Neurosurgical Review最新文献

Frame-based stereotactic biopsy has long been the gold standard for diagnostic brain biopsy, whereas robot-assisted stereotactic techniques have emerged as promising alternatives. However, rigorous methodological comparisons between these approaches remain scarce. To compare the diagnostic yield and complication rates of frame-and robot-assisted stereotactic brain biopsy using a rigorously matched cohort methodology. This retrospective, bicentric, comparative analysis included adult patients who underwent stereotactic brain biopsy between January 2011 and December 2019. Each patient who underwent robot-assisted biopsy (n = 230) was matched in a 2:1 ratio with patients who underwent frame-based biopsy (n = 460). Matching was performed based on clinically relevant criteria including lesion location, size, contrast enhancement, histopathology, and patient age. The primary outcomes were diagnostic yield and complication rates. The diagnostic yield was identical for both techniques 97.4%, with a non-diagnostic biopsy rate of 2.6% in each group (p = 1.0). The symptomatic temporary complication rates were higher in the robot-assisted group (6.5%) than in the frame-based group (2.8%) (OR = 2.40; 95% CI: 1.04-5.58; p = 0.02). No differences were found in symptomatic hemorrhage, infection, seizures, permanent neurological deficits, or mortality between groups. Frame-based and robot-assisted stereotactic biopsy techniques demonstrated equivalent diagnostic efficacies. Although robot-assisted biopsies were associated with a higher incidence of transient symptomatic complications, both techniques exhibited favorable safety profiles with respect to severe complications. The choice of technique should consider the surgeon's experience, institutional resources, and integration within existing workflows.

Trigeminal neuralgia (TN) is a neuropathic pain disorder characterized by severe orofacial pain. The underlying pathophysiological nuances remain under study, and their understanding is key to developing new and more effective therapies for this debilitating disease. The field of cellular therapies for neurological diseases is continuously evolving. This systematic review was performed after the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We sought studies on the preclinical and clinical uses of cellular therapies for trigeminal neuralgia. We included 8 studies encompassing 1 clinical and 7 preclinical applications. Of the preclinical studies, four used Stem Cells from Human Exfoliated Deciduous Teeth (SHED), two used Olfactory Ensheathing Cells (OECs), and one used Bone Marrow Mesenchymal Stem Cells (BMSCs). All preclinical studies showed a statistically significant behavioral improvement in groups receiving cellular therapies compared to controls (p < 0.05), with either local or systemic delivery. In addition, cellular therapies have the potential to mitigate TN by promoting myelin repair, reducing neuroinflammation, and modulating pain-related pathways. The only clinical report in the literature described the incidental use of Adipose-Derived Stem Cells (ADSCs) during a facial cosmetic procedure in a 60-year-old female with a long history of TN, who remained pain-free at 2-year follow-up. These findings highlight the promising role of cellular therapies in the treatment of TN, demonstrating significant behavioral and molecular benefits in preclinical models and a compelling clinical case. Further rigorous clinical studies are necessary to establish their safety, efficacy, and long-term therapeutic impact.

Cushing's disease (CD) is a severe systemic metabolic disorder caused by elevated levels of cortisol sustained by a pituitary neuroendocrine tumor. Endoscopic trans-sphenoidal surgery (ETS) is the first-line treatment, but does not achieve disease remission in all patients. For patients with persistent or recurrent Cushing's disease, stereotactic radiosurgery (SRS) has been reported as an effective treatment option. This review and meta-analysis assesses the available evidence to systematically highlight the current strengths and limitations of SRS in the treatment of CD. In May 2025, following the PRISMA 2020 statement, a systematic review of Pubmed, Scopus, and Ovid was performed. Of 687 articles screened, 9 were considered eligible, describing a population of 341 patients. Most patients (90%) underwent a single dose of Gamma Knife SRS. The tumor control rate was 97.4% (95% CI: 95.2-99.6%). After a mean follow-up of 61.5 months after the latest SRS cycle, biochemical remission was achieved in 67.1% (95% CI: 58.5-75.7%) of cases in a mean time of 26.4 months. Recurrence post-SRS remission was documented in 21% of cases after a mean time of 39 months. New-onset hypopituitarism was observed in 29.9% of cases, visual impairment and other cranial nerve dysfunction in 1.8% (95% CI: 0.2-3.4%), and 1.9% (95% CI: 0.1-3.7%), respectively. No cases of radionecrosis were seen. After a single cycle of treatment, SRS effectively controls the disease in about half of patients affected by persistent or recurrent CD, with a low percentage of post-treatment complications. Based on the available literature, SRS emerges as a safe and effective treatment, and its implementation in common clinical practice may play a relevant role in the management of CD. Nevertheless, prospective and standardized studies are needed to thoroughly assess its real potential.

Hemorrhagic stroke (HS) is a severe condition with high mortality. Identifying high-risk patients for early intervention remains challenging. The triglyceride-glucose-body mass index (TyG-BMI), a simple and cost-effective marker of metabolic dysfunction, has shown potential as a predictor of all-cause mortality (ACM) in critically ill HS patients. This study aims to evaluate TyG-BMI's role in predicting mortality and its clinical utility in risk stratification. This retrospective cohort study analyzed critically ill hemorrhagic stroke patients in the MIMIC-IV database. Kaplan-Meier curves assessed ACM across TyG-BMI groups, and Cox regression models explored the association between TyG-BMI and ACM. Restricted cubic spline (RCS) analysis identified nonlinear relationships, and subgroup analyses examined variations across clinical populations. A total of 1,121 patients with hemorrhagic stroke were included in the final analysis. Multivariable Cox regression demonstrated that patients in the highest TyG-BMI quartile had significantly elevated all-cause mortality risk compared to those in the lowest quartile after full adjustment for clinical confounders (HR 1.891, 95% CI 1.24-2.89; P = 0.003). RCS analysis revealed a predominantly linear association between TyG-BMI and mortality (P for nonlinearity > 0.05). Using a clinically relevant threshold of 211.32 (corresponding to the cohort median), patients with TyG-BMI ≥ 211.32 exhibited 1.82-fold higher mortality risk (95% CI: 1.45-2.28; P < 0.001) compared to those below this threshold. The addition of TyG-BMI to the APACHE-IV scoring system significantly improved predictive accuracy for in-hospital mortality (ΔAUC = 0.118, 95% CI 0.053-0.183; P = 0.002). This study demonstrates that TyG-BMI is an independent risk factor for ACM in critically ill HS patients, providing strong evidence to support its use as a reliable biomarker for identifying high-risk patients with elevated mortality.

Treatment of meningiomas refractory to resection and/or radiotherapy represents a therapeutic challenge. Azacitidine (AZA), a DNA methyltransferase inhibitor, is successfully used in the treatment of leukemia and sarcomas. Efficacy of Decitabine (DCT) - a chemical analogue of AZA - was demonstrated in a subset of primary meningioma cells. We aimed to investigate the efficacy of AZA and underlying molecular alterations in primary meningioma cells. Effects of AZA on cell viability and proliferation in primary meningioma cells were analyzed using a CellTiter-Glo Cell Viability Assay and immunofluorescence staining of Ki-67-expression. Immunofluorescence for DNA methyltransferases (DNMT1,3a,3b) was used to investigate the molecular preconditions for efficacy. Genome-wide DNA methylation analyses were performed prior and after drug exposition. 72 h after drug application (10 µM AZA), cell viability significantly decreased in 13 of 19 (68%) primary cells. In 9 of 16 cases (56%) we found a decrease in Ki67-expression after application of AZA. Furthermore, AZA significantly reduced DNMT1, DNMT3a and 3b expression in 44%, 27% and 18% of primary cells 72 h after drug exposition. DNMT expression was independent of cell viability and proliferation. Methylation profiles of cells sensitive or resistant to AZA as well as before or after treatment did not significantly differ. Compared to DCT, AZA more effectively reduced viability and proliferation in primary meningioma cells. Molecular impact was largely independent of DNMT expression and methylation profile. Next to inducing DNA demethylation and epigenetic reprogramming, efficacy of AZA may be due to other molecular mechanisms of action.

To evaluate the diagnostic value of a magnetic resonance imaging (MRI)-based imaging heterogeneity scoring system for differentiating high-grade glioma (HGG) from primary central nervous system lymphoma (PCNSL). This multicenter retrospective study analyzed clinical and preoperative MRI data from 314 pathologically confirmed cases (HGG = 167, PCNSL = 147), comprising 211 patients with single lesions (HGG = 130, PCNSL = 81) and 103 with multifocal lesions (HGG = 37, PCNSL = 66). Patients were randomly assigned to training (single-lesion: n = 147; multifocal: n = 72) and validation (single-lesion: n = 64; multifocal: n = 31) sets in a 7:3 ratio. Distinctive imaging features were used to construct separate logistic regression (LR) models for single-lesion and multifocal-lesion cases, with corresponding scoring systems developed. A baseline model incorporating conventional predictors was developed for comparison. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves (area under the curve [AUC], 95% confidence interval [CI]), Hosmer-Lemeshow tests (goodness-of-fit), calibration curves, and decision curve analysis (DCA). A sensitivity analysis was performed on excluded steroid-treated patients. For single-lesion cases, the training and validation AUCs were 0.940 (95%CI: 0.897-0.983) and 0.908 (0.836-0.981), respectively. Multifocal models achieved training and validation AUCs of 0.960 (0.921-0.999) and 0.927 (0.805-1.000). The heterogeneity scoring system demonstrated significant incremental value over the baseline model (ΔAUC: +0.160-0.290). Hosmer-Lemeshow tests indicated excellent model fit (single-lesion training: χ²= 2.489, P = 0.778; validation: χ² = 6.193, P= 0.185; multifocal training: χ² = 1.760, P = 0.881; validation: χ² = 9.241, P = 0.055). DCA demonstrated substantial net clinical benefit across threshold probabilities. The scoring systems established diagnostic thresholds as follows: ≥ 19 points for HGG (single-lesion) and > 19 points (multifocal), with lower scores indicating PCNSL. Center-stratified validation and repeated cross-validation confirmed strong generalizability across institutions (AUC: 0.934-0.941). The system maintained robust performance in the sensitivity analysis of steroid-treated patients. This MRI heterogeneity-based scoring system provides robust diagnostic accuracy for distinguishing HGG from PCNSL, serving as an objective clinical decision-support tool.