Clinical Neurology and Neurosurgery最新文献

{"title":"The impact of hospital ownership on ischemic stroke outcomes: A National Inpatient Sample study","authors":"Dora R. Tabachnick ,&nbsp;Samuel A. Tenhoeve ,&nbsp;Clayton Rawson ,&nbsp;Deondra Montgomery ,&nbsp;Denise Baloi ,&nbsp;Michael Karsy","doi":"10.1016/j.clineuro.2025.109217","DOIUrl":"10.1016/j.clineuro.2025.109217","url":null,"abstract":"<div><h3>Objective</h3><div>Stroke remains a leading cause of morbidity and mortality in the United States, with hospital ownership potentially influencing patient outcomes. This study evaluated how government-owned (GO) versus private for-profit (PFP) hospitals affect the length of stay (LOS), in-hospital mortality, and discharge disposition of stroke patients.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used National Inpatient Sample (NIS) data from 2019 to 2021 to identify patients with ischemic stroke affecting the internal carotid, middle cerebral, vertebral, or basilar arteries. Patients were stratified by hospital ownership type and differences in clinical characteristics and outcomes, including LOS, mortality, and discharge disposition, were analyzed. Multivariable regression models assessed the impact of hospital ownership on outcomes, adjusting for age, race, NIH Stroke Scale (NIHSS), functional status, and socioeconomic factors.</div></div><div><h3>Results</h3><div>A total of 116,280 stroke patients were included, with 59,755 (51.4 %) treated at GO hospitals and 56,525 (48.6 %) PFP hospitals. Multivariate analysis revealed a protective effect of PFP hospitals on mortality rates (OR 0.70, 95 % CI: 0.65–0.75, <em>p</em> &lt; 0.001), and a shorter LOS (β = −0.33, 95 % CI: −0.47 to −0.19, <em>p</em> &lt; 0.001) when controlling for disease severity via the NIHSS. Further, PFP hospitals had higher odds of discharge to a non-home disposition (OR 1.11, 95 % CI: 1.06–1.16, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>PFP hospitals were associated with shorter LOS and lower mortality rates among stroke patients, but also with a decreased likelihood of discharge to home. After adjusting for disease severity, these disparities persisted. Further research is needed to explore the mechanisms underlying these disparities in patient outcomes based on hospital ownership.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109217"},"PeriodicalIF":1.6,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145413779","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":"Novel liquid-gas exchange technique to reduce postoperative pneumocephalus in chronic subdural hematoma","authors":"Li PingGen,&nbsp;X. Zheng,&nbsp;ZY Li,&nbsp;WJ Wu,&nbsp;WX Liu,&nbsp;GB Huang","doi":"10.1016/j.clineuro.2025.109216","DOIUrl":"10.1016/j.clineuro.2025.109216","url":null,"abstract":"<div><h3>Objective</h3><div>Postoperative pneumocephalus after burr hole drainage for chronic subdural hematoma (CSDH) may delay brain re-expansion and worsen prognosis. This study assessed the \"liquid–gas exchange\" technique’s value in reducing intracranial air and promoting early brain re-expansion.</div></div><div><h3>Method</h3><div>A retrospective analysis included 147 CSDH patients who underwent single burr hole drainage (Jan 2021–Jul 2025). They were divided by intraoperative air evacuation: new technique group (n = 66) and conventional group (n = 81). Baseline characteristics (gender, age, medical history, antiplatelet/anticoagulant use, hematoma volume, bilaterality) were comparable (all P &gt; 0.05). Surgical position, anesthesia type, postoperative pneumocephalus volume, symptomatic pneumocephalus, 1-week residual cavity volume, complications, and 3-month recurrence were compared.</div></div><div><h3>Result</h3><div>On postoperative day 1, pneumocephalus volume was lower in the new technique group (15.2 ± 8.1 mL vs. 32.5 ± 18.3 mL, P &lt; 0.001). Tension pneumocephalus occurred in 12 conventional group cases (none in the new group, P = 0.003). At 1 week, residual cavity volume was smaller in the new group (24.5 ± 12.8 mL vs. 45.2 ± 18.5 mL, P &lt; 0.001). Complications: 1 epilepsy case/group; no infections; 2 subdural bleeding cases (conventional group only, P = 0.643). At 3 months, 3 conventional group cases recurred (none in the new group, P = 0.115).</div></div><div><h3>Conclusion</h3><div>The \"liquid–gas exchange\" technique reduces postoperative pneumocephalus (especially symptomatic cases) and 1-week residual cavity volume, promoting early brain re-expansion and better prognosis, with high clinical value for wider use.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109216"},"PeriodicalIF":1.6,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400009","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":"Medication-overuse headache: Bridging therapies for detoxification","authors":"Benjamin R. Wakerley ,&nbsp;Prut Koonalintip","doi":"10.1016/j.clineuro.2025.109205","DOIUrl":"10.1016/j.clineuro.2025.109205","url":null,"abstract":"<div><div>Medication-overuse headache (MOH) or rebound headache is caused by frequent use of acute pain medications and often complicates chronic migraine. The exact cause for this association remains unknown but is likely to represent complex interplay between psychosocial factors, class of medication overused and the presence of polymorphic gene variants of pain pathways involved in migraine. The most important treatment strategy for MOH is withdrawal (also known as detoxification) of the overused acute medication, which has repeatedly been shown to achieve a significant reduction in monthly headache days at 8 weeks. Reducing or stopping acute medication, however, typically worsens pre-existing headache and depending on the class of medication overused, may also cause psychological and physical symptoms. Numerous ‘bridging’ therapies have been used to try and reduce the frequency and intensity of withdrawal headaches and the severity of accompanying symptoms to aid successful withdrawal. The aim of this narrative review was to examine the withdrawal process for different classes of acute medication and examine different pharmacological and non-pharmacological bridging therapies in MOH.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109205"},"PeriodicalIF":1.6,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145430490","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 and radiological outcomes of hypofractionated stereotactic radiotherapy for arteriovenous malformations: A retrospective analysis","authors":"Dan Laukka ,&nbsp;Lotta Niinikoski ,&nbsp;Jussi Hirvonen ,&nbsp;Riitta Rautio ,&nbsp;Tiia Rissanen ,&nbsp;Sami Suilamo ,&nbsp;Pauliina Wright ,&nbsp;Paula Lindholm ,&nbsp;Melissa Rahi ,&nbsp;Olli-Pekka Kämäräinen ,&nbsp;Ilkka Haapala ,&nbsp;Jaakko Rinne ,&nbsp;Ville Vuorinen","doi":"10.1016/j.clineuro.2025.109214","DOIUrl":"10.1016/j.clineuro.2025.109214","url":null,"abstract":"<div><h3>Background</h3><div>The long-term efficacy of hypofractionated stereotactic radiotherapy (HSRT) for complex arteriovenous malformations (AVMs) remains uncertain. This study aimed to evaluate clinical and radiological outcomes following HSRT for AVMs.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of 59 patients treated with stereotactic radiotherapy between 2003 and 2020 at a tertiary center. Thirty-seven patients who received HSRT were included. AVM volumes were independently assessed by two radiologists using MRI. Radiological follow-up was available in 36 patients, clinical follow-up in 37. Treatment failure was defined as re-bleeding, re-treatment, or death.</div></div><div><h3>Results</h3><div>Median radiological follow-up was 4.6 years (range, 0.7–17.2), and clinical follow-up was 5.0 years (range, 0–18.0). Total obliteration was observed in 28 % (10/36) and partial obliteration in 39 % (14/36). Median AVM volumes were 3.8 cc (IQR 2.5–11.5) for total obliteration, 23.6 cc (IQR 11.1–45.1) for partial, and 17.1 cc (IQR 6.9–35.0) for no response (p = 0.004). Median biological effective dose (BED) was 146.4 Gy (IQR 73.0–146.4) for total obliteration, 54.1 Gy (IQR 35.2–56.4) for partial, and 54.1 Gy (IQR 28.4–56.4) for no response (p = 0.003). Treatment failure rates were 11 %, 36 %, 56 %, and 78 % at 2, 5, 10, and 15 years, respectively. Re-bleeding occurred in 0 % with total obliteration, 36 % with partial, and 30 % with no response (p = 0.13).</div></div><div><h3>Conclusions</h3><div>HSRT provided limited long-term efficacy in complex AVMs, with a high rate of treatment failure. Smaller AVM volumes and higher BED were associated with better outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109214"},"PeriodicalIF":1.6,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145413781","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":"Impact of frailty on morbidity and mortality in traumatic blunt cerebrovascular injury","authors":"William J. Smith ,&nbsp;Paul Serrato ,&nbsp;Shaila D. Ghanekar ,&nbsp;Edwin Owolo ,&nbsp;Bushra Fathima ,&nbsp;Varun Padmanaban ,&nbsp;Andrew B. Koo ,&nbsp;Ganesh M. Shankar ,&nbsp;Christopher J. Stapleton ,&nbsp;James D. Rabinov ,&nbsp;Charles C. Matouk ,&nbsp;Aladine A. Elsamadicy ,&nbsp;Aman B. Patel ,&nbsp;Nanthiya Sujijantarat","doi":"10.1016/j.clineuro.2025.109208","DOIUrl":"10.1016/j.clineuro.2025.109208","url":null,"abstract":"<div><h3>Background</h3><div>Although frailty is a known predictor of poor outcomes in surgical and critical care populations, its impact in blunt cerebrovascular injury (BCVI) has not been rigorously investigated. Our study aimed to evaluate the effect of frailty, as measured by the five-item modified Frailty Index (mFI-5), on clinical outcomes in BCVI patients.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort analysis of adult BCVI patients captured in the American College of Surgeons (ACS) Trauma Quality Programs (TQP) national database from 2017 to 2023. Patients were categorized as non-frail (mFI-5 =0), pre-frail (mFI-5 =1), or frail (mFI-5 ≥2). Demographics, comorbidities, injury characteristics, and clinical outcomes were analyzed. Multivariate logistic regression with model refinement using the Bayesian Information Criterion was used to identify independent predictors of adverse events (AE), non-routine discharges (NRD), and in-hospital mortality.</div></div><div><h3>Results</h3><div>Among 44,898 BCVI patients, 12 % were classified as frail. Falls were the predominant mechanism of injury in frail BCVI patients (53 %), while motor vehicle trauma was more common in non-frail patients (72 %); frail BCVI patients also sustained lower severity injuries (p &lt; 0.001). Despite the more benign mechanism, frail patients had higher rates of AEs (Frail: 21 %; Non-frail: 18 %; Pre-frail: 18 %, p &lt; 0.001), NRD (Frail: 67 %; Non-frail: 55 %; Pre-frail: 59 %, p &lt; 0.001), and in-hospital mortality (Frail: 17 %; Non-frail: 15 %; Pre-frail: 13 %, p &lt; 0.001). Frailty was an independent predictor of AEs (aOR 1.51, 95 %CI 1.37–1.66), in-hospital mortality (aOR 1.34, 95 %CI 1.18–1.52), and NRD (aOR 1.42, 95 %CI 1.30–1.54).</div></div><div><h3>Conclusion</h3><div>Despite lower injury severity and more benign trauma mechanisms, frail BCVI patients experienced significantly worse outcomes compared to non-frail and pre-frail patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109208"},"PeriodicalIF":1.6,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145399969","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":"A systematic review of management strategies for post-craniotomy surgical site infections","authors":"Zekai Qiang,&nbsp;Matthew Myers,&nbsp;Toby Thomas,&nbsp;David Eagle,&nbsp;Ramez Ibrahim","doi":"10.1016/j.clineuro.2025.109212","DOIUrl":"10.1016/j.clineuro.2025.109212","url":null,"abstract":"<div><h3>Background</h3><div>Post-craniotomy surgical site infections (SSIs) represent a significant complication associated with substantial morbidity, mortality, and healthcare burden. The optimal management of in such clinical scenario remains controversial and varies among clinicians. This systematic review comprehensively evaluates current evidence for post-craniotomy SSI, including bone flap retention versus removal.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, Scopus, Web of Science, Medline, and Cochrane databases were systematically searched. Studies reporting outcomes of bone flap management following post-craniotomy SSIs were included. Data extraction encompassed patient demographics, surgical characteristics, infection details, management strategies, and clinical outcomes. Risk of bias in the included studies was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) criteria.</div></div><div><h3>Results</h3><div>Nineteen studies encompassing 485 patients met the inclusion criteria, predominantly comprising retrospective case series (n = 17) of low evidence quality. Five distinct management strategies were identified: (1) bone flap removal without immediate reconstruction (240 patients, 49.5 %); (2) bone flap removal with immediate titanium cranioplasty (86 patients, 17.7 %); (3) bone flap retention with debridement/sterilisation (38 patients, 7.8 %); (4) bone flap retention with antibiotic irrigation systems (25 patients, 5.2 %); and (5) adjunctive hyperbaric oxygen therapy (31 patients, 6.4 %). Bone flap removal demonstrated more favourable infection resolution rates (ranging from 75.3 % to 100 %) compared to bone flap retention (range 64.5–100 %) but necessitated subsequent cranioplasty. Retention strategies showed promise in selected cases but exhibited higher infective recurrence rates, particularly in the presence of gross purulence.</div></div><div><h3>Conclusions</h3><div>Current evidence demonstrates significant heterogeneity in post-craniotomy SSI</div><div>management without clear consensus on optimal approaches. Bone flap removal remains the preferred strategy and yields the most reliable outcomes in cases of gross purulence, deep infection, osteomyelitis, sinonasal or otologic contamination, prior retention failure, or infection by relapse-prone organisms. Bone flap retention with meticulous debridement and sterilisation is appropriate for localised infections with viable bone and healthy soft tissue, while immediate titanium cranioplasty may be considered if the flap is unsalvageable but the operative field is clean, and closure is tension-free. In compromised patients, staged removal is generally safer. Future work should prioritise prospective comparative studies with standardised outcome measures and external validation of risk-stratified management algorithms.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109212"},"PeriodicalIF":1.6,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145360584","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":"Cortical activation and postural instability according to dizziness severity: A functional near-infrared spectroscopy study","authors":"Sang Seok Yeo ,&nbsp;In Hee Cho","doi":"10.1016/j.clineuro.2025.109209","DOIUrl":"10.1016/j.clineuro.2025.109209","url":null,"abstract":"<div><h3>Purpose</h3><div>Dizziness is a common clinical symptom that negatively affects balance, spatial orientation, and quality of life. While peripheral vestibular dysfunction has been widely studied, the central cortical mechanisms underlying dizziness remain poorly understood. Increasing evidence suggests that dizziness severity may alter multisensory integration and cortical compensation strategies. Therefore, the study aimed to investigate how the severity of dizziness influences cortical activation and postural stability using functional near-infrared spectroscopy (fNIRS) and center of pressure analysis during a tandem stance task.</div></div><div><h3>Methods</h3><div>Sixteen adults were divided into mild (n = 8) and moderate-to-severe (n = 8) dizziness groups based on dizziness handicap inventory and vertigo symptom scale–short form scores. Participants performed a tandem stance task under alternating eyes-open and eyes-closed conditions while cortical hemodynamics were recorded using fNIRS and postural sway was assessed using a force platform.</div></div><div><h3>Results</h3><div>Compared to the mild group, the moderate-to-severe dizziness group showed significantly increased oxyhemoglobin concentrations in the bilateral superior parietal lobule and the left superior temporal gyrus, suggesting increased cortical activation during postural control. Moreover, under eyes-closed conditions, the moderate-to-severe group demonstrated significantly greater postural sway in terms of sway length, ellipse surface, anteroposterior displacement, and average speed.</div></div><div><h3>Conclusion</h3><div>These findings suggest that greater dizziness severity is associated with increased neural compensation and reduced balance stability, particularly in the absence of visual input. fNIRS may serve as a valuable tool to assess cortical mechanisms in individuals with vestibular dysfunction.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109209"},"PeriodicalIF":1.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145360065","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 efficacy and safety of dexmedetomidine as an adjuvant to local anaesthetics in scalp nerve blocks in patients undergoing craniotomy: A systematic review and meta-analysis of randomized controlled trials","authors":"Ashwini Reddy ,&nbsp;Prachi Sharma ,&nbsp;Shoban Babu Varthya ,&nbsp;Ravneet Kaur Gill ,&nbsp;Ananya Ray ,&nbsp;Rajeev Chauhan ,&nbsp;Ankur Luthra ,&nbsp;Narender Kaloria","doi":"10.1016/j.clineuro.2025.109211","DOIUrl":"10.1016/j.clineuro.2025.109211","url":null,"abstract":"<div><h3>Background</h3><div>Craniotomy involves noxious stimuli such as skull pinning and dissection, causing hemodynamic instability and significant postoperative pain. Scalp nerve block (SNB) helps attenuate these responses. Dexmedetomidine, a selective α2-agonist, is effective as a perineural adjuvant in other blocks, but its role in SNB for craniotomy remains unclear. We evaluated its efficacy and safety as an SNB adjuvant in elective craniotomy.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing SNB with local anesthetic plus dexmedetomidine versus controls was conducted. Primary outcomes were hemodynamic response to perioperative noxious stimuli and postoperative pain scores; secondary outcomes were intraoperative opioid use, rescue analgesia, and adverse events. Data synthesis used RevMan 5.4; risk of bias was assessed with RoB 2.0 and certainty with GRADE.</div></div><div><h3>Results</h3><div>Seven RCTs (n = 528) were included. Dexmedetomidine significantly reduced heart rate (MD –8.1 bpm) and mean arterial pressure (MD –8.5 mmHg) at pin fixation, lowered pain scores at 24 h (SMD –0.31) and 48 h (SMD –0.35), prolonged time to first rescue analgesia by 215 min, and decreased intraoperative fentanyl (SMD –1.02) and rescue tramadol use (SMD –0.92). No serious adverse events were reported. Certainty of evidence was low to very low due to risk of bias, heterogeneity, and imprecision.</div></div><div><h3>Conclusion</h3><div>Dexmedetomidine as an SNB adjuvant may improve perioperative hemodynamic stability and postoperative analgesia in craniotomy. However, given the overall low certainty of evidence and methodological limitations of existing RCTs, these findings should be interpreted cautiously. Larger, high-quality multicenter trials are needed to confirm efficacy and establish optimal dosing.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109211"},"PeriodicalIF":1.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145360063","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":"Decompressive craniectomy following traumatic brain injury in pediatric patients: An aggregative and individual patient data meta-analysis","authors":"Anant Naik ,&nbsp;Cesar Ramirez ,&nbsp;Brandon Hoglund ,&nbsp;Ankitha Iyer ,&nbsp;Umaru Barrie ,&nbsp;Carolina Sandoval-Garcia ,&nbsp;Andrew S. Venteicher ,&nbsp;Daniel Guillaume ,&nbsp;Paul M. Arnold","doi":"10.1016/j.clineuro.2025.109210","DOIUrl":"10.1016/j.clineuro.2025.109210","url":null,"abstract":"<div><h3>Objective</h3><div>Traumatic brain injury (TBI) in pediatric patients is associated with significant mortality. Management ranges from conservative treatment to decompressive craniectomy (DC). Current guidelines weakly recommend DC in pediatric patients experiencing neurologic deterioration, herniation, or refractory intracranial hypertension. There are significant deficits in the literature regarding the benefits and optimal timing of DC for pediatric TBI. The objective of this review is to address these gaps via the largest meta-analysis on this subject to date.</div></div><div><h3>Methods</h3><div>Several electronic databases were searched for articles investigating the utility of DC for patients under 18 years of age suffering from TBI. The primary outcome measures evaluated included in-hospital mortality and Glasgow Outcomes Scale (GOS) scores. Risk of bias was assessed using the Newcastle-Ottawa Scale and Egger’s test. Fixed- or random-effects models were employed based on study heterogeneity. A meta-regression was performed for the pooled main effect.</div></div><div><h3>Results</h3><div>39 studies with 1332 patients were included for aggregate meta-analysis. No significant difference in mortality or GOS between patients managed with DC versus medical management was observed in this cohort. The results of the multivariable meta-regression in this cohort demonstrated younger age and midline shift greater than 5 mm (MLS) were associated with increased mortality. Intraparenchymal hemorrhage, subarachnoid hemorrhage, high ICP at presentation, delayed DC &gt; 5 days, and unilateral DC were associated with unfavorable neurological outcomes.</div></div><div><h3>Conclusion</h3><div>No significant difference in outcomes was identified between DC versus medical management for severe TBI. Several patient factors were identified that are significantly associated with unfavorable outcomes after DC.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109210"},"PeriodicalIF":1.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145360581","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":"Leukoencephalopathy with primary familial brain calcification: A rare phenotype associated with a novel SLC20A2 frameshift","authors":"Akihiko Kudo,&nbsp;Hiroaki Yaguchi,&nbsp;Taichi Nomura,&nbsp;Hisashi Uwatoko,&nbsp;Shinichi Shirai,&nbsp;Ikuko Takahashi-Iwata,&nbsp;Masaaki Matsushima,&nbsp;Takahiro Yamada,&nbsp;Ichiro Yabe","doi":"10.1016/j.clineuro.2025.109207","DOIUrl":"10.1016/j.clineuro.2025.109207","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"259 ","pages":"Article 109207"},"PeriodicalIF":1.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400014","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}