World neurosurgery最新文献

{"title":"The feasibility of prepsoas oblique lumbar interbody fusion (OLIF) at L5/S1 level --- a radiographic and clinical research.","authors":"Pengchao Yang, Yimin Dong, Pengju Wang, Yong Xu, Honglei Kang, Feng Li, Hanfeng Guan","doi":"10.1016/j.wneu.2025.124294","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124294","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective clinical study with prospective data collection.</p><p><strong>Objective: </strong>To investigate the feasibility of prepsoas OLIF at L5-S1 level and propose a new practical framework for approach selection of OLIF51.</p><p><strong>Methods: </strong>The feasibility of left-sided and right-sided prepsoas approaches was graded as easy, advanced and difficult depending on retraction distance (RD) and perivascular adipose tissue (PAT) in the radiographic study. The classification results were summarized and the OLIF51 approach selection framework was proposed to guide the subsequent clinical research. The clinical outcomes and incidence of complications were compared between two groups in which the inpatients underwent OLIF51 from 2019 to 2022.</p><p><strong>Results: </strong>Among the 200 consecutive randomized outpatients who met the inclusion criteria, the easy, advanced and difficult cases of left-sided prepsoas were 19, 158 and 23 respectively with right-sided prepsoas (40, 160, 0). Guided by the proposed framework, 65 inpatients underwent left-sided prepsoas OLIF51 were enrolled in group A and 71 inpatients underwent right-sided prepsoas OLIF51 were enrolled in group B. There was no significant difference in demographic and preoperative follow-up results. The ORT for OLIF51 alone was shorter in group B than group A. Operations were successfully completed in all patients of group B. In group A, sufficient exposure was not achieved in four patients(6.2%). Ligation of the iliolumbar vein was needed for adequate exposure in 16(24.6%) patients from group A and 14(19.7%) from group B. Postoperative clinical outcomes were improved and not significantly different between two groups.</p><p><strong>Conclusion: </strong>Prepsoas OLIF51 is feasible, which can serve as alternative approaches for anterior interbody fusion of L5-S1 according to preoperative imaging evaluation. Although there is no difference in the therapeutic effect between two groups, the right-sided prepsoas approach was preferred with its greater feasibility and advantages.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124294"},"PeriodicalIF":1.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668654","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 Outcomes of Microsurgical Flow Reconstruction in Long-Segment Cervical ICA Stenosis with Distal Grade 2 or 3 Kinking","authors":"Ertugrul Pinar M.D. ,&nbsp;Baylar Baylarov M.D. ,&nbsp;Efecan Cekic M.D ,&nbsp;Fatih Akbulut M.D. ,&nbsp;Aymer Cosar M.D. ,&nbsp;Mehmet Erkan Ustun M.D., Ph.D","doi":"10.1016/j.wneu.2025.124281","DOIUrl":"10.1016/j.wneu.2025.124281","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate the clinical outcomes of perivascular sympathectomy-assisted arteriolysis combined with kinking correction in patients with long-segment cervical internal carotid artery (ICA) stenosis accompanied by Grade 2 or 3 distal kinking.</div></div><div><h3>Methods</h3><div>Nineteen patients with symptomatic, non-atherosclerotic, ≥5 cm-long tubular ICA stenosis and distal kinking (Grade 2 or 3) underwent microsurgical decompression between 2017 and 2023. Surgical intervention included circumferential arteriolysis, perivascular sympathectomy, and correction of the kinking. Clinical symptoms such as hemiparesis, dysphasia, seizures, migraine, and tinnitus were assessed pre- and postoperatively up to 24 months. Radiological outcomes were evaluated using CT/MR angiography and perfusion imaging. Pre- and postoperative vessel diameters were measured intraoperatively. The analysis used SPSS and statistical significance was set at p&lt;0.05.</div></div><div><h3>Results</h3><div>Significant postoperative symptom resolution was observed in hemiparesis (100%), motor dysphasia (100%), migraine (88.9%), and seizures (83.3%). Intraoperative diameter of the ICA increased by 1.5–2-fold following sympathectomy (mean pre-op diameter: 3.4 mm; post-op: 7.5 mm; <em>p</em> &lt; 0.001). Perfusion imaging demonstrated improved cerebral blood flow in the affected vascular territory in all patients.</div></div><div><h3>Conclusion</h3><div>Microsurgical flow reconstruction using arteriolysis and perivascular sympathectomy with kinking correction is a promising technique for select patients with complex cervical ICA stenosis not amenable to endovascular treatment. It achieves significant symptomatic relief and improves hemodynamic parameters without major complications.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"201 ","pages":"Article 124281"},"PeriodicalIF":2.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive cyst drainage for cystic craniopharyngioma: Neuroendoscopic fenestration or Stereotactic cyst drainage?","authors":"Ao Chen, Tao Sun","doi":"10.1016/j.wneu.2025.124285","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124285","url":null,"abstract":"<p><strong>Purpose: </strong>The prognosis and optimal surgical techniques of minimally invasive cyst drainage (MICD) for cystic craniopharyngioma are poorly defined. The aim of this study was to evaluate the effect of neuroendoscopic fenestration versus stereotactic cyst drainage for cystic craniopharyngioma, based on two observational cohorts.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of prospectively collected clinical data from 39 craniopharyngioma patients treated with MICD between January 2015 and February 2025 at two neurosurgical centers in the same institution. All patients underwent either neuroendoscopic fenestration (n=21) or stereotactic cyst drainage (n=18), with Ommaya reservoir system (ORS) placement for potential cyst recurrence management. The primary outcome was tumor recurrence/progression, assessed through survival analysis using the Kaplan-Meier method, with prognostic factors identified via proportional hazards modeling. Secondary outcomes included visual and endocrine function results and surgical complications.</p><p><strong>Results: </strong>The distribution of preoperative clinical and tumor-related data was balanced between the two cohorts. In the entire mixed cohort, at a median follow-up of 40 months, tumor progression occurred in 48.7% of the patients. The neuroendoscopic group had lower progression than in the stereotactic group (38.1% vs. 61.1%). Neuroendoscopy achieved a greater reduction in postoperative cyst volume (P=0.011); the neuroendoscopic group had longer progression-free survival (median PFS: 66 months VS.41 months, P=0.064), and needed fewer therapeutic interventions than the stereotactic group. No patient suffered obvious visual functional decline, and the risk of endocrine deterioration was similarly low in both groups (P=0.341). In addition, neuroendoscopy was associated with fewer surgical complications.</p><p><strong>Conclusion: </strong>MICD is associated with low surgical morbidity and a relatively high cyst recurrence rate. Neuroendoscopic fenestration shows potential in delaying tumor progression and reducing the need for late interventions.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124285"},"PeriodicalIF":1.9,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650666","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":"Does Intraoperative Anal Area Covering Affect the Incidence and Causative Organisms of Surgical Site Infection After Posterior Lumbosacral Fusion Surgery?","authors":"Shuixia Li, Jun-Song Yang, Miao Wang, Hong Wang, Wen Chi, Jian Zhao, Xiaoli Chen, Jing Hu","doi":"10.1016/j.wneu.2025.124280","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124280","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates the impact of intraoperative anal area coverage on the incidence and causative organisms of surgical site infections (SSIs) following posterior lumbosacral fusion surgery.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 1226 patients who underwent posterior lumbosacral fusion surgery. Patients were divided into two groups based on whether intraoperative anal area coverage was used. Surgical site infection (SSI) rates, pathogen profiles, and perioperative parameters were recorded and compared between groups. Multivariable regression analysis was performed to assess the impact of intraoperative anal area coverage and other factors (e.g., BMI, intraoperative blood loss, drainage volume) on SSI incidence.</p><p><strong>Results: </strong>The findings demonstrate a significant reduction in the incidence of SSIs in the group where the anal area was covered during surgery. Additionally, the causative organisms differed between the covered and uncovered groups, with a lower incidence of gram-negative bacteria from gastrointestinal and urinary sources in the covered group. Multivariable regression analysis identified several factors associated with the incidence of surgical site infections (SSI) following posterior lumbosacral fusion surgery. Intraoperative anal area coverage was significantly associated with a reduction in SSI rates (β = -0.85, 95% CI -1.55 to -0.15, P = 0.024), indicating a protective effect. BMI (β = 0.15, P = 0.045), intraoperative blood loss (β = 0.01, P = 0.039), and drainage volume (β = 0.10, P = 0.018) were also significantly associated with increased SSI risk. Age and surgery duration were not statistically significant factors.</p><p><strong>Conclusions: </strong>Intraoperative coverage of the anal area appears to be an effective measure in reducing the incidence of SSIs following posterior lumbosacral fusion surgery. This practice also alters the microbial landscape, reducing the prevalence of gram-negative bacteria associated with gastrointestinal and urinary tracts, thereby improving infection prevention strategies.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124280"},"PeriodicalIF":1.9,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650665","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":"Microsurgical Management of Previously Coiled Intracranial Aneurysms.","authors":"Keng Siang Lee, Julian Han, Ramez Kirollos, Pascal Jabbour, Michael T Lawton","doi":"10.1016/j.wneu.2025.124297","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124297","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124297"},"PeriodicalIF":1.9,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638211","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 Lumbar Disc Herniation Classification Based on Endplate Destruction.","authors":"Hao Tang, Kai Hu, Xiao Ma, Yuankang He, Dong Li, Jiacheng Zhang, Tianwen Ye","doi":"10.1016/j.wneu.2025.124286","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124286","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to propose a new classification system based on endplate destruction for lumbar disc herniation to guide the selection of clinical treatment strategies.</p><p><strong>Methods: </strong>300 patients were included in our center from January 2016 to March 2023. Patients were followed up for two years. During the follow-up, basic demographic information, treatment plans, and the Oswestry Disability Index scores and Visual Analog Scale scores were collected. These data were used to evaluate the clinical efficacy of treatment protocols for each type of the new classification system. We performed variable selection using machine learning techniques and constructed a nomogram based on the selected important variables. Finally, we evaluated the model's performance on the validation set using the area under the receiver operating characteristic curve as the evaluation metric.</p><p><strong>Results: </strong>The study found that type A patients had the most severe initial symptoms, type C patients had the mildest, and type B patients' initial symptoms were intermediate. Patients with type C predominantly chose conservative treatment. Conversely, a higher proportion of type A patients chose surgical treatment. For type B patients, conservative treatment should be the primary approach. Machine learning analysis revealed that age and classification are key factors influencing surgical decision-making in patients. The predictive performance of the nomogram, validated by an AUC of 0.74, demonstrates high accuracy.</p><p><strong>Conclusions: </strong>Our novel classification system demonstrates excellent reliability. The findings of our study suggest that this classification provides significant reference value for guiding the formulation of treatment plans.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124286"},"PeriodicalIF":1.9,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638210","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":"Unveiling late adverse effects after stereotactic radiosurgery for dural arteriovenous fistulas: Highlighting chronic encapsulated hematoma as a characteristic radiographic finding.","authors":"Daisuke Sato, Yuki Shinya, Motoyuki Umekawa, Hirotaka Hasegawa, Satoshi Koizumi, Takeru Hirata, Atsuto Katano, Nobuhito Saito","doi":"10.1016/j.wneu.2025.124298","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124298","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124298"},"PeriodicalIF":1.9,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638212","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 \"Drainage versus Non-Drainage for Thoracolumbar Spine Surgery: An Evidence Synthesis\".","authors":"Muhammad Aqib Farooq Khan, Ayesha Anwar, Syeda Laraib Fatima","doi":"10.1016/j.wneu.2025.124263","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124263","url":null,"abstract":"<p><p>This letter addresses a study by Liu et al. comparing drainage versus non-drainage strategies in thoracolumbar spine surgery. While the authors reported multiple postoperative outcomes, they failed to differentiate their relative clinical significance. Outcomes such as surgical site infections and epidural hematomas are more impactful than mild postoperative fever, yet all were given equal emphasis. Recent literature also questions the utility of routine drainage, citing increased risks like transfusions and prolonged hospital stays without significant benefits. Studies by Reier, Muthu, and Elfiky collectively support limiting prophylactic drainage use. The letter urges the study authors to clarify the clinical weight of each parameter and provide a more conclusive stance, helping guide evidence-based postoperative care in spinal surgeries.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124263"},"PeriodicalIF":1.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627285","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":"Comparing Gabapentin and Pregabalin for Perioperative Pain Management in Lumbar Spine Surgery: A Systematic Review and Meta-Analysis.","authors":"Ali Ebada, Nicholas Bever, Christopher J Carron, Peace Odiase, Cody Wolfe, Mazin Al Tamimi, Salah G Aoun","doi":"10.1016/j.wneu.2025.124284","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124284","url":null,"abstract":"<p><strong>Introduction: </strong>The effectiveness of gabapentin and pregabalin in mitigating acute postoperative pain following lumbar surgery remains understudied. This study assessed the effectiveness of gabapentin and pregabalin in mitigating acute postoperative pain following lumbar spine surgery, measured through patient reported outcome measures (PROMs) such as VAS pain scores and the 24-hour morphine requirement.</p><p><strong>Methods: </strong>Online databases including PubMed/MEDLINE, Scopus, and Cochrane were searched for randomized clinical trials conducted among adults undergoing lumbar spine surgery who were treated with gabapentin, pregabalin, or placebo and reported VAS scores 24 hours postoperatively.</p><p><strong>Results: </strong>7 studies were identified involving 724 eligible patients. The mean age of the cohort was 53.97 years. No significant differences in VAS pain scores were noted 24 hours postoperatively for patients treated with gabapentin, pregabalin, or placebo. Of the 7 included studies, 3 directly compared the pain sparing effect of pregabalin and gabapentin. Again, no significant difference in 24-hour VAS scores was noted. However, patients treated with gabapentin had a significantly lower 24-hour morphine consumption (3.80 mg, 95% CI [2.00 mg-5.60 mg]) than patients treated with placebo [11.03 mg, 95% CI [8.98 mg-13.08 mg]). There was no significant difference in 24-hour morphine requirement between patients treated with pregabalin vs. placebo or pregabalin vs. gabapentin.</p><p><strong>Conclusions: </strong>Definitive conclusions regarding the efficacy of gabapentin and pregabalin in managing acute postoperative pain remain limited. Well-designed randomized controlled trials with standardized protocols are needed to clarify their role in perioperative pain management following lumbar spine surgery.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124284"},"PeriodicalIF":1.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627284","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":"Risk Factors for Increased Surgical Drain Output in Patients After Unilateral Expansive Open-Door Cervical Laminoplasty for Cervical Compressive Myelopathy: A Retrospective Study of 341 Patients","authors":"Hongwei Wang ,&nbsp;Shuang Zhai ,&nbsp;Zhihao Zhang ,&nbsp;Hongwen Gu ,&nbsp;Shanshan Liu ,&nbsp;Yin Hu ,&nbsp;Kangen Han ,&nbsp;Junchao Li ,&nbsp;Le Xing ,&nbsp;Ming Huang ,&nbsp;Yongcun Wei ,&nbsp;Hong Yuan ,&nbsp;Hailong Yu","doi":"10.1016/j.wneu.2025.124271","DOIUrl":"10.1016/j.wneu.2025.124271","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate determinants independently correlated with increased surgical drain output (ISDO) observed following unilateral expansive open-door cervical laminoplasty (UEOCL) procedures performed in individuals diagnosed with cervical spondylotic myelopathy.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed medical records from a single tertiary care center spanning January 2013 to December 2019 to identify individuals undergoing UEOCL with prophylactic drainage. Cases were stratified into 2 cohorts based on cumulative drainage volume, with the experimental group defined by outputs ≥500 ml (ISDO classification). Demographic characteristics, intraoperative parameters, and postoperative variables were systematically evaluated through univariate and multivariate statistical approaches to establish potential predictors of excessive fluid secretion.</div></div><div><h3>Results</h3><div>Among the 341 eligible UEOCL cases identified through inclusion criteria screening, the mean postoperative drainage volume across the cohort measured 449.0 ± 167.1 ml. Of these, 131 subjects (38.4%) exhibited ISDO criteria, defined as drainage exceeding 500 ml. Multivariable regression analysis identified 4 independent predictors: male gender (<em>P</em> = 0.011), age under 60 years (<em>P</em> = 0.008), elevated preoperative diastolic blood pressure (<em>P</em> = 0.039), and application of lateral mass screw fixation (<em>P</em> = 0.001). Those meeting ISDO criteria demonstrated extended hospitalization durations (<em>P</em> = 0.047) and increased medical expenditures (<em>P</em> &lt; 0.001) compared to counterparts with typical drainage volumes.</div></div><div><h3>Conclusions</h3><div>Multivariate analysis identified male gender, younger age (below 60 years), elevated preoperative diastolic blood pressure, and lateral mass screw fixation as independent predictors of ISDO development post-UEOCL. Furthermore, the presence of ISDO demonstrated significant correlations with prolonged hospitalization duration and elevated inpatient financial expenditures.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"201 ","pages":"Article 124271"},"PeriodicalIF":2.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627287","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}