Neurosurgical Review最新文献

{"title":"Earlier onset of cerebral vasospasm in ruptured infectious intracranial aneurysms.","authors":"Youssef M Zohdy, Jason Lamanna, Laurie Dimisko Bsn, Jonathan A Grossberg, Daniel L Barrow, C Michael Cawley, Hassan Saad, Feras Akbik, Gustavo Pradilla, Tomas Garzon-Muvdi, Ofer Sadan, Owen B Samuels, Ali M Alawieh, Brian M Howard","doi":"10.1007/s10143-025-03493-2","DOIUrl":"https://doi.org/10.1007/s10143-025-03493-2","url":null,"abstract":"<p><strong>Introduction: </strong>Infectious intracranial aneurysms(IIAs) are a rare complication of systemic and intracranial infections. IIAs are often diagnosed upon rupture, often leading to subarachnoid hemorrhage(SAH) similar to non-infectious aneurysms(non-IIAs). Although vasospasm is a common complication of both SAH and meningitis, the incidence, timing, and management of vasospasm in IIA patients are yet to be studied.</p><p><strong>Methods: </strong>This is a retrospective study of patients presenting with SAH secondary to IIAs or non-IIAs between 2015 and 2023. Patients with SAH who died within 48 h were excluded. Patients' charts were reviewed for demographics, imaging findings, management, and the timing, severity, and management of vasospasm. Propensity-score-matching was used to compare patients with IIAs versus non-IIAs. Primary outcome included incidence of vasospasm. Secondary outcomes included time to vasospasm, and treatment response.</p><p><strong>Results: </strong>Twenty patients with ruptured IIAs were included in this study of which 30%(n = 6) developed vasospasm. Among patients with vasospasm, 83% had neurological deficits due to vasospasm. Vasospasm was managed using intrathecal nicardipine in 5 patients(83%), while 2 patients required intra-arterial vasodilators. Compared to propensity-score-matched non-IIAs, patients with IIAs had a comparable rate of vasospasm(30%vs39%,P = 0.448). However, patients with IIAs developed vasospasm significantly earlier with a mean time from rupture to vasospasm of 3.5 ± 1.05days compared to 5.27 ± 3.15days in non-IIAs(P = 0.002).</p><p><strong>Conclusion: </strong>Patients with ruptured IIAs are at a similar risk of vasospasm compared to non-IIAs; however, they develop symptomatic and radiographic evidence of vasospasm earlier in the course of their disease. These findings argue for the need for routine and early screening for vasospasm in patients with ruptured IIAs.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"352"},"PeriodicalIF":2.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of chemonucleolysis and discectomy in the management of lumbar disc herniation: a comprehensive systematic review and meta-analysis.","authors":"Cristian D Mendieta-Barrera, Fernando De Nigris Vasconcellos, Kevin Mamani-Julian, Priscilla Isabel Freeman, Fabricio Garcia-Torrico, Vanessa Pamela Salolin Vargas, Emanuela Binello","doi":"10.1007/s10143-025-03501-5","DOIUrl":"10.1007/s10143-025-03501-5","url":null,"abstract":"<p><p>Lumbar disc herniation (LDH) represents a significant cause of pain and physical impairment, negatively impacting the quality of life, and burdening healthcare systems. Despite numerous treatment strategies, optimal management remains a subject of debate. This meta-analysis aims to compare the efficacy and economic impact of chemonucleolysis (CN) and discectomy in the management of LDH. An extensive search of Embase, PubMed, and Cochrane databases yielded 391 records. Following strict inclusion and exclusion criteria, twenty-one studies suitable for a comparative analysis between CN and discectomy were included. This selection was based on patient improvement, including pain scores, complications, and differences in cost and surgery time. A total of 2436 patients were included in this study. Among them, 1,121 patients (46%) underwent discectomy, while 1,315 patients (54%) received the CN approach. Our analysis revealed that discectomy had a significantly higher improvement rate compared with chymopapain CN (OR: 0.45; 95%CI 0.23,0.88) and non-chymopapain CN (OR: 0.61; 95%CI 0.38,0.97). A non-significant inclination towards complication rates was observed with chymopapain CN (OR: 1.90; 95%CI 0.68,5.29). Notably, CN was associated with a considerable cost reduction (SMD: 7.11; 95%CI -11.37,-2.85) and a shorter surgical time (MD: -53.54; 95%CI -57.91,-49.17) compared with discectomy. The evidence synthesized in this meta-analysis suggests superior clinical outcomes for discectomy when compared to CN in managing LDH. However, CN demonstrated a notable advantage in terms of cost-efficiency and operative time, marking it as a potentially preferable option in resource-constrained settings. Nonetheless, more randomized clinical trials and prospective studies are necessary to confirm these findings.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"347"},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of surgical timing on chronic subdural hematoma outcomes: novel insights from a multicenter study.","authors":"Stefano Colonna, Enrico Lo Bue, Alessandro Pesaresi, Lorenzo Dolci, Andrea Gatto, Luca Ceroni, Alessandro Pesce, Maurizio Salvati, Daniele Armocida, Alessandro Frati, Antonio Santoro, Alice Mistretta, Diego Garbossa, Fabio Cofano","doi":"10.1007/s10143-025-03502-4","DOIUrl":"10.1007/s10143-025-03502-4","url":null,"abstract":"<p><strong>Objective: </strong>Chronic Subdural Hematoma (CSDH) is one of the most frequently encountered conditions in the neurosurgical practice. The role of timing in CSDH surgery in mild symptomatic patients remains uncertain. The aim of this study was to analyze the prognostic role of surgical timing in patients with mild symptomatic CSDH.</p><p><strong>Methods: </strong>In this multicenter retrospective study, patients diagnosed with mild symptomatic CSDH who underwent surgical evacuation were enrolled. Marwalder Grading System (MGS) and GCS scores were used for neurological evaluation. Patients presenting with preoperative GCS score ≥ 13 and MGS score ≤ 2 scores were defined as \"mild symptomatic\". A ROC curve analysis was used to identify the optimal surgical timing associated with favorable postoperative outcome. Univariate and multivariate analysis were used to verify the association between surgical timing and postoperative neurological outcome, length of hospitalization, and postoperative complication.</p><p><strong>Results: </strong>A total of 160 patients were enrolled in the study. The mean latency from hospital admission to surgical intervention was 2.5 ± 3.2 days. All patients treated with surgical evacuation demonstrated postoperative clinical improvement in terms of GCS and/or MGS scores. The univariate and multivariate analyses demonstrated significantly better neurological outcomes and shorter length of hospitalization in patients treated within 3 days from hospital admission. No statistically significant associations were demonstrated between surgical timing and postoperative complication.</p><p><strong>Conclusions: </strong>This is the first study to identify a specific surgical timing cut-off in the treatment of mildly symptomatic CSDH associated with improved clinical outcomes and recovery, offering a potential reference point for clinical decision-making. Patients who underwent surgery within three days from hospital admission exhibited significantly better postoperative neurological outcomes and shorter hospital stays. Surgical timing did not influence postoperative complications, including hematoma recurrence or the need for early reintervention.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"349"},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pericallosal artery aneurysms: an evidence-based analysis of clinical presentations, therapeutic approaches, and outcome.","authors":"Amr Badary, Khadeja Alrefaie, Mohammed A Azab, Yasser F Almealay, Mohammed Q Alibraheemi, Wireko Andrew Awuah, Alan Hernández-Hernández, Sura N Alrubaye, Nabiha Midhat Ansari, Levent Tanrikulu, Oday Atallah","doi":"10.1007/s10143-025-03500-6","DOIUrl":"10.1007/s10143-025-03500-6","url":null,"abstract":"<p><p>Pericallosal artery aneurysms (PCAA) are relatively rare intracranial aneurysms that present unique challenges in diagnosis and management. This study provides a comprehensive review of the literature to assess demographic patterns, risk factors, treatment approaches, and complications associated with PCAA. Data from 23 studies were analyzed using Python with libraries such as Pandas and Matplotlib. Descriptive statistics and crosstabulations explored the relationships between treatment modalities (microsurgical, endovascular, combined) and complications, including hydrocephalus, vasospasms, and intraprocedural ruptures. Visualizations were employed to depict the prevalence and impact of various outcomes. Analysis revealed a notable gender disparity, with females constituting 70.47% of the study population. The average age was 49.93 years, and the average aneurysm size was 6.34 mm. A majority of aneurysms were ruptured (542 ruptured vs. 251 unruptured). Risk factors like smoking were prevalent, and radiological features such as subarachnoid hemorrhage (SAH) were commonly reported. Endovascular treatment was slightly more frequent (86.96%) than microsurgical treatment (73.91%). Vasospasm was the most reported complication (56.5%), followed by hydrocephalus and intraprocedural rupture. The analysis of the distribution of studies reporting complication for each treatment modality showed that endovascular treatment studies reported higher rates of vasospasms, hydrocephalus and intraprocedural rupture. The mortality rate was 6.52%, with a mean follow-up duration of 20.77 months. This review reveals that PCAAs predominantly affect females, with an average patient age of 49.93 years. Aneurysms averaged 6.34 mm and often caused SAH. Endovascular treatments were more common but had higher complication rates than microsurgical methods, which also carried risks. The mortality rate was 6.52%.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"348"},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of sedation levels on outcomes in neurocritical care patients with intracranial hemorrhage: a retrospective cohort study.","authors":"Hyo Jeong Kim, Yoohyun Kwon, Jinhoo Seok, Haewon Roh, Joonho Byun, Wonki Yoon, Jong Hyun Kim, Taek-Hyun Kwon, Hyunjun Jo","doi":"10.1007/s10143-025-03507-z","DOIUrl":"10.1007/s10143-025-03507-z","url":null,"abstract":"<p><p>Sedation in neurointensive care is essential for managing patients with acute brain injuries. While sedation is commonly employed to alleviate stress responses and enhance patient comfort, the relationship between sedation practices and clinical outcomes remains unclear. This retrospective cohort study analyzed electronic medical records of patients with intracranial hemorrhage admitted to a tertiary care neurosurgical center from January 2020 to December 2023. Patients with a Glasgow Coma Scale (GCS) ≥ 13, early mortality, or prior treatment elsewhere were excluded. Sedation depth was assessed using the Richmond Agitation-Sedation Scale. Outcomes included intensive care unit (ICU) length of stay, Glasgow coma scale at discharge, modified Rankin Scale (mRS) at three months, and infection rates. Among 562 patients screened, 138 met inclusion criteria, with 73 (52.9%) receiving sedation. No significant differences were observed in ICU stay, discharge GCS, or mRS between sedation and non-sedation groups, nor between light and deep sedation. The sedation group had longer mechanical ventilation (15 ± 12 days vs. 7.03 ± 12.83 days; p < 0.05) but similar rates of hospital acquired pneumonia (68.49% vs. 50.77%; p = 0.44). Sedation depth and the decision to sedate did not significantly impact key clinical outcomes. Individualized sedation strategies should prioritize patient comfort and clinical needs without assuming deeper sedation adversely affects recovery.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"351"},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors of postprocedure seizures following standalone middle meningeal artery embolization of chronic subdural hematomas: a bi-institutional retrospective analysis.","authors":"Felipe Ramirez-Velandia, Kasuni H Ranawaka, Aryan Wadhwa, Thomas B Fodor, Mira Salih, Emmanuel O Mensah, Tzak S Lau, Niels Pacheco-Barrios, Alejandro Enriquez-Marulanda, Imad S Khan, Philipp Taussky, Jennifer Hong, Christopher S Ogilvy","doi":"10.1007/s10143-025-03504-2","DOIUrl":"10.1007/s10143-025-03504-2","url":null,"abstract":"<p><strong>Background: </strong>Seizures have been reported to arise after middle meningeal artery embolization (MMAE) for the treatment of chronic subdural hematomas (cSDH). However, the rates and factors influencing their development have been poorly established in the literature. Herein, we assess for risk factors for seizures post-MMAE.</p><p><strong>Methods: </strong>A retrospective review of patients with cSDH treated with standalone MMAE from 2017 to 2021 was conducted at two academic institutions in the United States. Seizures were documented using the definition set by the International League Against Epilepsy. Medical charts and imaging were evaluated to assess risk factors associated with postprocedure seizures.</p><p><strong>Results: </strong>A total of 113 patients, mostly males (57.5%) with 132 cSDH, were included in this analysis. The median thickness of collections was 13.1 mm, and the midline shift was 3 mm. Seizures occurred in five patients (4.4%) and resulted in longer hospitalizations (9 vs. 4 days; p = 0.03) and in-hospital mortality (20.0% vs. 0.9%; p < 0.01). Univariate analysis demonstrated that a midline shift ≥ 5 mm (OR = 6.47; 95% CI = 1.25-33.56; p = 0.03) and a pre-procedure GCS ≤ 12 (OR = 20.33; 95% CI = 2.43-170.15; p < 0.01) were risk factors for developing seizures following MMAE.</p><p><strong>Conclusions: </strong>Seizures, although uncommon, can occur following MMAE, substantially impacting the length of hospitalization and hospital mortality, with variables such as a GCS score below 13 and a midline shift ≥ 5 mm associated with their development. The role of prophylactic AEDs post-MMAE still needs further evaluation.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"350"},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Yellow enhance mode is useful for distinguishing tissues in endoscopic transnasal surgery: case series with preliminary results.","authors":"Hirotaka Hasegawa, Yuki Shinya, Motoyuki Umekawa, Satoshi Koizumi, Yoshiaki Goto, Satoshi Kiyofuji, Shunya Hanakita, Masahiro Shin, Masao Iwagami, Nobuhito Saito","doi":"10.1007/s10143-025-03485-2","DOIUrl":"10.1007/s10143-025-03485-2","url":null,"abstract":"<p><p>Precise tissue differentiation is vital in neurosurgery, especially during endoscopic endonasal surgery (ETS), where visual information is critical. The Yellow Enhance (YE) mode, a novel image-enhanced endoscopy technology, emphasizes yellow pigments to potentially improve tissue differentiation. This study retrospectively evaluated the efficacy of YE mode in five cases (two primary pituitary neuroendocrine tumors, one recurrent skull base-invasive pituitary neuroendocrine tumor, one pituitary apoplexy, and one recurrent craniopharyngioma) using the Olympus VISERA ELITE III endoscope. Eight experienced neurosurgeons reviewed surgical videos and provided 40 structured evaluations. Statistical analyses (Kruskal-Wallis and Mann-Whitney U tests) compared scores among cases. Gross or near-total resection was achieved in all cases without neurological complications. YE mode improved differentiation between normal pituitary tissue and tumors in 80% of cases, but was less effective in cases like pituitary apoplexy with degenerative changes. Across 40 evaluations, 68% rated YE mode as \"useful\" or \"somewhat useful,\" while 20% noted limited utility in complex cases, such as recurrent craniopharyngiomas. YE mode shows promise in enhancing visual differentiation during ETS, particularly for normal pituitary tissue, but its utility depends on tissue characteristics. Larger prospective studies are needed to validate these findings and explore broader applications in neurosurgery.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"346"},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved pre-surgical localization of epileptogenic tubers in pediatric tuberous sclerosis complex using mean apparent propagator MRI.","authors":"Hui Sun, Zhiping Yan, Junhang Gao, Yingzhi Zheng, Yueyu Zheng, Yang Song, Jin Fang, Hong Qu, Yingying Song, Yanzhao Diao, Sulian Su, Guihua Jiang","doi":"10.1007/s10143-025-03495-0","DOIUrl":"https://doi.org/10.1007/s10143-025-03495-0","url":null,"abstract":"<p><p>Surgery is the most effective treatment for controlling refractory epilepsy in Tuberous Sclerosis Complex (TSC) patients, and accurate pre-surgical localization of epileptogenic tubers is crucial for improving outcomes. However, identifying epileptogenic tubers using conventional MRI remains challenging. This study aimed to evaluate the potential of combining Diffusion Tensor Imaging (DTI) and Mean Apparent Propagator (MAP) MRI for non-invasive tuber identification, enhancing pre-surgical assessment. This prospective study included 42 children with TSC who underwent preoperative MRI, including DTI and MAP sequences. A total of 342 cortical tubers were segmented and split into 70% training and 30% validation sets. LASSO regression was used for feature selection, and a multi-parametric logistic regression model was developed. The combined DTI-MAP model achieved an AUC of 0.83 (95% CI: 0.75-0.91) in the validation cohort, outperforming DTI alone (AUC = 0.769) and MAP alone (AUC = 0.804). Key predictive features included tuber volume (OR = 1.573, p = 0.03), Axial Diffusivity (AD, OR = 31.35, p = 0.011), Fractional Anisotropy (FA, OR = 0.26, p = 0.005), and Mean Squared Displacement (MSD, OR = 0.045, p = 0.023). A nomogram was constructed from these features, providing a visual tool for risk estimation and showing good calibration. Combining DTI and MAP MRI parameters significantly improves non-invasive identification of epileptogenic tubers, providing better guidance for surgical planning and improving long-term seizure control and clinical outcomes in children with TSC.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"344"},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Braden Scale and all-cause mortality in critically ill patients with non-traumatic subarachnoid hemorrhage: analysis of the MIMIC-IV database.","authors":"Yibo Yang, Hui Shen, Hao Guan, Bing Wang, Qing Mei, Jiachun Liu, Aihua Liu","doi":"10.1007/s10143-025-03508-y","DOIUrl":"https://doi.org/10.1007/s10143-025-03508-y","url":null,"abstract":"<p><p>The Braden Scale (BS) is a routine nursing measure used to predict the risk of pressure ulcer events; recent studies suggest its use as a tool for identifying frailty. However, it remains unclear whether the BS holds prognostic value for patients with severe non-traumatic subarachnoid hemorrhage (SAH). In this retrospective study, participants from the Medical Information Mart for Intensive Care (MIMIC-IV) database were categorized into two groups based on their Braden Scale (BS) scores: the high-risk group (BS ≤ 15) and the low-risk group (BS > 15). The primary outcome was all-cause mortality at 3 months. A Cox proportional hazards model was constructed to examine the association between BS and all-cause mortality in critically ill patients with non-traumatic subarachnoid hemorrhage. A restricted cubic spline model was employed to assess the relationship between BS and outcomes. A total of 750 patients were included in the study, with 43% being male. The mortality rates at 1 month, 3 months, and 1 year were 21%, 25%, and 29%, respectively. Multivariable Cox proportional hazards analysis revealed that the Braden Scale (BS) was independently associated with the risk of death at 1 month (HR, 2.84 [1.26-2.81], P=0.002 ), 3 months (HR, 2.84 [1.73-4.66], P<  0.001), and 1 year (HR, 1.65 [1.15-2.38], P = 0.006). The restricted cubic spline regression model showed that the risk of death at 3 months increased linearly with decreasing BS scores. The BS is significantly associated with all-cause mortality in critically ill patients with non-traumatic SAH. This finding suggests that the BS may be useful in identifying non-traumatic SAH patients at higher risk of all-cause mortality.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"345"},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 neuroendoscopic drainage in intraventricular hemorrhage: an updated meta-analysis.","authors":"Frederico de Lima Gibbon, Rafaela Jucá Lindner, Matheus Rech, Guilherme Gago, Lucca Biolcati Palavani, Gabriel Semione, Felipe Salvagni Pereira, Antônio Delacy Martini Vial, Feres Chaddad-Neto","doi":"10.1007/s10143-025-03471-8","DOIUrl":"https://doi.org/10.1007/s10143-025-03471-8","url":null,"abstract":"<p><p>External ventricular drainage (EVD) is a mainstay for intraventricular hemorrhage (IVH) treatment, improving ventricular clearance and reducing mortality but with suboptimal complications and morbidity. Meanwhile, several studies have shown that neuroendoscopic drainage (NED) provides superior results and is a promising therapy. Thus, we aimed to compare NED and EVD in patients with IVH. A systematic literature review was conducted using Embase, PubMed, and Cochrane databases. The primary outcome was shunt dependency. Secondary outcomes were infection, length of intensive care unit (ICU) and hospital stay, mortality, and functional outcome. Inclusion criteria: studies comparing NED and EVD with predefined outcomes. Exclusion criteria: age < five years. Statistical analysis was performed using RStudio 2024.04.1 + 748. Sensitivity analysis was performed with subgroup analysis. The risk of bias was assessed using ROBINS-I and RoB-2. Of 234 potential articles, 17 met our criteria, involving 1043 patients, with 495 undergoing NED and 548 receiving only EVD. Patients who underwent NED had lower odds of shunt dependency (OR 0.17; 95% CI 0.12,0.25; p < 0.001), infection (OR 0.29; 95% CI 0.16,0.53; p < 0.001), and mortality at one month (OR 0.44; 95% CI 0.20,0.96; p = 0.039) and six months (OR 0.31; 95% CI 0.16,0.58; p < 0.001), shorter hospital (MD -6.02; 95% CI -9.58,-2.45; p < 0.001) and ICU stay (MD -6.64; 95% CI -10.46,-2.83; p < 0.001), and better functional outcomes according to Glasgow Outcome Scale (MD -0.65; 95% CI -0.98,-0.32; p < 0.001) and modified Rankin Scale (MD -1.25; 95% CI -1.90,-0.60; p < 0.001) compared to patients who underwent EVD. To confirm the robustness of the results, we performed sensitivity analyses with subgroups of the RCT, which also showed significant superiority of NED over EVD. Our results suggest that NED has a positive impact on patients with IVH and may be a breakthrough intervention in this scenario.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"343"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}