Neurosurgical Review最新文献

Objective clazosentan has been approved in Japan for the prevention of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH) and has contributed to the significant suppression of angiographic vasospasm in clinical practice. We herein report the beneficial effects of clazosentan on the perioperative management of patients with aSAH. Methods The study population comprised 102 consecutive patients with aSAH: 49 received conventional treatment (fasudil with triple-H therapy) before May 2022, and 53 were treated with the current protocol (clazosentan management) thereafter. The factors associated with vasospasm and perioperative management, as well as the implementation status of postoperative rehabilitation, hospitalization and outcomes at discharge were compared. Results the prevalence of angiographic vasospasm was significantly lower in the clazosentan group than in the fasudil group (32.1% vs. 59.2%, p < 0.01). Although the incidence of vasospasm-related DCI and favorable outcomes at discharge tended to be better in the clazosentan group, these differences were not statistically significant. Despite equivalent timing of rehabilitation initiation, sitting training and physiotherapy in the training room were initiated significantly earlier in the clazosentan group than in the fasudil group (6.5 days vs. 10.7 days, p < 0.01; 11.8 days vs. 16.1 days, p < 0.01). Furthermore, the length of hospital stay was significantly shorter in the clazosentan group than in the fasudil group (22.3 days vs. 29.6 days, p < 0.01). Conclusion clazosentan-based management was associated with reduced angiographic vasospasm, earlier rehabilitation, and shorter hospitalization compared with fasudil-based management.

Radiomics is an emerging clinical application in medicine that extracts quantitative features from diagnostic imaging modalities to reveal patterns beyond human qualitative perception. While radiomic applications have been well developed in neuro-oncology, their relevance to other neurosurgical subspecialties and broader utility remain unexplored. Particularly, traumatic brain and spinal cord injuries demand rapid, high-stakes decisions often based on subtle or evolving imaging findings. Radiomics offers the potential to enhance real-time decision-making through predictive analytics and risk stratification. This review explores recent advances in radiomics for neurotrauma, highlighting its feasibility, barriers to clinical adoption, and pathways for integration into patient care. A comprehensive systematic search of PubMed, OVID, and Google Scholar was conducted through November 2025 using keywords related to radiomics and neurotrauma, including traumatic brain injury (TBI) and spinal cord injury (SCI). Studies were included if they involved human subjects and applied radiomics for predictive modeling in TBI or SCI. Non-traumatic, oncologic, degenerative, or purely descriptive studies were excluded. Reference lists were manually reviewed to ensure completeness, and the included studies were then categorized by TBI or SCI focus. Study quality and risk of bias were assessed using the PROBAST (Prediction model Risk of Bias Assessment Tool). Predictive models have shown significant promise in diagnosing neurological conditions, estimating prognosis, neurological recovery, in-hospital mortality, injury progression, intracranial hypertension, and diffuse axonal injury severity. Of the twenty-three studies that met the inclusion criteria, eight were multicenter studies. All but one study was retrospective, with six undergoing external validation. Radiomic models demonstrated strong predictive performance with all included studies reporting AUC values of greater than 0.80 (100%). Furthermore, eight studies that combined multi-omic modalities achieved high AUCs greater than 0.90. Radiomics can provide a tool to improve current clinical models to provide more accurate diagnosis, prediction of recovery, and risk stratification in neurotrauma. However, the current evidence is largely single-centered and retrospective without a clear direction for clinical translation and limited generalizability. Further research will need to standardize current protocols to create replicable models that can be applied across institutions.