Neurosurgical Review最新文献

{"title":"Efficacy of minimally invasive surgery versus conventional procedures for thalamic stroke hemorrhage: systematic review and meta-analysis.","authors":"Stephen Hilkia Pramatya, Asra Al Fauzi, Ira Humairah, Citrawati Dyah Kencono Wungu, Dija Melati Sastri, Hasya Nur Ahmad Fuady Dhuha","doi":"10.1007/s10143-025-03639-2","DOIUrl":"10.1007/s10143-025-03639-2","url":null,"abstract":"<p><p>Stroke is the second leading cause of death globally. Intracranial hemorrhage is the most destructive type, with the thalamus being the location that has the worst prognosis. A meta-analysis of minimally invasive surgery in intracranial hemorrhage patients has been carried out previously and resulted in an improved prognosis. However, the efficacy and safety of minimally invasive surgery procedures remain subjects of debate. A comprehensive search was conducted in major databases such as PubMed, Scopus, Web of Science, Sage, Taylor and Francis, and Preprints in August 2024. From the search results, 2798 articles were obtained and then selected into ten articles. A risk ratio analysis was performed to compare the prognosis of minimally invasive surgery with conventional procedures. Risk ratios and 95% confidence intervals for minimally invasive surgery compared with conventional procedures in clinical trials and observational studies were 0.68 [0.55-0.84] and 0.57 [0.46-0.71], respectively. This meta-analysis also demonstrated that there was a significant reduction in the risk of death and the length of hospital stay in minimally invasive surgery patients. Nevertheless, there was no difference in the risk of rebleeding when compared with conventional procedures in patients with hemorrhagic stroke localized to the thalamus.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"487"},"PeriodicalIF":2.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234638","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":"Neurocognitive effects of CSF biomarkers in idiopathic normal pressure hydrocephalus patients undergoing VP shunt placement.","authors":"Hannah Spielmann, Magomed Lepshokov, Anna Prajsnar-Borak, Gudrun Wagenpfeil, Joachim Oertel","doi":"10.1007/s10143-025-03609-8","DOIUrl":"10.1007/s10143-025-03609-8","url":null,"abstract":"<p><p>Idiopathic normal pressure hydrocephalus is an increasingly prevalent neurodegenerative condition among the elderly, characterized by the Hakim triad. Accurate diagnosis and prognosis are essential since the symptoms can be reversible with appropriate treatment, such as VP-shunt surgery. This study investigates the relationship between cerebrospinal fluid biomarkers, particularly Tau, Phospho-tau, the beta-amyloid ratio (Aβ42/Aβ40), and neurocognitive outcomes post-surgery. Eighty patients diagnosed with iNPH who underwent shunt placement between November 2021 and July 2023 were included. A comprehensive neuropsychological test battery was administered before, one hour after, and one day after lumbar puncture, and six weeks and three months post-surgery. CSF samples were analyzed for tau, phospho-tau and the beta-amyloid ratio. Neuropsychological tests assessed various cognitive functions, including executive functions, psychomotor speed, language, and memory. Patients with a higher beta-amyloid ratio showed significant cognitive improvement post-surgery. Neuropsychological tests, such as the DemTect and Trail Making Test A & B indicated enhanced performance over time, particularly at the three-month follow-up. Conversely, the MMSE did not show significant improvement. The data suggest that the beta-amyloid ratio is a potential prognostic marker for positive neurocognitive outcomes following VP-shunt surgery. The beta-amyloid ratio (Aß42/Aß40) may represent a valuable prognostic biomarker for predicting cognitive improvement after VP-shunt surgery. Patients with higher ratios exhibited better neurocognitive outcomes, emphasizing the importance of comprehensive neuropsychological assessments. These findings support the potential of personalized treatment strategies based on biomarker analysis to optimize patient selection and improve outcomes for iNPH patients undergoing VP-shunt surgery.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"484"},"PeriodicalIF":2.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226000","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":"Comparative assessment of seven surgical procedures in Carpal Tunnel Syndrome: a network meta-analysis empowering physician-patient decision-making.","authors":"Amr Elrosasy, Mahmoud Diaa Hindawi, Qasi Najah, Mohamed Abo Zeid, Hatem Eldeeb, Asem Ahmed Ghalwash, Eslam Afifi, Abdallah Bani-Salameh, Nereen Almosilhy, Mohamed Ahmed Shahen, Fatma Ahmed Monib, Yousef Hawas, Abdullah Raizah, Turki Ahmed Alqahtani, Mahmoud El-Rosasy, Rashad G Mohamad","doi":"10.1007/s10143-025-03587-x","DOIUrl":"10.1007/s10143-025-03587-x","url":null,"abstract":"<p><p>Carpal Tunnel Syndrome (CTS) is a common peripheral nerve entrapment disorder with a high global burden. Various surgical techniques have been developed to optimize symptom relief and minimize postoperative morbidity. This network meta-analysis (NMA) aimed to compare the relative efficacy and safety of different carpal tunnel release (CTR) procedures. We conducted a systematic review and NMA of randomized controlled trials (RCTs) comparing surgical CTR techniques. Outcomes included symptom severity, pain scores, functional status, patient-reported outcomes, operative time, and adverse events. Data were synthesized using the frequentist approach with the netmeta package in R. Confidence in network estimates was evaluated using the CINeMA framework. Thirty-two RCTs comprising 2,916 patients were included. One-port and two-port endoscopic CTR (ECTR) techniques demonstrated superior symptom relief compared to conventional open CTR (COCTR), particularly at three months (two-port ECTR: SMD = -4.47; 95% CI: -5.67 to -3.26). One-port ECTR consistently showed better functional outcomes across all timepoints, including improved grip (SMD = 1.37; 95% CI: 0.35 to 2.39) and pinch strength. Pain was significantly reduced with two-port ECTR at one and three months. Ultrasound-guided CTR (CTR-US) showed the highest patient satisfaction (OR = 6.89; 95% CI: 1.87 to 25.43) and a significantly shorter return-to-work duration. The double tunnels technique (DTT) had the lowest risk of adverse events (OR = 0.05; 95% CI: 0.01 to 0.42). Operational time and scar tenderness were comparable across all techniques. Heterogeneity was generally low to moderate across outcomes, and CINeMA assessments indicated moderate to low confidence in several comparisons. Endoscopic techniques, particularly one- and two-port ECTR, offer superior outcomes in symptom severity and functional recovery compared to COCTR. CTR-US appears to maximize patient satisfaction and early return to work, while DTT is associated with the fewest complications. These findings can guide individualized, evidence-based treatment decisions in CTS surgery.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"486"},"PeriodicalIF":2.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234637","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":"Clinical outcome of different surgical approaches for symptomatic Chiari malformation without syringomyelia: a 13-year retrospective study.","authors":"Qi-Shuai Yu, Teng Li, Ming Wan, Liang Zhang, Guang-Yu Qiao, Xin-Guang Yu, Yi-Heng Yin","doi":"10.1007/s10143-025-03640-9","DOIUrl":"https://doi.org/10.1007/s10143-025-03640-9","url":null,"abstract":"<p><p>Chiari malformation, a condition that disrupts cerebrospinal fluid circulation. While previous studies have extensively explored the symptoms, treatment approaches, and clinical outcomes for patients with Chiari malformation accompanied by syringomyelia, there is limited research focused on those without syringomyelia. This study aims to evaluate the symptoms, treatments, intradural findings, and clinical outcomes in patients with Chiari malformation without syringomyelia. This single-center, retrospective study analyzed 148 patients diagnosed with Chiari malformation without syringomyelia between January 2010 and September 2022. Patients underwent one of two surgical approaches: posterior fossa decompression (PFD) or posterior fossa decompression with duraplasty (PFDD). Data on clinical symptoms, intradural findings, surgical outcomes, and postoperative complications were collected and analyzed. A total of 148 patients were included in the study, with 30 undergoing PFD and 118 receiving PFDD. Patients treated with PFDD showed significantly improved CCOS scores compared to those treated with PFD (12.8 ± 1.9 vs. 11.8 ± 2.5, P = 0.018). Symptom improvement rates were comparable between the two groups. Among PFDD patients, over 80% exhibited intradural abnormalities, with 28.4% classified as severe. Severe intradural abnormalities were strongly associated with higher rates of Valsalva-provoked pain (59.5% vs. 26.3%, P < 0.001). PFDD significantly improves CCOS scores compared to PFD, highlighting its potential as a more effective surgical approach for Chiari malformation without syringomyelia. Clinical trial number Not applicable.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"485"},"PeriodicalIF":2.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225999","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":"Clinical factors associated with delayed ischemic and non-ischemic adverse events in clazosentan therapy after aneurysmal subarachnoid hemorrhage: early insights from a multicenter prospective registry.","authors":"Taku Sugiyama, Masaaki Hokari, Daisuke Shimbo, Haruto Uchino, Yusuke Shimoda, Michinari Okamoto, Yasuhiro Ito, Masayuki Gekka, Hisayasu Saito, Taiji Yamamoto, Yusuke Fujiwara, Miki Fujimura","doi":"10.1007/s10143-025-03646-3","DOIUrl":"10.1007/s10143-025-03646-3","url":null,"abstract":"<p><p>Clazosentan (CLZ) therapy prevents delayed ischemia following aneurysmal subarachnoid hemorrhage (aSAH), but non-ischemic adverse events necessitate optimized protocols. This study presents outcomes of contemporary CLZ therapy under a unified protocol and identifies factors influencing delayed ischemic and non-ischemic adverse events following aSAH. This multicenter prospective registry analyzed data from 80 aSAH patients receiving CLZ therapy (April 2023 - October 2024). Primary endpoints were delayed ischemic events and non-ischemic adverse events; secondary endpoint was favorable outcome (modified Rankin Scale 0-2) at discharge or six weeks post-onset. Delayed ischemic events occurred in 19 patients (23.8%), including delayed ischemic neurological deterioration (8.8%), moderate-to-severe cerebral vasospasm (20.0%), and symptomatic delayed cerebral infarction (7.5%). Non-ischemic adverse events were observed in 22 patients (27.5%). Favorable outcomes were achieved in 52 patients (65.0%). Delayed ischemic events were associated with female sex, poor severity grades, higher Fischer scale scores, and elevated neutrophil-to-lymphocyte ratios. Non-ischemic adverse events were associated with older age, anemia, hypoproteinemia, and elevated cardiothoracic ratios. Multivariate analysis identified non-ischemic adverse events as significant for unfavorable outcomes (FDR p <.001), whereas delayed ischemic events were not (FDR p =.705). Among non-ischemic adverse events, pulmonary edema was the strongest factor associated with unfavorable outcomes. In conclusion, CLZ therapy with appropriate candidate selection and management protocol appears promising as a treatment option to prevent delayed ischemia after aSAH, though potential confounders warrant careful consideration. Addressing clinical risk factors for non-ischemic adverse events may further enhance treatment outcomes. Clinical trial number Not applicable.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"482"},"PeriodicalIF":2.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225998","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":"Specific focus on the basal dura for improving Cushing's disease surgery: a cohort study.","authors":"Bertrand Baussart, Benoit Hudelist, Chiara Villa, Mirella Hage, Anne Jouinot, Vincent Reina, Maxime Barat, Delphine Leclercq, Thibault Passeri, Philippe Touraine, Hélène Cebula, Laurence Guignat, Carine Courtillot, Philippe Chanson, Camille Vatier, Sébastien Froelich, Jérôme Bertherat, Guillaume Assié, Stephan Gaillard","doi":"10.1007/s10143-025-03656-1","DOIUrl":"https://doi.org/10.1007/s10143-025-03656-1","url":null,"abstract":"<p><strong>Background and objectives: </strong>In Cushing's disease, the rate of endocrine remission after surgery reaches 80% in expert centers. However, due to the tumor's capacity to invade surrounding dural structures, hypercortisolism persists in 20% of patients or recurs in 15%. To improve the likelihood of remission, tumor resection can be extended to the dura in patients who show basal dura invasion. The objective was to evaluate the benefit of a surgical strategy based on a systematic focus on the basal dura.</p><p><strong>Methods: </strong>Endoscopic surgery was performed in 89 adult patients with no obvious cavernous invasion. The basal dura was systematically removed whenever a macroscopic invasion was suspected. Three groups were defined: (i) resected but noninvaded dura (n = 14); (ii) resected and invaded dura (n = 16); and (iii) nonresected dura (n = 59). The studied cohort was compared to a control personal series of Cushing's patients with no systematic focus on the basal dura.</p><p><strong>Results: </strong>The mean follow-up duration was 19.9 ± 9.4 months. Endocrine remission was achieved in 15/16 (94%) patients with invaded dura, 14/15 (93%) patients with resected noninvaded dura and 50/59 (85%) patients with nonresected dura. Anterior pituitary deficits and diabetes insipidus occurred in 3% and 9% of patients respectively. Compared to the control series, our remission rate was significantly higher (88% vs. 75%, P =.019).</p><p><strong>Conclusion: </strong>Tumorectomy extended to the basal dura is a safe procedure that maximizes surgical resection. Despite dura invasion, endocrine remission is high when the dura is removed. A systematic focus on the basal dura can optimize endocrine outcomes.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"483"},"PeriodicalIF":2.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226001","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":"Enhancing precision in MRgFUS for tremor treatment: a systematic review of tractography-based VIM targeting approaches.","authors":"Benjamin Mendelson, Joseph C Melott, Kate Gelman, Abdul Hadi Khan, Aniruddha Bhagwat, Peter Konrad, Adeel A Memon","doi":"10.1007/s10143-025-03627-6","DOIUrl":"10.1007/s10143-025-03627-6","url":null,"abstract":"<p><strong>Background: </strong>Magnetic resonance guided focused ultrasound (MRgFUS) thalamotomy has been an effective treatment option in the management of various tremor etiologies. The process of targeting the VIM thalamic location relies on indirect atlas/coordinate-based systems using anatomic reference points. With advancing imaging modalities, thalamic structures can be better visualized resulting in additional targeting techniques and improved accuracy.</p><p><strong>Objectives: </strong>To identify and evaluate MRgFUS thalamotomy targeting techniques for tremor beyond atlas/coordinate-based systems.</p><p><strong>Methods: </strong>A systematic review was conducted in Embase, Cochrane, and PubMed. Studies including MRgFUS for tremor, targeting methods, and tremor outcomes were included. After review of 297 studies, 13 met inclusion criteria.</p><p><strong>Results: </strong>All 13 studies used tractography to visualize various combinations of white matter tracts to guide target acquisition. These tracts include the medial lemniscus (ML), corticospinal tract (CST), and the dentatorubrothalamic tracts (DRTT) which was further delineated into the non-decussating (ndDRTT) and a decussating components (dDRTT) by some studies. At least 50% reduction was reported by all studies with paresthesia and gait instability being the most common side effects, although mostly mild and transient.</p><p><strong>Conclusions: </strong>Advanced targeting via tractography may lead to better outcomes and could broaden the eligibility criteria for MRgFUS. Individualized targeting allows for more precise sonication, potentially reducing the number of sonications needed, improving patient tolerance, making sedation a viable option, and boosting effectiveness, especially in cases of atypical anatomy. To confirm these potential benefits in MRgFUS thalamotomy, standardized trials are definitely needed.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"479"},"PeriodicalIF":2.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216353","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":"Predictors of pulmonary embolism in adult patients following neurosurgery: a Chinese single-center, retrospective study.","authors":"Jie Gong, Baoshu Xie, Yufang Wang, Yanting Zhang, Lei Shi, Mingli Yao, Jingchao Li, Bin Ouyang, Lingyan Wang, Yan Li","doi":"10.1007/s10143-025-03633-8","DOIUrl":"10.1007/s10143-025-03633-8","url":null,"abstract":"<p><p>Patients undergoing neurosurgery are at elevated risk for venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). The incidence and risk factors for PE in neurosurgical patients remain a subject of debate. This study aimed to identify risk factors for PE in this population. We conducted a retrospective case-control study of post-neurosurgical hospitalized patients with PE from January 2017 to March 2023 at the First Affiliated Hospital of Sun Yat-sen University. A control group, matched for age, sex, and entry time (1:3 ratio), consisted of patients without PE. Clinical and biomarker variables were recorded for analysis. Univariate and multivariable logistic regression (MLR) analyses were performed to identify predictive factors for postoperative PE, and diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis.47 PE patients confirmed by computed tomography pulmonary angiography (CTPA) and 141 matched controls were included. The average annual incidence of PE was 0.4%. MLR identified longer surgical duration (OR 1.404, P < 0.001), higher postoperative D-dimer levels (OR 1.170, P = 0.003), and lower platelet count (OR 0.991, P = 0.040) as independent risk factors for PE. The logistic regression model demonstrated strong diagnostic performance. Prognosis analysis revealed a lower mortality rate in the PE group (10.64%) compared to the non-PE group (20.57%). The clinical prediction model, incorporating surgery duration, postoperative D-dimer levels, and platelet count, effectively identifies patients at high risk for PE following neurosurgery, aiding in prevention strategies.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"481"},"PeriodicalIF":2.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216354","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":"Drug-Coated Balloon Versus Stent Angioplasty in Patients with Intracranial Atherosclerotic Disease: A Systematic Review and Meta-Analysis.","authors":"Luiz Guilherme Silva Almeida, Gabriel Semione, Lucca Tamara Alves Carretta, Lucas Copolillo Faria, Yasmin Picanço Silva, Ocílio Ribeiro Gonçalves, Rafael Torres Fonseca Dos Santos, Paweł Łajczak, Marcelo Costa, Marcio Yuri Ferreira, Christian Ferreira, David Gordon, Yafell Serulle","doi":"10.1007/s10143-025-03630-x","DOIUrl":"10.1007/s10143-025-03630-x","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke, particularly in high-risk populations. Endovascular treatment options, including drug-coated balloon (DCB) angioplasty and stent angioplasty (SA), have been explored as alternatives for patients with severe stenosis or refractory symptoms. However, the comparative efficacy and safety of these interventions remain a topic of debate.</p><p><strong>Methods: </strong>A systematic search was conducted across PubMed, Embase, Cochrane, Scopus, and Web of Science up to December 2024. Studies comparing DCB to SA were included. Outcomes analyzed were symptomatic restenosis, overall restenosis rates, and recurrent ischemic events.</p><p><strong>Results: </strong>Three studies with 213 patients met the inclusion criteria. DCB was associated with significantly lower rates of overall restenosis (OR: 0.22, 95% CI: 0.10-0.50, I2 = 0%,p < 0.001) and recurrent ischemic events (OR: 0.20, 95% CI: 0.07-0.63, I2 = 0%,p = 0.006). There was no statistically significant disparity between both methods concerning symptomatic restenosis (OR: 0.34, 95% CI: 0.09-1.24, I2 = 0%, p = 0.101).</p><p><strong>Conclusion: </strong>This meta-analysis suggests that DCB angioplasty may be safer and more effective than SA for ICAD, with lower rates of restenosis and ischemic complications. However, the evidence is primarily based on observational studies, highlighting the need for multicenter randomized controlled trials with standardized protocols to establish further the comparative efficacy and long-term outcomes between DCB and SA in patients with ICAD.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"480"},"PeriodicalIF":2.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216352","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":"Value of biomarkers in the prediction of shunt responsivity in patients with normal pressure hydrocephalus.","authors":"Miroslav Cihlo, Pavel Trávníček, Alena Tichá, Radomír Hyšpler, Marta Kalousová, Svatopluk Řehák, Karel Zadrobílek, Lucie Kukrálová, Pavel Póczoš, Jan Pospíšil, Pavel Dostál, Vlasta Dostálová","doi":"10.1007/s10143-025-03581-3","DOIUrl":"10.1007/s10143-025-03581-3","url":null,"abstract":"<p><p>Preoperative differentiation between responders and non-responders to ventriculoperitoneal (VP) shunting in the treatment of normal pressure hydrocephalus (NPH) remains a significant challenge. Identifying biomarkers in presurgical assessment represents a promising approach to reducing the need for invasive cerebrospinal fluid CSF testing. In this prospective observational study, thirty adult patients were classified into Group A (responders to VP shunting) and Group B (non-responders) based on their responsiveness to invasive CSF testing. The overall clinical condition and Idiopathic NPH (iNPH) scale were assessed at baseline. Additionally, biomarker levels were compared between the two groups. Elevated levels of Neurofilament Light Chain (NfL) and Neurofilament Heavy Chain (NfH) in CSF and a reduced level of beta-amyloid Aβ42 were observed. No significant differences in biomarker levels were found between groups. Individual biomarkers demonstrated only poor predictive value (AUC = 0.37-0.53). Clinical factors were stronger predictors (AUC = 0.642-0.669), with no improvement when combined with all examined biomarkers (AUC = 0.428-0.431). No single biomarker reliably predicted confirmed postoperative shunt responsiveness among patients who underwent VP shunt placement and demonstrated clinical improvement. Clinical factors were stronger predictors, suggesting that patient history and clinical assessment (e.g., the iNPH scale) provide more reliable diagnostic information. Notably, combining biomarkers with clinical factors did not improve predictive accuracy.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"474"},"PeriodicalIF":2.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208991","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}