World neurosurgery最新文献

{"title":"The impact of frailty on mechanical complications following lumbar fusion surgery: a propensity score-matched analysis.","authors":"Tao Hu, Wei Wang, Xiaolong Chen, Shibao Lu","doi":"10.1016/j.wneu.2026.125033","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125033","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of frailty on mechanical complications following lumbar fusion surgery in elderly patients.</p><p><strong>Methods: </strong>We retrospectively enrolled elderly patients who underwent lumbar fusion surgery between August 2021 and March 2023 and used propensity score matching (PSM) to control for confounding factors. Frailty was assessed using the 5-item modified Frailty Index (mFI-5). Univariate and multivariate logistic regression analyses were performed to compare the incidence of postoperative mechanical complications and revision rates between frail and non-frail patients.</p><p><strong>Results: </strong>After PSM, a total of 113 well-matched patient pairs were obtained. Frail patients had significantly longer length of stay (LOS) and higher paraspinal muscle fat infiltration ratios (FI%) compared to non-frail patients (p < 0.05). With regard to radiographic spinopelvic alignment and postoperative functional outcomes, frail patients exhibited significantly higher preoperative pelvic tilt (PT), as well as higher Oswestry Disability Index (ODI) and Visual Analog Scale for back (VAS-back) scores at the 2-year follow-up. Multivariable regression analysis further demonstrated that frail patients were 7.4 times more likely to develop adjacent segment degeneration (ASD), 6.8 times more likely to undergo any revision surgery, and 8.3 times more likely to require revision specifically for ASD compared to non-frail patients.</p><p><strong>Conclusion: </strong>In this study, patients with frailty had significant higher rate of paravertebral muscle FI%, as well as a relatively high incidence of ASD and reoperation, highlighting its value in preoperative risk stratification.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125033"},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864399","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":"Minimally Invasive Keyhole Interlaminar Detethering for Symptomatic Fatty Filum Terminale in Pediatric Patients: An Operative Technique.","authors":"Bin Yuan, Yi Zhong, Ruxuan Zhou, Yongjun Xiang, Tianquan Yang, Yong Han, Min Chen, Shungen Huang, Hangzhou Wang","doi":"10.1016/j.wneu.2026.125031","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125031","url":null,"abstract":"<p><strong>Objective: </strong>Fatty filum terminale (FFT) is a common cause of tethered cord syndrome (TCS) in children. Traditional detethering often requires laminectomy, which increases surgical trauma and complications. This study aimed to evaluate the safety and efficacy of a minimally invasive keyhole interlaminar approach for FFT.</p><p><strong>Methods: </strong>The study is a retrospective study. We analyzed 17 pediatric patients with symptomatic FFT who underwent keyhole interlaminar detethering between January 2020 and February 2021. A 1-2 cm midline incision was made at the L3-L4 interlaminar space to establish a working channel without bony removal. Microsurgical detethering was performed under neurophysiological monitoring. Preoperative and postoperative MRI was used to assess detethering, and neurological function was evaluated using the Spina Bifida Neurological Scale (SBNS).</p><p><strong>Results: </strong>All 17 patients underwent successful surgery with no intraoperative complications or conversions to open procedures. Postoperative MRI confirmed complete filum transection. The mean follow-up duration was 33 ± 5 months. The median SBNS score was 14 preoperatively and 15 at the final follow-up. After surgery, complete recovery was achieved in 14 patients (82%), while 3 patients (18%) experienced recovery with mild residual deficits. No late complications were observed in the follow up visit.</p><p><strong>Conclusion: </strong>The keyhole interlaminar approach is a safe and effective technique for FFT detethering in children. It offers reduced surgical trauma, faster recovery, and satisfactory neurological improvement, representing a promising alternative to conventional surgery.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125031"},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864481","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":"Glucose Levels and Granulocyte Colony-Stimulating Factor May Partially Mediate the Association Between Genetic Liability to Diabetes and Carpal Tunnel Syndrome.","authors":"Jing Wang, Xu Qiu, Xu Wu","doi":"10.1016/j.wneu.2026.125029","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125029","url":null,"abstract":"<p><strong>Background: </strong>Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, imposing substantial clinical and socioeconomic burdens due to chronic pain, functional disability, and reduced quality of life. While diabetes is a well-established risk factor for CTS in observational studies, the causal nature of this association and the mediating roles of glucose levels and inflammatory pathways remain unclear.</p><p><strong>Methods: </strong>We conducted a two-sample Mendelian randomization study using genetic data primarily from the UK Biobank. We assessed the causal effect of genetic liability to diabetes on CTS and evaluated genetically predicted glucose levels, HbA1c, and circulating levels of 41 inflammatory cytokines as potential mediators. Complementary analyses examined other genetically proxied CTS risk factors, including BMI and genetic liability to osteoarthritis. The inverse-variance weighted method was primary, supported by sensitivity analyses.</p><p><strong>Results: </strong>Genetic liability to diabetes was significantly associated with increased CTS risk (IVW OR: 3.36, 95% CI: 1.46 - 7.74, P = 0.0045). Mediation analysis indicated that genetically predicted higher glucose levels levels partially mediated this relationship (IVW OR: 1.28, 95% CI: 1.08 - 1.53, P = 0.0048), whereas genetically predicted HbA1c levels showed no significant association. Among inflammatory markers, genetically predicted circulating granulocyte colony-stimulating factor (G-CSF) levels emerged as a potential mediator (IVW OR: 1.05, 95% CI: 1.01 - 1.10, P = 0.018). Genetic liability to higher BMI, osteoarthritis, smoking status, hypothyroidism, and sleep apnoea syndrome was also significantly associated with increased CTS risk, while genetically predicted higher sex hormone-binding globulin (SHBG) levels were inversely associated with CTS. Sensitivity analyses revealed no evidence of directional pleiotropy or heterogeneity.</p><p><strong>Conclusion: </strong>This study provides genetic evidence supporting a causal effect of genetic liability to diabetes on CTS. The association may be partly mediated by genetically predicted glucose levels and candidate inflammatory pathways involving G-CSF, although these mediation findings require further validation.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125029"},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864486","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":"Frailty, Bone Health, and Radiographic Predictors of Complications After Long-Segment Fusion for Adult Spinal Deformity.","authors":"Sean O'Leary, Milan Sivakumar, Gillian Witten, Sam Bazzi, Dhillon Advano, Sruthi Ranganathan, Mina Guirguis, Srivats Srinivasan, Omar Akbik, Salah Aoun, Carlos Bagley","doi":"10.1016/j.wneu.2026.125028","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125028","url":null,"abstract":"<p><strong>Background: </strong>Surgery for adult spinal deformity (ASD) can result in complications such as proximal junctional kyphosis (PJK), pseudoarthrosis, hardware failure, and surgical site infection. This study sought to identify specific risk factors for these complications in ASD patients.</p><p><strong>Methods: </strong>Patients undergoing long-segment thoracolumbar fusion (>4 levels) for ASD between 2016-2021 were included. Univariate and multivariable analyses assessed pre-operative risk factors for complications. A subgroup analysis of patients undergoing ≥7-level fusion constructs was also performed.</p><p><strong>Results: </strong>Among 235 patients (66% female; mean age 70 years; mean BMI 28), higher BMI was associated with hardware failure (OR 1.087, 95% CI 1.023-1.157, p=0.007). Frailty measured by MFI-11 and DXA-defined bone health were not significantly associated with the studied complications. Lower preoperative sagittal vertical axis (SVA) was associated with higher pseudoarthrosis risk (OR 0.841, 95% CI 0.716-0.977, p=0.023). Smaller L3 vertebral surface area (OR 0.997, 95% CI 0.993-0.999, p=0.023), left L4 psoas area (OR 0.998, 95% CI 0.995-1.000, p=0.043), and L4 total psoas area (OR 0.998, 95% CI 0.997-1.000, p=0.015) were associated with increased PJK risk. Other radiographic measures were not significantly associated with complications. Findings were generally consistent in the ≥7-level fusion subgroup.</p><p><strong>Conclusion: </strong>In this single-center cohort, frailty, DXA-defined osteoporosis, and most radiographic alignment parameters were not significantly associated with postoperative complications, although these findings should be interpreted cautiously given limitations in frailty measurement, incomplete bone health assessment, and cohort power. BMI, sagittal alignment, and paraspinal muscle mass showed more consistent associations with adverse outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125028"},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864405","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 anatomical relationship between tonsillo-biventral fissure and dentate nucleus in surgical approaches for hypertensive cerebellar hemorrhage.","authors":"Kang Yang, Quan Li, Yi-Jian Hu, Chuan Huang, Jie Liu","doi":"10.1016/j.wneu.2026.125032","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125032","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the anatomical relationship between the tonsillo-biventral fissure and the dentate nucleus in detail. Additionally, to apply this knowledge to guide the surgical management of hypertensive cerebellar hemorrhage.</p><p><strong>Materials and methods: </strong>A total of nine cases of hypertensive cerebellar hemorrhage treated between January 2025 and October 2025 were reviewed, in which the anatomical relationship between the tonsillo-biventral fissure and the dentate nucleus was fully utilized to guide surgery. The specific operative steps and underlying rationale of this innovative surgical concept were analyzed and described in detail.</p><p><strong>Results: </strong>There is a close anatomical relationship between the tonsillo-biventral fissure and the dentate nucleus. Since hypertensive cerebellar hemorrhage mainly originates from the dentate nucleus, these anatomical characteristics should be integrated with patient-specific imaging findings to guide surgical planning. The hematoma can be directly exposed through the natural corridor of the tonsillo-biventral fissure, or this fissure can serve as a constant anatomical landmark to guide cortical fenestration, thereby providing the surgeon with a more straightforward operative strategy.</p><p><strong>Conclusion: </strong>Fully utilizing the anatomical relationship between the tonsillo-biventral fissure and the dentate nucleus to guide the surgical treatment of hypertensive cerebellar hemorrhage is a safe, efficient, simple, and minimally invasive technique worth promoting and disseminating.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125032"},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864411","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":"Clinical Efficacy Evaluation of Percutaneous Endoscopic Interlaminar Decompression under Local Anaesthesia for the Treatment of Degenerative Lumbar Spinal Stenosis in Elderly Patients with Medical Comorbidities:A multicenter retrospective study.","authors":"Shihao Zhou, Zhenxian Qi, Chao Zhu, Xiaowan Xu, Junhao Sun, Hongshun Zhao, Tianluo Guo, Peiran Hu, Zhihua Xu, Bin Yuan, Yan Hao, Yajun Deng, Chao Zhu, Dazhi Yang, Jiancuo A","doi":"10.1016/j.wneu.2026.125027","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125027","url":null,"abstract":"<p><strong>Objective: </strong>Percutaneous endoscopic interlaminar discectomy (PEID) is recognized as a safe and effective minimally invasive treatment for lumbar spinal stenosis (LSS). This study introduces a novel awake PEID strategy that involves the use of conscious sedation with stepwise local anaesthesia (LA) as an alternative to general anaesthesia (GA). The objective of this study was to evaluate the feasibility of awake PEID in elderly patients with degenerative lumbar spinal stenosis (DLSS) and multiple comorbidities.</p><p><strong>Methods: </strong>This retrospective analysis included 123 consecutive patients older than 70 years with comorbidities who underwent awake PEID for DLSS at four hospitals between January 2022 and January 2024. The operation time, blood loss, and hospital stay were recorded. Clinical outcomes were evaluated with the visual analogue scale (VAS) for leg and back pain, the Oswestry Disability Index (ODI), and the Japanese Orthopaedic Association (JOA) score at baseline and at 3 days, 3 months, 6 months, and 12 months post-operatively. Surgical efficacy was assessed at the final follow-up using the modified Macnab criteria. Complications and adverse events were documented. Intraoperative anaesthesia effectiveness and patient experience were measured with the intraoperative VAS score and a satisfaction scale. Descriptive statistics and multiple comparison tests were applied to compare surgical indicators, and longitudinal data were analysed with generalized linear mixed models.</p><p><strong>Results: </strong>All patients successfully completed PEID under local anaesthesia with conscious sedation. Overall, 100 patients (81%) rated their intraoperative experience as excellent or good, and 23 patients (19%) rated it as fair. The mean intraoperative VAS score was 3.4±1.1. Compared with baseline, leg and back pain VAS scores and ODI scores improved significantly at all follow-up intervals (p < 0.01). At the final follow-up, 116 patients (94%) achieved excellent or good outcomes according to the modified Macnab criteria, whereas 7 patients (6%) achieved fair results. No patient discontinued surgery because of intolerable pain.</p><p><strong>Conclusion: </strong>PEID under local anaesthesia is feasible for elderly patients with LSS and severe comorbidities. The anaesthesia strategy described in this study was safe, simple to implement, and associated with fewer anaesthesia-related adverse effects. Thus, in selected patients, particularly elderly patients with multiple comorbidities, this approach may serve as a promising alternative to general anaesthesia.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125027"},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864437","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":"Cervical Paraspinal Muscle Morphometry and Mechanical Failure: A Propensity-Matched Analysis.","authors":"Serhat Aydin, Benjamin Carnovale, Samuel H Wakelin, Armani Manov, Ayesha Akbar Waheed, Samuel Adida, Regan M Shanahan, Andrew Legarreta, Qazi Zeeshan, D Kojo Hamilton, Nitin Agarwal","doi":"10.1016/j.wneu.2026.125035","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125035","url":null,"abstract":"<p><strong>Objectives: </strong>Hardware-related complications are rare but important issues after posterior cervical fusion. Current risk stratification relies on bone quality parameters, but other variables may also contribute to mechanical complications. In lumbar spine surgery, paraspinal muscle morphometry has emerged as a predictor of mechanical failure, though cervical-specific evidence is limited. This study evaluates preoperative cervical paraspinal muscle morphometry in predicting mechanical failure following posterior cervical fusion.</p><p><strong>Methods: </strong>This retrospective propensity score-matched study included 26 patients who underwent multilevel posterior cervical decompression and fusion. Mechanical failure was defined as proximal junctional kyphosis, distal junctional kyphosis, adjacent segment disease, or pseudoarthrosis. Patients with mechanical failure were matched 1:1 with controls based on age, sex, BMI, smoking status, osteoporosis status, indication, the upper instrumented vertebrae, and lower instrumented vertebrae. Preoperative cervical MRIs from C2 to T1 were analyzed using an automated segmentation. Bilateral measurements included volume and fatty infiltration percentage for semispinalis capitis, semispinalis cervicis/multifidus, and splenius capitis muscles. Paired t-tests were used to compare measurements between groups. Statistical significance was set at p<0.05.</p><p><strong>Results: </strong>The mechanical failure group demonstrated significantly lower preoperative total paraspinal volume (188 ± 38 mL vs. 224 ± 46 mL, p=0.043) and total muscle volume (153 ± 33 mL vs. 184 ± 41 mL, p=0.044). Individual muscle groups demonstrated volume reductions without reaching significance.</p><p><strong>Conclusions: </strong>This study showed that preoperative cervical paraspinal muscle volume is associated with increased risk of mechanical failure following PCDF. Routine preoperative MRI might play an important role in assessing possible hardware outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125035"},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864416","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":"Comparison of Early versus Delayed Flow Diverter Implantation on Rebleeding and Clinical Outcomes in Patients with Ruptured BBA.","authors":"Xudong Cao, Zha Duo, Wenbo Wu, Huandong Liu, Yu Weng, Hongguo Wang, Ren Zeng","doi":"10.1016/j.wneu.2026.125034","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125034","url":null,"abstract":"<p><strong>Background: </strong>Flow diverter (FD) implantation is a key reconstructive treatment for BBA, but the optimal timing of implantation remains unresolved, which limits standardized clinical decision-making.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 90 consecutive patients with ruptured BBAs who underwent FD implantation. Patients were stratified into two groups based on the interval from BBA rupture to FD implantation: the early group (≤48 hours, n=45) and the delayed group (>48 to ≤96 hours, n=45). Baseline characteristics, treatment parameters, and clinical/angiographic outcomes were collected. Binary logistic regression was conducted to identify prognostic factors.</p><p><strong>Results: </strong>Baseline characteristics were well-balanced between the two groups (all P>0.05). Compared with the delayed group, the early group had a significantly lower rate of symptomatic rebleeding within 90 days (2.2% vs. 6.7%, P=0.039), a significantly higher rate of 90-day favorable functional outcomes (mRS ≤2: 82% vs. 69%, P=0.047), a numerically higher complete occlusion rate (73% vs. 69%, P=0.642), and a lower rate of procedure-related cerebral infarction (6.7% vs. 11%, P=0.456). Multivariate logistic regression showed that delayed FD implantation (adjusted OR=3.17, 95% CI: 1.15-8.72, P=0.026) and WFNS grade ≥3 (adjusted OR=2.89, 95% CI: 1.09-7.65, P=0.018) were independent risk factors for symptomatic rebleeding. Additionally, delayed FD implantation was an independent risk factor for poor 90-day functional outcomes (adjusted OR=2.31, 95% CI: 1.02-5.23, P=0.044).</p><p><strong>Conclusion: </strong>Early FD implantation (≤ 48 hours post-BBA rupture) was associated with a lower risk of symptomatic rebleeding and better short-term clinical outcomes in patients with ruptured BBA.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125034"},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864491","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":"Frequency and Timing of Programmable Shunt Valve Adjustments After Aneurysmal Subarachnoid Hemorrhage.","authors":"Josef D Williams, Claudia Fernandez Perez, Charles Withington, Jeffrey M Breton, Georgia Wong, Nik Nikaj, Gnel Pivazyan, Jason Chang, Daniel R Felbaum, Ehsan Dowlati","doi":"10.1016/j.wneu.2026.125024","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125024","url":null,"abstract":"<p><strong>Objective: </strong>Hydrocephalus requiring ventriculoperitoneal shunt (VPS) placement in patients with aneurysmal subarachnoid hemorrhage (aSAH). Programmable shunt valves may reduce the need for surgical revision by allowing noninvasive correction of over- or underdrainage. However, data describing the frequency and timing of postoperative valve adjustments in this population remain limited. We sought to characterize the incidence, direction, and temporal pattern of programmable valve setting changes following VPS placement after aSAH.</p><p><strong>Methods: </strong>We performed a single-institution retrospective analysis of patients who underwent programmable VPS placement (Medtronic Strata II or Codman Certas Plus) for hydrocephalus following treatment of ruptured intracranial aneurysms between 2017 and 2022.</p><p><strong>Results: </strong>Among 398 patients treated for aSAH, 49 (12%) required VPS placement for hydrocephalus. Aneurysms were treated endovascularly in 41 patients (84%) and surgically in 8 (16%). Forty-two patients received Medtronic Strata II valves (median initial setting: 1.0) and seven received Codman Certas Plus valves (median initial setting: 4). Valve adjustment was required in 18 patients (37%): 10 for underdrainage, 6 for overdrainage, and two requiring multiple adjustments. Most adjustments occurred during the index hospitalization, with 15 (83%) performed within 7 days of VPS placement.</p><p><strong>Conclusion: </strong>Valve setting adjustments were common following programmable VPS placement for post-aSAH hydrocephalus, occurring in more than one-third of patients. Underdrainage was the most frequent indication for adjustment, and the majority of changes occurred within the first postoperative week. These findings highlight the importance of early clinical and radiographic surveillance and support the utility of programmable valves in hydrocephalus after aSAH.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125024"},"PeriodicalIF":2.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843503","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":"Use of Doppler Ultrasound During Surgical Treatment of Intradural Spinal Arteriovenous Fistula.","authors":"Kevin T Kim, Tina Wang, Adedayo Olaniran, Jacob Cherian, Timothy Chryssikos","doi":"10.1016/j.wneu.2026.125022","DOIUrl":"https://doi.org/10.1016/j.wneu.2026.125022","url":null,"abstract":"<p><p>Spinal dural AV fistulas comprise 70% of spinal AVMs. If left untreated, patients typically experience progressive myelopathy, and surgical treatment remains the most definitive and curative strategy. We present an operative video illustrating the use of Doppler ultrasound during clip ligation and disconnection of a spinal AV fistula. A 73-year-old male patient presented with myelopathic symptoms with weakness and diminished sensation in his bilateral lower extremities. Neuroimaging demonstrated spinal cord edema from T6 to the conus with prominent epidural flow voids from T4-T10 on MRI, and an AV fistula with arterial supply from the left T11 segmental artery on DSA, consistent with a type 1 dural AV fistula. Doppler ultrasound was used to identify the location of the AV fistula prior to durotomy, verify the absence of shunting after temporary clip placement on the draining vein, and confirm no residual shunting after clip ligation and disconnection. Post-operatively, the patient was discharged to rehab with full strength in both lower extremities. At six-week and nine-months post-op, the patient remained at full strength, with improvement in myelopathic symptoms. Key features of intraoperative Doppler ultrasound include the ability to measure dAVF hemodynamics, real-time visualization of blood flow, identification of vessels not directly visible under the microscope, and confirmation of fistulous interruption. Compared with existing imaging tools, Doppler ultrasound does not require a dedicated microscope, hybrid operating suite, or injection of a systemic agent. Doppler ultrasound is a readily accessible adjunct surgical tool to localize and confirm obliteration of a spinal dural AV fistula.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"125022"},"PeriodicalIF":2.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843476","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}