Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), delayed postoperative relief is one of its main issues. We previously evaluated the morphology of the lateral spread response (LSR) and reported the correlation between delayed relief after MVD and polyphasic morphology of the LSR. The purpose of this study was to investigate the correlation between the morphology of the LSR with stimulation of the temporal and mandibular branches of the facial nerve and delayed relief of persistent HFS after MVD. We retrospectively analysed and compared data from 49 of 205 consecutive patients who underwent MVD for HFS at our hospital between January 2015 and March 2022. Based on the pattern of the initial LSR morphology, patients were divided into 4 groups (LSR with temporal branch stimulation/LSR with mandibular branch stimulation; polyphasic/polyphasic group, polyphasic/monophasic group, monophasic/polyphasic group, monophasic/monophasic group). The results of MVD surgery for HFS were evaluated 1 week, 1 month and 1 year postoperatively, by evaluating whether or not the symptoms of HFS persisted at the time of each follow-up. We found significant differences in residual postoperative HFS 1 week postoperatively among the 4 groups (p < 0.05), as assessed using m*n Yates chi-square test. There is a significant correlation between delayed relief after MVD and polyphasic morphology of the initial LSR in patients with HFS. The LSR with temporal rather than mandibular branch stimulation might be useful for predicting delayed relief following MVD in HFS patients.

This study aimed to evaluate the cost-effectiveness of mechanical thrombectomy (MT) in patients aged 90 years and older with acute ischaemic stroke (AIS). We developed a cost-effectiveness model to compare MT with standard medical care (SMC) to SMC alone. The model, incorporating parameters for the effectiveness and costs of MT with SMC and SMC alone, was simulated until the cohort reached 100 years of age. The parameters were estimated from the prospective cohort study of the RESCUE-Japan Registry 2, claims databases, and published literature, with the perspective being Japan's public healthcare system. In the base-case model for an 8-year simulation period, the quality-adjusted life years (QALYs) for MT with SMC and SMC alone were 1.463 and 1.054 years, respectively. The expected costs were 14,553,772 Yen and 13,732,646 Yen, respectively. The incremental cost-effectiveness ratio (ICER) of MT with SMC compared to SMC alone was 2,009,744 Yen per QALY. A probabilistic sensitivity analysis showed a 66% probability that MT with SMC would be below the ICER threshold of 5,000,000 Yen per QALY. The cost-effectiveness analyses demonstrated that performing MT in addition to SMC for AIS in patients aged 90 years and older was acceptable from a cost-effectiveness perspective.

This study aimed to investigate the patterns of anticoagulation therapy and coagulation parameters and to develop a prediction model to predict the type of anticoagulation therapy in geriatric patients with traumatic brain injury. A retrospective analysis was performed using the nationwide neurotrauma database of Japan. Elderly patients (≥65 years) with traumatic brain injury. Patients were divided into 3 groups based on their daily anticoagulant medication (none, direct oral anticoagulant [DOAC], and vitamin K antagonist [VKA]), and coagulation parameters were compared in each group. We then developed a machine-learning model to predict the anticoagulant using coagulation parameters and visualized the pattern using a heat map. A total of 495 patients were enrolled and divided into 3 groups: none (n = 439), DOACs (n = 37), and VKA (n = 19). Comparing none to DOAC and DOAC to VKA for prothrombin time-international normalized ratio (PT-INR), the mean difference and 95% confidence intervals (CIs) were 0.38 (95% CI: 0.59-0.17) and 1.56 (95% CI: 1.21-1.90), and for activated partial thromboplastin time (APTT), the mean difference between none to DOAC and DOAC to VKA was 3.46 (95% CI: 0.98-5.94) and 95% CI was 7.39 (95% CI: 3.29-11.48). A prediction model for the type of anticoagulant used by PT-INR and APTT was developed using machine-learning methods, and a heat map visually revealed their relationship with acceptable predictive ability. This study revealed the characteristic patterns of coagulation parameters in anticoagulants and a pilot model to predict anticoagulant use.

Three anti-calcitonin gene-related peptide monoclonal antibodies (CGRP-mAbs) are available in Japan: galcanezumab, fremanezumab, and erenumab. Early-onset efficacy has been demonstrated for each CGRP-mAb in comparison with placebo, but differences among the drugs are unclear. Only galcanezumab requires 2 doses at the initial injection. This study is a multicenter, open-label, randomized, two-group comparison trial, consisting of the random selection of a CGRP-mAb and 6 consecutive injections, and then discontinuation of the CGRP-mAb after 6 injections. The primary outcome is a comparison of early-onset efficacy between galcanezumab and both fremanezumab and erenumab after the initial injection. The secondary outcomes are comparisons between galcanezumab and both fremanezumab and erenumab, and between fremanezumab and erenumab as follows: weekly number of headache days, migraine days, and acute medication use are compared to baseline during one month after initial injection; time of subjectively perceiving onset of effect after initial injection; monthly changes in headache status from baseline to after third (3rd) injections; effective rates after initial and 3rd injections; improvement rates of depression scores between baseline and after 3rd injections; changes in number of absenteeism and presenteeism days in each month from baseline to after 3rd injections; proportion of ineffective cases after 3rd injections; recurrence rates and time to recurrence after CGRP-mAb discontinuation; effective rates of CGRP-mAb re-injections; detection of clinical factors associated with effectiveness after the initial and 3rd injections. The aim of this study is to investigate differences in early-onset efficacy among the CGRP-mAbs, and when and to what extent headache symptoms recur after discontinuation.

In focal epilepsy cases, precise identification and resection of the epileptogenic zone increase the likelihood of achieving a seizure-free outcome. Nevertheless, localizing the source of epilepsy in magnetic resonance imaging-negative epilepsy cases presents significant challenges for clinicians. In this study, we evaluated the diagnostic efficacy and impact on the seizure outcome by using 4 noninvasive modalities, including scalp video electroencephalography, magnetoencephalography, fluorodeoxyglucose-positron emission tomography, and iomazenil single-photon emission computed tomography, in a cohort of patients with magnetic resonance imaging-negative focal epilepsy who underwent resective surgery. The concordance status of each modality was assessed relative to the lobar resection area, and surgical outcome was assessed by Engel Classification at least 1 year after surgery. Comparison and diagnostic analyses were calculated for each individual and all possible combinations of scalp video electroencephalography, magnetoencephalography, fluorodeoxyglucose-positron emission tomography, and single-photon emission computed tomography with respect to Engel class I outcome. Eighteen patients (66.6%, 18/27) had Engel class I outcomes. Patients with at least 2 concordant modalities were associated with Engel class I outcome (p = 0.0262). For individual modality, fluorodeoxyglucose-positron emission tomography achieved the highest yield of sensitivity (72.2%) compared to scalp video electroencephalography, magnetoencephalography, and single-photon emission computed tomography (50.0%, 61.1%, and 61.6%, respectively). Scalp video electroencephalography, magnetoencephalography, and single-photon emission computed tomography showed similar specificities of 77.7%, while fluorodeoxyglucose-positron emission tomography showed a specificity of 55.5%. Combined modalities were able to achieve the highest sensitivity of 83.3% when there were at least 2 concordant modalities and a specificity of 100% with various multiple combinations. Our study showed that lobar concordance from multiple modalities increases the sensitivity and specificity for a seizure-free outcome in magnetic resonance imaging-negative focal epilepsy patients who underwent resective surgery.

To provide appropriate treatment, neurosurgeons and pediatricians must understand the chronological changes of the cranial morphology in normal children and the differences between normal and sagittal synostosis children. However, this issue has remained unresolved due to the traditional methods of analyzing cranial morphology. Therefore, we applied a new and precise method, geometric morphometrics, to understand cranial morphology in children with normal and sagittal synostosis. This study analyzed morphological differences in the cranium of 30 control children and 14 children with sagittal synostosis using geometric morphometrics and the landmark method on the lateral view of the three-dimensional computed tomography of the skull. The results showed that morphological changes in the cranium of normal children with age could be visualized (p < 0.01), with the parietooccipital and suboccipital areas being the main areas of change. Morphological analysis revealed different cranial morphologies among the control, scaphocephalic sagittal synostosis, and non-scaphocephalic sagittal synostosis groups (p < 0.01), as evidenced by a fan-like spread and reduced cranial height in the sagittal synostosis group compared to the control cranium. Visualization in wireframes could reveal morphological differences, even if small, with statistical differences. This study clarified 3 issues regarding the cranial morphology in normal and sagittal children. The study showed evident age-related differences and changes in the cranial morphology in normal children. Differences in cranial morphologies among the 3 groups were identified. Finally, the study demonstrates that geometric morphometrics is a precise and appropriate method for analyzing morphological differences and changes.