Neurosurgery最新文献

{"title":"Stereotactic Radiosurgery for World Health Organization Grade 2 and 3 Oligodendroglioma: An International Multicenter Study.","authors":"Anne-Marie Langlois, Christian Iorio-Morin, Justiss Kallos, Ajay Niranjan, L Dade Lunsford, Selcuk Peker, Yavuz Samanci, David J Park, Gene H Barnett, Roman Liscak, Gabriela Simonova, Stylianos Pikis, Georgios Mantziaris, Jason Sheehan, Cheng-Chia Lee, Huai-Che Yang, Greg N Bowden, David Mathieu","doi":"10.1227/neu.0000000000003177","DOIUrl":"10.1227/neu.0000000000003177","url":null,"abstract":"<p><strong>Background and objectives: </strong>Oligodendrogliomas are primary brain tumors classified as isocitrate deshydrogenase-mutant and 1p19q codeleted in the 2021 World Health Organization Classification of central nervous system tumors. Surgical resection, radiotherapy, and chemotherapy are well-established management options for these tumors. Few studies have evaluated the efficacy of stereotactic radiosurgery (SRS) for oligodendroglioma. As these tumors are less infiltrative than astrocytomas and typically recur locally, focal therapy such as SRS is an appealing option.</p><p><strong>Methods: </strong>This study was performed through the International Radiosurgery Research Foundation. The objective was to collect retrospective multicenter data on tumor control, clinical response, and morbidity after SRS for oligodendroglioma. Inclusion criteria were age of 18 years or more, single-fraction SRS, and histological confirmation of grade 2 or 3 oligodendroglioma. The primary end points were progression-free survival (PFS) and overall survival from SRS. Secondary end points included clinical evolution and occurrence of adverse radiation events or other complications. Descriptive statistics, Kaplan-Meier analyses, and univariate and multivariate analyses were performed.</p><p><strong>Results: </strong>Eight institutions submitted data for a total of 55 patients. The median follow-up time was 24 months. The median age at SRS was 46 years, and the median Karnofsky Performance Status was 90%. The median marginal dose used was 15 Gy. The median PFS was 17 months, with actuarial rates of 60% at 1 year, 31% at 2 years, and 24% at 5 years after SRS. Factors significantly associated with worsened PFS were World Health Organization grade 3, previous radiotherapy and chemotherapy, and higher marginal dose. The median overall survival post-SRS was 58 months, with actuarial rates of 92% at 1 year, 83% at 2 years, and 49% at 5 years. Karnofsky Performance Status remained stable post-SRS in 51% and worsened in 47% of patients, most often because of tumor progression (73%). Radiation-induced changes occurred in 30% of patients, of which only 4 were symptomatic.</p><p><strong>Conclusion: </strong>SRS is a reasonable management option for patients with oligodendroglioma.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"870-880"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984253","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":"Does Mechanism of Injury Affect Recovery After Sport-Related Concussion in Basketball? A Pilot Study.","authors":"Anthony E Bishay, Avi N Albert, Grant H Rigney, James T Corley, Kristen L Williams, Jacob Jo, Douglas P Terry, Scott L Zuckerman","doi":"10.1227/neu.0000000000003175","DOIUrl":"10.1227/neu.0000000000003175","url":null,"abstract":"<p><strong>Background and objectives: </strong>Understanding sport-related concussion (SRC) mechanisms can aid in prevention and treatment. Concussions in basketball have received relatively less attention compared with collision sports. In a cohort of concussed high school basketball players, this pilot study sought to (1) describe the mechanisms of how concussions occur in basketball and (2) assess the relationship between mechanisms and acute symptomatology and recovery time.</p><p><strong>Methods: </strong>A retrospective cohort, pilot study examined concussed adolescent athletes (aged 14-18 years) treated at a sports concussion center from 11/2017 to 04/2022. The primary independent variable was mechanism of injury, categorized into (1) contact (head-to-head, head-to-body, head-to-ball, head-to-ground), (2) player (offensive play, defensive play, both), and (3) awareness mechanisms (aware, unaware). The outcomes included acute symptom severity, time to return-to-learn, symptom resolution, and return-to-play. Associations between mechanisms and outcomes were analyzed using one-way analysis of variance, independent t -tests, multivariable linear regressions, and Cox regression.</p><p><strong>Results: </strong>Of 105 basketball players (16.2 ± 1.4 years; 50.5% male), head-to-ground contact (n = 44/105; 41.9%) was most common. Taking-a-charge (n = 12/53; 22.6%) was the most frequent player mechanism, with similar rates for offensive (n = 24/53; 45.3%) and defensive (n = 23/53; 43.4%) plays. Most were aware of impending collision (n = 37/46; 80.4%). Head-to-body concussions were associated with higher initial symptoms severity scores when compared with head-to-head (β = 0.33, P = .003) and head-to-ground (β = 0.23, P = .050) contacts. Player and awareness mechanisms were not significant predictors of outcome measures. Only higher initial symptom scores were associated with a longer time to return-to-learn, symptom resolution, and return-to-play.</p><p><strong>Conclusion: </strong>In this pilot study of concussed high school basketball players, head-to-ground was the most common concussion mechanism, with similar rates during offensive and defensive plays. Although head-to-body contact increased acute symptoms, other mechanisms did not predict recovery time. Given the limited information on concussions in basketball, the preliminary results of this pilot study may help inform larger studies on basketball SRC mechanisms.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"850-859"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292275","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":"So, You Want to Be a Chair?","authors":"Steven L Giannotta","doi":"10.1227/neu.0000000000003373","DOIUrl":"https://doi.org/10.1227/neu.0000000000003373","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"71 Supplement_1","pages":"17-22"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625519","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":"Neurological Surgery Resident ABNS Written Exam Scores Before and After Introduction of a Weekly Didactic Educational Intervention: A 12-Year Single-Institution Retrospective Study.","authors":"Scott Boop, Sharon Durfy, David Bass, Amy Lee, Sylvia Zavatchen, Richard G Ellenbogen, Ali C Ravanpay","doi":"10.1227/neu.0000000000003150","DOIUrl":"10.1227/neu.0000000000003150","url":null,"abstract":"<p><p>United States neurological surgery residency education has undergone substantive changes over the past 2 decades. Neurosurgical professional bodies have developed numerous initiatives providing standardized assessments and training opportunities for residency programs. However, there have been few studies using standardized measures to assess core components of educational programming in individual programs. We conducted a 12-year retrospective review of resident American Board of Neurological Surgery (ABNS) board scores using our institutional data from 2010 to 2021 to determine the effect of introducing a weekly didactic resident education hour (REH) on resident scores in the ABNS written in-training examination. ABNS scaled scores were analyzed before (2010-2016) and after (2017-2021) REH introduction. To account for a practice effect, we used a 2-factor linear regression model with an interaction term. We obtained ABNS scores from 43 residents representing 132 test attempts. The average ABNS scaled score significantly improved after the introduction of REH (319 vs 410, t = -3.44, P = .0008). Accounting for the practice effect revealed a significant interaction effect between the number of attempts taking the ABNS examination and whether formal didactics were taught, accounting for 46.2 points on the examination ( t = 2.309, P = .023); however, REH alone did not have a significant effect on the scaled scores ( t = -1.649, P = .102 ). ABNS written board scores represent a standardized metric by which educational initiatives within training programs may be assessed for efficacy. Further research is needed to identify educational approaches that are effective to meet the goal of demonstrated mastery of fundamental knowledge in neurosurgery across a diversity of neurological surgery residency programs.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e89-e95"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081053","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 and Efficacy of Balloon-Assisted Kyphoplasty Followed by Stereotactic Body Radiation Therapy for Pathological Fractures.","authors":"Samuel Adida, Michael R Kann, Suchet Taori, Shovan Bhatia, Roberta K Sefcik, Steven A Burton, John C Flickinger, Peter C Gerszten","doi":"10.1227/neu.0000000000003182","DOIUrl":"10.1227/neu.0000000000003182","url":null,"abstract":"<p><strong>Background and objectives: </strong>In patients experiencing pain secondary to pathological compression fractures, balloon-assisted kyphoplasty and subsequent stereotactic body radiation therapy (SBRT) may allow for restoration of vertebral height and irradiation of the underlying malignancy to control local disease progression. The aim of this study was to evaluate the safety and efficacy of kyphoplasty treatment before SBRT in patients with spinal metastases and benign tumors.</p><p><strong>Methods: </strong>An analysis of a prospectively collected database of 70 patients and 75 metastatic and benign spinal lesions that underwent kyphoplasty before SBRT at a single institution (2002-2023) was conducted. Patient characteristics were recorded, including treatment history, dosimetry and fractionation schedule, pain outcomes, local control (LC), and overall survival. The Bilsky score and Spinal Instability Neoplastic Score were calculated to assess epidural involvement and spinal stability, respectively.</p><p><strong>Results: </strong>The median time from kyphoplasty to SBRT was 29 days (range: 2-159). Seventy-two lesions (96%) were managed with single-fraction SBRT and 3 lesions (4%) with a multifraction regimen. The median single-fraction prescription dose was 20 Gy (range: 12-25) delivered to a median tumor volume of 35.1 cc (range: 2.2-160). After a median follow-up period of 9 months (range: 1-201), 6 lesions (8%) locally progressed. Pain was reported to improve or remain stable for most patients (88%). The LC rate was 88% at 6 months, 1 year, and 2 years. No prognostic factors were significantly associated with LC. The median overall survival was 11 months (range: 1-201) after radiosurgery. There were no reports of cement extravasation or radiation-induced neurological deficit. Two acute pain flares (3%) were reported 1 and 3 months after radiosurgery.</p><p><strong>Conclusion: </strong>The combined kyphoplasty and SBRT treatment paradigm can be used to treat patients with painful pathological compression fractures. Long-term LC and patient-reported improvement in pain were observed without the morbidity associated with open surgery.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"860-869"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292276","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":"Epilepsy Surgery for Drug-Resistant Epilepsy in Africa: A Systematic Review.","authors":"Kwadwo Darko, Pearl Ohenewaa Tenkorang, Olivia Asiedu, W Elorm Yevudza, Salim Issah, Eyako Dzantor, Marjidah Tahiru, Andrew Awuah Wireko, Sean O'Leary, Umaru Barrie, Hannah Weiss, Teddy Totimeh, Mabel Banson","doi":"10.1227/neu.0000000000003307","DOIUrl":"10.1227/neu.0000000000003307","url":null,"abstract":"<p><strong>Background and objectives: </strong>Nearly one-third of individuals with epilepsy have drug-resistant epilepsy, treated most effectively with surgery. This study aims to discuss the demographic profile, surgical access, and strategies used in drug-resistant epilepsy in Africa.</p><p><strong>Methods: </strong>A systematic review was performed using PubMed, Google Scholar, Embase, and Web of Science in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.</p><p><strong>Results: </strong>Nine studies encompassing 498 patients from 6 African countries (Egypt, Kenya, Morocco, South Africa, Tunisia, and Uganda) were included. The mean Methodological Index for Non-Randomized Studies score for these articles was 9.6 ± 1.6. The average patient age was 24.9 years (95% CI: 18.9-30.8 years), with a male predominance of 53.4%. The average age of seizure onset was 10.4 years (95% CI: 6.1-14.7 years). Most patients experienced focal onset seizures (73.1%), with head trauma (33.1%) being the most reported risk factor. The predominant etiologies were hippocampal sclerosis (66.8%, 95% CI: 42.7-91), microdysgenesis (26.7%, 95% CI: 20.7-32.7), and brain tumors (22.3%, 95% CI: 6.4-38.2). Lesions were primarily located in the left hemisphere (61.9%, 95% CI: 26.7-97.1), with temporal lobe involvement in 54.8% of cases (95% CI: 28.7-80.8). Temporal lobectomy was the most frequently performed surgery (59.6%), followed by lesionectomy (9.6%). Postoperatively, 80.6% of patients achieved Engel class I outcomes, indicating seizure freedom, and long-term follow-up (1 to 5 years) showed that 70.3% maintained Engel class I outcomes. Surgical complications were reported in 8.8% of cases.</p><p><strong>Conclusion: </strong>These findings demonstrate the efficacy and long-term benefits of epilepsy surgery in Africa, where epilepsy is a significant public health challenge. The high rates of seizure freedom and reduced seizure frequency from surgery highlight its potential to improve the quality of life for individuals with drug-resistant epilepsy in Africa.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"704-712"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813838","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":"Barriers to Care: Examining the Unique Obstacles of Indigenous American Patients With Acute Neurosurgical Injuries.","authors":"Kyril L Cole, Samuel A Tenhoeve, Majid Khan, Matthew C Findlay, Janet Cortez, Ramesh Grandhi, Sarah T Menacho","doi":"10.1227/neu.0000000000003162","DOIUrl":"10.1227/neu.0000000000003162","url":null,"abstract":"<p><strong>Background and objectives: </strong>Historically, Indigenous American (IA) populations have faced barriers to adequate health care. Although IA people experience higher rates of traumatic brain injury-related mortality than other racial groups in the United States, attributes of their neurosurgical care have not been evaluated. We demonstrate and compare care patterns and outcomes in IA and non-IA adults with acute neurosurgical injuries and identify disparities limiting access to medical care.</p><p><strong>Methods: </strong>Adults hospitalized for acute neurosurgical injuries between 2017 and 2022 were identified in this retrospective cross-sectional study at our Level 1 trauma center. We evaluated demographics, distance to care, and in-hospital/aftercare characteristics in a propensity-matched analysis.</p><p><strong>Results: </strong>A total of 81 IA patients were identified. Propensity score analysis matched 77 IA and 77 non-IA patients with similar inclusion criteria on demographics, medical comorbidities, and distance traveled to neurosurgical care. IA patients traveled longer distances for care (236.3 vs 146.4 miles, P < .001), were more often direct admissions (35.1% vs 0.0%), were more often transported via ambulance (72.7% vs 57.1%) and less often via helicopter (20.8% vs 41.6%), and came from a broader cross-section of states. Average time from injury to care was 6 hours (IQR 3.0, 9.4). In-hospital care did not differ between groups; however, IA patients were less often discharged to rehabilitation (2.6% vs 14.3%, P = .009). IA in-hospital traumatic brain injury-related mortality was 8.3%. Fewer follow-up visits were completed in IA than in non-IA patients (40.2% vs 90.0%, P < .001), despite more attempted contacts (66.7% vs 30.6%, P < .001), with low telemedicine use in both groups (2.7% vs 5.5%). IA status and distance traveled were independent predictors of unmet follow-up visits (odds ratio 6.22 [95% CI 1.49-25.99, P = .012] and odds ratio 12.34 [95% CI 1.19-127.99, P = .035], respectively).</p><p><strong>Conclusion: </strong>Clear barriers to care were demonstrated for IA patients with acute neurosurgical injuries. Our findings indicate improvements are needed for this vulnerable population.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"841-849"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984243","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":"Clinical Outcomes and Radiographic Results of Prone Transpsoas Lateral Lumbar Interbody Fusion: A Single-Institution Case Series.","authors":"Jeff Ehresman, S Harrison Farber, Madison Battista, Katriel E Lee, Bryan S Lee","doi":"10.1227/neu.0000000000003151","DOIUrl":"10.1227/neu.0000000000003151","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study assessed feasibility, radiologic parameters, and clinical outcomes in patients who underwent the prone transpsoas (PTP) approach for lateral lumbar interbody fusion.</p><p><strong>Methods: </strong>This retrospective observational study included consecutive patients who underwent PTP performed by a single surgeon. Data were collected including age, sex, body mass index, operative levels, retraction time, complications, radiographic measurements, and visual analog scale pain scores. Statistical analyses were performed using nonparametric Wilcoxon 2-sample tests.</p><p><strong>Results: </strong>A total of 106 consecutive patients (mean [SD] age, 66 [15] years; mean [SD] body mass index, 29.3 [5.0]) underwent PTP on 173 spinal levels, with a mean (SD) follow-up of 13 (8) months. Sixty of 106 (57%) patients underwent a 1-level PTP procedure (range, 1-4 levels), most commonly on L4-5. The mean (SD) retraction time was 10.4 (3.1) minutes for L1-2, 9.7 (2.8) minutes for L2-3, 9.3 (2.3) minutes for L3-4, and 9.5 (3.2) minutes for L4-5. Adverse events included incidental anterior longitudinal ligament release (3 of 173 [2%] levels) and transient ipsilateral hip flexor weakness (1 of 106 [0.9%] patients). The mean pelvic incidence was 57°. Lumbar lordosis increased from a mean of 44° to 51° ( P < .001). Pelvic tilt decreased from a mean of 20° to 12° ( P < .001). Pelvic incidence-lumbar lordosis mismatch decreased from a mean of 13 to 5 ( P < .001). Visual analog scale pain scores improved from a mean of 6 preoperatively to 5 postoperatively ( P < .001).</p><p><strong>Conclusion: </strong>In this single-institution patient series, the PTP approach was effective and safe for lateral lumbar fusion, with minimal complications and improved lumbar lordosis and patient-reported pain outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"763-768"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140664","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":"Vertebrobasilar Artery Occlusion Treatment Outcomes Within 24 hours of Estimated Occlusion Time.","authors":"Yingjie Xu, Pan Zhang, Miaomiao Hu, Wen Sun, Guoqiang Xu, Chunyan Dai","doi":"10.1227/neu.0000000000003160","DOIUrl":"10.1227/neu.0000000000003160","url":null,"abstract":"<p><strong>Background and objectives: </strong>The aim of this study was to investigate the efficacy and safety of endovascular treatment (EVT) in patients with acute vertebrobasilar artery occlusion (VBAO) within 24 hours of estimated occlusion time (EOT) and to evaluate the effect of early and late time window in a cohort of patients with VBAO treated with EVT.</p><p><strong>Methods: </strong>Retrospective analysis was conducted on patients within 24 hours of the EOT in 65 stroke centers in China. Favorable outcome was defined as modified Rankin Scale ≤3 at 90 days. Patients were divided into the medical management (MM) group and the EVT group. Times were dichotomized into early (EOT ≤6 hours) and late (>6 hours) time windows. Multivariate logical regression models were used to evaluate the efficacy and safety of EVT and the effect of time windows on outcomes in EVT patients.</p><p><strong>Results: </strong>Among 4124 patients, 2473 and 1651 patients were included in the early and late windows, respectively. 1702 patients received MM and 2422 were treated with EVT. EVT was associated with a higher rate of a favorable outcome at 90 days both in early (odds ratio [OR] 2.16, 95% CI 1.94-2.41) and late (OR 1.89, 95% CI 1.65-2.17) time windows. No differences were found regarding favorable outcome (OR 0.95, 95% CI 0.87-1.03) between VBAO patients treated with EVT within and beyond 6 hours.</p><p><strong>Conclusion: </strong>Patients with acute VBAO who received EVT within 24 hours were associated with improved favorable outcome compared with patients who received MM. EVT beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"779-786"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154706","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":"Traumatic Vertebral Artery Injury After Subaxial Cervical Spine Injuries: Incidence, Risk Factors, and Long-Term Outcomes: A Population-Based Cohort Study.","authors":"Victor Gabriel El-Hajj, Karl J Habashy, Paulina Cewe, Elias Atallah, Aman Singh, Alexander Fletcher-Sandersjöö, Mohamad Bydon, Michael Fagerlund, Pascal Jabbour, Paul Gerdhem, Adrian Elmi-Terander, Erik Edström","doi":"10.1227/neu.0000000000003173","DOIUrl":"10.1227/neu.0000000000003173","url":null,"abstract":"<p><strong>Background and objectives: </strong>Vertebral artery injury (VAI) because of traumatic subaxial cervical spine injury is a rare but potentially devastating condition as it could lead to stroke. The aim of this study was to examine the incidence, risk factors, outcomes, and radiographic predictors of VAI in patients surgically treated for subaxial cervical spine injuries at a tertiary care trauma center.</p><p><strong>Methods: </strong>This is a retrospective population-based cohort study, including all patients surgically treated for traumatic subaxial cervical spine injuries at the study center between 2006 and 2018. Primary outcomes included mortality and morbidity after the injury. Propensity score matching, survival, univariable, and multivariable analyses were used to study the outcomes of interest.</p><p><strong>Results: </strong>Traumatic VAI primarily occurred after high-energy traumas such as motor vehicle accidents and falls from heights. The median age was 64.4 years (47.4-69.1), and 69% were male. In the cohort of patients with subaxial cervical injury, 54% had a spinal cord injury (SCI). In the subgroup with VAI, the frequency of SCI was 66% and a concomitant SCI and VAI were associated with a more severe American Spinal Cord Injury Association Impairment Scale grade ( P = .015). However, after accounting for age, sex, and associated injuries, VAI did not affect postoperative complications, short- or long-term outcomes, or mortality rates. Facet joint dislocation was a unique radiographic predictor of VAI (odds ratio 3.8 [CI 1.42-10.7], P = .009).</p><p><strong>Conclusion: </strong>The findings suggest that clinical outcomes of patients with traumatic cervical spine injuries were not negatively affected by the presence of a VAI. Several radiographic factors were associated with VAI; however, only facet joint dislocation remained as an independent predictor of this injury.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"881-891"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984187","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}