Neurosurgical Review最新文献

{"title":"Tubular retractors in neuro-oncological surgery: a systematic review and meta-analysis.","authors":"Amir Rafati Fard, Owen Hibberd, Isaac Akinduro, Zainab Bhatti, Kieran J Smith, Reece Patel, Sejal Karmarkar, Oliver D Mowforth, Ciaran S Hill","doi":"10.1007/s10143-025-03677-w","DOIUrl":"10.1007/s10143-025-03677-w","url":null,"abstract":"<p><p>Neuro-oncological surgery necessitates a careful balance between maximising tumour resection whilst minimising damage to healthy brain parenchyma. Tubular retractors represent an emerging tool proposed to facilitate in the optimisation of this onco-functional balance. The objective was to evaluate the evidence regarding tubular retractors in neuro-oncological surgery. A systematic review and meta-analysis was performed. Studies reporting on surgical outcomes of tubular retractors in adult neuro-oncological cases were eligible. Medline, Embase, Cochrane Library, ClinicalTrials.gov, and ICTRP were searched to 14th July 2024. Duplicate title/abstract screening, data extraction, and risk of bias assessments were conducted. Prevalence of gross total resection (GTR) and complications were calculated using random effects models. 49 studies were included in the final analysis with a total of 684 patients. Combined pooled prevalence for GTR was 76% (95% CI: 67-85%), whilst for complications was 14% (95% CI: 8-20%). GTR rate by tumour histology was: 52% for gliomas (95% CI: 41-62%), 80% for metastases (95% CI: 65-92%), and 100% for colloid cysts (95% CI: 99-100%). Complication rate by tumour histology was: 16% for gliomas (95% CI: 5-30%), 12% for metastases (95% CI: 1-28%), and 16% for colloid cysts (95% CI: 8-24%). There was no significant difference between tubular retractor brands and GTR or complication rate (p > 0.05). Despite the mounting interest regarding the utility of tubular retractors in neuro-oncological surgery, the current evidence remains largely in the form of case series. Prospective studies with greater sample sizes, longer follow-up, and direct comparison to conventional retraction are now needed.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"530"},"PeriodicalIF":2.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507102","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":"Using a syringe as tubular retractor and working channel in minimally invasive cranial and spinal neurosurgery.","authors":"Guenther C Feigl, Daniel Staribacher, Iván N Camal Ruggieri, Gavin Britz, Dzmitry Kuzmin","doi":"10.1007/s10143-025-03642-7","DOIUrl":"10.1007/s10143-025-03642-7","url":null,"abstract":"<p><p>Minimally invasive spinal and cranial neurosurgery often requires tissue retraction. However, excessive tissue retraction is contrary to the principles of minimally invasive neurosurgery. Therefore, any retractor used should be small and atraumatic. Circular plastic retractors made from syringes of various sizes meet these requirements. We report a case series of patients with various cranial and spinal pathologies who underwent surgeries using \"self-made\" retractors made from plastic syringes of various sizes (2 mL, 5 mL, and 10 mL). All surgeries were performed via minimally invasive approaches. In all cases, the goals of surgical treatment were achieved with no neurological deficits. The use of \"self-made\" plastic retractors can be helpful in spinal and cranial minimally invasive neurosurgery. Making retractors from plastic syringes and using them is not labor-intensive. This method can extend the possibilities of the neurosurgeon, especially in the field of minimally invasive neurosurgery. Clinical trial number: Not applicable.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"529"},"PeriodicalIF":2.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485267","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 rupture of intracranial aneurysms in patients with autoimmune diseases.","authors":"Shenkun Tang, Yongkai Qin, Liyang Zhang, Yingchao Jing, Aihua Liu, Baorui Zhang","doi":"10.1007/s10143-025-03621-y","DOIUrl":"https://doi.org/10.1007/s10143-025-03621-y","url":null,"abstract":"","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"526"},"PeriodicalIF":2.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476130","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":"Comprehensive predictive modeling in subarachnoid hemorrhage: integrating radiomics and clinical variables.","authors":"Gemma Urbanos, Ana M Castaño-León, Mónica Maldonado-Luna, Elena Salvador, Ana Ramos, Carmen Lechuga, César Sanz, Eduardo Juárez, Alfonso Lagares","doi":"10.1007/s10143-025-03679-8","DOIUrl":"10.1007/s10143-025-03679-8","url":null,"abstract":"<p><p>Subarachnoid hemorrhage (SAH) is a severe condition with high morbidity and long-term neurological consequences. Radiomics, by extracting quantitative features from Computed Tomograhpy (CT) scans, may reveal imaging biomarkers predictive of outcomes. This study evaluates the predictive value of radiomics in SAH for multiple outcomes and compares its performance to models based on clinical data.Radiomic features were extracted from admission CTs using segmentations of brain tissue (white and gray matter) and hemorrhage. Machine learning models with cross-validation were trained using clinical data, radiomics, or both, to predict 6-month mortality, Glasgow Outcome Scale (GOS), vasospasm, and long-term hydrocephalus. SHapley Additive exPlanations (SHAP) analysis was used to interpret feature contributions.The training dataset included 403 aneurysmal SAH patients; GOS predictions used all patients, while vasospasm and hydrocephalus predictions excluded those with incomplete data or early death, leaving 328 and 332 patients, respectively. Radiomics and clinical models demonstrated comparable performance, achieving in validation set AUCs more than 85% for six-month mortality and clinical outcome, and 75% and 86% for vasospasm and hydrocephalus, respectively. In an independent cohort of 41 patients, the combined models yielded AUCs of 89% for mortality, 87% for clinical outcome, 66% for vasospasm, and 72% for hydrocephalus. SHAP analysis highlighted significant contributions of radiomic features from brain tissue and hemorrhage segmentation, alongside key clinical variables, in predicting SAH outcomes.This study underscores the potential of radiomics-based approaches for SAH outcome prediction, demonstrating predictive power comparable to traditional clinical models and enhancing understanding of SAH-related complications.Clinical trial number Not applicable.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"528"},"PeriodicalIF":2.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476128","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":"Morphological variability of the jugular foramen: a comprehensive anatomical-imaging study emphasizing its compartmentalization.","authors":"George Triantafyllou, Ioannis Paschopoulos, Panagiotis Papadopoulos-Manolarakis, Nektaria Karangeli, Fotis Demetriou, George Tsakotos, Maria Piagkou","doi":"10.1007/s10143-025-03681-0","DOIUrl":"10.1007/s10143-025-03681-0","url":null,"abstract":"<p><p>The jugular foramen (JF) is a structurally complex region of the skull base with critical neurosurgical relevance. This anatomical imaging study aimed to investigate the morphological variability of the JF by analyzing both its intracranial and extracranial orifices using a combination of osteological assessment and computed tomography (CT) scans.A total of 200 adult skulls (100 dried specimens and 100 CT scans) were examined bilaterally. The JF was classified based on the presence, number, and completeness of intrajugular processes (IJPs). Morphometric measurements of horizontal and transverse diameters were performed, and statistical analyses were used to evaluate differences by sex, laterality, and between the intracranial and extracranial aspects.IJPs were significantly more common in the intracranial orifice (41%) compared to the extracranial (19.5%), with type 1a (incomplete septation) being the most frequent. A right-sided predominance was observed for intracranial JF dimensions (p = 0.036), while no significant sex-related differences were found. The morphometric analysis revealed that JF compartments became progressively narrower with an increasing number of IJPs. A moderate positive correlation was found between intracranial and extracranial measurements (B = + 0.357, p < 0.001).This study provides a detailed anatomical and radiological analysis of JF variability, emphasizing its clinical implications for skull base surgery. The findings highlight the importance of preoperative imaging in identifying IJP-related compartmentalization, which may impact surgical planning and risk assessment. Future research should aim to better correlate bony septations with neurovascular content to define their relevance in both surgical and pathological contexts. Clinical trial number Not applicable.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"527"},"PeriodicalIF":2.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476129","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":"Inpatient neurosurgical mortality in germany: a comprehensive analysis of 2023 in-hospital data.","authors":"Marcel A Kamp, Christine Jungk, Matthias Schneider, Georgia Fehler, Antonio Santacroce, N Dinc, Florian H Ebner, Christiane von Sass","doi":"10.1007/s10143-025-03664-1","DOIUrl":"10.1007/s10143-025-03664-1","url":null,"abstract":"<p><strong>Background: </strong>Neurosurgical conditions and procedures are associated with varying in-hospital mortality rates, which represent one of several quality indicators. This study aims to determine and report in-hospital mortality rates across German neurosurgical departments in 2023.</p><p><strong>Methods: </strong>A cross-sectional analysis of all neurosurgical cases treated in Germany in 2023 was conducted using nationwide hospital billing data reported under § 21 of the Hospital Remuneration Act. In-hospital mortality was defined as death during hospitalization (discharge status: deceased).</p><p><strong>Results: </strong>Neurosurgical departments treated 222,158 inpatient cases, with 49% female and 48% aged ≥ 65 years. The overall mortality rate was 3.8% (8,338 cases), with significantly lower rates in females (3.3% vs. 4.2%, p < 0.0001). The most common fatal diagnoses included traumatic subdural hematomas (1,278 cases), subcortical intracerebral hemorrhages (611 cases) and traumatic subarachnoid hemorrhages (504 cases). Mortality rates varied by diagnosis: malignant brain tumors (4%), cerebral metastases (6%), benign meningeal tumors (1.3%), non-traumatic subarachnoid hemorrhages (7%), intracerebral hemorrhages (29%), and traumatic subdural hematomas (12%). Mortality for selected procedures was 3% for primary brain tumor resections, 9% for vascular reconstructions, 1% for spinal fusions, 2% for dynamic stabilizations, and 4% for vertebral body replacements.</p><p><strong>Conclusions: </strong>This study analyzes and reports neurosurgical in-hospital mortality rates in Germany, providing a national benchmark that may inform clinicians, policymakers, and patients. While the use of administrative billing data imposes inherent limitations - particularly regarding clinical detail and causality - the findings may offer a foundation for future research. Subsequent studies should aim to explore disease- and procedure-specific mortality more granularly and may identify underlying risk factors.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"525"},"PeriodicalIF":2.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369105","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":"Robot-assisted versus navigated spinal fusion surgery: a comparative multicenter study on transpedicular screw placement accuracy and patient outcomes.","authors":"Giada Garufi, Gianluca Scalia, Francesca Graziano, Roberta Costanzo, Massimiliano Porzio, Giancarlo Ponzo, Massimiliano Giuffrida, Giuseppe Ricciardo, Giuseppe Emmanuele Umana, Giovanni Federico Nicoletti, Salvatore Massimiliano Cardali","doi":"10.1007/s10143-025-03674-z","DOIUrl":"10.1007/s10143-025-03674-z","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The transpedicular screw placement has been the gold standard for over a decade in treating degenerative diseases of the lumbo-sacral spine related to vertebral instability. The evolution of neuronavigation and robotic surgery has mitigated many perioperative complications such as mispositioning, vascular damage, and nerve structure injuries, leading to enhanced postoperative outcomes, reduced blood loss, and decreased intraoperative radiation exposure. Our study proposes a multicenter comparison between robotic surgery and neuronavigation for treating degenerative diseases of the lumbo-sacral spine. We conducted a retrospective analysis at Papardo Hospital in Messina and Garibaldi Hospital in Catania, examining a consecutive series of 76 patients treated for degenerative diseases of the lumbo-sacral spine between March 2024 and December 2024 using the Excelsius GPS Robot and neuronavigation with the O-arm. We evaluated each procedure based on age, sex, body mass index, number of involved metameres, number of screws placed, operative times, estimated blood loss (EBL), radiation exposure, type of anesthesia, accuracy (using the Gertzbein and Robbins scale), and then compared various pre- and postoperative parameters through univariate statistical analysis. Patients were randomly assigned in a 1:1 ratio using a computer-generated sequence with permuted blocks of variable size (4-6). This ensured balanced allocation and minimized selection bias. A detailed statistical plan has been included: continuous variables were assessed using Student's t-test or Mann-Whitney U test depending on distribution (Shapiro-Wilk test), while categorical variables were evaluated with Chi-square or Fisher's exact test as appropriate. 48 out of 76 patients (average age 60.47 years) underwent pedicle screw placement via robotic surgery, and 28 patients (average age 65.92 years) via neuronavigation surgery. Robotic surgery showed comparable results to neuronavigation surgery in terms of blood loss. Additionally, functional outcomes, especially those evaluated with the ODI scale and VAS scale, were similar between the two patient groups. Despite a reported mispositioning rate of 2.2% in neuronavigation surgery, no clinical impact was observed in these specific cases. The surgical procedures included both decompression (laminectomy with partial facetectomy) and fusion in all patients. Operative time was recorded as skin-to-skin time, excluding anesthesia induction and positioning. Patients with prior surgeries at the index level, complex spinal deformities (Cobb angle &gt; 30°), or revision surgeries were excluded from this study. The included diagnoses were degenerative disc disease (RS: 56%, NS: 52%), spinal stenosis (RS: 28%, NS: 31%), spondylolisthesis (RS: 12%, NS: 14%), and traumatic pathology (RS: 4%, NS: 3%). While there was a trend towards greater precision in screw placement with robotic technology, no significant difference was observed compared to neuronavigat","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"524"},"PeriodicalIF":2.5,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340288","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 the development of hydrocephalus in traumatic brain injury: a systematic review and meta-analysis.","authors":"Zhen Kun Xiao, YongHong Duan, Ge Gao, Yang Wang, MingJia Huang, JianHua Liu, Bing Wang, AiHua Liu","doi":"10.1007/s10143-025-03611-0","DOIUrl":"10.1007/s10143-025-03611-0","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) is a significant public health issue, with 30% to 50% of patients developing post-traumatic hydrocephalus (PTH). This condition can elevate intracranial pressure, leading to headaches, vomiting, altered consciousness, and potentially coma or death, severely impacting quality of life. This study aims to systematically evaluate risk factors associated with PTH following TBI. The authors searched PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials for studies published from 2000 to 2024. Data extraction was standardized, and statistical analysis was performed using State 14.0 software. We assessed the risk of bias and compared patient characteristics, using fixed or random effects models to summarize PTH risk factors, calculating pooled odds ratios (OR) and 95% confidence intervals (CI). A total of 25 studies involving 1,383,328 TBI patients met the inclusion criteria. Significant factors associated with an increased risk of PTH included decompressive craniectomy (DC) (p < 0.001), intraventricular hemorrhage (IVH) (p = 0.016), lower Glasgow Coma Scale (GCS) scores (p < 0.001), subdural hematoma (p < 0.001), postoperative meningitis (p = 0.027), external ventricular drainage (EVD) (p < 0.001), traumatic subarachnoid hemorrhage (SAH) (p < 0.001), and epidural hematoma (p < 0.001). Age was not significantly correlated with PTH. Identifying these risk factors (DC, IVH, GCS, subdural hematoma, postoperative meningitis, external ventricular drainage, traumatic SAH, and epidural hematoma) highlights the importance of close monitoring in TBI patients. This approach aims to enable early identification of PTH and reduce its incidence, ultimately improving survival outcomes and long-term prognosis for TBI patients.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"522"},"PeriodicalIF":2.5,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between triglyceride-glucose index and intracranial aneurysm rupture: findings from a retrospective study.","authors":"Jiancheng Lin, Xin Feng, Zhuohua Wen, Chi Huang, Mengshi Huang, Jiwan Huang, Runze Ge, Anqi Xu, Gengwu Ma, Hongyu Shi, Yuqi Hu, Hao Yuan, Can Li, Ruizhe Yi, Yuheng Jin, Shuyin Liang, Xin Zhang, Xifeng Li, Chuanzhi Duan","doi":"10.1007/s10143-025-03680-1","DOIUrl":"10.1007/s10143-025-03680-1","url":null,"abstract":"<p><strong>Background: </strong>Limited studies investigated the relationship between triglyceride-glucose (TyG) index and the rupture of intracranial aneurysm (IA). We aimed to examine the association between TyG index and IA rupture in patients diagnosed with IAs.</p><p><strong>Materials and methods: </strong>Participants with IAs from January 2012 to April 2022 were retrospectively included. The association between TyG index and IA rupture was assessed by multivariable-adjusted logistic regression models, restricted cubic spline (RCS) models and subgroup analysis.</p><p><strong>Results: </strong>Among 1535 patients with 1901 IAs, 596 (31.4%) IA rupture cases occurred. The incidence of IA rupture rose along with elevated TyG index. The positive correlation persisted after adjusting for age, sex, and other covariates, with adjusted odds ratios of 1.64 (95% CI 1.26-2.14) and 1.85 (95% CI 1.41-2.42) for TyG index tertiles 2 and 3. RCS curves showed a linear trend of TyG index with the risk of IA rupture. In the subgroup analysis, similar relationships were observed across subgroups defined by age, sex, hypertension, TC and aneurysm size.</p><p><strong>Conclusions: </strong>There is a significant association between TyG index and the occurrence of IA rupture, indicating TyG index has the potential for risk assessment of IA rupture. Further prospective studies are warranted to validate its clinical utility.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT06456814). Registered on June 7, 2024.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"521"},"PeriodicalIF":2.5,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336761","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":"Post-traumatic hydrocephalus after decompressive craniectomy: a multidimensional analysis of clinical, radiological, and surgical risk factors.","authors":"Sérgio Miguel Fernandes Romualdo, Tareq Adnan Juratli, Ilker Eyüpoglu, Gabriele Schackert, Markus Dengl, Markus Prem, Mido Max Hijazi, Kerim-Hakan Sitoci-Ficici","doi":"10.1007/s10143-025-03673-0","DOIUrl":"10.1007/s10143-025-03673-0","url":null,"abstract":"<p><p>Decompressive craniectomy is a key treatment for refractory intracranial pressure after severe traumatic brain injury (TBI). Post-traumatic hydrocephalus (PTH) occurs in 7.6-36% of cases, and early diagnosis significantly improves rehabilitation outcomes. This retrospective study analyzed risk factors for shunt-dependent PTH in 126 TBI patients (93 men, 33 women, median age 53 years). Patients were divided into those requiring shunts and those who did not. Clinical and radiological characteristics, including volumetric measurements and surgical techniques, were assessed using SPSS^® Statistics 25. The incidence of shunt-dependent PTH was 27%. Multivariate analysis identified significant risk factors: advanced age at craniectomy (p = 0.008; OR 1.048), traumatic subarachnoid hemorrhage in the basal cisterns (p = 0.015; OR 7.545), post-traumatic ischemic infarcts (p = 0.003; OR 5.319), transcalvarial brain herniation (p = 0.012; OR 5.543), subdural hygroma (p = 0.004; OR 8.131), and progression of contusion hemorrhages (p = 0.013; OR 4.386). Operative parameters did not show statistical significance. Neurological outcomes in shunt patients, assessed via the modified Rankin Scale and Extended Glasgow Outcome Scale, were significantly worse than in non-shunt patients (mRS > 3, GOS-E < 5, p = 0.001-0.011). Our findings suggest that subarachnoid hemorrhage in the cisterns, advanced age, hygromas, ischemic infarcts, transcalvarial herniation, and contusion hemorrhage progression are independent risk factors for shunt-dependent PTH. Additionally, shunt placement was linked to poorer neurological outcomes.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"523"},"PeriodicalIF":2.5,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340286","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}