Journal of Clinical Neuroscience最新文献

{"title":"Efficacy of Neuromodulation in Postoperative Acute and Chronic Low Back Pain after Lumbar Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis and Meta-Regression","authors":"Plamen Penchev ,&nbsp;Daniela Milanova-Ilieva ,&nbsp;Lyubomir Gaydarski ,&nbsp;Dobromir Dimitrov ,&nbsp;Boris Tablov ,&nbsp;Noor Husain ,&nbsp;Remzi Hyusein ,&nbsp;Cristian Vladimirov ,&nbsp;Mihaela Mihaylova ,&nbsp;Ivan Lozanov ,&nbsp;Darko Stavrev ,&nbsp;Petar-Preslav Petrov ,&nbsp;Pavel Stanchev ,&nbsp;Andrey Velev ,&nbsp;Nikolai Ramadanov ,&nbsp;Nikolay Peev","doi":"10.1016/j.jocn.2025.111815","DOIUrl":"10.1016/j.jocn.2025.111815","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute and chronic postoperative low back pain are frequent occurrences after lumbar spine surgery, contributing to long-term disability and increased analgesic use. Neuromodulation techniques—both invasive and non-invasive—have emerged as promising non-pharmacological interventions. However, current evidence remains fragmented. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of neuromodulation in managing acute and chronic postoperative low back pain.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Scopus, and Cochrane databases from inception up to 30 June 2025 for randomized controlled trials (RCTs) published in English only comparing neuromodulation to sham modulation in patients with postoperative low back pain following lumbar spine surgery. The review protocol was registered in PROSPERO (CRD420251108776). Primary outcomes included pain intensity reduction, analgesic consumption, functional disability, and adverse effects. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) for continuous outcomes were calculated using a frequentist random-effects model. Proportions and 95% CIs for binary outcomes, including adverse events and sex distribution, were computed using the Freeman–Tukey double arcsine transformation to stabilize variance. Heterogeneity was assessed using the I²  statistic and Cochrane’s Q test.</div></div><div><h3>Results</h3><div>Twelve RCTs involving 413 patients (mean age 53 years; 55 % female) were included, with 207 (50%) receiving neuromodulation. In the pooled analysis, neuromodulation significantly reduced pain intensity (SMD − 0.82; 95 % CI [−1.13, −0.50]; p &lt; 0.00001; I² = 53 %) and analgesic consumption (SMD − 0.91; 95 % CI [−1.63, −0.20]; p = 0.01; I² = 81 %) compared to sham. No significant difference was found in functional disability (SMD − 0.31; 95 % CI [−0.85, 0.24]; p = 0.28; I² = 44 %). The pooled female proportion was 55 % (95 % CI [42.99, 66.95]; I² = 73 %), and the prevalence of adverse effects was 12.48 % (95 % CI [6.13, 20.39]; I² = 0 %).</div></div><div><h3>Conclusion</h3><div>This meta-analysis demonstrates that neuromodulation significantly reduces postoperative pain and opioid consumption after lumbar spine surgery, although it does not improve functional disability. Given the growing need for non-pharmacological pain management strategies, neuromodulation represents a promising evidence-based adjunct in postoperative care. Future high-quality RCTs should refine optimal protocols and evaluate long-term functional outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111815"},"PeriodicalIF":1.8,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794007","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":"In reply: External validation of a grading system predicting ischemia following middle cerebral artery aneurysm clipping","authors":"Cyrus Raki,&nbsp;Leon Lai","doi":"10.1016/j.jocn.2025.111817","DOIUrl":"10.1016/j.jocn.2025.111817","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111817"},"PeriodicalIF":1.8,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794073","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":"Helicobacter pylori infection is associated with the seriousness of carotid atherosclerosis and inflammatory parameters","authors":"Hong Zhao ,&nbsp;Yemeng Chu ,&nbsp;Ying Li ,&nbsp;Yawen Xu ,&nbsp;Zanhua Liu ,&nbsp;Cui Wang","doi":"10.1016/j.jocn.2025.111810","DOIUrl":"10.1016/j.jocn.2025.111810","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Carotid atherosclerosis is an important factor to ischemic stroke. Accumulating evidence indicated that certain viral and bacterial infections may contribute to the initiation and progression of atherosclerotic disease. Hp infection is common in China, however, the role of Hp infection in carotid atherosclerosis is still controversial and inconsistent. In our study, we aimed to determine the seroprevalence of &lt;em&gt;Helicobacter pylori&lt;/em&gt; (Hp) in patients with carotid atherosclerosis and the association between Hp seropositivity and the severity of carotid artery stenosis. The inflammatory serum cytokines of lipoprotein-associated phospholipase A2 (Lp-PLA2) and metalloproteinase-9 (MMP-9) were also tested to explore the possible mechanism of Hp linked atherosclerosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;94 participants with carotid atherosclerosis (patient group) and 56 individuals without carotid atherosclerosis (control group) whom all confirmed by color Doppler ultrasound were included in this study. According to the degree of carotid artery stenosis, the patient group was classified into three different subgroup: mild stenosis (&lt;50 % stenosis, n = 30), moderate stenosis (50–69 % stenosis, n = 34) and severe stenosis (≥70 % stenosis, n = 30). An enzyme linked immunosorbent assay (ELISA) for immunoglobulin (Ig) G test for Hp diagnosis was used on all enrolled subjects. Values higher than 30 IU/mL were considered Hp seropositivity. They were also divided into Hp seropositive (n = 77) and Hp seronegative group (n = 73) according to Hp test result. Lp-PLA2 and MMP-9 were also measured in all participants as inflammatory markers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The seropositivity rate for HP reached 62.8 % in patients with carotid atherosclerosis and it was significantly higher than that in controls 32.1 % (&lt;em&gt;P&lt;/em&gt; &lt; 0.001). The Hp-IgG levels in patients group were also significantly higher than those in controls (46.89 ± 22.34 IU/ml vs. 29.84 ± 11.83 IU/ml). Furthermore, the higher HP seropositivity, the more severe the extent of carotid atherosclerosis. Lp-PLA2 and MMP-9 levels in the mild, moderate and severe stenosis of carotid atherosclerosis were statistically higher than in controls. There were 77 (55.7 %) Hp positive and 73 (44.3 %) Hp negative subjects. Hp positive patients had a significantly higher incidence of carotid atherosclerosis (76.6 % vs. 47.9 %), TC levels (5.31 ± 0.7 mmo/l vs. 5.01 ± 0.66 mmo/l) and LDL-C levels (2.62 ± 0.66 mmo/l vs. 2.31 ± 0.61 mmo/l) when compared with Hp negative patients. In addition, Plasma Lp-PLA2 and MMP-9 levels in patients seropositive for Hp were significantly higher than in those seronegative for Hp.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;These results showed evidence that Hp seropositivity had a significantly correlation with carotid atherosclerosis as well as its severity evaluated by ultrasound. Furthermore, chronic infection with Hp might involve the p","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111810"},"PeriodicalIF":1.8,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781234","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":"Vascular injuries of the head and neck in martial Arts: A scoping review","authors":"Jack Hyler ,&nbsp;Kyle Singerman ,&nbsp;Frank A. De Stefano ,&nbsp;Shannon M. Kraft ,&nbsp;Hannah Kavookjian","doi":"10.1016/j.jocn.2025.111811","DOIUrl":"10.1016/j.jocn.2025.111811","url":null,"abstract":"<div><h3>Background</h3><div>Blunt cerebrovascular injury (BCVI) is one of the most feared complications of martial arts practice. Both striking and grappling disciplines place the cervical vasculature at risk either by way of direct blows or application of chokeholds, respectively. Research on BCVI in martial arts remains limited, primarily consisting of case reports. This study aimed to provide a scoping review of BCVI in martial arts.</div></div><div><h3>Methods</h3><div>Following the PRISMA guidelines, a systematic literature review was performed using PubMed and Ovid Embase databases from date of database inception to October 2024. Studies were selected based on predetermined inclusion and exclusion criteria.</div></div><div><h3>Results</h3><div>31 papers from 1964 to 2024 by 31 authors reported BCVI in martial arts. Of these, 40 individual cases (39 male) were reported, with ages ranging from 7 to 66 years old (mean 35.18 ± 14.56). 30 papers were single case reports, and one was a case series of 10 patients. Three mechanisms of injury were identified: chokeholds (n = 19, 53 %), “whiplash” (n = 6, 17 %), and direct blunt trauma (n = 11, 31 %). Brazilian Jiu Jitsu (BJJ) was the most implicated (n = 18 cases). The most frequently injured vascular structure was the vertebral artery (n = 16), followed by the cervical segment of the internal carotid artery (ICA) (n = 12), most often injured at its distal segment.</div></div><div><h3>Conclusion</h3><div>This study aims to highlight BCVI in martial arts. While rare, the findings suggest the highest rates of injury in BJJ and kickboxing. The V3 segment of the vertebral artery and cervical segment of the ICA were at greatest risk.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111811"},"PeriodicalIF":1.8,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774811","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":"Does arterial supply predict post-intervention neurological outcomes for cranial dural arteriovenous fistulas? A single center retrospective study","authors":"Lily Davies ,&nbsp;Leon Lai ,&nbsp;Ronil Chandra ,&nbsp;Calvin Gan ,&nbsp;Lee-Anne Slater ,&nbsp;Justin Moore","doi":"10.1016/j.jocn.2025.111812","DOIUrl":"10.1016/j.jocn.2025.111812","url":null,"abstract":"<div><h3>Background</h3><div>Dural arteriovenous fistulas (dAVFs) are rare vascular malformations characterized by direct shunting between dural arteries and venous sinuses or cortical veins. A comprehensive framework does not exist when deciding upon intervention for dAVFs. This study investigates the influence of arterial feeders in predicting treatment modality and neurological morbidity following intervention for dAVFs.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted of consecutive patients treated for intracranial dAVFs at a tertiary neurosurgical center in Victoria, Australia, between June 2016-June 2024. The primary outcome was functional morbidity at discharge (modified Rankin Scale ≥ 3). Secondary outcomes included the relationship between arterial feeders, treatment modality and obliteration rates.</div></div><div><h3>Results</h3><div>Fifty-two patients with 60 dAVFs were included. CVR was present in 93 % of lesions, and 22 % were ruptured at presentation. The middle meningeal artery was the most frequent feeder (68.3 %). Endovascular therapy was the initial treatment for 31 lesions (52 %), achieving an overall obliteration rate of 92 % and a complication rate of 21 %. Endovascular intervention was more common when the occipital (68 % vs 34 %, p = 0.01) or posterior meningeal (32 % vs 6.9 %, p = 0.011) arteries supplied the lesion, whereas surgical treatment predominated with superficial temporal (34 % vs 13 %, p = 0.048) or ophthalmic (28 % vs 3.2 %, p = 0.011) feeders. Functional morbidity at discharge was higher among lesions with posterior circulation supply (78 % vs 29 %, p = 0.009) and lower in those with external carotid artery (44 % vs 88 %, p value = 0.007). Posterior feeders were particularly associated with morbidity following surgery (80 % vs 17 %, p = 0.013).</div></div><div><h3>Conclusion</h3><div>Arterial supply may influence both treatment selection and neurological outcomes in dAVFs. Posterior circulation feeders were associated with greater morbidity, whereas lower morbidity rates were seen in lesions with external carotid supply. Recognition of these arterial factors may aid in tailoring intervention strategies and, when combined with known venous prognostic factors, may inform counselling regarding procedural risk.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111812"},"PeriodicalIF":1.8,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774777","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":"Changes in the blink reflex after a sport-related concussion: Test-retest reliability of a blink reflexometer in high school athletes","authors":"John E. Dugan ,&nbsp;Tag Alsir F. Osama ,&nbsp;Jacob Jo ,&nbsp;Connor C. Long ,&nbsp;Eunyoung Hong ,&nbsp;Samuel Fitch ,&nbsp;Grant H. Rigney ,&nbsp;Kristen L. Williams ,&nbsp;Scott L. Zuckerman ,&nbsp;Douglas P. Terry","doi":"10.1016/j.jocn.2025.111808","DOIUrl":"10.1016/j.jocn.2025.111808","url":null,"abstract":"<div><h3>Introduction</h3><div>Sport-related concussion (SRC) is a traumatic brain injury affecting approximately 20 % of high school athletes annually. Recent investigations propose the blink reflex as a potential diagnostic measure for SRC, with studies showing significant changes in the reflex post-concussion. The current study aims to assess the baseline test–retest reliability of the EyeStat device, a handheld blink reflexometer, in a cohort of healthy high school athletes.</div></div><div><h3>Methods</h3><div>A prospective cohort study of healthy youth athletes at a local high school was conducted. The EyeStat device, an FDA-approved blink reflexometer, was utilized to capture blink reflex responses from each participant. Participants underwent two 20-second baseline measurements separated by a 15-minute gap. Pearson’s/Spearman’s r and Intraclass Correlation Coefficient (ICC) tests were performed to determine the test–retest reliability of the device between the two baseline measurements.</div></div><div><h3>Results</h3><div>Forty-eight athletes (mean age: 15.3 ± 1.3; 65.2 % male) were included for our analyses. All 10 Eyestat parameters demonstrated significant positive relationships between the two baseline assessments (p &lt; 0.001), with intraclass correlation confirming test–retest reliability across measures (oscillations: 0.87; total blink time: 0.82; time to open: 0.82; time under threshold: 0.80; lid excursion: 0.77; lid velocity: 0.77; time to close: 0.76; latency: 0.57; differential latency: 0.49). Moderate to strong positive relationships were observed for latency, differential latency, and time under threshold, while parameters like delta 30, time to close, lid excursion, lid velocity, total blink time, and time to open showed strong correlation, and oscillations displayed a very strong positive relationship. None of the EyeStat parameters differed significantly based on sex, hours of sleep, or concussion history.</div></div><div><h3>Conclusions</h3><div>Our study demonstrates the consistent test–retest reliability of the EyeStat device across various blink reflex parameters in a cohort of non-concussed, healthy high school athletes. The findings support the potential utility of the EyeStat device as a reliable baseline measure for assessing the blink reflex in the context of SRC among young athletes. Further research and validation studies are warranted to confirm its effectiveness in diagnosing SRC and its applicability in diverse athlete populations.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111808"},"PeriodicalIF":1.8,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774848","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":"Outcomes of initially chosen non-operative management for spinal ependymoma","authors":"Guang-Hao Zheng ,&nbsp;Yao-Wu Zhang ,&nbsp;Kai Ji ,&nbsp;Hui Qiao ,&nbsp;Xiao Wu ,&nbsp;Yi-Xiang Liu ,&nbsp;Wei-Hao Liu ,&nbsp;Bo Wang ,&nbsp;Chong Wang ,&nbsp;Xing-Yu Liu ,&nbsp;Yong-Zhi Wang ,&nbsp;Wen-Qing Jia","doi":"10.1016/j.jocn.2025.111780","DOIUrl":"10.1016/j.jocn.2025.111780","url":null,"abstract":"<div><h3>Purpose</h3><div>With advancements in imaging, spinal ependymomas are increasingly detected early, often in asymptomatic or mildly symptomatic patients. This study evaluates the clinical and radiological outcomes in patients who initially underwent conservative management but subsequently underwent surgery due to disease progression.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 315 patients diagnosed between 2018 and 2023 identified 10 meeting the inclusion criteria (mean age: 51 years, range: 37–63). Three were asymptomatic, and seven had mild symptoms such as pain or numbness. The mean maximum tumor diameter on sagittal MRI was 23.5 mm. Tumor progression and symptom changes were monitored, with surgery performed as needed.</div></div><div><h3>Results</h3><div>Over a median conservative period of 36 months, all patients eventually required surgery due to symptom progression or tumor growth, with an average tumor size increase of 22 %. Gross total resection was achieved in 80 % of cases under electrophysiological monitoring. After a median follow-up of 31.5 months, 70 % of patients maintained their preoperative modified McCormick scores, while 30 % showed deterioration.</div></div><div><h3>Conclusion</h3><div>Conservative management provides a temporary option, but tumor progression is inevitable. Delayed surgery may risk worse outcomes, making timely intervention advisable for patients with tumor growth, syrinx formation, or worsening neurological symptoms.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111780"},"PeriodicalIF":1.8,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768277","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":"Theta burst stimulation effectively improves post-stroke aphasia: A systematic review and meta-analysis of randomized controlled trials","authors":"Kaini Zhang ,&nbsp;Yinchun Zhao ,&nbsp;Qixing Hu ,&nbsp;Haiyang Zhang ,&nbsp;Seong Hee Choi ,&nbsp;Gengbin Chen ,&nbsp;Yue Lan","doi":"10.1016/j.jocn.2025.111793","DOIUrl":"10.1016/j.jocn.2025.111793","url":null,"abstract":"<div><h3>Background</h3><div>Post-stroke aphasia (PSA) is a common disabling sequela of stroke, and existing speech therapies have limitations, such as inefficiency and high cost. Theta burst stimulation (TBS), a novel non-invasive brain stimulation technique, improves language function by modulating neuroplasticity; however, systematic evidence is lacking to support its efficacy and optimal intervention parameters. This study aimed to evaluate the rehabilitative effect of TBS on language function in patients with PSA.</div></div><div><h3>Methods</h3><div>We searched six major Chinese and English databases, including PubMed and Web of Science, for relevant literature from inception to October 04, 2025, and ultimately included 12 RCTs (combined n = 524). Additionally, subgroup analyses were conducted to explore the effects of different stimulation methods, stimulation site, stage of stroke, and treatment sessions on the efficacy of the treatment, and to analyze the related factors in depth.</div></div><div><h3>Results</h3><div>TBS significantly improved overall speech function (SMD = 0.97, 95 % CI: 0.51–1.43, P &lt; 0.001), particularly effective in enhancing naming, auditory comprehension, repetition, and spontaneous speech abilities. Selecting stimulation of Broca’s area, the iTBS protocol, early-stage (acute/subacute) patients, and multiple interventions (≥10 sessions) can significantly improve PSA. However, given the high degree of heterogeneity, caution should be exercised when interpreting our findings.</div></div><div><h3>Conclusion</h3><div>These findings suggest that TBS may represent a promising adjunct to conventional speech rehabilitation for patients with PSA.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111793"},"PeriodicalIF":1.8,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768264","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":"Efficacy and safety of embolization of brain arteriovenous malformations in pediatric patients: A systematic review and meta-analysis","authors":"Bruno Zilli Peroni ,&nbsp;Filipe Virgilio Ribeiro ,&nbsp;Marcelo Porto Sousa ,&nbsp;Rudolfh Batista Arend ,&nbsp;Natan Lucca Lima ,&nbsp;Samuel Luís Scaravonatto Baldo Cunha ,&nbsp;Caio Vinicius Figueredo Almeida ,&nbsp;Gabriel da Silva Simeone ,&nbsp;Pedro G.L.B. Borges ,&nbsp;Felippe Figueiredo Torres Ribeiro ,&nbsp;Marcos Vinicius do Nascimento da Silva ,&nbsp;João Pedro Bittar Sanches ,&nbsp;Marcio Yuri Ferreira ,&nbsp;Savio Batista ,&nbsp;Jennifer Sachiki Ronecker ,&nbsp;Chandan Krishna ,&nbsp;Herika Negri Brito ,&nbsp;Alex Roman ,&nbsp;Raphael Bertani","doi":"10.1016/j.jocn.2025.111802","DOIUrl":"10.1016/j.jocn.2025.111802","url":null,"abstract":"<div><h3>Background</h3><div>Brain arteriovenous malformations (bAVMs) are rare vascular anomalies involving direct artery-to-vein connections that bypass capillaries. These high-flow lesions have a significant risk of rupture. Despite a prevalence below 10 per 100,000 and an average diagnosis age around 30 years, bAVMs cause notable morbidity, particularly in children.</div></div><div><h3>Methods</h3><div>Medline, Embase, and Cochrane were searched for English studies from January 2000 to February 2025. Our primary focus was on studies that included at least three pediatric patients with AVMs treated using embolization and that reported outcomes such as occlusion rates, complications, favorable clinical outcomes, and mortality. A <em>meta</em>-analysis of proportions with 95% confidence intervals was conducted under a random-effects model to pool the data. Baujat plots, leave-one-out, and <em>meta</em>-regressions sensitivity analyses were performed to address high heterogeneity.</div></div><div><h3>Results</h3><div>Our search encompassed 20 studies included. The analysis for immediate occlusion revealed a rate of 63 % (95 %CI: 28;92 %; I² = 92 %), and for long-term obliteration, 43 % (95 %CI: 23;65 %; I² = 88 %). Subanalysis based on the Spetzler scale demonstrated an 85 % long-term obliteration rate for patients classified as I to III, contrasting with 27 % for those classified as IV to V. Recurrence resulted in a pooled rate of 15 % (95 %CI: 0;45 %; I² = 85 %). Clinical outcomes were favorable, with a rate of 91 % (95 %CI: 79;98 %; I² = 59 %). Notably, 50 out of 263 patients experienced perioperative complications, yielding a rate of 15 % (95 %CI: 5;28 %; I² = 71 %). Among 50 perioperative complications, 29 were identified as hemorrhages, confirming a hemorrhage rate of 8 % (95 %CI: 1;19 %; I² = 68 %). No fatal events occurred among the 342 patients examined.</div></div><div><h3>Conclusion</h3><div>Our <em>meta</em>-analysis showed that embolization for pediatric bAVMs results in modest long-term obliteration rates and carries a significant risk of complications. Thus, while it may serve as part of a multimodal approach or as standalone therapy in selected cases, its effectiveness is limited and the risk of adverse events remains high.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111802"},"PeriodicalIF":1.8,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145756969","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":"Spinal Rosai-Dorfman disease: systematic review and meta-analysis of clinical presentation, diagnosis, and treatment","authors":"Aafreen Azmi ,&nbsp;Daniela A. Perez-Chadid ,&nbsp;Jeremiah H. Wijaya ,&nbsp;Juan P. Avila-Madrigal ,&nbsp;Aditi Gorthy ,&nbsp;Sri Sai Lakshman Akkineni ,&nbsp;Andrew Egladyous ,&nbsp;Nemanja Novakovic ,&nbsp;Morana Vojnic ,&nbsp;Jonathan Sherman ,&nbsp;Anil Nanda","doi":"10.1016/j.jocn.2025.111787","DOIUrl":"10.1016/j.jocn.2025.111787","url":null,"abstract":"<div><h3>Background</h3><div>Spinal Rosai–Dorfman disease (RDD) is a rare histiocytic disorder that can mimic neoplastic and infectious processes, complicating diagnosis and management. Its natural history and optimal treatment strategies remain poorly defined.</div></div><div><h3>Objective</h3><div>To systematically review and perform an individual patient data (IPD) <em>meta</em>-analysis of clinical presentation, diagnostic features, management, and outcomes in adult patients with spinal RDD.</div></div><div><h3>Methods</h3><div>A PRISMA-compliant systematic review was performed using PubMed, Scopus, and Cochrane Library databases. Eligible studies included case reports, case series, and observational studies reporting histologically confirmed spinal RDD in adults (≥18 years). Patient-level data were pooled and analyzed using a one-stage mixed-effects model to identify factors associated with full neurological recovery. Recurrence-free survival (RFS) was assessed using Kaplan–Meier methodology.</div></div><div><h3>Results</h3><div>Sixty-seven studies reporting 85 patients (mean age 42.6  years; 70.6 % male) were included. Thoracic (61.2 %) and cervical (43.5 %) lesions predominated, with extradural (40 %), intradural-extramedullary (24.7 %), and intramedullary (31.8 %) involvement. Surgical resection was performed in 83.5 % of cases; gross total resection (GTR) was achieved in 45.9 %. At a mean follow-up of 19.9  months, 40 % of patients achieved full neurological recovery and 7.1 % experienced recurrence, most within one month postoperatively. Intradural-extramedullary location (RR 4.20, p = 0.008) and GTR (RR 4.31, p = 0.002) independently predicted full recovery, while intramedullary involvement was associated with worse outcomes (RR 0.29, p = 0.019).</div></div><div><h3>Conclusions</h3><div>Intradural-extramedullary location and GTR strongly predict favorable outcomes in spinal RDD, whereas intramedullary disease confers a poorer prognosis. The high early recurrence rate underscores the need for close postoperative surveillance and consideration of adjuvant therapy in high-risk cases. Standardized surgical protocols and prospective IPD studies are needed to refine management and improve long-term outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111787"},"PeriodicalIF":1.8,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742656","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}