Neurosurgical Review最新文献

To compare intraoperative findings and surgical outcomes in temporal lobe resections in patients with mesial temporal sclerosis in the language dominant hemisphere performed under general (GA) versus asleep-awake-asleep (AAA) anesthesia modalities. Single-center retrospective case-control study involving 31 adults who had clinical/imaging/neurophysiology concordant evidence of mesial temporal lobe epilepsy in the language dominant hemisphere submitted to temporal lobe epilepsy surgery. GA was used in 20 patients and AAA in 11 patients. Presurgical characteristics of the patients, intraoperative hemodynamic and physiological findings or complications and postoperative outcomes including ILAE scale scores at least 1 year of follow-up were analyzed using descriptive statistics and independent t-tests, Fisher's exact test, and χ² tests to identify differences between the groups. During the surgery, there were no notable differences between the groups in terms of hemodynamic parameters, arterial blood gas measurements, or bleeding. However, the surgery length was longer in AAA group. Postoperative outcomes, including hospital stay duration, complication rates, and follow-up periods, were also comparable without significant differences. Neurological deficits were minimal in both groups, with no statistically significant differences between them. Most patients achieved positive results based on the ILAE classification in both groups, with most experiencing either no seizures or rare, non-disabling seizures. AAA showed comparable results to general anesthesia, with no intraoperative complications or postoperative negative outcomes. However, due to the limited sample size, further evidence is needed to confirm its benefits in epilepsy surgery involving eloquent areas over GA.

Inflammation and angiogenesis are critical processes contributing to the progression of chronic subdural hematoma (CSDH). Tissue plasminogen activator (tPA), which is highly abundant in CSDH effusion, has been implicated not only in hematoma liquefaction but also in progressive hematoma enlargement. Notably, tPA expression has also been reported in intracranial neoplasms, where it contributes to the development of peritumoral edema, suggesting roles beyond fibrinolysis. We therefore hypothesized that tPA exerts non-fibrinolytic effects in the pathophysiology of CSDH. Twenty CSDH fluid specimens and eight outer membrane samples were analyzed. The concentrations of tPA and matrix metalloproteinase-9 (MMP-9) were markedly higher in CSDH fluid than in cerebrospinal fluid. Immunoblotting confirmed the presence of low-density lipoprotein receptor-related protein-1 (LRP-1), phosphorylated Mek (p-Mek), Mek, phosphorylated Erk (p-Erk), Erk, MMP-9, caspase-3, and cleaved caspase-3 in the outer membrane. Immunohistochemical analyses revealed that LRP-1, p-Erk, Erk, and MMP-9 were predominantly localized to vascular endothelial cells, whereas LRP-1, caspase-3, and cleaved caspase-3 were mainly expressed in fibroblasts within the outer membrane. Moreover, exposure of fibroblasts to CSDH effusion significantly attenuated staurosporine-induced cleaved caspase-3 expression in vitro. Collectively, these findings suggest that elevated tPA in CSDH effusion is associated with activation of LRP-1-dependent Mek-Erk signaling and increased MMP-9 expression, and may also be linked to anti-apoptotic responses in fibroblasts. These pathology-associated signaling features extend beyond the classical fibrinolytic role of tPA and may have therapeutic implications for refractory CSDH, warranting further functional and interventional studies.

The present study aimed to investigate the clinical characteristics, diagnosis, and treatment of arachnoid cyst complicated with subdural hematoma in children. Clinical characteristics of arachnoid cyst complicated with subdural hematoma in children were summarized by retrospectively analyzing the clinical data of 25 patients, including their onset characteristics, presence or absence of inducing factors, clinical manifestations, and imaging features. All patients underwent craniotomy for subdural hematoma removal along with arachnoid cystectomy. Following the surgical procedure, all 25 patients showed significant improvements in preoperative symptoms, without any severe complications, and were discharged smoothly. Postoperative follow-up ranged from 3 months to 10 years. Head computed tomography (CT) or magnetic resonance imaging (MRI) reexamination revealed that arachnoid cysts were significantly reduced or disappeared completely after surgery in all 25 patients. None of the patients experienced recurrence of subdural hematoma, and all have resumed normal study, work, and daily life. Subdural hematoma in children is usually secondary to head trauma or strenuous exercise. Arachnoid cyst is a critical risk factor for intracranial hemorrhage. The combined application of head CT and MRI is an important approach to confirm the diagnosis of this disease. Due to its definitive therapeutic effect and low postoperative recurrence rate, craniotomy for subdural hematoma removal in combination with arachnoid cystectomy plus cisternal communication surgery is the preferred treatment method for pediatric patients with intracranial hypertension, significant space-occupying effect of the arachnoid cyst, and compression of the surrounding brain tissues.

Objective: Delays in identification and management of penetrating cerebrovascular injury (PCVI) can lead to poor outcomes. With improvements in computed tomography angiography (CTA) there remains controversy regarding the role of digital subtraction angiography (DSA).

Methods: Consecutive patients with penetrating injury to the head or neck evaluated with both CTA and DSA at a single level 1 trauma center were included. CTA's performances for identifying an injury, identifying the correct vessel, and correctly classifying the injury with DSA as the gold standard were determined. Outcomes included favorable clinical outcome at discharge (Modified Rankin Scale 0-2), length of stay (LOS), and routine discharge disposition.

Results: A total of 95 patients were included. CTA identified 69 injuries in 54 patients while DSA identified 79 injuries in 58 patients. For identifying an arterial injury, CTA was 72.6% accurate, 74.1% sensitive, and 70.3% specific. The PPV was 79.6% and the NPV was 63.4%. For identifying the correct vessel injured, CTA was 96.2% accurate and the Cohen's Kappa (K) was 0.95. For characterizing the injury type, CTA was 70.0% accurate and K was 0.58. Biffl grade 5 injuries were associated with greater odds of unfavorable clinical outcome at discharge (OR 3.60, 95% CI 1.05-13.35; p = 0.046). Biffl grade 4 injuries were associated with greater odds of nonroutine discharge disposition (OR 4.39, 95% CI 1.23-18.37; p = 0.029).

Conclusion: CTA had low sensitivity, accuracy, and NPV for detecting PCVI. This highlights potential limitations of CTA as a screening tool and strengthens the role of DSA for patients with penetrating head and neck injuries.

This prospective study aimed to evaluate the clinical and radiological outcomes of lever-up laminoplasty (LLP) using innovative hinged titanium plates for treating multilevel cervical spondylotic myelopathy (CSM). Ten patients diagnosed with multilevel CSM underwent LLP between June and October 2022 were enrolled. Intraoperative parameters, including operative time, blood loss, transfusion volume, and complications, were systematically recorded. Postoperative imaging evaluated spinal cord decompression by measuring the midsagittal diameter, transverse area, and osseous canal volume. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score, and axial symptoms (AS) assessed with the the Visual Analogue Scale (VAS). All procedures were successfully performed, with follow-up periods ranging from 12 to 15 months. Postoperative imaging confirmed complete neural decompression in the treated segments, without any signs of cervical instability. Significant increases in the mid-sagittal diameter (C3-C7) and cross-sectional area of the spinal canal were observed compared to preoperative values (P < 0.01). The osseous spinal canal volume increased by an average of 61.82% ± 18.50%. Both the JOA and VAS scores demonstrated significant improvements at the final follow-up (P< 0.01). One patient experienced transient C5 nerve root palsy, which was resolved with conservative treatment. No other complications or significant AS were reported. LLP using hinged titanium plates is a safe and effective surgical approach for the treatment of multilevel CSM. The technique achieves significant spinal canal expansion and a reduced incidence of postoperative AS, offering a promising alternative to conventional laminoplasty methods. Nevertheless, additional comparative research with extended follow-up is essential to confirm its long-term benefits and comparative advantages over conventional surgery.

Bevacizumab only improves progression-free survival (PFS) but not overall survival (OS) in glioblastoma (GBM) patients. Drug-induced hypertension is a common adverse event associated with bevacizumab in GBM, and it may paradoxically be associated with a favorable treatment response. However, the prognostic role of hypertension as a biomarker for bevacizumab efficacy in GBM remains unresolved. This study aimed to systematically evaluate the prognostic role of drug-induced hypertension in GBM patients treated with bevacizumab. We included studies on hypertension and survival outcomes in GBM patients treated with angiogenesis inhibitors from PubMed, Cochrane Library, and Web of Science databases. We extracted time-to-event data, including hazard ratios, and reconstructed individualized patient data from Kaplan-Meier curves. We used a meta-analysis approach to analyze pooled hazard ratio outcomes. A total of 1082 patients were included from 7 studies. Of these, 215 (24.8%) patients developed drug-induced hypertension, while 867 (75.2%) patients were normotensive. Compared to normotensive patients, patients who developed drug-induced hypertension showed a median benefit of PFS ranging from 2 to 8 months and OS ranging from 4 to 10 months in individual studies. Pooled time-to-event analysis showed that drug-induced hypertension significantly prolonged both PFS (HR = 0.44; 95% CI:0.28-0.70; p = 0.008) and OS (HR = 0.50; 95% CI:0.30-0.83; p = 0.015). Meta-regression demonstrated that earlier onset of hypertension may confer a greater survival benefit (PFS: β = 0.0078, OS: β = 0.0056), and subgroup analysis indicated that a ≥ 140/90 mmHg threshold may serve as a practical biomarker cutoff. In conclusion, this meta-analysis suggest that drug-induced hypertension is significantly associated with improved PFS and OS in bevacizumab-treated GBM patients. These findings suggest its potential as a positive prognostic biomarker, warranting further prospective validation.

Ventricular entry (VE) in high-grade gliomas (HGGs) has been hypothesized to predispose patients to adverse events and poor outcomes; however, the extent remains unclear. This study aimed to systematically evaluate the impact of VE in patients with HGG. A PROSPERO-registered (CRD420251053281) systematic search was conducted in the ScienceDirect, Scopus, PubMed, Google Scholar, and Cochrane databases to identify longitudinal studies up to June 2025. Primary outcomes included leptomeningeal dissemination (LMD), distant parenchymal recurrence (DPR), and hydrocephalus. Additionally, survival analysis with Kaplan-Meier curve and meta-regression were conducted to assess survival patterns and identify study-level moderators contributing to heterogeneity. Seventeen studies involving 4,086 participants (mean age 57.24 ± 11.21 years; 52.26% male) met the inclusion criteria. VE was significantly associated with increased risks of LMD (RR 2.23; 95% CI 1.61-3.11; p < 0.001) and hydrocephalus (RR 3.57; 95% CI 1.88-6.80; p < 0.001), but not DPR in the overall analysis. Survival analysis revealed that VE is associated with increased mortality (HR 1.12; 95% CI 1.03-1.21) up to 84 months. Meta-regression revealed that prior treatment was inversely associated with LMD, whereas increasing age, male sex, glioblastoma histology, and receipt of chemotherapy or radiotherapy were positively associated with DPR. In contrast, non-methylated status and radiotherapy were inversely associated with hydrocephalus. VE in HGGs may be associated with increased risks of LMD, hydrocephalus, and reduced survival. However, these associations should be regarded as provisional.