World Neurosurgery: X最新文献

{"title":"Letter to the Editor regarding \"Using the modified frailty index as a predictor of complications in adults undergoing transforaminal interbody lumbar fusion\"","authors":"Muhammad Ibrahim","doi":"10.1016/j.wnsx.2025.100438","DOIUrl":"10.1016/j.wnsx.2025.100438","url":null,"abstract":"","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"26 ","pages":"Article 100438"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative utility analysis of Chordoma search information between ChatGPT vs. Google Web","authors":"Shankar S. Thiru ,&nbsp;Addisu Mesfin","doi":"10.1016/j.wnsx.2025.100437","DOIUrl":"10.1016/j.wnsx.2025.100437","url":null,"abstract":"<div><h3>Objective</h3><div>This study compares the utility of ChatGPT and Google searches in obtaining information about chordoma, a spine pathology. It is hypothesized that ChatGPT will provide a broader range of questions and more reliable sources due to its adaptive learning.</div></div><div><h3>Methods</h3><div>A Google and ChatGPT search for \"chordoma\" was performed, recording the first 10 FAQs and their sources. Responses to the 10 most common FAQs were collected and classified using the Rothwell scheme.</div></div><div><h3>Results</h3><div>There were 3 of 10 questions (30 %) similar amongst FAQs provided by a Google Web and ChatGPT search for the term “chordoma.” The most abundant Rothwell question category from Google, 4 of 10 questions (40 %), was “technical details.” The remaining questions were as follows: timeline of recovery (20 %), indications/management (20 %), and risks/complications (20 %). Pertaining to ChatGPT, the most abundant question classification was “specific activities,” 3 out of 10 questions (30 %). Remaining distribution was technical details (20 %), indications/management (20 %), risks/complications (20 %), and timeline of recovery (10 %). Regarding Google, 3 of the 10 questions asked were associated with a response from a commercial website, unlike 1 out of 10 for ChatGPT. In addition, ChatGPT predominantly utilized government sources (70 %), most frequently PubMed. Google's most abundant source type was academic (50 %). All numerical questions (100 %) had varied answers between Google and ChatGPT.</div></div><div><h3>Conclusion</h3><div>Differences exist between chordoma-related information from ChatGPT and Google. ChatGPT relies more on government sources, making it a useful adjunct tool for patients seeking spine pathology information. Further research is needed to assess its clinical applicability.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"26 ","pages":"Article 100437"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic radiosurgery alone for patients with 16 or more brain metastases: Retrospective single-institution analysis","authors":"Michael T. Milano ,&nbsp;Sara Hardy ,&nbsp;Dandan Zhang ,&nbsp;Terris Igwe ,&nbsp;Daniel Huang ,&nbsp;Amit K. Chowdhry ,&nbsp;Jihyung Yoon ,&nbsp;Tyler M. Schmidt ,&nbsp;Kevin A. Walter ,&nbsp;Hyunuk Jung ,&nbsp;Yuwei Zhou ,&nbsp;Kenneth Y. Usuki","doi":"10.1016/j.wnsx.2025.100432","DOIUrl":"10.1016/j.wnsx.2025.100432","url":null,"abstract":"<div><h3>Objective</h3><div>We sought to report outcomes of patients treated with linear accelerator-based stereotactic radiosurgery (SRS) alone (in one course) for 16+ brain metastases, without prior or planned whole-brain radiotherapy (WBRT).</div></div><div><h3>Methods</h3><div>We identified 29 eligible patients treated from 2019 to 2024, and retrospectively analyzed overall survival (OS) and cancer control outcomes. Twenty-eight underwent 3-fraction SRS (mostly 8–9 Gy per fraction), and 1 underwent single-fraction SRS (20 Gy).</div></div><div><h3>Results</h3><div>Primary cancers included non-small cell lung (<em>n</em> = 14), breast (<em>n</em> = 5) and kidney (<em>n</em> = 1) cancers, and melanoma (<em>n</em> = 9). For those who had undergone prior SRS for &lt;16 brain metastases (<em>n</em> = 9) versus those with newly diagnosed brain metastases (<em>n</em> = 20): 16–39 (median = 22) vs 16–41 (median = 26) brain metastases were treated; net lesion volumes were 0.2–10.0 (median = 2.0) vs 1.3–58.8 (median = 5.8) cc (<em>p</em> = 0.050); median OS was 19.8 vs 6.0 months (<em>p</em> = 0.47). Among all 29 patients, 10 underwent a second SRS for local recurrence (<em>n</em> = 2), new metastases (<em>n</em> = 7) or both (<em>n</em> = 1). Two underwent salvage WBRT, 1 received systemic therapy in lieu of WBRT and 4 developed intracranial disease progression not amenable to SRS (along with extracranial progression in 3) for whom WBRT was not consistent with their goals of care. One patient developed hemorrhagic transformation of a metastasis; no others experienced grade ≥3 late toxicity.</div></div><div><h3>Conclusions</h3><div>SRS-alone for 16+ brain metastases is well-tolerated in patients who, in general, experience poor OS. A multitude of factors confound assessment of potentially prognostic factors in our series. More study of SRS-alone for high-number multiple brain metastases is warranted.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"26 ","pages":"Article 100432"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in stroke-related mortality in California hospitals from 2010 to 2020: Have the large core stroke trials made a difference?","authors":"Suraj Shah ,&nbsp;Aymen Kabir ,&nbsp;Rithvik Ramesh ,&nbsp;Youssef Sibih ,&nbsp;Alexander F. Haddad ,&nbsp;Daniel S. Raper","doi":"10.1016/j.wnsx.2025.100436","DOIUrl":"10.1016/j.wnsx.2025.100436","url":null,"abstract":"<div><h3>Background</h3><div>Publicly reported hospital risk-adjusted mortality rates (RAMRs) reflect real-world outcomes and may be used to understand the impact of advances in medical evidence. Our study presents an analysis of RAMRs in California hospitals across the time period of publication of major trials in stroke intervention, to interrogate the effect of these trials upon population-level mortality from stroke.</div></div><div><h3>Methods</h3><div>Stroke (total acute, ischemic, hemorrhagic, subarachnoid hemorrhage) RAMR data from 2010 to 2020 was extracted from the California Hospital Inpatient Mortality Rates and Quality Ratings dataset. Hospitals were categorized by county population, size and type (academic/community). ANOVA with Tukey–Kramer and Bonferroni-corrected <em>t</em>-tests, and independent <em>t</em>-tests were used for statistical comparison of RAMRs across different population groups and hospital types.</div></div><div><h3>Results</h3><div>There was a statewide decline in acute stroke mortality from 11.4 % to 8.6 %, with ischemic stroke mortality decreasing from 24.9 % to 21.6 %. RAMRs decreased from 5.7 % to 5.0 % in community hospitals (<em>p</em> = 0.006), a trend not mirrored in academic settings. Hemorrhagic stroke RAMRs fluctuated, while subarachnoid hemorrhage RAMRs increased, except in academic institutions. Hospitals in the &gt;2M population group had significantly lower RAMRs (<em>p</em> &lt; 0.005) than the 0-500k group. There were no significant RAMR differences between academic and community hospitals across all stroke types.</div></div><div><h3>Conclusions</h3><div>Despite the publication of paradigm-shifting trials, California in-patient stroke mortality only modestly changed, reflecting the complexity of replicating clinical trial outcomes in real-world data. Consistent, longitudinal quality and outcome metrics at state and national levels remain essential for understanding the impact of clinical research and innovation.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"26 ","pages":"Article 100436"},"PeriodicalIF":0.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of body mass index on perioperative complications, radiographic outcomes, and pseudoarthrosis at one year after transforaminal lumbar interbody fusion: A retrospective cohort study","authors":"Joseph E. Nassar,&nbsp;Ashley Knebel,&nbsp;Manjot Singh,&nbsp;Michael J. Farias,&nbsp;Mohammad Daher,&nbsp;Bassel G. Diebo,&nbsp;Alan H. Daniels","doi":"10.1016/j.wnsx.2025.100431","DOIUrl":"10.1016/j.wnsx.2025.100431","url":null,"abstract":"<div><h3>Background</h3><div>Obesity rates have been increasing. Patients with high Body Mass Index (BMI) face unique perioperative complications including increased hospital stays, operative time and infection rates. Conflicting studies exist regarding the impact of obesity on patient-reported outcomes (PROMs) and alignment correction.</div></div><div><h3>Methods</h3><div>Adult patients who underwent transforaminal interbody fusion (TLIF) at a single academic institution were identified. Patient demographics, procedural characteristics, complications, preoperative to one-year postoperative radiographic parameters and PROMs were compared. Multivariate regression analyses were done, accounting for age, sex, BMI, Charlson Comorbidity Index and number of segments fused.</div></div><div><h3>Results</h3><div>Among 295 patients, 44 had BMI ≤24.9, 92 had 25 ≤ BMI ≤29.9, 75 had 30 ≤ BMI ≤34.9 and 84 had BMI ≥35. With each 10-unit BMI increase, hospital stays increased by 0.54 days (<em>r</em> = 0.34) and blood loss by 80.47 mL (<em>r</em> = 0.53) (<em>p</em> &lt; 0.05). Pseudoarthrosis was 128.0 % more likely with every 10-unit BMI increase (<em>p</em> &lt; 0.05). AUC of 0.75 (0.62–0.87). Radiographic parameters showed that each 10-unit increase in BMI was associated with 2.21° less L4-S1 lordosis and 2.22° less L1-S1 lordosis change at 1-year follow-up (<em>p</em> &lt; 0.05). PROMs were similar across BMI groups (<em>p</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>Higher BMI is associated with higher odds of pseudoarthrosis. Despite decreased lordosis correction, excellent PROMs were achieved across BMI categories. In future studies, BMI as a continuous variable may better predict complications. Additionally, BMI may be considered in preoperative planning for patients undergoing TLIF surgery to optimize outcomes.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"26 ","pages":"Article 100431"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the virtual global spine conference: Reflections on accessibility, engagement, and education","authors":"Aditi Choudhary ,&nbsp;Ben Carnovale ,&nbsp;Raj Swaroop Lavadi ,&nbsp;Kathryn Hoes","doi":"10.1016/j.wnsx.2025.100430","DOIUrl":"10.1016/j.wnsx.2025.100430","url":null,"abstract":"","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"26 ","pages":"Article 100430"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143508774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to ‘Cost differences between autologous and nonautologous cranioplasty implants: A propensity score–matched value driven outcomes analysis’ [World Neurosurgery: X (22C) (2024) (100358)]","authors":"Matthew Findlay ,&nbsp;Sawyer Z. Bauer ,&nbsp;Diwas Gautam ,&nbsp;Matthew Holdaway ,&nbsp;Robert B. Kim ,&nbsp;Walid K. Salah ,&nbsp;Spencer Twitchell ,&nbsp;Sarah T. Menacho ,&nbsp;Gurpreet S. Gandhoke ,&nbsp;Ramesh Grandhi","doi":"10.1016/j.wnsx.2024.100424","DOIUrl":"10.1016/j.wnsx.2024.100424","url":null,"abstract":"<div><h3>Objective</h3><div>Despite having higher rates of failure and revision than other implant materials, autologous bone implants are the historical gold standard for restoring cranial defects after decompressive hemicraniectomy. More reliable synthetic implants have been developed, but they are significantly more expensive than autologous bone. The authors sought to compare the initial and long-term costs of custom synthetic implants and autologous cranioplasty grafts.</div></div><div><h3>Methods</h3><div>The authors reviewed the hospital billing records over a 12-year period at their institution to identify patients who underwent cranioplasty after decompressive hemicraniectomy for trauma or stroke. The costs for imaging, hospital supplies, implants, pharmacy services, facility usage, and laboratory studies were captured for initial surgeries and for subsequent cranioplasty-related revision hospitalizations and surgeries. Clinical characteristics, long-term outcomes, and cost differences of autologous versus custom implants were compared by using univariate and multivariate analyses. These analyses were repeated after propensity-score matching adjusted for factors predictive of cranioplasty failure.</div></div><div><h3>Results</h3><div>On unmatched analysis, 32 custom and 128 autologous implants were analyzed. Differences in initial cranioplasty failure rates between custom and autologous grafts were insignificant (12.5 % custom vs. 23.4 % autologous, p = 0.18). On univariate analysis, autologous implants cost 46.8 % of custom grafts during the initial hospitalization period (p &lt; 0.01) and 58.7 % of custom grafts once long-term aggregated costs were factored (p &lt; 0.01). Upon multivariate analysis, although custom cranioplasty was independently predictive of higher initial hospitalization costs (standardized β = 0.20, p &lt; 0.01), it was not predictive of long-term total aggregated costs (standardized β = 0.10, p = 0.13). After propensity score matching (29 custom, 29 autologous cases), multivariate analysis of the matched cohorts likewise found custom implants were predictive of greater initial hospitalization costs (standardized β = 0.56, p &lt; 0.01), but were not an independent driver of aggregated long-term costs (standardized β = 0.22, p = 0.11).</div></div><div><h3>Conclusion</h3><div>Our matched and unmatched multivariate analysis found nonsignificant cost differences between custom and autologous cranioplasties once initial and long-term costs were aggregated, suggesting custom implants could be considered as a primary therapeutic intervention.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"25 ","pages":"Article 100424"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to ‘Role of nanotechnology in neurosurgery: A review of recent advances and their applications’ [World Neurosurgery: X (22C) (2024)100298)]","authors":"Javed Iqbal ,&nbsp;Evan Courville ,&nbsp;Syed Faraz Kazim ,&nbsp;Michael Kogan ,&nbsp;Meic H. Schmidt ,&nbsp;Christian A. Bowers","doi":"10.1016/j.wnsx.2024.100426","DOIUrl":"10.1016/j.wnsx.2024.100426","url":null,"abstract":"<div><div>The use of nanotechnology in medicine and healthcare is known as nanomedicine. These nanoparticles exhibit significant potential in medicine, including in imaging techniques and diagnostic tools, tissue-engineered constructs, drug delivery systems, pharmaceutical therapeutics, and implants. The association with neurosurgery had been less well established compared to other organ systems but has recently offered the promising future potential for a wide range of utilities, including CNS drug delivery, neuro-regeneration, neuro oncology, neuroimaging, and neuromodulation. This review summarizes the current developments in nanotechnology and nanomedicine that may yield future neurosurgery applications. A literature review was carried out with a focus on the use of nanotechnology and nanoparticles in the field of neurosurgery and its future implications. Although most therapeutic strategies involving nanotechnology discussed are still in an early experimental stage, it is expected that research on such frontline field will bring a major impact in several neurosurgical areas, opening new opportunities for the treatment of CNS neoplasms, neurodegenerative processes as well as vascular and traumatic injuries.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"25 ","pages":"Article 100426"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to “The usefulness of surgical drains on short term outcomes among patients undergoing craniotomy at the Bugando Medical Centre, Mwanza Tanzania” [World Neurosurgery: X(22C) (2024) (100323)]","authors":"Dennis Onsombi ,&nbsp;Gerald Mayaya ,&nbsp;Vladimir Herrera ,&nbsp;Anton Manyanga ,&nbsp;Washington Leonald ,&nbsp;Samuel Byabato ,&nbsp;James Lubuulwa","doi":"10.1016/j.wnsx.2024.100422","DOIUrl":"10.1016/j.wnsx.2024.100422","url":null,"abstract":"<div><h3>Background</h3><div>Postcraniotomy surgical drain placement is commonly used worldwide after various cranial surgical interventions despite the controversy surrounding their use leaving it to the surgeon's preference rather than evidence based practice. However, with the paucity of published data regarding utility in Tanzania, we sought out to determine the occurrence of SFC, incidence of SSI and the length of hospital stay among patients who underwent craniotomies.</div></div><div><h3>Methods</h3><div>This was a prospective cohort study conducted to determine the occurrence of SFC, rate of SSI and the length of hospital stay among patients who underwent craniotomies at BMC from Feb to June 2022. Patients were divided into two groups based on whether or not have undergone placement of drainage tube following craniotomy and data was collected, entered into Epi-Info version 7.0, extracted as Microsoft-Excel and analyzed using STATA v.13.0 software. Medians and proportions were utilized to describe data, and appropriate statistical tests applied whenever necessary to check for statistical significance. Ethical clearance was sought from the institution board to proceed with the study.</div></div><div><h3>Results</h3><div>A total of 77 patients were enrolled into the study, the median patient age (IOR) was 33(18–55) years, and 55 % of patients were males, giving male to female ratio of 2:1. Postcraniotomy drains were used in 36.36 %(28/77) of the patients. Of the craniotomy procedures 52(67.5 %) were due to trauma. Surgical site infection was encountered in 4 patients (5.2 %), subgaleal fluid collection among 11 patients (14.28 %) although this was not significant among the two groups on univariate analysis p = 0.538 and 0.624 respectively. The length of hospital stay was similar in both drainage and non-drainage groups (p = 0.498). In a bivariate analysis on drain use vs patient factors, dural closure (P value= &lt;0.001),skin closure (P value= &lt;0.001) and cormobidities (p value = 0.013),for which on further multivariate regression, watertight dural closure (p = 0.015, OR = 14.15) was found to be associated with less likelihood of drainage use.</div></div><div><h3>Conclusion</h3><div>In this single center observational study, we noted that outcomes of patients with post-craniotomy drains were largely equivalent and non-inferior to those without drains who underwent craniotomy for similar neurosurgical conditions at our institution with no statistical significance in terms of occurrence of subgaleal fluid collection, incidence of surgical site infection and length of hospital stay. The use of watertight dura closure significantly reduces the occurrence of SFC. Larger well randomized control and multicentered studies are recommended to further validate our findings.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"25 ","pages":"Article 100422"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to ‘Efficacy and safety of local fibrinolytic therapy in intracranial hemorrhages: A systematic review and meta-analysis of randomised controlled trials’ [World Neurosurgery: X (22C) (2024) 100316]","authors":"Arun Babu Rajeswaran ,&nbsp;Arshad Ali ,&nbsp;Saleh Safi ,&nbsp;Ahmed Eid Abdulghani Saleh","doi":"10.1016/j.wnsx.2024.100423","DOIUrl":"10.1016/j.wnsx.2024.100423","url":null,"abstract":"<div><h3>Background</h3><div>Local fibrinolytic therapy for ICH and IVH are used to dissolve clots, but their role remains debatable. This review aims to study the efficacy and safety of local fibrinolytic therapy.</div></div><div><h3>Methods</h3><div>Medline, Embase, CINAHL Plus, Cochrane, Scopus, Web of science, clinical trials.gov, WHO and EU Clinical Trials Register were searched for RCTs only, on intra-clot fibrinolytics vs standard treatments for ICH and IVH.</div></div><div><h3>Results</h3><div>Thirteen RCTs were included in the final data synthesis<strong>.</strong> In pooled analysis for IVH, fibrinolysis vs saline showed reduced mortality [RR-0.63 (0.46, 0.85)], less risk of ventriculitis [RR-0.59 (0.35, 1.00)] and higher daily reduction in clot size percentage [SMD-0.93 (0.39, 1.47)] with fibrinolysis but found no significant difference in functional outcome [RR-1.07 (0.88, 1.30)], in the risk of new bleedings [RR-1.36 (0.44, 4.23)] and shunt-dependent hydrocephalus (RR-1.10 [0.77, 1.59)]. In pooled analysis for ICH, with fibrinolysis vs standard craniotomy, there was a reduced mortality [RR-0.65 (0.20, 2.51)] with decreased risk for new hemorrhages in the fibrinolysis arm [RR-0.48 (0.30, 0.78)] while in fibrinolysis vs standard medical treatment, the trend was also a reduced mortality [RR-0.83 (0.65, 1.05)] with favourable outcome [RR-1.20 (1.00, 1.44)] and higher risk of new bleeds (RR-2.27 [1.23, 4.19]) but no significant difference in brain infections (RR-1.34 [0.24, 7.49]).</div></div><div><h3>Conclusion</h3><div>Local fibrinolytic therapy in ICH and IVH decreases mortality and improves the clot resolution but shows no substantial gain in the good functional outcome and has increased risk of new hemorrhages. Further studies required to consolidate evidence for their efficacy and safety.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"25 ","pages":"Article 100423"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}