World neurosurgery最新文献

Background: The clinical efficacy of endovascular recanalisation in patients with non-acute intracranial arterial occlusion (NAICAO) remains controversial.

Methods: We conducted a systematic search in three databases PubMed, EMBASE, and Web of science core for endovascular recanalisation for the treatment of NAICAO series cases according to PRISMA guidelines.

Results: Twenty-three articles with 1571 patients were included, with 1529 undergoing endovascular recanalisation and 42 receiving conservative drug therapy alone. The overall success rate of endovascular recanalisation was 87% (95% CI: 0.84-0.91, I²=78%); the rate of periprocedural complications was 13% (95% CI: 0.10-0.15, I²=48%); the periprocedural mortality rate was 0% (95% CI: 0.00-0.01, I²=0%); and imaging follow-up in patients with successful recanalisation showed that overall restenosis and reocclusion rate were 15% (95% CI: 0.13-0.18, I²=17%); long-term follow-up stroke recurrence and mortality in the successful recanalisation group were 7% (95% CI: 0.04-0.09, I²=67%); and in long-term follow-up stroke recurrence and mortality were significantly lower in the successful recanalisation group than in the failure to recanalise group (OR: 0.15, 95% CI: 0.06-0.37, I²=45%, P<0.01); in a subgroup analysis of technical success, the success rate of anterior circulation did not differ from that of posterior circulation (OR:1.45,95% CI: 0.95-2.20, I²=0%, P=0.08); similarly, there was no difference in the rate of perioperative complications between anterior and posterior circulation (OR: 1.25,95% CI: 0.67-2.31, I²=0%, P=0.48).

Conclusion: In NAICAO, endovascular recanalisation presents a good safety and efficacy. Endovascular recanalisation could be another option for patients with NAICAO ineffective on medical treatment.

Purpose: To evaluate the surgical approach, clinical efficacy, and safety of percutaneous spinal endoscopic "culvert decompression" in treating calcified thoracic disc herniation (TDH).

Methods: Four patients with calcified TDH underwent percutaneous endoscopic posterolateral decompression using the culvert decompression technique. Calcified disc material was incrementally removed in a controlled manner. Clinical outcomes were assessed using the Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), and postoperative radiographic imaging (CT/MRI).

Results: All procedures were completed without dural or thoracic nerve injury. Significant relief of thoracolumbar back pain and thoracic radicular pain was observed. Postoperative CT and MRI confirmed complete decompression of the thoracic spinal canal without residual compression. Final follow-up scores for VAS, JOA, and ODI showed statistically and clinically significant improvements compared with preoperative values.

Conclusions: The culvert decompression technique adheres to a "from anterior to posterior, from outside to inside" principle. Sequential drilling of bone and disc tissue from the posterior vertebral body extends toward the anterior dural space near the midline. This stepwise decompression maximizes buffer space and minimizes dural irritation-particularly beneficial in cases with dural adhesions. Thus, this minimally invasive percutaneous spinal endoscopic method appears to be a safe and feasible option for calcified TDH.

Objectives: To conduct a comprehensive comparative assessment of clinical performance between the novel TaminoVIA intracranial stent system and the established LVIS for endovascular aneurysm reconstruction in unruptured intracranial aneurysms (UIAs).

Methods: This prospective, multi-center, randomized, open-label, parallel positive-controlled, non-inferiority trial was conducted by 13 centers in China. Patients with unruptured IAs were randomized in a 1:1 ratio to receive EVT with the TaminoVIA stent or the LVIS stent. The primary outcome was successful occlusion at 6-month follow-up, assessed by a blinded core laboratory. The non-inferiority boundary was set at 12%. Secondary outcomes included immediate procedural success, recanalization rates, and safety endpoints.

Results: Between March 2022 and April 2024, 203 patients were enrolled and randomized. Per-protocol set (PPS) analysis revealed that a 6-month successful occlusion rate of 98.89% (89/90) in the TaminoVIA stent group, compared to 95.60% (87/91) in the LVIS stent group, with a difference of +3.28% (95% CI, -1.45% to 8.02%; P<0.01). Full Analysis Set (FAS) analysis showed a 6-month successful occlusion rate of 89.90% (89/99) in the TaminoVIA stent group, compared to 87.00% (87/100) in the LVIS stent group, with a difference of +2.90% (95% CI, -5.97% to 11.77%; P<0.01). Both PPS and FAS analyses exceeded the non-inferiority boundary. Immediate occlusion rates were comparable (68.89% vs. 61.54%; P=0.35), and recanalization rates at 6 months were identical (1.11% vs. 1.10%; P>0.99).

Conclusions: The TaminoVIA stent demonstrated non-inferiority to LVIS in both efficacy and safety for IA embolization, with superior 6-month occlusion rates. These findings support its clinical adoption, though long-term durability requires further validation.

Clinical trial registration number: ChiCTR2400092436.

Clinical observations suggest relative preservation of endocrine function following midline incisions during transsphenoidal pituitary surgery, despite the gland's rich vascularity. This study aimed to investigate the intrapituitary microvascular architecture to identify a potential anatomical correlate for this functional resilience.

Methods: This descriptive observational study utilized three human cadaveric pituitary glands. Histological sections were prepared in sagittal and coronal planes. Immunohistochemistry for the endothelial marker CD34 was performed to assess microvascular density (MVD). MVD was quantified and compared between the central midline region and the peripheral zone in both sagittal and coronal sections.

Results: In the sagittal plane, MVD was significantly reduced in the midline region (mean: 7,642 vessels/mm²) compared to the peripheral region (mean: 31,330 vessels/mm²). Conversely, no significant difference in MVD was observed between the central (mean: 32,090 vessels/mm²) and peripheral (mean: 28,270 vessels/mm²) regions in the coronal plane.

Conclusion: This study identifies a distinct zone of relative hypovascularity along the sagittal midline of the human pituitary gland, which we propose naming the Pituitary entry zone (PEZ). This anatomical finding offers a potential histological basis for the observed preservation of pituitary function after midline surgical approaches. While limited by a small sample size, these results highlight a previously under-characterized aspect of pituitary angioarchitecture that may represent a safer corridor for surgical intervention. Further investigation correlating this anatomical finding with postoperative outcomes is warranted.

Background: In moyamoya disease (MMD), enhanced sulci on contrast-enhanced (CE) magnetic resonance (MR) vessel wall imaging (VWI) are more sensitive to blood flow changes than the fluid-attenuated inversion recovery (FLAIR) ivy sign. FLAIR ivy sign is associated with cerebral blood flow and cerebrovascular reserve (CVR) but this remains controversial. We aimed to clarify the correlation between the number of enhanced sulci on CE-MR VWI or FLAIR ivy signs and CVR, which is essential for treatment planning.

Methods: We retrospectively analyzed patients with MMD who underwent CE-MR VWI and acetazolamide SPECT in 2020-2025. Enhanced sulci on CE-MR VWI and FLAIR ivy signs were quantified in basal ganglia slices, divided into four regions per hemisphere. Correlations with CVR in corresponding regions were assessed.

Results: Among 58 patients, both enhanced sulci on CE-MR VWI and FLAIR ivy signs were most common in the middle cerebral artery (MCA) territory and least in the posterior cerebral artery territory. The correlation coefficient between the number of enhanced sulci and mean CVR across all regions was -0.718 (p<0.05) (strong correlation), while that between the number of FLAIR ivy signs and mean CVR was -0.473 (p<0.05) (weak correlation). Enhanced sulci on CE-MR VWI correlated strongly with CVR in bilateral anterior MCA regions (|r|>0.7), while the correlation between FLAIR ivy signs and CVR was weaker in these regions (|r|≤0.4).

Conclusions: The number of enhanced sulci on CE-MR VWI correlates more with reduced CVR than FLAIR ivy sign. CE-MR VWI may aid CVR estimation and guide MMD treatment.