World Neurosurgery: X最新文献

{"title":"Skull base giant cell tumors uncovered: Clinical challenges and evolving treatment strategies – A case and literature review","authors":"Gervith Reyes Soto ,&nbsp;Carlos Castillo Rangel ,&nbsp;Ismail Bozkurt ,&nbsp;Daniel Alejandro Vega Moreno ,&nbsp;Andreina Rosario Rosario ,&nbsp;Ruben Dario Bleubar Ozoria ,&nbsp;Renat Nurmukhametov ,&nbsp;Manuel De Jesús Encarnación Ramirez","doi":"10.1016/j.wnsx.2025.100527","DOIUrl":"10.1016/j.wnsx.2025.100527","url":null,"abstract":"<div><h3>Background</h3><div>Giant cell tumor (GCT) is a low frequency, benign neoplasm that generally produces lytic lesions. It mainly affects women in the third to fifth decade of life. Its most frequently reported location is in the temporal bone, especially the petrous portion, followed by the sphenoid. There are multiple lines of treatment; however, surgical management remains the standard treatment.</div></div><div><h3>Methods</h3><div>An 18-year-old man presented with diplopia. Through imaging studies and biopsy, he was diagnosed with a GCT of the cranial base. The patient was managed surgically on two occasions and with complementary treatment with denosumab, which achieved complete remission and a total reduction in tumor volume. A systematic review of previously published studies was conducted.</div></div><div><h3>Results</h3><div>We identified a total of 128 records through database searching from PubMed, Medline, and Scopus. The screening process left 23 records for detailed review. Upon further evaluation, nine non-research letters or commentaries were excluded, resulting in 15 full-text articles being included in the final review.</div></div><div><h3>Conclusions</h3><div>GCTs have benign histological characteristics; however, the bony lytic destruction makes their management difficult. The main stray treatment modality continues to be surgery. However, as presented in our case supported with multiple studies adjuvant treatment with denosumab yields good responses.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100527"},"PeriodicalIF":2.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095025","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}

{"title":"A comparative analysis of suturectomy versus remodeling in non-syndromic craniosynostosis: A systematic review and meta-analysis","authors":"Tjokorda Istri Sri Dalem Natakusuma ,&nbsp;Bryan Gervais de Liyis ,&nbsp;Kadek Dede Frisky Wiyanjana ,&nbsp;Sri Maliawan ,&nbsp;Tjokorda Gde Bagus Mahadewa","doi":"10.1016/j.wnsx.2025.100526","DOIUrl":"10.1016/j.wnsx.2025.100526","url":null,"abstract":"<div><h3>Background</h3><div>Non-syndromic craniosynostosis, involving premature fusion of isolated cranial sutures, is managed surgically by either minimally invasive strip suturectomy or open cranial vault remodeling. Although individual cohort studies have described perioperative metrics and cranial index improvements for each technique, no meta-analysis has systematically compared their relative efficacy, safety, and morphologic impact across different suture types, leaving optimal procedural selection unresolved. This meta-analysis evaluates postoperative outcomes and complications of suturectomy versus cranial remodeling in pediatric patients with non-syndromic craniosynostosis.</div></div><div><h3>Methods</h3><div>Systematic searches of ScienceDirect, MEDLINE, Embase, and CENTRAL databases identified cohort studies up to October 2024 (PROSPERO ID: CRD42024606734). Postoperative outcomes included cephalic index (CI), interfrontal angle (IFA), interzygomaticofrontal distance (IZFD), and complications. Intraoperative outcomes encompassed operation time, estimated blood loss, hospital stay, revision surgeries, and transfusion requirements.</div></div><div><h3>Results</h3><div>This meta-analysis included 25 cohort studies with 3344 children (mean age 8.10 ± 3.34 months), divided into the suturectomy group (1424 children) and the remodeling group (2099 children). The suturectomy group showed significant advantages: shorter operation time (MD:-143.18; 95 %CI:- 180.06 to −106.29; <em>p</em> &lt; 0.001), reduced estimated blood loss (MD:-221.17; 95 %CI:-305.41 to −136.90; <em>p</em> &lt; 0.001), shorter hospital stay (MD:-2.58; 95 %CI:-3.07 to −2.09; <em>p</em> &lt; 0.001), lower revision surgeries (RR:0.31; 95 %CI:0.13–0.72; <em>p</em> = 0.01), decreased blood transfusion (RR:0.01; 95 %CI:0.00–0.05; <em>p</em> &lt; 0.001), and fewer complications (RR:0.28; 95 %CI:0.09–0.89; <em>p</em> = 0.03). In the suturectomy group, CI (MD:0.06; 95 %CI:0.03–0.08; <em>p</em> &lt; 0.001) and IFA (MD:12.05; 95 %CI:6.62–17.47; <em>p</em> &lt; 0.001) improved significantly, while IZFD did not. In the remodeling group, CI (MD:0.05; 95 %CI:0.02–0.08; <em>p</em> &lt; 0.001) and IFA (MD:13.47; 95 %CI:9.58–17.91; <em>p</em> &lt; 0.001) also improved, but IZFD showed no significant change. Cranial indices were not significantly different between both groups.</div></div><div><h3>Conclusions</h3><div>Suturectomy offers better intraoperative outcomes, with reduced operative time, blood loss, hospital stay, revision surgeries, blood transfusion, and complications, making it ideal for younger, single-suture cases. Cranial indices were found to be similar following both interventions.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100526"},"PeriodicalIF":2.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095024","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}

{"title":"Managing neurosurgical complications in emergency settings: An evidence-based review of challenges and strategies","authors":"Moustafa A. Mansour ,&nbsp;Salma Medhat ,&nbsp;Alaa Elnomary ,&nbsp;Mohammad M. Selim ,&nbsp;Ahmed Mohsen ,&nbsp;Mohammed Al-Amri ,&nbsp;Salah Musaed ,&nbsp;Mohamed E. Behiry ,&nbsp;Michael Zohney ,&nbsp;Hamdi Nabawi Mostafa","doi":"10.1016/j.wnsx.2025.100525","DOIUrl":"10.1016/j.wnsx.2025.100525","url":null,"abstract":"<div><div>Neurosurgical complications in emergency settings present significant challenges, requiring prompt and expert intervention. This evidence-based review analyzes critical post-operative complications, including infections (post-craniotomy, post-spinal, and rare pathogens), hematomas (epidural, subdural, intracerebral), seizures, cerebrospinal fluid (CSF) leakage, ischemia, elevated intracranial pressure (ICP), and hydrocephalus. Special emphasis is placed on ventriculoperitoneal (VP) shunt malfunctions and aneurysmal subarachnoid hemorrhage (aSAH) rebleeding, highlighting their pathophysiology, diagnostics, and management.</div><div>The review explores risk factors, clinical presentations, and advanced diagnostics like quantitative near-infrared spectroscopy (Q-NIRS) for ischemia. Treatment protocols include surgical interventions (e.g., craniotomy, endoscopic third ventriculostomy), medical management (e.g., antiepileptic drugs, hyperosmolar therapy), and preventive measures.</div><div>From a triage perspective, the review underscores the neurosurgeon's critical role in prioritizing time-sensitive emergencies, such as favoring immediate evacuation for a life-threatening epidural hematoma over other urgent cases, a decision that profoundly impacts survival.</div><div>Ethical and logistical challenges in emergency neurosurgery are examined, particularly in resource-limited settings, addressing triage dilemmas, consent issues, and global disparities in care access. The review synthesizes recent advancements, such as telemedicine and novel therapies like tranexamic acid for aSAH, while underscoring multidisciplinary collaboration.</div><div>By integrating current research and clinical best practices, this review aims to equip neurosurgeons and healthcare providers with actionable insights to optimize patient outcomes in high-stakes emergencies.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100525"},"PeriodicalIF":2.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157608","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}

{"title":"Spinal nerve sheath tumors: Contrasting surgical resection and stereotactic radiosurgery cohorts in a single-center","authors":"Emre Yilmaz ,&nbsp;Thomas M. O'Lynnger ,&nbsp;Sandra Vermeulen ,&nbsp;Christian Fisahn ,&nbsp;Sarah M. Strot ,&nbsp;Marc Moisi ,&nbsp;Basem Ishak ,&nbsp;Joseph R. Dettori ,&nbsp;Clifford Pierre ,&nbsp;Julius Gerstmeyer ,&nbsp;Rod J. Oskouian ,&nbsp;Jens R. Chapman","doi":"10.1016/j.wnsx.2025.100524","DOIUrl":"10.1016/j.wnsx.2025.100524","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary incidental spinal schwannomas, and neurofibromas are typically treated with surgical resection. Few studies have examined the effects of radiosurgery as the primary treatment of spinal benign tumors. The aim of this study was to evaluate the efficacy of radiosurgery as a primary treatment option for this pathology.</div></div><div><h3>Methods</h3><div>In this retrospective single-center study, the authors included all patients who were treated for spinal schwannomas, and neurofibromas with either radiosurgery or operative intervention from 2006 to 2016. Data points recorded include age, sex, BMI, smoking, immunosuppression status, neurological exam, functional scores, radiographic follow-up data, recurrence and treatment, medical comorbidities, and margins of resection.</div></div><div><h3>Results</h3><div>Seventeen patients (14 females, 3 males) underwent radiosurgery with a median age of 60 years (IQR 55–69). In comparison, 39 patients (15 females, 24 males) underwent surgical resection, with a median age of 52 years (IQR 42–67). Following radiosurgery, 13 of 17 patients demonstrated stable tumor size on follow-up imaging. There were notable significant changes for tumor state following treatments (p &lt; .001), however, there were no significant differences in preoperative symptoms, tumor volume, or postoperative outcomes between radiosurgery and open resection groups, including motor weakness, sensory loss, pain, neurological improvement, readmission, or reoperation rates.</div></div><div><h3>Conclusions</h3><div>Radiosurgery is a safe, feasible primary treatment for spinal neurofibromas and schwannomas. Surgery achieved greater tumor volume reduction, but both groups had comparable outcomes in pain, neurological improvement, adverse effects, readmission, and reoperation.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100524"},"PeriodicalIF":2.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109608","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}

{"title":"Thirty-day mortality in the oldest old with spontaneous subarachnoid hemorrhage","authors":"Yu-Hua Huang ,&nbsp;Tsung-Han Lee","doi":"10.1016/j.wnsx.2025.100523","DOIUrl":"10.1016/j.wnsx.2025.100523","url":null,"abstract":"<div><h3>Objective</h3><div>Spontaneous subarachnoid hemorrhage (SAH) is a severe disease with a high mortality rate that frequently occurs in the elderly. People aged 80 years and over can be regarded as the oldest old and are a rapidly growing segment of the population. It is unknown whether aggressive intervention for SAH is beneficial in this age cohort. We aimed to analyze the incidence and risk factors of 30-day mortality in the oldest old after spontaneous SAH.</div></div><div><h3>Methods</h3><div>A total of 1689 adult patients with a primary diagnosis of spontaneous SAH were retrospectively enrolled. Differences in clinical variables were evaluated between patients aged 18–79 years (N = 1592) and those aged ≥80 years (N = 97).</div></div><div><h3>Results</h3><div>The oldest old comprised 5.7 % of the study population. The 30-day mortality rate was 43.3 % (42/97) in the oldest old patients and 28.8 % (459/1592) in the non-oldest old patients (p &lt; 0.01). In a multivariate logistic regression model, the independent risk factor for 30-day mortality in the oldest old was hydrocephalus [odds ratio (95 % confidence interval) = 6.12 (1.54–24.25); p = 0.01]. The 30-day mortality rate was up to 58.3 % (21/36) among the oldest old patients accompanied by hydrocephalus.</div></div><div><h3>Conclusions</h3><div>The oldest old account for a significant proportion of patients with spontaneous SAH. As the incidence of 30-day mortality is remarkably high in this age group, the decision to aggressively treat the oldest old with SAH requires careful weighing, particularly in those who are highly risky.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100523"},"PeriodicalIF":2.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109609","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}

{"title":"Reasons for magnetic resonance imaging in subarachnoid hemorrhage patients: A retrospective, single center study","authors":"Sarah E. Nelson ,&nbsp;John Liang ,&nbsp;Alexandra S. Reynolds ,&nbsp;Neha Dangayach ,&nbsp;Hae-Young Baang ,&nbsp;Spyridoula Tsetsou ,&nbsp;Cappi Lay","doi":"10.1016/j.wnsx.2025.100521","DOIUrl":"10.1016/j.wnsx.2025.100521","url":null,"abstract":"<div><h3>Objective</h3><div>Aneurysmal subarachnoid hemorrhage (SAH) is associated with significant morbidity and mortality. MRI holds promise for improving aneurysmal SAH management, and reasons for its performance could improve knowledge of how this modality could be leveraged.</div></div><div><h3>Methods</h3><div>In this single-center cohort study, we retrospectively compared SAH patients who had undergone clinically-indicated MRIs vs those who had not and evaluated patients based on major reason for MRI. Wilcoxon rank-sum tests and chi-square tests were used to make univariate comparisons as appropriate. Performance of MRI was also included in multivariable models evaluating discharge outcomes.</div></div><div><h3>Results</h3><div>Among 132 SAH patients (median age (IQR) 57 (48–67) years, 62.1 % female) hospitalized from 2021 to 2022, 68 (51.5 %) underwent MRI during their acute hospitalization. SAH patients who underwent MRIs had longer hospital lengths of stay (median (IQR): 22 (14–38) vs 17.5 (13–22) days, <em>p</em> = 0.01) and were less frequently discharged as deceased (5.9 % vs 23.4 %, <em>p</em> = 0.004). Most common reasons for MRI performance were to evaluate for SAH cause (<em>n</em> = 23) and to assess for infarct or vasospasm (<em>n</em> = 27). In multivariable analyses, not having had an MRI was a significant predictor for the outcome discharged as deceased, while having had an MRI was a significant predictor of hospital and ICU lengths of stay.</div></div><div><h3>Conclusions</h3><div>In this single-center cohort study, about half of SAH patients underwent MRIs, frequently to assess for SAH cause and for vasospasm or infarct. Those who underwent MRIs had longer hospital stays and less frequently died while in the hospital. Additional studies to confirm these findings are needed.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100521"},"PeriodicalIF":2.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044722","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}

{"title":"Rational graft selection using the estimated stump pressure ratio in patients with complex internal carotid artery and M1 aneurysms treated with flow-replacement bypass and parent artery sacrifice: Simplifying avoiding the risks of the balloon occlusion test","authors":"Nasaeng Akharathammachote,&nbsp;Kitiporn Sriamornrattanakul,&nbsp;Chanon Ariyaprakai,&nbsp;Atithep Mongkolratnan,&nbsp;Areeporn Chonhenchob","doi":"10.1016/j.wnsx.2025.100522","DOIUrl":"10.1016/j.wnsx.2025.100522","url":null,"abstract":"<div><h3>Background</h3><div>To avoid ischemic complications after vessel sacrifice, universal revascularization is indispensable for treating complex cerebral aneurysms. The selection of the appropriate bypass graft can prevent low-flow–related ischemic stroke (LRIS) after extracranial-to-intracranial (EC-IC) bypass for aneurysms of the internal carotid artery (ICA) and M1 segment of the middle cerebral artery (M1) treated with parent artery sacrifice. Selecting the bypass graft via calculation using the formula proposed by Matsukawa et al requires obtaining the stump pressure ratio (PR) from the preoperative balloon occlusion test (BOT). To avoid BOT complications, we used this formula with the estimated stump PR. We proposed our modified calculation and evaluated its efficacy.</div></div><div><h3>Methods</h3><div>Twenty-three patients who underwent EC-IC bypass and parent artery sacrifice to treat complex ICA and M1 aneurysm were retrospectively evaluated for postoperative LRIS. The bypass graft was selected by calculation using the estimated stump PR.</div></div><div><h3>Results</h3><div>Twelve (52.2 %) and 11 (47.8 %) patients had ICA and M1 aneurysm, respectively. The radial artery, saphenous vein, double superficial temporal artery (STA), and single STA were used in 7 (30.4 %), 3 (13.1 %), 11 (47.8 %), and 2 (8.7 %) patients, respectively. The bypass graft was patent in all patients. No LRIS was detected after operation. Perforator infarctions were found in six patients (26.1 %), but two patients (8.7 %) were symptomatic.</div></div><div><h3>Conclusions</h3><div>The modified calculation using the formula with the estimated stump PR effectively determined an adequate graft size for flow-replacement bypass to treat the ICA and M1 aneurysms without the risk of the BOT.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100522"},"PeriodicalIF":2.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044721","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}

{"title":"Neurosurgical sepsis protocols following craniotomy: Clinical outcomes and survival analysis","authors":"Panu Boontoterm ,&nbsp;Siraruj Sakoolnamarka ,&nbsp;Karanarak Urasyanandana ,&nbsp;Pusit Fuengfoo","doi":"10.1016/j.wnsx.2025.100519","DOIUrl":"10.1016/j.wnsx.2025.100519","url":null,"abstract":"<div><h3>Objectives</h3><div>Central nervous system infections after craniotomy are associated with high perioperative mortality and morbidity. Despite the availability of Surviving Sepsis Campaign (SSC) guidelines, few studies have evaluated their clinical impact in neurosurgical patients. This study aimed to assess mortality and key clinical outcomes following SSC protocol implementation.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, 139 patients with neurosurgical sepsis were enrolled and divided into two groups: 67 patients received the SSC protocol (protocol group), and 72 patients received standard care (usual care group). Baseline characteristics, early resuscitation metrics, and clinical outcomes were compared over a 30-day follow-up period.</div></div><div><h3>Results</h3><div>The SSC protocol group demonstrated significantly improved survival, with a longer median survival time (20 vs. 15 days, <em>p</em> &lt; 0.001) and reduced ICU stay, hospital stay, and increased ventilator- and vasopressor-free days (<em>p</em> &lt; 0.001 for all). Early initiation of antibiotics, vasopressors, and source control was achieved more rapidly in the protocol group. Among adjunct therapies, intravenous hydrocortisone significantly reduced vasopressor duration and hospital length of stay (<em>p</em> = 0.001 and <em>p</em> &lt; 0.001, respectively). Thiamine was associated with shorter hospital stays (<em>p</em> = 0.023), while CRRT contributed to reduced vasopressor requirements (<em>p</em> = 0.013).</div></div><div><h3>Conclusions</h3><div>Implementation of SSC protocols in neurosurgical sepsis following craniotomy significantly improved survival and key clinical outcomes. Hydrocortisone and CRRT were associated with reduced vasopressor needs, and thiamine use correlated with decreased hospital stay. Early sepsis management protocols may improve outcomes in this high-risk population.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100519"},"PeriodicalIF":2.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043916","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}

{"title":"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","authors":"Betul Yaman ,&nbsp;Gulce Gel ,&nbsp;Cengiz Tuncer ,&nbsp;Sahin Hanalioglu ,&nbsp;Husamettin Bulut ,&nbsp;Ata Turker Arikok ,&nbsp;Bora Gurer ,&nbsp;Erhan Turkoglu","doi":"10.1016/j.wnsx.2025.100520","DOIUrl":"10.1016/j.wnsx.2025.100520","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100520"},"PeriodicalIF":2.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095023","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}

{"title":"Stereotactic radiosurgery for brain metastases from non-uterine Leiomyosarcoma: A retrospective case series","authors":"Juan J. Cardona,&nbsp;Yusuke S. Hori,&nbsp;Ahed H. Kattaa,&nbsp;Paul M. Harary,&nbsp;Fred C. Lam,&nbsp;Deya Abu-Reesh,&nbsp;Louisa Ustrzynski,&nbsp;Sara C. Emrich,&nbsp;Armine Tayag,&nbsp;Melanie Hayden-Gephart,&nbsp;David J. Park,&nbsp;Steven D. Chang","doi":"10.1016/j.wnsx.2025.100517","DOIUrl":"10.1016/j.wnsx.2025.100517","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100517"},"PeriodicalIF":2.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043922","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}