Journal of neurosurgery最新文献

{"title":"The association of statin therapy with reduced intracranial aneurysm recurrence after endovascular coiling: a post hoc propensity score-matched analysis of a randomized clinical trial.","authors":"Devi P Patra, Karl R Abi-Aad, Evelyn L Turcotte, Christopher S Ogilvy, Elad I Levy, Adnan H Siddiqui, Erol Veznedaroglu, H Hunt Batjer, Bernard R Bendok","doi":"10.3171/2024.7.JNS24781","DOIUrl":"https://doi.org/10.3171/2024.7.JNS24781","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular intracranial aneurysm (IA) management has significantly evolved over the last 2 decades. Despite these advancements, the aneurysm recanalization rate after coil embolization remains a concern. Statins have been found to affect vascular repair and remodeling; therefore, the authors hypothesized that patients receiving statin therapy at the time of coil embolization would have lower aneurysm recurrence and retreatment rates compared with patients not receiving statin therapy.</p><p><strong>Methods: </strong>A post hoc analysis was conducted of the primary data from patients enrolled in the Hydrogel Endovascular Aneurysm Treatment Trial focusing on the impact of statin use on the recurrence rates of 3- to 14-mm IAs after endovascular coiling. The primary outcome measured included aneurysm recurrence over 18-24 months using the Raymond-Roy Occlusion Classification. Secondary outcomes included major and minor recurrence rates and retreatment rates. Propensity score matching based on patient and aneurysm characteristics was performed to mitigate selection bias.</p><p><strong>Results: </strong>A total of 577 patients with data on statin use were eligible for this analysis. Of these, 178 (30.8%) patients were using statins and 399 (69.2%) were not. After propensity score matching, 156 (39.2%) patients were included in the statin group and 242 (60.8%) in the nonstatin group. The recurrence rate was 3.8% (6/156) in the statin group and 10.7% (26/242) in the nonstatin group (p = 0.013). In a subgroup analysis, statin use significantly reduced recurrence in patients with unruptured aneurysms (1.6% vs 9.7%, p = 0.005), but not in those with ruptured aneurysms (12.5% vs 13.6%, p = 0.876).</p><p><strong>Conclusions: </strong>Statin use was associated with a reduced rate of aneurysm recurrence in patients who underwent endovascular coiling for IAs with a decreased rate of retreatment during the follow-up period. Statins are a relatively low-risk treatment and may be an effective therapy to reduce recanalization of IAs, although further prospective studies are warranted to validate these findings.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of optimal versus suboptimal median household income on the surgically treated traumatic brain injury population at a level I trauma center in the Boston metropolitan area: a propensity score-matched analysis.","authors":"Kristine Ravina, Liliana Ladner, Michelle Safransky, Daniel Sconzo, Zachary P Wetsel, Aryan Wadhwa, Kaasinath Balagurunath, Monica L Ahrens, Emanuela Binello","doi":"10.3171/2024.7.JNS2440","DOIUrl":"https://doi.org/10.3171/2024.7.JNS2440","url":null,"abstract":"<p><strong>Objective: </strong>The median household income is a useful metric for healthcare disparity assessment. New England holds the highly diverse, densely populated Boston metropolitan area, which is known for having one of the highest living wages in the US. To the authors' knowledge, there is no published data on the effects of optimal versus suboptimal median household income on the surgical treatment of patients with traumatic brain injury (TBI). The authors sought to evaluate the disparities of an optimal versus suboptimal median household income-stratified population of patients with TBI who underwent surgical treatment at a single level I trauma center with a high safety-net burden in a major US metropolitan area.</p><p><strong>Methods: </strong>Demographic, clinical, and outcome data of patients who underwent surgery for TBI between 2015 and 2021 were collected and stratified based on optimal (≥ $80,000) and suboptimal (< $80,000) median residential household income. One-to-one tight caliper (0.01) propensity score matching was performed to balance the groups for comparative analysis.</p><p><strong>Results: </strong>From the initial 144 patients in the optimal and 140 patients in the suboptimal income groups, 53 patients were included in each group after propensity matching. The suboptimal income group was significantly more ethnically diverse (p = 0.02), with significantly more ethnic minority patients (p = 0.05). Significantly more patients in the optimal income group presented as transfers from other hospitals (p < 0.001). Insurance status, injury mechanism, type and location, imaging features, length of ICU stay, and distribution of disposition destinations, as well as the follow-up time and outcome measures were not significantly different between the two groups after propensity matching.</p><p><strong>Conclusions: </strong>Although the suboptimal income group is significantly more ethnically diverse, median household income does not seem to affect TBI outcomes and discharge disposition. Patients in the optimal income group more frequently presented as transfers from other facilities, potentially indicating fair high-level care at a specialized trauma center with a high safety-net burden adapted to a diverse patient population.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic pituitary gland transposition techniques to the interpeduncular and prepontine regions: an anatomical study.","authors":"Mariagrazia Nizzola, Yasaman Alam, Luciano C P C Leonel, Fabio Torregrossa, Stephen P Graepel, Yuki Shinya, Carlos D Pinheiro-Neto, Michael J Link, Maria Peris-Celda","doi":"10.3171/2024.7.JNS24234","DOIUrl":"https://doi.org/10.3171/2024.7.JNS24234","url":null,"abstract":"<p><strong>Objective: </strong>The floor of the third ventricle and the interpeduncular and prepontine regions represent challenging surgical targets. The expanded endoscopic endonasal approach (EEA) with pituitary gland (PG) transposition has been proposed to provide direct access to these anatomical regions. Through the years, different endoscopic PG transposition techniques have been studied and presented. The goal of this study was to compare the techniques, relevant anatomy, and surgical exposure of extradural, intradural, and interdural PG transposition techniques.</p><p><strong>Methods: </strong>Six formalin-fixed, latex-injected cadaveric head specimens were used to perform the EEA with extradural, unilateral interdural, and unilateral intradural PG transpositions. The interpeduncular and prepontine regions and the neurovascular structures located within these cisterns were carefully exposed and analyzed. The maximal cranial, caudal, and lateral accessible points within the surgical field were identified for each approach. Consequently, the relative craniocaudal and horizontal surgical axes were measured to quantify the extent of accessibility of each approach.</p><p><strong>Results: </strong>The extradural PG transposition technique provided the largest horizontal extensions and bilateral access to structures within the interpeduncular and prepontine regions; the mean horizontal axis was 17.9 (range 13.9-20.4) mm. The unilateral interdural PG transposition provided wider vertical exposure, with a mean craniocaudal axis of 16.2 (range 13.0-20.9) mm. In this approach, the surgical field was extended cranially above the ipsilateral mammillary body (MB). The unilateral intradural PG transposition provided a similar surgical exposure to the interdural approach, with a mean craniocaudal axis of 14.7 (range 12.9-15.8) mm. The approach required significant manipulation of the PG after opening both periosteal and meningeal dura layers.</p><p><strong>Conclusions: </strong>The extradural PG transposition is indicated for lesions of the upper clivus region that extend bilaterally and do not have a cranial extension beyond the MBs. The inter- and intradural PG transpositions are beneficial for unilateral lesions that extend cranially to the MBs. Both techniques require coagulation of the ipsilateral inferior hypophyseal artery. The intradural technique requires more manipulation of the PG, while the interdural technique requires opening and access to the cavernous sinus. If needed, the intra- and interdural techniques can also be performed bilaterally.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microsurgical obliteration of craniocervical junction dural arteriovenous fistulas via a suboccipital median approach: a retrospective study.","authors":"Yuanyuan Hu, Dongliang Qian, Bing Leng","doi":"10.3171/2024.7.JNS2497","DOIUrl":"https://doi.org/10.3171/2024.7.JNS2497","url":null,"abstract":"<p><strong>Objective: </strong>The authors report on a broad range of microsurgical procedures in which the suboccipital median technique was used to treat craniocervical junction arteriovenous fistulas. Their aim was to evaluate the efficacy of the suboccipital posteromedian approach and to assess the associated clinical outcomes.</p><p><strong>Methods: </strong>The authors extracted information on the fistula site, clinical manifestation, and structural characteristics of arterial and venous vessels by retrospectively evaluating cases from a neurointerventional database spanning 10 years.</p><p><strong>Results: </strong>In this study, 52 patients (median age 62 years; 23.1% female) were examined, with subarachnoid hemorrhage (SAH)/intracranial hemorrhage (61.6%) and myelopathy (34.6%) as prevalent presentations. Forty craniotomies (76.9%) were performed using the suboccipital median approach. Six craniotomies (11.5%) were performed using the far-lateral approach. Five patients (9.6%) underwent embolization, resulting in a residual lesion in 1. The C1 radicular artery served as the main feeding artery (78.9%). During the operation, the fistulas were mainly located near the C1 dural nerve root sleeve (ventrolateral and dorsolateral to the spinal cord). After the lesion was located, the dentate ligament was severed. Patients with SAH demonstrated a more favorable prognosis (modified Rankin Scale score 0-2, 93.8%) compared to those without SAH (modified Rankin Scale score 0-2, 70%), with a statistically significant difference (p = 0.02).</p><p><strong>Conclusions: </strong>The suboccipital posteromedian approach is suitable for resections of nearly all craniocervical junction dural arteriovenous fistulas. The prognosis of the patients with SAH was better than that of the patients without it.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor. Mixed reality for the patient's brain: what about the surgeon's brain?","authors":"Ziyu Qi","doi":"10.3171/2024.9.JNS242122","DOIUrl":"https://doi.org/10.3171/2024.9.JNS242122","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":3.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A proposed new classification system of hypothalamic hamartomas in the era of stereotactic ablation surgery.","authors":"Hiroshi Shirozu, Hiroshi Masuda, Shigeki Kameyama","doi":"10.3171/2024.7.JNS24560","DOIUrl":"https://doi.org/10.3171/2024.7.JNS24560","url":null,"abstract":"<p><strong>Objective: </strong>Since the recent development of stereotactic ablation surgery, which can provide good seizure outcomes without limitations in size or location, conventional classification systems have become unsuitable for surgical guidance. The present study aimed to evaluate the validity of a newly proposed classification system focusing on the attachment pattern.</p><p><strong>Methods: </strong>This retrospective study investigated 218 patients with hypothalamic hamartomas who underwent MRI-guided stereotactic radiofrequency thermocoagulation and were followed for at least 1 year after their last surgery. Hypothalamic hamartomas were classified by their attachments into six subtypes: parahypothalamic-unilateral (PU), parahypothalamic-bilateral (PB), intrahypothalamic-unilateral (IU), intrahypothalamic-bilateral (IB), mixed-unilateral (MU), and mixed-bilateral (MB) types. Clinical features, surgical factors, scales of surgical procedures including numbers of trajectories and coagulations, requirement for a trans-third ventricular approach, reoperation rates, and complication rates were investigated. Seizure outcomes were evaluated separately for gelastic seizures (GSs) and non-GSs.</p><p><strong>Results: </strong>In 218 patients (131 [60.1%] males, median age at surgery 7.2 [range 1.8-51] years), the hypothalamic hamartomas were classified as PU type in 10 (4.6%), PB type in 11 (5.0%), IU type in 41 (18.8%), IB type in 17 (7.8%), MU type in 40 (18.3%), and MB type in 99 (45.4%) patients. Patients with MB type were significantly younger at GS onset (p < 0.001) and surgery (p = 0.005). The numbers of trajectories and coagulations were significantly greater in MB type (p < 0.001) and the trans-third ventricular approach was more often required in the PB type (5/6, 83.3%, p < 0.001). Seizure outcomes were not different among subtypes. The rate of transient complications was not different among subtypes, but hyperthermia (p = 0.002) and hyponatremia (p < 0.001) were more frequently found in patients with PB and MB types. Prolonged or persistent neurological complications were also not different and were only found in bilateral subtypes.</p><p><strong>Conclusions: </strong>The new classification predicts clinical features, as well as surgical complexity and complications. Although seizure outcomes were not different among subtypes because the authors' surgical strategy is consistently based on complete disconnection at the border, the new classification could improve seizure outcomes and would be helpful in the appropriate guidance for surgery of hypothalamic hamartomas to provide consistently good outcomes regardless of surgical procedures.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor. Bypass in neurosurgery: a dying microsurgical procedure?","authors":"Leonardo O Brenner, Maria Fernanda Santana, Rafael Reis, Gustavo J S Sanchez, Taiane B Araújo, Raphael Bertani","doi":"10.3171/2024.8.JNS241958","DOIUrl":"https://doi.org/10.3171/2024.8.JNS241958","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-minimizing thresholds and recurrence rates in surgical evacuation with adjunctive middle meningeal artery embolization versus evacuation alone.","authors":"Matthew C Findlay, Matthew Holdaway, Diwas Gautam, Sawyer Z Bauer, Gurpreet Gandhoke, Ramesh Grandhi","doi":"10.3171/2024.7.JNS24200","DOIUrl":"https://doi.org/10.3171/2024.7.JNS24200","url":null,"abstract":"<p><strong>Objective: </strong>Cost-minimization approaches for the treatment of patients with chronic subdural hematoma (cSDH) are important given the increasing incidence of this pathology, particularly among elderly patients receiving antiplatelet and anticoagulation medications. The use of middle meningeal artery embolization (MMAE) as an adjunct to surgical evacuation has shown promise in reducing surgical recurrence; however, additional costs are involved with this procedure. Using their institutional experience, the authors identified thresholds for cost and the cSDH surgical recurrence rate that could influence treatment decisions in patients requiring surgical evacuation for cSDH.</p><p><strong>Methods: </strong>All patients who underwent cSDH evacuation surgery (ES) with concomitant MMAE or ES alone from January 2019 through August 2023 were identified. The authors collected hospital-related costs for the initial admission and any subsequent admissions to address surgical recurrence (rescue surgery [RS]) and conducted cost-minimization analyses. Base-case scenario calculations were supplemented with 1- and 2-way sensitivity analyses to study cost-minimizing variables.</p><p><strong>Results: </strong>Demographic characteristics, comorbidities, and presenting symptoms did not significantly differ between patients who received ES/MMAE (n = 44) and those who received ES (n = 100). ES/MMAE procedures required a mean ± SD 79.3 ± 34.8 minutes whereas ES alone required 54.3 ± 25.9 minutes (p < 0.01), and patients who underwent ES/MMAE had a greater immediate postoperative hemorrhage volume reduction (-62.5% ± 22.1% vs -54.3% ± 21.3%, p = 0.04). No differences in the rates of 30-day complications, readmissions, or mortality were observed (all p > 0.05), but the ES/MMAE cohort had no reoperations after initial surgery whereas 14% in the ES-alone cohort required RS (p < 0.01). The base-case calculations indicated that ES alone minimizes costs more than ES/MMAE when there is no RS. Two-way sensitivity analyses revealed that, given a 14% probability of RS for the ES-alone group and 0% for the ES/MMAE cohort, ES/MMAE becomes cost-minimizing when the costs for ES/MMAE are kept below $21,000. With these same failure rates and cost of ES/MMAE, if ES costs exceed $32,000, ES/MMAE becomes cost-minimizing.</p><p><strong>Conclusions: </strong>Although ES/MMAE is more efficacious for the prevention of surgical recurrence in patients requiring surgical evacuation of cSDH than ES alone, ES alone remains the cost-minimizing option. However, in select situations, as with a low RS rate and low cost for ES/MMAE or a high RS rate and high cost for ES alone, then ES/MMAE also becomes the cost-minimizing option. These thresholds can be used in combination with institutional costs and RS rates to help guide clinical and economic decision-making.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 cerebrovascular steno-occlusive disease subtype on surgical and clinical outcomes after direct STA-MCA bypass surgery.","authors":"Danielle Golub, Joshua D McBriar, Shyle H Mehta, Harshal A Shah, Justin Turpin, Timothy G White, Eric T Quach, Andrew B Koo, Christian Ferreira, Alexander F Küffer, Thomas W Link, Athos Patsalides, David J Langer, Amir R Dehdashti","doi":"10.3171/2024.7.JNS24321","DOIUrl":"https://doi.org/10.3171/2024.7.JNS24321","url":null,"abstract":"<p><strong>Objective: </strong>Although well-established in moyamoya disease (MMD), the role of direct superficial temporal artery (STA) to middle cerebral artery (MCA) bypass in non-MMD (N-MMD) cerebrovascular steno-occlusive syndromes remains controversial. Nonetheless, the recurrent stroke risk in patients with N-MMD, despite best medical management, remains exceedingly high-especially for those suffering from hypoperfusion-related ischemia. The study objective was to determine the relative safety and efficacy profiles of direct STA-MCA bypass surgery for MMD and N-MMD patients in a large contemporary cohort.</p><p><strong>Methods: </strong>The authors conducted a retrospective review of all direct STA-MCA bypass cases performed between 2014 and 2023 at a high-volume center, which yielded 139 cases. Cases were excluded if they involved double-barrel bypass, an interposition graft, or if the surgical indication was not cerebral hypoperfusion. Direct bypass graft patency was serially assessed on follow-up vessel imaging.</p><p><strong>Results: </strong>Of the 139 included cases, 88 (63.3%) were MMD and 51 (36.7%) were N-MMD cases. The mean patient age was 49.2 years and 60.4% were female. The mean follow-up duration was 18.5 months. The perioperative stroke risk within 30 days of revascularization was 6.5% for the overall cohort, with no significant difference (p = 0.725) observed between MMD (5.7%) and N-MMD (7.8%) cases. The overall postoperative ipsilateral hemispheric and MCA distribution stroke rates at last follow-up were 11.5% and 9.4%, respectively. Despite a greater medical comorbidity burden, N-MMD cases demonstrated comparable rates of direct bypass graft occlusion (21.6% N-MMD vs 28.4% MMD, p = 0.426), MCA-distribution ischemic stroke (11.8% N-MMD vs 7.9% MMD, p = 0.549), and ipsilateral ischemic stroke (15.7% N-MMD vs 9.1% MMD, p = 0.276) to patients with MMD at last follow-up. Higher preoperative total hemispheric flow on noninvasive optimal vessel analysis (NOVA) imaging was the only variable associated with prolonged direct bypass graft patency (hazard ratio [HR] 0.39, p = 0.036). Postoperative stroke-free survival was improved by performing dural synangiosis (HR 0.31, p = 0.033) and, in multivariate analysis, was reduced with direct bypass graft occlusion (HR 4.58, p = 0.009) and a preoperative diffusion-weighted imaging-Alberta Stroke Program Early CT Score (DWI-ASPECTS) < 8 (HR 3.90, p = 0.024).</p><p><strong>Conclusions: </strong>This robust cohort of MMD and N-MMD STA-MCA bypass cases highlights the safety and efficacy of a technically sound direct bypass across all subtypes of cerebrovascular steno-occlusive disease. Careful attention to preoperative MRI parameters, including hemispheric flow rates on NOVA imaging, may improve surgical risk stratification. Further examination of the benefits of adjunctive indirect bypass or dural synangiosis, especially for patients with N-MMD, remains warranted.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of intraoperative MRI in glioma surgery: a systematic review and meta-analysis of prospective randomized controlled trials.","authors":"Johannes Wach, Martin Vychopen, Alim Emre Basaran, Agi Güresir, Clemens Seidel, Andreas Kühnapfel, Erdem Güresir","doi":"10.3171/2024.7.JNS241102","DOIUrl":"https://doi.org/10.3171/2024.7.JNS241102","url":null,"abstract":"<p><strong>Objective: </strong>Maximum extent of resection in glioma yields enhanced survival outcomes. The contemporary literature presents contradictory results regarding the benefit of intraoperative MRI (iMRI). This meta-analysis aimed to investigate the efficacy and safety of iMRI-guided surgery.</p><p><strong>Methods: </strong>The authors searched the PubMed, Embase, and Cochrane Reviews databases for eligible prospective randomized controlled trials through the end of February 2024. Endpoints were extent of resection, progression-free survival (PFS), overall survival, neurological functioning, and surgical complications. Individual patient data regarding PFS were reconstructed using the R package IPDfromKM.</p><p><strong>Results: </strong>From 1923 identified results, 3 randomized controlled trials with 384 patients met the inclusion criteria. Extended resections after iMRI were performed in 29.2% of the iMRI cases. Intraoperative MRI-guided glioma surgery (OR 5.40, 95% CI 3.25-8.98; p < 0.00001) outperformed conventional navigation-guided surgery in attaining gross-total resection (GTR). In patients in whom a GTR was achieved, the median time to progression was 16.0 months (95% CI 12.3-19.7 months), while the median PFS in patients with a subtotal resection was 9.7 months (95% CI 6.9-12.5 months) (p < 0.001). Despite increased GTR rates, postoperative neurological deterioration was equal among the iMRI and control groups (OR 1.0, 95% CI 0.6-1.7; p = 0.91, I2 = 0%). Intraoperative MRI use prolongs surgery by 42 minutes on average (95% CI 3.3-80.7 minutes; p = 0.03, I2 = 56%). The risk of postoperative intracranial hemorrhage (OR 1.9, 95% CI 0.2-16.9; p = 0.55, I2 = 0%) was not increased, while in one study significantly increased infections were observed in the iMRI arm.</p><p><strong>Conclusions: </strong>Intraoperative MRI outperforms conventional surgery in achieving complete glioma resections of all contrast-enhancing tumor portions, enhancing PFS without added risk. Intraoperative MRI is a tool that facilitates these aims without reducing safety in terms of neurological deficits and surgical complications.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}