Pub Date : 2026-01-01DOI: 10.1016/j.wneu.2025.124715
Aliasghar Karimi, Saba Moalemi, Pegah Pedramfard, Amirahmad Moalemi
The integration of robotics and virtual reality (VR) in brain tumor surgery represents a transformative advancement in neurosurgery, offering enormous potential in enhancing precision, control, and visualization. This narrative review explores the current state of these cutting-edge technologies, their clinical applications, burdens, and future directions. We reviewed the studies evaluating the efficacy of integrating robotics and VR in neurosurgery. Robotic systems, such as da Vinci, ROSA, and NeuroMate, improve dexterity in complex tumor resections, while VR platforms like Surgical Theater and NeuroVR aid in three-dimensional visualization for preoperative planning and intraoperative guidance. Together, they reduce surgical risks and improve patient outcomes. However, challenges like high costs, lack of haptic feedback, and steep learning curves limit widespread use. Continued research and innovation are essential to overcome current limitations and ensure that these technologies can fully realize their potential to transform neurosurgical practice and set a new standard of care in neurosurgery.
{"title":"Merging Robotics and Virtual Reality for Brain Tumor Surgery: A New Frontier in Surgical Innovation","authors":"Aliasghar Karimi, Saba Moalemi, Pegah Pedramfard, Amirahmad Moalemi","doi":"10.1016/j.wneu.2025.124715","DOIUrl":"10.1016/j.wneu.2025.124715","url":null,"abstract":"<div><div>The integration of robotics and virtual reality (VR) in brain tumor surgery represents a transformative advancement in neurosurgery, offering enormous potential in enhancing precision, control, and visualization. This narrative review explores the current state of these cutting-edge technologies, their clinical applications, burdens, and future directions. We reviewed the studies evaluating the efficacy of integrating robotics and VR in neurosurgery. Robotic systems, such as da Vinci, ROSA, and NeuroMate, improve dexterity in complex tumor resections, while VR platforms like Surgical Theater and NeuroVR aid in three-dimensional visualization for preoperative planning and intraoperative guidance. Together, they reduce surgical risks and improve patient outcomes. However, challenges like high costs, lack of haptic feedback, and steep learning curves limit widespread use. Continued research and innovation are essential to overcome current limitations and ensure that these technologies can fully realize their potential to transform neurosurgical practice and set a new standard of care in neurosurgery.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124715"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752147","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}
Pub Date : 2026-01-01DOI: 10.1016/j.wneu.2025.124734
Jun Zhong
{"title":"In Reply to the Letter to the Editor Regarding \"The Key to Percutaneous Balloon Compression Success: Pear or Banana?”","authors":"Jun Zhong","doi":"10.1016/j.wneu.2025.124734","DOIUrl":"10.1016/j.wneu.2025.124734","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124734"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145763836","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}
Advances in imaging and artificial intelligence have enabled high-resolution three-dimensional (3D) constructions for neurosurgical simulation. However, accurate reproduction of the dura mater—particularly the tentorium, a thin yet critical structure in skull base surgery—remains challenging, limiting the fidelity of preoperative simulations. We describe a novel method for constructing the dura mater in 3D surgical simulation and demonstrate its utility in planning skull base tumor surgery.
Methods
Magnetic resonance imaging and contrast-enhanced computed tomography were imported into a simulation application (GRID, Kompath, Tokyo). By extracting regions of interest of brain parenchyma and cerebrospinal fluid, smoothing the structures, performing subtraction modeling, and trimming areas corresponding to the brainstem and spinal cord passages, a virtual dura was generated and fused with other anatomical structures.
Results
The technique was applied in a case of petrous apex meningioma. Virtual dura construction facilitated detailed comparison of the anterior transpetrosal and lateral suboccipital approaches. Volume analysis showed that 89.6% of the tumor was infratentorial, supporting selection of the lateral suboccipital approach. Intraoperative findings closely matched the simulation, enabling safe and complete tumor removal.
Conclusions
This novel technique enables reproducible 3D construction of the virtual dura mater, significantly improving the accuracy of skull base surgery simulations. It provides a valuable educational and decision-making tool, particularly for less-experienced neurosurgeons, bridging the gap toward expert-level surgical planning.
{"title":"High-Fidelity Simulation for Skull Base Surgery Enabled by Virtual Dura Mater Construction","authors":"Takumi Saito , Kohei Ishikawa , Kentaro Watanabe , Kenta Kazami , Toshihide Tanaka , Akihiko Teshigawara , Hirokazu Koseki , Yudo Ishii , Yasuharu Akasaki , Yuichi Murayama","doi":"10.1016/j.wneu.2025.124690","DOIUrl":"10.1016/j.wneu.2025.124690","url":null,"abstract":"<div><h3>Objective</h3><div>Advances in imaging and artificial intelligence have enabled high-resolution three-dimensional (3D) constructions for neurosurgical simulation. However, accurate reproduction of the dura mater—particularly the tentorium, a thin yet critical structure in skull base surgery—remains challenging, limiting the fidelity of preoperative simulations. We describe a novel method for constructing the dura mater in 3D surgical simulation and demonstrate its utility in planning skull base tumor surgery.</div></div><div><h3>Methods</h3><div>Magnetic resonance imaging and contrast-enhanced computed tomography were imported into a simulation application (GRID, Kompath, Tokyo). By extracting regions of interest of brain parenchyma and cerebrospinal fluid, smoothing the structures, performing subtraction modeling, and trimming areas corresponding to the brainstem and spinal cord passages, a virtual dura was generated and fused with other anatomical structures.</div></div><div><h3>Results</h3><div>The technique was applied in a case of petrous apex meningioma. Virtual dura construction facilitated detailed comparison of the anterior transpetrosal and lateral suboccipital approaches. Volume analysis showed that 89.6% of the tumor was infratentorial, supporting selection of the lateral suboccipital approach. Intraoperative findings closely matched the simulation, enabling safe and complete tumor removal.</div></div><div><h3>Conclusions</h3><div>This novel technique enables reproducible 3D construction of the virtual dura mater, significantly improving the accuracy of skull base surgery simulations. It provides a valuable educational and decision-making tool, particularly for less-experienced neurosurgeons, bridging the gap toward expert-level surgical planning.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124690"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662285","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}
Pub Date : 2026-01-01DOI: 10.1016/j.wneu.2025.124652
Juan José Valenzuela-Fuenzalida , Javiera Cornejo-Peña , Josefina Martinez-Cid , Cristobal Rojas-Acuña , Guinevere Granite , Juan. A. Sanchis-Gimeno , Alejandro Bruna Mejias , Pablo Nova Baeza , Mathias Orellana Donoso , Gustavo Oyanedel Amaro , Macarena Rodriguez-Luengo , Gkionoul Nteli Chatzioglou , Maria Piagkou , George Triantafyllou , Marko Konchaske
Background context
The arcuate foramen (FA) can present in various forms: it may be complete, incomplete, unilateral, or bilateral. This anatomical feature is relatively common, occurring in approximately 3%–15% of the population, with a higher prevalence in females.
Purpose
The purpose of this study is to provide rigorous scientific evidence detailing the anatomical characteristics of the AF. Furthermore, this work aims to analyze the prevalence and explore its relevance in clinical applications and surgical procedures.
Study desing
Systematic review and meta-analysis.
Methods
Data were compiled from numerous published studies accessed from the databases Medline, Scopus, Web of Science, EMBASE, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and of April 2025. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model, and differences in FA variant rates were assessed.
Results
FA variants were identified, the data were categorized into 3 groups: the first category was the type of sample, divided into cadaver donor samples and imaging findings; the second analysis focused on the geographical region from which the sample originated; and finally, sex and laterality were also considered. Overall, the prevalence of these variations was 16% (CI: 11%–20%), and significant heterogeneity (98.8%) was observed. Significantly higher rates were observed in the following subgroups: imaging studies versus donor data (P = 0.032), right side versus left side (P = 0.034), and bilateral versus unilateral findings (P = 0.019). Among the concerns raised were studies on the risk of iatrogenic damage during surgical procedures. Several studies also indicated a higher frequency of vertebral artery variations in patients with symptoms such as recurrent headaches, vertigo, dizziness, and/or syncope.
Conclusions
This review emphasized the importance of considering the vertebral artery (VA) in the preoperative assessment of surgical procedures involving the placement of screws in the cervical spine, such as treatment for atlantoaxial instability. Lack of knowledge regarding the anatomy of this region can lead to complications, such as vertebral artery injury and, consequently, impaired blood flow to the brain, cerebellum, and brainstem. Therefore, the authors recommend further research on this topic, particularly in other patient populations and in collaboration with other disciplines, to advance our understanding of the vertebral artery and to provide valuable tools for healthcare professionals and researchers, thus contributing to improved patient care.
背景背景：弓孔（FA）可以表现为多种形式：完全性、不完全性、单侧或双侧。这种解剖特征相对常见，约占人口的3-15%，女性患病率更高。目的：本研究旨在为房颤的解剖学特征提供严谨的科学证据。此外，本研究旨在分析房颤的患病率，并探讨其在临床应用和外科手术中的相关性。方法：数据汇编自Medline、Scopus、Web of Science、EMBASE、谷歌Scholar、护理与相关健康文献累积索引（CINAHL）等数据库和2025年4月的大量已发表的研究。用解剖学研究保证工具（AQUA）评估方法学质量。使用随机效应模型估计合并患病率，并评估FA变异率的差异。结果：鉴定出FA变异，将数据分为三组：第一类为样本类型，分为尸体供体样本和影像学表现；第二种分析侧重于样本起源的地理区域；最后，性别和侧性也被考虑在内。总的来说，这些变异的发生率为16% (CI: 11%-20%)，并且观察到显著的异质性（98.8%）。在以下亚组中观察到明显更高的发生率：影像学研究与供体资料（p=0.032），右侧与左侧（p=0.034），双侧与单侧发现（p=0.019）。引起关注的问题之一是对外科手术过程中医源性损伤风险的研究。几项研究还表明，出现复发性头痛、眩晕、头晕和/或晕厥等症状的患者椎动脉变异的频率更高。结论：这篇综述强调了考虑椎动脉（VA）在术前评估颈椎螺钉置入手术的重要性，如治疗寰枢椎不稳。缺乏对该区域的解剖知识可导致并发症，如椎动脉损伤，从而导致流向大脑、小脑和脑干的血流受损。因此，作者建议进一步研究这一主题，特别是在其他患者群体中，并与其他学科合作，以提高我们对椎动脉的理解，并为医疗保健专业人员和研究人员提供有价值的工具，从而有助于改善患者护理。
{"title":"Arcuate Foramen of the Atlas Vertebra and its Correlation with Clinical Implications in the Craniocervical Region: A Systematic Review and Meta-analysis","authors":"Juan José Valenzuela-Fuenzalida , Javiera Cornejo-Peña , Josefina Martinez-Cid , Cristobal Rojas-Acuña , Guinevere Granite , Juan. A. Sanchis-Gimeno , Alejandro Bruna Mejias , Pablo Nova Baeza , Mathias Orellana Donoso , Gustavo Oyanedel Amaro , Macarena Rodriguez-Luengo , Gkionoul Nteli Chatzioglou , Maria Piagkou , George Triantafyllou , Marko Konchaske","doi":"10.1016/j.wneu.2025.124652","DOIUrl":"10.1016/j.wneu.2025.124652","url":null,"abstract":"<div><h3>Background context</h3><div>The arcuate foramen (FA) can present in various forms: it may be complete, incomplete, unilateral, or bilateral. This anatomical feature is relatively common, occurring in approximately 3%–15% of the population, with a higher prevalence in females.</div></div><div><h3>Purpose</h3><div>The purpose of this study is to provide rigorous scientific evidence detailing the anatomical characteristics of the AF. Furthermore, this work aims to analyze the prevalence and explore its relevance in clinical applications and surgical procedures.</div></div><div><h3>Study desing</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>Data were compiled from numerous published studies accessed from the databases Medline, Scopus, Web of Science, EMBASE, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and of April 2025. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model, and differences in FA variant rates were assessed.</div></div><div><h3>Results</h3><div>FA variants were identified, the data were categorized into 3 groups: the first category was the type of sample, divided into cadaver donor samples and imaging findings; the second analysis focused on the geographical region from which the sample originated; and finally, sex and laterality were also considered. Overall, the prevalence of these variations was 16% (CI: 11%–20%), and significant heterogeneity (98.8%) was observed. Significantly higher rates were observed in the following subgroups: imaging studies versus donor data (<em>P</em> = 0.032), right side versus left side (<em>P</em> = 0.034), and bilateral versus unilateral findings (<em>P</em> = 0.019). Among the concerns raised were studies on the risk of iatrogenic damage during surgical procedures. Several studies also indicated a higher frequency of vertebral artery variations in patients with symptoms such as recurrent headaches, vertigo, dizziness, and/or syncope.</div></div><div><h3>Conclusions</h3><div>This review emphasized the importance of considering the vertebral artery (VA) in the preoperative assessment of surgical procedures involving the placement of screws in the cervical spine, such as treatment for atlantoaxial instability. Lack of knowledge regarding the anatomy of this region can lead to complications, such as vertebral artery injury and, consequently, impaired blood flow to the brain, cerebellum, and brainstem. Therefore, the authors recommend further research on this topic, particularly in other patient populations and in collaboration with other disciplines, to advance our understanding of the vertebral artery and to provide valuable tools for healthcare professionals and researchers, thus contributing to improved patient care.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124652"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640550","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}
Pub Date : 2026-01-01DOI: 10.1016/j.wneu.2025.124692
Gancheng Li , Maoxiang Li , Buqing Xie , Jianqiu Chen , Shuli Li , Shumin Luo , Changhong Mo
Background
Diabetes insipidus (DI) frequently occurs after surgery to remove pituitary tumors. It prolongs hospital stays, increases costs, and raises risks of other health issues. This study aims to identify risk factors for DI after pituitary tumor surgery to aid in early identification of high-risk patients.
Methods
We studied 141 patients who had endoscopic pituitary tumor surgery from 2019 to 2023. Patients were grouped based on whether they developed DI postsurgery. We used statistical analyses to identify risk factors.
Results
Among the patients, 67 (47.5%) developed DI postsurgery, mostly transient. Factors like preoperative adrenal insufficiency (odds ratio 4.22, 95% confidence interval 1.15–15.51, P = 0.030) and Ki-67 ≥ 3% (odds ratio 3.04, 95% CI 1.17–7.85, P = 0.022) were found to independently increase DI risk.
Conclusion
Patients with preoperative adrenal insufficiency or Ki-67 ≥ 3% are more likely to develop DI after surgery. Close monitoring of fluid balance is crucial post-surgery, and prompt use of desmopressin can help manage DI effectively.
背景：尿崩症（DI）常发生在垂体肿瘤切除手术后。它延长了住院时间，增加了费用，并增加了其他健康问题的风险。本研究旨在探讨垂体肿瘤术后DI的危险因素，以帮助早期识别高危患者。方法：对2019年至2023年接受垂体内窥镜手术的141例患者进行研究。根据术后是否出现DI对患者进行分组。我们使用统计分析来确定危险因素。结果：术后发生DI 67例（47.5%），多为一过性DI。术前肾上腺功能不全（OR 4.22, 95% CI 1.15 ~ 15.51, p=0.030）和Ki-67≥3% （OR 3.04, 95% CI 1.17 ~ 7.85, p=0.022）是单独增加DI风险的因素。结论：术前肾上腺功能不全或Ki-67≥3%的患者术后发生DI的可能性较大。术后密切监测体液平衡是至关重要的，及时使用去氨加压素可以帮助有效地控制DI。
{"title":"Ki-67 and Preoperative Hypocortisolism are Predictive Factors for Postoperative Diabetes Insipidus After Endoscopic Pituitary Tumor Resection","authors":"Gancheng Li , Maoxiang Li , Buqing Xie , Jianqiu Chen , Shuli Li , Shumin Luo , Changhong Mo","doi":"10.1016/j.wneu.2025.124692","DOIUrl":"10.1016/j.wneu.2025.124692","url":null,"abstract":"<div><h3>Background</h3><div>Diabetes insipidus (DI) frequently occurs after surgery to remove pituitary tumors. It prolongs hospital stays, increases costs, and raises risks of other health issues. This study aims to identify risk factors for DI after pituitary tumor surgery to aid in early identification of high-risk patients.</div></div><div><h3>Methods</h3><div>We studied 141 patients who had endoscopic pituitary tumor surgery from 2019 to 2023. Patients were grouped based on whether they developed DI postsurgery. We used statistical analyses to identify risk factors.</div></div><div><h3>Results</h3><div>Among the patients, 67 (47.5%) developed DI postsurgery, mostly transient. Factors like preoperative adrenal insufficiency (odds ratio 4.22, 95% confidence interval 1.15–15.51, <em>P</em> = 0.030) and Ki-67<!--> <!-->≥<!--> <!-->3% (odds ratio 3.04, 95% CI 1.17–7.85, <em>P</em> = 0.022) were found to independently increase DI risk.</div></div><div><h3>Conclusion</h3><div>Patients with preoperative adrenal insufficiency or Ki-67<!--> <!-->≥<!--> <!-->3% are more likely to develop DI after surgery. Close monitoring of fluid balance is crucial post-surgery, and prompt use of desmopressin can help manage DI effectively.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124692"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649175","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}
Spinal tuberculosis is the most common form of extra pulmonary tuberculosis. While cervical involvement, known as cervical Pott's disease, has traditionally been considered rare, its incidence is increasing. However, comprehensive data on its clinical presentation, diagnostic methods, treatment options, and outcomes remain limited. This review consolidates evidence on cervical spine tuberculosis, offering insights into its epidemiology, therapeutic strategies, and outcomes.
Methods
A systematic search of PubMed/MEDLINE and Google Scholar was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies related to cervical spine tuberculosis. Quantitative data were analyzed using Jamovi 2.3.0.
Results
The pooled mean age was 23.6 years (95% confidence interval: 18.3–29.0), with 54.6% of patients being male. Prior pulmonary tuberculosis and exposure were reported in 52% and 26% of cases, respectively. Common symptoms included cervical pain (69.5%), radicular pain (31%), motor-sensory deficits (46.2%), and fever (50.1%). Magnetic resonance imaging findings showed epidural/paravertebral abscesses with cord involvement in 72.9% of cases. Lesions affected a single vertebral level in 42.8% of cases, predominantly in the upper cervical spine (52.7%). Surgical intervention was performed in 71.9% of patients, using anterior (60.4%), posterior (44.1%), or combined approaches (18.2%). Bone fusion was achieved in 4.1 months. Surgery-related mortality was 1.0%.
Conclusions
Cervical spine tuberculosis, though rare, is a severe extrapulmonary form with a rising incidence. The condition leads to neurological impairments and spinal deformities, with symptoms including cervical pain, motor-sensory deficits, and fever. A combination of medical and surgical treatment can result in favorable neurological outcomes. Future research should focus on developing protocols and evaluating outcomes to improve management.
{"title":"Cervical Spine Tuberculosis: A Systematic Review and Meta-Analysis of Epidemiology, Clinical Presentation, Diagnosis, Management, and Outcomes","authors":"Roméo Bujiriri Murhega , Yao Christian Hugues Dokponou , Férol Baudelaire Babatundé Gbenou , Laté Dzidoula Lawson , Raïssa Diaby , Daniel Yamba Yamba , Omar Boladji Adébayo Badirou , Mèhomè Wilfried Dossou , Arsène Désiré Ossaga Madjoué , Comlan Jean-Claude Fréjus Lokossi , Joris Adjoglo , Yvan Carrel Ngoko Ngongang , Nikiema Habi Alizeta , Nicaise Agada , Nourou Dine Adeniran Bankole","doi":"10.1016/j.wneu.2025.124687","DOIUrl":"10.1016/j.wneu.2025.124687","url":null,"abstract":"<div><h3>Background</h3><div>Spinal tuberculosis is the most common form of extra pulmonary tuberculosis. While cervical involvement, known as cervical Pott's disease, has traditionally been considered rare, its incidence is increasing. However, comprehensive data on its clinical presentation, diagnostic methods, treatment options, and outcomes remain limited. This review consolidates evidence on cervical spine tuberculosis, offering insights into its epidemiology, therapeutic strategies, and outcomes.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed/MEDLINE and Google Scholar was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies related to cervical spine tuberculosis. Quantitative data were analyzed using Jamovi 2.3.0.</div></div><div><h3>Results</h3><div>The pooled mean age was 23.6 years (95% confidence interval: 18.3–29.0), with 54.6% of patients being male. Prior pulmonary tuberculosis and exposure were reported in 52% and 26% of cases, respectively. Common symptoms included cervical pain (69.5%), radicular pain (31%), motor-sensory deficits (46.2%), and fever (50.1%). Magnetic resonance imaging findings showed epidural/paravertebral abscesses with cord involvement in 72.9% of cases. Lesions affected a single vertebral level in 42.8% of cases, predominantly in the upper cervical spine (52.7%). Surgical intervention was performed in 71.9% of patients, using anterior (60.4%), posterior (44.1%), or combined approaches (18.2%). Bone fusion was achieved in 4.1 months. Surgery-related mortality was 1.0%.</div></div><div><h3>Conclusions</h3><div>Cervical spine tuberculosis, though rare, is a severe extrapulmonary form with a rising incidence. The condition leads to neurological impairments and spinal deformities, with symptoms including cervical pain, motor-sensory deficits, and fever. A combination of medical and surgical treatment can result in favorable neurological outcomes. Future research should focus on developing protocols and evaluating outcomes to improve management.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124687"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649590","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}
Pub Date : 2026-01-01DOI: 10.1016/j.wneu.2025.124695
Moustafa A. Mansour , Hamdi Nabawi Mostafa , Amr K. Elsamman
Meningioangiomatosis (MA) is a rare, enigmatic disorder straddling the boundary between developmental malformation and neoplastic process, characterized by meningothelial proliferation and vascular changes within the cerebral cortex. Despite its recognition over a century ago, MA remains diagnostically and therapeutically challenging due to its heterogeneous clinical presentations, overlapping radiological features with epileptogenic pathologies, and unresolved debates about its pathogenesis. This comprehensive review synthesizes a century of evidence to address critical gaps in the literature, including the molecular underpinnings of neurofibromatosis type 2-driven sporadic and syndromic MA, the diagnostic dilemmas posed by its histopathological mimicry of meningiomas and cortical dysplasia, and the absence of consensus on management strategies for asymptomatic or refractory epileptic cases. We present a visually reinforced, practical guide integrating advanced imaging hallmarks, immunohistochemical profiles, and surgical nuances—highlighting en bloc resection as the gold standard for seizure control (70–90% Engel Class I outcomes) while challenging the speculative role of radiotherapy given MA's low proliferative index. Controversies such as the hamartoma-neoplasm dichotomy, the inflammatory component's significance, and the potential of emerging therapies (e.g., mTOR inhibitors, bevacizumab) are critically evaluated. By proposing a diagnostic algorithm and management framework grounded in multimodal evidence, this review not only consolidates existing knowledge but also charts a roadmap for future research—emphasizing international registries, molecular profiling, and patient-centered outcomes. As the definitive resource for neurologists, neurosurgeons, and pathologists, this work bridges fundamental science with clinical pragmatism, aiming to transform MA from a diagnostic curiosity into a precisely managed entity.
{"title":"Decoding Meningioangiomatosis: A Century of Insights into Molecular Mechanisms, Clinical Dilemmas, and Therapeutic Innovations","authors":"Moustafa A. Mansour , Hamdi Nabawi Mostafa , Amr K. Elsamman","doi":"10.1016/j.wneu.2025.124695","DOIUrl":"10.1016/j.wneu.2025.124695","url":null,"abstract":"<div><div>Meningioangiomatosis (MA) is a rare, enigmatic disorder straddling the boundary between developmental malformation and neoplastic process, characterized by meningothelial proliferation and vascular changes within the cerebral cortex. Despite its recognition over a century ago, MA remains diagnostically and therapeutically challenging due to its heterogeneous clinical presentations, overlapping radiological features with epileptogenic pathologies, and unresolved debates about its pathogenesis. This comprehensive review synthesizes a century of evidence to address critical gaps in the literature, including the molecular underpinnings of neurofibromatosis type 2-driven sporadic and syndromic MA, the diagnostic dilemmas posed by its histopathological mimicry of meningiomas and cortical dysplasia, and the absence of consensus on management strategies for asymptomatic or refractory epileptic cases. We present a visually reinforced, practical guide integrating advanced imaging hallmarks, immunohistochemical profiles, and surgical nuances—highlighting en bloc resection as the gold standard for seizure control (70–90% Engel Class I outcomes) while challenging the speculative role of radiotherapy given MA's low proliferative index. Controversies such as the hamartoma-neoplasm dichotomy, the inflammatory component's significance, and the potential of emerging therapies (e.g., mTOR inhibitors, bevacizumab) are critically evaluated. By proposing a diagnostic algorithm and management framework grounded in multimodal evidence, this review not only consolidates existing knowledge but also charts a roadmap for future research—emphasizing international registries, molecular profiling, and patient-centered outcomes. As the definitive resource for neurologists, neurosurgeons, and pathologists, this work bridges fundamental science with clinical pragmatism, aiming to transform MA from a diagnostic curiosity into a precisely managed entity.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124695"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655798","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}
Pub Date : 2026-01-01DOI: 10.1016/j.wneu.2025.124706
Lo-Yi Lin , Han-Jui Lee , Chia-Hung Wu , Hsin-Wei Wu , Chih-Chun Wu , Kai-Wei Yu , Yi-Wei Chen , Yi-Yen Lee , Hsin-Hung Chen , Jau-Ching Wu , Wei-An Tai , Te-Ming Lin , Feng-Chi Chang
Background
Irradiation is one of the main therapeutic strategies used to treat patients with malignant pediatric brain tumors of the posterior fossa (MPBTPFs). Any recurrent intracranial lesion that forms after treatment completion is either a radiation-induced secondary tumor (RIST) or a recurrent tumor (RT), and patients with these tumors have similar presentations. The aim of our study was to diagnose RIST and RT on the basis of their clinical and magnetic resonance imaging (MRI) features to guiding optimal treatment strategies.
Methods
From 2003 to 2022, we retrospectively enrolled 20 MPBTPF patients with pathologically confirmed RIST after complete surgery and irradiation. We also enrolled 20 MPBTPF patients with RTs with matched primary tumor types and evaluated the clinical and MRI findings and outcomes of these patients.
Results
The latency period was significantly longer in RISTs than in RTs (152.5 vs. 22 months, P < 0.001). None of the RISTs arose from the primary surgical bed or exhibited leptomeningeal seeding. Benign RISTs tended to be well-defined and showed homogeneous enhancement. In contrast, malignant RISTs largely resembled RTs morphologically but demonstrated larger tumor volumes and higher apparent diffusion coefficient (ADC)min and ADC ratios (all P < 0.05). Receiver operating characteristic analysis revealed that latency was the strongest discriminator between malignant RISTs and RTs (area under the receiver operating characteristic curve [AUC] = 0.90), followed by tumor volume (AUC = 0.81), ADCmin (AUC = 0.76), and ADC ratio (AUC = 0.72)
Conclusions
In patients with MPBTPF who undergo surgery and radiotherapy, RISTs can be distinguished from RTs by clinical and MRI features, which may help guide early treatment planning.
{"title":"Clinical and Magnetic Resonance Findings for the Diagnosis of Recurrent Tumors versus Radiation-Induced Secondary Tumors of Malignant Pediatric Brain Tumors of the Posterior Fossa","authors":"Lo-Yi Lin , Han-Jui Lee , Chia-Hung Wu , Hsin-Wei Wu , Chih-Chun Wu , Kai-Wei Yu , Yi-Wei Chen , Yi-Yen Lee , Hsin-Hung Chen , Jau-Ching Wu , Wei-An Tai , Te-Ming Lin , Feng-Chi Chang","doi":"10.1016/j.wneu.2025.124706","DOIUrl":"10.1016/j.wneu.2025.124706","url":null,"abstract":"<div><h3>Background</h3><div>Irradiation is one of the main therapeutic strategies used to treat patients with malignant pediatric brain tumors of the posterior fossa (MPBTPFs). Any recurrent intracranial lesion that forms after treatment completion is either a radiation-induced secondary tumor (RIST) or a recurrent tumor (RT), and patients with these tumors have similar presentations. The aim of our study was to diagnose RIST and RT on the basis of their clinical and magnetic resonance imaging (MRI) features to guiding optimal treatment strategies.</div></div><div><h3>Methods</h3><div>From 2003 to 2022, we retrospectively enrolled 20 MPBTPF patients with pathologically confirmed RIST after complete surgery and irradiation. We also enrolled 20 MPBTPF patients with RTs with matched primary tumor types and evaluated the clinical and MRI findings and outcomes of these patients.</div></div><div><h3>Results</h3><div>The latency period was significantly longer in RISTs than in RTs (152.5 vs. 22 months, <em>P</em> < 0.001). None of the RISTs arose from the primary surgical bed or exhibited leptomeningeal seeding. Benign RISTs tended to be well-defined and showed homogeneous enhancement. In contrast, malignant RISTs largely resembled RTs morphologically but demonstrated larger tumor volumes and higher apparent diffusion coefficient (ADC)<sub>min</sub> and ADC ratios (all <em>P</em> < 0.05). Receiver operating characteristic analysis revealed that latency was the strongest discriminator between malignant RISTs and RTs (area under the receiver operating characteristic curve [AUC] = 0.90), followed by tumor volume (AUC = 0.81), ADCmin (AUC = 0.76), and ADC ratio (AUC = 0.72)</div></div><div><h3>Conclusions</h3><div>In patients with MPBTPF who undergo surgery and radiotherapy, RISTs can be distinguished from RTs by clinical and MRI features, which may help guide early treatment planning.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124706"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696425","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}
Craniosynostosis surgery is highly invasive, often resulting in significant blood loss and high transfusion rates (87%–95%) in pediatric patients. This retrospective study aimed to identify factors associated with lower transfusion requirements to improve perioperative management and reduce complications.
Methods
We analyzed 69 craniosynostosis surgeries performed from 2013 to 2023. A transfusion threshold of Hb < 7 g/dL was used. Surgical methods basically varied by age: endoscopic suturectomy for infants under 7 months and calvarial vault remodeling or distraction osteogenesis for older children. Blood conservation strategies included acute normovolemic hemodilution, intraoperative autologous blood recovery (Cell Saver), oral iron supplements, and tranexamic acid. Receiver operating characteristic curve analysis was used to determine key transfusion-reducing factors.
Results
The transfusion rate was 34.8%. Significant factors associated with reduced transfusion included blood loss, patient age, and preoperative iron supplementation. In subgroup analysis, for patients weighing ≥10 kg, autologous blood recovery was effective, while for those <10 kg, preoperative iron supplementation improved hemoglobin levels, reducing transfusion requirements. For patients weighing ≥10 kg, blood loss ≤8.8 mL/kg were identified as critical thresholds. Blood loss ≤8.3 mL/kg and preoperative Hb ≥ 9.2 g/dL were optimal for avoiding transfusion in patients weighing <10 kg.
Conclusions
Minimizing blood loss, optimizing preoperative hemoglobin levels, and using autologous blood recovery can significantly reduce transfusion rates. Implementing multiple strategies lowered the overall transfusion rate to 34.8%, potentially reducing complications and improving patient outcomes in pediatric craniosynostosis surgery.
{"title":"Perioperative Management to Minimize Blood Transfusion in Craniosynostosis Surgery","authors":"Yuki Kimoto , Atsuko Harada , Yumi Doi , Yoshinori Kadono , Kazushige Maeno , Shigeo Kyutoku , Koichi Ueda , Haruhiko Kishima","doi":"10.1016/j.wneu.2025.124713","DOIUrl":"10.1016/j.wneu.2025.124713","url":null,"abstract":"<div><h3>Objective</h3><div>Craniosynostosis surgery is highly invasive, often resulting in significant blood loss and high transfusion rates (87%–95%) in pediatric patients. This retrospective study aimed to identify factors associated with lower transfusion requirements to improve perioperative management and reduce complications.</div></div><div><h3>Methods</h3><div>We analyzed 69 craniosynostosis surgeries performed from 2013 to 2023. A transfusion threshold of Hb < 7 g/dL was used. Surgical methods basically varied by age: endoscopic suturectomy for infants under 7 months and calvarial vault remodeling or distraction osteogenesis for older children. Blood conservation strategies included acute normovolemic hemodilution, intraoperative autologous blood recovery (Cell Saver), oral iron supplements, and tranexamic acid. Receiver operating characteristic curve analysis was used to determine key transfusion-reducing factors.</div></div><div><h3>Results</h3><div>The transfusion rate was 34.8%. Significant factors associated with reduced transfusion included blood loss, patient age, and preoperative iron supplementation. In subgroup analysis, for patients weighing ≥10 kg, autologous blood recovery was effective, while for those <10 kg, preoperative iron supplementation improved hemoglobin levels, reducing transfusion requirements. For patients weighing ≥10 kg, blood loss ≤8.8 mL/kg were identified as critical thresholds. Blood loss ≤8.3 mL/kg and preoperative Hb ≥ 9.2 g/dL were optimal for avoiding transfusion in patients weighing <10 kg.</div></div><div><h3>Conclusions</h3><div>Minimizing blood loss, optimizing preoperative hemoglobin levels, and using autologous blood recovery can significantly reduce transfusion rates. Implementing multiple strategies lowered the overall transfusion rate to 34.8%, potentially reducing complications and improving patient outcomes in pediatric craniosynostosis surgery.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124713"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752126","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}
Pub Date : 2026-01-01DOI: 10.1016/j.wneu.2025.124719
Wenhong Peng , Mingzhu Feng , Jiayu Zhang , Mohammad Mofatteh , Zhaoyun Chen , Feng Ye , Dongwen Zhong , Zunbao Xu , Chuming Huang , Rongjuan Xu , Peican Zeng , Wei Xu , Jicai Ma , Sijie Zhou , Yuzheng Lai , José Fidel Baizabal-Carvallo
Background
Many acute ischemic stroke patients experience poor functional outcomes despite successful recanalization following endovascular treatment (EVT). We aimed to identify predictive factors for early neurological deterioration (END) following successful EVT in acute ischemic stroke patients and to evaluate the impact of END on clinical outcomes.
Methods
One thousand fifty-three patients who achieved successful recanalization (modified treatment in cerebral infarction 2b-3) were divided into two groups: without END (No-END, n = 942) and with END (n = 111). Baseline characteristics, pretreatment Alberta Stroke Program Early CT Score (ASPECTS), onset-to-puncture time, atrial fibrillation (AF), and parenchymal hematoma (PH) were analyzed. Binary regression analysis was performed to identify independent predictors of END. Favorable functional outcomes (modified Rankin scale 0–2) and mortality were assessed at 3 months.
Results
The END group had a lower prevalence of AF (26% vs. 36%, P = 0.026), lower pre-EVT ASPECTS scores (median 8 vs. 9, P < 0.001), longer onset-to-puncture time (median 360 vs. 290 minutes, P = 0.002), and a higher incidence of PH (39% vs. 10%, P < 0.001) compared to the No-END group. Binary regression analysis identified lower pre-EVT ASPECTS (odds ratio [OR] = 0.742, P = 0.001), absence of AF (OR = 0.575, P = 0.024), and presence of PH (OR = 5.373, P < 0.001) as independent predictors of END. At 3 months, the END group had lower favorable outcomes (6% vs. 56%, P < 0.001) and higher mortality (63% vs. 13%, P < 0.001).
Conclusions
Lower pre-EVT ASPECTS scores, absence of AF, and presence of PH are independent predictors of END following successful recanalization. END is associated with significantly worse clinical outcomes, including lower rates of favorable functional outcomes and higher mortality.
背景和目的：许多急性缺血性卒中（AIS）患者在血管内治疗（EVT）后成功再通，但功能预后不佳。我们旨在确定AIS患者EVT成功后早期神经退化（END）的预测因素，并评估END对临床结果的影响。材料与方法：将1053例成功再通（改良治疗脑梗死2b-3）患者分为无END组（No-END, n=942）和END组（n=111）。分析基线特征、治疗前阿尔伯塔卒中方案早期CT评分（ASPECTS）、发病至穿刺时间（OPT）、心房颤动（AF）和实质血肿（PH）。采用二元回归分析确定END的独立预测因素。3个月时评估良好的功能结局（mRS 0-2）和死亡率。结果：END组房颤患病率较低（26% vs 36%, p=0.026）， evt前ASPECTS评分较低（中位数8 vs 9）。结论：evt前ASPECTS评分较低，房颤无发生，PH存在是再通成功后END的独立预测因素。END与较差的临床结果相关，包括较低的良好功能结局率和较高的死亡率。
{"title":"Early Neurological Deterioration After Recanalization: A Retrospective Study of 1053 Endovascular Treatment Patients","authors":"Wenhong Peng , Mingzhu Feng , Jiayu Zhang , Mohammad Mofatteh , Zhaoyun Chen , Feng Ye , Dongwen Zhong , Zunbao Xu , Chuming Huang , Rongjuan Xu , Peican Zeng , Wei Xu , Jicai Ma , Sijie Zhou , Yuzheng Lai , José Fidel Baizabal-Carvallo","doi":"10.1016/j.wneu.2025.124719","DOIUrl":"10.1016/j.wneu.2025.124719","url":null,"abstract":"<div><h3>Background</h3><div>Many acute ischemic stroke patients experience poor functional outcomes despite successful recanalization following endovascular treatment (EVT). We aimed to identify predictive factors for early neurological deterioration (END) following successful EVT in acute ischemic stroke patients and to evaluate the impact of END on clinical outcomes.</div></div><div><h3>Methods</h3><div>One thousand fifty-three patients who achieved successful recanalization (modified treatment in cerebral infarction 2b-3) were divided into two groups: without END (No-END, n = 942) and with END (n = 111). Baseline characteristics, pretreatment Alberta Stroke Program Early CT Score (ASPECTS), onset-to-puncture time, atrial fibrillation (AF), and parenchymal hematoma (PH) were analyzed. Binary regression analysis was performed to identify independent predictors of END. Favorable functional outcomes (modified Rankin scale 0–2) and mortality were assessed at 3 months.</div></div><div><h3>Results</h3><div>The END group had a lower prevalence of AF (26% vs. 36%, <em>P</em> = 0.026), lower pre-EVT ASPECTS scores (median 8 vs. 9, <em>P</em> < 0.001), longer onset-to-puncture time (median 360 vs. 290 minutes, <em>P</em> = 0.002), and a higher incidence of PH (39% vs. 10%, <em>P</em> < 0.001) compared to the No-END group. Binary regression analysis identified lower pre-EVT ASPECTS (odds ratio [OR]<!--> <!-->=<!--> <!-->0.742, <em>P</em> = 0.001), absence of AF (OR<!--> <!-->=<!--> <!-->0.575, <em>P</em> = 0.024), and presence of PH (OR<!--> <!-->=<!--> <!-->5.373, <em>P</em> < 0.001) as independent predictors of END. At 3 months, the END group had lower favorable outcomes (6% vs. 56%, <em>P</em> < 0.001) and higher mortality (63% vs. 13%, <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Lower pre-EVT ASPECTS scores, absence of AF, and presence of PH are independent predictors of END following successful recanalization. END is associated with significantly worse clinical outcomes, including lower rates of favorable functional outcomes and higher mortality.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124719"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752171","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号