Journal of Clinical Neuroscience最新文献

{"title":"The utility of high-resolution magnetic resonance imaging in the detection of fibrotic plaques associated with chronic internal carotid artery occlusion","authors":"Zixuan Wei ,&nbsp;Hengping Wu ,&nbsp;Yu Feng,&nbsp;Yihui Ma,&nbsp;Weiyu Sun,&nbsp;Tingbao Zhang,&nbsp;Jincao Chen,&nbsp;Wenyuan Zhao","doi":"10.1016/j.jocn.2025.111829","DOIUrl":"10.1016/j.jocn.2025.111829","url":null,"abstract":"<div><h3>Objective</h3><div>High-resolution VWI is a non-invasive technique for evaluating atherosclerotic plaque composition. This study aims to delineate the characteristics of VWI and DSA in CICAO patients with highly fibrotic plaques, enhancing preoperative identification.</div></div><div><h3>Methods</h3><div>This retrospective study included patients with CICAO who underwent VWI and DSA before surgical intervention at our hospital from 2017 to 2024. Patients were categorized based on histopathological findings into two groups: those with highly fibrotic plaques and those with significant necrotic cores. A comparative analysis assessed differences in VWI and DSA characteristics between the groups. Imaging features were also summarized for five patients who underwent bypass surgery after unsuccessful interventional recanalization attempts.</div></div><div><h3>Results</h3><div>Five cases of CICAO were included, confirmed to have highly fibrotic plaques, while 22 cases had plaques with significant necrotic cores. The fibrotic plaques showed greater T1 isointensity on VWI (p=0.0005), while the necrotic cores exhibited higher signals on VWI T2 sequences and a trend toward conical residuals on DSA. In cases of failed interventional recanalization requiring bypass surgery, VWI showed T1 isointensity (40%) and T2 high signals (80%), while DSA indicated blunt or absent residuals (80%).</div></div><div><h3>Conclusion</h3><div>Clinical physicians can identify CICAO with fibrotic plaques using preoperative VWI and DSA, enabling them to select hybrid surgical techniques that enhance intervention success.</div><div>Abbreviations: CICAO, chronic internal carotid artery occlusion; DSA, digital subtraction angiography; VWI, vessel wall imaging; MRA, magnetic resonance angiography; CTA, computed tomography angiography; CEA, carotid endarterectomy.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111829"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145878450","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 outcomes and cost-utility analysis of programmable versus non-programmable ventriculoperitoneal shunts in communicating hydrocephalus: A population-based study","authors":"Yu-Lun Wu ,&nbsp;I-Chen Lee ,&nbsp;Chun-Hao Yin ,&nbsp;Jin-Shuen Chen ,&nbsp;Yao-Shen Chen ,&nbsp;Shih-Feng Weng ,&nbsp;Shu-Chuan Jennifer Yeh ,&nbsp;Hong-Yi Hsu ,&nbsp;Hon-Yi Shi","doi":"10.1016/j.jocn.2025.111838","DOIUrl":"10.1016/j.jocn.2025.111838","url":null,"abstract":"<div><h3>Objective</h3><div>This study evaluated the clinical outcomes and cost-utility of programmable versus non-programmable ventriculo-peritoneal (VP) shunts in patients with communicating hydrocephalus.</div></div><div><h3>Methods</h3><div>Patients who underwent VP shunt surgery at three major medical centers in Taiwan were included. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics between 1,161 patients receiving programmable shunts and 1,061 receiving non-programmable shunts. Cox regression analyses were conducted to compare shunt revision, complication, and mortality rates. Cost-utility was assessed using a Markov decision-analytic model constructed from a healthcare provider perspective, incorporating a 1-year cycle length, a 10-year time horizon, and a 2% annual discount rate for both costs and effectiveness.</div></div><div><h3>Results</h3><div>No significant differences were observed in shunt revision, complication, or mortality rates between the two groups. The cost-utility analysis demonstrated that programmable shunts yielded lower total costs (US$55,482.03 vs. US$63,176.72) and higher quality-adjusted life years (QALYs) (6.03 vs. 5.48). The incremental cost-utility ratio (ICUR) was −US$13,889.09/QALYs, indicating dominance of the programmable shunt strategy. At a willingness-to-pay threshold equivalent to one gross domestic product (GDP) per capita, programmable shunts could generate potential savings of US$69.4 million over 10 years, with an estimated net saving of approximately US$57 million after accounting for additional device costs.</div></div><div><h3>Conclusions</h3><div>Programmable VP shunts demonstrated superior cost-effectiveness and comparable clinical outcomes relative to non-programmable devices. These findings support the clinical and economic value of programmable shunts and provide evidence to inform policy decisions and shared decision-making in hydrocephalus management.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111838"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882454","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":"Neoadjuvant PD1 blockade with laser interstitial thermal therapy for recurrent high-grade glioma","authors":"Carter M. Suryadevara ,&nbsp;Hayley Donaldson ,&nbsp;Hammad A. Khan ,&nbsp;Karenna J. Groff ,&nbsp;Claire D. Kim ,&nbsp;Siddhant Dogra ,&nbsp;Jose Gautreaux ,&nbsp;Leah Geiser Roberts ,&nbsp;Matthew G. Young ,&nbsp;Matija Snuderl ,&nbsp;David Zagzag ,&nbsp;Christopher M. William ,&nbsp;J. Ricardo McFaline-Figueroa ,&nbsp;Maria del Pilar Guillermo Prieto Eibl ,&nbsp;Christine A. Cordova ,&nbsp;Sylvia Kurz ,&nbsp;Marissa Barbaro ,&nbsp;Dimitris G. Placantonakis","doi":"10.1016/j.jocn.2025.111823","DOIUrl":"10.1016/j.jocn.2025.111823","url":null,"abstract":"<div><h3>Background</h3><div>While immune checkpoint inhibitors (ICI) induce potent responses against several systemic malignancies, clinical efficacy against high-grade glioma has been limited by immunosuppression, low mutational burden and limited lymphocyte infiltration into tumors. Laser interstitial thermal therapy (LITT) induces coagulative necrosis and disrupts the peritumoral blood–brain barrier (BBB), creating a potentially antigenic milieu. We hypothesized that neoadjuvant and adjuvant ICI would synergize with LITT to potentiate antitumor immune responses and enhance survival.</div></div><div><h3>Methods</h3><div>This retrospective study is an exploratory case series that includes 9 adult patients with recurrent IDH wild-type glioblastoma (GBM, n = 6), IDH mutant high-grade astrocytoma (n = 2) and H3K27M mutant diffuse midline glioma (n = 1). All patients received neoadjuvant anti-PD1 ICI prior to LITT and most received adjuvant ICI (8/9). Disease burden was followed through radiographic volume segmentation of gadolinium-enhancing disease. Patients were followed for progression-free (PFS) and overall survival (OS).</div></div><div><h3>Results</h3><div>Patients (age 29–64 years; 7 male, 2 female) had pre-operative mean tumor volumes of 11.15 cm³ (range 2.93–26.09 cm³). Mean ablation volume was 12.08 cm³ (range 5.14–18.60 cm³). There were no perioperative complications. All patients showed an initial increase in gadolinium-enhancing volume after LITT. Seven of 9 (78 %) patients demonstrated subsequent regression in total gadolinium-enhancing volume. Three non-contiguous satellite lesions naïve to laser ablation exhibited complete or near-complete regression in 2 patients. Median PFS was 5.90 months (range 1.00–41.23), and median OS was 9.97 months (range 1.20–41.23).</div></div><div><h3>Conclusions</h3><div>Combination therapy with neoadjuvant and adjuvant pembrolizumab and LITT is feasible and safe in recurrent high-grade glioma. Responses may be more robust in certain molecular subtypes of glioma. Further studies are needed to investigate this potential synergy.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111823"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839243","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":"Association of plasma homocysteine levels with the presence of intracranial aneurysms and the risk of rupture: A systematic review and meta-analysis","authors":"Amirhossein Akhavan-Sigari ,&nbsp;Vita Olson ,&nbsp;Maria José Pachón-Londoño ,&nbsp;Charbel K. Moussalem ,&nbsp;Zhen Wang ,&nbsp;David J. Park ,&nbsp;Chandan Krishna ,&nbsp;Steven D. Chang ,&nbsp;Fredric B. Meyer ,&nbsp;Bernard R. Bendok","doi":"10.1016/j.jocn.2025.111830","DOIUrl":"10.1016/j.jocn.2025.111830","url":null,"abstract":"<div><h3>Background</h3><div>The majority of intracranial aneurysms (IAs) remain asymptomatic and undiagnosed throughout a patient’s life. However, IA rupture poses a significant risk of mortality. Elevated homocysteine (Hcy) levels are associated with increased vascular inflammation, leading to endothelial dysfunction and degradation of the extracellular matrix. The objective of this study is to synthesize existing evidence on the association between plasma Hcy levels and IA presence and their rupture risk.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and <em>meta</em>-analysis to assess plasma Hcy levels in relation to IA presence and rupture risk. Case-control and cohort studies comparing Hcy levels between patients with and without IAs or ruptured and unruptured IAs were included.</div></div><div><h3>Results</h3><div>A total of seven studies comprising 11,911 participants were included in the review. The studies were divided into two subgroups, four comparing hyperhomocysteinemia (HHcy) status in patients with and without IAs, and three comparing Hcy levels in patients with ruptured and unruptured IAs. Pooled odds ratios (ORs) indicated that HHcy was significantly associated with higher odds of IA presence (OR = 1.87, 95% CI = [1.78–1.97]). Among studies comparing Hcy levels in ruptured and unruptured IAs, there was no significant association between increasing Hcy levels and rupture risk (OR = 1.14, 95 % CI = [0.69–1.88]).</div></div><div><h3>Conclusion</h3><div>Individuals with HHcy have significantly higher odds of developing IAs, suggesting a potential association between HHcy and IA presence. Increasing Hcy levels were not associated with increased risk of IA rupture. Additional studies evaluating the effect of elevated Hcy levels on IA rupture risk and longitudinal studies evaluating the causal effect of HHcy on IA development are needed.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111830"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145863112","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":"Profile of neural tube defects in pediatric patients in Nigeria: A systematic review","authors":"Nicholas Kendall ,&nbsp;Joshua Woo ,&nbsp;Brady K. Browning ,&nbsp;Oluwafemi Owagbemi ,&nbsp;Temitayo O. Ayantayo ,&nbsp;Sean C. Holden-Kapshuck ,&nbsp;Haley G. Kieny ,&nbsp;Zoey Petitt ,&nbsp;Megan E.H. Still ,&nbsp;Elizabeth Blackwood ,&nbsp;Bamidele O. Adebayo ,&nbsp;Olawale A.R. Sulaiman ,&nbsp;Muhammad R. Mahmud ,&nbsp;Amos O. Adeleye ,&nbsp;Matthew T. Shokunbi ,&nbsp;Michael M. Haglund ,&nbsp;Alvan-Emeka K. Ukachukwu","doi":"10.1016/j.jocn.2026.111853","DOIUrl":"10.1016/j.jocn.2026.111853","url":null,"abstract":"<div><h3>Purpose</h3><div>Since the 2015 Lancet Commission on Global Surgery report, interest in addressing global surgical health inequities has grown. Neural tube defects (NTDs) pose significant challenges in low- and middle-income countries (LMICs), including Nigeria, due to inconsistent/ineffective folate supplementation and limited healthcare access. This systematic review examines trends in the presentation, management, and outcomes of NTDs in Nigeria.</div></div><div><h3>Methods</h3><div>A systematic review, conducted following PRISMA guidelines, included studies on NTDs in Nigeria from 1962 to 2023. Extracted data covered publication year, patient demographics, folate use, NTD type and location, diagnosis, treatment modality, post-treatment complications, and mortality. Temporal trends were analyzed by decade from the 1960 s to the 2020 s.</div></div><div><h3>Results</h3><div>A total of 63 studies involving 3,390 patients with NTDs were identified. Myelomeningocele was the most common defect, predominantly affecting the lumbosacral region. Folate usage improved from 12.5% (1990–99) to 60.9% (2020–23). Mortality trends initially fluctuated, rising from 14.4% (1960–69) to 33.3% (1990–99) before significantly declining to 9.3% (2000–09), 4.6% (2010–19), and 6.0% (2020–23).</div></div><div><h3>Conclusion</h3><div>The management of NTDs in Nigeria has seen some notable developments, particularly in mortality and increased folate supplementation. However, challenges persist in achieving consistent prevention through timely folate supplementation and addressing residual disparities in care. Ongoing research and targeted public health strategies are essential to sustain progress and improve outcomes for NTDs in Nigeria.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111853"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917579","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":"Mixed reality neurosurgical simulations and adult learning theories: a systematic review","authors":"Juan P. Giraldo,&nbsp;Nikhil Dholaria,&nbsp;Nicholas Williams,&nbsp;Chinami Michaels,&nbsp;Ryan B. Ehredt,&nbsp;Demos J. Fotias,&nbsp;Steve S. Cho,&nbsp;Volker K.H. Sonntag,&nbsp;Juan S. Uribe","doi":"10.1016/j.jocn.2025.111839","DOIUrl":"10.1016/j.jocn.2025.111839","url":null,"abstract":"<div><h3>Background</h3><div>Neurosurgical education relies on rigorous training to help learners develop technical proficiency and neuroanatomical comprehension. Traditional teaching methods, such as cadaveric dissections and live surgical observations, face limitations associated with accessibility, cost, and ethical concerns. Mixed reality (MR), an emerging technology within extended reality, offers an interactive and immersive approach to surgical training. This review examines the effectiveness of MR in neurosurgical education through established adult learning theories, aiming to determine the optimal integration model for enhancing trainee skill acquisition and knowledge retention.</div></div><div><h3>Methods</h3><div>A systematic literature search of MEDLINE, Scopus, Embase, and Cochrane databases was conducted. The search included studies of MR applications in neurosurgical education aligned with adult learning theories. A total of 341 articles were identified, with 18 meeting the inclusion criteria after screening. Studies were categorized based on their integration of adult learning theories, including experiential learning, constructivism, behaviorism, cognitivism, and self-directed learning. Data extraction focused on MR applications, assessment metrics, and performance improvements among trainees.</div></div><div><h3>Results</h3><div>The review found that MR-based neurosurgical training improved spatial understanding, procedural accuracy, and trainee engagement. Experiential learning was the most frequently applied model (18 studies), followed by constructivism (15 studies), behaviorism (7 studies), and cognitivism (6 studies). Studies on cranial procedures demonstrated enhanced spatial cognition and motor skills, whereas studies exploring spinal procedures, such as pedicle screw placement, showed increased precision and greater trainee confidence. Although no studies explicitly emphasized andragogy or connectivism, MR’s integration of feedback mechanisms and real-time simulation was found to facilitate skill refinement and knowledge retention.</div></div><div><h3>Conclusions</h3><div>MR-based neurosurgical training aligns effectively with theories of adult learning, particularly experiential and constructivist learning. The technology enhances procedural accuracy and spatial awareness, contributing to improved neurosurgical education. Although MR accelerates the learning curve, randomized controlled trials are needed to evaluate its long-term impact on surgical performance. Incorporating MR into neurosurgical curricula could revolutionize training by fostering active learning, optimizing skill acquisition, and improving patient safety.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111839"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922481","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":"Regulation of AI use: further consideration and a personal proposal","authors":"Shigeki Matsubara","doi":"10.1016/j.jocn.2025.111840","DOIUrl":"10.1016/j.jocn.2025.111840","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111840"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922582","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 novel bicortical alternating screw exchange lagging technique for reduction of cervical spinal deformity","authors":"Joshua Estin ,&nbsp;Alejandro Lopez ,&nbsp;Steven Vanni ,&nbsp;Sara Jarret ,&nbsp;Karthik Madhavan","doi":"10.1016/j.jocn.2026.111867","DOIUrl":"10.1016/j.jocn.2026.111867","url":null,"abstract":"<div><div>Cervical kyphosis in the presence of multilevel disc degeneration poses a significant challenge to surgical correction. Anterior cervical discectomy and fusion (ACDF) is a well-established approach to decompress the neural elements and relieve pain but may not specifically correct kyphosis. We describe an anterior only ACDF approach utilizing a novel lagging technique (Vanni technique) to correct cervical kyphosis. The objective is to reestablish lordosis without adding the morbidity of corpectomies or posterior osteotomies. The ACDF procedure with the lagging technique is summarized in the following steps: (1) multilevel discectomy, (2) lordotic interbody cage placement at each level, (3) lordotic plate positioning secured by a temporary pin, (4) bicortical screw placement bilaterally at each level using a screw exchange lagging technique, allowing the vertebral bodies to be sequentially translated toward the plate using progressively shorter bicortical screws until flush, and (5) final screw tightening and locking to the plate. In two illustrative cases, patients underwent anterior cervical discectomies and fusions from C3 to C7 using the Vanni lagging technique to correct deformity. Postoperative follow up showed improvement in Sagittal Vertical Axis (SVA) and lordosis with solid fusion. The current technique report provides a detailed description of a multilevel ACDF procedure with a novel lagging technique to effectively correct cervical deformity. It obviates the need for more extensive and morbid corpectomies and osteotomies in selected patients with reducible deformities.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111867"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979167","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 dehydration on functional outcomes in large vessel occlusion stroke","authors":"April Pivonka ,&nbsp;Manisha Koneru ,&nbsp;Abigail Baldwin-LeClair ,&nbsp;Jamir Pitton Rissardo ,&nbsp;Karan Patel ,&nbsp;Avish Patel ,&nbsp;Scott Kamen ,&nbsp;Lauren Thau ,&nbsp;Jared Wolfe ,&nbsp;Linda Zhang ,&nbsp;Nicholas Vigilante ,&nbsp;Mary Penckofer ,&nbsp;Michael J. Dubinski ,&nbsp;Olga R. Thon ,&nbsp;Tudor G. Jovin ,&nbsp;Jane Khalife ,&nbsp;Hermann Christian Schumacher ,&nbsp;Khalid A. Hanafy ,&nbsp;James E. Siegler ,&nbsp;Jesse M. Thon","doi":"10.1016/j.jocn.2025.111832","DOIUrl":"10.1016/j.jocn.2025.111832","url":null,"abstract":"<div><h3>Background</h3><div>Dehydration at stroke onset has been linked to worse outcomes, but its impact in large vessel occlusion (LVO) stroke treated with endovascular thrombectomy (EVT) remains unclear. We evaluated whether dehydration at presentation influences functional recovery in this population.</div></div><div><h3>Methods</h3><div>A prospectively maintained registry of adults with anterior circulation LVO (ICA, M1, M2) who achieved successful EVT (mTICI ≥ 2B) between 10/2019 and 12/2021 was analyzed. Dehydration was defined as serum osmolality ≥ 295 mOsm/kg and BUN/Cr ≥ 20. Primary outcomes were NIHSS at 24 h and good functional recovery at 90 days (mRS 0–2 or return to baseline). Multivariable logistic regression adjusted for age, sex, baseline NIHSS, ASPECTS, occlusion site, diuretic use, and pre-stroke mRS.</div></div><div><h3>Results</h3><div>Of 206 patients, 31 were dehydrated at presentation. They were older (median 77 vs. 69 years), more often female, and more likely to use diuretics (p ≤ 0.03). Dehydrated patients had higher NIHSS at 24 h (median 14 vs. 10, p = 0.02) and worse 90-day mRS (p = 0.003). Good functional recovery occurred in 30 % of dehydrated vs. 50 % of non-dehydrated patients (p = 0.04). Dehydration independently predicted lower odds of NIHSS improvement at 24 h (aOR 0.37, 95 % CI 0.14–0.98, p = 0.04), but not worse recovery at 90 days.</div></div><div><h3>Conclusion</h3><div>Dehydration at presentation is associated with worse early neurological improvement and potentially poorer functional outcomes after EVT for LVO stroke. These findings highlight the importance of recognizing hydration status in this patient population and the need for future studies to confirm these findings and assess potential interventions.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111832"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839244","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":"CSF-venous fistulas Reconsidered: Pressure paradox and the Volume-Elastance Relationship","authors":"Yusuf H. Wardak ,&nbsp;Behnam Shaygi ,&nbsp;Hong K. Kok ,&nbsp;Ronil V. Chandra ,&nbsp;Anousha Yazdabadi ,&nbsp;Ashu Jhamb ,&nbsp;Justin M. Moore ,&nbsp;Paul Smith ,&nbsp;Julian Maingard ,&nbsp;Calvin Gan ,&nbsp;Lee-Anne Slater ,&nbsp;Enrique Barvulsky ,&nbsp;Mark Schembri ,&nbsp;Andrew J. Gauden ,&nbsp;Jeremy Russell ,&nbsp;Augusto Gonzalvo ,&nbsp;Ali Khabaza ,&nbsp;Davor Pavlin-Premrl ,&nbsp;Mark Brooks ,&nbsp;Christen D. Barras ,&nbsp;Hamed Asadi","doi":"10.1016/j.jocn.2026.111861","DOIUrl":"10.1016/j.jocn.2026.111861","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Spontaneous intracranial hypotension (SIH) is a debilitating condition most often caused by spontaneous cerebrospinal fluid (CSF) leaks, with CSF-venous fistulas (CVF) representing an increasing number of cases. Pathophysiological understandings of CVFs, particularly those concerning pressure dynamics between the CSF and venous systems, remain elusive. This study aimed to mathematically model CVFs using first principles physics and to explore pressure dynamics and their implications for treatment and complications.</div></div><div><h3>Materials and Methods</h3><div>CSF-venous pressure dynamics were modelled using physics first-principles. Adjustable parameters included initial CSF pressure, CSF production rate, fistula radius, and dural elastance. Dynamic equilibrium pressures and volumes were calculated iteratively, with results plotted against fistula radius, CSF production rate, and dural elastance.</div></div><div><h3>Results</h3><div>The model demonstrated that an increase in CSF daily production increased the dynamic equilibrium pressure. Greater dural elastance lowered CSF volume at equilibrium without changing equilibrium pressure. CSF pressure rapidly equilibrated to that of venous pressure for larger fistulas and physiological CSF pressure for smaller fistulas.</div></div><div><h3>Conclusions</h3><div>Fistula radius, altered states of CSF production, and dural stiffening complicate the clinical presentation of CVFs. Current hypotheses do not adequately account for raised opening pressures and rebound intracranial hypertension. Instead, global CSF dysregulation, including increased production and impaired secondary outflow, may co-exist in patients with CVFs. Future management should evaluate CSF volume-pressure dynamics, rather than exclusively focusing on the fistula, to improve both diagnosis and anticipate complications.</div></div><div><h3>Key Messages</h3><div>CSF-venous fistulas are an increasingly recognised cause of spontaneous intracranial hypotension. Current understandings of CSF-venous pressure dynamics remain elusive. This study modelled the behaviour of CSF pressures to inform a discussion on potential secondary pathophysiological factors. In doing so, it seeks to ensure clinicians consider patient-specific compensatory mechanisms when providing treatment, to anticipate complications and ensure efficacy.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111861"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952312","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}