Acta Neurochirurgica最新文献

Introduction

Unruptured intracranial aneurysms (UIAs) and aneurysmal subarachnoid hemorrhage (aSAH) pose not only neurological but also psychological and cognitive challenges. This study aimed to compare patients with UIA and aSAH and explore how psychological symptoms relate to their quality of life (QoL).

Methods

Between May 2023 and May 2025, 128 patients (aged 31–79, M = 53.9, SD = 7.24) were enrolled: 63 with aSAH and 65 with UIA. All aSAH patients had favourable neurological outcomes (modified Rankin Scale score of 0 or 1). Assessment included the Montreal Cognitive Assessment (MoCA), State-Trait Anxiety Inventory – Trait (STAI-T), Beck Depression Inventory – Short Form (BDI-SF), Athens Insomnia Scale (AIS), Toronto Alexithymia Scale (TAS-20), and WHOQOL-BREF.

Results

There were no significant psychological or cognitive differences between the aSAH and UIA groups; thus, they were analysed together. Compared to normative data, patients showed reduced cognitive performance and elevated depressive symptoms. Psychological well-being was the most affected QoL domain. All psychological variables negatively correlated with QoL, with anxiety, depression, and sleep disturbances emerging as significant predictors in linear regression.

Discussion

Our results suggest that emotional and sleep-related symptoms have a more substantial impact on QoL than cognitive impairment. The lack of group differences implies that psychological vulnerability may already be present before aneurysm rupture, underlining the need for early intervention.

Conclusion

The knowledge of having an aneurysm alone places a significant psychological burden on patients even without SAH, affecting cognitive and psychological well-being and quality of life. Therefore, psychological follow-up and care of patients diagnosed with intracranial aneurysms should be a priority.

Trial registration

Not applicable because the health-related intervention was not conducted in this study.

Background

Idiopathic intracranial hypertension (IIH) in children is a rare but vision-threatening condition characterized by elevated intracranial pressure (ICP) without an identifiable cause. While medical therapy remains the first-line approach, a subset of pediatric patients remains refractory, necessitating surgical or endovascular interventions. Venous sinus stenting (VSS) has emerged as a promising, minimally invasive alternative to cerebrospinal fluid (CSF) shunting, but its safety and efficacy in pediatric populations are not well-defined.

Methods

A systematic literature review was conducted following PRISMA guidelines, focusing on pediatric patients (< 18 years) with medically refractory IIH treated with VSS. Databases searched included PubMed, ScienceDirect, Cochrane Library, and others, including studies published from January 1990 to September 2025. Data on patient selection, procedural outcomes, complications, and antiplatelet protocols were extracted and analyzed. Only studies rated ≥ 6 stars on the Newcastle–Ottawa Scale were included.

Results

Six primary studies were identified, reporting outcomes in 36 pediatric patients (mean age 13.32 ± 1.25 years). VSS led to marked improvement in headache (87.5%), papilledema (89.5%), and tinnitus (100%), with reduced need for acetazolamide in 66.7%. Complications included one retroperitoneal hematoma, decreased flow in the vein of Labbe and minor hemorrhagic events related to antiplatelet therapy, including epistaxis, menorrhagia, and oral bleeding leading to early discontinuation of clopidogrel. Persistent or recurrent symptoms after stenting underscore the need for individualized, multimodal evaluation, as standardized selection criteria for pediatric IIH are still lacking. The estimated retreatment rate across studies was approximately 20%, with re-stenting or CSF shunting required in select cases.

Conclusion

VSS appears to be a safe and effective treatment for selected pediatric IIH patients with venous sinus stenosis and demonstrable trans-stenotic gradients. However, its success relies heavily on appropriate patient selection and tailored antiplatelet management. Prospective pediatric studies and standardized guidelines are needed to clarify its optimal role in the therapeutic algorithm. Accordingly, our synthesis is intended to inform individualized decision-making in selected cases and does not constitute guideline-level recommendations.

Background

Tractography has been used in various studies with respect to the improvement of patient-specific DBS targeting. Nevertheless, methodological influences of the chosen parameters and associated errors are often neglected. The aim of this study was to estimate concrete errors associated with specific image processing steps when using measurements of distances to specific subcortical fiber tracts to predict optimal stimulation sites for DBS targeting.

Method

Probabilistic tractography of the crossing and non-decussating part of the dentato-rubro-thalamic-tract (c-/ nd-DRTT) was performed using FSL 6.0.3 in 40 PD- and ET-patients having received bilateral DBS surgery. DBS-electrodes were reconstructed using LeadDBS. The influence of (1) the choice of threshold for binarization of fiber tracts, (2) manual measurements compared to measurements using automized distance maps and (3) normalization into the MNI standard space on measured distances were investigated.

Results

Different thresholds for binarization resulted in non-linear and unpredictable variations of measured distances up to 1.72 ± 1.49 mm (mean value ± standard deviation). Manual measurements on the axial slice of the electrode contact showed a mean error of 0.91 ± 1.36 mm (maximum 14.9 mm) compared to automated measurements. Regarding normalization, a mean error of 0.82 ± 0.50 mm (maximum 2.34 mm) was found compared to measurements in native space.

Conclusion

Measured maximum errors reach up to several millimeters, which might have significant impact on clinical targeting in DBS. Researchers should be aware of these errors and define individual standards for specific studies.

Purpose

This study aimed to investigate the alterations in resting-state functional connectivity (rsFC) in patients with cervical spondylotic myelopathy (CSM) using functional near-infrared spectroscopy (fNIRS), and to explore the neuropathological mechanisms underlying these changes.

Methods

Fifteen CSM patients (JOA score: 12.3 ± 2.1) and 15 age-matched healthy controls (HCs) underwent fNIRS recording during an eyes-open resting state. Hemodynamic signals were acquired from 63 channels covering the prefrontal, parietal, and occipital cortices. Pearson correlation coefficients were calculated for channel-wise time series, and group differences in FC matrices were compared using two-sample t-tests (p < 0.05) with false discovery rate (FDR) correction.

Results

CSM patients exhibited significantly enhanced connectivity between the secondary somatosensory cortex and premotor/somatosensory association cortices at the total hemoglobin (HbT) level compared to HCs (frontal eye field-supramarginal gyrus: 0.77220 ± 0.09584 vs. 0.600266 ± 0.141879, FDR p < 0.05).

Hyperconnectivity was observed between the right occipital lobe and bilateral prefrontal cortices in CSM patients (left prefrontal-right occipital: 0.18390 ± 0.117860 vs. 0.049514 ± 0.11688, FDR p < 0.05; right prefrontal-right occipital: 0.190342 ± 0.144897 vs. 0.0544925 ± 0.0856284, FDR p < 0.05). Notably, the right occipital lobe showed more pronounced hyperconnectivity with the right dorsolateral prefrontal cortex ( 0.26741 ± 0.11123 vs. 0.02533 ± 0.13632, FDR p < 0.01).

Conclusion

This study provides the first fNIRS-based evidence of characteristic functional network changes and compensatory reorganization in CSM patients. The observed hyperconnectivity between the occipital and prefrontal cortices may reflect neuroplastic responses to visual and chronic sensorimotor deficits, while global integration impairments could underlie clinical disabilities. These quantifiable connectivity signatures offer novel targets for monitoring disease progression and evaluating therapeutic interventions.

Purpose

Given the heterogeneity of atypical meningioma (AM) and potential interobserver variability in WHO grade assignment among pathologists, there is a need for more objective criteria to improve risk stratification. This study examined conventional and novel risk factors for AM progression, focusing on mitotic count (MC) and Ki-67, and explored their clinical relevance.

Methods

This retrospective cohort study included 240 consecutive patients with AM surgically treated at a single tertiary institution between 2001 and 2020. The cut-off values for MC and Ki-67 were determined using the Youden index. Risk factors for progression were analyzed using cause-specific Cox proportional hazards models. Progression-free survival (PFS) was estimated using cumulative incidence function (CIF) and compared using the Gray’s test.

Results

AM progression occurred in 32.5% of patients with a median time to progression of 25.2 months. The median follow-up was 42.3 months. While a clinically meaningful Ki-67 cut-off was not identified, MC ≥ 6 was significantly associated with AM progression. On multivariate analysis, age, gross total resection (GTR), MC ≥ 6, brain invasion, sheeting, and adjuvant radiotherapy (RTx) were associated with progression. RTx improved PFS in the subtotal resection (STR) group but not in the GTR group. Among GTR patients, those with MC ≥ 6 had worse outcomes.

Conclusion

GTR and RTx may reduce the progression of AM. MC ≥ 6 significantly increases the risk of progression, even in GTR patients. RTx should be considered for all STR patients A more vigilant follow-up or consideration of RTx is warranted in GTR patients when a high MC is identified.

Background

Congenital intracranial cystic lesions—epidermoid, dermoid, neurenteric, Rathke, colloid—encompass a heterogeneous group of entities whose surgical behavior is only partly explained by histology. We propose a dual-axis cisternal topographic model (medial–lateral × dorsal–ventral) to compare surgical outcome in congenital intracranial cystic lesions.

Methods

We retrospectively analyzed 110 patients with histologically confirmed congenital intracranial cysts undergoing surgical resection at a single tertiary center. Each lesion was categorized by cisternal topography in coronal and axial planes, and correlations were assessed between topographic class, surgical parameters, recurrence, and outcomes. Inter-rater reliability of classification was measured using Cohen’s kappa.

Results

Lesions with complex cisternal topography—defined as extension across dorsal–ventral (multicompartmental, MCL) or combined median-paramedian compartments—showed higher recurrence (42.1% and 50%, respectively; p < 0.001), including late recurrence beyond five years (23.7% and 35%, respectively; p < 0.001). MCL carried greater surgical morbidity: higher rates of subtotal resection (44.7% vs. 8.3%, p < 0.001), prolonged hospitalization, and doubled complication burden (52.6% vs. 25%, p = 0.006). Functional outcomes were poorer in these subgroups (median GOS = 4, IQR: 4–5), and neurological sequelae, particularly cranial nerve VII/VIII deficits and cerebellar signs, were disproportionately more frequent. A strong correlation emerged between cyst topography and histopathology, epidermoids predominating in complex configurations (p < 0.001). Supplementary analyses indicated that although cyst size varied across histological subtypes, it was not associated with recurrence, and in multivariable models cisternal localization remained significant, whereas histology and maximum dimension did not.

Conclusions

Cisternal topography was associated with recurrence, surgical complexity, and postoperative outcome in congenital cystic lesions. Lesions with multicompartmental or midline-paramedian axial spread carry a high-risk profile and warrant extended surveillance beyond five years. This dual-axis anatomical model may inform more tailored operative strategies and long-term follow-up planning, complementing histological diagnosis in modern skull base surgery.

Background

Socioeconomic factors are increasingly recognized in spine surgery outcomes. Although neighborhood-level deprivation is gaining traction in health outcomes research, its impact in lumbar spine surgery remains inconclusive.

Objectives

We aimed to evaluate the association between area deprivation index and 90-day unplanned readmissions, reoperations, complications, and length of stay after lumbar spine surgery.

Methods

All adult patients who underwent lumbar spine procedures at a single institution between 2011 to 2023 were retrospectively identified using Current Procedural Terminology and International Classification of Diseases 9/10 codes. Geospatial analysis was used to retrieve area deprivation index, with higher indices (> 90) being a high degree of neighborhood socioeconomic disadvantage. Propensity score matching, logistic regressions, univariate comparisons, and log-rank tests were used to assess the association of neighborhood disadvantage with outcomes of interest.

Results

We identified 3568 patients [median age: 64, Interquartile Range (IQR) 56 – 71]. Patients with high neighborhood disadvantage had higher odds of unplanned readmission odds [aOR (adjusted Odds Ratio) 1.77, p = 0.001] and emergency department admission (OR 2.2, p < 0.001) within 30 days. These patients also had higher odds of readmission (aOR 1.72, p < 0.001) and had higher odds of ED readmission odds (OR 2.01, p < 0.001) within 90 days as well. Patients with high neighborhood disadvantage were more likely to have prolonged hospital length of stay (aOR 1.41, p = 0.038) compared to controls. Patients with high neighborhood disadvantage had delayed presentation within 30 days (14.32 vs 10.11 days, p < 0.01) when compared to matched controls. In sub-group analysis, patients who were black, rural, under-insured, and with high comorbidity burden were more sensitive to high neighborhood disadvantage.

Conclusions

Patients with high neighborhood disadvantage have independently increased readmissions and hospital lengths of stay after elective lumbar spine surgery. Neighborhood disadvantage may play a significant role in determining spine surgical outcomes.

Purpose

Conventional surgical techniques for posterior circulation bypass have certain limitations, necessitating innovative approaches. This study evaluates the indications and outcomes of cervical carotid-to-V2 vertebral artery bypass—functioning as an extracranial "posterior communicating artery"—in the treatment of vertebrobasilar lesions.

Methods

The V2 bypass procedure via a cervical anterolateral approach was applied in cases of (1) bilateral vertebral artery (VA) occlusions (Type I), (2) subclavian artery (SBA) occlusion with steal phenomenon (Type II), and (3) compensated posterior circulation aneurysm (Type III).

Results

All eight patients exhibited patent bypass grafts. In seven cases with anterior-to-posterior bypass flow, the carotid artery supplied the entire vertebrobasilar territory. All four Type I patients showed improved regional cerebral perfusion. Among the three Type II patients, two (with a non-dominant contralateral VA) underwent VA ligation, resulting in significant reduction of blood steal. In one patient with bilateral symmetric VAs, VA ligation was not performed due to personal reasons, and hemodynamic status remained unchanged. One Type III patient showed contrast retention within the aneurysm sac and progressive shrinkage following bypass.

Conclusion

The V2 bypass uses a short interposition graft between the anterior and posterior circulations, offering high flow and orthograde perfusion without complex skull base manipulation. This technique simplifies revascularization for posterior circulation ischemia, mitigates steal phenomena in SBA occlusion, and enables trans-circulatory flow modulation for compensatory aneurysms.

Objective

Delayed cerebral ischemia (DCI) is one of the most severe complications following aneurysmal subarachnoid hemorrhage (SAH) and can significantly worsen clinical outcomes. This study aimed to analyze the association between patients’ home medications and the risk of cerebral infarction and poor functional outcomes after SAH.

Methods

This retrospective analysis included 995 patients with aneurysmal SAH treated at our clinic between January 2003 and June 2016. Various demographic and clinical baseline characteristics were examined, with a particular focus on regular use of home medications. The study endpoints were the occurrence of early (within 72 h post-SAH) and DCI-related infarcts (> 72 h) in follow-up computed tomography scans, as well as the functional disability at six months, defined as a modified Rankin Scale > 2.

Results

There was no association between the occurrence of early infarcts and patients’ regular medications. In contrast, individuals with calcium channel blockers (CCB) use (n = 93) showed a higher rate of DCI (32.6% vs 19.3%, p = 0.005) and 6-months functional disability (57.8% vs 46.8%, p = 0.048). In multivariable analysis, CCB use was independently associated with the risk of DCI (adjusted odds ratio [aOR] = 4.05; p < 0.0001) and functional disability after six months (aOR = 2.73; p = 0.036).

Conclusions

Regular CCB use was independently associated with an increased risk of DCI and functional disability at six months. These findings warrant cautious interpretation and further validation in prospective studies.