Neurosurgical Review最新文献

{"title":"Medical student perceptions and career intentions toward neurosurgery: results from an international multicentre study.","authors":"Mohammad Ashraf, Hassan Ismahel, Gemma Learmonth, Aneesah Bashir Binti Azad Bashir, Conor K Kennedy, Conor S Gillespie, Katelyn Hudak, Mohammad Alabdulrahman, Attika Chaudhary, Ameerah Gardee, Devansh Mitesh Shah, Abdel Rahman Osman, Abdel-Rahman Ms Abdel-Fattah, Beth Behan, Brian Mc Cormick, Bryan Way Wern Lim, Wern, Caoilfhinn Tan, Dana Louise Hutton, Daniel Sescu, Emily Boyd, Hamzah S Hanif, Huzefah Hanif, Jane Birdie Shi Qi Ong, Kateryna Kohut, Maha Shehab, Reagan O'Kane, Sarah-Jane Dempsey, Vidushi Sharma, Yu Heng Ho, Zara Tebay, Nadeen Ismahel, Saife Salem, Sophia Ismahel, Victoria Grace Collins, Javed Iqbal, Samih Hassan, Matthew R Walters, Roddy O'Kane, Naveed Ashraf","doi":"10.1007/s10143-025-03771-z","DOIUrl":"10.1007/s10143-025-03771-z","url":null,"abstract":"<p><p>Despite neurosurgery's rapid evolution as a speciality, the presence of structured neurosurgical education in medical schools remains limited. There is growing concern that reduced exposure contributes to declining student interest in the field. The ScoTtish And iRish medical students' perceptions Towards neurosurgery (STARTS) study aimed to assess medical students' attitudes, perceptions, and experiences with neurosurgery, identifying factors that influence career interest and intent to pursue the speciality. A cross-sectional survey was distributed to medical students across Scotland, Northern Ireland, and the Republic of Ireland between January and June 2023. The study included all medical schools in these countries. The survey comprised demographic questions, Likert-scale responses, and free-text answers. Predictors of interest and intent to pursue neurosurgery were analysed using binomial generalised linear regression models. Qualitative data were analysed using thematic analysis. A total of 2,795 complete responses were analysed. While 73% of students found neurosurgery interesting, only 25% intended to pursue it as a career. Neurosurgical interest was highest among first-year students and declined as they progressed through medical school. A lack of structured exposure was evident, with 89% of students having never completed a neurosurgical clinical placement and 84% reporting no direct exposure to the speciality. Factors significantly associated with an increased interest, and intention to pursue neurosurgery included membership in a student neurosurgical interest group (OR = 2.14, p < 0.001), attending a neurosurgical conference (OR = 3.15, p < 0.001), an interest in academic medicine (OR = 1.64, p < 0.001), completing a neurosurgical clinical clerkship/mandatory placement (OR= 1.56, p < 0.023), and having a peer-reviewed neurosurgical publication (OR=1.96, p < 0.0017). However, progression through medical school was an independent negative predictor of both interest and intent to pursue neurosurgery. Fascination with neuroanatomy/neurosciences, surgical-neurology, and financial compensation were main attractors. In contrast, a competitive and long training process, poor work-life balance, and an inflexible schedule were major deterrents expressed by medical students. This is the largest study to date assessing medical students' interest in neurosurgery in a Western medical education setting. Our findings indicate that structured exposure-through clinical clerkships, mentorship, and student-led engagement-plays a critical role in fostering interest. The absence of early, formal neurosurgical education may contribute to the attrition of potential trainees. These results highlight an urgent need to integrate neurosurgical teaching into medical curricula, ensuring equitable access to exposure and mentorship. Future studies should explore the long-term impact of these interventions on neurosurgical recruitment and workforce development","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"661"},"PeriodicalIF":2.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125071","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":"Continuous electrical stimulation of the dorsal root ganglion (drg-s) as a salvation therapy in patients previously treated with spinal cord stimulation. systematic review and pooled analysis.","authors":"Juan Carlos Acevedo-Gonzalez, Isabella Lacouture-Silgado","doi":"10.1007/s10143-025-03769-7","DOIUrl":"10.1007/s10143-025-03769-7","url":null,"abstract":"<p><strong>Background context: </strong>Treatment techniques on the dorsal root ganglion has offered a broad overview in the chronic pain. The aim is to review the existing evidence on DRG-s as a \"salvation\" of spinal cord stimulation therapies. We make a grouped analysis of the patients treated.</p><p><strong>Methods: </strong>A systematic search of the medical literature was conducted based on the principles recommended by PRISMA. In the phase 1 (DRG-S therapy as a \"salvation\" treatment for patients with SCS) the following search words were used: \"ganglia\", \"DRG\", \"dorsal root ganglion\", \"neurostimulation\", \"salvage\", \"salvation\", \"habituation\", \"spinal cord stimulation\". In the phase 2 studies using DRG-S therapy with previous SCS were included. The following words were used as search words in the databases: \"spinal ganglia\", \"DRG\", \"dorsal root ganglion\", \"neurostimulation\". The search included articles from each databases creation through August 2025.</p><p><strong>Inclusion: </strong>Systematic review, randomized clinical trials, observational studies, case series. Cadaveric and experimental articles were excluded.</p><p><strong>Results: </strong>In the phase 1, 230 articles were identified and 10 of them were selected for analysis. In the phase 2, 530 articles were identified and 45 of them were selected for analysis. The Prisma checklist for systematic reviews was applied and the risk of bias and the quality of the study were evaluated based on the STROBE and CONSORT criteria. 147 patients were identified has having previously had a SCS, who had previously undergone a SCS trial phase or who had an implanted and active system at the time of the study. In 31/147 patients, detailed information on clinical or therapeutic aspects related to the SCS was not included in the articles. The cause of chronic pain was most frequently reported as CRPS (37%) and PSPS (36%). It included other pathologies such as: chronic pelvic pain, radiculopathy, peripheral neuropathic pain, gonalgia, post-thoracotomy pain, post-inguinal herniorrhaphy pain, phantom limb pain and severe peripheral artery disease. The follow-up period and the analysis of the results were very varied, but it can be concluded that in most cases the use of DRG-s was indicated due to a poor clinical response to SCS despite not specifying what type of stimulation was being performed (in most cases SCS-t) or whether the therapy was salvaged with other forms of SCS (Burst, high frequency, ECAP- controlled closed-loop, Differential Target Multiplexed,etc.). In most patients implanted with DRG-s the clinical result was better and the degree of patient satisfaction with the new therapy was clear.</p><p><strong>Conclusions: </strong>DRG-s is a useful procedure in the treatment of chronic pain. It emerges as a complementary tool that can be used even in patients who have (or have had) an SCS. It should be included together with new forms of spinal cord stimulation in the therapeutic arsenal of pati","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"660"},"PeriodicalIF":2.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113743","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":"Cranioplasty complications in severe traumatic brain injury: implications of timing of surgery, implant material and incidence of vetriculomegaly versus Post-Traumatic hydrocephalus.","authors":"Salvatore Chibbaro, Ismail Zaed, Guillaume Dannhoff, Julien Todeschi, Charles-Henry Mallereau, Lara Prisco, Alex Alfieri, Keeley Bernhardt, Elisabeth Sartoretti, Marc-Eric Halatsch, Giorgio Spatola, Andrea Cardia, Carmen Bruno, Nikolaos Syrmos, Biagio Roberto Carangelo, Alessandro Zalaffi, Franco Moruzzi, Laura Lippa, Giacomo Tiezi, Franco Servadei, Andrew Reisner, Smita Khilar, Corrado Iaccarino, Andres Rubiano, Giuseppe Maria Vincenzo Barbagallo, Francesca Tarantino, Rebecca Tinturini, Chiara Bartolozzi, Alfonso Cerase, Giacomo Gualtieri, Mario Ganau","doi":"10.1007/s10143-025-03832-3","DOIUrl":"10.1007/s10143-025-03832-3","url":null,"abstract":"<p><p>Background Despite the increasing number of decompressive craniectomy (DC) in neurotrauma, the optimal timing for elective cranioplasty (CP) is still debated. Little is known about the CP complications related to surgery, implant material, and post-traumatic hydrocephalus. Objectives To explore the correlation between CP timing, implant material, and the incidence of postoperative complications in patients undergoing CP after DC for severe head injuries. Materials and methods A retrospective multicenter study was conducted from January 2010 to December 2021 across 9 European neurosurgical centers. A cohort of 4007 patients who underwent CP following DC for severe head injury was analyzed. Timing was categorized as: ultra-early (< 30 days), early (31-90 days), late (> 90 days). Complications were defined according to Clavien-Dindo classification, requiring revision surgery and/or hospital readmissions. Results Among the 4007 patients, 352 (8.8%) had ultra-early CP, 1627 (40.5%), and 2028 (51.7%) had early and late CP respectively. Cerebrospinal fluid (CSF) derangement was more frequently associated with large defects and the incidence of Sinking Skin Flap Syndrome (SSFS). SSFS was more frequently diagnosed in patients undergoing late surgery whereas hydrocephalus and epilepsy were less frequently encountered in the ultra-early and early groups (p < 0,05). The overall complication rate was 24.6% (985 patients) including internal hydrocephalus (20%), infection (18%), external hydrocephalus (15%), epilepsy (15%), acute extradural (14%) or subdural hematomas (10%), and subdural hygroma (8%). CP stabilized CSF derangement in 80% of cases, which did not progress into overt hydrocephalus, whereas 17% with definite diagnosis of post-traumatic hydrocephalus required a Ventriculo-Peritoneal shunt (VPS). Simultaneous CP and VPS led to infections in all cases, regardless of implant material. Conclusion Surgery timing has a greater impact on CP complications than implant material. CSF derangement represents the single most relevant factor influencing the clinical course of patients undergoing CP.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"659"},"PeriodicalIF":2.5,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091993","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":"Elevated cerebrospinal fluid protein predicts lumbar drainage catheter occlusion in neurosurgical patients.","authors":"Xingyu Qiu, Haitao Hu, Xue Bai, Xing Wang, Chao You, Lu Ma, Chuanyuan Tao, Dingke Wen","doi":"10.1007/s10143-025-03801-w","DOIUrl":"https://doi.org/10.1007/s10143-025-03801-w","url":null,"abstract":"<p><p>Lumbar drainage (LD) is essential in neurosurgery, but catheter occlusion remains a common complication impairing treatment effectiveness. While cerebrospinal fluid (CSF) composition has been associated with occlusion, the predictive value of individual parameters requires clarification. This study aimed to evaluate the predictive value of CSF composition, particularly protein levels, in the development of catheter occlusion. This single-center, retrospective cohort study included consecutive patients who underwent lumbar drainage catheter placement at West China Hospital during the study period. Patients were followed until catheter removal. Catheter occlusion was defined as persistent drainage < 50 mL/day or abrupt cessation. Univariate and multivariate logistic regression analyses were conducted to identify predictors of occlusion. Receiver operating characteristic (ROC) curve analysis was used to assess predictive performance and determine optimal thresholds. Among 293 patients, 43 (14.7%) experienced catheter occlusion. The median CSF protein level was significantly higher in the occlusion group (9.48 g/L [IQR: 6.22-14.35]) than in the non-occlusion group (1.61 g/L [IQR: 1.05-2.64]) (p < 0.001). CSF cell count was also elevated in the occlusion group (360 × 10⁶/L [IQR: 100-1350]) relative to the non-occlusion group (27 × 10⁶/L [IQR: 10-200]); however, its discriminative capacity was inferior. CSF protein demonstrated high predictive performance, with an area under the ROC curve (AUC) of 0.935. CSF protein level remained an independent predictor of occlusion in multivariate analysis (OR: 1.933; 95% CI: 1.543-2.421). The optimal protein threshold was 4.265 g/L. When stratified according to protein levels, the incidence of occlusion increased Markedly across groups: 3.3% in the low-protein group (≤ 4.2 g/L), 50.0% in the medium group (4.2-10 g/L), and 100% in the high-protein group (> 10 g/L) (p < 0.001). CSF protein is an independent predictor of lumbar drainage catheter occlusion with excellent discriminatory ability. A CSF protein level exceeding 4.2 g/L should be considered a clinical warning threshold. Early detection and timely intervention may help reduce occlusion-related complications and improve patient outcomes.Clinical trial number: Not applicable.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"656"},"PeriodicalIF":2.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086638","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":"Infection rates following custom-made cranioplasty using heterologous materials: insights from a systematic review on 3260 patients with a focus on follow-up length.","authors":"Francesca Faedo, Ismail Zaed, Andrea Pizzi, Corrado Iaccarino, Franco Servadei","doi":"10.1007/s10143-025-03818-1","DOIUrl":"10.1007/s10143-025-03818-1","url":null,"abstract":"<p><strong>Introduction: </strong>Custom-made cranioplasty can be performed using various heterologous materials, each associated with a distinct complication profile. This systematic review focuses on infections, the most common complication following cranioplasty.</p><p><strong>Materials and methods: </strong>A systematic review of the available literature was conducted to identify infection and explantation rates associated with materials used in custom-made heterologous cranioplasty. A comprehensive search of PubMed/MEDLINE, Scopus, and Embase databases yielded 3437 articles. After screening, 43 articles met the inclusion criteria and data on study parameters, patient populations, and infection characteristics were extracted.</p><p><strong>Results: </strong>Forty-three articles were selected and included in this review, analyzing a total of 3260 implanted cranioplasties, divided by material as follows: 931 titanium, 1227 hydroxyapatite, 680 PMMA, 379 PEEK, and 143 composites. The cumulative infection and explantation rates were: 8.2% and 3.7% for titanium, 6.7% and 5.3% for hydroxyapatite, 14.9% and 6.1% for PMMA, 11.1% and 3.8% for PEEK, and 4.2% and 6.2% for composites. Importantly, the follow-up duration varied significantly among materials. Studies involving titanium and composites had the shortest follow-up, potentially underestimating infection rates, while studies on PMMA and hydroxyapatite had the longest follow-up, providing more robust estimates.</p><p><strong>Conclusions: </strong>This review confirms general trends in infection rates among cranioplasty materials and emphasizes the critical role of follow-up duration in interpreting complication rate. Differences in study design and reporting standards limit direct comparison between materials. Future research should adopt standardized follow-up thresholds and uniform outcome definitions to enable reliable cross-material comparisons.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"657"},"PeriodicalIF":2.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086661","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":"Adult pilocytic astrocytomas: challenging the benign paradigm with surgical risks, recurrence dynamics, and molecular insights.","authors":"Dorothea Mitschang, Helena Kleineidam, Felix Hinz, Felix Sahm, Andreas Unterberg, Sandro Krieg, Philip Dao Trong, Pavlina Lenga","doi":"10.1007/s10143-025-03800-x","DOIUrl":"10.1007/s10143-025-03800-x","url":null,"abstract":"<p><p>Purpose Adult pilocytic astrocytoma (APA) is rare and clinically distinct from pediatric counterparts. Despite generally favorable prognosis, recurrence rates vary significantly based on tumor characteristics and surgical approaches. Literature regarding the influence of tumor volume, location, and patient age on surgical outcomes and survival is limited and inconclusive. This study addresses these gaps, evaluating the combined impact of these variables on APA prognosis and management. Methods We retrospectively analyzed 32 adult patients with surgically treated APA at our institution (2014-2023), examining demographics, imaging, histology, and outcomes. Results Mean age was 35.8 years (SD 11.6); 59% were male. Median Karnofsky Performance Score (KPS) at admission was 90% (range 50-100%). Infratentorial tumors (56%) correlated significantly with lower KPS, increased cranial nerve deficits, cerebellar symptoms, hydrocephalus risk, prolonged operative time, higher CSF leaks (11%), and frequent revision surgeries. Gross total resection was achieved less frequently in infratentorial (33%) compared to supratentorial tumors (43%). Overall recurrence rate was 50%, strongly predicted by higher Ki-67 proliferation indices (p < 0.05), whereas resection extent alone lacked significant correlation. BRAF mutations occurred in only 38% of recurrent cases, highlighting APA's distinct molecular profile. Five-year mortality was 6%, exclusively in High-Grade Astrocytoma with Piloid Features (HGAP). Conclusion Our findings challenge assumptions of benign clinical courses for APAs. Infratentorial tumors present increased surgical challenges and require tailored management. With recurrence rates of 50% and Ki-67 as a key prognostic marker, APA treatment demands personalized, biomarker-guided strategies beyond conventional surgical approaches.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"658"},"PeriodicalIF":2.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086635","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":"Integrating artificial intelligence with Gamma Knife radiosurgery in treating meningiomas and schwannomas: a review.","authors":"Tasneem N Alhosanie, Bassam Hammo, Ahmad F Klaib, Abdulrahman Alshudifat","doi":"10.1007/s10143-025-03820-7","DOIUrl":"https://doi.org/10.1007/s10143-025-03820-7","url":null,"abstract":"<p><p>Meningiomas and schwannomas are benign tumors that affect the central nervous system, comprising up to one-third of intracranial neoplasms. Gamma Knife radiosurgery (GKRS), or stereotactic radiosurgery (SRS), is a form of radiation therapy. Although referred to as \"surgery,\" GKRS does not involve incisions. The GK medical device effectively utilizes highly focused gamma rays to treat lesions or tumors, primarily in the brain. In radiation oncology, machine learning (ML) has been used in various aspects, including outcome prediction, quality control, treatment planning, and image segmentation. This review will showcase the advantages of integrating artificial intelligence with Gamma Knife technology in treating schwannomas and meningiomas.This review adheres to PRISMA guidelines. We searched the PubMed, Scopus, and IEEE databases to identify studies published between 2021 and March 2025 that met our inclusion and exclusion criteria. The focus was on AI algorithms applied to patients with vestibular schwannoma and meningioma treated with GKRS. Two reviewers participated in the data extraction and quality assessment process.A total of nine studies were reviewed in this analysis. One distinguished deep learning (DL) model is a dual-pathway convolutional neural network (CNN) that integrates T1-weighted (T1W) and T2-weighted (T2W) MRI scans. This model was tested on 861 patients who underwent GKRS, achieving a Dice Similarity Coefficient (DSC) of 0.90. ML-based radiomics models have also demonstrated that certain radiomic features can predict the response of vestibular schwannomas and meningiomas to radiosurgery. Among these, the neural network model exhibited the best performance. AI models were also employed to predict complications following GKRS, such as peritumoral edema. A Random Survival Forest (RSF) model was developed using clinical, semantic, and radiomics variables, achieving a C-index score of 0.861 and 0.780. This model enables the classification of patients into high-risk and low-risk categories for developing post-GKRS edema.AI and ML models show great potential in tumor segmentation, volumetric assessment, and predicting treatment outcomes for vestibular schwannomas and meningiomas treated with GKRS. However, their successful clinical implementation relies on overcoming challenges related to external validation, standardization, and computational demands. Future research should focus on large-scale, multi-institutional validation studies, integrating multimodal data, and developing cost-effective strategies for deploying AI technologies.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"655"},"PeriodicalIF":2.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081253","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":"Anterior cervical V-Slot decompression and fusion for long-segment cervical ossification of the posterior longitudinal ligament: a follow-up study.","authors":"Sheng Ye, Jiang-Bi Yi, De-Li Li, Fu-Jun Wu, Wen-Jun Ji, Qian Du, Zhi-Jun Xin","doi":"10.1007/s10143-025-03812-7","DOIUrl":"10.1007/s10143-025-03812-7","url":null,"abstract":"<p><p>Cervical ossification of the posterior longitudinal ligament (OPLL) causes spinal cord compression due to spinal canal stenosis. Traditional anterior approaches such as anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) have limitations, including restricted decompression range, extensive vertebral resection trauma, or insufficient stability. This study aimed to evaluate the efficacy and safety of a novel surgical technique-Anterior Cervical V-Slot Decompression and Fusion (ACVDF)-for treating long-segment OPLL. A retrospective analysis was conducted on 30 patients with multilevel OPLL who underwent ACVDF between December 2021 and March 2024. A curved grinding drill was used to precisely remove portion of the vertebral body and ossified tissue (≤ 50% of the sagittal diameter) through the V-shaped distracted intervertebral space, achieving direct decompression of long-segment OPLL During surgery. Postoperative follow-up 14.70 ± 1.62 months (12-18 months). Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and imaging methods such as CT and MRI. All 30 patients successfully completed the surgery, with a mean operative time of 143.17 ± 10.96 min and intraoperative blood loss of 177.67 ± 49.45 ml. At the final follow-up, the JOA score improved from 8.50 ± 1.96 to 14.67 ± 0.71 (P < 0.05), with an excellent and good rate of 90.00%. The VAS score decreased from 6.53 ± 1.53 to 1.30 ± 0.79 (P < 0.05). The spinal canal occupancy rate decreased from 42.13 to 10.61% (P < 0.05). The Height of the fused segments was 62.70 ± 13.58 mm at 1 week postoperatively and increased to 62.94 ± 13.99 mm at the final follow-up (P > 0.05). Cervical range of motion (ROM) decreased from 51.57 ± 8.96° preoperatively to 33.07 ± 6.18° at the final follow-up (P < 0.05). The fusion rate reached 100% at the final follow-up. No complications such as dural tears or spinal cord injuries occurred during surgery. ACVDF can achieve direct decompression of long-segment OPLL while preserving anterior column structures, maintaining cervical stability, and getting favorable clinical outcomes. This technique provides a new safe and effective treatment option for long-segment OPLL.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"650"},"PeriodicalIF":2.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081138","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 single-center experience on endoscopic assisted evacuation of chronic subdural hematoma: is there a role for endoscopic evacuation in the modern era?","authors":"Netanel Ben-Shalom, Marcio Yuri Ferreira, James Feghali, Alon Orlev, Idan Levitan, Eilat Sapirstain, Sagi Harnof, Uzi Ben-David","doi":"10.1007/s10143-025-03815-4","DOIUrl":"https://doi.org/10.1007/s10143-025-03815-4","url":null,"abstract":"<p><p>Despite numerous randomized clinical trials (RCTs) published in recent years and the development of consensus guidelines, there is still room for refinement in treatment indications aimed at lowering recurrence rates and optimizing surgical and clinical outcomes in chronic subdural hematoma (cSDH). Herein, we report our single-center outcomes on endoscopic assisted evacuation of cSDH. We retrospectively assessed the patient charts for baseline characteristics and surgical and clinical outcomes of all consecutive patients who underwent endoscopic evacuation of cSDH during the period of January 2016 and January 2017. Endpoints assessed were postoperative hematoma size, difference between preoperative and postoperative hematoma size, postoperative midline shift, difference in incidence of preoperative and postoperative midline shift, mRS (modified Rankin Scale) at discharge, Glasgow outcome scale (GOS) at discharge, 30-day total complications, 30-day major complication, 30- day minor complication, reoperation, hematoma size at last follow up (FU), difference between last-FU hematoma size and preoperative hematoma size, 6-month mRS, incidence of worst mRS at last-FU in comparison to preoperative mRS, and procedure-related mortality. Fourty-four patients with a mean age of 74.5 ± 13.6 years, of which 16 (36%) were females, were included. The mean hospital LOS was 3.9 ± 2.4 days. Surgery achieved an average decrease in hematoma size and midline shift of 12.0 ± 4.4 mm and 5.2 ± 2.8 mm, respectively. The total 30-day complication rate was 36% with a major complication rate of 14%. The most frequent complication was seizure (31% of complications). There was one procedure-related mortality (2%). On discharge, most patients (29/44, 66%) had a good mRS score (0-2). A total of 4 (9%) patients required reoperation. Favorable 6-month GOS (4-5) and mRS (0-2) occurred in 31 (78%) and 35 (84%) patients, respectively. Compared to pre-operative functional status, 6-month mRS was worse only in 4 (10%) patients. In our single-center experience, including most patients with cSDH with membranes and mixed density hematomas, EAE was highly effective and safe. In the modern era, MMAE has proven to be effective as adjunctive to surgical evacuation in cSDH, and we believe that RCTs comparing EAE combined with MMAE to other surgical modalities.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"652"},"PeriodicalIF":2.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081085","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 of acromegalic patients undergoing endoscopic endonasal surgery: collaborative French and Italian cohort, a 25-year experience.","authors":"Bertrand Baussart, Matteo Zoli, Thibault Passeri, Federica Guaraldi, Chiara Villa, Sofia Asioli, Anne Jouinot, Marie Laloi, Mirella Hage, Carine Courtillot, Camille Vatier, Philippe Chanson, Jérôme Bertherat, Guillaume Assié, Stephan Gaillard, Sebastien Froelich, Diego Mazzatenta","doi":"10.1007/s10143-025-03797-3","DOIUrl":"https://doi.org/10.1007/s10143-025-03797-3","url":null,"abstract":"<p><p>It has been demonstrated that high expertise is crucial for pituitary surgery. Due to the low incidence of acromegaly, large data reporting the outcome of endoscopic surgery are limited. The objective was to evaluate the outcomes of acromegalic patients undergoing endoscopic surgery. This retrospective study included 822 consecutive acromegalic patients treated by endoscopic endonasal surgery by two expert French and Italian neurosurgical teams from 1998 to 2022. The primary outcome was postoperative endocrine remission. The secondary outcome was operative morbidity, including surgical complications and new endocrine deficits. Preoperative predictive factors of persistent postoperative hypersecretion were calculated. Mean follow-up was 46.3 months. The overall remission rate was 63%. Long-term remission was achieved in 202/230 (88%) enclosed microadenomas, 316/452 (70%) macroadenomas without obvious cavernous sinus invasion, and 3/140 (2%) obvious invasive tumors. Hematoma, nerve palsy, cerebrospinal fluid leak, meningitis and epistaxis occurred in 0.1%, 0.1%, 1%, 0.6% and 1.1% respectively. New anterior pituitary deficits and diabetes insipidus occurred in 25/822 (3%) and 30/822 (3.6%) of patients respectively. Age, obvious cavernous sinus invasion, and larger diameter were predictive of persistent hypersecretion in multivariate analysis. Recurrence of somatotroph hypersecretion occurred in 19/540 (4%) patients with early remission, with a mean time of 37.5 months. Endoscopic pituitary surgery is effective and safe for acromegaly, provided that patients are treated in tertiary reference centers. Remission rate is high in microadenomas. If normalized somatotroph axis is achieved after surgery, long-term remission can be expected in most patients.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"654"},"PeriodicalIF":2.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081219","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}