Nervous system involvement is uncommon in granulomatosis with polyangiitis (GPA), a systemic autoimmune disease with episodes of necrotizing vasculitis. It is usually due to the compressive effect of dural or epidural masses. Spinal hemorrhagic presentation is exceptional. A 41-year-old woman diagnosed with GPA presented with three episodes of acute spinal subdural hematoma separated by eight years and ten months, respectively. The symptomatic debut was pain and paresis in all episodes. On all occasions, a lesion compatible with acute spinal subdural hematoma was diagnosed by magnetic resonance imaging (MRI). All episodes were treated conservatively with corticosteroids and immunosuppressants. The patient presented complete neurological recovery in the first two episodes. A mild residual left lower limb paresis remains after the last one. Follow-up MRI was performed after all episodes, and no focal intraspinal lesions were detected. Spinal subdural hemorrhage is a form of manifestation of GPA, either as a debut or in the course of the disease. We describe the third confirmed case of spontaneous spinal hemorrhage secondary to GPA published in the literature and the first with recurrence. Given the extraordinary response to immunosuppressive therapy, a high level of clinical suspicion is necessary to establish treatment as early as possible.
{"title":"Recurrent spinal subdural hematoma in granulomatosis with polyangiitis","authors":"Teresa Kalantari , Celia Ortega-Angulo , Raquel Gutiérrez-González","doi":"10.1016/j.neucir.2025.500670","DOIUrl":"10.1016/j.neucir.2025.500670","url":null,"abstract":"<div><div>Nervous system involvement is uncommon in granulomatosis with polyangiitis (GPA), a systemic autoimmune disease with episodes of necrotizing vasculitis. It is usually due to the compressive effect of dural or epidural masses. Spinal hemorrhagic presentation is exceptional. A 41-year-old woman diagnosed with GPA presented with three episodes of acute spinal subdural hematoma separated by eight years and ten months, respectively. The symptomatic debut was pain and paresis in all episodes. On all occasions, a lesion compatible with acute spinal subdural hematoma was diagnosed by magnetic resonance imaging (MRI). All episodes were treated conservatively with corticosteroids and immunosuppressants. The patient presented complete neurological recovery in the first two episodes. A mild residual left lower limb paresis remains after the last one. Follow-up MRI was performed after all episodes, and no focal intraspinal lesions were detected. Spinal subdural hemorrhage is a form of manifestation of GPA, either as a debut or in the course of the disease. We describe the third confirmed case of spontaneous spinal hemorrhage secondary to GPA published in the literature and the first with recurrence. Given the extraordinary response to immunosuppressive therapy, a high level of clinical suspicion is necessary to establish treatment as early as possible.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 4","pages":"Article 500670"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519049","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 : 2025-07-01DOI: 10.1016/j.neucir.2025.500652
Santiago Cardona-Collazos , Ashly Arias , Sofia Torres-Figueroa , Carlos Alberto Meneses , Carlos Andres Varon
Intracranial hypertension due to central venous stenosis (CVS) is an under-recognized but potentially morbid complication of central venous catheters that can have a benign course if recognized and treated early. Here we report a case of a 23-year-old woman requiring hemodialysis via right subclavian catheter who presented with an intracranial hypertension syndrome and sudden visual loss secondary to right innominate vein thrombosis that improved after angioplasty treatment. This case illustrates how CVS can alter the pressure gradient between the subarachnoid space and the cerebral venous sinuses by increasing venous pressure, affecting cerebrospinal fluid drainage. Since CVS is a common finding in patients receiving hemodialysis, intracranial hypertension due to central venous stenosis is a differential diagnosis to consider in patients of this type who present with intracranial hypertension syndrome.
{"title":"Case report: Central venous stenosis-induced intracranial hypertension","authors":"Santiago Cardona-Collazos , Ashly Arias , Sofia Torres-Figueroa , Carlos Alberto Meneses , Carlos Andres Varon","doi":"10.1016/j.neucir.2025.500652","DOIUrl":"10.1016/j.neucir.2025.500652","url":null,"abstract":"<div><div>Intracranial hypertension due to central venous stenosis (CVS) is an under-recognized but potentially morbid complication of central venous catheters that can have a benign course if recognized and treated early. Here we report a case of a 23-year-old woman requiring hemodialysis via right subclavian catheter who presented with an intracranial hypertension syndrome and sudden visual loss secondary to right innominate vein thrombosis that improved after angioplasty treatment. This case illustrates how CVS can alter the pressure gradient between the subarachnoid space and the cerebral venous sinuses by increasing venous pressure, affecting cerebrospinal fluid drainage. Since CVS is a common finding in patients receiving hemodialysis, intracranial hypertension due to central venous stenosis is a differential diagnosis to consider in patients of this type who present with intracranial hypertension syndrome.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 4","pages":"Article 500652"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519004","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 : 2025-07-01DOI: 10.1016/j.neucir.2025.500664
Ali Rıza Güvercin, Mehmet Aktoklu, Mehmet Orbay Bıyık, Uğur Yazar
Retroclival subdural haematomas (RSH) are a rare occurrence, accounting for 0.3% of acute extra-axial haematomas. Although typically associated with trauma, non-traumatic causes include coagulopathy, pituitary apoplexy and vascular anomalies.The presence of cases due to non-traumatic causes can present significant diagnostic challenges. This article aims to shed light on the intricacies of non-traumatic RSH by conducting a review of the literature and presenting a case study of a 74-year-old woman on anticoagulants. The primary objective is to enhance our understanding of the diagnosis and treatment of this condition, emphasising the significance of bleeding in a location that often goes unnoticed, particularly in Computed Tomography (CT) scans, with the exception of trauma. A comprehensive review of the literature revealed 28 cases of non-traumatic RSH in adults. A detailed analysis was conducted on the demographic characteristics, causes, presentations and outcomes of these cases.The mean patient age was found to be 59 years, with a slight male predominance of 57.57%. The primary causes were identified as pituitary apoplexy (39.28%) and anticoagulants (21.42%), while 25% of cases had an unknown aetiology. Spinal canal extension occurred in 10.71% of cases, which increased morbidity.The recovery rate was 92.85% and the mortality rate was 3.57%.Non-traumatic RSH is under-recognised and often missed on standard imaging.Conservative treatment is effective without spinal cord compression.Awareness is very important, especially for diagnosis and treatment.
{"title":"Missed diagnosis; non-traumatic retroclival haematoma in adults, brief case report with review and evaluation of similar cases in the literature","authors":"Ali Rıza Güvercin, Mehmet Aktoklu, Mehmet Orbay Bıyık, Uğur Yazar","doi":"10.1016/j.neucir.2025.500664","DOIUrl":"10.1016/j.neucir.2025.500664","url":null,"abstract":"<div><div>Retroclival subdural haematomas (RSH) are a rare occurrence, accounting for 0.3% of acute extra-axial haematomas. Although typically associated with trauma, non-traumatic causes include coagulopathy, pituitary apoplexy and vascular anomalies.The presence of cases due to non-traumatic causes can present significant diagnostic challenges. This article aims to shed light on the intricacies of non-traumatic RSH by conducting a review of the literature and presenting a case study of a 74-year-old woman on anticoagulants. The primary objective is to enhance our understanding of the diagnosis and treatment of this condition, emphasising the significance of bleeding in a location that often goes unnoticed, particularly in Computed Tomography (CT) scans, with the exception of trauma. A comprehensive review of the literature revealed 28 cases of non-traumatic RSH in adults. A detailed analysis was conducted on the demographic characteristics, causes, presentations and outcomes of these cases.The mean patient age was found to be 59 years, with a slight male predominance of 57.57%. The primary causes were identified as pituitary apoplexy (39.28%) and anticoagulants (21.42%), while 25% of cases had an unknown aetiology. Spinal canal extension occurred in 10.71% of cases, which increased morbidity.The recovery rate was 92.85% and the mortality rate was 3.57%.Non-traumatic RSH is under-recognised and often missed on standard imaging.Conservative treatment is effective without spinal cord compression.Awareness is very important, especially for diagnosis and treatment.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 4","pages":"Article 500664"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519048","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 : 2025-07-01DOI: 10.1016/j.neucir.2025.500655
Mónica Maldonado-Luna , Ana María Castaño-León , Andrea Emanuela Baciu , Luis Alzamora-Llull , Elvira Vallés-Núñez , Alfonso Lagares
Antecedents and objective
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Traditional factors strongly associated with poor outcome are neurological condition and the amount of bleeding. Inflammation is considered a relevant mechanism of brain injury after aSAH. This study aims to investigate the potential role of new laboratory indexes related to inflammation for predicting the prognosis of aSAH patients, complementing established prognostic models.
Materials and methods
We conducted a retrospective observational study including adults admitted for aSAH at a single neurosurgery center from 2002 to 2023. Demographic data, clinical parameters, and blood test results at admission were collected. The main outcome variable was Glasgow Outcome Scale (GOS) six month post-bleeding. A second outcome variable was in-hospital mortality. Univariable analyses were performed to identify new laboratory predictors of poor prognosis. The independent association with outcome was evaluated after adjustment of traditional risk factors by logistic regression analysis. The additional value of new laboratory predictors was determined by comparison of the area under the receiver operating curve (AUROC).
Results
Among 542 patients with aSAH, 417 met inclusion criteria (age >18 years old and complete laboratory test available upon admission with aSAH confirmed by CT angiography (CTA) or digital subtraction angiography (DSA)). Elevated glucose/potassium ratio (GKR) in the first blood test at admission was significantly associated with unfavorable outcome and in-hospital mortality according to univariate analysis. The GKR was significantly associated with a worse final prognosis (OR 1.033, 95% CI 1.008–1.040) adjusted for age, WFNS and Fisher scales, history of diabetes mellitus and kidney disease, and prior use of diuretics, oral antidiabetic medications and insulin. Additionally, the inclusion of the GKR improved the predictive accuracy of a prognostic model compared to a model including only clinical and radiological data. The neutrophil-lymphocyte ratio (NLR) was not significantly different between subgroups of patients regarding their outcome.
Conclusion
GKR measured in the first 24 h after aSAH may improve the discrimination of patients with higher risk of experiencing poor outcome at six month after the bleeding.
前因和目的动脉瘤性蛛网膜下腔出血（aSAH）具有较高的发病率和死亡率。与预后不良密切相关的传统因素是神经系统状况和出血量。炎症被认为是aSAH后脑损伤的相关机制。本研究旨在探讨与炎症相关的新的实验室指标在预测aSAH患者预后方面的潜在作用，补充现有的预后模型。材料和方法我们进行了一项回顾性观察性研究，包括2002年至2023年在一家神经外科中心因aSAH入院的成年人。收集入院时的人口学资料、临床参数和血液检查结果。主要结局变量为出血后6个月格拉斯哥结局量表（GOS）。第二个结果变量是住院死亡率。进行单变量分析以确定新的预后不良的实验室预测因子。在调整传统危险因素后，通过logistic回归分析评估与预后的独立相关性。通过比较受试者工作曲线下面积（AUROC）来确定新的实验室预测指标的附加价值。结果542例aSAH患者中，417例符合纳入标准（年龄18岁，入院时可完成实验室检查，并经CT血管造影（CTA）或数字减影血管造影（DSA）证实aSAH）。单因素分析显示，入院时首次血液检查中葡萄糖/钾比值（GKR）升高与不良结局和住院死亡率显著相关。GKR与较差的最终预后显著相关（OR 1.033, 95% CI 1.008-1.040），经年龄、WFNS和Fisher量表、糖尿病和肾脏疾病史、既往使用利尿剂、口服降糖药和胰岛素等因素校正后，GKR与较差的最终预后显著相关。此外，与仅包含临床和放射学数据的模型相比，纳入GKR提高了预后模型的预测准确性。中性粒细胞-淋巴细胞比率（NLR）在亚组患者的预后方面无显著差异。结论aSAH术后第24 h测量的kr可提高对出血后6个月预后不良风险较高患者的鉴别。
{"title":"The role of Glucose/Potassium Ratio and Neutrophil/Lymphocyte Ratio in the prognosis of patients with aneurysmal subarachnoid hemorrhage","authors":"Mónica Maldonado-Luna , Ana María Castaño-León , Andrea Emanuela Baciu , Luis Alzamora-Llull , Elvira Vallés-Núñez , Alfonso Lagares","doi":"10.1016/j.neucir.2025.500655","DOIUrl":"10.1016/j.neucir.2025.500655","url":null,"abstract":"<div><h3>Antecedents and objective</h3><div>Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Traditional factors strongly associated with poor outcome are neurological condition and the amount of bleeding. Inflammation is considered a relevant mechanism of brain injury after aSAH. This study aims to investigate the potential role of new laboratory indexes related to inflammation for predicting the prognosis of aSAH patients, complementing established prognostic models.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective observational study including adults admitted for aSAH at a single neurosurgery center from 2002 to 2023. Demographic data, clinical parameters, and blood test results at admission were collected. The main outcome variable was Glasgow Outcome Scale (GOS) six month post-bleeding. A second outcome variable was in-hospital mortality. Univariable analyses were performed to identify new laboratory predictors of poor prognosis. The independent association with outcome was evaluated after adjustment of traditional risk factors by logistic regression analysis. The additional value of new laboratory predictors was determined by comparison of the area under the receiver operating curve (AUROC).</div></div><div><h3>Results</h3><div>Among 542 patients with aSAH, 417 met inclusion criteria (age >18 years old and complete laboratory test available upon admission with aSAH confirmed by CT angiography (CTA) or digital subtraction angiography (DSA)). Elevated glucose/potassium ratio (GKR) in the first blood test at admission was significantly associated with unfavorable outcome and in-hospital mortality according to univariate analysis. The GKR was significantly associated with a worse final prognosis (OR 1.033, 95% CI 1.008–1.040) adjusted for age, WFNS and Fisher scales, history of diabetes mellitus and kidney disease, and prior use of diuretics, oral antidiabetic medications and insulin. Additionally, the inclusion of the GKR improved the predictive accuracy of a prognostic model compared to a model including only clinical and radiological data. The neutrophil-lymphocyte ratio (NLR) was not significantly different between subgroups of patients regarding their outcome.</div></div><div><h3>Conclusion</h3><div>GKR measured in the first 24 h after aSAH may improve the discrimination of patients with higher risk of experiencing poor outcome at six month after the bleeding.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 4","pages":"Article 500655"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519046","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 : 2025-07-01DOI: 10.1016/j.neucir.2025.500656
Roser Garcia-Armengol , Sebastian Andres Menéndez-Girón , Cristina Hostalot , Ana Cristina Pérez-Balaguero , Carlos Javier Dominguez , Ana Rodriguez-Hernandez
Objective
This study aimed to identify and analyze the 100 most-cited articles in neurosurgical journals over the past 20 years.
Methods
The Thomson Reuters Web of Science citation index was used to analyze articles from high-impact neurosurgical journals identified via Journal Citation Reports. Data extracted included citations, citations per year, title, authors, year, country, institution, journal, study type, and thematic area. Citation analysis identified the most impactful articles. A bibliometric analysis compared trends between 2012–2022 and 2001–2011. Descriptive statistics and Pearson correlation were applied to examine the relationship between publication year and citation count. Stata V14.2 was used for statistical analysis.
Results
Citations for the top 100 articles ranged from 194 to 1,501. “Journal of Neurosurgery” and “Neurosurgery” published the most-cited articles, with peak productivity in 2012 and 2013. The USA was the leading country in article contributions. Neuro-oncology, especially tumor studies, was the dominant thematic field.
Conclusions
The bibliometric analysis highlighted a strong centralization in neurosurgical research, with most highly cited articles coming from two major journals, largely from the United States. This reveals the significant influence of a few key contributors in global neurosurgery.
目的对近20年来神经外科期刊上被引频次最高的100篇论文进行分类分析。方法采用Thomson Reuters Web of Science引文索引，对通过Journal citation Reports检索到的高影响力神经外科期刊的文章进行分析。提取的数据包括引文、每年引文、标题、作者、年份、国家、机构、期刊、研究类型和专题领域。引用分析确定了最具影响力的文章。文献计量分析比较了2012-2022年和2001-2011年的趋势。运用描述性统计和Pearson相关检验出版年份与被引次数之间的关系。使用Stata V14.2进行统计分析。结果前100篇文章的引用数在194 ~ 1501之间。《Journal of Neurosurgery》和《Neurosurgery》发表的文章被引用次数最多，在2012年和2013年达到高峰。美国是文章贡献最多的国家。神经肿瘤学，特别是肿瘤研究，是主要的主题领域。文献计量学分析强调了神经外科研究的高度集中，大多数高被引文章来自两大期刊，主要来自美国。这揭示了全球神经外科的几个关键贡献者的重大影响。
{"title":"Global trends in neurosurgical research: Insights from the top 100 most-cited articles","authors":"Roser Garcia-Armengol , Sebastian Andres Menéndez-Girón , Cristina Hostalot , Ana Cristina Pérez-Balaguero , Carlos Javier Dominguez , Ana Rodriguez-Hernandez","doi":"10.1016/j.neucir.2025.500656","DOIUrl":"10.1016/j.neucir.2025.500656","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to identify and analyze the 100 most-cited articles in neurosurgical journals over the past 20 years.</div></div><div><h3>Methods</h3><div>The Thomson Reuters Web of Science citation index was used to analyze articles from high-impact neurosurgical journals identified via Journal Citation Reports. Data extracted included citations, citations per year, title, authors, year, country, institution, journal, study type, and thematic area. Citation analysis identified the most impactful articles. A bibliometric analysis compared trends between 2012–2022 and 2001–2011. Descriptive statistics and Pearson correlation were applied to examine the relationship between publication year and citation count. Stata V14.2 was used for statistical analysis.</div></div><div><h3>Results</h3><div>Citations for the top 100 articles ranged from 194 to 1,501. “Journal of Neurosurgery” and “Neurosurgery” published the most-cited articles, with peak productivity in 2012 and 2013. The USA was the leading country in article contributions. Neuro-oncology, especially tumor studies, was the dominant thematic field.</div></div><div><h3>Conclusions</h3><div>The bibliometric analysis highlighted a strong centralization in neurosurgical research, with most highly cited articles coming from two major journals, largely from the United States. This reveals the significant influence of a few key contributors in global neurosurgery.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 4","pages":"Article 500656"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519047","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 : 2025-07-01DOI: 10.1016/j.neucir.2025.500654
Turgut Kuytu , Ahmet Karaoğlu
Introduction and objectives
In cases where adjacent segment disease (ASD) develops following lumbar fusion surgery, various surgical approaches can be employed. In such cases, removal of the instrumentation can positively impact lumbar pain syndrome. One frequently used method is short-segment fixation-decompression (SSFD). One of minimally invasive methods is microsurgical bilateral decompression via unilateral approach (MBDU). This study aims to determine which method is more effective and safe in cases that developed ASD following fusion surgery by comparing SSFD and MBDU after instrumentation removal.
Methods
A retrospective analysis was conducted on 47 cases treated with SSFD and 29 cases treated with MBDU. The groups were analyzed for gender, age, preoperative symptom duration, duration of hospitalization, and Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) scores during the preoperative and postoperative intermittent follow-up periods.
Results
Duration of hospitalization was higher in the SSFD group compared to the MBDU group (p = <0.001 CI = 56,42–76,24 and 22,04–25,13 respectively), mean transverse canal diameter ratio in the decompressed segment was lower in the SSFD group (p = 0,03 IC = 0,24–0,31 for SSFD y 0,40–0,47 for MBDU), and ODI indices were higher in the SSFD group in all follow-ups (p = <0.001). During the follow-up period, symptomatic ASD was observed in 3 of 47 patients in the SSFD group, whereas no symptomatic ASD was observed in the MBDU group.
Conclusion
In selected patients who develop ASD after fusion surgery MBDU after instrumentation removal can be considered as a minimally invasive option that does not exacerbate postoperative lumbar pain syndrome or lead to the development of new ASD. To the best of our knowledge, this is the first comparison of these two techniques in literature after removal of spinal fixators in lumbar ASD cases.
{"title":"“Short-segment lumbar fusion” vs.“microsurgical bilateral decompression via unilateral approach” after removal of the spinal fixators in patients with adjacent segment disease: Clinical retrospective study","authors":"Turgut Kuytu , Ahmet Karaoğlu","doi":"10.1016/j.neucir.2025.500654","DOIUrl":"10.1016/j.neucir.2025.500654","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>In cases where adjacent segment disease (ASD) develops following lumbar fusion surgery, various surgical approaches can be employed. In such cases, removal of the instrumentation can positively impact lumbar pain syndrome. One frequently used method is short-segment fixation-decompression (SSFD). One of minimally invasive methods is microsurgical bilateral decompression via unilateral approach (MBDU). This study aims to determine which method is more effective and safe in cases that developed ASD following fusion surgery by comparing SSFD and MBDU after instrumentation removal.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 47 cases treated with SSFD and 29 cases treated with MBDU. The groups were analyzed for gender, age, preoperative symptom duration, duration of hospitalization, and Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) scores during the preoperative and postoperative intermittent follow-up periods.</div></div><div><h3>Results</h3><div>Duration of hospitalization was higher in the SSFD group compared to the MBDU group (p = <0.001 CI = 56,42–76,24 and 22,04–25,13 respectively), mean transverse canal diameter ratio in the decompressed segment was lower in the SSFD group (p = 0,03 IC = 0,24–0,31 for SSFD y 0,40–0,47 for MBDU), and ODI indices were higher in the SSFD group in all follow-ups (p = <0.001). During the follow-up period, symptomatic ASD was observed in 3 of 47 patients in the SSFD group, whereas no symptomatic ASD was observed in the MBDU group.</div></div><div><h3>Conclusion</h3><div>In selected patients who develop ASD after fusion surgery MBDU after instrumentation removal can be considered as a minimally invasive option that does not exacerbate postoperative lumbar pain syndrome or lead to the development of new ASD. To the best of our knowledge, this is the first comparison of these two techniques in literature after removal of spinal fixators in lumbar ASD cases.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 4","pages":"Article 500654"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519109","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 : 2025-07-01DOI: 10.1016/j.neucir.2025.500653
Pilar Teixidor-Rodríguez , Ferran Brugada-Bellsolà , Maria Luisa Pérez , Sebastián Menéndez-Girón , Jordi Busquets-Bonet , Carlos Javier Domínguez-Alonso
Purpose
Although there may be benefits to adult patients who have had Chiari surgery when duroplasty is indicated, there are also more risks involved. The complications derived from a non-hermetic dural closure in the posterior fossa can be significant, mainly cerebrospinal fluid (CSF) leakage, meningitis and pseudomeningocele. We explored the option of utilizing a different duroplasty that we typically utilized in order to reduce these risks. The aim of this study is to assess the safety and efficacy of two duraplasties used for Chiari malformation (ChM) surgery: Tutopatch®, and a human acellular dermal matrix (hADM). Tutopatch®, a well-known collagen membrane commonly used by our senior surgeon, and hADM, prepared by the tissue establishment and with potential properties for use as duraplasty.
Methods
A unicentric prospective study was designed with one group of patients treated with hADM and another group that retrospectively acquired surgical treatment with Tutopatch®. There were nineteen patients in each group. The patients in both groups were diagnosed with same pathology and were operated on by the same senior surgeon. This study was approved by the same hospital’s Medical Ethics Committee. Demographics, clinical risk factors, clinical syndrome and pre/postoperative and postoperative events after surgery were analysed. All serious adverse events (SAEs) and adverse events (AEs) after surgery were recorded.
Results
No differences were found between the two groups related to sex, clinical risk factors, clinical syndrome and clinical outcomes. Seven patients presented with complications, seven the Tutopatch® group (two of them requiring a new reoperation) and none in the hADM group.
Conclusion
This pilot study shows that hADM is a safe and effective alternative to Tutopatch® duraplasty, as although the two materials performed equally well in the surgical repair of Chiari malformation, the former showed better clinical outcomes. Future studies are needed to confirm these outcomes in larger cohorts.
{"title":"Pilot study to assess the safety and efficacy of human acellular dermal matrix for Chiari surgery","authors":"Pilar Teixidor-Rodríguez , Ferran Brugada-Bellsolà , Maria Luisa Pérez , Sebastián Menéndez-Girón , Jordi Busquets-Bonet , Carlos Javier Domínguez-Alonso","doi":"10.1016/j.neucir.2025.500653","DOIUrl":"10.1016/j.neucir.2025.500653","url":null,"abstract":"<div><h3>Purpose</h3><div>Although there may be benefits to adult patients who have had Chiari surgery when duroplasty is indicated, there are also more risks involved. The complications derived from a non-hermetic dural closure in the posterior fossa can be significant, mainly cerebrospinal fluid (CSF) leakage, meningitis and pseudomeningocele. We explored the option of utilizing a different duroplasty that we typically utilized in order to reduce these risks. The aim of this study is to assess the safety and efficacy of two duraplasties used for Chiari malformation (ChM) surgery: Tutopatch®, and a human acellular dermal matrix (hADM). Tutopatch®, a well-known collagen membrane commonly used by our senior surgeon, and hADM, prepared by the tissue establishment and with potential properties for use as duraplasty.</div></div><div><h3>Methods</h3><div>A unicentric prospective study was designed with one group of patients treated with hADM and another group that retrospectively acquired surgical treatment with Tutopatch®. There were nineteen patients in each group. The patients in both groups were diagnosed with same pathology and were operated on by the same senior surgeon. This study was approved by the same hospital’s Medical Ethics Committee. Demographics, clinical risk factors, clinical syndrome and pre/postoperative and postoperative events after surgery were analysed. All serious adverse events (SAEs) and adverse events (AEs) after surgery were recorded.</div></div><div><h3>Results</h3><div>No differences were found between the two groups related to sex, clinical risk factors, clinical syndrome and clinical outcomes. Seven patients presented with complications, seven the Tutopatch® group (two of them requiring a new reoperation) and none in the hADM group.</div></div><div><h3>Conclusion</h3><div>This pilot study shows that hADM is a safe and effective alternative to Tutopatch® duraplasty, as although the two materials performed equally well in the surgical repair of Chiari malformation, the former showed better clinical outcomes. Future studies are needed to confirm these outcomes in larger cohorts.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 4","pages":"Article 500653"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519108","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 : 2025-07-01DOI: 10.1016/j.neucir.2025.500671
Ramiro D. Lobato , Alfonso Lagares , Pedro A. Gómez López , José A.F. Alén , Pedro González León , Angel Pérez Núñez , Beatriz Pascual
This is the first of five papers describing the origin and evolution of the so-called Academic Neurosurgery which will appear consecutively in the journal Neurocirugía. The three firsts focuse on the emergence of the specialty in Europe and the United States and its development in the last country between the origins and the present moment, paying special attention to the foundation of the neurosurgical societies (SNS, AANS, CNS) with their respective journals and the configuration of the residency programs. The fourth analyzes the same issues in Europe and, most specifically in Spain, also from the beginnigs to the XXI century. The fifth describes the development of Academic Neurosurgery in a neurosurgical unit of one of hospitals created by the National Social Security System in the early 1970s).
The present paper describes the initiatives, difficulties and achievements of the pioneers at both sides of the Atlantic during the so called Gestational Period for creating the new and independent specialty of Neurosurgey conceived as a scientific and clínico-surgical activiy with an academic profil.
{"title":"La génesis de la Neurocirugía académica. Parte I: el llamado «periodo gestacional» y las contribuciones de Harvey Cushing","authors":"Ramiro D. Lobato , Alfonso Lagares , Pedro A. Gómez López , José A.F. Alén , Pedro González León , Angel Pérez Núñez , Beatriz Pascual","doi":"10.1016/j.neucir.2025.500671","DOIUrl":"10.1016/j.neucir.2025.500671","url":null,"abstract":"<div><div>This is the first of five papers describing the origin and evolution of the so-called Academic Neurosurgery which will appear consecutively in the journal Neurocirugía. The three firsts focuse on the emergence of the specialty in Europe and the United States and its development in the last country between the origins and the present moment, paying special attention to the foundation of the neurosurgical societies (SNS, AANS, CNS) with their respective journals and the configuration of the residency programs. The fourth analyzes the same issues in Europe and, most specifically in Spain, also from the beginnigs to the XXI century. The fifth describes the development of Academic Neurosurgery in a neurosurgical unit of one of hospitals created by the National Social Security System in the early 1970s).</div><div>The present paper describes the initiatives, difficulties and achievements of the pioneers at both sides of the Atlantic during the so called Gestational Period for creating the new and independent specialty of Neurosurgey conceived as a scientific and clínico-surgical activiy with an academic profil.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 4","pages":"Article 500671"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519050","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}
Moyamoya disease (MMD) and moyamoya syndrome (MMS) are considered rare in Indonesia, without any proper epidemiological data backing this claim. Hence, this case series aims to assess all MMD and MMS cases from the perspective of a multicentre private hospital in Indonesia.
Methods
This is a descriptive analysis using data from the picture archiving and communication system (PACS) from January 2019 to December 2023. The inclusion criteria included all patients who fulfilled the radiological criteria for MMD and/or MMS, while patients who only underwent brain non-contrast computed tomography (CT) scans were excluded.
Results
There are 58,905 unique MRI scans from 2019 to 2023. The cohort comprises 8 females and 2 males, with a median age of 37 (7–65) years old. Three cases are probable MMD. with six MMD cases and one MMS case. Therefore, the prevalence rate for the four years is approximately 11.9 cases per 100,000 scans. Out of the confirmed Moya-Moya cases, the majority (4/7) are ischemic subtypes, followed by epileptic (electroencephalography shows slowing brain waves) and TIA in one case each. The most common presenting symptom is weakness in the extremity (N = 7), followed by headache (N = 5). Four patients underwent operative procedures, with three of them being superior temporal artery to middle cerebral artery (STA-MCA) bypass procedures and one of them being encephalo-duro-myo-arterio-pericraniosynangiosis (EDMAPS).
Conclusion
The paucity of confirmed cases either points towards the low prevalence of MMD and MMS in Indonesia or the underdiagnosis of these cases.
{"title":"Moyamoya disease and moyamoya syndrome: A case series from multicentre private hospitals in Indonesia","authors":"Rusli Muljadi , Koesbandono , Teodorus Alfons Pratama , Gilbert Sterling Octavius","doi":"10.1016/j.neucir.2024.10.012","DOIUrl":"10.1016/j.neucir.2024.10.012","url":null,"abstract":"<div><h3>Background</h3><div>Moyamoya disease (MMD) and moyamoya syndrome (MMS) are considered rare in Indonesia, without any proper epidemiological data backing this claim. Hence, this case series aims to assess all MMD and MMS cases from the perspective of a multicentre private hospital in Indonesia.</div></div><div><h3>Methods</h3><div>This is a descriptive analysis using data from the picture archiving and communication system (PACS) from January 2019 to December 2023. The inclusion criteria included all patients who fulfilled the radiological criteria for MMD and/or MMS, while patients who only underwent brain non-contrast computed tomography (CT) scans were excluded.</div></div><div><h3>Results</h3><div>There are 58,905 unique MRI scans from 2019 to 2023. The cohort comprises 8 females and 2 males, with a median age of 37 (7–65) years old. Three cases are probable MMD. with six MMD cases and one MMS case. Therefore, the prevalence rate for the four years is approximately 11.9 cases per 100,000 scans. Out of the confirmed Moya-Moya cases, the majority (4/7) are ischemic subtypes, followed by epileptic (electroencephalography shows slowing brain waves) and TIA in one case each. The most common presenting symptom is weakness in the extremity (N = 7), followed by headache (N = 5). Four patients underwent operative procedures, with three of them being superior temporal artery to middle cerebral artery (STA-MCA) bypass procedures and one of them being encephalo-duro-myo-arterio-pericraniosynangiosis (EDMAPS).</div></div><div><h3>Conclusion</h3><div>The paucity of confirmed cases either points towards the low prevalence of MMD and MMS in Indonesia or the underdiagnosis of these cases.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 151-160"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895895","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 : 2025-05-01DOI: 10.1016/j.neucir.2024.11.004
Marlon Manuel Ortiz Machín, Omar López Arbolay, Carlos Roberto Vargas Gálvez
Introduction
Sellar and parasellar tumors are frequent lesions in neurosurgical practice, highlighting pituitary adenomas, craniopharyngiomas, and sellar tubercle meningiomas. The clinical manifestations are similar, however; There are imaging aspects that differentiate them.
Objective
Show imaging aspects of tumors in the sellar and parasellar region that guide their histopathological diagnosis.
Method
A descriptive, longitudinal and prospective study was carried out that included 200 patients from the Hermanos Ameijeiras Hospital, of which 120 had a histopathological diagnosis of pituitary adenoma, 50 of craniopharyngioma and 30 of sellar tubercle meningioma. The variations in the displacement of the point of the anterior communicating arterial complex and in the premammillary angle were analyzed by means of a cerebral nuclear magnetic resonance study. For data analysis, absolute and relative frequencies were used as summary measures.
Results
A cephalic displacement of the anterior communicating arterial complex was evident in the craniopharyngiomas, of 10 -11.9 mm (84.0%); in pituitary macroadenomas, 12-14 mm (78.3%); and in sellar tubercle meningioma, ≥ 14 (86.6%) mm. When evaluating the premammillary angle, pituitary adenomas were identified between 85°-95° (73.3%); in craniopharyngiomas, < 85° (90.0%); and in meningiomas of the sellar tubercle, between 85-95° (86.6%).
Conclusions
The present study allows us to identify imaging characteristics in sellar and parasellar tumors that guide with high certainty the histopathological diagnosis and thus establish a more effective treatment.
鞍区和鞍旁肿瘤是神经外科的常见病变，突出表现为垂体腺瘤、颅咽管瘤和鞍区结节性脑膜瘤。然而，临床表现相似；它们在成像方面有区别。目的探讨鞍区和鞍旁区肿瘤的影像学特征，指导其组织病理学诊断。方法对来自Hermanos Ameijeiras医院的200例患者进行描述性、纵向和前瞻性研究，其中组织病理学诊断为垂体腺瘤120例，颅咽管瘤50例，鞍结节脑膜瘤30例。通过脑核磁共振研究，分析了前交通动脉复合体点位移和乳头前角位移的变化。对于数据分析，使用绝对频率和相对频率作为汇总度量。结果颅咽管瘤前交通动脉复丛明显向头移位，移位量为10 ~ 11.9 mm (84.0%)；垂体大腺瘤：12 ~ 14 mm (78.3%)；鞍结节脑膜瘤≥14 mm（86.6%）。当评估乳头前角时，垂体腺瘤在85°-95°之间（73.3%）；在颅咽管瘤中，85°(90.0%);鞍结节脑膜瘤在85-95°之间（86.6%）。结论本研究可明确鞍区及鞍旁肿瘤的影像学特征，对组织病理诊断具有较高的确定性，从而制定更有效的治疗方案。
{"title":"Consideraciones diagnósticas de los tumores de la región selar según su geometría de crecimiento vectorial","authors":"Marlon Manuel Ortiz Machín, Omar López Arbolay, Carlos Roberto Vargas Gálvez","doi":"10.1016/j.neucir.2024.11.004","DOIUrl":"10.1016/j.neucir.2024.11.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Sellar and parasellar tumors are frequent lesions in neurosurgical practice, highlighting pituitary adenomas, craniopharyngiomas, and sellar tubercle meningiomas. The clinical manifestations are similar, however; There are imaging aspects that differentiate them.</div></div><div><h3>Objective</h3><div>Show imaging aspects of tumors in the sellar and parasellar region that guide their histopathological diagnosis.</div></div><div><h3>Method</h3><div>A descriptive, longitudinal and prospective study was carried out that included 200 patients from the Hermanos Ameijeiras Hospital, of which 120 had a histopathological diagnosis of pituitary adenoma, 50 of craniopharyngioma and 30 of sellar tubercle meningioma. The variations in the displacement of the point of the anterior communicating arterial complex and in the premammillary angle were analyzed by means of a cerebral nuclear magnetic resonance study. For data analysis, absolute and relative frequencies were used as summary measures.</div></div><div><h3>Results</h3><div>A cephalic displacement of the anterior communicating arterial complex was evident in the craniopharyngiomas, of 10 -11.9<!--> <!-->mm (84.0%); in pituitary macroadenomas, 12-14<!--> <!-->mm (78.3%); and in sellar tubercle meningioma, ≥ 14 (86.6%) mm. When evaluating the premammillary angle, pituitary adenomas were identified between 85°-95° (73.3%); in craniopharyngiomas, <<!--> <!-->85° (90.0%); and in meningiomas of the sellar tubercle, between 85-95° (86.6%).</div></div><div><h3>Conclusions</h3><div>The present study allows us to identify imaging characteristics in sellar and parasellar tumors that guide with high certainty the histopathological diagnosis and thus establish a more effective treatment.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 179-184"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895898","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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