Journal of neurosurgical sciences最新文献

{"title":"Efficacy and safety of gamma knife radiosurgery in the management of pediatric gliomas: a systematic review and meta-analysis.","authors":"Rudolfh B Arend, Marcelo P Sousa, Daniel M Kieling, Filipe V Ribeiro, Bruno Z Peroni, Natan L Lima, Lucca T Carretta, Stefeson G Cabral Junior, Gabriel Simoni, Raphael Camerotte, Marcio Y Ferreira, Letícia M Kieling, Kim Wouters, Lucca B Palavani, Alex Roman, Guilherme Gago, Cleiton Formentin, Herika N Brito","doi":"10.23736/S0390-5616.26.06777-9","DOIUrl":"https://doi.org/10.23736/S0390-5616.26.06777-9","url":null,"abstract":"<p><strong>Background: </strong>Pediatric gliomas pose significant treatment challenges due to their location in eloquent areas and the vulnerability of the developing brain to toxicity. Gamma knife radiosurgery (GKRS) has emerged as a minimally invasive alternative aimed at maximizing local control while sparing healthy tissue. This systematic review and meta-analysis evaluated the efficacy and safety profile of GKRS in the management of pediatric gliomas.</p><p><strong>Methods: </strong>A comprehensive search was conducted across PubMed, Embase, and Web of Science databases for studies published between January 1994 and September 2024, adhering to PRISMA guidelines. Eligible studies included at least four patients and reported on tumor regression, control rates, or safety outcomes. Data were pooled using a random-effects model with single proportion analysis.</p><p><strong>Results: </strong>Eleven studies encompassing 203 patients were included in the quantitative synthesis. The pooled analysis demonstrated a complete tumor regression rate of 17% (95% CI 10-28%) and a partial regression rate of 47% (95% CI 34-60%). Favorable neurological outcomes were achieved in nearly all evaluated patients - 100% (95% CI 95-100%). Regarding safety, procedure-related mortality was 0%. The overall mortality rate was 9% (95% CI 4-18%), with significantly lower mortality observed in pilocytic astrocytomas (2%) compared to other tumor types (15%). Major and minor complications occurred in 3% and 6% of patients, respectively, while adverse radiation effects were noted in 11%.</p><p><strong>Conclusions: </strong>GKRS is a safe and effective treatment modality for pediatric gliomas, offering high rates of tumor regression and excellent neurological preservation. The procedure is associated with minimal morbidity and zero procedure-related mortality, supporting its utility as a reliable therapeutic option for selected pediatric patients.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773980","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":"Balancing benefits and risks: bevacizumab's role in postoperative recovery after spinal oncologic neurosurgery.","authors":"Lucas Pari Mitre, Marya E Jassé DE Souza Dias, Rebeca Oliveira DA Silva, Mariana L DE Bastos Maximiano, Aladine A Elsamadicy","doi":"10.23736/S0390-5616.26.06721-4","DOIUrl":"https://doi.org/10.23736/S0390-5616.26.06721-4","url":null,"abstract":"<p><strong>Background: </strong>Spinal oncologic neurosurgery presents considerable therapeutic challenges. Bevacizumab, a monoclonal antibody targeting VEGF, has shown potential to reduce tumor vascularity and postoperative fibrosis. However, its perioperative use raises safety concerns, particularly regarding wound healing.</p><p><strong>Methods: </strong>A systematic search of PubMed, Web of Science, and ClinicalTrials.gov was performed through January 2025. Studies including patients who received Bevacizumab perioperatively for spinal tumors were reviewed. Outcomes included clinical and radiographic response, overall survival, and adverse events. Pooled analyses used random-effects models, and subgroup comparisons were performed. Risk of bias was assessed via the ROBINS-I tool.</p><p><strong>Results: </strong>Ten studies with 85 patients were included. Clinical improvement occurred in 48% (95% CI: 0.22-0.75), and radiographic improvement in 61% (95% CI: 0.37-0.81). Overall survival across all patients averaged 20.8 months (95% CI: 13.6-31.9). A statistically significant survival benefit was observed in non-glioblastoma (non-GBM) tumors (39.1 months [95% CI: 33.0-46.3]) compared to GBM (16.2 months [95% CI: 9.7-27.0], P=0.0013). Adverse events included fatigue (35%), constipation (31%), hypertension (23%), anemia (22%), and wound infections (22%). No wound dehiscence was reported. Clinical and radiographic responses did not significantly differ between GBM and non-GBM groups, despite histologic differences. Heterogeneity varied across analyses, and risk of bias was generally high due to retrospective designs.</p><p><strong>Conclusions: </strong>Bevacizumab may offer clinical and radiologic benefit in select spinal tumor patients, particularly in non-GBM histologies, where a significant survival advantage was demonstrated. Though overall response was promising, complication rates, especially fatigue and hypertension, warrant diligence. The absence of reported wound dehiscence is encouraging but must be interpreted in the context of small, heterogeneous cohorts. Further prospective trials are needed to define optimal perioperative use strategies and establish clearer safety margins.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773992","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":"Neurosurgeons in Italy: results of a national census (2022-2024).","authors":"Francesca Vitulli, Maria A Cinalli, Maria R Scala, Maurizio Fornari, Vincenzo Esposito, Giuseppe Cinalli","doi":"10.23736/S0390-5616.26.06753-6","DOIUrl":"https://doi.org/10.23736/S0390-5616.26.06753-6","url":null,"abstract":"<p><strong>Background: </strong>A precise understanding of the national neurosurgical workforce is essential for effective healthcare planning and ensuring the long-term sustainability of the specialty. In Italy, the number of newly trained neurosurgeons is strictly limited by a competitive national residency entrance system, making accurate forecasting of workforce needs critical. Recent evidence suggests an aging neurosurgical population, highlighting the urgency of estimating retirements and training requirements to maintain adequate staffing levels. However, updated and comprehensive data on the national neurosurgical workforce have long been lacking. The Società Italiana di Neurochirurgia (SINCH) therefore promoted a national census to provide an accurate overview of all active neurosurgeons during the biennium 2022-2023.</p><p><strong>Methods: </strong>A national cross-sectional descriptive study was conducted between 2022 and 2023 to characterize the demographics and distribution of neurosurgeons within the Italian Public Health System and affiliated facilities. Three principal investigators and one supervisor coordinated the project under SINCH supervision. Data were collected through: 1) consolidation of the SINCH-PROGETKA database; 2) direct verification via personalized e-mails to all 113 neurosurgical unit directors (112 complete replies); 3) systematic web-based searches across 17 medical directory platforms; and 4) cross-matching with official medical organizations (FNOMCEO). Data were analyzed by institution type, geographic area, gender, age, and leadership role.</p><p><strong>Results: </strong>A total of 1489 active neurosurgeons were identified, with 1055 (74.1%) confirmed as SINCH members. Most professionals worked in public institutions (AOSSN 51.1%, AOU 17.2%, IRCCS 9.7%, AOU-IRCCS 5.4%), while 235 (15.9%) operated primarily in the private sector. Workforce distribution showed marked regional disparities: Northern and Central Italy accounted for 71% of neurosurgeons, whereas the South and Islands hosted only 29%. The national average was 1 neurosurgeon per 39,523 inhabitants, one of the highest ratios in Europe. Women represented 24.1% of active neurosurgeons but only <4% of unit directors. The mean age of directors was 59 years, reflecting an aging leadership cohort.</p><p><strong>Conclusions: </strong>This updated census provides the most comprehensive profile to date of Italian neurosurgeons. Despite adequate overall numbers, regional and gender imbalances persist, and leadership renewal remains limited. When compared with the previous ICoNe2 study, these data confirm Italy's exceptionally high neurosurgical density and underscore the need for coordinated workforce planning, optimization of training programs, and rational redistribution of resources to ensure sustainable and equitable neurosurgical care nationwide.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773983","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":"Robotic versus non-robotic sacroiliac joint fusion: a meta-analysis.","authors":"Zeyad Kamar, Emre Koyuncu, Michael J Albdewi, Ceyhan Ceran Serdar, Hussien Abouzeid, Paul Carne, Natalie Slosar, Noojan J Kazemi, Yamaan S Saadeh","doi":"10.23736/S0390-5616.26.06691-9","DOIUrl":"https://doi.org/10.23736/S0390-5616.26.06691-9","url":null,"abstract":"<p><strong>Introduction: </strong>This meta-analysis aimed to compare intraoperative metrics and postoperative outcomes of sacroiliac joint fusions (SIJF) performed under robotic versus non-robotic navigation.</p><p><strong>Evidence acquisition: </strong>Studies of adults undergoing SIJF with intraoperative navigation that reported ≥1 relevant outcome were included. PubMed, Scopus, and Web of Science were searched for studies published between September 14^th, 2015, and September 14^th, 2025. Before data analysis, patients were split into robotic and non-robotic fusion groups, and the non-robotic group was further split into fluoroscopic (F), virtual surgical planning (2D), and stereotactic (3D) navigation subgroups. Risk of bias was assessed using the revised Graphical Appraisal Tool for Epidemiological Studies (GATE). Datasets were analyzed using MedCalc and Stata.</p><p><strong>Evidence synthesis: </strong>Twenty papers describing 1581 SIJFs were analyzed for visual analogue scale (VAS) pain, Oswestry Disability Index (ODI), and postoperative complications. ODI and VAS showed postoperative improvement across all groups, with a steeper VAS reduction in the robotic group. Postoperative complication rates were lowest in the non-robotic (2D) subgroup, and lower in the robotic group than in the non-robotic (3D) subgroup. The non-robotic (F) subgroup had the lowest rate of new pain, whereas the robotic group had the highest. The robotic group showed the lowest rate of hematomas. Qualitative analysis of reported data suggests that robotic navigation demonstrates the highest accuracy rate, whereas fluoroscopy demonstrates the lowest. The results, although consistent, were not statistically significant, likely due to substantial heterogeneity among studies.</p><p><strong>Conclusions: </strong>Findings indicate a reduction in postoperative pain and favorable outcomes across both navigation modalities. Additionally, robotic approaches provide an added benefit of reducing intraoperative radiation exposure. Further prospective comparative studies with larger sample sizes are needed to obtain statistically significant comparative data between the groups and to reach definitive conclusions.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639176","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":"Effectiveness of selective dorsal rhizotomy for spastic cerebral palsy: a systematic review and single-arm meta-analysis.","authors":"Maria Antônia Pereira, Victor G Soares, Hilária S Faria, Filipe V Ribeiro, João V Andrade Fernandes, Altair P de Melo Neto, Izabely Dos Reis DE Paula, Helvécio N Feitosa Filho, Vitor E Ribeiro, Matheus S Ferreira, João Paulo Teles, Gustavo S Noleto","doi":"10.23736/S0390-5616.26.06768-8","DOIUrl":"https://doi.org/10.23736/S0390-5616.26.06768-8","url":null,"abstract":"<p><strong>Introduction: </strong>Selective dorsal rhizotomy (SDR) is used to treat spastic cerebral palsy (CP), but its effectiveness remains debated due to heterogeneous, predominantly non-randomized evidence.</p><p><strong>Evidence acquisition: </strong>This systematic review and single-arm meta-analysis was prospectively registered in PROSPERO (CRD420251132796) and conducted in accordance with PRISMA 2020 and the Cochrane Handbook. PubMed, Embase, and Web of Science were searched for studies evaluating SDR in pediatric CP. Eligible designs included case series, retrospective or prospective cohorts, and randomized trials reporting motor or spasticity outcomes. The primary endpoints were Gross Motor Function Measure-66 (GMFM-66) and Modified Ashworth Scale (MAS). Risk of bias was assessed using the ROBINS-I tool. Mean change values with 95% confidence intervals (CI) were pooled using random-effects models (REML). Statistical heterogeneity was evaluated with the I² statistic, and sensitivity analyses (including leave-one-out and varying correlation coefficients for missing SDs) were performed.</p><p><strong>Evidence synthesis: </strong>Sixteen studies including 756 children were analyzed. SDR was associated with significant improvements in GMFM-66 at the shortest (mean change 3.29; 95% CI 1.54-5.03; I²=71%) and longest (mean change 3.71; 95% CI 2.00-5.42; I²=72%) available follow-up. Spasticity was significantly reduced, with a pooled mean change in MAS of -1.98 (95% CI -3.26 to -0.70; I²=99%). Sensitivity analyses confirmed the stability of results across assumptions, and leave-one-out analyses did not materially alter effect estimates. All included studies were judged to have a moderate risk of bias.</p><p><strong>Conclusions: </strong>SDR is associated with clinically meaningful and durable improvements in gross motor function and reductions in spasticity in children with spastic CP.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593079","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 yet effective training model for mastering deep bypass procedures.","authors":"Alberto Benato, Davide Palombi, Rina DI Bonaventura, Alessio Albanese, Carmelo L Sturiale","doi":"10.23736/S0390-5616.25.06423-9","DOIUrl":"10.23736/S0390-5616.25.06423-9","url":null,"abstract":"<p><strong>Background: </strong>The acquisition of fine motor skills crucial for neurosurgical bypasses relies heavily on repetition. While conventional practice models adequately prepare surgeons for superficial anastomoses, they fall short when it comes to deep bypasses through skull base corridors, and realistic training setups are complex and expensive. In this study, we present a novel training concept that combines realism and simplicity, enabling virtually unlimited practice of deep anastomoses.</p><p><strong>Methods: </strong>Our training setup comprised a binocular microscope, inexpensive microsurgical instruments, vessels sourced from chicken wings, and a commercially available 3D brain-skull model not originally intended for microanastomosis training. By securing \"recipient\" chicken vessels to the plastic vessels within the model and employing standard techniques to anastomose them with \"donor\" chicken vessels in the surgical field, we created a simulation of deep neurosurgical bypasses.</p><p><strong>Results: </strong>With minimal preparation, we successfully replicated complex neurosurgical bypasses such as STA-PCA, PCA-SCA, and A1-graft-MCA. To our knowledge, no comparable training method in terms of realism, simplicity, and affordability exists in the literature.</p><p><strong>Conclusions: </strong>We present a cost-effective, straightforward, and realistic training approach that facilitates individual practice of deep bypasses at a high frequency. Its simplicity makes it replicable even in resource-limited settings.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"116-122"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657522","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":"Rapid versus gradual weaning of external ventricular drains in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.","authors":"George W Brown, Alexandra Lisitsyna, Mohammad Ashraf, Matthew Kingham, Danyal Khan, Joel Foo, Sai Liang, Jensen Ang, Jia-Xu Lim, Rikin Trivedi, Adel Helmy, Angelos Kolias, Peter J Hutchinson, Nicole Keong, Tien-Meng Cheong, Julian Han, Ramez Kirollos, Conor S Gillespie, Keng-Siang Lee","doi":"10.23736/S0390-5616.25.06669-X","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06669-X","url":null,"abstract":"<p><strong>Introduction: </strong>Aneurysmal subarachnoid hemorrhage commonly requires external ventricular drain (EVD) insertion. The effect of rapid versus gradual weaning on infection rates, hospital stay, and requirement for ventriculoperitoneal shunt (VPS) is not known. We aimed to compare rapid and gradual weaning strategies with measurable outcomes.</p><p><strong>Evidence acquisition: </strong>A PRISMA compliant systematic review and meta-analysis was conducted (PROSPERO ID 1144244). Articles published in MEDLINE, Embase, and Cochrane Library between inception and July 2025 were included. Weaning definitions, infection rates, hospital stay, and VPS insertion rates were identified. Binary and continuous outcomes were calculated using random effects meta-analysis models.</p><p><strong>Evidence synthesis: </strong>In total, six studies (1802 patients) were included. The mean age of the included patients was 56.3 years, and 35% of the population were male. Clinical severity of aSAH was high: 54% presenting with WFNS IV-V and 37% with WFNS I-II. The most common definition of rapid weaning was immediate clamping (83.3%, N.=5/6). Rapid weaning was not associated with increased VPS requirement (RR=0.94, 95% CI 0.57-1.54, P=0.7547), or Infection rates (RR=0.99, 95% CI 0.55-1.76, P=0.9462). Rapid weaning was associated with reduced length of stay in hospital (five studies, 25.6 vs. 29.5 days, mean difference -4.3 [95% CI: -5.7, -3.0], P<0.001).</p><p><strong>Conclusions: </strong>Rapid weaning does not appear to be associated with reduced VPS dependence, or infection. Further studies are required to establish the ideal EVD weaning protocol to minimize infection, failure rates and hospital stay.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"70 2","pages":"140-150"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633502","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":"Endoscopic approaches for the treatment of orbital cavernous hemangiomas: a retrospective multicentric case series.","authors":"Cesare Zoia, Vittorio Ricciuti, Paolo Battaglia, Daniele Bongetta, Mario Turri-Zanoni, Carlo G Giussani, Giannantonio Spena, Diego Mazzatenta, Matteo Zoli","doi":"10.23736/S0390-5616.25.06438-0","DOIUrl":"10.23736/S0390-5616.25.06438-0","url":null,"abstract":"<p><strong>Background: </strong>The treatment of choice for orbital cavernous hemangiomas (OCHs) is surgical resection, and multiple approaches have been proposed for these challenging deep-seated lesions of the orbit. In the latest years, endoscopic approaches, as the endonasal (EEA) or the transorbital (ETA), have been suggested as minimally invasive alternatives for these tumors, but few large works in literature are reported. In this article, the experience of three Italian referral centers with the endoscopic treatment of OCHs is described.</p><p><strong>Methods: </strong>All patients with OCHs operated with an endoscopic approach since January 2015 to January 2024 in 3 Italian referral centers were retrospectively collected. Patients' characteristics and symptoms, OCHs localization and type of endoscopic approach were reported. Postoperative complications, clinical outcome and cosmetic results (evaluated with Clavien-Dindo Classification and Scar Cosmesis Assessment and Rating Scale) at follow-up were assessed.</p><p><strong>Results: </strong>Thirty-four patients were included, 16 were females. ETA was preferred in 19 patients and EEA in 15. All OCHs of the lateral quadrants were treated with ETA. 14/18 cases located in the medial quadrants were treated with EEA, since in 4 of the supero-medial quadrants lesions, an ETA was preferred. Finally, the orbital apex lesion was treated with EEA. Complete resection was achieved in 31 (91.2%) cases. Complications were transient and consisted in 3 cases of diplopia, 1 of medial rectus palsy and 1 of supraorbital neuralgia, all spontaneously regressed at follow-up. An optimal cosmetic outcome was achieved in all patients both after an EEA and an ETA.</p><p><strong>Conclusions: </strong>Endoscopic approaches for the treatment of OCHs are a safe and valid surgical option, allowing a complete resection avoiding any brain manipulation. Thanks to their less invasiveness, endoscopic approaches guarantee limited neurological and functional sequalae. Moreover, they resulted well tolerated and ensured good cosmetic outcomes.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"123-130"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657525","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":"Historical evolution of extracranial-intracranial bypass: a single-center 45-year experience.","authors":"Davide Boeris, Octavian Vatavu, Maria Fragale, Martina Giordano, Davide Colistra, Elisa Colombo, Mariangela Piano, Marco Cenzato","doi":"10.23736/S0390-5616.25.06503-8","DOIUrl":"10.23736/S0390-5616.25.06503-8","url":null,"abstract":"<p><strong>Background: </strong>The technique for extracranial-intracranial (EC-IC) bypass was introduced in 1976. Over the subsequent 45 years, indications and surgical techniques have significantly evolved. This study aims to analyze the trends in patient demographics, bypass techniques, and clinical indications for bypass surgeries performed at our institution from 1976 to 2020.</p><p><strong>Methods: </strong>We conducted a retrospective review of patient records, using digital medical records available from 2001 and manually reviewing paper records for cases prior to that year. A comprehensive analysis was performed on surgical procedure descriptions and indications for bypass surgery.</p><p><strong>Results: </strong>A total of 374 patients underwent EC-IC bypass surgery from 1976 to 2020. The frequency of surgeries increased until 1985, followed by a marked decline in 1986. From 1996 onward, the average number of bypass surgeries performed annually was 4 until 2010, and this number increased to 7 from 2011 to 2020. Indications and detailed techniques were recorded in 284 cases. Between 1976 and 2000, occlusive cerebrovascular disease (OCVD) was the predominant indication for bypass surgery (69.2%); however, in the last two decades, the primary indication shifted to flow preservation for complex aneurysms (74.8%). Prior to 2011, the primary focus was on internal carotid artery (ICA) aneurysms, while in the last decade, middle cerebral artery (MCA) aneurysms have gained prominence. High-flow (HF) graft-mediated bypasses were mainly utilized for the management of complex aneurysms; notably, there has been a decline in HF bypass requirements, with only 10% of flow preservation surgeries needing this technique in the past decade.</p><p><strong>Conclusions: </strong>Our study underscores the significant evolution of cerebral bypass surgery over the past 45 years, with flow preservation for complex aneurysms currently being the leading indication for EC-IC bypass. The superficial temporal artery to middle cerebral artery (STA-MCA) bypass remains the most frequently performed technique. Moreover, the use of HF EC-IC bypass has declined in the last decade, reflecting the emergence of alternative methods for flow preservation.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"108-115"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251395","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":"Comparison of the performance metrics of two frailty scales in spinal surgery: a systematic review and meta-analysis.","authors":"Carmelo Venero Jr, Niels Pacheco-Barrios, Joanna M Roy, Stefan T Prvulovic, Gilberto Perez Rodriguez Garcia, Yusor Al-Nuaimy, Andre A Payman, Akshay Warrier, Fielding L Horne, Aryan Gajjar, Hikmat R Chmait, Nithin Gupta, Sanjeev Herr, Pemla Jagtiani, Damian Sanchez, Sina Zoghi, Javed Iqbal, Shubhang Bhalla, Christian A Bowers","doi":"10.23736/S0390-5616.26.06719-6","DOIUrl":"10.23736/S0390-5616.26.06719-6","url":null,"abstract":"<p><p>The United States is experiencing a significant demographic shift characterized by an increasingly aging population, or \"silver tsunami.\" These demographic changes have profound implications for spine surgery outcomes, as spinal surgery is one of the most frequent procedures performed annually by neurosurgeons and orthopedic spine surgeons. In current literature, two frailty indices, the Modified Frailty Index (mFI-5 or mFI-11) and the Risk Analysis Index (RAI), are the indices predominantly utilized to risk assess patients prior to surgical treatment. Utilizing a systematic search yielded ten studies. This study employs the area under the curve (AUC) from receiver operating characteristic (ROC) curves to develop a linear regression model aimed at evaluating the predictive performance of these indices for specific outcomes. This investigation focuses on the performance of the mFI and RAI in predicting three key postoperative outcomes in spine surgery patients: 30-day mortality, Clavien-Dindo IV complications, and non-home discharge (NHD). The results indicate that the RAI demonstrates superior predictive accuracy compared to the mFI for 30-day mortality (RAI AUC 0.82 [0.78-0.85] vs. mFI AUC 0.66 [0.62-0.70]) and Clavien-Dindo III-IV complications (RAI AUC 0.69 [0.66-0.72] vs. mFI AUC 0.63 [0.62-0.63]). However, no significant difference was observed in the ability to predict NHD (RAI AUC 0.81 [0.63, 0.91] vs. mFI AUC 0.71 [0.64, 0.77]). These findings suggest that the Risk Analysis Index is a more reliable predictor of 30-day mortality and Major complications (Clavien-Dindo III-IV) in patients undergoing spine surgery.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"131-139"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284379","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}