Neurosurgery最新文献

{"title":"Defensive Medicine in Neurosurgery: The Sub-Saharan Africa Experience.","authors":"François Waterkeyn, Chibuikem A Ikwuegbuenyi, Simon A Balogun, Myriam Thys, Romani R Sabas, Hervé M Lekuya, Dominique Vanpee","doi":"10.1227/neu.0000000000003620","DOIUrl":"https://doi.org/10.1227/neu.0000000000003620","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study investigates the prevalence and determinants of defensive medicine among neurosurgeons in Sub-Saharan Africa (SSA). It examines how economic, cultural, and legal factors unique to SSA influence these practices, providing insights to guide regional policy-making and medical education.</p><p><strong>Methods: </strong>A cross-sectional survey of 71 neurosurgeons in SSA was conducted via WhatsApp, LinkedIn, and conferences. The questionnaire, adapted to the SSA context from a Canadian study, explored demographics, practice types, liability profiles, defensive behaviors, and perceptions of the medicolegal environment. Data were analyzed using descriptive statistics in R software.</p><p><strong>Results: </strong>Among 71 respondents, 91.5% were men, and 29.6% were undergoing residency or fellowship training. All respondents reported engaging in at least 1 defensive medical behavior, with varying degrees of frequency. Common strategies included patient discussions (24.2%) and specialist referrals (16.7%). Economic and resource limitations constrained practices such as ordering imaging (17.5%) and prescribing medications (10.8%). Despite perceived medicolegal risks, 93% of participants reported no lawsuits in the past 3 years.</p><p><strong>Conclusion: </strong>Defensive medicine among neurosurgeons in SSA is less prevalent and intense than in high-income regions. Unique economic constraints, cultural norms, and weaker legal pressures limit defensive behaviors. These findings highlight the need for context-specific policies and educational strategies to balance medicolegal risk management with resource limitations in SSA.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608878","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: Clinical Characteristics and Outcomes of Traumatic Brain Injury in a High-Volume Tertiary Care Center in India: A Prospective Observational Cohort Study.","authors":"Moritz Steinruecke, Peter J Hutchinson, Angelos Kolias, Mathew Joseph","doi":"10.1227/neu.0000000000003629","DOIUrl":"https://doi.org/10.1227/neu.0000000000003629","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601101","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: Outcomes After Decompression Only Versus Decompression and Fusion for Lumbar Facet Cysts: A Systematic Review and Meta-Analysis.","authors":"Stavros Matsoukas, Divaldo Camara, Arianne Boylan, Patrick C Reid, Konstantinos Margetis","doi":"10.1227/neu.0000000000003636","DOIUrl":"https://doi.org/10.1227/neu.0000000000003636","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601102","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":"Assessing Brain Injury After Extra-Axial Brain Tumor Resection: Circulating Neurofilament Light Levels, Neurological Deficits, and Fatigue.","authors":"Isak Michaëlsson, Tobias Hallén, Dan Farahmand, Ubah Mahamud, Kaj Blennow, Henrik Zetterberg, Asgeir S Jakola, Thomas Skoglund","doi":"10.1227/neu.0000000000003612","DOIUrl":"https://doi.org/10.1227/neu.0000000000003612","url":null,"abstract":"<p><strong>Background and objectives: </strong>Circulating brain-injury biomarkers have recently gained increased interest, as new ultrasensitive measurement techniques have enabled quantification of brain injury through blood sampling. This prospective study explores relationships between plasma levels of the axonal injury biomarker neurofilament light chain (NfL) and postoperative outcomes, including new neurological deficits and fatigue, in patients undergoing extra-axial brain tumor surgery. In addition, we aimed to establish the temporal profile of changes in NfL levels after surgery.</p><p><strong>Methods: </strong>We included 41 adult patients scheduled for surgery for meningiomas or vestibular schwannomas. Plasma concentrations of NfL were measured the day before surgery and on postoperative days 1, 10, 30, and 60, with new neurological deficits assessed on day 1 postsurgery. Fatigue was measured using the Multidimensional Fatigue Inventory before and 6 months after surgery.</p><p><strong>Results: </strong>NfL levels peaked on day 10 after surgery, and patients with new neurological deficits postsurgery had higher NfL levels on days 10, 30, and 60 relative to those without new deficits. NfL levels at day 10 had the highest sensitivity and specificity in relation with new neurological deficits. No association was found between postoperative NfL levels and development of fatigue.</p><p><strong>Conclusion: </strong>The results suggest measuring NfL level as a promising method for quantifying structural brain damage associated with extra-axial tumor surgery. However, these findings did not reveal associations between elevated NfL levels and postoperative fatigue.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601099","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: Minimal Clinically Important Difference and Relative Change in Patients-Reported Outcomes After Surgery for Cervical Spondylotic Myelopathy, a Nationwide Study of 1700 Patients.","authors":"Zachary A Sorrentino, Julie L Chan","doi":"10.1227/neu.0000000000003626","DOIUrl":"https://doi.org/10.1227/neu.0000000000003626","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601100","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: Outcomes After Decompression Only Versus Decompression and Fusion for Lumbar Facet Cysts: A Systematic Review and Meta-Analysis.","authors":"Wei-Thing Khor, Yu Chang, Da-Wei Huang, Jung-Shun Lee","doi":"10.1227/neu.0000000000003637","DOIUrl":"https://doi.org/10.1227/neu.0000000000003637","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Silk Vista Baby Study: A Multicenter Aneurysm Report From North America and Europe.","authors":"Ricardo A Hanel, Otavio F de Toledo, Natalia V De Oliveira Souza, Salvador F Gutierrez-Aguirre, Monika Killer-Oberpfalzer, Eytan Raz, Maksim Shapiro, Tareq Kass-Hout, Michael Hurley, Rami Z Morsi, Visish M Srinivasan, Brian T Jankowitz, Pierce Davis, Adnan Siddiqui, Vinay Jaikumar, Gustavo M Cortez, Omar Kass-Hout, Tibor Becske, Ramesh Grandhi, Craig Kilburg, Demetrius K Lopes, Andrew F Ducruet, Lucas Elijovich, Gavin Britz, Maria M Toledo, Joshua Seinfeld, Robert M Starke, Raul G Nogueira, Matthew T Bender, Peter T Kan, Tyler Lazaro, Victor H C Benalia, Fernanda R Erazu, Montserrat Lara-Velazquez, Amin Aghaebrahim, Eric Sauvageau, Vitor M Pereira","doi":"10.1227/neu.0000000000003611","DOIUrl":"https://doi.org/10.1227/neu.0000000000003611","url":null,"abstract":"<p><strong>Background and objectives: </strong>The Silk Vista Baby (SVB) flow diverter (FD) stent (Balt SAS) is the first device designed for treating distally located brain aneurysms. It can be delivered through a 0.017-inch ID microcatheter, enabling access to small, distal vessels. The aim of this study was to evaluate the effectiveness, safety, technical success, occlusion rate, and clinical outcomes of the SVB device.</p><p><strong>Methods: </strong>This retrospective, multicenter study included data from 18 centers from November 2023 to September 2024. Procedures were performed by experienced neurointerventionalists following institutional standards of care. Outcomes analyzed included effectiveness, safety, and aneurysm occlusion rates. Descriptive analyses and Pearson χ2 or Independent t-Test were used for statistical evaluation.</p><p><strong>Results: </strong>A total of 95 patients, mean age 55.4 years, were included. A total of 31% of aneurysms were ruptured at admission. Most (58.3%) were located in the anterior circulation, and 45% had previous treatment, mainly coiling (69.4%). Complication rates were higher for ruptured aneurysms (24.1%) compared with unruptured ones (9.2%). Two deaths occurred, 1 (1.1%) related to the procedure. At discharge, 87% of patients had modified Rankin Scale ≤2. The latest follow-up showed overall complete/near-complete occlusion rates of 76.1%, with 81.14% for ruptured and 73.43% for unruptured aneurysms. Technical success was higher in unruptured cases (100% vs 93.1%).</p><p><strong>Conclusion: </strong>Our case series demonstrated the efficacy of the SVB with a high rate of technical success. The occlusion rates for ruptured cases are comparable with those of other FDs. However, the rates are lower for unruptured cases. This discrepancy is likely due to the characteristics of the aneurysms, particularly in the presence of side branches in bifurcation lesions. The SVB safety profile is similar to other FDs in unruptured cases, while the ruptured group presented more complications.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601106","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: Clinical Characteristics and Outcomes of Traumatic Brain Injury in a High-Volume Tertiary Care Center in India: A Prospective Observational Cohort Study.","authors":"Bibha Osti, M Marzia Noor, Md Moshiur Rahman","doi":"10.1227/neu.0000000000003628","DOIUrl":"https://doi.org/10.1227/neu.0000000000003628","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601103","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":"Minimal Clinically Important Difference and Relative Change in Patient-Reported Outcomes After Surgery for Cervical Spondylotic Myelopathy: A Nationwide Study of 1,700 Patients.","authors":"Victor Gabriel El-Hajj, Anita M Klukowska, Victor E Staartjes, Elias Atallah, Darius Babaei, Mohamad Bydon, Paul Gerdhem, Erik Edström, Adrian Elmi-Terander","doi":"10.1227/neu.0000000000003596","DOIUrl":"https://doi.org/10.1227/neu.0000000000003596","url":null,"abstract":"<p><strong>Background and objectives: </strong>Healthcare policies have seen significant reforms, with a marked transition toward a patient-centered approach. This shift emphasizes the use of subjective patient-reported outcome measures as key metrics. However, these measures often face limitations, particularly in identifying clinically meaningful changes over time. To address this challenge, the concept of the minimal clinically important difference (MCID) was introduced. This study aims to evaluate the predictive effectiveness of relative change and its associated threshold, the minimal clinically important relative change (MCIRC), as a potential alternative to absolute differences and the MCID.</p><p><strong>Methods: </strong>Data prospectively collected between 2006 and 2021 from the Swedish Spine Registry (Swespine) were analyzed. Patient-reported outcome measures included the Numeric Rating Scale (NRS) for neck and arm pain, the EQ5D index, EQ VAS, and the Neck Disability Index (NDI). Anchor-based methods were used to calculate the MCID and MCIRC. The predictive performance of absolute differences and relative changes was compared using the area under the receiver operating characteristic curve.</p><p><strong>Results: </strong>1756 patients were included. The selected MCID values were -3 for NRS neck pain intensity, -2 for arm pain intensity, 0.09 for the EQ5D index, 7 for EQ VAS, and -12 for NDI scores. For MCIRC, the chosen values were -47% for NRS neck pain intensity, -40% for arm pain intensity, 386% for the EQ5D index, 52% for EQ VAS, and -32% for NDI scores. On area under the ROC curve, relative change was superior for NRS neck and arm pain scores and NDI, while absolute difference was superior for EQ5D and EQ VAS scores.</p><p><strong>Conclusion: </strong>Relative change, along with its associated minimal clinically important value (MCIRC), proved to be a more suitable indicator of subjective satisfaction for NRS and NDI scores. By contrast, absolute differences and the MCID were better suited for evaluating the EQ5D index and EQ VAS scores.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601105","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 Retrospective Study of Stereotactic Radiosurgery for Gynecological Cancer Brain Metastases.","authors":"Mathilde Billau, Andréanne Hamel, Jean-Nicolas Tourigny, Christian Iorio-Morin, Roman Liscak, Jaromir May, Ajay Niranjan, Zhishuo Wei, L Dade Lunsford, Diego D Luy, Shalini Jose, Sydney Scanlon, Joshua Silverman, Reed Mullen, Kenneth Bernstein, Douglas Kondziolka, Selcuk Peker, Yavuz Samanci, Steve Braunstein, Christina Phuong, Jason Sheehan, Stylianos Pikis, Jacob Kosyakovsky, Rahul Neal Prasad, Joshua David Palmer, David Bailey, Brad E Zacharia, Christopher P Cifarelli, Denisse Arteaga Icaza, Daniel T Cifarelli, Rodney E Wegner, Matthew J Shepard, Gregory N Bowden, Narine Wandrey, Chad G Rusthoven, Eric B Hintz, Michael Schulder, Anuj Goenka, Jennifer L Peterson, David Mathieu","doi":"10.1227/neu.0000000000003609","DOIUrl":"https://doi.org/10.1227/neu.0000000000003609","url":null,"abstract":"<p><strong>Background and objectives: </strong>Gynecological cancers represent 10% to 15% of cancers in women, but brain metastases (BM) are uncommon, with limited evidence regarding their management. This study investigates the role of stereotactic radiosurgery (SRS) for BM from primary gynecological cancers.</p><p><strong>Methods: </strong>Institutions of the International Radiosurgery Research Foundation participated in this study. Inclusion criteria required histological diagnosis of epithelial ovarian, cervical, or endometrial cancer, SRS between 2000 and 2020, and at least 1 imaging or clinical follow-up.</p><p><strong>Results: </strong>A total of 276 patients having SRS for 977 BM were included. Median age at SRS was 62 years (IQR, 55-70). Primary cancer origin was ovarian in 128 (46%), cervical in 43 (16%), and endometrial in 105 patients (38%). Median Karnofsky Performance Scale was 80%, and systemic disease was active in 124 (45%) of patients. A median of 1 metastasis was treated (IQR, 1-3) per patient. Median individual metastasis volume was 0.27 cc (IQR, 0.05-1.59 cc). The majority (91%) received single-fraction SRS, using a median margin dose of 18 Gy (IQR, 16-20 Gy). Actuarial overall survival was 77%, 65%, and 44% at 6, 12, and 24 months, respectively. Predictors of worsened survival included older age, cervical and endometrial primary, previous whole-brain radiation therapy (WBRT), active systemic disease, worsened Karnofsky Performance Scale, absence of subsequent surgery, and increasing number of BM. Actuarial local control was 94% at 6 months, 89% at 12 months, and 78% at 24 months. Previous SRS or WBRT, tumor bed treatment, and cervical histology increased the risk of local failure. New remote BM and leptomeningeal dissemination occurred in 44% and 11% of patients, respectively. Adverse radiation effects (ARE) occurred in 13% of cases but were symptomatic in only 3%. Previous WBRT or SRS and increased tumor diameter increased the risk of ARE.</p><p><strong>Conclusion: </strong>SRS is an effective management for BM from gynecological cancers with low risks of symptomatic ARE.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575946","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}