Neurosurgery最新文献

{"title":"Particles, Liquids, and Antiplatelets: Restarting Antiplatelets on Postintervention Day 3 or Later is Associated with Improved Outcomes After Particle Embolization.","authors":"Pious D Patel, Sanjana Salwi, Georgios Sioutas, Jean Filo, Mohamed F Doheim, Alexandra Diamond, Mohamed Salem, Li Ma, Samer S Hoz, Abdullah Sultany, Raul G Nogueira, Alhamza R Al-Bayati, Michael J Lang, M Reid Gooch, Stavropoula Tjoumakaris, Christopher S Ogilvy, Robert H Rosenwasser, Jan-Karl Burkhardt, Pascal Jabbour, Visish M Srinivasan","doi":"10.1227/neu.0000000000003440","DOIUrl":"https://doi.org/10.1227/neu.0000000000003440","url":null,"abstract":"<p><strong>Background and objectives: </strong>Timing of restarting antiplatelet agents after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH) is a topic of controversy. The aim of this study was to determine whether the timing of antiplatelet restart after MMAE for cSDH affects long-term radiographic and clinical outcomes.</p><p><strong>Methods: </strong>A multi-institutional, retrospective cohort study was performed using data from 4 academic medical centers that performed MMAE for cSDH from 2018 to 2023. Patients were prescribed an antiplatelet agent before MMAE were included. Variables included demographics, comorbidities, timing of the procedure and antiplatelet restart, baseline modified Rankin Scale, initial size of SDH, and embolic material used. Outcomes were thickness of SDH at short-term (2 weeks) and long-term (6 weeks) follow-ups, need for unplanned surgical evacuation, and modified Rankin Scale at 90 days.</p><p><strong>Results: </strong>Of 128 patients (78% male, median age 76 years [IQR 70-83]), 67 patients (52%) had their antiplatelet agent restarted postintervention. Patients who did not have their antiplatelet agent restarted experienced higher mortality (20% vs 5%, P = .038). Among patients with antiplatelet agent restarted postintervention, there was a significant correlation (R = -0.43, P = .025) between timing of antiplatelet restart and long-term SDH size change. Antiplatelet restart on postintervention day 3 or later was associated with improvement in long-term SDH thickness (β = -5.7 mm, s.e. 2.5, P = .034). This effect was observed in the particle-embolization subgroup (β = -8.3 mm, s.e. 3.2, P = .021), but not the liquid-embolization subgroup (β = 1.7 mm, s.e. 5.5, P = .773).</p><p><strong>Conclusion: </strong>There was a higher rate of mortality and decreased functional independence among patients who did not have their antiplatelet agent restarted after MMAE for cSDH. Among patients who did have their antiplatelet restarted, a restart date of postintervention day 3 or later was associated with a significant decrease in long-term SDH size.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772817","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":"Proximal Junctional Kyphosis and Failure Prophylaxis Improves Cost Efficacy, While Maintaining Optimal Alignment, in Adult Spinal Deformity Surgery.","authors":"Peter G Passias, Oscar Krol, Tyler K Williamson, Claudia Bennett-Caso, Justin S Smith, Bassel Diebo, Virginie Lafage, Renaud Lafage, Breton Line, Alan H Daniels, Jeffrey L Gum, Themistocles S Protopsaltis, D Kojo Hamilton, Alex Soroceanu, Justin K Scheer, Robert Eastlack, Gregory M Mundis, Khaled M Kebaish, Richard A Hostin, Munish C Gupta, Han Jo Kim, Eric O Klineberg, Christopher P Ames, Robert A Hart, Douglas C Burton, Frank J Schwab, Christopher I Shaffrey, Shay Bess","doi":"10.1227/neu.0000000000003427","DOIUrl":"https://doi.org/10.1227/neu.0000000000003427","url":null,"abstract":"<p><strong>Background and objectives: </strong>To investigate the cost-effectiveness and impact of prophylactic techniques on the development of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in the context of postoperative alignment.</p><p><strong>Methods: </strong>Adult spinal deformity patients with fusion to pelvis and 2-year data were included. Patients receiving PJK prophylaxis (hook, tether, cement, minimally-invasive surgery approach) were compared to those who did not. These cohorts were further stratified into \"Matched\" and \"Unmatched\" groups based on achievement of age-adjusted alignment criteria. Costs were calculated using the Diagnosis-Related Group costs accounting for PJK prophylaxis, postoperative complications, outpatient health care encounters, revisions, and medical-related readmissions. Quality-adjusted life years were calculated using Short Form-36 converted to Short-Form Six-Dimension (SF-6D) and used an annual 3% discount rate. Multivariate analysis controlling for age, sex, levels fused, and baseline deformity severity assessed outcomes of developing PJK/PJF if matched and/or with use of PJK prophylaxis.</p><p><strong>Results: </strong>A total of 738 adult spinal deformity patients met inclusion criteria (age: 63.9 ± 9.9, body mass index: 28.5 ± 5.7, Charlson comorbidity index: 2.0 ± 1.7). Multivariate analysis revealed patients corrected to age-adjusted criteria postoperatively had lower rates of developing PJK or PJF (odds ratio [OR]: 0.4, [0.2-0.8]; P = .011) with the use of prophylaxis. Among those unmatched in T1 pelvic angle, pelvic incidence lumbar lordosis mismatch, and pelvic tilt, prophylaxis reduced the likelihood of developing PJK (OR: 0.5, [0.3-0.9]; P = .023) and PJF (OR: 0.1, [0.03-0.5]; P = .004). Analysis of covariance analysis revealed patients matched in age-adjusted alignment had better cost-utility at 2 years compared with those without prophylaxis ($361 539.25 vs $419 919.43; P < .001). Patients unmatched in age-adjusted criteria also generated better cost ($88 348.61 vs $101 318.07; P = .005) and cost-utility ($450 190.80 vs $564 108.86; P < .001) with use of prophylaxis.</p><p><strong>Conclusion: </strong>Despite additional surgical cost, the optimization of radiographic realignment in conjunction with prophylaxis of the proximal junction appeared to be a more cost-effective strategy, primarily because of the minimization of reoperations secondary to mechanical failure. Even among those not achieving optimal alignment, junctional prophylactic measures were shown to improve cost efficiency.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772820","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":"Ventricular Entry During Glioblastoma Resection is Associated With Reduced Survival and Increased Risk of Distant Recurrence.","authors":"Neslihan Nisa Gecici, Ahmed Habib, Arka N Mallela, Jeremy N Rich, Jan Drappatz, Megan Mantica, Kalil G Abdullah, Pascal O Zinn","doi":"10.1227/neu.0000000000003431","DOIUrl":"https://doi.org/10.1227/neu.0000000000003431","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although subventricular zone (SVZ) involvement is known to correlate with more aggressive tumor behavior and reduced survival in glioblastoma (GBM), the role of ventricular entry (VE) on outcomes is less clear and remains debated. This study aims to investigate the impact of VE on outcomes and overall survival (OS) in GBM.</p><p><strong>Methods: </strong>A retrospective analysis of patients with newly diagnosed supratentorial GBMtreated between 2013 and 2023 at the University of Pittsburgh Medical Center was performed. SVZ involvement, size, and extent of resection were identified through preoperative and postoperative imaging. VE was identified through operative notes and postoperative imaging review.</p><p><strong>Results: </strong>A total of 282 patients met inclusion criteria. VE occurred in 38.3% (n = 108) of patients and was more common in those with SVZ-contacting tumors (P < .001). Patients who had VE had significantly lower median OS compared with non-VE (12 months vs 18 months, P < .001). VE was identified as an independent risk factor for decreased OS in patients with GBM, after adjusting for well-known prognostic factors and SVZ contact (hazard ratios: 1.62 [1.12-2.34], P = .001). Only patients who had VE developed postoperative hydrocephalus (n = 4, 1.4%, P = .021) and had external ventricular drain placed (n = 6, 2.1%, P = .003). Distant parenchymal recurrence and leptomeningeal dissemination (LMD) rates were significantly higher in the VE group compared with the non-VE group (63.9% vs 39.7%, P < .001, and 23.1% vs 13.2%, P = .035), and VE emerged as an independent predictor of distant recurrences/LMDs in multivariable logistic regression (odds ratio: 4.7 [2.11-10.4], P < .001).</p><p><strong>Conclusion: </strong>Our data suggest that VE during GBM resection is a significant independent risk factor for decreased survival and increased distant recurrence/LMD. While maximizing tumor resection remains critical, neurosurgeons must consider the potential adverse outcomes associated with VE because it may diminish the survival benefits of gross-total resection. Prospective studies are warranted to better understand the risks and benefits of VE in GBM surgery.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772783","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":"Spinal Cord Tract Integrity in Degenerative Cervical Myelopathy.","authors":"Newton Cho, Abdul Al-Shawwa, W Bradley Jacobs, Nathan Evaniew, Jacques Bouchard, Steve Casha, Stephan duPlessis, Peter Lewkonia, Fred Nicholls, Alex Soroceanu, Ganesh Swamy, Kenneth C Thomas, Michael M H Yang, Julien Cohen-Adad, David W Cadotte","doi":"10.1227/neu.0000000000003428","DOIUrl":"https://doi.org/10.1227/neu.0000000000003428","url":null,"abstract":"<p><strong>Background and objectives: </strong>Degenerative cervical myelopathy (DCM) is the most common cause of spinal dysfunction globally. Despite surgical intervention, motor dysfunction may persist in many patients. The purpose of this study was to comprehensively examine specific spinal cord tract changes in patients with DCM, to better understand potential substrates for compensatory recovery of function.</p><p><strong>Methods: </strong>Cervical spinal cord MRI scans with diffusion tensor imaging were performed in patients with DCM and in healthy volunteers. Spinal Cord Toolbox was used to register the PAM50 template, which includes a probabilistic atlas of the white matter tracts of the spinal cord, to the imaging data. Fractional anisotropy (FA) was extracted for each tract at C3 above the level of maximal compression and compared between patients with DCM and healthy volunteers and between patients with mild vs moderate to severe DCM.</p><p><strong>Results: </strong>We included 25 patients with DCM (13 mild and 12 moderate to severe) and 6 healthy volunteers. FA was significantly reduced in DCM subjects relative to healthy volunteers for the lateral corticospinal tract (mild DCM vs healthy ∆ = -0.13, P = .018; moderate to severe DCM vs healthy ∆ = -0.11, P = .047), fasciculus gracilis (mild DCM vs healthy ∆ = -0.16, P = .010; moderate to severe DCM vs healthy ∆ = -0.13, P = .039), and fasciculus cuneatus (mild DCM vs healthy ∆ = -0.16, P = .007; moderate to severe DCM vs healthy ∆ = -0.15, P = .012). There were no differences in FA for all tracts between mild and moderate-to-severe DCM subjects.</p><p><strong>Conclusion: </strong>Patients with DCM had altered diffusion tensor imaging signal in their lateral corticospinal tract, fasciculus gracilis, and fasciculus cuneatus in comparison with healthy volunteers. These findings indicate that DCM is characterized by injury to these structures, which suggests that other tracts within the cord could potentially act as substrates for compensatory motor recovery.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780604","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: Safety of Postembolization Antithrombotic Therapy After Middle Meningeal Artery Embolization.","authors":"Xiaolin Du, Zeguang Ren, Hua Yang, Kaya Xu","doi":"10.1227/neu.0000000000003374","DOIUrl":"10.1227/neu.0000000000003374","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e99-e100"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441537","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: Long-Term Outcomes After CyberKnife Radiosurgery for Nonfunctioning Pituitary Adenomas.","authors":"Boyi Li, Colette Shen, Dominique Higgins","doi":"10.1227/neu.0000000000003266","DOIUrl":"https://doi.org/10.1227/neu.0000000000003266","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"96 4","pages":"e87-e88"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625525","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":"Central Nervous System Infections in Patients With Ventriculoperitoneal Shunts Admitted for Primary Abdominal Infections: A US Nationwide Cohort Analysis.","authors":"Cameron P Beaudreault, Eris Spirollari, Sabrina L Zeller, Odinachi Oguguo, John V Wainwright, Avinash Mohan, Michael Tobias, Chirag D Gandhi, Fawaz Al-Mufti","doi":"10.1227/neu.0000000000003156","DOIUrl":"10.1227/neu.0000000000003156","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although ventriculoperitoneal (VP) shunts are a common treatment for hydrocephalus, there are complication risks including infections. Late complications such as ventriculitis from ascending abdominal infections can have severe consequences. However, the incidence of central nervous system (CNS) infections in VP shunt patients with abdominal infections is not well understood. We aimed to determine the incidence of CNS infections in VP shunt patients admitted with abdominal infections.</p><p><strong>Methods: </strong>Using the National Inpatient Sample, we studied patients from 2016 to 2019 to determine the incidence of CNS infections in VP shunt patients admitted with abdominal infections. Results were compared with VP shunt patients admitted for primary pneumonia.</p><p><strong>Results: </strong>Among 725 VP shunt patients presenting with abdominal infections, 20 (2.8%) had CNS infections. Chronic obstructive pulmonary disease, hypertension, older age, and a smoking history were more common in patients with CNS infections and primary abdominal infection ( P < .05). Patients who developed CNS infection had a significantly higher likelihood of both blood transfusion and coma but a lower likelihood of seizures. VP shunt patients with CNS infections were more likely to undergo shunt removal (odds ratio [OR] = 23.167, P < .001). 4.1% of VP shunt patients with primary abdominal infections died during admission. In a population of primary abdominal infection and pneumonia patients with VP shunts, a multivariate logistic regression analysis controlling for age, sex, and comorbidities identified abdominal infection as an independent risk factor for both CNS infection (OR = 51.208, P < .001) and inpatient death (OR = 3.417, P < .001). Among 6620 VP shunt patients admitted with primary pneumonia, only 5 (0.1%) had CNS infection compared with 20 (2.8%) in those with a primary abdominal infection (OR = 37.532, P < .001), and mortality was 1.6% vs 4.1% for those with a primary abdominal infection ( P < .05).</p><p><strong>Conclusion: </strong>CNS infections in VP-shunted patients with abdominal infections are relatively rare but may lead to increased risks of death and other serious adverse outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"794-801"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154700","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: Comparison of In-Hospital Mortality and Neurosurgical Intervention Between Intracranial Gunshot Wounds Arising from Long Guns and Handguns: A Propensity Score-Matched Study.","authors":"Sam H Jiang, Dario Marotta, Ankit I Mehta","doi":"10.1227/neu.0000000000003356","DOIUrl":"10.1227/neu.0000000000003356","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e97-e98"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008917","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: Clinical Outcomes and Radiographic Results of Prone Transpsoas Lateral Lumbar Interbody Fusion: A Single-Institution Case Series.","authors":"Julie L Chan, Robert G Whitmore","doi":"10.1227/neu.0000000000003165","DOIUrl":"10.1227/neu.0000000000003165","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e83-e84"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140666","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: Comparison of In-Hospital Mortality and Neurosurgical Intervention Between Intracranial Gunshot Wounds Arising from Long Guns and Handguns: A Propensity Score Matched Study.","authors":"Syed Ali Munavar","doi":"10.1227/neu.0000000000003355","DOIUrl":"10.1227/neu.0000000000003355","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e96"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008918","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}