Canadian Journal of Neurological Sciences最新文献

{"title":"Complications of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Systematic Literature Review.","authors":"Gunjan Jindal, Yekta Sharafaddin-Zadeh, Omar Bukhari, Mayank Goyal, Johanna M Ospel","doi":"10.1017/cjn.2025.10369","DOIUrl":"10.1017/cjn.2025.10369","url":null,"abstract":"<p><strong>Background: </strong>Chronic subdural hematoma (cSDH) is a common condition, especially in the older population, and causes considerable morbidity. Recently, middle meningeal artery embolization (MMAE) has shown promise as a minimally invasive intervention for cSDH by disrupting the flow to the hematoma neomembranes and thus reducing recurrence.</p><p><strong>Methods: </strong>We performed a systematic review of the literature using PubMed/Medline and Google Scholar to identify studies reporting on MMAE for cSDH over the past 30 years. After screening 4103 articles and reviewing 600 full-text studies, 176 studies were selected, including case reports, case series, retrospective and prospective studies and randomized controlled trials. Patient demographics, embolic agents used, frequency, type and severity of complications, hematoma recurrence and need for repeat surgery were extracted from the included studies.</p><p><strong>Results: </strong>Our analysis included 9780 patients (75.9% male), with mean/median ages ranging from 62.1 to 82.5 years. MMAE-related complications were reported in approximately 3%. Procedure-related neurological complications were the most frequent, followed by systemic complications, access site, non-procedure-related neurological complications, procedure-linked vascular complications specific to MMA and miscellaneous complications. Hematoma recurrence was reported in 6%, and repeat or rescue surgery was necessary in 6.1%. These results are consistent with major clinical trials evaluating MMAE safety and efficacy in cSDH.</p><p><strong>Conclusion: </strong>Based on current published literature, MMAE appears to be an effective and overall safe treatment option for cSDH. Complications, although infrequent, can occur, and some of these are disabling. Meticulous pre-procedural planning and imaging are essential to reduce the risk of complications.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638804","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":"⁶⁸Ga-PSMA PET Uptake in Chronic Subdural Hematomas: Mechanism and Potential Future Applications.","authors":"Ian R Macdonald","doi":"10.1017/cjn.2025.10120","DOIUrl":"10.1017/cjn.2025.10120","url":null,"abstract":"","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-2"},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638778","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":"Adjunctive Intraarterial Thrombolysis after Thrombectomy in Large Vessel Occlusion Stroke: A Meta-Analysis of RCTs.","authors":"Mohammed A Almekhlafi, Hyungjong Park, Nishita Singh, Ronda Lun, Umberto Pensato, Katrina Hannah Dizon Ignacio, Johanna M Ospel, Aravind Ganesh, Mohamed Alshamrani, Andrew M Demchuk, Michael D Hill, Bijoy K Menon","doi":"10.1017/cjn.2025.10354","DOIUrl":"10.1017/cjn.2025.10354","url":null,"abstract":"<p><strong>Background and purpose: </strong>Adjunctive intraarterial (IA) thrombolysis after endovascular thrombectomy may improve clinical outcomes in patients with large vessel occlusion (LVO) stroke possibly due to improvement in microvascular reperfusion.</p><p><strong>Methods: </strong>We conducted a meta-analysis of randomized controlled trials (RCTs) evaluating IA thrombolysis with tenecteplase, alteplase or urokinase in anterior or posterior circulation LVO stroke after successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3). Efficacy outcomes were excellent functional outcome (modified Rankin Scale [mRS] 0-1), functional independence (mRS 0-2) and recovery without any disability (mRS 0) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (ICH), any ICH and death. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using random-effects models.</p><p><strong>Results: </strong>Seven RCTs (<i>n</i> = 2,130; 2022-2025) were included. IA thrombolytic drugs used were alteplase, tenecteplase and urokinase with doses ranging from 10 % to 50% of recommended IV dosage. IA thrombolysis significantly improved excellent functional outcome (mRS 0-1: OR 1.45, 95% CI 1.19-1.76) and recovery without any disability (mRS 0: OR 1.34, 95% CI 1.09-1.64), without safety risks (symptomatic ICH: 5.05% with IA thrombolytics vs. 4.49% in standard). Paradoxically, there was no difference in functional independence (mRS 0-2) (OR 1.09, 95% CI 0.99-1.20). Additionally, tenecteplase or alteplase at doses equivalent to 25% or 50% of recommended IV dosage significantly improved excellent functional outcome.</p><p><strong>Conclusions: </strong>IA thrombolysis offered immediately following EVT with successful reperfusion improved excellent functional outcome and recovery without disability at 90 days with an acceptable safety profile.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638779","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":"An Exploratory 12-Month Observational Study of Adults with Spinal Muscular Atrophy: Learning From Our Tools.","authors":"Jeremy Slayter, Lauren Casey, Dorothy Drost, Shane McCullum, Allison Christie, Colleen O'Connell","doi":"10.1017/cjn.2025.10356","DOIUrl":"10.1017/cjn.2025.10356","url":null,"abstract":"<p><strong>Objective: </strong>To describe motor, respiratory and quality of life changes in a mixed cohort of adults with spinal muscular atrophy (SMA) from a single tertiary rehabilitation center in Canada and to report preliminary psychometric evidence of a nationally recommended core outcome set over 12 months.</p><p><strong>Methods: </strong>This real-world, mixed-treatment cohort, exploratory, single-site, prospective observational study followed fifteen adults with SMA over 12 months. Participants completed the Spinal Muscular Atrophy Recommended Toolkit (SMART), which consists of eight outcome measures (OM) assessed at baseline and 12 months. Concurrent and predictive validity were assessed using Spearman's Correlation Coefficient (SCC). Longitudinal change and sensitivity to change were evaluated using the Wilcoxon signed-rank test and standardized response mean.</p><p><strong>Results: </strong>Ten participants were receiving disease-modifying treatments. None of the OMs demonstrated statistically significant changes over 12 months. Respiratory and motor function measures are independently clustered into two clusters. Only the Children's Hospital of Philadelphia - Adult Test of Neuromuscular Disorders (CHOP-ATEND) exhibited high sensitivity to change. Forced vital capacity (FVC) >2 L or peak cough flow (PCF) >200 L/min corresponds with ceiling effects of the Revised Upper Limb Module (RULM) and SMA Functional Rating Scale (SMAFRS).</p><p><strong>Conclusions: </strong>This exploratory study identified two collinear clusters between SMART OMs, suggesting measurement redundancy. SMART OMs did not demonstrate significant changes over 12 months in this small mixed-treatment cohort. Developing new OMs that are valid, reliable and responsive, and optimizing OM selection will reduce clinic and patient burden, and improve clinical utility in a real-world setting.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-10"},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638780","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":"Canadian Leader in Pediatric Neurology: Dr. Peter Humphreys.","authors":"Lauren Strasser","doi":"10.1017/cjn.2025.10359","DOIUrl":"10.1017/cjn.2025.10359","url":null,"abstract":"","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-6"},"PeriodicalIF":2.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627856","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":"MicroRNA Dysregulation in Neurodegeneration: Role, Biomarker Potential and Therapeutics.","authors":"Sunny Ramesh Dogra, Jyoti Bhonsle, Ashutosh Sharma","doi":"10.1017/cjn.2025.10361","DOIUrl":"10.1017/cjn.2025.10361","url":null,"abstract":"<p><p>Neurodegenerative diseases (NDDs) are a group of complex disorders marked by pathophysiological mechanisms involving protein aggregation, mitochondrial dysfunction, oxidative stress and neuroinflammation. Irrespective of extensive research advances, NDDs have become a serious global concern and persist as a major therapeutic challenge. In recent years, microRNAs (miRNAs), a class of small non-coding RNAs, have established a pivotal role in combating NDDs. The altered expression of miRNAs is reported to be associated with the progression of various NDDs. This review aims to discuss miRNA biogenesis; dysregulation in NDDs, specifically Alzheimer's disease, Parkinson's disease (PD) and amyotrophic lateral sclerosis; their potential as biomarkers; and promising therapeutic targets. Additionally, there are various emerging technologies discussed that are advanced approaches to enhance miRNA-based diagnostics and therapeutics.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-12"},"PeriodicalIF":2.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627857","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":"Minimally Invasive Surgery for Cervical Meningioma: A Systematic Review and Case Series.","authors":"Davaine Joel Ndongo Sonfack, Tristan Brunette-Clément, Leonardo Olijnyk, Antoine Gennari, Daniel Shédid, Sung-Joo Yuh","doi":"10.1017/cjn.2025.10366","DOIUrl":"10.1017/cjn.2025.10366","url":null,"abstract":"<p><strong>Background: </strong>Meningiomas are benign spinal arachnoid tumours, typically presenting as intradural extramedullary (IDEM) lesions that can compress the spinal cord and require surgical intervention. Minimally invasive surgery (MIS) techniques like mini-open, tubular and endoscopic approaches minimize tissue manipulation, reduce pain and accelerate recovery. This systematic review provides insights into current practices regarding MIS for cervical meningioma and presents a case series of eight patients with cervical meningioma effectively managed by MIS.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across Embase, PubMed and Medline Ovid, focusing on MESH terms related to cervical vertebrae, nervous system neoplasms and minimally invasive surgical procedures. Risk of bias in retained studies was assessed using the Joanna Briggs Institute Critical Appraisal tools for case series and case reports. A narrative synthesis of our results is presented.</p><p><strong>Results: </strong>Nine studies with 15 patients undergoing MIS for cervical meningioma were included. Most tumours were at the craniospinal junction. Gross total resection (Simpson grade 2) was achieved in 14 cases, with no reported post-operative complications. The length of stay (LOS) ranged from 2 to 6 days, and no tumour recurrence was observed. Our case series of eight patients confirmed MIS benefits, including shorter operative times, comparable surgical outcomes, and the avoidance of spinal deformities requiring instrumentation.</p><p><strong>Conclusion: </strong>In well-selected patients, MIS for cervical meningioma is a safe and effective procedure offering direct lateral access, minimal bony resection, limited soft tissue manipulation, and avoidance of cervical fusion, thereby minimizing post-operative complications and LOS.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627858","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":"Exploring Innovations and Factors to Optimize Adult Neurosurgery Inpatient Flow in Alberta.","authors":"Amelia Wells, Elisavet Papathanassoglou, Balraj Mann, Erin Barrett, Kiran Pohar Manhas","doi":"10.1017/cjn.2025.10358","DOIUrl":"10.1017/cjn.2025.10358","url":null,"abstract":"<p><strong>Background: </strong>Poorly managed inpatient flow can lead to adverse health outcomes, including increased mortality and readmission rates. In neurosurgery, optimizing inpatient flow is crucial to improving patient experience and outcomes, but the factors influencing it are unclear. A preliminary analysis revealed suboptimal average length of stay (ALOS) and expected length of stay (ELOS) rates - key metrics used to assess inpatient flow - across Alberta, Canada. The purpose of this study was to evaluate the current state of inpatient flow in Alberta's neurosurgical care and explore strategies for enhancement.</p><p><strong>Methods: </strong>This study used mixed methods: a rapid scoping review and a retrospective cohort study. The rapid scoping review synthesized peer-reviewed and gray literature (after a three-stage screening process) to identify factors impacting neurosurgery inpatient flow across jurisdictions. The cohort study analyzed Alberta's adult neurosurgical patient data from 2009 to 2019 to explore how patient- and system-level factors relate to ALOS/ELOS rates.</p><p><strong>Results: </strong>Nine of the 391 screened articles were included in the review. Three main themes emerged influencing neurosurgery inpatient flow: interdisciplinary care pathways, introducing new roles and identification of risk factors. Building on these themes, patient- and system-level factors impacting ALOS/ELOS were explored. ALOS/ELOS rates varied among the five Alberta Health Services zones, with Rural Zone 1 having the highest and significantly different rate. Age, sex, zone and comorbidities significantly accounted for differences in ALOS/ELOS rates (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Neurosurgery patients in Alberta are experiencing longer hospital stays than expected. Several areas requiring further research have been identified, along with potential strategies to enhance patient care and outcomes.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The International League Against Epilepsy's Classification of the Epilepsies Should Incorporate Multilobar Epilepsies.","authors":"Shashikant Seshia, M Pilar Vicuña, G Bryan Young, Seyed Mirsattari","doi":"10.1017/cjn.2025.10113","DOIUrl":"10.1017/cjn.2025.10113","url":null,"abstract":"","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-5"},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577061","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":"Central Retinal Artery Occlusion at a Canadian Academic Center - ERRATUM.","authors":"Matthew P Quinn, Victoria Liu, Danah Albreiki, Daniel A Lelli","doi":"10.1017/cjn.2025.10341","DOIUrl":"https://doi.org/10.1017/cjn.2025.10341","url":null,"abstract":"","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1"},"PeriodicalIF":2.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577059","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}