Clinical Neurology and Neurosurgery最新文献

{"title":"Increased cortical activation in dizziness: Neural compensation or maladaptive load?","authors":"Gül Yücel , Nur Yücel Ekici","doi":"10.1016/j.clineuro.2025.109246","DOIUrl":"10.1016/j.clineuro.2025.109246","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109246"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534418","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":"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":"2026-01-01","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":"2026-01-01","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":"The lateral orbitotomy approach: Technical nuances and video-illustration","authors":"Hussam Abou-Al-Shaar ,&nbsp;Tarek Y. El Ahmadieh ,&nbsp;Maximiliano Nuñez ,&nbsp;Vera Vigo ,&nbsp;Ju Hyung Moon ,&nbsp;Juan C. Fernandez-Miranda ,&nbsp;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":"2026-01-01","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}

{"title":"Quality of sleep in chronic migraine patients treated with fremanezumab – 6 months follow-up","authors":"Aleksandar Stojanov ,&nbsp;Jelena Stojanov ,&nbsp;Gordana Djordjevic","doi":"10.1016/j.clineuro.2025.109261","DOIUrl":"10.1016/j.clineuro.2025.109261","url":null,"abstract":"<div><h3>Оbjective</h3><div>Sleep disturbances are frequent in patients with chronic migraine (CM). Monoclonal antibodies, such as fremanezumab, may offer better-tolerated and efficacious alternatives to traditional migraine pharmacological preventive therapies. The aim was to assess the quality of sleep (QoS) in patients with CM, during the follow-up period of 6 months, during which they were treated with fremanezumab once per month.</div></div><div><h3>Methods</h3><div>The study included 82 patients with CM and 80 healthy control subjects. The study included the application of the Pittsburgh Sleep Quality Index (PSQI), Hamilton scales for the assessment of anxiety (HAM-A) and depression (HAM-D), and the 6-item Headache Impact Test (HIT-6).</div></div><div><h3>Results</h3><div>The PSQI global score and all subscores in patients with CM were significantly higher than in the control group (p &lt; 0.01). We noticed a statistically significant difference between the results in the PSQI global score between the first and third testing points (p &lt; 0.01). Also, some subscores were statistically significantly better during the follow-up period. Patients with higher scores on HIT-6, HAM-A, and HAM-D had higher scores on PSQI. Higher scores on PSQI were also noticed in female patients, the elderly, and patients with higher body mass index (BMI) levels.</div></div><div><h3>Conclusion</h3><div>The prevalence of sleep disturbance in CM patients is relatively high before starting the effective prophylactic treatment. Fremanezumab therapy had a significant beneficial influence on the QoS of CM patients. High levels of sleep disturbance correlate with higher disease-related disability, anxiety, depression, and some characteristics of the disease.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109261"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periventricular and deep white matter changes as predictors of major acute ischemic stroke outcome","authors":"Ying-Sheng Li ,&nbsp;Chung-Yao Hsu ,&nbsp;Meng-Ni Wu ,&nbsp;Yin-Chun Chen ,&nbsp;Yi-On Fong ,&nbsp;Poyin Huang","doi":"10.1016/j.clineuro.2025.109232","DOIUrl":"10.1016/j.clineuro.2025.109232","url":null,"abstract":"<div><h3>Objective</h3><div>Cerebral white matter changes (WMC) are considered indicative of small vessel diseases and are strongly associated with ischemic stroke outcomes in minor stroke populations. WMC are categorized into periventricular WMC (PVWMC) and deep subcortical WMC (DWMC), but their roles in major strokes remain unclear. Our study aims to investigate the specific roles of PVWMC and DWMC in predicting outcomes for major ischemic strokes.</div></div><div><h3>Methods</h3><div>We enrolled a total of 316 patients with ischemic stroke admitted to the intensive care unit of the stroke center. Utilizing the Fazekas scale, we assessed PVWMC and DWMC scores and analyzed their association with changes in NIHSS scores and mortality rates. Additionally, we collected information on vascular risk factors to compare among groups with different Fazekas scores.</div></div><div><h3>Results</h3><div>Among patients with major ischemic strokes, higher PVWMC scores, rather than DWMC scores, were significantly associated with changes in NIHSS scores (grading 2 and grading 3 to the mild PVWMC: OR 3.227, 95 % CI: 1.658, 6.280, P = 0.001; OR 6.090, 95 % CI: 2.296, 16.150, P &lt; 0.001, respectively) and the mortality rate (grading 2 and grading 3 to the mild PVWMC: OR 14.244, 95 % CI: 2.040, 99.474, P = 0.007; OR 40.691, 95 % CI: 4.537, 364.928, P = 0.001, respectively). Aging, diabetes mellitus, hypertension, atrial fibrillation, a history of cerebrovascular accidents, and high NIHSS scores were linked to high-grade PVWMC.</div></div><div><h3>Conclusions</h3><div>In patients with major ischemic stroke, PVWMC serves as an independent predictor of in-hospital mortality and stroke progression, while DWMC does not. These findings enhance our understanding of the distinct roles of PVWMC and DWMC and contribute to the development of models for predicting major stroke outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109232"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519291","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":"Letter to the editor: Cognitive impairment in calcified neurocysticercosis – Mechanistic and clinical considerations","authors":"Nathkapach K. Rattanapitoon,&nbsp;Patpicha Arunsan,&nbsp;Chutharat Thanchonnang,&nbsp;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":"2026-01-01","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}

{"title":"Utility of ASL-MRI in detecting disease evolution including de-novo formation and post-treatment changes of intracranial dural arteriovenous fistula","authors":"Hiroaki Neki,&nbsp;Yoshinobu Kamio,&nbsp;Tomoya Oishi,&nbsp;Kazuhiko Kurozumi","doi":"10.1016/j.clineuro.2025.109258","DOIUrl":"10.1016/j.clineuro.2025.109258","url":null,"abstract":"<div><h3>Purpose</h3><div>Intracranial dural arteriovenous fistula (dAVF) is a pathologic shunt between dural arteries and veins. The indication for invasive treatment of intracranial dAVF is primarily determined by the bleeding risk based on the location of the shunt and venous drainage. DSA is still the gold standard for diagnosing dAVF, but its invasive nature limits its use for early detection of disease progression or recurrence during follow-up. This study evaluates the clinical utility of noninvasive pseudo-continuous arterial spin-labeling MRI (ASL-MRI) in intracranial dAVFs, particularly its potential to detect progression, recanalization and de-novo formation.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study including patients with intracranial dAVF who were diagnosed with DSA or treated at our institution between April 2016 and December 2023. The proportion of patients was determined based on ASL-MRI signal changes in the cerebral parenchyma and venous sinuses during follow-up. If bright signal intensity was observed on ASL-MRI, repeat DSA was performed.</div></div><div><h3>Results</h3><div>Of the 65 patients with intracranial dAVF, 54 (83.1 %) received early therapeutic intervention immediately after diagnosis, while the remaining (n = 11; 16.9 %) followed up with MRI. Of the 11 patients, four patients transitioned to treatment, cortical ASL-MRI hyperintensity was exhibited interval augmentation. Of the 58 patients, 63 treatment procedures were performed, ASL-MRI successfully detected two cases of recurrent dangerous dAVF and three cases of de-novo dAVF.</div></div><div><h3>Conclusion</h3><div>ASL-MRI is a minimally invasive diagnostic modality that is useful both before and after treatment, providing support in determining treatment timing, identifying new lesions, and conducting post-treatment follow-up assessments.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109258"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"2026-01-01","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":"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":"2026-01-01","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}