World neurosurgery最新文献_第10页

Percutaneous Balloon Compression Exerts Multidimensional Efficacy in Trigeminal Neuralgia via Neuroinflammation and Neurotransmitter Regulation 经皮球囊压缩通过神经炎症和神经递质调节对三叉神经痛的疗效。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124685

Yihui Du, Haowei Shi, Zenghui Xi, Yinzhan Wang, Wenchang Guo, Tao Qian

Objective

This real-world study evaluated the multidimensional efficacy of percutaneous balloon compression (PBC) in trigeminal neuralgia (TN), focusing on pain relief, psychological comorbidities, quality of life, and neuroinflammation modulation.

Methods

A retrospective analysis included 140 TN patients (68 PBC vs. 72 pharmacotherapy controls), with 57 propensity score-matched pairs. Outcomes comprised visual analog scale (VAS), Hamilton Depression/Anxiety Scales, Short Form-36 Health Survey quality of life scores, and serum biomarkers (5-hydroxytryptamine, Substance P, interleukin 1β, and tumor necrosis factor-alpha). Difference-in-differences (DID) models quantified net treatment effects; generalized estimating equations identified predictors of efficacy.

Results

PBC demonstrated superior outcomes versus controls (all P < 0.05): greater VAS reduction (net DID: −0.97; 95% confidence interval: −1.41 to −0.53), Hamilton Depression Scale/Hamilton Anxiety Scale improvements, and Short Form-36 Health Survey gains (DID: +2.03). Biomarker analysis revealed significant declines in PBC-treated patients for 5-hydroxytryptamine, Substance P, interleukin 1β, and tumor necrosis factor-alpha (DID interactions P < 0.01). Total efficacy was higher with PBC (98.08% vs. 84.62%) with lower complications. Generalized estimating equation confirmed PBC intervention (β = 3.21, P = 0.002), pain reduction (βVAS_diff = −1.21, P = 0.003), and cytokine modulation as independent predictors of efficacy.

Conclusions

Beyond analgesia, PBC attenuates affective disorders and normalizes neuroinflammatory signaling in TN. Its modulation of the pain-neuroimmune axis supports integrated neuropsychiatric management strategies.

目的：本真实世界的研究评估了经皮球囊压迫（PBC）治疗三叉神经痛（TN）的多维疗效，重点关注疼痛缓解、心理合并症、生活质量（QoL）和神经炎症调节。方法：回顾性分析140例TN患者（68例PBC与72例药物治疗对照），57对倾向评分匹配。结果包括视觉模拟量表（VAS）、汉密尔顿抑郁/焦虑量表（HAMD/HAMA）、SF-36生活质量评分和血清生物标志物（5-HT、P物质、IL-1β、TNF-α）。差异中的差异（DID）模型量化了净治疗效果；广义估计方程（GEE）确定了疗效的预测因子。结果：与对照组相比，PBC表现出更好的结果（均p < 0.05）：更大的VAS降低（净DID: -0.97; 95%CI: -1.41至-0.53），HAMD/HAMA改善，SF-36增加（DID: +2.03）。生物标志物分析显示，pbc治疗患者的5-HT、P物质、IL-1β和TNF-α显著下降（DID相互作用P < 0.01）。PBC组总疗效更高（98.08% vs. 84.62%），并发症更少。GEE证实PBC干预（β=3.21, p=0.002）、疼痛减轻（β vas_diff =-1.21, p=0.003）和细胞因子调节是疗效的独立预测因子。结论：除镇痛外，PBC还能减轻情感性障碍并使TN的神经炎症信号正常化，其对疼痛-神经免疫轴的调节支持综合神经精神治疗策略。

{"title":"Percutaneous Balloon Compression Exerts Multidimensional Efficacy in Trigeminal Neuralgia via Neuroinflammation and Neurotransmitter Regulation","authors":"Yihui Du, Haowei Shi, Zenghui Xi, Yinzhan Wang, Wenchang Guo, Tao Qian","doi":"10.1016/j.wneu.2025.124685","DOIUrl":"10.1016/j.wneu.2025.124685","url":null,"abstract":"<div><h3>Objective</h3><div>This real-world study evaluated the multidimensional efficacy of percutaneous balloon compression (PBC) in trigeminal neuralgia (TN), focusing on pain relief, psychological comorbidities, quality of life, and neuroinflammation modulation.</div></div><div><h3>Methods</h3><div>A retrospective analysis included 140 TN patients (68 PBC vs. 72 pharmacotherapy controls), with 57 propensity score-matched pairs. Outcomes comprised visual analog scale (VAS), Hamilton Depression/Anxiety Scales, Short Form-36 Health Survey quality of life scores, and serum biomarkers (5-hydroxytryptamine, Substance P, interleukin 1β, and tumor necrosis factor-alpha). Difference-in-differences (DID) models quantified net treatment effects; generalized estimating equations identified predictors of efficacy.</div></div><div><h3>Results</h3><div>PBC demonstrated superior outcomes versus controls (all <em>P</em> < 0.05): greater VAS reduction (net DID: −0.97; 95% confidence interval: −1.41 to −0.53), Hamilton Depression Scale/Hamilton Anxiety Scale improvements, and Short Form-36 Health Survey gains (DID: +2.03). Biomarker analysis revealed significant declines in PBC-treated patients for 5-hydroxytryptamine, Substance P, interleukin 1β, and tumor necrosis factor-alpha (DID interactions <em>P</em> < 0.01). Total efficacy was higher with PBC (98.08% vs. 84.62%) with lower complications. Generalized estimating equation confirmed PBC intervention (β = 3.21, <em>P</em> = 0.002), pain reduction (βVAS_diff = −1.21, <em>P</em> = 0.003), and cytokine modulation as independent predictors of efficacy.</div></div><div><h3>Conclusions</h3><div>Beyond analgesia, PBC attenuates affective disorders and normalizes neuroinflammatory signaling in TN. Its modulation of the pain-neuroimmune axis supports integrated neuropsychiatric management strategies.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124685"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Transciliary Supraorbital Keyhole Approach for Different Intracranial Pathologies: Lessons Learned After the Implementation of a New Surgical Technique in a General Neurosurgical Department 经睫状眶上锁孔入路治疗不同颅内病变：一种新手术技术在普通神经外科实施后的经验教训。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124704

Nora Marie Ramm-Pettersen , Jon Ramm-Pettersen , Eirik Helseth , Karoline Skogen , Mads Aarhus

Objective

To evaluate the safety, efficacy, and feasibility of the transciliary supraorbital keyhole (TSK) approach for a range of intracranial pathologies in a general neurosurgical department.

Methods

Between 2009 and 2021, 50 patients underwent the TSK approach for various intracranial pathologies performed by 11 surgeons at the Department of Neurosurgery, Oslo University Hospital-Ullevaal. We assessed surgical efficacy, complication rates, and length of postoperative hospital stay. An independent physician, not involved in the surgical procedures or patient selection, reviewed data obtained from operative reports, follow-up notes, and magnetic resonance imaging scans.

Results

The study included 50 patients (median age 59 years; 50% female). Among them, 43 had intracranial tumors and 7 had head trauma. Tumor patients were divided into two groups; tumor resection (n = 40) and tumor biopsy (n = 3). In the resection group, gross total resection was achieved in 75% of the patients. The mean resection grades for meningiomas, gliomas, metastases, and epidermoid tumors were 97%, 70%, 92%, and 96%, respectively. Surgical goals were met in all biopsy and head trauma cases. Eleven patients had low-grade complications (Landriel Ibañez grade I or II), and no severe complications (grade III or IV) were reported. The median postoperative hospital stay was 3 days for tumor patients and 7 days for head trauma patients.

Conclusions

The TSK approach is a safe and effective method for various intracranial pathologies, even when performed in a general neurosurgical department by multiple surgeons.

目的：评价经睫状眶上锁孔（TSK）入路治疗普通神经外科多种颅内病变的安全性、有效性和可行性。方法：2009年至2021年间，奥斯陆大学乌勒瓦勒医院神经外科11名外科医生为50例患者实施了TSK入路治疗各种颅内病变。我们评估了手术疗效、并发症发生率和术后住院时间。一位独立的医生，不参与手术过程或患者选择，审查了从手术报告、随访记录和MRI扫描中获得的数据。结果：研究纳入50例患者（中位年龄59岁，50%为女性）。其中颅内肿瘤43例，头部外伤7例。肿瘤患者分为两组；肿瘤切除术（n=40）和肿瘤活检（n=3）。在切除组中，75%的患者实现了大体全切除。脑膜瘤、胶质瘤、转移瘤和表皮样瘤的平均切除率分别为97%、70%、92%和96%。所有活检和头部外伤病例均达到手术目的。11例患者出现低级别并发症（Landriel Ibañez I级和II级），无严重并发症（III级或IV级）报告。肿瘤患者术后中位住院时间为3天，头部外伤患者术后中位住院时间为7天。结论：TSK入路是一种安全有效的治疗各种颅内病变的方法，即使在普通神经外科由多名外科医生实施也是如此。

{"title":"The Transciliary Supraorbital Keyhole Approach for Different Intracranial Pathologies: Lessons Learned After the Implementation of a New Surgical Technique in a General Neurosurgical Department","authors":"Nora Marie Ramm-Pettersen , Jon Ramm-Pettersen , Eirik Helseth , Karoline Skogen , Mads Aarhus","doi":"10.1016/j.wneu.2025.124704","DOIUrl":"10.1016/j.wneu.2025.124704","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the safety, efficacy, and feasibility of the transciliary supraorbital keyhole (TSK) approach for a range of intracranial pathologies in a general neurosurgical department.</div></div><div><h3>Methods</h3><div>Between 2009 and 2021, 50 patients underwent the TSK approach for various intracranial pathologies performed by 11 surgeons at the Department of Neurosurgery, Oslo University Hospital-Ullevaal. We assessed surgical efficacy, complication rates, and length of postoperative hospital stay. An independent physician, not involved in the surgical procedures or patient selection, reviewed data obtained from operative reports, follow-up notes, and magnetic resonance imaging scans.</div></div><div><h3>Results</h3><div>The study included 50 patients (median age 59 years; 50% female). Among them, 43 had intracranial tumors and 7 had head trauma. Tumor patients were divided into two groups; tumor resection (n = 40) and tumor biopsy (n = 3). In the resection group, gross total resection was achieved in 75% of the patients. The mean resection grades for meningiomas, gliomas, metastases, and epidermoid tumors were 97%, 70%, 92%, and 96%, respectively. Surgical goals were met in all biopsy and head trauma cases. Eleven patients had low-grade complications (Landriel Ibañez grade I or II), and no severe complications (grade III or IV) were reported. The median postoperative hospital stay was 3 days for tumor patients and 7 days for head trauma patients.</div></div><div><h3>Conclusions</h3><div>The TSK approach is a safe and effective method for various intracranial pathologies, even when performed in a general neurosurgical department by multiple surgeons.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124704"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Microsurgical Considerations of the Internal Capsule: Correlations with the Thalamic Peduncles 内囊的显微外科考虑：与丘脑柄的相关性。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124711

Tahsin Saygi , Buruc Erkan , Ozan Barut , Muhammed Bayindir , Adem Yilmaz , Tufan Agah Kartum , Cihan İsler , Necmettin Tanriover

Objective

The dense fiber mass of the internal capsule (IC) has been parceled based on its relationship with the borders of the lentiform nucleus. We aimed to examine the microsurgical anatomy of the IC as a single compact massive fiber and reveal its relationship with thalamic peduncles.

Methods

Ten postmortem human brains were dissected to evaluate the relationship between the IC and the thalamic peduncles. Fiber microdissections were performed from lateral to medial and from inferomedial to superolateral.

Results

The anterior and posterior limbs of the IC were effectively disconnected from the deeper thalamic peduncle fibers, and the distinct S-shaped curved trajection of the anterior and superior thalamic peduncles were traced until their cortical terminations. Temporopulvinar and temporopontine fibers constituted the sublenticular-IC, forming a tightly interwoven configuration with the inferior thalamic peduncle. Layers along the roof of the temporal horn were segregated into seven layers from superficial to deep: ventral part of the external capsule, anterior commissure, Meyer's loop, auditory radiations, sublenticular-IC, stria terminalis/caudate nucleus tail, and tapetal fibers. The retrolenticular IC and the posterior thalamic peduncle together constituted the superficial and deep layers of the optic radiations and formed the deeper components of the sagittal stratum, respectively.

Conclusions

The anterior and superior thalamic peduncles can be separated from more superficially lying IC components. Meyer's loop and the sublenticular-IC form an inseparable subcortical connection to the thalamic peduncles. Awareness of distinct connectional features of the IC and their intimate relations with the thalamic peduncles may prove helpful during intraaxial surgery.

背景和目的：内囊致密纤维团块已根据其与透镜状核边界的关系进行了包裹。我们的目的是检查IC的显微外科解剖作为一个单一的致密块状纤维，并揭示其与丘脑脚的关系。方法：解剖10个死后的人脑，探讨脑内压与丘脑底的关系。从外侧到内侧和从内侧到上外侧进行纤维显微解剖。结果：IC的前肢和后肢与丘脑深丘纤维有效断开，并追踪到丘脑前肢和上肢明显的s形弯曲轨迹，直至其皮质末端。颞丘和颞桥纤维构成丘下纤维，与丘脑下脚紧密交织。沿颞角顶层由浅到深分为7层；外包膜腹侧、前联合、梅耶氏袢、听觉辐射、隐核下、尾纹/尾状核尾和绒毡纤维。视丘后IC和丘脑后脚共同构成视辐射的浅层和深层，分别构成矢状层的深层成分。结论：丘脑前肢和上肢可与较浅的IC部件分离。Meyer’s loop和丘脑丘下ic形成了与丘脑柄不可分割的皮质下连接。意识到IC的独特连接特征及其与丘脑脚的密切关系可能有助于轴内手术。

{"title":"Microsurgical Considerations of the Internal Capsule: Correlations with the Thalamic Peduncles","authors":"Tahsin Saygi , Buruc Erkan , Ozan Barut , Muhammed Bayindir , Adem Yilmaz , Tufan Agah Kartum , Cihan İsler , Necmettin Tanriover","doi":"10.1016/j.wneu.2025.124711","DOIUrl":"10.1016/j.wneu.2025.124711","url":null,"abstract":"<div><h3>Objective</h3><div>The dense fiber mass of the internal capsule (IC) has been parceled based on its relationship with the borders of the lentiform nucleus. We aimed to examine the microsurgical anatomy of the IC as a single compact massive fiber and reveal its relationship with thalamic peduncles.</div></div><div><h3>Methods</h3><div>Ten postmortem human brains were dissected to evaluate the relationship between the IC and the thalamic peduncles. Fiber microdissections were performed from lateral to medial and from inferomedial to superolateral.</div></div><div><h3>Results</h3><div>The anterior and posterior limbs of the IC were effectively disconnected from the deeper thalamic peduncle fibers, and the distinct S-shaped curved trajection of the anterior and superior thalamic peduncles were traced until their cortical terminations. Temporopulvinar and temporopontine fibers constituted the sublenticular-IC, forming a tightly interwoven configuration with the inferior thalamic peduncle. Layers along the roof of the temporal horn were segregated into seven layers from superficial to deep: ventral part of the external capsule, anterior commissure, Meyer's loop, auditory radiations, sublenticular-IC, stria terminalis/caudate nucleus tail, and tapetal fibers. The retrolenticular IC and the posterior thalamic peduncle together constituted the superficial and deep layers of the optic radiations and formed the deeper components of the sagittal stratum, respectively.</div></div><div><h3>Conclusions</h3><div>The anterior and superior thalamic peduncles can be separated from more superficially lying IC components. Meyer's loop and the sublenticular-IC form an inseparable subcortical connection to the thalamic peduncles. Awareness of distinct connectional features of the IC and their intimate relations with the thalamic peduncles may prove helpful during intraaxial surgery.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124711"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Building on a Legacy 以遗产为基础。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124735

R. John Hurlbert

引用次数: 0

A Single-Center Retrospective Study on Endoscopic Surgery and Craniotomy in Spontaneous Superficial Supratentorial Lobar Hemorrhages: Which Approach Yields Better Outcomes? 内窥镜手术和开颅治疗自发性浅表幕上大叶出血的单中心回顾性研究：哪种方法疗效更好？

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124693

Sait Kayhan , Ecma Yılmaz

Objective

We evaluated the efficacy, safety, and mortality of endoscopic surgery (ES) and craniotomy for superficial supratentorial lobar hemorrhages in this single-center retrospective study.

Methods

We retrospectively analyzed 73 patients with superficial supratentorial lobar intracerebral hemorrhage treated between March 2017 and December 2023 by either ES (n = 33) or craniotomy (n = 40). Demographic, clinical, and radiological variables were compared between groups. Postoperative Glasgow Coma Scale (GCS) and 3-month modified Rankin Scale scores were assessed as postoperative outcomes, and 1-year mortality was defined as the primary endpoint.

Results

Baseline clinical characteristics, including age, gender, hypertension, and anticoagulant use, were comparable between the 2 groups. In contrast, ES was associated with more favorable early neurological recovery, reflected by higher postoperative GCS scores (12.0 ± 2.97 vs. 10.4 ± 3.46; P = 0.040). ES also demonstrated a substantially lower 1-year mortality rate compared with craniotomy (15.2% vs. 52.5%; P < 0.001). These differences remained consistent after adjusted analyses.

Conclusions

Endoscopic evacuation of superficial supratentorial lobar hemorrhages was associated with shorter operative time, less blood loss, and higher 1-year survival compared with craniotomy despite baseline differences such as intraventricular hemorrhage and midline shift. Higher preoperative GCS and earlier surgery also predicted better outcomes. Given the retrospective design, baseline imbalances, and modest sample size, these findings should be interpreted cautiously. Larger prospective studies are needed to confirm the clinical benefits of endoscopic treatment.

目的：在本单中心回顾性研究中，我们评估内镜手术（ES）和开颅术治疗浅表幕上大叶出血的疗效、安全性和死亡率。方法：我们回顾性分析了2017年3月至2023年12月期间接受ES （n = 33）或开颅术（n = 40）治疗的73例浅表性幕上叶性脑出血患者。组间比较人口学、临床和放射学变量。术后格拉斯哥昏迷评分（GCS）和3个月修正兰金评分（mRS）作为术后结局，1年死亡率被定义为主要终点。结果：基线临床特征；包括年龄、性别、高血压和抗凝剂使用，两组之间具有可比性。相比之下，ES与更有利的早期神经恢复相关，反映在更高的术后GCS评分（12.0±2.97比10.4±3.46;p = 0.040）。与开颅手术相比，ES组的1年死亡率也显著降低（15.2% vs. 52.5%; p < 0.001）。这些差异在调整后的分析中保持一致。结论：尽管IVH和中线移位等基线存在差异，但与开颅手术相比，内镜下清除浅表幕上大叶出血的手术时间更短，出血量更少，1年生存率更高。术前GCS越高，手术越早，预后也越好。考虑到回顾性设计、基线不平衡和适度的样本量，这些发现应谨慎解释。需要更大规模的前瞻性研究来证实内镜治疗的临床益处。

{"title":"A Single-Center Retrospective Study on Endoscopic Surgery and Craniotomy in Spontaneous Superficial Supratentorial Lobar Hemorrhages: Which Approach Yields Better Outcomes?","authors":"Sait Kayhan , Ecma Yılmaz","doi":"10.1016/j.wneu.2025.124693","DOIUrl":"10.1016/j.wneu.2025.124693","url":null,"abstract":"<div><h3>Objective</h3><div>We evaluated the efficacy, safety, and mortality of endoscopic surgery (ES) and craniotomy for superficial supratentorial lobar hemorrhages in this single-center retrospective study.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 73 patients with superficial supratentorial lobar intracerebral hemorrhage treated between March 2017 and December 2023 by either ES (n = 33) or craniotomy (n = 40). Demographic, clinical, and radiological variables were compared between groups. Postoperative Glasgow Coma Scale (GCS) and 3-month modified Rankin Scale scores were assessed as postoperative outcomes, and 1-year mortality was defined as the primary endpoint.</div></div><div><h3>Results</h3><div>Baseline clinical characteristics, including age, gender, hypertension, and anticoagulant use, were comparable between the 2 groups. In contrast, ES was associated with more favorable early neurological recovery, reflected by higher postoperative GCS scores (12.0 ± 2.97 vs. 10.4 ± 3.46; <em>P</em> = 0.040). ES also demonstrated a substantially lower 1-year mortality rate compared with craniotomy (15.2% vs. 52.5%; <em>P</em> < 0.001). These differences remained consistent after adjusted analyses.</div></div><div><h3>Conclusions</h3><div>Endoscopic evacuation of superficial supratentorial lobar hemorrhages was associated with shorter operative time, less blood loss, and higher 1-year survival compared with craniotomy despite baseline differences such as intraventricular hemorrhage and midline shift. Higher preoperative GCS and earlier surgery also predicted better outcomes. Given the retrospective design, baseline imbalances, and modest sample size, these findings should be interpreted cautiously. Larger prospective studies are needed to confirm the clinical benefits of endoscopic treatment.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124693"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exploring Demographic, Clinical, Surgical, and Imaging Features in Relation to CDKN2A/B Status in Meningiomas 探讨脑膜瘤中CDKN2A/B状态的人口学、临床、外科和影像学特征。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124699

Hanan Abofani , Ofir Ben-Moyal , Zvi R. Cohen , Anton Wohl , Moshe Attia , Ahmad Maswadeh , Alisa Talianski , Ory Haisraely , Tehila Kaisman-Elbaz

Objective

Meningiomas are the most common primary intracranial tumors, mostly benign, but some exhibit aggressive behavior. The 2021 WHO classification considers CDKN2A/B homozygous deletion as sufficient for grade 3 designation, highlighting its prognostic significance. It remains unclear whether demographic, clinical, or radiological features can predict deletion status or guide testing.

Methods

This retrospective single-center study reviewed patients who underwent surgical resection of intracranial meningiomas from July 2023 to July 2024. Inclusion criteria included histologically confirmed meningiomas, preoperative MRI, and CDKN2A/B testing via FISH. Imaging features assessed were tumor volume, edema, enhancement pattern, diffusion restriction, and CSF cleft preservation. Comparisons between CDKN2A/B-deleted and non-deleted groups were performed using Mann-Whitney U and Fisher's exact or Chi-square tests.

Results

Of 77 patients, 44 (57.1%) underwent CDKN2A/B testing, with 9 (11.6%) showing deletion. Median age was 68 years (range 25–83), and 65% were female. No significant differences between deletion-positive and -negative meningiomas were observed in age (69 vs. 68, P = 0.36), sex (66.7% vs. 65.9% female, P = 0.89), or preoperative tumor volume (21.8 vs. 18.6 mL, P = 0.81). Imaging features and histological grades were similar; Ki-67 index median was 8%. Patients were classified as WHO grade I or II regardless of CDKN2A/B status.

Conclusions

In this cohort, demographic, clinical, or radiological features did not reliably predict CDKN2A/B deletion. Several deletion-positive meningiomas were classified as grade 1 or 2, underscoring the disconnect between morphology and molecular grading. These findings support universal CDKN2A/B testing for accurate WHO classification and risk assessment.

脑膜瘤是最常见的原发性颅内肿瘤，多数为良性，但也有一些表现出侵袭性。2021年WHO分级认为CDKN2A/B纯合缺失足以达到3级，突出了其预后意义。目前尚不清楚人口统计学、临床或放射学特征是否可以预测缺失状态或指导检测。方法：本回顾性单中心研究回顾了2023年7月至2024年7月行颅内脑膜瘤手术切除的患者。纳入标准包括组织学证实的脑膜瘤、术前MRI和FISH检测CDKN2A/B。影像学特征评估为肿瘤体积、水肿、增强模式、扩散限制和脑脊液裂隙保存。CDKN2A/ b缺失组和未缺失组的比较采用Mann-Whitney U和Fisher精确检验或卡方检验。结果：77例患者中，44例（57.1%）接受了CDKN2A/B检测，其中9例（11.6%）显示缺失。中位年龄为68岁（25-83岁），65%为女性。缺失阳性和阴性脑膜瘤在年龄（69比68，p=0.36）、性别（66.7%比65.9%女性，p=0.89）和术前肿瘤体积（21.8比18.6 mL, p=0.81）方面均无显著差异。影像学特征及组织学分级相似；Ki-67指数中位数为8%。无论CDKN2A/B状态如何，患者被划分为WHO I级或II级。结论：在该队列中，人口统计学、临床或放射学特征不能可靠地预测CDKN2A/B缺失。一些缺失阳性脑膜瘤被分类为1级或2级，强调形态学和分子分级之间的脱节。这些发现支持用于准确世卫组织分类和风险评估的CDKN2A/B通用检测。

{"title":"Exploring Demographic, Clinical, Surgical, and Imaging Features in Relation to CDKN2A/B Status in Meningiomas","authors":"Hanan Abofani , Ofir Ben-Moyal , Zvi R. Cohen , Anton Wohl , Moshe Attia , Ahmad Maswadeh , Alisa Talianski , Ory Haisraely , Tehila Kaisman-Elbaz","doi":"10.1016/j.wneu.2025.124699","DOIUrl":"10.1016/j.wneu.2025.124699","url":null,"abstract":"<div><h3>Objective</h3><div>Meningiomas are the most common primary intracranial tumors, mostly benign, but some exhibit aggressive behavior. The 2021 WHO classification considers CDKN2A/B homozygous deletion as sufficient for grade 3 designation, highlighting its prognostic significance. It remains unclear whether demographic, clinical, or radiological features can predict deletion status or guide testing.</div></div><div><h3>Methods</h3><div>This retrospective single-center study reviewed patients who underwent surgical resection of intracranial meningiomas from July 2023 to July 2024. Inclusion criteria included histologically confirmed meningiomas, preoperative MRI, and CDKN2A/B testing via FISH. Imaging features assessed were tumor volume, edema, enhancement pattern, diffusion restriction, and CSF cleft preservation. Comparisons between CDKN2A/B-deleted and non-deleted groups were performed using Mann-Whitney U and Fisher's exact or Chi-square tests.</div></div><div><h3>Results</h3><div>Of 77 patients, 44 (57.1%) underwent CDKN2A/B testing, with 9 (11.6%) showing deletion. Median age was 68 years (range 25–83), and 65% were female. No significant differences between deletion-positive and -negative meningiomas were observed in age (69 vs. 68, <em>P</em> = 0.36), sex (66.7% vs. 65.9% female, <em>P</em> = 0.89), or preoperative tumor volume (21.8 vs. 18.6 mL, <em>P</em> = 0.81). Imaging features and histological grades were similar; Ki-67 index median was 8%. Patients were classified as WHO grade I or II regardless of CDKN2A/B status.</div></div><div><h3>Conclusions</h3><div>In this cohort, demographic, clinical, or radiological features did not reliably predict CDKN2A/B deletion. Several deletion-positive meningiomas were classified as grade 1 or 2, underscoring the disconnect between morphology and molecular grading. These findings support universal CDKN2A/B testing for accurate WHO classification and risk assessment.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124699"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prognostic Performance of mFI-5 and mFI-11 Frailty Indices in Elective Spine Surgery: A Systematic Review and Meta-Analysis 择期脊柱手术中mFI-5和mFI-11衰弱指数的预后表现：系统回顾和荟萃分析。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124709

Grace D. Xu , Neerav Kumar , Alexander Yu , Abhinav Kumar , Danyal A. Quraishi , Izzet Akosman , Kyra Kwok , Rami Abuqubo , Ibrahim Hussain , Noel Akioyamen , Rafael De La Garza Ramos , Ananth Eleswarapu , Reza Yassari , Mitchell S. Fourman

Objective

Frailty is a known predictor of poor outcomes following spine surgery. While both mFI-11 and mFI-5 are used to assess frailty, no pooled analysis has independently evaluated their prognostic performance across multiple outcomes. This study examines how mFI-11 and mFI-5 stratify frailty and how consistently each index predicts postoperative outcomes in elective spine surgery.

Methods

A systematic literature search was conducted using PubMed, Scopus, and Web of Science databases to identify cohort studies reporting associations of mFI-11 or mFI-5 with postoperative outcomes in elective spine surgery. Meta-analyses using random-effects models calculated pooled odds ratios (ORs) and P-values for key outcomes including any adverse event, medical complication, surgical complication, mortality, reoperation, and non-routine discharge.

Results

A total of 22 studies were included in the meta-analysis. mFI-11 was associated with increased odds of medical complications (OR 2.09, P = 0.0014) and surgical complications (OR 2.03, P = 0.0390), but not reoperation (OR 0.95, P = 0.8822). These findings were inconsistently significant across sub-analyses comparing higher mFI-11 scores to mFI-11 = 0. mFI-5 predicted a broader range of outcomes, including any complication (OR 1.7, P < 0.0001), non-routine discharge (OR 3.29, P < 0.0001), and mortality (OR 2.29, P = 0.0133). These significant results persisted across sub-analyses comparing higher mFI-5 scores to mFI-5 = 0. mFI-5 showed more consistent associations with postoperative outcomes than mFI-11.

Conclusions

MFI-5 demonstrates greater consistency in predicting adverse outcomes in elective spine surgery than mFI-11. mFI-5 may serve as a practical tool for frailty stratification in surgical patients. Further studies are needed to validate these results and optimize frailty assessment in spine surgery.

简介：虚弱是脊柱手术后不良预后的已知预测因素。虽然mFI-11和mFI-5都被用于评估虚弱，但没有汇总分析独立评估它们在多个结局中的预后表现。本研究探讨了mFI-11和mFI-5如何对虚弱进行分层，以及每个指标如何一致地预测择期脊柱手术的术后结果。方法：使用PubMed、Scopus和Web of Science数据库进行系统的文献检索，以确定报告mFI-11或mFI-5与择期脊柱手术术后结果相关的队列研究。使用随机效应模型的荟萃分析计算了包括任何不良事件、医疗并发症、手术并发症、死亡率、再手术和非常规出院在内的关键结局的合并优势比（ORs）和p值。结果：meta分析共纳入22项研究。mFI-11与内科并发症（OR 2.09, p=0.0014）和手术并发症（OR 2.03, p=0.0390）的发生率增加相关，但与再手术无关（OR 0.95, p=0.8822）。在比较mFI-11得分较高和mFI-11=0的亚分析中，这些发现并不一致。mFI-5预测的预后范围更广，包括任何并发症（OR为1.7,p）。结论：与mFI-11相比，mFI-5在预测择期脊柱手术不良预后方面具有更高的一致性。mFI-5可作为外科患者虚弱分层的实用工具。需要进一步的研究来验证这些结果并优化脊柱外科的衰弱评估。

{"title":"Prognostic Performance of mFI-5 and mFI-11 Frailty Indices in Elective Spine Surgery: A Systematic Review and Meta-Analysis","authors":"Grace D. Xu , Neerav Kumar , Alexander Yu , Abhinav Kumar , Danyal A. Quraishi , Izzet Akosman , Kyra Kwok , Rami Abuqubo , Ibrahim Hussain , Noel Akioyamen , Rafael De La Garza Ramos , Ananth Eleswarapu , Reza Yassari , Mitchell S. Fourman","doi":"10.1016/j.wneu.2025.124709","DOIUrl":"10.1016/j.wneu.2025.124709","url":null,"abstract":"<div><h3>Objective</h3><div>Frailty is a known predictor of poor outcomes following spine surgery. While both mFI-11 and mFI-5 are used to assess frailty, no pooled analysis has independently evaluated their prognostic performance across multiple outcomes. This study examines how mFI-11 and mFI-5 stratify frailty and how consistently each index predicts postoperative outcomes in elective spine surgery.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted using PubMed, Scopus, and Web of Science databases to identify cohort studies reporting associations of mFI-11 or mFI-5 with postoperative outcomes in elective spine surgery. Meta-analyses using random-effects models calculated pooled odds ratios (ORs) and <em>P</em>-values for key outcomes including any adverse event, medical complication, surgical complication, mortality, reoperation, and non-routine discharge.</div></div><div><h3>Results</h3><div>A total of 22 studies were included in the meta-analysis. mFI-11 was associated with increased odds of medical complications (OR 2.09, <em>P</em> = 0.0014) and surgical complications (OR 2.03, <em>P</em> = 0.0390), but not reoperation (OR 0.95, <em>P</em> = 0.8822). These findings were inconsistently significant across sub-analyses comparing higher mFI-11 scores to mFI-11 = 0. mFI-5 predicted a broader range of outcomes, including any complication (OR 1.7, <em>P</em> < 0.0001), non-routine discharge (OR 3.29, <em>P</em> < 0.0001), and mortality (OR 2.29, <em>P</em> = 0.0133). These significant results persisted across sub-analyses comparing higher mFI-5 scores to mFI-5 = 0. mFI-5 showed more consistent associations with postoperative outcomes than mFI-11.</div></div><div><h3>Conclusions</h3><div>MFI-5 demonstrates greater consistency in predicting adverse outcomes in elective spine surgery than mFI-11. mFI-5 may serve as a practical tool for frailty stratification in surgical patients. Further studies are needed to validate these results and optimize frailty assessment in spine surgery.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124709"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

International Pituitary Education Day: Live Demonstration of Modern Pituitary Surgery 国际垂体教育日：现代垂体手术现场演示。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124708

Hamid Borghei-Razavi , Mohammadmahdi Sabahi , Badih Adada , Nickalus R. Khan , L.Madison Michael II

引用次数: 0

Hemodynamic Features of Rupture-Prone Blebs in Ruptured Intracranial Aneurysms: A Computational Fluid Dynamics Study 颅内动脉瘤破裂后易破裂气泡的血流动力学特征：计算流体动力学研究。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124726

Tomoaki Suzuki, Hitoshi Hasegawa, Hidemoto Fujiwara, Makoto Oishi

Background

Blebs on ruptured intracranial aneurysms are presumed rupture sites, yet the hemodynamic signature of rupture-prone blebs remains incompletely defined. Using computational fluid dynamics, we investigated the hemodynamic features of blebs in ruptured aneurysms in which rebleeding was prevented by intentional bleb coil embolization.

Methods

Of 106 patients with intracranial aneurysm rupture who underwent coil embolization at our hospital between January 2018 and December 2024, we retrospectively analyzed the data of those who were treated with intentional bleb coil embolization and experienced no rebleeding. Computational fluid dynamics analyses were performed retrospectively to characterize pressure and time-averaged wall shear stress (WSS) distributions in the aneurysms.

Results

Six aneurysms (5.6%; 4 anterior communicating arteries, 1 internal carotid artery, and 1 middle cerebral artery) were analyzed. No rebleeding occurred in any of the aneurysms. In all aneurysms, maximum pressure with flow impingement was observed at the neck of the bleb, inducing increased pressure inside the bleb. Moreover, minimum time-averaged WSS in the aneurysm dome was identified at the bleb (0.68 ± 0.45 Pa).

Conclusions

Aneurysmal blebs with hemodynamic features of maximum pressure with flow impingement and minimum time-averaged WSS have the potential to rupture. These features may help identify the highest-risk rupture point, which is a target of blood flow blockage by coil embolization.

背景：破裂的颅内动脉瘤上的气泡被认为是破裂部位，然而易破裂的气泡的血流动力学特征仍然不完全明确。利用计算流体动力学（CFD），我们研究了破裂动脉瘤中气泡的血流动力学特征，其中故意的气泡圈栓塞可以防止再出血。方法：对2018年1月至2024年12月在我院行血管圈栓塞术的106例颅内动脉瘤破裂患者进行回顾性分析，并对有意行血管圈栓塞术且无再出血的患者进行回顾性分析。回顾性CFD分析表征动脉瘤内压力和TAWSS分布。结果：共发现6例动脉瘤，占5.6%，其中4例为前交通动脉，1例为颈内动脉，1例为大脑中动脉。所有动脉瘤均未发生再出血。在所有动脉瘤中，在气泡颈部观察到最大压力并伴有血流冲击，导致气泡内压力增加。此外，在气泡处确定了动脉瘤圆顶的最小时间平均壁面剪切应力（0.68±0.45 Pa）。结论：具有最大压力伴血流冲击和最小TAWSS血流动力学特征的动脉瘤性气泡具有破裂的可能性。这些特征可能有助于确定最高风险的破裂点，这是线圈栓塞血流阻塞的目标。

{"title":"Hemodynamic Features of Rupture-Prone Blebs in Ruptured Intracranial Aneurysms: A Computational Fluid Dynamics Study","authors":"Tomoaki Suzuki, Hitoshi Hasegawa, Hidemoto Fujiwara, Makoto Oishi","doi":"10.1016/j.wneu.2025.124726","DOIUrl":"10.1016/j.wneu.2025.124726","url":null,"abstract":"<div><h3>Background</h3><div>Blebs on ruptured intracranial aneurysms are presumed rupture sites, yet the hemodynamic signature of rupture-prone blebs remains incompletely defined. Using computational fluid dynamics, we investigated the hemodynamic features of blebs in ruptured aneurysms in which rebleeding was prevented by intentional bleb coil embolization.</div></div><div><h3>Methods</h3><div>Of 106 patients with intracranial aneurysm rupture who underwent coil embolization at our hospital between January 2018 and December 2024, we retrospectively analyzed the data of those who were treated with intentional bleb coil embolization and experienced no rebleeding. Computational fluid dynamics analyses were performed retrospectively to characterize pressure and time-averaged wall shear stress (WSS) distributions in the aneurysms.</div></div><div><h3>Results</h3><div>Six aneurysms (5.6%; 4 anterior communicating arteries, 1 internal carotid artery, and 1 middle cerebral artery) were analyzed. No rebleeding occurred in any of the aneurysms. In all aneurysms, maximum pressure with flow impingement was observed at the neck of the bleb, inducing increased pressure inside the bleb. Moreover, minimum time-averaged WSS in the aneurysm dome was identified at the bleb (0.68 ± 0.45 Pa).</div></div><div><h3>Conclusions</h3><div>Aneurysmal blebs with hemodynamic features of maximum pressure with flow impingement and minimum time-averaged WSS have the potential to rupture. These features may help identify the highest-risk rupture point, which is a target of blood flow blockage by coil embolization.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124726"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145763337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Anterior Cord Herniation—Surgical Video 脊髓前疝-外科录像。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124748

Henrietta Nittby Redebrandt , Sven Köhler , Niklas Marklund

Anterior cord herniation is due to a ventral displacement of the spinal cord through a defect in the dura and/or arachnoid.¹ Though the condition is rare, some case reports are available.1, 2, 3 The neurological symptoms can slowly deteriorate over several years.1, 2, 3 A Brown-Séquard–like syndrome is the most common presenting neurological finding.1, 2, 3^,⁴ Asymptomatic cases may be discovered incidentally.1, 2, 3 However, when progressive neurological deficits are present, surgical exploration should be considered. Surgery is not without risks of impaired neurological function postoperatively, and intraoperative neurophysiological monitoring is important during the surgical procedure. We present a case of progressive impairment of lower extremity function, particularly gait function, due to anterior cord herniation (Video 1). The patient was initially managed conservatively, but due to rapid deterioration of motor function of the left leg accompanied by gait disturbance over the last year, surgical exploration was recommended, and the patient consented. Laminectomy was followed by dural opening. The denticulate ligament was cut for mobilization of the spinal cord, and the anterior dural defect was identified. The spinal cord could be freed and was carefully luxated from the defect, and a dural substitute was put in place to cover the dural defect. Throughout the procedure, D-wave and sensory evoked potentials could not be detected, but motor evoked potentials (MEPs) were present at the initiation of the surgery. However, the MEPs was lost during the end of the surgical procedure. Complete loss of MEPs during spinal surgery is a strong predictor of permanent deficits.⁵ Despite this, the patient had an uneventful recovery and could walk 700 m with crutches 3 months postoperatively, showing continuous improvement.

脊髓前疝是由于硬脑膜和/或蛛网膜的缺损导致脊髓腹侧移位所致。虽然这种情况很少见，但也有一些病例报道[1-3]。神经系统症状会在几年的时间里慢慢恶化。brown - ssamquard样综合征是最常见的神经学表现[2,4]。无症状病例可在旅客中发现。然而，当出现进行性神经功能缺损时，应考虑手术探查。手术并非没有术后神经功能受损的风险，术中神经生理监测在手术过程中非常重要。我们在这里提出的情况下，进行性损害的下肢功能，特别是在步态功能，由于前脊髓疝。患者最初采用保守治疗，但由于去年左腿运动功能迅速恶化并伴有步态障碍，建议并接受手术探查。椎板切除术后行硬脑膜切开。切断齿状韧带以活动脊髓，并确定硬脑膜前缺损。脊髓可以被释放，小心地从缺损处脱出，并放置硬脑膜替代物以覆盖硬脑膜缺损。在整个手术过程中，d波和感觉诱发电位（SEP）无法检测到，但运动诱发电位（MEP）在手术开始时存在。然而，在手术结束时，MEP丢失。脊柱手术中MEP的完全丧失是永久性bbb缺陷的一个强有力的预测指标。尽管如此，患者顺利康复，术后3个月可拄拐行走700米，病情持续改善。患者已就本报告的发表表示知情同意。

{"title":"Anterior Cord Herniation—Surgical Video","authors":"Henrietta Nittby Redebrandt , Sven Köhler , Niklas Marklund","doi":"10.1016/j.wneu.2025.124748","DOIUrl":"10.1016/j.wneu.2025.124748","url":null,"abstract":"<div><div>Anterior cord herniation is due to a ventral displacement of the spinal cord through a defect in the dura and/or arachnoid.<span><span><sup>1</sup></span></span> Though the condition is rare, some case reports are available.<span><span>1</span></span>, <span><span>2</span></span>, <span><span>3</span></span> The neurological symptoms can slowly deteriorate over several years.<span><span>1</span></span>, <span><span>2</span></span>, <span><span>3</span></span> A Brown-Séquard–like syndrome is the most common presenting neurological finding.<span><span>1</span></span>, <span><span>2</span></span>, <span><span>3</span></span><sup>,</sup><span><span><sup>4</sup></span></span> Asymptomatic cases may be discovered incidentally.<span><span>1</span></span>, <span><span>2</span></span>, <span><span>3</span></span> However, when progressive neurological deficits are present, surgical exploration should be considered. Surgery is not without risks of impaired neurological function postoperatively, and intraoperative neurophysiological monitoring is important during the surgical procedure. We present a case of progressive impairment of lower extremity function, particularly gait function, due to anterior cord herniation (<span><span>Video 1</span></span>). The patient was initially managed conservatively, but due to rapid deterioration of motor function of the left leg accompanied by gait disturbance over the last year, surgical exploration was recommended, and the patient consented. Laminectomy was followed by dural opening. The denticulate ligament was cut for mobilization of the spinal cord, and the anterior dural defect was identified. The spinal cord could be freed and was carefully luxated from the defect, and a dural substitute was put in place to cover the dural defect. Throughout the procedure, D-wave and sensory evoked potentials could not be detected, but motor evoked potentials (MEPs) were present at the initiation of the surgery. However, the MEPs was lost during the end of the surgical procedure. Complete loss of MEPs during spinal surgery is a strong predictor of permanent deficits.<span><span><sup>5</sup></span></span> Despite this, the patient had an uneventful recovery and could walk 700 m with crutches 3 months postoperatively, showing continuous improvement.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124748"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0