Neurosurgery最新文献

{"title":"High-Accuracy Augmented Reality Guidance for Intracranial Drain Placement Using a Standalone Head-Worn Navigation System: First-in-Human Results.","authors":"Frederick Van Gestel, Taylor Frantz, Félix Buyck, Anthony G Gallagher, Wietse Geens, Quentin Neuville, Michael Bruneau, Bart Jansen, Thierry Scheerlinck, Jef Vandemeulebroucke, Johnny Duerinck","doi":"10.1227/neu.0000000000003401","DOIUrl":"https://doi.org/10.1227/neu.0000000000003401","url":null,"abstract":"<p><strong>Background and objectives: </strong>External ventricular drain (EVD) placement is often performed freehand, a technique subpar to accurate yet impractical image-guided methods, yielding optimal placement in only 70%. The aim of this study was to address shortcomings in EVD placement and image guidance technologies by implementing high-accuracy augmented reality (AR) guidance.</p><p><strong>Methods: </strong>We conducted a prospective clinical pilot study to assess feasibility, safety, and clinical performance of EVD placement using a standalone AR headset equipped with high-accuracy inside-out infrared tracking and software addressing EVD placement. Placement quality was reported using a newly defined extended modified Kakarla scale, and dichotomized into clinically relevant outcome parameters. Results were compared with a nonconcurrent freehand control group using one-sided Fisher exact tests.</p><p><strong>Results: </strong>Eleven AR-guided EVD placements were performed, achieving functional placement in all cases on the first attempt, vs 7 (64%) in the control group (P = .045); successful placement in 9 (82%) vs 5 (45%); optimal in 8 (73%) vs 3 (27%) (P = .043); suboptimal in 2 (18%) vs 5 (45%); and failed in 0 vs 1 (9%). No AR-guided placements required revision, whereas the freehand group had a 36% reintervention rate (P = .045). Procedure-related complications occurred in 2 AR-guided cases (18%), vs 5 (45%) freehand (all post-reintervention).</p><p><strong>Conclusion: </strong>This study presents the first clinical use case of EVD placement using high-accuracy AR guidance contained in a standalone head-worn navigation system. Safe and reliable outcomes using a validated pipeline were demonstrated, eliminating stick-and-poke attempts and resulting in improved quality, increased single attempt success rates, and reduced revision and complication rates. Based on these results, a multicenter randomized controlled trial will be initiated.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670436","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: Letter: Central Nervous System Infections in Patients With Ventriculoperitoneal Shunts Admitted for Primary Abdominal Infections: A US Nationwide Cohort Analysis.","authors":"Cameron P Beaudreault, Eris Spirollari, Sabrina Zeller, Fawaz Al-Mufti","doi":"10.1227/neu.0000000000003412","DOIUrl":"https://doi.org/10.1227/neu.0000000000003412","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657703","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: Central Nervous System Infections in Patients With Ventriculoperitoneal Shunts Admitted for Primary Abdominal Infections: A US Nationwide Cohort Analysis.","authors":"Leonardo O Brenner, Valentina Ponchio, Gabriel Semione, Raphael Bertani","doi":"10.1227/neu.0000000000003410","DOIUrl":"https://doi.org/10.1227/neu.0000000000003410","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657704","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":"Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines Update for the Role of Emerging Therapies in the Management of Patients With Metastatic Brain Tumors.","authors":"Kristin Huntoon, J Bradley Elder, Guilherme Finger, D Ryan Ormond, Navid Redjal, Mark E Linskey, Jeffrey J Olson","doi":"10.1227/neu.0000000000003383","DOIUrl":"https://doi.org/10.1227/neu.0000000000003383","url":null,"abstract":"<p><strong>Background: </strong>Patients with metastatic brain tumors (MBTs) require a multidisciplinary team-based approach to select the best diagnostic, surgical, and radiation interventions.</p><p><strong>Objective: </strong>The aim of this guideline was to provide an update of the evidence-based recommendations of the guideline produced in 2019 regarding the use of emerging therapies for adult patients with MBTs.</p><p><strong>Methods: </strong>PubMed and Embase were searched from January 1, 2016, through May 3, 2022, using search strategies pertinent to the therapeutic topics: targeted agents, immune-modulating agents, interstitial modalities, radiosensitizers, laser interstitial thermal therapy, and magnetic resonance imaging-guided focused ultrasound. The search results were screened using pre-established exclusion/inclusion criteria. Evidence tables were constructed using these data, and the recommendations from the 2019 version were left unchanged, updated or, where appropriate, new recommendations were formulated.</p><p><strong>Results: </strong>Of 6403 qualifying abstracts, 162 met the inclusion criteria and were included in the evidence tables. They provided 8 class I recommendations, 3 class II recommendations, and 17 class III recommendations. In three instances, there was insufficient evidence to support a recommendation. The proliferation of qualifying literature since the end of 2015 was greatest regarding the topics related to targeted therapy and immunotherapy of MBTs. Fewer were available for laser interstitial thermal therapy and radiosensitizers, but enough information was available to formulate recommendations on these two topics. For interstitial modalities and magnetic resonance imaging-guided focused ultrasound, insufficient qualifying data were identified to create recommendations.</p><p><strong>Conclusion: </strong>This systematic review provides evidence-based recommendations for adult patients with MBTs regarding the use of therapies beyond standard surgical, radiation, and cytotoxic chemotherapy.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649813","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: A Reflection on Nursing in Neurosurgery.","authors":"Afnan Hassab E Siddig","doi":"10.1227/neu.0000000000003409","DOIUrl":"https://doi.org/10.1227/neu.0000000000003409","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648178","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":"Microsurgical Resection Versus Stereotactic Radiosurgery for Trigeminal Schwannoma: A Meta-Analysis of 949 Patient Treatment Outcomes.","authors":"Hana Hallak, Ramin A Morshed, Alex Pais, Ashley R Metzler, Jason P Sheehan, Varun R Kshettry, Jamie J Van Gompel, Michael J Link, Maria Peris-Celda","doi":"10.1227/neu.0000000000003391","DOIUrl":"https://doi.org/10.1227/neu.0000000000003391","url":null,"abstract":"<p><strong>Background and objectives: </strong>Schwannomas are benign, slow-growing peripheral nerve sheath tumors. Approximately 8% of intracranial schwannomas originate from the trigeminal nerve. No consensus exists regarding superiority of outcomes after resection vs stereotactic radiosurgery (SRS) in the treatment of trigeminal schwannomas (TS). The aim of this study was to compare the efficacy and outcomes of resection vs SRS for TS management.</p><p><strong>Methods: </strong>Embase, PubMed, and SCOPUS databases were queried from the date of inception to July 2023 for primary data reporting TS treatment outcomes after SRS or resection. Risk of bias was reported under Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Overall, 29 retrospective observational studies comprising 949 patients were included in the analysis. A total of 13 studies (n = 589) reported outcomes after SRS, and 16 studies (n = 360) reported outcomes after surgical resection, and 182 patients in the SRS group had previous resection. To ensure statistical validity of comparing the cohorts, 3 checkpoints were assessed: the median age (SRS: 48 vs surgery: 40 years old, P < .01), tumor volume (5.2 vs 8.9 cm3, P = .06), and median follow-up (53.9 vs 48.5 months, P = .59), which reflected the choice of treatment. Compared with surgical resection, the SRS group demonstrated significantly higher rates of facial hypesthesia improvement (44% vs 12%, P < .01) and lower rates of new onset (4% vs 15%, P = .051) at last follow-up. Facial pain was less likely to improve (58% vs 81%, P = .024) after SRS compared with surgery. However, worsened (5% vs 1%, P = .71) and new facial pain (2% vs 1%, P = .55) were comparable between cohorts.</p><p><strong>Conclusion: </strong>SRS seems to offer improvement in rates of hypesthesia and trigeminal motor deficits compared with surgical resection for TS. However, facial pain improvement was more favorable after surgery. These findings highlight the importance of individualized treatment decisions based on patient characteristics, tumor profile, and pretreatment symptoms.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625287","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":"Mobile Stroke Units Address Socioeconomic Disparities in Care.","authors":"Muhammad I Jalal, Jag Lally, Sajal Medha Akkipeddi, Nathaniel Ellens, Jason Burgett, Diana Proper, Jeremy Cushman, Timmy Li, Webster H Pilcher, Adam G Kelly, Curtis G Benesch, Thomas K Mattingly, Tarun Bhalla, Matthew T Bender","doi":"10.1227/neu.0000000000003393","DOIUrl":"https://doi.org/10.1227/neu.0000000000003393","url":null,"abstract":"<p><strong>Background and objectives: </strong>Strokes disproportionately affect underprivileged populations. Mobile stroke units (MSUs) bring diagnostic and treatment tools for stroke directly to patients. This study assessed how MSUs in Rochester, New York, address disparities in stroke care.</p><p><strong>Methods: </strong>This observational study compared demographics and ZIP code socioeconomic status (zSES) of patients transported by our MSUs in Rochester, New York, relative to stroke patients who arrived at our institution by traditional emergency medical service and private means.</p><p><strong>Results: </strong>Between October 2018 and January 2022, 468 stroke patients were transported by our MSU and 2296 stroke patients presented to our institution by traditional emergency medical service or private transport. Patients transported by the MSU had significantly lower overall zSES. Moreover, MSU patients resided in ZIP codes with higher percentages of population below the federal poverty line, single parent households, unemployment, and adult residents without a 12th grade education. In addition, MSU-transported patients were more frequently Black, female, and of Hispanic ethnicity. Age and per capita income did not differ between the two groups, but presenting stroke scale for MSU patients was significantly higher than non-MSU patients. For MSU patients, 86% received onboard computed tomography and 18% received onboard thrombolytic therapy. The median time from dispatch to scene, computed tomography slice, and thrombolytic therapy were 10, 24, and 43 minutes, respectively.</p><p><strong>Conclusion: </strong>MSU help address disparities in stroke care by bringing care to stroke patients who live in ZIP codes that have significantly lower zSES and are of historically underprivileged communities.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605322","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: So the Bone Flap Hit the Floor, Now What? An In Vitro Comparison of Cadaveric Bone Flap Decontamination Procedures.","authors":"Fardad T Afshari","doi":"10.1227/neu.0000000000003397","DOIUrl":"https://doi.org/10.1227/neu.0000000000003397","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557456","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: Neurosurgical Endovascular Credentialing in Europe and the United Kingdom for the \"Complete\" Neurovascular Surgeon: The Time has Come.","authors":"Howard A Riina","doi":"10.1227/neu.0000000000003405","DOIUrl":"https://doi.org/10.1227/neu.0000000000003405","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557365","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 After Gamma Knife Radiosurgery Treatment of Craniopharyngiomas: A Swedish Nationwide Cohort With a Mean Follow-Up of 21 Years.","authors":"Ali Buwaider, Mathan Kananathan, Sara Tabari, Sofia Hylin, Bodo Lippitz, Elfar Úlfarsson, Petter Förander, Michael Gubanski, Tiit Mathiesen, Alexander Fletcher-Sandersjöö, Jiri Bartek","doi":"10.1227/neu.0000000000003394","DOIUrl":"https://doi.org/10.1227/neu.0000000000003394","url":null,"abstract":"<p><strong>Background and objectives: </strong>Craniopharyngiomas are rare intracranial tumors associated with a high recurrence rate. Gamma Knife radiosurgery (GKRS) is a widely used modality to treat these tumors, either as primary or secondary treatment. Long-term control is desired, yet available evidence on the long-term efficacy of GKRS remains unknown because of the limited follow-up periods in existing studies. The aim of this study was to assess long-term outcomes of GKRS-treated craniopharyngiomas in a nationwide consecutive cohort.</p><p><strong>Methods: </strong>All patients with craniopharyngiomas who were treated by GKRS at the Karolinska University Hospital between 1968 and 2010 were included. Progression-free survival (PFS), overall survival (OS), and potential predictors of tumor growth and survival were assessed.</p><p><strong>Results: </strong>A total of 44 patients were included. Follow-up times ranged from 4 to 55 years, with a mean of 21 years and a median of 19 years. PFS was 64% at 5 years, 50% at 10 years, 45% at 20 years, and 40% at 30 years. No growth occurred after 30 years in patients who had been progression free until that point. 69% of recurrences required further treatment. OS was 91% at 5 years, 79% at 10 years, 64% at 20 years, and 64% at 30 years. Tumor volume was an independent predictor of tumor growth (OR 1.69, P = .020), and age (OR 1.07, P = .018) and tumor volume (OR 1.21, P = .049) were independent predictors of survival.</p><p><strong>Conclusion: </strong>GKRS demonstrates sustained long-term efficacy in treating craniopharyngiomas, with a PFS rate of 40% at 30 years and no tumor growth observed beyond this point. Initial tumor volume should be assessed when planning GKRS treatment and follow-up of craniopharyngioma patients because it is a significant predictor of both tumor growth and OS.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557473","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}