World neurosurgery最新文献

{"title":"Cost-Utility Analysis of Deep Brain Stimulation (DBS) for Generalized and Cervical Dystonia: A Perspective from Brazilian Healthcare.","authors":"Elene Paltrinieri Nardi, Lucas Caetano Araújo Silva, Daniele Yukari Kawakami, Ísis Nalin Fernandes Nonato, Tayanny Margarida Menezes Almeida Biase, Ricardo Ribeiro Alves Fernandes, Daniela Oliveira de Melo","doi":"10.1016/j.wneu.2024.08.153","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.08.153","url":null,"abstract":"<p><strong>Objective: </strong>In the Brazilian public national healthcare system, botulinum toxin type A has traditionally been the sole treatment option for patients with dystonia. However, as of October 2022, Deep Brain Stimulation (DBS) garnered positive recommendations for the condition. This study aims to assess the cost-effectiveness of DBS in treating adults with generalized and cervical dystonia within the Brazilian healthcare context, considering its recent inclusion.</p><p><strong>Methods: </strong>A systematic review identified randomized controlled trials (RCTs) assessing DBS efficacy in treating adults with generalized and cervical dystonia. Two cost-utility analyses compared the cost-effectiveness of DBS plus the Best Clinical Practice (BCP) to BCP alone. Markov models, which included three health states (no clinical improvement, clinical improvement, and death), employed a one-year cycle and a lifetime horizon. The study utilized both one-way and probabilistic sensitivity analyses.</p><p><strong>Results: </strong>Two RCTs, one for each condition, revealed superior clinical improvement with DBS when compared to sham simulation. The Incremental Cost-Utility Ratio (ICUR) was $ 1,121.66 for generalized dystonia and $4,556.50 for cervical dystonia. Effectiveness discount rates and age at surgery were identified as influential parameters. In 1,000 Monte Carlo simulations, 99.9% of the ICUR values for generalized dystonia and 74.2 % for cervical dystonia fell below the cost-effectiveness threshold in Brazil ($8,146.64 per QALY).</p><p><strong>Conclusions: </strong>From the perspective of the Brazilian public health system, the combination of DBS and BCP appears to be cost-effective for the treatment of both generalized and cervical dystonia when compared to BCP alone.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146474","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":"Optimizing Management of Cavernous Sinus Meningiomas: A Novel Strategy Integrating Endoscopic Endonasal and Transorbital Surgery with Adjuvant Stereotactic Radiotherapy.","authors":"Raywat Noiphithak, Juan Carlos Yanez-Siller, Pree Nimmannitya, Pornchai Yodwisithsak","doi":"10.1016/j.wneu.2024.08.164","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.08.164","url":null,"abstract":"<p><strong>Background: </strong>Cavernous sinus meningiomas (CSMs) are challenging skull base tumors due to their proximity to vital neurovascular structures. Traditional aggressive transcranial resection often leads to significant morbidities with limited improvement of cranial nerve (CN) deficits. Recent advancements in endoscopic skull base surgery and stereotactic radiation therapy (SRT) offer a more conservative approach, facilitating tumor decompression while preserving critical structures.</p><p><strong>Methods: </strong>This retrospective study reviewed medical records of patients with symptomatic CSMs who underwent endoscopic endonasal and/or transorbital surgery, followed by adjuvant SRT, at our institution between January 2017 and April 2022. Patient demographics, tumor characteristics, surgical approaches, radiation, treatment outcomes, complications, and follow-up time were analyzed.</p><p><strong>Results: </strong>Thirty nine patients with CSMs were included. Endoscopic endonasal approach (EEA) was performed in 24 patients (61.5%), endoscopic transorbital approach (ETOA) in 10 patients (25.6%), and combined approaches in 5 patients (15.2%). Adjuvant SRT was administered to 79.5% of patients. Postoperative outcomes showed recovery of CN 3-6 deficits and vision in 60.8% and 65% of cases, respectively. Complications included postoperative CN 3-6 deficits in 5 cases, and post-radiation visual deterioration in 1 case. During a mean follow-up period of 44 months, tumor progression occurred in 4 patients (12%), with 3 diagnosed as WHO grade II meningiomas and 1 as WHO grade I.</p><p><strong>Conclusions: </strong>This study supports the use of endoscopic skull base surgery combined with adjuvant SRT for symptomatic CSMs, demonstrating both safety and efficacy. This approach yielded favorable outcomes in symptom improvement, tumor control, and positive safety profile.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146489","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":"Obituary: Dr. George Samandouras (1964–2024)","authors":"","doi":"10.1016/j.wneu.2024.08.064","DOIUrl":"10.1016/j.wneu.2024.08.064","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1878875024014311/pdfft?md5=e23070d9da1e9f2bcae3a1b446253c06&pid=1-s2.0-S1878875024014311-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272555","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":"Biomechanical effects of a novel standalone posterior lumbar facet joint stabilization device: an in vitro cadaveric study.","authors":"Temesgen G Assefa, Alexis C Ratliff, Anna G U Sawa, Brian P Kelly","doi":"10.1016/j.wneu.2024.08.168","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.08.168","url":null,"abstract":"<p><strong>Objective: </strong>Although pedicle screw-rod (PSR) instrumentation remains the gold standard, it has complications, including pedicle breach and facet joint violation. There is current interest in facet joint stabilization with the potential to create a less invasive, natural arch of fixation that may avoid the complications of PSR instrumentation. This study examined the stabilizing potential of a novel facet joint fixation device for single-level (L4-L5) fixation in a human cadaveric model.</p><p><strong>Methods: </strong>Six L3-S1 specimens were tested multidirectionally under pure moment loading (7.5 Nm) in 3 conditions: 1) intact, 2) L4-L5 facet fixation without screws, and 3) L4-L5 facet fixation with screws. L4-L5 intervertebral disc angles were measured radiographically. Range of motion (ROM) and disc angles were compared using repeated-measures analysis of variance analysis, with statistical significance p<0.05.</p><p><strong>Results: </strong>Compared to the intact condition, L4-L5 bilateral facet fixation without or with screw fixation significantly reduced L4-L5 angular ROM in all directions (p≤0.003). No significant differences were observed in cranial and caudal adjacent-segment ROM (p≥0.08) except for L3-L4 fixation in extension, which exhibited small motion increases (0.12° without screws, 0.1° with screws) versus the intact condition (p≤0.003). No statistically significant differences were observed in disc angle values between the conditions (p=0.87).</p><p><strong>Conclusions: </strong>Bilateral lumbar facet fixation with and without supplemental transfacet screw fixation provided significant stability. Cranial and caudal adjacent-level ROM was not influenced by facet fixation except for a slight increase in cranial segment motion during extension. Facet fixation did not alter the lordotic intervertebral disc angle at the instrumented level.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146472","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":"Dynamic functional network connectivity in Acute Incomplete Cervical Cord Injury patients and its associations with sensorimotor dysfunction measures.","authors":"Bingyong Xie, Haoyu Ni, Ying Wang, Jiyuan Yao, Zhibin Xu, Kun Zhu, Sicheng Bian, Peiwen Song, Yuanyuan Wu, Yongqiang Yu, Fulong Dong","doi":"10.1016/j.wneu.2024.08.160","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.08.160","url":null,"abstract":"<p><strong>Background: </strong>Dynamic functional network connectivity (dFNC) captures temporal variations in functional connectivity during MRI acquisition. However, the neural mechanisms driving dFNC alterations in the brain networks of patients with Acute incomplete cervical cord injury (AICCI) remain unclear.</p><p><strong>Methods: </strong>This study included 16 AICCI patients and 16 healthy controls (HC). Initially, Independent Component Analysis (ICA) was employed to extract whole-brain independent components (ICs) from resting-state functional MRI (rs-fMRI) data. Subsequently, a sliding time window approach, combined with k-means clustering, was used to estimate dFNC states for each participant. Finally, a correlation analysis was conducted to examine the association between sensorimotor dysfunction scores in AICCI patients and the temporal characteristics of dFNC.</p><p><strong>Result: </strong>ICA was employed to extract 26 whole-brain ICs. Subsequent dynamic analysis identified four distinct connectivity states across the entire cohort. Notably, AICCI patients demonstrated a significant preference for State 3 compared to HC, as evidenced by a higher frequency and longer duration spent in this state. Conversely, State 4 exhibited a reduced frequency and shorter dwell time in AICCI patients. Moreover, correlation analysis revealed a positive association between sensorimotor dysfunction and both the mean dwell time and the fractional of time spent in State 3.</p><p><strong>Conclusions: </strong>Patients with AICCI demonstrate abnormal connectivity within dFNC states, and the temporal characteristics of dFNC are associated with sensorimotor dysfunction scores. These findings highlight the potential of dFNC as a sensitive biomarker for detecting network functional changes in AICCI patients, providing valuable insights into the dynamic alterations in brain connectivity related to sensorimotor dysfunction in this population.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146475","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":"Top 1000 Most Cited Papers in World Neurosurgery.","authors":"Siddig Ibrahim Abdelwahab, Manal Mohamed Elhassan Taha, Abdullah Farasani, Ahmed Ali Jerah, Saleh M Abdullah, Ieman A Aljahdali, Bassem Oraibi, Hassan Ahmad Alfaifi, Amal Hamdan Alzahrani, Omar Oraibi, Yasir Babiker, Waseem Hassan","doi":"10.1016/j.wneu.2024.08.161","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.08.161","url":null,"abstract":"<p><strong>Background: </strong>Over the past 15 years, World Neurosurgery (WN) has emerged as a pivotal source in the neurosurgery field, reflecting remarkable growth and development. Originally published as Surgical Neurology from 1973 to 2009, the journal transitioned to its current title in 2010, significantly expanding its reach and influence.</p><p><strong>Methods: </strong>A comprehensive bibliometric analysis of WN's publications from 1973 to 2023 was performed. The analysis focused on identifying the top authors, universities, countries, and sponsors in two periods: 1973-2009 and 2010-2023. Additionally, the study included a detailed examination of the top 1,000 most cited papers, and summary of top 10 most cited papers.</p><p><strong>Results: </strong>The analysis revealed that during the Surgical Neurology period, 6,567 research documents were published, including 6,503 articles and 64 reviews. Since rebranding as World Neurosurgery, the journal has published an additional 17,663 documents, comprising 15,366 articles and 2,297 reviews up to 2023. The top contributors (authors, universities, and sponsors) were identified, and the study found that WN has successfully increased its foothold across various continents. The co-word analysis provided insights into the thematic focus of the top 1,000 most cited papers, categorizing them into 15 distinct areas.</p><p><strong>Conclusion: </strong>This study underscores World Neurosurgery's significant role in advancing neurosurgical research over the past five decades. The findings highlight the journal's evolution, its expanding global influence, and the key contributors to its success.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146494","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":"Predictive factors for herpes simplex virus reactivation in patients with trigeminal neuralgia after surgery.","authors":"Zihao Zhang, Qingpei Hao, Gang Wu, Jia Ouyang, Wentao Zheng, Haoqi Zhou, Yezu Liu, Zeyu Miao, Guangbiao Qin, Ruen Liu","doi":"10.1016/j.wneu.2024.08.157","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.08.157","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the predictive factors associated with the reactivation of herpes simplex virus (HSV) in patients with trigeminal neuralgia (TN) after surgery, and to determine whether there is a correlation between reactivation and surgical efficacy.</p><p><strong>Methods: </strong>This study included 190 patients who underwent surgery between January 2020 and December 2021. Postoperative HSV reactivation was defined as the presence of perioral or gingival herpes and herpes labialis within 1 week postoperatively. Logistic regression analysis was used to evaluate clinical characteristics as potential predictors of HSV reactivation. Additionally, Spearman's rank correlation coefficient was used to determine any correlation between the postoperative barrow neurological institute (BNI) pain intensity score and HSV reactivation.</p><p><strong>Results: </strong>Of the 190 patients, 56 (29.5%) experienced postoperative HSV reactivation. Both univariate and multivariate analyses identified several significant predictors of HSV reactivation, such as a history of HSV infection, previous trigeminal nerve-damaging surgery, the use of internal neurolysis (IN) as a surgical technique, and an operation time of ≥25 min. No significant correlation was found between HSV reactivation and pain relief, as measured by BNI scores.</p><p><strong>Conclusions: </strong>HSV reactivation was observed in a considerable proportion of patients with TN. Long operative times (≥25 min), the use of IN as a surgical technique, a history of HSV infection, and previous trigeminal nerve-damaging surgery were identified as risk factors. Further research is needed to optimize surgical procedures and develop targeted management protocols to reduce the risk of HSV reactivation.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146490","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 Intradural Fungal Infection Masquerading as a Meningioma in an Immunocompetent Patient: A Case Report and Systematic Review","authors":"","doi":"10.1016/j.wneu.2024.08.150","DOIUrl":"10.1016/j.wneu.2024.08.150","url":null,"abstract":"<div><h3>Background</h3><div>Intradural spinal fungal infection is a rare phenomenon that can carry a significant increase in morbidity and mortality. This systematic review and case report provides a presentation of a 75-year-old male patient with an intradural cervical mass that was diagnosed as a fungal infection intraoperatively. We analyze and report on intradural spinal fungal infections in immunocompetent patients.</div></div><div><h3>Methods</h3><div>We performed a systematic literature review following the PRISMA protocol for studies of intradural fungal infections published in the past 25 years. Original articles with a description of treatment outcomes of such patients were included.</div></div><div><h3>Results</h3><div>A total of 8 studies were included in this review with the addition of the present case. There were 5 male and 4 female patients with an average age of 45.6 yeaers (range 24–75 years). <em>Aspergillus</em> and <em>Candida</em> species being the most isolated fungal organism. The origin of the lesions was identified and iatrogenic in 4 cases. Most patients underwent decompressive laminectomy with biopsy, abscess drainage, or resection of the identified lesion. There were 2 instances of cervical lesions, but most of the lesions were in the thoracic and lumbar spine. Half of the cases reported symptoms improvement, but 2 patients died from the infection or complications from the infections.</div></div><div><h3>Conclusions</h3><div>Intradural fungal infections are rare, with only 10 total cases reported in the past 25 years. Nonetheless, they can be associated with significant mortality and morbidity. Thus, the timeline from presentation to intervention should be evaluated and determined carefully.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146473","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":"One-stage surgical management for cervical pyogenic spondylodiscitis by anterior debridement, reconstruction, and instrumentation: a single-center experience.","authors":"Shutao Gao, Yukun Hu, Haonan Li, Fulati Mamat, Chuanhui Xun, Weibin Sheng","doi":"10.1016/j.wneu.2024.08.156","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.08.156","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>Surgical treatment is an effective strategy for cervical pyogenic spondylodiscitis (CPS). However, the optimal surgical approach is uncertain. This study was conducted to evaluate the clinical efficacy of debridement, reconstruction, and instrumentation via the anterior-only approach for CPS.</p><p><strong>Methods: </strong>We retrospectively collected the data of patients with CPS who underwent one-stage anterior debridement, reconstruction, and instrumentation from January 2013 to December 2022. The surgical duration and blood loss volume were analyzed. The Frankel grading classification was used to evaluate the improvement in neurological function. The Visual Analog Scale (VAS) and Japanese Orthopedic Association (JOA) scores were used to evaluate neck pain and functional recovery. The radiological parameters of regional lordosis angle (RLA) and C2-C7 Cobb angle were used to evaluate the recovery of cervical alignment. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were evaluated to assess the control of infection.</p><p><strong>Results: </strong>Totally, 32 patients were eligible. The surgical duration was 118.9 ± 14.3 minutes, and the blood loss volume was 88.4 ± 42.7 mL. Significant improvements in the Frankel grading were observed in patients with neurological deficit. The VAS and JOA scores significantly improved postoperatively and during follow-up (P < 0.01). The RLA significantly increased from 4.0° ± 6.6° preoperatively to 8.4° ± 5.8° at the final follow-up (P < 0.01). The C2-C7 Cobb angle increased from 11.1° ± 7.1° preoperatively to 13.8° ± 7.2° at the final follow-up (P < 0.01). Bony fusion occurred in all patients. CRP and ESR significantly decreased postoperatively and returned to normal during follow-up.</p><p><strong>Conclusions: </strong>One-stage debridement, reconstruction, and instrumentation via the anterior approach is an effective surgical strategy for CPS. In addition to surgery, targeted and prolonged antibiotic therapy is of crucial importance.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146488","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":"Revision Cranioplasty with Three-dimensional (3D) Custom-made Titanium Implants in patients with failed cranioplasty.","authors":"Sait Kayhan, Şahin Kırmızıgöz, Alparslan Kırık, Özkan Tehli, Yusuf İzci","doi":"10.1016/j.wneu.2024.08.154","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.08.154","url":null,"abstract":"<p><strong>Objective: </strong>Graft failure is a common complication of cranioplasty.Revision cranioplasty is required to overcome this complication. However, no previous studies have reported outcomes in revision cranioplasty with three-dimensional (3D) custom-made titanium implants. We described our experience with 3D titanium implants in patients with revision cranioplasty.</p><p><strong>Methods: </strong>We evaluated 43 consecutive patients who underwent revision cranioplasty using 3D custom-made titanium implants between January 2011 and December 2019.The 3D image of the patient's cranium and the plan to close the cranium defect were created in a virtual environment using software programs. Demographic and radiological features were compared based on the materials used in the initial cranioplasty.</p><p><strong>Results: </strong>Previous material was autologous graft (AG) in 27 patients and polymethyl methacrylate (PMMA) in 16 patients. The mean time without revision cranioplasty is longer in patients with PMMA implants than in patients with AG. There was no statistically significant difference in the length of hospital stay between patients with PMMA implants and patients with AG. There were no postoperative adverse events such as infection, wound dehiscence, convulsions, and epidural hematoma in 38 patients during hospitalization. Wound dehiscence developedin 5 patients and surgical repair was required in one.</p><p><strong>Conclusion: </strong>Initial cranioplasty with PMMA provides a longer time period than the AG before the revision. However, both of them have similar outcomes based on length of hospital stay and cranial defect area. Custom-made 3D titanium implant is a good option for revision cranioplasty to prevent implant failure and reduce patients' cosmetic concerns.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146491","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}