World neurosurgery最新文献

{"title":"Predictors of dura-brain neoangiogenesis after combined revascularization for patients with symptomatic atherosclerotic cerebral artery occlusion: A multivariate regression analysis.","authors":"Cong Ling, Ni Mo, Baoyu Zhang, Chuyang Tai, Yang Yang, Lei Wei, Hui Wang, Chuan Chen","doi":"10.1016/j.wneu.2025.124105","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124105","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the independent predictors of dura-brain neoangiogenesis (DBN) after superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass combined with dural inversion (DI) in patients with symptomatic atherosclerotic cerebral arterial occlusion (SACAO).</p><p><strong>Methods: </strong>We retrospectively analyzed SACAO patients who underwent STA-MCA bypass combined with DI at our center between November 2014 and October 2021. DBN was evaluated by superselective digital subtraction angiography and scored by the DBN scoring system. Independent predictors of DBN were identified by a multivariate logistic regression analysis. The differences in clinical outcomes between patients with \"good\" and \"poor\" DBN were also analyzed.</p><p><strong>Results: </strong>A total of 179 SACAO patients with an average age of 61.3 ± 7.0 years and an average follow-up of 63.0 ± 22.0 months were studied. Ninety-nine patients (55.3%) had good DBN, and 80 patients (44.7%) had poor DBN. The multivariate analysis revealed that old age (p < 0.001, OR [95% CI] 1.288 [1.184-1.400]) was an independent predictor of poor DBN. Diabetes (p = 0.005, OR [95% CI] 3.358 [1.434-7.867]) also independently predicted poor DBN. The recurrence rate of ischemic events in the good DBN group was significantly lower than that in the poor DBN group (2.0% vs. 10.0%, p = 0.044). The neurological status of patients in the good DBN group was also significantly better.</p><p><strong>Conclusions: </strong>Old age and diabetes status were independent predictors of poor DBN after combined revascularization in SACAO patients. Good DBN was associated with a lower recurrence rate of stroke and better neurological status.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124105"},"PeriodicalIF":1.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133097","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":"Transforming Neurosurgical Practice with Large Language Models: Comparative Performance of ChatGPT-Omni and Gemini in Complex Case Management.","authors":"Baris Colluoglu, Samil Dikici","doi":"10.1016/j.wneu.2025.124103","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124103","url":null,"abstract":"<p><strong>Background: </strong>Recent advancements in artificial intelligence, particularly in large language models (LLMs), have catalyzed new opportunities within medical domains, including neurosurgery. This study aims to evaluate and compare the performance of two advanced LLMs-ChatGPT-Omni and Gemini-in addressing clinical case inquiries on various neurosurgical conditions.</p><p><strong>Methods: </strong>A prospective observational study was conducted utilizing 500 case-based questions relevant to neurosurgery, covering 10 prevalent conditions. The questions were designed to simulate real-world clinical scenarios encompassing diagnosis, interpretation, and management and were asked again two months (phase 2) later. Responses were evaluated using a 6-point Likert scale by two independent neurosurgeons.</p><p><strong>Results: </strong>ChatGPT-Omni exhibited consistent superiority across all evaluation metrics. In Phase 1, its overall average score across all conditions was 5.38±0.12, which increased to 5.46±0.08 in Phase 2 (p<0.001). While exhibiting moderate improvements, Gemini trailed behind ChatGPT-Omni with an overall average score of 4.93±0.15 in Phase 1, which improved to 5.1±0.14 in Phase 2 (p<0.001). Subgroup analyses indicated that ChatGPT-Omni provided superior contextual accuracy across all conditions (p<0.001).</p><p><strong>Conclusion: </strong>The study underscores the transformative potential of LLMs in neurosurgery, with ChatGPT-Omni demonstrating superior accuracy, relevance, and clarity compared to Gemini. While both models improved over time, ChatGPT-Omni consistently excelled across all clinical scenarios, highlighting its potential utility in neurosurgical decision support and education.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124103"},"PeriodicalIF":1.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128932","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 “Prognostic Value of Lumbar Muscle Morphometrics for Survival of Patients with Spinal Metastasis: A Systematic Review and Meta-Analysis”","authors":"Rafael De la Garza Ramos ,&nbsp;Reza Yassari","doi":"10.1016/j.wneu.2025.124106","DOIUrl":"10.1016/j.wneu.2025.124106","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"199 ","pages":"Article 124106"},"PeriodicalIF":1.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Enalapril and Propranolol on Neurologic Recovery After Isolated Severe Traumatic Brain Injury: A Randomized Clinical Trial","authors":"Mehdi Mahmoodkhani ,&nbsp;Ahmad Sahraei ,&nbsp;Mehdi Shafiei ,&nbsp;Christian Bowers ,&nbsp;Arman Sourani ,&nbsp;Mina Foroughi ,&nbsp;Sadegh Baradaran Mahdavi ,&nbsp;Mohammad Sharafi ,&nbsp;Donya Sheibani Tehrani ,&nbsp;Roham Nik Khah ,&nbsp;Shaahin Veisi","doi":"10.1016/j.wneu.2025.124078","DOIUrl":"10.1016/j.wneu.2025.124078","url":null,"abstract":"<div><h3>Objective</h3><div>It has been hypothesized that propranolol and enalapril can provide cardiovascular stability without any negative impact on neurologic recovery after severe traumatic brain injury (TBI). Although propranolol and enalapril have been proposed to have beneficial effects as cardiovascular stabilizers in TBI, many neurologic effects remain obscure. We hypothesized which of the following drugs could improve The Glasgow Outcome Scale-extended (GOS-E) in severe TBI patients.</div></div><div><h3>Methods</h3><div>This single-blinded randomized, clinical trial was conducted in 2 university hospitals from 2020 to 2021. All the patients age &gt;18 years with severe isolated TBI who had legal consent to participate (by guardians) were enrolled. G1 (propranolol), G2 (enalapril), G3 (propranolol + enalapril), and G4 (no medication) were defined. The GOS-E was the primary outcome. Secondary outcomes included the Apraxia of Speech Rating Scale, cardiovascular stability, mortality rate, ventilator dependency, and hospital length of stay. <em>P ≤</em> 0.05 was defined as significant.</div></div><div><h3>Results</h3><div>One hundred and forty patients were reviewed in the final analysis. The mean patient age was 36.91 ± 16.19 years, and the median Glasgow Coma Scale (GCS) score was 5. Baseline vital signs and TBI severity indices were distributed equally among the 4 groups (<em>P</em> &gt; 0.05). Multivariate regression analysis showed that GOS-E was directly associated with discharge GCS in all groups (<em>P</em> &lt; 0.001, β = 0.199, 0.16 ≤ confidence interval [CI] ≤ 0.22). Multivariate regression analysis showed better on-discharge GCS in G1 (<em>P</em> &lt; 0.001; β = 2.26; 0.58 ≤ CI ≤ 3.9).</div></div><div><h3>Conclusion</h3><div>Regarding neurologic recovery and other outcomes, enalapril and propranolol, both alone and in combination, are effective and safe after severe isolated TBI. Considering long-term outcomes, propranolol showed more promising results in GOS-E during the follow-up period.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"199 ","pages":"Article 124078"},"PeriodicalIF":1.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128930","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":"Preoperative Differentiation of Spinal Schwannoma and Meningioma Using Machine Learning-Based Models: A Systematic Review and Meta-Analysis","authors":"Bardia Hajikarimloo ,&nbsp;Ibrahim Mohammadzadeh ,&nbsp;Rana Hashemi ,&nbsp;Mohsen Sheikhzadeh ,&nbsp;Dorsa Najari ,&nbsp;Ehsan Bahrami Hezaveh ,&nbsp;Fatemeh Ghorbanpouryami ,&nbsp;Mohammad Amin Habibi","doi":"10.1016/j.wneu.2025.124096","DOIUrl":"10.1016/j.wneu.2025.124096","url":null,"abstract":"<div><h3>Background</h3><div>Regarding the differences in surgical approaches for spinal schwannomas and meningiomas, preoperative differentiation of spinal schwannomas and meningiomas can be important in managing these lesions. This study evaluated the diagnostic performance of machine learning (ML)-based models in the differentiation of spinal schwannomas and meningiomas.</div></div><div><h3>Methods</h3><div>On December 18, 2024, a comprehensive search was conducted. The data for the best-performing model were used to calculate pooled sensitivity, specificity, area under the curve (AUC), and diagnostic odds ratio.</div></div><div><h3>Results</h3><div>Six studies with 644 patients were included, encompassing 364 schwannomas (59.9%) and 258 meningiomas (40.1%). Deep learning-based models (66.7%, 4/6) were the most frequent, followed by ML-based models (33.3%, 2/6). The best performance models' AUC and accuracy ranged from 0.876 to 0.998 and 0.8 to 0.982, respectively. Our findings showed a pooled sensitivity rate of 91% (95%CI: 81%–96%), a specificity rate of 92% (95%CI: 84%–96%), and a diagnostic odds ratio of 97.34 (95%CI: 23.5–403.6), concurrent with an AUC of 0.944.</div></div><div><h3>Conclusions</h3><div>ML-based models have a high diagnostic accuracy in preoperative differentiation of spinal schwannomas and meningiomas.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"199 ","pages":"Article 124096"},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121030","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 Robotic Systems in Spinal Surgery: A Review of Accuracy, Radiation Exposure, Hospital Readmission Rate, Cost, and Adverse Events.","authors":"Nikil Kumar, Sinnha Kumari, Muhammad Owais, Muhammad Saad Khan","doi":"10.1016/j.wneu.2025.124104","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124104","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124104"},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121026","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":"Research on Machine Learning Models Based on Cranial CT Scan for Assessing Prognosis of Emergency Brain Injury.","authors":"Jiajun Qin, Rui Shen, Jin Fu, Jiping Sun","doi":"10.1016/j.wneu.2025.124100","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124100","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the prognosis of patients with traumatic brain injury according to the Computed Tomography (CT) findings of skull fracture and cerebral parenchymal hemorrhage.</p><p><strong>Methods: </strong>Retrospectively collected data from adult patients who received non-surgical or surgical treatment after the first CT scan with craniocerebral injuries from January 2020 to August 2021. The radiomics features were extracted by Pyradiomics. Dimensionality reduction was then performed using the max relevance and min-redundancy algorithm (mRMR) and the least absolute shrinkage and selection operator (LASSO), with ten-fold cross-validation to select the best radiomics features. Three parsimonious machine learning classifiers, multinomial logistic regression (LR), a support vector machine (SVM), and a naive Bayes (Gaussian distribution), were used to construct radiomics models. A personalized emergency prognostic nomogram for cranial injuries was erected using a logistic regression model based on selected radiomic labels and patients' baseline information at emergency admission.</p><p><strong>Results: </strong>The mRMR algorithm and the LASSO regression model finally extracted 22 top-ranked radiological features and based on these image histological features, the emergency brain injury prediction model was built with SVM, LG, and naive Bayesian classifiers, respectively. The SVM model showed the largest AUC area in training cohort for the three classifications, indicating that the SVM model is more stable and accurate. Moreover, a nomogram prediction model for GOS prognostic score in patients was constructed.</p><p><strong>Conclusion: </strong>We established a nomogram for predicting patients' prognosis through radiomic features and clinical characteristics, provides some data support and guidance for clinical prediction of patients' brain injury prognosis and intervention.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124100"},"PeriodicalIF":1.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095000","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":"Treatment Landscape of Intracranial Aneurysms in Eastern China: A Propensity-Matched Analysis of Technique Adoption and Outcomes (2018–2022)","authors":"Xiaoli Pan ,&nbsp;Ruihai Zhang ,&nbsp;Tian Zhou ,&nbsp;Chengjian Lou ,&nbsp;Lintian Cao ,&nbsp;Weijian Feng ,&nbsp;Xiaoming Hu ,&nbsp;Minfeng Tong ,&nbsp;Yili Chen","doi":"10.1016/j.wneu.2025.124097","DOIUrl":"10.1016/j.wneu.2025.124097","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze treatment trends and outcomes for intracranial aneurysms (IAs) in Eastern China, comparing microsurgical clipping (SC) and endovascular coiling (EC), and exploring clinical and socioeconomic factors influencing treatment decisions.</div></div><div><h3>Methods</h3><div>A multicenter retrospective study of 2720 patients with 2811 aneurysms treated between 2018 and 2022 was conducted. Propensity score matching compared surgical procedures and clinical outcomes, while multivariable logistic regression identified determinants of treatment choice. Annual growth rates were calculated using compound annual growth rate.</div></div><div><h3>Results</h3><div>Of 1281 patients with ruptured IAs, 533 underwent SC and 748 received EC. For 1439 patients with unruptured IAs (UIAs), 1295 (90%) were treated with EC. Post-propensity score matching analysis showed EC had shorter operative times, fewer complications, but higher costs and recurrence risks. EC was preferred for UIAs and patients with higher Glasgow Coma Scale scores, while SC was chosen for complex aneurysms and severe clinical cases. Notably, EC adoption increased significantly, with a compound annual growth rate of 16.3% for ruptured IAs and 19.1% for UIAs, highlighting a shift toward technological preference.</div></div><div><h3>Conclusions</h3><div>This is the first multicenter study on IA treatment in Eastern China, integrating clinical outcomes with socioeconomic factors. Findings suggest EC is increasingly favored, particularly for UIAs, but SC remains essential for complex cases. Both approaches offer distinct advantages and should be considered in the context of clinical efficacy and economic realities.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"199 ","pages":"Article 124097"},"PeriodicalIF":1.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095013","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":"BOOTStrap-SCI: Beyond One Option of Treatment for Spinal Trauma and Spinal Cord Injury: consensus-based Stratified Protocols for Intensive Care and Surgical management.","authors":"Nicolò Marchesini, Riya Mandar Dange, Andreas K Demetriades, Oscar Alves, Amos Olufemi Adeleye, Ernest J Barthélemy, José Castillo, Juan Diego Ciro, Raul Echeverri, Kiwon Lee, Wellingson Paiva, Julio Pozuelos, Martin Aliaga Rocabado, Alvaro Soto, Gene Y Sung, Andrès M Rubiano","doi":"10.1016/j.wneu.2025.124099","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124099","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal trauma (STx), with or without spinal cord injury (SCI), represents a significant global health burden, particularly in low- and middle-income countries (LMICs). International guidelines often assume the availability of resources for intensive care and surgical management, limiting their applicability in resource-constrained settings. A resource-adapted approach may improve management in these contexts. This study aimed to develop resource-tiered protocols for the intensive care and surgical management of STx and SCI, addressing LMIC-specific challenges with clinical evidence and expert-based practices.</p><p><strong>Materials and methods: </strong>A multidisciplinary Delphi consensus process combined international evidence-based guidelines with expert input. Iterative discussions and voting by healthcare providers from LMICs and high-income countries (HICs) ensured context-sensitive and flexible protocols, tailored to varying levels of training, resource availability, and healthcare infrastructure.</p><p><strong>Results: </strong>The resulting protocols address key aspects of intensive care and surgical management, including resuscitation, cardiopulmonary optimization, imaging, and surgical criteria and timing. Two protocols were developed for intensive care (postoperative recovery and general ICU setting) and three for surgical management, reflecting resource levels: basic facilities without imaging, intermediate facilities with X-ray, and advanced facilities with CT/MRI.</p><p><strong>Conclusion: </strong>The proposed protocols may bridge gaps in STx and SCI care in LMICs by providing adaptable frameworks for resource-limited contexts. The consensus-driven approach can foster protocolized care delivery in LMICs, emphasizing feasibility and local adaptability. Future efforts should focus on validating these protocols in clinical practice.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124099"},"PeriodicalIF":1.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094949","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":"Total Resection of Clival Chordoma with Brainstem Invasion via Endoscopic Transnasal Approach: Technical Note","authors":"Guenther C. Feigl ,&nbsp;Roman Bosnjak ,&nbsp;Daniel Staribacher ,&nbsp;Gavin Britz ,&nbsp;Vlado Stolevski ,&nbsp;Dzmitry Kuzmin","doi":"10.1016/j.wneu.2025.124101","DOIUrl":"10.1016/j.wneu.2025.124101","url":null,"abstract":"<div><h3>Objective</h3><div>Clival chordomas with brainstem invasion are extremely rare; only 5 cases have been reported in the literature. In such cases total tumor resection is associated with high intraoperative risks and is a notable challenge for the neurosurgeon. However, it is the quality of surgical treatment that influences the future prognosis, despite the efficacy of proton therapy.</div></div><div><h3>Methods</h3><div>We describe the clinical case of a 39-year-old male patient with the sudden onset of double vision and left trochlear nerve paresis, who was diagnosed with a clival chordoma with brainstem invasion.</div></div><div><h3>Results</h3><div>The tumor was successfully resected via unilateral left mononostril endoscopic transnasal approach. The patient had a mild paresis of the left abducens nerve that improved during the postoperative period.</div></div><div><h3>Conclusions</h3><div>Clival chordomas with brainstem invasion are extremely rare. In some circumstances, total tumor resection can be achieved.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"199 ","pages":"Article 124101"},"PeriodicalIF":1.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095002","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}