Cost-minimizing thresholds and recurrence rates in surgical evacuation with adjunctive middle meningeal artery embolization versus evacuation alone.

Objective: Cost-minimization approaches for the treatment of patients with chronic subdural hematoma (cSDH) are important given the increasing incidence of this pathology, particularly among elderly patients receiving antiplatelet and anticoagulation medications. The use of middle meningeal artery embolization (MMAE) as an adjunct to surgical evacuation has shown promise in reducing surgical recurrence; however, additional costs are involved with this procedure. Using their institutional experience, the authors identified thresholds for cost and the cSDH surgical recurrence rate that could influence treatment decisions in patients requiring surgical evacuation for cSDH.

Hierarchical gradients of multiple timescales in the mammalian forebrain.

Many anatomical and physiological features of cortical circuits, ranging from the biophysical properties of synapses to the connectivity patterns among different neuron types, exhibit consistent variation along the hierarchical axis from sensory to association areas. Notably, the temporal correlation of neural activity at rest, known as the intrinsic timescale, increases systematically along this hierarchy in both primates and rodents, analogous to the increasing scale and complexity of spatial receptive fields. However, how the timescales for task-related activity vary across brain regions and whether their hierarchical organization appears consistently across different mammalian species remain unexplored.

Memory consolidation, temporal and parietal atrophy, and metabolism in amyloid-β positive and negative mild cognitive impairment.

Background: Alzheimer's disease (AD) is classically characterized by alterations in memory consolidation. With the advent of diagnostic biomarkers, some patients clinically diagnosed with AD display biomarkers inconsistent with the diagnosis.

Objective: We aimed to explore differences in memory consolidation and neurodegeneration of the temporal and parietal lobes as a function of amyloid-β status in amnestic mild cognitive impairment (aMCI).

Brain health is essential for smooth economic transitions: towards socio-economic sustainability, productivity and well-being.

Optimal brain health is essential to smoothing major global skill-intensive economic transitions, such as the bioeconomy, green, care economy and digital transitions. Good brain health is vital to socio-economic sustainability, productivity and well-being. The care transition focuses on recognizing and investing in care services and care work as essential for economic growth and social well-being.

Flow diverter versus stent-assisted coiling treatment for managing dissecting intracranial aneurysms: A systematic review and meta-analysis.

Background: Dissecting intracranial aneurysms (DIAs) have been treated through endovascular reconstructive manners, such as flow diverters (FDs) and stent-assisted coiling (SAC). Notably, no robust evidence has compared both approaches. Hence, the authors conducted a meta-analysis to compare their outcomes.

Individual Variability in the Structural Connectivity Architecture of the Human Brain.

The human brain exhibits a high degree of individual variability in both its structure and function, which underlies intersubject differences in cognition and behavior. It was previously shown that functional connectivity is more variable in the heteromodal association cortex but less variable in the unimodal cortices. Structural connectivity (SC) is the anatomical substrate of functional connectivity, but the spatial and temporal patterns of individual variability in SC (IVSC) remain largely unknown.

Glial scarring limits recovery following decompressive surgery in rats with syringomyelia.

Syringomyelia is a neurological disease that is difficult to cure, and treatments often have limited effectiveness. In this study, a rat model of syringomyelia induced by epidural compression was used to investigate the factors that limit the prognosis of syringomyelia. After we treated syringomyelia rats with surgical decompression alone, MRI revealed that the syringomyelia rats did not show the expected therapeutic effect.

Complications: skull base and cerebrovascular.

Neurosurgical complications are a rich source for learning, but they are grossly underutilized for the purpose of surgeon education. Details of the complications, which make them all the more powerful as teaching tools, are restricted to morbidity and mortality conferences behind closed doors, and open discussions of the topic are blurred by hypotheticals in order to shield the presenters from medicolegal risks. In this issue of Neurosurgical Focus, 9 neurosurgeons were invited to present complications they encountered along with the details and specific lessons they learned.

Comparative efficacy and safety of therapeutic strategies for mirror aneurysms: A systematic review and meta-analysis.

Mirror aneurysms are rare and pose therapeutic challenges, with both endovascular and microsurgical options available. Single-stage and two-stage procedures are employed, but the optimal strategy remains unclear. This systematic review and meta-analysis evaluate the efficacy and safety of different therapeutic strategies for managing mirror aneurysms.

The diagnostic journey of patients being investigated for myopathy in a tertiary centre in England.

Myopathies are heterogenous and can provide a diagnostic puzzle. Many patients investigated for myopathy will go on to other diagnoses. An overall understanding of how patients are investigated for suspected myopathy is lacking.

Induced pluripotent stem cell-related approaches to generate dopaminergic neurons for Parkinson's disease.

The progressive loss of dopaminergic neurons in affected patient brains is one of the pathological features of Parkinson's disease, the second most common human neurodegenerative disease. Although the detailed pathogenesis accounting for dopaminergic neuron degeneration in Parkinson's disease is still unclear, the advancement of stem cell approaches has shown promise for Parkinson's disease research and therapy. The induced pluripotent stem cells have been commonly used to generate dopaminergic neurons, which has provided valuable insights to improve our understanding of Parkinson's disease pathogenesis and contributed to anti-Parkinson's disease therapies.

Treatment Challenges in Hemifacial Spasm: The Role of Magnetic Resonance Imaging.

Hemifacial spasm (HFS) is an important condition for plastic surgeons to understand, as it significantly affects patients' quality of life and can complicate aesthetic and reconstructive procedures. Magnetic resonance imaging (MRI) has become vital in diagnosing HFS, assessing neurovascular relationships, and planning treatment. Transverse MRI scans often show an upward displacement of the inferior pons at the facial nerve attachment point, signaling neurovascular compression (NVC) in HFS.

Postoperative NEOadjuvant TEMozolomide followed by chemoradiotherapy versus upfront chemoradiotherapy for glioblastoma multiforme (NEOTEM) trial: Interim results.

Background: Glioblastoma multiforme (GBM) is an aggressive brain tumor with poor survival rates despite current treatments. The standard of care (SOC) includes surgery, followed by radiotherapy plus concurrent and adjuvant chemotherapy with temozolomide (TMZ). This phase II trial assessed the safety and efficacy of neoadjuvant TMZ (nTMZ) before and during chemoradiotherapy in newly diagnosed GBM patients.

Prognostic role of quantitative pupillometry in traumatic brain injury: a scoping review.

Background: Traumatic brain injury (TBI) is a major cause of global mortality and disability, leading to primary and secondary brain injuries that can result in severe neurological, cognitive, and psychological impairments. Accurate and early prognosis of TBI outcomes is critical, particularly in assessing the risk of neurological decline, intracranial pressure (ICP) changes, and mortality.

Objective: This systematic review aims to evaluate the prognostic value of quantitative pupillometry, particularly the Neurological Pupil Index (NPi), in predicting long-term outcomes in TBI patients.

Vaccination against Respiratory Infections in the Immunosenescent Older Adult Population: Challenges and Opportunities.

Respiratory infections are associated with a huge burden of disease every year and disproportionately affect older adults, namely those aged 65 years and older. Older adults are at increased risk of infections compared with their younger counterparts, and once infected, have a higher risk of experiencing severe disease course, complications, and long-term sequelae. Therefore, vaccination is clearly a key strategy to prevent infection and its attendant negative consequences.

Polygenic and Polyenvironment Interplay in Schizophrenia-Spectrum Disorder and Affective Psychosis; the EUGEI First Episode Study.

Background: Multiple genetic and environmental risk factors play a role in the development of both schizophrenia-spectrum disorders and affective psychoses. How they act in combination is yet to be clarified.

Methods: We analyzed 573 first episode psychosis cases and 1005 controls, of European ancestry.

Plasmodium knowlesi Infection Is Associated With Elevated Circulating Biomarkers of Brain Injury and Endothelial Activation.

Background: Malaria remains a major public health concern with substantial morbidity and mortality worldwide. In Malaysia, the emergence of Plasmodium knowlesi has led to a surge in zoonotic malaria cases and deaths in recent years. Signs of cerebral involvement have been observed in a noncomatose, fatal case of knowlesi infection, but the potential impact of this malaria species on the brain remains unexplored.

Excitatory-inhibitory synaptic imbalance induced by acute intra-hippocampus injections of amyloid-β oligomers.

Alzheimer's disease (AD) is characterized by the accumulation of soluble amyloid-β oligomers (AβOs) in the brain, which disrupt synaptic function and promote cognitive decline. Here, we investigated the effects of AβOs on excitatory and inhibitory synaptic transmission and plasticity by performing stereotaxic injections of AβOs directly into the hippocampal CA1 region, followed by hippocampal slice isolation for electrophysiological measurements. AβOs injections altered basal excitatory synaptic transmission, reducing field excitatory postsynaptic potentials (fEPSPs) and impairing excitatory long-term potentiation (LTP).