Journal of Clinical Neuroscience最新文献

{"title":"Impact of skull base cisterns invasion and extent of resection on the management of skull base intracranial epidermoid tumors.","authors":"Samuel Moscovici, Nir Lavi, Andrew H Kaye, Carlos Candanedo, José E Cohen, Sergey Spektor","doi":"10.1016/j.jocn.2025.111654","DOIUrl":"https://doi.org/10.1016/j.jocn.2025.111654","url":null,"abstract":"<p><strong>Background: </strong>This study reports the authors' experience with microsurgical resection of skull base epidermoid tumors, examining the relationship between the number of invaded intracranial subarachnoid cisterns (SC) and the extent of resection, recurrence and outcomes.</p><p><strong>Methods: </strong>Data from 84 patients who underwent skull base epidermoid tumor resection between 2000 and 2022 were prospectively collected and retrospectively reviewed. Clinical presentations, imaging findings (including the number of invaded cisterns), and extent of resection were analyzed for their influence on postoperative complications and long-term outcomes, including progression-free survival (PFS), intervention-free survival (IFS), and overall survival (OS).</p><p><strong>Results: </strong>A total of 84 patients were included (51 % female), with a mean age of 41.1 years. Headache was the most common symptom (39 %). The cerebellopontine angle (CPA) was the most frequently invaded cistern (71 %). The mean number of invaded cisterns was 5.8 (median: 4; range: 1-21), and the mean tumor volume was 26.1 cc (median: 18; range: 1-201.3). Gross total resection (GTR) was achieved in 40 patients (47.6 %), near-total resection (NTR) in 12 (14.3 %), subtotal resection (STR) in 22 (26.2 %), and partial resection (PR) in 10 (11.9 %). Patients with over 5 invaded cisterns had significantly lower GTR rates (p-value < 0.001). Tumor volume was significantly associated with resection extent, tumors over 45 cc were more likely to recur (p-value = 0.004). Over a mean follow-up of 9.5 years, 32 patients (39 %) experienced tumor recurrence/regrowth. PFS was significantly longer after GTR (p < 0.001). Thirteen patients (16 %) required reoperation due to recurrence. IFS did not differ significantly between the GTR and NTR (p = 0.114). Postoperative morbidity occurred in 40 patients (48 %), with no perioperative mortality.</p><p><strong>Conclusion: </strong>Cisterns tumor invasion is more predictive of resection success than tumor volume. GTR prolongs PFS, although IFS remains similar between GTR and NTR. Epidermoid tumor management is challenging, and surgical complication rate is significant. Maximal safe resection is recommended.</p><p><strong>Abbreviations: </strong>SC, Subarachnoid cistern; GTR, Gross total resection; NTR, Near total resection; STR, Subtotal resection; PR, Partial resection; PFS, Progression-free survival; IFS, Intervention-free survival; OS, Overall survival; CPA, Cerebellopontine angle; CSF, Cerebrospinal fluid; ITSTA, Infratranstentorial subtemporal approach; CD, Continuous drainage VPS, Ventriculo-peritoneal shunt; CPS, Cisto-peritoneal shunt; DVT, Deep vein thrombosis; SVT, Superficial vein thrombosis; CN, Cranial nerve.</p>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"111654"},"PeriodicalIF":1.8,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238696","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":"Adults are not just big kids: adults have higher reoperation and complication rates following lumbar laminectomy for tethered cord release","authors":"Adeesya Gausper ,&nbsp;Andrew Miller ,&nbsp;Weston Wright ,&nbsp;Justin K. Scheer ,&nbsp;David Bonda ,&nbsp;Tiffany G. Perry ,&nbsp;Moise Danielpour ,&nbsp;David L. Skaggs ,&nbsp;Corey T. Walker ,&nbsp;Alexander Tuchman","doi":"10.1016/j.jocn.2025.111664","DOIUrl":"10.1016/j.jocn.2025.111664","url":null,"abstract":"<div><h3>Objective</h3><div>Tethered cord syndrome (TCS) is a neurological condition characterized by pathological tension on the spinal cord and is treated with surgical detethering. While traditionally considered a pediatric condition, TCS in adults likely differs in pathophysiology, clinical presentation, and surgical outcomes. This study aims to compare reoperation rates and early postoperative complications following tethered cord release (TCR) in pediatric and adult patients.</div></div><div><h3>Methods</h3><div>A retrospective study of the PearlDiver national insurance claims database was conducted. Patients who underwent lumbar laminectomy with release of tethered cord were identified and grouped into pediatric (&lt;18 years) and adult (≥18 years) cohorts. The primary outcome was rate of subsequent lumbar surgery within 2-years of index surgery, including repeat TCR, CSF leak repair, syrinx drainage, 3-column osteotomy, lumbar laminectomy, and lumbar fusion. Secondary outcomes included 90-day complication rates. Statistical significance was determined with chi-square analysis.</div></div><div><h3>Results</h3><div>5,780 pediatric and 1,670 adult patients were identified who underwent TCR. Average age at index surgery was 6.1 (± 4.9) years in the pediatric cohort and 41.6 (± 16.4) years in adults. The overall rate of subsequent lumbar surgery at 2-years following index surgery was significantly higher in adult patients (12.75 % vs 3.89 %, p &lt; 0.00001). The most common reoperation in both cohorts was CSF leak repair (7.66 % adult and 1.87 % pediatric patients at 2-years). Adult patients had a significantly higher 90-day complication rate (21.6 % vs 15.8 %, p &lt; 0.00001), and most complications in both cohorts were attributable to urinary tract infections.</div></div><div><h3>Conclusions</h3><div>Adult patients have nearly threefold increased risk of reoperation, over fourfold risk of CSF leak repair, and a higher rate of postoperative complications following TCR. These findings highlight the need for tailored surgical planning, patient counseling, and long-term follow-up in pediatric and adult patients undergoing TCR. It is important for surgeons to recognize the significantly higher rates of complications and reoperations in adults and to avoid applying pediatric outcomes to the adult population.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111664"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222791","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":"Onyx plus stereotactic radiosurgery versus stereotactic radiosurgery alone in patients with cerebral arteriovenous malformations: A systematic review and meta-analysis","authors":"Luiz Guilherme Silva Almeida ,&nbsp;Ocílio Ribeiro Gonçalves ,&nbsp;Lucca Tamara Alves Carretta ,&nbsp;Mariana Lee Han ,&nbsp;Yasmin Picanço Silva ,&nbsp;Marcelo Costa ,&nbsp;Paweł Łajczak ,&nbsp;Julia Sader Neves Ferreira ,&nbsp;Gustavo Sousa Noleto","doi":"10.1016/j.jocn.2025.111653","DOIUrl":"10.1016/j.jocn.2025.111653","url":null,"abstract":"<div><h3>Introduction</h3><div>Stereotactic radiosurgery (SRS) is a primary treatment for cerebral arteriovenous malformations (AVMs). Onyx embolization is used before SRS to reduce AVM size, but its impact remains uncertain. This <em>meta</em>-analysis compares the efficacy and safety of Onyx + SRS versus SRS alone.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Cochrane Library, Scopus, Web of Science, and Embase, adhering to Cochrane guidelines, was conducted to identify studies comparing AVM obliteration rates following Onyx + SRS versus SRS. Data were pooled using a random-effects, inverse-variance model, with I² assessing heterogeneity, and sensitivity analyses performed in R.</div></div><div><h3>Results</h3><div>SRS alone had higher AVM obliteration rates (OR: 0.63, 95 % CI: 0.41–0.96, p = 0.030). No significant differences were found in post-SRS hemorrhage (OR: 1.37, 95 % CI: 0.63–3.01, p = 0.430), cyst formation (OR: 2.11, 95 % CI: 0.27–16.62, p = 0.477), or mortality (OR: 1.75, 95 % CI: 0.36–8.63, p = 0.490). The overall rate of post-SRS complications was 31.55 % (95 % CI: 23.36–39.75).</div></div><div><h3>Conclusion</h3><div>This <em>meta</em>-analysis indicates that SRS alone achieves higher AVM obliteration rates than combined Onyx embolization and SRS, without reducing hemorrhage risk or improving safety. Therefore, routine Onyx embolization prior to SRS is not supported by current evidence, suggesting a need for selective application and further investigation to identify optimal treatment strategies.</div><div>Takeaway message:</div><div>This <em>meta</em>-analysis found that SRS alone achieved a higher AVM obliteration rate compared to combined Onyx embolization plus SRS, with a pooled OR of 0.63 (95 % CI: 0.41–0.96; p = 0.030). No significant differences were observed between groups in post-SRS hemorrhage rates (OR: 1.37, 95 % CI: 0.63–3.01; p = 0.430), cyst formation (OR: 2.11, 95 % CI: 0.27–16.62; p = 0.477), or mortality (OR: 1.75, 95 % CI: 0.36–8.63; p = 0.490). The overall rate of post-SRS complications was 31.55 % (95 % CI: 23.36–39.75).These findings suggest that routine Onyx embolization prior to SRS does not improve efficacy or safety and should be reserved for selected cases.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111653"},"PeriodicalIF":1.8,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222790","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":"Prevalence of neuropathic pain following spinal cord injury: An updated systematic review and meta-analysis","authors":"Fatemeh Salehian ,&nbsp;Aryan Aarabi ,&nbsp;Shahryar Rajai Firouzabadi ,&nbsp;Mohammadreza Alinejadfard ,&nbsp;Soroush Oraee ,&nbsp;Ida Mohammadi ,&nbsp;Roozbeh Tavanaei ,&nbsp;Mehri Salari","doi":"10.1016/j.jocn.2025.111660","DOIUrl":"10.1016/j.jocn.2025.111660","url":null,"abstract":"<div><h3>Background</h3><div>Neuropathic pain (NP) is a debilitating condition following spinal cord injury (SCI), reducing quality of life and producing a significant economic burden. Although previous studies have attempted to measure its prevalence, they were limited by inadequate classification systems. Furthermore, determinants of NP prevalence are a point of contention in the literature. This systematic review and <em>meta</em>-analysis aims to determine the prevalence and determinants of NP after SCI.</div></div><div><h3>Methods</h3><div>PubMed/Medline, Scopus, and Web of Science were searched on March 17th, 2024. Studies reporting NP prevalence using valid classification systems in an adult population were included. Proportional <em>meta</em>-analysis was performed alongside <em>meta</em>-regressions for age, gender, time since injury, and ratio of traumatic SCI, subgroup analysis of injury severity, neurological level of injury (NLI), and level of NP. Quality assessment was assessed using a modified version of the Newcastle-Ottawa Scale.</div></div><div><h3>Results</h3><div>24 studies (n = 6,318) with low to moderate risk of bias were included. The pooled prevalence of NP was 57 % (95CI: 51 %, 64 %) with significant heterogeneity (I² = 96.2 %) and no publication bias. Subgroup analyses revealed prevalence rates of 30 %, 20 %, and 5 % for below-level, at-level, and at and below level NP. Age, gender, traumatic etiology, time since injury, injury severity, acute vs chronic SCI, and NLI did not affect the prevalence rate, yet the type of classification system did (p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>NP is prevalent after SCI and similarly affects people with different injury severity, NLI, etiology, age, and gender. The classification system used affects the prevalence rate. Further studies should aim to create a standardized classification system.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111660"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222789","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":"Extended reality in the changing landscape of cranial neurosurgery: Role of image fusions and connectomics in precision and safety","authors":"Gagandeep Singh ,&nbsp;Annie Singh ,&nbsp;Tejasvi Kainth ,&nbsp;Sidharth Sunil Menon ,&nbsp;Shubham Jain ,&nbsp;Vadim Spektor ,&nbsp;Prateek Prasanna ,&nbsp;Sunil Manjila","doi":"10.1016/j.jocn.2025.111652","DOIUrl":"10.1016/j.jocn.2025.111652","url":null,"abstract":"<div><div>Recently, augmented reality (AR), virtual reality (VR) and mixed reality (MR) technologies, collectively termed Extended Reality (XR), have been adopted to support enhanced visualizations for neurosurgeons by augmenting the clinical environment with relevant digital content. These groundbreaking technologies, including connectomics, have been successfully integrated into neurosurgery as tools for preoperative rehearsals, surgical simulation, and intraoperative augmentation. Adaptation of XR within the surgical field has assisted neurosurgeons with preoperative planning using connectomics and anticipation of potential complications. XR enables neurosurgeons to explore operative fields from various angles and visualize hidden neurovascular anatomy, enhancing precision in keyhole approaches. It also addresses resident work hour restrictions and challenges like COVID-19, offering advanced training tools for novices and experts alike. Additionally, XR facilitates telecasting, patient education, remote telecollaboration, and helps bridge global educational gaps in neurosurgery, including credentialing and recertification. This paper outlays the conceptual differences between AR, VR, and MR, emphasizing the benefits and limitations of XR, along with the growing role of connectomics in micro-neurosurgery and endoscopic neurosurgery. The role of 2D versus 3D imaging, merger of preoperative versus real-time imaging, fusion of additional imaging data such as ICG, 5-ALA, or fluorescein angiography, and utilization of emerging technologies like Surgical Theater, QuickTome, etc. are highlighted. We also bring forth the pivotal role of visuo-spatial orientation of co-participants, apart from shared intentions and varied competence during the use of MR in neurosurgery. We explore the latest XR applications in neurosurgery and discuss exciting future directions, limitations, and ethical implications for the trailblazing technology.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111652"},"PeriodicalIF":1.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206386","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":"Comorbid depression is associated with non-routine discharge following treatment of unruptured cerebral aneurysms","authors":"Jane Han ,&nbsp;Jonathan Dallas ,&nbsp;Angela Tang-Tan ,&nbsp;Michelle Lin ,&nbsp;Kristie Q. Liu ,&nbsp;Youhan Liu ,&nbsp;Sydney Brown ,&nbsp;Bridget Yu ,&nbsp;Li Ding ,&nbsp;William J. Mack ,&nbsp;Frank J. Attenello","doi":"10.1016/j.jocn.2025.111658","DOIUrl":"10.1016/j.jocn.2025.111658","url":null,"abstract":"<div><h3>Introduction</h3><div>Psychiatric comorbidities such as depression have previously been associated with adverse outcomes after neurosurgical interventions. Non-routine discharge, defined as discharge to any location other than the patient’s home, has subsequently been associated with an increased likelihood of adverse post-discharge outcomes, readmission, and negative impacts on quality of life. To date, no prior studies have evaluated the association between depression, other psychiatric comorbidities, and clinical outcomes following surgical management of unruptured cerebral aneurysms (UCAs).</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of the Nationwide Readmissions Database (NRD, 2016–2020). ICD-10-CM/PCS codes were used to select for patients who had (1) an unruptured aneurysm and (2) underwent open/endovascular treatment of their aneurysm. Patients with documented subarachnoid hemorrhage were excluded. Multivariable regression analyses were conducted to evaluate the association between comorbid depression and other psychiatric disease diagnoses (anxiety, schizophrenia, bipolar disorder, PTSD, etc.) with discharge disposition, length of stay (LOS), mortality, major complications, and 30-/90-day non-elective readmissions.</div></div><div><h3>Results</h3><div>From 2016 to 2020, 36,739 patients underwent repair (open or endovascular) of an UCA, and 15.4 % had a comorbid diagnosis of depression. Patients with depression were significantly more likely to have other psychiatric comorbidities such as anxiety (10.5 % vs 7.9 %, p &lt; 0.001), identify as female (83.2 % vs 73.1 %, p &lt; 0.001), and have an Elixhauser Comorbidity Index score of at least three (66.5 % vs 27.9 %, p &lt; 0.001). After adjusting for covariates, both depression (RR 1.08, 95 % CI 1.02–1.14, p = 0.007) and other psychiatric comorbidities (RR 1.21, 95 % CI 1.14–1.29, p &lt; 0.001) were associated with a higher likelihood of non-routine discharge. Depression was not associated with an increase in LOS or readmission rates; however, other psychiatric comorbidities were significantly associated with increases in both LOS (IRR 1.16, 95 % CI 1.09–1.24, p &lt; 0.001) and 90-day readmission rates (OR 1.20, 95 % CI 1.05–1.38, p = 0.007).</div></div><div><h3>Conclusion</h3><div>In patients undergoing surgical intervention for UCAs, comorbid depression and other psychiatric diagnoses are associated with higher likelihood of adverse discharge dispositions. This should be further queried to identify underlying, modifiable targets of intervention that may improve patient outcomes and lower overall cost of care.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111658"},"PeriodicalIF":1.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206420","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":"Histopathological patterns in meralgia paraesthetica: insights from lateral femoral cutaneous nerve neurectomies","authors":"Jan Fortuniak ,&nbsp;Marlena Hupało ,&nbsp;Dariusz J. Jaskólski ,&nbsp;Julia Sołek ,&nbsp;Marcin Braun ,&nbsp;Karolina Janczar ,&nbsp;Bartosz Szmyd","doi":"10.1016/j.jocn.2025.111657","DOIUrl":"10.1016/j.jocn.2025.111657","url":null,"abstract":"<div><h3>Background</h3><div>Surgical treatment of entrapment neuropathies based on nerve decompression. A different approach applies in the case of meralgia paraesthetica affecting the purely sensory lateral femoral cutaneous nerve (LFCN). Established treatment options include both decompression and LFCN neurectomy. The latter not only provides symptomatic relief but also enables proper histopathological analysis, offering deeper insight into the etiopathogenesis of meralgia paraesthetica.</div></div><div><h3>Material and method</h3><div>14 LFCNs neurectomies were performed 13 patients at our department between 2015 and 2022. Histopathological specimens were available for 12 LFCNs. We analyzed selected pathological features, for example interfascicular multifocal fiber loss, perivascular epineurial inflammation, perineurium thickness (μm), collagen content (%).</div></div><div><h3>Results</h3><div>Based on histopathological findings, patients were divided into three groups according to symptom duration: &lt;1 year, 1–3 years, and &gt;3 years. In the &lt;1 year group, interfascicular multifocal fiber loss and loss of large myelinated fibers with signs of regeneration were observed, while perineurial thickening and subperineurial edema were absent. In the 1–3 year group, all three features were present in the majority of cases, except one (20 %) lacking perineurial changes. In the &gt;3 year group, neither fiber loss nor regeneration was observed, while perineurial thickening and subperineurial edema were present in 50 % of cases. No correlation was found between the histopathological patterns and clinical parameters.</div></div><div><h3>Conclusion</h3><div>LFCN neurectomy provided a unique opportunity to examine the histopathological features of entrapment neuropathy. Our findings indicate that histopathological changes correlate primarily with the duration of symptoms rather than with the severity of clinical presentation or the degree of postoperative improvement.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111657"},"PeriodicalIF":1.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199649","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":"“Peak with a pain” – Description of a rare posterior fossa “Mountain peak” shape presenting with trigeminal neuralgia","authors":"K. Sridhar ,&nbsp;E. Thas ,&nbsp;A. Sridhar ,&nbsp;Satish Kannan","doi":"10.1016/j.jocn.2025.111655","DOIUrl":"10.1016/j.jocn.2025.111655","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111655"},"PeriodicalIF":1.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199600","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":"Re-organization of motor functions after early brain damage: Direct evidence from intraoperative neuromonitoring in four cases","authors":"Cihan İşler ,&nbsp;Taner Tanrıverdi ,&nbsp;Emine Taşkıran ,&nbsp;Gülçin Baş ,&nbsp;Bengi Gül Türk ,&nbsp;Çiğdem Özkara ,&nbsp;Mustafa Uzan","doi":"10.1016/j.jocn.2025.111650","DOIUrl":"10.1016/j.jocn.2025.111650","url":null,"abstract":"<div><h3>Background</h3><div>The re-organization of motor functions is a sign of adaptive brain plasticity to early brain damage and understanding its mechanisms may play a key role in the future treatment modalities. This study provides direct evidence of neural plasticity in four patients with early brain damage, who underwent epilepsy surgery due to drug-resistant epilepsy.</div></div><div><h3>Methods</h3><div>In this retrospective analysis, four patients with early brain damage who underwent resective or disconnective epilepsy surgery were examined. Intraoperative neuromonitoring was employed to preserve motor function during surgery, while functional MRI and diffusion tensor imaging were used to assess it before and after surgery.</div></div><div><h3>Results</h3><div>Preoperative functional imaging revealed that some motor representations of the limbs were located in unexpected cortical areas due to early brain damage. In the first and second patients, right-hand representations had shifted to the right hemisphere and to both hemispheres, respectively. In the remaining two patients, all motor functions of the affected hemisphere were completely relocated to the contralateral, unaffected hemisphere. Intraoperative neuromonitoring findings were in line with pre-operative functional imaging.</div></div><div><h3>Conclusion</h3><div>Our intraoperative neuromonitoring data provided direct evidence of motor function reorganization following early brain damage. Furthermore, the results indicated that these functional adjustments of motor circuits are progressive and long-lasting.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111650"},"PeriodicalIF":1.8,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185876","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":"Does embryologic basilar fusion type impact basilar apex aneurysm treatment outcomes?","authors":"Zachary Hubbard ,&nbsp;Julio Isidor ,&nbsp;Hidetoshi Matsukawa ,&nbsp;Rahim Abo Kasem ,&nbsp;Conor Cunningham ,&nbsp;Hasna Loulida ,&nbsp;Mohammad Mahdi Bagheri Asl ,&nbsp;Mohammad Mahdi Sowlat ,&nbsp;Shinichi Yoshimura ,&nbsp;Alejandro Spiotta","doi":"10.1016/j.jocn.2025.111632","DOIUrl":"10.1016/j.jocn.2025.111632","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Basilar apex aneurysms can be challenging entities for both open and endovascular treatment. The basilar artery forms from fusion of the paired longitudinal neural arteries that produces several anatomical morphologies known to correlate with basilar aneurysm formation. There is paucity of literature on these morphologic types on aneurysm treatment. The aim of this study was to examine endovascular treatment outcomes of basilar apex aneurysms based on embryologic fusion type.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of aneurysm databases from one American and one Japanese institution for basilar apex aneurysms treated using endovascular modalities. Angiographic studies were reviewed, and embryologic fusion type was assigned. Outcomes of interest included treatment type, angiographic and complications.</div></div><div><h3>Results</h3><div>151 patients were included in the analysis. There were 76 patients (50.3 %) with cranial fusion, 28 patients (18.6 %) with caudal fusion, and 47 patients (31.1 %) with asymmetric fusion. Mean aneurysm height was largest in the asymmetric fusion group (5.2 mm; [IQR] 3.7–7.0) compared to cranial (4.3 mm; [IQR] 2.9–5.8) and caudal (4.8 mm; [IQR] 3.5–8.0) groups (p = 0.03). Treatment modality did not differ among embryologic fusion types; stent assisted coil embolization was the most frequent treatment modality (58.9 %). There were no differences in complication rates between groups. One-year complete occlusion rates were lowest in the asymmetric fusion group (40.7 %) and highest in the cranial fusion group (72.9 %) (p = 0.03).</div></div><div><h3>Conclusion</h3><div>There are differences in one-year complete occlusion rates following endovascular treatment of basilar apex aneurysms among varying embryologic fusion types. Asymmetric fusion is associated with the lowest complete occlusion rate. Embryologic fusion type may portend differences in outcomes among patients undergoing treatment for basilar apex aneurysms.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111632"},"PeriodicalIF":1.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156520","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}