World neurosurgery最新文献_第7页

Implementation of Enhanced Recovery After Surgery in Neurosurgical Standardized Residency Training: Outcomes of Clinical Competency in a Pilot Study 在神经外科标准化住院医师培训中加强术后恢复（ERAS）的实施：一项试点研究的临床能力结果。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124686

Yuan Wang, Shaochun Guo, Jinghui Liu, Na Wang, Liang Wang, Peigang Ji

Background

Incorporating Enhanced Recovery After Surgery (ERAS) principles into clinical education offers a new direction for medical training reform. Especially in neurosurgery, the ERAS-based Standardized Residency Training (SRT) program is uncharted. This pilot study sought to design, implement, and evaluate an ERAS-based SRT program in neurosurgery.

Methods

This retrospective study analyzed 75 neurosurgery SRT trainees (ERAS group: n = 40; control: n = 35) at a tertiary center. The ERAS group received an ERAS protocol pathway utilizing small group discussions, case-based learning, protocol application, and mobile feedback. Controls received traditional training (lectures, demonstrations). Core competencies were assessed via a six-dimensional framework by supervising physicians; post-training exams evaluated knowledge and reasoning.

Results

The demographics and baseline characteristics were similar between groups. Overall post-training exam scores were not significantly different (ERAS: 82 ± 7 vs. control: 79 ± 8, P > 0.05). However, the ERAS group excelled in case analysis (21.4 ± 2.9 vs. 19.9 ± 3.2, P = 0.04) and had more “Excellent” ratings (>85 points) (30% vs. 14.3%). They also outperformed in professional quality (P = 0.013), expertise capacity (P = 0.002), patient management (P = 0.022), and communication (P < 0.001), with communication consistently superior. No significant differences were noted in teaching ability (P = 0.616) or learning and improvement (P = 0.08).

Conclusions

This pilot study indicated that an ERAS-based SRT program in neurosurgery effectively matches traditional training in knowledge acquisition while significantly improving residents' clinical skills, especially in communication, patient management, professionalism, and expertise. Integrating the ERAS principles into SRT successfully links theory with practice, offering a solid foundation for competency-based residency education.

背景：将手术后增强恢复（ERAS）原则纳入临床教育为医学培训改革提供了新的方向。特别是在神经外科，基于erass的标准化住院医师培训（SRT）项目是未知的。本初步研究旨在设计、实施和评估神经外科中基于erass的SRT计划。方法：回顾性分析某三级中心75名神经外科SRT学员（ERAS组40例，对照组35例）。ERAS小组通过小组讨论、基于案例的学习、协议应用和移动反馈获得ERAS协议路径。控制组接受传统培训（讲座、演示）。指导医师通过六维框架评估核心竞争力；培训后考试评估知识和推理能力。结果：两组患者的人口统计学特征和基线特征相似。两组训练后考试总分无显著差异（ERAS: 82±7 vs.对照组：79±8，p < 0.05）。然而，ERAS组在病例分析方面表现出色（21.4±2.9比19.9±3.2,p=0.04），并且具有更多的“优秀”评分（bb0 85分）（30%比14.3%）。他们在专业素质（p=0.013）、专业能力（p=0.002）、患者管理（p=0.022）和沟通(p)方面也表现出色。结论：本初步研究表明，基于erass的神经外科SRT项目有效地匹配了传统的知识获取培训，同时显著提高了住院医生的临床技能，特别是在沟通、患者管理、专业精神和专业知识方面。将ERAS的原则融入SRT，成功地将理论与实践联系起来，为胜任型住院医师教育提供了坚实的基础。

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引用次数: 0

L-Shaped Zygotomy: A Safe and Versatile Modification of the Zygomatic Approach with Quantitative and Cosmetic Advantages in Skull Base Surgery l型颧骨切开术：一种安全、通用的改良颧骨入路，在颅底手术中具有定量和美容优势。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124701

Fukutaro Ohgaki , Hidetoshi Murata , Masashi Uchida , Mitsuru Sato , Hiroshi Takasuna , Yuichiro Kushiro , Gaku Hidaka , Jun Suenaga , Kensuke Tateishi , Katsumi Sakata , Tetsuya Yamamoto

Background

The zygomatic approach provides extensive exposure of the anterior and middle skull base but carries risks of facial nerve injury, cosmetic deformity, and unstable arch reconstruction. We developed a modified L-shaped zygotomy designed to improve safety, reduce flap retraction, and ensure stable cosmetic and reconstructive outcomes, while allowing seamless transition to an orbitozygomatic craniotomy when required.

Methods

Thirty-five patients who underwent L-shaped zygotomy between August 2017 and February 2025 were retrospectively reviewed. The extent of resection, perioperative complications, and cosmetic outcomes were evaluated. Cosmetic assessment included objective ratings by 2 independent neurosurgeons and patient self-assessments using a 5-point Likert scale. Quantitative validation was also performed in one cadaveric head preserved with the saturated salt solution method and 4 3D-printed skull models to compare the L-shaped and conventional zygotomy techniques.

Results

Gross total resection was achieved in 25 patients (71%). No new permanent facial palsy, mastication disturbances, or wound complications occurred. At a mean follow-up of 46 ± 14 months, cosmetic outcomes were excellent (Likert scores: surgeons 4.4 ± 0.5, patients 4.7 ± 0.5). In cadaveric analysis, the L-shaped technique required 11 mm less skin flap retraction and, in 3D models, expanded the anterior surgical corridor by 3.9–4.2 mm compared with conventional zygotomy.

Conclusions

The L-shaped zygotomy is a safe and versatile modification of the zygomatic approach. It provides reproducible quantitative advantages in exposure, minimizes flap retraction, ensures stable cosmetic outcomes validated by long-term follow-up, and allows seamless transition to orbitozygomatic when broader exposure is necessary.

背景：颧骨入路广泛暴露前、中颅底，但有面神经损伤、外观畸形和弓重建不稳定的风险。我们开发了一种改良的l型颧骨切开术，旨在提高安全性，减少皮瓣缩回，并确保稳定的美容和重建结果，同时在需要时允许无缝过渡到眶颧（OZ）开颅术。方法：回顾性分析2017年8月至2025年2月间行l型颧切开术的35例患者。评估切除程度、围手术期并发症和美容结果。美容评估包括两名独立神经外科医生的客观评分和患者使用5分李克特量表的自我评估。在饱和盐溶液法保存的一个尸体头部和四个3d打印颅骨模型上进行了定量验证，比较了l形和传统的颧骨切开术。结果：25例患者（71%）全部切除。无新的永久性面瘫、咀嚼障碍或伤口并发症发生。平均随访46±14个月，美容效果非常好（Likert评分：外科医生4.4±0.5，患者4.7±0.5）。在尸体分析中，l型技术需要的皮瓣缩回少11毫米，在3D模型中，与传统的颧切开术相比，前路手术通道扩大了3.9-4.2毫米。结论：l型颧骨切开术是一种安全、通用的改良颧骨入路。它在暴露方面提供了可重复的定量优势，最大限度地减少皮瓣缩回，确保长期随访验证的稳定美容结果，并允许在需要更广泛暴露时无缝过渡到OZ。

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引用次数: 0

Complete Spontaneous Resolution of Lumbar Synovial Cyst: A Case Report and Systematic Literature Review 腰椎滑膜囊肿完全自然消退：1例报告及系统文献复习。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124712

Jakub Litak , Piotr Kamieniak , Michał Szymoniuk , Tomasz Mandat , Grzegorz Staśkiewicz , Justyna Zielińska-Turek , Kamil Torres , Wojciech Czyżewski

Background

Since the natural course of lumbar synovial cyst (LSC) remains unclear, the optimal management of symptomatic LSC constitutes a controversial topic. While surgical removal is considered as the most efficient treatment method, cases of spontaneous resolution have also been reported. The purpose of the current paper was to discuss the pathophysiology and clinical features of the spontaneous resolution of LSC based on the current evidence and present an illustrative case report.

Methods

The literature search was performed across MEDLINE, Web of Science, and Scopus databases on 11th November 2024. Articles were only included if they described cases of spontaneous resolution of LSC without surgery. Descriptive statistics were used for the analysis of the data retrieved from eligible articles.

Results

Twelve articles and the current report matched eligibility criteria, reporting 16 cases of spontaneous LSC resolution cumulatively. The mean age of the patients was 55.9 ± 14.0 years. LSCs were most frequently reported in female patients (68.8%), at L4-L5 level (68.8%), and on the right side of the spinal canal (56.2%). The mean time between the symptomatic onset of LSCs and its spontaneous complete resolution was 10.7 ± 6.8 months.

Conclusions

The current study supports a conservative management approach in selected patients with lumbar synovial cysts, highlighting the importance of follow-up before surgery is undertaken. Female gender and mild presenting symptoms might be factors predisposing to spontaneous resolution of LSC.

背景：由于腰椎滑膜囊肿（LSC）的自然病程尚不清楚，有症状的LSC的最佳治疗构成了一个有争议的话题。虽然手术切除被认为是最有效的治疗方法，但也有自发消退的病例报道。本文的目的是在现有证据的基础上讨论LSC自发消退的病理生理学和临床特征，并提出一个说明性的病例报告。方法：于2024年11月11日在MEDLINE、Web of Science和Scopus数据库中检索相关文献。文章只有在描述LSC自发消退而无需手术的情况下才被纳入。描述性统计用于分析从符合条件的文章中检索到的数据。结果：12篇文章和本报告符合入选标准，累计报道了16例LSC自发消退。患者平均年龄55.9±14.0岁。LSCs最常见于女性患者（68.8%）、L4-L5水平（68.8%）和椎管右侧（56.2%）。LSCs出现症状到自发完全消退的平均时间为10.7±6.8个月。结论：目前的研究支持对选定的腰椎滑膜囊肿患者采用保守治疗方法，强调了术前随访的重要性。女性和轻微的症状可能是诱发LSC自发消退的因素。

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引用次数: 0

Comparison of the Converging Decompression Technique and Foraminoplasty Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Very Highly Upward Migrated Lumbar Disc Herniation 会聚减压技术与椎间孔成形术治疗高度上移的腰椎间盘突出症的比较。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124718

Jianing Yang , Rongbo Yu , Yuyang Zheng , Pengfei Wang , Haitian Zhang , Bin Chen

Background

This study aims to describe converging decompression technique (CDT) procedure in detail and assess its clinical efficacy in comparison with foraminoplasty percutaneous transforaminal endoscopic discectomy (PTED) for the management of very highly up-migrated lumbar disc herniation (VHUM-LDH).

Methods

A retrospective study was performed on 66 patients diagnosed with VHUM-LDH who underwent surgery between January 2020 and January 2024. Of these, 27 patients were treated with CDT (CDT group), and 39 with foraminoplasty PTED (PTED group). Clinical parameters, including Oswestry Disability Index, visual analog scale scores for back and leg pain, and modified MacNab criteria were analyzed.

Results

Both groups demonstrated significant postoperative improvements in leg and back pain visual analog scale scores and Oswestry Disability Index scores. No significant differences were observed between the groups at any follow-up time point (P > 0.05). The PTED group required fewer fluoroscopic exposure times (10.82 ± 2.47 vs. 18.74 ± 3.66, P < 0.05) compared to the CDT group. However, the CDT group had a shorter endoscopic procedure duration (46.96 ± 4.17 vs. 59.77 ± 8.31 min, P < 0.05). There were no significant differences between the groups regarding complication rates or good-to-excellent outcomes as per the modified MacNab criteria (P > 0.05).

Conclusions

Both CDT and foraminoplasty PTED are safe and effective treatments for VHUM-LDH. However, CDT offers enhanced endoscopic efficiency and a reduced risk of postoperative nucleus pulposus remnants. Further prospective studies with larger cohorts and extended follow-up are required to fully assess the advantages and limitations of both techniques.

背景：本研究旨在详细描述会聚减压技术（CDT）手术，并比较其与椎间孔成形术(经皮经椎间孔内窥镜椎间盘切除术（PTED）治疗高度上移的腰椎间盘突出症（vhuml - ldh）的临床疗效。方法：对2020年1月至2024年1月期间接受手术诊断为VHUM-LDH的66例患者进行回顾性研究。其中，27例患者接受CDT治疗（CDT组），39例接受椎间孔成形术PTED治疗（PTED组）。分析临床参数，包括Oswestry残疾指数（ODI）、背部和腿部疼痛的视觉模拟量表（VAS）评分和修改的MacNab标准。结果：两组术后下肢和背部疼痛VAS评分和ODI评分均有显著改善。各组间随访各时间点差异无统计学意义（P < 0.05）。与CDT组相比，PTED组需要更少的透视暴露时间（10.82±2.47 vs. 18.74±3.66,P < 0.05）。而CDT组手术时间较短（46.96±4.17 min vs. 59.77±8.31 min, P < 0.05）。根据改良的MacNab标准，两组间并发症发生率和优良率无显著差异（P < 0.05）。结论：CDT和椎间孔成形术是治疗vham - ldh安全有效的方法。然而，CDT提供了更高的内镜效率和降低术后髓核残留的风险。进一步的前瞻性研究需要更大的队列和更长时间的随访，以充分评估这两种技术的优点和局限性。

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引用次数: 0

Clipping Posteriorly Directed Posterior Communicating Artery Aneurysms Using the Anterior Temporal Approach 颞前入路夹持后向性后交通动脉瘤。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124749

Tong-Fei Zeng , Guang-Sheng Zhu , Bin Chen , Xiao-Ling Jiang , Shen-Yu Li , He-Feng Huang , Jie Liu

Objective

To investigate the advantages and essential technical aspects of the anterior temporal approach (ATA) in clipping the posteriorly directed posterior communicating artery (PCOM) aneurysms.

Methods

Anatomical dissections using the ATA were performed on 2 cadaveric heads (4 sides) to expose PCOM aneurysms. A total of 9 patients with PCOM aneurysms who underwent clipping using the ATA between January 2024 and June 2025 were retrospectively summarized and analyzed. This included 7 cases with posteromedial inferior-directed, one with posterolateral inferior-directed, and one with posterolateral superior-directed PCOM aneurysms.

Results

The ATA provides significant advantages in exposing posteriorly directed PCOM aneurysms compared to the pterional trans-Sylvian, lateral supraorbital, and subtemporal approaches. Moreover, it allows a “Looking in” and “Looking up” exposure and operative view. In all 9 patients included in this study, the anatomical relationships among the internal carotid artery, PCOM, and the aneurysm were clearly demonstrated during clipping using the ATA. All patients recovered well postoperatively without any new neurological deficits.

Conclusions

The ATA effectively exposes and clips posteriorly directed PCOM aneurysms compared with other conventional approaches. It is a safe and reproducible surgical technique worth promoting and disseminating.

目的：探讨颞前入路（ATA）夹持后向后交通动脉（PCOM）动脉瘤的优势及技术要点。方法：对2具尸体头部（4侧）行ATA解剖，显露PCOM动脉瘤。回顾性总结分析了2024年1月至2025年6月期间9例经ATA夹闭的PCOM动脉瘤患者。其中7例为后内侧下向动脉瘤，1例为后外侧下向动脉瘤，1例为后外侧上向PCOM动脉瘤。结果：与翼点经外侧、外侧眶上和颞下入路相比，ATA在暴露后向PCOM动脉瘤方面具有显著优势。此外，它允许“向内看”和“向上看”的暴露和操作视图。在本研究的所有9例患者中，在使用ATA夹持时清楚地显示了颈内动脉、PCOM和动脉瘤之间的解剖关系。所有患者术后恢复良好，无新的神经功能缺损。结论：与其他常规入路相比，ATA能有效地暴露和夹住后向PCOM动脉瘤。它是一种安全、可复制的手术技术，值得推广和推广。

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引用次数: 0

Risk Factors for Residual Back Pain After Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Retrospective Analysis 经皮内窥镜腰椎间盘切除术治疗腰椎间盘突出症后残留腰痛的危险因素：回顾性分析。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124694

Zhengao Huang , Hao Chen , Yi Ding , Liulong Zhu , Xuepeng Wang

Objective

To investigate the incidence and risk factors for residual back pain in lumbar disc herniation (LDH) patients after percutaneous endoscopic lumbar discectomy (PELD).`

Methods

We retrospectively analyzed prospectively collected data from consecutive patients with LDH who underwent PELD from May 2021 to September 2022. Back pain intensity was assessed using a visual analog scale after surgery. Residual back pain was defined as persistent moderate-to-severe pain (average visual analog scale score≥ 4) at 1 day and 1 month postoperatively, and the variables comprised the patients' characteristics, radiological parameters, surgical factors, and postoperative factors. Univariate and multivariate logistic regression analyses were performed to identify risk factors.

Results

A total of 563 patients were included, and residual back pain was identified in 129 (22.9%). Multivariate analysis identified the following independent risk factors: Modic change (odds ratio (OR) = 1.895; P < 0.001), cartilage endplate injury (OR = 2.587; P = 0.019), unsuitable posterior longitudinal ligament incision (OR = 3.205; P = 0.001), prolonged bracing (OR = 2.044; P = 0.016), and depression (OR = 2.785; P = 0.016).

Conclusions

In patients with LDH, Modic change, cartilage endplate injury, unsuitable posterior longitudinal ligament incision, prolonged orthosis use, and depression were identified as independent risk factors for residual back pain after PELD. These factors can inform clinical decision-making for surgeons.

目的：探讨经皮内镜下腰椎间盘切除术（PELD）后腰椎间盘突出症（LDH）患者残留腰痛的发生率及危险因素。方法：我们回顾性分析了从2021年5月至2022年9月连续接受PELD治疗的腰椎间盘突出症患者的前瞻性数据。术后采用视觉模拟量表（VAS）评估背部疼痛强度。残余背痛定义为术后1天和1个月持续的中至重度疼痛（VAS平均评分≥4），变量包括患者特征、影像学参数、手术因素和术后因素。进行单因素和多因素logistic回归分析以确定危险因素。结果：共纳入563例患者，其中129例（22.9%）存在残留腰痛。多因素分析确定了以下独立危险因素：MC(优势比(OR)=1.895；结论：在LDH患者中，MC、软骨终板损伤、PLL切口不合适、矫形器使用时间过长、凹陷是PELD术后残留腰痛的独立危险因素。这些因素可以为外科医生的临床决策提供信息。

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引用次数: 0

X-Factor: Antithrombotic Coating Reduces Procedural Thromboembolic Events in Flow Redirection Endoluminal Device (FRED) Aneurysm Embolization x因素：抗血栓涂层减少血流重定向腔内装置（FRED）动脉瘤栓塞的程序性血栓栓塞事件。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124723

M. Harrison Snyder, Alper Dincer, Anthony J. Yu, Shane M. Burke, Taylor Ferraro, Adel M. Malek

Background

The Flow Redirection Endoluminal Device (FRED) is a dual-layer flow diverting stent with a dense inner mesh and outer braided support providing superior deployment control. Covalently bonded Poly(2-methoxyethyl acrylate) X coating was introduced to decrease metal-induced thrombogenicity in the newer FRED X variant. The objective of the current study is to evaluate procedural thromboembolic events associated with both variants.

Methods

A single-center retrospective analysis was undertaken comparing angiographically detected intraprocedural thromboembolic events, postprocedural magnetic resonance diffusion weighted imaging lesions (MR-DWI+), as well as a composite combined endpoint. Periprocedural (<24 hours) clinical events, demographics, aneurysm characteristics and platelet aggregation (using P2Y12 reactivity unit, PRU) were analyzed.

Results

Treatment was performed with 19 FRED procedures in 18 patients with 19 aneurysms, and with 37 FRED X procedures in 35 patients harboring 40 aneurysms. Both groups achieved therapeutic preprocedural platelet inhibition by PRU testing. Intraprocedural thromboembolic events including intraluminal filling defects and side-branch slowing or loss occurred in 7/19 (36.8%) FRED and 0/37 FRED X procedures (P = 0.0002), with all being successfully recanalized using intra-arterial platelet inhibitors, without symptomatic ischemic or hemorrhagic events. The composite endpoint was reached in 11/19 (57.9%) FRED and 5/37 (13.5%) FRED X cases (P = 0.001), with multivariable analysis identifying device type (P = 0.015) among age, gender, and PRU.

Conclusions

The surface modification of the FRED X device may be associated with improved thrombogenic risk profile in our cohort, with elimination of intraprocedural thrombus formation and reduction of composite thromboembolic events.

背景：血流重定向腔内装置（FRED）是一种双层血流转移支架，具有致密的内部网格和外部编织支撑，提供优越的部署控制。共价键合聚（2-甲氧基乙基丙烯酸酯）X涂层被引入到新的FRED X变体中，以降低金属诱导的血栓形成性。当前研究的目的是评估与这两种变异相关的程序性血栓栓塞事件。方法：进行单中心回顾性分析，比较术中血管造影检测到的血栓栓塞事件、术后磁共振弥散加权成像病变（MR-DWI+）以及复合联合终点。围手术期结果：18例19个动脉瘤患者行19次FRED手术，35例40个动脉瘤患者行37次FRED X手术。两组均通过PRU检测达到治疗性手术前血小板抑制。术中血栓栓塞事件包括7/19 (36.8%)FRED和0/37 FRED X手术的腔内充盈缺损和侧分支减慢或丢失（p= 0.0002），所有患者均通过动脉内血小板抑制剂成功再通，无症状性缺血或出血事件。11/19（57.9%）例FRED和5/37（13.5%）例FRED X达到了复合终点（p=0.001），多变量分析确定了年龄、性别和PRU之间的器械类型（p=0.015）。结论：在我们的队列中，FRED X装置的表面修饰可能与改善血栓形成风险相关，可以消除术中血栓形成和减少复合血栓栓塞事件。

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引用次数: 0

The Shifting Landscape of Traumatic Brain Injury After COVID-19: Prelockdown, Lockdown, and Postlockdown Trends: Data from a Referral Center in Colombia 2019冠状病毒病大流行期间创伤性脑损伤的变化：哥伦比亚一家转诊中心封锁前、期间和之后的趋势

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124667

Sara Gomez-Niebles , Valentina Osejo-Arcos , David Vergara-Garcia , María Paula Aguilera-Pena , Milciades Ibanez-Pinilla , Rafael Aponte-Caballero , Juan Felipe Abaunza-Camacho , Luis Carlos Avellaneda-Curcho , Lorena García-Agudelo , Cristhian Barrera-Guzmán , Nestor R. Gonzalez , William Mauricio Riveros-Castillo , Javier M. Saavedra

Background

The coronavirus disease 2019 pandemic required widespread lockdowns, which have been shown to influence the incidence and characteristics of traumatic brain injury (TBI) worldwide. However, the specific influence of the pandemic on TBI epidemiology in Latin America, particularly Colombia, remains largely unexplored.

Methods

This cross-sectional study included patients with TBI who were admitted to the Hospital Regional de la Orinoquía, a referral center in Colombia, from 2017 to 2021. The patients were categorized into 3 cohorts: prelockdown (PrL), lockdown (L), and postlockdown (PoL). Multivariate statistical analysis was used to compare differences among cohorts.

Results

A total of 4303 patients were included, including 2,795, 495, and 1013 in the PrL, L, and PoL cohorts, respectively. Patients in the L exhibited significantly lower Glasgow Coma Scale scores at admission than those in the other 2 cohorts. Additionally, the incidence of extracranial trauma was higher in the PoL, reaching levels similar to or even superior to those in the PrL.

Conclusions

TBI characteristics changed not only during the L but also in its aftermath, as PoL patients exhibited distinct features from those in the PrL.

背景：2019冠状病毒病（COVID-19）大流行需要大范围的封锁，这已被证明会影响全球创伤性脑损伤（TBI）的发病率和特征。然而，该流行病对拉丁美洲，特别是哥伦比亚的脑外伤流行病学的具体影响在很大程度上仍未得到探索。方法：本横断面研究纳入了2017年至2021年在哥伦比亚转诊中心Hospital Regional de la Orinoquía就诊的TBI患者。患者被分为三组：封锁前、封锁后和封锁后。采用多变量统计分析比较队列间差异。结果：共纳入4303例患者，其中封城前、封城后和封城前分别为2795例、495例和1013例。封锁队列患者入院时的格拉斯哥昏迷评分明显低于其他两个队列患者。此外，在封锁后的队列中，颅外创伤的发生率更高，达到与封锁前队列相似甚至更高的水平。结论：TBI特征不仅在封锁期间发生了变化，而且在封锁之后也发生了变化，因为封锁后的患者表现出与封锁前的患者截然不同的特征。

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引用次数: 0

Clinical Efficacy and Safety of a Treatment Strategy for Acute Carotid Tandem Lesions: Balloon Bridge-Blind Aspiration 急性颈动脉串联病变：球囊桥-盲吸治疗策略的临床疗效和安全性。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124669

Wenjun Jing , Yafei Zhou , Chaolai Liu , Peng Wang , Lei Zhang , Jianfeng Chu , Zhe Lu , Zhipeng Guo , Yanhong Wang , Yusen Cai , Xianda Zhang , Huakun Liu

Objective

For acute carotid tandem lesions (TLs), the optimal endovascular therapy strategy is still debatable. This study reports a single-center experience treating acute carotid TLs using the Balloon Bridge-Blind Aspiration (BBBA) treatment strategy. We assessed the efficacy and safety of the BBBA treatment strategy.

Methods

We conducted a retrospective analysis of patients admitted to the Department of Neurology at Jining First People's Hospital from January 2019 to December 2024. These patients were all treated with the BBBA treatment strategy for acute carotid TLs. Clinical data and imaging data were analyzed retrospectively. Efficacy was assessed by the rate of successful recanalization (modified Thrombolysis in Cerebral Infarction = 2 b/3) and the 90-day favorable outcome (modified Rankin Scale score of 0–2). Safety was evaluated by the occurrence of symptomatic intracranial hemorrhage and mortality at 90 days.

Results

The study included 83 patients with acute carotid TLs. Their median age was 67 years (interquartile range [IQR], 60–72 years), and the median National Institutes of Health Stroke Scale score at admission was 16 (IQR, 12–18). The median time from symptom onset to groin puncture was 270 minutes (IQR, 200–330 minutes). The median time from groin puncture to first recanalization was 50 minutes (IQR, 40–70 minutes), and the median operative time was 70 minutes (IQR, 60–90 minutes). Among the patients, 25.3% required the rescue technique, and 21.7% underwent acute stenting. Successful recanalization was achieved in 75 patients (90.4%). The rate of a favorable clinical outcome was 60.2%, the rate of symptomatic intracranial hemorrhage was 8.4%, and the mortality was 9.6%.

Conclusions

The BBBA treatment strategy may be a safe and effective treatment strategy for acute carotid TLs, improving patient outcomes and reducing the usage rate of acute stents.

目的：对于急性颈动脉串联病变（TLs），最佳血管内治疗（EVT）策略仍有争议。本研究报告了使用球囊桥盲抽吸（BBBA）治疗急性颈动脉TLs的单中心经验。我们评估了BBBA治疗策略的有效性和安全性。方法：对济宁市第一人民医院神经内科2019年1月至2024年12月收治的患者进行回顾性分析。这些患者均采用BBBA治疗急性颈动脉TLs。回顾性分析临床资料及影像学资料。通过再通成功率（mTICI = 2b/3）和90天的有利转归（mRS评分0-2）来评估疗效。通过90天症状性颅内出血（siich）的发生和死亡率来评估安全性。结果：本研究纳入83例急性颈动脉TLs患者。他们的年龄中位数为67岁（IQR， 60-72岁），入院时美国国立卫生研究院卒中量表（NIHSS）得分中位数为16分（IQR, 12-18）。从症状出现到腹股沟穿刺的中位时间为270分钟（IQR， 200-330分钟）。从腹股沟穿刺到第一次再通的中位时间为50分钟（IQR， 40-70分钟），中位手术时间为70分钟（IQR， 60-90分钟）。25.3%的患者需要抢救技术，21.7%的患者进行了急性支架置入。75例（90.4%）患者成功再通。临床转归优良率为60.2%，sICH发生率为8.4%，死亡率为9.6%。结论：BBBA治疗急性颈动脉TLs是一种安全有效的治疗策略，可改善患者预后，降低急性支架使用率。

{"title":"Clinical Efficacy and Safety of a Treatment Strategy for Acute Carotid Tandem Lesions: Balloon Bridge-Blind Aspiration","authors":"Wenjun Jing , Yafei Zhou , Chaolai Liu , Peng Wang , Lei Zhang , Jianfeng Chu , Zhe Lu , Zhipeng Guo , Yanhong Wang , Yusen Cai , Xianda Zhang , Huakun Liu","doi":"10.1016/j.wneu.2025.124669","DOIUrl":"10.1016/j.wneu.2025.124669","url":null,"abstract":"<div><h3>Objective</h3><div>For acute carotid tandem lesions (TLs), the optimal endovascular therapy strategy is still debatable. This study reports a single-center experience treating acute carotid TLs using the Balloon Bridge-Blind Aspiration (BBBA) treatment strategy. We assessed the efficacy and safety of the BBBA treatment strategy.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of patients admitted to the Department of Neurology at Jining First People's Hospital from January 2019 to December 2024. These patients were all treated with the BBBA treatment strategy for acute carotid TLs. Clinical data and imaging data were analyzed retrospectively. Efficacy was assessed by the rate of successful recanalization (modified Thrombolysis in Cerebral Infarction=2 b/3) and the 90-day favorable outcome (modified Rankin Scale score of 0–2). Safety was evaluated by the occurrence of symptomatic intracranial hemorrhage and mortality at 90 days.</div></div><div><h3>Results</h3><div>The study included 83 patients with acute carotid TLs. Their median age was 67 years (interquartile range [IQR], 60–72 years), and the median National Institutes of Health Stroke Scale score at admission was 16 (IQR, 12–18). The median time from symptom onset to groin puncture was 270 minutes (IQR, 200–330 minutes). The median time from groin puncture to first recanalization was 50 minutes (IQR, 40–70 minutes), and the median operative time was 70 minutes (IQR, 60–90 minutes). Among the patients, 25.3% required the rescue technique, and 21.7% underwent acute stenting. Successful recanalization was achieved in 75 patients (90.4%). The rate of a favorable clinical outcome was 60.2%, the rate of symptomatic intracranial hemorrhage was 8.4%, and the mortality was 9.6%.</div></div><div><h3>Conclusions</h3><div>The BBBA treatment strategy may be a safe and effective treatment strategy for acute carotid TLs, improving patient outcomes and reducing the usage rate of acute stents.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124669"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640553","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

Hidden Blood Loss and its Risk Factors in the Treatment of Osteoporotic Vertebral Compression Fractures Using Percutaneous Vertebroplasty: A Multicenter Retrospective Study 经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的隐性失血及其危险因素：一项多中心回顾性研究

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2026-01-01 DOI: 10.1016/j.wneu.2025.124705

Jiancuo A , Shihao Zhou , Junhua tian , Yamin Li , junhao Sun , Luming Xie , Tianluo Guo , Peiran Hu , hengji Li , Guilan Gou

Objective

Percutaneous vertebroplasty (PVP) is widely employed as a minimally invasive procedure for osteoporotic vertebral compression fractures. However, significant perioperative hidden blood loss (HBL) is frequently underestimated. This study aimed to quantify HBL during PVP and to determine its associated risk factors.

Methods

This multicenter retrospective study enrolled patients who underwent PVP at 2 hospitals from January 2020 to March 2024, and a total of 209 patients satisfied the inclusion criteria. Demographic characteristics, operative variables, and blood-loss parameters were collected, and HBL was calculated with the Nadler and Gross equations. Pearson or Spearman correlation analysis was conducted to evaluate associations between patient characteristics and HBL, and multiple linear regression analysis was subsequently applied to identify independent risk factors for HBL. To minimize collinearity in the regression model, principal component analysis was performed to combine 4 variables—number of fractured segments, vertebral height loss, height restoration, and operative time—into a single surgical complexity index, and the factor scores derived from this index were incorporated into the final regression model.

Results

The study cohort included 209 patients (40 males and 169 females). Single-segment vertebral fractures occurred in 65.07% of patients. The average operative duration was 33 ± 13 minutes. No intrathecal cement leakage was observed in any patient. The mean HBL volume was 270 ± 93 mL. Multiple linear regression analysis indicated that the surgical complexity index, defined by the number of fractured segments, vertebral height restoration, operative time, and vertebral height loss, was independently associated with HBL (P < 0.05).

Conclusions

HBL remains a significant perioperative concern during PVP for osteoporotic vertebral compression fracture and should not be overlooked, particularly in patients with compromised physical status or multiple vertebral fractures. Recognizing the risk factors for HBL is critical for orthopedic surgeons to optimize perioperative strategies and minimize its impact on patient outcomes.

目的：经皮椎体成形术（PVP）被广泛应用于骨质疏松性椎体压缩性骨折（OVCFs）的微创手术。然而，围手术期显著的隐性失血量（HBL）经常被低估。本研究旨在量化PVP期间的HBL并确定其相关危险因素。方法：本多中心回顾性研究纳入了2020年1月至2024年3月在两家医院行经皮椎体成形术（PVP）的患者，共209例患者符合纳入标准。收集统计学特征、手术变量、失血量参数，采用Nadler和Gross方程计算隐性失血量（HBL）。采用Pearson或Spearman相关分析评价患者特征与HBL之间的相关性，随后采用多元线性回归分析确定HBL的独立危险因素。为了减少回归模型中的共线性，采用主成分分析（PCA）将四个变量（骨折节段数、椎体高度损失、高度恢复和手术时间）合并为一个单一的手术复杂性指数，并将该指数得出的因子得分纳入最终的回归模型。结果：研究队列包括209例患者（男性40例，女性169例）。65.07%的患者发生单节段椎体骨折。平均手术时间33±13分钟。所有患者未见鞘内水泥渗漏。平均HBL体积为270±93 mL。多元线性回归分析显示，以骨折节段数、椎体高度恢复、手术时间、椎体高度损失为指标的手术复杂性指数与HBL独立相关（P < 0.05）。结论：HBL仍然是OVCF PVP围手术期的一个重要问题，不应忽视，特别是在身体状况不佳或多发椎体骨折的患者中。认识HBL的危险因素对于骨科医生优化围手术期策略和最大限度地减少其对患者预后的影响至关重要。

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引用次数: 0