Journal of Korean Neurosurgical Society最新文献

Objective: This study investigated the cerebrospinal fluid (CSF) dynamic changes before and after cranioplasty using phase-contrast cine magnetic resonance imaging (MRI).

Methods: We performed a prospective observational study in the patients who underwent cranioplasty in the neurosurgical department of our hospital between June 2022 and March 2025. We reviewed the changes of CSF flow parameters in the cerebral aqueduct before and after cranioplasty.

Results: Totally, nine patients were enrolled, including five males and four females, with a mean age of 48.1 years. The time interval between decompressive craniectomy (DC) and cranioplasty was 119.1 ± 45.1 days. The skull defect diameter and area were 10.7 ± 2.2 cm and 94.4 ± 34.6 cm², respectively. There are significant increases in forward flow volume (p = 0.002), backward flow volume (p = 0.002), net stroke volume (p = 0.012), absolute stroke volume (p = 0.001), mean flux (p = 0.005), mean velocity (p = 0.001), and peak velocity (p < 0.001) after cranioplasty when compared with those parameters before cranioplasty. No significant correlation was observed between patient characteristics and the improvement magnitude of CSF flow parameters caused by cranioplasty.

Conclusion: This study indicates that cranioplasty may have beneficial effects on CSF flow dynamics in the cerebral aqueduct after DC, which provides therapeutic potentials for complications related to CSF flow stagnancy after DC.

Objective: Epidural fibrosis (EF) is a major contributor to postoperative morbidity following laminectomy. This study investigated the antifibrotic, anti-inflammatory, and anti-angiogenic effects of nintedanib (NIN), a multi-tyrosine kinase inhibitor, in a rat model of post-laminectomy EF.

Methods: Twenty-one male Wistar albino rats were assigned to three groups: Control, Laminectomy (LAM), and Laminectomy + Nintedanib (NIN). The laminectomy procedure was performed at the L3 level. NIN administration, following laminectomy, was administered orally at a dose of 50 mg/kg/day for 28 days. Histopathological evaluations included hematoxylin-eosin staining for dura mater thickness and fibroblast density, and Masson's trichrome staining for collagen deposition and adhesion grading. α-smooth muscle actin (α-SMA) expression was evaluated using immunohistochemistry and RT-qPCR. Gene expression of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), vascular endothelial growth factor (VEGF), platelet-derived growth factor receptor (PDGFR), and transforming growth factor-β1 (TGF-β1) was quantified to characterize inflammatory, angiogenic, and fibrogenic responses. Statistical comparisons were conducted using one-way ANOVA or Kruskal-Wallis tests with appropriate post hoc analyses.

Results: The LAM group exhibited marked post-laminectomy changes, including increased dura mater thickness (8.20 ± 0.23 µm vs. 3.93 ± 0.08 µm in controls, p < 0.0001), elevated fibroblast density (p = 0.0006), severe collagen deposition, and high-grade epidural adhesions (Grade 3, p = 0.0006). NIN treatment attenuated these alterations, reducing dura mater thickness (4.80 ± 0.20 µm, p < 0.0001 vs. LAM), fibroblast density (p < 0.01), and adhesion grade (Grade 1, p = 0.0012). α-SMA immunoreactivity was high in LAM (Grade 3, p < 0.0001), whereas NIN significantly suppressed myofibroblast activation (Grade 1, p = 0.0012). NIN also significantly downregulated inflammatory mediators TNF-α (p < 0.001) and IL-1β (p < 0.001), as well as angiogenic markers VEGF (p < 0.001) and PDGF (p < 0.001), and fibrogenic mediators TGF-β1 (p < 0.001) and α-SMA (p < 0.01). These findings indicate that NIN suppresses fibroblast activation, extracellular matrix accumulation, and myofibroblast differentiation, thereby limiting epidural adhesion and scar maturation.

Conclusion: Nintedanib effectively mitigated epidural fibrosis after laminectomy through combined antifibrotic, anti-inflammatory, and anti-angiogenic actions. By improving the dural structure and reducing key molecules that contribute to scar formation, NIN shows significant promise as a treatment to prevent postoperative epidural adhesions. Future studies with extended follow-up may help clarify its clinical relevance.

Objective: This paper sets out to observe the comprehensive clinical effect and advantages of cryopreserved autogenous skull replantation.

Methods: We collected the data of 141 patients with skull defect. Among them, 111 patients underwent cryopreserved autogenous skull replantation, 68 cases were frozen without cryoprotectant and 43 cases were frozen with cryoprotectant. In addition, 30 patients received artificial skull repair. We collected several variables related to the occurrence of complications and explored their correlation, followed by clinical experiments.

Results: After treatment, all incisions of 141 patients healed in the first stage, and there was no infection or need for a second operation. During the follow-up period, bone resorption occurred in some of the 111 patients with autologous bone repair. The hospitalization cost of patients with autologous bone repair is lower than that of patients with artificial material repair. Internal repair within 60 days (the time interval between decompressive craniectomy and cranioplasty, that is the cryopreservation time of the bone flap is within 60 days) and cryopreservation using cryoprotectant can effectively reduce the absorption rating of the skull. Among them, the absorption rate is higher in diabetic patients. As for clinical experiments results, the cell activity decreases and the apoptosis rate rises with freezing time.

Conclusion: Revascularization was found in all the cryopreserved autogenous skulls after replantation. Cryopreservation can effectively reduce the absorption of autogenous bone.

Objective: Decompressive craniectomy (DC) is a surgical procedure in which a portion of the skull overlying edematous and vulnerable brain tissue is removed to reduce ICP. In cases where all other treatment modalities fail, DC can be life-saving. However, this procedure is not a "panacea";it can prolong the death process and condemn the patient to a life in need of care, with severe neurological sequelae.

Methods: This multicenter, retrospective study recorded patients' comorbidities, Glasgow Coma Scale, APACHE II and SOFA scores, as well as relevant laboratory parameters. Patients were categorized into three groups according to the Glasgow Outcome Scale (GOS).

Results: Among 201 patients, 41.3%ex, 33.8% survived with severe vegetative sequelae, and 24.9% had mild to moderate sequelae. Non-survivors had significantly lower preoperative and postoperative GCS scores (median 7 vs.9, p=0.010; 3 vs.10, p<0.001) and higher 24-hour peak glucose levels (186 vs.164 mg/dl,p=0.009). Steroid therapy was ineffective. Preoperative GCS scores were significantly lower in patients who later developed severe sequelae compared to those with better outcomes (median 8 vs.11; p<0.001). Postoperative GCS scores were also lower in this group (8 vs.13; p<0.001).Additionally, APACHE II(22 vs.18; p=0.002) and SOFA scores (4 vs.3; p<0.001) were higher, indicating greater disease severity.

Conclusion: DC can be a lifesaving procedure in selected patients with appropriate indications and appropriate timing. However, the possibility of this procedure resulting in high mortality and severe sequelae cannot be ignored. Therefore, the clinical outcomes that the patient and their families would find acceptable should be carefully considered.

Objective: This study investigated the relationship between arterial partial pressure of oxygen (PaO2) levels in the first 24 hours of intensive care unit (ICU) admission and clinical outcomes in neurocritically ill brain tumor patients.

Methods: In this single-center retrospective study of 2123 brain tumor patients, we analyzed PaO2 levels from arterial blood gas samples within 24 hours of ICU admission. The primary endpoint was 28-day mortality. Analysis utilized multivariable logistic regression and inverse probability of treatment weighting (IPTW).

Results: PaO2 exceeding 91.5 mmHg was defined as hyperoxia. The non-hyperoxia group showed higher 28-day mortality than the hyperoxia group (15.5% vs. 6.0%, p<0.002), a trend that persisted after IPTW adjustment (10.7% vs. 6.6%, p=0.019). In IPTW-adjusted regression, non-hyperoxia remained significant (adjusted odds ratio [OR], 3.24; 95% confidence interval [CI], 1.82-5.77). Survival analysis demonstrated significantly higher survival rates in the hyperoxia group (p<0.001). Subgroup analysis revealed significant heterogeneity across tumor types (p for interaction <0.001), with protective effects observed in malignant brain tumors (adjusted OR, 3.5; 95% CI, 1.88- 6.51) and brain metastases (adjusted OR, 3.86; 95% CI, 2.31-6.44), but not in benign tumors (adjusted OR, 1.14; 95% CI, 0.22-5.87).

Conclusion: Elevated PaO2 levels within the first 24 hours of ICU admission were associated with decreased mortality rates, suggesting oxygenation as a potential therapeutic target in brain tumor patients. The protective effects were most pronounced in patients with malignant brain tumors and brain metastases, supporting a tumor type-specific approach to oxygenation management.

Objective: The insertion of a surgical paddle lead for spinal cord stimulation (SCS) is a cornerstone therapy for chronic refractory pain, with lower impedance and reduced battery usage than a percutaneous lead. However, the greater invasiveness of this procedure can cause complications.

Methods: This study introduces a novel SCS technique using the unilateral biportal endoscopy (UBE) approach, illustrated through intraoperative images and endoscopic videos. We retrospectively reviewed 14 patients who underwent SCS using the UBE technique. Clinical, surgical, and radiological data were collected from electronic medical records and surgical videos.

Results: A total of 14 patients (five females, nine males) were included in the study. The mean endoscopic operating time was 76.3±22.3 minutes. After the trial period, 13 patients (92.8%, 13/14) improved and underwent permanent implantation. The complication rate was 21.4%, with two cases of thoracic radiculopathy and one case of asymmetrical lead positioning. No lead migration was observed in these 13 patients.

Conclusion: This study demonstrated the safety and efficacy of UBE-SCS as a minimally invasive alternative to conventional techniques, with high success rates and acceptable complications. However, further large-scale, long-term comparative studies are needed.

Objective: This study aimed to elucidate the normative upper lumbar lordosis (ULL) and lower LL (LLL) based on individual pelvic and spinal morphology within an asymptomatic elderly population.

Methods: Whole spine standing radiographs were obtained from asymptomatic elderly populations who had not undergone previous spinal surgery. The LL, LLL and ULL were measured. Pelvic incidence (PI), upper lumbar distribution index (ULDI), and lower LDI were calculated. Pearson correlation and linear regression analyses were performed, and the mean value for each parameter was obtained according to PI subgroup (PI <40°, 40°≤ PI <50°, 50°≤ PI <60°, and 60°≤ PI) and "theoretical" Roussouly type.

Results: Overall, data from 150 male were retrospectively collected in the study, with an average age of 64.1±6.4 years. The mean height was 167.0±5.5 cm, weight was 67.3±9.8 kg, and body mass index was 24.1±3.1 kg/m2. The average LL was -57.5°±9.0°, LLL was -39.7°±6.8°, and PI was 48.6°±8.6°. Pelvic tilt (PT) tended to increase with ULL, PI-LL, PI-ULL, PI-LLL, and ULDI and decrease with LLL and LDI. However, PT was not significantly related to LL. The mean ULDI and LDI were 30.4%±11.7% and 69.7%±11.7%, respectively. The differences between PI and LL (PI-LL) and between PI and LLL (PI-LLL) were -8.9°±8.0° and 9.0°±9.3°, respectively. As PI increased from low (<40°) to high (≥60°), ULDI increased significantly from 25.9% to 38.9%, while LDI decreased from 74.1% to 61.1%. Additionally, LDI varied by Roussouly type, ranging from 62.6% to 81.0%. The LDIs of Roussouly types 1 and 4 were significantly higher and lower, respectively, than those of types 2 and 3 (p<0.001).

Conclusion: As PI and Roussouly type increase, the contribution of ULL to overall LL rises, reaching up to 38.9%. Conversely, LLL substantially impacts LL in patients with a low PI and those classified as Roussouly type 1. PT is significantly related to LLL instead of LL according to PI.

Objective: Posterior endoscopic cervical foraminotomy (PECF) is a minimally invasive surgical technique for treating cervical radiculopathy. Traditionally, PECF is performed under general anesthesia in the prone position, but concerns over anesthesia-related complications have led to the exploration of local anesthesia in the lateral decubitus position as an alternative. This study aims to compare the clinical outcomes, safety, and efficacy of PECF performed under local anesthesia in the lateral decubitus position versus general anesthesia in the prone position.

Methods: We conducted a retrospective analysis of 13 patients who underwent PECF under local anesthesia in the lateral decubitus position. The outcomes were compared with data from 357 patients across eight studies who underwent PECF under general anesthesia in the prone position. Outcomes measures included Visual analog scale (VAS) pain scores, Oswestry disability index (ODI), length of stay (LOS), minimally clinically important difference (MCID), and complications.

Results: Patients in the local anesthesia group demonstrated significant reductions in neck pain (VAS-N : 4.93±1.32 to 1.49±0.52, p<0.001) and arm pain (VAS-A : 8.69±0.75 to 1.85±1.46, p<0.001), achieving a mean pain reduction of 78.8%. These improvements were comparable to the general anesthesia group (VAS-N : 4.80 to 1.28; VAS-A : 6.71 to 1.23). Functional outcomes improved significantly in both groups, with ODI scores improving from 54.76% to 9.82% locally and from 39.92% to 9.62% in the general group. Although LOS was slightly longer for the local anesthesia group (5.85±3.20 vs. 4.81±2.17 days, p=0.18), post-procedure monitoring time was significantly shorter (3.2 vs. 7.4 hours, p<0.001). The local anesthesia group reported zero complications (0%; 95% confidence interval [CI], 0-22.8%) compared to an 8.68% complication rate (95% CI, 5.8-11.6%) in the general anesthesia cohort (p=0.612).

Conclusion: PECF under local anesthesia in the lateral decubitus position provides comparably effective pain relief and functional improvement comparable to general anesthesia, though the difference in complication rates was not statistically significant and requires larger studies for confirmation. This technique may be particularly advantageous for patients at higher risk for anesthesia-related complications. Further research is warranted to validate these findings in larger, prospective studies.

Objective: Acoustic neuromas, or vestibular schwannomas, pose significant surgical challenges due to their proximity to critical cranial nerves, particularly the facial nerve. The primary goal in their surgical treatment is to achieve maximal tumor removal while preserving neurological function. Recent advancements in surgical technology have introduced neuroendoscopy as an adjunctive tool that can enhance visualization during surgery. This study aimed to evaluate the efficacy of integrating neuroendoscopy with intraoperative electrophysiological monitoring in near-total resection surgeries for acoustic neuroma.

Methods: We conducted a retrospective cohort study comparing 71 patients who underwent neuroendoscopy-assisted microsurgery technique with 68 patients who received standard care group technique. Both groups underwent the suboccipital retrosigmoid sinus approach for tumor resection with intraoperative electrophysiological monitoring. Surgical outcomes, including residual tumor size, facial nerve function, audiological outcomes, and complication rates, were compared between the two groups.

Results: The neuroendoscopy-assisted group demonstrated a significantly smaller residual tumor size, improved immediate and 1-year postoperative House-Brackmann grades, and a higher facial nerve preservation rate compared to the standard care group (p<0.05). There was no significant difference in operation time, blood loss, cerebrospinal fluid leakage, or complication rates between the groups. Word recognition scores after a year were significantly higher in the neuroendoscopy-assisted group (p<0.05).

Conclusion: The integration of neuroendoscopy-assisted microsurgery technique in acoustic neuroma surgery improves facial nerve function and residual tumor size without increasing surgical complications. These findings support the utility of this combined approach in enhancing surgical outcomes for patients with acoustic neuroma.