Neurosurgical focus最新文献

{"title":"Comparative effectiveness of standalone middle meningeal artery embolization versus surgical evacuation in noncritical patients with nonacute subdural hematomas.","authors":"Ignacio Mesina-Estarrón, Jose A Plascencia-Jimenez, Nanthiya Sujijantarat, Adam A Dmytriw, Varun Padmanaban, Sahin Hanalioglu, James D Rabinov, Christopher J Stapleton, Aman B Patel, Nirav J Patel, Mohammad A Aziz-Sultan, Rose Du, Timothy R Smith, Alfred P See, Robert W Regenhardt, Kevin Huang","doi":"10.3171/2025.7.FOCUS25468","DOIUrl":"https://doi.org/10.3171/2025.7.FOCUS25468","url":null,"abstract":"<p><strong>Objective: </strong>Middle meningeal artery embolization (MMAE) has emerged as an alternative to surgical treatment of nonacute subdural hematoma (NASDH). When used in conjunction with surgery, it has been shown to reduce recurrence, but its effectiveness as a standalone therapy remains to be established. The aim of this study was to investigate the comparative effectiveness of standalone MMAE (sMMAE) versus surgical evacuation in patients with NASDH.</p><p><strong>Methods: </strong>This retrospective propensity score-matched cohort study included consecutive patients with NASDH who underwent either sMMAE or surgical evacuation at a single institution from January 2017 to June 2024. The primary outcome was reintervention due to hematoma recurrence. Secondary outcomes included the hospital length of stay (LOS), new neurological deficits, and cardiorespiratory, neurological, and other medical adverse events.</p><p><strong>Results: </strong>Overall, 265 patients (median age 73 years) with NASDH were included. After matching, the sMMAE and surgical evacuation groups each included 85 patients. There was no baseline difference in clinical characteristics at presentation. During a median follow-up of 72 days in the sMMAE group and 59 days in the surgical group, the incidence rate of reintervention did not differ between the two treatments (incidence rate ratio [IRR] 1.38, p = 0.41). The median hospital LOS was shorter in the sMMAE group compared with the surgical evacuation group (4 days vs 6 days, p = 0.003). No differences were observed between groups in terms of new neurological deficits at 30 days (RR 0.85, p = 0.717) or the risk of cardiorespiratory (RR 0.50, p = 0.327) or neurological (RR 0.66, p = 0.657) adverse events. Patients treated with sMMAE had a lower risk of other medical adverse events compared with those treated with surgery (1.1% vs 15.2%; RR 0.07, p = 0.013).</p><p><strong>Conclusions: </strong>Patients who underwent sMMAE had shorter hospital stays and a lower risk of medical adverse events, without increased risk of recurrence, compared with patients who underwent open surgical treatment. Larger studies are warranted to establish the effectiveness of sMMAE in the management of NASDH.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E8"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High prevalence of inappropriate antithrombotic use in patients with symptomatic chronic subdural hematomas: should our focus be on preventing the subdural tsunami?","authors":"Diwas Gautam, David Botros, Caitlyn Wandvik, Ahmet Dalkilic, Manisha Koneru, Randall Treffy, Christina Feller, Peter Palmer, Sarah T Menacho, John D Nerva, Daniel A Tonetti, Ramesh Grandhi","doi":"10.3171/2025.7.FOCUS25286","DOIUrl":"https://doi.org/10.3171/2025.7.FOCUS25286","url":null,"abstract":"<p><strong>Objective: </strong>Antithrombotic (AT) therapy is frequently prescribed to patients for stroke prevention, atrial fibrillation, or other purposes, but it is a potential risk factor for chronic subdural hematoma (cSDH) development and growth. Premorbid AT use is common among patients who present with cSDH requiring treatment. The authors assessed the prevalence of AT use outside established clinical guidelines among patients who underwent cSDH treatment at three academic hospitals.</p><p><strong>Methods: </strong>This was a multicenter retrospective review of patients with cSDH who underwent surgical intervention and/or middle meningeal artery embolization (MMAE) between 2019 and 2024. Demographic data, presenting clinical and radiographic findings, and AT indications and types were extracted. Appropriateness of AT use was assessed according to clinical guidelines.</p><p><strong>Results: </strong>The cohort comprised 148 patients (77% male; mean age 74.96 ± 10.37 years) who underwent evacuation surgery alone (66.9%), MMAE (18.9%), or surgery with MMAE (14.2%). At presentation, the mean maximum hematoma thickness was 18.83 ± 6.5 mm, and 87.8% of patients had a midline shift. The most common indications for AT use were atrial fibrillation (27.0%) and coronary artery disease (24.3%). Antiplatelet monotherapy had been prescribed premorbidly to 58.1% of patients, anticoagulation monotherapy to 28.4%, and both to 13.5%. AT agents included aspirin (47.3%), direct oral anticoagulants (20.9%), warfarin (18.9%), dual antiplatelet therapy (18.2%), clopidogrel (7.4%), and therapeutic low-molecular-weight heparin (3.4%). Per clinical guidelines, 31.1% of patients were found to be inappropriately on AT therapy. Specific AT agents were not found to be associated with inappropriate AT consumption. Multivariable analysis identified cardiac stents (OR 3.95, 95% CI 1.05-14.88; p = 0.042) and primary and secondary stroke prevention (OR 10.59, 95% CI 3.20-35.09; p = 0.001) as indications associated with inappropriate AT use. Conversely, atrial fibrillation was associated with a lower likelihood of inappropriate AT use (OR 0.17, 95% CI 0.03-0.85; p = 0.031).</p><p><strong>Conclusions: </strong>In this study, nearly one-third of patients requiring treatment for cSDH were found to be inappropriately using AT medications, with primary and secondary stroke prevention and cardiac stents identified as independent predictors of such use. Greater vigilance among care teams is essential to address the burden of inappropriate AT use and potentially prevent the development of cSDH.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E13"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tipping point in middle meningeal artery embolization: a cost-effectiveness and algorithm-based analysis.","authors":"Luca H Debs, Scott Y Rahimi, Fernando L Vale","doi":"10.3171/2025.7.FOCUS25528","DOIUrl":"https://doi.org/10.3171/2025.7.FOCUS25528","url":null,"abstract":"<p><strong>Objective: </strong>Chronic subdural hematoma (cSDH) is one of the most common diseases treated by neurosurgeons. While surgical evacuation has been the traditional way to address symptomatic lesions, there is expanding evidence of the beneficial use of middle meningeal artery (MMA) embolization as a treatment or as an adjunct for cSDH. With the current strain on healthcare resources, physicians must balance providing the best care for patients and making cost-conscious decisions. Therefore, the aim of this study was to compare the cost of surgery alone versus surgery plus MMA embolization for treatment of cSDH, and to calculate an institutional tipping point for cost benefit.</p><p><strong>Methods: </strong>This is a retrospective study of patients with symptomatic cSDH requiring surgical intervention at a single institution from May 2019 to December 2022. The patients were concurrently enrolled in a prospective randomized controlled trial. To compare the cost of surgical treatment alone versus surgical treatment plus MMA embolization, all charges related to cSDH treatment from admission to the last follow-up were categorized (procedure, radiology, pharmacy, intensive care unit bed, laboratory, floor bed, and other) and assessed. The institutional tipping point (point at which it becomes financially beneficial to add MMA embolization to surgical evacuation during the same admission) was calculated to help guide decision-making.</p><p><strong>Results: </strong>Forty-one patients (28 male, mean age 67.9 years) were included in the analysis, and were previously randomized to surgical intervention only (n = 21) or surgical intervention plus MMA embolization (n = 20). The groups were comparable in terms of demographic and cSDH characteristics. The overall mean cost for the index admission was lower in the surgery only group (US$158,320 vs $235,263; p = 0.037). This was also true for all categories of charges. Throughout the duration of the study there were 27 admissions in the surgery only group and 20 admissions in the surgery plus MMA embolization group (p = 0.0052). When analyzing costs per patient instead of per admission, no differences were observed between treatment groups for any of the categories. Likewise, the overall mean costs related to the care of patients in either treatment group showed no statistical difference ($203,554 vs $235,263; p = 0.25). Consequently, the institutional tipping point for the addition of MMA embolization was 20.8%.</p><p><strong>Conclusions: </strong>MMA embolization can be considered as an adjunct to surgery in the treatment of symptomatic cSDH, decreasing the overall cost by lowering rates of readmission and repeat intervention. The tipping point formula used in this study is versatile and adaptable. It can be a useful guide to determine appropriate treatment options for patients with symptomatic cSDH according to institutional or national standards.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E10"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive burr hole craniotomy versus drill hole craniotomy for the management of chronic subdural hematoma: a randomized clinical trial.","authors":"Viktor M Eisenkolb, Lisa S Hoenikl, Nina Schwendinger, Thomas Obermueller, Niels Buchmann, Arthur Wagner, Amir K Aftahy, Sandro M Krieg, Bernhard Meyer","doi":"10.3171/2025.7.FOCUS241026","DOIUrl":"https://doi.org/10.3171/2025.7.FOCUS241026","url":null,"abstract":"<p><strong>Objective: </strong>Chronic subdural hematoma (cSDH) is a frequently treated entity for neurosurgeons worldwide. Because this pathology is common in older patients and those with multiple comorbidities, the demographic shift increases pressure on healthcare systems, which already face major economic challenges. Various surgical procedures are used, although the high recurrence rate leads to the even greater importance of standardizing the medical approach. Therefore, the aim of this study was to compare bedside cSDH evacuation using hollow screws (HSs) under local anesthesia with evacuation using enlarged burr holes (BHs) under general anesthesia.</p><p><strong>Methods: </strong>This prospective randomized study, conducted at a single center from September 2015 to August 2020, included patients with space-occupying (hematoma thicker than the skull) and/or symptomatic cSDH who underwent surgical treatment. During the study period, 140 patients were enrolled and 9 patients were excluded.</p><p><strong>Results: </strong>A total of 131 patients (mean age 77 years) were included in the analysis. HS trephination demonstrated comparable recurrence rates to that of BH trephination (BH 31.2% vs HS 47.8%, p = 0.06) and equivalent clinical outcomes (p > 0.05). Yet, HS placement was a less invasive surgical approach associated with a significantly shorter operation duration (p < 0.05) and shorter hospital stay (median BH 4.3 days vs HS 3.0 days, p = 0.003).</p><p><strong>Conclusions: </strong>In treating cSDH, HS trephination should be considered a reasonable alternative to BH trepanation, especially with the demographic changes occurring in modern society and the associated requirements for healthcare systems.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E2"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Air matters: the role of postoperative intracranial pneumocephalus in recurrence of chronic subdural hematomas evaluated through a multivariate analysis of 460 patients comparing closed drainage versus standard irrigation.","authors":"Maria Rosaria Scala, Ciro Mastantuoni, Valentina Cioffi, Salvatore Di Colandrea, Giuseppe Corazzelli, Anna Tucci, Sergio Carotenuto, Giuseppe Di Costanzo, Enrico Cavaglià, Raffaele de Falco, Antonio Bocchetti","doi":"10.3171/2025.7.FOCUS25521","DOIUrl":"https://doi.org/10.3171/2025.7.FOCUS25521","url":null,"abstract":"<p><strong>Objective: </strong>Chronic subdural hematoma (CSDH) is a common neurosurgical pathology, especially among older patients, with increasing incidence due to aging populations and widespread antithrombotic use. Despite the relatively straightforward nature of its surgical treatment, recurrence remains a major concern, with rates up to 30% reported. Among the factors implicated in recurrence, postoperative pneumocephalus has emerged as a significant and potentially modifiable risk factor. This study aimed to compare the efficacy and safety of a burr hole craniostomy with a closed drainage system (CDS) versus the traditional burr hole with standard irrigation (SI), with a focus on recurrence, pneumocephalus, and patient recovery.</p><p><strong>Methods: </strong>This retrospective, single-center cohort study included 460 patients undergoing surgical evacuation of symptomatic CSDH between 2010 and 2024. Patients were divided into two groups based on surgical technique: CDS (n = 358) and SI (n = 102). Demographics, clinical status, radiological features, and surgical outcomes were analyzed. Univariate and multivariate logistic regression analyses were utilized to assess predictors of 30-day recurrence. Volumetric analysis of hematomas and pneumocephalus was performed using standardized imaging protocols.</p><p><strong>Results: </strong>Baseline characteristics were well balanced. Postoperative pneumocephalus was significantly reduced in the CDS group (3.0 ± 1.78 cm3) compared with SI (49.3 ± 11.97 cm3) (p < 0.0001). Recurrence rates were markedly lower in the CDS group (10.1% vs 27.5%, p < 0.001), with CDS also associated with a mean shorter hospital stay (6.8 vs 11.2 days, p < 0.001), faster hematoma reabsorption (2.1 vs 3.2 months, p < 0.001), and lower 30-day mortality (1.1% vs 4.9%, p = 0.042). Multivariate analysis identified postoperative pneumocephalus volume (OR 1.0293 per cm3, p < 0.001) and residual hematoma (OR 1.00 per cm3, p = 0.046) as the only independent predictors of recurrence, while undergoing SI as opposed to the CDS was associated with a significantly increased risk of recurrence (OR 6.63, 95% CI 1.08-40.74; p = 0.041). No significant association was found between recurrence and antithrombotic therapy.</p><p><strong>Conclusions: </strong>The CDS technique offers a cost-effective, safe, and efficient approach for the treatment of CSDH. By limiting air entry and promoting controlled drainage, it significantly reduces recurrence and improves patient outcomes. Given its simplicity and low resource requirements, the CDS method should be considered as a preferred first-line surgical strategy, particularly in the context of value-based care for an aging population.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E4"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic subdural hematoma treatment in oncological patients: middle meningeal artery embolization versus surgical drainage.","authors":"Esteban Ramirez-Ferrer, Juan Pablo Zuluaga-Garcia, Jeffrey S Weinberg, Chibawanye I Ene, Shaan M Raza, Frederick F Lang, Peter T Kan, Stephen R Chen, Christopher C Young","doi":"10.3171/2025.7.FOCUS25553","DOIUrl":"https://doi.org/10.3171/2025.7.FOCUS25553","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to compare outcomes in cancer patients treated with middle meningeal artery embolization (MMAE) versus surgical treatment for chronic subdural hematomas (cSDHs), with outcome measures of requirement of rescue treatment and time to resumption of previously held systemic cancer therapy.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted that included a review of medical records of cancer patients with cSDH treated with MMAE or surgical drainage. Patients without adequate follow-up including radiological follow-up and patients who underwent dual therapy (i.e., MMAE plus surgery) were excluded. The primary outcome was the requirement for rescue treatment within 180 days, defined as surgical reintervention or repeat embolization due to hematoma progression or symptom recurrence. Secondary outcomes included the time to resumption of previously held systemic cancer therapy. Inverse probability of treatment weighting using covariate balancing propensity scores was used to adjust for baseline differences.</p><p><strong>Results: </strong>A total of 110 patients were included. Of these patients, 54 received MMAE and 56 were treated with surgical drainage. No significant differences were found regarding baseline demographic features. Although patients in the surgery group had a higher incidence of headaches and dizziness preoperatively, no difference in preoperative motor deficits was found. The MMAE group had a higher incidence of clotting disturbances and thrombocytopenia. Within 180 days, 5.6% of the patients who underwent MMAE required rescue treatment, all performed through surgical drainage. In contrast, 30.4% of the surgically treated patients required rescue treatment that included surgery, MMAE, or a combination of both. A Poisson regression analysis for rescue treatment within 180 days demonstrated that patients treated with MMAE had an 87.5% lower incidence rate of rescue treatment compared with those who underwent surgical drainage (p = 0.001). Additionally, the surgery group received significantly more postoperative platelet transfusions (median of 6 units) when compared with 0 units in the MMAE group. Time to restart previously held chemotherapy was significantly shorter in the MMAE group (p = 0.005).</p><p><strong>Conclusions: </strong>MMAE as a primary therapy for cSDH in cancer patients was associated with lower recurrence rates, earlier resumption of cancer therapy, reduction in platelet transfusion, and shorter hospitalizations compared with surgical drainage. These findings suggest that MMAE alone is safe and effective, and facilitates earlier resumption of chemotherapy in the oncology population.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E14"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction. Chronic subdural hematoma: a new focus on an old problem.","authors":"Adam S Arthur, Ramesh Grandhi, Christopher P Kellner, Jared Knopman, Anne-Christine Januel, Walavan Sivakumar, Pascal Jabbour","doi":"10.3171/2025.8.FOCUS24678","DOIUrl":"https://doi.org/10.3171/2025.8.FOCUS24678","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E1"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of 3D volumetrically assessed pre- and postoperative radiographic parameters of chronic subdural hematoma on clinical improvement and recurrence after surgery.","authors":"Adrian Liebert, Thomas Eibl, Markus Holtmannspoetter, Thomas Bertsch, Hans-Herbert Steiner, Karl-Michael Schebesch, Leonard Ritter","doi":"10.3171/2025.7.FOCUS25541","DOIUrl":"https://doi.org/10.3171/2025.7.FOCUS25541","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify the hematoma volume (HV) and midline shift (MLS) grade that need to be reduced for immediate postoperative improvement in patients with surgically treated chronic subdural hematoma (CSDH). Additionally, the study investigated risk factors for recurrence and explored whether specific anatomical burr hole locations and drain directions can influence these outcomes.</p><p><strong>Methods: </strong>This retrospective analysis included patients treated for hemispheric CSDH using burr hole trephination and subdural drain placement during a study period over 3 years. Volumetric assessment of HV and subdural air (SA) was performed with 3D reconstruction. Analysis A examined the relationship between postoperative HV and MLS reduction and immediate postoperative improvement of hematoma-associated signs and symptoms. Analysis B involved bivariate and multivariate analyses to identify risk factors for recurrence. Analysis C evaluated whether anatomical burr hole location and drain placement influenced postoperative outcomes. Patients were divided into three groups (group 1, frontal burr hole with parietal drain; group 2, frontal burr hole with frontal/temporal drain; group 3, parietal burr hole with frontal drain).</p><p><strong>Results: </strong>Analysis A found that patients with immediate postoperative improvement had significantly lower residual HV (38.5% vs 52%, p = 0.02) and MLS (37.3% vs. 60%, p = 0.039). Analysis B identified specific items associated with recurrence, including clopidogrel use (p = 0.029), statin use (p = 0.017), lower preoperative platelet count (p = 0.035), and higher preoperative HV (p < 0.001) and MLS (p = 0.024). Additionally, postoperative SA (p = 0.029) was associated with recurrence. Clopidogrel use and postoperative SA remained significant in multivariate analysis (p = 0.022 and p = 0.009, respectively). Cutoff values for preoperative HV (≥ 122.3 ml) and SA (≥ 6.95 ml) were identified, with high negative predictive values of 96.3% and 90.5%, respectively. Analysis C did not demonstrate any superiority of any of the treatment groups regarding HV and MLS reduction nor recurrence and complications.</p><p><strong>Conclusions: </strong>Reducing HV and MLS is crucial for immediate symptom relief in CSDH patients. Preoperative use of clopidogrel and postoperative SA are key factors associated with recurrence. The choice of burr hole and drain locations can be individualized.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E3"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superficial temporal artery retrograde access for the treatment of chronic subdural hematomas.","authors":"Akshal S Patel, Yince Loh, Luke L Jouppi, Radwan Takroni, Daniel C Norvell, Stepan Capek, Nicolas M Caffes, Majid Aljoghaiman, Aaron J Gustin, Aws A Alawi, Zane A Tymchak, Cameron G McDougall, Stephen J Monteith","doi":"10.3171/2025.7.FOCUS25539","DOIUrl":"https://doi.org/10.3171/2025.7.FOCUS25539","url":null,"abstract":"<p><strong>Objective: </strong>Middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH) has ushered in a treatment paradigm shift. The objective of this study was to determine whether the superficial temporal artery (STA) could be used consistently and just as effectively compared to conventional femoral and radial artery access.</p><p><strong>Methods: </strong>The authors retrospectively reviewed a series of consecutive cases from January 1, 2024, to February 28, 2025, where the STA was used to treat cSDH. The 90-day readmission, retreatment, and death rates were collected and compared against a set of internal comparison cases that underwent similar treatment, though via femoral or radial artery puncture.</p><p><strong>Results: </strong>The study included 40 patients with STA retrograde (STAR) access and 50 patients who had traditional transfemoral or radial artery approaches. In the STA group, there was significantly reduced radiation exposure (p < 0.001) and less contrast administration (p < 0.001). There were no differences between the groups in terms of the 90-day readmission (p = 0.82), retreatment (p = 0.93), or death rates (p = 0.42). One access site complication was observed after a transfemoral intervention.</p><p><strong>Conclusions: </strong>STAR access is an alternative for MMA embolization in cSDH. This innovative approach can potentially rival the results achieved by traditional techniques.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E11"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic subdural hematoma: clinical and surgical experience with surgical management in a large cohort of patients in the late and frailest phase of life.","authors":"Alessandro Pesce, Daniele Armocida, Fabio Cofano, Alexandro Paccapelo, Federica Novegno, Tamara Ius, Giuseppe Di Perna, Antonio Colamaria, Diego Garbossa, Antonio Santoro, Maurizio Salvati, Alessandro Frati, Mauro Palmieri","doi":"10.3171/2025.7.FOCUS25500","DOIUrl":"https://doi.org/10.3171/2025.7.FOCUS25500","url":null,"abstract":"<p><strong>Objective: </strong>To date, there is no consensus on treatment indications for chronic subdural hematoma (CSDH) in patients in their 10th decade of life. The present investigation aims to focus on and carefully evaluate the clinical course of this particularly fragile subgroup of patients.</p><p><strong>Methods: </strong>The authors retrospectively analyzed the clinical, radiological, and surgical records from a multicentric prospectively maintained database of patients with CSDH surgically treated between June 2005 and August 2021. Patients included in the study were divided into two subgroups: group A, those whose age was < 90 years; and group B, those whose age was ≥ 90 years. The following variables were recorded for each patient: age, sex, clinical disease onset, history of traumatic brain injury, antiplatelet or anticoagulant use, and pre- and/or postoperative corticosteroid medication intake. The surgical approach and whether a surgical drain had been left in the subdural space were recorded, as was the anesthesia protocol. Clinical results were measured using the Markwalder Grading Scale. Recurrence and mortality were analyzed separately.</p><p><strong>Results: </strong>The final cohort comprised 1312 patients who had undergone surgery for CSDH, 1240 patients whose age was < 90 years and 72 patients whose age was ≥ 90. Patients in their 10th decade of life experienced similar or even better clinical outcomes than their younger counterparts. In particular, the pre-postoperative variation in Markwalder grades was favorable in elderly patients (p = 0.006). Multivariate analyses confirmed that local anesthesia (p = 0.013), single-sided CSDH (p = 0.010), and no antiplatelet or anticoagulant intake (p = 0.004 and p = 0.037, respectively) are independent predictors of favorable outcomes.</p><p><strong>Conclusions: </strong>Patients in their 10th decade can experience clinical and radiological outcomes similar to those in their younger counterparts. Such patients could be eligible for standard minimally invasive treatments.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E12"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}