Journal of Korean Neurosurgical Society最新文献

Objective: Radiotherapy is a key treatment for brain tumors and arteriovenous malformations; however, it is associated with adverse effects such as brain edema, demyelination, and delayed necrosis. These adverse effects are driven by inflammation and apoptosis, initiated by cytokines such as tumor necrosis factor-α, transforming growth factor, and interleukin-1β. Adipose tissuederived mesenchymal stromal cells (ADMSCs) offer protection against radiation-induced damage owing to their pluripotency and antiinflammatory properties. In this study, we investigated the neuroprotective effects of ADMSCs on irradiated brain cells.

Methods: Rat cortical neurons, human glioblastoma cells (U87 cell line), and ADMSCs were exposed to radiation doses ranging from 3 Gy to 40 Gy. Co-cultures of irradiated neurons with ADMSCs or their secretomes were assessed for apoptotic and inflammatory markers. Cell viability was measured using lactate dehydrogenase (LDH) and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays. Apoptosis was determined by using Hoechst staining and western blot analysis of proteins such as Bax, caspase-3, and Bcl-2.

Results: Higher radiation doses (30-40 Gy) significantly increased apoptosis and decreased the viability of cortical neurons and U87 cells. Co-culture with ADMSCs reduced the levels of apoptosis markers, particularly Bax and cleaved caspase-3, and promoted cell survival. Direct co-culture provided more pronounced protection than did ADMSC secretome treatment, suggesting that cell-to-cell interactions are crucial for neuroprotection.

Conclusion: ADMSCs have a significant potential for mitigating radiation-induced brain damage by reducing apoptosis and inflammation. Direct ADMSC co-culture outperformed secretome treatment, thereby emphasizing the importance of physical cell interactions. ADMSC therapy may be a promising approach to protect against radiotherapy-induced neural damage. Further studies are required to optimize the delivery and timing of stem cell therapy.

Objective: Delayed cerebral ischemia (DCI) is a severe complication following aneurysmal subarachnoid hemorrhage (aSAH), potentially leading to functional impairments. Cerebral vasospasm (CVS) is one of the primary mechanisms of DCI. In cases of medically refractory CVS, intra-arterial (IA) nimodipine is a rescue treatment, but its effectiveness can be insufficient. We hypothesized that continuous IA nimodipine infusion (CIAN) could serve as a salvage treatment, and we evaluated its effectiveness and safety.

Methods: We evaluated 274 patients with aSAH admitted between October 2017 and February 2024, identifying those who received IA nimodipine and those who also received CIAN. Characteristics of the patients, length of stay, and modified Rankin scale (mRS) score at the time of discharge were compared between the conventional IA nimodipine and the CIAN groups.

Results: Of the 274 patients, 15 received IA nimodipine, and five of those underwent CIAN. More females were observed in the medically refractory CVS group compared with the non-refractory group (87% [13/15] vs. 66% [171/259]), but there was no sex difference between the CIAN and conventional IA nimodipine groups. CIAN was initiated at a mean of 9 days after the onset of aSAH and continued for 21-81 hours. Two complications were noted, including severe brain edema and suspected heparin-induced thrombocytopenia. However, radiological assessments showed no new lesions. The CIAN group exhibited a longer duration of abnormal findings on transcranial Doppler compared to the conventional IA group (16.0±10.1 vs. 9.4±7.9 days), as well as longer neurocritical care unit (17.4±10.1 vs. 14.1±7.0 days) and hospital stays (46.6±28.7 vs. 29.5±13.2 days). Nonetheless, more achieved a favorable outcome (mRS ≤2) in the CIAN group (80% [4/5] vs. 70% [7/10]).

Conclusion: CIAN is a viable salvage treatment for refractory CVS, providing a prolonged vasodilatory effect compared to conventional IA nimodipine, with favorable outcomes.

Neurofibromatosis type 1 (NF1) is an autosomal-dominant genetic disorder caused by pathogenic variants in the NF1 gene. Its clinical phenotype is heterogeneous and evolves across the lifespan; approximately 1 in 3000 individuals worldwide are affected. Cardinal features comprise café-au-lait macules, axillary/inguinal freckling, cutaneous neurofibromas, plexiform neurofibromas, and opticpathway gliomas. Advanced molecular diagnostics-including next-generation sequencing (NGS) and RNA sequencing-have markedly improved mutation detection rates and facilitate definitive diagnosis. Therapeutic progress has also accelerated : the U.S. Food and Drug Administration has approved the mitogen-activated protein kinase kinase (MEK) inhibitors selumetinib and mirdametinib for the treatment of plexiform neurofibromas, and these agents may offer benefit for additional NF1-related manifestations. The disorder further compromises skeletal integrity, neurocognitive function, and confers an increased risk of malignancy. This review highlights the necessity for multidisciplinary care of individuals with NF1, with emphasis on early diagnosis, age-stratified health-surveillance suggestion from infancy through adulthood, cancer-prevention strategies, and comprehensive genetic counseling, all aimed at mitigating complications and enhancing quality of life.

Objective: To evaluate the influence of preoperative disc morphology and cage-related variables on disc angle change following single-level L4/5 oblique lumbar interbody fusion (OLIF), and to identify predictors of postoperative angle loss and angular subsidence.

Methods: This retrospective study analyzed 80 patients who underwent L4/5 OLIF with posterior percutaneous screw fixation and 1-year radiographic follow-up. Radiographic parameters included preoperative disc angle (DAPRE), sacral slope (SS), and cage position along the anteroposterior axis (Cage_Y). Postoperative disc angle loss was defined as a decrease in disc angle immediately after surgery. Angular subsidence was defined as a decrease in disc angle at follow-up compared to the postoperative period multivariate logistic regression was used to identify independent predictors of these outcomes. Threshold values were determined by receiver operating characteristic curve analysis.

Results: DAPRE >6.0°, SS <32.0°, and posterior cage placement (Cage_Y <1.9 mm) were independently associated with immediate angle loss. Among them, DAPRE showed the strongest predictive power (odds ratio, 7.9). Additionally, a greater initial angular gain was associated with a higher risk of angular subsidence. Based on these three parameters, a risk score (0-3 points) was generated, which showed a stepwise increase in the incidence of angle loss (0% to 81.3%) and subsidence over follow-up.

Conclusion: DAPRE, SS, and Cage_Y are key predictors of disc angle outcomes after OLIF. This model provides a simple, clinically applicable tool to predict alignment maintenance and optimize surgical planning in degenerative lumbar conditions.

Objective: To identify the risk factors that influence the prognosis of patients with cervical spondylotic myelopathy (CSM).

Methods: Clinical data were collected from 158 CSM patients treated between January 2023 and January 2024 at a tertiary medical center. The data were retrospectively analyzed, with a 1-year follow-up. Based on the Japanese Orthopaedic Association (JOA) score, patients were categorized into good and poor recovery groups. Clinical characteristics, laboratory indices, and imaging findings were compared between the groups, and risk factors affecting CSM prognosis were identified.

Results: In a multivariable analysis, age, symptom duration, preoperative JOA score, spinal cord compression ratio, regulatory T cell (Treg) cell count, the number of surgical levels and diabetes history were identified as significant predictors of postoperative outcomes. Interestingly, Treg cell counts showed a novel positive correlation with improvement rates (p<0.001), suggesting their potential role in spinal cord recovery after surgery.

Conclusion: These findings underscore the prognostic relevance of clinical and immunological factors for predicting surgical outcomes in CSM. The observed association between peripheral Treg counts and recovery rates reveals new insights into the immunological mechanisms underlying CSM prognosis, suggesting potential targets for personalized treatment strategies.

Objective: Cervical disc herniation (CDH) is one of the most common pathologies that cause pain and functional loss in cervical spine disorders. The primary reasons for cervical disc patients' presentations are brachialgia, radiculopathy, and myelopathy. Pain leads to a decrease in sleep quality, and the reduction in sleep quality, in turn, negatively affects pain, resulting in a decline in quality of life. In the literature, there are limited studies evaluating pain, sleep quality, quality of life, and daily living activities in patients undergoing CDH surgery. Moreover, these studies do not adequately assess all these criteria together. Our study represents the most homogeneous (disconly) and comprehensive study in the current literature. We believe it will provide clear insights into the effects of CDH surgery and serve as a guide for preoperative patient selection and management.

Methods: This research is a prospective study. Between July 2024 and December 2024, a total of 43 patients underwent surgery for CDH. The patients included in the study were evaluated preoperatively and on the 45th postoperative day using Visual analog scale (VAS), Pittsburgh sleep quality index (PSQI), European quality of life 5 dimensions 3 level version (EQ-5D-3L), Neck disability index (NDI), and Copenhagen neck functional disability scale (CNFDS) scales.

Results: Of the 43 patients included in the study, 28 (65.1%) were female, with a mean age of 43.16±9.82 years. Regarding the levels affected, 25 patients (58.1%) had involvement at the C5-6 level, while 18 patients (41.9%) were at the C6-7 level. Significant improvements were observed in all parameters during the preoperative and postoperative evaluation of VAS, PSQI, EQ-5D-3L, NDI, and CNFDS scales (p<0.001 for each).

Conclusion: In cervical disc patients with ineffective conservative treatment, radicular pain, muscle weakness, and extruded discs, as well as high preoperative scale scores, immediate surgical intervention will result in a reduction in pain and improvements in sleep, quality of life, and daily living activities.

Objective: Familial cerebral cavernous malformation (FCCM) is a genetically inherited condition involving the collection of abnormal slow-flow venous capillaries with no cerebral parenchyma in between. In this case series, we review the clinical, radiological, pathological, and genetic findings of seven blood relatives diagnosed with FCCM and discuss their treatment in light of the different presentations.

Methods: The patients with FCCMs were assessed in our neurosurgery clinic between April 2016 and October 2024. All patients underwent detailed clinical evaluation, radiological imaging, histopathological examination, and genetic testing. Functional outcomes were evaluated using the Karnofsky performance scale (KPS).

Results: Five of the seven patients were symptomatic, while the remaining two were asymptomatic carriers. On radiological examination, hemorrhagic type I lesions were detected in symptomatic cases, whereas the asymptomatic carriers had non-hemorrhagic type 4 lesions. Genetic testing revealed a heterozygous pathogenic mutation in the CCM1 gene in one of the symptomatic patients. The three symptomatic cases underwent surgery for complete resection of the lesions; no additional neurological deficit or residual lesion was detected postoperatively (postoperative KPS score, 100). Histopathological examination revealed benign cavernous angioma in all cases. Over the postoperative follow-up, no seizures were detected in patients who underwent surgery due to refractory epilepsy.

Conclusion: Advances in molecular genetic testing have allowed for prompt diagnosis and timely management of patients with FCCMs. Surgical treatment is an effective option in symptomatic cases with progressive neurological deficits and refractory epilepsy. Regular neurological monitoring and radiological assessment are recommended in symptomatic cases and asymptomatic carriers.

In spinal fusion surgery, autogenous bone grafting remains the gold standard for achieving optimal bone fusion; however, challenges such as donor site morbidity and limited graft availability have prompted active research into alternative options. Recombinant human bone morphogenetic protein-2 (rhBMP-2) exhibits excellent osteoinductive properties. Using rhBMP-2 was anticipated to promote early and effective fusion, particularly in challenging surgical scenarios involving elderly patients, those with low bone density, or individuals with multiple comorbidities, although in these populations, the biological response to rhBMP-2 may be attenuated and the risk of complications increased. This review provides a comprehensive overview of the development, characteristics, and dose-related adverse reactions of rhBMP-2 in spinal fusion, based on extensive clinical and experimental findings. Factors contributing to the decline in rhBMP-2 usage are also discussed. Furthermore, this review proposes a safer carrier with reduced rhBMP-2 doses to optimize delivery and minimize complications. Emphasis is placed on the critical role of carriers in improving bioavailability control, minimizing side effects, and better aligning with natural bone healing processes.

Objective: The current understanding and clinical prediction of brainstem glioma (BSG) are still limited. This study aimed to conduct a large-scale population-based study to construct a clinical predictive model.

Methods: Patients with BSG diagnosed histologically from 1973 to 2016 were identified using the SEER (Surveillance Epidemiology and End Results) database. According to World Health Organization grade, the whole population was divided into the low-grade BSG (LGBSG) cohort and the high-grade BSG (HGBSG) cohort. Univariate and multivariate cox regression analyses were employed to determine prognostic factors of overall survival (OS). All independently prognostic variables were further used to construct nomograms to predict the 1- and 2-year OS probability. The precision and reliability of the nomogram were evaluated by C-index and calibration plots.

Results: Cox regression analysis showed that four independent prognostic factors, were identified in the LGBSG cohort and two independent prognostic factors were identified in the HGBSG cohort. These independently prognostic factors and the main demographic data were further used to construct clinical nomograms for the LGBSG and HGBSG cohorts, respectively. The C-index for the internal validation was 0.89 (95% confidence interval [CI], 0.83-0.95) and 0.64 (95% CI, 0.60-0.68) in the LGBSG and HGBSG cohorts, respectively. The results of the calibration plots showed that the actual observation and prediction values obtained by the nomogram had good consistency in the LGBSG and HGBSG cohorts.

Conclusion: This study identified several independent prognostic variables and further constructed the clinical nomogram model. The nomogram model can provide valuable clinical reference and risk assessments for clinicians to further manage these patients with BSG.