World neurosurgery最新文献

{"title":"Rethinking Definitive Treatment for Hydrocephalus in Infancy: A Review of Outcomes and Evolving Surgical Strategies.","authors":"Hannah G Black, Sara Ceccarini, Jimena Gonzalez-Salido, Antonio Salerno, Suhel F Batarseh, Mrinmoy Kundu, Isabella Lacouture, Megan Eh Still, Carolyn Quinsey","doi":"10.1016/j.wneu.2025.124371","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124371","url":null,"abstract":"<p><p>The current standard of treatment for hydrocephalus is attempted definitive management with ventriculoperitoneal (VP) shunt or endoscopic third ventriculostomy (ETV), often combined with choroid plexus cauterization (CPC). However, VP shunts, ETVs, and ETV/CPCs have high failure rates in young patients, raising the question if definitive management is the best treatment paradigm in this population. Accordingly, this review aims to compile treatment outcomes for pediatric hydrocephalus patients <6 months of age, with the aim of highlighting the need for alternative treatments or treatment strategies in this population. This review finds that definitive management with VP shunts in patients <6 months of age at time of surgery in pooled etiology cohorts have documented failure rates ranging from 38-59%. Definitive management with ETV or ETV/CPC in patients <6 months of age at time of surgery in pooled etiology cohorts have failure rates from 47-80%. Failure rates this high raise the question if early definitive management is effectively unpredictable temporized treatment. Temporizing procedures including ventriculosubgaleal shunts (VSGS) and ventricular access devices (VADs) can allow patients additional time to develop prior to definitive management, typically last for 1-2 months, and have been safely used in patients with a variety of hydrocephalus etiologies. Given the known, longstanding, high failure rates of definitive intervention with VP shunts and ETV/CPC in patients <6 months of age, alternative treatments or treatment strategies are needed. Temporizing procedures may represent one avenue to improve treatment strategy in young hydrocephalus patients.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124371"},"PeriodicalIF":2.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817653","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":"Predictors of Transradial Cerebral Angiography Failure and Comparative Outcomes with the Transfemoral Approach: A Single-Center, 5-Year Retrospective Study","authors":"Seung Yoon Song ,&nbsp;Sanghyo Lee ,&nbsp;Jin Eun ,&nbsp;Hae-Kwan Park ,&nbsp;Sanghyuk Im","doi":"10.1016/j.wneu.2025.124372","DOIUrl":"10.1016/j.wneu.2025.124372","url":null,"abstract":"<div><h3>Background</h3><div>Transradial cerebral angiography (TRCA) is increasingly favored over transfemoral cerebral angiography (TFCA) due to lower complication rates and improved patient comfort, despite anatomical and procedural challenges. This study aimed to assess factors influencing TRCA failure and compare clinical outcomes between TRCA and TFCA in patients undergoing diagnostic cerebral angiography at a single institution.</div></div><div><h3>Methods</h3><div>A retrospective review of 2314 patients (TRCA n = 1843; TFCA n = 471) undergoing cerebral angiography between April 2019 and February 2024 was conducted. TRCA and TRCA failure groups were compared based on demographic data, procedure duration, presence of aortic arch imaging, complications, and radial artery issues.</div></div><div><h3>Results</h3><div>TRCA was successful in 79.7% of cases, with 4.3% requiring conversion to TFCA. Main causes of failure were radial artery puncture failure (55%), severe tortuosity (17%), and stenosis (9%). Aortic arch imaging significantly increased TFCA selection (<em>P</em> &lt; 0.001). Overall complication rates were similar between TRCA (0.7%, 14 patients) and TFCA (0.6%, 3 patient) (<em>P</em> = 1.000), though 11 TRCA complications were symptomatic cerebral infarctions. Proximal large vessel anatomical variations (identified in 1% of patients) led to TFCA in 96% of these cases. Multivariate analysis identified procedure time (odds ratio 1.112, <em>P</em> &lt; 0.0001) and radial artery issues as significant predictors of TRCA failure.</div></div><div><h3>Conclusions</h3><div>TRCA holds promise as a standard approach in neurointervention, but proficiency in both TRCA and TFCA remains essential. Radial artery issues and prolonged procedure time are significant predictors of TRCA failure. Optimizing TRCA outcomes requires meticulous preprocedural aortic arch evaluation, enhanced operator experience, and continuous technical refinements.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"202 ","pages":"Article 124372"},"PeriodicalIF":2.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817652","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":"Correlation of the Triglyceride-Glucose Index with Clinical Prognosis of Patients with Acute Ischemic Stroke Treated with Mechanical Thrombectomy","authors":"Mengjie Fan ,&nbsp;Le Yao ,&nbsp;Yina Wang ,&nbsp;Xin Nie ,&nbsp;Zheng Dai ,&nbsp;Yunnan Lu ,&nbsp;Ruojun Wang ,&nbsp;Yejun Shi ,&nbsp;Chaosheng Li","doi":"10.1016/j.wneu.2025.124366","DOIUrl":"10.1016/j.wneu.2025.124366","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to investigate the correlation between the triglyceride-glucose (TyG) index, a surrogate index of insulin resistance, and the clinical prognosis of patients with acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT).</div></div><div><h3>Methods</h3><div>This retrospective study analyzed clinical data of 284 patients with AIS who underwent MT. Patients were divided into a good prognosis group modified Rankin Scale ([MRS] score ≤2) and a poor prognosis group ([modified Rankin Scale] score &gt;2) based on their outcomes 90 days post-MT. Differences in clinical parameters between groups were evaluated, and multifactorial logistic regression analysis identified risk factors associated with poor prognosis. Receiver operating characteristic (ROC) curve analysis assessed the predictive value of the TyG index and the combined variable (P) for poor prognosis at 90 days post-MT.</div></div><div><h3>Results</h3><div>The TyG index was identified as an independent risk factor for poor prognosis in patients with AIS undergoing MT. In the total AIS population, the area under the ROC curve for the TyG index and the combined variable (P) predicting poor prognosis were 0.5618 and 0.7870, respectively. In the nondiabetic subgroup, the area under the ROCcurves were 0.5517 and 0.8143, respectively.</div></div><div><h3>Conclusions</h3><div>The TyG index is a risk factor for poor prognosis in patients with AIS undergoing MT, applicable to both the total population and the nondiabetic subgroup. The combined variable (P), with improved predictive accuracy, can aid clinicians in early prognostic assessments of patients with AIS treated with MT.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"202 ","pages":"Article 124366"},"PeriodicalIF":2.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817650","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":"Navigated Percutaneous Cervical Pedicle Screw Placement: The Impact of Surgical Experience and Feasibility","authors":"Jula Gierse ,&nbsp;Kevin Klockow ,&nbsp;Eric Mandelka ,&nbsp;Benno Bullert ,&nbsp;Fenna Brunken ,&nbsp;Paul Alfred Gruetzner ,&nbsp;Sven Yves Vetter","doi":"10.1016/j.wneu.2025.124369","DOIUrl":"10.1016/j.wneu.2025.124369","url":null,"abstract":"<div><h3>Objective</h3><div>Surgical treatment of cervical instabilities using pedicle screws poses risks of nerve and vessel injury, particularly in percutaneous procedures due to limited visual feedback. Navigation can reduce screw misplacement, but data on its usability across different experience levels in percutaneous approaches remains limited.</div></div><div><h3>Methods</h3><div>Two surgeons performed navigated cervical pedicle screw placement on human specimens using two C-arm cone-beam computed tomography–based navigation systems (navigation system 1 [NAV1], navigation system 2). One surgeon was an experienced spine surgeon, and the other was a second-year resident (RS). Screw position was assessed via C-arm cone-beam computed tomography scans, and placement time was recorded.</div></div><div><h3>Results</h3><div>A total of 112 screws were placed, 56 per surgeon/system. Accuracy comparisons showed no significant difference (<em>P</em> = 0.060). However, RS achieved significantly better accuracy with NAV1 (<em>P</em> = 0.037∗). Experienced spine surgeon achieved an accuracy rate of 89.3% with NAV1 and 85.7% with navigation system 2 (<em>P</em> &gt; 0.99), requiring significantly less time than RS (<em>P</em> &lt; 0.001∗∗).</div></div><div><h3>Conclusions</h3><div>This study provides valuable insights into the feasibility and challenges of navigated percutaneous cervical pedicle screw placement. Both surgeons achieved accurate screw placement; however, the differences in RS's accuracy highlight the pivotal role of experience in cervical spine surgery for the safe application of navigation systems. Additionally, this study identifies pitfalls that should be considered in clinical practice and in the education of young spine surgeons when adopting new technologies.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"202 ","pages":"Article 124369"},"PeriodicalIF":2.1,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812418","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":"The Effect of A1 Segment Dominance on Angular Morphology of the Anterior Communicating Artery Bifurcation in Healthy and Aneurysmal Patients","authors":"Jeffrey M. Breton,&nbsp;Ryan Mulligan,&nbsp;Kaeden E. Freston,&nbsp;Emal Lesha,&nbsp;Gabrielle R. Seyouri,&nbsp;Alexandra Lauric,&nbsp;Adel M. Malek","doi":"10.1016/j.wneu.2025.124359","DOIUrl":"10.1016/j.wneu.2025.124359","url":null,"abstract":"<div><h3>Background</h3><div>The anterior communicating artery (ACOM) bifurcation, a common site for aneurysm formation, carries high risk of aneurysm rupture. Due to its anastomotic nature, it exhibits complex hemodynamic and morphological profiles. Previously, ACOM angles were evaluated without accounting for unique characteristics. We evaluate ACOM angular morphology bilaterally, based on A1 trunk dominance (size and angiographic presentation), in aneurysmal and healthy patients.</div></div><div><h3>Methods</h3><div>Bilateral catheter 3D rotational angiographic studies were available from 67 patients with ACOM aneurysms and 54 nonaneurysmal controls (242 samples total). A1 segments were classified as dominant, codominant, or nondominant based on relative diameter. Angle between ACOM and A2 segment (AcomA2) and angle between A1 and A2 segments (A1A2) angles were measured on 2D cut planes. Matched-pair analysis was performed on aneurysmal and nonaneurysmal patients with dominant/nondominant segment labels.</div></div><div><h3>Results</h3><div>Aneurysms occurred on dominant (70.1%) or codominant A1 segments. A1A2 angles were significantly wider in aneurysmal bifurcations (74.1 ± 21.75°) than contralateral (53.88 ± 21.59°, <em>P</em> &lt; 0.001) and nonaneurysmal controls (42.44 ± 14.43°, <em>P</em> &lt; 0.001), with a threshold of 59.2° (area under the curve = 0.88). AcomA2 angle could not be evaluated in 90 volumes (37.2%) due to poor angiographic visibility of the ACOM. In unilateral and matched-pair analysis, A1A2 was significantly wider in dominant control bifurcations than nondominant sides (45.85 ± 9.83° vs. 34.47 ± 12.21°, <em>P</em> = 0.003).</div></div><div><h3>Conclusions</h3><div>ACOM angular morphology is strongly determined by A1 dominance, independent of aneurysm presence. Unlike the AcomA2 angle, A1A2 was measurable in all samples and reliably captured bifurcation angulation. ACOM bifurcations, unlike other bifurcations, require bilateral morphological and hemodynamic evaluation of the full ACOM complex. These findings inform future evaluation and modeling of cerebral vascular architecture.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"202 ","pages":"Article 124359"},"PeriodicalIF":2.1,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812419","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":"Flow-Related Aneurysms in Infratentorial Arteriovenous Malformations: Location-Based Endovascular Treatment of 37 Aneurysms in 25 Cases","authors":"Xing-Long Liu,&nbsp;Run-Hao Jiang,&nbsp;Lin-Bo Zhao,&nbsp;Zhen-Yu Jia,&nbsp;Yue-Zhou Cao,&nbsp;Sheng Liu","doi":"10.1016/j.wneu.2025.124368","DOIUrl":"10.1016/j.wneu.2025.124368","url":null,"abstract":"<div><h3>Objective</h3><div>The management of flow-related aneurysms (FRAs) associated with infratentorial arteriovenous malformations (AVMs) remains challenging and controversial. In this study, we present our clinical experience with endovascular treatment of these complex lesions.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 25 consecutive patients with ruptured or symptomatic FRAs treated between January 2020 and June 2024. Treatment was tailored to FRA location: proximal FRAs underwent coil embolization to preserve distal flow, while distal FRAs received liquid embolics, often requiring parent artery sacrifice. Clinical outcomes, radiological findings, and treatment approaches were systematically reviewed.</div></div><div><h3>Results</h3><div>Hemorrhage was the most common presenting symptom (19/25, 76.0%), with FRA rupture accounting for 15 cases and AVM nidus bleeding for the remaining 4. Endovascular treatment was performed for 37 FRAs, with proximal aneurysms predominantly managed by coiling (21/22, 95.5%) to preserve distal perfusion, while distal FRAs were primarily treated with liquid embolics (14/15, 93.3%) via feeder sacrifice. Three (12.0%) clinically significant complications occurred, including 2 ischemic events and one case of hydrocephalus. At a mean follow-up of 22.1 months, 24 patients (96.0%) achieved favorable outcomes (modified Rankin Scale ≤2). One patient experienced rebleeding due to enlargement and rupture of an untreated FRA 3 years post-treatment.</div></div><div><h3>Conclusions</h3><div>The natural history of FRAs associated with AVMs remains unpredictable. We recommend aggressive treatment in all cases unless complete AVM occlusion is achieved. Endovascular treatment represents a safe and effective primary therapeutic approach for infratentorial AVM-associated FRAs.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"202 ","pages":"Article 124368"},"PeriodicalIF":2.1,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812416","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 “Repeat Microvascular Decompression for Recurrent Trigeminal Neuralgia”","authors":"Levent Aydin ,&nbsp;Adem Yilmaz","doi":"10.1016/j.wneu.2025.124363","DOIUrl":"10.1016/j.wneu.2025.124363","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"202 ","pages":"Article 124363"},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804985","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":"The Neurosurgeon's Role in the Brain Economy: How Strategic Investment in Neurosurgical Care and Innovation Will Improve Global Outcomes","authors":"Daniela A. Perez-Chadid ,&nbsp;Riya M. Dange ,&nbsp;Harris A. Eyre ,&nbsp;Graham Fieggen ,&nbsp;Kerry A. Vaughan ,&nbsp;Sameer A. Sheth ,&nbsp;Jafri Malin Abdullah ,&nbsp;Bello B. Shehu ,&nbsp;Daniel Donoho ,&nbsp;Samuel Browd ,&nbsp;Agustin Ibanez ,&nbsp;Saksham Gupta ,&nbsp;Frederick Lang ,&nbsp;Anil Nanda ,&nbsp;Gail Rosseau","doi":"10.1016/j.wneu.2025.124357","DOIUrl":"10.1016/j.wneu.2025.124357","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"202 ","pages":"Article 124357"},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800428","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 “Standalone Middle Meningeal Artery Embolization versus Medical Management for Chronic Subdural Hematomas: A Multiinstitutional and Multinational Database Study","authors":"Dhairya A. Lakhani ,&nbsp;Aneri B. Balar ,&nbsp;Sanjay Bhatia ,&nbsp;Ansaar T. Rai","doi":"10.1016/j.wneu.2025.124361","DOIUrl":"10.1016/j.wneu.2025.124361","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"202 ","pages":"Article 124361"},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804988","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":"Prediction of Neurological Recovery in Patients with Primary Basal Ganglia Hemorrhage Based on Non-Contrast Computed Tomography Radiomics Combined with Clinical Features","authors":"Zhe Wang ,&nbsp;Yuqiong Yang ,&nbsp;Jing Zhou ,&nbsp;Ruoshi Ji ,&nbsp;Yichuan Ma ,&nbsp;Jiali Xu","doi":"10.1016/j.wneu.2025.124365","DOIUrl":"10.1016/j.wneu.2025.124365","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to predict neurological recovery in patients with basal ganglia spontaneous intracerebral hemorrhage (SICH) by integrating non-contrast computed tomography radiomics with clinical features.</div></div><div><h3>Methods</h3><div>We retrospectively collected and analyzed clinical and imaging data of patients with primary basal ganglia hemorrhage. Radiomic features of hematoma and perihematomal edema were extracted to build a model for modified Rankin scale score changes. All cases were randomly divided into training and testing sets according to 8:2, the optimal hyperparameters were selected by 5-fold cross-validation for the training set to build the model. The radiomics model was constructed by Z-score homogenization, principal component analysis dimensionality reduction, relief for feature screening, and AdaBoost as a classifier.</div></div><div><h3>Results</h3><div>Among 162 patients, age (<em>P</em> = 0.017) and hypertension history (<em>P</em> = 0.030) independently indicated poor outcome. The area under the curve values of the radiomics model in the training and testing datasets were 0.873 (95% confidence intervals [CIs]: 0.8121–0.9281) and 0.8549 (95% CI: 0.7085–0.9648), respectively. The area under the curve of the combined model constructed by clinical and radiomics features was slightly lower than that of the radiomics feature model of 0.8632 (95% CI: 0.8005–0.9121) and lower than that of the radiomics feature model of 0.8633 (95% CI: 0.8006–0.9122). The decision curve analysis curve demonstrated clinical benefit of both models.</div></div><div><h3>Conclusions</h3><div>Based on non-contrast computed tomography radiomics and clinical characteristics, a model can be constructed into a quantitative clinical assessment tool to predict the status of neurological recovery in patients with SICH.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"202 ","pages":"Article 124365"},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804986","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}