Neurologia medico-chirurgica最新文献

{"title":"Risk of Cognitive Decline in Professional Soccer Players after Repetitive Subconcussive Impacts: A Systematic Review and Meta-analysis.","authors":"Tomasz Tykocki","doi":"10.2176/jns-nmc.2025-0451","DOIUrl":"10.2176/jns-nmc.2025-0451","url":null,"abstract":"<p><p>Repetitive soccer heading has been implicated as a potential source of cumulative subconcussive brain injury, yet the magnitude and consistency of its cognitive effects remain incompletely defined. We conducted a systematic review and meta-analysis to quantify global and domain-specific cognitive outcomes associated with repetitive heading exposure. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, PubMed/MEDLINE, Scopus, and Web of Science were searched through December 2025. Of 2,846 identified records, 46 studies met the inclusion criteria, and 28 provided standardized cognitive data suitable for quantitative synthesis. Effect sizes (Hedges g, Fisher z) were transformed into log odds ratios and pooled using DerSimonian-Laird random-effects models. Heterogeneity was assessed using Q, I², and H² statistics, and publication bias was evaluated with funnel plots, Egger regression, and trim-and-fill procedures, alongside leave-one-out influence analyses. Across 28 independent author-level datasets, repetitive heading was associated with significantly increased odds of global cognitive underperformance (odds ratio 1.67; 95% confidence interval 1.61-1.72), with moderate heterogeneity (I² ≈ 34%). Trim-and-fill adjustment yielded a modestly attenuated but still significant estimate (odds ratio 1.49). Domain-level analyses demonstrated consistent impairments across visuospatial ability (odds ratio 1.49), verbal memory (odds ratio 1.62), attention (odds ratio 1.71), processing speed (odds ratio 1.64), executive function (odds ratio 1.86), and composite cognition (odds ratio 1.58). Confidence intervals were narrow, once, and the effect directionality was uniform across domains. These findings indicate that repetitive soccer heading is associated with robust, reproducible cognitive deficits across multiple cognitive systems, supporting cumulative subconcussive exposure as an independent risk factor for measurable cognitive decline.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"321-331"},"PeriodicalIF":1.6,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Parietal Endoscopic Approach for Thalamic Hemorrhage: Technical Nuances and Preliminary Outcomes.","authors":"Yuri Yamagiwa, Toshikazu Kimura, Shunsuke Ichi","doi":"10.2176/jns-nmc.2025-0239","DOIUrl":"10.2176/jns-nmc.2025-0239","url":null,"abstract":"<p><p>We assessed the technical utility and preliminary outcomes of endoscopic hematoma evacuation via the high parietal approach for thalamic hemorrhage with intraventricular extension (intraventricular hemorrhage) by retrospectively reviewing 270 patients treated between April 1, 2006, and July 31, 2024. Prior to 2017, the primary treatment was external ventricular drainage, and in selected patients with thick intraventricular hematoma, an anterior endoscopic approach was used primarily for intraventricular hemorrhage removal. Since April 2017, the high parietal approach technique has been used for the simultaneous removal of both thalamic hematoma and intraventricular hemorrhage in 21 patients. The high parietal approach group showed a median hematoma evacuation rate of 92.2% and, compared with the external ventricular drainage-only group, a significantly shorter duration of ventricular drainage and a lower incidence of tracheostomy. No cases of surgical site infection or meningitis occurred in the high parietal approach group. Complications included 1 death due to postoperative rebleeding and another due to worsening pneumonia and heart failure. Secondary hydrocephalus requiring shunt placement was observed only in the external ventricular drainage group. Although not statistically significant, the high parietal approach group showed a higher rate of early resumption of oral intake. These findings suggest that endoscopic evacuation via the high parietal approach is a minimally invasive technique that achieves high hematoma removal rates, facilitates early postoperative recovery, and may reduce complications such as prolonged drainage, tracheostomy, and hydrocephalus in selected patients with large thalamic hemorrhage and intraventricular hemorrhage.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"403-409"},"PeriodicalIF":1.6,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Cerebrovascular Risk after Microsurgical Clipping of Unruptured Anterior Circulation Aneurysms: Low Subarachnoid Hemorrhage Incidence and Persistent Stroke Susceptibility over 7,600 Patient-years.","authors":"Shunsuke Kawamoto, Go Ikeda, Shunsuke Fukaya, Kanae Okunuki, Hiroyoshi Akutsu","doi":"10.2176/jns-nmc.2026-0003","DOIUrl":"10.2176/jns-nmc.2026-0003","url":null,"abstract":"<p><p>Microsurgical clipping is an established treatment for unruptured intracranial aneurysms; however, long-term cerebrovascular outcomes beyond aneurysm obliteration remain incompletely characterized in surgically treated patients, particularly regarding non-hemorrhagic cerebrovascular events. We retrospectively analyzed 930 patients (990 procedures; 655 females, 275 males; mean age, 62.8 years) with asymptomatic anterior circulation unruptured intracranial aneurysms treated between 2003 and 2025, with a total follow-up of 7,638 patient-years (median, 8.3 years). The primary endpoint was postoperative subarachnoid hemorrhage, and secondary endpoints included all-stroke events and all-cause mortality. Incidence rates with 95% confidence intervals were calculated, and rate ratios versus natural-history cohorts (Unruptured Cerebral Aneurysm Study and Small Unruptured Intracranial Aneurysm Verification Study) and standardized incidence ratios versus the general population were computed using Poisson methods. Ten subarachnoid hemorrhage events occurred (1.31 per 1,000 patient-years; 95% confidence interval, 0.63-2.41), with most arising from untreated or de novo aneurysms; only 1 case originated from a previously clipped site, demonstrating durable protection at treated sites. Subarachnoid hemorrhage incidence was substantially lower than that reported in natural-history cohorts of conservatively managed unruptured intracranial aneurysms. In contrast, age-adjusted all-stroke incidence remained approximately 2-fold higher than in the general population (standardized incidence ratio 2.11; 95% confidence interval, 1.50-2.90; p < 0.001), driven predominantly by ischemic events. These findings indicate that microsurgical clipping effectively reduces the risk of subarachnoid hemorrhage from treated aneurysms, whereas overall cerebrovascular risk remains elevated, reflecting persistent systemic vascular vulnerability rather than failure of local treatment. Long-term follow-up incorporating appropriate imaging surveillance and intensive management of modifiable vascular risk factors is therefore essential to optimize outcomes in this patient population.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"377-386"},"PeriodicalIF":1.6,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detailed Examination of the Sulci and Gyri Surrounding Broca's Area: A Comparative Morphological Study of Japanese and North American Populations.","authors":"Dai Uzuki, Mudathir Bakhit, Ryo Hiruta, Masazumi Fujii","doi":"10.2176/jns-nmc.2025-0203","DOIUrl":"10.2176/jns-nmc.2025-0203","url":null,"abstract":"<p><p>The inferior frontal cortex (IFC), which includes Broca's area, is a frequent target in neurosurgical procedures, yet its sulcal landmarks remain under-characterized across populations. We evaluated 7 IFC sulci-the inferior precentral sulcus (prcs-i), inferior frontal sulcus (ifs), triangular sulcus (ts), diagonal sulcus (ds), pretriangular sulcus (prts), and the ascending (aaLF) and horizontal (haLF) anterior rami of the lateral fissure-using high-resolution magnetic resonance imaging (MRI) data from 40 Japanese and 40 North American White adults, supplemented by 9 cadaveric hemispheres. Sulci were manually labeled in FreeSurfer, quantified for surface area and depth, and analyzed for interhemispheric and inter-racial differences. Maximum probability maps (MPMs) were projected against meta-analytic functional MRI maps to evaluate structure-function relationships. The prcs-i and haLF were universally present, whereas the ds showed the lowest incidence (≈55%-60% left, ≈75% right), with variability across studies partly explained by misclassification with the aaLF. The prts was also infrequent and highly variable, whereas the ts, although structurally diverse, was nearly universal. Quantitative analyses confirmed the aaLF was significantly deeper than the ds (p < 0.0001), providing an objective criterion for differentiation. Functionally, high-frequency sulci (aaLF, haLF, ifs, prcs-i, ts) aligned with reliable activation patterns for verbal fluency, semantics, and syntax, whereas the ds frequently coincided with hotspots despite inconsistent presence. These findings can offer anatomical insights that may guide future clinical research on the frontal language area.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"332-346"},"PeriodicalIF":1.6,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Safety and Efficacy between Endovascular Coiling and Surgical Clipping of Posterior Communicating Artery Aneurysms: A 10-year Retrospective Analysis of 851 Aneurysms.","authors":"Hikaru Wakabayashi, Sakyo Hirai, Tatsuhiko Anzai, Yohei Sato, Keigo Shigeta, Shin Hirota, Masataka Yoshimura, Jun Karakama, Kenji Yamada, Yoshikazu Yoshino, Motoshige Yamashina, Naoki Taira, Toshihiro Yamamura, Kana Sawada, Tadahiro Ishiwada, Yosuke Ishii, Mutsuya Hara, Shogo Imae, Yoshiki Obata, Bongguk Kim, Yuki Kinoshita, Hirotaka Sagawa, Shoko Fujii, Satoru Takahashi, Kyohei Fujita, Kunihiko Takahashi, Shigeru Nemoto, Taketoshi Maehara, Kazutaka Sumita","doi":"10.2176/jns-nmc.2025-0392","DOIUrl":"10.2176/jns-nmc.2025-0392","url":null,"abstract":"<p><p>Endovascular treatment is widely used for intracranial aneurysms, but evidence comparing endovascular treatment with surgical treatment for posterior communicating artery aneurysms is limited. Using a multicenter registry from January 2013 to December 2022, 841 patients with 851 posterior communicating artery aneurysms were analyzed. Logistic regression with multivariable adjustment and inverse probability of treatment weighting was applied to adjust for confounders. Of the aneurysms, 499 (58.6%) were treated by endovascular treatment. Patients undergoing endovascular treatment were generally older, had more comorbidities, and had larger aneurysms than those receiving surgical treatment. Functional outcomes assessed by the modified Rankin Scale showed no significant difference between endovascular treatment and surgical treatment in ruptured aneurysms (poor outcome at discharge: odds ratio, 1.09 [0.74-1.69]; p = 0.698; at final follow-up: odds ratio, 0.74 [0.48-1.15]; p = 0.183), whereas endovascular treatment was associated with significantly better outcomes in unruptured aneurysms (poor outcome at discharge: odds ratio, 0.11 [0.03-0.32]; p < 0.001; at final follow-up: odds ratio, 0.33 [0.11-0.96]; p = 0.045). Intraoperative and postoperative complications were similar overall (interoperative: odds ratio, 0.92 [0.55-1.54]; p = 0.752; postoperative: odds ratio, 0.76 [0.54-1.07]; p = 0.121). Subgroup analyses demonstrated that endovascular treatment reduced intraoperative complications in elderly patients, with a significant interaction between endovascular treatment and elderly age (p = 0.008). Endovascular treatment was associated with markedly higher recurrence (odds ratio, 37.41 [16.63-107.15]; p < 0.001) and retreatment rates (odds ratio, 13.73 [6.32-36.06]; p < 0.001). These findings suggest surgical treatment remains a viable option for ruptured aneurysms, providing similar functional outcomes with lower recurrence and retreatment rates, whereas endovascular treatment is suitable for unruptured aneurysms, offering comparable safety and potential advantages in elderly patients.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"302-310"},"PeriodicalIF":1.6,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between Delayed Relief after Microvascular Decompression and Morphology of the Lateral Spread Response in Patients with Hemifacial Spasm-Temporal versus Mandibular Branch Stimulation.","authors":"Yuki Amano, Bunsho Asayama, Shusaku Noro, Takenori Abe, Masahiro Okuma, Kaori Honjo, Yoshinobu Seo, Hirohiko Nakamura","doi":"10.2176/jns-nmc.2025-0398","DOIUrl":"10.2176/jns-nmc.2025-0398","url":null,"abstract":"","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"318-319"},"PeriodicalIF":1.6,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconsidering the Pathophysiological Interpretation of Polyphasic LSRs in Hemifacial Spasm.","authors":"Jongsuk Choi","doi":"10.2176/jns-nmc.2025-0188","DOIUrl":"10.2176/jns-nmc.2025-0188","url":null,"abstract":"","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"317"},"PeriodicalIF":1.6,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local Recurrence after Microsurgical Clipping of Unruptured Intracranial Aneurysms: Incidence, Timing, and Risk Factors over 20 Years.","authors":"Shunsuke Kawamoto, Go Ikeda, Shunsuke Fukaya, Kanae Okunuki, Hiroyoshi Akutsu","doi":"10.2176/jns-nmc.2025-0342","DOIUrl":"10.2176/jns-nmc.2025-0342","url":null,"abstract":"<p><p>This retrospective cohort study evaluated long-term local recurrence rates following microsurgical clipping of anterior circulation unruptured intracranial aneurysms. Between April 2003 and August 2025, 657 patients underwent 700 procedures for 786 aneurysms. Local recurrence was assessed by computed tomography angiography at 5-year intervals. During a mean follow-up of 10.5 ± 3.5 years (6,927.8 patient-years), 9 local recurrences were identified, yielding annual recurrence rates of 0.156% per patient-year and 0.111% per aneurysm-year. Cumulative recurrence-free rates were 100% at 5 years, 99.1% at 10 years, and 98.6% at 15 years. Location-specific analysis revealed significantly higher recurrence rates for internal carotid-anterior choroidal artery aneurysms (0.630% annually) and internal carotid-posterior communicating artery aneurysms (0.262% annually) compared with other locations (p = 0.011). Review of recurrent cases identified 3 mechanistic patterns: closure-line regrowth after parallel clipping (Pattern A, n = 2), residual thin-walled basal footprint in broad-based aneurysms (Pattern B, n = 2), and sub-angiographic remnants preserved for perforator safety (Pattern C, n = 5). The predominance of Pattern C at anterior choroidal artery and posterior communicating artery locations explains the location-specific recurrence risk. All recurrences occurred in aneurysms with complete obliteration (Sindou Grade 0) on early postoperative imaging, whereas no recurrences were observed among 26 cases (3.3%) with small neck remnants (Sindou Grades I-II). Microsurgical clipping of unruptured intracranial aneurysms demonstrated excellent long-term durability with very low local recurrence rates, though the gradual increase beyond 10 years highlights the need for continued surveillance, particularly at locations requiring perforator-preserving techniques.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"284-301"},"PeriodicalIF":1.6,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Metabolic Syndrome Components on Early Outcomes after Aneurysmal Subarachnoid Hemorrhage.","authors":"Emre Ozkara, Turan Kandemir, Gizem Kiper, Pinar Yildiz, Atilla Ozcan Ozdemir, Ali Arslantas","doi":"10.2176/jns-nmc.2025-0334","DOIUrl":"10.2176/jns-nmc.2025-0334","url":null,"abstract":"<p><p>Aneurysmal subarachnoid hemorrhage remains a devastating condition with persistently high rates of early mortality and disability. While numerous prognostic models exist, the prognostic relevance of metabolic dysfunction in aneurysmal subarachnoid hemorrhage remains uncertain. We retrospectively analyzed 60 consecutive patients with subarachnoid hemorrhage admitted between 2022 and 2024. Metabolic syndrome and its components-including impaired glucose tolerance, insulin resistance, hypertension, dyslipidemia, and obesity-were evaluated within 24 hours of admission. The primary endpoint was poor functional outcome at discharge (modified Rankin Scale 3-6). Secondary endpoints included in-hospital complications and mortality. In adjusted ridge-penalized logistic regression analyses, impaired glucose tolerance (adjusted odds ratio 4.93, 95% confidence interval 1.39-17.4, p = 0.014) and World Federation of Neurological Surgeons grade ≥3 (adjusted odds ratio 5.12, 95% confidence interval 1.62-16.18, p = 0.006) independently predicted poor outcome. Insulin resistance was independently associated with in-hospital complications (adjusted odds ratio 4.05, 95% confidence interval 1.15-14.3, p = 0.030). Mortality was independently predicted by age (adjusted odds ratio 1.06, 95% confidence interval 1.01-1.12, p = 0.032), World Federation of Neurological Surgeons grade ≥3, and impaired glucose tolerance. The composite metabolic syndrome variable was not an independent predictor of any outcome. In conclusion, specific metabolic abnormalities- impaired glucose tolerance, insulin resistance, and hypertension-rather than metabolic syndrome appear to drive early prognosis after subarachnoid hemorrhage. Early metabolic profiling and individualized glucose control may help identify patients at risk and guide future interventional studies.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"311-316"},"PeriodicalIF":1.6,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Management Strategy for Large Cystic Vestibular Schwannoma Based on the Cyst Classification.","authors":"Masahide Matsuda, Akinari Yamano, Eiichi Ishikawa","doi":"10.2176/jns-nmc.2025-0370","DOIUrl":"10.2176/jns-nmc.2025-0370","url":null,"abstract":"<p><p>Cystic vestibular schwannomas often grow more rapidly and adhere more strongly to the facial nerves and brainstem than do solid tumors. Patients with large cystic tumors may experience sudden clinical deterioration during the preoperative waiting period; furthermore, it is important to carefully consider whether to dissect the cyst wall from adjacent structures. Accordingly, we aimed to clarify the influence of different cyst types on surgical strategies. We included 19 patients with large cystic vestibular schwannomas (extrameatal diameter >30 mm) who underwent microsurgical resection. Tumors were classified using the Piccirillo et al. system based on the cyst location and wall thickness. We compared the incidence of sudden clinical deterioration and surgical outcomes according to the cyst types. Peripherally located thin-walled cysts (type B) were significantly more likely to cause sudden clinical deterioration than were centrally located thick-walled cysts (type A). In addition, when the thin cyst wall was firmly adhered to the facial nerve or brainstem, a conservative surgical strategy was applied, with the wall being intentionally left in place rather than attempting forceful dissection. This approach achieved excellent facial nerve preservation but relatively decreased the extent of resection. Taken together, these findings suggest that large cystic vestibular schwannomas with peripherally located thin-walled cysts have a high risk of rapid clinical deterioration and may require early surgical intervention. It is important to adapt the dissection strategy according to cyst wall thickness to achieve optimal postoperative preservation of the facial nerve.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"259-265"},"PeriodicalIF":1.6,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}