Journal of Clinical Neuroscience最新文献

{"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}

{"title":"Neurosyphilis presenting with extensive longitudinal Myelitis: an illustrative case","authors":"Joana Freitas,&nbsp;Filipa Proença","doi":"10.1016/j.jocn.2026.111879","DOIUrl":"10.1016/j.jocn.2026.111879","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111879"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125029","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":"Trends and disparities in cerebral edema-related mortality in the United States: A nationwide analysis using CDC WONDER data, 1999–2023","authors":"Hadiya Javed ,&nbsp;Shahtaj Tariq ,&nbsp;Wania Ahmer ,&nbsp;Muhammad Khalid Afridi ,&nbsp;Raheel Ahmed","doi":"10.1016/j.jocn.2026.111871","DOIUrl":"10.1016/j.jocn.2026.111871","url":null,"abstract":"<div><div>Cerebral edema (CE) refers to excess accumulation of fluid in the brain parenchyma, which can result from trauma, stroke, infections, or metabolic insults. Despite its clinical importance, national trends and disparities in CE-related mortality remain understudied. We analyzed mortality data from 1999 to 2023 using the CDC WONDER database. Deaths listing CE, defined by the International Classification of Diseases, 10th Revision, as a contributing cause were included. The trends were stratified by age, sex, race/ethnicity, region, and urbanization level. We calculated crude and age-adjusted mortality rates (AAMRs) and assessed trends using the Joinpoint Regression Program with results considered statistically significant if the two-sided <em>t</em>-test yielded p-values &lt; 0.05. A total of 77,278 CE-related deaths occurred from 1999 to 2023. National AAMRs rose from 0.94 per 100,000 population in 1999 to 1.3 per 100,000 population in 2023, with a significant overall increase (AAPC: +1.41 %, 95 % CI: 1.2–1.6; p &lt; 0.001). Adults aged 25–44 exhibited the sharpest rise (AAPC: 1.56 %; 95 % CI: 1.33 to 1.81). Black individuals experienced the highest mortality (peak AAMR: 0.43, AAPC: +2.08 %, 95 % CI: 1.67–2.51). The South showed the highest regional burden (AAMR: 0.32, AAPC: +1.59 %, 95 % CI: 1.38–1.79), while non-metropolitan areas reported disproportionately high mortality rates (AAPC: +2.4 %, 95 % CI: 1.5–3.2; p &lt; 0.001). CE-related mortality has increased significantly in the U.S., with marked disparities by age, race, and geography. These findings highlight the need for targeted prevention, early detection, and equity-focused intervention strategies.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111871"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037283","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":"Clinical and surgical significance of the jugular foramen anatomy: systematic review with meta-analysis","authors":"Nikolaos Taprantzis,&nbsp;Dimosthenis Chrysikos,&nbsp;Amir Shihada,&nbsp;Maria Piagkou,&nbsp;Theodore Troupis","doi":"10.1016/j.jocn.2026.111881","DOIUrl":"10.1016/j.jocn.2026.111881","url":null,"abstract":"<div><h3>Background</h3><div>The jugular foramen, at the junction of the temporal and occipital bones, contains critical neurovascular structures. Variations such as high-riding bulbs, bony domes, and septations can influence clinical syndromes and complicate surgery. While some reviews address individual features, no <em>meta</em>-analysis has comprehensively evaluated jugular foramen morphology and its clinical and surgical significance.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, Web of Science, and Scopus for studies reporting jugular foramen morphometry, including dome presence, septations, fossa depth, and high jugular bulbs. Pooled prevalence estimates were calculated using R programming software, with heterogeneity and risk of bias assessed via AQUA, Peter’s, and Egger’s tests.</div></div><div><h3>Results</h3><div>Our <em>meta</em>-analysis revealed significant intercontinental and sex-related variations in jugular foramen morphology. African populations had fewer bilateral domes (20% vs. ∼54–55%), higher dome absence (53.7% vs. &lt;13%), and larger AP diameters, while high-riding bulbs were more common in Asia (16.52%). Magnetic Resonance Imaging was associated with a significantly lower high jugular bulb prevalence, compared to osteological assessments and Computed Tomography-based techniques. Males showed slightly larger mediolateral dimensions, whereas females had a modestly higher incidence of high-riding bulbs (ratio 1.33). Bony septum analysis showed left partial septation as the most common pattern, with complete septations in 15.05% (right) and 12.11% (left) of individuals, indicating additional clinically relevant anatomical variation.</div></div><div><h3>Conclusion</h3><div>Anatomical variations of the jugular foramen—including asymmetry, dome morphology, high-riding bulbs, and septations—have direct clinical implications. They influence neurovascular compression, risk of hearing disturbances, tumor extension, and surgical planning for middle ear and skull base procedures. Recognition of these patterns is essential for safe operative navigation, minimizing intraoperative complications, and optimizing patient outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111881"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037286","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":"Experience-driven differences in acute ischemic stroke management: A nationwide study","authors":"Gao Yu ,&nbsp;Ge Manyue ,&nbsp;Jiang Yi ,&nbsp;Pang Miao ,&nbsp;Zhang Bin ,&nbsp;Zhang Xiaoxi ,&nbsp;Zhang Yongwei ,&nbsp;Dai Zhao ,&nbsp;Yang Pengfei ,&nbsp;Liu Jianmin","doi":"10.1016/j.jocn.2026.111882","DOIUrl":"10.1016/j.jocn.2026.111882","url":null,"abstract":"<div><h3>Introduction</h3><div>Recent advancements in endovascular thrombectomy (EVT) devices and pivotal trial evidence have revolutionised acute ischemic stroke management. However, translational gaps persist between guideline recommendations and real-world practice, particularly regarding operator experience-dependent technical preferences in resource allocation.</div></div><div><h3>Methods</h3><div>A national survey with 53 questions was designed to extract information regarding strategy decisions and clinical scenarios, including technical variations of thrombectomy and thrombolysis, blood pressure preference. The survey link was sent individually via email with a website link.</div></div><div><h3>Results</h3><div>1,289 responses from 883 hospitals were obtained and were included in the final analysis. Junior physicians exhibited reluctance to deviate from thrombolysis-centric paradigms, while senior physicians preferred thrombectomy. Conversely, junior physicians were more likely to use Balloon-guide catheters (BGC), thrombolysis after thrombectomy, local anesthesia, and radial access.</div></div><div><h3>Conclusion</h3><div>This nationwide study highlights significant heterogeneity in acute ischemic stroke management among Chinese physicians, driven by experience-based differences. Findings underscore the need for stratified training, standardized protocols, and collaborative platforms to harmonize practice and accelerate evidence translation.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111882"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076228","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 low body mass index on stroke outcomes: A propensity-matched analysis.","authors":"Barbara Buccilli","doi":"10.1016/j.jocn.2026.111875","DOIUrl":"10.1016/j.jocn.2026.111875","url":null,"abstract":"<p><strong>Introduction: </strong>Body mass index (BMI) influences stroke outcomes, but the impact of being underweight remains understudied. This analysis examines whether underweight status (BMI < 19.9) is associated with worse post-stroke outcomes compared to ideal BMI (20-24.9). We aim to evaluate functional and clinical outcomes in stroke patients with low BMI versus those with ideal weight.</p><p><strong>Methods: </strong>Using TriNetX data from the Mount Sinai Health System, we identified adult patients with ischemic stroke (ICD-10: I63) and categorized them based on BMI: ideal weight (BMI 20-24.9, n = 2,640) and underweight (BMI < 19.9, n = 1,610). Propensity score matching on demographics and comorbidities yielded two balanced cohorts of 1,600 patients each. We assessed outcomes over a 2-year follow-up, including modified Rankin Scale (mRS > 2), pneumonia, and survival probability using Kaplan-Meier analysis.</p><p><strong>Results: </strong>Underweight patients had a higher incidence of poor functional outcome (mRS > 2: 18.1 % vs 14.4 %; RR 1.26, p = 0.004), with a lower survival probability at 2 years (79.3 % vs 83.7 %; log-rank p = 0.002). Pneumonia occurred more frequently in the underweight group (8.8 % vs 6.9 %; p = 0.048). No significant differences were observed in rates of repeat stroke, motor deficits, or hemorrhagic transformation. Use of thrombolytics, thrombectomy, or need for intubation did not differ significantly.</p><p><strong>Conclusion: </strong>Underweight status is associated with poorer functional outcomes, increased pneumonia risk, and reduced survival following ischemic stroke compared to patients with ideal BMI. These findings support the consideration of nutritional status in post-stroke care planning and risk stratification.</p>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"111875"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146040875","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":"Development and temporal validation of an odds ratio-weighted prognostic score (NPH-RKP) for idiopathic normal pressure hydrocephalus shunt surgery: a retrospective cohort study","authors":"Usame Rakip ,&nbsp;Serhat Yildizhan ,&nbsp;İhsan Canbek ,&nbsp;Mehmet Gazi Boyacı ,&nbsp;Serhat Korkmaz ,&nbsp;Omer Kimsesiz ,&nbsp;Abdullah Guzel ,&nbsp;Anas Abdallah ,&nbsp;Adem Aslan","doi":"10.1016/j.jocn.2026.111883","DOIUrl":"10.1016/j.jocn.2026.111883","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic normal pressure hydrocephalus (iNPH) is a major cause of reversible gait and cognitive impairment in older adults, yet postoperative outcomes remain difficult to predict. Existing prognostic tools are limited by methodological shortcomings, including lack of temporal validation, dependence on subjective radiological markers, insufficient events-per-variable ratios, and absence of transparent graded risk stratification. To address these gaps, we developed the first temporally validated, odds ratio–weighted prognostic scoring system specifically designed for iNPH surgical outcomes.</div></div><div><h3>Methods</h3><div>This single-center retrospective study included 114 consecutive patients treated with ventriculoperitoneal shunting between 2015 and 2024. Candidate predictors were systematically assessed, and the Normal Pressure Hydrocephalus Risk-Prediction Score (NPH-RKP) was constructed using five objective clinical variables routinely available in standard practice: age, iNPH Grading Scale score, Mini-Mental State Examination (MMSE), Fazekas score, and diagnostic delay. Four competing scoring frameworks were compared, and the odds ratio-weighted graded model was selected based on performance and interpretability. The dataset was temporally divided into development (2015–2020, n = 59) and validation (2021–2024, n = 55) cohorts. The primary endpoint was global clinical improvement at 12 months, incorporating gait, cognitive, and urinary metrics.</div></div><div><h3>Results</h3><div>Multivariable modeling identified five independent predictors (OR range: 2.00–4.14, 95% CI: 1.82–9.42). The resulting 0–12-point NPH-RKP score demonstrated excellent discrimination in the development cohort (AUC = 0.939, 95% CI: 0.881–0.985) with strong calibration (Hosmer–Lemeshow p = 0.511; Brier score = 0.113). Temporal validation revealed retained prognostic accuracy (AUC = 0.824, 95% CI: 0.715–0.933), with expected performance attenuation attributable to evolving clinical practice and improved surgical outcomes. Distinct risk strata yielded sharply separated success rates: low-risk (0–4 points, 91.4%), intermediate-risk (5–7 points, 62.5%), and high-risk (8–12 points, 8.3%). The model achieved a robust EPV of 7.8, outperforming prior iNPH tools while maintaining ease of calculation.</div></div><div><h3>Conclusions</h3><div>The NPH-RKP provides a transparent, clinically accessible, and methodologically rigorous prognostic framework for predicting iNPH shunt outcomes. Its objective parameters, grading structure, and temporal validation enhance its clinical applicability in routine decision-making and patient counseling. Prospective multicenter validation is warranted to confirm its generalizability across diverse healthcare settings.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111883"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063802","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":"Geographic disparities in the supply, demand, and adequacy of the United States neurologist workforce","authors":"Jason Silvestre,&nbsp;Robert J. Ferdon,&nbsp;Robert A. Ravinsky,&nbsp;Charles A. Reitman","doi":"10.1016/j.jocn.2026.111855","DOIUrl":"10.1016/j.jocn.2026.111855","url":null,"abstract":"<div><h3>Background</h3><div>The primary objectives of this study were to determine disparities in the supply, demand, and adequacy of the United States (US) neurologist workforce utilizing projections from the Health Resources and Services Administration (HRSA).</div></div><div><h3>Methods</h3><div>This was an analysis of US-based neurologists leveraging data from the HRSA. Supply and demand were defined as the number of full-time equivalent (FTE) neurologists working and needed, respectively. Adequacy was defined as the ratio of supply over demand. Linear regression was used to analyze neurologist workforce trends from 2024 to 2037.</div></div><div><h3>Results</h3><div>From 2024 to 2037, the national supply of neurologists was projected to increase from 21,010 to 23,310 FTEs (10.9 % increase, P &lt; 0.001). Over the study period, the demand for neurologists was also projected to increase from 23,720 to 25,560 FTEs (7.8 % increase, P &lt; 0.001). Neurologist workforce adequacy was projected to increase from 2024 to 2037 (88.6 % to 91.2 %, P &lt; 0.001). By 2037, neurologist adequacy was projected to be lowest in the South (77.5 %) and highest in the Northeast (129 %) (P &lt; 0.001). Non-metropolitan areas were projected to have lower neurologist adequacy than metropolitan areas (21.4 % vs 102 %, P &lt; 0.001). In 2037, the states with the lowest projected neurologist workforce adequacy were Idaho (23.5 %), Wyoming (25.0 %), and Alaska (33.3 %). In 2024, neurology ranked 29th out of 35 specialties for physician adequacy.</div></div><div><h3>Conclusions</h3><div>As a specialty, neurology has among the least adequate physician workforces with deficiencies concentrated in non-metropolitan areas and certain identified states. While some future projected improvements were observed, additional strategies may be needed to enhance neurologist workforce adequacy in areas with identified deficiencies.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111855"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076187","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":"Neuromuscular ultrasound and nerve conduction studies as complementary tools for screening of diabetic peripheral neuropathy","authors":"Amani Nawito ,&nbsp;Shahenda Al Menabbawy ,&nbsp;Basma Bahgat El Sayed ,&nbsp;Mohamed Magdy Ahmed Mohamed ,&nbsp;Alshaimaa Sobhi Khalil","doi":"10.1016/j.jocn.2026.111876","DOIUrl":"10.1016/j.jocn.2026.111876","url":null,"abstract":"<div><div>Diabetic Polyneuropathy (DPN) is a common debilitating complication of Diabetes Mellitus (DM), causing pain which may progress to numbness and motor involvement. DPN may lead to diabetic foot ulcers and possible amputation. Thus, DPN affects the patients’ quality of life and poses a financial burden if not managed early. Nerve conduction studies (NCS) have been used as an objective method for diagnosis of DPN. Neuromuscular Ultrasound (NMUS) is a more comfortable tool used to complement NCS in diagnosis of many diseases. The study aimed to investigate NMUS as a possible screening tool for DPN. The study included 58 patients with Type-II DM who were divided into two groups according to presence/absence of DPN using the modified Toronto clinical neuropathy score (mTCNS). The cross-sectional area (CSA) and muscle thickness (MT) in the upper and lower limbs as well as their corresponding NCS were compared. CSA of posterior tibial nerve and the sural nerve were significantly larger in the group with DPN. A cut-off value 2 mm² CSA of the sural nerve showed sensitivity of 93.33%, specificity of 64.29% and area under the curve (AUC) was 80% for detecting DPN. This may be used as a complementary tool in certain situations to the corresponding NCS. Disease duration, HbA1c and mTCNS showed a positive correlation with NMUS findings. Patients with microvascular complications showed a significantly larger CSA of some nerves and less MT as compared to those without. NMUS represents a complementary tool to NCS and may be used for screening DPN.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111876"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037285","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":"Trends in Intervention Modality for Hospitalizations with Infectious Intracranial Aneurysms: A Nationwide Analysis","authors":"Giana Dawod,&nbsp;Alis J. Dicpinigaitis,&nbsp;Cenai Zhang,&nbsp;Hooman Kamel,&nbsp;Santosh Murthy,&nbsp;Alexander E. Merkler","doi":"10.1016/j.jocn.2026.111852","DOIUrl":"10.1016/j.jocn.2026.111852","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Data regarding the optimal treatment of infectious intracranial aneurysms remains sparse. With growing utilization of endovascular therapy for cerebrovascular disease, we examined trends in endovascular versus neurosurgical treatment of infectious aneurysms and investigated the impact of treatment modality on outcomes.</div></div><div><h3>Methods</h3><div>Using data from the National Inpatient Sample from 2000 to 2019, we conducted a trends analysis on rates of treatment modalities among hospitalizations with infective endocarditis with ruptured or unruptured cerebral aneurysms. Treatment modalities were categorized as endovascular versus open neurosurgical repair based on ICD-9 and ICD-10 codes. Logistic regressions were utilized to assess the association between treatment modality and the outcomes of in-hospital mortality and discharge disposition.</div></div><div><h3>Results</h3><div>We identified 24,461 hospitalizations with an infectious intracranial aneurysm in the setting of infective endocarditis. Mean age was 56.0 years (SD, 17.8) and 61.8 % were male. The overall rate of intervention was 5.8 % (95 % CI, 5.0–6.5 %), and this did not change over time (p = 0.669). There was a significant increase in the rate of endovascular repair (APC = 3.6 %; 95 % CI, 1.2 %-8.1 %) and a significant decrease in the rate of open neurosurgical repair (APC = -5.4 %; 95 % CI, −8.1 % to −3.5 %). Treatment modality was not associated with in-hospital mortality (p = 0.698) or non-home discharge disposition (p = 0.897).</div></div><div><h3>Conclusion</h3><div>Although rates of infectious intracranial aneurysm intervention for infective endocarditis did not change, utilization of endovascular treatment increased while the use of open neurosurgical treatment decreased without adverse effects on mortality rate. Further directions include elucidating predictors of favorable outcomes for undergoing intervention and the most beneficial timing for the procedure during hospitalization.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111852"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037288","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}