Neurosurgery最新文献

{"title":"Dynamic Tumor in Situ Fluid Circulating Tumor DNA Postsurgery Effectively Predicts Recurrence and Clinical Benefits for Glioblastomas.","authors":"Jiubing Zhang, Guanzheng Liu, Dayang Wang, Chaojie Bu, Guangming Lv, Ziyue Zhang, Guangzhong Guo, Yushuai Gao, Zhaoyue Yan, Chunxiao Ma, Gang Liu, Ruijiao Zhao, Meiyun Wang, Xingyao Bu","doi":"10.1227/neu.0000000000003384","DOIUrl":"https://doi.org/10.1227/neu.0000000000003384","url":null,"abstract":"<p><strong>Background and objectives: </strong>Glioblastoma (GBM) recurrence after surgery remains a significant clinical challenge because of limited early detection methods and effective molecular markers. This study investigates the potential of dynamic tumor in situ fluid circulating tumor DNA (TISF-ctDNA) as a tool for monitoring molecular residual disease and evaluating treatment efficacy in postsurgical patients with GBM.</p><p><strong>Methods: </strong>In this prospective cohort study, 75 resectable glioma patients were enrolled between October 2019 to June 2023. Primary tumor tissues and postsurgical TISF samples were collected, along with cranial imaging. TISF-ctDNA was identified through targeted next-generation sequencing, with positivity defined by the presence of one or more variants in the TISF matching those of the primary tumors or an increase of ≥10 single-nucleotide variants across consecutive assessments.</p><p><strong>Results: </strong>TISF-ctDNA positivity was identified in 62.2% of patients in the early postsurgical period, indicating a high prevalence of molecular residual disease. Patients with positive TISF-ctDNA showed a significantly higher risk of recurrence (hazard ratio 2.512, 95% CI 1.264-4.993, P = .0054). Conversion to TISF-ctDNA negativity post-treatment was associated with improved overall survival, highlighting its role in evaluating treatment response. Multivariate analysis revealed that TISF-ctDNA positivity was an independent predictor of progression-free survival during adjuvant therapy, with high predictive accuracy (sensitivity 86.2%, specificity 100%). Importantly, TISF-ctDNA positivity preceded imaging signs of recurrence by a median of 71 days. In this study, no significant impact of specific tumor markers in each subcohort (EGFR, TP53, PTEN, NF1) on progression-free survival or overall survival was observed.</p><p><strong>Conclusion: </strong>TISF-ctDNA is a promising biomarker for monitoring GBM recurrence and evaluating clinical benefit. It provides insight into tumor genomic evolution and identifies patients who may benefit from adjuvant chemotherapy. TISF-ctDNA positivity is a robust prognostic indicator for patient outcomes and a marker for molecular recurrence after frontline therapy.</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":"143557376","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: So the Bone Flap Hit the Floor, Now What? An In Vitro Comparison of Cadaveric Bone Flap Decontamination Procedures.","authors":"Alexis Marion, Christian Iorio-Morin","doi":"10.1227/neu.0000000000003398","DOIUrl":"https://doi.org/10.1227/neu.0000000000003398","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":"143557447","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: Neurological Surgery Manpower Training and Density in Islamic Republic of Iran: A Population Study.","authors":"Bizhan Aarabi, Seyed Mahmood Tabatabaei, Majid Reza Farrokhi, Hosseinali Khalili, Farideh Nejat, Fariborz Samini, Noori Akhtar-Danesh","doi":"10.1227/neu.0000000000003403","DOIUrl":"https://doi.org/10.1227/neu.0000000000003403","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542663","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: Long-Term Outcomes of Jugular Paragangliomas Undergoing Gamma Knife Radiosurgery: A Single Center Experience.","authors":"Nasser M F El-Ghandour","doi":"10.1227/neu.0000000000003399","DOIUrl":"https://doi.org/10.1227/neu.0000000000003399","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542660","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: Medical Therapy Alone for Ommaya Reservoir-Associated Bacterial Meningitis: When It Works and When It Fails.","authors":"Nasser M F El-Ghandour","doi":"10.1227/neu.0000000000003404","DOIUrl":"https://doi.org/10.1227/neu.0000000000003404","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542661","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: Neurological Surgery Manpower Training and Density in Islamic Republic of Iran: A Population Study.","authors":"Zahra Ramezani, Vafa Rahimi-Movaghar","doi":"10.1227/neu.0000000000003402","DOIUrl":"https://doi.org/10.1227/neu.0000000000003402","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542772","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: Dear Program Director: An Evaluation of Implicit Bias in Letters of Recommendation for Neurosurgery Residency.","authors":"Anne Coyle, Erin Graves, Theodore Hannah, Valeda Yong, Kaleb Rostmeyer, Cherie P Erkmen, Kadir Erkmen","doi":"10.1227/neu.0000000000003396","DOIUrl":"https://doi.org/10.1227/neu.0000000000003396","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542662","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":"A Novel Surgical Technique for Post-traumatic Syringomyelia Progressing to the Medulla Oblongata: Evidence of Upward Drainage of Central Canal Fluid Within the Spinal Cord.","authors":"Chenghua Yuan, Zhencheng Xiong, Houyuan Lv, Chenyuan Ding, Pingchuan Xia, Huixin Xue, Hui Zhan, Mingchu Li, Yueqi Du, Can Zhang, Zhenlei Liu, Kai Wang, Wanru Duan, Zuowei Wang, Xingwen Wang, Hao Wu, Zan Chen, Fengzeng Jian, Jian Guan","doi":"10.1227/neu.0000000000003378","DOIUrl":"10.1227/neu.0000000000003378","url":null,"abstract":"<p><strong>Background and objectives: </strong>The exact pathways of fluid outflow within the central canal (CC) of the spinal cord are not completely understood. The best management approach for patients with post-traumatic syringomyelia that progresses to the cranial end of the CC, also known as post-traumatic syringobulbia (PT-syringobulbia), is still a topic of debate. This study aims to introduce a new surgical indication for the foramen magnum and foramen of Magendie dredging (FMMD) procedure in patients with PT-syringobulbia and prospectively assess its surgical outcomes.</p><p><strong>Methods: </strong>The study included 15 consecutive patients with symptomatic PT-syringobulbia who underwent the FMMD procedure and 20 patients who underwent traditional arachnolysis. The surgical procedure included decompression of the foramen magnum, removal of all potential intradural factors, and clearance of any possible obstructions at the foramen magnum and the foramen of Magendie. The major presenting symptoms or signs were assessed in terms of symptom improvement, stabilization, or deterioration. Preoperative MRI and postoperative MRI were used to assess syringobulbia resolution. The mean follow-up period was 24 months (range 12-60 months).</p><p><strong>Results: </strong>Twelve patients showed clinical improvement, and 3 were stable. The mean length of the syrinx observed on preoperative MRI was 17.3 spinal levels, and the mean syringobulbia/medulla oblongata index was 69%. The mean syringobulbia/medulla oblongata index observed on postoperative MRI was 29%. The values were significantly lower than the preoperative values ( P < .01). Statistical analysis revealed no significant differences in age, sex, or initial clinical/radiological presentation between the FMMD and arachnolysis groups ( P > .05). However, the FMMD group showed superior outcomes compared with the arachnolysis group, including better clinical improvement, syringomyelia regression, lower complication rates, and reduced revision surgery rates ( P < .01).</p><p><strong>Conclusion: </strong>FMMD emerges as a potentially safe and effective surgical strategy for post-traumatic syringobulbia by restoring physiological fluid outflow through the cranial end of CC in midterm follow-up.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542659","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":"Outcomes After Decompression Only Versus Decompression and Fusion for Lumbar Facet Cysts: A Systematic Review and Meta-Analysis.","authors":"Stavros Matsoukas, Divaldo Camara, Arianne Boylan, Patrick C Reid, Konstantinos Margetis","doi":"10.1227/neu.0000000000003385","DOIUrl":"https://doi.org/10.1227/neu.0000000000003385","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lumbar facet cysts (LFCs) are considered the result of facet degeneration and segmental instability. Their surgical management has been controversial. Decompression only (DO) is less invasive, but it does not address the underlying degeneration/spondylolisthesis. Decompression and fusion (DF) is more invasive with higher perioperative morbidity. Comparative studies are scant in current literature. The objective of this study was to identify all such studies and synthesize outcomes including recurrence and reoperation rates. Secondary outcomes included back pain resolution, radiculopathy resolution, and length of stay.</p><p><strong>Methods: </strong>In this PROSPERO-registered Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review, the MEDLINE, Embase, and Cochrane databases were searched to identify comparative studies of DO vs DF patients with LFCs. A meta-analysis with random effects model was performed, and heterogeneity was assessed with the I2 statistic. Visual representation of results was performed with forest plots.</p><p><strong>Results: </strong>Nine comparative studies encompassing 3393 patients (DO: 1940, DF: 1453) were included. Spondylolisthesis rates were statistically significantly lower in the DO group (DO 24.3%; DF 65.8%; OR 0.04; CI 0.01-0.31; P < .01). The DO group had statistically significantly higher odds of cyst recurrence (DO 6.3%; DF 0%; OR 5.74; CI 1.51-21.72; P = .01) and lower odds of back pain resolution at follow-up (DO 56.6%; DF 74.5%; OR 0.43; CI 0.2-0.91; P = .03) compared with the DF group. Reoperation rates (DO 7.2%; DF 5.9%; OR 1.37; CI 0.72-2.6; P = .3) and odds for resolution of radiculopathy (DO 77.3%; DF 87.2%; OR 0.6; CI 0.3-1.21; P = .2) were comparable between the 2 groups. Length of stay was statistically significantly shorter in the DO group (mean difference -1.5; CI -2.38 to -0.63; P < .001).</p><p><strong>Conclusion: </strong>Decompression with concomitant fusion was associated with lower odds of cyst recurrence and higher odds of back pain resolution but slightly longer hospital stay. Reoperation rates and radiculopathy resolution were comparable between the two groups.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542777","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: Dear Program Director: An Evaluation of Implicit Bias in Letters of Recommendation for Neurosurgery Residency.","authors":"Anthony V Nguyen, Sarah-Marie C Gonzalez, Jose M Soto, Awais Z Vance","doi":"10.1227/neu.0000000000003395","DOIUrl":"https://doi.org/10.1227/neu.0000000000003395","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542754","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}