Journal of Korean Neurosurgical Society最新文献

{"title":"The Effect of Cranioplasty on Cerebrospinal Fluid Dynamics in the Cerebral Aqueduct.","authors":"Peiwen Yao, Zhouqi Qian, Rui Ji, Ke Wang","doi":"10.3340/jkns.2025.0239","DOIUrl":"10.3340/jkns.2025.0239","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the cerebrospinal fluid (CSF) dynamic changes before and after cranioplasty using phase-contrast cine magnetic resonance imaging.</p><p><strong>Methods: </strong>We performed a prospective observational study in the patients who underwent cranioplasty in the neurosurgical department of our hospital between June 2022 and March 2025. We reviewed the changes of CSF flow parameters in the cerebral aqueduct before and after cranioplasty.</p><p><strong>Results: </strong>Totally, nine patients were enrolled, including five males and four females, with a mean age of 48.1 years. The time interval between decompressive craniectomy (DC) and cranioplasty was 119.1±45.1 days. The skull defect diameter and area were 10.7±2.2 cm and 94.4±34.6 cm2, respectively. There are significant increases in forward flow volume (p=0.002), backward flow volume (p=0.002), net stroke volume (p=0.012), absolute stroke volume (p=0.001), mean flux (p=0.005), mean velocity (p=0.001), and peak velocity (p<0.001) after cranioplasty when compared with those parameters before cranioplasty. No significant correlation was observed between patient characteristics and the improvement magnitude of CSF flow parameters caused by cranioplasty.</p><p><strong>Conclusion: </strong>This study indicates that cranioplasty may have beneficial effects on CSF flow dynamics in the cerebral aqueduct after DC, which provides therapeutic potentials for complications related to CSF flow stagnancy after DC.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"609-615"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Twins as the Implementation Layer of Precision Medicine in Pediatric Neurosurgery.","authors":"Eun Jung Koh","doi":"10.3340/jkns.2026.0060","DOIUrl":"10.3340/jkns.2026.0060","url":null,"abstract":"<p><p>Pediatric neurosurgery increasingly utilizes precision medicine, but practitioners encounter challenges in translating complex data into individualized care. Digital twin (DT) bridges this gap by linking real-world data to a dynamic patient in-silico model, facilitating prediction and adaptive management as new data emerge. This narrative review explores the essential features of DTs, highlighting their relevance and associated risks in pediatric neurosurgery. The DT framework is structured around five components : the patient, a data connection, a patient-in-silico model, a clinician interface, and temporal synchronization. Foundational modeling approaches are summarized, spanning mechanistic simulations, artificial intelligence, and hybrid models that combine mechanistic structure with datadriven inference. Clinical translation is framed around uncertainty and calibration, along with interpretability and detection of distribution shifts. Potential applications are organized by concrete clinical questions in epilepsy surgery, pediatric neuro-oncology, cerebrovascular disease, hydrocephalus, and craniosynostosis. A translational pathway is outlined that progresses from decision-oriented prototypes and retrospective validation to prospective evaluation and interventional studies within learning health systems, supported by robust governance and auditable workflows. With meticulous validation and cautious deployment tailored to pediatric populations, DTs may enhance transparency, testability, and shared decision-making in precision pediatric neurosurgery.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"540-553"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored Postoperative Reconstruction for Low-Grade Cerebrospinal Fluid Leaks in Pituitary Neuroendocrine Tumors.","authors":"Yoon Hwan Byun, Ho Kang, Min-Sung Kim, Yong Hwy Kim","doi":"10.3340/jkns.2025.0207","DOIUrl":"10.3340/jkns.2025.0207","url":null,"abstract":"<p><strong>Objective: </strong>Various skull base reconstruction techniques have been proposed for the endoscopic trans-sphenoidal approach (eTSA). These methods often involve multilayer closure using autologous fat grafts and fascia lata, frequently combined with lumbar drainage (LD). This study suggests a modification of graded reconstruction methods for low-grade (grade 0-2) cerebrospinal fluid (CSF) leaks, particularly grade 2 leaks, following eTSA for pituitary neuroendocrine tumor (PitNET).</p><p><strong>Methods: </strong>A total of 401 consecutive patients who underwent eTSA for PitNET between 2017 and 2022 at a single institution were retrospectively reviewed, and ultimately 338 patients with intraoperative low-grade CSF leaks were included. Skull base reconstruction was performed according to intraoperative CSF leak grades. Grade 2 leaks were further subcategorized into 2a and 2b based on the size of the diaphragmatic defect. Grades 0, 1, and 2a leaks were reconstructed using fibrin sealant patches, hydrogel sealant, and reinforcement with nasoseptal flap where required. Grade 2b cases underwent rigid reconstruction with hydroxyapatite. Autologous fat grafts, fascia lata, and perioperative LD were not used. Postoperative CSF leaks and other complications were analyzed.</p><p><strong>Results: </strong>Among the 338 cases, there were 235 grade 0, 55 grade 1, 40 grade 2a and eight grade 2b intraoperative CSF leaks. No postoperative CSF leaks occurred. Two cases of postoperative meningitis were observed in grade 2a, all of whom were treated successfully with antibiotics.</p><p><strong>Conclusion: </strong>Our graded reconstruction approach is an effective and efficient method to prevent CSF leaks after eTSA in PitNET patients with low-grade intraoperative CSF leaks. Further subdividing grade 2 leaks based on defect size enables more precise and reliable skull base reconstruction. Moreover, autologous fat grafts, fascia lata, and perioperative LD appear unnecessary in low-grade cases.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"630-639"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145810467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Is a Large-Bore Catheter Necessary in Large Vessel Occlusion from a Biomechanical Perspective?","authors":"Hyeon Ji Lee, Il Won Suh, Chan Hee Park, Hyo Sung Kwak","doi":"10.3340/jkns.2025.0219","DOIUrl":"10.3340/jkns.2025.0219","url":null,"abstract":"<p><strong>Objective: </strong>Aspiration thrombectomy is a widely adopted treatment for acute ischemic stroke due to large vessel occlusion. Among several technical factors, the diameter of the aspiration catheter plays a critical role in determining thrombus fixation, aspiration efficiency, and overall procedural success. This study aimed to investigate the biomechanical effects of a larger catheter diameter on thrombus behavior and vessel wall response during aspiration thrombectomy.</p><p><strong>Methods: </strong>Finite element analysis was employed to simulate aspiration using three clinically relevant aspiration catheters with different diameters. Thrombi of two lengths and two compositions, varying in red blood cell content, were modeled to reflect clinical variability. Mechanical outcomes, including thrombus deformation, internal stress distribution, and vessel wall loading, were analyzed under standardized aspiration pressure conditions.</p><p><strong>Results: </strong>0.080- and 0.084-inch large-bore catheters produced greater thrombus deformation and internal stress than the 0.072-inch catheter, particularly in softer thrombi with higher red blood cell content. In both 3 and 5 mm thrombi with red blood cells, deformation increased by approximately 12.3% with the 0.084-inch catheter compared to the 0.072-inch catheter. These changes indicate improved clot engagement and aspiration efficiency, while vessel stress remained within physiological limits. This mechanical advantage is partly due to greater luminal occupancy, with the 0.084-inch catheter occupying 65.6% of the vessel lumen, about 14% more than the 0.072-inch catheter.</p><p><strong>Conclusion: </strong>Large-bore aspiration catheters can enhance thrombus fixation and aspiration performance without compromising vascular integrity. These findings support the broader clinical use of larger-bore catheters in patients with large artery occlusion, particularly in cases requiring strong clot engagement and efficient recanalization.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"554-562"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Radiological Outcomes of Double-Cage Full Endoscopic Transforaminal Lumbar Interbody Fusion Compared with Posterior Lumbar Interbody Fusion : A Retrospective Cohort Study.","authors":"Chi Ho Kim, Pius Kim, Chang Il Ju, Jong Hun Seo","doi":"10.3340/jkns.2025.0220","DOIUrl":"10.3340/jkns.2025.0220","url":null,"abstract":"<p><strong>Objective: </strong>Degenerative lumbar diseases accompanied by instability or severe foraminal stenosis are commonly treated with lumbar interbody fusion surgery. This study aimed to evaluate the clinical efficacy and safety of double-cage full endoscopic transforaminal lumbar interbody fusion (FE-TLIF) and posterior lumbar interbody fusion (PLIF) for the treatment of patients with severe degenerative lumbar disease.</p><p><strong>Methods: </strong>The clinical and radiological data of patients who underwent FE-TLIF using double cages or PLIF between March 2021 and February 2024 were retrospectively reviewed. Patients with single-level degenerative lumbar disease and Meyerding grade I spondylolisthesis who failed to respond to conservative treatment for 12 weeks were included. Patients with multilevel diseases, previous surgeries, or other spinal pathologies were excluded.</p><p><strong>Results: </strong>In total, 115 patients were included in the study (58 underwent FE-TLIF and 57 underwent PLIF). Baseline characteristics were comparable between the groups. The operation time and blood loss were significantly lower in the FE-TLIF group, and the cage height and angle were slightly greater. The FE-TLIF group showed faster postoperative pain relief, whereas the clinical outcomes at 6 and 12 months were similar between groups. At 12 months, the fusion rates and incidence of cage subsidence >2 mm did not differ significantly, even after adjustment. Both groups showed significant improvements in segmental and total lumbar lordosis and disc height, with slightly greater disc height restoration in the FE-TLIF group. The complication rates were low and comparable.</p><p><strong>Conclusion: </strong>Double-cage FE-TLIF achieved fusion and radiological outcomes comparable to those of PLIF, with the advantages of reduced blood loss, shorter operative time, and faster early pain relief. This technique may serve as a minimally invasive and effective alternative for treating single-level degenerative lumbar diseases.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"596-608"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generative AI-Assisted Medical Illustrations in Pediatric Neurosurgery : Workflows, Ethical Safeguards, and Journal Policy Considerations.","authors":"Jun Kyu Hwang, Dong-Su Jang","doi":"10.3340/jkns.2026.0037","DOIUrl":"10.3340/jkns.2026.0037","url":null,"abstract":"<p><p>Generative artificial intelligence (AI) has emerged as a transformative tool for creating high-quality visual materials in medical research and education. In pediatric neurosurgery, where ethical and legal constraints limit the use of real patient photographs, AI-assisted illustrations offer significant potential. However, concerns regarding clinical accuracy, intellectual property, and the protection of vulnerable pediatric patients necessitate rigorous oversight. We present a human-in-the-loop workflow that integrates generative AI with vector-based digital editing to produce scientifically accurate and ethically grounded medical illustrations. We reviewed current AI usage policies from major medical journals, including the International Committee of Medical Journal Editors and the Journal of Korean Neurosurgical Society (JKNS). To demonstrate practical application, we developed illustrative examples for conditions such as sacral dimple, Crouzon syndrome, and Down syndrome using clinician-led sketches and AI-assisted refinement. Vector-based workflows facilitate the transformation of AI-generated raster drafts into editable, high-resolution graphics, allowing clinicians to correct \"hallucinations\" and ensure anatomical precision. While most journals prohibit listing AI as an author, they permit its use for conceptual figures provided there is transparent disclosure of the tools and prompts used. Our proposed workflow emphasizes that AI should function as a \"constrained assistant\" rather than an autonomous creator, ensuring that the final output remains non-identifiable and respectful of pediatric patients' dignity. Generative AI tools can significantly enhance visualization in pediatric neurosurgery when governed by strict ethical and technical safeguards. Adherence to journal policies and the maintenance of human-directed validation are essential to uphold scientific integrity and patient privacy in the era of AI-assisted publishing.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"532-539"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nintedanib Attenuates Epidural Fibrosis after Laminectomy in Rats.","authors":"Kadri Kulualp, Meltem Kumaş Kulualp, Ziya Yurtal, Sefa Kizildağ, Beste Balbal Kandemir","doi":"10.3340/jkns.2025.0245","DOIUrl":"10.3340/jkns.2025.0245","url":null,"abstract":"<p><strong>Objective: </strong>Epidural fibrosis (EF) is a major contributor to postoperative morbidity following laminectomy (LAM). This study investigated the antifibrotic, anti-inflammatory, and anti-angiogenic effects of nintedanib (NIN), a multi-tyrosine kinase inhibitor, in a rat model of post-LAM EF.</p><p><strong>Methods: </strong>Twenty-one male Wistar albino rats were assigned to three groups : control, LAM, and LAM + NIN. The LAM procedure was performed at the L3 level. NIN administration, following LAM, was administered orally at a dose of 50 mg/kg/day for 28 days. Histopathological evaluations included Hematoxylin & Eosin staining for dura mater thickness and fibroblast density, and Masson's trichrome staining for collagen deposition and adhesion grading. α-smooth muscle actin (α-SMA) expression was evaluated using immunohistochemistry and reverse transcription-quantitative polymerase chain reaction. Gene expression of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), vascular endothelial growth factor (VEGF), platelet-derived growth factor receptor (PDGFR), and transforming growth factor-β1 (TGF-β1) was quantified to characterize inflammatory, angiogenic, and fibrogenic responses. Statistical comparisons were conducted using one-way analysis of variance or Kruskal-Wallis tests with appropriate post hoc analyses.</p><p><strong>Results: </strong>The LAM group exhibited marked post-LAM changes, including increased dura mater thickness (8.20±0.23 vs. 3.93±0.08 μm in controls, p<0.0001), elevated fibroblast density (p=0.0006), severe collagen deposition, and high-grade epidural adhesions (grade 3, p=0.0006). NIN treatment attenuated these alterations, reducing dura mater thickness (4.80±0.20 μm; p<0.0001 vs. LAM), fibroblast density (p<0.01), and adhesion grade (grade 1, p=0.0012). α-SMA immunoreactivity was high in LAM (grade 3, p<0.0001), whereas NIN significantly suppressed myofibroblast activation (grade 1, p=0.0012). NIN also significantly downregulated inflammatory mediators TNF-α (p<0.001) and IL-1β (p<0.001), as well as angiogenic markers VEGF (p<0.001) and PDGFR (p<0.001), and fibrogenic mediators TGF-β1 (p<0.001) and α-SMA (p<0.01). These findings indicate that NIN suppresses fibroblast activation, extracellular matrix accumulation, and myofibroblast differentiation, thereby limiting epidural adhesion and scar maturation.</p><p><strong>Conclusion: </strong>Nintedanib effectively mitigated epidural fibrosis after LAM through combined antifibrotic, anti-inflammatory, and anti-angiogenic actions. By improving the dural structure and reducing key molecules that contribute to scar formation, NIN shows significant promise as a treatment to prevent postoperative epidural adhesions. Future studies with extended follow-up may help clarify its clinical relevance.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"563-574"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-dose Intraventricular Recombinant Tissue Plasminogen Activator (rtPA) Priming Combined with Neuroendoscopic Lavage and Continuous Ventricular Irrigation for Severe Preterm Intraventricular Hemorrhage : A Technical Note.","authors":"Taehoon Kim, Ji Hoon Phi","doi":"10.3340/jkns.2026.0137","DOIUrl":"https://doi.org/10.3340/jkns.2026.0137","url":null,"abstract":"<p><p>Severe preterm intraventricular hemorrhage (IVH) with post-hemorrhagic ventricular dilatation (PHVD) may be difficult to manage when the clot burden is extensive and complete endoscopic evacuation is limited by clinical instability and rigid-scope constraints. We describe a staged clearance strategy in a preterm infant with bilateral grade IV IVH and progressive PHVD. Bilateral external ventricular drains (EVDs) were inserted for cerebrospinal fluid diversion. Low-dose intraventricular recombinant tissue plasminogen activator (0.1-0.3 mg per ventricle) was started 48 hours later and repeated every 48 hours for four sessions with a 2-hour dwell time under serial bedside cranial ultrasonographic surveillance. Sequential rigid neuroendoscopic lavage (NEL) was then performed, followed by 7 days of continuous ventricular irrigation using a bilateral inflow-outflow EVD configuration and a buffered glucose-containing artificial cerebrospinal fluid solution. No interval rebleeding, sustained intracranial hypertension, electrolyte instability, or culture-proven ventriculitis occurred during treatment. Ventricular size remained stable after drain removal, and no ventriculoperitoneal shunt had been required through the latest outpatient follow-up on postnatal day 157 (HD 151). This report presents a single-case conceptual proof-of-concept and technical feasibility experience for selected severe preterm IVH in a rigid-scope setting, rather than evidence of efficacy.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting IDH-Mutant Glioma with Vorasidenib : A New Era in Precision Neuro-Oncology.","authors":"Kyung-Min Kim, Yukyeng Byeon, Chaejin Lee, Won-Jae Lee, Kihwan Hwang, Yun-Sik Dho, Kyoung Su Sung, Tae Hoon Roh, Kyuha Chong, Ki-Su Park, Shin-Hyuk Kang, Eui Hyun Kim","doi":"10.3340/jkns.2026.0113","DOIUrl":"https://doi.org/10.3340/jkns.2026.0113","url":null,"abstract":"<p><p>Advancement of molecular targeted therapies has revolutionized the treatment of several challenging and previously refractory tumors. Since the introduction of rituximab in 1997, the field of molecular targeted agents have continued to evolve. Notably, vorasidenib, a brain-penetrant dual inhibitor of mutant isocitrate dehydrogenase (IDH) 1 and 2, has recently demonstrated promising results in the 2023 INDIGO trials with improved progression-free survival (PFS) and delayed need for subsequent interventions in patients with IDH-mutant low-grade gliomas. Although therapeutic options for glioma have long remained largely limited to surgery, radiation, and conventional chemotherapy despite extensive and ongoing research, the advent of vorasidenib opens a new chapter in glioma treatment. This review summarizes the key clinical studies of vorasidenib and discusses its potential role, limitations, and future directions in the evolving treatment paradigm of IDH-mutant gliomas.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Simple and Practical Thenar-Hypothenar Measurement Approach for Assessing the Severity of Carpal Tunnel Syndrome.","authors":"Ebru Doruk, Feyza Karagöz Güzey, Azmi Tufan, İlker Güleç, Nuri Serdar Baş, Kerem Kabadayı, Ece Dinleyen, Muhammed Eren Basyiğit","doi":"10.3340/jkns.2026.0066","DOIUrl":"https://doi.org/10.3340/jkns.2026.0066","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether the thicknesses of the thenar and hypothenar regions measured at the bedside using a caliper, along with their ratio (thenar/hypothenar; T/H), reflect the clinical and electrophysiological severity of carpal tunnel syndrome (CTS), and whether preoperative T/H asymmetry (Δ(T/H)) predicts postoperative functional recovery.</p><p><strong>Methods: </strong>This prospective case-control study included 50 patients with electrophysiologically confirmed CTS and 50 age- and sex-matched healthy controls. Thenar and hypothenar thicknesses were measured using a standard caliper protocol, and the T/H ratio was calculated. Symptoms and function were assessed using the Boston Symptom Severity Scale and the Functional Status Scale. Electrophysiological severity was classified based on sensory and motor conduction findings. Patients were re-evaluated 3-6 months after surgery.</p><p><strong>Results: </strong>Thenar thickness and the T/H ratio of the operated hand were significantly lower in CTS patients compared to controls (p < 0.001). T/H asymmetry, defined as Δ(T/H) = T/H (non-operated) - T/H (operated), showed significant differences according to motor severity categories (p = 0.002) and sensory severity categories (p = 0.004). Δ(T/H) was positively correlated with functional status (FSS) (Spearman ρ = 0.33; p = 0.018) but was not correlated with symptom severity (SSS) (p = 0.738). Preoperative Δ(T/H) showed a positive correlation with postoperative FSS (Spearman ρ = 0.34; p = 0.015). In a multivariable logistic regression adjusted for diabetes mellitus, age, and BMI, Δ(T/H) remained independently associated with severe motor involvement (adjusted OR = 1.26 per 0.01 increase in Δ(T/H); 95% CI, 1.07-1.49; p = 0.006), while diabetes mellitus was not independently associated (p = 0.674).</p><p><strong>Conclusion: </strong>Caliper-based thenar/hypothenar assessment incorporating contralateral comparison (Δ(T/H)) is a practical bedside adjunct method reflecting electrophysiological severity and functional limitation and may aid in predicting postoperative functional recovery; larger validation studies are needed.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}