Clinical Neurology and Neurosurgery最新文献

{"title":"Optimal timing for early cranioplasty following craniectomy: A propensity-matched national database study of 3241 patients","authors":"Georgios S. Sioutas,&nbsp;Alan Napole,&nbsp;Bhargavi Budihal,&nbsp;Pierce Davis,&nbsp;Saarang Patel,&nbsp;Oleg Shekhtman,&nbsp;Mohamed M. Salem,&nbsp;Visish M. Srinivasan,&nbsp;Jan Karl Burkhardt","doi":"10.1016/j.clineuro.2025.108989","DOIUrl":"10.1016/j.clineuro.2025.108989","url":null,"abstract":"<div><h3>Introduction</h3><div>Nearly 30 % of patients experience complications following cranioplasty after decompressive craniectomy. However, the optimal timing for this procedure is not well established.</div></div><div><h3>Objective</h3><div>To compare complication rates for cranioplasty performed at different early monthly intervals after craniectomy.</div></div><div><h3>Methods</h3><div>Using the TriNetX Research Network, we included patients who underwent either late cranioplasty (91 days-1 year), or cranioplasty in the first, second, or third month after craniectomy. Propensity score matching was used to match the late cranioplasty group separately with the other three cranioplasty groups based on baseline characteristics in the whole cohort and in a TBI-specific subgroup. Postoperative outcomes were assessed at 6 months after cranioplasty.</div></div><div><h3>Results</h3><div>We analyzed 3241 patients. After matching, 375 patients remained in the first-month, 365 in the second month, and 434 in the third-month group. Compared to late cranioplasty, ICH as a post-operative outcome was significantly more common in the first-month cranioplasty (p = 0.037) and second-month cranioplasty (p = 0.042) groups, while SDH as a post-operative outcome was more frequent in all early cranioplasty groups (p &lt; 0.01). The need for repeat cranioplasty was higher in the first month (p = 0.002) and second month (p = 0.031) groups. Repeat Craniectomy/Craniotomy and CSF leak were more common in the first-month group (p = 0.006 and 0.001, respectively). Mortality was higher in the first month (RR=2.9, 95 %CI:1.5–5.5, p = 0.001) cranioplasty group.</div></div><div><h3>Conclusion</h3><div>Cranioplasty within 2 months after craniectomy was associated with increased postoperative morbidity and mortality, especially for patients without TBI. Prospective studies are needed to establish the best timing for cranioplasty.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108989"},"PeriodicalIF":1.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168194","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":"Progression of intracranial hemorrhages in neurotrauma patients: A clinical and radiological comparison of isolated versus multiple areas of hemorrhage and associated transfusion treatment strategies","authors":"Cody J. Orton ,&nbsp;Samuel A. Tenhoeve ,&nbsp;Matthew C. Findlay ,&nbsp;Sarah Nguyen ,&nbsp;Sarah T. Menacho","doi":"10.1016/j.clineuro.2025.108984","DOIUrl":"10.1016/j.clineuro.2025.108984","url":null,"abstract":"<div><h3>Purpose</h3><div>The similar presentation of patients with multiple simultaneous (mICHs) or isolated (iICH) intracranial hemorrhages prompted investigation of clinical and radiological ICH progression during hospitalization in these cohorts. We also examined the role of aggressive transfusion and acute interventions on patient morbidity and mortality.</div></div><div><h3>Methods</h3><div>Adult (&gt;18 years) neurotrauma patients treated at our Level 1 trauma center between January 1, 2002, and December 31, 2022, with an iICH or mICH were included based on meeting 5 criteria: isolated neurotrauma; ICH injury beyond subarachnoid hemorrhage; repeat head CT available; no anticoagulant usage; and survivable injuries. Data collected retrospectively included demographics, potential risk factors for ICH, injury type, management details, transfusion characteristics, and outcomes. The primary outcome was the clinical and radiological progression of ICH during hospitalization, and the secondary outcome was the role of aggressive transfusion and acute interventions on patient morbidity and mortality.</div></div><div><h3>Results</h3><div>Among the 596 patients, 242 had iICH and 354 had mICH. Other than age (p = .01) and Glasgow Coma Scale score (p &lt; .001), most presentation characteristics, including comorbidities, were similar in the two groups. Although patients with iICH were less likely to have subarachnoid hemorrhage (p &lt; .001), epidural hematoma (p = .03), intraparenchymal hematoma (p &lt; .001), and hemorrhagic contusions (p &lt; .001), subdural hematomas were equally likely to occur in both groups (p = .52). There were no significant differences in neurosurgical treatment by ICH type. There were no significant differences in progression on imaging or transfusions received between the two groups.</div></div><div><h3>Conclusion</h3><div>Although our data are limited as a single-center retrospective analysis, these results highlight the similarities between patients with iICH and mICH and indicate that treatment may be independent of the number of bleeds.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108984"},"PeriodicalIF":1.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168195","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":"Altered default mode network connectivity in basal ganglia intracerebral hemorrhage: A resting-state fMRI study","authors":"Lichao Wei ,&nbsp;Jun Zhang ,&nbsp;Fengyuan Zhou ,&nbsp;Dewen Ru ,&nbsp;Caihua Xi ,&nbsp;Zhuoyin Du ,&nbsp;Biwu Wu ,&nbsp;Gang Wu ,&nbsp;Qiang Yuan ,&nbsp;Jin Hu","doi":"10.1016/j.clineuro.2025.108987","DOIUrl":"10.1016/j.clineuro.2025.108987","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigates the impact of basal ganglia intracerebral hemorrhage (ICH) on default mode network (DMN) connectivity and its relationship with cognitive impairment using resting-state functional magnetic resonance imaging (rs-fMRI).</div></div><div><h3>Method</h3><div>DMN differences between left/right basal ganglia ICH patients and healthy controls were analyzed respectively. Co-altered brain region were obtained by overlapping the differential brain regions of bilateral basal ganglia ICH. Gene and functional decoding analyses validated the role of co-altered brain regions in cognition. Whole-brain functional connectivity (FC) analysis was conducted using the co-altered brain region as a seed, and correlation analysis was performed with the Mini-Mental State Examination (MMSE) to obtain the cognitive representation brain network of patients in basal ganglia ICH. Finally, it was nested with the DMN of basal ganglia ICH patients to obtain the important brain regions regulating cognitive function in the DMN of basal ganglia ICH patients.</div></div><div><h3>Result</h3><div>A total of 89 basal ganglia ICH patients were enrolled. Compared to healthy controls, bilateral basal ganglia ICH patients showed significant alterations in DMN connectivity. The co-altered brain region mainly involved the medial prefrontal cortex (mPFC). Additionally, gene and functional decoding analyses revealed strong association with chemical synaptic transmission, synaptic signaling, cognition, and intelligence. The left parahippocampal gyrus, the left superior temporal gyrus, right temporal regions, the cerebellar, and posterior cingulate cortex exhibited significant correlation with MMSE. Furthermore, the left parahippocampal gyrus emerged as a key node in the DMN of basal ganglia ICH patients involved in cognitive regulation.</div></div><div><h3>Conclusion</h3><div>The mPFC-left parahippocampal circuit in the DMN plays a crucial role in cognitive regulation following basal ganglia ICH. These findings provide new insights into neural mechanisms underlying cognitive changes after basal ganglia ICH and suggest potential therapeutic targets for cognitive rehabilitation.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108987"},"PeriodicalIF":1.8,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138517","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":"Validation of the SHELTER score after aneurysmal subarachnoid hemorrhage cohort: An observational retrospective study","authors":"Marzia Savi ,&nbsp;Eva Vitali ,&nbsp;Gaia Furlan ,&nbsp;Chiara Faso ,&nbsp;Zoe Demailly ,&nbsp;Martina Polato ,&nbsp;Alessia Degrassi ,&nbsp;Ana Carolina Damsceno ,&nbsp;Marcos Vinicius Tavares de Magalhães ,&nbsp;Vinicius William Costa Dumont ,&nbsp;Fabio Silvio Taccone ,&nbsp;Elisa Gouvêa Bogossian","doi":"10.1016/j.clineuro.2025.108980","DOIUrl":"10.1016/j.clineuro.2025.108980","url":null,"abstract":"<div><h3>Objective</h3><div>Early brain injury (EBI) following aneurysmal subarachnoid hemorrhage (aSAH) occurs in the first 3 days after bleeding is associated with long-term complications and poor neurological outcomes. The aim of this study was to externally validate the SHELTER score, which has been developed to quantify the severity of EBI.</div></div><div><h3>Methods</h3><div>This is a retrospective single center study of adult aSAH patients consecutively admitted to the Intensive Care Department of Hôpital Universitaire de Bruxelles between January 2015 and December 2023.We calculated the SHELTER score using data from the first 72 h after admission, including age, the World Federation of Neurological Surgeons grade, prehospital cardiopulmonary resuscitation, mydriasis, midline shift, early clinical deterioration, and early ischemia. Unfavorable functional outcome was defined as the modified Rankin scale 3–6 at 6 months.</div></div><div><h3>Results</h3><div>We included 250 aSAH patients with a mean age of 55 (± 13) years. The SHELTER score demonstrated high predictive accuracy for unfavorable functional outcome with an area under the receiver operating characteristic of 0.80 [95 % confidence interval (CI) 0.75–0.86]. The optimal cut-off point for predicting unfavorable functional outcome was &gt; 5.0, with a sensitivity of 0.57, specificity of 0.88, positive predictive value of 0.77 and negative predictive value of 0.75. In a multivariable analysis, the SHELTER score was independently associated with unfavorable functional outcome (OR 1.70, 95 % CI 1.37–2.10).</div></div><div><h3>Conclusions</h3><div>The SHELTER score can help identify aSAH patients at high risk of unfavorable functional outcome with good discriminative performance. This score could be used to better stratify patients in future studies investigating interventional strategies aiming at enhancing recovery and long-term prognosis after aSAH.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108980"},"PeriodicalIF":1.8,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168196","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":"Cerebral microbleeds and renal dysfunction: Degenerative neurobiological shared mechanisms within intracerebral hemorrhage","authors":"Iulia-Ioana Enache ,&nbsp;Maria Mirabela Manea ,&nbsp;Sorin Tuță ,&nbsp;Carmen-Adella Sîrbu","doi":"10.1016/j.clineuro.2025.108981","DOIUrl":"10.1016/j.clineuro.2025.108981","url":null,"abstract":"<div><div>Intracerebral hemorrhage (ICH) is a significant global source of morbidity and mortality, with a frequently grim prognosis. Microvascular dysfunction in the form of small vessel disease appears to cause the vast majority of spontaneous cerebral hemorrhages. Cerebral microbleeds, hemorrhagic markers of small vessel disease, seem prevalent in ICH patients. The cerebral microvasculature resembles the renal microvasculature and therefore, the two may share common, complex degenerative mechanisms of frailty, and renal impairment appears to be an additional burden on ICH cases. There could be a potential neurobiological interplay between cerebral microbleeds and renal dysfunction in the context of ICH, with possible bidirectional influences on a molecular and cellular level. Separately, the two entities appear to influence ICH occurrence, recurrence and prognosis. Our review sheds light on the fact that when cerebral microbleeds and renal impairment are brought together, there is potential for clinically relevant pathophysiological feedback mechanisms.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108981"},"PeriodicalIF":1.8,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168193","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":"Headache as an indication for surgery in non-functioning pituitary adenoma and Rathke's cleft cyst: A systematic review","authors":"Adrianna Wierzbicka ,&nbsp;Hediye Gholamshahi ,&nbsp;Alireza Soltani Khaboushan ,&nbsp;Farhang Rashidi ,&nbsp;Mohammadmahdi Sabahi ,&nbsp;Mohammad Mofatteh ,&nbsp;Anam Baig ,&nbsp;Arnaldo Neves Da Silva ,&nbsp;Badih Adada ,&nbsp;Hamid Borghei-Razavi","doi":"10.1016/j.clineuro.2025.108976","DOIUrl":"10.1016/j.clineuro.2025.108976","url":null,"abstract":"<div><h3>Purpose</h3><div>Headaches are a common presentation in clinical practice, often necessitating further evaluation and management. This study aims to comprehensively analyze available literature regarding headaches as an absolute surgical indication for patients with nonfunctioning pituitary adenomas (NFPAs) and Rathke's cleft cysts (RCCs), shedding light on postoperative headache resolution, and surgical complications.</div></div><div><h3>Method</h3><div>Following PRISMA guidelines, PubMed, Scopus, Embase, and Web of Science were searched until October 10th, 2023, using specified keywords. Inclusion criteria involved studies describing patients with NFPA or RCC, where headache was the sole surgical indication. Data were extracted, and quality assessed using the Joanna Briggs Institute (JBI) checklist.</div></div><div><h3>Results</h3><div>A total of 13 studies met the inclusion criteria, comprising 183 individuals who underwent surgical intervention for headaches caused by NFPA (n = 111) or RCC (n = 75). The majority of patients experienced headache improvement (75.8 %), while persistent headaches were noted in 19.8 %, and worsening in 4.3 %. Headache recurrence was infrequent (7.1 %), and postoperative complications including transient diabetes insipidus (29.4 %), cerebrospinal fluid leak (17.6 %), postoperative infection (17.6 %), and adrenal insufficiency (17.6 %) were reported. Quality assessment using JBI checklists indicated variable risk of bias across studies.</div></div><div><h3>Conclusion</h3><div>Surgical interventions significantly improved headache resolution in patients with NFPAs and RCCs, especially with few recurrences and manageable complications. Further prospective research with standardized protocols and long-term follow-up is essential to validate headaches as a sole indication for surgery in these patients and optimize outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108976"},"PeriodicalIF":1.8,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal CSF leaks in spontaneous intracranial hypotension: A single-institution analysis of incidence, typology and treatment outcomes","authors":"Bala McRae-Posani ,&nbsp;Andrew Kim ,&nbsp;David Edasery ,&nbsp;Sara Strauss ,&nbsp;Michelle Roytman ,&nbsp;John K. Park ,&nbsp;Gayle Salama","doi":"10.1016/j.clineuro.2025.108978","DOIUrl":"10.1016/j.clineuro.2025.108978","url":null,"abstract":"<div><h3>Objective</h3><div>To report incidence, typology and treatment outcomes of spinal CSF leaks in patients with spontaneous intracranial hypotension (SIH).</div></div><div><h3>Methods</h3><div>In this IRB approved study, consecutive SIH patients with myelogram-confirmed spinal CSF leak location, who underwent treatment between 2021 and 2023 at a single institution were retrospectively analyzed. The outcome variable was definitive treatment of SIH, defined as clinical and/or radiographic resolution of symptoms. Leak type classification was: Type 1 = ventral dural tear, Type 2 = lateral dural nerve root sleeve tear, Type 3 = CSF-venous fistula (CVF).</div></div><div><h3>Results</h3><div>32 SIH patients (average age 48 ± 15, 28 % male, 72 % female) were analyzed. A majority of them had a Type 1 CSF leak (59 %), followed by Type 3 (31 %) and Type 2 (9 %) leaks. Thoracic spine was the predominant location of the leaks (84 %); notably all CSF-venous fistulas were located there. Following trials of conservative management, all patients underwent treatment with EBP after leak site localization. 22/32 patients (69 %) had at least some resolution of symptoms following the first EBP. For 2/32 (6 %, both Type 2 leak), one targeted EBP provided definitive treatment. 30/32 (94 %, all leak types) had persistent clinical symptoms and had additional EBP(s). The mean number of EBPs per patient was 1.4 (range = 1–3). Following treatment failure of EBP(s), 10 patients with Type 3 leaks had transvenous embolization, which resulted in definitive treatment for 9 (90 %); 16 patients (leak Type 1 = 15, Type 2 = 1) had open dural surgery, which resulted in definitive treatment for 15 (94 %, all Type 1 leaks).</div></div><div><h3>Conclusion</h3><div>Overall, our analysis is consistent with recent data demonstrating that SIH incidence is higher among female patients and that CVFs are slightly more prevalent than previously reported, seen in nearly a third of our patients. Thoracic spine is the predominant location of CSF leaks; all our CVFs were located there. On treatment modalities, while EBP remains an important tool offering immediate symptom relief to SIH patients in the short term, permanent closure of the CSF leak and complete resolution of symptoms is rarely achieved with EBP. Definitive treatment is more likely with targeted endovascular and surgical modalities.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108978"},"PeriodicalIF":1.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125270","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":"Circulating miR-425 can be a biomarker for depression in patients with Parkinson’s disease","authors":"Hong Liu ,&nbsp;Haonan Zhao ,&nbsp;Dongya Huang","doi":"10.1016/j.clineuro.2025.108969","DOIUrl":"10.1016/j.clineuro.2025.108969","url":null,"abstract":"<div><h3>Introduction</h3><div>Depression, a common comorbidity in patients with Parkinson's disease (PD), is often underdiagnosed and undertreated. Circulating microRNAs (miRNAs) have been proved to be promising biomarker candidates for PD. However, no miRNAs are currently available as biochemical markers of depression in PD.</div></div><div><h3>Method</h3><div>Serum samples from 52 healthy controls, 69 non-depressed PD patients (PD-ND), and 62 depressed PD patients (PD-D) were analyzed using qPCR to measure miR-425 levels. All the participants were assessed using detailed clinical scales.</div></div><div><h3>Results</h3><div>miRNA-425 (miR-425) expression in PD-D patients was downregulated compared with that in PD-ND patients, with an area under the curve of 0.867 in receiver operating characteristic curve analysis. miR-425 levels were negatively correlated with the severity of depression (HAMD, r = -0.423, p &lt; 0.001) and anxiety (HAMA, r = -0.469, p &lt; 0.001). Additionally, PD-D patients scored higher in H-Y, MDS-UPDRS (I, II, and III), NMSS (1, 3, 5, and 9), HAMD, HAMA, RBDSQ, ESS, and ADL and lower in NMSS7, MMSE, SS-16, and PDQ-39 than PD-ND patients. Binary logistic regression analysis identified that cognitive impairment (MMSE, p = 0.001) and anxiety (HAMA, p &lt; 0.001) were significantly associated with depression in PD.</div></div><div><h3>Conclusion</h3><div>Circulating miR-425 shows significant potential as a biomarker for depression in PD, with distinct downregulation in PD-D patients and a strong correlation with depression severity. Our findings suggest a unique potential for improving PD-D diagnosis and understanding its pathophysiology.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108969"},"PeriodicalIF":1.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138518","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":"Membrane presence in chronic subdural hematomas is associated with a reduced rate of resolution following middle meningeal artery embolization","authors":"Xihang Wang ,&nbsp;Alice Hung ,&nbsp;Oishika Das ,&nbsp;Wuyang Yang ,&nbsp;Vivek Yedavalli ,&nbsp;Christopher Jackson ,&nbsp;Judy Huang ,&nbsp;Rafael Tamargo ,&nbsp;Justin Caplan ,&nbsp;L. Fernando Gonzalez ,&nbsp;Risheng Xu","doi":"10.1016/j.clineuro.2025.108977","DOIUrl":"10.1016/j.clineuro.2025.108977","url":null,"abstract":"<div><h3>Background</h3><div>Membrane presence is believed to drive chronic subdural hematoma (cSDH) development. The associated inflammation and angiogenesis are thought to actively contribute to the hematoma collection. This study examines the impact of membrane presence on cSDH resolution following middle meningeal artery embolization (MMA).</div></div><div><h3>Methods</h3><div>All patients undergoing MMA embolization for cSDH treatment from 2019 to 2024 were identified at a single tertiary care institution. The cohort was divided into two groups based on evidence of cSDH membrane presence on pre-procedural CT or MR imaging. Demographic data, baseline information, and operative characteristics were compared via univariable statistical analysis, with full cSDH resolution as the primary outcome of interest. Secondary outcomes include time to resolution, cSDH progression, length of hospital stay, and complications rate.</div></div><div><h3>Results</h3><div>Among 131 total embolizations performed in 105 patients, 71 (54.2 %) showed evidence of cSDH membrane presence and 60 (45.8 %) did not. The membrane group experienced a lower rate of cSDH resolution compared to the non-membrane group (<em>p = 0.011</em>), and presence of membranes was independently associated with a decreased likelihood of cSDH resolution (OR 0.843, 95 % CI 0.722–0.984, <em>p = 0.032</em>). Time to resolution, cSDH progression, length of hospital stay, and occurrence of complications were similar between the two groups.</div></div><div><h3>Conclusion</h3><div>Membrane presence is associated with decreased rates of cSDH resolution following MMA embolization, suggesting that membrane pathophysiology may sustain the cSDH collection despite MMA vessel occlusion. Evaluation for membrane presence on pre-procedural imaging can improve patient counseling and patient selection for MMA embolization.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108977"},"PeriodicalIF":1.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168197","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":"Endovascular thrombectomy in late-window stroke: Do perfusion imaging and large infarcts really matter? A systematic review and meta-analysis of 10 randomized clinical trials","authors":"Ali Mortezaei ,&nbsp;Muhammed Amir Essibayi ,&nbsp;Bardia Hajikarimloo ,&nbsp;Khaled M. Taghlabi ,&nbsp;Jamal Majidpoor ,&nbsp;David Altschul ,&nbsp;Adam A. Dmytriw ,&nbsp;Redi Rahmani ,&nbsp;Mohamad Abdalkader ,&nbsp;Thanh N. Nguyen ,&nbsp;Sami Al Kasab","doi":"10.1016/j.clineuro.2025.108955","DOIUrl":"10.1016/j.clineuro.2025.108955","url":null,"abstract":"<div><h3>Background</h3><div>Several randomized trials have evaluated the benefits of endovascular thrombectomy (EVT) for anterior circulation large vessel occlusion strokes presenting beyond 6 hours of the last known well (LKW). We aimed to synthesize the results from these trials to provide high-level evidence regarding EVT treatment for patients presenting in the late window.</div></div><div><h3>Methods</h3><div>A systematic search was conducted through four electronic databases, with no language restriction. Binary outcomes were analyzed using the risk ratio (RR) and 95 % confidence interval (CI), while continuous outcomes were analyzed using the standardized mean difference (SMD) and 95 % CI.</div></div><div><h3>Results</h3><div>Out of 2824 patients from 10 trials comparing EVT plus BMT and BMT alone among patients with AIS who presented beyond 6 hours of LKW, 1871 patients (n = 981 EVT, n = 890 BMT) were included in the analysis. The results showed benefits toward the EVT than BMT alone in Modified Rankin Scale (mRS) 0–1 (RR= 1.84, 95 %CI= 1.4– 2.4), mRS 0–2 (RR= 2.3, 95 %CI= 1.5– 2.1), and mRS 0–3 (RR= 1.64, 95 %CI= 1.3– 1.63) at three months. No significant difference between EVT and BMT alone groups was found when analyzing either 90-day mortality or symptomatic intracranial hemorrhage. Subgroup analysis showed that there was no significant difference between patients with large core stroke and patients with non-large core stroke in 90-day mRS 0–2 (RR= 3.6 vs 2.37, P-value=0.26). Findings did not show significant difference between perfusion vs non-perfusion imaging modalities in 90-day mRS 0–2 and mortality.</div></div><div><h3>Conclusion</h3><div>These findings strengthen the previous evidence for the benefits of EVT over medical treatment in managing patients with stroke, even with large ischemic regions in the late time window.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108955"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138669","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}