Journal of Clinical Neuroscience最新文献

{"title":"Impact of smoking on occlusion rates following stereotactic radiosurgery for Spetzler Martin grade I-III brain arteriovenous malformations – A propensity score matched analysis of the MISTA consortium","authors":"Daniel Sconzo ,&nbsp;Felipe Ramirez-Velandia ,&nbsp;Sandeep Muram ,&nbsp;Alejandro Enriquez-Marulanda ,&nbsp;Coleman P. Riordan ,&nbsp;Nimer Adeeb ,&nbsp;Basel Musmar ,&nbsp;Hamza Adel Salim ,&nbsp;Sandeep Kandregula ,&nbsp;Adam A. Dmywtriw ,&nbsp;Ahmed Abdelsalam ,&nbsp;Cagdas Ataoglu ,&nbsp;Ufuk Erginoglu ,&nbsp;Douglas Kondziolka ,&nbsp;Assala Aslan ,&nbsp;Kareem El Naamani ,&nbsp;Jason Sheehan ,&nbsp;Min S. Park ,&nbsp;Hussein A. Zeineddine ,&nbsp;Natasha Ironside ,&nbsp;Christopher S. Ogilvy","doi":"10.1016/j.jocn.2025.111411","DOIUrl":"10.1016/j.jocn.2025.111411","url":null,"abstract":"<div><h3>Background<!--> <!-->and Objective</h3><div>The authors compare<!--> <!-->occlusion rates in grade I-III AVMs in smokers and non-smokers, using propensity score matching (PSM).</div></div><div><h3>Methods</h3><div>The authors performed a subgroup analysis of the MISTA consortium, a multicenter registry that includes patients aged 1 to 89 years with AVMs treated between January 2010 and December 2023. Only grade I-III AVMs were included. PSM was used to control confounders. Primary endpoints included angiographic obliteration.</div></div><div><h3>Results</h3><div>A total of 353 patients with bAVMs, with a median age of 37, were included in this study: 236 were never smokers, and 117 were current or previous smokers. After 1:1 PSM of smokers and non-smokers, 33 matched pairs were obtained. The smokers were more likely to display complete obliteration at last imaging follow-up compared to non-smokers (57.6 % vs. 27.3 %;<!--> <em>p &lt; 0.01</em>). The median time to last clinical<!--> <em>(p = 0.45)</em> <!-->and angiographic<!--> <em>(p = 0.33)</em> <!-->follow up was not statistically different between the two groups.<!--> <!-->There were no statistically significant differences between the two matched groups in the incidence of post-SRS edema (<em>p = 0.23</em>), post-treatment rupture (0 %), overall mortality (<em>p = 0.31</em>), and functional status at the last follow-up (<em>p = 0.69</em>).</div></div><div><h3>Conclusion</h3><div>Individuals with a positive history of smoking are more likely to achieve complete obliteration of grades I-III bAVMs following SRS treatment. However, smokers do not differ from non-smokers in terms of the incidence of post-treatment rupture, overall mortality, or functional status at the last follow-up.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489621","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":"Predictors of frame-based SEEG electrode implantation accuracy","authors":"Thanomporn Wittayacharoenpong ,&nbsp;Matthew Gutman ,&nbsp;Martin Hunn ,&nbsp;Jacob Bunyamin ,&nbsp;Zhibin Chen ,&nbsp;Simon Vogrin ,&nbsp;Wendyl D’Souza ,&nbsp;Amy Halliday ,&nbsp;Kristian Bulluss ,&nbsp;Udaya Seneviratne ,&nbsp;Cecilia Harb ,&nbsp;Paul Beech ,&nbsp;Matt Hudson ,&nbsp;Haris Hakeem ,&nbsp;Terence J. O’Brien ,&nbsp;Patrick Kwan ,&nbsp;Joshua Laing ,&nbsp;Andrew Neal","doi":"10.1016/j.jocn.2025.111430","DOIUrl":"10.1016/j.jocn.2025.111430","url":null,"abstract":"<div><h3>Background</h3><div>Factors affecting electrode accuracy in stereo-electroencephalography (SEEG) implantation have been inconsistently reported. In the setting of a recent expansion in stereotactic implantation techniques, we examined pre- and post-implantation variables influencing electrode accuracy, as well as factors contributing to unsuccessful sampling intended sub-lobar target from traditional frame-based method in order to provide a comprehensive reference for future implantation.</div></div><div><h3>Methods</h3><div>We analyzed consecutive patients who underwent frame-based SEEG implantations at two Australian centers. Pre-implantation MRI was co-registered with post-implantation CT to obtain planned and actual trajectories (PT/AT). Absolute target error (Euclidean distance), radial error (perpendicular to PT), and depth error (parallel to PT) were calculated between AT and PT. Pre- and post-implantation factors, including electrode trajectory and anatomical factors, were collected. AT were classified as <em>off-target</em> if they did not sample the intended cortical target/s. Multivariate generalized linear mixed model assessed factors associated with bone entry and radial errors. Binomial regression was employed to examine predictive factors for <em>off-target</em> electrodes.</div></div><div><h3>Results</h3><div>We collected data from 629 electrodes across 50 patients (12.58 ± 2.50 electrodes/patient). Median absolute, radial, depth errors, and bone entry point localization error (BEPLE) were 1.85 [IQR1.23–2.58], 1.56 [IQR0.95–2.26], 0.57 [IQR0.23–1.07] and 1.09[IQR0.74–1.45] mm, respectively. Fifty-four (8.59 %) electrodes were <em>off-target</em> and 19.89 %(41/207) of electrodes with radial error exceeded the 2 mm safety margin and were off-target. Of the pre-implantation factors, trajectory angle on the coronal plane (p = 0.01), bone thickness (p &lt; 0.001), and implantation depth (p = 0.001) predicted radial errors. BEPLE, p &lt; 0.001), bone thickness (p &lt; 0.001) and implantation depth (p = 0.001) were significant post-implantation predictive factors. <em>Off-target</em> trajectories were associated with bone thickness (p &lt; 0.001) and trajectory angle (p = 0.01) for pre-implantation and radial error (p &lt; 0.001) for post-implantation variables.</div></div><div><h3>Conclusions</h3><div>This study analyzed predictive factors of electrode accuracy using a traditional frame-based technique to provide a comprehensive reference. Electrode target radial error is strongly predicted by increased implantation depth, bone thickness along the trajectory, and electrode angle at bone entry. Increased radial error is strongly associated with electrodes missing the intended sub-lobar target. Further research is required to investigate the full clinical implications of electrode inaccuracy.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111430"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501205","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":"Helmet versus non-helmet treatment in infants with positional cranial deformation: A systematic review and meta-analysis","authors":"Yan Gondim de Sousa ,&nbsp;Thiago Luís Marques Lopes ,&nbsp;Áquila Matos Soares ,&nbsp;Marconny Alexandre Cavalcante ,&nbsp;Júlio Farias Rangel ,&nbsp;Leonardo de Macedo Filho ,&nbsp;Mateus Dutra Balsells ,&nbsp;Daniel Andrade Gervásio ,&nbsp;Isabela Fernandes de Melo Pereira ,&nbsp;Andressa Gabriella Duarte de Queiroz ,&nbsp;Miguel Vieira de Almeida ,&nbsp;George Pessoa Amorim Neto ,&nbsp;Cintia Gonçalves Urbano Cavalcante ,&nbsp;Lucas Alverne Freitas de Albuquerque","doi":"10.1016/j.jocn.2025.111431","DOIUrl":"10.1016/j.jocn.2025.111431","url":null,"abstract":"<div><h3>Background</h3><div>Active repositioning and cranial orthoses are the primary treatment choices for positional cranial deformation (CD). However, the superiority of helmet therapy over non-helmet therapies remains controversial. We conducted a <em>meta</em>-analysis of cranial asymmetry (CA) parameters from studies comparing helmet therapy to non-helmet therapy in infants with non-synostotic CD.</div></div><div><h3>Methods</h3><div>We systematically reviewed the literature from PubMed, Embase, and Cochrane databases. Exclusion criteria included lack of a control group, overlapping populations, and solely qualitative outcomes. Statistical analysis was performed using Review Manager 5.4.1.</div></div><div><h3>Results</h3><div>From the 788 articles identified, 13 were included, with 1189 infant patients. Treatment outcomes were measured using the Cranial Vault Asymmetry Index (CVAI), Cranial Index, and Diagonal Difference. From 10 studies incorporating all three scales, helmet were used in 509/980 (52 %) patients. The average follow-up period was 20.95 ± 23.84 months. The reduction in CA (SMD: −1.16; 95 % CI: [-1.66, −0.67]; p &lt; 0.00001; I² = 90 %) was more pronounced in the helmet group. Using only CVAI, there was a more significant improvement in CA (SMD: −1.29; 95 % CI: [-1.97, −0.62]; p = 0.0002; I² = 90 %) in the helmet group. When subdividing the non-helmet group into natural course and repositioning, there are greater improvements in the helmet group, both in relation to the natural course group (SMD: −1.37; 95 % CI: [-2.31, −0.43]; p = 0.004; I² = 94 %) and in relation to the repositioning group (SMD: −1.16; 95 % CI: [-2.01, −0.31]; p = 0.008; I² = 64 %). Comparing only CVAI for the helmet group, we observed a significant decrease (SMD: −1.70; 95 % CI: [-2.01, −1.39]; p &lt; 0.00001; I² = 48 %) compared to the non-helmet group (SMD: −0.54; 95 % CI: [-0.79, −0.29]; p &lt; 0.0001; I² = 25 %).</div></div><div><h3>Conclusion</h3><div>Our <em>meta</em>-analysis demonstrated that, in the short term, helmet therapy is significantly more effective in correcting cranial positional deformities than therapy that does not use orthoses. Nonetheless, due to study limitations and high heterogeneity, caution is necessary in interpreting these results and their clinical application. More high-quality randomized clinical trials are necessary to confirm these findings and assess the long-term effects of helmet therapy.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111431"},"PeriodicalIF":1.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490758","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 comparison of prone versus sitting position for the surgical treatment of Chiari malformation type I in children","authors":"Pasquale Gallo ,&nbsp;Fardad T. Afshari ,&nbsp;Catalina Stendall ,&nbsp;Chandrasekaran Kaliaperumal ,&nbsp;Mary Cheung","doi":"10.1016/j.jocn.2025.111429","DOIUrl":"10.1016/j.jocn.2025.111429","url":null,"abstract":"<div><h3>Objective</h3><div>Posterior fossa decompression and duroplasty (PFD-D) for Chiari type I malformation (CM-I) is usually performed in the prone position. Nevertheless, few centres routinely perform it in sitting position. This study aims to compare, for the first time in the literature, the <em>peri</em>-operative surgical and anaesthesiologic outcomes of two similar cohorts of paediatric patients with CM-I treated with PFD-D in prone and sitting position.</div></div><div><h3>Methods</h3><div>Patients younger than 17 years old, who had undergone PFD-D for CM-I performed by a single surgeon between November 2013 and June 2024, were included. Surgical time, intraoperative and perioperative events, and post-operative complications were recorded. All patients had at least a 10-month follow-up.</div></div><div><h3>Results</h3><div>Twenty-seven patients were operated in the prone position [mean age: 9.3 years, M/F: 0.59] and twenty-five in the sitting position [mean age: 11.3 years, M/F 0.47]. 15/27 (55 %) in the prone group and 13/25 (52 %) in the sitting group had pre-operative syringomyelia. The mean operative time in sitting was significantly shorter (143 min) compared to 175 min in the prone position (p &lt; 0.001), particularly in high BMI &gt; 30 patients. Complications in the prone cohort included 3 post-operative pseudomeningocele (11.1 %), 3 aseptic meningitis (1 %), 1 CSF leakage (3.7 %), and 1 post-infective hydrocephalus requiring VP shunt insertion (3.7 %). In the sitting position, 1 patient developed pseudomeningocele (4 %), and another patient had a post-operative hydrocephalus (4 %) successfully treated with an endoscopic third ventriculostomy. No patient in this series developed clinical air embolism or tension pneumocephalus.</div></div><div><h3>Conclusions</h3><div>The study did not show any significant difference in the surgical and anaesthetic complications between the two groups of patients. Sitting position for CM-I when performed by a trained neuro-anaesthesiologic team is a safe option with similar clinical outcomes compared to the prone position.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111429"},"PeriodicalIF":1.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481295","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":"Minimally invasive surgery versus craniotomy for intracerebral hemorrhage: An updated systematic review and meta-analysis of randomized clinical trials","authors":"Lucas de Oliveira Woehl ,&nbsp;PedroVicentini Denardi ,&nbsp;Maria Luísa Corrêa Scalco ,&nbsp;Emanuel Schumacher Pereira ,&nbsp;Frederico de Lima Gibbon ,&nbsp;Paulo Valdeci Worm","doi":"10.1016/j.jocn.2025.111407","DOIUrl":"10.1016/j.jocn.2025.111407","url":null,"abstract":"<div><div>Intracerebral hemorrhage (ICH) is a severe stroke with high mortality and incapacity rates, treatable by minimally invasive surgery (MIS) or craniotomy. However, the optimal surgical approach remains unclear. This study compares the outcomes of MIS and craniotomy for ICH patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. PubMed, Embase, Cochrane, and Web of Science were searched for randomized controlled trials (RCTs) comparing MIS and craniotomy for ICH patients. The Mantel-Haenszel and inverse variance tests were used for binary and continuous outcomes, respectively. We assessed favorable functional outcomes, intraoperative blood loss, operation time, rebleeding and mortality. R 4.4.2 was used for all statistical analyses. The risk of bias was evaluated with the Cochrane tool RoB 2. Of 1,247 potential articles, 12 RCTs met the eligibility criteria, comprising a total of 2,454 patients, with 1,368 (55.8 %) and 1,086 (44.2 %) patients in the MIS and craniotomy groups, respectively. MIS was superior to craniotomy in improving functional outcome (RR: 1.41; 95 % CI 1.26, 1.58; <em>p</em> &lt; 0.001), and both neuroendoscopy and minimally invasive puncture surgery subgroups also showed a benefit over craniotomy. Intraoperative blood loss was reduced with neuroendoscopy (MD: −158.50; 95 % CI −257.57, −59.44; <em>p</em> = 0.002). MIS also resulted in shorter operation time (MD: −109.51; 95 % CI −144.31, −74.71; <em>p</em> &lt; 0.001). Rebleeding and mortality rates did not reach statistical significance. MIS was associated with better functional outcomes, lower intraoperative blood loss, and shorter operative time compared with craniotomy.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111407"},"PeriodicalIF":1.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481823","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":"Neuromonitoring of recurrent laryngeal nerve using continuous intraoperative neuromonitoring system during anterior cervical spine surgery: A porcine model study","authors":"Dong Suk Kim ,&nbsp;Tae Sik Goh ,&nbsp;Yoon Jae Cho ,&nbsp;Jung Sub Lee","doi":"10.1016/j.jocn.2025.111427","DOIUrl":"10.1016/j.jocn.2025.111427","url":null,"abstract":"<div><h3>Purpose</h3><div>Recurrent laryngeal nerve (RLN) injury is a recognized complication of anterior cervical spine surgery (ACSS), particularly during anterior cervical discectomy and fusion (ACDF). This study explores the use of continuous intraoperative neurophysiological monitoring (CIONM) with an endotracheal electromyography (EMG) tube during ACSS in a porcine model, focusing on adverse EMG signal events during retraction and the differences in RLN injury and recovery between surgical levels and approach side (left or right).</div></div><div><h3>Materials and methods</h3><div>All 12 pigs were intubated with an EMG-equipped endotracheal tube. All surgical procedures were performed via an anterior approach. RLN injury caused by traction was assessed in four segments (C3/4, C4/5, C5/6, C6/7) on both sides, respectively. Laryngeal EMG was continuously measured through electrical stimulation of the vagus nerve using automatic periodic stimulation with CIONM. During surgery, an alarm was set to activate if the EMG amplitude decreased by more than 50% or latency increased by more than 10%, indicating nerve injury. When the alarm was triggered, traction was stopped, and EMG changes were observed. Traction time and recovery time were recorded until the EMG returned to baseline.</div></div><div><h3>Results</h3><div>There were no statistically significant differences in traction or recovery times between the left and right sides (p &gt; 0.05). However, traction times significantly differed by cervical level (p &lt; 0.001), with longer durations at C3/4 and C4/5. Recovery times also differed significantly by level (p &lt; 0.001), with notably prolonged recovery at C6/7, where some nerves failed to return to baseline within 30 min.</div></div><div><h3>Conclusion</h3><div>These findings suggest that lower cervical levels, particularly C6/7, are more vulnerable to nerve damage, requiring heightened attention during ACSS. The study highlights the advantages of CIONM, including real-time detection of RLN stretch and its benefits during complex surgeries.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111427"},"PeriodicalIF":1.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481294","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 finite element biomechanical investigation of lumbar spine segments through novel intervertebral disc design","authors":"Ashutosh Khanna ,&nbsp;Pushpdant Jain ,&nbsp;C.P. Paul","doi":"10.1016/j.jocn.2025.111425","DOIUrl":"10.1016/j.jocn.2025.111425","url":null,"abstract":"<div><div>Advancements in laser additive manufacturing have significantly contributed to the design and optimization of complex, biomimetic, and patient-specific spinal implants, particularly intervertebral disc (IVD) replacements. The proposed study investigates the biomechanical performance of a novel titanium alloy artificial IVD, engineered with an auxetic cellular core to restore spinal stiffness while enhancing biocompatibility and mechanical compliance. A validated finite element (FE) model of the lumbar spine was established from DICOM datasets, incorporating anatomically accurate geometries and material properties for cortical and cancellous bone, annulus fibrosus (AF), nucleus pulposus (NP), and major spinal ligaments. Simulations were conducted to compare the mechanical responses of stress, strain, and deformation for the intact spine (ISM), the spine implanted with a SB Charité™ (SBC), and a proposed novel implant (XCEL). Loading conditions along with human physiological motion activities such as flexion, extension, lateral bending, and twisting were considered. For one of the key results obtained by the application of a 1000 N compressive load and 10 Nm moment during the twisting motion, the maximum von-Mises stress observed was 116 MPa, 191.82 MPa, and 127.45 MPa in ISM, SBC, and XCEL, respectively. The proposed implant demonstrated improved stress distribution and mechanical resilience. Moreover, the auxetic core, characterized by a re-entrant geometry and the endplate curvatures closely mimicked those of natural lumbar vertebral endplates. Range of motion (ROM) analysis under flexion revealed the values of 17.3°, 11.9° and 11° for ISM, SBC and XCEL respectively. These findings confirm the suitability of the titanium alloy-based implant to restore near physiological ROM and spinal mechanics. The predicted parameters revealed that XCEL geometry implant can be engineered to the required ROM, effectively restoring natural biomechanics when replacing a natural IVD, highlighting its future clinical potential. Advanced models can be applied to customized, patient-oriented design, micro-structure mimicking manufacturing, pre-surgery planning, clinical follow-up, testing, and overall implant success.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111425"},"PeriodicalIF":1.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490759","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":"Lentiform fork sign in acute onset chorea after vomiting and diarrhea","authors":"Carolina Correia ,&nbsp;Rafaela Costa ,&nbsp;Luísa Sampaio ,&nbsp;Pedro Abreu ,&nbsp;Carolina Soares","doi":"10.1016/j.jocn.2025.111421","DOIUrl":"10.1016/j.jocn.2025.111421","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111421"},"PeriodicalIF":1.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490760","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":"Application, utility and safety of intraoperative 3T magnetic resonance imaging in pediatric epilepsy surgery: A 10-year retrospective single-center experience","authors":"Arthur R. Kurzbuch ,&nbsp;Ben Cooper ,&nbsp;John Kitchen ,&nbsp;Andrea McLaren ,&nbsp;Volker Tronnier ,&nbsp;Jonathan R. Ellenbogen ,&nbsp;on behalf of the NorCESS Team","doi":"10.1016/j.jocn.2025.111392","DOIUrl":"10.1016/j.jocn.2025.111392","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative magnetic resonance imaging (ioMRI) is increasingly used in neurosurgery to enhance surgical precision and decision-making. However, its implementation remains limited due to high costs, infrastructure demands, and workflow considerations. While well studied in adult neurosurgery, the role of ioMRI in pediatric epilepsy surgery is less clear. Reported challenges include wound complications, infections, and positioning difficulties. This study evaluates the application, utility, and safety of intraoperative 3T MRI in pediatric epilepsy surgery over a ten-year period at a tertiary specialized referral center.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed data from all pediatric epilepsy surgeries performed between 2013 and 2022 in our unit. We reviewed patient demographics, the treated pathologies, the application of intraoperative 3T MRI (ioMRI), the extent of continued ioMRI-guided surgery, seizure outcomes at one year postoperatively, and the requirement for reoperation. Intraoperative MRI-related complications documented within 90 days of surgery were also assessed.</div></div><div><h3>Results</h3><div>Altogether, 125 pediatric epilepsy patients underwent surgery. Resections were performed in 107 (85.6 %) and disconnection procedures in 18 (14.4 %) patients. Their overall median age was 10 years (range 0.5–19 years). In total, 108 (86.4 %) patients underwent surgery with ioMRI. Of these, 91 (84.3 %) had resection and 17 (15.7 %) had disconnection surgery. Of the 108 patients with ioMRI 56 (51.9 %) returned to theater, 45 (49.5 %) out of 91 for further resection, and 11 (64.7 %) out of 17 to complete disconnection. Thirteen (12 %) of the 108 patients were reoperated upon later in another session. In total, 17 (13.6 %) patients had surgery without ioMRI, 16 (94.1 %) of these for resection and 1 (5.9 %) for disconnection surgery; of these 3 (17.6 %) were reoperated upon later in another session. The complication rate for surgeries performed with ioMRI was 3.7 %. There were no wound healing disorders, position-related damages, or anesthesia-related complications.</div></div><div><h3>Conclusions</h3><div>While the technology may present certain logistical and financial challenges, we observed a lower rate of reoperations and a low complication rate in ioMRI-guided resective epilepsy surgeries in children compared to surgeries without ioMRI. These findings require confirmation through larger, multi-center studies to better define the role of ioMRI in pediatric epilepsy surgery.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"138 ","pages":"Article 111392"},"PeriodicalIF":1.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471980","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":"Comparison of microdiscectomy and fragmentectomy on clinical outcomes for single level lumbar disc herniation: a systematic review and meta-analysis of comparative studies","authors":"James Kelbert ,&nbsp;Nikhil Dholaria ,&nbsp;Giovanni Barbagli ,&nbsp;Diego T. Soto Rubio ,&nbsp;Annie Pico ,&nbsp;Courtney Deaver ,&nbsp;Amna Hussein ,&nbsp;Michael Prim ,&nbsp;Ali Baaj","doi":"10.1016/j.jocn.2025.111416","DOIUrl":"10.1016/j.jocn.2025.111416","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar disc herniation can lead to radiculopathy, pain, and weakness. Surgery is indicated if patients remain symptomatic despite medical management, or if they develop significant neurological deficits like footdrop or cauda equina syndrome. There is no consensus on whether fragmentectomy alone or aggressive discectomy leads to improved resolution of radicular pain and leads to lower reherniation rates. To the best of our knowledge, this systematic review presents the most comprehensive and up-to-date evaluation of comparative studies comparing microdiscectomy and fragmentectomy within the last ten years.</div></div><div><h3>Methods</h3><div>A systematic review was conducted according to PRISMA guidelines. A search was conducted on March 19th, 2024, of PubMed, EMBASE, Scopus and Web of Science databases. The systematic review software Rayyan was used to include or exclude studies with additional filters. After full text analysis for final inclusion, demographic data as well as those regarding reherniation rates and changes in axial and radicular pain were collected. Continuous meta-analysis and meta-analysis of proportions were conducted using R versions 4.3.3. Radiographic changes were described qualitatively, as there was not enough quantitative evidence to metaanalyze.</div></div><div><h3>Results</h3><div>A total of 9 comparative studies with 574 microdiscectomy and 449 fragmentectomy only patients were ultimately included after screening through a total of 183 unique papers. A random effects model meta-analysis of axial pain found a standardized mean difference of 0.09 [−0.33, 0.51] (p = 0.67) with an I2 of 91%. A random effects model meta-analysis of radicular pain demonstrated an overall standardized mean difference of 0.01 [−0.14, 0.17] (p = 0.87) with an I2 of 0%. Metaanalysis of proportions for reherniation showed a relative risk of 0.96 [0.54, 1.71] (p = 0.88) with an I2 of 0%. Reoperation rates between groups showed a relative risk of 0.86 [0.47, 1.55] (p = 0.61) with an I2 of 0%. The relative risk of complication rates was 0.96 [0.35, 2.66] (p = 0.93) with an I2 of 0 %.</div></div><div><h3>Conclusions</h3><div>There is no statistically significant difference between VAS axial and radicular pain relief after fragmentectomy alone or aggressive microdiscectomy based on this meta-analysis. The reherniation rate was 5 % for both groups and similarly there was no difference between reoperation and complication rates. Despite advances in technique, technology, and our understanding of lumbar disc herniation, this current and comprehensive review demonstrates that both fragmentectomy and aggressive microdiscectomy are equally effective.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111416"},"PeriodicalIF":1.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481117","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}