Journal of Clinical Neuroscience最新文献

{"title":"Intraoperative rupture during microsurgical clipping of intracranial aneurysms: a systematic review and meta-analysis of incidence and outcomes","authors":"Lily Davies ,&nbsp;Cyrus Raki ,&nbsp;Zenuka De Silva ,&nbsp;Leon Lai","doi":"10.1016/j.jocn.2026.111932","DOIUrl":"10.1016/j.jocn.2026.111932","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Intraoperative rupture (IOR) is a recognised complication of microsurgical aneurysm clipping, yet reported incidence and outcomes remain vary widely across published series. We performed a systematic review and <em>meta</em>-analysis to estimate the pooled IOR incidence and examine its association with postoperative morbidity and mortality.</div></div><div><h3>Methods</h3><div>This review was registered with PROSPERO (CRD420251051680) and conducted in accordance with PRISMA guidelines. MEDLINE, Embase, Emcare, Scopus and Cochrane were searched from January 1, 2005 to May 12, 2025. Eligible studies reported IOR in at least 20 surgically clipped aneurysms. Risk of bias was assessed using MINORS. The primary outcome was pooled IOR incidence, stratified by rupture status and arterial location. Secondary outcomes were morbidity and mortality, analysed as pooled proportions and odds ratios using random effects models.</div></div><div><h3>Results</h3><div>Seventy-eight studies comprising 19,243 clipped aneurysms and 2213 IOR events met inclusion criteria. The pooled IOR incidence was 12.6% (95% CI, 10.1–15.6%; I² = 94%). IOR occurred more frequently in ruptured than unruptured aneurysms (14.4% vs 2.2%). Incidence varied by arterial location, with lowest rates in pericallosal aneurysms. Aneurysm size showed no consistent association with IOR. Mortality following IOR was 9.1% (95% CI, 5.0–16.2%). Compared with non IOR cases, IOR was associated with higher odds of mortality (OR, 4.14; 95% CI, 1.67–10.27) and morbidity (OR, 3.33; 95% CI, 1.88–5.90).</div></div><div><h3>Conclusion</h3><div>Intraoperative rupture occurred in approximately 1 in 8 aneurysms treated with microsurgical clipping and was associated with higher morbidity and mortality. Reported incidence varied by rupture status and arterial location, while aneurysm size showed no consistent association. Marked heterogeneity, inconsistent IOR definitions, and complete outcome reporting underscore the need for standardised reporting and prospective patient level data to better characterise the clinical impact of IOR.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111932"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172489","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":"Spinal cord ischemia following pediatric cardiac arrest: An unexplored complication of hypoxic ischemic injury","authors":"Morgann Loaec ,&nbsp;Arastoo Vossough ,&nbsp;Conall Francoeur ,&nbsp;Kathryn Graham ,&nbsp;Ryan W. Morgan ,&nbsp;Alexis A. Topjian ,&nbsp;Matthew P. Kirschen","doi":"10.1016/j.jocn.2026.111916","DOIUrl":"10.1016/j.jocn.2026.111916","url":null,"abstract":"<div><h3>Background</h3><div>Hypoxic-ischemic brain injury (HIBI) is a well-described sequela of pediatric cardiac arrest, but the epidemiology and clinical implications of hypoxic-ischemic spinal cord injury (HISCI) remain poorly understood. Only isolated reports describe HISCI following cardiopulmonary resuscitation (CPR). We aimed to describe the incidence, imaging characteristics, and clinical context of HISCI in<!--> <!-->pediatric<!--> <!-->cardiac arrest patients undergoing clinically indicated MRI.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective descriptive case series of consecutively identified pediatric cardiac arrest patients who underwent spinal magnetic resonance imaging (MRI) within two weeks of resuscitation (2018–2023). Cases were identified from an institutional cardiac arrest database. MRI scans were independently reviewed by a pediatric neuroradiologist for evidence of HISCI.</div></div><div><h3>Results</h3><div>Of 717 cardiac arrest patients, 36 (5%) underwent spinal MRI within two weeks of arrest, primarily for trauma evaluation (72%). Four patients (11%) had MRI evidence of HISCI. All four experienced out-of-hospital cardiac arrest with CPR durations ranging from 8 to 90 min and initial serum lactate &gt; 4 mmol/L. Two arrests were traumatic. All four patients had concomitant HIBI, and two met criteria for death by neurologic criteria. Among the 32 patients without HISCI, 9 (28%) had HIBI and 19 (59%) had traumatic arrest.</div></div><div><h3>Conclusions</h3><div>HISCI was identified in 11% of pediatric cardiac arrest patients who underwent post-arrest spinal MRI for clinical indications. Recognition of HISCI has potential implications for neuroprognostication, rehabilitation planning, and determination of brain death by neurologic criteria. Larger prospective studies are needed to define the incidence, risk factors, and outcomes of HISCI following pediatric cardiac arrest.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111916"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172529","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":"Understanding the gap: How much do healthcare professionals know about functional neurological disorders?","authors":"Ghita Hjiej ,&nbsp;Asmae Sikkal ,&nbsp;Hajar Khattab ,&nbsp;Kamal Haddouali ,&nbsp;Salma Bellakhdar ,&nbsp;Hicham El Otmani ,&nbsp;Bouchra El Moutawakil ,&nbsp;Mohamed Abdoh Rafai","doi":"10.1016/j.jocn.2026.111913","DOIUrl":"10.1016/j.jocn.2026.111913","url":null,"abstract":"<div><h3>Background</h3><div>Functional Neurological Disorder (FND) manifests with neurological symptoms not attributable to structural abnormalities of the nervous system and is the second most common reason for referral to neurologists. Despite being treatable, FND is frequently underdiagnosed and linked to significant disability and emotional distress. This study aimed to assess the knowledge, perceptions, and attitudes of Moroccan healthcare professionals toward FND and explore misconceptions surrounding this condition.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional survey among 127 physicians across Morocco using an anonymous, online questionnaire disseminated via Google Forms. A snowball sampling approach was used, with the link distributed through social media and major unofficial specialty clusters on WhatsApp. The survey explored participants’ awareness, beliefs, and clinical practices regarding FND.</div></div><div><h3>Results</h3><div>Neurologists and neurology residents constituted 58% of respondents, followed by medical interns, general practitioners, and psychiatry residents. Overall, 22% reported no prior knowledge of FND, and 61% had never received formal training. Misconceptions were widespread: 18% associated FND with hysteria, 29% viewed it as purely psychological, and 10% were unaware of its pathophysiology. Only 4% recognized positive diagnostic signs, while 67% perceived FND solely as a diagnosis of exclusion. Additionally, 22% believed patients might exaggerate symptoms, 16% considered paraclinical examinations unnecessary, 44% thought psychiatric history was essential for diagnosis, and 50% underestimated the harms of underdiagnosis.</div></div><div><h3>Conclusion</h3><div>These findings highlight an urgent need for targeted educational interventions to correct misconceptions, promote accurate diagnosis, and improve patient care. Addressing these gaps could mitigate FND’s social and economic burden in Morocco.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111913"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157311","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 and Meta-Analysis of Middle meningeal artery embolization for Non-Acute Subdural Haematoma: A proposed treatment algorithm","authors":"Jack Edward Liu ,&nbsp;Christen D. Barras ,&nbsp;Behnam Shaygi ,&nbsp;Hong Kuan Kok ,&nbsp;Davor Pavlin-Premrl ,&nbsp;Lee-Anne Slater ,&nbsp;Calvin Gan ,&nbsp;Augusto Gonzalvo ,&nbsp;Paul D. Smith ,&nbsp;Jeremy Russell ,&nbsp;Ashu Jhamb ,&nbsp;Justin Moore ,&nbsp;Julian Maingard ,&nbsp;Andrew Gauden ,&nbsp;Ali Khabaza ,&nbsp;Ronil V. Chandra ,&nbsp;Anousha Yazdabadi ,&nbsp;Sean Stevens ,&nbsp;Mark Brooks ,&nbsp;Hamed Asadi","doi":"10.1016/j.jocn.2026.111917","DOIUrl":"10.1016/j.jocn.2026.111917","url":null,"abstract":"<div><h3>Objective</h3><div>To synthesize the evidence from recent large randomized controlled trials (RCTs) on middle meningeal artery embolization (MMAE) for non-acute subdural haematoma (SDH) and to propose a unified, evidence-based treatment algorithm to guide clinical practice.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and <em>meta</em>-analysis of large (n ≥ 100), multicentre RCTs comparing MMAE with surgical evacuation or conservative management for non-acute SDH. A comprehensive search of PubMed/MEDLINE, Embase, and CENTRAL was performed to August 2025. The primary outcome was treatment failure, a composite of radiological recurrence, symptomatic progression, or need for repeat surgery/surgical rescue at 90–180 days. Key secondary outcomes included functional status (modified Rankin Scale, mRS) and safety. Random-effects models were used for pooled analyses.</div></div><div><h3>Results</h3><div>Four RCTs involving 1,774 patients were included. For patients managed non-surgically, standalone MMAE was associated with a 64% relative risk reduction in treatment failure compared to conservative management (Risk Ratio [RR] 0.36, 95% CI [0.22, 0.60]). The number needed to treat was 4. As a surgical adjunct, MMAE offered a more modest but significant benefit in reducing recurrence or progression (RR 0.65, 95% CI [0.48, 0.89]). MMAE did not significantly improve functional outcomes or all-cause mortality but demonstrated a favourable safety profile with low rates of serious complications.</div></div><div><h3>Conclusions</h3><div>MMAE significantly reduces treatment failure in non-acute SDH, with the most profound benefit seen in non-surgical patients by lowering the need for surgical rescue. Its role as a routine surgical adjunct is less clear, suggesting a stratified approach for patients at high risk of recurrence.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111917"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172491","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 outcomes and longitudinal quality of life after endoscopic endonasal resection of craniopharyngioma","authors":"Jonathan Banting ,&nbsp;William Li ,&nbsp;Mendel Castle-Kirszbaum ,&nbsp;Jeremy Kam ,&nbsp;Joanne Rimmer ,&nbsp;Benjamin Dixon ,&nbsp;Yi Yuen Wang ,&nbsp;James King ,&nbsp;Tony Goldschlager","doi":"10.1016/j.jocn.2026.111927","DOIUrl":"10.1016/j.jocn.2026.111927","url":null,"abstract":"<div><h3>Background</h3><div>Craniopharyngiomas present a complex challenge for the neurosurgeon. The imperative is finding the balance between optimizing the extent of resection, decompressing critical structures and limiting the morbidity to the patient. The endoscopic endonasal approach is increasingly utilised for the management of craniopharyngioma, offering improved access to the suprasellar region while minimizing morbidity to the optic apparatus and neurovascular structures. Data regarding post operative quality of life outcomes remains limited in the literature. This mutli-centered prospective study evaluated surgical morbidity and patient reported outcomes measures following endoscopic endonasal resection within the Australian context.</div></div><div><h3>Method</h3><div>Patients undergoing endoscopic endonasal resection for craniopharyngioma at three tertiary skull base units in Melbourne, Australia were prospectively enrolled between 2016 and 2024. Pre-operative and serial post operative assessments included gross total resection, visual outcomes, endocrine outcomes and quality of life measures. Quality of life measures were reported using the Sinonasal Outcome Test (SNOT-22) and Anterior Skull Base Questionnaire (ASBQ-35). Patients’ questionnaires were collected at baseline and sequentially in the first 12 months post operatively.</div></div><div><h3>Results</h3><div>A total of 32 patients underwent endoscopic endonasal resection of craniopharyngioma over the study period. Sino-nasal specific quality of life initially worsened following surgery. As expected, day 1 SNOT-22 scores were significantly worse compared to baseline (mean difference –23.8 (95%CI: −41.4 to −6.17, p = 0.004). Based on the minimum clinically important difference (MCID) of 8.9, SNOT-22 scores remained worse at day 1, 3 and 7 before falling below MCID at week 3. This trend continued out to 6 and 12 months post-operatively with further reduction in mean difference to near zero at 12 months post-operatively (mean difference −0.1 (95%CI: −20.6 to 20.3). In the nasal subdomain, there was a significant increase in symptoms at Day 1 (p = 0.034) and 3 (p = 0.001) while no significant difference was found beginning at day 7 (p = 0.099). Overall quality of life, as measured by the ASBQ-35, was worse at 6 weeks post-operatively compared to baseline (107.0 ± 20.5 v 119.3 ± 18.5; mean change 12.1 (95%CI: 0.5–23.7, p = 0.042). This had returned to normal by 3 months and was maintained at 12 months post-operatively.</div></div><div><h3>Conclusion</h3><div>The endoscopic endonasal is a safe technique with good tumour control and acceptable visual and endocrine outcomes. Post-operative quality of life based on SNOT-22 and ASBQ appears to expediently return to baseline for patients with no evidence of long-term QOL detriment. It is the preferred technique in appropriately selected cases amongst our surgeons.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111927"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172487","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":"Short and long term post-operative outcomes in elderly versus very elderly glioblastoma patients","authors":"Maureen Rakovec ,&nbsp;Linda Tang ,&nbsp;Albert Holler,&nbsp;Sachiv Chakravarti,&nbsp;Anthony Maraviglia,&nbsp;Sumil Nair,&nbsp;David Botros,&nbsp;Chetan Bettegowda,&nbsp;Gary L. Gallia,&nbsp;Debraj Mukherjee","doi":"10.1016/j.jocn.2026.111903","DOIUrl":"10.1016/j.jocn.2026.111903","url":null,"abstract":"<div><h3>Introduction</h3><div>Glioblastoma is the most common and lethal adult primary brain cancer, and its incidence is predicted to increase among older patients. Elderly age has been associated with worse outcomes compared to younger patients with glioblastoma. It is unknown if very elderly patients are at even further increased risk of worse outcomes compared to elderly patients.</div></div><div><h3>Methods</h3><div>Patients ≥ 65 years old with primary glioblastoma treated surgically at a single institution (6/1/2008–12/31/2020) were identified through chart review. Patient demographics, disease characteristics, management data, and clinical outcomes were collected. Kaplan-Meier curves were generated to study overall survival. Chi square, independent t, and Wilcoxon-Mann-Whitney tests were used to identify associations between variables, and factors that affected clinical outcomes were identified using a multivariate logarithmic regression model. P-values &lt; 0.05 were considered significant.</div></div><div><h3>Results</h3><div>A total of 165 elderly (65–74 years) and 79 very elderly (≥ 75 years) patients were included. Compared to elderly patients, very elderly patients were more likely to have a higher mFI-5 score (elderly 0.8 ± 0.9; very elderly 1.2 ± 0.9; p = 0.0018) and lower KPS score (elderly 73.6 ± 16.3; very elderly 69.1 ± 16.3; p = 0.0439) pre-operatively. Very elderly patients were less likely to receive post-operative adjuvant radiotherapy (elderly 70.4 %; very elderly 56.6 %; p = 0.0359) or adjuvant temozolomide chemotherapy (elderly 37.2 %; very elderly 21.3 %; p = 0.0165).</div><div>In multivariate analysis, age ≥ 75 years was an independent predictor of extended ICU (OR 4.71, p = 0.0045) and overall length of stay (OR 2.03, p = 0.0374) compared to elderly patients. Adjuvant chemoradiation was associated with increased median overall survival in both the elderly (p &lt; 0.0001) and very elderly (p &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>Very elderly patients with glioblastoma may be less likely to receive adjuvant chemoradiation than elderly counterparts, but use of these modalities is associated with increased overall survival in both cohorts.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111903"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157229","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":"Determinants of anatomical decompression in symptomatic degenerative cervical myelopathy: A quantitative MRI analysis of unsatisfactory surgical outcomes","authors":"Antonio Montalvo-Afonso ,&nbsp;Vicente Martín-Velasco ,&nbsp;Javier Martín-Alonso ,&nbsp;Rubén Diana-Martín ,&nbsp;José Manuel Castilla-Díez ,&nbsp;Jerónimo González-Bernal ,&nbsp;Pedro David Delgado-López","doi":"10.1016/j.jocn.2026.111908","DOIUrl":"10.1016/j.jocn.2026.111908","url":null,"abstract":"<div><h3>Background</h3><div>While quantitative MRI (qMRI) metrics effectively describe preoperative compression in degenerative cervical myelopathy (DCM), their use in identifying determinants of postoperative anatomical decompression remains limited, particularly in patients with suboptimal clinical trajectories.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we analyzed 40 patients (78 segments) who underwent postoperative MRI due to suboptimal clinical recovery or late neurological worsening. Using Generalized Estimating Equations (GEE) to account for clustered data, we identified determinants for changes in maximum canal compromise (ΔMCC), transverse area of the cervical canal (ΔTACC), maximum spinal cord compression (ΔMSCC), transverse area of the spinal cord (ΔTASC), and compression ratio (ΔCR). Models controlled for surgical approach, demographics, and preoperative severity.</div></div><div><h3>Results</h3><div>Surgical intervention significantly improved all qMRI parameters (p &lt; 0.001). The posterior approach achieved markedly greater canal expansion (ΔTACC B = −34.86, p &lt; 0.001) and better restoration of cord morphology (ΔCR B = −6.33, p = 0.020). However, actual spinal cord re-expansion (ΔMSCC, ΔTASC) was not significantly determined by the surgical approach (p &gt; 0.10) but was primarily constrained by preoperative severity (B = −0.73 and B = −0.81, respectively; both p &lt; 0.001). Notably, isolated anterior compression significantly limited axial cord area re-expansion (B = −15.39, p = 0.018). Patients with ASA III showed significantly less sagittal cord expansion compared to those with ASA II (p = 0.029), while advanced age showed a strong trend toward reduced canal expansion (p = 0.079). Longer intervals to postoperative MRI were associated with greater measured decompression (p &lt; 0.05), suggesting morphometric stabilization after the acute postoperative phase.</div></div><div><h3>Conclusions</h3><div>In patients with suboptimal clinical recovery, a critical dissociation exists: spinal canal expansion is primarily determined by the surgical approach, whereas spinal cord re-expansion is constrained by preoperative severity and the specific compression pattern. These findings define the anatomical boundaries of surgical decompression and suggest that personalized planning must account for the “biological ceiling” of the cord. Quantitative MRI serves as an essential tool for establishing anatomical benchmarks in the postoperative assessment of DCM.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111908"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137589","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 three-dimensional robotic C-arm navigation for ventriculoperitoneal shunt placement: a single-center retrospective study","authors":"Jae Hwan Lee,&nbsp;Sheng-Jia Huang,&nbsp;Li-Wei Sun","doi":"10.1016/j.jocn.2026.111868","DOIUrl":"10.1016/j.jocn.2026.111868","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the accuracy, safety, and clinical outcomes of ventriculoperitoneal (VP) shunt placement using real-time three-dimensional (3D) robotic C-arm navigation in adults with hydrocephalus.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on 82 patients who underwent VP shunt placement in a hybrid operating room between September 2018 and December 2022. All procedures utilized intraoperative 3D robotic C-arm navigation for ventricular catheter placement. Data included demographics, operative details, postoperative imaging, and complications. Catheter tip position was graded, and patients were followed for at least three years.</div></div><div><h3>Results</h3><div>First-pass ventricular access was achieved in all cases. Optimal tip positioning (Grade 1) was observed in 79% of patients, Grade 2 in 20%, and Grade 3 in 1%. The mean operative time was 76.6 ± 20.6 min. Postoperative complications occurred in 7% of patients, primarily related to distal catheter issues; no cerebrospinal fluid–side revisions were required during follow-up.</div></div><div><h3>Conclusion</h3><div>Real-time 3D robotic C-arm navigation enables precise ventricular catheter placement with high first-pass success, and low complication rates. This technique may reduce mechanical shunt failure and warrants prospective comparative studies to confirm its benefits and cost-effectiveness.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111868"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142614","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":"Seizure risk prediction using machine learning following glioma resection surgery in seizure-naïve patients","authors":"Hua Yang ,&nbsp;Hao Wen ,&nbsp;Jiadan Ye ,&nbsp;Li Yang ,&nbsp;Zhigang Zhao","doi":"10.1016/j.jocn.2026.111869","DOIUrl":"10.1016/j.jocn.2026.111869","url":null,"abstract":"<div><h3>Background:</h3><div>Despite the ongoing controversy around the prophylactic use of antiseizure medications (ASMs) in seizure-naïve patients undergoing brain tumor surgery, this practice has persisted for years. This study aims to develop and validate a machine-learning framework for stratifying postoperative seizure risk.</div></div><div><h3>Methods:</h3><div>Demographic, tumor topographic, surgery-related details, and biomarkers were collected from a retrospective study involving patients undergoing glioma resection. The dataset was split in a stratified manner into an 80/20 ratio for training and testing purposes. Machine learning (ML) models, including random forest (RF), XGBoost, gradient boosting decision tree (GBDT), multi-layer perceptron (MLP), bootstrap-aggregation ensemble classifier with decision tree classifier (Bagging), and logistic regression (LR), were developed and evaluated. The SHAP method was applied to interpret the attribution values of the top features.</div></div><div><h3>Results:</h3><div>Among the 786 eligible patients, with a median age of 42.0 years (interquartile range [IQR] = 25.3-54.0), 154 (19.6%) experienced postoperative seizures. The multi-layer perceptron model demonstrated the best predictive performance, incorporating demographic, topographic, surgery-related, and biomarker variables (Test: AUC: 0.74, Accuracy: 0.70, Sensitivity: 0.56, Specificity: 0.73). Notably, a simpler model relying solely on demographic and topographic features also yielded comparable performance.</div></div><div><h3>Conclusions:</h3><div>This study underscores the effectiveness of the multi-layer perceptron model, which integrates demographic, topographic, surgery-related, and biomarker variables. This integration successfully developed a personalized prediction model for postoperative seizure risk. Such a model holds the potential to aid physicians in optimizing postoperative management, particularly in guiding decisions regarding the duration and discontinuation of prophylactic antiseizure medications.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111869"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076232","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":"Decoding the intricacy of insular glioma-lenticulostriate artery relationship: Results from a prospective comparative study of pre and postoperative magnetic resonance angiographic evaluation","authors":"Sudhakar Madheshiya ,&nbsp;Kuntal Kanti Das ,&nbsp;Shreyash Rai ,&nbsp;Vivek Singh ,&nbsp;Sudarsana Gogoi ,&nbsp;Prabhakar Mishra ,&nbsp;Soumen Kanjilal ,&nbsp;Ashutosh Kumar ,&nbsp;Ved Prakash Maurya ,&nbsp;Pawan Kumar Verma ,&nbsp;Kamlesh Singh Bhaisora ,&nbsp;Anant Mehrotra ,&nbsp;Arun Kumar Srivastava ,&nbsp;Awadhesh Kumar Jaiswal","doi":"10.1016/j.jocn.2026.111866","DOIUrl":"10.1016/j.jocn.2026.111866","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Insular glioma (IG) resection is technically demanding and carries a high risk of postoperative neurological deficits, primarily due to ischemic injury to the middle cerebral artery (MCA) perforators. Understanding pre- and postoperative lenticulostriate artery (LSA) anatomy may clarify the tumor-perforator relationship and its clinical impact.</div></div><div><h3>Methods</h3><div>This prospective single-center study analyzed pre- and postoperative three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) to assess IG-LSA relationships. The extent of resection (EOR) and complications were correlated with LSA involvement patterns and postoperative reduction in the number of visible LSAs.</div></div><div><h3>Results</h3><div>LSA involvement patterns included “displaced” (28%), “contact” (56%), and “engulfed” (16%) types. Postoperatively, mean LSA count declined from 3.76 to 3.0 (p = 0.007). Reduction occurred in all patients with engulfed LSAs and in 30% with contact type. Giant IGs were more frequent in contact and engulfed patterns (p = 0.008). Tumors with reduced LSAs were more often oligodendroglioma or glioblastoma than grade 2 astrocytoma (p = 0.004). LSA loss was unrelated to surgical approach but correlated with radical resection (p = 0.019) and neurological deficits (p = 0.001).</div></div><div><h3>Conclusion</h3><div>IGs with LSA engulfment should undergo subtotal resection, whereas contact-type lesions require intraoperative judgment regarding EOR. Radical resection in giant IGs with unsafe tumor-LSA relationships, especially in aggressive histologies, increases the risk of permanent deficits. Not all single-LSA injuries result in lasting impairment. Routine preoperative 3D-TOF MRA is recommended for evaluating IG resectability and minimizing ischemic complications.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111866"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146006771","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}