Clinical Neurology and Neurosurgery最新文献

{"title":"Comparative analysis of management techniques in the treatment of pediatric Middle fossa arachnoid cysts: A systematic review and meta-analysis","authors":"Abigail Jenkins ,&nbsp;Parker Smith ,&nbsp;Gillian Witten ,&nbsp;Mina Guirguis ,&nbsp;Soummitra Anand ,&nbsp;Jason Wang ,&nbsp;Michael Farid ,&nbsp;Srivats Srinivasan ,&nbsp;Sean O’Leary ,&nbsp;Umaru Barrie ,&nbsp;Bruno P. Braga","doi":"10.1016/j.clineuro.2025.109230","DOIUrl":"10.1016/j.clineuro.2025.109230","url":null,"abstract":"<div><h3>Introduction</h3><div>No consensus stands regarding optimal treatment for pediatric middle fossa arachnoid cysts (MFACs). This study aims to compare interventions for management of pediatric MFACs.</div></div><div><h3>Methods</h3><div>A systematic review was conducted per PRISMA guidelines using PubMed, Google Scholar, and Web of Science electronic databases to highlight management strategies of pediatric MFACs.</div></div><div><h3>Results</h3><div>Sixty two articles (22 retrospective studies, 40 case reports/series) were included. Across the retrospectives, 87.3 % patients were treated surgically and 24.0 % conservatively. Those treated surgically most underwent microscopic and endoscopic/keyhole fenestration. Microscopic fenestration was more frequently performed in ruptured cysts or cases with subdural hygroma (30.6 %, p = 0.044) while endoscopy was preferred for unruptured cysts (p = 0.005). Neurologic improvement was significantly greater with microscopic (99 %,) compared to endoscopic fenestration (91 %) (p = 0.01). Postoperative subdural fluid collections and mortality did not differ significantly between approaches. Conservative management primarily involved observation (24.6 %) and anticonvulsants (61 %). In case reports, 123 patients underwent surgery (102 open, 17 endoscopic), while 27 were managed conservatively. Microscopic fenestration correlated with preoperative cyst growth (OR: 37.63, p = 0.0004). Surgery carried greater complication risk (OR: Inf, p = 0.0014), while conservative management conferred higher cyst regression rates (OR: 20.84, p &lt; 0.001). Common complications included subdural fluid and hygroma.</div></div><div><h3>Conclusion</h3><div>Surgery is only warranted in severely symptomatic patients. Management of symptomatic, ruptured MFACs should target controlling acute subdural hygromas or hematomas. Microscopic and endoscopic surgeries yielded similar outcomes and complications. Most importantly, given the benign natural history of MFACs after the age of 4 years, most patients often require neither surgery nor follow-up imaging.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109230"},"PeriodicalIF":1.6,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145479112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Champagne bottle neck sign predicts intracranial hemorrhage in Moyamoya disease: A long-term follow-up study","authors":"Baobao Li ,&nbsp;Yuan Liu ,&nbsp;Xiangrong Du ,&nbsp;Shitong Liu ,&nbsp;Xiaopeng Wang ,&nbsp;Shengshu Wang ,&nbsp;Cong Han ,&nbsp;Xihai Zhao ,&nbsp;Fugeng Sheng ,&nbsp;Hongtao Zhang ,&nbsp;Mingming Lu ,&nbsp;Jianming Cai","doi":"10.1016/j.clineuro.2025.109233","DOIUrl":"10.1016/j.clineuro.2025.109233","url":null,"abstract":"<div><h3>Objective</h3><div>Given the poor prognosis associated with hemorrhagic events in Moyamoya disease (MMD), the early identification of patients at high risk is of paramount importance for improving clinical outcomes. This study aims to explore the predictive value of champagne bottle neck sign (CBNS) at baseline for post-treatment intracranial hemorrhage (ICH) occurrence in adult MMD patients.</div></div><div><h3>Methods</h3><div>This retrospective analysis included MMD patients without a history of ICH who were recruited from July 2014 to December 2020. All patients underwent preoperative digital subtraction angiography (DSA) and had a median follow-up of 6.5 years (1–10 years) to record ICH occurrence. The DSA features, including choroidal anastomosis and CBNS (ICA/CCA diameter ratio ≤ 0.5), were evaluated. Cox regression analysis was utilized to determine the associations between clinical and DSA characteristics and the occurrence of post-treatment ICH in MMD patients. Subsequently, receiver operating characteristic (ROC) curve analysis was conducted to calculate the area under the curve (AUC) of imaging characteristics in predicting ICH occurrence.</div></div><div><h3>Results</h3><div>Among 74 recruited MMD patients (mean age: 42.5 ± 10.4 years; 35 males), 9 (12.2 %) experienced ICH over up to ten years. Patients who experienced ICH during follow-up had significantly smaller ICA/CCA diameter ratio (0.39 ± 0.10 vs. 0.51 ± 0.12, <em>P</em> = 0.004) and higher CBNS incidence (88.9 % vs. 46.2 %, <em>P</em> = 0.03) at baseline. Multivariate Cox regression analysis demonstrated that choroidal anastomosis (HR = 3.82, 95 % CI: 1.02–14.35, <em>P</em> = 0.047) and CBNS (HR = 9.46, 95 % CI: 1.17–76.47, <em>P</em> = 0.035) were independent predictors of ICH occurrence. ROC analysis revealed that in predicting post-treatment ICH, the AUC value of CBNS was 0.714 (95 %CI: 0.558 – 0.870) to distinguish MMD patients with hemorrhage from those without, <em>P</em> = 0.039). When combined CBNS with choroidal anastomosis, the AUC value reached 0.785 (95 %CI: 0.650 – 0.919).</div></div><div><h3>Conclusions</h3><div>The CBNS has independent predictive value for risk of post-treatment ICH in adult MMD patients. This study suggests that CBNS might be a useful imaging biomarker for adverse outcome of MMD.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109233"},"PeriodicalIF":1.6,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145502487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synovial cyst of lumbar spine and facet joint effusion","authors":"Prabin Shrestha ,&nbsp;Satoshi Yamaguchi,&nbsp;Kirill V. Nourski,&nbsp;Hiroto Kawasaki,&nbsp;Matthew A. Howard,&nbsp;Patrick Hitchon","doi":"10.1016/j.clineuro.2025.109231","DOIUrl":"10.1016/j.clineuro.2025.109231","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal synovial cysts (SC) are often associated with facet joint effusion (FJE). However, there is a paucity of information in the literature regarding their relationship. The main objective of this study was to explore the association between FJE and lumbar SC.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed lumbar SC cases. FJE was identified and measured based on T2W magnetic resonance imaging, axial sections. Various aspects of association between lumbar SC and FJE were analyzed.</div></div><div><h3>Results</h3><div>A total of 153 lumbar SC cases and 306 facet joints were evaluated with FJE measurement. The mean size of FJE (ipsilateral to cyst) was significantly higher at L4–5 and lower at L1–2 (<em>p = 0.025</em>) and was higher in those with higher body mass index (BMI) &gt; 28 (median value) (p = 0.034). Of 306 facet joints, FJE was significantly bigger in those harboring SC (p = 0.029). Presence of SC was significantly associated with FJE &gt; 1.60 mm (median value) (p = 0.040). There was a significant positive correlation between BMI and FJE <em>(r = 0.252, p = 0.002)</em> in lumbar SC cases. However, FJE was not significant in terms of demography, type of surgery and outcome.</div></div><div><h3>Conclusion</h3><div>FJE is a sign of degeneration associated with lumbar SC and is significantly higher at L4–5, where SCs are mostly located. Bigger size of FJE is significantly associated with higher BMI and presence of SC. However, the size of FJE alone is not significant in terms of demography, treatment and surgical outcome. A positive correlation between BMI and FJE in lumbar SC cases suggests a triangular relationship among them.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109231"},"PeriodicalIF":1.6,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The sleep gap in deep brain stimulation in psychiatry: A systematic review","authors":"Zachary L. Bernstein ,&nbsp;Joseph N. Abergel ,&nbsp;David Cowan ,&nbsp;Nealen G. Laxpati ,&nbsp;Robert E. Gross","doi":"10.1016/j.clineuro.2025.109221","DOIUrl":"10.1016/j.clineuro.2025.109221","url":null,"abstract":"<div><h3>Introduction</h3><div>Deep brain stimulation (DBS) has emerged as a promising intervention for individuals with treatment-resistant psychiatric disease. While sleep plays a significant role in psychiatric health, the extent to which it impacts DBS patients is not known.</div></div><div><h3>Objective</h3><div>To quantify the number and type of studies that report sleep effects in DBS for psychiatric indications, and to report how sleep is impacted after DBS.</div></div><div><h3>Methods</h3><div>A systematic review was conducted using PubMed. We performed a search using the MeSH terms “deep brain stimulation” OR “DBS” plus each disease of interest. Inclusion criteria were human studies using DBS for psychiatric indications including case reports, case series, cohort studies, or clinical trials.</div></div><div><h3>Results</h3><div>A total of 3873 studies were screened, and 302 met inclusion criteria. Main diagnoses of included studies featured 163 obsessive-compulsive disorder (OCD), 113 depression, 12 substance use disorder, 7 schizophrenia, 6 post-traumatic stress disorder, and 1 anxiety disorder. 4 studies used the Pittsburgh Sleep Quality Index, 3 documented sleep as an adverse event, 1 used a wearable monitor, 1 utilized local field potentials from DBS, 3 used subscales of the Hamilton Depression Rating Scale, 1 used nocturnal electroencephalography (EEG), and 3 used self-reported scales. Ultimately, 5 studies reported improved sleep, 2 studies worsened sleep, and 6 studies reported no effect on sleep after DBS.</div></div><div><h3>Conclusion</h3><div>Despite the critical role of sleep in psychiatric health, a very limited number of studies measure sleep outcomes after DBS. Furthermore, methods vary widely, ranging from subjective self-reports to objective physiological recordings. These findings highlight the need for standardized sleep assessments in future DBS research to better understand its impact on psychiatric outcomes. Current data is underpowered and the impact of DBS on sleep for psychiatric indications remains unknown.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109221"},"PeriodicalIF":1.6,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145480897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: \"The application of machine learning for treatment selection of unruptured brain arteriovenous malformations: A secondary analysis of the ARUBA trial data\"","authors":"Stefan Knippen,&nbsp;Florian Putz,&nbsp;Haoran Cheng,&nbsp;Oliver Heese,&nbsp;Marciana-Nona Duma","doi":"10.1016/j.clineuro.2025.109227","DOIUrl":"10.1016/j.clineuro.2025.109227","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109227"},"PeriodicalIF":1.6,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145470851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hinge craniotomy versus decompressive craniectomy for the neurosurgical management of traumatic brain injury and stroke: A systematic review and meta-analysis","authors":"Honey Panchal ,&nbsp;Shaan Patel ,&nbsp;Shiva A. Nischal ,&nbsp;Ashviniy Thamilmaran ,&nbsp;Musa China ,&nbsp;Siddharth Vankipuram","doi":"10.1016/j.clineuro.2025.109225","DOIUrl":"10.1016/j.clineuro.2025.109225","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic brain injury (TBI) and stroke are major contributors to global morbidity and mortality, particularly in low- and middle-income countries. Decompressive craniectomy (DC) is an established neurosurgical intervention for reducing elevated intracranial pressure and preventing secondary neurological injury in the context of trauma and stroke. However, DC is a financially cumbersome two-stage procedure that requires specialised infrastructure, post-operative intensive care, and access to delayed cranioplasty, rendering it largely inaccessible to patients in resource-limited settings. Hinge craniotomy (HC) has emerged as a practical and potentially cost-effective alternative, mitigating the need for reoperation and long-term implant storage. This systematic review and meta-analysis aimed to evaluate the safety and clinical efficacy of HC compared to DC.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and CENTRAL databases were electronically searched to identify all relevant primary studies comparing HC versus DC. Primary outcomes of interest were decompressive efficacy (mean post-operative ICP and intracranial volume expansion), reoperation, and infection. Secondary outcomes of interest included functional recovery (Glasgow Outcome Score), mortality, operative time, length of hospital stay, duration of follow-up, and other post-operative complications, including hydrocephalus, haematoma, and radiological midline shift. Methodological quality and risk of bias were assessed. A random-effects meta-analysis was conducted.</div></div><div><h3>Results</h3><div>Twelve studies including 1546 patients were analysed. HC and DC achieved equivalent decompressive control, but HC significantly reduced postoperative infection risk (RR 0.55; 95 % CI: 0.31–0.96) and avoided the need for secondary cranioplasty, thereby lowering overall reoperation burden. Functional recovery showed a non-significant trend towards favouring HC, while mortality was similar overall, though subgroup analysis suggested improved survival in TBI patients undergoing HC. No significant differences were observed in operative time, length of hospital stay, hydrocephalus, haematoma, or radiological midline shift. Collectively, these findings indicate that HC offers clinical outcomes comparable to DC, with added advantages of lower infection risk and reduced need for reoperation.</div></div><div><h3>Conclusion</h3><div>HC provides a safe and effective alternative to DC for the management of elevated intracranial pressure in TBI and stroke. By achieving comparable efficacy whilst reducing infection risk and eliminating the need for delayed cranioplasty, HC offers distinct clinical and economic advantages, particularly in low- and middle-income countries. These findings support broader consideration of HC as a feasible alternative decompressive strategy, warranting further validation in large, high-quality randomised trials.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109225"},"PeriodicalIF":1.6,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145474934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standalone short-coil embolization of the middle meningeal artery for subdural hematomas: Efficient, safe, and radiation-sparing","authors":"Arevik Abramyan ,&nbsp;Muhammad Afridi ,&nbsp;Andrew Soliman ,&nbsp;Gaurav Gupta ,&nbsp;Daniela Perez Chadid ,&nbsp;Emad Nourollah-Zadeh ,&nbsp;Hai Sun ,&nbsp;Sudipta Roychowdhury ,&nbsp;Srihari Sundararajan","doi":"10.1016/j.clineuro.2025.109226","DOIUrl":"10.1016/j.clineuro.2025.109226","url":null,"abstract":"<div><h3>Background</h3><div>Traditional surgical management of chronic and nonacute subdural hematomas (NASDH) is associated with high recurrence and often requires reoperation. Middle meningeal artery (MMA) embolization has emerged as a minimally invasive alternative. Most studies to date have used liquid or particle embolics, which carry risks of non-target embolization and neurologic complications. Coil-only embolization offers controlled, localized occlusion and may represent a safer, simpler option, though existing data are limited by small cohorts and inconsistent techniques.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of all patients who underwent standalone coil MMA embolization for NASDH at our institution from 2022 to 2025. Short coils were deployed in a Y-configuration across anterior and posterior divisions or within the MMA trunk. Coil sizing was guided by the Spinosum Roentgen Index (S.R.I.).</div></div><div><h3>Results</h3><div>The study included 52 patients who underwent 71 procedures (mean age: 71 years). Embolization was performed upfront in 48 %, prophylactically post-surgery in 44 %, and as salvage in 8 %. Technical success was achieved in 97 %, with no procedural complications. Mean hematoma thickness decreased by 7.8 mm at one month and 13.6 mm at three months (both p &lt; 0.001). Density declined by 12.5 HU and 22.5 HU, respectively (both p &lt; 0.001). The S.R.I. correlated strongly with MMA diameter (p &lt; 0.001) and reliably guided coil sizing. Mean fluoroscopy time was 5.8 min. Larger MMA diameter was associated with greater early density reduction (p = 0.010).</div></div><div><h3>Conclusion</h3><div>This study represents the largest single-center series of standalone coil embolization for NASDH. The technique demonstrated excellent safety, hematoma resolution, and procedural efficiency.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109226"},"PeriodicalIF":1.6,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics, treatment, and outcomes in anti-metabotropic glutamate receptor-1 encephalitis: A systematic review","authors":"Yi-Xiao Li,&nbsp;Rui-Yun Wang,&nbsp;Yan-Lei Hao","doi":"10.1016/j.clineuro.2025.109229","DOIUrl":"10.1016/j.clineuro.2025.109229","url":null,"abstract":"<div><h3>Objectives</h3><div>To characterize the clinical manifestations, paraclinical findings, treatment, and outcomes in 42 cases of anti-metabotropic glutamatergic receptor-1 (mGluR1) encephalitis.</div></div><div><h3>Methods</h3><div>We conducted a systematic review of 42 reported cases of anti-mGluR1 encephalitis in accordance with the PRISMA statement. Clinical data were systematically extracted from published literature in PubMed, Web of Science, Embase, and Cochrane databases spanning January 2000 to August 2025. Statistical analysis was conducted on demographic characteristics, clinical presentations, paraclinical findings, treatment regimens, and clinical outcomes.</div></div><div><h3>Results</h3><div>Twenty-two articles with 42 cases were included. The median age at onset was 50.5 years (range: 3–81 years) with equal gender distribution. Prodromal symptoms were present in 26.2 % of cases. Cerebellar manifestations developed in nearly all cases (n = 41, 97.6 %) during the disease course. Lymphoma represented the most frequently associated malignancy. Magnetic resonance imaging (MRI) abnormalities were detected in 50.0 % of patients and inflammatory cerebrospinal fluid findings were frequently observed. Glucocorticoids constituted the most common immunotherapy (n = 29, 80.6 %). The majority of patients showed clinical improvement (n = 31), and a few of patients (n = 5) experienced disease relapses.</div></div><div><h3>Conclusions</h3><div>Anti-mGluR1 encephalitis represents a rare yet treatable autoimmune disorder, characterized by predominant cerebellar involvement, typically of non-paraneoplastic origin. Initial comprehensive neoplastic screening appears sufficient for most cases. Immunotherapy yields favorable responses in most patients, with generally good long-term outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109229"},"PeriodicalIF":1.6,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The safety and efficacy of tirofiban therapy after intravenous thrombolysis in patients with acute ischemic stroke: A systematic review and meta-analysis","authors":"Zhongfang He ,&nbsp;Xiaoping Huang ,&nbsp;Yuhui Wei ,&nbsp;Rongmei Chen ,&nbsp;Youquan Gu ,&nbsp;Junqiang Niu ,&nbsp;Pengqing Wang ,&nbsp;Zhongxia Kong ,&nbsp;Zhigang Li ,&nbsp;Yao Lu ,&nbsp;Xiangyun Meng ,&nbsp;Liting Zhang","doi":"10.1016/j.clineuro.2025.109228","DOIUrl":"10.1016/j.clineuro.2025.109228","url":null,"abstract":"<div><h3>Background</h3><div>The safety and efficacy of tirofiban administration following intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) remain controversial in clinical practice.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the safety and efficacy of tirofiban administration following IVT in AIS patients and provide comprehensive evaluation of its role in the treatment of AIS.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Library was performed up to December 31, 2024. Eligible studies compared outcomes between AIS patients who received tirofiban and those who did not following IVT, with reported endpoints including symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), mortality, 3-month modified Rankin Scale (mRS) score, and National Institutes of Health Stroke Scale (NIHSS) score. Both randomized controlled trials (RCTs) and cohort studies were included.</div></div><div><h3>Results</h3><div>Of the 951 articles identified, 14 studies (n = 2370 patients) met the inclusion criteria. Patients were stratified into two subgroups for analysis based on whether they received bridging therapy after IVT: the IVT alone group and the IVT bridging to endovascular therapy (EVT) group. Overall, compared with non-tirofiban group, tirofiban treatment did not significantly increase the risks of sICH, any ICH, or 90-day mortality (P &gt; 0.05).Tirofiban significantly reduced NIHSS scores (MD=3.36; 95 % CI[2.13, 4.59]; P &lt; 0.00001) and improved favorable functional outcomes (RR=1.16; 95 % CI [1.06, 1.27]; P = 0.002). Subgroup analysis showed that in the IVT alone group, tirofiban treatment improved excellent functional outcomes (RR=1.56; 95 % CI [1.21, 1.99]; P = 0.0005), compared with the non-tirofiban group.</div></div><div><h3>Conclusion</h3><div>Tirofiban administration may be safe and effective in AIS patients, regardless of whether they undergo bridging therapy after intravenous thrombolysis. However, further randomized controlled clinical trials are warranted to validate these findings.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109228"},"PeriodicalIF":1.6,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the efficacy of dexmedetomidine and dexamethasone as adjuvants to ropivacaine for scalp nerve block in patients undergoing awake craniotomy: A randomized controlled trial","authors":"Leena Sharma ,&nbsp;Ashwini Reddy ,&nbsp;Rajeev Chauhan ,&nbsp;Nidhi Panda ,&nbsp;Ankur Luthra ,&nbsp;Shyam Charan Meena ,&nbsp;Rashi Sarna ,&nbsp;Sushant Kumar Sahoo","doi":"10.1016/j.clineuro.2025.109223","DOIUrl":"10.1016/j.clineuro.2025.109223","url":null,"abstract":"<div><h3>Background</h3><div>Dexmedetomidine, an alpha-2 adrenoceptor agonist, and dexamethasone are known to prolong analgesia when used as adjuvants in peripheral nerve blocks. However, their comparative efficacy as perineural adjuvants in scalp nerve blocks (SNB) for awake craniotomy remains uncertain.</div></div><div><h3>Methods</h3><div>Fifty adults degree of postoperative sedation (18–65 years) undergoing awake craniotomy were randomized to receive SNB with 30 ml of 0.5 % ropivacaine plus dexmedetomidine 1 μg/kg (Group D, n = 25) or dexamethasone 8 mg (Group Z, n = 25), 20 min before skull pin fixation. The primary outcome was time to first rescue analgesia. Secondary outcomes included postoperative pain (numerical rating scale, NRS), 24-hour rescue analgesic consumption, onset of sensory block, perioperative hemodynamics during application of noxious stimulus, degree postoperative sedation, and incidence of any complications.</div></div><div><h3>Results</h3><div>The time to first rescue analgesia was significantly longer in Group D than in Group Z (14 [12–16] vs. 12.3 [9–13] h, P = 0.03). Rescue analgesic consumption was lower in Group D (1.64 ± 0.82 vs. 2.26 ± 0.89, P = 0.021). Pain scores were significantly reduced in Group D at 8 h (P = 0.01) and 12 h (P = 0.01). Group D also showed lower heart rate at skull pin fixation (P = 0.02), skin incision (P = 0.03), and closure (P = 0.001), and lower mean arterial pressure at dural (P = 0.001) and skin closure (P = 0.007). The onset of sensory block, sedation scores, and complications were comparable.</div></div><div><h3>Conclusion</h3><div>Perineural dexmedetomidine as an adjuvant to ropivacaine in SNB prolongs postoperative analgesia, reduces rescue analgesic requirements, and provides superior attenuation of the hemodynamic response to noxious stimulus as compared to dexamethasone, in the absence of any adverse effects.</div><div><strong>Clinical Trials Registry-India (CTRI) ID: CTRI/2024/01/062046</strong></div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109223"},"PeriodicalIF":1.6,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457680","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}