Neurosurgical Review最新文献

γ-Glutamyl Hydroxymethyl Rhodamine Green (γ-GHRG) fluorescence is a novel fluorescent agent used to enhance tissue visualization during surgical resections, especially in oncological procedures. This systematic review aims to evaluate the efficacy of γ-GHRG fluorescence in improving tumor margin detection, reducing recurrence rates, and enhancing surgical precision. A comprehensive search was conducted across PubMed, Embase, and Cochrane databases up to February 2024, following PRISMA guidelines. A total of 23 studies investigating the use of γ-GHRG fluorescence in surgical resection were included. Data on tumor visualization, surgical margin detection, and postoperative outcomes were analyzed. The included studies demonstrated that γ-GHRG fluorescence significantly improved tumor visualization in a variety of cancers, including ovarian cancer (26.1%), breast cancer (8.7%), lung cancer (8.7%), colorectal cancer (8.7%), kidney cancer (8.7%), head and neck cancer (8.7%), esophageal and gastric cancer (8.7%), prostate cancer (8.7%), brain tumors (gliomas) (4.3%), and liver cancer (4.3%). The probe's high specificity for γ-glutamyl transpeptidase (GGT), which is overexpressed in cancer cells, enabled real-time visualization of tumor margins, allowing for more precise resections. Studies also reported shorter surgical times and lower recurrence rates, particularly in high-grade tumors such as gliomas (4.3%). Although the results are promising, issues related to false positives, tissue specificity, and long-term safety were noted. γ-GHRG fluorescence shows significant potential in enhancing surgical outcomes by providing real-time guidance during tumor resections. Its high specificity for GGT and rapid fluorescence activation make it a valuable tool in cancer surgery. However, further clinical studies are required to address challenges related to sensitivity, specificity, and long-term safety, as well as to explore its application across different cancer types and surgical settings.

To use AI-assisted software to identify gender, racial, and socioeconomic differences in post-operative outcomes following pediatric neuro-oncology surgery. PubMed, Scopus, Web of Science, and Ovid were queried using a semi-automated software. Meta-analyses quantified pooled odds ratios for overall survival (OS), gross total resection (GTR), recurrence, 30-day readmission, medical complications (neurologic and endocrinologic), and surgical complications. Where possible, subanalyses were performed based on study type and cranial tumor location. Sixty-seven studies were included. Across all studies, white children had greater OS (OR 0.70, 95% CI [0.55, 0.88]) and GTR (OR 0.86, 95% CI [0.78, 0.93]), while non-white children more often had a medical complication (OR 1.33, 95% CI [1.01, 1.76]). Those with government insurance (OR 1.72, 95% CI [1.01, 2.92]) or lower household income (OR 1.25, 95% CI [1.10, 1.42]) had higher 30-day readmission rates. Patients treated at a small-volume facility had lower rates (OR 0.80, 95% CI [0.71, 0.91]). Subanalyses of case series showed female patients were at higher risk of endocrinologic complications (OR 2.56, 95% CI [1.17, 5.64]), namely hypopituitarism (OR 3.29, 95% CI [1.10, 9.86]). In cohort studies, female patients more often experienced diabetes insipidus (OR 2.22, 95% CI [1.20, 4.08]). Non-white, government-insured, lower-income, and female patients are more likely to experience an adverse event. This study identifies the importance of considering demographic variables during pre-operative risk assessment. Our findings warrant further subgroup analyses across varying tumor locations and types to elucidate parameters contributing to these disparities and explore interventions.

Objective: Blunt cerebrovascular injury (BCVI) is a collective term describing blunt-force trauma involving the carotid and/or vertebral arteries. As awareness, screening protocols, and diagnostic modalities have advanced over recent decades, reported incidence has risen accordingly. This bibliometric review examines the most highly cited literature on BCVI, spotlighting key academic trends, influential authors, and journals that have shaped our current understanding.

Methods: The Scopus database was queried for BCVI-related articles published through June 2024 with titles, abstracts, and/or keywords containing the terms "BCVI" OR "blunt cerebrovascular injury" OR " blunt carotid artery injury" OR "blunt carotid artery trauma" OR "traumatic carotid artery dissection" OR "blunt vertebral artery injury" OR "blunt vertebral artery trauma" OR "traumatic vertebral artery dissection." Results were organized by descending citation count and followed by citations per year. The top 50 most-cited articles were selected for analysis. Additional data collected included document titles, publication year, authors, specialty of the first author, affiliations, country of origin, and publishing journal.

Results: This study retrieved 426 BCVI-related articles published since 1974. The top 50, published between 1974 and 2018, garnered 6,760 citations, with an average of 135.2 citations per article, and a mean self-citation rate of 8.83%.

Conclusions: This bibliometric analysis maps the academic landscape of BCVI, presenting valuable insights into its evolution and the pivotal studies that have informed our knowledge and clinical practice thus far. It serves as a foundation for future research directions and clinical advancements, aimed at enhancing patient outcomes in the face of blunt cerebrovascular trauma.

Clinical trial number: Not applicable.

Trigeminal neuralgia (TN) is a disorder characterized by recurrent, severe, brief pain in the distribution of the trigeminal nerve. Secondary TN may be caused by tumors in the cerebellopontine angle (CPA), including vestibular schwannomas (VS), which are benign tumors originating from the Schwann cells of the vestibular nerve. While treatment options for TN include pharmacological therapy, radiofrequency ablation and microvascular decompression (MVD), there is no established gold standard for treating TN secondary to VS. This study aims to present clinical outcomes, including pain and numbness relief, following microsurgical treatment for 63 patients with VS and concurrent TN, while also analyzing potential factors influencing preoperative and postoperative symptom severity. A retrospective review of 63 patients with VS-associated secondary TN who underwent microsurgical treatment at Xuanwu Hospital, Capital Medical University, from December 2018 to May 2024. Patient demographics, clinical features, surgical approach, and outcomes were analyzed. All patients underwent routine preoperative imaging, and Koos grading system is used to describe the tumor size and its impact on surrounding structures. Facial nerve function was assessed using the House-Brackmann (H-B) scale. Pain and numbness were evaluated using the Barrow Neurological Institute (BNI) pain and numbness scores. Among the 63 patients, 95.2% achieved complete pain relief at the final follow-up, while 72.2% of patients with preoperative numbness achieved relief, while 15.6% without prior numbness developed new numbness postoperatively. Neurovascular compression (NVC) was identified in 20 patients (31.7%), with the superior cerebellar artery (SCA) as the offending vessel in 19 cases (95%) and the petrosal vein (PV) in 1 case (5%). Neither tumor size nor neurovascular compression (NVC) correlated significantly with preoperative pain (P = 0.963, P = 0.269) or numbness (P = 0.581, P = 0.626). Good facial nerve function was preserved in 87.3% of patients, with 25% of patients maintaining serviceable hearing postoperatively. Surgical complications occurred in 12.7% of cases, including 1 intracranial infection and 7 new numbness. No cases of intracranial hemorrhage or cerebrospinal fluid leakage were reported. Microsurgery is an effective treatment for VS-associated TN, providing high rates of pain and numbness relief while preserving neurological function. In these cases, the superior cerebellar artery was the predominant vessel responsible for NVC. Tumor size and the presence of NVC did not significantly correlate with the severity of preoperative symptoms. While some patients developed new postoperative numbness, facial nerve preservation was favorable, and surgical complications were minimal. Surgical outcomes indicate that microsurgical approaches, including MVD when necessary, are effective for patients with VS-associated secondary TN.

There are limited data on the impact of light sedation (LS) on changes in intraoperative hypotension related to carotid artery stenting (CAS). We aimed to investigate intraoperative hypotension and perioperative complications in CAS under LS with intravenous dexmedetomidine (Dex). A retrospective analysis of 140 consecutive patients who underwent CAS at our centre from September 2018 to March 2021 was performed. The primary endpoint was the incidence of intraoperative hypotension associated with CAS, defined as continuous systolic blood pressure < 90 mmHg. The secondary outcomes were perioperative complications, including dysphoria, transient ischaemic attacks (TIA), stroke, myocardial infarction (MI), reperfusion syndrome, and 24-h haemodynamic events after CAS. Eighty-nine patients were treated under LS, and 51 patients were treated under local anaesthesia (LA). Intraoperative haemodynamic instability was observed in 13 of 140 (9.3%) patients; hypotension occurred in 2.2% (2/89) of patients in the LS group, which was significantly lower than the rate in the LA group (2.2% vs. 11.8%, P = 0.027). Dysphoria occurred in 1.1% of the LS cohort and 15.7% of the LA cohort (P < 0.05). TIA was observed in 2.2% of the LS cohort and 15.7% of the LA cohort (P < 0.05), respectively. There were no statistically significant differences in periprocedural stroke, reperfusion syndrome, or 24-h haemodynamic events after CAS between the two groups, and none of the patients exhibited MI. Performing CAS under LS with intravenous Dex was a safe and effective anaesthesia option in terms of inhibiting intraoperative hypotension and could markedly decrease the incidence of dysphoria and TIA.

Deep brain stimulation in the subthalamic nucleus (STN-DBS) is a therapeutic intervention for patients with Parkinson's disease (PD) primarily aimed at improving motor symptoms. However, the effects of STN-DBS on non-motor symptoms (NMS), such as olfactory dysfunction (OD), remain poorly understood. We performed a systematic review and single-arm meta-analysis to evaluate the effects of STN-DBS on OD in PD patients. We searched Medline, Scopus, and Web of Science databases. Eligible studies included observational studies with ≥ 4 patients reporting the effects of STN-DBS on OD in PD patients. Mean differences (MD) between pre- and post-operative, along with the final mean pooled analysis, olfactory scores values with 95% confidence intervals (CI) with a random effects model were used. The statistical analysis was performed using the software R Studio. The heterogeneity was assessed with I² statistics, and leave-one-out sensitivity analysis was used to address high heterogeneity. A total of seven studies, encompassing 188 PD patients, with a mean age of 60.8 years, were included in our analysis. There was a statistically significant difference between pre- and post-operative value in Odor discrimination (ODI) (MD 2.16; 95% CI 1.37 to 2.96; p < 0.01; I² = 0%) and Unified Parkinson's Disease Rating Scale part III OFF medication (UPDRS III OFF_MED) (MD -11.96; 95% CI -22.57 to -1.35; p = 0.03; I² = 88%), showing improvement in OD and motor function after DBS, compared to baseline. In contrast, there was no statistically significant difference between the initial and final value in Odor thresholds (OT) (MD 1.54; 95% CI -0.22 to 3.30; p = 0.09; I² = 90%), and the University of Pennsylvania Smell Identification Test (UPSIT) (MD -0.37; 95% CI -3.40 to 2.66; p = 0.81; I² = 0%). Additionally, the pooled analysis for Odor identification (OI) showed a final mean of 7.06 (95% CI 4.39 to 9.72; I² = 100%), and for the TDI score (composite score derived from the sum of OD, OI, and OT results), a final mean of 25.96 (95% CI 17.31 to 34.62; I² = 94%). Despite the prior indication of STN-DBS for motor symptoms, it may improve OD in PD patients. Clinical trial number Not applicable.

Radiotherapy has been shown to potentially induce systemic anti-tumor immunity, a phenomenon that may be further enhanced by immune checkpoint inhibitor (ICI) therapy. However, whether this phenomenon occurs following Gamma Knife radiosurgery (GKRS) for brain metastases (BMs) and its potential clinical implications remain poorly understood. We retrospectively analyzed 36 non-small-cell lung cancer (NSCLC) patients with multiple BMs treated with multi-session GKRS. Spontaneous tumor regression (STR) was defined as ≥ 30% volume reduction in non-irradiated tumors. Competing risks analysis and Cox regression were used to evaluate local progression, distant brain failure (DBF), and survival outcomes. In this study, 44% (16/36) of patients received ICI therapy. STR was observed in 38.9% (14/36) of the cohort. Comparative analysis revealed that patients received ICI therapy did not exhibited an improved overall survival (OS) (p = 0.46), but demonstrated a trend toward a higher incidence of STR compared to those without ICI therapy (56.3% vs. 25.0%, p = 0.056). Multivariable regression analysis identified the absence of STR as an independent risk factor for mortality (Hazard Ratio [HR], 7.69; 95% CI: 1.61-33.33; p = 0.009) and local tumor progression (HR, 5.05; 95% CI: 1.71-14.93; p = 0.003). A systemic anti-tumor immunity could be induced by GKRS and cause STR of non-irradiated tumors. Patients exhibiting this phenomenon demonstrate significantly improved survival rates and local tumor control compared to those without this response. These findings underscore the potential immunomodulatory role of GKRS and its clinical implications in the management of BMs.

The existing literature on subdural hematomas (SDH) primarily focused on surgically treated cases. However, minor SDH remain unexplored. This study aims to investigate the association between subarachnoid space depth and neurosurgical intervention in children with minor SDH. Patients (age < 3 years) with minor SDH between June 2015 and June 2024 at the Children's Hospital of Soochow University were included. Patients with subarachnoid space depth ≥ 3 mm were classified into the ESS group. In total, 277 patients with minor SDH were included, of whom 100 (36.1%) had ESS. During conservative observation, 22 (7.94%) patients received a neurosurgical intervention. Patients with ESS had an adjusted odds ratio (OR) of 6.07 (95% CI: 1.57-23.4; p = 0.009) for receiving neurosurgical intervention. In subgroup analyses, the subarachnoid space depth was associated with the neurosurgical intervention in patients who were male (OR = 7.33; 95% CI: 1.96-27.39), infants (OR = 5.84; 95% CI: 1.63-20.85), those with an open fontanelle (OR = 4.92; 95% CI: 1.57-15.41), and those without a history of seizures (OR = 5.87; 95% CI: 1.81-19.03). The association was robust in sensitivity analyses. Subdural hematohygroma significantly mediated the association (p = 0.016), accounting for 16.79% of the correlation. The subarachnoid space depth may be a significant risk factor for neurosurgical intervention during conservative observation in children, particularly infants, with minor SDH.

Decompressive craniectomy (DC) is a critical surgical intervention for elevated intracranial pressure. However, the impact of preoperative antiplatelet or anticoagulant therapy on outcomes and complications remains unclear. A retrospective-prospective study was conducted on 145 patients undergoing DC between November 2021 and May 2023. Patients were categorized into two groups: those with (n = 48) and without (n = 97) preoperative antithrombotic therapy. Demographic data, comorbidities, antithrombotic therapy type and duration, clinical outcomes, and pre-operative risk factors (CHA2DS2-VASc and HAS-BLED scores) were analyzed. While there was a trend towards higher hemorrhagic complications in the antithrombotic therapy group (20.0% vs. 11.3%), this difference was not statistically significant. However, thromboembolic events, primarily stroke (27.7% vs. 9.3%) and acute myocardial infarction (10.6% vs. 0.0%), were significantly more frequent in the antithrombotic therapy group. Multivariate analysis revealed that ischemic stroke as a primary diagnosis, rather than antithrombotic therapy itself, was a significant predictor of thromboembolic complications (adjusted OR 3.49, 95%CI 1.47-8.28, p = 0.005). Pre-operative GCS was associated with improved outcomes (adjusted OR 0.81, 95%CI 0.67-0.97, p = 0.025). While antithrombotic therapy does not appear to increase the risk of hemorrhagic complications after DC, it is associated with a higher risk of thromboembolic events, especially in patients with ischemic stroke. Individualized assessment and tailored management of antithrombotic therapy are crucial to optimize outcomes in DC patients. Further studies are needed to refine strategies for bridging anticoagulation and managing antithrombotic therapy in this population, considering factors such as CHA2DS2-VASc and HAS-BLED scores, as well as patient-specific risk profiles.

Objective: Direct surgical resection may be the only choice for solid or predominantly solid third ventricle craniopharyngiomas (TVCs) complicated with hydrocephalus. Despite the increased use of the extended endoscopic endonasal approach (EEEA), the viewpoint that these tumors are unsuitable for endonasal resection remains prevailing. This paper presents the largest case series assessing the surgical outcomes of EEEA for solid or predominantly solid TVCs complicated by hydrocephalus.

Methods: We retrospectively analyzed the data of 27 patients newly diagnosed with solid or predominantly solid TVCs complicated with hydrocephalus treated by EEEA.

Results: Gross total resection (GTR) was achieved in 88.9% of 27 patients. The rate of hydrocephalus relief was 100%, with an average Evans' index decrease of 0.05 and a simplified callosal angle increase of 15.8°. The mean Mini-Mental State Examination score improved significantly in the strictly TVC group after surgery (p = 0.03) but not in the infundibulo-tuberal TVC group (p = 0.61). Postoperative visual worsening occurred in 11.1% of patients. New-onset hypopituitarism was observed in 62.9% of patients. Permanent diabetes insipidus occurred in 63.0% of patients. New-onset obesity was noted in 17.4%. During a mean follow-up of 38.9 months (range 12.9-67.9 months), tumor recurrence and mortality rates were 11.1% and 0%, respectively.

Conclusions: The EEEA could be a safe and effective choice for solid or predominantly solid TVCs complicated with obstructive hydrocephalus, offering a higher rate of GTR and a lower rate of newly developed postoperative hydrocephalus. Intraoperative VEP monitoring may be necessary to minimize the risk of postoperative visual deterioration.