World neurosurgery最新文献

{"title":"How to Choose the Measurement Methods for Cage Subsidence Following Anterior Cervical Discectomy and Fusion?","authors":"Chengkun Zhao,&nbsp;Shijie Wang,&nbsp;Jingjing Zhang,&nbsp;Hegang Niu,&nbsp;Yun Cao,&nbsp;Cailiang Shen,&nbsp;Yinshun Zhang","doi":"10.1016/j.wneu.2025.124485","DOIUrl":"10.1016/j.wneu.2025.124485","url":null,"abstract":"<div><h3>Background</h3><div>The methods for measuring cage subsidence from radiographs after anterior cervical discectomy and fusion were not standardized and are typically categorized into 3 approaches. The reliability and clinical correlation of these methods have not been fully elucidated. This study aims to evaluate 3 methods based on radiographs for measuring cage subsidence following anterior cervical discectomy and fusion and identify the most reliable one.</div></div><div><h3>Methods</h3><div>The patients with complete and clear lateral cervical radiographs were included in this study to assess subsidence. The cage migration into endplate height (ΔCMH), change in disc space height (ΔDH), and change in middle segment height (ΔMSH) were separately used to represent cage subsidence. The differences between the 3 measurement methods were compared. Interclass correlation coefficients were calculated to assess the reliability of the 3 measurement methods. Spearman's correlation coefficient was used to assess the clinical relevance of these 3 methods.</div></div><div><h3>Results</h3><div>A total of 105 patients with 142 levels were included in the study. There were significant differences between the ΔDH and the ΔCMH/ΔMSH methods, but not between the ΔCMH and ΔMSH methods. All methods presented good reliability, with the ΔMSH method showing the highest intra- and inter-observer interclass correlation coefficients. The subsidence values measured by ΔMSH showed good correlation with clinical outcomes, while those measured by the ΔDH and ΔCMH methods demonstrated poor clinical correlation.</div></div><div><h3>Conclusions</h3><div>The ΔDH method and the ΔCMH/ΔMSH method are not interchangeable within a single study. We recommend the ΔMSH method for measuring subsidence due to its relatively better reliability and clinical correlation.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124485"},"PeriodicalIF":2.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092458","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":"ML Prediction for SDS Blood Transfusion.","authors":"Meijia Luo, Xiaotian Lei, Zhendong Ding, Xubin Quan, Zhaohui Hu, Hao Jiang, Xin Zhou, Xiaolin Yu, Xiaozhu Liu, Yang Zhang, Tianyu Xiang, Kai Wang, Haizhen Ding, Chan Xu, Liuyi Zhang, Wenle Li, Wei Huang","doi":"10.1016/j.wneu.2025.124468","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124468","url":null,"abstract":"<p><strong>Background: </strong>Spinal deformity surgery (SDS) is usually accompanied by significant intraoperative blood loss and transfusion, which is not without risk, as transfusions can lead to transfusion reactions, transmission of infections, and immunosuppression. Therefore, limiting unnecessary intraoperative blood transfusion (IBT) by accurately predicting transfusion requirements is an important goal.</p><p><strong>Purpose: </strong>Constructing a predictive model for IBT in SDS based on multiple machine learning (ML).</p><p><strong>Method: </strong>Include patients with spinal deformities who received SDS at 11 large medical centers in China from 2012 to 2022. A total of 162 cases were randomized into a training cohort (70%) and a testing cohort (30%) with the outcome of IBT. A total of 39 candidate factors were collected, including basic personal data, medical comorbidities, surgery-related indicators, and preoperative blood draw indicators, among others. Lasso regression was used to screen potential modeling features. 10 ML algorithms incorporated include Logistic regression (LR), Decision tree, Elastic network, k-Nearest Neighbor (KNN), Neural Networks (NN), Light Gradient Boosting Machine (LightGBM), Random Forest (RF), eXtreme Gradient Boosting (XGBoost), Support Vector Machine (SVM) and Stacking ensemble model. The performance of these models was evaluated using operating characteristic curve (ROC), Precision-Recall, Calibration, and Decision curve analysis (DCA). In addition, SHapley Additive exPlanations (SHAP) was applied to interpret the predictive models. Finally, a web calculator and logistic analysis were created to quantify the hazard level of the features.</p><p><strong>Result: </strong>By comparing the training group, validation group and multiple parameter comparisons, the RF model had the strongest performance generalization ability (AUC of ROC: 0.8716; AUC of Precision-Recall: 0.8246; BS of Calibration curve: 0.142). Seven key variables were determined including age, BMI, Preoperative hematocrit, Fibrinogen, Prefunction, Bone graft and Number of levels fusion. Finally, Logistics determined that level 4 vertebral fusion surgery may have the greatest IBT risk (OR=20.78, 95% CI 3.9-110.83; P<0.001). A web calculator has also been established for clinical personnel to assess the risk of IBT.</p><p><strong>Conclusion: </strong>In this study, multiple ML algorithms were successfully established to predict the risk of IBT in SDS, thereby making reasonable use of blood resources and optimizing blood transfusion strategies.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124468"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087372","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":"Influence of Modic Changes on Lateral Vs Central Fusion Features in Stand-Alone Oblique Lumbar Interbody Fusion: A Retrospective Analysis of Outcomes, Imaging, And Histology.","authors":"Tong Yongjun, Qiu Xiaoming, Zhang Qibin, Huang Bao, Zhang Xuyang, Liu Junhui, Fan Shunwu, Zhao Fengdong","doi":"10.1016/j.wneu.2025.124486","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124486","url":null,"abstract":"<p><strong>Objective: </strong>Traditional lumbar interbody fusion evaluation emphasizes central bony bridging between endplates. However, Extra-Vertebral Bony Bridge (EVB) formation extending beyond the epiphyseal ring is frequently observed after Stand-Alone Oblique Lumbar Interbody Fusion (SA-OLIF), particularly in segments with Modic changes (MCs). This study aims to characterize this unique fusion pattern and investigate underlying biological mechanisms.</p><p><strong>Methods: </strong>A retrospective review of SA-OLIF procedures (July 2017-May 2023) was conducted. Surgical levels were stratified by the presence of MCs. Fusion characteristics, cage subsidence, and clinical outcomes (ODI, VAS) were compared. Annulus fibrosus samples underwent histology, immunohistochemistry, and RT-qPCR to evaluate osteogenic activity.</p><p><strong>Results: </strong>Of 132 patients initially reviewed, 105 met the inclusion criteria, and 98 patients (147 segments) were included in the final analysis. MCs were present in 63 segments. Overall lateral fusion rate was 50.3%, higher in MCs (61.9%) vs. non-MCs (41.7%) (p=0.015), with earlier fusion at 3 months (p<0.001). Lateral fusion correlated with preoperative osteophyte (p<0.001) and high endplate HU (p<0.001). Cage subsidence rates differed between MCs and non-MCs (p=0.018), and between fusion types (p<0.001). ODI and VAS scores improved significantly at all postoperative time points (p<0.001). MCs showed increased BMP-2 and OCN expression, and elevated mRNA levels of OCN, BMP-2, ALP, RUNX2, OPG, COL1A1, and FN1.</p><p><strong>Conclusions: </strong>SA-OLIF provides favorable outcomes with a high lateral fusion rate, particularly in segments with MCs. The early and frequent lateral fusion may be mediated by osteogenic activity in the annulus fibrosus, supporting SA-OLIF as an effective option for patients with normal BMD and MCs.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124486"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087632","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":"Innovative Approaches in Thoracic Surgery: Unilateral Biportal Endoscopy and 3D Printing in Managing Ligamentum Flavum Ossification","authors":"He-Qing Zhang,&nbsp;Xiao-Guang Fan,&nbsp;Lei-Sheng Wang,&nbsp;Jing-Jie Wang","doi":"10.1016/j.wneu.2025.124472","DOIUrl":"10.1016/j.wneu.2025.124472","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to assess the clinical efficacy of unilateral biportal endoscopy technology in conjunction with three-dimensional (3D) printing technology for treating thoracic spinal stenosis caused by thoracic ligamentum flavum ossification (TOLF).</div></div><div><h3>Methods</h3><div>A total of 21 patients diagnosed with TOLF through imaging who met surgical indications were selected. Demographic data, including sex, age, affected segments, etiological factors, operation duration, drainage volume, and postoperative complications, were documented. The modified Japanese Orthopaedic Association score was used to evaluate neurological function before and after the surgical intervention. Postoperative complications, including lower extremity deep vein thrombosis, neurological injury, cerebrospinal fluid leakage, and surgical site infection, were also recorded. Imaging studies, including computed tomography, magnetic resonance imaging, cross-sectional area of the spinal canal, and 3D printing models, were utilized to evaluate spinal cord compression and decompression outcomes.</div></div><div><h3>Results</h3><div>Among the 21 patients, 15 underwent single-segment decompression, and 6 underwent double-segment decompression. The average operation time for single-segment decompression was 95 minutes, while double-segment decompression averaged 125 minutes. The average drainage volume was 48 mL for single-segment and 80 mL for double-segment procedures. Computed tomography, magnetic resonance imaging, cross-sectional area of the spinal canal, and 3D-printed models demonstrated a significant increase in the effective volume of the spinal canal. The average recovery rate at 1 year postsurgery for patients with simple TOLF was recorded at 70 ± 11%, while that for double-segment cases was 57 ± 9.4%. There were no instances of lower extremity deep vein thrombosis, neurological injury, or surgical site infection among the patients. Only 2 patients experienced postoperative cerebrospinal fluid leakage.</div></div><div><h3>Conclusions</h3><div>Unilateral biportal endoscopy technology combined with 3D printing technology offers advantages such as minimal invasiveness, rapid recovery, and definite efficacy in the treatment of TOLF. This approach can significantly mitigate complications such as neurological deterioration.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124472"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087671","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":"Thoracic Kyphosis Reduction as the Important Compensatory Mechanism in Low-Grade Spondylolisthesis: A Correlation Analysis of Spinopelvic Parameters","authors":"Jinyi Bai ,&nbsp;Shu Liu ,&nbsp;Chi Peng ,&nbsp;Yingchuan Zhao ,&nbsp;Shuogui Xu","doi":"10.1016/j.wneu.2025.124484","DOIUrl":"10.1016/j.wneu.2025.124484","url":null,"abstract":"<div><h3>Background</h3><div>When spondylolisthesis occurs, several compensatory mechanisms are induced not only within the spine itself but also in the pelvis. We investigated the process of spine shift from a decompensated state to compensated malalignment. This study aimed to evaluate the sagittal plane malalignment and explore the major compensatory mechanism for maintaining sagittal balance in low-grade spondylolisthesis.</div></div><div><h3>Methods</h3><div>This was a retrospective study of 60 patients with low-grade spondylolisthesis and 30 volunteers without radiographical abnormalities of the spine and pelvis conducted between June 2016 and June 2017. Based on the Meyerding classification, 90 participants were divided into 3 groups: group A (n = 30), normal volunteers; group B (n = 30), patients with Meyerding grade I spondylolisthesis; and group C (n = 30), patients with Meyerding grade II spondylolisthesis. Correlation and partial correlation analyses between the slipping grade and spino-pelvic parameters were performed. One-way analysis of variance (ANOVA) was conducted to compare the effects of thoracic kyphosis (TK) and pelvic incidence (PI) in individuals with normal conditions as well as those with Meyerding grades I and II spondylolisthesis.</div></div><div><h3>Results</h3><div>A significant correlation was found between the grade of slipping and max thoracic kyphosis (maxTK) (r = −0.344, <em>P</em> = 0.002), PI (r = 0.601, <em>P</em> &lt; 0.001), sacrum slope (SS) (r = 0.354, <em>P</em> = 0.001), and pelvic tilt (PT) (r = 0.431, <em>P</em> &lt; 0.001), whereas no significant correlations were observed between the grade of slipping and age, bone mass index, sagittal vertical axis (SVA), and max lumbar lordosis. In partial correction, no significant correlations were observed in the grade of slipping and PT (r = 0.002, <em>P</em> = 0.988) and SS (r = −0.002, <em>P</em> = 0.988). A one-way ANOVA was conducted to compare TK and PI between the groups, and indicated there were significant effect at the <em>P</em> &lt; 0.05 level for the 3 conditions (<em>P</em> = 0.007, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Greater PI may lead to the development and progression of spondylolisthesis. In patients with low-grade spondylolisthesis, decreased TK acts as an important compensatory way to maintain sagittal balance, relative to the normal population.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124484"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081710","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":"Impacts of low BMI on fusion surgery for osteoporotic vertebral compression fracture: A National Readmission Database Analysis, 2016-2020.","authors":"Tsung-Hsi Huang, Yi-Chou Chen, Yu-Pao Hsu, Chih-Yu Yang","doi":"10.1016/j.wneu.2025.124476","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124476","url":null,"abstract":"<p><strong>Objective: </strong>Osteoporotic vertebral compression fractures (OVCFs) occur commonly among older adults and may require spinal fusion when instability or neurological compromise is present. Low body mass index (BMI), representing body weight relative to height, is often associated with frailty and undernutrition and may increase vulnerability to adverse surgical outcomes, but the influence of low BMI on OVCF fusion surgery remains unclear. This study aimed to evaluate associations between low BMI and short-term outcomes following spinal fusion for OVCFs in older adults.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data of older adults (≥50 years) undergoing spinal fusion for OVCF extracted from the US National Readmissions Database (NRD),2016-2020. Overweight or obese patients or those with malignancy were excluded. After 1:4 propensity score matching (PSM), multivariable regression models were used to assess outcomes.</p><p><strong>Results: </strong>The final matched cohort included 590 patients (118 low BMI, 472 normal BMI). Low BMI was significantly associated with 30- and 90-day readmission (OR = 2.66, 95% CI: 1.46-4.83; OR = 2.45, 95% CI: 1.52-3.96), discharge to long-term care (OR = 1.61, 95% CI: 1.09-2.39), longer hospital stays (β = 2.18 days, 95% CI: 0.17-4.19) and any postoperative complication (OR = 2.78, 95% CI: 1.86-4.14). Specific complications with significantly higher risks included dysphagia (OR = 2.42), pneumonia (OR = 2.82), sepsis (OR = 2.82), and blood transfusion (OR = 3.31), whereas a lower risk of wound dehiscence was observed (OR = 0.24).</p><p><strong>Conclusion: </strong>Low BMI is an independent risk factor for adverse short-term outcomes following spinal fusion for OVCFs, informing perioperative risk assessment and care planning.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124476"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087617","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 aesthetic outcomes after endoscopic versus open treatment for sagittal craniosynostosis according to Lausanne classification.","authors":"Giulia Cossu, Simon Mérillat, Teresa Lionetti, Daniele Starnoni, Agne Andriuskeviciute, Yann Bogli, Samia Messaoudi, Fanny Allano, Mahmoud Messerer","doi":"10.1016/j.wneu.2025.124473","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124473","url":null,"abstract":"<p><strong>Objective: </strong>The aesthetic outcome is one of the major determinants in the performance of surgical corrections of sagittal craniosynostosis. Parental satisfaction is underreported in literature and we used a modified Whitaker classification (Lausanne classification) to improve the stratification of aesthetic outcomes.The aim of this paper is to compare the aesthetic results of open remodelling surgery(ORS) versus endoscope-assisted suturectomy(EAS) for the correction of sagittal craniosynostosis for both surgeons and parents and to validate Lausanne classification.</p><p><strong>Methods: </strong>Paediatric patients diagnosed with sagittal craniosynostosis and operated by ORS or EAS between 2012 and 2022 were included.The aesthetic satisfaction was assessed using a modified version of the Whitaker classification, namely the Lausanne classification. Epidemiology, clinical and surgical outcomes were retrieved from electronic records and analysed for the two groups.</p><p><strong>Results: </strong>Forty patients were included in the study. Mean age at surgery was 3.4 months (± SD 0.6) for the EAS group and 7.0 months (± SD 2.0) for the ORS group (p < 0.0001). Aesthetic results were significantly better for the EAS than the ORS for both parents (p = 0.0014) and surgeons (p = 0.0013). Overall length of hospitalisation and length of stay at ICU were significantly shorter for the EAS than the ORS group (p < 0.0001 and p = 0.0007 respectively). We observed no differences in complication rates between the two cohorts.</p><p><strong>Conclusions: </strong>EAS treatment for sagittal craniosynostosis is a safe technique with better aesthetic results for both parents and surgeons according to Lausanne classification and shorter lengths of stay.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124473"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087624","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":"Active Exchange of CSF for Rapid Removal of Blood in Hemorrhagic Stroke: Multicenter Experience in 40 Patients","authors":"Behnam Rezai Jahromi ,&nbsp;Amir Reza Bahadori ,&nbsp;Albin Röblom ,&nbsp;Silja Soini ,&nbsp;Ammad Baig ,&nbsp;Jennifer Wilson Peltz ,&nbsp;Vikram Bhinder ,&nbsp;Ryan Hess ,&nbsp;Felix Göhre ,&nbsp;Ferzat Hijazy ,&nbsp;Päivi Tanskanen ,&nbsp;Jari Siironen ,&nbsp;Elad Levy ,&nbsp;Mika Niemelä ,&nbsp;Adnan Siddiqui ,&nbsp;Nicholas Brandmeir","doi":"10.1016/j.wneu.2025.124478","DOIUrl":"10.1016/j.wneu.2025.124478","url":null,"abstract":"<div><h3>Background</h3><div>Spontaneous intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) may present with intraventricular hemorrhage (IVH). Prior studies show IVH correlates with increased mortality and morbidity. Neuroinflammation from blood organization in cerebrospinal fluid (CSF) contributes to poor outcomes.</div></div><div><h3>Objective</h3><div>We hypothesized that active external ventricular drainage (EVD) would accelerate blood removal, reducing adverse events. Study sites used double-lumen EVDs with active irrigation and intracranial pressure control via passive drainage.</div></div><div><h3>Material and Methods</h3><div>Data from 6 centers in the EU and USA were analyzed. Forty patients in total were included: 21 with SAH, 13 with spontaneous ICH-related IVH, and 6 with vascular anomaly-related hemorrhage. Blood removal was assessed via CT imaging. Shunt dependency in SAH patients was calculated using CHESS scores.</div></div><div><h3>Results</h3><div>Blood removal via active EVD was safely achieved. Removal pace correlated with irrigation volume. All 13 ICH patients had median IVH clearance of 91.3% (range: 0.7%–100%) over 7.6 days. SAH patients showed lower shunt dependency (2) than expected (11) per CHESS scores and literature. The vascular anomaly group had median IVH clearance of 91.3% over 8 days. No CSF exchange-related infections occurred.</div></div><div><h3>Conclusions</h3><div>Accelerated blood removal from the CSF system via active EVD is safe and feasible. Active irrigation reduced adverse events. Blood clearance is strongly linked to irrigation rate. Prospective trials are needed to identify the patient population most likely to benefit from CSF exchange during hemorrhagic stroke treatment.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124478"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081755","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":"Keyhole Interlaminar Dorsal Rhizotomy: Assessing the Feasibility, Efficacy, and Innocuity of the Technique in one Center","authors":"Anthony Joud ,&nbsp;Fred Bteich ,&nbsp;Fanny Dalmont ,&nbsp;Irene Stella ,&nbsp;Olivier Klein ,&nbsp;Marc Sindou","doi":"10.1016/j.wneu.2025.124477","DOIUrl":"10.1016/j.wneu.2025.124477","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this article was to study the feasibility, efficacy, and innocuity and explore the nature of the complications of the keyhole interlaminar dorsal rhizotomy (KIDr) technique in the pediatric neurosurgery department in Nancy between 2018 and 2023.</div></div><div><h3>Methods</h3><div>We carried out a retrospective analysis of 62 children, who were operated on at our institution between January 2018 and December 2023, using a KIDr technique. We noted the duration of the surgery, as well as the intraoperative difficulties faced, which would help assess the feasibility of the surgical modality used. We also controlled the evolution of the spasticity using the Modified Ashworth Scale before and one year after the surgery, as well as the Gross Motor Function Classification System. We finally assessed the complications that occurred during the year that followed the procedure.</div></div><div><h3>Results</h3><div>In our series of 62 patients analyzed over 5 years, the average length of surgery was 250.3 minutes with a real learning curve. We had no complications during the procedure, except in 1 patient with a particular morphology. Prolonged electrophysiological monitoring was required in 8 patients but had no surgical consequences. During the first year that followed the surgery, we had a similar rate of complications to that of other selective dorsal rhizotomy (SDR) techniques described in the literature. The surgical efficacy was evaluated using the Gross Motor Function Classification System at one year, with 8 patients improving, with the others remaining clinically stable. The spasticity, which was assessed with the Modified Ashworth Scale at one year, showed a real improvement, going from an average score of 2.8 before the surgery to 0.53 afterward.</div></div><div><h3>Conclusions</h3><div>The KIDr shows similar results to other previously described SDR techniques in terms of operating time, intraoperative, and postoperative complications, functional results, and when it comes to the assessment of the spasticity at one year. It could be considered as a real surgical alternative to perform an SDR.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124477"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply to the Letter to the Editor Regarding “Improving Neurosurgical Care in Egypt: A Questionnaire-Based Study of Neurosurgeons' and Patients' Perspectives on Risk Factors for Malpractice Claims”","authors":"Islam Abdelsamad","doi":"10.1016/j.wneu.2025.124475","DOIUrl":"10.1016/j.wneu.2025.124475","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124475"},"PeriodicalIF":2.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081693","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}