The implementation of artificial intelligence (AI), particularly Viz.ai software in stroke care, has emerged as a promising tool to enhance the detection of large vessel occlusion (LVO) and to improve stroke workflow metrics and patient outcomes. The aim of this systematic review and meta-analysis is to evaluate the impact of Viz.ai on stroke workflow efficiency in hospitals and on patients’ outcomes. Following the PRISMA guidelines, we conducted a comprehensive search on electronic databases, including PubMed, Web of Science, and Scopus databases, to obtain relevant studies until 25 October 2024. Our primary outcomes were door-to-groin puncture (DTG) time, CT scan-to-start of endovascular treatment (EVT) time, CT scan-to-recanalization time, and door-in–door-out time. Secondary outcomes included symptomatic intracranial hemorrhage (ICH), any ICH, mortality, mRS score < 2 at 90 days, and length of hospital stay. A total of 12 studies involving 15,595 patients were included in our analysis. The pooled analysis demonstrated that the implementation of the Viz.ai algorithm was associated with lesser CT scan to EVT time (SMD −0.71, 95% CI [−0.98, −0.44], p < 0.001) and DTG time (SMD −0.50, 95% CI [−0.66, −0.35], p < 0.001) as well as CT to recanalization time (SMD −0.55, 95% CI [−0.76, −0.33], p < 0.001). Additionally, patients in the post-AI group had significantly lower door−in door-out time than the pre-AI group (SMD −0.49, 95% CI [−0.71, −0.28], p < 0.001). Despite the workflow metrics improvement, our analysis did not reveal statistically significant differences in patient clinical outcomes ( p > 0.05). Our results suggest that the integration of the Viz.ai platform in stroke care holds significant potential for reducing EVT delays in patients with LVO and optimizing stroke flow metrics in comprehensive stroke centers. Further studies are required to validate its efficacy in improving clinical outcomes in patients with LVO.

Factor Xa inhibitors (FXaI) are increasingly used for anticoagulation therapy, yet their association with intracranial hemorrhage poses a significant challenge. Although andexanet alfa (AA) and four-factor prothrombin complex concentrate (4F-PCC) have shown promise in reversing FXaI effects, their comparative efficacy and safety remain uncertain. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a literature search on electronic databases to obtain the relevant studies until May 16, 2024. Our primary outcomes were successful anticoagulation reversal, overall mortality (including 30-day and in-hospital mortality), and thromboembolic events. Secondary outcomes were length of hospital and intensive care unit stay and hematoma volume expansion. Data were pooled using a random-effects model. We included 16 eligible studies with a total of 2,977 patients. A statistically significant improvement in hemostatic efficacy rates was in favor of the AA group (risk ratio [RR] 1.10, 95% confidence interval [CI] 1.01–1.20, P = 0.02). Lower overall mortality rates were found in the AA group (RR 0.67, 95% CI 0.51–0.88, P = 0.004). However, no difference was found in 30-day mortality rates (RR 0.82, 95% CI 0.58–1.16, P = 0.26). In terms of thromboembolic events, more events were found in the AA group (RR 1.47, 95% CI 1.01–2.15, P = 0.046). AA was associated with a longer duration of hospital stay compared to 4F-PCC (mean difference [MD] 0.64, 95% CI 0.07–1.22, P = 0.03). Neither a significant difference in length of intensive care unit stay (MD 0.25, 95% CI − 0.36 to 0.86, P = 0.41) nor a significant difference in hematoma volume expansion was reported (MD − 0.89, 95% CI − 3.11 to 1.34, P = 0.435). Our results suggest that AA is superior to 4F-PCC in enhancing the hemostatic efficacy and reducing the overall and in-hospital mortality rates. More thromboembolic events are thought to be associated with the use of AA. However, more studies are required to validate whether the better results of AA in improving hemostatic efficacy are enough to make up for their higher cost and their possible risk of thromboembolic events.

Background: Tourette syndrome (TS) is a neurodevelopmental disorder characterized by motor and phonic tics. It is a condition that affects between 0.3% and 0.7% of children, and its pathophysiology remains largely elusive. TS is associated with structural and functional alterations in corticostriatal circuits and neurochemical imbalances. Even though TS is currently incurable, there are established treatment options available, including behavioral therapy and neuroleptics. The use of cannabis-based medicine for tic management is an emerging therapeutic strategy, although its efficacy is still under investigation. It is hypothesized to interact with the endogenous cannabinoid system, but further research is required to ascertain its safety and effectiveness in TS. Aim: In our systematic review and meta-analysis, we aim to assess the effectiveness of cannabis-based medicine in the treatment of TS. Methods: We searched PubMed, Cochrane, Scopus, and Web of Sciences until February 2024. We included clinical trials and cohort studies investigating the efficacy of cannabis-based medicine in the treatment of TS. Data extraction focused on baseline characteristics of the included studies and efficacy outcomes, including scores on the Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS). We conducted the meta-analysis using Review Manager version 5.4. software. We compared the measurements before and after drug intake using mean difference (MD) and 95% confidence interval (CI). Results: In total, 357 articles were identified for screening, with nine studies included in the systematic review and 3 in the meta-analysis. These studies involved 401 adult patients with TS treated with cannabis. YGTSS revealed a significant reduction in total scores (MD = -23.71, 95% CI [-43.86 to -3.55], P = 0.02), PUTS revealed a significant decrease in scores (MD = -5.36, 95% CI [-8.46 to -2.27], P = 0.0007), and Y-BOCS revealed no significant difference in score reduction (MD = -6.22, 95% CI [-12.68 to 0.23], P = 0.06). Conclusion: The current study indicates promising and potentially effective outcomes with the use of cannabis-based medicine in mitigating the severity of tics and premonitory urges. However, there is a need for larger, placebo-controlled studies with more representative samples to validate these findings.

Background: Middle meningeal artery (MMA) embolization is an increasingly common procedure involved in the treatment of various vascular and neoplastic diseases. Understanding its anatomical nuances and clinical implications is fundamental in enhancing the safety of preoperative embolization. Methods: A systematic review following PRISMA guidelines was conducted to consolidate literature on the MMA anomalous variations. PubMed, Scopus, and Web of Science were systematically searched using our predefined criteria until 2025. Inclusion encompassed studies focusing on the clinical perspectives of MMA’s anomalous anatomy and endovascular implications. Results: Twelve articles met inclusion criteria, exploring the clinical significance of the MMA’s anatomical variations in various clinical situations. We identified 11 case reports, and we also reported the clinical significance of the cases identified among different case series for the treatment of CSDH and other involved pathologies. Anomalous variations of the MMA involving either its origin, branching or connections were detected clinically in about 43 patients in the literature. We identified the basilar artery as an origin of the MMA in 9 case reports. The ophthalmic origin of the MMA was reported in about 12 patients, while an accessory meningeal artery arising from an ophthalmic artery was only reported in two cases. Conclusion: Properly identifying the anomalous variants of the MMA is considerably valuable in preoperative planning and decision-making for the endovascular management of various pathologies involving the dura. To choose an appropriate tool and method of endovascular intervention, understanding the anatomical features and variability of the MMA is crucial.

Epilepsy is a common neurological disease that is treated with medications; however, patients with drug-resistant epilepsy, commonly intractable temporal lobe epilepsy, tend to have better control with surgical treatment. While the mainstay of surgical treatment is anterior temporal lobectomy, it carries risk of potential adverse effects hence minimally invasive techniques are now being used as an alternative to open surgery. This systematic review and meta-analysis compare the efficacy and safety of three of the most used techniques: laser interstitial thermal therapy (LITT), radiofrequency ablation (RFA) and stereotactic radiosurgery (SRS). Multiple databases were searched and PRISMA guidelines were followed to make an indirect meta-analysis using the currently available studies for the three techniques in terms of seizure freedom, risk of major complications and reoperations. Further subgroup analyses were carried out for LITT in terms of follow up periods and seizure freedom in patients with or without hippocampal sclerosis. A total of 42 papers were included in this study with a total of 1675 patients (1303 treated by LITT, 188 treated by RFA and 184 treated by SRS). LITT had the highest rate of seizure freedom (55.0%, CI 51.5 − 58.5%, P = 0.148), and the lowest rates of major complications (2.3%, CI 1.2 − 3.5%, P = 0.070), and reoperations (14.3%, CI 10.4 − 18.3%, P = 0.042) compared to RFA and SRS which had seizure freedom of 46.3% (CI 18.8 − 73.7%, P = 0.000) and 53.8% (CI 44.4 − 63.3%; I^2 = 40.4%, P = 0.098), major complication rate of 3.9% (CI 0.7 − 7.0%; I^2 = 0%, P = 0.458) and 14.3% (CI 3.1 − 25.5%, P = 0.000) and reoperation rate of 28.6% (CI -4.3 − 61.5%, P = 0.000) and 15.4% (CI 6.1 − 24.8%; I^2 = 0%, P = 0.392) respectively. In conclusion, LITT showed the highest rate of seizure freedom and the lowest rate of major complications and reoperations compared to RFA and SRS in single-arm studies of intractable mesial temporal lobe epilepsy. However, the lack of direct comparisons between treatment modalities limits definitive conclusions. Despite this, LITT appears to offer a favorable safety profile, warranting further prospective, comparative studies to validate these findings.

Suturing techniques for wound closure in spine surgeries play a critical role in patient outcomes, including wound healing, reintervention, and risk of complications. Barbed sutures, characterized by their self-anchoring properties, have emerged as a potential alternative to conventional sutures in various surgical disciplines. While previous studies have underscored their efficacy and safety in spine surgeries, no meta-analysis has been conducted. Therefore, we are undertaking this study. Following the PRISMA guidelines, we conducted a literature search on electronic databases to obtain the relevant studies until May 5, 2024. Our primary outcomes were operative time, wound closure time, and postoperative wound complications like seroma or hematoma formation and wound infection. The secondary outcomes were the length of hospital stay, reintervention rates, and costs. Data was pooled using a random effects model. We included seven eligible studies with a total of 8645 patients. Our meta-analysis showed that barbed sutures had shorter operative time and wound closure time compared to conventional sutures (MD -20.13 min, 95% CI [-28.47, -11.78], P < 0.001) and (MD -16.36 min, 95% CI [-20.9, -11.82], P < 0.001), respectively. Both suturing techniques showed comparable results in terms of overall postoperative wound complications (RR 0.83, 95% CI [0.60, 1.14], P = 0.25), postoperative infections (RR 0.59, 95% CI [0.33, 1.06], P = 0.08), length of hospital stay (MD -0.26 day, 95% CI [-0.75, 0.22], P = 0.28), rates of reintervention between the two groups (RR 0.99, 95% CI [0.48, 2.05], P = 0.98). Barbed sutures in spine surgeries are associated with significantly shortened wound closure and operative times. However, high-quality RCT’s with long-term follow-up and cost-effectiveness assessment are required to support the evidence.