Clinical Neurology and Neurosurgery最新文献

{"title":"Characterizing post-operative ICU admission after cervical spondylotic myelopathy surgery","authors":"Lauren M. Boden ,&nbsp;Yixuan A. Pei ,&nbsp;Jennifer X. Hong ,&nbsp;Lori Jia ,&nbsp;Stephen Barchick ,&nbsp;David S. Casper ,&nbsp;James M. Schuster ,&nbsp;Amrit S. Khalsa","doi":"10.1016/j.clineuro.2025.108963","DOIUrl":"10.1016/j.clineuro.2025.108963","url":null,"abstract":"<div><h3>Study design</h3><div>Retrospective cohort</div></div><div><h3>Objective</h3><div>To characterize variables associated with post-operative intensive care unit (ICU) admission following cervical spondylotic myelopathy (CSM) surgery and determine if ICU stay is associated with increased length of stay (LOS).</div></div><div><h3>Summary of background data</h3><div>Routine post-operative ICU stay for mean arterial pressure monitoring is an established practice after acute spinal cord injury. However, there is no formal recommendation for CSM patients post-operatively. Variability exists in ICU utilization after CSM surgery, with some surgeons routinely sending patients to the ICU while others do not.</div></div><div><h3>Methods</h3><div>Patients who underwent primary, single-approach CSM surgery at a single institution over a two-year span were divided into ICU and non-ICU cohorts based on immediate post-operative destination. Primary outcome was LOS. Secondary outcomes included discharge disposition, complications, clinical status, and reoperation within three years. Propensity score matching (PSM) created matched cohorts of ICU and non-ICU patients. Outcomes were assessed using Mann-Whitney, McNemar, or 2-sided t-tests.</div></div><div><h3>Results</h3><div>452 patients were included in initial analysis. Variables that significantly predicted ICU disposition include age, increased number of stenotic levels, adapted spinal canal occupation ratio, Medicare insurance, management by orthopaedic service, posterior surgical approach, increased surgery duration, and increased estimated blood loss. After PSM to control these variables, non-ICU patients had shorter LOS (2.14 vs 4.14, p &lt; 0.001) and higher rate of discharge to home (83.5 % vs 55.3 %, p = 0.0009) with no difference in neurologic status change or complications at 6 weeks.</div></div><div><h3>Conclusion</h3><div>In CSM patients, routine post-operative ICU admission is associated with longer LOS and discharge to rehabilitation facilities without decreasing post-operative complications compared to patients routinely admitted to the floor.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108963"},"PeriodicalIF":1.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948432","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 utility of the PK papyrus covered stent in neurointervention: A prospective study on safety, efficacy, and aneurysm occlusion rates","authors":"Ahmed Abdelsalam ,&nbsp;Andrew Yu ,&nbsp;Sai Sanikommu ,&nbsp;Luis Guada ,&nbsp;Soumya Shrigiri ,&nbsp;Vasu Saini ,&nbsp;Hayes B. Fountain ,&nbsp;Turki Elarjani ,&nbsp;Emade Jaman ,&nbsp;Carolina Benjamin ,&nbsp;Michael E. Ivan ,&nbsp;Diogo Haussen ,&nbsp;Maxon V. Knott ,&nbsp;Aqueel H. Pabaney ,&nbsp;Robert M. Starke","doi":"10.1016/j.clineuro.2025.108933","DOIUrl":"10.1016/j.clineuro.2025.108933","url":null,"abstract":"<div><h3>Background</h3><div>Covered stents have become increasingly utilized in neurovascular interventions due to their ability to achieve immediate lesion occlusion while preserving the parent vessel. The PK Papyrus stent is a thinner balloon mounted covered stent that has been used off-label in neurointerventions, but there is limited evidence regarding its performance and clinical benefits. This study aims to evaluate the PK Papyrus stents safety, efficacy, and occlusion rates in managing complex neurovascular pathologies.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of a prospectively enrolling study that included 13 patients. The primary outcome was the rate of complete aneurysm and carotid-cavernous fistula (CCF) occlusion. Secondary outcomes focused on safety, including the incidence of periprocedural complications, device-related complications, and adverse events.</div></div><div><h3>Results</h3><div>The study included 13 patients, with 46.1 % being female. The median modified Rankin Scale (mRS) at presentation was 1. The PK Papyrus stent was successfully deployed in all cases (100 %). No periprocedural complications were encountered. Additionally, there were no device-related complications, including stent fracture or in-stent stenosis. Over a median follow-up duration of 6 months, all treated lesions remained completely occluded, with stable vessel patency and no evidence of recurrence or recanalization. No adverse events or neurological deficits were reported among the patients.</div></div><div><h3>Conclusion</h3><div>This study indicates that the PK Papyrus covered stent is a safe and effective option for managing complex neurovascular pathologies. It demonstrated a high technical success rate, with no periprocedural or device-related complications, supporting its use as a promising alternative to other endovascular modalities in select cases.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108933"},"PeriodicalIF":1.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090269","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":"Temporal muscle thickness and index predict overall survival after surgical evacuation of spontaneous intracerebral hemorrhage","authors":"Emilia K. Pesonen ,&nbsp;Otso Arponen ,&nbsp;Jaakko Niinimäki ,&nbsp;Nicole Hernández ,&nbsp;Lasse Pikkarainen ,&nbsp;Tommi K. Korhonen ,&nbsp;Sami Tetri","doi":"10.1016/j.clineuro.2025.108962","DOIUrl":"10.1016/j.clineuro.2025.108962","url":null,"abstract":"<div><h3>Objective</h3><div>The prognosis of spontaneous intracerebral hemorrhage (ICH) is poor, but an accurately selected subset of patients benefits from surgery. Loss of muscle mass is associated with various geriatric syndromes and poor overall physiological capacity. We investigated whether temporal muscle thickness (TMT) and temporal muscle index (TMI), non-invasive indicators of whole-body muscle mass, predict overall survival (OS) in surgically treated spontaneous ICH.</div></div><div><h3>Methods</h3><div>We identified all patients with surgically evacuated spontenous supratentorial ICHs in a single centre between 2014 and 2022. We measured TMT and TMI from preoperative computed tomography scans, and tested the prognostic capability of these measurements for post-operative OS. Cut-off values were calculated to divide patients into low and normal muscle status groups according to TMT and TMI.</div></div><div><h3>Results</h3><div>The median age of the 63 patients included in the study was 67 years (IQR 57–72), and 37 (59 %) were males. The overall mortality during the median follow-up period of 36 months (IQR 1–79) was significantly higher in the low muscle status group, as assessed using TMT and TMI cut-offs (67 % vs. 30 %, HR 2.65, 95 % CI 1.23–5.65, and 67 % vs. 31 %, HR 2.37, 95 % CI 1.11–5.04, respectively). The association persisted when adjusted with ICH score, pupillary status and blood pressure on admission (TMT HR 2.75, 95 % CI 1.27–5.96, TMI HR 2.30, 95 % CI 1.07–4.97).</div></div><div><h3>Conclusion</h3><div>TMT and TMI provide prognostic information supplemental to established outcome predictors in surgically treated ICH. These parameters may improve surgical patient selection and detection of patients at risk of poor outcomes who might benefit from intensified post-operative ancillary care.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108962"},"PeriodicalIF":1.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937270","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":"Safety first: A comparative study of mechanical thrombectomy techniques for M2 occlusions – stent-retriever thrombectomy (SRT) vs. first stenting without retrieval (FRESH)","authors":"Jonghoon Kim","doi":"10.1016/j.clineuro.2025.108956","DOIUrl":"10.1016/j.clineuro.2025.108956","url":null,"abstract":"<div><h3>Background</h3><div>The most appropriate method for mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to M2 segment middle cerebral artery (MCA) occlusion remains unclear. Hence, this study aimed to investigate the benefits of first stenting without retrieval (FRESH) vs. stent-retriever thrombectomy (SRT) for treating patients with M2 occlusion–associated AIS.</div></div><div><h3>Methods</h3><div>The data of patients who underwent MT for AIS at our institution between January 2019 and December 2023 were reviewed. Treatment variables, clinical outcomes, and complications were analyzed.</div></div><div><h3>Results</h3><div>Thirty-five patients with M2 MCA occlusion of the anterior circulation were included. Among these patients, 20 (57.1 %) underwent SRT, whereas 15 (42.9 %) underwent FRESH. The puncture-to-recanalization time was significantly shorter in the FRESH group (35 vs. 41.5 min, p &lt; 0.001). Asymptomatic intracranial hemorrhage was significantly more common in the SRT group than in the FRESH group (18.8 % vs. 0 %, p = 0.027). The FRESH group was more likely to experience both favorable clinical outcomes (modified Rankin score [mRS]: 0–2; 86.7 % vs. 55 %, respectively, p = 0.069) and excellent clinical outcomes (mRS: 0–1; 66.7 % vs. 25 %, p = 0.014).</div></div><div><h3>Conclusion</h3><div>The FRESH technique is a more efficient method for minimizing procedural risk while achieving recanalization in the treatment of patients with acute M2 occlusions.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108956"},"PeriodicalIF":1.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070014","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 challenge of simultaneous patient presentation for endovascular thrombectomy","authors":"Anas Alrohimi ,&nbsp;Maria Martucci ,&nbsp;Abhi Pandhi ,&nbsp;Mohammad Ammar Abdulrazzak ,&nbsp;Jenny Tsai ,&nbsp;Nina Z. Moore ,&nbsp;Mark Bain ,&nbsp;Gabor Toth ,&nbsp;Muhammad Shazam Hussain","doi":"10.1016/j.clineuro.2025.108923","DOIUrl":"10.1016/j.clineuro.2025.108923","url":null,"abstract":"<div><div>The demand for endovascular thrombectomy has raised significantly over the last few years, and it is anticipated to continue to grow. The stroke system of care has faced challenges in providing timely access to EVT for simultaneous presenting patients with large vessel occlusion (LVO). We present three patients with LVO who arrived at the emergency department simultaneously to highlight the issue related to access delays and suggested measures that could help the hospital systems to alleviate the impacts associated with these scenarios.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108923"},"PeriodicalIF":1.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116688","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":"A new diagnostic method in ischemic and hemorrhagic stroke: Doppler ultrasound of ophthalmic artery","authors":"Efe Kanter ,&nbsp;Umut Payza ,&nbsp;Zeynep Karakaya ,&nbsp;Hüseyin Acar ,&nbsp;Mehmet Göktuğ Efgan ,&nbsp;Süleyman Kırık ,&nbsp;Tutku Duman Şahan ,&nbsp;Semih Musa Coşkun","doi":"10.1016/j.clineuro.2025.108959","DOIUrl":"10.1016/j.clineuro.2025.108959","url":null,"abstract":"<div><h3>Objective</h3><div>Timely and accurate diagnosis of ischemic and hemorrhagic stroke is critical for optimizing early management and improving outcomes. However, reliance on advanced neuroimaging may cause delays, especially in resource-limited settings. This study evaluates the role of ophthalmic artery Doppler ultrasound (OAD-US) in assessing stroke-related hemodynamic alterations and its potential as a bedside diagnostic tool.</div></div><div><h3>Methods</h3><div>This prospective observational study included ischemic and hemorrhagic stroke patients admitted to the emergency department with confirmed diagnoses via computed tomography (CT) or magnetic resonance imaging (MRI). OAD-US was performed to measure peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) in both eyes. To assess hemispheric hemodynamic asymmetry, PSV and EDV ratios were calculated by comparing the affected and unaffected sides. A control group of healthy individuals determined baseline values.</div></div><div><h3>Results</h3><div>Both ischemic and hemorrhagic stroke patients showed significantly different PSV and EDV ratios compared to controls (p &lt; 0.001 and p = 0.001, respectively). ROC analysis demonstrated high diagnostic accuracy, with the PSV ratio achieving an AUC of 0.913 (85.7 % sensitivity, 91.3 % specificity) and the EDV ratio an AUC of 0.724 in distinguishing stroke patients from controls. RI did not differ significantly between groups.</div></div><div><h3>Conclusions</h3><div>OAD-US provides a rapid, non-invasive, and bedside-accessible method for detecting stroke-related cerebrovascular alterations. The significant differences in PSV and EDV ratios between stroke and control groups suggest OAD-US may serve as a valuable adjunct in acute stroke assessment, particularly where immediate neuroimaging is unavailable. Further multicenter studies are needed to validate its clinical utility.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108959"},"PeriodicalIF":1.8,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937269","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":"A patient with a MYORG variant in primary brain calcification has rapid clinical course and increased calcification volume on an image analyzer","authors":"Isao Hozumi ,&nbsp;Hisaka Kurita ,&nbsp;Fuminori Hyodo ,&nbsp;Kazuhiro Ozawa ,&nbsp;Yasuteru Inoue ,&nbsp;Megumi Yamada ,&nbsp;Yuichi Hayashi ,&nbsp;Takayoshi Shimohata ,&nbsp;Masayuki Matsuo ,&nbsp;Kazuki Ohuchi ,&nbsp;Masatoshi Inden","doi":"10.1016/j.clineuro.2025.108954","DOIUrl":"10.1016/j.clineuro.2025.108954","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary brain calcification (PBC), genetically heterogeneous disorder, is characterized by abnormal calcification deposition in various brain regions, including the bilateral basal nuclei. The disease presents with a variety of symptoms, including cognitive impairment, parkinsonism, psychiatric signs or even remains asymptomatic.</div></div><div><h3>Materials and Methods</h3><div>We herein present a case of a 39-year-old man with a homozygous rare variant with unknown pathological significance (c.284 T &gt; C, pLeu95Pro) in the major causative gene, <em>MYORG</em> for PBC. He presented to the hospital with mild speech disorder and ataxia. Over the years, dysarthria and ataxia progressed. Brain computed tomography (CT) scans were performed almost annually and evaluated using the total calcification score (TCS). The calcified part of the brain was observed in three-dimensional while rotating, and the total calcification volume was measured using an image analyzer.</div></div><div><h3>Results</h3><div>The TCSs remained unchanged, however, the image analyzer clearly showed the calcified area in the brain and an increasing calcification volume in the same CT machine and under the same condition.</div></div><div><h3>Conclusions</h3><div>The evaluation method is very useful for the three-dimensional observation and quantification of calcification.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108954"},"PeriodicalIF":1.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143940686","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":"Neuroendoscopic management of intraventricular neurocysticercosis: A systematic review and meta-analysis","authors":"Cristian D. Mendieta-Barrera ,&nbsp;Anuraag Punukollu ,&nbsp;Camila Rios-Hurtado ,&nbsp;Fernando De Nigris Vasconcellos ,&nbsp;Fabricio Garcia-Torrico ,&nbsp;Vanessa Pamela Salolin-Vargas ,&nbsp;Kevin Mamani-Julian ,&nbsp;Carlos Esteban Vidal Valderrama ,&nbsp;Luciana Rivera-Hurtado ,&nbsp;Daniel Ballesteros-Herrera ,&nbsp;Manjul Tripathi ,&nbsp;Jaime G. Torres-Corzo ,&nbsp;Arash Ghaffari-Rafi","doi":"10.1016/j.clineuro.2025.108953","DOIUrl":"10.1016/j.clineuro.2025.108953","url":null,"abstract":"<div><h3>Background</h3><div>Neurocysticercosis is parasitic infection responsible for intraventricular cysts and consequent obstructive hydrocephalus. While the cysts are sometimes treated endoscopically, the efficacy and safety of neuroendoscopic management for intraventricular neurocysticercosis (IVNCC) remains unclear. Therefore, we conducted a systematic review and meta-analysis to evaluate management outcomes of endoscopic IVNCC.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, a search of MEDLINE, Embase, and Lilacs databases was performed (inception to September 10, 2024), focusing on the neuroendoscopic management of IVNCC. Eligible studies included at least five patients and reported outcomes of cyst resection and complication rates.</div></div><div><h3>Results</h3><div>Fifteen studies met our inclusion criteria (n = 314 patients). Mean age at diagnosis was 20.6 years, with 55.6 % (n = 138) patients male, and 44 % (n = 138) of cysts in the fourth ventricle, 32.8 % (n = 104) in the third, and 28.7 % in the lateral ventricles. Preoperative hydrocephalus was observed in 92.3 % (n = 203) of cases. Complete cyst resection was achieved in 90.1 % (n = 214) of patients, with the highest success rates noted in third ventricular cysts (99.6 %; compared to 89.0 % in the lateral and 85.0 % in the fourth ventricles). Flexible endoscopy demonstrated superior outcomes for fourth ventricle cysts (100 %) relative to the rigid endoscope (79.0 %, p &lt; 0.01). Non-visualization of cysts was the primary etiology for incomplete resection (1.6 %). Intraoperative complications included bleeding at 0.76 % (n = 6) and cyst rupture at 0.48 % (n = 5). Postoperative complications involved seizures (1.6 %), neurological deficits (0.95 %), and infection-related mortality (0.85 %). The reintervention rate was 3.0 % (n = 18), with the intervention primarily being cranial shunt implantation. Postoperative anthelmintic therapy significantly improved outcomes from 69.0 % to 96.0 % (p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Neuroendoscopic management of IVNCC is effective and safe. Higher resection rates are achieved with the flexible endoscope, likely secondary to enhanced visualization. Finally, adjuvant postoperative anthelmintic therapy significantly improved outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108953"},"PeriodicalIF":1.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070013","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 use of onabotulinum toxin type A and other neurotoxins for the treatment of chronic migraine: An American Headache Society survey study","authors":"Utkarsh Agarwal ,&nbsp;Kendra Hamilton ,&nbsp;Ashhar Ali ,&nbsp;Paul G. Mathew","doi":"10.1016/j.clineuro.2025.108960","DOIUrl":"10.1016/j.clineuro.2025.108960","url":null,"abstract":"<div><h3>Purpose</h3><div>OnabotA is the only US Food and Drug Administration-approved neurotoxin for chronic migraine prevention; however, non-onabotA toxins may be equally effective. Few studies have explored clinician practices and patient outcomes with non-onabotA neurotoxins. Our study aimed to generate a statistical snapshot of clinician perspectives and treatment practices regarding onabotulinum toxin A (onabotA) and other neurotoxins for chronic migraine and comorbid conditions.</div></div><div><h3>Methods</h3><div>A 15-question survey was distributed online to clinician members of the American Headache Society (AHS) assessing clinical practices using onabotA and non-onabotA toxins for chronic migraine and comorbid conditions, and descriptive analysis was performed.</div></div><div><h3>Results</h3><div>168 respondents (162 from the United States and 6 from Canada) completed the survey (response rate 10.1 % [168/1665]). Of 48 respondents (28 % of total) using non-onabotA toxins for chronic migraine, 27 (16 %) used incobotulinum toxin A; 23 (14 %) used abobotulinum toxin A; and 12 (7 %) used rimabotulinum toxin B. Non-onabotA toxins were predominantly used due to administration/payor imposed issues (19/48; 40 %) and cost (18/48 [38 %]). Most clinicians using non-onabotA toxins reported similar efficacy to onabotA (32/48; 67 %), while fewer reported better efficacy (9/48 [19 %]) or worse efficacy (7/48 [15 %]) than onabotA. Many respondents (114/168 [68 %]) had used neurotoxins for chronic migraine in addition to other comorbid conditions, including temporomandibular joint disorders (95/114 [83 %]) and cervical dystonia (64/114 [56 %]).</div></div><div><h3>Conclusion</h3><div>While non-onabotA toxins are used less frequently for chronic migraine, they may have similar efficacy as onabotA and are used off-label in clinical practice due to administrative/payor issues or cost<strong>.</strong></div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108960"},"PeriodicalIF":1.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948431","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":"Drivers of neurosurgeon selection among operative intracranial tumor patients","authors":"Melanie Alfonzo Horowitz ,&nbsp;Joanna Roy ,&nbsp;Megan Parker ,&nbsp;Arushi Devgun ,&nbsp;Emre Derin ,&nbsp;A. Karim Ahmed ,&nbsp;Ryan P. Lee ,&nbsp;Christopher M. Jackson ,&nbsp;Debraj Mukherjee","doi":"10.1016/j.clineuro.2025.108932","DOIUrl":"10.1016/j.clineuro.2025.108932","url":null,"abstract":"<div><h3>Objective</h3><div>Despite increased access to online information, little is known about what factors patients consider when selecting a neurosurgeon for intracranial tumor resection. This study aims to identify patient priorities in neurosurgeon selection.</div></div><div><h3>Methods</h3><div>Patients who underwent intracranial tumor resection between January 1, 2023, and January 31, 2024, at a single institution were surveyed. They ranked 13 factors on a 5-point Likert scale. Survey data were analyzed alongside demographic and clinical information using ordinal logistic regression.</div></div><div><h3>Results</h3><div>Fifty patients (mean age 54.15 ± 13.82; 54 % female; 70 % white; 70 % privately insured) completed the survey. Surgeon caseload and procedure-specific experience (mean score 4.64 ± 0.72) were rated as most important, followed by hospital ranking (4.48 ± 0.68), years of experience (4.38 ± 0.75), and surgeon interpersonal skills (4.2 ± 1.14). Least important were social media presence, age, and word of mouth.</div><div>Subgroup analysis revealed that non-Caucasian patients valued word of mouth more (OR: 1.65), while patients undergoing repeat surgery valued it less (OR: 0.33). Older patients, non-Caucasians, ethnic minorities, and married individuals placed less importance on medical school prestige.</div></div><div><h3>Conclusion</h3><div>Neurosurgical patients prioritize surgeon experience, hospital reputation, and interpersonal qualities. These insights can inform provider transparency, resource allocation, and outreach to underserved groups.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108932"},"PeriodicalIF":1.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928624","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}