World neurosurgery最新文献_第6页

A Novel Radiation-Free Navigation Method for Robotic Pedicle Screw Placement Using 3D-Printed Guide Templates: A Cadaveric Study. 一种新的无辐射导航方法用于机器人椎弓根螺钉放置使用3d打印的导向模板：尸体研究。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-08 DOI: 10.1016/j.wneu.2026.124790

Yi Bao, Ce Bian, Hao-Tian Luo, Xiong-Gang Yang, Sheng Lu

Background: Robot-assisted spinal surgery has advanced surgical accuracy but increased radiation exposure for both staff and patients, raising safety concerns. The purpose of this study was to evaluate the clinical accuracy of thoracic pedicle screw placement performed with a 3D-printed navigation guide plate for robotic registration and to determine whether equivalent precision can be achieved without intraoperative imaging.

Materials and methods: Seven fresh-frozen human cadaveric torsos underwent preoperative CT of the thoracic spine. Reverse-engineering principles were used to design patient-specific 3D-printed navigation guide plates that were recognized by the robot's binocular vision system (XGK-6508A). After automatic guide-pin insertion, 168 thoracic pedicle screws (T1-T12 bilaterally) were implanted. Postoperative CT assessed accuracy against preoperative planning using the Gertzbein-Robbins scale (GRS), deviation distance (DD, mm), and deviation angle (DA, °). Implantation time per screw was recorded.

Results: 98% of screws met acceptable GRS grades (Grade A 85%, Grade B 13%). Mean DD at entry and exit points was 0.4 ± 0.3 mm and 0.5 ± 0.3 mm in the sagittal plane and 0.3 ± 0.2 mm and 0.4 ± 0.2 mm in the axial plane, respectively. Mean DA was 3.2 ± 2.0 ° sagittally and 2.4 ± 4.5 ° axially. The mean implantation time per screw was 2.4 ± 1.7 min. Average insertion time decreased from 8.0 ± 4.5 min per screw in the first three cadavers (72 screws) to 1.8 ± 2.2 min in the last four (96 screws) (p = 0.012).

Conclusion: 3D-printed navigation guide plates enable accurate, radiation-free robot-assisted thoracic pedicle screw placement. Surgical efficiency improved markedly with experience, supporting the technique as a safe alternative to conventional image-guided methods. This study involves no ionizing radiation in its methodology and transforms the traditional registration process for robots, making it safe and efficient.

背景：机器人辅助脊柱手术提高了手术精度，但增加了工作人员和患者的辐射暴露，引起了安全问题。本研究的目的是评估使用3d打印导航导向板进行机器人定位的胸椎弓根螺钉置入的临床准确性，并确定在没有术中成像的情况下是否可以达到相同的精度。材料与方法：术前对7具新鲜冷冻人尸体进行胸椎CT扫描。利用逆向工程原理设计了针对患者的3d打印导航导板，并由机器人的双目视觉系统（XGK-6508A）识别。自动导针插入后，植入168枚胸椎弓根螺钉（T1-T12双侧）。术后CT采用Gertzbein-Robbins量表（GRS）、偏移距离（DD, mm）和偏移角度（DA，°）评估术前计划的准确性。记录每颗螺钉植入时间。结果：98%的螺钉达到可接受的GRS等级（A级85%，B级13%）。矢状面入、出点平均DD分别为0.4±0.3 mm和0.5±0.3 mm，轴向面平均DD为0.3±0.2 mm和0.4±0.2 mm。矢状面平均DA为3.2±2.0°，轴向平均DA为2.4±4.5°。平均每颗螺钉植入时间为2.4±1.7 min。平均插入时间从前3具尸体（72枚）的8.0±4.5分钟减少到后4具尸体（96枚）的1.8±2.2分钟（p = 0.012）。结论：3d打印导航引导板可以实现精确、无辐射的机器人辅助胸椎弓根螺钉置入。随着经验的积累，手术效率显著提高，支持该技术作为传统图像引导方法的安全替代方法。本研究的方法不涉及电离辐射，改变了传统的机器人注册过程，使其安全高效。

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引用次数: 0

A New Way to Neuronavigate: Comments on a Novel Ultrasonographic Neuronavigation Device. 神经导航的新途径：一种新型超声神经导航装置的评述。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-07 DOI: 10.1016/j.wneu.2026.124787

Sean M Himel, Kevin T Foley

引用次数: 0

Where the Tool Meets the Tissue … 工具与组织的结合处....

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-06 DOI: 10.1016/j.wneu.2026.124788

Sanju Lama, Rahul Singh, Garnette R. Sutherland

引用次数: 0

Circumferential Minimally Invasive Adult Spinal Deformity Surgery: A Systematic Review With Key Concepts and Technical Considerations 环形微创成人脊柱畸形手术：关键概念和技术考虑的系统回顾。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-03 DOI: 10.1016/j.wneu.2025.124785

Marcos Real , Logan H. Sigua , Matthew R. Allen , Nolan J. Brown , Timothy Y. Kim , Martin H. Pham

Background

While open techniques have historically dominated adult spinal deformity (ASD) surgery, minimally invasive (MIS) approaches have become ubiquitous in recent years due to advances in intraoperative guidance, spinal robotics, and planning software. Despite its promise, circumferential MIS (cMIS) for ASD remains uncertain in matching the appropriate correction of open surgery. This systematic review highlights core principles and techniques behind successful cMIS outcomes in ASD.

Methods

A systematic search strategy was developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In November 2023, we queried PubMed, Embase, and Cochrane databases. We sought primary, peer-reviewed studies including ≥5 patients treated with cMIS for ASD, focusing on postoperative outcomes such as spinopelvic alignment and complication rates.

Results

We identified 401 studies (2014–2023), of which 25 (24 retrospective, 1 prospective) met inclusion criteria, encompassing 2565 patients (weighted mean age 63.3 [21–85], 63.2% female among studies reporting sex) undergoing a mean of 7.1 operated spinal levels. cMIS demonstrated significant clinical improvement, including reductions in Visual Analog Scale and Oswestry Disability Index scores, and achieved postoperative spinopelvic alignment comparable to open approaches. Compared to open and hybrid techniques, cMIS reduced blood loss and complication rates but showed higher pseudarthrosis rates at long-term follow-up. Predictors of cMIS feasibility included DEXA T-scores, staged surgery consideration, and preoperative sagittal vertical axis >100 mm as a relative contraindication.

Conclusions

CMIS for ASD is a safe and effective technique that achieves meaningful improvements in alignment and patient-reported outcomes while minimizing complications in appropriately selected patients.

导读：虽然开放技术历来主导着成人脊柱畸形（ASD）手术，但近年来，由于术中引导、脊柱机器人技术和规划软件的进步，微创（MIS）手术已经无处不在。尽管有希望，圆周MIS （cMIS）仍不确定是否适合开放手术的适当矫正。本系统综述强调了cMIS成功治疗ASD的核心原则和技术。方法：根据系统评价和荟萃分析指南的首选报告项目制定了系统搜索策略。在2023年11月，我们查询了PubMed， Embase和Cochrane数据库。我们寻找了包括≥5例接受cMIS治疗的ASD患者的初级同行评审研究，重点关注脊柱-骨盆对齐和并发症发生率等术后结果。结果：我们纳入了401项研究（2014-2023年），其中25项（24项为回顾性研究，1项为前瞻性研究）符合纳入标准，共纳入2565例患者（加权平均年龄63.3[21-85]，报告性别的研究中63.2%为女性），平均接受7.1个脊柱水平手术。cMIS表现出显著的临床改善，包括视觉模拟量表和Oswestry残疾指数评分的降低，并实现了与开放入路相当的术后脊柱骨盆对齐。与开放和混合技术相比，cMIS减少了出血量和并发症发生率，但在长期随访中显示出更高的假关节发生率。cMIS可行性的预测因素包括DEXA t评分、分期手术考虑、术前矢状垂直轴> 100mm作为相对禁忌症。结论：cMIS治疗ASD是一种安全有效的技术，可以在适当选择的患者中实现有意义的对齐和患者报告的结果的改善，同时最大限度地减少并发症。

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引用次数: 0

Adverse Impact of Frailty on Postoperative Outcomes of Cervical Laminoplasty 虚弱对颈椎椎板成形术术后疗效的不利影响。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-02 DOI: 10.1016/j.wneu.2025.124776

Ataollah Shahbandi, Pegah Ghamasaee, Abdul Mounnem Yassin Kassab, Saman Shabani

Background

Although prior studies have examined the impact of frailty on surgeries for degenerative cervical conditions, these studies often involved heterogeneous sample populations in terms of surgical approaches. This study aimed to examine the impact of frailty and its severity on postoperative outcomes after cervical laminoplasty.

Methods

This study examined the 2007–2022 ACS-NSQIP database. Patients who received cervical laminoplasty were queried and grouped according to the modified Frailty Index into nonfrail, prefrail, frail, and severely frail categories. The primary outcome was the occurrence of at least one complication within 30 days (excluding blood transfusions). Secondary outcomes were major and minor complication rates, readmission rates, and the length of hospital stay.

Results

A total of 2250 patients were included, categorized as 829 nonfrail, 873 prefrail, 474 frail, and 74 severely frail patients. After controlling for confounders, frailty (odds ratio [OR] 1.661, 95% confidence interval [CI] 1.122–2.463; P = 0.011) and severe frailty (OR 4.328, 95% CI 2.271–8.253; P < 0.001) were independently associated with prolonged hospitalization. Additionally, severe frailty was independently correlated with a heightened risk of readmission (OR 3.976, 95% CI 1.392–10.959; P = 0.008), increased overall complication rates (OR 2.831, 95% CI 1.282–6.12; P = 0.009), and a higher likelihood of experiencing at least one major complication (OR 4.879, 95% CI 1.947–12.229; P = 0.001).

Conclusions

Frailty and its severity may be associated with a higher rate of unfavorable perioperative outcomes after cervical laminoplasty. As a result, including frailty assessment in the preoperative evaluation of patients undergoing cervical laminoplasty could be beneficial for stratifying related risks.

背景：虽然先前的研究已经检查了虚弱对退行性宫颈疾病手术的影响，但这些研究通常涉及手术入路方面的异质样本人群。本研究旨在探讨虚弱及其严重程度对颈椎椎板成形术术后预后的影响。方法：本研究检查2007-2022 ACS-NSQIP数据库。对接受颈椎椎板成形术的患者进行查询，并根据改良的虚弱指数（mFI-5）分为非虚弱、预虚弱、虚弱和严重虚弱。主要终点是30天内至少发生一次并发症（不包括输血）。次要结局是主要和次要并发症发生率、再入院率和住院时间。结果：共纳入2250例患者，其中非体弱患者829例，预体弱患者873例，体弱患者474例，重度体弱患者74例。在控制混杂因素后，虚弱（OR 1.661, 95%CI 1.122-2.463； P=0.011）和严重虚弱(OR 4.328, 95%CI 2.271-8.253； P结论：虚弱及其严重程度可能与颈椎椎板成形术后较高的不良围手术期预后率相关。因此，在颈椎椎板成形术患者的术前评估中纳入脆弱性评估可能有利于相关风险的分层。

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引用次数: 0

Right-Angled Fenestrated Picket Fence Clipping Technique for an Anterior Communicating Artery Aneurysm 直角开窗尖栅栏夹闭技术治疗前交通动脉瘤。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-02 DOI: 10.1016/j.wneu.2025.124783

Sarah A. Hamimi , Awinita Barpujari , Jaeha Kim , Mikaeel Habib , Austin J. Borja , Sami Almasri , Om H. Gandhi , Omar A. Choudhri

Anterior communicating artery (AComm) aneurysms account for approximately 25% of all cerebral aneurysms.1, 2, 3 Their management remains challenging due to significant anatomic and morphologic variability, and a high recurrence rate after primary endovascular coiling.⁴ Recurrence is often due to coil compaction and thrombus incorporation into the aneurysm wall, necessitating more complex treatments such as stenting, flow diversion, or microsurgical clip reconstruction. The picket fence clipping technique is a strategy for treating large or recurrent aneurysms when conventional clipping across the neck is not feasible.⁵ In this report, we present a modified picket fence clipping technique using multiple right-angled fenestrated clips for a recurrent AComm aneurysm. The patient is a 42-year-old man with a history of subarachnoid hemorrhage from a ruptured large AComm aneurysm previously treated with coiling (Video 1). He presented with worsening intractable headaches, and follow-up imaging revealed coil compaction and residual aneurysm filling at the base. Due to the aneurysm's wide neck and complex morphology, a right orbital pterional skull base approach was recommended for clip reconstruction, with intraoperative angiography, and possible bypass. Intraoperatively, nine clips were used to reconstruct the aneurysm neck while preserving flow in all branch vessels. The patient recovered without complication and was discharged on postoperative day four. This case highlights the utility of right-angled fenestrated clips in a modified picket fence construct, providing a versatile and effective solution for managing complex, recurrent AComm aneurysms with residual coils and thrombus.

前交通动脉（AComm）动脉瘤约占所有脑动脉瘤的25%。1-3由于其解剖学和形态学的显著差异，以及原发性血管内盘绕后的高复发率，其治疗仍然具有挑战性复发通常是由于线圈压实和血栓进入动脉瘤壁，需要更复杂的治疗，如支架置入术、血流转移或显微手术夹重建。“尖桩栅栏”夹闭技术是一种治疗大型或复发性动脉瘤的策略，当传统的颈部夹闭不可行时在本报告中，我们提出了一种改良的尖桩栅栏夹技术，使用多个直角开窗夹治疗复发性AComm动脉瘤。患者是一名42岁的男性，有蛛网膜下腔出血史，此前曾接受过动脉瘤盘绕治疗。他表现为顽固性头痛恶化，随访影像显示动脉瘤圈压实和底部残留的动脉瘤填充。由于动脉瘤颈宽且形态复杂，建议采用右眶翼点颅底入路进行夹重建，术中进行血管造影，并可能进行搭桥。术中使用9个夹子重建动脉瘤颈部，同时保留所有分支血管的血流。患者康复无并发症，术后第4天出院。本病例强调了直角开窗夹在改良尖桩栅栏结构中的应用，为治疗复杂的复发性伴残余线圈和血栓的acmm动脉瘤提供了一种通用而有效的解决方案。

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引用次数: 0

Simultaneous Combined Multiportal Approach Using Transcranial and Endoscope-Assisted Midfacial Degloving Routes for Tumors with Skull Base and Extensive Sinonasal Involvement 经颅及内窥镜辅助下的面中脱手套同时联合多门静脉入路治疗颅底及广泛鼻窦受累的肿瘤。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-02 DOI: 10.1016/j.wneu.2025.124780

Tamás Fischer-Szatmári , Thannoon Masood , Seyed Arad Senaobar Tahaei , Zsolt Bella , Pál Barzó

Background

For many years, in cases of excessively extensive tumors affecting the sinonasal region and the skull base—where the novel technique of a combination of transciliary supraorbital keyhole craniotomy and endoscopic endonasal approach would not have yielded satisfactory outcomes due to anatomic limitations—our gold standard technique was a combination of transfacial and tailored transcranial approaches. To reduce surgical invasiveness, complications, and undesirable aesthetic outcomes during the surgical treatment of tumors with extensive sinonasal and skull base involvement, the transfacial approach was left behind in favor of a combination of simultaneously applied tailored transcranial and endoscope-assisted midfacial degloving approaches.

Methods

A microscope-assisted tailored transcranial approach was combined with an endoscope-assisted midfacial degloving approach.

Results

This paper presents five cases with various histologic types of tumors affecting both the sinonasal area and the skull base. All patients were selected for surgical treatment by our clinical team. The mean operative time was three hours. All procedures were free of intraoperative or postoperative complications, and either total or near-total tumor excision was accomplished. Follow-up revealed no surgery-related issues in any of the patients.

Conclusions

Our combined, simultaneous multiportal technique facilitates complete tumor resection with shortened operative times, low measures of intraoperative and postoperative complications, low mortality, and superb aesthetic outcomes.

背景：多年来，在影响鼻窦区和颅底的过度广泛的肿瘤病例中，由于解剖学的限制，经睫状眶上锁眼开颅联合内镜鼻内入路的新技术不能取得令人满意的结果，我们的金标准技术是经面和量身定制的经颅入路的结合。为了减少手术侵入性、并发症和手术治疗中对鼻窦和颅底广泛受损伤的肿瘤的不良审美结果，我们放弃了经颅入路，转而采用同时应用经颅和内窥镜辅助下的面中脱手套入路。方法：显微辅助下的经颅定制入路与内镜辅助下的面中脱手套入路相结合。结果：本文报道5例不同组织学类型的鼻窦及颅底肿瘤。所有患者均由我们的临床团队选择手术治疗。平均手术时间为3小时。所有手术均无术中或术后并发症，全部或近全部肿瘤切除完成。随访显示所有患者均无手术相关问题。结论：我们的联合，同时多门静脉技术有助于肿瘤完全切除，缩短手术时间，术中术后并发症少，死亡率低，美观效果好。

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引用次数: 0

Intracranial Candida Auris Infection: A Case Report and Scoping Review 颅内耳念珠菌感染1例报告及范围回顾。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-02 DOI: 10.1016/j.wneu.2025.124775

Gabriel L. Jelkin , Allie L. Heineman , Henry T. Beckett , Christopher M. Goddard , Laura B. Ngwenya

Objective

Candida auris (C. auris) is a multidrug-resistant yeast capable of causing invasive infections in both immunocompromised and immunocompetent hosts. While bloodstream and wound infections are well described, central nervous system (CNS) involvement remains rare and poorly characterized. We present a case of C. auris CNS infection and a scoping review of adult cases to identify trends in diagnosis and treatment.

Methods

We searched PubMed, Embase, Scopus, Web of Science, and Europe PMC for reports from 2009 to 2025 using CNS-specific and C. auris–specific terms. After deduplication and dual screening, 9 publications describing 11 cases met all criteria. Data on presentation, diagnostics, therapy, surgical intervention, and outcomes were extracted.

Results

Patients (aged 33–71 years) commonly presented with fever, headache, altered mental status, focal deficits, or hydrocephalus. Diagnosis relied on culture, molecular methods, or high clinical suspicion. Cerebrospinal fluid analyses typically demonstrated pleocytosis, elevated protein, and hypoglycorrhachia. Liposomal amphotericin B therapy was most frequently employed, often with flucytosine or echinocandins. Echinocandin monotherapy proved unreliable due to poor CNS penetration. Intrathecal echinocandins with systemic flucytosine achieved rapid clearance in selected cases. Voriconazole–micafungin combinations showed promise. Eight patients recovered with minimal sequelae; 4 had significant morbidity or mortality.

Conclusions

Key themes include 1) neurosurgical devices markedly increase CNS C. auris risk, 2) rapid diagnostics and susceptibility-guided therapy are imperative, 3) regimens targeting both systemic and CNS compartments may improve outcomes, and 4) device management is critical. Standardized protocols, multicenter registries, and pharmacokinetic studies are needed to guide treatment of this emerging, life-threatening infection.

目的：耳念珠菌（C. auris）是一种多重耐药酵母菌，能够在免疫功能低下和免疫功能正常的宿主中引起侵袭性感染。虽然血液和伤口感染被很好地描述，中枢神经系统（CNS）的累及仍然罕见和缺乏特征。我们提出一个病例的耳念珠菌中枢神经系统感染和成人病例的范围审查，以确定在诊断和治疗的趋势。方法：我们检索PubMed、Embase、Scopus、Web of Science和Europe PMC，检索2009年至2025年使用CNS和C. auris专有术语的报告。经过重复数据删除和双重筛选，9篇描述11例病例的出版物符合所有标准。提取有关表现、诊断、治疗、手术干预和结果的数据。结果：患者（年龄33-71岁）通常表现为发热、头痛、精神状态改变、局灶缺陷或脑积水。诊断依赖于培养、分子方法或高度的临床怀疑。脑脊液分析典型表现为细胞增多、蛋白升高和低糖血症。脂质体两性霉素B治疗最常用，常与氟胞嘧啶或棘白菌素联合使用。棘白菌素单药治疗由于中枢神经系统穿透力差而不可靠。在某些病例中，鞘内棘白菌素与全身氟胞嘧啶可以快速清除。伏立康唑-米卡芬联合用药显示出了希望。8例患者痊愈，后遗症极小；其中4例有显著的发病率或死亡率。结论：关键主题包括：(1)神经外科器械明显增加CNS C. auris的风险；(2)快速诊断和易感引导治疗势在必行；(3)同时针对系统和中枢神经室的方案可能改善预后；(4)设备管理至关重要。需要标准化方案、多中心登记和药代动力学研究来指导这种新出现的、危及生命的感染的治疗。

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引用次数: 0

Gyroscopic Radiosurgery: Clinical Experience and Prospective Analysis of over 500 Treated Tumors 陀螺仪放射外科-超过500个治疗肿瘤的临床经验和前瞻性分析。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124684

Antonio Santacroce , Alexander Muacevic , Nadja Kohlhase , Dochka Eftimova , Theresa Hofmann , Matthias Sammer , Annabel Graser , Markus Kufeld , Christoph Fürweger , Felix Ehret

Background

Stereotactic radiosurgery plays a significant role in the treatment of various benign and malignant tumors of the central nervous system. Recently, the first self-shielding treatment platform for gyroscopic radiosurgery (GRS) was introduced. Herein, we report our experience with GRS treatment of the first 541 tumors in a prospective setting.

Methods

This study enrolled patients who underwent GRS for intracranial tumors. Patient, treatment, and outcome data were prospectively collected and analyzed. Only patients with at least 1 imaging and clinical follow-up were included in this analysis. Volumetric assessments and major toxicity are presented.

Results

A total of 491 patients were treated between 2021 and 2024. Of those, 382 patients harboring 541 tumors underwent at least 1 imaging and clinical follow-up. The majority of tumor entities treated were vestibular schwannomas (196), brain metastases (188), and meningiomas (113). The median prescription dose for brain metastases was 20 Gy. For meningiomas and vestibular schwannomas, the median prescription doses were 15 and 13 Gy, respectively. Analysis of dosimetric performance showed that GRS treatments are highly conformal, achieving steep dose gradients. The median imaging follow-up was 10.6 months. Volumetry of the treated targets demonstrated an early treatment response with either volume reduction or stability for most tumors.

Conclusions

The early results of this prospective study, show the efficacy and safety of the new self-shielding treatment platform. Due to the limited follow-up of this analysis, future studies including long-term outcome data are needed.

背景：立体定向放射外科（SRS）在中枢神经系统各种良恶性肿瘤的治疗中发挥着重要作用。最近，首个陀螺放射外科（GRS）自屏蔽治疗平台问世。在此，我们报告了我们在前瞻性设置中使用GRS治疗前541例肿瘤的经验。材料和方法：本研究纳入了接受颅内肿瘤GRS治疗的患者。前瞻性地收集和分析患者、治疗和结局数据。只有至少有一次影像学检查和临床随访的患者被纳入本分析。介绍了体积评估和主要毒性。结果：在2021年至2024年期间，共有491例患者接受了治疗。其中，382例541个肿瘤患者接受了至少一次影像学检查和临床随访。大多数的肿瘤实体是前庭神经鞘瘤（196），脑转移瘤（188）和脑膜瘤（113）。脑转移的中位处方剂量为20gy。对于脑膜瘤和前庭神经鞘瘤，中位处方剂量分别为15 Gy和13 Gy。剂量学性能分析表明，GRS处理是高度适形的，实现陡峭的剂量梯度。中位影像学随访时间为10.6个月。治疗目标的体积测量显示了早期治疗效果，大多数肿瘤体积减小或稳定。结论：本前瞻性研究纳入了接受GRS治疗的患者，早期结果显示了新型自屏蔽治疗平台的有效性和安全性。由于本分析的随访有限，需要进一步的研究，包括长期的结果数据。

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引用次数: 0

Gross Total Resection of the Entire Cervical Spine Tumor: A Technical Note on Surgical Planning and Design of a Novel 3D-Printed Vertebral Prosthesis for Reconstruction from Skull Base to Thoracic Vertebra 全颈椎肿瘤大体切除：一种新型3d打印椎体假体从颅底到胸椎重建的手术计划和设计的技术说明。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124691

Jian Jiao, Ting Wang, Haiyi Gong, Bo Li, Juelan Ye, Jianru Xiao

Background

Gross total resection (GTR) is a cornerstone in the treatment of various primary spinal tumors, including chordoma. However, achieving GTR for multisegment cervical tumors presents significant technical challenges due to the complex surrounding anatomy and the absence of standardized methodologies for anterior spinal column reconstruction.

Methods

We describe the technical nuances of GTR and reconstruction for an 8-level (C1-T1) spinal chordoma in a 55-year-old female. The procedure was performed in 2 stages: a posterior approach for lamina and posterior element resection and neurovascular dissection, followed by an anterior approach for segmented tumor and vertebrectomy removal. In addition, we present an innovative design for a customized 3D-printed vertebral prosthesis aimed at facilitating multilevel cervical reconstruction. Perioperative complications, including respiratory muscle dysfunction, pulmonary infection, and cerebrospinal fluid leakage, were effectively addressed through a multidisciplinary approach.

Results

GTR was successfully achieved through a two-stage surgical procedure, which involved the reconstruction of the C1–T1 spine utilizing a posterior screw-rod system in conjunction with an anterior 3D-printed prosthesis between skull base and thoracic vertebra. By 3 months after surgery, neurological function was largely restored. During a 36-month follow-up period, there was no evidence of tumor recurrence or implant failure.

Conclusions

This case of a recurrent C1-T1 chordoma illustrates that GTR for extensive, multisegment cervical tumors is achievable through meticulous surgical planning. 3D-printed prostheses provide an effective approach for anterior cervical reconstruction after multi-segment resection. Multidisciplinary perioperative care remains essential for managing such complex multisegment resections.

背景：大体全切除（GTR）是治疗包括脊索瘤在内的各种原发性脊柱肿瘤的基础。然而，由于复杂的周围解剖结构和缺乏标准化的前脊柱重建方法，实现多节段颈椎肿瘤的GTR存在重大的技术挑战。方法：我们描述了55岁女性8节段（C1-T1）脊索瘤的GTR和重建技术的细微差别。手术分两个阶段进行：椎板和后椎体切除术和神经血管剥离的后路入路，接着是节段性肿瘤和椎体切除术的前路入路。此外，我们提出了一种创新的定制3d打印椎体假体设计，旨在促进多层次颈椎重建。围手术期并发症，包括呼吸肌功能障碍、肺部感染和脑脊液漏，通过多学科方法得到有效解决。结果：GTR通过两个阶段的外科手术成功实现，其中包括利用后路螺钉杆系统和前路3d打印假体在颅底和胸椎之间重建C1-T1脊柱。术后3个月，患者神经功能基本恢复。在36个月的随访期间，没有肿瘤复发或植入物失败的证据。结论：本例复发性C1-T1脊索瘤表明，通过精心的手术计划，可以实现广泛的多节段宫颈肿瘤的GTR。3d打印假体为颈椎前路多节段切除后重建提供了有效途径。多学科围手术期护理仍然是必要的管理这种复杂的多节段切除。

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