Pub Date : 2025-10-01DOI: 10.1016/j.wnsx.2025.100537
Ali İhsan Ökten , Saygı Uygur
Prof. Dr. Gazi Yaşargil passed away at the age of 100 with the title of “Neurosurgeon of the Century”, leaving numerous invented neurosurgical instruments and techniques as well as trained neurosurgeons behind as his legacy. What mattered most to Yaşargil was finishing a surgery without causing harm to normal tissue. To this end, he introduced microscope into neurosurgery for the first time and developed many instruments to enhance his new techniques. Yaşargil's minimalist studies dating back to 1960s paved the road to modern, more advanced minimally invasive techniques. Notably, emergence of minimalist art movement coincides with Yaşargil's initial studies. Even though art, science and philosophy are distinct disciplines, it cannot be denied that they influence, pass through, and converge with each other throughout the history. One can observe how movements from different disciplines are embraced by others, fostering mutual empowerment while allowing each to pursue its own course. Similar pattern is apparent in minimalist art movement and minimally invasive surgical approaches. The idea of telling more with less by avoiding unnecessary materials and minimizing the number of objects to enhance the expression in minimalist art, has transformed into performing surgery with minimal harm through less invasive techniques that optimally preserve normal tissue and promote rapid patient recovery. Gazi Yaşargil pioneered the development of minimally invasive techniques in neurosurgery, simultaneously, with the emergence of the minimalist art movement, science and art reunited after a long hiatus.
Gazi yaargil教授逝世，享年100岁，被誉为“世纪神经外科医生”，留下了许多发明的神经外科仪器和技术以及训练有素的神经外科医生作为他的遗产。对ya阿吉尔来说，最重要的是在不伤害正常组织的情况下完成手术。为此，他首次将显微镜引入神经外科，并开发了许多仪器来加强他的新技术。yaargil的极简主义研究可以追溯到20世纪60年代，为现代更先进的微创技术铺平了道路。值得注意的是，极简主义艺术运动的出现与yaargil最初的研究不约而同。尽管艺术、科学和哲学是不同的学科，但不可否认的是，它们在历史上是相互影响、相互贯通、相互融合的。人们可以观察到不同学科的运动是如何被其他学科所接受的，在允许每个学科追求自己的道路的同时，促进相互赋权。类似的模式在极简艺术运动和微创手术入路中也很明显。通过避免不必要的材料和减少物体的数量来增强极简主义艺术的表达，用更少的材料讲述更多的想法已经转变为通过更小的侵入性技术以最小的伤害进行手术，最佳地保护正常组织并促进患者快速康复。Gazi yaargil开创了神经外科微创技术的发展，同时，随着极简主义艺术运动的出现，科学与艺术在长时间的中断后重新统一。
{"title":"Gazi Yaşargil: A minimalist genius in neurosurgery in parallel with the minimalism movement in art","authors":"Ali İhsan Ökten , Saygı Uygur","doi":"10.1016/j.wnsx.2025.100537","DOIUrl":"10.1016/j.wnsx.2025.100537","url":null,"abstract":"<div><div>Prof. Dr. Gazi Yaşargil passed away at the age of 100 with the title of “Neurosurgeon of the Century”, leaving numerous invented neurosurgical instruments and techniques as well as trained neurosurgeons behind as his legacy. What mattered most to Yaşargil was finishing a surgery without causing harm to normal tissue. To this end, he introduced microscope into neurosurgery for the first time and developed many instruments to enhance his new techniques. Yaşargil's minimalist studies dating back to 1960s paved the road to modern, more advanced minimally invasive techniques. Notably, emergence of minimalist art movement coincides with Yaşargil's initial studies. Even though art, science and philosophy are distinct disciplines, it cannot be denied that they influence, pass through, and converge with each other throughout the history. One can observe how movements from different disciplines are embraced by others, fostering mutual empowerment while allowing each to pursue its own course. Similar pattern is apparent in minimalist art movement and minimally invasive surgical approaches. The idea of telling more with less by avoiding unnecessary materials and minimizing the number of objects to enhance the expression in minimalist art, has transformed into performing surgery with minimal harm through less invasive techniques that optimally preserve normal tissue and promote rapid patient recovery. Gazi Yaşargil pioneered the development of minimally invasive techniques in neurosurgery, simultaneously, with the emergence of the minimalist art movement, science and art reunited after a long hiatus.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100537"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219821","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}
Pub Date : 2025-10-01DOI: 10.1016/j.wnsx.2025.100536
Parth Aphale, Shashank Dokania, Himanshu Shekhar
{"title":"Comment on: Examining the correlation between hemoglobin-red blood cell distribution width ratio and hospital mortality in spontaneous intracerebral hemorrhage","authors":"Parth Aphale, Shashank Dokania, Himanshu Shekhar","doi":"10.1016/j.wnsx.2025.100536","DOIUrl":"10.1016/j.wnsx.2025.100536","url":null,"abstract":"","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100536"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219822","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}
Pub Date : 2025-10-01DOI: 10.1016/j.wnsx.2025.100501
Cumhur Kaan Yaltırık , Murat Şakir Ekşi
Through his work on microsurgical tools and techniques, Professor Mahmut Gazi Yaşargil revolutionized neurosurgery by making it a safer and more successful area of brain surgery. Mahmut Gazi Yaşargil, a Turkish-born neurosurgeon, died in Switzerland in 2025 after being born in 1925. The medical world recognized him as the “Father of Modern Neurosurgery” because he devoted his life to precision, education, and the upbringing of future surgeons. This article examines his life history, scientific discoveries, academic achievements, and his lasting impact on neurosurgery practices around the world.
通过他在显微外科手术工具和技术方面的工作，Mahmut Gazi yaargil教授彻底改变了神经外科，使其成为更安全、更成功的脑外科领域。出生于土耳其的神经外科医生马哈茂特·加齐·亚·阿吉尔出生于1925年，于2025年在瑞士去世。医学界公认他为“现代神经外科之父”，因为他毕生致力于精确、教育和培养未来的外科医生。本文考察了他的生平、科学发现、学术成就以及他对世界各地神经外科实践的持久影响。
{"title":"Professor Mahmut Gazi Yaşargil (1925–2025): The pioneer and architect of modern neurosurgery","authors":"Cumhur Kaan Yaltırık , Murat Şakir Ekşi","doi":"10.1016/j.wnsx.2025.100501","DOIUrl":"10.1016/j.wnsx.2025.100501","url":null,"abstract":"<div><div>Through his work on microsurgical tools and techniques, Professor Mahmut Gazi Yaşargil revolutionized neurosurgery by making it a safer and more successful area of brain surgery. Mahmut Gazi Yaşargil, a Turkish-born neurosurgeon, died in Switzerland in 2025 after being born in 1925. The medical world recognized him as the “Father of Modern Neurosurgery” because he devoted his life to precision, education, and the upbringing of future surgeons. This article examines his life history, scientific discoveries, academic achievements, and his lasting impact on neurosurgery practices around the world.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100501"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681113","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}
In recent years, the effectiveness of flow diverters (FDs) for the treatment of intracranial aneurysms has been reported. While FDs are effective, their deployment involves advancing a delivery wire distally, which may pose a risk if a distal aneurysm exists within the same artery. In such cases, the delivery wire could potentially perforate the distal aneurysm. Here, we present two cases of tandem aneurysms in which an internal carotid artery (ICA) aneurysm was treated with an FD following the treatment of a distal cerebral aneurysm.
Case description
A 44-year-old woman and a 67-year-old woman underwent magnetic resonance imaging for headache or abducens nerve palsy. In both cases, two aneurysms were revealed: one at the ICA and the other either at the middle cerebral artery or the top of the ICA. Due to the risk of perforation by the delivery wire during FD deployment, the distal aneurysms were treated first—either with surgical neck clipping or stent-assisted coil embolization. One month after the initial treatment, FD placement for the ICA aneurysm was performed as planned without complications in either case.
Discussion
This is the first report where tandem aneurysms were successfully treated with treatment for distal cerebral aneurysms, followed by FDs for proximal ICA aneurysms. We emphasize the potential risk of perforation of the distal aneurysm by the delivery wire during FD placement.
Conclusion
Treatment of distal cerebral aneurysms beforehand can help ensure the safe and effective use of FDs in patients with tandem aneurysms.
{"title":"Flow diverter treatment for internal carotid artery aneurysm following management of distal cerebral aneurysms: Technical note","authors":"Yuichi Hirata , Masafumi Hiramatsu , Kenji Sugiu , Fukiko Baba , Juntaro Fujita , Yuta Sotome , Masato Kawakami , Ryu Kimura , Yuki Ebisudani , Jun Haruma , Tomohito Hishikawa , Shota Tanaka","doi":"10.1016/j.wnsx.2025.100540","DOIUrl":"10.1016/j.wnsx.2025.100540","url":null,"abstract":"<div><h3>Background</h3><div>In recent years, the effectiveness of flow diverters (FDs) for the treatment of intracranial aneurysms has been reported. While FDs are effective, their deployment involves advancing a delivery wire distally, which may pose a risk if a distal aneurysm exists within the same artery. In such cases, the delivery wire could potentially perforate the distal aneurysm. Here, we present two cases of tandem aneurysms in which an internal carotid artery (ICA) aneurysm was treated with an FD following the treatment of a distal cerebral aneurysm.</div></div><div><h3>Case description</h3><div>A 44-year-old woman and a 67-year-old woman underwent magnetic resonance imaging for headache or abducens nerve palsy. In both cases, two aneurysms were revealed: one at the ICA and the other either at the middle cerebral artery or the top of the ICA. Due to the risk of perforation by the delivery wire during FD deployment, the distal aneurysms were treated first—either with surgical neck clipping or stent-assisted coil embolization. One month after the initial treatment, FD placement for the ICA aneurysm was performed as planned without complications in either case.</div></div><div><h3>Discussion</h3><div>This is the first report where tandem aneurysms were successfully treated with treatment for distal cerebral aneurysms, followed by FDs for proximal ICA aneurysms. We emphasize the potential risk of perforation of the distal aneurysm by the delivery wire during FD placement.</div></div><div><h3>Conclusion</h3><div>Treatment of distal cerebral aneurysms beforehand can help ensure the safe and effective use of FDs in patients with tandem aneurysms.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100540"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319593","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}
Complex, unclippable aneurysms of the pre-bifurcation segment of the M1 middle cerebral artery (pre-bM1) are rare and challenging to treat due to their association with lenticulostriate arteries (LSAs), particularly in ruptured cases. This study evaluates the outcomes and complications of microsurgical treatment employing distal occlusion and revascularization.
Methods
Eight patients with ruptured unclippable pre-bM1 aneurysms treated via distal occlusion and revascularization between 2018 and 2024 were retrospectively analyzed for radiographic and clinical outcomes.
Results
Complete aneurysm obliteration was achieved in all patients, with seven (87.5 %) out of eight patients attaining this within 7 days post-surgery. No postoperative rebleeding occurred, and all bypass grafts remained patent. Early postoperative LSA infarctions were detected in five patients (62.5 %), with only one (12.5 %) patient experiencing early worsening of hemiparesis. At discharge, good outcomes were observed in five (5/8: 62.5 %) patients overall and four patients (4/4: 100 %) of those with good preoperative grades.
Conclusions
Distal occlusion and revascularization proved safe and effective for treating ruptured unclippable M1 aneurysms. The procedure achieved high rates of aneurysm thrombosis with minimal symptomatic complications. Postoperative LSA infarction was the primary complication, although most cases were asymptomatic. Further refinement of microsurgical techniques is warranted to reduce this complication.
{"title":"Distal occlusion and revascularization for microsurgical treatment of ruptured unclippable M1 segment middle cerebral artery aneurysms: Surgical outcomes and complications","authors":"Nasaeng Akharathammachote, Kitiporn Sriamornrattanakul, Chanon Ariyaprakai, Atithep Mongkolratnan","doi":"10.1016/j.wnsx.2025.100549","DOIUrl":"10.1016/j.wnsx.2025.100549","url":null,"abstract":"<div><h3>Background</h3><div>Complex, unclippable aneurysms of the pre-bifurcation segment of the M1 middle cerebral artery (pre-bM1) are rare and challenging to treat due to their association with lenticulostriate arteries (LSAs), particularly in ruptured cases. This study evaluates the outcomes and complications of microsurgical treatment employing distal occlusion and revascularization.</div></div><div><h3>Methods</h3><div>Eight patients with ruptured unclippable pre-bM1 aneurysms treated via distal occlusion and revascularization between 2018 and 2024 were retrospectively analyzed for radiographic and clinical outcomes.</div></div><div><h3>Results</h3><div>Complete aneurysm obliteration was achieved in all patients, with seven (87.5 %) out of eight patients attaining this within 7 days post-surgery. No postoperative rebleeding occurred, and all bypass grafts remained patent. Early postoperative LSA infarctions were detected in five patients (62.5 %), with only one (12.5 %) patient experiencing early worsening of hemiparesis. At discharge, good outcomes were observed in five (5/8: 62.5 %) patients overall and four patients (4/4: 100 %) of those with good preoperative grades.</div></div><div><h3>Conclusions</h3><div>Distal occlusion and revascularization proved safe and effective for treating ruptured unclippable M1 aneurysms. The procedure achieved high rates of aneurysm thrombosis with minimal symptomatic complications. Postoperative LSA infarction was the primary complication, although most cases were asymptomatic. Further refinement of microsurgical techniques is warranted to reduce this complication.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100549"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519576","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}
This study aimed to evaluate the predictive value of spinopelvic parameters and clinical variables for recurrent lumbar disc herniation (rLDH) following percutaneous endoscopic lumbar discectomy (PELD).
Methods
We retrospectively collected data from 1219 patients who underwent PELD surgery between January 2017 and January 2023, randomly divided into training (70 %) and validation (30 %) groups. Univariate and multivariate logistic regression analyses were performed in the training set to identify independent risk factors and construct a nomogram model. Model accuracy was assessed using the area under the receiver operating characteristic curve (AUC). Calibration was evaluated through calibration curves and goodness-of-fit tests. Decision curve analysis (DCA) was performed to assess net clinical benefit.
Results
Multivariate analysis identified BMI ≥25 kg/m2, high-intensity labor, pelvic incidence (PI) <45° or >60°, sacral slope (SS) < 35°, Pfirrmann grade III, and Modic type II and III changes as independent predictors of rLDH (p < 0.05). The model achieved an AUC of 0.836 (95 %CI: 0.801–0.872) in the training set and 0.812 (95 %CI: 0.735–0.888) in the validation set. Calibration curves showed good agreement between predicted and observed values. DCA demonstrated that the model provided significant net clinical benefit when intervention threshold probabilities were set at 2 %–59 % for the training set and 2 %–45 % for the validation set.
Conclusion
The spinopelvic parameter-based nomogram prediction model demonstrated excellent predictive performance for rLDH after PELD and facilitates individualized risk assessment.
{"title":"Development and validation of a nomogram model based on spinopelvic parameters for predicting recurrent lumbar disc herniation","authors":"Tengyu Wang, Conggang Liao, Yufei Jin, Keyu Luo, Xiang Yin","doi":"10.1016/j.wnsx.2025.100545","DOIUrl":"10.1016/j.wnsx.2025.100545","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the predictive value of spinopelvic parameters and clinical variables for recurrent lumbar disc herniation (rLDH) following percutaneous endoscopic lumbar discectomy (PELD).</div></div><div><h3>Methods</h3><div>We retrospectively collected data from 1219 patients who underwent PELD surgery between January 2017 and January 2023, randomly divided into training (70 %) and validation (30 %) groups. Univariate and multivariate logistic regression analyses were performed in the training set to identify independent risk factors and construct a nomogram model. Model accuracy was assessed using the area under the receiver operating characteristic curve (AUC). Calibration was evaluated through calibration curves and goodness-of-fit tests. Decision curve analysis (DCA) was performed to assess net clinical benefit.</div></div><div><h3>Results</h3><div>Multivariate analysis identified BMI ≥25 kg/m<sup>2</sup>, high-intensity labor, pelvic incidence (PI) <45° or >60°, sacral slope (SS) < 35°, Pfirrmann grade III, and Modic type II and III changes as independent predictors of rLDH (<em>p</em> < 0.05). The model achieved an AUC of 0.836 (95 %CI: 0.801–0.872) in the training set and 0.812 (95 %CI: 0.735–0.888) in the validation set. Calibration curves showed good agreement between predicted and observed values. DCA demonstrated that the model provided significant net clinical benefit when intervention threshold probabilities were set at 2 %–59 % for the training set and 2 %–45 % for the validation set.</div></div><div><h3>Conclusion</h3><div>The spinopelvic parameter-based nomogram prediction model demonstrated excellent predictive performance for rLDH after PELD and facilitates individualized risk assessment.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100545"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145464886","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}
Pub Date : 2025-10-01DOI: 10.1016/j.wnsx.2025.100541
Muhammad Izhar , Yusuke S. Hori , Ahed H. Kattaa , Fred C. Lam , Neeraj Kalra , Nirmeen Zagzoog , Armine Tayag , Louisa Ustrzynski , Sara C. Emrich , Erqi L. Pollom , Scott G. Soltys , Melanie Hayden Gephart , David J. Park , Steven D. Chang
<div><h3>Background</h3><div>Brain metastases (BM) from hepatocellular carcinoma (HCC) are rare and typically associated with poor prognosis. While whole-brain radiotherapy (WBRT) and surgical resection have been used for treatment, their applicability is often limited due to hepatic dysfunction and associated comorbidities. Stereotactic radiosurgery (SRS) offers a less invasive, targeted approach, but its role in HCC-related BM, especially in the context of hepatitis C virus (HCV) infection, remains unclear.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated patients with BM secondary to HCV-related HCC who were treated with SRS. Treatment parameters, including prescribed radiation dose, local tumor control (LTC), radiological response, and overall survival (OS), were assessed. Tumor control was defined based on radiological response to CyberKnife (CK) SRS as a complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) per response evaluation criteria in solid tumors (RECIST) guidelines. Moreover, we conducted a systematic review in accordance with PRISMA using three databases: PubMed/MEDLINE, Embase, and Web of Science.</div></div><div><h3>Results</h3><div>This is the first study to report outcomes of SRS specifically in patients with BM from HCV-related HCC. A total of 3 patients with a total number of 7 lesions were treated with a median prescribed dose of 27 Gy (range: 20–30 Gy). All treated lesions achieved 100 % LTC at 3-month, 6-month, and final follow-up evaluations, with no evidence of local progression. Radiologic assessment showed complete response in 14.3 % of lesions, partial response in 28.6 %, and stable disease in 57.1 %, with no cases of progressive disease. The mean overall survival was 8 months, falling within the upper range of previously reported survival (4–20 weeks) in HCC BM patient populations. For the systematic review, a total of 98 studies were initially identified through database searches. Following the removal of 8 duplicate entries, 90 studies were screened by title and abstract, resulting in 9 studies for full-text assessment. Of these, 3 were excluded for not meeting the inclusion criteria. Ultimately, 6 studies were included in the final systematic review. According to the systematic review, treatment was most commonly performed with Gamma Knife radiosurgery, with marginal doses ranging from 10 to 32 Gy delivered at the 50 % isodose line. Tumor volumes varied significantly (0.01–67.3 cm<sup>3</sup>), and hemorrhagic presentation was frequent, occurring in up to 76 % of cases. Reported overall survival (OS) ranged from 2 to 47 weeks. SRS-related complications were generally minimal. However, the existing literature is limited by heterogeneity and inconsistent evaluation of key prognostic factors.</div></div><div><h3>Conclusion</h3><div>SRS is a safe and effective treatment for BM in patients with HCV-related HCC, offering excellent local control. Given the rar
肝细胞癌（HCC）的脑转移（BM）是罕见的，通常与预后不良有关。虽然全脑放疗（WBRT）和手术切除已被用于治疗，但由于肝功能障碍和相关合并症，其适用性往往受到限制。立体定向放射外科（SRS）提供了一种侵入性较小的靶向治疗方法，但其在丙型肝炎病毒（HCV）感染的丙型肝炎相关脑转移中的作用尚不清楚。方法回顾性评价接受SRS治疗的hcv相关性HCC继发BM患者。评估治疗参数，包括规定的放射剂量、局部肿瘤控制（LTC）、放射反应和总生存期（OS）。肿瘤控制根据射波刀（CK） SRS的放射学反应定义为完全缓解（CR），部分缓解（PR），疾病稳定（SD）和疾病进展（PD），根据实体瘤反应评价标准（RECIST）指南。此外，我们根据PRISMA使用PubMed/MEDLINE、Embase和Web of Science三个数据库进行了系统评价。这是第一个报道SRS治疗hcv相关HCC患者预后的研究。共有3例患者，共7个病灶，中位处方剂量为27 Gy（范围：20-30 Gy）。所有接受治疗的病变在3个月、6个月和最终随访评估时均达到100% LTC，无局部进展迹象。放射学评估显示14.3%的病变完全缓解，28.6%的病变部分缓解，57.1%的病变稳定，无进展病例。平均总生存期为8个月，处于先前报道的HCC脑转移患者群体生存期（4-20周）的上限范围内。在系统评价中，通过数据库搜索初步确定了总共98项研究。在删除8个重复条目后，根据标题和摘要筛选了90项研究，其中9项研究进行了全文评估。其中3例因不符合纳入标准而被排除。最终，6项研究被纳入最终的系统评价。根据系统评价，治疗最常用的是伽玛刀放射手术，边际剂量范围为10至32 Gy，以50%等剂量线递送。肿瘤体积差异显著（0.01-67.3 cm3），出血表现频繁，高达76%的病例发生。报告的总生存期（OS）为2至47周。srs相关并发症一般很少。然而，现有文献受到异质性和关键预后因素评估不一致的限制。结论srs是一种安全有效的治疗乙型肝炎相关HCC患者脑转移的方法，具有良好的局部控制性。鉴于这种情况的罕见性和较小的队列规模，我们的研究结果的普遍性是有限的；因此，需要更大规模的前瞻性研究来证实这些结果，并探讨肿瘤病因对治疗结果的影响。此外，需要在未来的研究中标准化报告，以解决当前文献中潜在的异质性和差距。
{"title":"Stereotactic radiosurgery for hepatitis C virus-related hepatocellular carcinoma brain metastasis: A retrospective analysis and systematic review","authors":"Muhammad Izhar , Yusuke S. Hori , Ahed H. Kattaa , Fred C. Lam , Neeraj Kalra , Nirmeen Zagzoog , Armine Tayag , Louisa Ustrzynski , Sara C. Emrich , Erqi L. Pollom , Scott G. Soltys , Melanie Hayden Gephart , David J. Park , Steven D. Chang","doi":"10.1016/j.wnsx.2025.100541","DOIUrl":"10.1016/j.wnsx.2025.100541","url":null,"abstract":"<div><h3>Background</h3><div>Brain metastases (BM) from hepatocellular carcinoma (HCC) are rare and typically associated with poor prognosis. While whole-brain radiotherapy (WBRT) and surgical resection have been used for treatment, their applicability is often limited due to hepatic dysfunction and associated comorbidities. Stereotactic radiosurgery (SRS) offers a less invasive, targeted approach, but its role in HCC-related BM, especially in the context of hepatitis C virus (HCV) infection, remains unclear.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated patients with BM secondary to HCV-related HCC who were treated with SRS. Treatment parameters, including prescribed radiation dose, local tumor control (LTC), radiological response, and overall survival (OS), were assessed. Tumor control was defined based on radiological response to CyberKnife (CK) SRS as a complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) per response evaluation criteria in solid tumors (RECIST) guidelines. Moreover, we conducted a systematic review in accordance with PRISMA using three databases: PubMed/MEDLINE, Embase, and Web of Science.</div></div><div><h3>Results</h3><div>This is the first study to report outcomes of SRS specifically in patients with BM from HCV-related HCC. A total of 3 patients with a total number of 7 lesions were treated with a median prescribed dose of 27 Gy (range: 20–30 Gy). All treated lesions achieved 100 % LTC at 3-month, 6-month, and final follow-up evaluations, with no evidence of local progression. Radiologic assessment showed complete response in 14.3 % of lesions, partial response in 28.6 %, and stable disease in 57.1 %, with no cases of progressive disease. The mean overall survival was 8 months, falling within the upper range of previously reported survival (4–20 weeks) in HCC BM patient populations. For the systematic review, a total of 98 studies were initially identified through database searches. Following the removal of 8 duplicate entries, 90 studies were screened by title and abstract, resulting in 9 studies for full-text assessment. Of these, 3 were excluded for not meeting the inclusion criteria. Ultimately, 6 studies were included in the final systematic review. According to the systematic review, treatment was most commonly performed with Gamma Knife radiosurgery, with marginal doses ranging from 10 to 32 Gy delivered at the 50 % isodose line. Tumor volumes varied significantly (0.01–67.3 cm<sup>3</sup>), and hemorrhagic presentation was frequent, occurring in up to 76 % of cases. Reported overall survival (OS) ranged from 2 to 47 weeks. SRS-related complications were generally minimal. However, the existing literature is limited by heterogeneity and inconsistent evaluation of key prognostic factors.</div></div><div><h3>Conclusion</h3><div>SRS is a safe and effective treatment for BM in patients with HCV-related HCC, offering excellent local control. Given the rar","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100541"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320242","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}
Pub Date : 2025-10-01DOI: 10.1016/j.wnsx.2025.100532
Ryan D. Alghamdi , Albandari S. Baatiyah , Ahmed Z. Awan , Fawaz M. Alhalafi , Aroob A. Jaad , Abdulaziz A. Alzahrani , Rakan Farouk Y. Bokhari , Abdulrahman J. Sabbagh
Background
Patients’ choices in selecting healthcare providers are increasingly complex, shaped by privatization, autonomy, and online resources. Physician-rating sites and social media let patients compare providers using reviews. Understanding determinants in Saudi Arabia can align care with expectations and improve outcomes. This study examined key factors shaping physician selection.
Methods
A cross-sectional survey was conducted using a validated 36-item questionnaire distributed online. Adults aged ≥18 years who had searched for a physician or undergone surgery were eligible. Responses on physician selection factors were rated using a Likert scale. Data were analyzed using SPSS with non-parametric tests to identify key determinants of physician choice.
Results
The study included participants aged 18–71 years (mean age 29.35), predominantly female (58.9 %) and of Saudi nationality (89.7 %). The most critical factors were the physician's experience and medical knowledge (83.3 %) and recommendations from other physicians and patients (79.1 %). Only 15 % considered a physician's social media presence essential. While 56 % sought physicians through relatives or friends, 22.4 % used the internet, primarily Google (51.6 %) and Twitter (31.2 %). Participants valued surgical outcomes (82.6 %) and academic qualifications (73.0 %) the most. Discomfort with sharing personal medical information on social media was highest among those undergoing elective surgery (p = 0.007).
Conclusion
Patients in Saudi Arabia prioritize physicians’ experience and qualifications, relying heavily on personal recommendations over social media presence. These findings highlight the importance of professional expertise and trusted networks in healthcare provider selection.
{"title":"Determinant of choice of health care providers among the general population, a cross-sectional study from Saudi Arabia","authors":"Ryan D. Alghamdi , Albandari S. Baatiyah , Ahmed Z. Awan , Fawaz M. Alhalafi , Aroob A. Jaad , Abdulaziz A. Alzahrani , Rakan Farouk Y. Bokhari , Abdulrahman J. Sabbagh","doi":"10.1016/j.wnsx.2025.100532","DOIUrl":"10.1016/j.wnsx.2025.100532","url":null,"abstract":"<div><h3>Background</h3><div>Patients’ choices in selecting healthcare providers are increasingly complex, shaped by privatization, autonomy, and online resources. Physician-rating sites and social media let patients compare providers using reviews. Understanding determinants in Saudi Arabia can align care with expectations and improve outcomes. This study examined key factors shaping physician selection.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted using a validated 36-item questionnaire distributed online. Adults aged ≥18 years who had searched for a physician or undergone surgery were eligible. Responses on physician selection factors were rated using a Likert scale. Data were analyzed using SPSS with non-parametric tests to identify key determinants of physician choice.</div></div><div><h3>Results</h3><div>The study included participants aged 18–71 years (mean age 29.35), predominantly female (58.9 %) and of Saudi nationality (89.7 %). The most critical factors were the physician's experience and medical knowledge (83.3 %) and recommendations from other physicians and patients (79.1 %). Only 15 % considered a physician's social media presence essential. While 56 % sought physicians through relatives or friends, 22.4 % used the internet, primarily Google (51.6 %) and Twitter (31.2 %). Participants valued surgical outcomes (82.6 %) and academic qualifications (73.0 %) the most. Discomfort with sharing personal medical information on social media was highest among those undergoing elective surgery (<em>p</em> = 0.007).</div></div><div><h3>Conclusion</h3><div>Patients in Saudi Arabia prioritize physicians’ experience and qualifications, relying heavily on personal recommendations over social media presence. These findings highlight the importance of professional expertise and trusted networks in healthcare provider selection.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100532"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265508","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}
Pub Date : 2025-10-01DOI: 10.1016/j.wnsx.2025.100529
Huan Liu , Ying-Jie Li , Li-Jun Jia , Li-Rong Wang , Sen Zhou , Hao Tao , Yi Li , Bing-Hu Li , Neng-Wei Yu
Background and purpose
Futile recanalization (FR) occurs in patients who achieve successful vessel recanalization but still have a poor prognosis. The aim of this study was to explore the association between systemic immune-inflammation index (SII) and futile recanalization following mechanical thrombectomy (MT) in acute ischemic stroke (AIS).
Methods
We retrospectively analyzed patients with AIS due to large vessel occlusion in the anterior circulation who achieved successful recanalization after MT. The SII was calculated as platelet count × neutrophil count/lymphocyte count from preoperative peripheral venous blood. FR was defined as a modified Rankin Scale (mRS) score of ≥3 at 3 months despite successful recanalization. Binary logistic regression was performed to identify independent predictors of FR. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of identified factors for FR.
Results
We retrospectively analyzed 262 patients, with the median age of 70 (58.75–78.00) years. The SII in the FR group was significantly higher than in the non-FR group. After adjusting for confounding factors, binary logistic regression analysis indicated that SII was an independent predictor for FR (OR = 1.999, 95% CI: 1.324–3.018, p < 0.001). The ROC curve showed that SII can effectively predict adverse outcomes 3 months after MT [area under the curve (AUC) value: 0.687, p < 0.001], and can help the comprehensive model better predict FR (AUC value: 0.807 versus 0.772).
Conclusions
A high preoperative SII may be associated with FR in anterior circulation AIS patients with mechanical thrombectomy.
{"title":"The predictive role of systemic immune-inflammation index on futile recanalization in acute ischemic stroke with mechanical thrombectomy","authors":"Huan Liu , Ying-Jie Li , Li-Jun Jia , Li-Rong Wang , Sen Zhou , Hao Tao , Yi Li , Bing-Hu Li , Neng-Wei Yu","doi":"10.1016/j.wnsx.2025.100529","DOIUrl":"10.1016/j.wnsx.2025.100529","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Futile recanalization (FR) occurs in patients who achieve successful vessel recanalization but still have a poor prognosis. The aim of this study was to explore the association between systemic immune-inflammation index (SII) and futile recanalization following mechanical thrombectomy (MT) in acute ischemic stroke (AIS).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients with AIS due to large vessel occlusion in the anterior circulation who achieved successful recanalization after MT. The SII was calculated as platelet count × neutrophil count/lymphocyte count from preoperative peripheral venous blood. FR was defined as a modified Rankin Scale (mRS) score of ≥3 at 3 months despite successful recanalization. Binary logistic regression was performed to identify independent predictors of FR. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of identified factors for FR.</div></div><div><h3>Results</h3><div>We retrospectively analyzed 262 patients, with the median age of 70 (58.75–78.00) years. The SII in the FR group was significantly higher than in the non-FR group. After adjusting for confounding factors, binary logistic regression analysis indicated that SII was an independent predictor for FR (OR = 1.999, 95% CI: 1.324–3.018, <em>p</em> < 0.001). The ROC curve showed that SII can effectively predict adverse outcomes 3 months after MT [area under the curve (AUC) value: 0.687, <em>p</em> < 0.001], and can help the comprehensive model better predict FR (AUC value: 0.807 versus 0.772).</div></div><div><h3>Conclusions</h3><div>A high preoperative SII may be associated with FR in anterior circulation AIS patients with mechanical thrombectomy.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100529"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219891","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}
Pub Date : 2025-10-01DOI: 10.1016/j.wnsx.2025.100543
Hu Chen , Lu Cao , Yinghua He , Hao Sun , Qiang Tu
Objective
The majority of previously published cervical spine models used in finite element (FE) analysis usually include only parts of motion units, resulting in differences in the realistic response of the whole cervical spine. This study aimed to develop a geometrically accurate, comprehensive, three-dimensional (3D) FE model for the entire cervical spine.
Methods
A 3D FE model of the full cervical spine was constructed based on CT data. The predicted range of motion (ROM) for each segmental motion of the cervical spine was compared with previous research. Additionally, the present FE model was used to evaluate von Mises stress in the bones, intervertebral disc pressure (IDP), and facet joint force to analyze the biomechanical effects under physiological loading.
Results
The complete FE model consisted of 2,218,790 elements and 3,332,459 nodes, including 7 cervical vertebrae, occiput, 5 intervertebral discs, 13 ligaments, and 7 pairs of facet joints. The ROMs obtained were consistent with published experiments in terms of both value and tendency. The IDP and facet joint force was asymmetric under flexion-extension, while symmetric under axial rotation and lateral bending.
Conclusion
The validation of our developed model coincided with experimental studies and proved to be more convincing than models that only considered parts of motion units.
{"title":"Development of a CT-based 3D finite element model of the whole cervical spine with occiput: Insights into sagittal balance, disc pressure, and facet joint forces","authors":"Hu Chen , Lu Cao , Yinghua He , Hao Sun , Qiang Tu","doi":"10.1016/j.wnsx.2025.100543","DOIUrl":"10.1016/j.wnsx.2025.100543","url":null,"abstract":"<div><h3>Objective</h3><div>The majority of previously published cervical spine models used in finite element (FE) analysis usually include only parts of motion units, resulting in differences in the realistic response of the whole cervical spine. This study aimed to develop a geometrically accurate, comprehensive, three-dimensional (3D) FE model for the entire cervical spine.</div></div><div><h3>Methods</h3><div>A 3D FE model of the full cervical spine was constructed based on CT data. The predicted range of motion (ROM) for each segmental motion of the cervical spine was compared with previous research. Additionally, the present FE model was used to evaluate von Mises stress in the bones, intervertebral disc pressure (IDP), and facet joint force to analyze the biomechanical effects under physiological loading.</div></div><div><h3>Results</h3><div>The complete FE model consisted of 2,218,790 elements and 3,332,459 nodes, including 7 cervical vertebrae, occiput, 5 intervertebral discs, 13 ligaments, and 7 pairs of facet joints. The ROMs obtained were consistent with published experiments in terms of both value and tendency. The IDP and facet joint force was asymmetric under flexion-extension, while symmetric under axial rotation and lateral bending.</div></div><div><h3>Conclusion</h3><div>The validation of our developed model coincided with experimental studies and proved to be more convincing than models that only considered parts of motion units.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100543"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145464883","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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