Neurosurgical Review最新文献

{"title":"Comparing surgical outcomes of the semisitting versus lateral position in large vestibular schwannoma surgery: a randomized clinical trial.","authors":"Gang Song, Binghan Zhang, Yuanchen Tang, Haoming Geng, Xiaolong Wu, Yiqiang Zhou, Jiantao Liang","doi":"10.1007/s10143-025-03624-9","DOIUrl":"https://doi.org/10.1007/s10143-025-03624-9","url":null,"abstract":"<p><p>The choice between the semisitting position (SSP) and the lateral position (LP) for vestibular schwannoma (VS) surgery remains a topic of debate, particularly for large tumors, and high-quality evidence is limited. This study aimed to prospectively determine the optimal surgical position for VS with a diameter of ≥ 3 cm. This analysis is based on a randomized clinical trial assessing the efficacy and safety of VS surgery in SSP versus LP. Outcomes included the extent of resection, functional results, complications, and health economics. A total of 115 consecutive patients with large VS were prospectively enrolled between December 2019 and November 2023 (SSP: 58, LP: 57). The gross-total resection (GTR) rate was significantly higher in the SSP group compared to the LP group (P = 0.026). There was no significant difference in facial nerve (FN) function between the groups 7 days post-operation; however, FN function was superior in the LP group after 1 year. Preoperative preparation duration and craniotomy durations in the SSP group were significantly longer, while overall operative time, tumor resection, and cranial closure durations showed no significant differences between the groups. In terms of health economics, patients in the SSP group had longer hospital stays and higher hospitalization costs. This study demonstrated that SSP offers advantages in achieving higher GTR rates. However, it does not provide any significant benefit in preserving facial nerve function. Given the elevated risks of VAE, SSP should primarily be considered for patients in good physical condition. Furthermore, patients in the SSP group required more extensive preoperative evaluations and intensive monitoring, resulting in longer hospital stays and increased costs. The financial implications of hospitalization should also be taken into account.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"472"},"PeriodicalIF":2.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199678","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":"Changes in preoperative and postoperative blood flow parameters are closely associated with in-stent stenosis after flow diverter treatment in unruptured intracranial aneurysms: a retrospective cohort study.","authors":"Zhikun Jia, Xuetao Wang, Jiahe Yin, Mengshi Huang, Bin Luo, Zhichao Wu, Jiayin Ma, Qiyu Xie, Jialin Gao, Qile He, Zhixi Li, Xin Jin, Chi Huang, Xifeng Li, Yanchao Liu, Chuanzhi Duan, Xin Zhang","doi":"10.1007/s10143-025-03569-z","DOIUrl":"https://doi.org/10.1007/s10143-025-03569-z","url":null,"abstract":"<p><p>Flow diverters (FDs) have emerged as a promising therapeutic option for unruptured intracranial aneurysms (UIAs), demonstrating favorable clinical outcomes. Nevertheless, the association between hemodynamic alterations and in-stent stenosis (ISS) following FD implantation remains poorly understood. This study sought to elucidate the independent relationship between perioperative blood flow velocity changes and ISS development in patients undergoing FD treatment for UIAs. A retrospective cohort analysis was conducted on 127 consecutive patients treated with FDs at our institution between July 2023 to September 2024. Hemodynamic parameters, including peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean velocity (MV), were meticulously assessed using transcranial color-coded duplex (TCCD) sonography at both preoperative and postoperative time points. Of the 74 patients who completed follow-up, 8 (10.81%) developed significant ISS, defined as stenosis exceeding 25% of the luminal diameter. Multivariate logistic regression analysis revealed a statistically significant inverse correlation between PSV changes and ISS risk (OR = 0.96, 95% CI: 0.92-0.99, P = 0.026). Stratification of PSV changes into tertiles demonstrated a dose-dependent protective effect, with the highest tertile exhibiting the most pronounced risk reduction. Furthermore, MV changes were independently associated with a 6% reduction in ISS risk per unit increase (OR = 0.94, 95% CI: 0.89-1.00, P = 0.048). A lower variation in preoperative and postoperative peak systolic velocity and MV was associated with an increased risk of ISS. If significant PSV and MV changes are observed between preoperative and postoperative measurements of the parent artery, it may suggest an increased risk of ISS, indicating the need for clinicians to provide additional interventions.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"473"},"PeriodicalIF":2.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199677","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":"Safety and efficacy of endoscopic vs. microscopic approaches in pituitary adenoma surgery: A systematic review and meta-analysis.","authors":"Nada Mostafa Al-Dardery, Abdulrhman Khaity, Youssef Soliman, Mohamed Osama Mohamed Ali, Esraa Mohamed Zedan, Kamila Muyasarah, Mohamed Diaa Elfakhrany","doi":"10.1007/s10143-025-03600-3","DOIUrl":"10.1007/s10143-025-03600-3","url":null,"abstract":"<p><p>Pituitary adenomas (PAs) represent a prevalent category of intracranial tumors, frequently resulting in endocrine dysfunction and neurological impairments. Transsphenoidal surgery (TSS) serves as the primary treatment modality, with the endoscopic transsphenoidal approach (ETSA) and microscopic transsphenoidal approach (MTSA) representing the two principal techniques. This systematic review and meta-analysis aimed to assess and compare the outcomes of ETSA and MTSA in treating PAs. A literature search was performed across PubMed, Scopus, Web of Science, and Cochrane Library. A total of 31 studies comprising 38,301 patients were included. The primary outcomes assessed were gross total resection (GTR) and cerebrospinal fluid (CSF) leak rates. Secondary outcomes encompass endocrine and surgical complications and mortality rates. Statistical analyses utilized R software, employing random-effects models. The analysis indicated insignificant differences in GTR rates between ETSA and MTSA (RR: 1.05, 95% CI [0.97, 1.15]) or in CSF leak rates (RR: 1.03, 95% CI [0.82, 1.31]). Meta-regression analysis revealed that nonfunctional tumors correlated with increased GTR rates, regardless of the surgical technique employed. No notable differences were detected in endocrine or surgical complications between the two methods. Notably, meta-regression analysis indicated that nonfunctional tumors and higher Knosp grade tumors are more likely to be completely resected. Moreover, larger preoperative tumor volume was significantly correlated with an increased risk of postoperative hypopituitarism. Nevertheless, a narrative review of total mortality demonstrated a higher rate in the MTSA group compared to the ETSA group (198 vs. 149 deaths), even with a larger patient cohort in the ETSA group. No publication bias was observed for GTR or CSF leak outcomes. ETSA and MTSA exhibit similar efficacy and safety profiles in treating PAs, with no significant differences in resection rates or complications. The findings highlight the necessity of personalized surgical planning, considering tumor characteristics and institutional expertise. Future research should prioritize long-term outcomes, patient-reported metrics, and the incorporation of emerging technologies to enhance surgical strategies for PAs.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"471"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192047","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":"Comparing the efficacy and safety of oral versus intravenous tranexamic acid in spine surgery: a systematic review and meta-analysis of randomized controlled trials.","authors":"Bin Zheng, Gen Li, Cunrui Li, Zhenqi Zhu, Haiying Liu","doi":"10.1007/s10143-025-03637-4","DOIUrl":"https://doi.org/10.1007/s10143-025-03637-4","url":null,"abstract":"<p><p>Spine surgery is associated with significant blood loss, increasing the risk of complications, transfusions, delayed recovery, and longer hospital stays. Tranexamic Acid (TXA) is widely used to reduce bleeding, but it remains unclear whether oral or intravenous TXA is more effective in spine surgery. We conduct a systematic review of randomized controlled trials (RCTs) comparing oral and intravenous TXA in spine surgery. The primary outcomes are perioperative blood loss, transfusion rates, and postoperative complications. Data are extract independently by two reviewers and analyzed using Review Manager 5.4, with results expressed as mean difference (MD) or odds ratio (OR). Four RCTs are included. Both oral and intravenous TXA show similar effects in reducing intraoperative blood loss, total blood loss, Hct, Hgb and transfusion rates. Oral TXA is superior in reduce postoperative drainage volume (MD = -16.36, P = 0.004). No significant differences are observed in DVT, infection rates, or hospital stay. Both oral and intravenous TXA are effective in reducing blood loss and transfusion needs, with similar safety profiles. While oral TXA showed statistically significant reduction in postoperative drainage, this difference may have limited clinical significance. Given its comparable effectiveness, potentially lower cost, and easier administration, oral TXA represents a viable alternative to intravenous TXA in spine surgery. Further studies are needed to determine the optimal TXA administration route for spine surgery.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"470"},"PeriodicalIF":2.5,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192046","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":"Lack of association between chronological age and fisher group and poor outcomes in older patients with severe-grade aneurysmal subarachnoid hemorrhage: a nationwide registry study in Japan.","authors":"Kaima Suzuki, Hiroki Sato, Takatoshi Sorimachi, Hitoshi Fukuda, Tetsuya Ueba, Masaki Chin, Hirofumi Nakatomi, Yoshiaki Shiokawa, Tatsuya Ishikawa, Takakazu Kawamata, Ichiro Nakahara, Norihito Shimamura, Hiroki Ohkuma, Nao Ichihara, Shota Kakizaki, Yuichi Murayama, Kazunori Toyoda, Hiroki Kurita, Fusao Ikawa","doi":"10.1007/s10143-025-03638-3","DOIUrl":"https://doi.org/10.1007/s10143-025-03638-3","url":null,"abstract":"<p><p>Older age and Fisher group scores predict poor outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, among aging societies, treatment indications and decisions in older patients with severe-grade aSAH (World Federation of Neurosurgical Societies [WFNS] grade IV or V) remain poorly understood. Therefore, we aimed to identify the risk factors associated with poor outcomes in non-older and older patients with severe-grade aSAH. We analyzed a database of patients with aSAH treated between April 2007 and December 2019 in Japan and divided them into either the non-older (< 75 years) or older group (age ≥ 75 years) to identify factors associated with poor outcomes (modified Rankin Scale score [mRS] 3-6) at discharge. The data analyzed included patient demographics, comorbidities, aneurysm characteristics, Fisher group, WFNS grade, treatment method, and mRS score at discharge. Among the 5,095 patients, 1,303 (986 non-older and 317 older) were classified as having severe-grade aSAH. In non-older patients, chronological age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03-1.05) and Fisher groups 3 and 4 were associated with poor outcomes as compared with Fisher group 1 + 2 (OR, 2.98; 95% CI, 1.59-5.58 and OR, 5.49; 95% CI, 2.86-10.54, respectively). However, chronological age and Fisher groups 3 and 4 were not associated with poor outcomes in older patients with severe-grade aSAH. This study suggests that outcomes in older patients with severe-grade aSAH cannot be predicted in the same manner as in non-older patients. Further research on potential prognostic factors, such as biological age, is warranted. Clinical trial number Not applicable.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"466"},"PeriodicalIF":2.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187439","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":"Efficacy and safety of intraoperative magnetic resonance imaging for low-grade and high-grade gliomas: an updated systematic review and meta-analysis.","authors":"João Marcelo Baptista, Leonardo B O Brenner, Arthur Henrique, Leonardo A Ito, Paulo H Nabarro, Lucas P Santos, Lucca B Palavani, Lorran U Berbet, João Victtor Koga, Cármine P Salvarani, Vitor S Nespoli, Raphael Bertani","doi":"10.1007/s10143-025-03631-w","DOIUrl":"https://doi.org/10.1007/s10143-025-03631-w","url":null,"abstract":"<p><p>Intraoperative magnetic resonance imaging (IMRI) has been increasingly used in glioma surgery, but previous studies did not differentiate low-grade (LGG) and high-grade gliomas (HGG). We conducted a meta-analysis to assess the efficacy and safety of IMRI compared to non-IMRI surgery, without association with fluorophores or multi-modality surgery (IMRI combined with other interventions), following PRISMA guidelines. Primary outcomes included gross total resection (GTR), extent of resection (EOR), and safety. A total of 22 studies (4 RCTs and 18 observational) were included. IMRI was associated with higher GTR rates in RCTs (RR 1.6, 95% CI 1.41-1.83) and observational studies (RR 1.53, 95% CI 1.39-1.68). Stratified analyses showed superior GTR rates for both LGG (RR 1.7, 95% CI 1.41-2.05) and HGG (RR 1.52, 95% CI 1.4-1.66). EOR was higher in observational studies (MD 7.3%, 95% CI 3.96-10.64%), with similar results for both LGG (MD 5.75%, 95% CI 2.66-8.83%) and HGG (MD 6.05%, 95% CI 1.75-10.3%). Regarding safety, IMRI was associated with fewer motor (RR 0.84; 95% CI 0.62-1.14; p = 0.27) and language deficits (RR 0.63; 95% CI 0.51-0.78; p < 0.0001). The incidence of early and late deficits was also lower in the IMRI group for both motor (early: RR 0.97; late: RR 0.57) and language (early: RR 0.51; late: RR 0.63) deficits. IMRI-assisted glioma surgery was associated with higher GTR and EOR, with better safety outcomes. However, the lack of significant differences in RCTs suggests further high-quality trials are needed to confirm the benefits.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"465"},"PeriodicalIF":2.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187438","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":"Clinical features and surgical outcomes of pediatric long-level intramedullary spinal cord tumors: a single-institution series of 42 cases.","authors":"Yiji Li, Mingquan Liu, Dongao Zhang, Xingang Zhao, Cong Liang, Yinqian Wang, Kun Wu, Zijun Zhao, Ze Ding, Tao Fan","doi":"10.1007/s10143-025-03586-y","DOIUrl":"https://doi.org/10.1007/s10143-025-03586-y","url":null,"abstract":"<p><p>Pediatric long-level intramedullary spinal cord tumor (PLIMSCT) is one of the more complicated neurosurgical diseases, and there is very little research on PLIMSCT at present. This study aims to analyze the relevant clinical features and surgical outcomes of PLIMSCT through comparison. This study retrospectively analyzed pediatric intramedullary spinal cord tumor patients who underwent surgical treatment in our hospital from January 2015 to June 2024. The relevant data of patients were collected to conduct a comparison of the differences in clinical characteristics among various levels, and to analyze the potential factors that might influence the surgical outcomes. A total of 96 pediatric intramedullary spinal cord tumor patients were included, among which there were 42 cases in the long-level group. All patients underwent surgical treatment. The most common initial symptom in all parents was motor deficit (n = 51, 53.1%). In the long-level group, the symptom duration was mainly ≤ 1 year (n = 30; 66.7%), while in the short-level group, it was mostly > 3 years (n = 25; 83.3%). The most frequently involved level of tumors in both the long-level and short-level groups was the thoracic level (n = 14, 32.6% versus n = 29, 67.4%). Among all patients, 71 cases underwent gross total resection (GTR), including 32 cases (45.1%) in the long-level group and 39 cases (54.9%) in the short-level group. At admission, most patients had mild neurological deficits (MMS II). Comparison showed that there was no statistical difference in preoperative MMS between the two groups (p = 0.590), but it was different in postoperative MMS (p = 0.003). The overall survival rate was not related to the length of the tumor but was related to the WHO grade of the tumor. For PLIMSCT patients, logistic regression indicated that initial symptoms independently affected short-term neurological function, while WHO grade and postoperative MMS were related to long-term neurological function. In PLIMSCT patients, low-grade astrocytoma is the prevalent pathological type. The initial state of patients independently affects short-term neurological function. Surgical resection extent has no impact on postoperative neurological function, and tumor length doesn't influence long-term neurological decline. Long-term neurological function is mainly determined by the characteristics of the tumor and the postoperative neurological status.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"467"},"PeriodicalIF":2.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187435","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 analysis for delayed cerebrospinal fluid leak as a late complication of endoscopic transnasal surgery: effects of irradiation and insights into reconstruction methods.","authors":"Motoyuki Umekawa, Hirotaka Hasegawa, Masahiro Shin, Yuki Shinya, Hideaki Ono, Kenji Kondo, Hironobu Nishijima, Nobuhito Saito","doi":"10.1007/s10143-025-03591-1","DOIUrl":"https://doi.org/10.1007/s10143-025-03591-1","url":null,"abstract":"<p><p>Aggressive skull base tumors such as chordomas and high-grade meningiomas often exhibit resistance to treatment, highlighting the need for improved management combining endoscopic transnasal surgery (ETS) with adjunctive radiation therapy (RT). However, repeated ETS and RT may lead to delayed cerebrospinal fluid (CSF) leaks, posing clinical challenges. This study aimed to assess the incidence and risk factors for delayed CSF leaks. From November 2016 to October 2023, a total of 287 patients who underwent ETS for skull base lesions were analyzed, with the median follow-up of 45 months. Delayed CSF leaks were defined as leaks occurring six months or more after the last ETS procedure. Among these patients, 69 (24%) underwent multiple ETS procedures, and 102 (36%) received RT. Skull base reconstruction methods involved simple closure with fat grafting (with or without sphenoid mucosal flap) in 46%, non-vascularized multilayer closure in 50%, and pedicled mucosal flap-based reconstruction in 5%. Delayed CSF leaks occurred in 5 patients (1.7%), with cumulative incidence rates of 0.6%, 1.2%, and 3.7% at 3, 5, and 10 years, respectively. Notably, all leaks occurred exclusively in RT patients, showing significantly higher incidence rates compared to those without RT (2.6% at 5 years, 7.0% at 10 years vs. 0% at 10 years; p = 0.030). Cox proportional hazards analysis identified chordoma pathology, increased ETS procedures, and RT sessions as independent risk factors. Mucosal flap-based reconstruction effectively prevented recurrence, indicating its potential advantage for managing delayed CSF leaks following ETS combined with RT.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"463"},"PeriodicalIF":2.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187440","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":"Stent match of pipeline embolization device: prediction of incomplete occlusion and in-stent stenosis by actual stent size after implantation.","authors":"Chi Huang, Yajun Zhu, Xin Feng, Xin Tong, Zhuohua Wen, Jiancheng Lin, Mengshi Huang, Hao Yuan, Lele Dai, Wenxin Chen, Yuqi Hu, Yiming Bi, Xueyan Deng, Zehui Xie, Gege Shang, Yingxue Luo, Yitong Zhao, Chao Peng, Changren Huang, Shixing Su, Xin Zhang, Xifeng Li, Zongduo Guo, Aihua Liu, Chuanzhi Duan","doi":"10.1007/s10143-025-03625-8","DOIUrl":"https://doi.org/10.1007/s10143-025-03625-8","url":null,"abstract":"<p><p>The size of the Pipeline Embolization Device (PED) relative to the vessel is related to the therapeutic effect. However, the association between the stent-to-vessel matching status and treatment outcomes remains unclear. In this study, we aimed to evaluate this potential by measuring the dynamic changes in stent size during implantation. Participants who underwent PED implantation between September 2018 and September 2022 were reviewed. Coil-assisted embolization and multiple stents that could affect the measure accuracy were excluded. Three parameters were set to quantize the stent-matching degree: nominal match ratio (NMR), actual match ratio (AMR), and elongation ratio (ER). Study outcomes were incomplete occlusion and significant in-stent stenosis (ISS). The results were generated using multivariate logistic regression and restricted cubic spline (RCS) curves. A total of 388 patients were ultimately enrolled. Incomplete occlusion was observed in 22.4% and significant ISS in 5.2% at the last follow-up (11.63 ± 3.19 months). A larger distal AMR was significantly associated with incomplete occlusion (odds ratio [OR] = 12.733, 95% confidence interval [CI] = 3.678-44.082, p < 0.001) and significant ISS (OR = 43.469, 95% CI = 3.350-564.073, p = 0.004). The RCS curve indicated that the possibility of incomplete occlusion and significant ISS increased as the distal AMR exceeded 0.72 and 0.85, respectively. Neurointerventionalists should avoid pursuing over-expansion at the distal end when PED implantation. To match the vessel with significant lumen disparities and non-symmetrically tubular shapes, tapered FD and real-time software with automatic measure function were supposed to be developed in the future. TRIAL REGISTRATION: ClinicalTrials.gov (NCT06446778). Registered on May 22, 2024.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"462"},"PeriodicalIF":2.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182387","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":"Comprehensive assessment of the feasibility, safety, and efficacy of the pressure cooker technique in the treatment of brain arteriovenous malformations: Systematic review and meta-analysis.","authors":"Marcio Yuri Ferreira, Emanuel Abrantes Barros, Ahmet Günkan, João Paulo L Scarramal, Lidia Cheidde, Gustavo de Oliveira Almeida, Leonardo Januario Campos Cardoso, Matheus de Souza Duarte, Henrique Garcia Maia, Raphael Bertani, Jhon E Bocanegra-Becerra, Leonardo B O Brenner, Christian Ferreira, David Gordon, Jason A Ellis, Yafell Serulle","doi":"10.1007/s10143-025-03620-z","DOIUrl":"https://doi.org/10.1007/s10143-025-03620-z","url":null,"abstract":"<p><strong>Purpose: </strong>The Pressure Cooker Technique (PCT) is an endovascular technique for brain arteriovenous malformations (bAVMs) that can minimize reflux and inadvertent embolization compared with conventional techniques, leading to a safer and more controlled embolization. This systematic review and meta-analysis aimed to assess the feasibility, safety, and efficacy of PCT for bAVMs.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and Web of Science databases. Eligible studies included ≥ 4 patients employing PCT for bAVMs and reporting on clinical and angiographic outcomes. We used single-proportion analysis with 95% confidence intervals under a random-effects model to pool the data. Transvenous (TVE) and transarterial (TAE) approaches were analyzed separately.</p><p><strong>Results: </strong>Eight observational studies involving 168 patients, 106 treated by TVE and 62 by TAE, were included. The immediate complete obliteration rate was 97% (94%-100%) with TVE and 70% (38%-100%) with TAE. Procedure failure rate was 3% (0%-6%) and 0% (0%-3%) for TVE and TAE, respectively. Intracranial hemorrhagic complications were the most prevalent, with a 13% rate (3%-23%) in TVE. A good clinical outcome rate (Modified Rankin Scale ≤ 2) was 93% (82%-100%) in the TVE. Recurrence was 0% (0%-10%) in the TVE. The surgical retreatment rate was 11% (3%-19%) and 49% (36%-62%) in TVE and TAE, respectively.</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis found that PCT is highly feasible, safe, and effective in treating bAVMs. Given the current evidence, PCT may be considered a valuable option for the treatment of high-grade bAVMs.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"469"},"PeriodicalIF":2.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187437","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}