World Neurosurgery: X最新文献_第10页

Potential use of decorin in preventing cerebral vasospasm through the inhibition of transforming growth factor-beta activity: Insights from an experimental rabbit subarachnoid hemorrhage model 通过抑制转化生长因子- β活性来预防脑血管痉挛的潜在用途：来自实验性兔蛛网膜下腔出血模型的见解

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-09-08 DOI: 10.1016/j.wnsx.2025.100520

Betul Yaman , Gulce Gel , Cengiz Tuncer , Sahin Hanalioglu , Husamettin Bulut , Ata Turker Arikok , Bora Gurer , Erhan Turkoglu

Objective

The development of vasospasm after subarachnoid hemorrhage (SAH) is a major cause of death and disability. It leads to structural changes such as smooth muscle and myofibroblast proliferation, necrosis, intimal hyperplasia, and vascular fibrosis. Transforming growth factor-beta1 (TGF-β1) activates nonmuscular myofibroblasts, promoting cerebral vasoconstriction. Decorin, a natural TGF-β inhibitor, has not yet been evaluated for its potential to prevent SAH-induced vasospasm. This study aimed to investigate the effects of decorin on cerebral vasculopathy and hippocampal injury in a rabbit model of TGF-β-induced vasospasm.

Methods

Thirty-two male New Zealand white rabbits (2.5–4 kg) were randomly assigned to four groups: control, SAH, decorin, and TGF-β1. Except for the control group, all underwent the SAH procedure. The decorin group received 100 μg/kg decorin intraperitoneally for 3 days; the TGF-β1 group received 50 μg TGF-β1 intracisternally in 1 cc autologous CSF. Animals were sacrificed at 72 h using perfusion–fixation. Basilar artery cross-sectional area, wall thickness, and hippocampal degeneration scores were assessed using histopathological and statistical analysis systems.

Results

Based on statistical analyses, decorin treatment significantly increased the cross-sectional area of the basilar artery but significantly reduced the wall thicknesses compared with those in the SAH and TGF-β1 groups. Furthermore, hippocampal neuronal degeneration scores were significantly lower in the decorin and control groups than in the SAH and TGF-β1 groups. There were no significant differences between the groups in terms of proliferating cell nuclear antigen.

Conclusion

Decorin treatment in rabbits with experimentally induced SAH ameliorated TGF-β1-induced vasospasm, cerebral vasculopathy associated with vascular wall fibrosis, and subsequent decreased vessel wall thickness.

目的蛛网膜下腔出血（SAH）后发生血管痉挛是导致死亡和残疾的主要原因。它导致结构改变，如平滑肌和肌成纤维细胞增生、坏死、内膜增生和血管纤维化。转化生长因子-β1 （TGF-β1）激活非肌成纤维细胞，促进脑血管收缩。Decorin是一种天然的TGF-β抑制剂，尚未对其预防sah诱导的血管痉挛的潜力进行评估。本研究旨在探讨decorin对TGF-β诱导的兔血管痉挛模型脑血管病和海马损伤的影响。方法32只雄性新西兰大白兔（2.5 ~ 4 kg）随机分为对照组、SAH组、decorin组和TGF-β1组。除对照组外，其余患者均行SAH手术。decorin组腹腔注射decorin 100 μg/kg，连续3 d；TGF-β1组灌胃TGF-β1 50 μg，灌胃1cc自体脑脊液。72h处死动物，采用灌注固定。使用组织病理学和统计分析系统评估基底动脉横截面积、壁厚和海马变性评分。结果经统计学分析，与SAH和TGF-β1组比较，decorin治疗显著增加基底动脉横截面积，显著降低基底动脉壁厚。此外，与SAH和TGF-β1组相比，decorin组和对照组海马神经元变性评分明显降低。各组间增殖细胞核抗原差异无统计学意义。结论对实验性SAH家兔进行decorin治疗可改善TGF-β1诱导的血管痉挛、脑血管病伴血管壁纤维化，并随之降低血管壁厚度。

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引用次数: 0

Stereotactic radiosurgery for brain metastases from non-uterine Leiomyosarcoma: A retrospective case series 立体定向放射外科治疗非子宫平滑肌肉瘤脑转移：回顾性病例系列

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-09-05 DOI: 10.1016/j.wnsx.2025.100517

Juan J. Cardona, Yusuke S. Hori, Ahed H. Kattaa, Paul M. Harary, Fred C. Lam, Deya Abu-Reesh, Louisa Ustrzynski, Sara C. Emrich, Armine Tayag, Melanie Hayden-Gephart, David J. Park, Steven D. Chang

Purpose

Leiomyosarcoma (LMS) is a rare malignant mesenchymal cancer derived from smooth muscle cells. The estimated incidence of brain metastases (BM) from uterine LMS ranges between 0.058 and 0.128 per 100,000 women. Moreover, studies focused on non-uterine LMS BM, and their management are scant. Herein, we determined the efficacy and safety of stereotactic radiosurgery (SRS) for the treatment of patients with BM secondary to non-uterine LMS.

Methods

We identified patients with BM from non-uterine LMS who underwent CyberKnife (CK) SRS treatment. Patient, lesion, treatment, and outcome data were documented. The radiological response was evaluated per RECIST guidelines. Statistical analysis included Kaplan–Meier survival estimates and descriptive statistics.

Results

This study included 16 tumors found in four patients (mean age: 57 ± 17.9 years) with a mean overall survival of 14 months (95 % CI: 5.88–22.12 months). The lesions were located predominantly in the supratentorial region (62.5 %). The median lesion volume was 1.89 cm³, with most lesions treated in a single fraction (87.5 %) using a median dose of 20 Gy. At 3- and 6-month follow-ups, complete or partial responses were observed in 75 % of lesions, with local progression-free survival (PFS) rates of 100 % at 3 months and 75 % at 6 and 12 months. Only one lesion showed progression, consistent with radiation necrosis.

Conclusions

Prior studies focused on uterine LMS BM alone or lacked tumor site stratification. Our study, the largest on non-uterine LMS BM, is the first to assess CK SRS as a standalone treatment, demonstrating its efficacy in local tumor control and PFS.

目的平滑肌肉瘤（LMS）是一种罕见的起源于平滑肌细胞的恶性间充质癌。子宫LMS脑转移（BM）的发生率估计在0.058至0.128 / 100,000女性之间。此外，研究主要集中在非子宫LMS BM，他们的管理很少。在此，我们确定了立体定向放射手术（SRS）治疗继发于非子宫LMS的BM患者的有效性和安全性。方法选择非子宫LMS患者行射波刀（CK） SRS治疗。记录患者、病变、治疗和结果数据。根据RECIST指南评估放射反应。统计分析包括Kaplan-Meier生存估计和描述性统计。结果4例患者16例肿瘤（平均年龄：57±17.9岁），平均总生存期为14个月（95% CI: 5.88-22.12个月）。病变主要位于幕上区（62.5%）。中位病灶体积为1.89 cm3，大多数病灶在单个部位治疗（87.5%），中位剂量为20 Gy。在3个月和6个月的随访中，75%的病变完全或部分缓解，3个月时局部无进展生存率为100%，6个月和12个月时为75%。只有一个病变出现进展，符合放射性坏死。结论以往的研究主要集中在子宫LMS的单独研究或缺乏肿瘤部位分层。我们的研究是最大的非子宫LMS BM研究，也是第一个评估CK SRS作为独立治疗的研究，证明其在局部肿瘤控制和PFS方面的有效性。

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引用次数: 0

Postoperative sagittal alignment measurements independently predict clinical outcomes after anterior cervical discectomy with anterior or circumferential fusion 术后矢状位测量可独立预测前路颈椎椎间盘切除术合并前路或周向融合后的临床结果

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-09-05 DOI: 10.1016/j.wnsx.2025.100515

Daniele Armocida , Giuseppa Zancana , Antonio Sportelli , Fabio Cofano , Diego Garbossa , Alessandro Frati

Background

Several studies have reported the impact of cervical sagittal alignment on surgical outcomes, with limited results. The primary objective of this study is to determine whether postoperative cervical sagittal balance is an independent predictor of health-related quality of life outcomes after anterior cervical discectomy (ACD) with anterior or circumferential fusion.

Methods

A retrospective observational study on a cohort of 91 patients undergoing ACD was examined. Preoperative and postoperative cervical lordotic angle, C2, C7, T1, Occipital slope and C2-C7 sagittal vertical axis (SVA) was measured on standing lateral cervical spine radiographs. Outcome was assessed with 3 disease-specific measures: post-operative recurrent neck pain, complete functional recovery (NDI = 0–20 %) and the patient's self-reported limitation of neck mobility. Clinical data, level of disease, presence of myelopathy, and surgical technique were evaluated in a multivariate analysis.

Results

C2-C7 SVA values exhibited the greatest variability among the treated cases. The postoperative change in C2-C7 SVA, demonstrated a significant distinction between subjects who experienced complete recovery for all the three outcome items at the end of follow-up (t-test: p test: p = 0.050.05). Low C2-C7 SVA values showed a positive correlation with the patient's functional recovery time (p = 0.03) and time to postoperative pain relapse (p = 0.04).

Conclusion

This study emphasizes the importance of considering postoperative sagittal alignment measurements in assessing patient outcomes after ACD surgery and fusion. Low C2-C7 SVA values (less than 30 mm) were indicative of shorter recovery times and improved outcomes.

背景：一些研究报道了颈椎矢状位对齐对手术结果的影响，但结果有限。本研究的主要目的是确定颈椎矢状面平衡是否是前路颈椎椎间盘切除术（ACD）合并前路或周向融合后健康相关生活质量的独立预测指标。方法对91例ACD患者进行回顾性观察研究。站立位颈椎侧位片测量术前和术后颈椎前凸角、C2、C7、T1、枕坡和C2-C7矢状垂直轴（SVA）。结果通过3种疾病特异性指标进行评估：术后复发性颈部疼痛、完全功能恢复（NDI = 0-20 %）和患者自我报告的颈部活动受限。临床资料、疾病水平、脊髓病的存在和手术技术在多变量分析中进行评估。结果sc2 - c7 SVA值在治疗病例中表现出最大的变异性。术后C2-C7 SVA的变化表明，随访结束时所有三个结果项目完全恢复的受试者之间存在显著差异（t检验：p检验：p = 0.050.05）。低的C2-C7 SVA值与患者功能恢复时间（p = 0.03）和术后疼痛复发时间（p = 0.04）呈正相关。结论：本研究强调了在评估ACD手术和融合后患者预后时考虑术后矢状位测量的重要性。较低的C2-C7 SVA值（小于30 mm）表明恢复时间较短，预后较好。

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引用次数: 0

Total iron and Fe2+ concentration in cerebrospinal fluid are strongly correlated with the incidence of hydrocephalus in intracerebral hemorrhage patients with intraventricular extension 脑脊液总铁和Fe2+浓度与脑出血脑室扩张患者脑积水发生率密切相关

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-09-04 DOI: 10.1016/j.wnsx.2025.100514

Petra Octavian Perdana Wahjoepramono , Aloysius Bagus Sasongko , Danny Halim , Kurnia Wahyudi , Achmad Adam , Yeo Tseng Tsai , Eka Julianta Wahjoepramono , Julius July , Tri Hanggono Achmad

Background

Hydrocephalus is a known complication of spontaneous intracerebral hemorrhage (ICH) extending into the cerebral ventricles (Intraventricular Hemorrhage, IVH) and is associated with poorer patient outcomes. Accurately predicting the risk of shunt-dependent hydrocephalus could help anticipate the need for permanent CSF diversion in these patients and improve outcomes. Based on the suspected molecular pathogenesis of hydrocephalus, certain biomarkers may be reliable predictors of shunt-dependent hydrocephalus in ICH + IVH patients.

Aim

This study aimed to test the reliability of Fe²⁺, Fe³⁺, total iron concentration, and high mobility group box 1 (HMGB1) protein levels in the cerebrospinal fluid to predict the risk of shunt-dependent hydrocephalus in patients with ICH + IVH.

Methods

This prospective cohort study included all adult ICH + IVH patients with hydrocephalus admitted to Siloam Hospitals Lippo Village between March 2021 and December 2023. Patient demographics, radiological characteristics, and CSF samples were analyzed to evaluate the clinical, radiological, and molecular parameters associated with the risk of shunt-dependent hydrocephalus.

Results

Thirty-six patients were included. Seventeen patients (47.2 %) developed shunt-dependent hydrocephalus. Analysis showed that increased total Fe (p = 0.048) and Fe²⁺ (p = 0.045) concentrations were significantly associated with the incidence of hydrocephalus. The AUCs of total iron (0.716), Fe²⁺ (0.758), Fe³⁺ (0.651), and HMGB1 (0.722) were higher than that of the mGraeb score (0.528) in predicting shunt-dependent hydrocephalus.

Conclusion

CSF total iron and Fe²⁺ levels are reliable predictors of hydrocephalus in patients with ICH + IVH. These biomarkers are more sensitive and specific in predicting shunt-dependent hydrocephalus compared to the mGraeb score.

背景：脑积水是自发性脑出血（ICH）延伸至脑室（IVH）的一种已知并发症，与较差的患者预后相关。准确预测分流依赖性脑积水的风险有助于预测这些患者是否需要永久性脑脊液分流并改善预后。基于脑积水的可疑分子发病机制，某些生物标志物可能是脑出血+ IVH患者分流依赖性脑积水的可靠预测指标。目的探讨脑脊液中Fe2+、Fe3+、总铁浓度及HMGB1蛋白水平预测ICH + IVH患者分流依赖性脑积水风险的可靠性。方法本前瞻性队列研究纳入2021年3月至2023年12月期间在西罗亚医院力宝村住院的所有成年ICH + IVH脑积水患者。分析患者人口统计学、放射学特征和脑脊液样本，以评估与分流依赖性脑积水风险相关的临床、放射学和分子参数。结果共纳入36例患者。17例（47.2%）发生分流依赖性脑积水。分析显示，总Fe （p = 0.048）和Fe2+ (p = 0.045)浓度升高与脑积水发生率显著相关。总铁（0.716）、Fe2+(0.758)、Fe3+(0.651)和HMGB1（0.722）的auc预测分流依赖性脑积水高于mgraaeb评分（0.528）。结论脑脊液总铁和Fe2+水平是脑出血+ IVH患者脑积水的可靠预测指标。与mGraeb评分相比，这些生物标志物在预测分流依赖性脑积水方面更加敏感和特异性。

{"title":"Total iron and Fe2+ concentration in cerebrospinal fluid are strongly correlated with the incidence of hydrocephalus in intracerebral hemorrhage patients with intraventricular extension","authors":"Petra Octavian Perdana Wahjoepramono , Aloysius Bagus Sasongko , Danny Halim , Kurnia Wahyudi , Achmad Adam , Yeo Tseng Tsai , Eka Julianta Wahjoepramono , Julius July , Tri Hanggono Achmad","doi":"10.1016/j.wnsx.2025.100514","DOIUrl":"10.1016/j.wnsx.2025.100514","url":null,"abstract":"<div><h3>Background</h3><div>Hydrocephalus is a known complication of spontaneous intracerebral hemorrhage (ICH) extending into the cerebral ventricles (Intraventricular Hemorrhage, IVH) and is associated with poorer patient outcomes. Accurately predicting the risk of shunt-dependent hydrocephalus could help anticipate the need for permanent CSF diversion in these patients and improve outcomes. Based on the suspected molecular pathogenesis of hydrocephalus, certain biomarkers may be reliable predictors of shunt-dependent hydrocephalus in ICH + IVH patients.</div></div><div><h3>Aim</h3><div>This study aimed to test the reliability of Fe<sup>2+</sup>, Fe<sup>3+</sup>, total iron concentration, and high mobility group box 1 (HMGB1) protein levels in the cerebrospinal fluid to predict the risk of shunt-dependent hydrocephalus in patients with ICH + IVH.</div></div><div><h3>Methods</h3><div>This prospective cohort study included all adult ICH + IVH patients with hydrocephalus admitted to Siloam Hospitals Lippo Village between March 2021 and December 2023. Patient demographics, radiological characteristics, and CSF samples were analyzed to evaluate the clinical, radiological, and molecular parameters associated with the risk of shunt-dependent hydrocephalus.</div></div><div><h3>Results</h3><div>Thirty-six patients were included. Seventeen patients (47.2 %) developed shunt-dependent hydrocephalus. Analysis showed that increased total Fe (<em>p</em> = 0.048) and Fe<sup>2+</sup> (<em>p</em> = 0.045) concentrations were significantly associated with the incidence of hydrocephalus. The AUCs of total iron (0.716), Fe<sup>2+</sup> (0.758), Fe<sup>3+</sup> (0.651), and HMGB1 (0.722) were higher than that of the mGraeb score (0.528) in predicting shunt-dependent hydrocephalus.</div></div><div><h3>Conclusion</h3><div>CSF total iron and Fe<sup>2+</sup> levels are reliable predictors of hydrocephalus in patients with ICH + IVH. These biomarkers are more sensitive and specific in predicting shunt-dependent hydrocephalus compared to the mGraeb score.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100514"},"PeriodicalIF":2.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prediction of perioperative ischemic events in flow diverter implantation using the adenosine diphosphate-induced platelet aggregation level system 应用二磷酸腺苷诱导血小板聚集水平系统预测分流器植入围手术期缺血事件

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-09-03 DOI: 10.1016/j.wnsx.2025.100518

Kenji Shoda , Keisuke Kitano , Yoshihiko Ueno , Ryosuke Nakanishi , Tasuku Sakayori , Ayumu Kanbe , Aki Oka , Daisuke Mizutani , Ryosuke Kikuchi , Yukiko Enomoto

Objective

Platelet reactivity is associated with perioperative complications during flow diverter (FD) implantation. Our study aimed to evaluate the association between adenosine diphosphate-induced platelet aggregation level (APAL) a platelet reactivity scoring system using light transmission methods and ischemic complications after FD implantation.

Methods

This retrospective study included 47 patients who underwent FD implantation for cerebral aneurysms between September 2020 and December 2023 at our institution and who were taking two or more antiplatelet agents before the procedure. Platelet reactivity was assessed using APAL scoring and VerifyNow, with evaluations conducted preoperatively, 1–3 days postoperatively, 1 month postoperatively, and at the time of ischemic complications.

Results

Ischemic complications occurred in four patients (8.5 %). The correlation coefficient between APAL and the P2Y12 reaction units (PRU) measured over the entire period was r = 0.553 (p < 0.001). Preoperative APAL values were significantly high in patients with ischemic complications (p = 0.024). The optimal cutoff APAL value calculated from the receiver operating characteristic curve, was 6.6. The APAL system exhibited a moderate correlation with PRU measurements.

Conclusion

As a fully automated test, APAL is characterized by fewer manual errors than conventional methods. Therefore, APAL may be useful for evaluating antiplatelet function during FD implantation.

目的探讨血小板反应性与分流器植入术围手术期并发症的关系。本研究旨在评价二磷酸腺苷诱导血小板聚集水平（APAL）与FD植入后缺血性并发症的关系。APAL是一种基于光透射法的血小板反应性评分系统。方法本回顾性研究包括47例于2020年9月至2023年12月在我院接受FD脑动脉瘤植入的患者，这些患者术前服用了两种或两种以上的抗血小板药物。采用APAL评分和VerifyNow评估血小板反应性，分别在术前、术后1 - 3天、术后1个月和出现缺血性并发症时进行评估。结果缺血性并发症4例（8.5%）。APAL与全周期测量的P2Y12反应单元（PRU）的相关系数为r = 0.553 （p < 0.001）。缺血性并发症患者术前APAL值显著增高（p = 0.024）。根据受试者工作特性曲线计算的最佳截止APAL值为6.6。APAL系统与PRU测量值表现出适度的相关性。结论APAL是一种完全自动化的检测方法，与传统方法相比，人工误差更少。因此，APAL可用于评价FD植入期间的抗血小板功能。

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引用次数: 0

Assessment of cognitive dysfunction in patients with temporal contusions undergoing surgical evacuation 颞部挫伤术后患者认知功能障碍的评估

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-09-03 DOI: 10.1016/j.wnsx.2025.100516

Sebastián Ordoñez-Cure , Lina M. Villegas-Trujillo , Carlos A. Hurtado-González , Sebastián Ospina-Otálvaro , César O. Quintero-Moreno , Santiago J. González-Daza , Juan F. Ayala-Rico , Óscar A. Escobar-Vidarte

Background

Traumatic brain injury (TBI) is a leading cause of death and disability, with cognitive sequelae affecting over six million people annually. These impairments can affect the patients social, familial, and work-related relationships, as well as their overall quality of life. This study aimed to identify cognitive dysfunction patterns in patients with temporal contusions requiring surgical drainage and assess their functional outcomes.

Methods

This cross-sectional cohort study was conducted at Hospital Universitario del Valle, Cali, Colombia, involving TBI patients with temporal contusions who underwent surgical drainage (craniectomy or craniotomy) between 2018 and 2022. Eligibility criteria included patients aged 15–70 requiring surgery, who underwent neuropsychological evaluation at least six months post-surgery. Exclusion criteria included vegetative state, lack of informed consent, and prior psychiatric disorders.

Results

The TBI group showed significant cognitive impairments, particularly in executive functions, memory, and language processing. Statistically significant differences were found in MoCA, FAB, Digit Span, and Boston Naming Test (p < 0.001). Three neurocognitive clusters were identified: Cluster 1 had deficits in memory, language, and executive functions; Cluster 2 showed high mental health scores according to the GHQ-28 test and moderate working memory performance; Cluster 3 exhibited enhanced cognitive abilities and attained low scores on the GHQ-28, indicating a favorable psychological well-being profile.

Conclusions

TBI patients with temporal contusions requiring surgical drainage exhibit significant cognitive dysfunction, particularly in executive functions, memory, and language. Individualized rehabilitation strategies are needed, and further research should focus on larger samples and more specific neurocognitive testing.

背景创伤性脑损伤（TBI）是导致死亡和残疾的主要原因，每年有超过600万人受到其认知后遗症的影响。这些障碍会影响患者的社会、家庭和工作关系，以及他们的整体生活质量。本研究旨在识别需要手术引流的颞挫伤患者的认知功能障碍模式，并评估其功能预后。方法本横断面队列研究在哥伦比亚Cali del Valle大学医院进行，涉及2018年至2022年期间接受手术引流（颅骨切除术或开颅术）的颞叶挫伤TBI患者。入选标准包括15-70岁需要手术的患者，术后至少6个月接受神经心理学评估。排除标准包括植物人状态、缺乏知情同意和既往精神疾病。结果脑外伤组表现出明显的认知障碍，特别是在执行功能、记忆和语言处理方面。MoCA、FAB、Digit Span和Boston Naming Test的差异有统计学意义（p < 0.001）。确定了三个神经认知集群：集群1在记忆、语言和执行功能方面存在缺陷；聚类2的GHQ-28测验心理健康得分高，工作记忆表现中等；第三组表现出认知能力增强，GHQ-28得分较低，表明心理健康状况良好。结论需要手术引流的颞挫伤患者表现出明显的认知功能障碍，尤其是执行功能、记忆和语言功能障碍。个性化的康复策略是必要的，进一步的研究应该集中在更大的样本和更具体的神经认知测试上。

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引用次数: 0

Robotic Spine Fusion Bridges the Surgeon Learning Gap: A 5-Year Analysis of Screw Placement Accuracy and Efficiency Between Experienced and Inexperienced Surgeons 机器人脊柱融合术弥合了外科医生的学习差距：经验丰富和经验不足的外科医生之间5年螺钉放置准确性和效率的分析

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-08-25 DOI: 10.1016/j.wnsx.2025.100513

Miracle C. Anokwute MD , Barnabas Obeng-Gyasi BS , Anoop S. Chinthala BS , Jesse Savage MD PhD , Gordon Mao MD

Background

Pedicle screw placement has evolved from freehand to fluoroscopic guidance to navigation-assisted techniques. While robotic-assisted spine surgery offers enhanced accuracy and pre-operative planning capabilities, its adoption has been limited by concerns regarding operative efficiency and surgeon experience requirements. Modern robotic platforms may help standardize screw placement across varying levels of surgical experience.

Methods

A retrospective review of prospective robotic spine fusion cases (2019-2024) compared experienced (n=2) and inexperienced (n=4) neurosurgeons performing lumbar fusions. Data included screw-to-screw placement times, accuracy (Gertzbein and Robbins system), and revision rates. Statistical analysis used Welch's t-test with p<0.05 considered significant.

Results

Analysis included 39 patients (179 pedicle screws). Inexperienced surgeons showed rapid improvement within their first 10 screws. No significant difference in average screw times between inexperienced (mean 3.3 mins, SD 4.34) and experienced surgeons (mean 2.27 mins, SD 1.71), p=0.238. Overall screw accuracy was 96.6% (173/179). Four screws (2.2%) had lateral misplacement due to facet arthropathy, all by experienced surgeons. One screw had minimal medial pedicle breach, and two (1%) were aborted.

Conclusion

Modern robotic spine surgery platforms standardize screw placement times across experience levels and accelerate learning. Inexperienced surgeons can reach proficiency comparable to experienced surgeons after fewer cases, effectively bridging the learning gap and enhancing surgical efficiency.

背景：椎弓根螺钉置入已经从徒手到透视引导再到导航辅助技术。虽然机器人辅助脊柱手术提供了更高的准确性和术前计划能力，但其采用受到手术效率和外科医生经验要求的限制。现代机器人平台可能有助于标准化不同手术水平的螺钉置入。方法回顾性分析2019-2024年机器人腰椎融合术病例，比较有经验的（n=2）和没有经验的（n=4）神经外科医生进行腰椎融合术。数据包括螺钉对螺钉放置时间、精度（Gertzbein和Robbins系统）和修正率。统计分析采用Welch’st检验，p<；0.05认为显著。结果纳入39例患者（179枚椎弓根螺钉）。缺乏经验的外科医生在前10颗螺钉内表现出快速改善。无经验的外科医生（平均3.3分钟，SD 4.34）和经验丰富的外科医生（平均2.27分钟，SD 1.71）的平均螺钉时间无显著差异，p=0.238。总体螺钉精度为96.6%（173/179）。4名螺钉（2.2%）因关节突病变发生外侧错位，均由经验丰富的外科医生操作。1颗螺钉内侧椎弓根断裂，2颗（1%）流产。结论：现代脊柱手术机器人平台规范了不同经验水平患者的螺钉置入时间，加快了学习速度。经验不足的外科医生可以在较少的病例中达到与经验丰富的外科医生相当的熟练程度，有效地弥合了学习差距，提高了手术效率。

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引用次数: 0

Applications of focused ultrasound for spinal disorders and beyond: Advances and future prospects – a narrative review 聚焦超声在脊柱疾病和其他疾病中的应用：进展和未来前景-叙述性回顾

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-08-24 DOI: 10.1016/j.wnsx.2025.100512

Muhammad Ammar Haider , Ysmeen Tariq Bucklain , Zainab Aslam , Santiago Pastrana-Brandes , Michelle Ennabe , Albert Alan , Martin Weinand

Ultrasound technology is a cornerstone of diagnostic medicine throughout the world. Equally noteworthy is its utility in therapeutics, leveraging the precise deposition of ultrasound energy within diverse tissues for a growing spectrum of therapeutic effects. It is in the interest of neurosurgeons — especially those managing patients with spine-specific morbidities such as back pain and motor disorders — to understand the basis and examples of such use. While transcranial focused ultrasound (tcFUS) dominates research and trials, both clinical interest and research in transpinal FUS may upend spine care from minimally to non-invasive. Although challenges both technical and specific to the spine exist, overcoming them will optimize integration into clinical practice.

超声技术是全世界诊断医学的基石。同样值得注意的是它在治疗方面的效用，利用超声能量在不同组织内的精确沉积，以获得越来越多的治疗效果。了解这种用法的基础和例子，对神经外科医生——尤其是那些治疗脊柱特异性疾病（如背痛和运动障碍）的病人——是有好处的。虽然经颅聚焦超声（tcFUS）在研究和试验中占据主导地位，但对经颅聚焦超声的临床兴趣和研究可能会将脊柱护理从微创转变为无创性。尽管存在技术和脊柱特异性的挑战，克服它们将优化整合到临床实践中。

引用次数: 0

Predictive factors of resolution of cranial nerve disfunction in symptomatic patients with intra-cavernous carotid aneurysms treated with ICA occlusion and by-pass procedure 有症状的海绵内颈动脉动脉瘤经ICA闭塞和旁路手术治疗后脑神经功能障碍消退的预测因素

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-08-23 DOI: 10.1016/j.wnsx.2025.100510

Daniele Armocida , Francesco Paglia , Alessandro Frati , Antonio Santoro

Background

Aneurysms of the cavernous segment of the internal carotid artery (cICA) frequently present with cranial nerve disfunctions (CNDs). The resolution of the CNDs could be guarantee with the occlusion of the proximal ICA and by-pass surgery. It is actually unknown how the type of surgical procedure and which factors have an impact on post-operative symptom relapse in CND.

Methods

We reviewed the clinical results related to the resolution of CNDs in 24 surgically-treated patients with symptomatic cICAs focusing on the difference between the treatment with high-flow or low-flow bypass.

Results

17 patients underwent to surgical treatment of ICA-exclusion with high-flow IC–IC by-pass and 7 patients with low-flow EC-IC by-pass. We divided the series into a group whose symptoms disappeared (improved group) or remained (Residual/worse group). Patients’ mean age was significantly younger in the improved group than in the residual/worse group (45.1 versus 56.62, p = 0.047). We found no significant relationship between the choice of bypass technique with the presence of aneurysm recurrence (p = 0.364), the performance status at follow-up and clinical improvement of CND (p = 0.65).

Conclusions

Surgical occlusion of the ICA with bypass is safe and effective in treating symptomatic iCAs, showing no significant differences with the type of technique used (low- or high-flow bypasses). The main factors in the resolution of CND after the treatment of cICA are age, size, clinical disability and surgery-timing.

背景：颈内动脉海绵状段动脉瘤常伴有颅神经功能障碍（CNDs）。近端ICA闭塞及旁通手术可保证CNDs的消退。实际上，手术类型和哪些因素对CND术后症状复发的影响尚不清楚。方法回顾24例经手术治疗的症状性心绞痛患者的CNDs消退的临床结果，重点分析高流量与低流量分流治疗的差异。结果17例患者行高流量IC-IC旁路治疗，7例行低流量IC-IC旁路治疗。我们将该系列患者分为症状消失组（改善组）和保留组（残留/恶化组）。改善组患者的平均年龄明显低于残留/恶化组（45.1比56.62,p = 0.047）。我们发现旁路技术的选择与动脉瘤复发的存在（p = 0.364）、随访时的表现状况和CND的临床改善（p = 0.65）无显著关系。结论手术阻断内腔动脉旁路治疗症状性内腔动脉是安全有效的，不同技术类型（低流量或高流量旁路）无显著差异。影响cICA治疗后CND消退的主要因素是年龄、大小、临床残疾和手术时机。

{"title":"Predictive factors of resolution of cranial nerve disfunction in symptomatic patients with intra-cavernous carotid aneurysms treated with ICA occlusion and by-pass procedure","authors":"Daniele Armocida , Francesco Paglia , Alessandro Frati , Antonio Santoro","doi":"10.1016/j.wnsx.2025.100510","DOIUrl":"10.1016/j.wnsx.2025.100510","url":null,"abstract":"<div><h3>Background</h3><div>Aneurysms of the cavernous segment of the internal carotid artery (cICA) frequently present with cranial nerve disfunctions (CNDs). The resolution of the CNDs could be guarantee with the occlusion of the proximal ICA and by-pass surgery. It is actually unknown how the type of surgical procedure and which factors have an impact on post-operative symptom relapse in CND.</div></div><div><h3>Methods</h3><div>We reviewed the clinical results related to the resolution of CNDs in 24 surgically-treated patients with symptomatic cICAs focusing on the difference between the treatment with high-flow or low-flow bypass.</div></div><div><h3>Results</h3><div>17 patients underwent to surgical treatment of ICA-exclusion with high-flow IC–IC by-pass and 7 patients with low-flow EC-IC by-pass. We divided the series into a group whose symptoms disappeared (improved group) or remained (Residual/worse group). Patients’ mean age was significantly younger in the improved group than in the residual/worse group (45.1 versus 56.62, <em>p</em> = 0.047). We found no significant relationship between the choice of bypass technique with the presence of aneurysm recurrence (<em>p</em> = 0.364), the performance status at follow-up and clinical improvement of CND (<em>p</em> = 0.65).</div></div><div><h3>Conclusions</h3><div>Surgical occlusion of the ICA with bypass is safe and effective in treating symptomatic iCAs, showing no significant differences with the type of technique used (low- or high-flow bypasses). The main factors in the resolution of CND after the treatment of cICA are age, size, clinical disability and surgery-timing.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100510"},"PeriodicalIF":2.0,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association between postoperative interleukin-6 levels in cerebrospinal fluid and invasiveness of surgery for subarachnoid hemorrhage 术后脑脊液中白细胞介素-6水平与蛛网膜下腔出血手术侵入性的关系

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-08-22 DOI: 10.1016/j.wnsx.2025.100511

Hidetaka Onda , Mizuki Kojima , Nodoka Miyake , Kenta Shigeta , Naoki Tominaga , Shoji Yokobori

Background

Interleukin (IL)-6 levels in cerebrospinal fluid (CSF) may reflect postoperative inflammation and affect the outcomes of aneurysmal subarachnoid hemorrhage (SAH).

Methods

This study retrospectively analyzed CSF IL-6 levels on the first postoperative day in 77 patients with SAH treated by craniotomy or endovascular coiling within 12 h of diagnosis. IL-6 levels were measured by enzyme-linked immunosorbent assay and compared between treatment groups. Associations with cerebral vasospasm and clinical outcomes were evaluated by multiple regression analysis.

Results

The median IL-6 level in CSF was 10,501 pg/mL [interquartile range 3037.8, 43,118.5] and was significantly lower in the endovascular group than in the craniotomy group (p < 0.001). In the craniotomy group, the IL-6 level was higher in patients with involvement of the anterior communicating artery than in those with aneurysm at other sites (p = 0.008). Cerebral vasospasm was identified in 13.0 % of cases and was associated with elevated IL-6 (p = 0.003). Higher IL-6 levels were correlated with unfavorable outcomes (p < 0.001).

Conclusion

Elevated IL-6 levels in CSF on postoperative day 1 were associated with cerebral vasospasm and worse outcomes in patients with SAH. Endovascular treatment resulted in lower IL-6 levels, suggesting that minimally invasive methods may reduce inflammation and improve the prognosis. Regulating IL-6 could be a potential therapeutic strategy in SAH management.

背景：脑脊液（CSF）中白细胞介素(IL)-6水平可能反映术后炎症并影响动脉瘤性蛛网膜下腔出血（SAH）的预后。方法回顾性分析77例经开颅或血管内盘绕术治疗的SAH患者术后第一天的脑脊液IL-6水平。采用酶联免疫吸附法检测IL-6水平，并比较两组间的差异。通过多元回归分析评估与脑血管痉挛和临床结果的关系。结果脑脊液中位IL-6水平为10,501 pg/mL[四分位数范围3037.8,43,118.5]，血管内组明显低于开颅组（p < 0.001）。在开颅组中，累及前交通动脉的患者IL-6水平高于其他部位动脉瘤的患者（p = 0.008）。13.0%的患者出现脑血管痉挛，并伴有IL-6升高（p = 0.003）。较高的IL-6水平与不良结果相关（p < 0.001）。结论术后第1天脑脊液IL-6水平升高与SAH患者脑血管痉挛及预后较差有关。血管内治疗可降低IL-6水平，提示微创方法可减轻炎症，改善预后。调节IL-6可能是SAH治疗的潜在治疗策略。

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引用次数: 0