Neurosurgical Review最新文献

{"title":"Multi-class subarachnoid hemorrhage severity prediction: addressing challenges in predicting rare outcomes.","authors":"Muhammad Mohsin Khan, Adiba Tabassum Chowdhury, Md Shaheenur Islam Sumon, Shaikh Nissaruddin Maheboob, Arshad Ali, Abdul Nasser Thabet, Ghaya Al-Rumaihi, Sirajeddin Belkhair, Ghanem AlSulaiti, Ali Ayyad, Noman Shah, Anwarul Hasan, Shona Pedersen, Muhammad E H Chowdhury","doi":"10.1007/s10143-025-03678-9","DOIUrl":"10.1007/s10143-025-03678-9","url":null,"abstract":"<p><p>Accurately predicting the severity of subarachnoid hemorrhage (SAH) is critical for informing clinical decisions and improving patient outcomes. This study addresses the challenges of imbalanced data in SAH severity classification by employing the Modified Rankin Scale (MRS) within a three-stage classification framework. We utilize a three-stage approach to effectively categorize SAH severity. In the first stage, we performed binary classification, grouping SAH severity into \"Good Outcome\" (class 0), which includes MRS levels 0, 1, 2, and 3, and \"Poor Outcome\" (class 1), encompassing levels 4, 5, and 6. Feature selection was done using a Random Forest algorithm to identify the top 20 features for the SAH severity prediction. We evaluated thirteen machine learning models at each stage, selecting the top-performing classifiers to optimize results. The dataset comprised 535 samples across seven MRS severity levels and was validated using 5-fold cross-validation and diverse subgroups to ensure robust model performance across various scenarios. Binary classification in the first stage achieved approximately 90% accuracy with Extra Trees. In the second stage, targeting the \"Good Outcome\" group, the Random Forest model reached 88% accuracy, while in the third stage, it achieved 86% accuracy for the \"Poor Outcome\" group. By increasing accuracy across unbalanced classes and emphasizing its potential for practical use, the multi-stage technique presents a promising solution for predicting the severity of SAH. Future research will concentrate on additional tuning to improve the model's efficacy in actual healthcare environments.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"554"},"PeriodicalIF":2.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601074","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":"Augmented reality intraoperative tractography for diffuse glioma resection adjacent to the corticospinal tract: a case series with preliminary results.","authors":"Anton Konovalov, Andrey Bykanov, Dmitry Okishev, Anton Artemyev, Alexander Knyazev, Vladimir Ivanov, Anton Smirnov, Sergey Strelkov, Igor Pronin, Galina Pavlova, David Pitskhelauri, Shalva Eliava","doi":"10.1007/s10143-025-03709-5","DOIUrl":"10.1007/s10143-025-03709-5","url":null,"abstract":"<p><p>This study explores the use of augmented reality (AR) for intraoperative guidance during the microsurgical resection of diffuse gliomas, especially those located near the critical corticospinal tract. AR provides surgeons with a three-dimensional view of essential brain structures in real time, overcoming the limitations of traditional navigation systems and potentially improving surgical precision. In our case series involving five patients, we combined AR-based visualization with neurophysiological monitoring, allowing precise mapping of the corticospinal tract relative to the tumor. This approach contributed to complete tumor removal in most cases, while also preserving motor function in all patients. Our findings suggest that AR technology can enhance spatial understanding during complex surgeries, minimizing the risk to critical neural pathways. While our initial results are promising, demonstrating reliable alignment accuracy and improved outcomes, further studies on larger patient groups are necessary to fully understand and validate AR's role in neurosurgery. This research underscores AR's potential to improve both safety and outcomes, adding valuable tools for intraoperative navigation.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"556"},"PeriodicalIF":2.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601070","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":"Influence of age and comorbidity on the frequency of complications of surgical treatment of unruptured intracranial aneurysms.","authors":"F V Grebenev, Sh Sh Eliava, An N Konovalov, G V Danilov, S B Yakovlev, Yu V Pilipenko, A S Kheyreddin, D N Okishev, O B Belousova, I O Kurzakova, D E Semenov, Yu V Koledova, G Sh Mamedbekova, S F Saidov, L R Gabrielyan, N D Shmelev","doi":"10.1007/s10143-025-03707-7","DOIUrl":"10.1007/s10143-025-03707-7","url":null,"abstract":"<p><p>Neurosurgeons are increasingly challenged with balancing the risks of unruptured aneurysm growth and rupture against the potential complications of surgical treatment. Equally important is an objective assessment of surgical complications in relation to the patient's age and comorbidities, which was the primary focus of this study. This single-center, retrospective, observational study included patients from the Burdenko Neurosurgical Center who underwent microsurgical or endovascular treatment for unruptured intracranial aneurysms (UIAs). Patient age and comorbidity were evaluated using the ASA Physical Status Classification System and the Charlson Comorbidity Index. Intrahospital complications and the occurrence of new neurological deficits were recorded. The study included 1,904 patients, with 1,051 in the microsurgical group and 853 in the endovascular group. The overall incidence of new neurological deficits was 7.4%, with rates of 9.7% in the microsurgical group and 4.5% in the endovascular group (p < 0.001, Pearson's chi-squared test = 19.052). Moderate to severe intrahospital complications occurred in 5.8% of cases overall, with 8.1% in the microsurgical group and 2.9% in the endovascular group (p < 0.001 (Pearson's chi-squared test = 47.778). A comprehensive analysis of the retrospective cohort was performed to assess whether the incidence of these complications varied according to patient age and comorbidity. All statistically significant results were incorporated into age-comorbidity scales. To facilitate their use, a web application was developed: http://acsforaneurysm.ru/en/ . The findings of this study provide valuable data for comparing the risks of the natural cousre of unruptured aneurysms with surgical risks. This information is particularly useful in determining whether to opt for observation or surgical intervention, as well as in selecting the optimal timing for surgery.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"553"},"PeriodicalIF":2.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601072","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":"Frailty evaluation for predicting the survival in patients with glioma: a meta-analysis.","authors":"Qiuyan Xiang, Sha Luo, Guangyao Chen, Yiwen Liu","doi":"10.1007/s10143-025-03693-w","DOIUrl":"10.1007/s10143-025-03693-w","url":null,"abstract":"<p><strong>Background: </strong>Frailty, a multidimensional syndrome associated with decreased physiological reserve, may influence survival outcomes in patients with glioma. This meta-analysis aimed to evaluate the association between frailty and survival outcomes in glioma patients, with implications for nursing and clinical practice.</p><p><strong>Methods: </strong>This meta-analysis included cohort studies investigating frailty and survival in glioma patients. Comprehensive searches were conducted in PubMed, Embase, and Web of Science up to October 2024. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Sensitivity analyses using a leave-one-out approach were performed to evaluate the robustness of the finding. Subgroup and meta-regression analyses were performed to evaluate the influence of study characteristics on the outcome.</p><p><strong>Results: </strong>Eleven cohort studies involving 2,519 patients were included. Frailty was significantly associated with poorer overall survival (OS) in glioma patients (HR: 1.47, 95% CI: 1.25-1.74, p < 0.001) with moderate heterogeneity (p for Cochrane Q test = 0.12, I² = 35%). Subgroup analyses revealed consistent results across tumor grades (p = 0.92), primary treatments (p = 0.82), age groups (p = 0.14), proportion of men (p = 0.23), frailty assessment methods (p = 0.43), follow-up durations (p = 0.25), analytic models (p = 0.30), and study quality scores (p = 0.21). Meta-regression did not show a significant influence of sample size, mean age, sex, follow-up duration, or study quality score on the association (p all > 0.05). Frailty was also associated with shorter progression-free survival (HR: 1.20, 95% CI: 1.06-1.36, p = 0.004) with mild heterogeneity (p for Cochrane Q test = 0.41, I² = 0%).</p><p><strong>Conclusion: </strong>Frailty appears to be a significant predictor of poorer survival in glioma patients, underscoring its importance in clinical decision-making and patient care. Integrating frailty assessments into nursing and treatment protocols could improve outcome predictions and tailored interventions.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"555"},"PeriodicalIF":2.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601071","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":"Triglyceride-glucose index: an independent risk factor for all-cause mortality in critically ill aneurysmal subarachnoid hemorrhage patients- a retrospective analysis of the MIMIC-IV database.","authors":"Zhen Kun Xiao, Duan Yong Hong, Yi Bo Yang, Fei Yi Fan Wang, Xiao Fei Liu, Gong Duo, Jian Hua Liu, Bing Wang, Ai Hua Liu","doi":"10.1007/s10143-025-03711-x","DOIUrl":"https://doi.org/10.1007/s10143-025-03711-x","url":null,"abstract":"<p><p>Aneurysmal subarachnoid hemorrhage (aSAH) is a severe cerebrovascular event linked to high mortality and disability. The triglyceride-glucose index (TyG), a marker of insulin resistance, has not been thoroughly investigated for its impact on prognosis in ICU patients with aSAH. This study examines the association between TyG and all-cause mortality (ACM) in aSAH patients in the ICU. Data from the MIMIC-IV (version 3.0) database were used to identify severe aSAH patients via ICD-9/10 codes. Cox regression assessed the relationship between TyG and ACM, with restrictive cubic splines (RCS) and Kaplan-Meier curves for further analysis. Among 560 patients (55.2% female), the ACM rates were 18.1%, 23.3%, 24.1%, and 27.9% at overall, 30-day, 90-day, and 1-year follow-ups, respectively. Elevated TyG was independently associated with higher hospital ACM (aHR, 2.447; 95% CI, 1.416-4.228), 30-day (aHR, 2.998; 95% CI, 1.764-5.095), 90-day (aHR, 3.355; 95% CI, 1.983-5.676), and 1-year ACM (aHR, 4.298; 95% CI, 2.624-7.038). RCS showed a linear increase in risk as TyG exceeded 7.43. Subgroup analysis revealed stronger associations in those with cerebral parenchymal hemorrhage and pulmonary infections. TyG is an independent risk factor for ACM in critically ill aSAH patients. This study supports TyG as a prognostic tool for assessing mortality risk in these patients.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"558"},"PeriodicalIF":2.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601076","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":"A vascularized \"superfascial\" flap for middle cranial Fossa reconstruction: technical note.","authors":"Rafael Martinez-Perez, Ahmed Aljuboori, Jorge Mura","doi":"10.1007/s10143-025-03692-x","DOIUrl":"10.1007/s10143-025-03692-x","url":null,"abstract":"<p><p>Reconstruction of the middle cranial fossa following extensive dural resection remains challenging, particularly in ensuring watertight closure and minimizing complications. We present a consecutive case series of five patients undergoing skull base surgery via a minipretemporal approach, in whom direct dural closure was not feasible due to resection-related dural loss or intraoperative dehiscence. A vascularized \"superfascial\" flap was used for reconstruction. This flap combines periosteum, galea, and superficial temporalis fascia in a single vascularized layer, preserving branches of the superficial temporal artery and minimizing risk to the frontal branch of the facial nerve. All patients underwent successful reconstruction without postoperative CSF leak, infection, pseudomeningocele, or wound dehiscence. One patient experienced transient frontalis weakness resolving within 6 weeks. No readmissions or returns to the OR were required. A surgical video and illustrative figures demonstrate flap harvesting and application. Compared to conventional options like the pericranial flap or autologous fat grafts, the superfascial flap offers enhanced vascularity, broader reach to lateral skull base defects, and excellent cosmetic outcomes. This technique is a reliable alternative in cases where primary closure is not achievable, providing robust coverage without additional donor site morbidity. Its implementation may reduce wound-related complications in select skull base cases.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"550"},"PeriodicalIF":2.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591802","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":"Overcoming career barriers in global neurosurgery: insights from the WFNS young neurosurgeons survey.","authors":"Manuel De Jesús Encarnacion Ramirez, Abuzer Güngör, Sabino Luzzi, Gervith Reyes Soto, Carlos Castillo Rangel, Jeff Ntalaja Mukengeshay, Tshiunza Mpoyi Chérubin, Vladimir Nikolenko, Andreina Rosario Rosario, Renat Nurmukhametov, Carlos Ernesto López Lara, Ismael Antonio Peralta Baez, Vishal Chavda, Salman Sharif, Ivana Roskova, Samuel Moscovici, Andreas K Demetriades","doi":"10.1007/s10143-025-03697-6","DOIUrl":"10.1007/s10143-025-03697-6","url":null,"abstract":"<p><strong>Introduction: </strong>The World Federation of Neurosurgical Societies (WFNS) Young Neurosurgeons Committee conducted a global survey to identify key challenges affecting early-career neurosurgeons. These challenges ranging from restricted access to advanced training and limited research funding to insufficient mentorship, work-life imbalance, and experiences of gender and racial bias pose significant obstacles to professional growth and equitable neurosurgical development worldwide.</p><p><strong>Methods: </strong>A cross-sectional, web-based survey comprising 49 structured and open-ended questions was disseminated through neurosurgical networks, mailing lists, and social media. The target group included neurosurgeons within 10 years of completing residency. Data were analyzed using descriptive statistics for quantitative responses and thematic analysis for qualitative insights.</p><p><strong>Results: </strong>Of the 500 respondents, 56.1% reported limited access to advanced training, 50.6% highlighted insufficient funding opportunities, and 48.2% cited a lack of mentorship. Work-life balance was a major concern for 87.1% of participants. Reports of gender and racial/ethnic bias were noted by 40.5% and 22.4% of respondents, respectively. While most participants worked in public hospitals, institutional support for career development varied considerably. Key recommendations included structured mentorship, equitable resource distribution, improved training access, flexible work policies, and targeted strategies to promote diversity and inclusion.</p><p><strong>Conclusion: </strong>The findings underscore persistent structural and institutional barriers confronting young neurosurgeons globally. Addressing these challenges through coordinated strategies including mentorship networks, funding reforms, international collaborations, and inclusive leadership policies is essential to cultivating the next generation of neurosurgical leaders and ensuring equitable progress in the field.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"551"},"PeriodicalIF":2.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591803","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":"Trends in spinal surgery pre- and post-pandemic in a large metropolitan area.","authors":"Matthew T Carr, John Caridi","doi":"10.1007/s10143-025-03705-9","DOIUrl":"10.1007/s10143-025-03705-9","url":null,"abstract":"<p><p>New York City was hit particularly hard by the COVID-19 pandemic, with lockdowns and elective surgery stoppages. Research into lasting trends in spine surgery volume following the COVID-19 pandemic remains scarce. The primary aim was to identify trends in spine surgery volume and secondary aim was to outline trends in patient characteristics during and after the COVID-19 pandemic in this large urban metropolitan area. The Statewide Planning and Research Cooperative System (SPARCS) database of New York was queried for all adult spine surgery claims from the 5 boroughs of New York City and Westchester County from 2019 to 2023. The principal submitted ICD10 code was used to categorize manually each claim by its associated spinal pathology. There were 26,066 claims in 2019, 20,437 in 2020, 24,829 in 2021, 26,271 claims in 2022, and 30,485 claims in 2023. Total ICD10 diagnoses per claim increased from 9.8 in 2019 to 10.3 in 2023. The proportion of ambulatory claims increased from 36.1% in 2019 to 49.1% in 2023. Length-of-stay averaged 3.23 days in 2019 and fell to 2.80 days by 2023. The percent of patients discharged home rose from 83.5 to 87.0%, with decreases in discharge to skilled nursing facilities (SNF) or rehabilitation. Spine surgery volumes decreased during the pandemic, but in 2022 and 2023 surpassed pre-pandemic numbers. These trends can help guide spine surgeons about ongoing changes in demographics, insurance status, and surgical characteristics, as well as prepare for future pandemics.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"549"},"PeriodicalIF":2.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12238211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591804","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":"Design and protocol for the decompression-plus trial: a phase 1 clinical study of dorsal myelotomy and expansive duroplasty with or without autologous nerve grafting in acute traumatic spinal cord injury.","authors":"Zahraa Al-Sharshahi, Jared T Wilcox, Hassan Darabi, Harshit Arora, Jorge E Quintero, Greg A Gerhardt, Craig G van Horne, Francis Farhadi","doi":"10.1007/s10143-025-03701-z","DOIUrl":"https://doi.org/10.1007/s10143-025-03701-z","url":null,"abstract":"<p><strong>Background: </strong>Traumatic spinal cord injury (tSCI) is a devastating condition marked by persistent neurologic deficits. Secondary injury processes following tSCI, including progressive hemorrhagic necrosis and elevated intraspinal pressure (ISP), contribute to ongoing neurologic deterioration. Existing therapeutic strategies have shown limited efficacy, emphasizing the critical need for innovative interventions. This phase 1 study introduces a novel approach involving dorsal myelotomy and expansive duroplasty (DMED) with or without autologous nerve graft implantation (ANGI) for acute tSCI. The study aims to specifically assess the safety, feasibility, and preliminary efficacy of DMED and ANGI (\"Decompression-Plus\"). Inspired by cranial trauma management, expansive duroplasty represents a promising approach given that the dura can propagate ischemic injury. ANGI provides a unique opportunity for cell-based therapy without the logistical challenges associated with cell culture, allografts, or immunosuppression.</p><p><strong>Methods: </strong>A total of 10 participants presenting to the emergency department and diagnosed with acute ASIA impairment scale A/B cervico-thoracic tSCI will be consented and blinded prior to undergoing either DMED alone or Decompression-Plus (1:1 ratio). Rigorous monitoring of adverse events with institutional data safety monitoring board oversight will be performed through regular clinical, laboratory, and imaging evaluations. Feasibility will be assessed by monitoring of recruitment rates, procedural adherence, and participant compliance. Clinical outcomes will be measured by American Spinal Injury Association impairment scale assessments.</p><p><strong>Conclusion: </strong>DMED with or without ANGI represent novel interventions for managing acute tSCI. The results of this phase 1 trial will determine whether these interventions can be performed safely and feasibly in a consecutive cohort of patients to potentially enhance recovery and improve outcomes.</p><p><strong>Trial registration numbers: </strong>Clinicaltrials.gov - NCT06243211 ( https://clinicaltrials.gov/study/NCT06243211?term=NCT06243211&rank=1 ) and UK Institutional Review Board - 91630.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"547"},"PeriodicalIF":2.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584391","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":"Functional outcomes in depressed skull fractures: the role of surgical timing and perioperative clinical radiological predictors.","authors":"Hervé Monka Lekuya, Jelle Vandersteene, David Patrick Kateete, Fredrick Makumbi, Stephen Cose, Jean-Pierre Okito Kalala, Moses Galukande, Edward Baert","doi":"10.1007/s10143-025-03708-6","DOIUrl":"https://doi.org/10.1007/s10143-025-03708-6","url":null,"abstract":"<p><strong>Background: </strong>Depressed skull fractures (DSFs) are features of traumatic brain injury (TBI), frequently associated with intracranial damage and long-term functional impairments. The neurological outcomes of the perioperative management are yet to be evaluated. This study aimed to assess the effect of surgical timing and perioperative clinical radiological factors on functional outcomes in DSFs.</p><p><strong>Methods: </strong>This prospective cohort study enrolled 205 patients with DSFs at a tertiary neurosurgical center in Uganda. Patients underwent surgical management, with the primary exposure variable being surgical timing (≤ 48 h vs. >48 h). Functional outcomes at six months were assessed using the Glasgow Outcome Scale-Extended (GOSE), categorized into favorable (GOSE 5-8) and unfavorable (GOSE 1-4). Multivariate regression models were used to identify functional outcome predictors.</p><p><strong>Results: </strong>The median-age was 24 years (IQR = 15-31), 89.5% were male, and 49.73% were assault victims. Approximately 73.1% had an admission GCS > 13. The frontal bone was most commonly involved (46.2%). Early surgical intervention (≤ 48 h) significantly reduced the risk of surgical site infections (SSIs) (p = 0.01) and shortened hospital stays. However, surgical timing had no significant association with functional outcomes {adjusted risk ratio (ARR): 0.95; 95%CI: 0.35-2.61; p = 0.92}. Several perioperative factors were strongly linked to unfavorable outcomes, including ASA class 3 (ARR: 5.09, 95%CI: 2.11-12.2; p < 0.01), compound DSFs (ARR: 3.18; 95%CI: 1.70-5.96; p < 0.01), and midline shift ≥ 5 mm (ARR: 2.84; 95%CI: 1.50-5.39; p < 0.01).</p><p><strong>Conclusions: </strong>Early surgery of DSFs reduces the infection rates and hospital length of stay; however, it does not significantly impact the 6-months functional outcomes. The outcomes are instead influenced significantly by clinical radiological perioperative factors such as the ASA classification, compound type, midline shift ≥ 5 mm, and others. We advocate for an aggressive treatment for increased ICP to improve the outcomes, and an early surgical intervention for infection reduction.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"548"},"PeriodicalIF":2.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584392","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}