World neurosurgery最新文献

{"title":"Clinical and Radiographic Presentation and Surgical Outcomes of T-Box Pituitary Transcription Factor (TPIT) Silent Corticotroph Pituitary Neuroendocrine Tumors: A Multi-institutional Experience and Review of the Literature","authors":"Spencer Raub ,&nbsp;Ben Fixman ,&nbsp;Thomas Hanks ,&nbsp;Dominic Nistal ,&nbsp;Racheal Peterson ,&nbsp;Jessica Eaton ,&nbsp;Evgeniya Tyrtova ,&nbsp;Luis Gonzalez-Cuyar ,&nbsp;Kathryn Weaver ,&nbsp;Asha Pathak ,&nbsp;Anthony DeSantis ,&nbsp;R. Alan Failor ,&nbsp;Brent Wisse ,&nbsp;Norman E. Garrett III ,&nbsp;Samuel Emerson ,&nbsp;David J. Cote ,&nbsp;Robert G. Briggs ,&nbsp;Gabriel Zada ,&nbsp;Manuel Ferreira Jr. ,&nbsp;Jacob Ruzevick","doi":"10.1016/j.wneu.2025.123791","DOIUrl":"10.1016/j.wneu.2025.123791","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to characterize the incidence, aggressiveness, and clinical outcomes of silent TPIT+ PitNETs, as well as treatment strategies in the event of recurrence/progression. We also review the current literature surrounding TPIT+ silent corticotrophs.</div></div><div><h3>Methods</h3><div>An institutional review board–approved retrospective study of prospectively acquired patients undergoing resection of PitNETs at the University of Washington and University of Southern California between 2011 and 2023 was performed. A prospectively maintained Research Electronic Data Capture database at each institution was queried for patients with tumors immunostaining positive for TPIT and included for study regardless of adrenocorticotropic hormone (ACTH) status. Exclusion criteria included patients with biochemically confirmed Cushing disease. Patient demographics, preoperative radiographic findings, and surgical outcomes were documented. Descriptive statistics were reported for the patient cohort and recurrence/progression free survival analysis was measured and visualized using Kaplan-Meier and Swimmer plots.</div></div><div><h3>Results</h3><div>A total of 1475 patients underwent surgical resection of PitNET with a total of 107 TPIT-immunoreactive tumors. Of these, 37 (34.6%) patients were diagnosed with Cushing disease preoperatively and were excluded from the analysis, leaving 70 (65.4%) patients with TPIT+ silent corticotroph PitNETs. A total of 56 (80%) tumors were only TPIT+, while 14 (20%) stained positive for multiple transcription factors including steroidogenic factor-1, pituitary-specific positive transcription factor 1, or both. The cohort consisted of 45 (64.3%) ACTH+ tumors and 25 (35.7%) ACTH tumors. There were 19 (27.1%) men and 51 (72.9%) women, with mean age 51.3 years. Radiographically, growth beyond the sella into the suprasellar space 54 (77.1%), cavernous sinus 41 (51.4%), and clival/sphenoid 12 (17.1%) compartments was common. A total of 67 (95.7%) of cases were treated via an endoscopic endonasal approach. Gross total resection (GTR) was achieved in 47 (70.1%) of cases. Of those undergoing GTR, two (4.3%) experienced tumor recurrence. Of those undergoing subtotal resection, four (20%) experienced tumor progression (<em>P</em> = 0.06). The median recurrence/progression free survival of TPIT+ tumors was 51.3 months. When stratified by extent of resection, median recurrence free survival was 38.3 months for GTR versus median progression free survival of 51.3 months for subtotal resection (<em>P</em> = 0.88).</div></div><div><h3>Conclusions</h3><div>With the addition of TPIT staining, the diagnosis of silent corticotroph PitNETs increased substantially versus those defined by ACTH immunostaining alone. Regardless of hormone status, these tumors continue to exhibit high rates of extrasellar growth and high rates of recurrence/progression.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123791"},"PeriodicalIF":1.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426448","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":"Comparing Postoperative Opioid Use in Primary and Revision Lumbar Fusion: A Propensity-Matched Analysis","authors":"Jonathan Dalton,&nbsp;Jarod Olson,&nbsp;Nicholas B. Pohl,&nbsp;Rajkishen Narayanan,&nbsp;Omar H. Tarawneh,&nbsp;Yunsoo Lee,&nbsp;Michael V. Carter,&nbsp;Gokul Karthikeyan,&nbsp;Logan Witt,&nbsp;Aayush Mehta,&nbsp;John J. Mangan,&nbsp;Mark F. Kurd,&nbsp;Jose A. Canseco,&nbsp;Alan S. Hilibrand,&nbsp;Alexander R. Vaccaro,&nbsp;Gregory D. Schroeder,&nbsp;Christopher K. Kepler","doi":"10.1016/j.wneu.2025.123800","DOIUrl":"10.1016/j.wneu.2025.123800","url":null,"abstract":"<div><h3>Objective</h3><div>This study compared postoperative opioid use for patients undergoing short segment primary versus revision lumbar fusion.</div></div><div><h3>Methods</h3><div>Patients who underwent primary or revision 1–2 level lumbar fusion (2017–2021) were included in this study. The state Prescription Drug Monitoring Program was reviewed for all patients to quantify preoperative and postoperative opioid, benzodiazepine, muscle relaxant, and gabapentin use. A 1:1 propensity match was performed to match primary lumbar fusion patients with revision lumbar fusion patients. Revision lumbar fusion patients were substratified into those with or without persistent postoperative opioid use to identify demographic differences between these patient cohorts.</div></div><div><h3>Results</h3><div>The final cohort included 216 primary and 216 revision 1–2 level lumbar fusion patients. The average time between index procedure and revision was 7.54 ± 9.22 years. Opioid use was similar within 1-year preoperatively and at all postoperative time points (up to 1 year) between primary and revision fusion patients. Benzodiazepine, muscle relaxants, and gabapentinoid use was also similar at all preoperative and postoperative time points. Further stratification of revision lumbar fusion patients found that persistent postoperative opioid use patients had a higher incidence of preoperative opioid use within the year prior to surgery with increased number of prescriptions (7.22 ± 7.62 vs. 1.38 ± 2.32; <em>P</em> &lt; 0.001) and morphine milligram equivalents totals (298 ± 565 vs. 45.6 ± 84.4; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Postoperative opioid requirements were similar amongst patients undergoing primary versus revision lumbar fusion. In the revision cohort, persistent postoperative opioid users had higher preoperative opioid use, which is supported by prior literature. Although revision lumbar fusion has been reported to lead to less pain improvement, this study's findings suggest these procedures may not lead to higher rates of persistent opioid use postoperatively.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123800"},"PeriodicalIF":1.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459658","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":"The biopsy site is critical for bacterial culture after percutaneous biopsy in patients with pyogenic spondylodiscitis.","authors":"Kai Tang, Xi Zhang, Yongchao Li, Tinglong Lan, Jun Fan, Yuan Li, Heng Wang, Wanli Kang, Shibing Qin, Weijie Dong","doi":"10.1016/j.wneu.2025.123904","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123904","url":null,"abstract":"<p><strong>Backgrounds: </strong>Previous studies have found that the positive rate of bacterial culture after percutaneous needle biopsy in patients with suspected pyogenic spondylodiscitis is influenced by a number of factors. At the same time, the choice of puncture site in percutaneous biopsy has been controversial.</p><p><strong>Objective: </strong>To explore the factors influencing the positive rate of bacterial culture after percutaneous biopsy in patients with pyogenic spondylodiscitis.</p><p><strong>Methods: </strong>The medical records of 186 patients with suspected spinal infection who underwent C-type arm-guided percutaneous biopsy in Beijing Chest Hospital Affiliated to Capital Medical University from January 2023 to December 2023 were retrospectively analyzed. According to inclusion and exclusion criteria, a total of 116 patients with suspected pyogenic spondylodiscitis were included. The positive rate of bacterial culture was calculated, and the effects of age, gender, course of disease, preoperative fever, preoperative antibiotic use, preoperative white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate and puncture site on the positive rate of culture were discussed. Logistic regression analysis was used to identify the relevant factors affecting the positive rate of culture.</p><p><strong>Results: </strong>Among the 116 patients, 63 were males and 53 were females. Age ranged from 13 to 87 years, with a median age of 59.5 years. The results of bacterial culture in 42 patients were positive, with a positive rate of 36.2% (42/116), including Staphylococcus aureus in 12 cases, streptococcus in 5 cases, Brucella in 5 cases, Escherichia coli in 4 cases, Staphylococcus epidermidis in 3 cases, Pseudomonas aeruginosa in 2 cases, Enterococcus faecalis in 2 cases, anaerobic bacteria in 2 cases and other bacteria in 7 cases. The positive rate of bacterial culture was 22.6% (14/62) in patients with vertebral body puncture and 51.9% (28/54) in patients with intervertebral disc puncture, and there was a significant difference between the two groups (P=0.001). Logistic regression analysis showed that the course of disease, the increase of C-reactive protein before puncture and the site of puncture were the factors influencing the positive rate of culture.</p><p><strong>Conclusion: </strong>The course of disease, the elevation of CRP before puncture and the site of puncture were the factors influencing the positive rate of bacterial culture in percutaneous biopsy of pyogenic spondylodiscitis patients. The positive rate of obtaining intervertebral disc in percutaneous puncture was significantly higher than that of vertebral body, suggesting that intervertebral disc is a more critical puncture site.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123904"},"PeriodicalIF":1.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664846","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":"Improving Short-term Outcomes of Cubital Tunnel Syndrome Decompression with Intraoperative Dexamethasone.","authors":"Tianyou Hu, Yujie Bian, Tao Zhou, Qiankun Wang, Ding Zhou, Liang He, Zifu Wang, Hongxiang Zhou","doi":"10.1016/j.wneu.2025.123885","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123885","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of intraoperative dexamethasone on short-term clinical outcomes following decompression procedures for cubital tunnel syndrome (CuTS) and its role in controlling postoperative inflammation.</p><p><strong>Methods: </strong>A total of 114 patients with severe CuTS were categorized based on intraoperative treatment records into the study group (55 patients) or control group (59 patients). In the study group, 10 mg of dexamethasone was injected into the epineurium after ulnar nerve decompression. Postoperative recovery was assessed using the Visual Analog Scale (VAS), PRUNE score, Modified Bishop score, two-point discrimination, and electromyography.</p><p><strong>Results: </strong>The study group demonstrated significantly better recovery in the first 4 weeks postoperatively compared to the control group. VAS scores decreased from 4.69±0.95 to 3.56±0.88, and PRUNE scores improved from 51.38±9.79 to 40.87±7.82 (p=0.045). The Modified Bishop score at 4 weeks was 8.69±1.18 in the study group versus 7.49±0.88 in the control group (p<0.001). Although differences between groups lessened at 6 months, the study group maintained better short-term outcomes. No adverse events such as infection, nerve tenderness, or delayed wound healing were observed.</p><p><strong>Discussion: </strong>Intraoperative dexamethasone significantly reduces inflammation and edema, promoting faster nerve function recovery in CuTS patients. Despite diminishing differences at 6 months, the findings highlight dexamethasone as a safe and effective option for improving short-term postoperative outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123885"},"PeriodicalIF":1.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664767","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 intracranial infection in surgical patients with suprasellar craniopharyngiomas by an expanded endoscopic endonasal approach:a single-center initial experience.","authors":"Xin Zheng, Yong Chen, Xiaoqing Zhang, Hui Yang, Song Li","doi":"10.1016/j.wneu.2025.123902","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123902","url":null,"abstract":"<p><strong>Objective: </strong>To explore the risk factors for intracranial infection in surgical patients with suprasellar craniopharyngiomas by an expanded endoscopic endonasal approach (EEEA) in a single-center.</p><p><strong>Methods: </strong>Forty-one patients with suprasellar craniopharyngiomas were retrospectively recruited. EEEA was applied in all patients. All patients were evaluated for the occurrence of intracranial infection after surgery, and the risk factors of infection were further analyzed. The databases of Pubmed, Web of Science were systematically reviewed to identify the rate of meningitis with suprasellar craniopharyngiomas treated with EETS.</p><p><strong>Results: </strong>Intracranial infection occurred in 21.95% of patients. Patients who were diagnosed as recurrent tumor presented with significant higher incidence of infection than that in the patients with first surgery (55.56% VS 18.75%, P<0.05). The rate of the third ventricle exposure was 88.89% in nine infected patients, which was significantly higher than 40.63% in uninfected patients (P<0.05). The risk factor for post-surgery infection was the exposure of third ventricle during surgery (P=0.043, OR=10.374). The incidence of EETS meningitis varies from 0% to 30%, and the rate of CSF leak varies from 0% to 58% in previous studies. 23 patients received gentamicin physiological saline irrigation in our study, and only two presented intracranial infection after surgery.</p><p><strong>Conclusion: </strong>The rate of EETS meningitis varies from 0% to 30% according to previous studies. Opening of the third ventricle during surgery was an independent risk factor for intracranial infection in surgical patients with suprasellar craniopharyngiomas by EEEA. Gentamicin physiological saline irrigation during surgery might prevent postsurgical infection.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123902"},"PeriodicalIF":1.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Treatment for Elderly and Very Elderly Patients with Intracranial Meningioma","authors":"Linda Tang,&nbsp;Debraj Mukherjee","doi":"10.1016/j.wneu.2025.123921","DOIUrl":"10.1016/j.wneu.2025.123921","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123921"},"PeriodicalIF":1.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143746679","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":"Understanding Risk Factors for Postoperative Seizure Following Surgical Treatment and Middle Meningeal Artery Embolization of Chronic Subdural Hematomas","authors":"Kasuni H. Ranawaka ,&nbsp;Felipe Ramirez-Velandia ,&nbsp;Thomas B. Fodor ,&nbsp;Aryan Wadhwa ,&nbsp;Mira Salih ,&nbsp;Tzak S. Lau ,&nbsp;Niels Pacheco-Barrios ,&nbsp;Imad S. Khan ,&nbsp;Alejandro Enriquez-Marulanda ,&nbsp;Rafael A. Vega ,&nbsp;Emmanuel Mensah ,&nbsp;Martina Stippler ,&nbsp;Philipp Taussky ,&nbsp;Christopher S. Ogilvy ,&nbsp;Jennifer Hong","doi":"10.1016/j.wneu.2025.123796","DOIUrl":"10.1016/j.wneu.2025.123796","url":null,"abstract":"<div><h3>Objective</h3><div>Chronic subdural hematoma (cSDH) is often associated with clinical seizures, with incidence rates ranging from 2.6% to 23%. While risk factors like hematoma size and craniotomy with membranectomy are well established, the impact of middle meningeal artery embolization (MMAe) remains underexplored. This study aims to evaluate postoperative seizure rates in cSDH patients treated with MMAe and compare them with those undergoing craniotomy or burr hole evacuation.</div></div><div><h3>Methods</h3><div>A bi-institutional retrospective review of 580 cSDH cases treated with burr hole evacuation (with or without MMAe), craniotomy (with or without MMAe), or MMAe alone from 2017 to 2021 was conducted. Fisher exact tests, <em>t</em> tests, and analysis of variance were used to analyze patient, hematoma, and procedural characteristics. Logistic regression identified factors associated with postoperative seizures, complications, and recurrence requiring reoperation. Linear regression was used to assess factors influencing length of hospital stay.</div></div><div><h3>Results</h3><div>Among 580 cases, postoperative seizure rates were 4.2% for burr hole evacuation, 1.3% for burr hole evacuation with MMAe, 12.1% for craniotomy, 11.8% for craniotomy with MMAe, and 4.3% for MMAe alone. Logistic regression showed significantly higher seizure risk in craniotomy with MMAe vs. burr hole with MMAe (odds ratio [OR] 9.14, 95% CI 1.02-81.66, <em>P</em> = 0.047). Standalone MMAe had a lower complication risk than standalone burr hole drainage (OR 0.37, 95% CI 0.16-0.84, <em>P</em> = 0.017) or craniotomy (OR 0.37, 95% CI 0.17-0.79, <em>P</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>Burr hole evacuation with MMAe had the lowest postoperative seizure rate, while MMAe alone was associated with the lowest risk of overall postoperative complications.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123796"},"PeriodicalIF":1.9,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441911","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":"Functional Outcome of Adult Traumatic Brain Injury Patients Treated by Decompressive Craniectomy in Ethiopian Trauma Center.","authors":"Sisay A Mulisa, Biruk G Wakjira, Samuel E Alem, Eyerusalem B Banti","doi":"10.1016/j.wneu.2025.123899","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123899","url":null,"abstract":"<p><strong>Objective: </strong>To describe the long-term functional outcome of traumatic brain injury (TBI) patients treated by decompressive craniectomy (DC).</p><p><strong>Method: </strong>Data was collected on decompressive craniectomy performed on TBI patients admitted between May 1, 2018, and May 1, 2021, using a multi-centered, cross-sectional study design. The long-term outcomes of survivors were assessed using a structured extended Glasgow outcome scale (GOSE) questionnaire. Descriptive statistics, including frequency, mean, median, and range, were analyzed. Predictors of functional outcomes were determined using multivariate regression analyses.</p><p><strong>Result: </strong>In this study, 74 patients were examined and their mean age at the time of DC was 33.9 years, with a male-to-female ratio of 11:1. Primary DC was performed in 93.2% of cases, and the in-hospital mortality rate was 24.3%, while the overall mortality rate was 36.5%. Overall, a favorable functional outcome (GOSE ≥4) was witnessed in 43 patients (58.1%). Among survivors, 91.5% had favorable outcomes. Age ≥40, GCS ≤5, chest infections, and noninfectious complications were independent predictors of an unfavorable functional outcome (GOSE<4). Patients with GCS ≤5 fared the worst with an unfavorable functional outcome rate of 85.7%.</p><p><strong>Conclusions: </strong>In this study, our results showed that significant number of our patients had favorable functional outcome after DC for TBI comparable to results from high income countries. We found that age, admission GCS, postoperative chest infection, and noninfectious complications were all independent factors predicting unfavorable functional outcome. In particular, patients with GCS ≤ 5 had a higher rate of mortality and unfavorable outcome.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123899"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639877","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":"Single-Institution Retrospective Propensity Score-Matched Comparative Cost Analysis of Multilevel Anterior Cervical Discectomy and Fusion versus Posterior Cervical Decompression and Fusion in Geriatric Patients with Cervical Disc Herniation","authors":"Bahie Ezzat ,&nbsp;Yehia Elkersh ,&nbsp;Roshini Kalagara ,&nbsp;Priya Bhanot ,&nbsp;Juhana Habib ,&nbsp;Matthew T. Carr ,&nbsp;Alexander J. Schüpper ,&nbsp;Hanya M. Qureshi ,&nbsp;Eugene Hrabarchuk ,&nbsp;Addison Quinones ,&nbsp;Tanvir F. Choudhri","doi":"10.1016/j.wneu.2025.123798","DOIUrl":"10.1016/j.wneu.2025.123798","url":null,"abstract":"<div><h3>Background</h3><div>Despite the surge in anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) procedures over the past 2 decades, there remains a paucity of data on their comparative costs in geriatric patients with cervical disc herniation. This study provides a comprehensive cost analysis of ACDF and PCDF in this patient population.</div></div><div><h3>Methods</h3><div>A total of 282 geriatric patients who underwent ACDF or PCDF for cervical disc herniation over a 12-year period were analyzed to assess total surgical costs, including preoperative, procedural, and postoperative expenses. Analysis of variance with post-hoc Tukey Honestly Significant Difference test was used in a propensity score-matched cohort to compare cost differences between ACDF and PCDF across various cost categories.</div></div><div><h3>Results</h3><div>In a geriatric cohort of 282 patients with cervical disc herniation meeting inclusion criteria, 221 (78.4%) underwent ACDF and 61 (21.6%) received PCDF (2–4 levels). The average age was 71.3 ± 5.6 years, with no significant demographic differences between groups. On analysis of variance, rehabilitation costs were 1.88 times higher (<em>P</em> &lt; 0.001), and blood bank costs were 2.16 times higher (<em>P</em> = 0.04) for PCDF patients, corresponding with significantly greater estimated blood loss (209.9 ± 217.7 mL vs. 66.7 ± 107.0 mL; <em>P</em> &lt; 0.001). After propensity score matching, PCDF remained associated with significantly higher rehabilitation costs (+170.79%; <em>P</em> &lt; 0.001), blood bank costs (+139.29%; <em>P</em> = 0.005), and total procedural costs (+33.92%; <em>P</em> = 0.015).</div></div><div><h3>Conclusions</h3><div>ACDF procedures in geriatric patients with cervical disc herniation are significantly cheaper than PCDF in terms of rehabilitation and blood bank costs, offering valuable insights for optimizing neurosurgical decision-making and high-value care.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123798"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469199","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":"Anterior and anterolateral approaches to the lumbar spine in a developing country: about a series of 28 cases.","authors":"Assoumane Issa Ibrahim, Brice Audrey Sawa Nouga, Haboubacar Chaibou Sode, Agada Kpègnon Nicaise, Late Dzidoula Lawson, Nourou Dine Bankole Adeniran, Kelani Aminath","doi":"10.1016/j.wneu.2025.123900","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123900","url":null,"abstract":"<p><strong>Background: </strong>The frequency of lumbar trauma in surgical emergencies at Niamey National Hospital is enormous. Injuries are most often amenable to an anterior or anterolateral approach, but due to a lack of expertise in surgical technique, they are usually operated on using a posterior approach.</p><p><strong>Objective: </strong>To evaluate the management of lumbar spine fractures, including hinge fractures, using an anterior or anterolateral approach in a precarious context.</p><p><strong>Patients and method: </strong>Retro and prospective observational descriptive study over 34 months including 28 patients who benefited from an anterior or anterolateral approach. The osteosynthesis material used was a bone graft fixed by a stainless-steel plate and screws. The mean follow-up was 3 months.</p><p><strong>Results: </strong>Anterior and anterolateral approaches had a hospital incidence of 3.16%. At follow-up, there was no neurological deterioration, with an improvement in 75% of patients, despite deterioration of locoregional kyphosis in 76.92% of cases. One patient died in the immediate postoperative period and 1 died during medium-term follow-up.</p><p><strong>Conclusion: </strong>The anterior approach to the spine is a therapeutic arsenal that needs to be mastered. Efforts are still required to acquire suitable equipment for correct sagittal balance.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123900"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639860","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}