Acta Neurochirurgica最新文献_第2页

Correlating postoperative muscle and long-term functional outcomes with intraoperative muscle motor evoked potential changes in patients with benign intramedullary spinal cord tumors

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica

Pub Date : 2025-02-05 DOI: 10.1007/s00701-025-06427-5

Ananth P. Abraham, A. Benjamin Francklin, K. Jayadeepan, Vedantam Rajshekhar

Background

We aimed to determine the diagnostic accuracy of intraoperative muscle motor evoked potentials (mMEPs) in predicting postoperative motor deficits in individual muscles of patients with benign intramedullary spinal cord tumors (IMSCTs), and to correlate them with long-term functional outcome.

Methods

A retrospective study of patients operated for benign IMSCTs from 2009 to 2021 was performed. Sixty-nine patients in whom baseline mMEP recordings were obtained from at least one muscle were included for analysis. A persistent drop of the baseline mMEP by ≥ 50% from baseline was considered significant.

Results

The mean age of the patients was 33.2 ± 15.8 years and 47 (68.1%) of them were male. The most common tumor was ependymoma (56.5%). Baseline mMEPs were obtained in 400/1011 muscles that were monitored. Postoperative worsening of motor power was noted in 109/400 (27.3%) muscles with baseline mMEP recordings compared to 213/611 (34.9%) muscles with no baseline recordings (p = 0.01). Patients who had deterioration of mMEPs had a significantly higher rate of worsening of muscle power postoperatively compared to those who had no deterioration of mMEPs (100% vs. 30.2%, p < 0.001). The sensitivity of mMEPs in predicting postoperative motor function in monitored muscles was 53.1% (95% CI 43.5–62.6), specificity was 97.9% (95% CI 95.5–99.2), PPV was 90.9% (95% CI 81.6–95.7) and NPV was 84.1% (95% CI 81.3–86.6). At median follow-up of 18.5 (IQR 13–40) months, there was no significant difference in Nurick grade between patients who had intraoperative deterioration of mMEPs and those who did not.

Conclusions

Intraoperative mMEP reduction had high specificity and low sensitivity for predicting immediate postoperative neurological deficits following IMSCT resection. However, the majority of patients who had worsening of mMEPs, recovered to their preoperative functional status or a better status at follow-up and there was no significant difference in long-term functional outcome between patients with and without intraoperative mMEP changes.

{"title":"Correlating postoperative muscle and long-term functional outcomes with intraoperative muscle motor evoked potential changes in patients with benign intramedullary spinal cord tumors","authors":"Ananth P. Abraham, A. Benjamin Francklin, K. Jayadeepan, Vedantam Rajshekhar","doi":"10.1007/s00701-025-06427-5","DOIUrl":"10.1007/s00701-025-06427-5","url":null,"abstract":"<div><h3>Background</h3><p>We aimed to determine the diagnostic accuracy of intraoperative muscle motor evoked potentials (mMEPs) in predicting postoperative motor deficits in individual muscles of patients with benign intramedullary spinal cord tumors (IMSCTs), and to correlate them with long-term functional outcome.</p><h3>Methods</h3><p>A retrospective study of patients operated for benign IMSCTs from 2009 to 2021 was performed. Sixty-nine patients in whom baseline mMEP recordings were obtained from at least one muscle were included for analysis. A persistent drop of the baseline mMEP by ≥ 50% from baseline was considered significant.</p><h3>Results</h3><p>The mean age of the patients was 33.2 ± 15.8 years and 47 (68.1%) of them were male. The most common tumor was ependymoma (56.5%). Baseline mMEPs were obtained in 400/1011 muscles that were monitored. Postoperative worsening of motor power was noted in 109/400 (27.3%) muscles with baseline mMEP recordings compared to 213/611 (34.9%) muscles with no baseline recordings (<i>p</i> = 0.01). Patients who had deterioration of mMEPs had a significantly higher rate of worsening of muscle power postoperatively compared to those who had no deterioration of mMEPs (100% vs. 30.2%, <i>p</i> < 0.001). The sensitivity of mMEPs in predicting postoperative motor function in monitored muscles was 53.1% (95% CI 43.5–62.6), specificity was 97.9% (95% CI 95.5–99.2), PPV was 90.9% (95% CI 81.6–95.7) and NPV was 84.1% (95% CI 81.3–86.6). At median follow-up of 18.5 (IQR 13–40) months, there was no significant difference in Nurick grade between patients who had intraoperative deterioration of mMEPs and those who did not.</p><h3>Conclusions</h3><p>Intraoperative mMEP reduction had high specificity and low sensitivity for predicting immediate postoperative neurological deficits following IMSCT resection. However, the majority of patients who had worsening of mMEPs, recovered to their preoperative functional status or a better status at follow-up and there was no significant difference in long-term functional outcome between patients with and without intraoperative mMEP changes.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06427-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143184760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Deep brain stimulation of the hypothalamic region: a systematic review

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica

Pub Date : 2025-02-04 DOI: 10.1007/s00701-025-06430-w

Mohammad Mofatteh, Abdulkadir Mohamed, Mohammad Sadegh Mashayekhi, Georgios P. Skandalakis, Clemens Neudorfer, Saman Arfaie, ArunSundar MohanaSundaram, Mohammadmahdi Sabahi, Ayush Anand, Rabii Aboulhosn, Xuxing Liao, Andreas Horn, Keyoumars Ashkan

Background

Deep brain stimulation (DBS) has been successfully used for the treatment of circuitopathies including movement, anxiety, and behavioral disorders. The hypothalamus is a crucial integration center for many peripheral and central pathways relating to cardiovascular, metabolic, and behavioral functions and constitutes a potential target for neuromodulation in treatment-refractory conditions. To conduct a systematic review, investigating hypothalamic targets in DBS, their indications, and the primary clinical findings.

Methods

PubMed, Scopus, and Web of Science databases were searched in accordance with the PRISMA guideline to identify papers published in English studying DBS of the hypothalamus in humans.

Results

After screening 3,148 papers, 34 studies consisting of 412 patients published over two decades were included in the final review. Hypothalamic DBS was indicated in refractory headaches (n = 238, 57.8%), aggressive behavior (n = 100, 24.3%), mild Alzheimer’s disease (n = 58, 14.1%), trigeminal neuralgia in multiple sclerosis (n = 5, 1.2%), Prader-Willi syndrome (n = 4, 0.97%), and atypical facial pain (n = 3, 0.73%). The posterior hypothalamus was the most common DBS target site across 30 studies (88.2%). 262 (63.6%) participants were males, and 110 (26.7%) were females. 303 (73.5%) patients were adults whereas 33 (8.0%) were pediatrics. The lowest mean age of participants was 15.25 ± 4.6 years for chronic refractory aggressiveness, and the highest was 68.5 ± 7.9 years in Alzheimer’s disease patients. The mean duration of the disease ranged from 2.2 ± 1.7 (mild Alzheimer’s disease) to 19.8 ± 10.1 years (refractory headaches). 213 (51.7%) patients across 29 studies (85.3%) reported symptom improvements which ranged from 23.1% to 100%. 25 (73.5%) studies reported complications, most of which were associated with higher voltage stimulations.

Conclusions

DBS of the hypothalamus is feasible in selected patients with various refractory conditions ranging from headaches to aggression in both pediatric and adult populations. Future large-scale studies with long-term follow-up are required to validate the safety and efficacy data and extend these findings.

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引用次数: 0

Tumour distribution and characteristics associated with poor surgical outcomes in patients with sporadic spinal schwannomas

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica

Pub Date : 2025-02-04 DOI: 10.1007/s00701-025-06439-1

Shinsuke Yoshida, Takaaki Suzuki, Masayuki Tanabe, Kazuo Saita

Purpose

Spinal schwannomas are benign tumours that can compress the spinal cord or nerve roots, causing neurological symptoms. Despite successful surgical resection, some patients experience suboptimal functional recovery. Several risk factors for poor prognosis have been identified, but limited research has explored the influence of tumour distribution and characteristics. In this study, we aimed to identify prognostic variables associated with residual neurological deficit in patients undergoing surgical resection for sporadic spinal schwannomas.

Methods

Clinical and radiological data of consecutive patients who underwent surgery for spinal schwannomas at Saitama Medical Centre between January 2010 and March 2024 were retrospectively reviewed. Patients with neurofibromatosis type 2 or foraminal and paravertebral schwannomas were excluded. Data collected included patient demographics, radiological features, and surgical complications. Residual neurological deficit was defined as a Modified McCormick scale grade of II–V, persistent neurogenic pain, or bladder/bowel dysfunction.

Results

Gross total resection was achieved in 55 cases (76.4%). Postoperative complications occurred in 6 cases (8.3%), including cerebrospinal fluid fistula and vascular injury. At a median follow-up of 26.4 months, 20 patients (27.8%) had residual neurological deficits. Univariable and multivariable logistic regression identified thoracic spine involvement (odds ratio [OR], 5.03; 95% confidence interval [CI], 1.47–18.6; p = 0.01) and dumbbell-shaped tumours (OR, 0.15; 95% CI, 0.02–1.28; p = 0.04) as significantly associated with residual neurological deficits. Moreover, thoracic spinal schwannomas were associated with a significantly higher incidence of persistent postoperative neurogenic pain than that associated with cervical or lumbosacral tumours (p = 0.001).

Conclusions

Thoracic spine involvement and tumours that are not dumbbell-shaped were identified as significant risk factors for residual neurological deficits in patients undergoing surgical treatment for spinal schwannomas. Awareness of tumour distribution and characteristics may assist in refining preoperative assessments, guiding strategic decisions, and potentially improving surgical management for better patient care.

{"title":"Tumour distribution and characteristics associated with poor surgical outcomes in patients with sporadic spinal schwannomas","authors":"Shinsuke Yoshida, Takaaki Suzuki, Masayuki Tanabe, Kazuo Saita","doi":"10.1007/s00701-025-06439-1","DOIUrl":"10.1007/s00701-025-06439-1","url":null,"abstract":"<div><h3>Purpose</h3><p>Spinal schwannomas are benign tumours that can compress the spinal cord or nerve roots, causing neurological symptoms. Despite successful surgical resection, some patients experience suboptimal functional recovery. Several risk factors for poor prognosis have been identified, but limited research has explored the influence of tumour distribution and characteristics. In this study, we aimed to identify prognostic variables associated with residual neurological deficit in patients undergoing surgical resection for sporadic spinal schwannomas.</p><h3>Methods</h3><p>Clinical and radiological data of consecutive patients who underwent surgery for spinal schwannomas at Saitama Medical Centre between January 2010 and March 2024 were retrospectively reviewed. Patients with neurofibromatosis type 2 or foraminal and paravertebral schwannomas were excluded. Data collected included patient demographics, radiological features, and surgical complications. Residual neurological deficit was defined as a Modified McCormick scale grade of II–V, persistent neurogenic pain, or bladder/bowel dysfunction.</p><h3>Results</h3><p>Gross total resection was achieved in 55 cases (76.4%). Postoperative complications occurred in 6 cases (8.3%), including cerebrospinal fluid fistula and vascular injury. At a median follow-up of 26.4 months, 20 patients (27.8%) had residual neurological deficits. Univariable and multivariable logistic regression identified thoracic spine involvement (odds ratio [OR], 5.03; 95% confidence interval [CI], 1.47–18.6; <i>p</i> = 0.01) and dumbbell-shaped tumours (OR, 0.15; 95% CI, 0.02–1.28; <i>p</i> = 0.04) as significantly associated with residual neurological deficits. Moreover, thoracic spinal schwannomas were associated with a significantly higher incidence of persistent postoperative neurogenic pain than that associated with cervical or lumbosacral tumours (<i>p</i> = 0.001).</p><h3>Conclusions</h3><p>Thoracic spine involvement and tumours that are not dumbbell-shaped were identified as significant risk factors for residual neurological deficits in patients undergoing surgical treatment for spinal schwannomas. Awareness of tumour distribution and characteristics may assist in refining preoperative assessments, guiding strategic decisions, and potentially improving surgical management for better patient care. </p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06439-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143108103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Has a fast treatment transition from surgical to endovascular operations improved the survival of aneurysmal subarachnoid hemorrhage?

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica

Pub Date : 2025-02-04 DOI: 10.1007/s00701-025-06447-1

Aleksanteri Asikainen, Ilari Rautalin, Rahul Raj, Miikka Korja, Mika Niemelä

Background

Several studies have attributed decreasing case fatality rates (CFRs) of aneurysmal subarachnoid hemorrhage (aSAH) to the gradually increasing use of endovascular treatment without considering improvements in other outcome-affecting factors. To assess the independent effect of a treatment modality on CFRs, we investigated CFR changes in a high-volume center rapidly transitioning from surgical to endovascular operations as the first-line treatment for all aSAH patients except those with middle cerebral artery (MCA) aneurysms.

Methods

We identified all surgically/endovascularly treated aSAH patients in Helsinki University Hospital (HUH) during 2012–2017. As the treatment shift occurred in 2015, we defined two treatment eras: surgical (2012–2014) and endovascular (2015–2017). We compared time-dependent changes in 1-year CFRs between non-MCA and MCA patients using a Poisson regression model. To analyze consistency in operation rates, we also identified sudden-death and conservatively treated aSAHs in the HUH catchment area via two externally validated registers.

Results

Of all 665 hospitalized aSAH cases in the HUH catchment area, 557 (84%) received operative treatment; 367 (66%) underwent surgical and 190 (34%) endovascular operations. Between the treatment eras, endovascular treatment for non-MCA cases increased from 21 to 79%, whereas 99% of the MCA cases were treated surgically during the whole study-period. Among the operatively treated patients, the 1-year CFRs decreased similarly in patients with non-MCA (42%; from 14 to 8%; adjusted risk ratio (aRR) = 0.66 (95% CI 0.37–1.19)) and MCA aneurysms (42%; from 15 to 9%; aRR = 0.66 (0.16–1.60)). The proportion of operatively treated patients, their clinical condition on admission, and amount of bleeding on the first CT-scan remained unchanged over time.

Conclusions

We found similar CFR decreases in aSAH groups with and without undergoing a fast transition from surgery to endovascular operations, providing real-world evidence on the small independent effect of endovascular treatment on the decreasing CFRs in high-volume centers.

{"title":"Has a fast treatment transition from surgical to endovascular operations improved the survival of aneurysmal subarachnoid hemorrhage?","authors":"Aleksanteri Asikainen, Ilari Rautalin, Rahul Raj, Miikka Korja, Mika Niemelä","doi":"10.1007/s00701-025-06447-1","DOIUrl":"10.1007/s00701-025-06447-1","url":null,"abstract":"<div><h3>Background</h3><p>Several studies have attributed decreasing case fatality rates (CFRs) of aneurysmal subarachnoid hemorrhage (aSAH) to the gradually increasing use of endovascular treatment without considering improvements in other outcome-affecting factors. To assess the independent effect of a treatment modality on CFRs, we investigated CFR changes in a high-volume center rapidly transitioning from surgical to endovascular operations as the first-line treatment for all aSAH patients except those with middle cerebral artery (MCA) aneurysms.</p><h3>Methods</h3><p>We identified all surgically/endovascularly treated aSAH patients in Helsinki University Hospital (HUH) during 2012–2017. As the treatment shift occurred in 2015, we defined two treatment eras: surgical (2012–2014) and endovascular (2015–2017). We compared time-dependent changes in 1-year CFRs between non-MCA and MCA patients using a Poisson regression model. To analyze consistency in operation rates, we also identified sudden-death and conservatively treated aSAHs in the HUH catchment area via two externally validated registers.</p><h3>Results</h3><p>Of all 665 hospitalized aSAH cases in the HUH catchment area, 557 (84%) received operative treatment; 367 (66%) underwent surgical and 190 (34%) endovascular operations. Between the treatment eras, endovascular treatment for non-MCA cases increased from 21 to 79%, whereas 99% of the MCA cases were treated surgically during the whole study-period. Among the operatively treated patients, the 1-year CFRs decreased similarly in patients with non-MCA (42%; from 14 to 8%; adjusted risk ratio (aRR) = 0.66 (95% CI 0.37–1.19)) and MCA aneurysms (42%; from 15 to 9%; aRR = 0.66 (0.16–1.60)). The proportion of operatively treated patients, their clinical condition on admission, and amount of bleeding on the first CT-scan remained unchanged over time.</p><h3>Conclusions</h3><p>We found similar CFR decreases in aSAH groups with and without undergoing a fast transition from surgery to endovascular operations, providing real-world evidence on the small independent effect of endovascular treatment on the decreasing CFRs in high-volume centers.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06447-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143108334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Characterization of facial nerve outcomes following radiosurgery for vestibular schwannoma: a meta-analysis

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica

Pub Date : 2025-02-01 DOI: 10.1007/s00701-024-06405-3

Gabrielle E. A. Hovis, Anubhav Chandla, Aryan Pandey, Zoe Teton, Isaac Yang

Purpose

Gamma Knife radiosurgery (GKRS) is a precise and efficacious treatment modality for vestibular schwannoma (VS) with favorable cranial nerve preservation rates. This study aims to better characterize facial nerve (FN) outcomes in VS after GKRS.

Methods

A query of six medical databases was conducted following PRISMA guidelines. Eligible studies exclusively reported VS managed with single-fraction GKRS and included House-Brackmann (HB) scale assessments prior to and following GKRS. Data was analyzed using random-effects modeling, and FN preservation was defined as HB I or II at last follow-up.

Results

Data was analyzed from 15 articles with 3,155 patients at an mean age of 55.0 years. Mean tumor volume, radiation dose, follow-up, tumor control, and hearing preservation were 4.28 cm³, 13.3 Gy, 59.4 months, 92.7%, and 62.6%, respectively. The pooled FN preservation rate was 92.9%. Mean preoperative tumor volume > 2.5 cm³ and age > 60 years were significantly associated with worse preoperative FN function (p = 0.019, p = 0.023, respectively). Normal FN function (HB = 1) at last follow up was 95.8% for VS volume < 2.5 cm³ and 89.4% with larger volumes (p < 0.001). Doses ≤ 13 Gy were significantly associated with superior FN preservation (96.5%) compared to higher doses (p < 0.001). Tumor control and hearing preservation were not significantly associated with FN preservation.

Conclusion

This meta-analysis identifies tumor volume and radiation dose as prognostic factors for FN preservation. A FN preservation rate of 93% may be expected at five years after GKRS. This study provides a unique characterization of FN outcome that should be considered in the management of VS.

{"title":"Characterization of facial nerve outcomes following radiosurgery for vestibular schwannoma: a meta-analysis","authors":"Gabrielle E. A. Hovis, Anubhav Chandla, Aryan Pandey, Zoe Teton, Isaac Yang","doi":"10.1007/s00701-024-06405-3","DOIUrl":"10.1007/s00701-024-06405-3","url":null,"abstract":"<div><h3>Purpose</h3><p>Gamma Knife radiosurgery (GKRS) is a precise and efficacious treatment modality for vestibular schwannoma (VS) with favorable cranial nerve preservation rates. This study aims to better characterize facial nerve (FN) outcomes in VS after GKRS.</p><h3>Methods</h3><p>A query of six medical databases was conducted following PRISMA guidelines. Eligible studies exclusively reported VS managed with single-fraction GKRS and included House-Brackmann (HB) scale assessments prior to and following GKRS. Data was analyzed using random-effects modeling, and FN preservation was defined as HB I or II at last follow-up.</p><h3>Results</h3><p>Data was analyzed from 15 articles with 3,155 patients at an mean age of 55.0 years. Mean tumor volume, radiation dose, follow-up, tumor control, and hearing preservation were 4.28 cm<sup>3</sup>, 13.3 Gy, 59.4 months, 92.7%, and 62.6%, respectively. The pooled FN preservation rate was 92.9%. Mean preoperative tumor volume > 2.5 cm<sup>3</sup> and age > 60 years were significantly associated with worse preoperative FN function (<i>p</i> = 0.019, <i>p</i> = 0.023, respectively). Normal FN function (HB = 1) at last follow up was 95.8% for VS volume < 2.5 cm<sup>3</sup> and 89.4% with larger volumes (<i>p</i> < 0.001). Doses ≤ 13 Gy were significantly associated with superior FN preservation (96.5%) compared to higher doses (<i>p</i> < 0.001). Tumor control and hearing preservation were not significantly associated with FN preservation.</p><h3>Conclusion</h3><p>This meta-analysis identifies tumor volume and radiation dose as prognostic factors for FN preservation. A FN preservation rate of 93% may be expected at five years after GKRS. This study provides a unique characterization of FN outcome that should be considered in the management of VS.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06405-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Characteristics of optic canal invasion in the large midline non-tuberculum sellae anterior skull base meningiomas and the surgical outcomes

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica

Pub Date : 2025-02-01 DOI: 10.1007/s00701-025-06446-2

Gahn Duangprasert, Pree Nimmannitya, Vich Yindeedej, Raywat Noiphithak, Takeo Goto

Objective

There is a lack of available data regarding the incidence and characteristics of optic canal invasion (OCI) in large midline non-tuberculum sellae anterior skull base meningiomas (NTSAM), specifically those originating predominantly from the olfactory groove and planum sphenoidale. This study aims to describe the incidence and characteristics of OCI as well as clinical and visual outcomes following extensive tumor resection with optic canal exploration in intra-optic canal tumor removal. In addition, the predictive performance of OCI by preoperative magnetic resonance imaging (MRI) is investigated.

Materials and methods

From 2016 to 2024, we retrospectively reviewed 24 patients with large midline NTSAM who underwent extensive tumor resection in our institution. The OCI was evaluated and compared between preoperative MRI and intraoperative findings. The OCI was classified as follows. Type 1 represented no invasion, type 2 represented secondary invasion, type 3 represented partial wall invasion (two subtypes), and type 4 represented invasion into the superior-medial-inferior walls of the optic canal. Visual functions were assessed before and after surgery.

Results

Among 24 patients, a mean tumor size of 57.2 mm (range 39.0–79.0). The OCI was observed intraoperatively in 22 cases (91.7%), with 19 cases exhibiting bilateral OCI. Among the 48 optic canals in the 24 patients, 18 (37.5%) were type 4, 12 (25.0%) were type 3-inferomedial, 9 (18.8%) were type 3-superomedial, and 2 (4.2%) were type 2, where 7 (14.6%) optic canals were without OCI. A significant correlation was observed between intraoperative OCI and the tumors that exhibited involvement of the tuberculum sellae (TS) on MRI (p < 0.001). For patients with visual impairment, the vision in 27 of 38 (71.1%) eye sides showed improvement following the surgery. There was 1 (4.2%) case of tumor recurrence at the mean follow-up time of 27.3 months (range 4–73 months).

Conclusions

A high incidence of OCI was observed in the large midline NTSAM. The identification of TS involvement on MRI can serve as a strong predictor of OCI. Therefore, optic canal exploration to remove the optic canal invasion during the surgical removal of these particular tumors should be contemplated to attain radical tumor resection to enhance the possibility of improving visual function and reduce the risk of recurrence.

目的：关于中线非结节蝶鞍前颅底大型脑膜瘤（NTSAM），特别是那些主要起源于嗅沟和蝶骨平面的脑膜瘤视神经管侵犯（OCI）的发生率和特征，目前缺乏相关数据。本研究旨在描述在视管内肿瘤切除术中通过视管探查进行广泛肿瘤切除后，OCI 的发生率、特征以及临床和视觉结果。此外，还研究了术前磁共振成像（MRI）对OCI的预测性能：从 2016 年到 2024 年，我们回顾性研究了 24 例在我院接受广泛肿瘤切除术的中线大 NTSAM 患者。我们对 OCI 进行了评估，并将术前 MRI 与术中发现进行了比较。OCI 分为以下几类。1型代表无侵袭，2型代表继发性侵袭，3型代表部分壁侵袭（两个亚型），4型代表侵袭视神经管的上壁-中壁-下壁。对手术前后的视功能进行了评估：24名患者的平均肿瘤大小为57.2毫米（范围39.0-79.0）。22例（91.7%）患者术中观察到OCI，其中19例表现为双侧OCI。在 24 例患者的 48 个视神经管中，18 个（37.5%）为 4 型，12 个（25.0%）为 3 型-内侧，9 个（18.8%）为 3 型-上内侧，2 个（4.2%）为 2 型，其中 7 个（14.6%）视神经管无 OCI。观察发现，术中 OCI 与核磁共振成像显示累及蝶鞍结节（TS）的肿瘤之间存在明显的相关性（P 结论）：在大型中线 NTSAM 中观察到了较高的 OCI 发生率。在磁共振成像中发现 TS 受累可作为 OCI 的有力预测指标。因此，在手术切除这些特殊肿瘤时，应考虑进行视神经管探查以清除视神经管侵犯，从而实现肿瘤的根治性切除，以提高改善视功能的可能性并降低复发风险。

{"title":"Characteristics of optic canal invasion in the large midline non-tuberculum sellae anterior skull base meningiomas and the surgical outcomes","authors":"Gahn Duangprasert, Pree Nimmannitya, Vich Yindeedej, Raywat Noiphithak, Takeo Goto","doi":"10.1007/s00701-025-06446-2","DOIUrl":"10.1007/s00701-025-06446-2","url":null,"abstract":"<div><h3>Objective</h3><p>There is a lack of available data regarding the incidence and characteristics of optic canal invasion (OCI) in large midline non-tuberculum sellae anterior skull base meningiomas (NTSAM), specifically those originating predominantly from the olfactory groove and planum sphenoidale. This study aims to describe the incidence and characteristics of OCI as well as clinical and visual outcomes following extensive tumor resection with optic canal exploration in intra-optic canal tumor removal. In addition, the predictive performance of OCI by preoperative magnetic resonance imaging (MRI) is investigated.</p><h3>Materials and methods</h3><p>From 2016 to 2024, we retrospectively reviewed 24 patients with large midline NTSAM who underwent extensive tumor resection in our institution. The OCI was evaluated and compared between preoperative MRI and intraoperative findings. The OCI was classified as follows. Type 1 represented no invasion, type 2 represented secondary invasion, type 3 represented partial wall invasion (two subtypes), and type 4 represented invasion into the superior-medial-inferior walls of the optic canal. Visual functions were assessed before and after surgery.</p><h3>Results</h3><p>Among 24 patients, a mean tumor size of 57.2 mm (range 39.0–79.0). The OCI was observed intraoperatively in 22 cases (91.7%), with 19 cases exhibiting bilateral OCI. Among the 48 optic canals in the 24 patients, 18 (37.5%) were type 4, 12 (25.0%) were type 3-inferomedial, 9 (18.8%) were type 3-superomedial, and 2 (4.2%) were type 2, where 7 (14.6%) optic canals were without OCI. A significant correlation was observed between intraoperative OCI and the tumors that exhibited involvement of the tuberculum sellae (TS) on MRI (<i>p</i> < 0.001). For patients with visual impairment, the vision in 27 of 38 (71.1%) eye sides showed improvement following the surgery. There was 1 (4.2%) case of tumor recurrence at the mean follow-up time of 27.3 months (range 4–73 months).</p><h3>Conclusions</h3><p>A high incidence of OCI was observed in the large midline NTSAM. The identification of TS involvement on MRI can serve as a strong predictor of OCI. Therefore, optic canal exploration to remove the optic canal invasion during the surgical removal of these particular tumors should be contemplated to attain radical tumor resection to enhance the possibility of improving visual function and reduce the risk of recurrence.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06446-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improving methodology of radiosurgery for posterior fossa cavernomas: higher volume, lower dose

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica

Pub Date : 2025-02-01 DOI: 10.1007/s00701-024-06409-z

François Nataf, Nathaniel Scher, Marc Bollet, Guillaume Mulier, Andrei Birladeanu, Lucian Sopanda, Jérôme Lambert, Gauthier Bouilhol, Stéphanie Guey, Homa Adle-Biassette, Anne-Laure Bernat, Rosaria Abbritti, Thibault Passeri, Emmanuel Mandonnet, Sébastien Froelich

Cavernous malformations (CM) of the brain are vascular abnormalities that carry a risk of bleeding, posing significant neurological and life-threatening challenges, particularly in posterior fossa. The efficacy of radiosurgery for cavernomas still remains a matter of debate, largely due to technical and statistical limitations. In this study, we present a series of posterior fossa cavernomas treated using CyberKnife radiosurgery, employing an innovative approach that integrates both technical and statistical advancements.

We conducted a prospective series involving 35 posterior fossa cavernomas in 33 patients treated with low-dose radiosurgery protocols (12 Gy in a single fraction or 18 Gy in 3 fractions). Compared to previously published series, our approach targeted a larger treatment volume, encompassing the entire hemosiderin ring surrounding the cavernoma. Radiosurgery was indicated for cases of hemorrhage or progressive neurological deficits in anatomically challenging, nonsurgical areas. The statistical analysis was designed to address the unknown onset time of cavernoma prior to radiosurgery, enabling a more accurate calculation of the hemorrhage incidence rate before treatment. Follow-up evaluations, including clinical assessments and MRI, were conducted at 3-6-9-12-18-24 months and subsequently on an annual basis.

With a mean follow-up duration of 26 months, exceeding the previously described latency period, and a median [IQR] follow-up of 13 months [8.7-30.4] which represents approximately half the latency period, only one patient experienced a recurrence of hemorrhage, occurring 20 months post-treatment and remaining asymptomatic. No patients exhibited radio-induced parenchymal changes or clinical deterioration following radiosurgery.

These preliminary results support the strategy of increasing the target volume while reducing the radiation dose for cavernous malformations. We further recommend incorporating sensitivity analyses to evaluate the robustness of results, particularly in the context of uncertainties surrounding the time of onset of cavernomas.

{"title":"Improving methodology of radiosurgery for posterior fossa cavernomas: higher volume, lower dose","authors":"François Nataf, Nathaniel Scher, Marc Bollet, Guillaume Mulier, Andrei Birladeanu, Lucian Sopanda, Jérôme Lambert, Gauthier Bouilhol, Stéphanie Guey, Homa Adle-Biassette, Anne-Laure Bernat, Rosaria Abbritti, Thibault Passeri, Emmanuel Mandonnet, Sébastien Froelich","doi":"10.1007/s00701-024-06409-z","DOIUrl":"10.1007/s00701-024-06409-z","url":null,"abstract":"<p>Cavernous malformations (CM) of the brain are vascular abnormalities that carry a risk of bleeding, posing significant neurological and life-threatening challenges, particularly in posterior fossa. The efficacy of radiosurgery for cavernomas still remains a matter of debate, largely due to technical and statistical limitations. In this study, we present a series of posterior fossa cavernomas treated using CyberKnife radiosurgery, employing an innovative approach that integrates both technical and statistical advancements.</p><p>We conducted a prospective series involving 35 posterior fossa cavernomas in 33 patients treated with low-dose radiosurgery protocols (12 Gy in a single fraction or 18 Gy in 3 fractions). Compared to previously published series, our approach targeted a larger treatment volume, encompassing the entire hemosiderin ring surrounding the cavernoma. Radiosurgery was indicated for cases of hemorrhage or progressive neurological deficits in anatomically challenging, nonsurgical areas. The statistical analysis was designed to address the unknown onset time of cavernoma prior to radiosurgery, enabling a more accurate calculation of the hemorrhage incidence rate before treatment. Follow-up evaluations, including clinical assessments and MRI, were conducted at 3-6-9-12-18-24 months and subsequently on an annual basis.</p><p>With a mean follow-up duration of 26 months, exceeding the previously described latency period, and a median [IQR] follow-up of 13 months [8.7-30.4] which represents approximately half the latency period, only one patient experienced a recurrence of hemorrhage, occurring 20 months post-treatment and remaining asymptomatic. No patients exhibited radio-induced parenchymal changes or clinical deterioration following radiosurgery.</p><p>These preliminary results support the strategy of increasing the target volume while reducing the radiation dose for cavernous malformations. We further recommend incorporating sensitivity analyses to evaluate the robustness of results, particularly in the context of uncertainties surrounding the time of onset of cavernomas.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06409-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Perioperative complications in spinal trauma patients: does timing matter?

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica

Pub Date : 2025-02-01 DOI: 10.1007/s00701-025-06442-6

Charlotte Y. Adegeest, Cas J. Hilke, Godard C. W. de Ruiter, Mark P. Arts, Carmen L. Vleggeert-Lankamp, Raoul D. Martin, Wilco C. Peul, Paula Valerie ter Wengel

Background

Early surgery in traumatic spinal fracture treatment may facilitate prompt mobilization, encountering affiliated complications. However, the safety and the benefits of early surgery are being questioned in spinal trauma patients. Therefore, the objective of this retrospective study is to investigate the effect of surgical timing on perioperative complications in these patients.

Methods

Spinal trauma patients who underwent surgery between 2010 and 2020 in two Dutch Level-I trauma centers were included retrospectively and divided into an early (< 24 h), late (between 24 and 72 h) and delayed (> 72 h) surgical cohort. The primary outcome was the occurrence of peri-operative complications. Besides surgical timing, trauma and patient-specific factors were also analyzed as potential risk factors for the occurrence of complications.

Results

A total of 394 patients were included, of whom 149 received early, 159 late and 86 delayed surgical treatment. The occurrence of perioperative complications was significantly associated with age, body mass index, comorbidities, ASA grade 3 and 4, spinal cord injury (SCI), AO Spine type C injury, additional chest injury, and surgical delay. A multivariable analysis showed that age, ASA category, AO Spine classification and SCI were significantly associated with perioperative complications. Moreover, a subsequent analysis in non-SCI patients demonstrated an association between perioperative complications and delayed surgery.

Conclusions

In this study, delayed surgical treatment is potentially associated with more perioperative complications compared to early surgery in non-SCI patients. Other possible risk factors for the occurrence of perioperative complications may be older age, ASA 3 and 4, AO spine C injury and SCI.

{"title":"Perioperative complications in spinal trauma patients: does timing matter?","authors":"Charlotte Y. Adegeest, Cas J. Hilke, Godard C. W. de Ruiter, Mark P. Arts, Carmen L. Vleggeert-Lankamp, Raoul D. Martin, Wilco C. Peul, Paula Valerie ter Wengel","doi":"10.1007/s00701-025-06442-6","DOIUrl":"10.1007/s00701-025-06442-6","url":null,"abstract":"<div><h3>Background</h3><p>Early surgery in traumatic spinal fracture treatment may facilitate prompt mobilization, encountering affiliated complications. However, the safety and the benefits of early surgery are being questioned in spinal trauma patients. Therefore, the objective of this retrospective study is to investigate the effect of surgical timing on perioperative complications in these patients.</p><h3>Methods</h3><p>Spinal trauma patients who underwent surgery between 2010 and 2020 in two Dutch Level-I trauma centers were included retrospectively and divided into an early (< 24 h), late (between 24 and 72 h) and delayed (> 72 h) surgical cohort. The primary outcome was the occurrence of peri-operative complications. Besides surgical timing, trauma and patient-specific factors were also analyzed as potential risk factors for the occurrence of complications.</p><h3>Results</h3><p>A total of 394 patients were included, of whom 149 received early, 159 late and 86 delayed surgical treatment. The occurrence of perioperative complications was significantly associated with age, body mass index, comorbidities, ASA grade 3 and 4, spinal cord injury (SCI), AO Spine type C injury, additional chest injury, and surgical delay. A multivariable analysis showed that age, ASA category, AO Spine classification and SCI were significantly associated with perioperative complications. Moreover, a subsequent analysis in non-SCI patients demonstrated an association between perioperative complications and delayed surgery.</p><h3>Conclusions</h3><p>In this study, delayed surgical treatment is potentially associated with more perioperative complications compared to early surgery in non-SCI patients. Other possible risk factors for the occurrence of perioperative complications may be older age, ASA 3 and 4, AO spine C injury and SCI.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of surgical approaches and outcome for symptomatic pineal cysts: microscopic/endoscopic fenestration vs. stereotactic catheter implantation

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica

Pub Date : 2025-01-31 DOI: 10.1007/s00701-025-06445-3

Michael Schmutzer-Sondergeld, Aylin Gencer, Tristan Schmidlechner, Hanna Zimmermann, Sebastian Niedermeyer, Sophie Katzendobler, Veit M. Stoecklein, Thomas Liebig, Christian Schichor, Niklas Thon

Purpose

Treatment strategies for space-occupying/symptomatic pineal cysts (PC) are still up for debate. In this study we present PC management, outcome data and risk factors for recurrence after surgery, focusing on microscopic/endoscopic procedures vs. stereotactic catheter implantation as alternative treatment concept to permanently drain PC into ventricles/cisterns.

Methods

This monocentric retrospective analysis included clinical data from all consecutive PC patients treated surgically between 2000 and 2022. Postoperative neurological and functional outcomes, along with perioperative complications, as well as time to PC recurrence and MR-morphological data were evaluated.

Results

39 patients (median age 32.6 years, range: 5.1–71.6 years) were analyzed. Main presenting symptoms were headaches, visual impairment, and epileptic seizures. In 18 patients (46.2%) an enlarged ventricular system was preoperatively found with 7 patients (18.0%) suffering from occlusive hydrocephalus. 14 patients underwent microscopic/endosocopic surgery, in 25 cases stereotaxy was preferred. No complication was seen in the microsurgery/endoscopy group compared to one intracystic postoperative bleeding (2.6%) and two CSF leaks (5.1%) after stereotaxy (p = 0.5). Overall, clinical improvement and significant cyst volume reduction (p < 0.0001) was seen in all patients. Recurrent PC were seen in 23.1%, independent of surgical procedure (p = 0.2). In cases of recurrence, TTR was 25.2 ± 31.2 months. Male gender (p = 0.01), longer surgery time (p = 0.03) and preoperatively increased Evans index (EI) (p = 0.007) were significant risk factors for PC recurrence in multivariate analysis.

Conclusion

In patients suffering from PC, microsurgical and stereotactic approaches can improve clinical symptoms at low procedural risk, with equal extent of volume reduction. However, preoperative ventricular enlargement and EI values should be considered for optimal treatment planning to reduce recurrence.

{"title":"Comparison of surgical approaches and outcome for symptomatic pineal cysts: microscopic/endoscopic fenestration vs. stereotactic catheter implantation","authors":"Michael Schmutzer-Sondergeld, Aylin Gencer, Tristan Schmidlechner, Hanna Zimmermann, Sebastian Niedermeyer, Sophie Katzendobler, Veit M. Stoecklein, Thomas Liebig, Christian Schichor, Niklas Thon","doi":"10.1007/s00701-025-06445-3","DOIUrl":"10.1007/s00701-025-06445-3","url":null,"abstract":"<div><h3>Purpose</h3><p>Treatment strategies for space-occupying/symptomatic pineal cysts (PC) are still up for debate. In this study we present PC management, outcome data and risk factors for recurrence after surgery, focusing on microscopic/endoscopic procedures vs. stereotactic catheter implantation as alternative treatment concept to permanently drain PC into ventricles/cisterns.</p><h3>Methods</h3><p>This monocentric retrospective analysis included clinical data from all consecutive PC patients treated surgically between 2000 and 2022. Postoperative neurological and functional outcomes, along with perioperative complications, as well as time to PC recurrence and MR-morphological data were evaluated.</p><h3>Results</h3><p>39 patients (median age 32.6 years, range: 5.1–71.6 years) were analyzed. Main presenting symptoms were headaches, visual impairment, and epileptic seizures. In 18 patients (46.2%) an enlarged ventricular system was preoperatively found with 7 patients (18.0%) suffering from occlusive hydrocephalus. 14 patients underwent microscopic/endosocopic surgery, in 25 cases stereotaxy was preferred. No complication was seen in the microsurgery/endoscopy group compared to one intracystic postoperative bleeding (2.6%) and two CSF leaks (5.1%) after stereotaxy (<i>p</i> = 0.5). Overall, clinical improvement and significant cyst volume reduction (<i>p</i> < 0.0001) was seen in all patients. Recurrent PC were seen in 23.1%, independent of surgical procedure (<i>p</i> = 0.2). In cases of recurrence, TTR was 25.2 ± 31.2 months. Male gender (<i>p</i> = 0.01), longer surgery time (<i>p</i> = 0.03) and preoperatively increased Evans index (EI) (<i>p</i> = 0.007) were significant risk factors for PC recurrence in multivariate analysis.</p><h3>Conclusion</h3><p>In patients suffering from PC, microsurgical and stereotactic approaches can improve clinical symptoms at low procedural risk, with equal extent of volume reduction. However, preoperative ventricular enlargement and EI values should be considered for optimal treatment planning to reduce recurrence.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Anterior communicating aneurysm clipping: How I do it

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica

Pub Date : 2025-01-27 DOI: 10.1007/s00701-025-06440-8

Bruno Vernile, Paolo Palmisciano, Sudhakar Vadivelu, Mario Zuccarello

Up to 40% of intracranial aneurysms arise from the anterior cerebral artery and anterior communicating artery (ACA-ACoA) complex. The vast variability of vessel anomalies and the surrounding critical structures correlate with severe morbidity and mortality rates in case of rupture. In the era of cutting-edge advantages of endovascular procedures, surgical expertise is reducing. This article describes our institutional surgical technique in managing ACoA aneurysms, focusing on anatomical variants, approach selection, and technical intraoperative nuances.

引用次数: 0