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

{"title":"Patient-Specific Computed Tomography-Based Three-Dimensional Spine Trauma Models for Preoperative Planning in Virtual Reality and 3D Printing: An EANS Young Neurosurgeons' Network Study.","authors":"Martin Trandzhiev, Erik Schulz, Martin N Stienen, Oliver Bozinov, Cateno Petralia, Carmelo Vitaliti, Martina Rossitto, Daniel Alvarado Flores, Giuseppe M V Barbagallo, Vincenzo Fanelli, Mary Solou, Efstathios J Boviatsis, Dimitrios Dimopoulos, Vivek Sanker, Antonia Vogt, Vladimir Nakov, Diogo Belo, Evangelos Drosos, Maria L Gandía-González, Toma Spiriev, Giovanni Raffa","doi":"10.1055/a-2726-3537","DOIUrl":"10.1055/a-2726-3537","url":null,"abstract":"<p><p>Lately, the wide availability of open-source modelling and rendering software in neurosurgery has led to the development of a methodological pipeline for creating patient-specific three-dimensional (3D) models based on preoperative imaging data. With recent innovations in virtual reality (VR) technology and 3D printing, these models can be applied to enhance preoperative planning and medical training. The main question this paper aims to answer is whether the proposed algorithm of intensity-based CT segmentation and basic 3D modelling is adequate to create a reference library of patient-specific models, categorized according to the AO Spine Injury Classification System, and suitable for VR and 3D printing-based preoperative planning.We used the open-source medical image viewer Horos to create volumetric renderings of CT scans of trauma patients from several European centers. The models were postprocessed using 3D modelling software and exported in appropriate formats for VR or 3D printing.We created 37 models of trauma patients, spanning from the upper cervical to the thoracolumbar segment, categorized according to the AO Spine Injury Classification System. Additionally, a remote case discussion conducted by uploading these models into a collaborative VR environment was demonstrated as a proof of concept.In the present study, we demonstrated that open-source software can create a database of patient-specific 3D models. Additionally, the communication between remote departments can be facilitated by uploading these models into a collaborative VR environment, and the comprehensive evaluation of spine fractures fostered through 3D printing. Further studies are needed to assess the database's educational value.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"197-206"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145856876","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 Perfusion Dynamics in Arachnoid Cysts: Insights from Pre- and Postendoscopic Intervention.","authors":"Gopal Krishna, Mohammad Sajid, Ishwar Singh, Seema Rohilla, Manjeet Singh, Meghna Chauhan","doi":"10.1055/a-2749-5829","DOIUrl":"10.1055/a-2749-5829","url":null,"abstract":"<p><p>Arachnoid cysts by virtue of their volume and intracystic tension, produce local mass effect, and impair the perfusion of surrounding brain parenchyma.The magnetic resonance (MR) perfusion parameters cerebral blood flow (CBF), relative cerebral blood volume (rCBV), and mean transit time (MTT) of brain parenchyma contiguous with the arachnoid cyst were compared with corresponding contralateral hemisphere. Twenty cases of arachnoid cyst were treated using endoscopic techniques. The perfusion changes in parenchyma were assessed 3 months postoperatively. Clinical outcomes were assessed at 6 months' postsurgery.Headache was the predominant symptom (85%), with Sylvian fissure representing the most frequent anatomical location (65%). Endoscopic procedure was successful in 80% of the cases, whereas 20% of the cases required conversion to minicraniotomy and microsurgical cyst excision. Preoperatively, mean CBF (mL/100 g/min), rCBV (mL/100 g), MTT (seconds) in perilesional brain area were 42.58 ± 7.17, 4.48 ± 1.25, 5.56 ± 1.72, respectively, and 3 months postoperatively were 45.83 ± 8.87, 4.48 ± 1.62, 4.37 ± 1.68, respectively. The mean CBF (mL/100 g/min), rCBV (mL/100 g), MTT (seconds) in corresponding contralateral hemisphere was 46.77 ± 10.85, 4.29 ± 1.35, 5.24 ± 1.104, respectively, whereas postoperatively they were 46.29 ± 8.49, 5.03 ± 1.16, 5.49 ± 1.97, respectively. The <i>p</i>-value, however, was not significant. Headache improved in 87.5%, whereas seizure in 60% of the cases.Endoscopic treatment of arachnoid cyst is an optimally invasive procedure. The perfusion study is a valuable tool in evaluation of arachnoid cysts. MR perfusion highlights regions of impaired blood flow and focal brain dysfunction. Additionally, changes in perfusion can help assess the therapeutic impact of surgery on the compressed brain tissue.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"213-219"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146064376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-Assisted C2 Laminar Screw Placement: Initial Experience and Accuracy Evaluation.","authors":"Yuki Yamamoto, Takashi Fujishiro, Fumiya Adachi, Takuya Obo, Sachio Hayama, Masashi Neo, Shuhei Otsuki","doi":"10.1055/a-2840-7567","DOIUrl":"10.1055/a-2840-7567","url":null,"abstract":"<p><strong>Background: </strong>The anchor at C2 often serves as a key stabilizer in cervical spine fusion surgery. Although the pedicle screw is considered the standard fixation method at C2, the laminar screw is also a widely used alternative due to its biomechanical stability, comparable to that of C2 PS. However, malpositioning of C2 LS carries a risk of neural injury and compromised fixation stability, and the use of surgical assistance has been reported to improve placement accuracy. The robotic system is a relatively new technology for PS placement, and its application has recently expanded to the cervical spine. The present study aimed to investigate the accuracy of C2 laminar screw placement with robot assistance.</p><p><strong>Methods: </strong>This prospective study evaluated 11 C2 laminar screws in 11 patients who underwent cervical fusion surgery with the robot assistance between March 2024 and June 2025.</p><p><strong>Results: </strong>All 11 C2 laminar screws were successfully placed with no cortical breaches and no screw-related complications. The mean deviations at both the entry point and at a depth of 20 mm were less than 1.0 mm in both the axial and sagittal planes.</p><p><strong>Conclusions: </strong>The results of this study suggest that the robotic system is a potential tool to facilitate accurate C2 laminar screw placement in clinical settings.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512972","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":"Accuracy of Magnetic Resonance Imaging-Based Vertebral and Endplate Bone Quality in Predicting Cage Subsidence in Anterior Cervical Spine Surgery: A Systematic Review and Meta-Analysis.","authors":"Alexander Erick Purnomo, Aldi Nanda Kurniawan, Yang Yang Endro Arjuna, Jephtah Furano Lumban Tobing, Hendra Tjong","doi":"10.1055/a-2793-1168","DOIUrl":"10.1055/a-2793-1168","url":null,"abstract":"<p><strong>Introduction: </strong>Conventional radiographs and bone mineral density are commonly used to predict cage subsidence, though their accuracy can be limited by several factors. Magnetic resonance imaging (MRI)-based measurement of vertebral bone quality (VBQ) and endplate bone quality (EBQ) offer a more detailed assessment of bone quality and subsidence risk. This study aims to evaluate the accuracy of MRI-based VBQ and EBQ in predicting cage subsidence in anterior cervical spine surgery patients.</p><p><strong>Methods: </strong>A comprehensive search was conducted across databases including PubMed, Europe PMC, ScienceDirect, and Google Scholar using keywords such as \"Magnetic Resonance Imaging,\" \"MRI,\" \"Vertebral Bone Quality,\" \"Endplate Bone Quality,\" \"Cage Subsidence,\" \"Anterior Cervical Spine Surgery,\" \"ACDF,\" \"ACCF,\" combined with Boolean operators \"AND\" and \"OR\" up to November 2024. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), with the primary outcome focusing on VBQ and EBQ values, and secondary outcomes examining the area under the curve (AUC), sensitivity, and specificity of VBQ and EBQ.</p><p><strong>Results: </strong>Nine retrospective cohort studies involving 911 patients were included. Pooled analysis showed that high VBQ and EBQ scores were significantly associated with increased subsidence risk (odds ratio [OR]: 2.63, 95% confidence interval [CI]: 1.51-4.60, <i>p</i> = 0.0007). Pooled sensitivity and specificity for VBQ were 78.9% (95% CI: 72.5-85.3%) and 85.7% (95% CI: 82.2-93.1%), respectively, with an AUC of 0.865. EBQ demonstrated pooled sensitivity of 81.8% and specificity of 88.7%, with an AUC of 0.890. The cutoff values for VBQ and EBQ ranged from 2.68 to 3.445 and 1.973 to 4.7, respectively.</p><p><strong>Conclusions: </strong>MRI-based VBQ and EBQ scores demonstrate strong diagnostic accuracy for predicting cage subsidence in anterior cervical spine surgery. These scores could aid in preoperative risk assessment, though further research should aim to standardize MRI protocols and validate cutoff values across diverse populations.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018886","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":"Microsurgical Resection of a Cavernous Malformation of the Trochlear Nerve: A Case Report.","authors":"Katharina Krause, Peter Vajkoczy, Anton Früh","doi":"10.1055/a-2844-9987","DOIUrl":"10.1055/a-2844-9987","url":null,"abstract":"<p><strong>Background: </strong>Cavernous malformations (CMs) involving cranial nerves are exceedingly rare. To date, only six cases of trochlear nerve involvement have been published in the literature. We present the case of a microsurgical resection of a CM affecting the trochlear nerve.</p><p><strong>Methods: </strong>We report the clinical case of a 32-year-old patient who developed diplopia due to a CM affecting the trochlear nerve. Magnetic resonance imaging (MRI) showed a contrast lesion measuring 9 × 5 mm affecting the trochlear nerve. Microsurgical resection of the lesion via a subtemporal approach under continuous neuromonitoring was performed.</p><p><strong>Results: </strong>The patient underwent successful microsurgical resection. Postoperatively, the patient's diplopia remained unchanged. No new neurological deficits were observed.</p><p><strong>Conclusion: </strong>This case demonstrates the feasibility and safety of microsurgical resection of a trochlear nerve CM. Given the rarity of this entity, individual case reports contribute valuable insight into diagnosis and surgical management.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581521","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":"Clinical Features and Survival Outcomes of Pediatric Meningioma Patients: An Integrative Analysis Based on the SEER Database.","authors":"Rui Zhang, Siyu Li, Yanming Ren, Qing Mao, Yuekang Zhang, Xiaodong Niu","doi":"10.1055/a-2846-3421","DOIUrl":"https://doi.org/10.1055/a-2846-3421","url":null,"abstract":"<p><p>Background Pediatric meningiomas are extremely rare. The clinical features and prognosis of these patients remain unclear, especially due to the lack of large-scale clinical data. Methods Pediatric and adult patients with meningiomas diagnosed between 2000 and 2021 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The clinical characteristics (age, sex, race, tumor laterality, tumor behavior, treatment methods, etc.) of the included patients were reviewed, and the survival analysis was estimated via the Kaplan‒Meier method. Results A total of 364 pediatric patients were identified from the database. Pediatric meningiomas accounted for 0.2%-0.6% of all meningiomas per year. The average age of pediatric patients was 12 years, and that of adult patients was 65. Adult meningioma patients were more commonly female, whereas no significant gender difference was observed in pediatric cases (P < 0.001). Moreover, a higher proportion of borderline and malignant tumors was found in pediatric meningioma patients compared to adults (P < 0.001). Survival analysis revealed that pediatric patients had a better survival prognosis than adult patients (P<0.001). Pediatric patients with coexisting tumors had a worse prognosis than those without coexisting tumors (P < 0.001). Conclusion This study comprehensively investigated the clinical features and survival outcomes of pediatric meningioma patients. Pediatric meningiomas are extremely uncommon and account for 0.2%-0.6% of all meningiomas annually. Pediatric meningiomas have different clinical characteristics and better survival prognoses than adult patients.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147673878","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":"Significance of High-Intensity Zones in Lumbar Discs: A Correlation with Endoscopic Findings.","authors":"Shutaro Fujimoto, Takafumi Ohshima, Syunsuke Tamaki, Kosuke Sugiura, Makoto Takeuchi, Masatoshi Morimoto, Fumitake Tezuka, Kazuta Yamashita, Koichi Sairyo, Atsushi Teramoto","doi":"10.1055/a-2846-3487","DOIUrl":"https://doi.org/10.1055/a-2846-3487","url":null,"abstract":"<p><strong>Background and study aims: </strong>The high-intensity zone (HIZ) in a lumbar intervertebral disc on T2-weighted magnetic resonance images has been associated with discogenic low back pain. However, its clinical significance remains uncertain. Histological studies reveal inflammatory changes surrounding the HIZ, suggesting a potential link to disc degeneration. Recent advancements in full-endoscopic spine surgery (FESS) have enabled more detailed intradiscal observations. The purpose of this study is to examine the characteristics of endoscopic findings in the HIZ.</p><p><strong>Material and methods: </strong>Eighty-six patients who underwent FESS between January 2020 and August 2022 were investigated. We defined intradiscal bleeding and/or inflammation as \"red annulus fibrosus\" (RAF) and compared its occurrence between patients with HIZ and without HIZ. In 45 patients with HIZ, the ratio of the signal intensity of the HIZ to that of cerebrospinal fluid (the HIZ/CSF ratio) was compared according to RAF status.</p><p><strong>Results: </strong>RAF was observed in 54.7% of all patients, with a higher prevalence in those with an HIZ (73.3% vs. 34.1%, p<0.01). The HIZ/CSF ratio was significantly higher in patients with RAF than in those without RAF (0.64 vs. 0.46, p=0.03). The receiver-operating characteristic curve for the ability of the HIZ/CSF ratio to predict intradiscal bleeding had an area under the curve of 0.74, with a cutoff value of 0.48 providing 72.7% sensitivity and 66.7% specificity.</p><p><strong>Conclusion: </strong>Intradiscal bleeding and inflammation were observed more often in patients with an HIZ, suggesting an association with degenerative changes. An HIZ/CSF ratio >0.48 on preoperative magnetic resonance images may predict intradiscal bleeding.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654303","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":"Intraoperative Differentiation of Pilocytic Astrocytoma and Hemangioblastoma with Indocyanine Green Video Angiography.","authors":"Berkay Paker, Deniz Kılıç, Kerem Kenan Özçınar, Akin Akakin, Türker Kılıç","doi":"10.1055/a-2849-8919","DOIUrl":"https://doi.org/10.1055/a-2849-8919","url":null,"abstract":"<p><strong>Purpose: </strong>Differentiating between pilocytic astrocytomas (PA) and hemangioblastomas (HB) during surgery is challenging due to their radiological similarities but distinct vascular characteristics and surgical considerations. This study explores the application of indocyanine green (ICG) fluorescence angiography for intraoperative differentiation of these tumors.</p><p><strong>Method: </strong>Four patients with cerebellar cystic masses underwent surgical resection using ICG video angiography. ICG fluorescence patterns were observed intraoperatively to distinguish vascular characteristics. Homogeneous enhancement in HB was hypothesized to contrast with the non-enhancing nodules of PA. The findings were correlated with preoperative imaging and histopathology.</p><p><strong>Results: </strong>In cases of HB, ICG angiography demonstrated early-phase homogeneous fluorescence, highlighting the tumor's high vascularity and aiding complete resection while preserving vascular integrity. In contrast, PA showed no fluorescence in the tumor nodule, enabling piecemeal resection with minimal blood loss. Histopathological diagnoses confirmed the intraoperative findings. The technique was safe, with no complications reported.</p><p><strong>Conclusion: </strong>This study demonstrates the utility of ICG video angiography as an intraoperative adjunct for differentiating PA from HB. Compared to digital subtraction angiography (DSA), ICG offers a cost-effective, safe, and efficient alternative without the need for specialized equipment or radiation exposure. ICG fluorescence enhances intraoperative decision-making and optimizes surgical outcomes for challenging posterior fossa lesions. Further studies are warranted to validate these findings and expand the role of ICG in neurosurgical practice.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645624","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":"Meyer Type III Vertical Atlantoaxial Distraction With Complete Ligamentous Disruption: A Case Report and Surgical Management.","authors":"Ali Hammed, Veit Braun","doi":"10.1055/a-2846-5094","DOIUrl":"https://doi.org/10.1055/a-2846-5094","url":null,"abstract":"<p><strong>Background: </strong>Vertical atlantoaxial distraction (AAD) represents a rare and severe form of craniocervical injury caused by high-energy trauma. It involves vertical separation of the atlas and axis due to complete rupture of the ligamentous stabilizers and poses an immediate risk of neurological or vascular compromise.</p><p><strong>Case description: </strong>A 33-year-old male sustained multiple injuries following a suicidal jump from 10 meters, including a Type III vertical AAD with 6 mm distraction between the C1 and C2 lateral masses. Imaging revealed complete rupture of the alar, apical, and posterior longitudinal ligaments, bilateral facet joint capsule disruption, and a Gehweiler Type I anterior arch fracture of C1. A traumatic dural tear with suspected CSF leak was also identified. Initial anterior stabilization was performed with mini-fragment screws, followed by delayed posterior C1/C2 fusion via transarticular screws one week later due to clinical instability. Intraoperative correction of a 10° C1-C2 rotational deformity was achieved, and dural repair was completed using TachoSil and muscle graft. The patient remained neurologically intact and had an uneventful recovery. Follow-up imaging at one year demonstrated stable alignment of the construct without signs of hardware loosening, failure, or new neurological findings. At the 6-year follow-up, the patient remained neurologically intact with preserved cervical rotation up to 50° Conclusion: This case highlights the diagnostic complexity and management challenges associated with vertical AAD. A classification-based surgical strategy supported by high-resolution imaging and intraoperative navigation led to successful stabilization and excellent neurological outcome.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639220","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 Role of A1 Variations on the Outcomes of Anterior Communicating Artery Aneurysm Treatment.","authors":"Feryal Bastaci, Erhan Çelikoğlu, Tayfun Hakan, Jülide Hazneci, Volga Ulaş Ercan, Yılmaz Önal","doi":"10.1055/a-2790-5115","DOIUrl":"10.1055/a-2790-5115","url":null,"abstract":"<p><p>Anterior communicating artery (ACoA) aneurysms are common and complex. This study investigated the effect of A1 artery variations (hypoplasia/aplasia) on treatment outcomes.We retrospectively reviewed 104 patients with ACoA aneurysms treated either microsurgically or endovascularly.Ruptured aneurysms were present in 58.7% of patients. A1 variations occurred in 45.2% of cases, more frequently in unruptured aneurysms (69.8%, <i>p</i> < 0.01). The neck width of ruptured aneurysms was significantly smaller than that of unruptured ones. Variations reduced the risk of rupture (odds ratio = 0.16, 95% confidence interval = 0.06-0.41; <i>p</i> = 0.001). Microsurgery was the primary treatment (74%), and the rate of A1 variations was significantly lower in these cases (<i>p</i> < 0.05). Second interventions were required in 11.5% of patients, with no significant association to variation or treatment type. Vasospasm occurred in 41% of the ruptured aneurysm cases. Functional outcomes (modified Rankin Scale) were better in patients with A1 variations (<i>p</i> < 0.05). Mortality was 11.5% and unrelated to A1 variation. A higher bottleneck ratio increased mortality risk, whereas a higher height/width ratio decreased it.A1 variations were more common in unruptured ACoA aneurysms. They did not significantly influence retreatment or mortality. These findings may guide management strategies as the detection of unruptured aneurysms increases.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989603","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}