Pub Date : 2025-08-22DOI: 10.1016/j.wnsx.2025.100511
Hidetaka Onda , Mizuki Kojima , Nodoka Miyake , Kenta Shigeta , Naoki Tominaga , Shoji Yokobori
Background
Interleukin (IL)-6 levels in cerebrospinal fluid (CSF) may reflect postoperative inflammation and affect the outcomes of aneurysmal subarachnoid hemorrhage (SAH).
Methods
This study retrospectively analyzed CSF IL-6 levels on the first postoperative day in 77 patients with SAH treated by craniotomy or endovascular coiling within 12 h of diagnosis. IL-6 levels were measured by enzyme-linked immunosorbent assay and compared between treatment groups. Associations with cerebral vasospasm and clinical outcomes were evaluated by multiple regression analysis.
Results
The median IL-6 level in CSF was 10,501 pg/mL [interquartile range 3037.8, 43,118.5] and was significantly lower in the endovascular group than in the craniotomy group (p < 0.001). In the craniotomy group, the IL-6 level was higher in patients with involvement of the anterior communicating artery than in those with aneurysm at other sites (p = 0.008). Cerebral vasospasm was identified in 13.0 % of cases and was associated with elevated IL-6 (p = 0.003). Higher IL-6 levels were correlated with unfavorable outcomes (p < 0.001).
Conclusion
Elevated IL-6 levels in CSF on postoperative day 1 were associated with cerebral vasospasm and worse outcomes in patients with SAH. Endovascular treatment resulted in lower IL-6 levels, suggesting that minimally invasive methods may reduce inflammation and improve the prognosis. Regulating IL-6 could be a potential therapeutic strategy in SAH management.
{"title":"Association between postoperative interleukin-6 levels in cerebrospinal fluid and invasiveness of surgery for subarachnoid hemorrhage","authors":"Hidetaka Onda , Mizuki Kojima , Nodoka Miyake , Kenta Shigeta , Naoki Tominaga , Shoji Yokobori","doi":"10.1016/j.wnsx.2025.100511","DOIUrl":"10.1016/j.wnsx.2025.100511","url":null,"abstract":"<div><h3>Background</h3><div>Interleukin (IL)-6 levels in cerebrospinal fluid (CSF) may reflect postoperative inflammation and affect the outcomes of aneurysmal subarachnoid hemorrhage (SAH).</div></div><div><h3>Methods</h3><div>This study retrospectively analyzed CSF IL-6 levels on the first postoperative day in 77 patients with SAH treated by craniotomy or endovascular coiling within 12 h of diagnosis. IL-6 levels were measured by enzyme-linked immunosorbent assay and compared between treatment groups. Associations with cerebral vasospasm and clinical outcomes were evaluated by multiple regression analysis.</div></div><div><h3>Results</h3><div>The median IL-6 level in CSF was 10,501 pg/mL [interquartile range 3037.8, 43,118.5] and was significantly lower in the endovascular group than in the craniotomy group (<em>p</em> < 0.001). In the craniotomy group, the IL-6 level was higher in patients with involvement of the anterior communicating artery than in those with aneurysm at other sites (<em>p</em> = 0.008). Cerebral vasospasm was identified in 13.0 % of cases and was associated with elevated IL-6 (<em>p</em> = 0.003). Higher IL-6 levels were correlated with unfavorable outcomes (<em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Elevated IL-6 levels in CSF on postoperative day 1 were associated with cerebral vasospasm and worse outcomes in patients with SAH. Endovascular treatment resulted in lower IL-6 levels, suggesting that minimally invasive methods may reduce inflammation and improve the prognosis. Regulating IL-6 could be a potential therapeutic strategy in SAH management.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100511"},"PeriodicalIF":2.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904441","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 : 2025-08-22DOI: 10.1016/j.wnsx.2025.100506
Yao Christian Hugues Dokponou, Mahjouba Boutarbouch, Yasser Arkha, Adyl Melhaoui, Mohammed Yassaad Oudrhiri, Mehdi Hakkou, Abdessamad El Ouahabi
Background
Rupture of intracranial aneurysm results in a potentially life-threatening subarachnoid hemorrhage (SAH) leading to a 45 % mortality rate with only 30 % returning to their normal life. Thus, the management decision is crucial. This study aimed to improve consistency, patient-centeredness, safety, and effectiveness of the decision-making for microsurgical or endovascular treatments of intracranial aneurysms (IAs) patients by appraisal of clinical, locational, and morphometric factors.
Methods
We use the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines to guide the appraisal of 394 patients with 435 IAs for quality improvement of aSAH treatment decision making. Between January 2013 and December 2022, our team developed a flexible patient selection criterion for microsurgical or endovascular treatments of ruptured IAs.
Results
We depicted 312 (71.7 %) and 123 (28.3 %) anterior cerebral circulation IAs and posterior cerebral circulation IAs respectively. About 65.5 %(n = 285) were clipped whereas 34.5 %(n = 150) underwent coiling. Multiple factors (age, location, type, size, dome-to-neck ratio, WFNS grade at admission, and modified Rankin Scale “mRS” score) were found to influence the quality-improving decision-making for microsurgery or endovascular treatment of IAs. There was a statistically significant difference (p < 0.001) between the aneurysmal morphometric factors for clinical decision of endovascular treatments (42 % vs 58 %) or microsurgical clipping (78.9 % vs 21.1 %) of the anterior and posterior cerebral circulation IAs respectively, with an Odds ratio 2.72; 95 %CI [1.76–4.18].
Conclusion
Despite the management of IA's for many decades, reliable indicators for making decisions on microsurgical versus endovascular treatments for IA's are still debated.
背景颅内动脉瘤破裂会导致潜在的危及生命的蛛网膜下腔出血（SAH），导致45%的死亡率，只有30%的患者恢复正常生活。因此，管理决策至关重要。本研究旨在通过评估临床、位置和形态计量学因素，提高颅内动脉瘤显微手术或血管内治疗决策的一致性、以患者为中心、安全性和有效性。方法采用质量改进报告卓越标准（SQUIRE 2.0）指南对394例患者的435个IAs进行评价，以提高aSAH治疗决策的质量。在2013年1月至2022年12月期间，我们的团队为破裂的IAs进行显微手术或血管内治疗制定了灵活的患者选择标准。结果脑前循环病变312例（71.7%），脑后循环病变123例（28.3%）。约65.5% （n = 285）的患者行夹持术，而34.5% （n = 150）的患者行卷取术。发现多因素（年龄、位置、类型、大小、颈圆比、入院时WFNS评分、改良Rankin量表“mRS”评分）影响IAs显微手术或血管内治疗的质量改善决策。脑前后循环动脉瘤形态计量学因素在临床决定血管内治疗（42% vs 58%）或显微手术夹持（78.9% vs 21.1%）方面的差异有统计学意义（p < 0.001），优势比为2.72；95% ci[1.76-4.18]。结论尽管IA的治疗已有几十年的历史，但对于IA的显微手术治疗和血管内治疗的可靠指标仍存在争议。
{"title":"Application of a SQUIRE-compliant framework to improve patient management decision-making quality for microsurgery versus endovascular treatments in ruptured intracranial aneurysms","authors":"Yao Christian Hugues Dokponou, Mahjouba Boutarbouch, Yasser Arkha, Adyl Melhaoui, Mohammed Yassaad Oudrhiri, Mehdi Hakkou, Abdessamad El Ouahabi","doi":"10.1016/j.wnsx.2025.100506","DOIUrl":"10.1016/j.wnsx.2025.100506","url":null,"abstract":"<div><h3>Background</h3><div>Rupture of intracranial aneurysm results in a potentially life-threatening subarachnoid hemorrhage (SAH) leading to a 45 % mortality rate with only 30 % returning to their normal life. Thus, the management decision is crucial. This study aimed to improve consistency, patient-centeredness, safety, and effectiveness of the decision-making for microsurgical or endovascular treatments of intracranial aneurysms (IAs) patients by appraisal of clinical, locational, and morphometric factors.</div></div><div><h3>Methods</h3><div>We use the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines to guide the appraisal of 394 patients with 435 IAs for quality improvement of aSAH treatment decision making. Between January 2013 and December 2022, our team developed a flexible patient selection criterion for microsurgical or endovascular treatments of ruptured IAs.</div></div><div><h3>Results</h3><div>We depicted 312 (71.7 %) and 123 (28.3 %) anterior cerebral circulation IAs and posterior cerebral circulation IAs respectively. About 65.5 %(n = 285) were clipped whereas 34.5 %(n = 150) underwent coiling. Multiple factors (age, location, type, size, dome-to-neck ratio, WFNS grade at admission, and modified Rankin Scale “mRS” score) were found to influence the quality-improving decision-making for microsurgery or endovascular treatment of IAs. There was a statistically significant difference (p < 0.001) between the aneurysmal morphometric factors for clinical decision of endovascular treatments (42 % vs 58 %) or microsurgical clipping (78.9 % vs 21.1 %) of the anterior and posterior cerebral circulation IAs respectively, with an Odds ratio 2.72; 95 %CI [1.76–4.18].</div></div><div><h3>Conclusion</h3><div>Despite the management of IA's for many decades, reliable indicators for making decisions on microsurgical versus endovascular treatments for IA's are still debated.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100506"},"PeriodicalIF":2.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908697","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 : 2025-08-20DOI: 10.1016/j.wnsx.2025.100507
Vladimir Pereverzev, Arkadii Kazmin, Sofia Eremushkina, Sergey Kolesov
Objective
To assess the changes of range of motion and spinal muscle strength after surgical correction of adolescent idiopathic scoliosis with the use of an intelligent biofeedback system.
Methods
Retrospective study of 48 adolescent idiopathic scoliosis patients: posterior fusion, PFS (Group 1, n = 22), anterior scoliosis correction (dynamic fixation) (Group 2, n = 14), and hybrid fixation (Group 3, n = 12). Range of motion and isometric strength were assessed using the Tergumed Pegasus 3D system. Statistical analysis used Mann–Whitney U and Kruskal–Wallis tests (p < 0.05).
Results
Group 1 (PFS) had the worst outcomes: limited rotation (26–31°), 47.5 % reduced extensor strength, and only 52.5 % of normal rotation. Group 2 (ASC) showed improved rotation (39–47°) and doubled extensor strength (143.5 Nm). Group 3 (hybrid fixation) had the best results: near-normal rotation (47–48°), full extensor strength recovery (106 %), and 95 % of retention of available mobility. Group 2 and Group 3 outperformed Group 1 in rotation degrees, while Group 3 showed better flexion, extension, and lateral bending. Back extensor strength in Group 1 was half that of Group 2 and Group 3. Group 3 did better than Group 1 in both range of motion and strength, while there were no significant differences between Group 2 and Group 3.
Conclusion
When using anterior (dynamic) scoliosis correction, the amount of spinal movement is greater, compared to posterior fusion. Muscle strength is also significantly higher during extension. Therefore, ASC is an effective method of scoliosis treatment and further research with more cases is needed to have better understanding of its benefits.
{"title":"Assessment of range of motion and muscle strength after idiopathic scoliosis surgery using fusion or anterior dynamic fixation","authors":"Vladimir Pereverzev, Arkadii Kazmin, Sofia Eremushkina, Sergey Kolesov","doi":"10.1016/j.wnsx.2025.100507","DOIUrl":"10.1016/j.wnsx.2025.100507","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the changes of range of motion and spinal muscle strength after surgical correction of adolescent idiopathic scoliosis with the use of an intelligent biofeedback system.</div></div><div><h3>Methods</h3><div>Retrospective study of 48 adolescent idiopathic scoliosis patients: posterior fusion, PFS (Group 1, n = 22), anterior scoliosis correction (dynamic fixation) (Group 2, n = 14), and hybrid fixation (Group 3, n = 12). Range of motion and isometric strength were assessed using the Tergumed Pegasus 3D system. Statistical analysis used Mann–Whitney U and Kruskal–Wallis tests (p < 0.05).</div></div><div><h3>Results</h3><div>Group 1 (PFS) had the worst outcomes: limited rotation (26–31°), 47.5 % reduced extensor strength, and only 52.5 % of normal rotation. Group 2 (ASC) showed improved rotation (39–47°) and doubled extensor strength (143.5 Nm). Group 3 (hybrid fixation) had the best results: near-normal rotation (47–48°), full extensor strength recovery (106 %), and 95 % of retention of available mobility. Group 2 and Group 3 outperformed Group 1 in rotation degrees, while Group 3 showed better flexion, extension, and lateral bending. Back extensor strength in Group 1 was half that of Group 2 and Group 3. Group 3 did better than Group 1 in both range of motion and strength, while there were no significant differences between Group 2 and Group 3.</div></div><div><h3>Conclusion</h3><div>When using anterior (dynamic) scoliosis correction, the amount of spinal movement is greater, compared to posterior fusion. Muscle strength is also significantly higher during extension. Therefore, ASC is an effective method of scoliosis treatment and further research with more cases is needed to have better understanding of its benefits.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100507"},"PeriodicalIF":2.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879529","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 : 2025-08-20DOI: 10.1016/j.wnsx.2025.100509
Methee Wongsirisuwan (.), Kritsada Buakate
Introduction
Primary lymphomas of the paranasal sinuses, particularly those affecting the sphenoid sinus, are rare and often diagnostic challenging. Diffuse large B-cell lymphoma (DLBCL) typically presents nonspecific symptoms, resulting in diagnostic delays. Imaging and histopathology evaluation are essential for accurate diagnosis and treatment planning.
Case description
A 65-year-old female presented with headache, diplopia, and unilateral ptosis. CT imaging revealed a “ground-glass” appearance with sphenoid sinus erosion, while MRI showed invasion of the cavernous sinus. Endoscopic endonasal resection was performed, and histopathological examination confirmed DLBCL. Following chemotherapy, the patient's headache resolved immediately, and both diplopia and ptosis improved within three months.
Methods
A comprehensive literature review was conducted via PubMed up to November 2024 using the terms “sphenoid sinus” and “lymphoma,” Only published, peer-reviewed articles with confirmed diagnoses were included.
Conclusion
This report underscores the importance of considering sphenoid sinus lymphoma in the differential diagnosis of skull base lesions presenting with cranial nerve deficits. This rare entity poses significant diagnostic challenges due to its nonspecific clinical and radiologic features. A combined approach of imaging, histopathology, and multidisciplinary treatment offers favorable outcomes.
{"title":"Primary diffuse large B-cell lymphoma (DLBCL) of the sphenoid sinus presenting with oculomotor nerve palsy: A case report and systemic review","authors":"Methee Wongsirisuwan (.), Kritsada Buakate","doi":"10.1016/j.wnsx.2025.100509","DOIUrl":"10.1016/j.wnsx.2025.100509","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary lymphomas of the paranasal sinuses, particularly those affecting the sphenoid sinus, are rare and often diagnostic challenging. Diffuse large B-cell lymphoma (DLBCL) typically presents nonspecific symptoms, resulting in diagnostic delays. Imaging and histopathology evaluation are essential for accurate diagnosis and treatment planning.</div></div><div><h3>Case description</h3><div>A 65-year-old female presented with headache, diplopia, and unilateral ptosis. CT imaging revealed a “ground-glass” appearance with sphenoid sinus erosion, while MRI showed invasion of the cavernous sinus. Endoscopic endonasal resection was performed, and histopathological examination confirmed DLBCL. Following chemotherapy, the patient's headache resolved immediately, and both diplopia and ptosis improved within three months.</div></div><div><h3>Methods</h3><div>A comprehensive literature review was conducted via PubMed up to November 2024 using the terms “sphenoid sinus” and “lymphoma,” Only published, peer-reviewed articles with confirmed diagnoses were included.</div></div><div><h3>Conclusion</h3><div>This report underscores the importance of considering sphenoid sinus lymphoma in the differential diagnosis of skull base lesions presenting with cranial nerve deficits. This rare entity poses significant diagnostic challenges due to its nonspecific clinical and radiologic features. A combined approach of imaging, histopathology, and multidisciplinary treatment offers favorable outcomes.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100509"},"PeriodicalIF":2.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892000","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 : 2025-08-20DOI: 10.1016/j.wnsx.2025.100508
Zachary T. Olmsted, Michael J. Dorsi
Objectives
Spinal cord stimulation (SCS) technology has become increasingly utilized and understood as a treatment for chronic pain. Epidural paddle electrodes have the advantage of lower rates of migration and infection. While percutaneous leads can be explanted without open surgery, paddle electrode explantation has been considered a high risk procedure. We describe our operative technique and the safety of SCS paddle electrode removal.
Methods
Twenty-four consecutive patients underwent SCS paddle stimulator explantation at a single institution between 2017 and 2024. The study was designed to evaluate the safety of SCS paddle electrode removal. Explant patients were identified by CPT code. Cervical explantation patients were excluded from this analysis. We reviewed demographic data, operative technique and postoperative outcomes. We present an operative technique for the safe explantation of paddle electrodes and report on outcomes within 60 days of reoperation.
Results
Paddle electrodes were explanted in 24 patients with mean age 59.6 ± 17.4 y (range 25–85). The interval between implant and removal ranged 4–192 mo. Reasons for explantation included ineffective pain relief (n = 16), pain resolution (n = 3), generator pocket pain (n = 4), paddle malpositioning (n = 1), progressive neurologic symptoms related to SCS (n = 3), and need for MRI (n = 7). We emphasize exposing the base of the paddle for ease of removal at the level of insertion.
Conclusions
For ineffective pain control or morbidity related to SCS, surgically placed paddle electrodes can be safely and consistently explanted, even after epidural scarring has occurred. Careful exposure of the paddle base is critical. This approach stands in contrast to battery removal only, which is not compatible with future MRI studies.
{"title":"Safe explantation of spinal cord stimulator paddle electrodes","authors":"Zachary T. Olmsted, Michael J. Dorsi","doi":"10.1016/j.wnsx.2025.100508","DOIUrl":"10.1016/j.wnsx.2025.100508","url":null,"abstract":"<div><h3>Objectives</h3><div>Spinal cord stimulation (SCS) technology has become increasingly utilized and understood as a treatment for chronic pain. Epidural paddle electrodes have the advantage of lower rates of migration and infection. While percutaneous leads can be explanted without open surgery, paddle electrode explantation has been considered a high risk procedure. We describe our operative technique and the safety of SCS paddle electrode removal.</div></div><div><h3>Methods</h3><div>Twenty-four consecutive patients underwent SCS paddle stimulator explantation at a single institution between 2017 and 2024. The study was designed to evaluate the safety of SCS paddle electrode removal. Explant patients were identified by CPT code. Cervical explantation patients were excluded from this analysis. We reviewed demographic data, operative technique and postoperative outcomes. We present an operative technique for the safe explantation of paddle electrodes and report on outcomes within 60 days of reoperation.</div></div><div><h3>Results</h3><div>Paddle electrodes were explanted in 24 patients with mean age 59.6 ± 17.4 y (range 25–85). The interval between implant and removal ranged 4–192 mo. Reasons for explantation included ineffective pain relief (<em>n</em> = 16), pain resolution (<em>n</em> = 3), generator pocket pain (<em>n</em> = 4), paddle malpositioning (<em>n</em> = 1), progressive neurologic symptoms related to SCS (<em>n</em> = 3), and need for MRI (<em>n</em> = 7). We emphasize exposing the base of the paddle for ease of removal at the level of insertion.</div></div><div><h3>Conclusions</h3><div>For ineffective pain control or morbidity related to SCS, surgically placed paddle electrodes can be safely and consistently explanted, even after epidural scarring has occurred. Careful exposure of the paddle base is critical. This approach stands in contrast to battery removal only, which is not compatible with future MRI studies.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100508"},"PeriodicalIF":2.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892131","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 : 2025-08-14DOI: 10.1016/j.wnsx.2025.100505
Nikhil Sharma , Jeffery R. Head , Regan M. Shanahan , Shovan Bhatia , Michael R. Kann , Sydney Scanlon , Amogh Vellore , Michael Raver , Hussam Abou-Al-Shaar , Nicolas M. Kass , Fritz Steuer , Lucille Cheng , Stephen P. Canton , Arka N. Mallela , Peter C. Gerszten , Edward G. Andrews
Objective
Ventricular catheter (VC) revision due to proximal catheter failure is a well-known but potentially avoidable complication of ventriculoperitoneal shunting (VPS). Anatomical “freehand” VC placement is still commonplace, despite image guidance availability. We sought to determine the impact of freehand versus image-guided VC placement on accuracy and consequent revision rates.
Methods
We conducted a retrospective review of all consecutive adult VPS procedures performed at a single hospital during a two-year period. Only frontal shunts and first-time cannulations of a ventricle were included. Accuracy was measured by linear distance from the catheter tip to the Foramen of Monro (Tip to Foramen, TTF) and Kakarla Grade (KG).
Results
Sixty patients met inclusion criteria, with a mean age of 54.1 ± 15.9 years. Most VCs were placed with the freehand technique (n = 40, 66.7 %), with all revisions (100 %) placed using freehand technique. Use of image guidance significantly increased accurate VC placement by TTF (7.6 ± 6.0 mm vs. 16.1 ± 8.2 mm, p < 0.001) and KG (KG1; 85 % vs. 35 %, p = 0.001), without increasing procedure length (74.8 ± 24.1min vs. 82.3 ± 38.7min, p = 0.219). Four shunts (6.67 %) required VC revision, all within 10 days of surgery. VCs requiring revision were placed significantly less accurately (26.8 ± 9.6 mm vs. 12.02 ± 7.46 mm, p < 0.001). VCs with TTF >2 cm had a significantly higher rate of proximal revision (30 % vs. 2.0 %, p = 0.001).
Conclusion
Image-guided placement increases accuracy of proximal shunt catheter placement without sacrificing operative efficiency. VC revision is associated with inaccurate placement and highly inaccurate VCs (>2 cm TTF) are more likely to require revision in the immediate post-operative period.
目的脑室-腹膜分流术（VPS）中，近端导尿管失效导致的室性导尿管翻修是一种众所周知但可以避免的并发症。解剖“徒手”VC放置仍然是司空见惯的，尽管图像引导可用。我们试图确定徒手与图像引导的VC放置对准确性和随后的修正率的影响。方法：我们对一家医院两年内所有连续的成人VPS手术进行回顾性分析。仅包括额叶分流术和首次心室插管。准确度通过导管尖端到Monro孔的线性距离（tip to Foramen， TTF）和Kakarla分级（KG）来衡量。结果60例患者符合纳入标准，平均年龄54.1±15.9岁。大多数vc采用徒手技术放置（n = 40, 66.7%），所有修订（100%）采用徒手技术放置。使用图像引导可显著提高TTF（7.6±6.0 mm vs. 16.1±8.2 mm, p < 0.001）和KG （KG1; 85% vs. 35%, p = 0.001）置入VC的准确性，而不增加手术时间（74.8±24.1min vs. 82.3±38.7min, p = 0.219）。4例分流术（6.67%）均在手术10天内进行了VC修复。需要翻修的VCs放置的准确性明显较低（26.8±9.6 mm对12.02±7.46 mm, p < 0.001）。TTF >；2 cm的VCs近端翻修率明显更高（30% vs. 2.0%, p = 0.001）。结论在不影响手术效率的前提下，图像引导下近端分流导管置入的准确性提高。VC翻修与定位不准确有关，高度不准确的VC （2 cm TTF）更有可能在术后立即需要翻修。
{"title":"Freehand ventricular catheter placement in ventriculoperitoneal shunt surgery is associated with higher rates of proximal catheter failure compared to image guidance","authors":"Nikhil Sharma , Jeffery R. Head , Regan M. Shanahan , Shovan Bhatia , Michael R. Kann , Sydney Scanlon , Amogh Vellore , Michael Raver , Hussam Abou-Al-Shaar , Nicolas M. Kass , Fritz Steuer , Lucille Cheng , Stephen P. Canton , Arka N. Mallela , Peter C. Gerszten , Edward G. Andrews","doi":"10.1016/j.wnsx.2025.100505","DOIUrl":"10.1016/j.wnsx.2025.100505","url":null,"abstract":"<div><h3>Objective</h3><div>Ventricular catheter (VC) revision due to proximal catheter failure is a well-known but potentially avoidable complication of ventriculoperitoneal shunting (VPS). Anatomical “freehand” VC placement is still commonplace, despite image guidance availability. We sought to determine the impact of freehand versus image-guided VC placement on accuracy and consequent revision rates.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of all consecutive adult VPS procedures performed at a single hospital during a two-year period. Only frontal shunts and first-time cannulations of a ventricle were included. Accuracy was measured by linear distance from the catheter tip to the Foramen of Monro (Tip to Foramen, TTF) and Kakarla Grade (KG).</div></div><div><h3>Results</h3><div>Sixty patients met inclusion criteria, with a mean age of 54.1 ± 15.9 years. Most VCs were placed with the freehand technique (<em>n</em> = 40, 66.7 %), with all revisions (100 %) placed using freehand technique. Use of image guidance significantly increased accurate VC placement by TTF (7.6 ± 6.0 mm vs. 16.1 ± 8.2 mm, <em>p</em> < 0.001) and KG (KG1; 85 % vs. 35 %, <em>p</em> = 0.001), without increasing procedure length (74.8 ± 24.1min vs. 82.3 ± 38.7min, <em>p</em> = 0.219). Four shunts (6.67 %) required VC revision, all within 10 days of surgery. VCs requiring revision were placed significantly less accurately (26.8 ± 9.6 mm vs. 12.02 ± 7.46 mm, <em>p</em> < 0.001). VCs with TTF >2 cm had a significantly higher rate of proximal revision (30 % vs. 2.0 %, <em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>Image-guided placement increases accuracy of proximal shunt catheter placement without sacrificing operative efficiency. VC revision is associated with inaccurate placement and highly inaccurate VCs (>2 cm TTF) are more likely to require revision in the immediate post-operative period.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100505"},"PeriodicalIF":2.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888799","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 : 2025-08-11DOI: 10.1016/j.wnsx.2025.100504
Susanna D. Howard , Ellie Gabriel , Shikha Singh , Iahn Cajigas , Whitley Aamodt , John Farrar , Matthew D. Kearney
Background
There is a dearth of evidence on knowledge and perceptions of procedures among patients with essential tremor (ET). The objective of this study was to utilize a mixed methods design incorporating in-depth individual interviews to investigate the perception of procedures among patients with ET who underwent surgical intervention.
Methods
Semi-structured, in-depth individual interviews paired with survey questionnaires were conducted among participants with ET who had a prior surgical procedure for the disorder. Thematic analysis of qualitative data was conducted using an approach based on grounded theory methodology.
Results
Of the 20 patients interviewed, nine patients (45 %) had undergone magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy, nine patients (45 %) had undergone deep brain stimulation (DBS) implantation, and two patients (10 %) had undergone both DBS implantation and MRgFUS thalamotomy. In ranking factors from most to least important in deciding which type of surgery to undergo, patients most frequently selected safety as the most important factor (9/20, 45 %). Hair shave required was most frequently selected as the least important factor (14/20, 70 %). Seven patients (35 %) reported having zero or minimal knowledge of the risks and benefits of either MRgFUS thalamotomy or DBS before their surgery. Patients discussed their surgical outcomes including adverse effects of surgery.
Conclusions
In deciding which type of surgery to undergo for tremor, participants discussed the role of safety, perceived invasiveness, and follow-up care required. Participants reflected on the life-changing benefits of tremor control but also discussed detrimental adverse effects such as dysarthria and gait instability following surgery.
{"title":"Perception of neurosurgery among surgical patients with essential tremor: A qualitative mixed methods study","authors":"Susanna D. Howard , Ellie Gabriel , Shikha Singh , Iahn Cajigas , Whitley Aamodt , John Farrar , Matthew D. Kearney","doi":"10.1016/j.wnsx.2025.100504","DOIUrl":"10.1016/j.wnsx.2025.100504","url":null,"abstract":"<div><h3>Background</h3><div>There is a dearth of evidence on knowledge and perceptions of procedures among patients with essential tremor (ET). The objective of this study was to utilize a mixed methods design incorporating in-depth individual interviews to investigate the perception of procedures among patients with ET who underwent surgical intervention.</div></div><div><h3>Methods</h3><div>Semi-structured, in-depth individual interviews paired with survey questionnaires were conducted among participants with ET who had a prior surgical procedure for the disorder. Thematic analysis of qualitative data was conducted using an approach based on grounded theory methodology.</div></div><div><h3>Results</h3><div>Of the 20 patients interviewed, nine patients (45 %) had undergone magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy, nine patients (45 %) had undergone deep brain stimulation (DBS) implantation, and two patients (10 %) had undergone both DBS implantation and MRgFUS thalamotomy. In ranking factors from most to least important in deciding which type of surgery to undergo, patients most frequently selected safety as the most important factor (9/20, 45 %). Hair shave required was most frequently selected as the least important factor (14/20, 70 %). Seven patients (35 %) reported having zero or minimal knowledge of the risks and benefits of either MRgFUS thalamotomy or DBS before their surgery. Patients discussed their surgical outcomes including adverse effects of surgery.</div></div><div><h3>Conclusions</h3><div>In deciding which type of surgery to undergo for tremor, participants discussed the role of safety, perceived invasiveness, and follow-up care required. Participants reflected on the life-changing benefits of tremor control but also discussed detrimental adverse effects such as dysarthria and gait instability following surgery.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100504"},"PeriodicalIF":2.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831390","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 : 2025-08-05DOI: 10.1016/j.wnsx.2025.100503
Jo Ee Sam , Dragan Janković , Yasuhiro Yamada , Riki Tanaka , Kento Sasaki , Takamitsu Tamura , Fuminari Komatsu , Yoko Kato
Objective
Recurrent and residual intracranial aneurysms (RA) are encountered with both clipping and endovascular treatment, and microsurgical treatment may be the only option at times. We present a series of 22 patients with RA that underwent microsurgical treatment, emphasizing on treatment strategies, occlusion rate, durability, and outcome.
Methods
This was a retrospective analysis of 22 patients with 23 RA treated with microsurgery. There was a total of 11 previously coiled and 12 previously clipped aneurysms. Data on demography, previous treatments, aneurysm characteristics, surgical indications, microsurgical treatment strategy, post-surgical occlusion rate, durability of treatment, complications, and functional outcome were collected.
Results
Clipping was performed on 21 (91.3 %) aneurysms, clipping and bypass on 1 aneurysm, and trapping and bypass on 1 aneurysm. Complete occlusion was achieved with 22 (95.7 %) aneurysms. Previous coils were removed in one case and previous clips were removed in 4 cases. One patient that had previous coiling and 2 patients that had previous clipping suffered complications. Good functional outcome was achieved for all retreated cases except one. Median follow-up was 5 years and no recurrence has been detected so far.
Conclusion
Outcome for microsurgical retreatment of RA is good provided proper selection of cases and treatment strategy is adhered to. The best clinical judgement is needed to prevent unnecessary morbidity from retreatment or a catastrophic rupture from a delay in retreatment. Ideally, the most efficient strategy to deal with RA is to prevent their occurrence altogether during the primary treatment as RA are definitely harder to treat compared to virgin aneurysms.
{"title":"Microsurgical treatment of recurrent and residual previously clipped/or coiled intracranial aneurysms: a single center series of 22 patients","authors":"Jo Ee Sam , Dragan Janković , Yasuhiro Yamada , Riki Tanaka , Kento Sasaki , Takamitsu Tamura , Fuminari Komatsu , Yoko Kato","doi":"10.1016/j.wnsx.2025.100503","DOIUrl":"10.1016/j.wnsx.2025.100503","url":null,"abstract":"<div><h3>Objective</h3><div>Recurrent and residual intracranial aneurysms (RA) are encountered with both clipping and endovascular treatment, and microsurgical treatment may be the only option at times. We present a series of 22 patients with RA that underwent microsurgical treatment, emphasizing on treatment strategies, occlusion rate, durability, and outcome.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of 22 patients with 23 RA treated with microsurgery. There was a total of 11 previously coiled and 12 previously clipped aneurysms. Data on demography, previous treatments, aneurysm characteristics, surgical indications, microsurgical treatment strategy, post-surgical occlusion rate, durability of treatment, complications, and functional outcome were collected.</div></div><div><h3>Results</h3><div>Clipping was performed on 21 (91.3 %) aneurysms, clipping and bypass on 1 aneurysm, and trapping and bypass on 1 aneurysm. Complete occlusion was achieved with 22 (95.7 %) aneurysms. Previous coils were removed in one case and previous clips were removed in 4 cases. One patient that had previous coiling and 2 patients that had previous clipping suffered complications. Good functional outcome was achieved for all retreated cases except one. Median follow-up was 5 years and no recurrence has been detected so far.</div></div><div><h3>Conclusion</h3><div>Outcome for microsurgical retreatment of RA is good provided proper selection of cases and treatment strategy is adhered to. The best clinical judgement is needed to prevent unnecessary morbidity from retreatment or a catastrophic rupture from a delay in retreatment. Ideally, the most efficient strategy to deal with RA is to prevent their occurrence altogether during the primary treatment as RA are definitely harder to treat compared to virgin aneurysms.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100503"},"PeriodicalIF":2.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144813980","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 : 2025-08-04DOI: 10.1016/j.wnsx.2025.100499
Bilal Bahadır Akbulut , Mehmet Zileli , Habib Canberk Karakoç
Purpose
This systematic review and meta-analysis evaluated whether recent advances have improved survival outcomes for sacral and mobile spine chordomas, examining the necessity of radical surgical resection, efficacy of modern radiotherapy techniques, and potential for biomarkers to predict outcomes.
Methods
We systematically searched English-language literature from 2004 to 2024, and of the 202 initially identified studies, 39 met the inclusion criteria for meta-analysis. We performed Z-test analysis and meta-analysis of overall survival (OS) and progression-free survival (PFS) at 5 and 10 years across three domains: treatment modalities (n = 31), surgical margins (n = 26), and radiotherapy modalities (n = 18).
Results
Five-year OS rates were 79 % for surgery alone, 82 % for radiotherapy alone, and 80 % for combined therapy. Negative margins were associated with lower local recurrence rates; however, overall survival did not differ significantly between negative and positive margins (83 % vs. 74 % five-year OS). Extensive resections for negative margins resulted in higher complication rates and negatively impacted quality of life. Proton beam therapy showed superior survival rates compared to conventional radiotherapy (85 % vs. 70 %, p = 0.012), although 10-year data remain unavailable. Biomarker and histopathological prediction methods, as well as chemotherapy approaches, lack standardization.
Conclusions
Recent advances in chordoma management have improved survival outcomes, with radiotherapy, particularly proton beam therapy, emerging as an effective primary or adjuvant treatment. Surgical margins do not significantly impact overall survival, which raises questions about the necessity of radical resections and their associated morbidity. While promising biomarkers and targeted therapies are under investigation, standardized protocols for predicting outcomes and administering systemic therapy remain to be established.
{"title":"Could recent advances improve the survival times and quality of life for sacral and mobile spine chordomas? A systematic review and meta-analysis","authors":"Bilal Bahadır Akbulut , Mehmet Zileli , Habib Canberk Karakoç","doi":"10.1016/j.wnsx.2025.100499","DOIUrl":"10.1016/j.wnsx.2025.100499","url":null,"abstract":"<div><h3>Purpose</h3><div>This systematic review and meta-analysis evaluated whether recent advances have improved survival outcomes for sacral and mobile spine chordomas, examining the necessity of radical surgical resection, efficacy of modern radiotherapy techniques, and potential for biomarkers to predict outcomes.</div></div><div><h3>Methods</h3><div>We systematically searched English-language literature from 2004 to 2024, and of the 202 initially identified studies, 39 met the inclusion criteria for meta-analysis. We performed <em>Z</em>-test analysis and meta-analysis of overall survival (OS) and progression-free survival (PFS) at 5 and 10 years across three domains: treatment modalities (<em>n</em> = 31), surgical margins (<em>n</em> = 26), and radiotherapy modalities (<em>n</em> = 18).</div></div><div><h3>Results</h3><div>Five-year OS rates were 79 % for surgery alone, 82 % for radiotherapy alone, and 80 % for combined therapy. Negative margins were associated with lower local recurrence rates; however, overall survival did not differ significantly between negative and positive margins (83 % vs. 74 % five-year OS). Extensive resections for negative margins resulted in higher complication rates and negatively impacted quality of life. Proton beam therapy showed superior survival rates compared to conventional radiotherapy (85 % vs. 70 %, <em>p</em> = 0.012), although 10-year data remain unavailable. Biomarker and histopathological prediction methods, as well as chemotherapy approaches, lack standardization.</div></div><div><h3>Conclusions</h3><div>Recent advances in chordoma management have improved survival outcomes, with radiotherapy, particularly proton beam therapy, emerging as an effective primary or adjuvant treatment. Surgical margins do not significantly impact overall survival, which raises questions about the necessity of radical resections and their associated morbidity. While promising biomarkers and targeted therapies are under investigation, standardized protocols for predicting outcomes and administering systemic therapy remain to be established.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100499"},"PeriodicalIF":2.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766856","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 : 2025-07-28DOI: 10.1016/j.wnsx.2025.100498
Terdsak Phonchan, Surachai Sae-Jung
Background
Lumbar laminectomy is a common surgical option for treating lumbar stenosis, but it can result in moderate to severe pain. Proper pain management is important for patients to recover quickly. This randomized trial aimed to compare ketorolac and dexamethasone for postoperative pain and morphine use in lumbar laminectomy patients.
Methods
This study included 120 patients, ranging in age from 18 to 75 years old, who underwent lumbar laminectomy. The patients were randomly assigned to either the ketorolac or dexamethasone group. The study aimed to evaluate two main factors: the amount of morphine used and the pain levels measured by the visual analog scale (VAS) at specific times after surgery, including the post-anesthetic care unit (PACU), as well as at 12, 24, and 48 h following the procedure. Furthermore, any adverse events that occurred during the study were thoroughly recorded.
Results
After 48 h, the patients who were given ketorolac required less morphine than those in the dexamethasone group (p-value = 0.01). However, patients in the dexamethasone group had lower VAS scores than those in the ketorolac group after 24 h (p-value = 0.01). Importantly, no serious adverse events occurred, including respiratory depression and surgical site infections.
Conclusions
After a lumbar laminectomy procedure, a single preemptive dose of ketorolac showed a slight decrease in postoperative morphine usage 48 h later when compared to dexamethasone. However, there was no noticeable effect on the patient's pain scores.
背景腰椎椎板切除术是治疗腰椎管狭窄症的常见手术选择，但它可能导致中度至重度疼痛。适当的疼痛管理对病人快速康复很重要。这项随机试验旨在比较酮罗拉酸和地塞米松对腰椎椎板切除术患者术后疼痛和吗啡使用的影响。方法本研究纳入120例患者，年龄从18岁到75岁，均行腰椎椎板切除术。患者被随机分配到酮咯酸组或地塞米松组。该研究旨在评估两个主要因素：吗啡的用量和视觉模拟量表（VAS）在手术后特定时间测量的疼痛水平，包括麻醉后护理单位（PACU），以及术后12、24和48小时。此外，研究期间发生的任何不良事件都被彻底记录下来。结果48 h后，酮罗拉酸组吗啡需取量低于地塞米松组（p值= 0.01）。而地塞米松组患者24 h VAS评分低于酮洛酸组（p值= 0.01）。重要的是，没有发生严重的不良事件，包括呼吸抑制和手术部位感染。结论腰椎椎板切除术后，与地塞米松相比，单次预先剂量的酮罗拉酸在48小时后的术后吗啡使用量略有下降。然而，对病人的疼痛评分没有明显的影响。
{"title":"A randomized trial comparing the effects of single-dose preemptive ketorolac and dexamethasone on postoperative pain and morphine consumption following lumbar laminectomy","authors":"Terdsak Phonchan, Surachai Sae-Jung","doi":"10.1016/j.wnsx.2025.100498","DOIUrl":"10.1016/j.wnsx.2025.100498","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar laminectomy is a common surgical option for treating lumbar stenosis, but it can result in moderate to severe pain. Proper pain management is important for patients to recover quickly. This randomized trial aimed to compare ketorolac and dexamethasone for postoperative pain and morphine use in lumbar laminectomy patients.</div></div><div><h3>Methods</h3><div>This study included 120 patients, ranging in age from 18 to 75 years old, who underwent lumbar laminectomy. The patients were randomly assigned to either the ketorolac or dexamethasone group. The study aimed to evaluate two main factors: the amount of morphine used and the pain levels measured by the visual analog scale (VAS) at specific times after surgery, including the post-anesthetic care unit (PACU), as well as at 12, 24, and 48 h following the procedure. Furthermore, any adverse events that occurred during the study were thoroughly recorded.</div></div><div><h3>Results</h3><div>After 48 h, the patients who were given ketorolac required less morphine than those in the dexamethasone group (<em>p</em>-value = 0.01). However, patients in the dexamethasone group had lower VAS scores than those in the ketorolac group after 24 h (<em>p</em>-value = 0.01). Importantly, no serious adverse events occurred, including respiratory depression and surgical site infections.</div></div><div><h3>Conclusions</h3><div>After a lumbar laminectomy procedure, a single preemptive dose of ketorolac showed a slight decrease in postoperative morphine usage 48 h later when compared to dexamethasone. However, there was no noticeable effect on the patient's pain scores.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100498"},"PeriodicalIF":2.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738756","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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