Journal of Clinical Neuroscience最新文献

{"title":"Timing of aneurysm repair after subarachnoid haemorrhage: a systematic review and meta-analysis of ultra-early and early intervention","authors":"Thenul Munasinghe ,&nbsp;Helen Huang ,&nbsp;Thanh Phan ,&nbsp;Leon Lai","doi":"10.1016/j.jocn.2025.111623","DOIUrl":"10.1016/j.jocn.2025.111623","url":null,"abstract":"<div><h3>Objective</h3><div>The optimal timing of aneurysm repair following aneurysmal subarachnoid haemorrhage (aSAH) remains uncertain. This systematic review and <em>meta</em>-analysis evaluated whether ultra-early (≤6h), early (≤12 h), or standard (≤24 h) treatment influences rebleeding, functional outcome, or mortality.</div></div><div><h3>Methods</h3><div>A systematic search of MEDLINE, EMBASE, and Scopus identified English-language studies published between 2000 and 2024 reporting outcomes after surgical or endovascular intervention within 24 h of aSAH. Pooled odds ratios (ORs) were calculated using random-effects models. Heterogeneity was assessed using the I² statistic. Poor functional outcome was defined as modified Rankin Scale score 3–6 at 6 months.</div></div><div><h3>Results</h3><div>Twenty-one studies comprising 8,108 patients were included. Ultra-early treatment (≤6h) was associated with a reduced risk of rebleeding (OR 0.21; 95 % CI 0.06–0.77), though this was based on two studies and should be interpreted cautiously. No mortality or functional outcome data were available for this subgroup. Early treatment (≤12 h) was associated with increased rebleeding risk (OR 2.36; 95 % CI 1.44–3.89) and no significant difference in functional outcome (OR 1.01; 95 % CI 0.47–2.15). Standard treatment (≤24 h) showed a directionally favourable estimate for functional outcome (OR 0.57; 95 % CI 0.33–1.00), though statistical significance was not reached. Mortality outcomes across all timing thresholds were inconclusive, with substantial heterogeneity observed.</div></div><div><h3>Conclusion</h3><div>Ultra-early aneurysm repair may reduce rebleeding, but current evidence is limited, underpowered, and insufficient to determine effects on survival or recovery. No consistent benefit was observed with early treatment. Further prospective, time-stratified studies are needed to define the optimal intervention window following aSAH.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111623"},"PeriodicalIF":1.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044962","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":"From optimized to validated: Embedding ethical, analytic, and accessibility screening in neurosurgical video education","authors":"Herul Wahyudin ,&nbsp;Maria Oktasari ,&nbsp;Randi Saputra ,&nbsp;Bagus Julian Hikmy ,&nbsp;Cici Yulia","doi":"10.1016/j.jocn.2025.111626","DOIUrl":"10.1016/j.jocn.2025.111626","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111626"},"PeriodicalIF":1.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044966","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":"Salvage medullary perforating artery revascularization using the muscular branch of the occipital artery following occipital artery-posterior inferior cerebellar artery bypass for trapping a ruptured vertebral artery dissecting aneurysm","authors":"Gahn Duangprasert ,&nbsp;Kosumo Noda ,&nbsp;Sergi Cobos Codina ,&nbsp;Hiroyuki Mizuno ,&nbsp;Tetsuya Kusunoki ,&nbsp;Nakao Ota ,&nbsp;Rokuya Tanikawa","doi":"10.1016/j.jocn.2025.111621","DOIUrl":"10.1016/j.jocn.2025.111621","url":null,"abstract":"<div><div>Vertebral artery dissecting aneurysms (VADAs) presenting with subarachnoid hemorrhage (SAH) are relatively rare. The re-rupture and mortality rates during the acute phase of SAH remain significantly high. Endovascular coil trapping is one of the definitive treatments to prevent re-rupture; however, it carries a potential risk of medullary infarction derived from occlusion of the medullary perforating arteries (Mperf). Here we present a case with poor-grade SAH resulting from a ruptured left VADA affecting the posterior inferior cerebellar artery (PICA). After obtaining informed consent, open surgery was selected. The OA and its muscular branches were preventively harvested in case an additional bypass was required. Following the occipital artery (OA)-PICA bypass, the aneurysm was then trapped using the transcondylar fossa corridor. The lateral Mperf, supplying the lateral medullary surface, arising directly from the VADA and having to be included in the trapped segment, was occluded shortly after the complete trapping. This necessitates additional Mperf revascularization. Consequently, a salvage end-to-side bypass was performed using the muscular branch of the OA to reestablish the flow to the Mperf and prevent medullary infarction. The patient tolerated the procedure well and was discharged without neurological deficits. Postoperative imaging demonstrated complete aneurysm obliteration and bypass patency without ischemic complications.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111621"},"PeriodicalIF":1.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044965","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":"Intravascular lymphoma-associated strokes following tumour necrosis factor inhibitor therapy","authors":"Charles Champeaux Depond ,&nbsp;Marc Ferrigno ,&nbsp;Nadia Ajili-Ferté ,&nbsp;Romain Appay","doi":"10.1016/j.jocn.2025.111556","DOIUrl":"10.1016/j.jocn.2025.111556","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111556"},"PeriodicalIF":1.8,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003910","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":"T4-5 transforaminal endoscopic approach for repair of ventral type 1 CSF leaks","authors":"Meng Huang ,&nbsp;Alex Hoang ,&nbsp;Kurt Yaeger ,&nbsp;Insun Chong","doi":"10.1016/j.jocn.2025.111610","DOIUrl":"10.1016/j.jocn.2025.111610","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111610"},"PeriodicalIF":1.8,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003911","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":"Developing aneurysm clipping capacity in Ghana through global neurosurgical collaboration: a case series from two global brainsurgery initiative mission trips","authors":"Teddy Totimeh ,&nbsp;Emmanuel K. Adjei Osei ,&nbsp;Irene Kweidjartey ,&nbsp;Kwadwo Darko ,&nbsp;Vincent Buckman ,&nbsp;Ulrick Sidney Kanmounye ,&nbsp;W. Elorm Yevudza ,&nbsp;Frederick Dogbe ,&nbsp;Nirali Patel ,&nbsp;Kwadwo Sarpong ,&nbsp;Hasan R. Syed ,&nbsp;Amjad Anaizi ,&nbsp;Daniel R. Felbaum ,&nbsp;Jean C. Walter","doi":"10.1016/j.jocn.2025.111607","DOIUrl":"10.1016/j.jocn.2025.111607","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of cerebral aneurysms in low- and middle-income countries (LMICs) faces significant barriers, including limited access to specialized neurosurgical care and equipment and dissipating human resources. Ghana’s inaugural experience with cerebral aneurysm clipping, facilitated by the Global Brainsurgery Initiative (GBI), represent an attempt to address these challenges through international collaboration.</div></div><div><h3>Methods</h3><div>This case series details the outcomes of six patients who underwent cerebral aneurysm clipping procedures at two neurosurgical centers. These cases were done in 2023 and 2024 by a team comprising local and international neurosurgeons. After a series of virtual case discussions, patients were selected. Case load was mainly limited by logistics and operative schedules. The preoperative planning; challenges encountered and strategies for capacity building are discussed.</div></div><div><h3>Results</h3><div>The patients were aged 15 to 63 years, predominantly female and presented with ruptured aneurysms at the internal carotid artery terminus, posterior communicating artery, and middle cerebral artery. All patients had their aneurysms clipped. There was an intraoperative rupture in one case and perioperative rupture with subsequent infarct in another. Most patients achieved good functional recovery, with mRS scores indicating minimal to moderate disability.</div></div><div><h3>Conclusion</h3><div>We outline the beginnings of a new global neurosurgery partnership. The GBI mission demonstrates that with appropriate planning and collaboration, neurosurgical care in low-resource settings can achieve appreciable outcomes. Continued investment in early diagnosis, advanced treatment modalities, and healthcare infrastructure is essential for scaling access to surgical aneurysm care in Ghana.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111607"},"PeriodicalIF":1.8,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996727","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":"Disparities in pediatric stroke-related mortality in the United States: Insights from the CDC WONDER database","authors":"Waleed Tariq ,&nbsp;Shahzaib Ahmed ,&nbsp;Sophia Ahmed ,&nbsp;Eeman Ahmad ,&nbsp;Neha Waseem ,&nbsp;Hoor Ul Ain ,&nbsp;Shkaib Ahmad","doi":"10.1016/j.jocn.2025.111592","DOIUrl":"10.1016/j.jocn.2025.111592","url":null,"abstract":"<div><h3>Objective</h3><div>Stroke is a rare but significant cause of mortality among the pediatric age group. Despite advances in treatment, disparities in stroke-related mortality persist. We aim to analyze stroke-related mortality among pediatric age groups in the US for over two decades. Methods: This retrospective cross-sectional study utilized the CDC WONDER database for stroke-related mortality in children (≤ 14 years). Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Annual percent changes (APC) with 95 % confidence intervals (CI) were determined from Joinpoint regression (Joinpoint Regression Program V 5.2.0). Results: From 1999 to 2020, a total of 15,512 deaths in the United States pediatric-stroke-related mortality were reported. An overall decrease in AAMR was observed, from 1.26 in 1999 to 1.02 in 2020. Males had higher AAMR (1.28) than females throughout the period (1.03). Across regions, the Midwest had the highest AAMR (1.24), followed by the South (1.23), the West (1.17), and the Northeast (0.95). Non-Hispanic (NH) Black or African American group had the highest AAMR (1.97) followed by Hispanic or Latinos (1.08), NH Whites (1.00), and NH Asian or Pacific Islanders exhibited the lowest AAMR (0.94). The CMR per 100,000 was noted to be the highest for the &lt;1 year age group (CMR: 8.14) while the 5–14 years group demonstrated the lowest crude rate (CMR: 0.56). Upon urbanization, the highest AAMR was observed in large central metro areas (1.23) while large fringe metro areas had the lowest AAMR (1.02). The highest AAMRs state-wise were observed in Alaska (1.79), South Dakota (1.77), and the District of Columbia (1.75). Conclusion: An increase in mortality trends was observed from 2012 onwards with males, infants, and African American children being the high-risk groups. A multifaceted approach, focusing on prevention, early recognition, and optimized management is required to mitigate pediatric-stroke-related mortality.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111592"},"PeriodicalIF":1.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988204","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":"Feasibility and safety of the non-radial-specific 6 Fr FUBUKI XF guiding sheath for transradial neuroendovascular procedures","authors":"Daisuke Yamazaki ,&nbsp;Akifumi Yokota ,&nbsp;Daisuke Satoh ,&nbsp;Takehiro Yako ,&nbsp;Kazuo Kitazawa ,&nbsp;Tetsuyoshi Horiuchi ,&nbsp;Shigeaki Kobayashi","doi":"10.1016/j.jocn.2025.111609","DOIUrl":"10.1016/j.jocn.2025.111609","url":null,"abstract":"<div><div>The transradial approach (TRA) is gaining popularity in neuroendovascular therapy due to its safety and patient comfort, but its application in emergency settings with complex vascular anatomy remains technically demanding. This study assessed the feasibility and safety of using the 6 Fr FUBUKI XF long guiding sheath—a non-radial-specific device—for neuroendovascular procedures via TRA. Nineteen consecutive patients treated with the FUBUKI XF long guiding sheath between April 2024 and June 2025 were retrospectively reviewed and compared with a small cohort treated using the radial-specific Rist guiding sheath during the same period. The FUBUKI XF cohort had a mean age of 70.2 years, and 57.9 % were female. Most procedures (73.7 %) were for ruptured aneurysms. Anatomical challenges included type III aortic arch and aberrant right subclavian artery. Technical access success was achieved in 94.7 % of cases, with one case converted to transfemoral access. Median procedure time was 111.0 min (IQR, 72.0), median fluoroscopy time was 54.0 min (IQR, 35.3), and median DAP was 153.0 Gy·m² (IQR, 46.0). Intermediate catheters were employed in 94.7 % of procedures. One case of carotid dissection required stenting, but no major access-site complications occurred. The FUBUKI XF sheath’s atraumatic tip, flexible shaft, and high trackability enabled effective navigation and support. These findings suggest that the FUBUKI XF is a feasible and safe option for TRA-based neurointerventions, with performance comparable to radial-specific devices in complex anatomical scenarios.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111609"},"PeriodicalIF":1.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996726","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":"Critical gaps in evidence on intensive statins for acute ischemic stroke","authors":"Amisha Kumari ,&nbsp;Muddassir Khalid ,&nbsp;Archana Kumari ,&nbsp;Reena Kumari ,&nbsp;Fred Segawa","doi":"10.1016/j.jocn.2025.111600","DOIUrl":"10.1016/j.jocn.2025.111600","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111600"},"PeriodicalIF":1.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931646","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":"Early exposure to neurosurgery: promoting early specialty interest through a single-day resident-driven neurosurgical course for preclinical students","authors":"Nicole A. Perez ,&nbsp;Zsombor T. Gal ,&nbsp;William Muñoz ,&nbsp;Brian Hsueh ,&nbsp;Pranav Nanda ,&nbsp;Bryan D. Choi ,&nbsp;Pamela Jones ,&nbsp;Christopher Stapleton ,&nbsp;Ganesh Shankar ,&nbsp;Jean Valery Coumans ,&nbsp;Brian Nahed","doi":"10.1016/j.jocn.2025.111612","DOIUrl":"10.1016/j.jocn.2025.111612","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Minimal exposure to neurosurgery in standard medical school curricula alongside a growing need for neurosurgical care necessitate early exposure programs that promote medical student retention in neurosurgery. Here, we evaluate preclinical students’ perceptions on a one-day, resident-designed introductory neurosurgical course.</div></div><div><h3>Methods</h3><div>Course curriculum involved hands-on and discussion-based elements split into three stations: (1) suturing/general information; (2) introduction to drilling/LPs/EVDs; and (3) case/clinical skills review. Anonymous online post-course surveys were administered immediately after the course and one year after the course following completion of clerkships.</div></div><div><h3>Results</h3><div>Ten medical students participated in the course, 70 % of which indicated desire to pursue neurosurgery at course onset. Nine students responded to an immediate post-survey, which revealed that, in students with a desire to pursue neurosurgery (n = 6) versus those undifferentiated in specialty interest (n = 3): the program was rated as having high versus moderate impacts on readiness and enthusiasm for surgical clerkships (readiness: avg 4 vs 3.67; enthusiasm: avg 4.3 vs 3.67), on fostering a sense of belonging within neurosurgery (avg 4.67 vs 3.33), and on clarifying specialty interests (avg 4.3 vs 3.3).</div><div>At 1-year, 75 % of participants (n = 6), including 100 % of students (n = 4) from minority backgrounds, noted a persistent desire to pursue neurosurgery. In participants with a continued interest in neurosurgery versus those planning to pursue different fields, the course was rated as having high versus moderate impacts on preparedness for surgery clerkship experiences (average 4.17 vs 3.5) and moderate impact on participant desire to pursue neurosurgery (3.67 vs 3).</div></div><div><h3>Conclusions</h3><div>Significant enthusiasm and sense of belonging fostered by the course, particularly amongst students with prior interests in neurosurgery, support that early specialty-specific exposure may promote retention of students in neurosurgery. High rates of persistent engagement in neurosurgery amongst minority students at 1-year post-course suggest that such courses may help to build a more representative neurosurgical workforce.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111612"},"PeriodicalIF":1.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988203","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}