Neurosurgical Review最新文献

{"title":"Predicting Surgical Site Infection after Lumbar Laminectomy and Discectomy: A Cutting-edge Algorithmic Approach by Incorporating Ensembled Stacking into the Current State-of-the-art for Automated Machine Learning.","authors":"Ali Haider Bangash, Kyle Mani, Samuel N Goldman, Rose Fluss, Sertac Kirnaz, Ananth S Eleswarapu, Mitchell S Fourman, Yaroslav Gelfand, Saikiran G Murthy, Reza Yassari, Rafael De la Garza Ramos","doi":"10.1007/s10143-025-03766-w","DOIUrl":"10.1007/s10143-025-03766-w","url":null,"abstract":"<p><p>To develop an algorithmic approach for predicting surgical site infections (SSIs) in patients undergoing lumbar laminectomy and discectomy for adult degenerative spinal disease (DSD) by incorporating ensembled stacking into state-of-the-art (SOTA) automated machine learning (aML). The study utilized a comprehensive dataset from a prospective multicenter surveillance study on SSIs following lumbar laminectomy and discectomy to manage adult DSD. The Google Colab environment was adopted to load the dataset using Python programming language. Nine algorithms, including eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LGBM), Neural Network (NN), Categorical Boosting (CatBoost), and Random Forest (RF), were adopted with hyperparameter tuning using the current SOTA for aML. Ensembling of the developed algorithmic models was carried out, followed by stacking and ensembled stacking. Five-fold stratified, shuffled cross-validation was implemented. The macro-weighted average Area Under the Receiver Operating Curve (mWA-AUROC) analysis was used to evaluate the discriminating classification ability of the developed models along with other evaluation metrics. A stacked ensemble algorithmic model, comprising a stacked XGBoost model and an ensemble of XGBoost, NN, CatBoost, LGBM, and RF algorithmic models, achieved an mWA-AUROC of 0.994, an accuracy of 98.7%, a sensitivity of 90% (95% CI: 68.30% - 98.77%) and a specificity of 98.81% (95% CI: 98.15% - 99.28%) upon predicting SSI. The top-weighted constituent model, XGBoost-20, identified operative time, smoking status, and patient age as the most significant predictors of SSI. We have made the development architecture of the algorithmic model available at GitHub for external validation. This study presented a novel algorithmic approach that integrated ensembled stacking into the current SOTA for aML to predict SSIs following lumbar laminectomy and discectomy procedures for adult DSD management. The performance of the stacked ensemble model highlighted its potential to serve as a valuable tool for clinicians, enabling more informed decision-making, optimized resource utilization, and enhanced patient outcomes in spine surgery. Future research should focus on validating the performance of the model in diverse clinical settings and exploring its integration into clinical practice.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"653"},"PeriodicalIF":2.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081172","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":"Tricortical screw spinal fixation: a scoping review and introduction of technique, biomechanical advantages, and clinical outcomes in high-risk vertebral fractures.","authors":"Hanyu Qiu, Daniel O'Connor, Kishore Balasubramanian, Graham G Mulvaney, Beste Gulsuna, Abigail A York, Chao Li DO","doi":"10.1007/s10143-025-03808-3","DOIUrl":"10.1007/s10143-025-03808-3","url":null,"abstract":"<p><strong>Background/objective: </strong>Tricortical pedicle screw (TCPS) fixation has emerged as a biomechanically superior alternative to conventional unicortical/bicortical methods for spinal stabilization in high-risk populations, particularly elderly patients with osteoporotic or diffuse idiopathic skeletal hyperostosis (DISH)-related vertebral fractures. This review evaluates TCPS fixation's biomechanical advantages, clinical outcomes, and surgical considerations to address these challenges.</p><p><strong>Methods: </strong>A scoping review was conducted using the PRISMA scoping review checklist. PubMed was searched through March 1, 2025. Inclusion criteria were studies reporting treatment parameters and follow-up results of TCPS spinal fixation. Data was analyzed to synthesize clinical outcomes, with a focus on hardware failure rates.</p><p><strong>Results: </strong>5 studies satisfied the final inclusion criteria, consisting of 3 case series and 2 cohorts. These 5 studies included 85 patient cases. The included patients had a weighted mean age of 78.97 years, with a sex distribution consisting of 54.8% (n = 40) males and 45.2% (n = 33) females. 62.4% (n = 53) patients were positive for DISH. Affected vertebrae were mostly located in the thoracolumbar region (64.1%), followed by the thoracic (21.8%) and lumbar regions (14.1%). 76.5% (n = 65) of patients were treated with TCPS fixation, and 23.5% (n = 20) were treated conventionally. A total of 636 screws were inserted, consisting of 46.2% (n = 294) tricortical and 53.8% (n = 342) conventional pedicle screws. Of the tricortical screws, 1.36% (n = 4) loosened, while 20.5% (n = 70) of conventional screws loosened. 3 patients treated with TCPS fixation experienced implant failure, while 6 patients treated with conventional pedicle screw fixation experienced implant failure.</p><p><strong>Conclusion: </strong>TCPS fixation enhances spinal stabilization in high-risk fractures through tri-cortical load distribution, minimizing screw loosening and invasiveness. While requiring precise trajectory planning to avoid perforation risks, it offers shorter operative times, reduced blood loss, and improved biomechanical stability, particularly in osteoporotic/DISH patients. Further prospective studies are needed to optimize patient selection and refine navigation-assisted techniques for broader applicability.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"649"},"PeriodicalIF":2.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081258","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":"Role of routine radiographs after anterior cervical discectomy and fusion.","authors":"Megan M Finneran, Emilio M Nardone","doi":"10.1007/s10143-025-03794-6","DOIUrl":"10.1007/s10143-025-03794-6","url":null,"abstract":"<p><strong>Background: </strong>Anterior cervical discectomy and fusion (ACDF) is a procedure commonly performed for cervical radiculopathy or myelopathy. No consensus exists regarding the necessity of radiographs in the postoperative period to review for possible complication. The aim of this study was to assess the role of routine radiographs following one- and two-level ACDF with a primary focus to determine if they would alter the treatment course.</p><p><strong>Methods: </strong>The authors conducted a single-surgeon, multi-institution randomized controlled study of adult patients who underwent one- or two-level ACDF between June 2019 and January 2023. Group 1 underwent lateral cervical radiographs two weeks and three months postoperatively; Group 2 underwent radiograph only when clinically indicated. Demographics, radiographic data, and post-treatment outcomes at a minimum follow-up of three months are reported.</p><p><strong>Results: </strong>Two hundred surgeries on 200 patients involving 298 intervertebral disc levels were included. One hundred five patients were randomized to Group 1 and 95 were randomized to Group 2. The majority of patients had no complaints two weeks (72.4% in Group 1 and 80.0% in Group 2) and three months (93.3% in Group 1 and 91.6% in Group 2) postoperatively. Only one asymptomatic patient, with known osteoporosis, had a finding on radiograph that prompted a change in treatment course with addition of a cervical collar.</p><p><strong>Conclusion: </strong>Our findings suggest that patients with osteoporosis may be considered for routine radiographs postoperatively, regardless of clinical presentation. However, outside this population, we recommend the use of radiographs be guided by symptomatology rather than as standard procedure.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"648"},"PeriodicalIF":2.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081165","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":"Approach-related complications of extradural anterior petrosal approach: systematic review and meta-analysis.","authors":"Guilherme Gago, Antonio Strangio, Frederico de Lima Gibbon, Marc-Olivier Comeau, Fernando Cotrim Gomes, Pierre-Olivier Champagne","doi":"10.1007/s10143-025-03813-6","DOIUrl":"10.1007/s10143-025-03813-6","url":null,"abstract":"<p><p>The extradural anterior petrosal approach (EAPA) is a surgical technique utilized to access pathologies in the petroclival region and the anterolateral aspect of the brainstem, allowing enhanced visualization and maneuverability. Despite its advantages, the EAPA is associated with significant potential complications that remain a topic of debate within the neurosurgical community. This meta-analysis aims to evaluate the incidence of approach-related complications following EAPA. A systematic literature review was conducted across several databases, including PubMed, Scopus, and Embase. The primary outcome was cerebrospinal fluid (CSF) leak, while secondary outcomes included facial palsy, hearing loss, temporal lobe injury, postoperative seizures, and dry eye. Statistical analysis was performed using RStudio 2024.04.1 + 748. Heterogeneity was assessed using I² statistics. Sensitivity analysis was performed with the leave-one-out test. The risk of bias was assessed using ROBINS-I for non-randomized studies. Publication bias was assessed using a funnel plot and Furuya-Kanamori's Doi plot. Exclusion criteria were cases of intradural anterior petrosal approaches and articles where the data concerning approach-related complications could not be extracted. Our systematic search yielded 1098 articles, of which five met the inclusion criteria, encompassing 404 patients. The overall CSF leak rate was estimated at 3.15% (95% CI: 0.07-8.92), with a lower reoperation rate for CSF leaks at 0.40%. Other complications included temporal lobe injury (1.12%), postoperative seizures (2.42%), approach-related facial palsy (2.23%), and approach-related hearing loss (1.04%). Notably, the incidence of postoperative dry eye was reduced from 6.04 to 2.36% following refinements in surgical practices. The EAPA is a safe procedure with a low complication rate when performed in specialized centers. Outcomes depend on meticulous technique, experienced teams, comprehensive preoperative assessment, and neurophysiological monitoring. This meta-analysis is the first to focus on approach-related complications of EAPA, providing valuable insights to enhance surgical safety and patient care.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"651"},"PeriodicalIF":2.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081250","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":"Treatment outcomes of dural arteriovenous fistula presenting as trigeminal neuralgia: a systematic review and pooled analysis of 53 reported cases.","authors":"Nazmin Ahmed, Asifur Rahman, Vishal Chavda, Md Morshad Alam, Raju Ahmed, Md Nazrul Hossain, Bipin Chaurasia","doi":"10.1007/s10143-025-03799-1","DOIUrl":"10.1007/s10143-025-03799-1","url":null,"abstract":"<p><strong>Objective: </strong>Dural arteriovenous fistulas (dAVFs) are rare vascular malformations that can mimic trigeminal neuralgia (TN), particularly in patients' refractory to medical therapy. This systematic review aimed to characterize the clinical and angioarchitectural features of dAVFs presenting as TN and to evaluate treatment outcomes across published cases.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we conducted a systematic review of English language literature up to December 2024. Fifty-three published cases of dAVFs presenting with TN-like symptoms were included. Extracted variables included demographics, Borden classification, arterial feeders, venous drainage, treatment modalities, and clinical outcomes. Descriptive and subgroup analyses were performed to identify factors influencing therapeutic success.</p><p><strong>Results: </strong>The median age at diagnosis was 56 years, with a male predominance (64.2%). Borden type I fistulas were most common (39.6%). Endovascular embolization was the primary treatment in 60.4% of cases and achieved complete pain relief in 71.9%. Early intervention (≤ 1 year from symptom onset) significantly (p < 0.05) improved outcomes (82.6% complete relief vs. 52.9% in delayed cases). Multimodal treatment (combined embolization and surgical approaches) was often required for high-grade or anatomically complex lesions. Complications occurred in 10 of 53 cases (18.9%) and were generally minor and transient.</p><p><strong>Conclusions: </strong>dAVFs should be considered in patients with atypical or refractory TN. Early diagnosis, detailed angiographic evaluation, and tailored intervention especially with endovascular embolization offer high rates of pain relief and low complication risk.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"644"},"PeriodicalIF":2.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075919","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":"A novel technique for monitoring somatosensory evoked potentials during brainstem surgery: an illustrative case series.","authors":"Kristina Lapteva, Andrey Gavrjushin, Aleksei Veselkov, Anastasiia Kuznetsova","doi":"10.1007/s10143-025-03805-6","DOIUrl":"10.1007/s10143-025-03805-6","url":null,"abstract":"<p><p>The surgical management of brainstem tumors and cavernous malformations represents one of the most demanding challenges in neurosurgery, given the critical concentration of eloquent neural structures in this region. These include nuclei, cranial nerve roots and their corticonuclear tracts, corticospinal and spinothalamic pathways. Intraoperative injury to these critical structures may result in permanent neurological deficits, including progressive sensory deterioration during the postoperative course. Therefore, continuous monitoring of the functional state of the spinothalamic tracts during surgery is essential. Peripheral somatosensory evoked potentials (pSEP) have some disadvantages and limitations during such procedures. The aim of this study was to evaluate the feasibility of a novel technique for monitoring SEPs during brainstem surgery, termed brain stimulus-induced somatosensory evoked potential (bsiSEP). Continuous bsiSEP monitoring by direct stimulation of the floor of the fourth ventricle and recording of cortical responses from the scalp was performed in five consecutive patients with brainstem lesions (3 medulla oblongata tumors, 1 tumor and 1 cavernous malformation of the pontine tegmentum) undergoing microsurgical resection. Preoperative and postoperative neurological sensory deficits, neurophysiological data, and surgical outcomes were analyzed. Continuous bsiSEP monitoring was available and reproducible in all cases, although 3 patients had varying degrees of preoperative sensory neurological impairment. One patient experienced a worsening of sensory symptoms. The results of the bsiSEPs were consistent with the neurological status of the patients after surgery in all cases. Peripheral SEPs were available in four cases, but all showed false-positive results. Continuous monitoring of bsiSEP is a reproducible technique and can predict outcome during brainstem surgery. It may improve the monitoring of spinothalamic tracts and overcome the limitations of pSEPs. This technique needs further refinement, but could be used during brainstem surgery to reduce postoperative sensory deficits.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"646"},"PeriodicalIF":2.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075848","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":"Analysis of the misdiagnosis of \"atypical\" thoracic spinal stenosis: Mid-Term Follow-Up results.","authors":"Jianqiang Bai, Qun Xia","doi":"10.1007/s10143-025-03790-w","DOIUrl":"https://doi.org/10.1007/s10143-025-03790-w","url":null,"abstract":"<p><p>To explore the reasons for misdiagnosis of \"atypical\" thoracic spinal stenosis and improve clinicians' diagnostic ability to distinguish such conditions, in order to prevent misdiagnosis and missed diagnoses. A retrospective review of 245 cases of thoracic spinal stenosis admitted to our department between May 2013 and May 2020, of which 15 were \"atypical\" thoracic spinal stenosis cases. These included 10 males and 5 females, aged between 41 and 74 years, with an average age of 61.2 years. The duration of clinical symptoms was an average of 3.5 years. During this time, patients were frequently misdiagnosed, resulting in ineffective treatment and symptom progression. Clinical manifestations of the \"atypical\" thoracic spinal stenosis varied, including 4 cases presenting with persistent abdominal pain, 4 with unilateral persistent chest and back pain, 4 with unilateral lower limb numbness and pain, and 3 with intermittent claudication. Preoperative JOA scores for these patients ranged from 4 to 10, with an average of 7.26. After detailed history taking, physical examination, and appropriate imaging studies, all 15 patients were diagnosed with thoracic spinal stenosis and underwent surgical decompression. Follow-up was performed for all 15 patients, with a follow-up period ranging from 4.7 to 11.7 years (average 8.2 years). Of these, 12 patients showed significant symptom improvement, while one patient, who had concomitant spinal arthritis, still experienced persistent lumbar stiffness post-surgery. Postoperative JOA scores ranged from 7 to 11, with an average of 9.46, and the recovery rate of neurological function was 69.6%. Of the patients, 12 had excellent outcomes, 2 had good outcomes, and 1 had acceptable outcome. \"Atypical\" thoracic spinal stenosis presents with diverse clinical symptoms. A thorough understanding of its clinical features and heightened awareness is crucial for accurate diagnosis, thus avoiding misdiagnosis and missed diagnoses.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"647"},"PeriodicalIF":2.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075904","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":"Bobble-head doll syndrome and Suprasellar Arachnoid cyst: A rare experience and systematic literature review.","authors":"Sivaraman Kumarasamy, Rajeev Sharma, Satish Kumar Verma, Pankaj Kumar Singh, Deepak Kumar Gupta, Ashish Suri, Shashank Sharad Kale","doi":"10.1007/s10143-025-03770-0","DOIUrl":"https://doi.org/10.1007/s10143-025-03770-0","url":null,"abstract":"<p><strong>Background: </strong>Bobble-head doll syndrome (BHDS) is a rare movement disorder characterized by continuous or periodic head movements. The head nodding or bobbing occurs either forward and backward (yes-yes) or side-to-side movement (no-no) direction at a 2-3 Hz frequency. It is due to lesions in and around the third ventricle, causing pressure on periventricular neuronal structures (thalami). The most common lesions are suprasellar arachnoid cysts. We intend to analyze the clinical presentation, imaging findings, treatment options, and surgical outcome of BHDS in suprasellar arachnoid cysts.</p><p><strong>Methods: </strong>We retrospectively reviewed our database for BHDS in suprasellar arachnoid cysts surgically treated between 2016-2023. Patient records were reviewed with special attention to patient demographics, presentation, imaging findings, site and extent, surgery performed, complications, and outcomes.</p><p><strong>Results: </strong>A total of 5 patients with a mean age of 6.7 years were included in the study. Abnormal head movements were the most common presenting complaint. The mean duration of symptoms was 2.9 ± 2 years. All patients underwent cyst fenestration (endoscopic or microscopic assisted). Approaches used: craniotomy and microscopic-assisted cyst fenestration in 1 patient (20%) and endoscopic-assisted cyst fenestration in 4 patients (80%). One patient had partial resolution of symptoms at 6 weeks' follow-up. The remaining four patients (80%) had complete resolution of symptoms at 3-month follow-up.</p><p><strong>Conclusion: </strong>BHDS is a rare movement disorder caused by lesions in and around the third ventricle. Neuroimaging can help in diagnosing this lesion. The most common clinical presentations are involuntary head movements related to the dilatation of the third ventricle and obstructive hydrocephalus. It is a surgical condition with a favourable outcome. Various treatment options are described in the literature. Endoscopic fenestration is the optimal and most commonly performed treatment option. The excellent outcome in BHDS with suprasellar arachnoid cysts can be achieved using endoscopic fenestration.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"645"},"PeriodicalIF":2.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075938","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: Comparative overall survival analysis of chordomas of the base of the skull from the Surveillance, Epidemiology, and End Results (SEER) program between 2000 and 2020.","authors":"Kevin E Agner, Michael C Larkins","doi":"10.1007/s10143-025-03819-0","DOIUrl":"10.1007/s10143-025-03819-0","url":null,"abstract":"","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"642"},"PeriodicalIF":2.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070082","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":"Middle meningeal artery embolization in patients treated with Japanese Kampo Goreisan for recurrent chronic subdural hematoma: a prospective cohort comparative study.","authors":"Yosuke Akamatsu, Kohei Chida, Kenya Miyoshi, Daigo Kojima, Shota Tsutsui, Koji Yoshida, Toshinari Misaki, Takahiro Koji, Shunrou Fujiwara, Hiroshi Kashimura, Kuniaki Ogasawara","doi":"10.1007/s10143-025-03821-6","DOIUrl":"10.1007/s10143-025-03821-6","url":null,"abstract":"<p><p>Adjuvant middle meningeal artery embolization (MMAE) after burr-hole drainage for chronic subdural hematoma (CSDH) has emerged as a promising strategy. However, in Japan, MMAE is not covered by national health insurance; thus, it has been reserved for patients with recurrent CSDHs after burr-hole drainage. Goreisan has been reported to lower the incidence of recurrent CSDHs. Hence, we investigated the synergistic effect of MMAE and Goreisan in patients with recurrent CSDH. We prospectively included patients with recurrent CSDHs who received Goreisan after burr-hole drainage and separated them into groups based on whether MMAE was performed (group B + G + MMAE) or not (group B + G). Out of 605 patients who underwent burr-hole drainage for CSDHs, groups B + G and B + G + MMAE comprised 20 and 34 consecutive patients, respectively. Patient characteristics, such as age, sex, antithrombotic medications, history of blood coagulopathy disorders, and the modified Rankin scale (mRS) scores before symptom onset, did not differ between the two groups. No significant differences in the incidence of re-recurrent CSDHs (5% and 5.8%, in groups B + G and B + G + MMAE, p > 0.05, respectively) and favorable functional outcome (mRS score ≤ 2) at 3-month retreatment (90% and 76.5% in groups B + G and B + G + MMAE, p > 0.05, respectively) were found in the two groups 3 months post-retreatment. A positive effect of MMAE in preventing the re-recurrence of CSDHs in patients treated with Goreisan for recurrent CSDHs was not observed.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"643"},"PeriodicalIF":2.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070045","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}