Neurosurgical Review最新文献

{"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}

{"title":"Surgical anatomy of the labyrinthine artery - a systematic review and meta-analysis.","authors":"Jonasz Tempski, Grzegorz Fibiger, Katarzyna Majka, Jakub Pękala, Oliwia Andrasz, Jakub Wilczek, Piotr Czajka, Aneta Kotlarek, Dominik Łazarz, Patrycja Jakubiec, Jerzy A Walocha, Ewa Mizia, R Shane Tubbs","doi":"10.1007/s10143-025-03592-0","DOIUrl":"10.1007/s10143-025-03592-0","url":null,"abstract":"<p><p>The labyrinthine artery (LA) is usually exposed during surgical approaches to the cerebellopontine angle (CPA). However, the literature lacks a systematic review of its anatomy. Therefore, this study aimed to determine the LA's surgical anatomy, including its morphometry, branches, cranial nerve relationship, and origin. Major databases (PubMed, Embase, Science Direct, Scopus, and Web of Science) were searched systematically until March 2024. A total of 33 studies (n = 3778 arteries) were included. The most prevalent pattern of LA was a single branch, constituting 51% (95% CI: 9.9-56.7; p < 0.001) of the general population. Nevertheless, in the North American and Asian populations, there was a dominance of double branching with a prevalence of 51.3% (95% CI: 2.9-66.1; p < 0.001) and 50.4% (95% CI: 1.4-67.1; p < 0.001), respectively. Regarding the LA relationship with cranial nerves (CN), we found the vessel to be superior to the cochlear nerve in 90.5% (95% CI: 61.3-100.0; p = 0.001), inferior to the vestibular nerve in 89.4% (95% CI: 44.9-100.0; p < 0.001), and inferior to the facial nerve in 88.0% (95% CI: 64.0-100.0; p < 0.001). The most common vessel that the LA originated from was the anterior inferior cerebellar artery (AICA) - 75.4% (95% CI: 62.7-86.4; p < 0.001). However, this was not constant in all populations, as in Colombians, it arose from the BA most frequently at 66.5% (95% CI: 44.6-85.4; p = 0.025). Neurosurgeons must understand the surgical anatomy of the LA. It can provide important topographical information during tumor resection and aneurysm clipping, preventing many complications, including vertigo and hearing loss.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"464"},"PeriodicalIF":2.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187441","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":"Comparative efficacy of urokinase and recombinant tissue-type plasminogen activators in intraventricular hemorrhage.","authors":"Kiyoon Yang, Kyung Hwan Kim, Heewon Jeong, Eun-Oh Jeong, Han-Joo Lee, Hyon-Jo Kwon, Seung-Won Choi, Seon-Hwan Kim, Hyeon-Song Koh","doi":"10.1007/s10143-025-03615-w","DOIUrl":"https://doi.org/10.1007/s10143-025-03615-w","url":null,"abstract":"<p><strong>Objective: </strong>Spontaneous intracerebral hemorrhage (ICH) with intraventricular hemorrhage (IVH) is associated with high mortality and severe disability. This study aimed to compare the effects of urokinase-type plasminogen activator (uPA) and recombinant tissue-type plasminogen activator (r-tPA) on functional outcomes and IVH clearance in patients with IVH.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 97 patients with IVH treated from January 2014 to February 2024. Patients received either uPA or r-tPA via external ventricular drainage (EVD) and were assessed using the modified Rankin Scale (mRS) at 180 days. Prognostic factors were analyzed to evaluate the treatment effects.</p><p><strong>Results: </strong>The 180-day mRS outcomes were similar between the uPA and r-tPA groups (P = 0.817). However, r-tPA achieved faster IVH clearance (P = 0.022) with shorter dosing and drain durations. By postoperative day 3, the IVH volume significantly decreased in the r-tPA group, allowing earlier intraventricular fibrinolysis cessation. ICU stays were shorter and infection rates lower in the r-tPA group, but these differences were not statistically significant. Multivariate analysis identified the NIHSS and initial ICH volume as key outcome predictors (P = 0.048, P = 0.035).</p><p><strong>Conclusion: </strong>While r-tPA facilitated faster IVH clearance, it did not improve long-term functional outcomes. Faster clearance with r-tPA may help reduce ICU stays and infection rates, but initial neurological status remains a primary prognostic factor. Larger studies are needed to confirm these findings and evaluate the potential benefits of r-tPA in IVH management.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"468"},"PeriodicalIF":2.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187436","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 of combined therapy with gamma knife radiosurgery and bevacizumab on survival outcomes in patients with recurrent high-grade glioma: a systematic review and meta-analysis.","authors":"Mehrdad Aghedi, Amirhossein Larijani, Ali Baradaran Bagheri, Hossein Rafiemanesh, Ehsan Saraee, Shayan Mardi, Mohammad Shirani","doi":"10.1007/s10143-025-03632-9","DOIUrl":"https://doi.org/10.1007/s10143-025-03632-9","url":null,"abstract":"<p><p>High-grade gliomas represent one of the most formidable challenges in neuro-oncology, characterized by rapid progression and poor prognosis despite aggressive multimodal interventions. The combination of Gamma Knife radiosurgery and bevacizumab has emerged as a promising therapeutic approach for extending survival in patients with recurrent high-grade gliomas. A systematic review and meta-analysis followed PRISMA guidelines, drawing on comprehensive searches of PubMed, Scopus, and Web of Science databases. Studies assessing the efficacy of Gamma Knife radiosurgery in conjunction with bevacizumab for recurrent high-grade gliomas were identified and subjected to rigorous quality assessment using the modified Newcastle-Ottawa Scale. Pooled hazard ratios (HRs) for progression-free survival and overall survival were calculated using a random-effects model to account for variability across studies. Six studies were included in the systematic review, among which four provided sufficient data for quantitative synthesis in the meta-analysis. The pooled analysis revealed that combined therapy significantly improved progression-free survival (HR: 0.712, CI: 0.467-0.956, p < 0.001) compared to monotherapy. However, the two groups had no significant difference in overall survival (HR: 1.069, CI: 0.395-1.742, p = 0.097). Sensitivity analyses confirmed the robustness of these findings. High heterogeneity was noted for overall survival (I² = 98.24%), warranting cautious interpretation. This meta-analysis suggests that while Gamma Knife combined with bevacizumab significantly prolongs progression-free survival in patients with recurrent high-grade glioma, it does not confer an overall survival advantage.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"459"},"PeriodicalIF":2.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174259","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":"Insular branch resembling lenticulostriate artery from M2 inferior trunk of middle cerebral artery: cadaver anatomic study.","authors":"Fukutaro Ohgaki, Jun Suenaga, Kengo Funakoshi, Takashi Shuto, Tetsuya Yamamoto","doi":"10.1007/s10143-025-03614-x","DOIUrl":"https://doi.org/10.1007/s10143-025-03614-x","url":null,"abstract":"<p><p>Whether the lenticulostriate artery (LSA) can branch from the M2 inferior trunk of the middle cerebral artery (MCA) remains unclear. However, although rare, some branches from the M2 inferior trunk have been observed to run along the LSA from the MCA M1 segment or M2 superior trunk. In addition, these branches could be clinical problems by running across the MCA bifurcation. Therefore, we investigated whether these branches were truly LSAs using cadaveric heads, and assessed their clinical significance. We examined 32 hemispheres of 16 cadaveric heads using microscopy to evaluate the branches from the M2 inferior trunk and their relationships with other arteries, including the M1 segment, M2 branches, and LSAs. Among the 32 hemispheres, four exhibited branches from the M2 inferior trunk running along the LSA. However, these branches terminated at the limen insulae and did not run in the Sylvian cistern and did not reach the anterior perforated substance. Therefore, they were not truly LSAs. We defined these branches from the M2 inferior trunk as \"insular branches from the M2 inferior trunk resembling LSA\". In some clinical cases, such as \"MCA bifurcation aneurysm\" and \"insular glioma\", these branches could be surgical problems by running across the MCA bifurcation. Moreover, in these four hemispheres, the LSAs were observed to branch from the M2 superior trunk. Although this variation is infrequent, awareness of this variation would be useful for the safer operations, particularly in cases that the LSAs branch from the M2 superior trunk.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"456"},"PeriodicalIF":2.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174265","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":"Artificial intelligence in neurosurgery: a systematic review of applications, model comparisons, and ethical implications.","authors":"Jheremy S Reyes, Vanshika N Lohia, Timoteo Almeida, Ajay Niranjan, L Dade Lunsford, Costas G Hadjipanayis","doi":"10.1007/s10143-025-03597-9","DOIUrl":"https://doi.org/10.1007/s10143-025-03597-9","url":null,"abstract":"<p><strong>Background: </strong>Artificial Intelligence (AI) has emerged as a transformative tool in medicine, particularly addressing neurosurgical challenges such as complex anatomical delineation and intraoperative decision-making. Despite advancements in diagnostic and prognostic algorithms, obstacles including algorithmic bias, data privacy, and model interpretability continue to limit its widespread clinical adoption.</p><p><strong>Objective: </strong>This systematic review aims to evaluate the current applications of AI in neurosurgery, compare the performance of various AI models, and examine the ethical challenges associated with their integration into clinical practice.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed, Scopus, and Web of Science databases, following PRISMA guidelines. Studies from 2015 to 2025 focusing on AI applications in diagnostic, prognostic, surgical, and intraoperative neurosurgical contexts were included. Statistical outcomes, model performance metrics, and ethical considerations were analyzed.</p><p><strong>Results: </strong>Thirteen studies met the inclusion criteria. AI models, particularly ML and DL, demonstrated superior diagnostic accuracy (AUC > 0.90) and improved prognostic predictions by up to 15%. AI-assisted surgical planning enhanced precision and reduced complication rates by 10-20%. However, algorithmic bias, limited transparency, and lack of external validation remain key barriers to clinical adoption.</p><p><strong>Conclusion: </strong>AI improves diagnostic accuracy, prognostic predictions, and surgical precision while reducing complication rates. However, challenges such as bias, limited interpretability, and the need for external validation must be addressed for widespread clinical integration.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"455"},"PeriodicalIF":2.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174251","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}