Objective : Carotid endarterectomy (CEA) reduces stroke risk in carotid stenosis patients, with potential but unclear benefits on cognitive function and cerebral blood flow (CBF). This study aimed to assess cognitive and CBF changes after CEA in patients with transient ischemic attack (TIA) and severe symptomatic carotid artery stenosis, exploring the relationship between these changes.Methods : In this prospective, observational study was conducted at Affiliated Hospital of Qingdao University between June 2021 and September 2022, and included patients with recent TIA and confirmed severe symptomatic carotid artery stenosis underwent CEA. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA), and CBF was assessed through arterial spin labeling magnetic resonance imaging (MRI). Measurements were taken preoperatively and at 1 and 6 months postoperatively. Statistical analysis involved paired and independent t-tests, with p<0.05 considered significant.Results : Forty-one patients (average age, 66.8 years; 75.6% male) were assessed. Initially, patients with left internal carotid artery (ICA) stenosis demonstrated naming ability scores significantly lower (2.8±0.4) than controls (3.0±0.2; p<0.05). Right ICA stenosis patients exhibited reduced MoCA scores (21.5±4.3) compared to controls (24.8±3.6, p<0.05). Significant improvements in cognitive performance and CBF were observed 1 month post-surgery, with sustained gains by 6 months. A positive association (R=0.437, p<0.01) was identified between increased CBF and cognitive improvement.Conclusion : CEA may enhance cognitive function and CBF in patients with severe symptomatic carotid artery stenosis. The association between cognitive gains and increased CBF suggests cerebral hemodynamics may play a role as a potentially reversible factor influencing cognitive dysfunction in this population.
Multicentric gliomas are rare clinical entities, and cases exhibiting distinct histological lineages despite sharing a common molecular origin are exceptionally scarce. We report a unique case of synchronous multicentric gliomas in the bilateral frontal lobes of a 59-yearold female that shared an ancestral IDH1-R132H mutation but diverged into distinct molecular trajectories. According to the 2021 World Health Organization (WHO) classification, the left frontal tumor was diagnosed as a central nervous system (CNS) WHO grade 3 oligodendroglioma characterized by 1p/19q co-deletion and CDKN2A mutation, while the right frontal tumor was identified as a CNS WHO grade 3 astrocytoma harboring ATRX and TP53 mutations. This case provides compelling evidence for the stem cell origin theory, suggesting that a common progenitor undergoes independent clonal evolution in different anatomical locations through disparate secondary genetic alterations. Our findings underscore that multicentric lesions cannot be assumed to be molecularly identical, necessitating comprehensive and individual molecular evaluation of each discrete lesion to ensure accurate prognostic stratification and the formulation of personalized therapeutic strategies in the era of integrated diagnostics.
Objective:Intraoperative language mapping under general anesthesia plays an important role in brain tumor surgery, particularly when awake surgery cannot be performed. Corticocortical evoked potential (CCEP) monitoring is considered a valuable method for localizing functional language regions and evaluating neuronal connectivity. The present study aimed to assess the clinical usefulness of intraoperative CCEP monitoring in preserving language function during glioma surgery. Methods:A total of 18 consecutive patients with glioblastoma located in the left language-dominant hemisphere underwent CCEP-guided tumor resection under general anesthesia between January 2022 and December 2024. Subdural electrodes were positioned over the presumed anterior and posterior perisylvian language cortices, and bidirectional single-pulse CCEP stimulation was used to evaluate connectivity between these regions and to localize the arcuate fasciculus. The primary monitoring pathway was selected according to the most robust and stable CCEP response, and tumor resection was performed while preserving the mapped language network. Language function was assessed clinically before surgery, immediately after surgery, and again at 3-6 months after surgery using a 4-level ordinal scale. Results:Language-related CCEP monitoring was feasible in 15 of 18 patients. Among these, intraoperative CCEP signals remained stable in 9 patients, transiently decreased with recovery in 2 patients, and persistently decreased by the end of surgery in 4 patients. Unfavorable language outcomes were observed in 1 of 11 patients (9.1%) in the preserved/recovered group and in 1 of 4 patients (25.0%) in the persistent-decrease group. A single patient showed an unfavorable language outcome despite stable intraoperative CCEP findings. Conclusion:Intraoperative CCEP monitoring under general anesthesia may provide clinically useful information for language preservation during glioblastoma surgery when awake mapping is not feasible. Although further investigation is required to define a solid threshold for intraoperative CCEP deterioration, qualitative CCEP changes may be clinically informative and helpful in guiding surgical strategy.
Severe traumatic brain injury (TBI) remains difficult to treat because successful control of mass lesions, intracranial pressure, cerebral perfusion, oxygenation, and systemic instability does not ensure that secondary cellular injury has stopped. PubMed/MEDLINE and ClinicalTrials.gov were searched through July 28, 2026, and representative candidates were organized across five overlapping pathophysiological nodes. Evidence was described by study source, purpose, and result direction rather than assigned a formal quality grade. Human evidence was heterogeneous. Glibenclamide/glyburide and hypertonic sodium lactate produced preliminary imaging or physiological signals without demonstrated functional benefit. Riluzole was neutral in an adult randomized trial, whereas a small study in chronic TBI found that minocycline reduced a neuroinflammatory imaging signal but increased plasma neurofilament light. Metformin and N-acetylcysteine plus probenecid provided exploratory pharmacokinetic, biomarker, or safety data. Amantadine provided phenotype-specific clinical proof of principle in traumatic disorders of consciousness. Cerebrolysin showed mixed human evidence, including a favorable day-90 multidimensional ensemble signal that requires independent replication. Deferoxamine and clemastine remain preclinical. We therefore propose a modular pharmacological framework composed of separable investigational modules rather than simultaneous multidrug treatment. Module activation should require optimized foundational care, a matching phenotype, measurable target activation or engagement, and acceptable systemic safety. This framework prioritizes phenotype-enriched, single-module development before any sequential or combination design and does not support routine off-label polypharmacy.
Uniportal full-endoscopic spine surgery (FESS) has expanded over three decades from percutaneous discectomy to include multilevel decompression, endoscopic interbody fusion (Endo-LIF), spinal infection management, and tumor surgery. The Republic of Korea is a leading contributor to this field: across bibliometric analyses, six of the world's top ten contributing authors and three of the top five contributing institutions are Korean. This article provides a Korea-centered critical appraisal of uniportal FESS, integrating five domains: Korean academic contributions, Level-I evidence by spinal region, expansion of indications, integration of next-generation technologies (navigation, augmented reality, artificial intelligence, robotics), and structural barriers in health policy and reimbursement. Level-I randomized evidence supports clinical equivalence to microscopic surgery for lumbar disc herniation and lumbar spinal stenosis, with cost-utility data from the Korean National Health Insurance Service showing a cost-per-quality-adjusted-life-year of approximately USD 5,241-well below conventional willingness-to-pay thresholds. Cervical FESS evidence remains limited to two single-center RCTs from 2008-2009, and thoracic FESS data derive from non-randomized multicenter case series showing large perioperative advantages over open surgery. Despite the maturity of the evidence, Korean reimbursement codes have not been updated to reflect modern uniportal techniques, Endo-LIF lacks dedicated coding, and the radiofrequency-related fee schedule still uses 1990s-era valuations. We propose a tiered policy roadmap-short-term code differentiation, mid-term Endo-LIF and navigation-track integration, and long-term registry-based credentialing-to align Korean reimbursement infrastructure with the country's established academic and clinical leadership in this field.
Sarcopenia and osteoporosis are prevalent age-related musculoskeletal disorders that frequently coexist and interact, giving rise to the clinical entity known as osteosarcopenia. Although traditionally considered distinct entities, growing evidence indicates that muscle and bone are functionally integrated through biomechanical and biochemical crosstalk. Sarcopenia is characterized by progressive loss of skeletal muscle mass, strength, and function, whereas osteoporosis is defined by reduced bone mineral density (BMD) and microarchitectural deterioration, resulting in increased fracture risk. Both conditions share common risk factors, including aging, chronic inflammation, hormonal changes, physical inactivity, and nutritional deficiencies. Emerging evidence highlights the important role of muscle-derived myokines, bone-derived osteokines, and adipokines in mediating inter-organ communication within the musculoskeletal unit. This narrative review synthesizes current evidence supporting osteosarcopenia as an integrated musculoskeletal syndrome, with a particular focus on biomechanical loading, biochemical crosstalk, and inflammatory signaling. In addition, we discuss diagnostic challenges and therapeutic strategies, emphasizing integrated assessment and management approaches that target skeletal fragility, muscle dysfunction, and musculoskeletal interfaces to reduce frailty, falls, and fractures in aging populations.
The 2025 Journal Citation Reports (JCR) reveal that the Impact Factor (IF) for the Journal of Korean Neurosurgical Society (JKNS) has risen to 1.9, an increase from 1.7 in 2024. The upward trend in the IF compared to previous years is a highly encouraging development. Although the IF of JKNS has increased, a substantial gap still remains compared to top-ranked neurosurgical journals. The time has come to set clear goals for where JKNS should head next and to explore how to reach them. While maintaining our existing strategies, we aim to consider actionable approaches to advance to the next level.
Thoracolumbar trauma in elderly patients has become increasingly important as population aging has reshaped the epidemiology of spinal injury. In the aging spine, low-energy trauma can produce clinically significant or unstable fractures because osteoporosis, degenerative stiffness, and rigid spine disorders alter mechanical behavior. Conventional classification systems and guideline-based algorithms remain useful for describing fracture morphology, neurological status, and structural instability. However, their applicability in elderly patients is limited because treatment decisions must account for frailty-related vulnerability and the functional consequences of immobilization. This review summarizes the distinctive features of thoracolumbar trauma in the aging spine and proposes an integrated framework that combines structural injury severity with frailty-based assessment of treatment tolerance. Frailty reduces physiologic reserve and limits the ability to tolerate treatment and recover after injury, while poor bone quality and spinal rigidity increase the risk of structural failure even with guideline-concordant care. Treatment should aim to restore stability, preserve neurological function, control pain, and enable early mobilization while minimizing physiologic burden. Depending on structural demand, treatment may range from non-operative care or vertebral augmentation in appropriate patients to definitive fixation, with selection guided by bone quality, frailty, and expected functional benefit. Thoracolumbar trauma in the aging spine should be managed as a distinct clinical entity for which an integrated frailty-based framework may better support practical, patient-centered decision-making.
Objective:To evaluate a surgical strategy for hemorrhagic brainstem cavernous malformations by assessing 1) the impact of surgical timing (hemorrhage-to-surgery interval), and 2) the utility of preoperative diffusion tensor imaging (DTI) tractography for corticospinal tract (CST) preservation. Methods:In a retrospective cohort of 41 consecutive patients, the hemorrhage-to-surgery interval was stratified into acute (<3 weeks), subacute (3-8 weeks), and delayed (>8 weeks). Preoperative DTI tractography for CST mapping was utilized in 24 patients (DTI group) and not in 17 (non-DTI group); assignment was determined by magnetic resonance imaging scanner availability rather than clinical selection. The primary outcome was unfavorable functional status (modified Rankin scale score >2) at final follow-up. Results:The median hemorrhage-to-surgery interval was 53.0 days. Delayed surgery independently predicted unfavorable outcome at discharge (adjusted odds ratio, 9.03; 95% confidence interval, 1.10-73.94; p=0.04). Preoperative DTI was associated with a significantly lower rate of postoperative motor deterioration at discharge (12.5% vs. 47.1%; p=0.04). Subgroup analysis showed that the protective effect of DTI was significant only in the delayed surgery group (p=0.04), whereas among patients operated within 8 weeks, motor deterioration rates were low regardless of DTI use (16.7% vs. 16.7%; p=1.00). Persistent postoperative motor deficit was the strongest determinant of long-term disability (44.4% vs. 3.1%; p=0.006). Conclusion:A hemorrhage-to-surgery interval exceeding 8 weeks independently predicts poorer early functional recovery. Preoperative DTI tractography reduces postoperative motor deficits-the key driver of long-term disability-with its benefit most pronounced in the delayed surgery setting. We propose a risk-stratified, dual-emphasis strategy : timely intervention within 8 weeks when feasible, complemented by DTI tractography, which is particularly valuable in mitigating the increased risks of delayed surgery. This framework offers a practical, evidence-informed approach for optimizing functional outcomes.
Objective : We investigated the relationship among regional alignments, the chronological sequence of compensatory mechanism changes, restoration of sagittal malalignment, and the effect of knee osteoarthritis (KOA) on resolution of compensatory mechanisms and clinical outcomes in deformity correction surgery.Methods : We reviewed medical records and images of 75 patients with adult spinal deformity undergoing thoracolumbar fusion, with a minimum of 2 years of postoperative follow-up. Data collection focused on changes in various spinal and lower extremity alignments, including global angle, pelvic shift, knee angles (KAs), and ankle angles (AAs). We conducted propensity-matched comparisons to elucidate the impact of OA on resolution of compensatory mechanisms between the KOA group and the non-KOA (NKOA) group based on the Kellgren-Lawrence grading (KLG). Additionally, the study assessed patient-reported outcome measures.Results : A significant linear correlation was observed between the change in T1 pelvic angle and the changes in various spinal and lower extremity parameters during follow-ups. Statistically significant correlation coefficients for thoracic kyphosis, sacro-femoral angle, and AA, initially not observed, were observed during the final follow-up. The KOA group exhibited limited restorative changes in compensatory spinal and lower extremities (KA : 1.1±5.5 vs. 7.1±9.3; p=0.015). Clinical outcomes showed improvement in both groups, with the NKOA group demonstrating more significant progress in 36-Item Short Form Health Survey (p<0.05).Conclusion : Restoring sagittal alignment leads to the disappearance of compensatory mechanisms in a temporal pattern, with lower extremity improvements continuing for years. Severe KOA over KLG 3 impedes this restoration and results in poorer clinical outcomes.
OBJECTIVE:Repeating surgical treatment remains the main option for recurrent chronic subdural hematoma, but a second recurrence frequently occurs. We employed middle meningeal artery embolization as an alternative treatment for recurrent hematoma. This study aimed to evaluate the effect and safety of middle meningeal artery embolization compared with conventional retreatment. METHODS:We retrospectively reviewed 1162 patients who underwent management for chronic subdural hematoma between May 1998 and March 2025 and included 142 patients with recurrent hematoma (middle meningeal artery embolization in 46 and conventional retreatment in 96) in this study. The primary outcome was second recurrence, defined as a composite of imaging (recurrent or residual hematoma >10 mm in thickness) and clinical (development or aggravation of symptoms, or second re-operation) events. Secondary outcomes included complications (any adverse events or death) and neurological recovery (return of the modified Rankin scale score to the level before initial hematoma development). Outcomes during treatment and 6-month follow-up were compared between the two study groups using logistic regression analysis, adjusted for variables showing baseline group differences with a p-value <0.2. RESULTS:The second recurrence rate was significantly lower in patients receiving middle meningeal artery embolization than in those receiving conventional retreatment (1/46 [2.2%] vs. 32/96 [33.3%]; adjusted odds ratio [OR], 0.056; 95% confidence interval [CI], 0.003-0.164; P=0.001). Complication rates did not differ significantly (1/46 [2.2%] vs. 10/96 [10.4%]; adjusted OR, 0.203; 95% CI, 0.019-1.221; P=0.103), but neurological recovery was more frequent in patients receiving middle meningeal artery embolization (32/46 [69.6%] vs. 46/96 [47.9%]; adjusted OR, 3.147; 95% CI, 1.198-8.268; P=0.020). CONCLUSION:Middle meningeal artery embolization for recurrent chronic subdural hematoma prevented second recurrence and improved neurological recovery compared with conventional retreatment, without increasing the complication rate. These findings suggest that middle meningeal artery embolization could be considered an effective and safe retreatment option for recurrent chronic subdural hematoma.
Objective : Early oral or enteral nutrition (EN) is recommended for critically ill patients; however, individuals with traumatic brain injury (TBI) often fail to meet their nutritional goals. Supplementary parenteral nutrition (SPN) in this instance may be of benefit, but evidence is lacking. This study examined the association between early SPN and nutritional adequacy and clinical outcomes in patients with TBI.Methods : This retrospective, non-randomized, single-center cohort study analyzed adult patients with TBI admitted to a trauma intensive care unit (ICU) from January 2023 to December 2024. Patients who received oral nutrition or EN on hospital day 4 (HD4) were included and classified based on their use of SPN. We assessed total caloric and protein intake on HD4, as well as survival rates, lengths of ICU and hospital stays, the occurrence of infectious complications, and unplanned ICU readmissions.Results : Among 260 screened patients, 122 were included in the study. The SPN group achieved higher caloric intake (1508 vs. 852 kcal; p<0.05) and total protein intake (79 vs. 41 g; p<0.05). Additionally, SPN was associated with lower rates of urinary tract infections (19.7% vs. 44.3%; p=0.004) and unplanned ICU readmissions (9.8% vs. 31.1%; p=0.004). Logistic regression analysis revealed a reduced risk for urinary tract infections (odds ratio [OR], 0.38; p=0.026) and unplanned ICU readmissions (OR, 0.25; p=0.007).Conclusion : Early SPN was associated with improved caloric and protein delivery and fewer infectious complications and unplanned ICU readmissions in TBI patients. Despite several limitations, these results suggest that SPN may be a beneficial strategy when oral or EN alone is inadequate.
Objective:Dural entrapment by the facet joint is an uncommon but potentially symptomatic finding following unilateral biportal endoscopic (UBE) lumbar decompression. Its incidence, associated factors, and underlying mechanisms remain poorly defined. This study aimed to investigate the incidence, clinical course, and anatomical and geometric factors associated with dural entrapment following UBE lumbar decompression. Methods:This retrospective cohort study included 181 patients (257 spinal segments) who underwent UBE lumbar decompression at a single institution between January 2023 and January 2024. Patients with prior lumbar surgery, deformity, severe instability, or incomplete imaging were excluded. Clinical and radiological parameters, including facet joint gap, facet joint angle, facetectomy ratio and dural sac-to-canal ratio, were evaluated. Because of the limited number of events, Firth's penalized logistic regression was applied using two complementary models - a preoperative susceptibility model and a postoperative geometric association model - with receiver operating characteristic (ROC) analysis. Results:Dural entrapment occurred in 15 of 257 segments (5.8%), of which 13 (86.7%) were ipsilateral. Symptomatic entrapment was observed in 2 cases (0.8%), one requiring revision surgery, while most followed a benign radiological course. In the preoperative susceptibility model, degenerative spondylolisthesis (DS; adjusted OR 49.14, p<0.001) and preoperative ipsilateral facet joint gap (adjusted OR 4.77, p=0.007) were independently associated with entrapment (combined AUC 0.875). In the postoperative geometric association model, DS (adjusted OR 34.87, p<0.001) and postoperative ipsilateral facet joint gap (adjusted OR 4.12, p=0.001) showed independent associations (combined AUC 0.897). The facetectomy ratio was not associated with entrapment (p=0.222). Conclusion:Dural entrapment after UBE lumbar decompression is uncommon and usually follows a benign course, although symptomatic cases may occur. DS and the ipsilateral facet joint gap were the principal associated factors, with the absolute facet gap width - rather than the relative extent of bone resection - being the more relevant determinant. These findings, together with the marked ipsilateral predominance, support a geometric basis for this phenomenon and may inform preoperative risk assessment.
Advancement of molecular targeted therapies has revolutionized the treatment of several challenging and previously refractory tumors. Since the introduction of rituximab in 1997, the field of molecular targeted agents have continued to evolve. Notably, vorasidenib, a brain-penetrant dual inhibitor of mutant isocitrate dehydrogenase (IDH) 1 and 2, has recently demonstrated promising results in the 2023 INDIGO trials with improved progression-free survival (PFS) and delayed need for subsequent interventions in patients with IDH-mutant low-grade gliomas. Although therapeutic options for glioma have long remained largely limited to surgery, radiation, and conventional chemotherapy despite extensive and ongoing research, the advent of vorasidenib opens a new chapter in glioma treatment. This review summarizes the key clinical studies of vorasidenib and discusses its potential role, limitations, and future directions in the evolving treatment paradigm of IDH-mutant gliomas.
Severe preterm intraventricular hemorrhage (IVH) with post-hemorrhagic ventricular dilatation (PHVD) may be difficult to manage when the clot burden is extensive and complete endoscopic evacuation is limited by clinical instability and rigid-scope constraints. We describe a staged clearance strategy in a preterm infant with bilateral grade IV IVH and progressive PHVD. Bilateral external ventricular drains (EVDs) were inserted for cerebrospinal fluid diversion. Low-dose intraventricular recombinant tissue plasminogen activator (0.1-0.3 mg per ventricle) was started 48 hours later and repeated every 48 hours for four sessions with a 2-hour dwell time under serial bedside cranial ultrasonographic surveillance. Sequential rigid neuroendoscopic lavage (NEL) was then performed, followed by 7 days of continuous ventricular irrigation using a bilateral inflow-outflow EVD configuration and a buffered glucose-containing artificial cerebrospinal fluid solution. No interval rebleeding, sustained intracranial hypertension, electrolyte instability, or culture-proven ventriculitis occurred during treatment. Ventricular size remained stable after drain removal, and no ventriculoperitoneal shunt had been required through the latest outpatient follow-up on postnatal day 157 (HD 151). This report presents a single-case conceptual proof-of-concept and technical feasibility experience for selected severe preterm IVH in a rigid-scope setting, rather than evidence of efficacy.
Objective:To determine whether the thicknesses of the thenar and hypothenar regions measured at the bedside using a caliper, along with their ratio (thenar/hypothenar; T/H), reflect the clinical and electrophysiological severity of carpal tunnel syndrome (CTS), and whether preoperative T/H asymmetry (Δ(T/H)) predicts postoperative functional recovery. Methods:This prospective case-control study included 50 patients with electrophysiologically confirmed CTS and 50 age- and sex-matched healthy controls. Thenar and hypothenar thicknesses were measured using a standard caliper protocol, and the T/H ratio was calculated. Symptoms and function were assessed using the Boston Symptom Severity Scale and the Functional Status Scale. Electrophysiological severity was classified based on sensory and motor conduction findings. Patients were re-evaluated 3-6 months after surgery. Results:Thenar thickness and the T/H ratio of the operated hand were significantly lower in CTS patients compared to controls (p < 0.001). T/H asymmetry, defined as Δ(T/H) = T/H (non-operated) - T/H (operated), showed significant differences according to motor severity categories (p = 0.002) and sensory severity categories (p = 0.004). Δ(T/H) was positively correlated with functional status (FSS) (Spearman ρ = 0.33; p = 0.018) but was not correlated with symptom severity (SSS) (p = 0.738). Preoperative Δ(T/H) showed a positive correlation with postoperative FSS (Spearman ρ = 0.34; p = 0.015). In a multivariable logistic regression adjusted for diabetes mellitus, age, and BMI, Δ(T/H) remained independently associated with severe motor involvement (adjusted OR = 1.26 per 0.01 increase in Δ(T/H); 95% CI, 1.07-1.49; p = 0.006), while diabetes mellitus was not independently associated (p = 0.674). Conclusion:Caliper-based thenar/hypothenar assessment incorporating contralateral comparison (Δ(T/H)) is a practical bedside adjunct method reflecting electrophysiological severity and functional limitation and may aid in predicting postoperative functional recovery; larger validation studies are needed.
Objective:The Pan-Immune-Inflammation Value (PIV) is a novel composite biomarker that reflects systemic inflammatory status. This study aimed to assess the prognostic value of preoperative PIV in predicting recurrence after burr hole drainage (BHD) in patients with chronic subdural hematoma (CSDH). Methods:We conducted a retrospective analysis of 521 patients who underwent BHD for CSDH between January 2015 and October 2025. Preoperative inflammatory markers, including PIV, the systemic Immune-Inflammation Index (SII), and the systemic Inflammation Response Index (SIRI), were calculated. We performed receiver operating characteristic (ROC) curve analysis and multivariate logistic regression to identify predictive factors for recurrence after BHD. Results:Recurrence was observed in 123 patients (23.6%). The recurrence group had a significantly higher mean PIV value compared to the non-recurrence group (481.8 ± 211.2 vs. 259.4 ± 164.7, p = 0.020). ROC analysis showed that PIV had the highest predictive accuracy for recurrence, with an area under the curve of 0.801 (95% confidence interval [CI] 0.753-0.850; p < 0.001). The optimal cutoff value for PIV to predict recurrence after BHD was determined to be 311.4. In multivariate analysis, elevated SII (≥ 551.2) (odds ratio [OR] 1.12, 95% CI 1.06-1.38; p = 0.048) and elevated PIV (≥ 311.4) (OR 1.28, 95% CI 1.08-1.86; p = 0.022) were identified as independent predictors of recurrence after BHD. Conclusion:Preoperative PIV is a strong, independent predictor of CSDH recurrence following BHD. Further research is needed to validate the prognostic role of PIV in patients with CSDH.
Objective:To describe an exploratory initial experience with two complementary digital platforms consisting of an AI-based telemedicine system and an SNS-based transfer coordination network, for acute brain conditions in rural areas with limited or no on-site neurosurgical coverage. Methods:We retrospectively reviewed patients with acute brain conditions who first presented to rural hospitals and were subsequently transferred to a regional hub hospital between January 2024 and March 2025. Transfers were coordinated using either an AI-integrated CT telemedicine platform or an SNS-based (KakaoTalk) collaboration network. Outcomes were assessed using the 3-month modified Rankin Scale (mRS), with favorable outcome defined as 0-2. Results:Eight patients (mean age 70.5 years) were managed via the AI platform, which supported collaboration between non-expert rural clinicians and hub-hospital neurospecialists. Referrals were initiated by general practitioners (n=5), an internist (n=1), and nurses (n=2). AI-assisted CT screening with integrated teleconsultation facilitated timely diagnostic clarification and early management. All eight patients had favorable outcomes at 3 months. Twelve patients were managed via the SNS platform for inter-hospital transfer. 11 required neurocritical care and 3 underwent neurosurgical or endovascular intervention after transfer. Overall, 9 patients achieved favorable functional outcomes (3-month mRS score, 0-2). Conclusion:This exploratory study describes the potential utility of a dual-platform strategy integrating AI-based telemedicine and SNS-based transfer coordination for supporting acute brain condition management in medically underserved rural areas. Further prospective studies are needed to determine whether this approach improves time-sensitive transfer processes and clinical outcomes.
Objective:The systemic inflammation response index (SIRI) is a novel inflammatory marker. This study aims to evaluate the association between early postoperative SIRI and a prolonged intensive care unit (ICU) stay exceeding 24 hours after brain tumor (BT) surgery. Methods:Patients aged 18 years or older who were admitted to the ICU following elective BT surgery between January 2023 and December 2024 were analyzed. Preoperative and postoperative variables were compared between patients with a short ICU stay (<24 hours) and those with a prolonged ICU stay. Logistic regression analyses were performed to evaluate the association between perioperative variables, including early postoperative SIRI, and prolonged ICU stay. Receiver operating characteristic (ROC) curve analysis, along with area under the curve (AUC) and Youden index, was conducted to assess the discriminatory performance of early postoperative SIRI. Results:A total of 206 patients who were admitted to the intensive care unit following elective BT surgery were included in the study. 109 patients were classified as having an ICU length of stay less than 24 hours, whereas 97 patients were classified as having an ICU length of stay exceeding 24 hours. In multivariable logistic regression analyses, hypertension (odds ratio [OR] = 4.365, 95% confidence interval (CI): 1.903-10.010, p = 0.001), postoperative SIRI level (OR = 1.090, 95% CI: 1.041-1.142, p < 0.001), hemorrhage (OR = 14.348, 95% CI: 1.663-123.812, p = 0.015), cerebral edema (OR = 5.972, 95% CI: 1.076-33.148, p = 0.041) and neurological deficit (OR = 2.582, 95% CI: 1.072-12.149, p = 0.032) were independently associated with prolonged ICU stay following BT surgery. Using prolonged ICU stay as the endpoint, ROC analysis identified an optimal SIRI cutoff value of 10.94, with a sensitivity of 56.7%, specificity of 81.7%, and an AUC of 0.728. Conclusion:Given the clinical importance of optimizing ICU resource utilization, early postoperative SIRI may provide adjunctive information reflecting postoperative inflammatory response associated with prolonged ICU stay, particularly when interpreted with other clinical parameters.
