World neurosurgery最新文献

{"title":"Cell-Intrinsic and Cell-Extrinsic Therapeutic Targets in Glioblastoma: Overcoming Resistance Through Tumor Microenvironment Modulation and Precision Medicine","authors":"Siddharth Shah ,&nbsp;Brandon Lucke-Wold","doi":"10.1016/j.wneu.2025.124142","DOIUrl":"10.1016/j.wneu.2025.124142","url":null,"abstract":"<div><h3>Background</h3><div>Glioblastoma (GBM) is an aggressive primary brain tumor with poor prognosis despite multimodal treatment. While prior research focused on tumor cell evolution, growing evidence highlights the tumor microenvironment (TME) as a key driver of therapeutic resistance and disease progression. Understanding GBM-TME interactions is crucial for identifying novel therapeutic targets.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in PubMed, Embase, and Web of Science for English-language studies up to December 2024. Relevant observational studies, clinical trials, meta-analyses, and reviews were analyzed to evaluate cell-intrinsic and cell-extrinsic mechanisms driving GBM progression and treatment resistance.</div></div><div><h3>Results</h3><div>Emerging evidence suggests that phenotypic plasticity, rather than DNA mutations, underlies GBM recurrence, allowing tumor cells to evade targeted therapies. Single-cell lineage tracking reveals that GBM cells dynamically adapt within the TME through complex signaling with astrocytes, microglia, and immune cells, fostering an immunosuppressive microenvironment. Recurrent GBM shows increased T-cell infiltration but is dominated by exhausted CD8+ T cells and regulatory T cells, promoting immune evasion. Disrupting these tumor-supportive interactions offers a therapeutic opportunity.</div></div><div><h3>Conclusions</h3><div>Recurrent GBM shifts toward a mesenchymal phenotype, driving resistance. Targeting mesenchymal transition pathways, such as activator protein 1 modulation, may improve therapy. Additionally, reversing CD8+ T-cell exhaustion and regulatory T cell-mediated immunosuppression could enhance immunotherapy. Disrupting TME-mediated signaling represents a promising strategy to overcome resistance. This review highlights both cell-intrinsic and cell-extrinsic therapeutic targets and insights from single-cell multiomics for future GBM treatments.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"199 ","pages":"Article 124142"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249877","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":"BISPECTRAL INDEX (BIS) MONITORING IN ENDOSCOPIC LUMBAR SPINE SURGERY: RETROSPECTIVE ANALYSIS OF CENTRAL NERVOUS SYSTEM COMPLICATIONS.","authors":"Abdullah Merter, Mustafa Özyildiran, Fatih Kurt, Menekşe Özçelik","doi":"10.1016/j.wneu.2025.124230","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124230","url":null,"abstract":"<p><strong>Background: </strong>Unilateral biportal endoscopic (UBE) spinal surgery involves two separate portals for viewing and working. If the outflow of irrigation fluid between portals is blocked, it can result in increased cerebrospinal fluid pressure, potentially leading to elevated intracranial pressure and related neurological complications. This sudden increase in intracranial pressure may cause transient cerebral hypoperfusion, manifesting as an isoelectric pattern on bispectral index (BIS) monitoring. This study aimed to investigate the use of BIS monitoring as an early indicator of increased intracranial pressure.</p><p><strong>Methods: </strong>Bispectral index monitoring was conducted on patients undergoing UBE surgery to noninvasively detect sudden increases in intracranial pressure. Cases with a follow-up period of less than twelve months were excluded. Intraoperative BIS values of the patients and postoperative neurological complications were retrospectively evaluated.</p><p><strong>Results: </strong>As of May 2023, BIS monitoring started to be conducted on all patients undergoing UBE surgery in our clinic. Between May and December 2023, 182 levels of endoscopic spinal surgery were performed on 111 patients. The isoelectric BIS pattern was observed intraoperatively in six of these patients. Among them, one patient experienced left retinal vein hemorrhage due to increased intracranial pressure. No neurological complications were observed in the remaining five patients.</p><p><strong>Conclusions: </strong>Bispectral index monitoring is a non-invasive technique that can indicate cerebral hypoperfusion due to sudden increases in intracranial pressure. Thus, BIS monitoring should be considered a valuable tool in the management of patients undergoing UBE spine surgery, aiding in the early detection and appropriate treatment of central nervous system complications.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124230"},"PeriodicalIF":1.9,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529888","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":"Global, regional, and national burden of brain and central nervous system cancer, with a secondary analysis of retinoblastoma, 1990-2021: analysis for the Global Burden of Disease Study.","authors":"Aierpati Maimaiti, Zheyong Jia, Yu Feng, Lin Pan, Yifan Li, Wenzhuo Yang, Haiqin Gao, Rui Zhou, Sheng Zhong, Merzat Turhon, Xixian Wang, Maimaitili Mijiti, Guofeng Fan, Hu Qin, Yongxin Wang","doi":"10.1016/j.wneu.2025.124228","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124228","url":null,"abstract":"<p><strong>Background: </strong>Brain and central nervous system cancers represent a significant and increasing global health burden. Although biologically distinct, retinoblastoma was included as a secondary objective to assess its unique impact on pediatric populations.</p><p><strong>Methods: </strong>A comprehensive analysis of the burden of these cancers was conducted, evaluating incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in 2021. Temporal trends in disease burden from 1990 to 2019 were analyzed using a linear regression model. To explore potential risk factors, correlations between Estimated Annual Percentage Changes (EAPCs) and Age-Standardized Rates (ASRs) in 1990, along with Human Development Index (HDI) scores in 2021, were assessed. Five forecasting models were applied to predict future burden. Decomposition analyses were employed to examine the factors influencing changes in disease burden between 1990 and 2021. Frontier analysis visually illustrated the potential for burden reduction in various regions based on their development levels.</p><p><strong>Results: </strong>Brain and central nervous system cancers, along with retinoblastoma, contributed significantly to global disease burden in 2021, with children identified as high-risk populations. The disease burden varied considerably across different SDI regions, GBD regions, and countries. From 1990 to 2021, the number of cases increased. Projections indicated that the disease burden for both sexes would remain substantial from 2022 to 2046. Regions and countries with higher SDI exhibited greater potential for burden reduction. Spearman correlation analyses revealed a significant negative correlation between EAPCs of DALYs and 1990 age-standardized death rates (p = 0.002), while retinoblastoma EAPCs showed a positive correlation with ASRs (p < 0.001).</p><p><strong>Conclusion: </strong>These findings highlight the urgent need for global efforts to address brain and central nervous system cancers, with the secondary analysis of retinoblastoma emphasizing specific priorities for childhood cancer control.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124228"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529902","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":"The Efficacy of Topical Vancomycin in Patients Undergoing Craniotomy to Reduce the Risk of Surgical Site Infection: A Systematic Review and Meta-Analysis.","authors":"Abdulrahman K Alotaibi, Lama M AlShehri, Alaa A Ashqar, Shahad R Almarwan, Lamar H Kuwaity, Arjwan O Alamoudi, Mohammed H Aref","doi":"10.1016/j.wneu.2025.124220","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124220","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infections (SSIs) are the top hospital-acquired infections in postoperative patients undergoing invasive procedures, leading to increased levels of morbidity and mortality.</p><p><strong>Objectives: </strong>The purpose of this study is to determine the efficacy of topical vancomycin in patients undergoing craniotomy to reduce surgical site infections.</p><p><strong>Method: </strong>This review was written based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data extraction and full-text review were conducted for the studies that met the inclusion criteria by six independent researchers. Articles reported the surgical site infection (SSI) after craniotomy in patients who were given topical vancomycin were included. Type of surgery, type of topical vancomycin, a dose of topical vancomycin, usage of other antibiotics, organism-caused SSIs, follow-up duration, onset of SSI, depth of SSI, scales used in the study, post-operative stay of SSI patients and patients with no SSI, SSI risk factors, antibiotics side effects, and craniotomy side effects were extracted.</p><p><strong>Results: </strong>Eight studies included a total number of 2510 patients. 998 patients received topical vancomycin, and the control group was 1512. The reported number of surgical site infections after using topical vancomycin was 12 (1.20%) compared to 81 (5.36%) in the control group. The overall effect size of the study group was RR=0.22, 95% CI (0.09, 0.53), P=0.0007, I²= 44%.</p><p><strong>Conclusion: </strong>Topical use of vancomycin in patients undergoing craniotomy procedures led to a significant reduction in infection rate and mortality post-craniotomy in comparison to the control group.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124220"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529922","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":"Augmented Reality in Spinal Neurosurgery: A Bibliometric Analysis of Trends and Clinical Applications.","authors":"Jad El Choueiri, Francesca Pellicanò, Leonardo Di Cosmo, Edoardo Caimi, Francesco Laurelli, Hamza Salman, Matteo Gionso, Victor Gabriel El-Hajj, Adrian Elmi-Terander, Delia Cannizzaro","doi":"10.1016/j.wneu.2025.124204","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124204","url":null,"abstract":"<p><p>Augmented reality (AR) is an emerging technology in spine surgery with the potential to enhance intraoperative visualization and precision by overlaying virtual images on anatomical structures. This bibliometric review analyzes trends in research and publication growth related to AR in spinal neurosurgery between 2013 and 2024. A search across PubMed identified 267 articles, and after screening, we analyzed 98 relevant studies, revealing exponential growth in AR research, with publications increasing from 1 in 2013 to 28 in 2024. The focus of research evolved over the years, with instrumentation being the dominant topic in 2020, and a broader emphasis on multi-domain AR applications in 2024. The United States led in publication output, followed by Germany, Sweden, and Switzerland. The increasing number of studies reflects AR's growing adoption in both specialized and broad spine surgery applications. Although AR has demonstrated its potential to improve surgical precision and education, further research is needed to assess long-term clinical outcomes and overcome barriers to widespread implementation.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124204"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529887","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":"Impact of inflammatory bowel disease on perioperative complications in patients undergoing cervical spine fusion.","authors":"Xuyang Yan, Xiaorong Yang, Hao Xie, Bofei Dong, Junhao Lin, Houqing Long, Congcong Liu","doi":"10.1016/j.wneu.2025.124210","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124210","url":null,"abstract":"<p><strong>Objective: </strong>The global prevalence of inflammatory bowel disease (IBD) is increasing rapidly, and its systemic inflammation and immune dysregulation may affect surgical outcomes. However, the impact of IBD on perioperative complications in cervical spine fusion has never been reported. This study aimed to investigate the association between IBD and perioperative complications of cervical spine fusion using the National Inpatient Sample (NIS) database and analyze the related risk factors.</p><p><strong>Methods: </strong>Data from patients undergoing cervical spine fusion between 2010 and 2019 were extracted using ICD-9-CM and ICD-10-CM codes. Patients under the age of 18 were excluded. Patients were grouped based on the presence or absence of IBD, and demographic, hospital, comorbidity, and perioperative complication data were compared. Statistical analyses included Pearson's chi-squared test, Wilcoxon rank-sum test, and logistic regression.</p><p><strong>Results: </strong>A total of 350,775 patients who underwent cervical spine fusion were enrolled, with 1,838 (0.52%) having comorbid IBD. The prevalence of IBD increased from 0.4% in 2010 to 0.8% in 2019. The presence of IBD was associated with an increased risk of specific perioperative complications, including dysphagia (odds ratio [OR] = 1.49), urinary tract infection (OR = 1.31), acute kidney injury (OR = 1.87), sepsis (OR = 1.51), pulmonary embolism (OR = 2.40), and acute myocardial infarction (OR = 2.04).</p><p><strong>Conclusions: </strong>The prevalence of IBD among patients undergoing cervical spine fusion is increasing, and patients with IBD face higher risks of specific perioperative complications. Spine surgeons should conduct more detailed risk assessments and adjust perioperative management accordingly.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124210"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529903","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":"Medical Students' Opinions on Women Pursuing a Career in Neurosurgery in Türkiye: A Cross-Sectional Survey at a Single Center.","authors":"Abdullah Talha Şimşek, Nur Topyalın, Neslihan Gökmen İnan, Fatih Çalış, Güliz Gültekin, Çimen Elias, Deniz Alyanak, İrem Nur Altun, Simge Sezgin, İsa Çınar, Melih Ramazan Parlak, Çağlar Bozdoğan, Tamer Tekin, Baha E Adam, Müjgan Tez, Naci Balak","doi":"10.1016/j.wneu.2025.124222","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124222","url":null,"abstract":"<p><strong>Objectives: </strong>Neurosurgery is lagging behind other surgical subspecialties in the recruitment of a more diverse physician workforce. The objective of this study was to explore the positive and negative factors affecting women's choice to pursue a career in neurosurgery.</p><p><strong>Methods: </strong>A self-administered questionnaire comprising 13 Likert-type questions was used to conduct this cross-sectional survey of medical students.</p><p><strong>Results: </strong>A total of 266 medical students (147 females, 119 males) completed the questionnaire. Fewer female students (38%) than male students (45%) indicated that \"neurosurgery is a demanding specialty for women\" (p < .05). Furthermore, while 46% of the female students indicated that \"women face inequality in neurosurgery,\" only 20% of their male counterparts agreed with this statement (p < .001). In addition, 78% of the females disagreed with the assertion that women's physical endurance is insufficient for neurosurgery, but only 53% of the men expressed the same views (p < .001). Twenty-three percent of the male students and 29% of the female students perceived the prevalence of a boys' club mentality in neurosurgery (p < .05). Moreover, 35% of the female students agreed that female neurosurgeons experience the glass ceiling syndrome, while only 18% of the male students held this opinion (p < .001).</p><p><strong>Conclusions: </strong>This study shows that students-regardless of gender-strongly believe neurosurgery residency training affects women's family lives more negatively than men's. While most participants rejected the idea that women lack the physical endurance for neurosurgery, female students perceived a glass ceiling and gender inequality in the field.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124222"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529909","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":"Feasibility and Efficacy of Venous Sinus Stenting for Idiopathic Intracranial Hypertension in a non-Western Country.","authors":"Hazem Abdelkhalek, Islam El Malky, Alaa Elkordy, Raed Ahmed, Essam Abdelhameed, Ashraf Elaggan, Ahmed Elhfnawy","doi":"10.1016/j.wneu.2025.124226","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124226","url":null,"abstract":"<p><strong>Background and purpose: </strong>Most patients with idiopathic intracranial hypertension (IIH) have venous sinus stenosis. In the previous decade, venous sinus stenting has emerged as an ultimate treatment for resistant or refractory cases with IIH. However, studies in this regard are relatively few, especially from lower income countries. We aimed to evaluate the feasibility and efficacy of venous sinus stenting in our tertiary center.</p><p><strong>Methods: </strong>We retrospectively reviewed our prospectively collected database from January 2021 to January 2023 and recruited eligible patients with IIH and venous sinus stenosis who underwent stenting.</p><p><strong>Results: </strong>We recruited 113 patients, all of them were females with a mean age of 30 ± 8 years and mean BMI of 30 ± 3.1. Stenting was technically successful in all our patients. Post stenting angioplasty was warranted in three cases (2.6%). Complications occurred in one case (0.9%) in the form of a rim of subdural hematoma without any clinical sequelae. At 3 months follow-up, 93 patients (82.3%) experienced complete relief of their symptoms, whereas 11 patients (9.7%) still had headache without papilledema and 9 patients (8%) had papilledema. Seven patients (6.2%) received ventriculoperitoneal shunting and two patients (1.8%) experienced restenosis and received another stenting procedure.</p><p><strong>Conclusions: </strong>Stenting of the venous sinus stenosis in IIH patients is effective and safe treatment and can be accomplished with a very low complication rate and relatively higher success rate.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124226"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529901","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 \"Penetrating Brain Injury: Bridging Global Disparities in Care and Advancing Management Strategies\".","authors":"Ronald Alvarado-Dyer, Ali Mansour, Fernando D Goldenberg, Christos Lazaridis","doi":"10.1016/j.wneu.2025.124223","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124223","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124223"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529904","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":"Do Anterior-Posterior Lumbar Fusions Provide More Short-Term Value Than Posterior-Only? An Application of the Operative Value Index.","authors":"Steven Glener, Advith Sarikonda, D Mitchell Self, Ashmal Sami, Danyal Quraishi, Emily Isch, Arbaz Momin, Cheritesh R Amaravadi, Jack Jallo, Joshua Heller, Ashwini Sharan, Alexander R Vaccaro, Srinivas K Prasad, James Harrop, Nicholas J Clark, Ahilan Sivaganesan","doi":"10.1016/j.wneu.2025.124139","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124139","url":null,"abstract":"<p><strong>Introduction: </strong>Lumbar fusion is a common treatment for degenerative spine changes. Although both anterior-posterior (AP) and posterior-only approaches are used, their cost-effectiveness remains uncertain. This study aims to compare the costs and short-term \"value\" (outcomes per dollar spent) of AP and posterior-only lumbar fusions using time-driven activity-based costing (TDABC) and patient-reported outcomes.</p><p><strong>Methods: </strong>A retrospective review of AP and posterior lumbar fusions from 2017 to 2022 was conducted. TDABC was used to assign intraoperative costs based on resource utilization, and the Oswestry Disability Index (ODI) was collected preoperatively and 3-months postoperatively. The Operative Value Index (OVI) was defined as the percent improvement in ODI per $1000 spent. Kruskal-Wallis analysis and multivariable regression compared costs, operative times, and OVI between AP and posterior-only lumbar fusions.</p><p><strong>Results: </strong>Among 108 analyzed patients, 33 underwent AP fusion and 75 underwent posterior-only fusion. The average cost of AP fusion ($22,590) was significantly higher than posterior-only fusion ($10,768) (p<0.001), driven by greater supply (p<0.001) and personnel costs (p<0.001). AP procedures also had longer operative times but showed no significant difference in ODI improvement (p=0.473). Although posterior-only was associated with significantly higher OVI (p<0.05) on univariate analysis, multivariable regression revealed no significant difference in OVI between posterior-only fusions and AP fusions (p=0.098).</p><p><strong>Conclusions: </strong>We provide a novel \"value\" metric that integrates granular costing methodology with prospectively collected patient-reported outcomes. Although AP fusions incur significantly greater cost than posterior-only fusions, there was no significant \"value\" difference between the two modalities when accounting for confounders.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124139"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529900","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}