Acta Neurochirurgica最新文献

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.

Purpose

Determine whether mirror intracranial aneurysms (MIAs) confer risk beyond aneurysm multiplicity and describe their distribution and longitudinal change.

Methods

Retrospective two-centre UK cohort of unruptured intracranial aneurysms (UIAs) diagnosed 2006–2020; outcomes to 2022. Endpoints: first rupture, SAH-specific/all-cause mortality, time to treatment, and lesion-level growth/morphology change. Rates used Poisson models with person-time offsets; lesion-level risks used GEE (modified Poisson). Rupture-free survival used inverse-probability-weighted Kaplan–Meier. Models adjusted for baseline aneurysm count.

Results

1,985 UIAs were identified; 289 (14.6%) were MIAs. MIAs clustered at the MCA bifurcation (57.8%) and ICA terminus (34.6%). First-rupture incidence was higher in MIAs (1.74/100 person-years (PY)) than aMIAs (0.76/100 PY) or SIAs (0.39/100 PY); MIA > SIA IRR 4.46 (q = 0.0003), MIA > aMIA IRR 2.29 (q = 0.0044). SAH-specific mortality incidence was higher in MIAs (1.21/100 PY) than SIAs (0.36/100 PY; IRR 3.36, q = 0.0057) and aMIAs (0.19/100 PY; IRR 6.37, q = 0.0002). IPW survival was poorer for MIAs vs aMIAs (weighted log-rank χ² = 9.95, p = 0.0016) and vs SIAs (χ² = 18.09, p = 2.11 × 10⁻⁵). Lesion-level GEE showed no symmetry-specific increase in rupture risk (omnibus p = 0.72). Lesion-level growth ≥ 1 mm (RR 1.67, q = 0.0380) and morphology change (RR 2.10, q = 0.0121) were higher in MIAs. With aneurysm count adjustment, effects attenuated with wide CIs, consistent with limited power.

Conclusion

MIAs were associated with higher patient-time rupture and SAH-specific mortality and greater lesion-level instability, but not with an independent per-aneurysm rupture hazard. The excess patient-level risk is largely explained by exposure (multiplicity); a symmetry-related effect remains plausible but unconfirmed. Larger, prospectively harmonised datasets are needed.

Purpose

In patient with Chiari type I malformations (CM1), indication for surgery can be difficult to establish. Headaches are a common complaint. Factors that predict headache relief have not been clearly identified. Several studies have aimed to examine cerebrospinal fluid (CSF) hydrodynamics in patients with CM1 by using phase-contrast MRI (pcMRI), which is currently the only non-invasive method for assessing craniospinal hydrodynamics and hemodynamics. People with CM1 present alterations in cerebrospinal fluid (CSF) and cerebral blood dynamics. The objective of the present study was to identify hydrodynamic criteria that are predictive of positive clinical outcome (headache relief) after posterior fossa decompression surgery in patient with CM1.

Method

41 patients who underwent posterior fossa decompression surgery at Amiens-Picardie University Hospital (Amiens, France) between 2016 and 2021 were retrospectively included. We used preoperative pcMRI to analyze CSF dynamics. Stroke volumes of cerebrospinal fluid were quantified at the aqueduct of Sylvius (SV_aqu), subarachnoid spaces near to C2-C3 (SV_C2C3) vertebral junction, prepontine cisterns, foramen magnum, and brainstem. CSF pulsatility was analyzed in relation to whether patients reported postoperative headache relief. Statistical analyses were based on Student's t-test.

Results

12 patients reported headache relief. The mean SV_aqu was significantly higher in patients with headache relief than in those without relief (65 and 32.13µL/CC, p ≤ 0.05). The mean SV_C2-C3 was significantly lower in patients with headache relief than in patients without relief (484.58 and 612.94µL/CC, p ≤ 0.05). The two groups of patients did not differ significantly in terms of the area of the narrowest part of the aqueduct of Sylvius or the Evans index.

Conclusion

SVaqu may have prognostic value for headache relief following surgery for CM1. Further investigation is warranted. This association is likely related to the recruitment of intraventricular pulsatility, which may help regulate potential intracranial pressure changes. Notably, this pulsatility does not appear to be linked to morphological features.

Introduction

Lumbar disc herniation (LDH) is one of the most common causes of lower back pain, radiculopathy, and functional impairment. Intra-articular (IA) steroid injections, including transforaminal (TFESI), interlaminar (IESI), and caudal (CESI) epidural steroid injections, are commonly administered to alleviate these symptoms when surgery is not indicated or opted for. This systematic review and meta-analysis evaluates the efficacy of these injection modalities in reducing pain and disability in LDH patients.

Methods

Following PRISMA, 19,664 studies on IA steroid injections for LDH were screened, yielding 41 eligible studies. Random-effects and fixed effects meta-analyses computed pooled standardized mean changes (SMC), depending on heterogeneity (I²).

Results

TFESI showed strong short-term efficacy, with the greatest pooled NRS improvement of -5.15 (95% CI: -6.59, -3.72, p < 0.001, I² = 99.14%) at 3 months and the largest VAS reduction of -30.53 (95% CI: -43.89, -17.17, p < 0.001, I² = 99.99%) at 3 months. CESI had the highest ODI improvement at 1 month (-18.99, 95% CI: -26.88, -11.10, p < 0.001, I² = 99.35%), while IESI demonstrated the greatest ODI reduction at 6 months (-16.06, 95% CI: -16.83, -15.28, p < 0.001, I² = 18.85%).

Conclusion

This meta-analysis suggests that IA injections may relieve LDH symptoms, with TFESI showing the greatest pain relief and functional improvement. However, significant heterogeneity calls for standardized protocols and further research. Demographic factors minimally influenced outcomes, whereas methodological variability underscores treatment complexity. Future studies should emphasize methodological consistency and personalized approaches to optimize patient outcomes.

Background

Growing evidence suggests that patient sex may influence perioperative outcomes in neurosurgery, yet the extent to which gender differences shape morbidity following intracranial tumor resection remains unclear. Elucidating these disparities is essential for refining risk stratification, tailoring perioperative management, and improving resource allocation in neuro-oncological practice.

Methods

A prospective single-center observational study was performed between January 2023 and December 2023, enrolling all adult patients undergoing surgery for for intracranial mass lesions (neoplasms and tumor-like non-neoplastic inflammatory lesions). Perioperative data, including demographic variables, tumor pathology, and adverse events (AEs) within 30 days of surgery, were recorded in a standardized database. The Clavien–Dindo classification was used to grade AEs. Logistic regression identified independent predictors of AEs, adjusting for age, sex, tumor location, and surgical urgency.

Results

Among 1173 patients (mean age 57.4 ± 15.3 years; 500 men, 673 women), men more frequently had gliomas (38.8% vs. 20.4%), whereas women exhibited significantly higher rates of meningiomas (41.8% vs. 28.2%) and neurinomas (8.8% vs. 4.2%; p < 0.05). Overall, 149 patients (12.7%) experienced one or more AEs. Men displayed a slightly higher unadjusted AE rate (14.0% vs. 11.7%) and revision rate (5.8% vs. 3.0%) without statistical significance. Women, however, required unplanned ICU or IMC admission more often (22.1% vs. 17.4%, p = 0.047). In the multivariable model, older age (p = 0.004), infratentorial tumor location (p = 0.017), and emergency surgery (p = 0.002) were independent risk factors for th occurrence of AE, while sex was not among the registered AEs.

Conclusions

These findings highlight sex‐specific differences in tumor distribution and postoperative outcomes in intracranial tumor surgery. Women were more likely to require escalated postoperative care, such as ICU or IMC admission, whereas men exhibited a higher crude rate of complications and revision surgeries. However, after adjusting for confounders such as age, tumor location, and surgical urgency, male sex was associated with a modestly reduced risk of adverse events, emphasizing the complex interplay of biological, clinical, and systemic factors in perioperative outcomes. Understanding these sex‐specific patterns is crucial for tailoring perioperative care strategies, improving patient outcomes, and advancing individualized treatment protocols in neuro-oncology. Further research should explore the underlying mechanisms driving these disparities to inform evidence-based, gender-sensitive neurosurgical care.

Background

Minimally invasive approaches to lumbar spine surgery are increasingly popular. Current guidelines highlight the importance of preoperative HbA1c in optimizing spine surgery outcomes. However, the role of preoperative HbA1c in minimally invasive lumbar spine surgery remains unclear.

Objectives

We sought to assess the association of HbA1c with readmissions, reoperations, and complications following minimally invasive lumbar spine surgery.

Methods

We retrospectively reviewed all adult patients at a single institution from 2011 to 2023 who underwent minimally invasive lumbar decompression or decompression with instrumented fusion using CPT and ICD9/10 codes. Multivariate logistic regressions were performed to assess the effect of high HbA1c on readmissions and reoperations.

Results

In total, 1013 [median age 64 (IQR 54–71)] patients met the inclusion criteria. The median preoperative HbA1c was 5.99% (IQR 5.62 – 6.39). Upon multivariate regression analysis adjusting for frailty, socioeconomic status, and other confounders, patients with high HbA1c (> 7.1) had increased odds of unplanned readmission within 90 days (OR 2.02, 95% CI 1.10– 3.56, p = 0.019) and reoperation within 90 days (OR 2.82, 95%CI 1.14–6.31) of the index operation. Patients with high HbA1c also had increased odds of requiring reoperation due to persistent symptoms (OR 2.9, 95%CI 0.91–7.87, p = 0.048). After propensity score matching, patients with high HbA1c also had prolonged hospital lengths of stay (1.32 days vs 1.24 days, p = 0.006), post operative UTI (4.7% vs 0.9%, p = 0.034).

Conclusions

Our results suggest high preoperative HbA1C may be associated with increased rates of readmission and reoperation following minimally invasive lumbar spine surgery. Preoperative HbA1C control may be indicated for surgical optimization in minimally invasive lumbar spine surgery.

Background

Subacute sclerosing panencephalitis (SSPE) is a chronic disease affecting the central nervous system (CNS) because of persistent measles virus (MeV) infection. Among the various treatment available the intraventricular interferon alpha administration demonstrated greater effectiveness.

Method

In this article is described the step-by-step surgical technique of the positioning of an intraventricular catheter connected to a rechargeable subcutaneous pump. The main surgical steps and the pump settings are illustrated in a supplementary video.

Conclusion

This surgical management guarantees a continuous drug release improving the therapeutic effect in terms of clinical and neuroradiological outcome and reducing the toxicity profile.

This paper illustrates a method to map cognitive subcortical white matter pathways in brain tumour surgery, in patients not eligible for awake intraoperative mapping. The latter being the gold standard, it is not feasible in all patients. Illustrated by three cases, the presented method includes a preoperative mapping of both motor and subcortical eloquent structures – such as arcuate fasciculus and basal ganglia – subsequentially using subcortical motor mapping as a landmark to indirectly identify the cognitive structures.

Background

Chronic subdural haematoma (CSDH) is a common neurosurgical condition with an increasing incidence due to an aging population. Given the expanding research landscape, assessing the state of recent trials is essential. This systematic review updates a previous review, which included randomised controlled trials (RCTs) up to 2019, by summarizing recently published and ongoing RCTs in CSDH, highlighting key areas of investigation and identifying directions for future research.

Methods

Clinical trial registries – including the Cochrane Controlled Register of Trials, WHO ICTRP, clinicaltrials.gov, and Clinical Trials Information System – were systematically searched for RCTs on CSDH from June 1, 2019, to February 18, 2025. Both published and ongoing trials were included in this review.

Results

This review identified 41 recently published RCTs and 54 ongoing RCTs, compared to 26 ongoing trials in 2019. Of the earlier review, eleven studies have been published, five remain active, and the remainder were either abandoned or did not adhere to their initial RCT design. Middle meningeal artery embolisation (MMAE) has become the most extensively studied intervention, with active trials increasing from 2 in 2019 to 21 in 2025. Trials investigating perioperative management (3 versus 7) and surgical techniques (5 versus 10) have also increased. In contrast, corticosteroid trials have decreased (7 versus 3), likely reflecting findings from recent high-impact studies. Research on tranexamic acid has increased (5 versus 7) as have studies on other pharmacological agents (4 versus 8).

Conclusions

The number of ongoing RCTs in CSDH has increased substantially, with a notable shift in research focus. MMAE now dominates the field, though the surge in studies may suggest research saturation. Future investigations may benefit from more collaborative efforts, consolidating resources into fewer, but larger and adequately powered trials.