Journal of neurological surgery. Part A, Central European neurosurgery最新文献

{"title":"Clinical Outcomes of Revision Posterior Lumbar Interbody Fusion for Late Deterioration after Laminotomy Assessed with the Zurich Claudication Questionnaire.","authors":"Hironobu Sakaura, Takahito Fujimori, Tsuyoshi Sugiura, Shutaro Yamada, Sadaaki Kanayama, Daisuke Ikegami","doi":"10.1055/a-2479-4972","DOIUrl":"10.1055/a-2479-4972","url":null,"abstract":"<p><p>A retrospective analysis of prospectively collected data.There have been a few studies comparing surgical outcomes between revision lumbar fusion surgery and the same primary surgery.Using the Zurich Claudication Questionnaire (ZCQ), we compared clinical outcomes of revision posterior lumbar interbody fusion (PLIF) for late deterioration after laminotomy with those of primary PLIF to examine whether surgical outcomes of revision PLIF for late deterioration after laminotomy are inferior to those of primary PLIF.Sixteen consecutive patients undergoing revision single-level PLIF for late deterioration after single-level laminotomy (R group) and 61 consecutive patients undergoing primary single-level PLIF during the same period (P group) were enrolled. Before PLIF surgery and at 2 years postoperatively, clinical outcomes were assessed using the ZCQ. Achievement rates of the minimum clinically important difference (MCID) of each domain (Symptom severity [SS] and Physical function [PF]) on the ZCQ were calculated in each group.In the R group, mean SS and PF before revision PLIF and at 2 years after surgery were 3.429 and 2.8, and 1.946 and 1.6, respectively. In the P group, mean SS and PF before primary PLIF and at postoperative 2 years were 3.438 and 2.5, and 2.194 and 1.6, respectively. Both SS and PF significantly improved at postoperative 2 years in both groups, and SS both before and after PLIF and PF at 2 years postoperatively showed no significant differences between the two groups. Achievement rates of the MCID of SS and PF were 81.3 and 68.8% in the R group, and 59.0 and 59.0% in the P group, respectively. None of the MCID achievement rates of SS and PF showed significant differences between the two groups.Clinical outcomes of revision PLIF for late deterioration after laminotomy were equivalent to those of primary PLIF assessed with the ZCQ at 2 years after PLIF surgery.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"532-536"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682051","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":"Report of the Outcome of 6-year Blood Blister-Like Aneurysm Treatment Using Clipping Technique: A Single-Center Experience.","authors":"Iman Ahrari, Abdelkarim Rahmanian, Meisam Eqbal, Mahsa Ghavipisheh, Ali Namjoo-Moghadam, Sobhan Ahrari, Ehsan Mohammad Hosseini, Mohammad Jamali","doi":"10.1055/a-2568-4665","DOIUrl":"10.1055/a-2568-4665","url":null,"abstract":"<p><p>Blood blister-like aneurysms (BBA) are rare vascular lesions with challenging treatment. While direct surgery has been the primary technique for treating BBA, there has been a shift toward endovascular methods in recent years. This article presents a retrospective case series of patients treated with direct surgery at our center over a 6-year period.Patients who underwent surgery for BBA from 2014 to 2019 were evaluated. Data on surgical procedures, complications, and clinical outcomes were obtained from patients' medical records. Additionally, patients were contacted to provide updates on their treatment outcomes.A total of 17 patients were treated for BBA during the study period. All cases presented with subarachnoid hemorrhage and were treated using the clipping method. Intraoperative rupture occurred in 11 patients. Additionally, internal carotid artery sacrificing was done in five patients due to avulsion during surgery. Of these 17 patients, 11 (64.7%) had favorable outcomes following surgery, while the mortality rate was 29.4% (5 patients).The rate of favorable outcomes and mortality associated with the direct surgery technique at our center was comparable to results from other centers. Further studies are required to determine the optimal method for treating BBA.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"509-515"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742958","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":"Chromosomal Abnormalities and Hydrocephalus: Could There Be an Association between Klinefelter's Syndrome and Idiopathic Normal-Pressure Hydrocephalus?","authors":"Alessandro Pesce, Graziano Taddei, Mauro Palmieri, Silvia Ciarlo, Rita Carnevale, Stefania Elia, Angelo Pompucci, Gianpaolo Petrella","doi":"10.1055/s-0045-1810046","DOIUrl":"10.1055/s-0045-1810046","url":null,"abstract":"<p><p>Idiopathic normal-pressure hydrocephalus shows a typical clinical triad consisting of gait disturbance, dementia, and urinary incontinence, often combined with ventriculomegaly. Fortunately, these clinical manifestations are potentially reversible by adequate surgical treatment. Men affected by Klinefelter's syndrome can present cognitive problems. These include impairments in both verbal and nonverbal memory and in executive functions, which could be related to idiopathic normal-pressure hydrocephalus in these patients. In this study, we describe the case of a 62-year-old-man genetically diagnosed with Klinefelter's syndrome with a history of gait ataxia resulting in recurrent falls. Direct associations between idiopathic normal-pressure hydrocephalus and Klinefelter's syndrome and clinical pathophysiologic and potential molecular implications are discussed.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"591-595"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789339","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":"Shifting the Culture: How Crew Resource Management Can Enhance Team Dynamics in Neurosurgery.","authors":"Marcel Alexander Kamp, Christiane von Sass, Felix Mühlensiepen, Christian Senft, Nazife Dinc","doi":"10.1055/a-2590-6245","DOIUrl":"10.1055/a-2590-6245","url":null,"abstract":"","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"602-606"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506005","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":"Impact of Suturing Techniques on Microvascular Anastomosis Maturation.","authors":"Jiri Dostal, Pavel Klein, Tereza Blassova, Vladimir Priban","doi":"10.1055/a-2389-7761","DOIUrl":"10.1055/a-2389-7761","url":null,"abstract":"<p><p>Microvascular anastomosis using interrupted suture is a widely accepted standard technique. Continuous suture is less common due to the presumption that its firmness can negatively affect anastomosis maturation. The purpose of this study was to determine whether the use of continuous suture allows maturation of the microanastomosis site.A rat common carotid artery (CCA) end-to-end microanastomosis model was utilized, with 19 Long-Evans rats in the interrupted suture group and 13 in the continuous suture group. Immediate blood flow of the operated and contralateral intact CCAs was compared before clamping, at the completion of the anastomosis and after 14 days. Quantitative transit time flowmetry measurement and histologic examination were employed.Initial blood flow in both intact CCAs was similar across all animals (<i>p</i> = 0.004). In the interrupted suture group, the median anastomosis blood flow was 88.9% of the contralateral CCA blood flow, with a median suture time of 46 minutes. After 2 weeks, blood flow increased to 96.1%. In the continuous suture group, the median anastomosis blood flow was 88.3% of the contralateral CCA blood flow, with a median suture time of 30 minutes. After 2 weeks, blood flow increased to 100.0%. The reduction in suture time achieved with continuous suture was 34.8% (<i>p</i> < 0.001). Histologic examination confirmed scar maturity.The maturation rates of continuous and interrupted suture microanastomosis were comparable in our study, implying that concerns about the suture restricting maturation may be unwarranted. Additional finding is the potential for a reduction in microanastomosis time when using the continuous suture technique.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"583-590"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995914","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":"Radiologic Outcomes after Operative Management of Traumatic Spine Fractures: Stand-Alone Posterior Stabilization versus Combined Anteroposterior Approach.","authors":"Ali Mulhem, Ziad Omran, Stefanie Hammersen, Sven Rainer Kantelhardt","doi":"10.1055/a-2331-2466","DOIUrl":"10.1055/a-2331-2466","url":null,"abstract":"<p><p>Previous research emphasizes correcting deformities resulting from spine fractures by restoring sagittal alignment and vertebral height. This study aims to compare radiologic outcomes, including sagittal index (SI) and loss of vertebral body height (LVBH), between stand-alone posterior stabilization (group I) and the posteroanterior/combined approach (group II) in the operative management of traumatic thoracic or lumbar spine fractures.In this retrospective single-center study, all patients with traumatic spine fractures (T1-L5) undergoing surgical stabilization between January 1, 2015, and May 31, 2021, were included. Two spine surgeons independently assessed imaging, recording the SI and LVBH values at baseline, after each surgical intervention, and during follow-up (at least 3 months posttreatment). The mean SI and LVBH values between the assessing surgeons were utilized. Linear mixed-effects regression models, adjusted to baseline values, compared the SI and the LVBH values between the two groups.In all, 71 patients (42 men), with the median age of 38 years (interquartile range [IQR]: 28-54) and median follow-up of 4 months (IQR: 3-17), were included. Thirty-two patients were in group I and 39 patients were in group II. Forty fractures included the thoracolumbar junction (T12 or L1), 15 affected the thoracic spine, and 14 the lumbar spine. The regression model revealed superior sagittal alignment in group II, with an adjusted mean difference for SI of -4.24 (95% confidence interval [CI]: -7.13 to -1.36; <i>p</i> = 0.004), and enhanced restoration of vertebral body height with an adjusted mean difference for LVBH of 0.11 in the combined approach (95% CI: 0.02-0.20; <i>p</i> = 0.02). Nine postoperative complications occurred in the entire cohort (4 in group I and 5 in group II).Combined posteroanterior stabilization for spine fractures improves deformities by enhancing sagittal alignment and increasing vertebral body height, with acceptable morbidity compared with the stand-alone posterior approach.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"516-523"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12513764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid Clinical Deterioration of a Patient with a Posterior Fossa Hemangioblastoma and Extensive Cerebellar Ischemia: Report of a Unique Case.","authors":"Adrian Liebert, Karl-Michael Schebesch, Cristiane Blechschmidt, Thomas Eibl, Leonard Ritter","doi":"10.1055/a-2521-3080","DOIUrl":"10.1055/a-2521-3080","url":null,"abstract":"<p><p>Hemangioblastomas are rare, benign, highly vascularized tumors, which among other locations arise in the central nervous system. Due to the tumor's dense vascularity, bleeding and interference with the surrounding brain tissue and vasculature have been reported. Rapid neurological deterioration due to hemorrhage from a hemangioblastoma, especially in spinal locations, has been reported.Rapid clinical deterioration occurred in a 47-year-old male patient with a cerebellar hemangioblastoma and delayed extensive cerebellar ischemia, consecutively. Initial cranial magnetic resonance imaging revealed the tumor with small ischemic areas in the left cerebellar hemisphere. A couple of days later, consciousness dropped significantly and immediate computed tomography revealed extensive ischemia of the left cerebellar hemisphere. Emergency suboccipital decompressive craniectomy and tumor resection were performed. The patient recovered and was discharged to neurological rehabilitation a couple of weeks later.Despite the benign character of hemangioblastomas, life-threatening rapid deterioration due to cerebellar ischemia can occur as reported in this case.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"596-601"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078509","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":"First Experience Using a New Minimally Invasive Screw-Rod System for Completely Percutaneous Pedicle Screw Fixation of the Cervical Spine.","authors":"Christoph Scholz, Marc Hohenhaus, Ulrich Hubbe, Florian Volz, Ralf Watzlawick, Jürgen Beck, Jan-Helge Klingler","doi":"10.1055/a-2479-5742","DOIUrl":"10.1055/a-2479-5742","url":null,"abstract":"<p><p>In contrast to the thoracolumbar spine, where pedicle screws can be inserted via a minimally invasive, percutaneous technique through small skin incisions, all previously available cervical instrumentation systems required a larger midline incision, especially for rod insertion. Screw placement via small incisions reduces the risk of wound healing disorders and blood loss, and patients can be mobilized more quickly and with less pain. In 2022, a cervical, minimally invasive stabilization system became available for the complete percutaneous insertion of both cervical pedicle screws and rods. We report on the first results and experiences with this new technology.In this retrospective case series, we included patients with cervical instability treated by minimally invasive percutaneous cervical and upper thoracic spine pedicle screw and rod insertion between August 2022 and August 2023. Intra- and postoperative complications as well as revision surgeries were recorded. The screw position was evaluated by three examiners in the postoperative computed tomography (CT) using the Bredow classification.Our series includes six male patients (age = 56.9 ± 12.9 years; body mass index [BMI] = 29.8 ± 9.6 kg/m²). The indication for surgery was trauma, tumor, and degenerative stenosis in two patients each. An excellent/good screw position (Bredow 1 and 2) was found in 84.4% of the screws (n = 27/32). None of the screws rated as Bredow 3 (<i>n</i> = 2/32) or Bredow 4 (<i>n</i> = 3/32) resulted in a neurological deficit or radicular pain and none had to be repositioned. No neurologic complication or revision surgery occurred. As a complication not directly related to the surgery technique, one patient died of a pulmonary lung embolism on the seventh postoperative day.The results of this study indicate that minimally invasive percutaneous implantation of a pedicle screw-rod system is also possible in the cervical spine with sufficient accuracy using intraoperative navigation. However, technical details, possible pitfalls and finally careful patient selection must be taken into account.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"537-543"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687155","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":"Risk Factors for and Molecular Pathology Characteristics of Systemic Metastasis of Adult Cerebral Glioblastoma: A Pooled Individual Patient Data Analysis and Systematic Review.","authors":"Lingcheng Zeng, Hongkuan Yang, Hua Li, Rudong Chen, Jian Chen, Jiasheng Yu","doi":"10.1055/a-2479-9978","DOIUrl":"10.1055/a-2479-9978","url":null,"abstract":"<p><p>The risk factors for and molecular mechanisms of systemic metastasis of cerebral glioblastoma (GBM) remain to be evaluated.Literature about adult GBM patients with systemic metastasis published before December 31, 2022, was searched in \"PubMed\" and \"Web of Science,\" and the patient's clinical data were collected and compared with those of patients without metastasis to evaluate the risk factors. The molecular pathology results were summarized to evaluate the mechanism.One hundred and forty-seven patients with metastasis in 113 papers published from 1928 to 2022 were included. Two hundred and forty-nine patients without metastasis who underwent surgery in our department in 2017 were included. Comparison of the two groups showed that age ≤40 years was significantly correlated with metastasis (hazard ratio [HR]: 2.086, 95% CI: 1.124-3.871, <i>p</i> = 0.020) and better overall survival (HR: 1.493, 95% CI: 1.067-2.083, <i>p</i> = 0.019). Molecular pathology results were reported in 39 cases (39/147, 26.5%). The genetic results showed obvious heterogeneity. According to the frequency and positive ratio, IDH-wild type (positive rate 27/30), TERT promoter mutation (11/13), PTEN mutation (10/11), TP53 mutation (10/13), and RB1 mutation (8/9) were common gene changes.In young adult GBM patients, especially those ≤40 years of age with long survival, attention should be given to the development of systemic metastases. Metastasis can be the result of multiclonal gene mutations, in which proliferation- and invasion-related gene changes, such as oncogene or tumor suppressor gene mutations and epithelial-mesenchymal transition-related genes, may play an important role in metastasis.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"574-582"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687256","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":"Maternal Matters: Neurosurgery During Pregnancy-A German Nationwide Survey.","authors":"Catharina Conzen-Dilger, Karlijn Hakvoort, Katharina Seyfried, Hans Clusmann, Anke Höllig","doi":"10.1055/a-2564-1213","DOIUrl":"10.1055/a-2564-1213","url":null,"abstract":"<p><p>In Germany, pregnancy often results in a ban from the operating theater for surgeons, reflecting legislation prioritizing maternal and fetal protection over individual autonomy. Due to limited data for German neurosurgeons, we aimed to assess the attitudes of German women neurosurgeons toward continuing surgical work during pregnancy and lactation to provide appropriate recommendations.We conducted an online SurveyMonkey survey among all female members of the German Society for Neurosurgery (Deutsche Gesellschaft für Neurochirurgie) and the Professional Association of German Neurosurgeons (Berufsverband Deutsche Neurochirurgie).Of 286 invited women neurosurgeons, 122 responded (42.6%), with 65 (53.3%) having children or being currently pregnant with their first child. The majority (98.5%) desired to continue surgery during pregnancy, yet 80% expressed concerns about announcing their pregnancy due to potential job-related disadvantages. However, 35.4% (23 out of 65) ceased surgery due to an immediate ban imposed by the company physician and only a minority due to health-related issues (<i>n</i> = 2). Of the remaining 42 women who initially continued operating, 73.2% reported good departmental support during pregnancy. However, 18.5% (12/65) faced a subsequent surgery ban after announcing their pregnancy. Overall, there were no successful appeals (<i>n</i> = 13). Nearly a third eventually resumed surgery, implementing additional protective measures such as extended disease testing. However, self-estimation revealed a reduced surgical performance of approximately 35% compared with the year before pregnancy. Five women (7.7%) informed the company physician only at the end of pregnancy to circumvent the ban. Approximately a quarter (27%) experienced surgery-free periods of 1 to 1.5 years, whereas 21% reported 1.5 to 2 years per pregnancy. Forty-four percent reported discrimination in surgery allocation upon return, whereas 48% reported none.Most women neurosurgeons aspire to continue surgery during pregnancy, yet face involuntary bans. Despite permission to operate, procedural volumes decrease significantly, compounded by surgery-free periods during lactation and parental leave, and reported discrimination upon return. We hypothesize that pregnancy-related bans exacerbate a glass ceiling effect, impeding women neurosurgeons' career progression, and propose removing bureaucratic obstacles to enable continued surgical practice.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"553-561"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506004","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}