World neurosurgery最新文献

Background: Spinal metastases significantly impair health-related quality of life (HRQoL), particularly neurological function, pain, and physical independence. The Spinal Oncology Study Group Outcome Questionnaire (SOSGOQ 2.0) is a disease-specific PROM, but no validated Spanish version exists. This study aimed to translate, culturally adapt, and validate the SOSGOQ 2.0 for Spanish-speaking patients with spinal metastases.

Methods: Following Beaton et al.'s cross-cultural adaptation guidelines, the SOSGOQ 2.0 was forward- and back-translated, reviewed by experts, and pretested with 10 patients. Psychometric validation was performed prospectively in 81 patients. Internal consistency was assessed using Cronbach's α, test-retest reliability using intraclass correlation coefficients (ICC, n = 21), and construct validity through correlations with SF-36 and EQ-5D domains. Known-groups validity was analyzed according to neurological status (ASIA scale) and pain severity (VAS).

Results: The Spanish SOSGOQ 2.0 showed excellent internal consistency (overall α = 0.89; domain range 0.70-0.93) and high test-retest reliability (ICC = 0.88; 95% CI, 0.81-0.93). Convergent validity was supported by moderate-to-strong correlations with SF-36 domains (r = 0.67-0.71). Known-groups analysis demonstrated expected differences between ambulatory (ASIA D-E) and non-ambulatory (ASIA A-C) patients, and between low (VAS ≤4) and high pain (VAS ≥5) groups. Neurological improvement post-treatment was observed in 32% of patients. The questionnaire was well understood and culturally appropriate.

Conclusions: The Spanish SOSGOQ 2.0 is a reliable and valid tool for assessing HRQoL in Spanish-speaking patients with spinal metastases, enabling standardized, disease-specific outcome measurement and supporting patient-centered care and international research collaboration.

Background: Obesity is linked to degenerative spinal disorders, but its effect on recurrence and re-surgery after lumbar spine surgery remains unclear. Elevated body mass index (BMI) may influence outcomes through biomechanical stress and metabolic inflammation.

Objective: To evaluate the association between BMI and the risk of recurrence and re-surgery following lumbar discectomy.

Methods: This retrospective cohort study included 286 adult patients (171 males, 115 females; mean age 41.9 ± 11.2 years) who underwent single-level lumbar discectomy for degenerative disc disease at Al-Ahrar Teaching Hospital and Zagazig University Hospitals, Egypt, between January 2015 and October 2025. Patients with multilevel disease, spinal instability, prior lumbar surgery, or incomplete follow-up were excluded. BMI was recorded at surgery and follow-up. Recurrence was defined clinically and radiologically, confirmed by re-surgery. Logistic regression and Kaplan-Meier analysis assessed associations between BMI and recurrence.

Results: Recurrence occurred in 28 patients (9.8%). Patients with recurrence had higher BMI at initial surgery compared with those without recurrence (25.8 ± 2.8 vs. 22.9 ± 2.0 kg/m²; p < 0.001). Overweight and obese patients (BMI ≥ 25 kg/m²) accounted for 64.3% of recurrences. Each 1 kg/m² increase in BMI increased recurrence odds by 38% (OR 1.38; 95% CI 1.17-1.63; p < 0.001). Kaplan-Meier analysis showed shorter recurrence-free survival in patients with elevated BMI (p < 0.001). Modic changes were the strongest independent risk factor.

Conclusion: Elevated BMI is significantly associated with increased recurrence and reoperation after lumbar discectomy. Preoperative BMI optimization may reduce the risk of re-surgery and improve postoperative outcomes.

Background: Primary optic nerve sheath meningioma (ONSM) is a rare but clinically significant benign tumor that can cause irreversible loss of vision. Active management strategies in primary ONSM are controversial and current treatment favors radiotherapy, despite its associated risks. Endoscopic endonasal approach (EEA) surgery offers a minimally invasive alternative to decompress the optic nerve and restore visual function. This systematic review evaluates the effectiveness and safety of EEA for decompression of the optic nerve, focusing on visual outcomes and complications.

Methods: A systematic review was performed following PRISMA guidelines to identify studies reporting operative management using EEA in patients above 16 years with radiographically confirmed primary ONSM that demonstrate optic canal confinement, excluding studies evaluating secondary ONSM or tumors with any evidence of intracranial extension. Post-operative outcome data was collected including visual acuity (VA), visual fields and complications.

Results: A total of 1065 articles were screened, with 13 patients included across 5 studies. VA improved post-operatively in 5 out of 13 patients (≥0.2 decrease in VA LogMAR score) and VA scores were stable in 7 out of 13 patients, post-operatively (where change in LogMAR score <0.2). 1 patient had worsened vision at 2-year follow-up (>0.2 increase in VA LogMAR score). Of note, this patient had established criteria for 'poor vision' pre-operatively, as defined by World Health Organization (WHO) (≥0.5 LogMAR) and although vision was stable during the first 6 months of follow up, VA deteriorated to WHO criteria for blindness (LogMAR >1.3) with scores of 1.38 and 1.78 LogMAR at 12 and 24 months, respectively. No intraoperative or postoperative complications were reported in the included studies.

Conclusion: These results suggest that EEA offers a safe and effective minimally invasive approach in preserving threatened vision for selected primary ONSM cases. Further research is required to determine optimal timing, long-term efficacy, and integration with radiotherapy.

Objective: To evaluate the learning curve, clinical outcomes, and radiological results of modified trans-Kambin endoscopic lumbar interbody fusion.

Methods: In this single-center retrospective study, 50 patients (66 segments) who underwent Kambin Torpedo endoscopic lumbar interbody fusion between January 2022 and April 2024 were assessed. Clinical outcomes included visual analogue scale (VAS) scores for back pain and ipsilateral and contralateral leg pain. Radiological measures included disc height, foraminal height and cross-sectional area, spinal canal area, segmental and lumbar lordosis, and adjacent segment motion. Fusion status was graded using the Bridwell classification system.

Results: The fusion rate was 99% (65/66 segments). VAS scores for back and leg pain improved significantly. Disc height was preserved in 97% of segments. Lumbar lordosis increased significantly, reaching the lower threshold of clinical relevance. Learning-curve analysis identified the 33rd patient as the threshold for shorter surgical duration, while outcome-based analyses showed cut-points of 23, 40, and 43 segments for graft volume, fusion grade, and VO, respectively. VO, observed in 35% of segments, was significantly associated with higher body mass index (BMI), male sex, and osteoporosis requiring pharmacological treatment. Greater graft volume correlated with better Bridwell grades. Heterotopic ossification occurred in three patients, with one presenting symptoms.

Conclusions: Modified trans-Kambin endoscopic lumbar interbody fusion is effective and safe, with high fusion rates and significant pain relief. Greater graft volume improved fusion grades. VO was linked to high BMI, male sex, and osteoporosis treatment. A 40-case threshold was associated with improved outcomes, underscoring the importance of surgical experience.

Objectives: To explore the risk factors for postoperative delirium (POD) in elderly patients after spinal surgery.

Methods: The clinical data of 1035 elderly patients (aged ≥65 years) who underwent spinal surgery were analysed from January 2018 to December 2022 at the Department of Spinal Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei. This study focused on patients at the ward level (non-ICU patients). Postoperative delirium (POD) was assessed using the Confusion Assessment Method (CAM). Patients were divided into two groups on the basis of whether POD occurred: the POD group (Group A) and the non-POD group (Group B). The variables included patient characteristics, baseline symptoms and operation-related factors. Risk factors were identified using univariate and multivariate logistic regression analyses.

Results: POD occurred in 116 of the 1035 patients included in the study, with an incidence rate of 11%. Univariate analysis revealed significant differences in age, emergency surgery, waiting days from admission to surgery (more than 3 days), diabetes status, preoperative cognitive dysfunction, operation time, intraoperative hypotension (SBP <80 mmHg) and PACU-VAS score between Group A and Group B (P < 0.05). Multivariate logistic regression analysis revealed that age (OR = 1.133, 95% CI: 1.109-1.267, P = 0.017), emergency surgery (OR = 2.527, 95% CI: 1.207-5.624, P = 0.012), diabetes (OR = 1.532, 95% CI: 1.012-2.321, P = 0.043), preoperative cognitive dysfunction (OR = 3.239, 95% CI: 1.529-9.092, P = 0.018), operation time (OR = 1.019, 95% CI: 1.008-1.027, P = 0.002), intraoperative hypotension (SBP <80 mmHg; OR = 2.105, 95% CI: 1.141-2.342, P = 0.014) and PACU-VAS (OR = 1.907, 95% CI: 1.265-2.334, P = 0.021) were positively correlated with POD in elderly patients after spinal surgery. While the factor "waiting days from admission to surgery (more than 3 days)" was associated with POD in the univariate analysis, it was not retained as an independent risk factor in the final multivariate model.

Conclusions: Advanced age, emergency surgery, diabetes, preoperative cognitive dysfunction, long operation time, intraoperative hypotension (SBP<80 mmHg) and a PACU-VAS score ≥4 were independent risk factors for POD in elderly patients after spinal surgery. In the perioperative period, reasonable and effective measures should be taken according to risk factors to reduce the incidence of POD in elderly patients after spinal surgery.

Objective: The mortality rate after endovascular treatment (EVT) in patients with acute basilar artery occlusion (ABAO) remains high. This study aimed to analyze the clinical factors associated with 90-day mortality following EVT.

Methods: We retrospectively analyzed patients with ABAO who underwent EVT within 24 hours of symptom onset in the Department of Neurology, Baotou Central Hospital, Inner Mongolia, China, between April 2017 and September 2023. A favorable functional outcome was defined as a modified Rankin Scale (mRS) score of 0-3 at 90-day follow-up, whereas poor outcome was defined as an mRS score of 4-6. Mortality was defined as an mRS score of 6 at 90 days. Univariate and multivariate analyses were performed to identify predictors of mortality.

Results: A total of 96 patients were included. Early reperfusion (modified Thrombolysis in Cerebral Infarction ≥ 2b) was achieved in 87 patients (90.6%). Fifty patients (52.1%) achieved a favorable outcome, while the overall mortality rate was 30.2%. Univariate analysis showed that baseline Glasgow Coma Scale, baseline National Institutes of Health Stroke Scale score, posterior circulation Alberta Stroke Program Early Computed Tomography Score, symptomatic intracranial hemorrhage, successful reperfusion, and onset-to-puncture time (OPT) were associated with mortality. In multivariable analysis (Model 3, including Percutaneous Transluminal Angioplasty (PTA) and stenting as salvage therapy), OPT (OR 1.004; 95% CI 1.002-1.007; p = 0.002), successful reperfusion (modified Thrombolysis in Cerebral Infarction ≥ 2b) (OR 0.058; 95% CI 0.004-0.804; p = 0.034), and PTA as salvage therapy (OR 9.202; 95% CI 1.783-47.505; p = 0.008) were identified as independent predictors of 90-day mortality.

Conclusion: Prolonged OPT and the use of PTA as salvage therapy may lead to an increased 90-day mortality. In contrast, early successful reperfusion significantly reduces 90-day mortality in ABAO patients treated with EVT. Therefore, early reperfusion remains critical. Meanwhile, efforts should be made to shorten the OPT and to reduce the use of PTA as a salvage therapy for ABAO.

Background and aims: The optimal treatment strategy of Intracranial atherosclerotic disease-related large vessel occlusion (ICAD-LVO) remains undetermined. Current evaluation criteria focus on 90-day functional independence for acute-phase management, yet this timeframe does not represent the therapeutic endpoint given the persistent risk of recurrent stroke in this patient population. This study aims to examine whether stent angioplasty in patients with ICAD-LVO reduces long-term stroke recurrence risk while achieving successful vascular recanalization.

Methods: In this retrospective cohort study of 131 ICAD-LVO patients (June 2022-January 2024), 65 underwent emergency stenting and 66 received non-stenting therapy. The primary outcome was 30-day to 1-year stroke recurrence, analyzed using competing risks regression (Fine-Gray model). Secondary outcomes included safety and 90-day functional status.

Results: The 1-year cumulative incidence of recurrence was 4.9% in the stent group vs. 13.7% in the non-stent group (Gray's test, P=0.088). After adjustment, stenting was significantly associated with a lower recurrence risk (sHR 0.19, 95% CI 0.04-0.82; P=0.026). A history of stroke/TIA predicted higher risk (sHR 8.81, P=0.002). Stenting was not associated with increased symptomatic intracranial hemorrhage, parenchymal hematoma type 2, 90-day mortality, or differences in 90-day functional independence.

Conclusion: In this retrospective cohort study, emergency stent angioplasty was associated with a lower risk of 30-day to 1-year stroke recurrence in intracranial atherosclerotic occlusions and was not associated with an increased risk of procedural complications.

Introduction: Parkinson's Disease (PD) is a neurodegenerative disorder characterized by the loss of dopaminergic neurons in the substantia nigra, resulting in motor and non-motor symptoms including diminished sleep quality and altered dream content. The neurocircuitry underlying the latter remain poorly understood. The goal of this study is to assess the influence of deep brain stimulation (DBS) on sleep quality and, for the first time, dream characteristics.

Methods: 10 PD patients undergoing bilateral DBS of the subthalamic nucleus prospectively completed questionnaires evaluating PD parameters, sleep quality, dream/nightmare frequency and content, preoperatively and 6-month post-DBS recovery.

Results: Participant quality of life and symptom severity improved following DBS. Participants reported sleeping for 5.8 hours per night, with an average of 3.2 interruptions per night, which did not change significantly after surgery. Prior to surgery, participants reported symptoms of REM sleep behavior disorder, with no difference in sleep quality after DBS. Dream and nightmare frequency did not change significantly following DBS. Dream content was coded and analyzed using the Hall/Van de Castle System demonstrating a significant reversal of dream content featuring Aggressor and Negative Emotions (p<0.01) and an increase in themes of Befriender, Physical Aggression, Familiar Setting, and Dreamer-Involved Success (p<0.01). When analyzing dreams with a least one, a significant decrease was found for Failure (p<0.05).

Conclusion: This pilot study provides novel insights into the effects of DBS on dream content in PD patients. DBS may influence and even reverse PD-altered dream content potentially through modulation of brain networks involved in dream generation.

Background: Complex aortic arch anatomies, such as type III or bovine arches, often hinder balloon guide catheter (BGC) navigation during carotid artery stenting (CAS). To address this issue, we devised the micro-balloon anchoring technique (MBAT), which ensures reliable BGC advancement even in challenging vascular anatomy.

Methods: MBAT was applied in 16 of 58 CAS procedures performed between October 2023 and February 2025 at Kobayashi Neurosurgical Hospital. These cases were retrospectively analyzed according to a predefined institutional strategy. In MBAT, a micro-balloon is inflated in a branch of the external carotid artery to provide distal anchoring, facilitating stable advancement of a long-neck Simmons catheter and BGC. Right distal radial access was prioritized. Procedural outcomes and complications were evaluated.

Results: MBAT enabled successful BGC navigation in all 16 cases (100%), including 14 with type III arch and 2 with bovine arch. Facial or lingual artery anchoring was most commonly used. No periprocedural strokes, dissections, or access-site complications occurred.

Conclusion: MBAT is a safe and effective technique for guiding BGCs into target vessels during CAS, particularly in anatomically challenging cases. It can be performed using widely available devices and enhances procedural success by improving catheter trackability. MBAT represents a practical adjunctive technique for neuroendovascular specialists managing complex access routes.

Background: Trigeminal neuralgia (TN) patients undergoing percutaneous balloon compression (PBC) may experience postoperative complications, warranting the investigation of influencing factors and preventive strategies.

Methods: A retrospective analysis of 164 TN patients who underwent PBC was conducted to compare baseline characteristics and identify risk factors using LASSO regression. A multivariate logistic regression model was developed to predict complications.

Results: Significant differences were observed between complication and non-complication groups related to nerve branches, hypertension, compression duration, and CD4+ levels. The final model identified nerve branches, diabetes, compression duration, and CD4+ levels as independent risk factors. The model exhibited good discriminatory power (AUC=0.793) and calibration, with meaningful clinical utility shown through DCA.

Conclusions: The study established a predictive model for postoperative complications in TN patients undergoing PBC, offering a framework for preoperative risk assessment and tailored preventive interventions.