Journal of Clinical Neuroscience最新文献

{"title":"Letter to the Editor Response","authors":"Neil D. Almeida , Julia Rupp , Babar Gulzar , Tyler V. Schrand , Venkatesh Madhugiri , Mengyu Fang , Rohil Shekher , Victor Goulenko , Divya Goyal , Shefalika Prasad , Michael T. Milano , Dheerendra Prasad","doi":"10.1016/j.jocn.2025.111107","DOIUrl":"10.1016/j.jocn.2025.111107","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"133 ","pages":"Article 111107"},"PeriodicalIF":1.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414402","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":"Suspected wernicke encephalopathy with hemorrhage after total gastrectomy: A fatal case in a non-alcoholic patient","authors":"Sabahattin Yuzkan , Huseyin Ekin Ergin , Ahmet Peker , Yunus Emre Senturk","doi":"10.1016/j.jocn.2025.111116","DOIUrl":"10.1016/j.jocn.2025.111116","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111116"},"PeriodicalIF":1.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387243","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":"Performance evaluation of ChatGPT-4.0 and Gemini on image-based neurosurgery board practice questions: A comparative analysis","authors":"Alana M. McNulty ,&nbsp;Harshitha Valluri ,&nbsp;Avi A. Gajjar,&nbsp;Amanda Custozzo,&nbsp;Nicholas C. Field,&nbsp;Alexandra R. Paul","doi":"10.1016/j.jocn.2025.111097","DOIUrl":"10.1016/j.jocn.2025.111097","url":null,"abstract":"<div><h3>Introduction</h3><div>Artificial intelligence (AI) has gained significant attention in medicine, particularly in neurosurgery, where its potential is frequently discussed and occasionally feared. Large language models (LLMs), such as ChatGPT-4.0 (OpenAI) and Gemini (Google DeepMind), have shown promise in text-based tasks but remain underexplored in image-based domains, which are essential for neurosurgery. This study evaluates the performance of ChatGPT-4.0 and Gemini on image-based neurosurgery board practice questions, focusing on their ability to interpret visual data, a critical aspect of neurosurgical decision-making.</div></div><div><h3>Methods</h3><div>A total of 250 image-based questions selected from two neurosurgical review textbooks were obtained. Each question was presented to both ChatGPT-4.0 and Gemini in its original format, including images such as MRI scans, pathology slides, and surgical visuals. The models were tasked with answering the questions, and their accuracy was determined based on the number of correct responses.</div></div><div><h3>Results</h3><div>ChatGPT-4.0 correctly answered 84 questions (33.6 %), significantly outperforming Gemini, which answered only 1 question correctly (0.4 %) (p &lt; 0.0001). ChatGPT-4.0 provided correct answers for 17.7 % of questions from The Comprehensive Neurosurgery Board Preparation Book and 50.0 % from Neurosurgery Board Review. Gemini exhibited a 17.8 % “inability response” rate, explicitly stating it could not interpret images. The performance gap between the two models was significant (p &lt; 0.0001), highlighting their limitations in handling complex visual data.</div></div><div><h3>Conclusions</h3><div>While ChatGPT-4.0 demonstrated some capacity to interpret image-based neurosurgery board questions, both models exhibited significant limitations, particularly in processing and analyzing complex visual data. These findings emphasize the need for targeted advancements in AI to improve visual interpretation in neurosurgical education and practice.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111097"},"PeriodicalIF":1.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387242","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":"Assessment of age-related variation in cervical neuroforaminal dimensions","authors":"Kai Nguyen ,&nbsp;Zachary Brandt ,&nbsp;David Shin ,&nbsp;Rohan Kubba ,&nbsp;Ethan Vyhmeister ,&nbsp;Jacob Razzouk ,&nbsp;Christopher Shaffrey ,&nbsp;Wayne Cheng ,&nbsp;Olumide Danisa","doi":"10.1016/j.jocn.2025.111095","DOIUrl":"10.1016/j.jocn.2025.111095","url":null,"abstract":"<div><div>Radiographic parameters for diagnosing cervical neuroforaminal stenosis (CNFS) are not well described. To develop definitive criteria for diagnosis of CNFS, a standardized baseline of average neuroforaminal dimensions must first be established. Thus, the aim of this study was to: (1) use computed tomography (CT) of patients without neck pain or spinal pathology to establish mean cervical neuroforaminal dimensions (CNFD) across multiple age groups and (2) assess differences in CNFD by age. Cervical CT scans of 1,457 asymptomatic patients were reviewed to measure CNFD, defined as follows: axial width, craniocaudal height, and area. Patients were divided into four groups based on age: 18–35, 36–50, 51–64, and 65 + years. Statistical analyses were used to assess differences in CNFD according to age group.<!--> <!-->Mean overall CNFD for the 18–35 year-old cohort were 6.43 mm for width, 9.28 mm for height, and 58.85 mm² for area. For the 36–50 year-old cohort, dimensions were 5.89 mm for width, 8.63 mm for height, and 52.78 mm² for area. For the 51–64 year-old cohort, dimensions were 5.29 mm for width, 8.52 mm for height, and 48.93 mm² for area. Finally, the 65 + year-old cohort had dimensions of 5.09 mm for width, 8.16 mm for height, and 45.91 mm² for area. Significant differences in CNFD were observed between age groups, with dimensions decreasing in size from the younger to older age groups. In the studied population, CNFD decreased progressively with age. The results of our study may have utility in the diagnosis of CNFS.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111095"},"PeriodicalIF":1.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350527","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 utility of the 5-Item frailty index in assessing the risk of complications and mortality following surgical management of non-traumatic subarachnoid hemorrhage","authors":"Qais AbuHasan ,&nbsp;Jakob V.E. Gerstl ,&nbsp;Chady Omara ,&nbsp;Harshit Arora ,&nbsp;Muhieddine Labban ,&nbsp;Abdullah H. Feroze ,&nbsp;Timothy R. Smith ,&nbsp;Mohammad A. Aziz-Sultan","doi":"10.1016/j.jocn.2025.111111","DOIUrl":"10.1016/j.jocn.2025.111111","url":null,"abstract":"<div><div>The modified 5-item frailty index (mFI-5), an index of reduced physiological reserve, has risen as a predictor of complications following surgical procedures. We examined the association of mFI-5 and surgical outcomes following the management of nontraumatic subarachnoid hemorrhage (nSAH). We queried the American College of Surgeons National Surgical Quality Improvement Program database for patients who received surgical management of nSAH between 2006 and 2021. We computed the mFI-5 by granting a point for each of 1) congestive heart failure, 2) hypertension requiring medications, 3) diabetes, 4) chronic obstructive pulmonary disease or pneumonia within 30 days before surgery, and 5) dependent functional status. Our 30-day endpoints were minor complications (Clavien-Dindo: 1 &amp; 2), major complications (Clavien-Dindo: 3 &amp; 4), and mortality. Using the Chi-squared test, we compared baseline patient demographics and comorbidities between patients with a mFI-5 ≥ 2, patients with a mFI-5 = 1, and non-frail patients. Then, we fitted a multivariable logistic regression adjusting for patient demographics, comorbidities, operative time, and frailty status. The cohort included 1,139 patients, of which 33.7 % were men and 2.9 % had a bleeding diathesis. After adjusting for covariates, mFI-5 ≥ 2 was independently associated with minor complications (1.93, 95 %CI: 1.31–2.84, p = 0.001), major complications (aOR: 1.62, 95 %CI: 1.10–2.37, p = 0.015), and mortality (aOR: 2.90, 95 %CI: 1.66–5.08, p = 0.003). The mFI-5 can be independently used by surgeons for risk stratification and postoperative planning.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111111"},"PeriodicalIF":1.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349439","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":"Direct transfer to angiosuite vs conventional workup for stroke: A systematic review and meta-analysis","authors":"Ali Mortezaei ,&nbsp;Mohammadreza Alizadeh ,&nbsp;Mohammad Mirahmadi Eraghi ,&nbsp;Sogand Sheikholeslami ,&nbsp;Taimur Hasan ,&nbsp;Ramin Shahidi ,&nbsp;Visish M. Srinivasan ,&nbsp;Jan-Karl Burkhardt ,&nbsp;Redi Rahmani","doi":"10.1016/j.jocn.2025.111110","DOIUrl":"10.1016/j.jocn.2025.111110","url":null,"abstract":"<div><h3>Background</h3><div>Reducing the stroke time metric in patients with stroke who underwent thrombectomy is associated with good functional recovery. We compared direct transfer to angiosuite (DTAS) vs conventional workup (CWU) in patients who underwent endovascular treatment due to large vessel occlusion (LVO).</div></div><div><h3>Methods</h3><div>A systematic search was conducted in four electronic databases. The continuous outcomes were analyzed using the standardized mean difference (SMD) and 95 % CI, while the binary outcomes were analyzed using the odds ratio (OR) and 95 % confidence interval (CI).</div></div><div><h3>Results</h3><div>We included a total of 3145 patients, which 1168 patients were in DTAS group and 1977 were in CWU group. DTAS showed a significantly higher likelihood of 90-day mRS0-1 (OR 1.6, p = 0.002) and mRS0-2 (OR 1.47, p &lt; 0.0001), successful reperfusion (OR 1.53, 95 % CI 1.1 to 2.1, p = 0.0122), and lower door-to-puncture (SMD −4.36, 95 % CI −7.4 to −1.3, p = 0.0096) than CWU. There was no significant difference between the two triage protocols in 90-day mortality (OR 0.98, 95 % CI 0.6 to 1.64, p = 0.94) and symptomatic intracranial hemorrhage (OR 0.78, p = 0.14). The proportion of patients who were triaged to DTAS with non-LVO on diagnostic angiography in angiosuite was 5.76 % (95 % CI 1.8 % to 11.4 %). There was a significant difference between randomized trials versus observational studies in 90-day mRS0-2 (OR 1.91 vs 1.16, p = 0.0042), 90-day mortality (OR 0.62 vs 1.27, p = 0.12), and door-to-puncture time (SMD −1.25 vs −5.53, p = 0.027).</div></div><div><h3>Conclusion</h3><div>DTAS is a feasible, safe, and cost-effective triage approach for managing patients with acute stroke due to LVO.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111110"},"PeriodicalIF":1.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350532","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":"Investigation of blood carnitine levels in hydrocephalus patients","authors":"Ebru Temiz ,&nbsp;Ismail Koyuncu ,&nbsp;Murat Tiken ,&nbsp;Kadir Egi ,&nbsp;Sukru Akmese ,&nbsp;Gulyara Cigdem ,&nbsp;Huseyin Taskiran ,&nbsp;Mehmet Enes","doi":"10.1016/j.jocn.2025.111098","DOIUrl":"10.1016/j.jocn.2025.111098","url":null,"abstract":"<div><div>Hydrocephalus is a complex neurological disorder that severely impacts the central nervous system. It is a multifactorial disease causing significant neurological deterioration and death in children. Despite numerous studies on hydrocephalus, its pathophysiology remains unclear. This study aims to identify possible changes in carnitine metabolism by comparing the carnitine profiles of children with hydrocephalus to those of healthy children. Additionally, the study seeks to determine the potential use of carnitine derivatives in the diagnosis and treatment of hydrocephalus. Blood samples from 32 hydrocephalic patients and 25 healthy individuals were analyzed. The carnitine profile (C0, C2, C4, etc.) was measured using LC-MS/MS. Statistical analyses of the data were performed using the MetaboAnalyst 5.0 program. The results showed that 23 carnitines were significantly lower in the hydrocephalus group compared to the control group. According to the MetaboAnalyst VIP score, C12 was identified as having high potential as a distinguishing marker. ROC analysis indicated that C12 had a specificity of 100% and a sensitivity of 80%. These findings suggest reduced carnitine profile with hydrocephalus pathology. Therefore, further research should be conducted to explore the addition of carnitine to hydrocephalus treatment protocols.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111098"},"PeriodicalIF":1.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372481","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":"Expanded applications of knotless tissue control devices in neurosurgical cranial and spinal applications","authors":"Samuel A. Tenhoeve ,&nbsp;Clayton Rawson ,&nbsp;Dora R. Tabachnick ,&nbsp;Mohammed A. Azab ,&nbsp;Omowumi Oladipo ,&nbsp;Michael Karsy","doi":"10.1016/j.jocn.2025.111108","DOIUrl":"10.1016/j.jocn.2025.111108","url":null,"abstract":"<div><h3>Objectives</h3><div>Effective wound closure is essential to neurosurgical procedures. Historical rates of neurosurgical wound complications range from 7 to 14 %. Knotless suturing with barbed sutures may offer effective closure rates but has had limited evaluation of safety in neurosurgical applications.</div></div><div><h3>Methods</h3><div>Consecutive patients undergoing cranial, spinal, and peripheral nerve neurosurgical procedures from 12/2022 until 7/2024 were included in a quality improvement initiative. A retrospective review of demographics, past medical history, and operative and postoperative variables was undertaken. The primary outcome of interest was wound complications, including surgical site infection (SSI), dehiscence, or CSF leak. A cost analysis of suture treatment was also compared. A comparison to historical control rates (7%) was performed (one-sample proportional z-test).</div></div><div><h3>Results</h3><div>A total of 195 consecutive patients were identified, with 10 wound-related complications including 3 superficial dehiscence treated with washout, 2 pseudomeningoceles, 2 cerebrospinal fluid leaks with meningitis, and 1 each of deep dehiscence with washout, superficial dehiscence with antibiotics, and epidural hematoma. A total of 53 (27.2 %) underwent cranial, 140 (71.8 %) spine, and 3 (1.0 %) peripheral nerve procedures. Ten patients (5.1 %) had incision complications with no difference to historical controls (p = 0.3). Cost analysis showed a range 0.35–3.03X cost differences using the knotless suture technique for different neurosurgical applications.</div></div><div><h3>Conclusion</h3><div>Knotless suture techniques can be an effective closure method for a variety of neurosurgical techniques comparable to expected wound complication rates. We expand on the potential applications of this technology compared with prior studies. Further studies will be necessary to confirm these findings.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111108"},"PeriodicalIF":1.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372482","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":"Time to response and predictors of seizure response to phenobarbitone therapy among neonates admitted with hypoxic-ischemic encephalopathy at Nekemte Comprehensive Specialized Hospital, Ethiopia","authors":"Wase Benti Hailu ,&nbsp;Getnet Yimer ,&nbsp;Serawit Deyno ,&nbsp;Lensa Tamiru Bacha","doi":"10.1016/j.jocn.2025.111104","DOIUrl":"10.1016/j.jocn.2025.111104","url":null,"abstract":"<div><h3>Background</h3><div>Hypoxic-ischemic encephalopathy is a brain injury that occurs in newborns when there is not enough blood flow to the brain. Recent studies have raised concerns about how well phenobarbitone works for treating seizures in newborns, as it may not effectively control seizures with the initial loading and repeated doses.</div></div><div><h3>Objective</h3><div>This study evaluated the time to respond and predictors of seizure response to phenobarbitone therapy among neonates admitted with hypoxic-ischemic encephalopathy.</div></div><div><h3>Methods and Materials</h3><div>A retrospective cohort study was conducted at Nekemte Comprehensive Specialized Hospital, using randomly selected medical records of 284 neonates who were treated between January 2020 and December 31, 2023. The study included neonates diagnosed with perinatal asphyxia stage II and III hypoxic-ischemic encephalopathy, who were treated with nasogastric phenobarbitone. The treatment included an initial loading dose of 20 mg/kg and two repeated doses of 10 mg/kg. Survival analysis was conducted. Predictor variables with a p-value ≤ 0.25 in bivariate Cox regression were included in the multivariable Cox regression analysis. Adjusted Hazard Ratios with 95 % confidence intervals were computed, and a p-value &lt; 0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Out of the 284 neonates, 210 (73.9 %) responded to the phenobarbitone treatment. The incidence rate of response was 27.73 per 1000 person-hours of observation, with a median time to response of 29 h (IQR 26.5–32 h). Low birth weight (AHR = 0.59; 95 %CI 0.58, 0.98), subtle seizure type (AHR: 2.35; 95 % CI 1.09, 5.08), severe hypothermia (AHR = 0.23; 95 % CI 0.052, 0.26), and seizure frequency of twice or more (AHR = 0.436, 95 % CI 0.31, 0.61) were identified as predictors of seizure response.</div></div><div><h3>Conclusion and recommendations</h3><div>The overall incidence rate of response was low. Having a history of twice or more frequency of seizure insult, severe hypothermia and low birth weight decreased the response rate while subtle types of seizure increased the likelihood of response to phenobarbitone therapy. Electroencephalogram-confirmed seizure treatment and combined management with therapeutic hypothermia for high-risk newborns need to be started for better response and reduced response time. Further controlled studies utilizing both clinical and neuroimaging for definitive outcome measurement are recommended.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111104"},"PeriodicalIF":1.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143096435","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 single-session gamma knife radiosurgery for deep-seated arteriovenous malformations","authors":"Mohammed Nadeem,&nbsp;Abhijit Goyal-Honavar,&nbsp;Subhas Konar,&nbsp;Kandimalla Praveen Krishna,&nbsp;Nishanth Sadashiva,&nbsp;Andiperumal Raj Prabhuraj,&nbsp;Vikas Vazhayil,&nbsp;Abhinith Shashidhar,&nbsp;Manish Beniwal,&nbsp;Arivazhagan Arimappamagan","doi":"10.1016/j.jocn.2025.111096","DOIUrl":"10.1016/j.jocn.2025.111096","url":null,"abstract":"<div><h3>Background</h3><div>Deep-seated arteriovenous malformations (AVMs) pose unique surgical challenges due to their proximity to critical structures. Gamma knife radiosurgery (GKRS) thus serves a promising alternative that may reduce treatment-related morbidity of deep-seated AVMs. However, the efficacy of GKRS in achieving obliteration in deep AVMs is not established. Therefore, we examined our experience with GKRS in deep-seated AVMs.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all deep-seated (thalamic, basal ganglia and brainstem AVMs) that underwent GKRS at our center between 2006 and 2022. Factors that predicted obliteration were assessed, and the incidence of various long-term complications was recorded.</div></div><div><h3>Results</h3><div>The cohort comprised 137 patients, 74 males (54 %) and 63 females (46 %). The mean age was 25.1 ± 11.9 years. The mean dose delivered was 21.7 ± 2.6 Gy. The median volume of AVMs in our cohort was 3.2 cc (IQR: 1.5, 6.3 cc). The median follow-up was 36 months (IQR: 24, 42 months), following which 66 AVMs (48.2 %) were obliterated. Radiation-induced edema occurred in 8 cases (5.8 %), 7 of whom were symptomatic with neurological deficits (5.1 %). However, all patients improved on further follow-up with no residual neurological deficits. The median volume was significantly greater among cases with residual AVM (3.45 cc, IQR: 1.77, 6.85 cc) than those that were obliterated (2.77 cc, IQR: 1.09, 5.10 cc, <em>p = 0.049</em>). The mean Pollock Flickinger score was significantly greater among non-obliterated cases, as was the mean dose delivered (22.3 ± 2.7 Gy vs. 21.5 ± 2.8 Gy, <em>p = 0.044</em>). Multivariate analysis revealed that a nidus volume less than 3 cc was the only factor that predicted obliteration of the nidus (HR: 4.994, 2.139, 9.166, <em>p = 0.016</em>).</div></div><div><h3>Conclusions</h3><div>GKRS is an effective and safe treatment option for deep-seated AVMs. Obliteration occurred in 48.2% of cases, with complications in 5.8%. Nidus volume, rather than other clinical or radiological factors, appears to be the most significant predictor of successful obliteration. Despite the challenges posed by the complex anatomy of deep AVMs, including variable venous drainage and the potential for radiation-induced edema, GKRS is similarly effective in AVMs located in the thalamus, basal ganglia, and brainstem.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111096"},"PeriodicalIF":1.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143096436","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}