World neurosurgery最新文献

{"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 ,&nbsp;Wen-Ya Gao ,&nbsp;Min-Gang Liang ,&nbsp;Fu-Li Yan ,&nbsp;Bin Liu ,&nbsp;Ming-Fei Yang","doi":"10.1016/j.wneu.2025.123943","DOIUrl":"10.1016/j.wneu.2025.123943","url":null,"abstract":"<div><h3>Background</h3><div>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 are undetermined.</div></div><div><h3>Methods</h3><div>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. Secondary outcomes included successful reperfusion defined as Thrombolysis In Cerebral Infarction 2b–3, symptomatic intracranial hemorrhage (sICH), and 90-day mortality.</div></div><div><h3>Results</h3><div>Six studies enrolled a total of 5868 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 (relative risk [RR]: 1.00, 95% confidence interval [CI]: 0.94–1.06, <em>P</em> = 0.96) and sICH (RR: 0.63, 95% CI: 0.35–1.16, <em>P</em> = 0.14) between the 2 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, <em>P</em> &lt; 0.05) and a lower risk of sICH (RR: 3.52, 95% CI: 1.11–11.20, <em>P</em> = 0.03), with no significant difference in 90-day mortality rates (RR: 0.86, 95% CI: 0.58–1.28, <em>P</em> = 0.46).</div></div><div><h3>Conclusions</h3><div>Our study found that the EVT time window did not significantly affect Thrombolysis In Cerebral Infarction 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.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123943"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","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":"Spinal Cord Injury in the 21st Century Part III: A Systematic Meta-Analysis on the Timing of Surgery","authors":"Breanna L. Sheldon ,&nbsp;Caitlin Scott ,&nbsp;Lisa Goudman ,&nbsp;Marisa DiMarzio ,&nbsp;R. John Hurlbert","doi":"10.1016/j.wneu.2025.123916","DOIUrl":"10.1016/j.wneu.2025.123916","url":null,"abstract":"<div><h3>Background</h3><div>Studies on acute spinal cord injury from fracture or dislocation (SCIwiFD) suggest surgery within 48 hours of injury maximizes neurologic recovery. However, the optimal timing of surgery for patients suffering SCI without fracture or dislocation (SCIwoFD) has not been established. Our experience suggests a need to critically reevaluate the role of early surgery.</div></div><div><h3>Methods</h3><div>We provide 2 illustrative cases raising concern for early surgery in SCIwoFD and performed a systematic meta-analysis examining differences in American Spinal Injury Association Motor Scores (AMS) for patients undergoing early (&lt;48–96 hours from injury) versus late (&gt;48–96 hours from injury) surgery. A random-effect meta-analysis was implemented using standardized mean difference (SMD) between baseline AMS and most recent follow-up to estimate effect size.</div></div><div><h3>Results</h3><div>Seven studies met inclusion criteria, with 210 patients undergoing early surgery and 279 undergoing late surgery. Overall, an SMD of −1.1 (95% CI: −1.3 to −0.9) was found (I² = 64%, <em>P</em> &lt; 0.001), indicating a 1-point improvement in AMS after surgery at any time point. When comparing SMD between subgroups, there was no significant difference in AMS from baseline to follow-up between those who underwent early surgery versus late surgery (<em>P</em> = 0.39, df = 1).</div></div><div><h3>Conclusions</h3><div>While there is considerable heterogeneity in the data, there is no significant difference in neurologic recovery seen in patients with SCIwoFD who undergo early surgical intervention compared to those who undergo surgery in a delayed fashion. Our anecdotal experience underscores the need to critically reexamine timing of surgery in this population.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123916"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671169","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":"Unilateral Biportal Endoscopic Discectomy via the Contralateral Sublaminar Approach for Lumbar Disc Herniation with Very High-Grade Migration: A Technical Note and Case Series","authors":"Yong Jin Park ,&nbsp;Man Kyu Park ,&nbsp;Sang Kyu Son ,&nbsp;Young San Ko","doi":"10.1016/j.wneu.2025.123939","DOIUrl":"10.1016/j.wneu.2025.123939","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar disc herniation (LDH) with very high-grade migration is difficult to manage surgically because of its anatomic complexity and the risk of incomplete decompression. The unilateral biportal endoscopic (UBE) contralateral sublaminar approach is a minimally invasive technique that may be an alternative option for managing these cases.</div></div><div><h3>Methods</h3><div>In this multicenter retrospective study, we analyzed the clinical data of 15 patients with lumbar disc herniation with very high-grade upward or downward migration of ruptured disc fragments removed via the UBE contralateral sublaminar approach between June 2022 and June 2024. Clinical outcomes were assessed using the visual analog scale for back and leg pain, Oswestry Disability Index, and modified MacNab criteria. Radiologic outcomes were evaluated on postoperative magnetic resonance images and serial plain radiographs.</div></div><div><h3>Results</h3><div>The mean operation time was 45.3 minutes, and the average length of hospital stay was 4.1 days. The visual analog scale scores for back and leg pain improved significantly, and the Oswestry Disability Index was notably lower at the final follow-up. Postoperative magnetic resonance imaging confirmed the complete removal of migrated disc fragments in all patients, with no segmental instability observed during the follow-up. The technique allows for effective decompression with minimal bone removal, thereby preserving adjacent structures.</div></div><div><h3>Conclusions</h3><div>This study showed the feasibility and potential benefits of the UBE contralateral sublaminar approach for lumbar disc herniation with very high-grade migration of ruptured disc fragments. Although initial outcomes are promising, further comparative studies with more patients are needed to validate its efficacy and safety.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123939"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732002","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":"Research Trends and Hotspots Evolution of Nerve Decompression: A Bibliometric Analysis From 2005 to 2024","authors":"Hui Han ,&nbsp;Sheng Wang ,&nbsp;Hongyue Zhang ,&nbsp;Jinlong Zheng ,&nbsp;Danyan Song ,&nbsp;Wenkui Wang ,&nbsp;Aimin Chen","doi":"10.1016/j.wneu.2025.123968","DOIUrl":"10.1016/j.wneu.2025.123968","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of nerve entrapment-related diseases, caused by a variety of factors, has been increasing annually, significantly impairing patients’ quality of life. Nerve decompression serves as one of the critical approaches for treating such conditions. However, there remains a scarcity of bibliometric analyses within the field of nerve decompression.</div></div><div><h3>Methods</h3><div>The publications related to nerve decompression in the Web of Science database from 2005 to 2024 were collected. Bibliometric methods were used to analyze the basic components of publications, synthesize research trends, and predict future research hotspots.</div></div><div><h3>Results</h3><div>A total of 606 publications were included in our study, with the number of publications ranging from 16 in 2005 to 52 in 2024. In terms of countries, the United States occupies a central position in both the number of publications (213 publications) and the quality (H-index = 34) and works closely with other countries. In terms of publishing institutions, Shanghai Jiao Tong University has the largest number of 18 publications. Acta Neurochirurgica is the journal with the highest number of 27 publications. The focus of research in this field can be divided into 3 main categories: cranial nerves, upper limb nerves, and lower limb nerves. The topic of research has gradually transferred to the lower limb nerve, and the keyword sacral nerve will be a hot topic in this field.</div></div><div><h3>Conclusions</h3><div>This is the first bibliometric study to comprehensively summarize trends and hotspots in nerve decompression research. Our findings shed light on future research directions, international collaborations, and interdisciplinary relationships. The sacral nerve has emerged as a current and potential future research hotspot, warranting further exploration.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"198 ","pages":"Article 123968"},"PeriodicalIF":1.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898880","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 \"Ultrasound-Guided EVD Insertion After Decompressive Craniectomy\"","authors":"Alick P. Wang ,&nbsp;Aneesh Karir","doi":"10.1016/j.wneu.2025.123969","DOIUrl":"10.1016/j.wneu.2025.123969","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"198 ","pages":"Article 123969"},"PeriodicalIF":1.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887408","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":"Factors Predicting Poor Outcomes Following Cranioplasty: A Single Center Analytical Study","authors":"Mangalkumar Girish Rachatte ,&nbsp;Soumya Pahari ,&nbsp;Anil Pande ,&nbsp;Poonam Mohanty ,&nbsp;M.C. Vasudevan ,&nbsp;Pooja Rokaya ,&nbsp;Udit Raut","doi":"10.1016/j.wneu.2025.123957","DOIUrl":"10.1016/j.wneu.2025.123957","url":null,"abstract":"<div><h3>Objective</h3><div>The study aims to assess the factors predicting poor outcomes after cranioplasty (CP).</div></div><div><h3>Methods</h3><div>A cross-sectional follow-up study including 80 patients who underwent CP following decompressive craniectomy (DC) and were followed up for six months. Poor outcome was defined as a modified Rankin Scale ≥3 at 6 months. Univariate and binary logistic regression analyses were used to explore the predictors.</div></div><div><h3>Results</h3><div>Eighty patients were included; the median age was 53.5 years, and 48 were males (60%). The primary pathologies requiring DC were intracerebral hemorrhage (n= 28, 35%), traumatic brain injury (n= 27, 33.75%), and malignant middle cerebral infarction (n= 25, 31.25%). Pre-CP modified Rankin Scale was 5 in all patients, and a poor outcome was seen in 44 (55%) patients after CP. The significant predictors of poor outcome were age (odds ratio [OR= 1.96, <em>P</em>= 0.011), quadratic term age² (OR= 0.99, <em>P</em>= 0.011), primary pathology requiring DC as middle cerebral artery infarction (OR= 0.03, <em>P</em>= 0.024), dominant lobe injury (OR= 48.24, <em>P</em>= 0.001), presence of any post-DC complications (OR= 61.01, <em>P</em> = 0.025), use of CP material other than autologous skull flap (OR= 10.09, <em>P</em>= 0.035), and indication for CP other than for cosmesis (OR= 25.86, <em>P</em>= 0.014). Presenting Glasgow Coma Scale was not a predictor of poor outcome (<em>P</em>= 0.586)</div></div><div><h3>Conclusions</h3><div>Both preoperative patient characteristics and procedural factors significantly influence post-CP recovery. Long-term functional outcomes are determined by patient factors like age, nature of injury (e.g., dominant lobe vs. nondominant lobe, which might affect rehabilitation potential), and surgical factors instead of initial neurological status.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"198 ","pages":"Article 123957"},"PeriodicalIF":1.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898879","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":"Corrigendum to “The Crane Technique in Cortical Bone Trajectory Screw Lumbar Fusion: Efficacy and Predictors of Spondylolisthesis Reduction” <Available Online 5 February 2025, Version of Record 5 February 2025.>","authors":"Kuan-Jung Chen ,&nbsp;Jung-Ying Chiang ,&nbsp;Chih-Ying Wu ,&nbsp;Chien-Yuan Wang ,&nbsp;Hsiang-Ming Huang","doi":"10.1016/j.wneu.2025.123905","DOIUrl":"10.1016/j.wneu.2025.123905","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123905"},"PeriodicalIF":1.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143806970","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":"Histological Characteristics of the Filum Terminale in Occult Tethered Cord Syndrome and Filum Terminale Lipoma","authors":"Fumitaka Sato ,&nbsp;Tomohiro Nakamura ,&nbsp;Tomoya Arakawa ,&nbsp;Masataka Hayashi ,&nbsp;Hirokazu Nakatogawa ,&nbsp;Yoshiro Otsuki ,&nbsp;Chikanori Inenaga","doi":"10.1016/j.wneu.2025.123962","DOIUrl":"10.1016/j.wneu.2025.123962","url":null,"abstract":"<div><h3>Background</h3><div>Tethered spinal cord syndrome is a neurological disorder characterized by pathological tethering of the spinal cord, leading to neurological, urological, and orthopedic dysfunction. Occult tethered cord syndrome (OTCS) presents with similar clinical manifestations but lacks definitive radiological evidence, whereas filum terminale lipoma (FTL) involves adipose infiltration of the filum terminale, contributing to spinal traction. The histopathological characteristics of the filum terminale in these conditions remain incompletely understood.</div></div><div><h3>Objective</h3><div>To characterize the histological features of the filum terminale in OTCS and FTL.</div></div><div><h3>Methods</h3><div>Filum terminale specimens were obtained from 17 patients with OTCS and 22 patients with FTL undergoing surgical untethering (April 2020–April 2024) and from six cadavers as reference samples. The histopathological evaluation included hematoxylin-eosin, Masson trichrome, and Elastica van Gieson staining. Immunohistochemistry assessed collagen types I and III.</div></div><div><h3>Results</h3><div>OTCS cases showed reduced collagen type I, sparse and irregularly looped elastic fibers, capillary dilation, and hyaline-like degeneration. FTL specimens exhibited adipose infiltration, densely packed and elongated elastic fibers, and intense collagen type I staining, although some showed reduced elasticity. Cadaveric samples displayed normal histology without degeneration.</div></div><div><h3>Conclusions</h3><div>The observed decrease in collagen type I and elastic fibers in OTCS suggests compromised filum terminale elasticity, potentially contributing to pathological tethering. In FTL, adipose infiltration is the primary factor driving spinal cord traction, although some cases also showed reduced elastic fiber integrity. These findings emphasize the importance of further research into the relationship between histopathological changes and clinical presentations. Better understanding of this correlation is crucial for developing standardized management strategies.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"198 ","pages":"Article 123962"},"PeriodicalIF":1.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887409","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 \"Ultrasound-Guided EVD Insertion after Decompressive Craniectomy\"","authors":"Jibo Zhang","doi":"10.1016/j.wneu.2025.123965","DOIUrl":"10.1016/j.wneu.2025.123965","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"198 ","pages":"Article 123965"},"PeriodicalIF":1.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878495","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":"Midsagittal Tissue Bridges as Predictors of Neurological Recovery in Traumatic Cervical Spinal Cord Injury","authors":"Chengcai Li ,&nbsp;Jiwei Wang ,&nbsp;Wei Liu ,&nbsp;Zan Wang ,&nbsp;Xiaojuan Luo ,&nbsp;Zhixin Liu ,&nbsp;Yihao Liu ,&nbsp;Zihan Ding","doi":"10.1016/j.wneu.2025.123963","DOIUrl":"10.1016/j.wneu.2025.123963","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to explore the relationship between intramedullary injury and midsagittal tissue bridges at the epicenter of subacute traumatic cervical spinal cord injury (SCI) and long-term clinical recovery.</div></div><div><h3>Methods</h3><div>Imaging and clinical data from 57 traumatic cervical SCI patients at the First Affiliated Hospital of Nanchang University were retrospectively assessed. Midsagittal T2-weighted scans at 1 month postinjury were used to quantify lesion size and tissue bridge width. Correlation analyses were performed to determine the association among tissue bridge width, lesion size, and long-term clinical recovery.</div></div><div><h3>Results</h3><div>At 1 month after SCI, ventral midsagittal tissue bridges (VMTB), dorsal midsagittal tissue bridges (DMTB), and total midsagittal tissue bridges (TMTB) were associated with better American spinal injury association Impairment Scale grades at 1 year postinjury. Shorter intramedullary lesion length (IMLL) and smaller intramedullary lesion width (IMLW) were linked to better outcomes. TMTB exhibited a stronger correlation with improved American spinal injury association Impairment Scale grades compared to VMTB, DMTB, IMLL, and IMLW. Moreover, IMLL and IMLW were significantly higher, while the DMTB, VMTB, and TMTB widths were significantly lower in patients with a poor prognosis than in those with a good prognosis. Receiver operating characteristic analysis showed TMTB had better predictive performance than other measures.</div></div><div><h3>Conclusions</h3><div>The observed association between clinical prognosis and midsagittal tissue bridges underscores the clinical relevance of these structures as neuroimaging biomarkers in patients with subacute SCI. Thus, midsagittal tissue bridges may serve as promising and reliable magnetic resonance imaging biomarkers during the transition from acute to chronic phase for stratifying, treating, and evaluating patient subgroups in clinical trials.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"198 ","pages":"Article 123963"},"PeriodicalIF":1.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894748","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}