Journal of Clinical Neuroscience最新文献

{"title":"James Kiffin Penry: shaping the modern epilepsy dialogue.","authors":"Victoria Wei, Brendan Huang, Simona Proteasa","doi":"10.1016/j.jocn.2026.111987","DOIUrl":"10.1016/j.jocn.2026.111987","url":null,"abstract":"<p><p>Understanding epilepsy, one of the most frequent chronic neurological conditions, requires recognizing it as a spectrum of brain disorders characterized by a persistent tendency to generate seizures. In the 20th century, researchers like James Kiffin Penry advanced the development and clinical testing of antiseizure medications, improving treatment options and patient outcomes. Dr. Penry helped shape modern standards for epilepsy treatment, expanded therapeutic options, strengthened collaboration between researchers and advocacy organizations, and contributed to better outcomes and quality of life for people with epilepsy worldwide. A systematic search of published articles was conducted using PubMed and Google Scholar to chronicle Penry's personal and professional life. We focus on James Kiffin Penry's contributions to epilepsy research, his advocacy for standardizing diagnostic criteria for epilepsy, and his pivotal role in advancing regulatory approval of carbamazepine and valproic acid, key antiseizure medications. We conclude with Penry's posthumous contributions to epilepsy education through the J. Kiffin Penry Epilepsy Fellow Network, held annually in his hometown of Winston-Salem, North Carolina. The contributions of Dr. James Penry earned him recognition as a leader in the field of modern epilepsy.</p>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"149 ","pages":"111987"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486038","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":"Haemorrhage pattern and clinical outcomes after angiogram negative subarachnoid haemorrhage: a systematic review and meta analysis","authors":"Thenul Munasinghe ,&nbsp;Hashni Senanayake ,&nbsp;Samiha Arulshankar ,&nbsp;Lee-Anne Slater ,&nbsp;Leon Lai","doi":"10.1016/j.jocn.2026.111930","DOIUrl":"10.1016/j.jocn.2026.111930","url":null,"abstract":"<div><h3>Background</h3><div>Angiogram-negative subarachnoid haemorrhage accounts for approximately 15% of spontaneous subarachnoid haemorrhage, yet surveillance practices and the role of repeat vascular imaging remain inconsistent. The extent to which haemorrhage pattern predicts clinical complications and delayed vascular lesion detection is uncertain.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. Studies reporting clinical outcomes in angiogram-negative subarachnoid haemorrhage were included. Outcomes were pooled using random-effects generalised linear mixed models and stratified by haemorrhage pattern, including perimesencephalic, non-perimesencephalic, diffuse, and convexity haemorrhage.</div></div><div><h3>Results</h3><div>Sixty-seven studies comprising 5,921 patients were included. Favourable functional outcome at 3–6 months occurred in 95–97% of patients across all haemorrhage patterns. Rebleeding was uncommon, occurring in 1% of perimesencephalic, 2% of non-perimesencephalic, and 3% of diffuse haemorrhage. Clinical vasospasm occurred in 3%, 11%, and 13%, respectively, while acute hydrocephalus requiring external ventricular drainage occurred in 7%, 29%, and 44%. Among studies reporting repeat vascular imaging, 82 vascular lesions were identified, predominantly in non-perimesencephalic haemorrhage. No lesions were detected on imaging performed within 7 days of ictus; all reported lesions were identified at or beyond 7 days, although repeat imaging was selectively performed and timing varied across studies.</div></div><div><h3>Conclusion</h3><div>Angiogram-negative subarachnoid haemorrhage is clinically heterogeneous. Haemorrhage pattern is associated with distinct complication profiles and differential observed yields of delayed vascular lesion detection, and may assist in individualising surveillance strategies. Prospective studies are required to define optimal imaging intervals.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111930"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172490","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":"Contemporary burden of subarachnoid hemorrhage: a comparative assessment of global and Asian trend","authors":"Xiaowei Luo,&nbsp;Wenjia Ma,&nbsp;Jiarong He,&nbsp;Qingsheng Yang,&nbsp;Zhuo Wang,&nbsp;Cheng Liang,&nbsp;Mingming Zhang","doi":"10.1016/j.jocn.2026.111907","DOIUrl":"10.1016/j.jocn.2026.111907","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the trends in the global and Asian burden of subarachnoid hemorrhage (SAH) from 1990 to 2021, explore its influencing factors, assess its relationship with sociodemographic development, analyze health inequalities, and predict future trends.</div></div><div><h3>Methods</h3><div>Epidemiological data on SAH from 1990 to 2021 were obtained from the Global Burden of Disease (GBD) database. Prevalence, disability-adjusted life years (DALYs), and other indicators were calculated. Joinpoint regression, age-period-cohort analysis, and decomposition analysis were used to investigate trends and influencing factors. Data envelopment analysis was employed to evaluate the relationship between SAH and the socio-demographic index (SDI). The slope index of inequality (SII) and concentration index (CI) were used to analyze health inequalities. The Bayesian age-period-cohort model was utilized to predict prevalence from 2022 to 2036.</div></div><div><h3>Results</h3><div>In 2021, the global and Asian age-standardized prevalence of SAH was 92.169/100,000 and 90.158/100,000, respectively. Joinpoint regression showed a decreasing trend in both global and Asian prevalence, with a slowing decline in recent years. The risk of SAH exhibited significant age, period, and cohort effects. Decomposition analysis indicated that population growth and aging were the main drivers of increased prevalence globally and in Asia. Data envelopment analysis revealed a nonlinear relationship between SAH and SDI. SII and CI analyses showed a trend of increasing health inequalities globally and in Asia. Bayesian predictions indicated that the prevalence would continue to decline globally and in Asia from 2022 to 2036, but at a slower rate.</div></div><div><h3>Conclusion</h3><div>Although the global and Asian burden of SAH showed a declining trend over the past 30 years, challenges such as population aging and increasing health inequalities persist. Future prevention and control strategies should focus on population effects and regional heterogeneity while strengthening interventions for high-risk populations.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111907"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172527","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":"Cisternal segment trochlear nerve schwannoma","authors":"Jinxing Lin ,&nbsp;Hailiang Tang ,&nbsp;Jian Xu","doi":"10.1016/j.jocn.2026.111904","DOIUrl":"10.1016/j.jocn.2026.111904","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111904"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142640","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":"Advancing access to emergency care for traumatic brain injuries in Indonesia: a national program integrating task-sharing and simulation technologies","authors":"Bryan Gervais de Liyis ,&nbsp;Francisco Rivera ,&nbsp;Muhammad Kusdiansah ,&nbsp;Cyrus Elahi ,&nbsp;Affan Priyambodo Permana ,&nbsp;I Wayan Niryana ,&nbsp;Wiryawan Manusubroto ,&nbsp;Eko Prasetyo ,&nbsp;Sri Maliawan ,&nbsp;Asra Al Fauzi ,&nbsp;Arnau Benet ,&nbsp;Gail Rosseau","doi":"10.1016/j.jocn.2026.111906","DOIUrl":"10.1016/j.jocn.2026.111906","url":null,"abstract":"<div><div>Severe shortages and geographic maldistribution of neurosurgeons continue to limit timely access to life-saving neurosurgical care in low- and middle-income countries, with Indonesia representing a particularly acute example due to its archipelagic geography, prolonged transfer times, and rising burden of traumatic brain injury and stroke. To address delays in emergency care in districts without neurosurgical coverage, Indonesia has launched a nationally endorsed neurosurgical task-sharing initiative in which selected general surgeons are trained to perform a restricted set of emergency cranial procedures under continuous neurosurgical oversight. This article describes the rationale, regulatory framework, and educational design of this national pilot program, initiated in late 2025. Developed collaboratively by the Ministry of Health, the Indonesian College of Neurosurgeons, and the Indonesian College of Surgeons, the program integrates formal ministerial authorization, defined eligibility criteria for hospitals and surgeons, and a three-phase competency-based training pathway. Training includes simulation-based education using virtual reality and locally produced three-dimensional printed cranial models, intensive supervised operative experience at accredited neurosurgical centers, and real-time tele-proctored emergency surgery in district hospitals. The operative scope is deliberately limited to decompressive craniotomy for epidural and subdural hematomas and decompressive craniectomy for selected hemorrhagic and non-hemorrhagic stroke. As implementation has only recently begun, clinical outcome data are not yet available. This manuscript is a descriptive account of one nation’s plan to address limitations in access to care for common, life-threatening neurosurgical conditions.</div><div>Future studies will describe governance, competency assessment, and prospective outcome monitoring of this novel program.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111906"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157306","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":"Real-time intraoperative depth estimation in transsphenoidal surgery using deep learning: A feasibility study","authors":"Olivier Zanier ,&nbsp;Aron Alakmeh ,&nbsp;Raffaele Da Mutten ,&nbsp;Alessandro Carretta ,&nbsp;Matteo Zoli ,&nbsp;Diego Mazzatenta ,&nbsp;Carlo Serra ,&nbsp;Luca Regli ,&nbsp;Victor E. Staartjes","doi":"10.1016/j.jocn.2026.111910","DOIUrl":"10.1016/j.jocn.2026.111910","url":null,"abstract":"<div><h3>Purpose</h3><div>Endoscopic endonasal and transcranial approaches are used for the resection of various pathological lesions in neurosurgery, especially pituitary adenomas, craniopharyngiomas, chordomas, or meningiomas. The video feed provided by endoscopes is generally two-dimensional, which can hinder depth perception. Thus, generating three-dimensional imaging without the need for special endoscopes using deep learning might be beneficial for enhanced intraoperative orientation.</div></div><div><h3>Methods</h3><div>DINOv2 is a pre-trained deep-learning model published by Meta in 2023. One of its capabilities is to estimate the depth in two-dimensional images. In this study, we explore the application of DINOv2 to the video feed of eight transsphenoidal endonasal surgeries. The results were evaluated for quality by both a senior neurosurgeon and a resident neurosurgeon. Furthermore, depth estimations from a randomly selected subset of 488 images taken from the videos were semi-quantitatively compared against manual segmentations for the estimation of deep, intermediate, and superficial areas.</div></div><div><h3>Results</h3><div>Using DINOv2, numeric depth maps were generated, and colormaps were created for depth visualization. Although these colormaps were not perfect, they aligned well with the subjective assessment of depth in the video feed by a senior neurosurgeon as well as a resident neurosurgeon. Semi-quantitative validation of the model’s estimations yielded a mean overall DICE Similarity Index of 0.48. These semi-quantitative results should be interpreted with caution, as the cutoffs used for model depth predictions and manual segmentation are not standardized.</div></div><div><h3>Conclusions</h3><div>Through the application of DINOv2, we were able to estimate depth in endoscopic imaging from transsphenoidal endonasal surgeries by generating numeric maps and depth colormaps. This illustrates the potential of deep learning-based depth estimations, which in the future could contribute to improving intraoperative orientation. It also highlights the opportunities in using artificial intelligence to augment endoscopic video feeds.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111910"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172540","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":"Microsurgical resection of brain arteriovenous malformations with or without preoperative embolization: a 10 year observational cohort study","authors":"Cyrus Raki ,&nbsp;Samiha Arulshankar ,&nbsp;Makar Kiselnikov ,&nbsp;Chris Xenos ,&nbsp;Leon Lai","doi":"10.1016/j.jocn.2026.111911","DOIUrl":"10.1016/j.jocn.2026.111911","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;The role of preoperative embolization as an adjunct to microsurgical resection of brain arteriovenous malformations (AVMs) remains uncertain. We evaluated clinical and angiographic outcomes of microsurgical resection performed with or without preoperative embolization and examined factors associated with selection for embolization.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a retrospective observational cohort study of consecutive patients undergoing microsurgical resection of AVMs at a tertiary centre between July 2015 and June 2025. Patients treated with microsurgery alone or with preoperative embolization were included. Baseline differences were addressed using propensity score methods, including 1:3 matching and inverse probability of treatment weighting. The primary outcome was treatment related morbidity at 90 days, defined as an increase of at least 1 point on the modified Rankin Scale (mRS). Secondary outcomes included functional dependence (mRS greater than 2), postoperative haemorrhage, parenchymal infarction, angiographic obliteration, operative duration and composite outcome of mRS deterioration of at least 2 points or death at 90 days. Factors associated with embolization use were evaluated with Firth penalized logistic regression, and discriminative performance of AVM size was assessed using receiver operating characteristic analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 104 patients, 91 (87.5%) underwent microsurgical resection alone and 13 (12.5%) underwent preoperative embolization followed by microsurgery. Embolized AVMs were larger (mean 3.8 vs 2.5 cm), more frequently demonstrated deep perforator supply, and were of higher Spetzler-Martin grade. After propensity score adjustment, no clear differences were observed in treatment related morbidity at 90 days (risk difference + 23.1%, 95% CI − 3.3 to 51.9), functional dependence (risk difference + 20.5%, 95% CI − 8.5 to 49.7), the composite outcome of mRS deterioration of at least 2 points or death, or mortality. AVM size was independently associated with embolization use (odds ratio 1.77 per cm increase), with moderate discriminative performance (AUC 0.76). A 3 cm threshold demonstrated the strongest association with embolization selection.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;In this single centre observational cohort, microsurgical resection with or without preoperative embolization was associated with similar short term functional and angiographic outcomes after adjustment for baseline differences, although estimates were imprecise. AVM size was the primary factor associated with selection for embolization, but this did not correspond to a demonstrable outcome advantage. These findings reflect contemporary practice patterns and underscore the need for prospective multicentre studies to clarify whether embolization confers incremental benefit in selected patients.&lt;/div&gt;&lt;div&gt;Abbreviations: AVM, arteriovenous malformation; mRS, modifie","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111911"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172528","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":"High flow, at a higher cost? A pilot study comparing direct vs. indirect bypass for Moyamoya disease using time-driven activity-based costing","authors":"Advith Sarikonda ,&nbsp;Danyal Quraishi ,&nbsp;Arbaz Momin ,&nbsp;Matthews Lan ,&nbsp;Ashmal Sami Kabani ,&nbsp;Semihan Adegbite ,&nbsp;D.Mitchell Self ,&nbsp;Stavropoula Tjoumakaris ,&nbsp;M.Reid Gooch ,&nbsp;Pascal Jabbour ,&nbsp;Ahilan Sivaganesan","doi":"10.1016/j.jocn.2026.111929","DOIUrl":"10.1016/j.jocn.2026.111929","url":null,"abstract":"<div><h3>Background and objective</h3><div>In the management of adult moyamoya disease (MMD), there is clinical equipoise regarding direct bypass (DB) vs indirect bypass (IB). One factor that may influence the choice of procedure is cost. Therefore, we sought to compare the true intraoperative costs (not charges or reimbursement) of DB vs. IB using a novel costing methodology, time-driven activity-based costing (TDABC).</div></div><div><h3>Methods</h3><div>A retrospective cohort study (2017–22) was conducted of all patients undergoing revascularization for symptomatic MMD. TDABC was used to calculate intraoperative costs. Supply cost was calculated as the aggregate of expenses related to implants, consumables, medications, and surgical tray sterilization. Personnel cost was determined by multiplying the per-minute wages of all intraoperative personnel by the amount of time they spent intraoperatively. Software was developed to automate this data from the electronic medical record. Multivariable regression was performed to compare the costs of DB vs. IB, adjusting for age, smoking status, hypertension, and coronary artery disease.</div></div><div><h3>Results</h3><div>Of 38 patients undergoing revascularization for MMD, 22 (57.9%) underwent DB, while 16 (42.1%) underwent IB. The median total cost of DB surgery was $7,802 (IQR: $7,802 − $9,881), compared to $6,120 (IQR: $5,609 − $6,900)for IB surgery (p &lt; 0.05). On descriptive analysis, DB also had higher median supply cost ($3,793 vs. $2,855, p &lt; 0.01), which was driven by higher cost of consumables ($2,268 vs. $1,996, p &lt; 0.01), surgical tray sterilization ($137 vs. $129, p &lt; 0.01), and implants ($1,022 vs. $568, p &lt; 0.05). On multivariable analysis, DB was associated with significantly higher total cost (β:$1,758±$768, p = 0.027) and supply cost (β:$1,032±$333, p = 0.004), with no significant differences in personnel cost (β:$726±$526,p = 0.175).</div></div><div><h3>Conclusions</h3><div>Using granular costing methodology, we demonstrate the individual drivers of cost which are responsible for differences in expenditures between DB and IB. This framework may inform surgical decision-making, guide institutional budgeting, and optimize resource allocation for the treatment of MMD.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111929"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165363","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":"Headache resolution following middle meningeal artery embolization in chronic subdural hematoma patients","authors":"James Feghali ,&nbsp;Jiwon Moon ,&nbsp;Crystal X. Wang ,&nbsp;Sumil Nair ,&nbsp;Alice Hung ,&nbsp;Oishika Das ,&nbsp;Xihang Wang ,&nbsp;Christopher M. Jackson ,&nbsp;Justin M. Caplan ,&nbsp;Judy Huang ,&nbsp;Rafael J. Tamargo ,&nbsp;L. Fernando Gonzalez ,&nbsp;Christina R. Graley ,&nbsp;Risheng Xu","doi":"10.1016/j.jocn.2026.111898","DOIUrl":"10.1016/j.jocn.2026.111898","url":null,"abstract":"<div><div>Headache is a common but underrecognized symptom in patients with chronic subdural hematoma (cSDH). Middle meningeal artery embolization (MMAe) has emerged as a minimally invasive treatment for cSDH, but its impact on headache remains unclear. We conducted a retrospective cohort study of cSDH patients presenting with headache who underwent MMAe between July 2019 and June 2025, excluding those with prior surgical intervention, ventricular shunts, or Glasgow Coma Scale &lt; 14. Clinical, imaging, and procedural data were collected, including headache status 2–6 weeks post-procedure. Of 135 patients who underwent MMAe, 78 (58%) presented with headaches, and 30 met inclusion criteria. Twenty-one (70%) reported complete headache resolution, and 6 of 9 remaining patients (67%) reported improvement, resulting in a combined resolution or improvement rate of 90% (77–99%, p &lt; 0.001). No procedural complications occurred. Headache outcomes were not significantly associated with baseline demographics, clinical variables, or follow-up hematoma characteristics, including resolution (p = 0.999), thickness (p = 0.758), or midline shift (p = 0.318). These findings indicate that MMAe is associated with significant short-term headache improvement in cSDH patients, independent of hematoma size or mass effect. This supports further investigation into MMAe’s potential role in managing both secondary headaches from cSDH and primary headache syndromes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111898"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116342","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":"Trends in lumbar degenerative spine pathologies causing severe pain and disability: a four-decade cohort study of 1495 Colombian women","authors":"Carolina Ramírez Martínez ,&nbsp;Viviana Marcela Plazas Bedoya ,&nbsp;Angie Tatiana Romero Miranda ,&nbsp;Jorge Felipe Ramírez León ,&nbsp;José Gabriel Rugeles Ortiz ,&nbsp;Nicolás Prada Ramírez ,&nbsp;Gabriel Oswaldo Alonso Cuéllar","doi":"10.1016/j.jocn.2026.111939","DOIUrl":"10.1016/j.jocn.2026.111939","url":null,"abstract":"<div><h3>Study design</h3><div>Retrospective Cohort Study.</div></div><div><h3>Objectives</h3><div>This study aimed to analyze trends in the frequency of degenerative lumbar spine pathologies in a large Colombian women cohort and their relationship with age, comorbidities, and the degree of functional limitation and pain intensity.</div></div><div><h3>Materials and methods</h3><div>This is a 4-decade retrospective study analyzing the clinical records of a cohort of Colombian women who sought consultation for lumbar pain at a specialized spine pathology management center. Demographic variables, comorbidities, and pain and disability scales were analyzed.</div></div><div><h3>Results</h3><div>A cohort of 1495 women who presented with lumbar pain between 1993 and 2024 was analyzed. The most frequent pathology over the decades was degenerative disc disease. The diagnosis of facet osteoarthritis increased significantly, from &lt; 1% in decade 1 (1993–1999) to &gt; 30% in decade 4 (2020–2024) (p &lt; 0.001). Concomitant diagnosis of DDD and facet arthrosis showed a linear upward trend, rising from 0% in D1 to 24% in D4, reflecting evolving diagnostic standards. Being a homemaker between the ages of 20 and 60 was a significant factor related to back pain. Pain and disability were higher in older patients.</div></div><div><h3>Conclusion</h3><div>Diagnostic analyses must consider the multifactorial nature of lumbar pain and not underestimate facet arthrosis as a pain generator. The occupation of women plays an important role in back pain and its intensity, so it should be considered in the anamnesis process of medical consultation. These results originate from a single-center cohort, which must be considered when interpreting the frequency of these pathologies.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111939"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172486","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}