Epilepsy is a neurological disorder affecting over 50 million people worldwide, with a global incidence of 7.6 per 1,000 individuals. Mesial temporal lobe epilepsy (MTLE) is characterized by recurrent, unprovoked seizures originating in the temporal lobe. The standard surgical treatment is anterior temporal lobectomy; however, many patients are not suitable candidates due to the risk of adverse effects, including significant memory impairment, language deficits, bilateral temporal involvement, or reluctance to undergo resective surgery. This study aimed to evaluate the anticonvulsant effect of linear accelerator (LINAC)-based radiosurgery in patients with drug-resistant unilateral MTLE. A prospective, single-center, exploratory pilot case series was conducted from March 1, 2017, to March 1, 2020, at the Hospital de Especialidades, Centro Médico Nacional de Occidente. Patients aged 18–65 years with a confirmed diagnosis of drug-resistant unilateral MTLE were enrolled. The primary outcome was defined as the achievement of complete freedom from disabling seizures (Engel Class I and ILAE Class 1) at 24 months post-radiosurgery. Secondary efficacy outcomes included achieving a ≥ 50
To descriptively evaluate short-term (48–72 h postoperatively) neurological functional outcomes in patients undergoing awake craniotomy for intracranial lesions located within eloquent brain areas, and conduct univariate exploratory analyses of clinical factors correlated with acute postoperative neurological deterioration. Secondary exploratory survival analyses are included solely for hypothesis generation; all survival-related findings carry no definitive clinical prognostic interpretation given the study’s critical limitations of small sample size, pathological heterogeneity, absent long-term functional follow-up, and missing key perioperative covariates. A single-center descriptive retrospective analysis was performed on 30 patients who received awake craniotomy between January 2019 and November 2024. The primary predefined endpoint was new or exacerbated neurological deficits within 48–72 h after surgery, quantified via Karnofsky Performance Status (KPS), Glasgow Coma Scale (GCS), Mini-Mental State Examination (MMSE), and manual muscle strength testing. Early postoperative dysfunction was categorized into three distinct phenotypes: transient global systemic functional decline, focal motor neurological deficits, and isolated language impairment (aphasia). Secondary exploratory endpoints included overall survival and all-cause mortality, with follow-up completed by February 28, 2025. Univariate logistic regression screened correlates of acute neurological decline; Kaplan–Meier survival curves, log-rank subgroup comparisons, and Cox proportional hazards regression were applied for exploratory survival modeling. All survival analyses are interpreted as purely descriptive and hypothesis-generating, with no confirmatory clinical value; the specific constraints are addressed in the Limitations section. The cohort contained 30 patients, with an awake craniotomy intraoperative mapping completion rate of 90.0
Background Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Agitation is a common complication after moderate to severe TBI and managing it in the acute hospital setting can be challenging. Aim Currently, there are no standardised interventions to manage agitation in TBI. This review aims to evaluate contemporary research over the past 10 years which addresses pharmacological and non-pharmacological strategies for managing agitation post-TBI. Method A scoping review literature search was conducted using PRISMA guidelines. The protocol was pre-registered on PROSPERO (ID 1295903). The literature search used Mesh and Boolean keywords ‘traumatic brain injury and ‘agitation management’ in PubMed, and a free-text search of ‘traumatic brain injury and agitation management’ with ‘map term to subject heading’ in Embase (Ovid) and Cochrane, covering studies from 01 January 2015 to 09 March 2026. Findings were analysed and discussed between two reviewers. Results A total of 65 studies were identified, and after careful review, 13 papers were selected from PubMed and Embase for our Scoping Review. Non-pharmacological strategies highlighted the importance of orienting the patient and the supportive role of family during the acute recovery period. Pharmacological strategies included found that the antipsychotic olanzapine was helpful in managing agitation in moderate to severe TBI. Valproic acid in a small male sample [1] and a separate study using dextromethorphan and quinidine [2] found that these medications were also helpful in managing agitation in TBI. Discussion and conclusion Clinicians and health professionals reported that treating the patient holistically, with the medical, social, and psychiatric history was of benefit. Antipsychotic Olanzapine and Valproic acid may have their uses in the short-term, interim acute setting under supervision. Future research with larger sample sizes further investigating these medications would be useful, along with personalisation of medications to the patient’s medical history. Most of the studies included in the review are observational and reviews, rather than randomised controlled trials, with a lack of primary evidence which may be a limitation. Systematic review registration PROSPERO CRD 1295903
Glioma is the most common primary malignant brain tumor in adults, among which glioblastoma (GBM) shows the highest degree of malignancy and the worst prognosis. Although standard therapeutic approaches, including surgical resection, radiotherapy, and chemotherapy, are routinely applied, the prognosis of glioma, especially GBM, remains poor. Metabolic rewiring is widely recognized as a major characteristic of malignant tumors and is especially evident in glioma. Recent studies have shown that fatty acid metabolic rewiring is a widespread feature of glioma and plays an important role in its pathogenesis and therapeutic resistance. Therefore, targeting metabolic reprogramming, particularly aberrant fatty acid metabolism, may have potential therapeutic implications in glioma. This review systematically synthesizes the molecular mechanisms underlying abnormal fatty acid metabolism in glioma pathogenesis and treatment responses. It also elucidates the regulatory networks governing key fatty acid metabolic pathways and integrates emerging strategies targeting these pathways to enhance the therapeutic sensitivity of glioma cells. Ultimately, this review aims to provide a conceptual framework and future research directions for overcoming the current limitations of glioma treatment through metabolic therapy.
Abstract Background Retraction serves as a critical mechanism for correcting flawed publications and preserving the integrity of the scientific literature. Systematic analysis focused on retractions in Central Nervous System (CNS) tumor research is still lacking. This study characterized retracted CNS tumor publications regarding temporal trends, geographic distribution, retraction reasons, citation patterns, and retraction lag. Methodology Retraction data were downloaded from the Crossref/Retraction Watch Database on December 31, 2025. CNS tumor‑related retractions were identified using tumor terms derived from the 2021 WHO Classification of Tumors of the Central Nervous System. Eligible records were screened manually, and tumor type, article type, retraction reason, first-author country, author count and time to retraction were extracted. Citation data were retrieved from Web of Science, and journal impact factor (JIF) and quartile were obtained from the 2024 Journal Citation Reports. Descriptive statistics, the Mann–Kendall test and Kruskal‑Wallis test were used. Results 582 CNS tumor articles were included. CNS tumor retractions increased over time and peaked in 2023. "Gliomas, glioneuronal tumors, and neuronal tumors" accounted for 74.57% (434/582). 80.58% (469/582) were retracted due to misconduct. In terms of absolute numbers, China was the leading first‑author country, followed by USA and India. Basic research accounted for 75.26% (438/582). The median time to retraction was 805.5 days (IQR: 423.25–1,711 days). A total of 515 articles received at least one citation (total citations 12,151), and 89.71% (462/515) had citation after retraction. The median pre‑retraction, post‑retraction, and total citations were 5 (IQR: 1–17), 3 (IQR: 1–7), and 10 (IQR: 3–24), respectively. Significant differences were observed in normalized citation counts and retraction lag across most retraction reason categories, JIF and quartiles, article types, author counts, and first‑author countries. Conclusions CNS tumor retractions have increased markedly as the primary driver. The persistent post-retraction citation of flawed research highlights a critical gap threatening evidence-based neuro-oncology.
Prolonged disorders of consciousness (pDOC)—including coma, vegetative state/unresponsive wakefulness syndrome (VS/UWS), and minimally conscious state (MCS)—remain diagnostically and therapeutically challenging. Even with validated instruments such as the Coma Recovery Scale–Revised (CRS-R), behavioral assessment yields misdiagnosis rates approaching 40
Abstract Glioblastoma (GBM) poses a tremendous challenge because it causes substantial morbidity and mortality. Treatment remains constrained by the tightly regulated blood–brain barrier (BBB) and the heterogeneous blood–brain tumor barrier (BBTB), which together severely limit drug delivery to tumor tissue. Nanomaterial-based drug delivery systems offer an opportunity to overcome the short half-life, low bioavailability, and poor BBB penetration that restrict conventional GBM therapeutics. Nanotechnology also provides safe, effective, and targeted drug delivery systems that enhance penetration, stability, and therapeutic efficacy. This review discusses biomaterials-based nanomedicine platforms for GBM, with a focus on lipid-based carriers, polymeric nanoparticles, dendrimers, inorganic nanomaterials, and biomimetic nanosystems designed to interact with the BBB/BBTB. We summarize how passive and active brain-targeting strategies are combined with endogenous and exogenous stimuli-responsive designs (pH/redox sensitivity, magnetic hyperthermia, photothermal/photodynamic therapy, and ultrasound-triggered systems) to enhance intratumoral accumulation and anti-GBM efficacy. Overall, this review discusses recent advances in BBB-aware, stimuli-responsive, and biomimetic nanomedicines for GBM, and outlines their therapeutic potential alongside persistent challenges in safety, large-scale manufacturing, and clinical translation. Graphical Abstract Illustration of ligand-functionalized nanomedicines crossing the BBB using magnetic and electric responsive stimuli.
Abstract Background Treating wide-necked aneurysms endovascularly is still difficult. Because of its high metal coverage and flow-diverting capabilities, the LVIS stent may lead to better results. We carried out this retrospective analysis to assess its hemodynamic impact, short-term efficacy, and procedural safety. Methods An observational, exploratory retrospective study was conducted between January and December 2023 on 61 consecutive patients with intracranial wide-necked aneurysms receiving LVIS stent-assisted coiling. The group consisted of 35 patients with ruptured aneurysms and 26 people with unruptured aneurysms. The Raymond-Roy Occlusion Classification (RROC) was used to assess the initial angiographic data. At 3 to 6 months, clinical outcomes were evaluated using the modified Rankin Scale (mRS), and parent artery patency and aneurysm recurrence were evaluated using follow-up digital subtraction angiography (DSA). Furthermore, a subset of patients underwent computational fluid dynamics (CFD) analysis to measure changes in intra-aneurysmal mean flow velocity and wall shear stress (WSS) in order to quantify hemodynamic modifications. Results This study included 35 patients with ruptured and 26 with unruptured aneurysms, with 61 patients totally. Immediate complete occlusion (RROC class I) was achieved in 80.0% (28/35) of ruptured and 84.6% (22/26) of unruptured aneurysms. Angiographic follow-up (available for 27 patients, 44.3%) at 6–12 months demonstrated stable occlusion in all initial RROC-I cases. Furthermore, in the ruptured cohort, the rate of favorable outcome (mRS 0–1) increased from 57.1% at discharge to 77.1% at follow-up, while 96.2% of unruptured patients maintained an mRS of 0–1. Procedure-related complications involved intraprocedural thrombosis (2 ruptured cases) and one fatal in-hospital stent thrombosis (unruptured case), resulting in overall morbidity and mortality rates of 16.4% and 1.6%, respectively. CFD analysis demonstrated significant and durable hemodynamic improvements. Specifically, post-operative reductions in relative inflow, aneurysm volume with high flow, and WSS were all sustained at 6-month follow-up (all P < 0.001). Conclusions Our study provides preliminary evidence that LVIS stent-assisted coiling may be related to high aneurysm occlusion rate, functional recovery in ruptured cases, and favorable hemodynamic modification. However, this study fails to achieve causal inference due to the retrospective design, and the complication profile underscores procedural risks, highlighting the need for prospective, comparative studies to confirm its safety and efficacy profile.
Vestibular schwannomas (VS) are benign tumors affecting the vestibulocochlear nerve. They cause symptoms like hearing loss and vertigo. Treatment options include surgery and stereotactic radiosurgery (SRS). However, SRS can lead to rare complications like intratumoral hemorrhage (ITH). This review aims to explore ITH post-SRS, including its incidence and risk factors, to improve patient care. This systematic review, conducted in accordance with PRISMA 2020 guidelines, examines intratumoral hemorrhage (ITH) post-radiosurgery for vestibular schwannomas. Searches encompassed PubMed, Google Scholar, the Cochrane Library, Embase, Web of Science, and Scopus up to January 2024. Inclusion criteria required documented vestibular schwannoma with confirmed ITH occurring after SRS. Data extraction involved study and participant characteristics, with discrepancies resolved by discussion. Given clinical and methodological heterogeneity, quantitative pooling was not performed; results are presented as a qualitative narrative synthesis. Eleven studies comprising 47 patients met inclusion criteria. Patients ranged from 25 to 79 years of age, with clustering in the sixth decade. A subset of patients had identifiable bleeding risk factors, most commonly hypertension and anticoagulant use. Symptom profiles were heterogeneous; trigeminal neuropathy and disequilibrium were the most frequently reported presentations. Management ranged from observation to surgical resection. On descriptive analysis, approximately half of patients demonstrated outcomes classified as favorable by the reporting authors; mortality was reported in 2 of 47 patients (4.35
Prolactinomas are the most prevalent functional pituitary adenomas. Significant advancements have been made in the diagnostic and therapeutic concepts for prolactinomas, driven by progress in surgical techniques and the accumulation of new clinical evidence-based medicine. Based on the 2014 version of the “Chinese Consensus on the Diagnosis and Treatment of Pituitary Prolactin Adenoma,” the China Pituitary Adenoma Specialist Council has revised this consensus in accordance with the latest evidence-based medical finding and clinical experience, aiming to provide standardized diagnosis and treatment recommendations for clinicians. The consensus systematically elaborates on the epidemiological characteristics, clinical manifestations, diagnostic criteria, differential diagnosis process, and treatment strategies for prolactinomas, and proposes individualized management suggestions for special populations (such as pregnant women, male patients, and refractory cases). Treatment decisions strongly advocate for comprehensive evaluation by a multidisciplinary team of experts, including neurosurgery, endocrinology, radiology, radiation oncology, pathology, ophthalmology, and obstetrics/gynecology. Through the formulation of recommendation questions, evidence summary and evaluation, formation of recommendation opinions, expert discussions, and integration with clinical practice, 36 recommendations have been developed covering aspects such as screening, assessment, diagnosis, treatment, and monitoring. This consensus balances clinical needs with international evidence-based standards, provides a highly reliable reference for diagnosis and treatment, and is expected to enhance the standardization and overall level of prolactinoma diagnosis and treatment in China. Practice guideline registration International Practice Guideline Registration for Transparency (PREPARE-2025CN1518).
BACKGROUND:Multifocal, deep-seated brain abscesses are uncommon and often lead to rapid neurological decline because of mass effects, widespread edema, and the challenge of safely accessing multiple intracranial compartments. Traditional surgical approaches may require staged operations or extensive craniotomy, increasing procedural risk. Robot-assisted stereotactic aspiration offers a minimally invasive and highly precise alternative, yet its application in single-session, multitarget drainage remains rarely reported. This case describes a young patient with extensive bilateral brain abscesses that were successfully treated through one-stage, robot-guided multisite aspiration, highlighting the potential advantages of this technique in complex infectious neurosurgical emergencies. CASE PRESENTATION:A 21-year-old woman presented with rapid onset of confusion, headache, and progressive neurological deficits. Magnetic resonance imaging revealed multiple deep abscesses involving the frontal, temporal, and occipital lobes, accompanied by severe cerebral edema and midline shift. After multidisciplinary evaluation, a single session of stereotactic aspiration was performed using a robot-assisted navigation system. Six abscess cavities were drained through four precisely planned trajectories during a single operation. Broad-spectrum antimicrobial therapy was initiated empirically and later tailored according to microbiological findings. A short-course of low-dose dexamethasone was added to reduce cerebral edema while minimizing the risk of impaired infection control. The patient demonstrated marked neurological improvement within several days and achieved full functional recovery within 1 month. CONCLUSIONS:This case illustrates that robot-assisted, minimally invasive stereotactic aspiration may represent a potentially safe and effective strategy for managing multifocal deep brain abscesses in selected patients, allowing accurate multitarget drainage in a single procedure. The rapid recovery observed in this patient supports the clinical value of integrating precise surgical intervention with optimized antimicrobial therapy and controlled edema management. This approach may offer a viable treatment pathway for similarly complex intracranial infections where conventional surgery is associated with significant risk.
BACKGROUND:Chronic traumatic encephalopathy (CTE) is classically defined as a neuroglial tauopathy characterized by perivascular accumulation of hyperphosphorylated tau within neurons and astrocytes. Defining lesions localize to the depths of cortical sulci, implicating vascular and glial elements in early pathogenesis. This systematic scoping review evaluates the extent to which astrocytic dysfunction contributes to CTE pathogenesis, specifically whether astrocytic alterations precede or potentiate neuronal tauopathy. METHODS:A structured search of PubMed, Embase, Web of Science, and Scopus was conducted from inception through December 2025 in accordance with PRISMA 2020 guidelines. Due to substantial heterogeneity in study design, including postmortem analyses, experimental models, and biomarker studies, a qualitative synthesis was performed. RESULTS:Forty studies met inclusion criteria, converging on four domains: (1) interface-specific astrogliosis at perivascular sulcal depths; (2) disruption of aquaporin-4 polarization with uncertain translational relevance in humans; (3) astrocytic degeneration and impaired glutamate homeostasis; and (4) sustained neuroinflammation mediated through astrocyte-microglia signaling. Circulating GFAP emerged as a sensitive but non-specific biomarker of neuroglial injury. CONCLUSION:CTE is best conceptualized as a neuroglial tauopathy in which astrocytes function as integral contributors to disease progression, likely in coordination with microglia. While astrocytic dysfunction may play an early role, its mechanistic specificity relative to other tauopathies remains incompletely defined.
Background Trigeminal neuralgia associated with multiple sclerosis (MS-TN) is frequently refractory to medical and procedural therapy, particularly in the absence of neurovascular compression. Surgical options are limited when microvascular decompression is not appropriate. We report a salvage surgical approach combining internal neurolysis and targeted proximal trigeminal root glycerol injection for refractory MS-related trigeminal neuralgia. Case presentation A 50-year-old woman with relapsing-remitting multiple sclerosis presented with medically refractory right-sided trigeminal neuralgia predominantly involving the V2/V3 distributions. She had previously failed optimisation of pharmacotherapy, two percutaneous retrogasserian glycerol rhizotomies, and Gamma Knife radiosurgery performed within the preceding year. Posterior fossa exploration via a retrosigmoid approach demonstrated no neurovascular conflict. Internal neurolysis (nerve combing) was therefore performed and supplemented with targeted glycerol delivery to the proximal cisternal segment of the trigeminal root adjacent to the radiologically relevant demyelinating lesion. Postoperatively, the patient experienced immediate improvement in facial pain with preservation of trigeminal sensation and no new neurological deficits. Her early postoperative course was complicated by a wound infection requiring surgical washout and antibiotic therapy. At 43-month follow-up, she remained free of ipsilateral trigeminal neuralgia with substantially reduced medication requirements. She later developed contralateral facial pain controlled with low-dose carbamazepine without recurrence on the operated side. Conclusion This report describes, to our knowledge, the first published case of combined internal neurolysis and targeted proximal trigeminal root glycerol injection for refractory multiple sclerosis-related trigeminal neuralgia. In this highly selected case, durable ipsilateral pain control was observed. However, causal interpretation is limited by the single-case design, the combined nature of the intervention, and the potential delayed effects of prior radiosurgery. This approach should therefore be regarded as hypothesis-generating rather than practice-defining, but may merit further study as a salvage strategy in selected patients without neurovascular compression after failure of medical, percutaneous, and radiosurgical treatments.
Abstract Background The IDH-mutant low-grade glioma (LGG) involving corpus callosum (ccLGG) is a rare type of LGG which has a poorer prognosis. To evaluate the efficacy of multimodal techniques (comprising neuronavigation, intraoperative MRI, and neuromonitoring) compared with the conventional approach guided solely by neuronavigation in the resection of IDH-mutant ccLGG, and to identify prognostic factors of ccLGG. Methods The IDH-mutant ccLGG cases that received resection in our center between 2014 and 2022 were collected and reviewed retrospectively. Comparisons were made between the multimodal and conventional groups regarding patient demographics, tumor characteristics, extent of resection (EOR), neurological function, Karnofsky Performance Status (KPS), progression-free survival (PFS), and overall survival (OS). Both univariate and multivariate analysis were employed to assess potential prognostic factors. Results Ultimately, 64 patients in the multimodal group and 34 in the conventional group were enrolled. Compared with the conventional group, the multimodal group achieved a significantly higher median EOR (100% vs. 93.55%, P = 0.001) and a greater gross total resection (GTR) rate (62.5% vs. 35.3%, P = 0.010). No significant differences were observed in postoperative neurological function or KPS between the two groups at any of the time points assessed. Compared with the conventional group, the multimodal group demonstrated significantly longer median PFS (78.5 vs. 48.1 months, P = 0.010) and OS (106.1 vs. 66.9 months, P = 0.009). Non-butterfly ccLGG, less tumor volume, genu invasion of CC (compared to splenium invasion), less volume of CC invasion, higher EOR, longer chemotherapy cycles of Temozolomide (TMZ), higher KPS on 3 months and MGMT methylation were positive factors for PFS of ccLGG. While four factors were associated with the longer OS of ccLGG, including genu of CC invasion compared to both genu and body invasion of CC, higher EOR, longer TMZ cycles and MGMT methylation. Conclusion Multimodal techniques are useful for achieving maximal safe resection and better prognosis of ccLGG. As higher EOR independently predicts improved survival in IDH-mutant ccLGG, maximal safe resection should be suggested and achieved by appropriate means tailored to available resources. The postoperative chemotherapy should also be recommended to patients with high risks. While whether postoperative radiotherapy should be performed should consider and balance many factors.
BackgroundRevascularization is the main effective treatment for moyamoya disease Moyamoya disease (MMD) but is associated with a high risk of postoperative cerebral infarction. We aimed to analyze the correlation between lesions in intracranial major arteries and postoperative cerebral infarction.MethodsAdult patients with ischemic MMD were enrolled in this analysis from June 1, 2021, to October 31, 2024. The preoperative clinical characteristics and features of digital subtraction angiography were recorded. Postoperative computed tomography or magnetic resonance imaging was performed to identify infarction complications. The Suzuki stage and lesions of the intracranial major arteries were analyzed to determine their correlations with postoperative cerebral infarction.ResultsA total of 119 adult patients with ischemic moyamoya disease were included in the final analysis. When the degree of stenosis was considered a disordered variable and the normal artery was taken as the reference, the logistic regression analysis showed that severe stenosis of the internal carotid artery (ICA), anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) was significantly correlated with postoperative infarction (ICA (OR, 8.833; 95% CI, 0.730-106.821; p = 0.046), ACA (OR, 49.500; 95% CI, 5.083-482.011; p = 0.001), MCA (OR, 24.000; 95% CI, 1.459 - 394.881; p = 0.026), and PCA (OR, 54.333; 95% CI, 4.307-685.462; p = 0.002)). Digital subtraction angiography (DSA) was performed on three patients with postoperative cerebral infarction and showed acute occlusion or aggravated stenosis of the major intracranial arteries with severe preoperative stenosis.ConclusionsSevere stenosis of major intracranial arteries is an important risk factor for cerebral infarction after combined revascularization in adult patients with ischemic MMD.
Abstract Background Hutchinson–Gilford progeria syndrome (HGPS) is an exceedingly rare genetic disorder characterized by accelerated aging and profound vascular fragility. While cerebrovascular accidents are common in this population, traumatic epidural hematomas (EDH) are clinical rarities, with only two pediatric cases previously documented. Currently, it is estimated that fewer than 200 children with HGPS are living worldwide. The primary objective of this report is to present a comprehensive multidisciplinary management strategy for traumatic EDH in a 15-year-old HGPS patient, highlighting the critical interplay between progerin-induced vascular stiffening, reduced intracranial compliance, and the formidable anesthetic challenges encountered in the oldest reported survivor of this pathology. Case presentation A 15-year-old female with HGPS presented with a right frontoparietal EDH following a ground-level fall. Initial Glasgow Coma Scale (GCS) was 14 but declined to 12 within 4 h. Cranial computed tomography (CT) revealed a large EDH measuring 22 mm at maximum thickness, causing a 6 mm midline shift. Due to severe glottic sclerosis and anatomical distortion, multiple orotracheal and fiberoptic (2.8 mm) intubation attempts failed. An emergency percutaneous tracheostomy was performed to secure the airway. Intraoperative findings revealed active bleeding from a coronal suture diastasis, which was managed with bone wax and dural tenting sutures. The patient achieved full neurological recovery and was discharged on postoperative day 10. Conclusion Managing HGPS patients requires a high index of clinical suspicion for intracranial injury even after minor trauma, as progerin-induced vasculopathy accelerates hematoma expansion. Standard airway techniques can fail due to progressive laryngeal changes, necessitating early consideration of surgical airways. Prompt multidisciplinary intervention and meticulous neurosurgical technique are essential to mitigate risks associated with extreme vascular fragility and complex anatomy in this high-risk population.
Background Flow diverter devices (FDDs) have revolutionized the treatment of intracranial aneurysms. However, comprehensive long-term outcome data across multiple device platforms remain limited, with most prior studies focusing exclusively on Pipeline embolization device (PED) outcomes. This study reports extensive long-term clinical follow-up of patients treated with various types of FDDs, providing critical safety and efficacy data for contemporary practice. Methods We conducted a retrospective analysis of intracranial aneurysms treated with FDDs from February 2011 to July 2016 in two tertiary care centers in France. The study included 209 patients with 216 cerebral aneurysms (91.2% anterior circulation, 8.8% posterior circulation; 66.2% unruptured, 31.0% recanalized, 2.8% ruptured). The duration of clinical and angiographic follow-up ranged from 24 to 156 months. Kaplan-Meier analysis performed for complication-free survival and aneurysm occlusion durability. Multivariate analysis showed risk factors for delayed complications. Results Long-term follow-up data were available for 202/209 (96.7%) patients. The early permanent morbidity and mortality rates were 3.8% and 1.4%, respectively. Between 12 and 18 months, procedure-related complications occurred in 5 of 202 patients (2.5%): two ischemic events, one delayed rupture, one silent intrastent stenosis, and one case of seizures following antiplatelet withdrawal. Only three patients (1.5%) were symptomatic. At the 24-month follow-up, complete aneurysm occlusion achieved in 81.0% of the patients, with adequate occlusion in 93.3%. Kaplan-Meier analysis revealed 97.5% complication-free survival at 18 months, with sustained durability thereafter. Multiple FDDs were the only significant independent predictor of delayed complications (OR: 7.066, 95% CI: 1.049-47.606, P < 0.045). No procedure-related complications or deaths occurred after 18 months. Conclusion Beyond 18 months of follow-up, FDD treatment for intracranial aneurysms proves exceptional safety with no delayed complications, regardless of device type. However, the findings of this study also show 18 months as a critical threshold for complication risk assessment, a key implication that clinicians and researchers need to be aware of. The study also underscores the need for modified management strategies when multiple overlapping FDDs are deployed, which significantly increases the risk of delayed complications.
Background Stereo-electroencephalography guided radiofrequency thermocoagulation (RF-TC) aims at changing epileptogenic networks to achieve therapeutic purpose. However, the functional connectivity mechanism of RF-TC remains unknown. We sought to determine the effects of RF-TC on functional connectivity and the relationship between these variations and the clinical outcome. Methods For this retrospective cohort study, we analyzed resting-state stereoelectroencephalography (SEEG) data segments to assess functional connectivity across sampling areas in seventeen epilepsy patients. We analyzed the variance of functional connectivity and graph theory indicators and assessed the relationship between variation and clinical response to RF-TC. Results We found decreased functional connectivity both within and between epileptogenic zone in alpha band (p < 0.05) after RF-TC. We also discovered the alteration of most graph theory properties in the alpha band. Moreover, within connectivity and betweenness were significantly decreased in alpha band in the non-improvement group (p < 0.05), while clustering coefficient showed opposite change in the improvement group (p < 0.05). Eventually, compared to improvement group, we discovered a greater decrease of within connectivity of alpha band in the epileptogenic zone (p < 0.01). Conclusion The research on network changes after radiofrequency thermocoagulation (RF-TC) is still an evolving field. Our research results indicate that significant changes occurred in functional connectivity and network characteristics in specific frequency bands and brain regions after RF-TC. Notably, the reduction in the internal connectivity within the alpha frequency band of the epileptic lesion not only provides early electrophysiological feedback for RF-TC, but also serves as a potential indicator for evaluating clinical response and prognosis.
Endovascular treatment (EVT) for basilar artery trunk aneurysm (BTA) is inadequately studied due to its rarity. The aim of this study was to report our experience regarding treatment modalities, complications and outcomes. A retrospective analysis of 2759 aneurysm patients who underwent EVT between January 2018 and December 2022 was performed. Patients with BTAs were involved, and their clinical characteristics, treatment modalities, complications, and clinical and angiographic outcomes were collected. Literatures from 2013 to 2024 were reviewed and studies included more than 5 BTA cases were summarized. Thirty-seven patients were involved, including 6 (16.2
BackgroundBrain arteriovenous malformation (bAVM) is a rare vascular disorder that can lead to severe neurological symptoms. The molecular mechanisms driving bAVM development and progression of bAVM remain poorly understood. This study aimed to investigate the molecular changes potentially associated with bAVM pathogenesis by performing RNA-seq on human microvascular endothelial cells (HMEC-1) overexpressing KRAS, a key driver of BAVM.ResultsHMEC-1 cells overexpressing KRAS were established as an in vitro model of bAVM. RNA-seq were conducted and transcriptomic analysis revealed that differentially expressed genes in HMEC-1 cells overexpressing KRAS were predominantly enriched in pathways related to cell adhesion, signaling, and transport, which may contribute to bAVM pathogenesis. Specifically, upregulated genes were mainly located in the cell-substrate junctions and focal adhesion, whereas downregulated genes were primarily located in the ribosomal subunits, ribosome, mitochondrial protein complex, and mitochondrial inner membrane.ConclusionsOur findings provided a preliminary delineation of molecular mechanisms after KRAS overexpression in endothelial cells, which may contribute to the development of bAVM. Future work will focus on validating these results in clinical specimens, functionally characterizing the dysregulated pathways, and exploring their potential as novel therapeutic targets.
