Vascular

Systematic Review of the predictive value of negative brain or low probability brain MRIs in patients with CSF venous fistulas

by

The article titled “Systematic Review of the Predictive Value of Negative Brain or Low Probability Brain MRIs in Patients with CSF Venous Fistulas” (American journal of neuroradiology) is a systematic review analyzing data from nine studies (898 patients) to assess how reliably negative brain MRI or low-probability MRI scores (Bern, Mayo) can rule out cerebrospinal fluid (CSF) venous fistulas, a surgically treatable cause of spontaneous intracranial hypotension (SIH) 1).

The authors found that although negative brain MRI has a high negative predictive value (89%), CVFs were still identified in a notable number of patients—especially when using the Mayo score (NPV only 65%).

The authors conclude that negative imaging does not exclude CVF, and invasive spinal imaging (e.g., DSM, dynamic CT myelography) should be considered in cases with strong clinical suspicion. This is especially relevant for neurosurgeons, as surgical ligation of CVFs may be necessary.

All authors are affiliated with Cedars-Sinai Medical Center (Los Angeles), with Dr. Wouter I. Schievink, a neurosurgeon, being a leading expert in the field of CSF leaks.

This so-called systematic review by Tay et al. (AJNR, June 2025) ambitiously sets out to clarify the diagnostic value of negative brain MRI in detecting cerebrospinal fluid venous fistulas (CVFs), yet ends up as a textbook example of how quantitative gloss can’t save a weak clinical premise.

Read more

Global burden and trend of stroke attributable to metabolic risks among young adults (20–39 years old) from 1990 to 2021

by

In a retrospective secondary analysis based entirely on data from the Global Burden of Disease Study (GBD) 2021 — with no original dataset, no prospective design, and no hypothesis testing — Liu et al., from the Department of Neurosurgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China, published in Frontiers in Cardiovascular Medicine an assessment of the global burden and long-term trends of stroke among young adults (ages 20–39) attributable to metabolic risk factors. The authors identify regional disparities and support the call for targeted prevention strategies.

The study concludes that the global burden of stroke attributable to metabolic risk factors among young adults (20–39 years old) has significantly increased from 1990 to 2021, both in terms of absolute numbers and age-standardized rates. The major contributors to this burden are high body mass index (BMI), high fasting plasma glucose, and high systolic blood pressure. The authors emphasize the need for targeted, age-specific public health interventions to reduce these modifiable risks and prevent early-onset stroke.

1)

Main Limitation

The study merely visualizes model-generated data without offering critical interpretation, clinical insight, or actionable public health strategies.

📉 Main Criticisms

Read more

Early clinical experience with the Emboguard Balloon Guide Catheter: impact on technical success and patient outcomes in large vessel occlusion thrombectomy

by

In a retrospective observational cohort study published in the Journal of NeuroInterventional Surgery, Mahat et al.—with participation from the Department of Neurosurgery at the University of Pittsburgh School of Medicine—evaluated the early clinical performance of the Emboguard Balloon Guide Catheter (EBGC) in anterior circulation large vessel occlusion (LVO) strokes treated with endovascular thrombectomy. The analysis relied on a prospectively maintained thrombectomy database, yet lacked a control group, randomization, or blinding, limiting its internal validity.

The study sought to assess:

Technical outcomes: rates of successful (mTICI 2b/3) and complete (mTICI 2c/3) recanalization, number of passes, and first-pass effect (FPE).

Clinical outcomes: NIHSS at discharge and functional status at 90 days (mRS).

Safety outcomes: incidence of symptomatic intracranial hemorrhage (sICH) and all-cause mortality.

While the reported results appear favorable, the commercial tone, lack of methodological rigor, and extensive conflicts of interest raise concerns that the study may serve more as an early promotional endorsement of the device rather than a robust, independent scientific evaluation. 1)

Read more

Use of N-hexyl Cyanoacrylate Monomers for the Treatment of Intra- and Extracranial Arteriovenous Malformations: A Single-Center Experience

by

In a retrospective single-center case series (n=22 patients, 24 procedures) with no control group or comparison, Murias Quintana et al. from the Hospital Universitario Central de Asturias, Oviedo, Hospital Clínic de Barcelona, Hospital Universitario Marqués de Valdecilla, Santander, Alfried Krupp Krankenhaus, Essen, Hospital Universitario de Salamanca 1) aim to describe outcomes after the use of N-hexyl cyanoacrylate (NHCA, “Magic Glue”) for AVM embolization. Despite its stated aim of evaluating “strengths and limitations,” the article offers a one-sided, promotional narrative that lacks critical analysis.

🧱 Structural and Conceptual Weaknesses

1. Journal-Level Issues: “Cureus Syndrome”

The journal *Cureus* is increasingly known for:

This paper reinforces that reputation, providing more of a procedural diary than a peer-reviewed study. It embodies editorial complacency and academic dilution.

2. Lowest Tier of Evidence

A retrospective case series offers no comparative insight. There is:

This is not hypothesis–testing research — it’s purely observational, anecdotal reporting.

📉 Methodological Limitations

3. “Success” Is Redefined to Mean Nothing

The paper defines technical success as “the outcome achieved based on objective.” This is circular reasoning and renders the concept of success meaningless.

4. Data Dump of Technical Details

Injection times and catheter models are listed with obsessive detail:

  • HeadWay Duo 167 cm in 70.8%
  • Magic 1.2F in the rest
  • Injection times: 27 seconds to 9 minutes 38 seconds

Yet none of these details translate to improved patient care or clinical insight.

5. Zero Complications ≠ Safety

No adverse events in 24 procedures cannot be extrapolated as “safe.” This cohort is underpowered to detect rare but serious complications — a classic false sense of security.

🤹 Interpretation Bias and Overreach

6. 12.5% Success = “Effective”?

Only '3 out of 24 cases (12.5%)‘ achieved complete occlusion with a single NHCA injection. The authors still call it “effective.” This is an example of:

  • ::unjustified enthusiasm::
  • ::intellectual dishonesty::

7. Promotional Tone

Frequent use of the term “Magic Glue” and positive adjectives for NHCA give this paper the tone of a product brochure, not a neutral scientific analysis.

🧠 What’s Missing?

Key omissions include:

  • No clinical or imaging follow-up data
  • No outcome measures beyond technical success
  • No comparison with other embolic agents (Onyx, PHIL, Squid)
  • No cost-benefit analysis
  • No discussion of failure cases or limitations in complex AVMs

🧾 Conclusion

This paper does not meet the standards of a rigorous scientific study. It provides:

  • No high-quality evidence
  • No clinically useful guidance
  • No long-term data

It reinforces the perception of *Cureus* as a platform for uploading technically correct but scientifically irrelevant work. A procedural note disguised as research, this article is a missed opportunity to meaningfully contribute to the field of neurointerventional radiology.

Final Verdict: This is not a “study” — it is a technical anecdote polished with promotional language and framed in a journal that too often rewards upload volume over scientific substance.

📎 References

1)

Murias Quintana E, Rodríguez Castro J, Puig J, Gil García A, Chapot R, Maestro V, Llibre JC, Gutiérrez Morales JC, García Arias F, Vega P. Use of N-hexyl Cyanoacrylate Monomers for the Treatment of Intra- and Extracranial Arteriovenous Malformations: A Single-Center Experience. Cureus. 2025 May 17;17(5):e84290. doi: 10.7759/cureus.84290. PMID: 40525034; PMCID: PMC12169607.