Journal of Clinical Neuroscience最新文献

{"title":"Acyclovir dosing strategies in herpes encephalitis: A retrospective charts review","authors":"Asma Aboelezz ,&nbsp;Maged Kharouba ,&nbsp;Sherif Hanafy Mahmoud","doi":"10.1016/j.jocn.2025.111230","DOIUrl":"10.1016/j.jocn.2025.111230","url":null,"abstract":"<div><h3>Background</h3><div>Herpes encephalitis is a life-threatening condition that causes severe inflammation of the brain, often leading to permanent neurological damage or death if not treated promptly. Acyclovir is the main antiviral treatment for herpes encephalitis. Early use is essential to lower the risk of severe brain damage and improve survival rates. The objectives of this study were to describe the dosing of acyclovir in patients with suspected encephalitis and to determine the potential association between acyclovir dosage regimen and its safety and effectiveness.</div></div><div><h3>Methods</h3><div>A retrospective single-center observational study of patients admitted to the University of Alberta Hospital who received acyclovir and were suspected of having or diagnosed with herpes encephalitis. Patient charts were reviewed. Patient demographics, history of comorbidities, concomitant nephrotoxic medications, hospitalization department, length of hospital stay, acyclovir dosing, viral encephalitis diagnosis and outcomes were collected. Effectiveness outcomes included full recovery, partial recovery and death. Safety outcomes included the development of acute kidney injury (AKI) while on acyclovir treatment. We analyzed predictors of the outcomes using regression modeling.</div></div><div><h3>Results</h3><div>A total of 237 patients were included in the study. Among the patients who received acyclovir for more than 2 days, 88 (57 %) patients received an adequate dose, 54 (35 %) patients received sub-therapeutic dosage regimen and 12 (8 %) patients received supra-therapeutic regimen. Older age was associated with less favorable outcomes (adjusted odds ratio (OR) 1.05, 95 % Confidence Interval (CI) 1.01–1.09, <em>p</em> = 0.02). Additionally, there was a trend suggesting that herpes simplex virus type 1 (HSV-1) resulted in the worst outcomes, with the highest percentage of unfavorable outcomes observed in the sub-therapeutic dosing group. In contrast, supra-therapeutic dose of acyclovir was significantly associated with AKI (adjusted OR 12.9, 95 %CI 3.14–53.07, <em>p &lt;</em> 0.001).</div></div><div><h3>Conclusion</h3><div>Our study suggests that administering acyclovir based on actual body weight for non-obese patients and adjusted body weight for obese patients may enhance outcomes by promoting recovery and preventing toxicity. Multicenter prospective studies are needed to confirm such association and to provide clear guidelines of the most appropriate dosing of acyclovir in herpes encephalitis.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111230"},"PeriodicalIF":1.9,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydrocephalus temporisation with ventricular reservoir or trans-fontanelle ventricular taps for intraventricular haemorrhage of prematurity: A retrospective cohort study","authors":"Michael J. Stuart ,&nbsp;Adam Burnett ,&nbsp;Liam G. Coulthard ,&nbsp;Peter S. Cunningham ,&nbsp;Pita Birch ,&nbsp;Robert AJ. Campbell ,&nbsp;Annabelle M. Harbison ,&nbsp;Craig R. Vonhoff","doi":"10.1016/j.jocn.2025.111225","DOIUrl":"10.1016/j.jocn.2025.111225","url":null,"abstract":"<div><h3>Purpose</h3><div>Hydrocephalus following intraventricular haemorrhage of prematurity (post haemorrhagic ventricular dilation/PHVD) is one of the most common causes of paediatric hydrocephalus. There is little evidence regarding the role of <em>trans</em>-fontanelle ventricular taps (TFVT) as a temporising strategy in the early management of these patients. This study aimed to compare the safety and efficacy of TFVT with the use of a ventricular reservoir/access device.</div></div><div><h3>Methods</h3><div>A retrospective review of prospectively maintained databases was conducted, including all patients who received a diagnosis of intraventricular haemorrhage or PHVD at the two major neonatal intensive care units in the State of Queensland, Australia between 1st January 2016 to 31st December 2022. Followup data was obtained from review of statewide electronic medical records.</div></div><div><h3>Results</h3><div>The medical records of 910 low birth-weight infants with intraventricular haemorrhage were screened. Of these, 28 patients underwent placement of a ventricular reservoir and 36 underwent serial TFVT alone.</div><div>There were no statistically significant differences in rates of ventriculoperitoneal shunt insertion (83 % vs 75 %, p = 0.41). There were no significant differences in mortality or two year Paediatric modified Rankin Scale. No clinically significant intracranial haemorrhages occurred in either group. CSF leak was more common from the ventricular reservoir wound (14 % vs 3 %, p = 0.02). There was no significant difference in the incidence of CSF infection between the cohorts (6 % vs 4 %, p = 0.71).</div></div><div><h3>Conclusion</h3><div>This study provides level III evidence to suggest that <em>trans</em>-fontanelle ventricular taps may have a similar safety and efficacy profile to the use of a ventricular reservoir.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111225"},"PeriodicalIF":1.9,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence of old hemorrhage in brain arteriovenous malformation","authors":"Lea Scherschinski,&nbsp;Visish M. Srinivasan,&nbsp;Michael T. Lawton","doi":"10.1016/j.jocn.2025.111216","DOIUrl":"10.1016/j.jocn.2025.111216","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111216"},"PeriodicalIF":1.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777318","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 between stent-assisted coiling and Woven EndoBridge embolization for unruptured wide-necked bifurcation intracranial aneurysms: A propensity score matching study","authors":"Kyu Seon Chung,&nbsp;Solbi Kim,&nbsp;Hyun Jin Han,&nbsp;Keun Young Park,&nbsp;Yong Bae Kim,&nbsp;Jung-Jae Kim","doi":"10.1016/j.jocn.2025.111204","DOIUrl":"10.1016/j.jocn.2025.111204","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Before the utilization of the Woven EndoBridge (WEB) for the treatment of wide-necked bifurcation intracranial aneurysms (WNBA), stent-assisted coiling (SAC) was the predominant endovascular treatment. Studies directly comparing the outcomes of these two methods are still limited. This study aimed to compare the safety and efficacy of SAC and WEB embolization for unruptured WNBAs through propensity score matching.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This retrospective study included patients treated with SAC or WEB for unruptured WNBAs at a single institution between January 2014 and June 2023. Propensity score matching was conducted based on patient and aneurysm characteristics. The matched groups were compared for periprocedural events and 6-month clinical and radiological outcomes, assessed using the modified Rankin Scale and Raymond-Roy occlusion classification, respectively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 286 patients, 74 were included in each group after propensity score matching. The WEB group exhibited significantly shorter fluoroscopy time than the SAC group (p &lt; 0.001). Periprocedural complications primarily comprised intraoperative thromboembolic events, with nine cases (12.2 %) in the SAC group and five cases (6.8 %) in the WEB group (p = 0.388). Throughout the 6-month follow-up period, nuisance bleeding occurred significantly more frequently in patients with SAC (8 cases, 10.8 %). The 6-month complete occlusion rates were 85.9 % and 77.5 % for the SAC and WEB groups, respectively (p = 0.309), whereas adequate occlusion rates were 91.5 % and 90.1 % for the groups, respectively (p = 1.000).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The 6-month clinical and radiological outcomes of unruptured WNBAs treated with WEB and SAC were comparable. WEB has advantages over SAC, including reduced fluoroscopy time and avoidance of dual antiplatelet therapy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Abstract&lt;/h3&gt;&lt;div&gt;Before the utilization of the Woven EndoBridge (WEB) for the treatment of wide-necked bifurcation intracranial aneurysms (WNBA), stent-assisted coiling (SAC) was the predominant endovascular treatment. Studies directly comparing the outcomes of these two methods are still limited. This study aimed to compare the safety and efficacy of SAC and WEB embolization for unruptured WNBAs through propensity score matching. This retrospective study included patients treated with SAC or WEB for unruptured WNBAs at a single institution between January 2014 and June 2023. Propensity score matching was conducted based on patient and aneurysm characteristics. The matched groups were compared for periprocedural events and 6-month clinical and radiological outcomes, assessed using the modified Rankin Scale and Raymond-Roy occlusion classification, respectively. Among 286 patients, 74 were included in each group after propensity score matching. The WEB group exhibited significantly shorter fluoroscopy time than the SAC group (p &lt;","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111204"},"PeriodicalIF":1.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777317","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 accuracy of ICH-FOS for spontaneous intracerebral hemorrhage: An analysis of ATACH-2 and the Qatar stroke database","authors":"Aizaz Ali ,&nbsp;Umar T. Ayub ,&nbsp;Omar Obaid ,&nbsp;Khaled Gharaibeh ,&nbsp;Sadik A. Khuder ,&nbsp;Naveed Akhtar ,&nbsp;Adnan Qureshi ,&nbsp;Mouhammad Jumaa ,&nbsp;Ashfaq Shuaib","doi":"10.1016/j.jocn.2025.111214","DOIUrl":"10.1016/j.jocn.2025.111214","url":null,"abstract":"<div><h3>Introduction</h3><div>Spontaneous intracranial hemorrhage(sICH) comprise between 15–20% of stroke with high rates of mortality and disability. Multiple scoring systems have been developed for sICH prognostication.</div></div><div><h3>Aims</h3><div>We explored the Qatar stroke database and the ATACH-2 database to study the independent predictors of 90-day mortality and poor functional outcomes[modified rankin score(mRS) 4–6] in patients with sICH. We compared admission national institute of health stroke scale (NIHSS) and Glasgow coma scale (GCS) with original intracerebral hemorrage(o-ICH), modified(m)ICH, ICH-GS(grading scale), Lanseed(LS)-ICH, Max-ICH, and ICH-FOS(functional outcome score) scores to evaluate 90-day mortality and functional outcomes.</div></div><div><h3>Methods</h3><div>Data on baseline characteristics, premorbid condition, laboratory tests, imaging findings, and surgical treatment were included. Outcomes were mortality and poor functional outcome(mRS 4–6) at 90-day follow-up. Prognostic accuracy of each score was assessed using Receiver Operating Characteristic(ROC) curve analysis. ICH-FOS risk categories were created for mortality and poor functional outcomes.</div></div><div><h3>Results</h3><div>There were 1660 patients with sICH admitted to Hamad General Hospital available for analysis. Mean age 49(SD 12) years, median GCS 15(IQR 11–15), median NIHSS 12(IQR 5–19). At 90-day follow-up, 124(11.3 %) died and 396(36 %) had poor functional outcome. ATACH included 1000 non-anti-coagulant related sICH patients with supratentorial bleeds without intra-ventricular extension(IVH). Mean age 62(SD 12) years, median GCS 15(IQR 13–15), median NIHSS 11(IQR 6–16). At 90-day follow-up, 54(5.9 %) patients died and 342(37.3 %) had poor functional outcomes. Patients in ATACH-2 were older, had 4-fold increased odds of having a prior stroke, and were 4-times more likely to be smokers. There were more lobar bleeds in Qatar and a higher proportion of patients in Qatar died at 90-days(11.3 v 5.9, p &lt; 0.001). No difference in the rate of poor functional outcomes was noted. ICH-FOS had the largest AUC in ATACH(0.83, 95 % CI 0.77–0.89) and Qatar(0.81, 95 % CI 0.77–0.84) databases for predicting 3-month mortality, and similarly for unfavourable functional outcomes(mRS 4–6), with AUC’s in ATACH(0.83, 95 % CI 0.79–0.85) and Qatar(0.85, 95 % CI 0.82–0.87), respectively.</div></div><div><h3>Conclusion</h3><div>ICH-FOS was the most accurate predictor of 90-day mortality and poor functional outcome in both Qatari and ATACH-2 patients with non-anticoagulant related supratentorial sICH without IVH. Our study extends the utility of the ICH-FOS from a Chinese population to both Middle-Eastern and Western populations.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111214"},"PeriodicalIF":1.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760448","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":"Expression of SARS-CoV-2 spike protein in cerebral Arteries: Implications for hemorrhagic stroke Post-mRNA vaccination","authors":"Nakao Ota ,&nbsp;Masahiko Itani ,&nbsp;Tomohiro Aoki ,&nbsp;Aki Sakurai ,&nbsp;Takashi Fujisawa ,&nbsp;Yasuaki Okada ,&nbsp;Kosumo Noda ,&nbsp;Yoshiki Arakawa ,&nbsp;Sadahisa Tokuda ,&nbsp;Rokuya Tanikawa","doi":"10.1016/j.jocn.2025.111223","DOIUrl":"10.1016/j.jocn.2025.111223","url":null,"abstract":"<div><h3>Background</h3><div>The rapid deployment of mRNA vaccines for SARS-CoV-2, such as BNT162b2 (BioNTech-Pfizer) and mRNA-1273 (Moderna), provided a critical tool in combating the COVID-19 pandemic. While their short-term safety and efficacy were demonstrated in clinical trials, rare adverse events, including hemorrhagic strokes, have been reported after widespread use. However, the long-term biodistribution and effects of mRNA vaccines remain underexplored.</div><div>This study aimed to investigate the long-term presence of SARS-CoV-2 spike protein in brain tissues of patients with hemorrhagic strokes, examining its potential association with mRNA vaccination.</div></div><div><h3>Methods</h3><div>A total of 19 cases of hemorrhagic stroke from 2023 to 2024 were retrospectively analyzed. Immunohistochemical staining for SARS-CoV-2 spike protein and nucleocapsid protein was performed on tissue samples. In situ hybridization was conducted in selected cases to confirm the origin of spike protein expression (vaccine or viral infection). Vaccination history and SARS-CoV-2 infection status were documented for all cases.</div></div><div><h3>Results</h3><div>Spike protein expression was detected in 43.8 % of vaccinated patients, predominantly localized to the intima of cerebral arteries, even up to 17 months post-vaccination. While no active inflammatory changes were identified, infiltration of CD4-, CD8- and CD68- positive cells was observed in the spike protein positive vessels. In situ hybridization confirmed the presence of both vaccine-derived mRNA and SARS-CoV-2 virus-derived mRNA, which encode the spike protein, in select cases. Notably, spike protein positivity was observed exclusively in female patients (P = 0.015). None of the cases showed nucleocapsid protein positivity, supporting the absence of active viral infection.</div></div><div><h3>Conclusion</h3><div>Although the possibility of spike protein expression due to asymptomatic SARS-CoV-2 infection cannot be entirely excluded, this study demonstrated prolonged presence of SARS-CoV-2 spike protein in the cerebral arteries following mRNA vaccination. Additionally, some inflammatory cell infiltration was observed in spike-positive vessels. These findings raise significant concerns regarding the biodistribution of lipid nanoparticle-based vaccines and their long-term safety. Global replication studies are urgently required to validate these findings and ensure comprehensive safety evaluations of mRNA vaccines.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111223"},"PeriodicalIF":1.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical resection of A giant ventral pontine cavernous malformation: Two-dimensional video","authors":"Xingfen Su ,&nbsp;Zixiao Yang ,&nbsp;Jianyu Zhu ,&nbsp;Jianping Song","doi":"10.1016/j.jocn.2025.111208","DOIUrl":"10.1016/j.jocn.2025.111208","url":null,"abstract":"<div><div>Cavernous malformations (CM) in the ventral pons pose significant surgical challenges due to their deep anatomical location and complex neurovascular structures <span><span>[1]</span></span>. This report details the successful surgical management of a giant ventral pontine CM in a 38-year-old female exhibiting left-sided limb weakness (muscle strength Grade IV), and was approved by the ethics committee. Magnetic resonance imaging (MRI) findings indicated the CM extended from the pial surface predominantly towards the right side. Utilizing diffusion tensor imaging (DTI), we determined that the corticospinal tract was laterally positioned. Subsequently, and with patient consent, we decided to remove the CM via a <em>trans</em>-Sylvian approach instead of the traditional subtemporal approach. During surgery, after the right frontal-temporal craniotomy, we carefully dissected the Sylvian fissure and excised a portion of the uncus to enhance the exposure of the oculomotor nerve, thereby improving surgical efficiency within both the carotid-oculomotor and oculomotor-tentorial triangles <span><span>[2]</span></span>, <span><span>[3]</span></span>. To alleviate tension on the oculomotor nerve, we carefully incised its overlying dura mater, minimizing intraoperative retraction injury. We employed piecemeal debulking and sharp dissection of the CM along the gliotic interface while preserving perforating arteries and protecting a notable developmental venous anomaly encountered during the procedure. Intraoperative endoscopy confirmed gross total resection, with stable electrophysiological monitoring maintained throughout the operation. Postoperatively, the patient experienced transient right oculomotor nerve palsy and left limb weakness (Grade III + ), both of which improved with rehabilitation at 3-month follow-up. This case underscores the complexities of ventral pontine CMs and the necessity for customized surgical strategies to achieve favorable outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111208"},"PeriodicalIF":1.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768029","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":"Gut microbiota characteristics and prognostic value in patients with aneurysmal subarachnoid hemorrhage: A clinical study","authors":"Pengzhao Zhang ,&nbsp;Yang Liu ,&nbsp;Mengyuan Xu ,&nbsp;Jiaqi Zhang ,&nbsp;Jing Xia ,&nbsp;Yi Shi ,&nbsp;Ju Wang ,&nbsp;Binsha Han ,&nbsp;Guang Feng","doi":"10.1016/j.jocn.2025.111200","DOIUrl":"10.1016/j.jocn.2025.111200","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to explore the characteristics of gut microbiota in the aneurysmal subarachnoid hemorrhage (aSAH) group and the healthy control group, as well as in the good prognosis group and the poor prognosis group. It also investigates the relationship between the severity of aSAH and gut microbiota, and the predictive value of gut microbiota for the prognosis outcome of patients with aSAH.</div></div><div><h3>Methods</h3><div>Stool samples from 22 patients with aSAH and 11 healthy controls were subjected to metagenomic sequencing, and species annotations were obtained through the taxonomic information database corresponding to the NR database. The characteristics of the gut microbiota in the aSAH group versus the healthy control group, and the good prognosis group versus the poor prognosis group were analyzed.<!--> <!-->The correlations between differential microbiota and clinical hematology markers between the aSAH and control groups and between gut microbiota and aSAH severity were analyzed. The prognosis of patients with aSAH after three months was assessed. Finally, gut microbiota with significant effects were screened for potential as biomarkers, and the predictive value of gut microbiota for different prognostic outcomes in patients with aSAH was explored.</div></div><div><h3>Results</h3><div>Gut microbiota composition, diversity, and abundance differed significantly between patients in the aSAH group and the control group. Additionally, the composition, diversity, and abundance differed between patients with good and poor prognosis. Five dominant genera--<em>Bacillus, Eggerthia, Hominisplanchenecus, Carnobacterium</em>, and <em>Bifidobacterium</em> were identified as potential biomarkers for predicting aSAH outcomes.</div></div><div><h3>Conclusion</h3><div>Patients with aSAH have altered gut microbiota composition, structure, and diversity compared with the healthy population. These alterations may be potential biomarkers for aSAH diagnosis and outcome prediction.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111200"},"PeriodicalIF":1.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microsurgery alone versus preoperative embolisation: A meta-analysis of outcomes in brain AVMs by Spetzler-Martin grade","authors":"Cyrus Raki ,&nbsp;Lily Davies ,&nbsp;Leon T Lai","doi":"10.1016/j.jocn.2025.111209","DOIUrl":"10.1016/j.jocn.2025.111209","url":null,"abstract":"<div><div>Preoperative embolisation is frequently used an adjunct to microsurgery for brain arteriovenous malformations (AVMs), yet high-level evidence supporting its routine use remains limited. This <em>meta</em>-analysis compares outcomes of microsurgery alone versus combined microsurgery and preoperative embolisation, stratified by Spetzler-Martin (SM) grade.</div><div>A systematic review of Embase, Medline, Scopus, Emcare, and the Cochrane Library identified 43 studies encompassing 3916 patients, equally divided between microsurgery alone (n = 1958) and combination therapy (n = 1958). Primary endpoints included functional dependence (modified Rankin Scale score &gt; 2), angiographic obliteration, haemorrhagic complications, and intraoperative blood loss.</div><div>Pooled analyses demonstrated no significant differences in functional dependence (OR 0.65, 95 % CI 0.32–1.32, p = 0.21), obliteration rates (OR 1.15, 95 % CI 0.60–2.19, p = 0.63), haemorrhagic complications (OR 1.67, 95 % CI 0.71–3.95, p = 0.20), or intraoperative blood loss (MD −98.90 mL, 95 % CI −417.38–219.57, p = 0.44). Subgroup analysis for SM grade I-II and III-V AVMs found no significant differences in outcomes between treatment modalities. For SM grade III AVMs, angiographic cure rates were comparable, though data scarcity precluded a robust assessment of functional dependence, postoperative haemorrhage, and intraoperative blood loss.</div><div>While theoretical advantages exist for preoperative embolisation in higher-grade or high-flow AVMs, current evidence does not demonstrate consistent benefits in outcomes or complication rates. Further studies, particularly for SM grade III AVMs, are needed to determine whether combination therapy provides a meaningful advantage over microsurgery alone.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111209"},"PeriodicalIF":1.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760447","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 biomechanical study on bilateral SAI annular fixation in the treatment of unilateral Denis Ⅱ sacral fractures","authors":"Peishuai Zhao ,&nbsp;Chengfei Peng ,&nbsp;Honghu Lin ,&nbsp;Wuqing Wei ,&nbsp;Weiyi Pang ,&nbsp;Chaoyong Bei","doi":"10.1016/j.jocn.2025.111221","DOIUrl":"10.1016/j.jocn.2025.111221","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the biomechanical properties of bilateral SAI annular internal fixation in the treatment of unilateral Denis type Ⅱ sacral vertical fracture, so as to provide a reference for clinical practice.</div></div><div><h3>Methods</h3><div>The finite element approach was utilized to simulate the Denis type Ⅱ fracture of the right sacral (the entire fracture through the sacral foraminarum) as well as the fracture of the upper and lower ramus of the right pubic bone, which represents unilateral vertical instability of the pelvic ring. The posterior pelvic ring was fixed using three different methods: lumbopelvic fixation and S1 transsacral screw (LPF-S1), bilateral S1AI annular fixation and S2 transsacral screw (BS1AI-S2), bilateral S2AI annular fixation and S1 transsacral screw (BS2AI-S1), and the anterior pelvic ring was fixed with pubic ramus screws. Six different loading methods are used to simulate six conditions: standing, forward bending, left flexion, right flexion, left rotation and right rotation. The maximum Von Mises stress of the implant, the vertical displacement of the upper surface of the sacral, and the relative intrafragmentary displacement (RID) of the observation point on the anterior surface of the sacral were recorded and analyzed.</div></div><div><h3>Results</h3><div>The maximum Von Mises stress of the implant in the three fixed models did not exceed the maximum yield stress of the titanium alloy under different motion conditions in the finite element model. The descending order from high to low was LPF-S1, BS1AI-S2, and BS2AI-S1. The RID of each observation point on the anterior surface of the sacral and the vertical displacement of the upper surface of the sacral were both lower in the BS2AI-S1 group than in the LPF-S1 group and the BS1AI-S2 group. In the standing, forward flexion, left flexion, right flexion, and left rotation conditions, the LSD test results indicated a statistically significant difference in the mean RID of observation points between the BS2AI-S1 and BS1AI-S2 groups (p &lt; 0.05), but not in the LPF-S1 group. In the condition of right rotational motion, there was no statistically significant difference in the mean RID between the three groups (p &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>The biomechanical stability of the fixation of Denis type II sacral fractures was satisfactory in the LPF-S1, BS1AI-S2, and BS2AI-S1 groups, with the BS2AI-S1 group exhibiting the maximum level of stability. Bilateral SAI annular internal fixation is a viable alternative to the fixation of vertical sacral fractures, as it does not impair the lumbar spine’s mobility and accomplishes satisfactory biomechanical stability.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111221"},"PeriodicalIF":1.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143748699","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}