Neurosurgical Review最新文献

{"title":"Spinal Anesthesia and Digital Anxiolysis (SPIDA) for the treatment of lumbar spinal stenosis - a feasibility study.","authors":"Anton Früh, Andreas Wetzel-Yalelis, Claudius Jelgersma, David Wasilewski, Clara F Weber, Peter Truckenmueller, Joan Alsolivany, Christian Uhl, Kiarash Ferdowssian, Robert Mertens, Ahmad Almahozi, Jan Arne Blanke, Anika Müller, Alawi Lütz, Nils Hecht, Peter Vajkoczy, Lars Wessels","doi":"10.1007/s10143-025-03433-0","DOIUrl":"10.1007/s10143-025-03433-0","url":null,"abstract":"<p><p>Lumbar spinal stenosis (LSS) is a prevalent condition, particularly in elderly patients, characterized by a clinical syndrome that includes buttock or lower extremity pain, commonly associated with sensory and motor dysfunction. The surgical management of these patients is challenging due to higher rates of comorbidities and increased risks of experiencing complications such as postoperative delirium, leading to intensive care and prolonged hospital stays. Awake surgery under spinal anaesthesia (SA) has been associated with advantages concerning the occurrence of complications and the clinical outcome after surgery. Within this study, we aim to investigate the combination of spinal anesthesia without administration of any systematically effective medication and digital anxiolysis for patients suffering from one-level lumbar spinal stenosis who were treated via microsurgical decompression. This is a single-centre feasibility study. We included patients with LSS that were treated via microsurgical decompression. The patients were divided into groups according to the anaesthetic technique employed: (a) classical GA-Group or (b) Spinal Anaesthesia and Digital Anxiolysis via Virtual Reality Goggles (SPIDA-Group). Demographic, clinical, and radiographic patient data were retrospectively extracted from clinical records and documentation. For SPIDA-Group patients Odom's criteria (excellent/good/fair/poor) were additionally routinely assessed. Matched pair analysis was performed to compare the outcomes of both groups. The final study population consisted of 65 patients. The surgical and clinical outcomes between GA-Group and SPIDA-Group were equivalent. 86.7% of the SPIDA-Group patients described their surgical experience as excellent, and 13.3% described it as good. All patients treated with the SPIDA-Bundle indicated that they would undergo the surgery again in the SPIDA setting. In 2 patients, the lumbar puncture was unsuccessful (punctio sicca), leading to the switch to GA. One patient reported an inadequate sensitive distribution of the spinal anesthetic, necessitating a switch to GA as well. Furthermore, in one patient, the intrathecal application caused a dural leak. This had to be surgically closed with sutures during the surgery. None of the patients suffered postoperative delirium. The combination of digital anxiolysis and spinal anesthesia is a feasible and promising approach for the microsurgical treatment of LSS. Patients report compelling satisfaction, and clinical outcomes are comparable to GA.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"316"},"PeriodicalIF":2.5,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692781","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":"A bibliometric and visualized analysis of interventional treatment for intracranial atherosclerotic stenosis (from 2004 to 2023).","authors":"Kai Du, Jieqin Gong, Jizhen Li, Hanchun Chen, Qi Fang","doi":"10.1007/s10143-025-03473-6","DOIUrl":"https://doi.org/10.1007/s10143-025-03473-6","url":null,"abstract":"<p><p>Intracranial atherosclerotic stenosis is a notable factor leading to ischemic strokes, with a sustained elevated risk of recurrence despite intensive medical management. Recent years have witnessed a surge in research focusing on interventional strategies for addressing this condition. This study seeks to assess the current state and future development paths of interventional therapies for intracranial atherosclerotic stenosis, offering critical insights and recommendations for future research endeavors in this field. A comprehensive bibliometric evaluation was conducted using the bibliometric analysis tools VOSviewer_1.6.20 and CiteSpace 6.3.1, sourcing data from the Web of Science Core Collection database. This analysis encompassed literature related to interventional treatments for intracranial atherosclerotic stenosis from 2004 to 2023, supplemented by graphical illustrations. Following a thorough screening process, we identified 3,384 articles suitable for inclusion in this analysis. An observable increase in publication volume has been noted over the last two decades, with the United States leading in the number of publications. Interestingly, China has shown a significant rise in publication activity in recent years, with Capital Medical University being a prominent contributor. Noteworthy authors in this domain include Derdeyn, C.P. and Levy, E.I., and the Journal of Neurointerventional Surgery has emerged as the primary venue for these articles. The domain of interventional treatments for intracranial atherosclerotic stenosis presents considerable potential for future developments, highlighting the need for a concerted approach towards personalized and precise therapeutic strategies grounded in rigorous multicenter research.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"315"},"PeriodicalIF":2.5,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692839","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":"Meta-analyses of the surgical outcomes using personalized 3D-printed titanium and PEEK vs. standard implants in cranial reconstruction in patients undergoing craniectomy.","authors":"Leonardo Di Cosmo, Francesca Pellicanò, Jad El Choueiri, Edoardo Schifino, Roberto Stefini, Delia Cannizzaro","doi":"10.1007/s10143-025-03470-9","DOIUrl":"https://doi.org/10.1007/s10143-025-03470-9","url":null,"abstract":"<p><p>The introduction of 3D-printing technology in cranial reconstruction introduces novel opportunities to optimize surgical outcomes. This meta-analysis investigates the efficacy of 3D-printed titanium and polyetheretherketone (PEEK) implants versus standard non-3D-printed implants in cranial reconstructions following craniectomy. A systematic search across PubMed, Cochrane, Embase, and Scopus was conducted, identifying studies between 2003 and 2024 meeting the inclusion criteria. 9 studies and a total of 942 patients were included in our analysis, of which 318 received 3D-printed implants and 624 underwent standard cranioplasties. Our results showed that 3D-printed titanium implants significantly reduced total complication rates (OR: 0.26, p = 0.0009) compared to standard implants, whilst 3D-printed PEEK implants presented with no statistical difference in comparison to standard implants (OR: 1.02, p = 0.972). Similarly, 3D-printed implants showed a significant decrease in infection rates compared to standard implants (OR: 0.33, p = 0.0238). However, 3D-printed implants were also associated with increased risk of effusion (OR: 2.20, p = 0.0103). There were no other significant differences in complications such as epilepsy, hematoma, or dehiscence. Although these findings suggest the potential benefits of 3D-printed implants in cranioplasty, specifically those of titanium implants, the quality of the current literature on the topic is relatively poor with the majority of studies being single-center retrospective studies. Therefore, prospective randomized control studies are required to confirm these trends and elucidate the comparative efficacy of this technique to standard treatment. Keywords: Cranioplasty; Cranial Reconstruction; 3D Printing; Personalized; Titanium; PEEK.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"312"},"PeriodicalIF":2.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674404","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 factors for bleeding in patients with arteriovenous malformations associated with intracranial aneurysms.","authors":"Nebojsa Lasica, Hanah Hadice Gull, Ulrich Sure, Petar Vulekovic, Djula Djilvesi, Dragan Andjelic, Ramazan Jabbarli, Cornelius Deuschl, Marvin Darkwah Oppong","doi":"10.1007/s10143-025-03468-3","DOIUrl":"https://doi.org/10.1007/s10143-025-03468-3","url":null,"abstract":"<p><strong>Background and objectives: </strong>Natural history of brain arteriovenous malformations (bAVMs) with associated intracranial aneurysms (IAs) reveals a higher rate of hemorrhage. We aimed to identify the prevalence and risk factors for hemorrhage in a subgroup of patients with bAVMs and associated arterial IAs.</p><p><strong>Methods: </strong>The authors conducted an international, bicentric retrospective study of patients with ruptured and unruptured bAVMs with associated IAs treated at tertiary centers between January 2013 and December 2022. Sociodemographic data, clinical characteristics, and radiological parameters in patients with bAVM and associated IAs were analyzed.</p><p><strong>Results: </strong>Of 944 patients with bAVM, 137 individuals with 191 associated arterial IAs were included in the final analysis. Bleeding presentation was documented in 85 cases (62.0%). The mean size of bAVM-associated IAs was 6.8 (SD = 4.8) mm. Multiple intracranial aneurysms (MIA) were present in 35 patients (25.5%). bAVM-associated IAs were classified as nidal in 19.0%, flow-related in 73.7%, and unrelated in 7.3% of cases. Univariate analysis revealed that arterial hypertension (odds ratio 4.37 [CI 1.52-12.57]; P =.004), history of smoking (odds ratio 5.77 [CI 1.26-26.53]; P =.013), and high-grade bAVMs (grades IV/V, odds ratio 0.35 [CI 0.15-0.87]; P =.02), were associated with a bleeding risk. In the multivariable analysis, only arterial hypertension remained significantly associated with the bleeding event (adjusted odds ratio 3.37 [CI 1.07-10.58]; P =.038).</p><p><strong>Conclusions: </strong>Observational data from our large bicentric cohort of patients with bAVM and associated IAs identified arterial hypertension as a risk factor associated with an increased risk of bleeding.</p><p><strong>Trial registration: </strong>The study was approved by the Institutional Review Board (IRB) of the University Clinical Center of Vojvodina and the University of Duisburg-Essen (20-9288-BO).</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"313"},"PeriodicalIF":2.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674405","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 of brain volume increase in patients with intracranial hypertension after decompressive craniectomy and expansion craniotomy.","authors":"Luigi Valentino Berra, Andres Rubiano, Guido Cedrone, Mattia Capobianco, Andrea Bassani, Antonio Santoro","doi":"10.1007/s10143-025-03440-1","DOIUrl":"https://doi.org/10.1007/s10143-025-03440-1","url":null,"abstract":"<p><p>Intracranial hypertension is a critical condition often resulting from traumatic brain injury or malignant middle cerebral artery ischemia, necessitating surgical intervention when conservative treatments fail. This study compares the efficacy of decompressive craniectomy (DC) and expansion craniotomy (EC) in managing cerebral edema. Sixty-three patients, 52 undergoing DC and 11 undergoing EC, were evaluated for changes in brain volume, midline shift, and other key parameters using pre- and post-operative CT scans. Results indicated that brain volume increased significantly more in the EC group (100 ± 51 cm³) compared to the DC group (72 ± 51 cm³, p < 0.05). Both techniques effectively reduced midline displacement, but EC showed a superior capacity for brain expansion. The findings suggest that EC, which raises the cranial operculum to reduce soft tissue tension and provide hemostatic effects, may offer advantages over DC by allowing greater decompression and reducing the risk of complications such as epidural hematomas. These results support the potential of EC as a promising alternative to DC for treating intracranial hypertension. Future research should investigate long-term outcomes to further validate these findings.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"311"},"PeriodicalIF":2.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670318","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":"The protective role of lidocaine in surgeries involving trigeminal nerve manipulation: a meta-analysis of trigeminocardiac reflex prevention.","authors":"Almonzer Al-Qiami, Sarah Amro, Khalid Sarhan, Yusra Arafeh, Mina Milad, Islam Omar, Abdulqadir J Nashwan","doi":"10.1007/s10143-025-03449-6","DOIUrl":"10.1007/s10143-025-03449-6","url":null,"abstract":"<p><p>The trigeminocardiac reflex (TCR) is activated when the trigeminal nerve is manipulated through mechanical pressure, traction, or irritation. This leads to a rapid increase in parasympathetic activity, resulting in a decrease in heart rate (HR) and blood pressure, which can potentially lead to bradycardia, and cardiac arrest, with a prevalence of 14.5% during neurointerventional procedures (8). The aim of this study was to assess the effect of lidocaine injection on preventing TCR during cranial surgeries. We conducted a comprehensive search of PubMed, Web of Science, and Cochrane CENTRAL electronic databases for clinical trials comparing the use of lidocaine versus placebo, or no intervention for TCR prevention during cranial surgeries up until 20 May 2024. Meta-analyses were performed using fixed-effects models, and heterogeneity was assessed using I-squared and Chi-square tests. A total of five studies involving 421 patients were included in this meta-analysis. The incidence of TCR was significantly lower in the lidocaine group compared to the control group, with a risk ratio of 0.05 (95% CI 0.01 to 0.37, P = 0.003). Additionally, the lidocaine group had a relatively small change in HR, with a mean difference of -10.56 (95% CI -13.30 to -7.83 beat per minute, P = 0.00001). No statistically significant difference in mean arterial pressure was observed between the two groups (MD -5.15, 95% CI [-10.38 to 0.08 mmHg], P = 0.09). Our results suggest that lidocaine may be effective in preventing TCR and stabilizing HR. The use of lidocaine could be considered a prophylactic measure during cranial surgeries. Further studies are needed to investigate the optimal dose and timing of lidocaine administration.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"310"},"PeriodicalIF":2.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663950","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":"Anatomical significance of the vestibular aqueduct in posterior wall of the internal auditory canal drilling through the retrosigmoid approach: a study utilizing 3D reconstruction technology.","authors":"Gai Hang, Jiangheng Guan, Hang Xie, Yu Feng, Xiang Li, Meng Zhang, Peng Sun, Yanna Zhang, Zhitong Han, Ruijian Zhang, Tianhao Xie","doi":"10.1007/s10143-025-03457-6","DOIUrl":"https://doi.org/10.1007/s10143-025-03457-6","url":null,"abstract":"<p><p>The anatomical importance of the vestibular aqueduct and posterior semicircular canal is explored in this study, which utilizes three-dimensional(3D) image reconstruction and registration fusion technology through the retrosigmoid approach for drilling the posterior wall of the internal auditory canal. A total of 200 temporal bone high-resolution computed tomography (HRCT) scans were collected from 100 patients without inner ear diseases at the Central Hospital of the PLA's Neurosurgery and Radiology Department between 2016 and 2024. Additionally, temporal bone HRCT and brain MRI imaging data were also collected concurrently from 32 patients diagnosed with vestibular schwannomas. The primary focus of this research is on 3D reconstruction and fusion registration of temporal bone HRCT and brain MRI images to accurately display and measure the anatomical structures as well as provide spatial positioning data in 3D dimensions for important structures such as the vestibular aqueduct, posterior semicircular canal, tumors, among others. Several important anatomical measurements were obtained using the 3D Reconstruction and fusion Technology. In non-tumor patients, the internal auditory canal measures (8.408 ± 1.078 mm), with P-1 (defined as the pole located near the posterior region on the long axis of an elliptical opening in the inner auditory canal) to vestibular aqueduct being (9.450 ± 1.522 mm) and to posterior semicircular canal being (10.348 ± 1.542 mm). In vestibular schwannoma patients, these dimensions change to (7.977 ± 0.903) mm, (7.598 ± 1.223 mm), and (8.687 ± 1.061 mm) respectively. Statistical analysis shows significant differences (p = 5.7416e-10 < 0.05, p = 5.8961e-9 < 0.05, p = 6.0e-6 < 0.05). ROC analysis sets a threshold of 8.438 mm from the internal auditory canal to the vestibular aqueduct, warning of caution near 8 mm during surgery to prevent vestibular aqueduct damage. In patients with vestibular schwannoma, the distance from the posterior internal auditory canal to the vestibular aqueduct is shorter compared to that of the posterior semicircular canal, implying a higher likelihood of damaging the vestibular aqueduct when eroding the posterior internal auditory canal during surgery.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"309"},"PeriodicalIF":2.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657880","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":"Comparative assessment of surgical outcomes and cost-efficiency between orthopedic surgeons and neurosurgeons in degenerative lumbar spine surgery: a systematic review with pairwise and proportional meta-analysis.","authors":"Yixi Wang, Rui Zhang, Qiuyuan Huang, Yang Xiao, Alafate Kahaer, Paerhati Rexiti, Ming Xia","doi":"10.1007/s10143-025-03452-x","DOIUrl":"https://doi.org/10.1007/s10143-025-03452-x","url":null,"abstract":"<p><p>This study combines pairwise and proportional meta-analyses to evaluate differences in outcomes and cost-efficiency between neurosurgeons (NS) and orthopedic surgeons (OS) for lumbar degenerative disease. Following PRISMA guidelines, PubMed, ScienceDirect, Ovid, Web of Science, and Springer Link were searched for studies comparing NS and OS outcomes. Results for pairwise meta-analysis were generated with the \"metabin\" function using standardized mean differences (SMD) for continuous variables and odds ratios (OR) for binary variables, while the \"metaprop\" function was used to calculate pooled proportions in proportional meta-analysis. The study was registered in PROSPERO (CRD42024545992). Of the 457 search results, 7 studies were included. Compared to OS patients, NS patients exhibited significantly higher overall complication rates [OR: 1.09 (95% CI: 1.03-1.15); NS: 9.49%, OS: 8.92%], hospital costs [SMD: 0.30 (95% CI: 0.28-0.31); NS: $37,251.78, OS: $31,024.18], and hospital stays [SMD: 0.03 (95% CI: 0.01-0.04); NS: 3.32 days, OS: 3.23 days], while with no significant differences in superficial surgical site infections [OR: 1.12 (95% CI: 0.97, 1.31); NS: 1.70%, OS: 1.13%], deep surgical site infections [OR: 1.09 (95% CI: 0.99, 1.20); NS: 0.78%, OS: 0.67%], wound dehiscence [OR: 1.10 (95% CI: 0.98, 1.22); NS: 0.66%, OS: 0.57%], pneumonia [OR: 1.06 (95% CI: 0.92, 1.22); NS: 1.29%, OS: 1.13%], urinary tract infections [OR: 1.22 (95% CI: 1.07, 1.38); NS: 1.51%, OS: 1.31%], sepsis [OR: 1.25 (95% CI: 0.97, 1.61); NS: 0.80%, OS: 0.58%], or pulmonary embolism [OR: 1.13 (95% CI: 0.85, 1.51); NS: 0.41%, OS: 0.35%]. NS patients showed lower, though insignificant, rates of deep vein thrombosis [OR: 0.95; NS: 0.66%, OS: 0.57%], unplanned readmissions [OR: 1.00; NS: 4.64%, OS: 4.67%], and reoperations [OR: 0.91; NS: 3.94%, OS: 4.25%] compared to OS patients. Despite differing training backgrounds, NS and OS show comparable outcomes overall, with unique strengths suggesting that collaborative efforts may enhance lumbar surgery outcomes.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"308"},"PeriodicalIF":2.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657881","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":"Correction to: Surgical risk of CSF leakage following endoscopic transorbital approach for anterior and middle skull base pathologies: a systematic review and meta-analysis.","authors":"Sergio Corvino, Jacopo Berardinelli, Giuseppe Corazzelli, Roberto Altieri, Iacopo Dallan, Francesco Corrivetti, Matteo de Notaris","doi":"10.1007/s10143-025-03461-w","DOIUrl":"10.1007/s10143-025-03461-w","url":null,"abstract":"","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"307"},"PeriodicalIF":2.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657882","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":"Traumatic vertebral artery occlusion is associated with high rates of recanalization: insights from a systematic review and meta-analysis.","authors":"Nanthiya Sujijantarat, Bushra Fathima, Varun Padmanaban, Jacob Kosyakovsky, Aladine A Elsamadicy, Joseph O Haynes, Andrew B Koo, Ganesh M Shankar, Robert W Regenhardt, Christopher J Stapleton, James D Rabinov, Ryan M Hebert, Charles C Matouk, Aman B Patel","doi":"10.1007/s10143-025-03460-x","DOIUrl":"https://doi.org/10.1007/s10143-025-03460-x","url":null,"abstract":"<p><strong>Background: </strong>Vertebral artery occlusion (VAO) is a known complication of blunt cervical injuries and can be associated with a risk of devastating strokes. VAO can spontaneously recanalize, particularly following cervical spine intervention. The aim of this study is to examine overall recanalization rates, recanalization in the context of cervical spine intervention, and the associations between VAO and stroke, spinal cord injury, and acute cervical deformity.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of literature using Medline, EMBASE, Cochrane, and manual citation searches. Included studies reported at least 5 adult patients with traumatic VAO and delayed radiographic outcomes, unless embolization was performed for permanent occlusion during the initial admission. Cervical spine intervention was defined as open surgery or external traction. Random effects meta-analysis was used.</p><p><strong>Results: </strong>Fifteen of 755 studies were included. VAO was associated with spinal cord injury in 67% of cases (95%CI, 43-92%, n = 132, p < 0.001) and acute cervical deformity in 73% (95%CI, 62-83%, n = 91, p < 0.001). The incidence of stroke at presentation was 13% (95%CI, 6-19%, n = 269, p < 0.001). The overall rate of VAO recanalization was 36% in non-embolized patients (95%CI, 23-48%, n = 285, p < 0.001). When only studies reporting on cervical spine intervention were considered, the rate of recanalization post-intervention was 57% (95%CI, 30-85%, n = 45, p < 0.001). Follow-up periods were highly variable, ranging from 1 to 103 weeks.</p><p><strong>Conclusions: </strong>A substantial portion of traumatic VAOs recanalized at follow-up, with more than half of patients undergoing cervical spine intervention recanalizing. The analyses revealed considerable heterogeneity, likely indicative of variability in clinical practices, established guidelines and reporting standards. These findings offer important insights into the natural history of traumatic VAO and should be considered when choosing management strategies for this patient population.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"306"},"PeriodicalIF":2.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649577","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}