Journal of neurosurgical sciences最新文献

{"title":"Advantages of robotic spine surgery.","authors":"Ismail Zaed, Andrea Cardia","doi":"10.23736/S0390-5616.25.06687-1","DOIUrl":"10.23736/S0390-5616.25.06687-1","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"86-87"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774705","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":"Radiosurgical management of pathology-proven low-grade glioma: a systematic review across the pre- and post-molecular classification era.","authors":"Yuka Mizutani, Yusuke S Hori, Paul M Harary, Shreyas Annagiri, Ruchit Jain, Justin Liu, Muhammad Izhar, Deyaaldeen A Reesh, Fred C Lam, Sara C Emrich, Louisa Ustrzynski, Armine Tayag, David J Park, Steven D Chang","doi":"10.23736/S0390-5616.25.06656-1","DOIUrl":"10.23736/S0390-5616.25.06656-1","url":null,"abstract":"<p><strong>Introduction: </strong>Low-grade gliomas (LGGs) are slow-growing heterogeneous tumors that remain challenging when complete resection is not feasible. While maximal safe resection remains standard, the evolving World Health Organization (WHO) classification emphasizing molecular characteristics has shifted perspectives on adjuvant therapies. In this context, the role of stereotactic radiosurgery (SRS) continues to be explored. This systematic review synthesizes literature on radiosurgical management of pathology-proven LGGs across pre- and post-molecular classification eras.</p><p><strong>Evidence acquisition: </strong>A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Scopus, and Web of Science were searched in August 2024 for studies on pathology-proven LGGs treated with SRS. An additional search was performed to incorporate studies reporting molecular characteristics.</p><p><strong>Evidence synthesis: </strong>Of the initially included eight studies, none reported molecular characteristics required by the 2021 World Health Organization classification, and an additional search identified one study reporting molecular characteristics, which was added to the review. Nine studies with 308 patients were included. Local control rates ranged from 66% to 94%. Several studies reported superior outcomes with surgery for recurrence, adjuvant rather than salvage SRS, and no prior radiotherapy. Adverse events were predominantly mild to moderate, including headache, dizziness, nausea, and transient neurological symptoms.</p><p><strong>Conclusions: </strong>SRS offers a non-invasive management option for selected LGGs with durable control and acceptable safety. Prognosis appears to be influenced by treatment history, including prior radiotherapy and surgical management. Lack of molecular stratification highlights the need for studies focused on IDH (isocitrate dehydrogenase)-mutant LGGs to clarify the role of SRS in the molecular era.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"66-74"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145708475","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":"Comparing short term clinical outcomes of elective robot-assisted vs. non-robot assisted posterior lumbar interbody fusions: a NSQIP analysis.","authors":"Taylor Furst, Aman Singh, Prasanth Romiyo, Jonathan Stone, Tyler Schmidt","doi":"10.23736/S0390-5616.25.06535-X","DOIUrl":"10.23736/S0390-5616.25.06535-X","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic lumbar degenerative changes impact millions of patients per year. Recent technological advances have increased the usability of robot-assisted spinal fusions to treat this pathology. Although the safety profile of robotic systems appears favorable, the impact of robotics on surgical outcomes and efficiency remains unclear.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database was queried for cases of elective posterior lumbar interbody fusions in adult patients with data available regarding the use of robotics. Univariate and multivariate analyses were performed. The purpose of this study is to compare rates of 30-day unplanned readmissions, unplanned reoperation (return to operating room [RTOR]), postoperative complications, non-home discharges, operative time, blood transfusions and length of stay (LOS) in adult elective robot-assisted (robot-assisted posterior lumbar interbody fusion [rPLIF] / transforaminal lumbar interbody fusion [TLIF]) vs. non-robotic PLIF/TLIF (nPLIF/TLIF).</p><p><strong>Results: </strong>There was no statistically significant difference in rates of 30-day readmissions (6.0% vs. 4.4%, P=0.48), RTOR (4.0% vs. 3.0%, P=0.66), postoperative complications (10.0% vs. 11.2%, P=0.51) nor need for blood transfusion (6.0% vs. 6.5%, P=0.59) between rPLIF/TLIF and nPLIF/TLIF cohorts, respectively. There were no differences in LOS or operative time between groups (LOS: rPLIF/TLIF = 3.5±3.3 days, nPLIF/TLIF = 3.6±2.8 days, P=0.29; operative time: rPLIF/TLIF = 208.7±101.1 minutes, nPLIF/TLIF = 225.1±100.4 minutes, P=0.087).</p><p><strong>Conclusions: </strong>rPLIF/TLIF and nPLIF/TLIF 30-day readmissions, RTOR, non-home discharges, need for blood transfusion, LOS and operative times are similar within these data, though results should be interpreted with caution given study limitations. Ongoing data on surgical outcomes of robot-assisted lumbar fusions are needed.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"4-11"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015667","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":"Dysplastic cerebellar gangliocytoma: a six-decade study.","authors":"Emily K Chapman, Tirone Young, Zerubabbel Asfaw, Rahul Raj, Mehek Dedhia, Clare Bryce, Isabelle M Germano","doi":"10.23736/S0390-5616.25.06567-1","DOIUrl":"10.23736/S0390-5616.25.06567-1","url":null,"abstract":"<p><strong>Introduction: </strong>Dysplastic cerebellar gangliocytoma (DCG) is a rare cerebellar tumor glioneuronal and neuronal tumor with phosphatase and tensin homolog (PTEN) identified as a key altered gene. The aim of this study is to establish DCG diagnostic and outcome trends over a six-decade and present cases from our institution.</p><p><strong>Evidence acquisition: </strong>A literature review of online databases was performed using relevant terms (January 1970-October 2024). Our institution pathology database was queried for patients with DCG (2000-2024). Data was extracted and dichotomized in adult and pediatric cases.</p><p><strong>Evidence synthesis: </strong>We report three new DCG cases in addition to the 170 DCG cases reported across 97 articles over seven decades, with 52% of articles published since 2010. DCG predominantly occurred in adults (>18 years, 82%), women (59%), at mean age 9.0±6.3 years and 38.1±13.7 years in pediatric and adult patients, respectively. Balance/coordination deficit, headache and visual deficit were the most common presenting symptoms. MRI \"tiger-stripe\" pattern was present in 67%. Surgical resection was the treatment of choice for >97% of patients. Association with Cowden Syndrome (CS) was confirmed in 67% of patients. PTEN mutations identified in 48.3% of cases, primarily affecting chromosome 10 (10q23.3). Progression-free survival was experienced by 74% of patients and reoperation for progression needed in 3.5% of cases.</p><p><strong>Conclusions: </strong>DCG is a rare tumor associated with PTEN mutations. MRI aids in diagnosis and surgery ensures favorable outcomes. Standardized genetic screening and targeted therapies require further study, as they hold promise for refining diagnosis and long-term management.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"47-55"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145377763","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":"Magnetic resonance guided laser interstitial thermal therapy in pediatric brain tumors: an institutional case series.","authors":"Giuseppe Mirone, Stefania Picariello, Carmela Russo, Domenico Cicala, Pietro Spennato, Nicola Onorini, Lucia Quaglietta, Eugenio Covelli, Giuseppe Cinalli","doi":"10.23736/S0390-5616.24.06381-1","DOIUrl":"10.23736/S0390-5616.24.06381-1","url":null,"abstract":"<p><strong>Background: </strong>Complete microsurgical removal of pediatric brain tumors remains a significant prognostic factor, but it is still associated with a significant degree of morbidity and mortality. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has recently been proposed for tumor ablation as an alternative to microsurgery in deep or eloquent tumors. We describe our experience and outcomes of using MRgLITT to treat pediatric brain tumors and analyze its limitations and strengths.</p><p><strong>Methods: </strong>We performed a retrospective analysis of 24 consecutive pediatric patients with brain tumors who underwent MRgLITT at our center. Clinical, radiological, and surgical data were retrospectively reviewed.</p><p><strong>Results: </strong>Twenty-five LITT procedures were performed on 24 patients. Median age at diagnosis was 7.5 years (range 1.2-15.09). The median tumor volume was 1.24 cm³. The cerebellum was the most common tumor location (11/24), followed by the cerebral hemisphere (7/24), thalamus (3/24), optic pathway (1/24), brainstem (1/24), and IV ventricle (1/24). Patients were followed for a median 3.2 (range 0.1-14.9) years. Of the 17 children with low-grade tumors, 11 underwent LITT at disease progression, and 6 underwent LITT at diagnosis. The 3-year PFS since the LITT was 100%. None of the children with low-grade tumors died. Of the seven children with high-grade tumors, 6 underwent the LITT procedure at disease progression. Four patients progressed and died after the LITT procedure, with an OS curve of 22.2% at 1.7 years after LITT.</p><p><strong>Conclusions: </strong>MRgLITT is a safe and effective approach for treating pediatric brain tumors with selected indications and has significant potential for use in several brain tumor treatment algorithms.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"36-46"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567414","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":"Increased preoperative levels of circulating erythrocytic hemoglobin might predict high-grade histology (WHO grade 2-3) in falcine and parasagittal meningiomas.","authors":"Filippo Gagliardi, Silvia Snider, Pierfrancesco DE Domenico, Matteo Braga, Lina R Barzaghi, Gianluca Nocera, Marcella Callea, Maria R Terreni, Pietro Mortini","doi":"10.23736/S0390-5616.24.06371-9","DOIUrl":"10.23736/S0390-5616.24.06371-9","url":null,"abstract":"<p><strong>Background: </strong>Falcine/parasagittal lesions account for the largest rate of high-grade (WHO grade 2-3) lesions. The ability to preoperatively estimate the tumors' grade and outcome would be of great value in customizing treatment.</p><p><strong>Methods: </strong>This is a single-center, retrospective study designed to assess the pre-operative peripheral blood markers' diagnostic and prognostic role in patients harboring falcine (FM) and parasagittal (PM) high-grade meningiomas. N=116 patients undergoing surgical resection were included. A propensity score-matched analysis accounted for gender imbalances in low-grade (LG) vs. high-grade (HG) cohorts.</p><p><strong>Results: </strong>Seventy-three (N.=73) FM (63%) and 43 PM (37%) lesions were included. Patients harboring HG lesions showed significantly higher Hb levels than LG (mean 14.5±1.40 vs. 13.5±1.16 g/dL, P<0.001). Multivariate analysis controlling for demographics, lesion characteristics, blood markers, and steroid dose confirmed preoperative Hb as an independent predictive value of lesion grade (OR 1.75, 95% CI:1.01-3.07, P=0.04). Accordingly, patients showing increased Hb levels >15.4 g/dL achieved shorter OS (60.4 months, 95% CI: 14.7-106.1 vs. 134.7 months, 95% CI: 111.2-158.2) compared to patients with lower Hb values, P<0.001. Data were confirmed in matched cohorts.</p><p><strong>Conclusions: </strong>Increased levels of circulating erythrocytic hemoglobin might be independent predictors for high-grade histology and be associated with shorter overall survival in falcine and parasagittal meningiomas.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"453-462"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111001","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":"Pycnogenol® improves retinal microcirculation and symptoms of optic nerve ischemic damage after sudden, reversible unilateral loss of vision: a pilot evaluation.","authors":"Gianni Belcaro, Maria R Cesarone, Claudia Scipione, Valeria Scipione, David Cox, Roberto Cotellese, Mark Dugall, Morio Hosoi, Marcello Corsi, Beatrice Feragalli, Corrado Gizzi, Patrizia Torino Rodrigues","doi":"10.23736/S0390-5616.24.06374-4","DOIUrl":"10.23736/S0390-5616.24.06374-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The aim of this pilot registry study was to investigate the use of Pycnogenol&lt;sup&gt;®&lt;/sup&gt; (French maritime pine bark, standardized extract) in subjects 2 weeks after an episode of sudden loss of vision (SLV).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Visual acuity, retinal edema, vasospasms, distal retinal circulation and blood flow at the Zinn-Haller circle (distal optic nerve) were examined over 4 weeks. In addition, symptoms of neurological alterations (ION: ischemic optic neuritis) associated with retinal flow decrease were monitored. One registry group used only the standard management (SM, control group), a second group used SM+ 150 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt;/day (Pycno150) and another group used SM+100 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; /day (Pycno100).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sixty subjects completed the study. 18 in the control group, 20 in the Pycno150 group and 22 subjects in the Pycno100 group. The registry groups were comparable at inclusion. No dropouts were observed in the two Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups whereas 2 dropouts occurred in the SM group (due to the occurrence of a new, minor visual loss episode). No side effects or tolerability problems were observed during the registry study. After 4 weeks, the visual acuity score of the affected eye was significantly higher in the Pycno150 group compared to the Pycno100 group and both Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups showed significantly higher acuity scores in comparison with controls using SM (P&lt;0.05). In parallel, after 4 weeks, the retinal edema score was significantly lower in both Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups compared to controls (P&lt;0.05 vs. SM patients) and even lower (P&lt;0.05) with the 150 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; dose compared to the 100 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; dose. After 4 weeks, retinal systolic and diastolic blood flow velocities of the affected eye were significantly higher in the two Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups in comparison with controls using SM (P&lt;0.05). The improvements in 150 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; group were significantly higher compared to the low-dose 100 mg/Pycnogenol&lt;sup&gt;®&lt;/sup&gt; group (P&lt;0.05). At the end of the study, blood flow velocity in the Zinn-Haller circle was significantly higher in both Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups compared to the control group (P&lt;0.05) and was higher (P&lt;0.05) with the 150 mg Pycnogenol&lt;sup&gt;®&lt;/sup&gt; dose compared to the 100 mg dose. ION symptoms (vision loss, visual field loss, loss of color vision, flashing lights) improved significantly in the Pycnogenol&lt;sup&gt;®&lt;/sup&gt; groups compared to controls (P&lt;0.05), with better improvements in the Pycno150 group compared to the Pycno100 group (P&lt;0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The study showed a dose-dependent effect of Pycnogenol&lt;sup&gt;®&lt;/sup&gt; on blood flow velocity increase, reduction of retinal edema, ION symptoms and increase in visual acuity. Pycnogenol&lt;sup&gt;®&lt;/sup&gt; was shown to be effective and safe in improving retinal microcirculation after an episode o","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"463-468"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150682","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":"Correction to: Early growth response 1 promoted the invasion of glioblastoma multiforme by elevating HMGB1.","authors":"Kai Du, Xiaoyou Wu, Xiaofei Ji, Nan Liang, Zheng Li","doi":"10.23736/S0390-5616.25.06668-8","DOIUrl":"10.23736/S0390-5616.25.06668-8","url":null,"abstract":"<p><p>This article was published in Volume 67, issue 4 of publishing year 2023, with a mistake in Figure 3. The correct Figure 3 is the one included in this erratum.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"69 6","pages":"504"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029926","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":"The impact of hyperoxemia on mortality and neurological outcomes in traumatic brain injury: a systematic review and meta-analysis.","authors":"Anna Fornaciari, Rossella Zangari, Martina Polato, Elisa Gouvea Bogossian, Elena G Bignami, Frank Rasulo, Fabio S Taccone, Michele Salvagno","doi":"10.23736/S0390-5616.25.06480-X","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06480-X","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic brain injury (TBI) is a critical condition where the management of oxygen levels plays a pivotal role in patient outcomes. While hypoxemia is known to worsen outcomes, the impact of hyperoxemia on mortality and neurological outcomes remains controversial. This systematic review and meta-analysis aims to evaluate the effects of hyperoxemia on these outcomes in TBI patients.</p><p><strong>Evidence acquisition: </strong>This study followed PRISMA guidelines and was registered with PROSPERO (registration number: CRD42024537543). A comprehensive search was conducted across MEDLINE, Embase, and SCOPUS databases, identifying relevant studies on hyperoxemia and its impact on mortality and neurological outcomes in TBI patients. Both observational studies and randomized controlled trials were included, and data were synthesized and analyzed using a random-effects model.</p><p><strong>Evidence synthesis: </strong>Fifteen studies including 38,718 patients were included in the qualitative synthesis, with 13 studies included in the quantitative meta-analysis. Hyperoxemia was not significantly associated with mortality (pooled OR=0.88 [0.66-1.16]; P=0.36; I²=86%) or with unfavorable neurological outcomes (pooled OR=1.04 [0.83-1.29]; P=0.75; I²=67%). Sensitivity analyses limited to studies with low or low/moderate risk of bias showed a statistically significant association between hyperoxemia and reduced mortality, although with high heterogeneity (OR=0.65 [0.48-0.88]; P=0.005; I²=82%). A subgroup analysis of studies assessing neurological outcome at 6 months suggested a trend toward improved functional outcomes with early moderate hyperoxemia (OR=1.32 [0.99-1.75]; P=0.06). An explorative meta-regression did not show a significant linear association between PaO<inf>2</inf> thresholds and outcomes.</p><p><strong>Conclusions: </strong>This systematic review and meta-analysis do not provide sufficient evidence to discourage the use of moderate hyperoxemia in TBI patients. Exploratory analyses suggesting potential benefits from early moderate hyperoxemia require further validation in selected patients. High-quality prospective studies are urgently needed to determine the optimal use of oxygen therapy in TBI.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"69 6","pages":"481-492"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029967","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":"Microsurgery and endovascular therapy serve instrumental roles in multimodal management of giant cerebral aneurysms: a systematic review.","authors":"Saarang Patel, Mohammad F Khan, Nolan J Brown, Ryan Gensler, Redi Rahmani, Julian Gendreau, Joshua S Catapano, Michael T Lawton","doi":"10.23736/S0390-5616.25.06617-2","DOIUrl":"10.23736/S0390-5616.25.06617-2","url":null,"abstract":"<p><strong>Introduction: </strong>Giant intracranial aneurysms are rare vascular lesions consisting of cerebral aneurysms measuring ≥25 mm in diameter. Their formation is the result of multiple factors including their association with a unique genomic landscape, pathophysiologic processes associated with the pathognomonic, histopathological changes observed within the arterial wall, the physical effects of the cerebral vasculature's unique fluid dynamics, and slow growth rates. Because giant intracranial aneurysms are considered among the most complex to manage, we herein perform a systematic review of the extant evidentiary base found within the neurosurgical literature with the goal of profiling multimodality management strategies for these lesions. Additionally, we will highlight the importance of integrating neuroendovascular surgery into microsurgical treatment regimens for giant cerebral aneurysms.</p><p><strong>Evidence acquisition: </strong>To this end, we performed a systematic review of the literature through the PubMed, Scopus and Web of Science databases according to PRISMA guidelines. By using predefined search terms, we intended to identify prior reports involving multimodality management of giant intracranial aneurysms. Specifically, we sought to highlight the integral role of both neuroendovascular and microsurgical interventions in treatment of these rare vascular lesions.</p><p><strong>Evidence synthesis: </strong>Ten studies reporting outcomes for 91 patients met criteria for inclusion in the present meta-analysis. Within this cohort of patients, mean age varied from 39.0 to 60.1 years. Among the giant aneurysms in the present review, many were found extending off of the supraclinoid ICA, which is one of the most common sites for giant intracranial aneurysms to form. In 1988, Batjer described the earliest combined intervention included in the present study. Since then, two common approach type themes involved in multimodal management have evolved: combined strategies often consist of 1) an endovascular approach to vessel occlusion, such as embolization, and 2) a microsurgical method capable of eliminating the aneurysm following control of blood flow. In other words, achieving obliteration via clipping, bypass surgery, clip reconstruction, wrapping, and Hunterian ligation (among others). Review of the literature indicated an overall mortality rate associated with multimodal management of 5.4%. Radiographic obliteration rates were reported in three of ten studies. One of the studies reported an 82.9% rate of successful obliteration. Rates of good outcomes (mRS 0-2, GOS 4-5) ranged from 60% up to a maximum of 87.5%.</p><p><strong>Conclusions: </strong>Combined, multimodality endovascular and microsurgical treatments appear to be most successful for the treatment of giant aneurysms because of their adaptability, the flexibility they confer, and the synergistic effect of combining the strengths of multiple modalities.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"69 6","pages":"493-501"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029977","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}