Neurosurgical Review最新文献

{"title":"Association of compression pressure and SCN8A and SCN9A gene polymorphisms with the recurrence of balloon compression-treated trigeminal neuralgia.","authors":"Xin Wang, Qiu Xia, Yanfeng Li, Yi Ma, Quancai Wang, Fangkun Jing, Haitao Huang, Bo Zhou","doi":"10.1007/s10143-025-03792-8","DOIUrl":"https://doi.org/10.1007/s10143-025-03792-8","url":null,"abstract":"<p><p>Compression pressure and Sodium channel, voltage-gated, type VIII, alpha subunit (SCN8A) and Sodium channel, voltage-gated, type IX, alpha subunit (SCN9A) gene polymorphisms were previously reported to be closely related to postoperative recurrence of trigeminal neuralgia (TN) treated with percutaneous balloon compression (PBC). Patients diagnosed with primary TN who met the criteria for surgery and had a pain intensity score of ≥ III on the Barrow Neurological Institute (BNI) pain intensity scale were included in this study. Patients who had previously undergone PBC treatment and lacked the ability to act independently were excluded. We divided the patients into two groups according to the levels of compression pressure: exposure and non-exposure. Blood samples were also collected for high-throughput sequencing. Based on the follow-up results, the recurrence of PBC-treated TN was assessed and compared between the two patient groups. Furthermore, the association of clinical factors and genetic factors with postoperative recurrence of PBC-treated TN was analyzed. Finally, a prediction model for TN recurrence within 12 months post-PBC was constructed. A total of 395 patients were included in this study, with 208 patients in the exposed group and 187 patients in the non-exposed group. There were 251 females (63.54%), with an average age of 66 years. Blood samples were provided by 195 patients (102 in the exposed group and 93 in the non-exposed group) for SNP testing. According to the multivariate analysis results, It is also noteworthy that the risk of TN recurrence post-PBC was 0.398 times higher in the exposure group than in the non-exposure group (hazard ratio (HR): 0.398; 95% Confidence Interval (CI): 0.196-0.808; P = 0.011). In TN patients with comorbid hypertension, the risk of recurrence post-PBC was 4.882-fold higher compared to those without hypertension (HR: 4.882; 95% CI: 2.023-11.785; P < 0.05). The SCN8A and SCN9A genes have also been associated with recurrence. The results of the codominant model showed that the risk of postoperative recurrence of PBC in patients with rs17125929 heterozygous mutant (TC) was 0.348 times higher than that of patients with rs17125929 wild-type (TT) (HR = 0.348, 95%CI = 0.123-0.988, P = 0.047). The results of the codominant model showed that the risk of postoperative recurrence of PBC in patients with rs36101458 heterozygous mutation (CT) was 0.280 times higher than that of patients with rs36101458 wild-type (CC) (HR = 0.280, 95%CI = 0.110-0.716, P = 0.008). The results of the explicit model showed that the risk of postoperative PBC recurrence in patients with rs36101458-CT TT was 0.396 times higher than that of patients with rs36101458-CC (HR = 0.396, 95%CI = 0.176-0.891, P = 0.025). Allele analysis showed that patients with rs36101458-T had a 0.385-fold higher risk of recurrence after PBC than patients with rs36101458-C (HR = 0.385, 95%CI = 0.192-0.773, P = 0.007). Compression pressure, hypertension","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"675"},"PeriodicalIF":2.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207053","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":"Traumatic brain injury among American indians/alaska natives in the united states: a comprehensive systematic review of the literature.","authors":"Laurel A Seltzer, Mohammed A Fouda, Susan C Pannullo","doi":"10.1007/s10143-025-03817-2","DOIUrl":"10.1007/s10143-025-03817-2","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) represents a significant public health burden, particularly among American Indian and Alaska Native (AI/AN) populations in the United States, and particularly in the State of Alaska. This systematic review aims to evaluate the incidence, risk factors, outcomes, and healthcare disparities associated with TBI in this population and to identify strategies for prevention and improved management. Following PRISMA guidelines, we conducted a systematic review of Medline/PubMed, Google Scholar, Web of Science, Scopus, and Embase through May 2025. Inclusion criteria targeted studies involving AI/AN populations in the United States that reported on epidemiology, causes of injury, hospitalization, and mortality rates, as well as healthcare access. Data were extracted and synthesized qualitatively as we summarized, compared, and interpreted findings narratively based on common patterns and themes. The NIH Quality Assessment Tool was used to evaluate the quality of the included studies. Fourteen studies met the inclusion criteria. AI/ANs exhibited significantly higher TBI-related emergency visits (1,026 per 100,000), hospitalizations (186.7 per 100,000), and mortality rates (up to 65.9 per 100,000) compared to other racial groups. Leading causes included motor vehicle accidents, falls, and self-harm. Geographic isolation, limited neurosurgical infrastructure, and mistrust towards non-Native healthcare providers exacerbated disparities. Interventions like telemedicine, community health training, and culturally sensitive healthcare were identified as potential solutions. AI/AN populations, particularly those residing in the state of Alaska, face significantly higher incidence and worse outcomes from TBI due to systemic healthcare barriers and regional challenges. These disparities necessitate a multifaceted, culturally informed approach that encompasses enhanced access to care, preventive strategies, and collaboration with tribal health organizations to mitigate the burden of TBI and improve long-term outcomes.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"674"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of contrast-enhanced MRI in the selection of surgical approaches for recurrent lumbar disc herniation in full-endoscopic surgery.","authors":"Qingqing Xiao, Li Huang, Fuming Chu, Xiaosong Tang, Wen Wang, Yue Li","doi":"10.1007/s10143-025-03860-z","DOIUrl":"https://doi.org/10.1007/s10143-025-03860-z","url":null,"abstract":"<p><p>To assess the value of contrast-enhanced lumbar MRI in guiding the selection of surgical approaches for recurrent lumbar disc herniation (RLDH) treated with full-endoscopic surgery. Clinical data were retrospectively analyzed from 237 patients with RLDH who underwent preoperative contrast-enhanced lumbar MRI. Surgical approaches were selected based on the location and degree of nucleus pulposus extrusion observed on MRI. The disc levels involved were as follows: L2/3 (1 case), L3/4 (11 cases), L4/5 (111 cases), and L5/S1 (114 cases). Surgical duration, intraoperative blood loss, length of hospital stays, and surgical complications were recorded. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores for low back and leg pain. All patients successfully underwent full-endoscopic discectomy. At one month postoperatively and at the final follow-up, VAS and ODI scores showed significant improvement compared to preoperative values (final follow-up vs. preoperative: lower back pain VAS [0.34 ± 0.50 vs. 2.54 ± 1.82], leg pain VAS [0.06 ± 0.29 vs. 5.53 ± 1.65], and ODI [0.51 ± 0.98 vs. 66.08 ± 47.14]). According to the modified MacNab criteria, outcomes were rated as excellent in 195 cases, good in 35, fair in 5, and poor in 2, yielding an excellent-to-good rate of 97.0%. No serious intraoperative, postoperative, or follow-up complications were observed. Contrast-enhanced lumbar MRI provides clear visualization of intraspinal anatomical structures in patients with RLDH, facilitating accurate preoperative determination of decompression boundaries. By assessing the spatial relationship between the reherniated nucleus pulposus and the pedicle, and incorporating iliac crest height and surgical history, the optimal surgical approach can be selected. This enables safe and effective removal of herniated disc material, adequate nerve root decompression, and favorable clinical outcomes.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"673"},"PeriodicalIF":2.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192275","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":"Compression-specific treatment strategies for vertebroarterial-involved hemifacial spasm: A single-centre retrospective analysis of surgical techniques.","authors":"Chenglong Cao, Mingwu Li, Fang He, Xiaofeng Jiang","doi":"10.1007/s10143-025-03868-5","DOIUrl":"https://doi.org/10.1007/s10143-025-03868-5","url":null,"abstract":"<p><p>Hemifacial spasms (HFS) are often triggered by vascular compression of the facial nerve, with the vertebral artery (VA) playing a role in 10-20% of cases. This study retrospectively analyses surgical techniques for personalised treatment strategies in patients with VA-involved HFS to determine the most effective surgical approach based on VA characteristics. This retrospective study analysed 112 patients with VA-involved HFS who underwent microvascular decompression (MVD) from July 2020 to June 2023. Patients were categorised into four subtypes of VA-involved HFS based on VA characteristics and neurovascular contacts: Type I, where the compression point of the VA on the branch vessel is found outside the branch vessel's compression point on the facial nerve; Type II, with a vertically superimposed compression relationship, further divided into IIa (VA diameter < 4.5 mm) and IIb (VA diameter ≥ 4.5 mm); Type III, the tortuous pushing type with VA bending into an arc shape and compression and deforming facial nerve; and Type IV, the bilateral VA parallel type with both VAs on the same side of the lesion. Three surgical techniques were applied: interposition decompression with Teflon™ implants, suspension decompression with fibrin glue, and bridge-layered decompression. Postoperative outcomes showed no significant difference in symptom relief rates (p = 0.537) and early complications (p = 0.357) among the three groups. The study concludes that a tailored approach to decompression based on VA subtypes is practical for VA-involved HFS, emphasising the importance of selecting the appropriate surgical method based on specific VA characteristics.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"672"},"PeriodicalIF":2.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186558","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":"Dural repair after intraoperative CSF leakage in endoscopic endonasal skull base surgery without pedicled nasoseptal flap: is it a safe surgical technique?","authors":"Bernardo Reyes Medina, Stefan Linsler, Safwan Saffour, Kerim Hakan Sitoci-Ficici, Joachim Oertel","doi":"10.1007/s10143-025-03831-4","DOIUrl":"10.1007/s10143-025-03831-4","url":null,"abstract":"<p><p>In this study we evaluated the outcome and efficacy of a multilayer closure technique of the sellar floor after transsphenoidal endoscopic approaches for sellar pathologies in correlation to the intraoperative grading of cerebrospinal fluid (CSF) leak. Overall 280 patients were reviewed retrospectively who underwent endonasal transsphenoidal endoscopic surgery for sellar pathologies from January 2011 to April 2020. Among them, 87 patients had an intraoperative cerebrospinal fluid leak and were included in this study. The intraoperative cerebrospinal fluid grading was based on the classification by Esposito. Clinical outcomes were evaluated based on postoperative complications and development of postoperative cerebrospinal fluid leak in correlation to the used closure technique and material of dural and skull base reconstruction. Their association with the intraoperative cerebrospinal fluid leak grade, underlying pathology and the tumor size were analyzed as well. From the 87 patients, there was 54 women (62%) and 33 men (38%). The mean age was 56.3 ± 14.8. The most frequent histological diagnosis was non-secreting adenoma in 40 cases (45%), followed by the secreting adenomas with 16 cases (18%). Eight cases of meningioma (9%), six cases of Rathke's cleft cyst (7%), six cases of craniopharyngioma (7%), four cases of colloid cysts (4%), four chordomas (4%) were observed. Of the 87 patients with intraoperative cerebrospinal fluid leaks, 20 cases were classified as grade 1, 37 cases as grade 2 and 30 cases as grade 3. The materials used for the closure of grade 1 were primarily sealant sponge Tachosil ® (70%), followed by fibrin glue (55%) and bone (55%). For grade 2, Tachosil ® (78%), bone (57%) and autologous fat graft (54%). In grade 3 dural leaks, the combination of lumbar drains (90%), autologous fat graft (87%) and fascia lata (60%) were mainly used. Only nine patients developed a new postoperative cerebrospinal fluid leak in this series, and were treated conservatively with lumbar drains, but only three of them discontinued by this method. The remaining six patients with persistent postoperative cerebrospinal fluid leak underwent revision surgery. The analyzed multilayer closure technique correlated to the intraoperative CSF leakage for endoscopic transsphenoidal surgery has been shown to be safe. This study shows a lower intraoperative cerebrospinal fluid leak rate compared to other studies and similar rate of postoperative cerebrospinal fluid leak (3.1% vs. 3.9%) compared to the pedicled vascular flap and other techniques in the literature. Based on these results, the multilayer closure represents a real alternative to nasoseptal flap application in selected cases. However, in large defects and complex reconstruction of anterior skull base defects, use of lumbar drain and pedicled nasoseptal flap should remain the gold standard of treatment.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"671"},"PeriodicalIF":2.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12479674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186594","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":"Neurosurgical journals' policies on artificial intelligence use in manuscript preparation and peer review.","authors":"Ali A Mohamed, Saahas Rajendran, Daniel Colome, Emma C Sargent, Clemens M Schirmer, Meena Vessell, Brandon Lucke-Wold, Akshay Sharma, Owoicho Adogwa, Stephen Pirris","doi":"10.1007/s10143-025-03793-7","DOIUrl":"https://doi.org/10.1007/s10143-025-03793-7","url":null,"abstract":"<p><p>As artificial intelligence (AI), particularly large language models (LLMs), continues to progress, its impact on academic publishing, both in manuscript drafting and peer review, has attracted considerable attention. In neurosurgery, where journals serve a crucial role in disseminating research, formal guidelines regarding AI remain relatively underexplored. Our study aims to investigate the current state of AI policies among prominent neurosurgical journals, focusing on their role in manuscript preparation and peer review. 38 neurosurgical journals were identified by searching the Johns Hopkins University of Medicine Welch Medical Library, combined with National Library of Medicine subject terms. Each journal's author instructions, editorial policies, and peer-review guidelines were examined for explicit AI usage policies, focusing on manuscript preparation and peer review. Tasks such as writing assistance, data analysis, figure generation, and citation management were documented if identified. Any stated requirements, prohibitions, and disclosure practices for AI were recorded, as well as instances where no policy existed. Of the 38 journals surveyed, 31 (81.6%) had AI use guidelines, 9 (23.7%) based on individual journal-level explicit policies and 22 (57.9%) based on publisher-level guidelines. Majority of journals (n=30, 78.9%) provided guidelines for using AI in manuscript preparation, with most prohibiting its inclusion as an author. Most journals allow but mandate transparent disclosure of AI involvement in readability improvements, grammar correction, and style editing. Fewer journals (n = 13, 34.2%) specified AI policies for peer review, although those that did mention AI often prohibited its use for evaluating submissions due to confidentiality concerns. Although many neurosurgical journals now acknowledge AI's role in manuscript preparation, guidelines for AI-driven peer review remain scarce. Given AI's rapid advancement, establishing clear, comprehensive, and standardized AI policies will be critical for upholding transparency, quality, and efficiency in neurosurgical publishing.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"670"},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145177026","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":"Minimally invasive evacuation for spontaneous supratentorial haemorrhage: scoping for candidates and hypothetical logistic burdens in a pragmatic scenario.","authors":"Alejandra Mosteiro, Melissa Coronel-Coronel, Leire Pedrosa, Álvaro Lambea-Gil, Ramón Torné, Pol Camps-Renom, Luis Prats-Sanchez, Joan Marti-Fabregas, Sergio Amaro, Anna Ramos-Pachón","doi":"10.1007/s10143-025-03823-4","DOIUrl":"10.1007/s10143-025-03823-4","url":null,"abstract":"<p><p>Minimally invasive surgery (MIS) is being evaluated as a promising treatment for spontaneous intracerebral haemorrhage (ICH). Transitioning to early clot removal requires accurate estimation of eligible candidates in practical scenarios. We conducted a prospective population-based observational study of ICH across all public stroke centres in Catalonia-Spain, between 2020 and 2022. Patient characteristics, need for conventional surgery and clinical outcomes were recorded. Inclusion and exclusion criteria from major trials assessing MIS for ICH were retrospectively applied to obtain the number of potential candidates. Sensitivity analyses examined the impact of withdrawal of care (WoC) decisions and variations in selection criteria on eligibility estimates. Among 2,197 reported ICH cases, 1,571 met the selection criteria and had complete follow-up to be analysed. Annually, 113 (14.4%) patients met the criteria for catheter plus thrombolysis evacuation (MISTIE-III criteria), and 45 (5.7%) for parafascicular evacuation (ENRICH criteria). Eligibility rates varied considerably depending on age and haematoma volume thresholds, and with changes in WoC, which affected 20-29% of potential candidates. Conventional evacuation was performed as a life-saving measure in 40 (5%) patients annually according to local protocols. If implemented, MIS protocols could increase the number of clot evacuation procedures in a range of 1.1-1.8 times. In a hypothetical scenario of MIS implementation for early ICH evacuation protocol in Catalonia, 5.7-14.4% of patients could potentially qualify for surgery. Consequently, the annual number of emergent clot evacuation procedures might increase 1.1-fold to 1.8-fold, highlighting substantial impact on healthcare infrastructure and resource planning.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"669"},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145177001","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":"Intra-hospital MRI transport in neurocritical patients with aneurysmal subarachnoid hemorrhage: complications and clinical impact with predominant continuation of care.","authors":"Alexandra Grob, Jonas Georg Buff, Lilian Kriemler, Federica Stretti, Giovanna Brandi","doi":"10.1007/s10143-025-03824-3","DOIUrl":"10.1007/s10143-025-03824-3","url":null,"abstract":"<p><p>Introduction Magnet Resonance Imaging (MRI) is essential for neurocritical care but requires intrahospital transport (IHT) in patients treated in an intensive care unit, which carries significant risks. This study assesses the risk profile and whether the benefits of MRI in aneurysmal subarachnoid hemorrhage (aSAH) outweigh the associated complications of IHT. Method In this retrospective study, all aSAH patients treated in our neurocritical care unit (NCCU) between 2016 and 2023 were screened. Data collection included baseline demographics, hemorrhage severity scores, aneurysm treatment strategies, additional neurosurgical procedures, and need for spasmolysis. IHT- and MRI-related variables were recorded, including timing, indication, duration, and associated physiological parameters such as blood gas values, vital signs, intracranial pressure (ICP), and cerebral perfusion pressure (CPP). The incidence of complications and the clinical impact of MRI findings were evaluated. Statistical comparisons were conducted using the Wilcoxon signed-rank test. Results Of 337 screened patients, 115 (34.1%) patients with aSAH underwent a MRI during the NCCU stay and were included in the analysis, with a total of 156 MRI scans performed. The most common reason for a MRI was ischemia exclusion (61%). Complications occurred in 16% of patients (n = 25), classified as systemic (56%), cerebral (37%), and technical (7%). Blood gas analysis showed no significant changes before and after IHT. In the subgroup of patients with an external ventricular drain (EVD) in situ (n = 93), ICP remained stable, while CPP increased from 85.4 (± 20.5) to 92.1 (± 19.9) mmHg (p = 0.009). Accordingly, systolic BP and MAP increased (p = 0.019 and < 0.001, respectively) and HR decreased by 4/min (p < 0.001). Conclusion We found lower frequency of IHT-related complication in brain MRI after aSAH compared to existing literature reflecting a well-established and safe clinical process. Moreover, MRI findings had a notable impact on key therapeutic decisions, supporting the use of MRI-based IHT in selected cases, provided that a thorough risk-benefit assessment is conducted.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"667"},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12474663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149920","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":"Single vs. multiple lesions in sporadic cerebral cavernous malformations: the role of developmental venous anomalies.","authors":"Delal Bektas, Giuseppe Lanzino, Kelly D Flemming","doi":"10.1007/s10143-025-03845-y","DOIUrl":"https://doi.org/10.1007/s10143-025-03845-y","url":null,"abstract":"<p><p>This study evaluated clinical and radiological factors associated with lesion multiplicity in sporadic cerebral cavernous malformations (CCMs), focusing on developmental venous anomalies (DVAs) as potential drivers of lesion multiplicity. Data from 269 patients with sporadic CCMs in a prospective registry were analyzed. Demographic, clinical, and radiological variables were collected, and patients were categorized into single or multiple CCM groups. CCM-DVAs were classified into Type I, II, or III based on angioarchitecture. Comparative analyses and multivariate logistic regression identified predictors of lesion multiplicity. The mean age at diagnosis was 45.5 years (SD 15.9); 41.3% of patients were male. Most patients had a single lesion (92.2%, n = 248), while 7.8% (n = 21) had multiple lesions. Lesions were most commonly supratentorial cortical (40.5%, n = 109), followed by the brainstem (26.8%, n = 72) and supratentorial subcortical (24.2%, n = 65). The mean lesion size was 13.2 mm (SD 7.5). DVAs were present in 51.1% of patients (n = 135), with Type I CCM-DVAs accounting for 51.1%, Type II for 32.6%, and Type III for 16.3%. The mean DVA size was 2.3 mm (SD 1.3), with Type III being the largest (mean: 3.82 mm, SD 1.18). CCM-DVA type was significantly associated with lesion multiplicity, and Type II and III were the strongest independent predictors (p = 0.011 and p < 0.001, respectively). Brainstem CCM lesions were also significant in both univariate and multivariate models (p = 0.044). No significant associations were found with modifiable risk factors. This study is the first to systematically evaluate clinical and radiological factors associated with lesion multiplicity in sporadic CCMs. The findings identify CCM-DVA type and brainstem CCM location as key predictors, underscoring the need for further investigation into the genetic and vascular mechanisms driving lesion formation and progression.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"668"},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149836","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":"Effect of fludrocortisone in the management of hyponatremia after aneurysmal subarachnoid hemorrhage.","authors":"Matthieu Sadoul, Baptiste Balança, Frédéric Dailler, Thomas Ritzenthaler","doi":"10.1007/s10143-025-03825-2","DOIUrl":"https://doi.org/10.1007/s10143-025-03825-2","url":null,"abstract":"<p><p>Aneurysmal subarachnoid hemorrhage (aSAH) is associated with significant morbidity, particularly related to delayed cerebral ischemia (DCI). Hyponatremia, defined as a serum sodium level < 135 mmol/l, is a common complication of aSAH and is associated with the development of DCI. Fludrocortisone is used to decrease natriuresis and improve hyponatremia, but has failed to demonstrate a reduction in the frequency of cerebral vasospasm or DCI. Using the ProReSHA database, we retrospectively analyzed the impact of fludrocortisone on the development of DCI in patients hospitalized in neurocritical care unit after aSAH and presenting hyponatremia. Two hundred sixteen patients were included, 88 in the fludrocortisone group and 128 in the control group. DCI occurred in 35 (39.8%) patients in the fludrocortisone group and 34 (26.6%) in the control group (p = 0.058). Hyponatremia was significantly deeper in the fludrocortisone group than in the control group (median [interquartile range]: 130 [128-131] vs. 132 [131-133] mmol/l; p < 0.001), and lasted longer (6.0 [4.0-8.3] vs. 3.0 [2.0-5.0] days; p < 0.001). An ancillary analysis stratified according to the etiology of hyponatremia (cerebral salt wasting syndrome or syndrome of inappropriate secretion of antidiuretic hormone) also found no significant difference regarding DCI occurrence (33.3% vs. 44.6%; p = 0.238) but a significantly lower natriuresis in the cerebral salt wasting syndrome group (225 [187-308] vs. 293 [253-359] mmol/d; p = 0.01). Fludrocortisone did not prevent the development of DCI in patients admitted to a neurocritical care unit for an aneurysmal subarachnoid hemorrhage and presenting with hyponatremia. Effect of fludrocortisone in the management of hyponatremia after aneurysmal subarachnoid hemorrhage.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"666"},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150291","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}