Neurosurgery最新文献

{"title":"Lack of Association of Chronological Age and Antithrombotic Agents With Acute Intracranial Hemorrhage in the Group of Older Adults With Traumatic Brain Injury.","authors":"Mizuki Kambara, Fusao Ikawa, Toshikazu Hidaka, Yuji Yamamori, Yoshiaki Yamamoto, Nobuaki Michihata, Masahiro Uchimura, Tsutomu Yoshikane, Yasuhiko Akiyama, Nobutaka Horie, Kentaro Hayashi","doi":"10.1227/neu.0000000000003240","DOIUrl":"10.1227/neu.0000000000003240","url":null,"abstract":"<p><strong>Background and objectives: </strong>Some reports suggest that older patients with traumatic brain injury (TBI) are more likely to experience acute intracranial hemorrhage, resulting in poor outcomes. However, the association between precise chronological age and use of antithrombotic agents with acute intracranial hemorrhage in these patients remains unknown. The aim of this study was to determine factors associated with acute intracranial hemorrhage and poor outcomes in patients with TBI, including chronological age and use of antithrombotic agents.</p><p><strong>Methods: </strong>Patients hospitalized for TBI between January 2006 and December 2021 were included. Patients were categorized by age groups of <65 years, 65 to 74 years, 75 to 84 years, and ≥85 years. Associations between each age group and acute intracranial hemorrhage, a poor outcome at discharge, and in-hospital mortality were evaluated.</p><p><strong>Results: </strong>The cohort included 1086 patients, with 713 (65.7%) in the ≥65 age group. Although chronological age was associated with acute intracranial hemorrhage in patients aged <65 years (odds ratio [OR] 1.02; 95% CI 1.01-1.03), it was not associated with patients aged ≥65 years. None of the antithrombotic agents investigated were associated with acute intracranial hemorrhage in the group aged ≥65 years. Although chronological age was associated with a poor outcome in patients aged <65 years (OR 1.03; 95% CI 1.01-1.07), it was not associated in those aged ≥65 years. The ≥85 year age group (OR 2.30; 95% CI 1.18-4.51) compared with <65 years were significantly associated with a poor outcome. None of the antithrombotic agents investigated were associated with a poor outcome in the group aged ≥65 years.</p><p><strong>Conclusion: </strong>Our findings confirmed the lack of an association of chronological age and antithrombotic agents with acute intracranial hemorrhage in the group of older adults with TBI. Our findings suggest that antithrombotic agents may be safely used, even in older adults.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1321-1332"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504922","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":"Dynamic Craniotomy With Khanna NuCrani Plates as an Alternative to Craniotomy With Fixed Plates in Traumatic Brain Injury.","authors":"Paul R Krafft, Ian Tafel, Anjali Khanna, Patrick Han, Rohit Khanna","doi":"10.1227/neu.0000000000003244","DOIUrl":"10.1227/neu.0000000000003244","url":null,"abstract":"<p><strong>Background and objectives: </strong>Dynamic craniotomy as opposed to a fixed plate craniotomy provides cranial decompression with a controlled outward bone flap movement to accommodate postoperative cerebral swelling and/or hemorrhage. The objective of this study was to evaluate if fixation of the bone flap following a trauma craniotomy with dynamic plates provides any advantage over fixed plates.</p><p><strong>Methods: </strong>A review of our clinical series of 25 consecutive adult patients undergoing dynamic craniotomy with the Khanna NuCrani reversibly expandable bone flap fixation plates for the treatment of traumatic brain injury associated with mass lesions including subdural, epidural, and cerebral hematomas was conducted.</p><p><strong>Results: </strong>Postoperative cerebral swelling was encountered in 21 of 25 patients (84%), which was compensated for with outward bone flap movement in all these patients and associated decreased midline shift. Severe brain swelling with outward bone flap movement of 8 mm or more was noted in 40% of the patients. All patients had a normal intracranial pressure after surgery. None of the patients required any reoperations for hematoma evacuation, rescue decompressive craniectomies, cranioplasty, or complications related to wound healing. The bone flap retracted after the resolution of the brain swelling, and none of the patients reported cosmetic symptoms related to bone flap or wound healing. Overall, 84% (21 of 25) of the patients achieved a good outcome.</p><p><strong>Conclusion: </strong>Craniotomy bone flap fixation with dynamic plates is an alternative to craniotomy with fixed plates. The main advantage of dynamic craniotomy over a craniotomy with fixed plates is that it allows for immediate intracranial volume expansion with reversible outward bone flap migration in patients who may develop postoperative worsening brain swelling and/or hemorrhage, with decreased need for repeat surgeries and associated complications.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1353-1363"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568507","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":"Predictive Value of Neurosurgery Applicant Metrics on Resident Academic Productivity.","authors":"Lauren Banko, Nathan Riesenburger, Ruchit V Patel, Courtney Gilligan, G Rees Cosgrove, E Antonio Chiocca, Mark R Proctor, Akash J Patel, Wenya Linda Bi","doi":"10.1227/neu.0000000000003251","DOIUrl":"10.1227/neu.0000000000003251","url":null,"abstract":"<p><strong>Background and objectives: </strong>Scholarship has been critical to neurosurgery. As grades and board examinations become pass-fail, finding metrics to distinguish applicants coupled with an emphasis on research has led to growth of reported academic output among neurosurgery applicants. We aimed to evaluate applicant factors that associate with an academically productive neurosurgery resident.</p><p><strong>Methods: </strong>Applicant characteristics were extracted from Electronic Residency Application Service archives from 2 geographically distinct neurosurgical programs for the 2014 to 2015 match cycle. Publications during residency were quantified, and residency careers were examined. Factors associated with residency publications were examined using univariate and multivariate regressions.</p><p><strong>Results: </strong>A total of 228 United States (US) applicants to neurosurgery were assessed (89% of US neurosurgery applicants), with 173 matching across 93 programs. The average publication number of matched applicants was higher at 6.6 (median: 4, range: 0-43) that of than unmatched applicants (mean: 2.9, median: 1, range: 0-51). A total of 93.1% of publications were substantiated on PubMed review. Matched candidates published 19.3 manuscripts (median: 13, range: 0-120) on average during residency. On univariate analysis, factors associated with higher residency publications included taking a non-degree-granting extra year for research in medical school, consistently high clerkship grades, depth of preresidency research involvement, number of coresidents, program R25 status, and academic output of neurosurgery department leadership. After multivariate correction, the training environment played an outsized role in predicting resident academic output, with program R25 status significantly associated with resident academic output (odds ratio: 1.25, P = .012). Taking an extra research year in medical school approached but was not significant (odds ratio: 1.19, P = .099). Twelve matched international medical school graduates (IMGs) were also assessed (75% of matched IMG neurosurgery applicants). IMGs exhibited higher total publications and conference abstracts than US matched applicants and also published more during residency.</p><p><strong>Conclusion: </strong>Cultivating an environment that promotes research endeavors is critical for neurosurgical resident academic growth. Preresidency publication number does not predict publication potential during residency.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1206-1216"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624585","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":"Multicenter External Validation of the Accuracy of Computed Tomography Criteria for Detecting Thoracolumbar Posterior Ligamentous Complex Injury.","authors":"Mohamed M Aly, Mohamed Abdelaziz, Faisal A Alfaisal, Rumian Abdulkarem Alrumian, Xavier A Santander Espinoza, Raquel Gutiérrez-González, Teresa Kalantari García, Areej Al Fattani, Waleed Almohamady, Abdulbaset M Al-Shoaibi","doi":"10.1227/neu.0000000000003263","DOIUrl":"10.1227/neu.0000000000003263","url":null,"abstract":"<p><strong>Background and objective: </strong>Recent studies have proposed computed tomography (CT) criteria for posterior ligamentous complex (PLC) injury: disrupted if ≥2 CT findings, indeterminate if single finding, and intact if 0 CT findings. The study aims to validate the CT criteria for PLC injury externally.</p><p><strong>Methods: </strong>Three level 1 trauma centers enrolled 614 consecutive patients with acute thoracolumbar fractures (T1-L5) who received CT and MRI. Three reviewers from each center assessed CT for facet joint malalignment, horizontal laminar fracture, spinous process fracture, and interspinous widening and MRI for disrupted PLC, defined as black stripe discontinuity. The primary outcome is the diagnostic accuracy of CT criteria (0, 1, ≥2 findings) in detecting disrupted PLC on MRI using all CT readings. A subgroup analysis was performed for each participating center and reviewer. The inter-reader agreement on PLC status on MRI and CT criteria was assessed using Fleiss Kappa ( k ).</p><p><strong>Results: </strong>The positive predictive value for PLC injury was 0 findings 3%, single positive CT 43%, and ≥2 CT findings in 94%. The accuracy measures were consistent across various centers and reviewers. The area under the curve for ≥1 CT finding in detecting PLC injury ranged from 90% to 97%, indicating excellent discrimination for all centers. The inter-reader k on PLC status by MRI and overall CT findings was substantial ( k > 0.60).</p><p><strong>Conclusion: </strong>This study externally validates the previously proposed CT criteria for PLC injury. A total of ≥2 positive CT findings or 0 CT findings can be used as criteria for a disrupted PLC (B-type injury) or intact PLC (A-type injuries), respectively, without added MRI. A single CT finding implies indeterminate PLC status and the need for further MRI assessment. The CT criteria will potentially guide MRI indications and treatment decisions for neurologically intact thoracolumbar burst fractures.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1236-1248"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785813","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":"Commentary: Initial Symptom Severity and Recovery of Sport-Related Concussion in Team Versus Individual Sport Athletes.","authors":"Gavin A Davis","doi":"10.1227/neu.0000000000003226","DOIUrl":"10.1227/neu.0000000000003226","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e127-e128"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546552","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: Nighttime Treatment of Ruptured Intracranial Aneurysms are Associated With Poor Outcomes.","authors":"Yu Chang, Pang-Shou Perng, Chih-Yuan Huang","doi":"10.1227/neu.0000000000003414","DOIUrl":"10.1227/neu.0000000000003414","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e134"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720946","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":"In Reply: Decoding Glioblastoma Heterogeneity: Neuroimaging Meets Machine Learning.","authors":"Jawad Fares, Stephen J Price","doi":"10.1227/neu.0000000000003423","DOIUrl":"10.1227/neu.0000000000003423","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e146-e148"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730907","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":"Comprehensive Morphometric Analysis to Identify Key Neuroimaging Biomarkers for the Diagnosis of Adult Hydrocephalus Using Artificial Intelligence.","authors":"Seifollah Gholampour, Jacob Benjamin Rosen, Michelangelo Pagan, Sonja Chen, Ibrahim Gomaa, Arshia Dehghan, Mark Graham Waterstraat","doi":"10.1227/neu.0000000000003248","DOIUrl":"10.1227/neu.0000000000003248","url":null,"abstract":"<p><strong>Background and objectives: </strong>Hydrocephalus involves abnormal cerebrospinal fluid accumulation in brain ventricles. Early and accurate diagnosis is crucial for timely intervention and preventing progressive neurological deterioration. The aim of this study was to identify key neuroimaging biomarkers for the diagnosis of hydrocephalus using artificial intelligence to develop practical and accurate diagnostic tools for neurosurgeons.</p><p><strong>Methods: </strong>Fifteen 1-dimensional (1-D) neuroimaging parameters and ventricular volume of adult patients with non-normal pressure hydrocephalus and healthy subjects were measured using manual image processing, and 10 morphometric indices were also calculated. The data set was analyzed using 8 machine, ensemble, and deep learning classifiers to predict hydrocephalus. SHapley Additive exPlanations (SHAP) feature importance analysis identified key neuroimaging diagnostic biomarkers.</p><p><strong>Results: </strong>Gradient Boosting achieved the highest performance, with an accuracy of 0.94 and an area under the curve of 0.97. SHAP analysis identified ventricular volume as the most important parameter. Given the challenges of measuring volume for clinicians, we identified key 1-D morphometric biomarkers that are easily measurable yet provide similar classifier performance. The results showed that the frontal-temporal horn ratio, modified Evan index, modified cella media index, sagittal maximum lateral ventricle height, and coronal posterior callosal angle are key 1-D diagnostic biomarkers. Notably, higher modified Evan index, modified cella media index, and sagittal maximum lateral ventricle height, and lower frontal-temporal horn ratio and coronal posterior callosal angle values were associated with hydrocephalus prediction. The results also elucidated the relationships between these key 1-D morphometric parameters and ventricular volume, providing potential diagnostic insights.</p><p><strong>Conclusion: </strong>This study highlights the importance of a multifaceted diagnostic approach incorporating 5 easily measurable 1-D neuroimaging biomarkers for neurosurgeons to differentiate non-normal pressure hydrocephalus from healthy subjects. Incorporating our artificial intelligence model, interpreted through SHAP analysis, into routine clinical workflows may transform the diagnostic landscape for hydrocephalus by standardizing diagnosis and overcoming the limitations of visual evaluations, particularly in early stages and challenging cases.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1386-1396"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605865","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":"Vertebral Bone Quality Score as a Predictor of Subsequent Fractures After Cement Augmentation for Osteoporotic Vertebral Compression Fracture.","authors":"Yu-Cheng Yeh, Mu-Ze Chen, Yung-Hsueh Hu, Ping-Yeh Chiu, Fu-Cheng Kao, Ming-Kai Hsieh, Chia-Wei Yu, Tsung-Ting Tsai, Chi-Chien Niu, Lih-Huei Chen, Wen-Jer Chen, Po-Liang Lai","doi":"10.1227/neu.0000000000003282","DOIUrl":"10.1227/neu.0000000000003282","url":null,"abstract":"<p><strong>Background and objectives: </strong>Dual-energy X-ray absorptiometry (DXA) T -scores have been shown to predict fragility fractures in population-based studies. Recently, a novel MRI-based vertebral bone quality (VBQ) score has been proposed, showing better predictability for fragility fractures compared with DXA T -scores. The aim of this study was to explore the correlation between VBQ scores and DXA T -scores and to determine the impact of VBQ scores on the risk of subsequent fragility fractures after cement augmentation for osteoporotic vertebral compression fracture (OVCF).</p><p><strong>Methods: </strong>Between January and December 2018, 251 consecutive patients who received cement augmentation for OVCF were included in the study. VBQ scores were calculated using noncontrast T1-weighted MRI. Correlations between VBQ and T -scores were assessed. Patients were divided into 2 groups based on the presence or absence of subsequent fragility fractures after cement augmentation: (1) no Subsequent fracture group and (2) subsequent fracture group. Comparisons between the groups were conducted, and risk factors of subsequent fractures were evaluated using multivariable logistic regression analysis.</p><p><strong>Results: </strong>Of the patients, 42 (16.7%) experienced subsequent fractures after cement augmentation. The VBQ score showed moderate correlations with the T -score of the hip (r = -0.523, P < .001) and the T -score of the lumbar spine (r = -0.383, P < .001). The subsequent fracture group had a significantly higher VBQ score (4.02 ± 0.56 vs 3.52 ± 0.62, P < .001) and a worse T -score of hip (-3.06 ± 1.28 vs -2.42 ± 0.98, P = .004). In the multivariable analysis, the VBQ score was the only independent predictor of subsequent fractures with 2.799 odds ratio (1.342 to 5.841, P = .006).</p><p><strong>Conclusion: </strong>In patients who received cement augmentation for OVCF, the VBQ score is significantly correlated with the DXA T -score and may be a more reliable predictor of subsequent fragility fractures.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1410-1418"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716824","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":"Commentary: Multicenter External Validation of the Accuracy of Computed Tomography Criteria for Detecting Thoracolumbar Posterior Ligamentous Complex Injury.","authors":"Danyas Sarathy, Brandon Lucke-Wold, Julie L Chan","doi":"10.1227/neu.0000000000003265","DOIUrl":"10.1227/neu.0000000000003265","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e125-e126"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785809","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}