Neurosurgical Review最新文献

{"title":"Development and external validation of a mixed-reality aneurysm clipping simulator.","authors":"Matthias Gmeiner, Andreas Schrempf, Thomas Thurner, Wolfgang Fenz, Bertram Sabrowsky-Hirsch, Michael Giretzlehner, Robert Prückl, Stefan Schaffelhofer, Zoltan Major, Sebastian Lämmermann, Melanie Baumgartner, Lukas Drabauer, Jozsef Nagy, Giuseppe Esposito, Elisa Colombo, Nico Stroh-Holly, Andreas Gruber","doi":"10.1007/s10143-025-03846-x","DOIUrl":"10.1007/s10143-025-03846-x","url":null,"abstract":"<p><p>Nowadays, surgical treatment of cerebral aneurysms remains one of the most demanding disciplines in neurosurgery. The increasing shift toward endovascular interventions leads to a decline in open surgical cases. This fact leaves residents and young neurosurgeons with fewer training opportunities and limited to complex and high-risk aneurysms. There is a growing need for realistic simulation tools to enhance neurosurgical training and preoperative planning. We developed and externally validated a patient-specific mixed-reality simulator for cerebral aneurysm clipping, during the research project \"Medical EDUcation in Surgical Aneurysm Clipping (MEDUSA)\". Our approach combines physical phantoms of the skull and brain tissue with virtual intracranial blood vessels, including a virtual intracranial aneurysm. Real surgical instruments provide an immersive training environment featuring integrated blood flow simulation for evaluating clipping strategies. A life-sized skull with silicone brain lobes is mounted in a standard neurosurgical head clamp. Optical tracking synchronizes the position of a real clip applier and an emulated surgical microscope with the corresponding virtual environment, allowing true mixed-reality interaction. After aneurysm clipping, blood flow is automatically simulated to assess residual aneurysms or stenoses of the parental vessels. We conducted an external validation with 40 neurosurgeons at two international events. Participants completed a 32-item questionnaire evaluating face and content validity on a 5-point Likert scale. Participants' surgical experience ranged from novice to expert (> 15 years). Average ratings for simulator realism and educational value were high, with mean scores between 3.13 and 4.25. The highest ratings were for the blood flow simulation (4.25) and the simulator's potential for preoperative planning (4.20). Most participants agreed that the physical and virtual components were valuable and that the simulator should be integrated into neurosurgical training and standard surgical workflows. Our mixed-reality simulator achieved robust face and content validity among a diverse group of neurosurgeons. Combining real surgical instruments with a deformable virtual aneurysm model, including blood flow simulation, offers a high level of realism and immediate objective feedback.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"686"},"PeriodicalIF":2.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252385","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":"Intensive vs. conventional insulin therapy in neurosurgical patients: a meta-analysis of postoperative infections and hypoglycemic risks.","authors":"Francisco Rivera, Abril Del Campo, Renata Comparato, Arnau Benet, Claudio D Gonzalez","doi":"10.1007/s10143-025-03826-1","DOIUrl":"https://doi.org/10.1007/s10143-025-03826-1","url":null,"abstract":"<p><p>Background Hyperglycemia significantly increases postoperative infection risk in neurosurgical patients. While intensive insulin therapy (IIT) has shown promise in general critical care populations, its specific benefits and risks in neurosurgical patients remain debated. Objective This meta-analysis evaluated the impact of intensive versus conventional insulin therapy on postoperative infection rates and hypoglycemic events in neurosurgical patients, examining diabetes as a potential effect modifier. Methods A systematic review was conducted following PRISMA guidelines, searching PubMed, Google Scholar, and Scopus databases through October 2024. We included randomized controlled trials and prospective observational studies comparing IIT versus conventional insulin therapy (CIT) in neurosurgical patients. Primary outcomes were postoperative infection rates; secondary outcomes included hypoglycemic events. Data were analyzed using random- and fixed-effects models, with subgroup analyses by publication year and diabetes prevalence. Results Seven studies encompassing 1,146 neurosurgical patients (578 IIT, 568 CIT) were included. Overall, 458 patients (40.0%) developed postoperative infections. The random-effects model yielded non-significant results (RR: 0.782, 95% CI: 0.610-1.003, P = 0.053), though the fixed-effects model demonstrated significant infection reduction with IIT (RR: 0.746, 95% CI: 0.649-0.859, P < 0.001). Studies published before 2010 showed significant infection reduction (RR: 0.66, 95% CI: 0.64-0.69, I² = 0%), whereas post-2010 studies demonstrated no significant benefit (RR: 0.96, 95% CI: 0.40-2.29, I² = 63.7%). Hypoglycemic events were more frequent with IIT. Diabetes prevalence negatively correlated with IIT efficacy (B = 0.13, p = 0.000). Conclusions While IIT shows potential benefits in reducing postoperative infections in neurosurgical patients, this effect was not statistically significant in the random-effects model and increases hypoglycemic risk. Efficacy appears diminished in diabetic patients and has declined over time. These findings highlight the need for individualized glycemic management strategies balancing infection prevention with hypoglycemic risks.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"684"},"PeriodicalIF":2.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251835","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":"Potential drug targets for intracranial aneurysms identified through Mendelian randomization analysis.","authors":"Liangsheng Peng, Huiling Peng, Nuojun Wu, Xiaolong Wang, Li Han, Xinmin Ding","doi":"10.1007/s10143-025-03870-x","DOIUrl":"https://doi.org/10.1007/s10143-025-03870-x","url":null,"abstract":"<p><p>The proteome is a key source of therapeutic targets. We conducted a comprehensive Mendelian randomization analysis across the proteome to identify potential causal relationships between proteins and the development of intracranial aneurysms (IAs). We conducted a Mendelian randomization study to explore potential therapeutic targets for IAs, using genetic data from the International Stroke Genetics Consortium. Genetic instruments for 734 plasma proteins and 154 cerebrospinal fluid (CSF) proteins were derived from recent genome-wide association studies. Independent validation was performed using datasets from FinnGen, deCODE, and the UK Biobank. We identified six proteins genetically associated with IAs risk. Among them, plasma RELT and CSF PDGF Rb passed false discovery rate (FDR) correction and were consistently validated in external cohorts. RELT was associated with a reduced risk of unruptured intracranial aneurysms, while PDGF Rb was linked to an increased risk of subarachnoid hemorrhage. Additionally, CSF levels of sFRP-3, IL-1 sRII, IL-1 R4, and LY86 showed initial associations with SAH risk; however, these associations were not confirmed in external validation. All findings were supported by sensitivity analyses. Our integrative analysis identifies RELT and PDGF Rb as robust, genetically supported protein candidates potentially involved in the pathogenesis of intracranial aneurysms and subarachnoid hemorrhage. These findings provide a foundation for future functional validation and clinical studies aimed at biomarker discovery or therapeutic targeting.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"683"},"PeriodicalIF":2.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251918","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":"Development and validation of a nomogram model for predicting infarction after superficial temporal artery‒middle cerebral artery bypass in patients with intracranial atherosclerotic stenosis.","authors":"Tao Sun, Lixin Huang, Yibo Zhao, Jun Sun, Zhimin Wu, Baoyu Zhang, Cong Ling, Chuan Chen, Hui Wang","doi":"10.1007/s10143-025-03855-w","DOIUrl":"https://doi.org/10.1007/s10143-025-03855-w","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop and validate a nomogram model for predicting cerebral infarction risk after superficial temporal artery-middle cerebral artery (STA-MCA) bypass in patients with intracranial atherosclerotic stenosis (ICAS).</p><p><strong>Methods: </strong>Patients with ICAS who received STA-MCA bypass were enrolled in this study. The independent risk factors for post bypass infarction were identified using univariate and multivariate logistic regression analyses. A nomogram model was developed and subsequently evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).</p><p><strong>Results: </strong>Eventually, 316 patients with ICAS were included in the study. Diabetes, smoking, and high triglyceride and total cholesterol levels were identified as the independent risk factors, and a nomogram model was developed. The model achieved areas under the curve (AUCs) of 0.88 (95% confidence interval [CI] = 0.79-0.97) in the training cohort and 0.84 (95% CI = 0.72-0.97) in the validation cohort. Moreover, the calibration curves matched well, and the DCA indicated favorable clinical utility of the model.</p><p><strong>Conclusions: </strong>We develop a nomogram model for infarction after STA-MCA bypass in patients with ICAS, which could assess the risk of infarction quickly. The model could significantly guide clinical decisions and reduce the incidence of infarction.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"682"},"PeriodicalIF":2.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239229","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":"Radiomics-based prediction of intraoperative blood loss during intracranial meningiomas surgery.","authors":"Elena Filimonova, Anton Pashkov, Aleksandra Poptsova, Abdishukur Abdilatipov, Ilya Barabanov, Elena Uzhakova, Anton Kalinovsky, Jamil Rzaev","doi":"10.1007/s10143-025-03802-9","DOIUrl":"https://doi.org/10.1007/s10143-025-03802-9","url":null,"abstract":"<p><p>Meningiomas surgery is frequently accompanied by substantial blood loss, which is associated with an increased incidence of medical morbidities. Neuroimaging features, such as radiomic characteristics, could provide additional quantitative information on the tumor. Nonetheless, the usefulness of radiomics in predicting intraoperative blood loss has yet to be validated. Our objective was to examine the potential of radiomics to predict intraoperative blood loss in patients with intracranial meningiomas. A total of 137 patients with primary diagnosed intracranial meningiomas were evaluated via high-resolution brain magnetic resonance imaging (MRI), which included T1-weighted pre- and postcontrast imaging, T2-weighted imaging, diffusion-weighted (with apparent diffusion coefficient) imaging, and arterial spin labeling (ASL). MRI data were processed with subsequent extraction of radiomic features. The most significant predictors were determined via random forest regression analysis to model the relationships between selected metrics and the rate of intraoperative bleeding. We created a regression model based on ten radiomic predictors, including first- and second-order radiomic features. The resulting model allowed us to predict intraoperative blood loss in patients with intracranial meningiomas with a mean absolute error of 135.14 ml and R-squared value of 0.29, which could be considered good prediction quality. Tumor volume, tumor location, histological grade, and surgery duration were found to be less significant predictors than the other parameters and did not improve the model. Radiomic features could be useful in predicting intraoperative blood loss and provide valuable information for the presurgical evaluation of patients with intracranial meningiomas.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"681"},"PeriodicalIF":2.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239276","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":"Applications of machine learning in deep brain stimulation for major depressive disorder: a systematic review and meta-analysis.","authors":"Marios Lampros, Solonas Symeou, Georgios Alexiou, Spyridon Voulgaris, Antonios Mammis","doi":"10.1007/s10143-025-03814-5","DOIUrl":"https://doi.org/10.1007/s10143-025-03814-5","url":null,"abstract":"<p><p>Depression is a significant public health issue, consistently ranking among the leading causes of mortality, reduced quality of life, and economic burden. Despite available treatments, approximately one-third of patients exhibit resistance to standard approaches. Deep brain stimulation (DBS) has emerged as a promising intervention for both major depressive disorder (MDD) and treatment-resistant depression (TRD), yet response rates vary considerably among individuals. In recent years, machine learning (ML) models have been introduced to predict patient response to DBS, offering the potential to enhance patient selection and enable more personalized treatment strategies. A systematic review and meta-analysis were conducted in accordance with the guidelines put forth by PRISMA. Three databases (PubMed, Scopus and Cochrane) were searched to identify studies applying ML to predict response to DBS in patients with MDD/TRD. Six studies were included in the systematic review, comprising of 32 ML models, most commonly support vector machines (SVM) and Naïve Bayes classifiers. All DBS procedures targeted the subcallosal cingulate gyrus (SCC). Input data included structural, functional, neuroelectrophysiological, and clinical information. Performance metrics varied widely: sensitivity ranged from 0.56 to 0.93, specificity 0.00 to 0.89, accuracy 0.44 to 0.84 And AUC from 0.57 to 0.95. A quantitative synthesis of four studies yielded a pooled sensitivity of 0.74 (0.67-0.79), specificity of 0.73 (0.66-0.79), And AUC of 0.83 (0.69-0.89), indicating strong discriminating ability, and supporting the expectation that ML models may offer robust predictive capabilities in this context. ML models show promising capability in predicting response to DBS to SCC for MDD/TRD, especially when leveraging multimodal data. The current body of evidence supports a favorable outlook for success of ML in the setting, indicating strong potential for future clinical applicability. However, standardized protocols and external testing are necessary to support clinical integration.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"680"},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232987","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":"Outcomes of trigeminal nerve microsurgical internal neurolysis for trigeminal neuralgia without neurovascular conflict: a systematic review and meta-analysis.","authors":"Arthur R Kurzbuch, Jonathan R Ellenbogen, Naureen Keric, Volker Tronnier, Constantin Tuleasca","doi":"10.1007/s10143-025-03833-2","DOIUrl":"https://doi.org/10.1007/s10143-025-03833-2","url":null,"abstract":"<p><p>Trigeminal neuralgia (TN) without neurovascular conflict poses a therapeutic challenge. Microsurgical internal neurolysis (IN), also known as nerve combing, has emerged as a viable surgical option when microvascular decompression (MVD) is not indicated. This systematic review and meta-analysis, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, included eight case series with a total of 193 patients. Pain relief outcomes were assessed using the University of California at San Francisco (UCSF) criteria and the Barrow Neurological Institute (BNI) pain intensity score. Excellent pain relief (UCSF criteria) was achieved in 76.3% (67.4-85.2%) of patients, while 9.9% (3.6-16.2%) had a good outcome, and 5.9% (1-10.9%) experienced poor outcomes. Based on the BNI scale, successful pain relief (BNI I-II) was observed in 82.2% (72.2-92.2%) of patients. Hypoesthesia occurred in 49.2% (17.5-81.0%) of cases, while pain recurrence was reported in 10.2% (4.8-15.7%). Our findings, demonstrating high rates of pain relief, suggest that IN can be viable therapeutic alternative for patients with TN in the absence of neurovascular conflict. However, the risk of hypoesthesia highlights not only the importance of careful patient selection but also the significance of the microsurgical technique -specifically, the extent of disruption and whether the cut is longitudinal or transversal-both of which likely account for the wide variability reported, ranging from 17.5% to 81%. According to the GRADE framework, the overall certainty of the evidence was rated as very low, primarily due to the inclusion of non-randomized studies, predominantly high risk of bias, and considerable variability in results across studies. Further comparative studies are necessary to refine surgical indications and optimize outcomes for this patient population.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"678"},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233012","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":"Association between periodontitis and rupture of saccular intracranial aneurysms: a multicenter cross-sectional study.","authors":"Wentao Gong, Jia Sun, Tonghui Liu, Huijian Ge, Shuo Liu, Zhihao Lin, Yu Wang, Kang Gan, Sheng Guan, Youxiang Li","doi":"10.1007/s10143-025-03866-7","DOIUrl":"https://doi.org/10.1007/s10143-025-03866-7","url":null,"abstract":"<p><p>This study aimed to explore the association between periodontitis and rupture of saccular intracranial aneurysms (SIAs). Patients with ruptured and unruptured SIAs were consecutively included in three hospitals, and periodontal examination was conducted to assess the presence of periodontitis. Multivariate generalized linear mixed-effects models was used to assess the association between periodontitis/edentulism and aneurysm rupture. Subgroup analysis evaluated the consistency and variability of above association. The dose-response relationship between periodontitis severity, assessed by clinical attachment loss (CAL) and probing depth (PD), and aneurysm rupture was also analyzed, along with tests for trend. This study involved 622 patients with 716 SIAs. Periodontitis was significantly associated with SIA rupture (OR = 2.65, p<0.001). Subgroup analysis revealed differences in the effect sizes of the association based on the aneurysm maximum diameter, with an interaction p-value of 0.045. In aneurysms ≤ 5 mm in diameter, the association was stronger (OR = 4.04, p < 0.001) compared to those > 5 mm (OR = 1.76, p = 0.039). No significant associations were observed between edentulism and aneurysm rupture (OR = 1.52, p = 0.208), nor between periodontitis or edentulism and aneurysm irregularity. A significant dose-response relationship was observed, whereby the correlation with aneurysm rupture increased stepwise with greater CAL-and with PD only at depths ≥ 5 mm-confirming overall trends for both measures. Periodontitis was significantly associated with saccular intracranial aneurysm rupture, with the association being most evident in aneurysms ≤ 5 mm and progressively strengthening with increasing severity of periodontal parameters. Causality remains to be confirmed in prospective or interventional studies.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"679"},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232957","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":"Pituitary adenoma extended to the basilar sinus: Lessons from anatomical and radiological studies (Experimental Research).","authors":"Xiao Wu, Li Min Xiao, Hao Yang Peng, Peng Wang, Shi Zhou Xing, Liang Liang, Bo Wen Wu, Lai Sheng Pan, Zhi Qiang Liu, Shen Hao Xie, Jie Wu, Jie Zhan, Bin Tang, Han Ding, Tao Hong","doi":"10.1007/s10143-025-03816-3","DOIUrl":"https://doi.org/10.1007/s10143-025-03816-3","url":null,"abstract":"<p><p>Pituitary adenoma (PA) with basilar sinus extension has often been overlooked in previous studies. In this study, 47 cases of such a subset of PAs were introduced, and the surgery-related anatomy and strategies were discussed.The medical records of patients with basilar sinus extension were analyzed retrospectively. Four human head specimens were used for epoxy sheet plastination, and five were used for endoscopic endonasal dissection.The connection between the cavernous sinus (CS) and the basilar sinus is in the superomedial space of the gulfar segment abducens nerve and beneath the petrosphenoidal ligament. The characteristic manifestation on enhanced sagittal MR images is the \"triangle\" sign, which means that the high signal in the basilar sinus disappears and is replaced by triangular-like tumor protrusions without destruction of the clivus or dorsum sellae. The most common symptom was endocrine dysfunction (17 patients; 36.2%), including 12 cases of limb hypertrophy, 3 cases of central obesity, and 2 cases of menstrual changes, with 88.2% of patients experiencing remission postoperatively. According to the dataset, 83% of patients achieved total resection through the endoscopic endonasal approach. Abducens nerve palsy (3 patients, 6.4%) was the most common postoperative complication, but it was alleviated in two patients during postoperative follow-up.The basilar sinus can serve as a potential breakthrough path through the CS compartments for PA invasion. With a clear anatomical understanding of the invasion corridor for this subset of PAs and corresponding surgical techniques, PAs can be safely removed without increasing surgical risk.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"677"},"PeriodicalIF":2.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213182","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":"Outcome and predictors of response to vagus nerve stimulation for drug-resistant epilepsy: a retrospective cohort study.","authors":"Robert Crutcher, David Horvat, Nicholas Lehman, Yitao Ma","doi":"10.1007/s10143-025-03839-w","DOIUrl":"10.1007/s10143-025-03839-w","url":null,"abstract":"<p><p>Vagus nerve stimulation (VNS) has been used as an adjunctive therapy for patients with drug-resistant epilepsy (DRE) for decades. Nonetheless, the predictors of response to VNS remain inadequately characterized. We aimed to find factors associated with responder status. We retrospectively reviewed records of patients who received VNS for DRE in our medical center between 2000 and 2023. Preoperative data and VNS parameters were analyzed with univariate and multivariate analysis to identify predictors associated with responder status. We used receiver operating characteristic (ROC) curves to select possible related factors and the cutoff values. The overall responder rate was 35.8%. Individuals with generalized epilepsy demonstrated significantly higher responder rates (86%) compared to those with focal (29%) or combined epilepsy (28%). Univariate analysis indicated that an epilepsy duration of < 5 years at the time of VNS implantation (p = 0.021) and a diagnosis of generalized epilepsy (p = 0.016) were associated with a favorable response. A multivariate logistic regression analysis confirmed these findings. There was no correlation between age at implantation, prior epilepsy surgery, VNS parameters, such as output current and duty cycle, and the responder status. An epilepsy duration of < 5 years at VNS implantation and generalized epilepsy are independent predictors of responder status to VNS. Future long-term, randomized controlled trials with larger cohorts are needed to better evaluate these critical variables and their association with VNS outcomes.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"676"},"PeriodicalIF":2.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213107","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}