Journal of Clinical Neuroscience最新文献

{"title":"Favorable clinical outcomes and complications of endoscopic third ventriculostomy in Chiari Malformation Type I: A systematic review and meta-analysis","authors":"Marcelo Porto Sousa ,&nbsp;Caio Vinicius Figueredo Almeida ,&nbsp;Stefeson Gomes Cabral Junior ,&nbsp;Pedro G.L.B. Borges ,&nbsp;Leonardo B.O. Brenner ,&nbsp;Marcio Yuri Ferreira ,&nbsp;Filipi Fim Andreão ,&nbsp;Sávio Batista ,&nbsp;Felippe Figueiredo Torres Ribeiro ,&nbsp;Fernando Campos Gomes Pinto ,&nbsp;Wellingson S. Paiva ,&nbsp;Jennifer S. Ronecker ,&nbsp;Herika Negri Brito ,&nbsp;Jamal McClendon ,&nbsp;Raphael Bertani","doi":"10.1016/j.jocn.2025.111582","DOIUrl":"10.1016/j.jocn.2025.111582","url":null,"abstract":"<div><h3>Introduction</h3><div>Chiari Malformation Type I (CM-I) is characterized by cerebellar tonsil herniation, often requiring posterior fossa decompression. However, when cerebrospinal fluid flow remains obstructed, additional interventions such as endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunting (VPS) may be necessary. Despite the frequent use of ETV in CM-I cases, evidence supporting its efficacy remains limited. To address this gap, we conducted an updated systematic review and <em>meta</em>-analysis to evaluate ETV outcomes in patients with CM-I.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search of the Medline, Embase, and Web of Science databases, adhering to PRISMA guidelines. The inclusion criteria for studies required a minimum of three patients and focused on outcomes such as symptom improvement, Endoscopic Third Ventriculostomy success, good clinical outcomes and complications.</div></div><div><h3>Results</h3><div>From 502 initially identified studies, 10 were selected, involving 100 patients, including 30 children across four studies, with a median follow-up of 42 months. Using random effects models, the combined analysis showed a 98 % (95 % CI: 93 % − 100 %, I² = 22 %) Favorable clinical outcomes rate. Specifically, symptom improvement related to hydrocephalus was observed at 97 % (95 % CI: 0.88–––1.00, I² = 16), and syrinx improvement at 78 % (95 % CI: 61 % − 96 %, I² = 21 %). Complication rates were 3 % (95 % CI: 0 % − 8 %, I² = 0 %) overall and 0 % (95 % CI: 0 % − 7 %, I² = 0 %) in the pediatric population. The ETV success rate was 92 % (95 % CI: 87 % − 98 %, I² = 29 %).</div></div><div><h3>Conclusion</h3><div>Endoscopic Third Ventriculostomy shows promising efficacy in treating hydrocephalus and syringomyelia, with minimal complications. Its potential as a less invasive alternative to shunts underscores the significance of our study.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111582"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895783","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":"Time-saved and time-invested with anti-amyloid treatments in early Alzheimer’s disease: practical considerations","authors":"Rui Araújo ,&nbsp;Diogo Reis Carneiro ,&nbsp;Rita Nunes Rato ,&nbsp;João Massano","doi":"10.1016/j.jocn.2025.111584","DOIUrl":"10.1016/j.jocn.2025.111584","url":null,"abstract":"<div><div>Anti-amyloid treatments for early Alzheimer’s disease very effectively remove amyloid deposits from the brain and have shown an approximately 30 % less worsening in cognitive functions compared to placebo. Some additional metrics, such as time-saved, i.e. the additional time people may live independently, have been suggested to better inform patients and the general public about the benefits and risks of these medications. Some authors report 4–6 months, and others 10–13 months, depending on the treatment period, time of follow-up, and the methodology used. Taking into consideration that these drugs’ regimens are monthly or bi-weekly intravenous infusions requiring clinical supervision, and the necessary brain MRIs for follow-up, we argue that the time spent travelling by the patients and their family members should also be taken into consideration when proposing anti-amyloid treatments, and specifically, when discussing the amount of time saved. In this study, we report that nearly half of the possible eligible patients for anti-amyloid treatments experience a reduction in motivation after receiving the information about the number of times required to come to the hospital, especially those travelling long distances (average time: 60 min for one-way). We propose a rough estimate for the additional time patients and their family members are likely to spend in these arrangements and suggest these additional calculations should be part of the decision-making process.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111584"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895781","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 heterogeneity, treatment patterns, and outcomes of advanced-age-onset myasthenia gravis in China: a retrospective cohort study","authors":"Ying Ji ,&nbsp;Shuxian Zhou ,&nbsp;Xiaoxiao He ,&nbsp;Wenbo Li ,&nbsp;Xue Zhao ,&nbsp;Yingna Zhang ,&nbsp;Jing Zhang ,&nbsp;Jie Lv ,&nbsp;Peipei Liu ,&nbsp;Weike Cui ,&nbsp;Junhong Yang ,&nbsp;Feng Gao","doi":"10.1016/j.jocn.2025.111586","DOIUrl":"10.1016/j.jocn.2025.111586","url":null,"abstract":"<div><h3>Objectives</h3><div>The clinical characteristics and outcomes of myasthenia gravis (MG) with onset at age 50 years or older, which commonly referred to as late-onset MG (LOMG), in elderly patients remain incompletely understood. This study aimed to address the clinical heterogeneity within LOMG and to clarify whether very-late-onset MG (≥70 years) constitutes a distinct phenotype requiring tailored management approaches.</div></div><div><h3>Methods</h3><div>We analyzed data from 2783 patients enrolled in the MG Registry between April 1, 2009, and December 31, 2020. Patients with LOMG were further stratified into two subgroups: those with MG onset at age 50–69 years (referred to as Early-LOMG), and those with onset at age ≥70 years (referred to as advanced-onset MG, AOMG). Clinical features, diagnostic tests, treatments, and outcomes were compared across subgroups.</div></div><div><h3>Results</h3><div>Of the 982 patients with LOMG, 191 (19.4 %) were classified as AOMG. Compared to patients with MG onset at age 50–69 years, those with onset at age ≥70 years (AOMG) had a higher proportion of females (57.6 % vs 48.7 %, p = 0.027), and were more frequently positive for AChR-Ab (81.2 % vs 70.4 %, p = 0.001) and Titin-Ab (32.5 % vs 22.5 %, p = 0.004), and were more likely to present with bulbar muscle involvement at onset (25.3 % vs 14.8 %) and during disease progression (53.7 % vs 38.6 %). The positive rate of repetitive nerve stimulation (RNS) testing was also higher in the AOMG group (57.1 % vs 35.8 %, p = 0.018). Thymoma was less frequent (12.1 % vs 29.6 %, p = 0.006), and fewer AOMG patients underwent thymectomy (2.6 % vs 31.0 %, p &lt; 0.001). AOMG patients generally required fewer immunosuppressive therapies and achieved comparable functional outcomes. However, the mortality rate was significantly higher in the AOMG group (p = 0.020), primarily due to MG crisis.</div></div><div><h3>Conclusions</h3><div>AOMG exhibits distinct clinical features compared to Early-LOMG, characterized by a higher frequency of bulbar involvement, lower thymoma prevalence, less aggressive treatment, and higher mortality. Tailored management strategies are warranted for elderly patients with MG.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111586"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895784","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":"Technical Report: Full endoscopic Trans-Kambin lumbar interbody fusion","authors":"Ralph J. Mobbs ,&nbsp;Chris Huang ,&nbsp;Jiun-Lih Lin ,&nbsp;Alison Ma","doi":"10.1016/j.jocn.2025.111579","DOIUrl":"10.1016/j.jocn.2025.111579","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111579"},"PeriodicalIF":1.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893844","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":"Diabetes-specific characteristics of intracranial artery atherosclerosis: a magnetic resonance vessel wall imaging study","authors":"Taichun Qiu ,&nbsp;Bing Ming ,&nbsp;Dandan Yang ,&nbsp;Huiyu Qiao ,&nbsp;Ning Xu ,&nbsp;Rui Shen ,&nbsp;Yongjun Han ,&nbsp;Xihai Zhao ,&nbsp;ICASMAP investigators","doi":"10.1016/j.jocn.2025.111585","DOIUrl":"10.1016/j.jocn.2025.111585","url":null,"abstract":"<div><h3>Background</h3><div>While diabetes mellitus (DM) is an established risk factor for intracranial atherosclerotic disease (ICAD), its impact on plaque characteristics across different intracranial vascular territories remains unclear.</div></div><div><h3>Methods</h3><div>Patients with symptomatic intracranial artery stenosis were recruited from a multi-center study of ICASMAP. Plaque characteristics, including the location, plaque burden measured by normalized wall index (NWI), luminal stenosis, length, T1 hyperintense, enhancement grade, and the enhancement ratio of atherosclerotic plaques were evaluated. Plaque characteristics were compared between patients with and without DM and the association between DM and plaque characteristics was analyzed.</div></div><div><h3>Results</h3><div>Of 171 recruited patients (mean age: 59.1 ± 8.9 years; 91 males), 76 (44.4 %) had DM. Diabetic patients had significantly greater luminal stenosis (49.6 %±25.6 % vs. 29.3 %±18.0 %, <em>P</em> &lt; 0.001), length of plaque (9.3 ± 2.9 mm vs. 7.9 ± 3.9 mm, <em>P</em> = 0.001), NWI (82.9 %±13.0 % vs. 75.9 %±15.4 %, <em>P</em> = 0.012), plaque enhancement Grade 0 (22.4 % vs. 48.0 %, <em>P</em> = 0.005), and plaque enhancement Grade 1 (72.4 % vs. 48.0 %, <em>P</em> = 0.009) in the ophthalmic and communion segment of the internal carotid artery compared with non-diabetic patients. In the basilar artery, there were significant differences in luminal stenosis (57.5 %±28.3 % vs. 42.5 %±25.8 %, <em>P</em> = 0.026), length of plaque (16.6 ± 8.2 mm vs. 10.2 ± 5.3 mm, <em>P</em> &lt; 0.001), and plaque enhancement Grade 1 (77.1 % vs. 51.4 %, <em>P</em> = 0.025) between diabetic and non-diabetic patients. No significant differences were observed in the M1-2 segment of the middle cerebral artery or the V4 segment of the vertebral artery. Adjusting for confounding factors, the differences remained statistically significant in luminal stenosis (<em>P</em> = 0.001), NWI (<em>P</em> = 0.011), plaque enhancement Grade 1 (<em>P</em> = 0.033), and plaque enhancement Grade 2 (<em>P</em> = 0.048) in the ophthalmic and communion segments of internal carotid artery and luminal stenosis (<em>P</em> = 0.001), length of plaque (<em>P</em> = 0.006) in basilar artery between diabetic and non-diabetic patients.</div></div><div><h3>Conclusion</h3><div>DM differentially affects atherosclerotic plaque characteristics across intracranial artery segments, predominantly the ophthalmic and communion segments of the internal carotid artery and basilar artery.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111585"},"PeriodicalIF":1.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893841","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":"Epidural arteriovenous malformation mimicking a dorsal spinal schwannoma","authors":"Charles Champeaux Depond ,&nbsp;Philippe Metellus ,&nbsp;Romain Appay","doi":"10.1016/j.jocn.2025.111583","DOIUrl":"10.1016/j.jocn.2025.111583","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111583"},"PeriodicalIF":1.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893842","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":"Translaminar contralateral endoscopic foraminotomy for foraminal stenosis and lumbar disc herniation at L5-S1","authors":"Ralph J. Mobbs ,&nbsp;Jiun-Lih Lin ,&nbsp;Christopher Huang ,&nbsp;Richard Parkinson ,&nbsp;Alison Ma","doi":"10.1016/j.jocn.2025.111566","DOIUrl":"10.1016/j.jocn.2025.111566","url":null,"abstract":"&lt;div&gt;&lt;div&gt;L5-S1 pathologies including foraminal disc herniation, foraminal stenosis and spondylolisthesis are well-recognized causes of radicular pain, functional limitation, and diminished quality of life, with many patients requiring surgical intervention due to refractory symptoms or progressive neurological compromise [&lt;span&gt;&lt;span&gt;1&lt;/span&gt;&lt;/span&gt;,&lt;span&gt;&lt;span&gt;2&lt;/span&gt;&lt;/span&gt;]. Traditionally, surgical decompression at L5-S1 has involved interbody fusion procedures, aimed at restoring foraminal height and stabilizing the segment to relieve nerve root impingement [&lt;span&gt;&lt;span&gt;3&lt;/span&gt;&lt;/span&gt;]. However, these procedures can result in prolonged recovery times, increased surgical morbidity, and the long-term risk of adjacent segment degeneration [&lt;span&gt;&lt;span&gt;4&lt;/span&gt;&lt;/span&gt;,&lt;span&gt;&lt;span&gt;5&lt;/span&gt;&lt;/span&gt;]. In recent years, endoscopic techniques have emerged as minimally invasive, motion-preserving alternatives for patients with radiculopathy due to foraminal compression [&lt;span&gt;&lt;span&gt;5&lt;/span&gt;&lt;/span&gt;,&lt;span&gt;&lt;span&gt;6&lt;/span&gt;&lt;/span&gt;]. Among these, the translaminar contralateral endoscopic foraminotomy (TCEF) approach allows for direct visualisation and precise neural decompression of the L5 nerve root without compromising segmental stability, offering faster recovery, less postoperative pain, and significant reduction in hospital stay [&lt;span&gt;&lt;span&gt;[7]&lt;/span&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;[8]&lt;/span&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;[9]&lt;/span&gt;&lt;/span&gt;].&lt;/div&gt;&lt;div&gt;The authors report a video technical note on a TCEF in a 39-year-old male with four years of worsening L5 radiculopathy and low back pain. MRI demonstrated a bilateral pars defect with low-grade spondylolisthesis, severe foraminal stenosis and annular bulging (&lt;span&gt;&lt;span&gt;Fig. 1&lt;/span&gt;&lt;/span&gt;). Under general anaesthesia, fluoroscopic guidance confirmed the L5–S1 level and contralateral translaminar entry point, and a 10-mm incision was made just lateral to the midline. A dilator was advanced to the L5 lamina (&lt;span&gt;&lt;span&gt;Fig. 2&lt;/span&gt;&lt;/span&gt;A), followed by placement of a 10-mm working cannula (&lt;span&gt;&lt;span&gt;Fig. 3&lt;/span&gt;&lt;/span&gt;A and B) and stenosis scope. A small laminotomy under the L5 spinous process and lamina was performed, creating a wider working corridor within the canal and providing access to the epidural space and contralateral L5-S1 foramen (&lt;span&gt;&lt;span&gt;Fig. 2&lt;/span&gt;&lt;/span&gt;B, C and &lt;span&gt;&lt;span&gt;3&lt;/span&gt;&lt;/span&gt;C). A 30° endoscope provided high-definition magnified visualization, facilitating precise discectomy and decompression of the L5 nerve root using endoscopic graspers, rongeurs, and radiofrequency probes (&lt;span&gt;&lt;span&gt;Fig. 3&lt;/span&gt;&lt;/span&gt;E–G). The incision was closed with a single subcutaneous suture and the procedure was completed in 53 min with estimated blood loss of &lt;1 cc. Postoperative imaging confirmed adequate decompression and preservation of the facet joint. Early clinical outcomes demonstrated the patient had resolution of radicular symptoms and no neurological complications.&lt;/div&gt;&lt;div&gt;Across three pe","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111566"},"PeriodicalIF":1.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893843","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 renal function with cognitive progression in de novo Parkinson’s disease","authors":"Xuanyue Zhang ,&nbsp;Li Cui","doi":"10.1016/j.jocn.2025.111495","DOIUrl":"10.1016/j.jocn.2025.111495","url":null,"abstract":"<div><h3>Background</h3><div>People with chronic kidney disease (CKD) who had decreased renal function were more likely to develop cognitive decline in contrast to the general population.</div></div><div><h3>Objective</h3><div>Whether renal function parameters can effectively predict cognitive progress in Parkinson’s disease is not yet clear.</div></div><div><h3>Methods</h3><div>In the present study, 612 de novo Parkinson’s Disease (PD) patients from the Parkinson’s Progression Markers Initiative (PPMI) database were recruited. To examine the associations between renal function parameters and cognition we utilized multiple linear regression models and mixed-effects models. Cox regression was used to investigate whether the renal function parameters were the risk factors for developing dementia in PD participants.</div></div><div><h3>Results</h3><div>Regression analyses indicated that creatinine (Cr), blood urea nitrogen (BUN), Blood urea nitrogen / Creatinine ratio (BUN/Cr), and estimated glomerular filtration rate(eGFR) were strongly associated with cognitive score as indicated by global cognition (MoCA, β = 0.066, p = 0.015; β = -0.043, p = 0.025; β = -0.070, p &lt; 0.001; β = -0.058, p = 0.013, respectively). Serum uric acid (SUA) and the serum uric acid / Creatinine ratio (SUA/Cr) were associated with cognitive decline as indicated by executive function/working memory (LNS, β = -0.045, p &lt; 0.001; β = -0.032, p = 0.025, respectively). Higher SUA/Cr and eGFR were associated with a higher incidence of developing PD dementia after an average follow-up of 7.26 ± 2.50 years (HR = 1.014, 95 % CI 1.004 to 1.024, p = 0.006; HR = 1.190, 95 % CI 1.023 to 1.384, p = 0.025, respectively).</div></div><div><h3>Conclusions</h3><div>Our findings revealed the relationship between renal function and cognition in PD patients, which indicated that renal function might play a role in cognitive progression in de novo Parkinson’s.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111495"},"PeriodicalIF":1.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893898","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":"Outcomes in restoration of shoulder abduction in upper trunk brachial plexus injuries: a randomized study comparing ipsilateral C7 fascicle and spinal accessory nerve as donor nerves","authors":"Varun H. Kashyap,&nbsp;Veena Kumari Singh,&nbsp;Ansarul Haq,&nbsp;Anupama Kumari,&nbsp;Shreosi Sarkar","doi":"10.1016/j.jocn.2025.111560","DOIUrl":"10.1016/j.jocn.2025.111560","url":null,"abstract":"<div><h3>Background</h3><div>Spinal accessory nerve (SAN) transfer is commonly used to reanimate the suprascapular nerve (SSN) in traumatic brachial plexus injuries (BPI). Despite its technical simplicity and satisfactory results, this transfer has two disadvantages: the inadequacy of the number of nerve fibers between donor and recipient and the weakening of the trapezius muscle. To avoid this, we transferred a fascicle from the C7 root for the pectoralis major muscle to the suprascapular nerve for shoulder abduction.</div></div><div><h3>Methods</h3><div>Patients with traumatic upper trunk brachial plexus injury presenting within 6 months of injury were randomly allocated to study &amp; control groups. The control group underwent SAN to SSN transfer, and the study group underwent C7 fascicle to SSN transfer. Transfer of the radial nerve branch to the triceps’ long head to the axillary nerve’s anterior branch and fascicle transfer to the musculocutaneous branches to the biceps and brachialis was also considered.</div></div><div><h3>Results</h3><div>A total of 13 patients were included in the study from August 2022 to December 2024. The control group comprised 7 patients with a mean age of 22.7 years (14–32 years), and the study group comprised 6 patients with a mean age of 34.8 years (16–38 years). At a mean follow up of 18.3 months (range of 12–28 months) in the study group, two of the 6 patients had shoulder abduction recovery power of M3 whereas 4 patients had MRC ≥ 3 recovery in shoulder abduction among the control group (M4-2, M3-2) at 20.6 months (range of 14–35 months) of follow up. However, there was no statistically significant difference observed in the shoulder recovery outcomes (p = 0.706).</div></div><div><h3>Conclusion</h3><div>There was no significance in the functional recovery of shoulder abduction power &amp; active range of motion among the two groups.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111560"},"PeriodicalIF":1.8,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893900","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":"Multimodality treatment maximizing outcome in spinal dural arteriovenous fistulae","authors":"A.J. Gauden ,&nbsp;B. Gu ,&nbsp;S. Han ,&nbsp;N.J. Telischak ,&nbsp;R. Dodd ,&nbsp;H.M. Do ,&nbsp;M.P. Marks ,&nbsp;G.K. Steinberg","doi":"10.1016/j.jocn.2025.111571","DOIUrl":"10.1016/j.jocn.2025.111571","url":null,"abstract":"<div><h3>Background</h3><div>Spinal dural arteriovenous fistula (sDAVF) is a rare cause of myelopathy and progressive paraplegia. sDAVFs are the most frequent type of spinal vascular malformation and comprise 70 % of all vascular spinal malformations. Despite the availability and published efficacy of both microsurgical resection and endovascular embolization, the optimal treatment for sDAVFs remains to be determined. We aimed to assess the efficacy of a multimodal treatment approach to sDAVFs at our institution.</div></div><div><h3>Methods</h3><div>A retrospective review of all sDAVFs treated between 1998 and 2021 at Stanford Hospital and Clinics was conducted. The medical records were inspected and data, including presenting symptoms, duration, angiographic features, and treatment modality, were extracted. Cure was defined as the absence of an arteriovenous fistulous connection on digital subtraction angiography and radiologic improvement on follow-up MRI. Functional outcomes were assessed at presentation and at last follow-up using the Aminoff-Logue Scale (ALS).</div></div><div><h3>Results</h3><div>47 patients underwent treatment of sDAVFs between August 1998 to May 2021. As an initial treatment, 32 patients underwent microsurgical excision, and 15 had endovascular embolization. Radiological cure was achieved in 84.4 % of patients during the first treatment and in 97.9 % of patients at the final treatment time point. At initial treatment, surgery cured the sDAVF in 84.4 % of patients, with endovascular embolization curing in 86.7 % of patients. When assessed as an additional treatment for failed prior treatment, surgery achieved cure in 80 % of patients and endovascular embolization in 100 % of patients. At all time points, high cure rates were observed, with success rates achieving 96.9 % and 100 % for surgery and endovascular embolization, respectively. A significant improvement in ALS Gait score was noted after treatment, with a mean reduction of 0.6 from baseline (p = 0.0003). A similar improvement trend was observed in the ALS Micturition score with a mean decrease of 0.3 points (p = 0.057).</div></div><div><h3>Conclusions</h3><div>Our study demonstrates high efficacy for cure and improved functional outcomes in both surgical and endovascular treatments, assuming good patient selection. This series also highlights the importance of a multimodality treatment approach in managing spinal dural arteriovenous fistulae. Further delineation is required to determine the radiological and patient factors that might recommend specific initial treatment modalities.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111571"},"PeriodicalIF":1.8,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893899","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}