Journal of neurosurgical sciences最新文献

Introduction: Digital subtraction angiography is considered the reference standard for diagnosing reversible cerebral vasoconstriction syndrome (RCVS); however, its invasive nature limits routine application. Transcranial Doppler ultrasonography (TCD) represents a noninvasive and bedside-accessible alternative, but its diagnostic and monitoring value in RCVS remains uncertain.

Evidence acquisition: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed, Embase, Cochrane Library, Scopus, and Web of Science up to January 2024. Eligible studies included case reports, case series, and observational designs involving adults with angiographically confirmed reversible vasoconstriction that reported TCD or color-coded sonography parameters (e.g., mean flow velocity, vasospasm). Risk of bias was assessed with ROBINS-I or Joanna Briggs Institute tools. Due to heterogeneity, results were synthesized descriptively.

Evidence synthesis: From 709 records, 8 studies encompassing 128 patients were included. TCD demonstrated increased mean flow velocities in the middle cerebral artery during the acute phase of RCVS, with reported peaks up to 146 cm/s, followed by gradual return to baseline within 6-12 weeks. Vasospasm was observed in up to 93.3% of patients, usually peaking between days 13 and 28. The Lindegaard index, ranging from 2.2 to >7, was valuable in distinguishing hyperemia from vasospasm. Serial bedside examinations, often every 24-48 hours during hospitalization, facilitated timely detection and monitoring of evolving hemodynamic changes. Nonetheless, included studies were small, heterogeneous, and methodologically limited.

Conclusions: Transcranial Doppler ultrasonography appears promising as a noninvasive method for detecting cerebral vasospasm and monitoring temporal hemodynamic trajectories in RCVS.

Predictive modeling has the potential to improve preoperative planning and resource allocation in lumbar fusion surgery. This study aimed to identify the 20 most important variables for predicting prolonged postoperative length of stay (pLOS) using machine learning (ML). The ACS-NSQIP database was queried for lumbar fusion procedures performed between 2012 and 2022, including ALIF, PlatIF, PLIF, and combined PLIF+PlatIF. Variable selection was performed using MUVR and Boruta, followed by hierarchical clustering and 5-fold cross-validation to ensure feature robustness. The 20 selected features were used to train multiple ML models, including tree-based classifiers (Random Forest, XGBoost, CatBoost, LightGBM), support vector classifiers, neural networks, ensemble methods, and logistic regression. A total of 114,892 patients were included. Eleven patient-specific and nine procedural variables were identified as most predictive of prolonged pLOS. Among patient factors, dialysis, congestive heart failure, and bleeding disorders were strongest predictors. Among procedural factors, osteotomy, billing of additional fusion codes, and longer operation time had the greatest impact. The neural network achieved the highest accuracy (71.2%), recall (79.4%), and F1-score (73.8%), though all models performed similarly, with minimal variation in classification metrics. These findings underscore that model choice plays a limited role once optimal features are selected - feature selection was the most critical determinant of predictive performance.

Background: Spinal chondrosarcoma is a rare malignant tumor requiring complex resection due to its resistance to chemotherapy and radiation. This study aimed to identify predictors of both 30-day readmission and prolonged length of hospital stay (LOS) following surgical resection of spinal chondrosarcoma using data from the National Cancer Database (NCDB).

Methods: Using the NCDB, we conducted a retrospective analysis of adult patients diagnosed with spinal or sacral chondrosarcoma between 2004 and 2017 who underwent surgical resection. We collected patient demographics, tumor characteristics, and treatment details. Patients were grouped based on 30-day readmission. A separate analysis was conducted on LOS, defining prolonged LOS as >75^th percentile. Multivariable analyses identified risk factors for each outcome.

Results: Of the 1971 patients in the 30-day readmission analysis, 114 (5.8%) experienced readmission. Of the 1392 patients included in the LOS analysis, 341 (24.5%) experienced prolonged LOS. The risk factors of prolonged LOS included age (OR=1.015; 95% CI, 1.006-1.024; P<0.001), male sex (OR=1.440; 95% CI, 1.076-1.926; P=0.014), tumor volume >11 cm³ (OR=1.001; 95% CI, 1.000-1.002; P=0.018), sacral/coccygeal tumors (OR=1.831; 95% CI, 1.162-2.844; P<0.001), and gross total resection (GTR) (OR=1.514; 95% CI, 1.068-2.146; P=0.020). Multivariate regression identified no significant predictors of 30-day readmission.

Conclusions: Tumor volume, sex, and other factors influence 30-day readmission and prolonged LOS. Prolonged LOS was further associated with sacral/coccygeal tumors and GTR, reflecting the complexity of surgical management.

Introduction: Spontaneous supratentorial intracerebral hemorrhage (SSICH) is a severe neurological condition associated with high morbidity and mortality, posing significant challenges to clinical management. Among the potential therapeutic strategies, decompressive craniectomy (DC) has been employed to reduce intracranial pressure and prevent secondary brain injury in various contexts, including traumatic brain injury (TBI) and spontaneous intracerebral hemorrhage (sICH). While its benefits are better established in some of these conditions, the specific role and efficacy of DC in the treatment of SSICH remain uncertain. In light of these uncertainties, we conducted a systematic review and meta-analysis to synthesize the available evidence and evaluate the impact of DC - alone or in combination with best medical treatment (BMT) - on clinical outcomes in patients with SSICH.

Evidence acquisition: A systematic search was conducted in the PubMed, Embase, and Cochrane databases. Eligible studies included patients aged 18 to 75 years with SSICH, with the intervention being DC alone or DC combined with BMT, and the control group receiving BMT alone. Studies had to report the outcomes of interest, particularly the primary outcome of mortality. No specific time restrictions were applied, and only randomized controlled trials (RCTs) and observational studies were eligible. The risk of bias in the only RCT included was assessed using version 2 of the Cochrane Risk of Bias tool (RoB-2), while the five observational studies were evaluated using the Risk of Bias in Non-randomized Studies of Interventions tool (ROBINS-I).

Evidence synthesis: A total of six studies were included, comprising 492 patients (224 treated with DC and 268 with BMT alone). Mortality at 30 days, 3 months, 6 months, and 12 months was lower in the intervention group (DC) compared to the control group (BMT alone). Subgroup analyses demonstrated statistical significance across all four timepoints. However, there were no statistically significant differences between groups regarding the incidence of overall infections, pneumonia and urinary tract infections.

Conclusions: Our study concludes that DC reduces mortality in patients with SSICH compared to BMT, although the choice between these treatments does not appear to significantly affect the risk of pneumonia or urinary tract infections. Despite these findings, further studies - particularly RCTs - are needed to provide more robust evidence on this topic.

Introduction: Low-grade gliomas (LGGs) are slow-growing heterogeneous tumors that remain challenging when complete resection is not feasible. While maximal safe resection remains standard, the evolving World Health Organization (WHO) classification emphasizing molecular characteristics has shifted perspectives on adjuvant therapies. In this context, the role of stereotactic radiosurgery (SRS) continues to be explored. This systematic review synthesizes literature on radiosurgical management of pathology-proven LGGs across pre- and post-molecular classification eras.

Evidence acquisition: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Scopus, and Web of Science were searched in August 2024 for studies on pathology-proven LGGs treated with SRS. An additional search was performed to incorporate studies reporting molecular characteristics.

Evidence synthesis: Of the initially included eight studies, none reported molecular characteristics required by the 2021 World Health Organization classification, and an additional search identified one study reporting molecular characteristics, which was added to the review. Nine studies with 308 patients were included. Local control rates ranged from 66% to 94%. Several studies reported superior outcomes with surgery for recurrence, adjuvant rather than salvage SRS, and no prior radiotherapy. Adverse events were predominantly mild to moderate, including headache, dizziness, nausea, and transient neurological symptoms.

Conclusions: SRS offers a non-invasive management option for selected LGGs with durable control and acceptable safety. Prognosis appears to be influenced by treatment history, including prior radiotherapy and surgical management. Lack of molecular stratification highlights the need for studies focused on IDH (isocitrate dehydrogenase)-mutant LGGs to clarify the role of SRS in the molecular era.

Background: Falcine/parasagittal lesions account for the largest rate of high-grade (WHO grade 2-3) lesions. The ability to preoperatively estimate the tumors' grade and outcome would be of great value in customizing treatment.

Methods: This is a single-center, retrospective study designed to assess the pre-operative peripheral blood markers' diagnostic and prognostic role in patients harboring falcine (FM) and parasagittal (PM) high-grade meningiomas. N=116 patients undergoing surgical resection were included. A propensity score-matched analysis accounted for gender imbalances in low-grade (LG) vs. high-grade (HG) cohorts.

Results: Seventy-three (N.=73) FM (63%) and 43 PM (37%) lesions were included. Patients harboring HG lesions showed significantly higher Hb levels than LG (mean 14.5±1.40 vs. 13.5±1.16 g/dL, P<0.001). Multivariate analysis controlling for demographics, lesion characteristics, blood markers, and steroid dose confirmed preoperative Hb as an independent predictive value of lesion grade (OR 1.75, 95% CI:1.01-3.07, P=0.04). Accordingly, patients showing increased Hb levels >15.4 g/dL achieved shorter OS (60.4 months, 95% CI: 14.7-106.1 vs. 134.7 months, 95% CI: 111.2-158.2) compared to patients with lower Hb values, P<0.001. Data were confirmed in matched cohorts.

Conclusions: Increased levels of circulating erythrocytic hemoglobin might be independent predictors for high-grade histology and be associated with shorter overall survival in falcine and parasagittal meningiomas.

This article was published in Volume 67, issue 4 of publishing year 2023, with a mistake in Figure 3. The correct Figure 3 is the one included in this erratum.