Brain & spine最新文献_第5页

Is it ethically permissible to allow untrained practitioners to perform IONM? An African perspective 允许未经培训的从业人员执行IONM在道德上是否允许？非洲视角

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105932

Jacques Nel, Cornelius Ewuoso

Background

Intraoperative neurophysiological monitoring (IONM) is often used in surgical procedures to limit harm. However, South Africa currently experiences an acute shortage of trained personnel and qualified specialists to perform IONM (Ukachukwu et al., 2023). This gap results in poor regulatory oversight with untrained persons providing IONM services. This article interrogates this. Specifically, it explores from an underexplored African perspective whether untrained personnel ought to be allowed to perform IONM.

Research question

Is it ethically permissible to allow untrained practitioners to perform IONM?

Method

This normative ethics article employs a philosophical analytic method to interrogate this research question. It does this by drawing on the moral norms (reciprocal relationships, positive obligations and collective responsibility) derived from solidarity, rooted in African moral philosophy.

Results

A surgeon's dependence on valuable feedback to ensure a successful surgery requires IONM practitioners to respect reciprocal relationships by returning feedback backed by competency-honouring interdependence. Reliable feedback results when positive obligations arise from deliberate actions that reflect a capacity to recognise one's role in reducing patients' potential suffering. Collective responsibility requires practitioners to contribute equally towards a shared goal of good postoperative outcomes.

Discussion and conclusion

Untrained personnel violate the value of solidarity by failing to display the competencies necessary to actively promote patients' well-being and honour positive obligations, effectively collaborate within teams, and contribute towards a shared goal.

背景术中神经生理监测（IONM）常用于外科手术以限制伤害。然而，南非目前严重缺乏训练有素的人员和合格的专家来执行IONM （Ukachukwu等人，2023）。这一差距导致监管监督不力，由未经培训的人员提供IONM服务。本文对此进行了探讨。具体地说，它从未被充分探索的非洲角度探讨是否应允许未经训练的人员执行国际流动监测。研究问题：允许未经培训的从业人员执行IONM在道德上是否允许？方法本文采用哲学分析的方法对这一研究问题进行探讨。它通过借鉴植根于非洲道德哲学的团结所产生的道德规范（互惠关系、积极义务和集体责任）来做到这一点。结果外科医生依赖有价值的反馈来确保手术成功，这就要求IONM从业者尊重相互关系，以能力-尊重相互依赖为基础，反馈反馈。当积极的义务来自深思熟虑的行动，反映出认识到自己在减少患者潜在痛苦方面的作用的能力时，就会产生可靠的反馈。集体责任要求从业者平等地为良好的术后结果的共同目标做出贡献。未经培训的人员违反了团结的价值，因为他们没有表现出积极促进患者福祉和履行积极义务所必需的能力，在团队中有效地合作，并为共同的目标做出贡献。

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引用次数: 0

Risk factor analysis of growing unruptured intracranial aneurysms: A single center cohort study 生长未破裂颅内动脉瘤的危险因素分析：一项单中心队列研究

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105972

Francis J. Kissling , Johannes Goldberg , Bettina L. Serrallach , Michael Murek , Tomas Dobrocky , Eike I. Piechowiak , Jan Gralla , Andreas Raabe , David Bervini

Introduction

Intradural unruptured intracranial aneurysms (UIA) can rupture and lead to subarachnoid hemorrhage. Previous studies suggest aneurysm growth being a strong risk factor for rupture. The natural history and the individual risk of growth of aneurysms remain controversial.

Research question

To analyze the time to growth and identify risk factors associated with growth of UIAs.

Materials and methods

Prospectively collected data of 588 patients with a total of 858 UIAs followed up by imaging were analyzed. Patients and aneurysms were categorized in a growing or a stable cohort. Logistic and survival analyses were used to assess potential factors associated with UIA growth.

Results

During a median follow-up of 3.4 years (IQR 1.3 – 6.6 years), 112 (13.1%) out of the 858 UIAs showed an increase in size or a change of morphology. Posterior circulation UIAs (OR 2.01 (1.15 – 3.52), p = 0.01), aneurysm size at diagnosis (OR 1.10 (1.04 – 1.16) per mm, p = 0.002) and arterial hypertension (OR 1.60 (1.03 – 2.49), p = 0.04) were significantly associated with growth. Survival analyses confirmed a time-dependent association with growth for posterior circulation UIAs (HR 3.9 (1.74 – 8.75), p = 0.002) and aneurysm size (HR 1.22 (1.13 – 1.31), p < 0.0001).

Discussion and conclusion

UIA location in the posterior circulation, a larger size at diagnosis and the presence of arterial hypertension are significant risk factors associated with UIA growth.

硬膜内未破裂颅内动脉瘤（UIA）可破裂并导致蛛网膜下腔出血。先前的研究表明，动脉瘤生长是动脉瘤破裂的一个重要危险因素。动脉瘤生长的自然历史和个体风险仍然存在争议。研究问题：分析尿路感染的生长时间，确定与尿路感染生长相关的危险因素。材料与方法回顾性分析588例uia患者的影像学随访资料，共858例uia。患者和动脉瘤被分类在一个增长或稳定的队列中。Logistic分析和生存分析用于评估与UIA生长相关的潜在因素。结果中位随访3.4年（IQR 1.3 ~ 6.6年），858例uia中有112例（13.1%）出现体积增大或形态改变。后循环UIAs （OR 2.01 (1.15 - 3.52), p = 0.01）、诊断时动脉瘤大小（OR 1.10 (1.04 - 1.16) / mm, p = 0.002）和动脉高血压（OR 1.60 (1.03 - 2.49), p = 0.04）与生长显著相关。生存分析证实了后循环UIAs的生长（HR 3.9 (1.74 - 8.75), p = 0.002）和动脉瘤大小（HR 1.22 (1.13 - 1.31), p < 0.0001）与时间依赖性相关。讨论与结论UIA位于后循环、诊断时体积较大、存在动脉高血压是UIA生长的重要危险因素。

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引用次数: 0

Power-drill fluoroscopy-controlled technique as an alternative to navigation-assisted pedicle screw placement: A propensity score-matched retrospective cohort study 电钻透视控制技术作为导航辅助椎弓根螺钉置入的替代方法：一项倾向评分匹配的回顾性队列研究

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105959

Felix Corr , Faizan Kareem , Linda Bättig , Benedict Caspari , Karl Kapahnke , Silvio Heinig , Simon Behringer , Erik Schulz , Yesim Yildiz , Nader Hejrati , Oliver Bozinov , Benjamin Martens , Kern Singh , Martin N. Stienen , Stefan Motov

Introduction

Power-drill fluoroscopy-controlled freehand (PFH) pedicle screw placement is a drill-based refinement of the freehand technique that combines fluoroscopic control with tactile feedback. Its performance in degenerative spine surgery remains underexplored. This study compared the accuracy and procedural characteristics of PFH and navigation-assisted (NA) screw placement in thoracolumbar posterior fusion.

Research question

To investigate whether PFH pedicle screw placement achieves comparable accuracy to NA techniques in degenerative thoracolumbar fusion surgery.

Material and methods

Adults undergoing elective thoracolumbar fusion with PFH or NA pedicle screw placement were retrospectively analyzed. Propensity score matching balanced demographic and clinical variables between groups. Screw accuracy was graded by the Gertzbein–Robbins Scale (GRS). Secondary outcomes included radiation exposure and perioperative variables. A generalized linear mixed model accounted for multiple screws per patient.

Results

After matching, 35 patients per group were analyzed (PFH, 224 screws; NA, 154 screws). Satisfactory screw placement was achieved in 97.8% of PFH and 93.5% of NA screws (p = 0.02). Revision rates within 12 months were similar (5.7% vs 17.1%; p = 0.26). Radiation exposure was lower with PFH (8378 ± 5302 vs 23,793 ± 13,162 mGy cm²; p < 0.001), despite longer constructs and more frequent cement utilization. Osteoporosis independently reduced accuracy (OR 0.43; 95% CI, 0.20–0.92; p = 0.02).

Discussion and conclusion

In this propensity-matched analysis, PFH demonstrated accuracy comparable to NA (absolute difference 4.3 percentage points) with significantly lower patient radiation exposure. Further investigations are needed to justify the PFH method as a potential alternative in selected degenerative cases where radiation reduction is prioritized or navigation is unavailable.

power -drill透视控制徒手（PFH）椎弓根螺钉置入是徒手技术的一种基于钻孔的改进，结合了透视控制和触觉反馈。其在退行性脊柱手术中的表现仍有待进一步研究。本研究比较了PFH和导航辅助（NA）螺钉在胸腰椎后路融合中的准确性和手术特点。研究问题：探讨在退行性胸腰椎融合手术中，PFH椎弓根螺钉置入是否能达到与NA技术相当的准确性。材料和方法回顾性分析成人择期胸腰椎融合置入PFH或NA椎弓根螺钉的病例。倾向评分匹配平衡组间人口统计学和临床变量。螺钉精度按Gertzbein-Robbins量表（GRS）分级。次要结果包括辐射暴露和围手术期变量。广义线性混合模型考虑了每位患者的多个螺钉。结果匹配后，每组分析35例患者（PFH， 224枚螺钉；NA， 154枚螺钉）。97.8%的PFH和93.5%的NA螺钉置入满意（p = 0.02）。12个月内的修正率相似（5.7% vs 17.1%; p = 0.26）。尽管施工时间更长，水泥使用频率更高，但PFH的辐射暴露较低（8378±5302 vs 23,793±13,162 mGy cm2; p < 0.001）。骨质疏松症单独降低准确率（OR 0.43; 95% CI, 0.20-0.92; p = 0.02）。在这种倾向匹配分析中，PFH显示出与NA相当的准确性（绝对差异4.3个百分点），患者辐射暴露明显降低。需要进一步的研究来证明PFH方法在减少辐射或无法导航的退行性病例中是一种潜在的替代方法。

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引用次数: 0

The role of dexamethasone during treatment phases in glioblastoma: Insights from a retrospective observational study 地塞米松在胶质母细胞瘤治疗阶段的作用：来自回顾性观察性研究的见解

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105968

Juliane Göbel , Maximilian Scheer , Clemens Kirchner , Sandra Leisz , Julian Prell , Christian Strauss , Sebastian Simmermacher , Stefan Rampp

Background

Glioblastoma (GBM) is the most aggressive primary brain tumor in adults. Dexamethasone (DEX) is commonly used to manage peritumoral edema, but its impact on overall survival (OS) and progression-free survival (PFS) remains unclear across treatment phases.

Methods

In this retrospective single-center study, we analyzed data from 106 GBM patients treated between 2016 and 2020 at the University Hospital Halle. We examined the effects of DEX on OS and PFS during the preoperative, postoperative, and adjuvant therapy phases using Kaplan-Meier and Cox regression analyses. Cutoff analyses identified phase-specific DEX dose thresholds.

Results

Preoperatively, DEX had no significant effect on OS (HR: 0.998, p = 0.379) or PFS (HR: 0.998, p = 0.373), though a positive trend is possible. Postoperatively, DEX was associated with improved OS (HR: 0.995, p = 0.017) and PFS (HR: 0.995, p = 0.029). Conversely, during adjuvant therapy, higher DEX doses trended toward worse OS (HR: 1.001, p = 0.069) and PFS (p = 0.258). Patients not receiving DEX during adjuvant therapy had significantly longer OS (17.9 vs. 6.4 months, p < 0.001) and PFS (9 vs. 4.6 months, p = 0.007).

Conclusion

DEX influences survival outcomes differently across treatment phases. Higher doses may be beneficial pre- and postoperatively but detrimental during adjuvant therapy. These findings underscore the importance of phase-specific DEX dosing and support further research into optimal corticosteroid strategies in GBM care.

胶质母细胞瘤（GBM）是成人中最具侵袭性的原发性脑肿瘤。地塞米松（DEX）通常用于治疗肿瘤周围水肿，但其对总生存期（OS）和无进展生存期（PFS）的影响尚不清楚。方法在这项回顾性单中心研究中，我们分析了2016年至2020年在哈雷大学医院治疗的106例GBM患者的数据。我们使用Kaplan-Meier和Cox回归分析检查了DEX在术前、术后和辅助治疗阶段对OS和PFS的影响。截止分析确定了药敏DEX的阶段性剂量阈值。结果术前DEX对OS （HR: 0.998, p = 0.379）和PFS （HR: 0.998, p = 0.373）均无显著影响，但可能呈阳性趋势。术后DEX与改善OS （HR: 0.995, p = 0.017）和PFS （HR: 0.995, p = 0.029）相关。相反，在辅助治疗期间，DEX剂量越大，OS （HR: 1.001, p = 0.069）和PFS （p = 0.258）越差。辅助治疗期间未接受DEX治疗的患者的OS（17.9个月vs 6.4个月，p < 0.001）和PFS（9个月vs 4.6个月，p = 0.007）显著延长。结论dex对不同治疗阶段生存结局的影响不同。高剂量可能在术前和术后有益，但在辅助治疗期间有害。这些发现强调了分阶段给药的重要性，并支持进一步研究皮质类固醇在GBM护理中的最佳策略。

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引用次数: 0

No surgical site infections observed after lumbar unilateral biportal endoscopy: a multicenter retrospective series of 1566 patients 腰椎单侧双门静脉内窥镜检查后未发现手术部位感染：1566例患者的多中心回顾性研究

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105949

Aurore Sellier , Joseph Cristini , Alexandre Dhenin , Matthieu Vassal , Francois Lechanoine , Nicolas Pellet , Jonathan Lebhar , Guillaume Lonjon

Background

Surgical site infection (SSI) remains a concern in spinal surgery despite advances in minimally invasive techniques. Unilateral biportal endoscopy (UBE) may reduce infection risk via limited tissue trauma and continuous saline irrigation, but its true SSI incidence remains unknown.

Research question

This study aimed to assess the incidence of SSI after lumbar UBE procedures.

Material and methods

This retrospective multicenter study included consecutive patients who underwent lumbar UBE for degenerative conditions between March 2022 and January 2025 in four French spine centers. Secondary outcomes included other complications and functional recovery.

Results

Among 1566 patients (mean age 58 ± 16 years; 53 % male), indications included disc herniation (59 %) and spinal stenosis (39 %). Half received perioperative antibiotic prophylaxis. No SSI occurred within 90 days after UBE. One SSI was observed after a subsequent open revision with fusion, unrelated to the initial procedure. Other complications occurred in 15 % of patients, including dural tears (5 %) and reoperations (4 %), mainly for recurrent herniation. At 3 months, ODI improved from 46 ± 19 to 20 ± 18, with a minimal clinically important difference achieved in 72 % of cases.

Discussion and conclusion

No SSI was identified after lumbar UBE in this large multicenter series. Continuous irrigation and minimal tissue trauma may confer a protective effect, supporting UBE as a safe minimally invasive approach with extremely low infection risk.

背景：尽管微创技术有所进步，但脊柱外科手术部位感染（SSI）仍然是一个值得关注的问题。单侧双门静脉内窥镜（UBE）可以通过有限的组织创伤和持续的生理盐水冲洗来降低感染风险，但其真正的SSI发生率尚不清楚。研究问题：本研究旨在评估腰椎UBE手术后SSI的发生率。材料和方法这项回顾性多中心研究纳入了2022年3月至2025年1月期间在法国四个脊柱中心连续接受腰椎UBE退行性疾病的患者。次要结局包括其他并发症和功能恢复。结果1566例患者（平均年龄58±16岁，男性53%），适应症包括椎间盘突出（59%）和椎管狭窄（39%）。半数患者接受围手术期抗生素预防治疗。UBE后90天内未发生SSI。在随后的开放翻修融合后观察到一例SSI，与初始手术无关。15%的患者出现其他并发症，包括硬脑膜撕裂（5%）和再手术（4%），主要是复发性疝。3个月时，ODI从46±19改善到20±18,72%的病例实现了最小的临床重要差异。讨论和结论在这个大型多中心研究中，没有发现腰椎UBE后的SSI。持续灌洗和最小的组织创伤可能具有保护作用，支持UBE作为安全的微创方法，感染风险极低。

{"title":"No surgical site infections observed after lumbar unilateral biportal endoscopy: a multicenter retrospective series of 1566 patients","authors":"Aurore Sellier , Joseph Cristini , Alexandre Dhenin , Matthieu Vassal , Francois Lechanoine , Nicolas Pellet , Jonathan Lebhar , Guillaume Lonjon","doi":"10.1016/j.bas.2026.105949","DOIUrl":"10.1016/j.bas.2026.105949","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infection (SSI) remains a concern in spinal surgery despite advances in minimally invasive techniques. Unilateral biportal endoscopy (UBE) may reduce infection risk via limited tissue trauma and continuous saline irrigation, but its true SSI incidence remains unknown.</div></div><div><h3>Research question</h3><div>This study aimed to assess the incidence of SSI after lumbar UBE procedures.</div></div><div><h3>Material and methods</h3><div>This retrospective multicenter study included consecutive patients who underwent lumbar UBE for degenerative conditions between March 2022 and January 2025 in four French spine centers. Secondary outcomes included other complications and functional recovery.</div></div><div><h3>Results</h3><div>Among 1566 patients (mean age 58 ± 16 years; 53 % male), indications included disc herniation (59 %) and spinal stenosis (39 %). Half received perioperative antibiotic prophylaxis. No SSI occurred within 90 days after UBE. One SSI was observed after a subsequent open revision with fusion, unrelated to the initial procedure. Other complications occurred in 15 % of patients, including dural tears (5 %) and reoperations (4 %), mainly for recurrent herniation. At 3 months, ODI improved from 46 ± 19 to 20 ± 18, with a minimal clinically important difference achieved in 72 % of cases.</div></div><div><h3>Discussion and conclusion</h3><div>No SSI was identified after lumbar UBE in this large multicenter series. Continuous irrigation and minimal tissue trauma may confer a protective effect, supporting UBE as a safe minimally invasive approach with extremely low infection risk.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105949"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The four-eye principle in preoperative indication for lumbar spine surgery: A retrospective cohort analysis with prospective follow-up 腰椎手术术前指征的四眼原则：前瞻性随访的回顾性队列分析。

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105947

Sophie Tielemann , Clara Berlin , Marcus Kelm , Markus Quante

Background

Accurate preoperative indication is crucial for achieving successful outcomes in lumbar spine surgery. The “four-eye principle,” requiring consensus between two independent specialists, has been proposed as a quality assurance measure, yet clinical evidence and the potential impact of selection bias remain insufficiently explored.

Methods

This monocentric retrospective cohort study with prospective follow-up included patients undergoing single-level TLIF or UD between 2010 and2020 at a DWG-certified spine center. Patients were allocated either to a control group (indication by a single spine surgeon) or a peer group (interdisciplinary four-eye principle involving a surgical and conservative specialist). PROMs (ODI, EQ-5D-5L, VAS back and leg pain) were recorded preoperatively and at 3, 12, and 24 months. Results were interpreted considering potential selection effects and surgeon variability.

Results

A total of 166 patients were included (54 TLIF, 112 UD). In the TLIF cohort, the peer group demonstrated significantly greater improvements in ODI, EQ-5D, and VAS back pain at 12 and 24 months (p < 0.05). Differences in leg pain favored the peer group without statistical significance. In the UD cohort, outcomes were broadly comparable between groups. Interpretation is limited by inherent selection differences and potential variability in surgical performance.

Conclusion

The four-eye principle was associated with superior functional and pain-related outcomes in patients undergoing lumbar fusion. While these findings suggest that structured, interdisciplinary indication processes may enhance patient selection, stricter thresholds for surgical approval and surgeon heterogeneity must be considered in interpreting the results. Prospective multicenter studies including non-operated patients are needed to validate the four-eye principle as a quality assurance tool.

背景：准确的术前指征是腰椎手术成功的关键。需要两位独立专家达成共识的“四眼原则”已被提议作为质量保证措施，但临床证据和选择偏差的潜在影响仍未得到充分探讨。方法：这项单中心回顾性队列研究的前瞻性随访包括2010年至2020年在dwg认证的脊柱中心接受单级别TLIF或UD的患者。患者被分配到对照组（由一名脊柱外科医生指示）或同伴组（涉及外科和保守专家的跨学科四眼原则）。术前、3个月、12个月和24个月分别记录PROMs （ODI、EQ-5D-5L、VAS背部和腿部疼痛）。结果的解释考虑了潜在的选择效应和外科医生的可变性。结果：共纳入166例患者（TLIF 54例，UD 112例）。在TLIF队列中，同行组在12个月和24个月时ODI、EQ-5D和VAS背痛方面表现出更大的改善(p结论：四眼原则与腰椎融合术患者优越的功能和疼痛相关结果相关。虽然这些发现表明，结构化的、跨学科的适应症过程可能会加强患者的选择，但在解释结果时必须考虑更严格的手术批准门槛和外科医生的异质性。需要包括未手术患者在内的前瞻性多中心研究来验证四眼原则作为质量保证工具的有效性。

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引用次数: 0

Vestibular schwannoma microsurgery peculiarities for better functional outcome and result comparison 前庭神经鞘瘤显微手术的特点为更好的功能结局和结果比较

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105970

Mykola Volodymyrovich Yehorov, Vasyl Volodymyrovich Shust, Volodymyr Olegovich Fedirko

Introduction

Vestibular schwannomas (VS) are surgically challenging due to proximity to critical neurovascular structures. Preservation of facial and cochlear nerve function is essential for quality of life (QoL).

Research question

Does a refined microsurgical technique with extent of tumor resection improve functional outcomes, quality of life, compared to conventional surgery? The need for generally accepted scale of VS removal radicality. ?

Material and methods

This retrospective cohort study included 829 patients treated at the Subtentorial Neurooncology Department Romodanov Institute of Neurosurgery (2001–2024). Group 1 (n = 474) underwent conventional surgery; Group 2 (n = 355) received a modified strategy with preoperative CT-MRI planning, intraoperative neuromonitoring, and nerve-sparing dissection. Facial nerve function was assessed using the HB, and QoL with PANQOL in 118 patients with paired data. Authors Vestibular Schwannoma Resection Grading scale (VSRG) suggested.

Results

Group 2 showed significant PANQOL improvements: Pain (+19.5%), Facial Function (+35.6%), General Health (+15.7%), Total Score (+11.1%), with smaller gains in Hearing (+8%), Balance (+4%), and Energy (+2.3%). Cochlear nerve preservation was achieved in 52.7% of patients with functional hearing in Group 2 versus none in Group 1. Total and subtotal resections were more frequent in Group 2 per VSRG, correlating with lower early residual tumor regrowth (mean follow-up 49.5 vs. 159.4 months) and higher QoL.

Discussion and conclusion

Individualized planning, nerve monitoring, and nerve-sparing dissection improves early functional outcomes, QoL, and extent of tumor resection. Prospective studies are needed to confirm long-term tumor control.

前庭神经鞘瘤（VS）由于靠近关键的神经血管结构，在手术上具有挑战性。面部和耳蜗神经功能的保存对生活质量（QoL）至关重要。研究问题：与传统手术相比，精细的显微外科技术与肿瘤切除的程度是否能改善功能结果和生活质量？需要普遍接受的VS去除自由基的尺度。？材料和方法本回顾性队列研究包括2001-2024年在罗莫达诺夫神经外科研究所幕下神经肿瘤科治疗的829例患者。第一组（n = 474）行常规手术；第2组（n = 355）接受了术前CT-MRI计划、术中神经监测和保留神经解剖的改进策略。采用HB评估118例患者的面神经功能，并结合PANQOL评估QoL。作者提出前庭神经鞘瘤切除分级量表（VSRG）。结果第二组PANQOL有显著改善：疼痛（+19.5%）、面部功能（+35.6%）、一般健康（+15.7%）、总分（+11.1%），听力（+8%）、平衡（+4%）和能量（+2.3%）有较小的改善。在第2组中，52.7%的功能性听力患者获得了人工耳蜗神经保存，而第1组中没有。第2组每VSRG进行全切除和次全切除的频率更高，与较低的早期残留肿瘤再生相关（平均随访49.5个月对159.4个月）和较高的生活质量。讨论与结论个体化规划、神经监测和保留神经的解剖可改善早期功能预后、生活质量和肿瘤切除程度。需要前瞻性研究来证实长期的肿瘤控制。

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引用次数: 0

Implementation of the open surgery reporting guidelines in ruptured brain arteriovenous malformations: Feasability and adaptations 脑动静脉破裂畸形开放性手术报告指南的实施：可行性和适应性

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2025.105920

Lucas Ribeiro , Julien Boetto , Pierre-Henri Lefevre , Kifah Khouri , Marine Le Corre

Introduction

Ruptured brain arteriovenous malformations (rAVMs) are a major cause of hemorrhagic stroke in young adults, often leading to severe neurological morbidity. The recently proposed Open Surgery Reporting Guidelines (OSRG) aim to standardize data reporting in microsurgical AVM studies.

Research question

This study assessed the feasibility of OSRG application in ruptured AVM surgery and identified limitations specific to this acute context.

Methods and materials

A retrospective analysis of 86 patients who underwent microsurgical treatment for rAVMs between 2012 and 2022 was performed. The OSRG, encompassing eight domains and 65 items, was retrospectively applied to each case. Reporting completeness, feasibility challenges, and inter-domain consistency were evaluated. Predictors of poor functional outcome (modified Rankin Scale [mRS] > 2) were determined using uni- and multivariate logistic regression.

Results

The mean age was 45.6 ± 17.2 years, and 59.4 % were female. Complete resection was achieved in 91.6 %, with a mortality rate of 4.6 %. Favorable outcome (mRS ≤2) increased from 53.4 % at 3 months to 72.0 % at last follow-up. WFNS >2 (OR 6.38, 95 % CI 1.50–31.36; p = 0.01) and acute hydrocephalus (OR 6.76, 95 % CI 2.09–25.97; p = 0.01) independently predicted poor outcome. OSRG adherence reached 81.5 % (53/65 items), with full completion in radiological, surgical, and administrative domains, while partial gaps concerned preoperative and adverse events reporting.

Conclusion

Applying the OSRG framework in rAVM surgery is feasible and improves reporting accuracy and transparency. Minor adaptations for emergency settings may further enhance its applicability and facilitate interstudy comparability in vascular neurosurgery.

脑动静脉破裂畸形（rAVMs）是青壮年出血性中风的主要原因，常导致严重的神经系统疾病。最近提出的开放手术报告指南（OSRG）旨在规范显微外科AVM研究的数据报告。研究问题：本研究评估了OSRG在AVM破裂手术中应用的可行性，并确定了这种急性情况下的局限性。方法与材料回顾性分析2012年至2022年接受显微手术治疗的86例ravm患者。OSRG包括8个领域和65个项目，回顾性应用于每个病例。评估报告的完整性、可行性挑战和域间一致性。功能不良预后的预测因子（改良Rankin量表[mRS] >； 2）采用单因素和多因素logistic回归确定。结果患者平均年龄（45.6±17.2）岁，女性占59.4%。完全切除率为91.6%，死亡率为4.6%。良好预后（mRS≤2）从3个月时的53.4%增加到末次随访时的72.0%。WFNS >2 （OR 6.38, 95% CI 1.50-31.36; p = 0.01）和急性脑积水（OR 6.76, 95% CI 2.09-25.97; p = 0.01）独立预测预后不良。OSRG的依从性达到81.5%（53/65项），在放射学、外科和行政管理领域完全完成，而在术前和不良事件报告方面存在部分差距。结论在rAVM手术中应用OSRG框架是可行的，提高了报告的准确性和透明度。在紧急情况下的细微调整可以进一步增强其适用性，并促进血管神经外科研究间的可比性。

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引用次数: 0

Endoscopic discectomy for L4-L5 disc herniation: A meta-analysis comparing transforaminal and interlaminar approaches 内窥镜椎间盘切除术治疗L4-L5椎间盘突出：一项比较椎间孔和椎间孔入路的荟萃分析

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105925

Ralph Maroun , Youssef Jamaleddine , Chahine Assi , Ramzi Moucharafieh , Mohammad Badra

Background

Lumbar disc herniation can be debilitating. Percutaneous endoscopic discectomy (PED) is an emerging minimally invasive alternative to microdiscectomy, performed through either an interlaminar (IL) or transforaminal (TF) approach.

Research question

There is existing evidence comparing these two approaches for managing the most common herniation level, L4-L5, but it lacks consistency and clear conclusions. Therefore, a meta-analysis is necessary to determine if one approach is superior to the other.

Methods

Medline, Cochrane, and Google Scholar (pages 1–20) were searched until August 1, 2025, following PRISMA guidelines. The data extracted included overall complications, reoperation rates, operative time, length of stay (LOS), and improvements in patient-reported outcome measures (PROMs) at least one year after surgery.

Results

Six studies involving 456 patients (276 TF; 180 IL) were included. No significant differences were found between the two approaches regarding overall complications (OR = 1.81; 95 % CI: 0.51–6.44; p = 0.36), reoperation rates (OR = 2.10; 95 % CI: 0.38–11.70; p = 0.40), operative time (MD = 0.73; 95 % CI: −14.83–16.29; p = 0.93), or LOS (MD = 0.03; 95 % CI: −0.13–0.19; p = 0.69). Similarly, improvements in ODI (MD = −1.06; 95 % CI: −2.63–0.52; p = 0.19), back pain (MD = 0.29; 95 % CI: −0.61–1.19; p = 0.53), and leg pain (MD = −0.44; 95 % CI: −1.19–0.31; p = 0.25) showed no significant differences.

Discussion and conclusion

Both approaches produce similar results regarding overall complications, reoperation rates, operative time, LOS, and PROMs. The choice of approach should thus be based on surgeon experience, patient-specific anatomy, and resource availability.

背景：腰椎间盘突出会使人衰弱。经皮内窥镜椎间盘切除术（PED）是一种新兴的微创替代显微椎间盘切除术，可通过椎间（IL）或椎间孔（TF）入路进行。研究问题已有证据比较这两种方法治疗最常见的L4-L5疝水平，但缺乏一致性和明确的结论。因此，有必要进行荟萃分析来确定一种方法是否优于另一种方法。方法按照PRISMA指南，检索medline、Cochrane和谷歌Scholar（第1 - 20页）至2025年8月1日。提取的数据包括总体并发症、再手术率、手术时间、住院时间（LOS）和术后至少一年患者报告的结果测量（PROMs）的改善。结果纳入6项研究，共纳入456例患者（276例TF， 180例IL）。两种入路在总并发症（OR = 1.81; 95% CI: 0.51-6.44; p = 0.36）、再手术率（OR = 2.10; 95% CI: 0.38-11.70; p = 0.40）、手术时间（MD = 0.73; 95% CI: - 14.83-16.29; p = 0.93）或LOS （MD = 0.03; 95% CI: - 0.13-0.19; p = 0.69）方面均无显著差异。同样，ODI （MD = - 1.06; 95% CI: - 2.63-0.52; p = 0.19）、背部疼痛（MD = 0.29; 95% CI: - 0.61-1.19; p = 0.53）和腿部疼痛（MD = - 0.44; 95% CI: - 1.19-0.31; p = 0.25）的改善无显著差异。讨论与结论两种方法在总体并发症、再手术率、手术时间、LOS和prom方面的结果相似。因此，入路的选择应基于外科医生的经验、患者的具体解剖结构和资源的可用性。

{"title":"Endoscopic discectomy for L4-L5 disc herniation: A meta-analysis comparing transforaminal and interlaminar approaches","authors":"Ralph Maroun , Youssef Jamaleddine , Chahine Assi , Ramzi Moucharafieh , Mohammad Badra","doi":"10.1016/j.bas.2026.105925","DOIUrl":"10.1016/j.bas.2026.105925","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar disc herniation can be debilitating. Percutaneous endoscopic discectomy (PED) is an emerging minimally invasive alternative to microdiscectomy, performed through either an interlaminar (IL) or transforaminal (TF) approach.</div></div><div><h3>Research question</h3><div>There is existing evidence comparing these two approaches for managing the most common herniation level, L4-L5, but it lacks consistency and clear conclusions. Therefore, a meta-analysis is necessary to determine if one approach is superior to the other.</div></div><div><h3>Methods</h3><div>Medline, Cochrane, and Google Scholar (pages 1–20) were searched until August 1, 2025, following PRISMA guidelines. The data extracted included overall complications, reoperation rates, operative time, length of stay (LOS), and improvements in patient-reported outcome measures (PROMs) at least one year after surgery.</div></div><div><h3>Results</h3><div>Six studies involving 456 patients (276 TF; 180 IL) were included. No significant differences were found between the two approaches regarding overall complications (OR = 1.81; 95 % CI: 0.51–6.44; p = 0.36), reoperation rates (OR = 2.10; 95 % CI: 0.38–11.70; p = 0.40), operative time (MD = 0.73; 95 % CI: −14.83–16.29; p = 0.93), or LOS (MD = 0.03; 95 % CI: −0.13–0.19; p = 0.69). Similarly, improvements in ODI (MD = −1.06; 95 % CI: −2.63–0.52; p = 0.19), back pain (MD = 0.29; 95 % CI: −0.61–1.19; p = 0.53), and leg pain (MD = −0.44; 95 % CI: −1.19–0.31; p = 0.25) showed no significant differences.</div></div><div><h3>Discussion and conclusion</h3><div>Both approaches produce similar results regarding overall complications, reoperation rates, operative time, LOS, and PROMs. The choice of approach should thus be based on surgeon experience, patient-specific anatomy, and resource availability.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105925"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reassessing vertebral endplate references in parametric spinal analysis: Validation of a centroid-based method for vertebral inclination measurement 在参数化脊柱分析中重新评估椎体终板参考：基于质心的椎体倾斜测量方法的验证

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2026-01-01 DOI: 10.1016/j.bas.2026.105962

Adimilson dos Santos Delgado , Bruna Souza Morais , Helton Luiz Aparecido Defino , Paulo Miguel da Silva Pereira , Arlindo Neto Montagnoli

Introduction

The vertebral endplate, the primary anatomical reference in spine measurements, is highly susceptible to observer variability. Alternatively, the geometric centroid model offers a more reproducible reference. This model is constructed by fitting a curve through geometric centroids derived from the four annotated vertices of each vertebral body.

Research question

To introduce vertebral slope measurement using the normal to the centroid-based spinal model.

Material and methods

Three evaluators annotated thirty-two standing lateral radiographs. Dedicated software computed geometric centroids, interpolated a mathematical spinal curve, and measured vertebral inclination relative to the curve's normal line. For comparison, vertebral slope was measured using the classical endplate-based method. Vertebral slope difference between adjacent vertebrae was also analyzed. Inter and intraobserver variability was evaluated using intraclass correlation coefficients (ICC). Paired t-tests were applied to compare methods at each vertebral level.

Results

Vertebral slope reflects the absolute spatial orientation of each vertebra, and the vertebral slope difference captures local curvature. Mean intraobserver ICCs were 0.88 for the endplate method and 0.97 for the centroid method, while interobserver ICCs were 0.85 and 0.96, respectively. The centroid method demonstrated significantly lower variability in vertebral inclination across most levels (C4 to L4, p < 0.05). Differences at L5 (p = 0.160) and S1 (p = 0.397) were not statistically significant.

Discussion and conclusion

Vertebral slope and vertebral slope difference offer an individualized analysis of the spine. Compared to the endplate method, the geometric centroid model substantially reduced observer variability. While the endplate proved suboptimal overall, the S1 endplate reference remains necessary due to sacral anatomy.

椎体终板是脊柱测量的主要解剖学参考，它极易受观察者差异的影响。另外，几何质心模型提供了一个更可复制的参考。该模型通过从每个椎体的四个注释顶点导出的几何质心拟合曲线来构建。研究问题：介绍基于法向到质心的脊柱模型的椎体斜率测量方法。材料和方法3名评估者对32张站立侧位x线片进行注释。专用软件计算几何质心，插值数学脊柱曲线，并测量相对于曲线法线的椎体倾角。为了比较，采用经典的基于终板的方法测量椎体斜率。分析相邻椎体间椎体坡度的差异。使用类内相关系数（ICC）评估观察者之间和观察者内部的变异性。采用配对t检验比较各椎体水平的方法。结果椎体斜率反映了各椎体的绝对空间方向，椎体斜率差反映了局部曲率。终端板法和质心法的平均观察者内icc分别为0.88和0.97，而观察者间icc分别为0.85和0.96。质心法显示，椎体倾斜在大多数水平上的可变性明显较低（C4至L4， p < 0.05）。L5 （p = 0.160）和S1 （p = 0.397）的差异无统计学意义。讨论与结论椎体坡度和椎体坡度差异提供了对脊柱的个体化分析。与端板方法相比，几何质心模型大大降低了观测者的可变性。虽然终板总体上不理想，但由于骶骨解剖，S1终板参考仍然是必要的。

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引用次数: 0