Neurosurgery最新文献

Background and objectives: Racial/ethnic disparities in health literacy, self-perception of health status, and barriers to care access have been described for many disease processes. However, few studies have characterized these factors in patients with Chiari malformation type I (CM-1).

Methods: We performed a cross-sectional analysis of data from the National Institutes of Health All of Us Research Program. Adults with CM-1 were identified through International Classification of Diseases, ninth revision and 10th revision diagnostic codes and stratified by race/ethnicity: non-Hispanic White (NHW), non-Hispanic Black or African American, and Hispanic or Latino (HL). Patient demographics and socioeconomic status were examined. Group-level differences in survey-reported baseline health status, health perceptions, health literacy, and perceived barriers to care were evaluated.

Results: Of the 966 patients identified, 552 (57.1%) were NHW, 225 (23.3%) were non-Hispanic Black, and 189 (19.6%) were HL. Socioeconomic status varied between strata, with the highest education level, income level, employment, retirement, marital status, and home ownership reported by NHW patients (P < .001 for all). Average pain was highest among HL patients, as well as proportions of best and worst general health status (all P < .001). The NHW cohort was able to accomplish more of their everyday activities than the other cohorts (P = .003). The worst general mental health (P = .015), general physical health (P = .004), and general quality of life (P < .001) were reported by HL patients. The HL cohort had the highest rates of difficulty in understanding information, required health material assistance, and had low medical form confidence (P < .001 for all). Furthermore, difficulties affording follow-up care (P = .041), concerns about payment (P = .033), and transportation-related delays in care (P = .002) were most common in the HL cohort.

Conclusion: The results of our study indicate racial/ethnic disparities in CM-1 patients' perception of their health, health literacy, and access to care.

Background and objectives: Dual-energy x-ray absorptiometry (DXA) is the standard for assessing bone mineral density (BMD); however, its accuracy is limited by bone architecture, acquisition quality, and clinical context. Hounsfield units (HUs) offer an alternative for osteoporosis risk stratification. Machine learning (ML) models can segment computed tomography (CT) anatomy and integrate HU data to generate BMD metrics previously unavailable. This study elucidates the capabilities of an automated CT segmentation platform and investigates the relationship between vertebral HUs and DXA stratifications of BMD.

Methods: A retrospective analysis of 229 patients with lumbar CT and DXA scans within 1 year was performed. The TotalSegmentator ML model obtained segmentations of the lumbar spine which were integrated with CT radiographic data to compute volume (cm3) and HU density of vertebral bodies, trabecular bone, and cortical bone. Vertebral body HU means were compared against lumbar, hip, and femoral neck DXA T scores in healthy individuals (T-score > -1.0), patients with osteopenia (-1.0 ≥ T-score ≥ -2.5), and patients with osteoporosis (T-score < -2.5) .

Results: Patients (85.2% female) had a mean age of 71.02 ± 13.62 years and body mass index of 28.04 ± 7.51 kg/m2. Mean HUs from L1-L5 correlated with femoral neck (r = 0.54, P < .001), lumbar (r = 0.54, P < .001), and hip (r = 0.46, P < .001) DXA T-scores. Compared with osteopenic individuals, healthy individuals had higher L1-L5 total HU (265.0 vs 226.4, P < .001), trabecular HU (179.3 vs 136.5, P < .001), and cortical HU (312.0 vs 274.8, P < .001). The L1-L5 total, trabecular, and cortical bone were predictive for low BMD (area under the curve [AUC] = 0.77, AUC = 0.80, and AUC = 0.75) and osteoporosis (AUC = 0.79, AUC = 0.75, and AUC = 0.80), respectively. Youden Index analysis identified optimal trabecular and cortical bone threshold values of 141.3 HU and 254.2 HU for low BMD as well as 132.3 HU and 249.0 HU for osteoporosis, respectively.

Conclusion: ML-driven CT segmentation correlates with DXA BMD stratifications and can provide a robust, consistent, and efficient assessment of HU density of critical vertebral structures.

Background and objectives: Identification of the symptomatic aneurysm in patients with multiple intracranial aneurysms (MIAs) represents a challenge. Aneurysm wall enhancement is a potential imaging biomarker to assess symptomatic status among intracranial aneurysms. We aimed to use aneurysm wall enhancement in the identification of symptomatic aneurysms in patients with MIAs.

Methods: Patients who underwent high-resolution 3 Tesla magnetic resonance imaging between 2018 and 2024 at 3 institutions-one in the United States and 2 in China-were included in the analysis. Eligible patients had MIAs, with at least 1 aneurysm classified as symptomatic. Morphological measurements were obtained from angiography studies. Three-dimensional circumferential aneurysm wall enhancement (3D-CAWE) was assessed for all aneurysms. Multivariate logistic regression was used to identify variables independently associated with symptomatic status.

Results: Thirty patients with 82 MIAs were included, 30/82 (36.6%) were symptomatic and 52/82 (63.3%) were asymptomatic. Aneurysmal size (adjusted odds ratio [aOR]: 1.5, 95% CI: 0.95-2.8, P = .1) and size ratio (aOR: 2.2, 95% CI: 0.8-3.2, P = .2) were not associated with symptomatic presentation. Symptomatic aneurysms were more likely to have a higher 3D-CAWE (aOR: 1.15, 95% CI: 1.05-1.24, P = .01) when compared with asymptomatic aneurysms. Receiver operating characteristic analysis revealed that a 3D-CAWE cutoff point of 1.02 has a specificity of 88% and negative predictive value of 79% in detecting symptomatic aneurysms among patients with MIAs.

Conclusion: 3D-CAWE can be used in the identification of symptomatic aneurysms in patients with MIAs.

Since its introduction into medical terminology by Lord Henry Cohen in 1941, the term "neurapraxia" has become established in the neurological and neurosurgical lexicon, although it is often misused or misspelled. It denotes a transient dysfunction of a peripheral nerve, as distinct from axonotmesis and neurotmesis, which describe more significant structural injuries to a peripheral nerve. To expand our understanding of neurapraxia, it is necessary to examine the phenomenon in both temporal and spatial contexts. This study examines neurapraxia in: (A) Time-(1) the origins of the term neurapraxia and (2) the time-course of a neurapraxic injury and its recovery, and (B) Space-(3) the microstructure of a neurapraxic injury and (4) the locations of neurapraxic injuries within the peripheral nervous system. We demonstrate that the term neurapraxia encompasses both a temporal and a spatial definition. In time, it applies to transient peripheral nerve palsy, from which recovery occurs before there is sufficient time for axonal regeneration, typically within a few weeks. In space, there is a histopathological change limited to localized demyelination in nerves lined by epineurium and myelinated by Schwann cells. Nerves distal to the spine qualify as nerves to which the term neurapraxia can apply; however, cranial nerves and spinal nerve roots (including cauda equina) are inconsistent with this owing to the variability in myelinating cells along their course (oligodendroglia proximally, i.e., central glial segment), the absence of an epineurial covering, and exposure to cerebrospinal fluid.

Background and objectives: Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive alternative to open craniotomy for patients deemed unsuitable for surgery due to deep-seated or eloquent lesion location, age, frailty, or comorbidities. However, its use in newly diagnosed deep-seated low-grade glioma (nLGG) has not been elucidated. We aimed to evaluate the safety and efficacy of LITT for deep-seated nLGG compared with a similar surgical cohort.

Methods: We retrospectively reviewed patients with unifocal, deep-seated nLGG treated with either LITT or surgical resection between 2013 and 2024. Demographic, perioperative, and follow-up data were compared between groups. Kaplan-Meier assessed progression-free and overall survival outcomes. To address baseline tumor volume differences, a subset analysis was performed using a greedy nearest-neighbor algorithm to generate a 1:1 matched cohort based on tumor volume.

Results: A total of 15 patients in the study group (median age 46 [IQR: 34-53] years, 40.0% men) were compared with 51 patients (median age 38 [IQR: 29-54] years, 43.1% men) in the control group. There were no significant differences in in-hospital complications (P = .999), 30-day complications (P = .999), or complications between 30 days and 3 months (P = .713), new postoperative motor or speech deficits (0.999) between groups. Postoperative adjuvant chemotherapy (23.1% vs 46.9%, P = .217) and radiation (23.1% vs 44.7%, P = .210) rates did not differ significantly. Among high-risk patients, time to adjuvant chemotherapy (64.7 vs 77.7 days) and radiation (36.0 vs 53.6 days) was earlier in the LITT group, although not statistically significant. Kaplan-Meier analysis showed no statistically significant differences in progression-free survival or overall survival between groups. On matched pair analysis, there remained to be no statistically significant differences in outcomes observed between LITT and craniotomy groups.

Conclusion: This pilot study is the first to suggest that LITT is a safe treatment option for patients with deep-seated nLGG, offering comparable outcomes with surgical resection.

Background and objectives: Myelomeningocele is defined by the presence of a fluid-filled sac that contains the neural placode and cerebrospinal fluid (CSF) at the level of the spinal defect. Alternatively, the term myeloschisis is used when the neural placode is not contained within a CSF-filled sac. While both are eligible for prenatal closure, few studies have characterized the impact of the type of lesion on postnatal outcomes. This study compares the outcomes of these 2 types of open spinal dysraphism using data from the Fetal Myelomeningocele Consortium registry sponsored by the North American Fetal Therapy Network.

Methods: The prospective observational Fetal Myelomeningocele Consortium registry was used to extract deidentified data corresponding to patients who underwent fetal closure of myelomeningocele vs myeloschisis. Demographics, operative characteristics, perioperative complications, and postnatal outcomes were collected.

Results: A total of 1327 patients were identified, including 991 (74.7%) with myelomeningocele and 336 (25.3%) with myeloschisis. Compared with myelomeningocele, myeloschisis was associated with lower rates of prenatal talipes (11% vs 24%, P < .001) and higher rates of favorable prenatal movement (94% vs 86%, P < .001). Postnatally, myeloschisis conferred higher rates of leg movement (97% vs 90%, P = .002) and an increased likelihood of ambulation in the household (10.4% vs 4.1%, P = .009) and outside (7.2% vs 1.9%, P = .004) at 1 year. However, myeloschisis was also linked to greater use of skin patches during closure (49% vs 27%, P < .001), higher CSF leak rates among those with wound dehiscence (26% vs 8%, P = .014), and more frequent CSF diversion and tethered cord surgeries at follow-up.

Conclusion: Myeloschisis and myelomeningocele demonstrate distinct clinical profiles. Although patients with myeloschisis may have favorable motor outcomes, they are also characterized by higher rates of CSF leakage, CSF diversion, and tethered cord surgery. These findings highlight the need for lesion-specific prognostication and may inform surgical planning and parental counseling in the context of prenatal spina bifida closure.

Background and objectives: Myelomeningocele (MMC) is a neural tube defect and 1 of 3 forms of spina bifida. The management of this disease is a matter of discussion in the literature. To attempt to alleviate this gap in the current literature, the authors conducted a systematic review and comparative meta-analysis on this topic.

Methods: Fulfilling Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the authors systematically searched the Embase, PubMed, and Web of Science databases to identify English articles reporting comparative cohorts of more than 4 patients with MMC being submitted for either prenatal or postnatal repair. Risk ratio (RR) with 95% CI was used to measure effects in comparative analysis with a random-effect model applied. Sensitivity analysis was used to explore cases of high heterogeneity.

Results: From 885 studies initially found, 20 studies with 2862 patients were included in the analysis. Of these patients 1587 were submitted to postnatal repair and 1275 to prenatal repair. No statistical difference between groups were found in mortality (RR 2.00 [0.71-5.63]; I2 = 0%), tethered cord syndrome (RR 1.40 [0.89-2.19]; I2 = 29%), and hindbrain herniation (RR 0.88 [0.74-1.04]; I2 = 81%). Hydrocephalus developed in 557 patients, significantly favoring prenatal repair 0.48 (RR 0.48 [0.41-0.56]; I2 = 5%). Shunt placement occurred in 360 patients, significantly favoring prenatal repair (RR 0.50 [0.43-0.58]; I2 = 47%). Motor dysfunctions happened in 197 patients significantly favoring prenatal repair 0.59 (RR 0.59 [0.49-0.71]; I2 = 0%).

Conclusion: Prenatal MMC repair was associated with a smaller risk of hydrocephalus development, shunt placement, and motor dysfunctions.

Background and objectives: Unrealistic or unmet expectations can contribute to lower satisfaction and decisional regret (DR), particularly as shared decision-making becomes more central in elective spine care. Understanding these dynamics in minimally invasive lumbar decompression may guide strategies to optimize preoperative counseling and patient-centered outcomes. Our study aims to evaluate the correlation between patient expectation-actuality differences and DR following minimally invasive lumbar decompression surgery and to identify other patient-reported outcomes associated with DR.

Methods: This prospective cohort study included adults undergoing elective one-level or two-level minimally invasive lumbar decompression. Patients completed preoperative Musculoskeletal Outcomes Data Evaluation and Management Systems (MODEMS) expectation surveys and postoperative MODEMS actuality surveys at 3 and 6 months, along with the Decisional Regret Scale at both time points. Expectation-outcome mismatch was calculated for each MODEMS domain. Predictors of DR were assessed using univariate linear regression, with significance set at P < .05.

Results: Among 104 patients (mean age 64.9 years, 54.5% male), 60% reported no regret and 11% high regret at 3 months, compared with 61% no regret and 6% high regret at 6 months. Across both time points, DR was strongly associated with greater expectation-outcome mismatch. In univariate regression, mismatch in pain relief, daily activity, exercise, sleep, return-to-work, and disability prevention significantly predicted higher regret, with pain relief showing the largest effect. Demographic and clinical factors, including age, sex, comorbidity burden, and preoperative disability, were not associated with regret. MODEMS mismatch remained the most consistent predictor at both follow-ups.

Conclusion: DR in minimally invasive lumbar decompression is strongly linked to expectation-actuality differences and reduced satisfaction, with pain relief, activity, and exercise emerging as key drivers. These findings highlight the importance of refining tools to assess expectations and identify unmet needs to reduce regret and improve patient-reported outcomes.

Background and objectives: Anterior cervical diskectomy and fusion (ACDF) and cervical disk replacement (CDR) are common options for cervical degenerative radiculopathy. While previous studies indicate comparable early outcomes at discrete time point, few have quantified cumulative postoperative disability over a year to compare these procedures. To develop novel cumulative postoperative disability and compare the metric between ACDF and CDR.

Methods: This is a retrospective study analyzing 327 patients undergoing primary 1- or 2-level ACDF or CDR for degenerative cervical radiculopathy between February 2016 and September 2024 in a single institution. Cumulative postoperative disability was quantified as the modified integrated health status (mIHS), which was area under the curve per week of the 1-year normalized Neck Disability Index modeled using mixed-effects regression. Baseline differences were adjusted using overlap weighting based on propensity scores.

Results: The mIHS demonstrated acceptable construct and modest concurrent validity. The mixed-effects model indicated significantly different recovery trajectories between groups (P < .001). The mIHS was significantly higher for ACDF than for CDR (3.71 vs 2.68; mean difference, 1.03 [95% CI, 0.80-1.25], P < .001). Level-specific analyses showed that 1-level CDR showed a 21.5% lower mIHS than 1-level ACDF (P < .001), whereas 2-level CDR had a 32.1% lower mIHS than 2-level ACDF (P < .001). The 2-level ACDF showed greater mIHS than 1-level ACDF (3.47 vs 3.89; P = .012), whereas 1-level CDR and 2-level CDR were comparable (2.76 vs 2.64; P = .59).

Conclusion: CDR was associated with less cumulative postoperative disability during the first year compared with ACDF. Two-level CDR resulted in disability comparable with 1-level CDR, whereas 2-level ACDF showed greater disability than 1-level ACDF.