Middle meningeal artery embolization (MMAE) has emerged as a treatment for chronic subdural hematoma (cSDH), but comprehensive real-world safety data remain limited. We performed a multicenter retrospective analysis of 1781 consecutive patients undergoing MMAE for cSDH (2019–2025). The primary outcome was any procedure-related complication within 30 days. Inverse probability of treatment weighting (IPTW) assessed the association between technical success and complications, adjusting for demographic, clinical, and procedural confounders. Mean age was 72.8 ± 12.4 years; 68.1

BACKGROUND:Postdiagnostic anxiety and depression's impact on management and outcomes in patients with unruptured intracranial aneurysms remains underexplored. We assessed associations with treatment patterns and outcomes using a large multi-institutional database. METHODS:This retrospective cohort study used TriNetX Global Collaborative Network records (2015-2025; >130 million patients across ≈250 health care organizations), identifying 127 361 adults with unruptured intracranial aneurysms. Addressing immortal time bias, we used a 127-day landmark analysis (median time to psychiatric diagnosis), requiring event-free survival before cohort assignment. Of 119 211 patients surviving to the landmark, those with anxiety/depression diagnosed within 0 to 127 days (n=7250) were 1:1 propensity score matched to controls (n=111 961), yielding 6800 per cohort. Cox proportional hazards models evaluated outcomes from a landmark. RESULTS:Matched cohorts (6800 each) had balanced characteristics (all standardized mean differences <0.10) and comparable follow-up (median, 1550 versus 1600 days). Anxiety/depression was associated with higher all-cause mortality (6.3% versus 4.5%; hazard ratio [HR], 1.28 [95% CI, 1.11-1.48]; P<0.001) and rupture (3.1% versus 2.2%; HR, 1.33 [95% CI, 1.08-1.64]; P=0.007). Five-year survival was 93.7% in the anxiety/depression cohort versus 95.5% in matched controls. Preventive treatment showed nonsignificant trends toward lower rates (odds ratio, 0.80 [95% CI, 0.62-1.03]; P=0.082). Sensitivity analysis using a 365-day landmark (n=10 200 per cohort) expanded eligibility by including diagnoses between days 128 and 365, and confirmed findings (mortality HR, 1.22 [95% CI, 1.08-1.38]; rupture HR, 1.28 [95% CI, 1.08-1.52]). Fine-Gray competing risk models yielded consistent results (mortality subdistribution HR, 1.27; rupture subdistribution HR, 1.31). Dose-response patterns emerged for psychiatric medication adherence: low (mortality HR, 1.50 [95% CI, 1.12-2.00]; P=0.006), moderate (HR, 1.29 [95% CI, 0.98-1.70]; P=0.071), and high (HR, 1.16 [95% CI, 0.89-1.51]; P=0.270). E values were 1.88 for mortality and 1.99 for rupture. CONCLUSIONS:Postdiagnostic anxiety and depression are associated with increased rupture risk and mortality in patients with unruptured intracranial aneurysms. Residual confounding cannot be excluded. These findings require further investigation to establish causality and suggest that an integrated psychiatric assessment may be considered in unruptured intracranial aneurysm management.

BACKGROUND:Mechanical thrombectomy has become standard-of-care in the treatment of emergent large vessel occlusion. However, it is not yet known if social factors impact post-thrombectomy recovery. We studied the association between clinical and sociodemographic factors with 3-month functional outcomes post thrombectomy. METHODS:In this prospective cohort study, 290 patients who underwent mechanical thrombectomy at Montefiore-Einstein Hospital in NYC between 1/1/2021 and 4/1/2024 were analyzed. The cohort spanned multiple census tracts and included a diverse patient population from New York City and surrounding areas. The primary outcome was change in modified Rankin Scale (ΔmRS) from pre-stroke baseline to 90-180 days post-stroke. Ordinal logistic regression was used to assess the relationship between ΔmRS and social vulnerability, adjusting for age, sex, stroke severity, and procedural success. RESULTS:Worse functional outcomes were associated with older age (OR 1.03; p = 0.003), male sex (OR 1.86; p = 0.006), higher stroke severity (OR 1.10; p < 0.001), and lower reperfusion success (OR 2.17; p = 0.012). Social vulnerability was not significantly associated with long-term outcomes (OR 1.21; p = 0.401). CONCLUSION:In this cohort, functional outcomes after mechanical thrombectomy were influenced by clinical and procedural factors rather than sociodemographic vulnerability. While equitable outcomes were observed in the acute setting, ongoing research is needed to explore potential disparities across the broader stroke care continuum, including post-acute recovery.

OBJECTIVE:The objective was to evaluate the trajectories of hematoma resolution and functional improvement after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH), model the temporal pattern of cSDH resolution, and identify factors associated with favorable outcomes. METHODS:This real-world multicenter retrospective study included cSDH patients treated with MMAE at 24 centers between 2019 and 2024. Hematoma thickness was measured at baseline and at follow-up intervals (1-4 weeks, 1-3 months, 3-6 months, 6-12 months, and > 12 months after embolization). Resolution patterns were modeled using exponential decay functions. Modified Rankin Scale (mRS) scores assessed functional outcomes. Good functional outcome was defined as mRS score ≤ 2. Resolution patterns were modeled using exponential decay functions to estimate time to 50% and 80% reduction. Patients were categorized as complete resolution (≥ 99%) or by quartile of the remaining distribution (substantial [73%-98%], moderate [53%-73%], partial [27%-53%], minimal [< 27%]). The primary outcome was good functional status (mRS score ≤ 2). RESULTS:The authors analyzed a total of 1781 patients with 2295 cSDHs who underwent MMAE. The mean ± SD age was 72.8 ± 12.4 years and 68.1% of patients were male. The initial mean hematoma thickness was 15.31 ± 6.53 mm, decreasing to 5.24 ± 5.91 mm at final follow-up (mean reduction 64.3% ± 42.1%). Resolution followed an exponential decay pattern, with an estimated time to 50% reduction of 1.8 months and to 80% reduction of 8.9 months. Complete resolution occurred in 1031 of 2224 patients (46.4%) with complete follow-up. The median (IQR) mRS score improved from 1 (0-3) at baseline to 0 (0-2) at > 12 months. Good functional outcomes were more common in patients with complete versus minimal resolution (68.9% vs 35.0%, p < 0.001). Achieving ≥ 73% resolution within 90 days was associated with better outcomes (good outcome in 76.9% of those with ≥ 73% resolution vs 67.3% in those without, p < 0.001). Neurological deterioration was the strongest predictor of lack of good outcome (23.7% in patients with neurological deterioration vs 82.4% without, p < 0.001). CONCLUSIONS:After MMAE for cSDH, reduction in hematoma thickness follows a predictable exponential decay pattern. Greater extent (≥ 80%) and faster timing (within 90 days) of resolution are valuable prognostic indicators. Functional outcomes improve progressively through 6-12 months after the procedure. The relationship between resolution extent and functional outcomes provides quantitative benchmarks for evaluating treatment response.

The optimal timing for reinitiating antiplatelet therapy after treatment of chronic subdural hematoma (cSDH) remains uncertain, especially when middle meningeal artery embolization (MMAE) is used as an adjunct to surgery. This study evaluated the safety and outcomes of early antiplatelet reinitiation in patients undergoing combined surgical evacuation and MMAE, and compared outcomes in antiplatelet-treated patients receiving surgery with versus without MMAE. Adult cSDH patients from the TriNetX database (May 2020–May 2025) were identified using ICD-10 and RXNORM codes. Two propensity score–matched analyses were performed: (1) patients receiving surgery with adjunct MMAE, stratified by antiplatelet initiation within 30 days; and (2) antiplatelet-treated patients undergoing surgery with adjunct MMAE versus surgery alone. Outcomes included rescue surgery and 6-month mortality. After matching, early antiplatelet use in surgery + MMAE patients (n = 163 per group) was not associated with higher rescue surgery rates (OR 0.68, 95

BACKGROUND AND PURPOSE:Chronic subdural hematoma (cSDH) affects approximately 20 per 100,000 individuals annually, with surgical recurrence rates of 10-20%. Middle meningeal artery embolization (MMAE) has emerged as a promising minimally invasive treatment, but the optimal timing remains unclear. We evaluated the association between MMAE timing and radiological and functional outcomes in cSDH. METHODS:We conducted a retrospective multicenter international cohort study across 33 centres, including patients who underwent MMAE for cSDH between January 2018 and December 2024. Patients were stratified by timing from diagnosis: Q1 (≤1 day), Q2 (2 days), Q3 (3-6 days), and Q4 (>6 days). The primary composite endpoint required radiological success (hematoma thickness <5 mm at 1-3 months), absence of emergency surgical evacuation, and either functional improvement or good functional outcome (modified Rankin Scale 0-2). Propensity score matching compared Q1 and Q4. RESULTS:Of 1,781 patients screened, 908 met inclusion criteria. Mean age was 73.7 ± 12.2 years, and 70.9% were female. Early embolization (Q1) achieved the primary composite endpoint more frequently than delayed embolization (Q4), with concordant improvements in radiological and functional components and no difference in rescue surgery. Good functional outcome was achieved in 76.0% of Q1 patients versus 63.8% in Q4 (absolute difference, 12.2%; P=.003; number needed to treat approximately 8). Hospital length of stay was 21.0 days shorter in Q1 versus Q4 (P<.001), partly attributable to the timing definition. In 174 propensity score-matched pairs, early embolization was associated with higher odds of achieving the primary endpoint (odds ratio, 6.41; 95% confidence interval, 3.29-12.48; P<.001), with pronounced benefit among patients receiving antithrombotic therapy (odds ratio, 8.06; 95% confidence interval, 3.65-17.80). CONCLUSIONS:Early MMAE (≤1 day from diagnosis) was overall associated with better outcomes compared with delayed intervention, particularly among patients receiving antithrombotic therapy. Prospective confirmation is warranted.

IntroductionSickle cell disease (SCD) confers a three-to fivefold increase in the prevalence of intracranial aneurysms (IA). Flow diversion (FD) requires mandatory dual antiplatelet therapy (DAPT), yet perioperative transfusion to reduce hemoglobin S (HbS) risks delayed hemolytic transfusion reaction (DHTR). No guidelines address this conflict between DHTR-associated coagulopathy and mandatory DAPT. We report the largest FD series in SCD.MethodsRetrospective single-center case series of SCD patients undergoing FD for IA (2017 to 2026). Of 12 SCD patients treated for aneurysms, seven received FD and comprised the analytic cohort.ResultsSeven patients (5 HbSS, 2 HbS/β0-thalassemia; median age 38; 71% female) harbored 29 aneurysms; 12 were treated with FD across 8 procedures using 15 devices. HbS <30% was achieved in 3 of 7 (43%); one patient underwent FD at HbS 78.5% due to alloimmunization. Clopidogrel hyporesponsiveness was identified in 2 of 4 TEG-tested patients (50%). Procedure-related mortality was 14% (1/7): fatal DHTR with DIC on postoperative day 8, the first reported DHTR-DAPT collision. Procedure-related morbidity included one intraoperative thrombus and one vasospasm episode, both resolved without sequelae (2/8 procedures, 25%). Additional events included asymptomatic in-stent stenosis and delayed stroke from SCD vasculopathy. At last follow-up, 5 of 6 survivors maintained mRS 0 to 1.Discussion and ConclusionFD is technically feasible in SCD, but the 14% procedure-related mortality from a fatal DHTR exposes the unresolved conflict between transfusion-associated hyperhemolysis and mandatory DAPT. CYP2C19-mediated clopidogrel resistance and alloimmunization pose additional challenges that require predefined protocols and prospective multicenter registries.

The Woven EndoBridge (WEB) device treats wide-necked bifurcation aneurysms, but occlusion rates vary. This study aims to identify factors associated with immediate WEB device occlusion. Data from patients treated with WEB devices across 36 sites were analyzed. Machine learning algorithms and ordinal regression models were developed to predict immediate incomplete occlusion for ruptured and unruptured aneurysms. The study included 1565 patients, with 436 ruptured and 1129 unruptured aneurysms. Immediate complete occlusion was achieved in 38.3% of ruptured and 32.8% of unruptured aneurysms. For ruptured aneurysms, the CatBoost classifier achieved an AUROC of 0.69. Key predictors of incomplete occlusion included pretreatment mRS, aneurysm diameter, and MCA location. Ordinal regression revealed that smoking history (OR: 1.95, p < 0.001), neck diameter (Odds Ratio [OR]: 1.50, p < 0.001), and presence of a branch from the aneurysm (OR: 2.06, p = 0.016) were associated with incomplete, while bifurcation aneurysms (OR: 0.55, p = 0.017) were associated with complete immediate occlusion. For unruptured aneurysms, the CatBoost classifier achieved an AUROC of 0.68. Significant predictors of immediate incomplete occlusion included aneurysm neck width, MCA location, and presence of daughter sac. Ordinal regression revealed that smoking history (OR: 1.29, p = 0.032), neck diameter (OR: 1.24, p < 0.001), and presence of a daughter sac (OR: 1.53, p = 0.005) were associated with incomplete, while bifurcation aneurysms (OR: 0.71, p = 0.02) and posterior circulation location (OR: 0.68, p = 0.01) were associated with complete immediate occlusion. Careful evaluation of patient demographics and specific aneurysm characteristics may help improve the outcomes of intracranial aneurysms treated with WEB device.

OBJECTIVE:This study aimed to analyze the comparative tumor resection rates and complication profiles of the transsylvian (TS) and transcortical (TC) approaches to the insular glioma (IG) and emphasize the concept of onco-microneurosurgery as a key to surgical success in these difficult areas. METHODS:A retrospective analysis of a single surgeon's prospectively maintained data of surgically resected, newly diagnosed IGs in adult patients (≥ 18 years old) was conducted. Propensity score matching was performed with a tolerance limit of 0.05 for comparison of the TS and TC cohorts. The extent of resection (EOR) was categorized with 90% resection as a cutoff. Neurological complications persisting beyond 3 months were considered permanent complications. These two variables were combined to derive a Composite Postoperative Outcome Index (CPOI) and graded as 0, 1a, 1b, or 2. RESULTS:Fifty-two patients (male-to-female ratio of 2.25:1) were studied, with 26 patients in each group. Radical tumor resection (≥ 90%) was obtained in 77% patients (n = 40), with transient and permanent neurological complication rates of 46.2% (n = 24) and 15.4% (n = 8), respectively. A significantly higher rate of maximal safe resection (CPOI grade 0) was obtained using a TS approach for the entire TS cohort (p = 0.008), as well as subgroups of non-giant segmental IGs (p = 0.011) and those with specific Berger-Sanai zone II involvement (p = 0.01). The TC approach was found to be significantly safer in giant IGs when a subtotal resection was performed (p = 0.03). Permanent neurological complications with ≥ 90% EOR (CPOI grade 1b) were significantly higher in the TC group (p = 0.009), including non-giant segmental IGs (p = 0.001) and those specifically involving Berger-Sanai zone II (p = 0.01) of the insula. Long-term functional status and disease progression were similar in both groups. CONCLUSIONS:These results suggest the continued role of the TS approach in IG resection in the contemporary era. Irrespective of the approach, the key variable appears to be a meticulous microsurgical technique, supplemented by the available adjuncts, in the preservation of perforator arteries and subcortical circuitry. Thus, an optimally designed, individual institution-tailored hybrid onco-microneurosurgical approach is the most pragmatic approach to IGs.

BACKGROUND AND PURPOSE:Preoperative embolization of anterior skull base meningiomas can facilitate surgical resection by reducing tumor vascularity. However, transophthalmic artery embolization carries risks of visual complications. This study aimed to evaluate the safety and efficacy of this technique by using modern endovascular tools. MATERIALS AND METHODS:This retrospective study included patients with anterior skull base meningiomas who underwent preoperative transophthalmic artery embolization followed by surgical resection between January 2022 and April 2024. Patient demographics, tumor characteristics, embolization details, surgical outcomes, and complications were analyzed. RESULTS:Seven patients (median age 57 years; 6 men) underwent embolization for tumors located primarily at the planum sphenoidale (58%). Unilateral embolization was performed in most cases, with 1 bilateral transophthalmic approach. Commonly embolized branches included the anterior and posterior ethmoidal arteries. Polyvinyl alcohol particles were the primary embolic agent (71%). Angiographic devascularization was achieved in all cases without complications. Gross total resection was achieved in 71%, with a median blood loss of 427 mL. At a 9-month follow-up, the median mRS score was 1. CONCLUSIONS:With careful patient selection, advanced microcatheter technology, and meticulous technique, preoperative transophthalmic artery embolization can be safely performed to facilitate resection of anterior skull base meningiomas. These results suggest it is a viable option for well-selected patients at experienced centers, though larger prospective studies are needed.

While the Woven EndoBridge (WEB) device has transformed the treatment of wide-neck intracranial aneurysms, incomplete occlusion remains a significant challenge requiring better understanding of contributing factors. A retrospective analysis was conducted on multicenter data from patients who underwent WEB device treatment for intracranial aneurysms between January 2011 and December 2022. Using machine learning models, Cox regression, and time-stratified analyses, we evaluated factors associated with persistent incomplete occlusion, defined as non-improving Raymond-Roy Occlusion Classification grade 2 or 3 at final follow-up. Among 813 patients (607 with < 24 months follow-up, 206 with ≥ 24 months), machine learning analysis identified aneurysm height, Acom location, neck diameter, and pretreatment mRS as predictors of persistent incomplete occlusion. On Cox regression. larger aneurysm neck diameter (HR 1.13, 95% CI 1.01–1.27, p = 0.027) and height (HR 1.14, 95% CI 1.02–1.26, p = 0.017), and radial access (HR 2.68, 95% CI 1.76–4.07, p < 0.001) increased, while posterior circulation location (HR 0.56, 95% CI 0.37–0.84, p = 0.005) decreased the risk of persistent incomplete occlusion. Time-stratified analysis revealed that in short-term follow-up (< 24 months), larger aneurysm neck diameter (OR 1.28, 95% CI 1.08–1.52, p = 0.004) increased the risk of incomplete occlusion. In long-term follow-up (≥ 24 months), smoking (OR 2.69, 95% CI 1.04–7.00, p = 0.04), higher pre-treatment mRS (OR 1.78, 95% CI 1.15–2.76, p = 0.009), and immediate flow stagnation (OR 0.33, 95% CI 0.11–0.96, p = 0.04) increased, while older age (OR 0.94, 95% CI 0.90–0.98, p = 0.002) and WEB-DL (OR 0.06, p < 0.001) and SLS devices (OR 0.02, p = 0.003) decreased the risk of persistent incomplete occlusion. Aneurysm characteristics and device type significantly influence long-term WEB treatment outcomes.

Introduction: Patients with high-grade aneurysmal subarachnoid hemorrhage (SAH) have classically been known to have poor functional outcomes. However, recent reports vary widely in citing the morbidity and mortality for these patients, with some studies citing that the majority of high-grade SAH will gain independent function. The authors sought to clarify functional outcomes expected of high-grade SAH through its own retrospective review as well as a review of the literature. Methods: A retrospective review was conducted of patients with high-grade SAH managed at a single institution between May 2015 and April 2020. High-grade SAH was defined using the Hunt-Hess (HH) scale 4 or 5 at admission. The primary outcome measures were functional outcome at discharge and at 90 days after discharge, defined using the modified Rankin Scale (mRS). Poor functional outcome was defined as mRS > 3. Additionally, a PubMed search was performed to identify functional outcomes expected of high-grade SAH patients. Results: Thirty-eight out of the total 229 (16.59 %) SAH patients treated at our center were included in this study. This included 24 (63.16 %) HH grade 4 patients and 14 (36.84 %) HH grade 5 patients. 22 out of 38 patients (57.9 %) survived during the initial admission and were successfully discharged from the hospital. A large majority (n = 20/22, 90.9 %) of patients had poor functional outcomes at the time of discharge, including four patients with mRS 4 and 16 patients with mRS 5. However, two patients (9.1 %) had favorable functional outcomes (mRS 3) at the time of discharge. Notably, 47.1 % of HH4 survivors with poor discharge mRS (8 of 17 patients) improved to mRS <= 3 during follow-up. Among the HH grade 5 patients (n = 14), only five patients survived the acute clinical course and subsequently got discharged from the hospital (n = 5/14, 35.7 %). Conclusion: This investigation provides support that functional outcomes remain poor in high-grade SAH patients. However, there is a large lack of consistency of functional outcomes reported for high-grade SAH among the literature. Of those high-grade SAH that do survive, there is evidence to suggest improvement in functional outcome over time. Longitudinal investigations tracking high grade SAH are warranted.

ABSTRACT Introduction Idiopathic intracranial hypertension (IIH) is a neurological disorder characterised by elevated intracranial pressure (ICP), predominantly affecting obese women of reproductive age. While GLP‐1 receptor agonists have shown promise in IIH management, the potential of dual GIP/GLP‐1 receptor activation through tirzepatide remains unexplored. This study aimed to evaluate tirzepatide's efficacy as an adjunctive therapy in IIH management. Methods We conducted a retrospective cohort analysis using the TriNetX Global Health Research Network, analysing data through November 2024. Through propensity score matching, we compared 193 tirzepatide‐exposed IIH patients with 193 controls receiving standard care. Primary outcomes included papilledema severity, visual function, headache frequency, and treatment resistance, monitored at multiple follow‐up timepoints. Results Our analysis revealed significant improvements across all measured outcomes in the tirzepatide group. At 24 months, we observed a 68% reduction in papilledema risk (RR 0.320, 95% CI 0.189–0.542, p < 0.001), a 73.9% reduction in visual disturbance and blindness risk (RR 0.261, 95% CI 0.143–0.477, p < 0.001), and a 19.7% reduction in headache risk (RR 0.803, 95% CI 0.668–0.966, p = 0.019). The tirzepatide group demonstrated significant body‐mass index reductions, reaching −1.147 kg/m2 (95% CI [−1.415, −0.879], p < 0.001) at 24 months compared to controls. Conclusions Our results demonstrate that tirzepatide, when used as an adjunctive therapy, provides significant therapeutic benefits in IIH management, particularly in improving papilledema and visual outcomes. Our findings suggest that dual GIP/GLP‐1 receptor activation may offer advantages over traditional single‐receptor therapies, potentially through enhanced metabolic regulation and direct effects on ICP dynamics.

Abstract Objective Idiopathic intracranial hypertension (IIH) is a neurological disorder predominantly affecting young women with obesity, characterized by elevated intracranial pressure. While current treatments include weight loss counseling, medical therapies, and surgical interventions, their limitations necessitate exploring novel therapeutic approaches. We investigated the efficacy of liraglutide as an adjunctive therapy in IIH management. Methods We conducted a retrospective cohort study, analyzing adult patients with IIH. Through propensity score matching, we compared patients receiving liraglutide alongside standard therapy (n = 204) with those receiving standard therapy alone (n = 204). Primary outcomes included papilledema, headache manifestations, and visual disturbances, assessed at 3, 6, 12, and 24 months posttreatment initiation. Results Our matched cohorts were predominantly female (95.1% vs. 97.1%) with comparable mean ages (37.6 vs. 37.3 years). Liraglutide treatment demonstrated significant reduction in papilledema risk at 3 months (RR 0.333, 95% CI 0.167–0.664, p = 0.001), with sustained benefits throughout 24 months (RR 0.524, 95% CI 0.325–0.845, p = 0.006). While improvements were observed in visual disturbances, headache symptoms, and refractory IIH cases, these did not reach statistical significance. Interpretation Our findings suggest that liraglutide as an adjunctive therapy significantly improves papilledema outcomes in IIH patients, with the greatest effect observed at 3 months and sustained benefits over 2 years. This study provides promising evidence for liraglutide's role in IIH management, particularly in addressing papilledema.

BACKGROUND:Pial arteriovenous fistulas (pAVFs) are rare vascular abnormalities in the subpial space, characterized by high-flow connections between pial arteries and draining veins, without an intervening nidus. This case report describes a left parietal pAVF feeding from the angular branch (M4) of the left middle cerebral artery, which presented as an acute subdural hematoma (SDH). OBSERVATIONS:The authors present the case of a 68-year-old neurologically intact male with 1-week history of progressive holocranial headache. Initial noncontrast CT imaging of the head revealed a left-sided SDH. Subsequent CTA confirmed the SDH with a spot sign in the posterior part of the SDH. Digital subtraction angiography identified a left parietal pAVF with an associated saccular aneurysm. The patient underwent successful microsurgical ligation and hematoma evacuation, with no residual fistula or vascular abnormality on follow-up angiography. LESSONS:This case highlights the importance of a lower threshold for advanced imaging in acute SDH with no known predisposing factors. It also focuses on the complexity of managing pAVFs with associated aneurysms, along with the importance of individualized treatment strategies integrating advanced imaging and microsurgical techniques. https://thejns.org/doi/10.3171/CASE25605.

IntroductionDelayed Cerebral Ischemia (DCI) is a significant complication following aneurysmal subarachnoid hemorrhage (aSAH) that can lead to poor outcomes. Machine learning techniques have shown promise in predicting DCI and improving risk stratification.MethodsIn this study, we aimed to develop machine learning models to predict the occurrence of DCI in patients with aSAH. Patient data, including various clinical variables and co-factors, were collected. Six different machine learning models, including logistic regression, multilayer perceptron, decision tree, random forest, gradient boosting machine, and extreme gradient boosting (XGB), were trained and evaluated using performance metrics such as accuracy, area under the curve (AUC), precision, recall, and F1 score.ResultsAfter data augmentation, the random forest model demonstrated the best performance, with an AUC of 0.85. The multilayer perceptron neural network model achieved an accuracy of 0.93 and an F1 score of 0.85, making it the best performing model. The presence of positive clinical vasospasm was identified as the most important feature for predicting DCI.ConclusionsOur study highlights the potential of machine learning models in predicting the occurrence of DCI in patients with aSAH. The multilayer perceptron model showed excellent performance, indicating its utility in risk stratification and clinical decision-making. However, further validation and refinement of the models are necessary to ensure their generalizability and applicability in real-world settings. Machine learning techniques have the potential to enhance patient care and improve outcomes in aSAH, but their implementation should be accompanied by careful evaluation and validation.