World neurosurgery最新文献

{"title":"Trigeminal microvascular decompression for medically refractory Short-lasting Unilateral Neuralgiform Headache Attacks: a single-centre retrospective analysis.","authors":"Sinan Barazi, Ho Lim Pak, Eleni Maratos, Steve Connor, Giorgio Lambru","doi":"10.1016/j.wneu.2025.124432","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124432","url":null,"abstract":"<p><strong>Objective: </strong>This analysis aims to evaluate the sustained effectiveness of trigeminal microvascular decompression (MVD) in patients with medically refractory Short-lasting Unilateral Neuralgiform Headache Attacks (SUNHA) who demonstrate trigeminal neurovascular conflict (NVC) ipsilateral to the painful side.</p><p><strong>Methods: </strong>This is a retrospective single-centre analysis of prospectively collected data conducted between September 2012 and March 2025 to investigate the efficacy and safety of trigeminal MVD in consecutive refractory chronic SUNHA patients suitable for surgery. All patients underwent a magnetic resonance imaging (MRI) with specific trigeminal sequences before surgery. The 5-point Barrow Neurological Institute (BNI) pain intensity score was used to quantify the response to surgery. Patients with a BNI of 1-2 at the final post-surgery follow-up were considered responders.</p><p><strong>Results: </strong>The study group consisted of 19 SUNHA patients (n=7 female), with a mean age of 58 (±12, range 35-81), refractory to medical therapy (BNI score=5), who underwent trigeminal MVD. Of the 18 patients included in the analysis, trigeminal NVC with morphological changes was found in 13 patients (72.2%). Post-operatively, 16 patients (89.0%) were responders. Two patients had a BNI score=3, reflecting a partial improvement (11.1%). The mean post-surgery follow-up was 54.3 months (±36.7, range 2-163 months). At the final follow-up, 13 patients remained responders (72.2%). One patient reported transient post-operative dizziness and one patient reported pain in the incision site.</p><p><strong>Conclusion: </strong>Trigeminal MVD may be a safe and effective treatment modality for those patients with medically refractory SUNHA with MRI evidence of trigeminal NVC with morphological changes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124432"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply to the Letter to the Editor Regarding \"Drainage versus Non-Drainage for Thoracolumbar Spine Surgery: An Evidence Synthesis\".","authors":"Shichao Liu, Jingyu Zhou","doi":"10.1016/j.wneu.2025.124429","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124429","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124429"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small Ruptured Anterior Communicating Artery Aneurysms in the Endovascular Right-of-First-Refusal Era: Intraprocedural Rupture Risk and Retreatment at Follow-up.","authors":"Li Ma, Samer S Hoz, Prateek Agarwal, Rachel C Jacobs, Alhamza R Al-Bayati, Raul G Nogueira, Georgios A Zenonos, Paul A Gardner, Robert M Friedlander, Michael J Lang, Bradley A Gross","doi":"10.1016/j.wneu.2025.124430","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124430","url":null,"abstract":"<p><strong>Background: </strong>Ruptured small anterior communicating artery (ACoA) aneurysms can pose a technical challenge for endovascular therapy. We sought to explore treatment and follow-up results in the modern endovascular right of first refusal era.</p><p><strong>Methods: </strong>Smaller (≤ 7mm) ruptured aneurysms of the ACoA undergoing treatment were compared with non-ACoA counterparts, and further dichotomized by size (≤3mm and 3-7mm). Immediate- and 2-year angiographic results, procedural complications, retreatment, and functional results at follow-up were stratified by treatment modalities and compared between aneurysm location and size groups.</p><p><strong>Results: </strong>Of 449 consecutive small ruptured aneurysms, 35% (n=155) were ACoA. Endovascular treatment was the first-line option in 68%. While the immediate aneurysm occlusion was more favorable in the ACoA group compared to other aneurysms treated endovascularly (Raymond-Roy I-II, 89% vs. 74%, P= .003), the residual and/or recanalization requiring retreatment rate at 2 years was higher (27% vs. 17%, P= .04). ACoA aneurysms were associated with a 2-fold higher risk of retreatment (OR 2.08, P= .02) in multivariate analyses of the endovascular cohort. The incidence of intraprocedural rupture was numerically higher for coiled ≤3mm ACoA aneurysms (12.5% vs. 2.2%, P= .11), corresponding to a higher major complication rate (12.5% vs. 1.1%, P= .06) in this subgroup. Endovascularly treated ≤3mm ACoA aneurysms were associated with a 4-fold higher risk of recanalization (OR 4.4, P= .01) and retreatment (OR 3.8, P= .03).</p><p><strong>Conclusion: </strong>While the immediate efficacy is satisfactory for endovascularly-treated small ruptured ACoA aneurysms, there are increasing needs for retreatment and non-negligible risks for coiling ACoA aneurysms ≤3mm.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124430"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occipital Monitoring of PSI During Frontal Tumor Resection: A Feasibility Study.","authors":"Ya-Xian Huang, Wei Xiao, Chun-Xiu Wang, Tian-Long Wang","doi":"10.1016/j.wneu.2025.124425","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124425","url":null,"abstract":"<p><strong>Background: </strong>Frontal patient state index (PSI) monitoring is impractical during frontal lobe tumor resection due to surgical field interference. No validated alternative monitoring positions exist currently. This study evaluated the agreement between standard frontal and experimental occipital PSI monitoring.</p><p><strong>Methods: </strong>A SEDline sedation monitor was used to record frontal and occipital PSI values in 16 patients who underwent frontal lobe tumor resection. PSI data was collected at 2-s intervals starting from sensor attachment to headframe fixation. Agreement was assessed using the Bland-Altman analysis and intraclass correlation coefficient (ICC). Subgroup analyses evaluated the impact of American Society of Anesthesiologists (ASA) classification (I/II/III) and tumor laterality. A Passing-Bablok regression established predictive equations between frontal and occipital PSI at seven critical time points.</p><p><strong>Results: </strong>Frontal and occipital PSI trends showed high temporal synchrony (P = 0.08) with a strong positive correlation (R² = 0.805, P < 0.001). Bland-Altman analysis demonstrated excellent agreement (mean log-transformed difference: -0.02; 95% LoA: -0.82 to 0.80). The ICC of all data was 0.82 (95% CI: 0.816-0.830, P < 0.001). Neither ASA classification (P = 0.368) nor tumor laterality (P = 0.382) significantly affected frontal-occipital PSI differences. A Passing-Bablok regression equation was derived to predict frontal PSI from occipital measurements:ePSI=0.37×(zPSI)^1.28.</p><p><strong>Conclusions: </strong>Occipital PSI demonstrates excellent agreement with frontal PSI during frontal tumor resection, offering a viable alternative to obstructed frontal monitoring.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124425"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expandable Cage in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparative Data with Static Cage from Single Institution, Single Surgeon.","authors":"Dongkyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Jeong Yoon Park","doi":"10.1016/j.wneu.2025.124428","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124428","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is widely adopted for the treatment of lumbar degenerative disease. Expandable cages are now increasingly used in MIS-TLIF to facilitate disc height restoration in narrow spaces. Despite theoretical advantages, the clinical and radiologic outcomes of expandable cage compared to static cage remain controversial.</p><p><strong>Methods: </strong>This retrospective study analyzed 151 patients who underwent single-level lumbar MIS-TLIF performed by a single surgeon at a single institution, with more than 1-year follow-up. Static cages were exclusively used from May 2022 to March 2023 (n=76), and expandable cages from April 2023 to March 2024 (n=75). The primary outcomes were radiological disc height and lordotic angles.</p><p><strong>Results: </strong>The expandable cage group demonstrated significantly greater postoperative disc height restoration compared to the static cage group at both immediate postoperative periods (10.3 ± 1.2 mm vs. 9.5 ± 1.5 mm, p = 0.003), and at 1-year follow-ups (9.6 ± 1.4 mm vs. 9.0 ± 1.6 mm, p = 0.028). There were no significant differences between the groups in lordotic angles, fusion rates and clinical outcomes. Various complications were also comparable, other than the incidence of cage subsidence >3 mm, which was higher in the expandable cage group (14.7% vs. 3.9%, p = 0.047) CONCLUSION: Expandable cages in MIS-TLIF demonstrated superior disc height restoration compared to static cages, which were maintained throughout a 1-year follow-up period, despite the relatively higher subsidence rate. No significant differences were observed in terms of lordotic angle restoration, clinical outcomes, or fusion rates.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124428"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Computed Tomography-Based Classification of Spondylolisthesis due to Pars Defect and Comparison with Meyerding Classification","authors":"Burhan Oral Güdü ,&nbsp;Belgin Karan","doi":"10.1016/j.wneu.2025.124335","DOIUrl":"10.1016/j.wneu.2025.124335","url":null,"abstract":"<div><h3>Objective</h3><div>We propose a new classification of spondylolisthesis based on the anterior displacement of the defective pars neck relative to the inferior articular process line on parasagittal computed tomography images. We aimed to compare this classification with Meyerding grades (MGs), assess its reliability and applicability, and evaluate its clinical implications.</div></div><div><h3>Methods</h3><div>A total of 205 lumbar computed tomography images of patients with pars defects and degenerative disc disease were included in the study. According to the algorithm, the pars listhesis grade (PLG) was determined as PLG 0 if the defective pars neck was behind the inferior articular process line, PLG 1 (mild) if it was within the line, PLG 2 (moderate) if it was entirely in front of the line, and PLG 3 (severe) if it was displaced in front of the line with the superior articular process. The rates of bilateral PLG and MG and demographic data were analyzed. Clinical data from 40 patients (10 per PLG grade) were analyzed.</div></div><div><h3>Results</h3><div>There was a moderate positive correlation between the PLG and MG (r = 0.46) and a strong positive correlation between right and left PLG grades (r = 0.82). Intra- and interobserver reliability showed almost perfect agreement (0.84–0.97). Clinical scores, the visual analog scale, the Oswestry Disability Index, and the SF-36 showed significant differences among PLG levels, with increased disability and decreased physical health observed with higher PLG levels.</div></div><div><h3>Conclusions</h3><div>PLG classification can be used as a new grading system for spondylolisthesis, especially with low Meyerding grades.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"201 ","pages":"Article 124335"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pioneering a Civilian-Military Neurosurgery Partnership Through the Department of Defense SkillBridge Program","authors":"Maria Cielito L. Robles ,&nbsp;Ryan P. Brennan ,&nbsp;Gavin P. Dunn","doi":"10.1016/j.wneu.2025.124313","DOIUrl":"10.1016/j.wneu.2025.124313","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"201 ","pages":"Article 124313"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prompt Engineering and Follow-Up Questioning Improves the Readability of Spine Surgery Questions in Large Language Models.","authors":"Sohail Daulat, Nikhil Dholaria, Gregory Burnet, Shaunak Patil, Bhavesh Manne, Aditi Choudhary, Rida Mitha, Qazi Zeeshan, D Kojo Hamilton, Nitin Agarwal","doi":"10.1016/j.wneu.2025.124423","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124423","url":null,"abstract":"<p><strong>Introduction: </strong>The field of spine surgery is complex, and patient education material within the field are often written at a reading level that exceeds the recommended standard. Large language models (LLMs), such as ChatGPT, have shown potential for generating educational content, but require further investigation regarding readability and adaptability in responding to follow-up questions. The purpose of this study is to evaluate which model and prompting strategies improve the readability the most, especially in newer models.</p><p><strong>Methods: </strong>ChatGPT-4o and 5 were prompted with 45 standardized spine surgery questions across five common procedures. Each question underwent five prompting phases: baseline (Phase 1), follow-up clarification (Phase 1.5), sixth-grade level request (Phase 2), rule-based prompting (Phase 3), and direct readability targeting (Phase 4). Readability was measured using SMOG, FRE, FKGL, GFI, and CLI scoring. Results were standardized and analyzed using paired tests, ANOVA, and interaction models. A resource for spine surgeons with the most readable answers was created.</p><p><strong>Results: </strong>ChatGPT-4o generated significantly more readable responses than ChatGPT-5 across all phases except Phase 1 (p<0.001). However, ChatGPT-5 produced more reliable citations (p<0.05). Phase 2 yielded the most readable responses, with 51.11% meeting the sixth-grade level. Follow-up clarification questions and simplified prompt engineering were more effective than complex rule-based prompts.</p><p><strong>Conclusion: </strong>Prompt engineering and follow-up questioning significantly enhanced the readability of LLM-generated responses to spine surgery questions at a level appropriate for patients. Further investigation needs to assess whether these responses are more readable in real-world clinical settings instead of relying on objective readability scoring methods.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124423"},"PeriodicalIF":2.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply to the Letter to the Editor Regarding \"BOOTStrap-SCI: Beyond One Option of Treatment for Spinal Trauma and Spinal Cord Injury: Consensus-Based Stratified Protocols for Intensive Care and Surgical Management\".","authors":"Nicolò Marchesini, Riya Mandar Dange, Andreas K Demetriades, Andrès M Rubiano, Amos Olufemi Adeleye, Oscal Luis Alves, Laura Antón Baeza, Ernest Barthélemy, Peña Rafael-Lanao Carlos, José Luiz Castillo, Nadya Aragón Castillo, Harold Mauricio Choco, Juan Diego Ciro Quintero, Edisson Lozada Dussan, Raul Guerra Echeverri, Angélica Gamboa, Dylan Griswold, Corrado Iaccarino, Kiwon Lee, Karol Palacios Martinez, Luz Llined Victoria Mendoza, Santiago Montoya, Henoc Montealegre Noscue, Wellingson Silva Paiva, Jonathan Pardo Carranza, Berhioska Perez, Julio Luiz Pozuelos, Andrew Reisner, Linda Vanesa Robles, Martin Aliaga Rocabado, Javier Figueredo Sanabria, Diana Marcela Sanchez, Alvaro Ricardo Soto, Gene Sung, Sebastián Vásquez-García, Jonathan Velazquez Quintero","doi":"10.1016/j.wneu.2025.124417","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124417","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124417"},"PeriodicalIF":2.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized double-blinded clinical study of early volumetric changes after shunt surgery and MRI-resistance of the Codman Certas® Plus shunt valve.","authors":"Rafael T Holmgren, Martin Nilsson, Charalampos Georgiopoulos, Peter Zsigmond","doi":"10.1016/j.wneu.2025.124424","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124424","url":null,"abstract":"<p><strong>Objective: </strong>Linear radiological measures have low sensitivity to detect changes in ventricular volume in patients with idiopathic normal pressure hydrocephalus (iNPH). Ventricular volumetry is accurate and sensitive in detecting subtle changes in cerebrospinal fluid volumes. The Codman Certas® Plus is an adjustable shunt valve with eight settings and resistant to MRI-induced inadvertent adjustments in vitro. The aim of this study was to investigate early volumetric changes in ventricles after ventriculoperitoneal shunting in relation to shunt setting and linear measures. We also wanted to evaluate the MRI-resistance of the Codman Certas® Plus valve in a clinical setting.</p><p><strong>Methods: </strong>Forty-five iNPH-patients underwent quantitative MRI including volumetry before and 36 hours after shunting with Codman Certas® Plus valves set to 4 (20 patients) and 8 (25 patients). Valve setting was blinded to patients and examiners and assessed after each MRI. Patients performed in total 156 MRI-examinations during 3 years.</p><p><strong>Results: </strong>There was significant difference in change of ventricular volume between groups 4 and 8 early after surgery. Patients with setting 4 had a ventricular volume reduction of 16 (SD±9) ml while setting 8 had a reduction of 5 (SD±5) ml. Constriction of subarachnoid CSF-spaces in cerebral high convexity and parafalcine sulci was significantly less in the setting 4 group postoperatively. There were no MRI-induced changes to valve setting after any MRI.</p><p><strong>Conclusions: </strong>Ventricular volumetry can detect shunt induced reduction in ventricle volume early after surgery. The magnitude of reduction is related to shunt valve resistance. The Codman Certas® Plus valve is stable against MRI-induced changes in a clinical setting.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124424"},"PeriodicalIF":2.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}