Pub Date : 2026-01-01DOI: 10.1016/j.neucie.2025.500736
Pelayo Hevia-Rodríguez, Laura Panés Laglera, Irati de Goñi García, Fernando Iturbe-Sarmiento, Nicolás Samprón
The anterior approach to the cervical spine is a widely used technique in spinal surgery. Although its most common complications involve vascular, neural, or digestive structures, there is also the potential for injury to lymphatic vessels, which can lead to serious complications if not promptly diagnosed and treated. We present the case of a 70-year-old woman with a history of lumbar arthrodesis and a C5-C6 cervical prosthesis, who underwent an anterior microdiscectomy at C7-T1 via a right-sided approach. During dissection, a dense whitish fluid compatible with chyle was observed, indicating injury to a lymphatic vessel. Ligation with suture was performed and a prevertebral drain was placed. In the postoperative period, the patient developed a mild hematoma in the acromioclavicular region, without cervical collections. The drain was removed after four days of total fasting, followed by the introduction of a low-fat diet. The patient was discharged without complications. After five years of follow-up, no associated complications have been observed. Chyle fistula following anterior cervical discectomy is a rare complication (0.02%) and should be suspected in the presence of milky fluid in the surgical wound, drainage, and/or progressive accumulation. Early diagnosis and appropriate treatment are essential to prevent more severe outcomes. The risk is higher in left-sided approaches near C6 and low right-sided approaches (C7-T1), particularly in the presence of anatomical variants.
{"title":"Chylous fistula during anterior cervical microdiscectomy: Case report and literature review","authors":"Pelayo Hevia-Rodríguez, Laura Panés Laglera, Irati de Goñi García, Fernando Iturbe-Sarmiento, Nicolás Samprón","doi":"10.1016/j.neucie.2025.500736","DOIUrl":"10.1016/j.neucie.2025.500736","url":null,"abstract":"<div><div>The anterior approach to the cervical spine is a widely used technique in spinal surgery. Although its most common complications involve vascular, neural, or digestive structures, there is also the potential for injury to lymphatic vessels, which can lead to serious complications if not promptly diagnosed and treated. We present the case of a 70-year-old woman with a history of lumbar arthrodesis and a C5-C6 cervical prosthesis, who underwent an anterior microdiscectomy at C7-T1 via a right-sided approach. During dissection, a dense whitish fluid compatible with chyle was observed, indicating injury to a lymphatic vessel. Ligation with suture was performed and a prevertebral drain was placed. In the postoperative period, the patient developed a mild hematoma in the acromioclavicular region, without cervical collections. The drain was removed after four days of total fasting, followed by the introduction of a low-fat diet. The patient was discharged without complications. After five years of follow-up, no associated complications have been observed. Chyle fistula following anterior cervical discectomy is a rare complication (0.02%) and should be suspected in the presence of milky fluid in the surgical wound, drainage, and/or progressive accumulation. Early diagnosis and appropriate treatment are essential to prevent more severe outcomes. The risk is higher in left-sided approaches near C6 and low right-sided approaches (C7-T1), particularly in the presence of anatomical variants.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 1","pages":"Article 500736"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.neucie.2025.500702
María J. García-Rubio , Jose Piquer-Martínez , Jose Piquer-Belloch , Ruben Rodríguez-Mena
Neurosurgery requires rigorous training, yet access remains limited in low-resource countries, particularly in Africa, creating a crisis in specialised care.
This paper, grounded in the principles of global neurosurgery, examines the essential competencies required in neurosurgical training, distinguishing between clinical skills—such as technical proficiency and decision-making—and non-clinical skills, including leadership, emotional management, and communication. Deliberate practice is emphasised as a key methodology for improving skill acquisition through structured repetition, continuous feedback, and expert supervision.
Additionally, the main challenges of specialisation in East Africa are analysed: inadequate infrastructure, overburdened health systems, limited and heterogeneous residency programmes, and a shortage of qualified mentors. Finally, the development of innovative educational strategies is proposed to enhance training in resource-constrained settings and contribute to the sustainable advancement of the specialty.
{"title":"Global neurosurgery training. Part 1: Skills and challenges for equity","authors":"María J. García-Rubio , Jose Piquer-Martínez , Jose Piquer-Belloch , Ruben Rodríguez-Mena","doi":"10.1016/j.neucie.2025.500702","DOIUrl":"10.1016/j.neucie.2025.500702","url":null,"abstract":"<div><div>Neurosurgery requires rigorous training, yet access remains limited in low-resource countries, particularly in Africa, creating a crisis in specialised care.</div><div>This paper, grounded in the principles of global neurosurgery, examines the essential competencies required in neurosurgical training, distinguishing between clinical skills—such as technical proficiency and decision-making—and non-clinical skills, including leadership, emotional management, and communication. Deliberate practice is emphasised as a key methodology for improving skill acquisition through structured repetition, continuous feedback, and expert supervision.</div><div>Additionally, the main challenges of specialisation in East Africa are analysed: inadequate infrastructure, overburdened health systems, limited and heterogeneous residency programmes, and a shortage of qualified mentors. Finally, the development of innovative educational strategies is proposed to enhance training in resource-constrained settings and contribute to the sustainable advancement of the specialty.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 1","pages":"Article 500702"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.neucie.2025.500713
Jorge Cabrera-Montes , Ricardo Díez-Valle
Anterior sacral meningocele is a rare complication associated with Marfan syndrome. There is no consensus regarding management and surgical treatment. Here, we describe the case of a 44-year-old women with Marfan syndrome who presented a progressive abdominal mass with gastrointestinal and urinary symptoms. Abdominopelvic MRI revealed a 3 cm S1 dural ectasia and a 19x17x15 cm abdominal mass. A posterior sacral transdural approach was performed. Dural friability made ligation unfeasible. Obliteration with a fat flap and fibrin sealant was the treatment alternative. Postoperative MRI imaging performed 4 months after surgery evidenced complete resolution of the intrabdominal collection. The patient remains free of symptoms 2 years later. Here we present one of the largest meningoceles reported to date in the literature, and illustrate the surgical management in a patient with Marfan syndrome, where technical difficulties arose. Solely posterior sacral transdural approach with fat graft may be sufficient for the treatment of these patients even with voluminous pelvic meningoceles.
{"title":"Giant Intrabdominal Meningocele in a Patient with Marfan Syndrome: Case Description and Surgical Management","authors":"Jorge Cabrera-Montes , Ricardo Díez-Valle","doi":"10.1016/j.neucie.2025.500713","DOIUrl":"10.1016/j.neucie.2025.500713","url":null,"abstract":"<div><div>Anterior sacral meningocele is a rare complication associated with Marfan syndrome. There is no consensus regarding management and surgical treatment. Here, we describe the case of a 44-year-old women with Marfan syndrome who presented a progressive abdominal mass with gastrointestinal and urinary symptoms. Abdominopelvic MRI revealed a 3<!--> <!-->cm S1 dural ectasia and a 19x17x15<!--> <!-->cm abdominal mass. A posterior sacral transdural approach was performed. Dural friability made ligation unfeasible. Obliteration with a fat flap and fibrin sealant was the treatment alternative. Postoperative MRI imaging performed 4 months after surgery evidenced complete resolution of the intrabdominal collection. The patient remains free of symptoms 2 years later. Here we present one of the largest meningoceles reported to date in the literature, and illustrate the surgical management in a patient with Marfan syndrome, where technical difficulties arose. Solely posterior sacral transdural approach with fat graft may be sufficient for the treatment of these patients even with voluminous pelvic meningoceles.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 1","pages":"Article 500713"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.neucie.2025.500705
Abdulkerim Goköğlu , Hüseyin Yiğit , Tolga Turan Dündar , Erdoğan Unur , Ahmet Selçuklu
Objective
Arteriovenous malformations are known as arterial-venous shunts that connect nidus, the nourishing arteries, to draining veins. Although they are not very common in the brain, they are responsible for approximately 2% of all strokes. The volumetric changes in the surrounding brain tissues caused by cerebral arteriovenous malformations have not yet been reported.
Methods
To detect these volumetric changes, MR data were acquired from 38 controls and 25 unoperated patients with arteriovenous malformations in the precentral and postcentral gyrus. MR data were analyzed with vol2Brain, Ceres and HIPS pipelines. The niduses of these patients were resected by transsulcal microsurgical dissection.
Results
A comprehensive volumetric analysis encompassing 135 distinct brain, cerebellar, and hippocampal structures was conducted using the Vol2brain software. Comparison between the patient group and the control group revealed significant volumetric differences. Specifically, the patient group exhibited significantly larger volumes in the nucleus accumbens, fusiform gyrus, middle occipital gyrus, anterior insula, inferior lateral ventricle, and the gray matter of cerebellar lobules VIIIA and VIIIB compared with the control group. Conversely, relative to the control group, the patient group demonstrated significantly smaller volumes in the gray matter of cerebellar lobules IV, I-II, and III, as well as in the hippocampal subfields of CA2-CA3, SR-SL-SM, and the subiculum.
Conclusion
Arteriovenous malformations occurring in the precentral and postcentral gyrus lead to volumetric changes in structures distant from the site of the malformation, including the brain, hippocampus, and even the cerebellum. Therefore, AVMs may influence the volumes of structures located not only within their immediate brain region but also in other parts of the cerebrum and cerebellum. Understanding these volumetric changes can aid in explaining patient symptoms. However, further research is required regarding whether these volumetric changes result from the mass effect of the nidus or stem from another underlying cause.
{"title":"Impact of arteriovenous malformations in the precentral and postcentral gyri on intracranial volumes","authors":"Abdulkerim Goköğlu , Hüseyin Yiğit , Tolga Turan Dündar , Erdoğan Unur , Ahmet Selçuklu","doi":"10.1016/j.neucie.2025.500705","DOIUrl":"10.1016/j.neucie.2025.500705","url":null,"abstract":"<div><h3>Objective</h3><div>Arteriovenous malformations are known as arterial-venous shunts that connect nidus, the nourishing arteries, to draining veins. Although they are not very common in the brain, they are responsible for approximately 2% of all strokes. The volumetric changes in the surrounding brain tissues caused by cerebral arteriovenous malformations have not yet been reported.</div></div><div><h3>Methods</h3><div>To detect these volumetric changes, MR data were acquired from 38 controls and 25 unoperated patients with arteriovenous malformations in the precentral and postcentral gyrus. MR data were analyzed with vol2Brain, Ceres and HIPS pipelines. The niduses of these patients were resected by transsulcal microsurgical dissection.</div></div><div><h3>Results</h3><div>A comprehensive volumetric analysis encompassing 135 distinct brain, cerebellar, and hippocampal structures was conducted using the Vol2brain software. Comparison between the patient group and the control group revealed significant volumetric differences. Specifically, the patient group exhibited significantly larger volumes in the nucleus accumbens, fusiform gyrus, middle occipital gyrus, anterior insula, inferior lateral ventricle, and the gray matter of cerebellar lobules VIIIA and VIIIB compared with the control group. Conversely, relative to the control group, the patient group demonstrated significantly smaller volumes in the gray matter of cerebellar lobules IV, I-II, and III, as well as in the hippocampal subfields of CA2-CA3, SR-SL-SM, and the subiculum.</div></div><div><h3>Conclusion</h3><div>Arteriovenous malformations occurring in the precentral and postcentral gyrus lead to volumetric changes in structures distant from the site of the malformation, including the brain, hippocampus, and even the cerebellum. Therefore, AVMs may influence the volumes of structures located not only within their immediate brain region but also in other parts of the cerebrum and cerebellum. Understanding these volumetric changes can aid in explaining patient symptoms. However, further research is required regarding whether these volumetric changes result from the mass effect of the nidus or stem from another underlying cause.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 1","pages":"Article 500705"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Central nervous system involvement by multiple myeloma is extremely rare and is diagnosed in less than 1% of cases. Differential diagnosis includes lymphomas, metastases, sarcomas, osteochondromas, hemangiopericytomas or meningiomas. We report a 46-year-old female with a history of multiple myeloma in apparent remission after autologous bone marrow transplantation, who consulted for a palpable mass in the frontal region associated with holocranial headache and decreased visual acuity of two months of evolution with imaging studies compatible with olfactory sulcus meningioma. A craniotomy and total resection of the lesion by bicoronal approach was performed and histological sections showed a neoplastic proliferation consisting of cells with a spherical nucleus and lateralized eosinophilic cytoplasm. Lesion compatible with involvement of the central nervous system by multiple myeloma. This case highlights the diagnostic challenge due to radiologic similarity with other tumours, especially meningiomas, and emphasizes including myeloma in differential diagnoses.
{"title":"Multiple myeloma mimicking olfactory sulcus meningioma: Case report and literature review.","authors":"Dilia Judith Mosquera Jiménez, Leandro Carballo, Matías Baldoncini, Gustavo Sevlever, Mickaela Echavarría Demichelis","doi":"10.1016/j.neucie.2025.500731","DOIUrl":"10.1016/j.neucie.2025.500731","url":null,"abstract":"<p><p>Central nervous system involvement by multiple myeloma is extremely rare and is diagnosed in less than 1% of cases. Differential diagnosis includes lymphomas, metastases, sarcomas, osteochondromas, hemangiopericytomas or meningiomas. We report a 46-year-old female with a history of multiple myeloma in apparent remission after autologous bone marrow transplantation, who consulted for a palpable mass in the frontal region associated with holocranial headache and decreased visual acuity of two months of evolution with imaging studies compatible with olfactory sulcus meningioma. A craniotomy and total resection of the lesion by bicoronal approach was performed and histological sections showed a neoplastic proliferation consisting of cells with a spherical nucleus and lateralized eosinophilic cytoplasm. Lesion compatible with involvement of the central nervous system by multiple myeloma. This case highlights the diagnostic challenge due to radiologic similarity with other tumours, especially meningiomas, and emphasizes including myeloma in differential diagnoses.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500731"},"PeriodicalIF":0.0,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.neucie.2025.500737
Andrés Barriga-Martín, Orlando Paredes-Muñóz, Miguel Peral-Alarma, Luis Maria Romero-Muñóz, Joint Halley Guimbard-Pérez
Most cases of sciatica are caused by compression of lumbar nerve roots, although some originate from extraradicular structures, such as in ischiofemoral impingement syndrome. We present the case of a 64-year-old man with a 10-year history of right-sided sciatic pain occurring only while seated. He underwent several lumbar surgeries for spinal stenosis (L4-L5, then L3-L4, and later L5-S1 with fusion to S1), as well as multiple infiltrations and pulsed radiofrequency, without improvement. Neurophysiological and imaging studies showed no significant compression, except for oedema at the ischial insertion of the quadratus femoris muscle. A diagnostic local anaesthetic infiltration temporarily resolved the pain, confirming ischiofemoral impingement syndrome. He was treated with osteotomy of the lesser trochanter, achieving complete pain resolution and functional recovery. This case highlights the importance of considering extraradicular causes in patients with persistent sciatic pain after spinal surgery.
{"title":"Failed back syndrome or extra-spinal sciatica? Ischiofemoral syndrome as a cause of persistent radicular pain after 4 lumbar spine surgeries.","authors":"Andrés Barriga-Martín, Orlando Paredes-Muñóz, Miguel Peral-Alarma, Luis Maria Romero-Muñóz, Joint Halley Guimbard-Pérez","doi":"10.1016/j.neucie.2025.500737","DOIUrl":"10.1016/j.neucie.2025.500737","url":null,"abstract":"<p><p>Most cases of sciatica are caused by compression of lumbar nerve roots, although some originate from extraradicular structures, such as in ischiofemoral impingement syndrome. We present the case of a 64-year-old man with a 10-year history of right-sided sciatic pain occurring only while seated. He underwent several lumbar surgeries for spinal stenosis (L4-L5, then L3-L4, and later L5-S1 with fusion to S1), as well as multiple infiltrations and pulsed radiofrequency, without improvement. Neurophysiological and imaging studies showed no significant compression, except for oedema at the ischial insertion of the quadratus femoris muscle. A diagnostic local anaesthetic infiltration temporarily resolved the pain, confirming ischiofemoral impingement syndrome. He was treated with osteotomy of the lesser trochanter, achieving complete pain resolution and functional recovery. This case highlights the importance of considering extraradicular causes in patients with persistent sciatic pain after spinal surgery.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500737"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.neucie.2025.500727
Giancarlo Mattos Piaggio, Emilio González Martínez, David Santamarta Gómez, Javier Ibáñez Plágaro, José García-Cosamalón
The experimental laboratory has been of paramount importance in the development and evolution of neurosurgery. In that research environment, many neurosurgical techniques were designed and the classics approaches to different regions of the brain were refined, until turning neurological surgery into atraumatic procedure, fulfilling one of the founding axioms of this speciality, that of delicate treatment on brain tissue, advocated by Harvey Cushing and later optimized by Professor Gazy Yasargil. The scenarios, their main characters, and the contributions they made to the development and progress of neurosurgery have all been analyzed in this article from a historical standpoint.
{"title":"The experimental laboratory in the development and evolution of neurosurgery-Historical perspective in tribute to Professor G. Yasargil.","authors":"Giancarlo Mattos Piaggio, Emilio González Martínez, David Santamarta Gómez, Javier Ibáñez Plágaro, José García-Cosamalón","doi":"10.1016/j.neucie.2025.500727","DOIUrl":"10.1016/j.neucie.2025.500727","url":null,"abstract":"<p><p>The experimental laboratory has been of paramount importance in the development and evolution of neurosurgery. In that research environment, many neurosurgical techniques were designed and the classics approaches to different regions of the brain were refined, until turning neurological surgery into atraumatic procedure, fulfilling one of the founding axioms of this speciality, that of delicate treatment on brain tissue, advocated by Harvey Cushing and later optimized by Professor Gazy Yasargil. The scenarios, their main characters, and the contributions they made to the development and progress of neurosurgery have all been analyzed in this article from a historical standpoint.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500727"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-03DOI: 10.1016/j.neucie.2025.500740
Alma R García-Nájera, Carolina Vásquez-Rafael, Francisco J Benítez-Rodríguez, Omar García-Nájera, Tania I Gamboa-Jiménez, Wendy Martínez-Pineda, Josué Vergara-Juárez, Armando Armas-Salazar, José D Carrillo-Ruiz, Fiacro Jiménez-Ponce, Jesús Q Beltrán
Pituitary metastases from renal cell carcinoma (PM-RCC) are rare, with an unfavorable prognosis and survival ranging from 6 to 22 months. The objectives of this study were (1) to present a case of a 61-year-old male who achieved a 44-month survival, and (2) to analyze the literature focusing on survival and worldwide distribution. The reported case achieved one of the longest survivals documented after multimodal treatment including surgery, radiotherapy, and targeted therapy. The systematic review showed that PM-RCC predominantly affects males (73.7%) and has a mean survival of 10.9 months, lower than that reported for other pituitary metastases (median 16.5 months). Metastasis was initially suspected in only 13.1% of cases, and surgery was the most common treatment (84%), with wide variation in adjuvant therapy use. Most cases originated from high-income countries, with very limited or no representation from some regions. Relevant characteristics and prognostic factors are discussed.
{"title":"Pituitary metastasis from renal cell carcinoma: Case report, systematic review, and worldwide distribution analysis.","authors":"Alma R García-Nájera, Carolina Vásquez-Rafael, Francisco J Benítez-Rodríguez, Omar García-Nájera, Tania I Gamboa-Jiménez, Wendy Martínez-Pineda, Josué Vergara-Juárez, Armando Armas-Salazar, José D Carrillo-Ruiz, Fiacro Jiménez-Ponce, Jesús Q Beltrán","doi":"10.1016/j.neucie.2025.500740","DOIUrl":"10.1016/j.neucie.2025.500740","url":null,"abstract":"<p><p>Pituitary metastases from renal cell carcinoma (PM-RCC) are rare, with an unfavorable prognosis and survival ranging from 6 to 22 months. The objectives of this study were (1) to present a case of a 61-year-old male who achieved a 44-month survival, and (2) to analyze the literature focusing on survival and worldwide distribution. The reported case achieved one of the longest survivals documented after multimodal treatment including surgery, radiotherapy, and targeted therapy. The systematic review showed that PM-RCC predominantly affects males (73.7%) and has a mean survival of 10.9 months, lower than that reported for other pituitary metastases (median 16.5 months). Metastasis was initially suspected in only 13.1% of cases, and surgery was the most common treatment (84%), with wide variation in adjuvant therapy use. Most cases originated from high-income countries, with very limited or no representation from some regions. Relevant characteristics and prognostic factors are discussed.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500740"},"PeriodicalIF":0.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-29DOI: 10.1016/j.neucie.2025.500744
Raquel Gutiérrez-González, Teresa Kalantari, Xavier Santander, Álvaro Zamarrón, Ana Royuela
Background and aim: There is no consensus regarding the best timing of vertebral augmentation (VA) procedures for the treatment of osteoporotic thoracolumbar fractures. This study aims to determine if early VA (performed during the first 2 weeks of evolution) show an advantage over delayed surgery in terms of efficacy and safety outcomes, and to evaluate the role of different modifiable therapeutic variables on the same outcomes.
Material and methods: Single-center retrospective study including all patients aged >50 years who underwent VA for thoracolumbar osteoporotic fracture from 2010 to 2023. Patients with two events in less than 3 months or incomplete follow-up were excluded. Pain relief, fracture progression and cement extravasation were assessed with regression analyses.
Results: One hundred fifty-four procedures were analyzed, with no significant difference in pain relief according to the timing of surgery. Early VA (1-14 days after symptoms onset) was associated with higher risk of fracture progression compared to intermediate (15-60 days; OR 15.2, p=0.001) and delayed (>60 days; OR 16.2, p=0.013) procedures; higher risk of cement leakage into the disc or vascular space (OR 3.2, p=0.025); but lower risk of spinal canal cement leakage (OR 0.16, p=0.027). No differences were observed between vertebroplasty and kyphoplasty.
Discussion: Early VA showed equivalent but earlier effect on pain relief and reduced risk of spinal canal leakage when compared with delayed procedures, despite a non-clinically significant increased risk of fracture progression and cement leakage into the disc or drainage vessels. Thus, it was identified as the most effective strategy for balancing analgesic efficacy and procedural safety.
{"title":"Timing matters: Influence of vertebral augmentation timing on pain relief, cement leakage, and fracture progression in thoracolumbar vertebral compression fractures.","authors":"Raquel Gutiérrez-González, Teresa Kalantari, Xavier Santander, Álvaro Zamarrón, Ana Royuela","doi":"10.1016/j.neucie.2025.500744","DOIUrl":"10.1016/j.neucie.2025.500744","url":null,"abstract":"<p><strong>Background and aim: </strong>There is no consensus regarding the best timing of vertebral augmentation (VA) procedures for the treatment of osteoporotic thoracolumbar fractures. This study aims to determine if early VA (performed during the first 2 weeks of evolution) show an advantage over delayed surgery in terms of efficacy and safety outcomes, and to evaluate the role of different modifiable therapeutic variables on the same outcomes.</p><p><strong>Material and methods: </strong>Single-center retrospective study including all patients aged >50 years who underwent VA for thoracolumbar osteoporotic fracture from 2010 to 2023. Patients with two events in less than 3 months or incomplete follow-up were excluded. Pain relief, fracture progression and cement extravasation were assessed with regression analyses.</p><p><strong>Results: </strong>One hundred fifty-four procedures were analyzed, with no significant difference in pain relief according to the timing of surgery. Early VA (1-14 days after symptoms onset) was associated with higher risk of fracture progression compared to intermediate (15-60 days; OR 15.2, p=0.001) and delayed (>60 days; OR 16.2, p=0.013) procedures; higher risk of cement leakage into the disc or vascular space (OR 3.2, p=0.025); but lower risk of spinal canal cement leakage (OR 0.16, p=0.027). No differences were observed between vertebroplasty and kyphoplasty.</p><p><strong>Discussion: </strong>Early VA showed equivalent but earlier effect on pain relief and reduced risk of spinal canal leakage when compared with delayed procedures, despite a non-clinically significant increased risk of fracture progression and cement leakage into the disc or drainage vessels. Thus, it was identified as the most effective strategy for balancing analgesic efficacy and procedural safety.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500744"},"PeriodicalIF":0.0,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-29DOI: 10.1016/j.neucie.2025.500741
João Meira Gonçalves, Jorge Moutinho, Paulo Linhares, Bruno Carvalho
Background: Since gliomas have no cure, the quality of life (QoL) reported by patients assumes utmost importance in the therapeutic strategy. However, few studies have provided longitudinal data about how surgical resection impacts QoL as reported by patients, and even fewer have included preoperative assessments. The aim of this pilot study was to assess how glioma patients' QoL changes in the early postoperative period of glioma resection, at 1 month and 6 months, compared to preoperative.
Methods: Patients undergoing surgical resection of low-grade glioma (LGG) or high-grade glioma (HGG) were prospectively included from January 2022 to December 2022. To analyze patient-reported QoL we used EORTC QLQ-C30 and BN20 questionnaires applied preoperatively and at 1 and 6 months after surgery.
Results: We evaluated 34 patients (LGG-9; HGG-25). There were no differences in QoL at all evaluation time points between LGG and HGG groups. Within the LGG patients, QoL scores remained stable throughout 1- and 6-month evaluations. In patients with HGG, when compared to baseline, there were no meaningful variations in QoL at 1 month, but a clinically and statistically significant improvement (p=0.035) was found at 6 months. Total resection was associated with improved QoL in HGG patients at 6 months (p=0.025). At individual level, considering a minimum clinically significant value of 10, most HGG patients improved their QoL, while most LGG patients remained stable. Regarding subdomain analysis, a clinically and statistically significant improvement in future uncertainty was found in both LGG (p=0.042) and HGG (p=0.024) patients at 6 months.
Conclusions: Contrarily to previous studies that revealed a deterioration in HGG patients at 6 months, our preliminary data suggest an improvement in the QoL of these patients at 6 months. Additionally, total resection seems to be beneficial, as it was not associated with QoL deterioration, and can even improve QoL.
{"title":"Early postoperative quality of life in glioma patients - A prospective cohort study.","authors":"João Meira Gonçalves, Jorge Moutinho, Paulo Linhares, Bruno Carvalho","doi":"10.1016/j.neucie.2025.500741","DOIUrl":"10.1016/j.neucie.2025.500741","url":null,"abstract":"<p><strong>Background: </strong>Since gliomas have no cure, the quality of life (QoL) reported by patients assumes utmost importance in the therapeutic strategy. However, few studies have provided longitudinal data about how surgical resection impacts QoL as reported by patients, and even fewer have included preoperative assessments. The aim of this pilot study was to assess how glioma patients' QoL changes in the early postoperative period of glioma resection, at 1 month and 6 months, compared to preoperative.</p><p><strong>Methods: </strong>Patients undergoing surgical resection of low-grade glioma (LGG) or high-grade glioma (HGG) were prospectively included from January 2022 to December 2022. To analyze patient-reported QoL we used EORTC QLQ-C30 and BN20 questionnaires applied preoperatively and at 1 and 6 months after surgery.</p><p><strong>Results: </strong>We evaluated 34 patients (LGG-9; HGG-25). There were no differences in QoL at all evaluation time points between LGG and HGG groups. Within the LGG patients, QoL scores remained stable throughout 1- and 6-month evaluations. In patients with HGG, when compared to baseline, there were no meaningful variations in QoL at 1 month, but a clinically and statistically significant improvement (p=0.035) was found at 6 months. Total resection was associated with improved QoL in HGG patients at 6 months (p=0.025). At individual level, considering a minimum clinically significant value of 10, most HGG patients improved their QoL, while most LGG patients remained stable. Regarding subdomain analysis, a clinically and statistically significant improvement in future uncertainty was found in both LGG (p=0.042) and HGG (p=0.024) patients at 6 months.</p><p><strong>Conclusions: </strong>Contrarily to previous studies that revealed a deterioration in HGG patients at 6 months, our preliminary data suggest an improvement in the QoL of these patients at 6 months. Additionally, total resection seems to be beneficial, as it was not associated with QoL deterioration, and can even improve QoL.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500741"},"PeriodicalIF":0.0,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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