Neurosurgical Review最新文献

{"title":"Fully endoscopic microvascular decompression for hemifacial spasm: a systematic review.","authors":"Ali Ansari, Roozbeh Tavanaei, Alireza Alikhani, Bardia Hajikarimloo, Sina Zoghi, Ahmed M Alnemari, MirHojjat Khorasanizadeh, Nathan T Zwagerman","doi":"10.1007/s10143-025-03181-1","DOIUrl":"https://doi.org/10.1007/s10143-025-03181-1","url":null,"abstract":"<p><p>Hemifacial spasm (HFS) is a distressing condition caused by facial nerve compression and characterized by involuntary facial muscle twitching, adversely impacting quality of life. Microvascular decompression (MVD) is effective but poses risks. Fully endoscopic MVD (E-MVD) as an emerging technique offers enhanced safety and efficacy. Therefore, this systematic review aimed to evaluate the use of fully E-MVD in treating HFS. In accordance with PRISMA guidelines, the systematic review included a thorough literature search in PubMed/MEDLINE, Embase, and Cochrane Library. Eligible studies were evaluated based on predefined criteria, with duplicates eliminated and conflicts resolved by a senior author. Data extraction was performed independently by two authors, with disagreements resolved by the senior author. Details on study characteristics, demographics, intraoperative observations, postoperative complications, and efficacy of fully E-MVD for HFS were gathered. Quality assessment was conducted using the NIH tool. A total of 408 patients were included in the study, with females comprising 68% and males 32% of the cohort. The mean age of patients was 52.4 years, with an average symptom duration of 4.5 years. Right-sided and left-sided symptoms were reported in 54.4% and 46.6% of patients, respectively. Intraoperatively, the most common offending blood vessel was a single AICA (48.1%). Early postoperative complications were reported in 13.6% of patients, which primarily consisted of transient facial palsy (6.8%) and hearing impairment (4%). All cases of facial palsy resolved during the follow-up period, yet 1.3% of hearing impairments persisted. The efficacy of Fully E-MVD for HFS was promising, with 93.3% of patients experiencing effective resolution at follow-up. With advancements in surgical techniques and technology, fully E-MVD continues to show promising results in improving the quality of life for patients suffering from HFS. Favorable outcomes and symptom resolution support fully E-MVD's advantages. Surgeons must consider limitations and proper techniques for optimal patient outcomes.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"285"},"PeriodicalIF":2.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573562","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":"Management of dropped head syndrome: a systematic review and single-arm meta-analysis.","authors":"Matheus Felipe Henriques Brandão, Ocílio Ribeiro Gonçalves, Gabriel de Almeida Monteiro, Vitor Ribeiro Gonçalves, João Vitor Andrade Fernandes, Thiago Gomes Martins","doi":"10.1007/s10143-025-03443-y","DOIUrl":"https://doi.org/10.1007/s10143-025-03443-y","url":null,"abstract":"<p><p>Dropped Head Syndrome (DHS) is a rare condition marked by severe neck extensor muscle weakness, leading to a chin-on-chest deformity caused by pathological kyphosis. This study aims to evaluate the efficacy of conservative versus surgical treatments for DHS. A systematic search of PubMed, Embase, and ScienceDirect was conducted for studies on DHS treatments. Outcomes included total/partial improvement, success, and failure rates. Statistical analyses were performed using R software and the \"meta\" package. We identified 1,252 articles, with 19 studies and 472 patients included. Of these, 134 (28.4%) underwent surgery and 338 (71.6%) received conservative treatment. Partial improvement after conservative treatment was 59% (95% CI 32.76-83.03%; I² = 78%), with total improvement at 4.45% (95% CI 0.01-13.21%; I² = 84%). Success rates were 6.73% (95% CI 0.74-16.16%; I² = 82%), and failure was 100% (95% CI 99.28-100%; I² = 78%). For surgical treatment, total improvement was 100% (95% CI 99.57-100%; I² = 18%), and success was also 100% (95% CI 98.37-100%; I² = 0%), with low heterogeneity. Only two surgical patients failed (95% CI 0.00-1.63%; I² = 0%). Conservative treatment was ineffective in achieving functional recovery and horizontal gaze. Surgical treatment is the preferred option for treating DHS and should be considered a disease-modifying therapy.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"284"},"PeriodicalIF":2.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567663","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":"An overview of the use of the dorsum sellae and clival line as a guide in endoscopic third ventriculostomy: historical, anatomical and technical aspects.","authors":"José Javier Guil-Ibáñez, Mario Gomar-Alba, María José Castelló-Ruiz, Leandro Saucedo, Tesifón Parrón-Carreño, Gracia M Castro-Luna, Antonio Huete-Allut, José Masegosa-González","doi":"10.1007/s10143-025-03434-z","DOIUrl":"https://doi.org/10.1007/s10143-025-03434-z","url":null,"abstract":"<p><p>Endoscopic third ventriculostomy (ETV) has become one of the fundamental procedures in the treatment of obstructive or non-communicating hydrocephalus nowadays. One of the main challenges faced by groups new to the technique, which determines its success, is the perforation of the floor of the third ventricle and entry into the prepontine cistern. In various descriptions of the technique, it is common to refer to the middle third of an imaginary line drawn between the mammillary bodies and the infundibular recess as the perforation point. However, this is often an arbitrary point that depends on different factors such as the patient's anatomy and the operator's level of experience. Our group believes that using the dorsum sellae and clival line as a reference point to guide this perforation and enter to the prepontine cistern can be helpful, providing neurosurgeons with a stable, consistent, and familiar anatomical landmark that reduces uncertainty regarding the technique. After conducting a literature search, we found limited representation of the topic we aim to address here. Therefore, the objective of this article is to provide a historical, anatomical, and technical review of the use of the dorsum sellae and clival line as a guide for performing ETV.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"283"},"PeriodicalIF":2.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical 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/s10143-025-03426-z","DOIUrl":"10.1007/s10143-025-03426-z","url":null,"abstract":"<p><p>The endoscopic superior eyelid transorbital approach (SETOA) has demonstrated considerable versatility and effectiveness in managing various paramedian anterior and middle skull base pathologies. However, as with any relatively new technique, potential complications remain. We conducted an extensive literature search in MEDLINE and Embase in accordance with PRISMA guidelines including case reports and surgical series reporting cerebrospinal fluid (CSF) leak rate following SETOA for intracranial pathologies. Factors analyzed included lesion location (extra- or intra-axial), reconstruction techniques, and complication management. ROBINS-I tool was employed to assess the risk of bias. Twenty-five studies including 240 cases were eligible. The majority of lesions were intradural extra-axial (68.3%), while trigeminal schwannomas comprised all extradural cases (25.0%). Sixteen patients (6.6%) presented intradural intra-axial tumors. Osteodural reconstruction involved dural substitutes in one third of the cases (32.5%) either alone (14.2%) or combined with fat free graft (18.3%). CSF leak occurred in 6 patients (2.50%), mostly resolving via conservative management (66.6%). The risk of postoperative CSF leak was found to be significantly higher in patients undergoing resection for intra-axial tumors (OR 0.13, 95% CI: 0.04-0.49) compared to those undergoing resection for extra-axial (OR 0.01, 95% CI: 0.00-0.02; I² = 0%; p < 0.001). Key limitations include the retrospective nature and small sample sizes among included studies as well as data heterogeneity and lack of standardized protocols for reconstruction across studies. SETOA appears safe for addressing selected extradural and intradural skull base pathologies with a low postoperative CSF leak rate. The natural repositioning of the orbital content to its original position may be instrumental in preventing its postoperative occurrence. The investigation followed a prespecified protocol registered on PROSPERO (PROSPERO 2024 CRD42024614111).</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"282"},"PeriodicalIF":2.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567766","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":"Influence of supratotal resection on overall survival and progression of tumor in gliomas grade 2 and 3: a systematic review and meta-analysis.","authors":"Luciano Falcão, Gabriel Araújo Cerqueira, João Pedro Fernandes Gonçalves, João Felipe Tenisi de Andrade, Caio Passos de Azevedo Figueiredo Trocoli, Gabriel Souza Medrado-Nunes, Vanessa Emanuelle Cunha Santos, Hugo Nunes Pustilnik, Jefferson Heber Marques Fontes, George Santos Dos Passos","doi":"10.1007/s10143-025-03428-x","DOIUrl":"https://doi.org/10.1007/s10143-025-03428-x","url":null,"abstract":"<p><strong>Background: </strong>Recurrence after resection is a major factor in poor prognosis for grade 2 and 3 gliomas. The effect of Supratotal Resection (STR) on recurrence timing remains debated. This meta-analysis examines overall survival (OS) and tumor progression in grade 2 and 3 gliomas after supratotal resection.</p><p><strong>Methods: </strong>Studies on patients with grade II and III gliomas who underwent supratotal resection were included, with comparisons to subtotal, partial, and total resections. The primary outcomes were overall survival (OS) and tumor progression, while secondary outcomes included return-to-work (RTW) rates, malignant transformations and cognitive impairments.</p><p><strong>Results: </strong>We included 954 patients from 8 studies, mean age was 39 (± 16) years. The mean OS for patients undergoing supratotal resection was 17.45 (95% CI: 3.39 to 89.74, p < 0.05) compared to TR. The OR for RTW in the STR group versus TR group was 0.12 (95% CI: 0.01 to 1.28, p = 0.08). Tumor progression OR was, no statistical significantly, 0.15 (95% CI: 0.00 to 38.00, p = 0.5), and the likelihood of malignancy was reduced 0.03 (95% CI: 0.01 to 0.18, p < 0.01) compared to the TR group. In the immediate pos-operatory, when comparing STR with TR, the OR of language impairment was 5.47 (95% CI: 2.73 to 10.97, p < 0.01) and cognitive impairment was 0.38 (95% CI: 0.17 to 0.58). During the follow-up, the OR of language impairment was 0.68 (95% CI: 0.25 to 1.81, p = 0.44) and cognitive impairment was 0.34 (95% CI: 0.03 to 3.61, p = 0.37) comparing STR with TR.</p><p><strong>Conclusion: </strong>Patients with grade 2 and 3 gliomas undergoing supratotal resection showed significantly higher overall survival, fewer malignant transformations and language impairments in immediate pos-operatory. While there was a trend towards higher return-to-work rates, progression of tumor and better cognitive status during the follow-up, it was not statistically significant. Further studies are needed for definitive conclusions.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"281"},"PeriodicalIF":2.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542616","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":"Anticipating complications in stereotactic brain biopsy: a predictive approach.","authors":"Alexandre Lavé, Henri Malaizé, Karima Mokhtari, Lucia Nichelli, Rémy Bernard, Bertrand Mathon","doi":"10.1007/s10143-025-03415-2","DOIUrl":"https://doi.org/10.1007/s10143-025-03415-2","url":null,"abstract":"<p><p>Stereotactic brain biopsy is a critical procedure in neurosurgery, particularly for the diagnosis of brain tumors and cryptogenic neurological diseases. Despite its safety profile, biopsy procedures carry a risk of complications. This study aimed to identify predictors of symptomatic complications in a large cohort and develop a risk prediction score. This retrospective single-center study examined data from 2,338 stereotactic brain biopsies performed over 15 years. The primary outcomes included complication rates, severity, timing, and management. Factors such as patient demographics, medical history, lesion characteristics, and biopsy procedures were analyzed. Predictive models were created using least absolute shrinkage and selection operator (LASSO) regression to select key variables with cross-validation and a random forest algorithm for further refinement. Owing to insufficient predictive performance for clinical use, we used variables selected by LASSO regression to construct an analytical multivariate model. Symptomatic complications occurred in 3.9% (95% confidence interval (CI) 3.1-4.7) of cases, with 0.8% being fatal. Of the symptomatic complications, 46.2% occurred within the first hour following biopsy and 71.4% within two hours. Key predictive factors included biopsy repetition (odds ratio, 3.3; 95%CI [1.1-9.6], p = 0.050), advanced age (1.2 [1.02-1.4], p = 0.048), lesion location (brainstem (4.1 [1.6-10.4], p = 0.004), pineal region (16.2 [3.0-89.4], p = 0.001), deep brain (1.8 [1.1-2.9], p = 0.016)), and toxoplasmosis (4.9 [1.4-17.7], p = 0.038). The best predictive model achieved an area under the curve (AUC) of only 0.64 and the random forest models had poorer discriminative accuracy (AUC < 0.6). Symptomatic complications following stereotactic brain biopsy are rare, but are associated with specific patient profiles. Although predictive modeling provided moderate accuracy, further refinement is necessary for reliable risk stratification. Awareness of high-risk patient characteristics and rigorous procedural planning are essential for minimizing complications. Future studies should explore advanced predictive methods and refine the risk assessment tools to improve patient outcomes.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"279"},"PeriodicalIF":2.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542558","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":"Dural suturing for the resolution of high-flow cerebrospinal fluid leakage after extended endoscopic endonasal approach surgery.","authors":"Hongpeng Guan, Qi Song, Shiting Li, Xuhui Wang","doi":"10.1007/s10143-025-03395-3","DOIUrl":"https://doi.org/10.1007/s10143-025-03395-3","url":null,"abstract":"<p><p>High-flow cerebrospinal fluid (CSF) leakage is a major complication after surgery via the extended endoscopic endonasal approach (EEA). Thus, surgeons are still searching for techniques to avoid postoperative cerebrospinal fluid (poCSF) leakage. Recently, several surgeons have attempted dural suturing to prevent poCSF leakage. This study was performed to evaluate the efficacy of dural suturing for preventing poCSF leakage and presents a description of our operative technique. A total of 167 patients who underwent surgery via the extended EEA were enrolled in this study from January 2020 to May 2024. Among them, 75 patients underwent multilayered reconstruction only before May 2022. 92 patients underwent multilayered reconstruction combined with dural suturing after May 2022. The clinical data of the dural suturing group were compared with those of the no dural suturing group. All surgeries were performed by an experienced endoscopic neurosurgical team. Eighteen of 75 (24.0%) patients in the no dural suturing group and 2 of 92 patients (2.2%) in the dural suturing group developed poCSF leakage (p < 0.001). This finding indicates that dural suturing helps prevent poCSF leakage after lesion resection via the extended EEA.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"277"},"PeriodicalIF":2.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536656","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":"Complications after resection of parasagittal and superior sagittal sinus meningiomas.","authors":"Ivo Peto, Elliot Pressman, Keaton Piper, Gabriel Flores-Milan, Casey A Ryan, Gavin Lockard, Jonah Gordon, Adam Alayli, Harry van Loveren, Siviero Agazzi","doi":"10.1007/s10143-025-03430-3","DOIUrl":"https://doi.org/10.1007/s10143-025-03430-3","url":null,"abstract":"<p><p>Parasagittal meningiomas (PSM) represent one of the most frequently encountered intracranial meningiomas and pose unique challenges given their intimate relationship with parasagittal bridging veins and superior sagittal sinus (SSS). Compromise of venous drainage during resection might be a source of significant postoperative complications including catastrophic intraparenchymal hemorrhage. Objective of this study was to identify postoperative complications and associated factors predisposing to their development. A retrospective review of histologically confirmed parasagittal meningiomas (Sindou grade 1-6) resected between 2011 and 2020 was performed. A total of 62 patients (35 females (56.45%); mean age 55.72) years were included. The mean follow-up was 40.84 months. Forty-two patients (67.74%) were treatment naïve. Complete SSS occlusion was noted in 23 (37.1%). WHO grade 1 tumor was diagnosed in 32 (51.61%), WHO 2 in 23 (37.1%) and WHO 3 in 7 cases (11.29%). The SSS was resected in 24 (38.71%) patients. Intraparenchymal hemorrhage (ICH) was noted after 8 (12.90%) surgeries. Prior surgery (p = 0.006, OR = 22.1; 95% CI = 2.48-196.5) and higher tumor grade (OR = 4.64, 95% CI = 1.45-14.79, p = 0.01) were independently associated with greater risk of ICH. Resection of the SSS was not associated with postoperative ICH (p = 0.1388). A procedure-related mortality was noted in 2 patients (3.2%). Long term postoperative headaches were reported in 14 (22.58%) patients, associated with the resection of the SSS (p = 0.0003). Four (6.56%) patients had a CSF diversion procedure noted at the last follow up, correlated with ICH (p = 0.0124). History of prior surgery and higher WHO grade seem to be correlated with a significantly elevated risk of hemorrhage. Increased intracranial pressure, requiring CSF diversion is relatively infrequent occurring only in 6% patients, however awareness is important as prevention of its sequela is straightforward, preventing debilitating morbidity.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"278"},"PeriodicalIF":2.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537475","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":"Retrospective analysis of the effectiveness and safety of sulodexide for venous thromboembolism prevention in neurosurgical patients.","authors":"Kaixuan Yan, Pengfei Yan, Lujie Cao, Jing Su, Qingqing Zhang, Liting Zhang, Xiaobin Jiang","doi":"10.1007/s10143-025-03409-0","DOIUrl":"https://doi.org/10.1007/s10143-025-03409-0","url":null,"abstract":"<p><p>Neurosurgery patients are at high risk of developing venous thromboembolism (VTE) which increases the risk of morbidity and mortality. This study is designed to investigate the effectiveness and safety of sulodexide in combination with routine VTE prophylaxis compared with routine VTE prophylaxis alone for VTE prevention in neurosurgical patients. This retrospective, cohort study included neurosurgical patients received routine VTE prophylaxis (control group) or routine VTE prophylaxis plus sulodexide (experimental group) during hospitalization. Predictors of VTE during hospitalization were determined using multivariable logistic regression. A total of 694 eligible patients were included in this study. The incidence of VTE in the experimental group (4.52%, 10/221) was lower compared with that in the control group (6.98%, 33/473) (P = 0.212). The change from baseline in serum creatinine and blood urea nitrogen of the experimental group was significantly higher compared with that in the control group (both P < 0.05). In elderly patients (>65 years), VTE incidence in the experimental group was 3.51% which was significantly lower than that in the control group (10.8%; P = 0.03) and odd ratio [OR] was 0.3 (95% confidence interval [CI]: 0.07, 0.92). Multivariate logistic regression analysis revealed that use of sulodexide plus routine VTE prophylaxis (OR = 0.172, 95% CI: 0.055, 0.535; P = 0.006) and baseline Glasgow Coma Scale (GCS) score (OR = 0.587, 95% CI: 0.521, 0.792; P < 0.001) were protective factors for VTE risk, and the length of hospital stay (OR = 1.134, 95% CI: 1.021, 1.199; P=0.007) was a risk factor for VTE. Sulodexide in combination with routine VTE prophylaxis effectively reduces the risk of VTE in neurosurgical patients. A high baseline GCS score is a protective factor for VTE, whereas length of hospital stay is a risk factor for VTE.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"280"},"PeriodicalIF":2.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541278","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":"Early surgery is associated with improved postoperative visual outcomes in apoplectic pituitary neuroendocrine tumors with acute visual deterioration.","authors":"Abhijit Goyal-Honavar, Subhas Konar, Nishanth Sadashiva, Shilpa Rao, Abhinith Shashidhar, A R Prabhuraj, Dwarakanath Srinivas, A Arivazhagan, Malla Bhaskara Rao, Jitendra Saini, Dhaval Shukla","doi":"10.1007/s10143-025-03427-y","DOIUrl":"https://doi.org/10.1007/s10143-025-03427-y","url":null,"abstract":"<p><strong>Background: </strong>Pituitary apoplexy is a neurosurgical emergency that often manifests visual deterioration and cranial nerve palsies, presenting a need for urgent surgical decompression. However, the timing of surgery remains controversial, and the impact of perioperative characteristics of patients with apoplexy on visual recovery following surgery remains nebulous.</p><p><strong>Methods: </strong>We retrospectively analyzed all cases of pituitary apoplexy with acute visual deterioration operated between 2013 and 2023, recording details of clinical presentation, surgery, and the postoperative period. Visual acuity (VA) and visual field defects at presentation were recorded, as was their evolution following surgery. Perioperative characteristics of patients were compared among cases where VA improved and those that did not.</p><p><strong>Results: </strong>The cohort comprised 55 patients, 29 males and 26 females. VA was negative for perception of light (PL-) in 13 cases. Forty-four patients (80%) underwent endoscopic transsphenoidal surgery, 4 patients (7.3%) underwent transcranial surgery, and 6 patients (10.9%) underwent microscopic transsphenoidal surgery. VA improved in 39 patients (75%), while significant improvement in VA occurred in 26 of 41 patients (63.4%). Multivariate analysis revealed that PL- vision, visual deterioration > 168 h, and cranial nerve palsy predicted non-improvement of VA.</p><p><strong>Conclusions: </strong>Visual deterioration is the most frequent presentation of pituitary apoplexy. Following surgical decompression, improvement in VA occurs in most cases, with significant improvement in more than half of cases. Improvement in VA is superior in patients operated within 96 h to a week of onset of visual deterioration, but not earlier, and less frequently occurs in patients who present with blindness (46.2%).</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"275"},"PeriodicalIF":2.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524098","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}