Since its US Food and Drug Administration approval in 2016, magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy has grown into one of the procedures of choice among patients with essential tremor (ET). Approved applications for the procedure have expanded over time from unilateral thalamotomy to treat ET and Parkinson disease tremor to bilateral staged thalamotomy for ET. As the procedure expands to healthcare environments beyond large academic centers, guidance is required to ensure that the responsible clinicians are appropriately trained to undertake this operative procedure. Although multidisciplinary movement disorder teams are important for the optimal management of patients, MRgFUS lesions are inherently surgical interventions. Neurosurgeons are trained to evaluate these patients, consider surgical alternatives and conduct these operations, particularly after completing a fellowship in the subspecialty of stereotactic and functional neurosurgery. At present, all high-level evidence regarding the safety and efficacy of MRgFUS lesions to treat movement disorders derives from procedures performed by neurosurgeons, so those results may not be generalizable to other physicians. Based on these considerations and potential liability issues, the American Society for Stereotactic and Functional Neurosurgery, which acts as the joint section representing the field of stereotactic and functional neurosurgery on behalf of the Congress of Neurological Surgeons and the American Association of Neurological Surgeons, puts forth this position statement that only neurosurgeons appropriately trained to conduct functional neurosurgery procedures should conduct MRgFUS surgical lesions.
Introduction Psychiatric comorbidity, particularly anxiety and depression, is associated with worse surgical outcomes across multiple specialties. In Ibero-America, no systematic evidence is available regarding the attitudes and practices of neurosurgeons toward this comorbidity. The present study characterizes such attitudes and self-reported practices and explores their associations with demographic, training-related, and institutional variables. Methods We conducted an observational, cross-sectional, multicenter study based on an ad hoc digital questionnaire deployed on LimeSurvey, with parallel Spanish and Portuguese versions, distributed through national neurosurgical societies and digital professional networks between November 2025 and April 2026. The instrument, with content validated qualitatively by a five-expert panel, comprised 37 items organized into four domains: sociodemographic characteristics, attitudes toward mental health, clinical practices and care integration, and professional training and adoption of technological tools. Statistical analysis was performed in Python and included chi-square goodness-of-fit and independence tests, Fisher's exact test, Spearman's correlation, and 95% confidence intervals computed using the Wilson method. Results Sixty-three complete responses were obtained from 12 countries (74.6% male; mean age 46.9 ± 9.8 years; median 13 years of practice in the specialty). Of the respondents, 95.2% acknowledged worse surgical outcomes in patients with untreated psychiatric comorbidity, and 90.5% endorsed a level of care equivalent to that afforded to somatic disease; nevertheless, behavior in an equivalent clinical scenario differed significantly (p = 0.002), and the required preoperative psychiatric stabilization time was the only questionnaire item whose distribution did not differ from uniform (p = 0.149). Specific training during residency was absent in 58.7% of participants, and 96.8% were receptive to further education. Institutional availability of neuropsychology units showed a significant regional gradient (χ²₍₄₎ = 15.79; p = 0.003), with the Southern Cone at 8% versus 50-67% in other regions. Acceptance of artificial intelligence and telemedicine tools was high (74.6% and 71.4%, respectively) and was inversely associated with respondent age (ρ = -0.28; p = 0.040 and ρ = -0.30; p = 0.020). Conclusions A gap exists between the recognition of the prognostic impact of mental health and the heterogeneity of clinical practice in Ibero-American neurosurgery. This gap is not explained by isolated individual variables but rather by modifiable structural factors. Incorporating dedicated training into residency programs, adopting brief preoperative screening protocols, integrating neuropsychology teams within neurosurgical services, and leveraging digital tools constitute concrete lines of action. Multicenter longitudinal studies with formal instrument validation will allow these findings to be confirmed and extended.
HER2-positive (HER2+) breast cancer (BC) is associated with a high incidence of brain metastases (BMs), which negatively affect prognosis and quality of life. Local therapies, such as whole-brain radiotherapy (WBRT), stereotactic radiotherapy, stereotactic radiosurgery, and neurosurgery, allow temporary control of metastatic spread. Systemic treatments are limited by the blood-brain barrier (BBB), which restricts the passage of many therapeutic molecules. Research initially focused on small molecule tyrosine kinase inhibitors due to their low molecular weight. Recent evidence suggests that tumor-induced disruption of the BBB may increase its permeability, potentially allowing larger molecules, including antibody-drug conjugates, to cross. Although trastuzumab deruxtecan (T-DXd) has demonstrated intracranial activity, evidence of durable complete responses in heavily pretreated patients with active BMs remains limited. We report a case of a HER2+ BC patient with multiple (>20) active BMs, previously treated with WBRT and trastuzumab emtansine (T-DM1), who developed intracranial progression. Third-line treatment with T-DXd resulted in a complete radiological intracranial response, which has been maintained for more than 20 months under ongoing therapy, with associated improvement in neurological symptoms and quality of life. This case provides preliminary evidence that T-DXd may achieve deep and durable intracranial responses even in heavily pretreated patients with active BMs, including those previously treated with WBRT and T-DM1. The exceptional duration of response observed in this case appears to exceed historical expectations and warrants further investigation in this high-risk population.
Severe acute brain injury (stroke, traumatic brain injury or hypoxic-ischemic encephalopathy; SABI) is increasingly recognized as a chronic condition with care and communication needs beyond the initial hospitalization. This study aimed to characterize post-acute care patterns among SABI survivors, focusing on healthcare utilization and outpatient communication. Data were collected from a prospective cohort of hospitalized SABI patients using surveys, chart reviews, and the ED Information Exchange database. Socioeconomic disadvantage was assessed using the Area Deprivation Index (ADI), and qualitative analysis of outpatient notes examined conversations around palliative care needs and goals-of-care. Two-thirds of patients (140/222) survived until discharge, primarily to nursing facilities (39%) or inpatient rehabilitation (38%). Among 109 with one-year follow-up, there were 89 hospitalizations, 104 ED visits, and 28 deaths. Patients from the most disadvantaged neighborhoods had significantly higher odds of rehospitalization or ED use within 30 days (OR 3.37, p=0.036). ADI was not linked to one-year utilization. Two-thirds of survivors (68%) were seen outpatient by primary care (40%), neurology/neurosurgery (57%), and palliative care (1%), but conversations rarely revisited prognosis or goals-of-care. Our findings highlight the need for improved long-term care planning and communication, particularly for socioeconomically disadvantaged survivors of SABI.
Cerebrospinal fluid (CSF) flow disturbance is not clear in craniosynostosis (CS). As far as we know, there are no reports that have evaluated changes in CSF flow disturbance after distraction osteogenesis. The aim of our pilot study was to examine CSF, grey matter (GM) and white matter (WM) volume ratios in CS patients before and after surgery using voxel based morphometry (VBM) in statistical parametric mapping (SPM) 12 software. We performed a retrospective cohort study of CS patients with distraction osteogenesis. We compared CSF, GM, and WM volume ratios between preoperative and postoperative cases. Data was analyzed using VBM in SPM 12 software. A 3 Tesla MRI machine provided 3DSPGR (spoiled gradient-recalled) sequence for all cases. Between April 2017 and June 2023, we assessed 14 consecutive cases. The ratio of GM and WM volume and CSF volume in preoperative cases was significantly higher in postoperative cases (19.8% vs 15.1%, p = 0.022, respectively). In our pilot study CS patients had CSF flow disturbance that was alleviated by cranial distraction osteogenesis.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used as an adjunct in haemorrhagic shock (HS) to restore proximal perfusion. Its cerebral metabolic effects during haemorrhagic shock, particularly in the presence of elevated intracranial pressure (ICP), remain incompletely characterised. In a controlled porcine model, HS was induced by controlled bleeding to a mean arterial pressure of approximately 40 mmHg. Animals were allocated to a normal ICP group or an experimentally elevated ICP group. Total REBOA (zone 1) was applied for 90 min. Cerebral metabolism was assessed using intracerebral microdialysis with measurements of lactate, pyruvate, and lactate-pyruvate ratio (LPR). Cerebral haemodynamics and ICP were continuously monitored. HS was associated with a statistically significant increase in LPR in both groups, indicating cerebral metabolic disturbance. Following aortic occlusion, LPR gradually decreased toward baseline in both groups. Animals with elevated ICP demonstrated a transient delay in metabolic normalisation during the early post-occlusion phase. Statistically significant differences between groups were limited to the first 10 min following occlusion. Overall metabolic trajectories were similar thereafter. Total REBOA restored cerebral metabolic markers of ischaemia during haemorrhagic shock, as reflected by normalisation of LPR, even in the presence of experimentally elevated ICP. These findings indicate acute metabolic recovery and so suggest that the use of tREBOA in the setting of elevated ICP is not contra indicated and can be a bridge to further treatment. Our findings do not demonstrate absence of tissue injury, or long-term neurological recovery. Further studies incorporating complementary physiological and structural outcome measures would be recommended.
Stem cell-based therapy holds great promise for treating Parkinson's disease (PD), yet its clinical translation depends on safely and efficiently generating midbrain dopaminergic cells (mDACs) in vitro. One major challenge in current protocols is the safety risks associated with extracellular matrix (ECM) components. Commonly used materials such as laminin may contain undefined animal-derived components, while their human recombinant alternatives face technical and economic limitations, highlighting an urgent need for safe and effective materials for scalable clinical-grade cell manufacturing. Sialic acid is recognized as a crucial nutrient during neural development and a key structural component of brain sialylglycopeptide and gangliosides, but its use to optimize in vitro neuronal differentiation protocols has not been assessed. In this study, starting from the observation that sialyllactose supports mDAC differentiation, we identified a series of sialyl-glycopeptides as candidate matrix materials and comparatively evaluated their supramolecular morphology, nanomechanical flexibility, and matrix-supporting performance. Among these candidates, SL-4F, replacing laminin, combined with poly-l-ornithine and fibronectin, promotes robust mDAC growth and differentiation. The efficacy and safety of this formulation are confirmed in vitro and in vivo, suggesting SL-4F as a synthetic and safer alternative for clinical-grade cell culture for PD and, potentially, other stem cell-based therapies.
Schlafen11 (SLFN11) has emerged as a powerful biomarker of sensitivity to DNA-damaging agents in various cancers. However, not much is known about its role in brain tumors. Conflicting reports show that it is a biomarker for response to cisplatin and a prognostic factor in some brain tumors, such as medulloblastomas, but can even be a negative prognostic factor in others, like glioblastomas. In this review, we discuss what is known about the various roles of SLFN11 in cancer, with special attention to brain tumors. Specifically, we focus on the seemingly dual role of SLFN11 in brain tumors; positive prognostic in some and negative in others. Additionally, we describe some glioma cases with high SLFN11 expression, often showing aggressive presentation, a good response to initial treatment, and subsequent widespread relapse. In brain tumors such as medulloblastomas and primary central nervous system lymphomas (PCNSL), when total cell killing can be expected by chemotherapy and/or chemoradiotherapy, high SLFN11 expression is a positive prognostic marker. However, SLFN11 can also be highly expressed in mesenchymal tumors, and in cases where total cell killing cannot be achieved, widespread relapse can accompany an initial response.
Acute liver injury (ALI) is a rapidly progressive inflammatory disease lacking precise noninvasive early diagnostic tools, as traditional enzyme-based tests frequently yield false-positive results. Polarity is a crucial physiological indicator, and its abnormal fluctuations are deeply involved in ALI pathogenesis, necessitating accurate in vivo monitoring. We rationally designed BDP-JL, a new near-infrared ratiometric fluorescent probe featuring a D-π-A architecture for highly sensitive polarity detection. It possesses excellent vesicle-targeting capabilities, enabling precise tracking of polarity dynamics within lipid droplets during ALI progression. With exceptional photostability, low cytotoxicity, and ratiometric signal output that effectively eliminates background interference, BDP-JL achieves accurate real-time imaging of polarity variations in live cells, zebrafish, and mice. Furthermore, we successfully utilized it as an optical platform to screen anti-inflammatory natural products. This work provides a robust noninvasive tool for dynamic polarity monitoring, early ALI diagnosis, and high-throughput drug discovery.
Surgical resection is a mainstay of treatment for pediatric patients with low-grade gliomas (LGG). However, LGG arising in eloquent cortex or in deep-seated regions represent a surgical challenge. Laser interstitial thermal therapy (LITT) has shown efficacy for treating lesions in anatomically or functionally challenging locations. In this study, we describe our experience with using LITT to treat pediatric patients with LGG. We performed a single-institution retrospective chart review to identify all patients under age 25 who underwent LITT for the treatment of LGG. Patient demographics, lesion and treatment characteristics, and postoperative clinical and radiographic outcomes were collected. Thirteen pediatric patients with LGG who were treated with LITT (mean volume 2.4 ± 3.7 cc). Lesions were subcortical in the frontal (n = 7; 54%) or parietal (n = 2; 15%) lobes, cerebellar (n = 3; 23%), or thalamic (n = 1; 8%). No technical challenges were noted. In two patients (15%) with large lesions (> 5 cc), two-trajectory LITT was used. A biopsy was performed prior to LITT using the same trajectory in twelve patients (92%). At last follow-up (mean 28mo), 12 patients (92%) experienced no disease progression. One patient experienced progression of disease 3 months after LITT. Two patients (15%) experienced transient neurological deficits, which resolved within 1 month with steroid medication. There were no mortalities or postoperative hemorrhages. Pediatric patients with LGG can be safely and effectively treated with LITT. This approach is particularly promising for treating small, deep-seated lesions that are often seen in pediatric patients and can be integrated into the surgical workflow for patients where a lesion biopsy is warranted.
A 5-year-old girl from an endemic area presented with progressive hemiparesis. Imaging revealed a large right frontoparietal cyst. Preoperative antiparasitic treatment was administered before a PAIR-D Craniotomy, resulting in the successful removal of the cyst intact. Histopathology confirmed E. granulosus. The patient achieved complete motor recovery and continued with albendazole.
The sphenoid sinus (SS) exhibits significant anatomical variability that critically impacts the safety and efficacy of endoscopic transsphenoidal surgery. This systematic review and meta-analysis aims to establish global prevalence rates for SS pneumatization patterns, extensions, and the relationship with adjacent neurovascular structures to guide surgical planning. A systematic literature search was conducted across PubMed, Google Scholar, Scopus, and Web of Science until October 2025. Studies reporting SS pneumatization types, extensions, and neurovascular protrusions/dehiscences based on imaging or cadaveric dissection were included. Random-effect models were used for the meta-analysis. The sellar type was the predominant pneumatization pattern, with the complete sellar type accounting for 48.39%. Statistically significant results were identified based on nationality and study type. Extensions into the greater wing (34.17%) and pterygoid process (25.51%) were common. The Vidian nerve (VN) showed the highest rates of protrusion (32.61%) and dehiscence (14.60%), followed by the internal carotid artery (ICA) (protrusion: 29.77%; dehiscence: 9.47%) and optic nerve (ON) (protrusion: 23.46%; dehiscence: 10.92%). The imaging modality used did not affect the neurovascular structure variations. The SS is a highly variable structure with frequent extensions that expose vital neurovascular structures to surgical risk. Although the subgroup analyses did not depict statistically significant results, computed tomography scan with less than 1 mm slice thickness should be used for evaluation of SS anatomy. The high prevalence of VN and ICA dehiscence necessitates rigorous preoperative evaluation. These findings provide a crucial anatomical reference for optimizing surgical approaches and minimizing complications in skull base surgery.
To evaluate the efficacy and safety of single-fraction LINAC-based radiosurgery (RS) for patients with drug-resistant trigeminal neuralgia (TN). We retrospectively reviewed 46 patients treated for TN between August 2008 and December 2024, 42 were evaluable. RS was delivered with a linear accelerator equipped with a micro-multileaf collimator. Diagnostic cisternography sequence MRI was co-registered with the CT plan to delineate the target volume and develop the treatment plan. The CTV was contoured on the retro-Gasserian ganglion. The dose was prescribed to the isocentre for all patients. The prognostic impact of parameters such as sex, side of TN, previous surgery, radiotherapy dose, clinical response probability, and response onset time was assessed. Statistical analysis was performed using the MedCalc software package and the Kaplan-Meier product limit method. Acute and late toxicities were graded according to the CTCAE v5.0 scale. Patient characteristics For the 46 treated patients were as follows: 29 out of 46 females (63%) and 17 out of 46 males (37%), with a median age of 63 years (range, 32-88), and Karnofsky Performance Status (KPS) was 90 (range, 80-100). The median planning target volume (PTV) was < 0.1 cc. Dosimetric characteristics Median prescribed dose was 70 Gy (range, 40-75 Gy). Four patients were lost during follow-up, so overall 42 of the 46 patients were evaluable for RS response analysis. Clinical Outcomes After a very long median follow-up of 8.5 years (range, 0.6-13.5 years), the clinical response probability was 92% ± 4% at 1 year, 71% ± 7% at 2 years, and 53% ± 9% at 5 years. The median time to response onset was 3 months (range, 1-16 months), and the median clinical response probability was 62 months (range, 37-158 months). In the univariate analysis, there was a statistically significant difference in clinical response probability favouring the higher dose ≥ 70 Gy (p = 0.0036) with HR (CI 95%) of 3.5 (1.4-8.5). However, achieving an initial complete response did not significantly affect the duration of the response. Toxicity No acute toxicity was recorded. Chronic toxicity was rare, with two patients (4%) developing G2 hearing loss and one (2%) experiencing G1 tearing and paresthesia. LINAC-based RS is a safe and effective non-invasive option for the treatment of medically refractory TN, particularly for patients without a neurovascular conflict but with significant comorbidities or contraindications to surgery. To obtain maximal and durable results, the prescribed dose must be at least 70 Gy and it is necessary to adhere to stringent dose constraints to maintain a low toxicity rate.
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The most common cell type in the central nervous system (CNS), astrocytes, is also the cell type most commonly associated with the brain cancer called astrocytoma. Advances in genetic/molecular techniques led to the 2021 CNS tumor reclassifications. In this review, we will simplify the somewhat complex 2021 neuropathological diagnostic algorithm and transition into a discussion on uncommon treatment options and the biochemical basis for their applications. Herein, the authors review the most common new CNS tumor classifications based on histological and genetic alterations. Treatment and prognosis of these tumors change as the diagnostic capabilities improve. The literature utilized to complete this manuscript was collected through www.pubmed.gov, from the years 1924-2026. The search focused on astrocytomas, neuropathology criteria, molecular/genetics of, and treatment options. Neuropathology is crucial for providing guidance to the neurosurgeons operating, oncologists and radiation oncologists treating, and most importantly the patients and families that go through these treatments. Neuropathology ultimately provides the most important first step in determining the treatment flow chart, thus the proper identification/diagnosis with a detailed genetic profile of the tumor enhances insight on the treatment and prognostic expectations. Our ability to better understand the genetic/molecular alterations occurring in CNS tumors leads us to better treatments and hopefully eventual cures.
Management of spinal cord injury includes surgical decompression and pharmacologic elevation of mean arterial pressure (MAP) to augment cord perfusion. However, the relationship between MAP augmentation and spinal cord blood flow remains poorly characterized, and it is unclear whether different adrenergic agents produce differential effects on cord perfusion. Thus, our objective was to directly characterize dynamic spinal cord blood flow responses to controlled MAP perturbations and compare the effects of common vasopressors. We developed a Doppler ultrasonography platform to measure dynamic blood flow signals in the sulcal arteries of uninjured porcine spinal cord. Eight female Yorkshire pigs underwent controlled hypotensive challenges using hemorrhage and hypertensive challenges with 4 adrenergic agonists: phenylephrine (α-agonist), dobutamine (β-agonist), norepinephrine (mixed α/β), and epinephrine (mixed α/β). Mean flow velocity (MFV) and mean power Doppler (MPD) were extracted from spectral Doppler recordings and analyzed in relation to step changes in MAP. During hypotensive challenges, reductions in MAP were accompanied by decreases in MFV and MPD, with minimal recovery toward baseline. During pharmacologic MAP augmentation, all agents produced increases in MAP, MFV, and MPD. However, dobutamine produced a greater change in blood flow measures when compared with norepinephrine, phenylephrine, and epinephrine. These findings represent the first dynamic measurements of spinal cord blood flow signals in vivo and demonstrate that MAP elevation does not uniformly translate to increased cord perfusion. Pure β-adrenergic stimulation with dobutamine produced a favorable blood flow profile, whereas agents with α-agonist activity may limit effective perfusion through vasoconstriction. This work provides a mechanistic framework for optimizing vasopressor selection in spinal cord injury and lays groundwork for future studies of spinal cord autoregulation.
Geomagnetic activity (GMA), particularly during auroras, has emerged as an intriguing area of research due to its potential health impact. Prior studies indicate that fluctuations in geomagnetic fields can affect diverse physiological and psychological outcomes. The aim of this article is to comprehensively review the impact of GMA on neurological health with an emphasis on implications for patients potentially undergoing a neurosurgical procedure or neurologic/psychiatric assessment. A comprehensive literature review was therefore performed, examining peer-reviewed articles sourced from PubMed and Google Scholar. The focus was on evaluating potential correlations between geomagnetic disturbances (GMDs) and a range of health outcomes, particularly in relation to neurosurgical, neurological and neuropsychiatric contexts. Reported associations included: increased seizure frequency in patients with epilepsy, sleep disturbances affecting recovery, and cognitive impairments that may complicate patient consent processes. Additionally, heightened stress and anxiety levels during geomagnetic storms could pose challenges for patient management in surgical settings. This review underlines that such disturbances can potentially result in significant postoperative complications, particularly in the elderly, necessitating enhanced monitoring and tailored care strategies. Understanding the diverse effects of GMA on health is essential for optimizing patient outcomes, particularly in surgical procedures. This review highlights the need for further research to elucidate underlying GMA-triggered molecular mechanisms and establish evidence-based guidelines that consider geomagnetic conditions in neurological/neuropsychiatric evaluations, surgical planning and postoperative care, especially for vulnerable populations. An enhanced awareness among neurosurgeons, psychiatrist, neurologist and healthcare providers is essential to mitigate potential adverse effects of GMA on patient health and optimize recovery. Geomagnetic storms derive from temporary disturbances of the earth's magnetosphere that are driven by solar interactions and often are associated with visually spectacular exhibitions of colorful light in the Earth's atmosphere–termed the “Northern and Southern Lights” (auroras). These storms and their associated auroras are principally observed in high‐latitude regions (around the Arctic and Antarctic circles). However, recently they are being routinely witnessed across northern Europe, North America, and parts of the Southern Hemisphere, including New Zealand, South Africa and South America. Our review article evaluates the available scientific literature–with a focus on neurological perspectives, the need for further research to elucidate underlying mechanisms and to establish evidence‐based guidelines that consider geomagnetic conditions in neurological/neuropsychiatric evaluations, surgical planning and postoperative care, particularly for vulnerable populations like the elderly. Previous studies have indicated a link between geomagnetic activity and various health outcomes, including an increase in seizure activity and mood disorders. However, comprehensive literature evaluations addressing the impacts on neurological and neurosurgical patients are lacking. This review provides a critical examination of the implications of geomagnetic activity on neurological health and surgical outcomes, emphasizing the need for awareness among healthcare providers to optimize patient management.
Oral diseases and masticatory dysfunction are more prevalent in hypertensive patients and may hinder blood pressure (BP) control during pharmacological treatment. However, the effect of the oral function on cardiovascular outcomes in patients with poorly controlled hypertension remains unclear. A total of 5 484 middle-aged and older hypertensive patients receiving antihypertensive medications without prior cardiovascular diseases (CVD) (mean age: 67.5 ± 8.0 years) were followed to investigate incident CVD. Cox proportional hazards models were used to examine associations between the baseline oral status (number of remaining teeth and denture use) and the risk of developing CVD, stratified by BP control status. Poorly controlled BP was defined as systolic BP (SBP) ≥ 130 mmHg or diastolic BP ≥ 80 mmHg. Over a mean follow-up period of 9.9 ± 2.7 years, 567 individuals (10.3%) experienced CVD events. In the poorly controlled BP group, tooth loss and non-use of dentures were significantly associated with an increased risk of CVD; the hazard ratios (95% confidence intervals) were 1.79 (1.28-2.48) for 10-19 teeth, 1.37 (0.97-1.94) for 1-9 teeth with denture use, 1.56 (1.13-2.17) for no teeth with denture use, and 2.17 (1.30-3.64) for 0-9 teeth with non-use of dentures, compared with ≥20 teeth. This association differed significantly between the poorly controlled and well-controlled BP groups (P for interaction = 0.016). In conclusion, tooth loss and non-use of dentures are associated with a higher risk of CVD among adults with poorly controlled hypertension, suggesting that BP control status under treatment modifies this association.
This study aimed to systematically summarize and pool the available evidence on the risk of incident hypertension associated with calcitonin gene-related peptide (CGRP)-targeted therapies. CGRP-targeted therapies have emerged as effective preventive treatments for migraine; however, concerns have been raised regarding their potential hypertensive effects. Prior studies have been limited by small sample sizes, inconsistent definitions of hypertension, and incomplete trial inclusion. We systematically searched MEDLINE, Embase, and ClinicalTrials.gov up to September 25, 2024. We included randomized controlled trials comparing CGRP-targeted therapies with placebo or another intervention arm in adult patients with migraine. The primary outcome was incident hypertension as defined by each individual study. Two reviewers independently assessed risk of bias using the Cochrane Risk of Bias 2 tool and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Eight publications or trial reports, comprising 19 underlying randomized controlled trials, were included. The pooled relative risk (RR) for hypertension with CGRP-targeted therapies versus control was 0.91 (95% confidence interval [CI] 0.58-1.43; I² = 0.0%), indicating no statistically significant increased risk. The certainty of evidence for this outcome was rated as very low. Erenumab showed no significant increase in risk (RR 0.71, 95% CI 0.30-1.70), whereas galcanezumab also showed no statistically significant association (RR 1.14, 95% CI 0.54-2.39). CGRP-targeted therapies were not associated with a statistically significant increase in hypertension risk in patients with migraine, particularly among relatively healthy populations enrolled in short-term randomized controlled trials. However, the certainty of evidence was very low, and possible variation across agents warrants further study. Longer term comparative studies and real-world observational studies with standardized blood pressure monitoring are needed to confirm these findings and better define hypertension risk in higher risk patient subgroups. Migraine treatments that block calcitonin gene‐related peptide (substances that help transmit pain signals in the body) are widely used, but there are concerns that these drugs might increase blood pressure. We reviewed and combined results from randomized clinical trials to evaluate whether calcitonin gene‐related peptide‐targeted therapies increase the risk of developing high blood pressure in people with migraine. Overall, these treatments were not linked to a higher risk of developing high blood pressure in clinical trials, although longer studies and real‐world data are needed to better understand blood pressure effects in patients who are already at higher risk for heart disease.