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Correlation Between Spinal-Pelvic Parameters and Ossification of the Thoracolumbar Ligamentum Flavum: A Cross-Sectional Study 脊柱-骨盆参数与胸腰椎黄韧带骨化的相关性：一项横断面研究。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-02-01 DOI: 10.1016/j.wneu.2025.124772

Luyang Wang , Tian Zhou , Qianmei Gao , Xizhong Zhu , Xingchen Li , Haiyang Wu , Yusheng Xu

Objective

To investigate the correlation between spinal-pelvic parameters and ossification of the ligamentum flavum (OLF) in the thoracolumbar segment.

Methods

A retrospective analysis was conducted on patients diagnosed with lumbar intervertebral disc degeneration between January 2021 and December 2024. All patients were divided into 2 groups: the non-OLF group and the OLF group. Comprehensive clinical data were collected for all participants, including age, sex, body mass index, disease duration, and the presence of comorbidities, as well as smoking and alcohol consumption history. Comparisons of spinal-pelvic parameters, including sacral slope (SS), pelvic tilt (PT), pelvic incidence, lumbar lordosis, and thoracolumbar kyphosis (TLK), were performed between the 2 groups. Multivariable logistic regression was used to assess the associations between each imaging parameter and the presence of OLF, and receiver operating characteristic curves were plotted.

Results

A total of 386 patients including 325 in non-OLF group and 61 in OLF group was included. Baseline analysis revealed that patients in the OLF group had significantly higher TLK and PI, greater SS, and were older compared to the non-OLF group. Additionally, hypertension was more prevalent in the OLF group. In contrast, gender distribution, smoking status, diabetes mellitus, body mass index, lumbar lordosis, and PT did not differ significantly between the 2 groups. Univariate logistic regression identified height, hypertension, SS, TLK, and age as significant factors associated with OLF. Multifactorial analysis confirmed that TLK was the only significant predictor for OLF occurrence. A receiver operating characteristic curve analysis developed based on TLK yielded a moderate area under the curve of 0.734.

Conclusions

TLK was found to be significantly associated with the presence of OLF; notably, an increase in TLK correlated with an elevated risk of developing OLF. A predictive model incorporating TLK and basic demographic factors demonstrated moderate diagnostic value.

目的：探讨胸腰椎段黄韧带骨化与脊柱-骨盆参数的关系。方法：对2021年1月至2024年12月诊断为腰椎间盘退变的患者进行回顾性分析。所有患者分为两组：非黄韧带骨化组和黄韧带骨化组。收集所有参与者的综合临床数据，包括年龄、性别、体重指数（BMI）、疾病持续时间、合并症的存在以及吸烟和饮酒史。比较两组患者的脊柱-骨盆参数，包括骶骨斜度（SS）、骨盆倾斜（PT）、骨盆发生率（PI）、腰椎前凸（LL）和胸腰椎后凸（TLK）。采用多变量logistic回归评估各影像学参数与黄韧带骨化的相关性，并绘制受试者工作特征（ROC）曲线。结果：共纳入386例患者，其中非黄韧带骨化组325例，黄韧带骨化组61例。基线分析显示，与非黄韧带骨化组相比，黄韧带骨化组患者的TLK和PI明显更高，SS更大，年龄更大。此外，黄韧带骨化组高血压更为普遍。相比之下，性别分布、吸烟状况、糖尿病、BMI、LL和PT在两组间无显著差异。单变量logistic回归发现身高、高血压、SS、TLK和年龄是与黄韧带骨化相关的重要因素。多因素分析证实TLK是黄韧带骨化发生的唯一显著预测因子。基于TLK建立的ROC曲线分析的AUC为0.734。结论：TLK与黄韧带骨化存在显著相关；值得注意的是，TLK的增加与黄韧带骨化的风险升高相关。结合TLK和基本人口统计学因素的预测模型显示出中等的诊断价值。

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引用次数: 0

Low Molecular Weight Heparin Initiated 3 Hours After Venous Sinus Stenting May Reduce Bleeding Risk in Patients with Cerebral Venous Sinus Stenosis 静脉窦支架植入术后3小时开始使用低分子肝素可降低脑静脉窦狭窄患者的出血风险。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-02-01 DOI: 10.1016/j.wneu.2026.124791

Guangyu Han , Da Zhou , Xiangqian Huang , Shuling Wan , Mengqi Wang , Xunming Ji , Ran Meng

Objective

This study aimed to assess whether the timing of low molecular weight heparin (LMWH) initiation after venous sinus stenting affects early hemorrhagic risk in patients with cerebral venous sinus stenosis (CVSS).

Methods

This single-center, real-world study consecutively enrolled CVSS patients at the subacute or chronic stage who underwent venous sinus stenting from January 2017 to July 2023. Based on the timing of LMWH initiation, patients were categorized into 2 groups: the immediate poststenting group and the third-hour poststenting group. Clinical characteristics, coagulation parameters, computed tomography imaging, and available follow-up data were compared.

Results

A total of 105 eligible patients (median age 37.0 years; 75 females and 30 males) were included in the analysis. Among them, 46 patients received immediate LMWH initiation, while 59 received LMWH 3 hours poststenting. Across all patients, postoperative coagulation parameters [e.g., activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen] changed significantly compared with baseline (all P < 0.001). Notably, activated partial thromboplastin time at 3 hours poststenting was significantly lower in the third-hour group than in the immediate group [73.20 (67.40–81.30) s versus 84.35 (80.13–93.23) s, P < 0.001]. The immediate group had a higher incidence of symptomatic intracranial hemorrhage than the third-hour group (8.7% vs. 0.0%, P = 0.034). During follow-up, no stent-related stenosis, restenosis, or delayed bleeding were observed in either group.

Conclusions

Delaying LMWH anticoagulation until 3 hours poststenting may effectively reduce bleeding risk in CVSS patients. These findings support optimizing early postoperative anticoagulation timing to enhance procedural safety and warrant validation in prospective studies.

目的：本研究旨在评估静脉窦支架植入术后低分子肝素（LMWH）起始时间是否影响脑静脉窦狭窄（CVSS）患者的早期出血风险。方法：这项单中心、真实世界的研究连续招募了2017年1月至2023年7月期间接受静脉窦支架植入术的亚急性或慢性期CVSS患者。根据低分子肝素起始时间，将患者分为支架置入术后即刻组和支架置入术后第3小时组。临床特征，凝血参数，计算机断层扫描（CT）成像，和可用的随访资料进行比较。结果：共纳入105例符合条件的患者（中位年龄37.0岁，女性75例，男性30例）。其中，46例患者立即开始使用低分子肝素，59例患者在支架置入后3小时开始使用低分子肝素。在所有患者中，术后凝血参数[如活化的部分凝血活素时间（APTT）、凝血酶原时间、凝血酶时间、纤维蛋白原]与基线相比发生了显著变化(所有结论：延迟低分子肝素抗凝至支架植入术后3小时可有效降低CVSS患者的出血风险。这些发现支持优化术后早期抗凝时间，以提高手术安全性，并值得在前瞻性研究中验证。

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引用次数: 0

Letter to the Editor Regarding “Early Postoperative Decline in Insulin-Like Growth Factor 1 (IGF-1) Predicts Surgical Remission of Acromegaly” 致编辑关于“术后早期胰岛素样生长因子1 （IGF-1）下降预测肢端肥大症手术缓解”的信。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-02-01 DOI: 10.1016/j.wneu.2026.124800

Sayedali Ahmadi , Ali Tavakoli Pirzaman

引用次数: 0

Short-Term Outcomes and 2-Year Reoperations Following Endoscopic versus Microdiscectomy for Lumbar Disc Herniation: A Propensity-Matched Analysis 内窥镜与显微椎间盘切除术治疗腰椎间盘突出症的短期疗效和两年再手术：倾向匹配分析。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-02-01 DOI: 10.1016/j.wneu.2026.124794

Ryan Wang , William Zeng , Alexander T. Hong , Hannah Cho , Syed I. Khalid , Ankit I. Mehta

Background

Endoscopic lumbar discectomy has gained popularity as a minimally invasive alternative to microdiscectomy, yet large-scale comparative data evaluating postoperative durability remain limited. This study assessed short-term complications and 2-year reoperation rates between endoscopic and microdiscectomy cohorts using a large multicenter database.

Methods

A retrospective cohort analysis was performed using the TriNetX US Collaborative Network. Adult patients undergoing endoscopic discectomy or microdiscectomy for lumbar disc herniation were identified using Current Procedural Terminology codes. A 1:1 propensity score matching was performed for demographics and baseline comorbidities. Ninety-day medical and surgical complications, hospital readmission, and emergency department utilization were evaluated using risk ratios (RRs). Two-year repeat lumbar decompression, subsequent lumbar fusion, and postlaminectomy syndrome were analyzed using Cox proportional hazards models.

Results

At 90 days, composite medical complications were significantly lower following endoscopic discectomy compared with microdiscectomy (2.3% vs. 3.7%; RR 0.61, 95% confidence interval (CI) 0.41–0.93; P = 0.020), as were composite surgical complications (0.9% vs. 2.5%; RR 0.37, 95% CI 0.20–0.68; P = 0.001). Hospital readmission and emergency department visits were not significantly different (P > 0.05). At two years, endoscopic discectomy was associated with a higher risk of repeat lumbar decompression (8.3% vs. 4.3%; hazard ratio 2.03, 95% CI 1.45–2.83; P < 0.001) and postlaminectomy syndrome (4.5% vs. 3.1%; hazard ratio 1.58, 95% CI 1.08–2.30; P = 0.018). Subsequent lumbar fusion rates were low and comparable between groups (3.5% vs. 3.3%; P = 0.595).

Conclusion

Endoscopic lumbar discectomy offers improved perioperative safety but reduced 2-year durability compared with microdiscectomy, highlighting the need to balance short-term advantages with long-term reoperation risk.

导论：内窥镜腰椎间盘切除术作为一种微创替代微创腰椎间盘切除术已经越来越受欢迎，但评估术后耐久性的大规模比较数据仍然有限。本研究使用大型多中心数据库评估内镜和显微椎间盘切除术组的短期并发症和两年再手术率。方法：采用TriNetX美国协作网络进行回顾性队列分析。采用CPT编码对接受内窥镜椎间盘切除术或显微椎间盘切除术的LDH成年患者进行识别。对人口统计学和基线合并症进行1:1的倾向评分匹配。使用风险比评估90天内的内科和外科并发症、再入院率和ED使用率。采用Cox比例风险模型对两年重复腰椎减压、腰椎融合和椎板切除术后综合征进行分析。结果：在90天，内镜椎间盘切除术后的综合内科并发症明显低于显微椎间盘切除术（2.3% vs 3.7%; RR 0.61, 95% CI 0.41-0.93; p = 0.020），综合外科并发症也明显低于内镜椎间盘切除术后的综合外科并发症（0.9% vs 2.5%; RR 0.37, 95% CI 0.20-0.68; p = 0.001）。再入院率和急诊科就诊率差异无统计学意义（p < 0.05）。两年时，内镜椎间盘切除术与重复腰椎减压（8.3% vs 4.3%; HR 2.03, 95% CI 1.45-2.83; p < 0.001）和椎板切除术后综合征（4.5% vs 3.1%; HR 1.58, 95% CI 1.08-2.30; p = 0.018）的高风险相关。随后的腰椎融合率较低，两组间具有可比性（3.5% vs 3.3%; p = 0.595）。结论：与显微椎间盘切除术相比，内镜下腰椎间盘切除术可提高围手术期安全性，但降低两年的持久性，突出了平衡短期优势与长期再手术风险的必要性。

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引用次数: 0

Minimally invasive management of collapsed OF-4 osteoporotic vertebral fractures: preliminary evidence for vertebroplasty combined with pediculoplasty. 塌陷的of -4骨质疏松性椎体骨折的微创治疗：椎体成形术联合椎弓根成形术的初步证据。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-31 DOI: 10.1016/j.wneu.2026.124838

Jia-Xuan Zhang, Shan Wu, Yang Liu, Dian Zhong, Ren-Jie Dong, Chang-Qing Wu, Zhen-Yong Ke, Guo-Sheng Zhao, Yang Wang

Background: Osteoporotic vertebral fractures with complete vertebral body collapse (A subtype within the OF4-type category, AO Spine-DGOU classification) represent a severe and unstable subtype of spinal injury in older adults. Owing to technical complexity and concerns over cement leakage, these fractures have traditionally been considered unsuitable for percutaneous vertebroplasty (PVP). However, open surgery carries substantial risks in elderly patients. Evidence regarding the safety and efficacy of PVP combined with pediculoplasty for the specific OF4-type osteoporotic vertebral fractures (OF4-OVFs) remains limited. This study aimed to evaluate the feasibility, safety, and potential clinical value of PVP combined with pediculoplasty in the treatment of these complex osteoporotic fractures.

Methods: A total of 18 patients with the collapsed OF4-OVFs presenting flattened vertebral bodies without neurological deficits were treated with PVP combined with pediculoplasty between May 2021 and December 2024. Vertebral height, local kyphotic angle (LKA), visual analogue scale (VAS), and Oswestry Disability Index (ODI) were assessed preoperatively, on postoperative day 1, and at the final follow-up.

Results: Significant improvements in VAS and ODI scores were observed 1 day after the procedure (p < 0.05), and these improvements were maintained at the final follow-up. Vertebral height was restored and LKA significantly improved postoperatively (p < 0.05). No neurological deterioration was noted. Asymptomatic cement leakage occurred in 5 of 20 vertebrae (25.0%).

Conclusion: Pediculoplasty-assisted percutaneous vertebroplasty appears technically feasible for selected patients with severely collapsed OF4 osteoporotic vertebral fractures who are poor candidates for general anesthesia. Larger prospective studies are needed to further evaluate its clinical role.

背景：骨质疏松性椎体骨折伴完全椎体塌陷（属于of4型分类中的A亚型，AO Spine-DGOU分类）是老年人脊柱损伤的一种严重且不稳定的亚型。由于技术的复杂性和对水泥泄漏的担忧，这些骨折传统上被认为不适合经皮椎体成形术（PVP）。然而，开放手术对老年患者有很大的风险。PVP联合椎弓根成形术治疗特定of4型骨质疏松性椎体骨折（OF4-OVFs）的安全性和有效性证据仍然有限。本研究旨在评价PVP联合椎弓根成形术治疗这些复杂骨质疏松性骨折的可行性、安全性和潜在临床价值。方法：在2021年5月至2024年12月期间，共有18例塌陷的of4 - ovf患者，椎体扁平，无神经功能缺损，采用PVP联合椎弓根成形术治疗。术前、术后第1天及最后随访时分别评估椎体高度、局部后凸角（LKA）、视觉模拟评分（VAS）和Oswestry残疾指数（ODI）。结果：术后1天VAS和ODI评分均有显著改善（p < 0.05），并在终期随访中保持改善。术后椎体高度恢复，LKA明显改善（p < 0.05）。未发现神经系统恶化。20个椎体中有5个发生无症状骨水泥渗漏（25.0%）。结论：椎弓根成形术辅助经皮椎体成形术在技术上是可行的，适用于不适合全身麻醉的严重塌陷的OF4骨质疏松性椎体骨折患者。需要更大规模的前瞻性研究来进一步评估其临床作用。

{"title":"Minimally invasive management of collapsed OF-4 osteoporotic vertebral fractures: preliminary evidence for vertebroplasty combined with pediculoplasty.","authors":"Jia-Xuan Zhang, Shan Wu, Yang Liu, Dian Zhong, Ren-Jie Dong, Chang-Qing Wu, Zhen-Yong Ke, Guo-Sheng Zhao, Yang Wang","doi":"10.1016/j.wneu.2026.124838","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.124838","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic vertebral fractures with complete vertebral body collapse (A subtype within the OF4-type category, AO Spine-DGOU classification) represent a severe and unstable subtype of spinal injury in older adults. Owing to technical complexity and concerns over cement leakage, these fractures have traditionally been considered unsuitable for percutaneous vertebroplasty (PVP). However, open surgery carries substantial risks in elderly patients. Evidence regarding the safety and efficacy of PVP combined with pediculoplasty for the specific OF4-type osteoporotic vertebral fractures (OF4-OVFs) remains limited. This study aimed to evaluate the feasibility, safety, and potential clinical value of PVP combined with pediculoplasty in the treatment of these complex osteoporotic fractures.</p><p><strong>Methods: </strong>A total of 18 patients with the collapsed OF4-OVFs presenting flattened vertebral bodies without neurological deficits were treated with PVP combined with pediculoplasty between May 2021 and December 2024. Vertebral height, local kyphotic angle (LKA), visual analogue scale (VAS), and Oswestry Disability Index (ODI) were assessed preoperatively, on postoperative day 1, and at the final follow-up.</p><p><strong>Results: </strong>Significant improvements in VAS and ODI scores were observed 1 day after the procedure (p < 0.05), and these improvements were maintained at the final follow-up. Vertebral height was restored and LKA significantly improved postoperatively (p < 0.05). No neurological deterioration was noted. Asymptomatic cement leakage occurred in 5 of 20 vertebrae (25.0%).</p><p><strong>Conclusion: </strong>Pediculoplasty-assisted percutaneous vertebroplasty appears technically feasible for selected patients with severely collapsed OF4 osteoporotic vertebral fractures who are poor candidates for general anesthesia. Larger prospective studies are needed to further evaluate its clinical role.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124838"},"PeriodicalIF":2.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107621","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

Comparison of Emergency Neurosurgical Referrals using Instant Messaging Application versus Smart Glasses to Optimize Telehealth Solutions for the Developing World. 使用即时通讯应用程序与智能眼镜优化发展中国家远程医疗解决方案的紧急神经外科转诊比较

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-31 DOI: 10.1016/j.wneu.2026.124835

Thangaraj Munusamy, Ronie Jayapalan, Abdul Khalil Haafiz Bin Abd Rahman, Amir Mehbodniya, Ravindran Karuppiah, Vicknes Waran

Objective: Prompt and precise decision making and management are important in neurosurgery for best outcomes. Emergency neurosurgical referral at the forefront of patients' journey is the most important checkpoint, however usually a junior doctor stands guard here lacking knowledge, skills and confidence. Information is subsequently relayed to the specialist in delayed fashion subject to inadequacies and discrepancies. Our study objective was to determine if telehealth via smart glasses was feasible and effective to overcome the barriers and challenges associated with emergency neurosurgical referrals.

Methods: A pair of junior doctor and specialist used either WhatsApp or smart glasses during emergency neurosurgical referrals. In WhatsApp referrals, the junior doctor reviews the patient and sends a summary message to the specialist with relevant radiological imaging, whom then responds with a management plan. In smart glasses referrals, they actively interact two-ways until a decision is reached. The next morning, a physical session identified missing or inaccurate information and the plan is amended if necessary. Both referral methods were compared and analyzed to identify differences and statistical significance.

Results: 100 emergency neurosurgical referrals were performed in each arm. Referrals using smart glasses resulted in significantly shorter response times where on average it was 18.7 minutes faster to receive a plan from the specialist. Smart glasses referrals also had significantly less inadequacies compared to WhatsApp referrals. This was consistent for all types of information.

Conclusions: Emergency neurosurgical referrals using telehealth via smart glasses were feasible and effective, thus offers an alternative solution for adoption by developing countries.

目的：在神经外科手术中，及时准确的决策和管理是获得最佳预后的重要因素。急诊神经外科转诊是患者就诊过程中最重要的一个关口，但往往是初级医生在这里站岗，缺乏知识、技能和信心。资料随后因不充分和不符而延迟转交给专家。我们的研究目的是确定通过智能眼镜进行远程医疗是否可行和有效，以克服与紧急神经外科转诊相关的障碍和挑战。方法：一对初级医生和专科医生在紧急神经外科转诊时使用WhatsApp或智能眼镜。在WhatsApp转诊中，初级医生会对患者进行检查，并向拥有相关放射成像的专科医生发送总结信息，专科医生随后会给出一个管理计划。在智能眼镜推荐中，他们会积极地进行双向互动，直到做出决定。第二天早上，物理会议确定缺失或不准确的信息，并在必要时修改计划。两种转诊方法比较分析差异及统计学意义。结果：两组各有100例神经外科急诊转诊。使用智能眼镜的转诊导致响应时间明显缩短，平均要快18.7分钟才能收到专家的计划。与WhatsApp的推荐相比，智能眼镜推荐的不足之处也少得多。这对所有类型的信息都是一致的。结论：通过智能眼镜进行远程医疗的急诊神经外科转诊是可行和有效的，因此为发展中国家提供了一种替代解决方案。

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引用次数: 0

Why Do Patients with Aneurysmal Subarachnoid Hemorrhage Postpone Treatment? 动脉瘤性蛛网膜下腔出血患者为何推迟治疗？

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-30 DOI: 10.1016/j.wneu.2026.124834

Ksenia Yarova, Yuliia Solodovnikova

Introduction: Early diagnosis of cerebral arterial aneurysm (CAA) rupture is critical, as recurrent ruptures significantly worsen the prognosis and increase mortality. The time to seek help varies: thunderclap headache and seizures prompt immediate treatment, while less obvious manifestations are often overlooked. The relationship between the nature of symptoms and the promptness of CAA rupture diagnosis remains poorly understood.

The aim of the study: to identify predictors of help-seeking behavior in patients with recurrent CAA ruptures.

Materials and methods: A retrospective single-center analysis from the medical records of 448 patients with ruptured CAA (2000-2023) was performed. Patients were divided into two groups based on the number of CAA ruptures. In both groups the pre-hospital period was defined as the time from the first rupture to the diagnosis of CAA. Factors affecting the timeliness of diagnosis were evaluated: sociodemographics, CAA characteristics, neurological symptoms at the time of CAA rupture, physician's specialty.

Results and discussion: Our study revealed significant diagnostic delays in patients with recurrent CAA ruptures due to delayed help-seeking, with verification occurring five-six days later than in those with single ruptures. Recurrent thunderclap headaches paradoxically prolonged diagnosis, while severe manifestations (paresis, seizures, transient loss of consciousness) accelerated verification by 12-23 days. Evaluation by a neurologist/neurosurgeon reduced delays by nearly seven days, whereas misdiagnosis by non-specialized physicians caused almost ten-day delays.

Conclusions: The main predictors of delayed consultation include non-focal symptoms, female gender, and social-psychological barriers. Improving early diagnosis and raising patient awareness of CAA risks are crucial.

脑动脉瘤（CAA）破裂的早期诊断至关重要，因为复发性破裂会显著恶化预后并增加死亡率。寻求帮助的时间各不相同：雷击式头痛和癫痫发作需要立即治疗，而不太明显的表现往往被忽视。症状的性质与CAA破裂诊断的及时性之间的关系仍然知之甚少。本研究的目的是：确定复发性CAA破裂患者寻求帮助行为的预测因素。材料与方法：对2000-2023年448例CAA破裂患者的医疗记录进行回顾性单中心分析。根据CAA破裂次数将患者分为两组。两组院前时间均定义为首次破裂至CAA诊断的时间。评估影响诊断及时性的因素：社会人口统计学、CAA特征、CAA破裂时的神经症状、医生专业。结果和讨论：我们的研究显示，由于求助延迟，复发性CAA破裂患者的诊断延迟显著，确诊时间比单次破裂患者晚5 - 6天。反复发作的雷击性头痛矛盾地延长了诊断时间，而严重的症状（麻痹、癫痫发作、短暂性意识丧失）使确诊时间缩短了12-23天。神经学家/神经外科医生的评估减少了近7天的延误，而非专业医生的误诊导致了近10天的延误。结论：延迟就诊的主要预测因素包括非局灶性症状、女性性别和社会心理障碍。改善早期诊断和提高患者对CAA风险的认识至关重要。

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引用次数: 0

PATIENCE. 耐心。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-30 DOI: 10.1016/j.wneu.2026.124839

Ed Benzel

引用次数: 0

Early Increase in Perihematomal Edema Volume After Intracerebral Hemorrhage Is an Independent Predictor of 90-Day Poor Functional Outcome. 脑出血后早期血肿周围水肿体积增加是90天功能不良预后的独立预测因子。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-30 DOI: 10.1016/j.wneu.2026.124837

Yongtian Zhao, Lijian Niu, Tenghong Ma, Hualing Xiang, Teng Zhang, Ye Yu, Weihua Rao

Objective: To investigate the association between the increase in perihematomal edema (PHE) volume within 72 hours after intracerebral hemorrhage (ICH) and 90-day poor functional outcome.

Methods: This retrospective cohort study consecutively enrolled patients with acute primary ICH admitted to a stroke center. All patients underwent CT scans at 6 hours and 72 hours after admission. Poor functional outcome at 90 days (modified Rankin Scale [mRS] 3-6) was used as the endpoint to evaluate the predictive value of hematoma volume, PHE volume, and their dynamic changes.

Results: A total of 81 patients were included, of whom 49 (61%) had poor outcomes (mRS 3-6). Compared to the good-outcome group, the poor-outcome group had older age, higher NIHSS scores, larger baseline and follow-up intraparenchymal hemorrhage (IPH) volumes, larger baseline and follow-up PHE volumes, and greater increases in IPH and PHE volumes. ROC curve analysis demonstrated that the increase in PHE volume had the highest predictive accuracy for 90-day poor outcome (AUC = 0.842, 95% CI: 0.758-0.927), significantly outperforming baseline hematoma volume, follow-up hematoma volume, and other conventional imaging indicators. Multivariate logistic regression confirmed that early PHE volume increase was an independent predictor of 90-day poor outcome (adjusted OR = 3.83, 95% CI: 1.21-12.74).

Conclusion: The increase in PHE volume within 72 hours after ICH is an independent predictor of poor early prognosis, with superior predictive value compared to traditional imaging markers. It may serve as a critical reference for early risk stratification and treatment decision-making in ICH patients.

目的：探讨脑出血（ICH）后72小时内血肿周围水肿（PHE）体积增加与90天功能不良预后的关系。方法：本回顾性队列研究连续纳入卒中中心收治的急性原发性脑出血患者。所有患者均在入院后6小时和72小时进行CT扫描。以90天功能不良结局（改良Rankin量表[mRS] 3-6）为终点，评价血肿体积、PHE体积及其动态变化的预测价值。结果：共纳入81例患者，其中49例（61%）预后不良（mRS 3-6）。与预后良好组相比，预后较差组年龄较大，NIHSS评分较高，基线和随访的肝实质内出血（IPH）体积较大，基线和随访的PHE体积较大，IPH和PHE体积的增加幅度较大。ROC曲线分析显示，PHE体积的增加对90天不良预后的预测准确率最高（AUC = 0.842, 95% CI: 0.758-0.927），显著优于基线血肿体积、随访血肿体积等常规影像学指标。多因素logistic回归证实，早期PHE容积增加是90天不良预后的独立预测因子（校正OR = 3.83, 95% CI: 1.21-12.74）。结论：脑出血后72h内PHE体积增加是早期预后不良的独立预测指标，与传统影像学指标相比具有更强的预测价值。可作为脑出血患者早期风险分层和治疗决策的重要参考。

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引用次数: 0

Pretemporal Transcavernous Approach to Cavernous Sinus Meningioma with Suprasellar Extension Synchronous with Sphenoid Wing Meningioma: Operative Technique: 2-Dimensional Operative Video. 颞前经海绵体入路治疗海绵窦脑膜瘤伴鞍上延伸伴蝶翼脑膜瘤：手术技术：二维手术影像。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-29 DOI: 10.1016/j.wneu.2026.124833

Shervin Taslimi

Cavernous sinus meningiomas with suprasellar extension are challenging to treat due to their proximity to the optic nerves, pituitary stalk, cranial nerves, and the cavernous/supraclinoid ICA. This complex anatomy necessitates precise microsurgical corridors for safe resection. We report the case of a 67-year-old woman who experienced a tonic-clonic seizure and left sided weakness who was found to have a right sphenoid wing meningioma and a synchronous meningioma involving the cavernous sinus with suprasellar extension. Tumors were resected via a right-sided pretemporal transcavernous approach.¹ A third asymptomatic left frontobasal meningioma was managed conservatively with clinical observation. The patient consented for the procedure and the publication of their images. Queen's university Ethics board approved this publication. INDICATION: This approach allows for resecting the tumors originating from cavernous sinus with extension into the suprasellar or posterior fossa locations. The presence of an interosseous bridge (IOB)² between the anterior and posterior clinoid processes posed a challenge to clinoidectomy and required meticulous drilling techniques. ESSENTIAL STEPS: Dissection and removal of the meningeal layer of the lateral wall of the cavernous sinus. Anterior clinoidectomy and skeletonization of the third nerve in the cavernous sinus and gentle inferior mobilization for safe drilling of the IOB/posterior clinoid to enhance access to suprasellar region. Cutting around the distal dural ring for safe superior mobilization of ICA during the resection of the suprasellar component. Gentle dissection of the tumor from optic nerve, third nerve, and pituitary stalk and preservation of critical vessels (PCOM, Anterior Choroidal,³ Superior Hypophyseal arteries).

鞍上延伸的海绵窦脑膜瘤由于靠近视神经、垂体柄、脑神经和海绵状/斜上突ICA，其治疗具有挑战性。这种复杂的解剖结构需要精确的显微手术通道来安全切除。我们报告一位67岁的女性，她经历了强直阵挛性发作和左侧虚弱，被发现有右侧蝶翼脑膜瘤和同步脑膜瘤累及海绵窦并鞍上延伸。肿瘤经右侧颞前经海绵体入路切除1第三例无症状左额基底脑膜瘤经临床观察保守治疗。病人同意手术和公布他们的照片。女王大学伦理委员会批准了本出版物。适应症：该入路可切除起源于海绵窦并延伸至鞍上或后窝的肿瘤。斜突前后之间存在骨间桥（IOB）2，这对斜突切除术提出了挑战，需要细致的钻孔技术。基本步骤：剥离和切除海绵窦侧壁的脑膜层。前斜突切除术和海绵窦第三神经骨骼化和温和的下移位，以安全钻孔IOB/后斜突，以加强对鞍上区域的通路。在鞍上部分切除过程中，在硬脑膜远端环周围进行切割，以确保ICA的安全上侧活动。从视神经、第三神经和垂体柄上轻轻剥离肿瘤，并保留关键血管（PCOM、前脉络膜、3根垂体上动脉）。

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