搜索结果：Asian journal of neurosurgery

The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.

Pial arteriovenous fistulas are extremely rare vascular malformations of the brain (accounting for approximately 1.6% of vascular malformations of the brain) and are classified as Galenic and non-Galenic pial fistulas. We present a rare association of a mural-type vein of Galen malformation with a pial fistula involving the precentral branch of the right middle cerebral artery (MCA) in a 12-month-old infant. A 12-month-old preterm male infant, born vaginally with a delayed cry (birth weight 1.2 kg), presented with progressive macrocephaly, recurrent upper respiratory tract infections, developmental delay, and a history of seizures. Neurologically, the child was intact with no focal deficits. He was the firstborn child of a non-consanguineous marriage; maternal antenatal history was notable for polyhydramnios and fetal cardiomegaly detected on antenatal ultrasound. Antenatal scans at 26 and 28 weeks revealed aneurysmal dilation of the vein of Galen. Postnatal transfontanelle ultrasound showed enlarged lateral and third ventricles with a midline cystic lesion exhibiting turbulent flow, suggestive of a high-flow arteriovenous shunt. At 12 months of age, multidetector computed tomography (MDCT)) identified a 37 × 15 mm lobulated soft tissue density in the perimesencephalic/suprasellar region with ventriculomegaly. MRI of the brain confirmed a 35 × 19 × 21 mm flow void in the region of the vein of Galen associated with hydrocephalus, periventricular ooze, and cerebral atrophy. Digital subtraction angiography revealed a mural-type vein of Galen malformation fed by the right posterior choroidal artery, draining into the torcula. Additionally, a separate pial arteriovenous fistula was identified, supplied by the precentral branch of the right MCA, with cortical venous drainage into the superior sagittal sinus. Left sigmoid sinus hypoplasia with redirected venous outflow into the left superior petrosal sinus and cavernous system was noted. Mural-type vein of Galen malformation with concurrent pial arteriovenous fistula. The child was taken up for endovascular embolization. The vein of Galen malformation was embolized using 70% N N-butyl cyanoacrylate (NBCA). Subsequently, transarterial embolization of the right MCA pial fistula was done using coils and Onyx liquid embolic agent in the same sitting. Post-embolization, complete closure of both fistulas was noted. Post-treatment, CT revealed closure of fistulas with no fresh parenchymal abnormality. The child was discharged on postoperative day 6 without any focal deficit. At 3-month follow-up, the patient remained neurologically stable without new deficits, and follow-up MRI was planned.

Avoiding or minimizing the interference of anesthetic agents with electrocorticography (ECoG) signals during ECoG-guided epilepsy surgery is vital to the successful resection of the epileptogenic area. Most agents in routine use have widely variable effects like suppression, enhancement, or no impact on the ECoG signals. Dexmedetomidine is reported to have no influence, or minimal depressant effect, on the signals, but studies evaluating its effect on intraoperative ECoG are limited. This study evaluates the effect of dexmedetomidine on ECoG signals during ECoG-guided epilepsy surgeries conducted under either isoflurane-based or propofol-based anesthesia regimens. It also assesses the safety of dexmedetomidine use in these combination forms by determining its impact on hemodynamic parameters, recovery from anesthesia, and incidence of intraoperative awareness. Thirty epilepsy patients, randomized into Group-I (dexmedetomidine-isoflurane, n  = 15) and Group-P (dexmedetomidine-propofol, n  = 15), underwent ECoG-guided epilepsy surgeries. After dural reflection, dexmedetomidine was administered as a bolus of 1 μg/kg, and ECoG signals were recorded before and after the bolus via brain surface grids. Dexmedetomidine infusion of 0.5 μg/kg/h was thereafter continued throughout surgery in both groups. The effect of dexmedetomidine on ECoG scores, hemodynamic parameters, anesthesia emergence times, and incidence of intraoperative awareness was evaluated in both groups and compared. Dexmedetomidine did not cause ECoG suppression when administered with either propofol or isoflurane anesthesia. However, it caused a significant increase in the ECoG score in Group-I (baseline: 1.8 ± 0.7; post-dexmedetomidine: 2.1 ± 0.9; p  = 0.02), while there was no change in scores in Group-P (baseline: 2.0 ± 0.7; post-dexmedetomidine: 2.10 ± 0.7; p  = 0.16). The anesthesia emergence time was within defined normal limits in both groups; however, in Group-I, it was significantly longer than that in Group-P ( p  = 0.03). The hemodynamic parameters were not affected by dexmedetomidine, and there was no incidence of awareness in both groups. Dexmedetomidine, when used with propofol anesthesia, had no effect on the intraoperative ECoG signals, hemodynamic parameters, and anesthesia recovery time. Use of dexmedetomidine with isoflurane anesthesia also did not cause ECoG suppression, but significantly augmented the ECoG scores, while normal hemodynamic and recovery status were maintained. There was no incident of intraoperative awareness in either group. As per this study, the dexmedetomidine-propofol anesthetic regimen appears to be suitable for use in ECoG-guided epilepsy surgeries. However, the ECoG-enhancing effect observed with dexmedetomidine when used with isoflurane necessitates further research for validation and to understand its clinical implications.

Neurosurgery is a high-demand specialty in medicine, yet the factors influencing medical students' decision to pursue it remain underexplored. This study aimed to evaluate the demographics, academic year-wise interest, motivating and deterring factors, and the role of undergraduate exposure in influencing students' intentions to pursue neurosurgery. A cross-sectional survey of 503 Bachelor of Medicine, Bachelor of Surgery (MBBS) students across India was conducted. The survey assessed demographics, academic year, interest in neurosurgery, motivating and deterring factors, and perceptions of neurosurgical exposure during undergraduate education. Statistical analyses, including chi-square and multinomial logistic regression, were applied to determine significant associations between variables. The study revealed that interest in neurosurgery was highest among first- and second-year students, with a sharp decline observed by the internship year. Primary motivators included personal interest in neuroscience and the prestige of the field. Significant deterrents were limited exposure to neurosurgery and concerns about work-life balance. A gender disparity was found, with males showing greater interest in neurosurgery, mirroring national trends in the specialty. Half of the respondents believed that neurosurgery was underrepresented in the MBBS curriculum, and most supported its inclusion as a mandatory subject. Additionally, students expressed a preference for practicing neurosurgery in India, citing familial and financial considerations as key factors. The findings emphasize the importance of early exposure, mentorship, and curriculum improvements in shaping students' career decisions. Addressing regional and gender disparities, alongside ensuring robust neurosurgical training, is essential for fostering a motivated, diverse workforce in the field of neurosurgery.

To analyze the trends in the global and Asian burden of subarachnoid hemorrhage (SAH) from 1990 to 2021, explore its influencing factors, assess its relationship with sociodemographic development, analyze health inequalities, and predict future trends. Epidemiological data on SAH from 1990 to 2021 were obtained from the Global Burden of Disease (GBD) database. Prevalence, disability-adjusted life years (DALYs), and other indicators were calculated. Joinpoint regression, age-period-cohort analysis, and decomposition analysis were used to investigate trends and influencing factors. Data envelopment analysis was employed to evaluate the relationship between SAH and the socio-demographic index (SDI). The slope index of inequality (SII) and concentration index (CI) were used to analyze health inequalities. The Bayesian age-period-cohort model was utilized to predict prevalence from 2022 to 2036. In 2021, the global and Asian age-standardized prevalence of SAH was 92.169/100,000 and 90.158/100,000, respectively. Joinpoint regression showed a decreasing trend in both global and Asian prevalence, with a slowing decline in recent years. The risk of SAH exhibited significant age, period, and cohort effects. Decomposition analysis indicated that population growth and aging were the main drivers of increased prevalence globally and in Asia. Data envelopment analysis revealed a nonlinear relationship between SAH and SDI. SII and CI analyses showed a trend of increasing health inequalities globally and in Asia. Bayesian predictions indicated that the prevalence would continue to decline globally and in Asia from 2022 to 2036, but at a slower rate. Although the global and Asian burden of SAH showed a declining trend over the past 30 years, challenges such as population aging and increasing health inequalities persist. Future prevention and control strategies should focus on population effects and regional heterogeneity while strengthening interventions for high-risk populations.

Scalp incision bleeds profusely due to its high vascularity. In other regions of the body, studies have debunked the initial concern of poor wound outcomes thought to be associated with thermal skin injury if diathermy is used to make skin incision and found that skin incision with diathermy led to reduced incisional blood loss. Studies on cranial operations involving scalp incisions in which incisional blood loss is more likely are scarce. The objective of this study was to compare the outcomes of scalp incisions using either cutting micro-needle diathermy (MND) or the traditional stainless-steel scalpel (TSSS) during craniotomy. The study was a hospital-based, prospective, randomized comparative study. Consented adult patients who had craniotomy were randomized into either cutting MND or TSSS group. Outcome measures were volume of blood loss per wound length and incision duration per wound length during scalp incision, 30-day surgical site infection (SSI), and scar appearance at 3 months postoperatively. The data were analyzed using SPSS version 23, and statistical significance was set at p -value <0.05. A total of 56 patients were recruited for the study, with 28 patients in each group. The mean age of the patients was 36.21&#x2009;&#xb1;&#x2009;13.90 years. The mean volume of incisional blood loss per wound length was 3.21&#x2009;&#xb1;&#x2009;2.06 and 4.65&#x2009;&#xb1;&#x2009;3.25&#x2009;mL/cm in MND and TSSS groups, respectively ( p &#x2009;=&#x2009;0.053). In the MND group, the mean incision duration per wound length was 0.39&#x2009;&#xb1;&#x2009;0.18&#x2009;minutes/cm, while it was 0.35&#x2009;&#xb1;&#x2009;0.10&#x2009;minutes/cm in the TSSS group ( p &#x2009;=&#x2009;0.364). Five patients (22.7%) and four patients (16.7%) developed SSI in the MND and TSSS groups, respectively ( p &#x2009;=&#x2009;0.885). At 3 months postoperatively, the mean scar score was 9.06&#x2009;&#xb1;&#x2009;0.94 in the MND group and 8.63&#x2009;&#xb1;&#x2009;1.26 in the TSSS group ( p &#x2009;=&#x2009;0.255). The study revealed no significant difference in the outcomes of craniotomy scalp incision between the two methods of making scalp incision. The study concludes that the use of diathermy in making scalp incision is not inferior to the use of the traditional scalpel, and the method of scalp incision may be left to the discretion of the surgeon.

Virtual reality (VR) is transforming the vast field of neurosurgery by providing realistic and interactive simulations of intricate brain structures. A literature search of PubMed, Google Scholar, and the Cochrane Library using the keywords "virtual reality," "VR in neurosurgery," "skill development," "neurosurgical education," "patient outcome," "3D visualisation," "evolution in neurosurgery," and "simulators" was performed. The relevant articles, including RCTs, meta-analyses, and systematic reviews and narrative reviews, were considered from inception up to March 2025. This review of existing literature was conducted to explore the evolution, current applications, and future potential of VR in neurosurgery. Emerging in the early 1990s, it lacked accuracy and precision, but now in the 2020s, it provides exceptional benefits to the field. The findings highlight how VR has enhanced the neurosurgical field through various simulators, optimized strategies and planning and decision making, and improved surgical training. Students of neurosurgery can get trained through various 3D models, providing them with a realistic experience of surgical procedures. Moreover, the integration of artificial intelligence (AI) has further refined surgical decision-making, risk evaluation, and real-time adaptability. However, various challenges exist, making VR accessibility limited. High cost, lack of numerous skilled operators, user discomfort, and no proper ethical protocols are critical hindrances that need to be addressed. VR has evolved into a crucial tool for neurosurgical innovation, although ongoing research needs to refine AI-driven models, expand accessibility, and establish standardized protocols for easy adoption across diverse healthcare settings.

Globally, severe traumatic brain injury (TBI) is a significant cause of death and disability, particularly among young adults in their productive years. The management of elevated intracranial pressure (ICP) following TBI remains one of the greatest challenges in neurotrauma care, with decompressive craniectomy (DC) being a prominent, albeit contentious, treatment option. DC, a surgical procedure that involves removing a portion of the skull to accommodate brain swelling, has emerged as a potential life-saving intervention in such scenarios. The rationale is that by reducing ICP and enhancing cerebral perfusion, DC may mitigate further neurological damage. However, while DC effectively reduces mortality, its association with a high prevalence of severe disability and poor long-term functional outcomes has led to ongoing debate regarding its clinical utility, ethical justification, and cost-effectiveness. From a health care economics standpoint, DC has been shown to be more cost-effective than alternatives like barbiturate coma, particularly in younger patients with less severe injuries. Yet, this advantage diminishes in older populations or those with profound neurological impairment, where survival often comes at the cost of substantial long-term care needs and significantly impaired quality of life. Additionally, the decision to perform DC often occurs under critical circumstances where inherent prognostic uncertainty of early outcome prediction and emotional stress further complicate the shared decision-making process. To aid in navigating these complex choices and to guide ethical resource allocation, prognostic models such as Corticosteroid Randomization After Significant Head injury (CRASH) and International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) have been developed, offering evidence-based predictions of functional outcomes based on preoperative clinical and radiographic variables. Nevertheless, these models have limitations. This review synthesizes current evidence on the clinical effectiveness, cost utility, and ethical dimensions of DC in severe TBI. It also explores the role of predictive tools in facilitating evidence-informed and ethically responsible decisions. A literature review was conducted using major biomedical databases to identify and synthesize clinical, ethical, and economic evidence related to DC in severe TBI. We also sought the opinion of various experts and tried to provide a comprehensive, multidimensional understanding of DC in neurotrauma care to support clinicians in navigating the complexities of managing severe TBI patients.

The purpose of this study was to evaluate the accuracy of different scoring systems, including the Acute Physiology and Chronic Health Evaluation (APACHE) II, the Simplified Acute Physiology Score (SAPS) II, the Sequential Organ Failure Assessment (SOFA) score, the Glasgow Coma Scale (GCS) and the Glasgow Coma Scale-Pupils (GCS-P), in predicting in-hospital mortality for critically ill patients after craniotomy. This was a single-centre retrospective diagnostic study. The study was conducted in three intensive care units (70 beds) of a teaching hospital. Adult patients who underwent craniotomy and stayed in the ICU for more than 24 hours were included. Pregnant or lactating women and patients enrolled in other clinical studies were excluded. Data on demographics, clinical characteristics and scoring systems (APACHE II, SOFA, SAPS II, GCS and GCS-P) were collected. Receiver operating characteristic (ROC) curves were used to assess the predictive accuracy of each scoring system. Among 1717 patients included, the in-hospital mortality rate was 6.8%. SAPS II (AUC = 0.822) and APACHE II (AUC = 0.819) demonstrated the highest predictive accuracy, followed by GCS-P (AUC = 0.812), GCS (AUC = 0.803) and SOFA (AUC = 0.762). SAPS II and APACHE II significantly outperformed SOFA, while no significant differences were observed among SAPS II, APACHE II, GCS and GCS-P. For patients with supratentorial lesions, APACHE II, SAPS II, GCS and GCS-P showed similar predictive accuracy, all superior to SOFA. For infratentorial lesions, SOFA outperformed GCS and GCS-P. Among patients with cerebrovascular diseases, SOFA had the lowest predictive accuracy, while GCS-P outperformed GCS. APACHE II, SAPS II, GCS and GCS-P demonstrated comparable predictive accuracy for in-hospital mortality in critically ill post-craniotomy patients, with SOFA being less effective. NCT06762184.

Vestibular schwannomas (VSs) are benign neoplasms commonly located in the cerebellopontine angle and are increasingly managed with stereotactic radiosurgery (SRS), particularly Gamma Knife radiosurgery (GKRS). The integration of artificial intelligence (AI), encompassing machine learning (ML) and deep learning (DL) algorithms, into GKRS has emerged as a promising strategy to enhance diagnostic accuracy, automate treatment planning, and predict treatment response. This systematic review evaluates the current applications and clinical utility of AI in the stereotactic radiosurgical management of VSs. A systematic search was conducted on July 31, 2024, across Medline (PubMed), Embase, Scopus, and the Cochrane Library, in accordance with PRISMA guidelines. Studies were selected if they investigated the use of AI at any stage of stereotactic treatment or follow-up of VSs. Articles were excluded if they focused solely on microsurgical interventions or were review articles. Eligibility was independently assessed by two reviewers, with discrepancies resolved by a third observer. A total of 22 original studies were included in the final qualitative synthesis. AI applications were categorized into three domains: (1) pre-treatment tumor characterization and segmentation, (2) radiosurgical treatment planning, and (3) post-treatment response prediction. Multiple studies demonstrated the efficacy of convolutional neural networks (CNNs) and federated learning for automated and accurate segmentation of VSs, often achieving performance metrics comparable to expert manual annotations. In treatment planning, AI-driven models enabled improved target delineation, dosimetric optimization, and reduced inter-planner variability. In the post-treatment phase, radiomic-based AI models accurately predicted pseudoprogression and long-term tumor response, while automated volumetric assessment tools reliably tracked tumor changes over time. Collectively, these AI applications showed potential to streamline clinical workflows, enhance precision, and support individualized decision-making. AI has shown significant promise in enhancing various aspects of stereotactic radiosurgical care for VSs, from diagnosis and planning to longitudinal monitoring. While current findings are encouraging, challenges such as data standardization, model generalizability, and integration into clinical practice remain. Further prospective multicenter studies and regulatory oversight are warranted to validate AI tools and facilitate their widespread clinical adoption. With continued refinement, AI is likely to augment the capabilities of radiosurgeons and improve outcomes for patients with VS.

Usually, complete burst fractures of the thoracolumbar spine responsible for neurological deficit are managed with posterior open long-segment fixation, laminectomy, and second-stage anterior corpectomy. Although SpineJack expansion kyphoplasty allows for one-stage posterior-only restoration of the anterior and middle columns of the spine, to date, it has not been employed for complete burst fracture with neurological deficit. Review of all cases of AO Spine A4 thoracolumbar complete burst fractures with neurological deficit treated by a single senior spine surgeon at Sainte-Anne Military Teaching Hospital using the same surgical procedure-SpineJack expansion kyphoplasty, posterior pedicle screw fixation, and posterior decompression-between November 2023 and October 2025. There were five patients with a mean age of 42.6&#x2009;&#xb1;&#x2009;16.8 years. Levels involved were T12, L1, L2, and L3 (patients 1-4), and combined L2L3 in a last severe trauma case (patient 5). Neurological deficit was classified as American Spinal Injury Association (ASIA) C in four cases, and ASIA B in patient 5. Mean preoperative loss of vertebral body height was 54&#x2009;&#xb1;&#x2009;10.3% and regional kyphosis 22.8&#x2009;&#xb1;&#x2009;4.4&#x2009;degrees. Mean postoperative length of stay was 16.2&#x2009;&#xb1;&#x2009;24.6 days, and 5.3&#x2009;&#xb1;&#x2009;2.5 days excluding patient 5. Patients 1 to 4 returned to work after a mean delay of 3.3&#x2009;&#xb1;&#x2009;0.5 months. At the 1-year follow-up, the mean visual analog scale score was 2.8&#x2009;&#xb1;&#x2009;0.5, the mean Oswestry Disability Index was 7.6&#x2009;&#xb1;&#x2009;5.2, the mean segmental kyphosis was 4.2&#x2009;&#xb1;&#x2009;6.9&#x2009;degrees, and the mean loss of vertebral body height was 11.2&#x2009;&#xb1;&#x2009;8.9%. SpineJack expansion kyphoplasty combined with short-segment monoaxial pedicle screw fixation and laminectomy is a possible one-stage surgical treatment option for complete burst fracture of the thoracolumbar spine with neurological deficit.

Intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. Intraventricular extension (IVE) and hydrocephalus (HCP) frequently prompt external ventricular drain (EVD) insertion, but objective criteria to guide EVD use are lacking. This article aims to identify clinical and radiological predictors of EVD insertion in spontaneous ICH and to develop a simple bedside scoring system (EVD-ICH score) to support decision-making. This is a prospective observational study of 100 consecutive adults with spontaneous nontraumatic ICH admitted to a tertiary-care center (March 2023 to February 2024). Clinical and CT variables were recorded. Multivariable logistic regression identified independent predictors of EVD insertion. A points-based score was created from adjusted odds ratios and internally validated using receiver operating characteristic (ROC) analysis. Of 100 patients, predictors independently associated with EVD insertion were IVE, HCP, Glasgow coma scale (GCS) &#x2264; 8, hematoma volume &#x2265;30&#x2009;mL, and history of hypertension (HTN). The 7-point EVD-ICH score (IVE 2 pts, HCP 2 pts, GCS &#x2264;8 1 pt, ICH &#x2265;30&#x2009;mL 1 pt, HTN 1 pt) achieved an area under the ROC curve (AUC) of 0.85 (95% CI: 0.78-0.92). Optimal cut-off &#x2265;3 yielded a sensitivity of 80% and a specificity of 77%. Predicted EVD probability ranged from 8% (score 0) to 92% (score 7). The EVD-ICH score provides a concise bedside tool to stratify risk of requiring EVD in spontaneous ICH. External multicenter validation and assessment of impact on patient-centered outcomes are recommended before routine adoption.

Early-onset colorectal cancer (EO-CRC) is increasing globally with substantial regional variation. We assessed epidemiological changes in EO-CRC in five East Asian populations. Using GBD 2023 data, we calculated age-standardized incidence, prevalence, mortality, and DALY rates (ASIR, ASPR, ASMR, ASDR), counts, and average annual percent changes (AAPC). Decomposition, age-period-cohort (APC), and forecast analyses assessed trends and risk factor contributions to mortality. In 2023, these populations accounted for 25%-31% of global EO-CRC cases. China had the highest absolute burden, and Taiwan (Province of China) had the highest ASR. From 1990 to 2023, North Korea had the highest ASIR increase (AAPC&#x2009;=&#x2009;1.34%), while South Korea's ASMR declined most (AAPC&#x2009;=&#x2009;-2.58%). Males had a higher burden than females. Decomposition analysis showed epidemiological changes increased incidence outside China but generally reduced mortality except in North Korea, with effects stronger for deaths than incidence. APC analysis revealed accelerated risk with age; period effects varied: North Korea showed the largest relative risk increase (RR 0.93&#x2009;&#x2192;&#x2009;1.32), and China showed a post-2014 rebound. Projections to 2038 suggest continued rises in incidence and DALYs. Risk analysis identified low calcium intake as the main mortality driver in North Korea, and low milk, low whole grains, and high red meat intake in the other populations; high BMI and processed meat-related deaths also increased markedly. EO-CRC incidence is rising in East Asia, with China highest in absolute numbers and Taiwan in ASR; men are disproportionately affected. Burden and risk analyses reveal population-specific effects. Interventions should target diet, screening, and sex- and population-specific risk factors.

Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259&#x2009;000 (95% uncertainty interval 202&#x2009;000-335&#x2009;000) global deaths and 2&#xb7;54 million (2&#xb7;20-2&#xb7;93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86&#x2009;600 [53&#x2009;300-149&#x2009;000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98&#x2009;700 deaths (77&#x2009;000-127&#x2009;000) and 594&#x2009;000 cases (514&#x2009;000-686&#x2009;000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.

Microsurgical clipping remains a vital treatment for ruptured cerebral aneurysms, particularly in regional hospitals where emergent endovascular access may be limited. Timely surgery by experienced neurosurgeons can yield favorable outcomes even outside academic centers. The aim of the study is to evaluate clinical outcomes of microsurgical clipping for ruptured cerebral aneurysms performed by a single neurosurgeon in a regional hospital over a seven-year period, with subgroup analysis by WFNS grade. A retrospective cohort study was conducted on 189 patients with radiologically confirmed ruptured cerebral aneurysms who underwent microsurgical clipping at our center between July 2018 and June 2025. Data on demographics, aneurysm characteristics, clinical grade, surgical timing, and outcomes were analyzed. Subgroup analyses included WFNS grade (good-grade I-III vs. poor-grade IV-V), timing of surgery, and operative phase. Favorable outcome was defined as a modified Rankin Scale (mRS) score of 0 to 2 at 6 months. Good-grade WFNS patients comprised 59.3% of the cohort and achieved excellent outcomes, with 85.1% attaining mRS 0 to 2 at 6 months. Ultra-early surgery (<24&#x2009;hours) was performed in 58.2% of cases. Overall mortality was 6.3%. At 6 months, 74.6% of all patients had favorable outcomes. Poor initial WFNS grade (OR 0.33, p &#x2009;=&#x2009;0.011) and vasospasm (OR 0.15, p &#x2009;<&#x2009;0.001) were independently associated with unfavorable outcomes. Microsurgical clipping remains a safe and durable option for ruptured cerebral aneurysms in regional practice. With consistent surgical experience and timely intervention, outcomes comparable to those of academic centers can be achieved.

Failed back surgery syndrome (FBSS) is a well-documented yet underinvestigated phenomenon, with prevalence estimates ranging from 10 to 40% among all spine surgeries. FBSS contributes significantly to chronic pain and disability, leading to socioeconomic burdens. Studies have emphasized the multifactorial etiology of FBSS, including inadequate decompression, misdiagnosis, iatrogenic injury, and psychosocial contributors. However, there is a scarcity of large-scale, real-world clinical datasets offering multidimensional analysis of FBSS. This retrospective study analyses 95 spinal surgeries performed between 2016 and 2024, with a focus on FBSS, defined as persistent or recurrent pain post-spinal surgery. Data include patient demographics, surgical techniques, recurrence rates, and complications. The mean patient age was 56.2 years, with a female-to-male ratio of &#x223c;1.2:1. The leading primary diagnosis was prolapsed intervertebral disc (60%), followed by lumbar canal stenosis (20%), traumatic pathology (10%), and tuberculosis-related or deformity cases (5%). The most frequent surgical procedures included posterior spinal fusion (30%), laminectomy (25%), and discectomy (20%). Approximately 40% of patients experienced full symptomatic relief, 30% reported partial relief, and 30% had unresolved or worsened symptoms. Complication rates included hardware failure (10%), dural tears/cauda equina syndrome (5%), infections (10%), and implant misplacements (8%). Revision surgery was required in 35% of patients, most commonly due to adjacent segment disease or implant-related failures, with an average interval of 2.3 years between primary and revision procedures. The study underscores the need for preoperative risk stratification, intraoperative precision, and multidisciplinary rehabilitation to mitigate FBSS.

Computational fluid dynamics (CFD) is being evaluated as a potential tool in diagnosing aneurysm hemodynamics. We have undertaken this study to evaluate the use of CFD as a tool to predict the atherosclerotic changes in unruptured middle cerebral artery (MCA) bifurcation aneurysm. In our study, we have compared the CFD images with intraoperative microscopic images of the MCA aneurysm. The purpose of our study was to find correlation between the CFD findings for the atherosclerotic changes in MCA bifurcation aneurysms. In aneurysms with atherosclerotic changes, there is risk of shower of emboli during the manipulation or placing of the clip because it can break the unstable local plaque resulting in distal arterial occlusion. To find the correlation between CFD studies and the atherosclerotic changes occurring in the MCA bifurcation aneurysm. A retrospective review of all intraoperative video recordings of patients with unruptured MCA bifurcation aneurysm from September 2014 to May 2017 at our hospital, Banbuntane Hotokukai Hospital, Fujita University, Nagoya, Aichi, Japan, was done. This is a single-center based study. Videos having atherosclerotic changes were selected. MCA bifurcation aneurysms with atherosclerotic changes were analyzed with CFD. We studied wall pressure, magnitude, and vectors of wall shear stress and streamline (flow pattern). The CFD findings were correlated with intraoperative findings. All the patients who were selected for this study had undergone open surgery. We found that there was decreased wall pressure in the areas of atherosclerotic changes. Low shear stress magnitude was seen in the atherosclerotic segment and there was divergent pattern of the shear stress vectors predicting the thick-walled segment with decreased flow velocity. Here, we have discussed four cases showing moderately decreased wall pressure in atherosclerotic segment and decreased wall shear stress magnitude in all these cases. Limitations of the study : This is a very small cohort study to establish any statistically significant correlation between the CFD findings and to predict atherosclerosis in MCA aneurysm. Hence, there is need of large multicentric cohort studies to establish the correlation and the statistical significance of the CFD findings in atherosclerosis.

This study aims to evaluate the global burden of adverse effects of medical treatment (AEMT) using data from the Global Burden of Disease Study (GBD) 2021. Data were extracted from the GBD 2021, covering 204 countries/territories from 1990 to 2021. AEMT was defined using ICD-9 and ICD-10 codes, encompassing complications from medical procedures, treatments, or healthcare exposures. Estimates were categorized into fatal and non-fatal outcomes and stratified by age, sex, year, and covariates, including the Socio-demographic Index (SDI). Mortality-incidence ratios (MIRs), defined as the ratio of mortality calculated by dividing the number of deaths by the total incident cases, were analyzed. In 2021, the global age-standardized prevalence, incidence, disability-adjusted life years (DALYs), and mortality rates of AEMT were 11.48 (95% uncertainty interval [UI], 8.86-14.13), 150.44 (131.19-171.81), 64.19 (51.06-73.11), and 1.53 (1.29-1.68) per 100,000 population, respectively. DALY rates were highest in the early neonatal group (4,789.47 per 100,000 population [95% UI, 3,682.00-5,963.30]), while mortality rates followed a U-shaped pattern across age groups. In 2021, MIRs were highest at both ends of the age range: the early neonatal group (0.58 [95% UI, 0.55-0.58]) and the 95+ age group (0.05 [0.04-0.06]). This pattern was consistent across all SDI quintiles, with higher MIRs observed in lower SDI quintiles. The significantly higher prevalence and incidence rates of AEMT among the older population in high SDI quintiles, compared to lower SDI quintiles, could be attributed to the healthcare overutilization, highlighting the need for policy adjustments.

Meningiomas are one of the most common primary tumors of the central nervous system, and surgical excision is the gold standard treatment for symptomatic patients. But there is no common algorithm for treatment in asymptomatic patients. Many studies have investigated the natural course of incidental meningiomas. Spontaneous regression refers to the shrinkage of a tumor without any intervention or treatment. Current data on spontaneous regression of meningiomas consists only of case reports. In this article, we present the case of a patient with an incidental meningioma that spontaneously regressed during follow-up and include a review of the literature.