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}
Chronic cerebral arterial occlusion and stenosis are significant medical conditions which can cause hemodynamic impairment, leading to symptoms such as transient ischemic attacks and progressive or recurrent strokes. Surgical bypass is a treatment modality available for these conditions, but its results are only similar to those of the best medical treatment. The CMOSS study analyzed a subgroup of patients receiving the best medical treatment and found that individuals with prolonged mean transit time may benefit from the surgical bypass procedure.
The objective of this report was to investigate the recurrence rate of unilateral chronic cerebral arterial occlusion with a mean transit time of more than 6 s treated with STA-MCA by-pass procedure during the follow-up period.
Methods
A retrospective review was conducted between January 2010 and December 2024 at Rajavithi Hospital, including patients who received the best medical treatment, had a mean transit time (MTT) greater than 6 s, and also had a relative cerebral blood flow (rCBF) of ≤0.5 m. All patients underwent STA-MCA bypass surgery. Data collected included demographic information, recurrence rates, pre- and post-operative Glasgow Coma Scores, and modified Rankin Scores.
Results
The demographic data of the predominantly male patients showed a mean age of 57.2 years. Regarding CT perfusion, all patients had an MTT greater than 6 s, and 93.3 % had an rCBF below 0.5. The postoperative results indicated that the modified Rankin Scale (MRS) was similar to the preoperative condition, but also that 80 % of symptoms improved. The recurrence rate was 0 % during the follow-up period; however, 3 patients died, and the cause of death in all cases was pneumonia (not due to ipsilateral stroke).
Conclusion
This report demonstrates that STA-MCA bypass is potentially useful for patients with single-vessel chronic ICA/MCA stenosis or occlusion who do not respond to the best medical treatment, as indicated by CT perfusion showing an MTT >6 s and an rCBF ≤0.5.
{"title":"Recurrence rate of chronic cerebral arterial occlusion with mean transit time more than 6 s: a case series","authors":"Ittipon Gunnarut , Kritsada Buakate , Nisarat Phatisuwan","doi":"10.1016/j.wnsx.2025.100497","DOIUrl":"10.1016/j.wnsx.2025.100497","url":null,"abstract":"<div><h3>Objective</h3><div>Chronic cerebral arterial occlusion and stenosis are significant medical conditions which can cause hemodynamic impairment, leading to symptoms such as transient ischemic attacks and progressive or recurrent strokes. Surgical bypass is a treatment modality available for these conditions, but its results are only similar to those of the best medical treatment. The CMOSS study analyzed a subgroup of patients receiving the best medical treatment and found that individuals with prolonged mean transit time may benefit from the surgical bypass procedure.</div><div>The objective of this report was to investigate the recurrence rate of unilateral chronic cerebral arterial occlusion with a mean transit time of more than 6 s treated with STA-MCA by-pass procedure during the follow-up period.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted between January 2010 and December 2024 at Rajavithi Hospital, including patients who received the best medical treatment, had a mean transit time (MTT) greater than 6 s, and also had a relative cerebral blood flow (rCBF) of ≤0.5 m. All patients underwent STA-MCA bypass surgery. Data collected included demographic information, recurrence rates, pre- and post-operative Glasgow Coma Scores, and modified Rankin Scores.</div></div><div><h3>Results</h3><div>The demographic data of the predominantly male patients showed a mean age of 57.2 years. Regarding CT perfusion, all patients had an MTT greater than 6 s, and 93.3 % had an rCBF below 0.5. The postoperative results indicated that the modified Rankin Scale (MRS) was similar to the preoperative condition, but also that 80 % of symptoms improved. The recurrence rate was 0 % during the follow-up period; however, 3 patients died, and the cause of death in all cases was pneumonia (not due to ipsilateral stroke).</div></div><div><h3>Conclusion</h3><div>This report demonstrates that STA-MCA bypass is potentially useful for patients with single-vessel chronic ICA/MCA stenosis or occlusion who do not respond to the best medical treatment, as indicated by CT perfusion showing an MTT >6 s and an rCBF ≤0.5.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100497"},"PeriodicalIF":0.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703155","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 : 2025-07-18DOI: 10.1016/j.wnsx.2025.100492
Nikita Das , Ravi Dhamija , Orlando Martinez , John Francis , Rohit Mauria , Collin M. Labak , Eric Z. Herring , Gabriel Smith
Objective
Lumbosacral transitional vertebrae (LSTV) are an underdiagnosed source of low back pain (LBP), or Bertolotti Syndrome. This study identifies trends in radiographic lumbo–pelvic parameters among LSTV patients that may serve as prognostic indicators for surgery.
Methods
A retrospective chart review identified LSTV patients using a free-text search of our institution's electronic medical record for terms related to “LSTV” and "Bertolotti." Patients lacking radiographic evidence of abnormal fusion between L5 and the sacrum/ilium were excluded. Clinical features and spinopelvic parameters, including lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT) were analyzed.
Results
Of 122 LSTV patients, 108 (88.5 %) had LBP consistent with Bertolotti Syndrome. Median L4-L5 lordosis was 17.9° [16.9°, 18.9°], L5-S1 lordosis was 15.2° [14.2°, 16.2°]. Median PI was 65.7° [63.4°, 67.9°], with a PI-LL mismatch of 8.4° [6.1°, 10.7°]. Median PT was estimated at 25.1° [23.3°, 26.9°]. Significant associations existed between pain severity and PT > 35° (p = 0.004), as well as increased PI (p = 0.03). Castellvi Type II LSTV patients were more likely to have an L5/S1 angle >15° (p = 0.02).
Conclusions
This study aims to improve and understand the impact of spinopelvic parameters for patients with LSTV. Elevated Pelvic Tilt and Pelvic Incidence are associated with increased risk of LSTV manifesting as Bertolotti Syndrome. Additionally, the lumbosacral transition may not be located at L5/S1 in these patients. Development of algorithm-based technologies that identify LSTV radiographically and measure corresponding spinopelvic parameters using standardized protocols may facilitate improvements in care for this patient population.
{"title":"Structural and compensatory trends in spinopelvic parameters of lumbosacral transitional vertebrae: A retrospective cohort analysis","authors":"Nikita Das , Ravi Dhamija , Orlando Martinez , John Francis , Rohit Mauria , Collin M. Labak , Eric Z. Herring , Gabriel Smith","doi":"10.1016/j.wnsx.2025.100492","DOIUrl":"10.1016/j.wnsx.2025.100492","url":null,"abstract":"<div><h3>Objective</h3><div>Lumbosacral transitional vertebrae (LSTV) are an underdiagnosed source of low back pain (LBP), or Bertolotti Syndrome. This study identifies trends in radiographic lumbo–pelvic parameters among LSTV patients that may serve as prognostic indicators for surgery.</div></div><div><h3>Methods</h3><div>A retrospective chart review identified LSTV patients using a free-text search of our institution's electronic medical record for terms related to “LSTV” and \"Bertolotti.\" Patients lacking radiographic evidence of abnormal fusion between L5 and the sacrum/ilium were excluded. Clinical features and spinopelvic parameters, including lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT) were analyzed.</div></div><div><h3>Results</h3><div>Of 122 LSTV patients, 108 (88.5 %) had LBP consistent with Bertolotti Syndrome. Median L4-L5 lordosis was 17.9° [16.9°, 18.9°], L5-S1 lordosis was 15.2° [14.2°, 16.2°]. Median PI was 65.7° [63.4°, 67.9°], with a PI-LL mismatch of 8.4° [6.1°, 10.7°]. Median PT was estimated at 25.1° [23.3°, 26.9°]. Significant associations existed between pain severity and PT > 35° (<em>p</em> = 0.004), as well as increased PI (<em>p</em> = 0.03). Castellvi Type II LSTV patients were more likely to have an L5/S1 angle >15° (<em>p</em> = 0.02).</div></div><div><h3>Conclusions</h3><div>This study aims to improve and understand the impact of spinopelvic parameters for patients with LSTV. Elevated Pelvic Tilt and Pelvic Incidence are associated with increased risk of LSTV manifesting as Bertolotti Syndrome. Additionally, the lumbosacral transition may not be located at L5/S1 in these patients. Development of algorithm-based technologies that identify LSTV radiographically and measure corresponding spinopelvic parameters using standardized protocols may facilitate improvements in care for this patient population.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100492"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666031","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 : 2025-07-17DOI: 10.1016/j.wnsx.2025.100494
Osman Efe Efeoğlu , Serdar Onur Aydın , Fırat Demir , Lütfi Postalcı , Bekir Can Kendirlioğlu , Gaye Filinte , Evren Aydoğmuş , Tufan Hiçdönmez
Background
This study aims to examine the demographic and clinical data of patients who underwent surgery for trigonocephaly at our clinic to evaluate the characteristics, assess cosmetic outcomes, and compare our results with findings reported in the existing literature.
Materials and methods
The clinical records and surgical techniques of patients who underwent surgery for trigonocephaly between 2010 and 2020 were retrospectively analyzed. Preoperative and postoperative photographs of the frontoorbital region were evaluated by two experienced surgeons using the Whitaker Classification to assess cosmetic outcomes. Statistical analysis was performed to compare the assessments made by the surgeons.
Results
Among 23 patients (15 males and 8 females), the median age at surgery was 7 months, and the median follow-up period was 6 years. A family history of craniosynostosis was present in 13 % of cases. Preoperative computed tomography (CT) imaging was performed in 57 % of patients, while the remaining were diagnosed clinically. Open reconstruction techniques were employed in all cases. According to the Whitaker Classification, 96 % of patients were categorized in the first two groups (excellent or good outcomes) by both surgeons, showing strong interobserver agreement.
Conclusion
Surgical intervention for trigonocephaly not only corrects cranial deformities but also supports proper brain development. Early surgical intervention is recommended to achieve optimal outcomes. The Whitaker Classification serves as a practical tool for standardizing the evaluation of both cosmetic and functional outcomes.
{"title":"Retrospective analysis of surgical management and aesthetic outcomes in trigonocephaly: A decade of experience","authors":"Osman Efe Efeoğlu , Serdar Onur Aydın , Fırat Demir , Lütfi Postalcı , Bekir Can Kendirlioğlu , Gaye Filinte , Evren Aydoğmuş , Tufan Hiçdönmez","doi":"10.1016/j.wnsx.2025.100494","DOIUrl":"10.1016/j.wnsx.2025.100494","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to examine the demographic and clinical data of patients who underwent surgery for trigonocephaly at our clinic to evaluate the characteristics, assess cosmetic outcomes, and compare our results with findings reported in the existing literature.</div></div><div><h3>Materials and methods</h3><div>The clinical records and surgical techniques of patients who underwent surgery for trigonocephaly between 2010 and 2020 were retrospectively analyzed. Preoperative and postoperative photographs of the frontoorbital region were evaluated by two experienced surgeons using the Whitaker Classification to assess cosmetic outcomes. Statistical analysis was performed to compare the assessments made by the surgeons.</div></div><div><h3>Results</h3><div>Among 23 patients (15 males and 8 females), the median age at surgery was 7 months, and the median follow-up period was 6 years. A family history of craniosynostosis was present in 13 % of cases. Preoperative computed tomography (CT) imaging was performed in 57 % of patients, while the remaining were diagnosed clinically. Open reconstruction techniques were employed in all cases. According to the Whitaker Classification, 96 % of patients were categorized in the first two groups (excellent or good outcomes) by both surgeons, showing strong interobserver agreement.</div></div><div><h3>Conclusion</h3><div>Surgical intervention for trigonocephaly not only corrects cranial deformities but also supports proper brain development. Early surgical intervention is recommended to achieve optimal outcomes. The Whitaker Classification serves as a practical tool for standardizing the evaluation of both cosmetic and functional outcomes.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100494"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680472","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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