World neurosurgery最新文献_第9页

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

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

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

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

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

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

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引用次数: 0

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

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

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

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

Objective

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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

{"title":"Gyroscopic Radiosurgery: Clinical Experience and Prospective Analysis of over 500 Treated Tumors","authors":"Antonio Santacroce , Alexander Muacevic , Nadja Kohlhase , Dochka Eftimova , Theresa Hofmann , Matthias Sammer , Annabel Graser , Markus Kufeld , Christoph Fürweger , Felix Ehret","doi":"10.1016/j.wneu.2025.124684","DOIUrl":"10.1016/j.wneu.2025.124684","url":null,"abstract":"<div><h3>Background</h3><div>Stereotactic radiosurgery plays a significant role in the treatment of various benign and malignant tumors of the central nervous system. Recently, the first self-shielding treatment platform for gyroscopic radiosurgery (GRS) was introduced. Herein, we report our experience with GRS treatment of the first 541 tumors in a prospective setting.</div></div><div><h3>Methods</h3><div>This study enrolled patients who underwent GRS for intracranial tumors. Patient, treatment, and outcome data were prospectively collected and analyzed. Only patients with at least 1 imaging and clinical follow-up were included in this analysis. Volumetric assessments and major toxicity are presented.</div></div><div><h3>Results</h3><div>A total of 491 patients were treated between 2021 and 2024. Of those, 382 patients harboring 541 tumors underwent at least 1 imaging and clinical follow-up. The majority of tumor entities treated were vestibular schwannomas (196), brain metastases (188), and meningiomas (113). The median prescription dose for brain metastases was 20 Gy. For meningiomas and vestibular schwannomas, the median prescription doses were 15 and 13 Gy, respectively. Analysis of dosimetric performance showed that GRS treatments are highly conformal, achieving steep dose gradients. The median imaging follow-up was 10.6 months. Volumetry of the treated targets demonstrated an early treatment response with either volume reduction or stability for most tumors.</div></div><div><h3>Conclusions</h3><div>The early results of this prospective study, show the efficacy and safety of the new self-shielding treatment platform. Due to the limited follow-up of this analysis, future studies including long-term outcome data are needed.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124684"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145639424","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

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

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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。

{"title":"Complete Spontaneous Resolution of Lumbar Synovial Cyst: A Case Report and Systematic Literature Review","authors":"Jakub Litak , Piotr Kamieniak , Michał Szymoniuk , Tomasz Mandat , Grzegorz Staśkiewicz , Justyna Zielińska-Turek , Kamil Torres , Wojciech Czyżewski","doi":"10.1016/j.wneu.2025.124712","DOIUrl":"10.1016/j.wneu.2025.124712","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"205 ","pages":"Article 124712"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752159","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

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