Journal of Clinical Neuroscience最新文献

{"title":"Identification of potential biomarkers and drug targets for meningioma by Mendelian randomisation analysis","authors":"Shiqing Du ,&nbsp;Lina Deng ,&nbsp;Keman Liao ,&nbsp;Pengpeng Li ,&nbsp;Xiaojie Lu","doi":"10.1016/j.jocn.2025.111348","DOIUrl":"10.1016/j.jocn.2025.111348","url":null,"abstract":"<div><div>Background: Meningiomas exhibit high levels of heterogeneity in terms of grade, treatment, and molecular background, and there are no effective therapeutic drug treatment options. Consequently, there is an urgent need to identify new biomarkers and therapeutic targets to improve the molecular typing and prognosis of patients. Methods: This study used summary-data-based Mendelian randomisation and Bayesian co-localisation analysis based on pooled data to investigate the causal relationship between quantitative trait loci for gene expression levels in the blood and brain, and meningioma. The use of a replication cohort ensured the robustness of the results. The identified genes were further analysed using single-cell expression analysis to detect specific cell types with enriched expression and to identify potential biomarkers and targets. Results: In the primary dataset, 12 genes were identified that were significantly associated with meningioma risk. HEterogeneity In Dependent Instruments testing, co-localisation analysis, and replicating cohorts were used to ensure the robustness of the results. The expression of tetratricopeptide repeat domain 28 (TTC28) (OR = 2.03; 95 % CI = 1.60–2.57) and HscB mitochondrial iron-sulfur cluster cochaperone(HscB) (OR = 1.12; 95 % CI = 1.06–1.17) showed a significant causal relationship with meningioma risk. These genes are primarily expressed in the fibroblasts and macrophages of meningioma tissues and are considered potential therapeutic targets and biomarkers. Conclusions: This study identified several genes significantly associated with meningioma risk and provides new insights that will aid in the development of biomarkers and therapeutics for meningioma.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111348"},"PeriodicalIF":1.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Evaluation of analgesic efficacy of ketamine and magnesium sulfate as adjuvants to bupivacaine for scalp block in supratentorial Craniotomy: A Randomized, Double-Blind clinical study","authors":"Sakshi Kadian ,&nbsp;Priyanka Gupta ,&nbsp;Sanjay Agrawal","doi":"10.1016/j.jocn.2025.111347","DOIUrl":"10.1016/j.jocn.2025.111347","url":null,"abstract":"<div><h3>Background</h3><div>Effective pain management during craniotomy is crucial for optimizing hemodynamics, recovery, and patient satisfaction. This study evaluated the efficacy of ketamine and magnesium sulfate as adjuvants to bupivacaine in preemptive scalp blocks, focusing on hemodynamics, postoperative pain, and analgesic consumption.</div></div><div><h3>Methods</h3><div>This study included 102 patients undergoing supratentorial craniotomy, randomized into three groups (n = 34 in each): Group K (ketamine), Group M (magnesium sulfate), and Group C (saline). Each group received a preemptive scalp block with bupivacaine with the respective adjuvants. Hemodynamics, postoperative pain (Critical-Care Pain Observation Tool, CPOT), and analgesic consumption were measured at various time points.</div></div><div><h3>Results</h3><div>Ninety-seven patients were analyzed. Scalp block reduced the hemodynamic response to pin insertion in all groups. Intra-operative fentanyl consumption was significantly lower in the ketamine (191.82 ± 53.18 µg) compared to the saline (304.06 ± 48.73 µg) and magnesium groups (275.31 ± 59.04 µg, p &lt; 0.001). The time (hours) to the first post-operative analgesic demand was longer in the ketamine (12.97 ± 4.13) compared to the saline (3.03 ± 1.47) and magnesium groups (4.19 ± 1.45, p &lt; 0.001). Ketamine resulted in the lowest CPOT scores at 4 h (0.30 ± 0.53) post-operatively compared to magnesium (1.12 ± 0.66) and saline (1.66 ± 0.55, p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Scalp block, with or without adjuvants, is effective in managing pin response. This study highlights ketamine as a valuable adjuvant to bupivacaine, significantly reducing analgesic consumption and prolonging pain relief. Magnesium provides moderate benefits. These findings support the preemptive use of ketamine in scalp block to enhance analgesia and maintain hemodynamic stability during craniotomy. However, further studies are needed to correlate the serum levels of ketamine to identify whether the effect is as adjuvant to local anesthetic or due to its systemic absorption.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111347"},"PeriodicalIF":1.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138740","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":"Mind the Gap: Social media analysis of 38,609 posts highlights discrepancies between clinical focus and patient priorities in neurosurgical care","authors":"Daniel Schneider,&nbsp;Ethan D.L. Brown,&nbsp;Max Ward,&nbsp;Timothy G. White,&nbsp;Daniel G. Eichberg,&nbsp;Daniel M. Sciubba,&nbsp;Sheng-Fu Larry Lo,&nbsp;Jung Park","doi":"10.1016/j.jocn.2025.111334","DOIUrl":"10.1016/j.jocn.2025.111334","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze social media discussions among cranial neurosurgical patients to identify prevalent concerns, emotional patterns, and quality of life impacts that may not be fully captured in traditional clinical assessments.</div></div><div><h3>Methods</h3><div>We analyzed 38,609 neurosurgery-related posts from Reddit using natural language processing and the Valence Aware Dictionary and sEntiment Reasoner (VADER) sentiment analysis tool. Posts were categorized into clinical domains (symptoms, conditions, procedures, treatments, complications, quality of life, and clinical course), with sentiment scores calculated for each category. Co-occurrence analysis identified significant term associations. Statistical comparisons used Mann-Whitney U tests with Benjamini-Hochberg correction.</div></div><div><h3>Results</h3><div>Patient discussions predominantly focused on symptoms (63.56 % of posts) and quality of life impacts (45.93 %), with work/education concerns (25.99 %) and headache-related complaints (32.10 %) being most prevalent. Cognitive symptoms appeared in 19.78 % of posts, while epilepsy-related terms dominated condition discussions (23.04 %). Sentiment analysis revealed a significant contrast between symptom discussions (mean sentiment: −0.007) and treatment discussions (0.056, effect size d = 0.27, p &lt; 0.001), with medication/therapy discussions showing the most positive sentiment across all categories. Surgical procedure discussions, while infrequent (7.41 %), maintained positive sentiment (0.031), suggesting patients may find reassurance in definitive interventions. Quality of life concerns showed substantial prevalence but received limited attention in clinical literature, with transportation/independence issues (10.09 %) and financial/insurance concerns (6.91 %) showing significant associations with treatment and procedure discussions, respectively. Anxiety terms demonstrated the strongest association with clinical course discussions (φ = 0.093), while condition-specific terminology showed robust co-occurrence patterns (e.g., “Chiari-malformation,” φ = 0.69).</div></div><div><h3>Conclusions</h3><div>This analysis reveals important disparities between traditional clinical priorities and patient-reported concerns in neurosurgical care. The negative sentiment surrounding symptom discussions contrasted with treatment optimism suggests opportunities for improved symptom management approaches. The high prevalence of work, education, and independence concerns highlights the need for comprehensive support services addressing functional outcomes. Implementation of enhanced symptom management strategies, psychological support services, and structured rehabilitation programs may help bridge the gap between clinical care and patient priorities in neurosurgical practice.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111334"},"PeriodicalIF":1.9,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138739","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":"Skeletal muscle quantity predicts short-term outcomes after endovascular thrombectomy for acute stroke due to large-vessel occlusion of the anterior circulation","authors":"Keisuke Honma ,&nbsp;Tomoyuki Ogino ,&nbsp;Masahiro Nagase ,&nbsp;Naoki Sasanuma ,&nbsp;Yuki Uchiyama ,&nbsp;Kazuhisa Domen","doi":"10.1016/j.jocn.2025.111345","DOIUrl":"10.1016/j.jocn.2025.111345","url":null,"abstract":"<div><h3>Objective</h3><div>Endovascular thrombectomy (EVT) is an essential treatment for large vessel occlusion (LVO) stroke, with expanding indications, including elderly patients and those with extensive ischemic regions. Skeletal muscle mass, a component of frailty, is gaining attention as a potential predictor of EVT outcomes. This study explored the relationship between skeletal muscle mass, assessed by bioelectrical impedance analysis (BIA), and short-term functional prognosis in EVT-treated LVO of anterior-circulation stroke.</div></div><div><h3>Methods</h3><div>This cohort study included 151 patients who underwent EVT for anterior-circulation LVO between July 2020 and January 2025. Skeletal muscle mass index (SMI) was measured using BIA within 72 h of admission. Functional outcomes were evaluated using the Functional Independence Measure (FIM) at discharge. Multiple regression analysis was performed to identify predictors of FIM, adjusting for age, NIHSS, ASPECTS, mTICI, pre-mRS, and other clinical variables.</div></div><div><h3>Results</h3><div>In multiple regression models, low SMI was independently associated with lower FIM scores at discharge (β =  − 10.255, P = 0.013), alongside age (β =  − 0.925, P &lt; 0.001), NIHSS on admission (β =  −1.506, P &lt; 0.001), mTICI (β = 7.168, P = 0.027), symptomatic intracranial hemorrhage (β =  − 2.982, P = 0.010), and pre-mRS (β =  − 5.424, P = 0.030). Logistic regression revealed that older age (odds ratio [OR], 1.088; 95 % confidence interval [95 % CI], 1.040–1.139), higher NIHSS (OR, 1.065; 95 % CI, 1.002–1.132), and lower GNRI (OR, 0.925; 95 % CI, 0.886–0.965) were significantly associated with low skeletal muscle mass during admission.</div></div><div><h3>Conclusion</h3><div>This study highlights the role of skeletal muscle mass as an independent predictor of short-term prognosis after EVT. BIA-based assessments offer a novel approach to evaluating treatment responsiveness. Enhancing skeletal muscle mass may represent a modifiable factor to improve EVT outcomes, emphasizing the need for further research to validate these findings and explore long-term effects.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111345"},"PeriodicalIF":1.9,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130871","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":"Right occipital to Right distal PICA bypass and trapping of ruptured Right PICA dissecting aneurysm after initial coil embolization","authors":"Sameer S. Tebha ,&nbsp;Rahim Abo Kasem,&nbsp;Samaher Fageiry,&nbsp;Brent G. Oxford,&nbsp;Kim Meyer,&nbsp;Akshitkumar Mistry ,&nbsp;Dale Ding ,&nbsp;Isaac Josh Abecassis","doi":"10.1016/j.jocn.2025.111342","DOIUrl":"10.1016/j.jocn.2025.111342","url":null,"abstract":"<div><div>Posterior inferior cerebellar artery (PICA) aneurysms are rare, constituting less than 5 % of intracranial aneurysms, and are associated with a high rupture risk [<span><span>1</span></span>]. Management is challenging due to proximity to brainstem structures, the need for vessel reconstruction or excision, and the risk of ischemia in PICA territory [<span><span>2</span></span>,<span><span>3</span></span>]. We present a case of subarachnoid hemorrhage caused by a ruptured, dissecting ∼1 cm proximal PICA aneurysm. The aneurysm had a calcified neck, and the contralateral PICA was small and not adjacent to the ipsilateral PICA. Treatment was staged: first, partial endovascular coil embolization to prevent re-rupture during ICU care [<span><span>4</span></span>,<span><span>5</span></span>], followed by an occipital-to-PICA artery (p3) bypass via a far lateral approach. The bypass enabled successful aneurysm trapping and resection. This case demonstrates the importance of staged endovascular and surgical interventions in managing large, complex aneurysms and highlights technical aspects of posterior circulation bypass.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111342"},"PeriodicalIF":1.9,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130841","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":"Surgical resection of cerebellum cavernous malformation via suboccipital trans-horizontal fissure approach: Two-dimensional video","authors":"Jianyu Zhu ,&nbsp;Xingfen Su ,&nbsp;Zixiao Yang ,&nbsp;Jianping Song","doi":"10.1016/j.jocn.2025.111339","DOIUrl":"10.1016/j.jocn.2025.111339","url":null,"abstract":"<div><div>Deep cerebellar cavernous malformations (CMs) pose considerable surgical challenges due to the difficulties in precise localization and achieving minimal invasive exposure during resection [<span><span>1</span></span>]. The horizontal fissure (HF), the largest cerebellar fissure, offers a natural cleavage plane to access deep cerebellar structures. This report details a successful deep medial cerebellar CM resection via a suboccipital Trans-HF approach. A 54-year-old male presented with dysarthria and gait instability, with a positive Romberg sign. Preoperative imaging revealed multiple suspected cerebellar CMs, with the largest hemorrhagic lesion situated deeply within the right cerebellum, adjacent to the dentate nucleus, surrounded by prominent developmental venous anomalies (DVAs). After discussion with the patient, microsurgical resection of the largest hemorrhagic CM was elected, informed consent was obtained and the procedure was approved by the ethics committee. Utilizing a prone, Concorde position, and a suboccipital midline craniotomy, the wide right suboccipital HF was identified and allowed for sharp and blunt dissection to enhance exposure [<span><span>2</span></span>,<span><span>3</span></span>]. Neuronavigation was employed, and the exposed DVAs served as anatomical landmarks to guide surgical trajectory toward the hidden lesion, minimizing parenchymal disruption [<span><span>4</span></span>]. Following the CM exposure, the hematoma inside was evacuated for decompression, and the CM was meticulously resected along its gliotic boundary, ensuring the preservation of adjacent DVAs, until complete removal was achieved. Pathological analysis confirmed the diagnosis of CM. Postoperative imaging demonstrated gross-total resection of the target CM with preserved DVAs. The patient exhibited significant symptomatic improvement. This case highlights the nuance of the suboccipital <em>trans</em>-HF approach for resecting deep medial cerebellar lesions.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111339"},"PeriodicalIF":1.9,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144123424","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":"Epidemiology of adult brain tumors in the Philippine General Hospital from 2018 to 2022: Initial steps to a national brain tumor registry in a lower-middle income country","authors":"Juan Silvestre G. Pascual ,&nbsp;Almira A. Dayrit ,&nbsp;Mary Angeline Luz U. Hernandez ,&nbsp;Almira Doreen Abigail O. Apor ,&nbsp;John Carlo B. Reyes ,&nbsp;Edwin L. Munoz ,&nbsp;Kathleen Joy O. Khu","doi":"10.1016/j.jocn.2025.111305","DOIUrl":"10.1016/j.jocn.2025.111305","url":null,"abstract":"<div><div>In the Philippines, there is a lack of epidemiological data on brain tumors due to the absence of a national registry. To bridge this gap, our team has set out to review histopathologically-confirmed brain tumor cases from 2018 to 2022 at the largest neurosurgical center in the country. 766 brain tumor cases were identified: 115 in 2018, 173 in 2019, 143 in 2020, 148 in 2021, and 187 in 2022. The crude incidences per year were 0.39, 0.58, 0.48, 0.50 and 0.66 per 100,000 from 2018 to 2022, respectively. The 5-year crude incidence rate was 2.58 per 100,000 persons. The five-year prevalence was 115.00, 266.00, 367.48, 456.39, and 566.30. Among patients, the mean age was 49 years old, with a male:female ratio of 2:3. Most cases were among the 51–60 age group (23.6 %). The most common types were meningioma (46 %) and gliomas, glioneuronal tumors, and neuronal tumors (23 %). Metastasis to the brain accounted for 6.5 % of all brain tumors. In our study, prevalence estimates were lower than globally-reported ones, likely due to its single-center nature. Tumor types approximated international reports, except for brain metastasis frequency. This initial work is a stepping stone for a future national brain tumor registry for the Philippines.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111305"},"PeriodicalIF":1.9,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144123422","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 surgery for vestibular schwannomas after failed stereotactic radiosurgery or radiation: A systematic review and meta-analysis”","authors":"Filipe Virgilio Ribeiro ,&nbsp;Marcelo Porto Sousa ,&nbsp;Marcio Yuri Ferreira ,&nbsp;Filipi Fim Andreão ,&nbsp;Lucca B. Palavani ,&nbsp;Luis F. Fabrini Paleare ,&nbsp;Gabriel Simoni ,&nbsp;Eduardo Corrêa ,&nbsp;Christian Ken Fukunaga ,&nbsp;Lucas Pari Mitre ,&nbsp;Rafaela Hamada Jucá ,&nbsp;Rudolfh Batista Arend ,&nbsp;Bruno Zilli Peroni ,&nbsp;Alex Roman ,&nbsp;Raphael Bertani ,&nbsp;Herika Negri Brito ,&nbsp;Allan Dias Polverini","doi":"10.1016/j.jocn.2025.111330","DOIUrl":"10.1016/j.jocn.2025.111330","url":null,"abstract":"<div><h3>Introduction</h3><div>Stereotactic radiosurgery effectively controls vestibular schwannoma (VS). However, in certain cases, microsurgical resection may be necessary for tumor progression after radiosurgery or, after failure of the latter. The results on the safety and efficacy of salvage surgery for VS are still unclear, with scarce literature on the subject.</div></div><div><h3>Objective</h3><div>The present study aimed to evaluate the safety and efficacy of salvage surgery on the resection of vestibular schwannomas that have been previously treated with stereotactic radiosurgery or radiotherapy.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, we searched Medline, Embase, and Web of Science databases. We used single proportion analysis with 95 % confidence intervals under a random-effects model, I² to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Eligible studies included those with ≥ 4 patients treated with salvage surgery to resection of vestibular schwannomas after failure of stereotactic radiosurgery or radiotherapy.</div></div><div><h3>Results</h3><div>Of the 1841 initially identified studies, 18 were selected, involving 455 patients, with a median follow-up of 33 months. The combined analysis showed a 69 % (CI: 58 % − 79 %) rate of good clinical outcomes. Regarding partial resection, the pooled analysis confirmed a 48 % rate (CI: 33 % to 63 %) and a 52 % complete resection rate (CI: 37 % to 67 %). The pooled analysis confirmed a 95 % hearing preservation rate in patients undergoing the retrosigmoid approach (CI: 90 % to 100 %) and a 78 % facial nerve preservation rate (CI: 72 % to 84 %). Regarding complications, the pooled analysis confirmed a 20 % complication rate (CI: 14 % to 28 %). There were no deaths related to the procedure.</div></div><div><h3>Conclusion</h3><div>Based on the results, our <em>meta</em>-analysis identified that rescue surgery has been shown to be safe and effective for resection of vestibular schwannomas after failure of stereotactic radiosurgery or radiotherapy, based on good facial nerve preservation rate and total lesion resection rate.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111330"},"PeriodicalIF":1.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115316","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":"Management of cerebrospinal fluid leaks from lateral sphenoid sinus wall: Tailored approach based on proposed zone-wise classification","authors":"Keyur Shah,&nbsp;Subhas Konar,&nbsp;Dhaval Shukla,&nbsp;Nishanth Sadashiva,&nbsp;Dwarakanath Srinivas,&nbsp;Arivazhagan Arimappamagan,&nbsp;A.R. Prabhuraj","doi":"10.1016/j.jocn.2025.111331","DOIUrl":"10.1016/j.jocn.2025.111331","url":null,"abstract":"<div><h3>Objective</h3><div>Management of cerebrospinal fluid (CSF) leaks of the lateral sphenoid sinus wall (LSW) can be challenging to accomplish via an endoscopic transsphenoidal approach. While transcranial repair is a less chosen approach in the era of the endoscopic transpterygoid approach, its role is still relevant. We review our experience with LSW CSF leak repair via both techniques to decide the success of these techniques based on preoperative radiological images.</div></div><div><h3>Methods</h3><div>Electronic medical records of patients with LSW CSF leaks operated at a tertiary referral centre were retrospectively reviewed. Preoperative computed tomography (CT), CT cisternography and MRI CISS (Magnetic resonance imaging with Construction interference in steady state) were reviewed. Based on preop Coronal CT (27) / CT-cisternography (7), each defect was categorised in Zone 1, 2 or 3 based on its relation to the VR line (an imaginary line connecting vidian canal and foramen rotundum). Outcomes were measured in terms of successful repair of CSF leak and complications.</div></div><div><h3>Results</h3><div>Twenty-seven patients with 34 LSW CSF leaks were identified. CSF leak was spontaneous in 23 cases, and four patients had CSF leak following trauma. Based on the zone-wise classification, there were ten, seven and seventeen defects in zones 1,2 and 3, respectively. The transcranial subtemporal (TC) approach was used for 13 defects, and the endoscopic transsphenoidal (ETS) approach was used for 21 defects. Successful repair of CSF leak was achieved in 85% (23/27 cases). Success rates for the TC vs ETS approach for zone 1,2, and 3 defects were NA*<span><span>¹</span></span> vs 100 %, 0% vs 100% and 100% vs 50 %, respectively. One patient had persistent CSF rhinorrhoea, and three patients had recurrent CSF rhinorrhoea. Three patients required re-exploration or another approach for successful repair, while one was managed conservatively. Complications were noted in 3 patients (11%), namely temporal lobe contusion with seizures, surgical site infection and cheek sensory loss. All complications were seen in the TC approach.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that the endoscopic transsphenoidal approach is more successful for zone 1 and zone 2 defects, while the transcranial subtemporal approach is more successful in zone 3 defects. Complications, though rare, were seen only with the transcranial approach. Hence, zone-wise classification helps in a clear understanding of the surgical approach for LSW CSF leaks.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111331"},"PeriodicalIF":1.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099428","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":"How I do laparoscopic insertion of the peritoneal catheter in a ventriculoperitoneal shunt","authors":"A. Sincari ,&nbsp;M. Jiwrajka ,&nbsp;R.L. Jeffree","doi":"10.1016/j.jocn.2025.111329","DOIUrl":"10.1016/j.jocn.2025.111329","url":null,"abstract":"<div><div>Insertion of a ventriculoperitoneal (VP) shunt requires surgical access to the peritoneal cavity to internalise the distal catheter. Classically this involved a 3 to 5 cm incision in the right upper quadrant, but the late 1990 s saw the introduction of laparoscopic techniques for distal catheter insertion and these have a number of advantages. We provide step by step descriptions of a straightforward technique to obtain pneumoperitoneum by a periumbilical approach. Once pneumoperitoneum is obtained, there are several simple methods for insertion of the distal catheter into the right upper quadrant (or elsewhere) under direct laparoscopic vision. This easy reference guide to the steps in the procedure will enable neurosurgeons to quickly learn the technique, or will inform general surgeons of what is required in combined operations.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111329"},"PeriodicalIF":1.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107944","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}