World neurosurgery最新文献

Objective: To develop and validate a clinical prediction model for hematoma expansion (HE) in traumatic brain contusion (TBC) patients, providing a quantitative tool for early identification of high-risk patients.

Methods: A single-center retrospective cohort study was conducted, collecting clinical data from 263 TBC patients admitted to the Department of Neurosurgery at Lianyungang First People's Hospital between July 2022 and December 2024. Patients were randomly divided into training (n=184) and validation (n=79) cohorts at a 7:3 ratio, with an additional 88 patients serving as a supplementary validation cohort. Demographic characteristics, clinical presentations, laboratory parameters, and imaging features were collected. Hematoma expansion was defined as >33% increase in hematoma volume or absolute increase >6mL on follow-up cranial CT within 24 hours post-injury, or emergence of new hemorrhagic lesions. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

Results: Among 263 TBC patients, HE occurred in 60% (157/263). Univariate analysis identified nine factors significantly associated with HE. Multivariate analysis determined five independent predictors: subdural hematoma (OR=7.71, 95%CI: 4.06-14.65), fibrin degradation products (FDP) >30 mg/L (OR=3.46, 95%CI: 1.80-6.63), subarachnoid hemorrhage (OR=3.04, 95%CI: 1.50-6.17), frontal lobe injury (OR=2.52, 95%CI: 1.30-4.89), and Glasgow Coma Scale (GCS) <13 (OR=2.50, 95%CI: 1.11-5.60) (all P<0.05). The prediction model achieved AUCs of 0.937 (95%CI: 0.95-0.99) and 0.888 (95%CI: 0.82-0.95) in training and validation cohorts, respectively. Hosmer-Lemeshow tests demonstrated good calibration (training cohort P=0.702, validation cohort P=0.944). DCA confirmed favorable clinical net benefit. Risk stratification classified patients into low-risk (0-2 points), intermediate-risk (3-4 points), and high-risk (5-6 points) groups, with HE rates of 11%, 48%, and 87%, respectively, in the supplementary validation cohort (P<0.001).

Conclusion: The developed prediction model for HE in TBC patients demonstrates excellent discrimination and calibration, providing quantitative evidence for individualized monitoring and treatment strategies that may improve patient outcomes. This scoring system is simple, practical, and holds promising clinical application potential.

Background: Native Americans (NA) experience a higher prevalence of stroke risk factors including obesity, hypertension, and cognitive impairment than any other American racial/ethnic group. We have studied a representative NA population at the Oneida Nation (NAON) of Wisconsin, for these risk factors. Omics-based approaches to identify clinically relevant biomarkers may predict the molecular mechanisms, risk of cerebrovascular disease (CVD), and recovery potential in people of all cultures.

Methods: We conducted a cross-sectional study on 113 adult NAON and 17 age- and sex-matched Wisconsin General Population (WGP). We used an antibody array-based targeted proteomics platform to identify plasma proteins significantly altered in NAON as compared to WGP.

Results: In NAON as compared to WGP, out of 58 targeted plasma proteins, levels of 14 proteins were significantly altered. Specifically, 10 proteins including Serpin E1 were significantly increased, and 4 proteins including Myeloperoxidase were significantly decreased. Within NAON, Leptin and Angiopoietin-like 3 were significantly increased in females as compared to males. Significantly increased levels of Oncostatin-M, Growth Hormone, and CCL2 were seen in historically hypertensive NAON. Six proteins including Leptin were significantly increased in obese NAON individuals. Increase in 3 biomarkers correlated with increasing age, increase in 6 biomarkers correlated with increasing body mass index, and increase in 3 biomarkers correlated with increasing carotid artery total plaque area.

Conclusion: We have identified altered blood biomarkers related to CVD in NAON for risk-stratification of CVD-related complications. Further study of these biomarkers may complement existing clinical risk factors for prevention, diagnosis, and therapy in CVD.

Study design: Multicenter retrospective cohort study BACKGROUND: Neuroform Atlas stent is widely used in the management of ruptured intracranial aneurysms (RIA); however, further investigation is required to establish its safety and efficacy.

Objective: To report on the safety and efficacy of Neuroform Atlas stent-assisted coiling (SAC) used for treating RIA.

Methods: A multicenter retrospective analysis of cases of RIA treated with the SAC using Neuroform Atlas stent from January 2020 to May 2023.

Results: Both the total numbers of patients and aneurysms with RIA enrolled in our analysis was 101. All of the RIA were treated with the SAC using Neuroform Atlas stent. Mean aneurysm dimension was 4.9 mm with an average neck width of 3.3 mm. Immediate modified Raymond-Roy-occlusion-outcome class I was observed in 59.4% of the patients, and increased to 87.7% at the latest follow-up, which averaged at 257.9 days. Favorable clinical outcomes accounted for 71.9% of the patients at discharge, and was up to 92.1% at the latest follow-up, which averaged at 279.3 days.

Conclusion: Our study demonstrated the safety and efficacy of Neuroform Atlas SAC in the treatment of RIA.

Background and objectives: Endoscopic third ventriculostomy (ETV) is a widely used surgical treatment for obstructive hydrocephalus. While the anatomical landmarks of the third ventricular floor are well described, the organization of white matter (WM) tracts along the transcortical ETV corridor and their correlation with neuronavigation and endoscopy remain insufficiently clarified. This study aimed to anatomically map the transcortical ETV trajectory from cortical entry to the third ventricular floor using stepwise cadaveric dissections integrated with neuronavigation and clinical correlation.

Methods: Stepwise WM dissections were performed in eight formalin-fixed human brains. Dissections were conducted with and without navigation guidance, extending from cortical entry points to the ventricular floor. Real-time tracking and endoscopic visualization were employed to document anatomical structures and their relationships to the corridor. The anatomically defined trajectory was subsequently applied in a pediatric cohort undergoing neuronavigation-guided transcortical ETV.

Results: Neuronavigation-guided cortical entry points were localized between the superior and middle frontal gyri, avoiding eloquent cortical regions. Stepwise dissections demonstrated the orderly traversal of U-fibers, superior longitudinal fasciculus, arcuate fasciculus, fronto-aslant tract, corona radiata, and callosal fibers before ventricular entry. Endoscopic correlation confirmed the midline tuber cinereum, just anterior to the mammillary bodies, as the optimal perforation site. In the clinical series, this trajectory was associated with favorable radiological and clinical outcomes without permanent neurological deficits.

Conclusions: Defining the transcortical ETV route on the basis of detailed WM anatomy and neuronavigation enables a reproducible and anatomically defined surgical pathway. This integrated anatomical framework supports standardized surgical planning and offers practical value for pediatric neuroendoscopic practice.

Objective: Posterior fossa aneurysms, especially ruptured ones, are challenging to treat due to their deep location, complex anatomy, and proximity to the brainstem, and lower cranial nerves. The semi-sitting position, though historically controversial due to concerns over venous air embolism (VAE), may offer distinct advantages. The aim of this study was to evaluate the safety and efficacy of the semi-sitting position for the clipping of ruptured posterior fossa aneurysms.

Methods: We retrospectively reviewed 39 consecutive patients with ruptured posterior circulation aneurysms treated with microsurgical clipping in the semi-sitting position between 1990 and 2023. Data included clinical presentation, surgical technique, intraoperative and postoperative complications, and functional outcomes measured by the Glasgow Outcome Scale (GOS) at discharge and at 6 months.

Results: Complete aneurysm occlusion was achieved in 92% (36/39). The most common aneurysm location was the posterior inferior cerebellar artery (PICA) (79%). Intraoperative rupture occurred in 8% (3/39), and new neurological deficits attributable to surgery were seen in 13% (5/39). VAE was detected in 20% (3/15) of patients monitored with transesophageal echocardiography (TEE), though no cases required abortion of the procedure or resulted in serious complications. Surgical mortality was 0%, and 84% (21/25) of surviving patients achieved a GOS >3 at 6 months.

Conclusion: Microsurgical clipping of ruptured posterior fossa aneurysms in the semi-sitting position is safe and effective when performed with appropriate monitoring. Close collaboration with the anesthesiology team is essential to ensure patient safety. Our findings reinforce the continued relevance of the semi-sitting position in posterior fossa aneurysm surgery.

Background: The development of new-generation flow diverters (FDs), such as the Lattice FD, seeks to address the limitations of conventional devices in the treatment of anatomically complex unruptured internal carotid artery (ICA) aneurysms. This study compares the procedural and angiographic outcomes of the novel Lattice FD with established devices (Pipeline and Tubridge).

Methods: A retrospective cohort study was conducted at Qilu Hospital (2022-2024), including patients with unruptured ICA aneurysms treated with either Lattice or control FDs (Pipeline/Tubridge). The primary endpoints were stent deployment time, microguidewire manipulation frequency, 6-month complete occlusion (O'Kelly-Marotta [OKM] grade D), and in-stent stenosis (≥50%).

Results: A total of 69 patients (Lattice, n=36; control, n=33) were included. The Lattice FD demonstrated significantly shorter median deployment time (P<0.001) and lower microguidewire manipulation frequency (relative risk [RR]=0.18, P=0.007). At 6 months, the Lattice FD showed a higher complete occlusion rate in ophthalmic-segment aneurysms (P=0.038). No in-stent stenosis was observed in the Lattice group compared to 12% in the controls (P=0.043). In multivariable analysis, smaller aneurysm diameter was independently associated with higher occlusion rates (adjusted OR 0.85 per mm increase, 95% CI 0.72-0.99, P=0.042).

Conclusion: The Lattice FD was associated with enhanced procedural efficiency. While the overall 6-month occlusion rate was not significantly different, a higher rate was observed in ophthalmic-segment aneurysms and the incidence of in-stent stenosis was lower. These findings suggest Lattice may be a viable alternative for select anatomical variants, though its non-inferiority or superiority requires confirmation in larger studies.

Purpose: This meta-analysis aimed to critically examine the effectiveness and safety of intraoperative topical vancomycin in preventing surgical site infections (SSIs) following spinal surgery.

Methods: A systematic literature search was performed across CNKI, Medline, Embase, PubMed, the Cochrane Library, Web of Science, and Clinical Trials Registry from database inception to June 2025. Only randomized controlled trials (RCTs) evaluating prophylactic intraoperative topical vancomycin in spinal operations were included.

Results: A total of 12 RCTs involving 4,366 patients were included. Pooled results demonstrated that the topical vancomycin group had a significantly lower incidence of overall SSIs compared to controls [OR = 0.60, 95% CI: 0.43-0.83, P = 0.002], as well as deep SSIs [OR = 0.66, 95% CI: 0.44-0.98, P = 0.04]. Subgroup analyses: (1) Dosage-Based Subgroup: Application of ≤1g vancomycin significantly reduced overall SSIs (P < 0.0001), deep SSIs (P = 0.004), and superficial SSIs (P = 0.005). (2) Surgical Type Subgroup: In patients undergoing instrumented spinal procedures, topical vancomycin use resulted in a marked decrease in SSI risk (P = 0.002).

Conclusion: Topical intraoperative application of vancomycin appears to be a safe and effective strategy for reducing the incidence of SSIs in spinal surgeries. Subgroup analyses suggest that doses ≤1g are particularly effective in reducing overall, deep, and superficial SSIs. Furthermore, the preventive effect is more pronounced in instrumented surgeries compared to non-instrumented procedures. However, due to the relatively limited pool of RCTs currently available, further high-quality, large-scale, and multicenter trials are essential to substantiate these conclusions.

Objective: This study evaluated the clinical outcome of trans-pleural extreme lateral interbody fusion (TP-XLIF) combined with posterior open internal fixation in treating thoracic spondylodiscitis.

Methods: We present a single-center case series on the use of TP-XLIF combined with posterior open internal fixation in treating thoracic spondylodiscitis beween January 2018 to December 2022. Perioperative characteristics, clinical outcomes and complication information were retrospectively collected.

Results: A total of 9 patients were included in this study. The lateral approach time(time for TP-XLIF) and the total operative time was 75±16 min, 210±28 respectively. And the estimated blood loss(EBL) for the lateral approach and the total EBL was 148±36 ml, 303±59 ml, respectively. According to the preoperative baseline, the VAS scores for back pain and ODI scores of all patients demonstrated significant reductions at 1 month, 3 months, and the final follow-up postoperatively. All 9 patients obtained bony fusion in one year. There were varying degrees of height loss and local kyphosis at the involved segments before surgery, and they demonstrated significant improvement postoperatively. 2 patients developed pleural effusion postoperatively, and they were successfully managed by placement of thoracic drainage tubes.

Conclusion: Data in this study demonstrated that TP-XLIF combined with posterior open internal fixation was an optional strategy in treating thoracic spondylodiscitis and was associated with less surgical trauma and blood loss, fast postoperative recovery, satisfactory intervertebral height and kyphosis correction, and rapid bone graft fusion.

Background: The involvement of infectious agents has been demonstrated in some cases of lumbar pseudarthrosis, but remains poorly documented and discussed for anterior cervical fusion (ACDF) pseudarthrosis. The purpose of our work was to determine whether an infectious source should be suspected in cervical pseudarthrosis following ACDF METHODS: Between August 2018 and August 2023, 45 patients with previous ACDF underwent surgical revision for pseudarthrosis.

Results: The median age at initial ACDF surgery was 46 years (SD 9.4). The mean time to clinical reoccurrence or worsening after the initial surgery was 13 months (SD 15.9). The mean time to pseudarthrosis confirmation by imaging was 25 months (SD 25.1). Pseudarthrosis was diagnosed directly by a CT scan positive non-fusion for 31/45 patients (68.9%) and by the addition of a positive ¹⁸F-NaF PET/CT for the remaining 14/45 patients (31.1%). The mean time from initial surgery to pseudarthrosis revision was 32.16 months (SD 25.4). During revision surgery, 29/45 patients (64.4%) had a bacterial culture taken, which revealed a microorganism. Among these 29 patients, 2 patients, for whom no initial cultures were taken during the pseudarthrosis revision, required a second surgery for recurrent-pseudarthrosis with positive bacterial cultures. However, patients in the pseudarthrosis with infection group had a significantly lower mean score percentage improvement in NDI than the others (26% vs. 59.3%, p=0.01).

Conclusion: In cervical pseudarthrosis, an infection should be considered as a potential cause. Surgical revision must include bacteriological sampling and antibiotic prophylaxis. Patients reoperated for infectious pseudarthrosis often suffered from residual neck pain.

Purpose: To determine the clinical outcomes of patients who had surgery to treat Knosp 3 and 4 prolactinomas with a particular focus on hormonal outcomes.

Methods: Retrospective cohort review of South Australian patients who had surgery to treat Knosp 3 and 4 prolactinomas from January 2000 to June 2025. Tumours were resected via an endoscopic, endonasal trans-sphenoidal approach. Demographic and clinical parameters were recorded. Hormonal outcomes were measured through assessment of prolactin levels and weekly cabergoline dose preoperatively and then at 3 months postoperatively.

Results: Of 54 total operated prolactinomas, 11 were Knosp 3 or 4 prolactinomas. Mean age at surgery was 43 years (± 16, range 26-77). Knosp grade was 3 in three cases and 4 in eight cases. The most common surgical indications were dopamine agonist resistance (5 cases) or intolerance (3 cases). Six patients had visual deficits preoperatively, with improvement following surgery in five cases (83%). PRL level prior to surgery was a mean of 82 times the upper limit of normal (± 16, range 0-576), with a decline to 28 (± 50, range 0 -16) at 3 months postoperatively. In six patients on cabergoline preoperatively, three were on a reduced dose at 3 months postoperatively, with three on a stable dose.

Conclusion: Surgery was effective at addressing visual compromise in cavernous sinus invasive prolactinomas but had a limited effect on prolactin control and the ability to reduce dopamine agonist use.