Clinical Neurology and Neurosurgery最新文献

{"title":"Benchmarking surgical approaches to thoracic disc herniation: A retrospective database study","authors":"Pranav Kumar ,&nbsp;Eric Z. Herring ,&nbsp;Rohit Mauria ,&nbsp;Collin M. Labak ,&nbsp;Tianqi Xiao ,&nbsp;Manish K. Kasliwal","doi":"10.1016/j.clineuro.2025.109100","DOIUrl":"10.1016/j.clineuro.2025.109100","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic disc herniations are a relatively uncommon form of degenerative disc disease, comprising an estimated 0.1–3 % of all spinal disc herniations. Surgical treatment may utilize an anterior, lateral, or posterior/posterolateral approach, and approach selection is based on a number of factors.</div></div><div><h3>Objective</h3><div>This study investigated national trends in surgical approach utilization as well as patient characteristics predictive of receiving a specific surgical approach.</div></div><div><h3>Methods</h3><div>This was a retrospective study querying the TriNetX national database. Patients were identified through specific ICD-9 coding for degenerative thoracic disc herniation and CPT coding for thoracic spinal procedures.</div></div><div><h3>Results</h3><div>Of 3009 total patients meeting inclusion criteria, 2703 patients (89.8 %) underwent decompression through a posterior or posterolateral approach, 222 (7.4 %) via anterior approach, and 84 (2.8 %) via lateral extracavitary approach. The number of posterior or posterolateral operations notably increased from 43 cases in 2010 to over 240 cases per year from 2022 to 2024. In contrast, anterior approach procedures reached a peak of 27 cases in 2017 and declined to 13 or fewer cases per year since.</div></div><div><h3>Conclusion</h3><div>Most thoracic disc herniation patients in the TriNetX database received surgical decompression via a posterior or posterolateral approach. Although the annual number of surgeries performed for thoracic disc herniation patients increased after 2017, there was a decreased utilization of anterior approaches. This study demonstrates the widespread utilization of posterolateral-based approaches in the surgical management of thoracic disc herniations.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109100"},"PeriodicalIF":1.6,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827855","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 “Timing of external ventricular drain placement and its effects on in-hospital outcomes in traumatic brain injury: A propensity score-matched analysis” [Clin. Neurol. Neurosurg. 257 (2025) 109044]","authors":"Sam H. Jiang ,&nbsp;Hadeel M. Mansour ,&nbsp;Michael Edgar ,&nbsp;Gabriel S. Gonzales-Portillo ,&nbsp;Zayed Almadidy ,&nbsp;Ankit I. Mehta","doi":"10.1016/j.clineuro.2025.109095","DOIUrl":"10.1016/j.clineuro.2025.109095","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109095"},"PeriodicalIF":1.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803754","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":"Retraction notice to “Fractionated stereotactic re-irradiation for recurrent glioblastoma: A systematic review and meta-analysis” [Clinical Neurology and Neurosurgery 229 (2023) 107728]","authors":"Tingfan Luo ,&nbsp;Jin Feng ,&nbsp;Pengfei Sun","doi":"10.1016/j.clineuro.2025.109061","DOIUrl":"10.1016/j.clineuro.2025.109061","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109061"},"PeriodicalIF":1.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803755","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":"Global visualization exploration of post-stroke cardiac changes: A bibliometric analysis based on CiteSpace and VOSviewer","authors":"Jingjie Huang ,&nbsp;Yan Zhang ,&nbsp;Ziyi Zhang ,&nbsp;Qiuxuan Wang ,&nbsp;Yupei Cheng ,&nbsp;Bangqi Wu","doi":"10.1016/j.clineuro.2025.109088","DOIUrl":"10.1016/j.clineuro.2025.109088","url":null,"abstract":"<div><h3>Background</h3><div>Stroke and cardiovascular diseases are the two primary contributors to the global disease burden. Modern studies have progressively uncovered the intricate interplay between the brain and the heart, with cerebral injury influencing cardiac dysfunction, leading to a causative relationship. post-stroke cardiac changes, a common clinical disease caused by brain injury resulting in cardiac dysfunction, often presents medical challenges within the first few days after a stroke. Acute brain injuries can trigger heart failure even in the absence of primary heart disease, leading to potential long-term cardiac complications such as myocardial infarction, arrhythmias, and heart failure. These complications have become the second leading cause of death after stroke, with approximately 2–6 % of stroke patients dying from cardiac causes within the first three months after an ischemic stroke. The pathophysiology of post-stroke cardiac changes is still under investigation, and there is no standardized clinical treatment or universally accepted therapeutic approach. This paper aims to review the current global research status and trends in post-stroke cardiac changes.</div></div><div><h3>Methods</h3><div>Articles on post-stroke cardiac changes published from 1990 to 2025 were identified using the Web of Science Core Collection database. Bibliometric methods were employed to analyze authors, institutions, countries, journals, and references using CiteSpace and VOSviewer, including a total of 268 articles.</div></div><div><h3>Results</h3><div>The United States leads in the number of publications in this field, followed by Germany. Charité-Universitätsmedizin Berlin is a leading institution in post-stroke cardiac changes research. Luciano A. Sposato, Zhili Chen, Poornima Venkat, Jan F. Scheitz, Christian H. Nolte, and Matthias Endres have all made significant contributions to this field. The journals Stroke and Annals Of Neurology are considered the most influential in this field. Using cluster analysis, keywords were categorized into four main groups: (1) Stroke-Induced Cardiac Changes; (2) Stroke-Induced Risks and Outcomes; (3) Brain-Heart Interactions; (4) Stroke-Induced Neurogenic Cardiac Injury.</div></div><div><h3>Conclusions</h3><div>This study systematically summarizes the research outcomes on post-stroke cardiac changes from 1990 to 2025, describing and predicting global research hotspots and trends. Research has found that the number of publications on this topic has been increasing significantly, and future research will constitute critical priorities in three domains: delineating brain-heart interplay mechanisms (particularly neurogenic pathways), characterizing the spectrum of stroke-induced cardiac alterations, and enhancing attention to early risk outcomes. Concurrently, efforts must prioritize refining and expanding therapeutic strategies, which holds significant promise for enhancing clinical applicability.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109088"},"PeriodicalIF":1.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144770129","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 value of D-dimer as a biomarker for the diagnosis of cerebral embolism: A meta-analysis","authors":"Kai Yang,&nbsp;Aihua Huang,&nbsp;Xiaolin Wang,&nbsp;Yidan Zhou","doi":"10.1016/j.clineuro.2025.109089","DOIUrl":"10.1016/j.clineuro.2025.109089","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral embolism is a subtype of acute ischemic stroke (AIS). D-dimer levels were significantly different among stroke subtypes. This meta-analysis evaluates the value of D-dimer for cerebral embolism diagnosis.</div></div><div><h3>Methods</h3><div>Literature was searched from PubMed, Cochrane Library, EMBASE, Wanfang, and China National Knowledge Infrastructure (CNKI) databases. The QUADAS-2 tool was used to evaluate study quality. D-dimer's diagnostic performance was assessed via SROC curves, pooled sensitivity, specificity, PLR, NLR, and DOR with their 95 % CIs. Cochran's Q test and I² statistic measured study heterogeneity.</div></div><div><h3>Results</h3><div>This meta-analysis enrolled ten studies (652 cerebral embolism patients and 2683 patients with other AIS subtypes). D-dimer showed promising diagnostic performance for cerebral embolism with a sensitivity of 0.77 (95 % CI: 0.65–0.86), specificity of 0.79 (95 % CI: 0.70–0.86), and an AUC of 0.85 (95 % CI: 0.82–0.88). Its PLR of 3.72 (95 % CI: 2.62–5.29) and NLR of 0.29 (95 % CI: 0.19–0.44) further supported its utility, while the DOR of 12.92 (95 % CI: 7.50–22.25) highlighted its significant diagnostic value. Case type was identified as the primary source of heterogeneity (I²=76, <em>P</em> = 0.02).</div></div><div><h3>Conclusion</h3><div>D-dimer has a significant diagnostic value for cerebral embolism, with moderate sensitivity and specificity within 24 h of onset.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109089"},"PeriodicalIF":1.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781275","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":"Comparative analysis of growth hormone-secreting mixed gangliocytomas and pure growth hormone pituitary adenomas","authors":"Hailey Mattheisen ,&nbsp;Abigail Peterson ,&nbsp;Abdullah Memon ,&nbsp;E. Kelly S. Mrachek ,&nbsp;Samon Tavakoli ,&nbsp;Adriana Ioachimescu ,&nbsp;Nathan Zwagerman ,&nbsp;Stephanie Cheok","doi":"10.1016/j.clineuro.2025.109097","DOIUrl":"10.1016/j.clineuro.2025.109097","url":null,"abstract":"<div><h3>Introduction</h3><div>Mixed gangliocytoma-pituitary adenomas (MGPAs) are rare sellar tumors, often presenting with signs and symptoms of acromegaly due to the somatotrophic component. The pathogenesis is not well understood, with few cases reported. We present our institutional experience in surgical management and compare surgical outcomes in growth hormone (GH)-secreting MGPAs and GH-secreting pituitary adenomas (GHPAs).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed demographic and clinical data of adult patients with MGPAs and GHPAs operated at our institution from 2018 to 2024.</div></div><div><h3>Results</h3><div>Six MGPA patients (3 males, 3 females) and 40 GHPA patients (20 males, 20 females) were included. Mean age was 47 (range 36–65) and 49 years (range 19–76), respectively. Common symptoms in both groups were headaches, acral enlargement, and facial changes. All patients underwent endoscopic endonasal transsphenoidal approach (EETA). Preoperative mean IGF-1 levels were similar. Tumor diameter was larger in MGPA (23 mm vs. 15 mm, p = 0.034). Cavernous sinus invasion Knosp 4 was more common in MGPA (16 %) than GHPA (5 %) (p = 0.121). Hormonal remission, defined as normalized IGF-1 at 3–6 months postoperatively, was achieved in 50 % of MGPA and 48 % of GHPA patients. Mean follow-up time for MGPA and GHPA patients was 19 months and 34 months respectively. Neither group experienced disease recurrence.</div></div><div><h3>Discussion</h3><div>MGPA is a rare subtype of pituitary adenoma; however, it represented 12.8 % of operated GH-secreting tumors at our institution. In our series, MGPAs were larger tumors and more likely to invade the cavernous sinus than GHPAs. EETA was safe and effective in both groups, with similar remission rates.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109097"},"PeriodicalIF":1.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826893","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":"Efficacy of andexanet alfa in non-surgical patients with spontaneous DOAC related intracerebral hemorrhage","authors":"Asha Sethuraman ,&nbsp;Agnieszka Ardelt ,&nbsp;Roman Finocchiaro ,&nbsp;Evgeniia Grik ,&nbsp;Kyle Hunter ,&nbsp;Deven Reddy ,&nbsp;Alfred Bowles ,&nbsp;Mary Joan Roach ,&nbsp;Tyler Frantz ,&nbsp;Haley Bajdas ,&nbsp;Ryan Mezinger ,&nbsp;Brandon Doppelheuer ,&nbsp;Michael L. Kelly","doi":"10.1016/j.clineuro.2025.109064","DOIUrl":"10.1016/j.clineuro.2025.109064","url":null,"abstract":"<div><h3>Introduction</h3><div>In 2018, andexanet alfa (Andexxa) became FDA approved as an anti-factor Xa inhibitor reversal agent for patients who require the reversal of anticoagulation due to rivaroxaban (Xarelto) or apixaban (Eliquis). A key consideration when utilizing Andexxa is its notably high cost. This study’s objective is to assess the clinical benefit of Andexxa on patients with spontaneous intracerebral hemorrhages (ICH) who did not undergo neurosurgical intervention.</div></div><div><h3>Methods</h3><div>For this retrospective study, the American Heart Association stroke registry was queried for patients admitted to MetroHealth for ICH between 2020 and 2023. The medical record was accessed to obtain more specific information for patients. Analyses were done to assess differences between groups.</div></div><div><h3>Results</h3><div>45 nonsurgical patients on a DOAC with spontaneous ICH between 2020 and 2023 were identified. There were no significant differences in baseline demographics. There were no significant differences in the baseline ICH score or the NIHSS. The Andexxa group trended towards a higher initial ICH volume (19 cc vs 7 cc; p = 0.16). We observed no significant differences in the hospital length of stay, ICH expansion volume between the two groups (2.4 cc vs 0.21 cc; p = .26) or mortality rates. Total pharmacy charges for Andexxa during the study period were $464,640.00.</div></div><div><h3>Conclusion</h3><div>In our study, patients who received Andexxa therapy and non-surgical management of spontaneous ICH showed no difference in ICH expansion within 24 h but had increased cost of care. Further studies should examine whether Andexxa is of clinical value for patients with spontaneous ICH.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109064"},"PeriodicalIF":1.6,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757987","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":"Effect of arterial transit artifact in arterial spin labeling imaging on prognostic outcomes in ischemic stroke patients: A meta-analysis","authors":"Junwei Hu,&nbsp;Junzhi Sang,&nbsp;Xin Huang","doi":"10.1016/j.clineuro.2025.109087","DOIUrl":"10.1016/j.clineuro.2025.109087","url":null,"abstract":"<div><h3>Background</h3><div>Arterial transit artifact (ATA) in arterial spin labeling (ASL) imaging have been suggested to predict functional outcomes in ischemic stroke patients; however, their clinical utility remains debated. Existing studies are predominantly limited by small sample sizes, single-center designs, and low levels of evidence. Furthermore, insufficient technical standardization and methodological heterogeneity across investigations have constrained the generalizability of conclusions. This study therefore aims to evaluate the prognostic implications of ATA in ischemic stroke patients through a systematic synthesis of current evidence.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted across PubMed, Embase, the Cochrane Library, Web of Science, CNKI, VIP, and Wanfang databases to identify potentially eligible studies published from database inception through February 2025. Pooled effect estimates were derived using standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes, both reported with 95 % confidence interval (CI), to quantify the association between ATA and prognostic outcomes in ischemic stroke patients. All statistical analyses were executed using STATA 17.0, adhering to Cochrane Collaboration methodological standards for meta-analytic precision.</div></div><div><h3>Results</h3><div>The meta-analysis incorporated 11 studies encompassing 747 participants. Pooled analyses demonstrated a significant association between the presence of ATA and favorable prognostic outcomes, evidenced by standardized mean difference (SMD = −0.91, 95 % CI: −1.13 to −0.70; p &lt; 0.001) and risk ratio (RR = 1.43, 95 % CI: 1.22–1.67; p &lt; 0.001). Sensitivity analyses confirmed the robustness of these effect estimates, revealing no substantial alterations upon sequential study exclusion. Publication bias assessments via Begg and Egger tests indicated no statistically significant evidence of small-study effects or publication bias.</div></div><div><h3>Conclusion</h3><div>This meta-analysis demonstrates a significant association between ATA and favorable functional outcomes in ischemic stroke patients, supporting their potential utility as a clinically actionable imaging biomarker for prognostic stratification.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109087"},"PeriodicalIF":1.6,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757986","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":"Dynamic correlation between brain edema scores and blood–brain barrier permeability predicts the outcome of aneurysmal subarachnoid hemorrhage","authors":"Chao Zhang ,&nbsp;Wenjuan Tang ,&nbsp;Pengzhan Yin ,&nbsp;Xintong Zhao ,&nbsp;Xinggen Fang ,&nbsp;Yunfeng Zhou","doi":"10.1016/j.clineuro.2025.109086","DOIUrl":"10.1016/j.clineuro.2025.109086","url":null,"abstract":"<div><h3>Objective</h3><div>Cerebral edema and disruption of the blood-brain barrier (BBB) are common consequences of aneurysmal subarachnoid hemorrhage (aSAH) and can be visualized by CT. This study investigated the dynamic correlation between the Subarachnoid Hemorrhage Early Brain Edema Score (SEBES) and BBB permeability (BBBP) between admission and during the delayed cerebral ischemia (DCI) time window (DCITW) in patients with aSAH.</div></div><div><h3>Methods</h3><div>We investigated 129 patients with aSAH who underwent CT perfusion imaging on admission and during DCITW. The correlations between SEBES and BBBP (measured by K^trans) and between their dynamic changes (expressed as ΔSEBES and ΔK^trans) were evaluated using Spearman correlation coefficients. Longitudinal changes in both parameters were analyzed. Multivariate logistic regression was employed to identify independent risk factors for DCI and poor outcomes.</div></div><div><h3>Results</h3><div>A moderate correlation was observed between SEBES and K^trans both on admission (ρ=0.64, <em>P</em> &lt; 0.001) and during DCITW (ρ=0.65, <em>P</em> &lt; 0.001). A moderately strong correlation (ρ=0.70, <em>P</em> &lt; 0.001) was found between ΔSEBES and ΔK^trans. Both the SEBES (2 [1,2] versus 1 [0,2], <em>P</em> &lt; 0.001) and K^trans (0.47 ± 0.14 versus 0.41 ± 0.14, <em>P</em> = 0.001) decreased significantly between admission and DCITW. In the adjusted models, the SEBES on admission and during DCITW were independent predictors of DCI (OR 1.92, 95 % CI 1.08–3.43; <em>P</em> = 0.028) and poor outcomes (OR 3.87, 95 % CI 2.14–6.99; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Following aSAH, the severity of cerebral edema is significantly correlated with the degree of BBB disruption. Their temporal evolution patterns between admission and DCITW are interrelated. This study provides mechanistic insights into their combined role in predicting clinical outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109086"},"PeriodicalIF":1.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763630","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":"Surgical success of subcutaneous systems for intrathecal nusinersen delivery in spinal muscular atrophy: A systematic review and meta-analysis","authors":"Victor M. Lu ,&nbsp;Sima Vazquez ,&nbsp;Caleigh S. Roach ,&nbsp;Toba N. Niazi","doi":"10.1016/j.clineuro.2025.109085","DOIUrl":"10.1016/j.clineuro.2025.109085","url":null,"abstract":"<div><h3>Background</h3><div>The intrathecal administration of nusinersen to treat spinal muscular atrophy (SMA) has demonstrated therapeutic effect, however, repeat lumbar punctures confer multiple disadvantages. As such, subcutaneous systems have been described to provide an alternative, less invasive strategy for repeat administration. Correspondingly this study aimed to aggregate metadata to better define the surgical success of these subcutaneous systems.</div></div><div><h3>Methods</h3><div>Searches of multiple electronic databases from inception to March 2025 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Quantitative outcomes were pooled by random-effects meta-analyses where possible.</div></div><div><h3>Results</h3><div>There were 8 studies describing 74 SMA patients that were managed with a subcutaneous system for intrathecal nusinersen. No official system currently exists for this purpose, and all studies reported off-label use of either an intravascular port (5 of 8 studies) or reservoir system (3 of 8 studies) as the subcutaneous port. These ports were located mostly in the lateral flank (5 of 8 studies). In terms of intrathecal access, a hemilaminotomy was used universally in most studies (6 of 8 studies), and access was obtained most commonly in the thoracolumbar region (3 of 8 studies). A total of 22 individual adverse events were reported amongst the cohort, the most common being cerebrospinal fluid leak needing intervention (7/74, 9 %). The pooled estimate by meta-analysis indicated an overall weighted rate of adverse events to be 27 % (95 % CI 16–40 %). Eight patients required revision surgery, with a pooled revision surgery rate estimate of 9 % (95 % CI 2–19 %).</div></div><div><h3>Conclusions</h3><div>Subcutaneous systems can be used in the setting of SMA for repeat nusinersen administration. There exists no consensus system or surgical approach currently, with multiple systems, port types, port location, intrathecal access techniques and intrathecal access locations reported. Future multidisciplinary efforts are needed to elevate the concept of subcutaneous delivery systems for SMA towards convention.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109085"},"PeriodicalIF":1.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739265","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}