Journal of Clinical Neuroscience最新文献

{"title":"Re-organization of motor functions after early brain damage: Direct evidence from intraoperative neuromonitoring in four cases","authors":"Cihan İşler ,&nbsp;Taner Tanrıverdi ,&nbsp;Emine Taşkıran ,&nbsp;Gülçin Baş ,&nbsp;Bengi Gül Türk ,&nbsp;Çiğdem Özkara ,&nbsp;Mustafa Uzan","doi":"10.1016/j.jocn.2025.111650","DOIUrl":"10.1016/j.jocn.2025.111650","url":null,"abstract":"<div><h3>Background</h3><div>The re-organization of motor functions is a sign of adaptive brain plasticity to early brain damage and understanding its mechanisms may play a key role in the future treatment modalities. This study provides direct evidence of neural plasticity in four patients with early brain damage, who underwent epilepsy surgery due to drug-resistant epilepsy.</div></div><div><h3>Methods</h3><div>In this retrospective analysis, four patients with early brain damage who underwent resective or disconnective epilepsy surgery were examined. Intraoperative neuromonitoring was employed to preserve motor function during surgery, while functional MRI and diffusion tensor imaging were used to assess it before and after surgery.</div></div><div><h3>Results</h3><div>Preoperative functional imaging revealed that some motor representations of the limbs were located in unexpected cortical areas due to early brain damage. In the first and second patients, right-hand representations had shifted to the right hemisphere and to both hemispheres, respectively. In the remaining two patients, all motor functions of the affected hemisphere were completely relocated to the contralateral, unaffected hemisphere. Intraoperative neuromonitoring findings were in line with pre-operative functional imaging.</div></div><div><h3>Conclusion</h3><div>Our intraoperative neuromonitoring data provided direct evidence of motor function reorganization following early brain damage. Furthermore, the results indicated that these functional adjustments of motor circuits are progressive and long-lasting.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111650"},"PeriodicalIF":1.8,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185876","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":"Does embryologic basilar fusion type impact basilar apex aneurysm treatment outcomes?","authors":"Zachary Hubbard ,&nbsp;Julio Isidor ,&nbsp;Hidetoshi Matsukawa ,&nbsp;Rahim Abo Kasem ,&nbsp;Conor Cunningham ,&nbsp;Hasna Loulida ,&nbsp;Mohammad Mahdi Bagheri Asl ,&nbsp;Mohammad Mahdi Sowlat ,&nbsp;Shinichi Yoshimura ,&nbsp;Alejandro Spiotta","doi":"10.1016/j.jocn.2025.111632","DOIUrl":"10.1016/j.jocn.2025.111632","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Basilar apex aneurysms can be challenging entities for both open and endovascular treatment. The basilar artery forms from fusion of the paired longitudinal neural arteries that produces several anatomical morphologies known to correlate with basilar aneurysm formation. There is paucity of literature on these morphologic types on aneurysm treatment. The aim of this study was to examine endovascular treatment outcomes of basilar apex aneurysms based on embryologic fusion type.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of aneurysm databases from one American and one Japanese institution for basilar apex aneurysms treated using endovascular modalities. Angiographic studies were reviewed, and embryologic fusion type was assigned. Outcomes of interest included treatment type, angiographic and complications.</div></div><div><h3>Results</h3><div>151 patients were included in the analysis. There were 76 patients (50.3 %) with cranial fusion, 28 patients (18.6 %) with caudal fusion, and 47 patients (31.1 %) with asymmetric fusion. Mean aneurysm height was largest in the asymmetric fusion group (5.2 mm; [IQR] 3.7–7.0) compared to cranial (4.3 mm; [IQR] 2.9–5.8) and caudal (4.8 mm; [IQR] 3.5–8.0) groups (p = 0.03). Treatment modality did not differ among embryologic fusion types; stent assisted coil embolization was the most frequent treatment modality (58.9 %). There were no differences in complication rates between groups. One-year complete occlusion rates were lowest in the asymmetric fusion group (40.7 %) and highest in the cranial fusion group (72.9 %) (p = 0.03).</div></div><div><h3>Conclusion</h3><div>There are differences in one-year complete occlusion rates following endovascular treatment of basilar apex aneurysms among varying embryologic fusion types. Asymmetric fusion is associated with the lowest complete occlusion rate. Embryologic fusion type may portend differences in outcomes among patients undergoing treatment for basilar apex aneurysms.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111632"},"PeriodicalIF":1.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156520","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":"Outcomes after spinal deformity surgery in patients with Parkinson’s Disease: a propensity matched analysis","authors":"Austin H. Carroll ,&nbsp;James Fookes ,&nbsp;Alejandro Quinonez ,&nbsp;Christopher P. Bellaire ,&nbsp;Brian McCormick ,&nbsp;Lancelot Benn ,&nbsp;Jonathan P. Japa ,&nbsp;Kevin Yoon ,&nbsp;Fred Mo ,&nbsp;Mark Ehioghae ,&nbsp;Addisu Mesfin","doi":"10.1016/j.jocn.2025.111630","DOIUrl":"10.1016/j.jocn.2025.111630","url":null,"abstract":"<div><div>Adult spinal deformity remains a complex challenge with medical and surgical complication rates post-operatively reported to be around 40 %. Patients with Parkinson’s Disease (PD) are particularly susceptible to musculoskeletal disease secondary to postural deformity, muscle rigidity, and bradykinesia and have an increased risk of spinal deformity compared to the general population. There is a paucity of literature investigating the outcomes of multi-level spinal deformity surgery in this at-risk population. Patients undergoing multi-level posterior spinal fusion for spinal deformity with a diagnosis of Parkinson’s Disease were identified using the PearlDiver database. Patients with PD were propensity-matched in a 1:1 ratio to a control group by age, Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). Medical complications and rates of surgical site infection (SSI) were assessed at 90 days. Surgical revision rates were assessed at 2 years. A total of 2776 patients met criteria with 1,388 patients in the PD group and 1,388 in the control group after propensity matching. Patients with PD had a significantly higher rate of surgical revision at 2 years and an increased risk of 90-day medical complications post-operatively. There was no difference in infection rates between groups within 90 days. Patients with Parkinson’s Disease undergoing multilevel posterior spinal fusion for spinal deformity correction have an increased risk of medical complications and need for surgical revision compared to age and comorbidity matched controls. Non-operative management should be exhausted prior to surgical treatment and further research is needed to optimize outcomes in this high-risk patient population.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111630"},"PeriodicalIF":1.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156519","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":"A systematic review on COVID-19 and spinal strokes, the end of an era","authors":"Marc Moisi ,&nbsp;Christian Bowers ,&nbsp;Smit Shah ,&nbsp;Sina Zoghi ,&nbsp;Carmelo Venero Jr ,&nbsp;Shubham Arora ,&nbsp;Sara Mirza ,&nbsp;Abilash Haridas ,&nbsp;Noushin Vahdat ,&nbsp;Mina Foroughi ,&nbsp;Sadegh Baradaran Mahdavi ,&nbsp;Arman Sourani","doi":"10.1016/j.jocn.2025.111639","DOIUrl":"10.1016/j.jocn.2025.111639","url":null,"abstract":"<div><h3>Aim</h3><div>To investigate the association of the COVID-19 virus with hemorrhagic and ischemic spinal strokes.,</div></div><div><h3>Background</h3><div>COVID-19 has extensive extrapulmonary manifestations. Myelitis, demyelinating syndromes, hemorrhagic and ischemic presentations have been reported. To date, there is no comprehensive study to delineate an evidence-based correlation between COVID-19 and spinal strokes comprehensively.</div></div><div><h3>Materials and methods</h3><div>A PRISMA-based systematic review.</div></div><div><h3>Results</h3><div>In the final review, 8 data sets for ischemia and 11 for hemorrhagic lesions were included.</div><div>The mean age for ischemia and hemorrhagic lesions was 52 and 47 years old, respectively. Patients with cord ischemia had more severe COVID-19 pneumonia as compared to hemorrhagic (62 % vs 27 %). Lab results showed 75 % coagulation abnormalities in cord ischemia patients while there was no coagulopathy in the hemorrhage group. Somatosensory deficits were the most prevalent neurological presentations in both groups.</div><div>MRI showed that the anterior spinal artery and central ischemia were the most common patterns of COVID-19 spinal ischemia. MRI images also revealed epidural and intramedullary hematomas were the most common type of hemorrhagic lesions with cervical and thoracic preferences.</div><div>The most common on-admission neurological status was American Spinal Injury Association (ASIA) impairment scale A-B(ischemia) and ASIA B-D(hemorrhage). All of the ischemic patients received conservative management. In hemorrhagic patients, there were 4 laminectomies, 6 conservative management, and 1 combined approach.</div><div>Post-intervention clinical outcomes in ischemia were unfavorable but in the hemorrhagic spinal strokes, it had more promising results.</div></div><div><h3>Conclusion</h3><div>COVID-19 can cause both ischemia and hemorrhagic spinal strokes. Coagulopathy may be a precipitating factor in cord ischemia development while other neuropathogenesis mechanisms may precipitate spinal hemorrhage. Early surgical or conservative management is the key factor in determining long-term outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111639"},"PeriodicalIF":1.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149071","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 repair of lumbar Segmental Myelocystocele and spinal cord Untethering: 2-Dimensional operative video","authors":"Mohammad Elbaroody ,&nbsp;Hadie Adams ,&nbsp;Muhammad Zubair Tahir","doi":"10.1016/j.jocn.2025.111643","DOIUrl":"10.1016/j.jocn.2025.111643","url":null,"abstract":"<div><div>Lumbar (non-terminal) myelocystocele is a rare form of closed spinal dysraphism which is characterized by posterior bony defect [<span><span>[1]</span></span>, <span><span>[2]</span></span>, <span><span>[3]</span></span>], a herniated segment of the spinal cord associated with cystic dilatation of the central canal [<span><span>[1]</span></span>, <span><span>[2]</span></span>, <span><span>[3]</span></span>], and surrounded by cyst filled with CSF in the subarachnoid space i.e. cyst-within-a-cyst. [<span><span>[1]</span></span>, <span><span>[2]</span></span>, <span><span>[3]</span></span>, <span><span>[4]</span></span>] The mass is covered by intact skin and variable amounts of subcutaneous fat which is often attached to neural tissue. [<span><span>[1]</span></span>, <span><span>[2]</span></span>, <span><span>[3]</span></span>]</div><div>Surgery is advocated to untether the cord and reconstruct the neural tube which will prevent further neurological deterioration. [<span><span>[1]</span></span>, <span><span>[2]</span></span>, <span><span>[3]</span></span>]</div><div>In this video, we present the case of a 7-month-old boy who was presented with skin skin-covered lumbar mass after birth. He had left foot drop with no movement in the toes and right foot inversion with associated weakness in the toes. There were no developmental delays and he did not have anorectal anomalies. Magnetic Resonance Imaging (MRI) spine confirmed the diagnosis of lumbar myelocystocele, and urinary flow studies showed good bladder capacity with reasonable voids. The patient underwent spinal cord untethering, neurulation of the neural placode, and duraplasty with an artificial dural graft to increase the cord-sac ratio. [<span><span>[5]</span></span>, <span><span>[6]</span></span>, <span><span>[7]</span></span>] Postoperative motor power was similar to baseline. The urinary catheter was removed three weeks after surgery with adequate voiding. The were no concerns related to the wound.</div><div>The parents consented to the procedure and the publication of the patient’s video. Institutional Review Board approval was not required.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111643"},"PeriodicalIF":1.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156558","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":"Delayed, catastrophic expansion of acute traumatic subdural hematomas: a case series","authors":"Shivani Bindal ,&nbsp;William Walker Wroe ,&nbsp;William Dow ,&nbsp;Ryan Kitagawa","doi":"10.1016/j.jocn.2025.111644","DOIUrl":"10.1016/j.jocn.2025.111644","url":null,"abstract":"<div><h3>Background</h3><div>Incidences of catastrophic, life-threatening expansion of acute traumatic subdural hematomas (SDH) greater than 72-hours after injury are rare and limited to single case reports in the literature. Here we report the largest series of this rare subset of patients and evaluate the incidence and associated clinical factors.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all asymptomatic acute traumatic SDH admissions that were managed conservatively to a single large academic tertiary trauma center over a 5-year period. Inclusion criteria were diagnosis of non-operative acute SDH, Glasgow coma score (GCS) ≥14, and severe symptomatic expansion greater than 72 h after injury.</div></div><div><h3>Results</h3><div>Nine patients met criteria for severe, symptomatic delayed expansion of asymptomatic acute SDH. The median age was 80.1 years. In all cases, the mechanism of injury was a low velocity, ground-level fall. The SDH size on initial imaging ranged from 3 mm to 16 mm at maximum diameter. All patients were admitted for observation with repeat imaging demonstrating stability of hemorrhage within 12 h. The median time to SDH expansion was 4.5 days. Repeat imaging demonstrated large, acute, operative SDHs, measuring 20.8 mm on average. Five patients underwent immediate surgical intervention, of which 4 were eventually discharged with GCS ≥14. The remaining 4 patients were transitioned to comfort measures without surgical intervention.</div></div><div><h3>Conclusion</h3><div>The risk of neurologic devastation and catastrophic event from SDH expansion &gt;72 h from injury is exceedingly low, and head imaging should be performed at the first sign of symptoms despite length of time from injury.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111644"},"PeriodicalIF":1.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119870","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":"Impact of intraoperative neurophysiological monitoring and anesthesia management parameters on postoperative recovery in patients undergoing complex intracranial aneurysm surgery","authors":"Dabao Wang ,&nbsp;Junwei Tong ,&nbsp;Buxing Liu ,&nbsp;Ye Li ,&nbsp;Xia Zhang","doi":"10.1016/j.jocn.2025.111631","DOIUrl":"10.1016/j.jocn.2025.111631","url":null,"abstract":"<div><h3>Background</h3><div>Complex intracranial aneurysms (CIAs) pose significant challenges in neurosurgery, with postoperative neurological deficits (PNDs) being a major concern. This study aimed to evaluate the combined impact of intraoperative neurophysiological monitoring (IONM) and standardized anesthesia management on postoperative recovery in patients undergoing microsurgical clipping for CIAs.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 106 patients with CIA (April 2022–March 2025) was conducted. Patients were divided into a non-IONM group (n = 45) and an IONM group (n = 61) receiving standardized total intravenous anesthesia with strict hemodynamic/temperature control. Neurological (National Institutes of Health Stroke Scale, NIHSS), cognitive (Mini-Mental State Examination, MMSE), and functional (Modified Rankin Scale, mRS) outcomes were assessed preoperatively and at 24 h, 7 days, and 1 month postoperatively. Additionally, IONM parameters and anesthesia variables were analyzed for associations with poor recovery.</div></div><div><h3>Results</h3><div>The IONM group exhibited significantly better NIHSS scores (24 h: 18.47 ± 3.02 vs. 19.83 ± 3.27, P = 0.029; 7d: 13.25 ± 2.58 vs. 15.04 ± 3.76, <em>P</em> = 0.007) and MMSE scores (24 h: 27.14 ± 2.12 vs. 26.16 ± 1.93, <em>P</em> = 0.016; 7d: 28.63 ± 1.13 vs. 27.94 ± 1.21, <em>P</em> = 0.003), lower PND incidence (9.84 % vs. 31.11 %, <em>P</em> = 0.006), and more favorable mRS distributions than the non-IONM group. Poor recovery was strongly associated with irreversible IONM changes (OR = 6.06–9.04, <em>P</em> &lt; 0.05) and increased intraoperative MAP/HR/temperature fluctuations (OR = 1.33–10.08 per unit, <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Integrating multimodal IONM with rigorous anesthesia parameter optimization significantly enhances early neurological and cognitive recovery while reducing deficits in CIA surgery. IONM alerts and physiological instability are interdependent risk amplifiers, underscoring the need for protocolized integration of real-time neural pathway surveillance and hemodynamic/thermal homeostasis as a unified neuroprotective strategy in high-risk neurovascular procedures.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111631"},"PeriodicalIF":1.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119771","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":"Thoracic stenosis decompression using Bi-portal endoscopic technique","authors":"Zihan Masood ,&nbsp;Richard J. Chung ,&nbsp;Julia Kincaid ,&nbsp;Ryan Turlip ,&nbsp;Daksh Chauhan ,&nbsp;Mert M. Dagli ,&nbsp;Hasan S. Ahmad ,&nbsp;Ben J. Gu ,&nbsp;Yohannes Ghenbot ,&nbsp;Jang W. Yoon","doi":"10.1016/j.jocn.2025.111608","DOIUrl":"10.1016/j.jocn.2025.111608","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic spinal stenosis is a relatively rare pathology. Surgical decompression is widely regarded as the most effective treatment. Many minimally invasive techniques exist, but there is a paucity of reports and operative videos demonstrating the bi-portal technique in the thoracic spine.</div></div><div><h3>Case description</h3><div>Herein, we demonstrate the techniques and effectiveness of bi-portal endoscopic thoracic decompression in a young patient with comorbidities.</div></div><div><h3>Conclusion</h3><div>Recent advances in endoscopic spine techniques, particularly the bi-portal approach, offers an effective minimally invasive approach, with minimal tissue dissection, reduced blood loss, shorter hospital stay, and faster recovery. These techniques can be safely and effectively applied to the thoracic spine.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111608"},"PeriodicalIF":1.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119871","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":"Factors predicting the outcome of thoracic ossification of ligamentum flavum (OLF) surgery: A systematic review and meta-analysis","authors":"Anish Tayal ,&nbsp;Pragya Mitra ,&nbsp;Aneeket Modak ,&nbsp;Sucharu Asri ,&nbsp;Kanwaljeet Garg","doi":"10.1016/j.jocn.2025.111649","DOIUrl":"10.1016/j.jocn.2025.111649","url":null,"abstract":"<div><h3>Background</h3><div>The study aimed to determine the association between demographics, clinical presentation, radiological findings, and intraoperative characteristics of patients with thoracic ossification of ligamentum flavum (OLF) surgery and their postoperative outcomes.</div></div><div><h3>Methods</h3><div>PubMed, Ovid, Embase, and Web of Sciences databases were searched until July 2023 to include articles regarding the prognostic factors for thoracic OLF surgery. The risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool. The outcome of surgery was evaluated by calculating the recovery rate (RR), as follows: RR = (postoperative Japanese Orthopedic Association (JOA) score − preoperative JOA score)/(11 − preoperative JOA score). Meta-analyses Of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Furthermore, factors associated with outcome were assessed separately within open and minimally invasive surgery (MIS) subgroups.</div></div><div><h3>Results</h3><div>Thirty-six studies with 1,511 patients were included. RR was associated with age (p-value = 0.012), JOA score (p-value &lt; 0.001), ossified region (middle vs. lower thoracic spine: p-value = 0.042), intramedullary signal intensity change on T2-weighted magnetic resonance imaging (p-value &lt; 0.001), and occurrence of dural ossification (p-value = 0.006). On subgroup analysis, JOA score (p-value &lt; 0.001) and operation time (p-value = 0.014) were associated with outcomes for patients managed with an open surgical approach, while none for those operated with the MIS technique.</div></div><div><h3>Conclusion</h3><div>Although surgery is the cornerstone of the management of OLF, careful patient prognostication should be performed considering the aforementioned factors. Further, high-quality research is warranted to confirm the findings of this study.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111649"},"PeriodicalIF":1.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119868","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":"Platelet function testing does not predict hemorrhage progression in mild traumatic brain injury","authors":"Tessa A. Harland ,&nbsp;Andrew Ku ,&nbsp;Gregory Topp ,&nbsp;Tarun Prabhala ,&nbsp;Sruti Bandlamuri ,&nbsp;Rachel Thiets ,&nbsp;Fernando Figueroa ,&nbsp;Samuel Ortiz ,&nbsp;Alan Boulos ,&nbsp;Pouya Entezami","doi":"10.1016/j.jocn.2025.111647","DOIUrl":"10.1016/j.jocn.2025.111647","url":null,"abstract":"<div><h3>Background</h3><div>Antiplatelet medications are frequently assumed to increase the risk of radiographic progression following traumatic intracranial hemorrhage (ICH), influencing guidelines that recommend prolonged observation and repeat imaging. However, antiplatelet use does not uniformly result in functional platelet inhibition, and the clinical relevance of therapeutic response remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adult patients with traumatic ICH and a Glasgow Coma Scale (GCS) score of 13–15 who were on antiplatelet therapy and underwent platelet function testing (VerifyNow PRU or PFA) on admission. Patients were classified as therapeutic or non-therapeutic based on test thresholds. All patients received follow-up CT imaging within 24 h. Clinical variables and outcomes, including radiographic progression, surgical intervention, and mortality, were compared between groups. A sensitivity analysis excluded patients with hematocrit &lt;30 % or platelet count &lt;100,000.</div></div><div><h3>Results</h3><div>A total of 239 patients were included: 190 in the non-therapeutic group and 49 in the therapeutic group. Radiographic progression occurred in 17.6 % of patients overall, with no significant difference between therapeutic and non-therapeutic groups (20.4 % vs. 16.8 %; p = 0.53). Surgical intervention (p = 0.57) and mortality (p = 0.38) rates were similarly low and comparable. Sensitivity analyses confirmed these findings (p = 0.81).</div></div><div><h3>Conclusions</h3><div>Therapeutic platelet inhibition was not associated with increased risk of radiographic or clinical worsening in patients with mild traumatic ICH. These findings challenge current assumptions regarding antiplatelet risk and suggest that platelet function testing may have limited utility in this setting. These findings support the need to reevaluate current guidelines and validate risk stratification approaches through prospective multicenter studies.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111647"},"PeriodicalIF":1.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119869","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}