Journal of Clinical Neuroscience最新文献

{"title":"A novel application of radiomics for the evaluation of transient wall shear stress on the surface of cerebral aneurysms","authors":"Alexandra Lauric,&nbsp;Adel M. Malek","doi":"10.1016/j.jocn.2026.111851","DOIUrl":"10.1016/j.jocn.2026.111851","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial aneurysm evaluation based on computational fluid dynamic (CFD) wall shear stress (WSS) analysis remains an active and evolving research field. We propose a novel application of radiomics for transient CFD, focusing on texture and pattern evaluation of aneurysmal WSS, beyond conventional distribution analysis.</div></div><div><h3>Methods</h3><div>Catheter 3D rotational angiographic volumes were available for 75 aneurysms (33 ruptured). Transient CFD simulations were performed on aneurysmal models across the cardiac cycle, exporting WSS distributions at 25 consecutive time steps. 3D WSS distributions were mapped to 2D by projection to unit sphere, followed by normalization and logarithmic transformation for analysis at extrema. The resulting 2D spatial WSS images over time formed 3D DICOM volumes for radiomics analysis. Uni- and multivariate analysis was used to evaluate radiomics features for rupture status discriminant performance.</div></div><div><h3>Results</h3><div>Compared to unruptured, ruptured aneurysms show increased complexity and heterogeneity in the spatial and temporal domains (higher DifferenceEntropy, JointAverage, JointEntropy), with distinct areas of low and high WSS-derived intensity (lower InverseDifference, higher SumAverage). Ruptured aneurysms showed significantly less uniformity of pattern both in size (higher SizeZoneNonUniformity) and intensity (higher GrayLevelNonUniformity). Multivariate analysis for rupture status discrimination resulted in an area under the curve (AUC) value of 0.81 (sensitivity 0.82, specificity 0.72).</div></div><div><h3>Conclusion</h3><div>Radiomics analysis of transient WSS resulted in strong rupture status discrimination. This novel approach extends the use of radiomics beyond angiographic analysis, enables evaluation of WSS evolution over the entire cardiac cycle, provides insights into rupture characteristics, and opens novel and promising avenues of future research.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111851"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922478","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":"Building a national repository of dural-based lesions: clinical, pathological, and demographic insights from the Indian population","authors":"Sarvesh Goyal ,&nbsp;Shweta Kedia ,&nbsp;Ritesh Kumar ,&nbsp;Kanwaljeet Garg ,&nbsp;Manoj Phalak ,&nbsp;Mohammed Shahin ,&nbsp;Shailesh Gaikwad ,&nbsp;Savyasachi Jain ,&nbsp;Vaishali Suri ,&nbsp;Debnath Pal ,&nbsp;Dwarkanath Srinivas ,&nbsp;Harsh Deora ,&nbsp;Pravin Salunke ,&nbsp;Awadhesh Jaiswal ,&nbsp;Ankur Bajaj ,&nbsp;Rabi Narayan Sahu ,&nbsp;George C. Vilanilam ,&nbsp;Harpreet Singh ,&nbsp;Shilpa Rao ,&nbsp;Jitender Saini ,&nbsp;A.N. Deepti","doi":"10.1016/j.jocn.2025.111834","DOIUrl":"10.1016/j.jocn.2025.111834","url":null,"abstract":"<div><h3>Background</h3><div>Meningiomas are the most common dural-based intracranial tumors, yet Indian literature is predominantly composed of limited single-center studies, restricting nationwide representation and data-driven decision making. With artificial intelligence (AI) becoming increasingly relevant in neuro-oncology for diagnosis, segmentation, and outcome prediction, the lack of a large, standardized national dataset poses a major barrier. The Medical Imaging Datasets for India (MIDAS) initiative, a collaborative national effort involving ICMR, IISc, and ARTPARK, aims to create high-quality, annotated medical imaging repositories that can support clinical research and AI model development. As a part of this initiative, we developed a multicenter national repository of dural-based lesions.</div></div><div><h3>Methods</h3><div>This ambispective study included patients with radiologically suspected and histopathologically confirmed dural-based lesions from seven neurosurgical centers across India (January 2022–July 2025). Standardized de-identified demographic, clinical, imaging, and pathological data were collected. Imaging was archived in DICOM format and annotated using ITK-SNAP, while histopathology followed WHO-2021 CNS tumor guidelines. Statistical analysis was performed using descriptive and comparative measures.</div></div><div><h3>Results</h3><div>Among 586 patients, women constituted two-thirds of the cohort, with a mean age of 47.2 years. Meningiomas accounted for 98.3 % of cases and were predominantly WHO Grade I, most commonly of transitional and meningothelial subtypes. Convexity, parasagittal, and falcine locations were most frequently involved. A small but important proportion of lesions were non-meningiomatous, including schwannomas, solitary fibrous tumors, granulomatous, and metastatic lesions. Simpson Grade II resection was the most common surgical outcome, and a subset of patients underwent postoperative adjuvant radiosurgery.</div></div><div><h3>Conclusion</h3><div>This MIDAS-linked national repository represents the largest structured dataset of dural-based lesions from India, integrating standardized clinical, imaging, and pathological information across multiple centers. In addition to defining national disease patterns, the availability of curated imaging and volumetric segmentations provides a strong translational platform for future artificial intelligence–based research, including automated segmentation, diagnostic classification, and outcome prediction.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111834"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922479","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":"Post-stroke seizures in malignant middle cerebral artery infarction treated with decompressive hemicraniectomy: A meta-analysis of predictive factors and clinical outcomes","authors":"Kaike Lobo ,&nbsp;Felipe Moraes Costa ,&nbsp;Rafael Reis de Oliveira ,&nbsp;Ruan Pablo da Silva Gomes ,&nbsp;Giovana Pereira Lobato Brito ,&nbsp;Enzo Gabriel Lacerda Rodrigues ,&nbsp;Janilzo de Jesus Mendes Costa Júnior ,&nbsp;Ana Luíza Mendonça de Almeida ,&nbsp;Yurie Lima Yamada ,&nbsp;Yasmin Lamas Medeiros ,&nbsp;M Ali Aziz-Sultan","doi":"10.1016/j.jocn.2025.111835","DOIUrl":"10.1016/j.jocn.2025.111835","url":null,"abstract":"<div><h3>Background</h3><div>Decompressive hemicraniectomy (DHC) is a life-saving intervention for malignant middle cerebral artery (MCA) infarction. However, the additional factors which further increase seizure risk within this high-risk population remain unclear. This <em>meta</em>-analysis aimed to evaluate incremental risk factors for seizure development after DHC in malignant MCA infarction and to assess the association between seizures and clinical outcomes.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, and Cochrane Library for studies evaluating risk factors for seizure development after DHC for malignant MCA infarction. Odds ratios (ORs) and mean differences were computed for dichotomous and continuous outcomes, respectively, using 95% confidence intervals (CIs) under a random-effects model. Heterogeneity was assessed with I² statistics.</div></div><div><h3>Results</h3><div>Five retrospective cohort studies were included, comprising a total of 456 patients, of whom 195 (42.76 %) developed seizures, and 261 (57.24 %) did not. No significant differences between groups were observed for age, female gender, hypertension, diabetes, dyslipidemia, alcohol consumption, history of previous ischemic event, stroke etiology, hemispheric laterality, presence of reperfusion therapy, stroke limited to MCA territory, hemorrhagic transformation, NIH Stroke Scale scores on admission, and time to craniectomy. However, there was a significantly higher proportion of modified Rankin Scale scores ≤ 3 and a lower mortality rate in patients with seizures when compared with those without.</div></div><div><h3>Conclusion</h3><div>In conclusion, none of the variables analyzed were identified as independent risk factors for seizure development, although there was an increased rate of good functional outcome and lower mortality in patients with seizures, possibly reflecting a time-dependent factor of seizure detection.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111835"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882397","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":"Glioblastoma in New Zealand: A retrospective cohort analysis post WHO CNS 5","authors":"Ben Harley ,&nbsp;Sung-Min Jun ,&nbsp;Michael Nichols ,&nbsp;Michael Heckelmann ,&nbsp;Jayne Sheridan ,&nbsp;Malinda Lucas ,&nbsp;Davina McAllister ,&nbsp;Heta Leinonen ,&nbsp;Simon John ,&nbsp;Andrew Parker ,&nbsp;Ahmad Taha ,&nbsp;Peter Heppner ,&nbsp;Stephen David Robinson ,&nbsp;Giles Critchley","doi":"10.1016/j.jocn.2025.111833","DOIUrl":"10.1016/j.jocn.2025.111833","url":null,"abstract":"<div><h3>Background</h3><div>Glioblastoma represents one of the deadliest primary brain cancers and has undergone frequent diagnostic classification changes. New Zealand has a relatively small population facilitating a national individual patient cohort analysis. This study looks at glioblastoma diagnosis, treatment including radiotherapy and outcomes across New Zealand for a calendar year.</div></div><div><h3>Methods</h3><div>Patients diagnosed with glioblastoma according to the 2021 WHO guidelines were identified across the five neurosurgical units in New Zealand between 01/01/2021–31/12/2021. A total of 184 patients were included.</div></div><div><h3>Results</h3><div>Crude overall incidence was 3.6 persons per 100,000, with a reduced age-standardised incidence in indigenous Māori at 2.5 diagnoses per 100,000 versus 3.8 per 100,000 for non– Māori was identified. Median overall survival (OS) was 10.6 months and did not differ across units (p = 0.782) or by ethnicity (p = 0.653). Gross total resection was associated with longest OS of 20.0 months, whilst OS after biopsy was only 4.0 months (p &lt; 0.001). Mean time to radiotherapy (TTR) was on average 41 days (interquartile range: 33 – 49 days), and there was no significant difference in OS in patients with delayed radiation therapy beyond 8 weeks (14.6 % of patients) compared to those with earlier radiotherapy (p = 0.538). However, identification of rapid early progression was associated with worse OS (p = 0.030). Patients who received conventionally fractionated chemoradiotherapy had a median OS of 19.1 months (95 % confidence interval: 15.3–––22.8 months), whilst those patients ≥ 65 years old who received hypofractionated chemoradiotherapy had a median OS of 12.6 months (95 % confidence interval: 7.6 – 17.6 months) in keeping with the landmark clinical trial outcomes of 14.6 months (95 % confidence interval: 13.2 – 16.8 months) median OS in the 2005 Stupp trial and 9.3 months (95 % confidence interval: 8.3 – 10.3 months) median OS in the 2017 Perry trial respectively.</div></div><div><h3>Conclusions</h3><div>This study is the first national cohort for glioblastoma patients diagnosed according to the 2021 WHO guidelines across a calendar year. There was a difference in the age-standardised incidence in Māori and non-Māori populations but with no difference in OS. We identified New Zealand population OS rates that match international cohorts and practice changing clinical trials, and we found no difference in OS depending on TTR, ethnicity or treating unit.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111833"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882451","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 Neuromodulation in Postoperative Acute and Chronic Low Back Pain after Lumbar Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis and Meta-Regression","authors":"Plamen Penchev ,&nbsp;Daniela Milanova-Ilieva ,&nbsp;Lyubomir Gaydarski ,&nbsp;Dobromir Dimitrov ,&nbsp;Boris Tablov ,&nbsp;Noor Husain ,&nbsp;Remzi Hyusein ,&nbsp;Cristian Vladimirov ,&nbsp;Mihaela Mihaylova ,&nbsp;Ivan Lozanov ,&nbsp;Darko Stavrev ,&nbsp;Petar-Preslav Petrov ,&nbsp;Pavel Stanchev ,&nbsp;Andrey Velev ,&nbsp;Nikolai Ramadanov ,&nbsp;Nikolay Peev","doi":"10.1016/j.jocn.2025.111815","DOIUrl":"10.1016/j.jocn.2025.111815","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute and chronic postoperative low back pain are frequent occurrences after lumbar spine surgery, contributing to long-term disability and increased analgesic use. Neuromodulation techniques—both invasive and non-invasive—have emerged as promising non-pharmacological interventions. However, current evidence remains fragmented. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of neuromodulation in managing acute and chronic postoperative low back pain.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Scopus, and Cochrane databases from inception up to 30 June 2025 for randomized controlled trials (RCTs) published in English only comparing neuromodulation to sham modulation in patients with postoperative low back pain following lumbar spine surgery. The review protocol was registered in PROSPERO (CRD420251108776). Primary outcomes included pain intensity reduction, analgesic consumption, functional disability, and adverse effects. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) for continuous outcomes were calculated using a frequentist random-effects model. Proportions and 95% CIs for binary outcomes, including adverse events and sex distribution, were computed using the Freeman–Tukey double arcsine transformation to stabilize variance. Heterogeneity was assessed using the I²  statistic and Cochrane’s Q test.</div></div><div><h3>Results</h3><div>Twelve RCTs involving 413 patients (mean age 53 years; 55 % female) were included, with 207 (50%) receiving neuromodulation. In the pooled analysis, neuromodulation significantly reduced pain intensity (SMD − 0.82; 95 % CI [−1.13, −0.50]; p &lt; 0.00001; I² = 53 %) and analgesic consumption (SMD − 0.91; 95 % CI [−1.63, −0.20]; p = 0.01; I² = 81 %) compared to sham. No significant difference was found in functional disability (SMD − 0.31; 95 % CI [−0.85, 0.24]; p = 0.28; I² = 44 %). The pooled female proportion was 55 % (95 % CI [42.99, 66.95]; I² = 73 %), and the prevalence of adverse effects was 12.48 % (95 % CI [6.13, 20.39]; I² = 0 %).</div></div><div><h3>Conclusion</h3><div>This meta-analysis demonstrates that neuromodulation significantly reduces postoperative pain and opioid consumption after lumbar spine surgery, although it does not improve functional disability. Given the growing need for non-pharmacological pain management strategies, neuromodulation represents a promising evidence-based adjunct in postoperative care. Future high-quality RCTs should refine optimal protocols and evaluate long-term functional outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111815"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794007","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":"MPO-to-albumin ratio at admission predicts 90-day stroke recurrence","authors":"Xiangqi Kong,&nbsp;Haobo Wang,&nbsp;Penghong Li,&nbsp;Xinyue Yuan,&nbsp;Wei Jing","doi":"10.1016/j.jocn.2025.111794","DOIUrl":"10.1016/j.jocn.2025.111794","url":null,"abstract":"<div><h3>Background</h3><div>Globally, acute ischemic stroke (AIS) remains a leading cause of mortality, and recurrence further worsens long-term outcomes. Oxidative–inflammatory imbalance plays a crucial role in stroke recurrence. Myeloperoxidase (MPO) is a key pro-oxidant enzyme, while albumin (Alb) is the predominant antioxidant protein. Integrating both parameters, the MPO-to-albumin ratio (MPO/Alb) may better capture this imbalance. This study examined the relationship between MPO/Alb and 90-day stroke recurrence.</div></div><div><h3>Methods</h3><div>In this retrospective cohort, 422 AIS patients admitted to Shanxi Bethune Hospital (October 2022–September 2023) were enrolled. Baseline clinical and laboratory data were collected, and MPO/Alb ratio was calculated. The primary outcome was 90-day recurrence, assessed via telephone follow-up. Multivariable logistic regression, quartile trend tests, restricted cubic spline (RCS) modeling and subgroup analyses were conducted.</div></div><div><h3>Results</h3><div>Of 422 patients, 23 experienced recurrence within 90 days. Compared with the non-recurrence group, recurrent cases had significantly higher MPO and MPO/Alb levels (p &lt; 0.05). Fully adjusted regression indicated that every unit increase in MPO/Alb predicted a 21 % greater recurrence risk (OR = 1.21). Quartile analysis indicated a dose–response relationship, with the highest quartile exhibiting a nearly 10-fold elevated risk (OR = 9.93). RCS analysis confirmed a linear association. No significant interactions were detected across the predefined subgroups.</div></div><div><h3>Conclusion</h3><div>Elevated MPO/Alb ratio at admission independently predicts 90-day recurrence in AIS. As a simple and inexpensive biomarker, it may aid early risk stratification and secondary prevention, pending validation in multicenter prospective studies.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111794"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701025","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":"Anesthetic reporting in stroke thrombectomy randomized clinical trials: a systematic review","authors":"Daniel Winecoff ,&nbsp;Elizabeth O. Moreton ,&nbsp;Anne Bryden ,&nbsp;Mia Kang ,&nbsp;Robb Wasserman ,&nbsp;James Williams ,&nbsp;Abhijit V. Lele ,&nbsp;Samuel N. Blacker","doi":"10.1016/j.jocn.2025.111785","DOIUrl":"10.1016/j.jocn.2025.111785","url":null,"abstract":"<div><div>This systematic review elucidates the level of detail of anesthesia care in randomized clinical trials (RCTs) of mechanical thrombectomy (MT) for acute ischemic stroke (AIS). RCTs between January 1, 2004, and December 31, 2024, were searched and reviewed. A scoring system for individual trial elements was developed and reported, categorized as demographic (n = 9), essential monitoring (n = 13), anesthetic care (n = 13), and MT outcomes (n = 5). The elements were reported as median [Q1; Q3] and compared before and after the 2014 Society for Neuroscience in Anesthesiology and Critical Care (SNACC) guidelines for endovascular thrombectomy were published. This study was registered on the International Prospective Register of Systematic Reviews on January 19, 2025. A total of 77 studies (25 enrolling patients before the SNACC guidelines and 52 enrolling afterwards) were included. The reporting of trial elements were: demographics (7 of 9 elements, 77.8 % [Q1:Q3: 77.8 %;88.9 %], essential monitoring (0 of 13 elements, 0 % [Q1:Q3: 0 %;8%], anesthesia (0 of 13 elements, 0 % [Q1:Q3: 0 %;8%]), and outcomes (3 of 5 elements, 60 % [Q1:Q3: 60 %;80 %]). When an anesthesiologist was included as an author, there was a significant improvement for the essential monitoring score (42 % vs. 0 %, p = 0.03) and the anesthesia score (42 % vs. 0 %, p = 0.0096), and in the anesthesia score in single-center studies (15 % vs. 0 %, p = 0.0024). Anesthesia and physiologic details are rarely included in the MT-related RCTs for AIS; therefore, future RCTs should include anesthesia-related details.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111785"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145692892","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":"Risk factors for subsidence and loss of segmental lordosis segmental lordosisfollowing 1–3-level anterior cervical diskectomy and fusion for degenerative disease: A time-to-event analysis","authors":"Zach Pennington ,&nbsp;Derrick Obiri-Yeboah ,&nbsp;Abdelrahman Hamouda ,&nbsp;Nikita Lakomkin ,&nbsp;William E. Krauss ,&nbsp;Michelle J. Clarke ,&nbsp;Brett A. Freedman ,&nbsp;Melvin D. Helgeson ,&nbsp;Ahmad N. Nassr ,&nbsp;Arjun S. Sebastian ,&nbsp;Anthony L. Mikula ,&nbsp;Jeremy L. Fogelson ,&nbsp;Benjamin D. Elder","doi":"10.1016/j.jocn.2025.111818","DOIUrl":"10.1016/j.jocn.2025.111818","url":null,"abstract":"<div><h3>Background</h3><div>Thousands of anterior cervical diskectomy and fusion (ACDF) procedures are performed annually. Increased interbody size offers better immediate segmental lordosis and disc height restoration but may increase the risk of subsequent subsidence. Our objective was to identify factors for subsidence and segmental lordosis loss following ACDF.</div></div><div><h3>Methods</h3><div>The charts of patients undergoing 1–3 level ACDF at a single-institution were queried for demographics, pre- and postoperative radiographic alignment, bone health (Hounsfield units on CT), procedural details, and interbody characteristics. Outcomes of interest were subsidence ≥2 mm and ≥3° loss in segmental lordosis (SL).</div></div><div><h3>Results</h3><div>199 patients (median 61.5 yr; 52.8 % male) were included – 98 single-level; 70 two-level, and 31 three-level. Forty treated levels (12.1 %) ≥3° decrease in SLand 19 (5.7 %) experienced ≥2 mm subsidence. Levels showing ≥3° loss of correction occurred in older patients (p = 0.021) and those with greater postoperative C2-7 lordosis (p = 0.002), postoperative SL (p &lt; 0.001), and perioperative change in SL (p &lt; 0.001). Subsidence was associated with allograft spacer use, lower postoperative segmental lordosis (p = 0.022) and greater postoperative disc height (p = 0.023). Decreased time to loss of SL was predicted by greater postoperative C2-7 lordosis (HR 1.04 per °; 95 % CI [1.00, 1.08]; p = 0.041) and greater postoperative SL (HR 1.27 per °; [1.13, 1.43]; p &lt; 0.001). Shorter subsidence time was predicted by allograft [versus titanium] spacer use (HR 21.40; [5.61, 81.54]; p &lt; 0.001) and greater postoperative disc height (HR 1.63 per mm; [1.37, 1.94]; p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Greater disc height predicted subsequent subsidence and greater SL restoration predicted SL loss following 1–3 level ACDF. Matching the interbody to the “natural” disc height of adjacent levels and using titanium versus corticocancellous allograft spacers may reduce the risk of subsidence and loss of correction.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111818"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827856","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":"No differences in the proportions of immune cells in CSF of patients with neurosarcoidosis and multiple sclerosis","authors":"Angie H. Kim ,&nbsp;Arnaldo A. Arbini ,&nbsp;Ilya Kister","doi":"10.1016/j.jocn.2025.111824","DOIUrl":"10.1016/j.jocn.2025.111824","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) and neurosarcoidosis (NS) can present as similar neuro-radiologic syndromes. Neither disease has pathognomonic clinical or laboratory findings and differentiating between them may be challenging. We hypothesized that cerebrospinal fluid (CSF) immune cell profiles, including CD4/CD8 cell ratio and proportion of B cells, might help to distinguish NS from MS.</div></div><div><h3>Methods</h3><div>Patients with probable or definite NS who were evaluated at the NYU MS Comprehensive Care Center (New York) and had CSF flow cytometry done as part of diagnostic workup were matched by age, sex, and race/ethnicity to MS patients with available CSF flow cytometry. All patients who received immunomodulatory therapy within 3 months of lumbar puncture were excluded. Flow cytometry was performed using BD FACSCanto™ and FACSCanto™ II Cell Analyzers (BDBiosciences, San Jose, CA) and manually verified by a hematopathologist. Group comparisons were made with an unpaired two-tailed Student’s <em>t</em>-test, Chi-square test, or Wilcoxon rank sum test, as appropriate; p &lt; 0.05 was considered significant.</div></div><div><h3>Results</h3><div>We identified 19 patients with NS and matched them with 19 MS patients by age, sex, and race/ethnicity (mean age NS v. MS: 56.9 ± 10.8 vs. 56.3 ± 9.7 years, p = 0.858; 68 % female in both groups; 74 % vs. 68 % non-white, p = 0.935). NS patients had significantly higher CSF leukocyte counts (16.0 ± 19.9 vs. 2.1 ± 2.6 cells/mm³, p &lt; 0.0001) and protein levels (101.2 ± 88.9 mg/dL vs. 35.7 ± 19.6, p = 0.003), while MS patients had more CSF-restricted oligoclonal bands (7.7 ± 5.3 vs. 1.7 ± 2.4, p &lt; 0.00042). No differences were found in CSF glucose concentrations or IgG indices. Proportions of all immune cells in CSF were similar in NS and MS, including the CD4/CD8 ratio and percentages of B cells.</div></div><div><h3>Conclusion</h3><div>Clinically available CSF flow cytometry immune profiles do not offer added discriminatory value for differentiating NS from MS. More granular immunophenotyping may be needed to improve diagnostic precision.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111824"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827825","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":"Cerebral air embolism","authors":"Erin Butcho ,&nbsp;Pranjal Rai ,&nbsp;Niharika Praveen ,&nbsp;Dhairya A Lakhani","doi":"10.1016/j.jocn.2025.111822","DOIUrl":"10.1016/j.jocn.2025.111822","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111822"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145819465","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}