World Neurosurgery: X最新文献

英文中文

Occipital transtentorial approach for posterior cranial fossa lesions located away from the midsagittal plane: A technical note 经枕幕入路治疗远离正中矢状面后颅窝病变：技术说明

Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-07-17 DOI: 10.1016/j.wnsx.2025.100493

Hideo Ohba , Toshiyuki Tsuboi , Yuko Miyazaki , Yosuke Kajihara , Shigeyuki Sakamoto , Kazutoshi Mukada , Shinji Ohba

Background

The occipital transtentorial approach (OTA) is a well-established technique for accessing lesions in the pineal region, posterior third ventricle, and dorsal midbrain. Compared to the supracerebellar infratentorial approach, OTA provides superior visualization without cerebellar obstruction. However, its application to posterior cranial fossa lesions located away from the midsagittal plane remains underexplored, and its lateral limitations have not been clearly defined.

Case presentation

A 65-year-old woman with a symptomatic cerebellar tentorial meningioma located away from the midsagittal plane underwent tumor resection via OTA. A stepwise cerebrospinal fluid drainage strategy was employed to minimize brain retraction and optimize surgical exposure. The craniotomy extended across the superior sagittal and transverse sinuses to maximize visualization. The cranial limit was defined by the ascending vein joining the superior sagittal sinus, while the lateral limit was delineated by the confluence of the Vein of Labbé with the transverse sinus. No postoperative complications or permanent neurological deficits were observed.

Discussion

A literature review revealed a lack of detailed reports on OTA for posterior fossa lesions located away from the midsagittal plane. We propose that the Vein of Labbé serves as a key anatomical landmark defining the lateral boundary of OTA. Embryological evidence further supports its validity as an anatomical constraint.

Conclusion

This report provides a detailed description of OTA for posterior fossa lesions located away from the midsagittal plane. Our findings highlight the importance of the Vein of Labbé as a lateral boundary, necessitating further case accumulation and comparative studies to refine OTA indications.

枕部经幕入路（OTA）是一种成熟的进入松果体区、后第三脑室和中脑背侧病变的技术。与小脑上幕下入路相比，OTA提供了更好的视觉效果，没有小脑阻塞。然而，其在远离中矢状面后颅窝病变中的应用仍未得到充分探讨，其外侧局限性也未得到明确界定。病例介绍：65岁女性，有症状性小脑幕脑膜瘤，位于矢状中平面外，经OTA行肿瘤切除术。采用渐进式脑脊液引流策略，以减少脑回缩和优化手术暴露。开颅延伸至上矢状窦和横窦，以最大限度地观察。颅界以升静脉连接上矢状窦为界，侧界以labb静脉与横窦的汇合处为界。无术后并发症或永久性神经功能缺损。一篇文献综述显示，对于远离中矢状面的后窝病变，OTA缺乏详细的报道。我们建议labb静脉作为确定OTA外侧边界的关键解剖学标志。胚胎学证据进一步支持其作为解剖学约束的有效性。结论本报告详细描述了远离中矢状面后窝病变的OTA。我们的研究结果强调了实验室静脉作为外侧边界的重要性，需要进一步的病例积累和比较研究来完善OTA的适应症。

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引用次数: 0

Single versus double burr holes craniostomy drainage for chronic subdural hematoma: A systematic review and meta-analysis of randomized clinical trials 慢性硬膜下血肿单孔与双孔开颅引流：随机临床试验的系统回顾和荟萃分析

Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-07-16 DOI: 10.1016/j.wnsx.2025.100495

Abdulaziz M. Alghamdi , Abdulrahman Ahmad Takroni , Abdulwhab M. Alotaibi , Razan Ayed Alboqami , Orjwan Hashem Ateeq , Fares F. Alsayegh , Faisal Alotaibi

Objective

This systematic review and meta-analysis aimed to compare the efficacy and safety of single- and double-burr hole craniostomies (sBHC) and (dBHC) in the management of chronic subdural hematoma (cSDH).

Methods

The PubMed, MEDLINE, Embase, and Cochrane CENTRAL databases were systematically searched for relevant articles. The included articles were randomized controlled trials (RCTs) written in English that compared the efficacy or safety of sBHC to that of dBHC for the treatment of patients with cSDH.

Results

Nine RCTs were included in this systematic review. The length of surgery was significantly shorter in the sBHC group (mean difference = −20.65, 95 % CI [-28.58, −12.72], p < 0.00001, I² = 96 %). The mean length of surgery in sBHC was 34.9 min, compared to 55.5 min for a dBHC. There was no significant difference in the postoperative Glasgow Coma Scale (GCS) between the groups, presence of postoperative infections, presence of postoperative pneumocephalus, length of hospital stay, recurrence rates, and mortality rate.

Conclusion

Both sBHC and dBHC are efficacious surgical techniques for managing cSDH. Based on this meta-analysis of RCTs, the safety and efficacy of sBHC and dBHC were comparable without statistically significant differences.

目的：本系统综述和meta分析旨在比较单、双钻孔开颅术（shbhc）和dBHC治疗慢性硬膜下血肿（cSDH）的疗效和安全性。方法系统检索PubMed、MEDLINE、Embase和Cochrane CENTRAL数据库的相关文章。纳入的文章均为英文随机对照试验（RCTs），比较了shbhc与dBHC治疗cSDH患者的疗效或安全性。结果本系统综述纳入9项随机对照试验。shbhc组手术时间明显缩短(平均差异= - 20.65,95% CI [-28.58, - 12.72], p <；0.00001, i2 = 96%)。shbhc的平均手术时间为34.9分钟，而dBHC的平均手术时间为55.5分钟。两组患者术后格拉斯哥昏迷评分（GCS）、术后感染、术后气脑、住院时间、复发率和死亡率均无显著差异。结论shbch和dBHC是治疗cSDH的有效手术方法。基于rct的荟萃分析，shbhc和dBHC的安全性和有效性具有可比性，无统计学差异。

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引用次数: 0

EC-IC direct bypass revascularization for intracranial atherosclerosis. Insights beyond the COSS trial 颅内动脉粥样硬化EC-IC直接旁路血运重建术。COSS试验之外的见解

Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-07-16 DOI: 10.1016/j.wnsx.2025.100496

Carlos Santos , Helena Calvo-Rubio , Dario Gandara , Carles Lorenzo-Bosquet , Marta Rubiera , Silvia Vazquez , Alejandro Tomasello , Fuat Arikan

Purpose

Despite the results of the EC-IC Bypass International Trial and the Carotid Occlusion Surgery Study (COSS), high-volume centers continue to treat symptomatic intracranial atherosclerotic patients with bypass revascularization. This study aimed to analyze our data and assess whether patient characteristics and outcomes differ from those in EC-IC Bypass and COSS trials.

Methods

Patients with intracranial atherosclerotic occlusions treated by EC-IC bypass from January 2012 to June 2022 were included. Inclusion criteria were: (1) intracranial atherosclerotic occlusion >70 %, (2) transient or permanent ischemic events in the affected territory, and (3) impaired cerebrovascular reactivity demonstrated by acetazolamide-challenged SPECT.

Results

Forty-nine patients were included. Half presented bilateral occlusions, and 53.1 % had hemodynamic symptoms. Most were asymptomatic or had mild strokes preoperatively. Postoperatively, mRS worsened in 34.78 % of patients without hemodynamic symptoms, compared to 15 % of symptomatic patients. No significant differences in NIHSS or mRS were observed between pre- and postoperative evaluations. The 30-day complication rate was 20.4 %, with one procedure-related death. High rates of bypass patency (97.95 %) and SPECT improvement (87.75 %) were achieved. Long-term ipsilateral ischemic stroke rate was 2 %.

Conclusion

EC-IC bypass remains a viable option in carefully selected patients with symptomatic intracranial stenosis and impaired cerebrovascular reserve. Patient selection based on clinical and functional criteria is essential. Our results contrast with those of the COSS trial, showing lower recurrence of ipsilateral ischemic stroke, neurological stability in most patients, and favorable outcomes in individuals with hemodynamic symptoms and contralateral stenosis.

目的：尽管有EC-IC搭桥国际试验和颈动脉闭塞手术研究（COSS）的结果，但大容量中心仍在继续治疗伴有搭桥血运重建术的症状性颅内粥样硬化患者。本研究旨在分析我们的数据，并评估患者特征和结果是否与EC-IC旁路和COSS试验不同。方法选取2012年1月至2022年6月行颅内动脉粥样硬化性闭塞EC-IC旁路治疗的患者。纳入标准为：(1)颅内动脉粥样硬化闭塞>； 70%;(2)受累区域发生短暂或永久性缺血事件；(3)乙酰唑胺激发SPECT显示的脑血管反应性受损。结果纳入49例患者。一半表现为双侧闭塞，53.1%有血流动力学症状。大多数患者术前无症状或有轻度中风。术后，34.78%无血流动力学症状的患者mRS恶化，而有症状的患者mRS恶化的比例为15%。在术前和术后评估中，NIHSS和mRS没有显著差异。30天并发症发生率为20.4%，有一例手术相关死亡。旁路通畅率高（97.95%），SPECT改善率高（87.75%）。长期同侧缺血性脑卒中发生率为2%。结论对于有症状性颅内狭窄和脑血管储备受损的患者，ec - ic旁路仍然是一种可行的选择。基于临床和功能标准的患者选择是必不可少的。我们的结果与COSS试验的结果相反，显示同侧缺血性卒中的复发率较低，大多数患者神经系统稳定，并且在有血流动力学症状和对侧狭窄的个体中有良好的结果。

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引用次数: 0

Examining the correlation between hemoglobin-red blood cell distribution width ratio and hospital mortality among patients with spontaneous intracerebral hemorrhage 探讨自发性脑出血患者血红蛋白-红细胞分布宽度比与住院死亡率的关系

Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-07-15 DOI: 10.1016/j.wnsx.2025.100491

Yu-Hua Huang , Tsung-Han Lee , Yu-Ming Chang

Objective

Spontaneous intracerebral hemorrhage (ICH) is a public health concern due to its high mortality rate. Although the hemoglobin to red blood cell distribution width ratio (Hb-RDW ratio) has been recognized as a prognostic indicator in numerous malignant conditions, its correlation with cerebrovascular event outcomes remains unclear. This study sets out to explore the association between the Hb-RDW ratio and hospital mortality after spontaneous ICH.

Methods

We conducted a retrospective analysis of 201 patients, gathering information on Glasgow Coma Score (GCS), existing medical conditions, and laboratory results. The Hb-RDW ratio was calculated using the formula: Hb (gm/dl)/RDW (%). The primary endpoint was hospital mortality. We performed a multivariable logistic regression analysis to pinpoint independent predictors of hospital mortality.

Results

The results disclosed a substantial inverse relationship between the Hb-RDW ratio and hospital mortality (OR: 0.06, 95 % CI: 0.004–0.90, p = 0.04). For every unit decrease in the Hb-RDW ratio, a 94 % increase in the risk of mortality was observed. A receiver operating characteristic curve analysis was performed, and the area under the curve for the Hb-RDW ratio was 0.633 (p = 0.01). Admission GCS was also an independent predictor of mortality (OR: 17.86, 95 % CI: 2.60–122.64, p < 0.01).

Conclusions

The Hb-RDW ratio serves as a significant predictor of hospital mortality in patients with spontaneous ICH. Lower Hb-RDW ratio values corresponded to a heightened mortality risk, underscoring the potential usefulness of this composite index in guiding clinical decisions and risk stratification.

目的自发性脑出血（ICH）因其高致死率而引起公众关注。虽然血红蛋白与红细胞分布宽度比（Hb-RDW比）已被认为是许多恶性疾病的预后指标，但其与脑血管事件结局的相关性尚不清楚。本研究旨在探讨Hb-RDW比值与自发性脑出血后住院死亡率之间的关系。方法回顾性分析201例患者的格拉斯哥昏迷评分（GCS）、现有医疗状况和实验室结果。Hb-RDW比值计算公式为：Hb (gm/dl)/RDW（%）。主要终点是医院死亡率。我们进行了多变量逻辑回归分析，以确定医院死亡率的独立预测因子。结果Hb-RDW比值与住院死亡率呈显著负相关（OR: 0.06, 95% CI: 0.004-0.90, p = 0.04）。Hb-RDW比值每降低一个单位，死亡风险就增加94%。进行受试者工作特征曲线分析，Hb-RDW比值曲线下面积为0.633 （p = 0.01）。入院GCS也是死亡率的独立预测因子(OR: 17.86, 95% CI: 2.60-122.64, p <；0.01)。结论Hb-RDW比值可作为自发性脑出血患者住院死亡率的重要预测指标。较低的Hb-RDW比值值对应于较高的死亡风险，强调了该综合指数在指导临床决策和风险分层方面的潜在有用性。

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引用次数: 0

Franz Anton Mesmer and the advancements in electromagnetic brain stimulation: from a flawed perspective to the transcranial magnetic stimulation 弗朗茨·安东·梅斯默和电磁脑刺激的进展：从一个有缺陷的角度看经颅磁刺激

IF 2 Q1 Medicine

World Neurosurgery: X

Pub Date : 2025-07-05 DOI: 10.1016/j.wnsx.2025.100489

Davide Costazza, Andreas Schwarz, Pier Paolo Berti, Vania Pirillo

Franz Anton Mesmer's 18th-century theory of animal magnetism was a fascinating early step in exploring how electromagnetic forces affect the human body. This journey of discovery, full of skepticism and false beliefs has since evolved into the modern practice of using transcranial magnetic stimulation. While Mesmers' persona was portrayed as a deceiver and a weak hypnotist, it can be argued that his ideas partook in laying the groundwork for exploring the relationship between magnetism and human homeostasis. This article introduces the figure of Mesmer, from his humble beginnings as a possible future priest to a beloved founder of a medical treatment philosophy, later disregarded as such by one of the first medical trial in history. This paper continues by analyzing Mesmers' controversial theories and practices and putting it into a perspective with the historical and scientific developments of his time. It introduces the electro-magnetic era from its beginnings to the first controversial therapies such as electroconvulsive shock to its latest application, the transcranial magnetic stimulation. A tool, still in its first stages of medical applications, already being used as a possible treatment for various conditions and as a support for neurosurgical advancements by improving navigation and anatomical mapping in tumor surgery.

弗朗茨·安东·梅斯默（Franz Anton Mesmer）在18世纪提出的动物磁力理论，在探索电磁力如何影响人体方面迈出了令人着迷的第一步。这个充满怀疑和错误信念的发现之旅，已经演变成使用经颅磁刺激的现代实践。虽然梅斯默斯的人格被描绘成一个骗子和一个软弱的催眠师，但可以认为，他的思想为探索磁性和人类体内平衡之间的关系奠定了基础。这篇文章介绍了Mesmer的人物，从他卑微的开始，作为一个可能的未来牧师，到一个受人爱戴的医疗哲学的创始人，后来被历史上第一次医学试验之一所忽视。本文继续分析梅斯默斯有争议的理论和实践，并将其与他所处时代的历史和科学发展联系起来。它介绍了电磁时代从它的开始到第一个有争议的治疗方法，如电休克，到它的最新应用，经颅磁刺激。该工具仍处于医学应用的第一阶段，已被用于各种疾病的可能治疗，并通过改善肿瘤手术中的导航和解剖绘图来支持神经外科的进步。

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引用次数: 0

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