Journal of Clinical Neuroscience最新文献

{"title":"Stereotactic radiosurgery for brain metastases from extra-renal clear cell carcinoma: A series of four patients and review of the literature","authors":"Paul M. Harary ,&nbsp;Yusuke S. Hori ,&nbsp;Ahed H. Kattaa ,&nbsp;Fred C. Lam ,&nbsp;Deya Abu-Reesh ,&nbsp;Sara C. Emrich ,&nbsp;Armine Tayag ,&nbsp;Louisa Ustrzynski ,&nbsp;Erqi L. Pollom ,&nbsp;David J. Park ,&nbsp;Melanie Hayden Gephart ,&nbsp;Steven D. Chang","doi":"10.1016/j.jocn.2025.111602","DOIUrl":"10.1016/j.jocn.2025.111602","url":null,"abstract":"<div><h3>Background</h3><div>Clear cell carcinoma occurring outside of the kidney represents an aggressive histological subtype which is frequently resistant to standard chemotherapy. Brain metastases (BM) from extra-renal clear cell carcinoma (erCCC) are exceedingly rare, and the optimal treatment approach for this histology remains uncertain. To our knowledge, stereotactic radiosurgery (SRS) has not been specifically investigated for this patient population.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of patients with erCCC treated with SRS at our institution from 2003 to 2024, identifying 4 cases with a total of 13 BM. Additionally, we conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to summarize prior reports of erCCC BM. The Embase, PubMed/MEDLINE, Scopus, and Web of Science databases were queried for initial identification of records. Gray literature was additionally searched. Baseline patient characteristics, treatment modality, and treatment outcomes were extracted from reports which met inclusion criteria.</div></div><div><h3>Results</h3><div>The median age at initial erCCC diagnosis was 54 years, with an interval to BM ranging from 0 to 3 years. The median lesion diameter was 5.1 mm, with a median size reduction of 52.9 % at the 3-month follow-up. The local control rates were 100 %, 100 %, and 100 % at 6, 12, and 18 months, respectively. Radiation necrosis was detected in a single lesion on 18-month MRI. The mean overall survival (OS) was 23.8 months (SD: 14.5). Twenty items met the inclusion criteria for our review, 19 of which reported a single case of erCCC BM. The majority of erCCC cases were associated with the ovary, followed by those of unknown origin. Among articles reporting the stage of the primary erCCC, 64.3 % were early stage while the remaining 35.7 % were advanced stage. Surgical resection and whole-brain radiotherapy were the most common treatments, with a median OS of 7 months. Genetic characteristics were available for only 2 cases, which identified pathogenic mutations in <em>PIK3CA</em> (p.E545K) or <em>BRCA2</em> (p.K3326*).</div></div><div><h3>Conclusion</h3><div>Our case series indicates that SRS may be an effective management option for erCCC BM, demonstrating high local control rates and a favorable safety profile. Our systematic review underscores significant variability in treatment outcomes and geographical incidence of this condition, along with existing gaps in genetic characterization and neurosurgical outcomes. Given known differences in clinical behavior between erCCC and other subtypes from the same site of origin, histology-directed treatment strategies may support improved outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111602"},"PeriodicalIF":1.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925327","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":"Efficacy of gamma knife radiosurgery for cerebral cavernous malformations – A single-institution retrospective study","authors":"Uyen Truc Gia Dang ,&nbsp;Binh Thanh Nguyen ,&nbsp;Dat Nguyen Tuong Do ,&nbsp;Minh Anh Ho ,&nbsp;Phuong Thi Minh Do ,&nbsp;Chuong Thanh Huynh ,&nbsp;Tu Minh Nguyen ,&nbsp;Huy Minh Tran","doi":"10.1016/j.jocn.2025.111606","DOIUrl":"10.1016/j.jocn.2025.111606","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral cavernous malformations (CCMs) are low-flow vascular malformations of the central nervous system. Although surgical resection is the primary treatment for symptomatic CCMs, gamma knife radiosurgery (GKRS) has been considered as an alternative treatment for CCMs with high surgical risk. This study aims to evaluate outcomes of GKRS in the treatment of CCMs.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on 235 patients diagnosed with CCMs who underwent GKRS at Cho Ray Hospital between October 2016 and September 2022. We assessed the annual hemorrhage rate (AHR) after GKRS, seizure control rate, and changes in symptoms after treatment. The mean follow-up duration was 40.34 ± 22.01 months.</div></div><div><h3>Results</h3><div>The overall post-GKRS AHR was 1.66 % per patient-year, increasing to 4.96 % among patients with brainstem lesions. Hemorrhagic events following GKRS were significantly associated with larger lesion diameters (p = 0.018). Among 43 patients with pre-GKRS epilepsy, 83.7 % achieved favorable seizure control (Engel class I–II). Most patients experienced stable or improved symptoms; worsening occurred in 3.0 % for headache, 2.1 % for dizziness, and 3.4 % for focal neurological deficits. Transient post-GKRS brain edema occurred in 7 patients (3.0 %), all of whom achieved full recovery. No cases of cyst formation were observed.</div></div><div><h3>Conclusions</h3><div>GKRS is an effective alternative treatment for controlling hemorrhage, reducing seizure rates, and alleviating symptoms for CCMs, particularly those at high surgical risk.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111606"},"PeriodicalIF":1.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931590","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":"Early diagnostic utility of BNP and NT-proBNP for cardioembolic stroke: A head-to-head comparison in the hyperacute and early acute phase","authors":"Eunhee Han ,&nbsp;Hyejeong Kim ,&nbsp;Minseok Kwon ,&nbsp;Ae-Ran Choi ,&nbsp;Jeong-Joong Lee ,&nbsp;Eun-Jee Oh ,&nbsp;Hyojin Chae","doi":"10.1016/j.jocn.2025.111595","DOIUrl":"10.1016/j.jocn.2025.111595","url":null,"abstract":"<div><h3>Background</h3><div>Cardioembolic (CE) stroke is a common and often severe subtype of ischemic stroke, but early and accurate differentiation from other stroke types remains challenging. Brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) have emerged as promising biomarkers, yet direct comparative studies evaluating their diagnostic utility in the hyperacute and early acute phase are limited.</div></div><div><h3>Methods</h3><div>This prospective study included 165 patients who presented with acute stroke symptoms within twenty-four hours of onset at a single tertiary center. Plasma BNP and NT-proBNP levels were measured upon admission and analyzed in relation to stroke subtype, with classification based on TOAST criteria. Diagnostic performance for identifying CE stroke was evaluated using receiver operating characteristic (ROC) curve analysis.</div></div><div><h3>Results</h3><div>Among 121 patients diagnosed with ischemic stroke, 32 (26.4  %) had CE stroke. Both BNP and NT-proBNP levels were significantly higher in CE stroke compared to other subtypes. ROC analysis showed that BNP (AUC = 0.845) and NT-proBNP (AUC = 0.861) demonstrated similar diagnostic accuracies. A BNP cutoff of 49.8 pg/mL achieved a sensitivity of 87.5  % and specificity of 79.0  %, while an NT-proBNP cutoff of 350 pg/mL yielded a sensitivity of 90.6  % and specificity of 75.2  %.</div></div><div><h3>Conclusion</h3><div>Our results demonstrate that BNP and NT-proBNP provide similar diagnostic accuracy for distinguishing CE stroke in the hyperacute and early acute setting. Their high sensitivity in hyperacute and early acute phase highlights the potential of both biomarkers to improve diagnostic accuracy, especially in setting with limited healthcare resources.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111595"},"PeriodicalIF":1.8,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144918931","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 post-discharge seizures in aneurysmal subarachnoid hemorrhage using EEG data","authors":"Ariyaporn Haripottawekul ,&nbsp;Viva Voong ,&nbsp;Karen L Furie ,&nbsp;Ali Mahta","doi":"10.1016/j.jocn.2025.111594","DOIUrl":"10.1016/j.jocn.2025.111594","url":null,"abstract":"<div><h3>Background</h3><div>The predictors of post-discharge seizures using electroencephalogram (EEG) features in patients with aneurysmal subarachnoid hemorrhage (aSAH) remain understudied. We sought to identify predictors of seizures in aSAH survivors after hospital discharge.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of a consecutive cohort of aSAH patients admitted to an academic center from 2016 to 2024. Univariable and multivariable analysis was performed to evaluate the association between clinical, radiographic and EEG variables and post-discharge seizure occurrence.</div></div><div><h3>Results</h3><div>We reviewed 626 SAH cases with suspected aneurysmal etiology and included 352 aSAH survivors (mean age 57 years [SD 13.6], 61 % female, 71 % white). Post-discharge seizures were more common in patients who had seizure on presentation or during hospitalization (33 % vs 11 %; p = 0.009), had intra-parenchymal hemorrhage (IPH) on admission (61 % vs 18 %; p &lt; 0.001), longer hospital length of stay (p = 0.032), higher scores on modified Rankin Scale at discharge (p = 0.048), and higher need for prescription of anti-seizure medications at discharge (p &lt; 0.001). EEG data revealed highly epileptic features and diffuse slowing were more common in patients who had seizures after hospital discharge (p &lt; 0.001) compared to those who did not. However, in a multivariable analysis only IPH (OR 3.75, 95 % CI 1.3–10.9; p = 0.014) and diffuse slowing on EEG (OR 3.67, 95 % CI 1.18–11.4; p = 0.022) remained independent predictors of post-discharge seizure.</div></div><div><h3>Conclusions</h3><div>IPH and diffuse slowing on EEG may predict post-discharge seizure in survivors of aSAH. Larger prospective studies are needed to better risk stratify and justify the prescription of anti-seizure medications in a subset of aSAH survivors.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111594"},"PeriodicalIF":1.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144918932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy of early facial nerve decompression in treating severe Ramsay Hunt syndrome","authors":"Qiuhuan Li ,&nbsp;Heyang Zhang ,&nbsp;Fang Zhang ,&nbsp;Jiaxing Zhao ,&nbsp;Siyu Chen ,&nbsp;Pingping He ,&nbsp;Xiaoying Zou ,&nbsp;Ru Zhang ,&nbsp;Zigang Jiang","doi":"10.1016/j.jocn.2025.111590","DOIUrl":"10.1016/j.jocn.2025.111590","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of Ramsay Hunt syndrome (RHS) has significantly increased in recent years, highlighting the need to explore effective surgical treatment strategies.</div></div><div><h3>Methods</h3><div>A total of 12 patients with severe RHS who visited our hospital from January 2021 to March 2023 were retrospectively included. The results of neuroelectrophysiological examination of the affected and healthy sides of all patients at baseline, 1 month postoperatively, 3 months postoperatively, 6 months postoperatively, and 12 months postoperatively were counted. House-Brackmann (H-B) scores and facial disability index (FDI) scores were collected.</div></div><div><h3>Results</h3><div>After surgery, the neuroelectrophysiological function of the facial nerve on the affected side improved, with decreasing differences compared to the healthy side in terms of latency of the facial muscles, transient reflexes, F-waves lead-out rate, frontalis muscle wave amplitude, orbicularis oculi wave amplitude, and chin wave amplitude. Postoperative chin latency, frontalis muscle wave amplitude, and F-waves lead-out rate on the affected side were significantly better than those at baseline (<em>P</em> &lt; 0.05). The H-B grading and FDI of the affected side were significantly better than the baseline at 12 months postoperatively (<em>P</em> &lt; 0.05), and the surgical efficiency of the patients was 100 % at 12 months postoperatively.</div></div><div><h3>Conclusion</h3><div>Within 12 months post-operation, there was a notable overall recovery of the facial musculoskeletal neural functions, with particularly good improvement observed in orbicularis oculi muscle movement.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111590"},"PeriodicalIF":1.8,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of preoperative disability in workers’ compensation patients undergoing lumbar decompression","authors":"Sloane O. Ward,&nbsp;Shriya N. Patel,&nbsp;Arash J. Sayari,&nbsp;Kern Singh","doi":"10.1016/j.jocn.2025.111581","DOIUrl":"10.1016/j.jocn.2025.111581","url":null,"abstract":"<div><h3>Background</h3><div>Typically, Workers’ Compensation (WC) patients present with worse disability preoperatively and may report inferior postoperative outcomes following lumbar decompression (LD) surgery. However, it remains unclear whether severe disability influences postoperative outcomes in WC patients. This study aims to evaluate the influence of Oswestry Disability Index (ODI) scores on patient-reported outcome measures (PROMs) for WC patients undergoing LD surgery.</div></div><div><h3>Methods</h3><div>Patients included in this study were those of WC status who underwent LD surgery and had PROM scores. Patients were split up into two cohorts depending on if their ODI scores were less than 41 or greater than or equal to 41. This study utilized various PROMs such as the Visual Analog Scale for Leg pain (VAS-L), VAS-Back pain (VAS-B), Oswestry Disability Index (ODI), Patient Health Questionnaire-9 (PHQ-9), Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), and 12-Item Veterans RAND Physical Component Summary (VR-12 PCS) scores. Outcome scores for patients were taken starting at baseline and up to two years postoperatively. Rates of minimum clinically important difference (MCID) achievement were also calculated. A linear regression was used to analyze PROMs and MCID rates of achievement.</div></div><div><h3>Results</h3><div>A total of 82 WC patients were stratified into the Mild Disability Cohort (ODI &lt; 41) and the Severe Disability Cohort (ODI ≥ 41). Thirty-two patients were in the Mild Disability Group and 50 were in the Severe Disability Group. There were no statistically significant differences in the patient demographics and perioperative characteristics. At baseline, WC patients with severe disability had significantly worse VAS-L, VAS-B, PROMIS-PF, and VR-12 PCS. At six weeks and the final postoperative time point, patients in both cohorts reported comparable scores across all PROMs besides the ODI. Patients in the Severe Disability cohort continued to report significantly worse ODI scores compared to the Mild Disability cohort. However, when measuring the magnitude of improvement in PROMs from preoperatively to the final follow-up of up to two years, patients in the Severe disability group had remarkably greater improvements in the ODI compared to patients with mild disability. Lastly, MCID achievement showed greater rates for the Severe disability group throughout. Notably, VAS-L and ODI MCID achievement rates were significantly higher in the Severe Disability Cohort.</div></div><div><h3>Conclusion</h3><div>The findings demonstrate worse baseline disability in WC patients can result in comparable improvements in PROMs when differentiating between the milder disability group. Importantly, WC patients with ODI ≥ 41 had clinically significant improvements in VAS-L and ODI scores following LD surgery.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111581"},"PeriodicalIF":1.8,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913593","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":"Optimizing neurosurgical video formats for effective learning in the social media era, bridging global gaps: A literature review on enhancing quality in video-based education","authors":"Marcos Cherem-Kibrit ,&nbsp;Nicolette Rolnick ,&nbsp;James King ,&nbsp;Pablo Gomes-da Silva de Rosenzweig ,&nbsp;Andrei Saffioti ,&nbsp;Natalia M. Barron Cervantes ,&nbsp;Samuel Moscovici","doi":"10.1016/j.jocn.2025.111589","DOIUrl":"10.1016/j.jocn.2025.111589","url":null,"abstract":"<div><div>In the ever-evolving landscape of medical education, the role of surgical videos has become increasingly crucial in facilitating the acquisition of essential skills and knowledge. Surgical techniques, which were once considered undeclared or silent knowledge, can now be digitized and disseminated through the latest technologies, providing a valuable resource for both young surgeons and seasoned experts alike. There is much evidence available that demonstrates the benefits of incorporating video-based education in surgical training. However, most of these videos lack a structured educational framework necessary for effective learning. To address this systemic gap, we conducted a comprehensive literature review to identify evidence-based principles that enhance the pedagogical value of surgical videos. Our findings suggest that the most effective formats are concise, incorporate high-definition visuals, included structured narration and annotations.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111589"},"PeriodicalIF":1.8,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913592","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 comprehensive study of non-dysraphic intradural extramedullary spinal lipoma in adults: A systematic review and single-arm meta-analysis","authors":"Áquila Matos Soares ,&nbsp;Yan Gondim de Sousa ,&nbsp;Daniel Salmito Chaves ,&nbsp;José Italo da Silva Damasceno Gomes ,&nbsp;George Pessoa Amorim Neto ,&nbsp;Thiago Luís Marques Lopes ,&nbsp;Júlio Farias Rangel ,&nbsp;Mateus Dutra Balsells ,&nbsp;Isabela Fernandes de Melo Pereira ,&nbsp;Camilly Ramos Sales ,&nbsp;Miguel Vieira de Almeida ,&nbsp;Andressa Gabriella Duarte de Queiroz ,&nbsp;Ana Karla Benigno Dantas ,&nbsp;Leonardo de Macedo Filho ,&nbsp;Lucas Alverne Freitas de Albuquerque","doi":"10.1016/j.jocn.2025.111591","DOIUrl":"10.1016/j.jocn.2025.111591","url":null,"abstract":"<div><h3>Background</h3><div>Spinal lipomas are defined by the premature separation of the neural ectoderm from the cutaneous ectoderm during primary neurulation. Non-dysraphic extramedullary intradural spinal lipoma (N-DEISL) represents less than 1% of spinal tumors. This study aims to analyze the anatomical and clinical presentations, and treatment strategies of N-DEISL in adults.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and <em>meta</em>-analysis of studies on N-DEISL, following PRISMA guidelines. Literature searches were performed using databases including EMBASE and PubMed. The studies included case reports, cohort studies, and clinical trials focusing on intradural-extramedullary lipoma. Data extraction and analysis were conducted by multiple reviewers, employing tools such as GraphPad Prism, R, and Python for statistical analysis and graphical representations.</div></div><div><h3>Results</h3><div>A total of 36 studies encompassing 55 patients were included. Most patients were male, with a mean age of 34.60 years. Common symptoms included motor disturbances (80.00 %) and sensory disturbances (94.54 %). Diagnosis was predominantly through Magnetic Resonance Imaging (MRI) (72.72 %). Surgical treatment was applied in 94.54 % of cases, with 67.27 % reporting symptom improvement. Neurophysiological Intraoperative Monitoring (NIOM) was used in 14.54 % of patients, showing significant symptom improvement without significant recurrence. Cubic spline regression analysis revealed a non-linear relationship between intraoperative monitoring and post-surgical recovery time.</div></div><div><h3>Conclusion</h3><div>Our systematic review and <em>meta</em>-analysis indicate that the use of NIOM can be a predictive factor in the recovery of patients with extramedullary intradural lipoma in adults. Moreover, it was found that these lipomas predominantly affect the thoracic level of the spinal cord, with definitive diagnosis primarily achieved through MRI. It was also verified that the time between the onset of symptoms and seeking medical assistance is a critical factor to be addressed. Finally, it can be inferred that, although partial resection presents remarkable results, further investigation into the role of intraoperative monitoring in future randomized studies is essential.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111591"},"PeriodicalIF":1.8,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913590","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":"Hypofractionated vs. single-session Gamma Knife radiosurgery for orbital cavernous hemangiomas: A systematic review, meta-analysis, and institutional case series","authors":"Victor Goulenko ,&nbsp;Sarthak Sinha ,&nbsp;Venkatesh Shankar Madhugiri ,&nbsp;Neil D. Almeida ,&nbsp;Robert J. Plunkett ,&nbsp;Kenneth V. Snyder ,&nbsp;Dheerendra Prasad","doi":"10.1016/j.jocn.2025.111587","DOIUrl":"10.1016/j.jocn.2025.111587","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Orbital cavernous hemangiomas (OCH) are rare benign vascular tumors that pose therapeutic challenges due to their proximity to critical visual structures. While surgical resection remains the standard of care, Gamma Knife radiosurgery (GKRS) has emerged as a minimally invasive alternative. However, the optimal fractionation strategy, single-session versus hypofractionated treatment, remains unclear. This review aims to evaluate the clinical and radiological outcomes of single-session versus hypofractionated GKRS for OCH through a systematic review, &lt;em&gt;meta&lt;/em&gt;-analysis, and a complementary institutional case series.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A systematic review was conducted following PRISMA guidelines and registered with PROSPERO (registration code:1061256). Databases were searched from inception through April 2025. Eligible studies reported outcomes of GKRS for OCH using either single-session or hypofractionated treatment. Meta-analyses were performed to compare (1) the proportion of patients with tumor volume reduction, (2) the mean percentage reduction in tumor volume, and (3) the proportion of patients with improvement in visual symptoms. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Funnel plots and Egger’s test were used to assess publication bias. Additionally, three institutional cases treated with GKRS were included to supplement the clinical context.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Eleven studies comprising 117 patients were included, with an additional 3 patients from our institution. Tumor volume reduction was observed in 100 % of patients in the fractionated group and 89 % in the single-session group (p = 0.0853). The pooled mean percentage volume reduction was −2.65 % (95 % CI: −6.36 to 3.97) in the fractionated group and −2.85 % (95 % CI: −8.97 to 4.43) in the single-session group (p = 0.9572). Improvement in visual symptoms was seen in 80 % of patients in the fractionated group and 69 % in the single-session group (p = 0.4763). Funnel plots demonstrated minimal publication bias, except for a potential small-study effect in visual symptom outcomes. JBI assessment indicated moderate to high methodological quality across most studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Both single-session and hypofractionated GKRS appear to be effective and safe treatment options for OCH, with comparable clinical outcomes. Hypofractionation may offer advantages in select patients with optic nerve proximity, though current evidence does not show statistically significant differences between approaches. Single-session GKRS remains a pragmatic and effective option in anatomically favorable cases and may be complemented by adaptive or rescue fractionation strategies when tumor response is suboptimal or recurrence is observed. Prospective multicenter studies with standardized outcome reporting are needed to define optimal treatment strategies.&lt;/div&gt;&lt;/di","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111587"},"PeriodicalIF":1.8,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902147","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":"Assessing the utility of SISCOM and PISCOM in mapping the epileptogenic zone for epilepsy surgery: A comparative outcome-based study","authors":"Aiswarya Hari ,&nbsp;Siby Gopinath ,&nbsp;Sonu Ravindran ,&nbsp;Manjit Sarma ,&nbsp;Akshaya Raman ,&nbsp;Anand Kumar ,&nbsp;Harilal Parasuram","doi":"10.1016/j.jocn.2025.111588","DOIUrl":"10.1016/j.jocn.2025.111588","url":null,"abstract":"<div><h3>Intro</h3><div>Ictal SPECT imaging stands out among non-invasive tools as the primary presurgical method for spatially defining the seizure network. Advanced image analysis methods like SISCOM and PISCOM improve the interpretation of SPECT images. However, research on their comparative utility, significance of their overlapping areas, and optimal z-scores for mapping/localizing the seizure onset zone is limited. Therefore, this study concentrates on a detailed analysis of these images in mapping of ictal networks and localization of the seizure onset zone.</div></div><div><h3>Methodology</h3><div>This study analyzed SOZ localization in 37 patients using SISCOM and PISCOM, corroborated by postoperative MRI and outcome. We aimed to determine optimal z-scores for both methods and investigated the influence of the SPECT injection time-seizure duration ratio on interpretation of these maps in SOZ localization accuracy. We also created a ratio image representing the overlap between SISCOM and PISCOM maps, using Z-scores greater than 1, 1.5, and 2 for both maps.</div></div><div><h3>Results</h3><div>Of 21 Engel-1 patients, in 16 (76 %) the SISCOM and PISCOM perfusion (large, high intensity) lateralized to the resection side, in 3 (14 %) patients to the contralateral side, and in 2 (10 %) showed bilateral activation. In Engel 1 patients, hyperperfusion on the PISCOM mapped the resection zone in 90 % of cases, compared to 80 % with the SISCOM map. The optimal z-scores were 1.9 for SISCOM, yielding a sensitivity of 88.5 % and specificity of 94.8 % for mapping the SOZ. For PISCOM, the optimal z-score was 2.2, achieving a sensitivity of 87.4 % and specificity of 93.3 %. The ratio map, created from SISCOM and PISCOM overlap (z-scores &gt; 2), was useful for delineating the SOZ and aligned better with the resection cavity than SISCOM and PISCOM maps. The analysis showed no significant median differences in injection-time-to-seizure-duration ratios between seizure-free and non-seizure-free patients (p = 0.8). We found a difference in the median injection-time-to-seizure-duration ratio between cases where SISCOM/PISCOM maps were concordant with the resection cavity in seizure-free patients, at 0.09 (0.06, 0.28), and discordant cases, at 0.41 (0.17, 0.61).</div></div><div><h3>Conclusion</h3><div>This study determined the optimal Z-score for mapping the SOZ and evaluated the use of ratio image in SOZ localization. Both SISCOM and PISCOM demonstrated their utility in identifying the SOZ in epilepsy surgery patients, with PISCOM emerging as a promising alternative to SISCOM, potentially eliminating the need for interictal SPECT.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111588"},"PeriodicalIF":1.8,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902190","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}