Neurosurgery最新文献

{"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}

{"title":"Cardiac Output Directly Influences Intracardiac Air After Venous Air Embolism: An Echocardiographic Model Comparing Position Change on Intracardiac Air Bubble Clearance.","authors":"Chris Marcellino, James A Nelson, John L D Atkinson, Jeffrey J Pasternak, Arnoley S Abcejo","doi":"10.1227/neu.0000000000003179","DOIUrl":"10.1227/neu.0000000000003179","url":null,"abstract":"<p><strong>Background and objectives: </strong>Venous air embolism (VAE) can cause significant morbidity and mortality. Prevention and management of VAE include cessation of air entrainment, positioning changes, and hemodynamic support. The degree to which position change and cardiac output (CO) moderate resolution of intracardiac air has not been rigorously studied using contemporary transesophageal echocardiography (TEE).</p><p><strong>Methods: </strong>This observational cohort-type study aimed to identify the effect of supine vs sitting positioning on the movement and resolution of intracardiac air. In 20 patients undergoing seated neurosurgery, central venous air aspiration catheters were placed through the median basilic vein. TEE was used to estimate the time required for clearance of agitated microbubbles from the right atrium and ventricle in both the supine and sitting position. Estimates of CO were also obtained echocardiographically in each position.</p><p><strong>Results: </strong>Average clearance time was faster in the sitting vs the supine position with no significant difference in CO. A negative correlation between CO and right atrial clearance time across all patients was demonstrated with a Pearson coefficient of -0.4 (95% CI -0.07, -0.65) with P = .02.</p><p><strong>Conclusion: </strong>During VAE, both patient position and CO can significantly affect how bubbles move through intracardiac chambers. However, augmenting CO during VAE may be clinically more feasible, efficient, and productive than changing positioning-especially during crises unless the changing in position is intended to halt the entrainment of air. Further TEE studies of intravascular air movement affected by other position changes (lateral, reverse Trendelenburg) and vasopressors should be considered.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"908-914"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292273","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":"Association Between Whole Blood Transfusion and Mortality Among Patients With Hemorrhagic Shock and Traumatic Brain Injury.","authors":"Makoto Aoki, Morihiro Katsura, Kazuhide Matsushima","doi":"10.1227/neu.0000000000003161","DOIUrl":"10.1227/neu.0000000000003161","url":null,"abstract":"<p><strong>Background and objectives: </strong>Whole blood (WB) transfusion in trauma has been revisited, and recent studies have reported an association between WB and improved survival among patients with hemorrhagic shock. However, no evidence of a similar association exists for patients with hemorrhagic shock and traumatic brain injury (TBI). This study aimed to assess the association between WB and mortality among patients with hemorrhagic shock and TBI.</p><p><strong>Methods: </strong>This study retrospectively analyzed data obtained from American College of Surgeons-Trauma Quality Improvement Program during January 2020 to December 2021. Patients (age ≥18 years) requiring blood transfusion within 4 hours of hospital arrival and sustaining TBI (head Abbreviated Injury Scale >2) were included. Survival at 30 days were compared after performing 1:1 propensity score matching for demographics, injury type, vital signs on admission, TBI characteristics, injury characteristics, comorbidities, hemorrhage control procedures, hospital characteristics, and withdrawal of life support.</p><p><strong>Results: </strong>A total of 15 967 patients were eligible for analysis. The median age was 42 years (interquartile range: 28-60 years); 11 789 (73.8%) patients were male, and 10 102 (63.2%) patients were White. Of them, 2725 (17.0%) received WB. After a 1:1 propensity score matching, 2720 matched pairs were compared. Matched patients had 1.0 as median shock index and 79 mm Hg as the lowest systolic blood pressure requiring immediate transfusion. WB was not associated with reduced 30-day mortality, compared with non-WB (34.0% vs 34.7%, odds ratio: 0.97, 95% confidence interval: 0.87-1.09).</p><p><strong>Conclusion: </strong>WB was not associated with reduced 30-day mortality among patients with hemorrhagic shock and TBI. These findings suggest that not all patients with hemorrhagic shock would benefit from WB.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"832-840"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154699","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":"Acute Implantation of a Bioresorbable Polymer Scaffold in Patients With Complete Thoracic Spinal Cord Injury: A Randomized Controlled Trial (INSPIRE 2.0).","authors":"James S Harrop, Kee D Kim, David O Okonkwo, Ira M Goldstein, K Stuart Lee, Richard M Toselli","doi":"10.1227/neu.0000000000003180","DOIUrl":"10.1227/neu.0000000000003180","url":null,"abstract":"<p><strong>Background and objectives: </strong>Traumatic spinal cord injury (SCI) remains a devastating condition with no proven effective treatment options available. In a prior single-arm study of patients with thoracic complete SCI (INSPIRE; ClinicalTrials.gov , NCT02138110), acute implantation of an investigational bioresorbable polymer scaffold (Neuro-Spinal Scaffold [NSS]) appeared to be safe through 24 months postimplantation and was associated with an American Spinal Injury Association Impairment Scale (AIS) conversion rate that exceeded historical controls. Here, we evaluated whether NSS implantation demonstrates probable benefit for safety and neurological recovery in patients with thoracic complete SCI vs standard-of-care spine surgery.</p><p><strong>Methods: </strong>INSPIRE 2.0 was a randomized, controlled, parallel, multicenter study conducted at Level I trauma centers in the United States ( ClinicalTrials.gov , NCT03762655; funded by InVivo Therapeutics Corporation). Patients with AIS grade A, thoracic (T2-T12), nonpenetrating SCI requiring spine surgery ≤7 days postinjury were randomized (1:1, computer-generated allocation) to undergo NSS implantation or spine surgery alone (control group). Patients and follow-up International Standards for Neurological Classification of SCI assessors were blinded. A predefined study success criterion required the proportion of patients with improvement of ≥1 AIS grade at 6 months postsurgery (primary endpoint) to be ≥20% higher in the NSS group than in the control group.</p><p><strong>Results: </strong>Target enrollment was reached (N = 20) with 10 patients randomized and analyzed in each group. At 6 months postsurgery, an improvement in the AIS grade was reported in 2 NSS patients (20%; both to AIS C) and 3 control group patients (30%; to AIS B [n = 2] or AIS C [n = 1]). No serious or unanticipated adverse device effects were reported. The study was closed to further follow-up because of not meeting its primary endpoint.</p><p><strong>Conclusion: </strong>In this small group of patients with thoracic complete (AIS A) SCI, implantation of an intraparenchymal bioresorbable scaffold did not produce probable clinical benefit. However, this study provides evidence that surgical intervention in an injured spinal cord parenchyma may be performed safely.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"751-762"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research as an Imperative for Clinical Excellence.","authors":"Henry Brem","doi":"10.1227/neu.0000000000003370","DOIUrl":"https://doi.org/10.1227/neu.0000000000003370","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"71 Supplement_1","pages":"6-16"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625517","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":"Stereotactic Radiosurgery With Versus Without Neoadjuvant Endovascular Embolization for Brain Arteriovenous Malformations With Associated Intracranial Aneurysms.","authors":"Andrea Becerril-Gaitan, Justin Nguyen, Cheng-Chia Lee, Dale Ding, Christopher P Cifarelli, Roman Liscak, Brian J Williams, Mehran B Yusuf, Shiao Y Woo, Ronald E Warnick, Daniel M Trifiletti, David Mathieu, Douglas Kondziolka, Caleb E Feliciano, Rafel Rodriguez-Mercado, Kevin M Cockroft, Scott Simon, John Lee, Jason P Sheehan, Ching-Jen Chen","doi":"10.1227/neu.0000000000003152","DOIUrl":"10.1227/neu.0000000000003152","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stereotactic radiosurgery (SRS) with neoadjuvant embolization is a treatment strategy for brain arteriovenous malformations (AVMs), especially for those with large nidal volume or concomitant aneurysms. The aim of this study was to assess the effects of pre-SRS embolization in AVMs with an associated intracranial aneurysm (IA).</p><p><strong>Methods: </strong>The International Radiosurgery Research Foundation AVM database from 1987 to 2018 was retrospectively reviewed. SRS-treated AVMs with IAs were included. Patients were categorized into those treated with upfront embolization (E + SRS) vs stand-alone SRS (SRS). Primary end point was a favorable outcome (AVM obliteration + no permanent radiation-induced changes or post-SRS hemorrhage). Secondary outcomes included AVM obliteration, mortality, follow-up modified Rankin Scale, post-SRS hemorrhage, and radiation-induced changes.</p><p><strong>Results: </strong>Forty four AVM patients with associated IAs were included, of which 23 (52.3%) underwent pre-SRS embolization and 21 (47.7%) SRS only. Significant differences between the E + SRS vs SRS groups were found for AVM maximum diameter (1.5 ± 0.5 vs 1.1 ± 0.4 cm 3 , P = .019) and SRS treatment volume (9.3 ± 8.3 vs 4.3 ± 3.3 cm 3 , P = .025). A favorable outcome was achieved in 45.4% of patients in the E + SRS group and 38.1% in the SRS group ( P = .625). Obliteration rates were comparable (56.5% for E + SRS vs 47.6% for SRS, P = .555), whereas a higher mortality rate was found in the SRS group (19.1% vs 0%, P = .048). After adjusting for AVM maximum diameter, SRS treatment volume, and maximum radiation dose, the likelihood of achieving favorable outcome and AVM obliteration did not differ between groups ( P = .475 and P = .820, respectively).</p><p><strong>Conclusion: </strong>The likelihood of a favorable outcome and AVM obliteration after SRS with neoadjuvant embolization in AVMs with concomitant IA seems to be comparable with stand-alone SRS, even after adjusting for AVM volume and SRS maximum dose. However, the increased mortality among the stand-alone SRS group and relatively low risk of embolization-related complications suggest that these patients may benefit from a combined treatment approach.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"787-793"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018167","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":"Safety of Postembolization Antithrombotic Therapy After Middle Meningeal Artery Embolization.","authors":"Rahul K Chaliparambil, Mykhaylo Krushelnytskyy, Khizar R Nandoliya, Shreya Mukherjee, Babak S Jahromi, William Metcalf-Doetsch, Matthew B Potts","doi":"10.1227/neu.0000000000003176","DOIUrl":"10.1227/neu.0000000000003176","url":null,"abstract":"<p><strong>Background and objectives: </strong>Middle meningeal artery embolization (MMAE) for the management of chronic subdural hematoma (cSDH) has been suggested as a preferred treatment in patients where reinitiating antithrombotic (AT) therapy is necessary. In this study, we evaluate whether reinitiating AT therapy before cSDH resolution after MMAE affects radiographic and clinical resolution.</p><p><strong>Methods: </strong>This is a retrospective study of patients who underwent MMAE at our institution between 2018 and 2024. Clinical and radiographic findings were analyzed with standard statistical approaches. Kaplan-Meier curves for nonresolution compared AT and no-AT groups and compared AT resumption before and after 30 days after surgery.</p><p><strong>Results: </strong>In 111 MMAE procedures, the median age was 73 years, 27.9% were female, and 80.6% were White. The median follow-up was 5.1 months. Forty-six patients (41.4%) demonstrated complete resolution of their cSDH. Eleven patients (9.9%) had reoperation after MMAE. The median cSDH depth was 14.0 mm, and the median midline shift was 3.0 mm. Thirty-two patients (28.8%) resumed AT before resolution. The median time to resumption was 35.5 days. Patients in the AT group were less likely to have radiographic resolution (21.9% vs 49.4%, odds ratios = 0.2872, 95% CI = 0.1113-0.7404, P = .0103) but comparable rates of reoperation and residual symptomatic presentations. Resumption of AT therapy before or after 30 days from surgery had no effects on outcome measures on univariate analysis. Major outcomes were similar between patients receiving antiplatelet-only or anticoagulant-only medications.</p><p><strong>Conclusion: </strong>Reinitiating AT therapy before cSDH resolution was associated with decreased rates of resolution, but comparable rates of reoperation and residual symptoms. Our results support the cautious reinitiation of AT therapy in patients requiring it after MMAE.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"901-907"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142350896","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":"Innovative External Cranial Devices for Protecting a Craniectomy Site: A Scoping Review on Noninvasive Approaches for Patients Awaiting Cranioplasty.","authors":"Laura L Fernandez, Diana Rodriguez, Dylan P Griswold, Isla Khun, Sarita Aristizabal, Jorge H Aristizabal, Grace Richards, Adriene Pavek, Sudha Jayaraman","doi":"10.1227/neu.0000000000003157","DOIUrl":"10.1227/neu.0000000000003157","url":null,"abstract":"<p><strong>Background and objectives: </strong>Decompressive craniectomy (DC) is a commonly performed procedure to alleviate high intracranial pressure. To enhance patient quality of life and minimize complications after DC in patients awaiting cranioplasty (CP), multidisciplinary teams have designed and implemented external protective prototypes, including 3-dimensional printing and plaster models, whenever feasible. The aim of this scoping review was to assess the evidence available on innovative external cranial devices that protect the craniectomy site for patients who have undergone DC while awaiting CP in high-income countries and low- and middle-income countries.</p><p><strong>Methods: </strong>This scoping review was conducted following the methodology outlined by the Joanna Briggs Institute. Searches were performed in databases such as MEDLINE, Embase, Web of Science, Scielo, Scopus, and World Health Organization Global Health Index Medicus. Patent documents were also searched in Espacenet, Google Patents, and World Intellectual Property Organization. This scoping review included external protective devices for adult patients who underwent DC and CP, while invasive devices were excluded.</p><p><strong>Results: </strong>A total of 9 documents described external cranial devices, with 7 of them led by researchers from high-income countries, including the United States (n = 4), Singapore (n = 1), the United Kingdom (n = 1), and Hong Kong SAR, China (n = 1). Among these devices, 77.7% (n = 7) were created using 3-dimensional printing, while 22.3% (n = 2) were developed through plaster hand modeling. The individual study results were summarized.</p><p><strong>Conclusion: </strong>Sustainable Development Goal (SDG) 3, SDG 9, and SDG 10 play a crucial role in the advancement of innovative strategies to ensure access to essential neurosurgical care, reduce global disparities in treatment outcomes, mitigate postoperative complications, and provide life-saving interventions. This scoping review provides fundamental evidence for multidisciplinary teams involved in designing noninvasive innovations to minimize the risks associated with post-DC complications. It is anticipated that more cost-effective models, particularly in low- and middle-income countries, can be implemented based on the findings of this review.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"713-724"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154704","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":"Spatial Distribution of Meningiomas: A Magnetic Resonance Image Atlas.","authors":"Ruchit V Patel, Shun Yao, Efrain Aguilar Murillo, Raymond Y Huang, Wenya Linda Bi","doi":"10.1227/neu.0000000000003149","DOIUrl":"10.1227/neu.0000000000003149","url":null,"abstract":"<p><strong>Background and objectives: </strong>The size and anatomic location of meningiomas have been shown to correlate with distinct clinical manifestations, histopathological subtypes, and surgical risk. However, meningioma anatomic origin sites can be obscured in large tumors and those crossing compartments. We therefore sought to apply unbiased lesion mapping to localize intracranial meningioma distributions and their association with biology and grade.</p><p><strong>Methods: </strong>MRI scans, World Health Organization (WHO) grade, and a molecularly Integrated Grade (IG) derived from cytogenetics were analyzed from adult patients with intracranial meningiomas. Semi-automated tumor segmentation was performed on T1-weighted contrast-enhanced MRI. We used the voxel-based lesion mapping technique to generate a meningioma atlas, mapping spatial frequency and correlating with tumor grades.</p><p><strong>Results: </strong>Of 881 patients with meningioma (median age: 57 years, 68.8% female), 589 were WHO grade 1 (66.8%), 265 WHO grade 2 (30.1%), and 27 WHO grade 3 (3.1%) with a median tumor volume of 14.6 cm 3 . After molecular reclassification, 585 were IG-1 (66.4%), 160 IG-2 (18.2%), and 136 IG-3 (15.4%). Benign tumors were concentrated in and around the midline anterior skull base while malignant meningiomas were enriched in the falcine/parasagittal region and the sphenoid wing, similar to the distribution when stratified by chromosome 1p loss. Meningiomas exhibited sharper spatial clustering when stratified by the molecular IG than by WHO grade. WHO grade 2 meningiomas divided equally across IG 1-3, with corresponding partition of spatial distribution in the midline anterior skull base (in WHO grade 2, IG-1) and falcine/parasagittal and sphenoid regions (WHO grade 2, IG-3). Meningioma volumes significantly varied across age, sex, and WHO/IG grades.</p><p><strong>Conclusion: </strong>We demonstrate the utility of voxel-based lesion mapping for intracranial tumors, characterizing distinct meningioma distribution patterns across histopathological and molecularly defined grades. Molecular grading associated with sharper tumor spatial clusters, supporting a phenotype-genotype association in meningiomas.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"769-778"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081054","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: Barriers to Care: Examining the Unique Obstacles of Indigenous American Patients With Acute Neurosurgical Injuries.","authors":"Sulaman Durrani, Michael Y Wang, Allan D Levi, Ian Cote","doi":"10.1227/neu.0000000000003186","DOIUrl":"10.1227/neu.0000000000003186","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e85-e86"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984247","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}