We aimed to evaluate the feasibility of neuroendoscopic fenestration (NEF) for the treatment of septated chronic subdural hematoma (scSDH), in comparison with burr hole drainage (BHD) and craniotomy. A retrospective analysis of 115 scSDH surgeries conducted from 2021 to 2026 at a single institution revealed 71 BHD procedures (61.7%), 34 NEF procedures (29.6%), and 10 craniotomies (8.7%), with NEF performed as either a primary treatment for septations or as a salvage after BHD failure. Outcomes were assessed through volumetric analysis on follow-up computed tomography and recurrence leading to reoperation. Postoperative hematoma in the NEF group was significantly lower (40.59 ± 47.06 cm3) than that in the BHD (74.07 ± 58.32 cm3, P = .012). The percentage reduction in hematoma was greatest with NEF (-71.74% ± 28.57%) compared with BHD (-44.89% ± 39.66%) and craniotomy (-61.96% ± 46.00%) (P = .003). On univariable analysis, NEF was associated with a significantly lower risk of reoperation compared with BHD (odds ratio [OR], 0.261; 95% CI, 0.082-0.827; P = .022). Multivariable analysis confirmed that smaller postoperative volume (OR, 1.022; 95% CI, 1.011-1.033; P < .001) and greater percentage reduction (OR, 1.033; 95% CI, 1.017-1.050; P < .001) were independent predictors of reduced recurrence, irrespective of the surgical method. NEF demonstrated significantly lower postoperative volume and greater percentage reduction compared with BHD (P = .012 and P = .002, respectively). NEF showed better hematoma clearance and a lower recurrence rate than BHD, with a similar incision size. It is a viable primary option for scSDH and an appropriate alternative after unsuccessful BHD, without requiring a larger incision.

Chronic subdural hematomas (cSDHs) have risen in incidence to ≈17 to 19 cases per 100 000 persons per year over the recent decade, especially in the elderly population, with an estimated incidence of up to 355 cases per 100 000 per year in those ≥85 years. cSDHs are projected to be the most common neurosurgical condition by 2030. Recurrence rates with current treatment approaches, such as surgical evacuation with burr hole craniostomy or craniotomy, are high. These treatments often do not address the underlying inflammatory process, which is a key driver in cSDH development and progression. cSDHs develop when trauma to the inner dural border cell layer leads to an inflammatory response promoting neoangiogenesis, the ingrowth of new fragile vessels that are highly prone to leakage. Subsequent rebleeding, exudation, and incomplete resorption exacerbate the inflammatory response, leading to a self-perpetuating process. This review provides an overview of the inflammatory mechanisms involved in cSDHs, highlighting key biomarkers and cellular pathways, as well as associated translational clinical implications. Expanding upon existing therapies, reexamining these pathways presents opportunities to identify future potential therapeutic targets.

FAERS based pharmacovigilance study and network pharmacology analysis of Lutathera and Pluvicto.

Robot-assisted, monoplane C-arm angiography systems designed for hybrid operating rooms represent an alternative approach to neuroendovascular procedures. Conversely, non-computer-assisted monoplane systems or conventional biplane systems in angiography suites are widely established. This study aims to evaluate the effectiveness, safety and efficiency of a robotic C-arm angiography system in performing neuroendovascular interventions, including cerebrovascular digital subtraction angiography (DSA), embolization of the middle meningeal artery (MMA) in subdural hematoma, and mechanical thrombectomy for vessel occlusion. All patients undergoing DSA, MMA embolization, or mechanical thrombectomy between July 2020 and December 2024 were retrospectively included. Procedures were performed using a monoplane robotic C-arm system (ARTIS pheno, Siemens Healthineers, Munich, Germany) in a hybrid operating room. Clinical data, procedural details, and imaging outcomes were analyzed. Radiation exposure was assessed by fluoroscopy time, air kerma, and dose-area product (DAP). A total of 49 procedures were analyzed, including 28 DSAs, 6 MMA embolizations, and 15 mechanical thrombectomies. DSA and MMA embolization (EMMA grade ≥2) achieved 100% procedural success, while mechanical thrombectomies achieved successful reperfusion (mTICI ≥2b) in 93.3% of cases. Median procedure durations were 34.0 (IQR 18.0-45.0) minutes for DSA, 70.0 (IQR 28.0-126.0) minutes for MMA embolization, and 84.0 (IQR 67.0-106.0) minutes for mechanical thrombectomy. Median fluoroscopy times were 5.2 (IQR 2.9-11.5) minutes (DSA), 21.3 (IQR 8.8-36.5) minutes (MMA embolization), and 21.2 (IQR 18.5-42.9) minutes (mechanical thrombectomy). Median DAPs were 7262.5 (IQR 3867.8-11570.8) µGy·m² (DSA), 16135.5 (IQR 8244.2-18216.2) µGy·m² (MMA embolization), and 9875.2 (IQR 6524.3-18455.5) µGy·m² (mechanical thrombectomy). Additional 3D-angiography or cone-beam CT (CBCT) was associated with higher radiation exposure. Basic neuroendovascular procedures can be safely and efficiently performed using a monoplane robotic C-arm in a hybrid operating room, achieving procedural success and radiation exposure levels comparable to conventional biplane systems.

Fatal pediatric collapse with bilateral subdural hematoma and retinal hemorrhage occurring in a public park: a forensic case study.

Single-Center Experience with the Optiblock Coil: An Efficient and Thrombogenic Solution for Targeted Vessel Takedown.

Effect of dexmedetomidine (precedex) administration during awake craniotomy on postoperative inflammatory markers and stress hormones in patients with chronic subdural hemorrhage: A randomized controlled study.

Chronic subdural hematoma (CSDH) is a common neurosurgical condition among older adults. Although surgical success rates are high, many patients experience poor multidimensional functional recovery postoperatively, significantly affecting their quality of life and increasing care burden. The World Health Organization's "intrinsic capacity" framework offers a comprehensive perspective for assessing functional status; however, the dynamic changes in intrinsic capacity after CSDH surgery remain poorly understood. This study applied longitudinal network analysis to dynamically explore the causal interactions among 6 domains of intrinsic capacity-locomotion, cognition, psychology, vitality, vision, and hearing-in CSDH patients from presurgery to 3 months postsurgery. The aim was to identify core driving factors across different recovery phases and to provide a basis for developing time-sensitive nursing interventions. A longitudinal observational study. We assessed a cohort of 172 postsurgical chronic subdural hematoma (CSDH) patients at 4 time points: preoperative (T0), 1-week (T1), 1-month (T2), and 3-month (T3) postoperatively, using a standardized digital tool. For the intervals T0→T1, T1→T2, and T2→T3, we constructed directed, temporal cross-lagged panel networks (CLPNs) through LASSO-regularized regression. Core domains within the networks were identified by computing their out-expected and in-expected influence (out-EI/in-EI). Network stability was rigorously evaluated using bootstrap resampling. The intrinsic capacity network exhibited marked dynamic restructuring throughout the recovery period. In the initial T0→T1 phase, vision emerged as the principal network driver (highest out-EI), exerting a strong positive influence on hearing. Vitality positively predicted cognition while being negatively associated with locomotion. During the T1→T2 interval, hearing superseded vision as the main driver, and psychological status imposed a persistent negative effect on cognition. In the final T2→T3 stage, vitality and hearing served as co-drivers of network effects, while cognition and psychology became the primary receivers of network effects (highest in-EI). The stability was acceptable for the T0→T1 and T2→T3 networks (CS-coefficient >0.25). The post-CSDH recovery of intrinsic capacity was characterized by distinct, stage-specific causal pathways. Early interventions should strategically target sensory function and vitality. In the mid-to-late phase management, it's necessary to proactively address the adverse impact of psychological state on cognition and simultaneously harness vitality as a positive lever. These findings furnish a dynamic evidence base for the implementation of timely, precise, and personalized nursing rehabilitative interventions.

Cerebral, spinal, ophthalmological and skeletal findings associated with abusive and non-abusive head injury in children under 2years old: A systematic review.

Beyond "Time to Surgery": a structured evidence review and multi-clock framework for emergency cranial neurosurgery.

Middle meningeal artery embolization (MMAE) has shown efficacy for chronic subdural hematoma (cSDH), but optimal patient selection and timing (pre-, post-surgical, or standalone) remain unclear. This study evaluated the impact of volume, and embolization timing on outcomes at discharge and follow-up. The study included 135 patients undergoing MMAE; only those with complete radiological data were analyzed. To reduce baseline clinical bias, patients were stratified into quartiles (Q) based on preoperative hematoma volume. Changes in functional status were assessed by calculating the difference in modified Rankin Scale (mRS) score between admission and discharge (ΔmRSa➝d), as well as between admission and follow-up (ΔmRSa➝f). The entire cohort was divided into three groups based on the timing of MMAE: pre-surgical, post-surgical and standalone. At admission, mRS distribution differed across quartiles (p = 0.005), with better functional status more common in Q1 and higher mRS (≥ 3) increasing in larger volumes. At discharge, outcomes varied by embolization timing (p < 0.001). Stand-alone treatment was associated with greater clinical stability, especially in Q1, while improvement increased with hematoma volume in the pre-surgical group. The post-surgical group showed a milder pattern of severity compared to the pre-surgical group. The same trends were observed at follow-up. On multivariable analysis, admission mRS was the strongest predictor of poor outcome (mRS ≥ 3) (OR 6.209, p < 0.001), with age also significant (OR 1.078, p = 0.027). Preoperative hematoma volume was the only independent predictor of reoperation (OR 1.017, p = 0.017). Discharge outcome was mainly driven by admission mRS and age, while preoperative hematoma volume was associated with reoperation risk. In patients with lower hematoma burden (Q1-Q2), stand-alone MMAE showed greater early functional stability than pre- or post-surgical strategies.

Electric scooter (e-scooter)-related traumatic brain injuries (TBIs) have become increasingly common with the adoption of shared e-scooters. Previous studies have focused on severe injuries. We aimed to describe the characteristics and outcomes of e-scooter-related TBIs. This retrospective cohort study included all e-scooter-related TBIs presenting to all three adult emergency departments in Helsinki during 2021-2023. Data were obtained based on a keyword search from the hospital database. TBI cases were identified using the International Classification of Diseases 10th Revision diagnostic codes and manually verified. All brain imaging reports were reviewed, and imaging-positive scans were re-evaluated. A total of 184 patients with e-scooter-related TBIs were included. The mean age was 32 years, and 128 (70%) were male. The incidence of TBIs was 1.3 per 100 000 e-scooter trips, decreasing from 2.2 to 1.0 per 100 000 trips after implementation of usage restrictions. Most injuries occurred during night-time hours, with Saturdays and Sundays being the most common days. Alcohol intoxication was documented in 82% of patients, while helmet use was reported in 9%. Concussion was the most common diagnosis (84%). 29 patients (16%) had intracranial findings on brain imaging, most commonly cerebral contusions, traumatic subarachnoid haemorrhages, subdural haematomas and diffuse axonal injuries. Four patients required operative treatment, including three who underwent neurosurgical procedures. Alcohol intoxication is highly prevalent among patients with e-scooter-related TBIs and represents an important modifiable risk factor for these injuries. Stricter enforcement against riding under the influence of alcohol may help reduce e-scooter-related TBI incidence and severity.

Subarachnoid hemorrhage (SAH) after mechanical thrombectomy (MT) occurs in about 4.51-7.23% of cases. This study evaluates the impact of isolated SAH after MT on clinical outcomes. This was a retrospective analysis of patients who underwent mechanical thrombectomy for acute ischemic stroke between January 2017-December 2024 at a single center in the United States. Cases were patients with SAH on their post-operative imaging, while controls were patients who did not exhibit signs of hemorrhagic conversion on their imaging. Patients with contrast leakage, intraparenchymal hemorrhage or subdural hemorrhage were excluded. Propensity-score weighting was used to adjust for confounders. A total of 471 patients were included. 12.14% (n= 51) were cases and 89.16% (n= 420) were controls. After propensity score weighting, patients who developed SAH after MT did not have increased risk for higher NIHSS on discharge (log beta= 0.004 (95% CI:-0.334, 0.343), P= 0.98 or increased length of stay (log beta=-0.081 (-0.302, 0.14), P= 0.472). Rates of 30-day readmission (OR: 0.61, 95% CI: 0.14-2.68, P= 0.513) and 90-day functional dependence (OR: 0.69, 95% CI: 0.28-1.68, P= 0.412) did not differ among patients who developed SAH and those who did not. In our retrospective study, isolated SAH after MT was not associated with increased risk for higher NIHSS on discharge, increased LOS, 30 day readmission or 90 day functional dependence. Further prospective studies with larger sample sizes could aim to validate these findings.

Paroxysmal Sympathetic Hyperactivity (PSH) is a well-recognized complication following severe traumatic brain injury (TBI), with an incidence of 5-33% in the acute phase, characterized by episodic autonomic and motor hyperactivity. Management is often challenging, and a subset of patients develop refractory PSH despite optimized first- and second-line therapies. Cannabidiol (CBD) possesses neuroregulatory and autonomic-modulating properties demonstrated in preclinical TBI studies and epilepsy trials including Epidiolex studies, but its role in PSH has not been previously described. We report the case of a 44-year-old South Indian gentleman with severe TBI following a road traffic accident (GCS 5: E1V1M3) with CT brain showing bilateral frontotemporo-parietal acute subdural hematoma with mass effect. He underwent emergency bilateral decompressive craniectomy and required mechanical ventilation with tracheostomy. Three weeks post-injury, he developed recurrent PSH episodes (4-6 episodes per day) characterized by severe tachycardia (heart rate 140-180bpm), hypertension (systolic blood pressure > 180mmHg), hyperthermia (up to 40°C), diaphoresis, and dystonic posturing. The diagnosis of PSH was established using the Paroxysmal Sympathetic Hyperactivity Assessment Measure (PSH-AM), with a total score of 28 (Clinical Feature Scale: 18, Diagnosis Likelihood Tool: 10), indicating probable PSH. Infective, metabolic, epileptic, and structural causes were excluded. Despite treatment with multiple conventional agents at maximum tolerated doses-including bromocriptine (titrated from 1.25mg twice daily to 40mg/day), baclofen (10mg/day), gabapentin (titrated from 150mg/day to 300mg/day), propranolol (15mg three times daily), clonidine (0.2mg/day), dexmedetomidine infusion (72-h infusion), and fentanyl (infusion followed by patches)-the autonomic storms persisted, fulfilling criteria for refractory PSH. Cannabidiol oil (100mg/mL) was therefore initiated as adjunctive therapy at 100mg twice daily (approximately 3mg/kg/day) and titrated to a 100-150-100mg/day regimen over one week via nasogastric tube. Within the first week, there was a marked reduction in episode frequency (from 4 to 6 per day to less than 1 per 48h) and severity, with PSH-AM scores decreasing from 28 (CFS: 18, DLT: 10) to 16 (CFS: 6, DLT: 10), and opioid and sedative infusions were successfully withdrawn. By the second week, complete resolution of PSH episodes was achieved with a PSH-AM score of 4. No adverse effects were observed, including no hepatic dysfunction, excessive sedation, or hemodynamic instability. This case highlights a potential adjunctive role for cannabidiol in refractory PSH following severe TBI. While causality cannot be inferred from a single observation, the sustained clinical improvement after failure of conventional therapies warrants further prospective investigation.

Traumatic brain injury (TBI) in patients ≥ 80years poses major clinical challenges, with limited evidence to guide neurosurgical decision-making. We evaluated mortality, functional outcomes, and prognostic factors in patients undergoing neurosurgical versus conservative management. This cohort study included patients ≥ 80years with imaging-verified TBI treated at a tertiary trauma centre. Demographics, injury characteristics, treatment, mortality, and 6-month outcomes were collected. Favourable outcome was defined as Glasgow Outcome Scale 4 and 5. Multivariable logistic regression identified predictors of mortality and unfavourable outcome, and Cox regression assessed 30, 180, and 365days mortality. A total of 608 patients (median age 85.8years; 52% female) were included; 84 (14%) underwent neurosurgical intervention. Thirty-day and one-year mortality were 24% and 42%, respectively. Neurosurgical intervention was associated with reduced 30-day mortality (HR 0.46, 95% CI 0.28-0.76; p = 0.002) but not one-year mortality (HR 0.84, 95% CI 0.63-1.12; p = 0.23). Favourable 6-month outcome occurred in 29% of patients having intervention versus 34% of conservatively managed patients (p = 0.439). Increasing age, higher ASA class, dependent preinjury living, and injury severity were independently associated with unfavourable outcome. Acute craniotomy was associated with higher mortality and unfavourable outcome, whereas later trephination for subsequent chronic subdural haematoma was associated with lower mortality (5%) and better outcomes. Guideline adherence for ICP monitoring was 54%. In patients ≥ 80years with TBI, neurosurgical intervention was associated with reduced early mortality but was not associated with improved 365-days survival or functional outcome at 6months. Outcomes were largely determined by preinjury status and injury severity. These findings suggest selective surgical decision-making, with consideration of baseline function, comorbidity, and patient-centred goals of care.

Chronic subdural hematoma (CSDH) remains a delayed complication after aneurysm clipping. Quantitative evidence linking postoperative pneumocephalus to CSDH is limited. To evaluate the association of a normalized CT index-the Air-Brain Index (ABI)-and intracranial volume (ICV) with postoperative CSDH, with prespecified sex adjustment. Single‑center retrospective cohort of adults undergoing clipping. Day‑1 CT underwent standardized segmentation to derive ABI (air/brain) and ICV (air + brain). Multivariable logistic regression included age and sex; sex‑stratified analyses and ROC curves assessed performance. Among 68 patients, 18 developed CSDH. Higher ABI was associated with CSDH in univariable analysis; however, after adjustment for age and sex, ABI was no longer significant, whereas older age and male sex remained independent predictors. Although ABI was not independently associated with CSDH after adjustment for age and sex, it demonstrated a significant univariable relationship and may serve as a descriptive postoperative marker of residual intracranial air burden for hypothesis-generating risk stratification.

Direct oral anticoagulant resumption patterns after traumatic subdural hemorrhage in atrial fibrillation: A multicenter cohort study.

To systematically map the currently available evidence from clinical trials on middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH) and propose potential management pathways for patient selection. This is critical given that cSDH represents a growing neurosurgical challenge, and surgical drainage (burr-hole craniostomy or craniotomy) remains the current gold standard treatment. A scoping review was conducted following the PRISMA-ScR protocol to map emerging trials and systematically identify critical knowledge gaps. The search covered international public clinical trial registries using specific terms like "chronic," "subdural hematoma," and "embolization." A rigorous selection process was used for active clinical trials comparing the minimally invasive MMAE option with the conventional surgical approach. The initial search yielded 27 active clinical trials. Only 4 (14.8%) are currently completed, with 13 (48.1%) in the recruitment phase. The remaining 37% are classified as active, withdrawn, or of unknown status. Only three active studies (EMBOLISE, MAGIC-MT, and STEM) have published relevant partial results. To date, no high-level evidence has demonstrated that MMAE is superior to conventional surgery. Based on the synthesis of available trial data, a potential management algorithm is proposed for the endovascular treatment of cSDH. MMAE has emerged as a promising option for reducing recurrence, but it has not yet supplanted surgery as the standard of care. Knowledge gaps persist regarding optimal timing, the utility of adjunct therapies, and long-term outcomes, but this algorithm establishes a foundation for future high-quality studies.

Intracranial hemorrhage is life-threatening and requires prompt and accurate diagnosis. Non-contrast head computed tomography is the standard first-line examination, but detecting small hemorrhages and classifying multiple subtypes require substantial expertise. Workforce shortages and increasing diagnostic workloads, especially in emergency settings, further challenge timely decision-making. Artificial intelligence (AI)-assisted interpretation has shown promise for improving accuracy and efficiency. This retrospective study evaluated the effect of AI assistance on the diagnostic performance of radiologic technologists (RTs). We analyzed the data for 100 non-contrast head computed tomography examinations (50 positive and 50 negative for hemorrhage) obtained from the Japan Medical Image Database. The interpretations of the five RTs (5-12 years of experience) with and without AI assistance were compared with those of two radiologists. The detection targets were intraparenchymal, intraventricular, subarachnoid, subdural, epidural, and any hemorrhages. We calculated the Area Under the Receiver Operating Characteristic Curve (AUC), accuracy, sensitivity, and specificity. The differences in the AUC for the AI-assisted and unassisted readings were tested using the DeLong method with Bonferroni correction. Significant AUC improvements were observed for five of the 30 reader-task comparisons (17%) after Bonferroni correction. These improvements were all related to intraventricular (p = 0.0001 to 0.0071) and subdural (p = 0.0022 to 0.0071) hemorrhages. AI assistance significantly improved RT detection of challenging subtypes such as intraventricular and subdural hemorrhages. However, it did not improve the diagnostic accuracy for detecting any hemorrhage overall (p = 0.0689 to 0.9669). AI can strengthen the role of RTs within task-sharing models and help stabilize preliminary assessments, especially in emergency care and resource-constrained environments.

Various studies have shown a beneficial effect of statins in patients with chronic subdural hematoma (cSDH) who do not require surgery. In surgical cohorts, however, the results of statin treatment in cSDH have been inconsistent, and meta-analyses showed no significant effect. It has been hypothesized that this lack of effect may be due to a higher proportion of patients in the statin group taking antithrombotic medication. Therefore, we designed a study to analyze the impact of statins on surgical cSDH patients who did not receive antithrombotic drugs. We conducted a retrospective chart review of patients who received cSDH evacuation via burr-hole trepanation with the implantation of a subdural drain at our institution from 2012 through 2021. The data were pooled with a previously analyzed cohort to result in a two-center analysis. Patients who received antithrombotic medication were excluded. We separated the patients into a statin group and a control group based on whether they received a statin as part of their home medication and evaluated the rate of reoperations for any reason as the primary outcome parameter, and reoperations for residual hematoma and hematoma recurrence, respectively, as secondary outcome parameters. We identified 614 patients in the total cohort, of whom 297 did not take antithrombotic medication. The mean age of these patients was 71.75 ± 13.27 years, and 195 were male (65.66%). A total of 42 patients took statins (14.14%). A reoperation was necessary in 5 patients in the statin group (11.90%) and 35 patients in the control group (13.73%), p = 0.749. Residual hematoma after the initial surgery was ascertained in 2 patients in the statin group (4.76%) and 17 in the control group (6.67%), p = 0.640, whereas 3 patients in the statin group (7.14%) and 18 patients in the control group (7.06%) experienced hematoma recurrence, p = 0.984. Logistic regression analysis revealed no significant associations with reoperation. We found no evidence of a beneficial effect of statins in patients undergoing surgery for cSDH, regardless of the use of antithrombotic medication.