Pub Date : 2026-01-01DOI: 10.1016/j.neucir.2025.500738
Luis Ayerbe , Quintí Foguet-Boreu , Ivo Forgnone , María Pérez-Piñar , Rohini Mathur , Salma Ayis
Objectives
Strong evidence on the risk of haemorrhagic strokes for those with psychiatric conditions may lead to more effective interventions for mental health patients and inform future studies. This systematic review aimed to identify all the studies that compare the risk of haemorrhagic stroke for patients with and without depression, anxiety, schizophrenia, bipolar or personality disorders. It also aimed to provide a summary estimate of the risk, where possible, using meta-analysis.
Methods
Electronic searches were conducted in Embase, PsycINFO, PubMED, Scopus and the Web of Science, from database inception to the 11th of March 2025. A Random-effects model to estimate the pooled effect size with 95% confidence intervals was used.
Results
Seventeen thousand, two hundred fourteen references were initially identified. Eleven articles were included. Seven of them, five observational and two mendelian randomisation studies, investigated depression. In the meta-analysis depression showed a significant association with an increased risk of haemorrhagic stroke, with pooled HR: 1.28 (1.19-1.38) when only observational studies were included. When mendelian randomisation studies were added the result was a pooled HR: 1.26 (1.08-1.44). The risk of haemorrhagic stroke was increased in one of the three studies that investigated patients with anxiety disorders and in one of the three that looked at patients with schizophrenia. Two studies of bipolar disorder, and one of personality disorders, reported that patients with these conditions do not have an increased risk of haemorrhagic stroke.
Conclusion
Patients with depression have an increased risk of haemorrhagic stroke. The association of mental illness with haemorrhagic stroke needs further research.
目的：关于精神疾病患者出血性中风风险的有力证据可能导致对精神健康患者更有效的干预，并为未来的研究提供信息。本系统综述旨在确定所有比较患有和不患有抑郁症、焦虑症、精神分裂症、双相情感障碍或人格障碍患者出血性中风风险的研究。在可能的情况下，它还旨在使用荟萃分析提供风险的汇总估计。方法在Embase、PsycINFO、PubMED、Scopus和Web of Science数据库中进行检索，检索时间为建库至2025年3月11日。采用随机效应模型估计合并效应大小，置信区间为95%。结果初步鉴定文献172414篇。纳入了11篇文章。其中7项研究，5项观察性研究和2项孟德尔随机研究，调查了抑郁症。在荟萃分析中，抑郁症与出血性卒中风险增加有显著关联，仅纳入观察性研究时，合并HR为1.28（1.19-1.38）。当加入孟德尔随机化研究时，合并风险比为1.26（1.08-1.44）。在调查焦虑症患者的三项研究中的一项和对精神分裂症患者的三项研究中的一项中，出血性中风的风险都有所增加。两项关于双相情感障碍的研究和一项关于人格障碍的研究报告称，患有这些疾病的患者发生出血性中风的风险并没有增加。结论抑郁症患者发生出血性脑卒中的风险增高。精神疾病与出血性中风的关系需要进一步研究。
{"title":"Riesgo de ictus hemorrágico en pacientes con trastornos psiquiátricos: revisión sistemática y metaanálisis","authors":"Luis Ayerbe , Quintí Foguet-Boreu , Ivo Forgnone , María Pérez-Piñar , Rohini Mathur , Salma Ayis","doi":"10.1016/j.neucir.2025.500738","DOIUrl":"10.1016/j.neucir.2025.500738","url":null,"abstract":"<div><h3>Objectives</h3><div>Strong evidence on the risk of haemorrhagic strokes for those with psychiatric conditions may lead to more effective interventions for mental health patients and inform future studies. This systematic review aimed to identify all the studies that compare the risk of haemorrhagic stroke for patients with and without depression, anxiety, schizophrenia, bipolar or personality disorders. It also aimed to provide a summary estimate of the risk, where possible, using meta-analysis.</div></div><div><h3>Methods</h3><div>Electronic searches were conducted in Embase, PsycINFO, PubMED, Scopus and the Web of Science, from database inception to the 11th of March 2025. A Random-effects model to estimate the pooled effect size with 95% confidence intervals was used.</div></div><div><h3>Results</h3><div>Seventeen thousand, two hundred fourteen references were initially identified. Eleven articles were included. Seven of them, five observational and two mendelian randomisation studies, investigated depression. In the meta-analysis depression showed a significant association with an increased risk of haemorrhagic stroke, with pooled HR: 1.28 (1.19-1.38) when only observational studies were included. When mendelian randomisation studies were added the result was a pooled HR: 1.26 (1.08-1.44). The risk of haemorrhagic stroke was increased in one of the three studies that investigated patients with anxiety disorders and in one of the three that looked at patients with schizophrenia. Two studies of bipolar disorder, and one of personality disorders, reported that patients with these conditions do not have an increased risk of haemorrhagic stroke.</div></div><div><h3>Conclusion</h3><div>Patients with depression have an increased risk of haemorrhagic stroke. The association of mental illness with haemorrhagic stroke needs further research.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500738"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.neucir.2025.500713
Jorge Cabrera-Montes, Ricardo Díez-Valle
Anterior sacral meningocele is a rare complication associated with Marfan syndrome. There is no consensus regarding management and surgical treatment. Here, we describe the case of a 44-year-old women with Marfan syndrome who presented a progressive abdominal mass with gastrointestinal and urinary symptoms. Abdominopelvic MRI revealed a 3 cm S1 dural ectasia and a 19 × 17 × 15 cm abdominal mass. A posterior sacral transdural approach was performed. Dural friability made ligation unfeasible. Obliteration with a fat flap and fibrin sealant was the treatment alternative. Postoperative MRI imaging performed 4 months after surgery evidenced complete resolution of the intrabdominal collection. The patient remains free of symptoms 2 years later. Here we present one of the largest meningoceles reported to date in the literature, and illustrate the surgical management in a patient with Marfan syndrome, where technical difficulties arose. Solely posterior sacral transdural approach with fat graft may be sufficient for the treatment of these patients even with voluminous pelvic meningoceles.
{"title":"Meningocele intraabdominal gigante en una paciente con síndrome de Marfan: descripción de un caso y manejo quirúrgico","authors":"Jorge Cabrera-Montes, Ricardo Díez-Valle","doi":"10.1016/j.neucir.2025.500713","DOIUrl":"10.1016/j.neucir.2025.500713","url":null,"abstract":"<div><div>Anterior sacral meningocele is a rare complication associated with Marfan syndrome. There is no consensus regarding management and surgical treatment. Here, we describe the case of a 44-year-old women with Marfan syndrome who presented a progressive abdominal mass with gastrointestinal and urinary symptoms. Abdominopelvic MRI revealed a 3<!--> <!-->cm S1 dural ectasia and a 19<!--> <!-->×<!--> <!-->17<!--> <!-->×<!--> <!-->15<!--> <!-->cm abdominal mass. A posterior sacral transdural approach was performed. Dural friability made ligation unfeasible. Obliteration with a fat flap and fibrin sealant was the treatment alternative. Postoperative MRI imaging performed 4<!--> <!-->months after surgery evidenced complete resolution of the intrabdominal collection. The patient remains free of symptoms 2<!--> <!-->years later. Here we present one of the largest meningoceles reported to date in the literature, and illustrate the surgical management in a patient with Marfan syndrome, where technical difficulties arose. Solely posterior sacral transdural approach with fat graft may be sufficient for the treatment of these patients even with voluminous pelvic meningoceles.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500713"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess if removal of stereoelectroencephalography (SEEG) or subdural grids (SDG) is associated with an increased seizure frequency in patients with refractory epilepsy during the immediate postoperative period.
Methods
37 patients with refractory epilepsy that underwent monitoring with SEEG or SDG during November 2012-March 2022 were identified using electronic medical records from asingle institution. Seizure history, duration of intracranial monitoring, and monitored brain regions were recorded.
Results
5.0% and 5.9% of SEEG and SDG patients had a seizure within 48 h post-termination of monitoring. 25% and 11.8% of SEEG and SDG patients had a seizure between 48 h and 1-week after surgery. Between 1 week and 1 month after SEEG or SDG removal, 35% and 41.2% of patients had a seizure. 30% and 50% SEEG or SDG patients had a seizure between 1- and 2-months following removal. Overall change in postoperative seizure frequency was not significant. Seizure frequency increased for 11.8% of SDG patients while frequency remained unchanged for 5.9% and decreased for 82.4%. No patients post-SEEG removal in our cohort experienced an increased seizure frequency. 95% experienced a decrease in seizure frequency and no change was observed in 5%.
Conclusion
SEEG is not associated with increased epileptogenicity after termination of monitoring. Two patients post-SDG removal experienced an increase in seizure frequency. While patients with refractory epilepsy may continue to have seizures during the immediate postoperative period, it is likely that patients will experience a decrease in seizure frequency after removal of SEEG or SDG.
{"title":"Epileptogenicidad después de estereoelectroencefalografía y monitorización invasiva de rejillas subdurales: un análisis retrospectivo de pacientes adultos y pediátricos con epilepsia refractaria","authors":"Sonia Pulido , Sven Ivankovic , Nolan Winslow , Andrés Maldonado","doi":"10.1016/j.neucir.2025.500703","DOIUrl":"10.1016/j.neucir.2025.500703","url":null,"abstract":"<div><h3>Objective</h3><div>To assess if removal of stereoelectroencephalography (SEEG) or subdural grids (SDG) is associated with an increased seizure frequency in patients with refractory epilepsy during the immediate postoperative period.</div></div><div><h3>Methods</h3><div>37 patients with refractory epilepsy that underwent monitoring with SEEG or SDG during November 2012-March 2022 were identified using electronic medical records from asingle institution. Seizure history, duration of intracranial monitoring, and monitored brain regions were recorded.</div></div><div><h3>Results</h3><div>5.0% and 5.9% of SEEG and SDG patients had a seizure within 48 h post-termination of monitoring. 25% and 11.8% of SEEG and SDG patients had a seizure between 48 h and 1-week after surgery. Between 1 week and 1 month after SEEG or SDG removal, 35% and 41.2% of patients had a seizure. 30% and 50% SEEG or SDG patients had a seizure between 1- and 2-months following removal. Overall change in postoperative seizure frequency was not significant. Seizure frequency increased for 11.8% of SDG patients while frequency remained unchanged for 5.9% and decreased for 82.4%. No patients post-SEEG removal in our cohort experienced an increased seizure frequency. 95% experienced a decrease in seizure frequency and no change was observed in 5%.</div></div><div><h3>Conclusion</h3><div>SEEG is not associated with increased epileptogenicity after termination of monitoring. Two patients post-SDG removal experienced an increase in seizure frequency. While patients with refractory epilepsy may continue to have seizures during the immediate postoperative period, it is likely that patients will experience a decrease in seizure frequency after removal of SEEG or SDG.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500703"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.neucir.2025.500704
D. Gagliano , R. Manfrellotti , N. Lasunin , A. Prats-Galino , A. Di Somma , J. Enseñat
Background and objective
Treatment of lesions located within and surrounding the orbit pose considerable surgical challenges, due to the presence of critical neurovascular structures in such deep, confined spaces. Historically, transcranial and craniofacial approaches have been widely used to deal with orbital pathologies. However, in recent decades we have witnessed the emergence of minimally invasive techniques to reduce morbidity and hospitalization times. Among these techniques are the endoscopic endonasal approach (EEA) and the subsequently developed endoscopic transorbital approach (ETOA). This anatomical study aims to compare and combine the surgical view offered by these 2 endoscopic pathways to achieve a circumferential access to the orbit.
Methods
Anatomic dissections were performed at the Laboratory of Surgical Neuroanatomy (LSNA) of the Human Anatomy and Embryology Unit, University of Barcelona (Barcelona, Spain) on 5 cadaveric specimens (10 sides), whose arterial and venous systems were injected with red and blue latex respectively. Dissections were made with microsurgical instruments and a surgical endoscope.
Results
After careful removal of the intraorbital fat, all the extraocular muscles were exposed and dissected, as well as the optic nerve, the ophthalmic artery, and the lacrimal gland. Special emphasis was given to dissecting the nerves’ course from the cavernous sinus to their muscle innervation: Oculomotor and its branches, trochlear, abducent and ophthalmic nerve with its branches (frontal, nasociliary and lacrimal nerve). Each of the 2 endoscopic pathways provided a different perspective of the orbit and its structures. After both corridors were completed, a communication between the surgical pathways was highlighted, in a so-called connection area.
Conclusions
The combination of the EEA and ETOA provides a 360° view of the orbit and its contents. The EEA offers an inferior and medial view of the orbit, through the lamina papyracea of the ethmoid in the first case and through the roof of the maxillary sinus in the latter. At the same time, the ETOA shows a lateral perspective, removing the lateral rim of the orbit, allowing great maneuverability inside the orbit and a wide visualization. This study provides a detailed overview of the surgical neuroanatomy of the orbit, which is an essential and didactic baseline in preparation for practical clinical applications. Overall, EEA and ETOA seem adequate to gain optimal exposure of the orbit and can be adapted to treat a wide range of pathologies. Yet, surgical case series are necessary to establish the true clinical value of these endoscopic approaches in orbital and peri-orbital surgery. However, the limited number of specimens analyzed (5 cadavers, 10 sides) must be acknowledged as a limitation.
背景与目的眶内及眶周病变的治疗带来了相当大的手术挑战，因为在如此深、狭窄的空间中存在关键的神经血管结构。历史上，经颅和颅面入路已被广泛用于治疗眼眶病变。然而，近几十年来，我们目睹了微创技术的出现，以减少发病率和住院时间。这些技术包括内窥镜鼻内入路（EEA）和随后发展的内窥镜经眶入路（ETOA）。本解剖研究的目的是比较和结合这两种内窥镜路径提供的手术视图，以实现眶周通道。方法在西班牙巴塞罗那大学（Barcelona, Spain）人体解剖与胚胎科（Human Anatomy and Embryology Unit）外科神经解剖实验室（LSNA）对5例（10侧）尸体标本进行解剖解剖，分别在动脉和静脉系统注射红色和蓝色乳胶。用显微手术器械和手术内窥镜进行解剖。结果仔细去除眶内脂肪后，所有眼外肌、视神经、眼动脉、泪腺均被显露和剥离。特别强调了从海绵窦到其肌肉神经支配的神经路线：动眼神经及其分支，滑车，展神经和眼神经及其分支（额神经，鼻睫神经和泪神经）。两种内镜路径中的每一种都提供了眼眶及其结构的不同视角。在两条通道完成后，在所谓的连接区域中，突出了手术路径之间的通信。结论EEA和ETOA的结合提供了360°的轨道和内容视图。EEA提供眶的下内侧视图，在第一种情况下通过筛骨的纸莎草层，在第二种情况下通过上颌窦的顶部。同时，ETOA显示了一个横向视角，去掉了轨道的外侧边缘，允许轨道内部的大机动性和广泛的可视化。本研究提供了眼眶手术神经解剖学的详细概述，这是为实际临床应用做准备的必要和教学基线。总的来说，EEA和ETOA似乎足以获得最佳的眶位暴露，并且可以适应治疗各种病理。然而，外科病例系列是必要的，以确定这些内窥镜入路在眼眶和眶周手术中的真正临床价值。然而，必须承认分析的标本数量有限（5具尸体，10面）是一种限制。
{"title":"Visión endoscópica 360° de la órbita: estudio anatómico comparativo de los abordajes endonasal y transorbital","authors":"D. Gagliano , R. Manfrellotti , N. Lasunin , A. Prats-Galino , A. Di Somma , J. Enseñat","doi":"10.1016/j.neucir.2025.500704","DOIUrl":"10.1016/j.neucir.2025.500704","url":null,"abstract":"<div><h3>Background and objective</h3><div>Treatment of lesions located within and surrounding the orbit pose considerable surgical challenges, due to the presence of critical neurovascular structures in such deep, confined spaces. Historically, transcranial and craniofacial approaches have been widely used to deal with orbital pathologies. However, in recent decades we have witnessed the emergence of minimally invasive techniques to reduce morbidity and hospitalization times. Among these techniques are the endoscopic endonasal approach (EEA) and the subsequently developed endoscopic transorbital approach (ETOA). This anatomical study aims to compare and combine the surgical view offered by these 2<!--> <!-->endoscopic pathways to achieve a circumferential access to the orbit.</div></div><div><h3>Methods</h3><div>Anatomic dissections were performed at the Laboratory of Surgical Neuroanatomy (LSNA) of the Human Anatomy and Embryology Unit, University of Barcelona (Barcelona, Spain) on 5 cadaveric specimens (10 sides), whose arterial and venous systems were injected with red and blue latex respectively. Dissections were made with microsurgical instruments and a surgical endoscope.</div></div><div><h3>Results</h3><div>After careful removal of the intraorbital fat, all the extraocular muscles were exposed and dissected, as well as the optic nerve, the ophthalmic artery, and the lacrimal gland. Special emphasis was given to dissecting the nerves’ course from the cavernous sinus to their muscle innervation: Oculomotor and its branches, trochlear, abducent and ophthalmic nerve with its branches (frontal, nasociliary and lacrimal nerve). Each of the 2<!--> <!-->endoscopic pathways provided a different perspective of the orbit and its structures. After both corridors were completed, a communication between the surgical pathways was highlighted, in a so-called connection area.</div></div><div><h3>Conclusions</h3><div>The combination of the EEA and ETOA provides a 360° view of the orbit and its contents. The EEA offers an inferior and medial view of the orbit, through the lamina papyracea of the ethmoid in the first case and through the roof of the maxillary sinus in the latter. At the same time, the ETOA shows a lateral perspective, removing the lateral rim of the orbit, allowing great maneuverability inside the orbit and a wide visualization. This study provides a detailed overview of the surgical neuroanatomy of the orbit, which is an essential and didactic baseline in preparation for practical clinical applications. Overall, EEA and ETOA seem adequate to gain optimal exposure of the orbit and can be adapted to treat a wide range of pathologies. Yet, surgical case series are necessary to establish the true clinical value of these endoscopic approaches in orbital and peri-orbital surgery. However, the limited number of specimens analyzed (5 cadavers, 10 sides) must be acknowledged as a limitation.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500704"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.neucir.2025.500736
Pelayo Hevia-Rodríguez, Laura Panés Laglera, Irati de Goñi García, Fernando Iturbe-Sarmiento, Nicolás Samprón
The anterior approach to the cervical spine is a widely used technique in spinal surgery. Although its most common complications involve vascular, neural, or digestive structures, there is also the potential for injury to lymphatic vessels, which can lead to serious complications if not promptly diagnosed and treated. We present the case of a 70-year-old woman with a history of lumbar arthrodesis and a C5-C6 cervical prosthesis, who underwent an anterior microdiscectomy at C7-T1 via a right-sided approach. During dissection, a dense whitish fluid compatible with chyle was observed, indicating injury to a lymphatic vessel. Ligation with suture was performed and a prevertebral drain was placed. In the postoperative period, the patient developed a mild hematoma in the acromioclavicular region, without cervical collections. The drain was removed after four days of total fasting, followed by the introduction of a low-fat diet. The patient was discharged without complications. After five years of follow-up, no associated complications have been observed. Chyle fistula following anterior cervical discectomy is a rare complication (0.02%) and should be suspected in the presence of milky fluid in the surgical wound, drainage, and/or progressive accumulation. Early diagnosis and appropriate treatment are essential to prevent more severe outcomes. The risk is higher in left-sided approaches near C6 and low right-sided approaches (C7-T1), particularly in the presence of anatomical variants.
{"title":"Fístula quilosa durante microdiscectomía cervical anterior: presentación de caso clínico y revisión de la literatura","authors":"Pelayo Hevia-Rodríguez, Laura Panés Laglera, Irati de Goñi García, Fernando Iturbe-Sarmiento, Nicolás Samprón","doi":"10.1016/j.neucir.2025.500736","DOIUrl":"10.1016/j.neucir.2025.500736","url":null,"abstract":"<div><div>The anterior approach to the cervical spine is a widely used technique in spinal surgery. Although its most common complications involve vascular, neural, or digestive structures, there is also the potential for injury to lymphatic vessels, which can lead to serious complications if not promptly diagnosed and treated. We present the case of a 70-year-old woman with a history of lumbar arthrodesis and a C5-C6 cervical prosthesis, who underwent an anterior microdiscectomy at C7-T1 via a right-sided approach. During dissection, a dense whitish fluid compatible with chyle was observed, indicating injury to a lymphatic vessel. Ligation with suture was performed and a prevertebral drain was placed. In the postoperative period, the patient developed a mild hematoma in the acromioclavicular region, without cervical collections. The drain was removed after four days of total fasting, followed by the introduction of a low-fat diet. The patient was discharged without complications. After five years of follow-up, no associated complications have been observed. Chyle fistula following anterior cervical discectomy is a rare complication (0.02%) and should be suspected in the presence of milky fluid in the surgical wound, drainage, and/or progressive accumulation. Early diagnosis and appropriate treatment are essential to prevent more severe outcomes. The risk is higher in left-sided approaches near C6 and low right-sided approaches (C7-T1), particularly in the presence of anatomical variants.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500736"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.neucir.2025.500702
María J. García-Rubio , Jose Piquer-Martínez , Jose Piquer-Belloch , Ruben Rodríguez-Mena
Neurosurgery requires rigorous training, yet access remains limited in low-resource countries, particularly in Africa, creating a crisis in specialized care.
This paper, grounded in the principles of global neurosurgery, examines the essential competencies required in neurosurgical training, distinguishing between clinical skills—such as technical proficiency and decision-making—and non-clinical skills, including leadership, emotional management, and communication. Deliberate practice is emphasized as a key methodology for improving skill acquisition through structured repetition, continuous feedback, and expert supervision.
Additionally, the main challenges of specialization in East Africa are analyzed: inadequate infrastructure, overburdened health systems, limited and heterogeneous residency programs, and a shortage of qualified mentors. Finally, the development of innovative educational strategies is proposed to enhance training in resource-constrained settings and contribute to the sustainable advancement of the specialty.
{"title":"Formación neuroquirúrgica en África. Parte 1: Habilidades esenciales y desafíos estructurales para la equidad","authors":"María J. García-Rubio , Jose Piquer-Martínez , Jose Piquer-Belloch , Ruben Rodríguez-Mena","doi":"10.1016/j.neucir.2025.500702","DOIUrl":"10.1016/j.neucir.2025.500702","url":null,"abstract":"<div><div>Neurosurgery requires rigorous training, yet access remains limited in low-resource countries, particularly in Africa, creating a crisis in specialized care.</div><div>This paper, grounded in the principles of global neurosurgery, examines the essential competencies required in neurosurgical training, distinguishing between clinical skills—such as technical proficiency and decision-making—and non-clinical skills, including leadership, emotional management, and communication. Deliberate practice is emphasized as a key methodology for improving skill acquisition through structured repetition, continuous feedback, and expert supervision.</div><div>Additionally, the main challenges of specialization in East Africa are analyzed: inadequate infrastructure, overburdened health systems, limited and heterogeneous residency programs, and a shortage of qualified mentors. Finally, the development of innovative educational strategies is proposed to enhance training in resource-constrained settings and contribute to the sustainable advancement of the specialty.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500702"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.neucir.2025.500735
Antonio Montalvo-Afonso , Vicente Martín-Velasco , Javier Martín-Alonso , Rubén Diana-Martín , Jerónimo González-Bernal , Pedro David Delgado-López
Introduction
Validated clinical scales for cervical myelopathy (CM) assess disease severity and treatment efficacy, but often fail to capture the patient's subjective perception of treatment effects. This study aimed to correlate commonly used clinical scales for CM with patient-perceived outcomes after surgical treatment. Additionally, it sought to establish minimum clinically important difference (MCID) thresholds for scales strongly correlating with patient perception.
Patients and methods
A prospective, single-center observational study followed 47 patients with degenerative CM who underwent simple cervical laminectomy for one year. Patients were assessed using the mJOA, Nurick, cervical and brachial Visual Analogue Scales (VAS), the Neck Disability Index (IDC), and the EuroQol-5D (EQ5D). Patient perception of global effect (PGE) was assessed at 6 months and 1 year post-surgery using an anchor question asking if they perceived improvement, worsening, or no change. MCID was calculated using three anchor-based methods: mean difference, change difference, and the Youden index from Receiver Operating Characteristic (COR) curves. Definitive MCID thresholds were the average of these three methods.
Results
At the end of the follow-up, 25 patients (53.2%) had perceived clinical improvement with surgery, 15 (31.9%) had perceived no changes, and 7 (14.9%) had perceived worsening. The scales that showed the best correlation with patient perception were mJOA (η2 = 0.25; p = 0.002), Nurick (η2 = 0.19; p = 0.009), and NDI (η2 = 0.17; p = 0.016). The definitive MCID thresholds for improvement were an increase in score ≥ 1.5 points in mJOA, a reduction of ≥0.56 points in the Nurick scale, and a reduction of ≥5 points in NDI. The definitive MCID thresholds for worsening were an increase of ≤ 0.23 points or a loss of score in mJOA, an increase of ≥ 0.33 points in the Nurick scale, and an increase of ≥1.26 points in NDI. According to the MCID thresholds, the majority of patients achieved clinically significant improvement: 59.6% in mJOA (compared to 25.5% with worsening), 27.7% in the Nurick scale (compared to 6.4% who worsened), and 42.5% in the NDI (versus 19.1% who worsened).
Conclusion
Patient perception of outcome following cervical laminectomy for spondylotic cervical myelopathy significantly correlates with functional scales like mJOA, Nurick, and NDI. The MCID thresholds indicate that patients require a more substantial change to perceive improvement than worsening, highlighting an asymmetry in subjective perception of treatment effects. These findings support using MCID, anchored in subjective perceptions, as a complementary tool to interpret the clinical relevance of quantitative changes in clinical scales.
经验证的脊髓型颈椎病（CM）临床量表评估疾病严重程度和治疗效果，但往往无法捕捉患者对治疗效果的主观感知。本研究旨在将CM的常用临床量表与手术治疗后患者感知的结果联系起来。此外，它试图为与患者感知强烈相关的量表建立最小临床重要差异（MCID）阈值。患者和方法一项前瞻性、单中心观察性研究对47例行单纯颈椎板切除术的退行性CM患者进行了为期一年的随访。采用mJOA、Nurick、颈椎和肱视觉模拟量表（VAS）、颈部残疾指数（IDC）和EuroQol-5D （EQ5D）对患者进行评估。在术后6个月和1年评估患者对整体效果的感知（PGE），使用锚定问题询问他们是否感觉到改善、恶化或没有变化。MCID采用三种基于锚点的方法计算：平均差、变化差和来自受试者工作特性（COR）曲线的约登指数。确定的MCID阈值为这三种方法的平均值。结果随访结束时，25例（53.2%）患者感觉手术后临床改善，15例（31.9%）患者感觉无变化，7例（14.9%）患者感觉病情恶化。与患者知觉相关性最好的量表为mJOA （η2 = 0.25, p = 0.002）、Nurick （η2 = 0.19, p = 0.009）和NDI （η2 = 0.17, p = 0.016）。mJOA评分增加≥1.5分，Nurick评分降低≥0.56分，NDI评分降低≥5分，是mJOA评分改善的确定阈值。mJOA评分增加≤0.23分或丧失评分，Nurick评分增加≥0.33分，NDI评分增加≥1.26分，为mJOA评分恶化的确定阈值。根据MCID阈值，大多数患者获得临床显着改善：mJOA为59.6%（与恶化相比为25.5%），Nurick量表为27.7%（与恶化相比为6.4%），NDI为42.5%（与恶化相比为19.1%）。结论颈椎病患者对颈椎板切除术后预后的感知与mJOA、Nurick和NDI等功能量表显著相关。MCID阈值表明，患者需要更大的变化来感知改善而不是恶化，突出了主观感知治疗效果的不对称性。这些发现支持使用基于主观感知的MCID作为解释临床量表定量变化的临床相关性的补充工具。
{"title":"Percepción del paciente y cambio clínicamente significativo tras laminectomía cervical simple en la mielopatía cervical degenerativa: estudio de cohorte prospectivo","authors":"Antonio Montalvo-Afonso , Vicente Martín-Velasco , Javier Martín-Alonso , Rubén Diana-Martín , Jerónimo González-Bernal , Pedro David Delgado-López","doi":"10.1016/j.neucir.2025.500735","DOIUrl":"10.1016/j.neucir.2025.500735","url":null,"abstract":"<div><h3>Introduction</h3><div>Validated clinical scales for cervical myelopathy (CM) assess disease severity and treatment efficacy, but often fail to capture the patient's subjective perception of treatment effects. This study aimed to correlate commonly used clinical scales for CM with patient-perceived outcomes after surgical treatment. Additionally, it sought to establish minimum clinically important difference (MCID) thresholds for scales strongly correlating with patient perception.</div></div><div><h3>Patients and methods</h3><div>A prospective, single-center observational study followed 47 patients with degenerative CM who underwent simple cervical laminectomy for one year. Patients were assessed using the mJOA, Nurick, cervical and brachial Visual Analogue Scales (VAS), the Neck Disability Index (IDC), and the EuroQol-5D (EQ5D). Patient perception of global effect (PGE) was assessed at 6 months and 1 year post-surgery using an anchor question asking if they perceived improvement, worsening, or no change. MCID was calculated using three anchor-based methods: mean difference, change difference, and the Youden index from Receiver Operating Characteristic (COR) curves. Definitive MCID thresholds were the average of these three methods.</div></div><div><h3>Results</h3><div>At the end of the follow-up, 25 patients (53.2%) had perceived clinical improvement with surgery, 15 (31.9%) had perceived no changes, and 7 (14.9%) had perceived worsening. The scales that showed the best correlation with patient perception were mJOA (η2<!--> <!-->=<!--> <!-->0.25; p<!--> <!-->=<!--> <!-->0.002), Nurick (η2<!--> <!-->=<!--> <!-->0.19; p<!--> <!-->=<!--> <!-->0.009), and NDI (η2<!--> <!-->=<!--> <!-->0.17; p<!--> <!-->=<!--> <!-->0.016). The definitive MCID thresholds for improvement were an increase in score ≥ 1.5 points in mJOA, a reduction of ≥0.56 points in the Nurick scale, and a reduction of ≥5 points in NDI. The definitive MCID thresholds for worsening were an increase of ≤ 0.23 points or a loss of score in mJOA, an increase of ≥ 0.33 points in the Nurick scale, and an increase of ≥1.26 points in NDI. According to the MCID thresholds, the majority of patients achieved clinically significant improvement: 59.6% in mJOA (compared to 25.5% with worsening), 27.7% in the Nurick scale (compared to 6.4% who worsened), and 42.5% in the NDI (versus 19.1% who worsened).</div></div><div><h3>Conclusion</h3><div>Patient perception of outcome following cervical laminectomy for spondylotic cervical myelopathy significantly correlates with functional scales like mJOA, Nurick, and NDI. The MCID thresholds indicate that patients require a more substantial change to perceive improvement than worsening, highlighting an asymmetry in subjective perception of treatment effects. These findings support using MCID, anchored in subjective perceptions, as a complementary tool to interpret the clinical relevance of quantitative changes in clinical scales.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500735"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.neucir.2025.500678
Cristina Sánchez-Viguera , Josep M. Badia
Introduction
Surgical site infections (SSI) are among the most common type of healthcare–associated infections and are involved with an increase in morbidity, mortality and higher healthcare costs.
Methods
The Observatory of Infection in Surgery has conducted a survey to assess the level of awareness and implementation of the preventive measures for SSI. A 64-question questionnaire was given to SENEC (Sociedad Española de Neurocirugía) members.
Results
The survey was answered by 123 neurosurgeons. There is a gap between clinical guidelines and neurosurgery practice (67%), even though neurosurgeons place a high value on international (81.7%) or national (78.7%) clinical guidelines. There are still practices not supported by scientific evidence that some of our respondents follow, including antibiotic prophylaxis ≥ 24 h (10.6%), the habit of not allowing the antiseptic solution to air dry (38.2%) or the use of transparent plastic adhesive drape on the surgical field (77.4%). The most widespread practice for hair management is the selective removal from the surgical area (83.3%). It is most commonly performed by the neurosurgeon himself, in the operating room, which is a significant difference from the use of other surgical specialties (68.5% vs 3.5%, P<.001). There are only 37% of respondents who use alcohol solutions. Double-gloving is utilized by 16.7% of neurosurgeons. The usual use of drainage is quite widespread (60.7%), while the rate of nutritional assessment prior to major surgery is very low (7.5%). Only 37.2% report providing feedback on SSI rates to surgical teams, and a small 16.5% have received specific training programs on SSI.
Conclusion
Scientific evidence-supported measures are not fully incorporated into neurosurgical practice, and there is a lack of specific training in surgical infection prevention. Additionally, a specific issue has been identified, particularly regarding hair management. Neurosurgeons should actively participate in SSI prevention programs and analyse the reasons why they do not implement certain strategies into their clinical practice.
手术部位感染（SSI）是最常见的医疗相关感染类型之一，涉及发病率、死亡率的增加和更高的医疗费用。方法对外科感染观察站进行调查，了解外科手术患者对SSI的认识和预防措施的实施情况。向SENEC （Sociedad Española de Neurocirugía）成员发放了一份包含64个问题的问卷。结果123名神经外科医生参与了调查。尽管神经外科医生高度重视国际（81.7%）或国家（78.7%）临床指南，但临床指南与神经外科实践之间存在差距（67%）。我们的一些调查对象仍然有一些没有科学证据支持的做法，包括抗生素预防≥24小时（10.6%），不让抗菌液风干的习惯（38.2%）或在手术现场使用透明塑料粘合剂（77.4%）。最普遍的毛发管理做法是从手术区域选择性脱毛（83.3%）。它最常由神经外科医生自己在手术室进行，这与其他外科专业的使用有显著差异（68.5% vs 3.5%, P<.001）。只有37%的受访者使用酒精溶液。16.7%的神经外科医生使用双手套。常规引流的使用相当普遍（60.7%），而大手术前营养评估率很低（7.5%）。只有37.2%的人报告向外科团队提供了SSI率的反馈，只有16.5%的人接受了SSI的具体培训计划。结论科学的循证措施未完全纳入神经外科实践，缺乏外科感染预防的专门培训。此外，一个具体的问题已经确定，特别是关于头发管理。神经外科医生应积极参与SSI预防计划，并分析他们没有在临床实践中实施某些策略的原因。
{"title":"Medidas de prevención de infecciones quirúrgicas en neurocirugía: encuesta y análisis comparativo","authors":"Cristina Sánchez-Viguera , Josep M. Badia","doi":"10.1016/j.neucir.2025.500678","DOIUrl":"10.1016/j.neucir.2025.500678","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical site infections (SSI) are among the most common type of healthcare–associated infections and are involved with an increase in morbidity, mortality and higher healthcare costs.</div></div><div><h3>Methods</h3><div>The Observatory of Infection in Surgery has conducted a survey to assess the level of awareness and implementation of the preventive measures for SSI. A 64-question questionnaire was given to SENEC (Sociedad Española de Neurocirugía) members.</div></div><div><h3>Results</h3><div>The survey was answered by 123 neurosurgeons. There is a gap between clinical guidelines and neurosurgery practice (67%), even though neurosurgeons place a high value on international (81.7%) or national (78.7%) clinical guidelines. There are still practices not supported by scientific evidence that some of our respondents follow, including antibiotic prophylaxis ≥ 24<!--> <!-->h (10.6%), the habit of not allowing the antiseptic solution to air dry (38.2%) or the use of transparent plastic adhesive drape on the surgical field (77.4%). The most widespread practice for hair management is the selective removal from the surgical area (83.3%). It is most commonly performed by the neurosurgeon himself, in the operating room, which is a significant difference from the use of other surgical specialties (68.5% vs 3.5%, <em>P</em><.001). There are only 37% of respondents who use alcohol solutions. Double-gloving is utilized by 16.7% of neurosurgeons. The usual use of drainage is quite widespread (60.7%), while the rate of nutritional assessment prior to major surgery is very low (7.5%). Only 37.2% report providing feedback on SSI rates to surgical teams, and a small 16.5% have received specific training programs on SSI.</div></div><div><h3>Conclusion</h3><div>Scientific evidence-supported measures are not fully incorporated into neurosurgical practice, and there is a lack of specific training in surgical infection prevention. Additionally, a specific issue has been identified, particularly regarding hair management. Neurosurgeons should actively participate in SSI prevention programs and analyse the reasons why they do not implement certain strategies into their clinical practice.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500678"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.neucir.2025.500705
Abdulkerim Gokoglu , Hüseyin Yiğit , Tolga Turan Dündar , Erdoğan Unur , Ahmet Selçuklu
Objective
Arteriovenous malformations are known as arterial-venous shunts that connect nidus, the nourishing arteries, to draining veins. Although they are not very common in the brain, they are responsible for approximately 2% of all strokes. The volumetric changes in the surrounding brain tissues caused by cerebral arteriovenous malformations have not yet been reported.
Methods
To detect these volumetric changes, MR data were acquired from 38 controls and 25 unoperated patients with arteriovenous malformations in the precentral and postcentral gyrus. MR data were analyzed with vol2Brain, Ceres and HIPS pipelines. The niduses of these patients were resected by transsulcal microsurgical dissection.
Results
A comprehensive volumetric analysis encompassing 135 distinct brain, cerebellar, and hippocampal structures was conducted using the Vol2brain software. Comparison between the patient group and the control group revealed significant volumetric differences. Specifically, the patient group exhibited significantly larger volumes in the nucleus accumbens, fusiform gyrus, middle occipital gyrus, anterior insula, inferior lateral ventricle, and the gray matter of cerebellar lobules VIIIA and VIIIB compared with the control group. Conversely, relative to the control group, the patient group demonstrated significantly smaller volumes in the gray matter of cerebellar lobules IV, I-II, and III, as well as in the hippocampal subfields of CA2-CA3, SR-SL-SM, and the subiculum.
Conclusion
Arteriovenous malformations occurring in the precentral and postcentral gyrus lead to volumetric changes in structures distant from the site of the malformation, including the brain, hippocampus, and even the cerebellum. Therefore, arteriovenous malformations may influence the volumes of structures located not only within their immediate brain region but also in other parts of the cerebrum and cerebellum. Understanding these volumetric changes can aid in explaining patient symptoms. However, further research is required regarding whether these volumetric changes result from the mass effect of the nidus or stem from another underlying cause.
{"title":"Impacto de las malformaciones arteriovenosas en los giros precentral y poscentral sobre los volúmenes intracraneales","authors":"Abdulkerim Gokoglu , Hüseyin Yiğit , Tolga Turan Dündar , Erdoğan Unur , Ahmet Selçuklu","doi":"10.1016/j.neucir.2025.500705","DOIUrl":"10.1016/j.neucir.2025.500705","url":null,"abstract":"<div><h3>Objective</h3><div>Arteriovenous malformations are known as arterial-venous shunts that connect nidus, the nourishing arteries, to draining veins. Although they are not very common in the brain, they are responsible for approximately 2% of all strokes. The volumetric changes in the surrounding brain tissues caused by cerebral arteriovenous malformations have not yet been reported.</div></div><div><h3>Methods</h3><div>To detect these volumetric changes, MR data were acquired from 38 controls and 25 unoperated patients with arteriovenous malformations in the precentral and postcentral gyrus. MR data were analyzed with vol2Brain, Ceres and HIPS pipelines. The niduses of these patients were resected by transsulcal microsurgical dissection.</div></div><div><h3>Results</h3><div>A comprehensive volumetric analysis encompassing 135 distinct brain, cerebellar, and hippocampal structures was conducted using the Vol2brain software. Comparison between the patient group and the control group revealed significant volumetric differences. Specifically, the patient group exhibited significantly larger volumes in the nucleus accumbens, fusiform gyrus, middle occipital gyrus, anterior insula, inferior lateral ventricle, and the gray matter of cerebellar lobules VIIIA and VIIIB compared with the control group. Conversely, relative to the control group, the patient group demonstrated significantly smaller volumes in the gray matter of cerebellar lobules IV, I-II, and III, as well as in the hippocampal subfields of CA2-CA3, SR-SL-SM, and the subiculum.</div></div><div><h3>Conclusion</h3><div>Arteriovenous malformations occurring in the precentral and postcentral gyrus lead to volumetric changes in structures distant from the site of the malformation, including the brain, hippocampus, and even the cerebellum. Therefore, arteriovenous malformations may influence the volumes of structures located not only within their immediate brain region but also in other parts of the cerebrum and cerebellum. Understanding these volumetric changes can aid in explaining patient symptoms. However, further research is required regarding whether these volumetric changes result from the mass effect of the nidus or stem from another underlying cause.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500705"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.neucir.2025.500674
Cezmi Çağrı Türk , Umut Ogün Mutlucan , Orhan Günay , Fatma Genç , Meltem Korucuk , Gültekin Kutluk
Background
The use of monopolar electrocautery in vagal nerve stimulator (∂VNS) revision surgeries has been debated due to concerns about device interference. Thus, herein, we aimed to evaluate the safety and efficacy of monopolar electrocautery during VNS generator replacement surgeries, particularly its impact on seizure control and battery performance.
Methods
A retrospective observational study was conducted on 30 patients who underwent VNS generator revision at a tertiary care center. Patients were divided into 2 groups: those in whom monopolar electrocautery was used (n = 18) and those in whom it was not used (n = 12). Pre- and postoperative data were collected, including seizure frequency, VNS settings, and operative time. The McHugh Outcome Classification was used to assess seizure control.
Results
The surgeries were significantly shorter in the electrocautery group than in the nonelectrocautery group (20.06 ± 2.29 vs. 51.83 ± 12.76 min, P < 0.001). Furthermore, there was no significant difference in seizure control between the 2 groups (P > 0.05). In 2 patients, a decline in seizure control classification was noted. However, this did not reach statistical significance. No lead damage or major complications developed in either group.
Conclusion
Monopolar electrocautery significantly reduces the operative time during VNS generator revisions without compromising seizure control or increasing the risk of complications. Thus, monopolar electrocautery can be safely used in VNS revision surgeries, potentially streamlining the procedure and improving patient outcomes. However, further studies with larger populations are needed to confirm these findings.
{"title":"¿El uso del electrocauterio monopolar en la cirugía de revisión de estimuladores del nervio vago es un riesgo que hay que evitar o una opción quirúrgica segura?","authors":"Cezmi Çağrı Türk , Umut Ogün Mutlucan , Orhan Günay , Fatma Genç , Meltem Korucuk , Gültekin Kutluk","doi":"10.1016/j.neucir.2025.500674","DOIUrl":"10.1016/j.neucir.2025.500674","url":null,"abstract":"<div><h3>Background</h3><div>The use of monopolar electrocautery in vagal nerve stimulator (∂VNS) revision surgeries has been debated due to concerns about device interference. Thus, herein, we aimed to evaluate the safety and efficacy of monopolar electrocautery during VNS generator replacement surgeries, particularly its impact on seizure control and battery performance.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted on 30 patients who underwent VNS generator revision at a tertiary care center. Patients were divided into 2<!--> <!-->groups: those in whom monopolar electrocautery was used (<em>n</em> = 18) and those in whom it was not used (<em>n</em> = 12). Pre- and postoperative data were collected, including seizure frequency, VNS settings, and operative time. The McHugh Outcome Classification was used to assess seizure control.</div></div><div><h3>Results</h3><div>The surgeries were significantly shorter in the electrocautery group than in the nonelectrocautery group (20.06 ± 2.29 vs. 51.83 ± 12.76<!--> <!-->min, <em>P</em> < 0.001). Furthermore, there was no significant difference in seizure control between the 2<!--> <!-->groups (<em>P</em> > 0.05). In 2<!--> <!-->patients, a decline in seizure control classification was noted. However, this did not reach statistical significance. No lead damage or major complications developed in either group.</div></div><div><h3>Conclusion</h3><div>Monopolar electrocautery significantly reduces the operative time during VNS generator revisions without compromising seizure control or increasing the risk of complications. Thus, monopolar electrocautery can be safely used in VNS revision surgeries, potentially streamlining the procedure and improving patient outcomes. However, further studies with larger populations are needed to confirm these findings.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 6","pages":"Article 500674"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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