Journal of neurological surgery. Part A, Central European neurosurgery最新文献

Background: The anchor at C2 often serves as a key stabilizer in cervical spine fusion surgery. Although the pedicle screw (PS) is considered the standard fixation method at C2, the laminar screw (LS) is also a widely used alternative due to its biomechanical stability, comparable to that of C2 PS. However, malpositioning of C2 LS carries a risk of neural injury and compromised fixation stability, and the use of surgical assistance has been reported to improve placement accuracy. The robotic system (RS) is a relatively new technology for PS placement, and its application has recently expanded to the cervical spine. The present study aimed to investigate the accuracy of C2 LS placement with RS assistance.

Methods: This prospective study evaluated 11 C2 LSs in 11 patients who underwent cervical fusion surgery with the RS assistance between March 2024 and June 2025 (11 patients, 11 C2 LSs).

Results: All 11 C2 LSs were successfully placed with no cortical breaches and no screw-related complications. The mean deviations at both the entry point and at a depth of 20 mm were less than 1.0 mm in both the axial and sagittal planes.

Conclusions: The results of this study suggest that the RS is a potential tool to facilitate accurate C2 LS placement in clinical settings.

Tuberculum sellae meningiomas (TSMs) tend to compress the optic apparatus and an ideal surgical route, whether transcranial or endonasal, is still debated. Another issue is if the minimally invasive supraorbital (SO) approach offers the same results compared with the more invasive craniotomies. Aiming to guide approach selection, preoperative grading systems have been described.All cases of TSMs treated from 2013 to 2018 by extended endoscopic endonasal approach (EEA) or SO approach have been reviewed and classified according to three preoperative grading systems: McDermott scale, Optic Nerve Laterality Score, and Yaşargil criteria.A total of 15 patients with TSMs were treated with the EEA (n = 6) or the SO (n = 9) approach. Globally, gross total resection was obtained in 87% (n = 13) of cases and was higher with the SO (100%, n = 9) compared with the EEA (67%, n = 4). Visual function improved in all but one patient (n = 14). Compared with the EEA group, patients treated by the SO approach had larger tumors (32.3 mm vs. 24.5 mm), a higher rate of optic canal invasion (4/9 vs. 0/6), and arterial encasement (6/9 vs. 1/5). Patients with McDermott total points of 1 to 2 (7/15) were treated mainly by the EEA; all patients with McDermott total score of ≥3 (8/15) were treated by the SO approach. All patients with optic canal invasion (4/15) and lateral extension of the tumor (ONL score = 1-3) were treated by the SO approach.The SO and EEA are two minimally invasive approaches safe and effective for treating TSMs. For tumors with lateral extension (optic nerve laterality [ONL] score = 1-3), larger diameter (>30-35 mm), vascular encasement, or optic canal involvement (McDermott total point = 2-3), the SO craniotomy is preferred. For small and median tumors with no optic canal invasion or vascular encasement (McDermott total point = 1-2), the EEA represents a valid option.

Ganglion cysts of the posterior longitudinal ligament (PLL) are a rare cause of lumbar radicular pain and claudication, primarily affecting young athletic males. These cysts are often linked to repetitive trauma and degenerative changes in the PLL, potentially aggravated by disc degeneration. Diagnosis is typically achieved through magnetic resonance imaging (MRI), with surgical excision being the preferred treatment in symptomatic cases. This systematic review consolidates the current knowledge on PLL ganglion cysts, examining clinical characteristics, diagnostic findings, and surgical outcomes to provide a basis for future research and clinical management.A systematic literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science, including studies from inception to June 2024. Search terms included "ganglion cyst," "posterior longitudinal ligament," "PLL," and "lumbar spine," among others. Studies published in English and French were reviewed if they reported on ganglion cysts of the PLL with clinical or radiological data. Data on demographics, symptoms, imaging findings, treatment approaches, outcomes, and follow-up were extracted. Due to the heterogeneity of the included studies, a narrative synthesis was performed, focusing on clinical presentation, diagnostic criteria, surgical techniques, and recurrence rates.A total of 14 studies comprising 20 patients were analyzed. The majority (90%) were male, with a mean age of 30.2 years (standard deviation [SD] = 11.47). The most common presenting symptom was radicular pain, primarily left-sided (70%). Disc degeneration was reported in 85% of cases, supporting a link between degenerative disc disease and PLL cyst formation. MRI revealed hypointense cysts on T1-weighted images and hyperintense on T2, aiding in differentiation from other intraspinal pathologies. Surgical excision was performed in all cases, with hemilaminectomy (50%) and interlaminar approaches (40%) being the most common techniques. Minimally invasive endoscopic methods were used in one case. Complete recovery was reported in 65% of patients, with a mean follow-up of 13.8 months (SD = 12.1). Recurrence data were limited due to inconsistent follow-up.This systematic review highlights the clinical and imaging characteristics of PLL ganglion cysts, with MRI as a critical tool for diagnosis. Surgical management, particularly hemilaminectomy and interlaminar approaches, is effective in providing symptom relief and preventing recurrence. Although minimally invasive techniques show promise, further research is needed to confirm their efficacy. Given the rarity of PLL cysts, tailored treatment and larger studies with standardized follow-up are essential to improve understanding and management of this condition.

Idiopathic normal pressure hydrocephalus (iNPH) is a common condition affecting the elderly. Numerous investigations highlight that its period-prevalence could be underestimated, as well as the economic burden of the missed treatments. The objective of the present investigation is to determine if a cohort of radiologically suspected iNPH patients presents the clinical landmarks of this condition, and to estimate the economic burden of these potentially missed diagnoses.We recorded age, sex, reason to access emergency rooms of our community hospitals, values of Evans' Index, callosal Angle, presence of disproportionately enlarged subarachnoid space hydrocephalus and obvious ventricular enlargement. We telephoned the patients who presented at least two radiological signs of iNPH and administered the idiopathic normal-pressure hydrocephalus grading scale (iNPHGS), to assess the severity of signs and symptoms linked to iNPH, to understand if a strong radiological suspect had a clinical correlation.Among the 308 brain computed tomography scans of a week, a total of 21 agreed to be enrolled in the present investigation. When administering iNPHGS questionnaire to radiologically suspected iNPH, 17/21 patients (80.1%) scored ≥1 in at least two of the three iNPHGS subscales. The scores of the three subscales were strongly associated to each other. The estimated monthly and yearly health-related costs may be EUR 4'799'440 and 57.59 million of Euros, respectively.There is an association between the radiological features of iNPH and the scores of iNPHGS. The period-prevalence could be 5.51%, implying high health care costs, with significant societal impact, and reduced quality of life in patients suffering from undiagnosed iNPH.

Intracranial aneurysms (IAs) are persistent, localized dilatations of the arterial wall that are found in ∼3% of the general population. The most severe complication of IAs is rupture, which results in devastating consequences such as subarachnoid hemorrhage and brain damage with serious neurologic sequelae. Numerous studies have characterized the mechanisms underlying IA development and growth and identified several environmental modifiable (smoking, hypertension) and nonmodifiable risk factors (related to the histology of cerebral arteries and genetic factors) in its pathogenesis. Hemodynamic stress also likely plays a crucial role in the formation of IAs and is conditioned by the geometry and morphology of the vessel tree, but its role in the natural history of unruptured IAs remains poorly understood; it is believed that changes in blood flow might generate the hemodynamic forces that are responsible for damage to the vascular wall and vessel remodeling that lead to IA formation. This review summarizes the most relevant data on the current theories on the formation of IAs, with particular emphasis on the roles of special conditions resulting from the microscopic anatomy of intracranial arteries, hemodynamic factors, bifurcation morphometry, inflammatory pathways, and the genetic factors involved in IA formation.

Giant intracranial aneurysms require complex treatment strategies including clipping, coiling, stenting, parent artery occlusion, bypass, or combined procedures. Neurovascular hybrid operating rooms (h-OR) combine a conventional operating theatre with high-resolution digital subtraction angiography (DSA). We describe a one-step combined surgical and endovascular treatment in a h-OR for a pediatric internal carotid artery (ICA) giant aneurysm that can be an optimal solution to manage such challenging cases.An 11-year-old boy presented with rapid onset right hemiparesis and left eyelid ptosis. A 3-month history of headache associated with sporadic vomit was reported. A giant, unruptured, left ICA aneurysm was detected on imaging. The patient underwent surgical trapping of the aneurysm. Intraoperative DSA showed residual backflow from the posterior communicating artery and coils were placed to completely exclude the aneurysm. At 18-month follow-up, the patient showed a complete recovery and magnetic resonance imaging showed a progressive reduction of the sac aneurysm.Due to their morphological variability, intracranial giant aneurysms may require a different procedural strategy instead of direct clipping or coiling. The introduction of h-OR allows combined treatments to be performed simultaneously in the same room setting. The present case shows that combined treatment in a neurovascular h-OR can be an optimal solution to manage challenging cases, such as giant aneurysms, reducing operative time with the added benefit of selecting an appropriate strategy adjustment in a multidisciplinary effort.

Acute epidural hematoma (AEDH) is recognized as one of the most urgent neurosurgical conditions. Traditionally, the primary treatment for AEDH has involved craniotomy with surgical evacuation of the hematoma. However, with the widespread adoption of neurointerventional techniques, interest in their application to various forms of traumatic brain injuries has increased. Among these, embolization of the middle meningeal artery (MMA) has emerged as a minimally invasive treatment option for AEDH. This study evaluates the effectiveness of MMA embolization as a primary treatment for AEDH.We conducted a retrospective review of patients treated for AEDH with embolization of the MMA at our institution from January 2019 to July 2024. Patient demographics, clinical presentation, procedural details, and outcomes were analyzed.MMA embolization was successfully performed in 20 patients with AEDH, with only 2 cases requiring subsequent burr-hole evacuation. The thickness of the AEDH was 10 mm or more in 47.8% of cases, and a midline shift was observed in 65.2% of cases. The most common angiographic findings included arteriovenous fistulas (AVFs) and contrast extravasation. N-butyl cyanoacrylate was used as the embolic material in all cases. In one case, Squid 12 was added to enhance penetration at sites of extravasation. No patients experienced recurrent AEDH postintervention.MMA embolization is a promising minimally invasive treatment for AEDH, showing effectiveness as both a primary and adjuvant therapy. Future prospective multicenter studies are needed to validate preliminary findings and optimize treatment protocols for this high-risk patient population.

This study aimed to explore whether exosome-derived circ0009910 can transcellularly regulate the growth of pituitary adenoma (PA) cells and to further explore the possible mechanisms of its action.Transmission electron microscopy and nanoparticle size analysis were used to observe the morphology and size of the exosomes. Real-time quantitative polymerase chain reaction (qRT-PCR) was used to determine the expression of circ_0009910, miR-106b-5p, and signal transducer and activator of transcription3 (STAT3). Western blotting was used to assess the expression of exosomal marker proteins, p-STAT3, E-cadherin, N-cadherin, and vimentin. Cell Counting Kit-8 (CCK-8) and 5-Ethynyl-2-deoxyuridine (EdU) assays were used to determine the proliferative capacity of the cells. Transwell assays were performed to assess the migratory and invasive capacity of the cells. Enzyme-linked immunosorbent assays (ELISAs) were used to determine the expression level of growth hormone (GH). A nude mouse xenograft model was established to observe the effects of exosome-derived circ0009910 on transplanted tumors in nude mice.circ0009910 can be transferred to other cells via exosomes. Knocking down the expression of circ0009910 can inhibit the proliferation, invasion, and migration of PA cells, reduce GH expression, and regulate the expression of epithelial-mesenchymal transition (EMT)-associated proteins. miR-106b-5p is a molecular sponge of circ0009910 and can partially reverse the procarcinogenic effect of circ0009910 in PA. STAT3 is a target gene of miR-106b-5p. In addition, circ0009910 knockdown inhibited tumor growth in vivo.Exosome-derived circ0009910 promotes PA progression and regulates EMT through the miR-106b-5p/STAT3 axis.

This study investigates the decision-making process among neurosurgeons regarding the surgical management of acute subdural hematomas (aSDH), focusing on the role of non-classical Brain Trauma Foundation (BTF) factors such as brainstem reflexes, hypocoagulation, and patient comorbidity, alongside traditional guidelines.We conducted an international survey that presented neurosurgeons with real-case scenarios, designed to assess the impact of both traditional and non-traditional prognostic indicators on their surgical decisions. The survey also collected demographic data to examine potential correlations with decision-making preferences.The survey garnered 67 responses from neurosurgeons across 22 countries, revealing a reliance on non-classical BTF factors in decision-making for aSDH cases with a potentially poor prognosis. No significant correlations were found between these decision-making practices and the surgeons' demographic characteristics.The findings highlight the complexity and nuanced nature of surgical decision-making in aSDH management, underlining the importance of non-traditional prognostic factors. The results advocate for further research to refine clinical guidelines, ensuring they encapsulate the breadth of factors considered in practice, thereby enhancing patient-centered care.

Many neurosurgical procedures are expensive and technically demanding. The incidence of complications is high. Based on the advantages of three-dimensional (3D) technology in surgical procedures, it is necessary to develop personalized navigation molds that use 3D printing technology and to analyze the clinical application of this technology in intracerebral hemorrhage, hydrocephalus, and brain abscess.According to the patient-specific brain computed tomography imaging data, we reconstructed intracranial lesions or target structures and important brain regions. By this, neurosurgeons can accurately locate the intracranial lesions under conditions equivalent to direct vision, analyze the morphology and size of lesions, and perform precise lesion puncture. Based on patient-specific differences, we designed the best 3D printed navigation molds to improve the accuracy of intracranial lesion targeting, analyzed the sources of deviation, and provided clinical application basis.Five cases of intracerebral hematoma, two cases of hydrocephalus, and two cases of brain abscess were treated between September 2020 to January 2022. Lesion puncture and drainage were performed with 3D printed navigation molds. The average puncture error was 2.86 mm. All nine patients recovered well after surgery, and no infection or death occurred.The personalized 3D printed navigation molds used in this study are beneficial to accurately locate intracranial lesions or target 3D structures during surgery.