Clinical Neurology and Neurosurgery最新文献

{"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}

{"title":"Is rheumatoid arthritis associated with worse outcomes following adult spinal deformity surgery?","authors":"Harsh Jain ,&nbsp;Omar Zakieh ,&nbsp;Tyler Zeoli ,&nbsp;Hani Chanbour ,&nbsp;Ambika Paulson ,&nbsp;Walter Navid ,&nbsp;Ranbir Ahluwalia ,&nbsp;Julian G. Lugo-Pico ,&nbsp;Amir M. Abtahi ,&nbsp;Byron F. Stephens ,&nbsp;Scott L. Zuckerman","doi":"10.1016/j.clineuro.2025.108967","DOIUrl":"10.1016/j.clineuro.2025.108967","url":null,"abstract":"<div><h3>Introduction</h3><div>Rheumatoid arthritis (RA) is a chronic inflammatory disease, frequently involving the spine;however, its impact on adult spinal deformity (ASD) surgery outcomes remains inconclusive. In patients undergoing ASD surgery, we sought to evaluate: 1) impact of RA on mechanical complications and patient-reported outcome measures (PROMs) and 2) effect of steroid-use and disease modifying antirheumatic drugs DMARDs on postoperative outcomes.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed for patients with RA undergoing ASD surgery from 2009 to 2021. Inclusion criteria were: ≥ 5-level fusion, and 2-year follow-up. The primary outcomes of interest were reoperation, mechanical complications and PROMs. Bivariate and multivariable analyses were performed.</div></div><div><h3>Results</h3><div>Among 238 patients undergoing ASD surgery, 34 (14.3 %) had RA, for a mean of 9.6 ± 4.4 years. Ten patients (29.4 %) were on steroids, and 14 (41.2 %) were on DMARDs preoperatively. Patients with RA had more proximal junctional kyphosis/ failure (PJK/F) (76.5 % vs. 42.6 %,p = 0.002), pseudarthrosis (44.1 % vs. 25.0 %,p = 0.021), and need for reoperation (58.8 % vs. 33.8 %, p = 0.005) compared to patients without RA, with no difference in other complications. On multivariable regression, RA was an independent predictor of PJK/F (OR=2.76, 95 %CI=1.03–7.39,p = 0.043) and reoperation (OR=2.51, 95 %CI=1.00–6.25,p = 0.048). Patients receiving DMARDs had a lower reoperation rate (28.6 % vs. 80.0 %,p = 0.003), with no significant difference in 2-year PROMs between the cohorts. Years of RA diagnosis or being on steroids had no association with outcomes.</div></div><div><h3>Conclusion</h3><div>RA significantly increased the risk of mechanical complications and reoperation following ASD surgery. However, the use of DMARDs reduced the likelihood of reoperation, emphasizing the importance of prioritizing medical management of RA patients prior to surgery.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108967"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125271","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":"Calcium pyrophosphate dihydrate crystal deposition (CPPD) in the retro-odontoid tissue with compression of cervicomedullary junction: Analysis of 46 cases (1984–2020) with literature review","authors":"Arnold H. Menezes,&nbsp;Matthew A. Howard,&nbsp;Brian J. Dlouhy","doi":"10.1016/j.clineuro.2025.108966","DOIUrl":"10.1016/j.clineuro.2025.108966","url":null,"abstract":"<div><h3>Objective</h3><div>Peri-odontoid calcium pyrophosphate dihydrate deposition (CPPD) results in extradural masses that compress the cervicomedullary junction (CMJ). The authors analyzed their experience in the MRI era to understand causation, radiographic pathology, treatment options, and outcome.</div></div><div><h3>Methods</h3><div>Retrospective analysis of University of Iowa Hospitals &amp; Clinics records of retro-odontoid masses consistent with diagnosis of CPPD was made. 46 patients were identified; 21 have been described and 25 now added. Patients underwent cervical motion radiographs, CT, MRI. Postoperative MRI was made in all 25 patients.</div></div><div><h3>Results</h3><div>Mean age was 75.8 years, mean symptom duration 3.6 years. Headache presented in 84 %, myelopathy 92 %, lower cranial nerve dysfunction 36 %, urinary incontinence 36 % and misdiagnosis 52 %. Subaxial pathology (cervical fusion, DISH, lateral mass fusion) with CVJ instability was seen in 92 %. MRI revealed rim enhancement in all and 11 associated cysts. CT calcification in the mass was 96 %, odontoid fractures in 4.</div><div>Primary ventral transoral resection made in patients with severe neurological deficits. Primary dorsal fixation patients had co-morbidities but showed improvement. Comparison of preoperative and postoperative status and JOA scores reflect the improvements.</div></div><div><h3>Conclusions</h3><div>Pathology proven diagnosis of CPPD was made in 36/46 patients of the entire series. Preoperative diagnosis can be based on retro-odontoid location, absence of MRI enhancement, CT calcifications in the mass and subaxial cervical fixation. Transoral resection of the mass should be reserved for severe CMJ compression. Dorsal C1 decompression and fusion has recently been shown to be satisfactory in others. All patients should be considered as being unstable and must be fused.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108966"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144098656","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":"Trends in mortality of congenital neurological malformations in the pediatric population: CDC data analysis (1999–2020)","authors":"Hafsa Shahid,&nbsp;Fatima Sial,&nbsp;Rabia Shahid,&nbsp;Ali Tanvir","doi":"10.1016/j.clineuro.2025.108965","DOIUrl":"10.1016/j.clineuro.2025.108965","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108965"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134675","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":"Resolving distal vessel occlusions caused by migrated emboli utilizing a modified stent retrieval technique","authors":"Hong Suk Ahn ,&nbsp;Jung Hyun Park ,&nbsp;Jun Hyong Ahn ,&nbsp;Hong Jun Jeon ,&nbsp;Byung Moon Cho","doi":"10.1016/j.clineuro.2025.108957","DOIUrl":"10.1016/j.clineuro.2025.108957","url":null,"abstract":"<div><h3>Background</h3><div>We retrospectively evaluated the safety and effectiveness of a modified stent retrieval technique that controls the unsheathing level of the microcatheter in resolving distal vessel occlusions resulting from migrated emboli.</div></div><div><h3>Methods</h3><div>From January 2016 to February 2022, a modified stent retrieval technique was applied to 24 of 445 patients with acute large vessel occlusion stroke in the anterior circulation, featuring secondary embolus migration into M2, M3, A2, or A3 branches. The coverage range was adjusted through partial re-sheathing of the stent retriever by the delivery microcatheter after full unsheathing. Primary and secondary recanalization rates were assessed using the modified thrombolysis in cerebral infarction (TICI) score.</div></div><div><h3>Results</h3><div>After recanalizing the primary large vessel occlusions, secondary distal vessel occlusions occurred in 12, 6, 4, and 2 patients in the M2, M3, A2, and A3 branches, respectively. The modified TICI score was 2a and 2b in 8 and 16 patients, respectively, for primary large vessel occlusion. The first pass rate of secondary distal vessel occlusions was 70.8 %, and 23 of 24 patients achieved a final recanalization rate of at least TICI 2c at the migrated distal vessel occlusion (mean duration: 23.2 ± 14 min) without significant complications. At 3 months, 16 patients (66.7 %) achieved favorable functional outcomes (modified Rankin score, 0–2).</div></div><div><h3>Conclusion</h3><div>This simple, effective, modified technique demonstrated safety and efficacy in resolving distal vessel occlusion.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108957"},"PeriodicalIF":1.8,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144098732","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 impact of tracheostomy timing on the outcomes of patients with acute traumatic spinal cord injury: A systematic review and meta-analysis","authors":"Negin Zameni ,&nbsp;Masoud Khoshnoodi ,&nbsp;Brandon Lucke-Wold ,&nbsp;James S. Harrop ,&nbsp;Armin Karamian","doi":"10.1016/j.clineuro.2025.108968","DOIUrl":"10.1016/j.clineuro.2025.108968","url":null,"abstract":"<div><h3>Background</h3><div>Spinal cord injury (SCI) can cause serious respiratory problems. Cervical high-level injuries may result in diaphragm paralysis, necessitating tracheostomy to assist airway protection and facilitate breathing.</div></div><div><h3>Methods</h3><div>A comprehensive literature search of PubMed, Google Scholar, and Web of Science was performed for published studies comparing outcomes between early versus late tracheostomy in acute traumatic SCI patients.</div></div><div><h3>Results</h3><div>The initial search returned 1837 articles, after the final review, 17 studies with a total of 3853 patients were included in the meta-analysis. The mortality rate between early and late tracheostomy was not statistically significant (OR = 0.81, 95 % CI = [0.37, 1.78], P = 0.61). However, early tracheostomy was associated with reduced duration of mechanical ventilation (MD = − 10.58, 95 % CI = [−15.22, −5.95], <em>P</em> &lt; 0.01), hospital length of stay (MD = − 8.50, 95 % CI = [−10.95, −6.05], <em>P</em> &lt; 0.01), and ICU length of stay (MD = − 9.12, 95 % CI = [−12.20, −6.05], <em>P</em> &lt; 0.01). Early tracheostomy was also associated with a lower incidence of pneumonia (OR = 0.68, 95 % CI = [0.51, 0.91], <em>P</em> &lt; 0.01). Patients in the early tracheostomy group also experienced fewer tracheostomy-related complications (OR = 0.50, 95 % CI = [0.33, 0.75], <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>In patients with acute traumatic SCI, early tracheostomy within seven days of injury, surgery, or intubation is associated with reduced duration of mechanical ventilation, and length of stay in the hospital and ICU. Early tracheostomy is also associated with a lower risk of tracheostomy-related complications.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108968"},"PeriodicalIF":1.8,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144098655","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":"Prognostic factors in ovarian cancer patients with brain metastases: A retrospective analysis","authors":"Tahir Eryılmaz ,&nbsp;Mehmet Tunç ,&nbsp;Hüseyin Akıllı ,&nbsp;Esra Kuşçu ,&nbsp;Tuğba Tekelioğlu ,&nbsp;Ali Ayhan","doi":"10.1016/j.clineuro.2025.108961","DOIUrl":"10.1016/j.clineuro.2025.108961","url":null,"abstract":"<div><h3>Objective</h3><div>Brain metastases (BM) from epithelial ovarian cancer (EOC) are rare but clinically significant due to their poor prognosis. This study aimed to investigate prognostic factors influencing survival in EOC patients who developed BM and to evaluate treatment-related outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on 1123 patients with EOC treated between 2008 and 2021. Among them, 27 patients (2.4 %) developed BM. Demographic, clinical, and treatment-related data were collected. Overall survival after BM diagnosis was assessed using the Kaplan–Meier method. Univariate and multivariate Cox regression analyses were performed on 21 patients who received active treatment (surgery and/or radiotherapy).</div></div><div><h3>Results</h3><div>The median time from ovarian cancer diagnosis to BM was 27 months, and the median post-BM survival was 12 months. Survival was significantly longer in platinum-sensitive patients (38 vs. 7 months, p = 0.04). Median survival was 30 months with combined therapy, 13 months with radiotherapy alone, and 1 month with palliative care (p = 0.01). Within the radiotherapy group, the median survival was 13 months in patients treated with stereotactic radiosurgery (SRS) and 6 months in those who received whole-brain radiotherapy (WBRT). Univariate analysis identified platinum sensitivity (p = 0.075), number of metastases (p = 0.017), and lesion localization (p = 0.021) as factors associated with survival. In multivariate analysis, platinum sensitivity remained the only independent predictor of improved survival (HR: 0.34; 95 % CI: 0.16–0.71; p = 0.04).</div></div><div><h3>Conclusion</h3><div>Platinum sensitivity is a key prognostic determinant in ovarian cancer patients with BM. Early identification and tailored multimodal treatment strategies may contribute to prolonged survival in selected patients</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108961"},"PeriodicalIF":1.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138520","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 impact of semaglutide use for weight loss on transforaminal lumbar interbody fusion outcomes","authors":"Syed I. Khalid ,&nbsp;Pranav Mirpuri ,&nbsp;Elie Massaad ,&nbsp;Ryan Wang ,&nbsp;Aladine Elsamadicy ,&nbsp;John H. Shin ,&nbsp;Owoicho Adogwa","doi":"10.1016/j.clineuro.2025.108952","DOIUrl":"10.1016/j.clineuro.2025.108952","url":null,"abstract":"<div><h3>Introduction</h3><div>While glucagon-like peptides 1 receptor agonists (GLP-1RAs) grow in popularity, their potential for presurgical weight optimization in spine surgery remains unclear. We examined the influence of semaglutide prescription on one- to three-level transforaminal lumbar interbody fusion (TLIF) outcomes.</div></div><div><h3>Methods</h3><div>Retrospective analysis of obese, non-diabetic patients was conducted from 2018 to 2022. A 1:1 exact match paired semaglutide users with non-users based on age, gender, surgical levels, and comorbidities. The primary outcome were the rates of surgical and medical complications at 30 days following TLIF. A sub analysis assessed outcomes after stratifying by prescription duration (greater or less than nine months). Kaplan-Meier survival analyses evaluated the need for additional lumbar fusion. The alpha was set to 0.05, but with the Bonferroni correction the significance threshold was set to 0.0045.</div></div><div><h3>Results</h3><div>471 semaglutide users were matched with 471 non-users with no baseline differences. Semaglutide users had higher rates of pneumonia (2.97 % vs 0.85 %, p &lt; 0.05) compared to nonusers. When stratified by prescription duration, patients with longer semaglutide use had a higher incidence of urinary tract infection (4.03 % vs 1.27 %, p &lt; 0.05) and acute kidney injury (3.18 % vs 0.85 %, p &lt; 0.05). The need for additional lumbar fusion was associated with both semaglutide use (17.0 % vs. 6.4 %, p &lt; 0.0001) and duration (28.3 % vs. 4.8 %, p &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Semaglutide may adversely affect lumbar fusion outcomes and necessitate additional surgery, possibly secondary to its systemic effects on bone metabolism and weight loss patterns. Further research into optimal drug formulation, dosage, and weight loss protocols will be required before mainstream use.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108952"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070016","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":"Phrenic nerve transfer for two different targets in adult brachial plexus injuries: Results of function and brain plasticity in a multi-center study","authors":"Jennifer An-Jou Lin ,&nbsp;Johnny Chuieng-Yi Lu ,&nbsp;Martin Bourguet ,&nbsp;Tommy Nai-Jen Chang ,&nbsp;David Chwei-Chin Chuang ,&nbsp;Mariano Socolovsky","doi":"10.1016/j.clineuro.2025.108964","DOIUrl":"10.1016/j.clineuro.2025.108964","url":null,"abstract":"<div><div>This study compares two cohorts of patients who underwent phrenic nerve transfer following a traumatic brachial plexus injury at two tertiary centers on different continents, each utilizing different targets for reinnervation. The aim was to determine whether statistical differences existed in: (1) shoulder abduction versus elbow flexion results, (2) brain plasticity at the final outcome, and (3) factors influencing outcomes in both populations. A retrospective review was conducted involving assessment of shoulder range of motion (ROM) and elbow flexion strength, while brain plasticity was evaluated using the Plasticity Grading Scale (PGS). A total of 104 patients were included, with 59 receiving phrenic nerve transfers to restore shoulder abduction (Ph-shoulder group), and 45 transfers aimed at elbow flexion (Ph-Ef group). Of these, 40 patients were assessed using the Plasticity Grading Scale (PGS). The shoulder group achieved an average ROM of 75.8°, with 61 % regaining ≥ 60° abduction within 16.8 months. The elbow group achieved an average MRC grade of 3.3 strength, with 80 % reaching ≥M3 flexion in 18.6 months. The mean PGS for the Ph-shoulder group was 2.8 (n = 18), while for the Ph-Ef group (n = 22), it was 2.6. Younger age and lower BMI were significant predictors of improved shoulder outcomes, while shorter intervals between shorter injury-tosurgery intervals enhanced elbow recovery. As both groups exhibited similar functional results and brain plasticity scores, we can conclude that the outcomes after a phrenic nerve transfer are comparable between them, demonstrating the predictability, adaptability, and consistency of this nerve transfer.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108964"},"PeriodicalIF":1.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948433","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}