Neurosurgical focus最新文献

{"title":"Introduction. Scoliosis surgery in adults: navigating complexity and optimizing outcomes.","authors":"Daniel M Sciubba, Camilo Molina, Kristen E Jones, Benjamin D Elder, Stephen J Lewis","doi":"10.3171/2025.3.FOCUS24673","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS24673","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E1"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199697","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":"Implications of lumbosacral transitional anatomy on vertebral numbering: evaluation of 3147 adult full-length spine radiographs.","authors":"Shahbaaz A Sabri, Renzo A Laynes, Clayton J Hoffman, Joseph C Chavarria, Parker J Prusick, Rachael E Weesner, Nathanial Stringer, James P Farrell, David Gimarc, Mary K Lowry, Vikas Patel, David Ou-Yang, Evalina Burger-Van Der Walt, Christopher J Kleck","doi":"10.3171/2025.3.FOCUS2555","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2555","url":null,"abstract":"<p><strong>Objective: </strong>When evaluating anomalous vertebral anatomy, limited consensus exists on how to best label vertebrae, leading to numbering discrepancies between radiologists and surgeons. Errors in vertebral numbering can have devastating implications for patients, especially when intraoperative numbering errors occur. Analyzing whole-spine radiographs and identifying patterns of transitional anatomy relative to vertebral numbering could allow for a consistent numbering method.</p><p><strong>Methods: </strong>This single-institution cross-sectional study included patients older than 18 years of age who underwent full-length spine imaging at the University of Colorado Hospital from January 31, 2018, to March 31, 2020. Patients with deformity or congenital fusion were included. A retrospective analysis was performed on full-length spine radiographs obtained in 3147 patients. The number of presacral mobile segments, number of ribs, and presence of hypoplastic or incomplete ribs were identified and recorded. Results were reviewed by a committee of musculoskeletal radiologists, neurosurgeons, and orthopedic spine surgeons, with verification through interobserver analysis.</p><p><strong>Results: </strong>Among 3147 patients (age range 18-89 years), 2868 (91.1%) had the conventional 24 presacral mobile segments (7 cervical, 12 thoracic, 5 lumbar). Transitional anatomy, defined as having fewer or more than 24 presacral segments, was observed in 279 patients (8.8%). Specifically, 174 patients (5.5%) had 25 presacral segments, 104 patients (3.3%) had 23, and 1 patient (0.03%) had 26. Regarding the number of ribbed vertebrae (thoracic), 2976 patients (94.6%) had 12 ribs, including hypoplastic ribs, while 143 (4.5%) had 11 ribs, and 28 (0.88%) had 13 ribs. The co-occurrence of both lumbosacral transitional anatomy and an abnormal number of ribbed vertebrae (thoracic) was least prevalent and observed in 56 patients (1.8%). Considering the first nonribbed vertebra as the first lumbar vertebra aligned with the most prevalent pattern of transitional anatomy.</p><p><strong>Conclusions: </strong>Evaluation of 3147 patients with full-length spine imaging demonstrated a lower prevalence of ribbed vertebral body anatomical variations compared with transitional lumbosacral anatomy. Based on these findings, the authors suggest further investigation of numbering vertebrae in a cranial to caudal progression, designating the first ribbed vertebra as thoracic (T1) and the first nonribbed vertebra in the lumbar spine as lumbar (L1). The clinical impact of a standardized vertebral numbering system is yet to be determined.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E13"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199696","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":"Is the upper arc or lower arc of lordosis more important in avoiding mechanical complications after adult spinal deformity surgery?","authors":"Harsh Jain, Iyan Younus, Lakshmi Suryateja Gangavarapu, Hani Chanbour, Ranbir Ahluwalia, Tyler Zeoli, Adam M Wegner, Julian G Lugo-Pico, Amir M Abtahi, Byron F Stephens, And Scott L Zuckerman","doi":"10.3171/2025.3.FOCUS2576","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2576","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Appropriate distribution of the upper and lower arcs of lordosis after adult spinal deformity (ASD) surgery is important in achieving a harmonious spinal shape. In a cohort of patients undergoing ASD surgery, the authors aimed to determine the impact of the preoperative and postoperative upper and lower arcs of lordosis on any mechanical complication, proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), and reoperation for mechanical complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A single-institution retrospective cohort study of patients who underwent ASD surgery from 2009 to 2021 was performed. Inclusion criteria were ≥ 5-level fusion, sagittal/coronal deformity, and 2-year follow-up data. The primary exposure variables were the preoperative and postoperative upper and lower lordosis arc angles, as described by Roussouly. Postoperative outcomes included mechanical complications and reoperations, and a separate analysis was performed for PJK/PJF. A bivariate analysis was performed, as well as a multivariable logistic regression analysis controlling for age, sex, BMI, preoperative type of malalignment, interbody fusion type, and osteoporosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 184 patients (140 females, mean age ± SD 68.6 ± 11.3 years) undergoing ASD surgery who were included, the mean number of instrumented levels was 10.6 ± 3.1. While the upper lordosis arc increased from before to after surgery (11.4° ± 8.8° to 18.5° ± 13.7°, p &lt; 0.001), the lower lordosis arc did not significantly increase (26.0° ± 14.3° to 28.0° ± 14.5°, p = 0.285). Preoperatively, a smaller upper lordosis arc (8.9° ± 8.6° vs 12.1° ± 8.8°, p = 0.046), lower lordosis arc (22.0° ± 12.2° vs 27.1° ± 14.6°, p = 0.049), and total lordosis angle (30.9° ± 14.9° vs 39.1° ± 17.3°, p = 0.008) were found in patients who had PJK/PJF that required reoperation compared with those who did not undergo reoperation for PJK/PJF. A smaller preoperative lower lordosis arc was found in patients with pseudarthrosis (21.7° ± 12.4° vs 27.9° ± 14.6°, p = 0.006) and reoperation due to mechanical complications (22.7° ± 12.3° vs 27.9° ± 15.0°, p = 0.018) compared to those without. Postoperatively, a smaller postoperative lower lordosis arc was found in patients with mechanical complications requiring reoperation (24.5° ± 16.8° vs 30.0° ± 12.8°, p = 0.014) and pseudarthrosis (23.9° ± 17.4° vs 29.8° ± 12.6°, p = 0.011). In the multivariable logistic regression analysis, a smaller preoperative lower lordosis arc was associated with total mechanical complications (OR 0.97, 95% CI 0.94-0.99; p = 0.006), PJK/PJF requiring reoperation (OR 0.97, 95% CI 0.94-1.00; p = 0.021), and mechanical complication requiring reoperation (OR 0.97, 95% CI 0.95-0.99; p = 0.006). Postoperatively, a smaller lower lordosis arc was associated with mechanical complications requiring reoperations (OR 0.97, 95% CI 0.94-0.99; p = 0.014).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A sm","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E7"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199698","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":"Validation of a novel artificial intelligence model (SpinePose) to automatically and accurately predict spinopelvic parameters using scoliosis radiographs in an external cohort.","authors":"Rushikesh S Joshi, Edward S Harake, Cheng Jiang, Jason J Haselhuhn, Joseph R Linzey, Jaes C Jones, Mark M Zaki, Kari Odland, Zachary Wilseck, Jacob R Joseph, David W Polly, Todd C Hollon, Paul Park","doi":"10.3171/2025.3.FOCUS2574","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2574","url":null,"abstract":"<p><strong>Objective: </strong>SpinePose was developed in 2024 as a novel artificial intelligence (AI) tool to automatically predict spinopelvic parameters with high accuracy and without the need for manual entry. The authors' published results demonstrated excellent performance comparable to a fellowship-trained spine surgeon with more than 15 years of experience. To date, there have not been any studies that have externally validated the performance of AI-based spinopelvic parameter measurement tools on data acquired from other institutions. To assess the generalizability of SpinePose, the authors report its performance on an external set of heterogeneous whole-spine scoliosis radiographs obtained from an outside institution.</p><p><strong>Methods: </strong>SpinePose was trained/validated on a dataset of 761 sagittal whole-spine scoliosis radiographs from a single institution, with expert-level performance on both whole-spine and lumbosacral radiographs. In this study, the existing SpinePose model was used for inference on a new set of 49 whole-spine radiographs acquired at a tertiary academic hospital located out of state. Externally acquired radiographs represented a diverse set of images, incorporating patients who had undergone instrumentation and those who had not, and a wide variety of fusion constructs including complex deformity patients. Predicted measures included sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), and T1-pelvic angle (T1PA). Predicted parameter values relative to ground-truth manual annotations were calculated to determine the model's accuracy.</p><p><strong>Results: </strong>Of the 49 images, 35 (71.4%) had instrumentation compared with 51.0% and 57.5% in the original SpinePose training and testing sets, respectively. All 5 parameters in the external dataset were significantly different at baseline compared with the original test set (p < 0.01). SpinePose accurately predicted all 5 spinopelvic parameters without any statistically significant differences: SVA, 50.7 mm vs 52.3 mm (p = 0.85); PT, 27.6° vs 30.5° (p = 0.24); PI, 58.0° vs 61.8° (p = 0.17); LL, 40.4° vs 42.4° (p = 0.77); and T1PA, 24.8° vs 28.0° (p = 0.21) when comparing ground truth annotations with predicted values.</p><p><strong>Conclusions: </strong>SpinePose was able to accurately predict spinopelvic parameters on an external validation cohort that was generated independently from the images on which the model was trained and validated. This highlights the generalizability of SpinePose to be implemented on novel images from other institutions and geographic settings with high accuracy and minimal preprocessing. The implementation of AI tools more broadly will help standardize our ability to both deliver and provide spine care and assist with surgical treatment and management of spine patients.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E10"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199705","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":"Early outcomes with virtual surgical planning software and patient-specific instrumentation in adult spinal deformity.","authors":"Joshua H Weinberg, Nathan Ritchey, Joshua L Wang, Ryan G Eaton, Bryan Ladd, Siri Khalsa, David Xu, Stephanus Viljoen, Andrew Grossbach","doi":"10.3171/2025.3.FOCUS259","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS259","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Software engineering innovations have led to the development of virtual surgical planning software (VSPS) for deformity correction. VSPS uses calibrated radiographs and machine learning predictive models to simulate postoperative spinopelvic parameters based on corrective techniques and anticipated compensatory/reciprocal changes. The authors aimed to assess the safety and efficacy of deformity correction in adult spinal deformity using VSPS and patient-specific rods manufactured based on a simulated plan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis of a prospectively maintained database was conducted, and 146 patients who underwent long-segment thoracolumbar fusions with pelvic fixation (October 2015-May 2023) with a minimum of 1 year of follow-up for deformity correction consistent with the Scoliosis Research Society (SRS)-Schwab classification were identified. Patients were dichotomized into a VSPS group (61 patients, mean age 62.1 years) and a historical control group (85 patients, mean age 64.3 years) prior to implementing VSPS. Comparative analyses were performed to assess VSPS accuracy and outcomes. Equivalence analysis was performed via the two one-sided t-test method using Cohen's d = 0.5.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the VSPS group, the achieved spinopelvic parameters at 3 months were equivalent to the simulated plan for lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), sacral slope, PI-LL mismatch, sagittal vertical axis (SVA), T1 pelvic angle (T1PA), thoracic kyphosis, and L4-S1 lordosis. Compared with controls, VSPS demonstrated an increased L4-S1 lordosis (p = 0.001) and decreased T1PA (p = 0.001); L4-S1 lordosis within 4.26° (p = 0.989) and T1PA within 3.85° (p = 0.969) were not significantly equivalent. VSPS demonstrated a significant increase in achievement of an SVA &lt; 5 cm (p = 0.026), T1PA &lt; 20° (p = 0.001), and age-adjusted T1PA (p &lt; 0.001). The age-adjusted PI-LL mismatch (p = 0.018), PT (p = 0.002), and SVA (p = 0.021) were equivalent. There was no significant difference in the improvement of 1-year patient-reported outcome measures (PROMs), proximal junctional kyphosis (p = 0.270), or proximal junctional failure (p = 0.290) between the two groups. In the multivariate analysis, VSPS use independently predicted achievement of age-adjusted T1PA (OR 6.51, p = 0.001). The upper instrumented vertebra, number of rods and rod material, and VSPS were not predictors of complications or reoperation for hardware failure. The time interval from the first surgery was not a predictor of complications or age-adjusted spinopelvic parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;VSPS accurately predicted achieved spinal alignment at 3 months. VSPS has the potential to facilitate global spinopelvic parameter correction, particularly reflected by T1PA and L4-S1 lordosis. However, this study did not demonstrate meaningful improvements in PROMs compared with controls. To justify the i","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E11"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199693","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":"Differences across various ideal lumbar lordosis measurement formulas for patient-specific sagittal alignment goals.","authors":"David W Polly, Jason J Haselhuhn, Nathan Keller, Paul Brian O Soriano, Kari Odland, Kristen E Jones, Jonathan N Sembrano","doi":"10.3171/2025.3.FOCUS2568","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2568","url":null,"abstract":"<p><strong>Objective: </strong>Multiple studies in the past have developed equations to determine the ideal lumbar lordosis (ILL) in the sagittal plane. These equations differ but all look to accomplish the same goal of providing the surgeon with specific alignment targets during surgery. To date, no study has compared the different equations of ILL against each other. This study compares 5 target alignment formulas in patients with high, normal, and low pelvic incidence (PI).</p><p><strong>Methods: </strong>The authors conducted a retrospective chart review from January 2015 through April 2022 and reviewed available full-spine standing spine radiographs. They classified patients by their PI: high (65°-95°), normal (50°-60°), and low (30°-45°) and included 5 patients for each classification. They calculated ILL based on the measured PI using 5 different formulas (Global Alignment and Proportion [GAP] score [ILL = 0.62 × PI + 29], Le Huec [ILL = 0.5 × PI + 28], Hyun [ILL = 0.62 × PI + 27.6], Hamamatsu University [ILL = 0.45 × PI + 31.8], and Kelly [ILL = 0.6 × PI + 30]). They compared the different ILL equations to determine if there were significant differences and considered any measurement ± 3° as equivalent to account for measurement variability.</p><p><strong>Results: </strong>Fifteen patients were included in the data analysis (5 patients for each PI classification). The mean PI measurements in the patients were as follows: high, 77.8°; normal, 54.6°; and low, 37.8°. The ILL measurements using the GAP formula were high, 77.2°; normal, 62.9°; and low, 52.4°. The ILL measurements using the Le Huec formula were high, 66.9°; normal, 55.3°; and low, 46.9°. The ILL measurements using the Hyun formula were high, 75.8°; normal, 61.5°; and low, 51.0°. The ILL measurements using the Hamamatsu University formula were high, 66.8°; normal, 56.4°; and low, 48.8°. Finally, the ILL measurements using the Kelly formula were high, 76.7°; normal, 62.8°; and low, 52.7°. Two-way ANOVA using Tukey Honestly Significant Difference post hoc multiple comparisons showed that the GAP, Hyun, and Kelly formulas for calculating ILL significantly differed from Le Huec and Hamamatsu University formulas (p < 0.001).</p><p><strong>Conclusions: </strong>Variation exists among the 5 different ILL equations, with 3 of the formulas being statistically different from the others. One must take note of these differences when considering patient-specific sagittal alignment goals. Further discussion is needed to determine which ILL equation should be widely used.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E9"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199691","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":"Letter to the Editor. Robot-assisted neurointervention: feasibility, safety, and current applications.","authors":"Ahmet Günkan, Jhon E Bocanegra-Becerra","doi":"10.3171/2025.1.FOCUS2551","DOIUrl":"https://doi.org/10.3171/2025.1.FOCUS2551","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E18"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199699","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":"Single-fraction versus multifraction stereotactic radiosurgery for spinal metastases: systematic review and meta-analysis.","authors":"Mohammad Amin Dabbagh Ohadi, Pouria Delbari, Muhammad Hussain Ahmadvand, Raha Zamani, Amirmasoud Karimi, Neshat Ohadi, Constantinos G Hadjipanayis","doi":"10.3171/2025.2.FOCUS24985","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24985","url":null,"abstract":"<p><strong>Objective: </strong>Stereotactic radiosurgery (SRS) plays an important role in the treatment of spinal metastases by delivering precise, high-dose radiation to the target region while sparing critical structures. Although various dosing and fractionation schemes have been reported, the optimal regimen remains a topic of debate. The aim of this study was to compare single- versus multifraction SRS (≤ 5 fractions) in the treatment of spinal metastases regarding oncological outcome, pain improvement, and complications, with special concern about vertebral compression fracture (VCF).</p><p><strong>Methods: </strong>A systematic review was conducted using the PubMed, Scopus, and Embase databases in October 2024 in accordance with PRISMA guidelines. The random-effects model was used for statistical analysis and quality appraisal was assessed using the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool.</p><p><strong>Results: </strong>A total of 26 studies comprising 4125 patients and 5408 lesions were included in this study. Single-fraction treatment demonstrated superior local control (HR 0.58, p = 0.023), particularly at doses exceeding 20 Gy (HR 0.28, p < 0.0001). However, overall survival did not differ significantly between the two groups (HR 0.78, p = 0.761). Pain relief was comparable between the groups (OR 0.94, p = 0.63). Although the VCF rate was higher in the single-fraction group (OR 1.32, p = 0.32), the difference was not statistically significant, even at doses greater than 20 Gy. Additionally, no significant differences were observed in overall complication rates (OR 1.98, p = 0.12).</p><p><strong>Conclusions: </strong>This study highlights the superiority of high-dose single-fraction regimen in controlling spinal metastatic tumors compared with multifraction lower doses, with comparable overall survival, complication rates, and VCF incidence. However, prospective randomized studies are necessary to better determine the optimal regimen for different patient populations.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E16"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021393","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":"Surgical management of schwannomas in schwannomatosis: a comprehensive analysis of clinical outcomes and determinants of local recurrence.","authors":"Abdel-Hameed Al-Mistarehi, Kelly Jiang, Jawad M Khalifeh, Avi N Albert, Carly Weber-Levine, Nicholas Orlando, William Blanks, Andrew M Hersh, Carlos G Romo, Jaishri Blakeley, Allan J Belzberg, Daniel Lubelski","doi":"10.3171/2025.2.FOCUS24751","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24751","url":null,"abstract":"<p><strong>Objective: </strong>Schwannomatosis is a rare genetic predisposition to develop multiple nonintradermal schwannomas affecting the spine and peripheral nerves, excluding vestibular schwannomas. Schwannomatosis-associated schwannomas can present with pain or motor deficits, prompting resection. In this study, the authors reported the clinical characteristics, surgical interventions, and postoperative outcomes of patients with schwannomatosis-related schwannomas treated with resection.</p><p><strong>Methods: </strong>This was a retrospective cohort study of adult patients with schwannomatosis who had undergone resection of a symptomatic peripheral or spinal schwannoma at the authors' institution from September 2003 to June 2023. Data were extracted from electronic health records and provider notes.</p><p><strong>Results: </strong>A cohort of 85 patients (57.6% women) had a mean follow-up of 68.4 ± 58.2 months after surgery. The mean age at the time of surgery was 44.6 ± 16.5 years. Pain was the most common presenting symptom (94.1%), followed by motor weakness (36.4%) and sensory deficits (32.9%). Just under two-thirds of the patients (64.7%) had undergone prior surgery for schwannoma, 20 (36.4%) of whom had a prior resection in the same exact location. Gross-total resection (GTR) was achieved in 88.2% of cases and en bloc resection in 69.4%. There were significant improvements in pain, motor weakness, and sensory deficits at the last postoperative follow-up visit. There was local tumor recurrence in 14 patients (16.5%), and the overall mortality rate was 4.7%. Univariate and multivariate analyses identified GTR as the strongest predictor of a decreased risk of local recurrence (HR 0.09, 95% CI 0.02-0.48, p = 0.005).</p><p><strong>Conclusions: </strong>Patients with schwannomatosis commonly presented with neurological symptoms of pain, sensory deficits, or motor weakness associated with their schwannomas. Resection significantly improved their preoperative symptoms, and GTR was associated with a decreased risk of local recurrence.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E2"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972431","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":"Management for chordoma of the spine and sacrum with stereotactic radiosurgery.","authors":"Samuel Adida, Suchet Taori, Roberta K Sefcik, Steven A Burton, John C Flickinger, Peter C Gerszten","doi":"10.3171/2025.2.FOCUS24935","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24935","url":null,"abstract":"<p><strong>Objective: </strong>Resection for spinal and sacral chordoma is associated with significant morbidity and high rates of local recurrence. Stereotactic radiosurgery (SRS) offers radiobiological benefits over conventional radiation therapy and has emerged as a viable treatment option for these historically radioresistant tumors. There are relatively few studies that have reported on the treatment of spinal chordoma with SRS, given its rarity. Thus, the aim of this study was to identify long-term outcomes after SRS in patients with spinal and sacral chordoma.</p><p><strong>Methods: </strong>A prospectively collected database analysis of patients with chordomas in the mobile spine and sacrum treated with SRS was conducted at a large quaternary referral center from February 2002 to January 2024. Patient demographic and histological data, prior treatment history, dosimetry, fractionation, and outcomes, including local control (LC), overall survival (OS), and resolution of neurological deficits and pain, were identified. SRS was used alone (9 tumors, 20%), as postoperative adjuvant therapy (12 tumors, 27%), and as salvage therapy for recurrent disease (23 tumors, 52%). The median single-fraction prescription dose was 21.25 Gy (range 13.5-25 Gy). Multifractionated treatment used prescription doses of 21-42 Gy in 3-5 fractions.</p><p><strong>Results: </strong>Twenty-four patients (median age 65 years) with 44 chordomas were included. The median follow-up duration was 20 months (range 1-203 months). The 1-, 2-, and 5-year LC rates were 87%, 64%, and 49%, respectively. The 1- and 2-year LC rates were 100% and 83% for SRS alone and 90% and 80% for postoperative adjuvant SRS, respectively. Rates of OS were 90%, 84%, and 51% at 1, 2, and 5 years, respectively. Univariate analysis showed that multifractionated SRS was associated with superior LC (HR 0.26, 95% CI 0.10-0.71; p = 0.008); however, no significant difference in LC was observed when accounting for the biologically effective dose. Among patients presenting with neurological deficits, complete or partial resolution occurred for 8 of 20 tumors (40%). In symptomatic patients, pain was fully or partially alleviated for 27 of 36 tumors (75%). Six adverse radiation events (14%) were observed following treatment, including vertebral compression fracture (n = 2, 5%), pharyngoesophageal toxicity (n = 1, 2%), and transient peripheral neuropathy (n = 1, 2%).</p><p><strong>Conclusions: </strong>This series is among the largest to date evaluating outcomes of SRS for spinal and sacral chordomas, demonstrating durable LC and symptom relief with acceptable rates of toxicity when used alone and as an adjunct to surgery. SRS is also an effective treatment option for patients with recurrent disease who seek noninvasive treatment or are not candidates for resection.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E17"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006934","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}