Clinical Neurology and Neurosurgery最新文献

{"title":"Vestibular migraine: Onabotulinum toxin effectivity, prospective-randomized study","authors":"Reyhan Surmeli , Mehmet Surmeli , Ayse Destina Yalcin , Ayse Asli Sahin Yilmaz , Tulay Erden Habesoglu , Gozde Gunay","doi":"10.1016/j.clineuro.2025.108949","DOIUrl":"10.1016/j.clineuro.2025.108949","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108949"},"PeriodicalIF":1.8,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906393","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":"Novel artificial intelligence approach in neurointerventional practice: Preliminary findings on filter movement and ischemic lesions in carotid artery stenting","authors":"Hirotaka Sagawa ,&nbsp;Yuya Sakakura ,&nbsp;Ryoichi Hanazawa ,&nbsp;Satoru Takahashi ,&nbsp;Hikaru Wakabayashi ,&nbsp;Shoko Fujii ,&nbsp;Kyohei Fujita ,&nbsp;Sakyo Hirai ,&nbsp;Akihiko Hirakawa ,&nbsp;Kenichi Kono ,&nbsp;Kazutaka Sumita","doi":"10.1016/j.clineuro.2025.108930","DOIUrl":"10.1016/j.clineuro.2025.108930","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Embolic protection devices (EPDs) used during carotid artery stenting (CAS) are crucial in reducing ischemic complications. Although minimizing the filter-type EPD movement is considered important, limited research has demonstrated this practice. We used an artificial intelligence (AI)-based device recognition technology to investigate the correlation between filter movements and ischemic complications.</div></div><div><h3>Methods</h3><div>We retrospectively studied 28 consecutive patients who underwent CAS using FilterWire EZ (Boston Scientific, Marlborough, MA, USA) from April 2022 to September 2023. Clinical data, procedural videos, and postoperative magnetic resonance imaging were collected. An AI-based device detection function in the Neuro-Vascular Assist (iMed Technologies, Tokyo, Japan) was used to quantify the filter movement. Multivariate proportional odds model analysis was performed to explore the correlations between postoperative diffusion-weighted imaging (DWI) hyperintense lesions and potential ischemic risk factors, including filter movement.</div></div><div><h3>Results</h3><div>In total, 23 patients had sufficient information and were eligible for quantitative analysis. Fourteen patients (60.9 %) showed postoperative DWI hyperintense lesions. Multivariate analysis revealed significant associations between filter movement distance (odds ratio, 1.01; 95 % confidence interval, 1.00–1.02; p = 0.003) and high-intensity signals in time-of-flight magnetic resonance angiography with DWI hyperintense lesions. Age, symptomatic status, and operative time were not significantly correlated.</div></div><div><h3>Conclusion</h3><div>Increased filter movement during CAS was correlated with a higher incidence of postoperative DWI hyperintense lesions. AI-based quantitative evaluation of endovascular techniques may enable demonstration of previously unproven recommendations. To the best of our knowledge, this is the first study to use an AI system for quantitative evaluation to address real-world clinical issues.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108930"},"PeriodicalIF":1.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932166","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":"Racial/ethnic disparities on resource utilization and outcomes for patients undergoing spine surgery: A NSQIP analysis of 402,765 patients","authors":"Aladine A. Elsamadicy ,&nbsp;Paul Serrato ,&nbsp;Shaila D. Ghanekar ,&nbsp;Sina Sadeghzadeh ,&nbsp;Justice Hansen ,&nbsp;Lucas P. Mitre ,&nbsp;Sheng-fu Larry Lo ,&nbsp;Daniel M. Sciubba","doi":"10.1016/j.clineuro.2025.108931","DOIUrl":"10.1016/j.clineuro.2025.108931","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the impact of race/ethnicity on postoperative adverse events (AEs), prolonged length of stay (LOS), non-routine discharge (NRD), and unplanned readmission in spine surgery patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed using the 2016–2023 ACS NSQIP database. Adults receiving spine surgery for trauma, degenerative disease, tumor, and infectious causes were identified using CPT codes and stratified based on race/ethnicity. The primary categories included Non-Hispanic White, Non-Hispanic Black, Non-Hispanic Asian, and Hispanic patients. Patient demographics, comorbidities, intraoperative variables, postoperative AEs, and healthcare resource utilization were assessed. Multivariate logistic regression analysis was utilized to identify predictors of AEs, prolonged LOS, NRD, and unplanned admission.</div></div><div><h3>Results</h3><div>In our cohort of 402,765 patients, postoperative outcomes displayed significant ethnic disparities in AEs, with the highest in Non-Hispanic Blacks (<em>p &lt; 0.001</em>). Similarly, Non-Hispanic Blacks had prolonged operation times and increased rates of unplanned readmissions and reoperations (all <em><u>p &lt; 0.001</u></em>). Multivariate analysis showed Non-Hispanic Blacks had an increased risk for extended LOS (<em>aOR: 1.83, 95 % CI: 1.78–1.88, <u>p &lt; 0.001</u></em>) and AEs (<em>aOR: 1.10, 95 % CI: 1.06–1.15, <u>p &lt; 0.001</u></em>). Non-Hispanic Blacks (<em>aOR: 1.84, 95 % CI: 1.78–1.90, <u>p &lt; 0.001</u></em>), Non-Hispanic Asians (<em>aOR: 1.14, 95 % CI: 1.07–1.21, <u>p &lt; 0.001</u></em>), and Hispanics (<em>aOR: 1.48, 95 % CI: 1.43–1.54, <u>p &lt; 0.001</u></em>) had higher odds of NRD. For unplanned readmissions, Non-Hispanic Blacks (<em>aOR: 1.13, 95 % CI: 1.08–1.19, <u>p &lt; 0.001</u></em>) had increased odds, while Non-Hispanic Asians showed decreased odds (<em>aOR: 0.80, 95 % CI: 0.72–0.90, <u>p &lt; 0.001</u></em>).</div></div><div><h3>Conclusion</h3><div>Our study demonstrates prominent racial/ethnic disparities in postoperative outcomes among spine surgery patients, with particularly elevated risks observed in Non-Hispanic Black individuals.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108931"},"PeriodicalIF":1.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899582","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":"Impact of lifetime and current smoking exposure on the rupture status, number, and size of intracranial aneurysms","authors":"Ramazan Jabbarli ,&nbsp;Marvin Darkwah Oppong ,&nbsp;Meltem Gümüs ,&nbsp;Mehdi Chihi ,&nbsp;Thiemo Florin Dinger ,&nbsp;Laurèl Rauschenbach ,&nbsp;Yahya Ahmadipour ,&nbsp;Philipp Dammann ,&nbsp;Yan Li ,&nbsp;Nika Guberina ,&nbsp;Karsten H. Wrede ,&nbsp;Ulrich Sure","doi":"10.1016/j.clineuro.2025.108924","DOIUrl":"10.1016/j.clineuro.2025.108924","url":null,"abstract":"<div><h3>Background</h3><div>Quantitative data on the impact of smoking on genesis of intracranial aneurysms (IA) is sparse. We aimed to analyze the association between lifetime and current smoking exposure and IA characteristics.</div></div><div><h3>Methods</h3><div>In this prospective observational cohort study (07/2016–01/2023, n = 918), all patients or next of kin filled out the questionnaire for assessment of smoking habits including the status (no/former/current) and consumption level (heavy vs light current smoker [≥/&lt;10 cigarettes/day], and lifetime exposure in pack-years). The study endpoints were the ruptured status, size, and presence of multiple IA.</div></div><div><h3>Results</h3><div>The distribution of non-, former, light, and heavy smokers was 23.2 %, 25.6 %, 11.2 % and 40 % respectively. The median lifetime smoking exposure was 20 pack-years. Current smokers were at higher risk of presenting with ruptured (adjusted odds ratio [aOR]=1.71, 95 % confidence interval [CI]=1.29–2.26, p &lt; 0.0001), large (≥7 mm, aOR=1.41, 95 % CI=1.05–1.89, p = 0.022) and multiple IA (aOR=1.34, 95 % CI=1.01–1.77, p = 0.045). In the subgroup analysis among ever smokers, heavy smoking additionally increased the risk of IA rupture (aOR=1.83, 95 % CI=1.33–2.50, p &lt; 0.0001) and larger size (aOR=1.65, 95 % CI=1.19–2.30, p = 0.003). Finally, longer history of smoking (&gt;20 pack-years) was related to higher probability of multiple (aOR=1.61, 95 % CI=1.21–2.13, p = 0.001) and large IA (aOR=1.40, 95 % CI=1.04–1.87, p = 0.025).</div></div><div><h3>Conclusions</h3><div>Our data underline the role of smoking in IA genesis, and the importance of smoking cessation for rupture prevention. Current and particularly heavy smoking increases the risk of IA rupture, whereas the chronic exposure over years more likely results in the development of multiple and large IA.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108924"},"PeriodicalIF":1.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143913233","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":"Treatment strategies and prognostic analysis of moyamoya disease associated with single intracranial aneurysm","authors":"Jing Lan ,&nbsp;Miao Hu ,&nbsp;Shuang-xiang Xu,&nbsp;Can Xin,&nbsp;Yi-hui Ma,&nbsp;Jian-jian Zhang,&nbsp;Jin-cao Chen","doi":"10.1016/j.clineuro.2025.108914","DOIUrl":"10.1016/j.clineuro.2025.108914","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and Objective&lt;/h3&gt;&lt;div&gt;Moyamoya disease (MMD) with intracranial aneurysm is relatively rare and its treatment is more challenging. There is little agreement regarding the optimal management strategies, treatment modalities and surgical timing for these refractory lesions. This study retrospectively analyzed and summarized the clinical characteristics, treatment strategies, and outcomes of MMD with intracranial aneurysms to further elucidate these issues.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The clinical and angiographic data of 690 patients with MMD were retrospectively collected and analyzed in a single institute from July 2017 to April 2023. Among them, 60 MMD patients with single intracranial aneurysm were included in this study. All patients underwent cerebral revascularization with endovascular embolization, surgical clipping, or aneurysmectomy to eliminate intracranial aneurysms, increase cerebral blood flow, and improve long-term prognosis. In this study, intracranial aneurysms were classified as the proximal aneurysms and the distal aneurysms according to the anatomic location. The patients were divided into a one-stage operation group and a staged operation group based on the different operative procedure. The main endpoint of this study was to summarize the clinical characteristics and treatment experience, and to explore whether there were differences in clinical results between the one-stage operation group and the staged operation group, analysis the potential risk factors for postoperative complications, to further guide the clinic and establish the appropriate treatment strategies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;There were significant differences in age of onset, presentation of MMD, status of aneurysm and types of hemorrhage between the proximal aneurysms group and the distal aneurysms group. The incidence of the proximal aneurysms was significantly higher than that of the distal aneurysms. Patients with distal aneurysms had a relatively younger age and a higher percentage of cerebral hemorrhage as an initial clinical presentation than patients with proximal aneurysms. The rate of procedure-related complications was significantly higher in the one-stage operation group than in the staged operation group (48.3 % vs. 22.6 %, respectively). Univariate analysis revealed that postoperative complications were significantly correlated with age, operative procedure (one-stage operation or staged operation). Multivariate analysis revealed operative procedure [OR 0.125 (0.023–0.665) p = 0.015] as independent risk factors for postoperative complications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;There is no consensus on the optimal treatment strategies and surgical timing for the management of MMD with intracranial aneurysms. In this regard, our results demonstrate that the current treatment strategy of interventional embolization or craniotomy with aneurysm clipping or excision followed by staged cerebral revasculari","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108914"},"PeriodicalIF":1.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143913232","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":"Relationships between dysarthria, lesion location, and oral/swallowing function in patients with first-ever stroke","authors":"Masahiro Nakamori ,&nbsp;Eiji Imamura ,&nbsp;Hayato Matsushima ,&nbsp;Keisuke Tachiyama ,&nbsp;Tomoko Ayukawa ,&nbsp;Masami Nishino ,&nbsp;Mineka Yoshikawa ,&nbsp;Mitsuyoshi Yoshida ,&nbsp;Hirofumi Maruyama","doi":"10.1016/j.clineuro.2025.108928","DOIUrl":"10.1016/j.clineuro.2025.108928","url":null,"abstract":"<div><h3>Objective</h3><div>Dysarthria negatively affects quality of life and social communication. This study focused on dysarthria in patients with acute-phase stroke and analyzed the association between lesion locations and oral/swallowing functions.</div></div><div><h3>Methods</h3><div>Patients with first-ever acute stroke were analyzed. Speech assessments included diadochokinesis rates for \"pa,\" \"ta,\" and \"ka,\" along with reading aloud passages. All patients underwent head magnetic resonance imaging, videofluoroscopic (VF) examinations, and tongue pressure measurements to identify stroke lesions.</div></div><div><h3>Results</h3><div>We analyzed 82 patients with acute stroke excluding those with bilateral or multi-regional lesions (mean age 67.6 ± 11.5 years, 32 women, NIHSS median 1.5). Dysarthria was diagnosed in 16 patients (19.5 %). The National Institutes of Health Stroke Scale (NIHSS) score (odds ratio [OR] 1.289, 95 % confidence interval [CI] 1.050–1.616) and lesions in the corona radiata (OR 9.981, 95 % CI 1.871 – 60.092) were significant risk factors for dysarthria. Tongue pressure was significantly lower in patients with dysarthria, with a cutoff value of 28.4 kPa for predicting dysarthria (area under of the receiver operating characteristic curve 0.688, <em>p</em> = 0.006). Swallowing assessments via VF examinations showed no significant differences between patients with and without dysarthria.</div></div><div><h3>Conclusion</h3><div>Lesions in the corona radiata are associated with dysarthria in patients with stroke. Reduced tongue pressure is also linked to dysarthria. These findings underscore the importance of evaluating dysarthria independently of dysphagia.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108928"},"PeriodicalIF":1.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899580","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":"NLR and LMR could powerfully predict unfavorable outcomes in patients with acute anterior circulation large vessel occlusion stroke (ALVOS) who underwent mechanical thrombectomy","authors":"Ruijing Xu ,&nbsp;Fei Guo ,&nbsp;Chunshui Yang ,&nbsp;Feiqi Zhu","doi":"10.1016/j.clineuro.2025.108925","DOIUrl":"10.1016/j.clineuro.2025.108925","url":null,"abstract":"<div><h3>Introduction</h3><div>To investigate the predictive value of Neutrophil to lymphocyte ratio (NLR) and Lymphocyte to monocyte ratio (LMR) on unfavorable outcomes of acute anterior circulation large vessel occlusion stroke (ALVOS) in patients who underwent mechanical thrombectomy (MT).</div></div><div><h3>Material &amp; method</h3><div>We retrospectively recruited 96 cases with ALVOS who underwent MT. These cases were divided into two groups including the favorable outcome group (3-month modified Rankin Scale scores (mRS) of 0–2) and the unfavorable outcome group (3-month mRS of 3-6). Logistic regression analysis was used to examine the independent risk factors of the 3-month unfavorable outcome of ALVOS. Moreover, we conducted a receiver operating characteristic curve (ROC) to estimate the valuable predictor of NLR, LMR, and the combination of NLR and LMR on unfavorable outcomes of ALVOS after MT.</div></div><div><h3>Results</h3><div>46.9 % (45/96) cases had an unfavorable outcome and 53.1 % (51/96) cases had a favorable outcome. In the univariate regression analysis, baseline NIHSS score, symptomatic intracranial hemorrhage, and fasting glucose were included in the multi-factor binary logistic regression, and this revealed that NLR (OR 3.776, 95 %CI 1.067‐13.363, p = 0.039) and LMR (OR 0.092, 95 %CI 0.017‐0.0506, p = 0.006) were independent predictors of unfavorable outcomes (mRS score 3-6) at 3-month. Higher NLR (&gt; 2.984) and lower LMR (&lt; 3.775) were independently associated with unfavorable outcomes, and the combined predictive levels of both NLR and LMR (AUC = 0.941) were higher than single indicators (NLR, AUC = 0.876; LMR, AUC = 0.934).</div></div><div><h3>Conclusions</h3><div>The combination of NLR and LMR was a more powerful predictor of unfavorable outcomes of ALVOS after MT than NLR alone.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108925"},"PeriodicalIF":1.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143913231","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":"Predicting the efficacy of medical therapy in patients with trigeminal neuralgia","authors":"Honglin Shang ,&nbsp;Jingxian Chen ,&nbsp;Yuhua Fan ,&nbsp;Shengqiao Huang ,&nbsp;Minghang Wu ,&nbsp;Xuguang Zhong ,&nbsp;Ying Yi ,&nbsp;Hai Zhao ,&nbsp;Yanyun Feng","doi":"10.1016/j.clineuro.2025.108926","DOIUrl":"10.1016/j.clineuro.2025.108926","url":null,"abstract":"<div><h3>Background</h3><div>While MRI has proven valuable in predicting the surgical outcomes of trigeminal neuralgia (TN), studies on predicting the efficacy of medical therapy remain limited. The goal of this study was to identify MRI and clinical characteristics that could predict the efficacy of medical therapy for TN.</div></div><div><h3>Method</h3><div>We conducted a blinded evaluation of MRI characteristics in TN patients. Clinical data were obtained from medical records or follow-up phone calls. The relationship between MRI findings and clinical characteristics with the efficacy of medical therapy was then analyzed.</div></div><div><h3>Results</h3><div>A total of 112 patients, including 44 men and 68 women, were enrolled in the study. After six months of follow-up, 35 patients (31.3 %) reported treatment failure, 30 patients (26.8 %) reported poor results, 19 patients (17.0 %) reported good results, and 28 patients (25.0 %) reported excellent results. Logistic regression analysis revealed that patients with the vertebral artery as the offending vessel were 5.625 times more likely to experience poor medical therapy efficacy (95 % confidence interval: 1.084–30.530, p = 0.040). In contrast, patients with involvement of the ophthalmic division (V1) of the trigeminal nerve were 0.416 times less likely to experience poor medical therapy efficacy (95 % CI: 0.178–0.974, p = 0.043).</div></div><div><h3>Conclusion</h3><div>Our study demonstrates that the vertebral artery as the offending vessel and involvement of the ophthalmic division of the TN are correlated with medical therapy efficacy. These findings may assist clinicians in providing more informed guidance when deciding between surgical and medical treatment options for TN patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108926"},"PeriodicalIF":1.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899581","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":"Spirituality and neurosurgery: A salutogenic current perspective","authors":"Gunjan Badwaik ,&nbsp;Priya Kadam ,&nbsp;Chandrasekaran Kaliaperumal","doi":"10.1016/j.clineuro.2025.108922","DOIUrl":"10.1016/j.clineuro.2025.108922","url":null,"abstract":"<div><h3>Aim</h3><div>This systematic review aims to determine how spirituality influences prehabilitation and post-operative patient outcomes along with their coping mechanisms while undergoing Neurosurgical intervention. We have endeavoured to explore the feasibility of safe integration of this concept into Neurosurgical care provision.</div></div><div><h3>Method</h3><div>A literature search was carried out and articles were retrieved from PubMed, Science Direct and Cochrane database using specific keywords. We identified a total of 381 studies that fit our criteria and were analysed using PRISMA guidelines.</div></div><div><h3>Results</h3><div>This review summarises evidence that spirituality significantly impacts multiple domains of neurosurgical patient care. Studies indicate that spirituality fosters meaning, hope, and comfort, aiding patients in coping with neurosurgical conditions like brain and spinal tumours. Patients with higher spirituality exhibited improved postoperative outcomes, including faster recovery, better quality of life, and greater healthcare satisfaction. The ethical necessity of addressing spiritual needs, particularly regarding end-of-life decisions and respecting cultural beliefs was also examined. Some types of spirituality measures showed more positive outcomes in patients than others. While a few studies found no association between quality of life and complementary spiritual therapies, trends have shifted. Neuroimaging research has identified potential neurobiological correlates of spiritual experiences in regions like the parietal lobe and prefrontal cortex. The World Health Organisation (WHO) now includes spirituality in the holistic approach to palliative care for terminal patients.</div></div><div><h3>Conclusion</h3><div>Current evidence suggests beneficial outcomes from utility of spirituality tools such as meditation, yoga, mantram repetition, exercise, and support groups. These can be safely integrated in provision of a salutogenic approach to improve overall outcome in patients undergoing neurosurgery. This is the first study to focus on spirituality in Neurosurgery aiming for holistic care provision across the globe. We believe that it is feasible to bring in a change to patient’s care balancing mind, body and spirit integrated with excellent Neurosurgical care.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108922"},"PeriodicalIF":1.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899656","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":"Angiographic response to endovascular treatment of post-hemorrhage cerebral vasospasm is not associated with clinical outcome","authors":"Faraz Behzadi ,&nbsp;John T. Tsiang ,&nbsp;Ronak H. Jani ,&nbsp;Andre A. Payman ,&nbsp;Brandon J. Bond ,&nbsp;Anthony W. Kam ,&nbsp;David D. Pasquale ,&nbsp;Joseph C. Serrone","doi":"10.1016/j.clineuro.2025.108927","DOIUrl":"10.1016/j.clineuro.2025.108927","url":null,"abstract":"<div><h3>Introduction</h3><div>Post-hemorrhagic cerebral vasospasm (PHCV) in aneurysmal subarachnoid hemorrhage (aSAH) often requires endovascular intervention with either intra-arterial (IA) vasodilator therapy or percutaneous transluminal balloon angioplasty (PTA). This study aimed to evaluate the angiographic efficacy of endovascular treatments with clinical outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients (≥18 years) who underwent IA vasodilator therapy or PTA for PHCV following aSAH at our institution from 2007 to 2023. Patients were stratified into “good” and “poor” outcome cohorts based on a 6-month modified Rankin Scale &gt; 2. Identifiable risk factors were assessed using univariate and multivariate analyses. We compared angiographic changes in vessel diameter, cerebral circulation time (CCT), and retreatment rates between (1) PTA plus IA vasodilator sessions vs. IA-only sessions, and (2) verapamil-only vs. verapamil plus another agent. The statistically significant variables were used to create a scoring model to predict poor outcome.</div></div><div><h3>Results</h3><div>Eighty-three patients (mean age 52 years, 66 % female) with 246 treated vessels met inclusion criteria. IA vasodilators alone were used in 220 vessels, and PTA plus IA vasodilators were used in 26 vessels. 65 % of patients had a poor 6-month outcome. Male sex (p = 0.016), Black race (p = 0.030), hypertension (p = 0.015), earlier vasospasm onset (p = 0.016), and longer initial pre-treatment CCT (p = 0.033) were independently associated with poor outcomes. Vasospasm symptom of headaches alone (p = 0.044) was protective. PTA plus IA vasodilators more effectively increased the M1 diameter than IA vasodilators alone but CCT reductions were the same. Improvement in angiographic parameters was not associated with improved clinical outcome. Verapamil-only had the same angiographic and clinical outcomes compared to Verapamil plus another agent. The scoring model used 6-variables with an AUC = 0.746 to predict clinical outcomes.</div></div><div><h3>Conclusions</h3><div>In this single-center retrospective study of PHCV, despite angiographic improvements with endovascular therapy, there was no associated improvement in clinical outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108927"},"PeriodicalIF":1.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894983","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}