Neurosurgical Review最新文献

{"title":"Predictors of pulmonary embolism in adult patients following neurosurgery: a Chinese single-center, retrospective study.","authors":"Jie Gong, Baoshu Xie, Yufang Wang, Yanting Zhang, Lei Shi, Mingli Yao, Jingchao Li, Bin Ouyang, Lingyan Wang, Yan Li","doi":"10.1007/s10143-025-03633-8","DOIUrl":"10.1007/s10143-025-03633-8","url":null,"abstract":"<p><p>Patients undergoing neurosurgery are at elevated risk for venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). The incidence and risk factors for PE in neurosurgical patients remain a subject of debate. This study aimed to identify risk factors for PE in this population. We conducted a retrospective case-control study of post-neurosurgical hospitalized patients with PE from January 2017 to March 2023 at the First Affiliated Hospital of Sun Yat-sen University. A control group, matched for age, sex, and entry time (1:3 ratio), consisted of patients without PE. Clinical and biomarker variables were recorded for analysis. Univariate and multivariable logistic regression (MLR) analyses were performed to identify predictive factors for postoperative PE, and diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis.47 PE patients confirmed by computed tomography pulmonary angiography (CTPA) and 141 matched controls were included. The average annual incidence of PE was 0.4%. MLR identified longer surgical duration (OR 1.404, P < 0.001), higher postoperative D-dimer levels (OR 1.170, P = 0.003), and lower platelet count (OR 0.991, P = 0.040) as independent risk factors for PE. The logistic regression model demonstrated strong diagnostic performance. Prognosis analysis revealed a lower mortality rate in the PE group (10.64%) compared to the non-PE group (20.57%). The clinical prediction model, incorporating surgery duration, postoperative D-dimer levels, and platelet count, effectively identifies patients at high risk for PE following neurosurgery, aiding in prevention strategies.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"481"},"PeriodicalIF":2.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216354","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":"Enhancing precision in MRgFUS for tremor treatment: a systematic review of tractography-based VIM targeting approaches.","authors":"Benjamin Mendelson, Joseph C Melott, Kate Gelman, Abdul Hadi Khan, Aniruddha Bhagwat, Peter Konrad, Adeel A Memon","doi":"10.1007/s10143-025-03627-6","DOIUrl":"https://doi.org/10.1007/s10143-025-03627-6","url":null,"abstract":"<p><strong>Background: </strong>Magnetic resonance guided focused ultrasound (MRgFUS) thalamotomy has been an effective treatment option in the management of various tremor etiologies. The process of targeting the VIM thalamic location relies on indirect atlas/coordinate-based systems using anatomic reference points. With advancing imaging modalities, thalamic structures can be better visualized resulting in additional targeting techniques and improved accuracy.</p><p><strong>Objectives: </strong>To identify and evaluate MRgFUS thalamotomy targeting techniques for tremor beyond atlas/coordinate-based systems.</p><p><strong>Methods: </strong>A systematic review was conducted in Embase, Cochrane, and PubMed. Studies including MRgFUS for tremor, targeting methods, and tremor outcomes were included. After review of 297 studies, 13 met inclusion criteria.</p><p><strong>Results: </strong>All 13 studies used tractography to visualize various combinations of white matter tracts to guide target acquisition. These tracts include the medial lemniscus (ML), corticospinal tract (CST), and the dentatorubrothalamic tracts (DRTT) which was further delineated into the non-decussating (ndDRTT) and a decussating components (dDRTT) by some studies. At least 50% reduction was reported by all studies with paresthesia and gait instability being the most common side effects, although mostly mild and transient.</p><p><strong>Conclusions: </strong>Advanced targeting via tractography may lead to better outcomes and could broaden the eligibility criteria for MRgFUS. Individualized targeting allows for more precise sonication, potentially reducing the number of sonications needed, improving patient tolerance, making sedation a viable option, and boosting effectiveness, especially in cases of atypical anatomy. To confirm these potential benefits in MRgFUS thalamotomy, standardized trials are definitely needed.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"479"},"PeriodicalIF":2.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216353","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":"Drug-Coated Balloon Versus Stent Angioplasty in Patients with Intracranial Atherosclerotic Disease: A Systematic Review and Meta-Analysis.","authors":"Luiz Guilherme Silva Almeida, Gabriel Semione, Lucca Tamara Alves Carretta, Lucas Copolillo Faria, Yasmin Picanço Silva, Ocílio Ribeiro Gonçalves, Rafael Torres Fonseca Dos Santos, Paweł Łajczak, Marcelo Costa, Marcio Yuri Ferreira, Christian Ferreira, David Gordon, Yafell Serulle","doi":"10.1007/s10143-025-03630-x","DOIUrl":"https://doi.org/10.1007/s10143-025-03630-x","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke, particularly in high-risk populations. Endovascular treatment options, including drug-coated balloon (DCB) angioplasty and stent angioplasty (SA), have been explored as alternatives for patients with severe stenosis or refractory symptoms. However, the comparative efficacy and safety of these interventions remain a topic of debate.</p><p><strong>Methods: </strong>A systematic search was conducted across PubMed, Embase, Cochrane, Scopus, and Web of Science up to December 2024. Studies comparing DCB to SA were included. Outcomes analyzed were symptomatic restenosis, overall restenosis rates, and recurrent ischemic events.</p><p><strong>Results: </strong>Three studies with 213 patients met the inclusion criteria. DCB was associated with significantly lower rates of overall restenosis (OR: 0.22, 95% CI: 0.10-0.50, I2 = 0%,p < 0.001) and recurrent ischemic events (OR: 0.20, 95% CI: 0.07-0.63, I2 = 0%,p = 0.006). There was no statistically significant disparity between both methods concerning symptomatic restenosis (OR: 0.34, 95% CI: 0.09-1.24, I2 = 0%, p = 0.101).</p><p><strong>Conclusion: </strong>This meta-analysis suggests that DCB angioplasty may be safer and more effective than SA for ICAD, with lower rates of restenosis and ischemic complications. However, the evidence is primarily based on observational studies, highlighting the need for multicenter randomized controlled trials with standardized protocols to establish further the comparative efficacy and long-term outcomes between DCB and SA in patients with ICAD.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"480"},"PeriodicalIF":2.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216352","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":"Value of biomarkers in the prediction of shunt responsivity in patients with normal pressure hydrocephalus.","authors":"Miroslav Cihlo, Pavel Trávníček, Alena Tichá, Radomír Hyšpler, Marta Kalousová, Svatopluk Řehák, Karel Zadrobílek, Lucie Kukrálová, Pavel Póczoš, Jan Pospíšil, Pavel Dostál, Vlasta Dostálová","doi":"10.1007/s10143-025-03581-3","DOIUrl":"10.1007/s10143-025-03581-3","url":null,"abstract":"<p><p>Preoperative differentiation between responders and non-responders to ventriculoperitoneal (VP) shunting in the treatment of normal pressure hydrocephalus (NPH) remains a significant challenge. Identifying biomarkers in presurgical assessment represents a promising approach to reducing the need for invasive cerebrospinal fluid CSF testing. In this prospective observational study, thirty adult patients were classified into Group A (responders to VP shunting) and Group B (non-responders) based on their responsiveness to invasive CSF testing. The overall clinical condition and Idiopathic NPH (iNPH) scale were assessed at baseline. Additionally, biomarker levels were compared between the two groups. Elevated levels of Neurofilament Light Chain (NfL) and Neurofilament Heavy Chain (NfH) in CSF and a reduced level of beta-amyloid Aβ42 were observed. No significant differences in biomarker levels were found between groups. Individual biomarkers demonstrated only poor predictive value (AUC = 0.37-0.53). Clinical factors were stronger predictors (AUC = 0.642-0.669), with no improvement when combined with all examined biomarkers (AUC = 0.428-0.431). No single biomarker reliably predicted confirmed postoperative shunt responsiveness among patients who underwent VP shunt placement and demonstrated clinical improvement. Clinical factors were stronger predictors, suggesting that patient history and clinical assessment (e.g., the iNPH scale) provide more reliable diagnostic information. Notably, combining biomarkers with clinical factors did not improve predictive accuracy.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"474"},"PeriodicalIF":2.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208991","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":"Impact of acute hydrocephalus after aneurysmal SAH on longitudinal cognitive outcome- post-hoc analysis of the MoCA-DCI study.","authors":"Vincens Kälin, Svenja Maschke, Menno R Germans, Philippe Bijlenga, Rodolfo Maduri, Roy Thomas Daniel, Thomas Robert, Johannes Goldberg, David Bervini, Anna M Zeitlberger, Oliver Bozinov, Emanuela Keller, Luca Regli, Martin N Stienen, Isabel C Hostettler","doi":"10.1007/s10143-025-03635-6","DOIUrl":"10.1007/s10143-025-03635-6","url":null,"abstract":"<p><p>Hydrocephalus is a common complication following aneurysmal subarachnoid hemorrhage (aSAH), associated with increased morbidity and mortality. While its immediate negative impact on cognitive function is well-known, the longitudinal effects, especially in lower-grade aSAH patients, remain unclear. This study aimed to assess these effects. Within the prospective, multicenter \"MoCA-DCI study\" (ClinicalTrials.gov NCT03032471), patients with a GCS of 13-15 < 72 h post-aSAH underwent serial neuropsychological assessments using the Montreal Cognitive Assessment (MoCA) at baseline (< 72 h post-aSAH), around discharge (14-28 days post-aSAH), and at 3-month follow-up. Standardized MoCA scores were compared to evaluate cognitive outcomes, and the likelihood of a clinically meaningful decline (≥ 2 points) was assessed in patients with and without hydrocephalus. We included 112 patients, mean age 53.9 years (SD 13.9), 66.1% female. Forty patients (35.7%) developed acute hydrocephalus and received external ventricular drainage; 10 of these (25%) required a ventriculo-peritoneal shunt. MoCA z-scores were significantly lower in the hydrocephalus group at baseline (-2.84 vs. -1.12, p < 0.001), at discharge (-3.35 vs. 0.53, p < 0.001), and at 3 months (-0.68 vs. 0.07, p = 0.02). Patients with hydrocephalus were more likely to experience a ≥ 2-point decline from baseline at discharge (OR 2.76, 95% CI 1.16-6.53; p = 0.02) but not at the 3-month follow-up (OR 1.22, 95% CI 0.32-4.62; p = 0.77). Acute hydrocephalus has a negative impact on longitudinal neurocognitive function, yet patients demonstrate improvements until 3-month follow-up. The impairment of cognitive function may be partially recovered as cerebrospinal fluid flow is restored or permanently diverted.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"476"},"PeriodicalIF":2.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208988","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 treatment for symptomatic pure arterial malformations: a single-center experience.","authors":"Weidong Xia, Xiangping Zhong, Zhongying Ran, Dacheng Ding, Meng Zhang, Xiaoguang Tong","doi":"10.1007/s10143-025-03619-6","DOIUrl":"https://doi.org/10.1007/s10143-025-03619-6","url":null,"abstract":"<p><p>Pure arterial malformations (PAMs) are rare cerebrovascular conditions characterized by dilated, tortuous arteries with a coil-like appearance, without venous components. Traditionally considered benign, PAMs are typically conservatively managed. However, their detection has increased with advancements in noninvasive imaging, and concerns about progression have emerged, with cases of cerebral hemorrhage or infarction being reported, raising questions about their benign nature and optimal treatment. Over nine years, our center surgically treated seven patients with symptomatic PAM, finding that PAMs are not invariably benign, especially in patients with aneurysm or prior stroke. We suggest that proactive surgical intervention, including malformation isolation or resection, complemented by cerebral bypass for vascular reconstruction, should be the preferred strategy. We also underscore the need for tailored management based on individual risk factors.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"478"},"PeriodicalIF":2.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208989","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":"Comparison between pipeline embolization device (PED) versus flow redirection endoluminal device (FRED) for intracranial aneurysms: a comprehensive systematic review and meta-analysis.","authors":"Seyed Farzad Maroufi, Mohammad Sadegh Fallahi, Muhammad Waqas, Othman Bin-Alamer, Manisha Koneru, Joanna M Roy, Jane Khalife, Hamza A Shaikh, Daniel A Tonetti","doi":"10.1007/s10143-025-03595-x","DOIUrl":"10.1007/s10143-025-03595-x","url":null,"abstract":"<p><strong>Objectives: </strong>The performance of the Pipeline Embolization Device (PED) and relatively newer double-layered Flow Re-Direction Endoluminal Device (FRED) have been studied for the treatment of intracranial aneurysms, but direct comparisons between PED and FRED are limited. The current systematic review aims at comparing the efficacy and safety of PED and FRED.</p><p><strong>Methods: </strong>A systematic review of the literature was conducted according to the PRISMA guideline. PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched, and related records were identified. A meta-analysis of double-arm studies comparing PED and FRED was conducted on angiographic and clinical outcomes, retreatment rates, and complications following treatment.</p><p><strong>Results: </strong>A total of 15 retrospective double-arm studies, published from 2017 to 2023, were included. Studies were predominantly from the US and Germany. A total of 2231 patients across these studies were analyzed, with 1214 treated using PED and 1017 with FRED. Angiographic outcomes demonstrated no significant difference in occlusion rates between PED and FRED (P = 0.35). Retreatment rates trended lower with FRED (P = 0.08) but were not significant. Moreover, adjunctive coiling was more frequently utilized with FRED (P = 0.04). Complication rates were similar between the two groups. There was no significant difference in mortality between the two devices (P = 0.80).</p><p><strong>Conclusion: </strong>This review provides evidence on the comparable safety and effectiveness of FRED with PED. PED and FRED show comparable angiographic outcomes, with a trend toward lower retreatment rates with FRED. Complication rates and mortality are comparable, with slightly higher historical hemorrhage rate for PED.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"475"},"PeriodicalIF":2.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208987","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 LITTability study - evaluation of the applicability of LITT in a real-world cohort of glioma patients.","authors":"Manuel Kaes, Vincenzo Rondinelli, Sandro M Krieg, Martin Jakobs","doi":"10.1007/s10143-025-03644-5","DOIUrl":"10.1007/s10143-025-03644-5","url":null,"abstract":"<p><p>Laser-interstitial thermal therapy (LITT) is a minimally invasive technique used in neurosurgery for ablation of epileptic foci and malignant lesions, especially for glioma located in regions that pose high surgical risk. Current research mainly focuses on maximizing the safety of the procedure and proving the non-inferiority compared to open resection of glioma. However, data regarding the current applicability in real-time cohorts are lacking. The goal of this study is to evaluate the real-world applicability of LITT in glioma patients, specifically focusing on those who had undergone stereotactic biopsy, and to define limiting factors. For this retrospective study, we analyzed n = 207 glioma patients from a monocentric stereotactic surgery database over a 5-year period (2018-2022). Clinical, histopathological and radiological data were assessed. To define a lesion suitable for LITT, a two-step approach was used. In a first step, predefined selection criteria were applied consisting of a Karnofsky Performance Score of 70 or higher, an ASA Score of 3 or less, MRI compatibility, and glioma presenting as a single or bifocal lesion. In a second step, the LITT simulation was performed with additional criteria consisting of at least 90% possible ablation volume, a safe trajectory with avoidance of vessels, and optimal lesion accessibility without brainstem involvement. Out of 207 patients, 137 cases met initial preselection criteria, while 36 cases (17.4%) were ultimately deemed suitable for LITT post-simulation. Common exclusion factors included multifocal lesions, irregular lesion shape, and size constraints. Among suitable cases, 94.4% had unifocal lesions. For 44.4% of cases, only a single catheter was needed, with the number of ablation points varying from one to twelve per trajectory. The average lesion diameter for LITT-suitable cases was 26.4 mm. Even though LITT offers a promising alternative for glioma not suitable for open resection, the current application is limited. Main reasons were due to lesion morphology and size. Enhancing LITT applicability could involve addressing constraints posed by lesion geometry and volume. Prospective studies comparing LITT with conventional resection could better define the subset of glioma patients who may benefit most, advancing the potential for LITT in clinical neurosurgical practice.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"477"},"PeriodicalIF":2.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208990","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":"Comparing surgical outcomes of the semisitting versus lateral position in large vestibular schwannoma surgery: a randomized clinical trial.","authors":"Gang Song, Binghan Zhang, Yuanchen Tang, Haoming Geng, Xiaolong Wu, Yiqiang Zhou, Jiantao Liang","doi":"10.1007/s10143-025-03624-9","DOIUrl":"https://doi.org/10.1007/s10143-025-03624-9","url":null,"abstract":"<p><p>The choice between the semisitting position (SSP) and the lateral position (LP) for vestibular schwannoma (VS) surgery remains a topic of debate, particularly for large tumors, and high-quality evidence is limited. This study aimed to prospectively determine the optimal surgical position for VS with a diameter of ≥ 3 cm. This analysis is based on a randomized clinical trial assessing the efficacy and safety of VS surgery in SSP versus LP. Outcomes included the extent of resection, functional results, complications, and health economics. A total of 115 consecutive patients with large VS were prospectively enrolled between December 2019 and November 2023 (SSP: 58, LP: 57). The gross-total resection (GTR) rate was significantly higher in the SSP group compared to the LP group (P = 0.026). There was no significant difference in facial nerve (FN) function between the groups 7 days post-operation; however, FN function was superior in the LP group after 1 year. Preoperative preparation duration and craniotomy durations in the SSP group were significantly longer, while overall operative time, tumor resection, and cranial closure durations showed no significant differences between the groups. In terms of health economics, patients in the SSP group had longer hospital stays and higher hospitalization costs. This study demonstrated that SSP offers advantages in achieving higher GTR rates. However, it does not provide any significant benefit in preserving facial nerve function. Given the elevated risks of VAE, SSP should primarily be considered for patients in good physical condition. Furthermore, patients in the SSP group required more extensive preoperative evaluations and intensive monitoring, resulting in longer hospital stays and increased costs. The financial implications of hospitalization should also be taken into account.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"472"},"PeriodicalIF":2.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199678","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":"Changes in preoperative and postoperative blood flow parameters are closely associated with in-stent stenosis after flow diverter treatment in unruptured intracranial aneurysms: a retrospective cohort study.","authors":"Zhikun Jia, Xuetao Wang, Jiahe Yin, Mengshi Huang, Bin Luo, Zhichao Wu, Jiayin Ma, Qiyu Xie, Jialin Gao, Qile He, Zhixi Li, Xin Jin, Chi Huang, Xifeng Li, Yanchao Liu, Chuanzhi Duan, Xin Zhang","doi":"10.1007/s10143-025-03569-z","DOIUrl":"10.1007/s10143-025-03569-z","url":null,"abstract":"<p><p>Flow diverters (FDs) have emerged as a promising therapeutic option for unruptured intracranial aneurysms (UIAs), demonstrating favorable clinical outcomes. Nevertheless, the association between hemodynamic alterations and in-stent stenosis (ISS) following FD implantation remains poorly understood. This study sought to elucidate the independent relationship between perioperative blood flow velocity changes and ISS development in patients undergoing FD treatment for UIAs. A retrospective cohort analysis was conducted on 127 consecutive patients treated with FDs at our institution between July 2023 to September 2024. Hemodynamic parameters, including peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean velocity (MV), were meticulously assessed using transcranial color-coded duplex (TCCD) sonography at both preoperative and postoperative time points. Of the 74 patients who completed follow-up, 8 (10.81%) developed significant ISS, defined as stenosis exceeding 25% of the luminal diameter. Multivariate logistic regression analysis revealed a statistically significant inverse correlation between PSV changes and ISS risk (OR = 0.96, 95% CI: 0.92-0.99, P = 0.026). Stratification of PSV changes into tertiles demonstrated a dose-dependent protective effect, with the highest tertile exhibiting the most pronounced risk reduction. Furthermore, MV changes were independently associated with a 6% reduction in ISS risk per unit increase (OR = 0.94, 95% CI: 0.89-1.00, P = 0.048). A lower variation in preoperative and postoperative peak systolic velocity and MV was associated with an increased risk of ISS. If significant PSV and MV changes are observed between preoperative and postoperative measurements of the parent artery, it may suggest an increased risk of ISS, indicating the need for clinicians to provide additional interventions.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"473"},"PeriodicalIF":2.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199677","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}