World neurosurgery最新文献

{"title":"CUSUM and RA-CUSUM Analysis of the First-Year Learning Curve for UBE in a Neurosurgeon with Endoscopic Skull Base Experience.","authors":"Eren Yılmaz, Atakan Emengen, Aykut Gökbel, Ayse Uzuner, Mehmet Korkmaz, Sibel Balci, Abdullah Merter, Savas Ceylan","doi":"10.1016/j.wneu.2025.124523","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124523","url":null,"abstract":"<p><strong>Background and objectives: </strong>Unilateral biportal endoscopy(UBE) has emerged as a minimally invasive alternative for lumbar spine surgery; however, its learning curve still presents certain challenges. This study aimed to evaluate the learning curve of UBE during its first year of adoption by a neurosurgeon with extensive endoscopic skull base surgery experience, using both cumulative sum(CUSUM) and risk-adjusted CUSUM(RA-CUSUM) analyses.</p><p><strong>Methods: </strong>Between May 2024 and May 2025, a total of 108 patients who underwent UBE were retrospectively analyzed. Procedures included lumbar discectomy(UBE-LD, n=89) and unilateral laminotomy for bilateral decompression(UBE-ULBD, n=19). CUSUM and RA-CUSUM analyses were applied to identify learning curve inflection points.</p><p><strong>Results: </strong>The mean operative time was 69.49±30.23 minutes. Perioperative or postoperative complications occurred in 10 patients(9.3%). CUSUM analysis demonstrated a significant cut-off point at the 26th case in the overall cohort(95% CI:28-37), and at the 17th case in patients with LDH(95% CI:15-20). RA-CUSUM analysis revealed that complication rates stabilized after the 49th case in the overall series(95% CI:45-55) and after the 35th case in the LDH subgroup(95% CI:31-42).</p><p><strong>Conclusions: </strong>This study provides a detailed assessment of the learning curve for unilateral biportal endoscopic spinal surgery from the perspective of a neurosurgeon with prior endoscopic skull base experience. Using both CUSUM and RA-CUSUM analyses, the transition points to technical and clinical proficiency were objectively defined. These results emphasize the role of previous endoscopic experience in facilitating a shorter learning process and underscore the value of individualized, risk-adjusted analyses for accurately evaluating surgical performance.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124523"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225997","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":"Superficial Temporal Artery-to-M2 Bypass and Clip Trapping of a Ruptured Fusiform MCA Aneurysm.","authors":"Madeleine P de Lotbiniere-Bassett, William T Couldwell, Robert C Rennert","doi":"10.1016/j.wneu.2025.124521","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124521","url":null,"abstract":"<p><p>Fusiform intracranial aneurysms (IAs) can be challenging to treat, especially when ruptured.^1-3 Clip trapping and bypass is an important treatment modality for complex IAs not amenable to endovascular approaches (i.e., stent-assisted coiling, flow diversion), which can be limited by low occlusion rates and anatomical constraints (e.g., tortuosity, proximity to branching vessels).^4,5 Here we highlight the treatment considerations and technical steps for clip trapping and intracranial bypass of a previously ruptured middle cerebral artery fusiform aneurysm. A 76-year-old man with a history of atrial fibrillation presented with subacute progressive headaches and lower-extremity weakness one month after admission elsewhere for reported hypertensive hemorrhage. Imaging demonstrated a right-sided 4.3×3.0-mm fusiform IA involving the proximal nondominant anterior temporal M2 artery and subacute bilateral basal ganglia strokes, presumably from vasospasm; prior imaging showed a right peri-sylvian hemorrhage. He was neurologically intact, except for diffusely weakened lower extremities (4/5). Endovascular treatment options were dismissed because of small vessel size and his hesitance toward dual-antiplatelet therapies. Vessel sacrifice was not selected because of the stroke risk. A clip-trapping and flow-preserving bypass was selected for treatment, with superficial temporal artery (STA)-M2 selected because there was a large frontal STA donor branch and nondominant M2 recipient vessel. After uneventful surgery, postoperative imaging demonstrated complete aneurysm occlusion, a patent bypass filling the temporal M2, and no new strokes. The patient returned to his prehemorrhage baseline by 2-month follow-up. Flow-preserving cerebral bypass remains an important skill for the management of complex IAs in properly selected patients in the endovascular era.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124521"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213863","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":"Patient Perceptions on Operative Reports Written by Surgeons Versus Versions Simplified by Artificial Intelligence.","authors":"James Pan, Evgeniya Tyrtova, Diana B Wiseman, Christine Park, Christoph P Hofstetter","doi":"10.1016/j.wneu.2025.124519","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124519","url":null,"abstract":"<p><strong>Background and objectives: </strong>The inherent complexity of medical documents remains a barrier to patient literacy and engagement. Aligning these documents with specific patient literacy levels and reading preferences without compromising semantic meaning can improve patient comprehension and participation in their care. This study evaluates the effectiveness of the GPT-4 large language model in simplifying operative reports, assess patient preferences for original versus artificial intelligence (AI) simplified reports, and elucidate attitudes on AI in medical documentation.</p><p><strong>Methods: </strong>A two-phase prospective study was conducted from June to October 2023. We surveyed adults 18 years or older who had undergone spine surgery. A total of 3,932 patients were identified, with 360 completing the initial survey, and 251 completing the subsequent evaluation. Phase 1 involved surveying patient preferences and attitudes towards operative reports and AI. Phase 2 involved comparing patients' perceptions of their original operative reports to those simplified by AI. Reports were also reviewed by two independent physicians for quality and safety. The primary outcome measured was patient preference for either the original or the AI-simplified operative report. Secondary measures included readability, comprehensibility, overall satisfaction with the document, linguistic metrics, and physician review.</p><p><strong>Results: </strong>The primary outcome showed that 55.4% (95% CI 48.6-61.2%) of participants preferred the GPT-simplified reports for being significantly clearer (mean 1.53±0.83 vs 1.98±1.92, p<0.001), terminology being more accessible (mean 1.50±0.70 vs 2.31±0.89, p<0.001), and overall, more understandable (mean 86.40±18.07 vs 73.70±20.82, p<0.001). Those with a bachelor's degree and below preferred the GPT-simplified report in higher proportion (59.6%, 95% CI 52.0-67.0%) of cases.</p><p><strong>Conclusions: </strong>This study suggests that operative reports simplified by AI can facilitate patient understanding. However, preferences varied according to patient demographics, indicating the need for individualized approaches to simplification. Further research is necessary to optimize the use of AI for personalized patient education and to evaluate the long-term impact on healthcare outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124519"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213778","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":"An International Course on Intraoperative Ultrasound in Neurosurgery: Evaluation of a Multi-center, Hands-on Courses in Promoting Familiarity and Use of Intraoperative Ultrasound in Neurosurgery.","authors":"Mercy H Mazurek, Mohamed J Bassa, Llewellyn Padayachy, Ethan A Wetzel, Aliasgar Moiyadi, Alessandro Perin, Cristian de Quintana, Francesco Prada, Brian V Nahed, Francesco DiMeco, Geirmund Unsgård","doi":"10.1016/j.wneu.2025.124524","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124524","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intraoperative ultrasound (ioUS) is a real-time imaging tool with the potential to improve neurosurgical outcomes; however, its adoption is hindered by the need for specialized training. Structured educational programs have been successful in improving proficiency and promoting their utility. This study evaluated the impact of an international ioUS training course on participants' familiarity, comfort, and ability to apply ioUS in routine neurosurgical procedures.</p><p><strong>Methods: </strong>Twenty-one ioUS courses were held across 12 countries (brainultrasound.org), featuring lectures, simulations, and hands-on training sessions. The curriculum covered ultrasound physics, artifacts, tumor characterization, 3D navigated ultrasound, and ioUS-guided procedures. Pre- and post-course surveys were administered at four courses-Cape Town (12/2023), Edinburgh (01/2024), Barcelona (04/2024), and Porto (05/2024)-to assess changes in knowledge and comfort.</p><p><strong>Results: </strong>Sixty-seven neurosurgeons and residents participated (19 in Cape Town, 20 in Edinburgh, 16 in Barcelona, and 12 in Porto), with a 100% survey response rate. The median scores improved for familiarity with ioUS (4-8), comfort with its functionality (4-7), probe selection (4-8), image acquisition (4-8), and interpretation (4-8). Comfort in ioUS-guided procedures improved for ventricular catheter insertion (3-7), endoscopy (3-6), tumor resection (4-7), and Chiari I decompression (3-6). Participants reported a median likelihood of 9 (out of 10) for using ioUS in future practice.</p><p><strong>Conclusions: </strong>The course significantly improved the participants' confidence and skills in performing ioUS. Structured training effectively bridges knowledge gaps and supports the broader adoption of ioUS in neurosurgical practice.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124524"},"PeriodicalIF":2.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207888","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":"Endoscope-assisted Transcranial Surgery for Petroclival Meningiomas: a Single Centre Experience.","authors":"Xiaoyu Ji, Siyuan Yang, Peng Zhou, Mingzhe Sun, Liang Sun, Weiwei Zhai, Zhengquan Yu, Jiang Wu","doi":"10.1016/j.wneu.2025.124516","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124516","url":null,"abstract":"<p><strong>Objective: </strong>The surgical management of petroclival meningioma (PCM) remains a challenge in neurosurgery. This study compared the outcomes of endoscope-assisted microsurgery and conventional microscopic approaches to evaluate the safety and efficacy of endoscope-assisted transcranial techniques for PCM treatment.</p><p><strong>Methods: </strong>This retrospective case-control study was conducted at our hospital. Clinical data from January 2018 and June 2024 were retrospectively analysed. The primary outcome was gross total resection (GTR) rate, and the secondary outcomes included patient status, tumour progression or recurrence. Propensity score matching (PSM) was used to account for group differences.</p><p><strong>Results: </strong>We enrolled 62 patients; 18 underwent endoscope-assisted transcranial surgery and 44 underwent transcranial microscopic surgery. The endoscope-assisted transcranial microsurgery group exhibited a higher GTR rate, shorter postoperative hospital stay, and lower tumour progression or recurrence rates than the transcranial microscopic surgery group (GTR: 83.3% vs. 52.3%, p = 0.046; postoperative hospital stay duration: 9.50 d [8.00, 13.75] vs. 13.00 d [10.00, 17.25], p=0.023; and lower tumour progression or recurrence: 11.1% vs. 50%, p = 0.01). After PSM, the endoscope-assisted surgery group had a better GTR rate, compared with the microsurgery group (odds ratio (OR): 7.51 [1.37, 41.10], 95% confidence interval: 1.37-41.10, p = 0.021).</p><p><strong>Conclusion: </strong>Petroclival meningioma remains a surgical challenge. Endoscope-assisted microsurgery provides an increased GTR rate, offering excellent visualisation and access to tumours. Therefore, it may be recommended as a first-line treatment for patients with PCM.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124516"},"PeriodicalIF":2.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193371","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":"Results of Spine Surgeries in Nonagenarians Compared with Octogenarians: A Propensity-Matched Analysis.","authors":"Takashi Sono, Takayoshi Shimizu, Koichi Murata, Koichiro Shima, Masaki Sakamoto, Ryohei Saito, Soichiro Masuda, Kazuaki Morizane, Kosei Ono, Yu Shimizu, Taisuke Yabe, Atsushi Tanaka, Yushi Sakamoto, Shinji Kawaguchi, Takaki Nakashima, Naoya Tsubouchi, Takuya Tomizawa, Yusuke Kanba, Takeru Kataoka, Shuichi Matsuda, Bungo Otsuki","doi":"10.1016/j.wneu.2025.124520","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124520","url":null,"abstract":"<p><strong>Purpose: </strong>While spinal surgery is common in octogenarians, it is less frequent in nonagenarians. Most research highlights complications and mortality, but few studies compare actual recovery outcomes between these groups. This study examines how spinal surgery outcomes differ between nonagenarians (people in their 90s) and octogenarians (people in their 80s).</p><p><strong>Methods: </strong>This study included patients aged 80-99 years who underwent spinal surgery between 2017 and 2022 at Kyoto University Hospital and affiliated institutions. Patients who underwent spinal surgery for degenerative disease or trauma and were followed up for more than one year were included. Exclusion criteria comprised surgeries limited to balloon kyphoplasty and procedures for tumors or infections. Patients were matched 1:1 based on sex, body mass index, modified Frailty Index-5 score, and American Society of Anesthesiologists Physical Status grade. Clinical outcomes, including preoperative and postoperative Japanese Orthopedic Association (JOA) scores and JOA recovery rates, and perioperative complications were analyzed.</p><p><strong>Results: </strong>Each group consisted of 41 patients. Nonagenarians exhibited significantly lower preoperative JOA scores compared with octogenarians (8.9 vs. 12.2, p=0.02). However, there were no significant differences in postoperative JOA scores (15.4 vs. 17.6) or JOA recovery rates (33.6% vs. 38.1%) between the two groups. There were no significant differences in perioperative complications.</p><p><strong>Conclusion: </strong>Despite lower preoperative JOA scores, nonagenarians achieved postoperative outcomes comparable to those of octogenarians, with similar recovery rates. These findings suggest that spinal surgery can yield satisfactory results in nonagenarians, highlighting the importance of careful patient selection and thorough risk assessment to optimize outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124520"},"PeriodicalIF":2.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193315","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":"Evaluation Of Presurgical Outcome Predictors In Oncological Neurosurgery.","authors":"Michela E Moretti, Morgan Broggi, Marco Schiariti, Francesco Restelli, Edoardo M Barbieri, Marco M Fontanella, Davide Maltoni, Antonio Fioravanti, Cesare Zoia, Andrea Montalbetti, Matilde Leonardi, Giorgia Camarda, Elisabetta Soldini, Leonardo Maresca, Luca Mattioli, Riccardo Ciocca, Erica Boccardi, Francesco Dimeco, Paolo Ferroli","doi":"10.1016/j.wneu.2025.124518","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124518","url":null,"abstract":"<p><strong>Background: </strong>Brain tumor (BT) resection carries a significant risk of postoperative functional impairment. Existing surgical complexity scales (e.g., Milan Complexity Scale) do not account for factors such as preoperative tumoral edema or deep tumor location (DTL), which may influence outcome. This study evaluates whether these variables improve prediction of six-month postoperative functional outcomes.</p><p><strong>Methods: </strong>We conducted a prospective multicenter cohort study including 231 patients undergoing BT resection. Preoperative variables (tumor size, eloquence, deep location, vascular/cranial nerve manipulation, posterior fossa location, edema) were collected. Functional status was assessed preoperatively and six months postoperatively using the Karnofsky Performance Scale (KPS) and modified Rankin Scale (mRS). Patients were grouped based on whether their six-month KPS/mRS scores worsened versus remained stable/improved. Correlations and multivariate logistic regression identified predictors of functional decline. Hierarchical clustering explored risk combinations.</p><p><strong>Results: </strong>Among 231 patients, 59% had tumors located in eloquent areas, 18% in DTL and 39% presented with edema. Both preoperative edema and DTL were significantly associated with functional deterioration at six months. Multivariate analysis identified edema (p=0.011), eloquent region involvement (p=0.037), vascular manipulation (p=0.040), tumor size >4 cm (p=0.041) and DTL (p=0.046) as independent predictors of decline. Cluster analysis showed that combinations of adverse factors-particularly edema, large size, deep or posterior fossa location, and neurovascular manipulation-were associated with the highest risk of poor outcomes.</p><p><strong>Conclusions: </strong>Preoperative tumoral edema and DTL are underrecognized predictors of functional deterioration after BT surgery. Their inclusion in preoperative risk models could enhance prognostic accuracy and guide surgical decision-making in neuro-oncology.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124518"},"PeriodicalIF":2.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193339","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":"A Novel Switching Portal Technique in Biportal Endoscopic Transforaminal Lumbar Interbody Fusion: Technical Notes and Comparative Outcomes.","authors":"Yun-Da Li, Chi-An Luo, Yung-Hsueh Hu, Wen-Chien Chen, Tsung-Ting Tsai, Po-Liang Lai, Tsai-Sheng Fu","doi":"10.1016/j.wneu.2025.124511","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124511","url":null,"abstract":"<p><strong>Objective: </strong>The use of a fixed portal arrangement during biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) may result in suboptimal instrument trajectory angles, leading to inadequate endplate preparation or difficulties in cage implantation. Therefore, we propose the switching portal technique, which enables the operator to switch the viewing and instrument portals. The aim of this study is to describe our surgical technique and present comparative outcomes.</p><p><strong>Methods: </strong>This study included 74 consecutive patients who underwent BE-TLIF at a total of 82 levels between January 2021 and July 2023 and were followed for at least 1 year after surgery. Patients were divided into two groups, the fixed portal group and the switching portal group, according to whether the switching portal technique was used for endplate preparation and insertion trajectory adjustment. Clinical and radiographical outcomes were analyzed between the two groups.</p><p><strong>Results: </strong>Endplate injuries were significantly more common in the fixed portal group than in the switching portal group. The modified McNab's criteria were not significantly different between the groups, but the switching portal group had a greater proportion of excellent and good outcomes (92.3%) than the fixed portal group did (82.9%). Cage subsidence occurred in 20.5% of patients in the fixed portal group and 4.7% in the switching portal group.</p><p><strong>Conclusions: </strong>The switching portal technique is safe and useful in BE-TLIF, as it enables effective disc preparation and ensures a precise trajectory for cage insertion, thereby significantly reducing the risks of endplate injury and cage subsidence.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124511"},"PeriodicalIF":2.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182212","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":"Robotic-guided percutaneous pedicle screw implantation using CIRQ Robotic Alignment Module.","authors":"Mirza Pojskic, Miriam Bopp, Christopher Nimsky, Benjamin Saß","doi":"10.1016/j.wneu.2025.124512","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124512","url":null,"abstract":"<p><p>CIRQ® Robotic Alignment Module is a second generation of Brainlab® (Munich, Germany) robotic arm (1). Previous studies have described use of the first generation with the so called passive assistance (2-5). In this operative video we demonstrate robotic-guided K-wire implantation using second generation with active assistance, followed by navigated pedicle screw implantation in lumbar spine in a patient with instability due to infection(6). Workflow includes preoperative screw planning, iCT with automatic registration, fusion with preoperative imaging and review of the preplanned screw trajectories, robotic-assisted insertion of K-wires and navigated insertion of pedicle screws, followed by control iCT scan(1, 7). Our operative video adds to the growing body of literature demonstrating minimally invasive robotic assisted spinal fusion techniques(8).</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124512"},"PeriodicalIF":2.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182249","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 and radiological differentiation of thoracic spinal meningiomas and schwannomas: insights from the Sapporo-Iowa Joint Study.","authors":"Satoka Shidoh, Kazutoshi Hida, Toru Sasamori, Ikuma Echizenya, Shunsuke Yano, Prabin Shrestha, Jangbo Lee, Matthew A Howard, Satoshi Yamaguchi","doi":"10.1016/j.wneu.2025.124509","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124509","url":null,"abstract":"<p><strong>Objective: </strong>Meningiomas and schwannomas are the most common intradural extramedullary spinal tumors, but differentiating between them remains challenging. This study aimed to identify clinical and growth pattern differences between the two thoracic spinal tumors beyond previously reported imaging signs.</p><p><strong>Methods: </strong>We retrospectively reviewed 114 patients with histologically confirmed thoracic spinal meningiomas (n = 74) and schwannomas (n = 40) from the Sapporo-Iowa Joint Study. Demographics, clinical symptoms, tumor location, imaging findings (dural tail sign, ginkgo leaf sign, cyst), tumor volume, and spinal cord compression metrics were analyzed.</p><p><strong>Results: </strong>Meningiomas demonstrated a higher female predominance (88% vs. 48%, p < 0.001) and older mean age at onset (69.2 vs. 59.4 years, p < 0.001). Schwannomas were more frequent in the lower thoracic spine (80%, p < 0.001). The dural tail sign was more common in meningiomas (53% vs. 20%, p < 0.001), whereas cysts occurred exclusively in schwannomas (35%, p < 0.001). Motor deficits were more frequent in meningiomas (91% vs. 55%, p < 0.001), whereas pain predominated in schwannomas (83% vs. 28%, p < 0.001). Schwannomas had a larger median volume but caused less cord compression. Multivariate analysis identified three independent predictors for schwannoma: pain (odds ratio [OR], 12.1), lower thoracic location (OR, 9.67), and tumor height (OR, 1.30). A scoring system based on these predictors showed strong diagnostic performance (area under the curve [AUC] = 0.874).</p><p><strong>Conclusion: </strong>Thoracic spinal meningiomas and schwannomas exhibit distinct clinical and radiological profiles. The proposed scoring system may support preoperative differentiation and decision-making.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124509"},"PeriodicalIF":2.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179135","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}