World neurosurgery最新文献

{"title":"A Population-Based Cohort Study of Glioblastoma (World Health Organization Grade 4 Gliomas) in Ontario: Continued Improvement in Care over 25 Years","authors":"Shervin Taslimi ,&nbsp;Susan Brogly ,&nbsp;Timothy P. Hanna ,&nbsp;Jonas Shellenberger ,&nbsp;Marlo Whitehead ,&nbsp;Ryan Alkins","doi":"10.1016/j.wneu.2025.123821","DOIUrl":"10.1016/j.wneu.2025.123821","url":null,"abstract":"<div><h3>Objective</h3><div>Grade 4 glioma is the most common and fatal primary malignant brain tumor in adults. We sought to describe the evolution of care and survival of patients with glioblastoma in a single-payer Canadian provincial health care system over a 24-year period.</div></div><div><h3>Methods</h3><div>Adult patients &gt;18 years old with pathologically or clinically diagnosed glioblastoma (based on fourth or earlier edition of World Health Organization classification) in Ontario between 1994 and 2018 were identified and followed until death or study end point of 2 years through provincial administrative health data. Patient characteristics, type of treatment, survival, and time spent in the hospital were compared across time periods, age groups, and centers.</div></div><div><h3>Results</h3><div>We included 9487 patients with glioblastoma treated from 1994 to 2018. Median survival and 2-year survival rate improved over the study period from 6.4 to 9.4 months and 10% to 18%, respectively. Older age was associated with shorter survival (median survival of 12 months at 65–74 years vs. 3 months at &gt; 85 years), less aggressive therapy, and a higher proportion of remaining lifetime spent in the hospital (more than one third of patients &gt;75 years spend ≥50% their remaining survival in hospital). Time in the hospital decreased by 8.9 days (95% confidence interval 8.53–9.25) over the study period. Significant heterogeneity exists in patient management and outcome between regional treatment centers.</div></div><div><h3>Conclusions</h3><div>The real-world prognosis for grade 4 glioma remains poor. However, an increased proportion of patients receiving maximal therapy is associated with a small but meaningful improvement in survival and decreased time in the hospital for all but the oldest patients.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123821"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NON-TUMORAL AMYGDALAR ENLARGEMENT IN TUMORAL EPILEPSY.","authors":"Subeikshanan Venkatesan, John Whalen, Giridhar Kalamangalam","doi":"10.1016/j.wneu.2025.123949","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123949","url":null,"abstract":"<p><p>An 18-year-old left-handed African American male presented with a year-long history of seizures characterized by episodic palpitations, sweating, and agitation. Brain MRI revealed an enhancing tumor in the right anterior entorhinal cortex with adjacent amygdalar enlargement. Interictal magnetoencephalography and video-EEG confirmed lesional right temporal lobe epilepsy. The patient underwent a partial right anterior temporal lobectomy, with histopathology revealing WHO Grade 2 pleomorphic xanthoastrocytoma (PXA) with a BRAF V600E mutation. The amygdala showed no tumor infiltration, confirming reactive hyperplasia rather than neoplastic involvement. This case underscores the importance of distinguishing tumor infiltration from benign seizure-related amygdalar enlargement in long-term epilepsy-associated tumors (LEATs), usefully informing surgical strategy.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123949"},"PeriodicalIF":1.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754803","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":"Letter to the Editor Regarding: \"Analysis of Endoscope-Assisted Retrosigmoid Approach versus Modified Transjugular Approach for Microvascular Decompression of the Facial Nerve: A Comparative Cadaveric Study\".","authors":"Zainab Azad, Zahra Ali Haque, Javed Iqbal, Brijesh Sathian","doi":"10.1016/j.wneu.2025.123946","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123946","url":null,"abstract":"<p><p>Microvascular decompression (MVD) is the standard surgical treatment for hemifacial spasm (HFS), with the retrosigmoid (RA) and modified transjugular (MTA) approaches being the most commonly used. Cadaveric models play a crucial role in neurosurgical training by providing anatomical accuracy and hands-on experience. However, traditional cadaveric models have notable limitations, including the absence of intraoperative bleeding, brain pulsations, and natural tissue elasticity, all of which reduce the realism of surgical simulations. Formalin fixation preserves tissue structure but increases stiffness, altering the tactile feedback essential for precise surgical maneuvers. Similarly, while silicone injection enhances vascular visualization, it does not simulate active bleeding, preventing trainees from practicing hemostatic techniques. Latex injection has been proposed as an alternative, offering better vessel flexibility and more realistic perfusion. Another key limitation is the lack of pulsatility, a critical factor in live surgeries where rhythmic vessel movements influence precision. Rumi Faizer's study on pulsatile cadaveric models demonstrated enhanced vascular training by improving realism in vessel handling and procedural execution. Applying similar pulsatile perfusion techniques to MVD training could create more dynamic simulations, allowing trainees to refine their skills in conditions that closely mimic live surgery. Incorporating fresh cadavers, latex perfusion, and pulsatile models into neurosurgical education could significantly enhance training fidelity, ensuring better preparedness and improved surgical outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123946"},"PeriodicalIF":1.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754801","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":"Letter to the Editor Regarding: \"The Association of Bone Mineral Density with Distal Junctional Kyphosis and Distal Junctional Failure After Multilevel Spine Fusions: A Systematic Review and Meta-Analysis.","authors":"Zainab Azad, Dua Sarfraz, Javed Iqbal, Brijesh Sathian","doi":"10.1016/j.wneu.2025.123945","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123945","url":null,"abstract":"<p><p>Spinal deformities, including scoliosis and kyphosis, frequently require multilevel spinal fusion surgery to restore stability and reduce pain. However, complications such as distal junctional kyphosis (DJK) and distal junctional failure (DJF) remain concerns. A recent study by Zeyad Daher et al. examined bone mineral density (BMD) as a risk factor for DJK/DJF, identifying CT-derived Hounsfield Units (HU) as a more reliable predictor than dual-energy X-ray absorptiometry (DEXA) T-scores. While the study provides valuable insights, it has notable limitations, including susceptibility to CT artifacts like beam-hardening effects, which can distort HU measurements, and the risks associated with repeated radiation exposure. Artificial intelligence (AI) presents a promising alternative by enhancing HU accuracy through artifact correction, image reconstruction, and precise BMD estimation. Research has shown that AI-based models demonstrate strong agreement with quantitative CT (QCT) values, supporting their potential as a safer and more reliable tool. Additionally, AI-powered low-dose CT imaging reduces radiation exposure while maintaining diagnostic precision. Despite these advantages, further validation and integration into clinical workflows are necessary before widespread adoption. This article highlights the limitations of CT-based HU for BMD assessment and advocates for AI-driven approaches to improve DJK/DJF risk prediction. Future studies should focus on refining AI models, validating their clinical application, and optimizing spinal fusion outcomes by incorporating AI-assisted BMD evaluation into preoperative planning.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123945"},"PeriodicalIF":1.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754802","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":"Ocular Manifestations of Carotid Cavernous Fistula: A Case of Macular Edema and Conjunctival Vessel Tortuosity.","authors":"Tian Xie, Limin Guo, Kailiang Li","doi":"10.1016/j.wneu.2025.123947","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123947","url":null,"abstract":"<p><p>A male in his 70s presented with progressive vision loss in his right eye for 2 months. The conjunctival vessels in both eyes appeared dark red, excessively dilated, and tortuous. Macular Optical coherence tomography (OCT) revealed macular edema in the right eye. A cerebral angiogram demonstrated the presence of a left carotid cavernous fistula. The patient was diagnosed with macular edema and tortuous conjunctival vessels secondary to a carotid cavernous fistula (CCF). Subsequently, the patient underwent endovascular interventional embolization of the fistula, resulting in complete occlusion of the fistula. At the one-month follow-up, the patient reported that the redness in his eyes had disappeared and his vision had improved.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123947"},"PeriodicalIF":1.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754804","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 Weill Cornell Skull Base and Microneurosurgery Skills-Based Neurosurgery Fellowship: A 20-Year, 200-Fellow Retrospective.","authors":"Antonio Bernardo, Alexander I Evins","doi":"10.1016/j.wneu.2025.123948","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123948","url":null,"abstract":"<p><strong>Background: </strong>Since 2004, the Weill Cornell Fellowship in Skull Base and Microneurosurgery has provided surgeons from around the world with structured, proficiency-driven instruction in complex skull base anatomy, approaches, and techniques in a lab-based setting. We report on the design of this program, review the factors that have contributed to its success, and evaluate its impact on 200 neurosurgeon-alumni over the past 20 years.</p><p><strong>Methods: </strong>The 6-12-month fellowship program is tuition-free and open to surgeons worldwide, from senior residents to mid-career surgeons. The program consists of an initial 3 months of training in skull base surgical anatomy, followed by 3-9 months of training in skull base surgical approaches and techniques. All training is closely supervised and follows a standardized sequential dissection curriculum covering the entirety of the skull base. In order to assess the effectiveness and impact of the fellowship program, all alumni were asked to complete a detailed anonymous survey reflecting on their experience and its influence on their surgical abilities and careers.</p><p><strong>Results: </strong>As of January 2025, 200 neurosurgeons from 57 countries have completed the fellowship program, of which 170 were reachable and 133 (78.2%) completed the survey. Respondents indicated a substantial 58.8% increase in their overall neurosurgical skills, abilities, and armamentarium following the fellowship. A significant increase in specific surgical skills was similarly found post-fellowship, with the greatest improvements in navigating the skull base (80.4%), skull base techniques (74.7%), and complications management (70.4%). Overall confidence in performing skull base approaches increased by 50.8%, with the greatest improvements seen in lateral (76.6%) and posterolateral approaches (78.8%). Overall confidence as a neurosurgeon increased by a notable 50.8%, and there was strong agreement that the fellowship was fundamental to their neurosurgery training and made them better neurosurgeons. 98.5% would recommend the program to other neurosurgeons.</p><p><strong>Conclusions: </strong>The lab-based Weill Cornell Fellowship in Skull Base and Microneurosurgery has had a profound and positive impact on its alumni, significantly enhancing their surgical skills and careers. The substantial degree of increases in perceived skills and abilities gained following the fellowship are especially notable given the fellowship's limited duration and are evidence that this model of focused, supervised training could serve as a global benchmark for skills-based neurosurgical training.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123948"},"PeriodicalIF":1.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754805","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":"Efficacy and safety of endovascular thrombectomy for large vessel occlusion stroke beyond 24 hours from time last known well: a systematic review and meta-analysis.","authors":"Jian Wu, Wen-Ya Gao, Min-Gang Liang, Fu-Li Yan, Ming-Fei Yang, Bin Liu","doi":"10.1016/j.wneu.2025.123943","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123943","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy (EVT) has become the standard of care for selected patients with acute ischemic stroke within 24 hours of symptom onset. However, the efficacy and safety of EVT for stroke presenting beyond 24 hours is undetermined.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis to examine the outcomes of EVT in patients with acute ischemic stroke beyond 24 hours from onset. The primary outcome was 90-day functional independence defined as the modified Rankin Scale score of 0-2 (mRS 0-2). Secondary outcomes included successful reperfusion defined as Thrombolysis in Cerebral Infarction 2b-3 (TICI 2b-3), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.</p><p><strong>Results: </strong>Six studies enrolled a total of 5,868 patients to compare the prognosis of EVT for stroke patients treated beyond 24 hours versus within 6-24 hours. The study results indicated that there was no difference in the rate of successful reperfusion (RR 1.00, 95% CI 0.94-1.06, P = 0.96) and sICH (RR 0.63, 95% CI 0.35-1.16, P = 0.14) between the two groups of patients who underwent EVT at different times. Four studies involving 707 patients compared the outcomes of EVT versus best medical treatment (BMT), including thrombolysis, for stroke patients treated beyond 24 hours. Compared to patients receiving BMT, those undergoing EVT were more likely to achieve 90-day functional independence (RR 1.96, 95% CI 1.27-3.01, P < 0.05) and a lower risk of sICH (RR 3.52, 95% CI 1.11-11.20, P = 0.03), with no significant difference in 90-day mortality rates (RR 0.86, 95% CI 0.58-1.28, P = 0.46).</p><p><strong>Conclusions: </strong>Our study found that the EVT time window did not significantly affect TICI 2b-3 and sICH, and EVT showed better therapeutic effects than BMT for stroke patients beyond 24 hours. Specifically, patients who underwent EVT beyond 24 hours had a higher proportion of functional independence at 90 days and a lower risk of sICH. Therefore, EVT remains an effective treatment option for patients with large vessel ischemic stroke beyond the traditional 24-hour time window.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123943"},"PeriodicalIF":1.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744077","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":"Revolution in Surgical Anatomy During the 16th Century: The Neglected Encounters Between Andreas Vesalius and Ambroise Paré","authors":"Thomas J. On ,&nbsp;Yuan Xu ,&nbsp;Jonathan A. Tangsrivimol ,&nbsp;Kivanc Yangi ,&nbsp;Marian T. Park ,&nbsp;Charles J. Prestigiacomo ,&nbsp;T. Forcht Dagi ,&nbsp;Mark C. Preul","doi":"10.1016/j.wneu.2025.123810","DOIUrl":"10.1016/j.wneu.2025.123810","url":null,"abstract":"<div><div>A new era of medicine and surgery began in the mid-16th century, driven by upheavals in religion, art, and science as well as advancements in printing. Two notable contributions were the clinical applications of Andreas Vesalius's anatomy and the surgical innovations of Ambroise Paré. Vesalius and Paré were contemporaries, overlapping in their education, anatomic interests, military experience, professional stature, and visionary use of anatomical illustrations. Nevertheless, their personal intersections, mutual adventures, and conjoint contributions have not been adequately described. During the mid-1530s, Vesalius and Paré performed dissections at the Paris Faculty of Medicine under Jacobus Sylvius. At the Siege of Metz in 1552, the two served opposing armies, Vesalius with Charles V and Paré with Francis I. After Paré surrendered to Spanish forces at Hesin in 1553, Vesalius, then a surgeon to the Spanish emperor, bade Paré to demonstrate his surgical techniques. Vesalius also attempted to convince Paré to change sides, but Paré demurred. In 1559, Henry II of France was mortally injured while jousting. Paré, the royal surgeon, took charge, but Vesalius was also summoned from Brussels, and both were engaged in Henry's management. Later, Vesalius permitted Paré to reproduce his illustrations in Paré’s 1561 <em>Anatomie Universelle</em> and 1575 <em>Oeuvres</em>. Paré’s <em>Oeuvres</em>, reprinted through the mid-1800s, perpetuated Vesalian images and helped ensure their ongoing survival. Although Vesalius's <em>Fabrica</em> and Paré’s <em>Oeuvres</em> were at the forefront of medical science, both men faced years of criticism, likely stemming from their challenges to established norms of practice and the jealousy of their peers.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123810"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explainable machine learning models for prediction of surgical site infection after posterior lumbar fusion surgery based on SHAP.","authors":"PeiYang Wang, Lei Liu, ZhiYang Xie, GuanRui Ren, YiLi Hu, MeiJi Shen, Hui Wang, JiaDong Wang, YunTao Wang, Xiao-Tao Wu","doi":"10.1016/j.wneu.2025.123942","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123942","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study OBJECTIVES: This study aims to develop machine learning (ML) models combined with an explainable method for the prediction of surgical site infection (SSI) after posterior lumbar fusion surgery.</p><p><strong>Methods: </strong>In this retrospective, single-center study, a total of 1016 consecutive patients who underwent posterior lumbar fusion surgery were included. A comprehensive dataset was established, encompassing demographic variables, comorbidities, preoperative evaluation, details related to diagnosed lumbar disease, preoperative laboratory tests, surgical specifics, and postoperative factors. Utilizing this dataset, six ML models were developed to predict the occurrence of SSI. Performance evaluation of the models on the testing set involved several metrics, including the Receiver Operating Characteristic (ROC) curve, the Area Under the Curve (AUC), accuracy, recall, F1-score, and precision. The Shapley Additive Explanations (SHAP) method was employed to generate interpretable predictions, enabling a comprehensive assessment of SSI risk and providing individualized interpretations of the model results.</p><p><strong>Results: </strong>Among the 1016 retrospective cases included in the study, 36 (3.54%) experienced SSI. Out of the six models examined, the XGBoost model demonstrated the highest discriminatory performance on the testing set, achieving the following metrics: precision (0.9000), recall (0.8182), accuracy (0.9902), F1 score (0.8571), and AUC (0.9447). By utilizing the SHAP method, several important predictors of SSI were identified, including the duration of indwelling jugular vein catheter, Bun levels, total protein levels, sustained fever, Cr levels, triglycerides levels, monocyte count, diabetes mellitus, drainage time, white blood cell count, cerebral infarction, estimated blood loss, prealbumin levels, prognostic nutritional index, low back pain, PF score, and osteoporosis.</p><p><strong>Conclusion: </strong>ML-based prediction tools can accurately assess the risk of SSI after posterior lumbar fusion surgery. Additionally, ML combined with SHAP could provide a clear interpretation of individualized risk prediction and give physicians an intuitive comprehension of the effects of the model's essential features.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123942"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744079","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":"Treatment outcomes of epidural blood patch guided by a novel overflow leak test with computed tomography myelography in patients with intracranial hypotension: a case series.","authors":"Eiichi Nakai, Hitoshi Fukuda, Hajime Kuroiwa, Yu Kawanishi, Tomohito Kadota, Tetsuya Ueba","doi":"10.1016/j.wneu.2025.123941","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123941","url":null,"abstract":"<p><strong>Objective: </strong>To describe the treatment outcomes of epidural blood patch (EBP) guided by a novel overflow leak test (OLT) combined with computed tomography myelography (CTM) in patients with intracranial hypotension, with focus on consistency and discrepancy between CTM and OLT findings METHODS: CTM followed by OLT was performed in 18 adults with a CSF pressure of ≤60 mmH₂O. Patients were categorized according to consistency or discrepancy between CTM and OLT findings: Group A, matching leak signals in CTM and OLT; Group B, leak signals detected by OLT only; Group C, discrepancy in leak signal sites between CTM and OLT; Group D, no leak signal detected by both CTM and OLT. EBPs were applied according to the treatment policy, and associations between the radiological categorization and treatment outcomes were determined. Thereafter, using CT and magnetic resonance imaging phantoms, we investigated the minimal amount of injected agent leaking from the lumbar puncture site visible, which could result in a false-positive signal in CTM and OLT.</p><p><strong>Results: </strong>Complete recovery following EBP was achieved for 13 (72%) patients; these included 50%, 82%, 100%, and 0% patients in Groups A, B, C, and D, respectively. In CT myelography phantoms, even 1 μL of contrast agent produced positive findings, whereas OLT phantoms required a minimum of 1,000 μL.</p><p><strong>Conclusions: </strong>These results suggest the potential additive diagnostic value of OLT when performed with CTM. The discrepancy in radiological findings could be partly explained by susceptibility to the contrast agent leaking from the lumbar puncture site.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123941"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744082","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}