Journal of Clinical Neuroscience最新文献

{"title":"Battle of the authors: Comparing neurosurgery articles written by humans and AI","authors":"Mehmet Yigit Akgun ,&nbsp;Melihcan Savasci ,&nbsp;Caner Gunerbuyuk ,&nbsp;Sezer Onur Gunara ,&nbsp;Tunc Oktenoglu ,&nbsp;Ali Fahir Ozer ,&nbsp;Ozkan Ates","doi":"10.1016/j.jocn.2025.111152","DOIUrl":"10.1016/j.jocn.2025.111152","url":null,"abstract":"<div><h3>Background</h3><div>The advancement of artificial intelligence (AI) has led to its application in various fields, including medical literature. This study compares the quality of neurosurgery articles written by human authors and those generated by ChatGPT, an advanced AI model. The objective was to determine if AI-generated articles meet the standards of human-written academic papers.</div></div><div><h3>Methods</h3><div>A total of 10 neurosurgery articles, 5 written by humans and 5 by ChatGPT, were evaluated by a panel of blinded experts. The assessment parameters included overall impression, readability, criteria satisfaction, and degree of detail. Additionally, readability scores were calculated using the Lix score and the Flesch-Kincaid grade level. Preference and identification tests were also conducted to determine if experts could distinguish between the two types of articles.</div></div><div><h3>Results</h3><div>The study found no significant differences in the overall quality parameters between human-written and ChatGPT −generated articles. Readability scores were higher for ChatGPT articles (Lix score: 35 vs. 26, Flesch-Kincaid grade level: 10 vs. 8). Experts correctly identified the authorship of the articles 61% of the time, with preferences almost evenly split (47% preferred CHATGPT, 44% preferred human, and 9% had no preference). The most statistically significant result was the higher readability scores of CHATGPT-generated articles, indicating that AI can produce more readable content than human authors.</div></div><div><h3>Conclusion</h3><div>ChatGPT is capable of generating neurosurgery articles that are comparable in quality to those written by humans. The higher readability scores of AI-generated articles suggest that ChatGPT can enhance the accessibility of scientific literature. This study supports the potential integration of AI in academic writing, offering a valuable tool for researchers and medical professionals.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111152"},"PeriodicalIF":1.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488126","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":"Characterizing the complication profile of spinal robotic systems: A MAUDE analysis of device failures and associated complications by device manufacturer and brand name","authors":"Neal A. Patel ,&nbsp;Nolan J. Brown ,&nbsp;Clifford He ,&nbsp;Saarang Patel ,&nbsp;Zach Pennington ,&nbsp;Julian Gendreau ,&nbsp;Ronald Sahyouni ,&nbsp;Martin H. Pham","doi":"10.1016/j.jocn.2025.111149","DOIUrl":"10.1016/j.jocn.2025.111149","url":null,"abstract":"<div><h3>Introduction</h3><div>Pedicle screw placement in spinal surgery has evolved to incorporate increased use of technology for both preoperative planning and intraoperative guidance. In recent years, robotic guidance has been used to increase the precision, accuracy, and overall patient safety of spinal column fixation via screw placement. Within this context, the present study aims to quantify and classify complications of spinal robotic devices using a nationally representative database.</div></div><div><h3>Methods</h3><div>The Manufacturer and User Facility Device Experience (MAUDE) was queried for adverse events involving the most widely used spinal robotic devices from inception to November 3rd, 2023. Entries were tabulated by assigning categorical variables based on event information.</div></div><div><h3>Results</h3><div>The query yielded 339 unique robotic failure events. The most frequent complications in robotic-assisted spinal surgeries were imprecision (73.6%), software errors (13.7%), and damaged or missing screws (4.9%). Most reported events occurred intraoperatively after the initial incision (78.5%) [compared to preoperatively or postoperatively]. The Mazor X™ system was the most represented spinal robotic platform in terms of complications, accounting for 71.6% of reported robotic failure events. Most reported errors were resolved intraoperatively or continued through the employment of alternative imaging methods and, overall, had minimal clinical significance. With respect to robot-assisted pedicle screw placement, medial breaches were 1.7x more common than lateral breaches across all robotic systems. Finally, regarding the impact of device failures on perioperative timing, we found that 10.3% of adverse events resulted in delays greater than 1 h.</div></div><div><h3>Conclusion</h3><div>Ultimately, imprecision and unresponsive software were found to be two of the most frequent complications of robot-assisted spine surgery. Though most reported errors were circumvented intraoperatively through conventional, non-robotic imaging/guidance methods, 10.3% of adverse events resulted in procedural delays of greater than 1 h.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111149"},"PeriodicalIF":1.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488127","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":"Effect of epidural gelfoam soaked levobupivacaine with or without pethidine on postoperative analgesia after single-level lumbar laminectomy: Randomized controlled study","authors":"Ahmed Mohammed Ragab,&nbsp;Magdy Omar El-Sheikh,&nbsp;Hassan Ahmed Abaza,&nbsp;Mansour Abdel Mageed Makkia","doi":"10.1016/j.jocn.2025.111134","DOIUrl":"10.1016/j.jocn.2025.111134","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative pain following spine surgery remains a challenge for patients, surgeons and healthcare facilities. This study aimed to evaluate the postoperative analgesic efficacy of gelfoam soaked in pethidine combined with levobupivacaine, compared to gelfoam soaked in levobupivacaine alone in single-level lumbar laminectomy patients.</div></div><div><h3>Methods</h3><div>This was a prospective, randomized, double blinded study. A total of 90 patients of either sex, aged 18 to 60 years with ASA class I or II planned for single-level lumbar laminectomy were randomly assigned into three equal groups: group A (levobupivacaine plus pethidine): epidural gelfoam soaked with 1 ml levobupivacaine 0.25 % plus 1 ml pethidine 50 mg, group B (levobupivacaine alone): epidural gelfoam soaked with 1 ml levobupivacaine 0.25 % plus 1 ml of 0.9 % sodium chloride; and group C (control group): epidural gelfoam soaked with 2 ml of 0.9 % sodium chloride. Total analgesic consumption, time to first rescue analgesic request, time to ambulate, postoperative VAS scores, vital signs and adverse effects were recorded.</div></div><div><h3>Results</h3><div>Demographic and baseline patients’ data were comparable among the 3 groups. Group B had lower total analgesic consumption, prolonged time to first rescue analgesia, earlier ambulation, and lower VAS scores in the first 24 h in compared to control group C. Significant differences were found between groups A and B in total analgesic consumption, time to first rescue analgesia, and VAS score in the first 24 h. However, no significant differences were found between the two groups regarding time of ambulation and average VAS scores 24 to 48 h after surgery. There were no significant differences in the occurrence of adverse effects among the 3 groups.</div></div><div><h3>Conclusions</h3><div>This study demonstrated that the addition of pethidine to epidural levobupivacaine in a gelfoam soaked form enhanced the postoperative analgesia in patients undergoing single-level lumbar laminectomy in terms of reduced total analgesic consumption, prolonged time to first rescue analgesia and lower postoperative pain scores.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111134"},"PeriodicalIF":1.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473951","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":"Beyond chronological age: The role of biological age in neurosurgical decision-making in long-lived individuals","authors":"Johana Patricia Galván-Barrios ,&nbsp;Jessica Manosalva-Sandoval","doi":"10.1016/j.jocn.2025.111142","DOIUrl":"10.1016/j.jocn.2025.111142","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"134 ","pages":"Article 111142"},"PeriodicalIF":1.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501467","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 cement cranioplasty on cerebrospinal fluid leaks after retrosigmoid craniotomy − A systematic review and meta-analysis","authors":"Alberto Benato ,&nbsp;Gianluca Trevisi ,&nbsp;Davide Palombi ,&nbsp;Fabio Zeoli ,&nbsp;Carmelo Lucio Sturiale","doi":"10.1016/j.jocn.2025.111109","DOIUrl":"10.1016/j.jocn.2025.111109","url":null,"abstract":"<div><h3>Background</h3><div>Cerebrospinal fluid (CSF) leaks and related complications (CLRC) are common after retrosigmoid approaches for cerebellopontine angle (CPA) surgeries. Bone cement cranioplasty (CCP) may provide additional sealing benefits over reconstruction without cement (RWC) in reducing these complications. This study aimed to compare the outcomes of CCP versus RWC in CPA surgery.</div></div><div><h3>Methods</h3><div>A systematic review and <em>meta</em>-analysis following PRISMA guidelines was conducted using three databases (PubMed, Scopus, Web of Science). Studies were included comparing CCP and RWC in retrosigmoid craniotomies/craniectomies for CPA pathologies. Primary outcomes were pseudo meningocele, external CSF leaks, and CLRC, while secondary outcomes included wound infection rates and rates of reoperation for wound problems. <strong>Results:</strong> Five retrospective studies were analyzed with 1,838 patients (931 CCP, 907 RWC). CCP significantly reduced the rates of pseudo meningocele (OR 0.264, CI 0.150–0.463), wound CSF leaks (OR 0.105, CI 0.028–0.399) and CLRC (OR 0.248, CI 0.078–0.794). In the CCP group, there were fewer wound infections (OR 0.310, CI 0.114–0.790) and lower reoperation rates (OR 0.189, CI 0.050–0.708).</div></div><div><h3>Conclusions</h3><div>Cement cranioplasty is associated with a lower incidence of CSF leaks and related complications compared to RWC following retrosigmoid approaches for CPA pathology. CCP also reduces reoperations and wound infections. These findings support using CCP as an effective technique for lowering postoperative complications of retrosigmoid approaches.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111109"},"PeriodicalIF":1.9,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epilepsy surgery candidate identification with artificial intelligence: An implementation study","authors":"Sheryn Tan ,&nbsp;Rudy Goh ,&nbsp;Alexander Wright ,&nbsp;Jeng Swen Ng ,&nbsp;Lewis Hains ,&nbsp;Joshua Kovoor ,&nbsp;Brandon Stretton ,&nbsp;Andrew E.C. Booth ,&nbsp;Shrirajh Satheakeerthy ,&nbsp;Sarah Howson ,&nbsp;Shaun Evans ,&nbsp;Aashray Gupta ,&nbsp;Christopher Ovenden ,&nbsp;James Triplett ,&nbsp;Ishith Seth ,&nbsp;Erin Kelly ,&nbsp;Michelle Kiley ,&nbsp;Amal Abou-Hamden ,&nbsp;Toby Gilbert ,&nbsp;John Maddison ,&nbsp;Stephen Bacchi","doi":"10.1016/j.jocn.2025.111144","DOIUrl":"10.1016/j.jocn.2025.111144","url":null,"abstract":"<div><h3>Background</h3><div>To (a) evaluate the effect of a machine learning algorithm in the identification of patients suitable for epilepsy surgery evaluation, and (b) examine the performance of a large language model (LLM) in the collation of key pieces of information pertaining to epilepsy surgery evaluation referral.</div></div><div><h3>Methods</h3><div>Artificial intelligence analyses were performed for all patients seen in the epilepsy or first seizure clinic at a tertiary hospital over a 12-month period. This study design was intended to emulate a case review that could subsequently be conducted periodically (e.g., quarterly). The previously derived random forest model was used to stratify all patients by their likelihood of being a candidate for epilepsy surgery evaluation, and the top 5% of cases underwent manual case note review. An open source LLM was utilised to answer 7 prompts summarising and extracting pieces of information from the most recent clinic note, which would be relevant to epilepsy surgery evaluation referral.</div></div><div><h3>Results</h3><div>310 patients were included in the study, with 15 undergoing manual review. Of these patients 8/15 (53.3 %) met the prespecified criteria for epilepsy surgery evaluation. 3/15 (20.0 %) of these patients were subsequently referred for further evaluation within 1 month of the study. The LLM had an accuracy ranging between 80 % to 100 % on the different prompts. Errors occurred most often when summarising the management plan. Errors included hallucinations, omissions, and copying erroneous information.</div></div><div><h3>Conclusions</h3><div>Artificial intelligence may be able to assist with the identification of patients suitable for epilepsy surgery evaluation.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111144"},"PeriodicalIF":1.9,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471179","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 between admission serum hemoglobin concentration and the Black Hole Sign on cranial CT in ICH patients: A cross-sectional study","authors":"Weiduo Zhou ,&nbsp;Yidan Liang ,&nbsp;Peng Chen ,&nbsp;Yongbing Deng ,&nbsp;Wenyi Tang ,&nbsp;Yanglingxi Wang","doi":"10.1016/j.jocn.2025.111140","DOIUrl":"10.1016/j.jocn.2025.111140","url":null,"abstract":"<div><h3>Objective</h3><div>This study explores the correlation between admission hemoglobin (HGB) concentration and the Black Hole Sign (BHS) presence on cranial CT scans in spontaneous intracerebral hemorrhage (ICH) patients. Given the prognostic value of BHS in predicting early hematoma expansion and the potential role of HGB levels in influencing outcomes in cerebrovascular conditions, this study seeks to explore the correlation between these two factors. By analyzing clinical and imaging data from the past five years, we aim to provide new insights into the relationship between HGB concentrations and BHS in ICH patients.</div></div><div><h3>Methods</h3><div>A single-center cross-sectional study gathered data from 330 ICH patients admitted to Chongqing Emergency Medical Center’s neurosurgery department between June 2018 and November 2023. Logistic regression and subgroup analysis analyzed the association between admission HGB concentration and BHS occurrence. Curve fitting evaluated any linear relationship.</div></div><div><h3>Results</h3><div>Among 330 patients (mean age: 58.4 ± 13.1 years, 72.1 % males), 40.0 % exhibited BHS on initial CT scans. Multifactorial adjustments revealed a negative correlation between admission HGB concentration and BHS. In subgroup analyses of age, sex, volume of cerebral hemorrhage, insular leaf damage, cerebral hernia, thalamic hemorrhage, and ventricular hemorrhage, No significant interactions were observed between subgroups. For every 1 g/L rise in HGB upon admission, there was a 3 % reduction in BHS likelihood (OR: 0.97, 95 % CI: 0.95–0.99).</div></div><div><h3>Conclusions</h3><div>Lower admission HGB concentrations in spontaneous cerebral hemorrhage patients correlated with increased BHS incidence on cranial CT scans. These findings underscore the importance of balanced HGB levels in ICH patients, potentially serving as a protective measure against stroke risk. Given the possible negative impact of low hemoglobin levels on coagulation and outcomes after a hemorrhage, we advise that middle-aged and elderly individuals with hypertension and other stroke risk factors receive regular medical evaluations. However, given the cross-sectional design of this study, the causal relationship between HGB levels and the BHS should be further validated through prospective cohort studies and large-scale, multicenter trials.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111140"},"PeriodicalIF":1.9,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464763","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":"Cervical extensor muscles involution in patients with symptomatic degenerative conditions: Comparative analysis and impact on alignment parameters","authors":"Brando Guarrera ,&nbsp;Cristina Cuppone ,&nbsp;Rossella Rispoli ,&nbsp;Changik Lee ,&nbsp;Giuseppe Canova ,&nbsp;Enrico Giordan","doi":"10.1016/j.jocn.2025.111112","DOIUrl":"10.1016/j.jocn.2025.111112","url":null,"abstract":"<div><h3>Introduction</h3><div>In recent years, researchers have studied the impact of lumbar paraspinal muscles’ fatty infiltration (FI) on instability and pain. FI is also commonly found in patients with cervical spine conditions such as degenerative myelopathy and spondylosis. Increased FI in the cervical flexor and extensor muscles has been linked to higher pain and disability. This study aims to analyze the composition of extensor muscles in preoperative imaging for patients undergoing cervical spine surgery, correlating them with cervical alignment and demographic parameters.</div></div><div><h3>Materials and Methods</h3><div>This retrospective study examined adults aged 18 and older who had surgery for cervical myelopathy due to spondylosis in the past five years. We recorded the type of surgery performed—either anterior cervical discectomy and fusion (ACDF) or posterior laminectomy—and categorized patients into two groups: anterior (AT) for disc spondylosis and posterior (PT) for degeneration of facet joints. We evaluated preoperative T2-weighted MRI scans for fat infiltration (FI) and cervical spine X-rays for alignment. Specifically, we assessed the FI to muscle tissue (MA) ratio in the paraspinal extensor muscles from C2 to C7. Univariate and multivariate logistic regression models were used to compare cervical alignment, %FI, and demographic factors.</div></div><div><h3>Results</h3><div>We identified 143 patients; 78 were included in the AT and 65 in the PT group. A significantly higher %FI was found in PT patients than in AT (1.8 % ± 2.6 % vs. 5.0 % ± 7.6 %, p-value: 0.015, respectively). Multivariate analysis showed a correlation with lower odds of spondylosis for lower values of T1S (OR 0.94, 95 % CI 0.89–0.98, p-value: 0.017) as well as lower odds of spondylosis for lower values of FI (OR 0.83, 95 % CI 0.71–0.98, p-value: 0.029).</div></div><div><h3>Conclusions</h3><div>We found that patients with single or multilevel stenosis had a much higher degree of %FI in the extensor muscles. Additionally, we observed significant differences in cervical lordosis and T1S values between the two groups, with patients with anterior compression showing significantly lower values of CL and T1S.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111112"},"PeriodicalIF":1.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464765","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 characteristics of late-onset neuromyelitis optica spectrum disorder in China","authors":"Qingli Sun,&nbsp;Jian Li,&nbsp;Danyang Tian","doi":"10.1016/j.jocn.2025.111137","DOIUrl":"10.1016/j.jocn.2025.111137","url":null,"abstract":"<div><h3>Background</h3><div>Neuromyelitis optica spectrum disorders (NMOSD) are central nervous system demyelinating diseases that are distinct from multiple sclerosis. According to epidemiological studies, the incidence of NMSOD peaks in individuals aged 30–40 years. Therefore, whether the clinical manifestations and prognoses of NMOSD differ on the basis of age at onset is worthy of further investigation.</div></div><div><h3>Methods</h3><div>The clinical, laboratory, and imaging data of NMOSD patients admitted to Peking University Third Hospital were retrospectively analyzed. EO-NMOSD was defined early onset NMOSD (age at onset &lt; 50 years), and LO-NMOSD was defined as late onset NMOSD (age at onset &gt; 50 years). Differences in clinical and imaging data were compared between the two groups.</div></div><div><h3>Results</h3><div>A total of 75 patients with NMOSD were enrolled. Among them, 45 patients were age &lt;50 years (EO-NMOSD), and 30 patients were age ≥ 50 years (LO-NMOSD). There was no significant difference in the EDSS score between the two groups at the time of onset (p = 0.071). The median EDSS scores at the last follow-up were 2 points and 3.5 points in the EO-NMOSD and LO-NMOSD groups, respectively, and the difference was statistically significant (p = 0.001). The proportions of patients with EDSS scores ≤ 3 points and 3 &lt; EDSS scores ≤ 6 points were significantly different between the two groups (p = 0.023, p = 0.014), and there was no significant difference in the proportion of patients with EDSS scores greater than 6 points between the two groups (p = 1.000). Spearman correlation analysis revealed that age at onset was positively correlated with EDSS scores at onset (r = 0.284, p = 0.013) and EDSS scores at the last follow-up (r = 0.425, p = 0.000) and negatively correlated with the number of attacks (r = -0.280, p = 0.015). The proportion of AQP4-ab(+) patients with EDSS scores &lt; 3 at onset was lower in the LO-NMOSD group than in the EO-NMOSD group (27.2 % vs. 59.5 %, p = 0.017), and the proportion of AQP4-ab(+) patients with 3 &lt; EDSS scores ≤ 6 was greater in the LO-NMOSD group than in the EO-NMOSD group, both at onset (72.7 % vs. 32.4 %, p = 0.003) and at the last follow-up (54.5 % vs. 24.3 %, p = 0.019). In addition, the proportion of patients with hypertension in the AQP4-ab(+) group of patients with LO-NMOSD was significantly greater than that in the AQP4-ab(+) group of patients with EO-NMOSD (5.4 % vs. 27.3 %, p = 0.043).</div></div><div><h3>Conclusion</h3><div>LO-NMOSD patients, particularly those who were AQP4-ab positive, had more severe functional impairments and poorer prognoses. The number of attacks in AQP4-ab(+) patients with EO-NMOSD was greater than that in AQP4-ab(+) patients with LO-NMOSD.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111137"},"PeriodicalIF":1.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in neuroradiological impacts of hematoma volume and midline shift on clinical symptoms and recurrence rate in patients with unilateral chronic subdural hematoma","authors":"Jun Takei ,&nbsp;Takayuki Inomata ,&nbsp;Takuya Aoki ,&nbsp;Shohei Nawate ,&nbsp;Tatsuya Hirotsu ,&nbsp;Keisuke Hatano ,&nbsp;Mitsuyoshi Watanabe ,&nbsp;Yasuto Noda ,&nbsp;Masato Matsushima ,&nbsp;Toshihiro Ishibashi ,&nbsp;Toshihide Tanaka ,&nbsp;Yuichi Murayama","doi":"10.1016/j.jocn.2025.111136","DOIUrl":"10.1016/j.jocn.2025.111136","url":null,"abstract":"<div><h3>Objective</h3><div>Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition, particularly among the elderly. Hematoma volume (HV) and midline shift (MLS) on CT imaging are critical for assessing CSDH severity and recurrence risk. Brain atrophy has also been linked to recurrence. This study investigates the impact of HV and MLS on clinical symptoms and recurrence, considering brain atrophy.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on patients with unilateral CSDH who underwent burr hole surgery for symptoms such as headache, disturbances of consciousness, hemiparesis, and gait disturbance. HV, MLS, and relative cortical atrophy index (RCAI) were measured using preoperative (pre-) and postoperative (post-) CT images. The rate of change in RCAI (RCAI-CR) between pre- and post-CT images was calculated to assess contralateral brain compression. Associations between HV, MLS, RCAI, RCAI-CR, symptoms, and recurrence were analyzed.</div></div><div><h3>Results</h3><div>The study included 293 patients (mean age 79.4 ± 12.1 years), with a recurrence rate of 15.0 % (44/293). Pre-HV (per 10 mL) was significantly associated with hemiparesis and gait disturbance (odds ratio [OR] 1.12, 95 % confidence interval [CI] 1.03–1.21, p = 0.011; OR 1.14, 95 % CI 1.05–1.24, p = 0.003). Pre-MLS was significantly correlated with disturbances of consciousness (OR 1.26, 95 % CI 1.14–1.39, p &lt; 0.001) and was elevated in patients with high RCAI-CR. Significant predictors of recurrence included Pre-HV (per 10 mL) (OR 1.16, 95 % CI 1.03–1.31, p = 0.014), postoperative subdural cavity volume (per 10 mL) (OR 1.18, 95 % CI 1.02–1.36, p = 0.026), antiplatelet drug use (OR 0.23, 95 % CI 0.06–0.89, p = 0.032), and CT classification (OR 2.35, 95 % CI 1.15–4.82, p = 0.020).</div></div><div><h3>Conclusions</h3><div>HV and MLS have distinct clinical implications in CSDH. Pre-HV is linked to motor disturbances, while Pre-MLS correlates with disturbances of consciousness, with high RCAI-CR indicating significant brain compression. HV is a key predictor of recurrence, while MLS and RCAI are not. These findings may improve outcome prediction and management strategies.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111136"},"PeriodicalIF":1.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453676","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}