World neurosurgery最新文献_第8页

Third Recurrent World Health Organization 1 Spinal Meningiomas: Case Series and Clinical Outcomes Following Surgery or Definitive Radiotherapy

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2025-02-19 DOI: 10.1016/j.wneu.2025.123704

Ory Haisraely, Marcia Jaffe, Alicia Taliansky, Yaakov Richard Lawerence

Background

Spinal meningiomas (SMs) are rare, predominantly benign tumors that account for 1.2%–12.7% of all meningiomas. While surgical resection is the primary treatment, recurrence occurs in a subset of patients, necessitating subsequent therapies such as reoperation or definitive radiation therapy (RT). This study evaluates the outcomes of definitive RT versus third surgery for recurrent World Health Organization (WHO) grade 1 SM, focusing on progression-free survival (PFS) and treatment-related toxicities.

Methods

A retrospective review of 48 patients with third progression of WHO grade 1 SM was conducted between 2008 and 2021. Inclusion criteria required prior second surgery and a confirmed pathology of WHO grade 1. Patients who received RT after earlier surgeries or whose pathology upgraded to WHO grade 2 or 3 were excluded. Data on demographics, tumor characteristics, surgical outcomes, and RT parameters were analyzed. PFS was assessed using Kaplan-Meier survival analysis, and treatment-related toxicities were recorded.

Results

Of the 48 patients, 31 underwent third surgery and 17 received definitive RT (median dose: 54 Gy in 30 fractions). Median follow-up was 30 months. PFS at 36 months was comparable between surgery (77.4%) and RT (76.4%). Tumor size was larger in the surgery group (median 1.8 cm vs. 1 cm, P < 0.001). Neurological improvements were noted in 79.1% of surgery patients and 58.3% of RT patients. RT offered superior pain control, with no cases of radiation myelopathy observed.

Conclusions

Definitive RT appears to be a feasible alternative to third surgery for recurrent SM in selected patients, providing comparable PFS and manageable toxicities. Larger prospective studies are needed to validate these findings and refine treatment approaches for recurrent SM.

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引用次数: 0

Progress on direct regulation of systemic immunity by the central nervous system.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2025-02-19 DOI: 10.1016/j.wneu.2025.123814

Xiaotian Tan, Junming Zhang, Weiming Chen, Tunan Chen, Gaoyu Cui, Zhi Liu, Rong Hu

This article reviews the research progress on the direct regulation of the immune system by the central nervous system. The traditional "neuro-endocrine-immune" network model has confirmed the close connection between the central nervous system and the immune system. However, due to the complex mediating role of the endocrine system, its application in clinical treatment is limited. In recent years, the direct regulation of the peripheral immune system through the central nervous system has provided new methods for the clinical treatment of neuro-immune related diseases. This article analyzes the changes in the peripheral immune system after central nervous system injury and summarizes the effects of various stimulation methods, including transcranial magnetic stimulation (TMS), transcranial electrical stimulation (TES), deep brain stimulation (DBS), spinal cord stimulation(SCS), and vagus nerve stimulation(VNS), on the peripheral immune system(Figure1). Additionally, it explores the clinical research progress and future development directions of these stimulation methods. It is proposed that these neural regulation techniques exhibit positive effects in reducing peripheral inflammation, protecting immune cells and organ functions, and improving immunosuppressive states, providing new perspectives and therapeutic potential for the treatment of immune-related diseases.

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引用次数: 0

Evaluating ChatGPT o1's Capabilities in Peripheral Nerve Surgery.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2025-02-19 DOI: 10.1016/j.wneu.2025.123805

Hinpetch Daungsupawong, Viroj Wiwanitkit

引用次数: 0

Is Force Control a safe and efficient surgical technology for thoracolumbar fusion surgery? A Post Market Clinical Follow-up Study.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2025-02-19 DOI: 10.1016/j.wneu.2025.123812

David C Noriega, Francisco Ardura, Kirollos Awad, Shefqet Hajdari, Israel Sánchez Lite, Yasser Abdalla

Background: Early screw loosening, a relevant complication after posterior thoracolumbar fusion, indicates high mechanical stress during rod connection. Force Control is a surgical technology that goes beyond the usual to identify, control and minimize intended and unintended, usually unnoticed forces to achieve the most stressless fixation. Optimized, extremely lightweight instruments support this principle on part of the pedicle screw system (PSS). The study objective is to evaluate the safety and efficacy of a novel PSS for Force Control fusion surgery.

Methods: In this literature-controlled observational study, patients underwent surgery with a PSS that supports Force Control. Safety is demonstrated 1 year postoperatively by non-inferiority in screw loosening rate and efficacy by non-inferiority in ODI improvement. Secondary endpoints: 2-year ODI, spine-related AEs and outcomes. Statistical significance p<0.025 (Bonferroni correction 0.05/2).

Results: 75 patients enrolled, main diagnoses were trauma (73.3%), spinal stenosis (17.3%), degenerative disc disease (6.7%). Screw loosening rate at 1-year was 2.7%, being not inferior (p=0.005) to the control group at 9.2%. Mean ODI improvement of 49.3 showed non-inferiority (p<0.001) versus 35.2 in the control group. Mean 2-year ODI was 19, mean VAS back pain improved from 80.3 to 24.1 (3-month) and 21.6 (1-year). The implant-related revision rate was 4.1%.

Conclusions: Force Control, aiming to go beyond the familiar by controlling intended and unintended forces to achieve the most stressless fixation, is a safe and efficient method. Lightweight instruments are designed to allow identifying, controlling and reducing mechanical stress. Patients benefit from Force Control regarding screw loosening and clinical outcome.

背景：早期螺钉松动是后路胸腰椎融合术后的一个相关并发症，表明在杆连接过程中存在较高的机械应力。力控制是一种超越常规的手术技术，可识别、控制并最大限度地减少预期的和非预期的、通常不被注意到的力，以实现最无应力的固定。椎弓根螺钉系统（PSS）中经过优化的轻型器械支持这一原则。研究目的是评估新型椎弓根螺钉系统在力控融合手术中的安全性和有效性：在这项文献对照观察研究中，患者使用支持力控制的椎弓根螺钉系统进行了手术。术后 1 年的安全性通过螺钉松动率的非劣效性和 ODI 改善率的非劣效性来证明。次要终点：2年ODI、脊柱相关AE和结果。统计学意义 p结果：75名患者入组，主要诊断为外伤（73.3%）、椎管狭窄（17.3%）、椎间盘退行性病变（6.7%）。1年后的螺钉松动率为2.7%，与对照组的9.2%相比毫不逊色（P=0.005）。平均 ODI 改善率为 49.3，与对照组的 9.2% 相比不具劣势（P=0.005）：力控制是一种安全高效的方法，旨在通过控制预期和非预期力来实现最无应力的固定，从而超越人们所熟悉的方法。轻型器械的设计可识别、控制和减少机械应力。在螺钉松动和临床效果方面，患者可从力控制中获益。

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引用次数: 0

Characterization of Radiological Markers in Relation to Time Elapsed Between Appearance and Ventriculoperitoneal Shunt Placement

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2025-02-19 DOI: 10.1016/j.wneu.2025.123670

Itai Pillar , Orly Yakir , Dan Paz

Objective

This study was conducted to evaluate the time gap between earliest head computed tomography (CT) with a significant Radscale score and ventriculoperitoneal (VP) shunt placement.

Methods

The study is a retrospective observational analytical study. The study population includes patients with idiopathic normal pressure hydrocephalus treated with a VP shunt in a single center between the years 2016 and 2022 and who have at least 2 CTs, one in proximity to diagnosis and another obtained at an earlier time point. The correlation among the parameters is tested with statistical analysis software.

Results

A total of 34 patients (mean age ± SD, 72.32 ± 7.24 years) were evaluated. Based on the diagnostic CT among the Radscale parameters, 94.1% of patients had high Evans index score, 79.4% had enlarged sylvian fissures, and 85.3% had enlargement of the temporal horns. A total of 79.4% had normal structure of sulci. The median time duration between the earliest CT with a significant Radscale score and VP shunt placement was 9.2 months (interquartile range, 1.9–27.2 months).

Conclusions

Evans index, enlarged sylvian fissures, and enlargement of the temporal horns have been observed in most diagnostic CTs. The median diagnosis time of idiopathic normal pressure hydrocephalus since appearance of radiologic markers is 9.2 months, making awareness and communication between referral and radiologist crucial.

{"title":"Characterization of Radiological Markers in Relation to Time Elapsed Between Appearance and Ventriculoperitoneal Shunt Placement","authors":"Itai Pillar , Orly Yakir , Dan Paz","doi":"10.1016/j.wneu.2025.123670","DOIUrl":"10.1016/j.wneu.2025.123670","url":null,"abstract":"<div><h3>Objective</h3><div>This study was conducted to evaluate the time gap between earliest head computed tomography (CT) with a significant Radscale score and ventriculoperitoneal (VP) shunt placement.</div></div><div><h3>Methods</h3><div>The study is a retrospective observational analytical study. The study population includes patients with idiopathic normal pressure hydrocephalus treated with a VP shunt in a single center between the years 2016 and 2022 and who have at least 2 CTs, one in proximity to diagnosis and another obtained at an earlier time point. The correlation among the parameters is tested with statistical analysis software.</div></div><div><h3>Results</h3><div>A total of 34 patients (mean age ± SD, 72.32 ± 7.24 years) were evaluated. Based on the diagnostic CT among the Radscale parameters, 94.1% of patients had high Evans index score, 79.4% had enlarged sylvian fissures, and 85.3% had enlargement of the temporal horns. A total of 79.4% had normal structure of sulci. The median time duration between the earliest CT with a significant Radscale score and VP shunt placement was 9.2 months (interquartile range, 1.9–27.2 months).</div></div><div><h3>Conclusions</h3><div>Evans index, enlarged sylvian fissures, and enlargement of the temporal horns have been observed in most diagnostic CTs. The median diagnosis time of idiopathic normal pressure hydrocephalus since appearance of radiologic markers is 9.2 months, making awareness and communication between referral and radiologist crucial.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"195 ","pages":"Article 123670"},"PeriodicalIF":1.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Preoperative Emergency Department Usage is a Sentinel Marker of Worsened Posterior Lumbar Interbody Fusion Outcome

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2025-02-19 DOI: 10.1016/j.wneu.2025.123696

Adeline L. Fecker , Maryam N. Shahin , Spencer Smith , Jung U. Yoo , Christina H. Wright , Josiah N. Orina , Won Hyung A. Ryu , Clifford Lin , Jonathan A. Kark , Travis C. Philipp , James M. Wright III

Background

Utilization of the emergency department (ED) is associated with medical and social comorbidities. These factors may also be associated with medical complications after complex surgeries. This study investigated how preoperative ED use increases risk of posterior lumbar interbody fusion (PLIF) complications.

Methods

We identified adult PLIF patients treated between 2016 and 2019 in the PearlDiver Claims Database. Clinical variables including preoperative ED use within 180 days were collected using International Classification of Disease (ICD-10) codes. Risk difference was calculated, and multivariable regression was performed.

Results

This study included 13,010 (21.1%) patients who went to the ED before surgery and 48,065 (78.9%) who did not. Having a preoperative ED visit significantly increased risk of a postoperative ED visit by 28.7 percentage points, 90-day readmission by 3.8 percentage points, and 30-day major-medical complications by 3.4 percentage points. Risk of these outcomes increased in a dose-dependent fashion. Compared with patients with zero preoperative ED visits, patients who had 6 or more preoperative ED visits had an 82.0 percentage point increase in risk for a postoperative ED visit, a 46.5 percentage point increase for six or more ED visits, a 6.1 percentage point increase for major medical complications, and 10.6% increase for readmission.

Conclusions

Patients with any preoperative ED visit had an increased risk for postoperative ED use, readmission, and medical complications. The risk difference increased with each additional preoperative visit. Patient counseling and protocols that reduce preventable ED visit in the preoperative period may reduce a patient's risk for costly postoperative complications.

{"title":"Preoperative Emergency Department Usage is a Sentinel Marker of Worsened Posterior Lumbar Interbody Fusion Outcome","authors":"Adeline L. Fecker , Maryam N. Shahin , Spencer Smith , Jung U. Yoo , Christina H. Wright , Josiah N. Orina , Won Hyung A. Ryu , Clifford Lin , Jonathan A. Kark , Travis C. Philipp , James M. Wright III","doi":"10.1016/j.wneu.2025.123696","DOIUrl":"10.1016/j.wneu.2025.123696","url":null,"abstract":"<div><h3>Background</h3><div>Utilization of the emergency department (ED) is associated with medical and social comorbidities. These factors may also be associated with medical complications after complex surgeries. This study investigated how preoperative ED use increases risk of posterior lumbar interbody fusion (PLIF) complications.</div></div><div><h3>Methods</h3><div>We identified adult PLIF patients treated between 2016 and 2019 in the PearlDiver Claims Database. Clinical variables including preoperative ED use within 180 days were collected using International Classification of Disease (ICD-10) codes. Risk difference was calculated, and multivariable regression was performed.</div></div><div><h3>Results</h3><div>This study included 13,010 (21.1%) patients who went to the ED before surgery and 48,065 (78.9%) who did not. Having a preoperative ED visit significantly increased risk of a postoperative ED visit by 28.7 percentage points, 90-day readmission by 3.8 percentage points, and 30-day major-medical complications by 3.4 percentage points. Risk of these outcomes increased in a dose-dependent fashion. Compared with patients with zero preoperative ED visits, patients who had 6 or more preoperative ED visits had an 82.0 percentage point increase in risk for a postoperative ED visit, a 46.5 percentage point increase for six or more ED visits, a 6.1 percentage point increase for major medical complications, and 10.6% increase for readmission.</div></div><div><h3>Conclusions</h3><div>Patients with any preoperative ED visit had an increased risk for postoperative ED use, readmission, and medical complications. The risk difference increased with each additional preoperative visit. Patient counseling and protocols that reduce preventable ED visit in the preoperative period may reduce a patient's risk for costly postoperative complications.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"195 ","pages":"Article 123696"},"PeriodicalIF":1.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Imbalance of Muscles Around the Cervical Spine in Patients with Degenerative Cervical Spondylotic Kyphosis and Myelopathy 退行性颈椎病、后凸和脊髓病患者颈椎周围肌肉的不平衡。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2025-02-19 DOI: 10.1016/j.wneu.2024.123605

Hongwei Wang , Haocheng Xu , Xianghe Wang , Shuo Yang , Fan Zhang , Feizhou Lyu , Xiaosheng Ma , Jianyuan Jiang , Hongli Wang

Background

To measure the muscle strength around the cervical spine; clarify the relationships among muscles, cervical sagittal alignment, and cervical spondylotic myelopathy (CSM); and understand the process underlying loss of cervical lordosis.

Methods

Sex, age, course of illness, and radiological data were obtained for patients with CSM and a control group of healthy individuals. C2–7 Cobb angles were measured in cervical radiographs, and the vertebral body areas (VBAs) and cross-sectional areas (CSAs) of the deep flexors, superficial flexors, deep extensors, and superficial extensors were measured from the C3/4 to C6/7 intervertebral levels in T2-weighted axial magnetic resonance images. The CSA/VBA ratio was compared among CSM patients with and without degenerative cervical kyphosis (DCK) and control group.

Results

Patients with CSM, especially those with DCK, showed an imbalance of muscles around the cervical spine. The CSA/VBA ratios of superficial flexor/superficial extensor at the C3/4 level (P = 0.036), total flexors/total extensors at the C6/7 level (P = 0.006), total deep muscles/total superficial muscles at the C4/5 level (P = 0.004), and total deep muscles/total superficial muscles at the C6/7 level (P = 0.031) differed significantly among the 3 groups. The CSM with DCK group tended to show larger CSA/VBA ratios of flexors/extensors and superficial muscles/deep muscles.

Conclusions

The greater strength of the flexors relative to the extensors and the superficial muscles compared with the deep muscles plays a role in pathogenesis of CSM with DCK, indicating the importance of neck and shoulder muscle-strengthening exercises in patients showing CSM with DCK.

背景：测量颈椎周围肌肉力量；阐明肌肉、颈椎矢状线和脊髓型颈椎病（CSM）之间的关系；了解颈椎前凸丧失的过程。方法：对CSM患者和健康对照者的性别、年龄、病程和影像学资料进行分析。在颈椎x线片上测量C2-7 Cobb角，并在t2加权轴向磁共振图像上测量C3/4至C6/7椎间水平的深屈肌、浅屈肌（SF）、深伸肌和浅伸肌（SE）的椎体面积（VBAs）和横截面积（csa）。比较伴有和不伴有退行性颈椎后凸（DCK）的CSM患者与对照组的CSA/VBA比值。结果：CSM患者，尤其是伴有DCK的CSM患者，颈椎周围肌肉失衡。三组间C3/4水平SF/SE （P=0.036）、C6/7水平总屈肌(TF)/总伸肌（TE）（P=0.006）、C4/5水平总深肌(TD)/总浅表肌（TS）（P=0.004）、C6/7水平TD/TS （P=0.031）的CSA/VBA比值差异均有统计学意义。CSM与DCK组倾向于显示较大的CSA/VBA比的屈肌/伸肌和浅肌/深肌。结论：屈肌相对于伸肌、浅表肌相对于深部肌的力量更大，这在CSM合并DCK的发病机制中起作用，提示颈肩部肌肉加强锻炼对CSM合并DCK患者的重要性。

{"title":"Imbalance of Muscles Around the Cervical Spine in Patients with Degenerative Cervical Spondylotic Kyphosis and Myelopathy","authors":"Hongwei Wang , Haocheng Xu , Xianghe Wang , Shuo Yang , Fan Zhang , Feizhou Lyu , Xiaosheng Ma , Jianyuan Jiang , Hongli Wang","doi":"10.1016/j.wneu.2024.123605","DOIUrl":"10.1016/j.wneu.2024.123605","url":null,"abstract":"<div><h3>Background</h3><div>To measure the muscle strength around the cervical spine; clarify the relationships among muscles, cervical sagittal alignment, and cervical spondylotic myelopathy (CSM); and understand the process underlying loss of cervical lordosis.</div></div><div><h3>Methods</h3><div>Sex, age, course of illness, and radiological data were obtained for patients with CSM and a control group of healthy individuals. C2–7 Cobb angles were measured in cervical radiographs, and the vertebral body areas (VBAs) and cross-sectional areas (CSAs) of the deep flexors, superficial flexors, deep extensors, and superficial extensors were measured from the C3/4 to C6/7 intervertebral levels in T2-weighted axial magnetic resonance images. The CSA/VBA ratio was compared among CSM patients with and without degenerative cervical kyphosis (DCK) and control group.</div></div><div><h3>Results</h3><div>Patients with CSM, especially those with DCK, showed an imbalance of muscles around the cervical spine. The CSA/VBA ratios of superficial flexor/superficial extensor at the C3/4 level (<em>P</em> = 0.036), total flexors/total extensors at the C6/7 level (<em>P</em> = 0.006), total deep muscles/total superficial muscles at the C4/5 level (<em>P</em> = 0.004), and total deep muscles/total superficial muscles at the C6/7 level (<em>P</em> = 0.031) differed significantly among the 3 groups. The CSM with DCK group tended to show larger CSA/VBA ratios of flexors/extensors and superficial muscles/deep muscles.</div></div><div><h3>Conclusions</h3><div>The greater strength of the flexors relative to the extensors and the superficial muscles compared with the deep muscles plays a role in pathogenesis of CSM with DCK, indicating the importance of neck and shoulder muscle-strengthening exercises in patients showing CSM with DCK.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"195 ","pages":"Article 123605"},"PeriodicalIF":1.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Keyhole Mini-Pterional Craniotomy for Clipping of Bilateral Middle Cerebral Artery Aneurysms

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2025-02-18 DOI: 10.1016/j.wneu.2025.123702

Brandon L. King, Andy A. Cannon, Sean M. Krahenbuhl, Errol Gordon, Tyler Auschwitz, M. Yashar S. Kalani

Middle cerebral artery aneurysms remain excellent candidates for microsurgical treatment, despite proliferation of new endovascular tools. Nonetheless, patients desire less invasive options for permanent, durable treatment of aneurysms¹; this is particularly the case for patients presenting without subarachnoid hemorrhage and patients with multiple aneurysms that may require several surgical approaches. Keyhole craniotomies, when properly used in well-selected patients, allow for minimally invasive treatment of both ruptured and unruptured cerebral aneurysms, including bilateral aneurysms, which may be treated from a single approach.² Middle cerebral artery bifurcation aneurysms are ideal for application of the keyhole concept, as they are located at the depth from the skull under a direct, linear path of access; obtaining early proximal control of the inflow vessel can be accomplished with minimal further dissection at the depth of a narrow corridor; there are few perforators that require dissection; a properly placed craniotomy exposes the entire proximal sylvian fissure as well as the contralateral sylvian contents; sharp dissection of the sylvian fissure further expands the corridor, which can be illuminated with lighted instruments as needed; and conversion to a larger craniotomy can be easily performed is bailout is necessary. A relative contraindication of this approach is if both aneurysms are laterally projecting, although in experienced hands this remains only a relative contraindication. A possible potential complication that the surgeon should be prepared for beforehand is intraoperative rupture of the distal aneurysm, but as demonstrated in Video 1, it is critical that the surgeon obtain proximal and distal control of the most distal aneurysm as would be obtained from an ipsilateral approach. We demonstrate in Video 1 the use of this approach for bilateral unruptured middle cerebral artery aneurysms, highlighting nuances for successful performance of this operation.

{"title":"Keyhole Mini-Pterional Craniotomy for Clipping of Bilateral Middle Cerebral Artery Aneurysms","authors":"Brandon L. King, Andy A. Cannon, Sean M. Krahenbuhl, Errol Gordon, Tyler Auschwitz, M. Yashar S. Kalani","doi":"10.1016/j.wneu.2025.123702","DOIUrl":"10.1016/j.wneu.2025.123702","url":null,"abstract":"<div><div>Middle cerebral artery aneurysms remain excellent candidates for microsurgical treatment, despite proliferation of new endovascular tools. Nonetheless, patients desire less invasive options for permanent, durable treatment of aneurysms<span><span><sup>1</sup></span></span>; this is particularly the case for patients presenting without subarachnoid hemorrhage and patients with multiple aneurysms that may require several surgical approaches. Keyhole craniotomies, when properly used in well-selected patients, allow for minimally invasive treatment of both ruptured and unruptured cerebral aneurysms, including bilateral aneurysms, which may be treated from a single approach.<span><span><sup>2</sup></span></span> Middle cerebral artery bifurcation aneurysms are ideal for application of the keyhole concept, as they are located at the depth from the skull under a direct, linear path of access; obtaining early proximal control of the inflow vessel can be accomplished with minimal further dissection at the depth of a narrow corridor; there are few perforators that require dissection; a properly placed craniotomy exposes the entire proximal sylvian fissure as well as the contralateral sylvian contents; sharp dissection of the sylvian fissure further expands the corridor, which can be illuminated with lighted instruments as needed; and conversion to a larger craniotomy can be easily performed is bailout is necessary. A relative contraindication of this approach is if both aneurysms are laterally projecting, although in experienced hands this remains only a relative contraindication. A possible potential complication that the surgeon should be prepared for beforehand is intraoperative rupture of the distal aneurysm, but as demonstrated in <span><span>Video 1</span></span>, it is critical that the surgeon obtain proximal and distal control of the most distal aneurysm as would be obtained from an ipsilateral approach. We demonstrate in <span><span>Video 1</span></span> the use of this approach for bilateral unruptured middle cerebral artery aneurysms, highlighting nuances for successful performance of this operation.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"195 ","pages":"Article 123702"},"PeriodicalIF":1.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effectiveness of Cerebellar Tonsillectomy Treatment for Revision Chiari Malformation Surgery: A Series of 63 Patients

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2025-02-18 DOI: 10.1016/j.wneu.2025.123690

Fan Yuan , Chenghua Yuan , Dingran Li , Pingchuan Xia , Jian Guan , Yueqi Du , Can Zhang , Zhenlei Liu , Kai Wang , Wanru Duan , Zuowei Wang , Xingwen Wang , Hao Wu , Zan Chen , Fengzeng Jian

Background

Revision surgery for patients with persistent, recurrent, or progressive syringomyelia following Foramen Magnum Decompression for Chiari malformation with syringomyelia (CM-SM) is not uncommon and presents both strategic and technical challenges.

Methods

We conducted a retrospective study including all patients who underwent revision Cerebellar Tonsillectomy (CTL) for CM-SM between 2003 and 2023. Additionally, we performed univariate and multivariate analyses to identify possible factors contributing to failed CTL outcomes.

Results

Sixty-three consecutive patients (13 males; average age 45.86 ± 11.18 years) underwent surgical treatment for persistent (n = 29), progressive (n = 21), or recurrent (n = 13) syringomyelia, with an average interval of 65.57 ± 73.33 months (range: 3–480 months) between the two surgeries. Factors significantly associated with the effectiveness of the revision CTL included dural incision and tonsil manipulation during the first surgery, severe intradural adhesions during the revision CTL, and spinal cord atrophy before the revision CTL. Multivariate logistic regression revealed that dural incision (P = 0.031, odds ratio [OR] = 6.779, 95% confidence interval {CI} [1.187∼38.719]), tonsillar manipulation (P = 0.037, OR = 7.432, 95% CI [1.131∼48.835]), and severe intradural adhesions (P = 0.030, OR = 11.465, 95% CI [1.264∼103.967]) constituted risk factors significantly statistical associated with prognosis outcomes. Long-term follow-up (average 18.75 ± 6.86 months, range: 12–72 months) of revision CTL demonstrated clinical stabilization in 55.6% of cases for at least 1.5 years. The complication rate for revision CTL was 14.3% (n = 9).

Conclusions

Dural incision and tonsillar manipulation during the first surgery, spinal cord atrophy prior to revision CTL, and severe intradural adhesions during revision CTL are significant risk factors associated with poor prognosis in revision surgery for CM-SM.

{"title":"Effectiveness of Cerebellar Tonsillectomy Treatment for Revision Chiari Malformation Surgery: A Series of 63 Patients","authors":"Fan Yuan , Chenghua Yuan , Dingran Li , Pingchuan Xia , Jian Guan , Yueqi Du , Can Zhang , Zhenlei Liu , Kai Wang , Wanru Duan , Zuowei Wang , Xingwen Wang , Hao Wu , Zan Chen , Fengzeng Jian","doi":"10.1016/j.wneu.2025.123690","DOIUrl":"10.1016/j.wneu.2025.123690","url":null,"abstract":"<div><h3>Background</h3><div>Revision surgery for patients with persistent, recurrent, or progressive syringomyelia following Foramen Magnum Decompression for Chiari malformation with syringomyelia (CM-SM) is not uncommon and presents both strategic and technical challenges.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study including all patients who underwent revision Cerebellar Tonsillectomy (CTL) for CM-SM between 2003 and 2023. Additionally, we performed univariate and multivariate analyses to identify possible factors contributing to failed CTL outcomes.</div></div><div><h3>Results</h3><div>Sixty-three consecutive patients (13 males; average age 45.86 ± 11.18 years) underwent surgical treatment for persistent (n = 29), progressive (n = 21), or recurrent (n = 13) syringomyelia, with an average interval of 65.57 ± 73.33 months (range: 3–480 months) between the two surgeries. Factors significantly associated with the effectiveness of the revision CTL included dural incision and tonsil manipulation during the first surgery, severe intradural adhesions during the revision CTL, and spinal cord atrophy before the revision CTL. Multivariate logistic regression revealed that dural incision (<em>P</em> = 0.031, odds ratio [OR] = 6.779, 95% confidence interval {CI} [1.187∼38.719]), tonsillar manipulation (<em>P</em> = 0.037, OR = 7.432, 95% CI [1.131∼48.835]), and severe intradural adhesions (<em>P</em> = 0.030, OR = 11.465, 95% CI [1.264∼103.967]) constituted risk factors significantly statistical associated with prognosis outcomes. Long-term follow-up (average 18.75 ± 6.86 months, range: 12–72 months) of revision CTL demonstrated clinical stabilization in 55.6% of cases for at least 1.5 years. The complication rate for revision CTL was 14.3% (n = 9).</div></div><div><h3>Conclusions</h3><div>Dural incision and tonsillar manipulation during the first surgery, spinal cord atrophy prior to revision CTL, and severe intradural adhesions during revision CTL are significant risk factors associated with poor prognosis in revision surgery for CM-SM.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123690"},"PeriodicalIF":1.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Single-Institution Retrospective Propensity Score-Matched Comparative Cost Analysis of Multilevel ACDF versus PCDF in Geriatric Patients with Cervical Disc Herniation.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

Pub Date : 2025-02-18 DOI: 10.1016/j.wneu.2025.123798

Bahie Ezzat, Yehia Elkersh, Roshini Kalagara, Priya Bhanot, Juhana Habib, Matthew T Carr, Alexander J Schüpper, Hanya M Qureshi, Eugene Hrabarchuk, Addison Quinones, Tanvir F Choudhri

Introduction: Despite the surge in Anterior Cervical Discectomy and Fusion (ACDF) and Posterior Cervical Decompression and Fusion (PCDF) procedures over the past two decades, there remains a paucity of data on their comparative costs in geriatric patients with cervical disc herniation. This study provides a comprehensive cost analysis of ACDF and PCDF in this patient population.

Methods: A total of 282 geriatric patients who underwent ACDF or PCDF for cervical disc herniation over a 12-year period were analyzed to assess total surgical costs, including pre-operative, procedural, and post-operative expenses. ANOVA with post-hoc Tukey HSD Test was used in a propensity score-matched cohort to compare cost differences between ACDF and PCDF across various cost categories.

Results: In a geriatric cohort of 282 patients with cervical disc herniation meeting inclusion criteria, 221 (78.4%) underwent ACDF and 61 (21.6%) received PCDF (2-4 levels). The average age was 71.3±5.6 years, with no significant demographic differences between groups. On ANOVA, rehabilitation costs were 1.88 times higher (p<0.001), and blood bank costs were 2.16 times higher (p=0.04) for PCDF patients, corresponding with significantly greater estimated blood loss (209.9±217.7 mL vs. 66.7±107.0 mL, p<0.001). After propensity score matching, PCDF remained associated with significantly higher rehabilitation costs (+170.79%, p<0.001), blood bank costs (+139.29%, p=0.005), and total procedural costs (+33.92%, p=0.015).

Conclusion: ACDF procedures in geriatric patients with cervical disc herniation are significantly cheaper than PCDF in terms of rehabilitation and blood bank costs, offering valuable insights for optimizing neurosurgical decision-making and high-value care.

{"title":"Single-Institution Retrospective Propensity Score-Matched Comparative Cost Analysis of Multilevel ACDF versus PCDF in Geriatric Patients with Cervical Disc Herniation.","authors":"Bahie Ezzat, Yehia Elkersh, Roshini Kalagara, Priya Bhanot, Juhana Habib, Matthew T Carr, Alexander J Schüpper, Hanya M Qureshi, Eugene Hrabarchuk, Addison Quinones, Tanvir F Choudhri","doi":"10.1016/j.wneu.2025.123798","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123798","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the surge in Anterior Cervical Discectomy and Fusion (ACDF) and Posterior Cervical Decompression and Fusion (PCDF) procedures over the past two decades, there remains a paucity of data on their comparative costs in geriatric patients with cervical disc herniation. This study provides a comprehensive cost analysis of ACDF and PCDF in this patient population.</p><p><strong>Methods: </strong>A total of 282 geriatric patients who underwent ACDF or PCDF for cervical disc herniation over a 12-year period were analyzed to assess total surgical costs, including pre-operative, procedural, and post-operative expenses. ANOVA with post-hoc Tukey HSD Test was used in a propensity score-matched cohort to compare cost differences between ACDF and PCDF across various cost categories.</p><p><strong>Results: </strong>In a geriatric cohort of 282 patients with cervical disc herniation meeting inclusion criteria, 221 (78.4%) underwent ACDF and 61 (21.6%) received PCDF (2-4 levels). The average age was 71.3±5.6 years, with no significant demographic differences between groups. On ANOVA, rehabilitation costs were 1.88 times higher (p<0.001), and blood bank costs were 2.16 times higher (p=0.04) for PCDF patients, corresponding with significantly greater estimated blood loss (209.9±217.7 mL vs. 66.7±107.0 mL, p<0.001). After propensity score matching, PCDF remained associated with significantly higher rehabilitation costs (+170.79%, p<0.001), blood bank costs (+139.29%, p=0.005), and total procedural costs (+33.92%, p=0.015).</p><p><strong>Conclusion: </strong>ACDF procedures in geriatric patients with cervical disc herniation are significantly cheaper than PCDF in terms of rehabilitation and blood bank costs, offering valuable insights for optimizing neurosurgical decision-making and high-value care.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123798"},"PeriodicalIF":1.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469199","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