Neurosurgical Review最新文献

{"title":"Repeated recurrence after endovascular treatment for cerebral aneurysms: predictive clinical factors and optimal therapeutic management.","authors":"Kota Kurisu, Hiroyuki Sakata, Yasushi Matsumoto, Atsushi Kanoke, Shunsuke Omodaka, Miki Fujimura, Hidenori Endo","doi":"10.1007/s10143-025-03758-w","DOIUrl":"10.1007/s10143-025-03758-w","url":null,"abstract":"<p><p>Despite significant advances in endovascular treatment (EVT) of cerebral aneurysms, post-treatment recurrence necessitating multiple retreatments remains a severe concern. Herein, we investigated the clinical characteristics of aneurysms necessitating multiple retreatments after EVT (refractory aneurysms: R-ANs) and explored appropriate management strategies. This retrospective cohort study enrolled 1,045 aneurysms initially treated with EVT between 2016 and 2022. R-ANs were defined as cases requiring two or more retreatment sessions due to repeated recurrence or regrowth. Clinical data were retrospectively reviewed, and predictive factors were identified. Furthermore, the treatments performed and clinical outcomes were investigated. Of 1,045 aneurysms, 101 (9.7%) exhibited recurrence or regrowth requiring retreatment. Among these, 23 aneurysms (2.2%) requiring two or more retreatment sessions, which were classified as R-ANs. As for the predictive factors of R-AN development, large size (> 10 mm), and circumferential aneurysmal wall enhancement on vessel wall imaging (VWI) were identified as relevant and independent predictive factors, with odds ratios of 3.92 (95% CI, 1.36- 11.62), 8.02 (95% CI, 2.02- 53.6), respectively. In terms of therapeutic outcomes, repeat EVT sessions provided favorable long-term clinical outcomes (aneurysm stabilization, 85.0%; favorable occlusion, 65.0%) and low periprocedural complication rates (2.6%). This study identified the relevant predictive factors for R-AN development, suggesting that careful follow-up is essential in patients with these factors. Furthermore, repeated EVT sessions appears to be a safe and efficient treatment strategy for such challenging cases.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"603"},"PeriodicalIF":2.5,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859396","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":"Efficacy of double anastomosis STA-MCA bypass in adult Moyamoya disease and cerebral atherosclerosis disease: a systematic review and meta-analysis.","authors":"Bryan Gervais de Liyis, Muhammad Kusdiansah, Affan Priyambodo Permana, Made Gemma Daniswara Maliawan, I Wayan Niryana, Arnau Benet, Rokuya Tanikawa","doi":"10.1007/s10143-025-03760-2","DOIUrl":"10.1007/s10143-025-03760-2","url":null,"abstract":"<p><p>Double anastomosis Superficial Temporal Artery-Middle Cerebral Artery (STA-MCA) bypass in Moyamoya disease (MMD) and cerebral atherosclerosis disease (CAD) remains underexplored. We aim to evaluate the clinical efficacy and vascular dynamics of double anastomosis STA-MCA bypass in each group, MMD and CAD. A systematic search was conducted in ScienceDirect, Embase, PubMed, and Cochrane databases until September 2024. Efficacy outcomes included stroke occurrences, patency, modified Rankin Scale (mRS), and complications. Vascular parameters included cerebral blood flow (CBF), cut flow index (CFI), MCA perfusion, and mean transit time (MTT). The meta-analysis included 15 studies with 417 patients (46.18 ± 4.69 years). At final follow-up, the MMD group showed lower total stroke (12 ± 7% vs. 20 ± 9%; p = 0.63), ischemic stroke (8 ± 5% vs. 18 ± 8%; p = 0.26), hemorrhagic stroke (4 ± 3% vs. 10 ± 7%; p = 0.49), and patency (85 ± 11% vs. 98 ± 8%; p = 0.10) compared to CAD group, without statistical difference. The MMD group exhibited reduced mRS (MD: -0.57; 95%CI: -0.95 to -0.19; p = 0.003), increased CBF (MD: 14.75; 95%CI: 2.32 to 27.19; p = 0.020), and increased MCA perfusion (MD: 9.28; 95%CI: 1.19 to 17.37; p = 0.025). CFI (1.30 ± 0.11 vs. 1.08 ± 0.13; p = 0.02) and MTT (4.49 ± 0.5 vs. 1.27 ± 0.27; p < 0.001) were significantly higher in the CAD group. Both 1D2R (MD: 27.59; 95%CI: 4.88 to 50.30; p = 0.017) and 2D2R (MD: 14.75; 95%CI: 2.32 to 27.19; p = 0.020) techniques exhibited increase in CBF. Additionally, double anastomosis showed a higher CFI compared to single anastomosis (MD: 0.25; 95%CI: 0.12-0.38; p < 0.001). Double anastomosis STA-MCA bypass demonstrated comparable stroke and patency rates between groups. MMD patients had significantly higher CFI and MTT values, with double anastomosis yielding superior CFI compared to single anastomosis.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"605"},"PeriodicalIF":2.5,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859395","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":"Correction to: Notable differences in changes between ventral and dorsolateral spinal longitudinal extradural CSF collection after treatment in patients with spontaneous spinal CSF leaks.","authors":"Tatsuya Ohtonari, Takahiro Himeno, Kyohei Sakai, Shohei Noguchi","doi":"10.1007/s10143-025-03774-w","DOIUrl":"10.1007/s10143-025-03774-w","url":null,"abstract":"","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"604"},"PeriodicalIF":2.5,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859394","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":"Accuracy of CT hounsfield units for predicting cage subsidence and pedicle screw loosening after lumbar interbody fusion: a systematic review and meta-analysis.","authors":"Alexander Erick Purnomo, Jephtah Furano Lumban Tobing, Aldi Nanda Kurniawan, Regan Elbert, Rivaldo Steven Heriyanto, Yang Yang Endro Arjuna","doi":"10.1007/s10143-025-03741-5","DOIUrl":"10.1007/s10143-025-03741-5","url":null,"abstract":"<p><p>Cage subsidence (CS) and pedicle screw loosening (PSL) are significant postoperative complications following lumbar interbody fusion (LIF) surgeries, often associated with poor bone quality. Hounsfield Unit (HU) measurements from preoperative CT scans have emerged as a potential non-invasive predictor of bone density. This study aims to evaluate the diagnostic accuracy of HU in predicting CS and PSL. A systematic review and meta-analysis were conducted according to PRISMA guidelines. Databases searched included PubMed, Europe PMC, ScienceDirect, and Google Scholar. Studies with irrelevant outcomes, review articles, case reports, case series, animal studies, cadaveric studies, and abstract only articles were excluded. Pooled estimates of standardized mean difference (SMD), sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated using a random-effects model. Risk of bias was assessed using QUADAS-2, and the GRADE framework was used to evaluate evidence quality. Seventeen retrospective cohort studies involving 2,294 patients were included. HU values were significantly lower in patients with complications. For CS, the pooled SMD was - 37.43 [95% CI: -44.80 to -30.08], and for PSL, -24.55 [95% CI: -29.04 to -20.06]. The pooled sensitivity and specificity of HU for predicting CS were 0.83 [95% CI: 0.71-0.90] and 0.86 [95% CI: 0.75-0.93], with an AUC of 0.91. For PSL, the pooled sensitivity and specificity were 0.80 [95% CI: 0.72-0.86] and 0.68 [95% CI: 0.56-0.78], with an AUC of 0.81. GRADE assessment rated the evidence as moderate quality. HU values are reliable predictors of CS and PSL after LIF, with stronger accuracy for CS, that may serve as a practical tool in preoperative planning to identify high-risk patients and reduce complication rates. However, the retrospective nature and methodological variability among included studies may affect generalizability, that warrants for further large scale, prospective studies.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"602"},"PeriodicalIF":2.5,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855828","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":"Consistency and grade prediction of intracranial meningiomas based on fractal geometry analysis.","authors":"Balázs Markia, Tamás Mezei, János Báskay, Péter Pollner, Adrienn Mátyás, Ákos Simon, Péter Várallyay, Péter Banczerowski, Loránd Erőss","doi":"10.1007/s10143-025-03737-1","DOIUrl":"10.1007/s10143-025-03737-1","url":null,"abstract":"<p><p>Meningiomas are the most common primary tumors in the central nervous system. Surgical resection remains the main treatment option, often resulting in a curative outcome; however, careful preoperative planning is essential. One of the primary concerns for neurosurgeons treating meningiomas is tumor consistency, as this has a significantly impact on the likelihood of complete resection. Predicting the consistency and histology of a meningioma prior to surgery is valuable for selecting the appropriate surgical instruments and planning the approach. We conducted a retrospective study to analyze clinical data and preoperative MRI images of patients who underwent surgery for intracranial meningiomas. T1, T1c, T2, and FLAIR sequences were obtained for all patients. Surgical notes were reviewed to assess tumor consistency. Tumor segmentation was performed using ITK-SNAP software. Fractal analysis and statistical analyses were made, including t-tests, Fisher's exact tests, logistic regression, and ROC analysis. Forty-eight patients met the selection criteria. For prediction of consistency when only fractal parameters were used, lacunarity index was able to discriminate between soft and hard consistency with an AUC value of 0.745 (95% CI: 0.538-0.958). When tumor homogeneity was added, these values changed to 0.763 (95% CI: 0.518-1.000). For prediction of histological grade, an AUC value of 0.697 (95% CI: 0.490-0.952) was found, using only fractal dimension. When age, tumor homogeneity and volume parameters were added, this value increased to 0.841 (95% CI: 0.625-1.000). Our study suggests that fractal metrics are useful tools for preoperative estimation of tumor consistency and histological grading.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"598"},"PeriodicalIF":2.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12350593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847966","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":"Middle meningeal artery embolization for chronic subdural hematoma in octogenarians and nonagenarians: an individual patient pooled meta-analysis.","authors":"Rahim Abo Kasem, Zachary Hubbard, Julio Isidor, Joshua Venegas, Omar Alwakaa, Felipe Ramirez-Velandia, Muhammed Amir Essibayi, Adnan Rehawi, Christopher S Ogilvy, Justin H Granstein, Alejandro M Spiotta","doi":"10.1007/s10143-025-03743-3","DOIUrl":"10.1007/s10143-025-03743-3","url":null,"abstract":"<p><p>Chronic subdural hematoma (cSDH) is a highly common neurosurgical condition with significant burden in the elderly, and patients aged ≥ 80 represent nearly one-third of cases. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment method to reduce hematoma growth and recurrence; however, octogenarians and nonagenarians remain underrepresented in clinical trials. We conducted a systematic review and meta-analysis of individual patient data to evaluate outcomes of MMAE in this high-risk group. We systematically searched PubMed, Scopus, and Web of Science through March 2025 for studies reporting patients aged ≥ 80 years treated with MMAE for cSDH. Individual-level data were extracted and pooled. Clinical, procedural, and radiographic outcomes were summarized. Multivariable mixed-effects logistic regression identified predictors of hematoma resolution and extended hospital stay (LOS ≥ 75th percentile). Twenty-six studies including 86 patients (mean age 83 years; 36% ≥90 years) met inclusion. Most were male (70%) and had comorbidities such as hypertension (57%) and diabetes (21%). MMAE was performed alone in 64% of cases and with surgery in 36%. Transfemoral access was used in 74%, while transradial access (associated with shorter LOS) was underutilized, especially in patients ≥ 90 (3%). Complication and in-hospital mortality rates were low (5.8% and 1.2%, respectively). At discharge, 81% returned home. Complete hematoma resolution occurred in 56%, more likely with adjunctive coiling (aOR 4.01) and less likely with antithrombotic use (aOR 0.12). Extended LOS was associated with age ≥ 90 (aOR 2.1) and general anesthesia (aOR 1.7). MMAE is safe and effective in patients aged ≥ 80. While outcomes are favorable across age groups, transradial access and conscious sedation may reduce hospital stay and anesthesia-related risks in this population. Future trials should prioritize inclusion of this high-risk group to guide age-appropriate, evidence-based care.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"600"},"PeriodicalIF":2.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12350427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847880","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":"A low-angle trans-magendie foraminal approach to the fourth ventricle and dorsal brainstem.","authors":"David Pitskhelauri, Alexander Konovalov, Gleb Danilov, Andrey Bykanov, Igor Pronin, Elina Kudieva, Alexander Sanikidze, Kristina Lapteva, Tatiana Melnikova-Pitskhelauri","doi":"10.1007/s10143-025-03755-z","DOIUrl":"10.1007/s10143-025-03755-z","url":null,"abstract":"<p><p>Traditional transvermian (TvA) and telovelar approaches (TelA) for accessing tumors of the fourth ventricle (FV) are associated with the need to dissect the cerebellar vermis or with traction and dissection of the uvulotonsilar fissure, which often leads to postoperative cerebellar disorders. A surgical approach to the fourth ventricle (59 patients) and the brainstem (18 patients) through the foramen of Magendie utilizing a low angle of surgical attack is proposed. Depending on their localization, the tumors were divided into 4 main groups: 1) upper region, 8 cases; 2) middle region, 14 cases; 3) lower region, 20 cases; and 4) tumors of the lower region of the fourth ventricle with extension into the cisterna magna, 12 cases; and various combinations of these localizations, 23 cases. All surgeries were performed using minimally invasive techniques with a 4 cm soft tissue incision and 0-21 mm of occipital bone resection (median of 12 mm). Total tumor resection was achieved in 55 (71.4%; 95% CI [60%, 81%]) patients, including 48 (81.4%; 95% CI [69%, 90%]) with fourth-ventricle tumors and 7 (41.2%; 95% CI [18%, 64%]) with brainstem tumors (p <.001). Among fourth-ventricle tumors, the extent of tumor resection decreased depending on the tumor localization level (p = 0.05). Postoperative cerebellar disorders manifested or deteriorated significantly rarely, with tumors located at the upper levels of the fourth ventricle or brainstem (p=0.05), as well as with smaller dorsoventral tumor sizes (p=.004). The low-angle trans-Magendie foraminal approach is an effective technique for the surgical treatment of space-occupying lesions of the fourth ventricle and dorsal brainstem.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"601"},"PeriodicalIF":2.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847965","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 circle of Willis integrity and variations on clinical and radiological outcomes after posterior communicating arteries covered by flow diverter devices.","authors":"Mengshi Huang, Zhuohua Wen, Yuqi Hu, Anqi Xu, Jiwan Huang, Xin Tong, Chi Huang, Gengwu Ma, Jiancheng Lin, Hongyu Shi, Hao Yuan, Runze Ge, Can Li, Zhikun Jia, Ruizhe Yi, Yuheng Jin, Shuyin Liang, Xifeng Li, Aihua Liu, Xin Feng, Chuanzhi Duan, Xin Zhang","doi":"10.1007/s10143-025-03740-6","DOIUrl":"10.1007/s10143-025-03740-6","url":null,"abstract":"","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"599"},"PeriodicalIF":2.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847881","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 coagulation disorders on intracranial hemorrhage outcomes: a case-controlled study.","authors":"Tzak Ying Lau, Omar Alwakaa, Aryan Wadhwa, Shashvat Purohit, Tzak Sing Lau, Mark Rotondo, Justin Granstein, Christopher S Ogilvy","doi":"10.1007/s10143-025-03749-x","DOIUrl":"https://doi.org/10.1007/s10143-025-03749-x","url":null,"abstract":"<p><p>Intracranial hemorrhage (ICH) is a severe condition associated with high morbidity and mortality. Coagulation disorders, such as thrombophilia, thrombocytopenia, hemophilia, and vitamin K deficiency, significantly influence the pathophysiology of bleeding, and therefore the outcomes of ICH patients. This study aims to examine the effects of these disorders on outcomes related to ICH. This study retrospectively examined the impact of these coagulation disorders on ICH outcomes using the Nationwide Inpatient Sample (NIS) database from 2011 to 2020. A total of 260,049 hospitalizations for ICH were included, and patients were grouped based on the presence of specific coagulation disorders. The outcomes assessed were in-hospital mortality and length of stay (LOS), with case-controlled matching applied to account for confounding variables such as age, sex, race, and comorbidities. Overall, the mortality rate across all 269,044 patients was 21.9%. ICH patients with vitamin K deficiency had the highest mortality rate (40.5%), followed by thrombocytopenia (28.2%) and primary thrombophilia (30.8%) (p < 0.001). Hemophilia and von Willebrand disease were associated with mortality rates of 21.6% and 32.1%, respectively. Additionally, vitamin K deficiency and hemophilia were linked to the longest LOS among the conditions studied (17.6 ± 23.9 days and 14.1 ± 18.1 days respectively) p < 0.001). Case-controlled matching confirmed significant differences in mortality and LOS based on the type of coagulation disorder after controlling for confounding variables. This study demonstrates the significant role of coagulation disorders in determining ICH outcomes. Vitamin K deficiency and thrombocytopenia were associated with particularly severe outcomes, including increased mortality and extended hospital stays. Early identification and targeted interventions for these coagulation disorders are crucial for improving ICH management and patient prognosis. Further research is needed to develop comprehensive guidelines for managing ICH patients with coagulation disorders.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"597"},"PeriodicalIF":2.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817227","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":"Correction to: Efficacy and safety of endoscopic compared with open surgical repair of cerebrospinal fluid fistulas: a systematic review and meta-analysis.","authors":"Marco Frusteri, Miguel Gaviria Zapata, Juan Esteban Suárez Sepúlveda, Carlos Rivas, Esteban Quiceno, Daniel Londoño Herrera, Francisco Javier Londoño Ocampo","doi":"10.1007/s10143-025-03754-0","DOIUrl":"https://doi.org/10.1007/s10143-025-03754-0","url":null,"abstract":"","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"594"},"PeriodicalIF":2.5,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799694","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}