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BACKGROUND AND OBJECTIVES: The artery of Davidoff and Schechter (ADS) is a dural branch of the posterior cerebral artery, supplying the falcotentorial junction. It is not commonly depicted on angiography due to its small size; thus, its visibility is usually indicative of a pathology, such as a dural arteriovenous fistula (DAVF). Recognizing the ADS as a feeder could be vital in enhancing management success, and understanding its anatomy is important for preventing complications during embolization or microsurgery. We present a scoping review of DAVFs fed by the ADS followed by an illustrative case report encountered at our institution. METHODS: An extensive literature review was conducted using PubMed, Embase, Web of Science, Scopus, and Cochrane databases. The search included the keywords: “Davidoff,” “Schechter,” “Davidoff and Schechter,” “dural branch,” “tentorial branch,” “medial branch,” and “meningeal branch,” in combination with “arteriovenous fistula,” “posterior cerebral artery,” and “superior cerebellar artery.” Only articles published in English or Spanish were included, with no restriction on publication date. Case reports and series were further screened based on best relevance. Data extraction and synthesis were performed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS: A total of 16 articles describing 32 cases of DAVFs supplied by the ADS were identified. The most common onset was headache (43.8%), followed by altered mental status (21.2%). Most DAVFs were classified as high grade based on Borden/Cognard scales. Transarterial embolization was the most used treatment (81.3%), achieving complete occlusion in 76.9% of cases. Among patients with complete occlusion, approximately half experienced full resolution of symptoms. In a mean follow-up of 27.4 months (IQR: 30), 2 cases reported complications due to reflux of the embolic agent. CONCLUSION: A comprehensive understanding of the ADS's angioarchitecture is essential to take full advantage of this artery's features in the treatment, mitigating potential complications and optimizing patient outcomes.

Thalamic neuromodulation has re-emerged as a central strategy for the treatment of drug-resistant epilepsy, driven by advances in stereo-electroencephalography, network neuroscience, and signal processing. This perspective paper summarizes and integrates the key scientific, technical, and clinical insights presented during the American Epilepsy Society (AES) 2025—Epilepsy Surgery Symposium on Advances in Thalamic Neuromodulation for Epilepsy: From Mechanisms of Action to Clinical Application . Beyond a summary of the individual presentations, this manuscript reflects the collective opinions of the panel regarding current evidence, unresolved controversies, and future directions. An unifying theme emerged: effective thalamic neuromodulation requires a shift from empiric, one-size-fits-all targeting toward patient-specific, hodology-informed strategies grounded in in situ electrophysiology and network-level biomarkers.

Background Studies have demonstrated an association between endothelial dysfunction and major depressive disorder (MDD). However, the link between coronary endothelial dysfunction (CED) and an incident diagnosis of MDD across sexes is unclear. Methods Patients with nonobstructive coronary artery disease (stenosis <40%) underwent an invasive assessment of CED. Macrovascular CED was defined as a percentage change in coronary diameter in response to acetylcholine of ≤−10% compared with baseline. Microvascular CED was defined as a percentage change in coronary blood flow in response to acetylcholine of ≤−50% compared with baseline. In the period after the index procedure, patients were followed up for developing a diagnosis of MDD, and logistic regression was performed to assess the association between baseline CED and incident MDD. Results In total, 2280 patients underwent invasive testing for CED. A total of 516 patients (23%) underwent an evaluation for MDD at a date after the index procedure (mean±SD age, 53±12 years; 72% women). A total of 160 (31%) were diagnosed with MDD. The percentage change in coronary diameter in response to acetylcholine was lower in those diagnosed with MDD in all patients (−10.8% versus −5.3%; P =0.008), and in men (−19.0% versus −4.8%; P =0.001). In men, a higher proportion of those with macrovascular CED were diagnosed with MDD compared with those not diagnosed with MDD (59% versus 38%; P =0.035). In multivariable analyses, macrovascular CED was associated with MDD in men (odds ratio: 2.99 [95% CI, 1.26–7.45]; P =0.015). Conclusions Macrovascular CED is significantly associated with incident MDD in men with nonobstructive coronary artery disease. Endothelial dysfunction in the coronary arteries could thus be a helpful biomarker to identify patients at risk of MDD.

Background Resuming anticoagulation in patients with mechanical heart valves after intracranial hemorrhage presents a clinical dilemma. The optimal timing must balance the risk of thromboembolism against hemorrhagic expansion. Prior studies have addressed this issue, but most were limited by small sample sizes. This systematic review and meta‐analysis aimed to determine the optimal timing for anticoagulation resumption in this population. Methods We conducted a systematic review and meta‐analysis using PubMed, Embase, Web of Science, and Scopus from database inception to August 23, 2024. The target population included adults with intracranial hemorrhage who required anticoagulation for mechanical heart valves. Results Thirteen studies involving 788 patients were included: 12 retrospective and 1 prospective observational study. While off anticoagulation, 32 patients developed ischemic stroke, with a pooled event rate of 5.23% (95% CI, 3.80–7.20%) and negligible heterogeneity ( I 2 = 0%). The pooled average time to stroke was 8.08 days (95% CI, 1.99–14.18). After anticoagulation resumption, 73 patients experienced hemorrhagic recurrence, corresponding to a pooled event rate of 10.95%, with nonsignificant heterogeneity ( I 2 = 40.4%). Conclusions Withholding anticoagulation for up to 7 days after intracranial hemorrhage in patients with mechanical heart valves appears relatively safe. Hemorrhagic recurrence after resumption was more common than ischemic stroke during interruption. However, the included studies were observational and carried serious or critical risk of bias. Prospective multicenter studies, and ideally randomized trials, are needed to provide more definitive evidence.

Background The prognostic significance of an adverse acid–base milieu despite venoarterial extracorporeal membrane oxygenation support in patients with cardiogenic shock remains poorly defined. We examined metabolic and respiratory disturbances in the ELSO (Extracorporeal Life Support Organization) Registry among patients who received venoarterial extracorporeal membrane oxygenation support for refractory cardiogenic shock. Methods Arterial blood gas acid–base values at 24 hours following venoarterial extracorporeal membrane oxygenation initiation were analyzed, with patients classified by pH, arterial partial pressure of carbon dioxide, and bicarbonate. Multivariable logistic regression and exploratory machine learning analyses were used to assess predictors of in‐hospital mortality. Results Among 15 144 adult patients, 74.6% (10 860) had neither respiratory nor metabolic acidosis, 13.1% (1909) had isolated respiratory acidosis, 11.6% (1684) had isolated metabolic acidosis, and 0.7% (100) had combined acidosis. In‐hospital mortality occurred in 7719 (51.0%) patients and increased incrementally across patients with lower pH (adjusted odds ratio [OR], 2.03 with each 0.1‐unit decrease in pH, using 7.4 as a reference point [95% CI, 1.82–2.26]), bicarbonate (adjusted OR, 1.93 per each 5‐mEq/L <24 mEq/L [95% CI, 1.76–2.12]) or base excess (adjusted OR, 1.90 per each 5‐mEq/L <0 mEq/L [95% CI, 1.75–2.07]) (all P <0.01). Mortality varied significantly, being highest for the low‐pH metabolic acidosis cluster (adjusted OR, 1.90 [95% CI, 1.70–2.12], P <0.01). Conclusions Survival decreased progressively with worse acidemia or metabolic acidosis despite 24 hours of hemodynamic support with venoarterial extracorporeal membrane oxygenation among patients with cardiogenic shock. Our findings emphasize the prognostic significance of metabolic parameters as potentially modifiable risk factors and underscore the need for early recognition and interventions to mitigate severe metabolic derangements.

Background An increasing number of patients with congenital heart disease (CHD) are pursuing pregnancy with the potential for cardiovascular complications. This study aimed to establish patient‐centered national research and care priorities to improve pregnancy‐related outcomes for individuals with CHD. Methods This mixed‐methods study used a modified Stakeholder Engagement in Question Development methodology to systematically identify patient‐centered priorities. Key activities included consortium engagement (phase 1), patient and provider questionnaires (phase 2), and an in‐person facilitated meeting to explore survey results and follow‐up virtual focus groups (phase 3). Reflexive thematic analysis was used to synthesize short‐ and long‐term research priorities (phase 4). Results Three overarching goals emerged: (1) improving access to specialized CHD, cardio‐obstetrics, and mental health care; (2) improving quality and consistency in clinical care; and (3) increasing patient and community engagement. These goals were then expanded into 5 central themes: (1) communication within the health care setting; (2) community engagement; (3) ancillary clinical support; (4) integration of patient‐reported outcomes; and (5) implementation, education, and knowledge mobilization. Short‐term (1–5‐year) goals included expanded telemedicine use, best practice recommendations for multidisciplinary care coordination, and targeted educational resources. Long‐term (5–10‐year) goals included expansion of adult CHD and cardio‐obstetrics programs, integration of mental health services, and advocacy to improve insurance coverage. Conclusions The consortium provided a national, community‐driven prioritization that highlights actionable pathways to improve pregnancy outcomes for people with CHD. Sustained engagement with patients and community partners is essential to achieving durable improvements across cardio‐obstetric care, education, research, and mental health.

ABSTRACT Background Fosaprepitant is non‐inferior to aprepitant in adults receiving highly emetogenic chemotherapy (HEC). We evaluated whether fosaprepitant is non‐inferior to aprepitant in children receiving HEC. Methods In this open‐label, non‐inferiority trial, children aged 5–18 years, receiving their first cycle of HEC, were randomized 1:1 to the fosaprepitant or aprepitant group. The fosaprepitant group received a single intravenous dose of 4 mg/kg (max 150 mg). The aprepitant group received oral aprepitant capsules (weight 15 to <30 kg: 80 mg Days 1–3; weight ≥30 kg, or age ≥12 years: 125 mg Day 1, 80 mg Days 2 and 3). Both groups received ondansetron and dexamethasone. The primary outcome was the complete response (CR) rate of vomiting during the acute phase (AP) with a non‐inferiority margin of 15%. Secondary outcomes included CR rates in the delayed (DP) and overall phases (OP), grade of vomiting, incidence and severity of nausea, and adverse effects. Results A total of 279 children were included in the modified intention‐to‐treat analysis (fosaprepitant group: 140; aprepitant group: 139). In AP, the difference of CR rate between fosaprepitant [76 (54.3%)] and aprepitant groups [84 (60.4%)] was −6.1% [90% CI: −15.7% to +3.6%], with the lower limit exceeding −15%, failing to establish non‐inferiority. The CR rate with fosaprepitant versus aprepitant was 62.1% ( n = 87) versus 65.5% ( n = 91) in DP (difference: –3.4%; 90% CI: –12.7% to 6.1%) and 42.9% ( n = 60) versus 49.6% ( n = 69) in the OP (difference: –6.7%; 90% CI: –16.5% to 3.1%). Grade of vomiting, incidence and severity of nausea, and adverse effects were similar between the two groups. Conclusions Non‐inferiority of fosaprepitant compared to aprepitant was not demonstrated in children undergoing their first cycle of HEC. Trial Registration Clinical Trials Registry, India (CTRI/2019/05/019082).

ABSTRACT The local treatment of bladder and prostate rhabdomyosarcoma is a multidisciplinary decision, incorporating elements of patient age, tumor size and location, nodal involvement, and access to local expertise and technology. The relative absence of long‐term bladder and bowel function outcome data complicates discussions, particularly given improved survival rates and development of new surgical and radiotherapy techniques. These INSTRuCT guidelines, a collaboration of the Children's Oncology Group, Soft Tissue Sarcoma Committee, European Pediatric Soft Tissue Sarcoma Study Group, and the Cooperative Weichteilsarkom Studiengruppe, reflect international expert consensus and are intended to inform practice, generate discussion, and highlight areas of future inquiry.

Abstract Faciobrachial dystonic seizures (FBDS), paroxysmal dizziness spells, and thermal sensory attacks are highly frequent and stereotypic phenomena experienced in leucine‐rich glioma inactivated 1 (LGI1)‐antibody encephalitis. This study aims to describe the electrophysiologic mechanism underlying these pathognomonic symptoms. LGI1‐antibody encephalitis patients with active symptoms were enrolled from two separate centers in South Korea and the United States. Patients were evaluated with simultaneous magnetoencephalography (306 channels) and electroencephalography. Regional alterations in neuronal excitability represented by interictal epileptiform discharges were present in the faciobrachial area of the motor cortex, insula, and somatosensory cortex, somatotopically aligned with each of the ictal semiologies observed in patients. FBDS and other LGI1‐antibody encephalitis‐specific spells localized to cortical regions neuroanatomically corresponding to ictal semiologies: the faciobrachial homunculus (FBDS), insular cortex (paroxysmal dizziness spells), and somatosensory cortex (thermal sensory attacks). Our findings support the ictal hypothesis underlying these unique phenomena.

Antithrombotic therapy plays an important role in reducing stroke recurrence. For noncardioembolic stroke, multiple trials have demonstrated the efficacy of antiplatelet monotherapy for secondary stroke prevention. In select situations, such as short-term treatment in the acute period after a minor stroke or transient ischemic attack, dual-antiplatelet therapy has demonstrated superiority to monotherapy. Multiple trials have tested more aggressive strategies using long-term combination antiplatelet medications or full-dose anticoagulation with limited evidence of a reduction in ischemic events but a relatively consistent increased risk of bleeding. Emerging new agents targeting factor XI/XIa may uncouple necessary hemostasis from pathological thrombosis and offer promise for enhancing secondary prevention of stroke without increasing bleeding. The recently positive OCEANIC-STROKE trial (Oral Factor Eleven A Inhibitor Asundexian as Novel Antithrombotic) testing dual-pathway inhibition with the factor XIa inhibitor asundexian in combination with antiplatelet therapy represents a major advance in antithrombotic therapy for noncardioembolic stroke. This review summarizes the current state of the evidence for antithrombotic therapy in secondary stroke prevention after noncardioembolic stroke and discusses completed and ongoing trials of novel factor XI/XIa inhibitors for stroke prevention.