Clinical Neurology and Neurosurgery最新文献

{"title":"Stroke in pregnancy and postpartum: Etiology, incidence, and risk factors in a tertiary care cohort","authors":"Adalet Göçmen ,&nbsp;Murat Çekiç ,&nbsp;Mehmet İncebıyık ,&nbsp;Dilek Ağırcan ,&nbsp;Tülin Gesoğlu Demir ,&nbsp;Özlem Öz ,&nbsp;Özlem Ethemoğlu","doi":"10.1016/j.clineuro.2025.109237","DOIUrl":"10.1016/j.clineuro.2025.109237","url":null,"abstract":"<div><h3>Background</h3><div>Stroke during pregnancy and the puerperium is rare but potentially devastating, contributing substantially to maternal morbidity, mortality, and adverse fetal outcomes. Data on incidence, etiology, and modifiable risk factors in low- and middle-income countries remain limited.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed medical records of women ≥ 18 years admitted with ischemic stroke (arterial or cerebral venous thrombosis) or hemorrhagic stroke during pregnancy or up to 12 weeks postpartum at Harran University Hospital between January 2013 and October 2024. Clinical features, neuroimaging findings, laboratory parameters, thrombophilia/genetic testing, and obstetric complications were analyzed. A control group comprised age-matched pregnant/postpartum women hospitalized for obstetric indications without stroke. Risk factors were compared between groups, and center-based incidence was calculated per 100,000 deliveries.</div></div><div><h3>Results</h3><div>Eighty-three women were included (25 pregnant, 58 postpartum). Ischemic stroke predominated over hemorrhagic events. Cerebral venous thrombosis was the most frequent subtype, particularly postpartum and within 6 weeks of delivery. Preeclampsia/eclampsia and anemia were significantly more common in cases than controls (p &lt; 0.01). Laboratory abnormalities included higher urea, creatinine, glucose, low-density lipoprotein cholesterol, C-reactive protein, erythrocyte sedimentation rate, red cell distribution width, and platelet counts, with lower hemoglobin, ferritin, albumin, thyroid-stimulating hormone, and mean corpuscular volume. Thrombophilia testing revealed higher frequencies of methylenetetrahydrofolate reductase C677T/A1298C, prothrombin G20210A, and Factor V Leiden variants among cerebral venous thrombosis patients. The incidence of pregnancy-associated stroke at our center was 57.8 per 100,000 deliveries.</div></div><div><h3>Conclusions</h3><div>Pregnancy-associated stroke, especially postpartum CVT, remains an important cause of maternal morbidity. Hypertensive disorders and anemia emerged as key modifiable correlates. Early postpartum surveillance, blood pressure control, treatment of anaemia, and risk-tailored thromboprophylaxis may reduce the burden of maternal stroke.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109237"},"PeriodicalIF":1.6,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145511981","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":"Short-term outcomes and hospitalization cost associated with flow diversion versus coil embolization for unruptured aneurysms: A national assessment","authors":"Jonathan Dallas ,&nbsp;Michelle Lin ,&nbsp;David J. Cote ,&nbsp;Anadjeet S. Khahera ,&nbsp;Li Ding ,&nbsp;Frank J. Attenello ,&nbsp;William J. Mack","doi":"10.1016/j.clineuro.2025.109236","DOIUrl":"10.1016/j.clineuro.2025.109236","url":null,"abstract":"<div><h3>Objective</h3><div>The use of flow diversion (FD) has rapidly increased over the last decade, particularly for treatment of complex aneurysms not amenable to conventional coil embolization (CE). We aimed to compare national outcomes and healthcare utilization associated with FD and CE of unruptured aneurysms.</div></div><div><h3>Methods</h3><div>The National Inpatient Sample (2019–2022) was used to identify patients with unruptured intracranial aneurysms who underwent CE or FD (patients undergoing both FD+CE were classified as FD). Pediatric patients, non-elective admissions, and patients with subarachnoid hemorrhage were excluded. Variables included sociodemographics (e.g., age, race, gender), hospital factors (e.g., size, ownership, teaching status, location), and basic clinical variables in bivariate and multivariable regression. Outcomes included in-hospital mortality, stroke, discharge disposition (favorable/unfavorable), length of stay, and total cost of hospitalization.</div></div><div><h3>Results</h3><div>7370 patients were identified, of which 4280 were CE and 3090 were FD. Given the elective nature of intervention, rates of mortality (0.19 %), unfavorable discharge disposition (2.77 %), and stroke (0.83 %) were low. On multivariable analysis, use of flow diversion was not associated with unfavorable discharge (OR 0.80, P = 0.211) or stroke (OR 0.91, P = 0.753). FD trended toward, but did not reach, statistical significance for elevated length of stay (IRR 1.04, P = 0.150); however, it did lead to a significantly higher overall cost (ß=$1260.98, P = 0.049)</div></div><div><h3>Conclusion</h3><div>Nationally, short-term outcomes are similar between FD and CE, although use of FD does imbue a mildly higher hospitalization cost. Further work is needed to characterize large-scale, long-term outcome differences, particularly as FD use increases for more complex aneurysms not amenable to CE.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109236"},"PeriodicalIF":1.6,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145479113","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":"2025-11-09","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":"From rodents to algorithms: The rise of virtual animals in drug development and neuroscience","authors":"Alireza Minagar,&nbsp;Mohammad Ali Sahraian","doi":"10.1016/j.clineuro.2025.109234","DOIUrl":"10.1016/j.clineuro.2025.109234","url":null,"abstract":"<div><div>Animal models have long been the foundation of biomedical research and experimentation. However, the utility of animal models in both research and preclinical testing of drugs has been challenged by the insufficiency and cost of such methods, including the fact that over 90 % of preclinically successful compounds ultimately fail in human trials, as well as concerns about irreproducibility, scalability, and ethics in animal studies; their limitations are increasingly recognized. Advances in artificial intelligence (AI) now offer a promising complementary approach through the creation of “virtual animals.” Recent examples include the U.S. Food and Drug Administration's AnimalGAN to predict toxicology outcomes in thousands of virtual rats, and Google DeepMind's virtual fruit fly, an anatomically accurate model that can reproduce locomotion and sensorimotor behavior. In these examples, AI systems may not replace, but rather support traditional experimentation, by increasing accuracy, reducing the number of animals needed for studies, and accelerating translational insight. Potential early applications in neurology and neurosurgery are just now emerging, such as neural-circuit simulation, prediction of neurotoxicity, and modeling of movement disorders. Legislative acts such as FDA Modernization Act 2.0, as well as European initiatives to implement the 3Rs, now include AI-based virtual testing as a possible evidentiary basis. Virtual organisms represent a potentially significant ethical and methodological shift that may influence the future of experimental neurology and drug development, while still upholding scientific rigor.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109234"},"PeriodicalIF":1.6,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145479114","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":"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}