Acta Neurochirurgica最新文献

Background

The advent of social media has significantly transformed various medical specialties, including neurosurgery. A systematic review of the literature was conducted to characterize the utilization of social media in neurosurgery and to evaluate the impact of social media usage in neurosurgery. Furthermore, the study aimed to determine the demographics of social media users in neurosurgery and delineate their purposes for engaging with social media platforms.

Methods

A comprehensive literature search was conducted across the PubMed, EMBASE, Scopus, and Cochrane databases to identify studies investigating the role of social media in neurosurgery. Articles were screened for relevance, and selected studies were systematically reviewed and analyzed to assess the integration of social media within neurosurgical practices.

Results

105 studies were included. 2023 represented the year with the most published articles (28%). Most studies (52%) addressed general neurosurgery, followed by intracranial (24%) and spine surgery (24%). X (formerly Twitter) was the most frequently studied platform (46%), followed by YouTube (38%) and Facebook (30%). The primary purposes of social media use were patient education (36%), evaluation of the impact (22%), healthcare provider education (20%), collaboration (9%), research dissemination (8%), and career development (6%). 64% of studies targeted healthcare professionals, while 36% focused on patients. Sentiment towards social media use was positive in 50% of studies, negative in 19%, and neutral or exploratory in 31%.

Conclusion

The literature highlights a notable increase in the use of social media in the neurosurgical field, particularly for education, impact analysis and research distribution. Platforms like X have become central for academic exchange and professional networking. Having a social media presence can be beneficial for neurosurgeons and can positively impact patient reviews, the department’s standing, and may even contribute to academic success. Furthermore, social media facilitates interdisciplinary collaboration and access to educational content.

Background

Intracranial atherosclerotic stenosis-related large vessel occlusion (ICAS-LVO) is a leading cause of acute large vessel occlusion stroke. For patients suffering from ICAS-LVO stroke, the first-line treatment is mechanical thrombectomy (MT). However, whether balloon angioplasty and/or stenting should be performed after MT in patients with ICAS-LVO stroke remains uncertain in clinical practice. In this study, a meta-analysis and systematic review was performed to assess the efficacy and safety of angioplasty and/or stenting after MT.

Methods

A thorough search of the PubMed, Web of Science, Cochrane, and Scopus databases from inception to February 28, 2025, was performed to retrieve clinical trials comparing angioplasty and/or stenting plus MT versus MT alone. Vessel recanalization, functional independence at 90 days, early neurological deterioration, symptomatic intracranial hemorrhage (ICH), asymptomatic ICH, any ICH, and mortality at 90 days were analyzed. RevMan version 5.4 was used to calculate the pooled risk ratio (RR) and 95% confidence interval (CI).

Results

The analysis included nine studies. No significant difference was observed between MT + angioplasty/stenting and MT alone in terms of vessel recanalization (RR = 1.03, 95%CI = 0.97–1.11, p = 0.33), symptomatic ICH (RR = 1.06, 95%CI = 0.65–1.71, p = 0.82), asymptomatic ICH (RR = 1.17, 95%CI = 0.86–1.60, p = 0.33), any ICH (RR = 0.97, 95%CI = 0.77–1.21, p = 0.79), and mortality at 90 days (RR = 0.97, 95%CI = 0.70–1.34, p = 0.84). Angioplasty and/or stent plus MT significantly increased the likelihood of functional independence (mRS 0–2) at 90 days (RR = 1.24, 95%CI = 1.11–1.38, p < 0.001) and decreased early neurological deterioration (RR = 0.60, 95% CI = 0.37–0.95, p = 0.03).

Conclusion

Angioplasty and/or stent after MT was associated with significantly better functional independence and reduced early neurological deterioration compared to MT alone a without significant adverse events.

Purpose

Glioblastoma (GBM) in elderly patients has a poor prognosis. About one-third of patients have impaired perioperative performance status (PS) and often excluded from clinical trials. Brain biopsy is the standard diagnostic approach when resection is not feasible. Previous studies on preoperative prognostic factors have mostly focused on resected patients. This study aimed to identify preoperative factors associated with reduced three-month survival and treatment incompletion in elderly biopsy-only patients, with the three-month endpoint reflecting early mortality and rapid disease progression that often prevents treatment completion.

Methods

We retrospectively reviewed biopsy-only GBM patients aged > 65 years between 2017 and 2020. Preoperative prognostic factors were analyzed using logistic regression, and overall survival (OS) was estimated using Kaplan–Meier.

Results

A total of 132 patients were included. Median OS was 4.6 months, and 50% completed treatment. Palliative treatment was given to 17% of patients (median OS 1.3 months). Poor PS (OR = 0.2), larger tumor volume (OR = 0.9), and central tumor location (OR = 0.3) were independently associated with reduced three-month survival. Poor PS was the only predictor of treatment incompletion (OR = 0.06); in this subgroup, The median OS was 1.6 months, with only one of 21 completing treatment.

Conclusion

In elderly patients with biopsy-only GBM, poor preoperative PS, central tumor location, and larger tumor volume were significantly associated with reduced short-term survival. Patients with poor preoperative PS were also less likely to complete treatment. These findings may aid in counseling on the potential benefits of biopsy in this vulnerable group.

Background

Long-tunneled external ventricular drainage (LTEVD) has been proposed as an alternative to conventional short-tunneled external ventricular drainage (STEVD), particularly to reduce complications such as catheter dislocation and secondary infections. Despite potential advantages, awareness of LTEVD and high-quality literature remain limited. This systematic review and meta-analysis intends to evaluate the safety and efficacy of LTEVD in pediatric and adult populations.

Methods

A systematic review was conducted to identify studies including both adult and pediatric patients undergoing LTEVD and reporting intra-, peri-, and postoperative clinical outcomes, indications, and complication rates. Major scientific databases were searched for articles published up to 2024. Two authors independently extracted data.

Results

Fifteen studies (n = 1,024; 612 adults, 412 children) met inclusion criteria, with most applying LTEVD to manage infections. The mean tunneling length was 41.3 cm, and the median duration of drainage was 7 days. LTEVD removal was performed in the operating room in 87% of cases, compared to 92% bedside removals for STEVD. Six studies (n = 123) reported conversion to ventriculoperitoneal shunt. Meta-analysis of infection rates (10 studies, n = 824) showed no statistically significant difference between LTEVD and STEVD (OR 1.83, 95%CI 0.84–3.99; p = 0.13). Blockage and dislocation rates were comparable (LTEVD 2.7% vs. STEVD 7.0%, p = 0.075; LTEVD 5.4% vs. STEVD 2.3%, p = 0.151).

Conclusion

Outcomes for LTEVD are generally comparable to STEVD in both children and adults. While LTEVD may offer potential long-term advantages for infection management, current evidence does not confirm its superiority. LTEVD may be appropriate for prolonged drainage needs, but further research is required due to limited evidence and study heterogeneity.

Purpose

Reliable head fixation is essential for accuracy in cranial neurosurgical procedures, particularly when using neuronavigation systems. While traditional skull clamps are designed to ensure rigid immobilization, undiscovered movement of patient´s head under external forces can undermine surgical precision.

Methods

In this study, we investigate the biomechanical performance of a head fixation device equipped with force and angle sensors. Using seven cadaveric heads and an external force applicator, we quantified resistance against the external force, the axial force at each pin and angular displacement of the two-pin rocker. The movement of head across three clinically relevant head positions for craniotomy: prone, middle fossa, and pterional was optically recorded by a neuronavigation system.

Results

In the pterional position, the horizontal orientation of the two-pin rocker resisted significantly higher external shear forces (575.1 N, SD: 202.3 N) than the vertical orientation (427.2 N, SD: 105.9 N; p = 0.0081). Correspondingly, angular displacement of the two-pin rocker was lower in the horizontal orientation (0.48°, SD: 0.65°) than in the vertical orientation (1.15°, SD: 0.76°; p = 9.92 · 10^–5). No statistically significant differences were observed in the prone or middle fossa positions for the external shear forces.

Conclusion

These results suggest that optimal two-pin rocker orientation can mitigate slippage and angular drift, improving intraoperative reliability. This study provides a foundation for developing a quantitative stability model and evidence-based recommendations for skull clamp application in neurosurgical practice.

Purpose

MRI-guided laser interstitial thermal therapy (LITT) is a minimally invasive technique for treating intracranial pathologies. Although the extent of ablation appears prognostically relevant, standardized imaging methods for post-LITT ablation zone measurements are lacking. This systematic review evaluates imaging-based approaches used to measure the ablation zone in patients undergoing LITT. As effect assessment is an integral part of the technique, this study aims to support the development of standardized imaging-based outcome metrics.

Methods

A systematic literature search was conducted in PubMed and Embase (March 15, 2024; updated April 2, 2025). Studies were included if they reported imaging-based methods for determining ablation extent or volume after LITT; studies without methodological detail, non-original research, or non-human studies were excluded. Study selection, data extraction, and risk of bias assessment (Newcastle–Ottawa Scale) were conducted independently by multiple reviewers.

Results

A total of 77 studies (2,312 patients) were included. Most studies (82%) were retrospective case series, with 74 (96%) categorized as having moderate risk of bias. All studies utilized MRI to assess post-LITT ablation volume. Conventional MRI sequences were used in 65 studies (84%), among which 54 (83%) used contrast-enhanced imaging. Forty-six studies (60%) reported a single time-point volume assessment. Of the 60 studies using contrast-enhanced imaging, 50% specified inclusion or exclusion of the enhancing rim.

Conclusion

Our results show considerable variation and underreporting regarding rim inclusion, measurement timing, and volume definitions. Standardized imaging protocols, covering timing, modalities, and rim handling, are essential to improve LITT research and outcomes. We propose four recommendations to guide future reporting of imaging methods.

Clinical trial number

Not applicable.

Background

Low-grade gliomas (LGG)—related seizures may persist after gross total resection (GTR). Supratotal resection (SpTR) seems to have better seizure outcomes, likely due to removing the epileptogenic peritumoral neocortex. However, its role in achieving postoperative seizure freedom remains poorly considered, likely because SpTR is achievable in only one out of three patients.

Methods

We retrospectively analyzed a prospectively collected series of epileptogenic surgically resected LGGs. Intraoperative Electrocorticography (iECoG) guided the extension of GTR to areas with interictal activity and negative on navigated Transcranial Magnetic Stimulation (nTMS). Patients were divided into Group I (GTR) and Group II [iECoG nTMS Tailored – SpTR (ETT-SpTR)], and we compared the seizure outcomes at follow-up (minimum 12 months). We also compared the rate of postoperative neurological deficits.

Results

Thirty patients were included. Group I (n = 15) showed only a 20% rate of seizure freedom (Engel IA), compared to 86.6% in Group II (n = 15, p = 0.0001). Neurological outcomes showed no differences between groups. Four patients (13.3%) with resection margins < 1 cm from nTMS-positive points developed transient deficits; no deficits were observed for distances > 1 cm.

Conclusion

The ETT-SpTR is more frequently achievable than radiologically defined SpTR. In our experience, ETT-SpTR yields better seizure outcomes without compromising functional outcomes compared to GTR. In our cohort, iECoG is a reliable technique for identifying LGG-related epileptogenic foci, while nTMS is a trustworthy method for predicting postoperative deficits.