Clinical Neurology and Neurosurgery最新文献

{"title":"Risk factors for periosteal fluid collection and surgical site infection based on cranioplasty material: Analysis of 434 cases","authors":"Chung Mo Koo ,&nbsp;In-Ho Jung ,&nbsp;Sang Koo Lee","doi":"10.1016/j.clineuro.2025.109308","DOIUrl":"10.1016/j.clineuro.2025.109308","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to clarify how the choice of cranioplasty material influences the risk of postoperative periosteal fluid collection (PFC) and surgical site infection (SSI) through large-scale analysis.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on 434 patients who underwent cranioplasty over a ten-year period. Patients were grouped by implant material: autologous bone (n = 339), polyetheretherketone (PEEK; n = 39), polymethylmethacrylate (PMMA; n = 31), and titanium (n = 25). Multivariable logistic regression identified risk factors for PFC and SSI.</div></div><div><h3>Results</h3><div>PFC occurred in 22.1 % of cases overall, but was significantly more frequent with PEEK (56.4 %) and PMMA (51.6 %) than with autologous bone (16.8 %) and titanium (4.0 %) (p &lt; 0.001). PEEK use increased the risk of PFC by 6.47-fold compared to autologous bone (OR: 6.47, p &lt; 0.001), while PMMA also showed a significant risk (OR: 3.78, p &lt; 0.001). Shunt operation (OR: 4.56, p = 0.001) and traumatic brain injury (OR: 3.28; p &lt; 0.001) were further independent predictors. SSI occurred in 9.0 % overall, with no statistically significant difference between materials after multivariate adjustment (p = 0.915), but PFC was the strongest independent risk factor for SSI (OR: 10.93, p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Selection of cranioplasty material significantly affects the risk of PFC, which is strongly associated with subsequent SSI. PEEK and PMMA implants substantially increase PFC compared to autologous bone and titanium, while titanium demonstrates the lowest risk. These findings suggest that, in addition to patient-specific considerations, material properties and their impact on tissue integration must be central to clinical decision-making in cranioplasty.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109308"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882392","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":"Usefulness of T1 volumetric isotropic turbo spin-echo acquisition black-blood magnetic resonance imaging for follow-up evaluation after flow diverter implantation","authors":"Eisuke Tsukagoshi ,&nbsp;Hiroki Sato ,&nbsp;Takuma Maeda ,&nbsp;Tomoyoshi Kuribara ,&nbsp;Kazuki Fukumoto ,&nbsp;Takahiko Taniguchi ,&nbsp;Masataka Yoshimura ,&nbsp;Hiroki Kurita ,&nbsp;Shinya Kohyama","doi":"10.1016/j.clineuro.2025.109303","DOIUrl":"10.1016/j.clineuro.2025.109303","url":null,"abstract":"<div><h3>Background</h3><div>Digital subtraction angiography (DSA), the standard for postoperative evaluation following flow diverter (FD) implantation, is invasive and associated with potential complications. Although time-of-flight magnetic resonance angiography (TOF-MRA) is effective, normal blood flow may be misinterpreted as T1-weighted hyperintense thrombi. T1 volumetric isotropic turbo spin-echo acquisition black-blood magnetic resonance imaging (T1-VISTA-BB MRI) can differentiate thrombus from blood flow. We evaluate the utility of T1-VISTA-BB MRI for postoperative evaluation following FD implantation.</div></div><div><h3>Methods</h3><div>This retrospective study included 52 patients who underwent FD implantation alone. Scheduled DSA was performed at 6 and 12 months postoperatively. MRI examinations, including TOF-MRA and T1-VISTA-BB MRI, were defined as the most recent scans acquired within a specified time window relative to each DSA. The concordance with DSA was assessed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and diagnostic accuracy were calculated for each modality.</div></div><div><h3>Results</h3><div>At 6-month, T1-VISTA-BB MRI demonstrated significantly higher specificity (T1-VISTA-BB MRI vs TOF-MRA: 97.2 vs. 77.8 %, p = 0.028) and PPV (T1-VISTA-BB MRI vs TOF-MRA: 92.3 vs. 57.9 %, p = 0.049) compared with TOF-MRA. At 12-month, no significant differences were found between the two modalities.</div></div><div><h3>Conclusions</h3><div>T1-VISTA-BB MRI demonstrated significantly higher specificity and PPV compared with TOF-MRA at 6 months following FD implantation. This finding suggests it may serve as a useful and less invasive complementary tool to DSA for early postoperative evaluation. However, this advantage was not observed at the 12-month follow-up. Further studies involving larger cohorts and longer follow-up periods are required to validate these findings.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109303"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882446","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":"Heart rate variability in adults with mild traumatic brain injury: a population-based cross-sectional study","authors":"Enkhjin Bat-Erdene ,&nbsp;Enkhnaran Tumurbaatar ,&nbsp;Gantsetseg Tumur-Ochir ,&nbsp;Battuvshin Lkhagvasuren ,&nbsp;Tsolmon Jadamba ,&nbsp;Hiroaki Adachi","doi":"10.1016/j.clineuro.2025.109289","DOIUrl":"10.1016/j.clineuro.2025.109289","url":null,"abstract":"<div><div>Autonomic nervous system disruptions following mild traumatic brain injury (MTBI) may play a role in elevated mortality risk. However, the relationship between MTBI-related autonomic dysfunction and mental health in the general population remains understudied. This study examined autonomic dysfunction and mental health symptoms among individuals reporting previous MTBI within a community sample. This population-based cross-sectional study was implemented among adults residing in Ulaanbaatar, Mongolia. Heart rate variability (HRV) analysis served as a non-invasive method for evaluating autonomic nervous system functioning. Mental health parameters including anxiety, depression, sleep disturbances, and quality of life were measured using validated instruments: Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), and the brief version of World Health Organization Quality of Life (WHOQOL-BREF). The study enrolled 177 individuals (74 % female) averaging 39.85 ± 9.82 years. Sixteen individuals reported experiencing MTBI previously. After adjusting for age and sex, the population prevalence was 2.4 %. Elevated body temperature, increased heart rate, and higher anxiety levels were observed among MTBI-exposed participants relative to unexposed individuals, while HRV indices showed reductions. Regression analysis indicated associations between MTBI and reduced HRV measures. The results demonstrate that pNN50 and RMSSD were predicted by marital status, LF/HF ratio, and MTBI-exposed history (r2 = 0.33, P = 0.017 and r2 = 0.37, P = 0.005, respectively). In conclusion, individuals with MTBI history demonstrated reduced HRV and elevated anxiety relative to individuals without MTBI history. These findings indicate potential persistent effects of MTBI on autonomic function, mental health, and quality of life.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109289"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839649","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 social deprivation index and perioperative outcomes following meningioma resection","authors":"Ali Ebada,&nbsp;Ishav Y. Shukla,&nbsp;Nicholas Bever,&nbsp;Matthew Z. Sun","doi":"10.1016/j.clineuro.2025.109307","DOIUrl":"10.1016/j.clineuro.2025.109307","url":null,"abstract":"<div><h3>Introduction</h3><div>The Social Deprivation Index (SDI) is a validated measure of neighborhood-level socioeconomic disadvantage. Its impact on perioperative outcomes following meningioma resection remains underexplored.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients who underwent intracranial meningioma resection at a single tertiary academic institution from 2011 to 2023, stratified by SDI quartile (Q1 to Q4). Outcomes included baseline characteristics, operative parameters, complications, readmissions, and functional status.</div></div><div><h3>Results</h3><div>In our analysis of 887 patients, we found that higher SDI quartiles had greater comorbidity burden, with hypertension, COPD, and obesity more prevalent, as well as higher rates of non-White race and Hispanic ethnicity. The total number of comorbidities increased progressively from Q1 to Q4 (p = 0.001). Tumor grade, volume, and operative time were generally similar across quartiles, but ASA class III-IV status was more common in Q4 (p = 0.002), and skull base tumors were more frequent in higher quartiles (p = 0.010). Multivariable regression revealed that patients in Q2 and Q4 had significantly longer operative times compared to Q1 (p = 0.018; p = 0.031). Functional outcomes demonstrated an unexpected finding: patients in Q3 showed greater improvement in postoperative mRS compared to Q1 (p = 0.010). No significant differences were found in change in KPS, EBL, LOS, or hospital charges. On univariable and multivariable logistic regression, Q4 patients had significantly increased odds of non-neurological complications compared to Q1 (p = 0.016). In contrast, neurological complications and 30-, 60-, and 90-day readmissions did not differ significantly across quartiles.</div></div><div><h3>Conclusion</h3><div>SDI quartile was associated with comorbidity burden, ASA class, skull base tumor location, operative time, and risk of non-neurological complications after meningioma resection. SDI may serve as a prognostic marker to help identify vulnerable patients, guide perioperative planning, and improve recovery counseling after meningioma resection.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109307"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882447","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":"Red cell distribution width and in-hospital mortality in intensive care unit patients with non-traumatic subarachnoid hemorrhage: A cohort study","authors":"Dong Wang ,&nbsp;Kaiwu Meng ,&nbsp;Xinyan He","doi":"10.1016/j.clineuro.2026.109315","DOIUrl":"10.1016/j.clineuro.2026.109315","url":null,"abstract":"<div><h3>Objective</h3><div>Non-traumatic subarachnoid hemorrhage (SAH) is the predominant form of SAH and is associated with substantial in-hospital mortality. Red cell distribution width (RDW) is a novel prognostic indicator for numerous diseases. However, its association with outcomes after SAH remains uncertain. This study aimed to investigate the association between RDW and in-hospital mortality among patients with severe non-traumatic SAH and to determine the pivotal threshold for the impact of RDW on in-hospital mortality in these patients.</div></div><div><h3>Methods</h3><div>In total, 877 patients aged ≥ 18 years with non-traumatic SAH were identified in the MIMIC-IV (v2.2) database. The primary exposure factor was the initial RDW documented after admission. The outcome measure was the in-hospital mortality rate among patients in the intensive care unit (ICU). To evaluate the link between RDW and in-hospital mortality, a multivariate logistic regression analysis was conducted, considering possible confounding variables.</div></div><div><h3>Results</h3><div>An elevated RDW was associated with increased in-hospital mortality among ICU patients with non-traumatic SAH (odds ratio [OR]: 1.36, 95 % confidence interval [CI]: 1.25–1.49). After adjustment for potential confounders, this association remained (OR = 1.22, 95 % CI: 1.09–1.37, P = 0.015). Furthermore, a nonlinear association was noted between RDW and in-hospital mortality, with no statistically significant link detected when RDW exceeded 16.12 %.</div></div><div><h3>Conclusions</h3><div>Elevated RDW was an independent risk factor for in-hospital mortality in ICU patients with non-traumatic SAH, showing a \"J\"-shape nonlinear association. RDW is a readily available, low-cost biomarker for clinical intervention and identification of high-risk patients with non-traumatic SAH in the ICU.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109315"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922892","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":"When big data outpaces expertise: Safeguarding retrospective clinical research","authors":"Joshua Wang,&nbsp;Florian Roser","doi":"10.1016/j.clineuro.2026.109313","DOIUrl":"10.1016/j.clineuro.2026.109313","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109313"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917228","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":"Toward clarity in antiseizure medication withdrawal decisions: Clinical challenges and machine learning-based scoring systems","authors":"Gül Yücel ,&nbsp;Nur Yücel Ekici","doi":"10.1016/j.clineuro.2026.109317","DOIUrl":"10.1016/j.clineuro.2026.109317","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109317"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973596","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":"Single-session combined middle meningeal artery embolization and hematoma evacuation versus staged approaches in symptomatic chronic subdural hematoma treatment: A single-center experience","authors":"Jaeha Kim ,&nbsp;Erin N. Walker ,&nbsp;Nathan Yu ,&nbsp;Sarah J. Snyder ,&nbsp;Mackenzie L. Castellanos ,&nbsp;Sami Almasri ,&nbsp;Om H. Gandhi ,&nbsp;Mikaeel Habib ,&nbsp;Luis O. Tierradentro-García ,&nbsp;Sarah Hamimi ,&nbsp;Aaron Anandarajah ,&nbsp;Adriana Castano ,&nbsp;Abdullah Feroze ,&nbsp;Patrick Connolly ,&nbsp;Linda Bagley ,&nbsp;Omar Choudhri","doi":"10.1016/j.clineuro.2026.109314","DOIUrl":"10.1016/j.clineuro.2026.109314","url":null,"abstract":"<div><h3>Background</h3><div>Middle meningeal artery (MMA) embolization can serve as an adjunct to prevent recurrent subdural hematoma. Hybrid operating rooms (ORs) with biplane neuroangiography now allow MMA embolization and cSDH drainage to be performed in a single stage. This study compares this single-stage approach with the traditional staged workflow, where patients undergo cSDH drainage in a neurosurgical OR followed by delayed MMA embolization in a separate neuroangiography suite.</div></div><div><h3>Methods</h3><div>Clinical data were extracted for 51 patients who underwent both cSDH drainage and MMA embolization at our center. Demographic information and surgically relevant parameters were compared between patients treated with a single-stage approach and those treated with a staged approach to identify differences beyond the timing of the procedures. The primary outcome was radiographic improvement following treatment, defined by reduction in hematoma thickness and midline shift. Secondary outcomes included total procedure room time, anesthesia duration, and operative duration.</div></div><div><h3>Results</h3><div>No significant differences were identified in the demographic characteristics of patients undergoing the single-stage or two-stage approach. Baseline cSDH characteristics, as well as operation-relevant parameters, were comparable between the two groups. Postoperative midline shift and reduction in hematoma thickness improved and were comparable between groups. Total procedure room time, anesthesia duration, and operative duration were also similar.</div></div><div><h3>Conclusion</h3><div>Results from this study suggest that single-stage MMA embolization procedures performed in hybrid ORs may not always be more efficient than the two-stage approach. Further research is needed to comprehensively evaluate the optimal timing and approach for patients undergoing MMA embolization procedures for cSDH management.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109314"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922889","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":"Corrigendum to “Evaluation of acute intraprocedural thromboembolism risk factors in endovascular treatment of unruptured intracranial aneurysms” [Clin. Neurol. Neurosurg. 252 (2025) 108837]","authors":"Yunus Emre Senturk ,&nbsp;Anil Arat","doi":"10.1016/j.clineuro.2026.109324","DOIUrl":"10.1016/j.clineuro.2026.109324","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109324"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017361","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":"Incidence, risk factors and management practices in post-viral encephalitis epilepsy: A long-term, nationwide population-based study and review of literature","authors":"Emilija Cvetkovska ,&nbsp;Bekim Adjami ,&nbsp;Bojan Boskovski ,&nbsp;Marija Babunovska ,&nbsp;Milena Stevanovic ,&nbsp;Marija Cvetanovska ,&nbsp;Igor Kuzmanovski ,&nbsp;Vineet Punia","doi":"10.1016/j.clineuro.2025.109302","DOIUrl":"10.1016/j.clineuro.2025.109302","url":null,"abstract":"<div><h3>Objective</h3><div>We investigated the incidence, risk factors, and management of post-viral encephalitis epilepsy (PEE) in a nationwide cohort in North Macedonia. Additionally, we conducted a comprehensive literature search on PEE.</div></div><div><h3>Methods</h3><div>Data were obtained from the electronic National Health System (eNHS), encompassing all patients diagnosed with viral encephalitis (VE) in 2016. Patients with pre-existing epilepsy diagnoses were excluded. Clinical, neuroimaging, and EEG data were collected and analyzed, and participants were followed for seven years.</div></div><div><h3>Results</h3><div>Of 1660,584 individuals registered in the eNHS in 2016, 68 were confirmed to have VE (incidence: 4.1/100,000). Among these, six patients died during hospitalization, and the remaining 62 were included in the study cohort. Acute symptomatic seizures (ASyS) occurred in 39 % of patients, with focal to bilateral tonic-clonic seizures (FBTCS) being the most common seizure type. Over the seven-year follow-up period, 11 patients (18 %) developed PEE, with 73 % of cases diagnosed within the first year. Significant risk factors for PEE included ASyS, younger age, and epileptiform abnormalities on EEG. By the end of the follow-up, seven patients with PEE (64 %) remained on antiseizure medications (ASMs).</div></div><div><h3>Conclusions</h3><div>Our results confirm ASyS and highlight acute electro-clinical findings and young age as risk factors for PEE. There is a need for evidence-based clinical pathways and care protocols for patients at risk.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109302"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899337","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}