World Neurosurgery: X最新文献_第2页

Real-time augmented reality trajectory lines technique for deep-seated glioblastoma: Technical note 深层胶质母细胞瘤的实时增强现实轨迹线技术：技术说明

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2026-01-01 DOI: 10.1016/j.wnsx.2025.100562

Yoshiki Fujikawa, Shinji Kawabata, Hironori Yamada, Yuichiro Tsuji, Masahiko Wanibuchi

Objective

To describe a practical and reproducible technique for real-time augmented reality (AR)–guided microsurgery, achieved through direct linkage between the surgical microscope and neuronavigation system, applied to the resection of a deep-seated glioblastoma.

Methods

A real-time AR visualization system was implemented by connecting a surgical microscope (ZEISS KINEVO 900) with a neuronavigation platform (StealthStation S8, Medtronic). The system dynamically projected tumor boundaries and depth-sensitive trajectory lines into the operative view, providing continuous spatial guidance without the need for additional instruments. The technique was applied during subpial dissection and resection of a deeply located frontal glioblastoma extending toward the corpus callosum.

Results

Dynamic AR trajectory lines enabled precise delineation of resection margins and depth while maintaining a seamless surgical workflow. Near-total tumor removal was achieved under direct microscopic AR visualization without introducing additional mechanical intrusion such as catheter placement or stereotactic probes. Postoperative MRI confirmed safe and effective resection, and neurological function was preserved.

Conclusion

This technical note illustrates the feasibility and potential advantages of real-time microscope-linked AR guidance for deep-seated glioblastoma resection. The method is readily applicable in standard neurosurgical settings, requiring no specialized equipment or additional cost. Institutional review board approval was obtained, and written informed consent for the procedure and publication was secured.

目的探讨实时增强现实（AR）引导下的显微手术技术，通过手术显微镜与神经导航系统的直接连接，应用于深部胶质母细胞瘤的切除。方法将蔡司KINEVO 900手术显微镜与神经导航平台（Medtronic公司StealthStation S8）连接，实现实时AR可视化系统。该系统动态地将肿瘤边界和深度敏感轨迹线投射到手术视野中，无需额外的仪器即可提供连续的空间引导。该技术应用于颅底剥离和切除深部额叶胶质母细胞瘤，该瘤向胼胝体延伸。结果动态AR轨迹线能够精确划定切除边缘和深度，同时保持无缝的手术工作流程。在直接显微AR可视化下，几乎完全切除了肿瘤，而无需引入额外的机械侵入，如导管放置或立体定向探针。术后MRI证实手术切除安全有效，神经功能得以保留。结论本技术说明了实时显微镜连接AR引导深部胶质母细胞瘤切除术的可行性和潜在优势。该方法很容易适用于标准的神经外科设置，不需要专门的设备或额外的费用。获得了机构审查委员会的批准，并获得了对程序和出版的书面知情同意。

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引用次数: 0

The cerebrospinal fluid leak illusion: Elevation of pulse pressure variation without true fluid deficit in foramen magnum decompression surgery 脑脊液漏错觉：在枕骨大孔减压术中无真正体液不足的脉压变化升高

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-12-09 DOI: 10.1016/j.wnsx.2025.100560

Bheemas B Atlapure, Subham Das, Ankita Medhi

引用次数: 0

Correlation of intra- and postoperative best active contact and its implication for STN-DBS outcome 术中与术后最佳主动接触的相关性及其对STN-DBS预后的影响

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-12-01 DOI: 10.1016/j.wnsx.2025.100558

Robert Nickl , Hannah Mais , Ghadir Abbas , Hazem Eldebakey , Jonas Roothans , Martin Reich , Cordula Matthies , Patrick Fricke

Objective

To assess the relationship between intraoperative test stimulation sites and postoperative best active contacts in STN-DBS for Parkinson's disease and to evaluate whether intraoperative VTAs predict long-term outcome.

Methods

We retrospectively analyzed 92 hemispheres in 46 patients undergoing bilateral STN-DBS. Coordinates of the best intraoperative stimulation point and the best active contact at one year postoperatively were compared using vector analysis. Corresponding VTAs were modeled and visualized in normalized MNI space using Guide XT and MATLAB-based tools. Response ratios were calculated based on motor improvement (UPDRS-III) at one year.

Results

The intraoperative and postoperative best stimulation points differed significantly (p < 0.001), with a consistent dorsolateral shift of the chronic stimulation site relative to the intraoperative test position. Group-level COG analysis showed a 1.61 mm Euclidean shift. VTA overlap between intraoperative and chronic stimulation sites was low (Dice index 0.26). Intraoperative VTAs did not predict clinical outcome. Mean motor improvement was 44 % (range 10–80 %). No significant difference in outcome was observed between patients with bilateral central trajectories and those with non-central implantations guided by intraoperative testing (p = 0.49).

Conclusion

Our findings demonstrate a systematic spatial difference between intraoperative and postoperative best active contact. Intraoperative VTAs, derived primarily from rigidity-based testing, did not predict global one-year motor improvement, underscoring the limited role of intraoperative testing as a universal predictor of long-term outcome. Imaging-based targeting achieved outcomes comparable to intraoperative test-guided implantation, supporting the feasibility of simplified, image-guided workflows in DBS planning.

目的评价STN-DBS术中试验刺激部位与术后最佳活动接触者的关系，并评价术中VTAs能否预测帕金森病的远期预后。方法回顾性分析46例双侧STN-DBS患者的92个半球。采用矢量分析比较术中最佳刺激点和术后1年最佳主动接触点的坐标。使用Guide XT和基于matlab的工具在规范化MNI空间中对相应的VTAs进行建模和可视化。根据一年的运动改善（UPDRS-III）计算反应比。结果术中、术后最佳刺激点差异有统计学意义（p < 0.001），慢性刺激点相对于术中试验位置有一致的背外侧移位。组水平COG分析显示欧几里得位移1.61 mm。术中与慢性刺激部位的VTA重叠较低（Dice指数0.26）。术中VTAs不能预测临床结果。平均运动改善44%（范围10 - 80%）。术中检测引导双侧中心轨迹植入患者与非中心植入患者的预后无显著差异（p = 0.49）。结论术中与术后最佳主动接触在空间上存在系统性差异。术中vta主要来源于基于刚度的测试，并不能预测整体一年的运动改善，强调术中测试作为长期预后的普遍预测因素的作用有限。基于成像的靶向治疗取得了与术中测试引导植入相当的结果，支持了DBS计划中简化的、图像引导的工作流程的可行性。

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引用次数: 0

Management of neurovascular compromise of the vestibulocochlear nerve: A systematic review and illustrative case series 前庭耳蜗神经神经血管损伤的处理：系统回顾和说明性病例系列

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-11-28 DOI: 10.1016/j.wnsx.2025.100557

Vera Ong , Paul M. Harary , Amit R. Persad, Yusuke S. Hori, Sara C. Emrich, Louisa Ustrzynski, Armine Tayag, David J. Park, Steven D. Chang

Objective

To review the outcomes of surgery for asymmetric sensorineural hearing loss (ASHL) from neurovascular compromise of the vestibulocochlear nerve.

Methods

A systematic review was conducted using the Web of Science, Cochrane, PubMed, and PsychINFO databases. We additionally performed a retrospective review of our institution's database for cases with ASHL resulting from vascular loop-induced vestibulocochlear nerve compression.

Results

Fifteen articles were included in our literature review, representing a total of 24 patients. Of these 24 patients, 8 patients were managed conservatively, and 16 patients were managed surgically. Among the patients who underwent conservative management, 4 patients (50 %) had no reported vestibulocochlear post-treatment outcomes. One patient mentioned subjectively improved hearing, whereas the remaining patients either had no change or worsening of hearing loss. One patient reported tinnitus improvement, while another had persistent tinnitus and vertigo. Among the 16 patients who underwent surgery, 7 patients (44 %) showed improved hearing postoperatively, while 1 patient's hearing continued to deteriorate. Improvement of vertigo/disequilibrium and tinnitus was mentioned in 11 and 9 patients, respectively. Separately, our institution presented 2 patients: one treated surgically with mild hearing improvement and another managed conservatively with ongoing evaluation.

Conclusion

Indications for treatment of ASHL with associated vascular loop causing vestibulocochlear nerve compression remain unclear. Overlapping vestibulocochlear symptoms of hearing loss and pulsatile tinnitus within a patient case seem of higher surgical priority versus a patient case with worsening hearing.

目的探讨前庭耳蜗神经血管损伤引起的非对称感音神经性听力损失的手术治疗效果。方法采用Web of Science、Cochrane、PubMed和PsychINFO数据库进行系统评价。此外，我们对本院数据库中由血管袢诱导的前庭耳蜗神经压迫引起的ASHL病例进行了回顾性分析。结果我们的文献综述纳入15篇文章，共24例患者。在这24例患者中，8例患者采用保守治疗，16例患者采用手术治疗。在接受保守治疗的患者中，4例患者（50%）未报告前庭耳蜗治疗后结果。1例患者主观听力有所改善，其余患者听力没有变化或恶化。一名患者报告耳鸣改善，而另一名患者持续耳鸣和眩晕。16例手术患者中，7例（44%）患者术后听力改善，1例患者听力继续恶化。眩晕/不平衡和耳鸣的改善分别有11例和9例。另外，我们的机构报告了2例患者：1例手术治疗轻度听力改善，另1例保守治疗并进行持续评估。结论ASHL合并血管袢致前庭耳蜗神经压迫的适应证尚不明确。与听力恶化的患者相比，前庭耳蜗重叠症状的听力损失和搏动性耳鸣患者的手术优先权似乎更高。

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引用次数: 0

Predictive value of maximum hemorrhage area and orthogonal diameter on non-contrast CT for assessing long-term unfavorable functional outcome in intracerebral hemorrhage 非对比CT最大出血面积和正交直径对评估脑出血远期不良功能结局的预测价值

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-11-28 DOI: 10.1016/j.wnsx.2025.100556

GuoLi Ren , ShuNing Liu , Xiao Gao , Bo Wang , Daliang Liu , XueHuan Liu , Hao Wang , Jun Liu

Background and purpose

Intracerebral hemorrhage (ICH) volume is a primary concern in acute ICH management, as timely prognostic assessment correlates with increased risk of long-term unfavorable functional outcome. This study aimed to evaluate the predictive value of the maximum hemorrhage area (sICH-MaxA) and orthogonal diameters (sICH-OD) on the slice with the largest hemorrhage area on non-contrast computed tomography (NCCT) for long-term (12-month) unfavorable functional outcome in supratentorial spontaneous intracerebral hemorrhage (sICH).

Methods

A total of 113 patients with supratentorial sICH admitted between June 2022 and June 2024 were enrolled. Patients were categorized into an unfavorable outcome group (modified Rankin Scale score >3, n = 41) and a favorable outcome group (modified Rankin Scale score ≤3, n = 72). sICH-MaxA and sICH-OD were measured on NCCT and compared with sICH volume. The efficacy of these metrics for assessing long-term unfavorable functional outcome in supratentorial sICH was evaluated.

Results

Correlation analysis revealed significant associations between sICH-MaxA, sICH-OD, and sICH volume (r = 0.957 and 0.954, respectively; p < 0.001). The thresholds of sICH-MaxA and sICH-OD for predicting long-term unfavorable outcome were ≥4.705 cm² (p < 0.001) and ≥9.255 cm² (p < 0.001), respectively. The thresholds for determining the need for surgical intervention were sICH-MaxA >5.56 cm² (p < 0.001) and sICH-OD >9.85 cm² (p < 0.001). The areas under the curve (AUC) for predicting long-term unfavorable functional outcome were: sICH volume = 0.873, sICH-MaxA = 0.866, sICH-OD = 0.855.

Conclusion

sICH-MaxA and sICH-OD measured on NCCT demonstrate predictive value for long-term unfavorable functional outcome in patients with supratentorial sICH.

背景和目的脑出血（ICH）容量是急性脑出血治疗的主要关注点，因为及时的预后评估与长期不良功能结果的风险增加相关。本研究旨在评价非对比计算机断层扫描（NCCT）最大出血面积（sICH- maxa）和正交直径（sICH- od）对幕上自发性脑出血（sICH）长期（12个月）不良功能结局的预测价值。方法选取2022年6月至2024年6月收治的113例幕上sICH患者。将患者分为预后不良组（改良Rankin量表评分≤3分，n = 41）和预后良好组（改良Rankin量表评分≤3分，n = 72）。在NCCT上测定sch - maxa和sch - od，比较sICH体积。评估这些指标对幕上siich长期不良功能结局的疗效。结果sICH- maxa、sICH- od与sICH体积呈显著相关（r = 0.957、0.954,p < 0.001）。sch - maxa和sch - od预测长期不良结局的阈值分别为≥4.705 cm2 （p < 0.001）和≥9.255 cm2 （p < 0.001）。确定是否需要手术干预的阈值分别为sch - maxa >；5.56 cm2 （p < 0.001）和sch - od >；9.85 cm2 （p < 0.001）。预测远期不良功能预后的曲线下面积（AUC）为：sICH volume = 0.873, sICH- maxa = 0.866, sICH- od = 0.855。结论NCCT检测的sICH- maxa和sICH- od对幕上siich患者的长期不良功能结局具有预测价值。

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引用次数: 0

Dermatological complications in superficial temporal artery embolization: An illustrative case and literature review 颞浅动脉栓塞的皮肤并发症：一例说明性病例和文献复习

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-11-27 DOI: 10.1016/j.wnsx.2025.100555

Verónica Garza-Rodríguez , Andrea Ortiz , Mariya Miteva , Hector R. Martinez , Nerea Martin del Campo , Paloma Acacia Guzman-Garcia , Beatriz Perez-Martinez , Oscar Gutierrez-Trevino , Rogelio E. Flores-Salcido , Mario Benvenutti-Regato , Jose A. Figueroa-Sanchez

Endovascular embolization is the mainstay of treatment for multiple diseases affecting the superficial temporal artery (STA). However, it is not exempt from complications. While neurologic complications are vastly reported in the literature, dermatological complications are seldom described. Here, we present the case of a 16-year-old female who developed pustules, erythema, trichodynia and regional pain along the facial branch of the STA following endovascular treatment. On trichoscopy follicular crusts with microhemorrhagic areas, erythema, telangiectasia and patchy brown-gray areas were visualized with histopathologic findings compatible with vasculopathy and increased telogen count. Additionally, we performed a literature review of dermatological complications associated with endovascular treatment of the STA. A total of 16 cases were identified, most of which involved trans-arterial embolization (TAE). The most common dermatological complication was scalp necrosis (50 %), followed by secondary infection (18.75 %) and mass effect (18.75 %). The time of presentation varied, from immediately after embolization up to 46 days post-procedure. The most common embolic agent associated with complications was Onyx (50 %). According to our review, dermatologic complications seem to arise from multiple mechanisms, including tissue inflammation, cell wall rupture, radiation damage, and infusion rate of the embolic agents. We emphasize the need for greater attention and reporting of these complications, as they can impact cosmetic outcomes and overall quality of life of patients. Physicians should be aware of cutaneous manifestations following STA embolization as early recognition and appropriate management can significantly improve cosmetic outcomes.

血管内栓塞是治疗多种影响颞浅动脉（STA）疾病的主要方法。然而，它也不能避免并发症。虽然神经系统并发症在文献中被大量报道，但皮肤并发症很少被描述。在这里，我们提出的情况下，16岁的女性谁发展脓疱，红斑，毛痛症和局部疼痛沿STA的面支血管内治疗。毛镜检查可见滤泡结痂伴微出血区、红斑、毛细血管扩张和斑片状棕灰色区，组织病理学结果与血管病变和休止期计数增加相符。此外，我们对STA血管内治疗相关的皮肤病并发症进行了文献回顾。共发现16例，其中大多数涉及经动脉栓塞（TAE）。最常见的皮肤并发症是头皮坏死（50%），其次是继发性感染（18.75%）和肿块效应（18.75%）。出现时间从栓塞后立即到术后46天不等。与并发症相关的最常见栓塞剂是缟玛瑙（50%）。根据我们的综述，皮肤并发症似乎是由多种机制引起的，包括组织炎症、细胞壁破裂、辐射损伤和栓塞剂的输注速度。我们强调需要更多的关注和报告这些并发症，因为它们会影响美容结果和患者的整体生活质量。医生应该意识到STA栓塞后的皮肤表现，因为早期识别和适当的处理可以显著改善美容效果。

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引用次数: 0

Acinetobacter baumannii ventriculoperitoneal shunt infection in the pediatric population: Clinical assessment and microbiological profile 鲍曼不动杆菌脑室腹腔分流感染在儿科人群：临床评估和微生物谱

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-11-26 DOI: 10.1016/j.wnsx.2025.100552

Amer A. Jaradat , Mohammed M. Barbarawi , Mohammed Jamous , Sultan M. Jarrar , Suleiman S. Daoud , Amjed Abdelal , Said Haddad , Reem Alazzam , Marah Bashyreh , Owais Ghammaz

Background

Ventriculoperitoneal (VP) shunt infections, notably when caused by Acinetobacter baumannii, present significant management challenges in pediatric neurosurgery due to antibiotic resistance. This study assesses clinical profiles, microbiological characteristics, treatment strategies, and outcomes of these infections.

Methods

A retrospective review at King Abdullah University Hospital, North Jordan, analyzed 27 pediatric cases of Acinetobacter baumannii VP shunt infections from 2013 to 2023. Data on demographics, clinical presentation, treatment strategies, and outcomes, including cerebrospinal fluid (CSF) clearance time and time to shunt re-insertion, morbidity, and mortality were evaluated.

Results

Colistin showed efficacy against multidrug-resistant strains, despite overall high resistance to conventional antibiotics. Infections predominantly occurred early post-surgery and an 11.1 % mortality rate was observed.

Conclusion

VP shunt infections caused by Acinetobacter baumannii significantly impact pediatric patients, emphasizing the need for early detection and the development of targeted treatment approaches. Colistin may offer a viable option against resistant strains, but prolonged hospitalization and mortality rates call for improved preventive measures.

背景脑室-腹膜（VP）分流感染，特别是由鲍曼不动杆菌引起的感染，由于抗生素耐药性，在儿科神经外科中提出了重大的管理挑战。本研究评估了这些感染的临床概况、微生物学特征、治疗策略和结果。方法回顾性分析2013 - 2023年约旦北部阿卜杜拉国王大学医院27例鲍曼不动杆菌VP分流感染病例。统计数据、临床表现、治疗策略和结果，包括脑脊液（CSF）清除时间和分流器重新插入时间、发病率和死亡率进行了评估。结果粘菌素对多药耐药菌株有效，但对常规抗生素总体耐药较高。感染主要发生在术后早期，死亡率为11.1%。结论鲍曼不动杆菌引起的vp分流感染对儿科患者影响显著，强调早期发现和制定有针对性的治疗方法的必要性。粘菌素可能是对抗耐药菌株的可行选择，但长期住院治疗和死亡率要求改进预防措施。

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引用次数: 0

Risk factors for patient outcomes following penetrating traumatic brain injury 穿透性创伤性脑损伤后患者预后的危险因素

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-11-24 DOI: 10.1016/j.wnsx.2025.100550

Alexa R. Lauinger , Anvita Mishra , Helen Kemprecos , Kathryn Tsai , Varshal Patel , Albert Yu , Wael Hassaneen

Background

Traumatic brain injury annually affects around 69 million individuals worldwide. Penetrating traumatic brain injuries (pTBI) have a high morbidity and mortality rate. There has been an increase in the incidence of pTBI and an increase in the rate of operative intervention. However, there's still limited data on how injury details and treatment can impact patient outcomes. This project will explore the factors associated with poor outcomes following pTBI using the United States National Trauma Data Bank (NTDB).

Methods

Data from the NTDB for patients with a pTBI between 2017 and 2021 were collected. Logistic regression was completed on data from 2017 to 2018 to develop a multivariable model. This model was tested internally and externally.

Results

The multivariable regression model for in-hospital complications included the emergency department Glasgow Coma Scale (GCS), penetration greater than 2 cm, external ventricular drain (EVD) placement, Injury Severity Score (ISS), and transfusion. This model achieved an accuracy of 89.5 % and 87.1 % in internal and external testing cohorts, respectively. The model for length of stay included ISS, transfusion, and EVD placement. The complications model included EVD placement, transfusion, and ISS. The accuracy for the length of stay model was around 71 %, while it was around 93 % for the complication model.

Conclusion

As the prevalence of pTBI remains high in the US, it is vital to understand the factors associated with poor prognosis. The severity of the overall injury, patient age, and procedures were the most predictive parameters. Interestingly, the location of fractures and associated complications was not as important in this model.

全球每年约有6900万人受到创伤性脑损伤的影响。穿透性创伤性脑损伤具有很高的发病率和死亡率。pTBI的发病率有所增加，手术干预率也有所增加。然而，关于损伤细节和治疗如何影响患者预后的数据仍然有限。本项目将利用美国国家创伤数据库（NTDB）探讨与pTBI后不良预后相关的因素。方法收集2017年至2021年pTBI患者的NTDB数据。对2017 - 2018年的数据进行Logistic回归，建立多变量模型。该模型在内部和外部进行了测试。结果院内并发症的多变量回归模型包括急诊科格拉斯哥昏迷评分（GCS）、穿透大于2 cm、外脑室引流（EVD）放置、损伤严重程度评分（ISS）和输血。该模型在内部和外部测试队列中的准确率分别为89.5%和87.1%。住院时间模型包括ISS、输血和EVD安置。并发症模型包括EVD放置、输血和ISS。住院时间模型的准确率约为71%，并发症模型的准确率约为93%。结论由于pTBI在美国的患病率仍然很高，因此了解与预后不良相关的因素至关重要。整体损伤的严重程度、患者年龄和手术是最具预测性的参数。有趣的是，在这个模型中，骨折的位置和相关并发症并不重要。

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引用次数: 0

Risk factors for early poor outcomes in intracerebral hemorrhage with mild-to-moderate volume: A retrospective cohort study 轻度至中度脑出血早期不良预后的危险因素：一项回顾性队列研究

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-11-24 DOI: 10.1016/j.wnsx.2025.100554

Ao Chen, Jianxian Li, Bin Tan, Rong Xiang, Renhui Zhou

Background

Compared to intracerebral hemorrhage (ICH) with large hemorrhage volume, early poor outcomes in mild-to-moderate hemorrhage volume ICH (MMV-ICH) remains poorly understood. We aimed to analyze risk factors in patients with MMV-ICH and establish a nomogram model to predict early poor outcomes in such cases.

Methods

We conducted a retrospective analysis of data from 681 patients with MMV-ICH treated at our hospital (May 2019–May 2024). Baseline demographic information, clinical characteristics, and outcomes were collected. Early poor outcomes were defined as in-hospital death or discharge against medical advice. Least absolute shrinkage and selection operator (LASSO) and stepwise logistic regression analyses were used to screen risk factors for early poor outcomes and construct the prediction model, respectively. The model was visualized using a nomogram; its predictive performance was compared with the original ICH score. The nomogram prediction model was internally validated using 10-fold cross-validation combined with Bootstrap resampling.

Results

Of 681 patients, 71 (10.4 %) experienced early poor outcomes during hospitalization. Univariate analysis revealed 16 risk factors. LASSO and stepwise logistic regression analyses identified four independent predictors: admission Glasgow Coma Scale (GCS) score, hematoma volume, hematoma expansion, and ventricular enlargement. The nomogram based on these factors demonstrated good calibration (mean absolute error 0.011) and superior predictive performance compared with the ICH score (area under the receiver operating characteristic curve: 0.895 vs. 0.801, p < 0.001). Decision curve analysis further demonstrated that the model had greater net benefit than the ICH score. Internal validation confirmed the model's stability and generalizability (10-fold cross-validation mean: 0.8893; bootstrap-corrected C-index: 0.8899).

Conclusions

Patients with MMV-ICH with lower admission GCS, larger hematoma, ventricular enlargement, and hematoma expansion post-admission exhibit higher risk of early poor outcomes. The nomogram incorporating these factors potentially identifies early poor outcomes during hospitalization in this population, aiding neurologists in early clinical-decision making.

背景：与大出血量脑出血（ICH）相比，轻至中度出血量脑出血（MMV-ICH）的早期不良结局仍然知之甚少。我们的目的是分析MMV-ICH患者的危险因素，并建立一个nomogram模型来预测此类病例的早期不良预后。方法回顾性分析2019年5月- 2024年5月在我院治疗的681例MMV-ICH患者的资料。收集基线人口统计信息、临床特征和结果。早期不良预后被定义为院内死亡或不遵医嘱出院。使用最小绝对收缩和选择算子（LASSO）和逐步逻辑回归分析分别筛选早期不良预后的危险因素和构建预测模型。模型采用模态图可视化；将其预测性能与原始ICH评分进行比较。采用10次交叉验证结合Bootstrap重采样对nomogram预测模型进行内部验证。结果681例患者中，71例（10.4%）在住院期间出现早期不良预后。单因素分析显示16个危险因素。LASSO和逐步逻辑回归分析确定了四个独立的预测因素：入院格拉斯哥昏迷量表（GCS）评分、血肿体积、血肿扩张和心室增大。与ICH评分（受试者工作特征曲线下面积：0.895 vs. 0.801, p < 0.001）相比，基于这些因素的nomogram显示出良好的校准（平均绝对误差0.011）和优越的预测性能。决策曲线分析进一步表明，该模型的净效益高于ICH评分。内部验证证实了模型的稳定性和可推广性（10倍交叉验证均值：0.8893；bootstrap校正的C-index: 0.8899）。结论MMV-ICH患者入院时GCS较低，入院后血肿、脑室增大、血肿扩张较大，早期预后不良的风险较高。结合这些因素的nomogram潜在地识别出该人群住院期间的早期不良预后，帮助神经科医生进行早期临床决策。

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引用次数: 0

Spinal Epstein–Barr virus-related smooth muscle tumors: Narrative review and case study 脊髓Epstein-Barr病毒相关平滑肌肿瘤：叙述性回顾和案例研究

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-11-24 DOI: 10.1016/j.wnsx.2025.100553

Giorgio Cracchiolo , Clifford Pierre , Luke L. Jouppi , Julius Gerstmeyer , Colin Gold , Mark Kraemer , Angela Kantor , Arnav Gambhir , Amir Abdul-Jabbar , Andrea Fanti , Carlo Brembilla , Rod Oskouian , Jens R. Chapman

Background

Epstein–Barr Virus (EBV) is associated with smooth muscle tumors (SMT) in immunocompromised individuals, including those with HIV or post-transplant status. EBV-related SMTs are rare in the spine, making diagnosis and treatment challenging. This study provides updated insights into their diagnosis and treatment.

Methods

A formal PubMed literature review was conducted using search terms related to EBV-SMTs with screening performed based on the JBI Critical Appraisal Criteria. We included systematic reviews, literature reviews, case series, and case reports while excluding any studies that were not related to EBV-SMTs. Included literature was analyzed for epidemiology, pathogenesis, histopathology, imaging, clinical presentation, management, and prognosis, with a focus on spinal cases.

Results

Between 1995 and 2023, 98 general articles were identified, 62 meeting our specific inclusion criteria. An updated treatment algorithm, including a multidisciplinary approach, was outlined. A pertinent clinical case of a 55-year-old HIV-positive female with multiple thoracic spine lesions and biopsy confirmation of EBV-SMT was presented. Following vertebroplasty, tumor excision, and antiretroviral therapy, she developed recurrent lesions four years later, requiring further treatment.

Conclusion

Spinal EBV-SMTs are rare CNS tumors to consider as differential diagnosis for immunocompromised patients with spine-related pain and/or neurological deficits. Neuroimaging for lesion detection followed by biopsy confirmation using specialized staining can confirm diagnosis. Multimodal treatment with efforts at optimizing immune competency, surgical resection, and emerging therapies such as mTOR inhibitors (sirolimus) and radiotherapy have been recommended. Our comprehensive review supports ongoing research efforts using multi-institutional databases to allow for enhanced scientific insights into these rare tumors.

背景：eb病毒（EBV）与免疫功能低下个体的平滑肌肿瘤（SMT）相关，包括HIV感染者或移植后患者。ebv相关的smt在脊柱中很少见，这使得诊断和治疗具有挑战性。这项研究为他们的诊断和治疗提供了新的见解。方法使用与ebv - smt相关的搜索词进行正式的PubMed文献综述，并根据JBI关键评价标准进行筛选。我们纳入了系统综述、文献综述、病例系列和病例报告，同时排除了任何与ebv - smt无关的研究。对纳入的文献进行流行病学、发病机制、组织病理学、影像学、临床表现、治疗和预后分析，重点是脊柱病例。结果1995 - 2023年共纳入98篇一般性文献，其中62篇符合纳入标准。概述了一种更新的治疗算法，包括多学科方法。一个相关的临床病例，55岁艾滋病毒阳性女性多胸椎病变和活检确认EBV-SMT提出。经过椎体成形术、肿瘤切除和抗逆转录病毒治疗后，四年后她出现复发性病变，需要进一步治疗。结论脊髓ebv - smt是一种罕见的中枢神经系统肿瘤，可作为免疫功能低下患者脊柱相关疼痛和/或神经功能障碍的鉴别诊断。神经影像学检查病变，然后活检确认使用专门的染色可以确诊。推荐多模式治疗，努力优化免疫能力，手术切除和新兴疗法，如mTOR抑制剂（西罗莫司）和放疗。我们的综合综述支持正在进行的研究工作，使用多机构数据库，以增强对这些罕见肿瘤的科学见解。

{"title":"Spinal Epstein–Barr virus-related smooth muscle tumors: Narrative review and case study","authors":"Giorgio Cracchiolo , Clifford Pierre , Luke L. Jouppi , Julius Gerstmeyer , Colin Gold , Mark Kraemer , Angela Kantor , Arnav Gambhir , Amir Abdul-Jabbar , Andrea Fanti , Carlo Brembilla , Rod Oskouian , Jens R. Chapman","doi":"10.1016/j.wnsx.2025.100553","DOIUrl":"10.1016/j.wnsx.2025.100553","url":null,"abstract":"<div><h3>Background</h3><div>Epstein–Barr Virus (EBV) is associated with smooth muscle tumors (SMT) in immunocompromised individuals, including those with HIV or post-transplant status. EBV-related SMTs are rare in the spine, making diagnosis and treatment challenging. This study provides updated insights into their diagnosis and treatment.</div></div><div><h3>Methods</h3><div>A formal PubMed literature review was conducted using search terms related to EBV-SMTs with screening performed based on the JBI Critical Appraisal Criteria. We included systematic reviews, literature reviews, case series, and case reports while excluding any studies that were not related to EBV-SMTs. Included literature was analyzed for epidemiology, pathogenesis, histopathology, imaging, clinical presentation, management, and prognosis, with a focus on spinal cases.</div></div><div><h3>Results</h3><div>Between 1995 and 2023, 98 general articles were identified, 62 meeting our specific inclusion criteria. An updated treatment algorithm, including a multidisciplinary approach, was outlined. A pertinent clinical case of a 55-year-old HIV-positive female with multiple thoracic spine lesions and biopsy confirmation of EBV-SMT was presented. Following vertebroplasty, tumor excision, and antiretroviral therapy, she developed recurrent lesions four years later, requiring further treatment.</div></div><div><h3>Conclusion</h3><div>Spinal EBV-SMTs are rare CNS tumors to consider as differential diagnosis for immunocompromised patients with spine-related pain and/or neurological deficits. Neuroimaging for lesion detection followed by biopsy confirmation using specialized staining can confirm diagnosis. Multimodal treatment with efforts at optimizing immune competency, surgical resection, and emerging therapies such as mTOR inhibitors (sirolimus) and radiotherapy have been recommended. Our comprehensive review supports ongoing research efforts using multi-institutional databases to allow for enhanced scientific insights into these rare tumors.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"29 ","pages":"Article 100553"},"PeriodicalIF":2.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145683122","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}

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