Journal of Clinical Neuroscience最新文献

{"title":"Alice in Wonderland syndrome by right parieto-occipital lobe encephalitis in the elderly","authors":"Toshiaki Takehara , Koji Hayashi , Sekai Tsujimoto , Yuka Nakaya , Mamiko Sato , Yasutaka Kobayashi","doi":"10.1016/j.jocn.2025.111574","DOIUrl":"10.1016/j.jocn.2025.111574","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111574"},"PeriodicalIF":1.8,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863256","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":"Applied microanatomy of the petrous internal carotid artery, greater superficial petrosal nerve, and tensor tympani muscle to improve safety during middle fossa surgery: laboratory cadaveric investigation","authors":"Ali Tayebi Meybodi ,&nbsp;Andrea L. Castillo ,&nbsp;Michael T. Lawton,&nbsp;Mark C. Preul","doi":"10.1016/j.jocn.2025.111561","DOIUrl":"10.1016/j.jocn.2025.111561","url":null,"abstract":"<div><h3>Background</h3><div>Middle cranial fossa surgery is challenging due to the proximity of several neurovascular structures, such as the otic capsule, greater superficial petrosal nerve (GSPN), and petrous internal carotid artery (pICA). The concept of middle fossa triangles aids in the recognition of landmarks and increases the safety of middle fossa surgery. However, a definitive description of the microanatomical interrelationship between the pICA, tensor tympani, and GSPN in middle fossa surgery is lacking.</div></div><div><h3>Methods</h3><div>This study investigates the relationship between the GSPN, pICA, and tensor tympani to improve the safety of pICA exposure during surgery of the middle fossa. The middle fossae of 5 cadaveric heads (10 sides) were drilled to expose the GSPN, pICA, and tensor tympani. The crossing points between the pICA, GSPN, and tensor tympani were recorded for the proximal and distal pICA using a stereotactic navigation system. Distances between the crossing points and the borders of the horizontal pICA were calculated. The GSPN and pICA crossed in all specimens.</div></div><div><h3>Results</h3><div>The mean (SD) distance between the GSPN and pICA was 3.0 (4.9) mm proximally and 5.3 (2.8) mm distally. The tensor tympani was lateral to the pICA with a mean (SD) distance of 4.2 (1.9) mm in all specimens (proximally and distally), except in 1 specimen in which it crossed only the proximal pICA.</div></div><div><h3>Conclusions</h3><div>Drilling the Kawase triangle on the medial side of the GSPN is not universally safe because the pICA and GSPN frequently cross along the course of the horizontal pICA. The tensor tympani muscle may be used as a reliable landmark to systematically localize the pICA.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111561"},"PeriodicalIF":1.8,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863253","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 vein to brain: Hemorrhagic abscess secondary to thrombosis extending from the internal jugular vein to the vein of Labbé","authors":"Cansu Sarıkaya ,&nbsp;Mustafa Kemal Demir ,&nbsp;Akın Akakın ,&nbsp;Turker Kılıc","doi":"10.1016/j.jocn.2025.111570","DOIUrl":"10.1016/j.jocn.2025.111570","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111570"},"PeriodicalIF":1.8,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863255","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":"Analyzing relationship between ureter and lumbar vertebrae: insights from digital radiography","authors":"Xiang Liu ,&nbsp;Xiao-jun Lu ,&nbsp;Yu-han Wang ,&nbsp;Pei-jie Liang ,&nbsp;Lian-jun Yang ,&nbsp;Hai Lu","doi":"10.1016/j.jocn.2025.111568","DOIUrl":"10.1016/j.jocn.2025.111568","url":null,"abstract":"<div><h3>Background</h3><div>In order to mitigate the risk of iatrogenic ureteral injury during surgical procedures, previous research has explored the anatomical relationship between the ureter and the lumbar spine. The primary aim of this study was to elucidate the anatomical relationship between the ureter and the lumbar vertebrae utilizing digital radiography (DR) images.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed anteroposterior DR images of the abdomen from 39 male and 40 female patients with double J ureteral stents. We measured the distance between the stents and the lumbar vertebral body using the superior, middle, and inferior margins of each vertebral body as reference points. The horizontal line from these points to the stent intersection was termed the vertebra-ureter distance, with negative values indicating the ureter was within the vertebral body.</div></div><div><h3>Results</h3><div>In the sex-based analysis, no significant differences were observed between sexes at any level from L2 to L5. In the laterality-based analysis, no significant differences were identified at levels L2 to L5, except at the inferior level of L5, where measurements on the right side were significantly smaller than those on the left. A gradual decrease in measurements was noted from the L2 to the L5 level. At the L5 level, measurements were zero or negative in 30 out of 237 cases.</div></div><div><h3>Conclusions</h3><div>In the anterior approach to the lumbar spine, the distal lumbar vertebrae have a closer anatomical relationship with the ureter. Notably, at the L5 level, the right ureter is more susceptible to injury than the left ureter.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111568"},"PeriodicalIF":1.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144861225","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":"Diagnostic accuracy of intraoperative neuromonitoring during non-tumor thoracic spine surgeries: A systematic review and meta-analysis","authors":"Raja Narendra Divakar Addanki ,&nbsp;Priti Ezhuvathra ,&nbsp;Abdullah M. Al-Qudah ,&nbsp;Benjamin B. Lee ,&nbsp;Katherine M. Anetakis ,&nbsp;Jeffrey R. Balzer ,&nbsp;Parthasarathy D. Thirumala","doi":"10.1016/j.jocn.2025.111567","DOIUrl":"10.1016/j.jocn.2025.111567","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic spine surgeries carry a higher risk of neurological complications due to the region’s narrow spinal canal and precarious blood supply, making effective monitoring critical. This study offers the first meta-analysis assessing accuracy and prognostic value of Intraoperative neuromonitoring (IONM) in non-tumor thoracic spinal surgeries, filling a key gap in the literature.</div></div><div><h3>Methods</h3><div>We adhered to PRISMA-DTA guidelines, conducting a PubMed search for relevant studies. Included studies had over 10 patients and excluded spinal cord tumors. Study quality was evaluated with QUADAS-2. Diagnostic metrics, sensitivity, specificity, and area under the curve, were calculated using a bivariate model. Comparisons between IONM methods utilized Z-tests and Bayesian meta-analysis. Heterogeneity assessments were also performed to ensure robustness.</div></div><div><h3>Results</h3><div>Across 19 studies with 3,261 cases, postoperative new neurological deficits occurred in 9.3 % of cases. Multimodal IONM outperformed other methods in detecting these deficits, achieving 82.0 % sensitivity (95 % CI: 66.7–91.2) and 94.7 % specificity (95 % CI: 88.4–97.6), compared to somatosensory evoked potentials (65.5 %, 93.0 %) and transcranial motor evoked potentials (79.7 %, 92.1 %). Its area under the curve reached 94.5 %, highlighting excellent accuracy. Notably, recovered IONM alerts correlated with a less rate of postoperative deficits (10.7–13.8 %).</div></div><div><h3>Conclusion</h3><div>Multimodal IONM, combining SSEP and TcMEP, surpasses single modalities in detecting and preventing neurological damage in thoracic spine surgeries. Immediate intervention after alerts, evidenced by low deficit rates with recovered alerts, makes it the optimal strategy. Adopting these insights into clinical protocols enhances patient safety and outcomes in this high-risk surgical context.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111567"},"PeriodicalIF":1.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144861216","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 vascular safe zone for endoscopic third ventriculostomy: a radiomorphometric study","authors":"Nicolás Rincón-Arias ,&nbsp;Nadin J. Abdala-Vargas ,&nbsp;Sabino Luzzi ,&nbsp;Julián D. Barraza ,&nbsp;Luisa Fernanda Jaimes ,&nbsp;Pablo Baquero ,&nbsp;Matias Baldoncini ,&nbsp;Álvaro Campero ,&nbsp;Daniela Martínez Laverde ,&nbsp;Edgar G. Ordoñez-Rubiano ,&nbsp;Hernando A. Cifuentes-Lobelo","doi":"10.1016/j.jocn.2025.111562","DOIUrl":"10.1016/j.jocn.2025.111562","url":null,"abstract":"<div><h3>Background and objective</h3><div>Endoscopic third ventriculostomy (ETV) is a minimally invasive procedure for hydrocephalus management. Variable neuroanatomical features in the floor of the third ventricle (3VF) and the basilar artery (BA) complex contribute to the risk of vascular lesions in the BA complex. This study aims to evaluate the neuroradiological characteristics of the 3VF with the BA complex to determine the ETV fenestration “vascular safe zone”.</div></div><div><h3>Methods</h3><div>Preoperative neuroimaging studies from a consecutive cohort of adult patients who underwent ETV between January 2016 and March 2025 were retrospectively reviewed. Preoperative MRIs were used to evaluate the neuroradiological axial and sagittal characteristics of the 3VF with the BA complex.</div></div><div><h3>Results</h3><div>The neuroradiological BA complex position was described. In the sagittal plane, Type II (74 %) was the most common, with mean distances ranging from 4.1 mm to 8 mm. The mean distance from the top of the BA complex to the 3VF was 6.86 mm (SD 1.56 mm). In the axial plane, Classes C and D (71.2 %) were predominant and had varied distances to the 3VF.</div></div><div><h3>Conclusions</h3><div>Our results suggest that the “vascular safe zone” for an ETV fenestration is primarily located in the anterior half of the 3VF. 71.2 % of our cases showed that the basilar artery (BA) complex was located in the posterior half. Future research should validate the “vascular safe zone” for ETV fenestration with neuroendoscopy intraoperative observations and assess clinical outcomes, including post-operative complications and success rates, to ensure the effectiveness of the proposed fenestration area.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111562"},"PeriodicalIF":1.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863252","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":"Lumbar interlaminar uniportal endoscopic discectomy: techniques and case presentation.","authors":"George Bourdages, Ali Hazama","doi":"10.1016/j.jocn.2025.111546","DOIUrl":"10.1016/j.jocn.2025.111546","url":null,"abstract":"<p><p>In this video we overview the techniques and methods of performing a lumbar interlaminar uniportal endoscopic discectomy utilizing a case presentation. A 26-year-old male presented with one year of low back pain radiating down his right lower extremity with associated numbness. Magnetic resonance imaging revealed a paramedian disc herniation at L5-S1 eccentric to the right side. An endoscopic discectomy was performed via an interlaminar approach. Intraoperative fluoroscopy was used to localize an incision. High quality video showed how to expose the ligamentum flavum and safely create a defect in the ligament for the working cannula, highlighting methods to prevent complications. Once the epidural space was entered, we detailed how to remove the epidural adipose tissue and separate the adhesions from the disc and adjacent thecal sac and nerve root. Detethering the tissue was a crucial step in alleviating patient symptoms. Once the disc was identified, an annulotomy was created. We reviewed how to protect the thecal sac during discectomy. We highlighted how the interlaminar approach can provide an excellent view medially permitting complete decompression of the thecal sac under direct visualization. The patient had improvement in his symptoms without recurrence at follow-up.</p>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"111546"},"PeriodicalIF":1.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882991","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":"Association of ophthalmic origin aneurysms with abnormally-enhanced hemodynamic stresses at the arterial wall","authors":"Li-Feng Xu,&nbsp;Ji-Wei Wang,&nbsp;Hui Li,&nbsp;Hao Guo,&nbsp;Jian-Feng Liu,&nbsp;Cong-Hui Li,&nbsp;Bu-Lang Gao","doi":"10.1016/j.jocn.2025.111564","DOIUrl":"10.1016/j.jocn.2025.111564","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate hemodynamic parameters associated with ophthalmic aneurysms using computational fluid dynamic (CFD) analysis.</div></div><div><h3>Materials and methods</h3><div>Sixty patients with or without ophthalmic origin aneurysms were enrolled, including 30 patients with and 30 patients without ophthalmic aneurysms. The demography, vascular diameter and angles, and hemodynamic parameters were analyzed.</div></div><div><h3>Results</h3><div>The bifurcation angle between the ophthalmic artery and internal carotid artery (ICA) distal segment was significantly (P &lt; 0.0001) greater in patients with than those without ophthalmic aneurysm (140.7 ± 16.3 vs. 120.8 ± 16.1). The hemodynamic parameters were all significantly decreased on aneurysm dome compared with those at the direct flow impingement zone (FIZ) after virtual aneurysm removal, including the dynamic pressure (0.36 ± 0.49 vs. 0.58 ± 0.40 Pa), total pressure (29.88 ± 3.37 vs. 32.94 ± 1.64 Pa), velocity angle (1.02 ± 1.62 vs. 1.66 ± 0.27 degree/s), vorticity (606.72 ± 254.12 vs. 853.84 ± 261.78 1/s), WSS (0.78 ± 0.30 vs. 1.11 ± 0.30 Pa), and strain rate (613.93 ± 233.21 vs. 870.78 ± 231.21 1/s). The total pressure profile was like a parabola, and the profiles of WSS and dynamic pressure were characteristic of one minimal value and two peaks. The greatest total pressure and minimal shear stress and dynamic pressure were at the FIZ center, and as blood flowed distally, the total pressure decreased rapidly while the other parameters quickly increased to peaks. The WSS peak distance was significantly (P &lt; 0.05) positively correlated with the bifurcation angle (ophthalmic/distal ICA angle) in patients with (R = 0.59 and P = 0.004) or without (R = 0.55 and P = 0.009) ophthalmic aneurysms. The WSS peak distance was significantly (P &lt; 0.05) positively correlated with the summit total pressure in patients with ophthalmic aneurysms (R = 0.49 and P = 0.02) rather than in patients without aneurysms or in the total patients. Transverse line 4 was located in the FIZ center, lines 1–3 on the distal ICA wall, lines 5–7 on the ophthalmic artery wall, and from transverse line 4 to line 1 or to line 7, the total pressure significantly (P &lt; 0.0001) decreased while all the other hemodynamic parameters significantly (P &lt; 0.0001) increased. Transverse line 5 on oe peak had significantly (P &lt; 0.01) greater dynamic pressure, velocity angle, WSS, vorticity and strain rate than those on transverse line 3 on the other peak.</div></div><div><h3>Conclusion</h3><div>Enlarged bifurcation angle between the ophthalmic artery and distal ICA segment significantly increases the hemodynamic parameters at the bifurcation apex and may contribute to the formation of ophthalmic aneurysms, which is to decrease the abnormally elevated hemodynamic parameters at the bifurcation apex.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111564"},"PeriodicalIF":1.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863254","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":"Prognosis-anchored outcome evaluation (PAOE) for detecting functional benefit in aSAH: A multicenter analysis of clazosentan use","authors":"Atsushi Sato ,&nbsp;Naomichi Wada ,&nbsp;Takehiro Yako ,&nbsp;Akihiro Nishikawa ,&nbsp;Takahiro Murata ,&nbsp;Tatsuya Seguchi ,&nbsp;Yuki Inomata ,&nbsp;Yasunaga Yamamoto ,&nbsp;Toshihiro Ogiwara ,&nbsp;Yoshiki Hanaoka ,&nbsp;Mana Wakabayashi ,&nbsp;Kazuhiro Hongo ,&nbsp;Tetsuyoshi Horiuchi","doi":"10.1016/j.jocn.2025.111552","DOIUrl":"10.1016/j.jocn.2025.111552","url":null,"abstract":"<div><h3>Background</h3><div>Although clazosentan has shown vasospasm-reducing effects in aneurysmal subarachnoid hemorrhage (aSAH), its impact on long-term functional outcomes remains controversial. Conventional randomized trials have reported limited benefits. This study applies Prognosis-Anchored Outcome Evaluation (PAOE), a model-based framework comparing observed outcomes to individualized prognostic expectations, to assess potential functional benefit in real-world practice.</div></div><div><h3>Methods</h3><div>We prospectively analyzed 331 aSAH patients across eight institutions. Predicted 3-month modified Rankin Scale (pmRS) scores were calculated using a validated prognostic model (S-Score). Observed outcomes (final mRS) were compared with pmRS to quantify individual-level benefit. Patients were grouped by clazosentan use. Subgroup analyses were performed by pmRS strata and surgical treatment status.</div></div><div><h3>Results</h3><div>The average pmRS did not differ significantly between groups. However, clazosentan-treated patients showed a greater frequency of favorable outcomes (final mRS ≤ 2) than predicted, particularly in the intermediate prognostic range (pmRS 3–5). A subanalysis limited to patients receiving definitive aneurysm treatment demonstrated significantly improved outcomes in the clazosentan group within pmRS 3–4 and 4–5 strata (p &lt; 0.05 and p &lt; 0.05, respectively). These findings suggest a targeted treatment-responsive zone.</div></div><div><h3>Conclusions</h3><div>PAOE provides a complementary approach to traditional cohort or RCT analyses by accounting for individual prognostic expectations. Our findings support the hypothesis that clazosentan may offer functional benefit in selected aSAH patients with moderate predicted disability. This approach may help identify patients who are most likely to benefit from vasospasm-targeted interventions in clinical practice.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111552"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852204","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":"Uniportal endoscopic facet joint cyst removal at L5-S1","authors":"Ralph J. Mobbs ,&nbsp;Alison Ma ,&nbsp;Chris Huang","doi":"10.1016/j.jocn.2025.111551","DOIUrl":"10.1016/j.jocn.2025.111551","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"140 ","pages":"Article 111551"},"PeriodicalIF":1.8,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841177","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}