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Haemorrhage pattern and clinical outcomes after angiogram negative subarachnoid haemorrhage: a systematic review and meta analysis 血管造影阴性蛛网膜下腔出血后的出血模式和临床结果:系统回顾和荟萃分析
IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-05-01 Epub Date: 2026-02-12 DOI: 10.1016/j.jocn.2026.111930
Thenul Munasinghe , Hashni Senanayake , Samiha Arulshankar , Lee-Anne Slater , Leon Lai

Background

Angiogram-negative subarachnoid haemorrhage accounts for approximately 15% of spontaneous subarachnoid haemorrhage, yet surveillance practices and the role of repeat vascular imaging remain inconsistent. The extent to which haemorrhage pattern predicts clinical complications and delayed vascular lesion detection is uncertain.

Methods

We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. Studies reporting clinical outcomes in angiogram-negative subarachnoid haemorrhage were included. Outcomes were pooled using random-effects generalised linear mixed models and stratified by haemorrhage pattern, including perimesencephalic, non-perimesencephalic, diffuse, and convexity haemorrhage.

Results

Sixty-seven studies comprising 5,921 patients were included. Favourable functional outcome at 3–6 months occurred in 95–97% of patients across all haemorrhage patterns. Rebleeding was uncommon, occurring in 1% of perimesencephalic, 2% of non-perimesencephalic, and 3% of diffuse haemorrhage. Clinical vasospasm occurred in 3%, 11%, and 13%, respectively, while acute hydrocephalus requiring external ventricular drainage occurred in 7%, 29%, and 44%. Among studies reporting repeat vascular imaging, 82 vascular lesions were identified, predominantly in non-perimesencephalic haemorrhage. No lesions were detected on imaging performed within 7 days of ictus; all reported lesions were identified at or beyond 7 days, although repeat imaging was selectively performed and timing varied across studies.

Conclusion

Angiogram-negative subarachnoid haemorrhage is clinically heterogeneous. Haemorrhage pattern is associated with distinct complication profiles and differential observed yields of delayed vascular lesion detection, and may assist in individualising surveillance strategies. Prospective studies are required to define optimal imaging intervals.
背景:造影阴性的蛛网膜下腔出血约占自发性蛛网膜下腔出血的15%,但监测方法和重复血管成像的作用仍然不一致。出血模式预测临床并发症和延迟血管病变检测的程度是不确定的。方法按照PRISMA指南进行系统评价和荟萃分析。研究报告了血管造影阴性的蛛网膜下腔出血的临床结果。采用随机效应广义线性混合模型对结果进行汇总,并按出血类型分层,包括脑膜周围出血、非脑膜周围出血、弥漫性出血和凸性出血。结果纳入67项研究,5921例患者。在所有出血类型的患者中,95% - 97%的患者在3-6个月时出现了良好的功能结局。再出血不常见,发生在1%的脑周围出血,2%的非脑周围出血,3%的弥漫性出血。临床血管痉挛发生率分别为3%、11%和13%,急性脑积水需要脑室外引流的发生率分别为7%、29%和44%。在报告重复血管成像的研究中,发现了82个血管病变,主要是非脑周出血。ictus后7天内影像学未发现病变;所有报告的病变都是在7天或7天以上发现的,尽管有选择性地进行了重复成像,并且不同研究的时间不同。结论血管造影阴性的蛛网膜下腔出血具有临床异质性。出血模式与不同的并发症和延迟血管病变检测的不同观察结果有关,并可能有助于个体化监测策略。需要前瞻性研究来确定最佳的成像间隔。
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引用次数: 0
Contemporary burden of subarachnoid hemorrhage: a comparative assessment of global and Asian trend 当代蛛网膜下腔出血的负担:全球和亚洲趋势的比较评估
IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-05-01 Epub Date: 2026-02-12 DOI: 10.1016/j.jocn.2026.111907
Xiaowei Luo, Wenjia Ma, Jiarong He, Qingsheng Yang, Zhuo Wang, Cheng Liang, Mingming Zhang

Objective

To analyze the trends in the global and Asian burden of subarachnoid hemorrhage (SAH) from 1990 to 2021, explore its influencing factors, assess its relationship with sociodemographic development, analyze health inequalities, and predict future trends.

Methods

Epidemiological data on SAH from 1990 to 2021 were obtained from the Global Burden of Disease (GBD) database. Prevalence, disability-adjusted life years (DALYs), and other indicators were calculated. Joinpoint regression, age-period-cohort analysis, and decomposition analysis were used to investigate trends and influencing factors. Data envelopment analysis was employed to evaluate the relationship between SAH and the socio-demographic index (SDI). The slope index of inequality (SII) and concentration index (CI) were used to analyze health inequalities. The Bayesian age-period-cohort model was utilized to predict prevalence from 2022 to 2036.

Results

In 2021, the global and Asian age-standardized prevalence of SAH was 92.169/100,000 and 90.158/100,000, respectively. Joinpoint regression showed a decreasing trend in both global and Asian prevalence, with a slowing decline in recent years. The risk of SAH exhibited significant age, period, and cohort effects. Decomposition analysis indicated that population growth and aging were the main drivers of increased prevalence globally and in Asia. Data envelopment analysis revealed a nonlinear relationship between SAH and SDI. SII and CI analyses showed a trend of increasing health inequalities globally and in Asia. Bayesian predictions indicated that the prevalence would continue to decline globally and in Asia from 2022 to 2036, but at a slower rate.

Conclusion

Although the global and Asian burden of SAH showed a declining trend over the past 30 years, challenges such as population aging and increasing health inequalities persist. Future prevention and control strategies should focus on population effects and regional heterogeneity while strengthening interventions for high-risk populations.
目的分析1990 - 2021年全球及亚洲地区蛛网膜下腔出血(SAH)负担变化趋势,探讨其影响因素,评价其与社会人口发展的关系,分析健康不平等现象,并预测未来趋势。方法从全球疾病负担(GBD)数据库获取1990 - 2021年SAH的流行病学数据。计算患病率、残疾调整生命年(DALYs)和其他指标。采用结合点回归、年龄-时期-队列分析和分解分析探讨其趋势和影响因素。采用数据包络分析评估SAH与社会人口指数(SDI)之间的关系。采用不平等斜率指数(SII)和浓度指数(CI)分析健康不平等。贝叶斯年龄-时期-队列模型用于预测2022年至2036年的患病率。结果2021年,全球和亚洲SAH年龄标准化患病率分别为92.169/10万和90.158/10万。全球和亚洲地区的接点回归均呈下降趋势,近年来下降趋势趋缓。SAH的风险表现出显著的年龄、时期和队列效应。分解分析表明,人口增长和老龄化是全球和亚洲患病率上升的主要驱动因素。数据包络分析显示SAH与SDI之间存在非线性关系。SII和CI分析显示,全球和亚洲的卫生不平等现象呈增加趋势。贝叶斯预测表明,从2022年到2036年,全球和亚洲的患病率将继续下降,但速度较慢。结论尽管全球和亚洲的SAH负担在过去30年呈下降趋势,但人口老龄化和健康不平等加剧等挑战仍然存在。未来的预防和控制战略应侧重于人口效应和区域异质性,同时加强对高危人群的干预。
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引用次数: 0
Cisternal segment trochlear nerve schwannoma 池段滑车神经鞘瘤。
IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-05-01 Epub Date: 2026-02-07 DOI: 10.1016/j.jocn.2026.111904
Jinxing Lin , Hailiang Tang , Jian Xu
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引用次数: 0
Advancing access to emergency care for traumatic brain injuries in Indonesia: a national program integrating task-sharing and simulation technologies 促进印度尼西亚获得创伤性脑损伤紧急护理:一项整合任务分担和模拟技术的国家方案。
IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-05-01 Epub Date: 2026-02-09 DOI: 10.1016/j.jocn.2026.111906
Bryan Gervais de Liyis , Francisco Rivera , Muhammad Kusdiansah , Cyrus Elahi , Affan Priyambodo Permana , I Wayan Niryana , Wiryawan Manusubroto , Eko Prasetyo , Sri Maliawan , Asra Al Fauzi , Arnau Benet , Gail Rosseau
Severe shortages and geographic maldistribution of neurosurgeons continue to limit timely access to life-saving neurosurgical care in low- and middle-income countries, with Indonesia representing a particularly acute example due to its archipelagic geography, prolonged transfer times, and rising burden of traumatic brain injury and stroke. To address delays in emergency care in districts without neurosurgical coverage, Indonesia has launched a nationally endorsed neurosurgical task-sharing initiative in which selected general surgeons are trained to perform a restricted set of emergency cranial procedures under continuous neurosurgical oversight. This article describes the rationale, regulatory framework, and educational design of this national pilot program, initiated in late 2025. Developed collaboratively by the Ministry of Health, the Indonesian College of Neurosurgeons, and the Indonesian College of Surgeons, the program integrates formal ministerial authorization, defined eligibility criteria for hospitals and surgeons, and a three-phase competency-based training pathway. Training includes simulation-based education using virtual reality and locally produced three-dimensional printed cranial models, intensive supervised operative experience at accredited neurosurgical centers, and real-time tele-proctored emergency surgery in district hospitals. The operative scope is deliberately limited to decompressive craniotomy for epidural and subdural hematomas and decompressive craniectomy for selected hemorrhagic and non-hemorrhagic stroke. As implementation has only recently begun, clinical outcome data are not yet available. This manuscript is a descriptive account of one nation’s plan to address limitations in access to care for common, life-threatening neurosurgical conditions.
Future studies will describe governance, competency assessment, and prospective outcome monitoring of this novel program.
在低收入和中等收入国家,神经外科医生的严重短缺和地理分布不均继续限制及时获得挽救生命的神经外科护理,印度尼西亚是一个特别突出的例子,因为它的群岛地理位置,转诊时间延长,创伤性脑损伤和中风的负担不断增加。为了解决在没有神经外科手术覆盖的地区急诊护理的延误问题,印度尼西亚发起了一项全国认可的神经外科任务分担倡议,其中对选定的普通外科医生进行培训,使其在神经外科的持续监督下执行一套有限的紧急颅脑手术。本文描述了这一国家试点计划的基本原理、监管框架和教育设计,该计划于2025年底启动。该方案由卫生部、印度尼西亚神经外科学院和印度尼西亚外科学院合作制定,整合了正式的部级授权、医院和外科医生的明确资格标准,以及基于能力的三阶段培训途径。培训包括使用虚拟现实和当地生产的三维打印颅骨模型的模拟教育,在认可的神经外科中心进行强化监督手术经验,以及在地区医院进行实时远程监督急诊手术。手术范围限于硬膜外和硬膜下血肿的减压开颅术,以及选择性出血性和非出血性中风的减压开颅术。由于最近才开始实施,尚未获得临床结果数据。这份手稿描述了一个国家的计划,以解决常见的、危及生命的神经外科疾病获得护理的限制。未来的研究将描述这个新项目的治理、能力评估和预期结果监测。
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引用次数: 0
Real-time intraoperative depth estimation in transsphenoidal surgery using deep learning: A feasibility study 应用深度学习进行蝶窦手术术中实时深度估计的可行性研究
IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-05-01 Epub Date: 2026-02-14 DOI: 10.1016/j.jocn.2026.111910
Olivier Zanier , Aron Alakmeh , Raffaele Da Mutten , Alessandro Carretta , Matteo Zoli , Diego Mazzatenta , Carlo Serra , Luca Regli , Victor E. Staartjes

Purpose

Endoscopic endonasal and transcranial approaches are used for the resection of various pathological lesions in neurosurgery, especially pituitary adenomas, craniopharyngiomas, chordomas, or meningiomas. The video feed provided by endoscopes is generally two-dimensional, which can hinder depth perception. Thus, generating three-dimensional imaging without the need for special endoscopes using deep learning might be beneficial for enhanced intraoperative orientation.

Methods

DINOv2 is a pre-trained deep-learning model published by Meta in 2023. One of its capabilities is to estimate the depth in two-dimensional images. In this study, we explore the application of DINOv2 to the video feed of eight transsphenoidal endonasal surgeries. The results were evaluated for quality by both a senior neurosurgeon and a resident neurosurgeon. Furthermore, depth estimations from a randomly selected subset of 488 images taken from the videos were semi-quantitatively compared against manual segmentations for the estimation of deep, intermediate, and superficial areas.

Results

Using DINOv2, numeric depth maps were generated, and colormaps were created for depth visualization. Although these colormaps were not perfect, they aligned well with the subjective assessment of depth in the video feed by a senior neurosurgeon as well as a resident neurosurgeon. Semi-quantitative validation of the model’s estimations yielded a mean overall DICE Similarity Index of 0.48. These semi-quantitative results should be interpreted with caution, as the cutoffs used for model depth predictions and manual segmentation are not standardized.

Conclusions

Through the application of DINOv2, we were able to estimate depth in endoscopic imaging from transsphenoidal endonasal surgeries by generating numeric maps and depth colormaps. This illustrates the potential of deep learning-based depth estimations, which in the future could contribute to improving intraoperative orientation. It also highlights the opportunities in using artificial intelligence to augment endoscopic video feeds.
目的内镜下经鼻和经颅入路用于神经外科各种病理病变的切除,尤其是垂体腺瘤、颅咽管瘤、脊索瘤和脑膜瘤。内窥镜提供的视频馈送通常是二维的,这可能会阻碍深度感知。因此,无需特殊内窥镜而使用深度学习生成三维成像可能有助于增强术中定位。方法dinov2是Meta在2023年发表的预训练深度学习模型。它的功能之一是估计二维图像的深度。在本研究中,我们探讨了DINOv2在8例经蝶窦内鼻手术视频馈送中的应用。结果由高级神经外科医生和住院神经外科医生对质量进行评估。此外,从视频中随机选择的488张图像子集的深度估计与人工分割的深度,中间和表面区域的估计进行了半定量比较。结果使用DINOv2生成数值深度图,并创建颜色图进行深度可视化。尽管这些颜色图并不完美,但它们与资深神经外科医生和住院神经外科医生对视频中深度的主观评估非常吻合。模型估计的半定量验证产生了0.48的平均总体DICE相似指数。这些半定量的结果应该谨慎解释,因为用于模型深度预测和人工分割的截止值是不标准化的。结论通过应用DINOv2,我们能够通过生成数值图和深度颜色图来估计经蝶窦内鼻手术的内镜成像深度。这说明了基于深度学习的深度估计的潜力,这在未来可能有助于改善术中定位。它还强调了使用人工智能来增强内窥镜视频馈送的机会。
{"title":"Real-time intraoperative depth estimation in transsphenoidal surgery using deep learning: A feasibility study","authors":"Olivier Zanier ,&nbsp;Aron Alakmeh ,&nbsp;Raffaele Da Mutten ,&nbsp;Alessandro Carretta ,&nbsp;Matteo Zoli ,&nbsp;Diego Mazzatenta ,&nbsp;Carlo Serra ,&nbsp;Luca Regli ,&nbsp;Victor E. Staartjes","doi":"10.1016/j.jocn.2026.111910","DOIUrl":"10.1016/j.jocn.2026.111910","url":null,"abstract":"<div><h3>Purpose</h3><div>Endoscopic endonasal and transcranial approaches are used for the resection of various pathological lesions in neurosurgery, especially pituitary adenomas, craniopharyngiomas, chordomas, or meningiomas. The video feed provided by endoscopes is generally two-dimensional, which can hinder depth perception. Thus, generating three-dimensional imaging without the need for special endoscopes using deep learning might be beneficial for enhanced intraoperative orientation.</div></div><div><h3>Methods</h3><div>DINOv2 is a pre-trained deep-learning model published by Meta in 2023. One of its capabilities is to estimate the depth in two-dimensional images. In this study, we explore the application of DINOv2 to the video feed of eight transsphenoidal endonasal surgeries. The results were evaluated for quality by both a senior neurosurgeon and a resident neurosurgeon. Furthermore, depth estimations from a randomly selected subset of 488 images taken from the videos were semi-quantitatively compared against manual segmentations for the estimation of deep, intermediate, and superficial areas.</div></div><div><h3>Results</h3><div>Using DINOv2, numeric depth maps were generated, and colormaps were created for depth visualization. Although these colormaps were not perfect, they aligned well with the subjective assessment of depth in the video feed by a senior neurosurgeon as well as a resident neurosurgeon. Semi-quantitative validation of the model’s estimations yielded a mean overall DICE Similarity Index of 0.48. These semi-quantitative results should be interpreted with caution, as the cutoffs used for model depth predictions and manual segmentation are not standardized.</div></div><div><h3>Conclusions</h3><div>Through the application of DINOv2, we were able to estimate depth in endoscopic imaging from transsphenoidal endonasal surgeries by generating numeric maps and depth colormaps. This illustrates the potential of deep learning-based depth estimations, which in the future could contribute to improving intraoperative orientation. It also highlights the opportunities in using artificial intelligence to augment endoscopic video feeds.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111910"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172540","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}
引用次数: 0
Microsurgical resection of brain arteriovenous malformations with or without preoperative embolization: a 10 year observational cohort study 术前或不术前栓塞的脑动静脉畸形显微外科切除术:一项10年观察队列研究
IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-05-01 Epub Date: 2026-02-13 DOI: 10.1016/j.jocn.2026.111911
Cyrus Raki , Samiha Arulshankar , Makar Kiselnikov , Chris Xenos , Leon Lai
<div><h3>Objectives</h3><div>The role of preoperative embolization as an adjunct to microsurgical resection of brain arteriovenous malformations (AVMs) remains uncertain. We evaluated clinical and angiographic outcomes of microsurgical resection performed with or without preoperative embolization and examined factors associated with selection for embolization.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational cohort study of consecutive patients undergoing microsurgical resection of AVMs at a tertiary centre between July 2015 and June 2025. Patients treated with microsurgery alone or with preoperative embolization were included. Baseline differences were addressed using propensity score methods, including 1:3 matching and inverse probability of treatment weighting. The primary outcome was treatment related morbidity at 90 days, defined as an increase of at least 1 point on the modified Rankin Scale (mRS). Secondary outcomes included functional dependence (mRS greater than 2), postoperative haemorrhage, parenchymal infarction, angiographic obliteration, operative duration and composite outcome of mRS deterioration of at least 2 points or death at 90 days. Factors associated with embolization use were evaluated with Firth penalized logistic regression, and discriminative performance of AVM size was assessed using receiver operating characteristic analysis.</div></div><div><h3>Results</h3><div>Among 104 patients, 91 (87.5%) underwent microsurgical resection alone and 13 (12.5%) underwent preoperative embolization followed by microsurgery. Embolized AVMs were larger (mean 3.8 vs 2.5 cm), more frequently demonstrated deep perforator supply, and were of higher Spetzler-Martin grade. After propensity score adjustment, no clear differences were observed in treatment related morbidity at 90 days (risk difference + 23.1%, 95% CI − 3.3 to 51.9), functional dependence (risk difference + 20.5%, 95% CI − 8.5 to 49.7), the composite outcome of mRS deterioration of at least 2 points or death, or mortality. AVM size was independently associated with embolization use (odds ratio 1.77 per cm increase), with moderate discriminative performance (AUC 0.76). A 3 cm threshold demonstrated the strongest association with embolization selection.</div></div><div><h3>Conclusion</h3><div>In this single centre observational cohort, microsurgical resection with or without preoperative embolization was associated with similar short term functional and angiographic outcomes after adjustment for baseline differences, although estimates were imprecise. AVM size was the primary factor associated with selection for embolization, but this did not correspond to a demonstrable outcome advantage. These findings reflect contemporary practice patterns and underscore the need for prospective multicentre studies to clarify whether embolization confers incremental benefit in selected patients.</div><div>Abbreviations: AVM, arteriovenous malformation; mRS, modifie
目的术前栓塞作为脑动静脉畸形(AVMs)显微手术切除辅助手段的作用尚不明确。我们评估了术前有或没有栓塞的显微外科切除术的临床和血管造影结果,并检查了与栓塞选择相关的因素。方法对2015年7月至2025年6月在某三级中心连续接受显微手术切除动静脉畸形的患者进行回顾性观察队列研究。包括单独显微手术或术前栓塞治疗的患者。使用倾向评分方法解决基线差异,包括1:3匹配和逆概率处理加权。主要终点是90天的治疗相关发病率,定义为在改良Rankin量表(mRS)上增加至少1点。次要结局包括功能依赖(mRS大于2)、术后出血、实质梗死、血管造影闭塞、手术时间和mRS恶化至少2分或90天死亡的综合结局。使用Firth惩罚逻辑回归评估与栓塞使用相关的因素,并使用受试者操作特征分析评估AVM大小的判别性能。结果104例患者中,单纯行显微手术切除91例(87.5%),术前栓塞后行显微手术13例(12.5%)。栓塞的avm更大(平均3.8 cm vs 2.5 cm),更频繁地显示深穿孔供应,并且更高的Spetzler-Martin分级。倾向评分调整后,90天治疗相关发病率(风险差异+ 23.1%,95% CI−3.3至51.9)、功能依赖(风险差异+ 20.5%,95% CI−8.5至49.7)、mRS恶化至少2分或死亡的综合结局或死亡率均无明显差异。AVM大小与栓塞使用独立相关(优势比为1.77 / cm),具有中等判别性能(AUC为0.76)。3cm阈值与栓塞选择的相关性最强。结论:在这个单中心观察队列中,在调整基线差异后,显微手术切除术前或不术前栓塞与相似的短期功能和血管造影结果相关,尽管估计不精确。AVM的大小是与栓塞选择相关的主要因素,但这并不对应于一个明显的结果优势。这些发现反映了当代的实践模式,并强调了前瞻性多中心研究的必要性,以澄清栓塞是否能在选定的患者中带来增量益处。缩写:AVM,动静脉畸形;mRS,改良Rankin量表;CI,置信区间;AUC:曲线下面积;mFI-5,修正的5项脆弱指数;SM, Spetzler-Martin;Supp-SM,补充斯佩茨勒-马丁。
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引用次数: 0
High flow, at a higher cost? A pilot study comparing direct vs. indirect bypass for Moyamoya disease using time-driven activity-based costing 高流量,高成本?一项使用时间驱动的基于活动成本法比较烟雾病直接与间接旁路治疗的试点研究。
IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-05-01 Epub Date: 2026-02-11 DOI: 10.1016/j.jocn.2026.111929
Advith Sarikonda , Danyal Quraishi , Arbaz Momin , Matthews Lan , Ashmal Sami Kabani , Semihan Adegbite , D.Mitchell Self , Stavropoula Tjoumakaris , M.Reid Gooch , Pascal Jabbour , Ahilan Sivaganesan

Background and objective

In the management of adult moyamoya disease (MMD), there is clinical equipoise regarding direct bypass (DB) vs indirect bypass (IB). One factor that may influence the choice of procedure is cost. Therefore, we sought to compare the true intraoperative costs (not charges or reimbursement) of DB vs. IB using a novel costing methodology, time-driven activity-based costing (TDABC).

Methods

A retrospective cohort study (2017–22) was conducted of all patients undergoing revascularization for symptomatic MMD. TDABC was used to calculate intraoperative costs. Supply cost was calculated as the aggregate of expenses related to implants, consumables, medications, and surgical tray sterilization. Personnel cost was determined by multiplying the per-minute wages of all intraoperative personnel by the amount of time they spent intraoperatively. Software was developed to automate this data from the electronic medical record. Multivariable regression was performed to compare the costs of DB vs. IB, adjusting for age, smoking status, hypertension, and coronary artery disease.

Results

Of 38 patients undergoing revascularization for MMD, 22 (57.9%) underwent DB, while 16 (42.1%) underwent IB. The median total cost of DB surgery was $7,802 (IQR: $7,802 − $9,881), compared to $6,120 (IQR: $5,609 − $6,900)for IB surgery (p < 0.05). On descriptive analysis, DB also had higher median supply cost ($3,793 vs. $2,855, p < 0.01), which was driven by higher cost of consumables ($2,268 vs. $1,996, p < 0.01), surgical tray sterilization ($137 vs. $129, p < 0.01), and implants ($1,022 vs. $568, p < 0.05). On multivariable analysis, DB was associated with significantly higher total cost (β:$1,758±$768, p = 0.027) and supply cost (β:$1,032±$333, p = 0.004), with no significant differences in personnel cost (β:$726±$526,p = 0.175).

Conclusions

Using granular costing methodology, we demonstrate the individual drivers of cost which are responsible for differences in expenditures between DB and IB. This framework may inform surgical decision-making, guide institutional budgeting, and optimize resource allocation for the treatment of MMD.
背景和目的:在成人烟雾病(MMD)的治疗中,直接旁路治疗(DB)和间接旁路治疗(IB)在临床上是一致的。可能影响手术选择的一个因素是成本。因此,我们试图使用一种新颖的成本计算方法,即时间驱动的基于作业的成本计算(TDABC)来比较DB与IB的真实术中成本(不是费用或报销)。方法:回顾性队列研究(2017-22)对所有因症状性烟雾病接受血运重建术的患者进行研究。TDABC计算术中成本。供应成本计算为与植入物、耗材、药物和手术托盘消毒有关的费用的总和。人员成本由所有术中人员的每分钟工资乘以他们在术中花费的时间来确定。开发了软件来自动处理电子病历中的数据。在调整年龄、吸烟状况、高血压和冠状动脉疾病等因素后,采用多变量回归比较DB和IB的成本。结果:在38例接受MMD血运重建术的患者中,22例(57.9%)接受了DB手术,16例(42.1%)接受了IB手术。DB手术的中位总成本为7802美元(IQR: 7802 - 9881美元),而IB手术的中位总成本为6120美元(IQR: 5609 - 6900美元)。使用颗粒成本计算方法,我们展示了导致DB和IB之间支出差异的单个成本驱动因素。该框架可以为手术决策提供信息,指导机构预算编制,并优化烟雾病治疗的资源分配。
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引用次数: 0
Headache resolution following middle meningeal artery embolization in chronic subdural hematoma patients 慢性硬膜下血肿患者脑膜中动脉栓塞后头痛缓解
IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-05-01 Epub Date: 2026-02-05 DOI: 10.1016/j.jocn.2026.111898
James Feghali , Jiwon Moon , Crystal X. Wang , Sumil Nair , Alice Hung , Oishika Das , Xihang Wang , Christopher M. Jackson , Justin M. Caplan , Judy Huang , Rafael J. Tamargo , L. Fernando Gonzalez , Christina R. Graley , Risheng Xu
Headache is a common but underrecognized symptom in patients with chronic subdural hematoma (cSDH). Middle meningeal artery embolization (MMAe) has emerged as a minimally invasive treatment for cSDH, but its impact on headache remains unclear. We conducted a retrospective cohort study of cSDH patients presenting with headache who underwent MMAe between July 2019 and June 2025, excluding those with prior surgical intervention, ventricular shunts, or Glasgow Coma Scale < 14. Clinical, imaging, and procedural data were collected, including headache status 2–6 weeks post-procedure. Of 135 patients who underwent MMAe, 78 (58%) presented with headaches, and 30 met inclusion criteria. Twenty-one (70%) reported complete headache resolution, and 6 of 9 remaining patients (67%) reported improvement, resulting in a combined resolution or improvement rate of 90% (77–99%, p < 0.001). No procedural complications occurred. Headache outcomes were not significantly associated with baseline demographics, clinical variables, or follow-up hematoma characteristics, including resolution (p = 0.999), thickness (p = 0.758), or midline shift (p = 0.318). These findings indicate that MMAe is associated with significant short-term headache improvement in cSDH patients, independent of hematoma size or mass effect. This supports further investigation into MMAe’s potential role in managing both secondary headaches from cSDH and primary headache syndromes.
头痛是慢性硬膜下血肿(cSDH)患者常见但未被充分认识的症状。脑膜中动脉栓塞术(MMAe)已成为cSDH的一种微创治疗方法,但其对头痛的影响尚不清楚。我们对2019年7月至2025年6月期间接受MMAe治疗的头痛cSDH患者进行了一项回顾性队列研究,排除了既往手术干预、心室分流或格拉斯哥昏迷量表的患者14。收集临床、影像学和手术资料,包括手术后2-6周的头痛状况。在135例接受MMAe的患者中,78例(58%)出现头痛,30例符合纳入标准。21例(70%)报告头痛完全缓解,其余9例患者中6例(67%)报告头痛改善,合并缓解或改善率为90% (77-99%,p < 0.001)。无手术并发症发生。头痛结局与基线人口统计学、临床变量或随访血肿特征(包括分辨率(p = 0.999)、厚度(p = 0.758)或中线移位(p = 0.318)无显著相关性。这些发现表明MMAe与cSDH患者的短期头痛改善相关,与血肿大小或肿块效应无关。这支持进一步研究MMAe在管理cSDH继发性头痛和原发性头痛综合征中的潜在作用。
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引用次数: 0
Trends in lumbar degenerative spine pathologies causing severe pain and disability: a four-decade cohort study of 1495 Colombian women 腰椎退行性脊柱病变导致严重疼痛和残疾的趋势:1495名哥伦比亚妇女的40年队列研究
IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-05-01 Epub Date: 2026-02-13 DOI: 10.1016/j.jocn.2026.111939
Carolina Ramírez Martínez , Viviana Marcela Plazas Bedoya , Angie Tatiana Romero Miranda , Jorge Felipe Ramírez León , José Gabriel Rugeles Ortiz , Nicolás Prada Ramírez , Gabriel Oswaldo Alonso Cuéllar

Study design

Retrospective Cohort Study.

Objectives

This study aimed to analyze trends in the frequency of degenerative lumbar spine pathologies in a large Colombian women cohort and their relationship with age, comorbidities, and the degree of functional limitation and pain intensity.

Materials and methods

This is a 4-decade retrospective study analyzing the clinical records of a cohort of Colombian women who sought consultation for lumbar pain at a specialized spine pathology management center. Demographic variables, comorbidities, and pain and disability scales were analyzed.

Results

A cohort of 1495 women who presented with lumbar pain between 1993 and 2024 was analyzed. The most frequent pathology over the decades was degenerative disc disease. The diagnosis of facet osteoarthritis increased significantly, from < 1% in decade 1 (1993–1999) to > 30% in decade 4 (2020–2024) (p < 0.001). Concomitant diagnosis of DDD and facet arthrosis showed a linear upward trend, rising from 0% in D1 to 24% in D4, reflecting evolving diagnostic standards. Being a homemaker between the ages of 20 and 60 was a significant factor related to back pain. Pain and disability were higher in older patients.

Conclusion

Diagnostic analyses must consider the multifactorial nature of lumbar pain and not underestimate facet arthrosis as a pain generator. The occupation of women plays an important role in back pain and its intensity, so it should be considered in the anamnesis process of medical consultation. These results originate from a single-center cohort, which must be considered when interpreting the frequency of these pathologies.
研究设计:回顾性队列研究。目的:本研究旨在分析哥伦比亚大型女性队列中退行性腰椎病变频率的趋势及其与年龄、合并症、功能限制程度和疼痛强度的关系。材料和方法这是一项为期40年的回顾性研究,分析了一组在专门的脊柱病理管理中心因腰痛求诊的哥伦比亚妇女的临床记录。分析人口统计学变量、合并症、疼痛和残疾量表。结果对1993年至2024年间1495名出现腰痛的女性队列进行了分析。几十年来最常见的病理是退行性椎间盘疾病。小关节骨关节炎的诊断率显著增加,从第1十年(1993-1999)的1%增加到第4十年(2020-2024)的30% (p < 0.001)。DDD和小关节突的合并诊断率呈线性上升趋势,从D1的0%上升到D4的24%,反映了诊断标准的不断发展。年龄在20岁到60岁之间的家庭主妇是背痛的一个重要因素。老年患者的疼痛和残疾发生率更高。结论诊断分析必须考虑腰椎疼痛的多因素性,不能低估小关节突关节炎作为疼痛产生源的作用。女性的职业在腰痛及其强度中起着重要的作用,因此在医疗咨询的记忆过程中应考虑到这一点。这些结果来自单中心队列,在解释这些病理的频率时必须考虑到这一点。
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引用次数: 0
Corrigendum to “Development and temporal validation of an odds ratio-weighted prognostic score (NPH-RKP) for idiopathic normal pressure hydrocephalus shunt surgery: a retrospective cohort study” [J. Clin. Neurosci. 146 (2026) 111883] 特发性常压脑积水分流术的优势比加权预后评分(NPH-RKP)的发展和时间验证:一项回顾性队列研究[J]。中国。神经科学。146(2026)111883]。
IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-05-01 Epub Date: 2026-02-07 DOI: 10.1016/j.jocn.2026.111901
Usame Rakip , Serhat Yıldızhan , İhsan Canbek , Mehmet Gazi Boyacı , Serhat Korkmaz , Ömer Kimsesiz , Abdullah Guzel , Anas Abdallah , Adem Aslan
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引用次数: 0
期刊
Journal of Clinical Neuroscience
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