Neurosurgery最新文献

{"title":"Primary Versus Salvage Stereotactic Radiosurgery for Patients With Olfactory Groove Meningiomas: A 35-Year Single-Institution Experience.","authors":"Chris Z Wei, Regan M Shanahan, Sydney Scanlon, Kenan Kerem Ozcinar, Vanshika Lohia, Hansen Deng, Constantinos G Hadjipanayis, L Dade Lunsford, Ajay Niranjan","doi":"10.1227/neu.0000000000003759","DOIUrl":"https://doi.org/10.1227/neu.0000000000003759","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stereotactic radiosurgery (SRS) is an important management strategy for patients with olfactory groove meningiomas (OGMs). This study aimed to compare outcomes after primary SRS vs salvage SRS postresection in our institution over the past 35 years.</p><p><strong>Methods: </strong>We reviewed the radiographic imaging of 2030 patients with meningiomas who underwent SRS between 1987 and 2022. Seventy-nine patients with OGM were identified. The median patient age at SRS was 62 years (range, 33-90 years). Forty-eight patients (60.76%) underwent primary SRS and 31 patients (39.24%) had previous resections. The median tumor volume was 4.30 cc (range, 0.19-26.90 cc), and the median margin dose prescribed at SRS was 13 Gy (range, 9-18 Gy). SRS protocol, neurological outcomes, overall survival, and local tumor control (LTC) were evaluated.</p><p><strong>Results: </strong>The overall survival for all OGM patients was 17 years (range, 0.8-24.3 years). No patient deaths were related to intracranial tumor progression. Among primary SRS in 48 patients, 4 (8.33%) had tumor progression at a median time of 9.2 years (range, 0.4-12.3 years). For patients who underwent salvage SRS, 7 patients (22.5%) had delayed tumor progression at a median time of 6.4 years (range, 0.4-15.2 years) after SRS. Previous resection was found to be associated with anosmia (P < .01) and decreased LTC (P = .024). After primary SRS, 73% of patients experienced symptom improvement change. After salvage SRS 23 % of patients showed clinical improvement. In patients with peritumoral edema at SRS, the median percentage edema volume reduction was 82% after SRS.</p><p><strong>Conclusion: </strong>SRS provided low risk long-term tumor control in OGM patients. Primary SRS provided superior LTC and preservation or improvement of olfactory function in most patients.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186353","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":"Deep 16S rDNA Sequencing of Chronic Subdural Hematomas Suggests Involvement of Bacterial Infection in Recurrences.","authors":"Johanna Mohr, Anne Albers, Frieder Schaumburg, Werner Paulus, Benjamin Brokinkel, Walter Stummer, Dorothee Cäcilia Spille, Christian Thomas","doi":"10.1227/neu.0000000000003754","DOIUrl":"https://doi.org/10.1227/neu.0000000000003754","url":null,"abstract":"<p><strong>Background and objectives: </strong>Chronic subdural hematoma (CSDH) is an encapsulated blood collection between the dura mater and arachnoid that often follows mild head trauma. It involves pronounced inflammation and angiogenesis, and recurrence remains common despite advances in surgical management. Subclinical bacterial involvement has been hypothesized as a potential factor in these recurrent cases. We aimed to determine whether bacteria are present in CSDH outer membranes and to define accompanying histological and transcriptomic changes.</p><p><strong>Methods: </strong>A total of 39 Formalin-fixed paraffin-embedded outer-capsule specimens from 19 patients (17 primary, 22 recurrent) underwent: (1) ultra-deep Nanopore 16S rDNA profiling; (2) histomorphology with Gram staining, lipopolysaccharide immunohistochemistry and quantitative immune-cell counts; and (3) RNA-seq of 3 matched primary-recurrent pairs, followed by differential-expression and pathway analysis.</p><p><strong>Results: </strong>Gram staining revealed bacteria in 2 recurrent samples (5%) from a single patient, whereas lipopolysaccharide immunohistochemistry was negative in all cases. Notably, 16S rDNA sequencing detected bacterial DNA exclusively in recurrent lesions (6 samples from 4 patients), with none in primary cases (P = .02, χ2 test). The identified bacterial genera included Staphylococcus, Neisseria, Prevotellamassilia, and Paracoccus. Histopathological evaluation showed no significant differences in eosinophils, myeloperoxidase-positive cells, CD3-positive T-cells, or CD20- positive B-cells when comparing primary with recurrent lesions, or infected to uninfected membranes. Unsupervised clustering of matched primary and recurrent CSDH samples revealed distinct transcriptomic profiles, identifying 184 differentially expressed genes (including consistent Toll-like receptor 4 upregulation) and highlighting pathways related to development, protein biosynthesis, and wound healing.</p><p><strong>Conclusion: </strong>These findings suggest that bacterial DNA is present in a subset of recurrent CSDH, suggesting that bacteria could be involved in recurrences. Further research with larger cohorts is needed to determine whether antimicrobial or anti-inflammatory strategies might help reduce recurrence.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186402","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":"Active Blood Clearance and Delayed Cerebral Ischemia Prevention Therapy Reduces Shunt-Dependent Hydrocephalus in Patients With Aneurysmal Subarachnoid Hemorrhage.","authors":"Manou Overstijns, István Csók, Marco Bissolo, Christian Scheiwe, Peter Reinacher, Jürgen Beck, Roland Roelz","doi":"10.1227/neu.0000000000003756","DOIUrl":"https://doi.org/10.1227/neu.0000000000003756","url":null,"abstract":"<p><strong>Background and objectives: </strong>Chronic shunt-dependent hydrocephalus (CSH) is a common and serious complication after aneurysmal subarachnoid hemorrhage (aSAH). Active blood clearance and delayed cerebral ischemia prevention (ABCD) therapy, using intrathecal urokinase and nimodipine irrigation, aims to enhance blood clearance and prevent vasospasm. This study evaluates whether ABCD therapy reduces the incidence of CSH in aSAH patients.</p><p><strong>Methods: </strong>A matched-pairs analysis was performed and 160 aSAH patients who had received ABCD therapy were compared with 160 controls. Patients were paired on the basis of a best fit model including the World Federation of Neurological Surgeons grade, age, cerebral herniation, intracerebral hemorrhage, and the initial Hijdra score. Patients were stratified by Hijdra score to account for blood load. The incidence of CSH was compared between groups using χ2 tests, whereas a multivariable cause-specific Cox proportional hazards model was used to assess time to shunt-dependent hydrocephalus. In addition, multivariate logistic regression was performed to identify predictors of hydrocephalus.</p><p><strong>Results: </strong>The incidence of CSH was significantly lower in the ABCD group (19.4%) compared with the standard care group (31.3%, P = .015). Subgroup analysis revealed that patients with the highest blood load (Hijdra 30-42) experienced a significant reduction in hydrocephalus (45.8% vs 22.5%, P = .026). By contrast, no significant effects were observed in patients with lower Hijdra scores. Multivariate analysis confirmed that the Hijdra score was a significant predictor of CSH in the standard care group (P = .008) but not in the ABCD-treated group (P = .843).</p><p><strong>Conclusion: </strong>aSAH patients selected for ABCD therapy had a significantly lower incidence of shunt-dependent hydrocephalus compared with matching controls. ABCD therapy may be an important preventive strategy in patients with severe subarachnoid hemorrhage.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186355","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":"Diagnosing Cerebrospinal Fluid Shunt Failure: Systematic Review and Meta-Analysis of Noninvasive and Minimally Invasive Tests in Children and Adults.","authors":"Jenna E Koschnitzky, Maxwell E Shramuk, Margaret V Kudlinski, Jacob M Schauer, Adam M Zysk, Gerald A Grant","doi":"10.1227/neu.0000000000003755","DOIUrl":"https://doi.org/10.1227/neu.0000000000003755","url":null,"abstract":"<p><strong>Background and objectives: </strong>The goal of this study was to assess the diagnostic performance of noninvasive and minimally invasive tools for the diagnosis of shunt failure in pediatric and adult patients.</p><p><strong>Methods: </strong>Eligible studies included patients with permanent cerebrospinal fluid shunt systems who underwent diagnostic testing (X-ray shunt series, computed tomography [CT], MRI, nuclear scintigraphy, or thermal flow evaluation) for possible shunt failure. A systematic review and meta-analysis was conducted (PROSPERO registration number CRD42024596142). Performance measures (accuracy, sensitivity, and specificity) were analyzed using a meta-regression model. The model incorporated index test type, age group, follow-up time frame, and shunt type. Odds ratios were calculated for each level of the analyzed variables. A bias assessment of each study was conducted using Quality Assessment Tool for Diagnostic Accuracy Studies-2 and Quality Assessment Tool for Diagnostic Accuracy Studies-Comparative, when applicable.</p><p><strong>Results: </strong>In total, 465 articles were reviewed (PubMed search October 22, 2024) with 33 included in the final analysis. There was a significant effect of index test type on sensitivity (P = .013). In the subgroup analysis, X-ray shunt series performed worse than CT (reference group) (odds ratio 0.106, 95% CI [0.056-0.201]). There was no overall effect of index test type on specificity (P = .192), but, in the subgroup analysis, X-ray shunt series performed better than CT (odds ratio 4.04, 95% CI [1.938-8.424]). There were no significant effects of age group, follow-up time frame, or shunt type on any of the performance measures.</p><p><strong>Conclusion: </strong>This is the largest systematic review and meta-analysis conducted to date to analyze the performance of minimally invasive tools to diagnose shunt failure. None of the tests performed well enough to be considered a stand-alone test for the diagnosis of shunt failure, and only X-ray shunt series performed significantly different than CT. Limitations include the high risk of bias in the reference standard domain for most studies as identified using Quality Assessment Tool for Diagnostic Accuracy Studies-2.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131406","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":"Long-Term Outcomes of Dorsal Root Entry Zone Lesioning for Neuropathic Pain After Brachial Plexus Avulsion: A 10-Year Follow-up Study.","authors":"Jin Weipeng, Li JunChi, Tao Wei, Yu Tao, Zhang Xiaohua, Gao Yang, Yang Dou, Li Jianyu, Hu Yongsheng, Shu Wei","doi":"10.1227/neu.0000000000003757","DOIUrl":"https://doi.org/10.1227/neu.0000000000003757","url":null,"abstract":"<p><strong>Background and objectives: </strong>Neuropathic pain resulting from brachial plexus avulsion (BPA) severely affects patients' quality of life and is often resistant to standard treatments. Surgical interventions, such as dorsal root entry zone (DREZ) lesioning, have shown promise in treating chronic pain. However, comprehensive long-term data on the effectiveness and safety of DREZ lesioning remain sparse. We aimed to evaluate the long-term efficacy and safety of DREZ lesioning for managing BPA-related neuropathic pain over a minimum 10-year period.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients undergoing DREZ lesioning for BPA-induced neuropathic pain from 2004 to 2014. Pain intensity was measured using the Numeric Rating Scale, and quality of life was assessed through validated questionnaires (Short Form-36 and EuroQol-5D). Surgical complications were systematically documented. Statistical analyses were conducted to compare preoperative and long-term postoperative outcomes.</p><p><strong>Results: </strong>Fifty-two patients completed at least 10 years of follow-up. The mean preoperative Numeric Rating Scale score of 8.63 significantly decreased to 2.44 at long-term follow-up (P < .001). Initially, after surgery, 37 patients (71.2%) achieved complete pain relief. At the final assessment, 28 patients (53.8%) experienced complete pain relief, and another 4 patients (7.7%) reported significant improvement. Apart from the health transition domain in the short form-36 and the mobility and usual activities domains in the EuroQol-5D, all other domains in both scales showed significant improvement (P < .001). The safety profile was favorable, with mild proprioceptive sense disturbance (9/52) and motor weakness (1/52) being the primary complications.</p><p><strong>Conclusion: </strong>DREZ lesioning provides significant, durable pain relief and enhances quality of life for patients suffering from neuropathic pain after BPA, demonstrating a tolerable safety profile over a decade of follow-up.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125089","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":"Trends in the Academic Neurosurgical Workforce: A Longitudinal Analysis of Gender and Racial/Ethnic Representation in the United States From 2012 to 2021.","authors":"Dana I Allison, Canada T Montgomery, Timi Akinwunmi-Williams, Brandy Ndirangu, Jarius Garner, Dejauwne Young, Kevon Bryan, Tianwen Ma, Owoicho Adogwa, William W Ashley, Sonia V Eden, Nnenna Mbabuike, Edjah K Nduom","doi":"10.1227/neu.0000000000003730","DOIUrl":"https://doi.org/10.1227/neu.0000000000003730","url":null,"abstract":"<p><strong>Background and objectives: </strong>The growing importance of diversity in health care and medical education prompted this study to identify trends and disparities in academic neurosurgery. The goal was to provide insights for reshaping future policies and educational strategies while evaluating the evolution of gender and racial/ethnic representation over time. The aim of this study was to assess demographic trends of neurosurgical academic faculty in the United States from 2012 to 2021, within the context of the neurosurgical educational pipeline.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using data from the Association of American Medical Colleges Report on Residents and the Accreditation Council of Graduate Medical Education GME Data Resource Book(s). The study focused on race, ethnicity, and gender data of medical school and neurosurgical residents and faculty from academic years 2012 to 2021.</p><p><strong>Results: </strong>Neurosurgery Faculty Trends (2012-2021): The data revealed that diversity of neurosurgery faculty lags behind the diversity of the US population at large. Most academic neurosurgery faculty positions are currently held by White and Asian physicians. There has been no significant increase in the proportion of neurosurgery faculty from ethnic groups viewed as underrepresented in neurosurgery over this time period. Neurosurgery faculty members and residents are predominately male, though there is a trend toward an increase in female neurosurgeons.</p><p><strong>Conclusion: </strong>The study is the first in neurosurgical literature to examine trends in neurosurgery faculty composition by race and gender over the past 10 years. To see changes in the demographics in the future, intentional efforts at diversification of the neurosurgery pipeline are needed.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125143","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":"Long-Term Outcomes in Patients With Isocitrate Dehydrogenase-Mutated Grade 2 Glioma Who Never Received Adjuvant Oncological Treatment After Upfront Mapping-Based Surgical Resection.","authors":"Hugues Duffau","doi":"10.1227/neu.0000000000003760","DOIUrl":"https://doi.org/10.1227/neu.0000000000003760","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patients with low-grade glioma (LGG) have a long-life expectancy, especially after initial surgery. However, no report specifically investigated LGG patients who underwent only resection without oncological therapy. In this study, long-run outcomes were analyzed in LGG patients who never received adjuvant treatment after upfront mapping-based surgical resection.</p><p><strong>Methods: </strong>Inclusion criteria were patients operated on by the author using intraoperative mapping for isocitrate dehydrogenase-mutated grade 2 gliomas, followed at least 3 years with no oncological treatment at last evaluation. Two groups were compared: group 1 comprising stable LGG or progressing very slowly (growth rate ≤1 mm/year) with a simple monitoring and group 2 comprising recurrent LGG (growth rate >1 mm/year), including patients who underwent reoperation(s).</p><p><strong>Results: </strong>This consecutive series included 111 patients (49 men, mean age 37.3 ± 10.4 years) with epilepsy in 74 cases (66.7%). The mean Karnofsky Performance Scale (KPS) score was 96.5 ± 5.7; 98 patients (88.3%) worked before surgery. The mean preoperative tumor volume (TV) was 21.4 ± 17.2 cm3. The mean postoperative KPS score was 96.7 ± 5.3 (no permanent deficit) with 92 patients who returned to work (93.8%). The mean extent of resection was 98.1 ± 4.7%, with 85 supratotal/total resections (76.6%)-mean residual TV of 0.6 ± 1.6 cm3. There were 60 isocitrate dehydrogenase-mutant astrocytomas (54%) and 51 oligodendrogliomas. Forty-nine patients (44.1%) underwent reoperation(s) without deterioration after 164 resections. The mean follow-up was 8.3 ± 4 years with an overall survival rate of 100%. At final evaluation, 108 patients (97.3%) had a KPS score ≥80 and 79 patients (80.6%) continued to work. In group 1, patients were older (P = .0009) with lower preoperative TV (P = .028), greater extent of resection (P = .002), higher rate of (supra)total resections (P = .024), and lower postoperative TV (P = .0009). The growth rate was higher in patients with reoperation (P < .0001).</p><p><strong>Conclusion: </strong>Postoperative simple monitoring can be considered in selected patients after upfront mapping-based surgery for LGG, especially when (supra)marginal resection was achieved in tumor with slow growth rate, even after the age of 40 years.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086552","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":"Health-Related Quality-of-Life Outcomes in Surgical Patients With Sacral Tarlov Cysts: A 2-Year Prospective Study.","authors":"Frank Feigenbaum, Susan E Parks, Madelene P Martin, Debbie A West, Tanishu D Ross, Onesica P Coleman, Kristina M Kupanoff","doi":"10.1227/neu.0000000000003758","DOIUrl":"https://doi.org/10.1227/neu.0000000000003758","url":null,"abstract":"<p><strong>Background and objectives: </strong>We describe our longitudinal experience with patients who underwent surgical treatment for Tarlov cysts. General and disease-specific validated outcome measures were used to assess health-related quality of life through 2 years postoperatively.</p><p><strong>Methods: </strong>Patients who underwent surgical treatment for sacral Tarlov cysts between 2008 and 2023 were included. Demographics and cyst characteristics were documented. End points were the disease-specific Tarlov Quality-of-Life Scale and general health-related quality-of-life measures including the Oswestry Disability Index, visual analog pain Scales, and Short-Form 36. Patients completed survey measures preoperatively and at 3, 6, 12, and 24 months after surgery.</p><p><strong>Results: </strong>Data were obtained from 417 patients with an average age of 52.5 ± 11.2 years, and 91.1% was female. Patients reported significant improvement in the Tarlov Cyst Quality of Life (3.2 ± 0.1 to 2.1 ± 0.1, P < .001), visual analog pain scales at rest (4.5 ± 0.1 to 2.3 ± 0.1, P < .001) and upon activity (5.7 ± 0.2 to 3.1 ± 0.1, P < .001), and the Oswestry Disability Index (45.5 ± 0.8 to 31.6 ± 1.0, P < .001). Patients also reported improvement on 7 of the 8 Short Form 36 scales: Physical Functioning, Physical Limitations, Bodily Pain, Vitality, Social Functioning, Emotional Limitations, and Mental Health (P < .001 for all models). There was significant improvement from the 1 to 2 years for physical functioning (P = .040) and social functioning (P = .016). The median tolerated sitting time increased from 15 min preoperatively to 45 minutes at 2 years postoperatively.</p><p><strong>Conclusion: </strong>This study, to our knowledge, is the first to demonstrate significant improvement in patients surgically treated for Tarlov cysts using general and disease-specific health-related quality-of-life scales for 2 years after surgery. Our results suggest that patients may continue to improve for up to 2 years after surgery in some domains.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086566","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":"Predictors of Intracranial Aneurysm Residual Filling After Treatment With Flow Diversion at Early Follow-up: A Multicenter Experience of 2277 Patients.","authors":"Joshua D Burks, Ahmed Abdelsalam, Evan M Luther, Kara M Christopher, Michael A Silva, Pascal Jabbour, Sami Al Kasab, Michael R Levitt, Sai Sanikommu, Adib A Abla, Peter Kan, Adam S Arthur, Joshua W Osbun, Min S Park, Nohra Chalouhi, Tiffany Eatz, Ahmad Sweid, Stacey Q Wolfe, Alejandro M Spiotta, Kyle M Fargen, Dileep R Yavagal, Eric C Peterson, Eva M Wu, Clemens M Schirmer, Eyad Almallouhi, Giuseppe Lanzino, Waleed Brinjikji, Mohammad H El-Ghanem, Robert M Starke","doi":"10.1227/neu.0000000000003747","DOIUrl":"https://doi.org/10.1227/neu.0000000000003747","url":null,"abstract":"<p><strong>Background and objectives: </strong>Flow-diverting stents (FDSs) have improved treatment options for intracranial aneurysms. Although FDS have proven successful in treating aneurysms that would previously have required complex microsurgical or endovascular repairs, treatment failures remain a concern. In this multicenter study, we aim to analyze the predictors of residual aneurysmal filling at early angiographic follow-up.</p><p><strong>Methods: </strong>A retrospective analysis of a prospectively maintained neuroendovascular database at 14 high-volume US centers was conducted for all patients who underwent FDS placement for intracranial aneurysms between 2011 and 2019. Aneurysms were graded on the O'Kelly-Marotta scale (OKM).</p><p><strong>Results: </strong>A total of 2277 patients underwent FDS embolization for intracranial aneurysms during the study period. The patient's mean age was 55 (SD ± 13.5) years, and 82% were female. The median maximal aneurysm diameter was 6.7 mm (IQR 4.10-11 mm). Complete aneurysm obliteration (OKM grade 4) occurred in 1109 patients (68%), and 146 (9%) were OKM grade 3, 188 (12%) were OKM grade 2, and 174 (11%) were OKM grade 1. In the adjusted multivariate analysis, individuals in the 65-74 years and 75+ years age groups had significantly increased risk of residual aneurysm filling at 6-month follow-up compared with the 18-44 years age group (odds ratio [OR] 1.92 (95% CI: 1.33-2.78) and 2.92 (95% CI: 1.79-4.77), respectively). Aneurysms arising from the superior cerebellar artery, the basilar artery, and the carotid terminus were more likely to have a residual filling (OR 12.6, 95% CI: 1.39-14.7; OR 4.27, 95% CI: 1.39-14.7; OR 3.16, 95% CI: 1.24-8.06, respectively).</p><p><strong>Conclusion: </strong>As the utilization of FDS for intracranial aneurysms becomes more widespread, the efficacy of aneurysm obliteration needs to be assessed. Our results indicate that several patient-dependent factors, such as age, aneurysm location, and size, predict the likelihood of residual aneurysm filling 6 months post-treatment.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086519","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 Potential of Magnetic Targeted Natural Killer Cell Therapy for Glioblastoma: An in Vivo Study of Natural Killer Cells Loaded With Low-Temperature Synthesized Folic Acid-Modified Superparamagnetic Iron Oxide Nanoparticles.","authors":"Pao-Chun Lin, Ya-Jyun Liang, Wei-Ting Kuo, Feng-Huei Lin, Fon-Yih Tsuang","doi":"10.1227/neu.0000000000003731","DOIUrl":"https://doi.org/10.1227/neu.0000000000003731","url":null,"abstract":"<p><strong>Background and objectives: </strong>Glioblastoma (GBM) is a highly malignant brain tumor with limited treatment options. While natural killer (NK) cell-based immunotherapy shows promise in cancer treatment, effective tumor targeting remains a challenge. This study investigates the use of folic acid-modified superparamagnetic iron oxide nanoparticles (SPIONs-PEG-FA) to magnetize NK cells, enabling them to accumulate at the tumor site under an external magnetic field while retaining their cytotoxic activity against GBM cells.</p><p><strong>Methods: </strong>SPIONs-PEG-FA were synthesized using PEGylation and coprecipitation to ensure efficient NK cell uptake. Their successful synthesis was confirmed through material characterization, including X-ray diffraction, Fourier transform infrared spectroscopy, transmission electron microscopy, and dynamic light scattering. In vitro studies evaluated their safety, cellular uptake, and cytolytic activity, whereas in vivo experiments assessed tumor targeting and therapeutic efficacy in GBM-bearing mice.</p><p><strong>Results: </strong>SPIONs-PEG-FA-loaded NK cells were successfully developed for targeted GBM therapy. In vitro studies confirmed their safety and effectiveness against GBM tumor cells, whereas transmission electron microscopy analysis verified the cellular uptake of SPIONs-PEG-FA by NK cells. In vivo experiments in GBM-bearing mice demonstrated improved tumor targeting, enhanced cytolytic efficiency, and overall safety of SPIONs-PEG-FA-loaded NK cells.</p><p><strong>Conclusion: </strong>SPIONs-PEG-FA-loaded NK cells represent a promising approach for targeted GBM therapy. Their successful synthesis and characterization, coupled with in vitro and in vivo validation, highlight their potential for improved therapeutic outcomes. This magnetic field-guided NK cell therapy offers a promising strategy for overcoming challenges in GBM treatment.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086486","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}