Journal of neurosurgical sciences最新文献

{"title":"Endovascular treatment as first-line therapy in Spetzler-Martin grade III brain arteriovenous malformations: a systematic review and meta-analysis.","authors":"Mariana L DE Bastos Maximiano, Ocílio R Gonçalves, Luciano Falcão, João V Fernandes, Gabriel Arruda, Marianna Leite, Paweł Łajczak, Antônio Mutarelli, Gustavo O Almeida, Gabriel A Monteiro, Joao P Scarramal, Anderson M DA Silva, Márcio Y Ferreira","doi":"10.23736/S0390-5616.25.06715-3","DOIUrl":"10.23736/S0390-5616.25.06715-3","url":null,"abstract":"<p><strong>Background: </strong>Spetzler-Martin (SM) grade III brain arteriovenous malformations (AVMs) present a therapeutic challenge due to their risk profile. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of endovascular treatment (EVT) as first-line therapy for these lesions.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane CENTRAL, and Web of Science from inception to January 2025. Eligible studies were observational, enrolled patients with SM grade III AVMs undergoing EVT, and reported clinical or radiological outcomes. Primary endpoints included obliteration rate, functional outcome, and adverse events. Random-effects models were used to calculate pooled proportions with 95% confidence intervals (CI). Heterogeneity was assessed with I². Statistical analysis was conducted in R^® version 4.4.0.</p><p><strong>Results: </strong>Nineteen studies (N.=1105; SM grade III: N.=588) were included. EVT achieved complete immediate obliteration in 51% (95% CI: 30-72%; I²=95%), while residual nidus persisted in 39% (95% CI: 19-60%). Functional independence (mRS 0-2) was reached in 96% (95% CI: 90%-99%; I²=32%), whereas poor functional outcome (mRS ≥3) occurred in 5% of patients (95% CI: 1-11%). Permanent neurological deficits were reported in 5% (95% CI: 1-12%), and procedural complications occurred in 14% (95% CI: 7-22%). Mortality and recurrence rates were both 0%. Adjunctive therapies were required in 49% of cases (95% CI: 26-73%). Rebleeding during follow-up occurred in 7% (95% CI: 2-15%).</p><p><strong>Conclusions: </strong>EVT as first-line therapy for SM grade III AVMs is associated with high functional independence, moderate obliteration rates, low permanent morbidity, and negligible mortality, although nearly half of patients require adjunctive treatment.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"250-258"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486360","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":"Safety and efficacy of the Neuroform Atlas stent in the treatment of intracranial arterial stenosis: a systematic review and single-arm meta-analysis.","authors":"Iago N Simon Petry, Kaike Lobo, Yasmin P Silva, Rafael R Oliveira, Gabriel C Tudella, Mariana L de Bastos Maximiano, João V Andrade Fernandes, Ocilio R Gonçalves, Anderson M Silva, Luis G Soares, João P Motta Telles","doi":"10.23736/S0390-5616.26.06711-1","DOIUrl":"10.23736/S0390-5616.26.06711-1","url":null,"abstract":"<p><strong>Background: </strong>Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke. Although early endovascular stenting trials showed high complication rates, the low-profile Neuroform Atlas stent may offer a safer alternative. This systematic review and single-arm meta-analysis consolidates current evidence on its safety and efficacy in treating ICAS.</p><p><strong>Methods: </strong>PubMed, Embase, and Web of Science were searched through August 3, 2025, for observational studies or randomized controlled trials (RCTs) reporting outcomes of the Neuroform Atlas in adult ICAS patients. Pooled proportional analyses used a double-arcsine transformation and a random-effects model. Risk of bias was assessed using the ROBINS-I tool. Primary endpoints included complication rates, stroke, mortality, and functional outcome (mRS 0-2).</p><p><strong>Results: </strong>Five observational studies, including 419 patients, were analyzed. The pooled complication rate was 8% (95% CI: 2-26%), with ischemic stroke at 12% (95% CI: 9-18%), hemorrhagic stroke at 2% (95% CI: 1-8%), and mortality at 3% (95% CI: 0-19%). A good functional outcome (mRS 0-2) was achieved in 85% (95% CI: 44-98%) of patients. Heterogeneity was moderate to high across outcomes (I²: 46.4-92.2%). Risk of bias was rated low to moderate.</p><p><strong>Conclusions: </strong>The Neuroform Atlas stent appears technically feasible and relatively safe for patients with symptomatic ICAS refractory to medical therapy, achieving high rates of functional independence. However, the evidence is limited by small, retrospective, single-arm studies and substantial heterogeneity. Large, randomized controlled trials are needed to define its role more clearly.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"242-249"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512773","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":"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}

{"title":"Predictors of 30-day readmission and prolonged length of hospital stay after spinal chondrosarcoma resection: insights from the National Cancer Database.","authors":"Joseph Rajasekaran, Abdel-Hameed Al-Mistarehi, Avi N Albert, Abdul K Ghaith, Jawad M Khalifeh, A Daniel Davidar, Fnu Ruchika, Feras Fayez, Xinlan Yang, John Gross, Christian Meyer, Sang H Lee, Kristin J Redmond, Nicholas Theodore, Daniel Lubelski","doi":"10.23736/S0390-5616.25.06677-9","DOIUrl":"10.23736/S0390-5616.25.06677-9","url":null,"abstract":"<p><strong>Background: </strong>Spinal chondrosarcoma is a rare malignant tumor requiring complex resection due to its resistance to chemotherapy and radiation. This study aimed to identify predictors of both 30-day readmission and prolonged length of hospital stay (LOS) following surgical resection of spinal chondrosarcoma using data from the National Cancer Database (NCDB).</p><p><strong>Methods: </strong>Using the NCDB, we conducted a retrospective analysis of adult patients diagnosed with spinal or sacral chondrosarcoma between 2004 and 2017 who underwent surgical resection. We collected patient demographics, tumor characteristics, and treatment details. Patients were grouped based on 30-day readmission. A separate analysis was conducted on LOS, defining prolonged LOS as >75^th percentile. Multivariable analyses identified risk factors for each outcome.</p><p><strong>Results: </strong>Of the 1971 patients in the 30-day readmission analysis, 114 (5.8%) experienced readmission. Of the 1392 patients included in the LOS analysis, 341 (24.5%) experienced prolonged LOS. The risk factors of prolonged LOS included age (OR=1.015; 95% CI, 1.006-1.024; P<0.001), male sex (OR=1.440; 95% CI, 1.076-1.926; P=0.014), tumor volume >11 cm³ (OR=1.001; 95% CI, 1.000-1.002; P=0.018), sacral/coccygeal tumors (OR=1.831; 95% CI, 1.162-2.844; P<0.001), and gross total resection (GTR) (OR=1.514; 95% CI, 1.068-2.146; P=0.020). Multivariate regression identified no significant predictors of 30-day readmission.</p><p><strong>Conclusions: </strong>Tumor volume, sex, and other factors influence 30-day readmission and prolonged LOS. Prolonged LOS was further associated with sacral/coccygeal tumors and GTR, reflecting the complexity of surgical management.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"89-97"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714674","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":"Transcranial Doppler in diagnosing and monitoring reversible cerebral vasoconstriction syndrome: a systematic review.","authors":"Mariana L DE Bastos Maximiano, Ocílio R Gonçalves, João Vitor A Fernandes, Luciano Falcão, Pedro L Magalhães, Victor A Ohannesian, Rebeca Oliveira DA Silva, Rodrigo F Rodrigues, Júlia Tirelli-Rocha, Anderson M DA Silva, Henrique S Cal, Carolina R Albuquerque","doi":"10.23736/S0390-5616.25.06654-8","DOIUrl":"10.23736/S0390-5616.25.06654-8","url":null,"abstract":"<p><strong>Introduction: </strong>Digital subtraction angiography is considered the reference standard for diagnosing reversible cerebral vasoconstriction syndrome (RCVS); however, its invasive nature limits routine application. Transcranial Doppler ultrasonography (TCD) represents a noninvasive and bedside-accessible alternative, but its diagnostic and monitoring value in RCVS remains uncertain.</p><p><strong>Evidence acquisition: </strong>A systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed, Embase, Cochrane Library, Scopus, and Web of Science up to January 2024. Eligible studies included case reports, case series, and observational designs involving adults with angiographically confirmed reversible vasoconstriction that reported TCD or color-coded sonography parameters (e.g., mean flow velocity, vasospasm). Risk of bias was assessed with ROBINS-I or Joanna Briggs Institute tools. Due to heterogeneity, results were synthesized descriptively.</p><p><strong>Evidence synthesis: </strong>From 709 records, 8 studies encompassing 128 patients were included. TCD demonstrated increased mean flow velocities in the middle cerebral artery during the acute phase of RCVS, with reported peaks up to 146 cm/s, followed by gradual return to baseline within 6-12 weeks. Vasospasm was observed in up to 93.3% of patients, usually peaking between days 13 and 28. The Lindegaard index, ranging from 2.2 to >7, was valuable in distinguishing hyperemia from vasospasm. Serial bedside examinations, often every 24-48 hours during hospitalization, facilitated timely detection and monitoring of evolving hemodynamic changes. Nonetheless, included studies were small, heterogeneous, and methodologically limited.</p><p><strong>Conclusions: </strong>Transcranial Doppler ultrasonography appears promising as a noninvasive method for detecting cerebral vasospasm and monitoring temporal hemodynamic trajectories in RCVS.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"158-164"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149463","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":"Time is money: a systematic review of time directed activity based costing in spine surgery.","authors":"Eric Singh, Long DI, Tyler Cardinal, Lauren Tierney, Andrew Sasser, Solomon Jackson, Seth Tigchelaar, Adham M Khalafallah, Gregory Basil","doi":"10.23736/S0390-5616.26.06646-4","DOIUrl":"10.23736/S0390-5616.26.06646-4","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare costs in the USA have increased without corresponding improvements in patient outcomes, prompting calls for value-based reimbursement models. Accurate cost measurement per episode of care is essential to this approach. Traditional methods, such as cost-to-charge ratio (CCR), lack precision. Time-driven activity-based costing (TDABC), which assigns costs based on time spent per activity, offers a more accurate alternative. This review evaluates TDABC use in spine surgery and its potential to enhance cost transparency and efficiency.</p><p><strong>Evidence acquisition: </strong>This systematic review followed PRISMA guidelines. A literature search was performed for studies published between 1996 and 2025 using terms related to costing strategies and spine surgery. Included studies applied TDABC in cost analysis; non-English and commentary articles were excluded. Extracted data included costing methodologies, cost categories, and study purpose. Bias was assessed using the Newcastle-Ottawa scale.</p><p><strong>Evidence synthesis: </strong>Twelve studies including 6143 patients were analyzed, covering procedures such as ACDF, lumbar laminectomy, and microdiscectomy. Reported costs for single-level ACDF ranged from $ 6776 to $ 27,558. Most studies focused on intraoperative costs, though some included full care episodes. TDABC identified cost differences tied to factors such as surgeon experience and BMI. Personnel time, hospital stay, and postoperative visits were common cost drivers.</p><p><strong>Conclusions: </strong>TDABC offers a more granular and accurate method for analyzing spine surgery costs. However, variation in methodology across studies limits comparability. Standardized protocols and direct comparisons with traditional costing methods are needed to fully leverage TDABC's potential for improving cost management and care efficiency.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"70 2","pages":"151-157"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633650","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}