Neurosurgical Review最新文献

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.

Several radiological signs have been recognized as valuable adjuncts to clinical criteria in the diagnosis of normal pressure hydrocephalus (NPH). Certain magnetic resonance imaging (MRI) findings may also provide information on postoperative outcomes following ventricular shunting. However, the evidence remains inconclusive. We conducted a retrospective cohort study including patients from our institution's Clinical Care Center for NPH. Preoperative MRI findings-specifically Evan's Index (EI), callosal angle (CA), disproportionately enlarged subarachnoid space hydrocephalus (DESH), and periventricular white matter hyperintensities (PWMH)-were analyzed in relation to pre- and postoperative clinical status. The median age was 80 years (IQR 75-85), and 68.3% of patients were males. All patients exhibited gait disturbances, 93.3% cognitive impairment, and 83.3% urinary symptoms. Median EI was 0.35 (IQR 0.33-0.37) and median CA was 85.2° (IQR 80-90). DESH was present in 60% of patients, while PWMH were detected in 48.3%. At 1-month follow-up, gait improvement was observed in 66.6%, urinary improvement in 75.6%, and cognitive improvement in 83.0%; sustained at 12 months in 63.8%, 63.8%, and 69.0%, respectively. PWMH correlated with gait improvement (p = 0.04), and DESH with cognitive improvement at 12 months (p = 0.02). DESH and PWMH demonstrated domain-specific prognostic value in idiopathic NPH, whereas EI and CA showed limited predictive utility. Imaging parameters should be interpreted in conjunction with clinical evaluation for outcome prediction.

Background: Traumatic brain injury-induced coagulopathy (TBI-IC) in the elderly is a severe complication of traumatic brain injury (TBI) that leads to unfavorable outcomes. Currently, there are no reliable machine learning (ML) models available for early identification. This study comprehensively assessed routine clinical characteristics at admission to develop a robust, generalizable, and explainable ML model for estimating TBI-IC risk in the elderly and to identify modifiable factors.

Methods: This study included two cohorts: a derivation cohort (n = 484) from the Medical Information Mart for Intensive Care IV (MIMIC-IV) and a validation cohort from the eICU Collaborative Research Database (eICU-CRD) (n = 788). Feature selection utilized the Boruta algorithm, followed by the implementation of a distinctive ML framework incorporating 12 ML algorithms to establish a consensus prediction model (TBI-IC index). The model and feature variable assessments were conducted using multiple analytical methods. Model interpretation and feature quantification relied on the Shapley additive explanation (SHAP) methodology for visualization purposes.

Results: Through Boruta algorithm selection, 17 characteristics were identified across two cohorts and incorporated into 12 ML methodologies, generating 113 permutations and an optimal algorithm for identifying TBI-IC. The TBI-IC index demonstrated strong diagnostic capabilities, achieving a mean area under curve (AUC) of 0.801 across both cohorts, along with notable discriminatory power, model fit, and clinical utility. Multivariate logistic regression and subgroup evaluations confirmed the stability and broad applicability of the TBI-IC model. SHAP explains the importance of ranking features and visualizes global and individual TBI-IC risk predictions. Restricted cubic spline (RCS) regression and threshold effect analysis suggested a nonlinear link between the model features and TBI-IC, and generated inflection points for the features.

Conclusion: An optimized explainable model (TBI-IC index) incorporating several modifiable parameters was established and confirmed to deliver an economical, readily available, and accurate diagnostic tool, along with preventive guidance for TBI-IC among elderly patients, with potential applications in TBI clinical management.