Pub Date : 2026-01-01Epub Date: 2025-12-14DOI: 10.1016/j.bas.2025.105909
Maximilian Lindemann , Donjetë Januzi , Sabine Borowski , Anne Neumeister , Denise Löschner , Daniel Dubinski , Peter Huppke , Christian Senft , Peter Baumgarten
Introduction
Helmet treatment is a worldwide acknowledged method to improve motor function, quality of life and aesthetics in patients with plagiocephaly.
Research question
The objective of this study is to assess percentile escape in head circumference in newborns receiving helmet therapy (HMT) for plagiocephaly.
Material and methods
All patients underwent HMT over 124.32 days on average (SD = 72.56), with 3D scans (Rodin4D neo) taken of their heads before, during and after the treatment. Eight participants were excluded due to insufficient data. Ten patients were excluded for either craniosynostosis or discontinuation of helmet therapy.
“German Health Interview and Examination Survey for Children and Adolescents” (KiGGS study) served as reference for the assessment of head circumference growth. Percentiles were calculated using the LMS-method.
Results
Out of 272 patients (94 females, 178 males), 238 had suitable parameters for the LMS-method. The average age at the onset of therapy was 5.99 (SD = 2.23) months, concluding at 10.06 months (SD = 3.01). The median percentile before HMT was 50.00 (SD = 39.5), which decreased significantly to 25.00 (SD = 33.84) after HMT (p < 0.001). Only 59 patients showed percentile adherence during the treatment. The mean difference in head circumference was 21.51 mm (SD = 14.81), ranging from −44.4 mm to 69.1 mm. Clinical examination revealed that the patients exhibit developmental progress consistent with respective ages.
Discussion and conclusion
Significant decrease in head circumferential growth was observed following HMT. Even though patients did not show clinical signs of raised ICP, to ascertain the clinical relevance of this percentile escape, conducting longer follow-ups involving a larger cohort of patients is crucial.
{"title":"Decreased skull growth in positional plagiocephaly patients undergoing helmet therapy","authors":"Maximilian Lindemann , Donjetë Januzi , Sabine Borowski , Anne Neumeister , Denise Löschner , Daniel Dubinski , Peter Huppke , Christian Senft , Peter Baumgarten","doi":"10.1016/j.bas.2025.105909","DOIUrl":"10.1016/j.bas.2025.105909","url":null,"abstract":"<div><h3>Introduction</h3><div>Helmet treatment is a worldwide acknowledged method to improve motor function, quality of life and aesthetics in patients with plagiocephaly.</div></div><div><h3>Research question</h3><div>The objective of this study is to assess percentile escape in head circumference in newborns receiving helmet therapy (HMT) for plagiocephaly.</div></div><div><h3>Material and methods</h3><div>All patients underwent HMT over 124.32 days on average (SD = 72.56), with 3D scans (Rodin4D neo) taken of their heads before, during and after the treatment. Eight participants were excluded due to insufficient data. Ten patients were excluded for either craniosynostosis or discontinuation of helmet therapy.</div><div>“German Health Interview and Examination Survey for Children and Adolescents” (KiGGS study) served as reference for the assessment of head circumference growth. Percentiles were calculated using the LMS-method.</div></div><div><h3>Results</h3><div>Out of 272 patients (94 females, 178 males), 238 had suitable parameters for the LMS-method. The average age at the onset of therapy was 5.99 (SD = 2.23) months, concluding at 10.06 months (SD = 3.01). The median percentile before HMT was 50.00 (SD = 39.5), which decreased significantly to 25.00 (SD = 33.84) after HMT (p < 0.001). Only 59 patients showed percentile adherence during the treatment. The mean difference in head circumference was 21.51 mm (SD = 14.81), ranging from −44.4 mm to 69.1 mm. Clinical examination revealed that the patients exhibit developmental progress consistent with respective ages.</div></div><div><h3>Discussion and conclusion</h3><div>Significant decrease in head circumferential growth was observed following HMT. Even though patients did not show clinical signs of raised ICP, to ascertain the clinical relevance of this percentile escape, conducting longer follow-ups involving a larger cohort of patients is crucial.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105909"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-03-03DOI: 10.1016/j.bas.2026.106001
Sourabh Zambre, Varidh Katiyar, Alok Umredkar
{"title":"Letter to editor: comment on the study “Català I, Roldán H, Fernández-Carballal C, Domínguez-Alonso C, Álvarez-Galovich L, Godino Ó. A new hernia blocking system prevents lumbar disc herniation recurrence and disc degeneration: 2-year results of a multicentric clinical investigation. Brain Spine. 2025;6:105898. https://doi.org/10.1016/j.bas.2025.105898","authors":"Sourabh Zambre, Varidh Katiyar, Alok Umredkar","doi":"10.1016/j.bas.2026.106001","DOIUrl":"10.1016/j.bas.2026.106001","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 106001"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radiation-induced cavernous malformation (RICM) is an uncommon late complication of radiation therapy. There are even fewer cases reported after stereotactic radiosurgery (SRS). In this study, we investigated the clinical characteristics, management considerations, and outcomes of RICM following SRS.
Research question
What are the clinical characteristics, management considerations, and outcomes of RICM following SRS?
Material and methods
We describe a case of a 50-year-old woman previously treated with Gamma Knife® radiosurgery for a vestibular schwannoma. Almost two decades later, brain magnetic resonance imaging revealed a brainstem cavernous malformation in the brainstem, in the dose fall-off region adjacent to the target volume. A literature review was subsequently conducted to identify comparable cases, associated therapeutic strategies, and clinical outcomes.
Results
We identified 32 reported cases of RICM following SRS in the literature. The mean age at SRS was 65 years, with 57% being female. Mean latency to RICM development was 7.3 years. Our case demonstrated one of the longest latency periods reported for this complication. The patient had mild symptoms and was managed conservatively with surveillance imaging. Literature review revealed that 78% of cases underwent surgical management, predominantly those presenting with hemorrhage or progressive neurological symptoms.
Conclusion
RICM represents a rare but clinically significant late complication of SRS that can occur after extended latency periods, even in adults. Management should be individualized based on symptoms, hemorrhage history, and lesion location. Further research is needed to develop more evidence-based management of RICM, and to better define the true incidence through long-term follow-up studies.
{"title":"Radiation-induced cavernous malformation in the brainstem after Gamma Knife radiosurgery for vestibular schwannoma: A case report and literature review","authors":"Erlend Moen Taule , Henrik Broch Kvernaas , Tor-Christian Aase Johannessen , Tormund Haugland Njølstad , Øystein Vesterli Tveiten , Rupavathana Mahesparan , Terje Sundstrøm","doi":"10.1016/j.bas.2026.105999","DOIUrl":"10.1016/j.bas.2026.105999","url":null,"abstract":"<div><h3>Introduction</h3><div>Radiation-induced cavernous malformation (RICM) is an uncommon late complication of radiation therapy. There are even fewer cases reported after stereotactic radiosurgery (SRS). In this study, we investigated the clinical characteristics, management considerations, and outcomes of RICM following SRS.</div></div><div><h3>Research question</h3><div>What are the clinical characteristics, management considerations, and outcomes of RICM following SRS?</div></div><div><h3>Material and methods</h3><div>We describe a case of a 50-year-old woman previously treated with Gamma Knife® radiosurgery for a vestibular schwannoma. Almost two decades later, brain magnetic resonance imaging revealed a brainstem cavernous malformation in the brainstem, in the dose fall-off region adjacent to the target volume. A literature review was subsequently conducted to identify comparable cases, associated therapeutic strategies, and clinical outcomes.</div></div><div><h3>Results</h3><div>We identified 32 reported cases of RICM following SRS in the literature. The mean age at SRS was 65 years, with 57% being female. Mean latency to RICM development was 7.3 years. Our case demonstrated one of the longest latency periods reported for this complication. The patient had mild symptoms and was managed conservatively with surveillance imaging. Literature review revealed that 78% of cases underwent surgical management, predominantly those presenting with hemorrhage or progressive neurological symptoms.</div></div><div><h3>Conclusion</h3><div>RICM represents a rare but clinically significant late complication of SRS that can occur after extended latency periods, even in adults. Management should be individualized based on symptoms, hemorrhage history, and lesion location. Further research is needed to develop more evidence-based management of RICM, and to better define the true incidence through long-term follow-up studies.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105999"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-08DOI: 10.1016/j.bas.2026.105931
Elle Vermeulen , Ramon Torné , Ebba Katsler , Nuri Alioski , Mihail Petrov , Teodora Sakelarova , Leire Pedrosa , Torstein Ragnar Meling , Nikolay Velinov , Hieronymus Damianus Boogaarts
Background
Angiography is a diagnostic and interventional technique in (endo)vascular neurosurgery that demands a high level of precision and technical expertise. Traditionally, mastery of angiographic techniques has relied on hands-on training, often limited by patient availability and procedural complexity. This study aims to investigate the effectiveness of simulator-based training for angiography, determining its role in enhancing procedural proficiency and its potential integration into a neuroendovascular training curriculum.
Research question
Is a simulator-based training for neuroangiography effective ?
Materials and methods
Participants (22 trainees and 10 experts) were recruited in neurosurgical departments from four international university hospitals. After a familiarization session, each participant performed 6 attempts of diagnostic angiography and 3 attempts of coiling on an Angio mentor endovascular simulator. Data gathered were procedure time, fluoroscopy time, amount of contrast injected, number of roadmap sequences and number of errors. The learning curve was studied and contrasting group assessment was performed.
Results
There was a clear steep improvement for all parameters in the learning curve which flattens out as the trainees master angiography and coiling. Trainees had a notable reduction in procedure time, approaching the experts' levels after sixth and seventh attempt of diagnostic angiography. The contrasting group assessment demonstrated discriminating results of experts compared to trainees and a distinctly increasing overlap between trainees and experts with increasing number of attempts.
Discussion and conclusions
Endovascular simulators enable skill acquisition in a controlled environment, enhancing technical proficiency in neuroendovascular coiling and angiography, and should play a role in neuroendovascular training.
{"title":"Validation of simulator-based neuroangiographical training","authors":"Elle Vermeulen , Ramon Torné , Ebba Katsler , Nuri Alioski , Mihail Petrov , Teodora Sakelarova , Leire Pedrosa , Torstein Ragnar Meling , Nikolay Velinov , Hieronymus Damianus Boogaarts","doi":"10.1016/j.bas.2026.105931","DOIUrl":"10.1016/j.bas.2026.105931","url":null,"abstract":"<div><h3>Background</h3><div>Angiography is a diagnostic and interventional technique in (endo)vascular neurosurgery that demands a high level of precision and technical expertise. Traditionally, mastery of angiographic techniques has relied on hands-on training, often limited by patient availability and procedural complexity. This study aims to investigate the effectiveness of simulator-based training for angiography, determining its role in enhancing procedural proficiency and its potential integration into a neuroendovascular training curriculum.</div></div><div><h3>Research question</h3><div>Is a simulator-based training for neuroangiography effective ?</div></div><div><h3>Materials and methods</h3><div>Participants (22 trainees and 10 experts) were recruited in neurosurgical departments from four international university hospitals. After a familiarization session, each participant performed 6 attempts of diagnostic angiography and 3 attempts of coiling on an Angio mentor endovascular simulator. Data gathered were procedure time, fluoroscopy time, amount of contrast injected, number of roadmap sequences and number of errors. The learning curve was studied and contrasting group assessment was performed.</div></div><div><h3>Results</h3><div>There was a clear steep improvement for all parameters in the learning curve which flattens out as the trainees master angiography and coiling. Trainees had a notable reduction in procedure time, approaching the experts' levels after sixth and seventh attempt of diagnostic angiography. The contrasting group assessment demonstrated discriminating results of experts compared to trainees and a distinctly increasing overlap between trainees and experts with increasing number of attempts.</div></div><div><h3>Discussion and conclusions</h3><div>Endovascular simulators enable skill acquisition in a controlled environment, enhancing technical proficiency in neuroendovascular coiling and angiography, and should play a role in neuroendovascular training.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105931"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-05DOI: 10.1016/j.bas.2026.105926
Enrico Aimar , Lucrezia Di Stefano , Federico Longhitano , Alberto Bona , Marco Meloni , Tommaso Alfiero , Federica Valente , Roberta Bonomo , Giulio Bonomo , Flavio Tancioni , Guglielmo Iess
Introduction
As the population ages, L4–L5 degenerative spondylolisthesis is increasingly common. Posterolateral fusion was long standard; interbody cages are widely used for perceived higher fusion rates.
Research question
Does adding an interbody cage to posterolateral fusion improve outcomes or reduce complications in elderly patients with grade I spondylolisthesis and severe stenosis?
Materials and methods
We retrospectively studied 319 adults aged 60–85 who underwent single-level L4–L5 fusion (2011–2018) after failed conservative care. Patients received posterior lumbar fusion (PLIF, n = 155) or posterolateral lumbar fusion (PLF, n = 164). Primary outcomes were Oswestry Disability Index (ODI) change and complications over a median five-year follow-up; secondary outcomes were operative time, hospital stay, and transfusions. Multivariable analyses adjusted for age, sex, BMI, year of surgery, and sagittal alignment.
Results
Functional improvement was similar (median ODI reduction ≈22 points; p = 0.97), and implant-related revision and revision-free survival did not differ. Cage use increased overall complications (24.5 % vs 7.9 %), prolonged surgery (125 vs 95 min) and hospital stay (4 vs 3 days), and raised transfusions (9.7 % vs 1.8 %), dural tears (11.6 % vs 2.4 %), and radicular deficits (6.5 % vs 1.2 %). The association between cage use and complications persisted after adjustment.
Conclusion
In this elderly, low-grade L4–L5 degenerative spondylolisthesis cohort, adding a posterior interbody cage to instrumented posterolateral fusion did not improve 5-year disability but was associated with higher peri-operative morbidity and greater resource use.
随着人口老龄化，L4-L5退行性椎体滑脱越来越常见。后外侧融合长标准；椎体间固定器被广泛用于更高的融合率。研究问题：对于患有I级椎体滑脱和严重椎管狭窄的老年患者，在后外侧融合中加入椎间笼是否能改善预后或减少并发症？材料和方法我们回顾性研究了319例年龄在60-85岁之间的成年人，他们在保守治疗失败后接受了单节段L4-L5融合（2011-2018）。患者接受后路腰椎融合术（PLIF, n = 155）或后外侧腰椎融合术（PLF, n = 164）。主要结局是Oswestry残疾指数（ODI）变化和中位5年随访期间的并发症；次要结局为手术时间、住院时间和输血量。多变量分析调整了年龄、性别、BMI、手术年份和矢状排列。结果功能改善相似（ODI中位数降低≈22点；p = 0.97），种植体相关翻修和无翻修生存期无差异。笼的使用增加了总并发症（24.5% vs 7.9%），延长了手术时间（125 vs 95分钟）和住院时间（4 vs 3天），增加了输血量（9.7% vs 1.8%），硬脑膜撕裂（11.6% vs 2.4%）和神经根缺损（6.5% vs 1.2%）。调整后，笼的使用与并发症之间的关系仍然存在。结论：在老年低级别L4-L5退行性椎体滑脱队列中，在固定后外侧融合中加入后路椎体间固定器并不能改善5年残疾，但会导致更高的围手术期发病率和更多的资源使用。
{"title":"Does adding an interbody cage in L4–L5 posterolateral fusion for degenerative spondylolisthesis and stenosis improve clinical outcome?","authors":"Enrico Aimar , Lucrezia Di Stefano , Federico Longhitano , Alberto Bona , Marco Meloni , Tommaso Alfiero , Federica Valente , Roberta Bonomo , Giulio Bonomo , Flavio Tancioni , Guglielmo Iess","doi":"10.1016/j.bas.2026.105926","DOIUrl":"10.1016/j.bas.2026.105926","url":null,"abstract":"<div><h3>Introduction</h3><div>As the population ages, L4–L5 degenerative spondylolisthesis is increasingly common. Posterolateral fusion was long standard; interbody cages are widely used for perceived higher fusion rates.</div></div><div><h3>Research question</h3><div>Does adding an interbody cage to posterolateral fusion improve outcomes or reduce complications in elderly patients with grade I spondylolisthesis and severe stenosis?</div></div><div><h3>Materials and methods</h3><div>We retrospectively studied 319 adults aged 60–85 who underwent single-level L4–L5 fusion (2011–2018) after failed conservative care. Patients received posterior lumbar fusion (PLIF, n = 155) or posterolateral lumbar fusion (PLF, n = 164). Primary outcomes were Oswestry Disability Index (ODI) change and complications over a median five-year follow-up; secondary outcomes were operative time, hospital stay, and transfusions. Multivariable analyses adjusted for age, sex, BMI, year of surgery, and sagittal alignment.</div></div><div><h3>Results</h3><div>Functional improvement was similar (median ODI reduction ≈22 points; p = 0.97), and implant-related revision and revision-free survival did not differ. Cage use increased overall complications (24.5 % vs 7.9 %), prolonged surgery (125 vs 95 min) and hospital stay (4 vs 3 days), and raised transfusions (9.7 % vs 1.8 %), dural tears (11.6 % vs 2.4 %), and radicular deficits (6.5 % vs 1.2 %). The association between cage use and complications persisted after adjustment.</div></div><div><h3>Conclusion</h3><div>In this elderly, low-grade L4–L5 degenerative spondylolisthesis cohort, adding a posterior interbody cage to instrumented posterolateral fusion did not improve 5-year disability but was associated with higher peri-operative morbidity and greater resource use.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105926"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-02-08DOI: 10.1016/j.bas.2026.105973
Lucas Rubisoier , Leonardo Lustgarten , Claudius Thomé , Christian F. Freyschlag , Johannes Kerschbaumer
Introduction
Brain tumors diagnosed during pregnancy are exceptionally rare, and their clinical progression is not yet fully understood. Managing intracranial tumors during pregnancy necessitates a specialized approach, balancing neuro-oncological considerations with obstetric concerns to evaluate therapeutic options effectively.
Tumor Treating Fields (TTF) therapy is a non-invasive, regionally-applied, anti-cancer treatment modality approved for adults with newly diagnosed and recurrent glioblastoma. To date, there is no data on the safety and efficacy of TTF therapy in pregnant patients harbouring malignant brain tumors.
Research question
To describe a case of TTF-use during pregnancy and provide a first insight into its feasibility.
Materials and methods
We describe the first reported case of a pregnant women treated with TTF. Medical records and imaging data were analysed. Relevant literature concerning the management of malignant brain tumors in pregnancy was reviewed.
Results
The patient diagnosed with a posterior fossa high-grade anaplastic ganglioglioma (CNS WHO grade 3-4) received surgical resection followed by radiotherapy with fetal shielding combined with TTF therapy during pregnancy.
Discussion and conclusion
Since TTF therapy represents a topical treatment without systemic application, we suggest it as a feasible option for pregnant patients diagnosed with malignant brain tumors.
{"title":"Use of tumor treating fields for a malignant brain tumor in a pregnant woman: Case report","authors":"Lucas Rubisoier , Leonardo Lustgarten , Claudius Thomé , Christian F. Freyschlag , Johannes Kerschbaumer","doi":"10.1016/j.bas.2026.105973","DOIUrl":"10.1016/j.bas.2026.105973","url":null,"abstract":"<div><h3>Introduction</h3><div>Brain tumors diagnosed during pregnancy are exceptionally rare, and their clinical progression is not yet fully understood. Managing intracranial tumors during pregnancy necessitates a specialized approach, balancing neuro-oncological considerations with obstetric concerns to evaluate therapeutic options effectively.</div><div>Tumor Treating Fields (TTF) therapy is a non-invasive, regionally-applied, anti-cancer treatment modality approved for adults with newly diagnosed and recurrent glioblastoma. To date, there is no data on the safety and efficacy of TTF therapy in pregnant patients harbouring malignant brain tumors.</div></div><div><h3>Research question</h3><div>To describe a case of TTF-use during pregnancy and provide a first insight into its feasibility.</div></div><div><h3>Materials and methods</h3><div>We describe the first reported case of a pregnant women treated with TTF. Medical records and imaging data were analysed. Relevant literature concerning the management of malignant brain tumors in pregnancy was reviewed.</div></div><div><h3>Results</h3><div>The patient diagnosed with a posterior fossa high-grade anaplastic ganglioglioma (CNS WHO grade 3-4) received surgical resection followed by radiotherapy with fetal shielding combined with TTF therapy during pregnancy.</div></div><div><h3>Discussion and conclusion</h3><div>Since TTF therapy represents a topical treatment without systemic application, we suggest it as a feasible option for pregnant patients diagnosed with malignant brain tumors.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105973"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-29DOI: 10.1016/j.bas.2025.105924
Tim Lampmann , Harun Asoglu , Haitham Alenezi , Mohammed Jaber , Bettina Otto , Mohammed Banat , Erdem Güresir , Hartmut Vatter , Motaz Hamed
Objective
Many patients suffering from aneurysmal subarachnoid hemorrhage (SAH) develop epileptic seizures. The recent guidelines do not recommend routine administration of antiepileptic drugs (AED).
Research question
We performed a retrospective single-center study to analyze the effect of AEDs on the outcome in patients suffering from epilepsy after SAH.
Methods
752 patients with SAH treated between 01/2006 and 12/2020 were analyzed. Patients were divided into good-grade (WFNS grades I-II) versus poor-grade (WFNS grades III-V) on admission. Data of patients’ history as well as clinical course were collected. Outcome according to the modified Rankin scale (mRS) score was assessed at 6 months after ictus. Outcome was dichotomized into favorable (mRS 0–2) and unfavorable (mRS 3–6). Univariate and multivariate analyses were performed.
Results
346 (46.0 %) patients suffered from poor-grade SAH and 366 (48.7 %) patients achieved unfavorable outcome. 202 (26.9 %) patients suffered from seizures after SAH and 136 (18.1 %) had to be treated with antiepileptic drugs (AEDs) for more than a week. Epilepsy and AED intake after 3 months was more often in patients with unfavorable outcome (18.9 % vs. 8.3 %; p < 0.001 and 21.9 % vs. 11.9 %; p < 0.001, respectively).
In multivariate analysis, ‘poor-grade SAH’ (p < 0.001, OR 10.5, 95 % CI 6.0–18.2), ‘age >50 years’ (p = 0.001, OR 2.7, 95 % CI 1.5–4.8, ‘aneurysm size >10 mm’ (p = 0.018, OR 2.2, 95 % CI 1.1–4.1), ‘hydrocephalus’ (p = 0.002, OR 2.6, 95 % CI 1.4–4.7), ‘delayed cerebral ischemia’ (p = 0.002, OR 5.0, 95 % CI 2.3–10.9) and ‘epilepsy within 3 months’ (p = 0.002, OR 5.9, 95 % CI 1.9–18.3) were predictors for unfavorable outcome, whereas ‘AED intake after 6 months’ (p = 0.037, OR 0.35, 95 % CI 0.13–0.94) was predictor for favorable outcome.
Conclusions
Manifestation of epilepsy in patients suffering from SAH deteriorates outcome. Continued AED intake in SAH patients who developed epileptic seizures should be advised.
{"title":"Influence of epilepsy and antiepileptic drug intake in patients suffering from aneurysmal subarachnoid hemorrhage on outcome","authors":"Tim Lampmann , Harun Asoglu , Haitham Alenezi , Mohammed Jaber , Bettina Otto , Mohammed Banat , Erdem Güresir , Hartmut Vatter , Motaz Hamed","doi":"10.1016/j.bas.2025.105924","DOIUrl":"10.1016/j.bas.2025.105924","url":null,"abstract":"<div><h3>Objective</h3><div>Many patients suffering from aneurysmal subarachnoid hemorrhage (SAH) develop epileptic seizures. The recent guidelines do not recommend routine administration of antiepileptic drugs (AED).</div></div><div><h3>Research question</h3><div>We performed a retrospective single-center study to analyze the effect of AEDs on the outcome in patients suffering from epilepsy after SAH.</div></div><div><h3>Methods</h3><div>752 patients with SAH treated between 01/2006 and 12/2020 were analyzed. Patients were divided into good-grade (WFNS grades I-II) versus poor-grade (WFNS grades III-V) on admission. Data of patients’ history as well as clinical course were collected. Outcome according to the modified Rankin scale (mRS) score was assessed at 6 months after ictus. Outcome was dichotomized into favorable (mRS 0–2) and unfavorable (mRS 3–6). Univariate and multivariate analyses were performed.</div></div><div><h3>Results</h3><div>346 (46.0 %) patients suffered from poor-grade SAH and 366 (48.7 %) patients achieved unfavorable outcome. 202 (26.9 %) patients suffered from seizures after SAH and 136 (18.1 %) had to be treated with antiepileptic drugs (AEDs) for more than a week. Epilepsy and AED intake after 3 months was more often in patients with unfavorable outcome (18.9 % vs. 8.3 %; p < 0.001 and 21.9 % vs. 11.9 %; p < 0.001, respectively).</div><div>In multivariate analysis, ‘poor-grade SAH’ (p < 0.001, OR 10.5, 95 % CI 6.0–18.2), ‘age >50 years’ (p = 0.001, OR 2.7, 95 % CI 1.5–4.8, ‘aneurysm size >10 mm’ (p = 0.018, OR 2.2, 95 % CI 1.1–4.1), ‘hydrocephalus’ (p = 0.002, OR 2.6, 95 % CI 1.4–4.7), ‘delayed cerebral ischemia’ (p = 0.002, OR 5.0, 95 % CI 2.3–10.9) and ‘epilepsy within 3 months’ (p = 0.002, OR 5.9, 95 % CI 1.9–18.3) were predictors for unfavorable outcome, whereas ‘AED intake after 6 months’ (p = 0.037, OR 0.35, 95 % CI 0.13–0.94) was predictor for favorable outcome.</div></div><div><h3>Conclusions</h3><div>Manifestation of epilepsy in patients suffering from SAH deteriorates outcome. Continued AED intake in SAH patients who developed epileptic seizures should be advised.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105924"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-12DOI: 10.1016/j.bas.2025.105892
Fee Christiane Keil , Emma Becke , Rejane Golbach , Angelo Ippolito , Fatma Kilinc , Jürgen Konczalla , Maximillian Rauch , Marcus Czabanka , Elke Hattingen , Katharina J. Wenger
Introduction
Adjunctive therapies such as statins have been proposed to reduce recurrence rates in chronic subdural hematoma (CSDH).
Research question
Does pre-existing statin therapy influence CSDH recurrence after middle meningeal artery embolization (MMAE), with or without surgical evacuation?
Material and methods
We retrospectively analyzed all patients who underwent MMAE for CSDH between January 2020 and October 2021 at a university hospital with a neurovascular focus. Indications were: salvage after recurrence without additional surgical drainage, first-line MMAE in patients at high surgical risk, adjunct after surgical drainage, and salvage after recurrence with additional drainage. Statin exposure referred to statins documented before MMAE and not discontinued during follow-up.
Data included clinical variables, adjunctive statin and CT-based hematoma characteristics.
Clinical therapy failure required radiological recurrence plus new neurological symptoms. Analyses were descriptive and exploratory.
Results
A total of 47 CSDHs in 38 patients (9 bilateral) were treated. Clinical failures occurred in 3/47 (6.4 %) overall, by indication: 2/13 (15.4 %) salvage-without-drainage, 1/15 (6.7 %) first-line MMAE, 0/6 (0 %) adjunct-after-drainage, 0/13 (0 %) salvage-with-drainage.
Statins were administered in a subset of patients. The overall recurrence rate was 6.4 %. No significant association was found between statin exposure (18/47, 38.3 % and recurrence.
One patient died from contrast-induced anaphylaxis prior to embolization; no intraprocedural device related complications were recorded.
Conclusion
In this cohort, statin use was not associated with reduced recurrence after MMAE. Combined surgery plus MMAE showed no observed recurrences, whereas events occurred after MMAE alone. Given the small sample these results are exploratory and require prospective confirmation.
{"title":"Chronic subdural hematoma management with MMA embolization ± surgery: Pre-existing statin therapy did not reduce recurrence","authors":"Fee Christiane Keil , Emma Becke , Rejane Golbach , Angelo Ippolito , Fatma Kilinc , Jürgen Konczalla , Maximillian Rauch , Marcus Czabanka , Elke Hattingen , Katharina J. Wenger","doi":"10.1016/j.bas.2025.105892","DOIUrl":"10.1016/j.bas.2025.105892","url":null,"abstract":"<div><h3>Introduction</h3><div>Adjunctive therapies such as statins have been proposed to reduce recurrence rates in chronic subdural hematoma (CSDH).</div></div><div><h3>Research question</h3><div>Does pre-existing statin therapy influence CSDH recurrence after middle meningeal artery embolization (MMAE), with or without surgical evacuation?</div></div><div><h3>Material and methods</h3><div>We retrospectively analyzed all patients who underwent MMAE for CSDH between January 2020 and October 2021 at a university hospital with a neurovascular focus. Indications were: salvage after recurrence without additional surgical drainage, first-line MMAE in patients at high surgical risk, adjunct after surgical drainage, and salvage after recurrence with additional drainage. Statin exposure referred to statins documented before MMAE and not discontinued during follow-up.</div><div>Data included clinical variables, adjunctive statin and CT-based hematoma characteristics.</div><div>Clinical therapy failure required radiological recurrence plus new neurological symptoms. Analyses were descriptive and exploratory.</div></div><div><h3>Results</h3><div>A total of 47 CSDHs in 38 patients (9 bilateral) were treated. Clinical failures occurred in 3/47 (6.4 %) overall, by indication: 2/13 (15.4 %) salvage-without-drainage, 1/15 (6.7 %) first-line MMAE, 0/6 (0 %) adjunct-after-drainage, 0/13 (0 %) salvage-with-drainage.</div><div>Statins were administered in a subset of patients. The overall recurrence rate was 6.4 %. No significant association was found between statin exposure (18/47, 38.3 % and recurrence.</div><div>One patient died from contrast-induced anaphylaxis prior to embolization; no intraprocedural device related complications were recorded.</div></div><div><h3>Conclusion</h3><div>In this cohort, statin use was not associated with reduced recurrence after MMAE. Combined surgery plus MMAE showed no observed recurrences, whereas events occurred after MMAE alone. Given the small sample these results are exploratory and require prospective confirmation.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105892"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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