Journal of Clinical Neuroscience最新文献

{"title":"Critical appraisal of: “expression of SARS-CoV-2 spike protein in cerebral arteries: implications for hemorrhagic stroke post-mRNA vaccination”","authors":"Ahmed Mueed ,&nbsp;Abia Shariq ,&nbsp;Manaal Ashar","doi":"10.1016/j.jocn.2025.111270","DOIUrl":"10.1016/j.jocn.2025.111270","url":null,"abstract":"<div><div>This correspondence offers a critical appraisal of the study by Ota et al. on the expression of SARS-CoV-2 spike protein in cerebral arteries following mRNA vaccination. While the original study contributes to understanding potential neurological sequelae post-vaccination, we identify several methodological limitations. Chief concerns include the absence of a control group, reliance on negative nucleocapsid staining to exclude prior infection, a small and unbalanced sample size, lack of lesionspecific tissue analysis, and unconfirmed RNA detection techniques. These issues collectively undermine causal inferences regarding vaccine-related spike protein persistence. We recommend methodological refinements for future studies, including matched controls, serial serological testing, tissue validation protocols, and robust subgroup stratification.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111270"},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855435","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":"Acromegaly with kissing carotids − Is gamma knife radiosurgery the answer?","authors":"Prachi Singh ,&nbsp;Sandeep Mishra ,&nbsp;Kanwaljeet Garg,&nbsp;Shashank Sharad Kale","doi":"10.1016/j.jocn.2025.111240","DOIUrl":"10.1016/j.jocn.2025.111240","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111240"},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855434","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 role of carotid artery stenosis severity in cognitive impairment and quality of Life: Insights from Jordan","authors":"Denny Indrawanto ,&nbsp;Dwi Kartikawati ,&nbsp;Muhammad Sukron Fauzi ,&nbsp;Ade Wahyuni Azhar ,&nbsp;Sri Wahyuni ,&nbsp;Sri Umiyati ,&nbsp;Prasiwi Citra Resmi ,&nbsp;Sri Yulianto Fajar Pradapa ,&nbsp;Erfan Ramadhani","doi":"10.1016/j.jocn.2025.111254","DOIUrl":"10.1016/j.jocn.2025.111254","url":null,"abstract":"<div><div>This study investigates the impact of carotid artery stenosis (CAS) severity on cognitive function and quality of life (QoL) in 140 patients in Jordan. Using the Mini-Mental State Examination (MMSE) and the WHO Quality of Life-Brief (WHOQOL-BREF), the study explores how CAS severity correlates with cognitive decline and QoL. Results show that higher CAS severity is associated with poorer cognitive scores and lower QoL, with mild CAS patients showing significantly better outcomes than those with moderate or severe stenosis. Sociodemographic factors, including lower educational attainment and lack of health insurance, were found to exacerbate the cognitive impairment and reduced QoL. The findings highlight the importance of early detection and management of CAS, particularly in low- and middle-income countries, where socioeconomic factors strongly influence health outcomes. The study underscores the need for integrated healthcare policies to address these disparities and improve patient wellbeing.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111254"},"PeriodicalIF":1.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852086","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":"Ibn Sina’s contributions to epilepsy management: Innovations from the Islamic Golden Age","authors":"Yasser F. Almealawy ,&nbsp;Hael F. Abdulrazeq ,&nbsp;Biam Saydo ,&nbsp;Rohaid Ali ,&nbsp;Athar N. Malik","doi":"10.1016/j.jocn.2025.111256","DOIUrl":"10.1016/j.jocn.2025.111256","url":null,"abstract":"<div><div>The historical understanding of epilepsy has evolved from supernatural beliefs in ancient Mesopotamia to scientific interpretations in the Islamic Golden Age. While early civilizations viewed epilepsy as a divine affliction, Greek and Roman physicians, notably Hippocrates, proposed a cerebral origin. However, significant advancements emerged during the Islamic Golden Age (7th–15th centuries), particularly through the works of Al-Razi and Ibn Sina (980–1037 CE).</div><div>Ibn Sina, or Avicenna, synthesized Greek, Roman, and Islamic medical knowledge in The Canon of Medicine, offering a systematic classification of epilepsy. He distinguished between idiopathic and symptomatic epilepsy, attributing its causes to cerebral dysfunction and humoral imbalances. His detailed descriptions of seizures and their clinical presentations demonstrated remarkable clinical insight. Ibn Sina also introduced innovative diagnostic techniques and treatments, including bloodletting, dietary adjustments, herbal remedies, and physical therapies. He recommended medicinal plants such as Lavandula stoechas and Pimpinella anisum, reflecting an advanced pharmacological approach.</div><div>This paper explores Ibn Sina’s contributions to epileptology, highlighting how The Canon of Medicine structured a more refined understanding of epilepsy. His emphasis on empirical observation, rational classification, and comprehensive treatment influenced medical traditions in both the Islamic world and medieval Europe. By integrating and expanding upon prior theories, Ibn Sina laid the groundwork for future advancements in neurology. His pioneering work represents a crucial step in the evolution of epilepsy research, bridging ancient concepts with emerging medical sciences.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111256"},"PeriodicalIF":1.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855432","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":"Initial seizure episodes risk factors identification during hospitalization of ICU patients: A retrospective analysis of the eICU collaborative research database","authors":"Nan Cheng ,&nbsp;Zian Yi ,&nbsp;Jiayue Wang ,&nbsp;Zhenliang Hui ,&nbsp;Jun Chen ,&nbsp;An Gao","doi":"10.1016/j.jocn.2025.111266","DOIUrl":"10.1016/j.jocn.2025.111266","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to identify risk factors for initial seizure episodes in ICU patients using various machine learning algorithms.</div></div><div><h3>Methods</h3><div>Using the extensive eICU database, we curated a dataset of 200,859 patient records, with 15,890 patients meeting inclusion and exclusion criteria. Among them, 497 experienced initial seizure episodes during hospitalization. We developed models to identify risk factors associated with these episodes using Logistic Regression, Random Forest, Gradient Boosting, Support Vector Machine (SVM), K-Nearest Neighbors (KNN), and Decision Tree. After developing and evaluating these individual models, we selected the two best-performing models and combined them using a stacking ensemble learning technique. Additionally, Recursive Feature Elimination (RFE) was used to select the most relevant features. Model performance was evaluated using metrics such as Area Under the Receiver Operating Characteristic Curve (AUC-ROC), accuracy, precision, recall, and F1 score, alongside calibration plots and Decision Curve Analysis (DCA).</div></div><div><h3>Results</h3><div>The incidence rate of initial seizure episodes was 3.10% (497/15,890), with no significant difference between the training and validation sets. The best-performing individual models were Gradient Boosting (AUC-ROC: 0.78) and Logistic Regression (AUC-ROC: 0.79). The ensemble model achieved an AUC-ROC of 0.80 (95%CI: 0.78–0.82), accuracy of 0.78, precision of 0.80, recall of 0.75, and F1 score of 0.77. Calibration plots demonstrated that the ensemble model’s predicted probabilities were well-aligned with observed outcomes. DCA indicated significant net benefit across a range of threshold probabilities, underscoring the model’s clinical utility.</div></div><div><h3>Conclusion</h3><div>The ensemble learning model, combining Gradient Boosting and Logistic Regression via a stacking technique, demonstrated superior performance for identifying risk factors for initial seizure episodes in ICU patients. This model was evaluated using a range of performance metrics, including accuracy, sensitivity, specificity, and the AUC-ROC curve, and was validated through 10-fold cross-validation to ensure its robustness and generalizability. These results offer clinically relevant risk factor identification. Key risk factors identified include age, GCS score, glucose levels, hematocrit levels, hyponatremia, stroke history, prothrombin time, potassium levels, and hypertension. The risk estimation table simplifies these complex interactions into a practical tool for clinical use.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111266"},"PeriodicalIF":1.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852090","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":"Effect of primary patient language on large-vessel occlusive stroke treatment and functional outcomes","authors":"Carl M. Porto ,&nbsp;Joshua R. Feler ,&nbsp;Dylan N. Wolman ,&nbsp;Abigail B. Teshome ,&nbsp;Mazen Taman ,&nbsp;Krisztina Moldovan ,&nbsp;Radmehr Torabi ,&nbsp;Elizabeth M. Perelstein ,&nbsp;Mahesh V. Jayaraman","doi":"10.1016/j.jocn.2025.111269","DOIUrl":"10.1016/j.jocn.2025.111269","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and purpose&lt;/h3&gt;&lt;div&gt;Patients with limited English proficiency may face barriers to acute ischemic stroke (AIS) care. This study investigates whether medical interpreter requirement for AIS patients affects access to endovascular therapy (EVT) or outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Retrospective review of an AIS database at a single comprehensive stroke center from 1/2021–12/2021 was conducted. Patient demographics, baseline and post-treatment AIS parameters were recorded. Patients were grouped by interpreter requirement. A propensity-matched cohort for interpreter requirement was created matching for age, presenting National Institute of Health Stroke Scale (NIHSS), occlusion site and side, thrombolytic treatment, and EVT. Primary outcomes included discharge NIHSS and modified Rankin score (mRS), and 90-day mRS. Secondary outcomes included NIHSS shift from presentation to discharge.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 355 included patients, 321 (90.4 %) spoke English. English speakers were more likely to identify as white (85.6 % vs 38.2 %, p &lt; 0.001). Non-English speakers presented with higher NIHSS (median 21 [IQR 15–24] vs. 14 [6–20], p &lt; 0.001). Rates of thrombolytic administration (41.7 % vs 20.9 %) or EVT (61.8 % vs. 66.0 %) were similar between groups. Among thrombectomy patients, the times from hospital arrival to device deployment or recanalization were not significantly different by language group. Discharge mRS (5 [4–5] vs. 4 [3–5], p = 0.023) and NIHSS (9 [1–19] vs. 3 [1–12], p = 0.026) were higher for non-English speakers. There was no significant difference in NIHSS shift or the rate of 90-day mRS 0–2 (23.5 % vs 34.3 %). The propensity-matched cohort included 30 patients in each group and demonstrated higher premorbid and discharge mRS, and admission and discharge NIHSS for non-English speakers (p &lt; 0.019).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Non-English speaking AIS patients present with more severe symptoms and are discharged with poorer reported neurological function despite receiving similar treatments to English speakers.&lt;/div&gt;&lt;div&gt;Patients with limited English proficiency may face barriers to acute ischemic stroke (AIS) care. This study investigates whether medical interpreter requirement for AIS patients affects access to endovascular therapy (EVT) or outcomes. Retrospective review of an AIS database at a single comprehensive stroke center from 1/2021–12/2021 was conducted. Patients were grouped by interpreter requirement. A propensity-matched cohort for interpreter requirement was created matching for age, presenting National Institute of Health Stroke Scale (NIHSS), occlusion site and side, thrombolytic treatment, and EVT. Primary outcomes included discharge NIHSS and modified Rankin score (mRS), and 90-day mRS. Secondary outcomes included NIHSS shift from presentation to discharge. Among 355 included patients, 321 (90.4 %) spoke English. English speakers were more likely","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111269"},"PeriodicalIF":1.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855433","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":"Analytical and comparative study of pterional craniotomy related to temporalis muscle dissection techniques: Interfascial temporalis and myocutaneous flap","authors":"Pedro Henrique Mouty Rabello ,&nbsp;Yuri Estevam Bandeira ,&nbsp;Victor Zanetti Strutz ,&nbsp;João Paulo Mota Telles ,&nbsp;Gustavo Rassier Isolan ,&nbsp;Carlos G. Carlotti Jr ,&nbsp;Eberval Gadelha Figueiredo","doi":"10.1016/j.jocn.2025.111274","DOIUrl":"10.1016/j.jocn.2025.111274","url":null,"abstract":"<div><h3>Background and objectives</h3><div>The pterional craniotomy (PT) is a widely used neurosurgery approach that provides access to various intracranial structures. This study compared the exposure provided by 2 techniques for temporalis muscle mobilization: interfascial dissection (IF) and myocutaneous flap (MF).</div></div><div><h3>Methods</h3><div>Eight adult cadavers underwent sequential craniotomies on the left side using both techniques. The measurement areas of surgical exposure, angular exposure, and linear exposure of the basilar artery were determined.</div></div><div><h3>Results</h3><div>Results showed no significant difference in the total area of exposure or linear exposure of the basilar artery between the IF and MF. However, interfascial dissection provided significantly greater vertical angular exposure.</div></div><div><h3>Conclusion</h3><div>Although both techniques offer comparable horizontal exposures, the choice between them should consider the anticipated working angles. The interfascial temporalis flap may be preferred for broader vertical exposure is required.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111274"},"PeriodicalIF":1.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852088","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 between multiple sclerosis lesion location, migraine and tension-type headache: A cross-sectional study","authors":"Panagiotis Gklinos ,&nbsp;Maria-Eleftheria Evangelopoulos ,&nbsp;Georgios Velonakis ,&nbsp;Dimos-Dimitrios Mitsikostas","doi":"10.1016/j.jocn.2025.111250","DOIUrl":"10.1016/j.jocn.2025.111250","url":null,"abstract":"<div><h3>Background</h3><div>An increased prevalence of migraine in people with MS (pwMS) has been documented over the past decade, with one of the leading explanations being the presence of lesions within regions, critical for pain modulation.</div></div><div><h3>Objective</h3><div>To investigate whether lesions within pain areas are associated with primary headaches in pwMS.</div></div><div><h3>Methods</h3><div>PwMS fulfilling the 2017 Mc Donald criteria were recruited prospectively in the study. Patients underwent a detailed neurological examination and assesment for primary headache disorders. Brain MRI scans were obtained and assessed. Odd-ratios (ORs) were calculated to examine the potential association of lesions within pain-perceiving brain regions and primary headache disorders.</div></div><div><h3>Results</h3><div>A total of 96 participants were included in the study. After adjusting for potential confounding factors, PAG lesions were statistically significantly associated with migraine (OR = 4.7; 95 % CI: 1.5 to 14.59; p = 0.008). Similarly, thalamic and cortical lesions were also statistically significantly associated with an increased prevalence of migraine (OR = 7.2; 95 %CI: 1.37 to 37.79; p = 0.02 and OR = 9.1; 95 %CI: 1.53 to 54.72; p = 0.02 respectively)</div></div><div><h3>Conclusions</h3><div>Lesions within critical brain regions are associated with migraine and are possibly the leading cause of the increased prevalence of migraine in pwMS.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111250"},"PeriodicalIF":1.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855708","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 fluorescence-guided glioblastoma resection with 5-aminolevulinic acid using ORBEYE™","authors":"Toshihiro Ogiwara ,&nbsp;Atsushi Sato ,&nbsp;Mana Wakabayashi ,&nbsp;Kotaro Nakamura ,&nbsp;Yoshiki Hanaoka ,&nbsp;Kazuhiro Hongo ,&nbsp;Yasuhiko Hayashi","doi":"10.1016/j.jocn.2025.111276","DOIUrl":"10.1016/j.jocn.2025.111276","url":null,"abstract":"<div><h3>Background</h3><div>Although fluorescence-guided surgery (FGS) using 5-aminolevulinic acid (5-ALA) for glioblastomas (GBMs) can maximize the extent of resection (EOR), its superiority when used with ORBEYE™, a three-dimensional exoscope, compared with that of conventional microscopy remains unclear. This study aimed to evaluate the effectiveness of ORBEYE™ in 5-ALA FGS for GBM resection and compare the results with those of conventional microscopic FGS.</div></div><div><h3>Methods</h3><div>This retrospective, single-center study included 41 patients with histologically confirmed GBM who underwent 5-ALA FGS between January 2016 and April 2024. Twenty patients underwent surgery using a conventional operating microscope, while 21 underwent surgery using ORBEYE™. Tumor size, location, EOR, operative time, and surgical complications were compared between the two groups.</div></div><div><h3>Results</h3><div>No significant differences in EOR were observed between the groups; gross total resection was achieved in 45 % and 52.4 % of patients in the microscope and ORBEYE groups, respectively. Although not significant, the ORBEYE group had shorter operative times (195.3 ± 53.8 min) than the microscope group (219.4 ± 79.3 min). Postoperative complications were comparable between the two groups. ORBEYE™ allowed continuous resection under blue light without switching modes, enabling “real-time FGS with 5-ALA,” which enhanced surgical workflow, reduced surgeon’s fatigue, and eliminated the need for repositioning the surgeon’s eyes to the operating microscope eyepieces—although this was a subjective opinion of the surgeons.</div></div><div><h3>Conclusions</h3><div>ORBEYE™ provides effective real-time visualization during 5-ALA FGS for GBM resection, comparable to conventional microscopy. Its continuous fluorescence guidance and improved ergonomics may contribute to shorter operative times and reduced surgeon fatigue. ORBEYE™ is a promising tool in GBM surgery, warranting further in-depth investigation.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111276"},"PeriodicalIF":1.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852087","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":"Natural history of small incidental intracranial aneurysms: a systematic review and pooled analysis on the influence of follow-up duration and aneurysm location on rupture risk reporting","authors":"Lily Davies ,&nbsp;Cyrus Raki ,&nbsp;Leon T. Lai","doi":"10.1016/j.jocn.2025.111241","DOIUrl":"10.1016/j.jocn.2025.111241","url":null,"abstract":"<div><h3>Background</h3><div>The rising detection of small unruptured intracranial aneurysms (sUIAs) poses a clinical challenge, requiring careful consideration between the low but real risk of rupture and the potential morbidity of intervention. Reported rupture rates vary widely across studies, influenced by heterogeneity in design, patient selection, aneurysm location, and follow-up duration. This study assessed how aneurysm location and follow-up length affect rupture rates in untreated sUIAs.</div></div><div><h3>Methods</h3><div>A systematic review and <em>meta</em>-analysis were conducted in line with PRISMA guidelines and registered with PROSPERO (CRD42024601692). Four databases (EMBASE, Ovid MEDLINE, EMCARE, Scopus) were searched for studies from January 2000 onwards reporting longitudinal outcomes for ≥20 untreated sUIAs ≤ 5 mm. The primary outcome was the pooled rupture rate, stratified by location and follow-up duration. Secondary analysis examined aneurysm growth. A random-effects model was used for <em>meta</em>-analysis, with heterogeneity assessed using the I² statistic. Sensitivity analyses evaluated the robustness of findings.</div></div><div><h3>Results</h3><div>From 10,694 screened records, 28 studies met inclusion criteria, encompassing 10,495 untreated sUIAs ≤ 5 mm. Over a mean follow-up of 38 months, 97 aneurysms ruptured, yielding a pooled rupture rate of 0.8 % (95 % CI, 0.6–1.2). Rupture risk did not significantly differ by location (p = 0.31): 1.1 % for middle cerebral artery, 3.9 % for anterior cerebral artery, and 0.3 % for <em>para</em>-ophthalmic artery aneurysms. Rupture rates remained consistent across follow-up durations (p = 0.53): 0.8 % for &lt;20 months, 0.8 % for 20–40 months, and 1.2 % for &gt;40 months. Although aneurysm growth appeared more frequent with longer follow-up, this was not statistically significant (p = 0.64).</div></div><div><h3>Conclusion</h3><div>This updated <em>meta</em>-analysis, incorporating novel subgroup analyses by location and follow-up duration, confirms that rupture risk for sUIAs ≤ 5 mm remains low (&lt;1%) over an average 38-month period. However, limited long-term data restrict accurate risk estimation beyond this timeframe, and underreporting of aneurysm location impairs site-specific risk assessment. The trend towards greater aneurysm growth with extended follow-up underscores the importance of continued surveillance.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"136 ","pages":"Article 111241"},"PeriodicalIF":1.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855431","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}