neurosurgery

Validation of the HERMES-24 Score for Outcome Prediction Post Large Vessel Occlusion Treatment in Later Time Window

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In a patient-level meta-analysis and external validation of the score Koji Tanaka et al. from the University of Calgary, Altair Biostatistics, St. Louis Park; Stanford University, Cooper University Health Care, Camden; Emory University, Atlanta; Barrow Neurological Institute, Phoenix; Federal University of Rio Grande do Sul, Porto Alegre; Hospital Vall d’Hebron, Barcelona; Prisma Health Upstate, Greenville; University at Buffalo, Buffalo; UCLA, Los Angeles published in the Neurology Journal to externally validate the HERMES-24 score for outcome prediction in patients with anterior circulation large vessel occlusion treatment in the late time window (beyond 6 hours from last known well). The HERMES-24 score demonstrated excellent predictive ability for 90-day functional outcomes and mortality across both EVT and control groups. The score maintained high AUC (>0.80) across all endpoints and treatment arms, confirming its robustness beyond early-window interventions 1).

Critical Review:

This well-powered meta-analysis utilizes pooled patient-level data from six late-window EVT trials, effectively excluding any overlap with the original HERMES cohort to reduce bias. The investigators clearly articulate the methodology and maintain rigorous exclusion criteria to ensure external validity. The study benefits from its straightforward scoring system (age/10 + NIHSS at 24h), which is practical for clinicians. However, the derivation and validation are still restricted to highly selected trial populations—limiting

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Efficacy of Adding Clonidine to Bupivacaine 0.25% Versus Plain Bupivacaine 0.25% Infiltration in Scalp Blocks for Supratentorial Craniotomy

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In a prospective randomized controlled trial Lemos et al. from the Netaji Subhash Chandra Bose Medical College, Jabalpur published in Cureus, to assess whether the addition of clonidine (2 mcg/kg) to 0.25% bupivacaine in scalp blocks improves perioperative analgesia and hemodynamic control during supratentorial craniotomy. Clonidine significantly prolonged analgesia duration and improved perioperative hemodynamic stability, with lower postoperative pain scores, reduced need for rescue analgesia, and decreased intraoperative and postoperative analgesic consumption 3)

Critical Review

While the study is prospective and randomized, the sample size of 60 patients (30 per group) is underpowered for robust generalization. The statistical significance of the analgesic duration and pain scores (p<0.001) is compelling, but it is unclear whether the effect size translates into meaningful clinical benefit beyond delayed rescue analgesia. Hemodynamic data is selectively highlighted, and potential bradycardia and hypotension risks with clonidine are underexplored. Additionally, the lack of blinding of the assessors and a placebo control weakens internal validity. The study does not account for potential long-term side effects or the impact on overall surgical outcomes.

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