Neurosurgery最新文献

{"title":"The Role of Minimally Invasive Surgery in Spinal Trauma: A Review of Techniques, Outcomes, and Limitations.","authors":"Mounica R Paturu, Joshua Woo, Brett Rocos, Peter Passias, Michael Haglund, Douglas Orndorff, C Rory Goodwin, Kristen Jones, Khoi D Than","doi":"10.1227/neu.0000000000003342","DOIUrl":"https://doi.org/10.1227/neu.0000000000003342","url":null,"abstract":"<p><p>Minimally invasive surgery (MIS) has significantly revolutionized spine surgery by reducing morbidity, minimizing tissue damage, and improving postoperative outcomes compared with traditional open surgeries. Although MIS is well-documented for degenerative spine diseases, its full scope and limitations in spine trauma remains underexplored. Thus, this review aims to address this gap by examining relevant literature on the evolution, current practices, and future directions of MIS applications in spinal trauma care. We conducted a PubMed search with keywords including \"MIS,\" \"percutaneous pedicle screw,\" \"lateral corpectomy,\" \"anterior thoracoscopic surgery,\" and \"transpsoas/direct lateral approach,\" both individually and in combination with \"thoracolumbar trauma,\" \"cervical trauma,\" and \"spine trauma.\" After screening abstracts and full-text manuscript review, articles meeting inclusion/exclusion criteria were reviewed including prospective and retrospective case-control studies, case reports, and reviews. Exclusionary criteria included studies not involving traumatic injuries of the thoracolumbar or cervical spine, lack of clinical follow-up, and studies in foreign languages. Based on a literature review of 85 studies, the following manuscript focuses on the indications, complications, current literature, clinical outcomes, future directions, and limitations of MIS in managing thoracolumbar and cervical spine injuries with particular emphasis on percutaneous pedicle screw fixation, lateral thoracic and lumbar corpectomies, anterior thoracoscopic/endoscopic approaches, and treatment algorithms. Although MIS for spinal trauma offers numerous advantages, continuous research and data collection are crucial to developing clear treatment algorithms and improving clinical outcomes. However, the future of MIS in spine trauma care remains promising, with advancements in technology and surgical techniques anticipated to enhance safety, efficacy, and patient satisfaction.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"96 3S","pages":"S129-S138"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414756","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":"Evaluating Linear Heuristics for Ventricular Volume in Healthy Adults Using a Fully Automated Algorithm: Implications for Defining the Normal.","authors":"Birra R Taha","doi":"10.1227/neu.0000000000003132","DOIUrl":"10.1227/neu.0000000000003132","url":null,"abstract":"<p><strong>Background and objectives: </strong>Linear metrics for ventricular volume play a large role in the rapid, approximate evaluation of ventricular volume. In this article, we automatically extract linear measures of ventricular volume to explore their correlation with lateral ventricular volume (LVV) in the healthy adult population and comprehensively define normal values.</p><p><strong>Methods: </strong>We automatically extract Evans' ratio (ER), Frontal-Occipital Horn Ratio (FOHR), and anteroposterior lateral ventricle index (ALVI) from an open MRI data set of healthy adults ( https://brain-development.org/ixi-dataset/ ). Indices have been correlated with corresponding LVVs and lateral ventricular volumes divided by supratentorial brain volumes. Spearman rank correlation was used to compare strength of correlation.</p><p><strong>Results: </strong>ER shows correlation with lateral ventricle volume based on sex (r = 0.58; men, r = 0.65; women P < .001), including when controlling for supratentorial volume (r = 0.57; men, r = 0.63). ER did not profoundly correlate with age (r = 0.29, men; r = 0.35, women; P < .001) and seemed normally distributed around 0.25. ALVI showed strong correlation with LVV with only slight gender differences (r = 0.83, men; r = 0.84, women) and LVV to supratentorial cortical volume ratio (r = 0.9, men; r = 0.86, women). FOHR was also normally distributed around a value of 0.37 and showed moderate correlation with LVV (r = 0.68, men; r = 0.73, women) and LVV to supratentorial cortical volume ratio (r = 0.69, men; r = 0.74, women).</p><p><strong>Conclusion: </strong>ALVI is a newer index with strong correlation with LVV and has strong potential for clinical use. Both FOHR and ER show moderate correlation with LVV. Reference values for linear estimates of ventricular volume may help clinicians better identify patients with pathological ventriculomegaly.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"693-699"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902435","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: Predictors of Durable Remission After Successful Surgery for Cushing Disease: Results From the Multicenter RAPID Registry.","authors":"Matthew C Findlay, Michael Karsy","doi":"10.1227/neu.0000000000003318","DOIUrl":"10.1227/neu.0000000000003318","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e78"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952131","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":"Role of Minimally Invasive Spine Surgery in Spine Oncology.","authors":"W Christopher Newman, Mark H Bilsky, Ori Barzilai","doi":"10.1227/neu.0000000000003340","DOIUrl":"https://doi.org/10.1227/neu.0000000000003340","url":null,"abstract":"<p><p>The application of minimally invasive spine surgery (MISS) in degenerative spine disease and deformity has seen rapid growth in the past 20 years. Building on this experience, such methods have been adopted into spine oncology in the past decade, particularly for metastatic disease. The impetus for this growth stems from the benefits of surgical decompression combined with radiation treatment in patients with metastatic disease in conjunction with the need for less morbid interventions in a patient population with limited life expectancy. The result of these two realizations was the application of minimally invasive techniques for the treatment of spine tumors including re-establishment of spinal stability, decompression of the spinal cord or nerve roots, and restoration of spinal alignment. Technological advancement and improvement in biomaterials have allowed for durable stabilization with short constructs even for patients with poor bone quality. The implementation of navigation and robotic capabilities has transformed MISS by streamlining surgery and further reducing the surgical footprint while laser ablation, endoscopy, and robotic surgery hold the potential to minimize the surgical footprint even further. MISS for intradural tumors is commonly performed, while the role for other primary tumors has yet to be defined. In this article, we describe the evolution of and indications for MISS in spine oncology through a retrospective literature review.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"96 3S","pages":"S119-S128"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414516","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":"Single-Position Prone Transpsoas Lateral Interbody Fusion at L4-L5: Technical Pearls.","authors":"Winward Choy, Ximena Serur, Juan P Giraldo, Juan S Uribe","doi":"10.1227/neu.0000000000003338","DOIUrl":"https://doi.org/10.1227/neu.0000000000003338","url":null,"abstract":"<p><p>Single-position prone transpsoas (PTP) lateral interbody fusion has been proposed as an alternative to lateral lumbar interbody fusion performed in the lateral decubitus position. The advantages to this single-position technique include facilitating segmental lordosis, obviating the need for repositioning for posterior instrumentation, and providing access for posterior decompression. Although PTP lateral interbody fusion can be a powerful and efficient technique, adopting and navigating this approach is challenging. A learning curve should be expected, even for surgeons who are experienced with traditional lateral lumbar interbody fusion. This review provides a detailed technical description of the PTP technique at L4-L5. In addition, we provide technical pearls aimed at improving surgical ergonomics, workflow, and safety.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"96 3S","pages":"S3-S8"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414723","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":"First Reported Series of Cerebral Angiography Performed at an Outpatient Center: Safety and Satisfaction Results.","authors":"Tyler A Scullen, Ming X Lian, Vinay Jaikumar, Jennifer L Gay, Pui Man Rosalind Lai, Matthew J McPheeters, Steven B Housley, Kunal P Raygor, Mehdi Bouslama, Hamid S Khan, Adnan H Siddiqui, Jason M Davies, Douglas B Moreland, Elad I Levy","doi":"10.1227/neu.0000000000003119","DOIUrl":"10.1227/neu.0000000000003119","url":null,"abstract":"<p><strong>Background and objective: </strong>Ambulatory surgery centers (ASCs) are increasingly common venues for same-day neurosurgical procedures, allowing for cost-effective, high-quality patient care. We present the first and largest series of patients undergoing diagnostic cerebral angiography at an ASC to demonstrate the effectiveness, safety, and efficiency of outpatient endovascular care.</p><p><strong>Methods: </strong>We retrospectively reviewed data for consecutive patients who underwent diagnostic cerebral angiography at our ASC between January 1, 2024, and May 29, 2024. Data collected included vascular access approach, procedural duration, turnover time, and periprocedural complications. Using a standardized 2-week postprocedural survey, patients were asked to provide comments and rate their subjective satisfaction from a 1 to 5 scale, with \"5\" being completely satisfied. All cases were performed with a physician team comprising 1 attending neuroendovascular neurosurgery and 1 neuroendovascular fellow present. Fentanyl and midazolam were administered for conscious sedation in all cases.</p><p><strong>Results: </strong>Among the 67 patients included in this series, the mean procedural duration was 29.4 ± 8.6 minutes. The mean turnover time was 13.7 ± 3.6 minutes. Between transradial (46 of 67 [68.7%]) and transfemoral (21 of 67 [31.3%]) access site approaches, there were no statistically significant differences in mean procedural duration (29.4 ± 8.0 vs 29.2 ± 9.9 minutes, respectively; P = .72) or turnover time (14.0 ± 3.9 vs 12.9 ± 2.8 minutes, respectively; P = .4). No complications occurred periprocedurally or within the 2-week follow-up period. A total of 48 (71.6%) of 67 patients responded to the postprocedural survey, all of whom unanimously reported a score of \"5.\"</p><p><strong>Conclusion: </strong>We found that diagnostic cerebral angiography performed at our ASC was safe and effective for patient care. In addition, all survey respondents (71.6% of those provided the survey) reported highest levels of satisfaction. The integration of neuroendovascular procedures into ASCs potentially offers a cost-effective and highly efficient option in an evolving economic landscape.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"539-544"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748705","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":"Extended Length of Stay After Mechanical Thrombectomy for Stroke: A Single-Center Analysis of 703 Patients.","authors":"Joanna M Roy, Shyam Majmundar, Shray Patel, Antony Fuleihan, Basel Musmar, Kareem El Naamani, Stavropoula I Tjoumakaris, M Reid Gooch, Robert H Rosenwasser, Pascal M Jabbour","doi":"10.1227/neu.0000000000003128","DOIUrl":"10.1227/neu.0000000000003128","url":null,"abstract":"<p><strong>Background and objectives: </strong>Mechanical thrombectomy (MT) is crucial for improving functional outcomes for acute ischemic stroke. Length of stay (LOS) is a reimbursement metric implemented to incentivize value-based care. Our study aims to identify predictors of LOS in patients undergoing MT at a high-volume center in the United States.</p><p><strong>Methods: </strong>This was a retrospective study of patients who underwent MT at a single institution from 2017 to 2023. Patients who experienced mortality during their course of hospital stay were excluded from this study. Extended LOS (eLOS) was defined as the upper quartile (≥75th) of the median duration of hospital stay. Univariate and multivariate analyses were performed, with P values < .05 denoting statistical significance.</p><p><strong>Results: </strong>Seven hundred three patients met criteria for inclusion. The median age of the cohort was 72 years (IQR: 61-82), and 57.2% was female. The median LOS was 6, IQR: 4-10. A total of 28.9% of the cohort (n = 203) patients experienced eLOS. The multivariate regression model identified age (odds ratio [OR]: 0.98, 95% CI: 0.97-0.99), diabetes mellitus (OR: 1.68, 95% CI: 1.15-2.44), and hemorrhagic transformation of stroke (OR: 2.89, 95% CI: 0.39-0.90) as predictors of eLOS, whereas antiplatelet use before admission (OR: 0.55, 95% CI: 0.34-0.89) and higher baseline modified Rankin Scale before stroke were associated with lower odds (OR: 0.59 [0.39-0.90]; P < .05) of eLOS.</p><p><strong>Conclusion: </strong>By identifying predictors of eLOS, we provide a foundation for targeted interventions aimed at optimizing post-thrombectomy care pathways and improving patient outcomes. The implications of our study extend beyond clinical practice, offering insights into healthcare resource utilization, reimbursement strategies, and value-based care initiatives.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"585-592"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748704","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 Management for Intraprocedural Rupture During Endovascular Treatment for Intracranial Aneurysms.","authors":"Sakyo Hirai, Ryoichi Hanazawa, Masataka Yoshimura, Keigo Shigeta, Yohei Sato, Naoki Taira, Yoshihisa Kawano, Jun Karakama, Yoshiki Obata, Mutsuya Hara, Kenji Yamada, Yosuke Ishii, Kana Sawada, Shogo Imae, Hikaru Wakabayashi, Hirotaka Sagawa, Kyohei Fujita, Shoko Fujii, Satoru Takahashi, Akihiro Hirakawa, Shigeru Nemoto, Kazutaka Sumita","doi":"10.1227/neu.0000000000003126","DOIUrl":"10.1227/neu.0000000000003126","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although intraprocedural rupture (IPR) is rare, it is a devastating complication of endovascular treatment (EVT) for intracranial aneurysms. Very few studies have been conducted on IPR, and the safety and efficacy of management techniques of IPR have not been investigated.</p><p><strong>Methods: </strong>Patients who experienced IPR during EVT between 2013 and 2022 were enrolled from a multicenter observational registry. We examined the safety and efficacy of the management of IPR using imaging markers, including increased hemorrhage and ischemic lesions, which were evaluated using postoperative computed tomography and diffusion-weighted imaging, respectively.</p><p><strong>Results: </strong>Of the 3269 EVTs for intracranial aneurysms, 74 patients who experienced IPR (2.26%) were analyzed. Fifty-five patients (3.36%) experienced IPR among 1636 EVT cases for ruptured aneurysms. Multivariate analysis revealed that increased hemorrhage was significantly associated with poor outcomes (odds ratio [OR], 6.37 [95% CI, 1.00-40.51], P = .050), whereas ischemic lesions were not. Regarding management techniques of IPR, antihypertensive medication use was significantly associated with increased hemorrhage (OR, 14.16 [95% CI, 2.35-85.34], P = .004). Heparin reversal was an independent factor for ischemic lesions (OR, 8.92 [95% CI, 1.54-51.58], P = .014).</p><p><strong>Conclusion: </strong>Although the setting of IPR may be miscellaneous, and optimal management varies depending on individual cases, heparin reversal might be associated with ischemic complications, and its role in the successful hemostasis in IPR during EVT for ruptured aneurysms remains unclear.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"568-576"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860448","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":"Scoring System Assessing Risks of Growth in Sporadic Vestibular Schwannoma.","authors":"Daniela Stastna, Robert Macfarlane, Patrick Axon, Richard Mannion, Neil Donnelly, James R Tysome, Rajeev Mathews, Mathew Guilfoyle, Daniele Borsetto, Ronie Jayapalan, Indu Lawes, Juliette Buttimore, Manohar Bance","doi":"10.1227/neu.0000000000003170","DOIUrl":"10.1227/neu.0000000000003170","url":null,"abstract":"<p><strong>Background and objectives: </strong>Surveillance studies offer sparse knowledge of predictors of future growth in sporadic vestibular schwannomas (VS).Our aim was identification of these risk factors. We propose a scoring system to estimate the risk of growth in sporadic vestibular schwannoma.</p><p><strong>Methods: </strong>This retrospective study is based on the demographic and radiological data of 615 adult patients under the surveillance for single VS in our center. Univariate analysis, multivariate regression, and Kaplan-Meier analysis were used when appropriate. The regression coefficient-based \"VS score\" was calculated based on Cox proportional-hazards regression.</p><p><strong>Results: </strong>During surveillance, 285 tumors (46%) remained stable, 314 tumors (51%) grew, and 16 tumors (3%) shrank. The significant risks factors for future growth identified both in univariate and multivariate analyses were younger age at onset, cystic morphology, larger tumor volume, and cisternal location (as per Hannover grade). The proportion of growing tumors was 40%, 75%, and 96% among the homogeneous VS, primary cystic, and VS transformed to cystic, respectively. Moreover, tumor growth during the 1st year was significant predictor of continuous growth. Our \"VS score\" includes variables such as age, sex, morphology, and Hannover grade. The score extends between -3 and 6 points. Kaplan-Meier, confusion matrix, and receiver operating characteristic analysis proved high accuracy of our scoring model.</p><p><strong>Conclusion: </strong>Our retrospective study revealed that younger age, cystic morphology, cisternal extent, larger volume, and growth during 1st year were strong predictors of future growth. Moreover, we propose a scoring system that accurately estimates the risks of future tumor growth.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"681-692"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546564","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: Predictors of Durable Remission After Successful Surgery for Cushing Disease: Results From the Multicenter RAPID Registry.","authors":"Rob Dickerman, Ezek Mathew, Mckinley Dews, Sterling Ortega","doi":"10.1227/neu.0000000000003317","DOIUrl":"10.1227/neu.0000000000003317","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e77"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952113","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}