Pub Date : 2026-02-13DOI: 10.1007/s10143-025-04122-8
Edmund John B Cayanong, Sichuan Edward S Rayco, Natalie Roxanne B Nisce, Kathleen Joy O Khu, Juan Silvestre G Pascual
Background: Bone flap replacement restores cranial protection and contour in neurosurgery. Accidental intraoperative contamination, particularly dropped bone flaps, poses risks of infection. Management strategies are heterogeneous and lack standardized guidelines.
Objective: To systematically review reported strategies for managing dropped cranial bone flaps, focusing on surgical context, decontamination methods, operative impact, antibiotic use, and outcomes.
Methods: A systematic review was conducted in accordance with PRISMA guidelines. Relevant databases were searched from inception to September 2025. Eligible studies described strategies for intraoperative bone flap decontamination and reported at least one clinical outcome. Data extracted included study type, sample size, surgical context, decontamination strategy and duration, post-operative antibiotic regimen, follow-up period, and outcomes.
Results: Three retrospective series comprising 48 cases met the inclusion criteria. Flaps were dropped during elevation, transfer, drilling, reinsertion, and plating. Chemical decontamination-typically saline irrigation, povidone iodine ± hydrogen peroxide, and antibiotic soak-was most common, adding 15-30 min to surgery, with no post-operative infections reported. Autoclaving ensured sterility but prolonged the operative time (37 min), and carried the risk of partial flap resorption. Discarding the flap with immediate cranioplasty was reserved for non-salvageable cases, incurring the longest delay (39 min).
Conclusion: Dropped cranial bone flaps are rare but have clinically significant implications. Available evidence, limited to small series and surveys, show comparable outcomes between chemical decontamination, autoclaving, and discarding the flap followed by cranioplasty. Standardized, evidence-based guidelines are lacking, underscoring the need for multicenter prospective studies.
{"title":"Decontamination strategies for dropped bone flaps in neurosurgical procedures: A systematic review.","authors":"Edmund John B Cayanong, Sichuan Edward S Rayco, Natalie Roxanne B Nisce, Kathleen Joy O Khu, Juan Silvestre G Pascual","doi":"10.1007/s10143-025-04122-8","DOIUrl":"https://doi.org/10.1007/s10143-025-04122-8","url":null,"abstract":"<p><strong>Background: </strong>Bone flap replacement restores cranial protection and contour in neurosurgery. Accidental intraoperative contamination, particularly dropped bone flaps, poses risks of infection. Management strategies are heterogeneous and lack standardized guidelines.</p><p><strong>Objective: </strong>To systematically review reported strategies for managing dropped cranial bone flaps, focusing on surgical context, decontamination methods, operative impact, antibiotic use, and outcomes.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines. Relevant databases were searched from inception to September 2025. Eligible studies described strategies for intraoperative bone flap decontamination and reported at least one clinical outcome. Data extracted included study type, sample size, surgical context, decontamination strategy and duration, post-operative antibiotic regimen, follow-up period, and outcomes.</p><p><strong>Results: </strong>Three retrospective series comprising 48 cases met the inclusion criteria. Flaps were dropped during elevation, transfer, drilling, reinsertion, and plating. Chemical decontamination-typically saline irrigation, povidone iodine ± hydrogen peroxide, and antibiotic soak-was most common, adding 15-30 min to surgery, with no post-operative infections reported. Autoclaving ensured sterility but prolonged the operative time (37 min), and carried the risk of partial flap resorption. Discarding the flap with immediate cranioplasty was reserved for non-salvageable cases, incurring the longest delay (39 min).</p><p><strong>Conclusion: </strong>Dropped cranial bone flaps are rare but have clinically significant implications. Available evidence, limited to small series and surveys, show comparable outcomes between chemical decontamination, autoclaving, and discarding the flap followed by cranioplasty. Standardized, evidence-based guidelines are lacking, underscoring the need for multicenter prospective studies.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":"220"},"PeriodicalIF":2.5,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146181390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-13DOI: 10.1007/s10143-026-04140-0
Jheremy S Reyes, Sofia-Isabella Leal, David F Estupiñan-Pepinosa, Nikolas Correa-Molina, Paola A Niño-Muñoz, Luis M Navarro-Ramirez, Juan S Aguirre-Patiño
{"title":"Surgical outcomes and prognostic factors in epilepsy associated with low-grade brain tumors: a systematic review.","authors":"Jheremy S Reyes, Sofia-Isabella Leal, David F Estupiñan-Pepinosa, Nikolas Correa-Molina, Paola A Niño-Muñoz, Luis M Navarro-Ramirez, Juan S Aguirre-Patiño","doi":"10.1007/s10143-026-04140-0","DOIUrl":"https://doi.org/10.1007/s10143-026-04140-0","url":null,"abstract":"","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":"221"},"PeriodicalIF":2.5,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146181439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-11DOI: 10.1007/s10143-025-04109-5
Tedy Apriawan, Alivery Raihanada Armando, Indri Lakhsmi Putri, Gunna Hutomo Putra, Citrawati Dyah Kencono Wungu, Surya Pratama Brilliantika, Muhammad Fadhil Kamaruddin, Muhammad Tidar Abiyu Amiruddin, Muhammad Hasan Al Banna
{"title":"Emerging microsurgical techniques for facial nerve reconstruction in traumatic skull base fractures: a systematic review and comprehensive evidence analysis.","authors":"Tedy Apriawan, Alivery Raihanada Armando, Indri Lakhsmi Putri, Gunna Hutomo Putra, Citrawati Dyah Kencono Wungu, Surya Pratama Brilliantika, Muhammad Fadhil Kamaruddin, Muhammad Tidar Abiyu Amiruddin, Muhammad Hasan Al Banna","doi":"10.1007/s10143-025-04109-5","DOIUrl":"https://doi.org/10.1007/s10143-025-04109-5","url":null,"abstract":"","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":"218"},"PeriodicalIF":2.5,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-10DOI: 10.1007/s10143-026-04158-4
Md Sohanur Rahman, Muhammad Mohsin Khan, Cathal John Hannan, Bipin Chaurasia, Noman Shah, Airton Leonardo de Oliveira Manoel, Ghaya Al Rumaihi, Ghanem Al Sulaiti, Shona Pederson, Micheal Lawton, Nazmin Ahmed, Muhammad E H Chowdhury, Jawad Yousaf
{"title":"Interpretable machine learning model for predicting rupture risk in anterior communicating artery aneurysms.","authors":"Md Sohanur Rahman, Muhammad Mohsin Khan, Cathal John Hannan, Bipin Chaurasia, Noman Shah, Airton Leonardo de Oliveira Manoel, Ghaya Al Rumaihi, Ghanem Al Sulaiti, Shona Pederson, Micheal Lawton, Nazmin Ahmed, Muhammad E H Chowdhury, Jawad Yousaf","doi":"10.1007/s10143-026-04158-4","DOIUrl":"https://doi.org/10.1007/s10143-026-04158-4","url":null,"abstract":"","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":"216"},"PeriodicalIF":2.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgical practices in decompressive hemicraniectomy for malignant middle cerebral artery infarction with hemorrhagic transformation: results from an international survey.","authors":"Beate Kranawetter, Tammam Abboud, Veit Rohde, Silvia Hernández-Durán","doi":"10.1007/s10143-026-04157-5","DOIUrl":"https://doi.org/10.1007/s10143-026-04157-5","url":null,"abstract":"","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":"215"},"PeriodicalIF":2.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-09DOI: 10.1007/s10143-025-04031-w
Albert Gabriel Turpo-Peqqueña, Lucia Fernanda Del Carpio-Velásquez, Francisco Martins Lamas, Victoria Elena Quispe-Pastor, Karen Veronica Quintanilla-Apaza, Diego Fernando Muñoz-Cervantes, Mayra Alejandra Quispe-Díaz, Pierina Valeria Bermejo-Rosado, Ariana Solange Rodriguez-Valenzuela, Josue Rodrigo Turpo-Peqqueña, Évrard Pérès, Juan Pedro Murillo Gutierrez, Julian Alejandro Rivillas, Richard Hernández Mayori
<p><p>Moyamoya disease is a rare progressive cerebral vasculopathy characterized by narrowing or occlusion of the internal carotid arteries, leading to the formation of fragile collateral vessels and a high risk of ischemic events, especially in pediatric patients. Although direct revascularization techniques are commonly used, they are technically challenging in children due to vascular fragility and anatomy. Indirect revascularization techniques favor the formation of new blood vessels through alternative flow routes. Their efficacy is usually assessed using the Matsushima scale, which measures the degree of revascularization achieved. This study aims to describe postoperative angiographic outcomes of indirect revascularization techniques in pediatric patients with Moyamoya disease. A systematic review and meta-analysis was performed following PRISMA guidelines, searching six databases (PubMed, Embase, Scopus, Web of Science, CENTRAL and Google Scholar) for observational studies that evaluated indirect revascularization techniques in pediatric patients with Moyamoya disease. Seventeen studies comprising 1360 hemispheres were included. Primary outcomes were the proportions of angiographic revascularization according to grades A, B, and C of the Matsushima scale. Secondary outcomes included postoperative clinical complications such as stroke, transient ischemic attacks (TIAs), seizures, bleeding, mortality, and functional status assessed using the modified Rankin scale (mRS ≤2). Meta-analyses were performed with random-effects models in R (version 4.2.3) and risk of bias was assessed with the MINORS tool. Meta-regression was applied to explore possible predictors of outcomes. The certainty of evidence was assessed with the GRADE approach. The combined proportions of hemispheres achieving Matsushima grades A, B and C were 47.1% (95% CI: 38.4-55.9; I<sup>2</sup> = 84.4%), 38.2% (95% CI: 32.0-44.9; I<sup>2</sup> = 84.4%) and 12.3% (95% CI: 9.3-16.0; I<sup>2</sup> = 47.0%), respectively. Postoperative complications were low: stroke 8.3%, TIA 7.2%, seizures 2.5%, bleeding 2.7% and mortality 0.8%. Good functional status (mRS ≤2) was achieved in 82.1% of patients. Meta-regression revealed that unilateral vs. bilateral procedures significantly predicted Matsushima grade B outcomes (p = 0.002). The risk of bias was low to moderate. The certainty of evidence was generally low to moderate, except for mortality which showed high certainty. Indirect revascularization techniques in pediatric Moyamoya show favorable angiographic and clinical results, with low complications and high functional independence. According to the Matsushima scale, about 47% of the hemispheres achieved grade A, 38% grade B and 12% grade C. Pial synangiosis and EDAMS were more effective in grade A, whereas EDAS showed a lower proportion in grade A and slightly more in grade C. Postoperative complications were low and most patients achieved good functional status (mRS ≤2). These findings
{"title":"Angiographic outcomes after indirect revascularization in pediatric Moyamoya disease: a systematic review and Meta-analysis.","authors":"Albert Gabriel Turpo-Peqqueña, Lucia Fernanda Del Carpio-Velásquez, Francisco Martins Lamas, Victoria Elena Quispe-Pastor, Karen Veronica Quintanilla-Apaza, Diego Fernando Muñoz-Cervantes, Mayra Alejandra Quispe-Díaz, Pierina Valeria Bermejo-Rosado, Ariana Solange Rodriguez-Valenzuela, Josue Rodrigo Turpo-Peqqueña, Évrard Pérès, Juan Pedro Murillo Gutierrez, Julian Alejandro Rivillas, Richard Hernández Mayori","doi":"10.1007/s10143-025-04031-w","DOIUrl":"https://doi.org/10.1007/s10143-025-04031-w","url":null,"abstract":"<p><p>Moyamoya disease is a rare progressive cerebral vasculopathy characterized by narrowing or occlusion of the internal carotid arteries, leading to the formation of fragile collateral vessels and a high risk of ischemic events, especially in pediatric patients. Although direct revascularization techniques are commonly used, they are technically challenging in children due to vascular fragility and anatomy. Indirect revascularization techniques favor the formation of new blood vessels through alternative flow routes. Their efficacy is usually assessed using the Matsushima scale, which measures the degree of revascularization achieved. This study aims to describe postoperative angiographic outcomes of indirect revascularization techniques in pediatric patients with Moyamoya disease. A systematic review and meta-analysis was performed following PRISMA guidelines, searching six databases (PubMed, Embase, Scopus, Web of Science, CENTRAL and Google Scholar) for observational studies that evaluated indirect revascularization techniques in pediatric patients with Moyamoya disease. Seventeen studies comprising 1360 hemispheres were included. Primary outcomes were the proportions of angiographic revascularization according to grades A, B, and C of the Matsushima scale. Secondary outcomes included postoperative clinical complications such as stroke, transient ischemic attacks (TIAs), seizures, bleeding, mortality, and functional status assessed using the modified Rankin scale (mRS ≤2). Meta-analyses were performed with random-effects models in R (version 4.2.3) and risk of bias was assessed with the MINORS tool. Meta-regression was applied to explore possible predictors of outcomes. The certainty of evidence was assessed with the GRADE approach. The combined proportions of hemispheres achieving Matsushima grades A, B and C were 47.1% (95% CI: 38.4-55.9; I<sup>2</sup> = 84.4%), 38.2% (95% CI: 32.0-44.9; I<sup>2</sup> = 84.4%) and 12.3% (95% CI: 9.3-16.0; I<sup>2</sup> = 47.0%), respectively. Postoperative complications were low: stroke 8.3%, TIA 7.2%, seizures 2.5%, bleeding 2.7% and mortality 0.8%. Good functional status (mRS ≤2) was achieved in 82.1% of patients. Meta-regression revealed that unilateral vs. bilateral procedures significantly predicted Matsushima grade B outcomes (p = 0.002). The risk of bias was low to moderate. The certainty of evidence was generally low to moderate, except for mortality which showed high certainty. Indirect revascularization techniques in pediatric Moyamoya show favorable angiographic and clinical results, with low complications and high functional independence. According to the Matsushima scale, about 47% of the hemispheres achieved grade A, 38% grade B and 12% grade C. Pial synangiosis and EDAMS were more effective in grade A, whereas EDAS showed a lower proportion in grade A and slightly more in grade C. Postoperative complications were low and most patients achieved good functional status (mRS ≤2). These findings","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":"211"},"PeriodicalIF":2.5,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-09DOI: 10.1007/s10143-025-04111-x
Jiamin Mou, Xiaoshu Wang, Qin Yin, Yi Liu, Hongfan Lu, Xiaochuan Sun, Gang Yang
{"title":"In-situ bone flap combined with a nasoseptal flap or a free mucosa flap for skull base reconstruction after endoscopic resection of craniopharyngiomas: A series of 115 cases.","authors":"Jiamin Mou, Xiaoshu Wang, Qin Yin, Yi Liu, Hongfan Lu, Xiaochuan Sun, Gang Yang","doi":"10.1007/s10143-025-04111-x","DOIUrl":"10.1007/s10143-025-04111-x","url":null,"abstract":"","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":"212"},"PeriodicalIF":2.5,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12883508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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