Neurosurgery最新文献

Background and objectives: Glioblastoma (GBM) isocitrate dehydrogenase-wildtype remains a devastating brain tumor with a poor prognosis despite optimal treatment. Even after supramaximal or complete contrast-enhancing (CE) resection, patient outcomes vary significantly, with some experiencing short-term survival (STS) and others long-term survival (LTS). This study aims to identify clinical and molecular markers predicting the survival of patients with GBM in these high-resection categories.

Methods: We retrospectively analyzed patients with newly diagnosed GBM who underwent supramaximal or complete CE resection, followed by next-generation sequencing at our institution (2009-2025). Patients were categorized as STS (survival ≤12 months), non-STS (survival >12 months), or LTS (survival ≥36 months). We compared clinical, radiological, and molecular features between these groups to identify potential prognostic markers.

Results: Among 85 patients who met the inclusion criteria, 24 (28%) were STSs and 61 were non-STS (from which 16 [18.8%] were LTSs), with no significant molecular differences observed between these groups. On comparing STS and LTS patients, CDKN2A/B loss (83.3% vs 43.8%, P = .01) and EGFR amplification (58.3% vs 25%, P = .05) were more frequent in STS patients vs LTS. Tumor location varied, with STS patients having more frontal lobe tumors (45.8%) and LTS patients having more temporal lobe tumors (62.5%). A trend, although not statistically significant, toward increased nonlocal recurrence rates was observed in STS patients (27.2%).

Conclusion: Despite aggressive extent of resection in GBM, the prevalence of STS patients remains notable at ∼28% and survival beyond 3 years remains limited at ∼18.8%. CDKN2A/B loss and EGFR amplification might correlate with shortened survival after supramaximal or complete CE resection. The impact of nonlocal recurrence remains uncertain among STSs. These findings highlight the need for collaborative studies to advance understanding of the biology of GBM as their behavior differs despite aggressive surgical and medical therapies.

Background and objectives: Cervical spine disease impairs quality of life through increased pain, discomfort, and altered sleep. Surgery is known to improve many quality of life domains as measured by patient-reported outcome measures, yet the interplay of sleep quality and surgical outcomes after cervical spine surgery remains understudied. This study aimed to characterize changes in sleep quality after cervical spine surgery over time using patient-reported outcome measurement information system (PROMIS) sleep disruption (PROMIS-SD) scores and identify factors associated with postoperative sleep improvement.

Methods: This single-center retrospective cohort study included patients 18 years and older who underwent cervical spine surgery for degenerative disease. Preoperative and postoperative PROMIS-SD scores quantified sleep quality changes. Repeated-measures analysis of variance analyzed trends in sleep disruption over time and by demographic and clinical factors whereas latent class analysis identified how sleep disruption affected surgical success through other PROMIS measure domains.

Results: Among 1015 patients (mean age: 61.5, 89.6% White), surgical approaches included anterior cervical diskectomy and fusion, arthroplasty, laminectomy and fusion, laminoplasty, and foraminotomy. Overall, PROMIS-SD scores improved postoperatively at 6 (P < .0001), 12 (P < .0001), 18 (P < .0001), and 24 months (P = .0419). Age at surgery (P = .0062) and preoperative sleep quality (P = .0007) were the strongest predictors of sleep improvement. Latent class analysis identified 6 patient outcome profiles. In our cohort, successfully meeting minimal clinically important difference for PROMIS mental health was only achieved in those patients also attaining minimal clinically important difference in either PROMIS physical health or PROMIS-SD.

Conclusion: Sleep improved or remained stable in >90% of patients after cervical spine surgery. Factors such as preoperative sleep scores and age most influenced changes in sleep improvement after surgery. Postoperative improvements in mental health were dependent on prerequisite improvements in physical health or sleep, and young patients with above average baseline sleep quality were most likely to experience postoperative sleep disruption.

Background and objectives: While Cell Saver (CS) is meant to give patients back their own blood products in surgery, its quality has been called into question. To determine the safety of CS in adult spinal deformity (ASD) surgery, we sought to evaluate the impact CS on (1) intraoperative transfusions, (2) postoperative hematocrit, and (3) complications.

Methods: A retrospective cohort study (2009-23) was performed for patients undergoing ASD surgery. Inclusion criteria were ≥5-level fusion, sagittal/coronal deformity, and ≥2-year follow-up. Primary exposure was use of CS. Primary outcomes were (1) intraoperative transfusions, (2) postoperative hematocrit, and (3) overall complications. Secondary outcomes were intraoperative hypotension, defined as total minutes mean arterial pressure was <65 mm Hg, length of stay, and discharge status. Multivariable analysis controlled for age, sex, body mass index, and operative time.

Results: Of 288 patients undergoing ASD surgery (mean age: 63 ± 18 years), 209 (73%) used CS. Mean CS given back was 428 ± 404 mL. CS use was associated with a longer operative time (442 ± 149 vs 382 ± 150 minutes, P = .003) and higher blood loss (1490 vs 765 mL, P < .001). The CS group paradoxically had higher intraoperative transfusion rates (68% vs 32%, P < .001) and blood product usage (3 ± 4 vs 1 ± 2 units, P < .001). Postoperative hematocrit was not different between groups (30 ± 4 vs 30 ± 5, P = .936). On multivariable regression, CS was independently associated with increased transfusions (odds ratio [OR] = 2.9, 95% CI: 1.6-5.5, P < .001) and medical complications (OR = 2.7, 95% CI: 1.0-7.0, P = .038). Multivariable regression analysis showed that CS was associated with longer intraoperative hypotension (β = 16.8, 95% CI: 3.8-29.7, P = .011) and higher odds of having mean arterial pressure <65 mm Hg for ≥90 minutes (OR = 3.3, 95% CI: 1.1-9.7, P = .032).

Conclusion: While controlling for operative time, CS use in ASD surgery was independently associated with increased intraoperative transfusions, medical complications, and prolonged hypotension without an improvement in postoperative hematocrit levels. Although giving patients back their own blood products seems beneficial, these data question the safety of CS use in ASD surgery.

Background and objectives: The benefits of oblique lateral interbody fusion (OLIF) vs transforaminal lumbar interbody fusion (TLIF) in severe lumbar stenosis (Schizas C/D) remain uncertain. This randomized trial compared clinical, radiographic, and safety outcomes of OLIF and TLIF.

Methods: From November 2018 to December 2021, a prospective, multicenter, randomized controlled trial enrolled 260 adults with single-level severe stenosis and instability. In total, 224 patients were randomized to OLIF or TLIF. Prespecified outcomes followed consolidated standards of reporting trials. Primary outcomes were visual analog scale back/leg pain and Oswestry Disability Index (ODI), with minimal clinically important difference thresholds of ODI ≥12-13 points or ≥30% improvement, and visual analog scale ≥1.5-2.0 points. Radiographic measures included disc height, lumbar and segmental lordosis, and canal cross-sectional area (CSA). Complications were recorded. Ethics approval was obtained from the institutional review board, the trial was registered with ISRCTN.com, and all patients provided written informed consent.

Results: In total, 224 patients were randomized, 5 were lost to follow-up (TLIF n = 2, OLIF n = 3). Baseline features were comparable. OLIF was associated with shorter operative time, less blood loss, earlier ambulation, and shorter hospital stay (all P < .05). Both groups achieved significant, clinically meaningful improvements. OLIF showed greater back pain reduction at 3-6 months and 2 years (P < .05) and superior ODI improvement at 3 and 6 months (P < .001), although long-term ODI scores were similar. Radiographically, OLIF provided greater restoration of disc height and segmental lordosis (all P < .001) and demonstrated progressive CSA increase (dynamic decompression), whereas TLIF achieved immediate, sustained CSA enlargement. Fusion rates were comparable at 1-2 years. Complication rates were low and similar (7.3% TLIF vs 5.5% OLIF), with most OLIF-specific events transient.

Conclusion: Both OLIF and TLIF yield improvements in severe lumbar stenosis. OLIF offers perioperative advantages, earlier functional recovery, radiographic restoration, and dynamic canal remodeling, supporting its role as an equivalent alternative for lumbar spinal stenosis with some secondary advantages.

Background and objectives: Patients with severe brain injury requiring decompressive craniectomy are at increased risk of developing chronic hydrocephalus, often necessitating both cranioplasty and shunt surgery. The optimal sequence of these procedures remains unclear, with limited and conflicting evidence on associated complication rates and outcomes. The aim of this study was to investigate clinical practices and outcomes associated with 3 procedural sequences: (1) cranioplasty before shunt, (2) simultaneous cranioplasty and shunt, and (3) shunt before cranioplasty.

Methods: In this multicenter retrospective cohort study, 99 patients from 4 Swedish neurosurgical centers who underwent both cranioplasty and shunt surgery over 15 years (2008-2022; only the first 10 years at 1 center) were included. Clinical data, surgical details, complications, and functional outcomes (modified Rankin Scale) were analyzed by each sequence group.

Results: Of 99 patients, 37 (37%) underwent cranioplasty before shunt, 37 (37%) had simultaneous procedures, and 25 (25%) received a shunt before cranioplasty. There was no significant difference in complications rates after cranioplasty or shunt surgery between these groups (P > .05). However, shunt before cranioplasty was associated with slightly higher rates of shunt complications (36% revision) but lower rates of cranioplasty removal (8%), whereas the inverse pattern was observed in the cranioplasty before shunt group (24% shunt revision; 30% cranioplasty removal). There was no difference in functional outcomes before or after cranioplasty or shunt surgery between the groups (P > .05).

Conclusion: The sequence of cranioplasty and shunt surgery did not significantly influence overall risks of implant revision or functional outcome, although complication patterns and their clinical severity differed between approaches. Cranioplasty implant removal remains a particularly serious event, while shunt infections can be equally detrimental. Future studies should refine sequencing strategies considering hydrocephalus type, timing, and procedural factors to minimize risk and improve patient outcomes.

Background and objectives: High-resolution ultrasonography (US) has become increasingly popular in cubital tunnel syndrome (CubTS). In this article, we confirmed the diagnostic role of US in a large and homogeneous cohort of patients. Our primary aim was to analyze the predictive role of US findings. By systematically re-evaluating neurosonographic abnormalities over time, we also sought to assess the role of US during follow-up.

Methods: Patients diagnosed with CubTS based on clinical, electrophysiological, and sonography findings and operated on for in situ decompression of the ulnar nerve (UN) at the elbow using the standard surgical technique between 2015 and 2024 were enrolled in this study. Clinical, US, and electrodiagnostic examination data at diagnosis and follow-up were retrospectively analyzed.

Results: One hundred patients were enrolled. Preoperatively, we found a negative correlation between UN motor conduction velocity (MCV) and cross-sectional area (CSA) at the precubital (P < .001) and cubital (P < .001) levels. The mean follow-up was 8.5 months. Clinical outcome defined by the Bishop scale was favorable in 68 patients and poor in 32. At multivariate logistic analysis, preoperative MCV (P < .0001), cubital UN CSA (P = .006), and postcubital CSA (P < .0001) resulted as independent predictors for surgical outcomes. At follow-up, multivariate logistic analysis confirmed the inverse relationship between postoperative cubital CSA and Bishop score (P = .0062) and the direct relationship between postoperative MCV and the clinical outcome (P = .0026).

Conclusion: US allows the depiction of morphological modifications because of chronic nerve compression in CubTS, both in the preoperative and postoperative period: precubital and cubital CSAs provide accurate diagnostic information; postcubital CSA could be considered a good predictor of clinical outcome; postoperative cubital CSA seems to provide important information regarding the UN recovery during follow-up.