Pub Date : 2025-11-16DOI: 10.1016/j.clineuro.2025.109247
Vishal V. Thakur , Jesse McClure , David Fletcher , Emily Melancon-Ricaurte , Luke Wilson , Dayton Miller , Tyler McGaughey , Dheeraj Gandhi , Huanwen Chen , Marco Colasurdo , Manish Ranjan , Nicholas Brandmeir , Sanjay Bhatia , Dhairya A. Lakhani
Background
The impact of steroid use in patients with chronic subdural hematoma (cSDH) treated with both surgical evacuation and middle meningeal artery embolization (MMAE) has not been previously reported. This study compares outcomes in this specific patient population.
Methods
We conducted a multi-institutional, multi-national, retrospective, propensity score–matched study using the TriNetX platform. Patients with cSDH who underwent both surgical evacuation and MMAE were included and stratified based on whether they received adjunctive steroid therapy. Primary outcomes included unplanned inpatient readmissions, need for repeat surgery, and six-month mortality.
Results
A total of 605 cSDH patients met the inclusion criteria, of whom 283 received adjunctive steroids. After propensity score matching, no significant differences were observed in the primary outcomes between patients who received steroids and those who did not. However, the steroid group exhibited non-significantly higher rates of inpatient readmission and mortality.
Conclusion
In patients with cSDH treated with a combination of surgical evacuation and MMAE, adjunctive steroid therapy was not associated with improved outcomes. These findings suggest that steroids may not confer a clear benefit in this setting and could potentially expose patients to unnecessary risks.
{"title":"Impact of adjunctive steroids on chronic subdural hematoma treated with surgery and MMAE: A propensity-matched study","authors":"Vishal V. Thakur , Jesse McClure , David Fletcher , Emily Melancon-Ricaurte , Luke Wilson , Dayton Miller , Tyler McGaughey , Dheeraj Gandhi , Huanwen Chen , Marco Colasurdo , Manish Ranjan , Nicholas Brandmeir , Sanjay Bhatia , Dhairya A. Lakhani","doi":"10.1016/j.clineuro.2025.109247","DOIUrl":"10.1016/j.clineuro.2025.109247","url":null,"abstract":"<div><h3>Background</h3><div>The impact of steroid use in patients with chronic subdural hematoma (cSDH) treated with both surgical evacuation and middle meningeal artery embolization (MMAE) has not been previously reported. This study compares outcomes in this specific patient population.</div></div><div><h3>Methods</h3><div>We conducted a multi-institutional, multi-national, retrospective, propensity score–matched study using the TriNetX platform. Patients with cSDH who underwent both surgical evacuation and MMAE were included and stratified based on whether they received adjunctive steroid therapy. Primary outcomes included unplanned inpatient readmissions, need for repeat surgery, and six-month mortality.</div></div><div><h3>Results</h3><div>A total of 605 cSDH patients met the inclusion criteria, of whom 283 received adjunctive steroids. After propensity score matching, no significant differences were observed in the primary outcomes between patients who received steroids and those who did not. However, the steroid group exhibited non-significantly higher rates of inpatient readmission and mortality.</div></div><div><h3>Conclusion</h3><div>In patients with cSDH treated with a combination of surgical evacuation and MMAE, adjunctive steroid therapy was not associated with improved outcomes. These findings suggest that steroids may not confer a clear benefit in this setting and could potentially expose patients to unnecessary risks.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109247"},"PeriodicalIF":1.6,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569932","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 : 2025-11-16DOI: 10.1016/j.clineuro.2025.109254
S. Dhanya Dedeepya , Vaishali Goel , Nivedita Nikhil Desai
{"title":"Comment on “Evaluation of preoperative cervical internal carotid artery diameter as a predictor of cerebral hyperperfusion syndrome following revascularization surgery”","authors":"S. Dhanya Dedeepya , Vaishali Goel , Nivedita Nikhil Desai","doi":"10.1016/j.clineuro.2025.109254","DOIUrl":"10.1016/j.clineuro.2025.109254","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109254"},"PeriodicalIF":1.6,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548400","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 : 2025-11-16DOI: 10.1016/j.clineuro.2025.109257
Basel Musmar, Joanna M. Roy, Hammam Abdalrazeq, Anthony Yulin Chen, Mary-Katharine Pontarelli, Shray Patel, Stavropoula I. Tjoumakaris, Michael Reid Gooch, Robert H. Rosenwasser, Pascal Jabbour
Background and objectives
The effect of statins on outcomes following aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. While randomized controlled trials (RCTs) and meta-analyses have not demonstrated consistent benefits, a key limitation is that these studies did not specifically examine patients already on statins prior to hemorrhage. This study aims to address this gap using a propensity-score weighted analysis.
Methods
This retrospective cohort study included patients with aSAH treated between 2017 and 2023. Patients were grouped based on pre-admission statin use: 79 in the statin group and 284 in the non-statin group.
Results
A total of 363 patients were included, with 79 in the statin group and 284 in the non-statin group. After adjustment, statin use was associated with a significantly lower risk of symptomatic vasospasm (OR = 0.23; 95 % CI, 0.05–0.95; p = 0.04). Statin use was also associated with lower odds of CTA/DSA-confirmed vasospasm, though this was not statistically significant (OR = 0.11; 95 % CI, 0.009–1.36; p = 0.08). There were no significant differences between groups in the incidence of hydrocephalus, ventriculoperitoneal (VP) shunt placement, mortality, or favorable functional outcome at discharge and at 30 days.
Conclusion
Chronic statin use prior to aSAH was associated with a significant reduction in symptomatic vasospasm. These findings highlight the importance of considering pre-ictal statin therapy when evaluating the role of statins in this setting and support further investigation in appropriately stratified populations. Given the small event rates and wide confidence intervals, these findings should be interpreted cautiously and considered hypothesis-generating.
背景和目的：他汀类药物对动脉瘤性蛛网膜下腔出血（aSAH）后预后的影响尚不清楚。虽然随机对照试验（rct）和荟萃分析没有证明一致的益处，但一个关键的局限性是，这些研究没有专门检查出血前已经服用他汀类药物的患者。本研究旨在利用倾向得分加权分析来解决这一差距。方法：本回顾性队列研究纳入了2017年至2023年间接受aSAH治疗的患者。患者根据入院前他汀类药物的使用情况进行分组：他汀类药物组79例，非他汀类药物组284例。结果：共纳入363例患者，他汀类药物组79例，非他汀类药物组284例。调整后，他汀类药物的使用与症状性血管痉挛的风险显著降低相关（OR = 0.23; 95 % CI, 0.05-0.95; p = 0.04）。他汀类药物的使用也与CTA/ dsa证实的血管痉挛的几率较低相关，尽管这没有统计学意义（OR = 0.11; 95 % CI, 0.009-1.36; p = 0.08）。在脑积水发生率、脑室-腹膜（VP）分流器放置、死亡率或出院和30天的良好功能结局方面，两组间无显著差异。结论：aSAH前慢性使用他汀类药物与症状性血管痉挛的显著减少相关。这些发现强调了在评估他汀类药物在这种情况下的作用时考虑他汀类药物孕前治疗的重要性，并支持在适当分层的人群中进行进一步的研究。考虑到小事件发生率和宽置信区间，这些发现应谨慎解释，并考虑到假设生成。
{"title":"The effect of statins on clinical outcomes in patients with aneurysmal subarachnoid hemorrhage: A propensity-score weighted analysis","authors":"Basel Musmar, Joanna M. Roy, Hammam Abdalrazeq, Anthony Yulin Chen, Mary-Katharine Pontarelli, Shray Patel, Stavropoula I. Tjoumakaris, Michael Reid Gooch, Robert H. Rosenwasser, Pascal Jabbour","doi":"10.1016/j.clineuro.2025.109257","DOIUrl":"10.1016/j.clineuro.2025.109257","url":null,"abstract":"<div><h3>Background and objectives</h3><div>The effect of statins on outcomes following aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. While randomized controlled trials (RCTs) and meta-analyses have not demonstrated consistent benefits, a key limitation is that these studies did not specifically examine patients already on statins prior to hemorrhage. This study aims to address this gap using a propensity-score weighted analysis.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients with aSAH treated between 2017 and 2023. Patients were grouped based on pre-admission statin use: 79 in the statin group and 284 in the non-statin group.</div></div><div><h3>Results</h3><div>A total of 363 patients were included, with 79 in the statin group and 284 in the non-statin group. After adjustment, statin use was associated with a significantly lower risk of symptomatic vasospasm (OR = 0.23; 95 % CI, 0.05–0.95; p = 0.04). Statin use was also associated with lower odds of CTA/DSA-confirmed vasospasm, though this was not statistically significant (OR = 0.11; 95 % CI, 0.009–1.36; p = 0.08). There were no significant differences between groups in the incidence of hydrocephalus, ventriculoperitoneal (VP) shunt placement, mortality, or favorable functional outcome at discharge and at 30 days.</div></div><div><h3>Conclusion</h3><div>Chronic statin use prior to aSAH was associated with a significant reduction in symptomatic vasospasm. These findings highlight the importance of considering pre-ictal statin therapy when evaluating the role of statins in this setting and support further investigation in appropriately stratified populations. Given the small event rates and wide confidence intervals, these findings should be interpreted cautiously and considered hypothesis-generating.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109257"},"PeriodicalIF":1.6,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562877","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 : 2025-11-16DOI: 10.1016/j.clineuro.2025.109256
Sebastian Koch , Tiffany Eatz , Berje H. Shammassian , Lili Zhou , Nicole Sur , Gillian Gordon Perue , Amedeo Merenda , Ayham Alkhachroum
Background
Hematoma expansion in intracerebral hemorrhage (ICH) is a predictor of poor outcome and remains an important therapeutic target. Little is known about the incidence and clinical characteristics of patients with severe hematoma expansion, who we hereafter label as super-expanders.
Methods
We retrospectively reviewed baseline clinical and radiological features in consecutive ICH patients admitted over a three-year period to a comprehensive stroke center. Hematoma expansion was defined conventionally as a > 33 % increase in hematoma volume or a > 6 ml increase in absolute hematoma volume between the baseline and 24-hour follow-up brain CT. Severe hematoma expansion was defined as a > 50 % increase in ICH volume associated with a decrease in the Glasgow Coma Scale of at least four points. We used Random Forest (RF) to generate importance plots searching for the determinants of super-expanders in ICH. In addition, a multivariable logistic regression model was done to examine independent factors associated with super-expanders.
Results
We analyzed 417 cases. Hematoma expansion, defined conventionally, occurred in 97/417 (23 %) patients of which 15/417 (4 %) were super-expanders. In the univariate analysis, super-expanders were more likely to have a lobar hemorrhage, spot sign, and increased in-hospital mortality. Using the RF analysis, age, platelet count, and presence of a spot sign emerged as important determinants of super-expansion. In a multivariable model, only spot sign was an independent predictor for super-expansion [Age (OR = 1.43, 95 % CI=0.61–3.37), spot sign (OR = 6.25, 95 % CI=2.30–17.00), lobar location (OR = 4.63, 95 % CI= 0.92–23.42)].
Conclusion
We describe a low incidence of 4 % of severe hematoma expansion in ICH. There were no definitive clinical or radiological characteristics that differentiated super-expanders. Identifying such characteristics may allow for patient risk stratification. We encourage further investigations into the early identification of super-expanders, who arguably have the most to benefit from aggressive interventions.
{"title":"Hematoma expansion in intracerebral hemorrhage retrospective chart review: Who are the super-expanders?","authors":"Sebastian Koch , Tiffany Eatz , Berje H. Shammassian , Lili Zhou , Nicole Sur , Gillian Gordon Perue , Amedeo Merenda , Ayham Alkhachroum","doi":"10.1016/j.clineuro.2025.109256","DOIUrl":"10.1016/j.clineuro.2025.109256","url":null,"abstract":"<div><h3>Background</h3><div>Hematoma expansion in intracerebral hemorrhage (ICH) is a predictor of poor outcome and remains an important therapeutic target. Little is known about the incidence and clinical characteristics of patients with severe hematoma expansion, who we hereafter label as super-expanders.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed baseline clinical and radiological features in consecutive ICH patients admitted over a three-year period to a comprehensive stroke center. Hematoma expansion was defined conventionally as a > 33 % increase in hematoma volume or a > 6 ml increase in absolute hematoma volume between the baseline and 24-hour follow-up brain CT. Severe hematoma expansion was defined as a > 50 % increase in ICH volume associated with a decrease in the Glasgow Coma Scale of at least four points. We used Random Forest (RF) to generate importance plots searching for the determinants of super-expanders in ICH. In addition, a multivariable logistic regression model was done to examine independent factors associated with super-expanders.</div></div><div><h3>Results</h3><div>We analyzed 417 cases. Hematoma expansion, defined conventionally, occurred in 97/417 (23 %) patients of which 15/417 (4 %) were super-expanders. In the univariate analysis, super-expanders were more likely to have a lobar hemorrhage, spot sign, and increased in-hospital mortality. Using the RF analysis, age, platelet count, and presence of a spot sign emerged as important determinants of super-expansion. In a multivariable model, only spot sign was an independent predictor for super-expansion [Age (OR = 1.43, 95 % CI=0.61–3.37), spot sign (OR = 6.25, 95 % CI=2.30–17.00), lobar location (OR = 4.63, 95 % CI= 0.92–23.42)].</div></div><div><h3>Conclusion</h3><div>We describe a low incidence of 4 % of severe hematoma expansion in ICH. There were no definitive clinical or radiological characteristics that differentiated super-expanders. Identifying such characteristics may allow for patient risk stratification. We encourage further investigations into the early identification of super-expanders, who arguably have the most to benefit from aggressive interventions.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109256"},"PeriodicalIF":1.6,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617485","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 : 2025-11-14DOI: 10.1016/j.clineuro.2025.109242
Samuel W. Terman , Navya Kalia , Micaela Dugan , Jordan M. Silva , Charlotte van Asch , James F. Burke , Shawna N. Smith , Susanna S. O’Kula , Chloe E. Hill
Background
Antiseizure medication (ASM) withdrawal can be considered after a period of seizure-freedom for patients with epilepsy. We interviewed clinicians who treat patients with epilepsy about challenges and existing information gaps regarding ASM withdrawal decisions.
Methods
We conducted six focus groups of 3–5 clinicians each (N = 25). We used purposive sampling to reach key informants with diversity of geography, specialty, and credentialing, focusing on epilepsy specialists who may have the greatest experience with these scenarios but also seeking non-specialist neurology input. We asked respondents to describe their greatest challenges when discussing ASM withdrawal with patients and making treatment decisions. We then performed thematic qualitative analysis.
Results
Twenty (80 %) participants were epileptologists or clinical neurophysiologists, and three (12 %) were physician extenders. Respondents identified many challenges when discussing ASM withdrawal with patients. Estimating an individual patient’s seizure risk was one of the greatest challenges, due to heterogeneity in etiologies, electroclinical syndromes, and other patient characteristics. Additional challenges included weighing the net benefit versus harm of ASM discontinuation, dealing with uncertainty even if one could accurately estimate the chance of another seizure, and questions about optimal use of EEG. Respondents also noted challenges when patient preferences are not aligned with physician recommendations and the feeling of personal responsibility should the patient have a seizure after withdrawal.
Conclusions
Many challenges remain in ASM discontinuation decisions after a period of seizure-freedom. Our results encourage future efforts to improve individualized seizure risk prediction and to develop prediction models into seizure risk calculators.
{"title":"Challenges in antiseizure medication discontinuation decisions: A qualitative study of clinicians who see patients with epilepsy","authors":"Samuel W. Terman , Navya Kalia , Micaela Dugan , Jordan M. Silva , Charlotte van Asch , James F. Burke , Shawna N. Smith , Susanna S. O’Kula , Chloe E. Hill","doi":"10.1016/j.clineuro.2025.109242","DOIUrl":"10.1016/j.clineuro.2025.109242","url":null,"abstract":"<div><h3>Background</h3><div>Antiseizure medication (ASM) withdrawal can be considered after a period of seizure-freedom for patients with epilepsy. We interviewed clinicians who treat patients with epilepsy about challenges and existing information gaps regarding ASM withdrawal decisions.</div></div><div><h3>Methods</h3><div>We conducted six focus groups of 3–5 clinicians each (N = 25). We used purposive sampling to reach key informants with diversity of geography, specialty, and credentialing, focusing on epilepsy specialists who may have the greatest experience with these scenarios but also seeking non-specialist neurology input. We asked respondents to describe their greatest challenges when discussing ASM withdrawal with patients and making treatment decisions. We then performed thematic qualitative analysis.</div></div><div><h3>Results</h3><div>Twenty (80 %) participants were epileptologists or clinical neurophysiologists, and three (12 %) were physician extenders. Respondents identified many challenges when discussing ASM withdrawal with patients. Estimating an individual patient’s seizure risk was one of the greatest challenges, due to heterogeneity in etiologies, electroclinical syndromes, and other patient characteristics. Additional challenges included weighing the net benefit versus harm of ASM discontinuation, dealing with uncertainty even if one could accurately estimate the chance of another seizure, and questions about optimal use of EEG. Respondents also noted challenges when patient preferences are not aligned with physician recommendations and the feeling of personal responsibility should the patient have a seizure after withdrawal.</div></div><div><h3>Conclusions</h3><div>Many challenges remain in ASM discontinuation decisions after a period of seizure-freedom. Our results encourage future efforts to improve individualized seizure risk prediction and to develop prediction models into seizure risk calculators.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109242"},"PeriodicalIF":1.6,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548306","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 : 2025-11-13DOI: 10.1016/j.clineuro.2025.109243
Nathkapach K. Rattanapitoon, Patpicha Arunsan, Chutharat Thanchonnang, Schawanya K. Rattanapitoon
{"title":"Letter to the editor: Cognitive impairment in calcified neurocysticercosis – Mechanistic and clinical considerations","authors":"Nathkapach K. Rattanapitoon, Patpicha Arunsan, Chutharat Thanchonnang, Schawanya K. Rattanapitoon","doi":"10.1016/j.clineuro.2025.109243","DOIUrl":"10.1016/j.clineuro.2025.109243","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109243"},"PeriodicalIF":1.6,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519293","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 : 2025-11-13DOI: 10.1016/j.clineuro.2025.109241
Andrew J. Larner
{"title":"Response to Komiotis et al. “Genetic perspectives on transient global amnesia: A narrative review”","authors":"Andrew J. Larner","doi":"10.1016/j.clineuro.2025.109241","DOIUrl":"10.1016/j.clineuro.2025.109241","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109241"},"PeriodicalIF":1.6,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519292","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 : 2025-11-12DOI: 10.1016/j.clineuro.2025.109235
Hussam Abou-Al-Shaar , Tarek Y. El Ahmadieh , Maximiliano Nuñez , Vera Vigo , Ju Hyung Moon , Juan C. Fernandez-Miranda , Aaron A. Cohen-Gadol
The lateral orbitotomy approach is a minimally-invasive transorbital technique that was originally developed to address orbital pathologies. With the increased understanding of orbital anatomy and multidisciplinary collaboration between neurosurgeons and oculoplastic surgeons, the approach has been expanded to address various pathologies of the anterior and middle cranial fossae, and intrinsic brain pathologies. Clipping select aneurysms and resecting both intrinsic and extra-axial brain tumors were made possible through a small skin incision around the eye. The lateral orbitotomy offers optimal visualization to pathologies located inferior to the anterior clinoid process, anterior to Meckel’s cave, lateral to the optic nerve, and medial to foramen ovale. In this report, the authors delineate the indications, advantages, and limitations of the lateral orbitotomy approach and discuss related technical nuances and common pitfalls. This report aims to provide a practical educational resource for neurosurgery trainees and junior neurosurgeons through high-quality dissections and 3D 4 K video presentations.
{"title":"The lateral orbitotomy approach: Technical nuances and video-illustration","authors":"Hussam Abou-Al-Shaar , Tarek Y. El Ahmadieh , Maximiliano Nuñez , Vera Vigo , Ju Hyung Moon , Juan C. Fernandez-Miranda , Aaron A. Cohen-Gadol","doi":"10.1016/j.clineuro.2025.109235","DOIUrl":"10.1016/j.clineuro.2025.109235","url":null,"abstract":"<div><div>The lateral orbitotomy approach is a minimally-invasive transorbital technique that was originally developed to address orbital pathologies. With the increased understanding of orbital anatomy and multidisciplinary collaboration between neurosurgeons and oculoplastic surgeons, the approach has been expanded to address various pathologies of the anterior and middle cranial fossae, and intrinsic brain pathologies. Clipping select aneurysms and resecting both intrinsic and extra-axial brain tumors were made possible through a small skin incision around the eye. The lateral orbitotomy offers optimal visualization to pathologies located inferior to the anterior clinoid process, anterior to Meckel’s cave, lateral to the optic nerve, and medial to foramen ovale. In this report, the authors delineate the indications, advantages, and limitations of the lateral orbitotomy approach and discuss related technical nuances and common pitfalls. This report aims to provide a practical educational resource for neurosurgery trainees and junior neurosurgeons through high-quality dissections and 3D 4 K video presentations.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109235"},"PeriodicalIF":1.6,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548353","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}
To further assess the mid-long term effects of dihydroergotoxine mesylate (DHM) on salivation in patients with Parkinson’s disease (PD).
Methods
Thirty-nine participants were enrolled in a 24-week, open, self-controlled study. After baseline assessments of salivation, swallowing, and motor and cognitive function, the participants were given DHM. The primary outcome was the difference in the Sialorrhea Clinical Scale for Parkinson’s disease (SCS-PD) scores of salivation before and after treatment. The secondary outcomes included ≥ 30 % improvement in the SCS-PD score at each posttreatment visit and changes in the scores from other scales.
Results
A total of 39 participants were included in this study, and 4 participants dropped out. Finally, 35 patients completed all the visits. Salivation: After treatment for 1 week, the primary outcome, namely, the median SCS-PD score, decreased from 9.0 (IQR 5.0–12.0) at baseline to 7.0 (IQR 4.7–10.0) (P = 0.03). This effect persisted at 24 weeks, and the median score at 24 weeks was 5.0 (IQR 2.0–8.0) (P < 0.001 compared with baseline). For the Drooling Severity and Frequency Scale (DSFS) scale, the median baseline score was 6.0 (IQR 5.0–7.0). After two weeks of treatment, the median score decreased from baseline to 5.0 (IQR 4.0–6.0) (P < 0.001), and the median score at the final visit was 4.0 (IQR 3.7–6.0) (P < 0.001). The second term of the second part of the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS-2.2) showed a trend that was consistent with that of the DSFS scale, and significant differences started to emerge at 2 weeks after treatment was initiated. Within one week of treatment, 25.64 % of the patients had improved SCS-PD scores, reaching improvements of 30 % or more. At 2–12 weeks, the proportion of patients with improved SCS-PD scores exceeded 50 %, and this proportion reached 64.10 % at 24 weeks. Swallowing function: The Eating Assessment Tool-10 (EAT-10) revealed that the median scores at 4–24 weeks were 1.0 (IQR 0–3.0), 1.0 (IQR 0–2.2) and 1.0 (IQR 0–3.0), which were significantly different from the baseline score of 2.0 (IQR 0.7–4.0) (P < 0.05). After 2 weeks of treatment, the median score of the Swallowing Disturbance Questionnaire for Parkinson’s Disease (SDQ-PD) decreased from 22.0 (IQR 18.0–27.0) at baseline to 19.0 (IQR 17.0–23.2) (P = 0.001). However, motor and cognitive function did not significantly change in this study. Moreover, only 7.69 % of patients experienced mild and transient adverse effects.
Conclusion
DHM can significantly ameliorate salivation in PD patients over 24 weeks, with fewer adverse effects.
{"title":"Mid-long term efficacy of dihydroergotoxine mesylate in treatment of sialorrhea in Parkinson's disease","authors":"Huihui Jin , Ting Huang , Jing Wu , Yanan Zhu , Qing Gao , Youyong Tian","doi":"10.1016/j.clineuro.2025.109239","DOIUrl":"10.1016/j.clineuro.2025.109239","url":null,"abstract":"<div><h3>Purpose</h3><div>To further assess the mid-long term effects of dihydroergotoxine mesylate (DHM) on salivation in patients with Parkinson’s disease (PD).</div></div><div><h3>Methods</h3><div>Thirty-nine participants were enrolled in a 24-week, open, self-controlled study. After baseline assessments of salivation, swallowing, and motor and cognitive function, the participants were given DHM. The primary outcome was the difference in the Sialorrhea Clinical Scale for Parkinson’s disease (SCS-PD) scores of salivation before and after treatment. The secondary outcomes included ≥ 30 % improvement in the SCS-PD score at each posttreatment visit and changes in the scores from other scales.</div></div><div><h3>Results</h3><div>A total of 39 participants were included in this study, and 4 participants dropped out. Finally, 35 patients completed all the visits. Salivation: After treatment for 1 week, the primary outcome, namely, the median SCS-PD score, decreased from 9.0 (IQR 5.0–12.0) at baseline to 7.0 (IQR 4.7–10.0) (<em>P</em> = 0.03). This effect persisted at 24 weeks, and the median score at 24 weeks was 5.0 (IQR 2.0–8.0) (<em>P</em> < 0.001 compared with baseline). For the Drooling Severity and Frequency Scale (DSFS) scale, the median baseline score was 6.0 (IQR 5.0–7.0). After two weeks of treatment, the median score decreased from baseline to 5.0 (IQR 4.0–6.0) (<em>P</em> < 0.001), and the median score at the final visit was 4.0 (IQR 3.7–6.0) (<em>P</em> < 0.001). The second term of the second part of the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS-2.2) showed a trend that was consistent with that of the DSFS scale, and significant differences started to emerge at 2 weeks after treatment was initiated. Within one week of treatment, 25.64 % of the patients had improved SCS-PD scores, reaching improvements of 30 % or more. At 2–12 weeks, the proportion of patients with improved SCS-PD scores exceeded 50 %, and this proportion reached 64.10 % at 24 weeks. Swallowing function: The Eating Assessment Tool-10 (EAT-10) revealed that the median scores at 4–24 weeks were 1.0 (IQR 0–3.0), 1.0 (IQR 0–2.2) and 1.0 (IQR 0–3.0), which were significantly different from the baseline score of 2.0 (IQR 0.7–4.0) (<em>P</em> < 0.05). After 2 weeks of treatment, the median score of the Swallowing Disturbance Questionnaire for Parkinson’s Disease (SDQ-PD) decreased from 22.0 (IQR 18.0–27.0) at baseline to 19.0 (IQR 17.0–23.2) (<em>P</em> = 0.001). However, motor and cognitive function did not significantly change in this study. Moreover, only 7.69 % of patients experienced mild and transient adverse effects.</div></div><div><h3>Conclusion</h3><div>DHM can significantly ameliorate salivation in PD patients over 24 weeks, with fewer adverse effects.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109239"},"PeriodicalIF":1.6,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519289","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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