
VNS is an effective and safe long-term therapy for pediatric DRE, with cumulative benefits over time. The presence of absence seizures and abnormal neuroimaging findings were key predictors of a less favorable response, which may inform clinical decision-making regarding patient selection. Caution is advised when initiating VNS therapy in children with DRE exhibiting these characteristics.
{"title":"Efficacy, safety, and predictors of vagus nerve stimulation in children with drug-resistant epilepsy: A single-center prospective study","authors":"Yuanxiang Zeng , Qiao Zeng , Xiaoling Peng , Ping Liang , Li Jiang , Xuan Zhai , Yue Hu","doi":"10.1016/j.clineuro.2025.109281","DOIUrl":"10.1016/j.clineuro.2025.109281","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the safety and effectiveness of vagus nerve stimulation (VNS) in treating drug-refractory epilepsy (DRE) in children and to identify key predictive factors influencing its efficacy.</div></div><div><h3>Methods</h3><div>This was a prospective, single-center study conducted from October 2016 to July 2020. A total of 54 children treated with VNS were followed for 24 months. The effectiveness and safety of VNS were assessed at 2, 6, 12, 18, and 24 months. Kaplan–Meier univariate survival analysis and Cox regression analysis were used to identify predictors of treatment response.</div></div><div><h3>Results</h3><div>At 2, 6, 12, 18, and 24 months, the effectiveness of VNS (defined as a ≥50 % reduction in seizure frequency) was 29.6 %, 20.4 %, 39.6 %, 76.0 % and 75.0 %, respectively. Seizure freedom rates were 0 %, 0 %, 3.8 %, 8.0 % and 10.4 %, respectively. The effectiveness rate for patients with Lennox–Gastaut syndrome at 24 months was 67.7 %. Significant improvements were also observed in neurodevelopmental scores and quality of life (p < 0.05). Cox regression identified absence seizures and abnormal neuroimaging (CT/MRI) as independent negative predictors of VNS response at 18 and 24 months. Adverse events were transient and tolerable, with 5 (9.3 %) cases of transient hoarseness, 3 (5.6 %) of cough, 3 (5.6 %) of decreased appetite, 2 (3.7 %) of skin irritation, 2 (3.7 %) of localized skin infection, and 1 (1.8 %) of menstrual cycle disturbance.</div></div><div><h3>Conclusion</h3><div>VNS is an effective and safe long-term therapy for pediatric DRE, with cumulative benefits over time. The presence of absence seizures and abnormal neuroimaging findings were key predictors of a less favorable response, which may inform clinical decision-making regarding patient selection. Caution is advised when initiating VNS therapy in children with DRE exhibiting these characteristics.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109281"},"PeriodicalIF":1.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682451","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 : 2026-02-01Epub Date: 2025-11-17DOI: 10.1016/j.clineuro.2025.109259
Linlin Liu , Chunmei Jia , Haoliang Shi , Jie Yu
Background
For acute symptomatic intracranial atherosclerotic disease (ICAD) with high-grade stenosis, endovascular strategies include balloon angioplasty (PTA) and angioplasty with stenting (PTAS). Comparative evidence in the acute phase and tools for predicting restenosis remain limited. This study aims to compare outcomes of PTAS versus PTA and develop a 12-month restenosis prediction model.
Methods
We conducted a single-center retrospective cohort of patients with acute symptomatic ICAD (time from symptom onset to intervention ≤14 days, ≥70 % stenosis/occlusion) treated between 2019–2024. Patients were grouped by final procedure (PTAS vs PTA). Primary endpoint was 12-month stroke/TIA in the target territory. Secondary outcomes included residual stenosis, restenosis ≥ 50 %, recovery scores (NIHSS, mRS, MoCA, ADL), perfusion imaging, and inflammatory biomarkers. Weighted analyses and propensity matching were applied.
Results
Among 262 patients (PTAS n = 141; PTA n = 121), PTAS achieved lower residual stenosis (21.3 % vs 34.1 %, p < 0.001) with comparable 30-day stroke/death (4.3 % vs 4.1 %). PTAS improved cerebral perfusion metrics and reduced inflammatory markers versus PTA. Twelve-month stroke/TIA occurred in 7.8 % vs 14.0 % (HR 0.62; IPTW-HR 0.58 (95 % CI 0.35–0.97), p = 0.039). Restenosis ≥ 50 % was less frequent with PTAS (12.8 % vs 24.2 %, OR 0.47, p = 0.029). MoCA scores improved more with PTAS (p = 0.034). A prediction model incorporating procedure type, residual stenosis, lesion length, diabetes, smoking, and LDL-C achieved AUROC 0.79 with good calibration.
Conclusions
PTAS provided superior angiographic, perfusion, inflammatory, and restenosis outcomes over PTA, without increased early risk. A validated restenosis model may guide individualized treatment and surveillance.
背景：对于急性症状性颅内动脉粥样硬化疾病（ICAD）伴高度狭窄，血管内策略包括球囊血管成形术（PTA）和血管成形术伴支架植入术（PTAS）。急性期的比较证据和预测再狭窄的工具仍然有限。本研究旨在比较PTA与PTA的预后，并建立一个12个月的再狭窄预测模型。方法：我们对2019-2024年间接受治疗的急性症状性ICAD患者（从症状发作到干预时间≤14天，≥70 %狭窄/闭塞）进行了单中心回顾性队列研究。患者按最终手术（PTAS vs PTA）分组。主要终点是目标区域12个月卒中/TIA。次要结局包括残余狭窄、再狭窄≥ 50 %、恢复评分（NIHSS、mRS、MoCA、ADL）、灌注成像和炎症生物标志物。采用加权分析和倾向匹配。结果：262例患者中（PTAS n = 141;PTA n = 121），PTAS获得了更低的残余狭窄(21.3% % vs 34.1% %，p 结论：PTAS比PTA提供了更好的血管造影、灌注、炎症和再狭窄结果，没有增加早期风险。一个有效的再狭窄模型可以指导个体化治疗和监测。
{"title":"Percutaneous transluminal angioplasty with stenting versus balloon angioplasty alone for acute high-grade occlusive cerebrovascular stenosis: A single-center retrospective cohort study","authors":"Linlin Liu , Chunmei Jia , Haoliang Shi , Jie Yu","doi":"10.1016/j.clineuro.2025.109259","DOIUrl":"10.1016/j.clineuro.2025.109259","url":null,"abstract":"<div><h3>Background</h3><div>For acute symptomatic intracranial atherosclerotic disease (ICAD) with high-grade stenosis, endovascular strategies include balloon angioplasty (PTA) and angioplasty with stenting (PTAS). Comparative evidence in the acute phase and tools for predicting restenosis remain limited. This study aims to compare outcomes of PTAS versus PTA and develop a 12-month restenosis prediction model.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective cohort of patients with acute symptomatic ICAD (time from symptom onset to intervention ≤14 days, ≥70 % stenosis/occlusion) treated between 2019–2024. Patients were grouped by final procedure (PTAS vs PTA). Primary endpoint was 12-month stroke/TIA in the target territory. Secondary outcomes included residual stenosis, restenosis ≥ 50 %, recovery scores (NIHSS, mRS, MoCA, ADL), perfusion imaging, and inflammatory biomarkers. Weighted analyses and propensity matching were applied.</div></div><div><h3>Results</h3><div>Among 262 patients (PTAS n = 141; PTA n = 121), PTAS achieved lower residual stenosis (21.3 % vs 34.1 %, p < 0.001) with comparable 30-day stroke/death (4.3 % vs 4.1 %). PTAS improved cerebral perfusion metrics and reduced inflammatory markers versus PTA. Twelve-month stroke/TIA occurred in 7.8 % vs 14.0 % (HR 0.62; IPTW-HR 0.58 (95 % CI 0.35–0.97), p = 0.039). Restenosis ≥ 50 % was less frequent with PTAS (12.8 % vs 24.2 %, OR 0.47, p = 0.029). MoCA scores improved more with PTAS (p = 0.034). A prediction model incorporating procedure type, residual stenosis, lesion length, diabetes, smoking, and LDL-C achieved AUROC 0.79 with good calibration.</div></div><div><h3>Conclusions</h3><div>PTAS provided superior angiographic, perfusion, inflammatory, and restenosis outcomes over PTA, without increased early risk. A validated restenosis model may guide individualized treatment and surveillance.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109259"},"PeriodicalIF":1.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676732","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 : 2026-02-01Epub Date: 2025-12-16DOI: 10.1016/j.clineuro.2025.109287
Gül Yücel , Nur Yücel Ekici
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Pub Date : 2026-02-01Epub Date: 2025-11-27DOI: 10.1016/j.clineuro.2025.109279
Sai Chandan Reddy, Toby Mao, Julian Gendreau, A. Karim Ahmed, Debraj Mukherjee
Objective
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).
Methods
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.
Results
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 < 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).
Conclusion
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.
{"title":"Clinical predictors of overall survival in elderly oligodendroglioma patients: A Surveillance, Epidemiology, and End Results (SEER) database analysis","authors":"Sai Chandan Reddy, Toby Mao, Julian Gendreau, A. Karim Ahmed, 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 < 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":"2026-02-01","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}
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).
Methods
A retrospective cohort of 656 patients with insufficiency-type VCFs aged > 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 < 0.05.
Results
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 < 0.001); The operative outcomes and complication rates did not differ significantly between KD and non-KD patients.
Conclusion
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.
k mmell病（KD）是椎体压缩性骨折（VCF）的迟发性后果，通常在轻微创伤后发生。其发病率和预后仍不确定。目的：探讨良性椎体VCF患者KD的发生率及预测因素，评价经皮椎体成形术（VP）的预后。方法回顾性分析设拉子地区（2004-2024）656例年龄>； 20岁的不充分型VCFs患者。Logistic回归确定了与KD相关的因素。使用治疗前和治疗后视觉模拟量表（VAS）和Oswestry残疾指数（ODI）评分评估VP结果。p <； 0.05。结果656例VCF患者（435例 F， 221例 M）中，77例（11.7 %）有KD。KD患者年龄较大（79.2 vs. 72.4），男性居多（37.7 % vs. 24.9 %），BMI较低（22.3 vs. 23.1）。KD与先前的CVA（45.5% % vs. 15.9 %）、轻度CRP升高（23.1 vs. 22.3）和脊柱下部骨密度（t评分- 3.0 vs. - 2.1）有关。CVA病史、CRP升高和骨质疏松是KD的独立危险因素；较高的BMI具有保护作用。VP可显著改善VAS、ODI和后凸角（p均为 <； 0.001）；KD和非KD患者的手术结果和并发症发生率无显著差异。结论：我们确定了与KD相关的关键临床特征，包括骨质疏松症、既往CVA、CRP水平轻度升高和高龄。由于人口老龄化和诊断方式的改进，KD的患病率越来越高，这表明它不应再被视为一种罕见的疾病。
{"title":"Kümmell’s disease in benign vertebral compression fractures: Incidence, risk factors, and outcomes following percutaneous vertebroplasty","authors":"Majid Reza Farrokhi , Seyed Reza Mousavi , Seyed Ali Hosseini , Reza Rafieossadat , Sadegh Masjoodi , 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 > 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 < 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 < 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":"2026-02-01","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}
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