Neurochirurgie最新文献

Introduction: Giant superior cerebellar artery (SCA) aneurysms are rare lesions with significant morbidity due to mass effect and present therapeutic challenges due to proximity to critical neurovascular structures.

Materials and methods: A systematic literature review through the PubMed and Scopus databases was performed according to the PRISMA guidelines to identify cases of giant saccular SCA aneurysms treated either microsurgically or by endovascular techniques. Patients' demographics, aneurysm size, preoperative and postoperative neurologic status, clinical outcomes as well as follow-up information were retrieved.

Results: Data from 5 studies including 6 patients were obtained. Mean patient age was 53.83 years, with a male-to-female ratio of 2:1. Mean maximum aneurysm diameter was 31.3 mm. All patients presented at mRS 3 or more. A favorable outcome (mRS 0-2) was reported on 50% of cases. Two patients underwent microsurgery (one resulting in a favorable outcome), while two underwent endovascular treatment with both achieving a favorable outcome. Two more underwent a combination of microsurgical STA-SCA bypass followed by endovascular aneurysm treatment, both with unfavorable outcomes. All aneurysms were at least partially thrombosed; the ones treated microsurgically were debulked due to mass effect.

Conclusions: Giant SCA aneurysms may cause severe, often persistent neurologic morbidity due to brainstem compression and may be approached by either microsurgery or endovascular treatment. Advanced endovascular techniques may be required to prevent recurrence. Thrombosed aneurysms which cannot be safely embolized or ones with significant mass effect may benefit from microsurgical clip occlusion and may require debulking, while hybrid techniques should be used judiciously.

Background: Circadian rhythms regulate DNA repair, cell-cycle progression, metabolism, and immune function processes central to glioblastoma (GBM) treatment response. Aligning therapy with intrinsic biological timing ("chronotherapy") may improve efficacy without increasing toxicity. This systematic review evaluated the impact of treatment time-of-day on outcomes in GBM, focusing on temozolomide (TMZ) administration, radiotherapy (RT) scheduling, and surgical timing.

Methods: Following PRISMA 2020 guidelines, PubMed, Embase, and Google Scholar were searched through October 2025 for original human studies of adults with GBM or high-grade glioma comparing outcomes by time-of-day exposure (PROSPERO-CRD420251185806). Eligible endpoints included overall survival (OS), progression-free survival (PFS), postoperative complications, and length of stay (LOS). Randomized and observational studies were assessed using RoB 2 and ROBINS-I tools, respectively, and synthesized narratively due to heterogeneity.

Results: Six studies met inclusion criteria: three on TMZ timing, two on RT timing, and one on surgical timing. Morning TMZ was associated with longer OS in a retrospective cohort (median 1.43 vs 1.13 years; HR 0.67, 95% CI 0.46-0.98) and a similar trend in a feasibility trial (20.3 vs 16.4 months), though a large pooled analysis from two EORTC trials showed no OS/PFS difference but higher myelosuppression with morning dosing. Afternoon RT improved OS (25.6 vs 18.5 months, p =  0.014) and PFS (20.6 vs 13.3 months, p =  0.022) in a circadian-synchronized cohort, while other RT and surgical studies reported no time-dependent effects.

Conclusion: Available evidence suggests that treatment time-of-day may be associated with modest and context-dependent differences in adjuvant therapy outcomes in glioblastoma. Signals favoring morning temozolomide administration and afternoon radiotherapy are biologically plausible but inconsistent, while current data do not support a clinically meaningful effect of surgical timing. These findings should be considered hypothesis-generating, underscoring the need for prospective, biomarker-guided chronotherapy trials before clinical implementation.

Background and aims: Indocyanine Green (ICG) fluorescence imaging is increasingly utilised in endoscopic pituitary surgery to enhance intraoperative visualisation and surgical accuracy. This systematic review evaluates the efficacy and clinical utility of ICG in improving tumour delineation, extent of resection, and anatomical orientation during pituitary surgery.

Materials and methods: A systematic PRISMA-guided search of multiple electronic databases was conducted through February 2025. Eligible studies included adult patients undergoing endoscopic pituitary surgery with intraoperative ICG use and reported surgical or diagnostic outcomes. Eleven studies, comprising 150 patients, met the inclusion criteria. Data on patient demographics, tumour characteristics, ICG administration protocols, fluorescence metrics, surgical and endocrine outcomes were extracted and analysed using weighted and proportional methods.

Results: ICG fluorescence visualised targets in 93.6% of cases (n = 87/93, range 75-100%) with onset 20 seconds to 32.5 minutes post-injection. Non-functioning adenomas were most common (55%, n = 68/124), predominantly macroadenomas. ICG improved margin delineation, enabled mapping of the internal carotid artery and cavernous sinus, and aided real-time differentiation of adenoma from normal gland. Where studies reported diagnostic performance, Delayed-Window ICG (DWIG) demonstrated sensitivity 89% and specificity 75%, while Second-Window ICG (SWIG) showed sensitivity 100% with specificity 20-29%. Complications were low; transient diabetes insipidus was most frequent (n = 6). Gross total resection was achieved in most cases (n = 53/65, range 80-87.5%), and no ICG-specific adverse events were reported.

Conclusions: ICG fluorescence appears to be a promising adjunct for endoscopic pituitary surgery, improving intraoperative visualisation and anatomical guidance. Distinct from prior narrative reviews, we present a technique-stratified synthesis (bolus, DWIG, SWIG) that integrates clinical outcomes. Standardised protocols and high-quality prospective studies are needed to validate diagnostic performance and define routine use.

Background: Repeated high precision radiotherapy may be an additional salvage treatment for patients with recurrent high-grade glioma, delivering a low minimum radiation dose to brain and a high effective dose to tumor.

Materials: 24 patients with high-grade gliomas (grade 3: 8 patients, grade 4: 16 patients) were treated by surgery, chemotherapy, and tomotherapy (CT-guided intensity-modulated radiotherapy (IMRT)). A total dose of 60 Gy was prescribed to PTVh (planning tumor volume h) and 40 Gy to PTV1 in 15 fractions each. PTVh and PTV1 were defined as the MRI contrast-enhanced area plus a margin and as high intensity area on the double inversion recovery images plus a margin, respectively. The planning for distant recurrence was performed as well as the first tomotherapy, and for invasive recurrence, 40 Gy or lower was prescribed to PTVh.

Results: The tomotherapy was performed for 14 of the 24 patients for the first recurrence, and for 7 of those 14 patients for the second or subsequent. Stepwise multiple regression analysis showed that patients with repeated tomotherapy had long survival time (p < 0.0001). Median survival time from the first tomotherapy (based on Kaplan-Meier estimates) was 18 months in the 14 patients with repeated tomotherapy versus 5.5 months in the 10 patients without repeated tomotherapy (P < 0.0001).

Conclusion: Repeated tomotherapy may be one of the additional salvage treatments without symptomatic adverse events for patients with repeated recurrences of glioma. Accurate and precise tomotherapy planning and neurosurgery for eloquent areas are essential for the comprehensive treatment of glioma patients.