Journal of Clinical Neuroscience最新文献

{"title":"A novel bicortical alternating screw exchange lagging technique for reduction of cervical spinal deformity","authors":"Joshua Estin ,&nbsp;Alejandro Lopez ,&nbsp;Steven Vanni ,&nbsp;Sara Jarret ,&nbsp;Karthik Madhavan","doi":"10.1016/j.jocn.2026.111867","DOIUrl":"10.1016/j.jocn.2026.111867","url":null,"abstract":"<div><div>Cervical kyphosis in the presence of multilevel disc degeneration poses a significant challenge to surgical correction. Anterior cervical discectomy and fusion (ACDF) is a well-established approach to decompress the neural elements and relieve pain but may not specifically correct kyphosis. We describe an anterior only ACDF approach utilizing a novel lagging technique (Vanni technique) to correct cervical kyphosis. The objective is to reestablish lordosis without adding the morbidity of corpectomies or posterior osteotomies. The ACDF procedure with the lagging technique is summarized in the following steps: (1) multilevel discectomy, (2) lordotic interbody cage placement at each level, (3) lordotic plate positioning secured by a temporary pin, (4) bicortical screw placement bilaterally at each level using a screw exchange lagging technique, allowing the vertebral bodies to be sequentially translated toward the plate using progressively shorter bicortical screws until flush, and (5) final screw tightening and locking to the plate. In two illustrative cases, patients underwent anterior cervical discectomies and fusions from C3 to C7 using the Vanni lagging technique to correct deformity. Postoperative follow up showed improvement in Sagittal Vertical Axis (SVA) and lordosis with solid fusion. The current technique report provides a detailed description of a multilevel ACDF procedure with a novel lagging technique to effectively correct cervical deformity. It obviates the need for more extensive and morbid corpectomies and osteotomies in selected patients with reducible deformities.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111867"},"PeriodicalIF":1.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979167","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":"To treat or not to treat? An inverse probability weighting analysis of intracranial aneurysms with inconclusive UIATS scores","authors":"Tiago Pedro ,&nbsp;Carolina Silva ,&nbsp;Pedro Simão ,&nbsp;Osvaldo Sousa ,&nbsp;Vasco Carvalho ,&nbsp;Patrícia Polónia ,&nbsp;António Vilarinho ,&nbsp;Pedro Alberto Silva ,&nbsp;Maria Luís Silva ,&nbsp;Luís Albuquerque","doi":"10.1016/j.jocn.2026.111865","DOIUrl":"10.1016/j.jocn.2026.111865","url":null,"abstract":"<div><h3>Introduction</h3><div>Management of unruptured intracranial aneurysms (UIAs) is challenging when the Unruptured Intracranial Aneurysm Treatment Score (UIATS) is inconclusive, leaving patients in a therapeutic “gray zone”. This study compared one-year outcomes between conservative and interventional management in patients with UIAs and inconclusive UIATS scores.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 149 adults with angiographically confirmed saccular UIAs and inconclusive UIATS scores treated at a tertiary center (2018–2024). Patients were stratified by management strategy: conservative (68 patients) or interventional (81 patients, endovascular or surgical). Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates. One-year outcomes included aneurysm rupture, procedural complications, ischemic and hemorrhagic events, retreatment, and functional status (mRS).</div></div><div><h3>Results</h3><div>After IPTW, the weighted pseudo-population comprised 125 patients managed conservatively and 143 treated. Intervention was associated with better functional outcomes (aOR 2.526, 95 % CI 1.075–5.935, p = 0.033) versus conservative management. Among patients managed conservatively, the aneurysm rupture rate was 4.0 %.</div></div><div><h3>Conclusions</h3><div>Active treatment in patients with unruptured intracranial aneurysms and inconclusive UIATS guidance yielded better functional results at one year, highlighting the need to improve current decision strategies through broader future research.</div></div><div><h3>Key messages</h3><div><strong>What is already known on this topic:</strong> Management of unruptured intracranial aneurysms is uncertain when the Unruptured Intracranial Aneurysm Treatment Score (UIATS) is inconclusive, leaving clinicians without clear guidance. Evidence directly comparing conservative and interventional strategies in this subgroup is limited.</div><div><strong>What this study adds:</strong> In patients with inconclusive UIATS recommendations, interventional management was associated with better one-year functional outcomes compared with conservative care.</div><div><strong>How this study might affect research, practice or policy:</strong> These findings support consideration of active treatment even when UIATS is indeterminate, emphasizing individualized, multidisciplinary decision-making.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111865"},"PeriodicalIF":1.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979136","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":"Esophageal Injury Following Anterior Cervical Discectomy and Fusion: A Single-institution Retrospective Study","authors":"Abhijith V. Matur ,&nbsp;Sanjit Shah ,&nbsp;Zachary J. Plummer ,&nbsp;Juan C. Mejia-Munne ,&nbsp;Yash Patil ,&nbsp;Michael K. Coffin ,&nbsp;Owoicho Adogwa ,&nbsp;Rani Nasser ,&nbsp;Joseph S. Cheng ,&nbsp;Justin N. Virojanapa","doi":"10.1016/j.jocn.2026.111864","DOIUrl":"10.1016/j.jocn.2026.111864","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal perforation is a known but rare complication of anterior cervical discectomy and fusion (ACDF). Due to its rarity, factors associated with esophageal perforation have not been conclusively identified.</div></div><div><h3>Methods</h3><div>A retrospective study of patients who underwent ACDF at a tertiary care center between September 2016 and September 2021. Patients were identified using CPT codes 22551, 22552, 22554, and 22558. All subaxial cervical interbody fusions utilizing an anterior approach, including both discectomies and corpectomies, were included. Odontoid screws, cervical arthroplasty, and posterior-only fusions were excluded. Patients who were determined to have esophageal perforation were identified based on head and neck surgeon involvement in their hospital admission and ICD-10 code K22.3.</div></div><div><h3>Results</h3><div>A total of 1454 patients met our inclusion criteria, among whom 13 patients were determined to have had a confirmed esophageal perforation (0.89%). There was a statistically significant association between multilevel ACDF and surgery for suspected esophageal perforation (p = 0.04655). There were no statistically significant associations between surgery for suspected esophageal perforation and age, female sex, active smoking status, diabetes, coronary artery disease, chronic obstructive pulmonary disease, or gastroesophageal reflux disease. Perforation occurred because of intraoperative injury in 4 patients and 3 patients underwent initial ACDF for an indication of trauma.</div></div><div><h3>Conclusion</h3><div>This study suggests that there may be an association between multilevel ACDF and esophageal perforation. Further larger studies will be needed to confirm this along with other risk factors for esophageal perforation.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111864"},"PeriodicalIF":1.8,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979138","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":"Safety and effectiveness of bolt-mounted versus tunnelled external ventricular drains: A systematic review, meta-analysis and trial-sequential analysis","authors":"Shaan Patel ,&nbsp;Shiva A. Nischal ,&nbsp;Ayush Sinha ,&nbsp;Kush M. Kale ,&nbsp;Pious D. Patel ,&nbsp;Jack Jallo ,&nbsp;Srinivas K. Prasad","doi":"10.1016/j.jocn.2026.111860","DOIUrl":"10.1016/j.jocn.2026.111860","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;External ventricular drains (EVDs) are fundamental to neurocritical care, yet substantial procedural heterogeneity persists, particularly regarding bolt-mounted versus tunnelled catheter fixation. The relative safety and effectiveness of these approaches remain unclear, with conflicting data from observational studies and a lack of trial-level evidence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To compare bolt-mounted and tunnelled EVDs across accuracy, reoperation, and key safety outcomes using systematic review, meta-analysis, and trial-sequential analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Following PRISMA guidelines, PubMed, Embase, and CENTRAL databases were searched (November 2025) for randomised or observational studies comparing bolt-mounted with tunnelled EVDs in adults. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Primary outcomes were optimal catheter placement (Kakarla Grade I) and reoperation for EVD-related complications. Secondary outcomes included iatrogenic intracranial haemorrhage (ICH), cerebrospinal fluid (CSF) infection, CSF leak, catheter obstruction or malfunction, accidental discontinuation, and drainage duration. Random-effects meta-analyses were conducted using restricted maximum likelihood estimation. Heterogeneity was quantified, and certainty of evidence was assessed using GRADE. Trial-sequential analysis was performed for reoperation to determine whether available data met required information size thresholds.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Ten studies encompassing 2008 patients (800 bolt-mounted, 1208 tunnelled) were included. Bolt-mounted EVDs demonstrated significantly higher optimal catheter accuracy (RR 1.27; 95% CI: 1.06–1.51; &lt;em&gt;P &lt;&lt;/em&gt; 0.01; I&lt;sup&gt;2&lt;/sup&gt; = 29.6 %). Reoperation was numerically lower with bolt-mounted systems (RR 0.51; 95% CI: 0.22–1.36; &lt;em&gt;P =&lt;/em&gt; 0.19; I&lt;sup&gt;2&lt;/sup&gt; = 85 %), although trial-sequential analysis showed the cumulative Z-curve crossed the monitoring boundary without reaching the required information size, indicating insufficient evidence for definitive inference. Bolt-mounted EVDs were associated with lower CSF leak risk (RR 0.13; 95% CI: 0.04–0.47; &lt;em&gt;P &lt;&lt;/em&gt; 0.01) and reduced catheter obstruction (RR 0.46; 95% CI: 0.25–0.83; &lt;em&gt;P&lt;/em&gt; &lt; 0.05). No significant differences were observed in iatrogenic ICH (RR 1.23; 95% CI: 0.54–2.81; &lt;em&gt;P =&lt;/em&gt; 0.62), CSF infection (RR 0.88; 95% CI: 0.71–1.09; &lt;em&gt;P =&lt;/em&gt; 0.23), accidental discontinuation (RR 0.41; 95% CI: 0.11–1.59; &lt;em&gt;P =&lt;/em&gt; 0.20), or drainage duration (MD 0.56 days; 95% CI = -1.02–2.13; &lt;em&gt;P&lt;/em&gt; = 0.49).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Bolt-mounted EVDs were associated with higher catheter accuracy, reduced CSF leak, and improved mechanical reliability without increased infection or haemorrhage. Although reoperation may be lower with bolt-mounted systems, current evidence remains underpowered for firm conclusions. Thes","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111860"},"PeriodicalIF":1.8,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979080","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 assessment of a Near-Infrared spectroscopy device for rapid triage in traumatic brain injury","authors":"Vedang Bhushan Mahajan ,&nbsp;Vivek Tandon ,&nbsp;Sri Surya Krishna Gour ,&nbsp;Amol Raheja ,&nbsp;Aarosh Dhamija ,&nbsp;Vinamrita Patni ,&nbsp;Deepak Gupta ,&nbsp;Deepak Agrawal ,&nbsp;Atin Kumar ,&nbsp;P Sarat Chandra","doi":"10.1016/j.jocn.2026.111850","DOIUrl":"10.1016/j.jocn.2026.111850","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic Brain Injury (TBI) poses a significant public health challenge in India, with nearly 2 million cases annually and limited CT availability causing delays in diagnosis. This study evaluated CEREBO®, a machine learning-enhanced near-infrared spectroscopy (mNIRS) device, as a rapid, non-invasive triage tool for TBI.</div></div><div><h3>Methodology</h3><div>A prospective quasi-experimental study was conducted at AIIMS, New Delhi, enrolling 202 suspected TBI patients. Participants were divided into control (standard care) and experimental (standard care + CEREBO®) groups. CEREBO® findings were compared with CT as the gold standard. Diagnostic performance (sensitivity, specificity, accuracy), time to preliminary diagnosis, and potential of impact on triage decisions were assessed.</div></div><div><h3>Results</h3><div>CEREBO® demonstrated high diagnostic performance with 98% sensitivity, 90% specificity, and 93.9% accuracy for detecting intracranial pathology. In a post-hoc exploratory simulation, using CEREBO®’s negative result as a hypothetical criterion for deferring CT suggested that CT imaging could have been potentially avoided in 82.1% of red (critical condition) cases and 80.6% of yellow (stable but urgent) cases. These simulations also indicated that CEREBO® may help identify patients whose urgency of care could be underestimated by initial triage classification.</div></div><div><h3>Conclusion</h3><div>The NIRS device demonstrated rapid, non-invasive assessment capability across a broad patient population, supporting its potential utility as an adjunct screening tool in resource-limited trauma settings. These findings suggest that the device may help streamline triage, optimize CT utilization, and improve workflow efficiency in high-volume emergency environments.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111850"},"PeriodicalIF":1.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959594","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":"SESA syndrome: synthesizing evidence and proposing diagnostic criteria and severity grading—a scoping review","authors":"Romil Kukadiya ,&nbsp;Arth Shah ,&nbsp;Soaham Desai","doi":"10.1016/j.jocn.2026.111857","DOIUrl":"10.1016/j.jocn.2026.111857","url":null,"abstract":"<div><h3>Background</h3><div>Subacute Encephalopathy with Seizures in Alcoholics (SESA) syndrome is an underrecognized neurological complication among chronic alcohol users, characterized by subacute encephalopathy, seizures, focal neurological deficits, and distinctive EEG and neuroimaging findings. Despite advancements, gaps remain in standardized diagnosis, therapeutic management, and long-term outcomes.</div></div><div><h3>Objectives</h3><div>This scoping review aims to synthesize published evidence on the clinical presentation, EEG and neuroimaging findings, management strategies, and outcomes of SESA syndrome, while proposing refined diagnostic criteria and a severity grading scale.</div></div><div><h3>Methods</h3><div>Studies reporting adult patients with chronic alcohol abuse presenting with SESA syndrome, as defined by the co-occurrence of encephalopathy, seizures, and focal deficits with supporting EEG or neuroimaging findings, were included. All study designs were eligible; reviews, commentaries, and editorials without original data were excluded. A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, relevant grey literature, and conference abstracts from January 1981 to April 2025. Reference lists of included articles were manually screened. Data were extracted independently into standardized forms for demographics, clinical features, diagnostics, management, and outcomes. Quality appraisal used the Joanna Briggs Institute checklist.</div></div><div><h3>Results</h3><div>Forty-five patient cases from 29 studies were included. SESA syndrome presents with a consistent triad, varied seizure types, hallmark EEG LPDs, and reversible MRI abnormalities. Proposed criteria and severity scale may facilitate early recognition and guide management.</div></div><div><h3>Conclusions</h3><div>SESA syndrome requires heightened awareness and multidisciplinary management. Future research should validate proposed diagnostic tools and elucidate pathophysiology and long-term outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111857"},"PeriodicalIF":1.8,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922421","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":"Facial-onset SOD1 amyotrophic lateral sclerosis: A case report and systematic review","authors":"Giammarco Milella ,&nbsp;Sebastiano Carlone ,&nbsp;Fedele Luisi ,&nbsp;Vittorio Velucci ,&nbsp;Giovanni Defazio","doi":"10.1016/j.jocn.2026.111856","DOIUrl":"10.1016/j.jocn.2026.111856","url":null,"abstract":"<div><h3>Background</h3><div>Facial-onset weakness is an exceptionally rare presentation of SOD1-associated amyotrophic lateral sclerosis (ALS), and its natural history, anatomical spread, and prognostic implications remain unclear.</div></div><div><h3>Methods</h3><div>We report a woman carrying a heterozygous SOD1 A5T variant who presented with isolated, rapidly progressive bilateral facial palsy, and we performed a PRISMA-compliant systematic review of MEDLINE, Scopus, and Web of Science to identify genetically confirmed SOD1-positive ALS with facial-onset weakness. Case-level demographic, genetic, clinical, neurophysiological, and outcome data were extracted and synthesised descriptively.</div></div><div><h3>Results</h3><div>Eleven patients were included (7 men, 4 women; mean age at onset 52.3 years). Seven SOD1 variants were represented, predominantly associated with short survival (e.g. A5V, C7G, A5T). Facial weakness was initially confined to the lower face in 5/11 patients, while 6/11 had combined upper and lower facial involvement. Disease spread followed a stereotyped pattern: early contralateral facial recruitment (mean 3.6 months), rapid bulbar involvement (4.2 months), and later extension to the upper limbs (9.2 months), frequently with side-concordance between facial and arm involvement. Lower motor neuron (LMN) signs predominated in the early phases of the disease. Survival was short (median 16 months), lower than reported for unselected SOD1-ALS cohorts with the same genotypes. Three patients received tofersen, with heterogeneous outcomes.</div></div><div><h3>Conclusions</h3><div>Facial-onset SOD1 ALS defines a distinctive phenotype characterised by LMN-predominant facial palsy in early phases, near-neighbour spread, and an aggressive course exceeding genotype-based expectations. Prompt recognition and genetic testing in progressive facial palsy unresponsive to immunotherapy are essential to ensure access to gene-targeted treatments.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111856"},"PeriodicalIF":1.8,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922480","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":"CSF-venous fistulas Reconsidered: Pressure paradox and the Volume-Elastance Relationship","authors":"Yusuf H. Wardak ,&nbsp;Behnam Shaygi ,&nbsp;Hong K. Kok ,&nbsp;Ronil V. Chandra ,&nbsp;Anousha Yazdabadi ,&nbsp;Ashu Jhamb ,&nbsp;Justin M. Moore ,&nbsp;Paul Smith ,&nbsp;Julian Maingard ,&nbsp;Calvin Gan ,&nbsp;Lee-Anne Slater ,&nbsp;Enrique Barvulsky ,&nbsp;Mark Schembri ,&nbsp;Andrew J. Gauden ,&nbsp;Jeremy Russell ,&nbsp;Augusto Gonzalvo ,&nbsp;Ali Khabaza ,&nbsp;Davor Pavlin-Premrl ,&nbsp;Mark Brooks ,&nbsp;Christen D. Barras ,&nbsp;Hamed Asadi","doi":"10.1016/j.jocn.2026.111861","DOIUrl":"10.1016/j.jocn.2026.111861","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Spontaneous intracranial hypotension (SIH) is a debilitating condition most often caused by spontaneous cerebrospinal fluid (CSF) leaks, with CSF-venous fistulas (CVF) representing an increasing number of cases. Pathophysiological understandings of CVFs, particularly those concerning pressure dynamics between the CSF and venous systems, remain elusive. This study aimed to mathematically model CVFs using first principles physics and to explore pressure dynamics and their implications for treatment and complications.</div></div><div><h3>Materials and Methods</h3><div>CSF-venous pressure dynamics were modelled using physics first-principles. Adjustable parameters included initial CSF pressure, CSF production rate, fistula radius, and dural elastance. Dynamic equilibrium pressures and volumes were calculated iteratively, with results plotted against fistula radius, CSF production rate, and dural elastance.</div></div><div><h3>Results</h3><div>The model demonstrated that an increase in CSF daily production increased the dynamic equilibrium pressure. Greater dural elastance lowered CSF volume at equilibrium without changing equilibrium pressure. CSF pressure rapidly equilibrated to that of venous pressure for larger fistulas and physiological CSF pressure for smaller fistulas.</div></div><div><h3>Conclusions</h3><div>Fistula radius, altered states of CSF production, and dural stiffening complicate the clinical presentation of CVFs. Current hypotheses do not adequately account for raised opening pressures and rebound intracranial hypertension. Instead, global CSF dysregulation, including increased production and impaired secondary outflow, may co-exist in patients with CVFs. Future management should evaluate CSF volume-pressure dynamics, rather than exclusively focusing on the fistula, to improve both diagnosis and anticipate complications.</div></div><div><h3>Key Messages</h3><div>CSF-venous fistulas are an increasingly recognised cause of spontaneous intracranial hypotension. Current understandings of CSF-venous pressure dynamics remain elusive. This study modelled the behaviour of CSF pressures to inform a discussion on potential secondary pathophysiological factors. In doing so, it seeks to ensure clinicians consider patient-specific compensatory mechanisms when providing treatment, to anticipate complications and ensure efficacy.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111861"},"PeriodicalIF":1.8,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952312","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":"Mixed reality neurosurgical simulations and adult learning theories: a systematic review","authors":"Juan P. Giraldo,&nbsp;Nikhil Dholaria,&nbsp;Nicholas Williams,&nbsp;Chinami Michaels,&nbsp;Ryan B. Ehredt,&nbsp;Demos J. Fotias,&nbsp;Steve S. Cho,&nbsp;Volker K.H. Sonntag,&nbsp;Juan S. Uribe","doi":"10.1016/j.jocn.2025.111839","DOIUrl":"10.1016/j.jocn.2025.111839","url":null,"abstract":"<div><h3>Background</h3><div>Neurosurgical education relies on rigorous training to help learners develop technical proficiency and neuroanatomical comprehension. Traditional teaching methods, such as cadaveric dissections and live surgical observations, face limitations associated with accessibility, cost, and ethical concerns. Mixed reality (MR), an emerging technology within extended reality, offers an interactive and immersive approach to surgical training. This review examines the effectiveness of MR in neurosurgical education through established adult learning theories, aiming to determine the optimal integration model for enhancing trainee skill acquisition and knowledge retention.</div></div><div><h3>Methods</h3><div>A systematic literature search of MEDLINE, Scopus, Embase, and Cochrane databases was conducted. The search included studies of MR applications in neurosurgical education aligned with adult learning theories. A total of 341 articles were identified, with 18 meeting the inclusion criteria after screening. Studies were categorized based on their integration of adult learning theories, including experiential learning, constructivism, behaviorism, cognitivism, and self-directed learning. Data extraction focused on MR applications, assessment metrics, and performance improvements among trainees.</div></div><div><h3>Results</h3><div>The review found that MR-based neurosurgical training improved spatial understanding, procedural accuracy, and trainee engagement. Experiential learning was the most frequently applied model (18 studies), followed by constructivism (15 studies), behaviorism (7 studies), and cognitivism (6 studies). Studies on cranial procedures demonstrated enhanced spatial cognition and motor skills, whereas studies exploring spinal procedures, such as pedicle screw placement, showed increased precision and greater trainee confidence. Although no studies explicitly emphasized andragogy or connectivism, MR’s integration of feedback mechanisms and real-time simulation was found to facilitate skill refinement and knowledge retention.</div></div><div><h3>Conclusions</h3><div>MR-based neurosurgical training aligns effectively with theories of adult learning, particularly experiential and constructivist learning. The technology enhances procedural accuracy and spatial awareness, contributing to improved neurosurgical education. Although MR accelerates the learning curve, randomized controlled trials are needed to evaluate its long-term impact on surgical performance. Incorporating MR into neurosurgical curricula could revolutionize training by fostering active learning, optimizing skill acquisition, and improving patient safety.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111839"},"PeriodicalIF":1.8,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922481","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":"Characterization of additional MRI findings in patients with Chiari spectrum disorders: focus on Chiari 0–1.5 subtypes","authors":"Leyla Salimli Mirzayeva ,&nbsp;Murat Uçar ,&nbsp;Emetullah Cindil ,&nbsp;Sümeyye Nur Budak ,&nbsp;Pelin Kuzucu","doi":"10.1016/j.jocn.2026.111858","DOIUrl":"10.1016/j.jocn.2026.111858","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the prevalence, distribution, and clinical significance of additional MRI findings in Chiari types 0–1.5 and their association with Chiari subtypes.</div></div><div><h3>Methods</h3><div>In this study, 147 patients who underwent comprehensive brain and whole-spine MRI for suspected Chiari deformity were categorized as Chiari 0, 0.5, 1, or 1.5 based on tonsillar descent and obex localization. Imaging review included assessment of syringomyelia (location, diameter, length, number), conus level, lumbosacral transitional vertebrae (LSTV), partial empty sella (PES), basilar invagination, block vertebrae, and hydrocephalus.</div></div><div><h3>Results</h3><div>Subtype distribution was Chiari 0 (16.3 %), 0.5 (6.8 %), 1 (40.1 %), and 1.5 (36.7 %). Syrinx morphology did not differ significantly among subtypes. A subforaminal obex was associated with higher syrinx prevalence (p = 0.04), whereas LSTV was more common when the obex was at or above the foramen magnum (p = 0.003). Additional findings included PES (13.6 %), basilar invagination (10.8 %), block vertebra (2.7 %), and paraspinal lipoma (0.7 %). PES was enriched in Chiari 1 (p = 0.02), and basilar invagination was enriched in Chiari 1.5 (p = 0.02). Syringomyelia occurred in 30.6 % overall and was positively correlated with hydrocephalus (5.4 % overall; p = 0.01; r = 0.23).</div></div><div><h3>Conclusions</h3><div>Additional craniospinal anomalies show subtype-specific patterns within the Chiari 0–1.5 spectrum: LSTV associates with a normal/high obex, PES with Chiari 1, and basilar invagination with Chiari 1.5. A significant syringomyelia–hydrocephalus association supports shared CSF dynamic disturbances. It is also thought that case-specific practices, such as hormonal screening in Chiari cases presenting with PES and dynamic flexion–extension screenings in Chiari 1.5 cases with basilar invagination, improve disease management.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111858"},"PeriodicalIF":1.8,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922583","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}