World neurosurgery最新文献

{"title":"Predicting 24-Hour Blood Pressure Variability Post Thrombectomy Using Machine Learning for Patients with Ischemic Stroke from Anterior Circulation Large Vessel Occlusion","authors":"Daniel Najafali ,&nbsp;Thomas M. Johnstone ,&nbsp;Sanjeev Herr ,&nbsp;Melissa Pergakis ,&nbsp;Adelina Buganu ,&nbsp;Megan Najafali ,&nbsp;Shriya Jaddu ,&nbsp;Taylor Kowansky ,&nbsp;Nabih Ramadan ,&nbsp;Chad Schrier ,&nbsp;Gaurav Jindal ,&nbsp;Quincy K. Tran","doi":"10.1016/j.wneu.2025.123787","DOIUrl":"10.1016/j.wneu.2025.123787","url":null,"abstract":"<div><h3>Background</h3><div>Mechanical thrombectomy is the standard of care for patients with ischemic stroke from large vessel occlusion. Blood pressure variability (BPV) in the post thrombectomy period is associated with poor functional outcomes. To determine predictive factors associated with increased BPV, a machine learning algorithm was used to identify factors that are linked with increased BPV indices at 24 hours post thrombectomy.</div></div><div><h3>Methods</h3><div>This retrospective study examined all patients from a Comprehensive Stroke Center's registry who underwent mechanical thrombectomy between January 2016 and December 2019. The primary outcome was BPV between patients who had adequate reperfusion post thrombectomy (Thrombolysis in Cerebral Infarction [TICI] grading 2b+) and those who did not. The secondary outcomes were good functional status at 90 days (modified Rankin Scale ≤2) and reperfusion (TICI 2b+). Random forest analysis was leveraged to determine predictors for BPV with reported root mean square error and normalized root mean square error metrics. Multivariable regression analysis was used to determine factors significantly associated with secondary outcomes. <em>P</em> &lt; 0.05 was the threshold for statistical significance.</div></div><div><h3>Results</h3><div>A total of 395 patients (49%, n = 195 females and 51%, n = 200 males) were included in the final analysis with mean age (± standard deviation) of 65 (±15) years. TICI 2b+ was achieved in 322 (82%) patients. Median Alberta stroke program early CT score and National Institutes of Health Stroke Scale (NIHSS) were 9 and 18, respectively. Higher age, NIHSS, number of passes, and mechanical ventilation were significantly associated with lower likelihood of modified Rankin Scale ≤2 at 90 days in multivariable regression analysis.</div></div><div><h3>Conclusions</h3><div>This study identified the interval from last-known-well time-to-groin puncture, age, and NIHSS as factors significantly associated with increased 24-hour BPV in random forest analysis. These predisposing factors in our machine learning analysis allow clinicians to identify patients who are at risk of having increased BPV and opportunities to augment these patients' blood pressure control.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123787"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426169","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":"Pedicle Screw Fixation Plus Cement Augmentation or Cement augmentation Only for Osteoporotic Vertebral Compression Fracture: A Systematic Review and Meta-Analysis","authors":"Chao Wang MD ,&nbsp;Ya-Wei Chu MD ,&nbsp;Cheng-Tang Lv MD","doi":"10.1016/j.wneu.2025.123952","DOIUrl":"10.1016/j.wneu.2025.123952","url":null,"abstract":"<div><h3>Background</h3><div>Osteoporotic vertebral compression fractures (OVCFs) are common fractures and pedicle screw system gains dissatisfactory results since bone mass loss. Cement augmentation (CA) is the most applied surgery modality for OVCFs but with shortcomings. Pedicle screw fixation plus CA (PSF + CA) has been reported superior to CA. This study aims to investigate the impact of PSF + CA on OVCFs.</div></div><div><h3>Methods</h3><div>We approached databases of PubMed, Europe PMC, Web of Science, CENTRAL, and Embase for studies published up to November 2023. Clinical outcomes (hospital stay, blood loss, cement volume, cement leakage, secondary fracture), radiological outcomes (local kyphotic angle and anterior vertebral height), and subjective outcomes (visual analog scale and Oswestry Disability Index) were extracted. We tested the sensitivity and publication bias, rated evidence, calculated total effect sizes with prediction intervals, and explained heterogeneity.</div></div><div><h3>Results</h3><div>Six studies were included with 255/339 patients in the PSF + CA group/CA-only group. The result is as follows: the PSF + CA group showed better in local kyphotic angle; anterior vertebral height claimed insufficient support favoring PSF + CA. The CA-only group showed better clinical outcome of hospital stay, blood loss, and operative time. Cement volume and cement leakage difference were not significant. Secondary fractures occurred more in the CA-only group. Visual analog scale scores favored the PSF + CA group, and Oswestry Disability Index results were too inaccurate to conclude.</div></div><div><h3>Conclusions</h3><div>PSF + CA and CA-only procedures achieved efficient clinical outcomes in OVCFs. PSF + CA showed better strength in deformity correction and long-term maintenance, less strength in incidence of secondary fracture, and more pain relief at the cost of length of hospital stay, blood loss, and operative time.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123952"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781326","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 Approach in Upward Migrated Foraminal Disc Herniations.","authors":"Cigdem Mumcu, Sait Naderi","doi":"10.1016/j.wneu.2025.123903","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123903","url":null,"abstract":"<p><strong>Purpose: </strong>Lumbar upward migrated foraminal disc herniations are extremely rare and technically challenging to operate. In this study, a contralateral approach using unilateral biportal endoscopy, which has the advantages of structural protection, efficacy, and safety is presented.</p><p><strong>Material and methods: </strong>Between 2019 and December 2022, five patients with lumbar upward migrated foraminal disc herniations underwent unilateral biportal endoscopic discectomy via the contralateral approach. The patients were four males and one female patient. All patients had severe radicular pain. Neurological examination revealed sensory impairment and motor weakness in two patients but no deficits in the others. Magnetic resonans images confirmed lumbar upward migrated foraminal disc herniations in all patients.</p><p><strong>Results: </strong>The study shows a significant reduction in Oswestry Disability Index. Symptoms improved immediately after surgery in all patients, and satisfactory results were achieved at the last follow-up. No surgical complications or recurrent herniations were observed. The mean preoperative Oswestry Disability Index decreased from 44.6 to 11.4. In addition, mean preoperative Visual Analogue Scale declined from 8.4 to 1.6. The patients were assessed after a follow-up period of at least 22 months, and their level of pain level was documented.</p><p><strong>Conclusion: </strong>Although unilateral biportal endoscopic discectomy via the contralateral approach is not a common surgical procedure, it can offer a viable alternative for patients with lumbar upward migrated foraminal disc herniations.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123903"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781341","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 initiating Intravenous Glycoprotein IIb/IIIa Inhibitors before acute stent Implantation in Patients with Cerebral Infarction: A Systematic Review and Meta-Analysis.","authors":"Wulan Yang, Qingmei Han, Aa Ruhan Bai, Ya Na, Yun Qing","doi":"10.1016/j.wneu.2025.123955","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123955","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety and efficacy of initiating GPI infusion prior to acute intracranial artery stent implantation.</p><p><strong>Method: </strong>We performed a meta-analysis using RevMan software to calculate the pooled risk ratio (RR) and 95% confidence intervals (CI) to assess efficacy and safety.</p><p><strong>Result: </strong>The systematic review and meta-analysis included 7 studies involving 1156 patients who underwent acute stent implantation. 1. Efficacy outcomes: GPI not significantly improved favorable 90-day functional outcome (P=0.05, I²=0%, CI 1.14[1.00-1.30]). GPI significantly reduced perioperative stent thrombosis (P<0.00001, I²=0%, CI 0.21[0.1-0.43]), The results did not indicate a significant advantage of glycoprotein inhibitors (GPI) in recanalization (P=0.53, I²=0%, CI 1.01[0.98-1.04]). 2. The findings showed that GPI did not result in a higher incidence of Spontaneous Intracerebral Hemorrhage (SICH) (P=0.76, I²=0%, CI 0.93[0.59-1.48]), GPI not significantly improved favorable 90-day functional outcome in patients after stenting (P=0.05, I²=0%, CI 1.14[1.00-1.30]). 3. Subgroup analysis: No statistically significant differences in recanalization (TICI≥2b) (P=0.9, I²=0%, CI 1.00[0.95 to 1.06]) and perioperative SICH (P=0.77, I²=5%, CI 1.50[1.01 to 2.22]) between the two groups ,GPI was associated with a significant reduction in the incidence of perioperative stent thrombosis (P=0.0003, I²=0%, CI 0.22[0.09-0.50]) and demonstrated an improvement in favorable clinical outcomes at 90 days after acute carotid stenting (P=0.04, I²=1%, P= 0.001, CI 1.23[0.98-1.54]).</p><p><strong>Conclusion: </strong>The use of intravenous GPI before acute stent implantation can reduce perioperative intravascular thrombosis but does not improve patient outcomes at 90 days. The use of intravenous GPI before carotid acute stenting may enhance 90-day outcomes and reduce perioperative stent thrombosis.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123955"},"PeriodicalIF":1.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773655","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":"Prognostic Value of Lumbar Muscle Morphometrics for Survival of Patients with Spinal Metastasis: A Systematic Review and Meta-analysis.","authors":"Lu Li, Si Wu, Jin-Chang Han, Xia Kuang, Li-Zhuang Su, Xiao-Qing Zhang, Qing-Tong Cui, Xiao-Yu Zhang","doi":"10.1016/j.wneu.2025.123953","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123953","url":null,"abstract":"<p><strong>Background: </strong>Spinal metastasis, a prevalent complication of advanced malignancy, poses significant challenges in patient management due to its potential to compromise spinal stability and quality of life. Accurate prognostication is crucial for tailored therapeutic strategies. This meta-analysis aimed to evaluate the prognostic significance of sarcopenia and lumbar muscle morphometrics in patients with spinal metastasis.</p><p><strong>Methods: </strong>Electronic databases, including PubMed, Embase, and the CENTRAL, were searched up to August 2024. Studies were included if they reported quantitative data on sarcopenia or lumbar muscle morphometric parameters and survival outcomes in patients with spinal metastasis. A quantitative meta-analysis was performed with hazard ratio (HR) as the effect size. Heterogeneity was assessed using the Cochran Q test and I² statistic. Publication bias was evaluated through funnel plot symmetry and Egger's and Begg's regression tests.</p><p><strong>Results: </strong>Our search identified 17 retrospective cohort studies comprising 3,023 patients. Various parameters were employed to assess sarcopenia, encompassing cross-sectional area (CSA) of the psoas muscles (left, right, total, or averaged), the ratio of psoas CSA to vertebral CSA, the ratio of psoas CSA to squared body height, and densities of the psoas or paravertebral muscles. Meta-analysis revealed that total/mean psoas area, when grouped by tertiles or medians, held independent prognostic value for survival outcomes. The ratio of psoas area to vertebral area also demonstrated significant prognostic value when grouped by tertiles or medians.</p><p><strong>Conclusions: </strong>Lumbar muscle morphometrics are independent prognostic factors for survival in patients with spinal metastasis. Integrating of these metrics into clinical decision-making could enhance personalized therapeutic strategies and prognostic accuracy.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123953"},"PeriodicalIF":1.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773657","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":"Nontumoral Amygdalar Enlargement in Tumoral Epilepsy","authors":"Subeikshanan Venkatesan ,&nbsp;John Whalen ,&nbsp;Giridhar Kalamangalam","doi":"10.1016/j.wneu.2025.123949","DOIUrl":"10.1016/j.wneu.2025.123949","url":null,"abstract":"<div><div>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 magnetic resonance imaging revealed an enhancing tumor in the right anterior entorhinal cortex with adjacent amygdalar enlargement. Interictal magnetoencephalography and video-electroencephalogram -confirmed lesional right temporal lobe epilepsy. The patient underwent a partial right anterior temporal lobectomy, with histopathology revealing WHO Grade 2 pleomorphic xanthoastrocytoma with a BRAF V600 E 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, usefully informing surgical strategy.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 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 ,&nbsp;Zahra Ali Haque ,&nbsp;Javed Iqbal ,&nbsp;Brijesh Sathian","doi":"10.1016/j.wneu.2025.123946","DOIUrl":"10.1016/j.wneu.2025.123946","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 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 ,&nbsp;Dua Sarfraz ,&nbsp;Javed Iqbal ,&nbsp;Brijesh Sathian","doi":"10.1016/j.wneu.2025.123945","DOIUrl":"10.1016/j.wneu.2025.123945","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 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 ,&nbsp;Limin Guo ,&nbsp;Kailiang Li","doi":"10.1016/j.wneu.2025.123947","DOIUrl":"10.1016/j.wneu.2025.123947","url":null,"abstract":"<div><div>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 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. Subsequently, the patient underwent endovascular interventional embolization of the fistula, resulting in complete occlusion of the fistula. At the 1-month follow-up, the patient reported that the redness in his eyes had disappeared and his vision had improved.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 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,&nbsp;Alexander I. Evins","doi":"10.1016/j.wneu.2025.123948","DOIUrl":"10.1016/j.wneu.2025.123948","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 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}