Neurosurgical Review最新文献

{"title":"Surgical treatment for symptomatic pure arterial malformations: a single-center experience.","authors":"Weidong Xia, Xiangping Zhong, Zhongying Ran, Dacheng Ding, Meng Zhang, Xiaoguang Tong","doi":"10.1007/s10143-025-03619-6","DOIUrl":"https://doi.org/10.1007/s10143-025-03619-6","url":null,"abstract":"<p><p>Pure arterial malformations (PAMs) are rare cerebrovascular conditions characterized by dilated, tortuous arteries with a coil-like appearance, without venous components. Traditionally considered benign, PAMs are typically conservatively managed. However, their detection has increased with advancements in noninvasive imaging, and concerns about progression have emerged, with cases of cerebral hemorrhage or infarction being reported, raising questions about their benign nature and optimal treatment. Over nine years, our center surgically treated seven patients with symptomatic PAM, finding that PAMs are not invariably benign, especially in patients with aneurysm or prior stroke. We suggest that proactive surgical intervention, including malformation isolation or resection, complemented by cerebral bypass for vascular reconstruction, should be the preferred strategy. We also underscore the need for tailored management based on individual risk factors.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"478"},"PeriodicalIF":2.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208989","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 between pipeline embolization device (PED) versus flow redirection endoluminal device (FRED) for intracranial aneurysms: a comprehensive systematic review and meta-analysis.","authors":"Seyed Farzad Maroufi, Mohammad Sadegh Fallahi, Muhammad Waqas, Othman Bin-Alamer, Manisha Koneru, Joanna M Roy, Jane Khalife, Hamza A Shaikh, Daniel A Tonetti","doi":"10.1007/s10143-025-03595-x","DOIUrl":"10.1007/s10143-025-03595-x","url":null,"abstract":"<p><strong>Objectives: </strong>The performance of the Pipeline Embolization Device (PED) and relatively newer double-layered Flow Re-Direction Endoluminal Device (FRED) have been studied for the treatment of intracranial aneurysms, but direct comparisons between PED and FRED are limited. The current systematic review aims at comparing the efficacy and safety of PED and FRED.</p><p><strong>Methods: </strong>A systematic review of the literature was conducted according to the PRISMA guideline. PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched, and related records were identified. A meta-analysis of double-arm studies comparing PED and FRED was conducted on angiographic and clinical outcomes, retreatment rates, and complications following treatment.</p><p><strong>Results: </strong>A total of 15 retrospective double-arm studies, published from 2017 to 2023, were included. Studies were predominantly from the US and Germany. A total of 2231 patients across these studies were analyzed, with 1214 treated using PED and 1017 with FRED. Angiographic outcomes demonstrated no significant difference in occlusion rates between PED and FRED (P = 0.35). Retreatment rates trended lower with FRED (P = 0.08) but were not significant. Moreover, adjunctive coiling was more frequently utilized with FRED (P = 0.04). Complication rates were similar between the two groups. There was no significant difference in mortality between the two devices (P = 0.80).</p><p><strong>Conclusion: </strong>This review provides evidence on the comparable safety and effectiveness of FRED with PED. PED and FRED show comparable angiographic outcomes, with a trend toward lower retreatment rates with FRED. Complication rates and mortality are comparable, with slightly higher historical hemorrhage rate for PED.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"475"},"PeriodicalIF":2.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208987","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":"The LITTability study - evaluation of the applicability of LITT in a real-world cohort of glioma patients.","authors":"Manuel Kaes, Vincenzo Rondinelli, Sandro M Krieg, Martin Jakobs","doi":"10.1007/s10143-025-03644-5","DOIUrl":"10.1007/s10143-025-03644-5","url":null,"abstract":"<p><p>Laser-interstitial thermal therapy (LITT) is a minimally invasive technique used in neurosurgery for ablation of epileptic foci and malignant lesions, especially for glioma located in regions that pose high surgical risk. Current research mainly focuses on maximizing the safety of the procedure and proving the non-inferiority compared to open resection of glioma. However, data regarding the current applicability in real-time cohorts are lacking. The goal of this study is to evaluate the real-world applicability of LITT in glioma patients, specifically focusing on those who had undergone stereotactic biopsy, and to define limiting factors. For this retrospective study, we analyzed n = 207 glioma patients from a monocentric stereotactic surgery database over a 5-year period (2018-2022). Clinical, histopathological and radiological data were assessed. To define a lesion suitable for LITT, a two-step approach was used. In a first step, predefined selection criteria were applied consisting of a Karnofsky Performance Score of 70 or higher, an ASA Score of 3 or less, MRI compatibility, and glioma presenting as a single or bifocal lesion. In a second step, the LITT simulation was performed with additional criteria consisting of at least 90% possible ablation volume, a safe trajectory with avoidance of vessels, and optimal lesion accessibility without brainstem involvement. Out of 207 patients, 137 cases met initial preselection criteria, while 36 cases (17.4%) were ultimately deemed suitable for LITT post-simulation. Common exclusion factors included multifocal lesions, irregular lesion shape, and size constraints. Among suitable cases, 94.4% had unifocal lesions. For 44.4% of cases, only a single catheter was needed, with the number of ablation points varying from one to twelve per trajectory. The average lesion diameter for LITT-suitable cases was 26.4 mm. Even though LITT offers a promising alternative for glioma not suitable for open resection, the current application is limited. Main reasons were due to lesion morphology and size. Enhancing LITT applicability could involve addressing constraints posed by lesion geometry and volume. Prospective studies comparing LITT with conventional resection could better define the subset of glioma patients who may benefit most, advancing the potential for LITT in clinical neurosurgical practice.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"477"},"PeriodicalIF":2.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208990","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":"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":"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126332/pdf/","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":"OA","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":"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":"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}