World neurosurgery最新文献

Background: Acute ischemic stroke caused by intracranial large vessel occlusion is associated with significant morbidity and mortality. Emerging evidence suggests that environmental exposures, including toxic metals, may be associated with cerebrovascular disease. However, the presence of toxic metals within intracranial thrombi and their relationship with clinical features of acute ischemic stroke remain largely unexplored.

Materials and methods: We conducted an observational cohort study including 59 patients with acute ischemic stroke due to large vessel occlusion treated with mechanical thrombectomy between November 2023 and April 2024. Retrieved thrombi were analyzed for aluminum, cadmium, nickel, and lead concentrations using Inductively Coupled Plasma-Mass Spectrometry. Histological and immunohistochemical analyses were performed to characterize thrombus composition. Associations between thrombus metal concentrations and clinical, radiological, and procedural variables, including NIHSS scores and first-pass recanalization, were assessed.

Results: Significant correlations were observed between metals: aluminum with cadmium (r = 0.733, P < 0.001) and nickel (r = 0.558, P = 0.001). Cadmium was positively associated with first-pass recanalization (FPR) success (r = 0.648, P < 0.001), while lead correlated with National Institutes of Health Stroke Scale (NIHSS) at onset (r = 0.502, P < 0.001). In 29% of thrombi containing all 4 metals, aluminum was inversely related to NIHSS at 12 hours (r = -0.775, P < 0.001).

Conclusion: This study identifies significant associations between thrombus toxic metal concentrations and clinical outcomes, suggesting that thrombus metal composition may be relevant to acute ischemic stroke characteristics.

Objective: Spinal hemangioblastomas are rare vascular lesions responsible for 1.6-2.1% of spinal cord tumors, while intradural extramedullary hemangioblastomas (IDEM) are much rarer, especially cases not associated with VHL. The aim of this article is to review the clinical presentation, diagnosis, and surgical treatment of IDEM and to present a case of isolated cervical IDEM in a patient without VHL .

Methods: A comprehensive search of databases including PubMed, Web of Science, Scopus, and Embase was performed to identify literature regarding surgical outcomes for IDEM. The current review discussed a total of 46 articles describing 62 patients treated for IDEM until 2024. We also describe here the case of a 41-year-old female with an isolated cervical IDEM presenting with neck pain, upper limb weakness, and paresthesia.

Results: In this systematic review, total resection was reported in 84%. 65% of the population showed complete resolution of symptoms and 23% symptomatically improved after surgery. Complications occurred in 7%, including one death. The case presented here was treated by surgical excision via C2-C3 laminectomy followed by spinal fusion. Histopathology proved the lesion to be an IDEM. The patient had no symptoms postoperatively without recurrence on follow-up imaging.

Conclusions: IDEM represents a rare benign tumor, with challenging diagnosis and surgical treatment. Advanced imaging-guided microsurgical resection and neuromonitoring enable favorable outcomes characterized by a high rate of total resection and symptom resolution. This article emphasizes on the importance of meticulous surgical planning and standardized reporting of outcomes as one way to optimize patient care.

Negative- and low-pressure hydrocephalus is an uncommon and frequently misdiagnosed condition lacking standardized diagnostic and management protocols. We conducted a systematic review of published studies from 1980 to 2024 to synthesize evidence on etiology, pathophysiology, and treatment. Thirty studies reporting 215 patients were identified, with antecedents including traumatic brain injury, aneurysmal subarachnoid hemorrhage, normal-pressure hydrocephalus, postoperative cases, and spontaneous presentations. Four interacting models were commonly described: viscoelastic brain change with reduced compliance, transmantle pressure gradients, poroelastic or glymphatic dysfunction, and impaired cerebrospinal fluid pulsatility. Management strategies centered on restoring compliance and cerebrospinal fluid pathways through subatmospheric external ventricular drainage, low-pressure or valveless shunting, targeted leak repair, and endoscopic third ventriculostomy. Outcomes were variable, but early recognition and carefully titrated drainage were repeatedly associated with clinical improvement, whereas delayed intervention, infection, and irreversible white-matter injury predicted poor recovery. This review highlights negative- and low-pressure hydrocephalus as a distinct neurosurgical entity and proposes a diagnostic and management framework, while emphasizing the urgent need for multicenter registries with standardized definitions and outcome measures to guide evidence-based care.

Objective: This study aimed to identify risk factors for cognitive impairment after aneurysmal subarachnoid hemorrhage (aSAH), evaluate the efficacy of lumbar drainage (LD), and assess the prognostic utility of the Montreal Cognitive Assessment (MoCA).

Methods: In this retrospective cohort study, 75 aSAH patients aged 18 to 75 years underwent cognitive (MoCA), neurological (modified Rankin Scale, mRS), and functional (functional activities questionnaire, FAQ) assessments at 3 months postoperatively. Multivariate regression and receiver operating characteristic analyses were used to identify predictors.

Results: The incidence of cognitive impairment (MoCA <26) was 53.3% (40/75). Multivariate analysis identified the following independent risk factors: education level <5 years (odds ratio [OR] = 4.644, 95% confidence interval [CI] 1.151-18.743, P = 0.031), Fisher grade 3-4 (OR = 9.176, 95% CI 1.997-42.163, P = 0.004), delayed cerebral infarction (OR = 7.867, 95% CI 1.932-32.039, P = 0.004), and chronic hydrocephalus (OR = 4.219, 95% CI 1.128-15.783, P = 0.032). LD reduced the risk of impairment (OR = 0.211, 95% CI 0.047-0.954, P = 0.043), particularly in severe subgroups (Hunt-Hess IV-V, WFNS IV-V, modified Fisher 3-4). The incidence of unfavorable clinical outcomes (mRS ≥3) was 25.3%, and that of impaired daily living ability (FAQ >5) was 41.3%. MoCA scores correlated strongly with both mRS (P < 0.001) and FAQ (P < 0.001), and effectively predicted unfavorable outcomes (area under the curve = 0.860, optimal cutoff ≈<23) and impaired daily living (area under the curve = 0.910, optimal cutoff ≈<25).

Conclusions: Cognitive impairment in aSAH patients is significantly associated with lower educational attainment, greater initial hemorrhage severity, and secondary brain injury. Our findings suggest that early LD intervention, particularly in high-grade cases, may be a promising therapeutic strategy. MoCA demonstrates robust prognostic value for functional recovery, supporting its clinical utility in early risk stratification.

Background: Spontaneous intracranial hemorrhage (sICH) is a severe stroke subtype with high morbidity, mortality, and health care costs. This study evaluated national trends in sICH hospitalizations in Brazil from 2017 to 2022, focusing on seasonal variation, neurosurgical access, financial burden, and the impact of the COVID-19 pandemic.

Methods: We conducted a retrospective analysis using Departamento de Informática do Sistema Único de Saúde (Brazil's Public Health Database), Brazil's public health database, including all hospitalizations for International Classification of Diseases, 10th Revision codes I61 and I62 from January 2017 to December 2022. Time-series methods (Seasonal-Trend Decomposition using Loess decomposition, Chow test, Cumulative Sum, Augmented Dickey-Fuller, and Mann-Kendall) assessed temporal trends, seasonality, and structural changes. Outcomes included in-hospital mortality, neurosurgical procedures, length of stay, and hospitalization costs.

Results: A total of 114,030 sICH hospitalizations occurred (mean: 16,497/year). In-hospital mortality was 25%, totaling over 28,000 deaths. A significant structural break occurred in March 2020 (Chow test: P < 0.001), aligning with the pandemic onset. Admissions showed a sustained upward trend (Cumulative Sum: P = 0.002). Seasonal variation was evident, with peaks between May and September, confirmed by the Augmented Dickey-Fuller test (P < 0.001) and 12-month autocorrelation (ρ = 0.41). Neurosurgical access declined (11% to 8.8%). Decompressive craniectomy was performed in 3.6% of all admissions (21% of all surgeries). Conversely, neuroendoscopy was utilized 0.2% of cases. Mean length of stay decreased slightly from 10.2 to 9.4 days. Total hospitalization costs surged by 54%.

Conclusions: The rising incidence, costs, and seasonal nature of sICH highlight a growing burden on the Brazilian public system. Current trends suggest demographic aging is outpacing prevention efforts, while the heavy reliance on decompressive techniques reveals a critical gap in the adoption of minimally invasive surgical options.

Background: Optimal treatment for osteoporotic thoracolumbar burst fractures (TLBFs) remains controversial. Therefore, identifying a more effective and feasible method to simplify reported surgical procedures remains crucial. In this study, we aimed to assess the clinical and radiological outcomes of a novel hybrid surgery involving unilateral extrapedicular percutaneous kyphoplasty combined with six-screw fixation in patients with osteoporotic TLBFs.

Methods: Fifty-one patients who underwent this procedure at 2 institutions between January 2019 and October 2023 were retrospectively enrolled. Back pain and function were evaluated using the visual analog scale and Oswestry disability index scores, respectively. Radiological outcomes included the anterior vertebral height, posterior vertebral height, and local kyphotic angle. The intraoperative data and complications were recorded.

Results: All patients underwent successful treatment. The postoperative visual analog scale and Oswestry disability index scores significantly decreased (P < 0.05) and continued to decrease at the last follow-up (P < 0.05). Postoperative anterior vertebral height of injured vertebrae, posterior vertebral height of injured vertebrae, and local kyphotic angle values were significantly corrected compared with the respective preoperative values (P < 0.05). No obvious loss of correction was observed during follow-up (P > 0.05). In 50 patients (98%), the cement diffused across the vertebral body midline. Three patients (5.8%) experienced asymptomatic cement leakage. No patient experienced other severe complications, including injuries to the segmental lumbar arteries and nerve roots, internal fixation failures, or deep infections.

Conclusions: The extrapedicular puncture technique avoided internal fixation obstruction and simplified the surgical procedure. This novel hybrid surgery showed good clinical and radiological outcomes. Therefore, it is considered safe and effective for osteoporotic TLBFs.

CNS metastases from pediatric solid tumors are rare but represent a devastating complication. This study aims to provide insight into this rare clinical presentation with a retrospective analysis of pediatric patients with solid tumors and CNS metastases treated at our institution over the past 21 years. Out of 386 pediatric patients with solid tumors, 19 (4.9%) developed CNS metastases, and 17 patients with consent for research were included in further analyses. The most common tumor types were sarcomas, followed by neuroblastomas. CNS metastases were rarely diagnosed at initial presentation (17,6%) and more common at time of disease progression/recurrence, often with multifocal localization (68,8%). In patients with bone sarcomas, the most common pattern of CNS involvement was contiguous spread from bone metastases (71.4%), whereas neuroblastoma patients showed a higher proportion of distant intraparenchymal metastases. Survival after diagnosis of CNS metastases was poor, with a median of 9 months (range 0-85 months). Patients with sarcomas appeared to benefit from therapies directed to CNS metastases, including radiotherapy and repeated surgery, with a 2-year overall survival of 66.7% (95% CI: 5.4%-94.5%) for soft tissue sarcomas and a 2-year overall survival of 57.1% (95% CI: 17.2%-83.7%) for bone sarcomas. For rare tumor types, such as BCOR-ITD sarcomas, CNS metastases may be treatable and underrecognized, and incorporating routine CNS imaging in follow-up could be beneficial. Though data are scarce, our findings suggest that whenever feasible, tumor debulking or stereotactic biopsy should be considered for local treatment and/or molecular profiling in pediatric patients with CNS metastases.